Radiation diagnosis of venous angiodysplasias

The paper proposes an original procedure for diagnosing venous dysplasias of different sites. The procedure is based on the analysis of the capacities of currently used invasive and noninvasive techniques of radiation visualization. The practical aspects of conduct of routine studies, their potentialities and shortcomings are outlined. The principle of the proposed procedure is a result of a complex use of the capacities of ultrasound visualization and interventional X-ray contrast studies of the vascular system. The procedure has been successfully used in 8 patients. It is concluded that it is promising to examine venous angiodysplasias by means of direct puncture made under ultrasound guidance, followed by mass contrasting and angiography which may be supplemented by sclerosing therapy.     

中晚期肝癌患者采用超声介入治疗引发并发症影响因素分析

摘要 目的：分析中晚期肝癌患者采用超声介入治疗引发并发症影响因素。方法：选取2019年2月～2023年2月在本院接受超声介入治疗的120例中晚期肝癌患者进行研究,治疗后记录患者的并发症发生率,并根据并发症发生情况将患者分为有并发症组（36例）和无并发症组（84例）,分别对两组患者的一般特征{性别、年龄、有无基础疾病、TNM分期、Child-Pugh分级、形态分型、肿瘤体积、腹水、门静脉高压、血供情况、白蛋白（ALB）及血清学指标[血红蛋白（Hb）、血小板（PLT）、凝血酶原时间（PT）、总胆红素（TBIL）、谷丙转氨酶（ALT）、谷草转氨酶（AST）]}进行分析,并建立logistic模型,对一般特征在中晚期肝癌患者超声介入治疗后引发并发症的影响中进行单因素和多因素分析。结果：120例患者经超声介入治疗后的并发症发生率为30.00%。有并发症组Child-Pugh B级、腹水+、ALB＜30 g/L的患者明显高于无并发症组,差异有统计学意义（P＜0.05）。单因素分析结果显示,Child-Pugh分级、腹水、ALB是导致中晚期肝癌患者超声介入治疗后引发并发症的影响因素（P＜0.05）。多因素logistic分析结果显示,Child-Pugh B级、腹水、ALB＜30 g/L均是导致中晚期肝癌患者超声介入治疗后引发并发症的独立危险因素（P＜0.05）。结论：Child-Pugh分级、腹水和ALB均是导致中晚期肝癌患者超声介入治疗后引发并发症的独立因素,只有尽早针对该类影响因素加强防治干预,才能有效降低中晚期患者的并发症发生率。     

Magnetic resonance imaging and ultrasound study in the diagnosis og facial angiodysplasias in children: competition or collaboration?

This study deals with the capacities of noninvasive magnetic resonance imaging (MRI) with magnetic resonance angiography (MRA) without administration of magnetic resonance contrast substances in the diagnosis of facial soft tissue angiodysplasias in children. Indications for their use are defined. The methodology of the studies is proposed. Their diagnostic role and relationship with the other noninvasive technique of medical visualization--ultrasound study (USS) with Doppler color mapping (DCM) are assessed. As compared with USS, MRI may more accurately and objectively establish the organotopic characteristics of facial soft tissue angiodysplasias and detect lesions of the deep facial parts, maxillary bones, and paranasal sinuses in the diagnosis of these abnormalities. The use of MRI may define the belonging of angiodysplasias to the arterial or venous bed, reveal afferent and efferent vessels, including intracranial ones, and to detect intracranial angiodysplastic changes. USS with DSM was superior to MRI with MRA in defining functional (hemodynamic) parameters of angiodysplasias, which makes this method indispendable in planning treatment and in evaluating its efficiency. Comprehensive examination of patients with large and extensive angiodysplasias of facial soft tissues has indicated that facial angiodysplasias are external manifestations of a more generalized angiodysplastic process in most cases, which, in large and extensive facial angiodysplasias, makes it expedient to perform MRI with MRA of the brain and, if possible, the whole body. The high informative value of MRI with MRA in studying angiodysplasias makes them the method of choice in the diagnosis of this group of diseases.     

Active Ultrasound Pattern Injection System (AUSPIS) for Interventional Tool Guidance

Accurate tool tracking is a crucial task that directly affects the safety and effectiveness of many interventional medical procedures. Compared to CT and MRI, ultrasound-based tool tracking has many advantages, including low cost, safety, mobility and ease of use. However, surgical tools are poorly visualized in conventional ultrasound images, thus preventing effective tool tracking and guidance. Existing tracking methods have not yet provided a solution that effectively solves the tool visualization and mid-plane localization accuracy problem and fully meets the clinical requirements. In this paper, we present an active ultrasound tracking and guiding system for interventional tools. The main principle of this system is to establish a bi-directional ultrasound communication between the interventional tool and US imaging machine within the tissue. This method enables the interventional tool to generate an active ultrasound field over the original imaging ultrasound signals. By controlling the timing and amplitude of the active ultrasound field, a virtual pattern can be directly injected into the US machine B mode display. In this work, we introduce the time and frequency modulation, mid-plane detection, and arbitrary pattern injection methods. The implementation of these methods further improves the target visualization and guiding accuracy, and expands the system application beyond simple tool tracking. We performed ex vitro and in vivo experiments, showing significant improvements of tool visualization and accurate localization using different US imaging platforms. An ultrasound image mid-plane detection accuracy of ±0.3 mm and a detectable tissue depth over 8.5 cm was achieved in the experiment. The system performance is tested under different configurations and system parameters. We also report the first experiment of arbitrary pattern injection to the B mode image and its application in accurate tool tracking.     

Hypothermia reduces neurologic deficits associated with placement of a vascular prosthesis in the abdominal aorta of rabbits

Treatment for atherosclerotic vascular disease in human beings ranges from medical management to interventional therapy, such as angioplasty, atherectomy, and bypass grafting. Recently, bypass grafting with a vascular prosthesis has received increased attention and clinical use. In the course of studies to optimize use of a small-caliber vascular prosthesis, five of six rabbits undergoing implantation of a polytetrafluoroethylene vascular prosthesis in the infrarenal abdominal aorta developed hind limb neurologic deficits, which resulted from focal ischemic damage to the spinal cord attributable to temporary vascular occlusion of the abdominal aorta during placement of the vascular prosthesis. In subsequent studies, induction of systemic hypothermia decreased the rate of development of neurologic deficits from 83 to 9% without any apparent perioperative complications associated with decreased body temperature. We determined that mild hypothermia (rectal temperature of 32 to 35 degrees C), combined with aortic occlusion time of < 40 min, is sufficient to afford protection from ischemic injury to the spinal cord in the rabbit.     

The potential role of homocysteine in percutaneous coronary interventions (PCI): review of current evidence and plausibility of action.

Several millions of patients with coronary heart disease worldwide are treated by means ofpercutaneous interventions each year. Above all conventional balloon dilation and implantation of uncoated stents are, however, only of limited success as reflected by 6-month restenosis rates of 50% (balloon dilation) and 25-35% (bare-metal stent). It is therefore of utmost importance to identify high-risk groups and explore further secondary-prophylactic measures for the prevention of restenosis. A large body of evidence suggests that elevated homocysteine and/or folate and B-vitamin deficiencies are relevant risk factors for restenoses due to their proatherothrombotic potential. Hyperhomocysteinemia is an ideal target as this parameter can be lowered easily, safely and at a low cost by means of folate and B-vitamin supplementation. The results of published studies exploring a potential correlation between homocysteine levels and the risk of restenosis and those of interventional studies for the reduction of the risk of restenosis have not yet lead to consistent conclusions. However, a critical assessment can by no means exclude the plausibility of postinterventional lowering of homocysteine levels. This review aims at providing insight into the current evidence and biological plausibility of homocysteine-lowering therapy in regard to PCI-related vascular damage. Currently available clinical observational and interventional studies are reviewed in detail.     

Improved Visualization of Intracranial Vessels with Intraoperative Coregistration of Rotational Digital Subtraction Angiography and Intraoperative 3D Ultrasound

Introduction

Ultrasound can visualize and update the vessel status in real time during cerebral vascular surgery. We studied the depiction of parent vessels and aneurysms with a high-resolution 3D intraoperative ultrasound imaging system during aneurysm clipping using rotational digital subtraction angiography as a reference.

Methods

We analyzed 3D intraoperative ultrasound in 39 patients with cerebral aneurysms to visualize the aneurysm intraoperatively and the nearby vascular tree before and after clipping. Simultaneous coregistration of preoperative subtraction angiography data with 3D intraoperative ultrasound was performed to verify the anatomical assignment.

Results

Intraoperative ultrasound detected 35 of 43 aneurysms (81%) in 39 patients. Thirty-nine intraoperative ultrasound measurements were matched with rotational digital subtraction angiography and were successfully reconstructed during the procedure. In 7 patients, the aneurysm was partially visualized by 3D-ioUS or was not in field of view. Post-clipping intraoperative ultrasound was obtained in 26 and successfully reconstructed in 18 patients (69%) despite clip related artefacts. The overlap between 3D-ioUS aneurysm volume and preoperative rDSA aneurysm volume resulted in a mean accuracy of 0.71 (Dice coefficient).

Conclusions

Intraoperative coregistration of 3D intraoperative ultrasound data with preoperative rotational digital subtraction angiography is possible with high accuracy. It allows the immediate visualization of vessels beyond the microscopic field, as well as parallel assessment of blood velocity, aneurysm and vascular tree configuration. Although spatial resolution is lower than for standard angiography, the method provides an excellent vascular overview, advantageous interpretation of 3D-ioUS and immediate intraoperative feedback of the vascular status. A prerequisite for understanding vascular intraoperative ultrasound is image quality and a successful match with preoperative rotational digital subtraction angiography.     

Ultrasound-guided versus anatomic landmark-guided vascular access in cardiac electrophysiology procedures: A systematic review and meta-analysis

IntroductionElectrophysiology (EP) procedures are nowadays the gold-standard method for tachyarrhythmia treatment with impressive success rates, but also with a considerable risk of complications, mainly vascular. A systematic review and meta-analysis was performed to evaluate the safety of ultrasound (US)-guided femoral vein access in EP procedures compared to the traditional anatomic landmark-guided method.MethodsWe searched Pubmed (MEDLINE), Embase, Web of Science, and Cochrane electronic databases for relevant entries, dated from January 1st, 2000 to June 30th, 2021. Only observational studies and randomized controlled trials were included in this analysis. Data extraction included study details, patient characteristics, procedure details, and all types of vascular complications. Complications were classified as major if any intervention, prolongation of hospitalization, or readmission was required.Results9 studies (1 randomized controlled trial and 8 observational), with 7858 participants (3743 in the US-guided group, 4115 in the control group), were included in the meta-analysis. Overall vascular complication rates were significantly decreased in the US-guided group compared to the control group (1.2 versus 3.2%, RR = 0.38, 95% CI, 0.27–0.53), in all EP procedures. Sub-group analysis of AF ablation procedures yielded similar results (RR 0.41, 95% CI, 0.29–0.58, p < 0.00001). The event reduction effect was significant for both major and minor vascular complications.ConclusionUS-guided vascular access in EP procedures is associated with significantly reduced vascular complications, compared to the standard anatomic landmark-guided approach, regardless of procedure complexity.     

Fine needle aspiration: past,current practice and recent developments

Fine needle aspiration (FNA) is a diagnostic technique that has become widely used. The procedure may be performed by interventional radiologists, endoscopists, pathologists and cytotechnologists; diagnostic interpretation of FNA samples is performed by pathologists and cytotechnologists. I provide here an introduction to the technique and applications of FNA with a review of current practice parameters and recent developments in the molecular application of FNA.     

超声介入治疗常见妇科囊性炎症包块的疗效评价

目的：比较超声引导介入治疗盆腔脓肿、输卵管积脓、输卵管积液、包裹性积液及宫颈囊肿的,临床效果,了解超声引导介入治疗常见的妇科囊性炎症包块的临床价值。方法：选取我院妇科门诊2007年1月～2011年3月收治的常见妇科囊性炎症包块共108例,其中盆腔脓肿11例、输卵管积脓19例、输卵管积液43例、盆腔包裹性积液31例、宫颈囊肿4例,给予超声实时引导抽囊液、甲硝唑冲洗治疗,治疗后3个月内复查超声评价和比较疗效。结果：盆腔脓肿、输卵管积脓、盆腔包裹性积液包块均明显缩小（12／43）或消失（29／43）,治疗有效率100％;输卵管积液包块治疗有效率95％（41／43）,宫颈囊肿均痊愈。各组间比较无统计学差异（P〉O．05）。结论：超声引导介入治疗对输卵管积脓、盆腔脓肿、盆腔包裹性积液均有显著的疗效,且治疗效果无差异,值得推广应用,代替传统的非必要的手术治疗。     

超声空化效应和超声微泡在生物医学中的应用

近年来,随着超声技术在医疗领域的广泛应用及超声造影剂研制的进展,空化效应和超声造影剂协同运用作为一种高效、安全、操作简单,且具有一定靶向性的无创治疗手段,在基因治疗、药物输送、溶栓和治栓,以及炎症与肿瘤的靶向诊断与治疗方面显示了巨大的运用潜力。简要综述了超声空化效应和超声微泡的治疗机制及应用。     

Cardiac evaluation and risk reduction in patients undergoing major vascular operations.

Occult coronary artery disease often accompanies symptomatic peripheral vascular disease and has an important effect on survival. Most perioperative and late fatalities after peripheral vascular operations are due to cardiac causes. Noninvasive cardiac testing can identify patients at increased risk for postoperative cardiac complications, although controversy exists regarding the optimal preoperative evaluation. Risk reduction strategies for patients known to be at high risk are also controversial. Some authors advocate coronary revascularization with coronary artery bypass grafting or percutaneous transluminal coronary angioplasty before the vascular procedure. Others believe that the combined morbidity and mortality of 2 operations exceed those of a peripheral vascular operation performed with aggressive monitoring and medical therapy. Continuous electrocardiographic monitoring after an operation has identified silent myocardial ischemia as a powerful predictor of cardiac complications. Ongoing research is likely to provide insights into the pathogenesis of postoperative cardiac complications and may lead to specific therapeutic interventions. Few prospective studies have been done in this area, and the threshold for preoperative and postoperative intervention is unknown. I review the literature and present an algorithm to guide cardiac testing and risk reduction in patients undergoing elective vascular surgical procedures.     

The new era of cardiac surgery: hybrid therapy for cardiovascular disease

Surgical therapy for cardiovascular disease carries excellent long-term outcomes but it is relatively invasive. With the development of new devices and techniques, modern cardiovascular surgery is trending toward less invasive approaches, especially for patients at high risk for traditional open heart surgery. A hybrid strategy combines traditional surgical treatments performed in the operating room with treatments traditionally available only in the catheterization laboratory with the goal of offering patients the best available therapy for any set of cardiovascular diseases. Examples of hybrid procedures include hybrid coronary artery bypass grafting, hybrid valve surgery and percutaneous coronary intervention, hybrid endocardial and epicardial atrial fibrillation procedures, and hybrid coronary artery bypass grafting/carotid artery stenting. This multidisciplinary approach requires strong collaboration between cardiac surgeons, vascular surgeons, and interventional cardiologists to obtain optimal patient outcomes.     

Non-invasive Parenchymal,Vascular and Metabolic High-frequency Ultrasound and Photoacoustic Rat Deep Brain Imaging

Photoacoustics and high frequency ultrasound stands out as powerful tools for neurobiological applications enabling high-resolution imaging on the central nervous system of small animals. However, transdermal and transcranial neuroimaging is frequently affected by low sensitivity, image aberrations and loss of space resolution, requiring scalp or even skull removal before imaging. To overcome this challenge, a new protocol is presented to gain significant insights in brain hemodynamics by photoacoustic and high-frequency ultrasounds imaging with the animal skin and skull intact. The procedure relies on the passage of ultrasound (US) waves and laser directly through the fissures that are naturally present on the animal cranium. By juxtaposing the imaging transducer device exactly in correspondence to these selected areas where the skull has a reduced thickness or is totally absent, one can acquire high quality deep images and explore internal brain regions that are usually difficult to anatomically or functionally describe without an invasive approach. By applying this experimental procedure, significant data can be collected in both sonic and optoacoustic modalities, enabling to image the parenchymal and the vascular anatomy far below the head surface. Deep brain features such as parenchymal convolutions and fissures separating the lobes were clearly visible. Moreover, the configuration of large and small blood vessels was imaged at several millimeters of depth, and precise information were collected about blood fluxes, vascular stream velocities and the hemoglobin chemical state. This repertoire of data could be crucial in several research contests, ranging from brain vascular disease studies to experimental techniques involving the systemic administration of exogenous chemicals or other objects endowed with imaging contrast enhancement properties. In conclusion, thanks to the presented protocol, the US and PA techniques become an attractive noninvasive performance-competitive means for cortical and internal brain imaging, retaining a significant potential in many neurologic fields.     

Method of sampling chorionic villi in first trimester of pregnancy under guidance of real time ultrasound.

Samples of chorionic villi were obtained in the first trimester by aspiration using a cannula passed transcervically under the guidance of real time ultrasound. In initial studies in 47 anaesthetised patients immediately before therapeutic abortion a method was developed giving a success rate of 89%. In 10 patients successful sampling was performed as an outpatient procedure without anaesthesia. In all, seven diagnostic procedures were undertaken and four of the five unaffected pregnancies continued. The technique of chorionic villous sampling using real time ultrasound is simple to learn and yields material for biochemical analysis and chromosomal study without the need for tissue culture. The exact obstetric risk, however, remains to be defined.     

右美托咪定在血管外科介入手术麻醉中的应用

目的:探讨靶控输注不同浓度右美托咪定对血管外科介入手术的效果。方法:选择周围血管疾病成年患者60例,随机分为I、II、III三组,每组20例。各组右美托咪定靶控输注浓度分别为0.2μg/kg/h,0.3μg/kg/h和0.4μg/kg/h,术中监测并记录各组手术开始前(T1),手术开始10 min(T2),手术开始30 min(T3),手术开始60 min(T4)四个时间点的平均动脉压(MAP),心率(HR),血氧(Sp O2),脑电双频指数(BIS)。结果:T2、T3、T4时平均动脉压Ⅰ组与Ⅱ组比较P0.05,Ⅰ组与Ⅲ组比较P0.05。T2时Ⅲ组与Ⅰ、Ⅱ组比较P0.05,T3、T4时Ⅱ、Ⅲ组与Ⅰ组比较均P0.05。结论:右美托咪定靶控输注浓度为0.3μg/kg/h和0.4μg/kg/h时,对血管外科介入手术能产生良好的镇静作用,并且可保证术中循环的稳定。     

上消化道出血在ICU的诊治近况

近年来,ICU在急重症上消化道出血救治中的作用越来越受到重视。上消化道出血是重症监护病房(ICU)内常见的危重病症 之一,与多器官功能不全密切相关,是多种危重病引起的常见并发症,病情严重者甚至危及生命。引起上消化道出血的病因很多, 其中非特异性粘膜异常、非甾体类抗炎药和抗血小板药物的不合理使用逐渐引起临床的重视。本文对国内外临床诊断和治疗上 消化道出血的近况进行了回顾分析,进一步阐述上消化道出血与多器官功能不全之间的联系,为多学科联合诊断提供参考。     

Glucose-induced endoplasmic reticulum stress is independent of oxidative stress: A mechanistic explanation for the failure of antioxidant therapy in diabetes

Oxidative stress contributes to the pathogenesis of diabetes and its complications. However, a large number of interventional studies have failed to show any health benefits of antioxidants. The overwhelming failure of antioxidant therapy to prevent disease can be explained by inadequacy of the doses of antioxidants used, short duration of therapy, or poor timing of initiation of the supplementation. A more likely reason for failure of antioxidants to reduce diabetes-related complications is the multiplicity of mechanisms of glucotoxicity that are independent of oxidative stress. Recently, endoplasmic reticulum (ER) stress has emerged as an important contributor to diabetes-related complications. Multiple lines of experimental evidence indicate that ER stress in endothelial cells can be uncoupled from oxidative stress induced by hyperglycemia, and antioxidants can ameliorate the latter without altering the ER stress. These observations provide a novel mechanistic explanation for the failure of antioxidant therapy in interventional clinical trials.     

Emerging technologies in therapeutic ultrasound: Thermal ablation to gene delivery

Ultrasound is used today in medicine as a modality for diagnostic imaging. Recently, there have been numerous reports on the application of thermal and nonthermal ultrasound energy for treating various diseases. In addition to thermal ablation of tumors, non-thermal ultrasound combined with drugs and genes have led to much excitement especially for cancer treatment, vascular diseases, and regenerative medicine. Ultrasound energy can enhance the effects of thrombolytic agents such as urokinase for treatment of stroke and acute myocardial infarction. New ultrasound technologies have resulted in advanced devices such as a) ultrasound catheters, b) Non-invasive methods as high intensity focused ultrasound (HIFU) in conjunction with MRI and CT is already being applied in the clinical field, c) Chemical activation of drugs by ultrasound energy for treatment of tumors is another new field recently termed “Sonodynamic Thew”, and d) Combination of genes and microbubble have induced great hopes for ideal gene therapy (sonoporation). Various examples of ultrasound combined modalities are under investigation which could lead to revolutionary therapy.     

In situ staining procedure for the detection of ornithine transcarbamylase activity in polyacrylamide gels

Ornithine transcarbamylase deficiency is a human genetic disease potentially susceptible to gene therapy. A murine model system exists for the disease in the sparse-fur (spf) mouse. Before gene therapy studies can be performed it is necessary to have practical methods which could detect successful gene transfer. Therefore we have developed an in situ staining procedure for the detection of ornithine transcarbamylase activity in polyacrylamide gels. Following electrophoretic separation under nondenaturing conditions inorganic phosphate cleaved from carbamyl phosphate in gels as a result of enzymatic activity was precipitated as phosphomolybdic acid and visualized by reduction with ascorbic acid. Results from the procedure correlated with ornithine transcarbamylase activity as measured by solution assay for citrulline, the other product of the reaction. This procedure readily distinguished mutant forms of ornithine transcarbamylase as exemplified by the murine spf mutation and resolved ornithine transcarbamylases of all animals tested into multiple forms. The procedure further distinguished ornithine transcarbamylases of animals of several different genera while yielding virtually identical patterns of the enzyme from species within the same genus. This procedure also suggested that the human enzyme was more labile than murine ornithine transcarbamylase; direct thermolability studies confirmed this finding.