Relative motion of lung and chest wall promotes uniform pleural space thickness

The pleural space is modeled in two dimensions as a thin layer of fluid separating a deformable membrane and a rigid surface containing a bump. We computed the steady-state membrane configuration and fluid pressure distribution during relative sliding of the two surfaces. For physiologically relevant values of membrane tension, shear flow-induced pressures near the bump and far-field pressure gradients are similar to those measured in vivo within the pleural space (e.g. Lai-Fook et al.) [J. Appl. Physiol.: Respirat. Environ. Exercise Physiol. 56 (1984) 1633-1639]. Deformation of the membrane over the bump suggests that the pressure field generated by the sliding motion promotes an even layer of fluid in the pleural space, preventing asperities from touching. Results also suggest a possible mechanism for pleural fluid redistribution during breathing, whereby irreversible fluid motion is associated with the deformability of the membrane.     

Elastohydrodynamic separation of pleural surfaces during breathing

To examine effects of lung motion on the separation of pleural surfaces during breathing, we modeled the pleural space in two dimensions as a thin layer of fluid separating a stationary elastic solid and a sliding flat solid surface. The undeformed elastic solid contained a series of bumps, to represent tissue surface features, introducing unevenness in fluid layer thickness. We computed the extent of deformation of the solid as a function of sliding velocity, solid elastic modulus, and bump geometry (wavelength and amplitude). For physiological values of the parameters, significant deformation occurs (i.e. bumps are 'flattened') promoting less variation in fluid thickness and decreased fluid shear stress. In addition, deformation is persistent; bumps of sufficient wavelength, once deformed, require a recovery time longer than a typical breath-to-breath interval to return near their undeformed configuration. These results suggest that in the pleural space during normal breathing, separation of pleural surfaces is promoted by the reciprocating sliding of lung and chest wall.     

胸腹水组织因子及组织因子途径抑制物的检测及其意义

目的研究三组疾病胸腹水组织因子(Tissue factor,TF)及组织因子途径抑制物(Tissue factor pathway inhibitor,TFPI)的表达及其鉴别诊断意义。方法TF和TFPI采用ELISA法测定抗原表达。结果胸腹水TF水平和TFPI水平,恶性肿瘤组(570.04±627.53)ng/L,(28.60±15.57)μg/L和结核病组(283.82±143.16)ng/L,(31.16±12.26)μg/L明显高于肝硬化组(60.83±66.87)ng/L,(7.84±5.45)μg/L,P<0.01。TF/TFPI比值则为恶性肿瘤组(32.17±44.19)明显高于结核病组(13.55±13.15)和肝硬化组(11.22±9.05,P<0.05)。在恶性肿瘤组中,胸腹水癌细胞阳性组的TF表达(1106.92±1244.28)ng/L高于阴性组(331.08±295.84)ng/L,P<0.05。而阳性组的TFPI水平(27.35±17.75)μg/L与阴性组(30.34±13.20)μg/L无明显差异(P>0.05)。TF/TFPI比值则为阳性组(59.59±65.10)明显高于阴性组(11.54±8.37,P<0.01)。结论检测胸腹水TF和TFPI并分析TF/TFPI比值可以作为临床实验室有鉴别诊断意义的辅助指标,同时还可了解疾病的某些病理机制,尤其是肿瘤的某些生物学行为。     

肺癌患者的血浆、胸水纤溶活性及其临床意义

目的：研究纤溶活性在肺癌扩散中的影响。方法：检测29例肺癌患者、21例良性胸腔积液患者血浆、胸液中组织纤溶酶原激活物活性（t－PA）纤溶酶原活化抑制因子（PAI－1）活性。结果：肺癌组血浆、胸液中（t－PA)活性均明显高于对照组（P＜0．05）,而PAI－1活性则与对照组相似（P＞0．05）。结论：肺癌患者的纤溶失衡与其远处转移可能有一定关系。     

Cytokines and fibrinolytic enzymes in tuberculous and parapneumonic effusions

Tuberculous (TB) pleurisy and parapneumonic effusion (PPE) are common causes of pleural fibrosis. The mechanisms underlying fibrin deposition may be different since involved inflammatory cells are distinct. In this study, we measured various cytokines and fibrinolytic enzymes and compared the differences between the two effusions. PPE was further divided into noncomplicated PPE and complicated PPE/empyema subgroups. Tumor necrosis factor (TNF)-alpha, interleukin (IL)-1beta, IL-6, IL-8, macrophage inflammatory protein (MIP)-1beta, monocyte chemoattractant protein (MCP)-1, plasminogen activator inhibitor type 1 (PAI-1) and tissue type plasminogen activator (tPA) were measured using enzyme-linked immunosorbent assays. Significantly higher values of PAI-1, PAI-1/tPA ratio, IL-1beta, IL-8 and MIP-1beta and significantly lower values of TNF-alpha, IL-6 and MCP-1 were observed in PPE/empyema than in TB effusions. Compared to noncomplicated PPE, complicated PPE/empyema had significantly higher levels of TNF-alpha, IL-1beta, IL-8 and MIP-1beta. TB pleurisy patients who had higher effusion levels of TNF-alpha, IL-1beta and IL-8 were predisposing to residual pleural thickening. The underlying mechanisms of fibrin formation and deposition between the two effusions studied (PPE/empyema and TB pleurisy) could not be fully explained by the results of the present study. More studies are needed to explore this further.     

恶性胸腔积液对晚期非小细胞肺癌预后的影响

目的 探讨恶性胸腔积液对晚期非小细胞肺癌（ＮＳＣＬＣ）预后生存的影响。方法 根据临床分期及有无胸腔积液将患者分为三组,用生存统计中的Ｋａｐｌａｎ－Ｍｅｉｅｒ表法做出三组生存曲线并比较显著性。结果 无胸腔积液的ⅢＢ期患者的生存与有胸腔积液的ⅢＢ期患者及Ⅳ期肺癌患者的生存期比较有显著性差异,而ⅢＢ期有胸腔积液的肺癌患者的生存期与Ⅳ期患者的生存期比较无显著性差异。在单因素及多因素预后分析中,胸腔积液均为     

肺癌胸水中肿瘤浸润淋巴细胞的生物学活性研究

目的 :探讨肺癌胸水中肿瘤浸润淋巴细胞 (TIL)的生物学活性 ,便于更好地应用于临床。方法 :用白细胞介素2 (IL 2 )诱导培养肺癌胸水TIL ,按常规法计数TIL细胞增殖量 ,采用流式细胞仪分析TIL细胞表型及MTT法检测其杀瘤活性。结果 :经IL 2诱导培养TIL 2 1天后 :TIL增殖大于 10 0 0倍的患者有 17例占 77%。CD3差异无显著性 (P >0 0 5 ) ,CD4、CD8差异有显著性 (P <0 0 1) ,而CD4 /CD8比值高达 3 5 3± 0 82 ,并且在 2 1天时TIL具有较高的细胞毒性。结论 :肺癌胸水中的TIL体外诱导培养 2 1天时TIL具有较强的生物活性 ,此时用于胸水治疗可取得可靠的疗效     

胸水中CEA CYFRA21-1 NSE和LDH对肺癌的临床诊断

目的:探讨CEA、CYFRA21-1、NSE、LDH水平对癌性胸水的诊断价值。方法:采用电化学发光方法检测胸水中的CEA、CYFRA21-1和NSE,采用酶法检测LDH。结果:恶性胸水的CEA、CYFRA21-1、NSE、LDH水平明显高于良性胸水(P<0.01),肺腺癌CEA明显高于鳞癌和小细胞肺癌(P<0.01),肺鳞癌CYFRA21-1水平明显高于腺癌(P<0.05)和小细胞肺癌(P<0.01),小细胞肺癌NSE明显高于鳞癌(P<0.01)。4项标志物联合检测的敏感性、准确性均比单项检测高。结论:联合检测胸水中的CEA、CYFRA21-1、NSE和LDH对肺癌的诊断具有重要的临床意义。     

食管癌贲门癌术后胸腔积液的防治

目的:探讨食管癌贲门癌术后胸腔积液的防治.方法与结果:从1989年1月1日～1996年12月31日,作者手术治疗食管癌贲门癌1951例,术后发生胸腔积液16例,发生率为0.82%.均经胸腔穿刺及闭式引流术治愈.结论:为预防食管癌贲门癌术后胸腔积液的发生:术中应细致操作,妥善处理食管床及淋巴结清扫创面,减少术后渗液;术中对侧纵隔胸膜破裂的病人,术末清除对侧胸腔积气积液,防止术后健侧胸腔积液;在食管重建术中,应用纵隔胃;保证通畅的胸腔闭式引流,促进肺的复张,并掌握好拔管的时机.     

全胸膜混合射线照射治疗恶性胸水的初步报告

目的研究６０Ｃｏ和电子线匹配作全胸膜放射治疗胸膜转移伴恶性胸水。方法２５例恶性胸水患者接受治疗。其中肺癌伴恶性胸水２０例，乳腺癌术后胸膜转移伴胸水３例，恶性胸腺瘤术后胸膜转移伴胸水２例。６０Ｃｏ野包括全肺，中央铅块屏蔽，屏蔽处照射电子束，计算中平面胸膜受量，１００％等剂量线为２Ｇｙ，常规照射１５次。可见肿瘤局部加量２０Ｇｙ／１０ＦＸ。中平面约２／３肺组织受量＜５０％。同时接受３～６个疗程化疗。结果２５例恶性胸水完全控制１７例，部分控制７例，总有效率９６％。２２例可见肿瘤３例完全消退，１７例部分消退。经随访，１例无瘤生存１４个月，２例１２个月，１６例４～１１个月。６例死亡，中位生存期９个月。胸水复发４例，总控制率为８０．０％。照射后患者血象较前下降，急性放射性食管炎（Ⅰ～Ⅱ级）１１例，２例胸膜明显增厚伴纤维化。结论６０Ｃｏ和电子线混合照射全胸膜临床上安全且具有较好的疗效