The COVID-19 pandemic threatens physical and mental health of adolescents worldwide and has caused increased risks of dependence and addiction on Internet use during home quarantine. Internet addiction has become an important issue in mental healthcare and its prevention and treatment is of great significance for the development of adolescents. We have gathered leading experts in China and developed this guideline to provide references and suggestions to prevent and treat Internet addiction in adolescents during home quarantine and help them get through the pandemic.

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Autism spectrum disorders (ASD) is a heterogeneous group of developmental disorders characterized by stereotyped behaviors and thoughts, and deficits in social behavior, interactions, and communication. The epidemiological evidence shows an increase in the prevalence of ASD although the etiology and pathology of ASD are still largely unknown. In addition to the core symptoms, patients with ASD show emotional and cognitive deficits, and are thought to suffer from abnormal levels of arousal and therefore increasingly studies have been performed to investigate alterations in the autonomic nervous system. The aim of the review is to focus on the changes in the cardiovascular system. Overall, the literature provides some evidence for an increase in baseline heart rate (HR) and a decrease in HR variability (HRV), specifically for high-frequency respiratory sinus arrhythmia. However, the review also illustrates the large variability in results. This is in part due to differences in methodology, but also to the heterogeneity of ASD per se. Moreover, as ASD already occurs at a very young age, differences in the age of the patients are also likely to play a role. Therefore, we propose a more systematic analysis of autonomic dysfunction in well-defined patient populations. In addition, given the plethora of genetic and environmental animal models for ASD that have been developed in recent years, we argue that investigation of HR and HRV could substantially improve the translational validity of these models.

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Stress is associated with negative outcomes and we all make effort to avoid it. Workplace stress is associated with poor performance, and organizations desire optimal performance from employees. In this case study, the researcher utilizes a heart rate variability biofeedback (HRVB) tool as a workplace stress intervention for his participant, a senior manager who works in a big company in Hong Kong. The researcher presents a review of each of the four sessions he has conducted with his participant. The participant was able to see directly how stressful thoughts and emotions can adversely affect his body. He was motivated to change from the visuals flaring up that he saw on the biofeedback. Stress reduction exercises (SREs) were used during the sessions, and the participant was able to profoundly shift his physiology. The present case demonstrated that emWave Pro Plus HeartMath tool can be used as an important HRVB and SRE tool in the future.

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Background: Previous research on bipolar disorder demonstrates greater-than-expected vascular dysfunction later in the course of illness, proportionate to the cumulative burden of mood symptoms. However, little is known about the effect of acute mood states on vascular function. Here, we examine the relation between vascular function and mood state in individuals with bipolar disorder. Materials and Methods: This prospective study followed forty individuals with bipolar disorder for up to 6 months. The participants were assessed for mood state and vascular function at baseline, 2 weeks, and 6 months. Mood state was determined using the clinician-administered Montgomery–Šsberg Depression Rating Scale and Young Mania Rating Scale. Vascular function was assessed by flow-mediated dilation (FMD) of the brachial artery, forearm vascular resistance (FVR), and arterial stiffness. Results: The participants had a mean age of 30.1 years, and 75% were male. Primary outcome measures such as FMD and nitroglycerine-mediated dilation were not found to have statistically significant associations with depressive or manic symptoms. In unadjusted models, higher manic symptoms were significantly associated with increased FVR nitroprusside-mediated dilation and diastolic blood pressure. In adjusted models, higher depressive symptoms were significantly associated with increases in augmentation index adjusted for heart rate of 75 bpm, and higher manic symptoms remained associated with increases in diastolic blood pressure. Conclusion: FMD may have limited sensitivity as a biomarker for measuring short-term effects of mood state. Long-term prospective studies are needed to clarify the temporal relation between chronic mood symptoms and vascular function in bipolar disorder.

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Background: Heart Rate Variability (HRV) is a parameter used to investigate the autonomous neural system (sympathetic and parasympathetic system). Reduced HRV is a risk factor which correlates with physical and psychological stress, psychoneuroendocrineimmunology dysregulation as well as with aging. HRV is considered a reliable parameter to investigate psycho-physical resilience, the latter being considered a key-factor for human longevity and the final target of hormesis pathways as well. Different chemical, physical, psychological stressors may interfere with HRV. Aims: The aim of our observational study was to assess the possible changes in HRV changes induced by a few targeted stimulations: breathing, maqui nutraceutical intake, physical activity and thermal stress, and maqui nutraceutical intake. Patients and Methods: An observational study was performed on 4 groups of subjects, for a total of 112 individuals, who underwent HRV analysis after administration of different stressors/stimuli, such as breathing, thermal stimulation, Maqui 500 ® nutraceutical intake and physical activity. The investigated parameters were: SDNN, RMSSD, MHRR, mean heart rate (MHR) and the three frequency-domain based bands (VLF, LF, HF). Results: Our outcomes demonstrate that HRV assessment is a useful and reliable investigation to highlight and monitor the effects of these stressors. Breathing was the stimulus which induced the most significant variation in HV parameters. Conclusions: Notwithstanding the short duration of the follow-up, immediate/short-term HRV assessment showed statistically significant variations of the main parameters (e.g. SDNN, RMSSD and frequency bands) in a few cases after stimuli exposure. Studies including larger cohorts and longer follow-up are needed and justified to corroborate our outcomes furthermore.

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Our appreciation and understanding of the interrelationships between disrupted metabolic function and depression have increased significantly over the last few decades. This review focuses still more specifically on the intersections between cardiovascular disease (CVD) and major depressive disorder (MDD). General pathophysiological mechanisms implicated in both diseases include inflammation, cytokine and hypothalamic–pituitary–adrenal axis dysregulation, oxidative stress, neurotransmitter disruptions, neuroplasticity, and the microbiome. Here, we explore these mechanistic overlaps of depression and CVD, including some discussion of related and frequently comorbid disorders, such as obesity and diabetes, and the closely related “metabolic syndrome.” Finally, we discuss integrated therapeutic strategies for treating MDD comorbid with CVD.

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Aim: The goal of the present study was to estimate the treatment patterns in outpatients with schizophrenia in Russia. Methods: A total of 44,836 outpatients with schizophrenia treated by 812 psychiatrists in 2018 were selected in the LRx database in Russia. We descriptively analyzed the proportions of patients treated with different therapy classes and drugs. Results: Typical antipsychotics (58.2%) were the therapies with the highest patient proportion, followed by anti-Parkinson drugs (38.3%) and antidepressants (30.6%). The most frequent anti-Parkinson drug was trihexyphenidyl; the most frequent antidepressant was amitriptyline. Conclusions: The findings of this study imply that the proportion of older drugs is higher in schizophrenia therapy in Russia than reported based on samples in Europe and the U.S.

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Background: The recent hype in yoga practice is concomitant with the fact that it helps the practitioner to achieve radiant health and serene mind. The science of yoga has also become a powerful stream of knowledge. It has increased the number of scientific studies on different yogic interventions, but has also been performed to evaluate its effects on brain wave activity, particularly in neural oscillations. Objectives: In this systematic analysis, we reviewed studies investigating the effect of integrated yoga, meditation, and pranayama on brain wave activity that affects overall cognitive functions. Methods: Broad search strategy was practiced using several online databases: PubMed, Google Scholar, Web of Science, Embase, Medline, PsycINFO, Europe PMC, Scopus, and IndMED. Studies were included in integrated yoga, meditation, and pranayama with brain wave activity, and the entire relevant articles were critically analyzed according to the nature of this study. Results: Several studies examined yogic interventions for restoring brain functions, nerve diseases, and cognitive impairment and suggested that integrated yoga, meditation, and pranayama practices improve verbal skills, reaction time, hand–eye coordination, speed accuracy, and neural activity. Yogic intervention increases overall brain wave (delta, theta, alpha, beta, and gamma) activity, which increases overall cognitive functions with greater perceived cognition, working memory, attention, better switching ability, focusing ability, positive mind, and perception. It has also been reported that yogic intervention activates dormant areas of brain while downgrading memories not of interest and upgrading useful ones.Conclusions: There is emerging evidence from randomized controlled trials to support yoga practice, which significantly improves brain wave activity resulting in better cognitive functions.

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At present, the relationship between hypertriglyceridemia (HTG) and coronary heart disease (CHD) is still uncertain. In recent years, many researchers have tried to clarify the relationship between HTG, atherosclerosis, and CHD. This article will review the relationship between HTG and CHD from the aspects of epidemiology, pathogenesis, and cardiovascular benefits of HTG treatment to further understand the relationship between the two. Dyslipidemia is closely related to the occurrence and development of the atherosclerotic cardiovascular disease. Elevated low-density lipoprotein cholesterol (LDL-C) has been recognized as an independent risk factor for cardiovascular events. Statins can effectively reduce LDL-C and reduce the incidence of cardiovascular events. HTG is the most common dyslipidemia in China, and the correlation between HTG and CHD deserves attention. Therefore, as for the progress of HTG and CHD in recent years, we will make a review on the relationship between HTC and CHD, the mechanism of atherosclerosis and the cardiovascular benefits of treatment, so as to further clarify the role and significance of triglyceride in the process of atherosclerosis and provide new ideas for the prevention an d treatment of CHD.

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Type 2 diabetes mellitus (T2DM) patients are commonly comorbid with psychological distress, such as depressive symptoms, anxiety symptoms, and diabetes distress, which cause great health and economic burden. However, the estimated prevalence of this psychological comorbidity is quite different between studies. Our aim is to estimate the pooled prevalence of depressive symptoms, anxiety symptoms, and diabetes distress in T2DM patients in China. Two Chinese academic databases (China National Knowledge Infrastructure and Wanfang) and two English academic databases (PubMed and Embase) were systematically searched for studies with information on the prevalence of depressive symptoms, anxiety symptoms, and diabetes distress among Chinese T2DM patients published from inception to April 20, 2018. Random-effects meta-analysis was performed to estimate the pooled prevalence. Data were extracted from 80 cross-sectional studies involving 31874 Chinese T2DM patients. The pooled prevalence of depressive symptoms, anxiety symptoms, and diabetes distress were 37.8% (95% confidence interval [CI] 34.6–41.0), 28.9% (95% CI 21.0–36.9), and 50.5% (95% CI 42.4–58.7), respectively. Patients aged 60 years or older have higher prevalence than patients aged <60 years for depressive symptoms, anxiety symptoms, or diabetes distress. Much attention should be paid to the psychological conditions of Chinese T2DM patients, especially for those patients aged 60 years or older in T2DM management.

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Background: Anxiety and depression are common after an acute cardiac event. While many studies have investigated the predictors of anxiety and depression, few have focused on the role of rumination. The aim of this study was to identify the ruminative styles that predict anxiety and depression in the 2 years' postcardiac event. Methods: A total of 426 cardiac patients, 210 admitted for acute coronary syndrome (ACS), and 216 to undergo coronary artery bypass graft surgery were recruited from three metropolitan hospitals in Melbourne, Australia. Participants completed self-report questionnaires at the time of their event and at 12- and 24-months postevent. Anxiety and depression were assessed at all three time points, whereas ruminative styles were assessed at 24 months. Clinical information was retrieved from the participants' medical records. Bivariate and multivariate analyses were undertaken to identify the factors associated with and predictive of anxiety and depression at 24-months postevent. Results: A diagnosis of ACS, history of depression, smoking, and brooding and intrusive rumination were associated with both anxiety and depression, while female gender was associated with anxiety only. Brooding and intrusive rumination were the unique predictors of anxiety and depression, after controlling for other factors. Limitations: Generalizability of the findings is limited by the preponderance of men in the sample and by participant attrition over the study period. Conclusion: The findings indicate the importance of screening for rumination styles after a cardiac event to enhance targeting of psychological treatments for cardiac patients at risk of persistent anxiety or depression.

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Objectives: Heart disease is one of the chronic diseases that require adjustment and extensive changes in the patient's life. The purpose of the present study was to investigate the mediating role of difficulties in emotion regulation on the relationship between anger rumination and worry with adjustment problems to heart disease. Methods: A total of 327 patients with coronary artery disease (138 women and 189 men) participated in this study. Participants were asked to complete the Penn State Worry Questionnaire, Anger Rumination Scale, Difficulties in Emotion Regulation Scale, and Adjustment to Illness Scale. Results: Worry, anger rumination, and difficulty in emotion regulation showed a negative correlation with adjustment to heart disease. The results of path analysis indicated that the relationship between worry and anger rumination with adjustment to heart disease was mediated by difficulties in emotion regulation. Conclusion: Based on the results of the present study, management of worry and anger rumination, as well as emotion regulation strategies, should be implemented in regular medical treatments for patients with heart disease.

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Background: Heart rate variability (HRV), the change in the time intervals between successive pairs of heartbeats, is influenced by interdependent regulatory systems operating over different time scales to adapt to psychological challenges and environmental demands. Low ageadjusted HRV is predictive of upcoming health challenges in healthy people as well as a wide range of diseases in patients and correlates with allcause mortality. 24h HRV recordings are considered the “gold standard” and have greater predictive power on health risk than shortterm recordings. However, it is not typically costeffective or practical to acquire 24h HRV recordings. This has led to the growing use of shortterm recordings in research and clinical assessments. Objective: The first study examined the correlations between a 10min restingstate period, a 1min paced deep breathing protocol, response to handgrip, and 24h HRV measures in 28 healthy individuals. Based on the results of the initial study, the primary study examined the correlations between the 1min paced deep breathing assessment and 24h measures in a general population of 805 individuals. Results: The highest correlations for the HRV variables were with the vagally mediated sources of HRV. The 1min paced deep breathing was positively correlated with 24h highfrequency power (r = 0.60, P < 0.01), root mean square of successive difference (r = 0.62, P < 0.01), lowfrequency (LF) power (r = 0.64, P < 0.01), veryLF power (r = 0.57, P < 0.01) total power (r = 0.42, P < 0.01), standard deviation of normaltonormal interval (SDNN) index (r = 0.59, P < 0.01), and SDNN (r = 0.41, P < 0.01). Conclusions: The findings from this study suggest that the 1min paced deep breathing protocol is an ideal shortterm assessment that can be used in a health risk screening context. When low values are observed, it is recommended that a 24h assessment be conducted.

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Background and Purpose: This study examines coronary artery bypass graft (CABG) patients, their baseline medical and psychosocial characteristics, and level of functioning after 1 year. Functioning was defined as ability to play their role in social, family, recreational, and occupational areas. Sex differences and the buffering effect of social support were also investigated. Methods: This prospective, observational study recruited 296 (42% female) post-CABG patients, of whom 234 (79%; 44% female) had complete data at 1-year follow-up. Clinical and demographic variables were collected following surgery via chart review and provincial database. Depressive symptoms, perceived social support, household responsibilities, marital status, pain, and role interference were assessed at baseline and 1 year later. Hierarchical linear regression examined relationships between baseline psychosocial variables and 1-year role interference controlling for potential medical confounding variables. Results: One-year role interference was partially predicted by baseline depression, social support, household responsibilities, and marital status (R² = 0.20,P < 0.001), but not disease severity. Baseline depression predicted 1-year role interference only at mean (b = 0.15, 95% confidence interval [CI] [0.01, 0.31]) and high (b = 0.30, 95% CI [0.12, 0.48]) perceived social support. Baseline perceived social support predicted greater reduction in 1-year role interference in women compared to men (interaction b = 0.29; 95% CI [0.06, 0.52]) and reduced the association between high depression symptoms and role interference in women only (b = −0.25, 95% CI [−0.42, −0.09]). Conclusions: Long-term role interference in bypass graft recipients was not associated with disease severity, but was predicted by social variables and depressive symptoms. In women perceived social support moderated the association between depression and role interference.

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China's rapid economic development has contributed to health improvement, such as increasing life expectancy, reducing communicable diseases, and mortality rate. However, the sustainable social and economic transformations, including industrialization, urbanization, globalization, and informatization, have triggered huge challenges to population health in China, particularly to mental health. This review discussed the mental health problems due to socioeconomic changes such as population, life-style, and environment changes, as well both the economic and disease burden of mental disorders. With awareness of these challenges, the following three possible responses are proposed: identify social and economic impact on mental health based on high-quality qualitative and quantitative analysis; improve mental health awareness and literacy; and enhance mental health-care system and promote implementation research. Lessons from China can be a great reference for other low- and middle-income countries. With efforts overcoming the current and potential challenges on mental health, the Sustainable Development Goals on mental health can be possibly achieved by 2030.

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Coronavirus disease 19 (COVID-19) has rapidly expanded to a global pandemic, resulting in significant morbidity and mortality. Even though predictors of infection remain unclear, age and preexisting cardiovascular conditions have been clearly identified as predictors of adverse outcomes and higher fatality rates. Since the virus infects host cells through angiotensin-converting enzyme 2 receptors, a key player in the renin-angiotensin-aldosterone system, the interaction between the cardiovascular system and the progression of COVID-19 is nowadays a focus of huge interest. In this review, the authors analyze the available and very recent evidence on the risk factors and mechanisms of the most relevant cardiovascular complications associated with COVID-19, including acute cardiac injury, myocarditis, stress-cardiomyopathy, ischemic myocardial injury, cytokine release syndrome, thrombotic disease, cardiac arrhythmias, heart failure, and cardiogenic shock. Finally, we discuss the cardiovascular impact of the therapies under investigation for COVID-19 treatment.

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In clinical practise physical illnesses are often accompanied by mental abnormality. Actually due to the development of our modern medical system, the underlying mental abnormality has been increasingly discovered, which in turn not only surprises researchers with the unexpected high morbidity, but also arouse the intense debate whether there is an interaction between mental disorders and physical illnesses. The attempt trying to figure out the mystery of mind and body can date back to the ancient time. It was not until 1818, the German psychiatrist Heinroth proposed the concept of mind-body disease for the first time. Later, William Osler successfully proved the close interaction between coronary heart disease and mental illness by dissecting cadaver of a patient with “angina” finding the coronary perfectly healthy. Owing to the importance of the cardiovascular system and the high sensitivity to the autonomic nervous system which is strongly influenced by the emotion, the intersection of cardiology and psychology gradually became the central issue in studying the physical and mental illness and eventually formed a new branch called “psycho-cardiology”.

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Background: Diathesis-stress perspectives of cardiovascular (CV) health and disease have long identified the important role of a host of mental health risk and protective factors in both illness course and recovery. Few studies, however, have investigated these factors within the same sample of healthy people. Aims and Objectives: Accordingly, we focused on the inter-relationships among well-established CV mental health risk factors, specifically childhood adversity, stress-related adult personality traits and psychiatric symptoms, and naturally occurring genetic polymorphisms. Materials and Methods: Here 100 college students completed the NEO Five Factor Model of personality in conjunction with measures of childhood adversity, psychiatric symptoms as well as genetic variables derived from assays of the serotonin transporter (5-HTTLPR) and the brain-derived neurotrophic factor (BDNF). Results: Single gene comparisons pointed to lower CV risk, as reflected in personality and psychiatric symptom measures for BDNF Met versus Val/Val carriers. In addition, polygenic comparisons revealed a significant BDNF x 5-HTTLPR interactional effect, suggesting that this particular allelic combination may moderate the phenotypic expression of key personality traits, namely neuroticism and extraversion, as well as psychiatric symptoms, all linked to cardiovascular health. In fact, the data showed across personality and symptom measures, evidence of stress-resistance, resilience and protection for carriers of the allelic pair, BDNF Met and 5-HTTLPR-S. Conclusions: The findings suggested the Met variant of the BDNF gene had a risk-reducing and health-promoting effect when paired with the short serotonin allele, arguably reversing the commonly reported 5-HTTLPR-S association with stress vulnerability.

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Background: The cardiovascular system and central nervous system are known to influence each other. Accordingly, neurological changes may occur after myocardial infarction (MI), which may be mediated by neuroinflammation. We investigated tumor necrosis factor alpha (TNF-α) and microglia activation in post-MI neuroinflammation. Materials and Methods: MI or sham surgery was induced in 28 male mice. Two weeks later, we performed echocardiography and dissected the brains for the western blot on TNF-α and its receptors (n = 10) or immunohistochemical stainings for microglia, doublecortin X (DCX), and TNF-α (n = 18). Plasma was collected for the measurement of circulatory cytokines. Results: The MI mice had an average infarct size of 38% of the left ventricle, heart failure was confirmed by decreased fractional shortening and increased lung weight. Plasma cytokine levels were unaltered. In brains of MI mice, there was a higher expression of TNF-α precursor protein, with trends for higher TNF-R1 and lower TNF-R2 expression. Furthermore, MI mice had more activated microglia in the inner blade of the dentate gyrus of the hippocampus. The amount of neurogenesis measured by DCX staining was unaltered. Conclusions: Our mouse model of MI showed signs of persistent neuroinflammation as indicated by raised levels of TNF-α precursor protein and an increased number of activated microglia in the hippocampus. The extent to which these neuroinflammatory hallmarks influence central nervous system functioning remain to be determined.

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Purpose: Many childhood cancer survivors are not engaging in sufficient physical activity despite high chronic disease incidence. We assessed satisfaction and acceptability of attending an exercise physiology consultation. Methods: An 8–18-year-old cancer survivor >1-year posttherapy were assessed by an exercise physiologist (T₀). We assessed parents' and survivors' satisfaction and acceptability with the consultation and information received 1-month later (T₁). Parents and survivors were asked whether they would see an exercise physiologist again and whether other survivors should be assessed. Results: We recruited 102 participants, with 70 unique families retained. Parents were more satisfied with information received about exercise from T₀to T₁ (43.4 ± 33.2 vs. 81.5 ± 17.6/100,P < 0.001). Parents reported high satisfaction from the consultation (94.7 ± 10.2/100). Most parents (96.6%) and survivors (95.9%) recommended other survivors see an exercise physiologist. Some parents (37.0%) wanted their child to be more active, while 47.8% of survivors wanted to be more active. Conclusions: There was support for an exercise physiology consultation from parents and survivors. Guidance from an exercise physiologist may be important to alter lifestyle behaviors, which can be potentially beneficial to cardiovascular and psychological well-being.

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Background: Insomnia is a prevalent sleep disorder and strong risk factor for poor quality of life, depression, and other lifestylerelated diseases. Objectives: To investigate the effect of the transcutaneous vagus nerve stimulation (taVNS) on sleep electroencephalographic (EEG) in the para-chlorophenylalanine (PCPA) insomnia rats. Methods: Rats were divided into control, model, taVNS and sham taVNS (stnVNS) (stimulate the auricular margin, as transcutaneous none VNS, stnVNS) group (n=6 in each group). A week before the experiment, the electrodes were fixed to the skull of all the rats for recording the sleep EEG. PCPA was used to establish insomnia models. The rats of taVNS and stnVNS group were treated via an electroacupuncture apparatus for seven consecutive days, and simultaneously, the sleep EEG were recorded for all groups after the treatment daily. And the power spectrum analysis was used in this experiment. Results: After modeling, the percentage of power spectrum of delta frequency band significantly decreased, while the theta, alpha, and beta frequency bands significantly increased in the model group compared to the control group. After intervention, the percentage of the delta frequency band significantly increased in the taVNS group as compared to the stnVNS group. Conclusion: These results suggest that taVNS can significantly modulate the power spectrum of the delta frequency band and may constitute a potential low-cost alternative for the treatment of insomnia.

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Atrial fibrillation (AF) affects about 2% of the population, with the increasing prevalence with age. It is associated with poorer quality of life, effort intolerance, frequent hospitalizations, heart failure, and increased risk of systemic embolization, stroke, and mortality. Warfarin has been the only choice of chronic anticoagulant therapy for over 50 years. Its disadvantages are reflected by interaction with various foods, drugs, and alcohol, while its action is highly dependent on liver function, age, and genetic background. Administration of direct oral anticoagulants (DOACs) to patients with AF and acceptable bleeding risk reduces the risk of systemic thromboembolic complications and stroke; these drugs are superior or at least as effective as warfarin. Their use is safer than warfarin in terms of reduced risk of major bleeding. This is a group of drugs with wide clinical use, except in patients with severely impaired renal and hepatic function. Proper use is a guarantee of the safety of DOACs, which in the future will be even more pronounced with the advent of new antidotes, such as Praxbind.

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While humans have known that the health of their heart is linked to the health of their mind since ancient times, scientifically evaluating the relationship of the heart and mind has only emerged within the last century. A relevantly new field has developed over the past several decades with names such as “Psychocardiology,”^[1] “Behavioral Cardiology,”^[2] and/or “Neuropsychocardiology”^[3] that designate effort to systematically investigating the interactions of the heart and mind to identify clinical impacts, the underlying mechanisms, and interventions alleviating the adverse interaction of heart and mind. Over a relatively very short period, these investigations have contributed positively to the medical literature elucidating the significant role of mind in cardiovascular health overall, and specifically in several particular clinical entities. The author of this article aims at briefly summarize what has been achieved and shares opinions regarding future directions in this field.

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