2014年 · 第42卷第09期

December 26, 2013 marks the 120th anniversary of Chairman Mao Zedong's birth. At the commemorative symposium, * summarized the three elements of Mao Zedong Thought: first, seeking truth from facts, second, the mass line, and third, independence. The first one promotes the combination of the universal truth of Marxism-Leninism and the reality of the Chinese revolution, realizes the Sinicization of Marxism-Leninism, that is, Mao Zedong Thought, and realizes the Chinese revolution from failure to victory and from victory to greater victory.

International exercise rehabilitation in chronic heart failure began in the late 1970s^[1]A certain amount of evidence-based medical evidence has proved its safety and effectiveness. Exercise rehabilitation can reduce the mortality rate of patients with chronic heart failure, reduce the number of repeated hospitalizations, improve patients' exercise endurance and quality of life, and reasonably control medical costs. Exercise rehabilitation in chronic heart failure has been recommended by international professional associations. In 2005, the European Heart Association Working Group on Cardiac Rehabilitation and Exercise Physiology and the Sports Cardiac Rehabilitation and Prevention Branch of the American Heart Association (AHA) recommended that exercise rehabilitation is an effective secondary preventive measure for patients with chronic heart failure and that exercise should be applied as part of cardiac rehabilitation to patients with stable heart failure. The 2013 American College of Cardiology Foundation (ACCF) /AHA Heart Failure Management Guidelines classify exercise rehabilitation as a Category IA recommendation for patients with chronic stable heart failure^[2]。 A random sample survey of 15 518 urban and rural residents aged 35-74 in China showed that the prevalence of heart failure was 0.9%, with about 4 million patients, and it showed an increasing trend with the increase of age. The 5-year survival rate of patients with chronic heart failure with clinical symptoms was similar to that of malignant tumors^[3]。 At present, exercise rehabilitation of patients with chronic heart failure in China is in the development stage. It is only carried out in a few areas, and it has not been paid attention to by most areas and hospitals. Patients with chronic heart failure do not get standardized exercise rehabilitation guidance, so they have repeated illness and hospitalization, which increases the medical burden, and even adverse events such as sudden death caused by inappropriate exercise occur. In order to promote the development of exercise rehabilitation of patients with chronic heart failure in China, experts in related fields jointly discussed and wrote the Chinese expert consensus on exercise rehabilitation of patients with chronic stable heart failure. This consensus defines chronic stable heart failure when the symptoms and signs of chronic heart failure are stable for more than 1 month.

One in every five adults in China suffers from cardiovascular and cerebrovascular diseases^[1]。 Different from Western countries, the rate of stroke in China is significantly higher, which is 5 times that of myocardial infarction^[2]。 Hypertension is the most important risk factor for cardiovascular and cerebrovascular diseases. Chinese data show that hypertension has a much greater impact on cardiovascular diseases in Chinese population than other risk factors, and is the primary risk factor for cardiovascular events in Chinese population. Its independent relative risk of pathogenesis is 3.4, and the attributable risk percentage of the population is as high as 35%^[3]。 Effective management of hypertension is an important means to reduce the incidence of cardiovascular and cerebrovascular diseases.

A 33-year-old male was admitted to the hospital in March 2012 due to "intermittent syncope for more than 3 years, shortness of breath after activity and diarrhea for 3 years". The patient suffered a sudden syncope during a change of posture in 2008, lasting several minutes. Since the spring of 2009, the patient has shortness of breath after activity. He can walk 2,000 to 3,000 m on flat ground or climb 5 to 6 floors of stairs. The frequency of defecation increases to 2 to 3 times/d, and each time he has 200 to 300 ml of yellow paste stool, containing undigested food. Later, the symptoms of shortness of breath gradually worsened, and it was obvious when he went up to 2 floors. The frequency of defecation increased to 6-7 times/d, and frequent syncope occurred once every 1-2 weeks, accompanied by palpitations, without headache, convulsions and fecal incontinence. In July 2010, local echocardiography showed thickening of the ventricular septum, the thickest part was 19 mm, the echo of the lesion was rough and showed speckle-like changes, the movement of the anterior wall of the left ventricle was reduced, and the blood flow velocity of the left ventricular outflow tract was normal, which was considered "hypertrophic cardiomyopathy (non-obstructive)". Betaloc 12.5 mg, twice a day, orally for 1 year, without remission. Since the disease, the patient's body weight has been reduced by 25 kg, and his sexual function has decreased significantly.

pulmonary arterial hypertension (PAH) is a kind of malignant disease, which mainly causes progressive increase of pulmonary vascular resistance caused by pulmonary vascular remodeling, and ultimately leads to right heart failure and death^[1]。 In the past 20 years, the use of drugs targeting the three classical pathways [endothelin pathway, prostacyclin pathway, and nitric oxide (NO) pathway] increased the 1-year, 3-year, and 5-year survival rates of PAH patients from 77%, 41%, and 27% to 85%, 68%, and 57%, respectively^[2]。 Nevertheless, existing treatments still cannot fundamentally reverse PAH, its mortality rate is still high, and current drugs cannot meet the needs of disease treatment. Therefore, the research and development of drugs for classical and novel pathways is continuous, and the new progress of PAH drug treatment in recent years is summarized as follows.

Hypertension is one of the main risk factors for cardiovascular and cerebrovascular diseases such as heart failure, stroke and myocardial infarction^[1]。 Blood pressure levels are mainly related to cardiac output and peripheral vascular resistance. Blood pressure increases when peripheral vascular resistance increases, while increased peripheral vascular resistance is closely related to the opening and closing of ion channels on vascular smooth muscle cell membrane^[2]Therefore, the abnormality of ion channels on the membrane of vascular smooth muscle cells plays an important role in the occurrence and development of hypertension, and its exact mechanism is still unclear. In recent years, many studies have shown that high-conductance calcium ions activate potassium channels (BK_CaChannel) abnormal expression is associated with the development of hypertension^[2,3], this paper deals with BK_CaChannel characteristics, BK in hypertension_CaChannel alterations and BK_CaThe study of channels as a new target for the treatment of hypertension is reviewed.

Phenotypic transformation of vascular smooth muscle cells (VSMC) is a key step in the development of cardiovascular diseases such as hypertension, atherosclerosis, and restenosis after angioplasty^[1], is a prerequisite for proliferation and migration to the vascular intima, which is mainly manifested by the transition of VSMC from contractile to synthetic and the acquisition of the ability to proliferate, migrate and synthesize, secrete a large amount of extracellular matrix^[1,2]。 The study of the phenotype regulation mechanism of VSMC is of great significance for the prevention and treatment of the above-mentioned cardiovascular diseases, their prognosis and efficacy evaluation.

Myocardial fibrosis is a common pathological manifestation of many cardiovascular diseases after progression to a certain stage, which can cause reduced ventricular wall compliance, weakened ventricular systolic function and abnormal cardiac conduction, etc. Clinically, it is manifested as diastolic and/or systolic dysfunction, heart failure, arrhythmia, and even sudden death. At present, there is a lack of satisfactory methods for specific treatment of myocardial fibrosis in clinic. Therefore, it is of great significance to elucidate the mechanism of occurrence and development of myocardial fibrosis for preventing and reversing myocardial fibrosis, improving prognosis and improving the survival rate and quality of life of patients with cardiovascular diseases.