Objective To observe the cardioprotection of Rhizoma Polygonati(RP)in natural aging rat and its molecular mechanism.Methods 16 SD rats aged 2 months were selected as the young group,another 64 SD rats aged 18 months were randomly divided into 4 groups:an old group,a RP-low,a RP-medium and a RP-high dose group,with 16 rats in each group.The RP-low,RP-medium and RP-high dose groups were administered of RP(1,2,4 g·kg-1)by gavage,the old and young groups were given the same amount of distilled water once a day for 12 weeks.At week 4 and 12,eight rats from each group were sacrificed under anesthesia and hearts were isolated.Then cardiac weight index(CI)were measured and the histopathologic observation was assessed.The contents of total antioxidant capacity(T-AOC),glutathione peroxidase(GSH-Px),superoxide dismutase(SOD)and malondialdehyde(MDA)were measured,and the expression of ataxia-telangiectasia mutated gene(ATM),ATM and Rad3-related kinase(ATR)-related protein in cardiac tissue were detected.Results With the increase of weeks of age,the fibrosis area in the old group was increased.The content of GSH-Px was decreased while MDA was increased;the expressions of Chk1 and Chk2 were also up-regulated(P<0.05).At week 4 or 12,compared to the young group,the CI was reduced,and the contents of T-AOC,SOD,GSH-Px were decreased while MDA was increased;the expression of ATM,ATR-related proteins were all significantly up-regulated in cardiac tissue of old group(P<0.05).After RP treatment,the CI was elevated,the structure of cardiomyocytes were intact and the myocardial fibers were arranged neatly,the fibrosis area was lowered.The contents of T-AOC,GSH-Px,SOD were increased while MDA was decreased.The expression of ATM,ATR-related proteins were significantly down-regulated in cardiac tissue(P<0.05).Conclusion RP could protect the heart in natural aging rats,and its mechanism may be related to the regulation of DNA damage response ATM,ATR signaling pathway.

Objective To establish an online gel permeation chromatography-gas chromatography/mass spectrometry(GPC-GCMS)method for the determination of etomidate in blood.Methods Blood samples were extracted with acetonitrile,dehydrated with anhydrous sodium sulfate,purified with an online GPC system,and then analyzed by GCMS using large volume injection.The external standard curve method was used for quantification.Results The detection limit of etomidate was 0.002 μg/mL,with good linearity in the concentration range of 0.01～5 μg/mL and a correlation coefficient of 0.9992.The extraction recovery rates ranged between 90%and 120%.In an actual case,the content of etomidate detected in the blood sample was 0.024 μg/mL.Conclusion This method is fast,simple,accurate,and stable,providing a reliable basis for the determination of etomidate content in blood.

Objective To establish an online gel permeation chromatography-gas chromatography/mass spectrometry(GPC-GCMS)method for the determination of etomidate in blood.Methods Blood samples were extracted with acetonitrile,dehydrated with anhydrous sodium sulfate,purified with an online GPC system,and then analyzed by GCMS using large volume injection.The external standard curve method was used for quantification.Results The detection limit of etomidate was 0.002 μg/mL,with good linearity in the concentration range of 0.01～5 μg/mL and a correlation coefficient of 0.9992.The extraction recovery rates ranged between 90%and 120%.In an actual case,the content of etomidate detected in the blood sample was 0.024 μg/mL.Conclusion This method is fast,simple,accurate,and stable,providing a reliable basis for the determination of etomidate content in blood.

Objective To observe the cardioprotection of Rhizoma Polygonati(RP)in natural aging rat and its molecular mechanism.Methods 16 SD rats aged 2 months were selected as the young group,another 64 SD rats aged 18 months were randomly divided into 4 groups:an old group,a RP-low,a RP-medium and a RP-high dose group,with 16 rats in each group.The RP-low,RP-medium and RP-high dose groups were administered of RP(1,2,4 g·kg-1)by gavage,the old and young groups were given the same amount of distilled water once a day for 12 weeks.At week 4 and 12,eight rats from each group were sacrificed under anesthesia and hearts were isolated.Then cardiac weight index(CI)were measured and the histopathologic observation was assessed.The contents of total antioxidant capacity(T-AOC),glutathione peroxidase(GSH-Px),superoxide dismutase(SOD)and malondialdehyde(MDA)were measured,and the expression of ataxia-telangiectasia mutated gene(ATM),ATM and Rad3-related kinase(ATR)-related protein in cardiac tissue were detected.Results With the increase of weeks of age,the fibrosis area in the old group was increased.The content of GSH-Px was decreased while MDA was increased;the expressions of Chk1 and Chk2 were also up-regulated(P<0.05).At week 4 or 12,compared to the young group,the CI was reduced,and the contents of T-AOC,SOD,GSH-Px were decreased while MDA was increased;the expression of ATM,ATR-related proteins were all significantly up-regulated in cardiac tissue of old group(P<0.05).After RP treatment,the CI was elevated,the structure of cardiomyocytes were intact and the myocardial fibers were arranged neatly,the fibrosis area was lowered.The contents of T-AOC,GSH-Px,SOD were increased while MDA was decreased.The expression of ATM,ATR-related proteins were significantly down-regulated in cardiac tissue(P<0.05).Conclusion RP could protect the heart in natural aging rats,and its mechanism may be related to the regulation of DNA damage response ATM,ATR signaling pathway.

Objectives:To introduce the definition of the spinal cord(SC)line,and its clinical classification and application strategies in posterior cervical open-door laminoplasty,and to examine and analyze the credibility and repeatability of this classification.Methods:The clinical data of a total of 86 patients who underwent cervical open-door laminoplasty via posterior approach in The Second Affiliated Hospital of Wen-zhou Medical University from January 2018 to December 2020 were analyzed retrospectively.There were 51 males and 35 females,aged 34-77 years old,with postoperative follow-up period ranging from 12 to 36 months.The patients were classified into three types based on the location relationships between the SC line and compressor in the preoperative MRI:Type Ⅰ,the compressor at compression level did not exceed the SC line;Type Ⅱ,the compressor contacted the SC line;Type Ⅲ,the compressor exceeded the SC line.Five spinal surgeons independently evaluated and classified the MRI images of the patients,and Kappa consistency tests were performed to analyze the credibility and repeatability.50 patients with multilevelcervical spinal cord compression diseases(cervical spondylotic myelopathy,ossification of the posterior longitudinal ligament,and developmental cervical spinal canal stenosis)were recruited and treated for a prospective study from January 2021 to December 2022,and the range of open-door segments was determined under the principle of improv-ing the SC line classification as much as possible.The patients were followed up for 12 to 34 months.The modified anterior spinal cord compression score,neck pain visual analogue scale(VAS),Japanese Orthopaedic Association(JOA)score and recovery rates of the patients were recorded pre-operatively and at final follow-up in both retrospective and prospective studies.Paired samples t test was used to compare the scores before and after surgery in each type of patients,and one-way ANOVA was used to compare the scores between the three groups,to assess the postoperative spinal cord decompression and clinical outcomes of the different SC line types.Results:Among the 86 patients analyzed retrospectively,38 were Type Ⅰ,31 were Type Ⅱand 17 were Type Ⅲ.The Kappa coefficient was 0.817-0.945 for inter-observer consistency,which was 0.891-0.963 for intra-observer consistency,indicating satisfactory credibility and repeatability.There was no significant difference in modified anterior spinal cord compression score and VAS score between the three types of patients before surgery(P＞0.05),and all of them were statistically different at the final follow-up compared with the preoperative period(P＜0.05).The modified anterior spinal cord compression score and VAS score were the lowest at the final follow-up in Type Ⅰ,which were the highest in Type Ⅲ(P＜0.05).The JOA recovery rate was(73.49±11.26)％in Type Ⅰ,(67.08±9.01)％in Type Ⅱ,and(53.74±7.93)％in TypeⅢ,with statistically significant differences between the three types(P＜0.05).Among the 50 patients analyzed prospectively,27 were Type Ⅰ,15 were Type Ⅱ and 8 were Type Ⅲ.The preoperative spinal cord com-pression score was 3.67±0.47 in Type Ⅰ,3.84±0.37 in Type Ⅱ,and 4.00±0.00 in Type Ⅲ,which was 1.24±0.62 in Type Ⅰ,2.60±0.58 in Type Ⅱ,and 3.40±0.52 in Type Ⅲ at the final follow-up,respectively.The VAS score decreased from 6.48±0.85 preoperatively to 1.11±0.51 at final follow-up in Type Ⅰ.Type Ⅱcases exhibited a decrease in VAS score from 6.67±0.90 preoperatively to 1.73±0.59 at final follow-up.And the VAS score decreased from a preoperative value of 7.13±0.64 to 2.38±0.52 at final follow-up in Type Ⅲ(P＜0.05).The modified anterior spinal cord compression score and VAS score were the lowest in Type Ⅰand the highest in Type Ⅲ at final follow-up(P＜0.05).The JOA score improved from 12.07±1.17 preopera-tively to 15.59±0.69 at final follow-up in Type Ⅰ.Type Ⅱ cases exhibited an improvement in JOA score from 10.93±0.80 preoperatively to 14.67±0.72 at final follow-up.And the JOA score improved from a preop-erative value of 10.13±1.13 to 13.63±0.74 at final follow-up in Type Ⅲ(P＜0.05).The JOA recovery rate was(72.50±12.38)％in Type Ⅰ,(61.99±9.78)％in Type Ⅱ,and(51.25±5.19)％in Type Ⅲ,which was statisti-cally different between the three groups(P＜0.05).Conclusions:The SC line and its classification are practical and reliable,demonstrating good credibility and repeatability.Suitable open-door segment in posterior open-door laminoplasty in patients of Type Ⅰ SC line can make anterior spinal cord compression relieved;And anterior surgery needs to be considered when anterior compression remained after posterior surgery in patients of Type Ⅲ SC line.

Diabetes, hypertension, and dyslipidemia, collectively referred to the " Three Highs, " represent increasingly prevalent metabolic risk factors in China. Many individuals experience all three conditions concurrently, significantly heightening the risk of cardiovascular disease and mortality. Although the National Metabolic Management Center(MMC) has been established for over eight years and has its unique features, the awareness, treatment, and control rates of these diseases in China remain low, and the efficiency of community management is insufficient. According to the previous two editions of management guidelines and the most recent domestic and international diagnostic and treatment guidelines, this paper conducts an in-depth analysis of the operational experience and management strategies of the MMC. Its aim is to improve the efficiency of grassroots MMC mode management for " Three Highs" patients and ensure that patients receive more standardized management.

Diabetes, hypertension, and dyslipidemia, collectively referred to the " Three Highs, " represent increasingly prevalent metabolic risk factors in China. Many individuals experience all three conditions concurrently, significantly heightening the risk of cardiovascular disease and mortality. Although the National Metabolic Management Center(MMC) has been established for over eight years and has its unique features, the awareness, treatment, and control rates of these diseases in China remain low, and the efficiency of community management is insufficient. According to the previous two editions of management guidelines and the most recent domestic and international diagnostic and treatment guidelines, this paper conducts an in-depth analysis of the operational experience and management strategies of the MMC. Its aim is to improve the efficiency of grassroots MMC mode management for " Three Highs" patients and ensure that patients receive more standardized management.

The latest epidemiological data suggests that the situation of adult diabetes in China is severe, and metabolic diseases have become significant chronic illnesses that have a serious impact on public health and social development. After more than six years of practice, the National Metabolic Management Center(MMC) has developed distinctive approaches to manage metabolic patients and has achieved a series of positive outcomes, continuously advancing the standardized diagnosis and treatment model. In order to further improve the efficiency, based on the first edition, the second edition guideline was composed by incorporating experience of the past six years in conjunction with the latest international and domestic guidelines.

Background: Subclinical hypothyroidism (SCH) is the most common thyroid dysfunction, and its relationship with blood pressure (BP) has been controversial. The aim of the study was to analyze the association between SCH and newly-diagnosed hypertension. Methods: Based on data from the Thyroid disease, Iodine nutrition and Diabetes Epidemiology (TIDE) study, 49,433 euthyroid individuals and 7,719 SCH patients aged ≥18 years were enrolled. Patients with a history of hypertension or thyroid disease were excluded. SCH was determined by manufacturer reference range. Overall hypertension and stage 1 and 2 hypertension were diagnosed according to the guidelines issued by the American College of Cardiology/American Heart Association in 2017. Results: The prevalence of overall hypertension (48.7%), including stage 1 (28.9%) and 2 (19.8%) hypertension, increased significantly in SCH patients compared with euthyroid subjects. With elevated serum thyroid stimulating hormone (TSH) level, the hypertension prevalence also increased significantly from the euthyroid to different SCH subgroups, which was more profound in females or subjects aged <65 years. The age- and sex-specific regression analysis further demonstrated the same trends in the general population and in the 1:1 propensity matched population. Similarly, several BP components (i.e., systolic, diastolic, and mean arterial BP) were positively associated with TSH elevation, and regression analysis also confirmed that all BP components were closely related with SCH in female subjects aged <65 years. Conclusion The prevalence of hypertension increases for patients with SCH. SCH tends to be associated with hypertension and BP components in females younger than 65 years.

Background: Subclinical hypothyroidism (SCH) is the most common thyroid dysfunction, and its relationship with blood pressure (BP) has been controversial. The aim of the study was to analyze the association between SCH and newly-diagnosed hypertension. Methods: Based on data from the Thyroid disease, Iodine nutrition and Diabetes Epidemiology (TIDE) study, 49,433 euthyroid individuals and 7,719 SCH patients aged ≥18 years were enrolled. Patients with a history of hypertension or thyroid disease were excluded. SCH was determined by manufacturer reference range. Overall hypertension and stage 1 and 2 hypertension were diagnosed according to the guidelines issued by the American College of Cardiology/American Heart Association in 2017. Results: The prevalence of overall hypertension (48.7%), including stage 1 (28.9%) and 2 (19.8%) hypertension, increased significantly in SCH patients compared with euthyroid subjects. With elevated serum thyroid stimulating hormone (TSH) level, the hypertension prevalence also increased significantly from the euthyroid to different SCH subgroups, which was more profound in females or subjects aged <65 years. The age- and sex-specific regression analysis further demonstrated the same trends in the general population and in the 1:1 propensity matched population. Similarly, several BP components (i.e., systolic, diastolic, and mean arterial BP) were positively associated with TSH elevation, and regression analysis also confirmed that all BP components were closely related with SCH in female subjects aged <65 years. Conclusion The prevalence of hypertension increases for patients with SCH. SCH tends to be associated with hypertension and BP components in females younger than 65 years.