Effect of Tongxinluo Capsule (通心络胶囊) on Plasma Endothelin,Calcitonin Gene-related Peptide and Nitrogen Oxide of Acute Cerebral Infarction Patients

Research of TCM shows that the chief pathological basis of acute cerebral infarction (ACI) is "blood stasis obstructing collateral". Here the authors used Tongxinluo capsule (通心络胶囊, TXLC) for replenishing qi, removing stasis and dredging collateral to treat qi deficiency-blood stasis type of ACI, and observed the change of plasma endothelin (ET), calcitonin gene-related peptide (CGRP) and nitrogen oxide (NO), aiming at exploring the effect of TXLC on vascular endothelial function and neurotransmitter.     

Astragaloside Ⅳ for Heart Failure: Preclinical Evidence and Possible Mechanisms,A Systematic Review and Meta-Analysis

Objective:To explore the cardioprotective effects of astragaloside Ⅳ(AS-Ⅳ) in heart failure(HF).Methods:PubMed,Excerpta Medica Database(EMBASE),Cochrane Library,Web of Science,Wanfang Database,Chinese Bio-medical Literature and Retrieval System(SinoMed),China Science and Technology Journal Database(VIP),and China National Knowledge Infrastructure(CNKI) were searched from inception to November 1,2021for animal experiments to explore AS-Ⅳ in treating HF in rats or mice. The left ventricular ejecti...     

Therapeutic Effects of Tongxinluo Capsule(通心络胶囊) on Patients with Acute Small Oerebral Infarction and Its Influence on SPECT Brain Periusion Image

Objective: To investigate the influence of Tongxinluo capsule (TXL,通心络胶囊) on regional cerebral blood flow (rCBF) with 99mTc-ECD single photon emission computed tomography (SPECT) brain perfusion imaging, and to observe the therapeutic effects of TXL on acute small cerebral infarction (ASCI). Methods: Thirty-four patients with ASCI were enrolled and randomly divided into two groups: the control group (n = 17) was treated with the conventional treatment, i.e. 1. Og of Citicoline added into 300 ml normal saline for intravenous dripping daily for 2 weeks and 0. 8 g of Piracetam taken three times a day orally for 4 weeks, and the treatment group (n = 17) was treated additionally with 4 TXL capsules three times a day for 4 weeks besides the conventional treatment. The 99mTc-ECD SPECT brain perfusion imaging was performed before and after treatment to observe the change of rCBF, and the neurological deficit was evaluated by Edinburgh-Scandinavia stroke scale (SSS) scores and Barthel index (Bl) at the same     

Therapeutic Effects of Tongxinluo Capsule(通心络胶囊) on Patients with Acute Small Cerebral Infarction and Its Influence on SPECT Brain Perfusion Image

Objective: To investigate the influence of Tongxinluo capsule (TXL, 通心络胶囊) on regional cerebral blood flow (rCBF) with 99mTc-ECD single photon emission computed tomography ( SPECT) brain perfusion imaging, and to observe the therapeutic effects of TXL on acute small cerebral infarction (ASCI).Methods: Thirty-four patients with ASCI were enrolled and randomly divided into two groups: the control group ( n = 17) was treated with the conventional treatment, i.e. 1.0g of Citicoline added into 300 mi normal saline for intravenous dripping daily for 2 weeks and 0.8 g of Piracetam taken three times a day orally for 4 weeks, and the treatment group ( n = 17)was treated additionally with 4 TXL capsules three times a day for 4 weeks besides the conventional treatment. The 99mTc-ECD SPECT brain perfusion imaging was performed before and after treatment to observe the change of rCBF, and the neurological deficit was evaluated by Edinburgh-Scandinavia stroke scale (SSS) scores and Barthel index (BI) at the same time. Results: After treatment, the rCBF in the treatment group was significantly improved ( P＜0.01), while that in the control group remained unchanged, with the comparison of the rCBF in the two groups after treatment showing significant difference (P＜0.01). In addition, the SSS score was significantly lower and BI significantly higher in the treatment group than those in the control group respectively after treatment. Conclusion: TXL could effectively improve rCBF and lessen the neurological deficit symptoms in patients with ASCI.     

Shenyi Capsule (参一胶囊) plus Chemotherapy versus Chemotherapy for Non-Small Cell Lung Cancer: A Systematic Review of Overlapping Meta-Analyses

Objective:To assist decision-makers interpret and choose among conflicting meta-analyses,as well as to offer treatment recommendations based on current best evidence by performing a systematic review of overlapping meta-analyses regarding Shenyi Capsule(参一胶囊,SC) plus chemotherapy versus chemotherapy of non-small cell lung cancer(NSCLC).Methods:A literature search was conducted to select systematic reviews comparing SC plus chemotherapy with chemotherapy for NSCLC.Meta-analyses only composed of randomized controlled trials(RCTs) met the inclusion criteria.Two authors individually estimated the quality of meta-analysis and extracted data.The Jadad decision algorithm was applied to guarantee which meta-analysis provided the best original evidence.Results:A total of 5 meta-analyses were included.All the studies composed of RCTs or quasi-RCTs and were regarded as level-Ⅱ evidence.The scores of the Assessment of Multiple Systematic Reviews ranged from 3 to 6(median 4).A high-quality meta-analysis with more RCTs was chosen,which suggested that SC plus chemotherapy could increase incidence of short-term efficacy,improve the quality of life and survival rate in comparison to chemotherapy.However,there was no statistically significant difference between SC plus chemotherapy and chemotherapy regarding chemotherapy-induced side effect,such as liver and kidney function obstacle,leukopenia,hemoglobin decrement and gastrointestinal adverse reaction.Conclusions:Based on the best available evidence,treatment effect of SC plus chemotherapy was better than chemotherapy and did not increase side effects.Therefore,SC plus chemotherapy may be superior to chemotherapy for treating NSCLC.However,due to some limitations,SC plus chemotherapy should be cautiously considered,and further high-quality meta-analyses are needed.     

Chinese Herbal Medicine Xingnaojing Injection (醒脑静注射液) for Hypoxic Ischemic Encephalopathy in Newborns: A Systematic Review and Meta-Analysis

Objectives: To evaluate the efficacy and safety of Chinese herbal medicine Xingnaojing Injection(醒脑静注射液) for newborns with hypoxic ischemic encephalopathy(HIE). Methods: Literature was identified by searching the Pub Med, EMBASE, Cochrane Library, Cochrane Central, and four Chinese literature databases from the establishment of database to October in 2013. Relevant reference lists were also screened. Two reviewers independently evaluated the methodological quality of included studies. We also conducted the meta-analysis. Results: Thirteen trials involving 1,169 patients were included. There was no trial reported death or disability at the end of follow-up period. Meta-analysis of 4 trials(n=371) showed that there was no significant difference in the reduction of mortality [risk ratios(RR)=0.48, 95% confidence intervals(CI, 0.21, 1.13), P=0.09] between the Xingnaojing and control groups. Meta-analysis of 5 trials(n=359) showed that there was significant difference in reducing the major neurodevelopmental disability [RR=0.36, 95% CI(0.19, 0.66), P=0.001]. Meta-analysis of 6 trials(n=447) showed that there was a significant difference in the author self-defined symptom improvement [RR=1.25, 95% CI(1.14, 1.37), P0.01]. No fatal side-effects were reported. Conclusion: Based on the limited evidence, the routine use of Xingnaojing Injection for treatment of HIE in newborns is not recommended. Further well-conducted trials are justified.     

Is Manipulative Therapy Clinically Necessary for Relief of Neck Pain? A Systematic Review and Meta-Analysis

Objective:To summarize and critically assess the efficacy of Eastern and Western manipulative therapies for the treatment of neck pain in adults. Methods:A search of Pub Med/MEDLINE, the Cochrane Central Register of Controlled Trials, Clinical Trials.gov, EMBASE, etc. from their inception date to January 2014 with Chinese, Japanese, and Korean databases. Two reviewers independently selected randomized controlled trials(RCTs) with negative control or blank control, extracted data and assessed methodological quality. Meta-analysis and levels of evidence were performed by Revman5.1 and Grades of Recommendations Assessment, Development and Evaluation(GRADE) approach. Results:Nineteen clinical trials with adequate randomization were included in this review, 11 of them had a low risk of bias. The primary outcome for shortterm pain had no significant differences, however, the secondary outcome, only the Numerical Pain Rating Scale(NPRS) score of intermediate-term [n=916, pooled mean differences(MD) =–0.29, P=0.02], the Neck Disability Index(NDI) score of short-term(n=1,145, pooled MD=–2.10, P0.01), and intermediate-term(n=987, pooled MD=–1.45, P=0.01) were significantly reduced with moderate quality evidence. However, it supported the minimally clinically important difference(MCID) of the Visual Analogue Scale and NPRS pain score to be 13 mm, while NDI was 3.5 points. The meta-analysis only suggested a trend in favor of manipulative therapy rather than clinical significance. Conclusions:The results do not support the existing evidences for the clinical value of Eastern or Western manipulative therapy for neck pain of short-term follow-up according to MCIDs. The limitations of our review related to blinding, allocation concealment and small sample size.     

Is Chinese Herbal Medicine Effective for Elderly Isolated Systolic Hypertension? A Systematic Review and Meta-Analysis

Objective: To study the efficacy of Chinese medicine (CM) on isolated systolic hypertension. Methods: Seven electronic databases were searched for randomized controlled trials (RCTs) published until August 2015. Subgroup analyses and meta-analysis were performed to assess the efficacy and safety of the included studies. Results: A total of 24 studies, including 2,096 patients (1,058 patients in the intervention group and 1,038 in the control group), were evaluated in the final analysis. Compared with a conventional therapy used alone, CM as additional intervention was more effective on systolic blood pressure [mean difference (MD)=–0.66, 95% confidence interval (CI)=(–0.97, –0.36), P<0.00001] and significantly diminished the pulse pressure [MD=–7.49, CI=(–12.69, –2.29), P<0.00001]. However it showed no additional benefit on diastolic blood pressure [MD=1.16, CI=(0.02, 2.29), P=0.87]. Adverse events were not explicitly reported in most RCTs. Conclusions: CM might be a promising approach for the elderly with isolated systolic hypertension, while the evidence for CM employed alone was insufficient. Considering the inherent limitations of the included studies, larger high-quality RCTs with extensive follow-up should be performed to validate our findings in the future.     

Songling Xuemaikang Capsule(松龄血脉康胶嚢)for Primary Hypertension: A Systematic Review of Randomized Controlled Trials

Objective:To evaluate the effectiveness and safety of Songling Xuemaikang Capsule(松龄血脉康胶囊,SXC) for the treatment of primary hypertension.Methods:An extensive search including Cochrane Library,PubMed,Cochrane Central Register of Controlled Trials(CENTRAL),Chinese Biomedical Literature Database(CBM),Chinese National Knowledge Infrastructure(CNKI),Chinese Scientific Journal Database(VIP),KoreaMed,Japanese database,and online clinical trial registry websites was performed up to February 2013.Randomized controlled trials(RCTs) regarding SXC for the treatment of primary hypertension were searched without no language restrictions.The quality of each trial was assessed according to the Cochrane Reviewers' Handbook 5.0,and RevMan 5.0 provided by the Cochrane Collaboration.Result:A total of 17 RCTs involving1,778 patients were included.Meta-analysis showed that there was no significant difference between SXC and antihypertensive agents on systolic blood pressure[mean difference(MD):-0.10[-4.83,4.63];P=0.97]and diastolic blood pressure(MD:1.00[-1.16,3.16];P=0.36),but SXC combined with antihypertensive drugs was more effective in lowering systolic blood pressure(MD:-6.17[-7.86,-4.49];P0.00001) and diastolic blood pressure(MD:-7.24[-8.62,-5.85];P0.00001) compared with the antihypertensive drugs alone.Conclusions:SXC used alone or combined with antihypertensive drugs appear to be an effective treatment for lowering elevated blood pressure and improving symptoms in patients with primary hypertension.However,the conclusion cannot be drawn definitely due to the poor quality of the included studies.There is still an urgent need for well-designed,long-term studies to address the benefits of SXC for treating primary hypertension.     

Intervention of Tongxinluo Capsule (通心络胶囊) against Vascular Lesion of Atherosclerosis and Its Effect on Lectin-like Oxidized Low Density Lipoprotein Receptor-1 Expression in Rabbits

Lectin-like oxidized low-density lipoprotein(ox-LDL) receptor-1 (LOX-1) is a newly identifiedreceptor for cytotoxic ox-LDL in endothelial cellsand plays an i mportant role in the occurrence anddevelopment of atherosclerosis ( AS)(1). Clinicalstudies have showed that Tongxinluo capsule (通心络胶囊,TXL) could alleviate the symptoms of angi-na and myocardial ischemia in patients with coro-nary heart disease.But there werefewstudies con-cerning the effect or therapeutic mechanism of itspreve…     

Effects of Aidi Injection(艾迪注射液)with Western Medical Therapies on Quality of Life for Patients with Primary Liver Cancer:A Systematic Review and Meta-Analysis

Objective: To evaluate the effects of Aidi Injection(艾迪注射液, AD) in combination with Western medical therapies(WMT) in patients with primary liver cancer(PLC). Methods: Randomized controlled trials(RCTs) comparing AD plus WMT with WMT alone were retrieved from inception to March 2013 by retrieving the literature database thoroughly and systematically. The extracted data from included studies were analyzed and synthesized by Review Manager 5.2 software. The Cochrane risk of bias tool was used to assess the quality of included studies, and Begg's and Egger's tests were used to evaluate the potential presence of publication bias. The studies were divided into 7 separate subgroups in terms of quality of life(QOL), recent chemotherapy and the incidence of leukocyte reduction. The subgroup analysis was applied to assess the heterogeneity between included researches, and the sensitivity analysis was used to weigh the stability of studies. Results: Twenty-four RCTs were included in this study. Compared with WMT used alone, AD as additional intervention was more effective on improving QOL(P0.01), increasing short-term efficacy(P0.01), prolonging life(P0.05 or P0.01), relieving clinical symptoms(P0.01), and reducing adverse events(e.g. reduce white blood cell counts, P=0.002; reduce in platelet counts, P0.01). Subgroup analysis showed that the hepatic artery interventions with AD was superior in improving QOL(P0.01) and enhancing short-term response rates(P=0.007) and reducing white blood cell counts(P=0.0004) than hepatic artery interventions alone(P0.01). The chemoembolization plus AD or the chemotherapy plus AD were both better than chemoembolization or the chemotherapy alone in improving the QOL and short-term response rate(P0.05 or P0.01). Conclusions: AD in combination with WMT improves QOL in patients with PLC. Considering the inherent limitations of the included studies, further well-designed, rigorously performed, high-quality, and double-blinded RCTs with large sample sizes are needed.     

Wendan Decoction(温胆汤) for Treatment of Schizophrenia: A Systematic Review of Randomized Controlled Trials

Objective: To assess the beneficial and adverse effects of Wendan Decoction(温胆汤, WDD) for the treatment of schizophrenia. Methods: Five electronic databases were searched until May 2014, including the Chinese National Knowledge Infrastructure, the Chinese Biomedical Literature Database, the Chinese Scientist Journal Database, Pub Med, and the Cochrane Central Register of Controlled Trials in the Cochrane Library. The randomized controlled trials(RCTs) testing WDD against placebo, antipsychotic drugs, or WDD combined with antipsychotic drugs against antipsychotic drugs alone were included. Study selection, data extraction, quality assessment, and data analyses were conducted according to the Cochrane standards. Results: Thirteen RCTs(involving 1,174 patients) were included and the methodological quality was evaluated as generally low. The pooled results showed that WDD combined with antipsychotic drugs were more effective in clinical comprehensive effect, Positive and Negative Syndrome Scale(PANSS) scores and Brief Psychiatric Rating Scale scores compared with antipsychotic drugs alone. However, WDD had less effectiveness compared with antipsychotics in clinical comprehensive effect; and WDD was not different from antipsychotic drugs for PANSS scores. The side effects were significantly reduced in the intervention group compared with the control group. Conclusions: WDD appears to be effective on improving symptoms in patients with schizophrenia. However, due to poor methodological quality in the majority of the included trials, the potential benefit from WDD needs to be confirmed in rigorous trials and the design and reporting of trials should follow the international standards.     

Effects of Tongguan Capsule(通冠胶囊)on Post-myocardial Infarction Ventricular Remodeling and Cardiac Function in Rats

<正>Objective:To observe the effects of Tongguan Capsule(通冠胶囊,TGC) on post-myocardial infarction ventricular remodeling and heart function in rats.Methods:A rat model of acute myocardial infarction (AMI) was established by coronary ligation.Experimental rats were randomized to 4 groups including three model groups(Group A:captopril 5 mg/kg·day,n=7;Group B:TGC 10 g/kg·day,n=7;and Group C:placebo, n=8),and a sham-control group(Group D:blank control,n=6).Animals were treated for 4 weeks.The cardiac function of rats was assessed at the end of the experiment based on left ventricular ejection fraction(LVEF) and left ventricular short axis fractional shortening(LVFS) detected by colored echocardiography;meanwhile, the condition of ventricular remodeling was observed through the levels of left ventricular mass(LVM),plasma aldosterone(ALD),myocardial angiotensinⅡ(AngⅡ) and myocardial collagen measurements.Results:At the end of the experiment,LVEF and LVFS in Group A and B were improved significantly,while those in Group C were unchanged,the LVEF in Group A,B,C,and D was 0.57±0.46,0.61±0.08,0.36±0.55 and 0.76±0.02,respectively;and their LVFS was 0.31±0.52,0.34±0.04,0.23±0.57 and 0.45±0.03,respectively.The difference was statistically significant when comparing the two indexes in Group A and B with those in Group C and D(P0.05).LVM,levels of plasma ALD and myocardial AngⅡwere lower in Group A and B than in Group C,but a comparison between Group A and B showed an insignificant difference in lowering LVM and ALD,while the lowering of AngⅡwas more significant in Group B than in Group A(754.7±18.7 pg/mL vs 952.6±17.6 pg/ mL,P0.05).Morphological examination showed that in Group A and B the swollen myocardial cells had shrunk, with regularly arranged myocardial fibers and decreased collagen proliferation,but the improvements in Group B were more significant.Conclusion:TGC could markedly improve the post-infarction ventricular remodeling and cardiac function in rats,showing that the efficacy was better than or equal to that of captopril.     

Tanreqing Injection (痰热清注射液) for Patients with Influenza: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Objective: To systematically evaluate the efficacy and safety of Tanreqing Injection (痰热清注射液, TRQI) combined with conventional treatment on clinical outcomes in the treatment of patients with influenza. Methods: The electronic databases searched were Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library), MEDLINE (PubMed), EMbase (OvidSP), Chinese Bio-medical Literature and Retrieval System (Sinomed), China National Knowledge Infrastructure Database (CNKI), China Science and Technology Journal Database (VIP) and WanFang Data Knowledge Service Platform, and we checked the reference sections of the retrieved articles as well. The search was performed in October 2018, and we used the randomized controlled trials (RCTs) that corresponded to the new diagnostic criteria for influenza. Two review authors independently screened the internalized articles in accordance with the Preferred Reporting Items for systematic review and Meta-Analysis (PRISMA) statement checklist. We evaluated the quality of the articles and extracted the data from the studies using the Revmen5.3 software. Results: We included 12 RCTs of over 882 cases in this meta-analysis. Compared to conventional treatment, TRQI combined with conventional treatment could increase the total effective rate [9 RCTs, n=648, odds ratio (OR): 4.92, 95% confidence interval (CI): 2.94, 8.24, P<0.0001, random effects model], decrease the average time for fever clearance [7 RCTs, n=564, mean difference (MD): –1.08, 95% CI: –1.68, –0.48, P=0.0004, random effects model] and decrease the time for resolution of cough (5 RCTs, n=362, MD: –1.76, 95% CI: –2.63, –0.90, P<0.0001, random effects model). Conclusion: Based on this meta-analysis of RCTs, TRQI combined with conventional treatment had a statistically significant benefit in increasing the total effective treatment rate and reducing the time for fever clearance as well as time for resolution of cough.     

通心络胶囊治疗冠心病(附90例疗效观察)

目的　观察通心络胶囊治疗冠心病的临床疗效。方法　对 180例住院的冠心病患者 ,随机分成 2组。对照组 90例在应用极化液及消心痛等常规治疗的基础上加通心络胶囊 ,3次 /d ,3片 /次 ,疗程均为 1个月。结果　临床疗效 :治疗组总有效率 87 78% ,对照组 70 0 0 % (P <0 0 5 ) ;心电图疗效 :总有效率治疗组84 4 4% ,对照组 72 2 2 % (P <0 0 5 ) ;血流变及血脂疗效 :治疗后两组各指标差异显著 (P <0 0 5 ,P <0 0 1) ,治疗组治疗前后比较 ,全血黏度与纤维蛋白差异显著 (P <0 0 1) ,其余各项观察指标差异显著 (P <0 0 5 )。结论　通心络胶囊具有降脂、抗凝、增强纤溶活性 ,改善血管内皮细胞功能 ,缓解冠心病缺血程度 ,促进受损心肌修复     

Shenqi Fuzheng Injection(参芪扶正注射液) for Advanced Gastric Cancer:A Systematic Review of Randomized Controlled Trials

Objective:To evaluate the effectiveness of Shenqi Fuzheng Injection(参芪扶正注射液,SFI)combined with chemotherapy for advanced gastric cancer.Methods:Randomized controlled trials(RCTs) from10 databases were searched for this meta-analysis till December 31,2012 without language restriction.Grey literature and potential unpublished literature was also searched.The key search terms were "chemotherapy","Shenqi Fuzheng Injection" and "advanced gastric cancer".Criteria were built to select these clinical trials,in which SFI combined with chemotherapy was compared with chemotherapy alone for advanced gastric cancer.The methodological quality of each RCT was assessed using the Cochrane risk of bias tool.RevMan 5.1software was applied for data analyses.Results:Thirteen RCTs involving 860 patients met the selection criteria(all articles were from Chinese databases).The meta-analysis showed positive results for the use of SFI combined with chemotherapy according to quality of life in terms of the scores when compared with chemotherapy alone.Positive results were also obtained for the combination treatment,in terms of complete remission and partial remission efficacy rate,body weight and decreased adverse events including nausea and vomiting at grade 3-4,oral mucositis at grade 1-2,leucopenia at grade 3-4,and myelo-suppression at grade 1-2.Conclusions:This systematic review found encouraging albeit limited evidence for SFI combined with chemotherapy.However,to obtain stronger evidence without the drawbacks of trial design and the quality of studies,we recommend comparative effectiveness researches to test the effectiveness of combination treatment.     

Is Chinese Medicine Injection Applicable for Treating Acute Lung Injury and Acute Respiratory Distress Syndrome? A Systematic Review and Meta-analysis of Randomized Controlled Trials

Objective: To assess the efficacy and safety of Chinese medicine injection(CMI) for treating acute lung injury/acute respiratory distress syndrome(ALI/ARDS). Methods: Randomized controlled trials(RCTs) were identified by searching 3 English databases and 4 Chinese databases from their inceptions until February 2019. The Cochrane Handbook was used to evaluate risk of bias in the included studies. Data analysis was conducted using RevMan 5.3.3 software. Results: A total of 19 eligible RCTs involving 1,334 participants was included in this systematic review and meta-analysis. The main meta-analysis showed that CMI combined with conventional therapy(CT) was more effective than CT alone in reducing the acute physiology and chronic health evaluation(APACHE) Ⅱ score [mean difference(MD): –1.74 points, 95% confidence interval(CI): –2.77 to –0.71, I~2=0] and increasing the total effective rate [relative risk(RR): 1.35, 95% CI: 1.17 to 1.56, I~2=37%]. Compared with CT, CMI combined with CT showed improvements in the arterial partial pressure of oxygen(PaO_2, MD: 9.25 mm Hg, 95% CI: 0.87 to 17.63, I~2=98%) and oxygenation index [arterial partial pressure of oxygen(PaO_2)/fraction of inspired oxygen(FiO_2), MD: 50.75 mm Hg, 95% CI: 35.18 to 66.31, I~2=94%]. CMI plus CT was superior to CT in reducing the systemic inflammatory response syndrome(SIRS) score(MD: –0.84 points, 95% CI: –1.26 to –0.42, I~2=65%), length of hospital stay(MD: –4.22 days, 95% CI: –6.49 to –1.95, I~2=92%), and duration of mechanical ventilation(MD: –2.94 days, 95% CI: –4.68 to –1.21, I~2=89%). Only 1 study reported adverse events. Conclusions: CMI as an adjuvant therapy showed great potential benefits for the treatment of ALI/ARDS. However, we could not make a definite conclusion due to low quality of included studies and uncertain security. Future studies should focus on improving research design, especially in blindness and placebo. The reporting of adverse events was also needed.     

Sodium Tanshinone Ⅱ A Sulfonate for Coronary Heart Disease: A Systematic Review of Randomized Controlled Trials

Objective: To assess whether an adjunctive therapy of Sodium Tanshinone ⅡA Sulfonate Injection(STS) is effective and safe in improving clinical outcomes in patients with coronary heart disease(CHD). Methods: A literature search was conducted through PubMed, the Cochrane Library, Knowledge Infrastructure Databases(CNKI), Chinese Biomedical Literature Database(SinoMed), Chinese Science and Technology Periodical Database(VIP) and Wanfang Database up to August 2017. Randomized controlled trials(RCTs) comparing STS with placebo or no additional treatments on the basis of standard conventional medicine therapies were included. The outcomes were all-cause mortality, major acute cardiovascular events(MACEs), cardiac function and inflammatory factors. The risk of bias assessment according to the Cochrane Handbook was used to evaluate the methodological quality of the included trials. Revman 5.3 software was used for data analyses. Results: A total of 22 RCTs involving 1,873 participants were included. All of the trials used STS as adjunctive treatment to standard conventional medicine therapy. Due to the poor quality of methodologies of most trials, only limited evidence showed that a combination of STS with percutaneous coronary intervention(PCI) or thrombolytic therapy(TT) might be more effective on reduction of all cause death rate than TT alone [risk ratio(RR) 0.25, 95% confidence interval(CI) 0.07 to 0.87] or PCI alone(RR 0.42, 95% CI 0.04 to 4.36). The results of 6 trials comparing STS plus TT with TT alone showed that the addition of STS significantly reduced the incidence of cardiac shock(RR 0.35, 95% CI 0.14 to 0.86), heart failure(RR 0.41, 95% CI 0.20 to 0.83) and arrhythmia(RR 0.21, 95% CI 0.12 to 0.46). STS combined with TT also showed a superior effect on cardiac function and inflammatory factor. No severe adverse event was reported related to STS. Conclusions: As an adjunctive therapy, STS combined with standard conventional medicine seems to be more effective on all-cause mortality or MACEs than conventional medicine treatment alone with less side effects. However, we cannot make a firm conclusion due to low quality of inclusion trials. Well-designed trials with high methodological quality are needed to validate the effect of STS for CHD patients.     

Comparison between Xingnaojing Injection(醒脑静注射液)and Naloxone in Treatment of Acute Alcohol Intoxication:An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials

Objectives: To investigate the effectiveness and safety of Xingnaojing Injection(XNJ, 醒脑静注射液) compared with naloxone for the treatment of acute alcohol intoxication(AAI), and provide the latest evidence through evidence-based approach. Methods: Seven electro-databases including Pub Med, EMBASE, Cochrane Central Register of Controlled Trials, Chinese National Knowledge Infrastructure Databases, Chinese Biomedical Literature Database, Chinese Science and Technology Periodical Database(VIP) and Wanfang Database were searched from the inception to January 2018. Randomized controlled trials(RCTs) comparing XNJ with naloxone for patients with AAI and reporting at least one of the below outcomes were included: patients' conscious recovery time, stay length in emergency department, disappearance time of the ataxia symptom, the severity of the symptoms, the blood alcohol content as wel as the adverse events. Methodological quality of included trials was assessed using the risk of bias tool which recommended by the Cochrane Col aboration. Meta-analysis was conducted by Review Manager 5.3 software. Results: Total y 141 trials with 13,901 patients were included in this review, al of them were assessed as unclear or high risk of bias. Results showed that on the basis of routine therapy, standard dose XNJ(10–20 m L) may have similar results with naloxone on the recovery time of consciousness(MD 12 min, 95% CI 7.2–17.4 min) and disappearance time of symptoms(MD 6 min, 95% CI –13.8–25.8 min) for patients with AAI. Larger dose of XNJ Injection(21–40 m L) may speed up the time(almost 1 h earlier). Combination of XNJ and naloxone seemed superior to the naloxone alone for al the relevant outcomes. The average difference of time in consciousness recovery was 2 h and the number of AAI patients whose consciousness recovery within 1 h was above 50% the combination group than in the control group(RR 1.42, 95% CI 1.29 to 1.56). No severe adverse events or adverse reactions of XNJ were reported in the included trials. Conclusions: Low quality of evidence showed XNJ may have equal effect as naloxone and may achieve better effect as add-on intervention with naloxone for patients with AAI. We failed to evaluate the safety of XNJ Injection due to the insufficient evidence in this review. Registration number in PROSPERO(No. CRD42018087804)