Background: Lianhua Qingwen Granules or Capsules (LHQW) has accumulated much research evidence in the fight against the coronavirus disease 2019 (COVID-19) epidemic. However, there are still few data on its efficacy and safety in children with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Purpose: To evaluate the efficacy and safety of LHQW in children with SARS-CoV-2 Omicron infection. Methods: We conducted a single-center, propensity-score matched retrospective cohort study of children with SARS-CoV-2 Omicron infection in Shanghai New International Expo Center mobile cabin hospital between April 1st and June 1st, 2022. Eligible patients received either LHQW granules/capsules plus supportive care (LHQW group) or supportive care alone (control group). The primary outcome was the negative conversion time of nucleic acid. Secondary outcomes included the negative conversion rate of nucleic acid, the length of hospital stay, clinical disease progression, and cycle threshold [Ct] values for SARS-CoV-2 open reading frame [ORF1ab] or nucleocapsid [N] genes. Results: Overall, 2808 patients were enrolled, and 346 patients in each group were included in the analysis. Among the propensity-score matched groups, LHQW treatment was associated with an accelerated negative conversion time of nucleic acid (median: 5 d vs. 6 d, Hazard ratio: 1.25, 95% CI: 1.08 - 1.46, Log-rank p < 0.001), a higher negative conversion rate of nucleic acid (Day 2 - 6: 2.9% vs. 0.6%, p = 0.036; 29.8% vs. 5.5%, p < 0.001; 42.5% vs. 24.3%, p < 0.001; 51.4% vs. 31.5%, p < 0.001; 63.3% vs. 55.2%, p = 0.030), shorter hospital stay (median: 10 d vs. 11 d, Hazard ratio: 1.50, 95% CI: 1.29 - 1.74, Log-rank p < 0.001), and lower rates of asymptomatic infection progressing to mild (37.9% vs. 46.5%, p = 0.021). Conclusion: Our study suggested that LHQW treatment was associated with faster clinical recovery in children with SARS-CoV-2 Omicron infection.

Objective: Reyanning mixture has been demonstrated to be effective in treating infected patients during the outbreak pandemic of SARS-CoV-2 Omicron variant of Coronavirus disease 2019 (COVID-19) in Shanghai 2022. The aim of this study is to further investigate the role of Reyanning mixture specifically in the treatment of elderly patients. Methods: This study enrolled 1,102 elderly patients who were infected with SARSCoV-2 Omicron variant. Of these, 291 patients received Reyanning mixture in conjunction with conventional Western medicine treatment were assigned to the treatment group, while 811 patients only received conventional Western medicine treatment were assigned to the control group. Clinical parameters including hospitalization duration, viral shedding time, and Cycle Threshold (Ct) values of novel coronavirus nucleic acid tests, as well as adverse events were recorded and analyzed in both groups. Results: There was no significant difference in baseline characteristics between two groups. In comparison to the control group, the treatment group demonstrated a substantial difference in hospitalization duration (median: 8 days vs. 10 days, HR: 0.638, 95% CI: 0.558-0.731, p < 0.001). The treatment group also showed a significantly shorter viral shedding time compared to the control group (median: 7 days vs. 8 days, HR: 0.754, 95% CI: 0.659-0.863, p < 0.001). Multivariate Cox proportional-hazards model analysis indicated that the use of Reyanning mixture was closely associated with a reduction in hospitalization duration (HR: 1.562, 95% CI: 1.364-1.789, p < 0.001) and viral shedding time (HR: 1.335, 95% CI: 1.166-1.528, p < 0.001). In addition, during the treatment process, no serious adverse event occurred in either group. Conclusion: The improvement of clinical parameters in the treatment group indicate a promising therapeutic benefit of Reyanning mixture for elderly patients infected with SARS-CoV-2 Omicron variant in the present study. Further investigations are required to validate this finding by examining the underlying mechanism and function of Reyanning mixture.

Objective: To evaluate the prognostic ability of systemic immune-inflammation index (SII) combine with quick Sequential Organ Failure Assessment (qSOFA) criteria in predicting the 28day mortality of sepsis.Methods: A retrospective cohort study was conducted, with the population comprised in whom sepsis was confirmed. Clinical and laboratory data recorded were analyzed. The score of Sequential Organ Failure Assessment (SOFA), SII, qSOFA were calculated. Multivariable regression, receiver operating characteristic (ROC) analysis and Kaplan-Meier method were used to identify and compared the predictors of prognosis among SOFA, qSOFA, and the combination of SII with qSOFA.Results: A total of 349 patients admitted from December 2020 and December 2022 were included in the cohort. 95 (27.2%) of whom had died by day 28. The SII, SOFA, and qSOFA scores were significant higher in the non-survivors than that of survivors (P < 0.05), and identified as independent predictors of sepsis mortality. The addition of SII to qSOFA shown an area under receiver operator characteristic (AUROC) of 0.840 (95% CI: 0.787-0.884), manifested an effective ability in predicting poor outcome than other scoring systems. The optimum cutoff for SII (>1.7668) and qSOFA (>1) represented a high risk level in 28-day mortality of sepsis, were performed and identified in Kaplan-Meier survival curves (log-rank test, HR: 6.942, 95% CI: 3.976-12.121; P < 0.0001).Conclusion: The SII in addition to qSOFA provided an effective prognostic tool for predicting mortality in sepsis.

Background:Sepsis is a life-threatening disease with high mortality and a poor prognosis,partly due to a lack of effective treatments.Therefore,more effective treatments are urgently needed.Methods:Eight databases were searched for use of traditional Chinese medicine（TCM） for sepsis.A meta-analysis was performed using Stata 15.0 software.The 28-day mortality,length of hospital stay,and Acute Physiology and Chronic Health Evaluation Ⅱ（APACHE-Ⅱ） score were the outcomes of this study.The Cochrane Collaboration tool for assessing risk of bias was used for quality assessment.Results:Ten studies with a total of 847 patients were included in this meta-analysis.Compared with the control group,the experimental group had lower 28-day mortality（relative risk [RR] 0.67;95% confidence interval [CI] 0.53 to 0.84;P=0.001）,shorter hospital stay（weighted mean difference [WMD]-2.17;95% CI:-3.2 to -1.14;P=0.000） and lower APACHE-Ⅱ score（WMD-2.164;95% CI:-3.236 to -1.091;P=0.000）.Conclusion:Our results demonstrate that TCM together with standard Western medicine was associated with significantly lower 28-day mortality,APACHE Ⅱ scores,and shorter hospital intensive care unit stays,suggesting that TCM might be an effective alternative treatment for sepsis.

目的 探讨脓毒症相关性血小板减少症的临床特点.方法 对上海中医药大学附属龙华医院急诊医学科2018年1月至2022年7月收治的脓毒症相关性血小板减少症患者的临床资料进行回顾性分析.分析不同患者年龄、基础疾病分布,统计其感染来源、病原学检测结果及治疗前后血常规、C反应蛋白(CRP)、降钙素原(PCT)及血小板的变化情况.结果 共纳入研究病例215例,年龄≥70岁者169例,基础疾病的以高血压病、糖尿病、冠心病、脑血管病和低蛋白血症为主,死亡病例76例.感染来源以呼吸系统感染、泌尿系统感染和消化系统感染为主.病原微生物培养结果以肺炎克雷白杆菌、鲍曼不动杆菌、铜绿假单胞菌、金黄色葡萄球菌和屎肠球菌为主.死亡患者血小板计数呈现下降的趋势.对纳入本研究的脓毒症相关性血小板减少症进行舌质统计,排在前3位的分别是舌淡暗(76,35.35％)、舌暗红(55,25.58％)、舌质暗(41,19.10％),排在前3位的舌苔分别是苔黄腻(80,37.21％)、苔黄(61,28.37％)、苔薄黄(49,22.79％),排在前3位的脉象分别是脉沉细数(51,23.72％)、脉细数(46,21.4％)、脉沉细涩(42,19.53％).结论 脓毒症相关性血小板减少症常发生于高龄患者,尤其是有基础疾病者.死亡患者与血小板计数呈进一步下降趋势.耐药菌感染成为加剧脓毒症相关性血小板减少症患者死亡的重要原因.

ETHNOPHARMACOLOGICAL RELEVANCE:JinHong Formula (JHF) was derived from the famous Rhubarb and Moutan Decoction which was prescribed for appendicitis. It was originally recorded in the classic of "Jingui Yaolve" written by Zhang Zhongjing. It is a kind of traditional Chinese medicine, widely used in the treatment of inflammation. However, the clinical effect of JHF for sepsis and its comprehensive mechanism in sepsis remained largely unknown.RESEARCH PURPOSE:The aim of our study was to evaluate the clinical effect of JHF in the treatment of sepsis, and to explore its mechanism from the perspective of network pharmacology.RESEARCH METHODS:The single-center randomized clinical trial was conducted to assess the effect of JHF in the treatment of sepsis. Additionally, we used the Chinese herbal medicine pharmacology database and analysis platform to identify the active components and therapeutic target of JHF. Numerous well-known disease target databases have been used to screen therapeutic target proteins for sepsis. Furthermore, we have established a Protein-Protein Interaction (PPI) network and carried out Gene Onotology/Kyoto Encyclopedia of Genes and Genomes (GO/KEGG) enrichment analysis. In order to conclude which active compounds from JHF may be responsible for signaling pathway, we performed network analysis.RESEARCH RESULTS:The study included 114 patients. By comparing participants with and without JHF, the results suggested that JHF significantly reduced all-cause mortality on 28 and 60 days after intervention, and improved Sequential Organ Failure Assessment (SOFA) on 7th day after intervention as well as. JHF had an effect of anti-inflammatories and antioxidants (SOD). By using network pharmacological analysis, we identified 72 active components and 426 target genes of JHF, and successfully constructed a "JHF-compound target-sepsis" network. 116 mentioned targets revealed by GO/KEGG enrichment analysis played a significant role in the inflammatory reaction and immunoregulation via interleukin-17 (IL-17) and tumor necrosis factor (TNF) signaling pathway. Moreover, the analysis of "pathway target-active component" revealed that Sennidin A, Rheidin A, Rheidin B, Rheidin C, (E)-4-Phenyl-3-Buten-2-One, Osmanthuside H, Esculetin, and Caffeicacid were responsible for IL-17, TNF signaling pathways.CONCLUSION:JHF contains potential active substance of anti-inflammatory and antioxidant. These active compounds may come into play through IL-17 and TNF signaling pathways. For sepsis, JHF may be a promising and effective treatment strategy.

目的 系统评价复元醒脑汤治疗急性脑梗死的有效性和安全性,为复元醒脑汤治疗急性脑梗死提供循证医学证据.方法 通过检索中国知网(CNKI)、中文科技期刊数据库(VIP)、万方数据知识服务平台、中国生物医学文献服务系统(CBM)、PubMed、Embase、Cochrane Library(Cochrane图书馆)进行文献筛选.采用Cochrane协作网研发的偏倚风险评估工具进行研究质量的评价.采用Stata 15.0软件进行Meta分析、敏感性分析和发表偏倚分析.结果 共纳入符合要求的中文文献17篇,共1617例患者.Meta分析结果表明:复元醒脑汤联合西医常规治疗的总有效率[相对危险度(RR)=1.23,95％置信区间(95％CI)(1.16,1.31),P＜0.05]、美国国立卫生院卒中量表(NIHSS)评分[加权均数差(WMD)=3.91,95％CI(2.55,,5.27),P＜0.05]、Barthel指数(BI)量表评分[WMD=-10.90,95％CI(-16.14,-5.66),P＜0.05]均优于对照组,差异均有统计学意义.不良反应发生率[RR=0.46,95％CI(0.12,1.69),P＞0.05],差异无统计学意义.结论 复元醒脑汤联合西医常规治疗与单用西医常规治疗相比可有效提高脑梗死总有效率、降低NIHSS评分,提高BI评分,但其安全性有待更多证据支持.以上结论存在相关文献质量与数量的限制,仍有待更多高质量的随机对照试验完善.

Objective:To observe the preventive effect of Qiangshen Kangyi Decoction on COVID-19 infection and to objectively evaluate its safety and adverse effects. Methods:A Cluster-randomized and controlled design was adopted. The included subjects were divided into the treatment group of traditional Chinese medicine intervention and the control group without intervention,and the symptoms and signs of patients,the number of positive cases of new coronavirus nucleic acid test,and the protection rate of the intervention were recorded in detail.Results:A total of 9 206 cases were followed,of which 149 were positive,with 133 cases in the control group（totaling 4 821 cases）,and 16 in the treatment group（0.33%）（totaling 4 385 cases）. The protection rate after the intervention was 86.96%,and the infection rate in the treatment group was significantly lower than that of the control group（3.03%）（P ＜ 0.01）. Conclusion:Qiangshen Kangyi Decoction can effectively prevent COVID-19 infection,and its mechanism needs to be further studied.

肺隐球菌病是临床上疑难疾病,常发生于免疫功能低下的患者,治疗难度大、周期长,且预后差.中医药辨证论治本病具有独特优势,能有效改善患者症状,如咳嗽咯痰、发热等,并能调节免疫功能,提高患者生活质量.方邦江教授从脾胃论治肺隐球菌病患者,以补益虚损、化痰祛瘀为治法,临床疗效显著.

体外血浆脂蛋白过滤(delipid extracorporeal lipoprotein filter from plasma,DELP)是一种应用体外血浆脂类吸附过滤器(JX-DELP-I-200)将患者的自体血浆进行体外过滤的新型体外血浆净化技术.该项技术由上海江夏血液技术有限公司自主研发,先后在全国多家医院广泛应用于治疗脑梗死,疗效明显.笔者现结合自身多年临床实践,对DELP应用于脑梗死的临床救治进行综述,旨在为开展非药物治疗脑梗死提供参考和借鉴.

ObjectiveTo evaluate determinants of prolonged viral RNA shedding in hospitalized patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron variant infection.Materials and methodsHospitalized patients tested SARS-CoV-2 positive by nasopharyngeal real-time reverse transcriptase-polymerase chain reaction (RT-PCR) were included in the single-center, retrospective study. Patients were divided into 2 groups according to the timing of viral clearance (≤ 8 days, “early clearance” and ≥15 days, “late clearance”).Results4,084 patients were included in the study (1,023 late clearance, 3,061 early clearance), with median age of 50 years and a higher proportion (61.4%) of male. Univariate analyses showed that comorbidities (including hypertension, diabetes, and coronary heart disease), receiving vaccine, the number of vaccinations, cycle threshold (Ct) open reading frame 1ab (ORF 1ab), and nucleocapsid protein (N) gene values on admission were associated with late viral clearance. In the multivariable analysis, the number of vaccinations (P = 0.010) and Ct ORF 1ab gene (P < 0.001) values on admission were significantly associated with late viral clearance. Generalized Estimating Equations (GEE) analysis showed that the Ct value of ORF 1ab gene and N gene remained unchanged within 3 days, and showed progressively higher values with increasing days during late viral RNA clearance.ConclusionThe number of vaccinations and Ct values of ORF 1ab gene were independently associated with a prolonged SARS-CoV-2 RNA shedding.

Objective: Severe cases of coronavirus disease 2019 (COVID-19) are expected to have a worse prognosis than mild cases. Shenhuang Granule (SHG) has been shown to be a safe and effective treatment for severe COVID-19 in a previous randomized clinical trial, but the active chemical constituents and underlying mechanisms of action remain unknown. The goal of this study is to explore the chemical basis and mechanisms of SHG in the treatment of severe COVID-19, using network pharmacology.Methods: Ultra-performance liquid chromatography-quadrupole time-of-flight mass spectrometry was employed to screen chemical constituents of SHG. Putative therapeutic targets were predicted by searching traditional Chinese medicine system pharmacology database and analysis platform, SwissTargetPrediction, and Gene Expression Omnibus (GEO) databases. The target protein-protein interaction network and enrichment analysis were performed to investigate the hub genes and presumptive mechanisms. Molecular docking and molecular dynamics simulations were used to verify the stability and interaction between the key chemical constituents of SHG and COVID-19 protein targets.Results: Forty-five chemical constituents of SHG were identified along with 131 corresponding therapeutic targets, including hub genes such as HSP90AA1, MMP9, CXCL8, PTGS2, IFNG, DNMT1, TYMS, MDM2, HDAC3 and ABCB1. Functional enrichment analysis indicated that SHG mainly acted on the neuroactive ligand-receptor interaction, calcium signaling pathway and cAMP signaling pathway. Molecular docking showed that the key constituents had a good affinity with the severe acute respiratory syndrome coronavirus 2 protein targets. Molecular dynamics simulations indicated that ginsenoside Rg4 formed a stable protein-ligand complex with helicase.Conclusion: Multiple components of SHG regulated multiple targets to inhibit virus invasion and cytokine storm through several signaling pathways; this provides a scientific basis for clinical applications and further experiments.

Background and aim: Presently, over-the-counter drugs that can treat upper respiratory tract infections (URTI) are rarely effective and safe. Chaiqin Qingning Capsule (CQQNC), a Chinese patent medicine, which has been verified by long-term clinical practice is recommended by Chinese experts for the treatment of URTI with fever. This study conducted a prospective, double-blinded, randomized, multicenter controlled trial to evaluate the effectiveness and safety of CQQNC in the treatment of URTI. Methods: The study was conducted at 4 clinical centers in China. Eligible subjects were recruited and randomized 1:1 to the CQQNC group and Qingkailing Capsule (QKLC) group. Both groups were administered orally three times a day for three consecutive days. Primary outcomes were the antipyretic onset time and the temperature recovery time. Secondary outcomes included the symptom disappearance rate, symptom score, and drug safety assessment. Results: A total of 269 subjects were analyzed (134 subjects in the CQQNC group, 135 subjects in the QKLC group). The antipyretic onset time and the temperature recovery time were significantly shortened in the CQQNC group (median: 5 h vs. 10 h, p < 0.0001, median: 19 h vs. 27 h, p < 0.0001). CQQNC was more effective than the QKLC in improving the symptoms of pharyngodynia and rhinobyon (85.07% vs. 71.11%, p = 0.008; 76.99% vs. 64.41%, p = 0.043), and in improving the overall symptom scores (-15.10 +/- 3.23 vs. -13.35 +/- 3.58, p < 0.0001). During the trial, no serious adverse events were reported in the two groups. Conclusion: CQQNC is effective and safe in the treatment of URTI with fever, and worthy of clinical application.

患者女,80岁,右下肢红肿、热痛2 d,意识不清3 h入院.患者入院后,检查白细胞计数、中性粒细胞计数、超敏C反应蛋白、降钙素原等感染相关指标异常,肝功能异常,肾功能异常,伴有神志改变,序贯器官衰竭评分(SOFA评分)4分.排除其他部位感染,结合患者临床表现诊断为丹毒引起的脓毒症.