著者博士ポール Zamudio、この原稿への彼の貢献のため腎臓と重要なケアの専門家を確認したいです。

1. 利尿する前に血管外区画評価: 胸部超音波
<ol><li>低周波のフェイズド アレイ プローブを使用します。</li>
	<li>画面マーカー演算子左 (腹部や肺) 適切なマシンの設定を選択します。</li>
	<li>8-12 cm に深さを調整します。</li>
	<li>患者を仰臥位または半横臥位置に配置し、前胸部を公開します。患者の前胸部に 90 ° の角度で頭の方に直面してプローブ マーカーで探触子を配置します。<ol>
<li>4 つの場所の合計のための胸のそれぞれの側に 2 つの場所で鎖骨中央線上でこのプロトコルを実行: 2nd-3rdや 3rd-4番目の肋間スペース、4th-5番目または 5番目の6番目の肋間スペース。</li>
		<li>存在する場合は、B ラインを可視化します。 注: B ライン胸膜線上では、元の狭い高エコー アーティファクトで同期的に呼吸の動き (図 1) に移動です。</li>
	</ol>
</li>
	<li>肺浮腫の程度を定量化する各スキャン平面内の B ラインの数をカウントします。 注: 1 B 線までは正常です。2 ~ 3 B ラインを表し B 行の 4 以上が重度の浮腫に中等度を表す軽度の肺水腫A ラインとホワイト アウトのパターンは、非常に重篤な肺浮腫 (図 2) を表します。</li>
</ol>2 下大静脈超音波の利尿する前に血管内のコンパートメントを評価:
<ol><li>低周波、フェイズド アレイ プローブを使用します。</li>
	<li>画面マーカーのオペレーター権限を持つ心臓のマシン設定を選択し、最適な画像の解像度の 12-21 cm に深さを調整します。</li>
	<li>患者を仰臥位にし、前胸部を公開します。プローブ マーカーが頭の方に直面している患者さんの剣サブ領域に 90 ° の角度で探触子を配置します。<ol>
<li>傾いている正中線のすぐ右側に位置する探触子でこのプロトコルを実行少し右横と頭の方。</li>
		<li>右から左をスキャンすることによって、下大静脈と大動脈を視覚化します。</li>
		<li>目的はその縦平面でカーヴォ心房の接合部、横隔膜、肝臓、肝静脈、下大静脈を視覚化することに注意してください。大動脈、スキャン面を内側に angulating によって可視化される (図 3)。</li>
	</ol>
</li>
	<li>下大静脈とカーヴォ心房の接合部を特定したら、超音波を下大静脈の前後径を測定する M モードに設定します。<ol>
<li>タッチ ・ パッドを使用して、近く直交] セクションでは、目に見える肝静脈を指し示すカーヴォ心房の接合部に 2-4 cm に対応する M モードのビームを選択します。</li>
		<li>2 回目の M モード ボタンを選択し、M モード読書の少なくとも 1 の呼吸サイクル完了後画面がフリーズします。</li>
		<li>すべての測定、内部エッジを内部エッジから容器を測定機キャリパーを使用します。</li>
	</ol>
</li>
	<li>通常の呼吸サイクルの間に、d-max と D 分を測定します。</li>
</ol>3. 肺浮腫のグラデーションと下大静脈の直径に基づく流体管理目標を設定します。
<ol><li>利尿 (図 2) の必要性を決定するため肺超音波を評価します。</li>
	<li>利尿 (図 3) に耐えられるように患者さんの能力を決定する下大静脈超音波を評価します。</li>
</ol>4. 利尿療法を通して管外および血管コンパートメントを再評価します。
<ol><li>利尿剤治療の進捗状況を評価し、流体管理目標をガイド、6 時間ごとに上記としてプロトコルを繰り返します。</li>
</ol>

<ol>
	<li>Zoccali, C., 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=Pulmonary+congestion+predicts+cardiac+events+and+mortality+in+ESRD.">Pulmonary congestion predicts cardiac events and mortality in ESRD.</a> Journal of the Amerian Society of Nephrology. 24, 639-646 (2013).</li><li>Vitturi, N., 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=Lung+ultrasound+during+hemodialysis,+the+role+in+the+assessment+of+volume+status.">Lung ultrasound during hemodialysis, the role in the assessment of volume status.</a> International Urology and Nephrology. 46, 169-174 (2014).</li><li>Noble, V. E., 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=Ultrasound+assessment+for+extravascular+lung+water+in+patients+undergoing+hemodialysis.+Time+course+for+resolution.">Ultrasound assessment for extravascular lung water in patients undergoing hemodialysis. Time course for resolution.</a> Chest. 135, 1433-1439 (2009).</li><li>Lang, R. M., 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=Recommendations+for+Cardiac+Chamber+Quantification+by+Echocardiography+in+Adults:+An+Update+from+the+American+Society+of+Echocardiography+and+the+European+Association+of+Cardiovascular+Imaging.">Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging.</a> Journal of the American Society of Echocardiography. 28, 1-39 (2015).</li><li>Barbier, C., 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=Respiratory+changes+in+inferior+vena+cava+diameter+are+helpful+in+predicting+fluid+responsiveness+in+ventilated+septic+patients.">Respiratory changes in inferior vena cava diameter are helpful in predicting fluid responsiveness in ventilated septic patients.</a> Intensive Care Medicine. 30, 1740-1746 (2004).</li><li>Feissel, M., 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+respiratory+variation+in+inferior+vena+cava+diameter+as+a+guide+to+fluid+therapy.">The respiratory variation in inferior vena cava diameter as a guide to fluid therapy.</a> Intensive Care Medicine. 30, 1834-1837 (2004).</li><li>Lichtenstein, D. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Lung+ultrasound+in+the+critically+ill.">Lung ultrasound in the critically ill.</a> Annals of Intensive Care. 4, 1 (2014).</li><li>Lichtenstein, D. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=BLUE-Protocol+and+FALLS-Protocol:+Two+Applications+of+Lung+Ultrasound+in+the+Critically+Ill.">BLUE-Protocol and FALLS-Protocol: Two Applications of Lung Ultrasound in the Critically Ill.</a> Chest. 147, 1659-1670 (2015).</li><li>Moore, C. L., Copel, J. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Point-of-care+ultrasonography.">Point-of-care ultrasonography.</a> New England Journal of Medicine. 364, 749-757 (2011).</li><li>Lichtenstein, D., 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-lines+and+B-lines:+lung+ultrasound+as+a+bedside+tool+for+predicting+pulmonary+artery+occlusion+pressure+in+the+critically+ill.">A-lines and B-lines: lung ultrasound as a bedside tool for predicting pulmonary artery occlusion pressure in the critically ill.</a> Chest. 136, (2009).</li><li>Trezzi, M., 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=Lung+ultrasonography+for+the+assessment+of+rapid+extravascular+water+variation,+evidence+from+hemodialysis+patients.">Lung ultrasonography for the assessment of rapid extravascular water variation, evidence from hemodialysis patients.</a> Internal and Emergency Medicine. 8, 409-415 (2013).</li><li>Lyon, M., Blaivas, M., Brannam, L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Sonographic+measurement+of+the+inferior+vena+cava+as+a+marker+of+blood+loss.">Sonographic measurement of the inferior vena cava as a marker of blood loss.</a> American Journal of Emergency Medicine. 23, 45-50 (2005).</li><li>Katzarski, K. S., 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+critical+evaluation+of+ultrasound+measurement+of+inferior+vena+cava+diameter+in+assessing+dry+weight+in+normotensive+and+hypertensive+hemodialysis+patients.">A critical evaluation of ultrasound measurement of inferior vena cava diameter in assessing dry weight in normotensive and hypertensive hemodialysis patients.</a> American Journal of Kidney Disease. 30, 459-465 (1997).</li><li>Goyfman, M., 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=Combined+aquaretic+and+diuretic+therapy+in+acute+heart+failure.">Combined aquaretic and diuretic therapy in acute heart failure.</a> International Journal of Nephrology and Renovascular Disease. 10, 129-134 (2017).</li></ol>

著者が明らかに何もありません。

多くの研究は、ベッドサイド米国であるショック ・呼吸困難5など様々 な病気の状態の管理をガイドとして使用することができます信頼性の高い診断ツールを示しています。優れた感度と特異性肺浮腫の評価であり、B ラインの血管外肺水分量との相関研究米国それ肺肺血管外水2,もささやかな変化を検知できます示されている10. ...

体液貯留が死亡の最も一般的な変更可能な危険因子と心血管イベント ボリューム患者1のオーバー ロードされました。体液貯留は、コントロール不良の高血圧症、心機能低下、肺水腫につながる、この人口の超過死亡率に関連付けられています。患者の症状、血圧や体重の変化を組み合わせることによって患者のボリューム状態の臨床評価は、不正確さ2に傾向がある臨床評価を表しています。この記事は、ベッドサイド超音波 (US) 肺水腫の効果的な管理を導くためのテクニックを利用したプロトコルを提案します。胸と下大静脈 (IVC) 米国は、この水分除去のための提案された臨床プロトコルの基礎を形成します。胸と下大静脈米国循環ショック、末期腎臓病 (ESRD)、急性呼吸不全の管理を含むアプリケーションのスペクトルのための文献で長い実績があります。
胸米国腎不全患者における肺浮腫の評価の客観的なデータを提供するために示されているし、透析が3になると、肺浮腫の減少の重症度を正確に反映します。同様に、下大静脈 (IVC) の米国は長い臨床用途に利用されています。米国は下大静脈は経胸壁心エコー検査のルーチン コンポーネントとしてお勧めし、ボリュームのステータスと4心前負荷のマークは、右心房の圧 (RAP) の推定を含むいくつかの目的を提供しています。いくつかの研究は、下大静脈口径とショック状態5,6流体感度の相関を解明しました。またショック状態の管理に注目、胸部超音波に使用されている米国のベッドサイド アプリケーションによって流体管理制限と呼ばれる方法で一般の循環ショックで輸液蘇生中に新しい肺浮腫の発症を検出肺超音波 (滝) プロトコル7,8。胸と下大静脈超音波肺浮腫の安全かつ効果的な管理のためのよくとり上げられる機能を組み合わせた逆滝プロトコルの名前、プロトコルは、ここで提案します。
ポータブル、またはベッドサイド、米国は放射線への暴露を削減され、患者の搬送が不要とリソース使用率を迅速かつ信頼性の高いデータを提供するイメージ投射様相です。その可用性と関連付けられた副作用の本質的な不在のため監視し、利尿剤治療を調整する米国のベッドサイドを繰り返すことができます。最後に、ベッドサイドは米国、簡単に実行し、リアルタイム9で解釈する臨床医。
米国の胸は、様々 な胸膜および実質の病理を表す特定のアーティファクト パターンを検出し広く受け入れられている手法です。例えば、「A ライン」は胸膜表面の水平方向のエコー (明るい) 残響アーティファクト流体の無料通常実質を示します。また、「B ライン」には胸膜線の下面から始まり、画面の端に拡張無エコー垂直成果物呼吸同期的に移動。疑いのあるボリューム オーバー ロードの設定で B ラインの存在は、血管外肺水分量を示します。これらの B ラインは特質上乾燥ライン アイテム パターン3の再出現につながる、ボリューム削除に対応する方法の中に放散します。研究は、これらの米国の調査結果が密接に関連付けられて上昇肺充填圧力10侵襲的方法により評価したことを示します。
米国は、IVC 容器直径と虚脱、ですがインデックスで自発呼吸の中に直径の減少の割合を測定する使用可能性があります。いくつかの研究は、利尿、肺水腫11症例に対する可能性とこのツールの有効性を示す時 IVC 計測と体積変化の関係を示しています。
ここでは、サンプル米国プロトコル、肺、下大静脈を肺浮腫症における水分除去療法を導き統合逆滝プロトコルを提案する.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Portable Ultrasound machine&#160;</td>
			<td>Shown in video: FUGIFILM/Sonosite</td>
			<td>Shown in video:&#160; M- Turbo</td>
			<td>Any portable ultrasound machine with the following capabilities 
			&#8226;&#160; B- Mode 
			&#8226;&#160; M- Mode 
			&#8226;&#160; Caliper measurement tool</td>
		</tr>
		<tr>
			<td>Transducer</td>
			<td>Shown in video: FUGIFILM/Sonosite</td>
			<td>Shown in video:&#160; P21</td>
			<td>Any ultrasound transducer probe with the following capabilities: 
			&#8226;&#160; Phased Array 
			&#8226;&#160; Low frequency (1-5MHz)</td>
		</tr>
	</tbody>
</table>

bedside ultrasound for guiding fluid removal in patients with pulmonary edema: the reverse-falls protocol

体液貯留が死亡と病気のボリューム オーバー ロード状態患者における心血管合併症の最も一般的な危険因子です。利尿や水分除去の程度は、頻繁不正確に応じてある身体検査によって決まります。
ベッドサイド超音波 (米国) は、患者さんのベッドサイドにリアルタイム診断をもたらすポータブル ツールです。この多彩な療法により、患者の血管外と血管内ボリュームの状態を調査する臨床医。肺浮腫の場合は特に、管外のボリュームは、左前胸部の私達によって定量的評価できます。血管内ボリュームを推定するには、下大静脈 (IVC) 口径を可視化.一緒に取られて、肺血管外水分と下大静脈口径程度の利尿効果はまだ安全性肺水腫の治療に必要なレベルを決定する臨床医を導くことができる客観的なデータを提供します。
この記事の目的は三重: 導き、流体管理、2) 3) テクニックを明らかにするガイド流体管理を支援するプロトコルの提案された超音波を記述するためのポータブル性 1) 前回の調査結果を要約するための研究を私たちポータブルを使用して血管内および血管外のボリュームの測定に対応します。

肺超音波は、図 1に示すように a ラインの可視化や B ライン人工物で管外区画中の流体の量を推定します。肺超音波 B 線の量は、図 2に示すように必要な水分の除去量を決定します。混合 a ラインと B ラインのパターン、またはラインの優勢なパターン余分な水分から比較的自由である肺実質を示唆しています。穏やかな利...

Watch this Scientific Journal Video about Bedside Ultrasound for Guiding Fluid Removal in Patients with Pulmonary Edema: The Reverse-FALLS Protocol at JoVE.com

Bedside Ultrasound for Guiding Fluid Removal in Patients with Pulmonary Edema: The Reverse-FALLS Protocol

肺水腫患者指導の水分除去のためのベッドサイド超音波: 逆滝プロトコル

視覚化する臨床医を可能にするイメージング プロトコルについて述べるリアルタイム、患者の血管内および血管外空間のボリュームとそれに応じて利尿および流体の除去パラメーターを設定肺水腫の安全で効率的な治療のため。

Fluid retention is the most common risk factor for mortality and cardiovascular complications in patients with volume-overloaded disease states. The ...

bedside-ultrasound-for-guiding-fluid-removal-patients-with-pulmonary

Research

JoVE Journal

Medicine

11.1K ビュー.  Stony Brook University School of Medicine. 視覚化する臨床医を可能にするイメージング プロトコルについて述べるリアルタイム、患者の血管内および血管外空間のボリュームとそれに応じて利尿および流体の除去パラメーターを設定肺水腫の安全で効率的な治療のため。

ビデオ: Bedside Ultrasound for Guiding Fluid Removal in Patients with Pulmonary Edema: The Reverse-FALLS Protocol

Real-time X-ray Imaging of Lung Fluid Volumes in Neonatal Mouse Lung

At birth, the lung undergoes a profound phenotypic switch from secretion to absorption, which allows for adaptation to breathing independently. Promoting and sustaining this phenotype is critically important in normal alveolar growth and gas exchange throughout life. Several in vitro studies have characterized the role of key regulatory proteins, signaling molecules, and steroid hormones that can influence the rate of lung fluid clearance. However, in vivo examinations must be performed to evaluate whether these regulatory factors play important physiological roles in regulating perinatal lung liquid absorption. As such, the utilization of real time X-ray imaging to determine perinatal lung fluid clearance, or pulmonary edema, represents a technological advancement in the field. Herein, we explain and illustrate an approach to assess the rate of alveolar lung fluid clearance and alveolar flooding in C57BL/6 mice at post natal day 10 using X-ray imaging and analysis. Successful implementation of this protocol requires prior approval from institutional animal care and use committees (IACUC), an in vivo small animal X-ray imaging system, and compatible molecular imaging software.

We present a protocol to assess the rate of alveolar fluid clearance or pulmonary edema in neonatal mouse lung using X-ray imaging technology.

新生児マウスの肺における肺流体体積のリアルタイムX線イメージング

At birth, the lung undergoes a profound phenotypic switch from secretion to absorption, which allows for adaptation to breathing independently. Promoting ...

医学

MRI-guided Focused Ultrasound Thalamotomy for Patients with Medically-refractory Essential Tremor

Essential tremor (ET) is the most common type of tremor in adults. While ET does not result in decreased life expectancy, the disabilities associated with ET can have a significant impact on quality of life, mood, functional activities, and socialization. Patients suffering from ET not sufficiently treated with first line medications may be eligible for alternative strategies such as deep brain stimulation, radiofrequency ablation, and MRI guided focused ultrasound (MRgFUS). High-intensity MRgFUS is an emerging modality to treat ET, its attraction for patients being that it is noninvasive and associated with short recovery time, as patients are home the day after treatment. While MRgFUS centers are still limited, it will become important for clinicians to consider MRgFUS as a treatment alternative, particularly in the case of a patient for whom open surgery is contraindicated. This article outlines the steps of patient selection, equipment setup, sonication, and post-treatment follow-up, as well as critical steps to be aware of when performing a MRgFUS procedure.

High-intensity MRI guided focused ultrasound is an emerging noninvasive technique to precisely ablate brain tissue. It has been shown to be safe and effective in treating medically-refractory essential tremor. This article describes the protocol for thalamotomy from patient selection to equipment setup to post-treatment follow-up.

医学的に難治性本態性振戦患者に対する MRI ガイド下集束超音波視床

Essential tremor (ET) is the most common type of tremor in adults. While ET does not result in decreased life expectancy, the disabilities associated with ...

A Detailed Protocol for Physiological Parameters Acquisition and Analysis in Neurosurgical Critical Patients

Intracranial pressure (ICP) monitoring is now widely used in neurosurgical critical patients. Besides mean ICP value, the ICP derived parameters such as ICP waveform, amplitude of pulse (AMP), the correlation of ICP amplitude and ICP mean (RAP), pressure reactivity index (PRx), ICP and arterial blood pressure (ABP) wave amplitude correlation (IAAC), and so on, can reflect intracranial status, predict prognosis, and can also be used as guidance of proper treatment. However, most of the clinicians focus only on the mean ICP value while ignoring these parameters because of the limitations of the current devices. We have recently developed a multimodality monitoring system to address these drawbacks. This portable, user-friendly system will use a data collecting and storing device to continuously acquire patients&#39; physiological parameters first, i.e., ABP, ICP, and oxygen saturation, and then analyze these physiological parameters. We hope that the multimodality monitoring system will be accepted as a key measure to monitor physiological parameters, to analyze the current clinical status, and to predict the prognosis of the neurosurgical critical patients.

Recently, we have developed a portable multimodality monitoring system for the monitoring of various physiological parameters in neurosurgical critical patients. Detailed protocols on how to use this multimodality monitoring system are presented here.

生理学的パラメーターの詳細なプロトコル獲得と脳神経外科の重要な患者の分析

Intracranial pressure (ICP) monitoring is now widely used in neurosurgical critical patients. Besides mean ICP value, the ICP derived parameters such as ...

An Optimized Evans Blue Protocol to Assess Vascular Leak in the Mouse

Vascular leak, or plasma extravasation, has a number of causes, and may be a serious consequence or symptom of an inflammatory response. This study may ultimately lead to new knowledge concerning the causes of or new ways to inhibit or treat plasma extravasation. It is important that researchers have the proper tools, including the best methods available, for studying plasma extravasation. In this article, we describe a protocol, using the Evans blue dye method, for assessing plasma extravasation in the organs of FVBN mice. This protocol is intentionally simple, to as great a degree as possible, but provides high quality data. Evans blue dye has been chosen primarily because it is easy for the average laboratory to use. We have used this protocol to provide evidence and support for the hypothesis that the enzyme neprilysin may protect the vasculature against plasma extravasation. However, this protocol may be experimentally used and easily adapted for use in other strains of mice or in other species, in many different organs or tissues, for studies which may involve other factors that are important in understanding, preventing, or treating plasma extravasation. This protocol has been extensively optimized and modified from existing protocols, and combines reliability, ease of use, economy, and general availability of materials and equipment, making this protocol superior for the average laboratory to use in quantifying plasma extravasation from organs.

In this article, an economical, optimized, and simple protocol is described which uses the Evans blue dye method for assessing plasma extravasation in the organs of FVBN mice that can be adapted for use in other strains, species, and other organs or tissues.

最適化されたエバンス ブルー マウス血管漏出を評価するためにプロトコル

Vascular leak, or plasma extravasation, has a number of causes, and may be a serious consequence or symptom of an inflammatory response. This study may ...

Left Atrial Stenosis Induced Pulmonary Venous Arterialization and Group 2 Pulmonary Hypertension in Rat

The mechanism of mitral stenosis-induced pulmonary venous arterialization and group 2 pulmonary hypertension (PH) is unclear. There is no rodent model of group 2 PH, due to mitral stenosis (MS), to facilitate the investigation of disease mechanisms and potential therapeutic strategies. We present a novel rat model of pulmonary venous congestion-induced pulmonary venous arterialization and group 2 PH caused by left atrial stenosis (LAS). LAS is achieved by constricting the left atrium using a half-closed titanium clip. After the LAS surgery, a rat model with a transmitral inflow velocity greater than or equal to 2.0 m/s on echocardiography gradually develops pulmonary venous arterialization and group 2 PH over an 8- to 10-week period. In this protocol, we provide the step-by-step procedure of how to perform the LAS surgery. The presented LAS rat model mimics MS in humans and is useful for studying the underlying molecular mechanism of pulmonary venous arterialization and for the preclinical evaluation of therapies for group 2 PH.

Left atrial stenosis (LAS) is a novel surgical technique used for studying group 2 pulmonary hypertension (PH) and mechanisms underlying pulmonary venous arterialization. Here, we present a protocol to constrict the left atrium using a titanium clip to cause pulmonary venous arterialization and moderate PH in a rat.

左心房狭窄による肺静脈動脈化術とグループ 2 肺高血圧症ラット

The mechanism of mitral stenosis-induced pulmonary venous arterialization and group 2 pulmonary hypertension (PH) is unclear. There is no rodent model of ...

Protocol and Guidelines for Point-of-Care Lung Ultrasound in Diagnosing Neonatal Pulmonary Diseases Based on International Expert Consensus

Ultrasound is a safe bedside imaging tool that obviates the use of ionizing radiation diagnostic procedures. Due to its convenience, the lung ultrasound has received increasing attention from neonatal physicians. Nevertheless, clear reference standards and guideline limits are needed for accurate application of this diagnostic modality. This document aims to summarize expert opinions and to provide precise guidance to help facilitate the use of the lung ultrasound in the diagnosis of neonatal lung diseases.

Lung ultrasound is a noninvasive and valuable tool for bedside evaluation of neonatal lung diseases. However, a relative lack of reference standards, protocols and guidelines may limit its application. Here, we aim to develop a standardized neonatal lung ultrasound diagnostic protocol to be used in clinical decision-making.

プロトコルおよび国際専門家のコンセンサスに基づいた新生児の肺疾患の診断にポイント ・ オブ ・ ケア肺超音波のためのガイドライン

Ultrasound is a safe bedside imaging tool that obviates the use of ionizing radiation diagnostic procedures. Due to its convenience, the lung ultrasound ...

A Real-World High-Intensity Interval Training Protocol for Cardiorespiratory Fitness Improvement

High-Intensity Interval Training (HIIT) has emerged as an interesting time-efficient approach to increase exercise adherence and improve health. However, few studies have tested the efficiency of HIIT protocols in a &#34;real world&#34; setting, e.g., HIIT protocols designed for outdoor spaces without specialized equipment. This study presents a &#34;real world&#34; training protocol, named &#34;beep training&#34;, and compares the efficiency of a HIIT regiment versus a traditional long-duration Moderate-Intensity Continuous Training (MICT) regiment using this beep training protocol on VO2 max of overweight untrained men. Twenty-two subjects performed outdoor running with MICT (n = 11) or HIIT (n = 11). Cardiorespiratory fitness was assessed before and after training protocols using a metabolic analyzer. Both training protocols were performed 3 days a week for 8 weeks using the Beep Test results. The MICT group performed the exercise program at 60%-75% of the maximum speed of the 20 m shuttle test (Vmax) and with a progression of the distance of 3,500-5,000 m. The HIIT group performed the interval exercise with 7-10 bouts of 200 m at 85%-100% of the maximum speed of the 20 m shuttle test (Vmax), interspersed with 1 min of passive recovery. Although the HIIT group presented a significantly lower training volume than the MICT group (p &#60; 0.05) after 8 weeks of beep training, HIIT was superior to MICT in improving VO2 max (MICT: ~4.1%; HIIT: ~7.3%; p &#60; 0.05). The &#34;real world&#34; HIIT regiment based on beep training protocol is a time-efficient, low-cost, and easy-to-implement protocol for overweight untrained men.

This study presents a low-cost and easy-to-implement "real world" high-intensity interval training (HIIT) protocol for scientific research and discusses its efficiency for cardiorespiratory fitness.

心肺機能改善のための現実世界の高強度インターバルトレーニングプロトコル

High-Intensity Interval Training (HIIT) has emerged as an interesting time-efficient approach to increase exercise adherence and improve health. However, ...

Modified Posterior Vertebral Column Resection for Patients with Thoracolumbar Kyphotic Deformity

Old compression vertebrae fracture or congenital kyphoscoliosis with abnormal vertebral body development and other diseases that invade the spine may cause severe thoracolumbar kyphotic deformity, often accompanied by intractable low back pain or compression of the spinal cord, leading to severe neurological symptoms or even paralysis. If conservative treatment cannot relieve the symptoms or correct the deformities, surgical treatment is usually needed. For severe kyphotic deformity, reconstruction of the physiological curvature and rigid fixation determine the prognosis of the patients. Osteotomy and orthopedics are the standard procedure for deformities with severe compression of the front and middle column, but the trauma to the patients is high, with a long operation time and massive blood loss. To avoid these disadvantages, we have developed a modified technique to remove the diseased vertebra unilaterally. In this technique, we use a modified trephine to resect the vertebral columns like in the pedicle screw technique by adding a locking instrument that can restrict the trephine to lower the risk of osteotomy and shorten the surgery time and blood loss.

We describe a modified technique for resecting the posterior vertebral column unilaterally based on a modified trephine for patients with thoracolumbar kyphotic deformity.

胸腰椎後弯変形症に対する修正後脊柱切除術

Old compression vertebrae fracture or congenital kyphoscoliosis with abnormal vertebral body development and other diseases that invade the spine may ...

Microscopic Cyst Resection for the Treatment of Patients Diagnosed with Epididymal Cyst

Epididymal cysts mostly occur in men aged 20-40 years old. Previous reports have covered concerns about postoperative complexes, including postoperative asoedema, hematoma, sustaining pain, and seminal tract obstruction in patients who have undertaken nonmicroscopic epididymal cyst resection or epididymal resection. Nonmicroscopic epididymal cyst surgery is suggested for patients with childbirth plans as a precaution. The treatment of male epididymal cysts via microtechnology is obviously a beneficial option; we took the lead in carrying out microscopic epididymal exploration and cyst resection surgery in China. From September 2017 to April 2021, 41 young and middle-aged male patients diagnosed with epididymal cysts underwent microtechnology treatment in a program titled &#34;microscopic epididymal exploration and cystectomy&#34;. The postoperative follow-up lasted for 3-50 months. The results confirmed that, as microscopic manipulation largely improved visualization of the subtle tissue structures of the epididymis, the cyst could be clearly dissected apart and completely removed intact under the microscope. Bleeding during the operation was significantly reduced (2-3 mL) and wound drainage was not required. According to follow-up data, microscopic treatment significantly reduced the incidence of postoperative scrotal hematoma, edema, and long-term postoperative pain, thereby promising a higher surgical success rate as well as recurrence prevention. Besides, preliminary experience and reflection suggest that microscopic epididymal exploration and cystectomy provide efficient preservation of the epididymal patency through refined treatment, while a better prognosis can be achieved. We recommend that surgery be carried out before the epididymal cyst develops to 0.8 cm in diameter, for fear that a larger epididymal cyst (&#62;0.9 cm in diameter) could cause the complete destruction of all tubules of the ipsilateral epididymis - a more severe case with damage to the testicular output network.

Here, we present a protocol to treat patients diagnosed with an epididymal cyst using microscopic cyst resection. Based on microscopic manipulation, a largely improved visualization of the subtle tissue structures of the epididymis was obtained, so the cyst could be clearly dissected apart and completely removed intact.

精巣上体嚢胞と診断された患者の治療のための顕微鏡嚢胞切除術

Epididymal cysts mostly occur in men aged 20-40 years old. Previous reports have covered concerns about postoperative complexes, including postoperative ...

全肺3D再構成による肺結節診断の強化

Three-Dimensional Reconstruction for the Whole Lung with Early Multiple Pulmonary Nodules

For patients with early multiple pulmonary nodules, it is essential, from a diagnostic perspective, to determine the spatial distribution, size, location, and relationship with surrounding lung tissue of these nodules throughout the entire lung. This is crucial for identifying the primary lesion and developing more scientifically grounded treatment plans for doctors. However, pattern recognition methods based on machine vision are susceptible to false positives and false negatives and, therefore, cannot fully meet clinical demands in this regard. Visualization methods based on maximum intensity projection (MIP) can better illustrate local and individual pulmonary nodules but lack a macroscopic and holistic description of the distribution and spatial features of multiple pulmonary nodules.
Therefore, this study proposes a whole-lung 3D reconstruction method. It extracts the 3D contour of the lung using medical image processing technology against the background of the entire lung and performs 3D reconstruction of the lung, pulmonary artery, and multiple pulmonary nodules in 3D space. This method can comprehensively depict the spatial distribution and radiological features of multiple nodules throughout the entire lung, providing a simple and convenient means of evaluating the diagnosis and prognosis of multiple pulmonary nodules.

著者スポットライト:早期肺がんにおける肺結節の診断と治療を強化するための3Dモデリングの進歩 

This study introduces a three-dimensional (3D) reconstruction method for the entire lung in patients with early multiple pulmonary nodules. It offers a comprehensive visualization of nodule distribution and their interplay with lung tissue, simplifying the assessment of diagnosis and prognosis for these patients.

早期多発性肺結節を有する全肺の三次元再構成

For patients with early multiple pulmonary nodules, it is essential, from a diagnostic perspective, to determine the spatial distribution, size, location, ...