Achromatized endomicroscope objective for optical biopsy

Currently, researchers and clinicians lack achromatized endomicroscope objectives that are as narrow as biopsy needles. We present a proof-of-concept prototype that validates the optical design of an NA0.4 objective. The objective, built with plastic lenses, has a 0.9 mm clear aperture and is achromatized from 452 nm to 623 nm. The objective’s measured Strehl ratio is 0.74 ± 0.05 across a 250 μm FOV. We perform optical sectioning via structured illumination through the objective while capturing fluorescence images of breast carcinoma cells stained with proflavine and cresyl violet. This technology has the potential to improve optical biopsies and provide the next step forward in cancer diagnostics.OCIS codes: (080.3620) Lens system design, (220.0220) Optical design and fabrication, (170.2520) Fluorescence microscopy, (170.3880) Medical and biological imaging, (220.1920) Diamond machining     

MEMS-based multiphoton endomicroscope for repetitive imaging of mouse colon

We demonstrate a handheld multiphoton endomicroscope with 3.4 mm distal diameter that can repetitively image mouse colon in vivo. A 2D resonant MEMS mirror was developed to perform beam scanning in a Lissajous pattern. The instrument has an effective numerical aperture of 0.63, lateral and axial resolution of 2.03 and 9.02 μm, respectively, working distance of 60 μm, and image field-of-view of 300 × 300 μm². Hoechst was injected intravenously in mice to stain cell nuclei. We were able to collect histology-like images in vivo at 5 frames/sec, and distinguish between normal and pre-malignant colonic epithelium.OCIS codes: (170.0170) Medical optics and biotechnology, (060.2350) Fiber optics imaging, (110.0110) Imaging systems, (190.4180) Multiphoton processes, (170.2150) Endoscopic imaging     

Low-cost,chromatic confocal endomicroscope for cellular imaging in vivo

We have developed a low-cost, chromatic confocal endomicroscope (CCE) that can image a cross-section of the tissue at cellular resolution. In CCE, a custom miniature objective lens was used to focus different wavelengths into different tissue depths. Therefore, each tissue depth was encoded with the wavelength. A custom miniature spectrometer was used to spectrally-disperse light reflected from the tissue and generate cross-sectional confocal images. The CCE prototype had a diameter of 9.5 mm and a length of 68 mm. Measured resolution was high, 2 µm and 4 µm for lateral and axial directions, respectively. Effective field size was 468 µm. Preliminary results showed that CCE can visualize cellular details from cross-sections of the tissue in vivo down to the tissue depth of 100 µm.     

High-throughput multi-resolution foveated laparoscope for minimally invasive surgery

Feasibility and clinical utility of a multi-resolution foveated laparoscope (MRFL) was previously tested in a porcine surgical study. The study revealed several clinical limitations of the system including moisture proofing, working distance, image quality, low light performance, color accuracy, size, and weight. In this paper, we discuss the root causes of these limitations and strategies to correct them, present the design and prototyping of a new high throughput multi resolution foveated laparoscope (HT-MRFL), and demonstrate the HT-MRFL prototype performance in comparison to the MRFL and simulated performance metrics.     

食管癌放射治疗研究进展

食管癌是常见的消化道恶性肿瘤,对人类健康造成了严重危害。目前食管癌有多种治疗方法,其中放射治疗是最重要的治疗方法之一。经过多年的临床研究及发展,食管癌放射治疗的方法、方式等均有了很大的改进,临床治疗效果也得到了很大提高。但目前靶区勾画及剂量分布、剂量分割方式等仍需继续研究。本文对食管癌放疗,特别是上段食管癌的放疗进行综述。     

Radiation-induced esophageal carcinoma

Radiation-induced carcinoma of the esophagus is rare and only 8 cases have been reported since 1957. This article presents 2 additional patients in whom esophageal carcinoma developed in segments previously exposed to large therapeutic doses of irradiation. The first patient had received 5,000 rads to her mediastinum and the second patient 3,200 rads to her neck region. The latent intervals were 11 years and 30 years, respectively.     

Antenatal sonographic detection of the proximal esophageal segment: Specific evidence for congenital esophageal atresia

To determine the biologic significance of a transient anechoic area observed in the midline of the fetal neck when attempting an antenatal ultrasound diagnosis of congenital esophageal atresia (CEA), a prospective study was made in 10 cases presenting both polyhydramnios and an unusually small stomach size due to a decrease in fetal stomach fluid. There were 8 cases indicating a transient anechoic area in the fetal neck, all of which were diagnosed as having CEA postnatally by plain roentgenogram, neonatal surgery, or autopsy findings. The remaining 2 cases had no CEA; one had Nager's syndrome and the other, a disorder involving neuronal migration in the central nervous system. These results suggest that an anechoic area in the middle of the fetal neck can be used as an indication of CEA and also for differentiating this condition from diseases with possible swallowing impairment. © 1995 John Wiley & Sons, Inc.     

人食管癌间充质干细胞对食管癌细胞株Eca-109侵袭性的影响

目的探讨人食管癌间充质干细胞(hEC-MSCs)对食管癌细胞株Eca-109侵袭性的影响。方法在体外将间质干细胞与食管癌细胞株ECA-109非接触共培养,使用RT-PCR和Western blotting的方法检测间质干细胞对ECA-109细胞株中基质金属蛋白酶-9(MMP-9)和抑癌基因E-cadherin表达的影响。结果间质干细胞可明显上调ECA-109细胞株中的MMP-9表达,显著下调ECA-109细胞株中E-cadherin的表达。结论食管癌间充质干细胞可能参与调节食管癌细胞的侵袭与转移。     

食管癌根治性术后放疗的预后因素分析

目的回顾性分析食管癌术后预防性放疗预后因素及临床疗效。方法 2008～2011年本院行食管癌术后放疗患者67例,术后病理分期Ⅱa、Ⅱb、Ⅲ期分别为22、10、35例,常规放疗20例、三维适形放疗(3DCRT)44例、调强放疗(IMRT)3例,中位放疗剂量50Gy,采用Kaplan-Meier法计算生存率并进行Log-rank法检验和单因素预后分析,Cox回归模型多因素预后分析。结果全组随访率为97.1%,随访满3年者28例。全组1、2、3年术后生存率分别为92.4%、72.4%、51.1%。Ⅱa期、Ⅱb期、Ⅲ期的3年生存率分别为75.7%、63.5%、32.2%(χ2=15.497,P<0.001)。淋巴结阴性与阳性的3年生存率分别为68.2%、40.6%(χ2=8.872,P=0.003)。单因素分析显示肿瘤分化程度、淋巴结是否转移、病理分期、肿瘤长度、术后开始放疗时间等为影响预后因素(χ2=9.337,8.872,15.497,10.716,5.190,P=0.002,P=0.003,<0.001,P=0.005,P=0.023),多因素分析显示肿瘤分化程度、淋巴结是否转移、术后放疗开始时间为影响预后因素(χ2=4.867,3.930,4.437,P=0.027,0.047,0.035)。主要失败原因中远处转移21例,胸内淋巴结转移15例,锁骨上淋巴结转移8例,腹腔淋巴结转移2例。结论肿瘤分化程度、是否淋巴结转移、术后放疗开始的时间是影响食管癌根治术后放疗的独立预后因素,有淋巴结转移食管癌术后患者宜45d内进行预防性放疗。     

Elevated serum eotaxin and IP‐10 levels as potential biomarkers for the detection of esophageal squamous cell carcinoma

Background and AimsEsophageal squamous cell cancer (ESCC) is one of the leading malignant cancers with a high incidence and mortality. Exploring novel serum biomarkers will help improve the management and monitoring of ESCC.MethodsIn the present study, we first used a ProcartaPlex Array to screen for serum proteins that were increased in 40 ESCC patients compared with matched normal controls; we found that eight proteins (IL‐2, IL‐5, IP‐10, IL‐8, eotaxin, TNF‐α, HGF, and MIP‐1b) had higher serum levels in ESCC patients than in normal controls. We further verified the clinical relevance of the candidate biomarkers with a larger sample of sera.ResultsIn the 174 tested ESCC patients and 189 normal controls, the serum levels of eotaxin and IP‐10 were significantly higher in patients than in normal controls (p = 0.0038, 0.0031). In particular, these two proteins were also elevated in the sera of patients with early‐stage (0‐IIA) ESCC (p = 0.0041, 0.0412). When combining CEA and CYFRA21‐1 (in use clinically) with eotaxin or IP‐10, the effectiveness of detecting ESCC was superior to that of CEA and/or CYFRA21‐1 alone. Moreover, the serum level of eotaxin dropped significantly after surgical resection of primary tumors compared with that in preoperative ESCC samples (p < 0.001).ConclusionsThe data suggest that serum eotaxin and IP‐10 might be potential biomarkers for the detection of ESCC.     

晚期食管癌食管动脉灌注化疗的临床研究

为了评价动脉灌注化疗在食管癌介入性治疗中的应用价值,本文分析了32例晚期食管癌经动脉数字减影血管造影证实靶血管后,经食管动脉灌注化疗药物的疗效及并发症.灌注药物为顺铂、丝裂霉素和平阳霉素.32例共进行76例次动脉灌注化疗.近期疗效:完全缓解1例,部分缓解12例,稳定14例,进展5例,总有效率40.6%.2例出现脊髓损伤.研究结果表明食管动脉灌注化疗是治疗晚期食管癌有效的新疗法.     

食管癌的MRI诊断

目的：探讨食管癌的ＭＲＩ诊断。方法：回顾分析６４例经手术或活检病理证实的食管癌的食管ＭＲＩ。采用自旋回波序列,常规行矢状面扫描：视野 ２３ｃｍ×２３ｃｍ～３６ｃｍ×３６ｃｍ、层厚 ３． ５～４ｍｍ,横断面扫描：视野 ２０ｃｍ ×２０ｃｍ～２６ｃｍ × ２６ｃｍ、层厚 ６～１０ｍｍ,矩阵１９２×２５６, ３～４次采集。结果：正常节段食管在 Ｔ１ＷＩ上显示为低到等信号;在 Ｔ２ＷＩ上粘膜层和粘膜下层均呈高信号而肌层呈低到等信号,两种信号对比明显,矢状面上可以看到高信号的粘膜线,在横断面上粘膜线呈环形。对于发生肿瘤的节段,矢状面上Ｔ１ＷＩ可见食管不规则增粗形成肿块,Ｔ２ＷＩ肿瘤呈低到等或不均匀信号并可看到高信号的粘膜线中断。在横断面上食管壁非对称性增厚形成以管壁为轴心的软组织肿块,食管管腔不规则狭窄,Ｔ２ＷＩ上环形高信号的粘膜线中断。结论：ＭＲＩ有很高的软组织对比度,尤其是在 Ｔ２ＷＩ上可以清晰地区分食管壁的粘膜层和肌层,结合ＭＲＩ能够矢状面成像观察食管长轴全貌的优势。ＭＲＩ在食管癌的诊断中有很高的应用价值。     

老年食管癌误诊分析

目的通过对 60岁以上食管癌患者的误诊情况分析 ,进一步提高老年食管癌的诊断水平与治愈率。方法对我院 1995年9月～ 2 0 0 2年 11月收治的 82例老年食管癌进行回顾性统计和分析 ,找出老年食管癌在门诊及住院诊治过程中产生误诊的主要原因。结果本组共有 3 9例误诊 ,院外误诊 3 0例 ,院内误诊 9例。手术治疗 16例 ;非手术治疗 2 3例 ,2 3例中行食管支架治疗 9例。治愈 10例 ,好转 16例 ,未治 9例 ,自动出院 3例 ,死亡 1例。结论院外误诊主要与患者的素质、门诊医生对老年食管癌特点的认识程度有关 ,误诊的时间较长 ,对治疗效果影响较大 ,约 73 3 %的患者失去手术机会。食管吞钡或食管碘油造影检查是诊断或鉴别诊断老年食管癌最方便、经济、易为患者接受的检查方法。院内误诊主要与患者的发病方式有关 ,误诊时间短 ,对治疗效果影响小。临床遇有进食梗阻感、胸骨后疼痛、剑突下或胸骨后烧灼感、排柏油样便、长期嗜烟酒、长期有不良饮食习惯、短期内突然严重咳嗽和大量咳痰者应高度怀疑食管癌。详细询问病史、充分认识老年食管癌的特点以及规范住院医疗制度 ,是避免老年食管癌误诊的关键     

食管鳞癌血清WCX2蛋白芯片诊断模型的研究

目的　分析食管鳞癌血清蛋白表达谱的改变 ,筛选并建立食管鳞癌血清标志物诊断模型。方法　采用表面增强激光解吸离子化飞行时间质谱 (SELDI TOF MS)技术分析 199例食管鳞癌患者和 10 6名性别、年龄匹配的健康人血清 ,获得WCX2蛋白芯片表达图谱。用BiomarkerPattern软件分析食管癌差异蛋白并初步建立诊断模型。扩大样本量 ,通过盲法分析进一步验证诊断模型。结果　在分子量 0～ 5 0 0 0 0范围内 ,共检测到 92个差异蛋白峰 ,其中 34个差异有显著意义 (P <0 0 5 )。建立了由 12个差异蛋白组成的食管鳞癌诊断模型 ,其敏感性为 91 5 % (5 4 / 5 9) ,特异性为86 9% (5 3/ 6 1)。扩大样本盲法验证结果其敏感性为 85 % (119/ 14 0 )、特异性为 84 4 % (38/ 4 5 )。结论　由 12个差异表达蛋白及其特定组合构成的诊断模型可以区分食管鳞癌与健康人     

食管癌三维适形放疗的疗效分析

目的探讨食管癌三维适形放射治疗(3DCRT)的疗效及放射治疗反应。方法采用3DCRT放射治疗食管癌患者58例,与常规放射治疗(CF)组的62例食管癌患者进行比较。结果 3DCRT组和CF组的1、2、3年局部控制率分别为69.3%、61.2%、43.5%和51.3%、42.1%、34.1%(P=0.023)。3DCRT组和CF组的1、2、3年生存率分别为61.5%、50.7%、41.6%和48.2%、42.1%、31.0%(P=0.032)。3DCRT组放射性食管炎发生率较CF组高(P=0.008),血液系统及全身反应较CF组低(P=0.012,P=0.028)。结论 3DCRT能明显改善食管癌的局部控制率和生存率。     

Vysis UroVysion for the detection of urothelial carcinoma

For decades, cystoscopy and urine cytology have been the mainstay for monitoring superficial urothelial carcinoma patients for tumor recurrence. However, urine cytology has poor sensitivity for urothelial carcinoma and, consequently, numerous investigators have been endeavoring to develop more sensitive assays for the detection of urothelial carcinoma. This article presents an overview of the types of new assays that have been developed for urothelial carcinoma detection but focuses primarily on the features and performance of a new fluorescence in situ hybridization assay for urothelial carcinoma detection known as Vysis UroVysion.     

食管癌病人放射治疗的健康教育

食管癌是我国常见的恶性肿瘤之一,放射治疗是目前治疗食管癌的重要手段之一.为保证放射治疗的顺利实施,提高病人的生存质量,做好食管癌病人放射治疗的健康教育至关重要.……     

胸腹腔镜联合手术治疗食管癌

目的探讨胸、腹腔镜联合手术在食管癌治疗中的安全性、手术方法及临床效果。方法对40例食管癌患者行电视胸腔镜联合腹腔镜下食管癌根治术。于左侧卧位行胸腔镜下胸段食管的游离及淋巴结清扫,胸部手术完成后改平卧位行腹腔镜下胃游离及淋巴结清扫,胃游离后剑突下小切口完成管状胃的制作,再将管状胃从食管床拉至颈部与颈段食管吻合。结果 2例因单肺通气不成功中转开胸。总手术时间215～400 min,平均280 min;术中无大出血,总出血量100～800 ml,平均227 ml。共清扫淋巴结413枚,平均每例10.3枚;术后住院8～30 d,平均13.6 d。住院期间无一例患者死亡。术后并发症：肺部感染3例,颈部吻合口漏1例（术后第4天）,声音嘶哑3例,乳糜胸1例。结论胸、腹腔镜联合,颈部吻合的食管癌切除在技术上是可行的,并且是安全的。