2018年 · 第46卷第01期

The report of the 19th National Congress of the Communist Party of China pointed out that innovation is the first driving force for development and the strategic support for building a modern economic system. In the report, "science and technology" was mentioned 17 times, and "innovation" was emphasized 59 times. "Scientific and technological innovation" became a frequent term in the report of the conference. Since the 18th National Congress of the Communist Party of China, the CPC Central Committee and the State Council have successively held the National Conference on Science and Technology Innovation and the National Conference on Health and Wellness, made systematic planning and careful arrangements from the perspective of national strategy, and put forward a series of new ideas, new judgments and new requirements to promote scientific and technological innovation. From the Outline of the National Implementation of Innovation-driven Development Strategy to the 13th Five-Year National Science and Technology Innovation Plan, and then to the promulgation and implementation of the Outline of the Healthy China 2030 Plan, the Chinese government has demonstrated the confidence and determination to comprehensively safeguard and improve people's health through scientific and technological innovation, and started a new journey to realize the coordinated development of social economy and people's health.

The rapid development of our society, modernization and urbanization have brought about changes in work and lifestyle, and the adverse impact on the epidemic trend of cardiovascular diseases is manifested in the increasing trend of cardiovascular mortality, prevalence and morbidity in recent years. The changes in the incidence of cardiovascular diseases reflect that the control of risk factors and the cardiovascular health status of adults in China are not optimistic. The research report "Cardiovascular Health Status of Chinese Adults" shows that by evaluating 7 health indicators (smoking, body mass index, exercise, eating habits, cholesterol, blood pressure and fasting blood glucose), the proportion of ideal cardiovascular health among Chinese adults (all 7 indicators are at an ideal level) is extremely low (2%)^[1]。 If the risk factors are not controlled, it is estimated that by 2030, the number of cardiovascular disease patients in China will increase by 21.3 million and the number of cardiovascular disease deaths will increase by 7.7 million^[2]。

Thrombosis aspiration treatment uses a thrombosis aspiration catheter, under negative pressure suction, to extract the thrombosis components that block the blood flow in the vascular cavity of the criminal from the body, reduce the thrombosis load in the vascular cavity of the criminal, and theoretically help to restore the anterior blood flow of the coronary artery, improve myocardial blood perfusion, and help to reduce distal thromboembolism, reduce the risks of no reflow (or slow blood flow) and in-stent thrombosis. However, several previous trials on thrombus aspiration have reached different conclusions. There have been many controversies about the application of thrombus aspiration in emergency interventional treatment of acute myocardial infarction for a long time.

In 2011, the Cardiovascular Branch of Chinese Medical Association and the Editorial Committee of Chinese Journal of Cardiovascular Diseases organized and published the Guidelines for the Prevention of Cardiovascular Diseases in China^[1]It has played an important role in actively responding to the severe challenges brought by cardiovascular diseases and guiding the prevention of clinical cardiovascular diseases in China.

A 52-year-old male was admitted to the hospital on February 22, 2017 due to "chest tightness for more than 3 months". The patient underwent "ascending aorta replacement + Sun's operation + ascending aorta-left femoral artery bypass" due to Standford type A aortic dissection 2 years ago, and recovered well after operation. Physical examination at admission: temperature 36.4 ℃, pulse 81 beats/min, breathing 19 beats/min, blood pressure 125/71 mmHg (1 mmHg =0.133 kPa). The heart rate was 81 beats/min, the heart rhythm was uniform, and no murmur was heard in the auscultation area of each valve. The breathing sounds of both lungs were clear, and there were no dry and wet rales. Soft abdomen, no tenderness. There was no edema in both lower limbs, and the bilateral radial artery pulsed well, while the left femoral artery pulsed weakly. Laboratory tests: No abnormalities in blood routine and biochemical tests; D-dimer 1 098 μ g/L. CT angiography showed that after Standford type A aortic dissection surgery, the ascending aorta and the proximal end of the intraoperative stent anastomosis leaked. The leak was located in the great curvature of the aortic arch, adjacent to the root of the left subclavian artery, with a diameter of 2 mm. The thoracic aortic false lumen was enhanced (Figure 1）。

A 56-year-old female patient was diagnosed mainly because of "chest stiffness and shortness of breath for 3 months after activity", and was hospitalized in our hospital twice. In January 2017, the patient began to experience chest stiffness and shortness of breath after activity and progressively aggravated, gradually developed facial edema, and then could not lie down at night. On February 8, the patient was admitted to an external hospital. The cardiac radionuclide examination showed that the left ventricular cavity was slightly enlarged, and there was no obvious abnormality in left ventricular myocardial blood perfusion. He was diagnosed with dilated cardiomyopathy and given symptomatic treatment. Since March 3rd, the symptoms have further aggravated, and I was admitted to our hospital for the first time on March 10th. Past history: It was found that blood pressure was slightly increased for 1 year, and he had taken antihypertensive drugs intermittently. Fertility history: G2P1, 1 child, no history of spontaneous abortion. Family history: The mother suffered from dermatomyositis at the age of 65 and died 6 months after the onset. Admission physical examination: blood pressure 80/60 mmHg (1 mmHg =0.133 kPa). High occipital position, bilateral jugular veins were filled, the heart boundary was enlarged, the heart rate was 80 beats/min, the heart sounds were low and blunt, the rhythm was uniform, no pathological murmur was heard, there was no edema in both lower limbs, and the skin temperature of the limbs was low. Admission ECG: sinus rhythm, extensive lead QRS complex low voltage (Figure 1）。 Blood gas analysis: pH 7.54, arterial oxygen partial pressure (PO₂) 70 mmHg, partial blood carbon dioxide pressure (PCO₂) 29 mmHg, blood oxygen saturation (SO₂）95%。 N-terminal B-type pronatriuretic peptide (NT-proBNP) 7 997.0 ng/L. Echocardiography: left ventricular end-diastolic diameter (LVIDD) 53 mm, right atrial diameter (RA) 53 mm ×53 mm, right ventricular anteroposterior diameter (RV) 32 mm (transverse diameter 50 mm), left ventricular ejection fraction (LVEF) 32%, diffuse attenuation of left and right ventricular wall motion, tricuspid valve insufficiency (severe), 18 mm ×38 mm hyperechoic mass in the right ventricle (FIG. 2A）。 Cardiac magnetic resonance and gadolinium delayed enhancement scan: right atrium and left and right ventricles were enlarged, left and right ventricular myocardial abnormalities with multiple delayed enhancement foci, myocardial involvement changed, and right ventricular thrombosis was possible (Figure 3）。 CT pulmonary angiography (CTPA): pulmonary artery embolism in the lingual segment of the upper lobe of the left lung (Figure 4）。 During hospitalization, he was treated to improve his cardiac function, and his shortness of breath was slightly alleviated. He was discharged from the hospital on March 31. The discharge diagnosis was: heart failure. Cause to be investigated: dilated cardiomyopathy? Right ventricular thrombosis, pulmonary embolism. Oral warfarin, torathamide, spironolactone and potassium chloride sustained-release tablets were administered.

microRNA (miRNA) is a kind of endogenous non-coding RNA with a length of about 22 nucleotides, which plays an important regulatory role in animals and plants^[1]。 miRNA was first found in Caenorhabditis elegans^[2]And successively found that it participates in the regulation of messenger RNA in cells, which is related to the formation of various diseases. In addition to being present intracellularly, miRNAs are also present in the extracellular environment. The first to discover that miRNAs exist extracellularly was Chim et al.^[3]They found that miRNAs in the placenta appear in the peripheral plasma of pregnant women. These studies have opened up people's exploration of extracellular miRNA. Subsequently, more and more studies have shown that miRNA can also exist stably in other body fluids, including saliva, urine, milk, tears, amniotic fluid, bronchoalveolar lavage fluid, cerebrospinal fluid, peritoneal fluid and pleural fluid^[4]。 Differences in miRNA classes and concentrations exist in different body fluids^[4]Moreover, changes in miRNA concentrations and classes in the blood are associated with a variety of diseases. This suggests that circulating miRNA can act as a biomarker to assist in the diagnosis of certain diseases, including acute myocardial infarction (AMI)^[5]。 At present, scholars have not reached a consensus on the biological significance of circulating miRNA. This paper summarizes the existence forms of circulating miRNA and its diagnostic value in patients with acute myocardial infarction, so as to better understand the existence significance of extracellular circulating miRNA.

Both coronary heart disease and cognitive dysfunction are major diseases that endanger human health. Recent studies have found that patients with coronary heart disease have an increased risk of cognitive dysfunction^[1]Cognitive function declines more rapidly in patients with cognitive dysfunction with coronary heart disease^[2]The risk of death is also significantly increased^[3]。 These two diseases, which once seemed to have no obvious correlation, may have common risk factors or pathogenesis, but at present clinicians have not fully recognized and attached importance to the fact that coronary heart disease is a risk factor for cognitive dysfunction.