BACKGROUND:Nonrheumatic valvular heart disease is an increasing public health concern. This study assessed the burden and quality of care for nonrheumatic valvular heart disease in Asia and at the global level from 1990 to 2021, and projected trends to 2050 using data from the GBS (Global Burden of Disease Study) 2021. METHODS:Incidence, age-standardized incidence rate, deaths, age-standardized mortality rate, disability-adjusted life years, and age-standardized disability-adjusted life years rate were analyzed. A time-series model (autoregressive integrated moving average was used for forecasting future trends. A quality-of-care index was constructed through principal component analysis, and future quality-of-care index trends were projected using a Bayesian age-period-cohort model. RESULTS:From 1990 to 2021, both incident nonrheumatic valvular heart disease cases and age-standardized incidence rate increased globally and in Asia, whereas age-standardized mortality rate and age-standardized disability-adjusted life years rate declined. Projections suggest that incident cases will continue to rise through 2050, with age-standardized incidence rate decreasing globally but remaining relatively stable in Asia. Although Asia has lower age-standardized rates than the global average, its projected age-standardized incidence rate increase is greater. Disease burden varied by age and sex, with incidence peaking at 70 to 74 years. Mortality exceeded that of men among women after age 70 to 74. Nonrheumatic aortic valve disease contributed to the greatest burden. Quality-of-care index improved markedly from 1990 to 2021 globally and in Asia, but recent gains have slowed, suggesting a plateau in care improvement. CONCLUSIONS:Nonrheumatic valvular heart disease burden is rising, especially in aging Asian populations. Despite declining mortality and improved care quality, increasing incidence and slowing quality-of-care index gains may intensify future health system pressures.

Background:Hydroxysafflor yellow A (HSYA) possesses a variety of pharmacological activities which has been demonstrated to be effective against ischemic heart disease (IHD). This study aimed to comprehensively examine the efficacy and summarize the potential mechanisms of HSYA against IHD in animal models. Methods:We conducted electronic searches for preclinical studies on PubMed, Embase, Web of Science, Cochrane Library, CNKI, SinoMed, Wanfang, and Chinese VIP databases from inception to 31 January 2024. The CAMARADES checklist was chosen to assess the quality of evidence. STATA 14.0 software was utilized to analyze the data. The underlying mechanisms were categorized and summarized. Results:Twenty-eight studies involving 686 rodents were included and the mean score of methodology quality was 5.04 (range from 4 to 7). Meta-analysis observed that HSYA could decrease myocardial infarction size (SMD: -2.82, 95%CI: -3.56 to -2.08, p < 0.001) and reduce the levels of biomarkers of myocardial injury including cTnI (SMD: -3.82, 95%CI: -5.20 to -2.44, p < 0.001) and CK-MB (SMD: -2.74, 95%CI: -3.58 to -1.91, p < 0.001). HSYA displayed an improvement in cardiac function indicators including LVEF, LVSP, +dp/dt max and -dp/dt max. Furthermore, HSYA was able to reduce the levels of MDA, TNF-α and IL-6, while increasing SOD and NO levels. Mechanistically, the protective effect of HSYA in alleviating myocardial injury after ischemia may be associated with NLRP3 inflammasome, Bcl-2, Bax, caspase-3, eNOS proteins, and TLR/NF-κB, Nrf2/HO-1, JAK/STAT, PI3K/Akt, AMPK/mTOR, VEGFA pathways. Conclusion:This study demonstrates that HSYA exerts cardioprotective effects in decreasing infarct size, reducing myocardial enzymes and improving cardiac function, which may be mediated by anti-inflammatory, antioxidant, anti-apoptotic, regulation of autophagy, improvement of microcirculation and promotion of angiogenesis. However, the absence of safety assessment, lack of animal models of co-morbidities, and inconsistency between timing of administration and clinical practice are limitations of preclinical studies. Systematic Review Registration:clinicaltrials.gov, Identifier, CRD42023460790.

ETHNOPHARMACOLOGICAL RELEVANCE:Shenlian-Fumai Formula (SLFM) is a traditional Chinese medicine (TCM) prescription that originates from the classical formulas Gui Pi Tang and Huanglian Wendan Tang. It has been further developed within the TCM Qi-Blood theory for the management of palpitations and related cardiac symptoms. Clinical trials have evaluated SLFM in patients with ventricular arrhythmias (VAs) associated with heart failure (HF). AIM OF THE STUDY:To evaluate the cardioprotective and antiarrhythmic effects of SLFM in a mouse model of HF with VAs and to explore its underlying mechanisms with a focus on sodium channel regulation. MATERIALS AND METHODS:HF was induced in male C57BL/6 J mice by transverse aortic constriction (TAC). Mice were randomly divided into six groups: Control, HF model (Model), SLFM low-dose (SLFM-L, 4.66 g/kg/d), SLFM medium-dose (SLFM-M, 9.31 g/kg/d), SLFM high-dose (SLFM-H, 18.62 g/kg/d), and Mexiletine (0.32 g/kg/d) groups. Cardiac function was evaluated by echocardiography, serum BNP, heart and lung weight indices, and myocardial histology were also assessed. Electrocardiographic (ECG) parameters and VA occurrence were recorded at baseline and after isoproterenol injection. Patch-clamp was used to assess action potentials (APs) and sodium currents (INa) in isolated cardiomyocytes. The role of CaMKII was examined using KN93. qPCR detected expression levels of CaMKII and SCN5A. RESULTS:SLFM dose-dependently improved cardiac function, reduced BNP, alleviated myocardial fibrosis, and lowered VA incidence. It also restored action-potential duration (APD), increased INa density, and normalized channel kinetics. These effects were partially associated with modulation of CaMKII and SCN5A mRNA expression. CONCLUSION:SLFM exhibits antiarrhythmic and cardioprotective effects in HF by regulating sodium channel function and CaMKII signaling, highlighting its potential as a therapeutic option for HF-related VAs. However, all data were obtained from a single batch of SLFM, limiting generalizability and requiring validation with additional batches and harvest years.

BACKGROUND:With prevalence rising from 5 to 13% (60-70 years) to as high as 50% (>80 years), sarcopenia is associated with frailty, falls, and up to a 41% 3-year mortality in high-risk cohorts. Early recognition is hampered by variability in definitions and limited access to imaging in many regions. SUMMARY:Comprehensive Geriatric Assessment (CGA) offers an integrated framework - spanning physical, functional, cognitive, psychological, and social domains - to improve the screening, diagnosis, and longitudinal monitoring of sarcopenia in older adults. KEY MESSAGES:(1) CGA-guided care enables tailored interventions that combine protein-rich nutrition, progressive-resistance exercise and - in selected cases - emerging pharmacological agents. (2) Economic analyses indicate CGA can be cost-neutral or cost-saving when targeted to high-risk groups, but workforce requirements challenge its scalability outside well-resourced centers. (3) Evidence remains heterogeneous and drawn largely from urban, high-income settings; caution is required when generalizing outcomes to rural or low-resource environments. (4) Future research should standardize a muscle-specific CGA core set, test implementation in diverse health systems, and evaluate digital tools that reduce staff time without widening the digital divide.

Background: This study aimed to assess the efficacy and safety of Tongxinluo capsule (TXLC) in combination with conventional therapies for treating stable angina pectoris (SAP) through a comprehensive meta-analysis and systematic review.Methods: We conducted a systematic search of the China National Knowledge Infrastructure, Wanfang, VIP, PubMed, Embase, and CENTRAL databases for randomized controlled trials investigating the use of TXLC as adjuvant therapy for SAP published up to June 2023. The Cochrane Handbook was used to evaluate the risk of bias. Meta-analysis was performed using Review Manager 5.4.1, and publication bias was assessed using Begg test and Egger test in the Stata SE 12.0 software. GRADEpro was used to assess the quality of the evidence.Results: This meta-analysis included 26 randomized controlled trials with a total of 2352 patients. TXLC co-administration demonstrated significant reduction in angina attack frequency (mean difference (MD) -0.91, 95% confidence interval (CI) -0.97 to -0.84, P < .00001) and duration (MD -1.71, 95% CI -2.24 to -1.19, P < .00001), decreased use of nitroglycerin tablets (MD -6.28, 95% CI -7.16 to -5.41, P < .00001), lowered C-reactive protein (MD -1.19, 95% CI -1.35 to -1.03, P < .00001) and low-density lipoprotein cholesterol levels (MD -0.68, 95% CI -0.86 to -0.51, P < .00001). TXLC co-administration did not increase gastrointestinal reactions (RR 1.17, 95% CI 0.38 to 3.57, P = .78). The Begg test and Egger test results indicated no publication bias. The evidence quality was rated as very low for frequency of angina attack, duration of angina attack, and nitroglycerin usage, and low for C-reactive protein, low-density lipoprotein cholesterol levels, and gastrointestinal reaction events.Conclusion: This meta-analysis supports TXLC as a beneficial adjunct treatment for SAP.

Background: Guanxinning tablet (GXNT), a Chinese patent medicine, is composed of salvia miltiorrhiza bunge and ligusticum striatum DC, which may play the role of endothelial protection through many pathways. We aimed to explore the molecular mechanisms of GXNT against atherosclerosis (AS) through network pharmacology and molecular docking verification. Methods: The active ingredients and their potential targets of GXNT were obtained in traditional Chinese medicine systems pharmacology database and analysis platform and bioinformatics analysis tool for molecular mechanism of traditional Chinese medicine databases. DrugBank, TTD, DisGeNET, OMIM, and GeneCards databases were used to screen the targets of AS. The intersection targets gene ontology and Kyoto encyclopedia of genes and genomes enrichment analysis were performed in DAVID database. GXNT-AS protein-protein interaction network, ingredient-target network and herb-target-pathway network were constructed by Cytoscape. Finally, we used AutoDock for molecular docking. Results: We screened 65 active ingredients of GXNT and 70 GXNT-AS intersection targets. The key targets of protein-protein interaction network were AKT1, JUN, STAT3, TNF, TP53, IL6, EGFR, MAPK14, RELA, and CASP3. The Kyoto encyclopedia of genes and genomes pathway enrichment analysis showed that pathways in cancer, lipid and atherosclerosis, and PI3K-Akt signaling pathway were the main pathways. The ingredient-target network showed that the key ingredients were luteolin, tanshinone IIA, myricanone, dihydrotanshinlactone, dan-shexinkum d, 2-isopropyl-8-methylphenanthrene-3,4-dione, miltionone I, deoxyneocryptotanshinone, Isotanshinone II and 4-methylenemiltirone. The results of molecular docking showed that tanshinone IIA, dihydrotanshinlactone, dan-shexinkum d, 2-isopropyl-8-methylphenanthrene-3,4-dione, miltionone I, deoxyneocryptotanshinone, Isotanshinone II and 4-methylenemiltirone all had good binding interactions with AKT1, EGFR and MAPK14. Conclusion: The results of network pharmacology and molecular docking showed that the multiple ingredients within GXNT may confer protective effects on the vascular endothelium against AS through multitarget and multichannel mechanisms. AKT1, EGFR and MAPK14 were the core potential targets of GXNT against AS.

心血管疾病负担是影响人类生命健康的首要原因,作为重要典籍的《伤寒杂病论》中有许多对于心系疾病论治的相关条文及方药,对胸痹心痛、心悸、心力衰竭都有不同的论述及其常用方药.这些方药又进一步经过近 2000年的临床验证及现代中药药理学佐证,具有良好的临床指导价值.而在使用这些方药时,也应该建立在中医理论框架的基础之上.

目的 观察参连复脉颗粒对脂多糖(LPS)诱导的RAW264.7巨噬细胞极化的影响,探讨其干预心房颤动的可能相关机制.方法 使用LPS刺激RAW264.7巨噬细胞24 h构建巨噬细胞炎症模型.细胞分为正常对照组(空白血清)、模型组(LPS+空白血清)、中药组(LPS+参连复脉颗粒含药血清)、阿托伐他汀钙组(LPS+空白血清+阿托伐他汀钙).采用四甲基偶氮唑盐(MTT)法检测巨噬细胞活性及增殖能力;采用荧光染色双标法观察巨噬细胞的极化状态;采用蛋白质印迹法(Western Blot)检测巨噬细胞白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)蛋白表达水平.结果 与正常对照组比较,模型组细胞活力OD值升高(P<0.05),CD163+/CD68+比值降低(P<0.05),IL-6、TNF-α蛋白表达水平升高(P<0.05);与模型组比较,中药组和阿托伐他汀钙组细胞活力OD值降低(P<0.05),CD163+/CD68+比值升高(P<0.05),中药组IL-6、TNF-α蛋白表达水平降低(P<0.05);中药组细胞活力OD值、CD163+/CD68+比值、IL-6及TNF-α蛋白表达水平与阿托伐他汀钙组比较,差异均无统计学意义(P>0.05).结论 参连复脉颗粒含药血清可以抑制LPS诱导的巨噬细胞IL-6、TNF-α蛋白的分泌表达,抑制炎症反应,促进M1型巨噬细胞向M2型巨噬细胞转化.

目的 基于网络药理学探讨黄芪、丹参治疗冠状动脉痉挛的活性成分与分子机制.方法 通过中药系统药理学数据库与分析平台(TCMSP)筛选出黄芪、丹参有效成分及相关靶点,将结果导入CytoScape 3.8.2绘制药物-有效成分-靶点网络图,使用其内置Network Analyzer工具对节点的网络拓扑参数分析并筛选出主要有效成分;通过基因名片(GeneCards)数据库筛选冠状动脉痉挛相关靶点并于在线人类孟德尔遗传数据库(OMIM)、DRUGBANK数据库中检索相关靶点予以补充;通过在线工具构建Venn图并得到黄芪、丹参-冠状动脉痉挛交集靶点,将靶点导入STRING平台构建PPI网络,得到的网络模型通过CytoScape 3.8.2进一步处理得到最终网络模型,使用其内置Network Analyzer工具对节点的网络拓扑参数筛选出主要作用靶点;通过Metascape数据库对主要作用靶点进行基因本体(GO)和京都基因与基因组百科全书(KEGG)通路富集分析;使用AutoDock Vina对主要有效成分及核心靶点进行分子对接验证.结果 黄芪、丹参治疗冠状动脉痉挛的主要有效成分为槲皮素、山奈酚、木犀草素等;核心靶点为蛋白激酶B1(AKT1)、肿瘤抑制蛋白p53(TP53)、白细胞介素6(IL6)等;涉及的主要通路为晚期糖基化终末产物(AGE)-糖基化终末产物受体(RAGE)信号通路及流体剪切应力与动脉粥样硬化通路等.分子对接验证中平均对接亲和力为-32.604 kJ/mol.结论 黄芪、丹参治疗冠状动脉痉挛的作用机制具有多成分、多靶点、多通路的特点,为之后基础研究提供了方向.

冠状动脉慢血流(CSF)是一种有反复发作心绞痛症状,而冠状动脉造影显示冠状动脉无明显狭窄(狭窄程度≤40％),但冠状动脉远端血流充盈延迟的现象.西医目前尚无确切疗效的治疗措施,中医学改善CSF具有独特的优势.研究发现,麝香通心滴丸可通过改善冠脉微循环、调节内皮细胞功能、改善炎症细胞功能、减少白细胞黏附以及抗动脉粥样硬化,进而缩小心肌缺氧范围,增加冠状动脉血流量,改善CSF.此外麝香通心滴丸不同服药方式和服用剂量表现出不同的即刻效应和长期疗效.

从血瘀探讨冠心病合并抑郁的病机及治法.冠心病病人常因病程迁延不愈、长期服药、家庭经济压力、社会因素导致紧张、焦虑、抑郁等情志问题.血瘀是冠心病合并抑郁的重要病理基础,治疗应注重活血化瘀,冠心病病人中血瘀与抑郁的发生发展密切相关.目前临床以疏肝解郁治疗为主,但应考虑血瘀的因素.

Background: Acupuncture has been recommended as a nonpharmacological intervention for managing cancer-related symptoms. However, there are few bibliometric analysis-based studies concerning the overall trends and characteristics in acupuncture therapy for cancer management. This study aims to summarize the status and bibliometric characteristics of acupuncture as an intervention for cancer-related symptoms. Methods: All clinical research papers on acupuncture for the management of cancer-related symptoms published up to October 1, 2020 were collected from the PubMed and Web of Science databases. Data on the included studies were extracted to reflect the following items: publication year, journal, country or region, institution, clinical indications, and acupuncture prescriptions. Characteristics were analyzed using bibliometric methods. Results: A total of 226 papers were included. The number of such publications has increased steadily since 2004. The 226 articles were published in 94 English journals, with Integrative Cancer Therapies (18 articles) and Acupuncture in Medicine (14 articles) being the most prolific. The included studies are dis-tributed across 20 countries and regions, among which the top two are the United States of America (68 articles) and China (60 articles). The types of cancer the studies addressed include breast, gastric, head and neck, etc. Acupuncture is mainly employed in the treatment of complications and side effects, among which nausea and vomiting, pain, hot flashes, and fatigue are the most frequently treated cancer-related symptoms. Acupuncture is the most commonly used treatment therapy, and the four most frequently used acupoints used are Neiguan ((sic)PC6), Sanyinjiao ((sic)SP6), Zusanli ((sic)ST36), and Hegu ((sic) LI4). The specific acupuncture prescription depends on individual patients' symptoms. Conclusion: Research on acupuncture as an adjunctive therapy for cancer-related symptoms is developing steadily, with results being reported in a growing number of mainstream medical journals. Hence, this field is expected to receive more attention in the future. (c) 2022 World Journal of Acupuncture Moxibustion House. Published by Elsevier B.V. All rights reserved.

目的:探讨活血化瘀汤对急性心肌梗死伴心房颤动患者的临床改善作用.方法:选取急性心肌梗死伴心房颤动患者72例,分为两组,对照组应用常规治疗,研究组应用活血化瘀汤治疗.比较两组各项指标改善情况、整体疗效、不良反应发生率、心功能、血清炎性细胞因子IL-10、血黏附因子.结果:研究组总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)均低于对照组(P<0.05),高密度脂蛋白胆固醇(HDL-C)高于对照组(P<0.05);研究组整体疗效优于对照组(P<0.05);研究组房室传导阻滞、心动过缓、窦性停搏、恶心呕吐情况均少于对照组(P<0.05);研究组心排血量(CO)、左心室射血分数(LVEF)高于对照组(P<0.05),左心室收缩末内径(LVESD)、左心室舒张末内径(LVEDD)低于对照组(P<0.05);研究组IL-10、血黏附因子均低于对照组(P<0.05).结论:急性心肌梗死伴心房颤动患者的治疗过程当中,活血化瘀汤治疗效果较好,可以改善患者临床症状.

Astronauts will have multiple adverse physiological and pathological reactions in weightlessness condition, and muscle atrophy is one of the most obvious changes manifesting as the reduction of muscle volume and weight, inability of limb lifting and so on. There are no the descriptions about corresponding disease in traditional TCM classics. According to the symptoms of muscle atrophy in weightlessness condition, we classify it into the category of fleshy wilting in wilting syndrome. Under the guide of holistic concept and syndrome differentiation and treatment and referring to the cognition on fleshy wilting by doctors in the past dynasties, we think that the main pathogenesis of muscle atrophy induced by weightlessness are spleen qi deficiency and lack of nutrition of muscle in early stage, and deficiency of spleen and kidney, and qi deficiency and blood stasis in later stage.