1. 사례 발표 <ol><li> 환자는 출혈 장애의 발생으로 인해 종종 부인과 클리닉에 방문하실 수 있습니다. 신체 검사가 수행됩니다. <ol><li> 적절하다고 인정하는 경우, 환자는 자궁 예정이다. 서류가 준비되고, 환자는 수술 하루 전 처치가 부여됩니다. </li><li> 환자 육십년 세 이상 먼저 혈액 샘플을 제출하고 절차를하기 전에 심전도 (또는 ECG)에 의해 모니터링해야합니다. </li></ol></li><li> 수술 당일, 환자는 이전의 입장에 6 시간 동안 입으로 아무것도 섭취 할 수 없습니다. <ol><li> 예외가 이전 입장 두 시간까지 사용할 수 있습니다 펄프없이 달콤한 맑은 음료를 위해 구성되어 있습니다. </li><li> 환자는 지난 음료를 전 처치 (t.Paracetemol 1g이 + t.Etodolac 300 MG + t.Dexamethason 8 밀리그램)가 소요된다. </li></ol></li><li> 환자는 응용 프로그램을 인정하고 있습니다. 1 시간 전수술 예약 된 시간. <ol><li> 병동 간호사는 먼저 수술 환자를 준비합니다. </li><li> 마취는 환자를 검사하고 마취에 대한 서류를 준비합니다. </li></ol></li><li> 작업 공간을 준비하고 팀이 준비가되면, 산부인과 의사가 수술실로 환자를 전송합니다. <ol><li> 환자는 수술대에 눕고 수술 담요로 덮여있다. </li><li> IV 선은 왼쪽에 배치됩니다 식염수 1,000 ml로가 시작됩니다. 모니터링 장비가 부속되어 있습니다. </li><li> 마취는 의식의 손실 (LOC)가 발생할 때까지 프로포폴 및 삽관으로 유도하고, TOF를 사용하여 유지됩니다. </li><li> 삽관을 촉진, rocuronium (15 밀리그램)의 작은 복용량을 관리합니다. </li><li> 직접 후두경 검사가 수행됩니다. 그것은 성대를 시각화하기 어려운 경우, 맥그래스 videolaryngoscop이 사용됩니다. 기관 내 삽관은 이후 수행됩니다. </li></ol></li><li> 흡입으로복부 12 mmHg 이상 CO 2에서 시작됩니다. <ol><li> 포트가 배치됩니다. </li><li> 절차가 시작됩니다. </li><li> 외과 의사는 4 개 (TOF) 비율의 기차&gt; 신경근 차단에 해당하는 90 %가 이유입니다 꺼져있을 때 이야기입니다. </li><li> 움켜 잡의 목에 곶에서 배꼽의 피부의 표면에 거리가 표시됩니다. </li><li> 움켜 잡는 수술 테이블에 배치됩니다. 측정 테이프, 움켜 잡의 끝 움켜 잡 (외과 의사의 손가락에서)의 목 사이의 거리가 표시되고 다음 계산 된 거리를 센티미터 단위로 측정됩니다. </li></ol></li><li> CO 2의 insufflations 압력은 8 개 mm HG가로 낮아진다. <ol><li> 움켜 잡의 목에 곶에서 배꼽의 피부의 표면에 거리가 표시됩니다. </li><li> 움켜 잡는 테이블에 배치됩니다. 측정 테이프로 표시된 거리를 cm로 해석됩니다. </li></ol></li><lI&gt; CO 2 흡입으로 압력은 12mm의 수은으로 조정됩니다. <ol><li> 깊은 신경근 차단이 글 파상풍 계수 (PTC) &lt;2에 적용됩니다. </li><li> 움켜 잡의 목에 곶에서 배꼽의 피부의 표면에 거리가 표시됩니다. </li><li> 움켜 잡는 테이블에 배치됩니다. 측정 테이프로 표시된 거리를 cm로 측정됩니다. </li></ol></li><li> CO 2 흡입으로 압력은 8 개 mm HG가로 낮아진다. <ol><li> 움켜 잡의 목에 곶에서 배꼽의 피부의 표면에 거리가 표시됩니다. </li><li> 움켜 잡의 목에 곶에서 배꼽의 피부의 표면에 거리가 표시됩니다. </li></ol></li><li> 절차가 완료됩니다. <ol><li> 프로포폴 및 삽관의 주입이 종료됩니다. </li><li> 환자는 깨어 그 혹은 그녀의 침대로 이동합니다. </li><li> 환자는 회복실로 전송됩니다. </li></oL&gt; </li></ol>

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관심 없음 충돌 선언하지 않습니다.

<html> 직접 복강경 수술에 사용할 수있는 작업 양을 계산하는 것은 어려운 일이지만, insufflating CO 2 압력과 복부 볼륨 사이의 관계 9를 측정하는 것이 더 쉽습니다. 여기, 우리는 주입 된 CO 2의 양을 기록하는 방법에 대한 대안으로, 통기 동안 복부 내의 공간을 추정하기 위해 수술 움켜 잡을 사용하는 방법을 제시한다. 이러한 측정은 흡입으로 압력을 낮추고 깊...

신경 근육 차단제는 일반적으로 수술을 용이하게하기 위해, 마취, 기관 내 삽관을 촉진하고하는 데 사용됩니다. 복강경 절차를 통하여 깊은 휴식을 달성하기 위해 약물 에이전트의 사용은 더 나은 수술 조건에서 혜택을, 또는 수술 합병증의 위험을 낮출 수 insufflating 압력을 낮추면서 어느 외과 CO 2 흡입으로의 동일한 수준에서 진행 할 수 있습니다. 몇몇 연구는 압력 5,6,7을 낮추는 긍정적 인 효과를 보여 주었다. 자주 복강경 자궁 절제술 후 보이는 하나의 현상은 후속에 환자에게 말할 때 종종 큰 문제 가장 중요한 문제로 언급되는 어깨 통증입니다. 8 더 보수적 인 방법은 자궁 근종으로 인한 증상을 조절하는 데 실패하는 경우 복강경 자궁 근종 절제술 또는 자궁 적출술은 일반적으로 권장합니다. 우리 기관에서, 이러한 절차는12mm의 수은 insufflating CO 2 압력에서 수행. 모든 부인과 케이스를 수행하는 두 고도로 숙련 된 산부인과가 있습니다. 모든 경우가 프로포폴과 삽관과 마취, 그리고 기관 내 삽관은 종종 rocuronium의 낮은 복용량 (15 밀리그램)를 촉진합니다. 우리의 일상 임상 일에서 우리는 문학 (8)에 의해 지원되는 복강경 자궁 적출술 후에, 대부분의 불안 부작용의 하나로서 어깨 통증을 발견했습니다. 연구는 복강 내 압력을 줄이는 것 또한 어깨 통증을 줄일 수있는 것으로 나타났습니다. 절차를 수행하는 동안 수술 부위 및 가시성이 손상 될 경우 CO 2 흡입으로 압력을 줄이기위한 노력의 일환으로, 당사의 사전 관심사 중 하나였다. 절차를 수행하는 동안 개요를 확인하기 위해 노력하고, 우리는 복강 내 작업 공간을 비교하는 방법을 설정합니다. 그러나 쉬르 동안 환자에서 정확한 복강 볼륨을 모니터링하는 것은 매우 어려울 수 있습니다GERY. 벨기에 연구에서는 볼륨 압력의 관계를 설명하지만, 연구의 저자는 중요한 간 개인 차이가 9가 있다는 결론을 내렸다되었습니다. 복강 내 공간을보다 안정적 문을 얻기 위하여는, 우리는 미터법으로 피부에 곶까지의 거리를 사용합니다.

deep neuromuscular blockade leads to a larger intraabdominal volume during laparoscopy

어깨 통증은 자궁 근종이나 자궁 적출술 등의 복강경 절차에 따라 일반적으로보고 증상이며, 최근의 연구는 수술하는 동안 흡입으로 압력을 낮추는 것은 수술 후 통증의 위험을 줄일 수 있다는 것을 보여 주었다. 이 파일럿 연구에서, 방법은 깊은 신경근 차단에 의해 생성 된 휴식 CO 2의 감소를 허용하도록 충분히 작업 수술 공간을 늘릴 수 있는지 여부를 조사하기 위해, laproscopy 동안 의사에게 제공 복강 내 공간을 측정하기 위해 제시 흡입으로 압력. 8mm 수은, 12 mmHg로 : 복강경 움켜 잡을 사용하여 피부에 곶까지의 거리가 두 개의 서로 다른 흡입으로 압력에서 측정됩니다. 초기 측정 한 후, 신경근 차단 에이전트는 (rocuronium) 환자에게 투여되고 복강 볼륨을 다시 측정한다. 15 명에서 수집 한 시험 데이터는 BLO 8 mmHg 이상에서 그 복강 내 공간을 보여줍니다ckade는 봉쇄하지 않고 수은 12mm에서 측정 한 복강 내 공간을 비교할 수 있습니다. 신경 근육 차단제의 효과는 환자의 신장, 체중, BMI, 나이와 상관하지 않았다. 따라서 흡입으로 압력을 줄이면서 꾸준히 볼륨을 유지하기 위해 신경 근육 차단제를 사용하여 향상된 환자 결과를 생성 할 수 있습니다.

15 명이 파일럿 연구는 복강경 수술 중에 깊이 신경 근육 차단제의 영향을 평가하기 위해 수행되었다. 여기에 나와있는 방법은 복강경 자궁 적출술 (그림 1)을받은 환자에서 복강 내 공간의 측정을 위해 사용되었다. 깊은 신경근 차단하지 않고 12mm 수은 압력, 봉쇄 12 mmHg로, 봉쇄하지 않고 8 개 mm 수은 및 봉쇄 8 mmHg로 각 환자에서 복강 내 공간의 측정은 다음과 같?...

Watch this Scientific Journal Video about Deep Neuromuscular Blockade Leads to a Larger Intraabdominal Volume During Laparoscopy at JoVE.com

Deep Neuromuscular Blockade Leads to a Larger Intraabdominal Volume During Laparoscopy

이 문서에서는 수술 움켜 잡을 사용하여 복강경 자궁 근종 절제술 동안 작업 복부 볼륨을 측정하는 방법을 제시하고, 깊은 신경 근육 차단제 (NMB)는 낮은 흡입으로 압력의 사용을 활성화 할 수 있는지 여부에 대한 시험 데이터를 얻기 위해이 기술을 적용합니다. 복강경 수술 중 감소 된 흡입으로 압력이 수술 후 통증을 줄이기 위해 표시되었습니다, 따라서 수술 중 NMB의 사용은 향상된 환자 결과를 가능하게 할 수 있습니다.

깊은 신경 근육 학 봉쇄 복강경​​시 복강 큰 볼륨으로 오퍼

Shoulder pain is a commonly reported symptom following laparoscopic procedures such as myomectomy or hysterectomy, and recent studies have shown that ...

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13.1K 조회수.  Aleris-Hamlet Hospitals, Soeborg, Denmark. 이 문서에서는 수술 움켜 잡을 사용하여 복강경 자궁 근종 절제술 동안 작업 복부 볼륨을 측정하는 방법을 제시하고, 깊은 신경 근육 차단제 (NMB)는 낮은 흡입으로 압력의 사용을 활성화 할 수 있는지 여부에 대한 시험 데이터를 얻기 위해이 기술을 적용합니다. 복강경 수술 중 감소 된 흡입으로 압력이 수술 후 통증을 줄이기 위해 표시되었습니다, 따라서 수?...

비디오: Deep Neuromuscular Blockade Leads to a Larger Intraabdominal Volume During Laparoscopy

Dorsal Column Steerability with Dual Parallel Leads using Dedicated Power Sources:  A Computational Model

In spinal cord stimulation (SCS), concordance of stimulation-induced paresthesia over painful body regions is a necessary condition for therapeutic efficacy. Since patient pain patterns can be unique, a common stimulation configuration is the placement of two leads in parallel in the dorsal epidural space. This construct provides flexibility in steering stimulation current mediolaterally over the dorsal column to achieve better pain-paresthesia overlap. Using a mathematical model with an accurate fiber diameter distribution, we studied the ability of dual parallel leads to steer stimulation between adjacent contacts on dual parallel leads using (1) a single source system, and (2) a multi-source system, with a dedicated current source for each contact. The volume conductor model of a low-thoracic spinal cord with epidurally-positioned dual parallel (2 mm separation) percutaneous leads was first created, and the electric field was calculated using ANSYS, a finite element modeling tool. The activating function for 10 um fibers was computed as the second difference of the extracellular potential along the nodes of Ranvier on the nerve fibers in the dorsal column. The volume of activation (VOA) and the central point of the VOA were computed using a predetermined threshold of the activating function. The model compared the field steering results with single source versus dedicated power source systems on dual 8-contact stimulation leads. The model predicted that the multi-source system can target more central points of stimulation on the dorsal column than a single source system (100 vs. 3) and the mean steering step for mediolateral steering is 0.02 mm for multi-source systems vs 1 mm for single source systems, a 50-fold improvement. The ability to center stimulation regions in the dorsal column with high resolution may allow for better optimization of paresthesia-pain overlap in patients.

Using a mathematical model of spinal cord stimulation, we found that a multi-source system with independent power sources for each contact can target more central points of stimulation on the dorsal column (100 vs 3) and has 50-fold more field steering resolution (0.02mm vs 1mm) than a single-source system.

전용 전원을 사용하여 이중 병렬 리드와 도설 칼럼 Steerability : 전산 모델

In spinal cord stimulation (SCS), concordance of stimulation-induced paresthesia over painful body regions is a necessary condition for therapeutic ...

연구

의학

Utilizing Transcranial Magnetic Stimulation to Study the Human Neuromuscular System

Transcranial magnetic stimulation (TMS) has been in use for more than 20 years 1, and has grown exponentially in popularity over the past decade. While the use of TMS has expanded to the study of many systems and processes during this time, the original application and perhaps one of the most common uses of TMS involves studying the physiology, plasticity and function of the human neuromuscular system. Single pulse TMS applied to the motor cortex excites pyramidal neurons transsynaptically 2 (Figure 1) and results in a measurable electromyographic response that can be used to study and evaluate the integrity and excitability of the corticospinal tract in humans 3. Additionally, recent advances in magnetic stimulation now allows for partitioning of cortical versus spinal excitability 4,5. For example, paired-pulse TMS can be used to assess intracortical facilitatory and inhibitory properties by combining a conditioning stimulus and a test stimulus at different interstimulus intervals 3,4,6-8. In this video article we will demonstrate the methodological and technical aspects of these techniques. Specifically, we will demonstrate single-pulse and paired-pulse TMS techniques as applied to the flexor carpi radialis (FCR) muscle as well as the erector spinae (ES) musculature. Our laboratory studies the FCR muscle as it is of interest to our research on the effects of wrist-hand cast immobilization on reduced muscle performance6,9, and we study the ES muscles due to these muscles clinical relevance as it relates to low back pain8. With this stated, we should note that TMS has been used to study many muscles of the hand, arm and legs, and should iterate that our demonstrations in the FCR and ES muscle groups are only selected examples of TMS being used to study the human neuromuscular system.

Transcranial magnetic stimulation (TMS) is a non-invasive tool to gain insight on the physiology and function of the human nervous system. Here, we present our TMS techniques to study cortical excitability of the upper limb and lumbar musculature.

인간 신경근육학 시스템을 공부하기 Transcranial 자기 자극을 활용

Transcranial magnetic stimulation (TMS) has been in use for more than 20 years 1, and has grown exponentially in popularity over the past decade.  While ...

A Murine Model of Muscle Training by Neuromuscular Electrical Stimulation

Neuromuscular electrical stimulation (NMES) is a common clinical modality that is widely used to restore1, maintain2 or enhance3-5 muscle functional capacity. Transcutaneous surface stimulation of skeletal muscle involves a current flow between a cathode and an anode, thereby inducing excitement of the motor unit and the surrounding muscle fibers. 
NMES is an attractive modality to evaluate skeletal muscle adaptive responses for several reasons. First, it provides a reproducible experimental model in which physiological adaptations, such as myofiber hypertophy and muscle strengthening6, angiogenesis7-9, growth factor secretion9-11, and muscle precursor cell activation12 are well documented. Such physiological responses may be carefully titrated using different parameters of stimulation (for Cochrane review, see 13). In addition, NMES recruits motor units non-selectively, and in a spatially fixed and temporally synchronous manner14, offering the advantage of exerting a treatment effect on all fibers, regardless of fiber type. Although there are specified contraindications to NMES in clinical populations, including peripheral venous disorders or malignancy, for example, NMES is safe and feasible, even for those who are ill and/or bedridden and for populations in which rigorous exercise may be challenging. 
Here, we demonstrate the protocol for adapting commercially available electrodes and performing a NMES protocol using a murine model. This animal model has the advantage of utilizing a clinically available device and providing instant feedback regarding positioning of the electrode to elicit the desired muscle contractile effect. For the purpose of this manuscript, we will describe the protocol for muscle stimulation of the anterior compartment muscles of a mouse hindlimb.

A murine model of neuromuscular electrical stimulation (NMES), a safe and inexpensive clinical modality, to the anterior compartment muscles is described. This model has the advantage of modifying a readily available clinical device for the purpose of eliciting targeted and specific muscle contractions in mice.

신경근육학 전기적 자극에 의​​해 근육 트레이닝의 Murine 모델

Neuromuscular electrical stimulation (NMES) is a common clinical modality that is widely used to restore1, maintain2 or enhance3-5 muscle functional ...

Construction of Vapor Chambers Used to Expose Mice to Alcohol During the Equivalent of all Three Trimesters of Human Development

Exposure to alcohol during development can result in a constellation of morphological and behavioral abnormalities that are collectively known as Fetal Alcohol Spectrum Disorders (FASDs). At the most severe end of the spectrum is Fetal Alcohol Syndrome (FAS), characterized by growth retardation, craniofacial dysmorphology, and neurobehavioral deficits. Studies with animal models, including rodents, have elucidated many molecular and cellular mechanisms involved in the pathophysiology of FASDs. Ethanol administration to pregnant rodents has been used to model human exposure during the first and second trimesters of pregnancy. Third trimester ethanol consumption in humans has been modeled using neonatal rodents. However, few rodent studies have characterized the effect of ethanol exposure during the equivalent to all three trimesters of human pregnancy, a pattern of exposure that is common in pregnant women. Here, we show how to build vapor chambers from readily obtainable materials that can each accommodate up to six standard mouse cages. We describe a vapor chamber paradigm that can be used to model exposure to ethanol, with minimal handling, during all three trimesters. Our studies demonstrate that pregnant dams developed significant metabolic tolerance to ethanol. However, neonatal mice did not develop metabolic tolerance and the number of fetuses, fetus weight, placenta weight, number of pups/litter, number of dead pups/litter, and pup weight were not significantly affected by ethanol exposure. An important advantage of this paradigm is its applicability to studies with genetically-modified mice. Additionally, this paradigm minimizes handling of animals, a major confound in fetal alcohol research.

We demonstrate the construction of alcohol vapor chambers using readily available materials that simultaneously house 6 mouse cages. We further describe their use in a mouse model of fetal alcohol exposure equivalent to all 3&#160;trimesters of human pregnancy. This paradigm exposes animals during gestation and postnatal days 1-12.

인간 발달의 세 삼 분기의 상당 기간 동안 알코올에 쥐를 노출하는 데 사용 증기 챔버의 건설

Exposure to alcohol during development can result in a constellation of morphological and behavioral abnormalities that are collectively known as Fetal ...

Clinical Assessment of Spatiotemporal Gait Parameters in Patients and Older Adults

Spatial and temporal characteristics of human walking are frequently evaluated to identify possible gait impairments, mainly in orthopedic and neurological patients1-4, but also in healthy older adults5,6. The quantitative gait analysis described in this protocol is performed with a recently-introduced photoelectric system (see&#160;Materials table) which has the potential to be used in the clinic because it is portable, easy to set up (no subject preparation is required before a test), and does not require maintenance and sensor calibration. The photoelectric system consists of series of high-density floor-based photoelectric cells with light-emitting and light-receiving diodes that are placed parallel to each other to create a corridor, and are oriented perpendicular to the line of progression7. The system simply detects interruptions in light signal, for instance due to the presence of feet within the recording area. Temporal gait parameters and 1D spatial coordinates of consecutive steps are subsequently calculated to provide common gait parameters such as step length, single limb support and walking velocity8, whose validity against a criterion instrument has recently been demonstrated7,9. The measurement procedures are very straightforward; a single patient can be tested in less than 5 min&#160;and a comprehensive report can be generated in less than 1&#160;min.

This protocol is used to evaluate spatial and temporal gait variables of neurological/orthopedic patients and older persons by means of a recently-introduced floor-based photocell system.

환자와 노인의 시공간 보행 매개 변수의 임상 평가

Spatial and temporal characteristics of human walking are frequently evaluated to identify possible gait impairments, mainly in orthopedic and ...

Busulfan as a Myelosuppressive Agent for Generating Stable High-level Bone Marrow Chimerism in Mice

Bone marrow transplantation (BMT) is often used to replace the bone marrow (BM) compartment of recipient mice with BM cells expressing a distinct biomarker isolated from donor mice. This technique allows for identification of donor-derived hematopoietic cells within the recipient mice, and can be used to isolate and characterize donor cells using various biochemical techniques. BMT typically relies on myeloablative conditioning with total body irradiation to generate niche space within the BM compartment of recipient mice for donor cell engraftment. The protocol we describe here uses myelosuppressive conditioning with the chemotherapeutic agent busulfan. Unlike irradiation, which requires the use of specialized facilities, busulfan conditioning is performed using intraperitoneal injections of 20 mg/kg busulfan until a total dose of 60-100 mg/kg has been administered. Moreover, myeloablative irradiation can have toxic side effects and requires successful engraftment of donor cells for survival of recipient mice. In contrast, busulfan conditioning using these doses is generally well tolerated and mice survive without donor cell support. Donor BM cells are isolated from the femurs and tibiae of mice ubiquitously expressing green fluorescent protein (GFP), and injected into the lateral tail vein of conditioned recipient mice. BM chimerism is estimated by quantifying the number of GFP+ cells within the peripheral blood following BMT. Levels of chimerism&nbsp;>80% are typically observed in the peripheral blood 3-4 weeks post-transplant and remain established for at least 1 year. As with irradiation, conditioning with busulfan and BMT allows for the accumulation of donor BM-derived cells within the central nervous system (CNS), particularly in mouse models of neurodegeneration. This busulfan-mediated CNS accumulation may be more physiological than total body irradiation, as the busulfan treatment is less toxic and CNS inflammation appears to be less extensive. We hypothesize that these cells can be genetically engineered to deliver therapeutics to the CNS.

We describe a protocol whereby busulfan conditioning permits the bone marrow of a recipient mouse to be replaced with bone marrow cells from donor mice ubiquitously expressing green fluorescent protein, in the absence of irradiation. This technique is useful to study bone marrow cell accumulation in the central nervous system.

마우스에서의 높은 수준의 안정적인 골수 키메라를 생성하기위한 에이전트로서 골수 억제 술판

Bone marrow transplantation (BMT) is often used to replace the bone marrow (BM) compartment of recipient mice with BM cells expressing a distinct ...

A Multicenter MRI Protocol for the Evaluation and Quantification of Deep Vein Thrombosis

We evaluated a magnetic resonance venography (MRV) approach with gadofosveset to quantify total thrombus volume changes as the principal criterion for treatment efficacy&#160;in a multicenter randomized study comparing edoxaban monotherapy with a heparin/warfarin regimen for acute, symptomatic lower extremities deep vein thrombosis (DVT) treatment. We also used a direct thrombus imaging approach (DTHI, without the use of a contrast agent) to quantify fresh thrombus. We then sought to evaluate the reproducibility of the analysis methodology and applicability of using 3D magnetic resonance venography and direct thrombus imaging for the quantification of DVT in a multicenter trial setting. From 10 randomly selected subjects participating in the edoxaban Thrombus Reduction Imaging Study (eTRIS), total thrombus volume in the entire lower extremity deep venous system was quantified bilaterally. Subjects were imaged using 3D-T1W gradient echo sequences before (direct thrombus imaging, DTHI) and 5 min after injection of 0.03 mmol/kg of gadofosveset trisodium (magnetic resonance venography, MRV). The margins of the DVT on corresponding axial, curved multi-planar reformatted images were manually delineated by two observers to obtain volumetric measurements of the venous thrombi. MRV was used to compute total DVT volume, whereas DTHI was used to compute volume of fresh thrombus. Intra-class correlation (ICC) and Bland Altman analysis were performed to compare inter and intra-observer variability of the analysis. The ICC for inter and intra-observer variability was excellent (0.99 and 0.98, p &#60;0.001, respectively) with no bias on Bland-Altman analysis for MRV images. For DTHI images, the results were slightly lower (ICC = 0.88 and 0.95 respectively, p &#60;0.001), with bias for inter-observer results on Bland-Altman plots. This study showed feasibility of thrombus volume estimation in DVT using MRV with gadofosveset trisodium, with good intra- and inter-observer reproducibility in a multicenter setting.

The goal of this study is to use magnetic resonance venography with long-circulating gadolinium-based contrast agent and direct thrombus imaging for quantitative evaluation of DVT volume in a multicenter, clinical trial setting. Inter- and intra-observer variability assessments were conducted, and reproducibility of the protocol was determined.

깊은 정맥 혈전증의 평가 및 정량화를위한​​ 다기관 MRI 프로토콜

We evaluated a magnetic resonance venography (MRV) approach with gadofosveset to quantify total thrombus volume changes as the principal criterion for ...

Using Saccadometry with Deep Brain Stimulation to Study Normal and Pathological Brain Function

The oculomotor system involves a large number of brain areas including parts of the basal ganglia, and various neurodegenerative diseases including Parkinson's and Huntington's can disrupt it. People with Parkinson's disease, for example, tend to have increased saccadic latencies. Consequently, the quantitative measurement of saccadic eye movements has received considerable attention as a potential biomarker for neurodegenerative conditions. A lot more can be learned about the brain in both health and disease by observing what happens to eye movements when the function of specific brain areas is perturbed. Deep brain stimulation is a surgical intervention used for the management of a range of neurological conditions including Parkinson's disease, in which stimulating electrodes are placed in specific brain areas including several sites in the basal ganglia. Eye movement measurements can then be made with the stimulator systems both off and on and the results compared. With suitable experimental design, this approach can be used to study the pathophysiology of the disease being treated, the mechanism by which DBS exerts it beneficial effects, and even aspects of normal neurophysiology.

This paper describes the use of quantitative measurement of eye movements in conjunction with stimulation of focal areas of the deep brain in order to study physiology, pathophysiology, and the mechanisms of deep brain stimulation.

깊은 뇌 자극과 Saccadometry를 사용하여 정상 및 병적 뇌 기능을 연구하는

The oculomotor system involves a large number of brain areas including parts of the basal ganglia, and various neurodegenerative diseases including ...

Assessment of Pulmonary Capillary Blood Volume, Membrane Diffusing Capacity, and Intrapulmonary Arteriovenous Anastomoses During Exercise

Exercise is a stress to the pulmonary vasculature. With incremental exercise, the pulmonary diffusing capacity (DLCO) must increase to meet the increased oxygen demand; otherwise, a diffusion limitation may occur. The increase in DLCO with exercise is due to increased capillary blood volume (Vc) and membrane diffusing capacity (Dm). Vc and Dm increase secondary to the recruitment and distension of pulmonary capillaries, increasing the surface area for gas exchange and decreasing pulmonary vascular resistance, thereby attenuating the increase in pulmonary arterial pressure. At the same time, the recruitment of intrapulmonary arteriovenous anastomoses (IPAVA) during exercise may contribute to gas exchange impairment and/or prevent large increases in pulmonary artery pressure.
We describe two techniques to evaluate pulmonary diffusion and circulation at rest and during exercise. The first technique uses multiple-fraction of inspired oxygen (FIO2) DLCO breath holds to determine Vc and Dm at rest and during exercise. Additionally, echocardiography with intravenous agitated saline contrast is used to assess IPAVAs recruitment.
Representative data showed that the DLCO, Vc, and Dm increased with exercise intensity. Echocardiographic data showed no IPAVA recruitment at rest, while contrast bubbles were seen in the left ventricle with exercise, suggesting exercise-induced IPAVA recruitment.
The evaluation of pulmonary capillary blood volume, membrane diffusing capacity, and IPAVA recruitment using echocardiographic methods is useful to characterize the ability of the lung vasculature to adapt to the stress of exercise in health as well as in diseased groups, such as those with pulmonary arterial hypertension and chronic obstructive pulmonary disease.

To assess the pulmonary diffusion and vasculature responses to exercise, we describe the multiple-inspired oxygen diffusion capacity technique to determine capillary blood volume and membrane diffusing capacity, as well as agitated saline contrast echocardiography to assess the recruitment of intrapulmonary arteriovenous anastomoses.

운동 중 폐 모세관 혈액 볼륨, 멤브레인 확산 용량 및 폐내 동정맥 문합 평가

Exercise is a stress to the pulmonary vasculature. With incremental exercise, the pulmonary diffusing capacity (DLCO) must increase to meet the increased ...

Surgical Techniques to Optimize Ovarian Reserve during Laparoscopic Cystectomy for Ovarian Endometrioma

Surgical management of ovarian endometrioma in patients desiring fertility is complicated by the need to balance maximal resection of disease with efforts to spare normal ovarian cortex. Optimization of tubal anatomy is another frequent consideration. Fertility-sparing laparoscopic techniques at the time of cystectomy for ovarian endometrioma seek to limit iatrogenic surgical damage to the ovarian cortex and strategically assess and respond to genital tract patency. Surgical candidates frequently desire relief from endometriosis-associated pain while also seeking to optimize spontaneous or assisted conception rates. Operative benefits include potential for surgical and histopathologic diagnosis of endometriosis, evaluation of genital tract patency, and treatment of visualized lesions. Resection of ovarian endometrioma nonetheless poses significant risks, including surgical injury, blood loss, post-surgical decline in ovarian reserve and post-operative inflammation with adhesion formation, both of which may impair folliculogenesis.
We present the case of a 32-year-old woman with known endometriosis and continued pain refractory to medical management who opted for surgical management of her disease tailored toward optimizing her chances at future conception. Using this case as an example, we describe techniques and considerations for diagnostic laparoscopy, adhesiolysis, ovarian cystectomy, chromopertubation, and salpingectomy with a focus on maintaining a fertility-preserving approach.

This protocol presents techniques to laparoscopically excise ovarian endometrioma, to perform adhesiolysis with sparing electrosurgical application, and to employ intraoperative chromopertubation to assess for genital tract patency. This systematic approach will facilitate optimal endometriosis management, guide concomitant adnexal surgeries, and enhance post-surgical fertility outcomes.

난소 자궁내막증에 대한 복강경 낭포절제술 중 난소 보호구역을 최적화하는 외과 기술

Surgical management of ovarian endometrioma in patients desiring fertility is complicated by the need to balance maximal resection of disease with efforts ...

깊은 신경 근육 학 봉쇄 복강경​​시 복강 큰 볼륨으로 오퍼

깊은 신경 근육 학 봉쇄 복강경시 복강 큰 볼륨으로 오퍼