抗原变异可使得多种致病微生物易于逃避宿主免疫应答。表达在感染红细胞表面的恶性疟原虫红细胞表面蛋白1（PfPMP1）与感染红细胞、内皮细胞、树突状细胞以及胎盘的单个或多个受体作用，在黏附及免疫逃避中起关键的作用。每个单倍体基因组var基因家族编码约60种成员，通过启动转录不同的var基因变异体为抗原变异提供了分子基础。

疟原虫var基因转换速率变化导致抗原变异[英]／Paul H, Robert P, Christodoulou Z, et al//Proc Natl Acad Sci U S A

ABCD
: Appropriate Blood pressure Control in Diabetes
ABI
: ankle–brachial index
ABPM
: ambulatory blood pressure monitoring
ACCESS
: Acute Candesartan Cilexetil Therapy in Stroke Survival
ACCOMPLISH
: Avoiding Cardiovascular Events in Combination Therapy in Patients Living with Systolic Hypertension
ACCORD
: Action to Control Cardiovascular Risk in Diabetes
ACE
: angiotensin-converting enzyme
ACTIVE I
: Atrial Fibrillation Clopidogrel Trial with Irbesartan for Prevention of Vascular Events
ADVANCE
: Action in Diabetes and Vascular Disease: Preterax and Diamicron-MR Controlled Evaluation
AHEAD
: Action for HEAlth in Diabetes
ALLHAT
: Antihypertensive and Lipid-Lowering Treatment to Prevent Heart ATtack
ALTITUDE
: ALiskiren Trial In Type 2 Diabetes Using Cardio-renal Endpoints
ANTIPAF
: ANgioTensin II Antagonist In Paroxysmal Atrial Fibrillation
APOLLO
: A Randomized Controlled Trial of Aliskiren in the Prevention of Major Cardiovascular Events in Elderly People
ARB
: angiotensin receptor blocker
ARIC
: Atherosclerosis Risk In Communities
ARR
: aldosterone renin ratio
ASCOT
: Anglo-Scandinavian Cardiac Outcomes Trial
ASCOT-LLA
: Anglo-Scandinavian Cardiac Outcomes Trial—Lipid Lowering Arm
ASTRAL
: Angioplasty and STenting for Renal Artery Lesions
A-V
: atrioventricular
BB
: beta-blocker
BMI
: body mass index
BP
: blood pressure
BSA
: body surface area
CA
: calcium antagonist
CABG
: coronary artery bypass graft
CAPPP
: CAPtopril Prevention Project
CAPRAF
: CAndesartan in the Prevention of Relapsing Atrial Fibrillation
CHD
: coronary heart disease
CHHIPS
: Controlling Hypertension and Hypertension Immediately Post-Stroke
CKD
: chronic kidney disease
CKD-EPI
: Chronic Kidney Disease—EPIdemiology collaboration
CONVINCE
: Controlled ONset Verapamil INvestigation of CV Endpoints
CT
: computed tomography
CV
: cardiovascular
CVD
: cardiovascular disease
D
: diuretic
DASH
: Dietary Approaches to Stop Hypertension
DBP
: diastolic blood pressure
DCCT
: Diabetes Control and Complications Study
DIRECT
: DIabetic REtinopathy Candesartan Trials
DM
: diabetes mellitus
DPP-4
: dipeptidyl peptidase 4
EAS
: European Atherosclerosis Society
EASD
: European Association for the Study of Diabetes
ECG
: electrocardiogram
EF
: ejection fraction
eGFR
: estimated glomerular filtration rate
ELSA
: European Lacidipine Study on Atherosclerosis
ESC
: European Society of Cardiology
ESH
: European Society of Hypertension
ESRD
: end-stage renal disease
EXPLOR
: Amlodipine–Valsartan Combination Decreases Central Systolic Blood Pressure more Effectively than the Amlodipine–Atenolol Combination
FDA
: U.S. Food and Drug Administration
FEVER
: Felodipine EVent Reduction study
GISSI-AF
: Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico-Atrial Fibrillation
HbA1c
: glycated haemoglobin
HBPM
: home blood pressure monitoring
HOPE
: Heart Outcomes Prevention Evaluation
HOT
: Hypertension Optimal Treatment
HRT
: hormone replacement therapy
HT
: hypertension
HYVET
: HYpertension in the Very Elderly Trial
IMT
: intima-media thickness
I-PRESERVE
: Irbesartan in Heart Failure with Preserved Systolic Function
INTERHEART
: Effect of Potentially Modifiable Risk Factors associated with Myocardial Infarction in 52 Countries
INVEST
: INternational VErapamil SR/T Trandolapril
ISH
: Isolated systolic hypertension
JNC
: Joint National Committee
JUPITER
: Justification for the Use of Statins in Primary Prevention: an Intervention Trial Evaluating Rosuvastatin
LAVi
: left atrial volume index
LIFE
: Losartan Intervention For Endpoint Reduction in Hypertensives
LV
: left ventricle/left ventricular
LVH
: left ventricular hypertrophy
LVM
: left ventricular mass
MDRD
: Modification of Diet in Renal Disease
MRFIT
: Multiple Risk Factor Intervention Trial
MRI
: magnetic resonance imaging
NORDIL
: The Nordic Diltiazem Intervention study
OC
: oral contraceptive
OD
: organ damage
ONTARGET
: ONgoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial
PAD
: peripheral artery disease
PATHS
: Prevention And Treatment of Hypertension Study
PCI
: percutaneous coronary intervention
PPAR
: peroxisome proliferator-activated receptor
PREVEND
: Prevention of REnal and Vascular ENdstage Disease
PROFESS
: Prevention Regimen for Effectively Avoiding Secondary Strokes
PROGRESS
: Perindopril Protection Against Recurrent Stroke Study
PWV
: pulse wave velocity
QALY
: Quality adjusted life years
RAA
: renin-angiotensin-aldosterone
RAS
: renin-angiotensin system
RCT
: randomized controlled trials
RF
: risk factor
ROADMAP
: Randomized Olmesartan And Diabetes MicroAlbuminuria Prevention
SBP
: systolic blood pressure
SCAST
: Angiotensin-Receptor Blocker Candesartan for Treatment of Acute STroke
SCOPE
: Study on COgnition and Prognosis in the Elderly
SCORE
: Systematic COronary Risk Evaluation
SHEP
: Systolic Hypertension in the Elderly Program
STOP
: Swedish Trials in Old Patients with Hypertension
STOP-2
: The second Swedish Trial in Old Patients with Hypertension
SYSTCHINA
: SYSTolic Hypertension in the Elderly: Chinese trial
SYSTEUR
: SYSTolic Hypertension in Europe
TIA
: transient ischaemic attack
TOHP
: Trials Of Hypertension Prevention
TRANSCEND
: Telmisartan Randomised AssessmeNt Study in ACE iNtolerant subjects with cardiovascular Disease
UKPDS
: United Kingdom Prospective Diabetes Study
VADT
: Veterans' Affairs Diabetes Trial
VALUE
: Valsartan Antihypertensive Long-term Use Evaluation
WHO
: World Health Organization

### 1.1 Principles

The 2013 guidelines on hypertension of the European Society of Hypertension (ESH) and the European Society of Cardiology …

/pdf/2013-esh-esc-guidelines-for-the-management-of-arterial-4ydvs5ifsx.pdf

2013 ESH/ESC Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC).

http://www.klinikaikozpont.u-szeged.hu/pedia/images/pdf/CME_TEL/Full-Text/25.pdf

The Hallmarks of Aging

The mediators and cellular effectors of inflammation are important constituents of the local environment of tumours. In some types of cancer, inflammatory conditions are present before a malignant change occurs. Conversely, in other types of cancer, an oncogenic change induces an inflammatory microenvironment that promotes the development of tumours. Regardless of its origin, 'smouldering' inflammation in the tumour microenvironment has many tumour-promoting effects. It aids in the proliferation and survival of malignant cells, promotes angiogenesis and metastasis, subverts adaptive immune responses, and alters responses to hormones and chemotherapeutic agents. The molecular pathways of this cancer-related inflammation are now being unravelled, resulting in the identification of new target molecules that could lead to improved diagnosis and treatment.

/pdf/cancer-related-inflammation-ltml0xgfd3.pdf

Cancer-related inflammation.

Evaluating complex interventions is complicated. The Medical Research Council9s evaluation framework (2000) brought welcome clarity to the task. Now the council has updated its guidance

https://www.bmj.com/content/bmj/337/bmj.a1655.full.pdf

Developing and evaluating complex interventions: The new Medical Research Council guidance

Transient Ischemic Attack and Stroke: Anatomy and physiology

Background Obstructive Sleep apnoea (OSA) has increasingly been linked to cardiovascular endpoints including hypertension, stroke, myocardial infarction, and carotid atherosclerosis. Snoring is strongly associated with OSA. More recently, the snoring component of OSA, by producing local arterial trauma, has been independently linked to the presence of carotid but not femoral atheroma,1 and to acute carotid trauma in an animal model.2 The aim of this study was to identify whether this relationship could be established retrospectively in a high vascular risk cohort of individuals with a recent cerebrovascular event (TIA or stroke). Method Participants with a recent TIA or stroke in the Oxford Vascular Study (OXVASC) completed an entry questionnaire which included frequency of snoring (never, rarely (1–2/year), occasionally (4–8/year), sometimes (1–2/month), often (1–2/week), usually (3–5/week) and always (every night). A subset of 316 individuals (aged 62–84 years), with both a completed snoring questionnaire and carotid Doppler data, were included. This information was used to retrospectively assess a potential relationship between presence and severity of snoring, and degree of carotid artery stenosis and plaque type (echogenic/echolucent/mixed, calcified/non-calcified and smooth/irregular). Results 160 out of 316 participants were male, mean (SD) age 73.2 (11.22). No significant association could be identified between intensity of self-reported snoring and degree of carotid stenosis or plaque morphology. Conclusions No significant association could be identified between snoring and carotid atheroma. There are no obvious explanations for the discrepancy between this study and previous work, except that the original study measured snoring objectively during a one night in hospital study, whereas in our study snoring was subjectively assessed and perhaps better represents the usual situation at home. Furthermore, the femoral artery may not be an appropriate ‘control’ artery with which to compare the carotid for atheroma.

https://thorax.bmj.com/content/thoraxjnl/65/Suppl_4/A161.2.full.pdf

P200 Snoring and carotid atheroma: no association

Management of stroke

It has been an interesting year in the ‘battle for supremacy’ between endarterectomy and stenting for carotid stenosis. The General anaesthetic versus local anaesthetic for carotid surgery (GALA) trial showed that endarterectomy can be performed at least as safely under local anaesthetic as under general anaesthetic, which potentially reduces any innate patient preference for endovascular treatment as a ‘more minor’ procedure (1). Longterm follow-up data on the durability of endarterectomy vs. endovascular treatment for symptomatic carotid stenosis were also published from the Endarterectomy Versus Angioplasty in Patients with Severe Symptomatic Carotid Stenosis (EVA-3S) (2), Stent-protected angioplasty in asymptomatic carotid artery stenosis: (SPACE) (3) and Carotid and Vertebral Transluminal Angioplasty Study (CAVATAS) trials (4, 5), with median followups of 2, 3.5 and 5 years, respectively. Severe re-stenosis (not determined in EVA-3S) was about three times more frequent with endovascular treatment than endarterectomy in both SPACE (P 5 0.009) and CAVATAS (Po0.0001), and all three trials showed trends towards worse long-term outcomes. Taken together with other long-term follow-up data, meta-analysis shows that long-term clinical outcomes are now significantly worse with endovascular treatment (6). In addition to this, the procedural risk results from the International Carotid Stenting Study (ICSS) (7), the largest trial so far, were also presented in 2009, with a nearly twofold higher procedural risk of stroke in the endovascular treatment group compared with endarterectomy, and a fivefold excess of new acute infarcts on brain imaging. The results of the equivalent US trial Carotid Revascularization Endarterectomy vs Stent Trial (CREST) (8), due to be presented in early 2010, are therefore awaited with great interest. References

Peter M. Rothwell

Papers

Transient Ischemic Attack and Stroke: Anatomy and physiology

P200 Snoring and carotid atheroma: no association

Management of stroke

The year in stroke: endarterectomy vs. angioplasty and stenting.

Local Versus General Anesthesia for Carotid Endarterectomy: Cochrane Review.