The underlying proinflammatory mechanism of coagulation factor VⅡ in coronary artery disease (CAD) remains unclear. According to the inclusion criteria, 24 non-CAD subjects and 24 patients with CAD were enrolled. The expression levels of pro-inflammatory (CD14+CD86+, CD14+CD163-), anti-inflammatory monocytes (CD14+CD163+), CD14+CD142+ and CD14+PAR2+ monocytes in peripheral blood were detected by flow cytometry. The levels of TNF-α, IL-1β, IL-6, IL-10, and FVⅡ in plasma were determined by ELISA. In vitro experiments were conducted to induce inflammatory THP-1 by FVⅡa. The FVⅡa/TF complex inhibitor PCI-27,483 and PAR2 antagonist AZ3451 were used to clarify the mechanisms. Compared with the control group, the percentage of CD14+CD86+ pro-inflammatory monocytes were significantly increased in the CAD group, and further elevated after PCI. The results of the levels of CD14+CD142+ and CD14+PAR2+ monocytes showed the same trends with CD14+CD86+ pro-inflammatory monocytes. The levels of CD14+CD163+ anti-inflammatory monocytes and IL-10 were decreased in CAD patients, but increased after PCI. The pro-inflammatory factors and FVⅡ were significantly elevated in the CAD group and significantly decreased after PCI. Correlation analysis revealed that FVⅡ, TF, and PAR2 were significantly associated with CD14+CD86+ pro-inflammatory monocytes, and inflammatory factors. In vitro studies further confirmed that the FVⅡa/TF coagulation complex and PAR2 could activate NF-κB in monocytes and aggravate inflammation. Our findings suggest that crosstalk between monocytes and the coagulation complex might contribute to residual inflammation in CAD, potentially involving the FVIIa/TF/PAR2-NF-κB signaling pathway. Based on these observations, we hypothesize that blocking the interaction between clotting factors and monocytes could represent a promising therapeutic strategy to mitigate residual inflammation, but further rigorous experiments are needed for verification. Crosstalk between the monocytes and coagulation complex might cause residual inflammation in CAD. FVⅡa/TF/PAR2-NF-κB signal pathway is related to the activation of monocytes. Blocking the interaction between FVⅡa/TF coagulation complex and monocytes might be a promising therapeutic target to reduce residual inflammation.

Autumn–Winter weather fluctuations, especially higher wind speed and lower temperature, may trigger acute coronary syndrome (ACS). However, evidence on seasonal exposure–response curves and lag structures remains scarce. We analyzed 2445 ACS admissions from a Beijing tertiary hospital (August 2016–July 2021). Daily meteorological data were linked to admission dates. We applied season-specific analyses—including Spearman correlations, multivariable logistic regression, restricted cubic spline (RCS) curves, and lag-response models—to the autumn and winter data. Wind speed showed a linear positive association with ACS risk: autumn odds ratio (OR) 1.32 (95

IntroductionPrevious studies on the optimal timing for antihypertensive medication administration have yielded inconsistent results. While earlier meta-analyses indicated that bedtime dosing significantly reduces myocardial infarction (MI) risk, more recent research has presented conflicting evidence. Therefore, we aimed to evaluate the impact of bedtime versus morning dosing of antihypertensive drugs on cardiovascular outcomes.MethodsWe conducted a systematic search across PubMed, EMBASE, and Web of Science databases, covering studies published from inception to 16 July 2025, to identify relevant randomized controlled trials. We calculated risk ratios (RRs) for dichotomous outcomes along with the corresponding 95% confidence intervals (CIs). The study protocol was registered in PROSPERO (ID: CRD420251102968).ResultsIn total, 8 studies involving 64,235 patients were included in our analysis. Compared with morning dosing, bedtime dosing exhibited no significant differences in all-cause mortality (RR: 0.78; 95% CI: 0.59–1.04; P = 0.09), major adverse cardiovascular events (RR: 0.80; 95% CI: 0.61–1.05; P = 0.10) or cardiovascular death (RR: 0.59; 95% CI: 0.34–1.04; P = 0.07). However, bedtime dosing significantly decreased heart failure risk (RR: 0.67; 95% CI: 0.46–0.96; P = 0.03), lowered clinical systolic blood pressure (mean difference: −3.27 mmHg; 95% CI: −4.13 to −2.41; P < 0.00001), and improved non-dipper conversion (RR: 0.61; 95% CI: 0.47–0.77; P < 0.0001). Non-significant trends favoring bedtime dosing were noted for MI and coronary revascularization.ConclusionFor critical outcomes, including MACE, all-cause mortality and cardiovascular death, no statistically significant benefits associated with bedtime dosing were observed. The overall findings are inconsistent, and the observed advantages for endpoints such as heart failure are closely linked to a single research group, necessitating cautious interpretation.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420251102968, identifier CRD420251102968.

Purpose/background:With the rising global prevalence of type 2 diabetes mellitus (T2DM), effective treatment strategies are essential. Sodium-glucose cotransporter-2 (SGLT2) inhibitors, key in T2DM management, offer benefits beyond glycemic control. This study aimed to assess global research trends, hotspots, and future directions of SGLT2 inhibitor studies in T2DM through bibliometric analysis. Methods:English-language publications on SGLT2 inhibitors in T2DM (2014-2024) were retrieved from the Web of Science Core Collection. Bibliometric techniques were applied to analyze publication output, geographic distributions, institutional contributions, and citation patterns. Visualization and network analyses were conducted using VOSviewer (v1.6.19) and CiteSpace (v6.3.1.0). Results:A total of 4,146 publications were identified. The USA led in research output (1,152 publications), followed by Japan (857) and China (792). Annual publications grew steadily. Keyword and citation analyses revealed a shift in research focus from glycemic control to cardiovascular and renal protection. The most cited paper, Dapagliflozin and Cardiovascular Outcomes (3,842 citations), emphasized the cardiovascular benefits of SGLT2 inhibitors, reflecting the evolving "prevention-treatment integration" approach in diabetes care. Conclusions:This analysis provides a comprehensive overview of global SGLT2 inhibitor research in T2DM. The findings highlight the transition from metabolic control to cardiorenal protection, guiding future research and clinical practice.

BackgroundDanshen [Salvia miltiorrhiza Bunge (Lamiaceae; Salviae miltiorrhizae radix et rhizoma)] class injections (DSCIs) are widely used in the treatment of coronary heart disease (CHD). However, there are various types of DSCIs available on the market, and it remains uncertain which DSCI has the best clinical efficacy, as well as which one is most effective in regulating inflammatory markers and oxidative stress indicators. The aim of this network meta-analysis (NMA) is to compare the therapeutic effects of different DSCIs to identify the optimal DSCI for the treatment of CHD.MethodsThe databases searched to identify randomized controlled trials (RCTs) of DSCIs for CHD included the China National Knowledge Infrastructure (CNKI), Wanfang Database, China Science and Technology Journal Database (VIP), Chinese Biomedical Literature Database (CBM), PubMed, Web of Science, and Cochrane Library. The search period spanned from the inception of each database up to June 2024. NMA was conducted using RevMan 5.3 and Stata 16.0 software.ResultsA total of 106 studies including 14,979 patients, involving 10,931 patients, with 5,640 in the experimental group and 5,291 in the control group. And ten DSCIs were extracted, namely: Danhong injection (DH), Danshen injection (DS), Danshenchuanxiongqin injection (DSCXQ), Dansenduofensuanyan injection (DSDFSY), Danshenfen injection (DSFZ), Fufang Danshen injection (FFDS), Guanxinning injection (GXN), Sodium Tanshinone IIA Sulfonate injection (STS), Xiangdan injection (XD), Shenxiongputaotang injection (SXPTT). The results of NMA showed that, XD injection significantly enhances clinical efficacy; STS is more effective in reducing hs-CRP levels; DSDFSY shows better efficacy in decreasing IL-1 and increasing NO levels; DSCXQ has a greater advantage in reducing IL-6 levels; GXN is more effective in regulating SOD levels; and DH is better at reducing MDA levels.ConclusionThe combined treatment of DSCIs and WM more significant efficacy in patients with CHD compared to WM treatment alone, including clinical efficacy evaluation, inflammatory markers, and oxidative stress markers. Overall, DSDFSY and DSCXQ show better performance in clinical efficacy evaluation and regulation of inflammatory markers, while DH exhibits a more stable effect in regulating oxidative stress. However, larger sample sizes and high-quality RCTs are still necessary to further compare the various DSCIs.Systematic Review Registration[PROSPERO], identifier [CRD42024548928].

ObjectiveThis study aimed to evaluate the impact of early rhythm control (ERC) on the occurrence of cardiocerebrovascular events in patients diagnosed with atrial fibrillation detected after stroke (AFDAS).MethodsA systematic search was conducted across nine databases from inception to October 15, 2023 to identify clinical trials comparing ERC with usual care interventions in AFDAS patients. The primary outcome assessed was recurrent stroke, with secondary outcomes including all-cause mortality, adverse events related to arrhythmias, and dementia.ResultsAnalysis of five studies, consisting of two randomized clinical trials (RCTs) involving 490 patients and three cohort studies involving 95,019 patients, revealed a reduced rate of recurrent stroke [odds ratio (OR) = 0.30, 95% confidence interval (CI) 0.11–0.80, P = 0.016 in RCTs; OR = 0.64, 95% CI 0.61–0.68, P < 0.00001 in cohort studies] and all-cause mortality (hazards ratio = 0.94, 95% CI 0.90–0.98, P = 0.005 in cohort studies) in the ERC group compared to the usual care group. In addition, ERC was associated with superior outcomes in terms of dementia.ConclusionsPatients with AFDAS who underwent ERC treatment exhibited a decreased risk of cardiocerebrovascular events compared to those receiving usual care. These results support the potential benefits of implementing an ERC strategy for this specific patient population.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/, Identifier [CRD42023465994].

BackgroundThe number of models developed for predicting major adverse cardiovascular events (MACE) in patients undergoing percutaneous coronary intervention (PCI) is increasing, but the performance of these models is unknown. The purpose of this systematic review is to evaluate, describe, and compare existing models and analyze the factors that can predict outcomes.MethodsWe adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 during the execution of this review. Databases including Embase, PubMed, The Cochrane Library, Web of Science, CNKI, Wanfang Data, VIP, and SINOMED were comprehensively searched for identifying studies published from 1977 to 19 May 2023. Model development studies specifically designed for assessing the occurrence of MACE after PCI with or without external validation were included. Bias and transparency were evaluated by the Prediction Model Risk Of Bias Assessment Tool (PROBAST) and Transparent Reporting of a multivariate Individual Prognosis Or Diagnosis (TRIPOD) statement. The key findings were narratively summarized and presented in tables.ResultsA total of 5,234 articles were retrieved, and after thorough screening, 23 studies that met the predefined inclusion criteria were ultimately included. The models were mainly constructed using data from individuals diagnosed with ST-segment elevation myocardial infarction (STEMI). The discrimination of the models, as measured by the area under the curve (AUC) or C-index, varied between 0.638 and 0.96. The commonly used predictor variables include LVEF, age, Killip classification, diabetes, and various others. All models were determined to have a high risk of bias, and their adherence to the TRIPOD items was reported to be over 60%.ConclusionThe existing models show some predictive ability, but all have a high risk of bias due to methodological shortcomings. This suggests that investigators should follow guidelines to develop high-quality models for better clinical service and dissemination.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=400835, Identifier CRD42023400835.

BackgroundThe angiography-derived index of microvascular resistance (A-IMR) is a novel tool for diagnosing coronary microvascular dysfunction (CMD) addressing limitation of unavailability. However, the clinical value of A-IMR remains controversial.MethodsA systematic review and meta-analysis was conducted. PubMed, EMBASE, Cochrane Library and Web of Science were searched for relevant studies. Studies that reported estimates of A-IMR's diagnostic accuracy (with thermodilution-based IMR as the reference test) and/or predictions of adverse cardiovascular events were selected. Pooled sensitivity, specificity, area under the summary receiver operating characteristic curve (sROC) were calculated to measure diagnostic performance; pooled hazard/risk ratio (HR/RR) and 95% confidence interval (95% CI) of major adverse cardiovascular events (MACE) or other independent adverse events were calculated to measure prognostic effect. This study was registered with PROSPERO (CRD42023451884).ResultsA total of 12 diagnostic studies pooling 1,642 vessels and 12 prognostic studies pooling 2,790 individuals were included. A-IMR yielded an area under sROC of 0.93 (95% CI: 0.91, 0.95), a pooled sensitivity of 0.85 (95% CI: 0.79, 0.89) and a pooled specificity of 0.89 (95% CI: 0.83, 0.93) for the diagnosis of CMD. CMD diagnosed using A-IMR was associated with higher risks of MACE (HR, 2.73, 95% CI: 2.16, 3.45), CV death (RR, 2.39, 95% CI: 1.49, 3.82) and heart failure hospitalization (HR, 2.30, 95% CI: 1.53, 3.45).ConclusionA-IMR demonstrated high diagnostic accuracy for CMD and showed a strong prognostic capability in predicting the risk of adverse CV outcomes.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023451884, PROSPERO (CRD42023451884).

目的 验证五龙通络解郁方对炎症模型的抑制作用.方法 通过灭菌手术刀切尾制备斑马鱼巨噬细胞迁移及聚集模型.EGFP斑马鱼随机分为空白对照组、模型组和五龙通络解郁方不同浓度(30μg/ml、100μg/ml、300μg/ml、1000μg/ml)组.通过巨噬细胞的迁移及积聚的情况,评价五龙通络解郁方对斑马鱼炎症抑制作用.结果 相较于空白对照组,模型组斑马鱼尾部巨噬细胞迁移及聚集明显(P<0.01).相较于模型组,不同浓度的五龙通络解郁方都能够使斑马鱼尾部巨噬细胞的迁移及聚集减少,300μg/ml组抑制26％的巨噬细胞迁移及聚集(P<0.01),1000μg/ml组抑制31％的巨噬细胞迁移及聚集(P<0.01);30μg/ml组抑制7.8％的巨噬细胞迁移及聚集(P>0.05),100μg/ml组抑制8.7％的巨噬细胞迁移及聚集(P>0.05),差异无统计学意义.结论 五龙通络解郁方可以有效地抑制炎症作用.

Objective:To investigate the influence of Luofengning No.2 on cardiac function and aquaporin-2（AQP2） expression in the urine of patients with chronic heart failure and diuretic resistance.Methods:A total of 70 patients with chronic heart failure and diuretic resistance admitted to Shunyi Hospital of Beijing Hospital of Traditional Chinese Medicine from January 2019 to January 2021 were selected as the study objects, and they were randomly divided into the observation group and the control group, with 35 patients in each group.The 24-hour urine volume, plasma n-terminal pro-brain natriuretic peptide（NT-proBNP）,AQP2 in urine, and the evaluation standard of curative effect of patients with heart failure were used as the index for evaluating the effect before and after treatment of two weeks respectively.Results:Before treatment, 24-hour urine volume, plasma NT-proBNP,and AQP2 in the urine of the two groups were not statistically significant（P＞0.05）.After treatment of two weeks, 24-hour urine volume, plasma NT-proBNP,and AQP2 in the urine of the two groups were improved and statistically significant（P＜0.01 or P＜0.05） compared with those before treatment.In addition, after treatment, 24-hour urine volume of the observation group was higher than that of the control group（P＜0.05）,but the NT-proBNP and AQP2 in urine declined obviously compared with those of the control group y（P＜0.05）.The difference in the total efficiency of the two groups was compared and was not statistically significant（P＞0.05）,but the observation group tended to be more efficient.Conclusion:Luofengning No.2 can increase 24-hour urine volume, reduce the state of water and sodium retention, and improve diuretic resistance and cardiac function of patients with chronic heart failure.At the same time, this study also shows that the combined monitoring of plasma NT-proBNP and AQP2 in urine can be used as a new target of water-fluid imbalance in patients with chronic heart failure.

1 病例 患者男性,51岁,主因"发作心悸伴恶心呕吐1 d"入院.患者1 d前用力搬重物后自觉心悸不适,持续数分钟不缓解,无胸痛及放射痛,伴乏力,意识淡漠,恶心,呕吐胃内容物2次后,意识丧失,脉搏不能测出,由同事呼叫120送至就近卫生院,途中随车医生判断为心脏骤停,行心肺复苏及电除颤1次,患者意识恢复,自诉心悸症状较前稍缓解.

Objective To analyze the effect of acupuncture and moxibustion therapy on related biochemical indexes of patients with acute coronary syndrome（ACS） after percutaneous coronary intervention（PCI）. Methods A total of 100 ACS patients after PCI admitted in our hospital from January to December 2020 were selected as the research objects and divided into control group and observation group according to different treatment regimens, with 50 cases in each group.The control group received conventional western medicine treatment, and the observation group received acupuncture and moxibustion therapy on the basis of the control group. The therapeutic effects of the two groups were compared. Results After treatment, the left ventricular end diastolic diameter（LVEDD）, left ventricular ejection fraction（LVEF）, cardiac output（CO） and cardiac index（CI） in the observation group were better than those in the control group（P＜0.05）. After treatment, the levels of total cholesterol（TC）, triglyceride（TG）, low-density lipoprotein cholesterol（LDL-C） and high-density lipoprotein cholesterol（HDL-C） in the observation group were better than those in the control group（P＜0.05）. After treatment, the thrombologram parameters in the observation group were better than those in the control group（P＜0.05）.After treatment, the levels of creatine kinase-MB（CK-MB）, cardiac troponin T（cTnT） and homocysteine（Hcy） in the observation group were lower than those in the control group（P＜0.05）. After treatment, the scores of each dimension of36-Item Short Form Health Survey（SF-36） of the observation group were higher than those of the control group（P＜0.05）.Conclusion Acupuncture and moxibustion therapy can effectively ameliorate the cardiac function, biochemical indexes and lipid indexes of ACS patients after PCI, and improve the quality of life.

基于"络风内动"探讨冠心病合并勃起功能障碍的病因病机及诊疗策略.从冠心病与勃起功能障碍的临床表现、中医病机、现代医学研究以及诊治策略4个方面阐述冠心病合并勃起功能障碍的"络风内动"病机,为临床治疗冠心病合并勃起功能障碍提供新思路.

Abstract Background Heart failure (HF) is a global public health problem with high morbidity and mortality. While machine learning (ML) has been perceived as a promising tool for HF research, a bibliometric analysis of this application is still lacking. This study aims to analyze the relevant papers from 2003 to 2023 and provide a comprehensive overview of this field in a visual way. Methods We systematically searched Web of Science Core Collection, PubMed, and preprint servers (arXiv, BioRxiv, and MedRxiv) to identify records from 2003 to 2023 on ML in HF research. After manual data cleansing, a Python approach based on the regular expression matching algorithm was used to automate text annotations, while three bibliometric analysis tools (CiteSpace, VOSviewer, and Bibliometrix) were used for the visualization of research trends, collaboration networks, and research hotspots. Results We analyzed 6,115 records (including 1,797 published papers) and observed a steady increase in annual publication rates since 2015, with a significant uptick after 2020. We identified 23 core journals in the field according to Bradford's law, and presented the top 10 journals with the highest citations, h-index, g-index, or m-index. The United States was the most productive country, followed by China and the United Kingdom. The most prolific institutions were Harvard Medical School and Mayo Clinic. Using text annotations, we identified 1,257 ML-related original HF research. In these studies, the main data modalities were ultrasound, electronic health records, and electrocardiograms. The most frequently applied ML methods were neural networks, followed by linear models and ensembles. The most common clinical goals were diagnosis, prediction, and classification. The main research topics included the classification of HF, AI-assisted medical diagnostic technologies, HF-related clinical prediction models, and HF-related bioinformatics research. Conclusions This bibliometric analysis revealed a significant growth in the application of ML in HF research over the past two decades. The current research landscape encompasses a wide range of ML techniques and applications, focusing on improving diagnosis, prognosis, classification, and precision treatment for HF patients.

目的 探讨紫杉醇/比伐卢定复合物(络风宁0号)对体外培养的人冠状动脉平滑肌细胞(HCASMC)和人冠状动脉内皮细胞(HCAEC)增殖的影响,为新一代中药单体复合药物涂层球囊(DCB)的研发提供依据.方法 将HCASMC和HCAEC体外培养并传代至4～6代,根据药物干预分为紫杉醇(1 μmol/L)组和紫杉醇/比伐卢定(PB)组,其中PB组所采用为1 μmol/L紫杉醇配伍不同浓度比伐卢定(1/256、1/128、1/64、1/32、1/16、1/8、1/4、1/2和1 mg/ml),48 h后用MTT法检测各组HCASMC和HCAEC细胞的增殖活力,以筛选出紫杉醇与比伐卢定之间的最佳配比,抑制HCASMC增殖的同时不影响甚至促进HCAEC增殖,为内皮友好型中药单体复合DCB的研发提供实验数据支持.结果 同紫杉醇组相比,PB组中紫杉醇配伍低浓度比伐卢定(1/256 mg/ml)即可增强紫杉醇对HCASMC增殖的抑制作用,该作用随比伐卢定浓度增高而增强,呈浓度依赖关系,差异有统计学意义(P＜0.05);紫杉醇配伍低浓度比伐卢定(1/256和1/128 mg/ml)时对HCAEC增殖无影响(P＞0.05),但比伐卢定浓度＞1/128 mg/ml时对HCAEC的抑制作用较紫杉醇组增强,呈浓度依赖关系,差异有统计学意义(P＜0.05).结论 1 μmol/L紫杉醇配伍1/128 mg/ml比伐卢定相较于单纯应用紫杉醇,体外培养的HCASMC相对增殖活性进一步下降至75%左右,同时HCAEC增殖活性不受影响,二者合用体现了中药配伍增效减毒的作用,可为新型内皮友好型中药单体复合DCB的研发提供思路和依据.

心力衰竭(heart failure,HF,心衰)是临床最常见的慢性心脏疾病之一,主要是由于多种原因导致的心脏的结构和(或)功能异常,导致收缩和(或)舒张功能障碍,泵血功能下降,全身器官组织灌注不足而导致的慢性疾病[1].阜外医院高润霖院士团队对于我国心力衰竭流行病学调查的最新结果显示,在我国年龄≥35岁居民中,加权的心衰患病率为1.3％,即约有1370万心衰患者,对于公共卫生事业带来极大的负担[2].目前心力衰竭的主要临床治疗包括改善症状的利尿剂和扩血管药物,改善预后的血管紧张素转换酶抑制剂/血管紧张素Ⅱ受体阻滞剂/血管紧张素受体脑啡肽酶抑制剂、β受体阻滞剂、醛固酮受体拮抗剂及SGLT-2抑制剂等,对于心衰具有良好的临床疗效,显著改善了患者的临床症状和预后[3].但由于患者的个体化差异、药物自身的局限性等原因,仍有部分患者存在胸闷、喘憋等症状,严重影响其生存质量.

目的:系统评价稳心颗粒联合常规西药治疗慢性心力衰竭合并室性心律失常的有效性和安全性.方法:计算机检索The Cochrane Library、PubMed、Embase、国家知识基础设施数据库(CNKI)、中国学术期刊数据库(CSPD)、中文科技期刊数据库(CCD)、SinoMed数据库,搜集稳心颗粒治疗慢性心力衰竭合并室性心律失常的相关随机对照试验(RCT),检索时限均从建库至2021年4月.由2名研究者独立筛选文献、提取资料和评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析.结果:共纳入19个RCT,包括1605例患者.Meta分析结果显示:在常规西药治疗基础上联用稳心颗粒,可显著提升临床疗效(RR=1.25,95％CI为1.19～1.32,P<0.00001)、提高左室射血分数(WMD=7.46,95％CI为6.91～8.00,P<0.0001)、减少24 h室性早搏总数(SMD=-2.05,95％CI为-3.73～-0.37,P=0.02)、降低静息心率(WMD=-7.97,95％CI为-10.51～-5.42,P<0.0001)、降低N端脑利尿钠肽前体水平(SMD=-1.29,95％CI为-1.66～-0.93,P<0.0001)、减小左室舒张末期内径(WMD=-3.31,95％CI为-5.15～-1.47,P=0.0004).2组患者不良反应发生率比较,观察组优于对照组,差异有统计学意义(RR=0.49,95％CI为0.34～0.71,P=0.0002).结论:稳心颗粒联合常规西药治疗慢性心力衰竭合并室性心律失常可提高临床疗效,且安全性较高.受纳入研究的数量和质量的限制,本研究结论尚需开展更多高质量研究予以证实.

Background: Depression is often present concurrently with coronary artery disease (CAD), a disease with which it shares many risk factors. However, the manner in which depression mediates and moderates the association between traits (including biomarkers, anthropometric indicators, lifestyle behaviors, etc.) and CAD is largely unknown.Methods: In our causal mediation analyses using two-step Mendelian randomization (MR), univariable MR was first used to investigate the causal effects of 108 traits on liability to depression and CAD. The traits with significant causal effects on both depression and CAD, but not causally modulated by depression, were selected for the second-step analyses. Multivariable MR was used to estimate the direct effects (independent of liability to depression) of these traits on CAD, and the indirect effects (mediated via liability to depression) were calculated. To investigate the moderating effect of depression on the association between 364 traits and CAD, a crosssectional phenome-wide interaction study (PheWIS) was conducted in a study population from UK Biobank (UKBB) (N=275,257). Additionally, if the relationship between traits and CAD was moderated by both phenotypic and genetically predicted depression at a suggestive level of significance (Pinteraction <= 0.05) in the PheWIS, the results were further verified by a cohort study using Cox proportional hazards regression. Results: Univariable MR indicated that 10 of 108 traits under investigation were significantly associated with both depression and CAD, which showed a similar direct effect compared to the total effect for most traits. However, the traits "drive faster than speed limit" and "past tobacco smoking" were both exceptions, with the proportions mediated by depression at 24.6% and 7.2%, respectively. In the moderation analyses, suggestive evidence of several traits was found for moderating effects of phenotypic depression or susceptibility to depression, as estimated by polygenic risk score, including chest pain when hurrying, reason of smoking quitting and weight change. Consistent results were observed in survival analyses and Cox regression.Conclusion: The independent role of traits in CAD pathogenesis regardless of depression was highlighted in our mediation analyses, and the moderating effects of depression observed in our study may be helpful for CAD risk stratification and optimized allocation of scarce medical resources.

目的 明确通络熄风汤改善糖尿病心肌损伤大鼠的治疗效果及机制.方法 本实验将大鼠分为正常组、模型组以及治疗组,利用STZ注射法将大鼠统一构建为糖尿病模型.治疗组予以中药配方颗粒通络熄风汤悬浮液灌胃治疗.采用Western blotting方法检测心肌细胞中P62、Mst1、Sirt3蛋白的含量,运用HE染色观察大鼠心肌组织结构变化,以评价通络熄风汤对糖尿病心肌损伤改善效果及机制.结果 与模型组相比,治疗组显著改善糖尿病大鼠的体重及血糖指标,差异有统计学意义(P＜0.01).同时与模型组相比,通络熄风汤治疗后大鼠心肌细胞的排列情况与坏死状态均有明显改善.与模型组相比,治疗组大鼠心肌组织中的Mst1、P62蛋白含量明显减少,Sirt3蛋白含量明显提高,差异均具有统计学意义(P＜0.01).结论 通络熄风汤可以对心肌组织细胞自噬水平进行调整,并保护心脏功能,上述机制通过Mst1通路发挥作用.

心房颤动(房颤)的有效治疗一直是房颤研究者的使命,近年来基于Marshall策略即Marshall韧带酒精注射消融联合肺静脉电隔离,对症状性、持续性房颤的治疗效果显著而倍受关注.本文就Marshall韧带包括Marshall束在内的解剖学、神经支配、电生理特征,以及在持续性房颤的联合消融治疗中的临床新进展进行综述.