一个方案经当地机构审查委员会（IRB）。参与者提供完成签署协议之前，知情同意书。 1.预程序<ol><li>确保候选人电磁导航肺穿刺抽吸有一个外围肺结节。确定肺结节利用想象的研究。 注：最常见的一种，需要对这个协议是通过评估以前获得的胸部CT。 </li><li>关于该过程的天附加电子基准点焊盘到目标病变的对侧胸廓，以尽量减少与TTNA活检入口点垫重叠。得到基线吸气和呼气未造影胸部层析，用0.5毫米的间隔和0.67 - 0.75毫米厚度。 </li><li>从CT扫描仪到规划软件传输医药（DICOM）数据的数字成像和通信。如果DICOM是不可用，CT的紧凑盘（CD）复制，可直接加载到系统的规划。数字选择目标病灶和重建一个三维虚拟地图呼吸道。 </li><li>从CT扫描仪到支气管镜套房设有到位的电子基准点被担架运送病人。 </li><li>评估患者对麻醉，建立静脉通路和附加标准的麻醉监测。 </li></ol>类=“jove_title”2。程序（支气管镜相） <ol><li>病人转移到支气管镜套装。 （ - 200微克/公斤/分钟100）使用异丙酚管理深度镇静麻醉。气道建立与喉罩（LMA）或气管气管导管（ETT）。 注：麻醉只能由经过认证的供应商进行管理。 </li><li>执行白光支气管镜（WLB）检查的标准方式检查气管支气管树的断片水平。 </li><li>执行ñEBUS-TBNA以下肺癌的研究（IASLC）淋巴结地图为肺癌分期的国际协会。如果可能，细针穿刺（FNA）标本进行现场细胞学分析。如果不是，所述样品是发生在福尔马林中用于以后计算。 </li><li>使用WLB支气管镜与纤维支气管镜EMN阶段程序紧跟先前电脑识别或手动刨支气管途径目标病变首选，proceduralists自由裁量权的文书（细胞刷，活检下颚的力量，FNA针）。 </li><li>通过工作通道前进的R EBUS并试图确认的病变的位置。 </li><li>一旦目标，品尝病变用来导航操作员选择可跟踪仪。 （细胞刷，活检下颚的力量，FNA针）。 </li><li>如果目标无法通过径向EBUS或验证的气道解剖禁止支气管导航取出支气管镜，并准备牛逼他耐心等待胸的方法。如果病变不能诊断支气管镜准备耐心等待胸的方法。 </li></ol> 3.程序（电磁肺穿刺抽吸） <ol><li>分配所需的所有TTNA用品。 （见材料表 ） </li><li>定位患者平卧在用于胸部CT扫描成像收购一家类似的方式。 </li><li>使用测试电磁导航针选择的入口点到胸腔和它在皮肤表面上标记。入口点要优于最接近的肋的表面上，并避免骨结构和任何血管结构。 </li><li>准备与2％氯己定溶液中的皮肤，悬垂性使用无菌技术领域和麻醉本地（约1至2 1％利多卡因毫升皮下浸润）。 </li><li>将无菌电磁导航针的入口点之上，选择的角度，以基于观察的横向和看到的电磁系统屏幕冠状目标。 （在至少两个不同的平面十字标记）。 </li><li>稳定的针，并通过胸壁进入靶病变坚决推进。 </li><li>从针取下针头的指导和钢丝小心避免针运动。此时需格外小心使用，以防止意外的针头移位。用手指挡住针枢纽。插入20G的针头FNA通过19克针。样品病变，并提供标本上涨。 </li><li>编程自动穿刺活检到所需的距离或根据病灶的大小投掷，然后通过19克针插入。稳定两个针和活检枪，触发穿刺活检枪机制来执行活检和电磁导航引导针使得中拆掉确保它保持在适当的POS机银行足球比赛。 </li><li>轻轻推进探头指导放回穿刺的内腔，并保持稳定。 </li><li>而针连续稳定，助理使用手术刀刀片从核心活检针的内套管轻轻取出样品，并将其放置在1/2 x 1/2英寸以前削减非附着垫。沉浸在福尔马林溶液垫。 </li><li>重新确认病灶内针的适当放置和然后重复该操作4至5倍，确保芯针顺时针或逆时针旋转来样不同的区域。 </li><li>一旦满意的标本取出针，施加压力并放置一个小绷带穿刺部位。 </li></ol> 4.程序后<ol><li>如果有的话，进行床旁超声以评估肺的滑动存在（不存在气胸）或使用任何其他成像模态（荧光透视等）。 </li><li>转移病人恢复区，并在标准的门诊手术单位的协议，直至观察到完全清醒。 </li><li>获得胸片，以排除并发症。 </li><li>病人出院回家就潜在的程序后并发症包括出血，气胸提供教育后。 </li></ol>

<ol>
	<li>Govert, J. A., Dodd, L. G., Kussin, P. S., Samuelson, W. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+prospective+comparison+of+fiberoptic+transbronchial+needle+aspiration+and+bronchial+biopsy+for+bronchoscopically+visible+lung+carcinoma.">A prospective comparison of fiberoptic transbronchial needle aspiration and bronchial biopsy for bronchoscopically visible lung carcinoma.</a> Cancer. 87, 129-134 (1999).</li><li>Gasparini, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Bronchoscopic+biopsy+techniques+in+the+diagnosis+and+staging+of+lung+cancer.">Bronchoscopic biopsy techniques in the diagnosis and staging of lung cancer.</a> Monaldi Arch Chest Dis. 52, 392-398 (1997).</li><li>. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=United+States+cancer+statistics:+1999-2010+incidence+and+mortality+web-based+report.">United States cancer statistics: 1999-2010 incidence and mortality web-based report.</a> US Department of Health and Human Services Centers for Disease Control and Prevention and National Cancer Institute. , (2014).</li><li>Silvestri, G. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Methods+for+staging+non-small+cell+lung+cancer:+Diagnosis+and+management+of+lung+cancer,+3rd+ed:+American+College+of+Chest+Physicians+evidence-based+clinical+practice+guidelines.">Methods for staging non-small cell lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines.</a> Chest. 143, e211S-e250S (2013).</li><li>Steinfort, D. P., Khor, Y. H., Manser, R. L., Irving, L. B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Radial+probe+endobronchial+ultrasound+for+the+diagnosis+of+peripheral+lung+cancer:+systematic+review+and+meta-analysis.">Radial probe endobronchial ultrasound for the diagnosis of peripheral lung cancer: systematic review and meta-analysis.</a> The European respiratory journal. 37, 902-910 (2011).</li><li>Gex, G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Diagnostic+yield+and+safety+of+electromagnetic+navigation+bronchoscopy+for+lung+nodules:+a+systematic+review+and+meta-analysis.">Diagnostic yield and safety of electromagnetic navigation bronchoscopy for lung nodules: a systematic review and meta-analysis.</a> Respiration; international review of thoracic diseases. 87, 165-176 (2014).</li><li>Wang Memoli, J. S., Nietert, P. J., Silvestri, G. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Meta-analysis+of+guided+bronchoscopy+for+the+evaluation+of+the+pulmonary+nodule.">Meta-analysis of guided bronchoscopy for the evaluation of the pulmonary nodule.</a> Chest. 142, 385-393 (2012).</li><li>Lee, K. A., Raval, A. A., Amir, L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cost-effectiveness+of+endobronchial+percutaneous+biopsy+compared+with+transthoracic+biopsy+for+diagnosis+of+peripheral+lung+lesions.">Cost-effectiveness of endobronchial percutaneous biopsy compared with transthoracic biopsy for diagnosis of peripheral lung lesions.</a> Lung Cancer Management. 3 (2), 135-148 (2014).</li><li>Rivera, M. P., Mehta, A. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=American+College+of+Chest,+P.+Initial+diagnosis+of+lung+cancer:+ACCP+evidence-based+clinical+practice+guidelines+(2nd+edition).">American College of Chest, P. Initial diagnosis of lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition).</a> Chest. 132, 131S-148S (2007).</li><li>Wiener, R. S., Schwartz, L. M., Woloshin, S., Welch, H. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Population-based+risk+for+complications+after+transthoracic+needle+lung+biopsy+of+a+pulmonary+nodule:+an+analysis+of+discharge+records.">Population-based risk for complications after transthoracic needle lung biopsy of a pulmonary nodule: an analysis of discharge records.</a> Annals of internal medicine. 155, 137-144 (2011).</li></ol>

笔者收到的是由Veran医疗技术公司，其产生本出版物中使用的EM和TTNA仪器提供的研究经费。

电磁指导有利于经皮肺活检技术。它是过程验证足够的设备校准过程中的关键。在针插入保持一个稳定的角度，并保持视觉对准使用至少两个不同的平面上是必不可少的，以有效地到达靶病变。 进针深度活检，以最大限度的覆盖区域之间进行修改。优选地，该过程可以由第二运营商的协助，特别是在活检枪操作的时间，但是单个操作过程是可行的。 熟悉的工具和技术，大约需要2〜3针插入。如果一个有经验的操作者的直接监督下幻象模式或尸体型号培训是可取的。电磁导航经胸壁针穿刺（E-TTNA）是一种新型的技术，补充CUR租一套设备对周围性肺结节的诊断价值。该过程的潜在局限性是固有的电磁导航技术，如CT到身体发散和相关的呼吸系统的动态特性。我们建议期待像气胸和出血的并发症，应在任何经皮过程服用。 在这篇文章中，我们介绍了如何在E-TTNA由介入肺病和技术，以当前可用支气管镜方法肺结节的评价纳入执行。 E-TTNA可以潜在地减少对其他图像引导经皮肺程序提供支气管镜，并在一个单一的程序非支气管镜技术的全面整合无形中增加了诊断率，提高安全性和降低程序的总数。进一步的研究需要ED确定这个现代活检技术的临床应用。

一个孤立性肺结节（SPN）是一种常见的临床场景，由于要增加胸部影像学研究的数量和肺癌筛查计划的实施。肺节结的定义是小于3厘米，直径和一个通常位于超出支气管镜可视化段支气管。病变大于3 cm的被认为是肺部肿块。大多数肺结节的病因是良性的条件（感染，炎症，血管），并在一个较小的比例由肺癌等恶性肿瘤引起的。评价的SPN的开始评估风险因素，放射线照相特性，大小，生长，位置，手术风险等风险分层有助于选择最合适的个体的管理，这从放射监视到主手术切除的范围内。诊断方法包括支气管镜技术：（支气管肺泡灌洗（BAL），细胞刷，transbronchial活检（TBBX），支气管针吸活检（滨海新区），径向探头超声支气管（R-EBUS），电磁导航（EMN），超薄纤维支气管镜，支气管镜虚导航）和非支气管镜：图像引导下肺穿刺活检和手术切除。 用简单的常规技术为病变支气管镜产量少&lt;3厘米范围从14 - 50％的1,2-肺癌仍然是癌症死亡的首要原因。它代表每年诊断所有的浸润性癌的14％和3预后和治疗管理由阶段确定的所有癌症死亡人数在美国的28％。非小细胞肺癌的分期（NSCLC）是由TNM分期系统中定义。 N或淋巴结状态的确定需要纵隔及肺门淋巴结的严格考核。 支气管内超声（EBUS）是用微创技术，支气管镜s超声检查，以确定结构邻接呼吸道促进支气管针吸活检（TBNA）。对于肺癌的分期最近的一项荟萃分析报告说，89％的中位数灵敏度值范围为46％〜97％和91％，中位数为阴性预测值PV为EBUS-TBNA 4径向EBUS是另一个支气管工具，可以进行用于本地化肺实质病变。它是用在产生360度的图像与5厘米的穿透尖端20-MHz的超声波探头中的1.4毫米直径的仪器。近日有消息称该技术的数据显示，73％（95％CI，0.70 - 0.76）确定肿瘤的灵敏度为任何规模大小结节和71％（95％CI，0.66 - 0.75）病灶比2.5厘米5较小。 电磁导航支气管镜（ENB）是围绕患者允许确定一个传感器装置的磁场内的空间位置的产生磁场的技术。 Ť他的信息叠加在先前获得的计算机断层扫描（CT）图像，这允许在相对于解剖结构的传感器位置的显示。患者的气道的虚拟支气管镜重建便于导航到靶病变。一旦在目标，样本被直接使用的两个可用技术之一采取;可追踪支气管镜仪器或通过扩展工作通道。总体诊断准确率为73.9％（95％CI 68.0％ - 79.2％）和阴性预测值52.1％（95％CI 43.5％ - 60.6％），并使用至少一个其它技术（虚拟支气管镜，ENB，Radial-时EBUS，引导护套，超薄支气管镜）的诊断率为70.0％与67.1％，95％CI为72.9％，6 7的一个商用系统的具有附加功能来补充支气管镜导航与从支气管镜方式转换的能力在一个情况下肺穿刺的方法s其中病变无法进行支气管镜访问。该系统使用电磁导航引导19克追针，允许使用一个20 G级自动活检装置核心肺活检取样。 肺穿刺抽吸（TTNA）是一种非支气管镜的诊断方法肺结节和肿块。外围肺部病变TTNA可在超声，X线透视，CT扫描或电磁的指导下进行。在一个更新的荟萃分析里维拉等 TTNA对周围型肺癌诊断的灵敏度汇总为0.90（95％CI，0.88〜0.91）。8在一项由维纳RS，其中包括15865例的风险报告与7％（95％CI，6％ - 7.2％） - 15％（16％95％CI，14％）后TTNA气胸，与胸管需要管理层9临床试验研究使用E-TTNA目前都正在进行中。 CASE PRESENTATION 一个83岁的女性既往吸烟者与氧相关的慢性阻塞性肺疾病被偶然发现用PET氟狂热的1.6×1.3厘米spiculated右肺上叶（RUL）结节（ 图1）。虽然她的恶性肿瘤的概率较高，患者拒绝手术干预和然后才考虑其他的治疗选择了诊断过程。在典型的情形，可能用于活组织检查的评估提示考虑将是恶性或恶性肿瘤的高概率用禁忌手术切除中间概率的情况。

<table border="0" cellpadding="0" cellspacing="0">
	<tbody>
		<tr>
			<td>20 G x 15 cm Programmable automatic biopsy needle</td>
			<td>SuperCore Argon Medical devices</td>
			<td align="right">701120150</td>
			<td></td>
		</tr>
		<tr>
			<td>Non Adherent Pads</td>
			<td>Telfa&#160;</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Sterile scissor</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>2% chlorhexidine gluconate pad</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Surgical Blade #11</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Sterile surgical drape</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>1% lidocaine</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Sterile gowns</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Sterile gloves</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Mask</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Scrub hair cap</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Electronic reference points&#160;</td>
			<td>vPAD2 (Veran Medical Technologies)</td>
			<td>INS-0049</td>
			<td></td>
		</tr>
		<tr>
			<td>Planning software&#160;</td>
			<td>SPiNDrive&#160;2.0 (Veran Medical Technologies)&#160;</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Eelectromagnetic navigation platform</td>
			<td>SPiNView (Veran Medical Technologies)</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>19 G x 105 mm Electromagnetic navigational needle</td>
			<td>SPiNPerc&#160; Veran Medical Technologies</td>
			<td>INS-0029</td>
			<td></td>
		</tr>
		<tr>
			<td>Standard diagnostic Fiberoptic Bronchoscope</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>EBUS Bronchoscope</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Radial EBUS probe UM-S20-17S</td>
			<td>Olympus</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Formaldehyde-based fixative solution.</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Ethanol based fixative</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
	</tbody>
</table>

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.

通过EBUS-TBNA和E-TTNA获得的所有组织样品由中央病理学实验室进行进一步的分析处理。样本的病理评估包括细胞学和组织学的评估。快速现场评价（ROSE）采用了改进型的Romanowsky污点，让充足的评估和病理标本的细胞形态学诊断评估。使用来自纵隔淋巴结站4L，4R和7所采取的EBUS-TBNA活检ROSE的初步程序内部评估是unrevealing明显的肿瘤的。导航支气管镜相，径向EBUS支持，未能本地化右上肺叶病变，由于解剖学的限制。该过程被迅速转化为E-TTNA。 E-TTNA成功地进行和获得的组织是足够的病理进一步和遗传分析。在E-TTNA核心活检样品的最终病理诊断是与腺癌一致。没有直接的并发症。 <img alt="图1" src="/files/ftp_upload/52723/52723fig1.jpg" /> 图1.胸部计算机断层扫描（图A）和正电子发射断层扫描（PET）（B组）。右肺上叶结节的PET负纵隔。规模厘米。

Watch this Scientific Journal Video about Use of Electromagnetic Navigational Transthoracic Needle Aspiration E-TTNA for Sampling of Lung Nodules at JoVE.com

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 ...

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Research

JoVE Journal

Medicine

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

22.1K 次观看.  Johns Hopkins University. We describe the novel use of electromagnetic navigational guided transthoracic needle aspiration for the pathologic assessment of human lung nodules. 

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

Transthoracic Echocardiography in Mice

In recent years, murine models have become the primary avenue for studying the molecular mechanisms of cardiac dysfunction resulting from changes in gene expression. Transgenic and gene targeting methods can be used to generate mice with altered cardiac size and function,1-3 and as a result, in vivo techniques are needed to evaluate their cardiac phenotype. Transthoracic echocardiography, pulse wave Doppler (PWD), and tissue Doppler imaging (TDI) can be used to provide dimensional measurements of the mouse heart and to quantify the degree of cardiac systolic and diastolic performance. Two-dimensional imaging is used to detect abnormal anatomy or movements of the left ventricle, whereas M-mode echo is used for quantification of cardiac dimensions and contractility.4,5 In addition, PWD is used to quantify localized velocity of turbulent flow,6 whereas TDI is used to measure the velocity of myocardial motion.7 Thus, transthoracic echocardiography offers a comprehensive method for the noninvasive evaluation of cardiac function in mice.

Transthoracic echocardiography offers a noninvasive method for the evaluation of cardiac function in mice. A combination of ultrasound and Doppler imaging modalities can be used to obtain dimensional measurements of the heart and intracardiac blood flow, which together provide an assessment of cardiac systolic and diastolic performance.

经胸超声心动图在小鼠

In recent years, murine models have become the primary avenue for studying the molecular mechanisms of cardiac dysfunction resulting from changes in gene ...

科研

医学

Substernal Thyroid Biopsy Using Endobronchial Ultrasound-guided Transbronchial Needle Aspiration

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 lack of a standardized definition for STG. Biopsy is often required to differentiate benign from malignant lesions. Unlike cervical thyroid, the overlying sternum precludes ultrasound-guided percutaneous fine needle aspiration of STG. Consequently, surgical mediastinoscopy is performed in the majority of cases, causing significant procedure related morbidity and cost to healthcare. Endobronchial Ultrasound-guided Transbronchial Needle Aspiration (EBUS-TBNA) is a frequently used procedure for diagnosis and staging of non-small cell lung cancer (NSCLC). Minimally invasive needle biopsy for lesions adjacent to the airways can be performed under real-time ultrasound guidance using EBUS. Its safety and efficacy is well established with over 90% sensitivity and specificity. The ability to perform EBUS as an outpatient procedure with same-day discharges offers distinct morbidity and financial advantages over surgery. As physicians performing EBUS gained procedural expertise, they have attempted to diversify its role in the diagnosis of non-lymph node thoracic pathologies. We propose here a role for EBUS-TBNA in the diagnosis of substernal thyroid lesions, along with a step-by-step protocol for the procedure.

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 ...

Open Tracheostomy Gastric Acid Aspiration Murine Model of Acute Lung Injury Results in Maximal Acute Nonlethal Lung Injury

Acid pneumonitis is a major cause of sterile acute lung injury (ALI) in humans. Acid pneumonitis spans the clinical spectrum from asymptomatic to acute respiratory distress syndrome (ARDS), characterized by neutrophilic alveolitis, and injury to both alveolar epithelium and vascular endothelium. Clinically, ARDS is defined by acute onset of hypoxemia, bilateral patchy pulmonary infiltrates and non-cardiogenic pulmonary edema. Human studies have provided us with valuable information about the physiological and inflammatory changes in the lung caused by ARDS, which has led to various hypotheses about the underling mechanisms. Unfortunately, difficulties determining the etiology of ARDS, as well as a wide range of pathophysiology have resulted in a lack of critical information that could be useful in developing therapeutic strategies.
Translational animal models are valuable when their pathogenesis and pathophysiology accurately reproduce a concept proven in both in vitro and clinical settings. Although large animal models (e.g., sheep) share characteristics of the anatomy of human trachea-bronchial tree, murine models provide a host of other advantages including: low cost; short reproductive cycle lending itself to greater data acquisition; a well understood immunologic system; and a well characterized genome leading to the availability of a variety of gene deletion and transgenic strains. A robust model of low pH induced ARDS requires a murine ALI that targets mainly the alveolar epithelium, secondarily the vascular endothelium, as well as the small airways leading to the alveoli. Furthermore, a reproducible injury with wide differences between different injurious and non-injurious insults is important.
The murine gastric acid aspiration model presented here using hydrochloric acid employs an open tracheostomy and recreates a pathogenic scenario that reproduces the low pH pneumonitis injury in humans. Additionally, this model can be used to examine interaction of a low pH insult with other pulmonary injurious entities (e.g., food particles, pathogenic bacteria).

This protocol induces acute lung injury in a mouse that has close fidelity to the pathogenesis of acid pneumonitis observed in humans. We generate a maximal acute nonlethal low pH lung injury and account for differences in rodent-human anatomic respiratory structure using an open tracheostomy coupled with circumferential pressure release.

急性肺损伤开放气管切开胃酸吸入小鼠模型结果在急性最大非致命性肺损伤

Acid pneumonitis is a major cause of sterile acute lung injury (ALI) in humans. Acid pneumonitis spans the clinical spectrum from asymptomatic to acute ...

Transthoracic Speckle Tracking Echocardiography for the Quantitative Assessment of Left Ventricular Myocardial Deformation

The value of conventional echocardiography is limited by differences in inter-individual image interpretation and therefore largely dependent on the examiners&#39; expertise. Speckle tracking Echocardiography (STE) is a promising but technically challenging method that can be used to quantitatively assess regional and global systolic and diastolic myocardial performance. Myocardial strain and strain rate can be measured in all three dimensions&#160;&#8212; radial, circumferential, longitudinal &#8212; of myocardial deformation. Standard cross-sectional two-dimensional B-mode images are recorded and subsequently postprocessed by automated continuous frame-by-frame tracking and motion analysis of speckles within the myocardium. Images are recorded as digital loops and synchronized to a 3-lead EKG for timing purposes. Longitudinal deformation is assessed in the apical 4-, 3-, and 2-chamber views. Circumferential and radial deformation are measured in the parasternal short axis plane.
Optimal image quality and accurate tissue tracking are paramount for the correct determination of myocardial performance parameters. Utilizing transthoracic STE in a healthy volunteer, the present article is a detailed outline of the essential steps and potential pitfalls of quantitative echocardiographic myocardial deformation analysis.

Speckle tracking echocardiography is an emerging diagnostic imaging technique for the quantitative assessment of global and regional myocardial performance. Standard view echocardiographic motion images are recorded and deformation parameters are subsequently measured by automated continuous frame-by-frame tracking and motion analysis of speckles within the B-mode images of the myocardium.

经胸斑点跟踪超声心动图左室心肌变形的定量评价

The value of conventional echocardiography is limited by differences in inter-individual image interpretation and therefore largely dependent on the ...

Absorption of Nasal and Bronchial Fluids: Precision Sampling of the Human Respiratory Mucosa and Laboratory Processing of Samples

The methods of nasal absorption (NA) and bronchial absorption (BA) use synthetic absorptive matrices (SAM) to absorb the mucosal lining fluid (MLF) of the human respiratory tract. NA is a non-invasive technique which absorbs fluid from the inferior turbinate, and causes minimal discomfort. NA has yielded reproducible results with the ability to frequently repeat sampling of the upper airway. 
By comparison, alternative methods of sampling the respiratory mucosa, such as nasopharyngeal aspiration (NPA) and conventional swabbing, are more invasive and may result in greater data variability. Other methods have limitations, for instance, biopsies and bronchial procedures are invasive, sputum contains many dead and dying cells and requires liquefaction, exhaled breath condensate (EBC) contains water and saliva, and lavage samples are dilute and variable.
BA can be performed through the working channel of a bronchoscope in clinic. Sampling is well tolerated and can be conducted at multiple sites in the airway. BA results in MLF samples being less dilute than bronchoalveolar lavage (BAL) samples.
This article demonstrates the techniques of NA and BA, as well as the laboratory processing of the resulting samples, which can be tailored to the desired downstream biomarker being measured. These absorption techniques are useful alternatives to the conventional sampling techniques used in clinical respiratory research.

This manuscript describes the use of nasal and bronchial absorption techniques, specifically using synthetic absorptive matrices (SAM) to sample the mucosal lining fluid (MLF) of the upper and lower airway. These methods provide better standardization and tolerability than existing respiratory sampling techniques.

鼻腔和支气管液的吸收: 人体呼吸道黏膜的精确取样和样品的实验室处理

The methods of nasal absorption (NA) and bronchial absorption (BA) use synthetic absorptive matrices (SAM) to absorb the mucosal lining fluid (MLF) of the ...

Electromagnetic Navigation Transthoracic Nodule Localization for Minimally Invasive Thoracic Surgery

The increased use of chest computed tomography (CT) has led to an increased detection of pulmonary nodules requiring diagnostic evaluation and/or excision. Many of these nodules are identified and excised via minimally invasive thoracic surgery; however, subcentimeter and subsolid nodules are frequently difficult to identify intra-operatively. This can be mitigated by the use of electromagnetic transthoracic needle localization. This protocol delineates the step-by-step process of electromagnetic localization from the pre-operative period to the postoperative period and is an adaptation of the electromagnetically guided percutaneous biopsy previously described by Arias et al. Pre-operative steps include obtaining a same day CT followed by the generation of a three-dimensional virtual map of the lung. From this map, the target lesion(s) and an entry site are chosen. In the operating room, the virtual reconstruction of the lung is then calibrated with the patient and the electromagnetic navigation platform. The patient is then sedated, intubated, and placed in the lateral decubitus position. Using a sterile technique and visualization from multiple views, the needle is inserted into the chest wall at the prechosen skin entry site and driven down to the target lesion. Dye is then injected into the lesion and, then, continuously during needle withdrawal, creating a tract for visualization intra-operatively. This method has many potential benefits when compared to the CT-guided localization, including a decreased radiation exposure and decreased time between the dye injection and the surgery. Dye diffusion from the pathway occurs over time, thereby limiting intra-operative nodule identification. By decreasing the time to surgery, there is a decrease in wait time for the patient, and less time for dye diffusion to occur, resulting in an improvement in nodule localization. When compared to electromagnetic bronchoscopy, airway architecture is no longer a limitation as the target nodule is accessed via a transparenchymal approach. Details of this procedure are described in a step-by-step fashion.

Presented here is a protocol for lung nodule localization using dye marking via electromagnetically navigated transthoracic needle access. The technique described here can be accomplished in the peri-operative period to optimize nodule localization and to successful resection when performing minimally invasive thoracic surgery.

电磁导航经胸结节定位用于微创胸外科手术

The increased use of chest computed tomography (CT) has led to an increased detection of pulmonary nodules requiring diagnostic evaluation and/or ...

Transthoracic Echocardiographic Examination in the Rabbit Model

Large animal models such as the rabbit are valuable for translational preclinical research. Rabbits have a similar cardiac electrophysiology compared to that of humans and that of other large animal models such as dogs and pigs. However, the rabbit model has the additional advantage of lower maintenance costs compared to other large animal models. The longitudinal evaluation of cardiac function using echocardiography, when appropriately implemented, is a useful methodology for preclinical assessment of novel therapies for heart failure with reduced ejection fraction (e.g. cardiac regeneration). The correct use of this non-invasive tool requires the implementation of a standardized examination protocol following international guidelines. Here we describe, step by step, a detailed protocol supervised by veterinary cardiologists for performing echocardiography in the rabbit model, and demonstrate how to correctly obtain the different echocardiographic views and imaging planes, as well as the different imaging modes available in a clinical echocardiography system routinely used in human and veterinary patients.

Here we describe, step by step, a detailed protocol for performing echocardiography in the rabbit model. We show how to correctly obtain the different echocardiographic views and imaging planes, as well as the different imaging modes available in a clinical echocardiography system routinely used in human and veterinary patients.

兔子模型中的跨胸超声心动图检查

Large animal models such as the rabbit are valuable for translational preclinical research. Rabbits have a similar cardiac electrophysiology compared to ...

Use of Magnetic Resonance Imaging and Biopsy Data to Guide Sampling Procedures for Prostate Cancer Biobanking

Previous methods for biobanking prostate tissue, following radical prostatectomy, generally involved random sampling. In order to increase efficiency, and enable a greater range of downstream applications, a more targeted method of sampling prostate tissue was developed. Here we use both magnetic resonance imaging (MRI) and biopsy data to target specific areas of the organ for sampling. The method involves use of a previously published prostate slicing device which removes a 5 mm transverse slice from a predetermined region of the prostate, followed by the removal of 6 mm punch biopsies from predetermined areas of this slice. These samples can be stored frozen or fixed for biobanking purposes, or used fresh immediately with 70% confidence of tumor content, as compared with 10% confidence from the random sampling approach. This enables the use of all standard downstream techniques such as genomics, proteomics or histological work, but also work that requires fresh tissue such as live tissue imaging or ex vivo culture.

This method involves utilization of clinical diagnostic data for prostate cancer patients in order to guide sampling procedures, when biobanking tissue following radical prostatectomy. This overcomes issues with previously published methods around efficiency and availability of fresh tissue for a wider range of downstream applications.

使用磁共振成像和活检数据指导前列腺癌生物库的取样程序

Previous methods for biobanking prostate tissue, following radical prostatectomy, generally involved random sampling. In order to increase efficiency, and ...

用于肺结节诊断和治疗的 3D 重建

A 3D Digital Model for the Diagnosis and Treatment of Pulmonary Nodules

The three-dimensional (3D) reconstruction of pulmonary nodules using medical images has introduced new technical approaches for diagnosing and treating pulmonary nodules, and these approaches are progressively being acknowledged and adopted by physicians and patients. Nonetheless, constructing a relatively universal 3D digital model of pulmonary nodules for diagnosis and treatment is challenging due to device differences, shooting times, and nodule types. The objective of this study is to propose a new 3D digital model of pulmonary nodules that serves as a bridge between physicians and patients and is also a cutting-edge tool for pre-diagnosis and prognostic evaluation. Many AI-driven pulmonary nodule detection and recognition methods employ deep learning techniques to capture the radiological features of pulmonary nodules, and these methods can achieve a good area under-the-curve (AUC) performance. However, false positives and false negatives remain a challenge for radiologists and clinicians. The interpretation and expression of features from the perspective of pulmonary nodule classification and examination are still unsatisfactory. In this study, a method of continuous 3D reconstruction of the whole lung in horizontal and coronal positions is proposed by combining existing medical image processing technologies. Compared with other applicable methods, this method allows users to rapidly locate pulmonary nodules and identify their fundamental properties while also observing pulmonary nodules from multiple perspectives, thereby providing a more effective clinical tool for diagnosing and treating pulmonary nodules.

作者聚焦：用于肺结节诊断和治疗的 3D 数字模型  

The objective of this study is to develop a novel 3D digital model of pulmonary nodules that serves as a communication bridge between physicians and patients and is also a cutting-edge tool for pre-diagnosis and prognostic evaluation.

用于肺结节诊断和治疗的三维数字模型

The three-dimensional (3D) reconstruction of pulmonary nodules using medical images has introduced new technical approaches for diagnosing and treating ...