Interrupting neural pathways that transduce stressful information into physiological responses

Stressor-stimuli evoke a noradrenergic process in the frontal lobes, the amplitude of which depends on both the individual’s experience with the stimulus and his or her genetic background. Novel and noxious stimuli evoke large frontocortical responses and benign ones evoke relatively larger reactions in persons with a family history of cardiovascular disease. Blockade of neural projections from the frontal cortex and amygdala to the brainstem cardiovascular centers will normalize blood-pressure elevations in experimental hypertension and prevent lethal arrhythmias in animals with a myocardial infarction. The anti-mortality effect of the cardiac drugs known as beta-blockers is exerted by inhibition of cerebral beta-receptors, not peripheral ones. A new putative neuropeptide, NLX, may have the same desirable cardiovascular effects, but without the side-effects that limit clinical usefulness. The neural regulation of the heart during stress can be detected by a new deterministic measure of low-dimensional chaos in heartbeat intervals. In both animals and humans undergoing myocardial infarction, this deterministic measure correctly predicts lethal arrhythmogenesis, minutes to hours prior to the event. Thus an approach combining both brain and heart studies (i.e., “neurocardiology”) has led to an understanding of how stressor-stimuli evoke autonomic reactions. This, in turn, has led to new methods in the diagnosis and treatment of cardiovascular disorders.     

干细胞移植治疗冠心病的现状与未来

冠心病仍然是全球的主要死亡原因。其所造成的心肌梗死及慢性心力衰竭对生活质量的影响和由此造成的高额医疗费用促使我们不断寻求新的医疗措施。近几年有关干细胞用于心肌梗死后心肌再生、心肌内新生血管形成,可能还会改善梗死后的心功能的研究成为心脏病学研究的最热门领域。尽管干细胞治疗有可能使心力衰竭的治疗得到彻底的革命,但仍有部分问题需要澄清。已发表的各个研究结果设计不尽相同,致使对该项治疗的效果较难得出一致的结论。但这些研究都强调干细胞治疗在未来心血管疾病的治疗中可能会发挥较大的作用。干细胞治疗与药学、外科及介入治疗的结合会显著改善冠心病患者的预后。     

Emotional appraisal is influenced by cardiac afferent information

Influential models highlight the central integration of bodily arousal with emotion. Some emotions, notably disgust, are more closely coupled to visceral state than others. Cardiac baroreceptors, activated at systole within each cardiac cycle, provide short-term visceral feedback. Here we explored how phasic baroreceptor activation may alter the appraisal of brief emotional stimuli and consequent cardiovascular reactions. We used functional MRI (fMRI) to measure brain responses to emotional face stimuli presented before and during cardiac systole. We observed that the processing of emotional stimuli was altered by concurrent natural baroreceptor activation. Specifically, facial expressions of disgust were judged as more intense when presented at systole, and rebound heart rate increases were attenuated after expressions of disgust and happiness. Neural activity within prefrontal cortex correlated with emotionality ratings. Activity within periaqueductal gray matter reflected both emotional ratings and their interaction with cardiac timing. Activity within regions including prefrontal and visual cortices correlated with increases in heart rate evoked by the face stimuli, while orbitofrontal activity reflected both evoked heart rate change and its interaction with cardiac timing. Our findings demonstrate that momentary physiological fluctuations in cardiovascular afferent information (1) influence specific emotional judgments, mediated through regions including the periaqueductal gray matter, and (2) shape evoked autonomic responses through engagement of orbitofrontal cortex. Together these findings highlight the close coupling of visceral and emotional processes and identify neural regions mediating bodily state influences on affective judgment.     

冠脉介入术支架内血栓的危险因素和预防策略

支架内血栓形成是经皮冠状动脉介入治疗罕见但极为严重的并发症,常导致患者心肌梗死和死亡。其危险因素包括抗血小板治疗、支架因素、介入操作因素、患者及病变因素等。预防的关键在于积极防治上述危险因素,主要包括延长抗血小板治疗疗程、选择合适的支架类型和操作技术、开发新型支架和抗血小板药物,同时注意冠心病二级预防。     

Individual differences in cardiovascular reactions to stress and cigarette smoking

The present study examined the stability of cardiovascular reactions to psychological stress and cigarette smoking, and the extent to which cardiovascular reactions to stress were predictive of cardiovascular reactions to smoking. Thirty subjects were given an initial test involving two repetitions of mental arithmetic stress and paced smoking while blood pressure and heart rate were measured. Two months later, 26 of these subjects were retested in the same paradigm. Large and stable individual differences were observed in cardiovascular reactivity to both stress and smoking. Moreover, for systolic and diastolic blood pressure, but not heart rate, reactions to stress were modestly correlated with reactions to cigarette smoking. These results are consistent with the possibility that level of reactivity to cigarette smoking may constitute a risk factor for coronary heart disease, and that one or more common variables may mediate the magnitude of blood pressure reactivity to both stress and cigarette smoking.     

Retraction Note: Globalization and vulnerable populations in times of a pandemic: A Mayan perspective

Understanding representations of disease in various art genres provides insights into how patients and health care providers view the diseases. It can also be used to enhance patient care and stimulate patient self-management. This paper reviews how cardiovascular diseases are represented in novels, films, and paintings: myocardial infarction, aneurysm, hypertension, stroke, heart transplantation, Marfan’s disease, congestive heart failure. Various search systems and definitions were used to help identify sources of representations of different cardiovascular diseases. The representations of the different diseases were considered separately. The Common Sense Model was used a theoretical model to outline illness perceptions and self-management in the various identified novels, films, and paintings. Myocardial infarction followed by stroke were the most frequently detailed diseases in all three art genres. This reflects their higher prevalence. Representations ranged from biomedical details through to social and psychological consequences of the diseases. Artistic representations of cardiovascular diseases reflect cognitions, emotions, and images of prevalent disease. These representations shape views and behaviour of ill and healthy persons regarding heart diseases. As these representations are amenable to change, they deserve further research, which may be instrumental in improving the quality of life of persons struck by cardiovascular diseases. Changing illness perceptions appears to be a method to improve self-management and thereby quality of life in patients with various cardiovascular diseases.     

Magnitude of cerebral asymmetry at rest: covariation with baseline cardiovascular activity

The cerebral regulation of cardiovascular functioning varies along both a lateral and a longitudinal axis. The parasympathetic and sympathetic nervous systems are lateralized to the left and right cerebral hemispheres, respectively. Further, the frontal lobes are known to be inhibitory in nature, whereas the temporal lobes are excitatory. However, no systematic investigation has been conducted to determine the nature and strength of the relationship between the left and right frontal and temporal lobes in regulating cardiovascular activity. The present investigation sought to examine these relationships by testing the hypothesis that negative correlations would be found between baseline heart rate and blood pressure and asymmetry of alpha magnitude across the frontal lobes. Further, positive correlations were hypothesized to exist across the temporal lobes. A total of 20 women were asked to relax with their eyes closed while heart rate and blood pressure as well as quantitative electroencephalography data were obtained. The results indicated that, as hypothesized, significant negative correlations existed across the frontal lobes and significant positive correlations existed across the temporal lobes. The results provide further support for a division of responsibility between the left and right frontal and temporal lobes in the regulation of heart rate and blood pressure.     

Thinking and feeling in the People's Republic of China: testing the generality of the "laws of emotion"

Cognitive theories of emotion assert that emotional reactions to events depend on the manner in which events are interpreted and appraised. From this perspective, the same outcome can produce different emotions. For example, a score of 85% on a test can evoke positive feelings if it is considered a success or negative feelings if it is considered a failure. Among the various appraisal dimensions that have been identified, causal attributions are thought to play a particularly influential role in shaping emotional reactions to various events. For example, success can evoke pride if it is attributed to high ability, gratitude if it is attributed to help from others, relief if it is attributed to a stroke of good fortune, or guilt if it is attained fraudulently or at the expense of others. These cognitive-affective linkages are thought to be universal. In this paper, we report two studies that tested the cross-cultural generality of some of these assumptions. In Study 1, participants from the People's Republic of China were led to succeed or fail on an (alleged) test of their intelligence and creativity. Consistent with previous findings with Western samples, attributions to ability predicted participants' emotional reactions to their test performance, with high ability attributions linked to greater pride following success. In Study 2, we extended these findings with American and Chinese participants, using a different experimental manipulation of success and failure, and a measure of attributions to effort. For both cultural groups, attributions to ability (but not attributions to effort) predicted greater emotional reactions to success. We conclude that attribution-emotion linkages have cross-cultural validity, and that pride is maximized when success is attributed to high ability.     

骨桥蛋白在心肌梗死后心力衰竭中研究进展

骨桥蛋白是一种糖基化的多功能蛋白,其具有激活细胞内信号传导、参与炎症细胞的趋化聚集、促进肿瘤的生长迁移等多种生物学功能。近年来研究表明其在心肌梗死后的炎症反应、心室重塑、细胞外基质沉积及肾素-血管紧张素-醛固酮系统的过度激活中具有重要的作用,同时其与心肌梗死后心力衰竭的严重程度及顸后亦密切相关。本文就骨桥蛋白在心肌梗死后心力衰竭中研究进展做一综述。     

2010年我国急性ST段抬高型心肌梗死诊断与治疗指南解读评析

近年来我国急性心肌梗死的发病率一直呈明显上升趋势,已接近国际平均水平。对于STEMI版早期诊断并及时开通梗死相关动脉、增加心肌再灌注、防止心肌进一步坏死,可显著降低心血管事件的发生。本文从STEMI的诊断、早期医疗、再灌注治疗、辅助治疗及二级预防等几个方面对2010年我国急性ST段抬高型心肌梗死的诊断与治疗指南进行了详细解读分析。     

The bradycardia of the dive reflex—A possible mechanism of sudden death

Slowing of the heart rate as part of an oxygen-conserving reflex has been observed in man when breath-holding with the face under water. Emotionally significant situations were found capable of either inhibiting or facilitating the reflex, thus placing the mechanism under the control of the cerebral hemispheres. Indeed, features of the reflex have been induced in human subjects during attempts to penetrate the brachial artery with a hypodermic needle and in association with a mild startle reaction. The latter was observed to a striking degree in four subjects who subsequently died of recurrent myocardial infarction. It is suggested that a protective response designed to conserve oxygen may be inappropriately involved under a variety of circumstances and may be lethal if excessive or if unbalanced by opposing forces.     

Neural correlates of theory-of-mind reasoning: an event-related potential study

Everyday understanding of human behavior rests on having a theory of mind—the ability to relate people's actions to underlying mental states such as beliefs and desires. It has been suggested that an impaired theory of mind may lie at the heart of psychological disorders that are characterized by deficits in social understanding, such as autism. In this study, we employed the event-related potential methodology to index the activity of neural systems that are engaged during theory-of-mind reasoning in adults. Specifically, neural activity elicited by tasks that required thinking about mental as compared with nonmental representations (i.e., beliefs vs. photographs) was characterized by a focally enhanced positivity over left frontal areas, which was diminished over left parietal areas. These findings provide an important perspective on both children's theory-of-mind development and the neurobiology of disorders in which theory of mind seems to be impaired.     

Object alternation and orbitofrontal system dysfunction in Alzheimer's and Parkinson's disease

Previous performance on measures of frontal system function have suggested prominent orbitofrontal system damage in Alzheimer's disease, but not in Parkinson's dementia. Object alternation (OA), a task sensitive to orbitofrontal system dysfunction in non-human animals, was therefore administered to determine whether this measure would distinguish Alzheimer's from Parkinson's dementia. OA was significantly impaired in Alzheimer's disease compared to Parkinson's dementia, even though both groups were equated for severity of dementia. Although the patients with Parkinson's dementia also showed impairment on OA compared to normals, an error analysis revealed that the performance of the Alzheimer's patients, but not the Parkinson's patients, was characterized by abnormal response perseveration. The marked perseverative deficit in Alzheimer's disease may reflect orbitofrontal system dysfunction whereas the milder, and qualitatively different, deficits in Parkinson's disease may reflect dorsolateral frontal system involvement.     

Association of heart rate and heart-rate variability with scores on the emotion profile index in patients with acute coronary heart disease.

We investigated the link between the eight basic emotions named by Plutchik and heart rate, heart-rate variability in the 114 patients, 86 men and 28 women (M = 53.8 yr., SD = 8.0) with acute coronary heart disease during the initial 24-hr. stay in the coronary care unit and again at hospital discharge. Variability in heart rate was significantly positively associated with scores on Trust (the emotional state acceptance) at hospital admission and discharge in the patients with unstable angina and non-Q-wave infarction, on Aggression in the patients with unstable angina at hospital discharge and at hospital admission in the patients with non-Q-wave infarction. There was inverse relation on Timid (the emotional state fear) and Gregarious (joy) at hospital admission and on Distrust (disgust or rejection), Depressed (sadness), and Dyscontrol (impulsiveness) at hospital discharge in the patient with non-Q-wave infarction. There was no significant association between heart-rate variability and the scores on the Emotion Profile Index in the patients with anterior and posterior myocardial infarction. There was no statistically significant association between heart rate and scores on the Emotion Profile Index in the patients with acute coronary disease at hospital admission and discharge. Our results suggest psychological interventions that enhance emotional states represented by the Trust and Aggression scales and minimize those represented by Depressed, Dyscontrol, Timid, and Distrust scales could have a beneficial effect on cardiovascular function in the patients with unstable angina and non-Q-wave infarction in a hospital setting.     

Cardiovascular dynamics during classical appetitive and aversive conditioning in laboratory primates

This report describes changes in the rate of rise of left and right intraventricular pressures during aversive and appetitive conditioning procedures in chair-restrained rhesus monkeys. The conditioning paradigm consisted of a one-minute tone followed, in the one case, by an electric shock, and in the other, by the delivery of Purina monkey pellets. The conditional cardiovascular response was characterized by short latency, highly significant elevations in the derivatives of both ventricular pressures as well as a marked arterial pressor response and tachycardia. The magnitude of the conditional response to the classical aversive procedure was somewhat larger than that to appetitive conditioning. These alterations in the rate of development of intraventricular pressure can be attributed largely to augmentation in the sympathetic neural input to the heart and contribute to an analysis of selective aspects of the nervous regulation of the heart in intact, behaviorally conditioned animals.     

Neuropsychological disorders indicative of postresuscitation encephalopaty in rats

The aim of this research was to study the effect of 12-minute clinical death on innate and acquired behavior, biogenic amine concentration, and the composition and quantity of neural populations in specific brain regions of white rats. The study shows that in animals during the postresuscitation period with formal restoration of neurological status, there are changes in emotional reactivity, orientation-exploration reactions, impairment of learning and memory, decrease in exercise tolerance and pain sensitivity. These processes are accompanied by alterations in serotonin and norepinephrine levels in the frontal cerebral cortex, dopamine and serotonin levels in the striatum, certain biochemical indices in blood plasma and neural loss in the CA1 sector of the hippocampus and lateral portions of the cerebellum.     

防治血管剩留风险的决策探讨

针对冠心病和（或）2型糖尿病患者,已有许多有效的防治措施。然而,尽管接受了当前的标准治疗,这类患者仍会反复发生许多大血管和微血管事件,这种现象称之为血管剩留风险。有许多因素影响血管剩留风险的存在,其中最为重要的是致动脉粥样硬化性血脂异常。因此,采取积极的全面干预措施如改善生活方式、联合降脂以改善所有的脂质异常指标,是最大程度降低血管剩留风险的动向。     

Heart rate variability in the human transplanted heart: Nonlinear dynamics and QT vs RR-QT alterations during exercise suggest a return of neurocardiac regulation in long-term recovery

Rationale. Functional reinnervation of the transplanted human heart by the autonomic nervous system has not been demonstrated. A lack of autonomic control of the transplanted allograft is reflected by an increased resting heart rate, a sluggish heart rate response to dynamical exercise and a reduced heart rate variability. Recent evidence suggests that a measure of deterministic chaos in the heartbeat interval series (point correlation dimension, PD2i) is superior to the conventional power spectrum or other stochastic measures in detecting changes in the mechanism underlying heartbeat generation.Methods. The PD2i is based on the presumption that the variability is determined and patterned, whereas the stochastic measures all assume that the variability is around a stationary mean and is noise. The PD2i reconstructs the degrees of freedom (number of independent variables) in the system that generates the time series examined, and does this irrespective of whether the system is stochastic or deterministic and is stationary in time.Results. PD2i was determined for heartbeat intervals (RR, ECG digitized at 1200 Hz; supine posture) of 23 heart transplant recipients (HTR: 9 adults, 14 children; 0.04-7.7 years after transplantation) and 21 healthy control subjects (CTL; 13 adults, 8 children). The PD2i (+/? SD) averaged 5.4 +/? 0.7 for the CTL adults and 5.4 +/? 0.6 for the CTL children. Mean PD2i was reduced after transplantation to 1.1 +/? 0.1 in 6 HTRs recorded within 1 year after surgery; in one HTR recorded 2 weeks after surgery the mean PD2i was 3.7. Between 1 to 2 years PD2i was found increased in 2 of 3 subjects and between 2 to 8 years it was increased in 13 of 13, but not to control levels. In normal hearts the QT subinterval of each heartbeat cycle is associated with inotropy and the RR-QT remainder with chronotropy (i.e., the dyastolic interval during which RR is primarily regulated). To examine more closely the residual and returning heartbeat dynamics of the HTR subjects, these subinterval series were examined during mild exercise (40 to 90 Watts) and its recovery. In recent HTRs, resting QT and RR-QT were moderately reduced and modulated by exercise and recovery, but with an approximate 100 beat latency. In long-term (7-8 years) HTR subjects there was a rapid and larger response to exercise/recovery, but compared to normal the range was smaller and the complexity of the subinterval trajectories in time was simpler.Conclusions. Recurrence of low-dimensional deterministic dynamics after transplantation suggests recovery of neurocardiac control attributable to 1) reorganization of the viable intrinsic cardiac nervous system, 2) reinnervation by the extrinsic autonomic nervous system, or 3) both.     

Modeling ADHD-type arousal with unilateral frontal cortex damage in rats and beneficial effects of play therapy

It has been recently shown that human adolescents with Attention Deficit/Hyperactivity Disorder (ADHD) have frontal lobe deficits, especially on the right sides of their brains (). ADHD is commonly treated with psychostimulants which may have adverse consequences. Hence, less invasive therapies need to be developed. In the present work, we tested the ability of right frontal lesions to induce hyperactivity in rats. We also evaluated the effects of chronic play therapy during early adolescence to reduce both hyperactivity and the elevated playfulness later in development. Play therapy was able to reduce both hyperactivity and excessive playfulness. In additional work, we found that access to rough-and-tumble play in normal animals could enhance subsequent behavioral indices of behavioral inhibition (i.e., freezing in response to a startle stimulus) that appeared to be independent of increased fearfulness and fatigue. Overall, these results suggest that (1) neonatal frontal lobe lesions can be used as an animal model of the overactivity in ADHD and (2) rough-and-tumble play therapy may be a new useful treatment for ADHD.