甲亢患者IL-4、IL-10水平检测的临床意义

目的 :探讨IL - 4、IL - 10水平变化在甲亢的临床意义。方法 :选择甲亢未治疗组 6 4例、甲亢经1 31 I治疗组 39例和正常对照组 35例 ,用化学发光法测定FT3、FT4 、TSH的含量 ,用放射免疫分析测定IL - 4、IL - 10含量。结果 :甲亢未治疗组患者血清IL - 4、IL - 10水平均高于正常对照组 (p <0 0 1、p <0 0 5 )。1 31 I治疗组患者血清IL - 4、IL - 10水平均低于未治疗组 (p <0 0 1、p <0 0 5 )。甲亢1 31 I治疗组患者血清IL - 4、IL - 10与正常对照组差异无显著性 (p>0 0 5 )。结论 :IL - 4、IL - 10在甲亢的发病机理中起重要作用 ,判断疗效有一定意义。     

脑血栓患者血清IL-10水平及其临床意义

目的 :测定急性脑血栓形成患者血清白细胞介素 - 10 (IL - 10 )的水平 ,探讨其临床意义。方法 :采用ELISA检测 5 0例病情不同程度脑血栓形成患者血清IL - 10的水平及变化 ,以 30例正常人 (对照组 )作比较。结果 :发病初期脑血栓组血清IL - 10水平显著低于对照组 (P <0 0 1) ,且随脑梗死程度加重而加重 (P <0 0 1) ,(7～ 10 )天后IL - 10水平上升。结论 :脑血栓形成可能与患者血清IL - 10水平低有关。     

肺癌患者血清IL-6,IL-8和TNF活性测定的临床意义

目的 :探讨了肺癌患者血清中IL - 6、IL - 8和TNF含量的变化。方法 :应用酶联免疫吸附法和放免法测定了 4 0例肺癌患者血清中IL - 6、IL - 8和TNF含量 ,且与 35名正常健康人作比较。结果 :肺癌患者血清中IL - 6、IL - 8和TNF水平均非常显著地高于正常人 (P <0 0 1) ,术后IL - 6、IL - 8和TNF水平下降。结论 :测定肺癌患者血清中IL - 6、IL - 8和TNF含量对判断患者的免疫状态有一定的临床价值。     

肺癌患者化疗前后血清IL-2,SIL-2R检测的临床意义

目的 :分析了 36例肺癌患者化疗前后血清中IL - 2和SIL - 2R水平的变化。方法 :采用放射免疫分析法测定患者血清中IL - 2和使用ELISA法测定SIL - 2R含量 ,并与 35名正常健康人作比较。结果 :化疗前IL- 2活性明显低于正常人 ,SIL - 2R水平明显高于正常人 (P <0 .0 1 ) ,化疗后 6个月复发者IL - 2 /SIL - 2R水平持续异常 ,未复发者IL - 2 /SIL - 2R水平恢复正常。结论 :观察肺癌患者免疫功能的变化与患者的病情和预后密切相关。     

肺癌患者化疗前后血清SIL-2R,CEA含量检测的临床意义

目的 :本文探讨了肺癌患者化疗前后血清SIL - 2R和CEA水平的变化。方法 :应用放免法测定 31例肺癌患者化疗前后血清SIL - 2R和CEA含量 ,并与 35名正常健康人作比较。结果 :肺癌患者化疗前血清SIL - 2R和CEA水平非常显著地高于正常人 (P <0 0 1) ,化疗后 3个月血清CEA水平与正常人比较无显著性差异 (P >0 0 5 ) ,而SIL - 2R仍高于正常人 (P <0 0 5 )。结论 :测定血清SIL - 2R和CEA水平可作为判断疗效的参考。     

胸水和血清中CEA、CYFRA21-1、TPS联合检测对良恶性胸水及肺癌的诊断价值

目的:探讨胸水和血清肿瘤标志物癌胚抗原(CEA),细胞角蛋白片段21-1(CYFRA21-1) ,组织多肽特异性抗原(TPS)在肺癌诊断中的临床意义.方法:应用电化学发光法和ELISA分别测定78例肺癌患者,45例肺部良性疾病胸水和血清CEA、CYFRA21-1、TPS水平,结果:肺癌组胸水CEA、CYFRA21-1、TPS水平明显高于良性疾病胸水组(P<0.01);肺癌组血清CEA、TPS水平明显高于良性疾病血清组(P<0.05,P<0.01);在不同病理类型肺癌中3种肺癌肿瘤标志物升高的程度均有所不同;恶性胸水组中肿瘤标志物的含量与同期血清中的含量相比,出现更早且浓度更高,尤以TPS升高最为明显.单项检测中,胸水TPS的敏感性最高,联合检测中,胸水TPS CYFRA21-1 CEA的敏感性和准确性最高.结论:CEA、CYFRA21-1、TPS三项联合检测对良恶性胸水的鉴别有较好的诊断价值. 胸水中3种肺癌标志物的联合检测较血清有更高的敏感性,准确性.其临床价值优于血清.     

乳腺癌患者手术前后血清CA15-3、SA和SIL-2R检测的临床意义

目的:探讨乳腺癌患者手术前后血清CA15-3、SA和SIL-2R水平的变化及临床意义。方法:应用放射免疫分析、分光光度法和酶联法对31例乳腺癌患者进行手术前后血清CA15-3、SA和SIL-2R检测,并与35例正常人作比较。结果:乳腺癌患者在手术前血清CA15-3、SA和SIL-2R水平均非常显著地高于正常人组(P<0.01),手术3个月后则与正常人组比较无显著性差异(P>0.05)。结论:乳腺癌患者血清CA15-3、SA和SIL-2R含量的变化与疾病的发生和发展密切相关。     

抗癫痫药物治疗对癫痫患者血清细胞因子水平的影响

目的 :观察抗癫痫药物治疗前后癫痫患者血清细胞因子水平变化 ,探讨白细胞介素 - 2 (IL - 2 )、白细胞介素 - 6 (IL - 6 )、肿瘤坏死因子 -α(TNF -α)在癫痫神经免疫调节中的作用。方法 :采用放射免疫分析测定 4 3例癫痫患者抗癫痫药物治疗前后 ,血清IL - 2、IL - 6、TNF -α的水平 ,并与年龄和性别相匹配的 32例正常对照组进行比较。结果 :癫痫患者治疗前血清IL - 2、IL - 6、TNF -α水平均显著高于正常对照组 (p <0 0 0 1 ) ,经治疗后有 1 8人疗效显著。其发作次数降低 75 %以上 ,其中有若干病人其血清细胞水平明显降低 ,但总体水平差异呈无显著性 (p >0 0 5 ) ,其余 2 5人疗效较差 ,其水平改变不大 ,但部分反有升高。患者血清IL - 2浓度与IL- 6、TNF -α水平变化呈显著正相关。结论 :癫痫患者血清细胞因子水平增高 ,提示免疫系统处于活化状态 ,但治疗后细胞因子水平改变难以预测 ,即使疗效显著者 ,亦有一些明显降低。     

IL-10对人肾小球系膜细胞细胞周期负调控蛋白p27的调节

观察白细胞介素 10 (IL 10 )对体外培养的人肾小球系膜细胞 (HMC )增殖影响 ,并探讨IL 10对HMC细胞周期负调控蛋白p2 7的影响 ,旨在了解其调节HMC增殖的内在机制。HMC用含 5 %FCS的RPMI16 4 0培养 ,加入IL 10刺激后 ,应用流式细胞术分别测定HMC细胞增殖周期的变化以及p2 7的水平。结果表明IL 10可抑制血清诱导的HMC增殖 ,IL 10显著减少了HMCG0 /G1期细胞进入S期和G2 /M期 ;2 5ng/mlIL 10明显地上调细胞周期负调控蛋白p2 7水平 ,是血清刺激组的 1 7倍 (P <0 0 5 )。IL 10抑制血清诱导的HMC增殖的作用机制可能部分是通过上调细胞周期负调控蛋白p2 7来实现的 ,提示IL 10在增殖性肾小球肾炎中可能发挥重要的调节作用     

肺癌患者化疗前后SIL-2R和TNF检测的临床意义

目的 :探讨了 4 0例肺癌患者化疗前后血清中SIL - 2R和TNF含量的变化。方法 :应用放免法和酶免法检测 4 0例肺癌患者血清中SIL - 2R和TNF含量并与 35名正常人作比较。结果 :肺癌患者在化疗前血清中SIL - 2R和TNF含量显著地高于正常人组 (p <0 0 1 ) ,化疗后明显下降 (p <0 0 5 )。 结论 :血清中SIL- 2R和TNF水平可作为肺癌患者免疫功能监测指标之一 ,并可作为疗效判断参考     

Transthoracic ultrasound assessment of B-lines for identifying the increment of extravascular lung water in shock patients requiring fluid resuscitation

Introduction:

Several studies have shown that the number of B-lines was related to the amount of extravascular lung water (EVLW). In our study, we aimed to demonstrate the magnitude of the incremental B-lines in shock patients with positive net fluid balance and the association with gas exchange impairment.

Materials and Methods:

We performed trans-thoracic ultrasound at admission (T₀) and at follow-up period (T_FL) to demonstrate the change of B lines (ΔB-lines) after fluid therapy. We compared the total B-line score (TBS) at T₀ and T_FL and calculated the Pearson''s correlation coefficient between the ΔB-lines and PaO₂/FiO₂ ratio.

Results:

A total of 20 patients were analyzed. All patients had septic shock. Net fluid balance was + 2228.05 ± 1982.15 ml. The TBS at T₀ and T_FL were 36.6 ± 23.73 and 63.80 ± 29.25 (P < 0.01). The ΔB-lines along anterior axillary line (AAL) correlated to the ΔTBS (r = 0.90, P < 0.01). The ΔB-lines along AAL had inverse correlation to PaO₂/FiO₂ ratio (r = −0.704, P < 0.05). The increase of B-lines ≥ 10 was related to the decrease of PaO₂/FiO₂ ratio. The inter-observer reliability between two ultrasound readers was high (r = 0.92, P < 0.01).

Discussion:

The number of B-lines increased in shock patients with positive net fluid balance and correlated to impaired oxygenation. These data supported the benefit of ultrasound for assessing the EVLW.     

CT图像肺结节自动检测

肺癌是对人类生命健康危害最大的恶性肿瘤之一。计算机辅助诊断系统对肺部CT图像进行自动分析后,可提示医生可疑肺结节,从而克服医生在诊断中的一些主观因素,为此本文提出了一种基于胸部CT图像的可疑肺结节自动检测算法。首先,根据胸部组织的特殊结构,利用一种新的分割算法提取出肺实质部分;在此基础上提取出灰度与结节相近的感兴趣区域,包括结节、肺血管、支气管;然后,以已标记的结节数据作为样本集,计算结节的面积、灰度均值、灰度方差、圆形度、形状矩、体积、球形度等特征值,利用最近邻法建立分类器判别函数;最后,计算测试集感兴趣区域的上述特征,对其进行判别、分类,并标记出结节。试验结果表明,该算法综合考虑了肺结节特征,具有较高的准确度。     

正常人肺与肺鳞癌间质中肥大细胞的比较研究

用正常人肺标本7例,肺鳞状细胞癌标本25例,对其间质中的肥大细胞进行光镜与电镜观察.结果表明,肺鳞癌间质肥大细胞比正常肺组织肥大细胞明显增多(P<0.002),每0.0169mm~2中肥大细胞均数分别为4.74±1.54和2.72±0.77.用Alcian蓝一藏红染色后,正常肺肥大细胞颗粒均为Alcian蓝阳性,而肺癌者则除Alcian蓝阳性外,还有藏红阳性的颗粒.电镜观察,正常肺中肥大细胞颗粒多为卷发状,而肺鳞癌中肥大细胞颗粒则多为细颗粒状,并伴有显著脱颗粒现象.以上提示,肥大细胞表型的变化与微环境有关,在肺癌中肥大细胞增多的同时,出现表型的变化,可能与抗肿瘤机制有关.     

周围型肺腺癌和周围型肺鳞癌的能谱CT表现

目的:观察周围型肺腺癌和周围型肺鳞癌的能谱CT表现。方法:回顾性分析经病理证实并行能谱CT扫描的周围 型肺腺癌122 例和周围型肺鳞癌89 例。测量病灶在动脉期及静脉期下的CT40 keV值、CT70 keV值、CT100 keV值、碘（水）浓度 （IC）、水（碘）浓度（WC）和有效原子序数（Zeff）,并计算能谱曲线斜率（K70 keV）。比较两组之间各能谱参数之间的差异。结 果:两组之间性别差异有统计学意义（P<0.05）,而其他临床特征和临床症状在两组之间差异无统计学意义（P>0.05）。动 脉期和静脉期,周围型肺腺癌的CT40 keV、CT70 keV、K70 keV、IC及Zeff均大于周围型肺鳞癌,差异具有统计学意义（P<0.05）;而 两组之间的WC和CT100 keV无统计学意义（P>0.05）。ROC曲线分析显示,动脉期各定量参数联合较静脉期各定量参数联 合的诊断效能好,曲线下面积、敏感性和特异性分别为86%、77%、83%。结论:周围型腺癌和周围型鳞癌的能谱CT表现 存在一定差异,可为二者的鉴别提供参考。     

Variations of pulmonary vessels: Some practical implications for lung resections

Anatomical variations of the bronchi and lung vessels may be important obstacles during lung resection if overlooked. We designed this study to determine the frequency and types of variations of lung vessels during lung resections. In a 3[1/2]‐year‐period, anatomical variations were recorded and registered by digital photography at the hilar and/or interlobar areas during lung resection surgery on 140 patients. Variations of the pulmonary blood vessels were observed in 23 patients. Of these, 12 patients had variations of the middle lobe vessels. Middle lobe veins emptying into the right inferior pulmonary vein, and middle lobe arteries originating from the artery for the basal segments, were observed in four patients each; two separate middle lobe arteries and a low origin of the middle lobe artery existed in three and one patient, respectively. Among seven patients with variations of the lingular vessels, the lingular artery originating from the artery for the basal segments was found in three patients; the remaining variations referred to absent or low origin of the lingular artery (in one patient each), and to an aberrant lingular vein, separate from the upper lobe vein (two patients). A single unilateral pulmonary vein and a left‐sided bronchial tree completely behind the pulmonary artery existed in three and one patient, respectively. Potential problems related to these variations during resectional lung surgery are discussed. Awareness of the most frequent variations is of utmost importance for safe lung resections. Clin. Anat. 22:698–705, 2009. © 2009 Wiley‐Liss, Inc.     

Branching of lung epithelium in vitro occurs in the absence of endothelial cells

Background: Early lung morphogenesis is driven by tissue interactions. Signals from the lung mesenchyme drive epithelial morphogenesis, but which individual mesenchymal cell types are influencing early epithelial branching and differentiation remains unclear. It has been shown that endothelial cells are involved in epithelial repair and regeneration in the adult lung, and they may also play a role in driving early lung epithelial branching. These data, in combination with evidence that endothelial cells influence early morphogenetic events in the liver and pancreas, led us to hypothesize that endothelial cells are necessary for early lung epithelial branching. Results: We blocked vascular endothelial growth factor (VEGF) signaling in embryonic day (E) 12.5 lung explants with three different VEGF receptor inhibitors (SU5416, Ki8751, and KRN633) and found that in all cases the epithelium was able to branch despite the loss of endothelial cells. Furthermore, we found that distal lung mesenchyme depleted of endothelial cells retained its ability to induce terminal branching when recombined with isolated distal lung epithelium (LgE). Additionally, isolated E12.5 primary mouse lung endothelial cells, or human lung microvascular endothelial cells (HMVEC‐L), were not able to induce branching when recombined with LgE. Conclusions: Our observations support the conclusion that endothelial cells are not required for early lung branching. Developmental Dynamics 244:553–563, 2015. © 2015 Wiley Periodicals, Inc.     

Time course of lung inflammatory and fibrogenic responses during protective mechanical ventilation in healthy rats

This study aimed to assess pulmonary inflammatory and fibrogenic responses and their impact on lung mechanics and histology in healthy rats submitted to protective mechanical ventilation for different experimental periods. Eighteen Wistar rats were randomized to undergo open lung-mechanical ventilation (OL-MV) for 1, 6 or 12 h. Following a recruitment maneuver, a decremental PEEP trial was performed and PEEP set according to the minimal respiratory system static elastance. Respiratory system, lung, and chest-wall elastance and gas-exchange were maintained throughout the 12 h experimental period. Histological lung injury score remained low at 1 and 6 h, but was higher at 12 h due to overinflation. A moderate inflammatory response was observed with a distinct peak at 6h. Compared to unventilated controls, type I procollagen mRNA expression was decreased at 1 and 12h, while type III procollagen expression decreased throughout the 12h experimental period. In conclusion, OL-MV in healthy rats yielded overinflation after 6 h even though respiratory elastance and gas-exchange were preserved for up to 12 h.     

肺灌注与通气显像诊断静注毒品者急性肺栓塞

为探讨肺灌注/通气显像对静脉注射毒品者肺栓塞的早期诊断,9例患败血症心内膜炎,急性脑梗塞患者用核素肺灌注、肺通显像进行观察,并与X线胸片、超声心动图结果进行对照,结果显示9例患者中,8例肺灌注呈双肺多节段稀蔬缺损,与通气显像不匹配,与通气显像不匹配,核医学诊断为急性肺栓塞1例溶栓治疗入病人肺灌注显像明显改善,与临床症状一致,从而证实灌注与肺通气显像联合运用对此类病人急性肺栓塞的早期诊断极有价值,并可做为溶栓治疗疗疗效的观察指标 另外也提示临床医师对静脉注射品者肺栓塞应有足够警惕.     

Preoperative pulmonary rehabilitation in patients with non-small cell lung cancer and chronic obstructive pulmonary disease

Introduction

The aim of this study was to assess the effects of preoperative pulmonary rehabilitation (PPR) on preoperative clinical status changes in patients with chronic obstructive pulmonary disease (COPD) and non-small cell lung cancer (NSCLC), and net effects of PPR and cancer resection on residual pulmonary function and functional capacity.

Material and methods

This prospective single group study included 83 COPD patients (62 ±8 years, 85% males, FEV₁ = 1844 ±618 ml, Tiffeneau index = 54 ±9%) with NSCLC, on 2–4-week PPR, before resection. Pulmonary function, and functional and symptom status were evaluated by spirometry, 6-minute walking distance (6MWD) and Borg scale, on admission, after PPR and after surgery.

Results

Following PPR significant improvement was registered in the majority of spirometry parameters (FEV₁ by 374 ml, p < 0.001; VLC by 407 ml, p < 0.001; FEF₅₀ by 3%, p = 0.003), 6MWD (for 56 m, p < 0.001) and dyspnoeal symptoms (by 1.0 Borg unit, p < 0.001). A positive correlation was identified between preoperative increments of FEV₁ and 6MWD (r _s = 0.503, p = 0.001). Negative correlations were found between basal FEV₁ and its percentage increment (r _s = –0.479, p = 0.001) and between basal 6MWD and its percentage change (r _s = –0.603, p < 0.001) during PPR. Compared to basal values, after resection a significant reduction of most spirometry parameters and 6MWD were recorded, while Tiffeneau index, FEF₂₅ and dyspnoea severity remained stable (p = NS).

Conclusions

Preoperative pulmonary rehabilitation significantly enhances clinical status of COPD patients before NSCLC resection. Preoperative increase of exercise tolerance was the result of pulmonary function improvement during PPR. The beneficial effects of PPR were most emphasized in patients with initially the worst pulmonary function and the weakest functional capacity.     

基于边界逼近的肺实质分割方法

肺部CT图像的分割是计算机辅助诊断系统处理的一个重要环节,其分割的结果影响到医生的诊断与进一步的分析。由于胸膜结节的灰度与肺实质外围的灰度相近,运用传统的分割方法无法正确分割出此类病灶。将胸膜结节包含肺实质一起分割出来,使计算机辅助诊断系统能够对此类病灶做进一步的分析。提出一种结合Graham算法以及边界逼近的方法,对肺实质的轮廓进行修正,进而得到修正的二值模板;将该模板与原图像做乘运算,得到包含胸膜结节的肺实质。运用所提出的方法,对公开数据库LIDC中68张含病灶的CT样本图像做处理,通过与传统方法的对比以及对算法的过分割比例、欠分割比例以及准确性的分析,得到准确率为98.5%,平均过分割比例为1.35%,平均欠分割比例为0.51%,证明了该方法的有效性。