肺音信号检测处理及其临床应用研究

近年来,随着传感器技术、电子技术、信号处理技术等的迅速发展,国外医学界对肺音发生与传播、肺音检测与处理、肺音临床应用等方面进行了许多研究,取得了较大进展。本文主要综述了肺音信号检测处理与肺音临床应用等方面的新进展。在肺音检测方面,涉及肺音检测用传感器及肺音中噪声的滤波技术等。在信号处理方面,涉及肺音信号特征与肺音分析的振幅分析、时域分析、频域分析等方法。并指出,开发适用于临床的肺音计,将有助于对肺音作全面分析,有助于肺音的广泛应用。最后,介绍了肺音在临床呼吸监护方面的应用。     

针对肺结节检测的肺实质CT图像分割

目的：针对CT图像上肺结节的自动检测，开发并评价对全肺螺旋CT扫描中的肺实质进行自动分割的一种综合方法。方法：首先利用全局阈值对CT图像进行二值化，然后消除由于支气管、细支气管等低密度影和由于结节、血管等高密度影以及由检查床造成的条状伪影等噪声，最后对包含胸膜连接结节的图像利用数学形态学运算和图像凸包运算进行完善形成肺实质掩膜。结果：利用该方法对从LIDC数据库中所有包含结节的505张CT扫描片（来自69个病例）进行肺实质分割，正确率为95．4％。其中，包含胸膜连接结节的139张CT扫描片的正确分割率为94．2％。结论：本文提出的方法较好地完成了肺实质分割任务，为利用CT图像进行计算机辅助肺结节的检测打下了基础。     

液体衰减反转恢复序列成像在弥漫性轴索损伤诊断中的应用

目的探讨液体衰减反转恢复序列MR成像在弥漫性轴索损伤诊断中的应用。方法将我院神经外科在2004年7月至2005年12月收治的62例临床诊断和CT检查均考虑为弥漫性轴索损伤的患者进一步行MRIT2WI、液体衰减反转恢复序列MR成像,比较其检测病灶的能力。结果在62例中,液体衰减反转恢复序列显示90.3%,MR显示80.6%,CT显示61.2%。结论液体衰减反转恢复序列MR成像有助于弥漫性轴索损伤的诊断。     

组织速度成像与应变率成像技术评价慢性阻塞性肺疾病患者右心室功能

目的应用定量组织速度成像（QTVI）和应变率成像（SRI）技术对慢性阻塞性肺疾病（COPD）患者右心室功能进行检测,旨在探讨两种技术评价COPD患者右心室功能可行性。方法COPD患者38例（男性25例,女性13例,年龄55-71岁,平均年龄62岁）、对照组50例（男性33例,女性17例,年龄48-72岁,平均年龄62岁）,获取心尖四腔TVI图像,测量收缩期峰值运动速度（Vs）、舒张早期峰值应变率（Ve）、收缩期峰值应变率（SRs）、舒张早期峰值应变率（SRe）。结果根据肺动脉压将COPD患者分为肺动脉高压（PAH）组和无肺动脉高压（NPAH）组;与对照组比较,PAH组和NPAH组右心室游离壁和室间隔Vs、Ve、SRs、SRe均显著减低,三尖瓣环Vs、Ve均显著减低;与NPAH组比较,PAH组右心室游离壁和室间隔Vs、Ve、SRs、SRe均显著降低,三尖瓣环Vs、Ve差异无统计学意义。结论COPD患者无论有无肺动脉压增高,其右心室局部与整体功能已经受损,但在肺动脉压增高患者右心室功能受损更重;QTVI与SRI技术可有效评价COPD患者右心室功能。     

电阻抗断层成像技术在肺灌注中的研究进展

电阻抗断层成像技术（EIT）是根据人体不同组织器官阻抗差异来进行实时监测的一种新兴技术,目前已被初步运用于临床研究和疾病诊疗。肺灌注是指肺组织的血流灌注功能,许多疾病的发生发展都和肺灌注情况密切相关,所以实时监测肺灌注显得尤为重要,而EIT的应用和发展进一步促进了肺灌注的监测,相关研究已取得极大进展。针对近几年相关研究,本文从EIT成像原理、肺灌注成像方法及其在临床中的应用等几个方面进行综述,以期对临床及科研工作者有所帮助。     

珂立苏治疗新生儿肺透明膜病临床应用初探

新生儿肺透明膜病（HMD）是早产儿的一种严重疾病，是由于肺泡表面缺乏活性物质所引起，国内用肺泡表面活性物质治疗肺透明膜病也有多年历史，但多为进口产品，我科用新型国产的肺表面活性物质珂立苏治疗肺透明膜病2例，总结报道如下。     

C-反应蛋白在慢性阻塞性肺疾病合并糖尿病患者中的水平变化的研究现状

C-反应蛋白（CRP）是由肝细胞合成的一种急性期蛋白,它通过与其受体结合发挥作用。本文概述了CRP的来源,生物学作用以及与感染的关系。着重综述了CRP在慢性阻塞性肺疾病（COPD）和糖尿病中的水平及升高机制。     

体外振动排痰机治疗慢性阻塞性肺疾病护理措施

目的：探讨体外振动排痰机治疗慢性阻塞性肺疾病护理措施。方法对我院收治的1例慢性阻塞性肺疾病患者采用体外振动排痰机进行治疗,并给予有效的护理措施,对治疗疗效进行分析。结果该患者经10d体外振动排痰机治疗后,患者痰量增加,且更容易排出痰液,肺部干性啰音明显减轻、自觉喘息症状得到有效改善,同时血氧饱和度由治疗前88.24%升为95.46%,呼吸频率由26次/min下降至18次/min。结论体外振动排痰机治疗慢性阻塞性肺疾病,不仅能够改善患者呼吸、血氧饱和度,减少痰量,同时能够使护理人员工作量有效减轻,效果肯定,值得临床推广。     

不同工种石棉肺患者CT肺功能成像指标的差异性研究

目的 采用多层螺旋CT肺功能成像技术评价不同工种石棉肺患者的肺功能指标改变及特点.方法 将30例石棉肺患者按工种分为压型组、梳纺组和原棉组,每组10例.分别于受试者深吸气末和深呼气末屏气行全肺扫描,测定肺容积指标(最大吸气与呼气末肺容积、肺容积差、肺容积比)、平均肺密度指标(吸气与呼气末平均肺密度、肺密度差、肺密度比)和小气道指标(吸气与呼气末壁厚直径比率、吸气末支气管壁面积百分比).结果 压型组、梳纺组和原棉组在性别、年龄、接触史、分期(Ⅰ期)方面差异均无统计学意义(均P＞0.05).肺容积、平均肺密度和小气道指标中,3组间呼气末平均肺密度、呼气末左肺平均肺密度、呼气末右肺平均肺密度、呼气末与吸气末平均肺密度比、吸气末壁厚直径比率、吸气末支气管壁面积百分比和呼气末壁厚直径比率差异均具有统计学意义(均P＜0.05);进一步两两比较发现,梳纺组的上述指标分别与原棉组和压型组比较,差异亦均具有统计学意义(均P＜0.05),而原棉组和压型组间差异均无统计学意义(均P＞0.05);3组间其余指标差异均无统计学意义(均P＞0.05).结论 与压型组和原棉组比较,梳纺组石棉肺患者的肺气肿及小气道壁和肺泡隔纤维性增厚更为明显,应加强对这部分人的保护.     

基于肺部CT序列图像的肺实质三维分割

目的:肺实质分割是基于CT图像的肺结节计算机辅助检测技术必不可少的步骤。结合阈值技术、连通区域标记以及形态学技术,提出了一种简单有效的从CT图像中分割三维肺实质的方法,以期能为后续肺结节计算机辅助检测技术的研究奠定基础。方法:首先,将原图像二值化,并应用三维连通域标记去除背景及细小空洞;然后,经三维区域生长法去除气管;最后,经形态学滤波平滑肺边界得到肺部精确的三维模板,并采用该模板从CT序列图像中分割出肺实质。结果:根据对20组层厚2.0mm、每组约250个切片的肺部CT临床数据实验验证,其肺实质分割的平均正确度为91.55%,处理单组数据平均耗时167.4563s。结论:实验结果表明,本文方法能自动快速地从CT序列图像中分割出肺实质。     

Bronchoalveolar lavage improves diagnostic accuracy in patients with diffuse lung disease

Bronchoalveolar lavage (BAL) is an established diagnostic tool in diffuse parenchyma lung disease. The objective of the present study was designed to investigate whether immunophenotyping affects BAL results and improves diagnostic accuracy. BAL from 61 patients was included in the study. The patients were also submitted to transbronchial biopsy, with a final diagnosis of granulomatous disease [tuberculosis (TB), n = 20; sarcoidosis (SARC), n = 3; and hypersensitivity pneumonitis (HP), n = 4]; idiopathic interstitial pneumonias (IIPs) [idiopathic pulmonary fibrosis (IPF), n = 9; organizing pneumonia (OP), n = 17]; and lung cancer (LC), n = 8. Immunohistochemistry and histomorphometry were used to identify and quantify type 1 and type 2 alveolar epithelial cells, macrophages, CD3+T‐cells, CD4+T‐cells, CD8+T‐cells, and CD20+B‐cells in BAL. These markers were correlated with a database and pulmonary function tests. The cellular, inflammatory, and immune components of BAL varied among the diagnostic groups and were negatively correlated with age and smoking history. An increased quantity of lymphocyte surface markers CD3 (P < 0.05) and CD20 (P = 0.01) was seen in IIPs. Patients with a pattern of OP had a higher proportion of type 2 alveolar epithelial cells; patients with SARC had a higher density of CD20+B‐cells and CD4+T‐helper cells; and patients with HP had a higher proportion of CD8+T‐cytotoxic cells. A positive association was found between the density of type I alveolar epithelial cells and forced vital capacity. The immunophenotyping affects the cellular, inflammatory, or immune constituents of BAL and improved the diagnostic accuracy in diffuse parenchymal lung disease. Diagn. Cytopathol. 2013. © 2011 Wiley Periodicals, Inc.     

Longitudinal preclinical magnetic resonance imaging of diffuse tumor burden in intramedullary myeloma following bortezomib therapy

Multiple myeloma (MM) is a largely incurable, debilitating hematologic malignancy of terminally differentiated plasma cells in the bone marrow (BM). Identification of therapeutic response is critical for improving outcomes and minimizing costs and off‐target toxicities. To assess changes in BM environmental factors and therapy efficacy, there is a need for noninvasive, nonionizing, longitudinal, preclinical methods. Here, we demonstrate the feasibility of preclinical magnetic resonance imaging (MRI) for longitudinal imaging of diffuse tumor burden in a syngeneic, immunocompetent model of intramedullary MM. C57Bl/KaLwRij mice were implanted intravenously with 5TGM1‐GFP tumors and treated with a proteasome inhibitor, bortezomib, or vehicle control. MRI was performed weekly with a Helmholtz radiofrequency coil placed on the hind leg. Mean normalized T1‐weighted signal intensities and T2 relaxation times were quantified for each animal following manual delineation of BM regions in the femur and tibia. Finally, tumor burden was quantified for each tissue using hematoxylin and eosin staining. Changes in T2 relaxation times correlated strongly to cell density and overall tumor burden in the BM. Median T2 relaxation times and regional T1‐weighted contrast uptake were shown to be most relevant in identifying posttherapy disease stage in this model of intramedullary MM. In summary, our results highlighted potential preclinical MRI markers for assessing tumor burden and BM heterogeneity following bortezomib therapy, and demonstrated the application of longitudinal imaging with preclinical MRI in an immunocompetent, intramedullary setting.     

Histopathological spectrum of hypersensitivity pneumonitis with clinico‐radiologic correlation

There is no consensus on the classification of the diagnostic certainty of hypersensitivity pneumonitis (HP) based on the histopathological findings. This retrospective study aimed to describe the clinical and histopathological spectrum of HP. Herein, we also propose different grades of diagnostic certainty. Based on the histology, the cases were classified as: ‘definite HP’, ‘probable HP’, and ‘possible HP’. Of the 47 subjects screened, 30 cases of histologically diagnosed HP (mean age 48.4 years; 50% women) were included. The findings of cellular bronchiolitis, interstitial pneumonia, interstitial granuloma, isolated interstitial multinucleated giant cells (MNGCs), airspace granulomas, isolated airspace MNGCs, and organizing pneumonia were present in 96.7%, 80%, 46.7%, 50%, 10%, 63.3%, and 16.7% cases, respectively. Based on the various combinations of histopathological findings, the cases were classified as ‘definite’, ‘probable’, and ‘possible’ HP in 56.7%, 33.3%, and 10%, respectively. Chronic HP was diagnosed in 56.7% cases based on the presence of fibrosis on histopathology. The histopathological diagnosis of subacute or chronic HP did not corroborate with the disease duration, and 17.6% of the subjects with duration of symptoms of <6 months had evidence of fibrotic disease on histopathology.     

血流动力学响应函数在脑疾病中的研究进展

血流动力学响应函数（HRF）是神经活动和功能磁共振成像（fMRI）之间的数学传递函数,与神经血管生理相关,其中携带着很多与脑功能和脑疾病病理相关的信息,而这些信息是不能用传统的fMRI分析得到的。本研究主要对HRF的研究进展进行综述,对fMRI和HRF进行介绍分析,重点介绍HRF的3个参数,即响应高度、到达峰值时间和半高全宽,随后介绍了一种反卷积估计HRF参数的方法,并对近年来HRF与脑疾病病理相关的研究现状进行总结。HRF与强迫症、自闭症谱系障碍、创伤后应激障碍和脑损伤等脑疾病的病理相关,对HRF进行建模和参数提取可以得到更多潜在的神经病理信息。HRF分析可以作为脑疾病病理研究的窗口,为传统的fMRI分析提供新的研究视角和方法。     

Technique for contralateral subtraction in lateral lung radionuclide imaging

A technique for the subtraction of the contralateral contribution in lateral-lung isotope imaging using a gamma camera and computer is described. The theory of the technique is presented and the validity of the assumptions involved is discussed. The sources of error are considered and the corresponding error magnitudes assessed. Some preliminary results are presented and the implications discussed.     

Mesenteric and splenic contributions to portal venous CT perfusion in hepatic diffuse disease

Aim: To investigate the changes and contributions of superior mesenteric venous perfusion (SMVP) and splenic venous perfusion (SpVP) to portal venous CT perfusion in canine model of hepatic diffuse disease. Materials and methods: By selective catheterization in superior mesenteric and splenic arteries respectively after CT perfusion scanning, SMVP and SpVP became available. Sixteen dogs were adopted and induced by carbon tetrachloride after data under normal conditions were collected. After 3, 6, 9 and 12 months from carbon tetrachloride intervention, liver biopsies by puncture or operation were performed after CT perfusion scanning. SMVP and SpVP under different pathologic conditions were compared and analyzed. Results: Three stages of hepatic diffuse lesions were defined according to pathologic changes, namely hepatitis, hepatic fibrosis, and cirrhosis. The number of dogs which survived from each stage was: 16 from normal, 12 from hepatitis, 10 from hepatic fibrosis and 4 from cirrhosis. During this progressive period, SpVP ml/(min·100 ml) declined slightly, but there were no significant differences between different stages (P > 0.05). SMVP ml/(min·100 ml) in stage of normal (64.1 ± 8.1) and hepatic fibrosis (44.4 ± 4.5), normal and cirrhosis (42.6 ± 5.4), hepatitis (61.3 ± 6.4) and hepatic fibrosis, hepatitis and cirrhosis was significantly different, but there was no significant difference of SMVP between normal and hepatitis (P = 0.326) or hepatic fibrosis and cirrhosis (P = 0.668). Conclusions: With our evidence of interventional CT perfusion, it is mesenteric, not splenic, perfusion that might coincide with hepatic portal venous perfusion during the progressive period of hepatic diffuse disease.     

Quantifying parenchymal tethering in a finite element simulation of a human lung slice under bronchoconstriction

Airway hyper-responsiveness (AHR), a hallmark of asthma, is a highly complex phenomenon characterised by multiple processes manifesting over a large range of length and time scales. Multiscale computational models have been derived to embody the experimental understanding of AHR. While current models differ in their derivation, a common assumption is that the increase in parenchymal tethering pressure P(teth) during airway constriction can be described using the model proposed by Lai-Fook (1979), which is based on intact lung experimental data for elastic moduli over a range of inflation pressures. Here we reexamine this relationship for consistency with a nonlinear elastic material law that has been parameterised to the pressure-volume behaviour of the intact lung. We show that the nonlinear law and Lai-Fook's relationship are consistent for small constrictions, but diverge when the constriction becomes large.     

A novel model for human interstitial lung disease: Hapten-driven lung fibrosis in rodents

A novel model is described of chronic pulmonary fibrosis in rodents. The condition is induced by a single intratracheal instillation of a well-characterized fluorescent haptenic antigen, fluorescein isothiocyanate (FITC), into non-immune animals. This results in an acute inflammatory response involving a granulocytic infiltrate, which disappears over a week and is replaced by a chronic mononuclear infiltrate in which T lymphocytes predominate. Over several months, a chronic patchy fibrosis is accompanied by a sustained mononuclear interstitial infiltrate localized at sites of persistent FITC deposition. Where no FITC is present, the lung tissues are apparently normal. An immune response is mounted, as measured by the appearance of specific anti-FITC serum antibodies. This model has relevance to the pathogenesis of some forms of human interstitial lung disease.     

基于相位衬度成像的小鼠肺肿瘤三维可视化研究

目的肿瘤的早期发现对患者意义重大。鉴于相位衬度成像对于如肺部这样的软组织成像效果显著,本文提出利用相位衬度成像技术,以微米尺度的空间分辨对肿瘤进行成像,并定量分析,早期发现肿瘤。方法在KM小鼠肺部原位接种人肺癌细胞,培育10d后取出肺组织,利用上海同步辐射光源进行相位衬度成像获取投影图像,拍摄结束后对样本进行切片、HE染色,并光学显微镜观察病理切片。然后利用滤波反投影对获取的投影图进行CT断层重建,并通过病理切片对比验证肿瘤位置,最后通过Amira软件进行三维模型的建立。结果重建出了清晰的三维模型,在模型上可以发现小肿瘤结节的存在,并测量得出该肿瘤体积为0．655mm3。结论相位衬度成像对软组织分辨率高,能发现体积较小的肿瘤．对肿瘤的早期发现有一定意义。