ObjectivesThe inconsistent reporting of clinical trial results in patients with atrial fibrillation (AF) hinders the comparison of findings. Developing a core outcome set (COS) in studies evaluating traditional Chinese medicine (TCM) for AF and recommending measurement instruments and time points may help standardize the selection, reporting, and measurement of outcomes in clinical trials.MethodsLiterature and registered trials were retrieved to systematically collect outcomes. Physician questionnaire surveys and semi-structured patient interviews were conducted to collect outcomes of clinical interest. These outcomes were standardized and compiled into a preliminary outcome pool. Consensus criteria were established in advance. Through two rounds of Delphi surveys and consensus meetings, perspectives from multiple stakeholder groups were gathered to establish a COS for TCM for AF (COS-TCM-AF).ResultsA total of 87 individuals participated in the Delphi survey, with 70 completing both rounds. During the consensus meeting, 19 stakeholders determined that seven core outcomes should be involved in the COS-TCM-AF, including AF episode frequency, AF episode duration, AF burden, TCM symptom-palpitation, thromboembolic (TE) event rate, AF recurrence rate, and incidence of acute heart failure (HF)/acute exacerbation of chronic HF. Among these, AF episode frequency and AF episode duration applied only to patients with paroxysmal AF.ConclusionThis COS comprehensively addresses multiple aspects including AF episodes, patient symptoms, complication risks and long-term prognosis. It also recommends measurement instruments and time points. Its implementation will contribute to facilitating the comparison of similar studies and provide a reference for selecting and measuring outcomes.

OBJECTIVE:To confirm the efficacy of Yiqi Huoxue formula (, YQHX) on heart failure with reduced ejection fraction (HFrEF), and elucidate its potential effect on calcium homeostasis. METHODS:Cardiac specific calcium/calmodulin-dependent protein kinase II delta C isoform (CaMKⅡδC)-overexpression transgenic mice (C-CaMKⅡδC+/- Tg mice) and calcium/calmodulin-dependent protein kinase II delta B isoform (CaMKⅡδB)-overexpression transgenic mice (C-CaMKⅡδB+/- Tg mice) were established by clustered regularly interspaced short palindromic repeats (CRISPR)/CRISPR-associated protein 9 technique, and their genotypes and phenotypes were identified thereafter. C57BL/6 mice and transgenic mice were divided into seven groups in random, each containing eight mice. The groups were Control group, CaMKⅡδB model group, CaMKⅡδB treatment group (B Treated), CaMKⅡδB inhibitor group (B Inhibitor), CaMKⅡδC model group (C Model), CaMKⅡδC treatment group (C Treated), CaMKⅡδC inhibitor group (C Inhibitor). B and C Treated groups were given YQHX once a day for 4 weeks by gavage. The cardiac function and structure were evaluated using echocardiogram. The myocardial cellular status and fibrosis were detected by hematoxylin and eosin staining and Masson staining. Calcium transients and calcium leakage from cardiac ventricular myocytes were detected to reflect calcium homeostasis, and the expressions of CaMKⅡδB, CaMKⅡδC, hypertrophy factors, calcium pathway-related genes, and the level of calcium handling proteins were assessed by western blotting and reverse transcription-quantitative polymerase chain reaction. RESULTS:We found CaMKⅡδB and CaMKⅡδC transgenic mice showed HFrEF phenotype. YQHX improved the systolic function of the CaMKⅡδB transgenic mice, reduced the cross-sectional area of cardiomyocytes, inhibited the overexpression of CaMKⅡδB and hypertrophy-related genes (B-type natriuretic peptide, myocyte enhancer factor 2, and atrial natriuretic factor), and increased calcium handling protein sarcoendoplasmic reticulum Ca2+ adenosine triphosphatase 2a (SERCA2a) and calcium capacity. YQHX improved the cardiac systolic function of CaMKⅡδC transgenic mice, reduced the ventricular diameter and cardiomyocyte cross-sectional area, alleviated myocardial fibrosis, increased SERCA2a expression and calcium capacity, and reduced calcium leakage. CONCLUSION:Our results suggest that YQHX improved HFrEF by inhibiting CaMKIIδB overexpression, which may be related to reduced expression of hypertrophy-related factors, and increased SERCA2a expression to increase calcium reserve. In addition, YQHX improved HFrEF by inhibiting CaMKIIδC overexpression, which may be related to reduce calcium leakage, and increase SERCA2a expression to increase calcium reserve.

Three novel flavonoid derivatives, named dalberavonoids A-C (1-3), were isolated from the roots of Dalbergia odorifera T. C. Chen. The structures of these flavonoid derivatives were determined by comprehensive spectroscopic analyses. Compounds 1 and 2 represent rare examples of isopentenyl-substituted flavanes from the genus Dalbergia. Compound 3 is a rare flavonoid containing 16 carbon atoms on the carbon skeleton. The inhibitory activities of dalberavonoids A-C against the nitric oxide (NO) production induced by lipopolysaccharide in mouse macrophage RAW 264.7 cells in vitro were evaluated. Compounds 1 and 2 exhibited significant inhibitory activities, possessing the minimum inhibitory concentration (IC50) values of 9.13 ± 0.11 and 12.58 ± 0.14 µM. The positive control, indometacin, displayed an inhibitory activity against NO production with an IC50 value of 23.86 ± 0.08 µM.

BACKGROUND:One of the goals of nursing education is to facilitate the transition of nursing students to nursing positions on graduation, and career locus of control can assess nursing students' expectations and beliefs about their future careers, while 'critical thinking skill' is listed by the International Organization for Medical Education as one of the most essential core competencies for medical graduates. OBJECTIVE:To investigate the distribution of career locus of control among nursing students before and after the COVID-19 epidemic, to explore the association between career locus of control and critical thinking and to analyse the pathways of influence of critical thinking on career locus of control among nursing students. DESIGN AND METHOD:In this study, a total of 456 current undergraduate nursing students were selected online from Chengdu University in China in December 2022 and March 2024, respectively. A career locus of control scale and a critical thinking disposition inventory-Chinese version were used. PATIENT OR PUBLIC INVOLVEMENT:This study was approved by the Department of Social Science and the School of Medicine of Chengdu University. The researchers explained the purpose of the study to the subjects, so as to obtain their voluntary participation, ensure anonymity and confidentiality, and require each subject to read the informed consent form carefully and have the right to refuse to participate. Two surveys were conducted separately in December 2022 (during the COVID-19 pandemic) and March 2024 (during the normal control period of the epidemic) among 227 and 229 undergraduate nursing students, yielding a full response rate of 100%. RESULT:There was a correlation between career locus of control and critical thinking, among which career internal control was positively correlated with the score of critical thinking, and low professional efficacy and career opportunities were negatively correlated with the score of critical thinking. Analyticity and inquisitiveness could be used to predict the scores of career internal control, and open-mindedness could be used to predict the scores of critical thinking (β=-0.103). Confidence in reasoning (β=-0.055) could be used to predict the scores of career opportunity. Analyticity and truth-seeking could be used to predict the scores of career external control. The COVID-19 epidemic reduced the career opportunity score by 0.596 points. CONCLUSION:Nurse educators should recognise the importance of critical thinking training for nursing students, which enables them to adjust their career locus of control by improving critical thinking and may influence professional expectations, improve self-image within the nursing profession and increase retention of nurses.

Background:Commercial Chinese polyherbal preparations (CCPPs) are widely used in China to treat coronary microvascular dysfunction (CMD). However, the discussion on the best CCPPs continues. This network meta-analysis (NMA) aimed to evaluate and rank the relative efficacy of CCPPs for CMD and summarize the possible mechanisms according to experimental researches. Method:From the time the database was established to 12 December 2024, We systematically searched eight databases and two registry systems, including Web of Science, Cochrane Library, PubMed, Embase, China National Knowledge Infrastructure (CNKI), Wanfang database, China Science and Technology Journal Database (VIP), Chinese Biomedical Literature database (CBM), Clinical Trials, and the China Clinical Trials Registry. Clinical randomized controlled trials (RCTs) of nine CCPPs in treating CMD, including Shexiangbaoxin Pill (SXBX), Tongxinluo Capsule (TXL), Shexiangtongxindi Pill (SXTXD), Yindanxinnaotong Capsule (YDXNT), Kedalin Tablet (KDL), Xinbao Pill (XB), Xinkeshu Tablet (XKS), Diaoxinxuekang Capsule (DAXXK), and Yixintongluo Capsule (YXTL), were retrieved. The primary outcomes were the Index of Microcirculatory Resistance (IMR) and Coronary Flow Reserve (CFR). Secondary outcomes included the Angina attack frequency, hypersensitive C-reactive protein (hs-CRP), Endothelin-1 (ET-1), Nitric oxide (NO), and Low-density lipoprotein cholesterol (LDL-C). Two researchers performed rigorous data extraction and quality assessment. The quality of the included RCTs was evaluated using the Cochrane Risk of Bias assessment tool, version 2.0 (RoB 2). We then conducted the NMA using a random-effects model under the frequentist framework with Stata version 15. Interventions were ranked based on the surface under the cumulative ranking curve (SUCRA) probability values. The risk of bias was detected using funnel plots and Egger's test. Result:A total of 39 RCTs involving 3,240 patients were included in this study. NMA results showed that SXBX had the highest probability of being the best treatment on account of the reduction of IMR [MD = -5.93, 95% CI (-8.75, -3.11)] and LDL-C [[MD = -0.56, 95% CI (-0.99, -0.14)], XB showed better efficacy in improving CFR [MD = 0.71, 95% CI (0.53, 0.89)], TXL showed better efficacy in angina attack frequency [MD = -5.30, 95% CI (-7.08, -3.53)]; YXTL showed better efficacy in hs-CRP [MD = -5.04, 95% CI (-8.38, -1.7)]; XKS showed better efficacy in ET-1 [MD = -43.3, 95% CI (-59.71, -26.89)]; YDXNT showed better efficacy in NO [MD = 17.69, 95% CI (6.07, 29.32)]. In addition, the protective effect of CCPP on CMD may be achieved by altering multiple signalling pathways through anti-atherosclerosis, anti-vascular smooth muscle cell proliferation and migration, anti-inflammation, antioxidant stress, protection of vascular endothelium, improving energy metabolism, antiplatelet activation and aggregation, and promoting angiogenesis. Conclusion:CCPPs combined with conventional therapy led to a significant improvement in CFR and NO, as well as a reduction in IMR, angina attack frequency, hs-CRP, ET-1, and LDL-C levels. SXBX emerged as the optimal treatment regimen for lowering IMR and LDL-C levels. Additionally, XB demonstrated superiority in improving CFR. TXL demonstrated superiority in reducing angina attack frequency, YXTL in lowering hs-CRP levels, XKS in lowering ET-1 levels, and YDXNT in increasing NO levels. Nevertheless, the majority of the evidence was rated as low certainty according to the GRADE assessment. Conclusion should be framed as hypothesis-generating rather than definitive, and there is a need for large-scale, multicenter, and direct comparative RCTs of CCPPs treated for CMD to generate higher-quality evidence. Systematic review registration:https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42025632143.

OBJECTIVE:Heart failure (HF) remains a significant health burden around the world, and Baduanjin is an effective intervention for patients with HF. This study aimed to objectively evaluate the effects of Baduanjin on exercise tolerance, cardiac function, and quality of life in patients with HF. METHOD:From the time the database was constructed to May 8, 2025, we searched eight databases and two registry systems. Clinical randomized controlled trials (RCTs) of Baduanjin in treating HF were retrieved. The primary outcomes were the 6-minute walk test (6MWT) and left ventricular ejection fraction (LVEF). Secondary outcomes were left ventricular end-diastolic dimension (LVDD), left ventricular end-systolic dimension (LVSD), N-Terminal Pro-Brain Natriuretic Peptide (NT-proBNP), BNP levels, Minnesota Living with Heart Failure Questionnaire (MLHFQ), Anaerobic threshold (AT), Metabolic equivalent of task (MET), peak oxygen consumption (VO2 peak), and Maximal oxygen consumption (VO2 max). Two researchers performed rigorous data extraction and quality assessment. The quality of the included RCTs was evaluated using the Cochrane Risk of Bias assessment tool, version 2.0 (RoB 2), and statistical analyses were performed using RevMan 5.4 and Stata 17.0 software. RESULT:A total of 46 RCTs involving 3597 people were included in this study. Meta-analysis showed that Baduanjin could improve the 6MWT [ MD= 50.71, 95 % CI (37.48, 63.94), P < 0.01], LVEF [ MD= 3.57, 95 % CI (2.70, 4.45), P < 0.01], LVDD [ MD = -2.33, 95 % CI (-2.82, -1.84), P < 0.01], LVSD [ MD = -1.83, 95 % CI (-2.31, -1.36), P < 0.01], NT-proBNP levels [ MD = -139.49, 95 % CI (-204.08, -74.89), P < 0.01], BNP levels [ MD = -77.68, 95 % CI (-110.80, -44.56), P < 0.01], MLHFQ [ MD = -8.15, 95 % CI (-12.31, -3.99), P < 0.01], MLHFQ-E [ MD = -3.23, 95 % CI (-3.71, -2.74), P < 0.01], MLHFQ-P [ MD = -3.23, 95 % CI (-4.17, -3.29), P < 0.01], MLHFQ-G [ MD = -3.56, 95 % CI (-4.76, -2.35), P < 0.01], AT [ MD= 1.65, 95 % CI (1.22, 2.09), P < 0.01], MET [ MD= 0.65, 95 % CI (0.12, 1.19), P ＜0.05], VO2 peak [ MD= 1.36, 95 % CI (0.40, 2.31), P ＜0.01], and VO2 max [ MD= 2.21, 95 % CI (1.05, 3.37), P < 0.01] when compared to control groups, and the subgroup analyses showed that the efficacy of 3 months of continuous intervention with Baduanjin was the best. CONCLUSION:Our study is the first comprehensive meta-analysis to evaluate the treatment of HF with Baduanjin. The results suggest that Baduanjin improves exercise tolerance, cardiac function, and quality of life in patients with HF.

OBJECTIVE:To evaluate the effect of Yiqi Liangxue Shengji prescription (, YQLXSJ) on cardiac function and outcomes in acute myocardial infarction (AMI) patients with myocardial ischemia-reperfusion injury (MIRI) and to determine its clinical efficacy. METHODS:This prospective, randomized, double-blind, placebo-controlled trial enrolled hospitalized patients with AMI who underwent percutaneous coronary intervention and experienced MIRI either intraoperatively or postoperatively. Participants were randomly allocated to the treatment group, which received YQLXSJ, or the control group, which received a placebo, concurrent with standard Western Medicine therapy. The intervention period lasted 8 weeks. The primary outcome measure was left ventricular ejection fraction (LVEF), determined by echocardiography. Secondary outcomes included N-terminal pro brain natriuretic peptide (NT-proBNP) and cardiac troponin I (cTnI) levels, left ventricular internal diameter, major adverse cardiovascular events (MACE), angina pectoris scores, and Chinese medicine evidence scores. RESULTS:Following 8 weeks of intervention, the treatment group demonstrated a significant increase in LVEF and a marked reduction in NT-proBNP when compared to the control group. There was also a significant decrease in peak cTnI levels, Chinese medicine evidence scores, and angina pectoris scores. The control group's left ventricular end-systolic diameter (LVESD) significantly increased compared to baseline after 8 weeks (P < 0.05), whereas the treatment group's LVESD showed no significant change from baseline (P > 0.05). Although the treatment group showed a downward trend in MACE incidence compared to the control group, this difference was not statistically significant (P > 0.05). CONCLUSIONS:This study demonstrated that the addition of YQLXSJ to standard therapy can improve cardiac function and alleviate clinical symptoms in AMI patients with MIRI, and also showed a potential to mitigate the incidence of MACE. Furthermore, YQLXSJ displayed a favorable safety profile in clinical application.

BackgroundCompartment syndrome is an uncommon but life-threatening condition. No study has comprehensively compared compartment syndrome (CS) association with available drugs. The objective of this study was to estimate the association between CS and drugs using the FDA Adverse Event Report System (FAERS).Research design and methodsFAERS reports from the first quarter of 2004 to the third quarter of 2023 were analyzed. The Medical Dictionary for Regulatory Activities (MedDRA) was used to identify CS cases. Reporting odds ratio (ROR), corresponding to 95% confidence intervals (95% CI) were calculated to detect a positive signal.ResultsA total of 2197 reports were considered in the study after the inclusion criteria were applied. Totally 100 drugs were found to be associated with CS. The median time for drug-associated CS was 45 days.ConclusionsBy analyzing the FAERS database, the study revealed that certain drugs are significantly associated with compartment syndrome. Further studies are needed to verify whether these drugs are associated with such a risk.

Objective: This study utilized network meta-analysis (NMA) to compare the efficacy of five commonly used traditional Chinese medicine monomers in reducing intimal hyperproliferation in arterial balloon injury models. Methods: Relevant literature up to January 2024 was systematically retrieved from seven major databases. The intima-to-media (I/M) ratio was chosen as the primary outcome measure. The risk of bias in animal studies was assessed using the SYstematic Review Centre for Laboratory Animal Experimentation (SYRCLE) tool. Statistical analysis was conducted using Stata 17 software. Results: A total of 43 studies were included in this meta-analysis. NMA results showed that in the rat model, compared to the control group, GS (SMD: 0.99, 95%CI: 1.25 to -0.73), ASIV (SMD: 1.16, 95%CI: 1.65 to -0.67), TMP (SMD: 0.68, 95%CI: 1.31 to -0.05), and TPNS (SMD: 1.36, 95%CI: 1.91 to -0.80) exhibited inhibitory effects on postoperative intimal hyperproliferation, reducing the I/M ratio. In the rabbit model, compared to the control group, TPNS (SMD: 1.23, 95%CI: 1.97 to -0.49) inhibited postoperative intimal hyperproliferation and reduced the I/M ratio. Superiority ranking analysis suggested that total Panax notoginseng saponin (TPNS) might be the most effective traditional Chinese medicine monomer in reducing intimal hyperproliferation in arterial balloon injury models, lowering the I/M ratio. Conclusion: NMA indicates that traditional Chinese medicine monomers can effectively reduce postoperative intimal hyperproliferation in arterial balloon injury models, lowering the I/M ratio, with TPNS showing optimal efficacy. However, the research on TIIA is insufficient, and the limited sample size may affect the robustness of the results. Furthermore, the majority of research on traditional Chinese medicine monomers is currently limited to the experimental stage, lacking further clinical validation. Conducting standardized animal experiments and reporting their findings can enhance the quality of evidence from animal studies, laying the foundation for future clinical trials.

Glucagon-like peptide-1 receptor (GLP1R) agonists have been shown to reduce major cardiovascular events in diabetic patients, but their role in heart failure (HF) remains controversial. Recent evidence implies their potential benefits on cardiometabolism such as lipid metabolism, which may contribute to lowering the risk of HF. Consequently, we designed a Mendelian randomization (MR) study to investigate the causal relationships of circulating lipids mediating GLP1R agonists in HF. The available cis-eQTLs for GLP1R target gene were selected as instrumental variables (IVs) of GLP1R agonism. Positive control analyses of type 2 diabetes mellitus (T2DM) and body mass index (BMI) were conducted to validate the enrolled IVs. Two-sample MR was performed to evaluate the associations between GLP1R agonism and HF as well as left ventricular ejection fraction (LVEF). Summary data for HF and LVEF were obtained from two genome-wide association studies (GWASs), which included 977,323 and 40,000 individuals of European ancestry, respectively. The primary method employed was the random-effects inverse variance weighted, with several other methods used for sensitivity analyses, including MR-Egger, MR PRESSO, and weighted median. Additionally, multivariable MR and mediation MR were applied to identify potentially causal lipid as mediator. A total of 18 independent IVs were included. The positive control analyses showed that GLP1R agonism significantly reduced the risk of T2DM (OR = 0.79, 95

Abstract Context Yiqi Liangxue Shengji prescription (YQLXSJ) is a traditional Chinese medicine (TCM) formula that has long been used for treatment after percutaneous coronary intervention (PCI). Objective To investigate the putative pharmacological mechanism of YQLXSJ on restenosis through an integrated approach utilizing metabolomics and network pharmacology. Materials and methods Forty male Sprague–Dawley rats were divided into sham, model, YQLXSJ, and positive groups. YQLXSJ group received the treatment of YQLXSJ (6 g/kg/d, i.g.) and the positive group was treated with atorvastatin (2 mg/kg/d, i.g.). After 4 weeks, the improvement in intimal hyperplasia was evaluated by ultrasound, H&E staining, and immunofluorescence. UPLC–MS/MS technology was utilized to screen the differential metabolites. Network pharmacology was conducted using TCMSP, GeneCards, and Metascape, etc., in combination with metabolomics. Eventually, the core targets were acquired and validated. Results Compared to models, YQLXSJ exhibited decreased intima-media thickness on ultrasound (0.23 ± 0.02 mm vs. 0.20 ± 0.01 mm, p < 0.01) and reduced intima thickness by H&E (30.12 ± 6.05 μm vs. 14.32 ± 1.37 μm, p < 0.01). We identified 18 differential metabolites and 5 core targets such as inducible nitric oxide synthase (NOS2), endothelial nitric oxide synthase (NOS3), vascular endothelial growth factor-A (VEGFA), ornithine decarboxylase-1 (ODC1) and group IIA secretory phospholipase A2 (PLA2G2A). These targets were further confirmed by molecular docking and ELISA. Discussion and conclusions This study confirms the effects of YQLXSJ on restenosis and reveals some biomarkers. TCM has great potential in the prevention and treatment of restenosis by improving metabolic disorders.

目的:观察芪参桃红颗粒对压力负荷心力衰竭模型小鼠不同时期胸主动脉缩窄(Transverse Aortic Constriction,TAC)术后2周、4周心肌重构的干预作用及对自噬和相关微RNA(miRNA)的影响.方法:将90只C57小鼠随机分为:模型组(M组)、芪参桃红颗粒组(后简称QSTH,T组)、QSTH+雷帕霉素组(TR组)、QSTH+3-甲基腺嘌吟组(T3M组)、依那普利组(E组),假手术组(S组).于术后2周、4周,监测心功能,行苏木精-伊红(HE)染色、Masson染色、凋亡检测并定量分析,于透射电镜下观察左室组织自噬体形成情况,并对S组、M组、T组左室组织行miRNA测序并验证.结果:术后2周时,T组在提高左心射血分数方面优于其他组(P＜0.05),术后4周时,T组、E组在提高左室心射血分数方面优于其他组;除S组,其他组可见不同程度心脏几何形状变形、心肌肥厚.T组和E组相比较其他组,心肌纤维凋亡百分比更低(P＜0.05).除S组,其他组可见自噬滤泡、自噬体及自噬溶酶体,肌纤维细胞排列紊乱.M组相较于S组,测序结果提示新陈代谢通路、溶酶体通路与心肌自噬的联系非常密切并且其富集因子较高,具有显著的差异性;在T组较M组中,哺乳动物雷帕霉素靶蛋白(mTOR)、溶酶体通路富集明显,与自噬密切相关.结论:QSTH有效改善由压力负荷导致的心力衰竭小鼠的心功能及其心肌重构,其作用机制可能是基于miRNA调节自噬通量以产生相应的保护作用.

[目的]分析中医药治疗微血管性心绞痛的研究现状、热点及趋势.[方法]分别检索中国知网、维普、万方、中国生物医学文献服务系统 4 个数据库的文献,检索时间跨度为建库至 2023 年 5 月 31 日,将检索的文献导入到NoteExpress进行除重后,阅读文题与摘要,必要全文阅读进行筛选,最后使用CiteSpace对纳入文献的作者、机构、关键词进行可视化分析.[结果]共计纳入 301 篇文献,年发文量呈上升趋势;作者合作图谱共纳入 823 名作者,其中核心作者 32 名,发文 138 篇,占总发文量 45.8%,未形成显著的核心作者群,以毛静远、王贤良、王恒和、葛永彬、张运、王强为核心成员的研究团队是该领域的主要研究团队,发文量前 3 位的作者分别为毛静远 14 篇、王贤良 9 篇、王恒和 7 篇;机构合作图谱中共纳入 271 家机构,主要研究机构为中医院校及中医医院,机构间有一定的合作,西医机构相对较少,发文量前 3 的机构分别为天津中医药大学第一附属医院 23 篇、天津中医药大学 19篇、黑龙江中医药大学9篇;关键词共现图谱中共纳入 405 个关键词,词频≥5次的关键词有 35个,高中心性的关键词 8 个,形成 13 个聚类及 20 个突现词.[结论]目前中医药治疗微血管性心绞痛不断发展,研究热点主要集中在微血管性心绞痛的诊断、中医证型及治法、临床疗效观察、基础机制的研究、Meta分析以及网络药理学等研究方法等方面,同时中西医结合研究也受到了学者们的重视,建议未来各机构间加强合作、开展多中心、高质量的临床研究,在基础研究方面取得突破性进展,充分发挥中医药治疗微血管性心绞痛的优势.

目的:系统评价破格救心汤加减联合常规西药治疗心力衰竭的有效性及安全性.方法:检索中国知网(CNKI)、万方医学数据库、维普中文科技期刊数据库(VIP)、中国生物医学文献数据库(CBM)、PubMed、EMbase、the Cochrane Library 7个数据库,检索时限为建库至2021年12月1日.纳入破格救心汤加减治疗心力衰竭的临床随机对照试验(RCT),采用Cochrane系统评价的方法对所纳入的文献进行质量评价,借助Review Manager 5.4及Stata SE 16软件进行Meta分析.结果:最终纳入10项RCT,涉及病人884例.Meta分析结果显示,与对照组(常规西药)比较,试验组(破格救心汤加减联合常规西药)左室射血分数增加[MD=6.16,95％CI(5.41,6.92),P<0.00001],左室舒张末期内径减小[MD=-4.04,95％CI(-5.90,-2.18),P<0.0001],N末端脑钠肽前体(NT-proBNP)水平降低[MD=-1232.13,95％CI(-1391.21,-1073.05),P<0.00001],脑钠肽(BNP)水平降低[SMD=-0.71,95％CI(-1.06,-0.36),P<0.00001],6 min步行距离增加[MD=77.17,95％CI(25.96,128.38),P=0.003],临床总有效率提高[RR=1.28,95％CI(1.17,1.39),P<0.00001],且药物不良反应较少,安全性良好.结论:现有证据表明,破格救心汤加减联合常规西药治疗心力衰竭的疗效优于常规西药,且不良反应少;鉴于纳入文献研究质量不高,仍需更多高质量的RCT进一步验证本结论.

目的 观察益气凉血生肌方对经皮冠状动脉介入治疗(PCI)术后患者8周内心绞痛复发和生活质量的影响.方法 纳入行PCI术的冠心病气虚血瘀兼瘀热互结证患者82例,随机分为治疗组及对照组各41例.治疗组在PCI术后西医常规治疗的基础上加用益气凉血生肌方颗粒口服,对照组在PCI术后西医常规治疗的基础上加用安慰剂颗粒口服,两组均每日1剂,疗程为8周.记录PCI术后8周内患者心绞痛复发率及再入院率,并于治疗前后记录患者中医证候总积分、西雅图心绞痛量表(SAQ)评分(包括躯体活动受限程度、心绞痛稳定状态、心绞痛发作情况、治疗满意程度及疾病认识程度5项)、健康调查简表(SF-36)评分(包括躯体健康评价评分、精神健康评价评分);观察并记录两组患者服药期间不良反应情况.结果 PCI术后8周内,治疗组心绞痛复发率为9.76％(4/41),低于对照组的26.83％(11/41,P＜0.05).治疗组心绞痛再入院率为2.44％(1/41),对照组为12.20％(5/41),两组比较差异无统计学意义(P＞0.05).与本组治疗前比较,两组治疗后中医证候总积分均明显降低,两组术后生活质量方面,SAQ中心绞痛稳定状态、心绞痛发作情况、疾病认识程度评分均提高,SF-36总分及躯体健康评价评分、精神健康评价评分均提高(P＜0.05或P＜0.01).治疗后两组间比较,治疗组中医证候积分较对照组明显降低(P＜0.01),SAQ各项评分及SF-36总分及躯体健康评价评分、精神健康评价评分两组间比较差异无统计学意义(P＞0.05).治疗期间两组均未出现不良反应.结论 益气凉血生肌方可减少冠心病PCI术后气虚血瘀兼瘀热互结证患者8周内心绞痛的复发率,改善中医证候,且服药后安全性较好,但在改善术后短期内生活质量方面与安慰剂疗效相当.

目的 探讨益气凉血生肌方促进损伤血管内皮细胞修复可能的机制.方法 取50只SD大鼠制备空白血清、益气凉血生肌方含药血清、阿托伐他汀含药血清、益气凉血生肌方+阿托伐他汀含药血清,对人脐静脉内皮细胞(HUVECs)进行缺氧/复氧(H/R)造模.实验分为对照组(HUVECs加空白血清培养)、模型组(H/R损伤HUVECs加空白血清培养)、生肌方组(H/R损伤HUVECs加益气凉血生肌方含药血清培养)、阿托伐他汀组(H/R损伤HUVECs加阿托伐他汀含药血清培养)、生肌方+阿托伐他汀组(H/R损伤HUVECs加益气凉血生肌方+阿托伐他汀含药血清培养).采用CCK-8法检测细胞增殖率,荧光探针法检测活性氧自由基(ROS)活性,比色法检测丙二醛(MDA)含量,WST-1法检测超氧化物歧化酶(SOD)含量,质谱法检测三磷酸腺苷(ATP)、一磷酸腺苷(AMP)含量(计算ATP/AMP),Western blot法检测AMP依赖性蛋白激酶(AMPK)、雷帕霉素靶蛋白(mTOR)、p70核糖体蛋白S6激酶(p70S6K)、4E结合蛋白1(4E-BP1)蛋白及磷酸化水平.结果 各含药血清组H/R损伤细胞增殖活性均明显高于模型组(P均<0.05),且生肌方+阿托伐他汀组明显高于生肌方组和阿托伐他汀组(P均<0.05).各含药血清组ROS活性、MDA含量均明显低于模型组(P均<0.05),且生肌方+阿托伐他汀组ROS活性明显低于生肌方组(P<0.05);各含药血清组SOD含量和生肌方组、生肌方+阿托伐他汀组ATP/AMP比值均明显高于模型组(P均<0.05),且生肌方+阿托伐他汀组ATP/AMP比值明显高于阿托伐他汀组(P<0.05).生肌方组、生肌方+阿托伐他汀组p-AMPK/AMPK明显低于模型组(P均<0.05),且生肌方+阿托伐他汀组明显低于阿托伐他汀组(P<0.05);各含药血清组p-mTOR/mTOR、p-p70 S6 K/p70 S6 K、p-4 E-BP1/4 E-BP1均明显高于模型组(P均<0.05),生肌方+阿托伐他汀组p-mTOR/mTOR、p-p70 S6 K/p70 S6 K均明显高于阿托伐他汀组(P均<0.05).结论 益气凉血生肌方可促进H/R损伤血管内皮细胞修复,其作用可能是通过改善H/R损伤内皮细胞能量代谢、减轻氧化应激、抑制AMPK激活,调节哺乳动物雷帕霉素靶蛋白复合物1(mTORC1)信号通路来实现的.

Acute coronary syndrome (ACS) is one of the leading causes of death in cardiovascular disease. Percutaneous coronary intervention (PCI) is an important method for the treatment of coronary heart disease (CHD), and it has greatly reduced the mortality of ACS patients since its application. However, a series of new problems may occur after PCI, such as in-stent restenosis, no-reflow phenomenon, in-stent neoatherosclerosis, late stent thrombosis, myocardial ischemia-reperfusion injury, and malignant ventricular arrhythmias, which result in the occurrence of major adverse cardiac events (MACE) that seriously reduce the postoperative benefit for patients. The inflammatory response is a key mechanism of MACE after PCI. Therefore, examining effective anti-inflammatory therapies after PCI in patients with ACS is a current research focus to reduce the incidence of MACE. The pharmacological mechanism and clinical efficacy of routine Western medicine treatment for the anti-inflammatory treatment of CHD have been verified. Many Chinese medicine (CM) preparations have been widely used in the treatment of CHD. Basic and clinical studies showed that effectiveness of the combination of CM and Western medicine treatments in reducing incidence of MACE after PCI was better than Western medicine treatment alone. The current paper reviewed the potential mechanism of the inflammatory response and occurrence of MACE after PCI in patients with ACS and the research progress of combined Chinese and Western medicine treatments in reducing incidence of MACE. The results provide a theoretical basis for further research and clinical treatment.

病态窦房结综合征是由窦房结及其周围组织病变引起的疾病.郭维琴教授对于病态窦房结综合征的诊治有独到见解.郭教授认为本病基本病机是本虚标实,心脾肾阳气虚损为本,表现为迟脉;血瘀痰阻为标,表现为结促交替脉.治疗原则主要有益气帅血,扶正强心;温阳通脉,脏腑与经络并重;重视辨病,活血化瘀祛风;平衡药性,佐以养阴.研制出治疗病态窦房结综合征的基础方——复窦合剂,临床随症加减,疗效显著.

目的 研究不同比例益气活血药对舒张性心力衰竭(DHF)大鼠的疗效,探讨其对心肌细胞钙稳态的影响机制.方法 采用改良缩窄腹主动脉术制备压力负荷致DHF大鼠模型.将大鼠分为假手术组、模型组、益气组(黄芪3 g、党参1.5 g)、益气活血1:1组(黄芪3 g、党参1.5 g、丹参3g、三七1g)、益气活血2:1组(黄芪6g、党参3g、丹参3g、三七1g),每组20只,连续干预12周.治疗4、12周进行心功能检测,测量舒张期左室前壁厚度、舒张期左室后壁厚度、舒张期左室内径、左室射血分数和左室短轴缩短率及舒张早期跨二尖瓣血流速度(E)与舒张早期二尖瓣环运动幅度(e)比值(E/e);12周进行血流动力学检测,分别在静息状态和盐酸多巴胺负荷状态下记录左室压力下降速率、左室舒张末期压力(LVEDP)以评价左室舒张功能,记录左室压力上升速率,左室收缩压力(LVESP)以评价左室收缩功能,并记录心率及颈动脉压力;12周后处死大鼠,检测心肌细胞舒缩功能及钙转运情况,测量心肌细胞的收缩速率、舒张速率、收缩50％时间(CT50)和舒张50％时间(RT50);测定钙释放速率、钙回摄速率、钙释放50％时间(CaT50-on)和钙回摄50％时间(CaT50-off),分析钙瞬态数据;Western blot法检测钙转运相关蛋白钙/钙调蛋白依赖性蛋白激酶Ⅱ(CaMKⅡ)、蛋白激酶A(PKA)、16-丝氨酸位点磷酸化受磷蛋白(PLBS16)、17-苏氨酸位点磷酸化受磷蛋白(PLBT17)表达水平.结果 干预12周后,全部治疗组均改善大鼠舒缩功能LVEDP、RT50、CT50,益气活血2:1组改善舒张早期二尖瓣血流速度E峰/舒张早期二尖瓣环纵向运动速率e峰(E/e)比值、多巴胺负荷下LVEDP和逆转心室重构(降低左室前壁和后壁厚度).在细胞水平,全部治疗组均缩短心肌细胞CT50、RT50、CaT50-on和降低CaMKⅡ表达,两组益气活血治疗组还可降低PKA过表达,益气活血2:1组可降低CaT50-off和改善PLBS16低磷酸化.结论 益气和活血药物以2:1比例配伍比1:1配伍治疗DHF具有更好的疗效,其作用机制可能与调节钙转运有关.

目的 探究益气凉血生肌方对肿瘤坏死因子-α(TNF-α)诱导人脐动脉内皮细胞(HUAECs)炎症损伤的作用及机制.方法 实验分为4组:对照组HUAECs加入空白兔血清培养;模型组、抑制剂组、抑制剂+益气凉血生肌方组采用TNF-α诱导HUAECs炎症损伤,之后模型组加入空白兔血清培养,抑制剂组加入TAK-242阻断剂培养,抑制剂+益气凉血生肌方组加入TAK-242阻断剂+益气凉血生肌方含药血清培养.采用CCK-8法检测各组细胞增殖情况,细胞划痕实验观察各组细胞增殖和迁移情况,Western blot和Real time-PCR法检测各组细胞中核因子-κB(NF-κB)信号通路相关因子Toll样受体4(TLR4)、髓样分化因子88(MyD88)、NF-κB和炎症相关细胞间黏附分子-1(ICAM-1)蛋白及mRNA表达情况.结果 模型组细胞增殖吸光度值、细胞迁移率均明显低于对照组(P均<0.05),抑制剂组和抑制剂+益气凉血生肌方组细胞增殖吸光度值、细胞迁移率均明显高于模型组(P均<0.05).模型组TLR4、MyD88、NF-κB/p65、ICAM-1蛋白及mRNA表达量均明显高于对照组(P均<0.05),抑制剂组和抑制剂+益气凉血生肌方组TLR4、MyD88、NF-κB/p65、ICAM-1蛋白及mRNA表达量均明显低于模型组(P均<0.05),且抑制剂+益气凉血生肌方组MyD88、ICAM-1蛋白及mRNA表达量均明显低于抑制剂组(P均<0.05).结论 益气凉血生肌方可抑制TNF-α诱导的血管内皮细胞的炎症反应,其机制可能与抑制TLR4/NF-κB通路相关.