Omniview检查诊断宫腔粘连的临床应用价值

目的探讨经阴道三维超声自由解剖成像(Omniview)检查诊断宫腔粘连的临床应用价值。方法选取本院收治的86例疑似宫腔粘连患者,全部患者均行Omniview检查与宫腔镜检查,以宫腔镜结果为金标准评价Omniview检查诊断宫腔粘连的效能。结果 Omniview检查诊断宫腔粘连的准确度为88.37%,与宫腔镜结果比较差异显著(P<0.05);Omniview检查诊断不同宫腔粘连程度的特异度、灵敏度、准确度结果如下:中央型粘连:90.00%、96.36%、94.67%,周围型粘连:95.52%、75.00%、93.33%,混合型粘连:93.65%、100.00%、94.67%,Omniview检查诊断不同程度宫腔粘连的总体符合率为94.68%,与宫腔镜结果相符(P>0.05)。结论 Omniview检查在宫腔粘连程度判断中结果可靠,能够有效检出中央型粘连、混合型粘连病例,但在周围型粘连诊断中仍存在局限性。     

超声作用下CTGF-siRNA对大鼠肝纤维化基因治疗的实验研究

目的探讨利用超声微泡造影剂介导携带结缔组织生长因子-小干扰RNA(CTGF-siRNA)真核表达质粒转染大鼠肝细胞的有效性。方法 (1)构建CTGF-siRNA真核表达质粒;(2)将40只实验大鼠随机分为7组:正常组,实验对照组,CTGF-siRNA质粒组,超声联合微泡组,超声联合微泡介导基因低、中、高剂量组;(3)建立肝纤维化模型,基因治疗4周后处死大鼠,超声及病理切片HE染色评价肝纤维化程度,masson染色观察胶原纤维含量,反转录-聚合酶链反应(RT-PCR)检测肝组织中CTGF、Ⅰ型和Ⅲ型胶原的mRNA表达。结果 (1)CTGF-siRNA基因治疗后超声及病理切片显示干预组纤维化程度降低;(2)masson染色显示超声介导微泡基因组胶原纤维含量表达量随着剂量增高而降低(P<0.05);(3)RT-PCR显示超声介导微泡基因组CTGF、Ⅰ型和Ⅲ型胶原的mRNA表达明显低于其他组,且随着质粒剂量增大而减少(P<0.05)。结论超声微泡作用下CTGF-siRNA基因能特异地作用于靶位点,有效抑制肝纤维化进程,提高对肝纤维化干预的特异度。     

儿童神经母细胞瘤骨转移的超声诊断

目的分析探讨儿童神经母细胞瘤骨转移的超声特征性影像表现。方法回顾性分析我院收治经病理确诊神经母细胞瘤骨转移并行超声探查的患儿43例,总结骨转移超声特征表现。结果神经母细胞瘤骨转移灶分布:脊柱1例,四肢骨6例,骨盆9例,头骨27例。43例骨转移灶超声见不规则骨破坏及软组织肿块形成,40例有密集垂直针状瘤骨,14例肿块中见点状钙化灶,所有肿块内均可探及血流。结论神经母细胞瘤骨转移超声表现鲜明,其中骨破坏表面形成的密集垂直针状瘤骨最具特征性。超声探及特征性神经母细胞瘤骨转移表现能有效缩短患儿诊治流程,可作为首选影像学检查方法。     

Spontaneous regression of cystic dysplasia of the rete testis in an 18-month-old boy: the key role of ultrasonography

Cystic dysplasia of the rete testis (CDT) is a rare cause of scrotal swelling in children. It is a congenital disorder and it can be associated with other genitourinary abnormalities. At present, there is no clear consensus on treatment. Surgical approach has traditionally been the treatment of choice, while, more recently, conservative approach has been applied, justified by the benign nature of the lesion and after few cases of spontaneous regression have been documented. Ultrasonography, supported by negative tumor markers, plays a key role in the diagnostic work up and during observational follow-up. We report a further case of spontaneous regression of suspected CDT in an 18-month-old boy, who has been followed with clinic and ultrasonographic checks.     

超声引导下骶髂关节注射用于产后骶髂关节炎的治疗有效性研究

目的研究超声引导下骶髂关节注射用于产后骶髂关节炎的治疗有效性。方法选取2019年1月至2020年6月在本院接受治疗的60例产后骶髂关节炎患者,采用超声引导下骶髂关节注射治疗,观察患者治疗前后的晨僵时间、疼痛评分及治疗总有效率。结果治疗后患者的晨僵时间明显缩短,疼痛评分显著下降(P<0.05)。治疗后患者总有效率为93.33%。结论对产后骶髂关节炎患者采用超声引导下骶髂关节注射治疗,能有效减轻患者的疼痛感,改善患者的临床症状,治疗效率有效提高。     

浸润式超声与接触式超声测量头静脉内径的可重复性研究

目的评价浸润式、接触式超声在测量头静脉内径中的可重复性。方法由2名从事超声诊断工作10年以上的医师,对重庆医科大学附属大学城医院收治的38例预行桡动脉-头静脉内瘘成形术前的患者,在左前臂同一位置处、不同时间点,分别使用浸润式、接触式超声2种方法进行头静脉内径测量。使用组内相关系数(interclass correlation coefficient,ICC)评价测量的组内和组间一致性。并进行Bland-Altman绘图分析,以再次评价重复性。结果浸润式超声法测量值组内和组间一致性非常好,ICC分别为0.968(95%CI:0.939~0.983,P<0.001)和0.960(95%CI:0.924~0.979,P<0.001)。接触式超声法测量值组内和组间一致性好,ICC分别为0.718(95%CI:0.521~0.843,P<0.001)和0.692(95%CI:0.482~0.827,P<0.001)。浸润法超声测量头静脉内径的组内与组间Bland-Altman散点图中,落在95%一致性界限(limits of agreement,LOA)内的点均为97%,接触法超声组内与组间Bland-Altman散点图中,落在95%LOA内的点均为94%。浸润式超声获得头静脉二维图像中,近场组织结构更清晰、头静脉前壁与腔内结构更清楚。同时,浸润式超声显示检查范围更广,更容易同时显示头静脉与桡动脉。结论浸润式超声测量头静脉内径的重复性优于接触式超声,浸润式超声获得的二维图像中,近场组织结构及扫描检查范围均优于接触式超声,浸润式超声可作为桡动脉-头静脉内瘘术前测量头静脉内径的优选方法。     

超声引导下PRP注射治疗肩袖损伤对局部炎症因子表达的影响

目的探讨超声引导下富血小板血浆(PRP)注射在部分肩袖损伤患者治疗中的安全性和有效性,及其对局部炎症因子表达的影响。方法选择2018年10月至2019年10月部分肩袖损伤患者84例,随机分为对照组和观察组,每组各42例。对照组采用超声引导注射玻璃酸钠,观察组注射等量自体PRP,1次/周,连续3周。比较两组治疗前,治疗结束后1、3和6个月疼痛视觉模拟量表(VAS)评分和上肢功能Fugl-Meyer量表(FMA)评分,治疗前及治疗结束后1周和1个月局部炎症因子白介素(I)-6、肿瘤坏死因子(TNF)-α、IL-10和转化生长因子(TGF)-β,随访6个月肩袖再撕裂率。结果观察组治疗结束后1、3、6个月VAS评分逐渐降低,上肢FMA评分逐渐升高,且同时间点观察组VAS评分比对照组降低,FMA评分比对照组升高,差异有统计学意义(P<0.05)。进一步发现,观察组治疗结束后1周和1个月局部IL-6和TNF-a水平明显低于对照组,而IL-10和TGF-β水平明显高于对照组(P<0.05)。随访观察组肩袖再撕裂率低于对照组(P<0.05)。结论超声引导下PRP注射治疗部分肩袖损伤有较好的安全性和有效性,能显著降低关节疼痛,改善关节功能,降低复发率,可能与抑制局部炎症反应,促进关节修复有关。     

Diagnostic ultrasound assessment of deep fascia sliding mobility in vivo: A scoping review – Part 1: Thoracolumbar and abdominal fasciae

BackgroundFailure of fascial sliding may occur in cases of excessive or inappropriate use, trauma, or surgery, resulting in local inflammation, pain, sensitization, and potential dysfunction. Therefore, the mechanical properties of fascial tissues, including their mobility, have been evaluated in vivo by ultrasound (US) imaging. However, this seems to be a method that is not yet properly standardized nor validated.ObjectivesTo identify, synthesize, and collate the critical methodological principles that have been described in the literature for US evaluation of deep fascia sliding mobility in vivo in humans.MethodsA systematic literature search was conducted on ScienceDirect, PubMed (Medline), Web of Science and B-On databases, according to the PRISMA Extension for Scoping Reviews (PRISMA-ScR) guidelines. The OCEBM LoE was used to evaluate the level of evidence of each study.ResultsFrom a total of 104 full-text articles retrieved and assessed for eligibility, 18 papers were included that evaluate the deep fasciae of the thoracolumbar (n = 4), abdominal (n = 7), femoral (n = 4) and crural (n = 3) regions. These studies addressed issues concerning either diagnosis (n = 11) or treatment benefits (n = 7) and presented levels of evidence ranging from II to IV. Various terms were used to describe the outcome measures representing fascial sliding. Also, different procedures to induce fascial sliding, positioning of the individuals being assessed, and features of US devices were used. The US analysis methods included the comparison of start and end frames and the use of cross-correlation software techniques through automated tracking algorithms. These methods had proven to be reliable to measure sliding between TLF, TrA muscle-fascia junctions, fascia lata, and crural fascia, and the adjacent epimysial fascia. However, the papers presented heterogeneous terminologies, research questions, populations, and methodologies.This two-part paper reviews the evidence obtained for the thoracolumbar and abdominal fasciae (Part 1) and for the femoral and crural fasciae (Part 2).ConclusionThe US methods used to evaluate deep fascia sliding mobility in vivo in humans include the comparison of start and end frames and the use of cross-correlation software techniques through automated tracking algorithms. These seem reliable methods to measure sliding of some fasciae, but more studies need to be systematized to confirm their reliability for others. Moreover, specific standardized protocols are needed to assess each anatomical region as well as study if age, sex-related characteristics, body composition, or specific clinical conditions influence US results.     

Efficacy of foam rolling with additional vibration stimulation on the mobility of the thoracolumbar fascia. An observational study

IntroductionObservations show that foam rolling improves joint movements. Likewise, it can be stated that a vibration stimulation of the tissue leads to improved joint mobility.MethodThis study investigates whether the combination of foam rolling and vibrations (31 Hz) can influence the sliding of the thoracolumbar fascia more effectively than normal foam rolling. 45 subjects participated in the study and were divided into a foam roll with additional vibration group (FRV), a foam roll group (FR) and a control group (CG). The intervention groups rolled out the gluteal muscles, the lateral trunk and the upper and lower back. Mobility measures were taken pre and post the respective intervention. Subsequent cross correlation software analysis quantified the sliding of the fascia and calculated its shear strain mobility (SSM).ResultsThe sliding of the thoracolumbar fascia improved significantly within the FRV by 2.83 mm (SD ± 1.08/p < .001), in the FR by 0.96 mm (SD ± 0.43/p < .001) and in the CG decreased the sliding by 0.1401 mm (SD ± 0.28/p = .076). The fascia/fascia SSM increased in the FRV by 22.61% (SD ± 15.64/p < .001), in the FR by 11.41% (SD ± 20.38/p = .056) and in the CG decreased the SSM by 0.9473% (SD ± 11.35/p < .751). The lumbar movement increased in both intervention groups, but showed no significant result.ConclusionThe use of a foam roll with additional vibration and standard intervention have increased thoracolumbar fascia sliding and lumbar movements. The improved shear strain mobility can be attributed to the multi-activity of mechanoreceptors, such as Pacini- and Ruffini-Bodies.