作者没有致谢。

根据丹麦法律，没有患者参与的教育研究不需要伦理批准。
1. 范围的处理
<ol><li>左手握住支气管镜，左手拇指放在转向杆上，左手食指放在抽吸按钮上。用右手握住支气管镜的远端。</li>
	<li>用直臂和手腕握住示波器，使吸力按钮直接指向前方，转向杆处于中立位置，定义为中立位置或 0°。通过扭动手腕，将示波器从中立位置/0° 转动。</li>
	<li>上下移动拇指以弯曲和伸展内窥镜的远端。移动手腕和手，而不是手臂和身体。</li>
</ol>2. 结构化进展:范围的角度和四个地标
<ol><li>通过口腔或鼻孔进入气道。通过声带进入气管。</li>
	<li>从地标 1 到 4 系统地找到四个标志，并注意内窥镜在每个位置的正确角度（表 1）。 注意:四个里程碑方法的设计令人难忘，以减少新型支气管镜医师的认知负荷。它基于支气管镜的角度和如何进入不同肺叶/地标之间的配对。因此，这种方法为新手学员提供了一个基本的训练工具，可以在支气管迷宫中导航。例如，通过了解支气管镜是否向右保持 90° 角，可以确定检查右上叶的正确位置。在可视化波瓣或地标时，应从指定角度延迟以检查各个部分。</li>
	<li>按时间顺序从 1-10 找到线段，首先找到右侧，然后根据四个地标找到左侧。</li>
</ol>3. 系统性支气管镜检查:四大标志方法
<ol><li>地标 1:从气管看到的带有左右主支气管的隆突（图 2）<ol><li>将支气管镜定位在气管远端，呈0°角 - 中立位置。如果方向丢失，请返回地标 1 重新定向。</li>
	</ol></li>
	<li>地标 2:右段 1、2 和 3（上叶）（图 3）<ol><li>将内窥镜向右转动 90°，同时通过向下推动左拇指来研究上叶，将支气管镜的远端向上弯曲。这个地标类似于梅赛德斯之星。</li>
		<li>可视化梅赛德斯星形时，从 90° 角度推迟以检查第 1、2 和 3 段。</li>
	</ol></li>
	<li>地标 3:右段 4 和 5（中叶）加上 6、7、8、9 和 10（下叶）（图 4）<ol><li>通过将内窥镜的远端向右呈 45° 角放置，以查看第 4 段和第 5 段（从侧面倾斜角度的数字），继续进入中间支气管。</li>
		<li>同样，从 45° 角推迟以检查第 4 段和第 5 段。回到 45° 角，用左手拇指向上推动炖煮器，以检查第 6 段（正好与中叶相对），从而延长内窥镜的尖端。</li>
		<li>将示波器转到 0° 角并前进到下瓣。第 7 节位于内侧，第 8、9 和 10 节（从侧面以倾斜角度排列的数字）位于底部。从 0° 角开始延迟以检查第 7-10 段。</li>
	</ol></li>
	<li>地标 4:左段 1+2、3、4 和 5（上叶），以及第 6、8、9 和 10 段（下叶）（图 5）<ol><li>将支气管镜移动到左主支气管（向左成 90° 角），向上看上叶，向下看下叶。</li>
		<li>将内窥镜保持在 90° 角，用舌骨检查左上叶。从 90° 角推迟以检查第 1+2 和 3 段（左上叶）以及第 4 段和第 5 段（舌）。</li>
		<li>回到左侧主支气管，将内窥镜转动至45°角，并伸出支气管镜的末端以检查第6段，该段与第4段和第5段（舌骨）相对。</li>
		<li>将示波器转到 0° 角以可视化带有第 8、9 和 10 段的下瓣。从 0° 角推迟以检查段。 注意:左侧没有第 7 段，因为该区域由心脏填充。第 4 段和第 5 段以及第 8、9 和 10 段遵循与右侧相同的编号，并从侧面以倾斜角度编号（图 6）。</li>
	</ol></li>
</ol>

适用于支气管镜新手的软式支气管镜检查

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J., 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=Identifying+technical+procedures+in+pulmonary+medicine+that+should+be+integrated+in+a+simulation-based+curriculum:+A+national+general+needs+assessment.">Identifying technical procedures in pulmonary medicine that should be integrated in a simulation-based curriculum: A national general needs assessment.</a> Respiration; International Review of Thoracic Diseases. 91 (6), 517-522 (2016).</li><li>Konge, L., Arendrup, H., von Buchwald, C., Ringsted, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Using+performance+in+multiple+simulated+scenarios+to+assess+bronchoscopy+skills.">Using performance in multiple simulated scenarios to assess bronchoscopy skills.</a> Respiration; International Review of Thoracic Diseases. 81 (6), 483-490 (2011).</li><li>Kennedy, C. 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F., Konge, L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Simulation-based+training+in+flexible+bronchoscopy+and+endobronchial+ultrasound-guided+transbronchial+needle+aspiration+(EBUS-TBNA):+A+systematic+review.">Simulation-based training in flexible bronchoscopy and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA): A systematic review.</a> Respiration; International Review of Thoracic Diseases. 93 (5), 355-362 (2017).</li><li>Sanz-Santos, J., 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=Systematic+compared+with+targeted+staging+with+endobronchial+ultrasound+in+patients+with+lung+cancer.">Systematic compared with targeted staging with endobronchial ultrasound in patients with lung cancer.</a> The Annals of Thoracic Surgery. 106 (2), 398-403 (2018).</li><li>Colella, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Assessment+of+competence+in+simulated+flexible+bronchoscopy+using+motion+analysis.">Assessment of competence in simulated flexible bronchoscopy using motion analysis.</a> Respiration; International Review of Thoracic Diseases. 89 (2), 155-161 (2015).</li><li>Cold, K. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Automatic+and+objective+assessment+of+motor+skills+performance+in+flexible+bronchoscopy.">Automatic and objective assessment of motor skills performance in flexible bronchoscopy.</a> Respiration; International Review of Thoracic Diseases. 100 (4), 347-355 (2021).</li><li>Follmann, A., Pereira, C. B., Knauel, J., Rossaint, R., Czaplik, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Evaluation+of+a+bronchoscopy+guidance+system+for+bronchoscopy+training,+a+randomized+controlled+trial.">Evaluation of a bronchoscopy guidance system for bronchoscopy training, a randomized controlled trial.</a> BMC Medical Education. 19 (1), 430 (2019).</li><li>Nilsson, P. M., Naur, T. M. H., Clementsen, P. F., Konge, L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Simulation+in+bronchoscopy:+current+and+future+perspectives.">Simulation in bronchoscopy: current and future perspectives.</a> Advances in Medical Education and Practice. 8, 755-760 (2017).</li><li>Strandbygaard, J., 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=A+structured+four-step+curriculum+in+basic+laparoscopy:+development+and+validation.">A structured four-step curriculum in basic laparoscopy: development and validation.</a> Acta Obstetricia et Gynecologica Scandinavica. 93 (4), 359-366 (2014).</li><li>Konge, L., 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=The+simulation+centre+at+Rigshospitalet,+Copenhagen,+Denmark.">The simulation centre at Rigshospitalet, Copenhagen, Denmark.</a> Journal of Surgical Education. 72 (2), 362-365 (2015).</li></ol>

作者没有什么可透露的。

我们建议对支气管节段进行系统而完整的检查，将支气管镜检查分为四个标志，以帮助指导新手支气管镜医师通过支气管迷宫。由于需要更具体的支气管镜检查培训指南14，我们建议应使用三种基本结局指标来评估我们的系统和阶梯式方法:DC、SP 和 PT。 
DC 和 PT 是既定的结果测量方法，也是评估支气管镜检查性能时首次使用的指标9。支气管...

肺癌是癌症死亡的主要原因1.可弯曲支气管镜检查对于在支气管树中导航并确定肺癌诊断和分期的正确节段以及为患者分配正确治疗至关重要2.在受训者学习曲线的早期部分，诊断活检材料的产量较低，并发症发生率较高，患者不适感增加 3,4,5。为确保对患者进行独立/无监督的实践，必须达到令人满意的教育水平。确保基本能力的一种培训方式是基于模拟的掌握学习，即受训者练习直到达到熟练程度标准6.已经开发了几种工具来评估支气管镜检查的性能7,8，并且已经建立了以下性能指标:（1） 诊断完整性 （DC） - 可视化节段的比例9;（2） 结构化进度 （SP） - 按正确进度顺序访问的路段数10;（3） 手术时间 （PT） - 从通过声带到手术结束的时间9.
新手支气管镜医师可能会被迷宫弄糊涂，看起来像相似的支气管，并且有些人未能完成基于模拟的支气管镜检查课程11，尽管它已被确定为肺病学中最重要的技术程序12。因此，通过该协议，我们提出了通过支气管树的逐步结构化进展（图1），依靠四个标志作为指导。我们建议新手操作者应根据这种方法进行教学，以确保在最短的时间内以结构化的方式可视化所有支气管节段，并正确处理内窥镜。

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Evis Exera II</td>
			<td>Olympus</td>
			<td>Not provided</td>
			<td>Endoscopy Tower</td>
		</tr>
		<tr>
			<td>BF-Q180 Bronchoscope</td>
			<td>Olympus</td>
			<td>Not provided</td>
			<td>Flexible Bronchoscope</td>
		</tr>
		<tr>
			<td>CLA Broncho Boy</td>
			<td>CLA</td>
			<td>Not provided</td>
			<td>Bronchial Tree Phantom</td>
		</tr>
	</tbody>
</table>

systematic bronchoscopy: the four landmarks approach

纤维支气管镜检查是一项技术上困难的手术，已被确定为最重要的手术，应整合到肺科医生基于模拟的培训计划中。然而，需要更具体的支气管镜检查培训指南来满足这一需求。为了确保患者能够胜任检查，我们提出了一种系统的、循序渐进的方法，将程序分为四个"里程碑"，以支持新手内窥镜医师在支气管迷宫中导航。该程序可以根据三个既定的结果指标进行评估，以确保对支气管树进行彻底有效的检查:诊断完整性、结构化进展和手术时间。
丹麦的所有模拟中心都采用了依赖于四个地标的逐步方法，并正在荷兰实施。为了在培训时为新手支气管镜医师提供即时反馈，并减轻顾问的时间限制，我们建议未来的研究在培训新的支气管镜医师时应将人工智能作为反馈和认证工具。

自 2011 年以来，CAMES 一直在教授四个里程碑方法，其中基于模拟的支气管镜课程通过最终测试结束 13.从 2015 年到 2017 年，有 77 名参与者参加了该课程，其中只有 33 人 （43%） 完成了11 门课程。完成率低是由于几个因素造成的:时间限制、课程不是强制性的、产假以及没有受保护的培训时间。在完成课程的人中，14人（42%）认为完成课程的最重要因素是:"基于系统...

Watch this Scientific Journal Video about Learning Systematic Bronchoscopy in a Simulation-Base Setting at JoVE.com

作者聚焦:在模拟基础环境中学习系统支气管镜检查 

在这里，我们提出了一种以结构化方式导航支气管迷宫的协议，将支气管镜检查分成逐步方法——四个标志方法。

系统性支气管镜检查:四个标志方法

Flexible bronchoscopy is a technically difficult procedure and has been identified as the most important procedure that should be integrated into a ...

该协议为新手支气管镜医师提供了一种令人难忘的方式来学习如何使用四个标志方法在支气管树上导航。对于没有经验的操作员来说，在进行支气管镜检查时很难在支气管三中找到方法。我们开发了一种四地标方法，这意味着您应该找到四个地标，当您迷路时，您可以随时返回四个地标，然后您可以继续前进。我们使用与角度相关的四个地标。这是内窥镜的远端，这是一个手柄，所以当我转动手腕时，我可以将内窥镜的远端转动到不同的角度。而这些角度，我们与四个地标相连。随着人工智能的发展，我们希望开发出一种自动支气管识别系统，可以帮助新手支气管镜医生识别各个节段，并确保对支气管树进行全面检查。支气管镜检查历来采用"看一做一教"的方法。但是通过这个协议，我们提出了一种标准化的支气管镜教学方法。

systematic-bronchoscopy-the-four-landmarks-approach

Research

JoVE Journal

Medicine

Systematic Bronchoscopy: the Four Landmarks Approach

2.1K 次观看.  University of Copenhagen and the Capital Region of Denmark. 该协议为新手支气管镜医师提供了一种令人难忘的方式来学习如何使用四个标志方法在支气管树上导航。对于没有经验的操作员来说，在进行支气管镜检查时很难在支气管三中找到方法。我们开发了一种四地标方法，这意味着您应该找到四个地标，当您迷路时，您可以随时返回四个地标，然后您可以继续前进。我们使用与角度相关的四个地标。这是内窥镜的远端，这是?...

视频: 作者聚焦:在模拟基础环境中学习系统支气管镜检查 

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 ...

科研

医学

Microsurgical Venous Pouch Arterial-Bifurcation Aneurysms in the Rabbit Model: Technical Aspects

For ruptured human cerebral aneurysms endovascular embolization has become an equivalent alternative to aneurysm clipping.1 However, large clinical trials have shown disappointing long-term results with unacceptable high rates of aneurysm recanalization and delayed aneurysm rupture.2 To overcome these problems, animal experimental studies are crucial for the development of better endovascular devices.3-5
Several animal models in rats, rabbits, canines and swine are available.6-8 Comparisons of the different animal models showed the superiority of the rabbit model with regard to hemodynamics and comparability of the coagulation system and cost-effectiveness.9-11 
The venous pouch arterial bifurcation model in rabbits is formed by a venous pouch sutured into an artificially created true bifurcation of both common carotid arteries (CCA). The main advantage of this model are true bifurcational hemodynamics.12 The major drawbacks are the sofar high microsurgical technical demands and high morbidity and mortality rates of up to 50%.13 These limitations have resulted in less frequent use of this aneurysm model in the recent years. These shortcomings could be overcome with improved surgical procedures and modified peri- and postoperative analgetic management and anticoagulation.14-16 Our techniques reported in this paper demonstrate this optimized technique for microsurgical creation of arterial bifurcation aneurysms.

An optimized technique for the microsurgical creation of arterial bifurcation aneurysms mimicking bifurcation human cerebral aneurysms is described. A venous pouch is sutured into an artificially created true bifurcation of both common carotid arteries. Facilitated microsurgical techniques and aggressive postoperative anticoagulation and analgesia lead to minimized morbidity rates and high aneurysm patency rates.

显微静脉袋分岔动脉瘤在兔模型:技术问题

For ruptured human cerebral aneurysms endovascular embolization has become an equivalent alternative to aneurysm clipping.1 However, large clinical trials ...

The Bovine Lung in Biomedical Research: Visually Guided Bronchoscopy, Intrabronchial Inoculation and In Vivo Sampling Techniques

There is an ongoing search for alternative animal models in research of respiratory medicine. Depending on the goal of the research, large animals as models of pulmonary disease often resemble the situation of the human lung much better than mice do. Working with large animals also offers the opportunity to sample the same animal repeatedly over a certain course of time, which allows long-term studies without sacrificing the animals.
The aim was to establish in vivo sampling methods for the use in a bovine model of a respiratory Chlamydia psittaci infection. Sampling should be performed at various time points in each animal during the study, and the samples should be suitable to study the host response, as well as the pathogen under experimental conditions.
Bronchoscopy is a valuable diagnostic tool in human and veterinary medicine. It is a safe and minimally invasive procedure. This article describes the intrabronchial inoculation of calves as well as sampling methods for the lower respiratory tract. Videoendoscopic, intrabronchial inoculation leads to very consistent clinical and pathological findings in all inoculated animals and is, therefore, well-suited for use in models of infectious lung disease. The sampling methods described are bronchoalveolar lavage, bronchial brushing and transbronchial lung biopsy. All of these are valuable diagnostic tools in human medicine and could be adapted for experimental purposes to calves aged 6-8 weeks. The samples obtained were suitable for both pathogen detection and characterization of the severity of lung inflammation in the host.

The Bovine Lung in Biomedical Research: Visually Guided Bronchoscopy, Intrabronchial Inoculation and In Vivo Sampling Techniques

This article describes bronchoscopic techniques in the bovine lung under experimental conditions, i.e. bronchoscopically guided inoculation, bronchoalveolar lavage, bronchial brushing, and transbronchial lung biopsy.

牛龙在生物医学研究:视觉引导支气管镜，支气管内接种和<em&gt;在体内</em&gt;抽样技术

There is an ongoing search for alternative animal models in research of respiratory medicine. Depending on the goal of the research, large animals as ...

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 ...

Posterior Approach for Debridement of the Psoas Abscess

This method focuses on outlining a safe zone for irrigation and debridement of a psoas abscess through a posterior approach. Initially, an anterior approach to the spine was performed to ensure that the anterior longitudinal ligament and the psoas muscle could be visualized. All the abdominal organs were removed. Subsequently, a posterior approach was performed to remove the paraspinal muscles from L1&#8211;L5. The transverse processes, pars interarticularis and lamina of L1&#8211;L5 were identified. The exiting nerve root was identified between the transverse processes and followed into the substance of the psoas muscle. Using the anterior and posterior approach, the lumbar plexus was isolated from the substance of the psoas muscle. Before and after various steps of dissection, digital photographs were obtained. These images were uploaded into ImageJ and multiple measurements, including the distance between the lateral superior and inferior tip of each TP to the most lateral region of the plexus, the distance between the lateral superior and inferior tip of the TP to the lateral edge of the psoas, and the width of the lumbar plexus were recorded. The safe zone for entering the substance of the psoas muscle was defined between the lateral edge of the psoas muscle and the lateral edge of the lumbar plexus. The relationship of this interval to the tip of the transverse process at each level was measured and reported.

This is a cadaveric study investigating the landmarks for the posterior approach for irrigation and debridement of the psoas abscess. The interval between the transverse processes (TP) was used to access the substance of the psoas muscle.

切除普索阿脓肿的后向方法

This method focuses on outlining a safe zone for irrigation and debridement of a psoas abscess through a posterior approach. Initially, an anterior ...

The Microscopic Transcanal Approach in Stapes Surgery Revisited

The microscopic transcanal (aka transmeatal) surgical approach was first described in the 60s, offering a minimally invasive means of reaching the external auditory canal, the middle ear, and epitympanon. Such an approach avoids a retroauricular or endaural skin incision; however, working through a narrow space needs angled microsurgical instruments and specific training in otologic surgery. The transcanal approach restricts the working space; however, it offers a binocular microscopic vision into the middle ear without extended skin incisions and thus, reducing post-operative pain and bleeding. In addition, this minimally invasive approach avoids scar tissue complications, hypoesthesia of the auricle, and potential protrusion of the pinna. Despite its numerous advantages, this method is still not routinely performed by otologic surgeons. Since this minimally invasive technique is more challenging, there is a need for extensive training in order for it to be widely adopted by otologic surgeons. This article provides step-by-step surgical instructions for stapes surgery and reports possible indications, pitfalls, and limitations using this microscopic transcanal technique.

This article describes the microscopic transcanal technique for stapes surgery, providing step-by-step surgical instructions for familiarizing surgeons with this approach.

重新审视镫骨手术中的显微经管入路

The microscopic transcanal (aka transmeatal) surgical approach was first described in the 60s, offering a minimally invasive means of reaching the ...

Four-Dimensional Computed Tomography-Guided Valve Sizing for Transcatheter Pulmonary Valve Replacement

The measurements of the right ventricle (RV) and pulmonary artery (PA), for selecting the optimal prosthesis size for transcatheter pulmonary valve replacement (TPVR), vary considerably. Three-dimensional (3D) computed tomography (CT) imaging for device size prediction is insufficient to assess the displacement of the right ventricular outflow tract (RVOT) and PA, which could increase the risk of stent misplacement and paravalvular leak. The aim of this study is to provide a dynamic model to visualize and quantify the anatomy of the RVOT to PA over the entire cardiac cycle by four-dimensional (4D) cardiac CT reconstruction to obtain an accurate quantitative evaluation of the required valve size. In this pilot study, cardiac CT from sheep J was chosen to illustrate the procedures. 3D cardiac CT was imported into 3D reconstruction software to build a 4D sequence which was divided into eleven frames over the cardiac cycle to visualize the deformation of the heart. Diameter, cross-sectional area, and circumference of five imaging planes at the main PA, sinotubular junction, sinus, basal plane of the pulmonary valve (BPV), and RVOT were measured at each frame in 4D straightened models prior to valve implantation to predict the valve size. Meanwhile, dynamic changes in the RV volume were also measured to evaluate right ventricular ejection fraction (RVEF). 3D measurements at the end of the diastole were obtained for comparison with the 4D measurements. In sheep J, 4D CT measurements from the straightened model resulted in the same choice of valve size for TPVR (30 mm) as 3D measurements. The RVEF of sheep J from pre-CT was 62.1 %. In contrast with 3D CT, the straightened 4D reconstruction model not only enabled accurate prediction for valve size selection for TPVR but also provided an ideal virtual reality, thus presenting a promising method for TPVR and the innovation of TPVR devices.

This study assessed a new methodology with a straightened model generated from the four-dimensional cardiac computed tomography sequence to obtain the desired measurements for valve sizing in the application of transcatheter pulmonary valve replacement.

用于经导管肺动脉瓣置换术的四维计算机断层扫描引导的瓣膜尺寸

The measurements of the right ventricle (RV) and pulmonary artery (PA), for selecting the optimal prosthesis size for transcatheter pulmonary valve ...

Laparoscopic Radical Antegrade Modular Pancreatosplenectomy via Dorsal-Caudal Artery Approach for Pancreatic Neck-Body Cancer

Laparoscopic radical resection of the pancreatic neck is one of the most complicated radical operations for pancreatic cancer, especially for patients who have had neoadjuvant chemotherapy. Here, we present a technique to perform laparoscopic radical antegrade modular pancreatosplenectomy (L-RAMPS) using the dorsal-caudal artery approach by making full use of the high-definition vision and operation modes of the laparoscope.
The innovation and optimization of this operation are provided in the protocol. Priority should be given to the dorsal resection plane, including the dorsal side of the superior mesenteric artery (SMA), the dorsal side of the pancreatic head, the root of the celiac artery (CeA), the ventral side of the left renal vessels, and the renal hilum. On the condition that the operation for pancreatic neck-body cancer is feasible and safe, the second step is to perform tumor resection en bloc surrounding the SMA and CeA from the caudal to the cephalic side to increase the rate of R0 (radical zero) resection and further prognosis.

Laparoscopic Radical Antegrade Modular Pancreatosplenectomy via Dorsal-Caudal Artery Approach for Pancreatic Neck-Body Cancer

With advancements in laparoscopic techniques, laparoscopic radical antegrade modular pancreatosplenectomy (L-RAMPS) has been widely recognized. However, owing to several technical difficulties in this procedure, the artery-first approach in L-RAMPS still remains uncommon. Here, we developed the dorsal-caudal artery approach for L-RAMPS, which might be safe and beneficial for pancreatic neck tumors.

腹腔镜根治性顺行屈行模块化胰腺脾切除术经背尾动脉 入路治疗 胰腺颈体癌

Laparoscopic radical resection of the pancreatic neck is one of the most complicated radical operations for pancreatic cancer, especially for patients who ...

研究人类微血管功能障碍的新机制

Intradermal Microdialysis: An Approach to Investigating Novel Mechanisms of Microvascular Dysfunction in Humans

The cutaneous vasculature is an accessible tissue that can be used to assess microvascular function in humans. Intradermal microdialysis is a minimally invasive technique used to investigate mechanisms of vascular smooth muscle and endothelial function in the cutaneous circulation. This technique allows for the pharmacological dissection of the pathophysiology of microvascular endothelial dysfunction as indexed by decreased nitric oxide-mediated vasodilation, an indicator of cardiovascular disease development risk. In this technique, a microdialysis probe is placed in the dermal layer of the skin, and a local heating unit with a laser Doppler flowmetry probe is placed over the probe to measure the red blood cell flux. The local skin temperature is clamped or stimulated with direct heat application, and pharmacological agents are perfused through the probe to stimulate or inhibit intracellular signaling pathways in order to induce vasodilation or vasoconstriction or to interrogate mechanisms of interest (co-factors, antioxidants, etc.). The cutaneous vascular conductance is quantified, and mechanisms of endothelial dysfunction in disease states can be delineated.

作者聚焦:一种揭示心血管疾病风险人群机制的药物解剖方法 

Intradermal microdialysis is a minimally invasive technique used to investigate microvascular function in health and disease. Both dose-response and local heating protocols can be utilized for this technique to explore mechanisms of vasodilation and vasoconstriction in the cutaneous circulation.

皮内微透析:研究人类微血管功能障碍新机制的方法

The cutaneous vasculature is an accessible tissue that can be used to assess microvascular function in humans. Intradermal microdialysis is a minimally ...