Collaborative diagnosis and treatment between Traditional Chinese Medicine(TCM)and Western Medicine,as an important measure for the modernization and innovation of TCM,faces great challenges such as inadequate medical resource supply and supply-demand imbalance in the context of high-quality development strategy.Supply-demand analysis and the input-output framework of modern economic theory were applied to systematically analyze the operational status of collaborative diagnosis and treatment of TCM and Western Medicine in China,and explore the intrinsic economic mechanism of its development.Furthermore,in line with the concept of the"Three Medical Synergistic Collaborations",it proposes policy recommendations from the dimension of medical care,medical insurance,and medicine.

Collaborative diagnosis and treatment between Traditional Chinese Medicine(TCM)and Western Medicine,as an important measure for the modernization and innovation of TCM,faces great challenges such as inadequate medical resource supply and supply-demand imbalance in the context of high-quality development strategy.Supply-demand analysis and the input-output framework of modern economic theory were applied to systematically analyze the operational status of collaborative diagnosis and treatment of TCM and Western Medicine in China,and explore the intrinsic economic mechanism of its development.Furthermore,in line with the concept of the"Three Medical Synergistic Collaborations",it proposes policy recommendations from the dimension of medical care,medical insurance,and medicine.

Objective To investigate the relationship between circulating microRNA-21 (miR-21 ) and unstable plague in patients with coronary artery disease (CAD).Methods A total of 100 consecutive patients with CAD admitted in the department of cardiology in Guangzhou first people’s hospital from January 2012 to December 2014 were enrolled.All patients were checked with coronary angiograph and intravascular ultrasound (IVUS)and were divided into two groups according to the presence of unstable plague detected by IVUS:stable plague group (n =45)and unstable plague group (n =55).Another 50 healthy people asking for routine physical examination during the same periods were enrolled as control group.Plasma miRNA-21 of patients were measured by the methods of quantitative realtime fluorescent Polymerase Chain Reaction (qRT-PCR).Results The levels of plasma miRNA-21 in patients of unstable plague group were significant higher than that in patients of stable plague group and control group (0.87 ±0.10)vs.(0.78 ±0.11)vs.(0.67 ±0.08),P <0.05.The receiver operation curve (ROC)showed that plasma miRNA-21 had great significance in assessing the CAD patients with unstable plague evidenced by the areas under the ROC curve to be 0.869 (95%CI:0.797 -0.940,P <0.05).Multivariate logistic regression analysis showed that plasma miRNA-21 was one strong independent predicative factor for unstable plague in patients with CAD (P <0.05 ).Conclusions The increasing levels of plasma miRNA-21 had the capabilitiy to predicate the unstable coronary plague in CAD patients.That miRNA-21 may be one valuable biomarker for predicating unstable plague in patients with CAD.

Objective To investigate the effect of stress-induced hyperglycemia (SHG) on myocardial perfusion and clinical prognosis in elderly patients with acute myocardial infarction (AMI) who underwent primary percutaneous coronary intervention (PCI).Methods 348 elderly patients with first-time occurrence of acute ST-elevation myocardial infarction (STEMI) who underwent primary PCI within 12 hours from June 2008 to June 2010 were enrolled and followed up.All patients were divided into three groups according to serum glucose (SG) on admission:normal group (SG＜ 7.0 mmol/L,n=112);SG elevation group (7.0 mmol/L≤SG≤11.1 mmol/L,n=128) and (steady high blood glucose) SHG group (SG＞11.1 mmol/L,n=108).Myocardial perfusion indexes,including ST segment resolution (STR),TIMI myocardial perfusion grade (TMPG),peak value of creatine kinase CK-MB,left ventricular ejection (LVEF),and major adverse cardiac events (MACE) of patients in three groups,were measured and compared after emergency PCI.Results The blood glucose levels were increased,ST-elevation 2 h after PCI were well declined,the percentages of patients with TMPG 2-3 were decreased and peak values of CK-MB were increased in the three groups (all P＜0.01).After 12 months of follow-up,Kaplan-Meier survival analysis showed that patients of three groups had significantly different cumulative non-events survival rates [89.3％ (100/112) vs.85.9％ (110/128),76.3％ (83/108),P＜0.05].Multivariate Cox regression analysis showed that steady high blood glucose were the independent predictor for the occurrence of MACE in patients undergoing PCI after adjusting for age and gender,and the risk of MACE was increased by 5.811 folds in SHG group as compared with normal group (P＜0.01).Conclusions Stress induced hyperglycemia in elderly patients with STEMI can decrease myocardial perfusion level after primary PCI,which will lead to high incidence of MACE.

Objective To investigate the relationship between cytochrome P450 (CYP) 2C19 genetic polymorphism and clopidogrel resistance (CR) in patients with acute coronary syndrome(ACS),and to assess the effects of genetic polymorphism at CYP2C19 (681G ＞ A) on the prognosis of ACS patients.Methods A total of 462 patients with ACS were enrolled and received loading dose clopidogrel(600 mg).The blood samples of patients were collected before and 24 hours after taking loading dose clopidogrel,then 5 μmol/L ADP-induced platelet aggregation ratio(PAR) was examined.Difference of two PAR ≤ 10％ was defined as CR.Genomic DNA of patients were extracted from whole blood samples according to standard protocols and the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method was used to genotype the single nucleotide polymorphism of the CYP2C19 681G ＞ A.According to whether the gene CYP2C19 681A was carried,patients were divided into two groups:wild type group and non-wild type group.After PCI treatment,patients were followed up for 6 months and major cardiac adverse events (MACE) happened during follow-up periods were recorded.Results Totally 127 enrolled cases were finally defined as CR(27.5％),the frequency of CYP2C19 681A in patients with CR was higher than that in patients without CR(46.9％ vs 28.1％,P ＜ 0.01).The ratio of CR in wild type group were lower than non-wide type group(17.4％ vs 36.1％,P ＜ 0.01).Binary logistic regression analysis indicated that gene CYP2C19 681A was a strong independent predictor for CR in patients with ACS(OR 3.642,P ＜ 0.05).After 6 months of follow-up,Kaplan-Meier survival analysis showed patients of wild type group and non-wild type group had significantly different cumulative non-events survival rates (94.8％ vs 89.6％,Log rank =4.296,P =0.038).Conclusions The genetic polymorphism of CYP2C19 was associated with CR in patients with ACS.The mutation of CYP2C19 gene increased the risk of MACE in ACS patients undergoing PCI treatments and affected the patients' prognosis.

Objective To investigate the association of insulin resistance (IR),blood pressure variability (BPV) and the severity of acute coronary syndrome (ACS),and assess the effect of percutaneous coronary intervention (PCI) on recent prognosis.Methods A total of 260 patients diagnosed as ACS and hospitalized in our department of cardiology from December 2009 to December 2010 were enrolled in the study.There were 93 cases of unstable angina pectoris ( UAP),84 of non ST segment elevation myocardial infarction and 83 of unstable angina pectoris.The subjects were divided into two groups according to 24 hour systolic blood pressure coefficient of variability (24 h SBP-CV) levels:high-CV group (24 h SBP-CV ＞11.5,n =130) and low-CV group(24 h SBP-CV ＜ 11.5,n =130).The differences in HOMA-IR and the severity of coronary artery diseases between the two groups were compared.The association of major adverse cardiac events within 6 months after PCI treatment,and IR as well as BPV was analyzed.Results Compared with the low-CV group,ACS patients in the high-CV group had obviously higher HOMA-IR levels (5.7 ± 1.2 vs 4.0 ± 1.4,P ＜0.01 ),more multivessel diseases (49.2％ vs 33.3％,P ＜0.05) and B2/C type coronary diseases (48.5％ vs 27.7％,P ＜0.01 ),and higher coronary Gensini scores (59.7 ± 17.5vs 43.8 ± 18.6,P ＜ 0.01 ).Multi-factors logistic regression analysis indicated that both 24 h BPV-CV and IR were independent predictors for MACE incidence within 6 months after undergone PCI ( P ＜ 0.05 or P ＜0.01 ).Conclusions IR and BPV were obviously associated with the severity of coronary artery diseases in ACS patients.IR and 24 h BPV-CV were valuable in predicting recent prognosis of ACS patients.

Objective To investigate the effects and the mechanism of tirofiban administration in myocardial ischemical reperfusion injury(MIRI) in patients with acute myocardial infarction(AMI) undergoing primary percutaneous coronary intervention(PCI). Method The study included 158 STEMI Patients who accepted primary PCI therapy and were randomly (random number) divided into two groups: tirofiban administration group and control group. Incidence of MIRI during PCI, Correct TIMI frame count(CTFC), ST segment resolution(STR), peak value and peak time of MB isoenzyme of creatine kinase( CK-MB), and incidence of major adverse cardiac events (MACE) during 30 days postoperation in both groups were measured. Results Tirofiban administration group was superior to control group in terms of incidence of MIRI, CTFC, STR, peak value and peak time of CK-MB, and incidence of MACE during 30 days postoperation (P < 0.05). Multiple factor logistic regression analysis indicated that intravenous tirofiban administration before primary PCI was the independently protective factor for MIRI. Conclusions Intravenous tirofiban administration in patients with STEMI before primary PCI can significantly decrease the incidence of MIRI,reduce myocardial damage and improve the prognosis.