墨汁灌注和血管铸型方法检测山羊胫骨血管应用性能的不同

目的：比较血管墨汁灌注和甲基丙烯酸甲酯血管铸型两种方法在山羊胫骨血管检测中的优缺点，为组织工程骨血管化检测寻找一种直观可行的方法。 方法：实验于2004-05／2005-07在南方医科大学南方医院创伤骨科骨组织工程实验室完成。①12只正常中国青山羊随机分为墨汁灌注组，甲基丙烯酸甲酯血管铸型灌注组，每组6只。②墨汁灌注组采用中华墨汁、甲醛及生理盐水体积比为3：1：6的复合墨汁，行双侧股动脉插管，经血管冲洗后进行灌注，低温放置24h后取下胫骨标本行进一步处理，甲基丙烯酸甲酯血管铸型灌注组，每只山羊均行双侧后肢股动脉插管，血管彻底冲洗后将预聚后的甲基丙烯酸甲酯灌注，低温放置24-28h后取下胫骨标本行下一步处理。③灌注后两组标本分别采用大体解剖，未脱钙骨磨片和脱钙后组织切片等方法观察青山羊胫骨血管的走行与分布。 结果：①山羊胫骨经墨汁灌注后大体解剖、未脱钙骨磨片和脱钙骨组织切片观察可清楚显示骨膜、骨皮质和骨髓腔血管；可以观察骨组织的显微结构，但不便于直观地观察胫骨与周围血管的空间立体结构。②血管铸型后的山羊胫骨制作的大体解剖标本，在胫骨中段制作2cm&;#215;1cm骨窗，可见髓腔内的铸型血管，骨皮质横、纵切面上可见微细的铸型血管断面；可以直观的观察山羊胫骨与周围血管的空间立体构筑，显示胫骨营养血管的分布、走行，未脱钙磨片能够清楚显示骨皮质血管网，扫描电镜可以观察到哈佛氏管内血管。 结论：血管墨汁灌注适合用于微血管检测，便于染色后同时观察骨组织的显微结构；而血管铸型标本则适合大体观察血管的空间立体构筑，较为直观，两者在组织工程骨血管化检测中有不同的应用价值。     

墨汁灌注和血管铸型方法检测山羊胫骨血管应用性能的不同

目的:比较血管墨汁灌注和甲基丙烯酸甲酯血管铸型两种方法在山羊胫骨血管检测中的优缺点,为组织工程骨血管化检测寻找一种直观可行的方法。方法:实验于2004-05/2005-07在南方医科大学南方医院创伤骨科骨组织工程实验室完成。①12只正常中国青山羊随机分为墨汁灌注组,甲基丙烯酸甲酯血管铸型灌注组,每组6只。②墨汁灌注组采用中华墨汁、甲醛及生理盐水体积比为3∶1∶6的复合墨汁,行双侧股动脉插管,经血管冲洗后进行灌注,低温放置24h后取下胫骨标本行进一步处理,甲基丙烯酸甲酯血管铸型灌注组,每只山羊均行双侧后肢股动脉插管,血管彻底冲洗后将预聚后的甲基丙烯酸甲酯灌注,低温放置24～28h后取下胫骨标本行下一步处理。③灌注后两组标本分别采用大体解剖,未脱钙骨磨片和脱钙后组织切片等方法观察青山羊胫骨血管的走行与分布。结果:①山羊胫骨经墨汁灌注后大体解剖、未脱钙骨磨片和脱钙骨组织切片观察可清楚显示骨膜、骨皮质和骨髓腔血管;可以观察骨组织的显微结构,但不便于直观地观察胫骨与周围血管的空间立体结构。②血管铸型后的山羊胫骨制作的大体解剖标本,在胫骨中段制作2cm×1cm骨窗,可见髓腔内的铸型血管,骨皮质横、纵切面上可见微细的铸型血管断面;可以直观的观察山羊胫骨与周围血管的空间立体构筑,显示胫骨营养血管的分布、走行,未脱钙磨片能够清楚显示骨皮质血管网,扫描电镜可以观察到哈佛氏管内血管。结论:血管墨汁灌注适合用于微血管检测,便于染色后同时观察骨组织的显微结构;而血管铸型标本则适合大体观察血管的空间立体构筑,较为直观,两者在组织工程骨血管化检测中有不同的应用价值。     

超声造影微血管成像技术评价肝细胞性肝癌微血管构筑及病理相关

目的评价微血管造影成像（micro flow imaging，MFI）对肝细胞性肝癌（HCC）微血管构筑的显示，探讨HCC血管构筑与病理分化程度的关系。 方法对37例病理确诊的HCC超声造影，造影剂为声诺维，成像方法为常规对比谐波成像（contrast harmonic imaging，CHI）以及MFI。观察2种成像方法对肿瘤内微血管的显示效果、微血管的形态及其与肿瘤病理分化的关系。组织病理诊断按Edmonson法分类。 结果37个病灶在CHI均为动脉期高增强、门脉期及延迟期低增强，动脉期肿瘤血管显示率为54．05％。MFI清晰显示全部病灶微血管构筑，形态分为3型：棉花型12（32．4％）、灌木型22（59．5％）、枯枝型3（8．1％）。肿瘤微血管构筑与病理分化程度相关：75．0％（3／4）EdmonsonⅠ级HCC表现为棉花型，75．0％（18／24）EdmonsonⅡHCC表现为灌木型，而枯枝型只见于EdmonsonⅢ、Ⅳ级HCC。 结论MFI可敏感地显示HCC微血管构筑。HCC肿瘤微血管构筑与病理分化程度相关。     

高频超声结合增强型能量多普勒成像评价Ⅱ型糖尿病患者指尖微血管变化的应用研究

目的寻找Ⅱ型糖尿病患者并发末梢微血管病变的早期证据，为临床提供有效的观察方法和指标。方法应用高频超声结合增强型能量多普勒显像（e-Flow）观察30例Ⅱ型糖尿病患者右手中指末节指腹和甲床内微血管床的分布特征、走行和数量，并计算指腹动脉和甲床动脉的收缩期峰值速度（PSV）、舒张期峰值速度（EDV）以及血管阻力（RI）参数。观察结果与32例年龄、性别相匹配的健康成人对照。结果①正常人中指末节指腹的血管供应丰富，e-Flow清晰显示手指的两支掌侧固有动脉及发出的分支，呈网状分布于整个指腹。血管形态勾勒清晰，走行正常，可追踪全程；甲床内微血管呈纵行分布，末梢可见横行吻合支，血管网清晰，血供丰富。②糖尿病患者中指的末节指腹血管网显示欠丰富，仅可显示一或两支固有动脉分支或仅见零星点条状血流，血管走行迂曲断续，与正常人差异有统计学意义（P〈0．05）；甲床内微血管，尤其是远端血管显示不良，仅见零星点条状血流，与正常人差异有统计学意义（P〈0．05）；糖尿病合并症者的指端微血管异常较单纯糖尿病患者为甚。③与正常人比较，糖尿病患者的指腹动脉、甲床动脉PSV、EDV测值稍减低（P〈0．05～0．09），RI相应升高（P〈0．05）。结论E-Flow结合传统彩色多普勒血流成像技术可敏感、准确地反映糖尿病患者的指端微血管分布减少，血管阻力增高，为临床早期诊断糖尿病微血管病变和评价治疗效果提供了新手段。     

增生性瘢痕胶原含量与微血管构筑的相关性

目的：研究增生性瘢痕（HS）胶原含量与微血管构筑的影响，以及两的变化规律和相互关系。方法：对两组HS病例，分别采取PDL照射（A组）及TA皮损内注射（B组）治疗，在治疗后1个月、3个月分别切取标本与自然病程未经治疗的相应时段标本，进行微血管构筑及胶原含量的对比分析。结果：在治疗组第1个月，A1组血管密度明显降低，B1组血管密度亦有降低；在第3个月，血管与胶原纤维密度明显低于对照组。结论：在HS中微血管构筑和胶原含量呈较强的正相关。     

苦参碱对S180肉瘤小鼠肿瘤血管形成抑制作用的研究

目的：探讨苦参碱抗肿瘤的作用机制。方法：40只Balb／c小鼠接种S180肉瘤细胞后，随机分成4组，即单纯肿瘤组（对照组），苦参碱组，环磷酰胺组．苦参碱组＋环磷酰胺组，连续10日施加处理因素，停药后次日断颈处死小鼠。采用计算抑瘤率；光镜下观察瘤体内血管数目的影响；免疫组化法检测瘤体内微血管密度（MVD）、血管内皮生长因子（VEGF）表达。结果：苦参碱具有明显的抑制S180肉瘤小鼠作用．其抑瘤率为34．7%；免疫组化显示瘤体内微血管密度、血管内皮生长因子（VEGF）阳性表达均明显低干对照组（p〈0.05）；血管内皮生长因子表达与微血管密度呈正相关。结论：苦参碱对S180肉瘤小鼠有一定的抑制作用，对S180内瘤小鼠血管形成有明显的抑制作用，降低VEGF表达可能是其抑制肿瘤血管形成的主要机制之一。     

口腔癌高温热疗的血液流变学机制探讨

为探讨口腔癌局部高温热疗的选择性杀伤机制，采用锥板粘度计测定了金黄地鼠血液在不同温度下的血液流变学参数，并采用扫描电镜观察了实验性口腔癌微血管构筑，结果发现：血液升温至４３℃时，血液流变各参数无明显变化．但当温度高于４３℃时，各参数随温度的升高发生明显改变，实验性口腔癌微血管观察发现毛细血管不规则狭窄、中断或极度扩张，可见铸型剂从血管内溢出，结果提示，肿瘤及其邻近组织血管构筑及血液流变特性的差异是口腔癌局部高温热疗选择性杀伤机制中的一个重要因素．     

微血管血流(MV-Flow)成像技术评估早产儿与足月儿脑微血管差异

目的 观察微血管血流（MV-Flow）成像技术评估早产儿与足月儿脑微血管差异的价值。方法 前瞻性纳入15例早产儿（早产儿组）和15例足月儿（足月儿组）；以超声MV-Flow成像技术观察脑微血管分布与形态，获取ROI内血管指数（VI）；比较组间临床及超声资料的差异。结果 MV-Flow成像可清晰显示脑微血管；皮质微血管在冠状面和矢状面上均表现为垂直于脑表面的短线样回声，髓质微血管在冠状面上表现为长曲线样回声、在矢状面上表现为长直线样回声。早产儿组髓质微血管均获显示，部分（2/15，13.33%）皮质微血管未能显示；足月儿组皮质微血管及髓质微血管均清晰可见，且分布较密集。早产儿组额叶及中央沟脑实质微血管VI均明显低于足月儿组（P均<0.05）。结论 MV-Flow成像技术可有效评估早产儿与足月儿脑实质微血管的差异。     

超声造影下以实时连续微血管叠合方法重建乳腺肿瘤血管

目的 观察超声造影(CEUS)下以实时连续微血管叠合方法重建乳腺肿瘤血管的价值。方法 收集545例患者共555个乳腺肿瘤，包括恶性409个、良性146个。基于常规超声及CEUS以实时连续微血管叠合方法获得乳腺肿瘤血管重建图，观察肿瘤血管特征，包括有无穿入血管、血流分级、血管主干与分支的关系、血管走行及超微血管构筑等，以单因素及多因素分析筛选乳腺恶性肿瘤的独立危险因素；以病理结果为金标准，观察超微血管构筑诊断乳腺良、恶性肿瘤的价值。结果 穿入血管、血流分级、血管主干与分支的关系及超微血管构筑均为乳腺恶性肿瘤的独立危险因素(P均<0.001)。以超微血管构筑诊断乳腺良、恶性肿瘤的敏感度、特异度、准确率及曲线下面积分别为88.75%、71.23%、84.14%及0.80。结论 CEUS下采用实时连续微血管叠合方法重建肿瘤血管有助于鉴别诊断乳腺良、恶性肿瘤。     

瘢痕微血管构筑的研究进展

众所周知，任何修复过程都伴有血管的变化。采用碱性磷酸酶组化法及CD34组化法已成功地显示了瘢痕中微血管构筑无论从瘢痕的临床表现、瘢痕的超微结构，还是治疗机制、手术时机的选择及治疗效果的观察上，无不与瘢痕的微血管构筑有关。     

三维彩色多普勒超声对兔VX2肿瘤血管的形态学观察

目的评价三维彩色多普勒超声（3DCDU）成像技术对兔VX2肿瘤血管形态学观察的价值。 方法选用新西兰大白兔10只，用VX2瘤株种植于兔大腿股外侧浅肌层，2～3周后应用TomTec二维超声T作站采集肿瘤及其血管的三维超声数据．建立肿瘤的三维灰阶及彩色多普勒声像图，并与离体肿瘤血管铸型标本进行形态学对比观察。 结果10只模型兔16个肿瘤病灶获得了满意的三维彩色多普勒声像图，3D—CDU可以从不同角度和方位清晰地显示肿瘤血管的多少、分布、空间走向以及与周围血管之间的关系．与离体的肿瘤血管铸型标本在立体形态学上非常相似。 结论3D—CDU能够较为敏感、客观、真实地反映肿瘤血管的多少、空间分布和走向，为在体无创性评价肿瘤血管及其灌注提供了一条新的途径和方法。     

Sonographic evaluation of vascular injuries.

OBJECTIVE: The purpose of this presentation is to highlight the color Doppler duplex sonographic features of procedure-related and blunt or penetrating trauma-related vascular injuries. METHODS: Different kinds of vascular complications such as pseudoaneurysms, arteriovenous fistulas, dissection, and thrombosis are discussed. Cases of vascular injuries in the extremities, neck, and abdomen are presented to illustrate the spectrum of sonographic appearances. RESULTS: Color Doppler duplex sonography is valuable in the diagnosis and monitoring of most vessel injuries and in the treatment of pseudoaneurysms. It is useful for flow analysis and for follow-up after treatment. However, because of limitations inherent to sonography, such as bones, air, casts, skin burns, and relatively slow performance of the test, magnetic resonance imaging, computed tomography, and angiography are necessary for further evaluation in selected cases. CONCLUSIONS: Color Doppler duplex sonography is a widely available, noninvasive, and accurate technique for evaluating vascular injuries and should be the first-line imaging modality in most patients.     

New techniques of analyzing the healing process of artificial vascular grafts,transmural vascularization,and endothelialization

Beside traditional techniques (light, immunofluorescence, transmission electron (TEM)- and scanning electron microscopy (SEM), a new more sensitive method for producing microcorrosion casts using a polyester-based resin has been developed. The SEM analyses of the microcorrosion casts of alloplastic vascular grafts was realized in an absolutely stable stage of polymerization. For the first time, a transprosthetic vascularization could be shown in great three-dimensional detail. The importance of a complete and rapid endothelialization of artificial vascular grafts is discussed.     

双胎反向动脉灌注序列征声像图与胎盘血管铸型的对比研究

目的 探讨双胎反向动脉灌注序列征(TRAP)的产前超声表现与分娩后胎盘血管铸型的关系.方法 6例TRAP孕妇接受产前超声检查,妊娠结束后行胎盘血管铸型.结果 本组TRAPⅣ型3例,Ⅱ型2例,Ⅰ型1例.胎盘血管铸型表现:6例无心畸胎与正常胎儿脐带血管之间均为动脉-动脉、静脉-静脉直接血管吻合,吻合血管表浅粗大,两条脐血管插入处间距离不等.6例中4例无心畸胎脐动脉和脐静脉在胎盘段仅为一根大的脐动脉与一根大的脐静脉,2例无心畸胎脐动脉和脐静脉在胎盘段可见较多血管分支.6例泵血儿中4例死亡,2例存活.结论 超声声像图与胎盘血管铸型有较好的一致性,有助于为深入研究TRAP的特殊血管吻合类型和预后提供有价值的信息.

Abstract：

Objective To investigate the relationship between the ultrasonography diagnosis in prenatal and the postnatal placental vascular casts of the twins reversed arterial perfusion(TRAP) sequence. Methods Six cases of TRAP sequence underwent the two-dimensional and color Doppler ultrasonography, and performed placental vascular casts after termination of pregnance. Results According to the anatomical features and ultrasonography, there were 3 cases of acardius acephalus( IV) ,2 cases of acardius anceps( II ) , and 1 case of acardius acormus( I ). In all 6 cases,there were arterio-arterial and veno-venous anastomoses at the level of the chorionic plate between the normal co-twin and the acardiac twin,these anastmosis vessels were superficial and large calibre, and the distances of the placental insertions of the umbilical cords were different,4 cases <0. 5 cm, 2 cases were 4-5 cm. In 4 cases, the vessels entered and went out of the acardiac twin were just one large umbilical artery and one large umbilical vein. In 2 cases, the umbilical artery and umbilical vein had many vascular branches in the placenta. Out of 6 cases of the pump twin, 4 cases died,and 2 cases survived. Conclusions Ultrasonography was consistent with the placental vascular casts,the contrast observing gives us new information for the further research of the special type of the vascular anastmosis and prognosis of the TRAP sequence.     

Diabetic plantar ulcers treated by total contact casting. A clinical report

The purpose of this clinical report is to describe the healing times of plantar ulcers treated by total contact casting (TCC) in nondiabetic and diabetic patients with and without evidence of severe peripheral vascular disease. Thirty patients with 33 chronic plantar ulcers were treated by applying total contact walking casts. Results demonstrate that 27 of 33 ulcers (81.8%) healed in an average time of 43.6 days. Healing times of patients with severe peripheral vascular disease secondary to diabetes mellitus are similar to those of patients without evidence of vascular disease. These results indicate that TCC is an effective and rapid treatment for chronic plantar ulcers in patients with or without vascular compromise secondary to diabetes mellitus. In addition, the results suggest that pressure reduction on the insensitive foot should be considered in treatment.     

经食管心脏超声对主动脉粥样硬化的研究

以经食管心脏超声技术在３５例患者和１０例离体主动脉检测了主动脉内膜－中层复合体最大厚度，同时计算了主动脉硬化指数。结果证明经食管心脏超声可清晰显示胸主动脉图像，并可作为评价主动脉解剖学病变及动脉粥样硬化的可靠措施在临床应用。     

Blood vascular organization of the human appendix: a scanning electron microscopic study of corrosion casts

Blood vascular beds of the human appendix were reproduced with a methacrylate casting medium and observed with a scanning electron microscope. The appendix received some small afferent arterial branches of the appendicular artery. These small arterial branches pierced the muscular layer and reached the submucosal plexus. Small arterioles arising from this plexus, climbed the mucosa and formed honeycomb-like capillary meshes at the luminal surface level. These capillaries were drained by the collecting veins, which descended the mucosa and joined the submucosal plexus. The large efferent veins arising from the submucosal plexus passed through the muscular layer and continued with the appendicular vein. In the mucosal and submucosal layers, several spherical basket-like casts of the germinal center (lymphoid follicle) were seen. In the parafollicular region (primary follicle), casts of postcapillary venules with prominent surface undulations were relatively frequently observed.     

"The inhibiting casts" used in cerebral palsed children

Inhibiting casts, introduced to rehabilitation practice by NDT-Bobath therapists, are being used with increasing frequency in the physiotherapy of children with cerebral palsy (CP). In the literature these plaster casts are known as tone-reducing plasters, spasticity-reducing plasters, or short leg plaster casts. The casts are installed on the lower leg and foot in the form of plaster shoes to immobilize the foot and ankle joints in the proper position. This creates conditions for constant manipulation of the limb using key points located on the lower leg and foot. According to the NDT-Bobath concept, this enables positive changes in postural and locomotor patterns, as well as the distribution of postural tone. The construction and application of these inhibitive casts are not the same as in the standard plaster casts used to correct foot deformations. The casts are placed on both feet regardless of the type of paresis, for a period from one to three weeks, depending on the child's age. New casts can be applied repeatedly during the child's rehabilitation. Experience shows that inhibitive casts are a very important aid in the treatment of CP children. The decision to use plaster casting requires experience and detailed functional assessment for each individual child, in terms of muscle tone distribution, the necessary compensatory patterns, and disturbances in the coordination of motor patterns.     

血清尿酸浓度与血管内皮功能的关系

目的本文应用高分辨率彩超检测血管内皮功能,探讨血清尿酸(UA)与血管内皮功能的关系。方法应用彩超检测血管内皮功能。采用自动生化分析仪检测UA。结果血管内皮功能障碍组血清UA浓度高于正常组(P<0.05)。结论UA与血管内皮功能有关,可能参与了血管内皮功能障碍的发生发展过程;应用高分辨率彩超评价血管内皮功能的方法有很高的临床实用价值。     

Substance P signaling contributes to the vascular and nociceptive abnormalities observed in a tibial fracture rat model of complex regional pain syndrome type I

Wrist and ankle fractures are the most frequent causes of complex regional pain syndrome (CRPS type I). The current study examined the temporal development of vascular, nociceptive and bony changes after distal tibial fracture in rats and compared these changes to those observed after cast immobilization in intact normal rats. After baseline testing the right distal tibial was fractured and the hindlimb casted. A control group was simply casted without fracturing the tibia. After 4 weeks the casts were removed and the rats retested. Subsequent testing was performed at 6, 8, 10, 16, and 20 weeks after onset of treatment. Distal tibial fracture or cast immobilization alone generated chronic hindlimb warmth, edema, spontaneous protein extravasation, allodynia, and periarticular osteoporosis, changes resembling those observed in CRPS. Hindlimb warmth and allodynia resolved much more quickly after cast immobilization than after fracture. Previously we observed that the substance P receptor (NK(1)) antagonist LY303870 reversed vascular and nociceptive changes in a sciatic section rat model of CRPS type II. Postulating that facilitated substance P signaling may also contribute to the vascular and nociceptive abnormalities observed after tibial fracture or cast immobilization, we attempted to reverse these changes with LY303870. Hindpaw warmth, spontaneous extravasation, edema, and allodynia were inhibited by LY303870. Collectively, these data support the hypotheses that the distal tibial fracture model simulates CRPS, immobilization alone can generate a syndrome resembling CRPS, and substance P signaling contributes to the vascular and nociceptive changes observed in these models.