Objective To prospectively study the diagnostic and therapeutic status and prognosis in elderly patients with coronary heart disease(CHD) in national 3rd class-A level hospitals of traditional Chinese medicine(TCM) or integrative western and Chinese medicine(IWCM) in Beijing and Tianjin. The problems and strategies of their in-hospital treatment and secondary prevention of CHD were analyzed combining with follow-up clinical events. Methods Using individualized Information Acquisition Platform of CHD, we collected in-hospital clinical information of CHD patients and then followed up for one year. The diagnostic and therapeutic conditions of elder CHD patients were evaluated based on clinical guidelines. The outcome-related indices were analyzed with one-way ANOVA and muhi-factors analysis. Results The average age of 1864 elderly CHD patients was (72.2±6.8) years, among those 1113 cases were male and 751 cases were female. The major accompanied diseases were hypertension, diabetes, cerebrovascular disease and hyperlipidemia.The standard-reaching rate of blood-lipid level of CHD patients with hyperlipidemia was as follows:TC 74.1%, TG 32. 9%, LDL-C 19. 4%, HDL-C 87. 8%, while it was 64.6% ( systolic pressure)and 84.70% ( diastolic pressure) respectively in CHD with hypertension. As for in-hospital treatment:β-receptor blocker 69.6%, ACEI/ARB 68. 4%, lipid-lowering statina 63. 6%, revascularization 29.1%. During the 12 months of follow-up, cardiogenic death 72 cases (4. 3%, 72/1682), other reasons 5 cases (0. 3%), acute myocardial infarction (AMI) 9 cases (0. 5%), revascularization 15cases (0. 8%). The multi-factors analysis showed that AMI, cardiac dysfunction could increase the incidence rate of endpoint events. Meanwhile, lipid-lowering statins, none of peripheral vessels disease, revaseularization, IWCM treatment, age below 75 years were related with the decreased incidence rate of endpoint events. Conclusions The standard-reaching rates of hlood-lipids (TG,LDL-C) of elderly CHD patients in TCM or IWCM hospitals in Beijing and Tianjin are insufficient,and revascularization should be intensified. There is still certain gap between the usage of ACEI/ARB,β-receptor blocker, lipid-lowering statins and related guidelines, and secondary prevention of CHD must be strengthened. It is the main strategy in preventing cardiovascular events to follow clinical guidelines in medical practice, control multiple risks factors and intervene comprehensively.

The study used questionnaires to investigate clinical TCM master degree students who enrolled in the year of 2011 and 2012 about the implementation effect of training plan before and after standardization of resident training. The results showed that a lot of students in the year 2011 and 2012 were satisfied with their training plan and training mode. However, the ability of clinical skills and academic research improved much higher after standardization of resident training among the students in 2012. The study showed that our education training plan met the training goal and reflected achievements in the cultivation of medical master degree of TCM. The training plan and training mode were higher satisfied for the students in the year 2011 and 2012. The conception of tutor, training target, the relationship between clinical skills and scientific research should be improved in future.

With the development of modern technology and clinical practice,the classic randomized controlled trial nowadays cannot meet the researchers' needs for evidence with more reliable external validity,especially in the field of TCM.Meanwhile,real-world study (RWS) has been attracting more attention and at the forefront of clinical research all over the world for providing evidence in conformity with the real world condition.In this paper,we firstly described the basic concept of RWS,and then found that it was characterized by large representative samples,loose inclusion or exclusion criteria,allocation of interventions according to patients conditions and willingness,long-term follow-up,and clinically relevant endpoints.By analyzing the existing examples of RWS,we noted and discussed the promising future of RWS in TCM clinical research.Finally,we hope this paper will provide some inspiration for TCM researchers.

To evaluate the clinical effects of Shengmai Injection in treating coronary heart disease (CHD) based on correct syndrome differentiation and incorrect syndrome differentiation.

To analyze the relationships among syndrome, therapeutic method and Chinese herbal medicine in patients with coronary artery disease (CAD).

Objective To further study the clinical efficacy and safety of salvianolate injection for the treatment of angina pectoris in coronary heart disease (CHD)with heart-blood stagnation syndrome. Methods A randomized imitative-blind mutli-center clinical trials with positive control and 3 parallel tests was carried out in 480 cases. The patients were divided into three groups: the control group received salviane injection 20 mL (n=120), the treatment group 1 (n=240) and treatment group 2 (n=120) received salvianolate injection in a dosage of 200 mg and 400mg respectively . After 14-daytreatment , the clinical efficacy and safety of salvianolate were observed. Results The total angina pectoris efficacy rates were 88.085 %in treatment group 1, 89.744 %in treatment group 2 and 67.257 %in control group (P

Objective To observe the influence of routine statins drugs combined with Guanxin Danshen (Coronary Salvia Root)Gutta Pills and Chuanxinlian(Andrographitis)Tablet on serum inflammatory markers and blood fat in patients with acute coronary syndrome(ACS)after percutaneous coronary inter-vention(PCI).Methods ACS patient(n=40)were randomly divided into control group and treatment group(each n=20)after PCI.The control group was treated with basic therapy of Western medicine and statins,and treatment group was additionally given Guanxin Danshen Gutta Pills and Chuanxinlian Tablet for 30 d.The levels of serum high sensitivity C-reactive protein(hs-CRP), tumor necrosis factor-α (TNF-α)and blood fat were detected by using ELISA,and integrals of blood stasis pattern were calculat-ed.Results The levels of hs-CRP and TNF-αdecreased significantly in 2 groups after treatment(P<0.05 or P<0.01), and difference between 2 groups had statistical significance after treatment(P<0.01).The level of serum total cholesterol(TC)decreased significantly and level of high-density lipo-protein-cholesterol(HDL-C increased in treatment group(P<0.05).The integrals of blood stasis pat-tern decreased significantly in treatment group after treatment(P<0.01).Conclusion Guanxin Dan-shen Gutta Pills and Chuanxinlian Tablet,with effects of activating blood and removing toxicity,can fur-ther reduce the levels of inflammatory markers, hs-CRP and TNF-α, relieve blood stasis and assist to control blood fat in patients with ACS after PCI.

Aim To study the causal relationship between coffee consumption and atherosclerosis risk.Methods Based on the public genome database IEU Open GW AS project website,relevant data were obtained,and in-strumental variables closely related to exposure and outcome were screened.Mendelian randomization analysis was per-formed using the inverse variance weighted method,weighted median method,and MR Egger method to assess the causal relationship between coffee consumption and arteriosclerosis(including coronary atherosclerosis,peripheral atherosclerosis,cerebral atherosclerosis,and other atherosclerosis).In addition,the Egger intercept method was used to detect the level of pleiotropy,the Cochran Q test was used to assess the heterogeneity,and the leave one out method was used to perform sensitivity analysis,so as to ensure the robustness of the results.Results The study showed that the F-values of the instrumental variables included in the study were all greater than 10,and there was no weak instrumental variables bias.Coffee consumption was positively correlated with the risk of coronary atherosclerosis(OR=1.535 5,95％CI=1.108 4～2.127 2,P=0.009 9),peripheral atherosclerosis(OR=2.098 6,95％CI=1.182 2～3.725 7,P=0.011 4),and other atherosclerosis(OR=1.864 7,95％CI=1.052 9～3.302 4,P=0.032 6),but not with the risk of cerebral atherosclerosis.Heterogeneity test Q_pval＞0.05,level pleiotropy test interval P＞0.05.Conclusions The single nucleotide polymor-phisms selected in the study are all strong instrumental variables,and there is no heterogeneity or horizontal pleiotropy,in-dicating reliable results.The research shows that coffee consumption increases the risk of coronary atherosclerosis,pe-ripheral atherosclerosis and other atherosclerosis,and has no significant correlation with the risk of cerebral atherosclerosis.The health management of atherosclerosis patients should reduce coffee consumption.

ObjectiveTo explore the effects of Qingxin Jieyu granules on ventricular remodeling of mice after myocardial infarction， and their regulatory role in mitophagy. MethodsSixty male C57BL/6 mice were randomly assigned to six groups： sham-operated group， model group， Qingxin Jieyu granules low-， medium-， and high-dose groups （1.3， 2.6， 5.2 g·kg^-1）， and sacubitril valsartan sodium group （0.03 g·kg^-1）， with 10 mice per group. Except for the sham-operated group， all other groups utilized left anterior descending coronary artery ligation to build a myocardial infarction model. Ultrasound was used to measure left ventricular parameters， including end-diastolic and end-systolic diameters （LVIDd， LVIDs）， diastolic and systolic posterior wall thickness （LVPWd， LVPWs）， end-diastolic and end-systolic volumes （LV Vold， LV Vols）， left ventricular ejection fraction （LVEF）， and fractional shortening （LVFS）. Additionally， the heart mass index and heart weight/tibia length ratio of mice were calculated. Enzyme-linked immunosorbent assay （ELISA） was employed to quantify brain natriuretic peptide （BNP）， creatine kinase isoenzyme （CK-MB）， angiotensinⅡ （AngⅡ）， and lactate dehydrogenase （LDH） levels in the serum of mice. Histological analysis using hematoxylin-eosin （HE） and Masson staining was conducted to examine morphological changes in myocardial tissue. Immunohistochemistry assessed the expression of vascular growth factors， including basic fibroblast growth factor （bFGF） and vascular endothelial growth factor （VEGF）. Transmission electron microscopy was used to scrutinize mitochondrial morphology in the myocardial tissue of mice. Western blot was performed to analyze the expression of phosphorylated adenosine monophosphate activated protein kinase （p-AMPK） and phosphorylated mammalian target of rapamycin （p-mTOR） proteins in myocardial tissue from each experimental group. ResultsCompared to the sham-operated group， the model group mice exhibited significantly elevated levels of LV Vold， LV Vols， LVIDd， LVIDs， cardiac mass index， heart weight/tibia length ratio， BNP， LDH， and p-mTOR protein expression （P<0.05）， along with decreased levels of LVPWd， LVPWs， LVEF， LVFS， and p-AMPK protein expression （P<0.05）. The model group also displayed substantial inflammatory cell infiltration， collagen deposition in myocardial cells， reduced expression of bFGF and VEGF， mitochondrial swelling， and cristae fragmentation. Compared to the model group， the sacubitril/valsartan group and mid-dose Qingxin Jieyu granules group showed significant reductions in LVIDs， LV Vold， LV Vols， BNP， CK-MB， LDH， and p-mTOR protein expression （P<0.05）， coupled with increases in LVEF， LVFS， and p-AMPK expression （P<0.05）. Improvements were observed across all treatment groups， including reduced inflammatory cell infiltration and collagen deposition， increased bFGF and VEGF expression， alleviated mitochondrial swelling， and the presence of autophagosomes and lysosomes. ConclusionThe results show that Qingxin Jieyu granules can regulate mitochondrial autophagy in myocardial tissue and inhibit ventricular remodeling to improve cardiac performance， by up-regulating the p-AMPK expression in the myocardial tissue of mice with ventricular remodeling after myocardial infarction， and down-regulating the p-mTOR expression.

Ventricular remodeling is a crucial pathological process in the prognosis and regression of myocardial infarction. Guided by the theory of “yang transforms into qi， while yin constitutes form" of The Inner Canon of Yellow Emperor （《黄帝内经》）， combined with the pathological characteristics and manifestations of ventricular remodelling， it is believed that insufficient "yang transforms into qi" and excess "yin constitutes form" resulting to heart yang deficiency and turbid pathogen obstruction are the basic pathomechanism of ventricular remodelling after myocardial infarction； insufficient "yin constitutes form" and excess "yang transforms into qi" resulting to inadequate nourishment of the heart meridians and the emergence of various pathological changes are the key pathomechanism of prognosis and regression. Combined with clinical practice， we advocated that harmonizing yin and yang to maintain the dynamic balance of "yang transforms into qi" and "yin constitutes form". We also proposed the use of warming and tonifying to harmonise qi and transform it to help yang transport； resolving phlegm and removing dampness， invigorating blood and resolving toxins to disperse yin accumulation； clearing heat and extinguishing wind， and nourishing yin and channels to improve the prognosis. All these findings and summary could provide ideas on traditional Chinese medicine for prevention and treatment of ventricular remodelling after myocardial infarction.