冷冻治疗古已有之.随着医疗器械、临床技术的不断发展,冷冻技术因其特有的优势在临床应用中占据着重要地位.冷冻不仅应用于皮肤表面疾病的治疗,而且也用于肺部肿瘤、胃部肿瘤等体内脏器疾病的治疗.此外,各种内镜腔内冷冻技术也在不断发展,扩大了冷冻在临床中的应用范围.其中经支气管镜冷冻治疗就用于多种临床疾病,包括恶性和良性中央气道阻塞的治疗,异物清除或支气管结核的治疗和支气管内活检等.有关研究证实了冷冻技术在气道疾病治疗中的有效性.作者就近年来经支气管镜介入冷冻技术在呼吸系统疾病中的应用及进展进行综述,以期相关临床工作者更加全面地了解经支气管镜介入冷冻技术的特点.

目的 探讨支气管镜介入技术在气管支气管结核所致中叶综合征治疗中的应用价值.方法 回顾性分析2015年11月至2017年12月解放军总医院第八医学中心全军结核病研究所确诊的全部气管支气管结核所致中叶综合征118例患者的临床资料,根据是否接受支气管镜介入治疗分为观察组(82例)和对照组(36例),对118例患者的临床症状、影像学表现、支气管镜下表现、气促评级、治疗效果进行对比分析.结果 观察组和对照组患者出院后6个月时的气促评级分别为(0.74±0.12)和(1.36±0.07),差异有统计学意义(t=2.791,P=0.006).观察组患者治疗后的总有效率为80.5％(66/82),对照组患者治疗后的总有效率为61.1％(22/36),两组患者治疗疗效比较差异有统计学意义(x2=12.743,P=0.002).结论 支气管镜介入技术可提高气管支气管结核所致中叶综合征治疗的有效率,是治疗气管支气管结核所致中叶综合征的重要手段.

Recent strides in micro-and nanofabrication technologies have enabled researchers to design and develop micro-and nanoscale robotic systems with enhanced power, functionality, and versatility. Because of their capability of remote actuation and navigation, synthetic micro-and nanomotors powered by oscillating magnetic fields have recently gained considerable attention. In this article, a new type of magnetic surface walker that can achieve speeds of up to 18.6 mu m s(-1) (approximate to 4 body length s(-1)) in an oscillating magnetic field operated at 25 Hz and approximate to 2.7 mT is reported. Two magnetic Janus microspheres spontaneously form a microdimer via magnetic dipolar interactions, and this microdimer rolls its two "feet" back and forth in an alternating fashion. In addition to propulsion, the oscillating magnetic field can also precisely steer these surface walkers through complicated structures, and an extensive discussion of their performance in various experimental conditions is provided. The reported propulsion mechanism opens new possibilities for the design of remotely actuated microrobots for a wide range of applications.

Photonic crystal nanocavities, which can be used to localize electromagnetic fields in a low refractive index region, hold great promise in fabricating micromechanical sensors for their potential applications in physical, chemical and biological engineering. In this paper, effects of optical and material properties on the performance of three different types of photonic crystal based mechanical sensors, i.e., force, displacement, and strain sensors, are investigated. The microcantilevers of sensors are made in Si and Si/SiO2 and exhibited in air and water atmosphere. As we found, both the resonant wavelength and the resonant wavelength shift for microcantilever mechanical sensors exhibit a linear relationship to the signal detection parameters (i.e., force, displacement, and strain) both in air and water. The sensitivity of force and strain sensors operated in water is higher than that in air. Si/SiO2 bilayer microcantilever sensor shows a higher sensitivity in force detection, whereas the Si cantilever sensor shows a higher sensitivity in strain and vertical displacement detection. The optical, material and mechanical properties of sensor material have great effect on the sensitivity of the new photonic crystal based microcantilever mechanical sensor.

Background: Previous studies indicated that the single nucleotide polymorphisms (SNPs) in TLR9 gene might be associated with Tuberculosis (TB) risk. However, the results are inconsistent and inconclusive.Methods: 1745 articles from four databases were involved in our study. A meta-analysis on the associations between the seven polymorphisms and TB risk was carried out by comparison using different genetic models.Results: In this systematic review 8 studies from seven English articles were analyzed. Our results showed that rs352139 is significantly associated with TB risk (AA vs. AG, OR 0.77, 95% CI 0.65-0.92, P = 0.004). In the ethnic subgroup analysis, Indonesians with AA genotype had a decreased susceptibility while Mexicans with GG allele had an increased risk.Conclusions: The meta-analysis indicated that rs352139 polymorphism might be associated with decreased TB risk in Indonesians whereas increased risk in Mexicans. Whether the observed association was due to causal effect needs to be further studied.

The regulatory mechanism of miRNA induction in response to Mycobacterium tuberculosis (MTB) infection has not been clearly established. Autophagy has recently been identified as an effective way to control intracellular survival of MTB. In the present study, we demonstrate a novel role of miR-30A in the negative regulation of the autophagy-mediated anti-MTB response. We found that overexpression of miR-30A suppresses the elimination of intracellular MTB through the inhibition of autophagy. Furthermore, there was a negative correlation between concentrations of miR-30A and beclin-1 in MTB positive patients and miR-30A expression decreased after anti-TB treatment. Our results indicate that miR-30A plays a key role in immune response against MTB and, therefore, may serve as a potential target for future treatments of tuberculosis infection.

The fluoroquinolone moxifloxacin has potent activity against Mycobacterium tuberculosis and has been recommended by the guidelines for the treatment of pulmonary tuberculosis (TB). Monotherapy is not recommended by the guidelines and only a few studies have evaluated the efficacy and safety of moxifloxacin plus standard first-line therapy in treating TB. The purpose of this meta-analysis was to further investigate the efficacy and safety of moxifloxacin plus standard therapy compared with standard therapy alone in treating patients with pulmonary TB. Medline, Cochrane, EMBASE and Google Scholar (until February 12, 2015) were searched for studies that evaluated the clinical efficacy and tolerability of moxifloxacin in the treatment of pulmonary TB. Rate of culture conversion and serious adverse events (SAEs) were assessed. Risk of bias and sensitivity analysis, using the leave-one-out approach, was used to assess the robustness of the findings. Six studies were included in the meta-analysis which covered 2056 patients with pulmonary TB. For all included studies, the drug regimens at least contained rifampicin and pyrazinamide and the length of treatment was at least eight weeks. The odds ratio (OR) for the negative culture rate for moxifloxacin plus first-line medications compared first-line medications alone (the control group) was 1.60 with 95% CI in 0.93-2.74 (P = 0.089), indicating the moxifloxacin plus first-line medications had no significantly greater rate of culture conversion compared with first-line medication alone. The odds ratio of SAEs for moxifloxacin plus first-line medications compared with first-line medications alone found no difference in rate of SAEs between treatment groups (OR = 0.94, P = 0.862). In conclusion, our meta-analysis suggests that there was a trend for the addition of moxifloxacin to standard first-line therapy for non-drug resistant TB resulted to increase the rate of culture conversion but this effect requires confirmation in more randomized control trials. (C) 2015 Elsevier Ltd. All rights reserved.

The ciprofloxacin chitosan microspheres for interventional bronchoscopy were prepared by phase inversion emulsification with glutaraldehyde as the crosslinking agent.The influence factors on appearance,average particle size,drug loading and encapsulation efficiency were optimized by single factor test and orthogonal design.The optimal product was spherical with the average particle size of(142.31±7.85)μm.The drug loading and encapsulation efficiency were(14.20±0.61)% and(56.43±1.31)%,respectively.The in vitro release of the product fitted to Higuchi equation.The cumulative amount at 2 h and 48 h were 44.3% and 92.1%,respectively.It indicated that the product had a sustained-release property,so that it might reduce the administration frequency.

Objective To preliminarily analyze the mechanism of drug resistance tuberculosis by observing the entire process of isoniazid-resistant tuberculosis in vitro experiments.Methods The tuberculosis virulent strain (H37RV) induced in the different levels of drug and 30 isolated strains of clinical drug resistance were detected by polymerase chain reaction-single strand conformation polymorphism (PCR-SSCP) and sequence analysis.Results PCR-SSCP electrophoresis was abnormal in 7th generation of H37RV.Confirmed by sequencing,katG gene occurred mutation,same as clinical mutant type.Conclusions Stimulating constantly tubercle bacillus with drug is an important reason that causes isoniazid-resistance.

<正>支气管结核(endobronchial tuberculosis,EBTB),是指发生在气管、支气管黏膜或黏膜下层及外膜(软骨和纤维组织)的结核病。国外文献报道,活动性肺结核患者中约有10%~40%并发EBTB[1-3]。目前我国尚无专门针对EBTB的流行病学调查,张广宇[4]对1992例进展期肺结核患者行纤维支气管镜

Objective To observe the efficacy and safety of subclavian arterial angiography and interventional treatment for massive hemoptysis of pulmonary tuberculosis.Methods The 257 patients were divided into two groups.Control group with 103 patients were received bronchial and intercostal angiography and embolization.Therapeutic group with 154 patients were received bronchial and intercostal and subclavian arterial angiography and embolization.The therapeutic effect,respond and complication were observed.Results The efficacy rate was 94.2% for therapeutic group and 80.6% for control group,with obviously statistically significant.Recurrence rate were 3.2% and 11.7%,with obviously statistically significant.Some patients had chest-back pain but no spinal cord injuries and abnormal position embolization postoperatively.The pain rate were 66.9% and 48.5%,with obviously statistically significant.However,severity pain rate were 7.8% and 2.9%,with no statistically significant.Conclusions The subclavian arterial angiography and interventional treatment can improve effective power and depress recurrence rate obviously.

Immune system is a complicated dynamic balance system. Tuberculosis infection,occurrence, development and prognosis are closely related to changes of immune system. The major protective immunity is cellular immunity which regulates immunization by T cell subsets. CD4 and CD8+ T cells play an important role in anti-tuberculosis infection. However, the interaction between immune cells is not isolated, a variety of cytokines are involved. The release of cytokines directly affect the immune response. The effective host protective immunity is important and irreplaceable for prevention and treatment of tuberculosis.

Objective To observe local and systemic immunity effect of Mycobacterium vaccae gel administered in lung. Methods 60 Japanese long-eared rabbits were randomly divided into five groups.Group 1 was injected with 3 ml normal sodium. Group 2 was injected with 3 ml carbomer gel. Group 3,4,5 were injected with 3 ml carbomer gel with 3.75,7.50,9.37 mg/L Mycobacterium vaccae. The peripheral blood T cell subsets and interferon-γ were tested. Results Before sacrificed,CD3 percents in group 4 and group 5 [(55.8±9.7) % and (54.5±11.8) %] were higher than that in group 1 [(43.1±3. 0) %] (all P ＜0.05),CD4 + percents in group 4 and group 5 [ (44.1 ± 5.8) % and (43.3 ± 6.2) %] were higher than that ingroup 1 [(33.5± 3.1)%] (all P ＜0.05),CD8+ percents in group 3, 4, 5 [(21.3±3.3)%,(21.1 ± 4.5) % and (20. 5 ± 4.1) % ] were lower than that in group 1 [ (28.2 ±1.7) % ] (all P ＜0.05).Interferon-γ was positive in the lung tissues injected with carbomer gel with Mycobacterium vaccae in group 4 and group 5. Conclusions Local immune stimulation can cause systemic immune response in healthy Japanese long-eared rabbits.

Objective:To study nursing and cooperation of bronchoscopic cryotherapy to endobronchial tuberculosis.Methods: Bronchoscopic cryotherapy and anti-tuberculosis chemotherapy were applied to 66 endobronchial tuberculosis patients.To intensify intraoperative monitoring and psychological nursing,ensure safety of patients,observe the effect.Results:clinical symptoms were improved totally or partly in 63 patients,lung recruitment were observed and airway stenosis alleviated(1/2～2/3).No effect was observed in 3 patients. Conclusion:Bronchoscopic cryotherapy to endobronchial tuberculosis has a positive effect,increasing trend of application.Holistic nursing should be concerned in bronchoscopic cryotherapy to endobronchial tuberculosis.

Objective To observe the efficacy and safety of the sonophoresis of antituberculosis drugs in the treatment of superficial lymphoid tuberculosis.Methods 72 patients with superfical lymphoid tuberculosis were randomly divided into treatment group and control group(n=36).Apart from basic antituberculosis chemotherapy,treatment group received the percutaneous sonophoresis of Isoniazide Injection and Amikacin Sulfate Injection,and control group was only injected above two drugs.The efficacy and complications in both groups were followed up,and the curative effects were assessed by cardinal symptoms,physical signs and ultrasonographic findings.Results After two courses of treatment,patients in treatment group had a higher improvement rate than those in control group(P<0.05).Severe adverse effects and complications were not found in all cases.Conclusion The sonophoresis of antituberculosis drugs is an effective and safe method in the treatment of superficial lymphoid tuberculosis.

There are so many challenges and difficulties for diagnosis and treatment of endobronchial tuberculosis(EBTB).In China,EBTB is classified into five types,including inflammatory hyperaemia(Ⅰ),mucosal ulceration(Ⅱ),hyperplastic polyp(Ⅲ), bronchostenosis(Ⅳ),malacia of bronchial wall(Ⅴ).We suggest that tuberculosis bronchial fistula be derived from typeⅡand become an independent type(Ⅵ).As for treatment of EBTB,various combinations of interventional technology can be used depending on the specific types,including electrocautery,cyrotherapy,argon plasma coagulation,laser,tracheobronchial stent implantation,balloon dilatation,and submucous puncture combined with injection of anti-tuberculosis drugs,etc.

Objective To evaluate the efficacy,indications and the possible side effects of sequential therapy of endobronchial tuberculosis by argon plasma coagulation and cryotherapy.Methods Thirty-six patients with endobronchial tuberculosis that were diagnosed by acid-fast stain and culture of sputum(bronchoalveolar lavage fluid),radiology,bronchoscopy and pathology were studied.Sequential therapy by argon plasma coagulation and cryotherapy were performed on the basis of antituberculosis chemotherapy.Efficacy and complication were assessed and followed up after the sequential therapy.Results Efficacy was assessed by symptoms,physical signs,radiology and bronchoscopy.Thirty-six patients with endobronchial tuberculosis were treated 4±2 times by the sequential therapy.The significant improvement rate was 66.7%(24/36 patients),the clinical effective rate was 27.8%(10/36 patients),the light effective rate was 5.6%(2/36 patients).Severe adverse effects have not found in all the patients.Conclusions The sequential therapy by argon plasma coagulation and cryotherapy could rapidly relieve clinical symptoms and inhibit efficiently granulation.The sequential therapy by argon plasma coagulation and cryotherapy is an effective and safe method of treatment in patients with endobronchial tuberculosis.

Objective To determine the antimicrobial susceptibility profile of Mycobacterium tuberculosis in elderly patients with drug-resistant pulmonary tuberculosis.Methods The clinical data were compared between elderly patients with pulmonary tuberculosis(elderly group) and non-elderly patients with pulmonary tuberculosis(non-elderly group).All were admitted to our hospital from March 2006 to October 2010.Elderly group included 21 males and 7 females,with age of(67±8) years.Non-elderly group included 23 males and 9 females,with age of(32±8) years.The Mycobacterium tuberculosis were cultured and antimicrobial susceptibility testing were performed in Bactec-MGIT960 system with Lowenstein-Jensen medium.The data were processed by SPSS 12.0 software package.Results The four most commonly resistant drugs in both groups were S,H.R and E sequentially.There were 17 cases(60.71%) resistant to 2 to 3 drugs in elderly group,whereas 10 cases(31.25%) in non-elderly group;and 19 cases(59.38%) resistant to 3 to 4 drugs in elderly group,while 14 cases(50%) in non-elderly group.Resistance to 2 to 3 drugs was predominant in elderly group,while resistance to 3 to 4 drugs in non-elderly group,with significant difference between the two groups.Antimicrobial susceptibility rate of KOP regimen was highest in both groups.Conclusion For elderly patients with pulmonary tuberculosis,the chemotherapy should be under close supervision to avoid the appearance of drug resistant flora.For drug resistant cases, chemotherapeutic drugs should be carefully selected according to the antimicrobial susceptibilty features,and KOP regimen is strongly recommended if the culture test result is not yet available.

Objective To provide basis for the local immune therapy of tuberculosis by observing the absorption and security of Mycobacterium vaccae (micro card) gel after administered into lung and analysing the optimum dose and side effects. Methods Fifty Japanese long-eared rabbits were randomly divided into five groups. Group 1 was injected with 3 ml normal sodium. Group 2 was injected with 3 ml carbomer gel. Group 3, 4, 5 were injected with 3 ml carbomer gel with 3.75, 7.50, 9.37 mg/L Mycobacterium vaccae. The temperature, weight, blood were tested durirg four weeks. The animals were sacrificed at the end and tissue pathology was observed. Results There was no statistical significance on temperature, weight, blood among all groups. Compared with group 1, the changes of pathology in lung of group 2 and group 3 were not obvious. There were no obvious changes on the bronchiole between group 4,5 and group 1, alveolar structure remained intact, interval mildly widened,and there was lymphocytic infiltration in interval. Conclusions Gel with Mycobacterium vaccae administered in lung has better security.

Objective To observe the effect of hyperselective embolization of bronchial arteries on the treatment of hemoptysis of TB with sodium alginate micro spheres.Methods 33 massive hemoptysis patients who were not cured by medical treatment were treated by hyperselective embolization of bronchial arteries.Results After treatment,immediate hemostasis rate was 100%.Recurrence rate was 6.1% in 1 year follow-up.Conclusions Hemoptysis of TB can be effectively and fast cured by hyperselective embolization of bronchial arteries and long-dated treatment effect is good.