覆膜支架封堵治疗食管胃吻合口-胸腔瘘的临床疗效

目的：探讨采用自膨式覆膜支架封堵治疗食管胃吻合口-胸腔瘘的,临床价值及其安全性。方法：6例经碘水造影检查证实的食管胃吻合口-胸腔瘘患者,植入覆膜支架后,持续性胸腔引流,抗感染治疗。结果：6例患者共植入7枚支架,支架展开良好,1枚移位。有效率6／7（86％）。置入覆膜支架后,既封堵了瘘口又解决了进食问题,控制了感染。结论：采用自膨式覆膜支架封堵治疗食管胃吻合口-胸腔瘘具有较高的临床价值及安全性。     

覆膜支架封堵治疗食管胃吻合口- 胸腔瘘的临床疗效

目的:探讨采用自膨式覆膜支架封堵治疗食管胃吻合口-胸腔瘘的临床价值及其安全性。方法:6例经碘水造影检查证实的食管胃吻合口-胸腔瘘患者,植入覆膜支架后,持续性胸腔引流,抗感染治疗。结果:6例患者共植入7枚支架,支架展开良好,1枚移位。有效率6/7(86%)。置入覆膜支架后,既封堵了瘘口又解决了进食问题,控制了感染。结论:采用自膨式覆膜支架封堵治疗食管胃吻合口-胸腔瘘具有较高的临床价值及安全性。     

Lubrication regimes in mesothelial sliding

To function normally, the lungs, heart, and other organs must undergo changes in shape and size, sliding against surrounding body walls. It is not known whether the delicate mesothelial surfaces covering these organs and body wall are in contact during sliding, or if hydrodynamic pressure in the lubricating liquid increases separation between their surfaces. To address this question, we measured the coefficient of friction (mu) of the mesothelial surface of nine rat-abdominal walls sliding in saline on a smooth glass surface. Sliding at physiological velocities of 0.0123-6.14 cm/s with normal stresses of 50-200 Pa, mu varied with velocity (P<0.001). On average, mu was relatively high at low speeds (0.078 at 0.041 cm/s), decreased to a minimum at intermediate speeds (0.034 at 1.23 cm/s), and increased slightly again at higher speeds (0.045 at 6.14 cm/s), consistent with a mixed lubrication regime in which there is at least partial hydrodynamic separation of surfaces. We conclude that mesothelial surfaces, sliding under physiological conditions, are protected from excessive shear by hydrodynamic pressures that increase separation of surfaces.     

应用电视胸腔镜诊治病因不明胸腔积液的疗效观察

目的:探讨电视胸腔镜(video-assisted thoracoscopic surgery VATS)在诊治病因不明胸腔积液中的应用价值.方法:回顾分析2005年4月～2011年4月196例病因不明胸腔积液经电视胸腔镜手术的临床资料.均应用电视胸腔镜进行探查,根据病变情况选择切口部位.排净胸腔积液后,分离粘连,进行胸膜活检后恶性患者行胸膜固定术.结果:196例均明确诊断:140例恶性胸腔积液,36例结核胸腔积液,20例炎性胸腔积液.胸腔镜手术178例,胸腔镜辅助胸壁小切口手术18例.手术时间30～75min,平均54 min.出血量10～120mL,平均53 mL.10例出现术后肺漏气,胸腔引流量＜50 mL/24h拔除胸腔引流管,胸管留置时间4～19天,平均9.4天.191例成功控制胸腔积液,全组无院内死亡.22例接受化疗的恶性胸腔积液患者,随访14～34个月,平均23个月,复查胸片显示无胸腔积液、积气.结论:电视胸腔镜安全、有效、微创,便于操作,可作为诊治病因不明胸腔积液的主要方法.     

信息管理系统下胸腔镜胸膜固定术治疗恶性胸腔积液

目的:分析基于信息管理系统的胸腔镜滑石粉胸膜固定术控制恶性胸腔积液患者术后的并发症,死亡率及生存时间。方法:2011年9月至2014年10月,一共400个患者完成了胸腔镜辅下滑石粉胸膜固定术。对手术前后的患者的并发症,死亡率,成功率和中位生存时间进行评价。结果:中位随访时间为40个月(范围4-61月)。所有患者的呼吸困难症状都得到明显缓解。围手术期死亡率为0。患者对这一手术的耐受性良好,没有观察到明显的副作用。院内死亡率为2%,胸膜固定的成功率为85%。较差的KS评分及胸腔积液诊断到完成胸膜固定术之间的时间延误与院内死亡的发生明显相关。乳腺癌的生存情况最好,其次为卵巢癌,淋巴瘤和胸膜间皮瘤。结论:胸腔镜滑石粉胸膜固定术是一项安全有效的操作,胸膜固定的成功率较高,呼吸困难会能够得到长期有效的控制。     

碘伏胸膜固定术与胸腔镜滑石粉胸膜固定术治疗恶性胸腔积液的对比研究

目的:对乳腺癌胸腔转移的恶性胸腔积液的患者,通过使用胸腔镜滑石粉喷洒和通过胸导管注入聚合碘行胸膜固定术,比较两种方法的有效性、安全性及成功率。方法:42个乳腺癌胸腔转移的恶性胸腔积液的患者纳入了此项前瞻性随机对照研究。所有患者都有中度至重度呼吸困难(MRC呼吸困难量表Ⅲ-Ⅴ级)。22个患者完成胸腔镜滑石粉胸膜固定术(A组),而20例(B组)在床旁完成胸腔注入聚合碘。比较两组患者胸膜固定的成功率,呼吸困难缓解情况,住院时间以及胸痛、发热等并发症发生情况。结果:胸膜固定术成功率两组无明显差异(91%vs 85%,P=0.9),术后并发症两组均较低。手术后,因胸膜炎性胸痛需要止痛处理的A组明显高于B组(18%vs 0,P=0.2)。手术后48小时内,A组患者中有4个病人(18%),B组中1个患者(5%)出现发热(38℃)。治疗后两组呼吸困难症状得到了较好的控制,呼吸困难程度为(Ⅰ-Ⅱ),但两组之间无统计学差异(P0.05)。没有患者在医院内死亡。术后B组患者的住院时间更短(P=0.009)。平均症状无进展时间隔为6.6(范围3-15)月。随访中胸腔积液复发需要从新干预的A组有2例,B组3例。结论:对于乳腺癌转移性胸腔积液,聚合碘可作为胸腔镜滑石粉胸膜固定术外不错的选择。聚合碘容易获得,便宜且安全,可通过胸腔引流管给药,如果必要可以重复操作。     

Use of narrow‐range peptide IEF to improve detection of lung adenocarcinoma markers in plasma and pleural effusion

In this study we applied narrow‐range peptide IEF to plasma or pleural effusion prior to LC/MS/MS. Two methods for narrow‐range IEF were run; IPG strips and free‐flow electrophoresis. Data from this study was compared with cell line data to evaluate the method performance in body fluids. To test the methods potential in quantitative biomarker discovery studies, plasma and pleural effusion from patients with lung adenocarcinoma (n=3) were compared with inflammatory pleuritis (n=3) using iTRAQ quantification. Using narrow‐range IEF on the peptide level we were able to identify and quantify 282 proteins in plasma and 300 proteins in pleural effusion. These body fluid proteomes demonstrated high degree of overlap; however, more proteins significantly differently altered levels related to adenenocarcinoma were found in pleural effusion compared with plasma, suggesting enrichment of lung tissue‐related proteins in pleural effusion. Nine proteins were chosen for initial validation with Western blot, and one protein (NPC2) was chosen for further validation using imunohistochemistry. Overall, the quantitative results from IEF/LC/MS/MS showed good correlation with the results from Western blot and imunohistochemistry, showing the potential of this methodology in quantitative biomarker discovery studies.     

Induction of cytolytic activity of lymphocytes from carcinomatous pleural effusion by IL-2 and autologous tumor cells

We established a cell line (STKM-1) from tumor cells obtained from carcinomatous pleural effusion of a gastric cancer patient. The lymphocytes separated from her peripheral blood or pleural effusion were cryopreserved and immunological experiments were performed after the establishment of the cell line. They were treated with IL-2 or with both IL-2 and mitomycin C (MMC)-treated autologous STKM-1 cells. The cytolytic activity against STKM-1 cells was elevated in lymphocytes cultured with IL-2, and was more prominently augmented in lymphocytes cultured with both IL-2 and MMC-treated STKM-1 cells. The elevation in cytolytic activity was more marked with pleural effusion lymphocytes than with the peripheral blood lymphocytes. The results suggest that the lymphocytes obtained from the pleural effusion would be an excellent source for adoptive immunotherapy.Abbreviations IL-2 interleukin-2 - LAK lymphokine activated killer - MLTC mixed lymphocyte tumor cell culture - MMC mitomycin C - MoAbs monoclonal antibodies - TIL tumor infiltrating lymphocytes     

A century and a half of research on the evolution of insect flight

The gill and paranotal lobe theories of insect wing evolution were both proposed in the 1870s. For most of the 20th century, the paranotal lobe theory was more widely accepted, probably due to the fundamentally terrestrial tracheal respiratory system; in the 1970s, some researchers advocated for an elaborated gill (“pleural appendage”) theory. Lacking transition fossils, neither theory could be definitively rejected.Winged insects are abundant in the fossil record from the mid-Carboniferous, but insect fossils are vanishingly rare earlier, and all earlier fossils are from primitively wingless insects. The enigmatic, isolated mandibles of Rhyniognatha (early Devonian) hint that pterygotes may have been present much earlier, but the question remains open.In the late 20th century, researchers used models to study the interaction of body and protowing size on solar warming and gliding abilities, and stability and glide effectiveness of many tiny adjustable winglets versus a single, large pair of immobile winglets. Living stoneflies inspired the surface-skimming theory, which provides a mechanism to bridge between aquatic gills and flapping wings. The serendipitously discovered phenomenon of directed aerial descent suggests a likely route to the early origin of insect flight. It provides a biomechanically feasible sequence from guided falls to fully-powered flight.