冷冻消融对正常家猪各级支气管及伴随结构的影响

通过观察各级支气管及伴随结构的病理变化,探讨氩氦刀冷冻消融对各级支气管及伴随血管、淋巴管、神经的影响,为临床治疗提供实验依据.将10只健康家猪分为2组,进行经皮穿刺正常肺组织氩氦刀冷冻消融,分别于消融后3 d(A组)、28 d(B组)各宰杀5只,观察冷冻消融后各级支气管和伴随血管、淋巴管、神经的病理表现.结果表明:(1)随着支气管腔的变小,冷冻对支气管的损伤加重;对主支气管、二级支气管的损伤较轻;主支气管、二级支气管消融后28 d恢复较好.(2)氩氦冷冻消融对大血管无明显影响,可致小血管损伤.(3)氩氦刀冷冻消融对于淋巴管、神经有损伤,且神经损伤在28 d时未完全恢复.CT引导下经皮穿刺氩氦刀冷冻消融对主支气管、二级支气管及大血管影响较小,是一种可以耐受、安全的肺部肿瘤微创治疗方法之一.     

正常兔肺组织氩氦靶向冷冻后的组织学及CT影像变化

观察正常兔肺组织经氩氦靶向冷冻后的组织学变化及CT影像变化。方法：新西兰大白兔25只，共分5组，每组5只，行经皮穿刺肺氩氦冷冻，分别于术后2h，3d，7d，14d，28d行CT检查后处死，观察肺组织的组织学变化。结果表明，无实验动物死亡，CcT复查均未见胸腔积液和气胸发生。冷冻后早期肺组织呈出血性渗出，3d后，冷冻区肺组织表现为明显出血坏死，至30d时，冷冻坏死区明显缩小，呈纤维化表现，周围界限清楚。肺组织经氩氦冷冻后早期以出血坏死为主，后期出现纤维化改变的组织学演变过程，氩氦冷冻用于治疗肺部肿瘤很安全。     

经皮微波消融治疗肝硬化脾功能亢进症的临床研究

目的:探讨经皮穿刺微波消融治疗肝硬化脾功能亢进症的安全性、疗效和临床应用前景。方法:2012年8月至2015年4月在超声引导下对50例(29例患者1次微波消融,12例患者重复2次微波消融,9例患者重复3次微波消融)肝硬化脾功能亢进症患者实施经皮穿刺脾脏微波消融治疗,对脾微波消融术过程中的术前及术后观察进行总结。结果:平均手术时间为(2.1±0.9)h,平均消融时间为(1.5±0.6)h;术后3 d外周血小板计数较术前明显下降;术后6个月随访发现患者白细胞以及血小板计数均较术前改善,差异有统计学意义(P0.05),肝肾功能指标、凝血功能、红细胞计数无明显差异(P0.05)。术后白细胞计数指标在Child-Pugh分组和消融次数分组中存在显著差异(P0.05),术后血小板计数指标在消融次数分组和脾大程度分组中存在显著差异(P0.05)。结论:经皮穿刺微波消融治疗肝硬化脾功能亢进症是一项具有临床应用前景的微创治疗方法,对患者白细胞及血小板指标的改善有显著作用。     

13例大血管损伤手术治疗体会

目的 总结手术治疗大血管损伤的经验。方法 对13例大血管损伤患者进行手术治疗。结果 12例治愈,1例术后窒息死亡。结论 手术修复大血管损伤是抢救患者生命和保全肢体的关键。抗休克应与手术同时进行。术前备血应充足。手术应在吸引器引导下按解剖层次进行。切忌盲目止血,以免损伤神经,肌腱和腺体组织。吻合或修补血管时,要将血管游离充分,减小血管两端张力,防止术后发生管腔狭窄或血栓栓塞等并发症。     

新生儿肺的淋巴管

本文对40例新鲜的新生儿肺,采用色素乳胶注射制成塑型标本结合注射普鲁士兰分别制成连续组织切片的方法,对肺淋巴管的分布特点进行了详细的观察。肺的淋巴管分为胸膜下浅层淋巴管及深层淋巴管,并证实肺韧带内亦有淋巴管和淋巴结存在。深淋巴管基本可归纳为间质～肺静脉淋巴管系及支气管～肺动脉淋巴管系。两者之间有大量的侧支吻合,其吻合部位多见于肺内各级支气管的分叉处。最远处毛细淋巴管起于终末细支气管的分叉处。肺内淋巴管的瓣膜多数为单瓣,多见于胸膜下及肺小叶外围的淋巴管内;肺门附近次之;而肺中央的大部特别稀少。     

高氧对新生鼠肺组织VEGF蛋白表达及肺血管内皮细胞超微结构的影响

目的探讨高浓度氧对新生鼠肺组织血管内皮生长因子(VEGF)蛋白表达及肺血管内皮细胞超微结构影响的动态变化规律。方法建立高浓度氧诱导新生鼠CLD模型,60只新生鼠随机分为实验组和对照组,分别采用免疫组化和透射电镜技术,测定实验组和对照组在生后1d、3d、7d、14d和21dl肺组织内VEGF蛋白表达,同时观察肺血管内皮细胞超微结构变化。结果对照组肺组织VEGF蛋白表达1d主要以传导气道上皮为主,3d以后远端气道上皮表达增加,7d以后肺泡上皮和肺泡间隔明显增多,14d达高峰,以后持续高表达,实验组肺组织VEGF蛋白表达水平7d开始下降,14d以后未见阳性表达。高氧可引起肺血管内皮细胞肿胀、线粒体肿胀和毛细血管基底膜厚薄不均等各种损伤性形态变化,损伤程度随高氧时间延长而加重。结论肺血管的生长是正常肺泡发育重要环节,推测肺组织VEGF蛋白表达下降和肺血管内皮细胞的损伤在高氧诱导CLD肺血管发育障碍中可能发挥重要作用。     

先天性肺淋巴管扩张症

介绍６例少见先天性畸形——肺淋巴管扩张症。肺的特征性改变为肺呈蜂窝状，肺膜下、肺小叶间隔内、支气管周围和血管周围结缔组织内淋巴管极度扩大。其壁很薄，仅以内皮细胞围成。扩张的淋巴管可能由于先天性发育缺陷或由于淋巴管主干梗阻，但仅表现于肺静脉高压时。     

淋巴管内皮细胞来源外泌体促进周围神经损伤后的轴突再生

背景：研究表明淋巴管系统参与调控神经再生进程,外泌体具有细胞间通讯功能及多种生物学特性,由此可见淋巴管系统来源外泌体在周围神经损伤疾病治疗中具有巨大潜力。目的：探讨淋巴管内皮细胞来源外泌体促进周围神经损伤后轴突再生的作用及机制。方法：(1)体外通过EdU细胞增殖实验探究淋巴管内皮细胞来源外泌体对施万细胞增殖能力的影响。(2)24只雄性SD大鼠,随机分为3组(n=8),即假手术组、周围神经损伤组及淋巴管内皮细胞来源外泌体治疗组,假手术组仅显露右侧坐骨神经,其余2组右侧坐骨神经挤压后分别在神经外膜下注射PBS及淋巴管内皮细胞来源外泌体,所有大鼠左侧坐骨神经均未做处理。术后28 d取各组大鼠双侧腓肠肌测量肌肉湿质量比,取右侧坐骨神经,通过苏木精-伊红染色及Masson染色评价坐骨神经组织病理学变化及轴突排列情况,采用免疫荧光染色分析轴突再生情况。结果与结论：(1)与对照组相比,淋巴管内皮细胞来源外泌体显著增强了施万细胞的增殖能力,差异有显著性意义(P <0.05)。(2)术后28 d,淋巴管内皮细胞来源外泌体治疗组肌肉湿质量比显著高于周围神经损伤组,差异有显著性意义(P <0.0...     

重组人促红细胞生成素对慢性高氧致支气管肺发育不良的保护作用

探讨重组人促红细胞生成素(recombinant human erythmpoietin,rhEPO)作为血管生长样因子对高氧致新生大鼠支气管肺发育不良(bronchopulmonary dysplasia,BPD)的血管保护作用。将96只新生Wistar大鼠生后1h随机分为4组:(1)空气对照,(2)空气+rhEPO,(3)高氧对照,(4)高氧+rhEPO。第3、第4组置于玻璃氧箱中,持续输入氧气,FIO2=850ml/L,第2、第4组于生后即刻、高氧暴露前30min和生后2d给rhEPO 2400IU/kg背部皮下注射,第1、第3组给予等量生理盐水注射。于生后第3、7及10d采集肺组织标本,光镜下观察肺组织学改变,应用免疫组化测定肺组织织血管内皮标志CD31及肺血管内皮细胞生长因子(vascular endothelial growth factor VEGF)表达的变化。研究发现:与高氧组相比,高氧+rhEPO组大鼠肺组织CD31阳性面积比和VEGF的表达明显增高;3d增高,10d达高峰。结果提示:rhEPO(2400IU/kg)可以促进肺血管的发育和修复,对高氧致新生鼠BPD有血管保护作用。     

恩度联合TACE序贯微波消融治疗原发性肝癌的临床研究

目的观察恩度联合TACE序贯微波消融治疗原发性肝癌的临床疗效。方法2011年10月~2014年2月总共40例原发性肝癌患者入组,随机分为恩度联合TACE序贯微波消融治疗组及TACE序贯微波消融对照组。比较两组患者肿瘤治疗至进展时间(TTP)、临床获益率、生活质量(QOL)、治疗前后外周血血管内皮生长因子(VEGF)水平变化。结果治疗组患者TTP延长、14d后治疗组外周血VEGF水平与对照组比较下降明显,均有统计学意义。治疗组临床获益率83.33%,对照组为77.27%,治疗组临床获益率稍优于对照组,但没有统计学意义,QOL两组患者均有改善,无明显统计学意义。结论恩度联合TACE序贯微波消融治疗原发性肝癌能够有效改善患者临床疗效。     

A coaxial slot antenna with frequency of 433 MHz for microwave ablation therapies: design,simulation, and experimental research

Investigation of the structures and properties of antennas is important in the design of microwave ablation (MWA) system. In this study, we studied the performance of the novel tri- and single-slot antennas with frequency of 433 MHz in ex vivo conditions. The dielectric properties of liver tissue under different thermal coagulation levels were explored, which was beneficial to evaluate ablation condition of tissue and simulate temperature field. Then, the performances of the antennas were analyzed by using numerical method based on finite element method (FEM). It indicated that the present antennas with frequency of 433 MHz could produce a gourd-shaped MWA area with a longer length. Compared to antenna with frequency of 2450 MHz, the designed single-slot antenna could obtain the larger MWA area. In addition, the multiple-point ablations and a larger MWA area could be achieved simultaneously by using the present tri-slot antenna. This study has a potential for the innovative design of MWA antenna for treatment of liver tumor with a large range and a long length.     

原位微波消融为诱导抗肝癌免疫反应提供有效抗原

目的： 研究微波消融（MWA）灭活的肝癌组织诱导抗肿瘤免疫反应的效能。方法: 建立C57L/J小鼠皮下肝癌MWA模型，观察MWA小鼠对抗Hepa1-6细胞冲击的效果，采用结晶紫染色分析法测定淋巴细胞的杀瘤活性。提取MWA灭活的肝癌组织与粒细胞-巨噬细胞集落刺激因子（GM-CSF）和白细胞介素-2（IL-2）缓释微粒配制成MWA瘤苗免疫小鼠，观察此瘤苗诱导保护性抗肿瘤免疫的效能。结果: 与对照组小鼠全部生长肿瘤相比，17％的MWA小鼠获得保护，荷瘤MWA小鼠的肿瘤生长受到显著抑制，小鼠的生存时间显著延长。MWA组无瘤小鼠的脾细胞能够特异性杀伤Hepa1-6细胞。MWA瘤苗保护免疫小鼠的效能比单用MWA灭活肝癌组织者高50％，与阳性对照的甲醛固定瘤苗相近。结论: 原位MWA能为诱导特异性抗肿瘤免疫提供有效抗原，细胞因子的使用加强了这一保护性免疫作用。     

温度开环和闭环反馈在高压脉冲电场消融中的对照研究

目的:对比温度开环和闭环反馈在高压脉冲电场消融中的区别。方法:温度开环组应用高压方波脉冲发生器以场强1.5 kV/cm、频率1 Hz、脉宽100 μs、脉冲数20个的条件对细胞悬液、3D细胞模型和离体猪肝组织3种不同负载施加高压脉冲电场。闭环组在相同脉冲条件下增加温度闭环算法对微控制器及温度传感器编程控制脉冲发放。分别从电场消融后的电极温度、细胞悬液电导率和细胞死亡率,3D细胞模型消融截面积以及猪肝组织消融区病理特点进行定量比较和定性分析。结果:消融后开环组电极温度、细胞悬液电导率、细胞死亡率和3D细胞模型消融截面积分别为（53.2±5.5）℃、（1.43±0.03） S/m、（86.8±5.5）%和（0.46±0.15） cm2,均高于闭环组对应的（38.5±1.6） ℃、（1.21±0.02） S/m、（73.6±10.2）%和（0.37±0.08） cm2,差异均有统计学意义（P<0.05）;开环组消融区猪肝组织H-E染色可见热损伤导致的凝固性坏死区,闭环组表现为肝血窦增宽、细胞质脱水丢失和核聚集。结论:该实验条件下,温度开环和闭环反馈高压脉冲电场消融存在差异。传统温度开环高压脉冲电场消融效果略强于温度闭环,这可能与电导率增加和热效应介导的电场杀伤效应增强有关。温度闭环反馈能避免热损伤效应,实现真正意义上的非热性消融。     

A review of coaxial-based interstitial antennas for hepatic microwave ablation

Although surgical resection remains the gold standard for treatment of liver cancer, there is a growing need for alternative therapies. Microwave ablation (MWA) is an experimental procedure that has shown great promise for the treatment of unresectable tumors and exhibits many advantages over other alternatives to resection, such as radiofrequency ablation and cryoablation. However, the antennas used to deliver microwave power largely govern the effectiveness of MWA. Research has focused on coaxial-based interstitial antennas that can be classified as one of three types (dipole, slot, or monopole). Choked versions of these antennas have also been developed, which can produce localized power deposition in tissue and are ideal for the treatment of deep-seated hepatic tumors.     

Microwave ablation of primary breast cancer inhibits metastatic progression in model mice via activation of natural killer cells

Surgery is essential for controlling the symptoms and complications of stage IV breast cancer. However, locoregional treatment of primary tumors often results in distant progression, including lung metastasis, the most common type of visceral metastasis. As a minimally invasive thermal therapy, microwave ablation (MWA) has been attempted in the treatment of breast cancer, but the innate immune response after MWA has not yet been reported. Using two murine models of stage IV breast cancer, we found that MWA of primary breast cancer inhibited the progression of lung metastasis and improved survival. NK cells were activated after MWA of the primary tumor and exhibited enhanced cytotoxic functions, and the cytotoxic pathways of NK cells were activated. Depletion experiments showed that NK cells but not CD4+ or CD8+ T cells played a pivotal role in prolonging survival. Then, we found that compared with surgery or control treatment, MWA of the primary tumor induced completely different NK-cell-related cytokine profiles. Macrophages were activated after MWA of the primary tumor and produced IL-15 that activated NK cells to inhibit the progression of metastasis. In addition, MWA of human breast cancer stimulated an autologous NK-cell response. These results demonstrate that MWA of the primary tumor in metastatic breast cancer inhibits metastatic progression via the macrophage/IL-15/NK-cell axis. MWA of the primary tumor may be a promising treatment strategy for de novo stage IV breast cancer, although further substantiation is essential for clinical testing.     

Baroreceptor-related dysrhythmias in piglets with selective autonomic denervation of the heart

This study was carried out to determine whether selective cardiac autonomic denervation performed on neonatal swine would evoke dysrhythmias later in development. Piglets (n = 27; 5-10 days old) underwent unilateral stellate ganglion ablation, or right cardiac vagotomy, or sham surgery. Fifty to sixty days after denervation, acute experiments were performed to evaluate responses to baroreceptor activation. Of all animals who exhibited prolonged R-R intervals, only those with right stellate ganglion ablation had prolonged corrected QT intervals. Despite findings suggesting an arrhythmogenic state (predominance of left-sided cardiac innervation), dysrhythmias occurred in all animals with stellate ganglion ablation, regardless of laterality, but in few vagotomized or control animals. Our results suggest that partial sympathetic innervation may alter cardiac function so that dysrhythmias are more likely to occur during baroreceptor activation.     

Structure and size of bronchopulmonary anastomoses in sheep lung

The distribution and drainage of bronchial arterial blood flow are complex. We used two different methods to study the bronchial-pulmonary anastomoses in sheep lung. Initially, we injected two different sizes of fluorescent microspheres (15 and 100 microm diameter) into the bronchial artery and histologically determined where the different-size microspheres were entrapped in the lung. In a second series of animals, we injected Microfil into the bronchial artery to observe the anastomotic vessels. The microsphere data confirmed the existence of bronchial-to-pulmonary anastomoses. No microspheres were found in the systemic organs (heart and kidney), confirming the absence of large bronchial artery-to-pulmonary vein anastomoses. Unexpectedly, proportionately more large microspheres (100 microm) lodged in the alveolar parenchyma when compared to 15 microm microspheres. This suggests that there are many more small bronchial (< 100 microm) arterioles feeding the airway mucosa than the larger anastomotic vessels feeding into the parenchyma. In the Microfil cast lungs, we observed four types of anastomotic vessels: bronchial arteries/arterioles that anastomose with pulmonary arteries/arterioles that accompany airways; bronchial arterioles that anastomose directly with parenchymal (and eventually alveolar) vessels; bronchial arterioles that anastomose with blood vessels that do not accompany airways; and bronchial arterioles that anastomose with bronchial veins. Based on our in vivo microsphere data, the vessels that do not accompany the airways are most likely bronchial venules, not pulmonary venules.     

Heating characteristics of antenna arrays used in microwave ablation: A theoretical parametric study

A numerical study of the performance of antenna arrays used in microwave ablation (MWA) is carried out. Double-slot coaxial antennas in triangular and square configurations are studied. Clinical (healthy vs. malignant) and experimental (in vs. ex vivo) scenarios for hepatic cancer treatment are modeled, and further application in bone and lung tissue is examined. It is found that triangular arrays can create spherical ablation zones, while square configurations result in flatter ones. Thresholds in power and application times for creating continuous ablation zones are calculated, and the characteristics of the latter are quantified.     

Repeated exposure to low levels of sulfur dioxide (SO2) enhances the development of ovalbumin-induced asthmatic reactions in guinea pigs.

BACKGROUND: Sulfur dioxide (SO2) is one of the major air pollutants. It is known to aggravate asthma symptoms in human beings, but few studies have focused on the effects of SO2 upon the development of bronchial asthma in animal models. OBJECTIVE: This study was undertaken to evaluate the role of SO2 upon the development of ovalbumin (OA)-induced asthmatic reactions in guinea pigs. METHODS: Guinea pigs were divided into four groups: (1) OA- and SO2-exposed group (n = 12), (2) SO2-exposed group (n = 12), (3) OA-exposed group (n = 11), and (4) saline-exposed group (n = 7). Guinea pigs of the first and second groups were exposed to 0.1 ppm SO2 for 5 hours a day on 5 consecutive days. Guinea pigs in the first and third groups inhaled 0.1% OA aerosols for 45 minutes a day on days 3, 4, and 5. One week after the sensitization procedure, all the guinea pigs underwent bronchial challenge with 1.0% OA aerosols, using unrestricted whole-body plethysmography. Bronchoalveolar lavage and histopathologic examination were performed 24 hours after the bronchial challenge. RESULTS: Increases in enhanced pause (Penh), as an index of airway obstruction, after the bronchial challenge was significantly higher in OA- and SO2-exposed group (group 1) than the other groups (P < .05, respectively). Eosinophil counts in bronchoalveolar lavage fluids were also significantly higher in group 1 than in the other groups (P < .05, respectively). Histopathologic findings of bronchial and lung tissue in the group 1 showed an infiltration of inflammatory cells, bronchiolar epithelial damage, and mucus and cell plug in the lumen, but no significant abnormalities were observed in the other groups. CONCLUSIONS: These results indicate that repeated exposure to low levels of sulfur dioxide may enhance the development of ovalbumin-induced asthmatic reactions in guinea pigs.