2015年 · 第54卷第04期

Atherosclerosis is a chronic lesion of the blood vessel wall and the leading cause of death worldwide. Epidemiological data consistently suggest that LDL-C levels are associated with myocardial infarction and vascular death^[1]。 Unlike the average person who develops atherosclerosis in middle age, patients with low-density lipoprotein (LDL) receptor deficiencies have atherosclerosis progression at least 20 years earlier^[2]。 Mendelian randomized studies confirmed that LDL-C is a causal factor in atherosclerotic plaque formation and progression and is only associated with LDL-C levels, not with allele involvement in mediated LDL metabolic processes^[3]。

By inhibiting cholesterol synthesis in hepatocytes, statins can effectively reduce blood cholesterol, especially LDL-C concentration, delay or even resolve atherosclerotic plaques, and significantly reduce the morbidity and mortality of coronary heart disease. Because these drugs play a significant role in the primary and secondary prevention of atherosclerotic cardiovascular disease (ASCVD), they are the first-line basic drugs for intervening dyslipidemia and preventing ASCVD, and they are widely used in clinical practice.

With the widespread spread of the concept of patient-centered treatment, compliance is no longer a simple concept of patients following doctor's advice, but has developed into a "treatment mode", that is, "patients and doctors reach mutually agreed behavior codes, actively, voluntarily and cooperatively participate in the treatment process to achieve the expected treatment goals"^[1]。 Similar to the fact that a healthy lifestyle is fundamental to cardiovascular disease prevention, drug adherence also plays a decisive role in its efficacy. A meta-analysis of 21 studies evaluating subject adherence^[2]It was found that subjects with good adherence had a significantly lower risk of death compared to subjects with poor adherence (OR0.56，95%CI0.50 to 0.63), even patients who used placebo but had good adherence had a reduced risk of death, but good adherence to harmful treatment also increased the risk of death. The researchers call this phenomenon the "healthy adherent" effect, in which good adherence predicts a better prognosis for treatment.

Abnormal cardiac function is present in nearly 50% of sepsis patients^[1]。 Study confirms^[2,3]The uncontrolled inflammatory response of myocardial tissue is the key link leading to myocardial injury in sepsis. The damage to tissues and organs caused by the inflammatory response is due to dysfunction of the vascular endothelial barrier^[4]。 Adhesive junctions are mainly composed of vascular endothelial cadherin, which can regulate the permeability of microvascular endothelial cells. Lipopolysaccharides can activate a variety of protein tyrosine kinases (PTKs), the most important of which is non-receptor type protein tyrosine kinase (Src). Rho is a member of the GTPase superfamily, and Rac1 mainly regulates vascular permeability by mediating skeletal protein remodeling. Therefore, the changes of vascular endothelial permeability under inflammation are inseparable from the changes of Src, Rac1 and vascular endothelial cadherin activities. This study aimed to investigate the molecular mechanism of lipopolysaccharide-induced increased permeability of myocardial microvascular endothelial cells (CMECs).

Long-term administration of adefovir dipivoxil may cause nephrotoxicity, often manifested by increased serum creatinine or decreased serum phosphorus concentrations. Long-term hypophosphatemia can lead to abnormal bone density. This study investigated the incidence and influencing factors of hypophosphatemia in chronic hepatitis B patients who took adefovir dipivoxil for a long time, and analyzed the incidence and influencing factors of abnormal bone mineral density in patients with hypophosphatemia.

Vertigo is a symptom of patients' movement illusion of static objects or themselves, which is often manifested as rotation of vision and unstable swing. It is a common symptom in neurology and can be seen in benign paroxysmal positional vertigo, vestibular neuronitis and other diseases. In recent years, malignant vertigo (MV) has been reported one after another, but it is still lacking in clinical understanding. Patients with such vertigo who suspect posterior circulation ischemia often use cranial MRI, especially diffusion weighted imaging (DWI) to determine whether they are acute cerebral infarction. However, in a few cases, the head MRI examination was negative at the onset of the disease, but it was diagnosed as cerebral infarction in the later stage. This type of MV is easy to miss diagnosis due to negative imaging, and the consequences are serious. Three cases of MY are reported. No new lesions were found on MRI of the head at the onset of the disease, but the disease progressively aggravated, and later it was diagnosed as brainstem infarction. By summarizing its clinical and imaging characteristics, the aim is to strengthen the understanding of MV diagnosis and outcome by specialists.

McCune-Albright syndrome (MAS) is a rare condition characterized mainly by the triad of one or more endocrine gland dysfunction, multiple fibrous dysplasia (FD), and cutaneous milk caffeine-like pigmented spots (CALMs) due to mutations in the GNAS1 gene^[1]。 A typical and complicated patient with MAS is reported below in order to improve clinicians' understanding of the disease and help in the early diagnosis and treatment of this disease.

The patient was a 73-year-old female. Diabetes for more than 20 years, due to poor blood sugar control, routine examination in hospital found that blood calcium was elevated, and there was no obvious bone pain, fracture, peptic ulcer and other manifestations. Physical examination: Thyroid degree II, the right side is larger than the left side, and two nodules about 1 cm in size can be palpable in the left lobe, which are tough in texture, without tenderness, and can move with swallowing; A 2 cm nodule can be palpable near the trachea in the right lobe of the thyroid gland, which is soft and non-tender. Auxiliary examination: normal thyroid function; The highest blood calcium was 3.3 mmol/L, the lowest blood phosphorus was 0.3 mmol/L, and the blood parathyroid hormone (PTH) was 663ng/L (Table 1)； Ultrasound examination of the neck showed that a 31.8 mm ×15.8 mm slightly hypoechoic mass was seen on the dorsal side of the right lobe of the thyroid gland, which seemed to have a capsule (Figure 1)； A slightly hypoechoic nodule of 18.9 mm ×12.1 mm was seen in the middle of the left thyroid lobe without obvious envelope, and an isoechoic area of 19.9 mm ×11.0 mm was seen in the lower pole, which seemed to have envelope; Abdominal plain X-ray showed no calculi. Primary hyperparathyroidism is highly clinically suspected, but the localization diagnosis is not clear. The patient is older and has been diabetic for more than 20 years. The risk of surgery is high, and the unclear preoperative positioning increases the difficulty of surgery. Then thyroid fine needle puncture was performed, and the pathological return was: puncture of the left lobe of the thyroid nodule, with more gelatinous substances and phagocytic cells under the microscope, and the diagnosis was consistent with goiter; The right lobe nodule was punctured, and a large number of follicular cells were arranged in dense clusters under the microscope, with more nude nucleated cells in the background (Figure 2), diagnosis: parathyroid parenchymal nodule or tumor. During puncture, the remaining material after smear of the fine needle puncture of the right thyroid nodule was repeatedly eluted three times with 1ml normal saline, and the eluate was sent for PTH measurement. PTH was detected by electrochemiluminescence method (Cobase 602), directly with 1ml eluate after centrifugation and other treatments, and the results reported that PTH was greater than 3000 ng/L. The diagnosis was right parathyroid adenoma or nodule with primary hyperparathyroidism. Immediately after definite localization, left lobectomy + right parathyroid adenoma resection was performed. The operation was smooth, and the postoperative pathological return was: left lobe nodular goiter, right lobe parathyroid adenoma (Figure 3)。 The serum calcium and PTH were significantly decreased on the second day and the second week after operation (Table 1)。

The patient was a 19-year-old female. The main reason was "intermittent dizziness for 18 months, memory loss and abnormal mental behavior for more than 6 weeks". The patient experienced dizziness, occasional nausea, increased sleep, and transient pain in his right eye 18 months ago without trigger. The serum sodium was 114.6 mmol/L, the cerebrospinal fluid protein was 0.661 g/L, and the cranial MRI showed bilateral deep temporal lobe and symmetric lesions of the brain parenchyma around the third ventricle. PET-CT showed no abnormalities. Sodium supplementation (approximately 10 g/d), antiviral, intravenous infusion of gamma globulin (IVIG, 0.4 g·kg^–1• d^–1), methylprednisolone (1,000 mg/d, halved every 3 days until 120 mg/d, discontinued and switched to oral prednisolone acetate 60 mg/d), symptoms gradually relieved after about 1 month, and oral prednisolone acetate (60 mg/d ×1 month) was continued, and then reduced by 5 mg every week until discontinued. MRI reexamination of the head 16 months ago showed that the intracranial lesions basically disappeared, and the brain parenchyma around the third ventricle showed cavity-like changes. Ten months ago, the patient's head MRI reexamination at the time of dizziness attack showed that T2 image bilateral medial temporal lobe hyperintensity lesions reappeared and left insular hyperintensity was newly added. Six months ago, dizziness and vomiting occurred again, and the serum sodium was normal, which improved about 3 days. Re-examination of the skull MRI showed abnormal patch signal near the insula in the left basal ganglia area, and serum aquaporin 4 (AQP4) antibody and SSA antibody were positive. Azathioprine 50 mg/d ×1 month and 100 mg/d ×2 months were given. Three months ago, the attack recurred, accompanied by right eyelid twitching and holding breath when fatigued, and completely relieved after oxygen inhalation. The evolution of brain lesions in the patient is shown inFigure 1。

List of expert working groups (sorted by pinyin of surname): Ding Yansheng (Department of Cardiology, Peking University First Hospital); Dong Jianzeng (Department of Cardiology, Beijing Anzhen Hospital affiliated to Capital Medical University); Fang Quan (Department of Cardiology, Peking Union Medical College, Peking Union Medical College, Chinese Academy of Medical Sciences); Guo Jihong (Heart Center, Peking University People's Hospital); Hu Dayi (Heart Center, Peking University People's Hospital); Huawei (Department of Cardiology, Fuwai Cardiovascular Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences); Huang Congxin (Department of Cardiology, People's Hospital of Wuhan University); Huang Dejia (Department of Cardiology, West China Hospital, Sichuan University); Jiang Wenping (Department of Cardiology, The First Affiliated Hospital of Suzhou University); Ke Yuannan (Department of Cardiology, China-Japan Friendship Hospital); Li Chunsheng (Emergency Department, Beijing Chaoyang Hospital affiliated to Capital Medical University); Liu Shaowen (Department of Cardiology, Shanghai First People's Hospital); Lu Yiming (Emergency Department, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine); Ma Changsheng (Department of Cardiology, Beijing Anzhen Hospital affiliated to Capital Medical University); Ma Jian (Department of Cardiology, Fuwai Cardiovascular Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences); Qi Xiangqian (Department of Cardiology, Tianjin TEDA International Cardiovascular Hospital); Sun Genyi (Department of Cardiology, Tianjin Chest Hospital); Wan Zheng (Department of Cardiology, General Hospital of Tianjin Medical University); Wu Shulin (Department of Cardiology, Guangdong People's Hospital, Guangdong Academy of Medical Sciences); Yang Xinchun (Department of Cardiology, Beijing Chaoyang Hospital affiliated to Capital Medical University); Yang Yanzong (Department of Cardiology, First Affiliated Hospital of Dalian Medical University); Yang Yanmin (Acute and Critical Care Center, Fuwai Cardiovascular Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences); Zhan Siyan (Center for Evidence-Based Medicine, Peking University School of Public Health); Zhang Ping (Department of Cardiology, Tsinghua Chang Gung Memorial Hospital, Beijing); Zheng Qiangsun (Department of Cardiology, Tangdu Hospital, Fourth Military Medical University); Zhu Jun (Acute and Critical Care Center, Fuwai Cardiovascular Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences)

Community-acquired pneumonia (CAP) is an important disease with high prevalence and mortality. According to a survey in the United States, 12 people per 1,000 people develop pneumonia every year, and the daily rate of pneumonia in Japan is 25 per 100,000 people^[1]。 The United States, Europe and China have successively published guidelines for the diagnosis and treatment of CAP^[2,3,4]。 The cognition and clinical diagnosis and treatment of CAP at home and abroad are generally consistent or similar. The Guidelines for the Treatment of Community Acquired Pneumonia in Adults in Japan were published by the Guidelines for Respiratory Infectious Diseases of the Japan Respiratory Society in 2000 and republished and updated in 2006^[1]。 This policy has many principles and norms similar to the widely used CAP guidelines in China, but there are also differences. Now, the main contents are summarized and summarized for readers to think and practice.

In December 1952, the London smog event caused more than 4,000 wrongful deaths in just 4 d days^[1]This incident caused scientists and government departments in various countries to pay attention to the impact of air pollution on human health. Air pollution has been proven to be associated with many diseases in humans, including respiratory diseases, cardiovascular diseases, tumors, and others. Among them, particulate matter (PM) PM2.5 in air pollutants is more closely related to cardiovascular diseases (CVD). PM2.5 is a particulate pollutant with an aerodynamic diameter of less than 2.5 μ m, mainly derived from the combustion of fossil fuels. The following will focus on the relationship between PM2.5 and CVD and analyze the possible mechanisms.

Acute coronary syndrome (ACS) is a group of clinical syndromes including ST-segment elevation myocardial infarction (STEMI), non-ST-segment elevation myocardial infarction (NSTEMI) and unstable angina pectoris, which seriously threaten the health and life of patients. Antiplatelet and antithrombotic therapy are important therapeutic methods for patients with ACS. At present, aspirin, the earliest and most widely used antiplatelet drug in the treatment of cardiovascular diseases, plays a pivotal role in the treatment of ACS. Although studies in recent years have confirmed that new antiplatelet drugs also have obvious efficacy in the treatment of ACS, and the recommendation status of new antiplatelet drugs in the guidelines is also on the rise, aspirin has always been the cornerstone of the treatment of ACS patients. The following will be an overview of the application progress of aspirin in the treatment of ACS based on the new research and new guidelines in the past two years.

IL-33, also known as IL-1F11, is a new member of the IL-1 family discovered in recent years. It can be produced by many types of tissues and cells. It induces the expression of Th2-type cytokines by binding to heterodimeric receptor complexes composed of ST2L and IL-1 receptor accessory proteins and participates in the regulation of immune and inflammatory responses. Previous studies have shown that the serum IL-33 expression level is significantly increased in patients with inflammatory arthritis (rheumatoid arthritis, spondyloarthritis) and diffuse connective tissue disease (systemic lupus erythematosus, systemic sclerosis), and it is significantly correlated with disease activity. IL-33/ST2 signal transduction pathway plays an important regulatory role^[1]。 The research progress of IL-33/ST2 pathway and its role in the pathogenesis of systemic vasculitis are summarized as follows.

cerebral microbleeds (CMBs) are a manifestation of cerebral small vessel disease. They are lesions with signal loss in small areas on T2*-weighted sequences (or other sequences sensitive to magnetic susceptibility), and there are smudges around the lesions. The diameter of the lesion is generally 2~5 mm, with a maximum of 10 mm. It is usually distributed in the cortex and subcortex junction area, deep cortex gray matter nucleus, cerebral hemisphere white matter, brainstem and cerebellum^[1]。 At present, it is believed that there are two pathological mechanisms: one is small vessel hyaline degeneration caused by cardiovascular risk factors such as hypertension; The second is the damage of tiny blood vessel wall caused by vascular amyloidosis. Sensitivity-weighted imaging sequences (SWI) were more sensitive to CMBs than T2*W-GRE sequences.

colorectal cancer (CRC) is one of the most common malignant tumors in China. In western countries, the incidence of colorectal cancer ranks 2nd ~3rd among malignant tumors. With the continuous improvement of people's living standard and the change of dietary habits, the incidence of colorectal cancer in China is also increasing year by year, and has jumped to 3rd ~5th place^[1]。

October 2014HeartRelationship between atmospheric fine particulate pollution and morbidity and mortality of ischemic heart disease, led by Beijing Anzhen Hospital, Capital Medical University [Xie W, Li G, Zhao D, et al. Relationship between fine particulate air pollution and ischaemic heart disease morbidity and mortality. Heart, 2015, 101 (4): 257 – 263.]. The study is the first internationally to report a dose-response relationship between atmospheric fine particulate matter (PM2.5) concentration and morbidity and death from ischemic heart disease (IHD) in highly polluted environments.

November 2014International Journal of Cardiology"Risk prediction model of contrast nephropathy after cardiac catheterization in patients with chronic coronary artery occlusion" organized by professors Chen Jiyan, Tan Ning and Liu Yong, Department of Cardiology, Guangdong Institute of Cardiovascular Diseases, Guangdong People's Hospital, Guangdong Academy of Medical Sciences (Liu Y, Liu YH, Chen JY, et al. A simple pre-procedural risk score for contrast-induced nephropathy among patients with chronic total occlusion undergoing percutaneous coronary intervention. Int J Cardiol, 2015, 180:69 – 71.). This study is a prospective observational study, the first to establish a risk prediction model for the development of contrast-agent nephropathy (CIN) after percutaneous coronary intervention (PCI) in patients with chronic coronary artery occlusion (CTO).

http: / /www.journals.elsevier.com/jacc – journal – of – the – american – college – of – cardiology/

[Website] http: / /www.bcs.com/pages/default.asp

Recently, a cohort study compared the safety of dabigatran and warfarin in the treatment of elderly patients with non-valvular atrial fibrillation (AF). The results showed that dabigatran was associated with a reduced risk of ischemic stroke, intracranial hemorrhage and death and an increased risk of major gastrointestinal bleeding events at general doses (Circulation, 2015, 131:157-164).

A randomized crossover trial compared the effects of combination preparations on cardiovascular risk factors when administered in the morning, late and usual hours, and patient adherence. Combination preparations were more effective in reducing LDL – C levels when administered in the evening than when administered in the morning; Patients are more willing to take combination formulations (Int J Cardiol, 2014, 181C: 193 – 199).

The patient was a 32-year-old female. Married, Han nationality, nurse. He was admitted to the hospital with "pneumonia" on January 10, 2013 due to fever accompanied by chest tightness and shortness of breath for 1 week. The patient gave birth to a daughter on 08 Dec 2012. One fever occurred on the 10th postpartum day, with a body temperature of 39℃, and the fever subsided after 3 days of intravenous infusion of melocillin sodium (4 g, twice/d). One week before admission, I experienced chills and fever again, with the highest body temperature of 40℃, accompanied by sore throat, cough, cough with a little white phlegm, chest tightness and shortness of breath, and no relief was seen after intravenous infusion of melocillin sodium (4 g, 2 times/d) for 2 days. Later, he was hospitalized in the local hospital. Chest CT showed inflammation of the right lower lung and right pleural effusion (Figure 1)。 Intravenous infusion of piperacillin/tazobactam (4.5 g, once/8 h) and moxifloxacin (0.4 g, once/d) for 3 days showed no significant decrease in body temperature. From January 8, 2013, intravenous bolus injection of methylprednisolone (40 mg, twice/d), intravenous infusion of butacanal (0.4 g, once/d) and oral administration of ethambutol tablets (0.75 g, once/d) showed that the body temperature fluctuated from 37.5 to 38.0℃ after 2 days of treatment. During the course of the disease, the patient's chest tightness and shortness of breath progressively I was in good health and had a miscarriage 2 years ago. Deny history of chronic diseases and infectious diseases. No smoking or drinking habits.