Traditional Chinese Medicine Is Widely Used for Cardiovascular Disease

A review article by Hao et al.(J Am Coll Cardiol 2017;69(24):2952– 66)has had huge repercussions among those familiar with traditional Chinese medicine(TCM)in the international academic community.It evaluated the effi cacy and safety of TCM for cardiovascular disease and the pharmacological effect of active TCM ingredients on the cardiovascular system and potential mechanisms.We have several comments:Firstly,we give a brief summary addressing nonpharmacotherapy in TCM,including acupuncture,moxibustion,Qigong,and Tai Chi.Secondly,we have added traditional antiarrhythmic drug– related randomized controlled trials to make the coverage more comprehensive.Lastly,we support the concept that research into,development of,and application of active ingredients is part of modern TCM.

A comprehensive cardiovascular disease lifestyle treatment controlled trial among high-risk African Americans

Background: The purpose of this study was to assess the effects of a comprehensive lifestyle intervention on modifiable cardiovascular risk factors among high-risk African Americans. Methods: The study included a randomized treatment/controlled intervention trial among 136 African Americans residing in Atlanta, GA who were overweight and had elevated blood pressure. The treatment group was exposed to 3-months of a multi-component intervention and the control to an abbreviated 6-week intervention after the completion of the treatment group’s intervention. The main outcomes included mean systolic blood pressure (SBP), mean diastolic blood pressure (DBP), mean waist circumference, mean body mass index (BMI), mean number of times exercise per week, mean number of servings of fruits and vegetables per day, and mean level of daily stress. Data were collected at baseline and at 6-month follow-up. Separate linear regressions were used with an established significance level of P P P = 0.002). Conclusion: These results show that a comprehensive lifestyle intervention can improve cardiovascular risk factor profile among high risk African Americans. Caregivers should encourage patients to participate in such programs and public health policymakers should allocate resources to community based health oriented organizations to implement comprehensive lifestyle program.

Cardiovascular Automatic Feedback Control Instrument for Rescuing Critical Patients With Abnormal Blood Pressure

Objectives Most medical instruments are designed for diagnosis purpose but very few for clinical treatment. Our research aim is to design and develop a cardiovascular automatic feedback control instrument （CAFCI） for rescuing the critical patients with abnormal blood pressure. Methods The CAFCI was designed on the basis of abundant clinical experiences and on successful mathematic modeling of our blood pressure, pulmonary experimental data. The capillary wedge pressure, and rates of heart beat were measured and inputted into a computer and drugs were chosen by a doctor through a user-friendly interface with the computer. The responses to medication were rapidly acquired and feed back to the computer by automatic detection system in a close-loop system. every 7.5 sec in order to dosage The data were refreshed regulate the speed and of the medications that were given. Results The experimental results with ten dogs showed that the CAFCI system took samples promptly and accurately so that the targeted blood pressure could be reached reliably based on our input parameters and our designing requirements. Conclusions Since the dependability and accuracy of the CAFCI system are much superior to that of the traditional method, its clinical application to rescue the critical patient warrants evaluation in the future.

Thirty-day outcomes of in-hospital multi-vessel versus culpritonly revascularization strategy for ST-segment elevation myocardial infarction with multivessel coronary disease

BACKGROUND Many studies have demonstrated the benefit of complete multivessel revascularization versus culprit-only intervention in patients of ST-segment elevation myocardial infarction(STEMI)and multivessel coronary artery disease.However,only a few single-center retrospective studies were performed on small Chinese cohorts.Our study aims to demonstrate the advantage of multivessel percutaneous intervention(PCI)strategy on 30-day in-hospital outcomes to patients with STEMI and multivessel disease in larger Chinese population.METHODS From the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome(CCC-ACS)project,5935 patients with STEMI and multivessel disease undergoing PCI and hospitalized for fewer than 30 days were analyzed.After 5:1 propensity score matching,3577 patients with culprit-only PCI and 877 with in-hospital multivessel PCI were included.The primary outcome was major adverse cardiovascular and cerebrovascular event(MACCE),defined as a composite of myocardial infarction,all-cause death,stent thrombosis,heart failure,and stroke.RESULTS Multivariable logistic regression analysis revealed that in-hospital multivessel PCI was associated with lower risk of 30-day MACCE(adjusted OR=0.75,95%CI:0.57-0.98,P=0.032)than culprit-only PCI and conferred no increased risk of allcause death,myocardial infarction,stent thrombosis,stroke,or bleeding.Subgroup analysis showed that MACCE reduction was observed more often from patients with trans-femoral access(OR=0.34,95%CI:0.15-0.74)than with trans-radial access(OR=0.87,95%CI:0.66-1.16,P for interaction=0.017).CONCLUSIONS The in-hospital multivessel PCI strategy was associated with a lower risk of 30-day MACCE than culprit-only PCI in patients with STEMI and multivessel coronary artery disease.

Emotion recognition support system: Where physicians and psychiatrists meet linguists and data engineers

An important factor in the course of daily medical diagnosis and treatment is understanding patients’ emotional states by the caregiver physicians. However, patients usually avoid speaking out their emotions when expressing their somatic symptoms and complaints to their non-psychiatrist doctor. On the other hand, clinicians usually lack the required expertise(or time) and have a deficit in mining various verbal and non-verbal emotional signals of the patients. As a result, in many cases, there is an emotion recognition barrier between the clinician and the patients making all patients seem the same except for their different somatic symptoms. In particular, we aim to identify and combine three major disciplines(psychology, linguistics, and data science) approaches for detecting emotions from verbal communication and propose an integrated solution for emotion recognition support. Such a platform may give emotional guides and indices to the clinician based on verbal communication at the consultation time.

Gefapixant,a Novel P2X3 Antagonist,Protects against Post Myocardial Infarction Cardiac Dysfunction and Remodeling Via Suppressing NLRP3 Inflammasome

Objective The ATP responsive P2 purinergic receptors can be subdivided into metabotropic P2X family and ionotropic P2Y family.Among these,P2X3 is a type of P2X receptor which is specifically expressed on nerves,especially on pre-ganglionic sensory fibers.This study investigates whether gefapixant possesses the potential of inhibiting cardiac sympathetic hypersensitivity to protect against cardiac remodeling in the context of myocardial infarction.Methods The Sprague-Dawley rats were divided randomly into three groups:sham group-myocardial infarction group,and myocardial infarction with gefapixant treatment group.Myocardial infarction was induced by left anterior descending branch ligation.The gefapixant solution was intraperitoneally injected each time per day for 7 days and the appropriate dosage of gefapixant was determined according to the results of hematoxylin-eosin(HE)staining and myocardial injury biomarkers.Conditions of cardiac function were assessed by echocardiograph and cardiac fibrosis was evaluated by Western blotting and immunofluorescence staining of collagen I and collagen III.The sympathetic innervation was detected by norepinephrine concentration(pg/mL),in-vivo electrophysiology,and typical sympathetic biomarkers.Inflammatory cell infiltration was shown from immunofluorescence staining and pro-inflammatory signaling pathway activation was checked by immunohistology,quantitative realtime PCR(qPCR)and Western blotting.Results It was found that gefapixant injection of 10 mg/kg per day had the highest dosage-efficacy ratio.Furthermore,gefapixant treatment improved cardiac pump function as shown by increased LVEF and LVFS,and decreased LVIDd and LVIDs.The expression levels of collagen I and collagen III,and TNF-αwere all decreased by P2X3 inhibition.Mechanistically,the decreased activation of nucleotide-binding and oligomerization domain-like receptors family pyrin-domain-containing 3(NLRP3)inflammasome and subsequent cleavage of caspase-1 which modulated interleukin-1β(IL-1β)and IL-18 level in heart after gefapixant treatment were associated with the suppressed cardiac inflammation.Conclusion It is suggested that P2X3 inhibition by gefapixant ameliorates post-infarct autonomic nervous imbalance,cardiac dysfunction,and remodeling possibly via inactivating NLRP3 inflammasome.

Nocturnal hypertension and riser pattern are associated with heart failure rehospitalization in patients with heart failure with preserved ejection fraction

BACKGROUND Nocturnal hypertension is reported as a risk factor for cardiovascular disease.This study aimed to explore the potential association between nocturnal hypertension and heart failure(HF)rehospitalization in patients with HF with preserved ejection fraction(HFpEF).METHODS A total of 538 patients with HFpEF from May 2018 to December 2021 were consequently recruited in this study and followed up until they were readmitted for HF or the end of this study.Cox regression analysis was used to reveal the potential association between nighttime blood pressure(BP)levels,nocturnal hypertension and nocturnal BP patterns and HF rehospitalization.Kaplan-Meier curve was used to assess the cumulative event-free survival rate between groups.RESULTS There were 537 patients with HFpEF were included in the final analysis.The mean age of the study population was 77.14±8.68 years,and 41.2% of patients were men.After a median follow-up duration of 10.93(4.19–21.13)months,176 patients(32.7%)with HFpEF were readmitted for HF.Cox regression analysis had revealed that nighttime systolic BP level[hazards ratio(HR)=1.018,95%CI:1.008–1.028,P=0.001],nighttime diastolic BP level(HR=1.024,95%CI:1.007–1.042,P=0.007),nocturnal hypertension(HR=1.688,95%CI:1.229–2.317,P=0.001)were associated with HF rehospitalization.Kaplan-Meier analysis had demonstrated that patients with nocturnal hypertension had significantly lower event-free survival rate(log-rank P<0.001).Furthermore,patients with a riser pattern had a higher risk of HF rehospitalization(HR=1.828,95%CI:1.055–3.166,P=0.031)and lower eventfree survival rate(log-rank P=0.003)than those with a dipper pattern.These findings were also confirmed in patients with HFpEF and hyperuricemia.CONCLUSIONS Nighttime BP levels,nocturnal hypertension and a riser pattern are independently associated with HF rehospitalization in patients with HFpEF,and prominently in patients with HFpEF and hyperuricemia.Well controlled nighttime BP levels should be emphasized and considered in patients with HFpEF.

体质量指数对青少年学生血压升高的影响

目的调查青少年学生的高血压现状,分析学生体质量指数(BMI)与血压之间的关系。方法本研究是一项490名学生包括体格检查在内的整群抽样调查研究,按我国成人BMI标准来进行分组,采用统计软件SPSS13.0来进行分析。结果大多数青少年学生是我国南方地区汉族人群。超重和肥胖合并发生率是12.9%,肥胖率为4.1%。血压正常高值占50.0%,高血压者仅占0.8%。新生超重和肥胖组中高血压和血压高值所占比率较高(χ2值=21.38,P<0.01)。除心率外,新生血压随着BMI升高而增高的线性趋势;超重组和肥胖组的收缩压均明显高于正常组和过低组,正常组的收缩压也高于过低组。新生BMI值与收缩压、舒张压正相关(相关系数分别为0.29和0.19;均P<0.001)。结论 BMI是青少年学生血压升高的一项预测指标,应减少青少年体质量超重和肥胖的发生。

心肌α肌球蛋白重链启动子驱动的绿色荧光蛋白表达载体的构建及鉴定

目的:构建并鉴定心肌α肌球蛋白重链启动子驱动的绿色荧光蛋白表达载体(MHC-EGFP),该基因只在心肌中特异性表达。方法:设计5’和3’分别具有SalI/H indⅢ酶切位点的EGFP引物,聚合酶链反应法(PCR)从pLEGFP质粒中扩增增强型绿色荧光蛋白(EGFP)的cDNA,插入pGEM-T Easy载体表达盒,构建pGEM-EGFP,Sa-lI/H indⅢ双酶切后回收729 kb片断,插入经相同酶切的含5.5 kb心肌特异性α肌球蛋白重链启动子的pNC26质粒,构建pMHC-EGFP。连接产物转化感受态DH5α,挑选克隆,PCR扩增鉴定,重组质粒经NotI酶切,回收7.2 kbMHC-EGFP表达盒。分离培养小鼠心肌细胞与骨骼肌成肌细胞。MHC-EGFP表达盒通过脂质体法分别转染心肌与骨骼肌成肌细胞。荧光显微镜观察转染细胞是否出现绿色荧光,以鉴定MHC-EGFP表达盒是否具有表达特异性。结果:EGFP cDNA正确插入pNC26质粒中αMHC启动子3’端。成功转染MHC-EGFP表达盒的心肌细胞出现绿色荧光,而转染的骨骼肌成肌细胞无荧光出现。结论:MHC-EGFP表达盒具有心肌特异性表达特性,为进一步监测干细胞向心肌分化研究奠定基础。

血管内超声分析重复支架术有或无联合冠脉内放疗对患者支架内再狭窄复发的作用

目的 系列血管内超声 (IVUS)分析重复支架术 (RS)有或无联合冠脉内的放射治疗 (IRT)对支架内再狭窄 (ISR)患者再狭窄复发的作用。方法 99例 ISR的患者经 RS治疗后随机分为 1 92 Ir放疗组 (n=5 7)和对照组 (n=4 2 ) ,行系列冠脉造影和 IVUS检查 ,分别测量支架、管腔及增生内膜的面积和容积。结果 随访 6月 ,冠脉造影显示放疗组较对照组再狭窄复发率低。两组基线和随访的支架最小面积、平均面积和容积均无变化。两组在随访 6月支架最小腔内面积、平均腔内面积和管腔容积均减小 ,平均增生内膜面积和增生内膜容积均增加 ,但对照组比放疗组的变化更明显。结论 系列 IVUS证实 :IRT抑制新生的内膜形成 ,RS联合 IRT较 RS不联合 IRT更有效减少患者的

介入治疗后有或无冠脉内放射治疗对老年支架内再狭窄的作用和疗效:血管内超声分析

目的采用血管内超声(IVUS)评价常规介入治疗术(CIT)有或无联合冠脉内放射治疗(IRT)对支架内再狭窄(ISR)复发的作用及随访观察1年的临床疗效.方法 99例 ISR 的患者经常规介入治疗后随机分为CIT+IRT组和CIT组,在放疗后即刻和6个月行IVUS检查,分别测量支架、管腔及增生内膜(IH)面积,经计算得到支架、管腔内和IH体积并临床随访1年.结果两组基线指标无显著性差异,具有可比性.术后6个月,CIT+IRT组和CIT组的最小管腔面积(MLA)各为(4.30±2.00)mm2与(2.81±2.56)mm2(P=0.006),随访6个月与放射治疗后即刻MLA差值各为(-0.55±1.35)m2与(-1.93±1.66)mm2(P＜0.001).CIT+IRT组和CIT组的IH体积各为(69.23±58.57)mm3与(116.91±121.83)mm3(P=0.021),随访6个月与放射治疗后即刻IH体积差值各为(19.50±35.90)mm与(51.36±58.80)mm3(P=0.017).CIT+IRT组,随访6个月,MLA≥4mm2的比例明显高于CIT组(52.7%与24.0%).术后6个月,冠脉造影显示,CIT+IRT 组和 CIT 组 ISR 的复发率分别为24.53%与78.6%(P=0.027).临床随访1年,CIT+IRT与CIT组的主要不利心脏事件(MACE)、靶血管再次成形术(TVR)及靶病变再次成形术(TLR)的发生率各为27%(11/63)与51.4%(18/35)(P=0.027),23.8%与51.4%(P=0.006),11.6%与40.9%(P=0.007).结论系列IVUS证实,由于IRT抑制支架内的新生内膜形成,因此CIT联合IRT比单纯CIT能更有效地减少老年患者的ISR复发,且改善1年的预后.IVUS测量的MLA＞或＜4mm2可能对患者的远期预后有一定影响.

Sanguinarine Attenuates Lipopolysaccharide-induced Inflammation and Apoptosis by Inhibiting the TLR4/NF-KB Pathway in H9c2 Cardiomyocytes

The inflammatory response is involved in the pathogenesis of the most common types of heart disease. Sanguinarine （SAN） has various pharmacological properties such as anti-inflammatory, antioxidant, antibacterial, antitumor, and immune-enhancing properties. However, few studies have investigated the effects of SAN on lipopolysaceharide （LPS）-induced inflammatory and apoptotic responses in H9c2 cardiomyocytes. Therefore, in this study, H9c2 cells were co-treated with SAN and LPS, and the mRNA levels of pro-inflammation markers and the apoptosis rate were measured to clarify the effect of SAN on cardiac inflammation. The underlying mechanism was further investigated by detecting the activation of Toll-like receptor （TLR）4/nuclear faetor-κB （NF-κB） signaling pathways. As a result, increased mRNA expression of interleukin （IL）-1β, IL-6, and TNFα induced by LPS was attenuated after SAN treatment; LPS-induced apoptosis ofHge2 cardiomyocytes and cleaved-caspase 8, 9, 3 were all significantly reduced by SAN. Further experiments showed that the beneficial effect of SAN on blocking the inflammation and apoptosis of H9c2 cardiomyocytes induced by LPS was associated with suppression of the TLR4/NF-κB signaling pathway. It was suggested that SAN suppressed the LPS-induced inflammation and apoptosis of H9c2 cardiomyocytes, which may be mediated by inhibition of the TLR4/NF-κB signaling pathway. Thus, SAN may be a feasible therapy to treat sepsis patients with cardiac dysfunction.

Shensong Yangxin (SSYX) Ameliorates Disordered Excitation Transmission by Suppressing Cardiac Collagen Hyperplasia in Rabbits with Chronic Myocardial Infarction

The traditional Chinese medicine Shensong Yangxin（SSYX） can improve the clinical symptoms of arrhythmia in an integrated manner. This study aimed to investigate the electrophysiological effect of SSYX on the hearts of myocardial-infarcted rabbits and further explore the mechanism by which SSYX alleviates myocardial fibrosis. Myocardial infarction（MI） was established in rabbits by ligation of the left circumflex coronary. The rabbits were treated with SSYX（0.5 g/kg/d） or saline for 8 weeks by oral administration. Microelectrode array（MEA） technology was used in vivo for extracellular electrophysiological recordings of the infarct border zone. Masson＇s trichrome staining was used to observe myocardial fibrosis. Western blotting was performed to evaluate the protein expression levels of collagen Ⅰ（COL Ⅰ） and collagen Ⅲ（COL Ⅲ）. Quantitative real-time polymerase chain reaction（real-time PCR） was performed to evaluate the TGF-β1 and MMP-2 m RNA expression levels. The results showed that the total activation time（TAT） and the dispersion of TAT were significantly increased and the excitation propagation markedly disordered after MI. SSYX could significantly decrease TAT and the dispersion of TAT, and significantly ameliorate the chaotic spread pattern of excitation. Furthermore, SSYX treatment could significantly decrease COL Ⅰ and COL Ⅲ protein levels and down-regulate TGF-β1 and MMP-2 m RNA expression levels in MI rabbits. It was concluded that SSYX may ameliorate cardiac electrophysiological abnormalities in infarcted hearts by decreasing the protein levels of COL Ⅰ and COL Ⅲ, down-regulating the m RNA expression levels of TGF-β1 and MMP2, and thereby reducing adverse cardiac remodeling.

Gender-specific associations between coronary heart disease and other chronic diseases: cross-sectional evaluation of national survey data from adult residents of Germany

Background Combinations of coronary heart disease(CHD) and other chronic conditions complicate clinical management and increase healthcare costs. The aim of this study was to evaluate gender-specific relationships between CHD and other comorbidities. Methods We analyzed data from the German Health Interview and Examination Survey(DEGS1), a national survey of 8152 adults aged 18-79 years. Female and male participants with self-reported CHD were compared for 23 chronic medical conditions. Regression models were applied to determine potential associations between CHD and these 23 conditions. Results The prevalence of CHD was 9%(547 participants): 34%(185) were female CHD participants and 66%(362) male. In women, CHD was associated with hypertension(OR = 3.28(1.81-5.9)), lipid disorders(OR = 2.40(1.50-3.83)), diabetes mellitus(OR = 2.08(1.24-3.50)), kidney disease(OR = 2.66(1.101-6.99)), thyroid disease(OR = 1.81(1.18-2.79)), gout/high uric acid levels(OR = 2.08(1.22-3.56)) and osteoporosis(OR = 1.69(1.01-2.84)). In men, CHD patients were more likely to have hypertension(OR = 2.80(1.94-4.04)), diabetes mellitus(OR = 1.87(1.29-2.71)), lipid disorder(OR = 1.82(1.34-2.47)), and chronic kidney disease(OR = 3.28(1.81-5.9)). Conclusion Our analysis revealed two sets of chronic conditions associated with CHD. The first set occurred in both women and men, and comprised known risk factors: hypertension, lipid disorders, kidney disease, and diabetes mellitus. The second set appeared unique to women: thyroid disease, osteoporosis, and gout/high uric acid. Identification of shared and unique gender-related associations between CHD and other conditions provides potential to tailor screening, preventive, and therapeutic options.

Efficacy and safety of fondaparinux versus enoxaparin in patients undergoing percutaneous coronary intervention treated with the glycoprotein IIb/IIIa inhibitor tirofiban

Background: In worldwide, the mortality rate of acute myocardial infarction(AMI) raises year by year. Although the applications of percutaneous coronary intervention(PCI) and anticoagulants effectively reduce the mortality of patients with acute coronary syndrome(ACS), but also increase the incidence of bleeding. Therefore, drugs with stable anticoagulant effects are urgently required.Methods: We enrolled 894 patients with acute coronary syndrome who underwent percutaneous coronary intervention in Shenyang Northern Hospital from February 2010 to May 2012; 430 patients were included in the fondaparinux group(2.5mg/d), and 464 were included in the enoxaparin group(1mg/kg twice daily). Fondaparinux and enoxaparin were applied for 3–7 days. All patients were treated with tirofiban [10μg/kg for 3min initially and 0.15μg/(kg·min) for 1 to 3 days thereafter]. The primary efficacy endpoint was the incidence of a major adverse cerebrovascular or cardiovascular event. The primary safety endpoint was bleeding within 30 days and 1 year after percutaneous coronary intervention.Results: One-year data were available for 422 patients in the fondaparinux group and for 453 in the enoxaparin group. The incidence of a major adverse cerebrovascular or cardiovascular event(10.9% vs 12.6%, P=0.433) and cardiac mortality(0.5% vs 1.5%, P=0.116) were generally lower in the fondaparinux group than in the enoxaparin group, although the differences were not significant. Compared with the enoxaparin group, the fondaparinux group had a significantly decreased rate of bleeding at 30 days(0.9% vs 2.9%, P=0.040) and 1 year(2.4% vs 5.5%, P=0.018). In addition, the rate of major bleeding events was lower in the fondaparinux group, but this difference was not significant(0.2% vs 0.9%, 0.2% vs 1.1%).Conclusion: In tirofiban-treated patients with acute coronary syndrome undergoing percutaneous coronary intervention, fondaparinux presented similar efficacy for ischemia events as enoxaparin. However, fondaparinux significantly decreased the incidence of bleeding, thus providing safer anticoagulation therapy.

Myocardin in biology and disease

Myocardin （MYOCD） is a potent transcriptional coactivator that functions primarily in cardiac muscle and smooth muscle through direct contacts with serum response factor （SRF） over cis elements known as CArG boxes found near a number of genes encoding for contractile, ion channel, cytoskeletal, and calcium handling proteins. Since its discovery more than 10 years ago, new insights have been obtained regarding the diverse isoforms of MYOCD expressed in cells as well as the regulation of MYOCD expression and activity through transcriptional, post-transcriptional, and post-translational processes. Curiously, there are a number of functions associated with MYOCD that appear to be independent of contractile gene expression and the CArG-SRF nucleoprotein complex. Further, perturbations in MYOCD gene expression are associated with an increasing number of diseases including heart failure, cancer, acute vessel disease, and diabetes. This review summarizes the various biological and patho- logical processes associated with MYOCD and offers perspectives to several challenges and future directions for further study of this formidable transcriptional coactivator.

Autonomic function and ventricular tachyarrhythmias during acute myocardial infarction

Most cases of sudden cardiac death are attributed to sustained ventricular tachyarrhythmias(VTs), triggered by acute coronary occlusion. Autonomic dysfunction, an important arrhythmogenic mechanism in this setting, is being actively investigated, aiming at the advent of preventive strategies. Recent experimental studies have shown vagal withdrawal after anterior myocardial infarction, coinciding with high incidence of VTs, followed by more gradual sympathetic activation coinciding with a second arrhythmia peak. This article summarizes recent knowledge on this intriguing topic, generating hypotheses that can be investigated in future experimental and clinical studies.

Effects of neuregulin-1 on autonomic nervous system remodeling post-myocardial infarction in a rat model

Sympathetic nerve and vagus nerve remodeling play an important part in cardiac function post-myocardial infarction （MI）. Increasing evidence indicates that neuregulin-1 （NRG-1） improves cardiac function following heart failure. Since its impact on cardiac function and neural remodeling post-MI is poorly understood, we aimed to investigate the role of NRG-1 in autonomic nervous system remodeling post-MI. Forty-five Sprague-Dawley rats were equally randomized into three groups： sham （with the left anterior descending coronary artery exposed but without ligation）, MI （left anterior descending coronary artery ligation）, and MI plus NRG-1 （left anterior descending coronary artery ligation followed by intraperitoneal injection of NRG-1 （10 lag/kg, once daily for 7 days））. At 4 weeks after MI, echocardi- ography was used to detect the rat cardiac function by measuring the left ventricular end-systolic inner diameter, left ventricular diastolic diameter, left ventricular end-systolic volume, left ventricular end-diastolic volume, left ventricular ejection fraction, and left ventricular fractional shortening, mRNA and protein expression levels of tyrosine hydroxylase, growth associated protein-43 （neuronal specific pro- tein）, nerve growth factor, choline acetyltransferase （vagus nerve marker）, and vesicular acetylcholine transporter （cardiac vagal nerve fiber marker） in ischemic myocardia were detected by real-time PCR and western blot assay to assess autonomous nervous remodeling. After MI, the rat cardiac function deteriorated significantly, and it was significantly improved after NRG-1 injection. Compared with the MI group, mRNA and protein levels of tyrosine hydroxylase and growth associated protein-43, as well as choline acetyltransferase mRNA level significantly decreased in the MI plus NRG-1 group, while mRNA and protein levels of nerve growth factor and vesicular acetylcholine transporters, as well as choline acetyltransferase protein level slightly decreased. Our results indicate that NRG- 1 can improve cardiac function and regulate sympathetic and vagus nerve remodeling post-MI, thus reaching a new balance of the autonomic nervous system to protect the heart from injury.

Path analysis of relationship among personality, perceived stress, coping, social support, and psychological outcomes

AIM: To provide a structural model of the relationship between personality traits, perceived stress, coping strategies, social support, and psychological outcomes in the general population.METHODS: This is a cross sectional study in which the study group was selected using multistage cluster and convenience sampling among a population of 4 million. For data collection, a total of 4763 individuals were asked to complete a questionnaire on demographics, personality traits, life events, coping with stress, social support, and psychological outcomes such as anxiety and depression. To evaluate the comprehensive relation-ship between the variables, a path model was fitted.RESULTS: The standard electronic modules showed that personality traits and perceived stress are important determinants of psychological outcomes. Social support and coping strategies were demonstrated to reduce the increasing cumulative positive effects of neuroticism and perceived stress on the psychological outcomes and enhance the protective effect of extraversion through decreasing the positive effect of perceived stress on the psychological outcomes. CONCLUSION: Personal resources play an important role in reduction and prevention of anxiety and depression. In order to improve the psychological health, it is necessary to train and reinforce the adaptive coping strategies and social support, and thus, to moderate negative personality traits.