Comparative study for predictability of type 1 gastric variceal rebleeding after endoscopic variceal ligation:High-frequency intraluminal ultrasound study

BACKGROUND The efficacy of endoscopic ultrasonography for the follow-up of gastric varices treated with endoscopic variceal ligation(EVL)has not been established.AIM To evaluate the diagnostic correlation of esophagogastroduodenoscopy(EGD)and high-frequency intraluminal ultrasound(HFIUS)for type 1 gastric varices(GOV1)after EVL and to identify the predictability for rebleeding of EGD and HFIUS.METHODS In liver cirrhosis patients with GOV1,we performed endoscopic follow-up using EGD and HFIUS synchronously after EVL for hemorrhage from GOV1.Endoscopic grading and red color signs were analyzed using EGD,and the largest variceal cross-sectional areas were measured using HFIUS.In addition,1-year follow-up was performed.Variceal rebleeding was defined as the presence of hematemesis,hematochezia,or melena without other evidence of bleeding on endoscopic follow-up.RESULTS In 26 patients with GOV1,variceal cross-sectional areas on HFIUS of GOV1 was poorly correlated with EGD grading of GOV1(r=0.36).In 17 patients who completed the 1-year follow-up,variceal cross-sectional areas on HFIUS was a good predictor of subsequent rebleeding,whereas EGD grading was not a predictor of subsequent rebleeding.CONCLUSION HFIUS measurement is more predictive of GOV1 rebleeding than EGD grading,so HFIUS measurement may be necessary for endoscopic follow-up after EVL in patients with GOV1.

Automatic Measurement of Fetal Abdominal Biometric Parameters—Feasibility on a Portable Ultrasound Device

An automatic method for measuring the fetal mean abdominal diameter (MAD) or abdominal circumference (AC) with ultrasound is proposed. From a correctly presented abdominal section suitable for MAD or AC measurement, the location of fetal abdomen is detected by image processing. Thereafter, an active contour model is converged along the abdominal boundary for measurement purposes. The validation data set contained 310 images of fetuses with gestational age (GA) from 14 to 41 weeks. The measurement success rate was 88.1%. By manually indicating the location of the abdomen, the success rate was further improved to 95.8% for the failed cases. The correlation between manual and automatic measurements was 0.95 and the intraclass correlation coefficient (ICC) was 0.976 (95% confidence interval (CI);0.969 - 0.981). The average method execution time was 0.3 s. The mean error was lower in young fetuses (0.4%) than in older fetuses (-2.1%). The proposed cross-platform method was implemented on a portable, low-cost ultrasound machine prototype targeted for low- and middle-income countries (LMIC);the results achieved were comparable to those of other state-of-the-art automatic methods.

Application Value of High-Frequency Ultrasound and Contrast-Enhanced Ultrasound in Patients with Knee Osteoarthritis with Different TCM Syndromes

Objective: To explore the application value of high-frequency ultrasound and contrast-enhanced ultrasound in different syndrome types of knee osteoarthritis, and to provide more imaging evidence for clinical diagnosis and treatment. Method: Sixty patients with KOA were selected according to TCM classification, which were mainly divided into Qi stagnation and blood stasis type and cold-dampness blockage type. All knee joints were routinely examined by high frequency ultrasound, and those with synovial hyperplasia were examined by contrast-enhanced ultrasound. High frequency ultrasound is the examination of synovium, cartilage and collateral ligament of knee joint based on two-dimensional ultrasound. Contrast-enhanced ultrasound (CEUS) refers to the contrast examination of synovium in knee joint patients with synovial hyperplasia. Result: Among them, the suprapatellar sac effusion and synovial thickening of Qi stagnation and blood stasis type were more obvious than those of cold-dampness arthralgia type (P < 0.05), and the degree of wear of the intercondylar cartilage of cold-dampness arthralgia type was more obvious than that of Qi stagnation. The blood stasis type is heavier and the meniscus bulge is higher (P < 0.05). The radiography of synovial hyperplasia showed that the area under the curve of Qi stagnation and blood stasis type was higher than that of cold dampness arthralgia type (P < 0.05), and the peak time was significantly shorter than that of cold dampness arthralgia type. There was no statistical difference in effective peak gradient and onset time of type (P > 0.05). Conclusion: To a certain extent, the high-frequency ultrasound and contrast-enhanced ultrasound performance of knee osteoarthritis can be used as a dialectical reference for different TCM syndrome types.

Automatic Detection and Measurement of Fetal Biparietal Diameter and Femur Length —Feasibility on a Portable Ultrasound Device

An automatic method able to recognize a presented section through the biparietal plane of the fetal head and a section through the fetal femur in ultrasound images is developed. Once the correct anatomical section for measurement is identified by the machine, the placement of the measurement calipers is automatically determined by fitting an active contour model to the structure of interest. The fetal biparietal diameter (BPD) and femur length (FL) are then measured automatically. The validation data set contained 167 and 197 B-mode images for BPD and FL measurements, respectively. The images were acquired using 4 different ultrasound scanners, which resulted in varied image quality and gain settings. The mean gestational age (GA) of the fetuses was 19.4 weeks, range 16 to 41 weeks. A measurement success rate of 90% was achieved for both BPD and FL. The correlation coefficients between the manual and automatic measurements were 0.995 (BPD) and 0.967 (FL), mean errors were 0.5 mm (BPD) and -1.7 mm (FL) and error range with 95% confidence interval (CI) were ﹣3.8 - 4.8 mm (BPD) and ﹣11.4 - 8.1 mm (FL). The automatic measurement results were consistent in both high and low gain settings. The intraclass correlation coefficients between manual and automatic measurements were 0.995 (95% CI;0.981 - 0.999) for BPD in high gain, 1.0 (95% CI;0.998 - 1.0) for BPD in low gain, 0.998 (95% CI;0.991 - 0.999) for FL in high gain and 0.999 (95% CI;0.996 - 1.0) for FL in low gain settings. The method was implemented on a prototype, portable ultrasound machine designed to be used in low- and middle-income countries (LMIC). The overall performance of the method supports our hypothesis that automated methods can be used and are beneficial in a clinical setting.

Development of a High-frequency Ultrasound System for High-speed Image Scanning

High-frequency image technique has been widely applied in medical diagnosis recently. For high voltage protection, high speed stage and trigger control circuitry are difficult to implement a high-frequency ultrasound imaging system. In this study, we utilized a linear servo with high noise tolerance and a novel multi-depth expression method to overcome those issues in developed high-speed image system. B-mode image of the chicken phantom by 25 MHz transducer shows the resolution of lateral and axial resolutions are up to 123 μm and 59 μm respectively. In addition, the experiment demonstrates that the axial resolution and depth of field (DOF) can be improved by time gain compensation(TGC) and multi-depth method. The results indicate that the proposed system could achieve over 24 fps for 1 mm scan distance and 100 lines per frame. In the future, the developed system is potential for other clinical applications such as ophthalmology and dermatology.

Efficacy evaluation of high-frequency ultrasound in the treatment of diabetic peripheral neuropathy with α-lipoic acid combined with traditional Chinese medicine package treatment

Objective:To use high-frequency ultrasound to evaluate the efficacy ofα-lipoic acid combined with traditional Chinese medicine in the treatment of diabetic peripheral neuropathy(DPN),so as to provide a basis for clinical medication and evaluation of therapeutic effect.Methods:From December 2018 to December 2019,110 patients with DPN who met the inclusion and exclusion criteria were divided into observation group and control group according to different treatment plans.The control group was treated withα-lipoic acid,and the observation group was treated withα-lipoic acid combined with traditional Chinese medicine encapsulation treatment,and used high-frequency ultrasound,nerve conduction velocity and serological examination to comprehensively evaluate the effectiveness of the two treatment methods.Results:The mean amplitude of glycemic excursions(MAGE)value of the observation group and the control group after treatment was significantly lower than before treatment(P<0.05);After treatment,the SCV of the ulnar nerve,median nerve,and common peroneal nerve in the two groups was significantly faster than before treatment(P<0.05).Similar to SCV,the MCV of the three nerves measured after treatment in the two groups was significantly faster than before treatment(P<0.05).Compared between the groups after treatment,the three kinds of nerve SCV and MCV in the observation group were significantly faster than those in the control group(P<0.05).The cross-sectional area(CSA)value of the ulnar nerve,median nerve and common peroneal nerve in the observation group after treatment was significantly lower than before treatment(P<0.05).Compared with the control group after treatment,the three nerves CSA in the observation group was significantly lower than that in the control group(P<0.05).Abnormal ultrasound performance:The proportion of abnormal ultrasound performances of the ulnar nerve,median nerve,and common peroneal nerve in the observation group after treatment was significantly lower than before treatment(P<0.05).The composition ratio of internal echo reduction and ambiguity in the observation group after three nerve treatments was significantly lower than that in the control group after treatment(P<0.05).In the correlation analysis,the three kinds of nerve CSA before and after treatment were negatively correlated with SCV and amplitude(P<0.05),and positively correlated with latency(P<0.05).Conclusion:The combination ofα-lipoic acid and Chinese medicine encapsulation technology has a good effect on the treatment and repair of DPN nerve damage,and can be routinely applied in clinical treatment.High-frequency ultrasound can intuitively observe changes in peripheral nerves and can be used to evaluate the prognosis of DPN.

Analysis of High-Frequency Ultrasound in the differential Diagnosis of Lumps in Foot and Hand

Objective:To investigate the ultrasonogram characteristics of common lumps in hand and foot,pursuing for greater understanding of hand and foot lumps.Methods:65 cases of ultrasonographic characteristics of lumps in hand and foot were retrospectively analyzed,including the location,size,shape,boundary,internal echo and posterior echo,surrounding relationship and blood flow.Results:Among 65 cases,there were 26 cases of tendon sheath cyst,16 cases of tenosynovitis giant cell tumor,10 cases of hemangioma,4 cases of tendon sheath fibroma,3 cases of epidermoid cyst,2 cases of Schwannoma,2 cases of fibrolipoma,1 case of angiolipoma and 1 case of neurofibroma.The preoperative and postoperative pathological diagnoses of 45 cases,accounting for 69.23%,were consistent,3 cases(4.62%)were misdiagnosed,which included that 2 cases of tenosynovitis giant cell tumor were misdiagnosed as tendon sheath cyst,1 case of neurofibroma as epidermoid cyst,and the preoperative diagnosis of the rest 17 cases(26.15%)were indefinite.Conclusion:The high-frequency ultrasound can diagnose properties of lumps in foot and hand well,providing diagnosis basis for further treatment in clinic.

彩超云技术实时远程教学系统在超声医师住培中的应用

目的 探讨超声医师在住院医师规范化培训时应用基于智能便携彩超云技术实时远程教学系统的实际效果。方法 选取滨州医学院附属医院超声医学科2020年1月—2023年1月进行规范化培训的46名超声医师为研究对象,按随机数字法分为观察组和对照组,每组23名。对照组采用传统教学进行授课,观察组采用基于智能便携彩超云技术的实时远程教学进行授课,均培训6个月。培训前后2组学员均接受超声技能考核,考核完成后采用自编问卷对试验组学员进行调查。结果 观察组理论考试成绩及上机操作考试成绩为(82.96±5.44)分、(81.72±4.69)分,对照组为(73.82±4.51)分、(71.64±5.07)分,观察组各评分均高于对照组,差异有统计学意义(P <0.001)。观察组教学方式满意度、提高学习效率、有利于培养临床思维、提高自主学习能力认可率分别为91.30%、91.30%、95.65%、86.96%,高于对照组的43.48%、34.78%、39.13%、34.78%,差异有统计学意义(P <0.001)。结论 针对超声医学住培学员进行基于智能便携彩超云技术的远程教学培训可以提升超声医学住培学员的临床操作技能,获得了学员的认可。

便携式多模态医学影像系统在应急医学救援中的应用

随着精密制造技术的迅速发展,轻便、环境适应性强且性能高的便携式医学影像设备已经取得重要突破,为灾难、灾害现场高质量医学救援提供客观的医学影像依据,在救援领域得到了广泛应用。便携式医学影像设备为救援工作提供了更高效、更准确的诊断和救治参考,尤其是在应急救援领域和战伤救援中效果显著。根据应急救援和战伤救援的特点,结合便携式医学影像设备在应急救援中应用的相关文献,讨论便携式多模态医学影像系统在应急救援中的应用价值。

Diagnostics in inflammatory bowel disease: Ultrasound

Diagnosis of chronic inflammatory bowel diseases (IBD) is based on a combination of clinical symptoms, laboratory tests and imaging data. Imaging of the morphological characteristics of IBD includes the assessment of mucosal alterations, transmural involvement and extraintestinal manifestations. No single imaging technique serves as a diagnostic gold standard to encompass all disease manifestations. Ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI) allow cross-sectional imaging of the transmural alterations and extraintestinal manifestations. While in the USA the technique of choice is CT, in Europe the focus is more on MRI and ultrasound (US). Most patients with chronic IBD are diagnosed at a young age. After baseline diagnosis many of these young patients have to undergo repetitive imaging procedures during the variable clinical course of the disease, characterized by alternate periods of remission and active disease, and in monitoring the response to treatment. US has the advantage of being noninvasive, less costly, and easily repeatable, and thus can be very useful in following up patients with IBD. In addition, rising concern about radiation exposure in young adults indicates the demand for radiation-sparing techniques like US and MRI. This article focuses on the current clinical practice of US in IBD, describing the current technologies used in transabdominal intestinal US and the characteristic sonographic findings in Crohn′s disease and ulcerative colitis.

Endoscopic ultrasound using ultrasound probes for the diagnosis of early esophageal and gastric cancers

Endoscopic ultrasound (EUS) devices were first designed and manufactured more than 30 years ago, and since then investigators have reported EUS is effective for determining both the staging and the depth of invasion of esophageal and gastric cancers. We review the present status, the methods, and the findings of EUS when used to diagnose and stage early esophageal and gastric cancer. EUS using high-frequency ultrasound probes is more accurate than conventional EUS for the evaluation of the depth of invasion of superficial esophageal carcinoma. The rates of accurate evaluation of the depth of invasion by EUS using high-frequency ultrasound probes were 70%-88% for intramucosal cancer, and 83%-94% for submucosal invasive cancer. But the sensitivity of EUS using high-frequency ultrasound probes for the diagnosis of submucosal invasive cancer was relatively low, making it difficult to confirm minute submucosal invasion. The accuracy of EUS using high-frequency ultrasound probes for early gastric tumor classification can be up to 80% compared with 63% for conventional EUS, although the accuracy of EUS using high-frequency ultrasound probes relatively decreases for those patients with depressed-type lesions, undifferentiated cancer, concomitant ulceration, expanded indications, type 0-I?lesions, and lesions located in the upper-third of the stomach. A 92% overall accuracy rate was achieved when both the endoscopic appearance and the findings from EUS using high-frequency ultrasound probes were considered together for tumor classification. Although EUS using high-frequency ultrasound probes has limitations, it has a high depth of invasion accuracy and is a useful procedure to distinguish lesions in the esophagus and stomach that are indicated for endoscopic resection.

Clinical Value of Transperineal 3D Volume Ultrasound Combined with 2D High Frequency Ultrasound in Anal Fistula

Objective: To explore the clinical diagnostic value of transperineal volume ultrasound combined with two-dimensional high-frequency ultrasound for anal fistula. Methods: A total of 52 patients with anal fistula admitted to the Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine from December 2017 to July 2018 were selected. They were all undergoing transperineal 3D volume ultrasound combined with 2D high-frequency ultrasound examination, and the diagnosis results were analyzed. The results of ultrasonography and surgical pathology were compared. Results: Among 52 patients, 3D volume ultrasound combined with 2D high-frequency ultrasound were used to diagnose 32 cases of anal fistula intersphincteric type, 14 cases of transsphincter type, 5 cases of supra-sphincter type, and 1 case of extra-sphincter type. T supervisor classification accuracy rate is 90%. The detection rate of branch pipes was 92%, and the compliance rate of internal fistula was 95%. Two-dimensional high-frequency ultrasound was used to diagnose 34 cases of anal fistula intersphincteric type, 14 cases of transsphincter type, 4 cases of supra-sphincter type, and 0 cases of extra-sphincter type. The detection rate of branch canals was 42%, and the accuracy of type classification was 90%. The coincidence rate was 95%. There was a statistically significant difference in the detection rate of the anal fistula branch and the coincidence rate of the internal fistula between the two methods (both P Conclusion: 1) The overall coincidence rate of three-dimensional volumetric ultrasound combined with two-dimensional high-frequency ultrasound in the diagnosis of anal fistula is high;2) Three-dimensional volumetric ultrasound technology has great application prospects in infants and anal fistulas.

掌上无线超声引导桡动脉穿刺置管的护理配合

目的总结掌上无线超声引导桡动脉穿刺置管的护理配合要点。方法对51例患者采用掌上超声定位桡动脉穿刺置管,护理配合包括患者准备、仪器及耗材等准备,Allen试验评估,穿刺中配合医生摆放穿刺体位、进行桡动脉穿刺配合,穿刺后护理及常见并发症处理等。结果51例均完成置管,其中一次穿刺成功44例(86.28%),1例5次穿刺成功患者出现穿刺处血肿,其余患者未发生感染、血管痉挛、动脉血栓、神经损伤等并发症。结论高效、规范的护理配合可提高掌上无线超声引导桡动脉穿刺置管成功率,减少并发症。

5G便携式远程超声的应用进展

随着网络信息技术的发展和超声仪器性能的改进,便携化、智能化的超声设备在临床诸多领域发挥了重要作用,远程技术的实现使超声诊疗工作摆脱了空间位置的束缚,应用场景的外延得以拓展。本文通过总结便携式远程超声在临床疾病诊断、急危重症抢救、围手术期辅助、军事卫勤保障、学员带教等方面的应用现状,充分体现其“小身材、大功能”的独特优势,并结合目前5G技术高速率、低延迟的特点,对其应用拓展进行展望。

“互联网+创伤急救”区域性可视化院前急救模式的研究

目的 探讨创伤超声重点评估(focused assessment with sonography for trauma, FAST)在区域性院前创伤患者中应用,利用“互联网+创伤急救”建立一个集统筹调度、绿色通道等功能的院前可视化急救模式。方法 自2020年6月起,广州市番禺区在全区范围内采用FAST对院前创伤患者进行创伤评估,开展区域性院前可视化急救,2021年12月完成培训工作。收集2020年6月至2023年6月期间全区创伤急救患者的数据,将2020年6月至2021年12月的患者分为对照组,2022年1月至2023年6月的患者分为实验组。利用“急救绿道”APP、紫云系统以及各医院信息系统收集急诊准备时间、FAST完成时间、术前准备时间、门术时间,以及漏诊、误诊、死亡人数等信息,采用大数据回顾性分析院前可视化急救实施效果。结果 回顾性分析符合标准的804例急诊创伤患者显示,与对照组相比,实验组明显缩短急诊准备时间[(2.23±1.30)min vs.(11.54±4.61)min]、FAST完成时间[(9.08±3.45)min vs.(29.23±5.36)min]、超声检查准备时间[(2.43±0.79)min vs.(11.14±3.29)min]、紧急手术术前准备时间[(21.45±6.73)min vs.(46.15±17.10)min]、门术时间[(40.44±25.20)min vs.(71.40±47.65)min],差异有统计学意义(P<0.05);实验组在信息预警比例(82.9%vs. 63.8%)、直达手术室比率(4.98%vs. 0.01%)高于对照组,差异有统计学意义(P<0.05);实验组在漏诊率(3.9%vs. 13.2%)、误诊率(1.3%vs. 4.9%)、病死率(0.2%vs. 2.6%)、严重创伤患者病死率(0.7%vs. 5.9%)明显低于对照组,差异有统计学意义(P<0.05)。结论 “互联网+创伤急救”区域性院前可视化急救模式缩短FAST完成时间、急诊准备时间和创伤救治时间,降低漏诊率和严重创伤患者病死率,实现创伤性疾病的快速、可视化、高效的诊疗,这种模式显著提高区域性创伤急救水平。

High-frequency ultrasound features of basal cell carcinoma and its association with histological recurrence risk

Background: Due to advances in high-frequency ultrasound technology, it is easier to detect fine structures of skin lesions. The aim of this study was to examine the ultrasonographic features and use recurrence risk stratification to assess the diagnostic performance of pre-operative ultrasound examination of basal cell carcinoma (BCC). Methods: This was a retrospective study. Forty-six BCC lesions underwent pre-operative ultrasound examination using 50- and 20- MHz probes. Ultrasonographic shape, margin, internal echoes, hyper-echoic spots, posterior echoes, and depth of the lesion were evaluated and correlated with the risk of recurrence based on histological features. Results: Forty-two patients had 46 skin lesions in total. The high-risk (n = 6) and low-risk (n = 40) groups exhibited considerable overlap in the ultrasonographic manifestations and no significant difference in margin (χ^2 = 3.231, P = 0.072), internal echo (χ^2 = 1.592, P = 0.207), or posterior echo (P = 0.169). However, high-risk BCCs tended to be irregular in shape than low-risk lesions (χ^2 = 4.313, P = 0.038). Both types presented hyper-echoic spots (χ^2 = 1.850, P = 0.174). Additionally, 78% of low-risk lesions were confined to the dermis (31/40), and 100% of high-risk lesions infiltrated into the sub-cutaneous tissue, resulting in a significant difference between the two groups (χ^2 = 10.951, P = 0.001). Ultrasound detected sub-clinical lesions in five patients. Conclusions: High-frequency ultrasound can provide important information for pre-operative evaluation of risk in BCC foci and reveal hidden lesions. The technique may play a crucial role in guiding therapeutic options for BCC.

Differential diagnosis of isolated calf muscle vein thrombosis and gastrocnemius hematoma by high-frequency ultrasound

Background Differential diagnosis of isolated calf muscle vein thrombosis （ICMVT） and gastrocnemius hematoma is essential for early identification of deep vein thrombosis （DVT）.This study aimed to investigate the diagnostic value of high-frequency color Doppler ultrasound for differential diagnosis of ICMVT and gastrocnemius hematoma.Methods A retrospective case series of 35 ICMVT （M∶F,21∶14; mean age （64.5±10.6） years） and 23 gastrocnemius hematoma （M∶F,16∶7; mean age （75.4±11.8） years） patients with bilateral/unilateral lower limb pain was conducted between January 2006 and September 2012.Characteristics and the morphology of high-frequency color Doppler ultrasonography of the lower limb deep vein,great saphenous vein,calf muscles,skin,and soft tissue were examined.Results ICMVT hypoechoic signals were characterized by long,tube-like masses on longitudinal sections and oval masses on transverse sections,with apparent muscle thrombosis boundaries,distal and proximal venous connections,and,often,lower limb DVT.Gastrocnemius hematoma hypoechoic signals were characterized by large volumes,enhanced posterior hematoma echo,hyperechoic muscle boundaries,no hematoma blood flow,and no DVT,and clear differences in trauma/exercise-and oral anticoagulant-induced hematomas were readily apparent.According to the measurement,the ratio of long diameter/transverse diameter （D/T） in ICMVT patients was about less than 2.0,whereas in gastrocnemius hematoma patients the ratio was more than 2.0.Early stage isoechoic and hypoechoic signals were detected with gradually increasing ovular anechoic areas.Partial muscle fibers in the hematoma due to muscle fractures were apparent.Conclusion High-frequency color Doppler ultrasound was found to be a sensitive and reliable method for differential diagnosis of ICMVT and gastrocnemius hematoma due to trauma and exercise or prolonged oral anticoagulant use.

手持式便携超声仪在肥胖产妇硬膜外麻醉中的应用效果

目的探究手持式便携超声仪对肥胖产妇硬膜外麻醉的效果及应激反应因子的影响。方法选择2021年7—10月择期行硬膜外麻醉剖宫产术的肥胖产妇60例。依据随机数字表法分为手持式便携超声仪组(超声组)和触诊组,每组30例。观察手持式便携超声仪测量皮肤至硬膜外腔距离与实际进针深度的相关性;比较2组穿刺情况及患者满意度、麻醉相关评分及产时发热率、应激反应因子水平;记录不同时间点新生儿Apgar评分、麻醉相关并发症及腰椎软组织损伤发生情况。结果触诊组因更换麻醉方式失访1例,最终纳入59例产妇。超声测量皮肤至硬膜外腔距离与实际进针深度具有相关性(r=0.926,P<0.001)。超声组首针穿刺成功率高于触诊组,插针次数及穿刺次数少于触诊组,定位时间长于触诊组,穿刺时间短于触诊组,患者满意度高于触诊组(P<0.05,P<0.01)。超声组硬膜外麻醉效果评分高于触诊组,视觉模拟评分法评分低于触诊组(P<0.05,P<0.01)。分娩后6 h,2组促肾上腺皮质激素、皮质醇、去甲肾上腺素、C反应蛋白均高于麻醉前,但超声组低于触诊组(P<0.05)。2组不同时间点新生儿Apgar评分比较差异无统计学意义(P>0.05)。2组均未发生严重并发症。结论手持式便携超声仪可有效减少肥胖产妇硬膜外麻醉失误、提高硬膜外穿刺准确性和产妇满意度,减少对腰椎软组织的损伤,降低麻醉相关应激反应因子水平。

Impact of intestinal ultrasound with a portable system in the management of Crohn’s disease

Background:Intestinal ultrasound(IUS)is a valid cross-sectional imaging technique for the evaluation of Crohn’s disease(CD).With advancements in technology,portable ultrasound systems are becoming widely available,and the inevitable change to their use by non-radiologist clinicians would be a valuable contribution to improving patient care.This study aimed to investigate the diagnostic yield of IUS examination performed by a gastroenterologist with a portable system as an adjunct imaging modality in the routine care of CD patients.Methods:A total of 117 CD patients were assessed by IUS imaging.Pre-and post-IUS clinical-management decisions were recorded.The primary outcome was to evaluate the change in the patients’clinical-management decision following the IUS examination.The diagnostic accuracy was compared against the reference decision reached via a multidisiplinary meeting after the evaluation of all patient-related data.The endoscopic disease activity was determined using the simple endoscopic score for Crohn’s disease(SES-CD).Results:The initial clinical-management decision was changed in 47 patients(40.2%)after the IUS examination(P=0.001).The accuracy of patient-management decisions improved from 63.2%to 90.6%in comparison to reference decisions(P<0.001).After IUS examination,a further 13 cases(11.1%)were identified for urgent surgical/interventional procedures.The accuracy of colonoscopic(SES-CD≥3)assessment was shown to be comparable to that of IUS(94%vs 91%).The sensitivity for disease presence was 95%with colonoscopy and 94%with the IUS assessment.Conclusion:IUS examination with the use of a portable ultrasonography system significantly improves clinicalmanagement decisions.With further supporting data,this practice would possibly become a requirement for CD management.

地震后危重多发伤患者野外条件下的救治体会

目的:探讨突发灾难后危重多发伤患者在野外条件下的救治方案。方法和结果:患者女性,53岁,因"地震中骨盆砸伤、大量血尿"入院,呼吸困难,全腹压痛,褥疮。便携式B超示腹腔积液,左胸腔积液,膀胱破裂。便携式血气分析仪提示"严重贫血+低氧血症+低钾+酸中毒"。术前行左胸腔穿刺,膀胱穿刺引流。剖腹探查见直肠破裂(穿孔),遂行Harttman手术加膀胱造瘘术和抗感染治疗。术后第18日基本恢复。结论:术者具有精湛的技术和丰富的经验、充分发挥便携式设备的作用、依靠具有地理优势的当地医院、积极抗感染是艰苦环境下救治危重多发伤患者的成功因素。