Effect of Microbubble-Enhanced Ultrasound on Radiofrequency Ablation of Rabbit Liver

Microbubble-enhanced ultrasound (MEUS) can non-invasively disrupt and block liver blood perfusion. It may potentially overcome the heat sink effect during a thermal ablation and consequently enhance radiofrequency ablation (RFA) of the liver. We propose a new strategy combining RFA with MEUS. For ultrasound treatment, an 831-kHz air-backed focused transducer directed 400-cycle bursts at 4.3?MPa to the liver at a 9-Hz rate. The treatment was nucleated by a lipids microbubble forming MEUS. Eighteen surgically exposed rabbit livers were treated using MEUS combined with RFA; the other 32 livers were treated using MEUS (n?=?14) or RFA (n?=?18) alone and served as the controls. Contrast ultrasound imaging confirmed that MEUS treatment significantly reduced liver blood perfusion by cutting contrast peak intensities in half (44.7%–54.1%) without severe liver function damage. The ablated liver volume treated using MEUS combined with RFA was 2.8 times greater than that treated using RFA alone. In conclusion, RFA of the liver can be safely and greatly enhanced by combination with MEUS pre-treatment.     

超声在子宫肌瘤射频治疗中的应用价值

目的探讨超声在子宫肌瘤射频治疗中的应用价值。方法术前超声确定肌瘤大小、部位,术中准确引导并动态观察射频针的位置,术后复查肌瘤大小及血流信号的变化情况。结果120例患者中肌瘤结节151个,其中26个黏膜下肌瘤,均取出或排出;98个壁间肌瘤,4个术后一个月内自行从阴道排出;94个壁间肌瘤和9个宫颈肌瘤及18个浆膜下肌瘤术后半年较术前缩小约70％～75％;1例浆膜下、多发子宫肌瘤（小于2cm）穿孔。结论超声在子宫肌瘤射频治疗术前筛查患者、术中定位、术后监测随访等均具有重要作用。     

Expression of Heat Shock Proteins after Ultrasound Exposure in HL-60 Cells

One of the important cellular defense mechanisms against stress is the induction of heat shock proteins (HSPs). We have recently demonstrated that a low frequency electromagnetic field is unable to induce the heat shock response (HSR). In the present study, we expanded our investigations to the induction of HSPs, particularly Hsp72, by ultrasound (US). Human promyelocytic leukemia HL-60 cells were exposed in suspension to US at 1, 3 and 10 MHz, as well as combinations of two of these frequencies. The ability of US to induce Hsp72 was tested for different frequencies, intensities and exposure times. In addition, the water bath temperature was varied from 30 to 36°C. The Hsp72 protein expression was determined 4 and 24 h after treatment. We found that the amount of Hsp72 increased with increasing US frequency, reaching its highest level of about 1800%, induced by 10 MHz. After increasing the temperature of the water bath, the amount of Hsp72 in the treated cells was also increased, whereas no induction was observed at 30°C. For all treatment conditions, ultrasound of 1 MHz was unable to significantly induce Hsp72. At 10 MHz, the exposure time was varied from 0 to 20 min. We found that the induction of Hsp72 took place after 5 min of exposure. For a fixed level of absorbed US energy, the continuous regime, as well as a pulsation of 1:2 (5 ms on and 5 ms off) induced the same Hsp72 level. Pulsation of 1:5 (2 ms on and 8 ms off) and 1:10 (1 ms on and 9 ms off) did not show any effect. A single sonication of 20 min, as well as a fractionated sonication of two 10 min exposures induced the same level of Hsp72, whereas four exposures of 5 min reduced the Hsp72 level. At the optimum exposure conditions (10 MHz, 10 min), the concentration of other HSPs was also determined. Hsp27 showed no effect but Hsp32, Hsp40 and Hsp72 were induced. Taken together, these results suggest a synergistic interaction between heat and US. (E-mail: werner.sontag@ibg.fzk.de)     

超声引导下经皮射频治疗兔肾VX2瘤模型的声像图变化的动态观察

目的超声引导下经皮射频治疗兔肾VX2肿瘤模型,动态观察其声像图变化特征。方法对25只已建立VX2肾肿瘤模型的大白兔行超声引导下射频治疗,并于治疗后定期行超声检查,二维超声观察肿瘤大小和形态,彩色多普勒血流显像(CDFI)观察肿瘤内部及周边血流。结果超声成功引导所有兔肾VX2肿瘤射频治疗,治疗即刻二维声像图呈现斑片状强回声伴声影,CDFI显示毁损灶无血流信号,治疗后毁损区呈边界清楚的强回声;在肿瘤部分区域发现低回声,CDFI显示点条状血流信号,病理证实为肿瘤残存或复发。结论二维及彩色多普勒超声在兔肾VX2肿瘤射频的引导和治疗中具有特征性声像图表现,对于评价射频疗效具有重要的应用价值。     

解脲脲原体热休克蛋白HSP70与男性不育的相关研究

支原体是引起不育的致病菌之一。解脲脲原体通过改变精液参数、影响精子运动方式、产生抗精子抗体、导致精子凋亡数增加而引起男性不育。解脲脲原体热休克蛋白与男性不育的关系主要在于热休克蛋白70(HSP70)可以抑制解脲脲原体细胞凋亡。     

谷氨酰胺不同作用时间对单个核细胞热休克蛋白70表达的影响

目的 探讨经内毒素(lipopolysaccharide,LPS)预处理后,谷氨酰胺(glutamine,Gln)不同作用时间对单个核细胞(peripheral blood mononuclear cell,PBMC)热休克蛋白70(HSP70)表达的影响.方法 取健康志愿者新鲜外周血滤过的血盘,用0.9％氯化钠注射液按1∶1稀释血液,Ficoll-泛影酸钠(Ficoll-Hypaque)密度梯度离心法提取PBMC,以LPS刺激PBMC2h后,使用10 mmol/L的Gln分别刺激PBMC 0、0.5、1、2、3h后提取蛋白,采用Western blot方法检测PBMC中HSP70表达情况.结果 PBMC经LPS刺激2h后,予Gln分别作用0、0.5、1、2、3h,结果显示作用1h后,HSP70的表达量最高,与其他时间段比较差异均有统计学意义(P＜0.05),随后表达量减少；作用2、3h后表达量虽有减少,但与作用0.5h比较,差异亦有统计学意义(P＜0.05).结论 早期补充Gln可上调LPS诱导的PBMC中HSP70的表达,Gln发挥作用快速,但作用时间短.     

超声造影评价兔肝VX2肿瘤射频消融疗效的研究

目的与组织病理对照，探讨超声造影（contrast enhanced uhrasonography，CEUS）在肝肿瘤射频消融治疗（radiofrequency ablation，RFA）疗效判断中的可靠性。 方法建立8只兔肝VX3肿瘤模型，并进行RFA，有选择地控制消融范围，确保有存活肿瘤组织。在ERFA后4d，CEUS和组织病理检查，比较CEUS获得的消融灶最大径与病理标本的最大径，CEUS切面与病理切片层面基本一致的情况下，分析CEUS与组织病理的相关性。 结果CEUS发现7个消融灶内有残存肿瘤组织，4个消融灶周边出现明显的良性增强带，与组织病理检查对应一致。CEUS获得的消融灶最大径与病理标本的最大径无统计学差异，CEUS和组织病理获得的肝肿瘤坏死成分占病灶总面积的百分比具有良好的相关性（r=0．986）。 结论CEUS在RFA后早期能较准确地鉴别RFA引起的凝固样坏死与残存的肿瘤组织，辨别消融灶周边的良性增强，是评价RFA疗效的有效方法，具有较高的临床应用价值。     

超声影像在经皮射频治疗肾VX2肿瘤中应用体会

目的探讨超声影像在经皮集束电极射频消融肾肿瘤模型中的引导方法及应用价值。方法将27只新西兰大白兔在超声引导下经皮穿刺组织块悬液注射法建立肾VX2肿瘤模型，成模后超声影像观测肿瘤结节并确定穿刺点，行超声引导下经皮射频消融肿瘤结节，于治疗后观察肿瘤的生长情况和消融灶的位置、大小及声像图变化。结果27只兔形成31个肿瘤灶接受射频治疗。超声影像引导穿刺成功率1DO％；二维声像图显示19个消融灶电极针放置合理，病灶消融完全，12个病灶消融不完全，出现残余灶，均经病理解剖证实。4只兔出现周围脏器灼伤，3只兔出现针道转移。结论超声影像引导经皮射频消融肾脏肿瘤安全、有效，超声准确的术前定位、精确的术中引导和医师熟练的配合是操作成功的关键。     

超声造影及三维彩色能量成像在射频消融治疗子宫肌瘤中的应用价值

目的探讨超声造影(CEUS)及三维彩色能量成像(3D-CPA)指导射频消融治疗子宫肌瘤的应用价值。方法选取98例拟行射频消融治疗的子宫肌瘤患者,随机分为CEUS组46例和3D-CPA组52例。CEUS组术前行超声造影检查,记录达峰期肌瘤增强程度;3D-CPA组术前行三维超声成像检查,记录肌瘤血流分级情况及供血血管走行,两组术后均行超声造影检查,比较术后2 h肌瘤完全消融率,以及两组内术前和术后3个月的肌瘤体积缩小率。结果两组术前高增强与Ⅲ级血流信号、等增强与Ⅱ级血流信号的病灶射频消融治疗后2 h完全消融率比较差异无统计学意义,低增强与Ⅰ级血流信号的病灶完全消融率比较差异有统计学意义(P0.05)。术后3个月两组内肌瘤平均体积缩小率下降,差异均有统计学意义(均P0.05),但两组间术后平均体积缩小率比较差异无统计学意义。结论 3D-CPA和CEUS均能较好地指导具有丰富血管的肌瘤进行射频消融,但3D-CPA成像对细小血管的显示低于CEUS。     

Performance of Shear Wave Elastography in Delineating the Radiofrequency Ablation Boundary: An in Vivo experiment

This study was aimed at exploring the cutoff value of Young's modulus of ablated tissue and the optimal scale at which shear wave elastography (SWE) can delineate the ablation boundary. The livers of 30 rabbits were radiofrequency (RF) ablated, and ultrasonic imaging, including SWE and contrast-enhanced ultrasound (CEUS), was performed. The ablation boundary in the SWE image was located using CEUS, and the SWE parameters of the boundary were measured to calculate the cutoff value of Young's modulus. The cutoff value of the ablated tissue was 48–50 kPa 2 h to 28 d post-ablation. The regions of increased stiffness in SWE images at a scale of 0–50 kPa overlapped well with the non-enhanced regions of CEUS images in 88% of specimens. Therefore, elasticity values differed significantly between ablated and non-ablated tissues, and the cutoff value for Young's modulus differentiated these tissues. SWE delineated the ablation boundary well at the optimal SWE scale with respect to the cutoff value.     

Application of contrast-enhanced ultrasound in minimally invasive ablation of benign thyroid nodules

ObjectiveThis study aimed to investigate the application value of contrast-enhanced ultrasound (CEUS) before and after minimally invasive ablation procedures for benign thyroid nodule(s) (BTN).MethodsThis prospective study included patients with BTNs scheduled to undergo ultrasound-guided minimally invasive ablation treatment. CEUS was performed before and after ablation (at 1 day, and 1, 6, and 12 months after ablation). Changes in microvascular perfusion and the volume of BTNs were noted and assessed.ResultsSixty-two patients (62 BTNs), who underwent ablation procedures between June 2016 and August 2020, were included. All lesions were confirmed by biopsy, and histopathological results were obtained before ablation treatment. On preoperative CEUS, the lesions exhibited hyperenhancement (53.23%) or iso-enhancement (46.77%) during the arterial phase, and all lesions exhibited iso-enhancement in the venous and late phases. One day after ablation, none of the BTNs exhibited obvious enhancement on CEUS. One (1.61%) lesion was re-treated due to a nodule-like enhancement area detected by CEUS at the 6-month follow-up. The mean nodular volume reduction rate (VRR) at 1, 6, and 12 months follow-up demonstrated no significant difference between the two ablation groups (microwave ablation versus radiofrequency ablation). Twelve months after ablation, the mean (±SD) VRR of all BTNs was 60.3 ​± ​10.3%.ConclusionCEUS helped guide treatment decisions for BTNs before ablation treatment. Moreover, it could also be used to accurately and noninvasively evaluate treatment efficacy.     

聚焦超声增强聚桂醇消融兔肝的实验研究

目的 研究聚焦超声同步辐照对聚桂醇消融正常兔肝脏的增效作用。方法 健康新西兰大白兔26只随机分为三组：聚焦超声组（FUS组,6只）、聚桂醇组（LAU组,10只）及聚焦超声+聚桂醇组（FUS+LAU组,10只）,分别给予聚焦超声辐照、聚桂醇及聚桂醇联合聚焦超声同步辐照处理。FUS焦点的平均声强（ISPTA）30.0W/cm2,工作占空比50%。48小时后观察处理区解剖及超声造影表现,测量血流充盈缺损区最大径。采用量筒法测定消融体积,消融灶HE染色后镜下观察组织学改变。采用Wilcoxon秩和检验比较LAU组与FUS+LAU组肝脏充盈缺损区最大径及消融体积的差异。结果 FUS组实验兔肝脏处理区未出现消融灶,LAU组与FUS+LAU组形成相似的黄白色消融灶。两组兔肝超声造影充盈缺损区平均最大径分别为(0.73±0.15)mm、(0.91±0.16)mm,差异有统计学意义(Z=-2.077,P=0.038);两组平均消融体积分别为(0.19±0.06)ml、(0.47±0.20)ml,差异有显著统计学意义(Z=-3.182,P=0.001),FUS+LAU组平均消融体积约为LAU组的2.5倍。两组消融灶HE染色均表现为典型的肝细胞坏死性改变。结论 聚焦超声同步辐照对聚桂醇消融正常兔肝有增效作用。     

热休克蛋白90α、70、27mRNA在急性白血病细胞中表达的研究

运用RNA分子杂交的方法,观察了热休克蛋白(heat shock protein,HSP)90α、70、27在22例白血病病人细胞,正常血细胞及K562红白血病细胞系中的表达。结果表明:16例白血病病人中,4例急性淋巴细胞白血病(ALL),6例急性非淋巴白血病(ANLL)、1例慢性粒细胞白血病急变期(慢粒急变)和2例骨髓增生异常综合征(MDS)血细胞呈现HSP27高水平表达,较正常血细胞显著增多,ALL(5例)与ANLL(7例)白血病细胞HSP27表达水平无明显改变。检测了7例白血病细胞HSP70的表达水平,除1例ALL及1例MDS明显升高外,其余5例(包括1例ALL,3例ANLL和1例慢粒急变)显著低于正常血细胞。17例白血病病人细胞(包括9例ANLL、5例ALL、2例慢粒急变和1例MDS)HSP90α表达水平均升高,明显高于正常。结果提示:白血病细胞HSP90α表达水平的升高可能与白血病细胞活跃异常增殖有关,而HSP27基因的高表达可能不是某种急性白血病的特殊标志。     

HIFU消融后兔肝细胞凋亡与增殖的研究

目的探讨高强度聚焦超声（HIFU）消融兔肝组织后细胞凋亡和增殖细胞核抗原（PCNA）表达的变化。 方法24只新西兰大白兔肝组织接受HIFU辐照，辐照后5min，1、3、6、9、14d分别处死4只动物，取出肝脏，HE染色观察组织病理改变，透射电镜观察细胞超微结构变化，原位末端标记法（TUNEL）检测细胞凋亡，免疫组织化学方法检测PCNA表达。 结果HE染色显示HIFu辐照后靶区边缘形成纤维包裹带，随时间逐渐加宽（P〈0．05）。电镜发现辐照后靶区周围组织有凋亡小体生成，TUNEL检测凋亡指数于辐照后3d最高。辐照后靶区周围组织出现PCNA阳性细胞，PCNA阳性细胞指数于辐照后6d达到峰值。 结论HIFU辐照后凝固坏死区域逐渐机化包裹，靶区周围组织出现凋亡细胞和PCNA阳性细胞，数量随时间变化，为进一步控制和增强HIFu消融作用提供实验基础。     

热休克蛋白90在多发性骨髓瘤患者中的表达及临床意义

目的:检测多发性骨髓瘤(MM)患者骨髓标本中HSP90的表达情况,并探讨其临床意义.方法:利用免疫组化技术检测HSP90在76例MM患者及29例健康供者中的表达;收集临床资料,分析HSP90表达情况与临床指标的相关性.结果:MM患者骨髓标本中HSP90表达阳性患者数明显高于对照组;HSP90表达水平与患者的β2-微球蛋...     

热休克蛋白70在大鼠黑质多巴胺神经元损伤中的表达

目的 :探讨热休克蛋白 70 (HSP70 )在大鼠黑质多巴胺 (DA)神经元损伤中的表达以及在帕金森病 (PD)诊断中的意义。方法 :将 48只大鼠随机分为黑质DA神经元损毁组 (PD组 )和对照组各 2 4只。PD组注射 6 羟多巴胺 (6 OHDA)损毁大鼠黑质DA神经元 ,对照组仅注射 6 OHDA溶媒。于注射后 1、7、14及 2 1d采用免疫组织化学、尼氏染色、电镜手段动态观察HSP70在损毁的DA神经元中的表达以及DA神经元形态学变化。结果 :在 6 O HDA损毁黑质 1～ 2 1d ,对照组黑质HSP70表达和尼氏细胞计数差异无显著性 (P >0 .0 5 )。PD组HSP70表达在 1d最高 ,7d锐减 ,14和 2 1d则逐渐减少 ,分别为 2 5 %、74%、87%及 88% ;尼氏细胞计数在 4个时间点分别减少1%、13%、35 %及 48% ;超微结构损伤程度呈进行性加重。结论 :PD渐进性发病具有其形态学基础 ,HSP70可作为DA神经元存活的指标和早期诊断PD的指标。     

超声造影引导单极射频消融及No-touch多极射频消融治疗肝肿瘤的应用价值比较

目的 探讨实时超声造影(Contrast-enhanced ultrasound,CEUS)引导下单极射频消融(Monopolar Radiofrequency Ablation,M-RFA)与无接触多极射频消融(No-touch Multipolar Radiofrequency Ablation,No-touch RFA)治疗肝肿瘤的临床应用价值。方法 本研究回顾性分析自2015年2月至2017年5月,在我院行实时CEUS引导下M-RFA 及No-touch RFA两种方法治疗肝肿瘤患者94例(M-RFA方法44例,No-touch RFA方法50例),分析术后病灶灭活范围、灭活率、并发症,比较治疗前、后肝功能、AFP、CEUS、增强CT、MRI情况,并定期随访24个月,观察患者的无瘤生存率。结果 RFA治疗后,CEUS测量消融灭活范围平均值：M-RFA组为38.36x31.31mm,No-touch RFA组为46.70x35.82mm;完全灭活率：M-RFA组90.9%(40/44),No-touch RFA组98.00%(49/50),差异具有统计学意义(P＜0.05)。治疗术后1～6个月,M-RFA组21例甲胎蛋白(AFP)阳性的患者,8例明显下降,12例转阴;No-touch RFA组20例AFP阳性的患者,5例明显下降,14例转阴,两组AFP水平,术前术后比较,差异具有统计学意义(P＜0.05);术后规律随访至24个月,无瘤生存率：M-RFA组47.72%(21/44),No-touch RFA组68.00%(34/50),差异具有统计学意义(P＜0.05)。结论 实时CEUS引导下No-touch RFA治疗肝肿瘤,有助于提高肿瘤的灭活率,疗效显著,无瘤生存率高,具有重要应用价值。     

中性粒细胞膜表面与胞内热休克蛋白70含量比值和严重脓毒症患者预后的相关分析

目的:探讨外周血中性粒细胞膜表面与胞内热休克蛋白70(heat shock protein 70,HSP70)含量的比值对严重脓毒症患者病情及预后的影响.方法:采用前瞻性随机对照的临床试验设计,选择上海市浦东新区公利医院急诊科确诊的严重脓毒症患者60例作为研究组,同期40例健康人群作为健康对照组.采用流式细胞术检测入急诊科24 h内研究对象外周血中性粒细胞膜表面与胞内HSP70表达水平,同时在进入急诊室24 h内进行简化急性生理学评分Ⅱ(simplified acute physiology score Ⅱ,SAPSⅡ),采用集束化治疗策略治疗,治疗28 d后判定患者的预后,比较研究组内存活患者(存活亚组)与病死患者(病死亚组)的中性粒细胞膜表面与胞内HSP70含量的比值和SAPSⅡ,并对2组中性粒细胞膜表面与胞内HSP70含量的比值和SAPSⅡ进行相关分析.结果:研究组患者中性粒细胞膜表面与胞内HSP70含量的比值显著高于对照组[(0.76±0.53)比(0.08±0.10)],P＜0.01.研究组60例患者中存活42例,病死18例,存活亚组中性粒细胞膜表面与胞内HSP70含量的比值显著低于病死亚组[(0.68±0.13)比(0.83±0.18)],P＜0.05;存活亚组SAPSⅡ显著低于病死亚组[(48.30±8.15)比(68.30±18.58)],P＜0.05.相关性分析显示,中性粒细胞膜表面与胞内HSP70含量的比值与SAPSⅡ呈显著正相关(r=0.295,P=0.01).结论:外周血中性粒细胞膜表面与胞内热休克蛋白HSP70含量的比值可反映严重脓毒症患者病情及预后.