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简介：Objective:　ToinvestigatethevalueoftranscranialDoppler(TCD)ultrasonographyinevaluatingtheoutcomeofseveretraumaticbraininjuryandtocorrelatetheTCDvalueswithintracranialpressure(ICP)andcerebralperfusionpressure(CPP)monitoring.　　Methods:　AprospectivestudywasconductedtoevaluatethecontributionofTCDultrasonographytoneurologicaloutcomeinaseriesof96severetraumaticbraininjurypatients.ThequantitativevariablesofTCDultrasonographyincludedthemeanbloodflowvelocityofthemiddlecerebralartery(MCA)andpulsatilityindexwithinthefirst24hoursofadmission.TheICPandCPPvalueswerealsorecorded.Outcomein6monthspostinjurywasevaluatedusingtheGlasgowOutcomeScale(GOS4-5wasconsideredas“good”andGOS1-3as“poor”).　　Results:　ThemeanbloodflowvelocityoftheMCAwaslargerthan40cm/sin30(51%)patientswithgoodoutcomewhereasitwaslessthan40cm/sin27(73%)patientswithpooroutcome(P<0.025).ThemeanPIincasesofgoodoutcome(34patients,57%)waslowerthan1.5whereasinpooroutcome(30patients,83%)washigherthan1.5(P<0.001).ThecorrelationsofICPandCPPtopulsatilityindexwerestatisticallysignificant(P<0.01).　　Conclusions:　TCDultrasonographyisvalidinpredictingthepatientsoutcomeof6monthsandcorrelatessignificantlywithICPandCPPvalueswhenitisperformedinthefirst24hoursofseveretraumaticbraininjury.

简介：Pancreaticcysticlesions(PCLs)areincreasinglybeingidentifiedbecauseofthewidespreaduseofhighresolutionabdominalimaging.Thesecystsencompassaspectrumfrommalignantdiseasetobenignlesions,andtherefore,accuratediagnosisiscrucialtodeterminethebestmanagementstrategy,eithersurgicalresectionorsurveillance.However,thecurrentstandardofdiagnosisisnotaccurateenoughduetolimitationsofimagingandtissuesamplingtechniques,whichentailtheriskofunnecessaryburdensomesurgeryforbenignlesionsormissedopportunitiesofprophylacticsurgeryforpotentiallymalignantPCLs.Inthelastdecade,endoscopicinnovationsbasedonendoscopicultrasonography(EUS)imaginghaveemerged,aimingtoovercomethepresentlimitations.ThesenewEUS-basedtechnologiesarecontrastharmonicEUS,needle-basedconfocalendomicroscopy,through-the-needlecystoscopyandthrough-theneedleintracysticbiopsy.Here,wepresentacomprehensiveandcriticalreviewoftheseemergingendoscopictoolsforthediagnosisofPCLs,withaspecialemphasisonfeasibility,safetyanddiagnosticperformance.

简介：AIM:Toevaluatetheclinicalusefulnessofendoscopicultrasonography(EUS)forthediagnosisoftheinvasiondepthofulcerativecolitis-associatedtumors.METHODS:Thestudygroupcomprised13patientswith16ulcerativecolitis(UC)-associatedtumorsforwhichthedepthofinvasionwaspreoperativelyestimatedbyEUS.Thelesionswerethenresectedendoscopicallyorbysurgicalcolectomyandwereexaminedhistopathologically.Themeanageofthesubjectswas48.2±17.1years,andthemeandurationofUCwas15.8±8.3years.Twolesionsweretreatedbyendoscopicresectionandtheother14lesionsbysurgicalcolectomy.ThedepthofinvasionofUCassociatedtumorswasestimatedbyEUSusinganultrasonicprobeandwasevaluatedonthebasisofthedeepestlayerwithnarrowingorruptureofthecolonicwall.RESULTS:ThediagnosisofUC-associatedtumorsbyEUSwascarcinomafor13lesionsanddysplasiafor3lesions.Theinvasiondepthofthecarcinomaswasintramucosalfor8lesions,submucosalfor2,themuscularispropriafor2,andsubserosalfor1.Eleven(69%)ofthe16lesionsaroseintherectum.Themacroscopicappearancewasthelaterallyspreadingtumor-non-granulartypefor4lesions,sessiletypefor4,laterallyspreadingtumor-granulartypefor3,semipedunculatedtype(Isp)for2,type1for2,andtype3for1.ThedepthofinvasionwascorrectlyestimatedbyEUSfor15lesions(94%)butwasmisdiagnosedasintramucosalfor1carcinomawithhigh-gradesubmucosalinvasion.The2lesionstreatedbyendoscopicresectionwereintramucosalcarcinomaanddysplasia,andbothwerediagnosedasintramucosallesionsbyEUS.CONCLUSION:EUSprovidesagoodestimationoftheinvasiondepthofUC-associatedtumorsandmaythusfacilitatetheselectionoftreatment.

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简介：Endoscopicultrasonography-guidedfine-needleaspiration（EUS-FNA）hasbeenappliedtopancreaticobiliarylesionssincethe1990sandisinwidespreadusethroughouttheworldtoday.Weusedthismethodtoconfirmthepathologicalevidenceofthepancreaticobiliarylesionsandtoperformsuitabletherapies.ComplicationsofEUS-FNAarequiterare,butsomeofthemaresevere.OperatorsshouldmasterconventionalEUSobservationandexperienceaminimumof20-30casesofsupervisedEUS-FNAonnon-pancreaticandpancreaticlesionsbeforeattemptingsoloEUSFNA.StudiesconductedonpancreaticobiliaryEUSFNAhavefocusedonselectionofsuitableinstruments（e.g.,needleselection）andsamplingtechniques（e.g.,fanningmethod,suctionlevel,withorwithoutastylet,optimumnumberofpasses）.Today,thediagnosticabilityofEUS-FNAisstillimproving;thedetectionofpancreaticcancer（PC）currentlyhasasensitivityof90%-95%andspecificityof95%-100%.InadditiontoPC,avarietyofrarepancreatictumorscanbediscriminatedbyconductingimmunohistochemistryontheFNAmaterials.Aflexible,largecaliberneedlehasbeenusedtoobtainalargepieceoftissue,whichcanprovidesufficienthistologicalinformationtobehelpfulinclassifyingbenignpancreaticlesions.EUSFNAcansupplyhighdiagnosticyieldsevenforbiliarylesionsorperi-pancreaticobiliarylymphnodes.ThisreviewfocusesontheclinicalaspectsofEUS-FNAinthepancreaticobiliaryfield,withtheaimofprovidinginformationthatcanenablemoreaccurateandefficientdiagnosis.

简介：BackgroundAcuterespiratorydistresssyndrome(ARDS)causedbyH7N9influenzainpregnantwomanisalife-threateningeventwithanincreasedriskformaternalandbaby'sdeath.Theaimofthisstudywastoevaluatetheimpactofpoint-of-careultrasonography(POCUS)onthemanagementandprognosisofthesepatients.MethodsAcaseof31-yr-oldpregnantwomaninourhospital,whowasunderwentPOCUSforevaluatingcardiopulmonaryfunctions,volumestate,fluidresponsivenessandultrasound-guidedprocedureswasadmittedtoIntensiveCareUnit(ICU).Weperformedultrasonographydailyformonitoringorganfunctions.Reviewofrelatedliteratureswasalsoconducted.ResultsWiththehelpofPOCUS,wemadequicklydiagnosisofseverepneumoniaandARDScausedbyH7N9influenza.ThetherapieshadalsobeenchangedafterPOCUSexaminations,suchasrestrictfluidadministrationrelyingontheassessmentsoftheinferiorvenacava(IVC)toestimatepreloadandlungultrasoundmonitoringtoidentifytheearlypresenceofextravascularlungwater(EVLW)andavoidfluidoverresuscitation,ultrasound-guidedrecruitmentmaneuvertoimprovedrespiratorydistresssyndrome,andsoon.ConclusionsPOCUShasasignificantimpactondecision-makingandtherapeuticmanagementandshouldbecomeaclinicalroutineinthemanagementofARDSpatientscausedbyH7N9influenzainpregnancy.

简介：瞄准：与颜色在病人在肝切除术期间发现秘密转移表面的癌症肝转移(CRCLM)，提高对比的intraoperativeultrasonography(CE-IOUS)用一个新微水泡代理人被执行，sonazoid，它在Kupffer房间基于它的累积提供一幅实质特定的对比图象。方法：有CRCLM的八个病人在肝切除术前用sonazoid经历了CE-IOUS。肝在迟了的Kupffer阶段成像期间被调查，它是sonazoid的一个珍贵特征。结果：用sonazoid的CE-IOUS提供了早脉管阶段并且为10min的正弦曲线阶段图象在sonazoid的注射以后由迟了的Kupffer阶段图象列在后面直到30min。IOUS没在8个病人提供变形损害的新调查结果。在sonazoid的迟了的Kupffer阶段图象期间，然而，变形损害最新在8个病人中的二个被发现。这些最新检测的损害被作为转移诊断的另外的肝切除术和组织病理学说的联盟者移开。结论：用sonazoid的CE-IOUS能允许外科医生与足够的时间调查整个肝并且intraoperatively发现新转移。