BACKGROUND AND PURPOSE:Cognitive impairment (CI) is prevalent in clinical patients with heart failure (HF). However, there are no effective pharmacological interventions for CI treatment. Astragaloside IV (AS-IV) is the principal constituent of Astragalus Radix and effective in HF, but its action on CI after HF has not yet been studied. EXPERIMENTAL APPROACH:Cognitive function was evaluated in behavioural experiments on male rats with HF. Transcriptomics and network pharmacology were used to identify potential pathways. Western blots, quantitative real-time polymerase chain reaction (qRT-PCR), Elisa, and electron microscopy were used to validate changes in identified pathways, brain inflammatory cytokines, postsynaptic membrane glutamate receptors and levels of apoptosis. Molecular docking and molecular dynamics simulation confirmed the binding ability of AS-IV and selected core proteins. KEY RESULTS:AS-IV improved cardiac function and disordered cardiac muscle structure in rats with HF. The advanced glycation end-products-receptor of advanced glycation end-products (AGE-RAGE) signalling pathway was the core pathway. AS-IV reduced the expression levels of RAGE, extracellular regulated protein kinases 1/2 (ERK1/2) and nuclear factor kappa-B (NF-κB). AS-IV also attenuated the expression of proinflammatory factors, increased the levels of anti-inflammatory factors, and up-regulated postsynaptic membrane glutamate receptor expression. Molecular docking and molecular dynamics simulation showed that AS-IV had favourable binding energy with RAGE. CONCLUSION AND IMPLICATIONS:AS-IV enhances cognitive function of HF rats by inhibiting the RAGE-ERK1/2-NF-κB signalling pathway to reduce inflammation and apoptosis and thereby improve synaptic function. AS-IV emerges as a promising candidate for the prevention and treatment of HF-CI.

Objective:To explore the pharmacological mechanism of the compound Congrong Yizhi Capsule in treating vascular dementia.Methods:Based on the method of network pharmacology and molecular docking, the active ingredients of each drug in the compound Congrong Yizhi Capsule are obtained through the traditional Chinese medicine systems pharmacology database and analysis platform（TCMSP）,and the targets of the active ingredients of the drug are predicted through the SwissTarget prediction database.The disease targets of vascular dementia are obtained through GeneCards, online Mendelian inheritance in man（OMIM）,and DRUGBANK databases.A protein-protein interaction（PPI） network is constructed with STRING 11.0 database and Cytoscape 3.8.0 to explore potential protein functional modules and core networks in the network; DAVID database is used to perform gene ontology（GO） enrichment analysis and Kyoto encyclopedia of genes and genomes（KEGG） pathway enrichment analysis, and Cytoscape 3.8.0 is adopted to construct the “drug-active ingredient-target-pathway” network diagram.In addition, molecular docking technology is employed to verify the results of the PPI network and the “drug-active ingredient-target-pathway” network diagram.Results:Thirty-five main active ingredients are screened, involving 134 targets.Among them, the main active ingredients include Armepavine, DFV,Isorhamnetin, etc.; key targets include amyloid precusor protein（APP）,PIK3CA,SRC,PIK3R1,MAPK1,TP53,MAPK3,JUN,AKT1,vascular endothelial growth factor A（VEGFA）,EGFR,F2,etc.; the biological pathways of compound Congrong Yizhi Capsule in treating vascular dementia act mainly in cancer signal pathway, Rap1 signal pathway, PI3K-AKT signal pathway, focal adhesion, Ras signal pathway, neuroactive ligand-receptor interaction, etc.The verification of the molecular docking results indicates that the main active ingredient has an excellent binding ability with the target.Conclusion:This study preliminarily reveals that the compound Congrong Yizhi Capsule may treat vascular dementia through multi-component, multi-target, and multi-channel cooperation, which provides a reference for the subsequent in-depth research.

Ethnopharmacological relevance: Alzheimer's disease (AD) is a degenerative disease of the central nervous system (CNS) with insidious onset. AD is also the most common cause of dementia. Compound Congrong Yizhi Capsules (CCYC), a traditional Chinese medicine compound developed by the team of Beijing University of Chinese Medicine, has been widely used to treat AD.Aim of this study: To systematically evaluate the clinical efficacy and safety of CCYC for AD by meta-analysis, Trial Sequential Analysis (TSA) and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system.Methods: This study was registered at PROSPERO (CRD42022295496). Randomized controlled trials (RCTs) of CCYC as the treatment for AD published before December 1, 2021 were retrieved from 4 Chinses databases, 4 English databases and 2 clinical trials registration systems. RevMan 5.4 and STATA 17.0 was used to conduct the meta-analysis of the included studies, the quality of outcomes was rated by the GRADE system, the TSA was conducted by TSA 0.9.5.10 software.Results: Seven studies were included, and the total sample size was 746. Meta-analysis showed that 6 months of treatment with CCYC plus conventional western medicine treatments (CTs) improved MMSE scores compared with CTs alone (WMD: 4.32, 95% CI: 3.23, 5.42), and TSA confirmed that more trials in the future will not reverse the result. Among which, CCYC combined with donepezil can significantly improve MMSE scores (WMD: 3.54, 95% CI: 2.86, 4.22). CCYC combined with olanzapine also showed good effect on both MMSE (WMD: 6.49, 95% CI: 5.54, 7.44) and ADL scores (WMD: 5.23, 95% CI: 4.63, 5.83). No serious adverse events were reported. The strengths of the evidences above are MODERATE.Conclusion: CCYC combined with cognition-modifying western medicine can improve cognitive function, mental behavioural symptoms, and activities of daily living in AD patients with good safety.

Objective To carry out data mining on the prescription law for TCM treating migraine; To provide ideas for the clinical treatment of migraine. Methods The literature about migraine was retrieved from CNKI,Wanfang Data, VIP, DRUGDATAEXPY, CBM and PubMed database. Excel 2019 software was used to gain prescription information, and the R language, SPSS Statistics 26 software and Ancient and Modern Medical Records Cloud Platform 2.3.5 were used to analyze the medicine from the aspects of frequency of medication, property and taste and meridian tropism, and conduct association rule analysis, cluster analysis, factor analysis and decision tree analysis. Results A total of 753 prescription for treating migraine were screened, including 244 kinds of Chinese medicinal herbs. The single herb with the highest frequency was Chuanxiong Rhizoma（621 times）. The commonly used Chinese medicinal herbs were Chuanxiong Rhizoma, Angelicae Dahuricae Radix, Paeoniae Radix alba,Glycyrrhizae Radix et Rhizoma, Angelicae Sinensis Radix, Gastrodiae Rhizoma, Asari Radix et Rhizoma, Scorpio,Bupleuri Radix. The analysis of drug properties found that the majority drugs belong to the liver meridian（4 356times, 27.60%）. The association rules analysis showed that the known commonly used medicine pairs were the compatibility of Angelicae Dahuricae Radix-Chuanxiong Rhizoma, and Carthami Flos-Persicae Semen. The clustering analysis showed that the number of clustering categories was better in 7. Conclusion The core drugs for clinical treatment of migraine is mainly Chuanxiong Rhizoma, and compatible medication to expelling wind and resolving superficies syndrome, activating blood and resolving stasis, calming the liver and extinguishing wind,which can provide a certain reference for the clinical research and new drug development for migraine.

Objective:To systematically evaluate the quality of traditional Chinese medicine(TCM)rehabilitation guidelines for is-chemic stroke,and provide reference for the formulation of guidelines.Methods:TCM rehabilitation guidelines for ischemic stroke were collected from PubMed,China National Knowledge Infrastructure(CNKI),Chinese Science Citation Database(CSPD),Chi-nese Citation Database(CCD),China Biology Medicine(CBM)the National Institute for Health and Care Excellence(NICE),Guidelines International Network(GIN),MedSci,China Association of Chinese Medicine(),and Chinese Association of Integrated Traditional and Western Medicine()from the incep-tion of the databases to September,2021.The Appraisal of Guidelines for Research and Evaluation(AGREE)Ⅱ was used to evalu-ate the quality of the included guidelines,and the recommendations from the guidelines of medium quality and above were summa-rized.Results:A total of 13 guidelines were included.The average scores of the guidelines in six domains of AGREE Ⅱ were:scope and purpose 65.67％,stakeholder involvement 43.02％,rigor of development 43.64％,clarity of presentations 63.82％,applica-bility 19.87％,and independence 32.05％.In the 13 guidelines,7 were of medium quality and 6 were of low quality.And 23 rec-ommendations for TCM rehabilitation treatment were obtained,of which 2 were highly recommended.Conclusion:The overall quali-ty of the included guidelines is not high.Future guidelines should be standardized from the aspects of applicability,rigor and inde-pendence.Moreover,high quality clinical research should be carried out to provide evidence support for the formulation of guide-lines.

Background Acupuncture is a proven technique of traditional Chinese medicine (TCM) for ischemic stroke. The purpose of this overview was to summarize and evaluate the evidence from current systematic reviews (SRs) of acupuncture for early recovery after acute ischemic stroke (AIS). Methods We performed a comprehensive search for SRs of acupuncture for AIS in seven electronic databases up to May 23, 2022. Two reviewers independently selected SRs, extracted data, evaluated the methodological quality using the Assessment of Multiple Systematic Reviews 2 (AMSTAR 2), and rated evidence certainty using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). Results Seven SRs were included. The overall methodological quality of SRs was critically low. As for GRADE, 3 outcomes had moderate-quality evidence, 14 had low-quality evidence, and 12 had very low-quality evidence. Moderate-quality evidence demonstrated that initiating acupuncture therapies within 30 days of AIS onset significantly improves neurological function and the total effective rate of patients. Low-quality evidence showed that for patients within 2 weeks of AIS onset Xingnao Kaiqiao acupuncture (XNKQ Ac) could reduce disability rate and might reduce mortality. Regarding the safety of acupuncture therapies, low-quality evidence showed that there was no difference in the incidence of adverse reactions between the 2 groups, and very-low quality evidence showed that acupuncture did not promote hemorrhagic conversion. Conclusions In the acute and early recovery phases after AIS onset, acupuncture is a promising therapeutic strategy to improve the curative effect of current treatments, especially in the recovery of neurological function. Patients in the acute phase might receive XNKQ Ac, and patients in the early recovery phase might receive EA1, CA, or SA. However, considering the current certainty of evidence, a solid recommendation warrants further exploration. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022335426.

目的 系统评价中药治疗紧张型头痛(TTH)的疗效和安全性.方法 计算机检索中国知网(CNKI)、万方(WanFang Data)、中国生物医学文献数据库(CBM)、维普(VIP)、PubMed、EMbase、the Cochrane Library、ClinicalTrials.gov数据库,纳入中药治疗TTH的随机对照试验(RCT),应用Cochrane偏倚风险评估工具评价纳入研究的方法学质量,对纳入研究进行描述性分析和Meta分析.结果 共纳入12项RCT,涉及927例受试者.Meta分析结果显示,中药组在减少头痛天数方面优于对照组,差异有统计学意义[MD=-5.09,95％CI(-9.03,-1.16),P=0.01],在改善生活质量方面优于对照组(P<0.00001),且未见严重不良反应.结论 现有证据表明,中药在改善TTH病人头痛天数和生活质量方面具有潜在优势,且未发现到严重不良反应.

Background: In the past, systematic reviews (SRs) and meta-analyses (MAs) have been used to assess the efficacy of Chinese herbal medicine (CHM) in the treatment of migraines. However, robust conclusions have not yet been determined because of variations in the methodological and evidence quality of these SRs/MAs.Objectives: We aimed to assess the methodological and reporting quality of SRs/MAs and evaluate the available evidence of the efficacy of CHM treatment of migraines.Methods: We searched eight electronic databases from inception until 10 January 2022, without language restrictions. Two researchers were independently responsible for study screening and data extraction. The methodological and reporting quality of SRs/MAs were assessed using A Measurement Tool to Assess Systematic Reviews (AMSTAR) 2 and Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). The evidence quality of included SRs/MAs was evaluated by Grading of Recommendations Assessment, Development and Evaluation (GRADE). In addition, a descriptive analysis of the included SRs/MAs was included.Results: Sixteen SRs/MAs, including 69 outcomes, were finally included in this overview. Data synthesis of the included SRs/MAs outcomes showed that CHM plus Western medicine (WM) was beneficial in the improvement of migraines. In comparison, there was conflicting evidence for the effectiveness of CHM used alone. CHM was better than WM in improving responder rate and acute medication usage and was superior to placebo in improving migraine days, responder rate, and migraine duration. However, there was insufficient evidence to verify the effectiveness of CHM for migraine treatment regarding pain severity and migraine frequency. All the included SRs/MAs showed extremely low methodological and reporting quality. The results of the GRADE system indicated that the quality of most of the pooled evidence was very low.Conclusions: CHM may be beneficial in improving migraines and can be used as a complementary therapy. However, we should treat the conclusions of the evaluated SRs/MAs cautiously because of the low quality of evidence. Future SRs/MAs should focus on improving methodological and reporting quality. High-quality randomized controlled trials (RCTs) are needed to provide strong evidence for the efficacy of CHM treatment of migraines.

为探索实现传统医学在"治未病中的主导作用,重大疾病治疗中的协同作用,疾病康复治疗中的核心作用"的有效途径,并总结经验,为其他优势病种评价提供可行性方案.中国中医药循证医学中心脑病项目组聚焦中医药治疗缺血性脑卒中方面有效性、安全性及经济性,成立评价工作组,确定工作方案,并在方法学、临床专家指导下,依据快速评估的方法,围绕高质量证据、专家意见调研、专家访谈及药物目录梳理以上4个方面,按照制定计划书、资料收集与数据提取、证据的合成和评价、报告撰写4个环节完成了评价工作.最终通过中、西医专家审议,将中医药治疗缺血性卒中的优势定位于恢复期的治疗,优势作用为改善神经功能缺损,提高日常生活能力.有效性表现在,卒中恢复期,中医干预措施可改善卒中后运动功能障碍、卒中后认知障碍、意识障碍、吞咽障碍、失语、便秘、泌尿功能、复视等,以针刺、中药、传统功法的优势较为突出.安全性表现在,中医治疗缺血性脑卒中安全性较好,不良反应发生率较低、不良事件出现次数较少,且相关症状程度较轻.经济性表现在,中西医结合方案可起到协同增效的作用,并有使诊疗费用更加合理的可能,中西医结合康复方案相比常规干预更具经济效益和社会效益.

Ethnopharmacological relevance: Rehmannioside A is derived from Rehmannia glutinosa Libosch, which is widely used as an important ingredient in diverse traditional Chinese medicines to treat diseases caused by "kidney deficiency" such as cerebral arteriosclerosis, aging-related stroke and dementia in China. Recent studies have proved that Rehmannia glutinosa Libosch and Rehmannioside A can improve memory capability and recover nerve damage. Aim of the study: To investigate the effect of Rehmannioside A on cognitive impairment after ischemia in rats and SH-SY5Y cells, and further evaluate the anti-oxidative and anti-ferroptosis mechanisms. Materials and methods: Differentially expressed proteins (DEPs) in patients after cerebral ischemic stroke were revealed by a RayBio protein array. Cognitive impairment model was established by middle cerebral artery occlusion and reperfusion (MCAO) 14 days in rats. Rehmannioside A was administered intraperitoneally injection at dose of 80 mg/kg. The SH-SY5Y cells were exposed to H2O2 for 24 h and treated with Rehmannioside A (80 mu M) for 24 h. The neuroprotecion of Rehmannioside A were evaluated by infarct volume (TTC), neurological defects (Garcia score) and learning memory (Morris water maze test) in vivo, and cell viability (CCK-8 or LDH) in vitro. Superoxide dismutase (SOD), malondialdehyde (MDA) and myeloperoxidase (MPO) activity of rats, glutathione (GSH), oxidized glutathione (GSSG) and nicotinamide adenine dinucleotide phosphate (NADPH) of cells were detected by biochemical assay. Intracellular reactive oxygen species (ROS) were measured by DCFH-DA assay. Myeloperoxidase (MPO), PI3 kinase (PI3K), p-PI3K, Akt, p-Akt, heme oxygenase-1 (HO-1), nuclear factor-E2-related factor 2 (Nrf2), SLC7A11, glutathione peroxidase 4 (GPX4) of the cerebral cortex in rats or SHSY5Y cells were examined by western blotting. Results: Compared with model group, the cognitive impairment and neurological deficits of Rehmannioside A group were significantly improved, and the cerebral infarction was reduced in MCAO rats. Moreover, the cell viability obviously increased and the H2O2-induced toxicity was reduced in Rehmannioside A group. Further research indicated that the expression of p-PI3K, p-Akt, nuclear Nrf2, HO-1 and SLC7A11 in Rehmannioside A group was significantly higher than model group. Conclusion: Rehmannioside A has neuroprotection effect and improves cognitive impairment after cerebral ischemia by inhibiting ferroptosis and activating PI3K/AKT/Nrf2 and SLC7A11/GPX4 signaling pathway. These findings provide valuable insight into the pathogenesis and therapeutic target of ischemic stroke.

To overview the systematic reviews of Panax notoginseng saponins in the treatment of acute cerebral infarction. CNKI, CBM, Wanfang, VIP, PubMed, Cochrane Library and EMbase databases were retrieved to collect the systematic reviews of the efficacy of P. notoginseng saponins in the treatment of acute cerebral infarction. The retrieval time was from the time of database establishment to January 2021. After two researchers independently screened out the literature and extracted the data, AMSTAR-2 scale was used to evaluate the methodological quality of the included systematic reviews, GRADE system was used to grade the quality of evidences of the outcome indicators, and the efficacy evaluation was summarized. A total of 5 systematic reviews were included. AMSTAR-2 evaluation results showed that 3 items were relatively complete, while 4 items had a poor overall quality. P. notoginseng saponins combined with conventional Western medicine therapy was superior to single conventional therapy in the recovery of neurological function, enhancement of the total effective rate in clinic, and improvement of activities of daily living. GRADE evaluation results showed that the quality of evidence was from low quality to very low quality. In conclusion, in the treatment of acute cerebral infarction, P. notoginseng saponins can improve the clinical efficacy, with a good safety but a not high methodological quality and a low evidence quality. It is suggested that high-quality clinical studies shall be further carried out to provide evidence-based basis for the application of P. notoginseng saponins in the treatment of acute cerebral infarction.

目的 对针刺治疗紧张型头痛的系统评价/Meta分析进行再评价.方法 计算机检索中国知识资源总库(CNKI)、中国生物医学文献数据库(CBM)、中文科技期刊数据库(维普网)、中国学术期刊数据库(万方数据)、PubMed、Embase、Cochrane Library有关针刺治疗紧张型头痛的系统评价/Meta分析,检索时间范围为建库至2019年12月30日,应用AMSTAR 2量表、GRADE工具对纳入文献及重要结局指标进行质量评价并进行疗效评价.结果 共纳入7篇系统评价,AMSTAR 2方法学质量评价结果显示1篇为低质量、6篇为极低质量,GRADE分级显示22个结局指标证据质量为中级,8个为低级.结论 7篇系统评价并未得出一致结论,且方法学质量低,结局指标证据质量为中、低级.今后的临床研究及系统评价应严格遵守相关规范.

To analyze the use of outcome indicators of randomized controlled trial(RCT) of acupuncture in the treatment of acute ischemic stroke in recent three years, so as to provide a basis for building a study on the core outcome indicators for the treatment of acute ischemic stroke with acupuncture. The RCTs of acupuncture treatment for acute ischemic stroke in recent three years were collec-ted through computer retrieval of eight Chinese and English databases and two clinical trial registries at home and abroad. Literature was screened out, and data was extracted. Risk of assessment bias tool Cochrane 6.1 was used for bias risk assessment, outcome indicators were summarized and analyzed. A total of 47 RCTs were included, and 3 studies were trials registration scheme. Outcome indicators were divided into 6 categories according to functional attributes, namely physical symptoms/signs, physical and chemical examination, quality of life, traditional Chinese medicine symptoms/syndromes, safety events and long-term prognosis. The study found that in addition to the common problems in previous studies covered by the status quo of outcome indicators selection of RCT of acupuncture in the treatment of acute ischemic stroke, there were also the other problems as follows: emphasis on macroscopic efficacy indicators but neglect of acupuncture specific indicators, lack of characteristic indicators and economic indicators of traditional Chinese medicine therapy, and unification of indicators measurement tool and measurement time point. In the future, the outcome indicators set for the treatment of acute ischemic stroke with acupuncture shall be established, and the core outcome indicators set shall be in line with the characteristics of traditional Chinese medicine treatment.

There have been many clinical trials, systematic reviews/Meta-analysis proving that Xingnaojing Injection has a good clinical efficacy in treatment of cerebral ischaemic stroke, but with fewer comprehensive descriptions. In this study, an overview of systematic reviews/Meta-analysis of Xingnaojing Injection in treating cerebral ischaemic stroke was performed to provide current situation of evidences and basis for clinical practice. CNKI, Wanfang, VIP, CBM, EMbase, PubMed, Cochrane Library, Web of Science were retrieved through computers. A total of 6 literatures were included in this study. By AMSTAR-2 checklist and GRADE, the quality of included systematic reviews and the efficacy of Xingnaojing Injection were evaluated. The results of AMSTAR-2 checklist showed an extremely low quality for all of the 6 systematic reviews. According to the results of GRADE evaluation, among 55 outcomes, there were 2 outcomes with a medium quality, 4 outcomes with a low quality and 49 outcomes with an extremely low quality. The 6 systematic reviews reached a consistent conclusion that Xingnaojing Injection was effective in the treatment of cerebral ischaemic stroke. This therapy could improve the total efficacy, neurological deficit scores, hemodynamic and hemodynamic parameters. However, the methodolo-gical quality of all literatures was extremely low. The evidence levels of outcomes were between extremely low to medium. The effectiveness of Xingnaojing Injection in the treatment of cerebral ischaemic stroke still needs to be further verified by more high-quality studies. In the future, relevant clinical studies and systematic reviews/Meta-analysis shall be carried out in a strict accordance with relevant regulations.

目的 观察活血化瘀法对慢性脑缺血大鼠神经元自噬及Aβ42生成的影响.方法 采用改良后两步双侧颈总动脉结扎法建立慢性脑缺血大鼠模型,SD大鼠分为假手术组、模型组、脑得生组.用Morris水迷宫实验检测认知功能损伤程度,Western Blot法检测海马组织自噬相关蛋白Beclin-1、LC3-Ⅱ、p62及淀粉样前体蛋白(APP蛋白)表达水平,ELISA法检测海马组织Aβ42水平.结果 与假手术组相比,模型组大鼠认知功能存在明显损伤,自噬相关蛋白Beclin-1、LC3-Ⅱ及p62表达显著升高(P ＜0.05,P＜0.01),APP蛋白表达无变化(P＞0.05),Aβ42水平显著升高(P＜0.01);与模型组比较,脑得生组认知功能损伤减轻,自噬相关蛋白Beclin-1、LC3-Ⅱ及p62表达均显著降低(P ＜0.01,P＜0.05),Aβ42表达显著降低(P＜0.05).结论 活血化瘀法可通过抑制神经元自噬激活减少Aβ42生成,从而发挥改善慢性脑缺血大鼠认知功能的作用.

卒中后认知障碍是卒中后常见的并发症之一,属中医学"善忘""呆病"的范畴.通过阐述从脾肾论治卒中后认知障碍的理论基础和治则治法,认为脾肾与卒中后认知障碍关系密切,其中脾肾亏虚、痰瘀内阻是本病的主要病因病机,健脾益肾、活血化痰法治疗能够有效改善患者症状,从脾肾论治卒中后认知障碍具有重要的临床意义.

To systematically search and sort out the clinical randomized controlled trial(RCT) on the prevention and treatment of acute cerebral infarction with traditional Chinese medicine(TCM) by using the method of evidence map, and to understand the evidence distribution of related studies. CNKI, Wanfang, VIP, CBM, PubMed, EMbase, Cochrane Library and Web of Science were retrieved from January 2016 to September 2020, and literatures related to the prevention and treatment of acute cerebral infarction with traditional Chinese medicine were included. Text description combined with table and bubble chart were used to analyze the distribution characteristics of evidence. A total of 1 102 clinical articles in recent five years were retrieved. The annual trend of clinical study publication, study size, TCM therapy category and main scheme, and study literature quality were analyzed. We find that TCM treatment of acute cerebral infarction has become a hot topic of clinical research, the number of literature showed a trend of increased year by year, various means of intervention of TCM in the treatment of the advantages of increasingly highlight. Follow-up clinical research should highlight the characteristics of TCM: in the analysis of outcome indicators; increase the neuropsychological patients after stroke and cognitive ability, and the theory of combined treatment of TCM disease when thoughts; At the same time, the quality of clinical research needs to be improved. At present, there is still a lack of unified standards for the production of evidence map. This study is the first to explore the application of evidence map to summarize and display the clinical research status of TCM treatment of acute cerebral infarction, and combine it with the setting of priority areas of TCM clinical research, so as to provide a reference basis for determining the priority topic selection of TCM treatment optimization research.

Importance. Panax Notoginseng Saponins (PNS) are proven to have antiplatelet effects in patients with acute ischemic stroke (AIS). Objective. To assess the efficacy and safety of PNS on antiplatelet therapy in the treatment of AIS. Methods. We searched 7 literature databases and 2 clinical studies databases for randomized controlled studies (RCTs) evaluating PNS as an adjuvant therapy for AIS. Relevant studies were retrieved and screened, and data were extracted independently by two reviewers. The quality of the included studies was assessed using the Cochrane Risk Assessment Tool. Meta-analysis was carried out with the Rev Man 5.4 software. Results. Of 8267 records identified, 43 RCTs met our inclusion criteria (n = 4170 patients). Patients assigned to PNS with conventional treatments (CTs) had improved functional independence at 90 days compared with those assigned to CTs alone (RR = 1.87, 95% CI = 1.37, to 2.55, P<0.0001). Patients who received PNS combined with CTs showed significantly high improvements in neurological function among individuals with AIS on the neurologic deficit score (NDS) (MDCSS = −5.71, 95% CI = −9.55 to −1.87, P=0.004; MDNIHSS = −3.94, 95% CI = −5.65 to −2.23, P<0.00001). The results also showed PNS contributed to a betterment in activities of daily living (ADL) on the Barthel index (MDday10 BI = 4.86, 95% CI = 2.18, to 7.54, P<0.00001; MDday 14 BI = 13.92, 95% CI = 11.46 to 16.38, P<0.00001; MDday 28 BI = 7.16, 95% CI = 0.60, to 13.72, P<0.00001). In addition, PNS, compared with CTs alone, could significantly improve overall response rate (ORR) (RRNIHSS = 1.20, 95% CI = 1.16, to 1.24, P<0.00001; RRCSS = 1.15, 95% CI = 1.08, to 1.24, P<0.0001), hemorheological parameters, maximum platelet aggregation rate (MPAR) (MD = −6.82, 95% CI = −9.62 to −4.02, P<0.00001), platelet parameters (MDPLT = 4.85, 95% CI = 1.82 to 7.84, P=0.002; MDMPV = −0.79, 95% CI = −1.09 to −0.48, P<0.00001), and serum CD62P (MD = −0.21, 95% CI = −0.29 to −0.13, P<0.00001). The incidence of adverse reactions in PNS was lower than that in the control group (RR = 0.62, 95% CI = 0.39 to 0.97, P=0.04). Adverse reactions in the PNS were mild adverse reactions. Conclusion. PNS may be effective and safe in treating AIS on ameliorating neurological deficit, improving activities of daily living function, and enhancing antiplatelet effects. However, more high-quality evidence is needed before it can be recommended for routine antiplatelet therapy in patients with AIS.

目的 通过系统评价来评估化痰通腑法治疗急性脑梗死的临床疗效及安全性.方法 检索8个常用中英文数据库,应用RevMan5.4.1软件进行Meta分析,并进行偏倚风险评估.结果 干预组vs对照组:NIHSS的评分较低,BI评分、临床有效率较高.但在中医证候积分上,疗程小于14 d无显著差异,大于14 d疗效较好[MD疗程<14 d=-3.12,95％CI[-7.30,1.05],P=0.14;MD疗程>14 d=-5.77,95％CI(-6.53,-5.01),P<0.00001].结论 化痰通腑法相对常规西医可降低NHISS评分和中医证候积分,提高BI评分和临床有效率,但考虑相关临床研究及样本量较少,仍需开展更多大规模、高质量的研究来进一步验证.

目的 评价针刺治疗卒中后认知障碍(post-stroke cognitive impairment,PSCI)的疗效.方法 检索从建库至2020年7月30日中国知网数据库(CNKI)、中文维普数据库(VIP)、万方数据库(WanFang)、CBM、PubMed、Embase、Cochrane Library Database7个数据库和ClinicalTrials.gov.纳入所有针刺治疗PSCI的临床随机对照试验(RCT).对纳入的研究逐个进行质量评价和描述性分析,而后采用RevMan 5.4软件进行Meta分析.结果 共纳入15个RCT,共1 301例受试者符合纳入标准,干预组652例,对照组649例.研究结果显示针刺干预在改善患者蒙特利尔认知评估量表(MoCA)、简易精神状态检查量表(MMSE)、Barthel指数评定量表(BI)、日常生活能力量表(ADL)、美国国立卫生研究院卒中量表(NIHSS)的评分方面均优于对照组,且未见严重的不良反应.结论 现有临床证据表明,针灸可减轻脑卒中后神经功能缺损的程度,并可以提高患者的自我生活能力,但鉴于目前评价针灸疗效的临床试验及病例数较少,尚不能作出其是否有效的确切结论,有必要进一步开展高质量、大样本RCT研究评价其疗效.