目的 总结超声引导下经皮经肝穿刺胆管引流术(PTCD)的优、缺点,为临床治疗重症急性胆管炎（SAC）提供参考。方法 回顾性分析我院1994年8月至2008年7月期间对156例老年SAC患者行在超声引导下的PTCD治疗的临床资料。结果 156例行PTCD均获成功,1次穿刺成功140例，其成功率达89.7%（140/156）; 16例首次穿刺失败后再次穿刺均成功。无一例发生腹腔出血、胆汁性腹膜炎等并发症。本组引流效果较好,中毒危象缓解，黄疸减退，肝功能改善。结论 PTCD较外科手术创伤小、操作简单、快速,具有微创的特点,对老年、有严重合并症及复杂疾病不能耐受手术及麻醉的SAC患者，其作为紧急抢救措施切实可行,并为后期施行根治性手术争取了时间。
ObjectiveTo analyze the feasibility and effectiveness of elastic intramedullary nail fixation for the fifth metacarpal neck fracture under the guidance of high frequency ultrasound.MethodsThe clinical data of 30 patients with the fifth metacarpal neck fractures who were treated with elastic intramedullary nails fixation under the guidance of high frequency ultrasound and met the selection criteria between May 2013 and September 2017 were retrospectively analysed. There were 24 males and 6 females, the age ranged from 18 to 58 years, with an average of 31.4 years. The head-shaft angle of the fifth metacarpal was (55.6±11.3)°. The time from injury to operation was 12 hours to 8 days, with an average of 2.4 days. The operation time, number of intraoperative fluoroscopy, fracture reduction, complications, and fracture healing time were recorded. The head-shaft angle of the fifth metacarpal on the affected side after fracture healing were measured and compared with the healthy side. At last follow-up, the active range of motion of the fifth metacarpophalangeal joint of both sides were measured, and the function was evaluated by using the total active movement (TAM) evaluation standard of the Hand Surgery Association of Chinese Medical Association.ResultsThe operation time was 22-40 minutes, with an average of 32.4 minutes; the intraoperative fluoroscopy was performed once; ultrasound images and X-ray fluoroscopy showed that the fracture was well reduced and no adjustment was required. The incisions healed well after operation, without tendon adhesion or local numbness. All 30 patients were followed up 8-16 months, with an average of 11.7 months. The fracture healing time was 4-8 weeks, with an average of 5.6 weeks. The head-shaft angle of the fifth metacarpal was (13.2±1.4)°, which was significantly improved when compared with preoperative value (t=−20.02, P=0.00); and there was no significant difference (t=1.94, P=0.06) when compared with the healthy side [(12.6±1.0)°]. At last follow-up, the active range of motion of the fifth metacarpophalangeal joint on the affected side was (89.4±2.4)°, showing no significant difference (t=−1.58, P=0.13) when compared with the healthy side [(90.3±2.0)°]. According to the TAM evaluation standard of the Hand Surgery Association of Chinese Medical Association, all patients were considered to be excellent.ConclusionThe effectiveness of elastic intramedullary nail fixation for the fifth metacarpal neck fracture under the guidance of high frequency ultrasound is definite. It can dynamically observe the fracture reduction from different angles, reduce ionizing radiation and postoperative complications.
ObjectiveTo explore the diagnostic value of ultrasound elastography (USE) combined with long non-coding RNA actin filament associated protein 1 anti-sense RNA 1 (AFAP1-AS1) mRNA in thyroid fine-needle aspiration (FNA) wash-out fluid for distinguishing benign from malignant thyroid nodules. MethodsThe patients with thyroid nodules who were treated in the Shenzhen Futian District Second People’s Hospital from January 2020 to June 2022 were collected. Before operation, the patients’ thyroid nodules were evaluated by the USE score and the AFAP1-AS1 mRNA in the thyroid FNA wash-out fluid was detected. The pathological result of the thyroid nodule after operation was as a gold standard for diagnosis of malignant thyroid nodules. The clinical diagnostic value of USE score combined with AFAP1-AS1 mRNA in the FNA wash-out fluid of the benign and malignant thyroid nodules were analyzed. ResultsA total of 174 thyroid nodules (124 patients) were detected in this study, of which 62 (45 patients) were histologically diagnosed as malignant. There was a statistical difference in the comparison of the composition ratio of USE score grading between the benign and malignant thyroid nodules (Z=8.82, P<0.001). The point of USE of the benign thyroid nodules was statistically lower than that of the malignant thyroid nodules [2.28±1.16 vs. 4.26±1.01, mean difference (MD) and 95% confidence interval (95%CI)=2.98 (2.76, 3.20), t=30.85, P<0.001]. The AFAP1-AS1 mRNA in the FNA wash-out fluid of the malignant thyroid nodules was statistically higher than that of the benign thyroid nodules [1.45±0.27 vs. 1.13±0.16, MD (95%CI)=1.45(1.39, 1.50), t=10.69, P<0.001]. Pearson correlation analysis showed that there was a positive correlation between the USE score of thyroid nodules and the expression of AFAP1-AS1 mRNA in the FNA wash-out fluid (r=0.58, P<0.001). The sensitivity and specificity of USE score in combination with expression of AFAP1-AS1 mRNA in the FNA wash-out fluid for diagnosing the malignant thyroid nodules by receiver operating characteristic (ROC) curve was 93.5% and 88.4% respectively. The area under the ROC curve (95%CI) was 0.91 (0.86, 0.96). Conclusion According to preliminary results of this study, USE score combined with AFAP1-AS1 mRNA in the thyroid FNA wash-out fluid is more sensitive and shows a potential diagnostic performance than USE score or AFAP1-AS1 mRNA detection alone for distinguishing benign from malignant thyroid nodules.
Objective To investigate the effect of allogeneic chondrocytes-calcium alginate gel composite under the intervention of low intensive pulsed ultrasound (LIPUS) for repairing rabbit articular cartilage defects. Methods Bilateral knee articular cartilage were harvested from 8 2-week-old New Zealand white rabbits to separate the chondrocytes by mechanical-collagen type II enzyme digestion. The 3rd passage chondrocytes were diluted by 1.2% sodium alginate to 5 × 106 cells/mL, then mixed with CaCl2 solution to prepare chondrocytes-calcium alginate gel composite, which was treated with LIPUS for 3 days (F0: 1 MHz; PRF: 1 kHz; Amp: 60 mW/cm2; Cycle: 50; Time: 20 minutes). An articular cartilage defect of 3 mm in diameter and 3 mm in thickness was established in both knees of 18 New Zealand white rabbits (aged 28-35 weeks; weighing, 2.1-2.8 kg), and divided into 3 groups randomly, 6 rabbits in each group: LIPUS group, common group, and model group. Defect was repaired with LIPUS-intervention gel composite, non LIPUS-intervention gel composite in LIPUS group and common group, respectively; defect was not treated in the model group. The general condition of rabbits was observed after operation. The repair effect was evaluated by gross and histological observations, immunohistochemical staining, and Wakitani score at 8 and 12 weeks after operation. Results Defect was filled with hyaline chondroid tissue and white chondroid tissue in LIPUS and common groups, respectively. LIPUS group was better than common group in the surface smooth degree and the degree of integration with surrounding tissue. Defect was repaired slowly, and the new tissue had poor elasticity in model group. Histological observation and Wakitani score showed that LIPUS group had better repair than common group at 8 and 12 weeks after operation; the repair effect of the 2 groups was significantly better than that of model group (P lt; 0.05); and significant differences in repair effect were found between at 8 and 12 weeks in LIPUS and common groups (P lt; 0.05). The collagen type II positive expression area and absorbance (A) value of LIPUS and common groups were significantly higher than those of model group (P lt; 0.05) at 8 and 12 weeks after operation, and the expression of LIPUS group was superior to that of common group at 12 weeks (P lt; 0.05); and significant differences were found between at 8 and 12 weeks in LIPUS group (P lt; 0.05), but no significant difference between 2 time points in common and model groups (P gt; 0.05). Conclusion Allogeneic chondrocytes-calcium alginate gel composite can effectively repair articular cartilage defect. The effect of LIPUS optimized allogeneic chondrocytes-calcium alginate gel composite is better.
The development and progression of atherosclerosis and thrombosis are closely related to changes of hemodynamics parameters. Ultrasonic pulse wave Doppler technique is normally used for noninvasively blood flow imaging. However, this technique only provides one-dimensional velocity and depends on the angle between the ultrasound beam and the local velocity vector. In this study, ultrasonic particle image velocimetry method was used to assess whole field hemodynamic changes in normal blood vessels. By using the polynomial fitting method, we investigated the velocity gradient and assessed the shear in different blood flow velocity of 10 healthy rats. It was found that using four polynomial fitting could result in optimal measurement results. The results obtained by ultrasonic particle image velocimetry accorded with the results obtained using Doppler technique. The statistical average of cyclical vessel wall shear stress was positively related to the locational mean velocity. It is proven that ultrasonic particle image velocimetry method could be used to assess directly the real-time whole field hemodynamic changes in blood vessels and was non-invasively, and should be a good prosperous technique for monitoring complex blood flow in stenotic arteries.