The authors acknowledge the Carefusion Foundation for support via a clinical excellence grant of this work titled &#8220;Prospective evaluation of procedural povidone iodine rectal preparation to reduce infectious complications following ultrasound guided prostate needle biopsy.&#8221;

这名患者的相关研究经机构审查委员会（IRB）对人类的研究。 1.患者准备和定位<ol><li>把病人的程序套件，并将其放置在他们的右侧或左侧膝盖弯曲至胸前。 </li><li>执行手术超时即病人，手术过程，并指示进行审查和确认。 </li><li>当指出，通过麻醉服务管理静脉镇静。 </li></ol> 2.进行直肠指诊（DRE） <ol><li>将大小合适的手套到双手。 </li><li>将戴手套的手指润滑进入直肠后穹窿并检查前列腺感觉需要注意力集中在经直肠超声检查的潜在可疑的地方。10 </li></ol> 3.创建聚维酮碘直肠制备（PIRP） <ol><li>倾将15ml 10％的市售的聚维酮碘溶液到无菌盆地。 </li><li>添加5毫升市售1％利多卡因凝胶此盆。 </li><li>混合内容物15秒以创建碘伏浆料。 </li></ol> PIRP 4初级管理<ol><li>使用无菌肛拭培养直肠保管库。 </li><li>开辟一个4厘米×4厘米的无菌纱布上，浸泡在聚烯吡酮碘的浆液，然后插入到直肠保管库。只有一个小尾巴纱布留从肛门所产生的。 </li><li>留在原地的纱布为其后它被取出并丢弃2分钟。 </li></ol> PIRP 5.二级管理<ol><li>使用一次性棉签妇科画肛周区域与PIRP解决方案。 </li><li>插入此妇科拭子插入直肠跳马到3厘米从肛门的距离。 </li><li>为了进一步延长直肠黏膜PIRP的曝光，拭直肠VAU其中在一个类似的方式中至少三次。 </li><li>使聚维酮碘溶液干燥2 -在进行标准经直肠超声检查和随后的活组织检查之前3分钟11这是重要的，因为PIRP的杀菌作用所需要的溶液以干燥在暴露粘膜。 </li><li>使用无菌肛拭培养直肠保管库。 </li></ol> 6.直肠超声和活检<ol><li>通过直肠插入超声波探头。 </li><li>请在所有泌尿惯例相一致的标准的方式对前列腺和随后的活检测量。11,12 </li></ol>

<ol>
	<li>Nam, R. K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Increasing+hospital+admission+rates+for+complications+after+transrectal+ultrasound+guided+prostate+biopsy.">Increasing hospital admission rates for complications after transrectal ultrasound guided prostate biopsy.</a> J Urol. 189, S12-S17 (2013).</li><li>Feliciano, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+incidence+of+fluoroquinolone+resistant+infections+after+prostate+biopsy+are+fluoroquinolones+still+effective+prophylaxis.">The incidence of fluoroquinolone resistant infections after prostate biopsy are fluoroquinolones still effective prophylaxis.</a> J Urol. 179 (3), 952-955 (2008).</li><li>Kehinde, O., Al-Maghrebi, M., Sheikh, M., Anim, J. T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Combined+ciprofloxacin+and+amikacin+prophylaxis+in+the+prevention+of+septicemia+after+transrectal+ultrasound+guided+biopsy+of+the+prostate.">Combined ciprofloxacin and amikacin prophylaxis in the prevention of septicemia after transrectal ultrasound guided biopsy of the prostate.</a> J Urol. 189 (3), 911-915 (2013).</li><li>Taylor, A. K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Targeted+antimicrobial+prophylaxis+using+rectal+swab+cultures+in+men+undergoing+transrectal+ultrasound+guided+prostate+biopsy+is+associated+with+reduced+incidence+of+postoperative+infectious+complications+and+cost+of+care.">Targeted antimicrobial prophylaxis using rectal swab cultures in men undergoing transrectal ultrasound guided prostate biopsy is associated with reduced incidence of postoperative infectious complications and cost of care.</a> J Urol. 187 (4), 1275-1279 (2012).</li><li>Gyorfi, J. R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Peri+procedural+povidone+iodine+rectal+preparation+reduces+microorganism+counts+and+infectious+complications+following+ultrasound-guided+needle+biopsy+of+the+prostate.">Peri procedural povidone iodine rectal preparation reduces microorganism counts and infectious complications following ultrasound-guided needle biopsy of the prostate.</a> World J Urol. 32 (4), 905-909 (2014).</li><li>Park, D. S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Control+of+infective+complications+of+transrectal+prostate+biopsy.">Control of infective complications of transrectal prostate biopsy.</a> Surg Infect Larchmt. 15 (4), 431-436 (2014).</li><li>Park, D. S., Oh, J. J., Lee, J. H., Jang, W. K., Hong, Y. K., Hong, S. K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Simple+use+of+the+suppository+type+povidone+iodine+can+prevent+infectious+complications+in+transrectal+ultrasound+guided+prostate+biopsy.">Simple use of the suppository type povidone iodine can prevent infectious complications in transrectal ultrasound guided prostate biopsy.</a> Adv Urol. , (2009).</li><li>AbuGhosh, Z., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+prospective+randomized+trial+of+povidone+iodine+prophylactic+cleansing+of+the+rectum+before+transrectal+ultrasound+guided+prostate+biopsy.">A prospective randomized trial of povidone iodine prophylactic cleansing of the rectum before transrectal ultrasound guided prostate biopsy.</a> J Urol. 189 (4), 1326-1331 (2013).</li><li>Gerber, G. S., Brendler, C. B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Evaluation+of+the+Urological+Patient:+History,+Physical+Exam,+and+Urinalysis.">Evaluation of the Urological Patient: History, Physical Exam, and Urinalysis.</a> Campbell Walsh Urology. , (2015).</li><li>Hodge, K. K., McNeal, J. E., Terris, M. K., Stamey, T. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Random+systematic+versus+directed+ultrasound+guided+transrectal+core+biopsies+of+the+prostate.">Random systematic versus directed ultrasound guided transrectal core biopsies of the prostate.</a> J Urol. 142 (1), 71-74 (1989).</li><li>Donoghue, P. M., McSweeney, S. E., Jhaveri, K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Genitourinary+imaging:+current+and+emerging+applications.">Genitourinary imaging: current and emerging applications.</a> J Postgrad Med. 56 (2), 131-139 (2010).</li></ol>

The authors have nothing to disclose.

下面TRUS PNB感染继发于直肠跳马细菌易位进入富含血管的前列腺。基于该原理，我们已经探索使用主题防腐剂如聚烯吡酮碘，以减少前，前列腺活检微生物菌落计数的简单方法。我们的经验突出了从4.3％下降至0.6％（P = 0.02），在使用这个PIRP方案的活检的时间。此外，我们假设在直肠保管库的微生物的减少97％是本降低全身性感染的基本原理的因素。 我们与外用聚维酮的结果是类似的其他团体提出。具体地说，Park等人7评估谁收到抗生素预防由单一静脉内注射一第三代头孢菌素的的5天头孢克肟将100mg BID对比谁接受相同抗生素治疗方案，除了360例121例一个聚维酮碘栓之前活检。这项研究指出，感染并发症8例（6.6％），对照组相比，1（0.3％）在他们的研究队列。最近，AbuGhosh 等前瞻性随机865男性接受口服环丙沙星治疗直肠清洗用聚维酮碘或直肠PNB之前没有直肠清洗。8此研究中观察到的直肠制剂组的感染并发症在11（2.6％）和20（4.5 ％）对照组，和脓毒病是在4（1.0％可见，对照组的）治疗组和在7（1.6％）。 我们PIRP技术在这部影片中提出的新颖性和吸引力是几折。首先，PIRP不需要额外的准备或全身抗生素治疗超出标准的口腔预防剂。其次，PIRP技术是便宜的最小的相关费用的做法购买市售的聚维酮碘。第三，PIRP是简单与任何泌尿科的内电流办公基础设施进行，同时加入5分钟内到活检程序的能力。最后，PIRP疗法的副作用是低，没有患者在我们目前的串联不良事件呈现。 有一些值得进一步讨论这个协议的几个关键步骤。先插入碘伏纱布浸泡入直肠跳马2分钟，然后将其删除，允许溶液干燥是很重要的。作为聚维酮碘的杀菌作用的前提是在粘膜表面的溶液干燥此过程是必不可少的。第二个关键的协议步骤涉及绘画与聚维酮碘，从而防止细菌易位，在肛门周围成直肠金库活检时肛周区域。 协议一般不需要修改由于其在递送简单。某些情况下如患者直肠裂隙或暴露痔疮可能会遇到的聚维酮碘溶液局部不适和刺激。因此，该治疗是版主在此类患者。此外，患者的碘或贝类过敏是在危险的过敏反应（很少过敏反应）和治疗应在这样的患者中使用。最后，前列腺活检在我们的机构中​​约10％在办公环境中完成，而其余病例均在静脉镇静完成。患者接受局部麻醉经历无不良反应的PIRP虽然较大的研究是必要的，以验证这些意见。 这种方法的局限性包括碘的递送系统进入直肠保管库。而以下PIRP当前直肠拱顶计数是97％，低于基线，仍然存在一些生物体是持久的哪个理论上可能传染源。因此，势的人的存在，以改善PIRP的递送系统，以进一步降低直肠微生物计数。此外，本研究中提出的数据以一种预期，尽管非随机设计的环境中完成了。我们承认，患者随机将提供最客观的方法来评估治疗效果。

前列腺癌是最常见的癌症的男性和癌症相关死亡的第二大原因。在2014年，大约233000箱子将被诊断在美国有近3万人屈服于这种恶性肿瘤。1在前列腺特异性抗原（PSA）验血和直肠指诊（DRE）发挥前列腺癌筛查的重要作用，经直肠超声引导下前列腺穿刺活检（TRUS PNB）更是获得了病理组织学诊断最常用的手段。 TRUS PNB过程​​包括将超声探头插入病人的直肠，然后通常获得12-14活检正好位于前方前列腺的周边区。每个穿刺活检需要一个18G的针头通过直肠前壁通道进入富含血管的前列腺。因此，出血和感染引起的细菌易位的理论风险存在以下的步骤。无theless，精算并发症发生率后处理过程在历史上仍然很低。 预防性抗生素前TRUS PNB是常规处方与喹诺酮类抗生素是最常用的药物。尽管有足够的预防，当代研究牵连增加感染并发症后活检。2。此外，有研究认为这上升的感染并发症TRUS PNB以喹诺酮类耐药微生物尤其是大肠杆菌的出现大肠杆菌 。3 喹诺酮类药物耐药性的这种上涨的幅度意味着需要替代预防方案的TRUS PNB程序。为此，几个不同的途径正在调查中。一种方法涉及一个静脉内或肌内抗生素的给药在活检时间结合的口服喹诺酮4虽然这种策略可以减少以下TRUS PNB败血症事件这种方法的一个主要限制是进一步发展抗性微生物此抗生素家族的潜力。另一最近研究方法融合使用预活检直肠拭子筛选患者定植喹诺酮耐药直肠菌群5如果检测到这样的生物体，一个"针对性"抗生素治疗方案可以基于所识别的耐药性细菌的灵敏度分布可以采用株。虽然该方法是优雅的，取得这样的棉签，有选择地对喹诺酮类药物的选择性培养基中培养，和剪裁抗生素的实际过程之后要求可能缺乏的许多临床实践的临床和实验室的基础设施。 政府防腐剂，以减少可能出现其他的方法来限制​​TRUS PNB感染活检前直肠金库微生物菌落计数的一个话题。聚维酮iodone是一种廉价的，容易得到的试剂是当应用到手术部位记录，以减少细菌的数量。在两种结直肠癌和妇科手术应用是公知的。因此，使用povidine碘作为直肠制剂会提出一个可生产，简单，经济有效的方法，以减少TRUS PNB感染，而无需进行前活组织检查额外的准备。相对于泌尿文献，先前的工作已经指出，在下面的TRUS PNB临床感染的降低。6-9本视频演示PIRP的技术中，突出的容易和简单地集成到临床实践。 所有接受TRUS PNB患者最初出现在一个专业泌尿外科就诊转诊或初步评估前列腺癌筛查。该评估entailed患者的血清前列腺特异性抗原（PSA）及直肠指诊（DRE）的表现进行了审查。无论是PSA或DRE异常提示的建议一个TRUS PNB。 该TRUS PNB过程​​，所有的病人和包括感染，出血相关风险的讨论，和尿潴留进行了澄清。所有患者接受口服抗生素预防三天无论是喹诺酮类药物（如环丙沙星）或磺胺（复方新诺明）前活检。

<table border="0" cellpadding="0" cellspacing="0">
	<tbody>
		<tr>
			<td>Povidone Iodine Solution, 10% Topical Microbicide Antiseptic, 8 fl oz.</td>
			<td>Equate</td>
			<td>4067979</td>
			<td></td>
		</tr>
		<tr>
			<td>4x4 sterile gauze pads, white</td>
			<td>Dukal Corporation</td>
			<td>DKL1412</td>
			<td></td>
		</tr>
		<tr>
			<td>disposable gynecologic swab&#160;</td>
			<td>numerous vendors</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>1% lidocaine gel&#160;</td>
			<td>numerous vendors</td>
			<td></td>
			<td></td>
		</tr>
	</tbody>
</table>

povidone iodine rectal preparation at time of prostate needle biopsy is a simple and reproducible means to reduce risk of procedural infection

单一的机构和人群为基础的研究强调，感染并发症经直肠超声引导前列腺穿刺活检（直肠PNB）正在增加。这种感染主要由于喹诺酮类其中殖民直肠跳马和被转运到活检手术过程中血液性微生物。聚维酮碘直肠制剂（PIRP）活检的时间是一个简单的，可重复的方法，以减少下TRUS PNB直肠微生物菌落计数，因此产生的感染。 所有患者施用的口服抗生素治疗前三天活检。该PIRP技术包括最初的定位病人的标准方式的TRUS PNB。以下直肠指检，15毫升市售聚维酮碘的10％溶液中，用5毫升1％利多卡因果冻混合以创建浆料。 4cm的×4厘米的无菌纱布是SOA的KED在该浆料，然后插入之后将其除去直肠保管库2分钟。此后，一次性妇科棉拭子用于绘制两肛门周围区域和直肠拱顶至3厘米从肛门的距离。聚维酮碘溶液然后使其干燥2 - 继续进行标准经直肠超声检查和随后的活组织检查之前3分钟。 此PIRP技术已在我们的机构自2012年三月在实践与相关联的减少后的活检感染的从4.3％至0.6％（P = 0.02）。这种预防治疗方案的主要优点是它的简单性和可重复性，以采用容易获得，便宜的试剂，以减少感染。此外，该技术避免了暴露患者额外全身性抗生素具有多重耐药生物的潜在进一步传播。 PIRP在TRUS PNB的使用，但是，是不适用的患者碘或贝类一个llergies。

自2012年一月份（截止目前）有165例患者已纳入本质量改进措施，这PIRP技术已经在实践中。在这个时候，只有一个病人（0.6％）经历了全身性败血症的形式的感染性并发症。这名患者定植一个多重抗药性E.大肠杆菌菌株 。该患者下面PIRP给予直肠拭子指出，直肠跳马仍然定植2.1×10 5 CFU / ml的细菌，从而质疑PIRP是否适当治疗直肠保管库。 一个当代人口进行TRUS PNB 2008年1月和2012年1月谁只接受口服抗生素治疗充当比较对照人群之间。这一人群经历了4.3％的感染率（22 515例），包括17例泌尿道感染（UTI）和5定义为发热伴血培养阳性的临床败血症。一个LL 5脓毒症患者有多重耐药E.大肠杆菌而UTI的病例归因于几个不同的生物。 图1;总体而言，整合PIRP技术到临床实践中的溶液用在后活检感染减少从4.3％至0.6％（P = 0.02）相关联。 直肠培养物中的165例患者之前进行和PIRP后记录归属于治疗的变化直肠跳马微生物菌落总数。简言之，将培养物通过使用无菌拭子培养获得。所述拭子浸入在PBS中，涡旋，以释放的细菌，并连续稀释在Mueller-Hinton琼脂平板上。细菌允许生长36 - 48小时并计数。所有形态的品种所产生的平板的细菌菌落被包括以提供一个总的计数。总体而言，在微生物菌落减少了97.2％注意到PIRP给药后（平均2.3×10 5 CFU /毫升与5.8×10 3 CFU /毫升，P &lt;0.001） 报告了患者或者在施用或7-日后过程的时间PIRP的无不良影响。 <img alt="图1" src="/files/ftp_upload/52670/52670fig1.jpg" /> 图1.尿路感染（UTI）和败血症发生的事件的聚维酮碘直肠准备（PIRP）和标准队列。

Watch this Scientific Journal Video about Povidone Iodine Rectal Preparation at Time of Prostate Needle Biopsy is a Simple and Reproducible Means to Reduce Risk of Procedural Infection at JoVE.com

Povidone Iodine Rectal Preparation at Time of Prostate Needle Biopsy is a Simple and Reproducible Means to Reduce Risk of Procedural Infection

Here, we present a protocol for use at the time of transrectal ultrasound guided prostate needle biopsy (TRUS PNB) that is a simple and cost-effective means to reduce infections following the procedure.

聚维酮碘直肠准备在前列腺穿刺活检的时间是一个简单的和可重复的手段，以减少程序感染的风险

Single institution and population-based studies highlight that infectious complications following transrectal ultrasound guided prostate needle biopsy ...

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31.9K 次观看.  Penn State Milton S. Hershey Medical Center. Here, we present a protocol for use at the time of transrectal ultrasound guided prostate needle biopsy (TRUS PNB) that is a simple and cost-effective means to reduce infections following the procedure.

视频: Povidone Iodine Rectal Preparation at Time of Prostate Needle Biopsy is a Simple and Reproducible Means to Reduce Risk of Procedural Infection

Evaluation of Nanoparticle Uptake in Tumors in Real Time Using Intravital Imaging

Current technologies for tumor imaging, such as ultrasound, MRI, PET and CT, are unable to yield high-resolution images for the assessment of nanoparticle uptake in tumors at the microscopic level1,2,3, highlighting the utility of a suitable xenograft model in which to perform detailed uptake analyses. Here, we use high-resolution intravital imaging to evaluate nanoparticle uptake in human tumor xenografts in a modified, shell-less chicken embryo model. The chicken embryo model is particularly well-suited for these in vivo analyses because it supports the growth of human tumors, is relatively inexpensive and does not require anesthetization or surgery 4,5. Tumor cells form fully vascularized xenografts within 7 days when implanted into the chorioallantoic membrane (CAM) 6. The resulting tumors are visualized by non-invasive real-time, high-resolution imaging that can be maintained for up to 72 hours with little impact on either the host or tumor systems. Nanoparticles with a wide range of sizes and formulations administered distal to the tumor can be visualized and quantified as they flow through the bloodstream, extravasate from leaky tumor vasculature, and accumulate at the tumor site. We describe here the analysis of nanoparticles derived from Cowpea mosaic virus (CPMV) decorated with near-infrared fluorescent dyes and/or polyethylene glycol polymers (PEG) 7, 8, 9,10,11. Upon intravenous administration, these viral nanoparticles are rapidly internalized by endothelial cells, resulting in global labeling of the vasculature both outside and within the tumor7,12. PEGylation of the viral nanoparticles increases their plasma half-life, extends their time in the circulation, and ultimately enhances their accumulation in tumors via the enhanced permeability and retention (EPR) effect 7, 10,11. The rate and extent of accumulation of nanoparticles in a tumor is measured over time using image analysis software. This technique provides a method to both visualize and quantify nanoparticle dynamics in human tumors.

We present a novel approach to quantify nanoparticle localization in the vasculature of human xenografted tumors using dynamic, real-time intravital imaging in an avian embryo model.

使用实时活体成像在肿瘤纳米粒子吸收的评价

Current technologies for tumor imaging, such as ultrasound, MRI, PET and CT, are unable to yield high-resolution images for the assessment of nanoparticle ...

科研

医学

Combined In vivo Optical and &#181;CT Imaging to Monitor Infection, Inflammation, and Bone Anatomy in an Orthopaedic Implant Infection in Mice

Multimodality imaging has emerged as a common technological approach used in both preclinical and clinical research. Advanced techniques that combine in vivo optical and &#956;CT imaging allow the visualization of biological phenomena in an anatomical context. These imaging modalities may be especially useful to study conditions that impact bone. In particular, orthopaedic implant infections are an important problem in clinical orthopaedic surgery. These infections are difficult to treat because bacterial biofilms form on the foreign surgically implanted materials, leading to persistent inflammation, osteomyelitis and eventual osteolysis of the bone surrounding the implant, which ultimately results in implant loosening and failure. Here, a mouse model of an infected orthopaedic prosthetic implant was used that involved the surgical placement of a Kirschner-wire implant into an intramedullary canal in the femur in such a way that the end of the implant extended into the knee joint. In this model, LysEGFP mice, a mouse strain that has EGFP-fluorescent neutrophils, were employed in conjunction with a bioluminescent Staphylococcus aureus strain, which naturally emits light. The bacteria were inoculated into the knee joints of the mice prior to closing the surgical site. In vivo bioluminescent and fluorescent imaging was used to quantify the bacterial burden and neutrophil inflammatory response, respectively. In addition, &#956;CT imaging was performed on the same mice so that the 3D location of the bioluminescent and fluorescent optical signals could be co-registered with the anatomical &#956;CT images. To quantify the changes in the bone over time, the outer bone volume of the distal femurs were measured at specific time points using a semi-automated contour based segmentation process. Taken together, the combination of in vivo bioluminescent/fluorescent imaging with &#956;CT imaging may be especially useful for the noninvasive monitoring of the infection, inflammatory response and anatomical changes in bone over time.

Combined In vivo Optical and  &#181;CT Imaging to Monitor Infection, Inflammation, and Bone Anatomy in an Orthopaedic Implant Infection in Mice

Combined optical and &#956;CT imaging in a mouse model of orthopaedic implant infection, utilizing a bioluminescent engineered strain of Staphylococcus aureus, provided the capability to noninvasively and longitudinally monitor the dynamics of the bacterial infection, as well as the corresponding inflammatory response and anatomical changes in the bone.

结合<em&gt;在体内</em&gt;光学及μCT成像监视感染，炎症和骨解剖在骨科植入物感染的小鼠

Multimodality imaging has emerged as a common technological approach used in both preclinical and clinical research. Advanced techniques that combine in ...

Substernal Thyroid Biopsy Using Endobronchial Ultrasound-guided Transbronchial Needle Aspiration

Substernal thyroid goiter (STG) represents about 5.8% of all mediastinal lesions1. There is a wide variation in the published incidence rates due to the lack of a standardized definition for STG. Biopsy is often required to differentiate benign from malignant lesions. Unlike cervical thyroid, the overlying sternum precludes ultrasound-guided percutaneous fine needle aspiration of STG. Consequently, surgical mediastinoscopy is performed in the majority of cases, causing significant procedure related morbidity and cost to healthcare. Endobronchial Ultrasound-guided Transbronchial Needle Aspiration (EBUS-TBNA) is a frequently used procedure for diagnosis and staging of non-small cell lung cancer (NSCLC). Minimally invasive needle biopsy for lesions adjacent to the airways can be performed under real-time ultrasound guidance using EBUS. Its safety and efficacy is well established with over 90% sensitivity and specificity. The ability to perform EBUS as an outpatient procedure with same-day discharges offers distinct morbidity and financial advantages over surgery. As physicians performing EBUS gained procedural expertise, they have attempted to diversify its role in the diagnosis of non-lymph node thoracic pathologies. We propose here a role for EBUS-TBNA in the diagnosis of substernal thyroid lesions, along with a step-by-step protocol for the procedure.

Substernal thyroid lesions are common, and need to be differentiated from malignancy. Obtaining percutaneous fine needle biopsy is not possible due to its retrosternal location. This article proposes a protocol for biopsy of substernal thyroid lesions using Endobronchial Ultrasound-guided Transbronchial Needle Aspiration (EBUS-TBNA).

胸骨后甲状腺活检使用支气管内超声引导下经支气管针吸

Substernal thyroid goiter (STG) represents about 5.8% of all mediastinal lesions1. There is a wide variation in the published incidence rates due to the ...

Preparation and Respirometric Assessment of Mitochondria Isolated from Skeletal Muscle Tissue Obtained by Percutaneous Needle Biopsy

Respirometric profiling of isolated mitochondria is commonly used to investigate electron transport chain function. We describe a method for obtaining samples of human Vastus lateralis, isolating mitochondria from minimal amounts of skeletal muscle tissue, and plate based respirometric profiling using an extracellular flux (XF) analyzer. Comparison of respirometric profiles obtained using 1.0, 2.5 and 5.0 &#956;g of mitochondria indicate that 1.0 &#956;g is sufficient to measure respiration and that 5.0 &#956;g provides most consistent results based on comparison of standard errors. Western blot analysis of isolated mitochondria for mitochondrial marker COX IV and non-mitochondrial tissue marker GAPDH indicate that there is limited non-mitochondrial contamination using this protocol. The ability to study mitochondrial respirometry in as little as 20 mg of muscle tissue allows users to utilize individual biopsies for multiple study endpoints in clinical research projects.

Methods for biopsy of Vastus lateralis, preparation of purified mitochondria, and respirometric profiling are described. The use of small muscle volume makes this technique suitable for clinical research applications.

线粒体的制备及透气性评估，从骨骼肌组织通过穿刺活检获得的分离

Respirometric profiling of isolated mitochondria is commonly used to investigate electron transport chain function. We describe a method for obtaining ...

A Simple Critical-sized Femoral Defect Model in Mice

While bone has a remarkable capacity for regeneration, serious bone trauma often results in damage that does not properly heal. In fact, one tenth of all limb bone fractures fail to heal completely due to the extent of the trauma, disease, or age of the patient. Our ability to improve bone regenerative strategies is critically dependent on the ability to mimic serious bone trauma in test animals, but the generation and stabilization of large bone lesions is technically challenging. In most cases, serious long bone trauma is mimicked experimentally by establishing a defect that will not naturally heal. This is achieved by complete removal of a bone segment that is larger than 1.5 times the diameter of the bone cross-section. The bone is then stabilized with a metal implant to maintain proper orientation of the fracture edges and allow for mobility. 
Due to their small size and the fragility of their long bones, establishment of such lesions in mice are beyond the capabilities of most research groups. As such, long bone defect models are confined to rats and larger animals. Nevertheless, mice afford significant research advantages in that they can be genetically modified and bred as immune-compromised strains that do not reject human cells and tissue.
Herein, we demonstrate a technique that facilitates the generation of a segmental defect in mouse femora using standard laboratory and veterinary equipment. With practice, fabrication of the fixation device and surgical implantation is feasible for the majority of trained veterinarians and animal research personnel. Using example data, we also provide methodologies for the quantitative analysis of bone healing for the model.

Animal models are frequently employed to mimic serious bone injury in biomedical research. Due to their small size, establishment of stabilized bone lesions in mice are beyond the capabilities of most research groups. Herein, we describe a simple method for establishing and analyzing experimental femoral defects in mice.

一个简单的临界尺寸股骨缺损模型小鼠

While bone has a remarkable capacity for regeneration, serious bone trauma often results in damage that does not properly heal. In fact, one tenth of all ...

Establishment of Human Epithelial Enteroids and Colonoids from Whole Tissue and Biopsy

The epithelium of the gastrointestinal tract is constantly renewed as it turns over. This process is triggered by the proliferation of intestinal stem cells (ISCs) and progeny that progressively migrate and differentiate toward the tip of the villi. These processes, essential for gastrointestinal homeostasis, have been extensively studied using multiple approaches. Ex vivo technologies, especially primary cell cultures have proven to be promising for understanding intestinal epithelial functions. A long-term primary culture system for mouse intestinal crypts has been established to generate 3-dimensional epithelial organoids. These epithelial structures contain crypt- and villus-like domains reminiscent of normal gut epithelium. Commonly, termed &#8220;enteroids&#8221; when derived from small intestine and &#8220;colonoids&#8221; when derived from colon, they are different from organoids that also contain mesenchyme tissue. Additionally, these enteroids/colonoids continuously produce all cell types found normally within the intestinal epithelium. This in vitro organ-like culture system is rapidly becoming the new gold standard for investigation of intestinal stem cell biology and epithelial cell physiology. This technology has been recently transferred to the study of human gut. The establishment of human derived epithelial enteroids and colonoids from small intestine and colon has been possible through the utilization of specific culture media that allow their growth and maintenance over time. Here, we describe a method to establish a small intestinal and colon crypt-derived system from human whole tissue or biopsies. We emphasize the culture modalities that are essential for the successful growth and maintenance of human enteroids and colonoids.

We describe a method to establish human enteroids from small intestinal crypts and colonoids from colon crypts collected from both surgical tissue and biopsies. In this methodological article, we present the culture modalities that are essential for the successful growth and maintenance of human enteroids and colonoids.

从整体组织和活检建立人类上皮Enteroids和Colonoids的

The epithelium of the gastrointestinal tract is constantly renewed as it turns over. This process is triggered by the proliferation of intestinal stem ...

A Simple Device to Rapidly Prepare Whole Mounts of the Mouse Intestine

Preparing whole mounts of the mouse small intestine and colon for subsequent analysis or quantification can be time consuming and difficult. We describe the use of a simple device to cut and &#8216;roll&#8217; mouse intestines to rapidly prepare whole mount preparations of superior and uniform quality to that which can be achieved by hand. The device comprises a base that holds 4 stainless steel rods and a top, which acts a cutting guide. The rods are inserted into the lumen of the small intestine [divided into thirds] and the colon. The rods and samples are then placed over a piece of filter paper or card into the holding slots in the base of the device. The top of the device is then positioned and serves as a cutting guide. The two angled sections in the center of the top piece are used to guide a knife or scalpel and cut the intestines longitudinally on the top of the rods. Once the intestinal sections have been cut, the top is removed and the card,&#160;tissue and rods gently removed from the device and placed on the bench. The rods are then gently rolled sideways to flatten and stick the intestinal segments onto the underlying piece of filter paper or card. The final preparation can then be examined or fixed and stored for later analysis. The preparations are invaluable for the study of intestinal changes in normal or genetically modified mouse models. The preparations have been used for the study and quantification of the effects of inflammation (colitis), damage, pre-cancerous lesions (aberrant crypt foci (ACFs) and mucin depleted foci (MDFs)) and polyps or tumors.

The use of a simple device to cut and &#8216;roll&#8217; mouse intestines to rapidly prepare whole mount preparations is described.

一个简单的设备，迅速准备小鼠肠的全坐骑

Preparing whole mounts of the mouse small intestine and colon for subsequent analysis or quantification can be time consuming and difficult. We describe ...

A Simple Mechanical Procedure to Create Limbal Stem Cell Deficiency in Mouse

Limbal stem cell deficiency (LSCD) is a state of malfunction or loss of limbal epithelial stem cells, after which the corneal epithelium is replaced with conjunctiva. Patients suffer from recurrent corneal defects, pain, inflammation, and loss of vision.
Previously, a murine model of LSCD was described and compared to two other models. The goal was to produce a consistent mouse model of LSCD that both mimics the phenotype in humans and lasts long enough to make it possible to study the disease pathophysiology and to evaluate new treatments. Here, the technique is described in more detail.
A motorized tool with a rotating burr has been designed to remove the rust rings from the corneal surface or to smooth the pterygium bed in patients. It is a suitable device to create the desired LSCD model. It is a readily available, easy-to-use tool with a fine tip that makes it appropriate for working on small eyes, as in mice. Its application prevents unnecessary trauma to the eye and it does not result in unwanted injuries, as often is the case with chemical injury models. As opposed to a blunt scraper, it removes the epithelium with the basement membrane. In this protocol, the limbal area was abraded two times, and then the whole corneal epithelium was shaved from limbus to limbus. To avoid stroma injury, care was taken not to brush the corneal surface once the epithelium was already removed.

The following article provides an easy, reproducible technique to effectively create a sustainable mouse model of limbal stem cell deficiency (LSCD). This animal model is useful in testing and comparing the efficacy of treatments for limbal stem cell diseases.

一个简单的机械过程来创建在小鼠角膜缘干细胞缺乏症

Limbal stem cell deficiency (LSCD) is a state of malfunction or loss of limbal epithelial stem cells, after which the corneal epithelium is replaced with ...

An Anatomical Study of Nerves at Risk During Minimally Invasive Hallux Valgus Surgery

The growing popularity of minimally invasive surgical (MIS) procedures makes it necessary that new anatomical references arise, to aid in tridimensional orientation and localization of structures that are not directly visible to the surgeon. This is especially critical for structures at risk like nerves or blood vessels. Optimization of the handling of cadaveric material and the combination of multiple techniques compensate for the limited availability of adequate specimens. The described protocol combines anatomical plane-by-plane dissection and sectional anatomy of fresh-frozen specimens to help localize relevant structures, such as nerves, arteries, veins and to correctly position the portals during MIS procedures. Depiction of these structures in anatomy textbooks can differ from what is encountered in the surgical field; and for this reason, new anatomical studies with a surgical orientation are needed. However, this is a complex, time-consuming technique requiring specific training. The anatomical references described with the so-called 'clock method' provide the surgeon with an easy and reproducible system to locate the path of the nerves at risk in Hallux Valgus MIS procedures. This model can be extrapolated to many other minimally invasive surgical procedures.

Minimally invasive surgical (MIS) procedures rely on anatomical references to localize structures not directly visible to the surgeon. This manuscript describes a combined method of plane-by-plane dissection and sectional anatomy of fresh-frozen specimens to locate the structures at risk during MIS procedures.

微创拇外翻手术中神经风险的解剖学研究

The growing popularity of minimally invasive surgical (MIS) procedures makes it necessary that new anatomical references arise, to aid in tridimensional ...

Use of MRI-ultrasound Fusion to Achieve Targeted Prostate Biopsy

Here, we present a protocol to perform targeted prostate biopsy using a magnetic resonance imaging-ultrasound (MRI/US) fusion system. Prostate cancer has traditionally been diagnosed via transrectal ultrasound (TRUS) biopsy. Though considered the gold standard, TRUS is unable to visualize most prostate cancer lesions and therefore requires sampling of the entire prostate. This biopsy method often undergrades prostate cancer and fails to detect up to 35% of cancers on initial biopsy. Prostate MRI has been shown to have excellent sensitivity in the detection of cancerous lesions, and advancements in MRI technology during the last decade have led to the development of targeted biopsy. In targeted biopsy, a software platform overlays MRI data onto live TRUS images to create a fused MRI/US three-dimensional model of the prostate. Regions suspicious for malignancy on MRI are contoured by a radiologist, uploaded into the fusion system, and then displayed within the live MRI/US fused model. The urologist is then able to directly biopsy these targets. When compared to conventional TRUS biopsy, MRI/US fusion technology has been demonstrated to improve the detection of clinically significant cancer while reducing insignificant cancer detection. This technology, therefore, has the potential to diagnose prostate cancer primarily in men who would benefit from treatment.

Presented herein is a protocol to perform targeted biopsy of the prostate using an MRI-ultrasound fusion system.

Mri-超声融合技术在靶向前列腺活检中的应用

Here, we present a protocol to perform targeted prostate biopsy using a magnetic resonance imaging-ultrasound (MRI/US) fusion system. Prostate cancer has ...