作者承认在倡导基督医学中心支持紧急医药的部门。

1.评估准则此前布局<ol><li>在插入之前，评估禁忌直肠开放，其中包括： 病变，肿瘤，脓肿，直肠出血，腹泻或最近肠手术（少于6周）。 </li><li>通过向配售前进行直肠指检评估大便直肠。 注意：这是最好的，如果直肠是空的，但是，在直肠中形成的大便不使用的禁忌症。 </li></ol> 2.设备的插入<ol><li>从顶端用水溶性润滑剂的蓝色标记线润滑导管。 </li><li>将导管插入直肠的两个蓝色箭头之间的蓝色标记线。 </li><li>通过注入15毫升清水或生理盐水膨胀与露儿注射器气球。 </li><li>轻轻拖船导管，以确保气囊靠住直肠括约肌。 </li><li>两腿之间的位置导管和安全来的前方面病人的大腿或下腹部与导管固定装置。 </li></ol> 3.药物制备及管理<ol><li>粉碎药物固体形式。 </li><li> 20毫升水研磨药物产生microenema悬架 - 10添加。 </li><li>拉microenema悬挂到肠内注射器，并在大约3迅速注入导管口 - 5秒。 注：对于药物已经在液体形式，步骤3.1和3.2是没有必要的。 </li><li>用3毫升肠内注射器快速冲洗用3mL水的药物管理端口（在小于1秒）。 </li></ol> 4.水化（直肠滴注过程） <ol><li>辖低渗溶液只（水，0.2％生理盐水，0.5％生理盐水， 等等 ）。 </li><li>管理使用大（45或60毫升）的肠内注射大丸剂流体在约60毫升在15的速率 - 30秒。 注意：通过导管的储水输液可能会做ü唱重力管饲袋子很容易附着在梅西导管用药端口。输注在高达250个评分- 400毫升/小时已显示出良好的耐受性7。 </li></ol> 5.拔除尿管<ol><li>排便前取出导管。导管可以保持在直肠长达28天。 注：导管容易排便排出，不会抑制大便的传递。 </li><li>与鲁尔注射器取出导管放气的气球。附加20毫升注射器露儿球囊充气阀，轻轻地从气球收回15毫升水。从直肠轻轻取出。 注：禁忌使用。不要使用导尿管的患者直肠病变，肿瘤，积极直肠出血或近期肠手术（不到6个星期）。如果直肠黏膜受到损害（溃疡或缺血性直肠炎）不要使用。不要使用患者腹泻。 </li></ol>

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The authors have nothing to disclose.

通过直肠黏膜吸收药物和流体的政府一直通过这条路线用在各种环境在很长一段时间内，以提供流体具体给出期限直肠滴注或rectoclysis 6-9。然而，尽管这条路线的有效性，实际使用被限制由一个方便，易于使用的设备的可用性来利用它。在ED使用的初始报告显示，该导管是容易放置，并经由导管施用药物效果的发作很快出现。由于放置设备的时间是最小的，导管似乎是在紧急情况和重症监护设置了宝贵的药物和液体给药装置。 因为该装置是在非无菌，并且被放置在直肠中以类似的方式，以一个标准福利导管置于尿道，最小技能是必需的，而且几乎没有ADVANCED训练是必要的。在直肠递送的药物的最关键的部分是通过直肠途径给药的理解。最鸦片制剂，苯并二氮，和NSAIDs的被很好地吸收和给药相当于口服途径。在姑息设置中使用药物的直肠吸收文学的广泛审查已编制15。要注意的是低渗流体应该用于直肠滴注，因为吸收通过直肠黏膜通过被动扩散和等渗和高渗流体发生可具有泻下作用是重要的。通过在高达400毫升/小时的速率注入水的使用低渗流体，直肠水合已经证明，用224毫升/小时7的平均速率。 由于该装置的简单性是最小的需要进行故障排除。要注意的重要的是在导管配合药物端口唯一与肠内注射器。露儿注射器不能连接到克拉服药端口。此功能旨在避免肠道设备（鲁尔注射器）和胃肠道设备（肠内注射器）之间的误错误。出于这个原因，IV袋不能直接附连到所述导管为作为第四管道装配有路厄接头的流体的施用。 A“鲁尔到肠内”适配器可以购买用于此目的，或者可以通过bolusing使用附带在由制造商提供的试剂盒中的导管60毫升肠内注射器流体的患者中进行水化。 危急情况下，如休克，败血症或心脏骤停需要肠外访问或者通过静脉或骨内方法，如直肠用药和输液不提供直接的吸收;然而，直肠导管可以提供在这些情况下的附加快速访问路由。例如，在败血症的发生，当协议的需求大量的液体在很短的时间内，多个第四接入点是必要的，和直肠流体输送可迅速增加血管体积，而正在执行的多个IV型的一种方式。此外，导管可以为不能被静脉内灌输药物，如丁螺环酮在低温诱导和阿司匹林发抖血小板抑制和发热降低的控制提供访问的路由。 很难IV连接在ED设置一个越来越常见的问题。 Fields 等人发现，1 10允许进入城市ED患者被认为是“困难的静脉通路”16。对于患者在其中血管通路困难，延迟或不必要的药物和流体输送的这种新方法可以证明在急诊无价的。药物和液体可在几分钟内给药，同时等待超声放置，中心静脉安置，或者在在外围放置反复尝试。在这些情况下，直肠升导管可允许的患者的病情水合或管理可静脉通路复杂化，通过减少安置的难度。在儿科患者，谁是公知有困难静脉通路（通常害怕侵入或疼痛的程序），该技术可能是一个很好的选择。 骨内输液是痛苦和用药前用利多卡因可能会非常耗时。警报患者是不病危，使用这种导管可以是从成本，时间和患者的舒适度的角度优选的，因为该装置的成本提供了超过替代显著节省诸如流行骨内针递送系统中广泛使用的。导管可能是一个很好的替代了，因为没有成像液和药物治疗，如放置的X射线确认鼻胃管安置，是必要的，它不太可能放置过程中造成不适或伤害。即使是在超声引导技术术，四的位置可以显著延误治疗可以启动，无静脉通路，提供时间和金钱更多的节省就算完成了。显著节省所用的使用成本较低的口服药物（如片剂，可以粉碎并通过导管施用）相比，在相同的药物的静脉内制剂来实现。最后，该器件具有较静脉通路的并发症，降低感染，浸润的发病率与静脉注射治疗相关的可能性更小，而且等症。 中通常存在困难外周静脉通路，并且可以从该方法中受益的患者类型，包括糖尿病患者，肥胖，肾功能衰竭，水肿，静脉吸毒或那些接受化疗。大多数儿童和老年患者也可能受益。具体临床需要的量，导管可以在急诊设置用于可以包括水合，发烧，疼痛，情绪激动，癫痫发作，偏头痛，镰状细胞危机，胃轻瘫或恶心和呕吐。 导管也可用于保留灌肠剂的滴注如乳果糖高架氨，Kayexalate为升高钾和盐水或其它制剂为严重的便秘，或协助进行disimpaction。它是用于保留灌肠剂比其中采用较大直径的轴和气球与当前所用肠管理系统的一个替代方案，这是更容易插入和使用。 有使用征求意见稿设置导管的其他几个好处，包括减少等待时间，降低工作人员的负担，并降低相关的静脉注射治疗医源性并发症。患者的满意度可以减小等待时间得到改善，以及病人的症状，如疼痛，呕吐可能很快，而不必等待静脉通路被解除。

施用在急诊护理设置药物和流体的最常见的路线是通常口服（如果病人能耐受口服），静脉内（更快速施用，或提供药物不口服生物可利用的），或骨内（的情况下其中，血管内访问难以获得）。然而，在许多情况下，患者谁是太不容忍误服也脱水，与不良血管通路，防止血管内的放置（IV）的线。在多数情况下，骨内的位置是不是一个理想的选择，因为施用在清醒的患者的不适可以显著。 一个新的设备，导管，通过提供直肠黏膜吸收，这是长期已知有效且很容易访问1-11路由的替代路线。吸收通过直肠黏膜一般迅速，很多药物达到治疗水平rapidl血药浓度Y，部分是由于避免了首过效应的结果。12 该导管具有一个硅胶管是14星期五的直径，并具有在前端15毫升的气球。气球提供了导管施用药物和流体的保留的安全保留，但也允许消除通过通路经由排便。所述导管具有在所述远侧尖端用于流体和药物通道的多个出口端口，以及在所述近端的内部单向阀，以防止流体的倒流（ 图1）。该装置的部件的描述示于表1中 。 该导管，它在2014年面世，最初是用于姑息治疗和临终关怀的患者，被设计用于满足照顾病人在家里设置家庭成员的需求，省去了住院和更具侵入性服务的需求。产品设计尤其能够保存而被病人的尊严容易足以让那些没有医疗背景。然而，由于其与急诊和危重病人使用上诉，该设备已被越来越多地在此设置使用的最近。特别是，病例报告和病例系列描述在急诊设置这种方法的新颖性最初只是在去年13,14出现了。 导管的功能和优点能更容易和更有效地利用直肠黏膜给药途径比已问世之前。导管的位置是容易的，而不需要为无菌。该装置的使用不需要先进的训练，因为它被放置在一个方式类似于标准福利导管。因为位置是简单，能够避免在进入脉管的重复尝试，这增加了提供者和患者的满意度。该设备适应症是提供直肠进入管理液体/药物。 案例介绍 一些用在紧急情况下的导管，包括急诊和重症监护室的例子，最近已报道13-14。这些的实例包括： 情况1 一个80岁的男性有多个合并症，包括肥胖，慢性腿上的伤口，皮肤移植，HTN，CAD，和COPD，救护车通过向急诊科（ED）有发热，精神状态，和咳嗽减少。在静脉通路由救护人员，并随后到达后ED人员的尝试，均告失败。患者最初的生命体征：BP68分之124，HR 98，T 38.4对2L NC 92％℃， 氧饱和度，以及14 GCS（由于混淆）。 案例2 通过救护车酒精withdr提出了一种41岁女回历与BP七十八分之一百一十，HR 120的生命体征，T 36.9℃，氧对室内空气的98％饱和度。醇（CIWA）得分为她的临床研究所戒断评估是9.用于流体和苯并二氮杂卓给药获得第四接入尝试均告失败，并且患者被视为太迷失方向和搅拌以安全地耐受口服施用。 案例3 一个25岁的女性通过急性混乱，躁动，心动过速滥用药物，包括可卡因和海洛因造成救护车呈现。她对这些患者以前服用他巴唑底层未经处理的甲状腺功能亢进症。她的生命体征的BP七十三分之一百十八，HR 117，T 37.4℃，对室内空气97％的氧饱和度。成立有一定的难度静脉通路;然而，患者仍然太糊涂，并搅拌以安全承受甲巯咪唑片（药物只在口头形式提供）。 一位59岁的男性被带进ED心脏骤停后除颤后自主循环恢复，但持续昏迷。低温治疗被提起，但尽管外表垫提供最大冷却功率，患者体温有人指出，攀登，可能正在进行瑟瑟发抖的结果。因为一个鼻胃管放置到吸透露胃内容物是在外观上的咖啡渣相似，胃肠道出血被怀疑，并被认为药物，包括对乙酰氨基酚和丁螺环酮的鼻胃管施用是禁忌。 诊断，评估和计划 在上述所有的患者中，药物递送的这种方法提供了一种有用的替代治疗方法，以解决有挑战性药物和输液的条件。

<table border="0" cellpadding="0" cellspacing="0" width="688">
	<tbody>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">Macy Catheter</td>
			<td style="width:115px;">Hospi Corp.</td>
			<td style="width:119px;">MAC 1001</td>
			<td style="width:239px;">Single Macy catheter device</td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:216px;">Macy Catheter Bedside Care Kit</td>
			<td style="width:115px;">Hospi Corp.</td>
			<td style="width:119px;">MCK 1001</td>
			<td>Kit with syringes, Liqui-Pill grinder</td>
		</tr>
	</tbody>
</table>

a novel approach for the administration of medications and fluids in emergency scenarios and settings

常用于急性护理设置药物和液体管理的可用路由通常限于口服，静脉内或骨内的路线，但在许多患者，特别是在紧急情况或重症监护设置的航线往往不可用或时间耗时访问。一种新颖的设备现在是可用，提供了用于经由直肠黏膜吸收的药物或流体给药的容易途径（也以流体管理和随后的吸收的情况下，简称为直肠滴注）。虽然最初打算姑息治疗市场上，这种装置在急诊设置的实用最近被描述。具体地，患者报告正在接受治疗脱水，酒精戒断，呕吐，发烧，心肌梗塞，甲状腺机能亢进，心跳骤停显示用的各种药物或流体（包括水，阿司匹林，劳拉西泮，ondans施用成功钰创，对乙酰氨基酚，甲巯咪唑，丁螺环酮和）。设备的位置是简单的，并且基于从药物施用预期效应的观察，吸收是迅速的。吸收动力学的迅速在最近巴比妥药物动力学的测量报告被进一步证实。我们在这里描述该装置的放置和使用，并演示本方法施用的药物的药代动力学的测量方法。

使用药物和流体输送急诊或重症监护设置这个方法的初步报告显示从各种条件的给予药物和液体快速效果描述13,14。此外，这些患者的耐受性的方法以及无不适的投诉。采取导管的放置的平均时间为约1分钟。此外，该程序被广泛接受和谁是清醒和警觉的语言表达的患者满意度的液体和药物输送此模式。对于提出的四种情况的临床结果如下所示。 临床结果 情况1 80岁的男性，多合并症是一个总的提供的50毫升的液体和药物，包括水，阿司匹林溶解在水中的片剂，和对乙酰氨基酚（口服制剂），发烧，脱水和肌钙蛋白升高的治疗。大约90分钟后，患者体温正常，警报和定向（ 图2）。 案例2 这位41岁的女性在酒精戒断和酒精的临床研究所提款评估（CIWA）的9分给予2毫克的劳拉西泮，导致病人的躁动，方向和心动过速立即改善。然后，给予患者4毫克的恩丹西酮在10毫升每2的速度自来水多个等份沿 - 10分钟，在随后的时间，解决她的心动过速和消除她的恶心，而把她CIWA得分为零。 案例3 “jove_content”FO：保together.within页=“1”&gt; 25岁的女性急性混乱，情绪激动，和滥用药物（可卡因和海洛因）有一个基本的未经处理的甲状腺功能亢进导致心动过速，给予他巴唑后片被压碎并悬浮于水中。导管到位依然是在重症监护病房（ICU），用于后续施用每六个小时，直到病人充分的改善，开始容忍口服入院后一天。 案例4 这位59岁的心脏骤停患者经导管，然后用普通的自来水冲洗液给予对乙酰氨基酚（650毫克）和丁螺环酮（30毫克）。这些药物的给药后不久，患者此前上涨的核心温度在有效36.9℃，趋于稳定，他在临床停止发抖。 ENT“FO： - together.within页保留=”1“&gt; <img alt="图1" src="/files/ftp_upload/54622/54622fig1.jpg" /> 图1. 导管的图。从制造商的许可再版。 <a href="https://www.jove.com/files/ftp_upload/54622/54622fig1large.jpg" target="_blank">请点击此处查看该图的放大版本。</a> <img alt="图2" src="/files/ftp_upload/54622/54622fig2.jpg" /> 图2. 通过导管提供退烧一个80岁的男患者的温度曲线。 <a href="https://www.jove.com/files/ftp_upload/54622/54622fig2large.jpg" target="_blank">请点击此处查看该图的放大版本。</a> <table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always"><tbody><tr><td> 导管部分 </td><td> 描述 </td><td> Purpose </td></tr><tr><td>投药孔口</td><td>透明塑料端口标有“MEDS” </td><td>与肠内/口服注射器递送药物和液体直肠连接</td></tr><tr><td>囊吹胀口</td><td>红色塑料端口标有“充气W 15毫升” </td><td>与鲁尔型注射器充气气球，用15ml水连接</td></tr><tr><td>放置标记线</td><td>黑线之间的两个黑色箭头标记朝向导管的尖端</td><td>协助导管正确放置在直肠的远端1/3 </td></tr><tr><td>气球</td><td>朝向导管的尖端可充气气球</td><td>保持在直肠用药及设备，很容易被排便排出。 </td></tr><tr><td>药物输送孔</td><td>导管的尖端附近的四个孔</td><td>允许药物和flui传输从导管到直肠DS。 </td></tr></tbody></table> 表1：导管-零件/说明/用途。

Watch this Scientific Journal Video about A Novel Approach for the Administration of Medications and Fluids in Emergency Scenarios and Settings at JoVE.com

A Novel Approach for the Administration of Medications and Fluids in Emergency Scenarios and Settings

这项研究提出了一种新的设备，它提供了一个简单的方法来快速提供药物和液体的患者有限或难以静脉通路。这种小直径的装置被放置在直肠的远端三分之一，允许正在进行的药物和流体管理。

应急方案和设置药物和液体管理的新方法

The available routes of administration commonly used for medications and fluids in the acute care setting are generally limited to oral, intravenous, or ...

a-novel-approach-for-administration-medications-fluids-emergency

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Pharmacology

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Unit 1

Drugs for Nausea and Vomiting

SCIENTISTS IN ACTION

30.2K 次观看.  University of Illinois at Chicago. 这项研究提出了一种新的设备，它提供了一个简单的方法来快速提供药物和液体的患者有限或难以静脉通路。这种小直径的装置被放置在直肠的远端三分之一，允许正在进行的药物和流体管理。 

视频: A Novel Approach for the Administration of Medications and Fluids in Emergency Scenarios and Settings

Vascular Occlusion Training for Inclusion Body Myositis: A Novel Therapeutic Approach

Inclusion body myositis (IBM) is a rare idiopathic inflammatory myopathy. It is known to produces remarkable muscle weakness and to greatly compromise function and quality of life. Moreover, clinical practice suggests that, unlike other inflammatory myopathies, the majority of IBM patients are not responsive to treatment with immunosuppressive or immunomodulatory drugs to counteract disease progression1. Additionally, conventional resistance training programs have been proven ineffective in restoring muscle function and muscle mass in these patients2,3. Nevertheless, we have recently observed that restricting muscle blood flow using tourniquet cuffs in association with moderate intensity resistance training in an IBM patient produced a significant gain in muscle mass and function, along with substantial benefits in quality of life4. Thus, a new non-pharmacological approach for IBM patients has been proposed. Herein, we describe the details of a proposed protocol for vascular occlusion associated with a resistance training program for this population.

The present article presents the details pertaining to the application of resistance training associated to vascular occlusion in IBM patients.

血管闭塞包涵体肌炎培训：一种新的治疗方法

Inclusion body myositis (IBM) is a rare idiopathic inflammatory myopathy. It is known to produces remarkable muscle weakness and to greatly compromise ...

科研

医学

Bronchial Thermoplasty:  A Novel Therapeutic Approach to Severe Asthma

Bronchial thermoplasty is a non-drug procedure for severe persistent asthma that delivers thermal energy to the airway wall in a precisely controlled manner to reduce excessive airway smooth muscle. Reducing airway smooth muscle decreases the ability of the airways to constrict, thereby reducing the frequency of asthma attacks. Bronchial thermoplasty is delivered by the Alair System and is performed in three outpatient procedure visits, each scheduled approximately three weeks apart. The first procedure treats the airways of the right lower lobe, the second treats the airways of the left lower lobe and the third and final procedure treats the airways in both upper lobes. After all three procedures are performed the bronchial thermoplasty treatment is complete.
Bronchial thermoplasty is performed during bronchoscopy with the patient under moderate sedation. All accessible airways distal to the mainstem bronchi between 3 and 10 mm in diameter, with the exception of the right middle lobe, are treated under bronchoscopic visualization. Contiguous and non-overlapping activations of the device are used, moving from distal to proximal along the length of the airway, and systematically from airway to airway as described previously. Although conceptually straightforward, the actual execution of bronchial thermoplasty is quite intricate and procedural duration for the treatment of a single lobe is often substantially longer than encountered during routine bronchoscopy. As such, bronchial thermoplasty should be considered a complex interventional bronchoscopy and is intended for the experienced bronchoscopist. Optimal patient management is critical in any such complex and longer duration bronchoscopic procedure. This article discusses the importance of careful patient selection, patient preparation, patient management, procedure duration, postoperative care and follow-up to ensure that bronchial thermoplasty is performed safely.
Bronchial thermoplasty is expected to complement asthma maintenance medications by providing long-lasting asthma control and improving asthma-related quality of life of patients with severe asthma. In addition, bronchial thermoplasty has been demonstrated to reduce severe exacerbations (asthma attacks) emergency rooms visits for respiratory symptoms, and time lost from work, school and other daily activities due to asthma.

Bronchial thermoplasty is a non-drug procedure for severe persistent asthma that delivers thermal energy to the airway wall in a precisely controlled manner to reduce excessive airway smooth muscle. Reducing airway smooth muscle decreases the ability of the airways to constrict, thereby reducing the frequency of asthma attacks.

支气管Thermoplasty：严重哮喘的一种新的治疗方法

Bronchial thermoplasty is a non-drug procedure for severe persistent asthma that delivers thermal energy to the airway wall in a precisely controlled ...

A Novel Surgical Approach for Intratracheal Administration of Bioactive Agents in a Fetal Mouse Model

Prenatal pulmonary delivery of cells, genes or pharmacologic agents could provide the basis for new therapeutic strategies for a variety of genetic and acquired diseases. Apart from congenital or inherited abnormalities with the requirement for long-term expression of the delivered gene, several non-inherited perinatal conditions, where short-term gene expression or pharmacological intervention is sufficient to achieve therapeutic effects, are considered as potential future indications for this kind of approach. Candidate diseases for the application of short-term prenatal therapy could be the transient neonatal deficiency of surfactant protein B causing neonatal respiratory distress syndrome1,2 or hyperoxic injuries of the neonatal lung3. Candidate diseases for permanent therapeutic correction are Cystic Fibrosis (CF)4, genetic variants of surfactant deficiencies5 and &alpha;1-antitrypsin deficiency6.
Generally, an important advantage of prenatal gene therapy is the ability to start therapeutic intervention early in development, at or even prior to clinical manifestations in the patient, thus preventing irreparable damage to the individual. In addition, fetal organs have an increased cell proliferation rate as compared to adult organs, which could allow a more efficient gene or stem cell transfer into the fetus. Furthermore, in utero gene delivery is performed when the individual's immune system is not completely mature. Therefore, transplantation of heterologous cells or supplementation of a non-functional or absent protein with a correct version should not cause immune sensitization to the cell, vector or transgene product, which has recently been proven to be the case with both cellular and genetic therapies7.
In the present study, we investigated the potential to directly target the fetal trachea in a mouse model. This procedure is in use in larger animal models such as rabbits and sheep8, and even in a clinical setting9, but has to date not been performed before in a mouse model. When studying the potential of fetal gene therapy for genetic diseases such as CF, the mouse model is very useful as a first proof-of-concept because of the wide availability of different transgenic mouse strains, the well documented embryogenesis and fetal development, less stringent ethical regulations, short gestation and the large litter size.
Different access routes have been described to target the fetal rodent lung, including intra-amniotic injection10-12, (ultrasound-guided) intrapulmonary injection13,14 and intravenous administration into the yolk sac vessels15,16 or umbilical vein17. Our novel surgical procedure enables researchers to inject the agent of choice directly into the fetal mouse trachea which allows for a more efficient delivery to the airways than existing techniques18.

We developed a novel surgical approach for intratracheal administration of bioactive agents into the mouse fetus. The delivery route is more efficient in targeting the fetal mouse lungs than the commonly used intra-amniotic injection. This procedure has to date not been described in a mouse model.

一种新的手术方法气管内注射生物活性剂在胎鼠模型

Prenatal pulmonary delivery of cells, genes or pharmacologic agents could provide the basis for new therapeutic strategies for a variety of genetic and ...

Isolation and Excision of Murine Aorta; A Versatile Technique in the Study of Cardiovascular Disease

Cardiovascular disease is a broad term describing disease of the heart and/or blood vessels. The main blood vessel supplying the body with oxygenated blood is the aorta. The aorta may become affected in diseases such as atherosclerosis and aneurysm. Researchers investigating these diseases would benefit from direct observation of the aorta to characterize disease progression as well as to evaluate efficacy of potential therapeutics. The goal of this protocol is to describe proper isolation and excision of the aorta to aid investigators researching cardiovascular disease. Isolation and excision of the aorta allows investigators to look at gross morphometric changes as wells as allowing them to preserve and stain the tissue to look at histologic changes if desired. The aorta may be used for molecular studies to evaluate protein and gene expression to discover targets of interest and mechanisms of action. This technique is superior to imaging modalities as they have inherent limitations in technology and cost. Additionally, primary isolated cells from a freshly isolated and excised aorta can allowing researchers to perform further in situ and in vitro assays. The isolation and excision of the aorta has the limitation of having to sacrifice the animal however, in this case the benefits outweigh the harm as it is the most versatile technique in the study of aortic disease.

Pathology of the aorta can lead to severe morbidity and mortality, therefore research of disease progression and potential therapies is warranted. Here, we present a protocol to isolate and excise the murine aorta to aid researchers in their investigation of cardiovascular disease.

隔离和小鼠主动脉切除;心血管疾病研究的一个多功能的技术

Cardiovascular disease is a broad term describing disease of the heart and/or blood vessels. The main blood vessel supplying the body with oxygenated ...

Setting Up a Stroke Team Algorithm and Conducting Simulation-based Training in the Emergency Department - A Practical Guide

Time is of the essence when caring for an acute stroke patient. The ultimate goal is to restore blood flow to the ischemic brain. This can be&#160;achieved by either&#160;thrombolysis with recombinant tissue-plasminogen activator (rt-PA), the standard therapy for stroke patients who present within the first hours of symptom onset without contraindications, or by an endovascular approach, if a proximal brain vessel occlusion is detected. As the efficacy of both therapies declines over time, every minute saved along the way will improve the patient&#39;s outcome.
This critical situation requires thorough work and precise communication with the patient, the family and colleagues from different professions to acquire all relevant information and reach the right decision while carefully monitoring the patient. This is a high fidelity situation. In nonmedical high-fidelity environments such as aviation, Crew Resource Management (CRM) is used to enhance safety and team efficiency.
This guide shows how a Stroke Team algorithm, which is transferable to other hospital settings, was established and how regular simulation-based trainings were performed. It requires determination and endurance to maintain these time-consuming simulation trainings on a regular basis over the course of time. However, the resulting improvement of team spirit and excellent door-to-needle times will benefit both the patients and the work environment in any hospital.
A dedicated Stroke Team of 7 persons who are notified 24/7 by a collective call via speed dial and run a binding algorithm that takes approximately 20 min, was established. To train everybody involved in this algorithm, a simulation-based team training for all new Stroke Team members was conceived and conducted at monthly intervals. This led to a relevant and sustained reduction of the mean door-to-needle time to 25 min, and enhanced the feeling of stroke readiness especially in junior doctors and nurses.

Every min counts in acute stroke care. This guide shows how to establish a Stroke Team algorithm and enhance its performance with regular simulation training. The principles of Crew Resource Management (CRM) facilitate a straight workflow, reduce door-to-needle times and increase staff satisfaction.

建立中风病研究小组算法并进行急诊科基于仿真的培训 - 实用指南

Time is of the essence when caring for an acute stroke patient. The ultimate goal is to restore blood flow to the ischemic brain. This can ...

Use of a Central Venous Line for Fluids, Drugs and Nutrient Administration in a Mouse Model of Critical Illness

This protocol describes a centrally catheterized mouse model of prolonged critical illness. We combine the cecal ligation and puncture method to induce sepsis with the use of a central venous line for fluids, drugs and nutrient administration to mimic the human clinical setting. Critically ill patients require intensive medical support in order to survive. While the majority of patients will recover within a few days, about a quarter of the patients need prolonged intensive care and are at high risk of dying from non-resolving multiple organ failure. Furthermore, the prolonged phase of critical illness is hallmarked by profound muscle weakness, and endocrine and metabolic changes, of which the pathogenesis is currently incompletely understood. The most widely used animal model in critical care research is the cecal ligation and puncture model to induce sepsis. This is a very reproducible model, with acute inflammatory and hemodynamic changes similar to human sepsis, which is designed to study the acute phase of critical illness. However, this model is hallmarked by a high lethality, which is different from the clinical human situation, and is not developed to study the prolonged phase of critical illness. Therefore, we adapted the technique by placing a central venous catheter in the jugular vein allowing us to administer clinically relevant supportive care, to better mimic the human clinical situation of critical illness. This mouse model requires an extensive surgical procedure and daily intensive care of the animals, but it results in a relevant model of the acute and prolonged phase of critical illness.

This protocol describes a centrally catheterized mouse model of prolonged critical illness. We combine the cecal ligation and puncture method to induce sepsis with the use of a central venous line for fluids, drugs and nutrient administration to mimic the human clinical setting.

在重大疾病的小鼠模型中使用中心静脉导管的流体，药物和营养管理

This protocol describes a centrally catheterized mouse model of prolonged critical illness. We combine the cecal ligation and puncture method to induce ...

Cardiopulmonary Bypass in a Mouse Model: A Novel Approach

As prolonged cardiopulmonary bypass becomes more essential during cardiac interventions, an increasing clinical demand arises for procedure optimization and for minimizing organ damage resulting from prolonged extracorporal circulation. The goal of this paper was to demonstrate a fully functional and clinically relevant model of cardiopulmonary bypass in a mouse. We report on the device design, perfusion circuit optimization, and microsurgical techniques. This model is an acute model, which is not compatible with survival due to the need for multiple blood drawings. Because of the range of tools available for mice (e.g., markers, knockouts, etc.), this model will facilitate investigation into the molecular mechanisms of organ damage and the effect of cardiopulmonary bypass in relation to other comorbidities.

This paper describes how to perform cardiopulmonary bypass in mice. This novel model will facilitate the investigation of the molecular mechanisms involved in organ damage.

小鼠体外循环模型: 一种新方法

As prolonged cardiopulmonary bypass becomes more essential during cardiac interventions, an increasing clinical demand arises for procedure optimization ...

A Novel Approach to Monitoring Graft Neovascularization in the Human Gingiva

Laser speckle contrast imaging (LSCI) is a novel method for measuring superficial blood perfusion over large areas. Since it is non-invasive and avoids direct contact with the measured area, it is suitable for monitoring blood flow changes during wound healing in human patients. Vestibuloplasty is periodontal surgery to the oral vestibule, aiming to restore vestibular depth with simultaneous enlargement of the keratinized gingiva. In this special clinical case, a split thickness flap was elevated at the first upper premolar and a xenogenic collagen matrix was adapted to the resulting recipient bed. LSCI was used to monitor the re- and neovascularization of the graft and the surrounding mucosa for one year. A protocol is introduced for the correct adjustment of microcirculation measurement in the oral mucosa, highlighting difficulties and possible failures.
The clinical case study presented demonstrated that &#8212; following the appropriate protocol &#8212; LSCI is a suitable and reliable method for following up microcirculation in a healing wound in the human oral mucosa and gives useful information on graft integration.

This study introduces a protocol for measuring microcirculation in human oral mucosa by laser speckle contrast imaging. The monitoring of wound healing after vestibuloplasty combined with a xenogenic collagen graft is presented on a clinical case.

一种监测人牙龈移植新生血管的新方法

Laser speckle contrast imaging (LSCI) is a novel method for measuring superficial blood perfusion over large areas. Since it is non-invasive and avoids ...

Setup and Execution Of the Blindfolded Code Training Exercise

Miscommunication is the most common cause of preventable patient harm in medicine. Currently, there is limited knowledge of innovative techniques to improve resident physician communication and leadership strategies in high-acuity situations. The blindfolded code training exercise removes visual stimuli from the team leader, forcing the team leader to effectively utilize closed-loop communication. The simple act of blindfolding the team leader creates a learning environment where the leader must utilize a conceptual framework and critical thinking strategies to organize the team and manage the resuscitation. An advantage to this teaching technique is that it does not require any special simulation equipment, making it a low-cost approach. The blindfolded code training exercise can be applied to the management of any critically ill patient where the primary objective is to focus on developing communication skills in acute resuscitations. The purpose of the description of the blindfolded code training exercise is to provide guidance on how to perform this innovative teaching technique to force effective closed-loop communication.

The blindfolded code training exercise, which blindfolds the team leader in a code resuscitation simulation, is an advanced teaching technique to improve closed-loop communication, organizational skills, and critical thinking.&#160;

盲民代码训练练习的设置和执行

Miscommunication is the most common cause of preventable patient harm in medicine. Currently, there is limited knowledge of innovative techniques to ...

Orthotopic Rat Kidney Transplantation: A Novel and Simplified Surgical Approach

Kidney transplantation offers increased survival rates and improved quality of life for patients with end-stage renal disease, as compared to any type of renal replacement therapy. Over the past few decades, the rat kidney transplantation model has been used to study the immunological phenomena of rejection and tolerance. This model has become an indispensable tool to test new immunomodulatory pharmaceuticals and regimens prior to proceeding with expensive preclinical large animal studies.
This protocol provides a detailed overview of how to reliably perform orthotopic kidney transplantation in rats. This protocol includes three distinctive steps that increase the probability of success: perfusion of the donor kidney by flushing through the portal vein and the use of a cuff system to anastomose the renal veins and ureters, thereby decreasing cold and warm ischemia times. Using this technique, we have achieved survival rates beyond 6 months with normal serum creatinine in animals with syngeneic or tolerant kidney transplants. Depending on the aim of the study, this model can be modified by pre- or posttransplant treatments to study the acute, chronic, cellular, or antibody-mediated rejection. It is a reproducible, reliable, and cost-effective animal model to study different aspects of kidney transplantation.

The purpose of this manuscript and protocol is to explain and demonstrate in detail the surgical procedure of orthotopic kidney transplantation in rats. This method is simplified to achieve the correct perfusion of the donor kidney and shorten the reperfusion time by using the venous and ureteral cuff anastomosis technique.

大鼠原位肾移植: 一种新的简化的手术方法

Kidney transplantation offers increased survival rates and improved quality of life for patients with end-stage renal disease, as compared to any type of ...