2014年 · 第42卷第12期

Professor Sun Yingxian's research group of China Medical University carried out a large-scale epidemiological survey of hypertension in rural areas of Fuxin, Liaoning Province in 2004, and selected 45,925 subjects. The results showed that the prevalence of hypertension was 37.8%, the treatment rate was 23.6%, the awareness rate was 29.5%, and the control rate was only 1.1%. The standardized prevalence of stroke, cerebrovascular mortality 193.2/100,000, overweight and obesity 20.3%, and smoking 41.4% among the rural population aged ≥35 years in Fuxin. The average daily salt intake was 16.88 g in hypertensive people and 15.07 g in non-hypertensive people. The prevalence of metabolic syndrome was 36.2%, the prevalence of diabetes was 10%, and the dyslipidemia rate was 69.4%.

Platelet adhesion, activation and aggregation play an important role in the pathophysiological process of acute coronary syndromes (ACS) and percutaneous coronary intervention (PCI). Aspirin and P2Y12 receptor inhibitors (e.g. clopidogrel), as the two most commonly used classes of antiplatelet drugs, are the cornerstones of the current prevention of thrombotic events after ACS and/or PCI. The study found that the differences in individual responsiveness to antiplatelet therapy were significantly correlated with adverse events such as thrombus and bleeding. Through platelet function testing, we can understand the individual's responsiveness to antiplatelet therapy and adjust the treatment plan accordingly, which may be an effective means to improve the efficacy and safety of antithrombotic therapy. However, due to the numerous methods and inconsistent standards of platelet function detection, and the numerous individualized adjustment of antiplatelet therapy schemes, there is still no consensus on the clinical detection and treatment of the diversity of antiplatelet therapy responses at home and abroad. In view of the importance of thromboprophylaxis and many problems in its clinical practice, the American Society of Cardiology and the European Society of Cardiology have successively published corresponding expert consensus^[1,2]To standardize clinical diagnosis and treatment. With the substantial increase in the number of PCI cases in China, the importance of optimizing antiplatelet therapy and improving patient prognosis has become increasingly prominent. According to the actual situation in China, this expert recommendation is formulated for the reference of clinicians.

In the traditional concept, the position of the right ventricle in the cardiovascular system is not paid enough attention. In recent years, right ventricular function has received more and more attention. For many diseases, right ventricular function is an important predictor of survival rate. For example, the decrease of right ventricular ejection fraction in pulmonary arterial hypertension (PAH) is a predictor of poor clinical prognosis, and its prediction accuracy even exceeds the increase of pulmonary vascular resistance^[1,2]。 In the early stage of the disease, right ventricular hypertrophy (RVH) is mostly an adaptive response, but as the disease progresses, the right ventricle enlarges and eventually develops right ventricular failure (RVF) (difficult adaptive right ventricular remodeling)^[3]。 Studies have shown that many mechanisms are involved in refractory right ventricular remodeling, including myocardial energy metabolism transition, mitochondrial damage, contractilin isoform transition, myocardial excitation-contraction coupling-related enzyme and ion channel changes, matrix remodeling, neurohumoral and cytokine activation, etc^[3]。 This article discusses the changes of energy metabolism in RVH and RVF and the treatment of related targets.

hypertrophic cardiomyopathy (HCM) is a common autosomal dominant heart disease with prominent heterogeneity of genotype and clinical phenotype. The abnormal hypertrophy of the ventricular wall in the vast majority of patients with HCM occurs mainly in the interventricular septum, and in few cases may involve the apex or the middle of the left ventricle. The main involvement of the right ventricle is rare, while the simple occurrence of right ventricular hypertrophy is rare. right ventricular hypertrophic cardiomyopathy (RVHCM) mainly involves the anterior or free wall of the right ventricle, and may be accompanied by obstruction of the right ventricular outflow tract or even apical occlusion of the right ventricular cavity. At present, there is a lack of clear definition for the diagnosis of RVHCM, and right ventricular hypertrophy and dysfunction are often neglected in clinical diagnosis. In this study, the research progress of RVHCM is discussed in combination with domestic and foreign literature reports.

China's Chronic Disease Prevention and Treatment Work Plan (2012-2015) pointed out that the number of chronic diseases in China has increased rapidly, and now there are 260 million confirmed patients. The medical and health problems of chronic diseases have become the main public health problems in China. The key to improving personal health is the development of regional health services, which depends on the development and organizational ability of health authorities. In order to solve this highly concerned people's livelihood problem, Handan Health Bureau of Hebei Province explored the construction of a new service mode of grass-roots health service system-Handan Model Health Cabin, so as to prevent illness before illness, improve the functions of grass-roots health services, and provide high-quality and efficient medical services for the benefit of the people.

A 48-year-old male was admitted to the hospital due to intermittent chest tightness and shortness of breath for 1 year, aggravated for 2 days. No prior history of hypertension. Smoking history for 30 years, 20-40 cigarettes/d. Physical examination: blood pressure 110/70 mmHg (1 mmHg =0.133 kPa); The lips are not cyanotic; Dry and wet rales were not heard in both lungs; There was no enlargement of the heart turbidity boundary during percussion, the heart rate was 88 beats/min, the rhythm was absolutely irregular, the intensity of the first heart sound was different, and no heart murmur was heard; There was no edema in both lower limbs. Electrocardiogram showed atrial fibrillation at admission. Echocardiography showed left atrial anteroposterior diameter 38 mm, no left atrial thrombosis, left ventricular ejection fraction 55%. Chest X-ray showed no abnormalities in heart, lung and diaphragm. There were no abnormalities in hematuria, fecal routine, liver and kidney function, electrolyte and thyroid function; Triglyceride 2.26 mmol/L. Diagnosis: coronary heart disease, unstable angina pectoris, cardiac function grade II (NYHA grade); arrhythmia, persistent atrial fibrillation; Hypertriglyceridemia. Selective coronary angiography was performed on July 12, 2011. The results showed that the distribution of coronary arteries was right dominant; The right coronary artery was roughly normal; Stenosis of the 7th to 8th segments of the left anterior descending artery is 30% to 40%; Stenosis of the 13th segment of the left circumflex artery was 90% to 95%, and distal blood flow TIMI grade 3. Interventional treatment of the left circumflex artery was decided. A 3.0 mm ×33 mm Firebird stent was placed in the 13th segment of the left circumflex artery using a JL3.5 guide catheter (product of Cordis, USA). Sinus rhythm was revealed by ECG monitoring 2 h after operation. Reexamination of ECG showed: sinus rhythm, no obvious abnormality in ST-T segment. Postoperative treatment according to the secondary prevention of coronary heart disease. After 30 months of follow-up, all patients' ECG showed sinus rhythm, no chest tightness, shortness of breath and palpitations, and no adverse cardiovascular events occurred.

A 42-year-old female went to the outpatient department of cardiology of our hospital on November 14, 2013 because of "2 years after heart valve replacement, large ecchymosis of both lower limbs for 2 days". The patient underwent mechanical valve replacement of mitral and aortic valves in Nanjing Drum Tower Hospital due to rheumatic heart disease and combined valvular disease 2 years ago. The patient recovered well after operation, and his cardiac function was grade I ~ II. Long-term warfarin (Shanghai Xinyi Pharmaceutical) anticoagulant therapy, the dose is 2.5 mg, once/d, the international standardized ratio (INR) is stable at 2.0~2.5. The patient had a history of recurrent abdominal pain for many years. He was diagnosed with endometriosis in Suqian Obstetrics and Gynecology Hospital 2 months ago. He was given gestrinone (Beijing Zizhu Pharmaceutical) 2.5 mg orally twice a week for 4 weeks. The warfarin dose was not adjusted and the INR monitored while the patient was on gestrinone. About 2 days ago, the patient found flaky bruises on both lower limbs, which were not paid attention to at first. In the past 2 days, the area of ecchymosis was enlarged compared with before, so he went to a doctor. The patient denied taking other drugs at the same time, and there was no significant change in dietary structure; No yellow urine, anorexia, anorexia, no melena, bloody stool, no hematemesis, no hematuria, no headache and other manifestations.

A 20-year-old male was admitted to hospital due to chest tightness and chest pain after repeated activities for 2 months, and recurred for 1 d. The patient self-complained of chest tightness and chest pain after running 2 months ago, and the symptoms were relieved after 10 min of rest. One day ago, after lunch, he had sudden chest pain, which was squeezing-like and radiated to his back and left hand. After 1 hour of rest, the symptoms did not relieve and he was admitted to hospital. Previous continuous ketamine use for 1 year, now withdrawn; No history of trauma; No family history of coronary heart disease and hypercholesterolemia; No history of smoking and drinking. Admission physical examination: body temperature 36.4 ℃, pulse 86 beats/min, heart rate 18 beats/min, blood pressure 110/68 mmHg (1 mmHg =0.133 kPa); Cardiopulmonary examination showed no abnormalities. After admission, blood lipid, liver and kidney function, thyroid function, coagulation index and erythrocyte sedimentation rate were all normal, and HIV antibody and serological test, Treponema pallidum antibody, rheumatism and immune related indexes, vasculitis related indexes and lupus related indexes were all negative. Creatine kinase (CK) 400 U/L, creatine kinase isoenzyme (CK-MB) 26.1 U/L, serum troponin T 46.1 ng/L, N-terminal B-type natriuretic peptide 96 ng/L, D-dimer 250 μ g/L. ECG showed V₁~ V₄Lead ST segment elevation; Chest X-ray: no abnormalities; Echocardiography: attenuated anterior and lateral wall motion, left ventricular systolic hypofunction, mild mitral regurgitation, mild tricuspid regurgitation, left ventricular ejection fraction 56%.

Since 1993 Wightman et al.^[1]First discovery of the first microRNA (miRNA) By 2011, the total number of miRNAs registered in version 18.0 of the miRNA database had reached 21,643, including 1,424 in the human genome, regulating about 60% of the coding genes. Each miRNA regulates multiple different target mRNAs, which have been shown to be involved in regulating various biological processes such as cell development, differentiation, proliferation, metabolism, apoptosis, tumorigenesis, and hematopoiesis. In 2008, researchers found that miRNA can be detected in plasma, platelets, red blood cells and nucleated blood cells, and pointed out that miRNA in plasma is highly stable, and each disease has a specific miRNA expression profile. Heart failure (HF) is the terminal manifestation of all cardiovascular diseases and the main cause of death. Its 5-year mortality rate is about 50%, which is more than that of many cancers. Once heart failure occurs, cardiac function will progressively deteriorate, seriously affecting the patient's survival status. In recent years, more and more studies have shown that miRNA is involved in the pathophysiological process of heart failure by regulating the expression of related genes during myocardial remodeling, and specific miRNA is elevated in the plasma of patients with heart failure. With the deepening of understanding of miRNA, it may have important clinical value in the diagnosis and treatment of heart failure.

Alpha B crystallin is a soluble lens protein belonging to the family of small molecule heat shock proteins. The molecular chaperone function of α B crystalline proteins mainly protects cells from stress damage under stress by binding to proteins to prevent protein denaturation and aggregation. Mutations in the gene encoding α B crystal protein can cause a variety of myocardial diseases, including desmin-associated cardiomyopathy and dilated cardiomyopathy^[1]。 Understanding the various mechanisms by which α B crystal protein mutations lead to cardiomyocardial diseases can help to explore possible treatment strategies for such diseases in clinic.

In July, 2013, the ceremony of giving the books collected by Professor Liu Zesheng to the hospital had just been completed. Everyone had a common wish, hoping to collect all kinds of articles published by Professor Liu Zesheng before his death into a book, supplemented by all kinds of memories and memories, to express their feelings and respect for the deceased.

Dear teacher, a famous cardiovascular disease expert in China, Professor Wei Taixing, Department of Cardiovascular Medicine, the First Affiliated Hospital of Zhengzhou University, has been away from us for more than a month. I think he is still by our side: the window of the office on the second floor flashes with his reading and writing lights every night, showing that his voice of analyzing difficult cases echoes in the classroom. On the podium, he holds a gauge and a ruler to analyze electrocardiogram theory for students, and he is carefully observing the condition by the bedside of critically ill patients...