Diet influences plaque stability through its potential to modulate inflammation, a process that involves complex interactions among various lipid metabolites. This study aims to utilize metabolomics to identify key metabolites involved in this pathway and to elucidate the mechanisms by which dietary factors affect plaque stability. The Dietary Inflammatory Index (DII), derived from dietary data, was used to assess the inflammatory potential of individual diets. Propensity score matching categorized serum samples from coronary heart disease (CHD) patients into an anti-inflammatory group (n = 108) and a pro-inflammatory group (n = 108). A comprehensive analysis of lipid profiles was performed using an UPLC-MS/MS detection platform combined with the broad-targeted lipid metabolomics technique, and lipid metabolites with significant differences were screened out. Concurrently, we measured serum levels of inflammatory factors and plaque stability. A Bayesian network model was then applied to elucidate the causal relationships among DII, lipid metabolites, inflammatory factors, and plaque stability. A lipidomics analysis identified 22 differentially expressed lipid metabolites, which were associated with sphingolipid metabolism pathways in the KEGG (Kyoto Encyclopedia of Genes and Genomes) database, particularly involving nine ceramide species. The Bayesian network model exploring the impact of DII on plaque stability comprises 16 nodes and 23 directed arcs. It revealed multiple causal relationships among DII, ceramide species, inflammatory factors, and plaque stability. Specifically, six ceramide species [Cer(d16:0/20:1), Cer(d24:3/15:1), Cer(t14:1/21:0), Cer(t20:0/18:2), Cer(t22:1/16:1), Cer(t26:1/12:1)] and five inflammatory factors (IFN-γ, IL-1β, IL-8, IL-12, IL-13) were found to be involved in these associations. Ceramide species emerged as differential lipid metabolites that distinguish between the anti-inflammatory and pro-inflammatory groups, simultaneously serving as key lipid metabolic products through which diet exerts its influence on plaque stability.

OBJECTIVE:To determine whether Type D personality and higher metabolic syndrome (MetS) severity jointly associate with 2-year major adverse cardiac events (MACE) after acute coronary syndrome (ACS). METHODS:This prospective cohort study included 5441 patients diagnosed with ACS between May 2021 and May 2023. Type D personality was assessed, and an age-sex-ethnicity-specific MetS scoring model (MetS score) was used to evaluate metabolic syndrome severity at baseline. MACE were analyzed after a 2-year follow-up period. RESULTS:During the 2-year follow-up period, 518 patients developed MACE. A nonlinear association was observed between MetS score and MACE risk (p for nonlinearity = 0.025). Compared with the Type D(-)/Low MetS risk group, the Type D(+)/High MetS risk group exhibited the highest risk of MACE (HR: 2.331, 95 % CI: 1.810-3.002). Subgroup analyses further revealed a pronounced sex difference: the association was strongest among women, with the Type D(+)/High MetS risk group showing the highest risk (HR: 3.505, 95 % CI: 2.092-5.872), whereas men in the same group also demonstrated elevated risk, though to a lesser degree (HR: 2.065, 95 % CI: 1.544-2.761). CONCLUSION:Type D personality and higher MetS severity were jointly associated with increased 2-year MACE risk after ACS, with sex-specific patterns. These findings support integrated psychosocial and metabolic risk management, particularly among women with high MetS severity.

BACKGROUND AND AIMS:Diet, as a modifiable lifestyle factor, has garnered increasing attention in cardiovascular epidemiology. To investigate the potential mechanisms by which distinct dietary patterns influence coronary plaque vulnerability in patients with coronary heart disease (CHD), with a particular focus on the mediating role of the Dietary Inflammatory Index (DII). METHODS AND RESULTS:A total of 320 patients with angiographically confirmed CHD who underwent optical coherence tomography were enrolled. Dietary patterns were derived using exploratory factor analysis. Associations between dietary patterns and plaque vulnerability were analyzed with multivariable logistic regression, and the mediating role of the Dietary Inflammatory Index (DII) was examined using structural equation modeling (SEM). Four dietary patterns were identified. After adjustment for confounders, dietary pattern I (DP-I) was independently associated with increased plaque vulnerability (OR = 3.00; 95 % CI: 1.27-7.07; P = 0.012). SEM further indicated that DP-I exerted both a direct effect on plaque vulnerability and an indirect effect through elevated DII levels, whereas dietary patterns II and III were linked to lower DII values. CONCLUSION:This study emphasizes that dietary patterns are important influencing factors of coronary plaque vulnerability and identifies the DII as a potential mechanism linking diet to coronary artery disease, providing a possible target for prevention and intervention. In addition, the findings underscore the importance of dietary factors in the pathogenesis of coronary artery disease and provide a theoretical basis for further exploration of the diet-inflammation-plaque mechanism.

BACKGROUND:Stressful life events are independent psychological risk factor for diabetes and cardiovascular disease, yet studies on cardiometabolic multimorbidity (CMM) are scarce. This study aimed to examine the effects of stressful life events and their accumulation on the prevalence of CMM, as well as the mediating role of allostatic load in the association between accumulated stressful life events and CMM. METHODS:A total of 7493 participants from Wave 3 (2015) of the China Health and Retirement Longitudinal Study (CHARLS) were included. Stressful life events were assessed using five simple questions. CMM, defined as having two or more of cardiometabolic diseases, including diabetes, heart disease and stroke, was obtained through self-reports. RESULTS:The prevalence of CMM increased with the number of stressful life events, ranging from 5.73 % for one stressful life event to 6.61 % for two or more. In the fully adjusted model, the odds ratios (95 % confidence interval) for CMM were 1.49 (1.01-2.20) for participants experiencing marital problems and 1.93 (1.45-2.56) for those with functional disability. Compared with no stressful life events, an increasing number of stressful life events was associated with a higher risk of CMM (P-trend <0.001). The mediation analysis results demonstrated that allostatic load was a significant mediator of the association between accumulated stressful life events and CMM, accounting for a mediated proportion of 16.7 %. CONCLUSIONS:In the general population, the presence of specific and cumulative stressful life events is associated with an increased prevalence of CMM, and allostatic load plays a crucial mediation effect.

Background Diet influences plaque stability through its potential to modulate inflammation, a process that involves complex interactions among various lipid metabolites. This study aims to utilize metabolomics to identify key metabolites involved in this pathway and to elucidate the mechanisms by which dietary factors affect plaque stability. Methods The Dietary Inflammatory Index (DII), derived from dietary data, was used to assess the inflammatory potential of individual diets. Propensity score matching categorized serum samples from coronary heart disease (CHD) patients into an anti-inflammatory group (n = 108) and a pro-inflammatory group (n = 108). Broad-spectrum lipidomics technology was employed to perform a comprehensive analysis of lipid profiles and identify significantly different lipid metabolites. Concurrently, we measured serum levels of inflammatory factors and plaque stability. A Bayesian network model was then applied to elucidate the causal relationships among DII, lipid metabolites, inflammatory factors, and plaque stability. Results A lipidomics analysis identified 22 differentially expressed lipid metabolites, which were associated with sphingolipid metabolism pathways in the KEGG (Kyoto Encyclopedia of Genes and Genomes) database, particularly involving nine ceramide species. The Bayesian network model exploring the impact of DII on plaque stability comprises 16 nodes and 23 directed arcs. It revealed multiple causal relationships among DII, ceramide species, inflammatory factors, and plaque stability. Specifically, six ceramide species [Cer(d16:0/20:1), Cer(d24:3/15:1), Cer(t14:1/21:0), Cer(t20:0/18:2), Cer(t22:1/16:1), Cer(t26:1/12:1)] and five inflammatory factors (IFN-γ, IL-1β, IL-8, IL-12, IL-13) were found to be involved in these associations. Conclusions Ceramide species emerged as differential lipid metabolites that distinguish between the anti-inflammatory and pro-inflammatory groups, simultaneously serving as key lipid metabolic products through which diet exerts its influence on plaque stability.

ObjectiveSubjective motoric cognitive risk syndrome (MCR-S) is a well-established screening tool that has been validated for objective motoric cognitive risk syndrome (MCR-O) and predicted risk of incident dementia. MCR is associated with cardiovascular factors and coronary artery disease (CAD). MCR-S is crucial for remote cognitive screening but has only been validated in community settings so far. Our study aimed to validate a Chinese version of the MCR-S in CAD patients.MethodThe Chinese version of the MCR-S was obtained through a standardized forward-backward translation and cultural adaptation. 338 CAD patients were recruited. Traditional analysis based on classical test theory and Rasch analysis based on latent trait theory were performed on the MCR-S for validation. Receiver operating characteristic analysis was applied to determine the discriminative ability of MCR-S for the MCR-O in CAD patients.ResultsThe MCR-S met the unidimensionality, lack of local dependency or disordered thresholds, and good fit value for each item of the Rasch model, the item-person map shows that the item’s estimate of capacity is appropriate. MCR-S has good content validity, criterion-related validity, and test-retest reliability. An optimal cut-score of 4.6 on the MCR-S score was determined to have good sensitivity (79.2%) and specificity (71.3%) for MCR-O in CAD patients.ConclusionThe Chinese version of MCR-S meets the requirements of the Rasch model and has good validity in CAD patients. The validated MCR-S cutoff can support long-term monitoring and early intervention for CAD patients at risk of MCR-O.

OBJECTIVE:This cross-sectional study aimed to examine the association between type D personality and the severity of coronary artery disease in patients with acute coronary syndrome (ACS), with a specific focus on sex-stratified differences. METHODS:ACS patients (n=9236) completed the Chinese Type D Personality Scale. The Gensini score assessed disease severity. Multivariate linear regression, adjusted for covariates, analyzed the relationship between type D personality and Gensini score, with a sex stratified analysis exploring the impact of sex. RESULTS:In total, 20.1% (1853) of ACS patients had a type D personality. Type D personality was measured using standardized scores of negative affectivity (Z-NA) and social inhibition (Z-SI). Multivariate linear regression analysis showed that Z-NA (B=0.03, 95% CI=0.02-0.05, p <.001), Z-SI (B=0.05, 95% CI=0.04-0.07, p <.001), and their interaction term (B=0.02, 95% CI=0.01-0.03, p <.001) were all significantly associated with the Gensini score [Ln]. Further sex-stratified analyses revealed that, among male patients, Z-NA (B=0.04, 95% CI=0.03-0.06, p <.001), Z-SI (B=0.06, 95% CI=0.04-0.07, p <.001), and their interaction (B=0.03, 95% CI=0.02-0.04, p <.001) were all significantly associated with the Gensini score [Ln]. However, no statistically significant associations were observed in female patients. CONCLUSIONS:Sex differences significantly influence the relationship between type D personality and coronary disease severity in ACS patients, particularly in males, warranting targeted interventions.

BACKGROUND AND AIMS:Current evidence underscores that oxidative stress (OS) is a pivotal factor in the formation of vulnerable plaques in individuals with coronary heart disease (CHD). The Oxidative Balance Score (OBS), a comprehensive measure of systemic OS, consists of 15 antioxidants and 5 pro-oxidants, with higher scores indicating greater antioxidant activity. We hypothesized that a high OBS would be associated with improved coronary plaque stability in CHD patients. METHODS AND RESULTS:A total of 635 patients diagnosed with CHD were included in this study. After accounting for confounding variables, we found a significant inverse association between higher OBS and the formation of thin-capped fibroatheroma (TCFA) (OR = 0.933, 95 % CI: 0.913, 0.953). This relationship exhibited a nonlinear pattern, plateauing at an OBS score of 18.1. Mediation analysis revealed that OBS significantly mediates the relationship between food intake (soy, grains, vegetables, fruits) and plaque stability (p < 0.05). CONCLUSION:Our findings indicate that a higher OBS is inversely associated with the presence of vulnerable plaques. Adopting a diet rich in antioxidants, characterized by increased consumption of soy, grains, vegetables, and fruits, along with an antioxidant-focused lifestyle, may serve as an effective preventive strategy to enhance plaque stability in CHD patients.

Background The occurrence and development of acute coronary syndrome(ACS)are closely associated with inflammatory responses,but the relationship between dietary inflammatory potential and severity of coronary artery disease of ACS patients is currently unknown.Objective To investigate the relationship between dietary inflammatory potential evaluated by dietary inflammation index(DII)and severity of coronary artery disease in ACS patients.Methods Convenient sampling method was used to select 309 patients diagnosed as ACS for the first time by coronary arteriography in the Department of Cardiology,the Second Affiliated Hospital of Harbin Medical University from April 2022 to March 2023,and they were divided into DII-1 group(from-8.35 to-4.56),DII-2 group(from-4.55 to-0.77),DII-3 group(from-0.76 to 3.02)and DII-4 group(from 3.03 to 6.81)according to the quartile of DII,into Q1 group(4-32 scores),Q2 group(34-52 scores),Q3 group(54-84 scores)and Q4 group(86-192 scores)according to the quartile of Gensini score.Demographic and clinical features,overall DII,and DII of nutrient were compared in ACS patients with different severity of coronary artery stenosis,multivariate Logistic regression analysis was used to analyze the relation of DII with the severity of coronary artery stenosis.Results There was significant difference in educational level,LDL-C,LP-a,overall DII,DII of total fat,saturated fatty acids,vitamin E,carotene in ACS patients with different severity of coronary artery stenosis,respectively(P≤0.05).After the correction of confounders of educational level,LDL-C and LP-a,the multivariate Logistic regression analysis showed that,DII-4 group was the influencing factor of Q2 group(OR=15.389,95%CI=1.595-148.432),Q3 group(OR=15.102,95%CI=1.620-140.788)and Q4 group(OR=17.319,95%CI=1.901-157.807),respectively(P<0.05);DII of total fat(OR=3.831,95%CI=1.195-9.094),saturated fatty acids(OR=8.562,95%CI=1.519-48.258)and vitamin E(OR=0.640,95%CI=0.460-0.890)was the influencing factor of Q4 group,respectively(P<0.05).Conclusion Dietary inflammatory potential as well as inflammatory potential of nutrient total fat,saturated fatty acids and vitamin E are influencing factors of severity of coronary artery disease in ACS patients,thus clinicians should further strengthen the reasonable anti-inflammatory dietary guidance of ACS patients.

AbstractBackgroundType D personality and depression are the independent psychological risk factors for adverse outcomes in cardiovascular patients. The aim of this study was to examine the combined effect of Type D personality and depression on clinical outcomes in patients suffering from acute myocardial infarction (AMI).MethodsThis prospective cohort study included 3568 patients diagnosed with AMI between February 2017 and September 2018. Type D personality and depression were assessed at baseline, while the major adverse cardiac event (MACE) rate (cardiac death, recurrent non-fatal myocardial infarction, revascularization, and stroke) and in-stent restenosis (ISR) rate were analyzed after a 2-year follow-up period.ResultsA total of 437 patients developed MACEs and 185 had ISR during the follow-up period. The Type D (+) depression (+) and Type D (+) depression (−) groups had a higher risk of MACE [95% confidence interval (CI) 1.74–6.07] (95% CI 1.25–2.96) and ISR (95% CI 3.09–8.28) (95% CI 1.85–6.22). Analysis of Type D and depression as continuous variables indicated that the main effect of Type D, depression and their combined effect were significantly associated with MACE and ISR. Moreover, Type D (+) depression (+) and Type D (+) depression (−) emerged as significant risk factors for MACE and ISR in males, while only Type D (+) depression (+) was associated with MACE and ISR in female patients.ConclusionsThese findings suggest that patients complicated with depression and Type D personality are at a higher risk of adverse cardiovascular outcomes. Individual assessments of Type D personality and depression, and comprehensive interventions are required.

目的 探讨网络学习环境对护理本科生评判性思维能力的影响.方法 采用便利抽样法,于2021年9月—2022年1月,选取哈尔滨医科大学护理学院三年级84名护理本科生为研究对象.采用网络学习环境量表和中文版评判性思维能力量表进行调查.结果 84名护理本科生网络学习环境量表总分为(63.21±15.29)分,中文版评判性思维能力量表总分为(248.71±36.35)分.护理本科生网络学习环境量表总分与中文版评判性思维能力总分呈正相关(P＜0.01).多重线性回归分析结果显示,护理本科生评判性思维能力的影响因素包括家庭经济情况、是否能接收到学校免费网络数据库资源和网络学习环境(P＜0.05).结论 护理本科生的网络学习环境处于中等水平,建议护理教育者应优化网络学习内容及形式,提供针对性学习支持资源,从而提升护理本科生的评判性思维能力.

We aimed to explore the association between stressful life events and coronary plaque vulnerability, and examine the moderating effects of psychological distress and physiological indices. A total of 311 patients with acute coronary syndrome (ACS) completed Life Events Scale, Zung Self-Rating Depression and Anxiety Scales. Plaque vulnerability was assessed by in vivo optical coherence tomography (OCT). The regression analysis showed that that stressful life events were independent predictors of plaque vulnerability including lipid-rich plaque (OR = 1.018, 95% CI = 1.005, 1.031, p = 0.005), thin-cap fibroatheroma (TCFA) (OR = 1.038, 95% CI = 1.025, 1.051, p < 0.001), rupture (OR = 1.025, 95% CI = 1.013, 1.037, p < 0.001) and thrombus (OR = 1.030, 95% CI = 1.012, 1.048, p = 0.001). The moderated mediation model revealed that there were significant indirect effects of stressful life events on TCFA through total cholesterol, and the path between stressful life events and TCFA can be moderated by depression. Stressful life events increase the risk of vulnerable plaque in ACS patients. The relationship could be moderated by depression and mediated by physiological indices.

Objective:To explore the mediating effect of negative cognitive processing bias between type D personality and depression after percutaneous coronary intervention (PCI) .Methods:Using the convenient sampling method, a total of 340 patients who underwent PCI for the first time in Department of Cardiology in the Second Affiliated Hospital of Harbin Medical University from September to December 2021 were selected as the research objects. The General Demographic Data Questionnaire, Type D Personality Scale (DS14), Negative Cognitive Processing Bias Questionnaire (NCPBQ) and Beck Depression Inventory-Ⅱ (BDI-Ⅱ) were used to investigate. Spearman correlation analysis was used to determine the correlation between type D personality, negative cognitive processing bias and depression. The mediating effect model was established by AMOS 24.0 software to analyze the mediating effect of negative cognitive processing bias between type D personality and depression.Results:A total of 340 questionnaires were sent out in this study, and 317 valid questionnaires were recovered, with an effective questionnaire recovery rate of 93.2%. The total score of Type D Personality Scale of 317 patients after PCI was (18.05±4.15), in which the score of negative affectivity dimension was (9.51±2.33) and the score of social inhibition dimension was (8.54±2.61). The proportion of patients with type D personality is 24.9% (79/317). The score of Beck Depression Inventory-Ⅱ (BDI-Ⅱ) was (9.52±4.83), and the incidence of depression was 20.2% (64/317). Correlation analysis showed that D-type personality of patients, negative cognitive processing bias and depression were positively correlated ( P<0.05). The mediating effect analysis showed that type D personality could directly affect the occurrence of depression (effect size 0.431, P<0.001), or indirectly through negative cognitive processing bias (effect size 0.145, P<0.001) . Conclusions:The negative cognitive processing bias is an important factor in the occurrence of depression in patients with CHD and with type D personality. Improving the negative cognitive processing bias will help reduce the occurrence of depression and improve the prognosis.

Coronary plaque stability is a key pathological mechanism of coronary heart disease (CHD). Inflammation is recognized as a key factor of coronary plaque stability. The dietary inflammatory index (DII) is calculated from 21 dietary nutrients to predict the inflammation potential of an individual's diet. We hypothesized that high DII may be associated with decreased coronary plaque stability in CHD patients; therefore, this study aimed to evaluate the association between DII and plaque stability in patients with CHD. This cross-sectional study included 314 patients with CHD. DII was calculated based on food frequency questionnaires. Plaque stability was measured with optical coherence tomography. The DII ranged from -1.41 to 3.04. After adjusting for confounding factors, higher DII scores were associated with unstable plaque characteristics including thin-capped fibroatheroma (odds ratio [OR], 3.60; 95% confidence interval [CI], 1.78-7.29), macrophage infiltration (OR, 2.16; 95% CI, 1.01-4.61), and plaque rupture (OR, 3.55; 95% CI, 1.73-7.29). Mediation analyses revealed that DII was important mediator of the relationship between plaque stability and food intake including soybeans and nuts, fish and shrimp, eggs (P < .05). The present study confirmed that higher DII is significantly associated with decreased plaque stability in CHD patients, suggesting an important protective role of anti-inflammatory diets in the pathogenesis of CHD.

目的 探讨经皮冠状动脉介入术(percutaneous coronary intervention,PCI)后患者心血管健康评分轨迹的特征.方法 采用方便抽样法,选取2019年5月—10月于哈尔滨市某三级甲等医院心内科首次行PCI且术后规律随访的急性心肌梗死患者339例,依据其术后基线、6个月、12个月的心血管健康评分,使用群组发展模型识别异质性轨迹,采用Cox比例风险回归模型分析轨迹组别对主要心脏不良事件的影响.结果 该研究识别出5条心血管健康评分轨迹,分别为低-升高组(19.8％)、中-先降后升组(24.8％)、中-快速升高组(14.4％)、中-稳定组(31.9％)和高-稳定组(9.1％).Cox比例风险回归模型表明,在调整混杂因素(年龄、性别、高密度脂蛋白胆固醇和饮酒)后,中-先降后升组、中-快速升高组、中-稳定组和高-稳定组发生主要心脏不良事件的风险分别是低-升高组的0.498(P=0.033)、0.446(P=0.049)、0.403(P=0.006)和0.259(P=0.030)倍.结论 急性心肌梗死患者PCI术后1年的心血管健康评分呈现不同的变化轨迹,提升及保持较高水平的心血管健康评分与主要心脏不良事件的风险呈负相关.医护人员可动态监测心血管健康评分变化特征,加强危险因素管理并早期采取干预手段以改善预后.

在自然计算方法中,种群规模大,计算复杂度高;种群规模小,容易陷入局部最优.本文提出多空间协同进化(Multi-space Coevolution,简称MSC)的自然计算方法,该方法适用于各种基于种群进化的优化算法,不依赖于算法进化的具体步骤,具有普适性.在传统的生物种群进化的基础上,将大种群分解为个数有限的小种群,部分小种群组成进化空间,另一部分构成指导空间,两个空间拥有不同的功能,指导空间通过特定的信息传递方式将经验概括信息传递到进化空间,从而使整个种群协同进化.将该策略分别应用到粒子群优化算法(PSO)和遗传算法(GA)中,并与标准粒子群算法、遗传算法以及目前主流的针对大规模问题进行优化的7个算法对比,在高维测试函数中,结果表明,寻优性能方面新的种群进化算法相比其他算法提高80％左右,具有普适性.

Objective:To analyze the current situation of professional identity of nursing students in China, and explore the research hotspots and development trends.Methods:We searched relevant articles in China National Knowledge Infrastructure, VIP and WanFang Data, and the retrieval time limit was from January 1, 2006 to December 31, 2021. CiteSpace software (version 5.8. R2) was used for bibliometric and visual analysis of the number of articles, authors, institutions and keywords.Results:Since 2016, the number of articles increased significantly. At present, there were large numbers of cross-sectional studies, but there were some limitations and lack of longitudinal studies. There was much cooperation between authors and little cooperation between research institutions, and no large-scale cooperation network was formed. The keyword emergence analysis found that the research on nursing students' professional identity and clinical practice had the longest emergence time, and the keyword with the highest emergence in 2020 was "COVID-19".Conclusions:At present, it is a critical period for the development direction of nursing students' professional identity research to change. It is necessary to establish a large cooperation network model, carry out longitudinal investigation and intervention research, so as to improve nursing students' professional identity.

PurposeCardiovascular events and coronary plaque vulnerability are linked to Type D personality. However, the fundamental mechanism has not been clarified. Our study determined to illustrate whether inflammatory status in plasma, in combination with kynurenine pathway activity in Type D individuals, is associated with plaque vulnerability and cardiovascular events in patients with coronary artery disease (CAD).Materials and methodsThe Type D personality of 177 CAD patients were evaluated. Plasma biomarkers of inflammation (TNF-α, IL-6, and hs-CRP) were measured and pooled into standardized sumscores. Tryptophan and kynurenine metabolites were measured, and the kynurenine/tryptophan ratio (KTR) was calculated. Plaque vulnerability was measured in vivo by optical coherence tomography. All patients had a follow up of 2 years in which cardiovascular adverse events were recorded.ResultsType D individuals exhibited elevated TNF-α (p = 0.007), IL-6 (p = 0.049), inflammation sumscores (p = 0.002), kynurenine (p = 0.008), and KTR (p = 0.005) than non-Type D group. The serial-multiple mediation showed that the Type D personality with a direct, favorable impact on plaque vulnerability, including thin cap fibroatheroma (TCFA) (point estimate = 0.81; 95% CI = 0.09–1.53), macrophages (point estimate = 0.79; 95% CI = 0.05–1.51), and major adverse cardiac events (MACE) (point estimate = 0.88, 95% CI = 0.08–1.70). In addition, the standardized inflammation sumscores and KTR were mediators of the Type D personality associations with TCFA, macrophages and MACE.ConclusionThese results demonstrated that the connection between Type D personality and poor cardiovascular outcomes in CAD patients can be mediated by pro-inflammatory biomarkers and KTR.

Objective:To construct a home-based cardiac rehabilitation intervention system for patients after percutaneous coronary intervention, and to provide reference for improving the self-management ability and family support of home-based cardiac rehabilitation of patients after PCI.Methods:Based on the literature study and group discussions, a draft of home-based cardiac rehabilitation intervention system for patients after PCI based on empowerment theory was constructed. From January to April 2021, the Delphi method was used to conduct 2 rounds of expert consultations among 18 experts from 9 hospitals, and the items were modified according to the experts′ advice.Results:The expert positive coefficients of the 2 rounds were 94.44% and 100.00%, the expert authority coefficients was 0.91, and the Kendall coefficients were 0.188 and 0.255. Finally, a home-based cardiac rehabilitation intervention system for patients after PCI was formed, including 5 first-level items, 19 second-level items and 21 third-level items.Conclusion:The home-based cardiac rehabilitation intervention system for patients after PCI is reliable, scientificity and practical, and has guiding significance for promoting the development of home-based cardiac rehabilitation for PCI patients.

Objective:To clarify the mechanism of type D personality on plaque vulnerability in patients with coronary heart disease based on the stress-mediator model.Methods:Using the convenient sampling method, a total of 386 patients with coronary heart disease who were admitted to Department of Cardiology of the Second Affiliated Hospital of Harbin Medical University from December 2020 to May 2021 were selected as the research objects. The patients were investigated using Type D Personality Scale-14 (DS-14) , Self-rating Anxiety Scale, Self-rating Depression Scale, The Stress Appraisal Measure (SAM) and Trait Coping Style Questionnaire (TCSQ) . At the same time, optical coherence tomography was used to evaluate the plaque characteristics of patients with coronary lesions. A structural equation model was used to construct a model of influencing factors of plaque vulnerability in patients with type D personality coronary heart disease.Results:Among the patients with coronary heart disease in this study, there were 138 patients with type D personality and 200 patients in the vulnerable plaque group. The D-type personality score, anxiety, depression, negative coping and cognitive evaluation scores in the vulnerable plaque group were higher than those in the non-vulnerable plaque group, and the differences were statistically significant ( P<0.01) . The active coping score of the vulnerable plaque group was lower than that of the non-vulnerable plaque group, and the difference was statistically significant ( P<0.01) . The results of structural equation modeling showed that type D personality could directly or indirectly affect plaque vulnerability through cognitive assessment (β=0.588, P<0.01) and negative coping (β=0.189, P<0.05) . Among them, cognitive assessment (β=-0.061, 0.121; P<0.01) and negative coping (β=-0.124, 0.031; P<0.01) had indirect effects on plaque vulnerability. Negative coping (β=0.215, P<0.01) , psychological responses (β=0.241, -0.150, P<0.01) and physiological responses (β=-0.321, P<0.01) had direct effects on plaque vulnerability. Conclusions:Cognitive evaluation, coping style, psychological response and physiological response of patients with type D coronary heart disease can affect plaque vulnerability through various pathways. Therefore, strengthening the clinical screening of type D personality can early identify the high-risk population of plaque vulnerability, and at the same time, individualized and systematic psychological behavior intervention should be carried out for such population, so as to move the prevention and treatment of coronary heart disease forward.