ObjectiveTo systematically evaluate the efficacy and safety of Qi-reinforcing and blood-activating/stasis-expelling Chinese patent medicines in the treatment of coronary microvascular disease （CMD）. MethodsPubMed， Cochrane Library， CNKI， Wanfang Data， and VIP were searched for the randomized controlled trials （RCTs） on the treatment of CMD with Chinese patent medicines for reinforcing Qi and activating blood/expelling stasis with the time interval from inception to December 31， 2023. The primary outcome indicators included the index of microcirculatory resistance （IMR）， coronary flow reserve （CFR）， and corrected TIMI flow frame count （cTFC）. The secondary outcome indicators included symptomatic efficacy， left ventricular ejection fraction （LVEF）， hypersensitive C-reactive protein （hs-CRP）， nitric oxide （NO）， and adverse events. Cochrane risk-of-bias assessment tool 2.0 （RoB 2.0） and Stata 17.0 were used for literature quality evaluation and meta-analysis of the included RCTs. The Grading of Recommendations， Assessment， Development and Evaluation （GRADE） was used to evaluate the quality of evidence. ResultsA total of 36 RCTs were included in this study， involving 3 029 patients. Compared with conventional Western medicine alone， the combined use of Chinese patent medicines for reinforcing Qi and activating blood/expelling stasis and Western medicine reduced the IMR ［mean difference （MD）=-5.93， 95% confidence interval （95%CI） ［-8.73，-3.14］， n=382， P<0.01］， cTFC （MD=-9.35， 95%CI ［-13.94，-4.76］， n=618， P<0.01）， and hs-CRP ［standard mean difference （SMD）=-1.50， 95%CI ［-1.90，-1.11］， n=1 483， P<0.01］， improved the CFR （SMD=1.14， 95%CI ［0.08，2.19］， n=304， P=0.03）， symptomatic efficacy ［relative risk （RR）=1.36， 95%CI ［1.21，1.53］， n=756， P<0.01］， LVEF （MD=4.39， 95%CI ［2.31，6.47］， n=533， P<0.01）， and NO （SMD=3.16， 95%CI ［2.07，4.25］， n=946， P<0.01） of CMD patients. In terms of safety， the combined therapy reduced the occurrence of adverse events in CMD patients （RR=0.49， 95%CI ［0.29，0.82］， n=591， P=0.01）. GRADE showed moderate quality evidence for adverse events， low quality evidence for cTFC， symptomatic efficacy， LVEF， and NO， and very low quality evidence for IMR， CFR， and hs-CRP. ConclusionBased on microcirculatory function indicators， the combined use of Qi-reinforcing and blood-activating/stasis-expelling Chinese patent medicines and Western medicine may further improve the coronary microvascular function in CMD patients with good safety. The above conclusions remain to be verified with high-quality clinical trials.

Objective To observe the value of MRI quantified uterine indictors in late pregnancy for predicting uterine inertia in delivery.Methods A total of 182 pregnant women were retrospectively collected and were divided into uterine inertia group(inertia group,n=67)and non-uterine inertia group(non-inertia group,n=115)based on delivery or cesarean section records.MRI quantified uterine indicators were compared between groups,and those being statistically different were included to build a multivariate logistic regression model for predicting uterine inertia in delivery.The predictive performance of this model was evaluated using receiver operating characteristic(ROC)curve and the area under the curve(AUC).Results The inertia group had more previous uterine surgeries,also higher proportion of in vitro fertilization and embryo transfer(IVF-ET)and cesarean sections compared to the non-inertia group(all P＜0.05).In late pregnancy,the longitudinal diameter of the uterus,cervical length and the thickness of the myometrium at the placental attachment site in inertia group were larger than those in non-inertia group(all P＜0.05).Increased times of previous uterine surgeries,undergoing IVF-ET,as well as increased longitudinal diameter of the uterus and cervical length in late pregnancy were all independent predictors of uterine inertia in delivery(all P＜0.05).AUC of the multivariate logistic regression model established based on the above factors for predicting uterine inertia in delivery was 0.733.Conclusion MRI quantified uterine indictors in late pregnancy could be used to predict uterine inertia in delivery.

Objective To observe the clinical efficacy of Yiqi Shengjin Powder combined with conventional Western medicine in the treatment of diabetic heart disease,and the effects on cardiac autonomic nervous function,cardiac function and inflammatory factors.Methods Totolly 84 patients with diabetic heart disease were divided into control group and treatment group with random number table method,with 42 cases in each group.The control group developed personalized hypoglycemic plans and heart disease treatment drugs based on the patients'blood glucose levels.The treatment group took Yiqi Shengjin Powder in addition to the control group,and after an interval of 0.5 hours with Western medicine,they took it with warm water,2 bags each time,twice a day,for 6 consecutive weeks of treatment.TCM therapeutic effects of two groups,TCM symptoms score,sinus rhythm RR interval(SDNN),root mean square of adjacent interval difference(RMSSD),standard deviation of RR interval mean(SDANN),high frequency(HF),low frequency(LF),various indicators of cardiac function[left ventricular ejection fraction(LVEF),left ventricular end systolic diameter(LVESD),left ventricular end diastolic diameter(LVEDD)],inflammatory factors[interleukin-6(IL-6),transforming growth factor beta 1(TGF-β1),tumor necrosis factor alpha(TNF-α)]and adverse reactions before and after treatment were observed.Results The total effective rate of the treatment group was 90.48%(38/42),while that of the control group was 73.81%(31/42).The therapeutic effect of the treatment group was better than that of the control group(P<0.05).Compared with before treatment,both group showed a significant decrease in chest pain,tightness,palpitations,palpitations and shortness of breath,excessive dreaming and sweating,five heart restlessness and fatigue scores after treatment(P<0.05);after treatment,the treatment group showed a decrease in chest pain,tightness,palpitations,palpitations and shortness of breath,excessive dreaming and sweating,five heart restlessness and fatigue scores compared to the control group(P<0.05).Compared with before treatment,both group showed a significant increase in SDNN,SDANN,RMSSD,HF and LF after treatment(P<0.05);after treatment,the SDNN,SDANN,RMSSD,HF and LF levels in the treatment group were significantly higher than those in the control group(P<0.001).Compared with before treatment,LVEF increased,LVEDD and LVESD decreased in both group after treatment(P<0.001);after treatment,the LVEF of the treatment group increased compared to the control group,while LVEDD and LVESD decreased compared to the control group(P<0.001).Compared with before treatment,the serum levels of TNF-α,TGF-β1 and IL-6 in both groups decreased(P<0.001);after treatment,the serum levels of TNF-α,TGF-β1 and IL-6 in the treatment group were lower than those in the control group(P<0.001).There was no statistical significance in adverse reactions between the two groups(P>0.05).Conclusion Yiqi Shengjin Powder combined with conventional Western medicine therapy for patients with diabetes heart disease has significant effect and high safety.It can effectively improve patients'cardiac autonomic nervous function and cardiac function,reduce inflammatory reaction,and has no serious adverse reactions.

Objective To observe the value of MRI quantified uterine indictors in late pregnancy for predicting uterine inertia in delivery.Methods A total of 182 pregnant women were retrospectively collected and were divided into uterine inertia group(inertia group,n=67)and non-uterine inertia group(non-inertia group,n=115)based on delivery or cesarean section records.MRI quantified uterine indicators were compared between groups,and those being statistically different were included to build a multivariate logistic regression model for predicting uterine inertia in delivery.The predictive performance of this model was evaluated using receiver operating characteristic(ROC)curve and the area under the curve(AUC).Results The inertia group had more previous uterine surgeries,also higher proportion of in vitro fertilization and embryo transfer(IVF-ET)and cesarean sections compared to the non-inertia group(all P＜0.05).In late pregnancy,the longitudinal diameter of the uterus,cervical length and the thickness of the myometrium at the placental attachment site in inertia group were larger than those in non-inertia group(all P＜0.05).Increased times of previous uterine surgeries,undergoing IVF-ET,as well as increased longitudinal diameter of the uterus and cervical length in late pregnancy were all independent predictors of uterine inertia in delivery(all P＜0.05).AUC of the multivariate logistic regression model established based on the above factors for predicting uterine inertia in delivery was 0.733.Conclusion MRI quantified uterine indictors in late pregnancy could be used to predict uterine inertia in delivery.

Objective To observe the clinical efficacy of Yiqi Shengjin Powder combined with conventional Western medicine in the treatment of diabetic heart disease,and the effects on cardiac autonomic nervous function,cardiac function and inflammatory factors.Methods Totolly 84 patients with diabetic heart disease were divided into control group and treatment group with random number table method,with 42 cases in each group.The control group developed personalized hypoglycemic plans and heart disease treatment drugs based on the patients'blood glucose levels.The treatment group took Yiqi Shengjin Powder in addition to the control group,and after an interval of 0.5 hours with Western medicine,they took it with warm water,2 bags each time,twice a day,for 6 consecutive weeks of treatment.TCM therapeutic effects of two groups,TCM symptoms score,sinus rhythm RR interval(SDNN),root mean square of adjacent interval difference(RMSSD),standard deviation of RR interval mean(SDANN),high frequency(HF),low frequency(LF),various indicators of cardiac function[left ventricular ejection fraction(LVEF),left ventricular end systolic diameter(LVESD),left ventricular end diastolic diameter(LVEDD)],inflammatory factors[interleukin-6(IL-6),transforming growth factor beta 1(TGF-β1),tumor necrosis factor alpha(TNF-α)]and adverse reactions before and after treatment were observed.Results The total effective rate of the treatment group was 90.48%(38/42),while that of the control group was 73.81%(31/42).The therapeutic effect of the treatment group was better than that of the control group(P<0.05).Compared with before treatment,both group showed a significant decrease in chest pain,tightness,palpitations,palpitations and shortness of breath,excessive dreaming and sweating,five heart restlessness and fatigue scores after treatment(P<0.05);after treatment,the treatment group showed a decrease in chest pain,tightness,palpitations,palpitations and shortness of breath,excessive dreaming and sweating,five heart restlessness and fatigue scores compared to the control group(P<0.05).Compared with before treatment,both group showed a significant increase in SDNN,SDANN,RMSSD,HF and LF after treatment(P<0.05);after treatment,the SDNN,SDANN,RMSSD,HF and LF levels in the treatment group were significantly higher than those in the control group(P<0.001).Compared with before treatment,LVEF increased,LVEDD and LVESD decreased in both group after treatment(P<0.001);after treatment,the LVEF of the treatment group increased compared to the control group,while LVEDD and LVESD decreased compared to the control group(P<0.001).Compared with before treatment,the serum levels of TNF-α,TGF-β1 and IL-6 in both groups decreased(P<0.001);after treatment,the serum levels of TNF-α,TGF-β1 and IL-6 in the treatment group were lower than those in the control group(P<0.001).There was no statistical significance in adverse reactions between the two groups(P>0.05).Conclusion Yiqi Shengjin Powder combined with conventional Western medicine therapy for patients with diabetes heart disease has significant effect and high safety.It can effectively improve patients'cardiac autonomic nervous function and cardiac function,reduce inflammatory reaction,and has no serious adverse reactions.

Objective:To explore the effective components and potential mechanisms of Xiefei Lishui Prescription in the treatment of heart failure.Methods:Ultra high-performance liquid chromatography tandem four stage rod time of flight mass spectrometry (UPLC-Q-TOF-MS) technology was used to analyze and identify the active components of Xiefei Lishui Prescription. Drug targets were predicted through the Swiss Target Prediction database, and disease targets were collected from Gene Cards, Dis GENET, and TTD databases. The intersection of drug targets and disease targets was screened using a STRING database for protein interaction to identify core targets. The core targets were included in the DAVID database for GO enrichment and KEGG analysis. Finally, molecular docking validation was performed between the drug components and the corresponding core targets.Results:The results identified 10 active components of Xiefei Lishui Prescription, and 8 potential active components were screened using network pharmacology for the treatment of heart failure with Xiefei Lishui Prescription, corresponding to 160 related action targets. A total of 1 305 disease-related targets were collected, and a total of 51 targets ad 17 core targets were included in the string database for protein interaction analysis. GO functional enrichment and KEGG analysis indicated that the mechanism of Xiefei Lishui Prescription in treating heart failure may be related to pathways such as protein binding, ATP binding, and negative regulation of the VEGF signaling pathway and T cell receptor pathway during apoptosis. The molecular docking results showed that baicalin exhibited good binding activity with ESR1, sorghum isoflavones with ESR1, and quercetin with AKT1, EGFR, IL2, and ABCB1.Conclusion:Xiefei Lishui Prescription may exert therapeutic effects on heart failure through multiple pathways by targeting ESR1, AKT1, EGFR, and other targets.

Myocardial fibrosis is characterized by pathological remodeling of extracellular matrix,which is a common pathological change during the development of various cardiovascular diseases.Qi transformation dysfunction in the zang-fu organs,subtle substance accumulation,and endogenous turbid evil production lead to the occurrence of diseases.The theory of turbid blood is widely used to elucidate the pathological changes of diseases and guide the prevention and treatment.Turbid blood,as a special pathogenic factor and pathological product,plays a crucial role in the oxidative stress process of myocardial fibrosis.Qi deficiency of the heart and spleen,stagnation of turbid blood,impaired blood circulation in the heart,and the inability to maintain the oxidative-reductive system balance of myocardial cells are the root causes of disease onset.Accumulation of turbid blood,intermingled phlegm and blood stasis,blockage of heart vessels,and accumulation of metabolic waste products contribute to disease progression.Prolonged turbidity accumulation leads to cardiac enlargement,scattered mental state,and pathological remodeling of the extracellular matrix,indicating a severe disease stage.Early treatment focuses on strengthening the vital qi and spleen,reducing turbidity and recovering clarity.In the middle stage,the key is to resolve phlegm,eliminate stasis,and promote clarity while removing turbidity.In the late stage,detoxification,turbidity elimination,and restoring clarity are emphasized.By adhering to the characteristics of the pathological mechanism and using traditional Chinese medicine intervention,it is possible to suppress oxidative stress,prevent pathological remodeling of the extracellular matrix,and improve myocardial fibrosis.

Objective To observe the value of placental MRI morphological indicators for diagnosing placenta accreta spectrum(PAS).Methods Totally 214 pregnant women who underwent prenatal placental MR examination were retrospectively enrolled and divided into PAS group(n=110)and non PAS group(n=104)based on the presence of PAS or not,also into PAS subgroup and non PAS subgroup during different weeks of pregnancy.Clinical and MRI data were compared between groups and subgroups,and the value of placental MRI morphological indicators for diagnosing PAS was analyzed.Results Significant differences of pregnant women's age,gestational week at MR examination,delivery gestational week,times of pregnancies,deliveries,cesarean sections,miscarriages and uterine clearances,as well as proportion of placenta praevia were found between groups(all P＜0.05).During 28-32 weeks and 32+1-36 weeks of pregnancy,significant differences of placental diameter,area and volume were found between subgroups(all P＜0.05),while no significant differences of placental MRI morphological indicators at gestational age＞36 weeks was found between subgroups(all P＞0.05).The area under the curve(AUC)of placental diameter,area and volume for diagnosing PAS at 28-32 weeks of pregnancy was 0.749,0.729 and 0.791,respectively,at 32+1-36 weeks was 0.718,0.686 and 0.614,respectively,being not significantly different(all P＞0.05).Conclusion Placental MRI morphological indicators at 28-36 weeks of pregnancy were helpful for diagnosing PAS.

Objective To observe the value of placental MRI morphological indicators for diagnosing placenta accreta spectrum(PAS).Methods Totally 214 pregnant women who underwent prenatal placental MR examination were retrospectively enrolled and divided into PAS group(n=110)and non PAS group(n=104)based on the presence of PAS or not,also into PAS subgroup and non PAS subgroup during different weeks of pregnancy.Clinical and MRI data were compared between groups and subgroups,and the value of placental MRI morphological indicators for diagnosing PAS was analyzed.Results Significant differences of pregnant women's age,gestational week at MR examination,delivery gestational week,times of pregnancies,deliveries,cesarean sections,miscarriages and uterine clearances,as well as proportion of placenta praevia were found between groups(all P＜0.05).During 28-32 weeks and 32+1-36 weeks of pregnancy,significant differences of placental diameter,area and volume were found between subgroups(all P＜0.05),while no significant differences of placental MRI morphological indicators at gestational age＞36 weeks was found between subgroups(all P＞0.05).The area under the curve(AUC)of placental diameter,area and volume for diagnosing PAS at 28-32 weeks of pregnancy was 0.749,0.729 and 0.791,respectively,at 32+1-36 weeks was 0.718,0.686 and 0.614,respectively,being not significantly different(all P＞0.05).Conclusion Placental MRI morphological indicators at 28-36 weeks of pregnancy were helpful for diagnosing PAS.

Coronary microcirculation disorder after myocardial ischemia reperfusion （MIR） is a prominent problem in the treatment of coronary heart disease. According to the physiological commonality between “collaterals-sweat pore qi and fluid” and coronary microcirculation， and the evolution of the course of MIR， it is believed that “heart collateral stasis obstruction， sweat pore constraint and block” is the cause of coronary microcirculation disorder. The evolution of the pathogenesis can be divided into three periods. During the myocardial ischemia period， the pathogenesis is heart collaterals obstruction and sweat pores empty， while during the ischemia reperfusion period， it is internal formulation of deficiency wind， spasms of collaterals or slight heart collaterals obstruction； in the coronary microcirculation disorder period， sweat pores constraint and block， constraint transforming into heat， qi and fluid failing to diffuse are the pathogenesis. The corresponding treatment principle is assisting dredge with supplementation， and supplementing deficiency to dispel stasis； treating wind and blood simultaneously， and extinguishing wind to arrest convulsion； clearing heat and cooling blood， and diffusing qi and unblocking qi and fluid. Moreover， it is recommended to treat the heart and lungs simultaneously， and regulate the heart and liver at the same time.