Objective: o develop an onset risk prediction nomogram for patients with homocysteine-type (H-type) hypertension (HTH) based on pulse diagram parameters to assist early clinical prediction and diagnosis of HTH. Methods: Patients diagnosed with essential hypertension and admitted to Shanghai Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai Hospital of Traditional Chinese Medicine, and Shanghai Hospital of Integrated Traditional Chinese and Western Medicine from July 6th 2020 to June 16th 2021, and from August 11th 2023 to January 22nd 2024, were enrolled in this retrospective research. The baselines and clinical biochemical indicators of patients were collected. The SMART-I TCM pulse instrument was applied to gather pulse diagram parameters. Multivariate logistic regression was adopted to analyze the risk factors for HTH. RStudio was employed to construct the nomogram model, receiver operating characteristic (ROC) curve, and calibration curve (bootstrap self-sampling 200 times), and clinical decision curve were drawn to evaluate the model’s discrimination and clinical effectiveness. Results: A total of 168 hospitalized patients with essential hypertension were selected and divided into non-HTH group (n = 29) and HTH group (n = 139). Compared with non-HTH group, HTH group had a lower body mass index (BMI), and higher proportions of male patients and drinkers (P < 0.05). The ventricular wall thickening (VWT) could not be determined. The proportions of left common carotid intima-media wall thickness (LCCIMWT) and serum creatinine (SCR) were higher in HTH group (P < 0.05). The pulse diagram parameter As was significantly higher, and H4/H1 and T1/T were lower in HTH group (P < 0.05). Gender, alcohol consumption, serum creatinine, and the pulse diagram parameter H4/H1 were identified as independent risk factors for HTH (P < 0.05). The nomogram’s area under the ROC curve (AUC) was 0.795 [95% confidence interval (CI): (0.706 6, 0.882 8)], with a specificity of 0.724 and sensitivity of 0.799. After 200 times repeated bootstrap self-samplings, the calibration curve showed that the simulated curve fits well with the actual curve (x2 = 9.5002, P = 0.301 9). The clinical decision curve indicated that the nomogram’s applicability was optimal when the threshold for predicting HTH was between 0.38 and 1.00. Conclusion The nomogram model could be valuable for predicting the onset risk of HTH and pulse diagram parameters can facilitate early screening and prevention of HTH.

High normal blood pressure is a crucial period for preventing cardiovascular and cerebrovascular events in our country.Target organs such as blood vessels,heart,kidney and brain may already be damaged even at the stage of high normal blood pressure.Early diagnosis and treatment can reduce the risk of cardiovascular and cerebrovascular events in patients with high normal blood pressure.Modern research methods for TCM pulse-taking are increasingly mature and have been widely used in screening,diagnosing,predicting,and intervening in cardiovascular and cerebrovascular risk events,such as hypertension,coronary heart disease,and stroke,with remarkable results.By detecting the pressure pulse map corresponding to the pulse of traditional Chinese medicine,it is possible to obtain information on the blood vessel function and elasticity in patients with high normal blood pressure.This can aid in the management of cardiovascular and cerebrovascular risks in such patients.This paper discusses the management of cardiovascular and cerebrovascular risk events in patients with high normal blood pressure.It reviews the application of traditional Chinese medicine pulse diagnosis and considers its value in risk event management.The paper proposes corresponding risk management strategies.

Objective To construct a nomograph model for predicting the risk of renal damage in patients with essential hypertension based on pulse parameters.Methods 518 patients with essential hypertension who were hospitalized in Shuguang Hospital affiliated to Shanghai University of Traditional Chinese Medicine and Cardiology Department of Shanghai Integrated Hospital of Traditional Chinese and Western Medicine from August 2018 to June 2021 were selected,and were divided into hypertension without renal damage group and hypertension with renal damage group according to the evaluation criteria of essential hypertension with renal damage.The general data and blood biochemical indexes of the patients were collected,and the pulse parameters were detected by SMART-I digital pulse analyzer of traditional Chinese medicine,and the differences between the two groups were compared.Single factor and multi factor logistic regression were used to analyze the related parameters;The nomogram model was constructed by R Studio,and the model was evaluated by the ROC curve,calibration curve,and Hosmer Lemeshow goodness of fit test.Results The age,serum uric acid,serum creatinine,urea nitrogen,cystatin C and homocysteine in the group of primary hypertension with renal damage were significantly higher than those in the group without renal damage(P＜0.05).The pulse parameters H4,H3/H1,H4/H1,H5/H1,T1/T4,W1/T in patients with primary hypertension and renal injury were significantly lower than those in patients without renal injury(P＜0.01),and As/Ad was significantly higher than those in patients without renal injury(P＜0.01).Age,current diastolic b1ood pressure,H4/H1,T1/T4,W1/T were independent risk factors of renal damage in patients with essential hypertension.The nomogram model was established based on the above independent risk factors,and the model was tested.The area under the ROC curve was 0.703(95％CI:0.625-0.781),and the calibration curve was well fitted with the ideal curve.The Hosmer Lemeshow goodness of fit test showed that the nomogram model had good calibration.Conclusion The nomogram model based on pulse parameters can accurately predict the risk of renal damage in patients with essential hypertension,and can provide a reference for clinical prediction of the risk of renal damage in patients with essential hypertension.

High normal blood pressure is a crucial period for preventing cardiovascular and cerebrovascular events in our country.Target organs such as blood vessels,heart,kidney and brain may already be damaged even at the stage of high normal blood pressure.Early diagnosis and treatment can reduce the risk of cardiovascular and cerebrovascular events in patients with high normal blood pressure.Modern research methods for TCM pulse-taking are increasingly mature and have been widely used in screening,diagnosing,predicting,and intervening in cardiovascular and cerebrovascular risk events,such as hypertension,coronary heart disease,and stroke,with remarkable results.By detecting the pressure pulse map corresponding to the pulse of traditional Chinese medicine,it is possible to obtain information on the blood vessel function and elasticity in patients with high normal blood pressure.This can aid in the management of cardiovascular and cerebrovascular risks in such patients.This paper discusses the management of cardiovascular and cerebrovascular risk events in patients with high normal blood pressure.It reviews the application of traditional Chinese medicine pulse diagnosis and considers its value in risk event management.The paper proposes corresponding risk management strategies.

Objective To construct a nomograph model for predicting the risk of renal damage in patients with essential hypertension based on pulse parameters.Methods 518 patients with essential hypertension who were hospitalized in Shuguang Hospital affiliated to Shanghai University of Traditional Chinese Medicine and Cardiology Department of Shanghai Integrated Hospital of Traditional Chinese and Western Medicine from August 2018 to June 2021 were selected,and were divided into hypertension without renal damage group and hypertension with renal damage group according to the evaluation criteria of essential hypertension with renal damage.The general data and blood biochemical indexes of the patients were collected,and the pulse parameters were detected by SMART-I digital pulse analyzer of traditional Chinese medicine,and the differences between the two groups were compared.Single factor and multi factor logistic regression were used to analyze the related parameters;The nomogram model was constructed by R Studio,and the model was evaluated by the ROC curve,calibration curve,and Hosmer Lemeshow goodness of fit test.Results The age,serum uric acid,serum creatinine,urea nitrogen,cystatin C and homocysteine in the group of primary hypertension with renal damage were significantly higher than those in the group without renal damage(P＜0.05).The pulse parameters H4,H3/H1,H4/H1,H5/H1,T1/T4,W1/T in patients with primary hypertension and renal injury were significantly lower than those in patients without renal injury(P＜0.01),and As/Ad was significantly higher than those in patients without renal injury(P＜0.01).Age,current diastolic b1ood pressure,H4/H1,T1/T4,W1/T were independent risk factors of renal damage in patients with essential hypertension.The nomogram model was established based on the above independent risk factors,and the model was tested.The area under the ROC curve was 0.703(95％CI:0.625-0.781),and the calibration curve was well fitted with the ideal curve.The Hosmer Lemeshow goodness of fit test showed that the nomogram model had good calibration.Conclusion The nomogram model based on pulse parameters can accurately predict the risk of renal damage in patients with essential hypertension,and can provide a reference for clinical prediction of the risk of renal damage in patients with essential hypertension.

Objective:To investigate the clinical efficacy of atomoxetine combined with cognitive-behavioral therapy (CBT) on children with attention deficit hyperactivity disorder (ADHD).Methods:Totally 104 children diagnosed with ADHD were randomly divided into atomoxetine group ( n=34), CBT group ( n=35) and atomoxetine combined with CBT group ( n=35). After 12 weeks of treatment, questionnaire-children with difficulties (QCD), Swanson child behavior checklist (SNAP-Ⅳ) and Conners parents rating scales (CPRS) were used to evaluate the efficacy and recorded the adverse reactions during the treatment. SPSS 23.0 software was used for statistical analysis. Paired sample t-test was used to compare the scores of the same group before and after treatment, and one-way ANOVA was used to compare the difference between the three groups after treatment. Results:(1)Compared with baseline, the score of QCD increased(32.96±3.01, 43.00±2.22) ( t=-13.35, P<0.01) , while the attention deficit(15.67±3.46, 6.07±1.73), hyperactivity/impulse(13.59±3.41, 7.30±2.43), opposition disobedience(9.85±3.98, 2.59±2.17) and total score(39.11±6.65, 16.59±3.91) of SNAP-Ⅳ decreased in atomoxetine combined with CBT group after treatment ( t=14.96, 10.87, 11.77, 21.49, all P<0.01). The factor scores of behavior problems(0.81±0.30, 0.70±0.26), learning problems(1.58±0.31, 0.32±0.13), psychosomatic disorders(0.22±0.25, 0.16±0.20), impulse hyperactivity(1.27±0.37, 0.71±0.18), anxiety(0.32±0.26, 0.23±0.17) and hyperactivity index(1.19±0.40, 0.79±0.22) of CPRS also decreased ( t=2.71, 21.23, 2.41, 8.87, 2.96, 6.19, all P<0.05) in atomoxetine combined with CBT group after treatment. (2) After treatment, the changes of QCD scores, attention deficit dimension in SNAP-Ⅳ scale, learning problems and impulse hyperactivity dimension in CPRS scale of the three groups before and after treatment were statistically significant (all P<0.05). (3) Post LSD comparison showed that the change in CBT group was significantly lower than that in atomoxetine group and atomoxetine combined CBT group in QCD score(both P<0.05). In the dimension of attention deficit of SNAP-Ⅳ, the difference in CBT group was significantly lower than that in atomoxetine combined CBT group ( P<0.01). In the learning problems and impulse hyperactivity dimensions of CPRS, the changes of atomoxetine combined with CBT group were significantly higher than those of atomoxetine group and CBT group (all P<0.01). Conclusion:Atomoxetine combined with CBT has better curative effect than atomoxetine or CBT alone in patients with ADHD. It can effectively improve the core symptoms and daily life function of ADHD children, and has high safety.

Objective: To analyze the effects of twirling reinforcing and reducing manipulations on protein expres-sion in parietal cortex of spontaneously hypertensive rats (SHRs), and elucidate the main mechanisms and differences between two manipulations in hypertension treatment. Methods: Rats were randomly divided into the control, model, twirling reinforcing manipulation (TRFM), and twirling reducing manipulation (TRDM) groups. The control and model groups received catch and fixation stimulations once a day for 14 days. The TRFM and TRDM groups were intervened once a day for 20 min for 14 days. On days 0, 2, 6, 10, and 14 after acupuncture, rat systolic blood pressures (SBPs) were measured. Differential protein (DP) expression in the rat parietal cortices was detected. Thereafter, GO functional significance and KEGG pathway enrichment analyses were performed. Results: Compared with the model group, SBP of rats in the TRDM and TRFM groups decreased on days 6 and 10 of acupuncture, respectively (P=.009; P<.001). Moreover, SBP of the TRDM group was signif-icantly lower than that of the TRFM group on days 10 and 14 of acupuncture (P = .015; P = .013). Compared with control group, 601 and 1040 DPs were up-and downregulated, respectively, in the model group. Compared with model group, 44 and 28 up-and downregulated DPs were expressed, respectively, in the TRFM group. Compared with model group, expression of 616 and 427 up-and downregulated DPs, respectively, was found in the TRDM group. After combining the results of GO and KEGG enrichment analyses, five and one pathways were found to be related to the central antihypertensive mechanism of the parietal cortex during twirling reducing and reinforcing manipulations, respectively. Conclusion: TRDM showed a more effective antihypertensive effect on SHRs than TRFM; this antihy-pertensive effect was related to the regulation of different proteins and their biological functions.

Objective:To investigate the effects of sodium arsenite (NaAsO 2) on the expression of sterol regulatory element-binding protein-1c (SREBP-1c), peroxisome proliferator activated receptor α (PPARα) and fatty acid synthase (FAS) in human liver cells (L-02 cells). Methods:L-02 cells were cultured in vitro, and exposed to NaAsO 2 at 0 (control), 2, 4, 8, 16, 32, 64 and 128 μmol/L for 24 h, respectively, and the cell survival rate was determined by CCK-8 method. And a fitting curve was made to calculate the half inhibitory concentration (IC 50), subsequent experiments were carried out with 0, 1/8, 1/4 and 1/2 of IC 50 as arsenic exposure doses. Glycerol phosphate oxidase-catalase (GPO-PAP) method was used to detect the content of triglyceride (TG) in cells; the mRNA expression levels of SREBP-1c, PPARα and FAS were detected by Real-time PCR; and the protein expression levels of SREBP-1c and PPARα were detected by Western blotting. Results:The cell survival rates of 8, 16, 32, 64 and 128 μmol/L NaAsO 2 groups [(92.000 ± 1.414)%, (91.000 ± 0.000)%, (76.500 ± 0.707)%, (53.000 ± 1.412)%, (47.000 ± 1.412)%] were significantly lower than that of the control group [(100.000 ± 0.000)%, P < 0.01]. The IC 50 was 64 μmol/L, and subsequent experiments were conducted with 0 (control), 8, 16 and 32 μmol/L NaAsO 2, respectively. Compared with the control group [(1.000 ± 0.000) mmol/g prot], TG contents of 8, 16 and 32 μmol/L NaAsO 2 groups [(0.691 ± 0.064), (0.474 ± 0.162), (0.184 ± 0.045) mmol/g prot] were significant decreased ( P < 0.01). Compared with the control group, the mRNA expression levels of SREBP-1c, PPARα, FAS, and the protein expression levels of SREBP-1c and PPARα in NaAsO 2 groups were significantly decreased ( P < 0.01 or < 0.05). Correlation analysis showed that NaAsO 2 content was negatively correlated with TG content, SREBP-1c and PPARα protein expression levels ( r =-0.954,- 0.875,-0.965, P < 0.01). Conclusion:NaAsO 2 can reduce the TG content and the expression of lipid metabolism related genes SREBP-1c, PPARα and FAS in L-02 cells, suggesting that arsenic-induced liver injury can cause lipid metabolism disorders.

Objective To investigate the effects of three mitogen-activated protein kinase (MAPK) inhibitors on the expressions of transforming growth factor-β1 (TGF-β1),α-smooth actin (α-SMA) mRNA and protein in human liver stellate cells (LX-2 cells) activated by sodium arsenite.Methods Cultured in vitro LX-2 cells in the logarithmic growth stage were exposed to sodium arsenite at 0.0 (control),2.5,5.0,10.0,20.0,40.0,80.0 μmol/L for 24 h,respectively,and the cell survival rate was determined by CCK-8 assay.According to the results of the study,LX-2 cells were divided into 5 groups:control group,sodium arsenite group,extracellular signal regulation kinase (ERK) inhibition group,c-Jun amino-terminal kinase (JNK) inhibition group,and p38 inhibition group.LX-2 cells were pre-treated with 10.0 μmol/L ERK,JNK,p38 kinase inhibitors (PD98059,SP600125,SB203580) for 30 min in the 3 inhibition groups,and then 20.0 μmol/L sodium arsenite for 24 h.The control group was not treated with sodium arsenite and inhibitors.Sodium arsenite group was not treated with inhibitors.Then mRNA and protein expression levels of TGF-β1 and α-SMA in LX-2 cells were determined by Western blotting and real-time PCR,respectively.Results The survival rates of LX-2 cells in 5.0,10.0,20.0,40.0,80.0 μmol/L sodium arsenite groups were [(92.35 ± 0.92)％,(84.06 ± 0.84)％,(74.27 ± 0.74)％,(59.57 ± 0.60)％,(27.77 ± 0.23)％],which were significantly lower than that of the control group [(100.00 ± 0.00)％,P ＜ 0.05].It was found that the expressions of TGF-β1,o-SMA mRNA and protein of sodium arsenite group were higher than those of the control group (P ＜ 0.01).The expressions of TGF-β1,α-SMA mRNA and protein of the three inhibition groups were lower than those of the sodium arsenite group (P ＜ 0.05).Conclusions Arsenic exposure can cause abnormally high expressions of TGF-β1,α-SMA mRNA and protein in LX-2 cells.Intervention with three MAPK inhibitors can improve the effects of arsenic induced LX-2 cells activation on the expressions of TGF-β1,α-SMA mRNA and protein.

Objective To investigate the clinical feature of perioperative management of non-small cell lung cancer(NSCLC) in aged patients and improve the efficacy of surgical treatment.Methods The clinical data of 35 aged patients with NSCLC were retrospectively analyzed.The risk factors of postoperative complications were analyzed by single factor analysis,the factors had statistical significance were included in Logistic regression analysis.Results Postoperative complications occurred in 10 cases,accounting for 28.6％,and 1 case died,accounting for 2.9％.Logistic regression analysis showed that smoking,chronic bronchitis,coronary heart disease,pulmonary lobectomy were independent risk factors of postoperative complications.ConCLusion Correct staging before operation,strict surgical indication,choose the standard surgical method to reduce surgical trauma,strengthen the perioperative management can still achieve satisfactory therapeutic effect in surgical operation for aged patients with NSCLC.