The European Society of Cardiology (ESC) released the "2024 ESC guidelines for the management of elevated blood pressure and hypertension" on August 30, 2024. This guideline updates the 2018 "Guidelines for the management of arterial hypertension." One notable update is the introduction of the concept of "elevated blood pressure" (120-139/70-89 mm Hg). Additionally, a new systolic blood pressure target range of 120-129 mm Hg has been proposed for most patients receiving antihypertensive treatment. The guideline also includes numerous additions or revisions in areas such as non-pharmacological interventions and device-based treatments for hypertension. This article interprets the guideline's recommendations on definition and classification of elevated blood pressure and hypertension, and cardiovascular disease risk assessment, diagnosing hypertension and investigating underlying causes, preventing and treating elevated blood pressure and hypertension. We provide a comparison interpretation with the 2018 "Guidelines for the management of arterial hypertension" and the "2017 ACC/AHA guideline on the prevention, detection, evaluation, and management of high blood pressure in adults."

Metabolic-associated fatty liver disease (MAFLD) and osteoporosis (OP) are two very common metabolic diseases. A growing body of experimental evidence supports a pathophysiological link between MAFLD and OP. MAFLD is often associated with the development of OP. Rutaecarpine (RUT) is one of the main active components of Chinese medicine Euodiae Fructus. Our previous studies have demonstrated that RUT has lipid-lowering, anti-inflammatory and anti-atherosclerotic effects, and can improve the OP of rats. However, whether RUT can improve both fatty liver and OP symptoms of MAFLD mice at the same time remains to be investigated. In this study, we used C57BL/6 mice fed a high-fat diet (HFD) for 4 months to construct a MAFLD model, and gave the mice a low dose (5 mg·kg^-1) and a high dose (15 mg·kg^-1) of RUT by gavage for 4 weeks. The effects of RUT on liver steatosis and bone metabolism were then evaluated at the end of the experiment [this experiment was approved by the Experimental Animal Ethics Committee of Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences (approval number: IMB-20190124D₃03)]. The results showed that RUT treatment significantly reduced hepatic steatosis and lipid accumulation, and significantly reduced bone loss and promoted bone formation. In summary, this study shows that RUT has an effect of improving fatty liver and OP in MAFLD mice.

OBJECTIVE To explore the effects of prescription pre-review system on rational drug use and off-label drug use management in outpatient and emergency department. METHODS A retrospective analysis was conducted on outpatient and emergency department prescription data from three phases in our hospital： January to May 2023 （silent review phase， control group）， June to October 2023 （systematic automatic review phase， intervention group 1）， and November 2023 to March 2024 （phase combining systematic automatic review with centralized feedback from pharmacists to physicians regarding irrational prescriptions， intervention group 2）. These phases followed the implementation of our hospital’s pre-prescription review software. Statistical analysis of the prompt rate of alert， rate of irrational prescriptions， registered the off-label drug use rate and false positive irrationality prescription rate were conducted. Meanwhile， the composition of irrational prescriptions was analyzed， and evidence- based evaluation of the off-label drug use proposed by clinicians was also conducted. RESULTS Compared with control group， the prompt rate of alert and the rate of irrational prescriptions in intervention group 1 were all decreased significantly after receiving pop-up notification， with statistically significant differences （P＜0.05）. With the help of system warning and the pharmacists feedback， the prompt rate of alert and the rate of irrational prescriptions declined further in the intervention group 2， but there was no statistically significant difference when compared with intervention group 1 （P＞0.05）. The main type of irrational drug use was improper administration routes. When comparing intervention group 1 with the control group， as well as intervention group 2 with intervention group 1， a significant decrease in the rate of improper administration routes was observed， with statistically significant differences （P＜0.05）. Compared with control group， there was no significant difference in the registered off-label drug use rate of intervention group 1 and intervention group 2 （P＞0.05）. The doctor’s awareness of off-label drug use registration increased due to the real-time alerts from the pre-prescription review software， along with the pharmacists’ regular summarization and feedback. Total 13 items registrations of off-label drug use were proposed by clinicians from June 2023 to March 2024， all of which were supported by evidence of varying levels； among them， 3 items received FDA approval， 4 items were included in the Micromedex database， and the remaining 6 items were supported by evidence from system reviews or randomized controlled trials. CONCLUSIONS Prescription pre-review system can improve the level of rational drug use and assist in the standardized management of off-label drug use.

The World Health Organization (WHO) released the “Global report on hypertension” on September 19, 2023. This report systematically summarizes the prevalence, mortality, diagnosis and treatment of hypertension in various countries, and elucidates the current situation of hypertension management, and gives a series of suggestions on how to manage hypertension, providing new thinking and inspiration for countries to optimize hypertension management. Through the summary of relevant studies and reports, this paper further reviews the present situation, early identification and management of hypertension.

Objective To explore the feasibility and operability in identifying the therapeutic dominant stages of traditional Chinese medicine(TCM)based on subdivision model of disease course.Methods The hierarchical Bayesian model was used to differentiate the disease course of 125 cases of premature ovarian failure(POF),and the disease course of POF were divided into the occult stage,diminished ovarian reserve(DOR)stage,premature ovarian insufficiency(POI)stage,and POF stage.An then the paired sample t-test,Pearson correlation analysis and expert in-depth interview were used for the analysis of the therapeutic effects of TCM for POF at various stages.Results(1)Compared with POF stage,DOR and POI stages were frequently intervened by Chinese patent medicine.(2)In DOR(complicated with POI)stage and POF stage,there was significant difference between the degree of TCM intervention and the therapeutic effect(t =-3.70,P＜0.001).(3)The degree of TCM intervention was positively correlated with treatment outcomes in the DOR stage(r = 0.679,P＜0.001),so did in the POF stage(r = 0.432,P＜0.001),but the correlation in the POF stage was slightly lower than that in the DOR stage.(4)The results of in-depth interviews with experts of TCM gynecology showed that in the concealed phase of POF,the prognosis would be most favorable if TCM regulation and intervention were performed.In the DOR stage and POI stage,treatment with Chinese medicine prescriptions usually brought about better curative effect and prognosis.For the patients at POF stage,the therapeutic effect of TCM depended on the patients'compliance and the treatment course,and the effect was relatively not as good as that of the previous stages.Conclusion In the DOR stage and POF stage,the higher the degree of TCM intervention,the better the prognosis will be achieved for the patients treated with western medicine.In the POF stage,the efficacy of TCM intervention is reduced to a certain extent compared with the DOR stage.The results indicated that it is feasible and operable to identify the TCM therapeutic dominant stages based on the subdivision model of disease course.

Objective:To explore the application effects of a neurosurgical mixed-reality distance teaching (NMDT) model in standardized residency training in neurosurgery.Methods:We built an NMDT system using mixed-reality technology and remote interaction technology, and designed the implementation procedure according to the teaching objectives. After the teaching activities were completed, a teaching satisfaction questionnaire survey was conducted among 20 neurosurgery resident trainees, in which they provided satisfaction scores for the same teaching content with different teaching models (i.e., the NMDT model and traditional teaching model). SPSS 22.0 software was used to perform the t test for data analysis. Results:There were significant differences between the NMDT model and the traditional teaching model in key indicators including the score for "completion of teaching objectives" (9.20±0.68 vs. 8.25±0.70, P<0.001) and the score for "satisfaction with learning gains" score (8.95±0.67 vs. 8.05±0.92, P=0.001). The NMDT model also outperformed the traditional teaching model in the other individual scores and the total score. Conclusions:The NMDT model can improve teaching quality, increase training efficiency, and enrich teaching content, which is worthy of promotion.

Objective To investigate the effects of Shugan Bushen Decoction combined with laparoscopic surgery on ovarian volume,serum homeobox gene A10(HOXA10)expression and pregnancy rate in patients with refractory polycystic ovary syndrome(PCOS).Methods A total of 80 patients with refractory PCOS of liver stagnation and kidney deficiency type were randomly divided into an observation group and a control group,with 40 cases in each group.The control group was given conventional laparoscopic surgery and conventional medicine treatment.The observation group was treated with Shugan Bushen Decoction on the basis of treatment for the control group.One menstrual cycle constituted one course of treatment,and 3 continuous courses of treatment were given.The changes of traditional Chinese medicine(TCM)syndrome scores,ovarian volume,follicular diameter,serum HOXA10 expression and levels of sex hormones of luteinizing hormone(LH),estradiol(E2),progesterone(P),follicle stimulating hormone(FSH)and testosterone in the two groups before and after treatment were observed.Moreover,the pregnancy outcomes of the two groups during the follow-up for half a year were monitored.Results(1)After treatment,the ovarian volume in the two groups was decreased to different degrees(P＜0.05),and the follicular diameter was increased to different degrees(P＜0.05).The intergroup comparison showed that the decrease of ovarian volume and the increase of follicular diameter in the observation group were significantly superior to those in the control group(P＜0.01).(2)After treatment,the levels of LH,FSH and testosterone in the two groups were significantly lower than those before treatment(P＜0.05),and the levels of HOXA10,E2 and P were significantly higher than those before treatment(P＜0.05).The decrease of LH,FSH and testosterone levels and the increase of HOXA10,E2 and P levels in the observation group were significantly superior to those in the control group(P＜0.05 or P＜0.01).(3)After treatment,the overall TCM syndrome scores and the scores of the syndrome manifestations of abnormal menstrual volume,abnormal menstrual cycle,soreness and weakness of waist and knees,darkish red tongue,deep and unsmooth pulse in the two groups were significantly lower than those before treatment(P＜0.05),and the decrease of overall TCM syndrome scores and the scores of each of the syndrome manifestations in the observation group was significantly superior to that in the control group,the differences being statistically significant(P＜0.01).(4)The pregnancy rate of the observation group was 55.00%(22/40),which was significantly higher than that of 32.50%(13/40)in the control group,and the difference was statistically significant(P＜0.05).Conclusion For the treatment of refractory PCOS of liver depression and kidney deficiency type,Shugan Bushen Decoction combined with laparoscopic surgery can effectively improve the ovarian function of the patients,promote the recovery of sex hormone levels,increase the expression level of HOXA10,improve the endometrial receptivity,and enhance the pregnancy rate of the patients.

Objective To investigate the effects of Chaihuang Yishen Granules on renal fibrosis in unilateral ureteral obstruction(UUO)mice and its underlying mechanisms.Methods Twenty-four 8-week-old male C57BL/6 mice were randomly divided into control group,model group,and low and high dose groups of Chaihuang Yishen Granules(6 in each group).In control group,only right kidney ureter was exposed and dissected.In model group,the UUO animal model was established by UUO.In low and high dose groups,mice were administered intragastrically at doses of 3.8 and 7.6 g/kg of Chaihuang Yishen Granules respectively,following the model group's method to establish the UUO model.After 7 days,the mice were euthanized and renal samples were collected.HE and Masson staining were used to observe pathological changes and fibrosis degree of the kidneys in each group,Sirius red staining was used to observe collagen deposition.The expression levels of α-smooth muscle actin(α-SMA),fibronectin(FN),type Ⅰ collagen(Col-Ⅰ),glycogen synthase kinase 3β(GSK-3β),and β-catenin related proteins were detected using Western blotting.Changes in A33 and GSK-3β,β-catenin mRNA levels were measured by RT-PCR.Additionally,a normal transformed C3H mouse kidney-1(TCMK1)was used as control(normal group);an in vitro fibrosis model was established using TCMK1 stimulated with Transforming Growth Factor-β(TGF-β);and an in vitro drug model was established using TCMK1 treated with serum containing Chaihuang Yishen Granules.A33 was overexpressed in TCMK1 cells using a transfection with an A33 overexpression plasmid,and changes in fibrosis-related indicators and the expression of A33 and GSK-3β,β-catenin mRNA were observed.Results RT-PCR results showed that,compared with control group,A33 level was significantly increased in model group,while it was significantly reduced in both low and high dose groups of Chaihuang Yishen Granules(P＜0.05).Western blotting showed that the expression levels of fibrosis-related factors such as α-SMA,FN,Col-Ⅰ in model group were significantly higher than those in control group(P＜0.05);while compared with model group,the expression levels of α-SMA,FN,Col-Ⅰ in low and high dose groups of Chaihuang Yishen Granules were significantly lower(P＜0.05).HE,Masson,immunohistochemical staining results showed that model group had severe kidney structural damage,significant increase in collagen deposition,and significantly higher expression levels of GSK-3β and β-catenin proteins compared with those in control group(P＜0.01).In contrast,low and high dose groups of Chaihuang Yishen Granules had good kidney structure,significant improvement in kidney damage and fibrosis,and significantly lower expression levels of GSK-3β and β-catenin proteins compared with those in model group(P＜0.05).In vitro experiment results confirmed that,compared with normal group,A33 overexpression promoted the upregulation of fibrosis-related factors in TCMK1 cells,significantly increase the expression of downstream target genes GSK-3β and β-catenin mRNA in the Wnt/β-catenin signaling pathway(P＜0.05),and A33 overexpression reversed the cellular fibrosis changes downregulated by the serum containing Chaihuang Yishen Granules(P＜0.01).Conclusion Chaihuang Yishen Granules significantly improve renal fibrosis in UUO mice by downregulating the A33/Wnt/β-catenin signaling pathway,suggesting that A33 may be a potential therapeutic target for renal fibrosis.

Objective:To investigate the effect and predictive value of plasma apolipoprotein A1(ApoA1)/apoli-poprotein B(ApoB)ratio on early cerebral infarction(CI)after transient ischemic attack(TIA).Methods:A total of 147 TIA patients who were hospitalized in the Neurology or Emergency Department of Affiliated Hospital of North China University of Science and Technology from September 2018 to May 2021 were retrospectively collect-ed.According to presence of cerebral infarction within 7d,they were divided into CI group(n=65)and no CI group(n=82).Immunoturbidimetry was used to detect plasma ApoA1 and ApoB levels,then ApoA1/ApoB ratio was calculated;ROC curve was used to analyze the predictive value of plasma ApoA1/ApoB ratio for early CI after TIA;Logistic regression was used to analyze influencing factors of early CI after TIA.Results:Compared with no CI group,CI group had significantly higher proportions of hyperlipidemia history(52.44％vs.69.23％),stroke history(36.59％vs.55.38％),intracranial artery stenosis(21.95％vs.38.46％)and cerebral ischemia duration≥30min(51.22％vs.73.85％),levels of triglyceride[(1.27±0.48)mmol/L vs.(1.65±0.53)mmol/L]and fast-ing blood glucose[FBG:(5.43±1.52)mmol/L vs.(6.05±1.65)mmol/L](P＜0.05 or＜0.01);significant lower plasma ApoA1 level[(1.35±0.32)g/L vs.(1.07±0.30)g/L]and ApoA1/ApoB ratio[(1.52±0.34)vs.(1.03±0.31)]and significant higher ApoB level[(0.85±0.23)g/L vs.(1.04±0.27)g/L](P＜0.001 all).Sen-sitivity and specificity of plasma ApoA1/ApoB ratio predicting early CI after TIA was 86.15％and 82.93％respec-tively,the area under the curve was 0.884(95％CI 0.821～0.931,P＜0.001)and cutoff value was 1.33.Multi-variate Logistic regression analysis suggested that hyperlipidemia,stroke history,intracranial artery stenosis,FBG＞6.1 mmol/L and cerebral ischemia duration＞30min were independent risk factors for early CI after TIA(OR=1.128～6.613,P＜0.05 or＜0.01),while ApoA1/ApoB ratio＞1.33 was its independent protective factor(OR=0.005,P＜0.001).Conclusion:Plasma ApoA1/ApoB ratio significantly decreases in patients with cerebral infarc-tion after TIA,which is a factor affecting early cerebral infarction after TIA,and it has certain predictive value for it.

The discoid meniscus is a common congenital meniscal malformation that is prevalent mainly in Asians and of-ten occurs in the lateral discoid meniscus.Patients with asymptomatic discoid meniscus are usually treated by conservative methods such as observation and injury avoidance,while patients with symptoms and tears need to be treated surgically.Arthroscopic saucerization combined with partial meniscectomy and meniscus repair is the most common surgical approach.,and early to mid-term reports are good.The prognostic factors are the patient's age at surgery、follow-up time and type of surgery.Some patients experience complications such as prolonged postoperative knee pain,early osteoarthritis,retears and Osteochondritis dissecans.The incidence of prolonged postoperative knee pain was higher and the incidence of Osteochondritis dissecans was the lowest.Retears of the lateral meniscus is the main reason for reoperation.