Essential hypertension (EH) is one of the most common cardiovascular diseases worldwide, entailing a high level of morbidity. EH is a multifactorial disease influenced by both genetic and environmental factors, including mitochondrial DNA (mtDNA) genotype. Previous studies identified mtDNA mutations that are associated with maternally inherited hypertension, including tRNAIle m.4263A>G, m.4291T>C, m.4295A>G, tRNAMet m.4435A>G, tRNAAla m.5655A>G, and tRNAMet/tRNAGln m.4401A>G, et al. These mtDNA mutations alter tRNA structure, thereby leading to metabolic disorders. Metabolic defects associated with mitochondrial tRNAs affect protein synthesis, cause oxidative phosphorylation defects, reduced ATP synthesis, and increase production of reactive oxygen species. In this review we discuss known mutations of tRNA genes encoded by mtDNA and the potential mechanisms by which these mutations may contribute to hypertension.

目的 探究新冠肺炎疫情下改良的线上PBL教学模式在心血管内科住院医师规范化培训中的应用及效果.方法 2019年12月—2020年3月在解放军总医院心血管内科参加住院医师规范化培训的学员40人为实验组,采用改良的线上PBL教学模式并进行出科前在线问卷调查、理论及实践考核;2019年6—11月在心血管内科进行住院医师规范化培训的52名学员为对照组,采用传统面授式PBL教学.对两组的问卷调查情况、考核情况进行对比.结果 规培住院医师对线上教学接受度高,改良的线上PBL教学模式能够达到心血管内科住院医师规范化培训的目的,同时激发规培学员的学习兴趣,培养其思考、分析及解决问题的能力,取得较为满意的教学效果.结论 改良PBL线上教学是新冠肺炎疫情等突发事件形势下心血管内科住院医师规范化培训的有效方法,可以进一步完善、推广.

INTRODUCTION:Metoprolol is the most frequently used β-receptor blockers; however, the prescribed dose in China is far less than the recommended doses in the guidelines. Based on the Chinese and International guidelines and the Chinese clinical practice, we are conducting this study (NCT03413410) to test the feasibility and tolerability of the metoprolol optimal dosing pathway by observing the percentage of patients achieving target dose in Chinese acute coronary syndrome (ACS) patients during hospitalisation.METHODS AND ANALYSIS:A total of about 1000 patients aged ≥18 years, hospitalised for ACS will be enrolled from ~15 hospital sites in China between February 2018 and April 2019. The percentage of patients achieving the target metoprolol dosage at discharge is the primary endpoint. The secondary endpoints included the following: mean heart rate (HR) and blood pressure (BP) of the patients who have achieved target dose at discharge and during the follow-up period, percentage of patients experiencing bradycardia (HR <50 beats/min), hypotension (BP <90/60 mm Hg) and drug-related temporary heart failure worsening during hospitalisation and 1 month after discharge, respectively. We will also assess the proportion of patients reporting metoprolol-related adverse events and the leading causes for metoprolol discontinuation.ETHICS AND DISSEMINATION:The study protocol has been approved by the Ethics committee of the Chinese PLA General Hospital (number: S2017-112-01). Study findings will be disseminated through presentations at national and international conferences and submitted for publications in peer-reviewed journals.TRIAL REGISTRATION NUMBER:ClinicalTrials.gov registry (NCT03413410).

Objective To study the effect of allicin ( All) on potassium current in single atrial myocytes in rats. Methods Isolated rat atrial myocytes were isolated by perfusion and administered by extracellular perfusion method.Whole cell patch clamp technique was used to record transient outward potassium current ( Ito ) in atrial myocyte. Results In presence of 30 μmol·L-1 of All,the peak current of Ito was significantly reduced from (20.5±2.2) pA/pF to (11.3±2.1) pA/pF at+50 mV of test potential (P<0.01,n=12).This effect of All showed voltage- and concentration-dependence with IC50 of (19.0±2.5)μmol·L-1 .The steady-state activation curve of Ito was shifted to more positive potential and recovery time from inactivation was prolonged.In addition, they fail to find any effect of All on the steady-state inactivation and closed-state inactivation of Ito. Conclusion All can inhibit Ito by slowing down the process of activation and recovery from inactivation of channel.

医学信息化飞速发展，临床大数据库的开发与建立是未来临床科研发展的重要方向。临床医生应该充分利用临床大数据库，深入分析数据库，建立精准医疗分析评估模型，指导临床实践，缩短医生学习曲线，提高工作效率，将临床和科研更好的结合，提高临床科研工作效率，完善的解决了临床医疗和科研业务之间的矛盾。

医生不仅是手术匠，也是音乐家与艺术家，在复杂的生理系统中寻找跳动的韵律；医生不仅是修理工，也是画家、诗人，在冰冷的培养基上寻找变幻的图案。脱下白大褂，医生还是儿女、父母……是个平凡而真实的人，在生活中寻找精神标杆，用感恩的心歌颂世间美好。AME在一群优秀医生中，发现了诗人、书法家、歌手、漫画家……因此，我们推出Art@Med专栏，带您踏上一场人文之旅，去挖掘医学的艺术，医生的诗意。

Mitochondrionisan eukaryotic organelle that generatesmore than 90%of the energy in the cell by oxidative phosphorylation (OXPHOS). Mitochondrial dysfunction is an important pathophysiological mechanism for many common disorders, associated with impairing of OXPHOS and increasing reactive oxidative species (ROS) production. In this review we will discuss production of ROS caused by mitochondrion, affected factors and multiple effects on the tissue and cells.

BACKGROUND:This study aimed to investigate whether there were sex differences in in-hospital and long-term outcomes for elderly patients over 75 years of age undergoing percutaneous coronary intervention for coronary heart disease.METHODS:Consecutive patients aged ≥75 years who underwent percutaneous coronary intervention at a single center in the People's Republic of China from January 2005 to December 2010 were included in this cohort study. Clinical characteristics and in-hospital and long-term outcomes were compared between men and women.RESULTS:A total of 465 patients (34.8% women, mean age 78.5±3.2 years) were recruited. Men had a higher prevalence of ST elevation myocardial infarction but were less likely to have heart failure than women (P<0.05). Similar rates of successful in-hospital procedures and deaths were observed in men and women. After a mean follow-up of 3 years, no significant differences were observed between men and women in mortality (12.5% versus 8.0%, P=0.151), myocardial infarction (1.4% versus 2.7%, P=0.368), target vessel revascularization (6.1% versus 4.7%, P=0.540), or cerebral vascular disease (7.9% versus 6.0%, P=0.472). Cox proportional hazards analysis revealed that sex was not independently associated with either in-hospital mortality or long-term mortality.CONCLUSION:In elderly patients over 75 years of age, sex influences the prognosis after percutaneous coronary intervention for coronary heart disease.

Objective: Genetic studies of essential hypertension have mainly focused on the genome-wide association study of nuclear genes, which could explain just a small fraction of the heritability of blood pressure traits. This study aimed to investigate the relationship between mitochondrial genetic variants and essential hypertension (EH) in Chinese general population. Methods: Demographic and clinical matched 100 pairs of Chinese-Han EH patients and controls were recruited in the derivation cohort. A total of 797 EH patients and 816 controls were recruited in the derivation cohort. DNA was extracted from the peripheral whole blood of each patient. The whole mitochondrial genome was re-sequenced in the derivation cohort. The screened related variants were genotyped in the derivation cohort. Association analysis was performed to identify EH related variants. Results: In the derivation cohort, a total of 537 variants were detected in mitochondrial genome with 29 in tRNA-coding genes, 45 in rRNA-coding genes, 10 in D-Loop functional regions, and 453 in protein-encoded genes. No statistical difference could be found between EH patients and controls for the distribution of t-RNA, r-RNA and D-loop variants. For the protein-encoded genes, compared with controls, the occurrence of ND2 C5178A genetic variant was significantly lower [18% (18 in 100) vs. 31% (31 in 100), P = 0.03] in EH cases. Similarly, the distribution of C8414T of ATP8 gene in EH cases was significantly lower(10% vs. 22%, P = 0.02)than that in controls. No other mitochondrial variant exhibited significantly different distribution between EH cases and controls in the derivation cohort. The significant protective roles of ND2 and ATP8 genetic variants on EH were confirmed in the validation cohort (For ND2 C5178A: 24.59% (196 in 797) in EH vs. 32.72% (267 in 816) in control; adjusted OR: 0.62, 95% CI: 0.49-0.79, P < 0.001; For ATP8 C8414T: 17.69% (141 in 797) in EH vs. 23.16% (189 in 816) in control; adjusted OR: 0.68, 95% CI: 0.52-0.89, P = 0.005). Conclusion: This study provides the evidence that mitochondrial genetic variants of C5178A in ND2 gene and C8414T in ATP8 gene may exert protective role against EH in Chinese general population.

OBJECTIVE:To evaluate the prognostic effects of radial artery access (RA) versus femoral artery access (FA) in octogenarians undergoing percutaneous coronary intervention (PCI) due to acute coronary syndrome (ACS). METHODS:From January 2008 to January 2013, 279 octogenarians with ACS underwent PCI. PCI was performed through RA in 125 patients and FA in another 154. Clinical and procedural characteristics, combined endpoints including death, acute myocardial infarction, stroke, and major bleeding, and peripheral vascular complications were obtained from both groups. RESULTS:The clinical baseline characteristics of two patient groups, including target vessel location, lesion type, number of implanted stents, fluoroscopy duration and utilization of contrast media had no statistical difference.Femoral approach was associated with a higher rate of ST elevation myocardial infarction (STEMI) than radial approach (27.9% vs 11.2%, χ² = 11.868, P < 0.05). Procedural rate of success, fluoroscopy duration and utilization of contrast media were equivalent with both approaches. Radial approach was associated with a higher crossover rate (10.4% vs 3.9%, χ² = 4.599, P < 0.05) to alternate access site compared with the femoral approach.No difference in combined endpoint during 30 days after PCI including death, acute myocardial infarction, stroke and major bleeding was found between two groups (P > 0.05).However, ambulation time (4.2 ± 0.9 vs 19.3 ± 4.1h, t = 40.381, P < 0.01), incidence of access site bleeding (2.4% vs 7.8%, χ² = 3.943, P < 0.05), hematoma (2.4% vs 9.1%, χ² = 5.398, P < 0.05), pseudoaneurysm (0.0% vs 5.2%, χ² = 4.950, P < 0.05) and vascular complications (4.8% vs 19.5%, χ² = 13.231, P < 0.01) were significantly lowered in radial approach group. Multivariate regression analysis identified radial approach as an independent negative predictor of postprocedural vascular complications (OR = 0.329, 95% CI: 0.124-0.517, P < 0.05).Female gender (OR = 1.955, 95% CI: 1.326-2.248, P < 0.05) and utilization of glycoprotein IIb/IIIa receptor antagonist (OR = 2.787, 95% CI: 2.435-3.071, P < 0.01) were independent predictors of postprocedural vascular complications. CONCLUSIONS:Compared with femoral approach, radial approach significantly reduces the vascular complications of PCI in octogenarians with ACS.However, PCI through RA is not associated with reduced combined endpoint at 30 days in octogerians with ACS.

PURPOSE: To investigate the effectiveness of an intensive nursing care electronic followup system for cardiovascular risk management after percutaneous coronary intervention (PCI).METHODS: In total, 840 subjects who underwent PCI in a single hospital in Beijing between January 2010 and January 2012 were enrolled. All subjects were randomized into the control and intensive nursing care groups (n = 420 each group). Both groups received standard secondary prevention according to guidelines. The control group received regular followup while the intensive nursing care group was closely monitored and followed by specific nursing staff with the electronic followup system.RESULTS: In total, 807 subjects were followed up for 1 year. Compared with subjects in the control group, those in the intensive group had decreased levels of total cholesterol (3.99 +/- 1.08 vs 3.76 +/- 0.98; P<.05), systolic blood pressure (142.41 +/- 11.53 vs 135.71 +/- 14.57 mm Hg; P<.05), low-density lipoprotein cholesterol (LDL-C) (2.72 +/- 1.01 vs 2.42 +/- 0.81; P <.05), and body mass index (25.13 +/- 5.12 vs 24.23 +/- 6.22; P <.05); a higher percentage with target LDL-C <2.6 mmol/L (66.99% vs 47.88%; P <.05); increased use of medication including aspirin (96.51% vs 99.26%; P <.05), clopidogrel (87.53% vs 98.77%; P <.05), statins (52.62% vs 93.10%; P <.05), beta-blockers (48.63% vs 61.33%; P <.05), and angiotensin-converting enzyme inhibitors (32.92% vs 61.82%; P <.05); and better dietary control and physical exercise (55.66% vs 26.18%, P <.05; 62.56% vs 38.65%, P <.05).CONCLUSIONS: Intensive nursing care by the electronic followup system may lead to an improvement in quality of secondary prevention after PCI, including risk factor control, the use of medication, and self-management abilities.

The objective of the present study was to explore the relationship between mitochondrial tRNAMet mutation and development of essential hypertension in Chinese Han individuals. A total of 990 patients with essential hypertension were involved. The general data (sex, age, body mass index, onset age, and family history) and information on routine blood test, blood biochemical examination, and color Doppler echocardiography of these patients were collected. All subjects under-went venous blood drawing for seperating white blood cells and DNA extraction. Then, mitochondrial tRNAMet was amplified and sequenced after purification. The patients who carried the tRNAMet mutation were taken as the indicative cases and the controls were the patients with essential hypertension who did not carry the mutation. We performed a comparative analysis on the routine blood test, blood biochemical examination, color Doppler echocardiography, and other data between the indicative cases and control cases. Among the 990 essential hypertensive patients, there were 8 who carried the tRNAMet mutation, and 6 mutation sites were confirmed, including A4401G, C4410A, U4418C, A4435G, U4454C, and C4456U. Compared with the control cases, the indicative cases developed essential hypertension at earlier ages. The average levels of high density of lipoprotein cholesterol, left ventricular end diastolic diameter, stroke volume, and cardiac index were higher in the indicative cases than in the controls. While the average levels of hemoglobin and left ventricular ejection fraction were lower in the indicative cases than in the control cases. Among the 8 indicative cases, 5 had maternally inherited hyper-tension; one had paternally inherited hypertension; and two denied any family history of hypertension. These results indicated that the mitochondrial tRNAMet mutations might induce the changes in structure and function, which was involved in the progress of the essential hypertension by disturbing the blood metabolism, the steady-state of the blood cells, and the cardiac structure and function.

A im To define the heterogeneous changes of ion channels in the noninfarcted myocardium after myocardial infarction in rabbit and effects of imidapril. Mehods Rabbits with left coronary artery ligation were prepared and allowed to recover for 8 wk. Myocytes were isolated from subendocardial, midmyocardial and subepicardial regions of the noninfarcted left ventricular free wall. Ion currents were recorded with whole-cell patch clamp way. Results The densities of the transient outward K + currents (I to ) and the inward rectifier K + currents (I K1 ) were greatly reduced in midmyocardium and subepicardium while two currents reduced gently in subendocardium. The densities of the delayed rectifier K + currents (I K ) were reduced in noninfarcted three layers similarly. Imidapril could reverse the changes of membrane currents in healed myocardial infarction cells and depress the dispersion of repolarization. Conclusions The heterogeneities of K currents were enhanced in noninfarcted area. Normalization of heterogeneous changes of repolarizing after treatment with imidapril was observed.(J Geriatr Cardiol 2008; 5: )

207年6月13日,美国美丽的海滨城市圣地亚哥迎来了一年一度的线粒体医学盛会--2007年线粒体医学会议(Mitochondrial Medicine 2007 Riding the Wave of the Future).

Objective:To evaluate the effect of aspirin and cilostazol on aggregation of platelet in coronary heart disease(CHD) patients with or without diabetes.Methods:The 45 CHD patients with type 2 diabetes mellitus(DM) and 45 CHD patients without DM were selected according to inclusive criteria.Two groups were divided into aspirin groups,cilostaxol groups and combinative groups according to administer drugs respectively.The aggregation of activated platelet,TXB2,6-K-PGF1a and MPO were detected and analyzed for their correlation.Those data were compared among groups.Results:(1)Multivariate correlative analysis showed that blood glucose was the most important factor correlated with the aggregation of activated platelet(R=0.914,P0.01);(2)Compared the without diabetes group,the level of aggregation of activated platelet,TXB2,MPO increased,the level of 6-K-PGF1a decreased in CHD patients with diabetes group;(3)For patients without DM,the level of aggregation of activated platelet and TXB2 had no significant difference between aspirin and cilostazol groups,the level of 6-K-PGF1a was higher,while the level of MPO was lower in cilostazol group than those of aspirin group(P0.001).For patients with DM,the level of the aggregation of activated platelet,TXB2,MPO were lower while the level of 6-K-PGF1a was higher in cilostazol group than those of aspirin group(P0.05~0.001).Conclusion:Cilostazol is more effective than aspirin to inhibit the aggregation of activated platelet for CHD patients with DM.