简介：摘要Endoscopic ultrasound (EUS) has both diagnostic and therapeutic clinical applications. This review article focuses on recent advances in two commonly performed procedures: EUS-guided tissue acquisition and EUS-guided drainage. There is a shift from acquiring aspirates for cytology to obtaining tissue cores for histological diagnoses and molecular analyses. There is growing interest and research about artificial intelligence in EUS. Artificial intelligence may potentially be useful to guide clinical decision making if biopsy results are non-diagnostic. The range of EUS-guided drainage procedures has expanded. EUS-guided drainage of walled-off pancreatic fluid collections is an accepted first line treatment option. EUS-guided palliative drainage of malignant biliary obstruction after unsuccessful endoscopic retrograde cholangiopancreatography (ERCP) is now an accepted alternative to percutaneous transhepatic biliary drainage. EUS-guided gallbladder drainage for management of acute cholecystitis is now a preferred option over percutaneous cholecystostomy for non-surgical candidates. Other EUS-created gastrointestinal anastomoses such as EUS-guided gastroenterostomy in the context of gastric outlet obstruction, and EUS-directed transgastric ERCP for Roux-en-Y gastric bypass are now technically feasible, but further prospective randomized studies are needed to establish the actual clinical impact.

简介：TherevisedAtlantaclassificationofacutepancreatitiswasadoptedbyinternationalconsensus,andisbasedonactuallocalandsystemicdeterminantsofdiseaseseverity.Thelocaldeterminantispancreaticnecrosis(sterileorinfected),andthesystemicdeterminantisorganfailure.Localcomplicationsofpancreatitiscanincludeacuteperi-pancreaticfluidcollection,acutenecroticcollection,pseudocystformation,andwalledoffnecrosis.Interventionalendoscopicultrasound(EUS)hasbeenincreasingutilizedinmanagingtheselocalcomplications.AfterperformingaPubMedsearch,theauthorsmanuallyappliedpre-definedinclusioncriteriaorafiltertoidentifypublicationsrelevanttoEUSandpancreaticcollections(PFCs).Theauthorsthenreviewedtheutility,efficacy,andrisksassociatedwithusingtherapeuticEUSandinvolvedEUSdevicesintreatingPFCs.Duetothedevelopmentandregulatoryapprovalofimprovedandnovelendoscopicdevicesspecificallydesignedfortransmuraldrainageoffluidandnecroticdebris(accessandpatencydevices),theauthorspredictcontinuingevolutioninthemanagementofPFCs.WebelievethatEUSwillbecomeanindispensablepartofproceduresusedtodiagnosePFCsandperformimage-guidedinterventions.AfterdrainingaPFC,theamountoftissuenecrosisisthemostimportantpredictorofasuccessfuloutcome.Hence,itseemslogicaltoclassifythesecollectionsbasedontheirpercentageofnecroticcomponentordebrispresentwhenviewedbyimagingmethodsorEUS.Finally,theauthorsproposeanalgorithmformanagingfluidcollectionsbasedontheirsize,location,associatedsymptoms,internalechogenicpatterns,andcontent.

简介：Commonpracticedictatestheperformanceofpercutaneouscoronaryinterventionunderconventionalangiographicguidance.Withstudiessuggestingthehighincidenceofintraobservervariability,especiallyinangiographicborderlinelesions,newmodalitiessuchasintravascularultrasound(IVUS)guidanceduringpercutaneouscoronaryinterventionhavesurfaced.MultiplestudieshaveshownimprovedoutcomeswithIVUSguidance,mainlydrivenbyadecreaseinischemia-driventargetlesionrevascularization.Inthepasttwodecades,amultitudeofstudieshaveinvestigatedtheusesandclinicaloutcomesassociatedwiththistechnology.Inthisreview,wehighlighttheutility,advantages,economicimplications,andclinicaloutcomesofIVUSguidanceoverstandardangiographicguidance,withemphasisondataastheypertaintoIVUS-guidedstentimplantation.

简介：ObjectiveToinvestigatetheefficacyandthemechanismofmoxibustioninulcerativecolitis(UC)ratsmodel.MethodsFortygeneralclean-classhealthWistarrats,wererandomlydividedintofourgroups(eachwith10rats),namelythenormalgroup,theblankgroup,moxibustiongroupandthecontrolgroups.

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简介：肝炎B病毒(HBV)感染是使世界范围的3.5亿个人担心的一个全球公共健康问题。有长期的肝炎B(CHB)的个人在开发肝肝硬化，肝的补偿不全和hepatocellular癌的增加的风险。为了维持，无法发现的病毒的负担减少长期的感染复杂并发症。没有治疗，根除HBV感染。当前的药是昂贵的，与不利事件被联系，并且具有有限功效。当前的指南试着标准化临床的实践。不过，争吵与CHB关于无征状的病人的管理留下，并且什么是肝炎Be抗原(HBeAg)与正常丙氨酸aminotransferase积极是病毒的负担的截止价值区分HBeAg否定的CHB病人和不活跃的搬运人。我们详细讨论DNA水平为什么独自不是足够的开始CHB的治疗。

简介：瞄准：为了为内视镜的超声(EUS)比较结果，指导了清楚的液体的排水有脓肿的结果的胰腺的pseudocysts排水。方法：所有病人参考了因为一个液体集合的内视镜的排水有希望地被包括。结果被记录。结果：总的来说26pseudocysts或脓肿在25被对待(6女性)病人。一endoscopist执行了过程。非感染的pseudocysts在15个病人是在场的，10个病人感染了液体集合。包囊尺寸在28厘米漠?桴?潢瑴敬之间变化了吗？

简介：AbstractPurpose:Treatment of irreducible femoral intertrochanteric fractures often requires open reduction. However, the technique unavoidably causes patients to suffer greater trauma. As such, minimally invasive techniques should be employed to reduce the surgical-related trauma on these patients and maintain a stable reduction of the fractures. Herein, a minimally invasive wire introducer was designed and used for the treatment of femoral intertrochanteric fractures. The effectiveness of using a wire-guided device to treat irreducible femoral intertrochanteric fractures was evaluated.Methods:Between 2013 and 2018, patients with femoral intertrochanteric fractures who were initially treated by intramedullary nail fixation but had difficult reduction using the traction beds were retrospectively reviewed. Decision for an additional surgery was based on the displacement of the fracture. The patients were then divided into two groups: those in the control group received an open reduction surgery while those in the observation group received a closed reduction surgery using a minimally invasive wire introducer to guide the wire that could assist in fracture reduction. The operation time, blood loss, visual analogue scale scores, angulation, reduction, neck-shaft angle, re-displacement, limb length discrepancy, and union time were then recorded and analyzed to determine the efficiency of the wire introducer technique. Categorical variables were analyzed by using Chi-square test, while continuous variables by independent t-test and the Mann-Whitney test accordingly.Results:There were 92 patients included in this study: 61 in the control group and 31 in the observation group. There were no significant differences in baseline demographic factors between the two groups. All surgeries were successful with no deaths within the perioperative period. The average follow-up time for the patients was 23.8 months. However, the observation group had a significantly shorter operation time, lower visual analogue scale score, less intraoperative bleeding, and shorter fracture healing time. There were no significant differences in the angulation, reduction, neck-shaft angle, and limb length discrepancy between the two groups.Conclusion:The minimally invasive wire guide achieved a similar effect to that of open reduction in the treatment of intertrochanteric fractures with difficult reduction. Moreover, the minimally invasive wire introducer is a good technology that accurately guides the wire during reduction. Indeed, it is an effective technique and achieves good clinical outcomes in restoration of irreducible femoral intertrochanteric fractures.

简介：AbstractObjective:Immunotherapy is an effective tumor treatment strategy. However, its long treatment cycle limits its wide application across all cancer types. In this study, we optimized upconversion nanoparticles and manganese composite particles with a porous structure as a nanoplatform for synergistic photodynamic therapy (PDT) and photothermal therapy (PTT), and subsequent longer-term immunotherapy.Methods:The morphology, phase, and stability were first characterized to evaluate the biocompatibility of this material. The upconversion and near infrared II luminescence properties of the material and its stimuli-response effect were assessed from the absorbance and photoluminescence spectra. Phototherapy including PDT and PTT was demonstrated in vitro and in vivo, and immunotherapy was used to enhance the phototherapy. This study was approved by the Xi’an Jiaotong University, China (approval No. XJTULAC2020-585) on April 2, 2020.Results:The nanoplatform showed good PDT and PTT effects with high upconversion luminescence, and exhibited a more sensitive glutathione response (detection limit: 55 μg/mL) using fluorescence recovery than that based on absorbance recovery, with the detection range extending up to 1.2 mg/mL. When the surface of the composite particles was modified with an anti-PD-L1 immune checkpoint inhibitor, it targeted A549 lung cancer cells. The resulting immune response enhanced the long-term anti-tumor effect of the therapy, especially in lung cancer patients with high PD-L1 expression.Conclusion:The designed composite can be simultaneously used to detect the glutathione concentration based on luminescence recovery in the tumor cells and as a theranostic nanoplatform for synergistic immuno-phototherapy when combined with an antibody.

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简介：BackgroundUltrasound-guidedtemporarypacemakerimplantationhasbeenprovensafeandefficient.However,fewstudieshavefocusedonelderandcriticalpatients.MethodsTwelveelderandcriticalpatientsunderwenttemporarycardiacpacingthroughthejugularveinorsubclavianvein,withbedsideultrasoundimagestoassisttheplacementofelectrodewithintherightventricle.ResultsUltrasound-guidedtemporarycardiacpacemakerinsertionwassuccessfulinallofthe12patients.Electrodesweresentintotherightventriclecorrectlywiththehelpofultrasoundimaging.Inallcases,temporarypacemakerfunctionedwellwithoutprocedure-relatedcomplications.ConclusionTemporarycardiacpacingguidedbyultrasoundissafeandeffectiveinelderandcriticalpatients,whichisworthofpromoting,especiallyinintensivecareunit.

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简介：Percutaneouscoronaryintervention(PCI)improvessymptomsandprognosisinischemia-inducing,functionallysignificant,coronarylesions.Useoffractionalflowreserveallowsphysicianstoinvestigatetheischemia-inducingpotentialofaspecificlesionandcanbeusedtoguidecoronaryrevascularization,especiallyinmultivesselcoronaryarterydisease.Fractionalflowreserve-guidedPCIhasbeenextensivelyinvestigated.Resultsshowthatdeferralofstentinginnon-significantlesionsissafe,whereasdeferralofstentinginfunctionallysignificantlesionsworsensoutcome.FFR-guidedPCIimprovesoutcomeinmultivesseldiseaseoverangiography-guidedPCI.Untilrecently,therewaslittleknownaboutthelong-termoutcomeofFFR-guidedrevascularizationanditsvalidityinacutecoronarysyndromes.Thisreviewaimstoaddressthenewevidenceregardinglong-termappropriatenessofFFR-guidedPCI,theneedforhyperemiatoevaluatefunctionalseverity,andtheuseofFFRinacutecoronarysyndromes.

简介：Inthispaper,weproposeanovelautomaticobjectextractionalgorithm,namedtheTemplateGuidedLiveWire,basedonthepopularlyusedlivewiretechniques.Wediscussindetailsthenovelmethod'sapplicationsontongueextractionindigitalimages.Withtheguidesofagiventemplatecurvewhichapproximatesthetongue'sshape,ourmethodcanfinishtheextractionoftonguewithoutanyhumanintervention.Inthepaper,wealsodiscussedindetailshowthetemplateguidesthelivewire,andwhyourmethodfunctionsmoreeffectivelythanotherboundarybasedsegmentationmethodsespeciallythesnakealgorithm.Experimentalresultsonsometongueimagesareaswellprovidedtoshowourmethod'sbetteraccuracyandrobustnessthanthesnakealgorithm.

简介：瞄准：为了评估胰腺的织物的组织学的评估的诊断精确性，一个修改方法为恢复并且处理内视镜的超声(EUS)获得的样品指导了好针渴望(FNA)在胰腺的固体的鉴别诊断的材料集中。方法：有胰腺的群众的62个连续病人有希望地被学习。EUS被线性扫描PentaxFG-38UX回响内诊镜执行。三FNA(22G针)在每个过程期间被执行。与第一和第二根刺获得的材料为cytological学习被处理。第三根刺的材料被盐溶液的小心的注射通过针为摩尔答案恢复进10%，并且为组织学的学习处理了。结果：一些为组织学的分析获得的核心标本是6.5+/-5.3公里(范围1-22公里)。Cytological和组织学的样品在51被看作足够(82.3%)并且52个盒子(83.9%)分别地。为恶意的诊断的胰腺的细胞学和组织学的全面敏感是68.4%。与细胞学相反，组织学能诊断除煽动性的群众的腺癌，和所有情况以外的瘤。细胞学和组织学的联合允许在56种情况(90.3%)中获得一件足够的样品，与84.21%的全球敏感，100%的特性和90.32%的全面精确性。复杂并发症率是1.6%。结论：为组织学的检查的足够的胰腺的核心标本能被指导EUS的FNA获得。这种技术为胰腺的瘤的不同类型和良性的疾病的评估的诊断主要是有用的。

简介：Preoperativestagingoftheaxillainwomenwithinvasivebreastcancerusingultrasound-guidedneedlebiopsy(UNB)identifiesapproximately50%ofpatientswithaxillarynodalmetastasespriortosurgicalintervention.Althoughmoderatelysensitive,itisahighlyspecificstagingstrategythatisrarelyfalsely-positive,henceapositiveUNBallowspatientstobetriagedtoaxillarylymph-nodedissection(ALND)avoidingpotentiallyunnecessarysentinelnodebiopsy(SNB).Inthisreview,weextendourpreviousworkthroughanupdatedliteraturesearch,focusingonstudiesthatreportdataonUNButility.Basedondatafor10,934breastcancerpatients,sourcedfrom35studies,apositiveUNBallowedtriageof1,745cases(simpleproportion16%)toaxillarysurgicaltreatment:theutilityofUNBwasamedian19.8%[interquartilerange(IQR)11.6%-26.7%]acrossthesestudies.Wealsomodelleddatafromasubgroupofstudies,andestimatedthatamongstpatientswithmetastasestoaxillarynodes,theoddsratio(OR)forhighnodaldiseaseburdenforapositiveUNBversusanegativeUNBwas4.38[95%confidenceinterval(95%CI):3.13,6.13],P<0.001.Fromthismodel,theestimatedproportionwithhighnodaldiseaseburdenwas58.9%(95%CI:50.2%,67.0%)forapositiveUNB,whereastheestimatedproportionwithhighnodaldiseaseburdenwas24.6%(95%CI:17.7%,33.2%)ifUNBwasnegative.Overall,axillaryUNBhasgoodclinicalutilityandapositiveUNBcaneffectivelytriagetoALND.However,theevolvinglandscapeofaxillarysurgicaltreatmentmeansthatUNBwillhaverelativelylessutilitywheresurgeonshavemodifiedtheirpracticetoomissionofALNDforminimalnodalmetastaticdisease.

简介：镇静可以在指导的transrectal超声(TRUS)期间疼痛地导致减小前列腺活体检视。我们试图在在护理费用的指导TRUS的前列腺活体检视和相关增加期间评估propofol和remifentanil注入的联合的功效和安全。从1月到2010年9月，经历transrectal前列腺活体检视的100个人被使随机化进二个组。在组1，50个病人收到了propofol和remifentanil的联合注入；在组2，50个病人收到了lidocaine果冻。在指导TRUS的活体检视被执行以后，疼痛和耐心的满足被一个10点评估视觉模拟规模(管)，和一张费用相关的耐心的满足问询表被所有病人完成。病人们也被问他们是否将愿意由一样的方法经历重复活体检视。在1看了显著地更低的管的组的病人在组2比那些得分(吝啬的管分数：0.9±；1.1对6.3±；2.5；P<；0.001)。另外，耐心的满足规模在组1是显著地更高的(P=0.002)。尽管全面费用在组1是显著地更高的(P=0.006)，就费用而言的耐心的满足规模在这个组(P=0.009)也是更高的。propofol和remifentanil的联合在指导TRUS的前列腺活体检视期间是到减少病人疼痛和增加病人满足的一条安全、有效的路。尽管费用在收到了镇静，期望的组是更高的，病人展出了提高的满足和心甘情愿由一样的方法重复活体检视。

简介：ＣＴＧＵＩＤＥＤＰＥＲＣＵＴＡＮＥＯＵＳＴＲＡＮＳＴＨＯＲＡＣＩＣＦＩＮＥＮＥＥＤＬＥＡＳＰＩＲＡＴＩＯＮＢＩＯＰＳＹＯＦＳＭＡＬＬＰＥＲＩＰＨＥＲＡＬＰＵＬＭＯＮＡＲＹＬＥＳＩＯＮＳＺｈａｎｇＪｕｎ张军ＺｈａｏＨｕｉｒｕ赵惠儒ＦｕＺｈｉｍｉｎ付...

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