Objective:To explore the mechanism of Fuyuan Xingnao Decoction in treatment of cerebral infarction based on network pharmacology and molecular docking.Methods:The active components and action targets of Fuyuan Xingnao Decoction were screened by using Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform (TCMSP),Traditional Chinese Medicine Integrated Database (TCMID),Bioactivity data of small organic molecules (PubChem),Universal Protein (Uniprot) and Swiss Target Prediction database platform. The databases of GeneCards, Online Mendelian Inheritance in Man (OMIM), Therapeutic Target Database (TTD), and Drug Bank and Pharmacogenomics Knowledgebase (PharmGKB) were used to screen targets of cerebral infarction. The drug target genes in Fuyuan Xingnao Decoction were intersected with those of cerebral infarction, the intersecting targets were introduced into Cytoscape 3.8.2 software to construct the component target network, and the PPI protein interaction network was constructed by using STRING analysis platform and Cytoscape 3.8.2 software to screen the core targets. Gene Ontology (GO) function enrichment analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) function enrichment analysis were carried out on the common target genes of Fuyuan Xingnao Decoction and cerebral infarction disease to obtain the relevant signal pathways. Finally, AutoDock and Pymol software were used for molecular docking between the predicted target and its corresponding components.Results:After screening, 80 effective components of Fuyuan Xingnao Decoction for treatment of cerebral infarction and 214 common targets of Fuyuan Xingnao Decoction and cerebral infarction were obtained. The core targets such as MAPK1, RELA, TP53, JUN, AKT1 and HSP90AA1 were related to the key targets of cerebral infarction, and they participated in the biological process of regulating the response to drugs, lipopolysaccharide and oxygen level, etc. The cell composition involved membrane raft, membrane micro region and nerve cell body, etc. Molecular functions mainly focused on nuclear receptor activity, ligand activated transcription factor activity, DNA binding transcription factor binding, etc.; it also involved in signal pathway of lipid and atherosclerosis, chemical carcinogen and receptor activation, fluid shear stress and atherosclerosis, etc. Molecular docking showed that good binding activities were seen between Quercetin and HSP90AA1 (-9.4 kJ/mol), between Kaempferol and HSP90AA1 (-9.4 kJ/mol), between Isorhamnetin and HSP90AA1 (-9.1 kJ/mol), and between Quercetin and JUN (-8.6 kJ/mol).Conclusion:Fuyuan Xingnao Decoction can prevent and treat cerebral infarction by regulating vascular endothelial function, promoting blood circulation, repairing and improving neural function, protecting blood-brain barrier, reducing cell apoptosis, and regulating immune and inflammatory response.

Objective:To analyze the clinical characteristics and prognosis of patients infected with novel coronavirus Omicron variant in Shanghai, as to provide a reference for epidemic prevention, clinical diagnosis, and treatment.Methods:Altogether 4 264 novel coronavirus Omicron variant-infected patients with positive results of nucleic acid admitted to Shanghai New International Expo Center N3 Mobile Cabin Hospital from April 2 to May 7, 2022, were included. The demographic and baseline clinical characteristics, treatment strategy, prognosis, and different factors affecting the length of hospital stay were analyzed.Results:A total of 4 264 novel coronavirus variant Omicron-infected cases were collected, including 3 111 cases (73.0%) asymptomatic infections and 1 153 cases (27.0%) mild infections. The overall median age was 45 (33, 55) years old with a range from 2 years old to 81 years old. The male to female ratio was 1.37∶1. Altogether 3 305 cases (77.5%) had been vaccinated, of which 3 166 cases completed more than 2 doses. The upper respiratory tract symptoms such as cough and expectoration were the most common clinical manifestations of these infected patients. During the course of the disease, patients with asymptomatic infection were mainly treated with traditional Chinese medicine (TCM, 55.1%) and clinical observation (36.8%), and those with mild infection were mainly treated with TCM (42.2%) or integrated Chinese and Western medicine (30.4%). All patients were cured and discharged. The overall median length of hospital stay and the negative conversion time of nucleic acid were 9 (6, 10) days and 8 (5, 9) days, respectively. Compared with the asymptomatic infected patients, the hospitalization duration and the nucleic acid negative conversion time of the mildly infected patients were slightly longer [days: 10 (8, 11) vs. 9 (5, 10); 8 (6, 10) vs. 7 (4, 9), both P < 0.001]. Multiple linear regression analysis showed that the increasing age and mild infection were associated with longer hospitalization duration, and the treatment of TCM or integrated Chinese and Western medicine was associated with shortened length of hospital stay (all P < 0.05). Conclusions:The current novel coronavirus Omicron variant epidemic in Shanghai mainly caused asymptomatic and mild infections. The young and middle-aged population had a relatively high infection rate. The upper respiratory tract symptoms such as cough and expectoration were the most common clinical symptoms. Elderly and confirmed patients had prolonged hospitalization duration, while for patients receiving TCM treatment, the hospitalization duration was shortened.

Xiyanping injection, a traditional Chinese medicine injection made of andrographolide sulfonate, consisting of well-defined ingredients with antiviral, antibacterial, anti-inflammatory and antipyretic efficacy, has been widely used for treating infectious diseases of respiratory and digestive systems. However, its wide applications may easily lead to unreasonable clinical medication. In order to guide the precise clinical application and rational use of Xiyanping injection, experts in related fields conducted systematically literature review, evaluated and deliberated the application of Xiyanping injection in treating acute infectious diseases using evidence-based medicine method, and jointly drafted the consensus to summarize types of acute infectious diseases in children and adults that can be treated with Xiyanping injection, and recommend the intervention time, usage and dosage, course of treatment and combined medication of the injection. Besides, the consensus elucidates the safety, precautions and contraindications of the injection, so as to provide guidance for clinical use.

Expert Consensus on the Application of Chinese Patent Medicine for Acute Upper Respiratory Tract Infection was established under the joint sponsorship of Specialty Committee of Emergency of World Federation of Chinese Medicine Societies, Emergency Physician Branch of Chinese Medical Doctor Association, Emergency Medicine Professional Committee of Chinese Association of Integrative Medicine and Chinese Emergency Medical Parternerships. In the consensus, the Chinese patent medicines for treatment of acute upper respiratory tract infection (AURI) were summarized and analyzed, and after the expert writers had discussed the contents of the consensus together, they decided to formulate the experts' consensus related to the AURI, expecting to provide a reference to the clinical treatment of this disease.

Objective To investigate the effect of Kuanxiong Lifei decoction on inflammatory factors in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and turbid phlegm obstructing lung syndrome. Methods Two hundred patients with AECOPD and turbid phlegm obstructing lung syndrome diagnosed by traditional Chinese medicine (TCM) differentiation visiting four hospitals of Longhua Hospital Affiliated to Shanghai University of TCM, Shanghai Seventh People's Hospital, Punan Hospital of Shanghai Pudong New Area, Gongli Hospital of Shanghai Pudong New Area were selected from May 2017 to March 2018, and they were divided into a test group and a control group by a random number table, 100 cases per group. The patients in the two groups were treated with routine western medicine according to the guidelines, and in the test group, additionally Kuanxiong Lifei decoction (components: pinellia ternate 15 g, allium macrostemon 12 g, ephedra 9 g, trichosanthes 30 g, poria cocos 15 g, almond 12 g, lumbricus 12 g, citrus peels 12 g, peach kernel 12 g , roasted licorice 6 g) was used for 10 days, the decoction was uniformly made by Chinese Medicine Pharmacy of Longhua Hospital, 1 dose daily, 2 times a day orally taken, warm 200 mL each time, 0.5 hours before or after meal. The efficacy was evaluated after treatment for 10 days. The level changes of white blood cell count (WBC), neutrophils (N), C-reactive protein (CRP), interleukin-8 (IL-8), tumor necrosis factor-α (TNF-α) before and after treatment and the improvement of TCM syndrome scores and clinical efficacy were observed in two groups. Results After treatment, the levels of WBC, N, CRP, IL-8, TNF-α, TCM syndrome score of the patients in the two group were significantly decreased compared with those before treatment in the two groups (P < 0.05), and the above indexes in the test group were all significantly lower than those in the control group after treatment [WBC (×109/L): 6.58±1.41 vs.7.44±1.85, N: 0.58±0.08 vs. 0.64±0.08, CRP (mg/L): 7.3±1.8 vs. 9.6±1.7, IL-8 (ng/L): 23.5±6.2 vs. 27.8±9.8, TNF-α (ng/L): 9.45±2.18 vs. 10.25±1.67, TCM syndrome total score: 4.0 (3.0, 8.0) vs. 8.0 (5.0, 10.0), all P < 0.05]. The total effective rate of the test group was significantly higher than that of the control group [88% (88/100) vs. 84% (84/100), P < 0.05]. Conclusion Kuanxiong Lifei decoction can significantly reduce lung inflammatory factors, ameliorate overall symptoms and improve the prognosis of AECOPD patients with turbid phlegm obstructing lung syndrome.

Objective To study the extraction technology and optimize the extraction process of Fuyuan Xingnao gran-ule.Methods The preliminary extraction process was designed by routine extraction method combined with the results of pharmacological activity experiment.The extraction process was optimized with orthogonal test.Results The extract was ob-tained by ethanol reflux extraction,water decoction extraction or ethanol precipitation followed by filtration and concentration. The optimal process for ethanol reflux extraction was extracting twice with 50% ethanol.The ratio of liquor to dry material was 8∶1 for the first time and 6∶1 for the second time.The extraction time was 120 minutes for the first time and 80 minutes for the second time.The optimal process for water decoction extraction was extracting twice with 120 minutes and 80 minutes each time.The ratio of liquor to dry material was 10∶1 for the first time and 8∶1 for the second time.The extraction temper-ature was100 ℃.The best ethanol precipitation process was 16 hour extraction with 80% ethanol.The ratio of ethanol to dry material was 2∶1.Conclusion The quality of Fuyuan Xingnao granule extract with this optimized extraction process was in line with requirements of Pharmacopoeiaof the People's Republic of China 2015,4 Volumes(0104 granule).

In 2018, the American Heart Association/American Stroke Association (AHA/ASA) has developed the latest 2018 guidelines for the early management of patients with acute ischemic stroke (AIS), based on the latest evidences. The 2018 guidelines including recommendations on pre-hospital and in-hospital management treatment, has revised and add new recommendations from 2013 guideline. The major changes in 2018 guideline involve applications of brain imaging in early stage, intravenous thrombolysis and mechanical thrombectomy, et al. This review interprets the 2018 guidelines for clinicians to improve the clinical diagnosis, treatment and outcome of patients with AIS.

Objective To explore the correlations between different traditional Chinese medicine (TCM) syndromes and the heart rate variability (HRV) accompanying patients with chest pain,and to provide a referen()for clinical syndrome differentiation in such patients.Methods A prospective study was conducted.()hundred and seventeen patients with chest pain admitted into Longhua Hospital Affiliated to Shanghai U()of TCM from January 2015 to October 2016 were assigned in a study object,and according to the diffe()TCM syndromes,they were divided into syndrome of qi deficiency with blood stasis,the blood sta()the deficiency of qi and yin,suppression of the chest yang,phlegm and blood stasis,qi-stagnan ()syndromes.In the same period,123 healthy people having undergone physical examination wer()control group.The time domain indexes of HRV were recorded by dynamic electrocardiogr()normal control group were compared to those of patients with different TCM syndrom()distribution in different TCM syndromes and various HRV time domain indexes we()cycle time domain indexes were as follows:the average standard deviation o()standard deviation of R-R interval (SDNN),24 hours standard deviation of()5 minutes (SDANN),24 hours the mean square root of difference values,()were observed in both groups.Results The chest pain patients a()accounting for the largest proportion (35 cases,29.9％),and ac()smallest proportion (5 cases,4.3％) in the study group;the nu()syndrome (17 cases vs.14 cases),blood stagnation of hea()(6 cases vs.2 cases) and qi-stagnation and blood stasis s()in men;the numbers of patients with deficiency of qi()(4 cases vs.2 cases) in men were more than thos()female patients were lower than those in maj()66.8 (33.4,33.4) vs.103.4 (39.7,135.4),124.7 (88.0,143.4) vs.167.0 (90.5,230.1),84.0 (22.5,132.6) vs.152.4 (31.4,240.0),all P ＜ 0.05].The SDANN in patients with chest discomfort accompanied by any one of the above mentioned types of TCM syndrome was significantly lower than that in the control group,and its degree of descent was more remarkable in the patients with qi deficiency with blood stasis,the blood stagnation of heart and suppression of the chest yang syndromes (ms:74.86± 25.69,80.39± 20.53,70.97± 23.53 vs.131.30± 34.70,all P ＜ 0.05);the SDNN of patients with deficiency of qi and yin syndrome was higher than that in the blood stagnation of heart syndrome,phlegm and blood stasis,and qi-stagnation and blood stasis syndrome significantly (ms:181.25 ± 65.20 vs.97.88± 23.61,84.28 ± 22.34,89.93 ± 8.43,all P ＜ 0.05);the RMSSD of patients with deficiency of qi and yin syndrome was increased significantly compared with that in the healthy controls and in patients with the blood stagnation of heart syndrome (ms:91.94 ± 44.02 vs.28.00± 10.50,32.21 ± 18.25,both P ＜ 0.05).Conclusions Patients with chest pain accompanied by different TCM syndrome types may develop obvious heart rate variability,and the descent of SDANN level was the most significant.The analysis of HRV changes in such patients has positive significance for their diagnosis and treatment.

Objective To investigate the clinical effects of different dosages of Shenfu injection for treatment of elderly patients with refractory chronic congestive heart failure (CHF).Methods A prospective study was conducted, 360 patients with CHF from Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine were enrolled, and they were randomly divided into low dose, middle dose and high dose Shenfu injection groups. In the three groups, the patients received the same conventional medicine therapy, and additionally they were treated by low, medium and high dose Shenfu injection (60, 80, 100 mL/d, respectively), once a day. The therapeutic course was 10 days in the three groups. After treatment, the clinic therapeutic effect, left ventricular diastolic end diameter (LVEDD), left ventricular ejection fraction (LVEF), stroke volume (SV), cardiac output (CO), cardiac index (CI) and plasma B type natriuretic peptide (BNP) were observed in the three groups.Results The total therapeutic effective rate in middle dose Shenfu injection group was significantly higher than that in low dose and high dose Shenfu injection groups [82.5% (99/120) vs. 54.2% (65/120), 60.0% (72/120), bothP < 0.05]. In high dose Shenfu injection group, increase of blood pressure occurred in 15 cases (12.5%), but no such phenomenon appeared in low and middle dose Shenfu injection groups. In the three groups, no cardiac arrhythmia, liver function abnormality, myocardial enzymogram abnormality, etc. adverse reactions occurred. Compared with those before treatment, after treatment in three groups the LVEDD and BNP were significantly decreased, while LVEF, SV, CO and CI were markedly increased. The changes of above index in middle dose Shenfu injection group were more significant [LVEDD (mm): 46.1±6.3 vs. 58.3±4.4; LVEF: 0.561±0.056 vs. 0.324±0.044, SV (mL): 58.1±6.3 vs. 35.7±5.4, CO (L/min): 5.78±0.60 vs. 4.21±0.78, CI (mL·s-1·m-2): 81.85±7.33 vs. 53.01±9.00, BNP (ng/L): 355.4±76.6 vs. 3 263.2±65.7, allP < 0.05]. Conclusion Shenfu injection 80 mL/d is the best effective dosage for treatment of elderly patients with refractory CHF and its incidence of adverse events is low.

First-aid stations were divided randomly into 4 groups.Advanced airway for sudden cardiac arrest patients with laryngeal mask airway (LMA) was established in groups A and C while trachea cannula was inserted on spot of emergency medical service (EMS) or in ambulance in groups B and D.According to the results,the success rate of insertion and cardiopulmonary resuscitation (CPR) of groups A and C were higher than the other two groups (P ＜ 0.05).However,the required time was shorter (P ＜ 0.05).Due to a difficult catheterization environment,LMA is more effective and convenient than trachea cannula in EMS.