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.
ObjectiveTo evaluate the efficacy and reversible effect of anti-VCAM-1 ultrasound-targeted microbubbles on extracorporeal circulation (ECC) related bone marrow neutrophil releasing.
MethodsThirty-six male SD rats were randomly divided into 6 groups with 6 rats in each group, including an antibody group (group A), antibody with ultrasound group (group AU), targeted microbubble group (group T), targeted microbubble rupture group (group TU), post-ECC plasma simulation group (group MC) and control group (group C) after in situ perfusion model establishment. Rats in group C received buffer perfusion for 4 cycles, and rats in other groups received perfusion for 5 cycles. After buffer perfusion for the first cycle, post-ECC plasma was infused to each group from the second cycle to the fifth cycle in group MC, A, AU, T and TU. Rats in group A and AU received injection with anti-VCAM-1 antibodies, while rats in group T and TU were given anti-VCAM-1 targeted microbubbles after the second perfusion cycle. Same ultrasound radiation was given to group AU and TU in the third perfusion cycle. Neutrophil counts from perfusate were compared among the 6 groups.
ResultsUnder simulated inflammatory condition after ECC, compared with group MC, significant reduction of neutrophil count released from bone marrow was found in group A and T, especially in group T (P < 0.05). After ultrasonic radiation, neutrophil mobilization recovered in group TU and its neutrophil count was significantly higher than that of group T (P < 0.05). There was no significant difference in neutrophil count between group A and AU in each perfusion cycle (P > 0.05).
ConclusionsAnti-VCAM-1 targeted microbubbles can block the binding of VCAM-1 and its ligand, and form a barrier on the surface of bone marrow sinusoids endothelium to inhibit neutrophils migrating and releasing. The binding of VCAM-1 and its ligand on microbubbles is separated by cavitation of disrupting microbubbles with ultrasound, and neutrophils recover the ability to cross the sinusoidal endothelium of bone marrow in inflammatory conditions to achieve the controllability of neutrophil releasing.
ObjectiveTo investigate the value of ultrasound knife in modified radical mastectomy for remaining pectoral nerve and intercostobrachial nerve.
MethodsOne hundred and sixty patients with breast cancer were divided into ultrasound knife group and electroscalpe group and then performed modified radical mastectomy with pectoral nerve and intercostobrachial nerve remainning. the pectoralis major thickness and paresthesia of skin of inner upper arm and axillary fossa were detected on the different time after operation.
Results①The age, body mass index, and mean opera-tion time had no significant differences between these two groups (P > 0.05).②On 6 months after operation, the thickness of bilateral pectoralis major was not significantly different in the ultrasound knife group (P > 0.05), which of injuried pectoralis major was significantly thinner than that of uninjuried pectoralis major in the electroscalpe group (P < 0.05).③The rates of paresthesia of skin on postoperative 3 months and 6 months in the ultrasound knife group were signifi-cantly lower than those in the electroscalpe group (P < 0.05).
ConclusionCompared with monopolar electro diathermy, the use of ultrasonic harmonic scalpel in modified radical mastectomy could better protect pectoral nerve and intercosto-brachial nerve, and thus decrease nerve parafunctional rate.
Objective To observe the ultrasonographic features of idiopathic uveal effusion syndrome (IUES). MethodsA retrospective controlled study. From January 2012 to December 2023, 13 patients with IUES (26 eyes) diagnosed by ophthalmology examination in Department of Ophthalmonogy of Beijing Tongren Hospital (IUES group) and 22 healthy people with 30 eyes (control group) were included in the study. Both eyes of all participants were examined by color Doppler ultrasound (CDU) and ultrasonic biomicroscopy (UBM). The thickness of the ocular wall at 300 μm on the temporal side of the optic disc was measured by CDU. UBM was used to measure the thickness of the nasal and temporal scleral processes. Corneal thickness (CT), anterior chamber depth (AD), lens thickness (LT) and axial length (AL) were measured by A-mode ultrasound. There were no significant differences in age (t=0.842), sex component ratio (χ2=0.540), eye difference (χ2=0.108) and AL (t=0.831) between IUES group and control group (P＞0.05). The CDU and UBM imaging features and biometrics of IUES affected eyes were observed. Independent sample t test was used for comparison between groups. ResultsCDU examination results showed that in 26 eyes of IUES group, choroidal detachment occurred in 20 eyes (76.9%, 20/26), which showed arc-shaped band echo connected with peripheral and equatorial eye wall echo, with uniform low echo area below, and blood flow signal could be seen on the band echo. The echo thickened and decreased in 4 eyes (15.3%, 4/26). Nine eyes (33.3%, 9/26) were accompanied by retinal detachment, which showed that the posterior pole vitreous echo was connected to the optic disc echo, and the blood flow signal was seen on the ribbon echo. UBM results showed ciliary detachment in 22 eyes (84.7%, 22/26), showing a spongy thickening of the ciliary body with interlamellar echo separation and an echoless area between the sclera. Ciliary body echo thickened and decreased in 2 eyes (7.7%, 2/26). Shallow space between ciliary body and sclera was observed in 2 eyes (7.7%, 2/26). Compared with the control group, CT (Z=2.054), LT (Z=1.867), scleral thickness (Z=2.536) and ocular wall thickness (Z=2.094) were thickened in IUES group, and AD (Z=1.888) were decreased, with statistical significance (P＜0.05). ConclusionsThe CDU of IUES is characterized by a thickened echo of the ocular wall and a uniform low echo area under the detached choroid. UBM is characterized by a spongy thickening of the ciliary body echo with interlaminar echo separation.
ObjectiveTo investigate the therapeutic effect of B ultrasound-guided percutaneous catheter drainage combined with veno-venous hemofiltration at different time points and multi-site in treatment of hyperlipidemic severe acute pancreatitis (HL-SAP).
MethodsThe clinical data of 34 patients with HL-SAP initially underwent B ultrasound-guided percutaneous catheter drainage combined with veno-venous hemofiltration at different time points and multi-site from January 2010 to June 2014 were retrospectively analyzed. According to the different of the onset to treatment time, 34 cases were divided into the≤24 h group and > 24 h group. The serum platelet activating factor (PAF) and triglyceride (TG) at the time of admission and after admission 1, 3, 5, 7, and 10 days were detected, and the hospitalization time, mortality, and the rate of conversion to open surgery were observed.
ResultsThe levels of PAF and TG in the both groups tended to gradually decrease with different degrees, were significantly lower than that the before treatment (P < 0.05), and the decline of PAF and TG in≤24 h group were more significant than > 24 h group. The hospitalization time, mortality, and the rate of conversion to open surgery in the≤24 h group were significantly lower than those of the > 24 h group (P < 0.05).
ConclusionThe early using of B ultrasound-guided percutaneous catheter drainage combined with veno-venous hemofiltration at different time points and multi-site would have a beneficial impact on the management of HL-SAP and complications.
ObjectiveTo investigate whether inferior vena cava (IVC) ultrasound can improve the success rate of weaning in patients with respiratory failure by comparing the difference of success rate between ultrasound-guided weaning mode and spontaneous breathing test (SBT) weaning mode.MethodsFrom November 2017 to May 2018, 31 respiratory failure patients underwent mechanical ventilation in intensive care unit were randomly divided into an ultrasonic guidance group (16 cases) and a control group (15 cases). All of them were offline after meeting the offline indications. The routine group was assessed by SBT for offline procedures. The diameter and variation rate of inferior vena cava were measured at SBT. IVC diameter >2.0 cm and variation rate < 50% were given intravenous diuretics. After the IVC diameter reached the standard again, the catheter was taken off the machine after passing SBT. The patients of both groups were considered as successfully weaned when they were able to tolerate at least 48 consecutive hours of spontaneous breathing. The following data were recorded at weaning, ie. Acute Physiological and Chronic Health Evaluation Ⅱ (APACHEⅡ) score, arterial blood gas analysis, plasma albumin, serum electrolyte sodium, potassium, 7-day and 14-day weaning success rate.ResultsThere were no significant differences in APACHEⅡ score, plasma albumin level, arterial oxygen partial pressure, carbon dioxide partial pressure, pH, blood sodium level or blood potassium level between the two groups at the beginning of weaning (all P>0.05), and the 2-day weaning success rate was higher in the ultrasound group than that in the control group (95% vs. 73%, P=0.039); the 7-day weaning success rate was higher in the ultrasound group than that in the control group (87% vs. 66%, P=0.043). No significant difference was found in the 14-day weaning success rate (68% in the ultrasound group vs. 53% in the control group, P=0.446).ConclusionUltrasound can improve the success rate of weaning in patients with respiratory failure.
Objective To systematically review the clinical value of color Doppler ultrasonic for diagnosing female breast cancer. Methods We electronicaaly searched the databases including The Cochrane Library (Issue 2, 2013), EMbase, PubMed, CNKI, WanFang Data, MedaLink ,VIP and CBM for diagnostic tests on breast cancer diagnosed with color Doppler ultrasonic vs. with pathological biopsy (golden criteria) from 1982 to the March, 2013. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of the included studies according to QUADAS items. The Meta-DiSc software (version 1.4) was used to conduct pooling on sensitivity, specificity, positive likelihood radio, and negative likelihood radio. Heterogeneity test was performed and the summary receiver operating characteristic curve (SROC) was drawn for area under the curve (AUC). Results A total of 25 studies involving 3 274 patients were included. The results of meta-analysis showed that, SPE, SEN, +LR, ?LR and DOR were (0.76, 95%CI 0.74 to 0.78), (0.80, 95%CI 0.78 to 0.82), (3.58, 95%CI 2.63 to 4.87), (0.28, 95%CI 0.22 to 0.35) and (13.76, 95%CI 8.47 to 22.36), respectively. The AUC of SROC curve was 0.865 7. Conclusion Current evidence shows that color Doppler ultrasonic has high sensitivity (80%) and high specificity (76%) in the diagnosis of high-frequency Ultrasound. The positive rate in the breast cancer group is 13.76 times as high as that in non-breast cancer, which indicates color Doppler ultrasonic has good diagnostic value for breast cancer.
ObjectiveTo evaluate the diagnostic value of ultrasound for gallbladder carcinoma (GA), in order to improve the ability of early ultrasonic and clinical diagnosis of GA.
MethodsWe analyzed and compared the clinical data and ultrasonic results of 42 GA cases confirmed by surgery and pathology between January 2008 and December 2013, and summarized the classification, ultrasonographic features, and diagnosis of GA.
ResultsAmong the 42 cases, 25 were correctly diagnosed by ultrasound (59.5%), among which 9 were thick-wall type, 11 were protrusion type and 5 were solid type. Seventeen cases were misdiagnosed (40.5%). Pathological results showed 14 cases of highly-differentiated adenocarcinoma, 16 of moderately differentiaed adenocarcinoma, 9 of poorly-differentiated adenocarcinoma, 2 of squamous adenocarcinoma and 1 of neuroendocrine carcinoma.
ConclusionUltrasound is the preferred method for the diagnosis of GA because of its convenience, although the diagnostic accuracy is still not good and more efforts should be done.
Objective To compare the effectiveness of ultrasound-guided closed reduction with Kirschner wire fixation and open reduction with Kirschner wire fixation in the treatment of humeral lateral condyle fracture (HLCF) in children. Methods A clinical data of 53 children with HLCF admitted between May 2020 and April 2023 and met selective criteria was retrospectively analyzed. Of these, 25 cases were managed with closed reduction and Kirschner wire fixation under ultrasound guidance (closed group), while 28 cases underwent open reduction and Kirschner wire fixation (open group). There was no significant difference between the two groups in terms of gender, age, cause of injury, fracture side, fracture classification, and time from injury to operation (P>0.05). The following variables were recorded and compared between the two groups: operation time, intraoperative fluoroscopy frequency, fracture healing time, incidence of complications, and the Flynn elbow function score at last follow-up. Results In the closed group, the fractures were successfully reduced under ultrasound guidance, with no nerve damage reported in either group. The operation time and intraoperative fluoroscopy frequency were significantly less in the closed group than in the open group (P<0.05). One case of infection (Kirschner wire irritation) was observed in the closed group, while 3 cases in the open group (2 of Kirschner wire irritation and 1 of incision infection). However, the difference in the incidence of infection between the two groups was not significant (P>0.05). All patients in both groups were followed up 6-18 months (mean, 10.2 months). X-ray examinations confirmed that fractures had healed in both groups, with no significant difference in healing time (P>0.05). During follow-up, 5 cases of lateral humeral process formation were observed in the closed group, compared to 12 cases in the open group, although this difference was not significant (P>0.05). At last follow-up, the excellent and good rate of elbow joint function was evaluated as 96.0% (24/25) in the closed group and 92.9% (26/28) in the open group according to the Flynn scoring criteria, with no significant difference between the two groups (P>0.05). Both groups showed no occurrence of ossifying myositis or elbow internal/external rotation. Conclusion The effectiveness of ultrasound-guided closed reduction and Kirschner wire fixation in the treatment of HLCF in children is comparable to open reduction and Kirschner wire fixation, but the former can reduce operation time and intraoperative fluoroscopy frequency, and obtain lower the incidence of complications.
Ultrasound guided percutaneous interventional therapy has been widely used in clinic. Aiming at the problem of soft tissue deformation caused by probe contact force in robot-assisted ultrasound-guided therapy, a real-time non-reference ultrasound image evaluation method considering soft tissue deformation is proposed. On the basis of ultrasound image brightness and sharpness, a multi-dimensional ultrasound image evaluation index was designed, which incorporated the aggregation characteristics of the organization. In order to verify the effectiveness of the proposed method, ultrasound images of four different models were collected for experiments, including prostate phantom, phantom with cyst, pig liver tissue, and pig liver tissue with cyst. In addition, the correlation between subjective and objective evaluations was analyzed based on Spearman’s rank correlation coefficient. Experimental results showed that the average evaluation time of a single image was 68.8 milliseconds. The evaluation time could satisfy real-time applications. The proposed method realizes the effective evaluation of real-time ultrasound image quality in robot-assisted therapy, and has good consistency with the evaluation of supervisors.
