2017年 · 第03卷第02期

《中华心脏病学杂志》发布的《2016中国成人血脂异常管理指南》（简称新指南）是在2007年《中国成人血脂异常预防指南》（简称2007高脂血症指南）的基础上，经过专家团队一年的努力和工作的成果。¹

Currently, China has a growing need for rehabilitative care; however, rehabilitative care has been underdeveloped for decades. Since the end of 2010, pilot programs in 46 cities (districts) of 14 provinces have been initiated by the Ministry of Health in China to establish formal arrangements for facilitating the delivery of continuous medical rehabilitative care for local communities. After 2 years of pilot work, an evaluation was conducted by researchers. This paper reviews the current status of rehabilitative care in China and discusses the findings of the nationwide pilot program on the integrated rehabilitative service. Some key mechanisms and main issues were identified after analyzing the preliminary outcomes of some of the pilot programs.

The chronic conditions growth is determined by an increase of cases of adaptive system imbalance following a recent disease. One of its most significant causes is decrease of crisis importance (a stage of disease) as a moderator of a qualitative changeover of an adaptive system. The contemporary treatment methods increase efficiency of pre-crises adaptive responses, but simultaneously they equalize the crisis to a level, which is insufficient for complete after-crisis alignment of body defenses. But the crisis is the very key to a solution to a chronic conditions problem. One of the ways of the problem solving is medical interventions, which cause sparing provocation crisis and a successive changeover of an adaptive system. Based on this it is worth reviewing critically, studying and developing the existing experience of bio-regulatory therapy, where the principle of sparing provocation is often used. The new term definitions, such as "medical intervention" , "health problems" , "crisis" are described in terms of biomedicine. The patients and physicians should be motivated to deal with chronic conditions correction and the aforesaid sets new tasks before a health care system.

Atherosclerosis is a chronic, progressive disease which eventually leads to coronary heart disease (CHD), ischemic stroke and other atherosclerotic cardiovascular disease (ASCVD). Numerous studies have demonstrated an atherogenic role of oxidized low-density lipoprotein (ox-LDL) in the progression of ASCVD. This article briefly reviews the atherogenic mechanism of ox-LDL, the methods of measuring ox-LDL in the circulation, effect of medical therapy and life-style modification on ox-LDL level, and the association between circulating ox-LDL and atherosclerosis, including clinical ASCVD events and subclinical atherosclerosis, in observational studies.

The proposal of the present study was to investigate whether the TP53 rs1042522 polymorphism confers susceptibility to prostate cancer (PCa), by performing an updated meta-analysis.

Eligible publications investigating the association between the TP53 rs1042522 polymorphism and PCa susceptibility were selected from PubMed, Google Scholar, and Web of Science. We used STATA 12.0 software to conduct the analyses. Odds ratio (OR) with 95% confidence interval (CI) was calculated.

A total of 17 case—control studies were retrieved reporting a total of 2683 cases and 2981 controls. However, no significant association was uncovered between the TP53 rs1042522 polymorphism and PCa susceptibility in the overall population under the five genetic models. In the stratification analysis by source of control, an increased susceptibility to PCa was identified in the population-based (P-B) group (CG vs. GG: OR = 1.48, 95% CI: 1.24—1.77, P < 0.01; CC/CG vs. GG: OR = 1.32, 95% CI: 1.12—1.57, P < 0.01), whereas a decreased susceptibility was uncovered in the hospital-based (H-B) group (CG vs. GG: OR = 0.67, 95% CI: 0.46—0.96, P = 0.03; CC/CG vs. GG: OR = 0.67, 95% CI: 0.46—0.99, P = 0.04) under heterozygous and dominant model.

This study did not find an association between the TP53 rs1042522 polymorphism and PCa susceptibility in the overall population and corresponding subgroup analyses except in the stratification analysis by source of control. The results suggest that the TP53 rs1042522 polymorphism is not a risk factor for PCa.

Wharton jelly-derived mesenchymal stem cells (WJMSCs) exhibit multilineage differentiation potential and can be used to treat multiple organs. However, diabetes affects the repair capability of MSCs. The aim of this study was to evaluate the effect of diabetic patient-derived serum on WJMSC behavior.

WJMSCs at passage 3 were treated with serum derived from type 2 diabetic patients. WJMSCs were characterized for surface markers expression by using immunocytochemistry technique. The effects on cell viability, proliferation, cell death rate, and vascular endothelial growth factor level were assessed by crystal violet staining, 3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide (MTT) assay, lactate dehydrogenase assay, and enzyme-linked immuno-sorbent assay, respectively. Oxidative stress was assessed by the estimation of free radical species malondialdehyde (MDA) and enzymes glutathione (GSH), catalase, and superoxide dismutase (SOD).

WJMSCs isolated in this study were positive for CD29, CD49, CD73, CD90, CD105, and SSEA4 and negative for CD45 and CD34. Under diabetic stress conditions, WJMSCs showed low viability and high lactate dehydrogenase release. A low level of vascular endothelial growth factor was also observed after diabetic serum treatment. Antioxidant level was also lower in diabetic serum-treated WJMSCs compared to in normal serum-treated WJMSCs.

The results of the present study suggest that pre-treatment of WJMSCs with type 2 diabetic serum decreases the survival of WJMSCs. The findings of this study provide insight into diabetes-induced harmful effects on WJMSCs.

The purpose of this study was to investigate the distribution of chronic illness and associated disability, out-of-pocket payment (OOPP), and other related factors using survey data from Bangladesh.

This study analyzed Bangladesh Household Income and Expenditure Survey data that include socio-economic and demographic data, such as consumption, expenditures, and assets, along with information regarding chronic illness and disability. Multiple linear regression models were used to identify factors significantly associated with OOPP. Furthermore, a binary Logistic regression model was employed to assess the association of the explanatory variables with disability status.

A higher prevalence of chronic illness was found for those with chronic gastritis (18.70%), and 41.92% of the population had at least one side disability. The average OOPP healthcare expenditure for chronic illness was estimated to be US$7.59. Higher OOPP was found among the upper 2 wealth quintiles. Overall OOPP health expenditure was significantly higher among individuals with an associated disability (P < 0.001). The likelihood of having an associated disability was higher among those individuals with a lower education level (OR = 2.36, 95% CI: 1.95—4.06), those who not earning an income (OR = 2.85, 95% CI: 2.53—3.21), those who did not seek care (OR = 1.73, 95% CI: 1.57—1.90), those who sought care from a pharmacy (OR = 8.91, 95% CI: 7.38—10.74), and those in the lowest wealth quintile (OR = 7.21, 95% CI: 6.41—8.12).

The high OOPP illustrates the necessity of financial risk protection for the population at low socio-economic status. Therefore, we recommend that the government strengthen the healthcare system with appropriate support directed to the rural and elderly populations.

To present our treatment experiences and the follow-up data of patients with paradoxical embolism (PDE).

The clinical characteristics, management, and follow-up data of all included patients who were diagnosed with PDE at Fuwai Hospital from January 1994 to October 2015 were recorded.

Twelve patients were included; all had a pulmonary embolism, and 8 had deep venous thrombosis. The artery embolisms involved the cerebral artery (7 patients), renal artery (2 patients), mesentery artery (2 patients), popliteal artery (1 patient), descending aorta thrombus (1 patient), and thrombus-straddled patent foramen ovale (PFO) (1 patient). PFO was found in 3 cases. One patient underwent thrombectomy and PFO closure; Six patients received thrombolysis; and 3 patients were implanted with a vena cava filter. Long-term anticoagulation with warfarin was recommended for each patient. One patient died from ventricular fibrillation despite cardiopulmonary resuscitation. Eleven patients were discharged with improvements. No late mortality occurred in 8 patients with a complete follow-up of 10.6—17.7 years. One had a recurrent deep venous thrombosis. No patient had a recurrent pulmonary or arterial embolism. Two patients changed their treatment from warfarin to aspirin; others remained on warfarin. Only 1 case had an occasional gum bleeding.

PDE treatment including thrombolysis, anticoagulation, and embolectomy should be individualized. We recommend long-term anticoagulation therapy to prevent the recurrence of PDE, especially to those with an intracardiac communication or persistent risk factors for re-thrombosis.

Stroke is the leading cause of death and disability, and is closely related to a lack of exercise. Currently, most Chinese medical staff members lack exercise and may be at risk for stroke. We sought to determine the risk factors for stroke and study the significance of health-related physical fitness testing in stroke prevention among Chinese medical staff members.

A total of 627 subjects from Urumqi, Xinjiang, China, were included in the study and a survey was conducted from 1st January 2016 to 1st February 2016. Stroke screening and health-related physical fitness testing were completed according to the standard protocol, and the related data were analyzed.

Based on the screening, 27.6% (n = 173) of the subjects were at high risk for stroke. The top risk factors for stroke in these subjects were dyslipidemia, lack of exercise or mild physical activity, being overweight or obese, and high blood pressure. Body weight, body mass index, body fat, visceral fat area, body fat percentage, and basal metabolic rate were significantly higher (P < 0.01) in subjects at high risk for stroke than in subjects who were not at high risk. Lung capacity, step index, grip test, vertical jump, and sit-up/push-up index were significantly lower (P < 0.01) in subjects at high risk for stroke than in subjects who were not at high risk.

A large proportion of China's on-the-job medical personnel is at high risk for stroke. This may be related to the nature of the profession and warrants more attention from the society. The health-related physical fitness measurement parameters in subjects at high risk for stroke were significantly different from those in subjects who were not at high risk. Screening and health-related physical fitness testing in medical staff members may contribute to stroke prevention. More rigorous controlled clinical trials will be needed in the future.