ObjectiveTo observe the effect of Zhengan Xifengtang on blood pressure and fecal microflora of spontaneously hypertensive rats （SHRs）. MethodA total of 75 male SHRs aged nine weeks were randomly divided into SHR group， Benazepril group （1.00 mg·kg^-1·d^-1）， high-dose Zhengan Xifengtang group （34.5 g·kg^-1·d^-1）， medium-dose Zhengan Xifengtang group （17.25 g·kg^-1·d^-1）， and low-dose Zhengan Xifengtang group （8.625 g·kg^-1·d^-1）. A total of 15 male Wistar-Kyoto （WKY） rats aged nine weeks were selected as the normal group. The normal group and SHR group were administrated with an equal volume of distilled water for eight weeks. During the administration， the blood pressure of the rats was measured regularly. After the intervention， fresh feces were collected with a sterile frozen storage tube， and 16S amplicon information was collected and analyzed. Plasma， hippocampus， and ileum of rats were collected for ultra-high performance liquid chromatography-tandem mass spectrometry（UPLC-MS/MS） detection. ResultZhengan Xifengtang decreased the systolic blood pressure and diastolic blood pressure of SHRs. Compared with the SHR group， Zhengan Xifengtang decreased the diversity of fecal microflora of SHRs. At the phylum level， Zhengan Xifengtang increased the relative abundance of SHR Verrucomicrobia and Actinobacteria and decreased the relative abundance of Synergistetes， Tenericutes， and Candidatus Saccharibacteria. Compared with the SHR group， Zhengan Xifengtang increased the relative abundance of Blautia wexlerae， Fusicatenibacter saccharivorans， and Akkermansia muciniphila and decreased the relative abundance of Clostridium lavalense， Intestinimonas butyriciproducens， Acetatifactor muris， Alloprevotella rava， and Oscillibacter valericigenes. Spearman correlation analysis showed that the systolic blood pressure of rats was negatively correlated with the relative abundance of Ethanoligenens， Aerococcus， Butyrivibrio， Olsenella， Bifidobacterium， Clostridium XIVb， Allobaculum， and Fusicatenibacter and positively correlated with the relative abundance of Alloprevotella. Zhengan Xifengtang increased the contents of plasma， hippocampal 5-hydroxy tryptamine（5-HT）， and 5-hydroxyindole acetic acid（5-HIAA） in SHRs and decreased the contents of 5-HT and 5-HIAA in the ileum， and the content of 5-HT in the hippocampus was negatively correlated with that in the ileum. ConclusionZhengan Xifengtang can reduce the blood pressure of SHRs， which may be related to reducing the diversity of SHR microflora， regulating the structure of the microflora， increasing the relative abundance of 5-HT and short-chain fatty acids bacteria， and lowering the relative abundance of pathogenic bacteria related to intestinal inflammation.

There is a bidirectional relationship between intestinal flora and bile acids,and the imbalance of intestinal flora-bile acid axis metabolism is closely related to hypertension.Based on classical TCM literature and clinical practice,this article found that"earth deficiency"is the important pathological basis of hypertension,"wood depression"is the initiating factor of hypertension,and"earth deficiency and wood depression"is the key pathogenesis of hypertension.Combined with the research results of modern medicine and molecular biology,it is considered that the imbalance of intestinal flora and abnormal bile acid metabolism are closely related to the"earth deficiency"and"wood depression"of TCM respectively,and the imbalance of intestinal flora-bile acid axis coincides with the"earth deficiency and wood depression"of TCM in the process of hypertension.It is of great theoretical and practical significance to explore the biological connotation of hypertension"earth deficiency and wood depression"from the perspective of intestinal flora-bile acid axis for guiding TCM to prevent and treat hypertension.

Objective To investigate the clinical efficacy of endoscopic assisted minimally invasive trans foraminal lumbar interbody fusion(MIS-TLIF)and traditional open TLIF in the treatment of senile degenerative spondylolisthesis.Methods From January 2020 to March 2021,100 elderly patients with degenerative spondylolisthesis were selected and divided into MIS-TLIF group and TLIF group according to the surgical method,with 50 cases in each group.The preoperative and postoperative VAS,Japanese Orthopedic Association score(JO A)and Oswestry disability index(ODI),and the rate of interbody fusion and the incidence of complications were compared and analyzed between the two groups.Results In MIS-TLIF group,the operative time,intraoperative blood loss,incision length,postoperative drainage volume and hospital stay were(167.5±54.2)minutes,(173.8±47.1)ml,(3.5±0.7)cm,(69.6±16.3)ml,and(8.3±2.7)days,respectively.In the TLIF group,it was(136.3±38.9)minutes,(281.0±50.3)ml,(10.0±2.1)cm,(148.4±28.2)ml,and(11.2±3.1)days,respectively.The difference between the two groups was statistically significant(P＜0.05).The VAS,JO A and ODI scores of MIS-TLIF group were(2.17±0.62)points,(21.72±3.14)points and(13.22 ±2.43)points,respectively.The results in TLIF group were(3.24±1.06)points,(17.06±2.85)points and(16.83±2.87)points,respectively,and there was statistical significance between the two groups(P＜0.05).There was no significant difference in the rate of interbody fusion between the two groups at 12 months after operation(P＞0.05).The incidence of postoperative complications in MIS-TLIF group(8.00％)was significantly lower than that in TLIF group(24.00％,P＜0.05).Conclusion MIS-TLIF assisted by endoscope has the advantages of less trauma,faster recovery and less postoperative complications,and the short-term curative effect is more satisfactory than TLIF.

Objective:To evaluate the clinical application of three dimensional artificial intelligence(3D-AI) localization technology in chest CT scan.Methods:A total of 100 patients who underwent chest CT for COVID-19 screening in Nanjing University Medical School Affiliated Drum Tower Hospital were collected from September 2020 to October 2020 were analyzed retrospectively. The patients were divided into manual positioning group ( n=50) and 3D-AI automatic positioning group ( n=50) with block randomization method. All patients were scanned with the same CT scanning protocol. The off-center distance, CT dose index (CTDI), dose length product (DLP) and CT examination time were measured and recorded. Quantitative image evaluation of mediastinal window images and qualitative image evaluation of chest window images were assessed by two radiologists. The off-center distance, CTDI, DLP, CT examination time and objective indexes of image quality of two groups were compared by independent sample t test. The quantitative image quality scores were compared with χ 2 test. Results:Compared with manual positioning group, the overall off-center distance of 3D-AI automatic positioning group was reduced by 42.86% [(15.4±9.7) vs. (8.8±7.2)mm, t=3.65, P<0.01], CTDI was reduced by 10.67%[(7.5±2.5) vs. (6.7±2.6)mGy, t=0.59, P=0.04], DLP was reduced by 13.33%[(270±95) vs. (234±86)mGy·cm, t=1.98, P=0.02], the average examination time was reduced by 29.91% [(214±26) vs. (150±14)s, t=15.79, P<0.01]. There were no significant differences in the background noise, signal to noise ratio of descending aorta and erecting spinal muscle, and subjective score between two groups ( P>0.05). Conclusion:The 3D-AI automatic positioning technology can greatly improve the accuracy of patient positioning and reduce the radiation dose for chest CT imaging, and improve work efficiency with qualified chest CT image quality.

Objective:To investigate the effect of SCN1A gene polymorphism (SCN1A-rs3812718) on the alterations of spontaneous brain activity using amplitude of low-frequency fluctuations (ALFF) of MR in patients with temporal lobe epilepsy (TLE).Methods:A total of 37 TLE patients (TLE group) admitted to the Epilepsy Center of the 900th Hospital of Joint Logistic Team from March 2018 to August 2019 were retrospectively analyzed, and another 28 healthy volunteers matched for gender, age, and years of education with the TLE group were selected as the healthy control group (HC group). Sixty-five subjects were divided into four groups by genotype and diagnosis: 34 cases in AA/AG-TLE subgroup, 3 cases in GG-TLE subgroup, 20 cases in AA/AG-HC subgroup and 8 cases in GG-HC subgroup. All subjects underwent sagittal 3D-T 1WI and resting-state functional MRI using a Siemens 3.0 T Trio Tim MR scanner. Then ALFF values of the four groups were calculated using DPABI by the MATLAB 2010 platform. The ALFF values between two groups were compared by independent samples t-test. The ALFF values of different genotypes at rs3812718 locus in TLE and HC group were analyzed by multivariate analysis of variance to find out the corresponding brain regions with interaction, and then post hoc simple effect analysis was performed. Results:The ALFF values in TLE group significantly increased in left marginal lobe, left parahippocampal gyrus, left fusiform gyrus, left hippocampus, right insular lobe and right inferior temporal gyrus (Alphasim corrected P<0.001) and decreased in the left superior frontal gyrus, left middle frontal gyrus, left inferior frontal gyrus, right middle frontal gyrus, right precuneus, left precuneus, bilateral cingulate gyrus and right angular gyrus (Alphasim correction P<0.05) compared with HC group. Subjects carrying the non-risk G allele had higher ALFF values in the right inferior temporal gyrus, right fusiform gyrus, and right cerebellum than subjects carrying the risk A allele ( t=3.30, Alphasim corrected P=0.002). There was a significant interaction effect on posterior cerebellar lobe, left anterior cerebellar lobe, left inferior temporal gyrus, left superior parietal lobule and right precuneus of TLE patients with SCN1A-rs3812718 genotype. Post-hoc simple effect analysis showed that ALFF significantly increased in the left posterior cerebellar lobe, left anterior cerebellar lobe, left inferior temporal gyrus and left fusiform gyrus in GG-TLE subgroup ( t=5.97, P<0.001), but significantly decreased in the right superior parietal lobule, right precuneus, right posterior cerebellar lobe in AA/AG-TLE subgroup compared to the HC group. Compared with GG-TLE subgroup, ALFF in left posterior cerebellar lobe, left fusiform gyrus and left inferior temporal gyrus decreased in AA/AG-TLE subgroup. Conclusion:SCN1A gene polymorphism in the rs3812718 locus affects spontaneous neural activity in resting state, which may be one of the pathophysiological mechanisms of TLE.

Objective: To analyze the function of essential hypertension′s working memory network by using task-fMRI and independent component analysis (ICA). Methods: According to the enrollment criteria, 24 hypertensive patients and 23 healthy controls (May 2016 to January 2017) in the 900 Hospital of the Joint Service Support Force were collected, who underwent task-state functional MRI data acquisition of N-back by using Siemens 3.0 T MRI. All subjects completed neuropsychological cognitive tests, blood pressure measurements and biochemical tests before MRI. Task-state functional MRI was analyzed by SPM 12, and independent component analysis was performed by GIFT 4.0 software. The independent-samples t-test was used to analyze the maps of the two groups′s task-state fMRI and ICA. The results were adjusted by multiple comparison correction of Alphasim, P<0.05 showed that the difference was statistically significant. Results: Compared with the healthy group, the activation of left superior frontal gyrus and left middle frontal gyrus in hypertension group was enhanced (P<0.05), but there was no obvious weakened activation area. In the independent component analysis, the functional connectivity of left middle frontal gyrus and left anterior central gyrus in hypertension group was significantly lower than that in healthy control group (P<0.05), and there was no significant enhancement of functional connectivity. Conclusions The working memory network of patients with essential hypertension may change abnormally due to the influence of long-term hypertension. This kind of damage can compensate through the functional enhancement of brain regions, thus maintaining the normal cognitive level of hypertensive patients.

Objective To study the effect of masked hypertension (MH) and white coat hypertension (WCH) on vascular elasticity and endothelial function in elderly patients.Methods Four hundred and eighty-seven elderly patients who underwent physical examination in our our hospital were divided into normotension group (n=128),WCH group (n=115),MH group (n=112) and hypertension group (n=132) according to their diagnostic office blood pressure and 24 h ambulatory blood pressure.The brachial artery FMD,serum NO and endothelin-1 (ET-1) levels,and cfPWV were measured.Results The FMD and serum NO level were significantly lower while the serum ET-1 level and cfPWV were significantly higher in WCH group,MH group and hypertension group than in normotension group (P＜0.05).The FMD and serum NO level were significantly higher while the serum ET-1 and cfPWV were significantly lower in WCH group and MH group than in hypertension group (P＜ 0.05).Multivariate linear stepwise regression analysis showed that WCH,MH and hypertension were the independent influencing factors for FMD,serum NO and ET-1 level and cfPWV with normotension used as reference after adjustment of confounding factors (P＜0.01).Conclusion MH and WCH are the risk factors for the decreased vascular elasticity and endothelial dysfunction in elderly patients.

Objective To study the effect of empty-nest (EN) on the variability of HBPV in elderly hypertensive patients.Methods 457 elderly essential hypertensive patients admitted to our hospi tal were divided into non EN group (A group,n =183),EN couple group (B group,n =150),and EN single group (C group,n=124).They underwent 7-day HBPV,their BPV was detected,their loneliness and depressive symptoms were assessed according to the UCLA-LS and GDS.Results The variability of self-measured DPB and SBP,UCLA-LS and GDS score were significantly higher in B and C groups than in A group (P＜0.05).The variability of SBP,UCLA-LS and GDS score were significantly higher in C group than in B group (46.06±7.98 vs 38.95±8.11;7.67±2.58 vs 6.48±2.60,P＜0.05).Partial correlation analysis showed that the variability of SBP and DBP was positively related with the UCLA-LS and GDS score (P＜0.05).The variability of SBP was significantly higher in B and C groups than in A group after adjustment of confounding factors (P=0.000).Conclusion EN,an independent influencing factor for the variability of blood pressure in elderly hypertensive patients,is related with their loneliness and depression.

Objective To study the effect of telmisartan combined with rosuvastatin on white matter lesion (WML) in elderly hypertensive patients.Metheds Three hundred and twenty-nine elderly patients with mild-moderate essential hypertension (EH) were divided into control group (n=167) and combined treatment group (n=162).The patients in control group were treated with telmisartan (40 mg/d) and those in combined treatment group were treated with telmisartan plus rosuvastatin (10 mg/d).Their white matter hyperintensivity (WMH),periventricular white matter hyperintensity (PWMH),and deep white matter hyperintensity (DWMH) were measured by head MRI.Results The total WMH,PWMH and DWMH were significantly higher in two groups in the third and fifth years than at the baseline (P＜0.05).The growth rate of total WMH,PWMH and DWMH was significantly lower in combined treatment group than in control group in the third and fifth years (P＜0.05).Conclusion Telmisartan combined with rosuvastatin plays an important role in stablizing blood pressure,regulating blood lipids,and delaying WML.

Objective To study the association between morning surge (MS) of systolic blood pressure (SBP) and white matter lesions in elderly essential hypertensive (EH) patients.Methods Three hundred and thirty-seven elderly EH patients from Zhangqiu of Shandong Province were divided into MS group (n=150) and non-MS group (n=187).Their 24 h ambulatory SBP was monitored.Their white matter hyperintensity (WMH) was assessed according to their brain MRI.Results The total WMH,periventricular WMH,and deep WMH were significantly higher in MS group than in non-MS group (P＜0.01).The MS of SBP was positively related with the total WMH,periventricular WMH,and deep WMH (r=0.561,r=0.563,r=0.283,P＜0.01),and was an independent risk factor for total WMH,periventricular WMH,and deep WMH after adjustment for confunders (r=0.479,r=0.486,r=0.208,P＜0.01).Conclusion MS of SBP is an independently risk factor for WMH in elderly EH patients.