Gas flow during bronchoscopic ablation therapy causes gas emboli to the heart: a comparative animal study

BACKGROUND: Thermal ablation is one of the most commonly used modalities to treat central airway obstruction. Both laser and argon plasma coagulation (APC) have been reported to cause gas emboli and cardiac arrest. We sought to determine whether bronchoscopic ablation therapy can result in systemic gas emboli, correlate their presence with the rate of gas flow, and establish whether a zero-flow (ZF) modality would result in the significant reduction or elimination of emboli. METHODS: CO(2) laser delivered through a photonic bandgap fiber (PBF) and APC were applied in the trachea and mainstem bronchi of six anesthetized sheep at varying dosages and gas flow rates. Direct epicardial echocardiography was used to obtain a four-chamber view and detect gas emboli. RESULTS: The presence of gas flow accompanying APC and the CO(2) laser with forward flow correlated significantly with the appearance of gas bubbles in the atria. A definite dose response was observed between the gas flow rate and the number of bubbles seen. When the CO(2) laser was delivered through a PBF with ZF to the trachea or bronchi, no bubbles were observed. CONCLUSION: Bronchoscopic thermal ablation therapy using gas flow is associated with gas emboli in a dose-dependent fashion. The use of the flexible PBF with ZF is not associated with the development of gas emboli. Further study is required to determine whether a clinically safe threshold of gas emboli exists, and the relationships among the pathologic depth of tissue destruction, gas flow, pulse duration, and the development of gas emboli.     

曹式丽教授中医药防治慢性肾功能衰竭消化系统症状经验初探

消化系统症状作为慢性肾功能衰竭重要表现,发病率高,临床治疗复杂。寻找有效防治方案已成为当前中医肾病学领域的现实问题。全国名老中医药专家曹式丽教授对慢性肾功能衰竭消化系统症状的中医药防治具有丰富经验,疗效确切。文章就相关特色学术观点予以初步总结,为曹式丽教授中医肾病学术思想的完整阐释提供前期工作基础。     

《素问·痹论》藏府痹小考

<素问·痹论>中"凡痹之客五藏者"至"痹聚在脾"一段,林亿认为是王冰次注<素问>将其他篇章移至<痹论>中,张琦等以为王氏所移过于轻率.通过考察巢元方<诸病源候论>,对上述观点提出不同看法<病源>中已把此段文字与<痹论>痹久入藏的论述相联系.王冰次注<素问>,或受<病源>影响,或出自临床经验,似非轻率之举.而且,从"凡痹之客五藏者"一段出现在<内经>中的不同篇章,从古人对五藏痹的前后认识的不同,恰体现出古代对疾病认识是逐渐深入的.     

曹式丽教授防治老年慢性肾功能衰竭经验

慢性肾功能衰竭（CRF）是各种病因引起肾脏损害和进行性恶化的结果。因其对人类健康构成严重威胁,目前已经成为全球性的公共卫生事件。由于中国人口老龄化现象日趋严重,老年人CRF发病率持续上升。老年CRF的发生率随年龄增高而上升,合并症多,治疗上十分棘手。曹式丽教授从老年CRF的中医病机出发,明辨证型,以扶正泄浊为原则对症治疗,重视发掘机体代偿潜能,提出把握中焦、补益扶正、通腑降浊、祛瘀生新的治疗原则,在临床上取得了较好的效果。     

曹志群基于气机升降理论运用药串治疗消化系统疾病经验

"药串"是指相对固定的3味或3味以上的药物组合,作为中药配伍的独立单元,是针对一定病证,从历代医家用药经验中提炼出来的行之有效的、符合一定理论依据和法度的固定配伍。曹志群提出了"脏腑气血升降—在经(气)、入络(血)—久病及肾"的辨证模式,运用药串升降、消补、燥润、清化等方法治疗消化系统疾病,积累了丰富经验。从肺大肠、脾胃、肝胆气机升降三个方面列举运用药串治疗反流性食管炎、溃疡性结肠炎、功能性便秘、消化道溃疡、慢性胃炎、消化吸收不良综合征、胆囊炎、反流性胃炎等消化系统疾病经验。     

章次公生平和崇尚“革新源于继承”理念

章次公先生治学严谨,务求实据真理,崇尚"革新源于继承,真知出自实践"理念。主张"发皇古义,融会新知"学术思想,倡导科学发展中医、振兴民族文化。在上海,为振兴中医学术及培养众多中医后继人才方面作出了卓越贡献,为海派中医丁甘仁学术流派奠定了基础,为发扬我国传统医学作出了卓越贡献。     

曹颖甫常用药剂量的统计分析

文章应用文献计量分析手段,对曹颖甫临床著作《经方实验录》和《曹颖甫先生医案》中的方药系统化,数字化整理,总结出现频次大于10次的30味常用药物,对其不同剂量频次分类整理,得出曹颖甫常用药物的使用剂量,借助医学统计知识计算常用药物的常用剂量范围。将曹颖甫常用药的剂量与张仲景用量比较,分析总结曹颖甫常用药物的剂量规律。本研究为经方方药剂量研究提供更多的思路,为《药典》及《中药学》教材中剂量的标准设定提供更具体和详实的参考。     

曹晓岚清心疏肝法治疗头风病经验

曹晓岚为山东中医药大学附属医院神经内科主任医师,博士生导师,对神经内科诸多疾病有自己独特的经验,她总结了用清心疏肝法治疗头风病经验。     

State of the art: interventional pulmonology

Interventional pulmonology (IP) provides comprehensive care to patients with structural airway disorders and pleural diseases. A growing armamentarium of diagnostic and therapeutic tools has expanded the interventional pulmonologist's ability to care for pulmonary patients with complex abnormalities, often in concert and close collaboration with physicians in other specialties, such as thoracic surgery. Innovative technologies promise to have an impact on diseases and clinical entities not traditionally treated by invasive pulmonary interventions, such as asthma, COPD, and the solitary pulmonary nodule. Training, credentialing, reimbursement, and scientific validation remain key necessities for the continued growth of IP, and require a concerted effort by chest physicians and their professional organizations.