OBJECTIVE: To explore the functional roles and underlying mechanisms of neferine in the context of angiotensin II (Ang II)-induced hypertension and vascular dysfunction. METHODS: Male mice were infused with Ang II to induce hypertension and randomly divided into treatment groups receiving neferine or a control vehicle based on baseline blood pressure using a random number table method. The hypertensive mouse model was constructed by infusing Ang II via a micro-osmotic pump (500 ng/kg per minute), and neferine (0.1, 1, or 10 mg/kg), valsartan (10 mg/kg), or double distilled water was administered intragastrically once daily for 6 weeks. A non-invasive blood pressure system, ultrasound, and hematoxylin and eosin staining were performed to assess blood pressure and vascular changes. RNA sequencing and network pharmacology were employed to identify differentially expressed transcripts (DETs) and pathways. Vascular ring tension assay was used to test vascular function. A7R5 cells were incubated with neferine for 24 h and then treated with Ang II to record the real-time Ca²⁺ concentration by confocal microscope. Immunohistochemistry (IHC) and Western blot were used to evaluate vasorelaxation, calcium, and the extracellular signal-regulated kinase (ERK)1/2 pathway. RESULTS: Neferine treatment effectively mitigated the elevation in blood pressure, pulse wave velocity, aortic thickening in the abdominal aorta of Ang II-infused mice (P<0.05). RNA sequencing and network pharmacology analysis identified 355 DETs that were significantly reversed by neferine treatment, along with 25 potential target genes, which were further enriched in multiple pathways and biological processes, such as ERK1 and ERK2 cascade regulation, calcium pathway, and vascular smooth muscle contraction. Further investigation revealed that neferine treatment enhanced vasorelaxation and reduced Ca²⁺-dependent contraction of abdominal aortic rings, independent of endothelium function (P<0.05). The underlying mechanisms were mediated, at least in part, via suppression of receptor-operated channels, store-operated channels, or voltage-operated calcium channels. Neferine pre-treatment demonstrated a reduction in intracellular Ca²⁺ release in Ang II stimulated A7R5 cells. IHC staining and Western blot confirmed that neferine treatment effectively attenuated the upregulation of p-ERK1/2 both in vivo and in vitro, which was similar with treatment of ERK1/2 inhibitor PD98059 (P<0.05). CONCLUSIONS Neferine remarkably alleviates Ang II-induced elevation of blood pressure, vascular dysfunction, and pathological changes in the abdominal aorta. This beneficial effect is mediated by the modulation of multiple pathways, including calcium and ERK1/2 pathways.
Animals ; Angiotensin II ; Male ; Benzylisoquinolines/therapeutic use* ; Network Pharmacology ; Blood Pressure/drug effects* ; Sequence Analysis, RNA ; Mice ; Hypertension/chemically induced* ; Mice, Inbred C57BL ; Calcium/metabolism*

Objective To explore the efficacy of"internet+"family doctor contract service model on controlling risk factors related to atherosclerotic cardiovascular disease(ASCVD)such as hypertension,dyslipidemia,and diabetes in young and middle-aged patients in the community.Methods A total of 231 young and middle-aged patients with ASCVD who were contracted and treated regularly in Shanghai Yangpu District Xinjiangwancheng Community Health Service Center from Jan to Dec 2020.According to the different intervention models,they were divided into the traditional group receiving the conventional family doctor contract service and the Internet group taking"internet+"family doctor contract service mode for intervention.The systolic blood pressure,diastolic blood pressure,fasting plasma glucose(FPG),low density lipoprotein(LDL-C),triglyceride(TG)and total cholesterol(TC)were compared within and between the two groups before intervention,three months after intervention,and one year after intervention,to evaluate the control effects of the two intervention modes.Results The 231 patients,of which 113 cases in traditional group and 118 cases in Internet group,were recruited in the study.there were no significant differences in gender,age and proportions of hypertension,diabetes and dyslipidemia between the two groups.Before intervention,there were no significant differences in systolic blood pressure,diastolic blood pressure,FPG,LDL-C,TG and TC between the two groups.Three months after intervention,the systolic blood pressure,diastolic blood pressure,FPG,LDL-C,TG and TC of the two groups were significantly lower than those before the intervention(all P<0.05),and the systolic blood pressure and diastolic blood pressure of the Internet group were significantly lower than those of the traditional group(all P<0.05),but there was no significant difference between the two groups in FPG,LDL-C,TG and TC.One year after the intervention,the systolic blood pressure,diastolic blood pressure,FPG,LDL-C,TG and TC of the patients in the two groups decreased significantly compared with those before intervention(all P<0.05),while the Internet group decreased more significantly(all P<0.05).Conclusion Compared with the traditional contract model,"internet+"family doctor contract service had better management effect on ASCVD-related risk factors in young and middle-aged patients in the community,and benefits the patients to a higher degree.

Objective Based on nuclear factor E2 associated factor 2(NRF2)/PTEN induced hypothesized kinase 1(PINK1)pathway,explored the ameliorating effect of rutaecarpine on chronic obstructive pulmonary disease(COPD)rats and its repairing effect on airway epithelial barrier.Methods COPD rat model were established by smoke combined with airway infusion of lipopolysaccharide;and were randomly divided into model group,control group,and experimental-L group,experimental-M group,experimental-H group,10 rats per group.Another 10 normal rats were selected as the normal group.Experimental-L,-M,-H groups were intraperitoneally injected 15,30 and 60 mg·mL-1 rutaecarpine at the dose of 10 mL·kg-1,respectively.The control group was received 4.05 x 10-2 mg·mL-1 prednisone acetate at the dose of 10 mL·kg-1 by gavage.The normal and model groups were given 0.9％NaCl by intraperitoneal injection.Six groups were treated for 28 days with once a day.The first second forced expiratory volume(FEV1)and forced vital capacity(FVC)of rats were measured by minor animal lung function tester.The levels of interleukin(IL)and interferon-γ(INF-γ)in alveolar lavage fluid were determined by enzyme-linked immunosorbent assay method.The expression levels of PINK1 and NRF2 proteins in the lung tissue were determined by Western blot.Results The levels of FEV1 in the experimental-M group,experimental-H group,control group,model group and normal group were(5.17±0.16),(6.36±0.12),(5.06±0.07),(2.24±0.20)and(6.84±0.11)mL;the levels of FVC were(6.71±0.13),(7.56±0.12),(6.81±0.07),(4.46±0.14)and(7.92±0.11)mL;the levels of IL-12 in alveolar lavage fluid were(7.08±0.51),(9.03±0.54),(7.92±0.79),(3.61±1.01)and(10.15±0.82)pg·mL-1;the levels of IL-9 in alveolar lavage fluid were(22.49±2.27),(15.02±1.41),(17.47±1.84),(38.72±1.28)and(11.78±0.94)pg·mL-1;the levels of INF-γ in alveolar lavage fluid were(13.18±0.54),(16.25±0.60),(15.23±0.43),(6.97±0.89)and(17.22±1.15)pg·mL-1;the relative expression levels of PINK1 protein were 1.10±0.06,1.30±0.09,1.18±0.15,0.42±0.03 and 1.61±0.05;the relative expression levels of NRF2 protein were 0.91±0.05,1.46±0.03,1.35±0.07,0.53±0.07 and 1.64±0.11,respectively.The differences of above indexes were statistically significant between the experimental-M group,experimental-H group,control group and the model group(all P＜0.05).Conclusion Rutaecarpine can inhibit inflammation,improve lung function and repair airway epithelial barrier in COPD rats,and its mechanism may be related to regulating NRF2/PINK1 pathway.

Objective Based on nuclear factor E2 associated factor 2(NRF2)/PTEN induced hypothesized kinase 1(PINK1)pathway,explored the ameliorating effect of rutaecarpine on chronic obstructive pulmonary disease(COPD)rats and its repairing effect on airway epithelial barrier.Methods COPD rat model were established by smoke combined with airway infusion of lipopolysaccharide;and were randomly divided into model group,control group,and experimental-L group,experimental-M group,experimental-H group,10 rats per group.Another 10 normal rats were selected as the normal group.Experimental-L,-M,-H groups were intraperitoneally injected 15,30 and 60 mg·mL-1 rutaecarpine at the dose of 10 mL·kg-1,respectively.The control group was received 4.05 x 10-2 mg·mL-1 prednisone acetate at the dose of 10 mL·kg-1 by gavage.The normal and model groups were given 0.9％NaCl by intraperitoneal injection.Six groups were treated for 28 days with once a day.The first second forced expiratory volume(FEV1)and forced vital capacity(FVC)of rats were measured by minor animal lung function tester.The levels of interleukin(IL)and interferon-γ(INF-γ)in alveolar lavage fluid were determined by enzyme-linked immunosorbent assay method.The expression levels of PINK1 and NRF2 proteins in the lung tissue were determined by Western blot.Results The levels of FEV1 in the experimental-M group,experimental-H group,control group,model group and normal group were(5.17±0.16),(6.36±0.12),(5.06±0.07),(2.24±0.20)and(6.84±0.11)mL;the levels of FVC were(6.71±0.13),(7.56±0.12),(6.81±0.07),(4.46±0.14)and(7.92±0.11)mL;the levels of IL-12 in alveolar lavage fluid were(7.08±0.51),(9.03±0.54),(7.92±0.79),(3.61±1.01)and(10.15±0.82)pg·mL-1;the levels of IL-9 in alveolar lavage fluid were(22.49±2.27),(15.02±1.41),(17.47±1.84),(38.72±1.28)and(11.78±0.94)pg·mL-1;the levels of INF-γ in alveolar lavage fluid were(13.18±0.54),(16.25±0.60),(15.23±0.43),(6.97±0.89)and(17.22±1.15)pg·mL-1;the relative expression levels of PINK1 protein were 1.10±0.06,1.30±0.09,1.18±0.15,0.42±0.03 and 1.61±0.05;the relative expression levels of NRF2 protein were 0.91±0.05,1.46±0.03,1.35±0.07,0.53±0.07 and 1.64±0.11,respectively.The differences of above indexes were statistically significant between the experimental-M group,experimental-H group,control group and the model group(all P＜0.05).Conclusion Rutaecarpine can inhibit inflammation,improve lung function and repair airway epithelial barrier in COPD rats,and its mechanism may be related to regulating NRF2/PINK1 pathway.

Objective To explore the efficacy of"internet+"family doctor contract service model on controlling risk factors related to atherosclerotic cardiovascular disease(ASCVD)such as hypertension,dyslipidemia,and diabetes in young and middle-aged patients in the community.Methods A total of 231 young and middle-aged patients with ASCVD who were contracted and treated regularly in Shanghai Yangpu District Xinjiangwancheng Community Health Service Center from Jan to Dec 2020.According to the different intervention models,they were divided into the traditional group receiving the conventional family doctor contract service and the Internet group taking"internet+"family doctor contract service mode for intervention.The systolic blood pressure,diastolic blood pressure,fasting plasma glucose(FPG),low density lipoprotein(LDL-C),triglyceride(TG)and total cholesterol(TC)were compared within and between the two groups before intervention,three months after intervention,and one year after intervention,to evaluate the control effects of the two intervention modes.Results The 231 patients,of which 113 cases in traditional group and 118 cases in Internet group,were recruited in the study.there were no significant differences in gender,age and proportions of hypertension,diabetes and dyslipidemia between the two groups.Before intervention,there were no significant differences in systolic blood pressure,diastolic blood pressure,FPG,LDL-C,TG and TC between the two groups.Three months after intervention,the systolic blood pressure,diastolic blood pressure,FPG,LDL-C,TG and TC of the two groups were significantly lower than those before the intervention(all P<0.05),and the systolic blood pressure and diastolic blood pressure of the Internet group were significantly lower than those of the traditional group(all P<0.05),but there was no significant difference between the two groups in FPG,LDL-C,TG and TC.One year after the intervention,the systolic blood pressure,diastolic blood pressure,FPG,LDL-C,TG and TC of the patients in the two groups decreased significantly compared with those before intervention(all P<0.05),while the Internet group decreased more significantly(all P<0.05).Conclusion Compared with the traditional contract model,"internet+"family doctor contract service had better management effect on ASCVD-related risk factors in young and middle-aged patients in the community,and benefits the patients to a higher degree.

Tricuspid regurgitation(TR)is a common heart valve disease.According to the pathogenesis,TR can be divided into primary(organic)and secondary(functional)regurgitation,of which functional TR accounts for more than 90%.Patients with severe TR have poor prognosis and poor drug treatment,and surgery(valvuloplasty)is the main treatment.At present,transcatheter edge-to-edge tricuspid valve repair(T-TEER)has become an essential program of transcatheter treatment for TR,providing minimally invasive treatment for TR patients who cannot undergo surgery or are at high risk of surgery.T-TEER reduces the degree of regurgitation by clamping leaflets,and is currently in the early stage of research and development exploration and clinical validation,mainly for functional TR.T-TEER devices have also made significant progress(TriClip,PASCAL),and Chinese-made novel-designed T-TEER devices are also undergoing clinical trials(DragonFly-TTM,SQ-Kyrin-TTM,NeoBlazarTM).This paper reviews the current applications and research progress of T-TEER.

The study aims to analyze the outcome indicators of randomized controlled trial(RCT) of traditional Chinese medicine(TCM) in the treatment of hypertensive intracerebral hemorrhage(HICH) in recent three years, and thus provide suggestions for the future studies in this field. Four English databases, four Chinese databases and two online registration websites of clinical trials were searched. The RCTs published between January 2018 and September 2020 were screened. The risk of bias was assessed and outcome measures were classified. A total of 151 839 articles were retrieved, of which 44 RCTs were included for analysis after screening. The outcome measures of the included RCTs were classified into 7 categories, among which the symptoms/signs category showed the highest reporting rate. National Institute of Health stroke scale(72.73%) was the most frequently reported outcome indicator, while the vo-lume of intracerebral hemorrhage determined by computerized tomography(36.36%) was the most frequently reported lab test outcome. Most studies collect the outcomes at the end of treatment, while 9 studies reported long-term outcomes 3 months or more after onset. Compared with those of international clinical trials, the application of some of the outcomes was reasonable, focusing on patients' symptoms, quality of life and objective outcomes. However, there were still several problems: unclear primary and secondary outcome measures, insufficient attention to long-term prognosis, insufficient attention to social function, few TCM outcomes, lack of measurement blindness and the use of unreasonable composite outcomes. It is recommended that researchers should rationally design the outcome indicators of clinical trials and develop the core outcome set.
Drugs, Chinese Herbal/therapeutic use* ; Humans ; Intracranial Hemorrhage, Hypertensive/drug therapy* ; Medicine, Chinese Traditional ; Quality of Life ; Randomized Controlled Trials as Topic

Idiopathic pulmonary fibrosis （IPF） is a common， lethal interstitial lung disease characterized by airway remodeling， inflammation， alveolar destruction， and fibrosis. The mammalian target of rapamycin complex 1/4E binding protein 1 （mTORC1/4E-BP1） axis is closely related to the expression of collagen by fibroblasts， and its role in pulmonary fibrosis remains to be further elucidated. Traditional Chinese medicine （TCM） has shown promising efficacy in improving the lung function， exercise capacity， and quality of life in patients with IPF. The theory of "same treatment for different diseases" provides a TCM theoretical basis for the treatment of pulmonary fibrosis with Bupleuri Radix， while the research in western medicine has preliminarily shown that both the formulation and single herb as well as the active ingredients of Bupleuri Radix have good therapeutic effects on pulmonary fibrosis. Therefore， this review will elaborate on the role of the mTORC1/4E-BP1 axis in the pathomechanism of IPF， as well as the research results of the active components of Bupleuri Radix on the phosphoinositide 3-kinase/protein kinase B/mammalian target of rapamycin protein（PI3K/AKT/mTOR） pathway， so as to provide a reference for the treatment and drug development of IPF.

Objective::To clarify the inhibitory effect of essential oil from Alpinia zerumbet rhizome (EOFAZ) on oxidized low-density lipoprotein (ox-LDL)-induced transformation of macrophage into foam cell and explore its possible mechanism. Method::THP-1 monocyte was incubated with 100 μg·L^-1 phorbol myristate acetate (PMA) to grow into macrophage, experiment was divided into 4 groups as follows, control group, model group (80 mg·L^-1 ox-LDL), EOFAZ at low dose (80 mg·L^-1 ox-LDL+ 4 μg·L^-1 EOFAZ)and EOFAZ at high dose (80 g·L^-1 ox-LDL+ 20 μg·L^-1 EOFAZ). Mathye thiazolye telrazliurn (MTT) method was employed to examine the influence of EOFAZ on macrophage viability. Western blot was used to analyze the expression level of cluster of differentiation 36(CD36) and ATP-binding cassette transporter A1(ABCA1) protein in macrophage. Enzyme-linked immunosorbent assay (ELISA) was used to detect cholesteryl ester contents in macrophage. Oil red O staining was applied to determine the accumulation of lipids in macrophage. Result::EOFAZ showed non-toxic effect on macrophage. Compared to control group, macrophage in model group displayed higher level of cholesteryl ester and lipid droplet(P<0.01), as well as significant increasing of CD36 expression (P<0.01), but no effect on ABCA1 expression. EOFAZ notably reduced the contents of lipids and cholesteryl ester(P<0.01), down-regulated expression of CD36 and up-regulated expression of ABCA1 in macrophage in comparison with the model group(P<0.01), indicating that EOFAZ inhibited transformation of macrophage into foam cell. Conclusion::EOFAZ could inhibit ox-LDL-induced transformation of macrophage into foam cell, the underlying mechanism may involves its ability to increase CD36 expression and decrease ABCA1 expression in macrophage.