A Consideration on the new classification of latest lung ventilators

Concerning the classification of ventilators, Elam (1958), Faireley (1959), and Hunter (1961) reported some simple ones such as pressure limited, volume limited, pressure preset, or volume preset models. Mapleson (1969) also classified them by the generating force or cycling together with the above-mentioned types.The latest ventilators applicable to patients with respiratory failure usually have some cut-off function at high airway pressures as a safety measure. Therefore, all of them belong to the pressure limited type. Some ventilators are of two types such as the time cycled and pressure cycled type.Therefore, we attempted to classify ventilators into four groups, i.e. the time cycled, volume cycled, pressure cycled and selective time-pressure cycled types according to the fundamental mode of ventilator function, the so-called change of cycling from inspiration to expiration. Each group was further divided into subgroups according to preset dials such as respiratory rate, I/E ratio, inspiration time, expiration time, tidal volume, flow rate and airway pressure.By this method, fifty one ventilators on the market in Japan can be classified without overlapping. Although this classification seems complex, it will be of use in selecting ventilators by emphasizing preset dials according to the users needs, ability or both.(Goto Y, Takahashi K, Harada J et al.: A consideration on the new classification of latest lung ventilators. J Anesth 1: 178–182, 1987)     

Suppression of spontaneous breathing during high-frequency jet ventilation

Conditions which suppress spontaneous breathing activity during high-frequency jet ventilation (HFJV) were analysed in Yorkshire piglets under pentobarbital anesthesia. The highest P_aCO₂ at which the animals did not breathe against the ventilator (apnea point) was established during different patterns of ventilation, either by changing the minute volume or by adding CO₂ to the inspiratory gas. Arterial oxygen tension was maintained throughout the study above 80 mm Hg. An elevation of ventilatory rate increased the apnea point, suggesting a progressive suppression of spontaneous breathing. This suppression did not depend on the amount of lung stretch during insufflation, because at higher rates lower tidal volumes were used. Suppression also appeared to be independent of insufflatory flow, i.e. the velocity of lung stretch. At higher frequencies end-expiratory airway pressure (P_EE) increased and there appeared to be a positive relationship between the apnea point and P_EE. In a separate series this positive relationship between the apnea point and P_EE was confirmed. A hysteresis effect in this relationship, however, suggests that other than jet frequency, lung volume rather than positive end-expiratory pressure (PEEP) is a major determinant of suppression of spontaneous breathing activity during HFJV.     

Preliminary report on AT1727 as a potential radiosensitizer

AT1727 is a derivative of ICRF 154. The purpose of this study was to evaluate its "radiosensitizer" properties. From October 1979 until the end of December 1980, 89 patients with radiation resistant cancers such as soft tissue sarcoma, squamous lung cancer (with large lesion, 6-8 cm diameter) and other cancers had been included in trial. Radiation therapy was carried out using CO60 or 8 Mev Linac. Fifty-five patients had a remarkable objective remission rate of 61.8% (55/89). Eighteen of 30 patients with soft tissue sarcomas obtained obvious remission (60%), and 26 of 38 patients with lung cancer had remission (68.4%). Patients with esophageal cancer (5/6) and nasopharyngeal cancer (5/5) also had good remission rates. The side-effects of this treatment were very mild: anorexia and vomiting were noted in 50% and no significant changes were noted in liver and kidney function tests and blood platelet count. Leucopenia was slight in all but one patient. No difference in the lung fibrosis rate was noted between the two randomized groups. From the results of this study we concluded that AT1727 had some effect as a "radiosensitizer" but much more work is needed to confirm this.     

基于CT的三维数字化导航技术在肺癌介入微波消融治疗中的应用价值

目的 在肺癌微波消融治疗中探究基于CT的三维数字化导航技术的应用价值。方法 回顾性分析我院收治的92例肺癌患者,随机进行三维数字化导航微波消融或传统CT引导下微波消融,分为三维导航组和传统组,依据肿瘤位置、大小（最大径差值≤2 mm）及微波消融条件不同两两配对,共46对,比较2组手术时间、微波针穿刺次数、CT剂量指数、术中并发症发生率、术后病灶控制情况。结果 三维导航组与传统组的手术时间分别为（30.07 ± 6.36）min、（47.20 ± 9.65）min、穿刺次数分别为（1.72 ± 0.69）次、（7.13 ± 3.00）次、CT剂量指数分别为（11.16 ± 2.20）mGy、（26.67 ± 8.72）mGy、术中并发症发生率分别为10.87%、34.78%,以上3个指标三维导航组均低于传统组,三维导航组治疗有效率（93.48%）高于传统组（71.74%）,差异均有统计学意义（P < 0.05）。结论 CT引导下利用三维数字化导航技术行肺癌微波消融治疗,使介入穿刺手术的操作更加精准安全。     

无呼吸道症状肺癌35例临床分析

目的：探讨完全无症状或无呼吸道症状肺癌的早期诊断。方法：随机抽取1995年2月至2001年3月经临床及病理诊断为肺癌的380例,其中“无症状”肺癌35例进行分析。结果：由于“无症状”肺癌的异位内分泌等作用,致使患者表现为神经科,骨科,皮肤科,消化科,内分泌科学等多学科病变。结论：为了提高“无症状”肺癌的早期确诊率,及早行胸片,CT片,支行镜等相关检查相当重要,定期体检对于早期发现肺癌有重要的意义。     

肺癌细胞凋亡和PCNA p53关系的研究

目的　通过肺癌组织中凋亡细胞的原位观察和对核增殖抗原 (PCNA)、p53蛋白表达的研究 ,探讨不同类型肺癌、不同增殖情况、不同p53表达的细胞凋亡情况。方法　 97例术前未经任何治疗的肺癌。Sclc35例 ,Nsclc62例 ,分别进行凋亡细胞检测 (TUNEL法 )、PCNAp53蛋白的免疫组化染色。结果　不同类型肺癌、不同增殖能力肺癌细胞凋亡的程度有差异 ,p53阴性和阳性细胞凋亡无差异。结论　小细胞肺癌细胞凋亡数高于非小细胞肺癌 ,细胞增殖活跃自发凋亡也相应增多。     

云南个旧和宣威地区肺癌p53突变检测研究

目的　云南个旧及宣威地区是云南省肺癌的两大点状高发区 ,个旧以矿工为高发人群 ,宣威以农民为高发 ,该两地区肺癌发生的病因已初步阐明 ,本研究旨在深入探讨其发病的分子生物学基础。方法　对 2 6例个旧矿工肺癌患者 ,15例宣威农民肺癌患者 ,应用聚合酶链反应 -单链构象多态性法研究 p5 3第 5至第 8外显子突变 ,并对有突变的个体进行测序。结果　发现云锡矿工肺癌患者中有 13例、宣威农民肺癌患者中有 4例发生 p5 3突变 ,应用 DNA测序 ,发现云锡矿工肺癌中有 1例于第 135位密码子发生突变 ,由 GCC→ GTC,导致氨基酸改变 ,由丙氨酸→缬氨酸 (Ala→ Val) ,宣威农民肺癌患者中有 1例于 2 47位密码子突变 ,由 AAC→ TTC,导致氨基酸发生改变 ,由天冬酰氨→苯丙氨酸 (Asn→ Phe)。结论　 p5 3突变在云锡矿工肺癌和宣威农民肺癌中较常发生 ,并发现两例新的突变位点。 p5 3突变与病人的年龄、性别、坑龄及组织学分类无明显联系     

基于“气血”理论探讨中医治疗肺系疾病之思路

中医学认为,气血失和,百病丛生,气血是构成人体和维持其生命活动的物质基础。现基于气血理论探讨中医治疗肺系疾病的辨治思路,认为肺系疾病的发病与气血关系密切,系因机体气血功能异常,加之外邪侵袭,导致“肺气虚弱,肺虚络瘀,肺热瘀阻,热壅血瘀”,总结出主要病机是“气血亏虚为本,痰热瘀阻为标”,治疗上应以“调和阴阳、理顺气血”为主要原则,临床上辨证应用“补肺理气、养血活血、化痰逐瘀、清肺热、利肺气、止咳平喘、凉血”之法,为临床从气血角度论治肺系疾病提供新思路。