作者要感谢Restech提供的教育补助金。

以下研究方案由科隆大学医学院伦理委员会审查和批准。
注意：确保患者到达NPO进行以下胃肠功能测试。进行高分辨率测压以确定食管下括约肌 （LES） 的确切位置，并排除食管运动障碍疾病，如贲门失弛缓症。患者在服用抗分泌药物前应停用抗分泌药物至少 7 天，以确保有效的 pH 值测量。
1. 建立食管pH监测系统
<ol><li>将电池插入食管监测系统。</li>
	<li>将食管 pH 导管连接到设备。</li>
	<li>启动设备。确保日期和时间准确无误。选择“ 开始研究”。</li>
	<li>在pH 4和7的溶液中校准导管，并在水中冲洗探头。将探头放在一边以便插入。</li>
</ol>2.首先用患者数据格式化SD卡，建立喉咽部pH监测系统。
<ol><li>将SD卡插入计算机并打开用于喉咽部pH监测的软件（例如，DataView 4）。通过单击“ 新建 ”并键入有关该患者的所有详细信息来添加新患者。单击“ 保存 ”将数据保存到SD卡。弹出SD卡并将其插入录像机。</li>
	<li>使用随附的螺丝刀将电池插入发射机，以卸下发射机外壳的盖子，然后安装新的 CR1632 纽扣锂电池。</li>
	<li>将两节AA电池插入录像机。</li>
	<li>打开录像机。使用向上/向下键选择 “设置”。按任意圆角键选择 设置 模式。如果需要，通过使用向上/向下键更改数字和任何舍入键来选择相应的值，从而修改时间和日期。如果时间和日期正确，请选择“ 是 ”并继续。</li>
	<li>当录像机询问“Tst PSG 适配器？” 时选择否。</li>
	<li>在主菜单中选择 学习 。</li>
	<li>现在会自动检测变送器。确认检测到正确的发射机，然后按任意圆键进行确认。发射器显示与录像机配对的序列号。</li>
	<li>将探头连接到变送器。 注：当连接到发射机时，探头尖端的红色发光二极管（LED）将每秒闪烁一次。LED 在四小时后停止闪烁，以延长电池寿命。</li>
	<li>选择 “水合物 ”进行校准过程。通过将探针尖端置于清水溶液中并短暂搅拌，用提供的清水溶液对探针进行水合。按任意圆键开始补水过程。 注意：记录器将显示“补水”，并从“300秒”倒计时到零，或者当记录器检测到探头已补水时，将转换到15秒倒计时。将探头放在一边以便插入。</li>
</ol>3. 首先放置食管pH导管
<ol><li>确保患者坐直，直视并定期吞咽。用吸管提供一小杯水，以帮助吞咽。</li>
	<li>询问患者鼻子的哪一侧更清晰，更容易呼吸。</li>
	<li>将含有局部麻醉剂的局部凝胶涂抹在探针轴上，以便于插入。</li>
	<li>通过患者的鼻子插入探头，直接进入而不是向上。探头轴上的测量刻度有助于确定正确的位置。 注：正确位置比 LES 高 5 cm，之前已通过高分辨率测压仪确定。</li>
</ol>4. 固定食管 pH 导管
<ol><li>将探针尽可能靠近鼻孔，以确保在研究过程中使用手术胶带不会移动。</li>
	<li>将探头连接到脸颊，靠近鼻子。</li>
	<li>将探头套在耳朵上，并用胶带将探头固定在耳朵的颈部，耳朵后面和下方。</li>
</ol>5. 放置喉咽pH导管
<ol><li>确保患者坐直，直视并定期吞咽。</li>
	<li>将含有局部麻醉剂的局部凝胶涂在探针轴的远端，以便于插入。 谨慎： 不要将局部凝胶涂在传感器所在的探头尖端。</li>
	<li>将探针插入患者食管导管的相反鼻孔，向后直而不是向上。 注意：圆形探针尖端将帮助它围绕腭咽端口弯曲并进入口咽部。从患者鼻孔到口咽的距离通常可以通过使用从鼻孔到耳垂的距离来估计。</li>
	<li>确认红光清晰可见，位于悬雍垂的侧面或略低于悬雍垂。如果需要，使用压舌板以获得清晰的视野。 注意：如果触发了患者的呕吐反射，请将探针缩回口咽部的较高位置。</li>
</ol>6. 固定探头和变送器
<ol><li>将探针尽可能靠近鼻孔，以确保在研究过程中使用手术胶带不会移动。</li>
	<li>将探头连接到脸颊，靠近鼻子。</li>
	<li>将探头套在耳朵上，并用胶带将探头固定在耳朵的颈部，耳朵后面和下方。</li>
	<li>使用夹式发射器手提箱将发射器连接到患者的衣服上。</li>
</ol>7. 确保同时进行pH测量
<ol><li>确保两个pH测量设备的内部时钟同步。如果需要，请手动调整时间。</li>
	<li>同时开始食管和喉咽 pH 值检查。选择喉咽 pH 测量设备的 24 小时研究。</li>
</ol>8. 患者日记和说明
<ol><li>要求患者填写详细的日记，其中包括进餐时间，仰卧期的确切时间以及他们在研究期间经历的症状。</li>
	<li>向患者提供以下24小时测量周期的说明，以确保数据记录成功： 研究第1天三餐时间，研究第2天一餐时间。 晚上9点之前没有仰卧期。 像往常一样吃，喝，行为（可以做日常活动）。 谨慎： 设备不防水。</li>
</ol>9. 24小时研究结束后取出食管和喉咽探针
<ol><li>同时在两台设备上结束研究。<ol>
<li>通过同时按下位于中间的两个按钮结束食管pH研究，直到显示屏上出现“稍后上传”。</li>
		<li>通过同时按下咳嗽，ESC和胃灼热按钮结束喉咽部pH值研究，直到显示屏上出现“完成”。</li>
	</ol>
</li>
	<li>取下胶带，轻轻拉出两根导管。</li>
</ol>10. 解释食管pH值研究的结果
<ol><li>将设备连接到计算机。打开用于分析从食管pH测量设备获得的结果的软件，并上传患者的研究。</li>
	<li>手动输入患者数据和患者日记获得的信息，例如进餐时间，直立和仰卧期以及研究期间经历的症状。删除患者在研究期间可能意外执行的任何按钮按下。</li>
	<li>从数据分析中排除进餐时间。</li>
	<li>在报告中，查看为确定异常食管酸暴露而提供的重要参数和阈值，例如综合评分，低于基线的总pH值百分比（直立和仰卧）和事件总数。</li>
	<li>使用 pH <总和仰卧、直立和仰卧、总事件总数、持续时间超过 5 分钟的事件数和最长事件的持续时间14 计算研究期间的综合评分（DeMeester 评分）。确保报表显示复合分数。 注意：DeMeester 评分 > 14.72 显示食管酸暴露异常。</li>
</ol>11. 解释喉咽pH监测获得的结果
<ol><li>将SD卡插入计算机，打开用于分析喉咽pH测量系统获得的结果的软件。要上传研究，请单击检索。</li>
	<li>手动添加患者日记获得的信息，例如进餐时间，直立和仰卧期以及研究期间经历的症状。左键单击图表，然后拖动并突出显示要添加事件的区域，然后选择相应的事件。删除患者在研究期间可能意外执行的任何按钮按下。</li>
	<li>从数据分析中排除进餐时间。</li>
	<li>单击 “报告 ”以查看显示研究期间口咽部酸暴露的图表，包括仰卧期，症状和进餐时间以及研究摘要。</li>
	<li>在报告中，查看重要的参数和阈值以确定异常的口咽酸暴露，例如复合评分，总pH低于基线（pH <5.5直立和pH<5仰卧）和事件总数。</li>
	<li>使用 pH 值低于 5.5 直立和仰卧的 % 时间计算直立和仰卧期的综合评分（RYAN 评分）、总事件数和最长事件持续时间8。确保报告中显示了直立和仰卧期的综合评分。 注意：RYAN 评分为 > 9.4 直立，> 6.8 仰卧位，显示口咽酸暴露严重异常。</li>
</ol>

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多洛雷斯·穆勒（Dolores Müller）从Restech获得了教育补助金。所有其他作者都没有什么可披露的。

食管 pH 监测通常用于确诊有典型反流症状的患者的 GERD。然而，除了典型的反流症状外，许多患者还会出现非典型反流症状，例如咳嗽或声音嘶哑，很可能与 LPR 有关。目前的指南建议使用PPI进行经验性试验，以证明这些症状的回流相关起源，并且缺乏标准化的客观测量2。喉咽 pH 值检测由于其位于食管上括约肌上方，为测量口咽酸异常暴露提供了一种新的客观诊断方法，并可能...

胃食管反流病（GERD）是最常见的良性疾病之一，影响西方国家高达20%的人1。除了胃灼热或反流等典型症状外，一些患者还可能出现咳嗽、声音嘶哑或哮喘等非典型症状2，3。尽管人们一致认为慢性咳嗽、慢性喉炎和哮喘可能具有与反流相关的起源，并且与喉咽反流 （LPR） 显著相关，但确切的病理机制仍不清楚。由于这些症状通常是多因素过程的一部分，因此它们描绘了一个巨大的诊断和治疗挑战4。
在疑似 GERD2 的患者中，远端食管 pH 监测位于食管下括约肌上方 5 cm 处，通常用于确定食管酸暴露异常。为了尝试使用相同的技术，近端常规pH监测在20世纪90年代后期被引入作为诊断设备，以测量当探针放置在UES或略高于UES时食管上括约肌（UES）的异常酸暴露。然而，这种方法并不总是提供有效和准确的结果，因为探针不是为口咽环境设计的，导致测量无效伪影，例如由探针5，6干燥引起的假反流事件。
最近，喉咽pH监测作为一种新的诊断设备被引入，专门设计用于测量口咽部的酸暴露，因为探针放置在UES上方，略微横向于悬雍垂（图1）。由于先前的研究表明，在主要有非典型症状的患者中，抗反流手术后成功结果具有80%的阳性预测值，因此这种新工具已成为选定患者诊断途径的宝贵补充。其泪滴传感器配备了锑技术，可检测液体和雾化酸，并且不需要直接接触粘膜来测量有效结果。此外，与近端pH监测相比，传感器可以抵抗干燥，从而可能导致更可靠的结果7，8。
目前关于伴随常规食管和喉咽pH测量相关性的文献很少。以前的研究要么只包括少数患者，要么没有同时进行两种测量9，10，11。我们最近发表了关于101名疑似GERD患者的大型队列中两种pH测量值之间相关性的数据。我们得出结论，喉咽和食管的pH测量不一定需要对应，因为存在各种不同的反流情景12。此外，我们还开发了一种人类反流模型，用于食管切除术和胃间置重建后的患者，显示两种pH监测方法在容量反流器中100%相关 13。
在这里，我们的目标是提供使用远端食管和喉咽部pH监测同时测量pH的说明。此外，还给出了关于分析复合酸暴露评分以及通过两种方法获得的结果之间的相关性的指导。此外，我们还介绍了使用同时监测食管和喉咽 pH 值评估的大型患者队列的最新数据。

<table>
	<tbody>
		<tr>
			<td>AA Battery</td>
			<td>-</td>
			<td>-</td>
			<td>-</td>
		</tr>
		<tr>
			<td>Calibration Solutions pH 4 and 7</td>
			<td>Medtronic</td>
			<td></td>
			<td>part of the Digitrapper Reflux Testing system</td>
		</tr>
		<tr>
			<td>CR 1632 Lithium coin cell battery</td>
			<td>-</td>
			<td>-</td>
			<td>-</td>
		</tr>
		<tr>
			<td>Digitrapper pH &#38; Impedance catheter</td>
			<td>Medtronic</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Digitrapper Recorder</td>
			<td>Medtronic</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Gelicain</td>
			<td>PUREN</td>
			<td></td>
			<td>topical gel</td>
		</tr>
		<tr>
			<td>Hydration vials with clear water</td>
			<td>Respiratory Technology Corporation</td>
			<td></td>
			<td>part of the Restech Dx pH system</td>
		</tr>
		<tr>
			<td>Leukoplast</td>
			<td>BSN medical GmbH</td>
			<td></td>
			<td>surgical tape</td>
		</tr>
		<tr>
			<td>Restech Dx pH probe</td>
			<td>Respiratory Technology Corporation</td>
			<td></td>
			<td>part of the Restech Dx pH system</td>
		</tr>
		<tr>
			<td>Restech Recorder</td>
			<td>Respiratory Technology Corporation</td>
			<td></td>
			<td>part of the Restech Dx pH system</td>
		</tr>
		<tr>
			<td>Restech Transmitter</td>
			<td>Respiratory Technology Corporation</td>
			<td></td>
			<td>part of the Restech Dx pH system</td>
		</tr>
		<tr>
			<td>Screwdriver</td>
			<td>Respiratory Technology Corporation</td>
			<td></td>
			<td>part of the Restech Dx pH system</td>
		</tr>
		<tr>
			<td>SD Card plus Adapter</td>
			<td>Respiratory Technology Corporation</td>
			<td></td>
			<td>part of the Restech Dx pH system</td>
		</tr>
		<tr>
			<td>tongue depressor</td>
			<td>NOBAMED</td>
			<td></td>
			<td>wooden</td>
		</tr>
	</tbody>
</table>

simultaneous laryngopharyngeal and conventional esophageal ph monitoring

除典型反流症状外，许多胃食管反流病 （GERD） 患者还会出现食管外症状，如咳嗽、声音嘶哑或哮喘，这些症状可由喉咽反流 （LPR） 引起。由于其多因素起源，这些症状可能是一个巨大的诊断和治疗挑战。食管 pH 监测通常用于确定食管酸暴露异常和确诊 GERD。然而，为了更好地评估食管上括约肌上方的酸暴露，现在有一种新的喉咽 pH 测量系统，该系统可能在主要有食管外症状的患者中产生更可靠的结果。本文旨在提出一种使用食管和喉咽pH探针同时进行pH测量的标准化方案，以便从两种测量中获得酸暴露评分。

共有181名患者使用前面描述的标准化方案进行评估。前101例患者的病结果此前已发表12例。以下数据描述了先前发表的队列的扩展，然而，使用新软件评估通过喉咽pH测试获得的结果15。人口统计数据如 表1所示。所有患者均出现非典型症状，包括慢性咳嗽、声音嘶哑、咽痛或咽灼热。此外，大多数患者患有典型的胃食管反流病症状，如胃灼热、反流...

Watch this Scientific Journal Video about Simultaneous Laryngopharyngeal and Conventional Esophageal pH Monitoring at JoVE.com

Simultaneous Laryngopharyngeal and Conventional Esophageal pH Monitoring

喉咽 pH 监测专门设计用于测量食管上括约肌上方的酸暴露，并补充主要表现为食管外反流症状的患者的诊断评估。怀疑喉咽反流（LPR）的患者同时使用远端食管和喉咽pH检测进行评估。

同时监测喉咽和常规食管 pH 值

In addition to typical reflux symptoms, many patients with gastroesophageal reflux disease (GERD) present with extraesophageal symptoms such as cough, ...

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Unit 1

Disorders of the Esophagus

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2.6K 次观看.  University of Cologne. 喉咽 pH 监测专门设计用于测量食管上括约肌上方的酸暴露，并补充主要表现为食管外反流症状的患者的诊断评估。怀疑喉咽反流（LPR）的患者同时使用远端食管和喉咽pH检测进行评估。

视频: Simultaneous Laryngopharyngeal and Conventional Esophageal pH Monitoring

A Rat Model of Ventricular Fibrillation and Resuscitation by Conventional Closed-chest Technique

A rat model of electrically-induced ventricular fibrillation followed by cardiac resuscitation using a closed chest technique that incorporates the basic components of cardiopulmonary resuscitation in humans is herein described. The model was developed in 1988 and has been used in approximately 70 peer-reviewed publications examining a myriad of resuscitation aspects including its physiology and pathophysiology, determinants of resuscitability, pharmacologic interventions, and even the effects of cell therapies. The model featured in this presentation includes: (1) vascular catheterization to measure aortic and right atrial pressures, to measure cardiac output by thermodilution, and to electrically induce ventricular fibrillation; and (2) tracheal intubation for positive pressure ventilation with oxygen enriched gas and assessment of the end-tidal CO2. A typical sequence of intervention entails: (1) electrical induction of ventricular fibrillation, (2) chest compression using a mechanical piston device concomitantly with positive pressure ventilation delivering oxygen-enriched gas, (3) electrical shocks to terminate ventricular fibrillation and reestablish cardiac activity, (4) assessment of post-resuscitation hemodynamic and metabolic function, and (5) assessment of survival and recovery of organ function. A robust inventory of measurements is available that includes &#8211; but is not limited to &#8211; hemodynamic, metabolic, and tissue measurements. The model has been highly effective in developing new resuscitation concepts and examining novel therapeutic interventions before their testing in larger and translationally more relevant animal models of cardiac arrest and resuscitation.

This article describes a rat model of electrically-induced ventricular fibrillation and resuscitation by chest compression, ventilation, and delivery of electrical shocks that simulates an episode of sudden cardiac arrest and conventional cardiopulmonary resuscitation. The model enables gathering insights on the pathophysiology of cardiac arrest and exploration of new resuscitation strategies.

室颤由传统的封闭胸技术大鼠模型和复苏

A rat model of electrically-induced ventricular fibrillation followed by cardiac resuscitation using a closed chest technique that incorporates the basic ...

科研

医学

Surgical Models of Gastroesophageal Reflux with Mice

Multiple surgical procedures have been reported to induce gastroesophageal reflux in animals. Herein, we report three surgical models with mice aiming to induce reflux of gastric contents, duodenal contents or mixed contents. Surgical procedures and general principles have been described in detail. A researcher with surgical experience should be able to grasp the technique after a short period of practice. After surgery, most mice can survive and develop reflux esophagitis similar to that in humans. However, it should be noted that histological differences between mouse and human esophagus are the inherent limitations of these surgical models. If used for research on Barrett&#8217;s esophagus and adenocarcinoma, these procedures may need to be combined with genetic modifications.

This article demonstrates surgical procedures of gastroesophageal reflux with mice. These models are useful tools for research on mechanisms and treatment of gastroesophageal reflux disease and potentially Barrett&#8217;s esophagus and esophageal adenocarcinoma.

胃食管反流与小鼠手术模型

Multiple surgical procedures have been reported to induce gastroesophageal reflux in animals. Herein, we report three surgical models with mice aiming to ...

Three Different Protocols of Corneal Collagen Crosslinking in Keratoconus: Conventional, Accelerated and Iontophoresis

Keratoconus is a bilateral and progressive corneal ectasia. In order to slow down its progression, corneal collagen cross-linking (CXL) has recently been introduced as an efficient treatment option. In biological and chemical sciences, crosslinking refers to new chemical bonds formed between reactive molecules. Hence, the aim of corneal collagen CXL is to synthetically increase the formation of crosslinks between collagen fibrils in the corneal stroma. Despite the fact that the efficiency of the conventional CXL (C-CXL) protocol has already been shown in several clinical studies, it might benefit from improvements in duration of the procedure and removal of corneal epithelium. Hence, in order to provide a coherent evaluation of two new and optimized CXL protocols, we studied keratoconus patients who had undergone one of the three CXL treatments: iontophoresis (I-CXL), accelerated CXL (A-CXL), and conventional CXL (C-CXL). A-CXL is a 6 time faster CXL procedure using a ten time higher UVA irradiance but still including an epithelium removal. Iontophoresis is a transepithelial non-invasive technique in which a small electric current is applied to improve riboflavin penetration throughout the cornea. Using anterior segment optical coherence tomography (AS OCT) and in vivo confocal microscopy (IVCM), we conclude that regarding the depth of treatment penetration, conventional CXL protocol remains the standard for treating progressive keratoconus. Accelerated CXL seems to be a quick, effective and safe alternative to treat thin corneas. The use of iontophoresis is still being investigated and should be considered with greater caution.

Corneal collagen cross-linking (CXL) is the only conservative treatment currently available to halt keratoconus progression by improving the biomechanical rigidity of the corneal stroma. The aim of this manuscript is to highlight the methods of three different protocols of CXL: conventional CXL (C-CXL), accelerated CXL (A-CXL), and iontophoresis CXL (I-CXL).

角膜胶原交联的圆锥角膜的三种不同的协议：常规，加速和离子导入

Keratoconus is a bilateral and progressive corneal ectasia. In order to slow down its progression, corneal collagen cross-linking (CXL) has recently been ...

ADSC-sheet Transplantation to Prevent Stricture after Extended Esophageal Endoscopic Submucosal Dissection

In past years, the cell-sheet construct has spurred wide interest in regenerative medicine, especially for reconstructive surgery procedures. The development of diversified technologies combining adipose tissue-derived stromal cells (ADSCs) with various biomaterials has led to the construction of numerous types of tissue-engineered substitutes, such as bone, cartilage, and adipose tissues from rodent, porcine, or human ADSCs. Extended esophageal endoscopic submucosal dissection (ESD) is responsible for esophageal stricture formation. Stricture prevention remains challenging, with no efficient treatments available. Previous studies reported the effectiveness of mucosal cell-sheet transplantation in a canine model and in humans. ADSCs are attributed anti-inflammatory properties, local immune modulating effects, neovascularization induction, and differentiation abilities into mesenchymal and non-mesenchymal lineages. This original study describes the endoscopic transplantation of an ADSC tissue-engineered construct to prevent esophageal stricture in a swine model. The ADSC construct was composed of two allogenic ADSC sheets layered upon each other on a paper support membrane. The ADSCs were labeled with the PKH67 fluorophore to allow probe-based confocal laser endomicroscopy (pCLE) monitoring. On the day of transplantation, a 5-cm and hemi-circumferential ESD known to induce esophageal stricture was performed. Animals were immediately endoscopically transplanted with 4 ADSC constructs. The complete adhesion of the ADSC constructs was obtained after 10 min of gentle application. Animals were sacrificed on day 28. All animals were successfully transplanted. Transplantation was confirmed on day 3 with a positive pCLE evaluation. Compared to transplanted animals, control animals developed severe strictures, with major fibrotic tissue development, more frequent alimentary trouble, and reduced weight gain. In our model, the transplantation of allogenic ADSCs, organized in double cell sheets, after extended ESD was successful and strongly associated with a lower esophageal stricture rate.

This study reports a successful method of endoscopical adipose tissue-derived stromal cell (ADSC)-sheet transplantation for esophageal stricture prevention after an extended endoscopic submucosal dissection (ESD) in a swine model.

ADSC表移植到扩展食管内镜黏膜下剥离术之后防止狭窄

In past years, the cell-sheet construct has spurred wide interest in regenerative medicine, especially for reconstructive surgery procedures. The ...

Esophageal Heat Transfer for Patient Temperature Control and Targeted Temperature Management

Controlling patient temperature is important for a wide variety of clinical conditions. Cooling to normal or below normal body temperature is often performed for neuroprotection after ischemic insult (e.g. hemorrhagic stroke, subarachnoid hemorrhage, cardiac arrest, or other hypoxic injury). Cooling from febrile states treats fever and reduces the negative effects of hyperthermia on injured neurons. Patients are warmed in the operating room to prevent inadvertent perioperative hypothermia, which is known to cause increased blood loss, wound infections, and myocardial injury, while also prolonging recovery time. There are many reported approaches for temperature management, including improvised methods that repurpose standard supplies (e.g., ice, chilled saline, fans, blankets) but more sophisticated technologies designed for temperature management are typically more successful in delivering an optimized protocol. Over the last decade, advanced technologies have developed around two heat transfer methods: surface devices (water blankets, forced-air warmers) or intravascular devices (sterile catheters requiring vascular placement). Recently, a novel device became available that is placed in the esophagus, analogous to a standard orogastric tube, that provides efficient heat transfer through the patient&#39;s core. The device connects to existing heat exchange units to allow automatic patient temperature management via a servo mechanism, using patient temperature from standard temperature sensors (rectal, Foley, or other core temperature sensors) as the input variable. This approach eliminates vascular placement complications (deep venous thrombosis, central line associated bloodstream infection), reduces obstruction to patient access, and causes less shivering when compared to surface approaches. Published data have also shown a high degree of accuracy and maintenance of target temperature using the esophageal approach to temperature management. Therefore, the purpose of this method is to provide a low-risk alternative method for controlling patient temperature in critical care settings.

This study presents a novel method to provide efficient patient temperature control for cooling or warming patients. A single use, triple lumen device is placed into the esophagus, analogous to a standard orogastric tube, and connects to existing heat exchange units to perform automatic patient temperature management.

病人体温控制的食管传热及靶温管理

Controlling patient temperature is important for a wide variety of clinical conditions. Cooling to normal or below normal body temperature is often ...

Cardiac Magnetic Resonance for the Evaluation of Suspected Cardiac Thrombus: Conventional and Emerging Techniques

We present the conventional cardiac magnetic resonance (CMR) protocol for evaluating a suspected thrombus and highlight emerging techniques.&#160;The appearance of a mass on certain magnetic resonance (MR) sequences can help differentiate a thrombus from competing diagnoses such as a tumor. T1 and T2 signal characteristics of a thrombus are related to the evolution of hemoglobin properties. A thrombus typically does not enhance following contrast administration, which also helps differentiation from a tumor. We also highlight the emerging role of T1 mapping in the evaluation of a thrombus, which can add another level of support in diagnosis. Prior to any CMR exam, patient screening and interviews are critical to ensure safety and to optimize patient comfort. Effective communication during the exam between the technologist and the patient promotes proper breath holding technique and higher quality images. Volumetric post processing and structured reporting are helpful to ensure that the radiologist answers the ordering services&#39; question and communicates these results effectively. Optimal pre-MR safety evaluation, CMR exam execution, and post exam processing and reporting allow for delivery of high quality radiological service in the evaluation of a suspected cardiac thrombus.

The goal of this article is to describe how cardiac magnetic resonance can be used for the evaluation and diagnosis of a suspected cardiac thrombus. The method presented will describe data acquisition as well as the pre-procedure and post-procedure protocol.

心脏磁共振评估疑似心脏血栓:常规和新兴技术

We present the conventional cardiac magnetic resonance (CMR) protocol for evaluating a suspected thrombus and highlight emerging techniques.&#160;The ...

Simultaneous Electrocardiography Recording and Invasive Blood Pressure Measurement in Rats

For studies related to cardiovascular physiology or pathophysiology, blood pressure (BP) and electrocardiography are basic observational parameters. Research focusing on cardiovascular disease models, potential cardiovascular therapeutic targets or pharmaceutical agents requires assessment of systemic arterial pressure and heart rhythm changes. In situations where radio telemetry systems are not available or affordable, the technique of femoral artery cannulation is an alternative way to obtain intra-arterial pressure waveform recordings and systemic BP measurements. This technique is economical and can be performed with standard equipment in animal facilities. However, invasive arterial pressure recording requires cannulation of small arteries, which can be a challenging surgical skill. Here, we present step-by-step protocols for femoral artery cannulation procedures. Key procedures include the calibration of the data acquisition system, tissue dissection and femoral artery cannulation, and setup of the arterial cannulation system for pressure recording. Surface electrocardiography recording procedures are also included. We also present examples of BP recordings from normotensive and hypertensive rats. This protocol allows reliable direct recordings of systemic BP with simultaneous electrocardiography.

Here, we describe a setup for simultaneous recording of electrocardiography and intra-arterial blood pressure (BP) in experimental rats, which can be done with standard equipment in animal facilities and can be applied to physiological or pharmacological studies to investigate pathogenic or therapeutic mechanisms in cardiovascular medicine.

大鼠同时心电图记录及侵入性血压测量

For studies related to cardiovascular physiology or pathophysiology, blood pressure (BP) and electrocardiography are basic observational parameters. ...

Laparoscopic Repair of Para-Esophageal Hernia Using Absorbable Biosynthetic Mesh

Para-esophageal hernia repairs are challenging procedures and there is no consensus on the optimal approach to repair. Mesh reinforcement has been associated with lesser hernia recurrence when compared to the primary suture repair. The type of mesh that is most appropriate is still debatable. Synthetic and biosynthetic materials have been studied in the literature. It is well documented that a synthetic mesh is associated with esophageal erosion and migration into the stomach. Though there are limited long-term data on biosynthetic mesh, the short-term results are excellent and promising.
This paper illustrates how a biosynthetic prosthesis can be safely used with fibrin glue fixation and anterior Dor fundoplication to repair any para-esophageal defect. The absorbable biosynthetic mesh has been shown to produce good long-term patient satisfaction outcomes and low recurrence rates compared to conventional methods including repair with synthetic mesh. This technique also avoids the risk of esophageal erosion whilst strengthening the repair. Tacks that are still widely used to secure the mesh can be abandoned due to the associated risk of developing cardiac tamponade, or other disastrous consequences. This repair method, also, highlights how the prosthesis can be fashioned into a V-shape and easily placed in an onlay fashion behind the esophagus. The protocol demonstrates an alternative and safer method for mesh fixation using fibrin glue.

Presented here is a protocol of para-esophageal hernia repair. Use of absorbable biosynthetic mesh avoids the risk of erosion through the esophagus whilst reinforcing the repair. Glue fixation is preferred to avoid the risk of trauma such as bleeding or cardiac tamponade, which are associated with stitches or tacks.

使用可吸收的生物合成网格对副食管气喘进行拉帕罗镜修复

Para-esophageal hernia repairs are challenging procedures and there is no consensus on the optimal approach to repair. Mesh reinforcement has been ...

Evaluation of Capnography Sampling Line Compatibility and Accuracy when Used with a Portable Capnography Monitor

Capnography is commonly used to monitor patient&#8217;s ventilatory status. While sidestream capnography has been shown to provide a reliable assessment of end-tidal CO2 (ETCO2), its accuracy is commonly validated using commercial kits composed of a capnography monitor and its matching disposable nasal cannula sampling lines. The purpose of this study was to assess the compatibility and accuracy of cross-paired capnography sampling lines with a single portable bedside capnography monitor. A series of 4 bench tests were performed to evaluate the tensile strength, rise time, ETCO2 accuracy as a function of respiratory rate, and ETCO2 accuracy in the presence of supplemental O2. Each bench test was performed using specialized, validated equipment to allow for a full evaluation of sampling line performance. The 4 bench tests successfully differentiated between sampling lines from different commercial sources and suggested that due to increased rise time and decreased ETCO2 accuracy, not all nasal cannula sampling lines provide reliable clinical data when cross-paired with a commercial capnography monitor. Care should be taken to ensure that any cross-pairing of capnography monitors and disposable sampling lines is fully validated for use across respiratory rates and supplemental O2 flow rates commonly encountered in clinical settings.

The goal of this study was to evaluate the accuracy of capnography sampling lines used in conjunction with a portable bedside capnography monitor. Sampling lines from 7 manufacturers were evaluated for tensile strength, rise time, and ETCO2 accuracy as a function of respiratory rate or supplemental oxygen flow rate.

与便携式刻度学监视器一起使用时，评估卡光采样线兼容性和准确性

Capnography is commonly used to monitor patient&#8217;s ventilatory status. While sidestream capnography has been shown to provide a reliable assessment ...

Establishment and Evaluation of a Porcine Vein Graft Disease Model

Venous graft disease (VGD) is the leading cause of coronary artery bypass graft (CABG) failure. Large animal models of CABG-VGD are needed for the investigation of disease mechanisms and the development of therapeutic strategies. 
To perform the surgery, we enter the cardiac chamber through the third intercostal space and carefully dissect the internal mammary vein and immerse it in normal saline. The right main coronary artery is then treated for ischemia. The target vessel is incised, a shunt plug is placed, and the distal end of the graft vein is anastomosed. The ascending aorta is partially blocked, and the proximal end of the graft vein is anastomosed after perforation. The graft vein is checked for patency, and the proximal right coronary artery is ligated. 
CABG surgery is performed in minipigs to harvest the left internal mammary vein for its use as a vascular graft. Serum biochemical tests are used to evaluate the physiological status of the animals after surgery. Ultrasound examination shows that the proximal, middle, and distal end of the graft vessel are unobstructed. In the surgical model, turbulent blood flow in the graft is observed upon histological examination after the CABG surgery, and venous graft stenosis associated with intimal hyperplasia is observed in the graft. The study here provides detailed surgical procedures for the establishment of a repeatable CABG-induced VGD model.

In this protocol, novel pig vein bypass grafting was performed through a small incision in the left chest wall without cardiopulmonary bypass. A postoperative pathology study was done, which showed intimal thickening.