玄参中苯丙素苷对大鼠肝损伤细胞凋亡的影响

目的:观察玄参中苯丙素苷对大鼠肝损伤细胞凋亡的影响.方法:采用D-氨基半乳糖(D-Gal)造成大鼠急性肝损伤模型,观察玄参中苯丙素苷对此模型肝细胞凋亡及相关基因表达的影响.结果:玄参中苯丙素苷明显抑制模型肝细胞凋亡,上调bcl-2蛋白表达,下调Fas/FasL的表达.结论:玄参中苯丙素苷抗肝损伤细胞凋亡可能与其调控肝细胞凋亡相关基因有关.     

Fas/FasL在急性胰腺炎肝损伤中的作用

Fas/FasL介导的凋亡参与急性胰腺炎肝损伤的发生发展,急性胰腺炎上调肝内的促凋亡通路并且促使肝细胞损伤和肝细胞凋亡.急性胰腺炎时通过上调Kupffer细胞内FasL生成的信号使FasL表达增加,FasL激活Fas相关的死亡域和暴露死亡效应结构域,随后活化Caspase级联反应和下游的效应Caspases,最终导致DNA裂解和肝细胞凋亡,从而介导肝损伤.本文就Fas/FasL结构、分布、功能及介导急性胰腺炎肝损伤的机制作一综述.     

HDV/HBV感染树鼩肝组织Fas/FasL表达与肝细胞凋亡

目的 探讨HDV感染树鼩肝组织中Fas/FasL表达与HDV感染之间的关系,以及Fas/FasL在丁型肝炎肝细胞凋亡中的作用。 方法 采用免疫组化和原位杂交技术对45份HDV感染树鼩肝组织中HDAg,Fas/FasL和Fas/FasL mRNA的表达进行了检测;应用原位末端标记技术对肝细胞凋亡进行了检测;并应用免疫组化双重染色对HDAg,Fas/FasL的表达以及肝细胞凋亡进行了检测。 结果 45份肝组织中有39份可检出Fas/FasL(阳性率87％),有41份可检出凋亡细胞(阳性率91％),HDAg表达与Fas/FasL表达之间有显著相关性(X_1~2=29.2,X_2~2=27.9,P<0.05),HDAg表达越强,Fas和FasL表达也越强,凋亡在HDAg阳性和阴性细胞中均可发生,以HDAg阳性细胞发生为主,Fas/FasL表达与肝细胞凋亡之间有显著相关性(X_1~2=35.1,X_2~2=40.2,p<0.05),Fas和FasL表达越强,凋亡阳性细胞越多。 结论 丁型肝炎病毒感染和未感染的肝细胞均可发生凋亡,但凋亡只在少数细胞发生;肝细胞内的病毒抗原表达可诱导Fas/FasL的表达;Fas/FasL肝细胞凋亡中起重要作用。     

赤芍承气汤对急性肝衰竭大鼠肝细胞凋亡的影响

目的：观察赤芍承气汤对内毒素脂多糖（LPS）致急性肝衰竭大鼠肝细胞凋亡的影响。方法：以内毒素（LPS）＋D－氨基半乳糖（D－GalN)）联合制备大鼠急性肝衰竭模型,模型组用生理盐水、治疗组用复方中药赤芍 承气汤分别灌胃,4天后开腹取鼠肝组织作病理检查,以HE染色观察大鼠肝组织病理学变化;以免疫组化法（SP法）检测Fas,FasL蛋白在大鼠肝 的表达情况,并观察赤芍承气汤对肝细胞凋亡的影响。结果：LPS＋D－GalN可引起严重的急性肝坏死并有广阔物肝细胞凋亡,伴Fas,FasL蛋白在肝细胞中强烈表达;肝细胞Fas／FasL阳性率,模型组为83％：92％,中药组为53％：50％,经统计学分析,P＜0．01;其阳性表达率随肝细胞坏死程度加重而增加,结论：赤芍承气汤可减轻肝细胞Fas／FasL的表达,抵抗内毒素诱发的肝细胞凋亡。     

胃癌及癌旁组织Fas、Fas L的表达

目的：探讨细胞凋亡相关蛋白的Fas、FasL在胃癌发生、发展中的作用。方法：对74例手术切除胃癌标本，应用免疫组化S－P法检测Fas、FasL蛋白在癌组织和相应癌旁组织中的表达。结果：在高中分化型胃癌Fas和FasL的阳性表达率一致性显著高于低分化型胃癌（P＜0．05）。而在早期和进展期胃癌间，有淋巴结转移和无淋巴结转移胃癌间Fas和FasL的阳性表达率无显著性差异（P＞0．05）。胃癌组织Fas 阳性表达率显著低于癌旁组织（P＜0．05）。FasL在两者间无显著性差异（P＞0．05）。结论：Fas和FasL的异常表达可能是胃粘膜癌变过程中细胞凋亡抑制的重要机制之一，并与胃癌的分化和免疫逃逸有关。     

丁型肝炎患者肝组织中Fas/FasL和肝细胞凋亡表达

目的探讨Fas/FasL及肝细胞凋亡在丁型肝炎患者肝组织中的表达及作用.方法采用免疫组化双重染色和TUNEL技术,检测79例丁肝患者肝组织HDAg,Fas/FasL表达,以及肝细胞凋亡,以54例乙型肝炎作对照.结果Fas以肝细胞浆表达为主,HDAg以核浆型表达为主,二抗原表达及分布有相关性.FasL主要表达在浸润淋巴细胞浆、肝细胞核,与HDAg表达及分布不全一致.HDAg,Fas/FasL和肝细胞凋亡在各型肝炎中的表达强度有显著性差别意义.结论HDV感染可诱导肝细胞Fas/FasL表达,增强Fas/FasL途径介导的肝细胞凋亡,这一机制在丁型肝炎发病机制中可能有一定的重要作用.     

HDV/HBV感染树鼠句肝组织FasFasL表达与肝细胞凋亡

目的 探讨HDV感染树 肝组织中Fas/FasL表达与HDV感染之间的关系,以及Fas/FasL在丁型肝炎肝细胞凋亡中的作用。方法 采用免疫组化和原位杂交技术对45份HDV感染树 肝组织中HDAg,Fas/FasL和Fas/FasL mRNA的表达进行了检测;应用原位末端标记技术对肝细胞凋亡进行了检测;并应 用免疫组化双重染色对HDAg,Fas/FasL的表达以及肝细胞凋 亡进行了检测。 结果 45份肝组织中有39份可检出Fas/FasL(阳性率87％), 有41份可检出凋亡细胞(阳性率91％)．HDAg表达与 Fas/FasL表达之间有显著相关性x =29．2,x =27．9, P     

Fas/FasL、bcl-2、caspase-8在丹皮酚诱导大肠癌细胞凋亡中的相互作用及机制

目的探讨丹皮酚（Paeonol，Pae）诱导人大肠癌HT-29细胞凋亡过程中Fas／FasL、bcl-2、caspase-8细胞凋亡调节基因的相互关系及可能的作用机制。方法应用透射电镜技术对Pae诱导HT-29细胞凋亡进行形态学观察；应用免疫细胞化学技术检测用药前后凋亡相关基因Fas／FasL、caspase-8、bcl-2表达的变化。结果HT-29细胞经Pae作用后，在透射电镜下观察到HT-29细胞出现典型的细胞凋亡形态；免疫细胞化学结果显示Pae作用后HT-29细胞Fas／FasL、caspase-8蛋白表达明显升高，bcl-2蛋白表达显著降低。结论Pae能抑制HT-29细胞增殖并诱导其凋亡，其作用可能是通过上调Fas／FasL、caspase-8蛋白表达，下调bcl-2的表达有关。     

Fas/FasL在丁型肝炎发病机理中的作用

目的检测丁型肝炎病人肝组织Fas/FasL和HDAg表达,了解Fas/FasL在丁型肝炎致病机理中的作用。方法采用免疫组化单、双标记技术,检测48例丁型肝炎病人肝组织Fas、FasL和HDAg表达,以54例乙型肝炎作疾病对照。结果 Fas以肝细胞浆表达为主,HDAg以肝细胞核和胞浆表达为主,二抗原表达及分布呈一致性。FasL主要表达在浸润淋巴细胞浆、肝细胞核,与HDAg表达及分布不全一致,丁型肝炎组Fas、FasL检出率及表达强度较对照组高,三成分在各型肝炎中的表达强度有显著性差别意义。结论 Fas、FasL和HDAg均与肝组织炎症活动和病理损害相关,HDV感染可诱导肝细胞大量表达Fas,CTL通过Fas/FasL途径介导的肝细胞凋亡与HDV致病可能有关。     

Fas/FasL途径在柔红霉素诱导HL-60及U937细胞凋亡中作用的研究

目的；研究柔红霉素（DNR）诱导白血病细胞凋亡的机制，进一步探讨Fas/FasL 途径在DNR诱导白血病细胞凋亡中的作用。并评价sFAsL与DNR联用的致凋亡效应。方法：将DNR作用于白血病细胞系HL－60，K562，U937细胞，并用流式细胞术（FCM）检测其Fas抗原表达的改变。sFasL,DNR诱导白血病细胞凋亡，以抗Fas单抗（IgG1)阻断Fas/FasL 途径，借助原位末端标记法（TUNEL）和FCM检测白血病细胞凋亡率。结果：DNR处理HL－60，K562，U937细胞18h后，Fas表达阳性率无明显变化（P＞0．05），与sFasL联合作用后显示出协同效应，。IgG1不能阻断DNA致白血病细胞凋亡的作用，但可阻断sFasL致白血病细胞凋亡的作用。结果：DNR致白血病细胞株U937，HL－60凋亡的作用不依赖于Fas/FasL 途径，但sFasL与DNR联合应用可协同增强抗肿瘤效应。     

Trousseau Syndrome in a 25-Year-Old Woman with Occult Colon Malignancy,Lynch Syndrome,and Chronic Thromboembolic Pulmonary Hypertension

We present a rare case of thrombosis associated with an occult colon malignancy (Trousseau syndrome) in a 25-year-old woman who also presented with previously unidentified Lynch syndrome and acute-on-chronic thromboembolic pulmonary hypertension. Staged treatment included bilateral pulmonary endarterectomy under deep hypothermic circulatory arrest, followed 11 days later by laparoscopic subtotal colectomy and creation of a primary anastomosis. The patient tolerated both procedures well and recovered normal functional status. Final pathologic analysis of the resected colon mass revealed a pT3N0, stage IIA adenocarcinoma; no adjuvant therapy was administered. At her one-year follow-up visit, the patient was cancer-free, remained on lifelong apixaban anticoagulation, and was undergoing routine monitoring and genetic counseling. This case highlights the need for multidisciplinary management of a patient with severe chronic thromboembolic pulmonary hypertension and a concomitant malignancy.     

Large Lipomatous Hypertrophy of the Interventricular Septum

We present the case of a 58-year-old woman who had large lipomatous hypertrophy of the interventricular septum, a condition that is reported very infrequently. Preoperative cardiac magnetic resonance images revealed an inhomogeneous, infiltrating mass that was suppressed in fat-suppression mode. The extensive mass was causing right ventricular dysfunction, so we excised it through a right ventricular approach. The findings on histologic analysis of the mass were consistent with lipomatous hypertrophy. The patient died of septic shock on the 28th postoperative day. In addition to the patient''s case, we discuss the characteristics and diagnosis of this rare entity.     

Conservative Management of Cardiac Hemangioma for 11 Years

Cardiac hemangiomas are benign tumors with an unpredictable natural history. Surgical resection is the treatment of choice; however, conservative management can be an alternative in some patients.We report a case of a left-sided cardiac hemangioma that we managed conservatively for 11 years without obvious major complications in the patient, an adult woman.     

Resolution of Right-Sided Heart Failure Symptoms after Resection of a Primary Ovarian Carcinoid Tumor

Carcinoid tumors are rare neuroendocrine malignancies that typically originate from the gastrointestinal tract. Patients who are diagnosed with carcinoid heart disease generally have poor prognoses because of advanced metastases during staging and few therapeutic options. We present the case of a 61-year-old woman with right-sided heart failure, secondary to carcinoid heart disease caused by a primary ovarian carcinoid tumor. After undergoing surgical resection of the left ovary and fallopian tube, the patient experienced complete resolution of her heart failure symptoms. In addition to the patient''s case, we discuss the diagnosis, nature, and treatment of this rare condition.     

Cardiac Sarcoidosis Presenting as Constrictive Pericarditis

In patients with cardiac sarcoidosis, the sarcoid granulomas usually involve the myocardium or endocardium. The disease typically presents as heart failure with ventricular arrhythmias, conduction disturbances, or both. Constrictive pericarditis has rarely been described in patients with sarcoidosis: we found only 2 reports of this association.We report the case of a 57-year-old man who presented with clinical and hemodynamic features of constrictive pericarditis, of unclear cause. He was admitted for treatment of recurrent pleural effusion. After a complicated hospital course, he underwent pericardiectomy. His clinical and hemodynamic conditions improved substantially, and he was discharged from the hospital in good condition. The pathologic findings, the patient''s clinical course, and his response to pericardiectomy led to our diagnosis of cardiac sarcoidosis presenting as constrictive pericarditis. In addition to the patient''s case, we discuss the nature and diagnostic challenges of cardiac sarcoidosis. Increased awareness of this disease is necessary for its early detection, appropriate management, and potential cure.     

Prompt Recognition of Left Ventricular Free-Wall Rupture Aided by the Use of Contrast Echocardiography

In the modern period of reperfusion, left ventricular free-wall rupture occurs in less than 1% of myocardial infarctions. Typically, acute left ventricular free-wall rupture leads to sudden death from immediate cardiac tamponade. We present the case of a 59-year-old woman who sustained a posterior-wall myocardial infarction and subsequent cardiac arrest with pulseless electrical activity. A bedside transthoracic echocardiogram showed pericardial effusion with cardiac tamponade. Emergency pericardiocentesis yielded 500 mL of blood, and spontaneous circulation returned. Contrast-enhanced echocardiograms revealed inferolateral akinesis and a new, small myocardial slit with systolic extrusion of contrast medium, consistent with left ventricular free-wall rupture. During immediate open-heart surgery, a small hole in an area of necrotic tissue was discovered and repaired. This case highlights the usefulness of bedside contrast-enhanced echocardiography in confirming acute left ventricular free-wall rupture and enabling rapid surgical treatment.     

肝硬变腹水患者钾钠氯及酸碱失衡

目的研究肝硬变腹水患者的钾、钠、氯及酸碱失衡。方法肝硬变腹水患者１５４例，血Ｋ＋、Ｎａ＋、Ｃｌ－测定采用ＥＥＬ公司自动分析仪及火焰光度计。血气及酸碱度测定采用ＩＬ１３０２型自动微机分析仪。结果低血钾者５７例，高血钾者６例，低血钠者８１例，高血钠者１２例，低血氯者３４例，高血氯者８例。２４例血气及酸碱度测定结果显示，以碱中毒者为主。依次为呼碱、呼碱＋代酸、代酸、代碱、呼酸。本组高血钾、低血钠与Ｃｈｉｌｄ分级、ＢＵＮ、Ｃｒ值相关。从本组资料表明，重症肝硬变腹水患者水盐代谢失衡多为医源性所致，且加重原有失衡。高钾血症、急性低钠血症及高钠血症大多如此，多为住院后发生，常可危及生命。结论肝硬变腹水患者的高钾血症、低钠血症和高钠血症大多在肝肾功能低下，不适当的治疗所致，是影响预后的重要因素     

Benefits and Limitations of Multimodality Imaging in the Diagnosis of a Primary Cardiac Lymphoma

Primary cardiac tumors are far rarer than tumors metastatic to the heart. Angiosarcoma is the primary cardiac neoplasm most frequently detected; lymphomas constitute only 1% of primary cardiac tumors.We present the case of a 55-year-old woman with a recently diagnosed intracardiac mass who was referred to our institution for consideration of urgent orthotopic heart transplantation. Initial images suggested an angiosarcoma; however, a biopsy specimen of the mass was diagnostic for diffuse large B-cell lymphoma. The patient underwent chemotherapy rather than surgery, and she was asymptomatic 34 months later.We use our patient''s case to discuss the benefits and limitations of multiple imaging methods in the evaluation of cardiac masses. Certain features revealed by computed tomography, cardiac magnetic resonance, and positron emission tomography can suggest a diagnosis of angiosarcoma rather than lymphoma. Cardiac magnetic resonance and positron emission tomography enable reliable distinction between benign and malignant tumors; however, the characteristics of different malignant tumors can overlap. Despite the great usefulness of multiple imaging methods for timely diagnosis, defining the extent of spread and the hemodynamic impact, and monitoring responses to treatment, we think that biopsy analysis is still warranted in order to obtain a correct histologic diagnosis in cases of suspected malignant cardiac tumors.     

Primary Cardiac Sarcoidosis with Syncope and Refractory Atrial Arrhythmia: A Case Report and Review of the Literature

We discuss the case of a 38-year-old black man who presented at our hospital with his first episode of syncope, recently developed atrial arrhythmias refractory to pharmacologic therapy, and a left atrial thrombus. He was diagnosed with primary cardiac sarcoidosis characterized by predominant involvement of the epicardium that caused atrial fibrillation and atrial flutter. Histologic analysis of his epicardial lesions yielded a diagnosis of sarcoidosis. This patient''s atrial arrhythmia was successfully treated with a hybrid operation that involved resection of his atrial appendage, an Epicor maze procedure, and radiofrequency ablation during a catheter-based electrophysiologic study. The cardiac sarcoidosis was successfully managed with corticosteroid therapy.Our case report shows that sarcoidosis can initially manifest itself as syncope with new-onset atrial arrhythmia. Sarcoidosis is important in the differential diagnosis because of its progressive nature and its potential for treatment with pharmacologic, surgical, and catheter-based interventions.     

Acute Coronary Thrombosis and Multiple Coronary Aneurysms in a 22-Year-Old Man with the Human Immunodeficiency Virus

The human immunodeficiency virus (HIV) can cause diverse cardiovascular complications. In HIV patients on antiretroviral therapy, the prevalence of myocardial infarction has steadily increased over the years. Young patients who are naïve to antiretroviral therapy and who experience coronary events are not well represented in the medical literature. We describe the case of a 22-year-old man, infected with HIV for 4 years and never treated with antiretroviral therapy, who emergently presented with a non-ST-segment-elevation myocardial infarction. Coronary angiograms revealed thrombosis and multiple coronary artery aneurysms; however, no areas of atherosclerotic stenosis were apparent. He was successfully treated with coronary stenting, antiplatelet therapy, and anticoagulation. Nine months after the initial presentation, he exhibited excellent exercise capacity, and no ischemia was evident. We discuss the various therapeutic approaches in this case.