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10th Anniversary of JCM—Evidence-Based Medicine, Research and Education in Integrative and Personalized Medicine for Cardiovascular Medicine Section

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiovascular Medicine".

Deadline for manuscript submissions: closed (30 June 2023) | Viewed by 49090

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Special Issue Editor

Prof. Dr. Nandu Goswami

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Guest Editor

1. Division of Physiology, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Medical University of Graz, Auenbruggerpl. 2, 8036 Graz, Austria
2. Center for Spaceflight and Aviation Health, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
Interests: cardiovascular system; heart rate variability; gravitational adaptation
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Special Issue Information

Dear Colleagues,

Introduction—Changing demands in Global Health

Created in 1948, the WHO laid an emphasis on treatment and cure of diseases. However, it was not until the Alma Ata declaration in 1978 that a health promotion and disease prevention narrative and primary health care were emphasized. The recently concluded Global Conference on Primary Health Care in Astana, Kazakhstan (25–26 October) saw a coming together of health leaders from around the world to celebrate the 40th anniversary of the declaration and to renew a commitment to primary healthcare and to achieve universal health coverage and the Sustainable Development Goals. The Alma Ata declaration is particularly significant for the future of global healthcare at a time when attempts to contain chronic diseases of epidemic proportions are failing. Many of these conditions are preventable—for instance, up to 70% of cardiovascular diseases and similar proportions of food-, diet-, and lifestyle-related conditions.

Evidence for China’s Traditional Chinese Medicine (TCM) and India’s AYUSH (Ayurveda, Yoga, Unaani, Siddha and Homeopathy) Systems and Further Needs to Address Global Health Challenges:

TCM and AYUSH practices such as acupuncture, Yoga, and meditation are health-promoting practices which have a centuries-long history in China and India, not just in the places where they were conceived, where they evolved and where they were systematized, but throughout both countries. Well-established institutions for higher education are now in place in almost all parts of both these countries. Large nation-wide programs for diabetes management and prevention and research programs for management for mental health issues are now running in China and India, and hospitals and practitioners for all these modalities can be found even in the most rural locations. Many other large programs for health promotion and disease prevention are now being managed by the respective governments in China and India. The beneficial effects of these programs mean that many more of their facets for improving public health are also being implemented.

While TCM, Ayurveda, Yoga, and meditation are part of daily life in China and India, they are not particularly positively perceived and, therefore, still not well-received in the western world. There are many pre-conceptions and much skepticism in the minds of western medical practitioners, and this makes it difficult for them to even consider “alternative” forms of medical therapy that differ from the standard allopathic approaches to which they were exposed in medical school for regular treatment of patients. To convince medical practitioners and health workers to accept other forms of healthcare, there is a need to present solid evidence-based research, using western state-of-the-art research tools, to critically examine TCM and ayurvedic products/ supplements, Yoga, and meditation. Similarly, the medical community is mostly skeptical about the beneficial effects of TCM, Ayurveda, Yoga, and meditation and would benefit from insights developed from such a critical examination.

Meditation and Cardiovascular Diseases—An example:

A number of studies on the beneficial effects of meditation provide important examples of how alternative approaches to medical treatment can be integrated into contemporary western medicine. Conventional drug therapies do not always address the causes of cardiovascular disease, which are often rooted in unhealthy lifestyle behaviors. Furthermore, conventional pharmacological and surgical therapies for cardiovascular disease often lead to serious adverse effects, including adverse drug effects, impairments in quality of life, and increased mortality. For these reasons, national practice guidelines of the American Heart Association, the American College of Cardiology, the National Institutes of Health (NIH), and other professional associations recommend non-drug lifestyle modifications as the first line of therapy for individuals with hypertension and as part of a comprehensive package of lifestyle modifications and drug therapy for individuals with diagnoses of CHD. It is also well established that stress causes, contributes to, and/or exacerbates cardiovascular diseases such as hypertension and coronary heart disease, and a large body of evidence shows that meditation is the most effective stress-reduction technique available for cardiovascular disease patients. Thus, stress reduction limits the physiological and pathological consequences of chronic stress, and alternative medical applications of meditation can provide both a treatment and preventive healthcare solution. ^1-7

Scope of the Special Issue:

The Special Issue we propose will provide a platform to enlighten the scientific community, health practitioners, and policy makers about TCM, Ayurveda, Yoga, and meditation. By presenting in-depth and critical analyses and also incorporating an evidenced-based perspective (using randomized cross over clinical trials, where available), the beneficial effects of TCM, Ayurveda, Yoga and meditation will be objectively considered. The Special Issue will encompass a series of reviews, including meta-analyses and systematic reviews and some original representative research papers that examine research of very high quality that has been carried out in these areas. Additionally, such analysis and new approaches based on TCM, Ayurveda, Yoga, and meditation hold much promise for leading the medical community to develop new approaches in both the curative and preventative arenas. Such a detailed exploration and detailed discussion will be a crucial step to remove the biases held by western medical practitioners and educators and shine light on the benefits.

Finally, this Special Issue also underlines the need for a shift in the educational paradigm of medical training so that aspects related to prevention of disease and promotion of a healthy lifestyle are included in the curriculum. This need was echoed recently by Harvard Medical School, which since September 2018 is reassessing its mission statement away from a purely disease focus toward improving health and wellness for everyone: “To create and nurture a diverse community dedicated to teaching and learning, discovery and scholarship, service and leadership to improve health and wellness for everyone.”, https://todayspractitioner.com/john-weeks/paradigm-shift-harvard-medical-school-considering-mission-reframe-from-sickness-model-to-health/#.W83zNlJRdsM). This review series will provide concrete examples of how the preventative care dimension of TCM, Ayurveda, Yoga, and meditation can be integrated into western medical school curricula and also how research should be carried out in a typical western medical school setting regarding preventative care and healthy living.

References

American Journal of Hypertension 21: 310–316, 2008
Current Hypertension Reports 9: 520–528, 2007.
Hypertension 26: 820–827, 1995.
Stroke, 2000 Mar., 31(3):568-73.
Ethnicity and Disease, 2004. 14: S2-54.
Archives of Internal Medicine 166: 1218–1224, 2006.
American Journal of Cardiology, 2005. 95(9): 1060- 1064.
Journal of Clinical Psychology, 1989. 45(6): 957–974.

Prof. Dr. Nandu Goswami
Guest Editor

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

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Keywords

TCM
Ayurveda
Yoga
meditation
cardiovascular health

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Published Papers (12 papers)

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12 pages, 1165 KiB

Open AccessArticle

Impact of Clinical Pharmacist Running Anticoagulation Clinic in Saudi Arabia

by Abdulrahman Alshaiban, Sirajudeen S. Alavudeen, Ibrahim Alshahrani, Abdulaziz M. Kardam, Ibrahim Mohammed Alhasan, Saleh Abdulrahman Alasiri, Mohammad Tarique Imam, Ziyad Saeed Almalki and Md Sayeed Akhtar

J. Clin. Med. 2023, 12(12), 3887; https://doi.org/10.3390/jcm12123887 - 7 Jun 2023

Cited by 4 | Viewed by 2324

Abstract

Despite the effectiveness of warfarin in extended anticoagulation, its narrow therapeutic index requires frequent dose adjustments and careful patient monitoring. Thus, we aimed to evaluate the outcomes of clinical pharmacists’ intervention in warfarin therapy management in terms of International Normalized Ratio (INR) control, reduction of bleeding, and hospitalization in a tertiary care hospital. An observational retrospective cohort study was conducted on 96 patients taking warfarin therapy in a clinical pharmacist-led anticoagulation clinic. We observed that 39.6% of patients required dose adjustments at their first and second visits. However, dose adjustments during the third, fourth, and fifth weeks were required at 31.1%, 20.8%, and 4.2%, respectively, to achieve INR levels. We also observed that 36.46% of the patients attained the target INR at baseline, which was increased over the first week to the fifth week to 57.29%, 61.46%, 61.46%, 68.75%, and 85.42%, respectively. No one reported the ADR between the third and fifth weeks. Based on our findings, the study strongly suggests that pharmacists’ interventions can improve the health-related quality of life of patients undergoing warfarin therapy. Thus, competent pharmacy personnel must be a priority in both usual patient care and critical care among primary care networks. Full article

(This article belongs to the Special Issue 10th Anniversary of JCM—Evidence-Based Medicine, Research and Education in Integrative and Personalized Medicine for Cardiovascular Medicine Section)

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12 pages, 808 KiB

Open AccessArticle

Vascular Responses following Light Therapy: A Pilot Study with Healthy Volunteers

by Adam Saloň, Bianca Steuber, Ruslan Neshev, Karin Schmid-Zalaudek, Patrick De Boever, Eva Bergmann, Rainer Picha, Per Morten Fredriksen, Benedicta Ngwechi Nkeh-Chungag and Nandu Goswami

J. Clin. Med. 2023, 12(6), 2229; https://doi.org/10.3390/jcm12062229 - 13 Mar 2023

Cited by 5 | Viewed by 3551

Abstract

(1) Background: Studies have reported the effectiveness of light therapy in various medical conditions. Our pilot study aimed to assess the effect of Maharishi light therapy (MLT) on physiological parameters, such as the heart rate (HR), HR variability (HRV), blood pressure (BP), BP variability (BPV), and the retinal microvasculature of healthy participants; (2) Methodology: Thirty (14 males and 16 females) healthy, non-smoking participants between 23 and 71 years old (46 ± 18 years) were included in this randomized crossover study. Each participant was tested with a placebo (using LED light) and gem lights, 24 h apart. Hemodynamic parameters were recorded during the session, and 24 h heart rate and BP levels were assessed via mobile devices. Retinal vascular responses were captured with fundus images and the subsequent analysis of retinal vessel widths. A linear model, using repeated measures ANOVA, was used to compare the responses across the sexes and to assess the effect of the MLT; (3) Results: Changes in the central retinal artery equivalent (CRAE) (p < 0.001) and central retinal vein equivalent (CRVE) (p = 0.002) parameters were observed. CRAE and CRVE decreased under MLT and increased under the placebo condition from before to after. However, the baseline values of the participants already differed significantly before the application of any therapy, and the variation in the retinal vessel diameters was already large in the baseline measurements. This suggests that the observed effect results may only reflect naturally occurring fluctuations in the microcirculation and not the effect of MLT. Furthermore, no significant effects were observed in any other investigated parameters; (4) Conclusion: Our study with healthy participants finds significant changes in retinal parameters, but the biological variation in the baseline measurements was large to begin with. This suggests that the observed effect results only reflect naturally occurring fluctuations in the microcirculation and not the effect of MLT. However, in the future, larger studies in which MLT is applied for longer periods and/or in patients with different diseases could discover the physiological impacts of this type of therapy. Full article

(This article belongs to the Special Issue 10th Anniversary of JCM—Evidence-Based Medicine, Research and Education in Integrative and Personalized Medicine for Cardiovascular Medicine Section)

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12 pages, 1317 KiB

Open AccessArticle

Effects of Meditation on Cardiovascular and Muscular Responses in Patients during Cardiac Rehabilitation: A Randomized Pilot Study

by Maximilian E. Rudlof, Boštjan Šimunić, Bianca Steuber, Till O. Bartel, Ruslan Neshev, Petra Mächler, Andreas Dorr, Rainer Picha, Karin Schmid-Zalaudek and Nandu Goswami

J. Clin. Med. 2022, 11(20), 6143; https://doi.org/10.3390/jcm11206143 - 18 Oct 2022

Cited by 4 | Viewed by 3007

Abstract

Background: Cardiovascular diseases are the world’s number one cause of death, with exceeding psychosocial stress load being considered a major risk factor. A stress management technique that has repeatedly shown positive effects on the cardiovascular system is the Transcendental Meditation (TM) technique. The present pilot study aimed to investigate the potential effect of TM on the recovery of cardiac patients. Objectives: We hypothesized that practicing TM in patients undergoing a 4-week cardiac rehabilitation program augments the recovery of cardiovascular parameters and reduces skeletal muscle tone after rehabilitation. Methods: Twenty cardiac patients were recruited and randomly assigned to either the control or the TM group. Cardiovascular parameters were assessed with the Task Force Monitor (TFM) and skeletal muscle contractile properties by Tensiomyography during a sit-stand test, performed at the beginning and end of a 4-week in-patient rehabilitation program. Results: Systolic blood pressure (SBP) was significantly lower after 4 weeks of cardiac rehabilitation, while the RR-interval (RRI) significantly increased. At the skeletal muscle level, the contraction time and maximal displacement increased, though only in the gastrocnemius medialis and biceps femoris muscles and not in vastus lateralis. Group interactions were not observed for hemodynamic parameters nor for muscle contractile properties. Discussion: Although significant improvements in hemodynamic and muscular parameters were observed after 4 weeks of rehabilitation, we could not provide evidence that TM improved rehabilitation after 4 weeks. TM may unfold its effects on the cardiovascular system in the longer term. Hence, future studies should comprise a long-term follow-up. Full article

(This article belongs to the Special Issue 10th Anniversary of JCM—Evidence-Based Medicine, Research and Education in Integrative and Personalized Medicine for Cardiovascular Medicine Section)

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23 pages, 2904 KiB

Open AccessArticle

Stress Reduction by Yoga versus Mindfulness Training in Adults Suffering from Distress: A Three-Armed Randomized Controlled Trial including Qualitative Interviews (RELAX Study)

by Jan Moritz Fischer, Farid-Ihab Kandil, Christian S. Kessler, Lucas Nayeri, Laura Sophie Zager, Theresa Rocabado Hennhöfer, Nico Steckhan, Daniela A. Koppold-Liebscher, Holger C. Bringmann, Thomas Schäfer, Andreas Michalsen and Michael Jeitler

J. Clin. Med. 2022, 11(19), 5680; https://doi.org/10.3390/jcm11195680 - 26 Sep 2022

Cited by 14 | Viewed by 6658

Abstract

Distress is a growing public health concern. In this three-armed randomized controlled trial, n = 102 adults with elevated stress levels and stress-related symptoms were randomly assigned to (1) “integrative” yoga classes which combined physical exercises, mindfulness training, and ethical/philosophical aspects of traditional yoga; to (2) Iyengar yoga classes which entailed primarily physical exercises; or to (3) mindfulness training without physical training. We hypothesized the synergistic effects of physical yoga exercises, mindfulness, and ethical/philosophical aspects. The primary outcome was the group difference on Cohen’s Perceived Stress Scale (PSS) after 12 weeks. Secondary outcomes included burnout, quality of life, physical complaints, depression, anxiety, mindfulness, interoceptive awareness, self-regulation, spirituality, mysticism, and posttraumatic stress. All outcomes were evaluated at baseline (V0), after 12 weeks (V1), and after 24 weeks (V2). A subset of participants took part in qualitative interviews. A lasting and clinically relevant stress reduction was observed within all groups (PSS ΔV0–V1_{Integrative Yoga} = −6.69 ± 6.19; ΔV0–V1_{Iyengar Yoga} = −6.00 ± 7.37; ΔV0–V1_Mindfulness = −9.74 ± 7.80; all p < 0.00). Effect sizes were also statistically large at the end of the follow-up period (Cohen’s d _{Integrative Yoga} = 1.41; d _{Iyengar Yoga} = 1.37; d _Mindfulness = 1.23). There were no significant group differences or evidence of relevant synergistic effects from combining mindfulness and physical yoga exercises. All three interventions were found to be equally effective methods of stress reduction. Their use in practice should be based on availability and patient preference. Full article

(This article belongs to the Special Issue 10th Anniversary of JCM—Evidence-Based Medicine, Research and Education in Integrative and Personalized Medicine for Cardiovascular Medicine Section)

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14 pages, 846 KiB

Open AccessArticle

Prevalence and Clinical Impact of Electrocardiographic Abnormalities in Patients with Chronic Kidney Disease

by Sejun Park, Yunjin Yum, Jung-Joon Cha, Hyung Joon Joo, Jae Hyoung Park, Soon Jun Hong, Cheol Woong Yu and Do-Sun Lim

J. Clin. Med. 2022, 11(18), 5414; https://doi.org/10.3390/jcm11185414 - 15 Sep 2022

Cited by 1 | Viewed by 2758

Abstract

Chronic kidney disease (CKD) is a strong risk factor for cardiovascular disease. An electrocardiogram (ECG) is a basic test for screening cardiovascular disease. However, the impact of ECG abnormalities on cardiovascular prognosis in patients with CKD is largely unknown. A total of 2442 patients with CKD (stages 3–5) who underwent ECG between 2013 and 2015 were selected from the electronic health record database of the Korea University Anam Hospital. ECG abnormalities were defined using the Minnesota classification. The five-year major adverse cerebrocardiovascular event (MACCE), the composite of death, myocardial infarction (MI), and stroke were analyzed. The five-year incidences for MACCE were 27.7%, 20.8%, and 17.2% in patients with no, minor, and major ECG abnormality (p < 0.01). Kaplan–Meier curves also showed the highest incidence of MI, death, and MACCE in patients with major ECG abnormality. Multivariable Cox regression analysis revealed age, sex, diabetes, CKD stage, hsCRP, antipsychotic use, and major ECG abnormality as independent risk predictors for MACCE (adjusted HR of major ECG abnormality: 1.39, 95% CI: 1.09–1.76, p < 01). Among the detailed ECG diagnoses, sinus tachycardia, myocardial ischemia, atrial premature complex, and right axis deviation were proposed as important ECG diagnoses. The accuracy of cardiovascular risk stratification was improved when the ECG results were added to the conventional SCORE model (net reclassification index 0.07). ECG helps to predict future cerebrocardiovascular events in CKD patients. ECG diagnosis can be useful for cardiovascular risk evaluation in CKD patients when applied in addition to the conventional risk stratification model. Full article

(This article belongs to the Special Issue 10th Anniversary of JCM—Evidence-Based Medicine, Research and Education in Integrative and Personalized Medicine for Cardiovascular Medicine Section)

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15 pages, 691 KiB

Open AccessArticle

Effects of Fasting and Lifestyle Modification in Patients with Metabolic Syndrome: A Randomized Controlled Trial

by Holger Cramer, Christoph Hohmann, Romy Lauche, Kyung-Eun (Anna) Choi, Nadia Schneider, Nico Steckhan, Florian Rathjens, Dennis Anheyer, Anna Paul, Christel von Scheidt, Thomas Ostermann, Elisabeth Schneider, Daniela A. Koppold-Liebscher, Christian S. Kessler, Gustav Dobos, Andreas Michalsen and Michael Jeitler

J. Clin. Med. 2022, 11(16), 4751; https://doi.org/10.3390/jcm11164751 - 14 Aug 2022

Cited by 2 | Viewed by 3309

Abstract

Background: Lifestyle interventions, such as fasting, diet, and exercise, are increasingly used as a treatment option for patients with metabolic syndrome (MS). This study assesses the efficacy and safety of fasting followed by lifestyle modification in patients with MS compared to lifestyle modification only. Methods: Single-blind, multicenter, parallel, randomized controlled trial in two German tertiary referral hospitals in metropolitan areas. Interventions: (a) 5-day fasting followed by 10 weeks of lifestyle modification (modified DASH diet, exercise, mindfulness; n = 73); (b) 10 weeks of lifestyle modification only (n = 72). Main outcomes and measures: Co-primary outcomes were ambulatory systolic blood pressure and the homeostasis model assessment (HOMA) index at week 12. Further outcomes included anthropometric, laboratory parameters, and the PROCAM score at weeks 1, 12, and 24. Results: A total of 145 patients with metabolic syndrome (62.8% women; 59.7 ± 9.3 years) were included. No significant group differences occurred for the co-primary outcomes at week 12. However, compared to lifestyle modification only, fasting significantly reduced HOMA index (Δ = −0.8; 95% confidence interval [CI] = −1.7, −0.1), diastolic blood pressure (Δ = −4.8; 95% CI = −5.5, −4.1), BMI (Δ = −1.7; 95% CI = −2.0, −1.4), weight (Δ = −1.7; 95% CI = −2.0, −1.4), waist circumference (Δ = −2.6; 95% CI = −5.0, −0.2), glucose (Δ = −10.3; 95% CI = −19.0, −1.6), insulin (Δ = −2.9; 95% CI = −5.3, −0.4), HbA1c (Δ = −0.2; 95% CI = −0.4, −0.05;), triglycerides (Δ = −48.9; 95% CI = −81.0, −16.9), IL−6 (Δ = −1.2; 95% CI = −2.5, −0.005), and the 10-year risk of acute coronary events (Δ = −4.9; 95% CI = −9.5, −0.4) after week 1. Fasting increased uric acid levels (Δ = 1.0; 95% CI = 0.1, 1.9) and slightly reduced eGRF (Δ = −11.9; 95% CI = −21.8, −2.0). Group differences at week 24 were found for weight (Δ = −2, 7; 95% CI = −4.8, −0.5), BMI (Δ = −1.0; 95% CI = −1.8, −0.3), glucose (Δ = −7.7; 95% CI = −13.5, −1.8), HDL (Δ = 5.1; 95% CI = 1.5, 8.8), and CRP (Δ = 0.2; 95% CI = 0.03, 0.4). No serious adverse events occurred. Conclusions: A beneficial effect at week 24 was found on weight; fasting also induced various positive short-term effects in patients with MS. Fasting can thus be considered a treatment for initializing lifestyle modification for this patient group; however, it remains to be investigated whether and how the multilayered effects of fasting can be maintained in the medium and longer term. Full article

(This article belongs to the Special Issue 10th Anniversary of JCM—Evidence-Based Medicine, Research and Education in Integrative and Personalized Medicine for Cardiovascular Medicine Section)

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19 pages, 5686 KiB

Open AccessArticle

Anti-Hypertensive Activity of Some Selected Unani Formulations: An Evidence-Based Approach for Verification of Traditional Unani Claims Using LC-MS/MS for the Evaluation of Clinically Relevant Blood Parameters in Laboratory Rats

by Md. Adil Shaharyar, Rudranil Bhowmik, Obaid Afzal, Abdulmalik S. A. Altamimi, Sami I. Alzarea, Waleed Hassan Almalki, Sk Zeeshan Ali, Pallab Mandal, Avishek Mandal, Mohd Ayoob, Imran Kazmi and Sanmoy Karmakar

J. Clin. Med. 2022, 11(15), 4628; https://doi.org/10.3390/jcm11154628 - 8 Aug 2022

Cited by 1 | Viewed by 4160

Abstract

Background: Systemic arterial hypertension, which is associated with an increased risk of cardiovascular disease(CVD), is the most significant modifiable risk factor for mortality and morbidity worldwide. WHO has recognized Unanipathy as an alternate system of medicine. The aim of the present study is to investigate the anti-hypertensive activity of some selected unani formulations using L-NAME model. Method: Group I or hypertensive control group: L-NAME administered for 7 days and left for the next 7 days; Group II or KASgroup: L-NAME administered (i.p) for 7 days and L-NAME + KAS (1000 mg/kg b.w) for the next 7 days; Group III or DMM group: L-NAME administered (i.p) for 7 days and L-NAME + DMM (2000 mg/kg b.w) for the next 7 days; Group IV or MSR group: L-NAME administered (i.p) for 7 days and L-NAME + MSR (300 mg/kg b.w) for the next 7 days; Group V or HJ group: L-NAME administered (i.p) for 7 days and L-NAME + HJ (113 mg/kg b.w) for the next 7 days; Group VI or KGS group: L-NAME administered (i.p) for 7 days and L-NAME +KGS (2000 mg/kg b.w) for the next 7 days. Non-invasive systolic blood pressure and RR-interval (ECG) was measured. Plasma was investigated forsodium, potassium, nitrite, ANP, adrenaline, noradrenaline and aldosterone on day 0, 7 and 14 using LC-MS/MS. Result: Treatment showed a non-significant lowreduction in SBP (systolic blood pressure) of KAS, MSR and HJ while that of DMM was quite significant (p < 0.05), but in the case of KGS, SBP increased. DMM on day 14 significantly (p < 0.05) reduced plasma nitrite while no significant plasma Na+ was noted. In the case of both DMM and KGS, potassium increased significantly (p < 0.05) on day 14. No significant changes in plasma ANP and aldosterone was observed against DMM and KGS while blood levels of adrenaline and noradrenaline significantly (p < 0.05) changed. No significant change in body weight was found. Conclusions: L-NAME KAS, MSR and HJ showed no change in SBP while DMM showed a significant reduction in SBP with decreased plasma nitrite. Probably, DMM may have anti-hypertensive activity mediated through NO inhibition while KGS may involve central sympathomimetic action. Full article

(This article belongs to the Special Issue 10th Anniversary of JCM—Evidence-Based Medicine, Research and Education in Integrative and Personalized Medicine for Cardiovascular Medicine Section)

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17 pages, 792 KiB

Open AccessArticle

Who Benefits Most? Interactions between Personality Traits and Outcomes of Four Incremental Meditation and Yoga Treatments

by Karin Matko, Anne Berghöfer, Michael Jeitler, Peter Sedlmeier and Holger C. Bringmann

J. Clin. Med. 2022, 11(15), 4553; https://doi.org/10.3390/jcm11154553 - 4 Aug 2022

Cited by 5 | Viewed by 5685

Abstract

Mind–Body Medicine (MBM) includes a broad range of interventions with proven preventive and clinical value, such as yoga and meditation. However, people differ in their preferences and response to different MBM treatments and it remains unclear who benefits most from what type of practice. Thus, finding moderators of treatment outcome seems to be a promising approach. This was the aim of the present study. We conducted a single-case multiple-baseline study investigating the outcomes and moderators of four different MBM treatments. Fifty-seven healthy participants with no prior experience were randomly assigned to three baselines (7, 14, and 21 days) and four eight-week treatments: mantra meditation alone, meditation plus physical yoga, meditation plus ethical education and meditation plus yoga and ethical education. We analysed the data using effect size estimation, multiple regression and cluster analyses. High anxiety, high absorption, low spirituality, low openness and younger age were associated with a range of positive outcomes, such as increased wellbeing or decentering and decreased mind wandering. Receiving ethical education consistently improved wellbeing, while engaging in physical yoga reduced mind wandering. In the cluster analysis, we found that participants with a more maladaptive personality structure enhanced their emotion regulation skills more. Consequently, people do differ in their response to MBM interventions and more vulnerable people, or those high in absorption, seem to benefit more. These findings could support the development of custom-tailored MBM interventions and help clinicians to make scientifically sound recommendations for their patients. Full article

(This article belongs to the Special Issue 10th Anniversary of JCM—Evidence-Based Medicine, Research and Education in Integrative and Personalized Medicine for Cardiovascular Medicine Section)

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11 pages, 730 KiB

Open AccessArticle

Diversity of Hemodynamic Reactive Profiles across Persons—Psychosocial Implications for Personalized Medicine

by Miguel Ángel Gandarillas and Nandu Goswami

J. Clin. Med. 2022, 11(13), 3869; https://doi.org/10.3390/jcm11133869 - 4 Jul 2022

Viewed by 2249

Abstract

This study analyzed the individual differences in hemodynamic time patterns and reactivity to cognitive and emotional tasks, and explored the diversity of psycho-physiological profiles that could be used for the personalized prediction of different diseases. An analysis of heart rate (HR)—blood pressure (BP) relationship patterns across time using cross-correlations (CCs) during a logical-mathematical task and a task recalling negative emotions (rumination) was carried out in a laboratory setting on 45 participants. The results showed maximum HR–BP CCs during the mathematical task significantly more positive than the maximum HR–BP CCs during the rumination task. Furthermore, our results showed a large variety of hemodynamic reactivity profiles across the participants, even when carrying out the same tasks. The most frequent type showed positive HR–BP CCs under cognitive activity, and several positive–negative HR–BP CCs cycles under negative emotional activity. In general terms, our results supported the main hypothesis. We observed some distinct time-based “coordination strategies” in the reactivity of the autonomic nervous system under emotional vs. cognitive loading. Overall, large individual, as well as situational, specificities in hemodynamic reactivity time patterns were seen. The possible relationships between this variety of profiles and different psychosocial characteristics, and the potential for integrative predictive health within the provision of highly personalized medicine, are discussed. Full article

(This article belongs to the Special Issue 10th Anniversary of JCM—Evidence-Based Medicine, Research and Education in Integrative and Personalized Medicine for Cardiovascular Medicine Section)

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14 pages, 1498 KiB

Open AccessArticle

Ayurveda in Knee Osteoarthritis—Secondary Analyses of a Randomized Controlled Trial

by Christian S. Kessler, Michael Jeitler, Kartar S. Dhiman, Abhimanyu Kumar, Thomas Ostermann, Shivenarain Gupta, Antonio Morandi, Martin Mittwede, Elmar Stapelfeldt, Michaela Spoo, Katja Icke, Andreas Michalsen, Claudia M. Witt and Manfred B. Wischnewsky

J. Clin. Med. 2022, 11(11), 3047; https://doi.org/10.3390/jcm11113047 - 28 May 2022

Cited by 3 | Viewed by 3345

Abstract

Background: Ayurveda is widely practiced in South Asia in the treatment of osteoarthritis (OA). The aim of these secondary data analyses were to identify the most relevant variables for treatment response and group differences between Ayurvedic therapy compared to conventional therapy in knee OA patients. Methods: A total of 151 patients (Ayurveda n = 77, conventional care n = 74) were analyzed according to the intention-to-treat principle in a randomized controlled trial. Different statistical approaches including generalized linear models, a radial basis function (RBF) network, exhausted CHAID, classification and regression trees (CART), and C5.0 with adaptive boosting were applied. Results: The RBF network implicated that the therapy arm and the baseline values of the WOMAC Index subscales might be the most important variables for the significant between-group differences of the WOMAC Index from baseline to 12 weeks in favor of Ayurveda. The intake of nutritional supplements in the Ayurveda group did not seem to be a significant factor in changes in the WOMAC Index. Ayurveda patients with functional limitations > 60 points and pain > 25 points at baseline showed the greatest improvements in the WOMAC Index from baseline to 12 weeks (mean value 107.8 ± 27.4). A C5.0 model with nine predictors had a predictive accuracy of 89.4% for a change in the WOMAC Index after 12 weeks > 10. With adaptive boosting, the accuracy rose to 98%. Conclusions: These secondary analyses suggested that therapeutic effects cannot be explained by the therapies themselves alone, although they were the most important factors in the applied models. Full article

(This article belongs to the Special Issue 10th Anniversary of JCM—Evidence-Based Medicine, Research and Education in Integrative and Personalized Medicine for Cardiovascular Medicine Section)

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14 pages, 532 KiB

Open AccessReview

Artificial Intelligence in Cardiology—A Narrative Review of Current Status

by George Koulaouzidis, Tomasz Jadczyk, Dimitris K. Iakovidis, Anastasios Koulaouzidis, Marc Bisnaire and Dafni Charisopoulou

J. Clin. Med. 2022, 11(13), 3910; https://doi.org/10.3390/jcm11133910 - 5 Jul 2022

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Abstract

Artificial intelligence (AI) is an integral part of clinical decision support systems (CDSS), offering methods to approximate human reasoning and computationally infer decisions. Such methods are generally based on medical knowledge, either directly encoded with rules or automatically extracted from medical data using machine learning (ML). ML techniques, such as Artificial Neural Networks (ANNs) and support vector machines (SVMs), are based on mathematical models with parameters that can be optimally tuned using appropriate algorithms. The ever-increasing computational capacity of today’s computer systems enables more complex ML systems with millions of parameters, bringing AI closer to human intelligence. With this objective, the term deep learning (DL) has been introduced to characterize ML based on deep ANN (DNN) architectures with multiple layers of artificial neurons. Despite all of these promises, the impact of AI in current clinical practice is still limited. However, this could change shortly, as the significantly increased papers in AI, machine learning and deep learning in cardiology show. We highlight the significant achievements of recent years in nearly all areas of cardiology and underscore the mounting evidence suggesting how AI will take a central stage in the field. Full article

(This article belongs to the Special Issue 10th Anniversary of JCM—Evidence-Based Medicine, Research and Education in Integrative and Personalized Medicine for Cardiovascular Medicine Section)

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25 pages, 4719 KiB

Open AccessSystematic Review

Efficacy and Safety of Different Courses of Tongxinluo Capsule as Adjuvant Therapy for Coronary Heart Disease after Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

by Jiaqi Hui, Rong Yuan, Pengqi Li, Qiqi Xin, Yu Miao, Xiaoxu Shen, Fengqin Xu and Weihong Cong

J. Clin. Med. 2022, 11(11), 2991; https://doi.org/10.3390/jcm11112991 - 25 May 2022

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Abstract

Tongxinluo capsule (TXLC) is a widely used traditional Chinese medicine for coronary heart disease (CHD). However, the efficacy and safety of different courses of TXLC for CHD after percutaneous coronary intervention (PCI) have not been systematically evaluated yet. The Cochrane Library, PubMed, Embase, China National Knowledge Infrastructure, Wanfang Database, and Chinese Scientific Journal Database were searched from the inception to 26 August 2021. A meta-analysis was performed using a fixed- or random-effects model. The risk of adverse cardiovascular events, mortality, or adverse effects was evaluated by risk ratio (RR) with 95% confidence interval (CI). Thirty-four studies involving 3652 patients were finally included. After the 6-month treatment, compared with conventional treatment alone, TXLC combined with conventional treatment achieved better efficacy in lowering the risk of angiographic restenosis (RR = 0.37, 95% CI = 0.28–0.48, p < 0.001), myocardial infarction (RR = 0.38, 95% CI = 0.25–0.60, p < 0.001), heart failure (RR = 0.32, 95% CI = 0.18–0.56, p < 0.001), angina (RR = 0.26, 95% CI = 0.17–0.38, p < 0.001), revascularization (RR = 0.20, 95% CI = 0.09–0.46, p < 0.001), all-cause mortality (RR = 0.24, 95% CI = 0.10–0.58, p = 0.001), and mortality due to any cardiovascular event (RR = 0.27, 95% CI = 0.09–0.80, p = 0.018). After the 12-month treatment, TXLC reduced the recurrence risk of angina (RR = 0.40, 95% CI = 0.20–0.80, p = 0.009). However, there was no difference in any outcomes after the 3-month treatment. Besides, no difference was found in the incidence of adverse effects after the 3-month and 6-month treatments (3 months: RR = 0.73, 95% CI = 0.35–1.56, p = 0.418; 6 months: RR = 1.71, 95% CI = 0.74–3.93, p = 0.209). The certainty of evidence ranged from very low to moderate due to the risk of bias, inconsistency, and imprecision. TXLC showed beneficial effects on reducing the adverse cardiovascular events without compromising safety for CHD patients after PCI on the 6-month course. However, due to the unavoidable risk of bias, more high-quality and long-term studies are still needed to further evaluate the efficacy and safety of TXLC in many countries, not only in China. Full article

(This article belongs to the Special Issue 10th Anniversary of JCM—Evidence-Based Medicine, Research and Education in Integrative and Personalized Medicine for Cardiovascular Medicine Section)

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