彩色多普勒超声高频浅表小器官联合腔内探头对肛周脓肿的诊断价值

目的：研究联合应用彩色多普勒超声高频浅表小器官及腔内探头对肛周脓肿的诊断价值。方法选取2013年8月~2014年8月本院收治的78例经病理证实为肛周脓肿患者的临床资料,根据数字随机分组法原则,将患者分为两组,每组各39例。对照组给予常规专科检查(彩超检测),观察组联合应用高频浅表小器官及腔内探头检查,比较两种检测方式的检测结果。结果①观察组患者与括<肌关系符合、支管符合、主管符合、内口符合率均高于对照组,差异均有统计学意义(均P<0.05)。②观察组肛周脓肿检出率为97.44%,对照组肛周脓肿检出率为82.05%,观察组肛周脓肿检出率较对照组升高,差异有统计学意义(P<0.05)。③观察组肛瘘检出率为94.44%,高于对照组(75.00%),差异有统计学意义(P<0.05)。结论联合使用高频浅表小器官与腔内探头检查,能够提高肛周脓肿的检出率,诊断价值非常高,便于为疾病的治疗提供依据,值得临床推广应用。     

高频单味中药组方联合普罗布考治疗缺血性脑卒中的临床疗效观察

目的：探讨高频单味中药组方联合普罗布考治疗缺血性脑卒中的临床疗效。方法将212例缺血性脑卒中患者随机分为试验组和对照组各106例。2组均给予降低颅内压、抗凝、控制血糖及血压、改善脑微循环等常规对症治疗,在此基础上,试验组给予高频单味中药组方联合普罗布考进行治疗,对照组单纯给予普罗布考进行治疗,治疗3个月后,比较2组临床疗效。结果治疗3个月后,试验组的总有效率为100．00％高于对照组的81．13％（P＜0．05）。结论高频单味中药组方联合普罗布考治疗缺血性脑卒中有很好的临床疗效,值得推广应用。     

超声引导锁骨下静脉置管对导管相关性血流感染控制研究

目的采用高频彩色多普勒超声实时引导锁骨下静脉精确置管对导管相关性血流感染发生率影响的临床研究,降低导管血流感染发生率。方法将实施锁骨下静脉精确置管的48例患者随机分为观察组和对照组,每组各24例,其中观察组采用高频彩色多普勒超声显像进行锁骨下静脉精确置管;而对照组则采用常规的方法进行置管,对所得的相关数据均采用SPSS13.0软件进行分析处理。结果两组患者临床资料比较差异无统计学意义;观察组锁骨下静脉精确置管一次成功23例占95.83%,对照组一次成功18例占75.00%;置管操作时间<2min者观察组21例、对照组9例;出现并发症观察组2例占8.33%、对照组7例占29.17%;置管一段时间后进行血液细菌检查,结果显示观察组感染1例占4.17%、对照组感染3例占12.50%;4个指标观察组与对照组对比差异均有统计学意义(P<0.05)。结论采用高频彩色多普勒超声引导锁骨下静脉精确置管和常规置管相比操作简便安全、异常成功率较高、并发症和感染率比较低,在临床上对于锁骨下静脉精确置管有一定的临床指导意义。     

Abnormal Anterior Cingulate N-Acetylaspartate and Executive Functioning in Treatment-Resistant Depression After rTMS Therapy

Background:

Cognitive impairment is a key feature of treatment-resistant depression (TRD) and can be related to the anterior cingulate cortex (ACC) function. Repetitive transcranial magnetic stimulation (rTMS) as an antidepressant intervention has increasingly been investigated in the last two decades. However, no studies to date have investigated the association between neurobiochemical changes within the anterior cingulate and executive dysfunction measured in TRD being treated with rTMS.

Methods:

Thirty-two young depressed patients with treatment-resistant unipolar depression were enrolled in a double-blind, randomized study [active (n=18) vs. sham (n=14)]. ACC metabolism was investigated before and after high-frequency (15Hz) rTMS using 3-tesla proton magnetic resonance spectroscopy (1H-MRS). The results were compared with 28 age- and gender-matched healthy controls. Executive functioning was measured with the Wisconsin Card Sorting Test (WCST) among 34 subjects with TRD and 28 healthy subjects.

Results:

Significant reductions in N-acetylaspartate (NAA) and choline-containingCompound levels in the left ACC were found in subjects with TRD pre-rTMS when compared with healthy controls. After successful treatment, NAA levels increased significantly in the left ACC of subjects and were not different from those of age-matched controls. In the WCST, more perseverative errors and fewer correct numbers were observed in TRD subjects at baseline. Improvements in both perseverative errors and correct numbers occurred after active rTMS. In addition, improvement of perseverative errors was positively correlated with enhancement of NAA levels in the left ACC in the active rTMS group.

Conclusions:

Our results suggest that the NAA concentration in the left ACC is associated with an improvement in cognitive functioning among subjects with TRD response to active rTMS.     

Combination of high frequency oscillatory ventilation and interventional lung assist in severe acute respiratory distress syndrome

Background

The combination of high-frequency oscillatory ventilation (HFOV) and extracorporeal carbon dioxide removal with the interventional lung assist (iLA) in severe acute respiratory distress syndrome (ARDS) represents a novel treatment option.

Methods

The study used a retrospective single-center analysis of 21 consecutive adult patients with severe ARDS, ventilated with HFOV/iLA. Efficiency, side effects, and outcome of combined treatment are presented as median (interquartile range).

Measurements and Main Results

The following were used to determine patient characteristics: sequential organ failure assessment score, 14; simplified acute physiology score II, 41; and Murray score, 4. The duration of combined treatment was 6 days. The blood flow through the iLA was 1.9 L/min.The Pao₂/inspired fraction of oxygen ratio increased from 61 (47-86) to 98 (67-116) within 2 hours and to 106 (70-135) mm Hg at 24 hours. Paco₂ decreased from 58 (50-76) to 37 (29-47) mm Hg at 2 hours with normalization of pH 7.28 (7.16-7.36) to 7.43 (7.33-7.49) after 2 hours associated with hemodynamic stabilization. In 6 patients, complications due to iLA treatment were observed, and in 3 patients, complications associated with HFOV were seen. Weaning from HFOV/iLA was successful in 10 patients. The 30-day mortality rate was 43%, and hospital mortality rate was 57%.

Conclusion

The combination of HFOV/iLA is an option in severe pulmonary failure if conventional ventilation fails and pumpdriven extracorporeal membrane oxygenation therapy is not available.     

Frequency-specific effects of low-intensity rTMS can persist for up to 2 weeks post-stimulation: A longitudinal rs-fMRI/MRS study in rats

BackgroundEvidence suggests that repetitive transcranial magnetic stimulation (rTMS), a non-invasive neuromodulation technique, alters resting brain activity. Despite anecdotal evidence that rTMS effects wear off, there are no reports of longitudinal studies, even in humans, mapping the therapeutic duration of rTMS effects.ObjectiveHere, we investigated the longitudinal effects of repeated low-intensity rTMS (LI-rTMS) on healthy rodent resting-state networks (RSNs) using resting-state functional MRI (rs-fMRI) and on sensorimotor cortical neurometabolite levels using proton magnetic resonance spectroscopy (MRS).MethodsSprague-Dawley rats received 10 min LI-rTMS daily for 15 days (10 Hz or 1 Hz stimulation, n = 9 per group). MRI data were acquired at baseline, after seven days and after 14 days of daily stimulation and at two more timepoints up to three weeks post-cessation of daily stimulation.Results10 Hz stimulation increased RSN connectivity and GABA, glutamine, and glutamate levels. 1 Hz stimulation had opposite but subtler effects, resulting in decreased RSN connectivity and glutamine levels. The induced changes decreased to baseline levels within seven days following stimulation cessation in the 10 Hz group but were sustained for at least 14 days in the 1 Hz group.ConclusionOverall, our study provides evidence of long-term frequency-specific effects of LI-rTMS. Additionally, the transient connectivity changes following 10 Hz stimulation suggest that current treatment protocols involving this frequency may require ongoing “top-up” stimulation sessions to maintain therapeutic effects.     

High-Frequency Micro-Ultrasound Imaging and Optical Topographic Imaging for Spinal Surgery: Initial Experiences

High frequency micro-ultrasound (µUS) transducers with central frequencies up to 50?MHz facilitate dynamic visualization of patient anatomy with minimal disruption of the surgical work flow. Micro-ultrasound improves spatial resolution over conventional ultrasound imaging from millimeter to micrometer, but compromises depth penetration. This trade-off is sufficient during an open surgery in which the bone is removed and theultrasound probe can be placed into the surgical cavity. By fusing µUS with pre-operative imaging and tracking the ultrasound probe intra-operatively using our optical topographic imaging technology, we can provide dynamic feedback during surgery, thus affecting clinical decision making. We present our initial experience using high-frequency µUS imaging during spinal procedures. Micro-ultrasound images were obtained in five spinal procedures. Medical rationale for use of µUS was provided for each patient. Surgical procedures were performed using the standard clinical practice with bone removal to facilitate real-time ultrasound imaging of the soft tissue. During surgery, the µUS probe was registered to the pre-operative computed tomography and magnetic resonance images. Images obtained comprised five spinal decompression surgeries (four tumor resections, one cystic synovial mass). Micro-ultrasound images obtained during spine surgery delineated exquisite detailing of the spinal anatomy including white matter and gray matter tracts and nerve roots and allowed accurate assessment of the extent of decompression/tumor resection. In conclusion, tracked µUS enables real-time imaging of the surgical cavity, conferring significant qualitative improvement over conventional ultrasound.     

新生儿经腹手术中适宜高频电刀切割和凝血输出功率探讨

目的探讨新生儿经腹手术中高频电刀适宜切割和凝血的输出功率。方法新生儿外科固定副主任医师主刀经腹手术患儿46例,设置高频电刀输出功率为切割15W,凝血15W。应用序贯法调整输出功率梯度,设定输出功率梯度为1W。若前一例输出功率出现切凝效果不佳,则下一例患者升高一个输出功率梯度;若前一例输出功率出现焦粘组织,则下一例患者降低一个输出功率梯度。将切凝效果不佳与焦粘组织的功率中点设为平衡点,计算所有平衡点高频电刀输出功率的平均值。结果新生儿经腹手术高频电刀切割的输出功率95%可信区间为（14.24±2.16）W、凝血的输出功率95%可信区间为（16.68±2.52）W。结论新生儿经腹手术高频电刀切割的输出功率平均值为14W,凝血的输出功率平均值为16W。     

Using an Ultrasound Elasticity Microscope to Map Three-Dimensional Strain in a Porcine Cornea

An ultrasound elasticity microscope was used to map 3-D strain volume in an ex vivo porcine cornea to illustrate its ability to measure the mechanical properties of this tissue. Mechanical properties of the cornea play an important role in its function and, therefore, also in ophthalmic diseases such as kerataconus and corneal ectasia. The ultrasound elasticity microscope combines a tightly focused high-frequency transducer with confocal scanning to produce high-quality speckle over the entire volume of tissue. This system and the analysis were able to generate volume maps of compressional strain in all three directions for porcine corneal tissue, more information than any previous study has reported. Strain volume maps indicated features of the cornea and mechanical behavior as expected. These results constitute a step toward better understanding of corneal mechanics and better treatment of corneal diseases.