調査はもっぱら部門や機関のリソースからの支援を受けて実施した。凝固装置（Hemochron 801）はメーカーからの義務を負うことなく、貸された。アッセイカートリッジは小売コストで購入した。ビデオの入門図はSanderink らから変更されました。ビデオで12番目の図（ヘパリナーゼ消化の時間経過）がInchiosa らの許可を得て再現しました。1

1。ヘパリナーゼ再構成<ol><li>凍結乾燥ヘパリナーゼ私は精製されたタンパク質の1μgを含むバイアル中（シーメンス、ニューアーク、デラウェア州DadeHepzyme REF B4240-10）市販のものを入手されています。タンパク質は、生理食塩水の0.25ミリリットル（0.9％NaCl）中に溶解させる。 </li></ol> 2。血液サンプルの収集<ol><li>バキュテイナー管（;フ​​ランクリンレイクス、ニュージャージーベクトン·ディッキンソン）は、バッファリングされた、2つの血液サンプルは、クエン酸ナトリウム（3.2％0.3ミリリットル0.109M）に真空によって描かれているチューブは、両方のエノキサパリンの既知濃度のプレスパイクであり、血液量2.7ミリリットルは描かれている。総含有量は、3.0 mlである。 </li></ol> 3。ヘパリナーゼ消化<ol><li>シリンジ（;バイアルの80％、約0.2ミリリットルタンパク質の0.8μg）の中に吸引することができますヘパリナーゼバイアルの内容全体を、1バキュテイナー管に転送され、生理食塩水0.2ミリリットル（0.9％NaCl）をに追加されますバーゼルとなる第2のチューブ、エノキサパリン効果控除前の伊根状態。 </li><li>両方バキュテイナー管を5分間にわたりHemochron装置のサーモスタットウェルに入れています。 （ヘパリナーゼで5分間の消化時間の妥当性は私たちの以前に出版された仕事に設立されました。1） </li></ol> 4。凝固アッセイ<ol><li>ヘパリナーゼのインキュベーションの終了時に、血液2.0mlのアッセイ用カートリッジに転送されます。 MAAの管の場合には、凝固を開始する250 mMのCaCl 2 0.1mlであらかじめ入力されています。商業APTTアッセイカートリッジ（A104）は抗凝固剤としてクエン酸ナトリウムを含有するバキュテイナー管に引き込まれた全血中の凝固開始するために設計されています。 </li><li> Hemochron装置は、血液凝固の完了を通知し、数秒で凝固時間​​を保持します。凝固ダシで割っヘパリナーゼ処理試料と基準試料との間の凝固時間の差は、私は、ベースライン試料に対して、エノキサパリンの除去に起因％の減少をもたらす。後述するように、強い線形相関が凝固時間と全血の添加サンプルで、ならびに抗Xaのchromgenicアッセイによるエノキサパリンの測定濃度との相関のためのエノキサパリンの濃度のパーセントの減少との間の関係のために得られている活動。エノキサパリン濃度の抗Xaアッセイは二段発色アッセイ（; Aniara、メーソン、オハイオBIO​​PHEN）の市販のキットを用いて行った。 </li></ol>

<ol>
	<li>Inchiosa, M. A. J. r., Pothula, S., Kubal, K., Sanchala, V. T., Navarro, I. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Toward+development+of+a+point-of-care+assay+of+enoxaparin+anticoagulant+activity+in+whole+blood.">Toward development of a point-of-care assay of enoxaparin anticoagulant activity in whole blood.</a> J. Thromb. Thrombolysis. 32, 47-53 (2011).</li><li>Despotis, G. J., Filos, K. S., Levine, V., Alsoufiev, A., Spitznagel, E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Aprotinin+prolongs+activated+and+nonactivated+whole+blood+clotting+time+and+potentiates+the+effect+of+heparin+in+vitro.">Aprotinin prolongs activated and nonactivated whole blood clotting time and potentiates the effect of heparin in vitro.</a> Anesth. Analg. 82, 1126-1131 (1996).</li><li>Pothula, S., Inchiosa, M. A., Sanchala, V. T., Sarabu, M., Inchiosa, A. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=In+vitro+effect+of+protamine+excess+on+blood+coagulation+assays.">In vitro effect of protamine excess on blood coagulation assays.</a> Anesth Analg. 96, SCA39 (2010).</li><li>Inchiosa, M., Pothula, S., Sanchala, V., Kubal, K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Detection+of+low+plasma+levels+of+low+molecular+weight+heparin.">Detection of low plasma levels of low molecular weight heparin.</a> Anesth Analg. 102, SCA10 (2010).</li><li>Gogarten, W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+influence+of+new+antithrombotic+drugs+on+regional+anesthesia.">The influence of new antithrombotic drugs on regional anesthesia.</a> Curr. Opin. Anaesthesiol. 19, 545-550 (2006).</li><li>Gouin-Thibault, I., Pautas, E., Siguret, V. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Safety+profile+of+different+low-molecular+weight+heparins+used+at+therapeutic+dose.">Safety profile of different low-molecular weight heparins used at therapeutic dose.</a> Drug Saf. 28, 333-349 (2005).</li><li>Bazinet, A., Almanric, K., Brunet, C., Turcotte, I., Martineau, J., Caron, S., Blais, N., Lalonde, L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Dosage+of+enoxaparin+among+obese+and+renal+impairment+patients.">Dosage of enoxaparin among obese and renal impairment patients.</a> Thromb. Res. 116, 41-50 (2005).</li><li>El Rouby, S., Cohen, M., Gonzales, A., Hoppensteadt, D., Lee, T., Zucker, M. L., Khalid, K., LaDuca, F. M., Fareed, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+use+of+a+HEMOCHRON+JR.+HEMONOXTM+point+of+care+test+in+monitoring+the+anticoagulant+effect+of+enoxaparin+during+interventional+coronary+procedures.">The use of a HEMOCHRON JR. HEMONOXTM point of care test in monitoring the anticoagulant effect of enoxaparin during interventional coronary procedures.</a> J. Thromb. Thrombolysis. 21, 137-145 (2006).</li><li>Yang, V. C., Bernstein, H., Cooney, C. L., Kadam, J. C., Langer, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Removal+of+the+anticoagulant+activities+of+the+low+molecular+weight+heparin+fractions+and+fragments+with+flavobacterial+heparinase.">Removal of the anticoagulant activities of the low molecular weight heparin fractions and fragments with flavobacterial heparinase.</a> Thromb Res. 44, 599-610 (1986).</li><li>Maddineni, J., Walenga, J. M., Jeske, W. P., Hoppensteadt, D. A., Fareed, J., Wahi, R., Bick, R. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Product+individuality+of+commercially+available+low-molecular-weight+heparins+and+their+generic+versions:+therapeutic+implications.">Product individuality of commercially available low-molecular-weight heparins and their generic versions: therapeutic implications.</a> Clinical and Applied Thrombosis/Hemostasis. 12, 267-276 (2006).</li><li>Wijnhoven, T. J., van de Westerlo, E. M., Smits, N. C., Lensen, J. F., Rops, A. L., vander Vlag, J., Berden, J. H., vanden Heuvel, L. P., van Kuppevelt, T. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Characterization+of+anticoagulant+heparinoids+by+immunoprofiling.">Characterization of anticoagulant heparinoids by immunoprofiling.</a> Glycoconj. J. 25, 177-185 (2008).</li><li>Sanderink, G. -. J. C. M., Guimart, C. G., Ozoux, M. -. L., Jariwala, N. U., Shukla, U. A., Boutouyrie, B. X. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Pharmacokinetics+and+pharmacodynamics+of+the+prophylactic+dose+of+enoxaparin+once+daily+over+4+days+in+patients+with+renal+impairment.">Pharmacokinetics and pharmacodynamics of the prophylactic dose of enoxaparin once daily over 4 days in patients with renal impairment.</a> Thromb. Res. 105, 225-231 (2002).</li></ol>

著者らは、開示することは何もない。

エノキサパリンの効果このアッセイは、出血や血腫の開発の付随リスクを持っている侵襲的手技を行うの相対的な安全性を決定するための重要な選択肢となる可能性があります。硬膜外注射を検討しているとき、これは特に重要であろう。ガイドラインの大部分は、エノキサパリンと侵襲的処置の開始の注入の間に12時間の待機期間をお勧めします5腎機能障害、肥満、妊娠はエノキサパリンの投与要件に影響を与える可能性がある6,7アッセイは10以内に完了することができるので。 -分の期間は、それは、静脈血栓塞栓症の発症リスクがある患者における抗凝固療法の妥当性に関する情報を提供する診療所や医師のオフィスでも使用することができます。必要に応じて即時投与量の調整は、提起することができます。 血漿中のエノキサパリン濃度が発色することによって測定することができる凝固因子、Xaの阻害の程度ssay。しかし、これだけではありません具体的にはその濃度は、個々の患者によって大きく異なり、その抗凝固効果をもたらす。6月8日 我々の研究は、エノキサパリンを用いて行った。しかし、このアッセイは、すでにダルテパリン、ナドロパリン及びチンザパリンためのケースであることが知られているヘパリナーゼIによって分解され、任意の低分子ヘパリンにも適用できることが予想できます9月11日は、我々の機能に関連してアッセイをデザインHemochron凝固時間測定器。楽器は、比較的安価であり、また、使い捨ての採血管、ヘパリナーゼアンプル、アッセイカートリッジは一人の患者のための分析を完了するには約15ドルです。したがって、それは、様々な臨床現場で抗凝固状態を監視するのに適していることが予想される。

<table border="1"><tbody><tr><td> 試薬の名称 </td><td> 会社 </td><td> カタログ番号 </td><td> 注釈 </td></tr><tr><td> Hepzyme </td><td>ジーメンス</td><td> B4240 </td><td>ヘパリナーゼ私</td></tr><tr><td> &quot;MAA&quot;カートリッジ</td><td> Technidyne </td><td> FTK-ACT </td><td>カオリンを除去することによって修正された</td></tr><tr><td> APTTカートリッジ</td><td> Technidyne </td><td> A104 </td><td></td></tr></tbody></table>

rapid point-of-care assay of enoxaparin anticoagulant efficacy in whole blood

患者の血液を効果的に低分子量ヘパリン（LMWH）、エノキサパリンによる抗凝固する程度を決定するための臨床検査の必要があります。これは急速に決定することができれば、それは重要であろう緊急の臨床状況もあります。本アッセイは、これを達成するために設計されています。我々は唯一のエノキサパリンの既知濃度を添加したヒト血液試料をアッセイした。本アッセイの本質的な特徴は、ヘパリナーゼと非アクティブを完了するために分解することによって、患者の血液試料中のエノキサパリンの効果の定量化である。エノキサパリンを添加した。2つの血液サンプルがバキュテイナー管（フランクリンレイクス、ニュージャージー州ベクトン·ディッキンソン）に引き込まれた1サンプルは37°Cで5分のためにヘパリナーゼで消化した後、他のサンプルは、患者のベースライン抗凝固状態を表していた。 bに比べてヘパリナーゼ処理したサンプルの凝固時間のパーセント短縮、aseline状態は、エノキサパリンの抗凝固貢献をもたらした。私たちは、凝固時間の測定（国際Technidyne社、エジソン、ニュージャージー州）のためのポータブル、バッテリ駆動Hemochron 801装置を使用していました。装置は2サーモスタット制御（37℃）アッセイ井戸を持っています。我々は、楽器のメーカーから入手可能であるアッセイカートリッジの2種類のアッセイを実施した。ワンカートリッジはその感度を向上させるように変更されました。我々は、活性化剤として、唯一の管のガラス表面、おそらく検出用マグネットを残して、蒸留水でリンスすることにより広範FTK-ACTカートリッジからカオリンを削除しました。我々は、この私たちの最低限の活性化アッセイ（MAA）を呼んだ。最小限の活性化アッセイを使用することは、私たちと他の人が研究されてきた。検討した2月4日第二カートリッジは、活性化部分トロンボプラスチン時間（APTT）アッセイ（A104）であった。メーカーから供給されるので、これを使用した。楽器WERのサーモスタット井戸eはヘパリナーゼ消化および凝固アッセイの両方に使用される。アッセイは10分以内に完了することができます。 MAAのアッセイは、典型的な臨床濃度範囲にわたって、エノキサパリンのヘパリナーゼ消化後に凝固時間で堅牢な変化を示した。 0.2で血液試料1ml当たりエノキサパリンの抗Xa IU、ヘパリナーゼ消化は、凝固時間で9.8％（20.4秒）の平均減少を引き起こし、エノキサパリンのmlあたり1.0 IUで41.4％減（148.8秒）であった。このレポートは、アッセイの実験的なアプリケーションを提示します。臨床現場でその値がまだ確立されなければならない。

図1は、エノキサパリンのスパイク濃度（0.2、0.4、1.0ミリリットル当たり抗Xa IU）の一連のヘパリナーゼとエノキサパリンの除去後に凝固時間のパーセントの減少との関係についての結果を提示します。結果はMAAおよびAPTTアッセイカートリッジの両方のために提示されます。抗Xa活性の発色アッセイからエノキサパリンの測定濃度はまた、各グラフの横軸に含まれています。 図2は、抗Xa活性を発色測定対凝固時間のパーセントの減少と同じデータのプロットを示します。 高い統計的有意性を持つ強い線形相関は、すべての4つの関係でした。 <img src="/files/ftp_upload/3852/3852fig1.jpg" alt="図1" /> 図1エノキサパリンCONTRのケアの決定ポイントのヘパリナーゼとのインキュベーション後の凝固時間の割合（％）の変化に基づいて、スパイクされた全血の凝固時間にibution（短縮）。全血と測定抗Xa血漿中濃度（カッコ内に、平均±SE）に追加されたスパイクエノキサパリン濃度は、各グラフの横軸に配置されます。凝固時間のすべてのパーセントの変更は数秒で凝固時間​​の平均短縮とともに、手段とSEとして提示されます。同じ患者からのデータは、破線によって接続されています。プロット内のアスタリスクで識別された4人の患者のデータが（MAAの結果）B区で4人の患者（APTTアッセイ）と同じです。すべての結果は、単一の決定を表す。ピアソンの相関係数はr = 0.869（P = 1.9×10 -5）およびr =それぞれMAAおよびaPTTassayとの関係のために0.916（P = 2.8×10 -5）であった。 Inchiosa らから許可を得て複製。1 図2は、図1A及びBに示すように、ポイントオブケアアッセイにおける凝固時間の変化率の結果は、血漿抗Xa因子の濃度に対してプロットされ、MAAの結果、B、APTTアッセイ。すべての結果は、単一の凝固時間ア​​ッセイおよび抗Xa因子濃度の単一の測定からです。ピアソンの相関係数はそれぞれInchiosa らから許可を得て複製、MAAおよびAPTTアッセイとの関係のためにはr = 0.910（P = 2.5×10 -6）とr = 0.922（P = 2.0×10 -5）であった。1

Watch this Scientific Journal Video about Rapid Point-of-Care Assay of Enoxaparin Anticoagulant Efficacy in Whole Blood at JoVE.com

Rapid Point-of-Care Assay of Enoxaparin Anticoagulant Efficacy in Whole Blood

低分子量ヘパリン、エノキサパリンによる血液凝固の阻害の迅速な定量分析のデモンストレーション。エノキサパリンの寄与はヘパリナーゼで消化することを通じてその影響を除去することにより評価される。アッセイのより詳細な説明は、当社発表された論文に詳述されている。<sup&gt; 1</sup&gt;アッセイはまだ臨床の確認が必要です。

全血におけるエノキサパリン抗凝固効果の迅速なポイントオブケアアッセイ

There is the need for a clinical assay to determine the extent to which a patient's blood is effectively anticoagulated by the ...

rapid-point-care-assay-enoxaparin-anticoagulant-efficacy-whole

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Unit 1

Cardiovascular Drugs: Anticoagulants and Antianginal Agents

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13.7K ビュー.  New York Medical College. 低分子量ヘパリン、エノキサパリンによる血液凝固の阻害の迅速な定量分析のデモンストレーション。エノキサパリンの寄与はヘパリナーゼで消化することを通じてその影響を除去することにより評価される。アッセイのより詳細な説明は、当社発表された論文に詳述されている。 1アッセイはまだ臨床の確認が必要です。

ビデオ: Rapid Point-of-Care Assay of Enoxaparin Anticoagulant Efficacy in Whole Blood

Rapid Fractionation and Isolation of Whole Blood Components in Samples Obtained from a Community-based Setting

Collection and processing of whole blood samples in a non-clinical setting offers a unique opportunity to evaluate community-dwelling individuals both with and without preexisting conditions. Rapid processing of these samples is essential to avoid degradation of key cellular components. Included here are methods for simultaneous peripheral blood mononuclear cell (PBMC), DNA, RNA and serum isolation from a single blood draw performed in the homes of consenting participants across a metropolitan area, with processing initiated within 2 hr of collection. We have used these techniques to process over 1,600 blood specimens yielding consistent, high quality material, which has subsequently been used in successful DNA methylation, genotyping, gene expression and flow cytometry analyses. Some of the methods employed are standard; however, when combined in the described manner, they enable efficient processing of samples from participants of population- and/or community-based studies who would not normally be evaluated in a clinical setting. Therefore, this protocol has the potential to obtain samples (and subsequently data) that are more representative of the general population.

We outline a methodology for the processing of whole blood to obtain a variety of components for further analysis. We have optimized a streamlined protocol that enables rapid, high-throughput simultaneous processing of whole blood samples in a non-clinical setting.

迅速な分別とコミュニティベースの設定から得られた試​​料中の全血液成分の単離

Collection and processing of whole blood samples in a non-clinical setting offers a unique opportunity to evaluate community-dwelling individuals both ...

医学

Assessment of the Anticoagulant and Anti-inflammatory Properties of Endothelial Cells Using 3D Cell Culture and Non-anticoagulated Whole Blood

In vivo, endothelial cells are crucial for the natural anticoagulation of circulating blood. Consequently, endothelial cell activation leads to blood coagulation. This phenomenon is observed in many clinical situations, like organ transplantation in the presence of pre-formed anti-donor antibodies, including xenotransplantation, as well as in ischemia/reperfusion injury. In order to reduce animal experimentation according to the 3R standards (reduction, replacement and refinement), in vitro models to study the effect of endothelial cell activation on blood coagulation would be highly desirable. However, common flatbed systems of endothelial cell culture provide a surface-to-volume ratio of 1 - 5 cm2 of endothelium per mL of blood, which is not sufficient for natural, endothelial-mediated anticoagulation. Culturing endothelial cells on microcarrier beads may increase the surface-to-volume ratio to 40 - 160 cm2/mL. This increased ratio is sufficient to ensure the &#34;natural&#34; anticoagulation of whole blood, so that the use of anticoagulants can be avoided. Here an in vitro microcarrier-based system is described to study the effects of genetic modification of porcine endothelial cells on coagulation of whole, non-anticoagulated human blood. In the described assay, primary porcine aortic endothelial cells, either wild type (WT) or transgenic for human CD46 and thrombomodulin, were grown on microcarrier beads and then exposed to freshly drawn non-anticoagulated human blood. This model allows for the measurement and quantification of cytokine release as well as activation markers of complement and coagulation in the blood plasma. In addition, imaging of activated endothelial cell and deposition of immunoglobulins, complement- and coagulation proteins on the endothelialized beads were performed by confocal microscopy. This assay can also be used to test drugs which are supposed to prevent endothelial cell activation and, thus, coagulation. On top of its potential to reduce the number of animals used for such investigations, the described assay is easy to perform and consistently reproducible.

We present an in vitro model which allows the study and analysis of coagulation in whole, non-anticoagulated blood. Anticoagulation in the system depends on the natural anticoagulation effect of healthy endothelial cells and endothelial cell activation will result in clotting.

3 D 細胞培養と非高血圧症全血を用いた血管内皮細胞の抗凝固および抗炎症作用の評価

In vivo, endothelial cells are crucial for the natural anticoagulation of circulating blood. Consequently, endothelial cell activation leads to blood ...

Evaluation of a Point-of-Care Testing Analyzer for Measuring Peripheral Blood Leukocytes

White blood cell (WBC) is an important indicator of inflammation in the body, and it can help distinguish between bacterial and viral infections. At present, most primary medical institutions in China have a poor percentage of adoption of blood-testing technology, and a hematology detection system with a high price to performance ratio and easy operation is urgently needed in primary healthcare centers. This paper introduces the principle and operation procedures of a point-of-care testing (POCT) card-based leukocyte analyzer (evaluated system), which was used to detect WBC indexes such as neutrophils, lymphocytes, and intermediate group cells (including eosinophils, basophils, and monocytes) in whole blood. The results from the evaluated system were compared to those from two commercial automatic hematology analyzers (reference system). The correlation and consistency between the evaluated system and the commercial reference systems were analyzed. The results showed that WBC count and number of granulocytes detected by the evaluated and reference systems showed a strong positive correlation (rs = 0.972 and 0.973, respectively), while the number of lymphocytes showed a relatively low correlation (rs = 0.851). A Bland-Altman plot showed that the major difference between the values detected by the evaluated system and the reference systems is within 95% limits of agreement (LoA), indicating that the two systems are in good agreement. In conclusion, the evaluated system has an excellent correlation, robust consistency, and a reliable comparison with the results of the widely used automatic hematology analyzers. It is ideal for WBC detection in primary medical institutions where a full-automatic five-category hematology analyzer is unavailable, especially during the COVID-19 normalized prevention and control period.

A protocol to measure peripheral blood leukocytes using a POCT card-based leukocyte analyzer is presented here. Same blood samples were tested by two automated hematology analyzers to evaluate the consistency and accuracy of the results. The results showed that the evaluated analyzer had a good correlation with the reference system.

末梢血白血球を測定するためのポイントオブケア検査分析装置の評価

White blood cell (WBC) is an important indicator of inflammation in the body, and it can help distinguish between bacterial and viral infections. At ...

Point-Of-Care Ultrasound Screening for Proximal Lower Extremity Deep Venous Thrombosis

Acute lower extremity deep venous thrombosis (DVT) is a serious vascular disorder that requires accurate and early diagnosis to prevent life-threatening sequelae. While whole leg compression ultrasound with color and spectral Doppler is commonly performed in radiology and vascular labs, point-of-care ultrasound (POCUS) is becoming more common in the acute care setting. Providers appropriately trained in focused POCUS can perform a rapid bedside examination with high sensitivity and specificity in critically ill patients. This paper describes a simplified yet validated approach to POCUS by describing a three-zone protocol for lower extremity DVT POCUS image acquisition. The protocol explains the steps in obtaining vascular images at six compression points in the lower extremity. Beginning at the level of the proximal thigh and moving distally to the popliteal space, the protocol guides the user through each of the compression points in a stepwise manner: from the common femoral vein to the femoral and deep femoral vein bifurcation, and, finally, to the popliteal vein. Further, a visual aid is provided that may assist providers during real-time image acquisition. The goal in presenting this protocol is to help make proximal lower extremity DVT exams more accessible and efficient for POCUS users at the patient&#39;s bedside.

Traditionally, lower extremity deep venous thrombosis (DVT) is diagnosed by radiology-performed venous duplex ultrasound. Providers appropriately trained in focused point-of-care ultrasound (POCUS) can perform a rapid bedside examination with high sensitivity and specificity in critically ill patients. We describe the scanning technique for focused POCUS DVT lower extremity examination.

近位下肢深部静脈血栓症のためのポイントオブケア超音波スクリーニング

Acute lower extremity deep venous thrombosis (DVT) is a serious vascular disorder that requires accurate and early diagnosis to prevent life-threatening ...

Point-of-Care Lung Ultrasound in Adults: Image Acquisition

Consultative ultrasound performed by radiologists has traditionally not been used for imaging the lungs, as the lungs&#39; air-filled nature normally prevents direct visualization of the lung parenchyma. When showing the lung parenchyma, ultrasound typically generates a number of non-anatomic artifacts. However, over the past several decades, these artifacts have been studied by diagnostic point-of-care ultrasound (POCUS) practitioners, who have identified findings that have value in narrowing the differential diagnoses of cardiopulmonary dysfunction. For instance, in patients presenting with dyspnea, lung POCUS is superior to chest radiography (CXR) for the diagnosis of pneumothorax, pulmonary edema, lung consolidations, and pleural effusions. Despite its known diagnostic value, the utilization of lung POCUS in clinical medicine remains variable, in part because training in this modality across hospitals remains inconsistent. To address this educational gap, this narrative review describes lung POCUS image acquisition in adults, including patient positioning, transducer selection, probe placement, acquisition sequence, and image optimization.

Point-of-care ultrasound (POCUS) of the lungs provides quick answers in rapidly changing clinical scenarios. We present an efficient and informative protocol for image acquisition for use in acute care settings.

成人におけるポイントオブケア肺超音波:画像取得

Consultative ultrasound performed by radiologists has traditionally not been used for imaging the lungs, as the lungs&#39; air-filled nature normally ...

Point-of-Care Ultrasound: A Review of Ultrasound Parameters for Predicting Difficult Airways

Airway management remains a crucial part of perioperative care. The conventional approach to assessing potentially difficult airways emphasizes the LEMON method, which looks for and evaluates the Mallampati classification, signs of obstruction, and neck mobility. Clinical findings help predict a higher likelihood of difficult tracheal intubation, but no clinical result reliably excludes difficult intubation. Ultrasound as an adjunct to clinical examination can provide the clinician with a dynamic anatomical airway assessment, which is impossible with clinical examination alone. In the hands of anesthesiologists, ultrasound is becoming more popular in the perioperative period. This method is particularly applicable for identifying proper endotracheal tube positioning in specific patient populations, such as those who are morbidly obese and patients with head and neck cancer or trauma. The focus is on identifying the normal anatomy, correctly positioning the endotracheal tube, and refining the parameters that predict difficult intubation. Several ultrasound measurements are clinical indicators of difficult direct laryngoscopy in the literature. A meta-analysis revealed that the distance from the skin to the epiglottis (DSE) is most associated with a difficult laryngoscopy. An ultrasound of the airway could be applied in routine practice as an adjunct to the clinical examination. A full stomach, rapid sequence intubation, gross visual anatomical abnormalities, and restricted neck flexibility prevent using ultrasound to assess the airway. The airway evaluation is performed with a linear array transducer of 12-4 MHz, with the patient in the supine position, with no pillow, and with the head and neck in a neutral position. The central axis of the neck is where the ultrasound parameters are measured. These image acquisitions guide the standard ultrasound examination of the airway.

A point-of-care ultrasound (POCUS) is a simple, non-invasive, and portable tool that enables dynamic airway assessment. Several studies have attempted to determine the role of ultrasound parameters as an adjunct to clinical examination in predicting difficult laryngoscopies.

ポイントオブケア超音波:困難な気道を予測するための超音波パラメータのレビュー

Airway management remains a crucial part of perioperative care. The conventional approach to assessing potentially difficult airways emphasizes the LEMON ...

Micro-CFU法による結核判定の迅速化

Micro-Colony Forming Unit Assay for Efficacy Evaluation of Vaccines Against Tuberculosis

Tuberculosis (TB), the leading cause of death worldwide by an infectious agent, killed 1.6 million people in 2022, only being surpassed by COVID-19 during the 2019-2021 pandemic. The disease is caused by the bacterium Mycobacterium tuberculosis (M.tb). The Mycobacterium bovis strain Bacillus Calmette-Gu&#233;rin (BCG), the only TB vaccine, is the oldest licensed vaccine in the world, still in use. Currently, there are 12 vaccines in clinical trials and dozens of vaccines under pre-clinical development. The method of choice used to assess the efficacy of TB vaccines in pre-clinical studies is the enumeration of bacterial colonies by the colony-forming units (CFU) assay. This time-consuming assay takes 4 to 6 weeks to conclude, requires substantial laboratory and incubator space, has high reagent costs, and is prone to contamination. Here we describe an optimized method for colony enumeration, the micro-CFU (mCFU), that offers a simple and rapid solution to analyze M.tb vaccine efficacy results. The mCFU assay requires tenfold fewer reagents, reduces the incubation period threefold, taking 1 to 2 weeks to conclude, reduces lab space and reagent cost, and minimizes the health and safety risks associated with working with large numbers of M.tb. Moreover, to evaluate the efficacy of a TB vaccine, samples may be obtained from a variety of sources, including tissues from vaccinated animals infected with Mycobacteria. We also describe an optimized method to produce a unicellular, uniform, and high-quality mycobacterial culture for infection studies. Finally, we propose that these methods should be universally adopted for pre-clinical studies of vaccine efficacy determination, ultimately leading to time reduction in the development of vaccines against TB.

著者スポットライト:結核ワクチンの有効性と抗原提示分析の効率的な評価のためのCFU決定の最適化 

The determination of colony-forming units (CFU) is the gold-standard technique for quantifying bacteria, including Mycobacterium tuberculosis which can take weeks to form visible colonies. Here we describe a micro-CFU for CFU determination with increased time efficiency, reduced lab space and reagent cost, and scalability to medium and high throughput experiments.

結核ワクチンの有効性評価のためのマイクロコロニー形成ユニットアッセイ

Tuberculosis (TB), the leading cause of death worldwide by an infectious agent, killed 1.6 million people in 2022, only being surpassed by COVID-19 during ...

Optic Nerve Sheath Point of Care Ultrasound: Image Acquisition

The goal of this protocol is to develop a standardized method for acquiring images of the optic nerve sheath and measuring the optic nerve sheath diameter (ONSD). Diagnostic ultrasound of the ONSD to detect intracranial hypertension has traditionally faced many problems because of methodologic discrepancies. Due to inconsistencies in the measuring techniques, the potential for ONSD to become a non-invasive bedside monitoring tool for ICP has been hampered. However, establishing a transparent, consistent methodology for measuring the ONSD would support its use as a valid and reliable method of identifying intracranial hypertension. This is important as it has both high sensitivity and specificity in acute care settings. This narrative review describes ONSD POCUS image acquisition, including patient positioning, transducer selection, probe placement, the acquisition sequence, and image optimization. Further, visual aids are provided to assist in real-time during image acquisition. This method should be considered for patients for whom there are concerns regarding intracranial hypertension but who do not have an intracranial monitor in place.

Point-of-care ultrasound (POCUS) of the optic nerve sheath diameter (ONSD) has been shown to be useful in identifying patients with increased intracranial pressure (ICP). However, the non-standardized technique for this POCUS has hampered its use. We present a standardized image acquisition protocol for use in the acute care setting.

視神経鞘ポイントオブケア超音波:画像取得

The goal of this protocol is to develop a standardized method for acquiring images of the optic nerve sheath and measuring the optic nerve sheath diameter ...