Background and aims Acute myocardial infarction (AMI) is divided into left ventricular myocardial infarction (LVMI) and right ventricular myocardial infarction (RVMI) according to the regions of myocardial ischemic necrosis. Clinical characteristics, treatment strategies, and prognosis differences between isolated RVMI and LVMI have not been well characterized. This study aimed to explore this difference of patients with isolated RVMI and LVMI. Methods This retrospective cohort study included 3,506 patients hospitalized with coronary angiography diagnosed type 1 myocardial infarction (MI). Characteristics of admission and treatment strategies were compared in patients with isolated RVMI and LVMI. COX proportional hazards models with and without inverse probability of treatment weighting (IPTW) adjustment were performed to estimate the difference in all-cause and cardiovascular mortality between the two groups. Results In this retrospective study, we found the frequency of isolated RVMI was significantly lower in the population than that of isolated LVMI (406 (11.6%) vs 3,100 (88.4%)). Patients with isolated RVMI have similar age, sex, and comorbidities to the patients with isolated LVMI. However, patients with isolated RVMI have lower heart rate and blood pressure, but higher rates of cardiogenic shock and atrioventricular block. It is noteworthy that patients with isolated RVMI are more likely to be complicated with the multivessel lesion. Patients with isolated RVMI have lower risk of all-cause mortality (HR 0.36; 95% CI [0.24–0.54], p < 0.001) and cardiovascular mortality (HR 0.37; 95% CI [0.22–0.62], p < 0.001) than patients with isolated LVMI. Conclusions This study showed that patients with isolated RVMI and LVMI have similar baseline characteristics. However, the clinical manifestations were different in the isolated RVMI and LVMI patients. This study revealed a better prognosis of isolated RVMI patients compared to isolated LVMI, which indicates the ischemic region could be considered in AMI risk stratification models for better assessment of risk for adverse clinical events.

Cardiological disorders contribute to a significant portion of the global burden of disease. Cardiology can benefit from Big Data, which are generated and released by different sources and channels, like epidemiological surveys, national registries, electronic clinical records, claims-based databases (epidemiological Big Data), wet-lab, and next-generation sequencing (molecular Big Data), smartphones, smartwatches, and other mobile devices, sensors and wearable technologies, imaging techniques (computational Big Data), non-conventional data streams such as social networks, and web queries (digital Big Data), among others. Big Data is increasingly having a more and more relevant role, being highly ubiquitous and pervasive in contemporary society and paving the way for new, unprecedented perspectives in biomedicine, including cardiology. Big Data can be a real paradigm shift that revolutionizes cardiological practice and clinical research. However, some methodological issues should be properly addressed (like recording and association biases) and some ethical issues should be considered (such as privacy). Therefore, further research in the field is warranted.

高风险植入类无源医疗器械的上市后监测是医疗器械风险管理的重要环节,通过对高风险医疗器械上市后安全性信号的监测和评价,最大限度地控制医疗器械潜在的风险,保证医疗器械安全、有效地使用,避免发生群体性严重后果,是医疗器械生产、经营、使用机构和技术监测部门的共同职责。为了更好地促进和辅助高风险植入类无源医疗器械的上市后监测,本专家共识采用系统性文献回顾、专题小组讨论和专家咨询过程,系统梳理国内外医疗器械上市后风险监测现状,并提出适宜于我国国情的高风险植入类无源医疗器械上市后风险监测模式和高风险医疗器械风险监测关键技术。

高血压是心血管病最常见的独立危险因素[1],是全球心血管病死亡和残疾的罪魁祸首.据2015年一项全球高血压调查显示,全世界每年将近1 000万人死于高血压并发症,与高血压相关的残疾调整生命年损失高达2亿[2].有效防治高血压是减轻世界人口心血管病负担、延长寿命的关键[3].高血压防控的目标是降低高血压的心脑肾与血管并发症发生和死亡的总危险.大量研究证实早期干预是最经济有效的防控策略.然而,目前关于起始降压的时机仍然存在争议,不同高血压人群起始降压治疗的阈值可能也存在差异,本文就近年来各指南推荐的不同人群起始降压治疗阈值进行综述.

Background Previous studies have investigated the association of ambient air pollution with blood pressure (BP) in children and adolescents, however, the results are not consistent. We conducted a systematic review and meta‐analysis to assess the relationship between short‐term and long‐term ambient air pollutant exposure with BP values among children and adolescents. Methods and Results We searched PubMed, Web of Science, and Embase before September 6, 2020. Two reviewers independently searched and selected studies, extracted data, and assessed study quality. The studies were divided into groups by composition of air pollutants (NO2, particulate matter (PM) with diameter ≤10 μm or ≤2.5 μm) and length of exposure. The beta regression coefficients (β) and their 95% CIs were calculated to evaluate the strength of the effect with each 10 μg/m3 increase in air pollutants. Out of 36 650 articles, 14 articles were included in this meta‐analysis. The meta‐analysis showed short‐term exposure to PM with diameter ≤10 μm (β=0.267; 95% CI, 0.033‒0.501) was significantly associated with elevated systolic BP values. In addition, long‐term exposure to PM with diameter ≤2.5 μm (β=1.809; 95% CI, 0.962‒2.655), PM with diameter ≤10 μm (β=0.526; 95% CI, 0.095‒0.958), and NO2 (β=0.754; 95% CI, 0.541‒0.968) were associated with systolic BP values and long‐term exposure to PM with diameter ≤2.5 μm (β=0.931; 95% CI, 0.157‒1.705), and PM with diameter ≤10 μm (β=0.378; 95% CI, 0.022‒0.735) was associated with diastolic BP. Conclusions Our study indicates that both short‐term and long‐term exposure to some ambient air pollutants may increase BP values among children and adolescents.

循证医学诞生至今,历经三十年发展,应用领域从临床诊疗到公共卫生再到广义循证观的提出,推动了医疗卫生决策的科学化进程,深刻影响着卫生健康领域的各个层面。随着疾病与健康领域重点问题的演化,证据多样化需求也日益迫切;随着信息技术的突飞猛进,证据生产和转化利用的方式方法面临变革。这是新时代循证医学发展的一大特点,并在新冠肺炎疫情科学防控决策中得到了体现。

目的 确定中青年人群中各种体质量代谢表型的患病率,尤其是正常体质代谢异常(MONW)和代谢正常肥胖(MHO)这两种特殊表型,并调查各表型相关的人口统计学和行为学因素.方法 以中南大学湘雅三医院健康管理中心44 551例中青年(30-59岁)体检人群为研究对象,根据体质量和代谢状态将人群分为四种表型:正常体质代谢正常(MHNW)、正常体质代谢异常(MONW)、代谢正常肥胖(MHO)和代谢异常肥胖(MAO).收集一般资料,进行体格检查及生化指标检测;采用Logistic回归分析评估生活方式因素与正常体质代谢异常和代谢正常肥胖表型的相关性.结果 正常体质代谢正常、正常体质代谢异常、代谢正常肥胖、代谢异常肥胖表型在中青年人群中的患病率分别为58.0％、6.4％(占正常体质人群的10.0％)、18.0％和17.6％.多元Logistic回归分析结果显示,在校正了年龄、文化程度后,男性正常体质代谢异常表型与吸烟(OR = 1.12,95％CI:1.02-1.24)、饮酒(OR =1.22,95％CI:1.11-1.35)呈正相关,与健康的饮食习惯(OR = 0.88,95％CI:0.80-0.98)呈负相关.而女性正常体质代谢异常表型与中高度体育锻炼(OR = 0.83,95％CI:0.73-0.93)和健康饮食习惯(OR = 0.80,95％CI:0.71-0.90)呈负相关.结论 在中青年人群中,正常体质代谢异常表型患病率为6.4％,约占正常体质人群的10.0％,代谢正常肥胖表型患病率为18.0％,约占肥胖人群的一半.代谢表型在不同性别的中青年人群之间具有不同的临床特征.为了预防体质量正常人群出现代谢异常,应多锻炼身体,健康饮食,尤其是男性还应该戒烟、戒酒.

<span id="ChDivSummary" name="ChDivSummary" class="abstract-text">目的探讨G蛋白信号调节因子6（RGS6）对心肌细胞肥大的调控作用及机制。方法用AdRGS6和AdshRGS6慢病毒分别感染心肌细胞使RGS6表达上下调,AngⅡ构建肥大模型。测定各组细胞面积和ANP、BNP的表达,检测活性氧（ROS）和丝裂原活化蛋白激酶（ERK1/2、p38、JNK1/2）的表达。明确改变的信号通路后,用ROS抑制剂（DPI）开展逆转实验。结果 （1）与AdG FP/AngⅡ组相比,AdRGS6/AngⅡ组细胞面积、ANP和BNP明显增加,信号通路中ROS和磷酸化（p）-JNK1/2表达增加。（2）与AdshRNA/AngⅡ相比,AdshRGS6/AngⅡ组细胞面积、ANP和BNP明显降低,信号通路中ROS和p-JNK1/2表达下降。（3）逆转实验:与AdRGS6/AngⅡ组相比,DPI干预的AdRGS6/AngⅡ组心肌细胞面积明显降低,p-JNK1/2蛋白表达降低。结论 RGS6通过激活ROS/JNK1/2通路促进心肌细胞肥大。</span>

目的 对我国高血压患者现阶段(2017-2019年)盐(氯化钠)摄入量状况进行调研和分析.方法 在中国23个省/市130家医院,纳入年龄18～85岁明确诊断的高血压患者9 686例,采用电极法对所有患者的全天(24 h)尿液进行尿钠测定,同时记录病史、体质量指数(BMI)和用药史(包括降压药),并对高血压患者6 494例行24 h动态血压监测(ABPM).结果 入选的高血压患者24 h平均尿钠排泄为156.8 mmol/d(相当于食入钠3.6 g/d,钠盐9.2 g/d),其中7 103例(占73％)患者平均钠盐摄入超过6 g/d,按照WHO标准钠盐＜5 g/d仅有1 840例(占19％).根据测定的平均尿钠排泄水平可将入选的患者分为低钠(尿钠＜100)、中钠(尿钠100～＜200)和高钠(尿钠≥200mmo/d)3组,3组尿钠排泄水平分别为(69.7±21.0)、(145.8土28.0)和(268.7±58.9)mmol/d.平均尿钠排泄水平在全国中以西北地区最高(184.2 mmol/d,相当于钠盐10.8 g/d),华南地区最低(111.3 mmol/d,相当于钠盐6.5 g/d).血压随着钠摄入的增加而升高.结论 我国23个省/市高血压患者平均钠盐摄入量仍显著高于中国和WHO标准,纠正高钠摄入对血压管理具有重要的意义.

Background Lipid metabolism factors may play an important role in the progression of nonalcoholic fatty liver disease (NAFLD) and its related cardiovascular dysfunctions. The study aims to assess whether Apolipoprotein A-1 (ApoA1) was associated with vascular stiffness in NAFLD patients. Methods From 2012 to 2013, we included 2,295 non-alcohol users with fatty liver disease (1,306 male patients) and completely excluded subjects who drank any alcohol ever to eliminate the effect of alcohol intake. The serum ApoA1 levels and the brachial-ankle pulse wave velocity (baPWV) were measured. Results The baPWV in men was much higher than in female patients (1,412.79 cm/s vs. 1,358.69 cm/s, P < 0.001). ApoA1 level was positively associated with baPWV odd ratio (OR), 4.18; 95% confidence interval (CI) [1.16–15.1], P < 0.05) in patients with AST/ALT < 1 and (OR, 4.70; 95% CI [1.36–16.23], P < 0.05) in patients with AST/ALT ≥ 1 respectively. Only arterial stiffness in men was associated with ApoA1 (OR, 3.96; 95% CI [1.29–12.30], P < 0.05) in logistics regression models adjusted for age, gender, body mass index, education attainment, physical activity, smoking, history of hypertension and high-density lipoprotein. The relationship between ApoA1 and baPWV in male NAFLD patients remained significant (confidence, 156.42; 95% CI [49.34–263.50], P < 0.05) in the fully adjusted linear regression model. Conclusion The serum ApoA1 was associated with arterial stiffness in male NAFLD patients. Increased ApoA1 level should be considered as an independent risk factor for arterial stiffness in male NAFLD patients, suggesting that NAFLD may alter arterial stiffness by “ApoA1-related” mechanism in men.

目的:采用混合探针法研究白藜芦醇对人细胞色素酶P450五种亚型CYP1A2、CYP2D6、CYP2C9、CYP3A4和CYP2C19的影响.方法:采用随机对照研究,将26名男性健康受试者随机分为安慰剂组和白藜芦醇组,分别予以口服安慰剂/白藜芦醇每次1 g,每日一次,连续服药14 d,再口服咖啡因、氯沙坦、奥美拉唑、右美沙芬和咪达唑仑五种探针药物,采集不同时间的血样,检测咪达唑仑、咖啡因、奥美拉唑三种探针药物的血药浓度.并收集0～8h尿液,记录尿量,检测氯沙坦及右美沙芬的代谢速率.比较两组之间的药代动力学差异.结果:与对照组相比,白藜芦醇组CYP1A2的探针药物咖啡因AUC0-12、AUC0-∞、Cmax分别增加32.10％(P<0.001)、71.52％(P<0.001)、10.62％(P=0.004),同时T1/2也显著增加(P=0.002);CYP2C19的探针药物奥美拉唑和CYP3A4的探针药物咪达唑仑的药代动力学参数AUC0-12、AUC0-∞、T1/2和Cmax均未见显著改变(P>0.05);CYP2C9探针药物右美沙芬与其代谢产物去甲右美沙芬比率(DTM/DT)的比率增加了79.91％(P=0.003);CYP2D6探针药物氯沙坦与其代谢产物E-3174的比率(losartan/E-3174)增加了531.34％(P<0.001).结论:白藜芦醇多次给药后,能显著抑制CYP1A2、CYP2D6和CYP2C9的酶活性,而对CYP3A4和CYP2C19的酶活性无显著影响.

目的 比较强化降压与标准降压对中老年慢性肾脏病(CKD)患者心血管及肾脏结局的影响.方法 通过计算机检索英文数据库Pubmed、Embase、Cochrane,同时手工检索纳入文献的参考文献,收集截至2017年12月发表的比较中老年CKD患者强化降压与标准降压的随机临床试验,运用RevMan 5.3软件评价中老年CKD患者强化降压对心血管事件及肾脏事件的影响.结果 共纳入随机对照试验4项,包含患者8 122例,其中强化降压组4 057例,标准降压组4 065例.分析发现,与标准降压组比较,强化降压组发生心血管病死亡风险降低31％(95％ CI10％～47％,P＜0.01),全因死亡风险降低23％ (95％ CI 8％～36％,P＜0.05),综合心血管事件风险降低17％(95％ CI 3％～28％,P=0.02).而两组主要冠状动脉事件(RR=0.88,95％ CI 0.70～0.90,P=0.24)和综合肾脏事件(RR=0.92,95％ CI0.70～1.21,P=0.53)差异无统计学意义.结论 强化降压能降低中老年CKD患者心血管病死亡率、全因死亡率及综合心血管事件发生率,而在主要冠状动脉事件发生率及综合肾脏事件发生率上没有明显差异.

肥胖是一种脂肪组织过度积累的状态,其在全球范围内的流行已经成为了一个重大的公共卫生挑战.世界卫生组织报道,截至2016年,在全球范围内,18岁及以上的成年人中超重人数超过19亿,肥胖人数超过6.5亿(超重率为39％,肥胖率为13％),且全球肥胖流行率在1975至2016年间增长近3倍[1].体质指数(BMI)增高会增加与其相关的心脏代谢疾病的患病风险,如高血压、冠心病和2型糖尿病等[2].

Objectives: To establish the effects of RDN on blood pressure and arterial stiffness in hypertensive beagles, and explore the underlying mechanisms. Methods: We randomized 16 beagles into RDN, sham and control groups in the ratio of 2:1:1. The beagles in RDN and sham group were fed with high sodium and high fat diet while controls with normal diet, but RDN treatment was only performed in RDN group. Comparison and correlation analysis were made for the BP, concentrations of serum eNOS, NO, Ang II and NE among three groups. Results: RDN decreased SBP by 17.8 ± 4.2mmHg, significantly more than sham, but the differences of DBP reduction were not significant (P = 0.052). There were not significant differences of pulse pressure reduction among three groups (P = 0.081). RDN decreased RI by 0.03 ± 0.03, significantly more than sham and control (P < 0.05). RDN did not affect the concentrations of serum eNOS, NO or Ang II but decreased the concentration of serum NE by 151.7 ± 50.8pg/ml, significantly more than sham (P = 0.014). The change of RI was significantly correlated by change of SBP, DBP, concentrations of NO and NE (P < 0.05), but not concentrations of eNOS or Ang II (P > 0.05); the change of NE concentration was significantly correlated by change of SBP, DBP, concentrations of NO and Ang II (P < 0.05), but not concentration of eNOS (P > 0.05). Conclusion: RDN could significantly reduce BP and improve arterial stiffness in hypertensive beagles, and the improvement of arterial stiffness could be correlated by decrease of BP, improvement of endothelial function and reduction of sympathetic activity.

Drug-induced diseases (DIDs)are serious problems,resulting in huge social and economic burdens.Drugs with high rates of drug-induced disease in older adults are warfarin,insulin,oral antiplatelet agents,oral hypoglycemic agents,opioid analgesics and antineoplastic agents.To the drugs mentioned above,foreign progress of related research in risk assessments and early warning models has been made.Aiming to provide evidence for the prevention and control of drug-induced diseases in the elderly population,this review will briefly introduce the harm of DIDs,and review the research progress of the risk assessment model of common DIDs in older adults.

PURPOSE:To determine whether preoperative renin-angiotensin system (RAS) inhibitor use within 7 days of noncardiac surgery is associated with a lower incidence of postoperative acute kidney injury (AKI) in hypertensive patients.MATERIALS AND METHODS:We retrospectively analyzed 12,545 hypertensive patients undergoing noncardiac surgery at the Third Xiangya Hospital of Central South University from February 2007 to November 2015. According to the use of RAS inhibitors within 7 days of surgery, the patients were divided into a RASI group and a non-RASI group. We used a multivariable logistic regression model and propensity score matching (PSM) analysis to examine the association between preoperative RAS inhibitor use and postoperative AKI incidence.RESULTS:Among the 12,545 hypertensive patients undergoing noncardiac surgery who met the inclusion/exclusion criteria, 18.74% received preoperative RAS inhibitor treatment within 7 days of surgery. After PSM, 2,192 patients in each group were matched successfully. The incidence of postoperative AKI in the RASI group was significantly lower than that in the non-RASI group (7.39% vs. 12.32%, p < 0.001). The multivariable logistic regression analysis and the PSM analysis demonstrated similar associations between preoperative RAS inhibitor use and postoperative AKI incidence. This association was modified by the presence of preoperative congestive heart failure (CHF) (p-value for the interaction: 0.027), and the observed association was not evident in patients without CHF (CHF: adjusted odds ratios (ORs): 0.47; 95% CI: 0.31 - 0.70 vs. no CHF: adjusted OR: 0.80; 95% CI: 0.62 - 1.03).CONCLUSION:The preoperative use of RAS inhibitors in hypertensive patients was associated with a lower incidence of AKI following noncardiac surgery, and this association was not significant in the subgroup population without CHF.
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A comprehensive search of PubMed and Embase was performed in January 2015 to examine the available literature on validated diagnostic models of the pre-test probability of stable coronary artery disease and to describe the characteristics of the models.Studies that were designed to develop and validate diagnostic models of pre-test probability for stable coronary artery disease were included.Data regarding baseline patient characteristics, procedural characteristics, modeling methods, metrics of model performance, risk of bias, and clinical usefulness were extracted.Ten studies involving the development of 12 models and two studies focusing on external validation were identified.Seven models were validated internally, and seven models were validated externally.Discrimination varied between studies that were validated internally (C statistic 0.66-0.81)and externally (0.49-0.87).Only one study presented reclassification indices.The majority of better performing models included sex, age, symptoms, diabetes, smoking, and hyperlipidemia as variables.Only two diagnostic models evaluated the effects on clinical decision making processes or patient outcomes.Most diagnostic models of the pre-test probability of stable coronary artery disease have had modest success, and very few present data regarding the effects of these models on clinical decision making processes or patient outcomes.

Medical ethics theory and practice is rooted in a certain period of the social economy,culture and education,and then change and development.With the progress of the global economic integration,the culture and education of different countries has worldwide connectivity,in turn,affects the foreign land local medical culture.Currently,from the overview of our country's medical ethics education and practice,medical ethics teaching and evaluation system can not meet the ever-changing global medical development process.This article start with traditional medical culture and origin of medical ethics theory in China,aims on problems that existing in the teaching practice of cultivating virtue less attention,loss of clinical decision making ability,lack of standardized appraisal system,and try to discusses the path of the teaching reform and to promote the development of medical ethics teaching theory and practice in China.

Background 6-Chloro-2-methoxy- N -(phenylmethyl)-9-acridinamine (BA), a novel sponge-derived compound, has been reported to elicit a cytotoxic effect by inhibiting cell proliferation. Methods In this study, we investigated the anti-tumor effect of BA in human hepatocellular carcinoma (HCC) in vitro and in vivo using SMMC-7721 cells. The impact of BA on SMMC-7721 cells was determined by proliferation (clonogenicity and MTT), apoptosis (flow cytometry with annexin V-FITC labeling) and tumor cell migration (Transwell). Apoptosis-related molecules in the PI3K/AKT signaling pathway were examined via Western blotting. We also evaluated the effects of BA on tumor growth using a xenograft nude mouse model. Results The data showed that BA induced dose-dependent cytotoxicity, anti-proliferation, anti-migration and apoptosis in SMMC-7721 cells, accompanied by activation of caspase-3 and a decreased level of caspase-9. Moreover, BA decreased PI3K and p-AKT levels, which indicated the cytotoxicity of BA through the PI3K/Akt pathway. Finally, we confirmed that BA inhibited tumor growth in an HCC xenograft mouse model. Conclusions We concluded that BA induced apoptosis and decreased PI3K and p-AKT expression in human HCC with no effect on the liver, kidney, spleen or lungs. These findings suggest that BA could provide a novel strategy for the treatment of HCC.

Considering that the weak signal detection methods based on Duffing oscillator with periodic driving force signal have the defects that the detection accuracy can be affected by the critical threshold and the frequency resolution is not high enough, a new weak signal detection method was presented based on Duffing oscillator, which was driven by the linear perturbation of the to-be-detected signal. In the method, the small change of the linear perturbation parameters could cause the output change, and then this characteristic could be used to detect the weak signals submerged in the background noise. Meanwhile, based on the Melnikov function and the maximum of Lyapunov exponent, the feasibility of the detection system was analyzed. The results show that the method can greatly improve the frequency resolution of weak signal, and the precision of the frequency achieves 10-4. It can also enhance the noise immunity ability and eliminate the effect of critical threshold on the precision of the system.