CT 灌注成像在肝癌 TACE 术后疗效评价中的应用价值

目的探讨双源CT灌注成像（CTPI）在HCC TACE术后疗效评价中的价值。方法对２４例HCC患者于TACE术前１～３d、术后６～８d和３０～４０d分别行双源CT灌注扫描,经肝脏CT灌注软件得到肝动脉灌注量（HAP）、门静脉灌注量（PVP）、肝动脉灌注指数（HPI）等彩色灌注图,在图像上分别测定相应的灌注参数值,观察TACE治疗前后肿瘤组织的血流灌注变化及肿瘤的大小改变,评价TACE治疗肿瘤的疗效。结果TACE术前９例肿瘤呈均匀高灌注,１５例呈不均匀高灌注。术后８例瘤灶内碘油沉积密实,１６例碘油沉积不均。灌注图像显示碘油沉积区域无血流灌注,碘油稀疏及缺乏区域仍有血流灌注。所有患者术前、术后６～８d及肿瘤残留患者复发前后的肿瘤组织HAP、HPI差异均有统计学意义（P＜０．０５）,而PVP则差异无统计学意义（P＞０．０５）。术前、术后６～８d肿瘤最大径以及肿瘤残留患者复发前后肿瘤最大径均无明显变化（P＞０．０５）。TACE术后,１６例残瘤组织及正常肝组织HAP、PVP、HPI差异均有统计学意义（P＜０．０１）。结论CT灌注成像能直观和定量地反映肝癌TACE前后的血流动力学变化,有助于TACE疗效的评价。     

全肝CT灌注成像在原发性肝癌TACE术后局部病灶活性评估中的临床应用

目的探讨全肝灌注CT增强扫描检查在肝癌TACE术后局部病灶活性评估中的作用。方法３８例行TACE治疗的肝癌患者,术后６周在Siemens１２８排CT上行全肝灌注CT增强扫描和DSA造影。根据全肝灌注扫描图像获得肝脏灌注参数,与DSA造影结果进行对比,以DSA造影作为标准,分别分析CT灌注对TACE术后局部肿瘤活性的显示情况。结果全肝CT灌注共检出病灶４２处（１００％）,诊断正确率８８．０９％,灵敏度９４．１１％,特异度６２．５０％,阳性预测值＝９１．４２％;阴性预测值＝７１．４２％;一致性检验Kappa值０．８６１３。TACE术后局部肿瘤生长区的相关灌注参数与非瘤区肝组织的灌注参数,两者的血流量（BF）、血容量（BV）、肝动脉指数（HAI ）和肝门脉灌注（PVP）差异均有统计学意义（P＜０．０１）。结论全肝灌注CT增强扫描能很好的显示肝癌TACE术后局部病灶的活性,在肝癌TACE术后评估中具有较高的应用价值。     

原发性肝癌经导管动脉化疗栓塞术治疗前后血清血管内皮生长因子与CT灌注成像的相关性研究

目的探讨原发性肝癌（PLC）患者行经导管动脉栓塞（TACE）术前、术后血清血管内皮生长因子（VEGF）与肿瘤组织CT灌注参数的相关性。方法对１８例PLC患者TACE术前１d,术后６～８d、３２～４０d行血清VEGF检测及CT灌注扫描成像（CTPI ）,得到血清VEGF、肿瘤组织肝动脉灌注量（ALP）、门静脉灌注量（PVP）、肝动脉灌注指数（HPI ）等参数值,并进行统计学分析。结果根据TACE治疗效果分为完全缓解（CR）组和部分缓解及无变化（PR＋SD）组。术前两组血清VEGF及ALP、PVP、HPI 差异无统计学意义（P＞０．０５）;术后６～８d两组血清VEGF及PVP较术前变化差异无统计学意义（P＞０．０５）,而ALP、HPI 较术前明显降低（P＜０．０５）。术后３２～４０d,CR组血清VEGF较术前明显降低（P＜０．０５）,PR＋SD组则较术前增高,但差异无统计学意义（P＝０．２２１）。血清VEGF与肿瘤组织ALP、HPI 呈正相关。结论血清VEGF能间接反映TACE术后肿瘤组织微血管及侧支循环生成情况;CTPI 能直观和定量反映肿瘤组织TACE术前后的血流动力学变化;血清VEGF与肿瘤组织ALP、HPI 呈正相关。故联合应用血清VEGF及CTPI 有助于TACE疗效的评价,对进一步治疗时间、方案的确定提供重要参考依据。     

CT灌注成像评价抗血管生成药物不同给药方式的疗效

【摘要】 目的 利用CT灌注成像技术评价兔VX2后腿肌肉间移植瘤经抗血管生成药物不同给药方式治疗后肿瘤解剖形态及血管功能的改变,探讨不同给药途径的肿瘤抗血管生成治疗的疗效差异。方法 新西兰大白兔18只,建立兔后腿移植瘤动物模型,按数字法随机分成3组,每组6只,分别经静脉给药途径（静脉组）、局部瘤内注药途径（局部组）给予重组人血管内皮抑制素注射液和局部生理盐水注射（对照组）处理。治疗7 d后测量各组VX2肿瘤体积,利用CT灌注成像参数血流量（BF）、血容量（BV）和表面渗透性（PS）进行血管功能评价;与病理结果和免疫组化检测的微血管密度（MVD）进行对照分析。结果 建模成功率100%。静脉组及局部组肿瘤体积较对照组小（P ＜ 0.05）,静脉组及局部组抑瘤率分别为50.52%和56.21%。此外,局部组中有1只动物肿瘤出现明显坏死。CT灌注检查显示静脉组及局部组治疗后CT灌注参数BF、BV及PS较治疗前减少（P ＜ 0.05）,而对照组治疗前后灌注参数差异无统计学意义（P > 0.05）。另外,治疗后各组间CT灌注参数比较,静脉组与局部组间的BF、BV、PS差异无统计学意义（P ＞ 0.05）。静脉组及局部组BF、BV、PS平均值均少于对照组（P ＜ 0.05）。病理组织学检查显示静脉组及局部组切片中组织内可见大片坏死结构,对照组肿瘤内少量坏死。免疫组化检查显示静脉组与局部组间MVD差异无统计学意义（P ＞ 0.05）。而静脉组与局部组MVD均低于对照组（P ＜ 0.05）。相关性分析提示CT灌注参数与MVD之间均具有相关性。结论 CT灌注成像技术是评估肿瘤血管生成及血管功能状态的有效、便捷方法。抗血管生成药物的局部瘤内注射术是有效的抗肿瘤治疗方案。

     

磁共振扩散加权成像在肝癌TACE术后随访中的定性和定量应用

目的探讨MR扩散加权成像（DWI）在肝癌经导管动脉化疗栓塞术（TACE）后随访中定性和定量评价残留或复发肿瘤组织的能力。方法对１６例行TACE术后肝癌患者分别进行DWI、上腹部增强CT和DSA造影检查。DWI检查取扩散敏感梯度因子（b值为０及５００s／mm ２ ），利用固定参数组合的自旋回波－平面回波（SE-EPI）序列。与上腹部增强CT和DSA造影检查相对照，观察碘化油沉积灶、肿瘤坏死组织和肿瘤组织在DWI上的信号特征；分别测量TACE术后病灶的ADC值和对应的CT最大强化值，并作相关性分析。结果DWI显示TACE术后病灶内部信号较复杂，２例（２／１６）病灶碘油沉积完整，DSA检查无肿瘤染色，CT图像显示为完整的碘化油沉积灶，DWI为均匀低信号；２例（２／１６）病灶为碘油沉积但出现局部缺损，DSA检查可见缺损区肿瘤染色，DWI图像上碘油沉积区表现为低信号，肿瘤染色区为高信号；１２例（１２／１６）病灶DSA检查可见无或稍许碘油沉积，造影见大量肿瘤染色，其内可见无或轻微染色的缺血、坏死肿瘤组织，DWI图像上肿瘤染色区域表现为高信号，缺血坏死区为低或较低信号；对１４例（１４／１６）病灶内肿瘤组织的ADC值与其最大CT强化值进行相关性分析，两者存在相关性（r＝－０．７６４９０，P＜０．０１）。结论DWI是一种灵敏的检测肝癌TACE术后肝内新发病灶的无创性成像方法，可监测TACE术后病灶残留或复发活组织和坏死情况，小b值（５００s／mm ２ ）的ADC值可在一定程度上反映肿瘤的血供，可以用于肝癌TACE术后随访。     

海藻酸钠微球与碘化油栓塞治疗兔VX2肝转移瘤对比研究

【摘要】 目的 对比海藻酸钠（KMG）微球与碘化油栓塞治疗兔VX2肝转移瘤模型效果，分析KMG微球栓塞治疗肿瘤的安全有效性及可行性。方法 VX2肿瘤细胞悬液（浓度1×107/ml）1 ml接种新西兰大白兔脾脏，制作兔肝转移瘤模型。50只成功建模的兔模型随机分为3组，A组（n=20）以KMG微球栓塞肝固有动脉，B组（n=20）于以碘化油栓塞肝固有动脉，C组（n=10）未作栓塞。A、B组接种瘤株后15 d作DSA造影及栓塞治疗。分别观察各组模型兔子生存时间（接种VX2瘤株至死亡），栓塞前、栓塞后7 d及栓塞后14 d测定谷氨酸转氨酶（ALT）和天冬氨酸转氨酶（AST）值，栓塞后7 d CT灌注扫描检测瘤灶边缘血流量（BF）、血容量（BV）及肝动脉分数（HAF）；兔模型死亡后取肝脏作苏木精-伊红（HE）染色病理切片，镜下观察肿瘤坏死情况。结果 A组KMG微球栓塞剂平均用量为（0.15±0.03） g，B组碘化油栓塞剂平均用量为（1.3±0.4） ml，均无栓塞剂反流。栓塞后7 d、14 d血清ALT、AST值，A、B两组均较术前明显升高，C组变化不明显；A、B两组与C组相比，差异均有显著统计学意义（P=0.015，P=0.005），但A、B两组间差异无统计学意义（P=0.423）。栓塞后7 d CT灌注扫描显示，A组BV、BF、HAF值明显低于B组（P=0.003，P=0.002，P＜0.000 1）。兔模型生存时间分别为A组（46.28±2.85） d、B组（43.92±2.17） d、C组（33.44±1.86） d，A、B两组均明显长于C组（P=0.001，P=0.004）。A、B两组组织病理HE染色显示，癌巢中央可见大片坏死，坏死区中残存瘤细胞核明显固缩。结论 KMG微球作为肿瘤栓塞剂安全有效、可行。KMG微球栓塞治疗兔VX2肝转移瘤效果优于碘化油。

     

肝动脉化疗栓塞联合门静脉栓塞治疗中晚期肝癌的疗效评价

目的评价经导管肝动脉化疗栓塞术（TACE）联合门静脉化疗栓塞术（PVCE）治疗中晚期肝癌的疗效。方法中晚期肝癌患者４８例,随机分为治疗组２２例和对照组２６例,分别采用TACE联合PVCE和常规TACE方法治疗。结果术后复查CT和甲胎蛋白（AFP）,治疗组有效率较对照组高,两组差异有统计学意义（P＜０．０５）。治疗组术后非栓塞肝组织体积显著增大。结论TACE和PVCE联合治疗中晚期肝癌疗效优于单独TACE技术,且可有效增加手术切除率。     

不同微创介入治疗原发性肝癌对机体T细胞免疫功能的影响

【摘要】 目的 探讨微创介入治疗肝癌对机体T细胞免疫功能的影响。方法 肝动脉栓塞化疗（TACE）治疗肝癌31例，射频消融（RFA）治疗肝癌19例，根据肿瘤直径大小分为小肝癌组（直径 ≤ 5 cm）和大肝癌组（直径 > 5 cm）。分别于术前及术后1、7 d留置外周血，用流式细胞术检测CD3、CD4、CD8及 CD4/CD8比值的变化。结果 小肝癌组，TACE与RFA治疗术后1 d外周血T细胞亚群无明显变化，但术后7 d时，RFA治疗组外周血T细胞亚群 CD3、CD4、CD8及CD4/CD8比值较治疗前相比明显增高，而TACE组外周血T细胞亚群 CD4及CD4/CD8比值较治疗前明显下降。大肝癌组，无论TACE还是RFA治疗，术后1 d外周血T细胞亚群指标较治疗前明显下降（P < 0.05），而7 d后外周血T细胞亚群 CD3、CD4、CD8及CD4/CD8比值较治疗前显著增高，其中RFA组T细胞亚群较TACE组恢复更为显著。结论 不同微创治疗方式治疗肝癌后对机体T细胞免疫系统影响不同，与肿瘤大小密切相关。

     

经动脉化疗栓塞联合索拉非尼治疗肝癌的肝动脉血流动力学

夏燕娜  郭华  谭红娜  姬丽娟  高剑波 《工业加热》2014,(3):232-235

火电厂节能工作浅析

本文探讨了火电厂节能基本程序和工作方法,分析节能工作要从基础工作、技术创新、设备整治、燃烧管理等方面入手的论述.     

浅析磨合期汽车的使用

如何合理使用磨合期的汽车，使其摩擦机件的磨损量能够平稳、均匀地磨合而不至于过度磨损，对汽车实际使用寿命有着重要的意义。从机器磨合期的特点和磨损机理出发，对汽车磨合期如何正确使用进行了有实际意义的探讨。     

Geothermal energy in agriculture in Yugoslavia

SFR Yugoslavia has natural hot water springs practically all over its territory, indicating the presence of geothermal reservoirs underground. There is no final estimate of how much energy can be expected from this new resource, except for figures based on the results of studies and investigations.The first use of geothermal energy in Yugoslavia in numerous spas dates back to the 19th century. Some remarkable examples of central heating are known, but the most widespread use is in agriculture (in greenhouse heating, farm heating and drying of agricultural products).     

Energy conservation measures in an institutional building in sub-tropical climate in Australia

In this study, various energy conservation measures (ECMs) on heating, ventilating and air conditioning (HVAC) and lighting systems for a four-storied institutional building in sub-tropical (hot and humid climate) Queensland, Australia are evaluated using the simulation software called DesignBuilder (DB). Base case scenario of energy consumption profiles of existing systems are analysed and simulated first then, the simulated results are verified by on-site measured data. Three categories of ECMs, namely major investment ECMs (variable air volume (VAV) systems against constant air volume (CAV); and low coefficient of performance (COP) chillers against high COP chillers); minor investment ECMs (photo electric dimming control system against general lighting, and double glazed low emittance windows against single-glazed windows) and zero investment ECMs (reset heating and cooling set point temperatures) are evaluated. It is found that the building considered in this study can save up to 41.87% energy without compromising occupancies thermal comfort by implementing the above mentioned ECMs into the existing system.     

Uncertainties in decarbonising heat in the UK

Heating is arguably one of the most difficult sectors to decarbonise in the UK's energy system. Meeting the 80% greenhouse gas emission reduction target by 2050 is likely to require that heat related emissions of CO₂ from buildings are near zero by 2050, and there is a 70% reduction in emissions from industry (from 1990 levels). Though it is clear that the use of the natural gas network will reduce over time, recent modelling suggests a limited residual role for gas by 2050 to help meet peaks in heat demand. High levels of uncertainty about the way in which heat will be decarbonised present a number of challenges to policy makers. This paper will explore the risks and uncertainties associated with the transition to a low carbon heat system in the UK as outlined by the 4th carbon budget review. The potential impact of key uncertainties on the levelised costs of heat technologies and the development of energy networks are explored using a sensitivity analysis approach. Policy changes required to decarbonise the heat sector are also examined.     

Viscous heating in liquid flows in micro-channels

Many experimental works on forced convection through micro-channels evidenced that when the hydraulic diameter is less than 1 mm, conventional theory can no longer be considered as suitable to predict the pressure drop and convective heat transfer coefficients. This conclusion seemed valid for both gas and liquid flows. Sometimes the authors justified this claim by invoking “new” micro-effects. On the contrary, in this paper the explanation of the experimental results obtained for micro-channels in terms of friction factors will be researched inside the conventional theory (Navier-Stokes equations). In particular, this paper will focus on the role of viscous heating in fluids flowing through micro-channels. A criterion will be presented to draw the limit of significance for viscous dissipation effects in micro-channel flows. The role of the cross-sectional geometry on viscous dissipation will be highlighted and the minimum Reynolds number for which viscous dissipation effects can no longer be neglected will be calculated as a function of the hydraulic diameter and of the micro-channel geometry for different fluids. It will be demonstrated how viscous effects can explain some experimental results on the Poiseuille numbers in micro-channels, which recently appeared in the open literature.     

Solar drying in sludge management in Turkey

Two main wastewater treatment plants in Bursa city in Turkey will start to operate and produce at least 27,000 tons of dry solids per year by the end of 2006. The purpose of this study was to investigate an economical solution to the sludge management problem that Bursa city would encounter. The general trend in Turkey is mechanical dewatering to obtain a dry solid (DS) content of 20%, and liming the mechanically dewatered sludge to reach the legal landfilling requirement, 35% DS content. This study recommends limited liming & solar drying as an alternative to only-liming the mechanically dewatered sludge. Open and covered solar sludge drying plants were constructed in pilot scale for experimental purposes. Dry solids and climatic conditions were constantly measured. Faecal coliform reduction was also monitored. The specially designed covered solar drying plant proved to be more efficient than the open plant in terms of drying and faecal coliform reduction. It was found that, if the limited liming & solar drying method was applied after mechanical dewatering instead of only-liming method, the total amount of the sludge to be disposed would be reduced by approximately 40%. This would lead to a reduction in the transportation, handling, and landfilling costs. The covered drying system would amortize itself in 4 years.     

Electoral cycles in electricity losses in India

A third of electricity in India is lost each year, where losses refer to power that is supplied but not billed. Utilizing data from the power corporation of Uttar Pradesh, India's most populous state, we study the politics of electricity losses. Examining annual data over four decades, we document that UP's electricity losses tend to increase in periods immediately prior to state assembly elections. Drawing upon geographically disaggregated data for the period 2000–09, we observe higher line losses just prior to the 2002 and 2007 state elections. Our analysis shows that the incumbent party was more likely to retain the assembly seat as line losses in the locality increased. We interpret these results as corroboration that political parties deliberately redirect electricity to flat rate and unbilled users in a context of chronically inadequate supply. Political factors appear to affect line losses in ways that technical and economic factors alone cannot explain.     

Energy consumption in rural transportation in India

Energy consumption in rural transportation has been computed, taking into account the energy embodied in vehicles or bullocks, as well as the fuels or feeds and food (of operators). Bullock cart transport consumes over four times more energy than vehicles. However, animal transport will continue to be preferred because of its availability.