ObjectiveTo evaluate clinical outcomes of real-time ultrasound-guided percutaneous dilatational tracheostomy (PDT)for patients after cardiac surgery. MethodsFrom July 2008 to August 2012, 51 patients received tracheostomy after cardiac surgery in Nanjing Drum Tower Hospital of Nanjing University Medical School, including 20 patients after heart valve replacement, 17 patients after aortic dissection (De Bakey type I)surgery, 11 patients after coronary artery bypass grafting and 3 patients after surgical correction of congenital heart diseases. According to different surgical methods, all the patients were divided into 3 groups. In surgical tracheostomy (ST)group, there were 17 patients including 10 males and 7 females with their average age of 58.0±15.2 years. In fiberoptic bronchoscope guided PDT (FOB-PDT)group, there were 21 patients including 15 males and 6 females with their average age of 63.5±13.5 years. In real-time ultrasound-guided PDT (US-PDT)group, there were 13 patients including 7 males and 6 females with their average age of 64.5±10.2 years. Surgical outcomes were compared among the 3 groups. ResultsAll PDT operations were successfully completed. There was 1 failed patient in ST group. The incidence of bleeding was 41.18% in ST group, 9.53% in FOB-PDT group and 7.70% in US-PDT group (P=0.038). The incidence of mediastinal infection was 17.65% in ST group, 0% in FOB-PDT and US-PDT group (P=0.046). There was no statistical difference in endotracheal tube retention time, length of ICU stay and hospitalization, mortality or morbidity (hypoxemia, pneumothorax, subcutaneous emphysema)among the 3 groups. One patient in ST group developed late tracheal stenosis. ConclusionReal-time ultrasound can provide information about cervical anatomy and help choose puncture site for PDT, which can improve the safety and reduce surgical difficulty and morbidity of PDT of patients after cardiac surgery.
Diabetes and its complications that seriously threaten the health and life of human, has become a public health problem of global concern. Glycemic control remains a major focus in the treatment and management of patients with diabetes. The traditional lifestyle interventions, drug therapies, and surgeries have benefited many patients with diabetes. However, due to problems such as poor patient compliance, drug side effects, and limited surgical indications, there are still patients who fail to effectively control their blood glucose levels. With the development of bioelectronic medicine, neuromodulation techniques have shown great potential in the field of glycemic control and diabetes intervention with its unique advantages. This paper mainly reviewed the research advances and latest achievements of neuromodulation technologies such as peripheral nerve electrical stimulation, ultrasound neuromodulation, and optogenetics in blood glucose regulation and diabetes intervention, analyzed the existing problems and presented prospects for the future development trend to promote clinical research and application of neuromodulation technologies in the treatment of diabetes.
ObjectiveTo explore the significance of ultrasound combined with magnetic resonance imaging (MRI) in the diagnosis of pernicious placenta previa (PPP).MethodsA total of 101 patients with suspected PPP admitted to Chengdu Women’s and Children’s Central Hospital from January 2016 to February 2019 were retrospectively analyzed. The surgical results were used as the gold standard, and the diagnostic value of ultrasound, MRI, ultrasound combined with MRI was compared.ResultsSurgery results showed that among the 101 patients with suspected PPP, 79 patients had positive PPP diagnosis and 22 patients had negative PPP diagnosis. There was no significant difference in the diagnostic sensitivity, negative predictive value, or diagnostic coincidence rate of PPP among ultrasound, MRI, and ultrasound combined with MRI (P>0.05). The diagnostic specificity of the series combination of ultrasound and MRI (86.36%) was higher than that of ultrasound (59.10%), MRI (59.10%), and the parallel combination of ultrasound and MRI (31.32%), and the differences were statistically significant (P<0.05). The diagnostic coincidence rates of abnormal placental attachment of MRI (96.20%) and the parallel combination of ultrasound and MRI (96.20%) were higher than that of ultrasound (87.34%) and the series combination of ultrasound and MRI (87.34%) (P<0.05).ConclusionsUltrasound combined with MRI has a high diagnostic value for PPP. If necessary, ultrasound combined with MRI can be considered to improve the diagnostic efficiency.
Objective To Assess the efficacy of using lung ultrasound to guide alveolar recruitment maneuver in patients with acute respiratory distress syndrome (ARDS). Methods Sixty patients with ARDS were randomly divided into two groups, ie, maximal oxygenation group (n=30) and lung ultrasound group (n=30). All the patients had artificial airway and needed mechanical ventilation. The patients in the two groups accepted recruitment maneuver guided by maximal oxygenation or lung ultrasound respectively. During the course of recruitment maneuver, the arterial partial pressure of oxygen (PaO2), positive end-expiratory pressure (PEEP), central venous pressure (CVP), mean arterial pressure (MAP), cardiac output (CO), and extravascular lung water index (EVLWI) were recorded and compared between both groups. Results The PaO2 in lung ultrasound group was higher than that in maximal oxygenation group (P=0.04). The PEEP was higher in lung ultrasound group but without significant difference (P=0.910). There was no significant difference of the other outcomes (CVP, MAP, CO, EVLWI) between the two groups (all P>0.05). Conclusion Lung ultrasound is an effective means that has good repeatability and security for guiding recruitment maneuver in patients with ARDS.
Objective To assess value and limitations of non-invasive methods in assessing liver fibrosis．Methods By summarized current situation and advancement of serum fibrotic markers, ultrasound, CT and MRI in assessing liver fibrosis, we investigated their value and limitations. Results In addition to diagnosis, non-invasive methods of assessing liver fibrosis assess severity of liver fibrosis. For liver fibrosis, however, non-invasive methods can not monitor effectively reaction to therapy and progression. Conclusion Non-invasive methods play important roles in diagnosis and assessing severity of liver fibrosis, and reduce the need of liver biopsy.
Objective To explore the clinical value and experience of ultrasound guided combined with laparoscopic microwave ablation in treatment for special site liver cancer．Methods The clinical data of 9 patients with liver cancer treated by ultrasound guided combined with laparoscopic microwave ablation in our hospital from February 2008 to October 2010 were analyzed retrospectively．Results There were 6 cases of primary liver cancer， 3 cases of metastatic hepatic carcinoma. Eight cases of multiple tumors， 1 case of single tumor．There were one or more lesions invading liver capsular，a total of 13 lesions in all the patients． Among them，6 lesions located in diaphragm， 3 closed to bowel， 2 neared stomach，1 located in gallbladder bed and 1 in hilar．No serious complications and no death happened during operation．The following-up time was （9.2±4.7） months （4 to 18 months）， there were 2 lesions of part residual， including 1 case of microwave ablation again，1 case of percutaneous ethanol ablation， and 11 lesions of complete ablation （84.6%，11/13） 1 month after operation by CT examination．Four cases recurred 3 months after operation by CT examination， including 2 cases of microwave ablation again，1 case of percutaneous ethanol ablation，1 patient with pulmonary metastasis and giving up treatment，1 patient with poor liver function and died of liver failure 6 months after operation；1 patient with multiple lesions died of brain metastases 10 months after operation； the rest were still alive．Conclusions Ultrasound guided combined with laparoscopic microwave ablation is a safe and effective method in the treatment for special site liver cancer，the curative effect is good and worth of spread．
ObjectiveTo systematically evaluate the value of magnetic resonance imaging (MRI) combined with ultrasound in the diagnosis of node metastases in breast cancer patients. MethodsThe articles concerning the diagnosis of node metastases by using MRI combined with ultrasound until September 2016 were searched in the databases including The Cochrane Library, PubMed, EMbase, Web of Science, CBM, WanFang Data and CNKI. Two reviewers independently screened literature, extracted data according to pre-set included and excluded criteria, and assessed the risk of bias of included studies by using the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies-2) tool. Then, meta-analysis was performed by using Stata 12.0 software. The pooled weighted sensitivity (Sen), specificity (Spe), Positive likehoodn (+LR), Negative likehood (-LR) and diagnostic odds ratio (DOR) were calculated, the summary receiver operating characteristic (SROC) curve was drawn and the area under the curve was calculated. ResultsA total of eight studies were included, involving 2 288 patients. The pooled Sen, Spe, +LR,-LR, DOR and area under SROC curve of MRI combined with ultrasound in the diagnosis of breast cancer patients with node metastases were 0.74 (95%CI 0.54 to 0.87), 0.95 (95%CI 0.88 to 0.98), 13.95 (95%CI 6.04 to 32.22), 0.28 (95%CI 0.15 to 0.52), 50.38 (95%CI 17.56 to 144.60), and 0.94 (95%CI 0.91 to 0.96), respectively. ConclusionMRI combined with ultrasound has more diagnostic efficiency for assessing lymph node in breast cancer, therefore, it can be used as an effective method with the diagnosis of node metastases in breast cancer patients.
ObjectiveTo explore the clinical efficacy and safety of ultrasound-guided intra-articular injection of platelet-rich plasma (PRP) in the treatment of avascular necrosis of the femoral head.MethodsWe retrospectively collected and analyzed the clinical characteristics, imaging data, and clinical outcomes of patients with femoral head necrosis who received ultrasound-guided intra-articular PRP injection in the Department of Rehabilitation Medicine of Sun Yat-sen Memorial Hospital, Sun Yat-sen University between June 2019 and June 2020. All the patients received 4 injections at one-week intervals. The Visual Analogue Scale (VAS), Western Ontario and McMaster University Osteoarthritis Index (WOMAC), and Harris Hip Joint Function Scale (HHS) were evaluated before treatment and 1 month, 3 months, and 6 months after the first injections. Adverse events were recorded. The normally distributed data were presented as mean±standard deviation, and analyzed by one-way repeated measures analysis of variance; the non-normally distributed data were presented as median (lower quartile, upper quartile), and analyzed by Friedman test.ResultsA total of 29 patients were included. According to the Association Research Circulation Osseous classification standard, 2 patients were classified as stageⅠ, 11 as stageⅡ, 11 as stage Ⅲ, and 5 as stage Ⅳ. Before treatment and 1 month, 3 months, and 6 months after treatment, the VAS scores were 7.0 (5.5, 8.0), 4.0 (3.0, 5.0), 3.0 (2.0, 3.0), and 3.0 (2.0, 5.0), respectively, the WOMAC scores were 39.27±11.70, 28.34±8.08, 22.82±6.09, and 24.13±7.55, respectively, and the HHS were 46.0 (40.0, 64.0), 71.0 (57.5, 75.0), 78.0 (68.0, 80.5), and 78.0 (64.0, 80.0), respectively. The time effects in VAS (χ2=65.423, P<0.001), WOMAC (F=46.710, P<0.001), and HHS (χ2=66.347, P<0.001) were all statistically significant. There were significant differences in each index between the values 1 month, 3 months, and 6 months after treatment and those before treatment respectively, and there was also a significant difference in each index between the value 1 month after treatment and that 3 months after treatment (P<0.05). There was no significant difference in any indicator between the value 6 months after treatment and that 3 months after treatment (P>0.05). Significant difference was shown between the value 6 months after treatment and that 1 month after treatment in WOMAC (P=0.016), but not in VAS or HHS (P>0.05). No obvious adverse event was reported during the follow-up period.ConclusionsUltrasound-guided intra-articular PRP injection can effectively alleviate the pain and improve the hip joint function of patients with femoral head necrosis for at least 6 months. However, randomized controlled studies with a larger sample size and longer-term follow-up are needed in the future to confirm the efficacy and safety of PRP injection in femoral head necrosis.
Objective To compare canine decel luarized venous valve stent combining endothel ial progenitor cells (EPC) with native venous valve in terms of venous valve closure mechanism in normal physiological conditions. Methods Thirty-six male hybrid dogs weighing 15-18 kg were used. The left femoral vein with valve from 12 dogs was harvested to prepare decelluarized valved venous stent combined with EPC. The rest 24 dogs were randomly divided into the experimental group and the control group (n=12 per group). In the experimental group, EPC obtained from the bone marrowthrough in vitro ampl ification were cultured, the cells at passage 3 (5 × 106 cells/mL) were seeded on the stent, and the general and HE staining observations were performed before and after the seeding of the cells. In the experimental group, allogenic decelluarized valved venous stent combined with EPC was transplanted to the left femoral vein region, while in the control group, the autogenous vein venous valve was implanted in situ. Color Doppler Ultrasound exam was performed 4 weeks after transplantation to compare the direction and velocity of blood flow in the distal and proximal end of the valve, and the changes of vein diameter in the valve sinus before and after the closure of venous valve when the dogs changed from supine position to reverse trendelenburg position. Results General and HE staining observations before and after cell seeding: the decelluarized valved venous stent maintained its fiber and collagen structure, and the EPC were planted on the decelluarized stent successfully through bioreactor. During the period from the reverse trendelenburg position to the starting point for the closure of the valve, the reverse flow of blood occurred in the experimental group with the velocity of (1.4 ± 0.3) cm/s; while in the control group, there was no reverse flow of blood, but the peak flow rate was decreased from (21.3 ± 2.1) cm/s to (18.2 ± 3.3) cm/s. In the control group, the active period of valve, the starting point for the closure of the valve, and the time between the beginning of closure and the complete closure was (918 ± 46), (712 ± 48), and (154 ± 29) ms, respectively; while in the experimental group, it was (989 ± 53), (785 ± 43), and (223 ± 29) ms, respectively. There was significant difference between two groups (P lt; 0.05).After the complete closure of valve, no reverse flow of blood occurred in two groups. The vein diameter in the valve sinus of the experimental and the control group after the valve closure was increased by 116.8% ± 2.0% and 118.5% ± 2.2%, respectively, when compared with the value before valve closure (P gt; 0.05). Conclusion Canine decelluarized venous valve stent combined with EPC is remarkably different from natural venous valve in terms of the valve closure mechanism in physiological condition. The former rel ies on the reverse flow of blood and the latter is related to the decreased velocity of blood flow and the increased pressure of vein in the venous sinus segment.
Objective To explore the sonographic features of testicular torsion in adult males (≥25 years). Method We retrospectively analyzed the clinical, pathological and sonographic data of 79 adult male patients with testicular torsion, in whom 20 underwent resection of testis and 59 retained testis in West China Hospital from September 2006 to March 2017. Results There were 56 patients with spermatic cord nodules or mass with the largest mass of about 36 mm ×31 mm; the scrotal wall thickened in 48 patients with the thickness of 5–10 mm; axial changes of the affected testis were found in 24 patients; there were 61 patients with testicular growth in the affected side, while the affected testis was reduced in 7; there were 67 patients with asymmetric echo in the affected side, and the maximum hypoechoic area was about 36 mm×26 mm; the epididymis of the affected side in 35 patients with were unclear, and the epididymis of the affected side was enlarged in 19; 25 patients had hydrocele of testis; there was no blood flow in 49, blood flow reduced in 25, and blood flow increased in 5. Four patients were diagnosed by contrast-enhanced ultrasound, and there was no enhancement in 3 and partial enhancement in 1. Conclusion The sonographic features of testicular torsion in adult males are obvious, and the early diagnosis of testicular torsion can be confirmed by contrast-enhanced ultrasonography.