Objective To apply network Meta-analysis to evaluate the clinical efficacy of 3 classical prescriptions Xuebijing,Xijiao Dihuang decoction,and Qingyuan Shenghua decoction in treating sepsis complicated with coagulation dysfunction.Methods Computer-based searches were conducted in the following databases:China National Knowledge Infrastructure(CNKI),VIP Database,Wanfang Database,PubMed Database,and the Cochrane Library,to retrieve randomized controlled trial(RCT)on the treatment of sepsis complicated with coagulation dysfunction and disseminated intravascular coagulation(DIC)using 3 classical prescriptions-Xuebijing,Xijiao Dihuang decoction,and Qingyuan Shenghua decoction.The search period was from database inception to May 1,2023.The control group received conventional Western medicine treatment alone,while the treatment group received additional therapy with Xuebijing,Xijiao Dihuang decoction,or Qingyuan Shenghua decoction.Primary outcome measures included the sequential organ failure assessment(SOFA)score,acute physiology and chronic health evaluationⅡ(APACHEⅡ)score,activated partial thromboplastin time(APTT),D-dimer,fibrinogen(Fib),prothrombin time(PT)and platelet count(PLT).Two researchers evaluated and screened the included studies,performed data extraction,and assessed literature quality.The network Meta-analysis was conducted using Stata 17.0 software.Results A total of 27 RCTs were finally included,with 2268 cases enrolled.The network Meta-analysis results showed that the surface under the cumulative ranking curve(SUCRA):①In terms of improving APACHEⅡscores:Qingyuan Shenghua decoction combination group(93.2%)>Xuebijing combination group(67.9%)>Xijiao Dihuang decoction combination group(37.5%)>conventional Western medicine treatment alone group(1.4%);②In terms of improving SOFA scores:Qingyuan Shenghua decoction combination group(93.7%)>Xuebijing combination group(63.0%)>Xijiao Dihuang decoction combination group(41.8%)>conventional Western medicine treatment alone group(1.5%);③In terms of improving APTT:Qingyuan Shenghua decoction combination group(95.6%)>Xijiao Dihuang decoction combination group(57.1%)>Xuebijing combination group(46.6%)>conventional Western medicine treatment alone group(0.7%);④In terms of improving D-dimer:Xijiao Dihuang decoction combination group(86.1%)>Qingyuan Shenghua decoction combination group(80.5%)>Xuebijing combination group(33.3%)>conventional Western medicine treatment alone group(0.0%);⑤In terms of improving Fib:Xijiao Dihuang decoction combination group(97.5%)>Qingyuan Shenghua decoction combination group(63.5%)>conventional Western medicine treatment alone group(37.8%)>Xuebijing combination group(1.2%);⑥In terms of shortening PT:Qingyuan Shenghua decoction combination group(67.5%)>Xuebijing combination group(67.4%)>Xijiao Dihuang decoction combination group(63.0%)>conventional Western medicine treatment alone group(2.2%);⑦In terms of improving PLT:Xuebijing combination group(83.6%)>Qingyuan Shenghua decoction combination group(54.9%)>Xijiao Dihuang decoction combination group(49.4%)>conventional Western medicine treatment alone group(12.1%).Conclusion The 3 classical Chinese herbal prescriptions combined with conventional Western medicine all demonstrated significant improvement effects on sepsis complicated with coagulation dysfunction.Among them,Xuebijing showed the most stable clinical efficacy,improving both disease severity scores and multiple coagulation indicators.Qingyuan Shenghua decoction was more effective in improving overall prognosis compared to the other two prescriptions.As for Xijiao Dihuang decoction,its clinical efficacy in ameliorating sepsis-related thrombosis warrants further exploration.

Objective To apply network Meta-analysis to evaluate the clinical efficacy of 3 classical prescriptions Xuebijing,Xijiao Dihuang decoction,and Qingyuan Shenghua decoction in treating sepsis complicated with coagulation dysfunction.Methods Computer-based searches were conducted in the following databases:China National Knowledge Infrastructure(CNKI),VIP Database,Wanfang Database,PubMed Database,and the Cochrane Library,to retrieve randomized controlled trial(RCT)on the treatment of sepsis complicated with coagulation dysfunction and disseminated intravascular coagulation(DIC)using 3 classical prescriptions-Xuebijing,Xijiao Dihuang decoction,and Qingyuan Shenghua decoction.The search period was from database inception to May 1,2023.The control group received conventional Western medicine treatment alone,while the treatment group received additional therapy with Xuebijing,Xijiao Dihuang decoction,or Qingyuan Shenghua decoction.Primary outcome measures included the sequential organ failure assessment(SOFA)score,acute physiology and chronic health evaluationⅡ(APACHEⅡ)score,activated partial thromboplastin time(APTT),D-dimer,fibrinogen(Fib),prothrombin time(PT)and platelet count(PLT).Two researchers evaluated and screened the included studies,performed data extraction,and assessed literature quality.The network Meta-analysis was conducted using Stata 17.0 software.Results A total of 27 RCTs were finally included,with 2268 cases enrolled.The network Meta-analysis results showed that the surface under the cumulative ranking curve(SUCRA):①In terms of improving APACHEⅡscores:Qingyuan Shenghua decoction combination group(93.2%)>Xuebijing combination group(67.9%)>Xijiao Dihuang decoction combination group(37.5%)>conventional Western medicine treatment alone group(1.4%);②In terms of improving SOFA scores:Qingyuan Shenghua decoction combination group(93.7%)>Xuebijing combination group(63.0%)>Xijiao Dihuang decoction combination group(41.8%)>conventional Western medicine treatment alone group(1.5%);③In terms of improving APTT:Qingyuan Shenghua decoction combination group(95.6%)>Xijiao Dihuang decoction combination group(57.1%)>Xuebijing combination group(46.6%)>conventional Western medicine treatment alone group(0.7%);④In terms of improving D-dimer:Xijiao Dihuang decoction combination group(86.1%)>Qingyuan Shenghua decoction combination group(80.5%)>Xuebijing combination group(33.3%)>conventional Western medicine treatment alone group(0.0%);⑤In terms of improving Fib:Xijiao Dihuang decoction combination group(97.5%)>Qingyuan Shenghua decoction combination group(63.5%)>conventional Western medicine treatment alone group(37.8%)>Xuebijing combination group(1.2%);⑥In terms of shortening PT:Qingyuan Shenghua decoction combination group(67.5%)>Xuebijing combination group(67.4%)>Xijiao Dihuang decoction combination group(63.0%)>conventional Western medicine treatment alone group(2.2%);⑦In terms of improving PLT:Xuebijing combination group(83.6%)>Qingyuan Shenghua decoction combination group(54.9%)>Xijiao Dihuang decoction combination group(49.4%)>conventional Western medicine treatment alone group(12.1%).Conclusion The 3 classical Chinese herbal prescriptions combined with conventional Western medicine all demonstrated significant improvement effects on sepsis complicated with coagulation dysfunction.Among them,Xuebijing showed the most stable clinical efficacy,improving both disease severity scores and multiple coagulation indicators.Qingyuan Shenghua decoction was more effective in improving overall prognosis compared to the other two prescriptions.As for Xijiao Dihuang decoction,its clinical efficacy in ameliorating sepsis-related thrombosis warrants further exploration.

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.

Objective To investigate the efficacy and safety of intravenous thrombolysis with low-dose and standard-dose recombinant tissue plasminogen activator(rt-PA)in the elderly patients(aged over 80 years)with acute ischemic stroke(AIS).Methods A total of 201 elderly patients with AIS treated at Tianjin Fourth Central Hospital from February 2019 to February 2023 were prospectively included and randomly assigned to the rt-PA low-dose group(n=93,0.6 mg/kg)and rt-PA standard-dose group(n=108,0.9 mg/kg).The incidence of intra-cranial hemorrhage,symptomatic intracranial hemorrhage,fatal intracranial hemorrhage,neurologic deterioration within 7 days and mortality within 90 days were observed to evaluate the safety.The neurologic improvement rate and good prognosis rate at 90 days were used to evaluate the effectiveness.A stratified analysis of 90-day outcomes was performed based on stroke severity and age.Results The incidence of intracranial hemorrhage,symptomatic intracranial hemorrhage and fatal intracranial hemorrhage within 7 days in rt-PA low-dose group was lower than that in rt-PA standard-dose group(P＜0.05).There were no statistically significant differences between the two groups concerning the residual safety index and the effectiveness index.The 90-day good prognosis rate of moderate stroke sub-group and of≥90 years of age sub-group in rt-PA low-dose group were both higher than that of rt-PA standard-dose group(P＜0.05).Conclusions For AIS patients with moderate stroke and aged over 90 years,intravenous thrombolytic therapy with rt-PA 0.6 mg/kg is recommended.

Acute ischemic stroke (AIS) is a kind of central nervous system disease that seriously threatens human health and life. Current treatment for AIS is mainly reperfusion. However, the time-sensitive of reperfusion limits its clinical application, and a considerable part of patients within the time window cannot achieve the expected effect after reperfusion; related complications of reperfusion have not been completely solved. So far, some clinical trials have confirmed that neuroprotectants are useful supplements and adjuncts to reperfusion. This paper reviews the recent advance in neuroprotectants combined with reperfusion in AIS to provide references for AIS treatment.

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.

Objective:To investigate the efficacy and safety of thrombolytic therapy with intravenous alteplase(rt-PA)for elderly acute ischemic stroke patients on maintenance hemodialysis.Methods:In this retrospective study, data of 165 elderly patients with acute cerebral infarction on maintenance dialysis, aged 65-85, treated at the Stroke Center of the Fourth Central Hospital Affiliated to Nankai University between May 2018 and March 2021, were collected.Based on whether intravenous thrombolysis with alteplase(rt-PA)was used and differences in thrombolytic schemes, patients were divided into a conservative treatment group( n=58, receiving only standardized secondary stroke prevention), a low-dose rt-PA group( n=57, receiving rt-PA intravenous thrombolysis, 0.6 mg/kg)and a standard-dose rt-PA group( n=50, receiving rt-PA intravenous thrombolysis, 0.9 mg/kg). The safety and efficacy of rt-PA treatment were assessed. Results:The rate of effectiveness at 24 h and the rate of good prognosis at 7 d were 64.9%(37/57)and 70.2%(40/57)for the low-dose rt-PA group and 68.0%(34/50)and 74.0%(37/50)for the standard dose group, respectively.There was no significant difference between the two groups( χ2=0.417, P=0.518; χ2=0.636, P=0.425), but these rates were better than 29.3%(17/58)and 41.4%(24/58)for the conservative treatment group( χ2=10.583、16.714, P<0.001). The good prognosis rate at 90 days were 73.7%(42/57), 78.0%(39/50)and 69.0%(40/58)for the three groups, respectively, with no significant difference( χ2=1.126, P=0.569), but the fatality rate for the low-dose rt-PA group was 7.0%(4/57), lower than 18.0%(9/50)( χ2=5.420, P=0.020)for the standard dose rt-PA group and 20.0%(8/58)for the conservative treatment group( χ2=5.048, P=0.025). The incidence of intracranial hemorrhage was 8.8%(5/57)for the low-dose rt-PA group, lower than 24.0%(12/50)for the standard-dose rt-PA group( P=0.032). The incidence of extracranial complications was 15.8%(9/57)for the low-dose rt-PA group, lower than 36.0%(18/50)for the standard-dose group( P=0.017). Conclusions:For elderly patients with acute cerebral infarction on maintenance hemodialysis, intravenous thrombolytic therapy with low dose rt-PA should be considered with caution.

OBJECTIVE To investigate the effects of β-sitosterol on the function of rheumatoid arthritis （RA） fibroblastic synoviocytes MH7A cells and its mechanism. METHODS Network pharmacology was adopted to screen the targets of β-sitosterol and the targets for the treatment of RA. After the intersection of them， topological analysis was performed to find the most critical target in the treatment of RA. MH7A cells were treated with different concentrations （0， 5， 10， 20， 40 μmol/L） of β-sitosterol， and CCK-8 was used to assay cell viability for screening the optimal concentration of β-sitosterol. MH7A cells were induced by 10 ng/mL TNF-α in vitro and treated with β-sitosterol （the optimum concentration）. CCK-8 and EdU were used to detect the ability of cell proliferation. Scratch experiment and Transwell invasion assay were used to analyze cell migration and invasion. The levels of interleukin-1β （IL-1β） and IL-6 in cell supernatant were detected by enzyme-linked immunosorbent assay （ELISA）. The mRNA and protein expressions of peroxisome proliferator-activated receptor α （PPARα） were measured by qRT-PCR and Western blot， respectively. The siRNA targeting PPARα was transfected into MH7A cells， and the effects of β-sitosterol on cell proliferation， migration， invasion， the secretion of inflammatory factors and the expression of PPARα after PPARα knockdown were detected by the above experimental methods. RESULTS PPARα was the most critical target of β-sitosterol in the treatment of RA. The optimal concentration of β-sitosterol was 20 μmol/L. Compared with model group， β-sitosterol decreased the viability of MH7A cells， and the number of proliferating cells also decreased significantly （P＜0.05）； the cell migration rate and the number of cell invasion decreased significantly （P＜0.05）. The levels of IL-1β and IL-6 were also significantly decreased （P＜0.05）， and the mRNA 15 and protein expression levels of PPARα were significantly increased （P＜0.05）. Compared with negative control small interfering RNA group， after PPARα knockdown， the cell viability increased by about 35.6% （P＜0.05）， the number of cell proliferation， the cell migration rate and the number of cell invasion increased significantly （P＜0.05）， and the levels of IL-1β and IL-6 also increased significantly （P＜0.05）. CONCLUSIONS β-sitosterol could effectively inhibit the proliferation， migration， invasion and secretion of inflammatory factors in MH7A cells， the mechanism of which may be associated with activating PPARα pathway.

Objective:To investigate the efficacy and safety of recombinant tissue plasminogen activator (rt-PA) intravenous thrombolysis combined with edaravone dexborneol at different timing in super elderly patients (aged≥85 years) with moderate to severe acute ischemic stroke (AIS).Methods:A prospective study was performed. Seventy-one super elderly patients with moderate to severe AIS treated with rt-PA intravenous thrombolysis combined with edaravone dexborneol from December 2020 to March 2023 in Department of Neurology, Affiliated Fourth Central Hospital of Nankai University were selected and randomly divided into early group ( n=35) and advanced group ( n=36); patients in the early group were given edaravone dexborneol immediately after rt-PA intravenous thrombolysis, and patients in the advanced group were given edaravone dexborneol 24 h after rt-PA intravenous thrombolysis. In addition, 31 patients with moderate to severe AIS received rt-PA intravenous thrombolysis only in Department of Neurology of the hospital from August 2018 to December 2020 were selected as control group. Differences in efficacy and safety indexes among the 3 groups were compared. Results:After 7 d of treatment, the improvement rate of neurological function in early group was significantly higher than that in control group and advanced group ( P<0.05). After 90 d of treatment, modified Rankin scale (mRS) scores in early group were statistically lower than those in control group and advanced group ( P<0.05); good prognosis rate in early group was statistically higher than that in control group and advanced group ( P<0.05). The incidences of intracranial hemorrhage and symptomatic intracranial hemorrhage in early group were significantly lower than those in control group and advanced group ( P<0.05). After 30 and 90 d of treatment, the advanced group had significantly lower mortality than the control group, but significantly higher mortality than the early group ( P<0.05). Conclusion:Edaravone dexborneol immediately after rt-PA intravenous thrombolysis is the optimal timing for super elderly patients with moderate to severe AIS, which can improve the efficacy and safety.

Objective:To investigate the efficacy and safety of intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) for acute ischemic stroke with stress hyperglycemia under the guidance of glycosylated hemoglobin A1c (GHbA1c).Methods:The clinical data of 195 patients of acute cerebral infarction with admission blood glucose over 22.2 mmol/L and GHbA1c less than 15.59% were collected in Nankai University Affiliated Tianjin Fourth Central Hospital from January 2018 to June 2021 and analyzed retrospectively. Patients were divided into control group (60 cases), rt-PA low-dose group (0.6 mg/kg, 70 cases) and rt-PA standard-dose group (0.9 mg/kg, 65 cases) to evaluate the guiding effect of GHbA1c and the efficacy and safety of rt-PA.Results:The effective rate at 24 hours and good rate at 7 days were 61.4% (43/70) and 72.9% (51/70) in the rt-PA low-dose group, 64.6% (42/65) and 69.2% (45/65) in the rt-PA standard-dose group, respectively, both better than the control group [30.0% (18/60); χ2=18.25, P<0.001 and 46.7% (28/60); χ2=13.65, P=0.001]. The good outcome rate at 90 days was 82.8% (58/70) in the rt-PA low-dose group, which was better than 63.3% (38/60) in the control group (χ2=6.38, P=0.016), but without statistically significant difference compared with the rt-PA standard-dose group [72.3% (47/65); χ2=2.17, P=0.153]. The case fatality rate at 90 days of the rt-PA low-dose group was 7.1% (5/70), which was lower than 20.0% (13/65) in the rt-PA standard-dose group (χ2=4.82, P=0.041) and 18.3% (11/60) in the control group (χ2=5.04, P=0.030). The incidence of intracranial hemorrhage and symptomatic intracranial hemorrhage was 8.5% (6/70) and 2.9% (2/70) in the rt-PA low-dose group, lower than 20.0% (13/65; P=0.048) and 13.8% (9/65; P=0.020) in the rt-PA standard-dose group. The incidence of extracranial hemorrhage was 7.1% (5/70) in the rt-PA low-dose group, lower than 18.9% (12/65) in the rt-PA standard-dose group ( P=0.042). Conclusion:Acute cerebral infarction patients with admission blood glucose over 22.2 mmol/L can receive rt-PA treatment when GHbA1c is less than 15.59%, and 0.6 mg/kg dosage is recommended.