Evidence-based optimization of integrated traditional Chinese and Western medicine therapies for prevention and treatment of coronary heart disease： design and implementation

As a chronic disease that seriously endangers public health, the number of coronary heart disease （CHD） patients in China has increased in recent years. There is great potentiality to integrate traditional Chinese and Western medicine therapies to prevent and treat CHD in clinical practice. However, most of the current integrated therapies still lack sufficient high-quality evidence, and the key links in how to apply are unclear. It is urgent to optimize them through evidence-based research to further improve the effectiveness. Therefore, we propose strategies to conduct evidence-based optimization of integrated traditional Chinese and Western medicine therapies in prevention and treatment of progressive cardiovascular diseases. These are integrated clinical trial design, attention to the key links of taking effect, combination of clinical and basic research. Based on the strategies, we started the national key research and development project ＂Evidence-based optimization research of TCM therapies in prevention and treatment of CHD （angina pectoris - myocardial infarction - heart failure）＂, which is expected to be a new paradigm in the field.

Improving the heart team:An interdisciplinary team and integrated practice unit

Heart Team emerged as an important tool in the cardiovascular care,improving the efficiency of decision-making process.In addition to the benefits in patient care,it symbolizes a new culture and mindset.However,beyond the clinical condition,in low/middle-income countries other concerns arise regarding patient's background and these demands are,usually,as challenging as the medical treatment.New models have been proposed face these demands and to assure a holistic care by Integrated Practice Units.Optimization and reorganization of already existing resources and promotion of interdisciplinary and holistic care may be an effective manner to improve outcomes despite socioeconomic barriers.

Effect of Integrated, Person-Centred Palliative Advanced Home and Heart Failure Care on NT-proBNP Levels: A Substudy of the PREFER Study

Objective: In 2012, we initiated a new person-centred model, integrated Palliative advanced home caRE and heart FailurE caRe (PREFER), to integrate specialised palliative home care with heart failure care. Natriuretic peptide-guided treatment is valuable for younger patients (age < 75 years), but its usefulness in palliative care is uncertain. We explored whether patients in PREFER reduced mean level of N-terminal pro B-type natriuretic peptide (NT-proBNP) more than the control group. Design: A pre-specified, exploratory substudy, analysed within the prospective, randomised PREFER study, which had an open, non-blinded design. Participants: Patients in palliative care with chronic heart failure, New York Heart Association class III-IV were randomly assigned to an intervention (n = 36;26 males, 10 females, mean age: 81.9 years) or control group (n = 36;25 males, 11 females, mean age:76.5 years). The intervention group received the PREFER intervention for 6 months. The control group received care as usual at a primary health care centre or heart failure clinic at the hospital. NT-proBNP was measured at the start and end of study. Results: Plasma levels of NT-proBNP differed significantly between groups at baseline. By the end of the study, no significant difference was found between the groups. The mean value for NT-proBNP decreased by 35% in the PREFER group but was not statistically significant (P = 0.074);NT-proBNP increased 4% in the control group. Conclusions: We found no statistically significant reductions of NT-proBNP levels neither between nor within the PREFER and the control group at the end of the study.

Study on the Heart Sound Signal Denoising Technology based on Integrated Filtering Algorithm

In the previous studies of heart sounds, the calculation model of small waveform is often used, and new waveform graph is formed through the decomposition and restructuring of small waveform so as to remove the noise from the new waveform. There are a lot of shortcomings in the use of such a method. The features of new waveform are difficult to be controlled, and thus the noise generated by the wave and the interference of wave will be disturbed by the filter to certain degree. In this paper, the integrated faltering algorithm is introduced, and a wave can be used in the studied use of small waveform, and also the high-order algorithm in mathematics is used, so that the frequency is controlled in a certain range, the frequency of heart sounds to be interfered is effectively reduced, and also the harmonic harm generated by the waveform is considered. After the signal sources are protected with some technologies, the effect of filtering and denoising is eventually achieved.

Clinical efficacy and significance of serum fibroblast growth factor-21 and ghrelin in the treatment of type 2 diabetes complicated with coronary heart disease with integrated traditional Chinese and western medicine

Objective: To treat the patients with type 2 diabetes mellitus complicated with coronary heart disease, to explore the clinical efficacy and mechanism of conventional western medicine combined with Yiqi Yangyin Huoxue herbs, and to detect the level of serum fibroblast growth factor-21 (FGF-21) and Ghrelin. Changes and significance. Methods: A randomized control method was used to collect 100 patients with type 2 diabetes mellitus complicated with coronary heart disease who were diagnosed and treated in our hospital from March 2015 to March 2018.They were randomly divided into two groups according to the random number table method: 50 patients separately. The patients in the control group were treated with conventional western medicine and basic treatment;the observation group was treated with the addition and subtraction of traditional Chinese medicine formulas on the basis of the control group;the clinical curative effect was evaluated after two months of treatment, and the treatment efficiency and scores of traditional Chinese medicine symptoms were observed in the two groups. Basic laboratory indicators were improved, and serum levels of FGF-21 and Ghrelin in patients were measured and the difference between the results of the tests was compared with the condition and efficacy. Results: After treatment, the total effective rate of the observation group (86.0%) was significantly higher than that of the control group (68.0%) (P<0.05), suggesting that the combination of Chinese and Western medicine treatment can significantly improve the clinical efficacy;before treatment,there is no difference between the two groups of Chinese medicine symptom scores (P>0.05). After treatment, the symptom scores of the two groups were significantly improved after treatment (P<0.05). The observation group was better among the two groups (P<0.05).After treatment, the basic biochemical indicators were improved. The observation group was better than the control group (P<0.05);Serum FGF-21 levels were significantly lower in both groups after treatment (P<0.05), and Ghrelin levels were significantly increased. There was a statistically significant difference between the two groups (P<0.05). Conclusion: The use of conventional western medicine in combination with Yiqi Yangyin Huoxue Chinese medicine for the treatment of type 2 diabetes mellitus patients with coronary heart disease can significantly improve the clinical efficacy, effectively promote the improvement of symptoms, and can be used in clinical work through serum FGF-21, Ghrelin levels combined detection of the value of Abnormal changes to predict the severity of type 2 diabetes mellitus with coronary heart disease severity and treatment effect should be widely used in clinical diagnosis and treatment.

Conservation-minded Urban Green Space System Planning in the Urban-rural Integration

Environmental and ecological problems in the urban-rural integration were analyzed, characteristics of urban green space system introduced, such as excellent landscape eco-structure, distinctive historical and humanistic features, and diversified natural landscape resources, and also challenges pointed out. Evolution, overall spatial structure and conservation concept of conservation-minded urban green space system planning were elaborated, on the basis of which the evaluation system of conservation-minded urban green space system was studied, and it was proposed that mutual relationship between impact factors of compound value and qualitative evaluation factors should be taken into consideration as a whole in evaluating conservation effects of green space system. Quantitative evaluation indexes and qualitative evaluation measures were analyzed, an objective and precise evaluation system for the conservation-minded urban green space system was established by combining qualitative and quantitative analysis to improve ecological environment during the urbanization, and fully show planning concepts of conservation-minded green space system.

The application of integrated medical and nursing rehabilitation in the management of patients with chronic heart failure and diabetes

Background At present,patients with chronic heart failure complicated with diabetes are often treated with drugs in clinical practice.Most patients cannot adhere to regular and quantitative medication for a long time,and their poor compliance has adverse effects on their rehabilitation.The aim of this study was to explore the application effects of integrated medical and nursing rehabilitation in the management of patients with chronic heart failure and diabetes.Methods A total of 75 patients with chronic heart failure and diabetes,admitted to our center from May 2020 to May 2023,were randomly divided into Group A(n=38)and Group B(n=37)using a random number table.Group A received integrated rehabilitation management,while Group B received conventional rehabilitation management.The left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDD),left ventricular end-systolic diameter(LVESD),fasting blood glucose(FBG),2-hour postprandial blood glucose(2h PG),glycated hemoglobin(Hb Alc),and self-care ability were compared between the two groups before and after intervention.Results After intervention,the LVEDD and LVESD in both groups were lower than before,while LVEF was higher than before(P<0.05).The LVEDD and LVESD in Group A were lower than in Group B after intervention,while LVEF was higher than in Group B(P<0.05).After intervention,the levels of FBG,2h PG,Hb Alc,and the scores of the European Heart Failure Self-care Behavior Scale(EHFSc B-9)in both groups decreased,with Group A being lower than Group B(P<0.05).Conclusions Integrated medical and nursing rehabilitation can effectively improve the cardiac function and blood glucose levels of patients with chronic heart failure and diabetes,control the patients’condition,and enhance their quality of life and self-care ability.[S Chin J Cardiol 2024;25(1):44-49]

Integrated Navigation Filtering Method Based on Wavelet Neural Network Optimized by MEA Model

In the experiment of combined navigation filtering using wavelet neural network, the initial parameters of the network have the influence of randomness on network convergence and navigation accuracy. A combined navigation filtering method based on wavelet neural network optimized by mind evolution algorithm is proposed. Firstly, the efficient global search ability of the mind evolution algorithm was used to quickly and accurately obtain the initial parameters of the appropriate wavelet neural network, and then the optimized wavelet neural network was applied to directly predict the position and velocity error data. This method is different from the traditional filtering method, while avoiding the drawbacks of the neural network. The simulation experiments with wavelet neural network and GA-wavelet network were carried out. The results show that the proposed method can effectively improve the accuracy of the integrated navigation system and provide a feasible path for combined navigation filtering.

Hearts and Minds

PROFESSIONAL ballerina Yu Chuanya sets high standards for herself. After a recent long haul flight from Beijing to Johannesburg, the 25-year-old went straight into intensive rehearsals soon after landing, ignoring the effects of jet lag in pursuit of her craft. What drove her passion was the unique collaboration on the ballet classic Swan Lake, iointly presented by Joburg Ballet of South Africa and Liaoning Ballet of China.

基于情绪ABC理论的正念训练对PCI患者的应用研究

目的探讨基于情绪ABC理论的正念干预对冠心病经皮冠状动脉介入治疗(PCI)术后患者的应用效果。方法选取2022年收治的80例冠心病PCI术后患者,随机分为试验组和对照组,每组40例。对照组给予心内科常规治疗与护理,试验组在常规护理的基础上给予基于情绪ABC理论的正念训练。分别于干预前、干预2个月后、干预6个月后评价患者的心肺功能[6 min步行距离(6 MWD)]、睡眠[匹兹堡睡眠质量指数(PSQI)]、焦虑抑郁[焦虑自评量表(SAS)、抑制自评量表(SDS)]、心脏不良事件的发生情况。结果干预前,2组患者6MWD、PSQI评分、SAS、SDS评分比较,差异均无统计学意义(P>0.05);干预2个月和6个月后,试验组6MWD、PSQI、SAS、SDS评分均优于对照组,差异有统计学意义(P<0.05);干预6个月后,2组患者心脏不良事件发生率比较,差异无统计学意义(P>0.05)。重复测量方差分析结果显示时间效应、组间效应、交互效应均有统计学意义(P<0.05)。结论基于情绪ABC理论的正念训练可提高患者的睡眠质量,改善负性情绪,提升心肺功能,值得临床推广应用。

象性合参论远志效用特色与优势

采用药性与法象理论合参方法,融合现代药理与临床认识,阐释远志双调心神的作用机制,为远志治疗难治性病证提供药学与临床依据。研究发现,远志的特殊药象是其宁心安神功效的药材学基础,结合其“辛烈开窍”的性能特点,采用象性合参的方法,不仅有助于理解远志双调心神的特殊功效及其“安神不闭窍,开窍不动神”的药效特点,而且对认识用其治心神疾患、睡眠紊乱以及惊风、中风、癫痫等病证的作用优势,也提供了“象思维”的路径。象性合参还可揭示远志交通心肾的作用机制,并与其双调心神作用结合,拓展治疗心神失常之应用范围。因此,运用象性合参阐释远志的多重药理效用,是探析其治疗疑难杂病机制的重要方法。

王阳明心学的澄明、贯通与夯实——论薛侃在学术上对王阳明心学的独特贡献

薛侃是王阳明的大弟子,但学界较少关注薛侃在学术上对王阳明心学的贡献。基于对薛侃相关文献的考察和分析可知,薛侃在学术上对阳明心学作出了独特贡献。首先表现在继承王阳明心学的基本观念上,如在良知即先天判断、“万物一体”基础的论证等方面;其次表现在对王阳明心学的某些核心观念的分辨和明晰上,如在“良知作为主人翁的资格”、“知行合一”的两种形式、“万物一体”的关怀与境界旨趣等方面;再次表现在创造性地发展、夯实阳明心学的内涵上,如对“致良知”的“致”之思想意识层面的强调、对“知行合一”之本体性论证、对“见在”即本体与工夫的统一之界定等方面;最后表现在对王阳明心学四大基本观念的贯通上,如以“见在”为枢纽,对“心即理”“知行合一”“致良知”“万物一体”四个基本观念进行贯通,言简意丰地阐述了四者复杂而有机的关系,认为“心”或良知是“万物一体”之基础,“万物一体”也是“心即理”“致良知”“知行合一”的基础,而做到了“心即理”“致良知”“知行合一”,也就实现了“万物一体”,从而将王阳明心学体系脉络更为深刻、更为生动地呈现出来。薛侃在学术上对王阳明心学所作出的贡献是值得肯定的。

基于心率变异性的阵发性心房颤动预测方法

基于心率变异性(HRV)的特征分析,提出一种患者阵发性房颤(PAF)发作的预测系统方法。首先,基于一种新的自适应滤波技术逐次平滑滤波并粗粒化HRV后,采用熵量化HRV在多个自适应尺度的复杂性特征;其次,特征经MinMax归一化和序列前向选择特征子集,输入支持向量机识别HRV类型,预测PAF发作。经50例时长5 min HRV序列集的五折交叉验证,得到最优预测结果为:准确率98%,敏感性100%,特异性96%,性能表现优越。另外,实验表明远离和紧随PAF时的HRV复杂性特征值在不同频率段内,分别具有不同的显著变化(P<0.05),反映受试者神经系统调节心脏节律改变,以及调控机体、应激等适应外界环境变化能力的下降。

叙事的肿瘤临床运用及其意义分析

就叙事肿瘤学的概念及设想的实操性运用,以九个实际医案,进行分析讨论。认为借助叙事:有助于更好洞察肿瘤患者的心身特点,揭示一些易被忽略的临床真相;帮助破解部分临床难题;且可促进心身兼治;促使患者形成良好生活方式。因此叙事方法值得重视,是当下解决一些临床痛点的好方法及可操作手段。其后,讨论了肿瘤临床部分“痛点”所在;包括医患双方对患病真相不明、并未消解患者疑惑、未着手消除患者相关危险因素、患者焦虑状态并未加以纠治、没给予患者有效心理支持、未有效促使及帮助患者消解恐惧等;且认为上述部分“痛点”可借助叙事等有所破解。

全国名中医王檀从“心神失控”论治肺癌经验

介绍王檀治疗肺癌临证经验。王檀认为“异生”是肿瘤发生、发展的核心,提出“肺异生物”中医病名,病机关键为“心神失控、肺气不足、相火司令”,治疗基本原则为“养心调神、补益肺气、制约肝火”,形成纠正“异生状态”、改善“异生环境”和削减“异生物生长”三位一体的治疗模式。

正念减压疗法在支架植入术治疗晚期肝癌合并冠心病患者中的应用效果

目的探讨正念减压疗法(MBSR)在支架植入术治疗晚期肝癌合并冠心病患者中的应用效果。方法根据干预方法的不同将90例晚期肝癌合并冠心病患者分为对照组(n=48)和MBSR组(n=42),对照组患者采取常规干预,MBSR组患者在对照组的基础上采取MBSR干预。比较两组患者的自我感受负担[自我感受负担量表(SPBS)]、生活质量[肝病患者生命质量测定量表(LDQOL)]及心血管不良事件发生情况。结果干预后,两组患者SPBS各维度评分均低于本组干预前,MBSR组患者SPBS各维度评分均低于对照组,差异均有统计学意义(P﹤0.05)。干预后,两组患者LDQOL各维度评分均高于本组干预前,MBSR组患者LDQOL各维度评分均高于对照组,差异均有统计学意义(P﹤0.05)。术后3个月,MBSR组患者心血管不良事件总发生率低于对照组,差异有统计学意义(P﹤0.05)。结论MBSR应用于支架植入术治疗的晚期肝癌合并冠心病患者,可降低自我感受负担,提高生活质量,减少心血管不良事件。

“第二个结合”的思想解放意义

阐释“第二个结合”的思想解放意义不能脱离马克思主义文化理论。“第二个结合”以文化灵魂说为基础,从生活视域、意义导向和精神维度等方面丰富和发展了马克思主义的“文化”概念;“第二个结合”提出了马克思主义与中华优秀传统文化的有机结合论,将马克思主义与中华优秀传统文化相结合提升为政党和民族的普遍自觉,有力推进了马克思主义与中华优秀传统文化的深度结合;以“第二个结合”为指导,中华优秀传统文化的思想智慧及其时代意义得到了全面阐发,中华优秀传统文化中的宝贵经验、精神力量和哲学智慧被分别转化为新时代治国理政的思想资源、巩固文化主体性的有力支柱和习近平新时代中国特色社会主义思想的重要理论来源。

中国心画理论与川端康成的文学理念——从写心、适意到求品

中国自宋以降,在苏轼等精英知识分子的自觉引领下,形成了心画(文人画)传统。这也正是川端康成热爱中国宋元美术的重要原因。在“达吾心”“适吾意”以及诗画结合的精神品格等方面,川端康成的文学理念与中国文人画家的艺术追求十分契合。首先,心画理论强调人情味和抒情性,这是宋代文人画家们在清楚地意识到自己作为士大夫群体的艺术担当之后,着力倡导并身体力行的。而川端康成也认为绘画不仅可以写形状物,更可以表达人的潜在的精神世界,这一艺术观念在其《梦》《阵雨》等小说中均有明显体现。川端康成在大量作品中所描写的绘画都是一种“心画”,它们并不是静止的物体,而是精神的流动。其次,中国宋元时代文人向绘画领域的主动渗透和理论引领,带来了绘画“适吾意”的思潮,使得绘画得以抒“胸中盘郁”。在这一点上,川端的文学创作理念与中国文人画家的主张完全相通,因此也使得其小说中的绘画作品具有了内涵的无限性和解读的丰富性。第三,宋代带有精英阶层之精神自觉的文人对绘画提出指导性的艺术理论,在诗画结合的基础上进一步追求品格。这种绘画理论也伴随中国绘画传入日本的第二次浪潮而东传,这恰值川端康成人生的前三十年,对他的文学道路产生了潜在而深远的影响。中国的心画理论不仅对日本文人画的形成,而且对日本近现代文学都产生了跨文化、跨学科的影响。从川端康成文学的个案可以看到,渗透于域外的中国画论,作为艺术理论的一个侧面,展现了中外文化交流的样态。这一越境的文化传播现象,还有很多极具学术价值的课题值得挖掘和探究。

专病一体化护理联合协同护理模式对老年慢性心力衰竭患者的影响

目的:探讨专病一体化护理联合协同护理模式对老年慢性心力衰竭(CHF)患者的影响。方法:选取2022年2月1日~2023年2月28日收治的98例老年CHF患者作为研究对象,依据入院时间采用抽签法分为对照组和观察组各49例,对照组给予常规护理,观察组在此基础上实施专病一体化护理联合协同护理模式;比较两组入院时、出院时、出院3个月的积极度评分,护理前后生命质量[简明健康状况调查问卷(SF-36)]评分、睡眠质量(明尼苏达心力衰竭睡眠质量量表)评分、自我护理(欧洲心力衰竭自我护理行为量表)评分、汉密顿焦虑量表(HAMA)评分、汉密顿抑郁量表(HAMD)评分,护理满意度。结果:干预后,两组积极度评分逐渐提高(P<0.01),观察组出院时、出院3个月积极度评分高于对照组(P<0.01);护理后,两组生命质量评分高于护理前(P<0.05),且观察组高于对照组(P<0.01);护理后,两组睡眠质量、自我护理评分及HAMA、HAMD评分低于护理前(P<0.05),且观察组低于对照组(P<0.01);观察组护理满意度高于对照组(P<0.01)。结论:专病一体化护理联合协同护理模式能够有效改善CHF患者的不良情绪和积极度,提高睡眠质量和生命质量,提升护理满意度。