Based on the holistic view of "spleen-vessels-heart-spirit" system， this article explores the pathogenesis and progression of atrial fibrillation. It is proposed that the onset of atrial fibrillation is due to failure of the spleen to transport and disharmony of blood vessels； phlegm and blood stasis obstructing the collaterals and damage to the heart structure are the basis of its pathogenesis； the unclear mind and disorder of body and spirit are the causes of its progression. Based on the characteristics of pathological changes in different stages of the disease， it is proposed that early treatment should focus on restoring the middle jiao， clearing and promoting blood vessels， using modified Yigong Powder （异功散）； during the progression of the disease， treatment should remove blood stasis and phlegm， nourish heart and protect the pulse， using self-prescribed modified Mengshi Tongmai Decoction （礞石通脉汤）； meanwhile， calming mind and stabilizing palpitations， and regulating spirit should be sequentially incorporated， with self-prescribed Jiazao Ningmai Decoction （甲枣宁脉汤） or Shenying Dingji Decoction （参英定悸汤） and modified as appropriate. Clinical treatment should focus on the whole disease course of atrial fibrillation， implementing stage-based treatments to enable early intervention and holistic regulation.

Atherosclerosis is a complex pathological condition resulting from lipid deposition， chronic inflammatory responses， and fibrosis， with a prolonged disease course and multifactorial etiology. Based on the traditional Chinese medicine （TCM） theory of accumulation syndrome， atherosclerosis can be classified under this category， with its pathogenesis involving phlegm， blood stasis， deficiency， and accumulation. This paper proposed a stage-based intervention strategy using the four therapeutic principles of "attacking， supplementing， dispersing， dissipating"， and divided into six stages based on the pathological progression， including the stage of accumulation before formation， the stage of accumulation already formed， the stage of nucleus accumulation， the stage of nucleus accumulation decay， the stage of nucleus accumulation consolidation， and the stage of severe stenosis of nucleus. At different stages， the intervention focuses on reinforcing healthy qi and consolidating the root， tonifying the kidneys and spleen， dispersing and removing turbidity， removing phlegm stagnation， promoting qi circulation， dispersing accumulations and removing stasis， attacking accumulation and expelling stasis， directing the turbid downward and dispersing accumulation， and treatment would be adjusted based on specific symptoms， which provides a theoretical framework for the prevention and treatment of atherosclerosis with TCM.

A novel technology is proposed for non-contact and real-time detection of atrial fibrillation using millimeter-wave radar.A 60 GHz PCR millimeter wave radar is used to continuously detect the chest echo signal of the subject.After signal acquisition,I-Q signal is generated through I-Q demodulation,and the signal phase information is extracted using effective points phase trend evaluation for obtaining the signals from oscillations in the chest wall,from which the respiratory signals and cardiac signals are extracted through digital filtering for the analysis of cardiac movement.Whether the atrial fibrillation occurs or not is determined by the characteristics of atrial fibrillation wave in the time domain.The effective points phase trend evaluation for extracting more accurate signal phase information and the time-domain method for real-time atrial fibrillation detection are the innovations of the study.The experimental results show that the proposed method achieves a detection accuracy of 99.2%in clinic.

OBJECTIVE To summarize and analyze the profile of the implementation of pharmaceutical service by community pharmacists for patients with chronic diseases in China. METHODS Literature was searched from CNKI， Wanfang database， PubMed （Medline）， Embase， and Scopus to collect studies about community pharmacists providing pharmaceutical services for patients with chronic diseases. The ways and contents of the implementation of pharmaceutical services for chronic diseases by community pharmacists were summarized descriptively. RESULTS A total of 75 studies were included， involving 49 trial studies and 26 cross-sectional studies. The study sites were mainly located in the developed regions of China， and the types of disease involved in the studies were mainly diabetes mellitus （n＝30） and hypertension （n＝28）； most studies used the following indexes to evaluate pharmaceutical services， such as changes in disease symptoms and related indicators（n＝35）， improvement of patient compliance（n＝34）， and the occurrence of adverse drug reactions （irrational drug use） （n＝25）. The pharmaceutical service provided by community pharmacists included medication education （84.0%）， monitoring and follow-up （64.0%）， and identifying and solving medication-related problems （58.7%）. Thirty-eight studies mentioned that pharmaceutical services were achieved through teamwork， 16 of which mentioned healthcare alliances. A few studies investigated stratified healthcare systems （n＝15） and internet-based pharmaceutical services （n＝10）. CONCLUSIONS In China， pharmaceutical services provided by community pharmacies for patients with chronic diseases are still mainly confined to economically developed areas， and the scope of services is limited to a few diseases and basic pharmaceutical practices. In the future， the implementation of precise pharmaceutical services for different diseases and patients’ disease status， the establishment of medical alliances， and the development of internet-based pharmaceutical services should become the focus of pharmaceutical services.

Paroxysmal atrial fibrillation can be attributed to the category of xinji （palpitations） and zhangchong （severe palpitations） in traditional Chinese medicine， and its onset has the characteristics of urgency， change， and movement， which is similar to the characteristics of diseases induced by wind pathogen. It is believed that the internal movement of wind pathogen runs through the whole course of this disease， and palpitations due to wind as the direct pathogenesis. Palpitations caused by wind pathogen showed different characteristics of deficiency and excess pattern. In the acute exacerbation period， excess wind is the main cause of disease. For excessive heat generating wind， the treatment is to clear the liver and extinguish wind by self-modified Lingxia Qinggan Decoction （羚夏清肝汤）； for blood stasis generating wind， the treatment is to remove blood stasis and stop wind by self-modified Yandan Limai Decoction （延丹理脉汤）； for phlegm-heat accumulation with wind， the treatment is to dissolve phlegm and eliminate wind by self-modified Lianlou Danxing Decoction （连蒌胆星汤）. In the prolonged recovery period， deficiency wind is more common. For stirring of wind due to yin deficiency， the treatment is to nourish yin and extinguish wind by self-modified Zaoshao Zhenzhu Deoction （枣芍珍珠汤）； for spleen deficiency generating wind， the treatment is to strengthen spleen and nourish wind by self-modified Shenying Dingji Deoction （参英定悸汤）. Clinical prescriptions closely follow the characteristics of wind， weigh the changes of deficiency and excess， tailor with the patterns， and regulate qi and blood of the zang-fu organs， in order to extinguish wind and arrest convulsion.

Objective To explore training programs for pharmacists in retail pharmacies to implement medication therapy management services for patients with chronic diseases.Methods Combined with national conditions in China,the expert consultation method was used to establish a training program for pharmacists in retail pharmacies on chronic disease medication therapy management in terms of curriculum setting,teaching mode,and teaching assessment,and to implement the training.Qualitative interviews were conducted to gain an in-depth understanding of pharmacists'evaluations and suggestions on the training program.Results The training curriculum covered practice skills of pharmaceutical care and pharmacotherapeutics.The teaching modes included online learning and Q&A,case writing,role-playing and standardized patient case practices,and teaching assessment was conducted through knowledge quizzes,objective structured clinical exams,practice tests and questionnaires.181 pharmacists attended and completed the training,and the score of their overall satisfaction with the training program was 4.7(out of a maximum score of 5.0).Through the training,pharmacists'knowledge and skill levels in medication therapy management as well as attitudes,confidence and perceptions of practice were significantly improved and demonstrated better pharmacy practice abilities.Most pharmacists expressed their learning needs for disease-based pharmacy service model and communication skills training with patients in qualitative interviews.Conclusion A training program suitable for retail pharmacists to improve the comprehensive ability of chronic disease medication therapy management has initially formed,and disease-based doctor-patient communication ability and pharmaceutical care process training should become the focus of learning in medication therapy management service ability of retail pharmacists.

Objective To explore the specific plasma exosomal protein expression in Coronary Heart Disease(CHD)with phlegm-turbidity syndrome(PTS),so as to provide biological reference for the diagnosis of CHD with PTS.Methods A total of 20 CHD patients with PTS and 20 healthy subjects at the same period were included.Plasma exosomes were extracted from all subjects using the qEV size exclusion method.First,10 CHD cases with PTS and 10 healthy subjects were randomly selected,and differentially expressed proteins between the two groups were screened using label free non-targeted protein quantification analysis.Then,MRM targeting protein labeling technique was applied to verify the differentially expressed proteins in the remaining subjects.Results Compared with healthy controls,214 differentially expressed plasma exosomal proteins(61 up-regulated and 153 down-regulated)were found in CHD patients with PTS,mainly related to cholesterol metabolism,complement and coagulation cascade,and immune effects.ANXA6,C4BPB,F8,CFB,APOE,C9,and CLU proteins were further validated by MRM targeting protein.Conclusion CHD patients with PTS had differences in plasma exosomal protein expression from healthy controls,and the differential proteins are mainly related to cholesterol metabolism,complement,and the coagulation cascade.

Objective:To investigate the diagnostic and prognostic value of the growth differentiation factor 15 (GDF15) and the procalcitonin (PCT) in sepsis.Methods:A total number of 137 patients with sepsis (considered as the sepsis group) and 59 patients with inflammatory infection but not diagnosed as sepsis (the non-sepsis group) received treatment in intensive care unit of Renming Hospital of Wuhan University were collected from July 2020 to January 2021, and 62 cases of healthy physical examination (control group) were simultaneously chosen as control. Sepsis patients were divided into two groups (death group [ n=48] and survival group [ n=89]) according to their 28-day′s survival. The serum levels of GDF15, PCT, C-reactive protein (CRP), interleukin-6 (IL-6) and interleukin-10 (IL-10) were examined, and the levels of each index, was dynamically monitored on the 1st, 3rd and 7th day after admission. The differences of the two indicators between different groups were compared by non-parametric test. The correlation between GDF15 and PCT was analyzed by Spearman correlation test. The receiver operating characteristic (ROC) curve was drawn to evaluate the diagnostic and prognostic value of the two indicators for sepsis. Results:The levels of GDF15 in the sepsis group, non-sepsis group and control group were 3.22 (1.39, 6.31) μg/L, 0.84 (0.21, 1.66) μg/L and 0.11 (0.09, 0.13) μg/L, respectively. The levels of PCT were 13.10 (1.99, 50.25) μg/L, 0.24 (0.13, 0.68) μg/L and 0.05 (0.03, 0.10) μg/L, respectively. The levels of CRP were 115.80 (26.40, 184.07) mg/L, 24.20 (11.30, 53.20) mg/L and 0.50 (0.50, 2.76) mg/L, respectively. The levels of IL-6 were 68.26 (21.59, 255.46) ng/L, 33.20 (10.81, 89.27) ng/L and 8.82 (7.33, 11.23) ng/L, respectively. The levels of IL-10 were 11.30 (5.88, 25.50) ng/L, 9.34 (5.65, 16.90) ng/L and 4.94 (4.31, 5.31) ng/L, respectively. The GDF15, PCT, CRP and IL-6 of the sepsis group were significantly higher than those of the non-sepsis group (The U values were 67.681, 86.034, 44.164 and 38.934, respectively, with P values less than 0.05) and the control group (The U values were 136.475, 138.667, 120.701 and 100.886, respectively, with P values less than 0.001). There was no significant difference in IL-10 between sepsis group and nonsepsis group, but it was higher than that of control group ( U=80.221, P<0.001). There was a positive correlation between GDF15 and PCT in patients with sepsis, and the spearman correlation coefficient was 0.234 ( P=0.006). The GDF15 of the death group and the survival group were 5.49 (3.60, 8.25) μg/L and 2.03 (1.06, 3.69) μg/L, and the PCT levels were 26.45 (11.23, 94.25) μg/L and 9.08 (1.33, 22.75) μg/L, respectively. GDF15 and PCT in the death group were significantly higher than those in the survival group ( U values were 3 305.500 and 3 060.000, respectively, and P values were both less than 0.001). The GDF15 and PCT levels in the death group were higher than those in the survival group on the 1st, 3rd and 7th day of dynamic monitoring ( P<0.05), however, the level of CRP and IL-10 were not significantly different ( P>0.05). The level of IL-6 in the death group was not significantly different from that of the death group on 1st day, but was higher than that of the survival group on the 3rd and 7th day ( P<0.05). The area under the curve (AUC) of GDF15, PCT, CRP, IL-6 and IL-10 alone and in the combined diagnosis of sepsis were 0.899, 0.938, 0.874, 0.789, 0.698 and 0.962, respectively. The combined detection of AUC was better than a single index; the GDF15, PCT, CRP, IL-6 and IL-10 alone and combined detection of sepsis prognosis AUC were 0.774, 0.716, 0.522, 0.623, 0.520 and 0.839, respectively, the combined detection of AUC is also better than single index. Conclusions:GDF15 and PCT have good clinical reference value in the differential diagnosis and prognosis of sepsis. The combination of indicators has a higher clinical value. GDF15 may become a biomarker for the diagnosis and prognosis of sepsis.

This paper aimed at investigating the effects of Xinfukang Oral Liquid on mitochondrial proteomic alterations in rats with heart failure after myocardial infarction and exploring its possible mechanisms. Heart failure models were established by ligating the left anterior descending coronary artery of SD rats. Rats were randomly divided into sham group, model group, Xinfukang group. 8 weeks after drug intervention, the mitochondrial proteomic alterations of myocardial tissue were detected by two-dimensional gel electrophoresis (2-DE) and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF-MS) . Furthermore, expression levels of part of the differently expressed proteins were verified by western blot. Compared with model group, 20 differentially expressed protein spots were detected in Xinfukang group, 13 of which showed increased protein expression and 7 decreased; 13 differentially expressed protein spots were successfully identified by MALDI-TOF-MS. Bioinformatics analysis showed that these differential proteins were mainly associated with energy metabolism, stress reaction, oxidative damage, cyto-skeleton, cell differentiation and proliferation. Western blot results showed that the expression of Stress-70 protein and Nucleophosmin increased and the expression of ATP-αdecreased in model group. The expression of Stress-70 protein and Nucleophosmin decreased and the expression of ATP-αincreased in Xinfukang group, which shows the same results in proteomics. Xinfukang Oral Liquid can partly adjust proteomic alterations of myocardial mitochondrial in HF rats, and its intervention mechanism may involve improving energy metabolism, reliving stress reaction and oxidative damage, as well as regulating cell differentiation and proliferation. The results of comparative proteomic analysis performed by using2-DE and MALDI-TOF-MS are acurate, stable and reliable.

Objective: To investigate the effects of Trimetazidine on mitochondrial proteomic alterations in heart failure rats with qi- deficiency and blood- stasis syndrome after myocardial infarction. Methods: Heart failure models were established by ligating the left anterior descending coronary artery of SD rats. Rats were randomly divided into sham group, model group, Trimetazidine group. 8 weeks after drug intervention, the mitochondrial proteomic alterations of myocardial tissue were detected by two-dimensional gel electrophoresis (2-DE) and matrix-assisted laser desorption/ ionization time- of- flight mass spectrometry (MALDI- TOF- MS). Furthermore, expression levels of part of the differentially expressed proteins were verified by western blot. Results: Compared with model group, 18 differentially expressed protein spots were detected in Trimetazidine group, 10 of which were successfully identified by MALDI-TOFMS. Bioinformatics analysis showed that these differential proteins were mainly associated with energy metabolism, stress reaction, oxidative damage, cyto-skeleton, cell differentiation and proliferation. Western blot results showed that the expression of Stress-70 protein and Nucleophosmin increased and the expression of ATP-αdecreased in model group. The expression of Stress- 70 protein and Nucleophosmin decreased and the expression of ATP- αincreased in Trimetazidine group, which showed the same results in proteomics. Conclusion: Trimetazidine can partly adjust proteomic alterations of myocardial mitochondrial in HF rats with qi-deficiency and blood-stasis syndrome, and its intervention mechanism may involve improving energy metabolism, relieving stress reaction and oxidative damage, as well as regulating cell differentiation and proliferation. The results of comparative proteomic analysis performed by using 2-DE and MALDI-TOF-MS are accurate, stable and reliable.