Background:Drug-coated balloons (DCB) represent a novel therapeutic approach for treating native coronary artery disease. However, the clinical outcomes of DCB in patients with left anterior descending (LAD) artery stenosis proximal to a myocardial bridge (MB) remain unclear. This study aims to investigate the effects of DCB in patients with LAD artery stenosis proximal to MB. Method:This retrospective cohort study included consecutive patients with LAD artery stenosis proximal to MB who underwent DCB or drug-eluting stent (DES) procedures between January 2020 and July 2021. The DCB group comprised 30 patients treated with DCB alone, while the DES group included 105 patients treated with DES alone. Major adverse cardiac events (MACEs) during a median follow-up of 507 days (IQR 391.5-622.0 days) were defined as a composite of unstable angina requiring hospitalization, acute myocardial infarction, cardiac death, and target lesion revascularization (TLR). Results:Both groups exhibited generally comparable baseline clinical and lesion characteristics, except for age and MB systolic compression. Over a median follow-up of 507 days (IQR 391.5-622.0 days), Kaplan-Meier survival analysis revealed no statistically significant difference in MACE-free survival rates between the two groups (73.96%, 95% CI 55.8-98.0 vs. 82.49%, 95% CI 73.9-90.8; Log-rank P = 0.678). Cox proportional regression analysis showed no statistically significant difference in MACEs between DCB and DES patients (HR = 1.58, 95% CI = 0.56-4.45, P = 0.383). Conclusion:In this exploratory retrospective study, we did not detect a statistically significant advantage of DCB over DES in treating LAD stenosis proximal to MB. Given the limited sample size, these findings should be considered preliminary and do not support DCB as a reasonable alternative to DES. Larger prospective studies are warranted to validate the potential role of DCB in this specific anatomical setting.

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.

Early identification of high-risk individuals for coronary artery disease (CAD) is critical, especially in acute coronary syndrome (ACS) patients who face elevated risks of adverse cardiovascular events and are in need of intensified secondary prevention. This study aimed to investigate the combined value of the triglyceride-glucose (TyG) index—a surrogate marker of insulin resistance—and the systemic inflammatory response index (SIRI), calculated as (neutrophil count × monocyte count)/ lyphocyte count, in assessing coronary artery stenosis severity, proposing a cost-effective strategy for risk stratification in ACS management. A retrospective cohort study included 415 ACS patients diagnosed by coronary angiography at Beijing University of Chinese Medicine Third Affiliated Hospital (June 2021–February 2024). Patients were stratified into low stenosis (Gensini score < 34, n = 204) and high stenosis (Gensini score ≥ 34, n = 211) groups based on the median Gensini score. Clinical parameters and inflammatory markers were analyzed using logistic regression and ROC curves. High stenosis group showed significantly higher TyG (1.95 vs. 1.42, P < 0.001) and SIRI (1.07 vs. 0.75, P < 0.001) than the low stenosis group. Both indices independently associated with severe stenosis (OR = 3.094 and 2.064, P < 0.001). The combined TyG-SIRI model achieved an AUC of 0.744 (sensitivity 61.61

卵圆孔未闭(patent foramen ovale,PFO)是左、右心房之间的开放交通,属于常见的先天性心脏结构异常,约25%的成年人存在PFO[1].PFO相关疾病的临床表现多样,以不明原因卒中(隐源性卒中)、偏头痛为主,也可能出现短暂性脑缺血发作(transient ischemic attack,TIA)、斜卧呼吸-直立低氧血症、不明原因晕厥,乃至非动脉粥样硬化性心肌梗死[2-4].

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 对冠心病不稳定型心绞痛风邪证候要素特征性条目进行专家调查,筛选、优化以确定其诊断要点.方法 采用德尔菲法,依据前期文献及临床研究结果,制定专家咨询问卷.经过2轮专家问卷调查,采用多个统计指标评价咨询结果,结合临床经验对条目进行整合.结果 第1、2轮问卷咨询的专家积极指数分别为97％、100％,最终达成一致的专家共识共包含9项:情绪变化诱发或加重、风速增高等天气突变诱发或加重、脉弦、胸闷、胸痛性质≥2种、脉紧、胸痛部位≥2处、舌黯、畏风.参与调查的专家代表性和积极性均较高,其权威程度及协调性好.结论 应用德尔菲法筛选规范、简明的冠心病不稳定型心绞痛风邪证候要素特征性条目,可为相关中医证候学研究及进一步建立证候诊断标准提供依据和参考.

对中医风邪病因的客观化研究进行综述.风邪在中医病因理论中有着丰富的内涵,而随着现代科学技术的发展,认识到风邪可能存在相应的物质基础,外风与气象因素中的异常风速以及自然界的病原微生物、过敏源等密切相关,内风则与机体炎性因子具有内在一致性,也与免疫系统有重要联系.

Objectives: Wuling capsule has been used in treatment of insomnia disorder in China for decades, but the reported treatment efficacy of different studies was not consistent. This study intended to evaluate the efficacy and safety of Wuling capsule for insomnia disorder, so as to provide evidence for clinical application. Methods: Eight databases (MEDLINE, EMBASE, Ovid, Cochrane Library, Chinese National Knowledge Infrastructure, VIP information database, Chinese Biomedical Database and Wanfang) were searched from inception to September 14, 2021. Randomized controlled trials (RCTs) comparing Wuling capsule with controls in adults with insomnia disorder were eligible. The primary outcome was sleep quality assessed by Pittsburgh Sleep Quality Index (PSQI), and the secondary outcomes were severity of insomnia disorder measured by Sleep Dysfunction Rating Scale (SDRS) and adverse events. This study was conducted according to the Cochrane Handbook for Systematic Reviews of Interventions version 5.1.0. Results: Nineteen RCTs with a total of 1850 participants were included. In terms of sleep quality assessed by PSQI, Wuling capsule significantly lowered PSQI score (MD:-1.92, 95% CI: [-2.34,-1.50], P < 0.00001, I-2 = 95%) compared to controls, and the effect of Wuling capsule was significantly better than control no matter when Wuling capsule as monotherapy (MD:-1.71, 95% CI: [-2.33,-1.09], P < 0.00001, I-2 = 97%) or as adjunctive therapy (MD:-2.10, 95% CI: [-2.66,-1.55], P < 0.00001, I-2 = 90%). Wuling capsule was more effective for the treatment duration lasted 8 weeks (MD:-2.57, 95% CI: [-3.52,-1.62], P < 0.00001, I-2 = 93%) than 4 weeks (MD:-1.68, 95% CI: [-2.13,-1.22], P < 0.00001, I-2 = 95%). In terms of severity of insomnia disorder measured by SDRS, Wuling capsule significantly reduced SDRS score (MD:-4.21, 95% CI: [-4.95,-3.46], P < 0.00001, I-2 = 0%) compared to benzodiazepines. Wuling capsule significantly reduced adverse events compared to controls (RR: 0.47, 95% CI: [0.34, 0.65], P < 0.00001, I-2 = 43%). Conclusion: Wuling capsule can safely and effectively improve sleep quality in patients with insomnia disorder. However, these findings require careful recommendation due to the high heterogeneity and high risk of bias in the included trials. Clinical trials with higher quality designs are needed. (c) 2022 The Authors. Published by Elsevier B.V.

Background: Lipid-lowering therapy is very important in secondary prevention of coronary heart disease (CHD). In many clinical trials, it has been found that Sodium Tanshinone IIA Sulfonate Injection (STS) have a lipid-lowering effect while reducing major cardiovascular events in patients with CHD. However, up to now, there is no system review on the effectiveness and safety of STS affecting blood lipids.Purpose: The aim of this review is to systematically assess the effects of STS on blood lipid levels in patients with CHD.Methods: Until Mar 2021, five databases (PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure, and Wanfang Database) were searched for randomized controlled trials (RCTs) about STS treating patients with CHD. Risk bias was assessed for included studies according to Cochrane handbook. The primary outcome was total cholesterol (TC). The secondary outcomes were triglycerides (TG), low-density lipoprotein cholesterol (LDL-c), high-density lipoprotein cholesterol (HDL-c), and adverse events (AEs).Results: A total of 27 trials including 2,445 CHD patients met the eligibility criteria. Most trials had high risks in random sequence generation, allocation concealment, blinding of patients and personal, blinding of outcome assessment. Meta-analysis showed that STS significantly reduced plasma TC levels [MD = -1.34 mmol/l 95% CI (-1.59, -1.09), p < 0.00001, I-2 = 98%], TG levels [MD = -0.49 mmol/l 95% CI (-0.62, -0.35), p < 0.00001, I-2 = 97%], LDL-c levels [MD = -0.68 mmol/l (-0.80, -0.57), p < 0.00001, I-2 = 96%], increased HDL-c levels [MD = 0.26 mmol/l (0.15, 0.37), p < 0.00001, I-2 = 97%], without increasing the incidence of AEs [RR = 1.27 95% CI (0.72, 2.27), p = 0.94, I-2 = 0%] in patients with CHD.Conclusion: STS can safely and effectively reduce plasma TC, TG and LDL-c levels in patients with CHD, and improve plasma HDL-c levels. However, these findings require careful recommendation due to the low overall quality of RCTs at present. More multi-center, randomized, double-blind, placebo-controlled trials which are designed follow the CONSORT 2010 guideline are needed.

目的 通过Meta分析明确温阳活血中药治疗冠状动脉粥样硬化性心脏病(冠心病)心力衰竭(心衰)的临床疗效.方法 采用计算机检索Cochrane library、Embase、PubMed、CNKI、WanFang Data、VIP、CBM中关于温阳活血中药治疗冠心病心衰的随机对照试验并行Meta分析.检索时间为2000年1月1日至2020年3月31日.根据纳入排除标准遴选文章,提取数据,采用Cochrane系统评价手册偏倚风险评估工具进行质量评价,运用Review Manager 5.3软件进行Meta分析.结果 最终纳入12篇研究文献,共1031例冠心病心力衰竭患者.Meta分析结果显示,与西药常规治疗相比,加用温阳活血中药治疗冠心病心衰患者能够改善心功能(RR=1.24,95％CI:1.15～1.34),提高6分钟步行距离(MD=38.37,95％CI:24.97～51.78),增加左室射血分数(MD=2.65,95％CI:2.03～3.28).结论 西药治疗基础上加用温阳活血中药疗效确切,具有较好的安全性,是治疗冠心病心衰的有效方法,还需更高质量更大样本量的临床研究加以验证.

目的 探讨风速对冠状动脉粥样硬化性心脏病(冠心病)心血管事件的影响.方法 收集铜川地区2017～2018年650例冠心病患者的临床资料和同期气象资料、环境污染资料,回顾性分析风速与心血管事件的相关性.结果 650例冠心病患者累计发生心血管事件754次,包括心源性死亡9例、非致命性心肌梗死59例、不稳定型心绞痛506例、急性心力衰竭50例、卒中85例.单因素分析显示,日均风速与心血管事件显著相关(OR=1.58,95％CI:1.02～2.45).多因素Logistic回归分析显示,相对于低风速(0.70～1.90 m/s),中等风速(2.00～2.60 m/s)发生心血管事件的风险显著增加(OR=3.29,95％CI:1.49～7.26).结论 一定范围的风速增高会增加冠心病患者心血管事件风险.

近年来,随着介入心脏病技术的发展、新型药物及器械的研发、一级和二级预防策略使数以千万冠状动脉粥样硬化性心脏病(冠心病,CHD)患者受益,使CHD的死亡率大幅下降,然而对冠状动脉微血管病变(CMVD)却力有未逮.有50％的冠心病患者接受经皮冠状动脉介入治疗(PCI)后仍有胸痛发作[1],PCI虽可开通狭窄的冠状动脉(冠脉),但却对于直径<0.1 mm的冠脉微血管却无能为力.临床上很大一部分患者,虽具有典型心绞痛症状,但冠脉造影检查并未发现明显的狭窄(其冠脉狭窄程度<50％),称为X综合征,既往认为其长期预后良好,但目前研究发现其主要心血管事件和全因死亡率显著高于对照人群[2].由于现阶段对CMVD缺乏有统一的诊断标准,且在治疗方面,药物的选择也存在很大分歧,相当一部分有着顽固性心绞痛症状,但冠脉造影阴性的患者,在临床上并未得到有效治疗,使得CMVD成为心血管领域亟待解决的问题.

目的 通过文献计量学对现代文献从风论治冠心病证候分布及用药规律进行总结,为冠心病风邪致病的理论和临床实践提供参考.方法 检索中国期刊全文数据库、万方数据库、中文期刊服务平台从风论治冠心病相关的现代文献,采用SPSS 21.0统计软件对证候、临床表现及风药进行频数统计.结果 共检索到相关文献1 595篇,最终纳入20篇,共10种证候类型,从风论治冠心病常见的中医证型为气虚血瘀证;风邪侵袭常见的病位为心络;治疗冠心病常用风药为黄芪、川芎、羌活、威灵仙、芍药、葛根.结论 风邪与冠心病气虚血瘀证密切相关且最易侵袭心络,“益气活血、祛风通络”是从风论治冠心痛的重要治法.

络脉学说是中医学的重要研究领域之一,近些年的研究十分广泛,对气络、血络、络风内动等新说的探讨也不断深入.络脉包括气络、血络、络脉缠绊等基本生理结构,三者的相互作用构成了完整的络脉系统.中医学认为"有诸内者,必形诸外",定位诊断、定性诊断、定量诊断相结合的络脉望诊体系为认识和诊断疾病提供了一个新的思路.

随着我国经济的迅速发展及城市化进程的加快,心血管病(CVD)发病人数也在持续增加,心血管病死亡已成为城乡居民的首要死亡原因.而冠状动脉粥样硬化性心脏病(冠心病,CHD)是临床常见的心血管病之一,具有高发病率和高致死率的特点,严重威胁着人们健康.据推算,我国目前心血管病总患病人数约2.9亿人,其中冠心病约有1100万人,仅次于卒中[1].气象因素如温度、湿度、风速等对冠心病的发病有着重要影响[2],了解气象因素与冠心病发病间的规律,对冠心病患者的日常生活指导及远期预后有着重要意义,本文将对其相关研究进展进行综述.

Abstract Background: Coronary heart disease (CHD) has become the primary cause of heart failure (HF). Wenyang Huoxue method can significantly improve cardiac function in patients with CHD complicated with HF, but it has not been systematically evaluated for efficacy and safety. Methods: We will search China National Knowledge Infrastructure Database, Wanfang database, China Biomedical Literature Database, China Science Journal Database PubMed, Excerpt Medica Database, and Cochrane library. Clinical trial registrations, potential grey literature, related conference abstracts, and reference lists of identified studies will also be retrieved. The electronic database will be searched for literatures published from January 2000 to September 2019. Based on the heterogeneity test, data integration is performed using a fixed effect model or a random effects model. Changes in total effective rate in cardiac function will be assessed as primary outcome. 6-minute walk test, left ventricular ejection fraction, and plasma brain natriuretic peptide will be assessed as secondary outcomes. RevMan 5.3.5 will be used for meta-analysis. Results: This study will provide a high-quality comprehensive evaluation of the efficacy and safety of Wenyang Huoxue method for treating patients with CHD complicated with HF. Conclusions: This systematic review will determine whether Wenyang Huoxue method provides evidence for effective intervention in patients with CHD complicated with HF. Ethics and dissemination: This systematic review and meta-analysis of randomized controlled trials does not require ethical recognition, and the results of this paper will be published in an open access, internationally influential academic journal. Trial registration number: CRD42016025957

气虚血瘀是动脉粥样硬化疾病稳定期的重要病机之一,而动脉粥样硬化疾病在急性发作期,常有起病急骤、进展迅速、临床表现变化多端的特点,类似中医风证,难以用单纯的气虚血瘀理论阐释,因此我们提出"气虚血瘀-因风致变"的病机体系,这可能是影响动脉粥样硬化疾病进展及转归的关键病机.

目的 通过文献统计冠心病风邪致病的临床表征,为相关诊断标准的制定提供数据支持.方法 检索中国期刊全文数据库(CNKI)、万方数据库(Wanfang Data)及中文期刊服务平台(VIP)中冠心病风邪致病研究的相关文献,采用文献计量学方法对各临床表征进行统计.结果 共纳入文献89篇,冠心病风邪致病临床表征共183种,冠心病风邪致病具有阵发性、发作部位多样、起病急骤、反复性的发病特点,而心悸、脉弦、头晕、肢体麻木和脉结代更能体现风邪致病的症状体征特点,C反应蛋白或超敏C反应蛋白升高、易损斑块、斑块多样性和多支病变是风邪致病的微观指标特征.结论 风邪致病的临床表征不是单一症状或理化指标的变化,而是一系列症状、体征及理化指标的组合.

近年来,随着动脉粥样硬化相关的心脑血管疾发病率逐年升高,活血化瘀中药的应用也日益增多,水蛭作为活血化瘀中药的代表药之一,其在临床的广泛应用为动脉粥样硬化的干预提供了很多新的思路,文章主要对水蛭及其相关制剂抗动脉粥样硬化作用的可能机制进行综述.

目的 观察柴胡桂枝干姜汤加味治疗原发性高血压寒热错杂证的临床疗效.方法 将62例患者分为治疗组31例、对照组31例.对照组给予口服缬沙坦氨氯地平片治疗,治疗组在对照组治疗的基础上,予柴胡桂枝干姜汤加味口服.观察2组降压疗效、中医证候疗效、中医症状评分、焦虑评分.结果 2组降压疗效比较差异无统计学意义(P>0.05).2组中医证候疗效比较:治疗组30例中,显效19例,有效10例,无效1例,总有效29例,总有效率为96.7％;对照组30例中,显效9例,有效13例,无效8例,总有效22例,总有效率为73.3％.经秩和检验,Z=-4.404,P<0.001,说明治疗组中医证候疗效优于对照组.2组治疗后眩晕、头痛、口干、口苦、畏寒肢冷、心烦急躁评分较本组治疗前均降低(P<0.05).治疗组腹中冷评分较本组治疗前降低.对照组腹中冷评分与本组治疗前比较差异无统计学意义(P>0.05).治疗组头痛、口干、口苦、腹中冷评分较对照组降低明显,治疗前后评分差值比较,差异均有统计学意义(P<0.05),治疗组优于对照组.2组眩晕、畏寒肢冷、心烦急躁治疗前后评分差值比较,差异无统计学意义(P>0.05).2组治疗后焦虑评分较本组治疗前均降低(P<0.05),治疗组评分较对照组降低明显,治疗前后评分差值比较,差异有统计学意义(P<0.05),治疗组优于对照组.结论 柴胡桂枝干姜汤加味联合缬沙坦氨氯地平片治疗原发性高血压寒热错杂证具有较好的临床疗效.