In vitro demonstration of an echogenic emulsion: Relationship of lipid particle size to echo detection

To prove that protein-lipid emulsions can be echogenic, we made two lipid-in-water emulsions. The first emulsion was composed of lipid micelles approximately 10 microns in diameter. The second emulsion was composed of micelles approximately 100 microns in diameter. The first emulsion was anechoic; the second emulsion was echogenic. These results are consistent with the physical laws governing the scatter of ultrasound and demonstrate that collagen containing connective tissue is not necessary for echoes. In addition, these data support the hypothesis that the wide differences in echogenicity of fatty tissues is due to the differences in the thickness of their connective tissue stromata.     

Risk Marker Variability in Subclinical Carotid Plaques Based on Ultrasound is Influenced by Cardiac Phase,Echogenicity and Size

Identification of risk markers based on quantitative ultrasound texture analysis of carotid plaques has the ability to define vulnerable components that correlate with increased cardiovascular risk. However, data describing factors with the potential to influence the measurement variability of risk markers are limited. The aim of this study was to evaluate the influence of electrocardiogram-guided image selection, plaque echogenicity and area on carotid plaque risk markers and their variability in asymptomatic carotid plaques. Plaque risk markers were measured in 57 plaques during three consecutive heartbeats at two cardiac cycle time instants corresponding to the electrocardiogram R-wave (end diastole) and end of T-wave (end systole), resulting in six measurements for each plaque. Risk marker variability was quantified by computing the coefficient of variation (CV) across the three heartbeats. The CV was significantly higher for small plaques (area <15?mm2, 10%) than for large plaques (area >15?mm2, 6%) (p?<?0.001) in measurements of area, and the CV for measurements of gray-scale median were higher for echolucent plaques (<40, 15%) than for echogenic plaques (>40, 9%) (p?<?0.001). No significant differences were found between systole and diastole for the mean of any risk marker or the corresponding CV value. However, in a sub-analysis, the echolucent plaques were found to have a higher CV during systole compared with diastole. The variability also caused plaque type reclassification in 16% to 25% of the plaques depending on cutoff value. The results of this study indicate that echolucent and small plaques each contribute to increased risk marker variability. Based on these results, we recommend that measurements in diastole are preferred to reduce variation, although we found that it may not be possible to characterize small plaques accurately using contemporary applied risk markers.     

Effects of transcranial ultrasound and intravenous microbubbles on blood brain barrier permeability in a large animal model

We sought to determine whether transtemporal-applied 1-MHz ultrasound-induced microbubble destruction may be a safe method of transiently altering blood brain barrier (BBB) permeability for drug delivery in a large animal model. Endothelial cells are an integral component of the BBB but also prevent passage of potentially therapeutic drugs. Ultrasound-mediated destruction (UMD) of microbubbles has been shown to disrupt this barrier in small animals when ultrasound is delivered through bone windows. However, the effects of temporal bone attenuation and scattering in a large animal may limit the clinical application of such a technique. Twenty-four pigs were studied. One-MHz pulsed-wave ultrasound at 2.0 W/cm(2) (20% duty cycle) across the temporal bone was applied for 30 min after intravenous injections of either albumin-coated perfluorocarbon microbubble (PESDA, 8 pigs), lipid-encapsulated perfluorocarbon microbubbles (LEMB, 8 pigs) or ultrasound alone (8 pigs). BBB leak was quantified at 30 and 120 min after insonation using Evans blue. Serial magnetic resonance imaging (MRI) was performed in nine of the pigs (3 for each group) to quantify Gadolinium leak within the parenchyma. Peak negative pressures decreased ten-fold when ultrasound was transmitted across the pig temporal bone. Despite this, spectrophotometric analysis showed that both IV LEMB and PESDA combined with transtemporal ultrasound resulted in a significant increase in Evans blue extravasation across BBB of the treated side at 30 min after insonation (p < 0.001; compared with ultrasound alone) but not at 120 min. There was significant retention of Gadolinium within the insonified parenchyma at 60 and 90 min after insonation, but not at 120 min. Oxygen saturation and arterial pressures were not changed after any microbubble injection. Intravenous microbubbles, combined with transtemporal ultrasound, can transiently increase BBB permeability in a large animal. This induced opening of BBB is reversible and may be a safe noninvasive method of achieving drug or gene delivery across the BBB.     

In vivo time-dependent gene expression of cationic lipid-based emulsion as a stable and biocompatible non-viral gene carrier

To make stable and biocompatible non-viral gene carriers for therapeutic gene therapy, we developed a cationic lipid-based emulsion (CLE) prepared by an oil-in-water (O/W) emulsion method, wherein squalene oil was used as an oil core and the cationic lipid, 1,2-dioleoyl-sn-glycero-3-trimethylammonium-propane (DOTAP), was employed as an emulsifier. To evaluate in vivo characteristics such as toxicity and time-dependent gene expression, a bioluminescence reporter gene in pCMV-luc plasmid DNA was simply mixed with CLE in aqueous condition, resulting in a CLE/DNA complex. The CLE/DNA complex was optimized to form a compact and stable nano-sized particle by adding different amounts of plasmid DNA, and an optimal cationic lipid-to-DNA (C/D) weight ratio of 4 was identified. Freshly prepared CLE/DNA complex, with a C/D of 4, showed a high transfection efficiency and minimal cytotoxicity in vitro, compared to controls of a liposome (DOTAP)/DNA complex and a branched poly(ethyleneimine) (Mw = 25 kDa) (bPEI)/DNA complex, respectively. The in vivo characteristics of the CLE/DNA complex were evaluated after intravenous injection into Balb/c mice. Time-dependent gene expression data in vivo were obtained using a non-invasive, whole animal bioluminescence imaging system. These data showed that the CLE/DNA complex offered prolonged high-level gene expression for 1 week, particularly in the liver and spleen. On the other hand, the controls of DOTAP/DNA complex and bPEI/DNA complex showed a relatively lower gene expression, because of the unstable and toxic properties of the control carriers. Our in vivo gene expression data demonstrate the potential of the CLE/DNA complex as a non-viral gene carrier for in vivo gene delivery.     

超声斑点追踪技术评价微泡造影剂介导SERCA2a基因治疗心肌梗死大鼠的实验研究

目的 应用二维超声斑点追踪显像技术评价超声微泡造影剂介导rAAV2-SERCA2a基因靶向治疗心肌梗死大鼠左心室功能的疗效.方法 健康雄性SD大鼠35只,随机分为3组:假手术组、心肌梗死组和基因治疗组.心肌梗死组及基因治疗组结扎冠状动脉左前降支近端,造成前壁心肌梗死.假手术组单纯开胸不结扎冠状动脉.4周时,基因治疗组注射rAAV2-SERCA2a与造影剂混合液,假手术组及心肌梗死组仅注射造影剂,以上各组均给予心肌定点超声辐照.干预4周时,测量各组大鼠左心室短轴观乳头肌水平径向应变率(radial strain rate,SRrad)和圆周应变率(circumferential strain rate,SRcir)的收缩期峰值(SRrad-S,SRcir-S)及舒张早期峰值(SRrad-E,SRcir-E)以及左室心肌扭转角度等.结果 干预4周时,基因治疗组各节段SRcir-S、SRcir-E、SRrad-S、SRrad-E以及左室扭转角度较心肌梗死组增加(P＜0.01),与假手术组差异无统计学意义.结论 超声微泡造影剂介导rAAV2-SERCA2a基因转导至心肌组织,可有效改善心肌梗死大鼠左室心肌功能.     

Parenteral nutrition in the critically ill: Use of a medium chain triglyceride emulsion

Objectives The study investigated the use of an intravenous lipid emulsion containing medium chain tryglycerides (MCTs) in critically ill patients, and compared the effects with those of a conventional long chain triglyceride (LCT) preparation.Design Patients received a parenteral nutrition regime including either 500 ml 20% Lipofundin MCT/LCT (1/1) per day, or 500 ml 20% Lipofundin S (LCT) infused over 8 h each evening.Setting The patients were receiving treatment, including assisted ventilation, in the Intensive Care Unit of a large teaching hospital. All patients on this unit for at least 3 days and who were likely to receive parenteral nutrition for at least a week were considered, unless they had severe renal or liver disease, or trauma/major surgery in the previous 3 days. Because ICU patients are a heterogenous group, subjects were randomised within clinical groups to receive either lipid. There were 24 patients entered into the study and the data on 20 matched patients is reported.Measurements and results Blood specimens were collected pre-TPN, daily at 0800 and after 5 h lipid infusion on days 1 and 6. Urine collections (24 h) were also performed. There were no apparent adverse effects due to the new MCT/LCT emulsion. Plasma ketone and glycerol concentrations were higher during MCT/LCT infusion, but 8 h post infusion plasma levels of ketones, triglycerides, non-esterified fatty acids and glucose were similar. Urinary carnitine excretion was high in all patients and was not significantly different between the groups. Nitrogen balance was less negative in patients receiving MCT/LCT on days 6 and 9.Conclusion MCTs are rapidly hydrolysed and oxidised to fatty acids and ketones which can be readily utilised. This study indicates that intravenous lipid emulsion containing MCT are safe in critically ill patients and may have advantages over LCT. The number and range of patients studied was, however, small and larger studies are needed.     

Use of a lipid emulsion in a patient with refractory hypotension caused by glyphosate-surfactant herbicide

Context. Circulatory shock is a major cause of mortality in glyphosate-surfactant herbicide (GlySH) poisoning, and this condition responds poorly to conventional therapies. We report a case of GlySH poisoning with shock that was refractory to vasopressors but responsive to intravenous fat emulsion (IFE). Case details.?A 52-year-old man was brought to the emergency department by ambulance. He was found unconscious in his living room along with an empty bottle of GlySH herbicide, which contained glyphosate, polyoxyethyleneamine (POEA) surfactant, and water. He was drowsy at presentation. His heart rate was 44 beats/min, his blood pressure could not be measured with an arm cuff, but he had a palpable femoral pulse. After about 2.5 h of supportive care after admission, he remained hypotensive, and his systolic blood pressure was 80 mmHg. A 500 mL bottle of 20% IFE product was prepared. As a bolus, 100 mL of IFE was injected, and the remaining 400 mL was then infused. His blood pressure was 100/60 mmHg 1 h after the bolus injection. At 5 h after IFE injection, his blood pressure reached 160/100 mmHg and vasopressors were tapered. Conclusion.?IFE should be considered in cases of refractory hemodynamic instability caused by GlySH after aggressive fluid and vasopressor support.     

Characterization of the Dynamic Activities of a Population of Microbubbles Driven by Pulsed Ultrasound Exposure in Sonoporation

Ultrasound-driven microbubble activities have been exploited to transiently disrupt the cell membrane (sonoporation) for non-viral intracellular drug delivery and gene transfection both in vivo and in vitro. In this study, we investigated the dynamic behaviors of a population of microbubbles exposed to pulsed ultrasound and their impact on adherent cells in terms of intracellular delivery and cell viability. By systematically analyzing the bubble activities at time scales relevant to pulsed ultrasound exposure, we identified two quantification parameters that categorize the diverse bubble activities subjected to various ultrasound conditions into three characteristic behaviors: stable cavitation/aggregation (type I), growth/coalescence and translation (type II) and localized inertial cavitation/collapse (type III). Correlation of the bubble activities with sonoporation outcome suggested that type III behavior resulted in intracellular delivery, whereas type II behavior caused the death of a large number of cells. These results provide useful insights for rational selection of ultrasound parameters to optimize outcomes of sonoporation and other applications that exploit the use of ultrasound-driven bubble activities.     

Pelvic cellulitis caused by Raoultella planticola in a neutropenic patient

Raoultella planticola is a gram-negative, encapsulated, aerobic bacterium within the Enterobacteriaceae family. It has been primarily described as pathogen in cases with pneumonia and gastrointestinal infections. Here we describe a case of severe pelvic cellulitis in a patient with neutropenia following induction therapy for myeloid sarcoma. The patient experienced a septic shock and was treated successfully with antibiotic therapy. A literature review is provided to put this case in context with previous reports on R. planticola. This report highlights that awareness for uncommon pathogens is crucial in the clinical management of infections in neutropenic patients.     

Small bowel obstruction caused by endometriosis in a postmenopausal woman

We report a rare case of small bowel obstruction (SBO) caused by endometriosis in a postmenopausal woman. A 54‐year‐old postmenopausal woman presented with severe abdominal pain and vomiting. Before menopause, she sometimes had abdominal pain associated with menses. Axial multi‐dimensional CT images revealed a SBO with small nodules near the terminal ileum. The obstruction was diagnosed as being caused by small bowel endometriosis. Curved planar reconstruction images showed a complicated obstruction of the small intestine 15 cm from the terminal ileum. Based on the stenotic lesion, a SILS procedure was performed. The patient's SBO diagnosis was histologically confirmed as being caused by small bowel endometriosis. SILS was deemed to be a safe, feasible procedure for treating this bowel obstruction. Curved planar reconstruction images were useful in preoperative imaging and diagnosis of SBO, especially as they were able to highlight the constricting legion.     

儿童危重甲型H1N1流感合并急性呼吸窘迫综合征的临床特征与救治

目的 了解儿童危重甲型H1N1流感合并急性呼吸窘迫综合征(ARDS)的临床特点,探讨救治措施.方法 前瞻性观察上海交通大学附属儿童医院收治的3例危重甲型H1N1流感的临床表现、化验检查、诊断、治疗转归.结果 实时RCT-PCR检测3例患者均为甲型H1N1流感感染.以发热、咳嗽起病,全身性炎症反应相对轻.病程4～6 d病情突然恶化,出现口唇发绀,呼吸急促.X线片显示双肺多叶渗出或弥漫性炎症阴影.入院时已发展为ARDS.采用奥司他韦,小潮气量(6 mL/kg)、适当高PEEP通气策略和相对保守液体等治疗,3例患儿中存活2例,死亡1例.结论 儿童危重甲型H1N1流感患儿,突然咳嗽加重和呼吸急促时,应高度怀疑ARDS.及时氧疗及呼吸支持,保守液体管理,预防继发感染等可能是关键治疗措施.需要积累更多病例资料来明确危重甲型H1N1流感特征和评价救治手段.     

Clinical course of disease and prognosis in patients with ischemic heart disease with stable angina pectoris,caused by stenosing coronary atherosclerosis (data from a a 20-year study

AIM: To study a course and prognosis of ischemic heart disease (IHD) with stable angina pectoris (SAP) caused by stenotic coronary atherosclerosis (SCA) by 20-year follow-up data. MATERIAL AND DATA: Prognosis of survival was made in 318 patients with SAP due to SCA. RESULTS: The results of a 20-year study show that prognosis in IHD patients depends on SAP severity (by the functional class), exercise tolerance (by the exercise test), severity of coronary bed affection and of left ventricular contractility affection as assessed by coronary- and ventriculography. If lethality of the test subjects was not higher than in the population, the patient had good prognosis associated with one-vessel lesion, normal myocardial contractile function, high exercise tolerance, absence of the leading risk factors. CONCLUSION: The multivariance analysis with stepwise selection enabled the design of the model of the integral prognostic index (IPI) for the studied patients. The IPI index under 1.86 suggests a favourable prognosis, 1.87-2.33--an intermediate prognosis and in IPI higher than 2.34--unfavourable prognosis. Early surgery is recommended for patients with high IPI.     

False-negative capnographic reading caused by a malfunctioning bag-valve-mask device resulting in a pneumomediastinum

Bag-valve-mask ventilation is generally a safe, and often a life-saving procedure for children who are unable to oxygenate or ventilate by themselves. A case is presented which describes a malfunctioning expiratory valve in a disposable manual bag-valve-mask device resulting in a pneumomediastinum in a child. This is a rare cause of a false-negative colorimetric end-tidal carbon dioxide (ETCO(2)) reading after endotracheal intubation. However, it is important to recognize so that further adverse outcomes can be prevented.     

一起学校水源污染引起菌痢暴发疫情的调查

2010年10月,浙江省衢州市衢江区某乡镇中心学校发生一起水源污染引起的细菌性痢疾暴发疫情,共发病178例,无死亡病例,罹患率为13.8%,疫情波及小学部22个班级、幼儿园部2个班级和一些教职员工。细菌学检测显示水源细菌总数、大肠菌群、耐热大肠埃希菌均超标,采集的58份肛拭标本,37份检出宋内志贺菌,阳性率为63.79%。     

Purulent pericarditis caused by nontypeable Haemophilus influenzae in a pediatric patient

We report the 1st case of purulent pericarditis due to nontypeable Haemophilus influenzae in an immunocompetent 2-year-old male, which was successfully treated with surgical drainage, debridement, and antimicrobial therapy. The shifting microbial epidemiology of this disease, associated with changes in community health care practices, and the increasing virulence of this organism are discussed.     

Acute myocardial infarction in a young man caused by centipede sting

It is known that insects can cause various clinical effects such as myocardial ischaemia and hypotension from vasospasm and the myocardial toxic effects of the venom and anaphylaxis. Although myocardial ischaemia resulting from centipede sting has been reported once before, myocardial injury has not. In this report, the authors present the case of a 20 year old male patient bitten by a centipede and admitted to the emergency room with chest pain, abnormal electrocardiographic findings, and increased cardiac enzymes (cardiac troponin T) suggesting acute myocardial infarction.     

Complicated meningitis caused by a rare serotype of Haemophilus influenzae in Portugal

We report a case of meningitis due to Haemophilus influenzae serotype d strain in an infant. As far as we know, this is the first report of a serotype d strain, responsible for childhood invasive disease in Europe, demonstrating an emerging of H. influenzae non-b serotype, in the post-vaccination era.     

Hematocolpos caused by genital bullous lesions in a patient with Stevens-Johnson syndrome

We report a case of complete vaginal fusion with subsequent development of hematocolpos in a 14-year-old sexually inactive girl previously treated for Stevens-Johnson syndrome. The epidermal disease was likely precipitated by Mycoplasma pneumoniae pneumonia. The patient presented with lower abdominal cramping and amenorrhea that had persisted for 5 months. Sonography demonstrated a markedly distended vagina filled with echogenic fluid. A diagnosis of hematocolpos secondary to Stevens-Johnson syndrome was rendered, and the patient underwent surgery with incision of the fused introitus and drainage of about 300 ml of dark blood. While unusual, this case demonstrates that hematocolpos should be considered in patients with a history of epidermal bullous disease and amenorrhea. © 1998 John Wiley & Sons, Inc. J Clin Ultrasound 26 : 52–54, 1998.