Heart failure is a significant disease that threatens human life and health globally, yet its pathogenesis remains incompletely understood, posing challenges for targeted treatment. The pleiotropic transcription factor c-Myc participates in the regulation of various biological processes and has been extensively studied in the field of oncology. Recent studies have increasingly indicated that c-Myc is also associated with the development of non-oncological diseases such as heart failure, playing a role in regulating key biological processes including cardiac hypertrophy, cardiac fibrosis, energy metabolism, and cardiac regeneration and repair in heart failure. This article reviews the latest research progress on c-Myc in heart failure, discussing its role in the pathogenesis of heart failure, its clinical significance, its potential as a therapeutic target, and the regulatory effects of traditional Chinese medicine on c-Myc. c-Myc is widely involved in the pathological process of the occurrence and development of HF, but its function is highly diverse. The specific effects of c-Myc vary considerably depending on the pathological context, disease stage, and its expression level. Current research on c-Myc is primarily at the preclinical stage. In order to facilitate the clinical translation of c-Myc as a potential therapeutic target for HF, future research may focus on precise targeting of c-Myc, optimal expression and timing, exploration of its mechanisms, and the potential of traditional Chinese medicine in modulating its effects.

Proangiogenic therapy offers a promising strategy for treating and preventing heart failure and cardiac remodeling following a myocardial infarction (MI). Although exosome-based proangiogenic therapy has significant potential in regenerative medicine and MI treatment, its application remains limited by suboptimal therapeutic efficacy. Here, we present exosomes (HXYQR-Exo) derived from the serum of mice treated with the Huoxue Yiqi Recipe (HXYQR) to promote angiogenesis and repair cardiac tissue post-MI, with a systematic elucidation of the underlying mechanisms. Our findings show that HXYQR-Exo incorporates pharmaceutically active components of HXYQR, enhancing the proliferation, invasion, migration, and tube formation of human umbilical vein endothelial cells (HUVECs) under hypoxic conditions. In vivo studies demonstrate significant improvements in cardiac function and angiogenesis. Mechanistic investigations reveal that these effects are mediated through the activation of the HIF-1α/VEGF, Focal Adhesion Kinase (FAK), and p38/Mitogen-Activated Protein Kinase-Activated Protein Kinase (MAPKAPK)/Heat Shock Protein 27 (HSP27) pathways. This study introduces an exosome-based approach for MI treatment and cardiac repair, offering an effective strategy to enhance exosome biological activities and functions via traditional Chinese medicine preconditioning.

OBJECTIVE:This study aimed to investigate the protective effects of Qiliqiangxin capsule (QLQX) against cognitive impairment in rats with heart failure (HF), as well as the underlying mechanisms. MATERIALS AND METHODS:Heart failure was induced in rats by LAD ligation. The animals were randomized into four groups (sham, model, QLQX [0.6 g/kg/d], and valsartan [13.3 mg/kg/d]) and received treatment for 60 days. Cardiac function was evaluated by echocardiography, while cognitive function was assessed using the Morris water maze. Myocardial and hippocampal morphology were examined by HE and Nissl staining, respectively. Hippocampal levels of Ang II, Aβ42, and ROS were quantified via ELISA and DHE staining. Finally, Western blot analysis was performed to measure the expression of AT1R, NF-κB, P-gP, RAGE, and the tight junction proteins (Claudin-5, Occludin). RESULTS:Echocardiographic assessments revealed that QLQX significantly improved cardiac function in rats with HF-induced cognitive impairment. The Morris water maze test demonstrated that, compared with the model group, QLQX treatment enhanced the targeting of swimming path and increased the number of platform crossings-consistently indicating alleviation of cognitive dysfunction. Histological analysis using HE staining confirmed that QLQX preserved myocardial structural integrity. Nissl staining further demonstrated that QLQX mitigated neuronal damage in the hippocampus. Additionally, QLQX reduced the levels of Ang II, AT1R, ROS, and Aβ42. It also downregulated the expression of NF-κB and P-gP while upregulating that of Claudin-5 and Occludin. CONCLUSIONS:QLQX improves cardiac function and mitigates cognitive decline in rats with heart failure. These protective effects likely involve the reduction of Ang II, AT1R, and ROS levels, alongside inhibition of the NF-κB pathway. Furthermore, QLQX upregulates the tight junction proteins Claudin-5 and Occludin, which helps preserve blood-brain barrier (BBB) integrity. This cascade of events ultimately reduces cerebral Aβ deposition.

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.

Coronary heart disease (CHD) is the leading cause of death globally, posing a serious threat to human health. However, the current treatment approaches available for CHD fall short of the ideal results. Tongxinluo (TXL) is a traditional Chinese medicine (TCM) that has been employed in the clinical treatment of cardiovascular and cerebrovascular diseases (such as angina pectoris, stroke, etc.) in China for many years and holds great potential as a prospective treatment. TXL either as a standalone treatment or in combination with interventions recommended in CHD guidelines has been shown to be effective and well tolerated in clinical trials for CHD. Drawing on the evidence from clinical trials and experimental studies, this review will focus on the cardiovascular protective properties and related mechanisms of TXL. By searching 8 Chinese and English databases, more than 4000 articles were retrieved. These articles were categorized, then read, and finally written into this review. In this review, the pharmacological properties of TXL include regulation of blood lipids, improvement of endothelial function, anti-inflammatory, antioxidant, inhibition of apoptosis and regulation of autophagy, anti-fibrosis, promotion of angiogenesis, and modulation of exosome communication. The information provided in this review will help the reader to comprehend better the insights that TCM has developed over time in practice and provide new perspectives for the treatment of CHD.

The onset of Alzheimer's disease is related to neuron damage caused by massive deposition of Aβ in the brain. Recent studies suggest that excessive Aβ in the brain mainly comes from peripheral blood, and BBB is the key to regulate Aβ in and out of the brain. In this study, we explored the pathogenesis of AD from the perspective of Aβ transport through the BBB and the effect of QKL injection in AD mice. The results showed that QKL could improve the cognitive dysfunction of AD mice, decrease the level of Aβ and Aβ transporter-RAGE, which was supported by the results of network pharmacology, molecular docking and molecular dynamics simulation. In conclusion, RAGE is a potential target for QKL's therapeutic effect on AD.

Objective: This study aims to evaluate the clinical and preclinical efficacy of SMI in treating CHF, and to summarize the relevant mechanisms of action in order to provide evidence for its role in CHF treatment.Methods: A systematic computerized search of eight databases and three registry systems was performed, with the time frame spanning from the inception of the databases to 30 June 2023. Strict procedures were used for data extraction, quality assessment, and data analysis. The methodological quality of the included studies was assessed using RoB-2 and SYRCLE tools. Statistical analysis was performed using Rev Man 5.4 software, using either fixed-effects or random-effects models.Results: A total of 25 clinical trials (including test group 1,367 patients, control group 1,338 patients) and 11 animal studies (including 201 animals) were included in this review. The meta-analysis of clinical studies showed that SMI can improve cardiac function indicators (LVEF, LVFS, LVEDV, LVESV, LVEDD, LVESD) (p < 0.00001), reduce BNP/NT-proBNP levels (p < 0.01), and improve inflammatory markers (hs-CRP, TNF-α, IL-6) (p < 0.00001) and endothelin (ET) levels (p < 0.0001). In animal studies, SMI demonstrated improved cardiac function (LVEF, LVFS) (p < 0.05), and improved heart failure markers (NT-proBNP, p < 0.05) when compared to control groups.Conclusion: This study represents the first meta-analysis which includes both preclinical and clinical studies on SMI. Clinical and animal studies have shown that SMI can improve cardiac function in CHF patients through its anti-apoptotic effects, antioxidant activities, anti-inflammatory effects, and improvement of myocardial metabolism. This study has certain limitations in terms of literature quality, quantity, and follow-up time. Therefore, the conclusions drawn from this study may require further validation through larger-scale, high-quality RCT trials.

Background: Chinese patent medicines (CMPs) have curative effectiveness in preventing coronary restenosis. However, the relative efficacy between different CPMs has not been sufficiently investigated. Methods: Randomized clinical trials were searched from electronic databases including PubMed, Web of Science, Cochrane Library, Embase, CNKI, VIP, WanFang, SinoMed, Chinese Clinical Trial Registry, and ClinicalTrials.gov. Bayesian network meta-analysis was performed to analyze CPMs' efficacy in preventing angiographic restenosis, recurrence angina, acute myocardial infarction, and target lesion revascularization after percutaneous coronary intervention. Results: This network meta-analysis included 47 trials with 5,077 patients evaluating 11 interventions. Regarding angiographic restenosis, the efficacy of CPMs (except Xuezhikang capsule) combined with standard treatment (Std) was superior to Std alone, and Guanxin Shutong capsule plus Std reduced the risk of angiographic restenosis by 76% (relative risk 0.24, 95% confidence interval 0.11-0.45, and very low to moderate certainty of evidence), most likely the best intervention. Fufang Danshen dripping pill combined with Std showed superiority over other interventions for relieving recurrence angina, which can reduce the risk by 83% (RR 0.17, 95% CI 0.04-0.51, very low to moderate certainty of evidence) compared to Std alone. In acute myocardial infarction after percutaneous coronary intervention, compared with Std alone, Danhong injection plus Std displayed a significant effect (RR 0.11, 95% CI 0.00-0.69, very low to moderate certainty of evidence) and was the best treatment probably. Chuanxiongqin tablet plus Std was the most effective treatment for reducing target lesion revascularization by 90% (RR 0.10, 95% CI 0.00-0.60, very low to moderate certainty of evidence) compared with Std alone. Conclusion: The results indicated that CPMs combined with Std reduced the risk of coronary restenosis after percutaneous coronary intervention. However, the results should be interpreted cautiously due to significant data limitations.

慢性心力衰竭是以心为主,多脏腑功能失调的一种本虚标实的疾病.慢性心衰患者常常出现认知功能障碍的现象,其原因尚不明确.而中医藏象学说中的"心肾相交"理论为阐释慢性心衰导致认知功能障碍的发生提供了理论依据."心神"与"肾志"是认知功能的主要组成部分,当心肾相交之时,神气清明,志意常治.若心气不足,肾失气化,心火不能下温肾水,肾水不能上济心火,导致心肾不交,就会出现健忘、迟钝等神志的异常.从而出现认知功能障碍.本文旨在通过"心肾相交"理论探讨慢性心衰患者出现认知功能障碍的可能病机,为慢性心衰导致的认知功能障碍的论治提供思路与方法.

心血管疾病是全球人口死亡的主要原因,饮食对动脉粥样硬化性心血管疾病(ASCVD)有重要影响.2022 年,美国预防心脏病学会(ASPC)发表声明,强调改变饮食模式对预防 ASCVD及其危险因素的重要性,推荐预防 ASCVD的最佳饮食结构,并讨论特殊人群预防 ASCVD的饮食建议.在该指南基础上进行解读,旨在为临床实践提供参考.

目的:观察益气泻肺汤对慢性心力衰竭大鼠心脏和认知功能的影响.方法:将24只无特定病原体(SPF)级SD大鼠分为假手术组、模型组和益气泻肺汤组,每组8只.通过冠状动脉结扎术制作心肌梗死后慢性心力衰竭大鼠模型,益气泻肺汤组给予益气泻肺汤13 g/(kg·d)灌胃,假手术组及模型组按100 g体质量1 mL纯净水灌胃,连续给药8周后,采集大鼠舌象,超声检测大鼠左室射血分数(LVEF)、左室短轴缩短率(LVFS),水迷宫实验检测大鼠空间学习及记忆能力,酶联免疫吸附试验(ELISA)检测大鼠血清血管紧张素Ⅱ(AngⅡ)浓度,苏木精-伊红(HE)染色观察大鼠心肌组织镜下形态.结果:与假手术组比较,模型组大鼠心脏LVEF、LVFS水平明显降低,水迷宫逃避潜伏期时间延长,穿越平台次数减少,血清AngⅡ浓度增加,差异均有统计学意义(P<0.05或P<0.01).与模型组比较,益气泻肺汤组大鼠心脏LVEF、LVFS水平增高,水迷宫逃避潜伏期时间缩短,穿越平台次数增加,血清AngⅡ浓度减少,差异均有统计学意义(P<0.05或P<0.01).结论:益气泻肺汤能够有效改善大鼠心脏泵血功能,延缓心肌重塑进程,整体改善心脏功能,并提高大鼠认知水平,其机制可能与下调AngⅡ水平有关.

ETHNOPHARMACOLOGICAL RELEVANCE:Chinese herbal medicine (CHM) is widely used for treating coronary heart disease complicated with heart failure (CHD-HF). However, the exact mechanisms involved are still not fully understood. AIM OF THE STUDY:To assess the clinical effectiveness and potential pharmacological mechanisms of CHM for treating CHD-HF. METHODS:Eight databases were retrieved for Randomized Controlled Trials of CHM for CHD-HF published from their inception to March 2023. Quality assessment of include studies was performed by the Cochrane risk-of-bias. Meta-analysis was used to assess the effectiveness of CHM for CHD-HF, and then core drugs and active ingredients were selected by data mining and network pharmacology. Finally, cluster and enrichment analysis were adopted to explore the potential targets and signaling pathways. RESULTS:A total of 52 studies enrolling 5216 patients were included. Meta-analysis revealed that CHM treatment groups significantly improved left ventricular ejection fraction (LVEF), 6-min walk test (6-MWT), left ventricular end-diastolic dimension (LVEDD) and left ventricular end systolic diameter (LVESD) than control groups: [LVEF: SMD = 0.7, 95%CI (0.54, 0.87), p < 0.00001, I2 = 80%; 6-MWT: SMD = 0.72, 95%CI (0.58, 0.86), p < 0.0001, I2 = 67%; LVEDD: SMD = -0.79, 95%CI (-0.89, -0.69), p < 0.0001, I2 = 49%; LVESD: SMD = -0.6 (-0.74, -0.46), p < 0.0001, I2 = 0%]. The results of various biological information analysis showed the internal relationship between prescriptions, core drugs, active ingredients and therapeutic targets. Twelve core herbs with the most commonly use and high correlation were selected from 110 CHMs of 52 prescriptions for CHD-HF treatment, and further 65 effective components were screened out according to the most strength value, which were divided into 12 compounds such as terpenoids, flavonoids, steroids and alkaloids and etc. At the same time, 67 therapeutic targets of active ingredients in CHD-HF were filtrated. On these bases, cluster and enrichment analysis of the components and targets were used to explore relevant pharmacological mechanisms, mainly including anti-myocardial cell damage, anti-inflammation, anti-apoptosis, anti-fibrosis, regulation of oxidative stress, anticoagulation and angiogenesis, and improvement of glucose and fatty acid metabolism. CONCLUSION:CHM are effective in treating CHD-HF compared with conventional treatment. Some of the included studies have high risks in the implementation of blinding, so more high-quality studies are needed. The active ingredients of CHM could protect the myocardium and improve pathological environment of CHD-HF in various ways. And CHM has the advantage of multi-component and multi-target treatment for complex diseases.

Sick sinus syndrome (SSS) is a refractory arrhythmia disease caused by the pathological changes of sinoatrial node and its adjacent tissues. 2,251 publications related to SSS were retrieved from Web of Science database from 2000 to 2022 and analyzed by using VOS viewer and CiteSpace software. The results showed the United States dominated the field, followed by Japan, Germany, and China. SSS was closely related to risk factors such as atrial fibrillation and aging. Sick sinus syndrome, atrial fibrillation and sinus node dysfunction were the top three keywords that had the strongest correlation with the study. Pacemaker implantation, differentiation and mutation are research hotspots currently. Clinical studies on SSS found that sick sinus syndrome, atrial fibrillation, and pacemakers were the top three keywords that had the largest nodes and the highest frequency. In the field of basic applied research and basic research, atrial fibrillation and pacemaker cells were the focus of research. In conclusion, bibliometric analysis provided valuable information for the prevention, treatment and future research trends of SSS.

Ethnopharmacological relevance: Danhong injection (DHI),which is extracted from Salviae miltiorrhizae and Flos carthami,has been widely prescribed to patients with unstable angina pectoris (UAP) in China. However, a high quality clinical trial is needed. Aim of the study: To determine whether DHI can relieve symptoms of transient myocardial ischemia in patients with unstable angina pectoris. Materials and methods: A double-blind, placebo-controlled, randomized clinical trial was conducted in nine hospitals in China. Inpatients with UAP with blood stasis syndrome (BSS) were randomized 1:1 to receive DHI or placebo. The primary outcome was improvement rate in the quantification score of angina pectoris. Secondary outcomes included blood stasis syndrome scale, nitrates use, electrocardiogram recordings, PCI procedures, Seattle Angina Questionnaire (SAQ) and biochemical indexes. Results: 160 participants were enrolled and 159 were analyzed. There was no significant difference in primary outcome as compared with control group at the end of 7-day treatment, but significant difference at 28-day follow up (70.53% [95% CI, 59.97-81.09%] and 54.34% [95% CI, 42.68-65.99%]; P = 0.0423). The BSS score was significantly lower in the DHI group than that in the control group at day 28 (6.49 [6.96] vs 10.53 [9.07], P = 0.0034). In addition, DHI was significantly superior to placebo in the angina stability score of SAQ (91.10 [17.37] versus 78.21 [22.08], P < 0.001). There were no significant differences in other secondary outcome measures. Conclusions: A small decrease in the total effective rate and an increase in the angina stability score were observed 28 days after implementation of DHI in UAP with a total blood stasis syndrome score decrease, but the efficacy was not observed at day 7. The findings support that DHI may potentially relieve clinical symptoms and can benefit angina stability. Clinical trial registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT02007187.

慢性心力衰竭(chronic heart failure,CHF)是指心脏的收缩及舒张功能下降,引起心脏收缩射血和或充盈能力受损,心脏泵血不能满足组织代谢需要的严重疾病,是各种心血管疾病发生发展的终末期阶段,此类患者生存质量差,预后不良[1-2].中医药对心衰病有着非常显著的效果,可明显改善心衰病患者的胸闷、憋气、水肿的症状[3].从中医理论角度分析,心衰病其病位在心,涉及肝脾肺肾.郭维琴教授认为当代人饮食不节、嗜食肥甘厚味损伤脾胃,或者工作压力大、情志焦虑抑郁致情志郁结,二者共同致病,导致心衰病,总属本虚标实、寒热错杂之症.此类患者生存质量低,预后差,因此在治疗过程中郭维琴教授针对该病复杂病因病机,主张在治疗心力衰竭应当在益气活血利水的基础上,从肝脾论治,以疏肝健脾、益气活血、温阳利水为治疗大法,临床每获良效.

郭维琴教授治疗心系疾病的临床经验方以益气活血法为主,使用活血化瘀药物方面独具特色.常用对药组合有丹参与红花、郁金与片姜黄,2组药对均为寒热并用,药性平和.特色角药组合有鬼箭羽、郁金与枳壳,莪术、昆布与浙贝母,前者3药合用契合气血同调理论,适合冠心病心绞痛症状明显患者,后者以莪术配伍昆布、浙贝母治疗严重的动脉硬化斑块.同时,郭教授亦善用其他活血药,如川芎、泽兰等.

目的 观察参桂胶囊联合西药治疗冠心病慢性心力衰竭阳虚血瘀证临床疗效.方法 将57例冠心病慢性心力衰竭阳虚血瘀证患者按照随机数字表法分为治疗组30例,对照组27例.两组均予规范化药物治疗,治疗组在此基础上联合使用参桂胶囊,每次1.2 g,每日3次,两组均治疗8周;比较治疗前后两组患者纽约心脏协会(New York Heart Association,NYHA)心功能分级、中医证候积分、N端B型脑钠肽前体(NT-proBNP)、超声心动图指标及心肌能量消耗值(MEE),并分析MEE与NT-proBNP相关性.结果 治疗后两组NYHA心功能分级比较,治疗组优于对照组(P＜0.05),治疗组心功能疗效总有效率(70.0％)优于对照组(37.0％)(P＜0.05).与治疗前相比,两组患者治疗后阳虚症状积分、血浆NT-proBNP水平均明显下降(P＜0.05);治疗后治疗组气喘、气短、乏力、畏寒肢冷症状评分及血浆NT-proBNP水平改善优于对照组(P＜0.05).与治疗前相比,两组患者治疗后左室每搏输出量(LVSV)、二尖瓣舒张早期与舒张晚期血流速峰值比值(E/A)、左室射血分数(LVEF)均升高(P＜0.05),治疗组LVSV、E/A、LVEF较对照组升高更明显(P＜0.05).与治疗前相比,治疗组MEE明显降低(P＜0.05),治疗组MEE降低优于对照组(P＜0.05).Pearson相关性分析结果显示,MEE水平与NT-proBNP呈正相关(r=0.320,P=0.015).结论 参桂胶囊联合常规标准化西医治疗能显著改善冠心病慢性心力衰竭阳虚血瘀证患者临床症状、心脏舒张功能,并降低心肌能量消耗水平.

目的 观察具有神经毒性的寡聚肽Aβ42对体外血脑屏障通透性及转运Aβ的影响以及清开灵的干预作用.方法 通过体外培养Balb/c小鼠脑微血管内皮细胞形成血脑屏障,随机分为正常对照组(加入DMEM)、模型组(加入Aβ42)和清开灵组(加入Aβ42+清开灵),测定各组TEER值、HPR 2小时通透率,用ELISA法检测各孔Aβ40浓度值,用Western blot法检测RAGE、LRP-1、Claudin-5、Occludin、PKC和ERK的表达水平.结果 与正常组比较,模型组TEER值、claudin-5的表达显著降低(P＜0.05,0.01),HRP、Aβ40的透过量、RAGE、PKC蛋白的表达量明显增加(P＜0.01);与模型组比较,清开灵能够增加TEER值(P＜0.05)、claudin-5的表达(P＜0.01),抑制HPR和Aβ40的透过量(P＜0.05,0.01),明显减少RAGE、PKC蛋白表达(P＜0.01).结论 清开灵注射液对血脑屏障的结构和功能均有保护作用,通过明显减少RAGE表达,增加Claudine-5表达,分别从细胞内转运途径和细胞旁转运途径抑制Aβ的透过,阻断AD发病过程中的恶性循环,这主要与抑制PKC信号通路有关.

Objective To assess the value of left atrium volume index（LAVI）for diagnosing heart failure with preserved ejection fraction (HFpEF) based on the invasive determination of left ventricular end-diastolic pressure (LVEDP). Methods A total of 710 cases of patients with dyspnea (LVEF≥50%) were enrolled in this retrospective study. Left ventricular end-diastolic pressure (LVEDP) was measured through selective coronary angiography. According to the value of LVEDP, cases were divided into the HFpEF group ( LVEDP≥15mmHg) and the control group (LVEDP<15mmHg). LAVI was calculated based on cardiac compartment diameter, as measured by echocardiography, and body surface area (BSA). Differences of LAVI between the HFpEF group and the control group, and between subgroups in the HFpEF group were analyzed. Results The difference in LAVI between the control group and the HFpEF group was statistically significant (41.35±2.28vs.46.78±2.63ml/m 2 , p=0.008). LVEDP was positively correlated with LAVI (Pearson: r=0.787, P＜0.001). When LAVI took the best cutoff value of 43.7 mm/m 2 , the sensitivity and specificity of diagnosis of HFpEF were 92.0% and 88.9%. When the boundary value of LAVI was from 41.7 to 45.7 mm/m 2 , the sensitivity of the diagnosis of ejection fraction retention heart failure was from 97.4% to 64.4% and the specificity was from 51.2.0% to 92.2%. Conclusion In patients with dyspnea after exclusion of heart failure with reduced ejection fraction (HFrEF), LAVI is positively correlated with LVEDP. LAVI can be used to diagnose HFpEF when HFrEF is excluded.

心悸是中医内科常见的心系疾病,以患者自觉心中跳动难安,常伴有胸闷、憋气甚或晕厥为主要临床表现[1].临床无器质性病变的心悸较为多见,西医对此类疾病治疗效果不甚理想.郭维琴教授结合当今社会发展特点及临床经验,认为内伤七情和药食劳逸不当是此类心悸的主要病因,提出其主要病位在心,责之肝、脾,肝失疏泄、脾失健运及两者同时发生都可导致心血亏虚、心脉失养.本文主要总结其对此类心悸发生发展的中医理论认识,详述从肝脾论治此类疾病的临床用药经验并附医案一则.