双氢青蒿素、青蒿琥酯治疗大鼠肺孢子虫肺炎的疗效研究

目的研究双氢青蒿素、青蒿琥酯对实验大鼠肺孢子虫肺炎的疗效.方法以醋酸可的松皮下注射Wistar大鼠诱导建立肺孢子虫肺炎动物模型,用双氢青蒿素、青蒿琥酯治疗实验大鼠,以蒿甲醚、复方磺胺为对照治疗组,通过存活率、存活天数、肺重、肺重/体重比值、肺印片的每视野包囊均数等指标考核疗效.结果双氢青蒿素30mg/kg×5d、60mg/kg×5d治疗组的大鼠存活率提高,存活天数延长,治疗后体重增加,肺重、肺重/体重比值、肺印片的每视野包囊均数低于模型对照组;青蒿琥酯60mg/kg×5d治疗组除存活率外,其余指标接近双氢青蒿素组;各治疗组的减虫率均高于60%,接近复方磺胺组的73.1%.结论双氢青蒿素、青蒿琥酯对大鼠肺孢子虫肺炎具有疗效.     

鸦胆子与补骨脂治疗大鼠卡氏肺孢子虫肺炎的研究

目的研究中药鸦胆子和补骨脂对卡氏肺孢子虫肺炎病鼠的治疗作用。方法用地塞米松皮下注射SD大鼠6周，建立卡氏肺孢子虫肺炎动物模型。用中药鸦胆子与补骨脂合剂治疗大鼠，设立1周治疗组、2周治疗组、阳性对照组1、阳性对照组2和健康对照组。观察大鼠体重、肺组织病理、肺印片中每视野虫体包囊均数及血液CD4^＋和CD8^＋T细胞、IFN-γ的动态变化。结果鸦胆子和补骨脂合剂治疗组大鼠体重回升，1周治疗组和2周治疗组体重回升率分别达到26．85％和31．77％；肺组织虫体包囊数目明显减少或消失，两个治疗组包囊减少率分别为94．44％和98．15％；血液CD4^＋、CD8^＋T细胞和IFN-γ水平较阳性对照组升高，其中CD4^＋T细胞和IFN-γ显著升高（P〈0．05）。结论中药鸦胆子和补骨脂对卡氏肺孢子虫肺炎大鼠有明显的治疗效果．     

经双氢青蒿素治疗后卡氏肺孢子虫肺炎大鼠的肺部病理学变化

目的　研究经双氢青蒿素治疗后卡氏肺孢子虫肺炎 (PCP)大鼠肺部病理学变化。方法　以地塞米松磷酸钠皮下注射Wistar大鼠建立卡氏肺孢子虫肺炎动物模型 ,用 6 0mg/kg双氢青蒿素治疗实验大鼠 ,杀鼠取肺 ,用光镜和电镜观察肺部病理学变化 ,同时设有感染对照组和正常对照组。结果　肺印片中卡氏肺孢子虫 (Pc)包囊数目显著减少 ,肺组织炎症明显减轻 ,Pc滋养体表膜和核膜破裂 ,胞质中出现大量空泡和高电子密度颗粒 ,Pc包囊中也出现空泡 ,囊内小体变性坏死。结论　双氢青蒿素可杀死Pc滋养体和包囊 ,从而减轻肺组织的炎症反应。     

双氢青蒿素对患卡氏肺孢子虫肺炎大鼠血清和肺泡巨噬细胞上清液IL-1水平的影响

为研究双氢青蒿素对患卡氏肺孢子虫肺炎（Pneumocystis carinii pneumonia,PCP）大鼠血清和肺泡巨噬细胞培养上清液IL－1水平的影响，以醋酸可的松皮下注射Wistar大鼠建立卡氏肺孢子虫肺炎动物模型，用60mg/kg双氢青蒿素治疗实验大鼠，杀鼠取肺，用胶原酶消化法分离大鼠肺泡巨噬细胞，用LPS刺激培养72h，同时设有感染对照组和正常对照，用IL－1β试剂盒分别检测血清和培养上清液IL－1β的水平，结果显示感染组和治疗组大鼠IL－1β水平显著高于正常对照，治疗组大鼠IL－1β水平则低于感染组，说明卡氏肺孢子虫感染可能引起大鼠肺泡巨噬发泌高水平IL－1，经双氢青蒿素治疗PCP后大鼠肺泡巨噬细胞产生IL－1水平降低。     

保元汤加减对卡氏肺孢子虫肺炎模型大鼠的免疫调节作用初探

目的 观察中药保元汤加减煎剂对卡氏肺孢子虫肺炎模型大鼠免疫状态的调节作用，以探索中医药治疗卡氏肺孢子虫肺炎的新途径。方法 在造模不同时间，以保元汤加减煎剂给卡氏肺孢子虫肺炎(PCP)模型大鼠灌胃，2ml／次，1次／d，于造模后第8周末，测定各组实验大鼠淋巴细胞转化率及T细胞亚群百分率。结果 预防组大鼠淋巴细胞转化率明显高于PCP模型对照组，其值与正常对照组差异无显著性；预防组和治疗组大鼠的CD4^ 及CD4^ ／CD8^ 值高于PCP模型对照组和治疗对照组，预防组CD4^ 及CD4^ ／CD8^ 值与正常对照组差异无显著性。结论保元汤加减煎剂，可提高卡氏肺孢子虫肺炎模型大鼠的机体免疫功能，可作为防治卡氏肺孢虫子肺炎的药物。     

双氢青蒿素对卡氏肺孢子虫肺炎大鼠脾细胞凋亡的影响

目的　检测双氢青蒿素对卡氏肺孢子虫肺炎 (PCP)大鼠脾细胞凋亡的影响。方法　以醋酸可的松皮下注射Wis tar大鼠建立PCP动物模型 ,用 60mg/kg双氢青蒿素治疗实验大鼠 ,杀鼠取肺 ,用胶原酶消化法分离其脾细胞 ,用PI和TUNEL染色法检测其凋亡 ,同时设有感染组和正常大鼠对照组。结果　感染组和治疗组大鼠脾细胞凋亡率显著高于正常对照组 ,治疗组大鼠脾细胞凋亡率明显低于感染组。结论　卡氏肺孢子虫感染引起大鼠脾细胞发生凋亡 ,而双氢青蒿素治疗后PCP大鼠脾细胞凋亡降低     

双氢青蒿素对大鼠体内卡氏肺孢子虫作用的超微结构研究

目的 研究双氢青蒿素（DHA）治疗对大鼠体内卡氏肺孢子虫（PC）超微结构的影响。方法 以地塞米松磷酸钠对Wistar大鼠进行皮下注射，建立卡氏肺孢子虫肺炎（PCP）动物模型，用60mg／kgDHA治疗实验大鼠，杀鼠取肺，用透射和扫描电镜观察大鼠肺内PC的超微结构变化，并与感染对照组进行比较。结果 透射电镜发现PC滋养体表膜和核膜破裂，胞质中出现大量空泡和高电子密度颗粒，PC包囊中也出现空泡，囊内小体变性坏死；扫描电镜发现PC滋养体丝状伪足和微绒毛稀疏、变短甚至脱落，表膜出现缺损。结论 DHA可破坏PC滋养体和包囊。     

蒿甲醚用于卡氏肺孢子虫肺炎大鼠的治疗及其对IL-6影响的研究

目的 从病理学和细胞因子角度探讨蒿甲醚对大鼠卡氏肺孢子虫肺炎（Pneumocystiscarinii Pneumonia POP）的治疗效果和作用机理。方法 给SD大鼠皮下注射地塞米松磷酸钠建立卡氏肺孢子虫肺炎动物模型，治疗组给予蒿甲醚治疗。ELISA双抗夹心法分别检测血清和支气管肺泡灌洗液中1L-6水平。结果 与感染对照组比较，蒿甲醚治疗组症状显著改善、肺印片中卡氏肺孢子虫包囊数目显著减少、肺组织炎症明显减轻、血清和肺泡灌洗液中IL-6水平明显下降。结论 蒿甲醚具有一定抗大鼠卡氏肺孢子虫肺炎作用，能够降低PCP大鼠IL-6。     

蒿甲醚治疗实验大鼠肺孢子虫肺炎的初步观察

用皮下连续注射醋酸可的松６周建立大鼠肺孢子虫肺炎动物模型，并用国产蒿甲醚进行实验治疗，经蒿甲醚１００ｍｇ／ｋｇ．次，每日１次连续５ｄ，大腿肌肉注射后，治疗组大鼠肺印片中卡氏肺孢子虫包囊均数较未治疗对照组有所减少，与成戊烷脒治疗组相近，提示蒿甲醚可能是一种有前途的抗卡氏肺孢子虫新药。     

卡氏肺孢子虫低死亡率SD大鼠动物模型的建立

目的建立低死亡率卡氏肺孢子虫肺炎(PCP) SD 大鼠动物模型. 方法将雌性SD大鼠随机分为实验组和对照组,实验组采用按体重定量皮下注射地塞米松免疫抑制的方法诱导建立PCP动物模型,对照组注射与地塞米松等体积的生理盐水.分别制作肺印片,经瑞-姬氏复合染色后,检查卡氏肺孢子虫包囊.制作肺组织病理切片,经HE染色后观察肺组织病理变化.制作感染大鼠肺组织超薄切片,透射电镜观察Pc包囊和滋养体. 结果用地塞米松诱导后,实验组SD大鼠死亡率为0,肺印片阳性率为76.7%(23/30).肺组织出现典型的病理变化,并可观察到Pc包囊.实验组SD大鼠体重下降明显,与对照组体重比较具有极显著性差异(P<0.01).电镜下可观察到Pc包囊和滋养体的形态结构. 结论采用按体重定量皮下注射地塞米松的方法可建立低死亡率PCP动物模型.     

青蒿素衍生物抗卡氏肺孢子虫体外作用的研究

目的 研究不同浓度青蒿素衍生物双氢青蒿素、青蒿琥酯对体外培养卡氏肺泡子虫的作用。方法 接种卡氏肺孢子虫（Pc）于人肝癌细胞系（HepG-2)。4h加入试验药物和对照试剂。双氢青蒿素药物浓度分别为：100、50、10、5、0．5μmol/L；青蒿琥酯药物浓度分别为：100、50、10、5μmol/L；对照药喷他脒：15μmol/L。以后每隔1d取培养液观察，分别作六亚甲基四胺银（GMS）和Diff-Quik(DQ)染色计数Pc包囊和滋养体数目。结果 Pc滋养体和包囊在体外培养细胞上的生长高峰出现于第5d，双氢青蒿素浓度为50μmol／L和100μmol／L时对Pc滋养 的抑制率分别为88．0％与90．1％，与喷他脒15μmol/L的抑制率90．0％相当；而青蒿琥酯浓度为100μmol/L时方可达到Pc滋养体抑制率83．4％。Pc包囊抑制率，双氢青蒿素和青蒿琥酯浓度为100μmol/L分别为67．5％和67．3％，与喷他脒的抑制率75．0％之间无统计学差异。结论 双氢青蒿素和青蒿琥酯在一定浓度时67．3％，对Pc的抑制作用与喷他脒相当；而双氢青蒿素的抑制作用略高于青蒿琥酯。两者对Pc滋养体的抑制率均高于对Pc包囊。     

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.