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Abstract pulmonary hypertension (pulmonary arterial hypertension, PAH) is not uncommon in the clinical, the disease is due to unexplained pulmonary artery pressure continued to rise and led to the development of chronic diseases. PAH screening, early identification and diagnosis of great importance. Clinical Cardiology of the most common pulmonary hypertension (pulmonary hypertension, PH) is pulmonary hypertension, PH with left ventricular pressure are often linked to improve the current clinical primary pulmonary hypertension also found that more and more. The most common respiratory PAH often associated with respiratory diseases, chronic obstructive pulmonary disease (chronic obstructive pulmonary disease, COPD), hypoxia may have contributed to the promotion of PAH, in the clinical treatment of PAH's a very big problem.
Pulmonary agents to expand the application of the theory is based on pulmonary hypertension when there is an obvious shrinkage of the pulmonary artery, vasodilator therapy, can improve their symptoms, hemodynamics and survival rate. However, in patients with pulmonary hypertension, because of the lower reaches of the existence of obstruction, systemic vasodilator application can lead to the expansion of the lung caused by pulmonary artery and pulmonary edema血流量增加. From chronic lung disease or interstitial lung disease caused by hypoxia in patients with pulmonary hypertension, vasodilator banned because vasodilator therapy ventilation can cause blood disorders and increase the ratio of hypoxemia [1].
A calcium channel blocker
Studies have suggested that calcium channel blockers on the reaction of patients with pulmonary hypertension, long-term application of high-dose calcium channel blockers, can extend their survival time. Such as amlodipine, 10% of the effective treatment of pulmonary hypertension cases. Pulmonary hypertension in patients with right heart catheterization, the application of a number of short-acting drug to expand blood vessels (intravenous prostacyclin or adenosine, or inhaled nitric oxide), the reaction may determine based on its long-term application of calcium channel blockers on their Whether or not useful. But the short-term vasodilator response does not prompt a long-term application of calcium channel blockers can be satisfied with the effect of [2,3].
2, prostacyclin and similar drugs
Intravenous prostacyclin: prostacyclin by endothelial produce. Early 1980s, intravenous prostacyclin (epoprostenol, epoprostenol) for the first time used in the treatment of pulmonary hypertension. On intravenous epoprostenol acute lack of response does not mean its not a long-term efficacy of pulmonary hypertension. Since the mid-1990s onwards, in North America and some European countries have already ratified epoprostenol can be used in the treatment of pulmonary hypertension [4]. Although epoprostenol to improve the number of pulmonary hypertension in patients with clinical symptoms, but in view of its complications, patients do not apply when the application of expensive and the price of intravenous epoprostenol is not the ideal treatment for pulmonary hypertension. Common side effects include jaw pain, headaches, diarrhea, and the red and leg pain and nausea [6].
Subcutaneous treprostinil: the recent application of stable prostacyclin analogue of continuous subcutaneous treprostinil. Multicenter, randomized, placebo-controlled clinical trials have shown that, treprostinil can significantly improve the patient's clinical symptoms and hemodynamic parameters, the main side effect is the injection of local pain. In 2002, the United States has approved treprostinil can be used in the treatment of pulmonary hypertension [7]. McLaughin [8] 2005 years, a report said: treprostinil to receive intravenous infusion of the patient to improve 6MWD (6min walking distance), to improve the cardiac index, mPAP and reduce peripheral vascular resistance.
Ilo-inhalation in the forefront: the forefront of Ilo-(iloprost) is a chemical stability of prostacyclin analogue, it can be inhaled for the treatment of pulmonary hypertension, but the role of short-term, the daily inhaled to be 6 to 12. Europe has approved the forefront of the Ilo-used in the treatment of primary pulmonary hypertension. Higenbottam [9] found, and so on: the forefront of Ilo-inhalation therapy, pulmonary artery pressure decreased and oxygen saturation increased by intravenous infusion PGI2 more than obvious, and pulmonary artery pressure and heart rate fluctuations was not obvious. In addition, the inhalation of Ilo in the forefront in the lower-resistance pulmonary circulation at the same time, but also reduced mean pulmonary artery pressure, the selective expansion of the role of high pulmonary blood vessels. But its still relatively short plasma half-life, an inhalation treatment, hemodynamic effects almost disappear in 1h, which twice in the treatment of inhalation, as well as between the night to stop inhaling lead to pulmonary hypertension rebound, which has attracted wide attention.
Oral Beraprost: Beraprost sodium (beraprost sodium) is the first biological and stability of the orally active prostacyclin analogue. After the rapid oral absorption, 30min and reached the peak, half-life of 35 ~ 40min [10]. The main side effect is that early treatment can cause systemic vasodilator [11]. A 12-month randomized, double-blind, placebo-controlled clinical trials have shown that beta-during the forefront of 3 months and 6 months in patients with pulmonary hypertension to improve exercise capacity, but in 9 months and 12 months are null and void [ 12]. Japan has approved the forefront of-Pui used in the treatment of pulmonary hypertension.
3 endothelin receptor antagonist
At present, can be used in the clinical endothelin (ET) receptor antagonist bosentan is (bosentan), other endothelin receptor antagonists are still being developed. Clinical trials have shown that bosentan can significantly improve the movement of patients with pulmonary hypertension and hemodynamic parameters, to improve the cardiac index, right ventricular systolic function, left ventricular early diastolic filling. Take medication during the monthly monitoring of liver function. North America (2001) and Europe (in 2002) has approved bosentan for the treatment of pulmonary hypertension, but its long-term role for further evaluation.
4 phosphodiesterase inhibitor
For the treatment of erectile dysfunction treatment Viagra PAH transformed into an effective drug sildenafil. Sildenafil is a selective vasodilator, through selective inhibition of cGMP specific PDE-5 MB cGMP to increase the role of time to play a role. Sildenafil can reduce the patient's pulmonary artery pressure, the more the forefront of Ilo-the role of the longer, only to the mean pulmonary arterial pressure of less affected.
5 others
Nitric oxide (NO): Since the discovery of nitric oxide (NO) can be selective pulmonary vascular smooth muscle relaxation effect after it began low-concentration NO gas inhalation treatment of pulmonary hypertension. Animal experiments and clinical studies have confirmed that low concentrations of NO gas inhalation on adult respiratory distress syndrome and other pulmonary hypertension and hypoxemia-based Feibujihuan significant effect. However, when inhaled NO withdrawal may appear a sharp increase in pulmonary artery pressure rebound phenomenon, known as the rebound pulmonary hypertension. In recent years, the study [13 to 15] that rebound pulmonary hypertension in endothelin-1 may be the participation of exogenous NO inhibition of the endogenous nitric oxide synthase activity or cGMP-specific phosphorus Increase in the enzyme acid, causing blood vessels in the body of a factor than relaxing factor, so that the pulmonary vascular resistance increased. NO gradually reduce the concentration of respirable re-evacuation or dipyridamole combination therapy may reduce the rebound pulmonary hypertension.
Adenosine: adenosine on pulmonary blood vessels is not only highly selective treatment of primary pulmonary hypertension is of great significance, but also for the treatment of such patients before an accurate assessment of the degree of reversibility of pulmonary blood vessels to provide a basis [16].
6 combination
Combination of different mechanism of action of the drug can enhance the treatment of pulmonary hypertension, such as oral, inhalation or intravenous prostacyclin analogue, given sildenafil or bosentan can produce better results. But there are also reports, has accepted the vasodilator (calcium channel blockers, epoprostenol or bosentan) therapy in patients with pulmonary hypertension, plus long-term use of sildenafil have little effect.
PAH is a complex mechanism, the poor prognosis of the disease, PAH screening, early identification and diagnosis of great importance. The main effects of treatment for all PAH disease progression, that is, neuroendocrine imbalance. Even if a single drug after symptoms improved, it should intervene in combination as far as possible all the neuroendocrine mechanisms, reasonable treatment to improve the prognosis is particularly important. In recent years, pulmonary hypertension in the pathophysiology and molecular biology have made progress in promoting the development of drug treatment for pulmonary hypertension patients new hope that the current foreign animal experiments have shown that specific 5-HT2B receptor antagonist PRX-08066 As well as soluble guanylate cyclase PAH may be an effective means of treatment. This constant awareness of the disease will make new progress in treatment, is expected to improve the prognosis of patients with PAH.
 
References 【】
1 British cardiac society guidelines and medical practice committee.Recommendations on the management of pulmonary hypertension in clinical practice.Heart, 2001,86 (Suppl) I :1-13.
2 Voelkel NF, Tuder RM, Weir EK.Pathophysiology of primary pulmonary hypertension.In: Rubin L, Rich S, eds.Primary pulmonary hypertension.New York: Marcal Dekker ,1997,83-129.
3 Sitbono, Humbert M, Loos V, et al.Who benefits from long term calcium channel blocker therapy in primary pulmonary hypertension.Am J Respir Crit Care Med, 2003,167: A440.
4 Humbert M, Sitbon O, Simonneau G. Treatmeat of pulmonary arterial hypertension.N Engl J Med ,2004,351:1425-1436.
5 Barst RJ, Rubin LJ, Long WA, et al.A comparison of continuous intravenous epoprostenol (prostacyclin) with conventional therapy for primary pulmonary hypertension.N Engl J Med ,1996,334:296-302.
6 Sitbon O, Humbert M, Simonneau G, et al.Primary pulmonary hypertension: current therapy.Prog Cardiovasc Dis ,2002,45:115-128.
7 Simonneau G, Barst RJ, Galie N, et al.Continuous subcutaneous infusion of treprostinil, a prostacyclin analogue, in patients with pulmonary arterial hypertension: a double-blind randomized controlled trial.Am J Respir Crit Care Med, 2002,165:800 -804.
8 Gomberg-Maitland M, Tapson VF, Mc Laughlin VV, et al.Transition from intravenous epoprostenol to intravenous treprostinil in pulmonary hypertension.Am J Respir Crit Care Med, 2005,172 (12) :1586-1589.
9 Olschewski H, Simonneau G, Higenbottam T, et al.Inhaled iloprost for severe pulmonary hypertension.N Engl J Med, 2002,347 (5) :322-329.
10 Galie N, Manes A, Branzi A. The new clinical trials on pharmacological treatment in pulmonary arterial hypertension.Eur Respir J ,2002,20:1037-1049.
11 Galie N, Humbert M, Vachiery JL, et al.Effects of beraprost sodium, an oral prostacyclin analogue, in patients with pulmonary arterial hypertension: a randomized, double-blind placebo-controlled trial.J Am Coll Cardiol, 2002,39: 1496-1502.
12 Barst RJ, Mc Goon M, Mclaughlin V, et al.Beraprost therapy for pulmonary arterial hypertension.J Am Coll cardiol ,2003,41:2119-2125.
13 Cueto E, Lopez-heree J, Sanchez A, et al.Life-threatening efects of dise-tinuing inhaled nitric oxide in ctfildren.Acta Peliatr, 1997,86 (12) :1337-1339.
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Poker interesting city in Germany阿尔切布克city in the world today is the famous "poker City." In the center of the square, stands a towering column 4, respectively, to support heart, spade, box, plum statue of the four to form the city's emblem of the city.

     The magical effect in 1885 playing cards, playing cards with the rulers of France to repay the debt part of the war;

     University of Pennsylvania used as a poker Jinjiao Shi's license;

     During the French Revolution, Napoleon also made a quantitative supply of poker cards!

     The poker historical figures spade K King Solomon of Israel's father, David;
                        K is the heart of King Charles I, Frank Shale Man;
                        Plum K was one of the first to conquer the world of King Alexander;

Early & P has been very hard to find a license, if the market to buy from the collection, each deputy in more than a few hundred dollars. The medium-term card Platts in a number of mainland small town, village and township cultural market can sometimes be found. As a result, S & P card collectors should be licensed as early as possible to save the mid-Cape.

     Then the medium-term card Platts what features it? According to the poker industry in order to Mr. Lv Guangping in the early 1990s, the invention of new technology into the line in the near future, the medium-term poker on poker with the old production process characteristics.

     First, the medium-term card Platts of the box are basically straight-inclusive. What is a straight-pack? If the poker open box, box shape for the long straight shape. If you do not open, then it is not at the bottom of the box openings. The S & P license in the near future because of mechanical stick box of kit for more cross-package, such as opening, was a square. Do not open, are opening up and down.

     Second, the medium-term card Platts box at the top of the opening for long-tongued. That is, the larger openings of a longer tongue. The S & P in the near future licensing tongue short box.

     Third, the medium-term S & P plates are generally the same as the size of poker with a "license for." This is because the old technology of production, printing a few cardboard signs need to manually license allocation, less vulnerable to leakage license card, customers can determine their "distribution license", which marked a small card to fill the factory license. The new process is a cardboard printing a license, no license allocation of this process, the most recent licensing & P did not put the "distribution license." There are only a small certificate. A small number of works by Fang Yan "distribution license" there.

     Four-, medium & P licensing round four-round unnatural. The S & P license in the near future as a result of the second die-cutting process, the fillet is natural, of course, as a result of the reasons for process equipment, not to distinguish times.

     There are other similar paper, printing and so on professional and the other more, collectors are not easily distinguishable, but more than four features (especially before the three-point) is more easily distinguishable.

World beauty contest has long held a very attractive cultural activities worldwide. The author of a collection of printing products from Heze in Shandong's "Miss International" Poker (ID is No.9011), it is a comprehensive account of the 1990 Miss International beauty contest of good shots. King and the envelope are the Miss International title - Spain Deaisite girl million after the coronation of the good phase.

     World beauty contest originated in the United States, far more than 50 years of history. In 1952, the Great Depression of the world economy, by the name of an American Academy of the Ming Hate entrepreneurs brought together 39 young American girl and the 29 Caribbean countries, organized the first World beauty contest, named "World beauty A Celebration of the Arts. " Finland's 19-year-old girl Ami Seurat library to be champions. Since then, the world's beauty contest is in full swing, "Miss World" and "Miss Universe" and "Miss International" contest of the three major activities today to enjoy the most prestigious beauty contest.

     With the change of time and changes people's aesthetic concepts, beauty standards have resulted in some changes, but万变不离其宗. To participate in the pageant are in the country or the region that year's pageant was the first event of the Miss, they should be in addition to beautiful face, body shape and symmetry of the right measurements, there are also charming temperament, A wealth of knowledge and strong language ability.

     It is understood that the beauty of our history can be traced back over 1000 years ago in the Song Dynasty, the first in the West than the "beauty of the world" contest for hundreds of years earlier. The most modern and contemporary beauty contest in 1946's "Miss Hong Kong" election. Guangzhou launched in 1989 "in the United States Huacheng" ad star contest, is considered to be the embryonic form of beauty in the Mainland. In 2001, for the first time China participated in the 51st Miss World contest.

     "Miss International" playing cards, the only spade "8" is an emerging player in Hong Kong, China, we can see that at the time of the World beauty pageant Chinese girl can be few and far between. Now, the world's three major activities of the beauty pageant held in China at all events, Chinese and foreign girl beauty stage one after another, people feel really beautiful.

In recent years, the collection of playing cards in the expansion of the size of collection, collection of species-rich areas such as a rapid prosperity of the gratifying situation. A lot of collectors and enthusiasts to write a large number of articles reviewed, discovered a large amount of historical data and early in the poker treasures in the country within the framework set off one after another view of the new collection. In particular, the leaflet is a growing collection of cards by collectors.

     A few years ago, with its own collection of the number of cards increased because of limited storage space, to my storage and display of poker has brought a lot of inconvenience. Subject to a number of foreign possession of the home inspired, I started to licensing by the general category of the fitted sheet, such as book collections and exhibitions designed to produce some version of the box and select Set, and so on. I "spent four home Bao" fundamental changes have taken place.

     Recently, many proposed by the Friends of Tibet, the collection of playing cards leaflets have any significance? Why should we leaflets collection poker? And many other questions, based on their own over the past few years the collection and study of some of the leaflets poker feelings and understanding that poker is still quite leaflet collection of fun, a lot of reasons. N is finishing possession of the grounds and friends to share.

     N1, increased collection of fun playing cards

     Collection of leaflets poker is more fun. We imagine that when a card to the collection, like the extreme, but how many people are willing to put the whole Vice Licensing always opened each card to see so often? When the audience to enjoy, and how many people are willing to have the whole Vice Licensing to open one by one so that the audience appreciate it? Talking about family, in addition to fear of affecting the quality of the card itself, more time is not convenient to enjoy, there is a lack of amenities to enjoy. Some of the special, beautiful card, just to put it in boxes under the counter in poker can not feel the charm of its own. This perception could not even itself is a deck of cards. Our collection is it?

     N2, its rich collection of the type and quantity.

     Since many of the licenses, especially the earlier of playing cards, the world kept low, even to the collection of which is a very exciting. Imagine, then decades, the number of species present lack of playing cards will be rare commodities. Re-imagine, if only some of the collection of a license, and during the collection of classified categories, our collection will be the number of varieties and the number of species? Collection of playing cards would have this kind of a sense of pride? As a result, I think some of the general collection card, advertising, art licensing, licensing, and other special varieties of leaflets license for its rich collection of the type and quantity of a very important role.

     N3, playing cards showing your own charm.

     We have already been carried out in a variety of theme exhibitions and cultural collections of playing cards, the whole Vice Licensing participate in the display of the number of gardeners? The most attractive is not that attractive faces, different styles Kuo-chung, a distinct theme of the leaflets do poker!

     Poker is a two-dimensional objects, the need to appreciate the plane. If only the whole of the Under-cabinet on the cards in the three-dimensional display or collection can not be fully display the charm of its own cards. If all licenses are flat-start, not to provide extensive storage space. Only some of the characteristics of individual cards to show the way the plane and kept in order to experience the kind of poker itself deep sense of taste.

     I have produced a trump card, the spade A, KQJ, and so some of the display box, the collection of some of the leaflets to the playing cards loaded books by category, hold up, in addition to find, very easy to keep, the better to appreciate those who have been Much appreciated. I am also in possession of the poker room is full of cultural flavor, but also my house is full of warmth and the collection of distinct personality. This is in itself a kind of poker at.

    N4, saving space for collections and collection of funds.

    As the price of poker a lot of reasons, most of the civilian population for collectors, and can not be expected to be some feeling. There are a number of space as the reasons for some of the collector to force a change in the type of collection. If we can use some of the leaflets in the form of card collection, according to the type of equipment such as the collection of books, that is, saving a great deal of money, but also reduced the space for the collection pressure.

     On my own, if I am one of the general collections have nearly 3000 kinds of licensing, storage is a big problem, not to mention the issue of how to display. If three years ago, I did not put them into the "information" and "Atlas of the back" and "select set" and so on, can not find and appreciate, it can be said is only "mountain" of the store. At the same time, over the past three years, I have a lot of collectors and enthusiasts to provide more than 2,300 leaflets dozens of sets of playing cards, so we spent very little money to get a lot of poker materials. Many collectors and fans after finishing as very attractive, but also a genuine feeling of playing cards collection leaflet is a very cost-effective, value for money to a collection.

     N5, Friends of Tibet and to promote exchanges and cooperation between.

     Now, we have to the whole of the playing cards as a vice possession of an exchange between the Friends of the way prevailing. However, as many of the stock of playing cards have been unable to meet the needs of all collectors of the entire collection of vice. Friends of Tibet is now among the growing number of exchanges to take the leaflets. Friends of Tibet to foreign exchanges, for example, most of them unlicensed leaflets exchange and the exchange. This. We are rich in their own fine collection at the same time, but also with possession of more Friends of the harvest to share the joy. In addition to the collection to meet their own ray of happiness, Friends of Tibet is more sincere feelings between that. Who can not speak with the feelings of Tibetan friends to carry out the exchange of this collection?

     N6, playing cards enhance the horizontal comparison study.

    Since 2004, a lot of poker enthusiasts and collectors began to pay attention leaflets poker collection and research, and collections in the forum, launched a call for the establishment of a nationwide collection of playing cards leaflets, research organizations, the poker License to explore deeper into the collection phase of the study, a lot of fans and collectors began to focus on the characteristics of their own playing cards. Products such as the age, region, factories and so on. However, due to the limited number of species collection, longitudinal study to bring playing cards very difficult, there are a lot of research to identify and rely on trademarks, ace, spade A, map, and so on the back of the leaflets and cards for the horizontal comparison and研究. This is the largest poker leaflets of a collection of the original driving force.

     N7, expanding collections and research in the field.

     In recent years, China's collection of types of poker, focusing on areas such as direction of the collection there have been some changes. From the simple theme of the collection of playing cards to the professional poker collection; from the entire collection to the vice-card poker leaflets collection; Complete Works from the collection to the topic-based collection; from the simple collection of playing cards to their own poker-related derivatives; from the Single collection of poker cards related to the collection. The establishment of a general study of poker, poker club ads, cards will be China's special research institutions. With the possession of friends constantly update the concept, I believe that in the near future, leaflets and research collections of playing cards is bound to be a growing number of collectors and fans of great importance, is bound to make the leaflets poker The research and development to a new stage.

     N8 ... ...

     Collection of playing cards leaflets have many reasons to list, but I have gone through the collection, like, constant research and collection of leaflets poker, poker, I have become a very important collection of a group As part of the. I believe there will be more determined collection of playing cards and leaflets in the possession of Friends of the study, in the near future and I share the joy of this collection!