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Vigny S, Rubinstenn E, Michelin P, Sabatier T, Dhellemmes O, Duparc F, Auquit-Aukbur I, Lalevee M. Ultrasound identification of hand and wrist anatomical structures by hand surgeons new to ultrasonographic techniques. Surg Radiol Anat 2024; 46:795-804. [PMID: 38597950 DOI: 10.1007/s00276-024-03355-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 03/21/2024] [Indexed: 04/11/2024]
Abstract
PURPOSE Ultrasound is becoming an essential tool for hand surgeons, but most of them are trained on the job, without any diploma or dedicated training. The aim of this study was to assess the ability of hand surgeons new to ultrasound to identify hand and wrist anatomical structures. METHODS A monocentric study was conducted from January 2022 to April 2022. Ten residents and five attending hand surgeons, ultrasound novices, were involved in this study. The participants underwent two tests, wherein they were required to identify 17 anatomical structures using ultrasound, on the same subject. The second test was similar and carried out 2 to 6 weeks later by all participants. The number of structures successfully identified and if it was the case, the detection time per structure, were recorded. The correlations between participants age, years of surgical experience, surgical background (orthopedic or plastic) and the ability to perform immediately during the first test or to progress between the two tests were also assessed. RESULTS The average number of structures identified during the first test (T1) was 14.1+/-2.1 (82.9%), versus 16.2+/-0.8 (95.3%) structures during the second test (T2) (p = 0.001). The mean detection time per structure was 53.4 +/- 18.9 s during T1 versus 27.7 +/- 7.2 s during T2 (p < 0.0001). A moderate negative correlation between the progression in the number of anatomical structures identified between the two tests and the years of surgical experience (ρ=-0.56; p = 0.029) was found. The other parameters were neither correlated with the ability to perform at the first test nor with the progression between the two tests. CONCLUSION Hand surgeons new to ultrasound are most of the time able to identify hand and wrist anatomical structures. Comparison of their first and second tests showed significant potential for improvement in anatomical structure identification and detection time of those, especially in surgeons with limited surgical experience.
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Affiliation(s)
- Solène Vigny
- Department of Orthopedic Surgery, Rouen University Hospital, Rouen, 76000, France
- Laboratory of Anatomy, Faculty of Medicine, Rouen Normandy University, Rouen, 76000, France
| | - Eva Rubinstenn
- Department of Orthopedic Surgery, Rouen University Hospital, Rouen, 76000, France
| | - Paul Michelin
- Department of Radiology, Rouen University Hospital, Rouen, 76000, France
- Rouen Normandy University, CETAPS, Mont Saint Aignan, UR 3832, 79821, France
| | - Thibaut Sabatier
- Department of Epidemiology and Health Promotion, Rouen University Hospital, Rouen, 1073, F 76000, France
| | - Octave Dhellemmes
- Department of Plastic and Hand Surgery, Rouen University Hospital, Rouen, 76000, France
| | - Fabrice Duparc
- Department of Orthopedic Surgery, Rouen University Hospital, Rouen, 76000, France
- Laboratory of Anatomy, Faculty of Medicine, Rouen Normandy University, Rouen, 76000, France
- Rouen Normandy University, CETAPS, Mont Saint Aignan, UR 3832, 79821, France
| | | | - Matthieu Lalevee
- Department of Orthopedic Surgery, Rouen University Hospital, Rouen, 76000, France.
- Rouen Normandy University, CETAPS, Mont Saint Aignan, UR 3832, 79821, France.
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Zhang X, Li J, Zeng D, Liang C, Zhong Y, Huang T, Mo Y, Rao H, Pan X, Wu J. A novel method for measuring pulmonary artery pressure by high-frequency ultrasound-guided transthoracic puncture in rats. Front Cardiovasc Med 2022; 9:995728. [PMID: 36247441 PMCID: PMC9554409 DOI: 10.3389/fcvm.2022.995728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 08/25/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectivesThe success of the rat model of pulmonary hypertension (PH) is primarily dependent on the measurement of pulmonary artery pressure. We herein demonstrate a novel method for measuring pulmonary artery pressure through a high-frequency ultrasound-guided transthoracic puncture in rats. The efficacy and time of this novel method are also discussed.MethodsA single subcutaneous injection of monocrotaline (MCT) was used to establish a rat model of PH. Through the heat shaping method, the tip of that puncture cannula was maintained at a certain angle after the needle core was removed. In-plane real-time guided trocar puncture of the right ventricular outflow tract was performed in the short-axis section of the parasternal aorta. The external pressure sensor was used to record the real-time waveform of right ventricular systolic pressure, pulmonary artery systolic pressure, and diastolic pressure.ResultsThe success rates of which using this novel method in the model group and the control group were 88.5 and 86.7%, respectively. The time of puncture pressure measurement was 164 ± 31 and 235 ± 50 s, respectively. The right ventricular systolic blood pressure, pulmonary systolic blood pressure, and diastolic blood pressure of the model group were higher than those of the control group.ConclusionThe modified method for trocar is helpful for accurately positioning pulmonary artery manometry. The method described in this paper has a high success rate and short operation time. It can simultaneously measure systolic blood pressure, diastolic blood pressure, and mean pressure of the right ventricle and pulmonary artery. It has a broad application prospect in verifying the rat PH model and pulmonary artery pressure monitoring.
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Aytekin K, Balta O, Altinayak H, Eren MB, Gedíkbaş M, Takir S. Comment on "Accuracy of Ultrasound-Guided versus Landmark-Guided Intra-articular Injection for Rat Knee Joints". ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:1163. [PMID: 35346520 DOI: 10.1016/j.ultrasmedbio.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 02/03/2022] [Indexed: 06/14/2023]
Affiliation(s)
- Kürşad Aytekin
- Department of Anatomy and Department of Orthopedics and Traumatology, Faculty of Medicine, University of Giresun, Giresun, Turkey.
| | - Orhan Balta
- Department of Anatomy and Department of Orthopedics and Traumatology, Faculty of Medicine, University of Giresun, Giresun, Turkey
| | - Harun Altinayak
- Department of Anatomy and Department of Orthopedics and Traumatology, Faculty of Medicine, University of Giresun, Giresun, Turkey
| | - Mehmet Burtaç Eren
- Department of Anatomy and Department of Orthopedics and Traumatology, Faculty of Medicine, University of Giresun, Giresun, Turkey
| | - Mete Gedíkbaş
- Department of Anatomy and Department of Orthopedics and Traumatology, Faculty of Medicine, University of Giresun, Giresun, Turkey
| | - Selçuk Takir
- Department of Anatomy and Department of Orthopedics and Traumatology, Faculty of Medicine, University of Giresun, Giresun, Turkey
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Ruiz A, Adler RS, Raya JG. Reply to Aytekin et al.: Comment on "Accuracy of Ultrasound-Guided versus Landmark-Guided Intra-articular Injection for Rat Knee Joints". ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:1164. [PMID: 35287995 DOI: 10.1016/j.ultrasmedbio.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 02/03/2022] [Indexed: 06/14/2023]
Affiliation(s)
- Amparo Ruiz
- Center for Biomedical Imaging, Department of Radiology, New York University Langone Health, New York, New York, USA.
| | - Ronald S Adler
- Division of Musculoskeletal Radiology, Department of Radiology, New York University Langone Health, New York, New York, USA
| | - José G Raya
- Center for Biomedical Imaging, Department of Radiology, New York University Langone Health, New York, New York, USA
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Adamiak P, Inkpen P, Bardi M. Ultrasound guided anterior approach to intra-articular injection of the knee. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:435-440. [PMID: 34939689 DOI: 10.1002/jcu.23110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 12/07/2021] [Accepted: 12/08/2021] [Indexed: 06/14/2023]
Abstract
In this clinical practice article, we describe a novel, anterior, approach for therapeutic intra-articular injection of the knee under ultrasound guidance. The benefits of this approach are improved accuracy in knees that do not have an effusion, simplified sonoanatomy for learners, and easy localization in patients with enlarged body habitus or altered anatomy. This article describes the positioning, sonographic anatomy, risks, and technical considerations for this anterior approach.
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Affiliation(s)
- Paul Adamiak
- Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, Canada
| | - Peter Inkpen
- Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, Canada
| | - Mohammad Bardi
- Division of Rheumatology, University of British Columbia, Vancouver, Canada
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Ruiz A, Duarte A, Bravo D, Ramos E, Zhang C, Cowman MK, Kirsch T, Milne M, Luyt LG, Raya JG. In vivo multimodal imaging of hyaluronan-mediated inflammatory response in articular cartilage. Osteoarthritis Cartilage 2022; 30:329-340. [PMID: 34774790 PMCID: PMC8792232 DOI: 10.1016/j.joca.2021.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 10/31/2021] [Accepted: 11/02/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE One driving factor in the progression to posttraumatic osteoarthritis (PTOA) is the perpetuation of the inflammatory response to injury into chronic inflammation. Molecular imaging offers many opportunities to complement the sensitivity of current imaging modalities with molecular specificity. The goal of this study was to develop and characterize agents to image hyaluronan (HA)-mediated inflammatory signaling. DESIGN We developed optical (Cy5.5-P15-1) and magnetic resonance contrast agents (Gd-DOTA-P15-1) based in a hyaluronan-binding peptide (P15-1) that has shown anti-inflammatory effects on human chondrocytes, and validated them in vitro and in vivo in two animal models of PTOA. RESULTS In vitro studies with a near infrared (NIR) Cy5.5-P15-1 imaging agent showed a fast and stable localization of Cy5.5-P15-1 on chondrocytes, but not in synovial cells. In vivo NIR showed significantly higher retention of imaging agent in PTOA knees between 12 and 72 h (n = 8, Cohen's d > 2 after 24 h). NIR fluorescence accumulation correlated with histologic severity in cartilage and meniscus (ρ between 0.37 and 0.57, P < 0.001). By using in vivo magnetic resonance imaging with a Gd-DOTA-P15-1 contrast agent in 12 rats, we detected a significant decrease of T1 on injured knees in all cartilage plates at 48 h (-15%, 95%-confidence interval (CI) = [-18%,-11%]) while no change was observed in the controls (-2%, 95%-CI = [-5%,+1%]). CONCLUSIONS This study provides the first in vivo evidence that hyaluronan-related inflammatory response in cartilage after injury is a common finding. Beyond P15-1, we have demonstrated that molecular imaging can provide a versatile technology to investigate and phenotype PTOA pathogenesis, as well as study therapeutic interventions.
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Affiliation(s)
- Amparo Ruiz
- Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, NY, USA.,Tech4Health Institute, New York University Langone Health, New York, NY, USA
| | - Alejandra Duarte
- Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, NY, USA
| | - Dalibel Bravo
- Musculoskeletal Research Center, Department of Orthopaedic Surgery, New York University School of Medicine, New York, NY, USA
| | - Elisa Ramos
- Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, NY, USA
| | - Chongda Zhang
- Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, NY, USA
| | - Mary K. Cowman
- Musculoskeletal Research Center, Department of Orthopaedic Surgery, New York University School of Medicine, New York, NY, USA.,Department of Biomedical Engineering, New York University Tandon School of Engineering, New York, NY, USA
| | - Thorsten Kirsch
- Musculoskeletal Research Center, Department of Orthopaedic Surgery, New York University School of Medicine, New York, NY, USA.,Department of Biomedical Engineering, New York University Tandon School of Engineering, New York, NY, USA
| | - Mark Milne
- The University of Western Ontario, London, ON, Canada.,London Regional Cancer Program, Lawson Health Research Institute, London, ON, Canada
| | - Leonard G. Luyt
- The University of Western Ontario, London, ON, Canada.,London Regional Cancer Program, Lawson Health Research Institute, London, ON, Canada
| | - José G. Raya
- Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, NY, USA.,Tech4Health Institute, New York University Langone Health, New York, NY, USA
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Wang Y, Wang S, Luan S, Yu S, Zheng Y, Ma C, Wu S. Accuracy and Feasibility of Ultrasound-Guided Intra-articular Injection of the Rat Hip Joint. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:2936-2940. [PMID: 34266679 DOI: 10.1016/j.ultrasmedbio.2021.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 05/18/2021] [Accepted: 06/07/2021] [Indexed: 06/13/2023]
Abstract
Intra-articular injection is frequently used as an effective diagnostic and treatment tool for hip joint diseases. However, the underlying treatment mechanism remains unclear because of a lack of experimental animal models. A challenge facing researchers is how to accurately and consistently perform injections involving animal hip joints. The purpose of this study, then, was to establish an ultrasound (US)-guided intra-articular (IA) injection technique using rat hip joints and to evaluate its accuracy and feasibility versus a fluoroscopy (FL)-guided technique. For this study, 20 US-guided and 20 FL-guided IA injections were administered to separate groups of Sprague-Dawley rats. For each procedure, 50 μL of iohexol was injected into the hip joint using a 25G needle. The US-guided injections were performed using a linear probe, and the FL-guided IA injections were performed using C-arm X-ray fluoroscopy. All injections were verified by computed tomography imaging. The number of successful injections and needle repositions per injection, as well as operating times, were recorded, and the rats were observed for complications for 10 d after the injections. Statistical analysis was used to compare US-guided and FL-guided techniques with significance set at p < 0.05. The success rate was markedly higher for the US-guided interventions (90%) than for the FL-guided interventions (75%) (p<0.05). The intervention time was shorter in the US-guided group (95.95 ± 8.376 s) than in the FL-guided group (110.70 ± 20.236 s) (p < 0.05), and the median number of needles repositioned per injection in the US-guided group (1.20 ± 0.41) was notably less than that in the FL-guided group (1.60 ± 0.68) (p < 0.05). A puncture site hematoma was noted in two rat hips (10%) the day after injection in the FL-guided group. Overall, the study indicated that ultrasound-guided intra-articular injection of the hip is a feasible, accurate and safe method for use in rats. This makes it a promising tool for diagnosing coxofemoral pain, producing hip osteoarthritis animal models and administering intra-articular medication.
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Affiliation(s)
- Yanxue Wang
- Department of Rehabilitation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Shaoling Wang
- Department of Rehabilitation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Shuo Luan
- Department of Rehabilitation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Shaojun Yu
- Department of Rehabilitation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yaochao Zheng
- Department of Rehabilitation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Chao Ma
- Department of Rehabilitation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Shaoling Wu
- Department of Rehabilitation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.
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