We thank Dr. Gerard Silvestri and &#8220;Proceedings of The American Thoracic Society&#8221; for their permission to reproduce their schematic diagram of the Convex-Probe Endobronchial Ultrasound (Figure 2; Proc Am Thorac Soc Vol 6. pp 180&#8211;186, 2009). We thank &#8220;American College of Chest Physicians&#8221; for their permission to reproduce the image of the substernal thyroid biopsy (Figure 4; CHEST Journal 137.6 (2010): 1435-1436). We thank Kelly Watson, RN, for her help in preparation of the procedure video.

下面列出的协议遵循机构（美国纽约州立大学布法罗分校罗斯威尔帕克癌症研究所，NY）的指导方针。 1，前期准备工作<ol><li>在中度镇静进行支气管内超声引导下经支气管针吸活检（EBUS-TBNA），监测麻醉护理（MAC），或深度镇静和全身麻醉。 注：病人的调查显示良好的满意度与中度镇静19，但最近的数据显示，采用全身麻醉20高诊断率。 </li><li>或者，执行该程序，而不在中度镇静的气道装置。使用喉罩（LMA;大小4）涉及深度镇静或全身麻醉过程。 注：使用LMA的病变在气管较高。由于胸骨甲状腺高气管的位置，气管插管不应该在这些情况下使用的</li> &lt;利&gt;在实验过程中，使用最低有效剂量的1％或2％利多卡因（的≤7毫克/公斤的累积最大剂量;最大血清浓度≤5毫克/升）用于局部麻醉气道通过支气管镜的工作通道21。 </li></ol> 2.预过程监控支气管镜检查<ol><li>通过口腔，或在LMA介绍常规的柔性支气管镜进入气道。执行每个子段的左和右气管支气管树的支气管明显异常的顺序检查和确保足够的呼吸道畅通。通过抽吸清洁任何分泌物或粘液的气道。完成时从气道中删除支气管镜。 </li></ol> 3.本地化兴趣的病变<ol><li>引入凸探头，支气管内超声（CP-EBUS）支气管镜具有35°向前倾斜的角度来看。观察前气道壁和相邻的腔的得到控制而一小部分Ë推进支气管镜集中在气道。当通过声带传递，确保声门开放的只有前角可见。当气管，看到整个管腔与35°后倾屈需要。 </li><li>当使用白光支气管镜观察显示屏幕。前进支气管镜到病灶的估计水平。始终，确保推进支气管镜，当管腔不完全可见。管腔的全视图表明CP-EBUS探针的尖端处于向后弯曲，并造成对后气道壁创伤刮削的风险。 </li><li>到达所感兴趣的所需部位后，膨胀用约2ml生理盐水的气球。弯曲的CP-EBUS前进的尖端，使之与气道的接触。 </li><li>打开使用专用超声处理器超声图。使用双屏幕显示（或分屏显示）看的这两个的内窥镜图管腔，以及相应的超声波图像一起在屏幕上。 </li><li>确保EBUS支气管镜在屈曲位。动在小角度对CP-EBUS顺时针和逆时针方向在同一水平，以确定所述胸骨甲状腺。找出病灶。通过移动它向上和向下的，使得病变的最大直径被认为是调整CP-EBUS探针。 </li><li>利用多普勒模式中，确定在相邻的血管结构，以确定病变的准确站22，并避免血管意外穿刺。 </li><li>在损伤的程度，弯曲的EBUS支气管镜向前的顶端，以便其超声探针与所述气道接触，得到的病变的超声图。当需要时，弯曲的尖向后完全内窥镜观察。重复的机动飞行，并确定一个点两个气管环之间的滨海新区落针的。 </li></ol> 4.获得支气管超声引导支气管穿刺活检<ol><li>与CP-EBUS尖在中性（非弯曲）的位置，引入专用的22或21g的新区针入EBUS支气管镜的工作通道中。固定在针组件上使用的锁定机构的工作通道。 </li><li>松开鞘调节旋钮和推进护套，使针尖可以勉强可视内窥镜图像上。现在固定鞘调节旋钮。 </li><li>弯曲的CP-EBUS探头向前，使之与气道壁接触。上的超声图像，再次确认病灶的最长直径与针的突出路径对齐。确保针离开工作通道以20°的角度。 </li><li>松开针调节旋钮，并通过气道壁穿刺进入实时超声引导下病变。随着病变内EBUS针，动摇内部钢丝清理出针尖。 </li><li>除去内部STylet并附加20毫升真空产生注射器施加负压力。 </li><li>移动针回的往复（“通”）的病灶内，用 - 20毫升负压通过一个特殊的真空产生注射器施加。总共有3-7遍，建议根据目前的文献10,11。 </li><li>使遍足够数量后，负压旋钮处于关闭状态，并针被检索出的工作通道。 </li><li>使用内部鞘压出组织学的核心。同时获得组织学核心以及细胞学抽吸通过该方法。另外，使用空气填充的6或12毫升注射器排出针的内容到幻灯片上，或在样品杯中。 </li><li>确定使用的现场服务细胞学样品的adequateness。 </li></ol> 5.手术后支气管镜检查监督<ol><li>删除CP-EBUS支气管镜活检出来之后。重新引入传统支气管镜和执行监督支气管镜检查，以确认没有显著出血在滨海新区的网站。止血保证后，取出气管镜出来，总结的过程。 </li></ol>

The authors have nothing to disclose.

Substernal goiter was first described in 1749 by Haller23. The reported incidence of substernal or mediastinal goiter varies between 0.2% and 45% of all goiters, depending on the definition used24. More than ten definitions of substernal goiter have been proposed. By the simple clinical definition, a part of the substernal thyroid remains permanently retrosternal on physical exam without neck in hyperextension, as opposed to with neck in hyperextension as per Torre&#8217;s definition25. K...

胸骨后甲状腺肿（STG）是生长缓慢的肿瘤，最终导致症状的病例中70％-80％。按照文献综述，STG的2.5-22.6％之间可有恶变2。气管，食管，喉返神经和上腔静脉的压迫常常会导致像呼吸困难，喘鸣，咳嗽，吞咽困难，发音困难，声带麻痹，Horner氏综合征，上腔静脉综合征，脑水肿症状。也有报道显性甲亢偶然的情况下。一项回顾性研究由Shin 等人报道了甲状腺的大小和呼吸急促的存在，梅核气的感觉，和3甲亢症状之间存在正相关关系。这项研究，但没有发现甲状腺肿大尺寸和吞咽困难的存在，局部不适，改变声音，咯血，或甲状腺功能减退的症状之间的相互关系。无论胸骨后及颈部甲状腺肿进行类似恶性肿瘤的风险。 HoweveR，胸骨位置，使活检诊断和治疗STG非常具有挑战性的。大多数情况下，最终需要手术切除纵隔镜使用或胸骨。 支气管内超声（EBUS）最早是在1992年由Hurter和Hanrath 4所示 。多年来，EBUS-TBNA成为了选择用于诊断非小细胞肺癌和分期的方法。报告的敏感性，特异性和阳性预测值EBUS-TBNA对纵隔及肺门淋巴结肿大为94％，100％和100％分别有并发症发生率低使得它非常安全，有效，优于传统的滨海新区5。然而，常规和EBUS引导新区被发现有统计学上相似的结果为隆突淋巴结6。 两种类型的EBUS探针已经开发到目前为止 - 径​​向探头（RP-EBUS）和曲线形探针（CP-EBUS）。 RP-EBUS是第一个成为1999年商用它拥有水充气的气球提示里面薄薄的超声探头。探头转动一角度360°垂直于插入轴线的方向。膨胀的气球提供了一个圆形接触的探针，从而使其能够获取周围气道的360°视图。它是用于评价外周位于病变7,8的中央气道的气道浸润的评估，并获得活检。后病灶局限，径向探头必须取出引导鞘在支气管镜的工作通道让路活检工具。因此，一个实时超声引导的活检不能进行。三个不同的径向探测当前可用 - 20 MHz和30 MHz的微型探针，以及20 MHz的超微型探头。微型探针可以通过支气管镜在280毫米的工作通道插入，到达子断片的气道;更高的频率探头提供更好的图像清晰度olution 9。为1.4毫米的外径，所述的超微型探头适合的小支气管镜2毫米的工作通道，并到达多个外围病变。 CP-EBUS于2005年引入的是一个7.5兆赫凸探针生理盐水膨胀气囊，在支气管镜的前端内侧（ 图1）。支气管镜管的外径为6.3毫米，且尖端的为6.9毫米。工作通道的内径为2.2毫米。范围看起来在一个35°向前倾斜角，用图的80°（ 图2）的角度。凸探头本身产生一个50°的图像，并且扫描平行于插入轴线。超声图像可以通过使用前向屈曲，或通过附加膨胀球囊用生理盐水直接将探头在支气管壁而得到。水比超声波的空气更好的导体，并且提高了图像质量。沃什丘拉尔结构可以从使用​​彩色多普勒模式扫描组织区别开来。使用专用的22或21g的新区针与回声-凹形前端（ 图3），其散发出来，在20°至支气管镜的长轴的角度进行活检。针具有40毫米的最大挤压行程，以用于停止它为20mm，以防止过度的突出部的安全机构。在针的内部导线最小化样品污染，而针穿过支气管壁。它也可用于清理针后，已通过支气管壁并进入靶疾患通过。的愿望“通过”的最佳数目据说是3-7令人满意的样品，但最高产量是从第一遍10,11。的图像中的专用超声处理器处理。这两种超声波和白光支气管镜图像在监视器上同时可见，允许EASY导航到疑似病变的部位。 CP-EBUS具有中度的镇静或全身麻醉进行实时新区直接超声引导的能力。该过程可以在门诊进行，消除了外科手术相关的发病率和需要住院手续。 为胸骨后甲状腺的诊断使用EBUS-滨海新区是新的，据报道，在只有少数病例报告12-18。根据目前的文献回顾，本文试图阐述的程序要求，并提出EBUS-TBNA的方式为胸骨后甲状腺活检。请注意，上面的设备的描述更具体奥林巴斯公司还有其他可商购的产品，以及，和较小的变化是存在的。

<table border="0" cellpadding="0" cellspacing="0" width="443">
	<tbody>
		<tr height="21">
			<td height="21" style="height:21px;width:443px;">7.5-MHz Convex Probe-EBUS bronchoscope</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Dedicated 22-gauge or 21-gauge TBNA needle</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Ultrasound processor unit</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">On-site cytopathology (optional)</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Moderate sedation drugs - Benzodiazepines or fentanyl&#160;</td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Deep sedation / General anesthesia drugs - Propofol or Remifentanil</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Local anesthesia (for airways) - 1% or 2% Lidocaine</td>
		</tr>
	</tbody>
</table>

substernal thyroid biopsy using endobronchial ultrasound-guided transbronchial needle aspiration

胸骨后甲状腺肿（STG），约占5.8％的纵隔病变1。有在由于缺乏对STG的一个统一的定义已发布的发生率有很大不同。活检通常需要区分恶性病变是良性的。与颈椎甲状腺，上覆胸骨排除STG超声引导下经皮细针穿刺。因此，外科纵隔镜是在大多数情况下进行的，从而导致显著过程相关的发病率和成本的医疗服务。支气管内超声引导下经支气管针吸活检（EBUS-TBNA）是一种常用的方法进行诊断的非小细胞肺癌（NSCLC）和分期。可以使用EBUS实时超声引导下进行微创活检为邻近于气道病变。其安全性和功效是公认的具有超过90％的灵敏度和特异性。执行EBUS作为能力与同一天排放的门诊手术具有明显的发病率和资金优势的手术。当执行EBUS医师获得程序的专门知识，他们试图分散其中的非淋巴结胸椎病状的诊断作用。我们在这里提出的EBUS-TBNA作用于胸骨后甲状腺病变的诊断，随着一步一步的协议的过程。

Endobronchial Ultrasound-guided Transbronchial Needle Aspiration (EBUS-TBNA) biopsy of substernal thyroid has been reported in eight case reports as per literature review12-18. The first case of substernal thyroid biopsy using Endobronchial Ultrasound was reported by Rosario et al. in 200612, wherein a CT chest done for metastatic work-up of prostate adenocarcinoma showed mediastinal lymphadenopathies. EBUS-TBNA of the lesion revealed a previously undiagnosed papillary thyroid carcinoma met...

Watch this Scientific Journal Video about Substernal Thyroid Biopsy Using Endobronchial Ultrasound-guided Transbronchial Needle Aspiration at JoVE.com

Substernal Thyroid Biopsy Using Endobronchial Ultrasound-guided Transbronchial Needle Aspiration

Substernal thyroid lesions are common, and need to be differentiated from malignancy. Obtaining percutaneous fine needle biopsy is not possible due to its retrosternal location. This article proposes a protocol for biopsy of substernal thyroid lesions using Endobronchial Ultrasound-guided Transbronchial Needle Aspiration (EBUS-TBNA).

胸骨后甲状腺活检使用支气管内超声引导下经支气管针吸

Substernal thyroid goiter (STG) represents about 5.8% of all mediastinal lesions1. There is a wide variation in the published incidence rates due to the ...

substernal-thyroid-biopsy-using-endobronchial-ultrasound-guided

Research

JoVE Journal

Medicine

25.4K 次观看.  State University of New York, Buffalo. Substernal thyroid lesions are common, and need to be differentiated from malignancy. Obtaining percutaneous fine needle biopsy is not possible due to its retrosternal location. This article proposes a protocol for biopsy of substernal thyroid lesions using Endobronchial Ultrasound-guided Transbronchial Needle Aspiration (EBUS-TBNA).

视频: Substernal Thyroid Biopsy Using Endobronchial Ultrasound-guided Transbronchial Needle Aspiration

Ultrasound-guided Transthoracic Intramyocardial Injection in Mice

Murine models of cardiovascular disease are important for investigating pathophysiological mechanisms and exploring potential regenerative therapies. Experiments involving myocardial injection are currently performed by direct surgical access through a thoracotomy. While convenient when performed at the time of another experimental manipulation such as coronary artery ligation, the need for an invasive procedure for intramyocardial delivery limits potential experimental designs. With ever improving ultrasound resolution and advanced noninvasive imaging modalities, it is now feasible to routinely perform ultrasound-guided, percutaneous intramyocardial injection. This modality efficiently and reliably delivers agents to a targeted region of myocardium. Advantages of this technique include the avoidance of surgical morbidity, the facility to target regions of myocardium selectively under ultrasound guidance, and the opportunity to deliver injectate to the myocardium at multiple, predetermined time intervals. With practiced technique, complications from intramyocardial injection are rare, and mice quickly return to normal activity on recovery from anesthetic. Following the steps outlined in this protocol, the operator with basic echocardiography experience can quickly become competent in this versatile, minimally invasive technique.

Echocardiography-guided percutaneous intramyocardial injection represents an efficient, reliable, and targetable modality for the delivery of gene transfer agents or cells into the murine heart. Following the steps outlined in this protocol, the operator can quickly become competent in this versatile, minimally invasive technique.

超声引导下经皮内注射小鼠

Murine models of cardiovascular disease are important for investigating pathophysiological mechanisms and exploring potential regenerative therapies. ...

科研

医学

Preparation and Respirometric Assessment of Mitochondria Isolated from Skeletal Muscle Tissue Obtained by Percutaneous Needle Biopsy

Respirometric profiling of isolated mitochondria is commonly used to investigate electron transport chain function. We describe a method for obtaining samples of human Vastus lateralis, isolating mitochondria from minimal amounts of skeletal muscle tissue, and plate based respirometric profiling using an extracellular flux (XF) analyzer. Comparison of respirometric profiles obtained using 1.0, 2.5 and 5.0 &#956;g of mitochondria indicate that 1.0 &#956;g is sufficient to measure respiration and that 5.0 &#956;g provides most consistent results based on comparison of standard errors. Western blot analysis of isolated mitochondria for mitochondrial marker COX IV and non-mitochondrial tissue marker GAPDH indicate that there is limited non-mitochondrial contamination using this protocol. The ability to study mitochondrial respirometry in as little as 20 mg of muscle tissue allows users to utilize individual biopsies for multiple study endpoints in clinical research projects.

Methods for biopsy of Vastus lateralis, preparation of purified mitochondria, and respirometric profiling are described. The use of small muscle volume makes this technique suitable for clinical research applications.

线粒体的制备及透气性评估，从骨骼肌组织通过穿刺活检获得的分离

Respirometric profiling of isolated mitochondria is commonly used to investigate electron transport chain function. We describe a method for obtaining ...

Povidone Iodine Rectal Preparation at Time of Prostate Needle Biopsy is a Simple and Reproducible Means to Reduce Risk of Procedural Infection

Single institution and population-based studies highlight that infectious complications following transrectal ultrasound guided prostate needle biopsy (TRUS PNB) are increasing. Such infections are largely attributable to quinolone resistant microorganisms which colonize the rectal vault and are translocated into the bloodstream during the biopsy procedure. A povidone iodine rectal preparation (PIRP) at time of biopsy is a simple, reproducible method to reduce rectal microorganism colony counts and therefore resultant infections following TRUS PNB.
All patients are administered three days of oral antibiotic therapy prior to biopsy. The PIRP technique involves initially positioning the patient in the standard manner for a TRUS PNB. Following digital rectal examination, 15 ml&#160;of a 10% solution of commercially available povidone iodine is mixed with 5 ml&#160;of 1% lidocaine jelly to create slurry. A 4 cm x 4 cm sterile gauze is soaked in this slurry and then inserted into the rectal vault for 2 min after which it is removed. Thereafter, a disposable cotton gynecologic swab is used to paint both the perianal area and the rectal vault to a distance of 3 cm from the anus. The povidone iodine solution is then allowed to dry for 2 - 3 min prior to proceeding with standard transrectal ultrasonography and subsequent biopsy.
This PIRP technique has been in practice at our institution since March of 2012 with an associated reduction of post-biopsy infections from 4.3% to 0.6% (p = 0.02). The principal advantage of this prophylaxis regimen is its simplicity and reproducibility with use of an easily available, inexpensive agent to reduce infections. Furthermore, the technique avoids exposing patients to additional systemic antibiotics with potential further propagation of multi-drug resistant organisms. Usage of PIRP at TRUS PNB, however, is not applicable for patients with iodine or shellfish allergies.

Here, we present a protocol for use at the time of transrectal ultrasound guided prostate needle biopsy (TRUS PNB) that is a simple and cost-effective means to reduce infections following the procedure.

聚维酮碘直肠准备在前列腺穿刺活检的时间是一个简单的和可重复的手段，以减少程序感染的风险

Single institution and population-based studies highlight that infectious complications following transrectal ultrasound guided prostate needle biopsy ...

Use of Electromagnetic Navigational Transthoracic Needle Aspiration (E-TTNA) for Sampling of Lung Nodules

Lung nodule evaluation represents a clinical challenge especially in patients with intermediate risk for malignancy. Multiple technologies are presently available to sample nodules for pathological diagnosis. Those technologies can be divided into bronchoscopic and non-bronchoscopic interventions. Electromagnetic navigational bronchoscopy is being extensively used for the endobronchial approach to peripheral lung nodules but has been hindered by anatomic challenges resulting in a 70% diagnostic yield. Electromagnetic navigational guided transthoracic needle lung biopsy is novel non-bronchoscopic method that uses a percutaneous electromagnetic tip tracked needle to obtain core biopsy specimens. Electromagnetic navigational transthoracic needle aspiration complements bronchoscopic techniques potentially allowing the provider to maximize the diagnostic yield during one single procedure. This article describes a novel integrated diagnostic approach to pulmonary lung nodules. We propose the use of endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) for mediastinal staging; radial EBUS, navigational bronchoscopy and E-TTNA during one single procedure to maximize diagnostic yield and minimize the number of invasive procedures needed to obtain a diagnosis. This manuscript describes in detail how the navigation transthoracic procedure is performed. Additional clinical studies are needed to determine the clinical utility of this novel technology.

Use of Electromagnetic Navigational Transthoracic Needle Aspiration E-TTNA for Sampling of Lung Nodules

We describe the novel use of electromagnetic navigational guided transthoracic needle aspiration for the pathologic assessment of human lung nodules.

用于肺内结节样利用电磁导航肺穿刺抽吸术（E-TTNA）的

Lung nodule evaluation represents a clinical challenge especially in patients with intermediate risk for malignancy. Multiple technologies are presently ...

Ultrasound-guided Botulinum Toxin-A Injections: A Method of Treating Sialorrhea

Neurological diseases can be complicated by sialorrhea, an excessive flow of saliva. Patients suffering from moderate to severe sialorrhea have an impaired quality of life, often worsened by correlated complications such as aspiration pneumonia, oral infections, dental caries, and maceration of the skin. Diverse therapeutic approaches have been proposed for the treatment of sialorrhea, including surgery and the use of anticholinergic agents, with limited results and the possible occurrence of serious adverse events. Recently, botulinum toxin (BoNT) injection within the major salivary glands has been proposed in patients refractory to anticholinergic therapy, with the aim of inhibiting local acetylcholine release and gland activity. 
In order to obtain a better outcome in terms of reduction of saliva production, efficacy, duration, and avoidance of major adverse events, we developed an ultrasound-guided BoNT-type A injection technique accurately described in the text. Here we present a method of treating sialorrhea with bilateral parotid and submandibular gland BoNT-type A injections under ultrasound guidance. Four quadrants of the parotid gland and two quadrants of the submandibular gland are visualized and injected using two accesses and one access, respectively. 
The ultrasound-guided procedure provides a simple, non-invasive, real-time visualization of the muscular and glandular tissues and their surrounding structures, optimizing treatment efficacy and safety.

Botulinum toxin is injected into the salivary glands for the treatment of sialorrhea. The ultrasound-guided botulinum toxin injection in both the parotid and submandibular glands demonstrates a sustained efficacy and the absence of serious side effects.

超声引导下肉毒毒素-A注射液：治疗流涎的一种方法

Neurological diseases can be complicated by sialorrhea, an excessive flow of saliva. Patients suffering from moderate to severe sialorrhea have an ...

International Expert Consensus and Recommendations for Neonatal Pneumothorax Ultrasound Diagnosis and Ultrasound-guided Thoracentesis Procedure

Pneumothorax (PTX) represents accumulation of the air in the pleural space. A large or tension pneumothorax can collapse the lung and cause hemodynamic compromise, a life-threatening disorder. Traditionally, neonatal pneumothorax diagnosis has been based on clinical images, auscultation, transillumination, and chest X-ray findings. This approach may potentially lead to a delay in both diagnosis and treatment. The use of lung US in diagnosis of PTX together with US-guided thoracentesis results in earlier and more precise management. The recommendations presented in this publication are aimed at improving the application of lung US in guiding neonatal PTX diagnosis and management.

Pneumothorax is a common emergency and critical disease in newborn infants that needs rapid, clear diagnosis and timely treatment. Diagnosis and treatment based on chest X-rays are associated with delayed management and radiation damage. Lung ultrasound (US) provides useful guidance for rapid, accurate diagnosis and the precise thoracentesis of pneumothorax.

国际专家共识与新生儿肺功能超声诊断与超声引导性胸腔手术建议

Pneumothorax (PTX) represents accumulation of the air in the pleural space. A large or tension pneumothorax can collapse the lung and cause hemodynamic ...

Using a Chemical Biopsy for Graft Quality Assessment

Kidney transplantation is a life-saving treatment for a large number of people with end-stage renal dysfunction worldwide. The procedure is associated with an increased survival rate and greater quality of patient&#8217;s life when compared to conventional dialysis. Regrettably, transplantology suffers from a lack of reliable methods for organ quality assessment. Standard diagnostic techniques are limited to macroscopic appearance inspection or invasive tissue biopsy, which do not provide comprehensive information about the graft. The proposed protocol aims to introduce solid phase microextraction (SPME) as an ideal analytical method for comprehensive metabolomics and lipidomic analysis of all low molecular compounds present in kidneys allocated for transplantation. The small size of the SPME probe enables performance of a chemical biopsy, which enables extraction of metabolites directly from the organ without any tissue collection. The minimum invasiveness of the method permits execution of multiple analyses over time: directly after organ harvesting, during its preservation, and immediately after revascularization at the recipient&#8217;s body. It is hypothesized that the combination of this novel sampling method with a high-resolution mass spectrometer will allow for discrimination of a set of characteristic compounds that could serve as biological markers of graft quality and indicators of possible development of organ dysfunction.

The protocol presents utilization of the chemical biopsy approach followed by comprehensive metabolomic and lipidomic analysis for quality assessment of kidney grafts allocated for transplantation.

使用化学活检进行移植质量评估

Kidney transplantation is a life-saving treatment for a large number of people with end-stage renal dysfunction worldwide. The procedure is associated ...

Endoscopic Ultrasound-Guided Biliary Drainage: Endoscopic Ultrasound-Guided Hepaticogastrostomy in Malignant Biliary Obstruction

Patients with unresectable malignant biliary obstruction often require biliary drainage to decompress the biliary system. Endoscopic Retrograde Cholangiopancreatography (ERCP) is the primary biliary drainage method whenever possible. Percutaneous Transhepatic Biliary Drainage (PTBD) is used as a salvage method if ERCP fails. Endoscopic Ultrasound-Guided Biliary Drainage (EUS-BD) provides a feasible alternative biliary drainage method where one of the methods is EUS guided Hepaticogastrostomy (EUS-HGS). Here we describe the EUS-HGS technique in a case of unresectable malignant hilar biliary obstruction to achieve biliary drainage.
Presented here is the case of a 71-year-old female with painless jaundice and weight loss for 2 weeks. Computed Tomography (CT) imaging showed a 4 x 5 cm hilar tumor with lymphadenopathy and liver metastasis. EUS fine needle biopsy (FNB) of the lesion was consistent with cholangiocarcinoma. Her bilirubin levels were 212 &#181;mol/L (&lt;15) during presentation.
A linear echoendoscope was used to locate the left dilated intrahepatic ducts (IHD) of the liver. The segment 3 dilated IHD was identified and punctured using a 19 G needle. Contrast was used to opacify the IHDs under fluoroscopic guidance. The IHD was cannulated using a 0.025-inch guidewire. This was followed by the dilation of the fistula tract using a 6 Fr electrocautery dilator along with a 4 mm biliary balloon dilator. A partially covered metallic stent of 10 cm in length was deployed under fluoroscopic guidance. The distal part opens in the IHD and the proximal part was deployed within the working channel of the echoendoscope that subsequently released into the stomach. The patient was discharged three days after the procedure. Follow up performed in the second and fourth weeks showed that the bilirubin levels were 30 &#181;mol/L and 14 &#181;mol/L, respectively. This indicates that EUS-HGS is a safe method for biliary drainage in unresectable malignant biliary obstruction.

Endoscopic Ultrasound-Guided Biliary Drainage (EUS-BD) is an alternative method of biliary decompression in malignant biliary obstruction. Here we describe the technique of EUS guided-Hepaticogastrostomy (EUS-HGS) in a case of unresectable malignant hilar biliary obstruction.

内镜超声引导下胆道引流：内镜超声引导下肝胃造瘘术治疗恶性胆道梗阻

Patients with unresectable malignant biliary obstruction often require biliary drainage to decompress the biliary system. Endoscopic Retrograde ...

Ultrasound-Guided Induced Pluripotent Stem Cell-Derived Cardiomyocyte Implantation in Myocardial Infarcted Mice

The key objective of cell therapy after myocardial infarction (MI) is to effectively enhance the cell grafted rate, and human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) are a promising cell source for cardiac repair after ischemic damage. However, a low grafted rate is a significant obstacle for effective cardiac tissue regeneration after transplantation. This protocol shows that multiple hiPSC-CM ultrasound-guided percutaneous injections into an MI area effectively increase cell transplantation rates. The study also describes the entire hiPSC-CM culture process, pretreatment, and ultrasound-guided percutaneous delivery methods. In addition, the use of human mitochondrial DNA help detect the absence of hiPSC-CMs in other mouse organs. Lastly, this paper describes the changes in cardiac function, angiogenesis, cell size, and apoptosis at the infarcted border zone in mice 4 weeks after cell delivery. It can be concluded that echocardiography-guided percutaneous injection of the left ventricular myocardium is a feasible, relatively invasive, satisfactory, repeatable, and effective cellular therapy.

Ultrasound-guided cell delivery around the site of myocardial infarction in mice is a safe, effective, and convenient way of cell transplantation.

超声引导诱导多能干细胞来源心肌细胞植入心肌梗死小鼠

The key objective of cell therapy after myocardial infarction (MI) is to effectively enhance the cell grafted rate, and human induced pluripotent stem ...

Non-Intubated Ultrasound-Guided Thoracic Paravertebral Blockade Under Anesthesia

Begin by adjusting the temperature of the operating room to between 24 to 26 degrees Celsius. Insert a 20-gauge top-winged infusion needle into the elbow vein of the non-surgical hand of the patient. Now monitor the electrocardiography, blood pressure, pulse oxygen saturation, and respiratory rate of the patient.Apply a Bispectral Index Quatro Sensor to the patient's forehead. To induce anesthesia by continuous oxygen administration, insert a laryngeal mask airway. Maintain the sevoflurane concentration at 1.5 to 2%and an oxygen flow rate of 0.5 to one liter per minute.Monitor the inhaled oxygen concentration, the end tidal carbon dioxide, the body temperature, and the level of consciousness. Place the patient in a lateral decubitus position and place the ultrasound probe directly above the spinous processes of the third and seventh thoracic vertebrae. Obtain a cross-sectional image of the spinous processes.Move the ultrasound probe laterally to show the transverse process in its entirety. Move it outward to visualize the transverse process, transverse rib joints, and the ribs. Keep moving the probe caudally until the transverse process, pleura, and the thoracic paravertebral space are detected in the image.Under ultrasound guidance, insert a block needle with the in plain approach from the lateral to the medial side. Next, carefully increase the aspiration before the injection to ensure no blood reflux is seen. After injecting 0.5 milliliters of ropivacaine, visualize the anterior displacement of the pleura and the widening of the thoracic paravertebral space.Maintain a Bispectral Index value of 40 to 60. Using an infusion pump, continuously perfuse norepinephrine. Perform arterial blood gas analysis 15 minutes before the end of the surgery.Inject one milligram per kilogram of flurbiprofen 30 minutes before the end of the surgery. The pulmonary complication rate was observed to be significantly lower in the non-intubated video-assisted thoracic surgery, or NIVATS group, related to the general anesthesia, or GA group. Six patients in the GA group developed postoperative pneumothorax.Three patients in the GA group developed plural effusion compared to one in the NIVATS group, which was not statistically significant. Seven patients in the GA group developed pneumonia compared to none in the NIVATS group, and the difference between the two groups was statistically significant. Additionally, three GA patients developed pulmonary atelectasis and two developed pulmonary embolisms.Neither group developed acute respiratory distress syndrome. The NIVATS group showed reduced intraoperative blood loss at 20 milliliters, shorter mean surgery duration, and post-anesthesia care unit stay time. Furthermore, the chest drain was removed from the NIVATS group on day two and the GA group on day three, which was significant.Significant differences were observed in the amount of postoperative chest drainage between the NIVATS and the GA group. Three patients in the GA group had prolonged ICU stays, and four had postoperative chest tightness with shortness of breath. Relative to the GA group, the NIVATS group had significantly shorter hospital stay lengths at five days.