高血压脑出血灶周围缺血区血脑屏障的改变

目的研究高血压脑出血灶周围缺血区血脑屏障的形态学变化。方法利用光学显微镜,透射电子显微镜观察高血压脑出血患者出血灶周围缺血区的形态学改变。结果出血灶周围区的脑组织血管管腔面微绒毛数目增多,胞饮小泡形成增加,内皮细胞间紧密连接有一定程度增宽。结论出血灶周围缺血区的血脑屏障通透性增加,为临床用药通过血脑屏障奠定基础。     

冷热交替消融正常兔肝的影像学与病理学研究

目的 探讨正常兔肝冷热交替消融后消融灶的动态影像学和病理学变化。方法 对20只正常兔肝进行冷热交替消融。消融后1、3、7、14天行CT和CEUS,之后各处死5只兔,观察消融灶的病理学改变。结果 消融灶中心呈凝固性坏死。消融后7天内,坏死灶周围组织充血水肿和急性炎细胞浸润,CT平扫为低或等密度灶,常规超声为低回声为主的混合回声区;增强后均表现为无强化坏死灶和动脉期周边环状增强。消融后7~14天,坏死灶周围组织充血水肿好转,有纤维组织增生、慢性炎细胞浸润及钙化形成,表现为环形强化逐渐减轻消失,消融灶缩小。结论 冷热交替消融可在正常兔肝中产生凝固坏死灶;CT增强扫描和CEUS能有效反映不同时期肝脏消融灶的病理学变化,准确显示消融灶范围。     

高强度聚焦超声治疗子宫肌瘤的剂量学研究

目的 探讨高强度聚焦超声(high intensity focused ultrasound,HIFU)在不同投射方式下治疗子宫肌瘤的剂量与效应关系。方法 在声换能器聚焦参数和工作声强、频率不变的前提下,观察在不同投射时间HIFU定点损伤和扫描损伤致离体人子宫肌瘤组织凝固性坏死灶的大小,并对两种投射方式下的能效因子、形态学改变等进行比较。结果 HIFU所致的凝固性坏死灶的大小、形态与投射方式及投射时间密切相关,在同样的声强下,两组最佳能效因子差异有显著性意义(P<0.05)。结论 HIFU 治疗子宫肌瘤时采用扫描损伤优于定点损伤。     

兔脑激光间质热毁损及血脑屏障急性期改变

目的 观察激光间质加热(laser interstitial thermotherapy,LITT)后兔脑毁损组织与周边脑组织的超微病理改变,评估LITT后急性期的血脑屏障(blood brain barrier,BBB)开放性.方法 浙江大学动物实验中心提供新西兰大白兔共70只.经随机筛选设LITT A组(2 W,600 s,20只)及B组(15W,100 s,20只),应用立体定向技术插入半导体激光光纤,分别对兔右侧前脑实行立体定向问质加热,另随机设甘露醇灌注组和假手术对照组各15只.透射电镜下观察LITT后3 h,6 h,12 h,24 h的中心热毁损灶及靶周边脑组织BBB的超微形态学的改变;酶联免疫吸附法测定相廊不同时间的S100B蛋白变化;另检测脑脊液白蛋门与血清白蛋白比值(BBB系数).实验数据作单因素方差分析,组间均数比较用q检验.结果 接触激光光纤前端成为加热毁损灶,以细胞坏死为主,细胞膜结构损伤,线粒体、内质网等细胞器膨胀,线粒体嵴消失,胞浆稀疏等.形态学改变明显于对照组.热能传导至周边,可见部分细胞发牛不同时期的凋亡改变.急性期内可见内皮细胞肿胀、血管基膜模糊断裂、周围间隙增宽、缝隙结构破坏,且S100B蛋白及BBB系数在LITT组明显升高,BBB开放的时程较甘露醇灌注组长.但24 h后LITT A组开始恢复,S100B与BBB系数较LITT B组的差异具有统计学意义(P=0.0087).结论 利用立体定向技术半导体激光加热兔脑组织的毁损灶,急性期内可导致明确的细胞组织损伤,BBB结构破坏,小功率加热组血脑屏障开放时程较大功率组缩短.提示利用小功率半导体激光可形成精确安全的脑毁损灶,为功能神经外科发展提供了新思路.     

5-氟尿嘧啶磁性白蛋白微球对离体牛肝脏射频消融增效作用的研究

目的探讨射频消融(RFA)联合5-氟尿嘧啶磁性白蛋白微球(5-Fu-MAMS)对离体牛肝脏射频消融体积的影响。 方法实验材料采用新鲜离体牛肝,根据消融介质的不同,随机数字表法分为3组：A组为单纯RFA组;B组为RFA联合游离5-Fu组;C组为RFA联合5-Fu-MAMS组。观察各组消融灶形态学特征,测量消融灶平均最大纵径和横径,计算消融灶体积,通过肉眼大体观察和显微镜下观察消融灶病理改变。射频消融时间、温度、消融灶纵径、消融灶横径以均数±标准差表示,显著性检验采用单因素方差分析。 结果离体牛肝对射频融灶的形态肉眼观,所有消融灶中心横切面大体形态均呈灰白色椭圆形外观;剖面可见明显的凝固性坏死区,中央组织干燥,治疗区域和周围肝组织分界比较清楚;镜下呈典型凝固性坏死改变。A、B、C组所形成的平均消融体积最大纵径分别为(4.45±0.23)cm、(4.93±0.53)cm、(5.68±0.59)cm,差异有统计学意义(F＝10.23,P<0.05);平均最大横径分别为(2.83±0.25)cm、(3.08±0.22)cm、(4.10±0.14)cm,差异有统计学意义(F＝61.23,P<0.05), RFA联合5-Fu-MAMS组平均消融体积明显大于其他两组。A、B、C组平均消融时间分别为：(472.00±20.49)s、(632.50±21.05)s、(836.50±19.10)s,差异有统计学意义(F＝489.28,P<0.05)。A、B、C组消融完成时距离中心穿刺点周围3cm处的平均温度变化分别为：(41.83±2.04)℃、(47.33±3.83)℃、(55.67±2.16)℃,差异有统计学意义(F＝37.20,P<0.05)。 结论RFA联合5-Fu-MAMS,能产生更大的组织消融灶,组织病理上呈典型凝固性坏死改变。     

高强度聚焦超声体外治疗肝肿瘤的剂量学研究

目的 探讨高强度聚焦超声（ＨＦＵ）破坏肝肿瘤剂量与效应的关系。为ＨＩＦＵ体外治疗肝肿瘤的临床剂量学提供参考数据,方法 在换能器聚焦参数和工作为的前提下,观察并测定不同的输出功率、单次脉冲时间和治疗总时间致离体牛肝组织和活体猪肝脏靶区内组织凝固性坏死灶的大小。结果 肝组织内凝固性坏死灶的大小是可变的,且可能与ＨＩＦＵ治疗剂量和活体组织的生物学特性有关系。结论 肝脏靶区出现凝固性坏死是聚焦超声束作用于     

超声引导激光消融实验兔肾的有效性评估

目的初步评估超声引导激光消融实验兔肾的有效性。方法超声引导下对4只正常新西兰兔肾进行单针或多针激光消融(每根光纤设定功率5W,持续6min,总能量1800J),观察消融过程中和消融结束后二维超声表现及消融结束后消融灶超声造影表现,并观察消融灶大体及镜下病理表现。结果二维超声上消融灶大体呈椭圆形,其中央部分为高回声,周边部分为稍低回声,与周围肾实质分界模糊,内未见血流信号;超声造影示消融灶整体呈无增强;双针消融灶(30mm×15mm)比单针消融灶(13mm×12mm)范围大。大体标本示消融灶中央为碳化区,周边呈粉红色区,与未消融区分界清晰。镜下可见消融灶中央凝固性坏死,周边变性伴间质出血,未消融区组织形态正常且与消融灶分界清晰。结论超声可引导激光对肾脏进行有效消融。结合超声造影,可进一步评估消融效果。多针消融可扩大消融范围。     

实验性脑出血血肿周围血脑屏障超微结构的动态观察

【目的】动态观察实验性脑出血血肿周围血脑屏障的形态学变化。【方法】建立稳定的脑出血大鼠模型，观察脑出血后不同时间血肿周围血脑屏障超微结构变化。【结果】脑出血后24h，毛细血管内皮细胞出现肿胀；48h，内皮细胞高度肿胀，胞质突向管腔，紧密连接消失；d7血管内皮细胞胞膜、核膜溶解．核固缩．紧密连接开放、管周高度水肿，可见红细胞阻塞毛细血管。【结论】采取措施预防脑出血血肿周围血脑屏障的损伤，是脑出血治疗的一个重要方面。     

高强度聚焦超声定位损伤幼猪肌肉组织的即时和延迟反应

目的 观察高强度聚焦超声损伤幼猪肌肉组织后即时和延迟的超声影像学改变和病理学改变，为临床应用提供依据。方法 实验幼猪后肢皮下肌内层高强度聚焦超声照射后即刻和存养2周后，观察照射靶区超声影像学改变和病理改变，结果高强度聚焦超声（HIFU）照射后靶区灰度明显增加，与正常组织界限清晰。光镜下靶区组织呈凝固性坏死。HIFU照射2周后凝固灶回声较前减弱，靶区灰度强弱不等，凝固灶体积较前有缩小。与正常组织的界限清晰度较前下降。光镜下发现靶区肉芽组织生成。结论高强度聚焦超声能有效地损伤幼猪肌肉组织，使之发生凝固性坏死，治疗2周后靶区肉芽组织生成。为HIFU治疗软组织肿瘤提供了实验依据。     

高强度聚焦超声定位损伤幼猪肌肉组织的即时和延迟反应

目的观察高强度聚焦超声损伤幼猪肌肉组织后即时和延迟的超声影像学改变和病理学改变,为临床应用提供依据。方法实验幼猪后肢皮下肌内层高强度聚焦超声照射后即刻和存养2周后,观察照射靶区超声影像学改变和病理改变。结果高强度聚焦超声(HIFU)照射后靶区灰度明显增加,与正常组织界限清晰。光镜下靶区组织呈凝固性坏死。HIFU照射2周后凝固灶回声较前减弱,靶区灰度强弱不等,凝固灶体积较前有缩小。与正常组织的界限清晰度较前下降。光镜下发现靶区肉芽组织生成。结论高强度聚焦超声能有效地损伤幼猪肌肉组织,使之发生凝固性坏死,治疗2周后靶区肉芽组织生成。为HIFU治疗软组织肿瘤提供了实验依据。     

微波外科技术行兔脾部分切除术后病理及超微结构观察

目的 探讨微波外科技术在脾部分切除术中的应用价值。方法 微波组织凝固(MTC)行兔脾部分切除术0h、术后7d和14d分别切取脾脏行病理与电镜检查。结果 光镜下脾组织凝固止血带呈坏死区、致密区和边缘区三个区域。术后14d，纤维隔在组织内形成，透射电镜显示脾的网状细胞接近正常，细胞线粒体嵴尚不完整。结论 MTC行脾部分切除对脾的损害短期内可修复。微波外科技术行保脾手术是一种有价值的治疗方法。     

Interstitial 1.06 Nd:YAG laser thermotherapy for brain tumors under real-time monitoring of MRI: experimental study and phase I clinical trial

This paper presents the experimental and clinical results of interstitial 1.06 Nd:YAG laser thermotherapy (ILTT) for brain tumors under real-time monitoring by magnetic resonance imaging. The authors chose a laser heat source for interstitial thermotherapy of brain tumors for several important reasons: (1) Laser heat delivery is less complicated and more controlled; (2) laser effects on tissue can be tested, monitored, and controlled by MRI. A 1.064 nm Nd:YAG laser and a specially designed laser optic fiber (ILTT) were used in C.W. mode this study. The laser was used at 4 W at a C.W. mode pulse and total exposure duration was 10 minutes (total energy was 2400 joules). Temperature distribution was determined with a microprocessor-based thermometer and by the levels of the signal intensity under MRI. The relationship between the temperature and MRI signal intensity allowed exploration of the possibility of using MRI as a noninvasive temperature monitoring method. Two patients with glioblastoma and one patient with a brain metastasis were treated with this modality. The results and indications are presented and discussed.     

Real-time high resolution laser speckle imaging of cerebral vascular changes in a rodent photothrombosis model

The study of hemodynamic and vascular changes following ischemic stroke is of great importance in the understanding of physiological and pathological processes during the thrombus formation. The photothrombosis model is preferred by researchers in stroke study for its minimal invasiveness, controllable infarct volume and lesion location. Nevertheless, there is a lack in high spatiotemporal resolution techniques for real time monitoring of cerebral blood flow (CBF) changes in 2D-profile. In this study, we implemented a microscopic laser speckle imaging (LSI) system to detect CBF and other vascular changes in the rodent model of photothrombotic stroke. Using a high resolution and high speed CCD (640 × 480 pixels, 60 fps), online image registration technique, and automatic parabolic curve fitting, we obtained real time CBF and blood velocity profile (BVP) changes in cortical vessels. Real time CBF and BVP monitoring has been shown to reveal details of vascular disturbances and the stages of blood coagulation in photothrombotic stroke. Moreover, LSI also provides information on additional parameters including vessel morphologic size, blood flow centerline velocity and CBF spatiotemporal fluctuations, which are very important for understanding the physiology and neurovascular pathology in the photothrombosis model.OCIS codes: (110.6150) Speckle imaging, (170.3880) Medical and biological imaging     

Comparative Efficacy of Continuous and Pulsed Argon Laser Ablation of Human Diseased Ventricle

We compared the tissue lesions obtained in a saline medium using single continuous argon laser discharges with paired sequential continuous laser discharges in nine segments of diseased human ventricle resected from patients with and without ventricular tachycardia (VT) at cardiac surgery. Single continuous argon laser discharges were delivered to separate sites on the endocardial surface of the tissue segments for periods of 10, 20, and 30 seconds at laser beam power of 5 W (group IA) and 8 W (group IIA). Paired sequential argon laser discharges of 5, 10, and 15 seconds in duration were delivered to separate sites at a laser power of 5 W (group IB) and 8 W (group IIB). Gross and microscopic examination of each tissue lesion and its dimensions were performed. Laser irradiation of excised human ventricle resulted in a circular discrete burn at the site of application. Histologic examination showed crater formation due to tissue vaporization with the crater lining consisting of charred tissue and a zone of coagulation necrosis. Analysis of lesion dimensions in groups IA and IIA showed comparable lesion depth and diameter with single continuous and paired sequential laser discharges at energies of 50 J (p greater than .2), 100 J (p greater than .2), and 150 J (p greater than .2). Similarly, lesion depth and diameter were comparable in groups IB and IIB at the same energies. We conclude that paired sequential argon laser discharges may be used to produce comparable tissue lesions to single continuous argon laser discharges in diseased human ventricle.     

超声弹性成像技术评估无水乙醇诱导肝脏凝固灶的实验研究

目的探讨超声弹性成像技术评估无水乙醇诱导肝脏凝固灶的价值。方法选取新鲜离体猪肝共25个肝叶,随机分为5组,每组各5个肝叶。分别行单点、两点相距0.5cm、两点相距1.0cm、两点相距1.5cm及两点相距2.0cm注射无水乙醇,各点无水乙醇注射量均为2.0ml。注射无水乙醇前、后观察实验区常规二维超声声像图及应变力弹性成像图（EI）变化,同时运用声触诊组织定量技术（VTQ）测定实验区剪切波速度。实验结束后剖开标本,记录凝固灶的形态、范围。采用配对t检验比较注射无水乙醇前后实验区肝组织剪切波速度差异。结果无水乙醇不同注射方式可形成不同形态的凝固灶,常规二维超声下局部区域出现短暂高回声,随之迅速消散,而EI图可显示较恒定红色硬变区,比常规二维超声更接近实际凝固灶;但对于间距小于0.3cm的双凝固灶,EI图难以分辨。凝固后的肝组织剪切波速度均明显增高,与注射无水乙醇前比较差异均有统计学意义（P〈0.01）,表明凝固性坏死的肝组织硬度增加。结论超声弹性成像技术可反映肝脏凝固灶力学变化,是常规二维超声的有力补充,但细微分辨力还有待提高。     

微波消融灶组织病理变化与超声弹性成像图对照的实验研究

目的研究微波消融灶大体标本不同区域与弹性成像图相应区域问的关系,探讨超声弹性成像评价微波消融组织病理改变的可行性。方法单导水冷2450MHz微波,作用功率50w,作用时间200s,消融离体猪臀部肌组织,消融前、消融后即刻行静态超声弹性检查,分别测量弹性图的蓝色区及蓝色区＋绿色区大小。消融后测量大体标本灰白色＋灰粉色区及灰白色区大小。大体标本常规甲醛固定,石蜡切片,HE染色,光镜下观察各消融区域组织细胞变化,并采用配对t检验比较大体标本测值及镜下检查结果同弹性图相应测值。结果共进行了30次微波消融,形成30个消融灶。所有消融灶最终均能获得满意的弹性成像图。消融后消融灶剖面大体观呈以天线为长轴的椭圆形,由中心向外依次分为：棕黄色区,光镜下肌细胞完全破坏、崩解;灰白色区,硬而致密;光镜下肌细胞凝固性坏死;灰粉色区,光镜下肌细胞形态大致正常,细胞问水肿。消融后,弹性图像显示消融灶呈椭圆形,中心为较均匀蓝色,周边呈宽度较均匀一致绿色,与周围混杂颜色的正常组织分界清楚。弹性图蓝色区＋绿色区（灰白色区＋灰粉色区）长、宽、高测值分别为（3．750±0．289）、（2．773±0．264）、（2．223±0．229）cm,大体标本总消融区长、宽、高测值分别为（3．768±0．277）、（2．668±0．337）、（2．291±0．378）cm。2种方法长、宽、高测值的差异均无统计学意义（t=-0．568、1．994、1．078,P均〉0．05）,且有相关性（r=-0．86、0．69、0．62,P均〈0．01）。弹性图蓝色区长、宽、高测值分别为（3．307±0．231）、（2．260±0．269）、（1．827±0．271）cm,大体标本灰白色区长、宽、高测值分别为（3．280±0．273）、（1．980±0．373）、（1．840±0．297）cm。2种方法长、高测值的差异亦无统计学意义（t=0．576、0．238,P均〉0．05）,且有相关性（F0．76、0．71,P均〈0．01）。结论微波消融后超声弹性图像的蓝色区＋绿色区与消融灶标本灰白色区＋灰粉色区（凝固性坏死区＋水肿区）相对应,蓝色区与灰白色区（凝固性坏死区）相对应,超声弹性成像可以初步反映组织的热损伤程度。     

Radiofrequency ablation does not induce apoptosis in the rat myocardium

Background: The mechanisms implicated in the genesis of delayed radiofrequency (RF) effects remain unclear, but may be related to extension of the lesion beyond the region of coagulative necrosis. The role of apoptosis in this process has not been previously reported. We assessed whether RF promotes apoptosis in the region surrounding acute ablation lesions in a rat model. Methods: Wistar rats (n = 30; weight 300 g) were anesthesized, the chest was opened, and the heart was exposed. A modified unipolar RF ablation (custom catheter 4.5‐mm‐tip diameter, 12 Watts, 10 seconds) was undertaken on the left ventricular anterolateral epicardial surface and the chest was closed. After 2 hours, animals were killed for histological (hematoxylin and eosin, TdT‐mediated dUTP Nick End‐Labeling [TUNEL] assay) and immunohistochemical (anti‐BAD and anti‐caspase 3 antibodies) analysis (n = 18). Additional animals (n = 12) were sacrificed at 2 (n = 3), 24 (n = 3), 48 (n = 3), and 72 hours (n = 3) after ablation exclusively for anti‐BAD Western Blotting analysis. Results: Lesions were characterized by well‐defined regions of coagulative necrosis. In 18/18 (100%) animals, TUNEL assay revealed positive luminescent reaction cells in the region surrounding the lesion, extending up to 2 mm from the border zone. However, microscopic evaluation of the nuclei and immunohistochemical and anti‐BAD Western Blotting analysis were negative in all (100%) rats. Thus, positive TUNEL reaction in the periphery of the ablation lesion likely reflects nonspecific DNA damage. Conclusion: RF ablation does not promote apoptosis in the periphery of the myocardial lesion. This finding may have implications for the elucidation of late lesion extension following RF ablation. PACE 2012; 35:449–455)     

罗格列酮对家兔脑出血模型病灶周围内皮素-1表达 及血脑屏障通透性的影响

目的:探讨罗格列酮对家兔脑出血(ICH)模型血肿周围脑组织内皮素1(ET-1)表达及血脑屏障通透性的影响。方法:45只健康家兔随机分为正常对照组(NC组)、模型对照组(MC组)及罗格列酮灌注组(RSG组),各15只。自体血注入法制备基底核区ICH模型。造模后6 h,RSG组给予罗格列酮病灶区灌注,各组分别在处理后1、3和7 d处死,每时间点5只。处死前行Purdy神经功能评分,伊文思蓝法判断血脑屏障通透性,比较血肿周围脑组织ET-1表达,分析ET-1表达水平与血肿周围脑组织伊文思蓝含量及Purdy神经功能评分相关性。结果:与NC组比较,MC组和RSG组出现显著神经功能损害(P<0.05),病灶周围ET-1表达、血脑屏障通透性均显著增加(P<0.05);与MC组比较,RSG组神经功能损害减轻,病灶周围ET-1表达、血脑屏障通透性均降低(P<0.05);血肿周围脑组织ET-1表达水平与血脑屏障通透性及Purdy神经功能评分呈显著相关性(P<0.01)。结论:ICH后血肿周围脑组织ET-1表达及血脑屏障通透性增加,罗格列酮灌注治疗可降低血肿周围脑组织ET-1表达及血脑屏障通透性,减轻神经功能损害。     

亚低温对犬心脏骤停后脑水肿及血脑屏障的影响

目的观察亚低温干预对犬心脏骤停后脑水肿及血脑屏障的影响。方法共选取16只成年健康杂种犬，将其随机分为亚低温组（n=8）和对照组（n=8），采用诱发室颤的方法导致上述2组动物心跳、呼吸骤停，随后施行脑复苏程序；亚低温组动物在心跳骤停期间给予亚低温干预。采用双抗夹心酶联免疫吸附技术测定各组动物血清S100B蛋白含量，同时观察其脑组织含水量及病理学改变。结果亚低温组动物经亚低温干预后，发现其血清S100B蛋白含量显著低于对照组（P〈0．05），脑组织含水量也显著低于对照组（P〈0．05）；2组实验动物脑标本经病理学检测后发现，亚低温组动物脑组织缺氧损伤程度明显轻于对照组。结论亚低温干预能减轻心跳骤停实验犬的脑水肿程度，改善其血脑屏障功能，从而发挥脑保护效应。     

Morphologic effects of defibrillation: a preliminary report

A 72-yr-old man receiving more than 300 separate DC countershocks in 2 wk exhibited morphologic heart changes, including areas of coagulation necrosis in the subepicardium and areas of frank hemorrhage. In other sites the myocytes were pathologically contracted, a finding previously demonstrated in experimental animals as a result of defibrillation but not seen in man. We suggest that these changes may occur more often than has been previously supposed and thus may be of clinical importance.