Evidence-based medicine (EBM), formalized in the 1990s, has redefined clinical practice by advocating the integration of research evidence, clinical expertise, and patient values. This paradigm has introduced methodological rigor through randomized controlled trials (RCTs) to establish causality, systematic reviews to synthesize findings, and the GRADE approach to evaluate evidence based on risk of bias, inconsistency, indirectness, imprecision, and publication bias. These advancements have shaped clinical guidelines, reduced practice variability, and influenced medical education toward evidence-based inquiry. Despite its contributions, EBM faces challenges in the evolving landscape of modern medicine. The lengthy process of evidence generation, often requiring years for trials and guideline updates, limits responsiveness to emerging health needs, as observed during the COVID-19 pandemic. The external validity of RCT results is constrained by strict inclusion criteria, posing difficulties in applying findings to diverse patient populations with comorbidities. Additionally, the siloed nature of evidence complicates comprehensive care for multifactorial conditions, while the annual influx of over one million medical publications overwhelms traditional synthesis methods. Artificial intelligence (AI) presents a promising avenue to address these issues, leveraging capabilities in processing heterogeneous data. Natural language processing may enhance literature analysis, machine learning could identify patterns in complex datasets, and causal inference might improve the reliability of observational data insights. These technologies hold potential to accelerate evidence development and tailor it to individual needs. This paper proposes digital intelligent evidence-based medicine (i-EBM) as a conceptual evolution of EBM, designed for the AI era. i-EBM envisions a three-layered framework. The data foundation layer aims to integrate structured evidence from RCTs, domain knowledge such as biomedical ontologies and traditional Chinese medicine principles, and multi- modal patient data, including electronic health records, genomics, and wearable device outputs. Knowledge graphs are proposed to link these elements into a unified, computable knowledge network. The intelligent processing layer seeks to apply AI for evidence retrieval, data extraction, quality assessment, and synthesis, potentially using large language models to assist these processes. The knowledge service layer intends to provide dynamic guidelines and individualized predictions, supported by ongoing human-machine collaboration to ensure clinical relevance and ethical considerations. i-EBM has the potential to mitigate EBM's limitations by facilitating real-time evidence updates, reducing knowledge fragmentation through integrated data, and offering personalized decision support. For instance, it may support precision medicine by connecting diverse data sources, with applications possibly extending to fields like oncology or traditional Chinese medicine. Future research could explore autonomous AI systems, optimized clinical workflows, and governance frameworks to address data privacy, bias, and global standardization. In conclusion, i-EBM offers a theoretical framework to extend EBM principles, harnessing AI's potential alongside human expertise to advance medical research and practice. Meanwhile, for issues such as the quantitative study of the complex intervention characteristics and syndrome differentiation patterns of traditional Chinese medicine, i-EBM can provide methodological support in data integration, pattern recognition, and causal inference, offering potential tools and insights for uncovering the intrinsic regularities of TCM evidence and optimizing its evaluative framework.

ObjectiveTo explore the application effect of video education program based on the timing theory in young and middle⁃aged patients with coronary heart disease undergoing PCI.MethodsA total of 93 young and middle⁃aged patients with coronary heart disease undergoing PCI who were hospitalized in the department of cardiovascular medicine of the First Affiliated Hospital of Henan University of Chinese Medicine from January to August 2024 were selected as the research subjects.They were divided into an observation group of 47 cases and a control group of 46 cases according to the order of admission.The control group received conventional health education,while the observation group implemented a video health education program based on the timing theory.The scores of the Coronary Artery Disease Self⁃management Scale(CSMS),the China Questionnaire of Quality of Life in Patients with Cardiovascular Diseases(CQQC),satisfaction with health education and the incidence of cardiovascular negative related events were compared between two groups of patients before the intervention and 3 months after the intervention.ResultsA total of 92 patients completed the intervention,with 46 cases in the observation group and 46 cases in the control group.After 3 months of intervention,the scores of CSMS and CQQC in the observation group were higher than those in the control group,the satisfaction with health education was higher than that in the control group,and the incidence of cardiovascular negatively related events was lower than that in the control group.The differences were all statistically significant(P<0.05).ConclusionsThe video education program based on the timing theory was helpful for young and middle⁃aged patients with coronary heart disease undergoing PCI to establish and maintain healthy behaviors,improve self⁃management ability,reduce the incidence of cardiovascular negatively related events,and thereby improve the quality of life.

Myocardial fibrosis (MF) is a common pathological process in various cardiac diseases, including myocardial infarction (MI), hypertensive heart disease, and dilated cardiomyopathy. MF is characterized by excessive deposition of extracellular matrix (ECM), reduced myocardial compliance, and impaired cardiac function. This process can lead to arrhythmias and sudden cardiac death. Currently, effective and safe therapies for MF are limited. This review summarizes recent advances in the use of natural compounds to treat MF by regulating signaling pathways. Representative compounds, such as Salvianolic acid B (Sal B), Astragaloside IV (AS-IV), Pachymic acid, Resveratrol, Curcumin, Matrine, Artemisinin, and Artesunate, among others, can modulate multiple profibrotic signaling pathways. These compounds reduce profibrotic cytokines, inhibit collagen deposition, reverse myofibroblast differentiation, enhance ECM degradation, and alleviate inflammation and oxidative stress. As a result, they improve MF and regulate systemic inflammatory responses. However, comprehensive data on the pharmacokinetics, bioavailability, long-term safety, and clinical efficacy of these natural compounds are still lacking. Future studies should focus on optimizing delivery strategies and conducting rigorously designed clinical trials to support the clinical translation of these compounds for MF treatment.

ObjectiveTo evaluate the effect of the Eight Deficiency tapping method on cardiac rehabilitation in patients with acute myocardial infarction after percutaneous coronary intervention(PCI).MethodsA total of 80 patients with acute myocardial infarction who underwent emergency PCI in our hospital from January 2023 to January 2024 were selected as the research subjects.They were randomly divided into observation group and control group,with 40 patients each.The control group received conventional exercise rehabilitation,while the observation group received the Eight Deficiency tapping method exercise.The intervention lasted for 12 weeks.The TCM symptom scores,6⁃minute walk distance,quality of life,and compliance of the two groups were compared before the intervention,1 month and 3 months after the intervention.The adverse events caused by the Eight Deficiency tapping method were counted.ResultsThe TCM symptom scores of the observation group were lower than those of the control group.The 6⁃minute walk distance was longer than that of the control group.The scores of the physical activity limitation dimension,angina stability dimension,angina attack frequency dimension,treatment satisfaction dimension,disease subjective feeling dimension,and the total score of the Seattle Angina Questionnaire in the observation group were higher than those of the control group.The compliance were better than that of the control group.And the differences were all statistically significant(P<0.05).There were no adverse events caused by the Eight Deficiency tapping method in the observation group.ConclusionsThe Eight Deficiency tapping method could improve the TCM symptoms of patients with acute myocardial infarction after PCI,enhance their quality of life,exercise tolerance.And it may improve the effect of cardiac rehabilitation.

Neutrophil extracellular traps (NETs) are positively correlated with the severity of calcific aortic valve disease (CAVD). This study aims to elucidate the mechanism by which NETs contribute to CAVD. The CAVD mice model was established by calcification-promoting diets, and NETs formation was modulated via intraperitoneal injection of Cl-amidine. We observed the effect of NETs on Raw264.7 cells by regulating NETs and TLR9 in vitro. Concentrations of TNF-α, MPO-DNA complex, and IL-10 were measured using ELISA. NETs formation was assessed through immunofluorescence assay citrullinated histone H3 (citH3). Expression levels of BMP2, RUNX2, IL-1β, TNF-α, IL-10, and TLR 9 were analyzed by qRT-PCR and Western blotting, while flow cytometry was used to assess the expression of CD86 and CD206 on Raw264.7 cells. Results indicated that compared to the vehicle group, the CAVD group exhibited significant valve thickening and increased calcium deposition, as well as elevated levels of inflammatory factors TNF-α and IL-1β, NET-related markers MPO-DNA complexes and citH3, ossification factors BMP2 and RUNX2, and TLR9. Conversely, IL-10 levels were significantly reduced. Cl-amidine intervention in early CAVD mice significantly improved valve thickness and reduced calcium deposition, inflammatory factors, NETs-related markers, ossification factors, and TLR9 levels, while increasing IL-10 levels. Cl-amidine may delay CAVD progression in mice by reducing NETs. In vitro studies confirmed that serum from CAVD mice induced NETs, promoting the polarization of Raw264.7 cells to the M1 phenotype via TLR9 signaling pathway, thereby releasing pro-inflammatory factors (TNF-α, IL-1β, and IL-6), and inhibiting M2 polarization and IL-10 expression. In summary, our findings suggest that NETs promote Raw264.7 cell polarization to M1 through the TLR9 signaling pathway, contributing to the inflammatory response in CAVD. This study proposes a novel therapeutic strategy targeting NETs to delay CAVD progression.

BackgroundThe global and regional burden of lower extremity peripheral artery disease (LEPAD) and its trends have not been systematically studied. Utilizing data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021, this study analyses the global burden and associated risk factors for LEPAD from 1990 to 2021 and predicts its incidence trends to 2050.MethodsLEPAD-related data including the number of morbidity, mortality, disability-adjusted life years (DALYs), age-standardized rate (ASR), were extracted from the GBD 2021 database. The analysis assesses the burden stratified by social demographic index (SDI), age, and sex. Bayesian age-period-cohort (BAPC) models were used to predict the future age-standardized incidence.FindingsThe global incidence, death, and DALY of LEPAD increased significantly between 1990 and 2021; however, age-standardized incidence rate (ASIR), age-standardized rates of death (ASMR), and age-standardized disability-adjusted life years (ASDR) have shown an overall decline. In addition, ASIR and SDI were positively correlated. Age-specific analyses revealed that ASMR increased with age. The predictions from the BAPC model indicate a slight increase in ASIR over the next 29 years. While high fasting glucose dominated LEPAD DALYs, summary exposure value (SEV) metrics exposed high Low-Density Lipoprotein Cholesterol (LDL-C) as the primary metabolic exposure burden, highlighting a critical prevention gap.InterpretationThe burden of LEPAD increases progressively with age, and its prevalence is influenced mainly by the SDI. Despite the increased incidence of LEPAD in women, mortality and DALYs were substantially higher in men. The global burden of LEPAD is projected to increase progressively by 2050, representing a major health concern.

Cardiovascular disease poses a significant risk to human health and remains the leading cause of illness and death globally, with its incidence continuing to rise. The intricate pathophysiological mechanisms of CVDs include inflammation, oxidative stress, autophagy, and myocardial fibrosis. In light of these underlying mechanisms, traditional Chinese medicine (TCM) and its constituents have demonstrated distinct advantages in managing CVDs. By exerting synergistic effects across multiple components and targets, traditional Chinese medicine can modulate the inflammatory response, mitigate oxidative stress, regulate excessive autophagy, and enhance myocardial fibrosis repair. This article reviews the latest advancements in understanding how TCM compounds regulate signaling pathways involved in the treatment of CVDs.

ObjectiveTo explore the behavioral determinants in capacity management of chronic heart failure patients,in order to enhance their self⁃management ability and quality of life,and provide new perspectives and methods for clinical practice.MethodsBy purpositive sampling,a total of 12 patients with chronic heart failure who visited the cardiology department of a tertiary grade A hospital from June to October 2024 were selected as the research subjects.Based on the descriptive qualitative research method,semi⁃structured interviews were used to collect data,and the directed content analysis method was adopted to analyze the data.ResultsThis study had distilled three behavioral determinants:ability,opportunity,and motivation.In terms of ability,it included cognitive deficiency,weak execution ability,and limited ability to optimize diet structure.In terms of opportunities,it covered the limited accessibility of medical resources and the imperfect social support system.In terms of motivation,there were insufficient automatic driving power and lack of reflective driving power.ConclusionsThe determinants of volume management behavior in patients with chronic heart failure involved multiple dimensions.Each element respectively influenced patient capacity management from aspects such as behavior execution,support acquisition,and behavioral willingness.Strategies should be formulated from aspects such as strengthening cognitive and executive abilities,optimizing support and resources,and stimulating internal drive to enhance patient capacity management capabilities.

The ratio of triglycerides to high-density-lipoprotein cholesterol (TG/HDL-C) is increasingly recognized as a practical marker for insulin resistance and cardiovascular risk assessment. This retrospective study investigates the potential of the TG/HDL-C ratio to predict the development of calcific aortic valve disease (CAVD), thereby extending its applicability in cardiovascular diagnostics. Data from 400 individuals, comprising 200 patients with diagnosed CAVD and 200 matched healthy controls, were analyzed. Clinical parameters were compared between groups, and logistic regression was utilized to explore the association of the TG/HDL-C ratio with CAVD. The diagnostic performance of the TG/HDL-C ratio was assessed using receiver operating characteristic (ROC) curves. The TG/HDL-C ratio was notably higher in the CAVD group than in the controls (Z = -7.98, P < 0.001). Multivariable logistic regression analysis indicated that the TG/HDL-C ratio is an independent predictor of CAVD after adjusting for confounders including gender. The ROC curve analysis revealed that the TG/HDL-C ratio achieved a sensitivity of 80.5

目的 为系统评价麝香保心丸联合西药对比常规西医治疗稳定型心绞痛的有效性与安全性.方法 检索国内外7个数据库(PubMed、Embase、Cochrane、CNKI、WanFang、CBM及VIP)建库起至2021年1月31日,收集麝香保心丸治疗稳定型心绞痛的随机对照研究.两名研究者按照纳排标准对相关研究进行独立筛选、基线及结局指标等资料提取及风险偏倚的评估,如有争议由第三人进行评判.运用RevMan 5.4软件对研究数据进行Meta分析.结果 纳入35项符合标准的研究,总样本量6447例.Meta分析显示,稳定型心绞痛患者在西医常规治疗上加用麝香保心丸后,可进一步提高临床有效率(RR=1.27,95%CI:1.21～1.34,P＜0.00001)、心电图有效率(RR=1.41,95%CI:1.25～1.58,P＜0.00001)和高密度脂蛋白胆固醇(HDL-C)水平(MD=0.19,95%CI:0.05～0.33,P=0.01),降低三酰甘油(TG)水平(MD=-0.31,95%CI:-0.46～-0.16,P=0.01)、总胆固醇(TC)水平(MD=-0.39,95%CI:-0.57～-0.22,P＜0.0001)和低密度脂蛋白胆固醇(LDL-C)水平(MD=-0.25,95%CI:-0.32～-0.19,P＜0.00001),且能更好的降低主要心血管不良事件的发生率(RR=0.62,95%CI:0.45～0.86,P=0.004).结论 麝香保心丸联合常规西药治疗稳定型心绞痛不仅可进一步改善临床症状、心电图疗效,还可降低主要不良心血管事件的发生率,对改善低密度脂蛋白(LDL-C)、高密度脂蛋白(HDL-C)、胆固醇(TC)、三酰甘油(TG)的血脂水平具有积极调理作用,且无严重不良反应的发生.但仍需更多的双盲大样本、长时间随访及实施规范的随机对照试验,为麝香保心丸治疗稳定型心绞痛提供更高质量的临床证据.

经穴体外反搏是特色中医外治技术,可从血流动力学、穴位、经络等多维度治疗冠心病,该疗法将传统中医经络穴位理论应用于体外反搏,具有多途径、多靶点、多效应等特点.本研究综述经穴体外反搏改善血管内皮功能、抗炎、提高剪切应力、改善心肌重塑、促进血管生成及侧支循环开放等的作用,以期抑制动脉粥样硬化的发展,为冠心病的康复治疗提供循证依据.

Intervention based on "digital therapeutics" (DTs) to aid smoking cessation (SC) has developed in recent years. This systematic review and meta-analysis aimed to explore the efficacy of DTs in SC. Databases (PubMed, Embase, Scopus, Institute of Electrical and Electronics Engineers Xplore, ClinicalTrials, Science Direct, Web of Science, China National Knowledge Infrastructure, Chinese Science and Technology Periodical Database, Wanfang, Cochrane Central Register of Controlled Trials) from inception to June 27, 2022 were searched to collect randomized controlled trials focusing on use of DTs for SC. Revman 5.3 and Stata16 were used for meta-analysis. After literature screening, data extraction, and quality assessment by two researchers. 33 studies (19,749 participants) were included. Compared with the control group, DTs significantly increased the prevalence of abstinence of smokers [OR ​= ​1.77, 95% CI [1.39,2.26], p ​= ​0], significantly increased the point prevalence abstinence (PPA) [OR ​= ​1.45,95% CI [1.18,1.78], p ​= ​0], and improved participation in SC programs [OR ​= ​1.12,95% CI [1.01,1.24], p ​= ​0.038]. Subgroup analysis showed that, among different intervention groups, the prevalence of DTs-assisted SC in chronic obstructive pulmonary disease (COPD) smokers was higher than that in other groups [OR ​= ​5.18,95% CI [1.49,18.05], p ​= ​0.001], the prevalence of WeChat-assisted SC in smokers was higher than that in other groups [OR ​= ​4.37,95% CI [2.21,8.67], p ​= ​0]. This meta-analysis showed that DTs-assisted SC improved the prevalence of abstinence, PPA, and increased the participation of smokers in SC programs.

高血压、冠心病、脑卒中等心脑血管疾病越来越年轻化,湿热证为青中年高血压病人最常见的证型之一.通过中医天人合一、取象比类的思维方法,认为痰湿与高血压、血管内皮功能障碍密切相关.临床上治疗高血压疾病时抓住湿、热、毒壅滞这一主要病机,予以芳香利湿化浊、清热解毒、轻清宣透之甘露消毒丹,取得较好疗效.

综述钙化性主动脉瓣膜病发病机制的研究现状.钙化性主动脉瓣膜病是世界范围内最常见的瓣膜疾病,但其发病率和死亡率仍很高.钙化性主动脉瓣膜病潜在病理生理学是复杂的,涉及血流动力学、炎症、代谢等多因素.

心力衰竭(心衰)是各种心血管疾病的终末期阶段,其因患病率高、死亡率高,再住院次数多,给社会经济带来沉重负担.预计2030年美国心衰患者的年均医疗费用将达到700亿[1].心衰是一种全球性疾病,中国心衰患病率为1.3％,日本为1.0％,新加坡为4.5％,澳大利亚为1.0％～2.0％[2].2030年全球心衰患病率预计比2012年高46％,成人心衰患病人数超过800万人[3].据统计,英国心衰住院人数已达到100万个住院床日,占所有急诊入院患者的5％,在未来25年,这些数据预计会增加50％[4].减少心衰患者再住院是已成为心衰管理的主要任务.

心力衰竭(心衰)是一组复杂的临床综合征,以心功能下降和心输出量不足难以满足外周组织代谢需求为特征.心输出量下降导致液体潴留在肺和其他组织,引起呼吸困难、外周水肿和乏力.心衰并不局限于心功能不全,同时还伴随心外组织和器官功能异常,其作为一种全球性疾病,患病率及死亡率均较高.对心衰患者早期诊断,尽早有效干预,提高生活质量,降低再住院率是其治疗的首要任务.仅靠心衰的临床症状和心功能测定很难做出正确的诊断,近年来发现了很多潜在心衰生物标记物,可反映心衰时不同的基因表达通路和心衰的病理过程,并帮助医师对心衰患者进行危险分层,识别高危及心衰高发人群.本文就心衰的新型生物标记物做一概述,以期为后续研究提供参考.

目的 系统评价免疫球蛋白辅助治疗扩张型心肌病(DCM)的疗效与安全性.方法 检索中国期刊全文数据库(CNKI)、中国生物医学文献数据库(CBM)、维普生物医学数据库(VIP)、万方数据库(Wanfang Deta)、PubMed、Embase、Cochrane Librery等数据库,收集从建库至2022年1月发表的免疫球蛋白治疗DCM的临床随机对照试验(RCTs).由2名研究员独立筛选文献、提取数据及质量评价后,采用RevMan 5.3和R 4.1.0软件进行Meta分析.结果 共纳入21篇RCTs,1691例患者,其中试验组(常规治疗联合免疫球蛋白)患者851例、对照组(常规治疗)患者840例.Meta分析结果显示:与对照组比较,试验组患者的临床疗效更好[RR=1.35,95％CI(1.25,1.45),P＜0.000 01],左心室射血分数显著增加[MD=7.35,95％CI(6.13,8.57),P＜0.000 01];显著降低左心室舒张末期内径[MD=-6.23,95％CI(-7.41,-5.05),P＜0.000 01]、免疫球蛋白 G 水平[MD=-1.37,95％CI(-1.96,-0.78),P＜0.000 01]及脑钠肽水平[MD=-474.79,95％CI(-609.29,-340.28),P＜0.000 01].结论 免疫球蛋白辅助治疗进一步改善DCM患者的临床疗效、左心室射血分数、左心室舒张末期内径、免疫球蛋白G及脑钠肽水平.但是纳入文献数目和样本量较少,该结论还需更多高质量、多中心的RCTs来验证.

目的 观察在钙化性主动脉瓣膜病早期进行通心络干预能否延缓其进展.方法 小鼠造模1周后通过随机区组法分成5组,分别为:假手术组、模型组、通心络大剂量组、通心络中剂量组、通心络小剂量组,通心络干预6周后行多普勒超声检测主动脉瓣峰值流速变化;检测血清髓过氧化物酶(MPO)活力和总胆固醇(TC)的浓度;病理学观察主动脉瓣膜组织病理变化和钙盐沉积情况;免疫组化染色检测瓣膜小叶内巨噬细胞浸润,瓣膜间质细胞分化为肌成纤维细胞和成骨细胞的情况.结果 通心络干预6周后,与模型组相比能够显著降低主动脉瓣膜的峰值流速(P<0.05),并且能够显著降低血清总胆固醇水平和血清MPO活力(P<0.01);与通心络干预各组相比,模型组主动脉瓣小叶厚度明显增加(P<0.05)并表现出钙盐沉积;免疫组化结果显示:与模型组比,通心络干预各组巨噬细胞募集减少,α-SMA和OPN阳性细胞表达降低.结论 在钙化性主动脉瓣膜病早期通心络能够通过降低血清TC浓度,抑制炎性巨噬细胞的浸润和降低MPO活性减少病变内氧化应激,进而影响瓣膜间质细胞向肌成纤维细胞和成骨细胞分化,延缓瓣膜钙化的进展.

目前,心血管疾病严重危害着全球人民的身体健康,是造成全球范围内因疾病死亡的首要原因.其中尤以冠状动脉病变为重,冠状动脉疾病中最危急的当属急性心肌梗死(AMI),最容易造成患者的死亡.近几年,随着心肌血运重建治疗逐渐兴起,AMI患者突然死亡的概率大大减低,但AMI最终发展成心力衰竭的患者仍然在稳定的增加[1].近年来,抑制或逆转心肌重构是治疗AMI、改善AMI后心力衰竭的研究热点.然而,研究表明,微小RNA(microRNA,miR)在心肌重构的病理过程中起到了重要的作用,可以通过调控miR来改善心力衰竭的发生发展,这就为心力衰竭的诊治提出了新的思路和方法.本研究主要就miR对AMI后心力衰竭的调控作用做一综述.