2016年 · 第44卷第10期

The National Health and Wellness Conference was held in Beijing from August 19 to 20, 2016. * delivered an important speech. He pointed out: "Integrate health into all policies, and the people should build and share it together" and "we must unswervingly implement the principle of prevention first, adhere to the combination of prevention and treatment, joint prevention and control, group prevention and control, and strive to provide the people with health and wellness services in the whole life cycle".

The Guidelines for the Prevention and Treatment of Dyslipidemia in Adults in China (2016 Revised Edition) (referred to as the New Guidelines) published in this journal is the result of more than one year's hard work by an expert team on the basis of the 2007 Guidelines for the Prevention and Treatment of Dyslipidemia in Adults in China (referred to as the 2007 Guidelines for Blood Lipids).

According to the characteristics of Chinese population's own dyslipidemia and its research results, and with reference to the new progress of international dyslipidemia research in recent years, the Joint Committee on the Revision of Chinese Adult Dyslipidemia Guidelines and the Revision Working Group jointly completed the revision of the Guidelines for the Prevention and Treatment of Chinese Adult Dyslipidemia (2016 Revision) (referred to as the New Guidelines) after repeated discussions. The author has participated in the whole process of the revision of the guide, and now tries to briefly describe its main points and personal understanding.

In recent years, with the emergence of new technologies and the development of new devices, the interventional treatment of structural heart diseases has made great progress. From early congenital heart disease occlusion and balloon valve plasty, to the current transcatheter valve placement (aortic valve, pulmonary valve and mitral valve), valve repair (mitral valve and tricuspid valve), left atrial appendage occlusion and left ventricular volume reduction, the interventional therapy of structural heart disease has become a research hotspot in cardiology. These micro-innovative technologies and new methods not only reduce surgical risks, but even improve clinical efficacy, which will undoubtedly open up a new chapter in the treatment model of cardiovascular diseases.

In the past 30 years, the blood lipid level of Chinese population has gradually increased, and the prevalence of dyslipidemia has increased significantly. The results of the 2012 national survey showed that^[1]The mean adult serum total cholesterol (TC) was 4.50 mmol/L and the prevalence of hypercholesterolemia was 4.9%; The mean value of triglyceride (TG) was 1.38 mmol/L, and the prevalence of hyperTGemia was 13.1%; The mean value of high-density lipoprotein cholesterol (HDL-C) was 1.19 mmol/L, and the prevalence of hypoHDL-Cemia was 33.9%. The overall prevalence of dyslipidemia in Chinese adults is as high as 40.40%, which is a substantial increase compared with 2002. The increase of serum cholesterol in the population will lead to an increase of about 9.2 million cardiovascular disease events in China between 2010 and 2030^[2]。 The prevalence of hyperTGemia in children and adolescents in China has also increased significantly^[3]It indicates that the burden of dyslipidemia and related diseases among adults in China will continue to increase in the future.

A 67-year-old male was admitted to the hospital on 2 November 2015 due to "repeated loss of consciousness for more than 2 months". The patient had symptoms such as palpitation, nausea and dizziness after being tired more than 2 months ago, and suddenly lost consciousness when standing, which lasted for 1 min and relieved by itself, accompanied by sweating all over the body. Deny limbs twitching, chest pain and foaming at the mouth. Similar symptoms occurred 4 times in 2 months. Many times in the external hospital, coronary angiography, echocardiography, dynamic electrocardiogram, tilt test, head CT, electroencephalogram and cerebral blood flow Doppler diagram were performed in the external hospital, and no obvious abnormalities were found. Has taken beta blockers and the treatment has not been effective.

The patient was an 82-year-old female who was admitted to the hospital on October 3, 2015 due to "repeated chest tightness and shortness of breath for 1 year, recurring for 10 days". The patient underwent coronary angiography in our hospital 1 year ago, and the results showed that the left anterior descending artery (LAD) had 80% proximal stenosis and 85% middle tubular stenosis; 50% stenosis of the middle right coronary artery. After medication, the patient's condition improved. Prior history of hypertension for 1 year. Physical examination: temperature 37.0 ℃, pulse 79 beats/min, breathing 20 beats/min, blood pressure 135/95 mmHg (1 mmHg =0.133 kPa). Dry and wet rales were not heard in both lungs. The heart boundary was normal, there was no pericardial friction sensation and friction sound, the heart rate was 79 beats/min, the heart rhythm was uniform, and no murmur was heard. Electrocardiogram in the emergency department of our hospital showed sinus rhythm, V₃~ V₅The ST segment of the lead moved down by 0.1~0.2 mV. Electrocardiogram was re-examined after admission, showing V₁~ V₅Lead T-wave inversion deepens. Troponin I 1.70 μ g/L, creatine kinase isoenzyme (CK-MB) 35 U/L. The initial diagnosis was acute non-ST-segment elevation myocardial infarction.

The patient was a 60-year-old male who came to the clinic on April 9, 2015 due to "cough and expectoration with dyspnea for 2 days and aggravation for 15 hours". The patient developed dyspnea after coughing and expectorating 2 days ago, which could occur after walking about 50 m. There was no chest tightness, chest pain, loss of appetite, and no edema. The patient had aggravated dyspnea during sleep 15 h ago, was unable to lie down, and had no chest tightness, chest pain and sweating. Had been seen in an external hospital, and the ECG showed left bundle branch block, V₄~ V₆The T wave of the leads was upright, and the ST segment of the leads I and aVL was depressed. Troponin (Tn) T 2.89 μ g/L. Arterial blood gas analysis showed pH 7.32, partial pressure of carbon dioxide 26.4 mmHg (1 mmHg =0.133 kPa), partial pressure of oxygen 52.1 mmHg, and blood oxygen saturation 87.6%. WBC 17.01×10⁹/L, the percentage of neutrophils was 86.4%. X-ray chest radiograph showed exudative lesions in both lungs. Transferred to the emergency department of our hospital 5 h ago. There were no obvious dynamic changes in ECG. TnI 3.20 μ g/L, N-terminal B-type pronatriuretic peptide (NT-Pro BNP) 14 000 ng/L. Creatine kinase isoenzyme (CK-MB) 118 U/L and creatine kinase (CK) 1 038 U/L. Echocardiography showed abnormal segmental movement of ventricular wall (left ventricular anterior wall, middle segment of anterior septal wall, apical segment of each wall), normal thickness and echo, left ventricular ejection fraction 38%. Non-invasive ventilator-assisted breathing was given, oral clopidogrel 300 mg, vasodilatation with nitrates, diuresis with furosemide, acidosis corrected with sodium bicarbonate, and ertapenem against infection. Admitted to Cardiac Intensive Care Unit (CCU) on April 9, 2015. The patient's urine output was less than 400 ml/d in the last 2 days. 20 years of previous hypertension; Type 2 diabetes 8 years; Renal insufficiency 4 years; Acute cerebral infarction was diagnosed 3 years ago, leaving inconvenient movement of the right limb; After interventional recanalization of left subclavian artery occlusion, aspirin was taken, and the patient spontaneously discontinued atorvastatin and cilostazol. Previous ECG showed left bundle branch block. Long history of heavy smoking. Physical examination at admission: body temperature 39.0 ℃, pulse 122 beats/min, breathing 22 beats/min, blood pressure 101/60 mmHg (dopamine 7 μ g·kg^－1• min^－1Pump in). Sense clear, semi-recumbent position, jugular vein not filled. Scattered wet rales and wheezing sounds can be heard in both lungs. The heart boundary was enlarged to the left, the heart rate was 122 beats/min, the rhythm was uniform, no murmur was heard in the auscultation area of each valve, and there was no pericardial friction sound. The abdomen is soft, without tenderness, and the liver and spleen are not palpable under the costs. There was no edema in both lower limbs.

A 63-year-old male was admitted to the hospital due to "chest tightness, shortness of breath with precordial discomfort for more than 8 years". Physical examination at 45 years old revealed abnormal electrocardiogram and echocardiogram revealed asymmetric hypertrophy of ventricular myocardium. He had a history of hypertension for 20 years, and his blood pressure was well controlled for a long time. He denied family history of cardiomyopathy and sudden familial death, and denied other medical histories. Physical examination, blood pressure 130/75 mmHg (1 mmHg =0.133 kPa), general condition acceptable. The heart rate was 75 beats/min, and no pathological murmur was heard in the precordial area after auscultation. No abnormalities were found in the remaining heart and other physical examinations. Resting electrocardiogram showed asymmetric inversion of the T wave (Figure 1)。 The 24-h dynamic electrocardiogram showed a total heart rate of about 90,000 beats, an average heart rate of 63 beats/min, occasional ventricular and atrial premature beats, no malignant arrhythmias, and persistent T-wave inversion or low level. The 24-h ambulatory blood pressure showed a mean systolic blood pressure of 127 mmHg and a mean diastolic blood pressure of 85 mmHg, with a spoon curve. Laboratory examination showed that B-type natriuretic peptide (BNP) was 246.81 ng/L (reference range of normal value 0-100 ng/L), and other indexes were normal. Echocardiography showed left ventricular ejection fraction (LVEF) 58%, E/E' (mitral annular velocity of motion) 13.7 (lateral wall), large left atrium (left atrial diameter 44 mm), asymmetric left ventricular hypertrophy, normal left ventricular outflow tract blood flow velocity, accelerated left ventricular middle segment blood flow velocity, peak velocity about 3.1 m/s, pressure difference about 38 mmHg. Coronary CT angiography showed roughly normal coronary arteries. Cardiac magnetic resonance, plain scan showed asymmetric hypertrophy in the middle part, mainly the septal wall and anterior wall, the hypertrophy was uneven, the thickest part reached 22.9 mm, the apex of left ventricle showed spherical changes, the apical myocardium was thin, the thinnest part was 2.8 mm, and the delayed enhancement scan showed patchy enhancement shadows on the lower wall and lateral wall of the middle part of left ventricle, and ring enhancement shadows under the apex endocardium, with an enhancement area of 18.2% (Figure 2)。 Diagnosis of hypertrophic cardiomyopathy, middle ventricular cavity obstruction with apical ventricular aneurysm; Grade 2 high risk of hypertension. Treatment was administered with metoprolol succinate 95 mg once daily (47.5 mg once daily before admission). Implantation of an embedded cardioverter-defibrillator (ICD) was recommended and the patient refused. Follow-up has been 2 years, and the patient has no syncope, palpitations, occasional chest tightness, shortness of breath with precordial discomfort. The patient had been regularly taking beta blockers for 2 years before this admission.

Dyslipidemia plays a central and pathogenic role in the occurrence and development of atherosclerotic cardiovascular disease (ASCVD)^[1]。 A large number of clinical studies have repeatedly confirmed that no matter what drugs or measures are taken, as long as serum low-density lipoprotein cholesterol (LDL-C) levels can be reduced, atherosclerotic plaques can be stabilized, delayed or resolved, and can significantly reduce the incidence, disability and mortality of ASCVD. Guidelines for the prevention and treatment of dyslipidemia at home and abroad all advocate reducing blood LDL-C level to prevent and control the risk of ASCVD^[1,2,3]。 Therefore, my country's "Chinese Adult Blood Lipids Guidelines (2016 Revision)" still recommends LDL-C as the primary intervention target^[4]。

Mitral valve disease is a common clinical heart disease with high morbidity and mortality. Surgical thoracotomy for mitral valvuloplasty or replacement has long been recognized as the gold standard of treatment. Although clinical technology is developing rapidly, its mortality and complications are significantly lower than before, but there are still problems such as large trauma, postoperative paravalvular leakage and high early mortality rate. In the past 30 years, percutaneous balloon valvoplasty has been widely used in the treatment of valve stenosis diseases with reliable efficacy^[1]。 However, for patients with moderate to severe valve insufficiency and severe stenosis and valve calcification who are not suitable for balloon angioplasty, the most effective treatment is still surgical thoracotomy for valve replacement. In recent years, with the continuous development of bioengineering and minimally invasive valve therapy technology, the surgical technique and valve design of transcatheter mitral valve implantation (TMVI) have been improved to varying degrees. This paper mainly introduces the current situation and research progress of this technology.

There are trillions of bacteria that inhabit the human gut, and these bacteria make up the largest microbiome in the human body, namely gut bacteria. There are as many as 500 kinds of intestinal bacteria in adults. After a normally delivered baby is born, bacteria from the mother's birth canal quickly colonize the intestine. Intestinal bacteria and the host co-evolve in an interdependent way. The host provides a comfortable and unique living environment for the growth of intestinal bacteria. Intestinal bacteria provide the host with some physiological functions that the host cannot complete, such as digesting complex carbohydrates, producing vitamins and regulating immune functions, and participating in the occurrence and development of many diseases. Cardiovascular disease is a kind of serious disease that seriously endangers human health and life. Worldwide, about 16.7 million people die of cardiovascular diseases every year, accounting for the first place in the global mortality rate, and atherosclerosis is an important pathological basis for the occurrence and development of cardiovascular diseases. Intestinal bacteria are involved in the occurrence and development of atherosclerosis and its high-risk factors such as obesity, diabetes and dyslipidemia by affecting the metabolism of host nutrients, the absorption and utilization of energy, chronic systemic low-grade inflammation and oxidative stress.

Mesenchymal stem cells are derived from mesoderm and ectoderm in early development, while amniotic membrane and chorionic membrane, the main part of placenta, are derived from mesoderm. Therefore, it is theoretically possible to isolate and obtain mesenchymal stem cells from placenta. Although there have been reports of successful acquisition of placental derived mesenchymal stromal cells (PMSCs) and targeted induction of differentiation at home and abroad, their cell characteristics, differentiation potential and differences from bone-marrow derived mesenchymal stromal cells (BM-MSCs) have not been revealed.