In vivo solid phase microextraction for therapeutic monitoring and pharmacometabolomic fingerprinting of lung during in vivo lung perfusion of FOLFOX

In vivo lung perfusion(IVLP)is a novel isolated lung technique developed to enable the local,in situ administration of high-dose chemotherapy to treat metastatic lung cancer.Combination therapy using folinic acid(FOL),5-fluorouracil(F),and oxaliplatin(OX)(FOLFOX)is routinely employed to treat several types of solid tumours in various tissues.However,F is characterized by large interpatient variability with respect to plasma concentration,which necessitates close monitoring during treatments using of this compound.Since plasma drug concentrations often do not reflect tissue drug concentrations,it is essential to utilize sample-preparation methods specifically suited to monitoring drug levels in target organs.In this work,in vivo solid-phase microextraction(in vivo SPME)is proposed as an effective tool for quantitative therapeutic drug monitoring of FOLFOX in porcine lungs during pre-clinical IVLP and intravenous(IV)trials.The concomitant extraction of other endogenous and exogenous small molecules from the lung and their detection via liquid chromatography coupled to high resolution mass spectrometry(LC-HRMS)enabled an assessment of FOLFOX's impact on the metabolomic profile of the lung and revealed the metabolic pathways associated with the route of administration(IVLP vs.IV)and the therapy itself.This study also shows that the immediate instrumental analysis of metabolomic samples is ideal,as long-term storage at80℃ results in changes in the metabolite content in the sample extracts.

Spectral CT imaging as a new quantitative tool? Assessment of perfusion defects of pulmonary parenchyma in patients with lung cancer

Objective： This study investigated the capability of dual-energy spectral computed tomography （CT） to quantitatively evaluate lung perfusion defects that are induced by central lung cancer. Methods： Thirty-two patients with central lung cancer underwent CT angiography using spectral imaging. A univariate general linear model was conducted to analyze the variance of iodine concentration/CT value with three factors of lung fields. A paired t-test was used to compare iodine concentrations and CT values between the distal end of lung cancer and the corresponding area in the contralateral normal lung. Results： Iodine concentrations increased progressively in the far, intermediate and near ground sides in the normal lung fields at 0.60±0.28, 0.93±0.27 and 1.25±0.38 mg/mL, respectively （P〈0.001）. The same trend was observed for the CT values [-（840.64±49.08）, -（812.66±50.85） and -（760.83±89.17） HU, P〈0.001]. The iodine concentration （0.70±0.42 mg/mL） of the lung field in the distal end of lung cancer was significantly lower than the corresponding area in the contralateral normal lung （1.19±0.62 mg/mL） （t=-7.23, P〈0.001）. However, the CT value of lung field in the distal end of lung cancer was significantly higher than the corresponding area in the contralateral normal lung [-（765.29±93.34） HU vs. -（800.07±76.18） HU, t=3.564, P=0.001]. Conclusions： Spectral CT imaging based on the spectral differentiation of iodine is feasible and can quantitatively evaluate pulmonary perfusion and identify perfusion defects that are induced by central lung cancer. Spectral CT seems to be a promising technique for the simultaneous evaluation of both morphological and functional lung information.

Correlation analysis of dual-energy CT iodine maps with quantitative pulmonary perfusion MRI

AIM:To correlate dual-energy computed tomography(DECT) pulmonary angiography derived iodine maps with parameter maps of quantitative pulmonary perfusion magnetic resonance imaging(MRI).METHODS:Eighteen patients with pulmonary perfusion defects detected on DECT derived iodine maps were included in this prospective study and additionally underwent time-resolved contrast-enhanced pulmonary MRI [dynamic contrast enhanced(DCE)-MRI].DCE-MRI data were quantitatively analyzed using a pixel-by-pixel deconvolution analysis calculating regional pulmonary blood flow(PBF),pulmonary blood volume(PBV) and mean transit time(MTT) in visually normal lung parenchyma and perfusion defects.Perfusion parameterswere correlated to mean attenuation values of normal lung and perfusion defects on DECT iodine maps.Two readers rated the concordance of perfusion defects in a visual analysis using a 5-point Likert-scale(1 = no correlation,5 = excellent correlation).RESULTS:In visually normal pulmonary tissue mean DECT and MRI values were:22.6 ± 8.3 Hounsfield units(HU);PBF:58.8 ± 36.0 mL/100 mL per minute;PBV:16.6 ± 8.5 mL;MTT:17.1 ± 10.3 s.In areas with restricted perfusion mean DECT and MRI values were:4.0 ± 3.9 HU;PBF:10.3 ± 5.5 mL/100 mL per minute,PBV:5 ± 4 mL,MTT:21.6 ± 14.0 s.The differences between visually normal parenchyma and areas of restricted perfusion were statistically significant for PBF,PBV and DECT(P < 0.0001).No linear correlation was found between MRI perfusion parameters and attenuation values of DECT iodine maps(PBF:r = 0.35,P = 0.15;PBV:r = 0.34,P = 0.16;MTT:r = 0.41,P = 0.08).Visual analysis revealed a moderate correlation between perfusion defects on DECT iodine maps and the parameter maps of DCE-MRI(mean score 3.6,k 0.45).CONCLUSION:There is a moderate visual but not statistically significant correlation between DECT iodine maps and perfusion parameter maps of DCE-MRI.

The Use of CT Perfusion to Determine Microvessel Density in Lung Cancer: Comparison with FDG-PET and Pathology

Objective： To investigate the validity of CT perfusion in assessing angiogenic activity of lung cancer. Methods： Fifty-six patients with lung cancer scheduled for elective surgical resection received 16-slice helical CT perfusion imaging. Time-density curve （TDC）, blood flow （BF）, blood volume （BV）, mean transmit time （MTT） and permeability surface area product （PS） were calculated. 18F-deoxyglucose-positron emission tomography （FGD-PET） was carried out in 14 out of the 56 patients to calculate standardized uptake values （SUVs）. Tumor microvessel density （MVD） was examined using CD34 immunohistochemical staining of the resected tumor tissue. Pearson’s correlation analysis was used to evaluate potential correlation between CT perfusion parameters and MVD or SUV. Results： Average time to peak height （TPH） of the TDCs （including two types of TDC） was 24.38±5.69 seconds. Average BF, BV, MTT and PS were 93.42±53.45 ml/100g/min,93.42±53.45 ml/100g,6.83±4.51 s and 31.92±18.73 ml/100g/min, respectively. Average MVD was 62.04±29.06/HPF. The mean SUV was 6.33±3.26. BF was positively correlated with MVD （r=0.620,P0.01） and SUV （r=0.891, P0.01）. PS was also positively correlated with SUV （r=0.720, P0.05）. A positive correlation was also observed between tumor MVD and SUV （r=0.915, P0.01）. Conclusions： CT perfusion imaging is a reliable tool to evaluate the tumor neovascularity of lung cancer.

Positron emission tomography to assess hypoxia and perfusion in lung cancer

In lung cancer, tumor hypoxia is a characteristic feature, which is associated with a poor prognosis and resistance to both radiation therapy and chemotherapy. As the development of tumor hypoxia is associated with decreased perfusion, perfusion measurements provide more insight into the relation between hypoxia and perfusion in malignant tumors. Positron emission tomography(PET) is a highly sensitive nuclear imaging technique that is suited for non-invasive in vivo monitoring of dynamic processes including hypoxia and its associated parameter perfusion. The PET technique enables quantitative assessment of hypoxia and perfusion in tumors. To this end, consecutive PET scans can be performed in one scan session. Using different hypoxia tracers, PET imaging may provide insight into the prognostic significance of hypoxia and perfusion in lung cancer. In addition, PET studies may play an important role in various stages of personalized medicine, as these may help to select patients for specifictreatments including radiation therapy, hypoxia modifying therapies, and antiangiogenic strategies. In addition, specific PET tracers can be applied for monitoring therapy. The present review provides an overview of the clinical applications of PET to measure hypoxia and perfusion in lung cancer. Available PET tracers and their characteristics as well as the applications of combined hypoxia and perfusion PET imaging are discussed.

Diagnosis of peripheral lung cancer using MSCT perfusion imaging compared with microvessel density (MVD)

Objective: To investigate the clinical diagnostic value of peripheral lung cancer using multi-slice CT (MSCT) perfu- sion imaging and the relationship with microvessel density (MVD). Methods: 38 patients with pulmonary masses proved by pathology including 25 cases of peripheral lung cancer and 13 cases of benign masses were studied prospectively with GE Lightspeed Qx/I plus 16-slice helical CT perfusion imaging, and 25 patients with lung cancer were comparative studied with its MVD calculated using LSAB. With the CT perfusion 2-body tumor software, the parameters of CT perfusion including blood value (BV), blood flow (BF), mean transit time (MTT) and permeability surface (PS) were analyzed. Results: The four param- eter values in lung cancer were all higher than that in pulmonary benign masses, and there were significant differences among BV, MTT and PS (P<0.05), especially in BV (P<0.01). The MVD value of lung cancer was higher than that of pulmonary benign masses (P<0.05), and the MVD of adenocarcinoma was higher than that of squamous cell carcinoma (P<0.05). In 25 cases with lung cancer, there was positive correlation only between BV and MVD value (r=0.852, P<0.01). Conclusion: It is helpful to diagnose the peripheral lung cancer with MSCT perfusion imaging and to differentiate from pulmonary benign masses, its bases are MVD pathologically.

Technetium-99m-labeled macroaggregated albumin lung perfusion scan for diagnosis of hepatopulmonary syndrome: A prospective study comparing brain uptake and whole-body uptake

BACKGROUND Hepatopulmonary syndrome (HPS) is an arterial oxygenation defect induced by intrapulmonary vascular dilatation (IPVD) in the setting of liver disease and/or portal hypertension.This syndrome occurs most often in cirrhotic patients(4%-32%) and has been shown to be detrimental to functional status,quality of life,and survival.The diagnosis of HPS in the setting of liver disease and/or portal hypertension requires the demonstration of IPVD (i.e.,diffuse or localized abnormally dilated pulmonary capillaries and pulmonary and pleural arteriovenous communications) and arterial oxygenation defects,preferably by contrast-enhanced echocardiography and measurement of the alveolar-arterial oxygen gradient,respectively.AIM To compare brain and whole-body uptake of technetium for diagnosing HPS.METHODS Sixty-nine patients with chronic liver disease and/or portal hypertension were prospectively included.Brain uptake and whole-body uptake were calculated using the geometric mean of technetium counts in the brain and lungs and in the entire body and lungs,respectively.RESULTS Thirty-two (46%) patients had IPVD as detected by contrast-enhancedechocardiography.The demographics and clinical characteristics of the patients with and without IPVD were not significantly different with the exception of the creatinine level (0.71±0.18 mg/dL vs 0.83±0.23 mg/dL;P=0.041),alveolararterial oxygen gradient (23.2±13.3 mmHg vs 16.4±14.1 mmHg;P=0.043),and arterial partial pressure of oxygen (81.0±12.1 mmHg vs 90.1±12.8 mmHg;P=0.004).Whole-body uptake was significantly higher in patients with IPVD than in patients without IPVD (48.0%±6.1%vs 40.1%±8.1%;P=0.001).The area under the curve of whole-body uptake for detecting IPVD was significantly higher than that of brain uptake (0.75 vs 0.54;P=0.025).The optimal cut-off values of brain uptake and whole-body uptake for detecting IPVD were 5.7%and 42.5%,respectively,based on Youden’s index.The sensitivity,specificity,and accuracy of brain uptake> 5.7%and whole-body uptake> 42.5%for detecting IPVD were23%,89%,and 59%and 100%,52%,and 74%,respectively.CONCLUSION Whole-body uptake is superior to brain uptake for diagnosing HPS.

Animal models of ex vivo lung perfusion as a platform for transplantation research

Ex vivo lung perfusion(EVLP) is a powerful experimental model for isolated lung research. EVLP allows for the lungs to be manipulated and characterized in an external environment so that the effect of specific ventilation/perfusion variables can be studied independent of other confounding physiologic contributions. At the same time,EVLP allows for normal organ level function and real-time monitoring of pulmonary physiology and mechanics. As a result,this technique provides uniqueadvantages over in vivo and in vitro models. Small and large animal models of EVLP have been developed and each of these models has their strengths and weaknesses. In this manuscript,we provide insight into the relative strengths of each model and describe how the development of advanced EVLP protocols is leading to a novel experimental platform that can be used to answer critical questions in pulmonary physiology and transplant medicine.

A Controlled Study on Comparing Differences in CT Perfusion Imaging between Rabbits inoculated with VX2 Lung Tumor and Patients with Squamous Cell Carcinoma of the Lung

OBJECTIVE By analysis and evaluation of the perfusion images and perfusion parameters of the rabbits with VX2 lung tumor, the association between the perfusion parameters and tumor angiogenesis of patients with squamous cell carcinoma of the lung has been studied in order to establish a non-invasive and effective way to detect tumor blood supply, which is be able to exhibit hemodynamic data in tumors during cancer treatments. METHODS Fifteen Netherlands rabbits inoculated with VX2 lung tumor （rabbit group） and 25 patients with squamous cell carcinoma of the lung （patient group） received a multi-slice spiral CT perfusion imaging test using the Netherlands PHILIPS Brilliance 16-slice spiral CT and a U.S. MEDRAD binocular highpressure syringe. Image postprocessing was done using the special perfusion software and EBW 4.0 Workstation. Perfusion volume （PV）, peak enhanced increment （PEI）, transit time peak （TTP）, and blood volume （BV） were measured and analyzed. RESULTS In the rabbit group, the values of the PV, PEI, TTP, and BV of the tumor margin were （53.89 ± 13.38） mL/（min.mL）, （45.71 ± 15.52） Hu, （39.29 ± 10.10） sec, and （31.45 ± 18.19） mL/100 g, respectively; these values of the tumor center were （36.57 ± 14.17） mL/（min.mL）, （28.64 ± 11.74） Hu, （39.00 ＋ 9.78） sec, and （19.76 ± 13.95） mL/100 g, respectively; the values of the muscles were （12.45± 4.38） mL/（min.mL）, （10.98 ± 5.03） Hu, （38.86 ± 10.04） sec, and （5.38 ±2.87） mL/100 g, respectively. The values of the relative perfusion volume （RPV）, relative peak enhanced increment （RPEI）, and relative blood volume （RBV） of the tumor margin were 4.38 ± 1.45, 3.96± 1.45, 9.99 ± 11.7, respectively; these values of the tumor center were 2.14 ± 1.08, 1.83±1.45, 4.17 ±3.39, respectively. The values of the PV, PEL BV of the tumor margin vs. the values of the muscles developed t-values, which were 15.028, 10.79, and 5.88, respectively （P ≤ 0.01）, with statistical significance; the values of the PV, PEI, BV of the tumor center vs. the values of the muscles produced t-values, which were 8.67, 7.49, and 4.55, respectively （P 〈 0.01）, with statistical significance. The values of the TTP of the tumor margin vs. TTP values of the muscles, and the TTP values of the tumor center vs. TTP values of the muscles developed t-values, which were 1.7 and 0.806, respectively （P ≥ 0.05）, without statistical significance. In the patient group, the values of the PV, PE, TTP, and BV of the tumor margin were （88.95 ± 30.89） mL/（min.mL）, （61.87 ± 27.31） Hu, （37.72 ± 12.53） sec, and （18.38 ± 7.2） mL/100 g, respectively; these values of the tumor center were （39.77 ± 18.29） mL/（min.mL）, （14.57 ± 8.1） Hu, （35.64 ± 12.41） sec, and （11.22 ± 6.02） mL/100 g, respectively; these values of the muscles were （12.45 ± 6.5） mL/（min.mL）, （6.14 ± 2.66） Hu, （35.68± 12.35） sec, and （2.23 ± 1.11） mL/100 g, respectively. The values of the RPV, RPEI, and RBV of the tumor margin were 8.05 ± 5.04, 8.87 ± 4.32, and 12.16 ± 8.49, respectively; these values of the tumor center were 2.39 ± 1.68, 2.97 ± 2.1, 3.53 ± 2.82, respectively. The values of the PV, PEI, BV of the tumor margin in the patient group vs. the values of the muscles produced t-values, which were 13.8, 10.85, and 12.22, respectively （P 〈 0.01）, with significant differences; these values of the tumor center vs. the values of the muscles developed t-values, which were 9.158, 6.26, 8.654, respectively （P 〈 0.01）, with significant differences. The TTP value of the tumor margin vs. that of the muscles produced t-value, which was 0.371, and the TTP value of the tumor center vs. that of the muscles developed t-value, which was 1 （P 〉 0.05）, without statistical difference. CONCLUSION CT perfusion imaging technics demonstrates directly dynamic changes of blood flow to tumors, which assists in identifying tumor growth and necrosis, therefore, this research provides an evidence-based guidelines for the treatment of human lung squamous cell carcinoma and has far-reaching clinical significance.

Metabolomic fingerprinting of porcine lung tissue during pre-clinical prolonged ex vivo lung perfusion using in vivo SPME coupled with LC-HRMS

Normothermic ex vivo lung perfusion(NEVLP)has emerged as a modernized organ preservation technique that allows for detailed assessment of donor lung function prior to transplantation.The main goal of this study was to identify potential biomarkers of lung function and/or injury during a prolonged(19 h)NEVLP procedure using in vivo solid-phase microextraction(SPME)technology followed by liquid chromatography-high resolution mass spectrometry(LC-HRMS).The use of minimally invasive in vivo SPME fibers for repeated sampling of biological tissue permits the monitoring and evaluation of biochemical changes and alterations in the metabolomic profile of the lung.These in vivo SPME fibers were directly introduced into the lung and were also used to extract metabolites(on-site SPME)from fresh perfusate samples collected alongside lung samplings.A subsequent goal of the study was to assess the feasibility of SPME as an in vivo method in metabolomics studies,in comparison to the traditional inlab metabolomics workflow.Several upregulated biochemical pathways involved in pro-and antiinflammatory responses,as well as lipid metabolism,were observed during extended lung perfusion,especially between the 11th and 12th hours of the procedure,in both lung and perfusate samples.However,several unstable and/or short-lived metabolites,such as neuroprostanes,have been extracted from lung tissue in vivo using SPME fibers.On-site monitoring of the metabolomic profiles of both lung tissues through in vivo SPME and perfusate samples on site throughout the prolonged NEVLP procedure can be effectively performed using in vivo SPME technology.

Mechanical circulatory support in lung transplantation: Cardiopulmonary bypass, extracorporeal life support, and ex-vivo lung perfusion

Lung transplant is the standard of care for patients with end-stage lung disease refractory to medical management. There is currently a critical organ shortage for lung transplantation with only 17% of offered organs being transplanted. Of those patients receiving a lung transplant, up to 25% will develop primary graft dysfunction, which is associated with an 8-fold increase in 30-d mortality. There are numerous mechanical lung assistance modalities that may be employed to help combat these challenges. We will discuss the use of mechanical lung assistance during lung transplantation, as a bridge to transplant, as a treatment for primary graft dysfunction, and finally as a means to remodel and evaluate organs deemed unsuitable for transplant, thus increasing the donor pool, improving survival to transplant, and improving overall patient survival.

Correlation between Automated Quantification of Lung Perfusion Blood Volume (PBV) and Pulmonary Artery Pressure

Purpose: Dual-energy CT (DECT) can be used for quantification of lung perfusion blood volume (PBV), allowing objective evaluation. However, no reports have investigated pulmonary perfusion correlating with pulmonary artery pressure (PAP) in patients with chronic pulmonary diseases. The purpose was to evaluate automated quantification of the lung PBV using dual-energy CT, and its correlation with PAP. Methods: 274 patients who underwent echocardiography within two weeks also underwent CT. The population was divided into high (&ge;40 mmHg) and low (<40 mmHg) estimated systolic PAP (sPAP) groups (n = 63 and n = 211, respectively). We retrospectively eva-luated the lung PBV using Syngo software, and correlations between the lung PBV and estimated sPAP. Results: Lung PBV values were 25.0 ± 9.6 and 29.0 ± 9.3 Hounsfield units (HU) in high and low sPAP groups, respectively, with a significant difference between them (p = 0.003). In the high sPAP group with underlying lung diseases (n = 15), chronic thromboembolism (n = 25), pulmonary artery stenosis (n = 12), and left heart failure (n = 11), using the Dana Point classification system, lung PBV values were 18.6 ± 1.6, 25.1 ± 4.5, 25.8 ± 4.5, and 32.7 ± 9.4 HU, respectively. There were significant differences in quantification of the lung PBV among them. The mean sPAP of subjects with left heart failure was significantly higher than in the others. In subjects with left heart failure, a positive correlation between the lung PBV value and sPAP was noted (R = 0.721, p < 0.0001). Conclusions: Automated quantification of the lung PBV may estimate the high sPAP. The lung PBV may contribute to clarifying the etiology of a high PAP due to left heart failure.

Correlation study between CT perfusion parameters of non-small cell lung cancer and angiogenesis, cell proliferation as well as tumor load

Objective:To study the correlation between CT perfusion parameters of non-small cell lung cancer and angiogenesis, cell proliferation as well as tumor load.Methods: Patients diagnosed with non-small cell lung cancer in our hospital between May 2012 and December 2015 were selected, CT perfusion was used to measure the blood volume (BV), blood flow (BF) and time to peak (TTP) of lung cancer lesions and unaffected-side lung tissue, and the lung cancer tissue and para-carcinoma tissue were collected to determine the expression of angiogenesis and cell proliferation molecules.Results:BV and BF of non-small cell lung cancer tissue were significantly higher than those of unaffected-side lung tissue while TTP was significantly shorter than that of unaffected-side lung tissue;PCDGF, bFGF, FGFR, VEGF, VEGFR, TCF3, Skp2, Livin and Survivin expression in non-small cell lung cancer tissue were significantly higher than those in para-carcinoma tissue, positively correlated with BV and BF, and negatively correlated with TTP.Conclusion:CT perfusion parameters BV, BF and TTP are closely related to the expression of angiogenesis molecules and cell proliferation molecules in non-small cell lung cancer lesions, and are valuable for the assessment of angiogenesis and cell proliferation.

Assessment of the efficacy and safety of bronchial artery perfusion chemotherapy combined with high-frequency hyperthermia for advanced non-small cell lung cancer

Objective:To study the efficacy and safety of bronchial artery perfusion chemotherapy combined with high-frequency hyperthermia for advanced non-small cell lung cancer. Methods:Patients with advanced non-small cell lung cancer who were treated in Navy General Hospital between May 2014 and October 2016 were selected and randomly divided into two groups, the observation group received bronchial arterial infusion chemotherapy combined with high-frequency hyperthermia, and the control group received bronchial arterial infusion chemotherapy. Before and after treatment, the expression of tumor activity indexes and liver and kidney function indexes in serum as well as and proliferation and invasion genes in tumor lesions were detected respectively.Results: 5 d and 7 d after treatment, serum CEA, MIF, CYFRA21-1 and HE4 levels of both groups of patients were significantly lower than those before treatment and serum CEA, MIF, CYFRA21-1 and HE4 levels of observation group were significantly lower than those of control group;7 d after treatment, MEF2D, c-myc, Survivin, Bcl-2, Vimentin, N-cadherin and Slug expression in tumor lesions of both groups of patients were significantly lower than those before treatment and MEF2D, c-myc, Survivin, Bcl-2, Vimentin, N-cadherin and Slug expression in tumor lesions of observation group were significantly lower than those of control group;serum Scr, BUN, ALT and AST levels were not significantly different between two groups of patients before and after treatment. Conclusion:Bronchial artery perfusion chemotherapy combined with high-frequency hyperthermia for advanced non-small cell lung cancer can significantly inhibit the tumor proliferation and invasion and is with ideal safety.

输入动脉选择对CT Perfusion 3.0软件包肺灌注成像的影响

目的:探讨输入动脉的选择对CT Perfusion 3.0软件包肺灌注成像的影响。方法:健康新西兰白兔2只,非离子型对比剂优维显5ml,对比剂的注射流率分别为0.1、0.3、0.5和0.8ml/s。所得数据传输到工作站,经Perfusion 3.0软件包以三种不同的灌注成像方案处理。结果:以主动脉为输入动脉的体部肿瘤方案组所计算的血容量(BV)、血流量(BF)分别与以肺动脉为输入动脉组和肝脏肿瘤方案组所得数值间差异存在显著性意义(t=4.376、t=2.779);以肺动脉为输入动脉组和肝脏肿瘤方案组所得数值组间差异无显著性意义(t=1.5)。结论:应用CT Perfusion 3.0软件包,选择不同的输入动脉会对肺灌注成像结果产生影响,其实际应用有待进一步研究。

Association of CT perfusion imaging with plasma levels of TGF-β1 and VEGF in patients with NSCLC

Objective: To study the association of CT perfusion imaging parameters with plasma level of transforming growth factor-β1(TGF-β1) and vascular endothelial growth(VEGF) in patients with non small cell cancer(NSCLC). Methods: A total of 67 patients with NSCLC(NSCLC group) and 64 patients with benign lesion(control group) were given with CT perfusion imaging to obtain blood flow, blood volume, mean transit time, time to peal and permeability surface through CT perfusion software. The plasma levels of TGF-β1 and VEGF were tested by ELISA. The relationship between plasma levels of TGF-β1, VEGF and CT perfusion imaging parameters were analyzed. Results: CT perfusion imaging parameters and the plasma levels of TGF-β1 and VEGF of NSCLC group were significantly higher than the control group(P<0.05), while CT perfusion parameters and the levels of TGF-β1 and VEGF in NSCLC group showed significant difference in different tumor node metastasis stages(P<0.05). Correlation analysis showed that the level of plasma TGF-β1 and VEGF were positively correlated with blood flow, blood volume, and mean transit time(P<0.05), and negatively correlated with time to peal(P<0.05). There was no significant correlation between TGF-β1 and VEGF with the permeability surface. Conclusions: CT perfusion imaging parameters in patients with NSCLC is closely associated with plasma TGF-β1, VEGF and its biological characteristics. CT perfusion imaging is a convenient method to detect tumor blood perfusion.

Effects of amniotic fluid embolism-like plasma on isolated perfused rabbit lungs

<Abstract>Effects of amniotic fluid embolism-like plasma (AFEP) on the isolated perfused rabbit lungs (IPRL)were studied. It was found that AFEP could induce elevation of pulmonary artery pressure (PAP) and development of lung edema, which could be partially prevented by ibuprofen, a cycloxygenase inhibit0r, but amniotic fluid itself could not cause elevation of PAP and lung edema. The result suggests that AFEP-induced mediator from whole blood cells may be the important factor resulting in above-mentioned pathological changes.

采用MSCT灌注成像检查评估周围型非小细胞肺癌分化程度的可行性分析

目的分析多层螺旋CT(MSCT)灌注成像检查评估周围型非小细胞肺癌(NSCLC)分化程度的可行性。方法选取本院2017年7月至2018年10月本院收治确诊的52例周围型NSCLC患者作为研究对象,比较不同分化级别患者的MSCT灌注成像参数;分析灌注参数与分化程度的相关性。结果高分化、中分化周围型NSCLC患者BF、BV、PS、MTT及PH数值均高于低分化周围型NSCLC,以高分化周围型NSCLC的BF、BV、PS、MTT及PH数值最高。各个灌注参数值,其中高分化、中分化周围型NSCLC的BF、PH与低分化周围型NSCLC比较差异显著(P<0.05),三者BV、PS及MTT数值比较,均为明显差异(P>0.05)。周围型NSCLC患者灌注参数BF、PH与其分化程度成负相关,且相关性显著(P<0.05)。结论MSCT灌注成像检查可有效反映周围型NSCLC的分化程度,其灌注参数中BF、PH对评估其分化程度有一定帮助,与周围型NSCLC分化程度具有一定相关性。

斑蝥酸钠维生素B_(6)联合化疗药物胸腔内热灌注治疗肺癌合并恶性胸腔积液的疗效和安全性

目的观察斑蝥酸钠维生素B_(6)联合化疗药物胸腔内热灌注治疗肺癌合并恶性胸腔积液的疗效和安全性。方法选取2018—2022年扬中市人民医院收治的肺癌合并恶性胸腔积液患者130例,按照随机抽签法分为A组与B组,各65例。所有患者将胸腔积液完全排出后,A组经导管注入注射用顺铂、地塞米松磷酸钠注射液、注射用人白介素-2胸腔内热灌注,B组在A组基础上加用斑蝥酸钠维生素B_(6)注射液胸腔内热灌注。比较2组临床疗效,KPS评分改善分级,治疗前后肿瘤标志物[癌胚抗原(CEA)、细胞角蛋白19片段抗原21-1(CYFRA21-1)和神经元特异性烯醇化酶(NSE)],不良反应。结果B组客观缓解率高于A组(82.67%vs.50.67%,χ^(2)=17.280,P<0.001)。B组KPS评分改善分级优于A组(u=2.053,P=0.040)。治疗后,2组血清CEA、CYFRA21-1、NSE水平低于治疗前,且B组低于A组(P<0.01)。B组与A组不良反应总发生率比较,差异无统计学意义(34.67%vs.29.33%,χ^(2)=0.490,P=0.484)。结论斑蝥酸钠维生素B_(6)联合化疗药物胸腔内热灌注治疗肺癌合并恶性胸腔积液可提高疗效、改善患者功能状态,抑制肿瘤标志物表达,延缓病情进展,且未提高不良反应发生率。

256层CT灌注成像联合半乳糖凝集素-3在术前肺癌纵隔淋巴结转移诊断中的应用

目的:分析256层CT灌注成像参数(CTPI)联合半乳糖凝集素-3(Gal-3)在术前肺癌纵隔淋巴结转移诊断中的应用价值。方法:回顾性分析2022年4月-2023年4月收治的87例肺癌患者的临床资料,根据纵隔淋巴结转移情况分为转移组(n=45)和未转移组(n=42)。另选取2022年4月-2023年4月进行体检的健康人群作为对照组(n=40)。对所有受试者进行血清Gal-3水平检测,并采用Brilliance iCT扫描仪进行CT灌注扫描。比较三组CTPI[表面通透性(PS)、灌注值(PV)、肺动脉血流量(PAF)、血容量(BV)、平均通过时间(MTT)、强化峰值(PEI)、支气管动脉血流量(BAF)]和血清Gal-3水平,并采用受试者工作特征(ROC)曲线评估CTPI、血清Gal-3水平及联合检测在术前肺癌纵隔淋巴结转移中的诊断效能。结果:转移组PS,PV和Gal-3均高于未转移组和对照组,未转移组PS,PV和Gal-3均高于对照组,差异有统计学意义(P<0.05)。ROC曲线分析显示,PS值、PV及Gal-3水平联合检测肺癌纵隔淋巴结转移的线下面积高于各项单独检测,差异有统计学意义(P<0.05)。结论:256层CTPI联合血清Gal-3检测对术前肺癌纵隔淋巴结转移具有较高的诊断价值,可为肺癌患者术前评估提供重要依据。