2014年 · 第42卷第07期

Professor Jin Hongyi, a member of the Communist Party of China, a famous cardiovascular disease in China, a famous health care medical expert and geriatric expert, and one of the leading figures in cardiovascular disease in Zhejiang Province, died at 9: 58 on August 30, 2013 in Hangzhou at the age of 83 due to ineffective treatment.

Drug pleiotropy is a very hot topic. Such as the effects of antihypertensive drugs other than lowering blood pressure, statins other than lowering cholesterol, and hypoglycemic drugs other than lowering blood sugar...

From the first report (JNC 1) of the National Joint Committee on the Prevention, Detection, Evaluation, and Treatment of Hypertension in the United States in 1976 to JNC 7 in 2003, it has been all-powerful for decades. The long-awaited JNC 8 is a model of evidence-based medicine. Rigorous and scientific, only randomized controlled trials (RCTs) were collected, while other observational study evidence was excluded. However, RCT cannot cover all the problems involved in clinical practice and has its limitations. There are many important concepts of JNC 8 that have not been mentioned. I think there are some shortcomings, mainly as follows.

In 2009, Krum et al.^[1]The study of percutaneous catheter-based renal sympathetic denervation (RDN) for intractable hypertension (SYMPLICITY HTN-1) was reported for the first time, followed by SYMPLICITY HTN-2^[2]The results showed that at 6 months, blood pressure decreased by an average of 32/12 mmHg (1 mmHg =0.133 kPa,P<0.001）。 Renal artery injury occurred in one patient in the RDN treatment group.

The international general definition of "orphan drug" refers to drugs, vaccines or reagents used to prevent, diagnose and treat rare diseases or rare states. The World Health Organization defines rare diseases as diseases or lesions that affect 0.65% to 1.00% of the total population^[1]Among them, there are more than 130 rare cardiovascular diseases recognized by the National Institutes of Health (NIH), including long QT syndrome, Brugada syndrome, arrhythmogenic right ventricular cardiomyopathy, catecholamine-sensitive polymorphic ventricular tachycardia (catecholaminergic polymorphic ventricular tachycardia, CPVT), Ebstein malformation, glycogen accumulation disease, Danon's disease, Fabry's disease, left heart hypoplasia syndrome, etc. (https: / /rarediseases.info.nih.gov/gard/categories), most of which are hereditary or genetically predisposed diseases. Because the commercial profits of "orphan drugs" are extremely low, the R&D and production costs cannot be repaid through sales at all, and pharmaceutical companies lack interest in such drugs because they are unprofitable, leaving many patients with rare diseases in a situation where they have no drugs available. This phenomenon is particularly prominent in China, especially in the field of cardiovascular diseases.

A 53-year-old male was admitted for "intermittent chest pain for 5 years, aggravated for 1 month". Five years ago, postactive retrosternal dull pain appeared, which could be relieved by itself after 2 minutes of rest. The symptoms were more than those occurred during strenuous exercise. I went to the cardiology clinic of our hospital and was admitted to the hospital with unstable angina pectoris. He denied the history of hypertension and diabetes, and denied the history of metallurgy. Smoking for 30 years. More than 20 years ago, he was injured in a car accident and had a history of blood transfusion. Physical examination showed old trauma scars on the forehead, no obvious skin lesions on the whole body, no obvious positive signs in the heart and lungs, and no pathological signs of nervous system.

2013 can be described as the "Year of Guidelines", and Europe has published the "2013 European Hypertension Society (ESH) /European Society of Cardiology (ESC) Guidelines for the Management of Arterial Hypertension"^[1]And the United States completed the "three consecutive" guidelines within one month, including "2013 American Heart Association (AHA) /American College of Cardiology (ACC) /Centers for Disease Control and Prevention (CDC) Scientific Recommendations for Effective Control of Hypertension"^[2]"2013 American Hypertension Society (ASH) /International Hypertension Society (ISH) Community Hypertension Management Guidelines"^[3]And the new American hypertension guide "JNC 8", which "comes out long-awaited"^[4]。

stem cells are a class of pluripotent cells with self-replication ability and can differentiate into multiple functional cells. induced pluripotent stem cells (iPSCs) are a special type of stem cells, which can constantly renew themselves and have multidirectional differentiation potential. At present, the source of pluripotent stem cells has been a hot research topic in biomedical field. The latest research has found that urine is a completely non-invasive source of cells, mainly used for disease-assisted diagnosis and detection of related markers of diseases. In 1972, surviving exfoliated cells (hereinafter referred to as urine cells) were first successfully isolated from urine samples of newborns^[1], which are urine-derived stem cells^[2], especially urine-derived induced pluripotent stem cells (urine induced pluripotent stem cells, UiPSC)^[3,4,5]Successful induction of, provides an important basis. Therefore, urine cells provide an ideal source for further research on stem cells, and have great application value in regenerative medicine, tissue engineering and drug discovery and evaluation.

Clinical management of left-to-right shunt congenital heart disease represented by patent ductus arteriosus combined with severe pulmonary hypertension, aortic root lesions represented by coronary artery fistula and ruptured aortic sinus aneurysm, and residual lesions after surgery of some complex malformations of congenital heart disease is very difficult. Especially for patients with patent ductus arteriosus complicated with severe pulmonary hypertension, traditional surgery is very risky, sometimes "overwhelmed", while conservative treatment is "sitting still". In view of these residual postoperative lesions that are difficult to grasp the curative effect by surgery alone, limited by conventional methods, and other residual postoperative lesions that require secondary thoracotomy, our project team, with the support of National Science and Technology Research and National Natural Science Foundation of China, designed an interventional treatment plan integrating diagnosis and treatment, opened up a new clinical treatment path and established a new diagnosis and treatment standard. Its innovative results are as follows.