目的 检测乌龙茶提取物是否可作为电子染色剂取代醋酸双氧铀用于心肌淀粉样变染色,并在染色过程当中使用不同的染色方法,改进制备方法,比较其安全性与高效性.方法 收集中国医学科学院阜外医院2017年1～12月临床怀疑淀粉样变性的病例共计40例,其中心肌组织经病理学观察和特殊染色呈阳性者10例.利用树脂812常规包埋和改进后方法对心肌组织进行制备,再在复染铅与不复染铅这两种情况下对超薄切片样品进行两种不同染色剂(3％醋酸双氧铀水溶液、0.5％乌龙茶提取物)和两种不同染色方法(滴染法、切片盒染色法)的电子染色,然后在透射电子显微镜下观察比较其不同之处.结果 复染铅的情况下,在透射电子显微镜下心肌中淀粉样物质,利用2种电子染色剂和改进后的制备方法进行染色的结果均较理想,切片背景干净,对比度高,所获图像清晰.结论 在观察心肌淀粉样变中,乌龙茶提取物配合切片盒染色与改进后的制备方法,可以更加安全、快速地替代醋酸双氧铀进行透射电子显微镜电子染色.

Objective To evaluate the sensitivity and specificity of immunohistochemistry(IHC)in the classification of cardiac amyloidosis on endomyocardial biopsy(EMB)and heart allograft. Methods Twenty cardiac tissues from 19 patients at Fuwai Hospital from January, 1990 to April, 2017 with histopathologic features of amyloidosis and Congo red staining positivity were included. IHC was performed with monoclonal antibodies against AA amyloid and polyclonal antibodies against transthyretin(ATTR), λ-light chain(AL-λ),κ-light chain(AL-κ),ApoAⅠ,ApoAⅡ,ApoAⅣand β2-microglobin. The extent of interstitial staining was evaluated by light microscopy,and three patterns were recognized;these included diffuse pericellular pattern, discrete pericellular pattern, and nodular pattern. Two patterns of vascular deposition were also noted,including arterial pattern and venous pattern. Endocardial involvement was also assessed and recorded. Results Nineteen cases were divided into three groups according to the pattern of proteins expression in specimens. The first group(5 cases)only showed single protein expression on EMB. The second group(6 cases)showed more than one protein expression,but one of them was intensely stained or any staining of any protein together with ApoA Ⅳ co-staining. The third group(8 cases)also showed more than one protein expression and all of them had intense staining. Amyloid deposits were successfully subtyped as AL-λ,ATTR,AL-κ and ApoAⅠby IHC in the former two groups with the sensitivity of 11/19. In the third group, amyloid deposits could not be subtyped by immunohistochemistry due to their poor specificity. The pericellular pattern tended to favor AL over ATTR amyloidosis and vascular deposition tended to favor ATTR. Conclusions Amyloid deposits can be reliably subtyped in diagnostic cardiac specimens using IHC. The co-deposition of chaperon proteins, the distribution of amyloid proteins and clinical features are also auxiliary to subtype cardiac amyloidosis.

Objective The pathological evaluation is an important aspect in the preclinical research of cardiovascular devices.The aim of the study was to set up a pathological evaluation strategy for preclinical safety study of annuloplasty rings.Methods Total 22 annuloplasty rings were implanted separately in 22 adult male sheep,including 17 sheep in the test group of two kinds of new rings and 5 sheep in the control group.The implant position was the mitral valve in 17 sheep and the tricuspid valve in 5 sheep.When the animals were sacrificed 20 weeks after surgery,pathological examination was performed to evaluate the integrity of the annuloplasty rings,inflammatory reaction,endothelization,fibrous sheath,pannus,thrombosis at the gross,histological and ultrastructural levels.We also evaluated the injury of the heart and remote organs.Results All rings appeared well implanted at the mitral or tricuspid valves without any surgical injury on valves and coronary arteries.The annulopasty rings were well in the structural integrity and encapsulated by a thin fibrous sheath without thrombus and pannus.A few lymphocytes,macrophages and multinuclear giant cells were observed around the rings in all sheep while neutrophil infiltration was found only in 1 sheep of the test group.Scanning electron microscopy showed almost complete endothelization on the surface of rings.There was no significant difference of endothelization rate between the two groups [(92.0 ± 8.1) ％ vs.(97.0 ±2.4) ％,P =0.081].Other changes included focal myocardial necrosis in 6 sheep,kidney infarction in 1 sheep and granulomatous inflamation of liver in 1 sheep.Unexpected death occurred in 4 sheep (3 in the test group and 1 in the control group) at the 2nd,11th,12th and 13th week after surgery respectively.Their causes of death were regarded as pulmonary infection while autopsy also found incomplete fibrous sheath and lower endothelization rate of 5％ to 60％ in 3 sheep and a micro thrombi in 1 sheep.Conclusion A good pathological evaluation about annuloplasty rings should focus on the structural integrity,biocompatibility and complication of the heart and other organs at several morphological levels.It is important for preclinical safety study to differentiate adverse effect of annuloplasty rings,surgical injury and infection as the cause of complications and death.

Aims: Endomyocardial biopsy (EMB) is the routine procedure for monitoring the outcome of heart grafts. This article reports acute cellular rejection and antibody-mediated rejection after heart transplantation, as detected by EMB. Methods: We retrospectively evaluated 496 patients who underwent heart transplantation in Fuwai Hospital between August 2004 and June 2015. The EMB specimens were used for evaluating acute cellular rejection (ACR) and antibody-mediated rejection (AMR) by histopathology and immunohistochemistry. Results: Of 496 patients who underwent HTX, a total of 856 EMBs were performed in 261 patients. Among 850 myocardium biopsies, 425 (52.9%, 425/850) showed no evidence of ACR and AMR. ACR was seen in 345 EMBs (40.6%, 345/850) with mild rejection observed (grade 1R) in 318 cases (37.4%, 318/850), moderate rejection in 25 cases (2.9%, 25/850) EMBs and severe rejection (3R) in 2 cases (0.23%, 2/850). Antibody-mediated rejection (AMR) was found in 8 EMBs, including 5 AMR alone and 3 AMR mixed with ACR. CD68 positive macrophages were found in all 8 EMBs with AMR and C4d staining was positive in 6 cases (75.0%). S6RP and pS6K were positive in 7 (87.5%) and 5 (62.5%) EMBs with AMR separately. Conclusions: Intravascular macrophages are a sign of microvascular inflammation and the earliest evidence of antibody-mediated allograft injury. Phosphorylated S6RP has the highest sensitivity in diagnosis of AMR, followed by C4d and pS6K. C4d is still a useful marker for AMR diagnosis.

目的:病理学检测是评价心血管置入器械安全性的重要方面.本研究通过两种国产成形环动物实验的病理学分析,探索建立规范的成形环临床前体内实验的病理评价方法.

1临床资料患者女性，57岁；20年前行左侧乳腺癌根治术，并行放射治疗（剂量不详）。近因“间断性胸闷、气促，伴全身水肿10个月”入院，常规血液学、肝肾功能检查未见异常。胸部计算机断层摄影术（CT）及超声心动图检查，示双侧胸腔及腹腔积液，左肺尖斑片影，右肺中叶及双肺下叶磨玻璃、索条状影，纵隔淋巴结增大，左侧胸膜增厚；心血管表现为心包腔内有纤维素沉着可能，二尖瓣少中量反流，三尖瓣中大量反流。主动脉及冠状动脉多发钙化斑块。近1个月以来，患者轻微活动后胸闷、气促加重，伴双下肢水肿、颜面部水肿，药物治疗无效，经医院伦理委员会讨论批准择期行心脏移植术。

OBJECTIVE:To assess the pathologic markers for evaluation of reversibility in pulmonary hypertension (PAH) related to congenital heart disease.METHODS:Twenty-eight patients with congenital heart disease complicated by PAH were subclassified into reversible pulmonary hypertension (RPAH) and irreversible pulmonary hypertension (IPAH), according to post-operative mean pulmonary artery pressure (MPAP). Pulmonary vascular lesion was analyzed according to Ruan's method. Mean medium thickness percent, mean medium area percent and pulmonary arteriolar density were measured by quantitative morphometry. Immunohistochemical study for transgelin and filamin A was carried out.RESULTS:Amongst the 28 cases studied, 24 were RPAH and 4 were IPAH. Of the 24 patients with RPAH, 13 (54.2%, 13/24) had pulmonary vascular lesion of grade 0, 9 (37.5%, 9/24) of grade 1 and 2 (8.3%, 2/24) of grade 2. Of the 4 patients with IPAH, 1 had lesion of grade 1, 1 of grade 2 and 2 of grade 3. Both preoperative and postoperative MPAP were higher in IPAH patients than that in RPAH patients[(53.3±23.4) mmHg versus (34.1±12.7) mmHg, P=0.020 and (35.0±8.8) mmHg versus (17.8±3.9) mmHg, P<0.01]. Compared to patients with pulmonary vascular lesion of grades 0 and 1, the preoperative MPAP in patients with grades 2 and 3 showed no significant difference, but the postoperative MPAP was higher (P<0.05 or 0.01). Compared to control group, mean medium thickness percent and mean medium area percent were significantly higher in RPAH and IPAH categories (12.0±3.5, 8.5±2.0 versus 5.7±1.0, P<0.01 and 55.8±11.1, 49.0±9.4 versus 34.0±5.5, P<0.01). Mean medium thickness percent was significantly higher in IPAP group than that in RPAH group (12.0±3.5 versus 8.5±2.0, P=0.001). Correlation analysis demonstrated that mean medium thickness percent and mean medium area percent had positive correlation with preoperative and postoperative MPAP. There was no correlation between grading of pulmonary vascular lesion and reversibility. Transgelin and filamin A had stronger staining in pulmonary vascular smooth muscle cells in IPAH than those in RPAH and controls(P<0.05).CONCLUSIONS:Pathologic assessment of lung biopsy remains the gold standard for evaluation of the reversibility in PAH related to congenital heart disease. Mean medium thickness percent, mean medium area percent and immunoreactivity for transgelin and filamin A are useful parameters.

OBJECTIVE To investigate the pathological changes and related factors leading to failure of bioprosthetic valves. METHODS The surgical explanted bioprosthetic valves in Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College from January 2006 to December 2014 were retrospectively reviewed. Calcification, cusp tears, pannus and infectious endocarditis of bioprosthetic valves were evaluated by gross examination, X ray photography and histopathological analysis. Meanwhile, the age and the site at implantation, and the tissue type of bioprosthetic valves, the implantation duration were obtained by chart review and used to be analyzed with the modes of valve failure. U test, χ(2) test and Fisher exact test were used to analyze the data. RESULTS Total 48 bioprosthetic valves were collected from 40 cases with 26 females. Their age at the time of implantation was 12 to 71 years (median 58 years). The tissue types of bioprosthesis included 24 bovine pericardial valves and 24 porcine aortic valves respectively. The implantation sites included mitral in 29 valves, aortic in 14 valves and tricuspid in 5 valves. The implantation duration ranged from 5 days to 27 years (mean (111±77) months). The study showed that the commonest mode of valve failure was structural valve deterioration (32 valves, 66.7%). The fewer modes of valve failure were infectious endocarditis (9 valves, 18.7%) and non-structural valve deterioration (7 valves, 14.6%). No thrombosis was found in this series. The degree of calcification was correlated positively with implantation duration (r=0.52, P=0.000). The implantation duration of bovine pericardial valves was longer than that of porcine aortic valves ((146±74) months vs. (77±68) months, Z=-3.24, P=0.001). Porcine aortic valves had a higher incidence of cusp tears than bovine pericardial valves (66.7% vs. 16.7%, χ(2)=12.34, P=0.000) despite they had a relatively lower incidence of calcification (41.7% vs. 75.0%, χ(2)=5.37, P=0.019). For the age at the time of implantation, the patients ≤60 years old had more calcification of bioprosthetic valves compared with those >60 years old (45.1% vs. 2/17, χ(2)=5.51, P=0.019) whereas the patients ≤60 years old had fewer cusp tears (12.9% vs. 58.8%, P=0.002). Infectious endocarditis was found more frequently in the valves failure within 5 years than those failure after 5 years (6/14 vs. 8.8%, P=0.006). CONCLUSIONS Structural valve deterioration is the principle cause of bioprosthetic valve failure while infectious endocarditis mainly involves the valves failure in early and middle terms after surgery. The mode of valve failure in the patients ≤60 years old is different from that in the patients >60 years old at the time of implantation. More calcification would occur in bioprosthetic valve in the younger patients.

目的 初步探讨特发性主动脉夹层的病理变化和发病机制.方法 收集特发性主动脉夹层病例(除外遗传性结缔组织病、高血压、炎症反应、主动脉瓣二叶化畸形)25例,在常规组织形态学观察的基础上,运用弹力纤维和Masson三色染色法及免疫组化结合图像分析,检测动脉中膜弹力纤维、胶原纤维和平滑肌细胞的变化及与弹力纤维合成相关的因子Fibulin-5的变化.结果 特发性主动脉夹层的病理变化主要表现于中膜层,为中膜弹力纤维灶性破坏,黏液样基质增多.弹力纤维含量明显低于对照组(P＜0.01);胶原纤维含量高于对照组(P＜0.05);平滑肌细胞量较对照组明显少(P＜0.05);Fibulin-5阳性细胞的阳性表面积率显著低于正常对照组(P＜0.05).Fibulin-5含量与弹力纤维含量呈正相关(P＜0.05).结论 特发性主动脉夹层的病理变化主要是中膜层变化.Fibulin-5蛋白减少引起的弹力纤维合成减少是导致特发性主动脉夹层的发病因素之一,Fibulin-5蛋白对检测特发性主动脉夹层具有诊断意义.

目的：瓣膜疾病是心脏外科常见病、多发病，每年全世界瓣膜置换术约17万例，本文以近2年国家心血管病中心进行主动脉瓣置换术患者为研究对象，探讨主动脉瓣置换的病因。<br>　　方法：总结阜外医院2013-03至2015-03期间第一次采用单纯主动脉瓣置换术或二尖瓣主动脉瓣联合置换术治疗的患者3369例，对其组织病理学资料及临床、手术所见进行分析讨论。

目的：原发性心脏肿瘤罕见，血管肉瘤（AS）是组织学上常见的原发性心脏肉瘤，组织学类型多变，诊断较困难，遗传学及分子改变知之甚少。本文探讨心脏原发性血管肉瘤的临床病理特征、免疫表型、诊断和鉴别诊断及预后。

目的 探讨D2-40和CD31蛋白在海绵状血管瘤和海绵状淋巴管瘤中的表达及鉴别诊断意义.方法 采用免疫组化PV-9000二步法检测14例海绵状血管瘤和海绵状淋巴管瘤中D2-40和CD31蛋白的表达.结果 D2-40在海绵状淋巴管瘤中的阳性淋巴管密度(LVD)为10.78±3.76,而在海绵状血管瘤中呈(-),两者之间差异显著.CD31在海绵状淋巴管中呈(-),而在海绵状血管瘤中的阳性微血管密度(MVD)为12.34±3.86;两者同样差异显著.结论 D2-40和CD31蛋白在海绵状血管瘤和海绵状淋巴管瘤中的表达差异显著,有助于鉴别诊断.

OBJECTIVE:To investigate the association between clinical and histopathological features in patients with left ventricular non-compaction cardiomyopathy (LVNC). METHODS:Histopathological examinations were made on 11 LVNC recipient hearts from June 2004 to June 2014 in Fuwai Hospital, myocardial ultrastructure changes were detected using transmission electron microscopy. Association between clinical and pathological features were analyzed. RESULTS:Patients were (24 ± 11) years old. There were 6 patients with mucus matrix LVNC, 3 patients with fibrous fatty infiltration, and 2 patients with cardiomyocytes proliferation. The gross morphological changes of LVNC hearts were characterized by numerous and prominent trabeculations with deep intratrabecular recesses in left ventricular myocardium. Ratios of the thicker noncompacted endocardial layer (N) and thin epicardial compacted layer (C) (N/C ratio) were ≥ 2.0, and the most serious lesions were located in the left ventricular apex, and followed by the left ventricular free wall. Histological microscopic examinations evidenced numerous matrix-like material and immature cardiomyocytes on endocardial tissue. Transmission electron microscopy revealed mitochondrial abnormalities on morphology, number, and distribution, underdeveloped cardiomyocytes and anomalies of intercalated disc structure, increased deposition of extracellular matrix-like substance and perinuclear glycogen. Pathological changes on cytoplasmic matrix and intercalated disc were present in all three tissue types of LVNC in this cohort and mitochondria hyperplasia was detected in patients with fibrous fatty infiltration. Heart weight ≥ 350 g is often associated with increased number of mitochondria. Increased cytoplasmic matrix was often detected in patients with LVEF ≥ 30% while intercalated disc anomalies were often detected in patients with LVEF < 30%. CONCLUSION:Histological changes were closely related clinical features in patients with LVNC.

OBJECTIVE:To identify clinical and pathological features of giant cell myocarditis.METHODS:Clinical presentation and follow-up data of three patients with giant cell myocarditis were collected.Gross, histopathological, immunohistological and ultrastructural findings of extransplantated hearts of the patients were documented.RESULTS:Grossly, multifocal involvement of the myocardium with variably dilated cardiac chambers were observed in all 3 cases.Histological examination revealed pronounced focal inflammatory infiltrates with multinucleated giant cells. Multinucleated giant cells were positive for CD68 and CD11b immunostains but were negative for CD163 in all cases. Transmission electron microscopy showed that the multinucleated giant cells derived from fusion of several macrophages with adherent lymphocytes and secretary cells. Clinically, the overall patient condition improved in all three cases after heart transplantation.One patient experienced acute cellular rejection (2R level) 4 months after transplantation, but recovered after treatment. One patient developed multinucleated giant cells observed in heart biopsy two weeks after transplantation.CONCLUSIONS:Giant-cell myocarditis is a rare disease of adult, and cardiac transplantation could improve the clinical outcome. Multinucleated giant cell in the myocarditis lesions were derived from macrophages, likely participating in the immune response. Endomyocardial biopsy is important for the diagnosis of giant cell myocarditis.

目的：心脏炎性肌纤维母细胞瘤（IMFT）非常罕见，探讨心脏IMFT的临床病理学特点，提高对本病的认识。

目的：分析生物瓣置换术后生物瓣衰竭的病理变化及其相关因素。

目的：探讨D2-40和CD31蛋白在海绵状血管瘤和海绵状淋巴管瘤中的表达及鉴别诊断意义。

目的：通过观察先天性心脏病相关性肺动脉高压肺活检组织内肺血管组织学改变，探讨肺血管病理学变化在判断肺动脉高压可逆性中的应用价值。

目的：巨细胞心肌炎（GCM）通常导致暴发性心力衰竭，心律失常，心肌梗死，需要积极的免疫抑制治疗、心室辅助装置插入或心脏移植。本文着重探讨巨细胞心肌炎的临床、病理特征、心脏移植及移植后免疫抑制的治疗效果。

In order to develop a biodegradable iron stent, a feasibility study of biodegradable nitriding iron stent in coronary artery of mini-swine was undergone. Eight iron stents (Lifetech Scientific, Shenzhen, China) and eight Vision stents (Abbott Vascular, CA, USA) as control were randomly implanted