Abtract: Acute coronary syndrome is a common clinical and frequently occurring disease, belonging to the chest discomfort, heartache, and true heart pain of TCM category. The clinical observation shows that the heat and blood stasis, and poison damage heart nutrient is one of the important mechanisms of triggering coronary syndrome. Therefore, the method of promoting blood circulation to remove meridian obstruction and the Qing Ying detoxication was established as the basic treatment, and Danshen Tongluo Jiedu Decoction is applied as the main formula. According to the different types of disease and syndrome differentiation, flexible modification can achieve good efficacy. It is expected that these will provide new ideas and methods for clinical treatment of acute coronary syndrome.

According to ZHANG Zhong-jing, the main reason for the stroke was the exogenous wind, and the most important pathogenesis was the deficiency of qi and exogenous pathogenic factor. Three methods are stressed to cure the stroke: the equal treatment focused on the liver and the spleen, the use of tranquilizing medicine to stop the wind, and the use of strengthening body resistance to get rid of the exogenous pathogenic factors. While YE Tian-shi considered that the main reason for stroke was the deficiency of liver-yin and kidney-yin. The chief pathogenesis in stroke was the yang transforms to the interior wind. There are three therapeutic features in the treatment: the equal treatment focused on the liver and the spleen, the synchronous treatment of the liver and stomach, and select the medicine according to the four seasons climate. ZHANG Zhong-jing's theory of exogenous wind and YE Tian-shi's theory of yang transforms to the interior wind not only reflect the different angles in treatment for stroke, but also reflect the development of pathogenesis of stroke in the history.

Objective To explore the effects ofDanshen Tongluo Detoxication Decoction on the inflammatory response of rats with bone marrow stem cell (BMSC) transplantation in acute myocardial infarction (AMI); To discuss its mechanism of action.Methods The whole bone marrow adherent method was adopted for BMSCs separation and culture. The AMI model was established by closing the left anterior descending coronary artery of SD rats. After the modeling, SD rats were randomly divided into sham-operation group, model group and BMSCs group (BMSCs transplantation group),Danshen Tongluo Detoxication Decoction group, Danshen Tongluo Detoxication Decoction + BMSCs group, 10 rats in each group. BMSCs cell suspension was injected directly into the edge of the myocardial tissue infarction area; Chinese medicine or normal saline were administered for gavage. 4 weeks later, the contents of MCP-1 and sICAM-1 in each group were detected by ELISA. TLR-4 expression was measured by Western blot method, and HE staining was used to observe the myocardial tissue pathological changes.Results Compared with the model group, the contents of MCP-1 and sICAM-1 and the protein expression of TLR-4 in BMSCs group,Danshen Tongluo Detoxication Decoction group, andDanshen Tongluo Detoxication Decoction + BMSCs group decreased, Danshen Tongluo Detoxication Decoction group was better than BMSCs group (P<0.05,P<0.01), andDanshen Tongluo Detoxication Decoction + BMSCs group was better than BMSCs group andDanshen Tongluo Detoxication Decoction group(P<0.05,P<0.01).Conclusion BMSCs transplantation combined withDanshen Tongluo Detoxication Decoction can restrain the inflammatory response of AMI model rats and repair ischemic myocardium issue, which mechanism may be related to regulating TLR-4 induced inflammatory response.

Objective To investigate the safety and efficacy of the modified laparoscopic radical cystectomy and standard pelvic lymph node dissection for female bladder cancer patients.Methods Fortyone female patients with bladder cancer who underwent laparoscopic radical cystectomy(LRC) and standard pelvic lymph node dissection(sPLND) in our hospital from June 2003 to January 2016 were retrospectively analyzed.The patients were divided into two groups according to the surgical procedure.There were 15 patients with ≤ cT2 tumor and 1 patient with cT3 in the modified group.The average age was (62.2 ± 11.5) years.The median BMI was 20.7 kg/m2,ranging 18.4 to 22.2 kg/m2;The ASA level was less than Ⅱ in 9 (56.2％) cases and was level Ⅲ in 7 (43.8％) cases.There were 22 patients with ≤ cT2 tumor and 3 patients with cT3 in the traditional group.The average age was (60.4 ± 12.9)years.The median BMI was 21.7 kg/m2,ranging 18.4 to 23.1 kg/m2.ASA was less than level Ⅱ in 15(60.0％) cases and level Ⅲ in 10(40.0％) cases.All operations are performed under general anesthesia.In the traditional group,the plane between rectus and uterus is separated first.Then open the posterior cervical fornix and cut off the lateral bladder pedicle,cardinal ligament of uterus and urethra.The bladder and uterus are removed together.The sPLND is performed at last.In the modified group,the sPLND is performed first.Then separate the bladder and uterus until the anterior wall of the vagina can be exposed.The bladder and uterus are removed separately.Data of the operation and the complications were collected and analyzed.Results All patients were performed the operation successfully.No open conversion was recorded during the operation.No patient died during the peripheral operative phase.In modified group,10 patients received orthotopic ileal neobladder (OIN),5 patients received ileal conduit and 1 patient received ureterostomy.In traditional group,19 patients received OIN,3 patients received ileal conduit and 3 patients received ureterostomy.No significant difference of surgical method was noticed in those group.The median operative time in modified group and traditional group was 290 min (ranging 265-335 min) and 315 min (ranging 270-380 min),respectively(P ＞ 0.05).The median estimated blood loss in modified group and traditional group was 100ml (100,100) and 200ml (200,400),respectively (P ＜ 0.05).The rate of transfusion in modified group and traditional group was 6.3％ (1/16) and 18.5％ (5/27),respectively (P ＜0.05).The incidence of early complications between two groups showed no statistically difference.No major (Clavien grade 3 to 5) complications occurred in modified group.However major complications occurred in 3 patients in traditional group,followed by 2 neobladder vagina fistula,1 ileal anastomotic stoma fistula.All those complications were cured by operation.All patients were diagnosed urothelium carcinoma.In modified group,the tumor stage included carcinoma in suit in 2 cases,pTa-pT1 in 7 cases,pT2 in 6 cases,pT3 in one case.In traditional group,the tumor stage included pT1 in 12 cases,pT2 in 10 cases,pT3 in 3 cases.The numbers of resected lymph node in modified group and conventional group were 16 (ranging 7-19) and 10 (ranging 7-13),respectively (P ＞ 0.05).Conclusions The modified laparoscopic radical cystectomy and pelvic lymph node dissection for female bladder cancer patients could reduce the blood loss and incidence of neobladder vaginal fistula comparing with the traditional operation.

The study on etiology and pathogenesis of coronary heart disease / thoracic obstruction has been carried on for a long time, and the understanding of TCM concept of blood stasis, heat and toxin was deeper and wider.A large quantity of clinical trials have proved that one of key pathogenesis of coronary heart disease / thoracic obstruction is the toxin induced by accumulation of blood stasis and heat, which damages heart blood or nutrient.In detail, the evil of blood stasis and heat were blocked or accumulated in human bodies to generate the toxic materials called toxin, which can damage collaterals of heart, burn out nutriment-blood of heart, block vessels of heart, and in the end, cause coronary heart disease / thoracic obstruction.Undoubtedly, the therapy of activating blood, clearing heat from the nutritive level, removing toxic substances has positive effectiveness.This article explains the relationship between the evil of blood stasis, heat and toxin with the occurrence and progress of coronary heart disease / thoracic obstruction, and discuss the theoretical basis of TCM therapy mentioned above directed at the evils.

Objective:To understand the current situation of nursing undergraduate students ' mastery of core skills and analyze the impact paths of learning environment and self-efficacy on the level of nursing core ability mastery. Methods:Using the convenient sampling method, a total of 431 nursing undergraduates from 6 universities in Macao and Guangdong Province were selected as the research objects from November to December 2022. The self-made general data questionnaire, Nursing Core Skills Mastery Questionnaire and General Self-Efficacy Scale were used to investigate the patients.Results:The total score of core nursing skills for 431 undergraduate nursing students was (3.55±0.59). The learning environment had a positive direct effect on the mastery of core skills ( P<0.05), which could indirectly affect the mastery of core skills through the mediating effects of self-efficacy, personal foundation and planning ( P<0.05) . Conclusions:Application-oriented colleges, progressive practice plans and increasing the proportion of electives are conducive to the improvement of self-efficacy and the mastery of core nursing skills. It is recommended that nursing colleges clarify the direction of talent cultivation based on their own situation, increase the proportion of elective courses and add clinical practice content in the course process, in order to promote the mastery of core nursing skills for nursing undergraduate students.