BackgroundAlthough Shen Gui capsules (SGCP) are widely used as an adjuvant treatment for chronic heart failure (CHF), their clinical efficacy and safety remain controversial.PurposeTo assess the efficacy and safety of SGCP in the treatment of CHF through a systematic review and meta-analysis, to provide high-quality evidence for evidence-based medicine.MethodsSeven databases were searched for randomized controlled trials (RCTs) assessing SGCP for CHF, from inception to 9 January 2023. RCT quality of evidence was evaluated using the Cochrane Handbook for the Evaluation of Intervention Systems to assess risk of bias and Grading of Recommendations Assessment, Development, and Evaluation. A meta-analysis with subgroup and sensitivity analyses was performed using Review Manager 5.4 and Stata 12.ResultsNine RCTs representing 888 patients with CHF were included in the review. Meta-analysis revealed that SGCP combined with conventional heart failure therapy is more advantageous for improving left ventricular ejection fraction [LVEF; mean difference (MD) = 5.26, 95% confidence interval (CI) (3.78, 6.74), p < 0.0000] and increasing effective rate [relative risk (RR) = 1.21, 95%CI (1.14, 1.29), p < 0.001] compared with conventional therapy alone. The experimental treatment also reduced brain natriuretic peptide [MD = −100.15, 95%CI (−157.83, −42.47), p = 0.0007], left ventricular end-diastolic diameter [MD = −1.93, 95%CI (−3.22, −0.64), p = 0.003], and hypersensitive C-reactive protein [MD = −2.70, 95%CI (−3.12,−2.28), p < 0.001] compared with the control group. However, there was not a statistically significant difference in tumor necrosis factor-α [MD = −14.16, 95%CI (−34.04, 5.73), p = 0.16] or left ventricular end-systolic diameter [MD = −1.56, 95%CI (−3.13, 0.01), p = 0.05]. Nor was there a statistically significant between-groups difference in incidence of adverse events (p > 0.05).ConclusionSGCP combined with conventional heart failure therapy can improve LVEF and increase the effective rate to safely treat patients with CHF. However, further high-quality studies are needed to confirm these findings, due to the overall low quality of evidence in this literature.Clinical Trial Registration:https://www.crd.york.ac.uk/PROSPERO/logout.php, PROSPERO [CRD42023390409].

Background. Atrial fibrillation is one of the most common cardiac arrhythmias. Wenxin Keli (WXKL) is a Chinese herbal extract widely used in China to treat patients with atrial fibrillation. This study aimed to outline and summarize the current evidence of systematic reviews (SRs)/meta-analyses (MAs) investigating the clinical efficacy of WXKL in atrial fibrillation. Methods. From inception to December 2021, 6 electronic databases in English and Chinese were searched for potential SRs/MAs. The GRADE (Grading of Recommendations Assessment, Development, and Evaluation), PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) checklist, and AMSTAR-2 (Assessing the Methodological Quality of Systematic Reviews-2) were used to evaluate the quality of the evidence, reporting, and methodology of SRs/MAs regarding WXKL for the treatment of atrial fibrillation. Results. A total of 8 SRs/MAs were included in the present study. The results of AMSTAR-2 and PRISMA were unsatisfactory for the main insufficiency founded in registration and protocol, search strategy, excluded study statement, evidence certainty assessment, and funding and conflict of interest information. All the included SRs/MAs were assessed as very low in methodological quality. Moreover, 23 outcomes were evaluated by GRADE for the certainty of evidence, and 2 outcomes were assessed as moderate, while 15 were low and 6 were very low. Risk of bias and publication bias contributed to the downgrading. Conclusion. WXKL may be clinically efficacious and safe for the treatment of atrial fibrillation. This finding, however, should be regarded with caution because of the low level of evidence and methodological qualities of the involved SRs/MAs. More standardized, rigorous, and comprehensive SRs/MAs and randomized control trials are needed to provide strong evidence to reach more convincing conclusions.

Objectives: Evidence from systematic reviews/meta-analyses about the efficacy and safety of Qishen Yiqi (QSYQ) dripping pills in chronic heart failure (CHF) remains unclear. This study comprehensively reviewed available systematic reviews on latest evidence to provide reliable information for the clinical use of QSYQ in CHF. Methods: The systematic review was performed on studies retrieved from six major medical databases. Eligible studies were evaluated in terms of methodological quality and quality of evidence using the Assessment of Multiple Systematic review 2 (AMSTAR-2) tool, the Risk of Bias in Systematic Reviews (ROBIS) was used to assess the risk of bias, and the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) 2020 was utilized for assessing reporting quality. In addition, the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was used to determine primary outcome indicators' evidence quality. Results: A total of 14 systematic reviews were included in this study, based on which it could be concluded that QSYQ combined with conventional medicine (CM) treatment tended to be superior to CM treatment alone in terms of improving cardiac function-related indices (e.g., increasing the left ventricular ejection fraction [LVEF] and reducing the left ventricular end-diastolic dimension [LVEDD] and left ventricular end-systolic internal diameter [LVESD]), improving the total effective rate and 6-min walking distance (6MWD), and reducing N-terminal pro-brain natriuretic peptide (NT-proBNP). Overall, no serious QSYQ-related adverse events were observed. However, the GRADE results showed "very low " to "moderate " evidence for these outcomes, with no high-quality evidence supporting them. Unsatisfactory results were obtained in terms of methodological quality, risk of bias and reporting quality after assessment using the AMSTAR-2, ROBIS, and PRISMA 2020, limited mainly by deficiencies in the following areas: registration of study protocols, explanation of the inclusion of randomized controlled trials (RCTs), complete and detailed search strategy, list of excluded literature, description of funding sources for inclusion in RCTs, investigation of the impact of risk of bias on the results of meta-analysis, and reporting of potential conflicts of interest. Conclusion: The efficacy and safety of QSYQ adjuvant therapy in CHF remain to be further clarified due to the lack of high-quality evidence provided by current systematic reviews.

Background: Coronary heart disease (CHD) is a clinical syndrome caused by coronary atherosclerosis (AS) or functional changes of coronary arteries. Our previous experimental study found that the main component of Astragalus, Astragaloside IV, and the main component of Salvia Miltiorrhiza, Tanshinone IIA, can effectively improve myocardial ischemic injury. Methods: This study was a prospective, randomized, blinded, parallel design trial. A total of 160 eligible patients were randomized to a treatment group (in three groups) or the placebo control group in a 1:1:1:1 ratio using a central randomization system. Patients will receive appropriate treatment for 7 days within 24 hours after enrollment and follow-up for 28 days. Main evaluation indicators: cell count, serum high-sensitivity C-reactive protein (hs-CRP) level, monocyte chemoattractant protein 1 (MCP-1), Interleukin-6(IL-6), IL-1β, IL-8, IL-18, IL-10, Tumor necrosis factor(TNF-α), Oxidized low density lipoprotein(OX-LDL), exosome levels, and angina grade and Traditional Chinese Medicine (TCM) symptom changes scale. Secondary evaluation indicators: B-type natriuretic peptide (BNP) level, troponin (cTn), muscle enzyme isoenzyme (CK-MB), heart-type fatty acid binding protein (H-FABP), liver function, renal function, blood coagulation and the like. Adverse events will be monitored throughout the trial. Discussion: This is a randomized controlled trial of Chinese herbal extracts for the treatment of coronary heart disease. The results of this trial will provide valuable clinical evidence for the recommendations for disease management and identify its underlying mechanisms.

Xiao Ai Ping injection (XAPI), extracted from the Chinese herbal medicine Marsdenia tenacissima, is widely used in the adjuvant treatment of tumors in China. The present study aimed to evaluate the efficacy and safety of XAPI combined with chemotherapy for treating patients with advanced gastric cancer. Seven databases were searched for relevant studies published up to October 1, 2018, and Review Manager 5.3 software and Stata 12.0 software were used for meta-analysis. Fourteen studies, representing 1097 enrolled patients, were included in our analysis. Compared with chemotherapy alone, combination treatment with XAPI and the XELOX regimen (capecitabine plus oxaliplatin) was found to improve the objective response rate (ORR) [RR=1.36; 95%CI (1.10, 1.70); P=0.006], disease control rate (DCR) [RR=1.15; 95% CI (1.04, 1.28); P=0.010], and Karnofsky Performance Status (KPS) improvement rate [RR=1.51; 95%CI (1.14, 2.00); P=0.004] and to reduce the incidence of leukopenia [RR=0.68; 95%CI (0.55,0.84); P=0.0005], liver damage [RR=0.59; 95% CI (0.37, 0.92); P=0.02], renal impairment [RR=0.39; 95% CI (0.18, 0.85); P=0.02], and hand-foot syndrome [RR=0.56; 95%CI (0.35,0.90); P=0.02]. However, median progression-free survival (PFS), 1-year survival rate, and median overall survival (OS) were not extended by XAPI plus XELOX. Combination treatment with XAPI and the SOX regimen (tegafur plus oxaliplatin) did not improve ORR or DCR, but it did enhance the KPS improvement rate [RR=1.73; 95%CI (1.23,2.43); P=0.002] and reduce the incidence of nausea and vomiting [RR=0.66; 95% CI (0.50, 0.88); P=0.004]. XAPI in combination with the FOLFOX regimen (fluorouracil/calcium folinate/oxaliplatin) enhanced only the KPS improvement rate [RR=1.68; 95%CI (1.18,2.39); P=0.004] and had no significant effect on ORR or DCR or the incidence of adverse events. A single study reported that XAPI combined with the CPT-11 regimen (irinotecan) was superior to chemotherapy alone with respect to DCR and also reduced the incidence of leukopenia, liver damage, and hand-foot syndrome during chemotherapy, while prolonging PFS. Finally, one study reported that XAPI combined with the TP regimen (palitaxel plus cisplatin) improved ORR and KPS improvement rate to a greater extent than TP alone. Although the present review has some limitations, the findings suggest that XAPI combined with chemotherapy may represent a beneficial treatment strategy, particularly the combination of XAPI and XELOX.

Background: Essential hypertension is one of the most common chronic diseases, as well as one of the leading risk factors for cardio-cerebrovascular diseases. Tianma Gouteng decoction has been commonly used in clinical practice for patients with essential hypertension. It is important to update the search and evaluation to provide the best available evidence for essential hypertension. Here, we provide a protocol to evaluate the efficacy and safety of Tianma Gouteng decoction (TGD) for essential hypertension. Methods: Retrieve literature on the TGD treatment for essential hypertension in the databases including PubMed, Cochrane Library, EMBASE, Chinese Biomedical database (CBM), Chinese National Knowledge Infrastructure (CNKI), Wanfang database, and Chinese Science and Technology Periodical database (VIP) on computer. The literature to be collected will be those published from the time when the respective databases were established to January 2018. The therapeutic effects according to the blood pressure (BP) will be accepted as the primary outcomes. We will use RevMan V.5.3 software as well to compute the data synthesis carefully when a meta-analysis is allowed. Results: This study will provide a high-quality synthesis of current evidence of TGD for essential hypertension from several aspects including BP, life quality, heart rate, and adverse events. Conclusion: The conclusion of our systematic review will provide evidence to judge whether TGD is an effective intervention for patient with essential hypertension.

Background: Insomnia is a highly widespread sleep disorder in the general population. Electroacupuncture (EA) has been widely received attention as a potential treatment for primary insomnia. However, few previous studies are available to report that EA is a beneficial therapeutic approach to primary insomnia. In addition, there is no critical systematic review or meta-analysis published regarding the effectiveness of this treatment. Here, we provide a protocol to systematically evaluate the efficacy and safety of EA for primary insomnia. Methods: The reference lists of included studies for relevant randomized controlled trials and 8 electronic databases will be systematically searched by 2 review authors in January 2018, including 4 English databases (PubMed, EMBASE, Cochrane Central Register of Controlled Trials and Cumulative Index to Nursing and Allied Health Literature) and 4 Chinese databases (Chinese National Knowledge Infrastructure, Chinese Biomedical Literature Database, VIP Database, and Wanfang Database). The primary outcomes will be assessed according to the Pittsburgh Sleep Quality Index. Data synthesis will be computed with the use of RevManV5.3 software when a data-analysis is allowed. Methodological quality will be evaluated with the risk of bias according to Cochrane Handbook. Results: This study will provide a high-quality synthesis of current evidence of EA for primary insomnia. Conclusion: The conclusion of this systematic review will provide evidence to judge whether EA is an effective therapeutic intervention for patient with primary insomnia.

Background: Essential hypertension is one of the most common chronic diseases, as well as one of the leading risk factors for cardio-cerebrovascular diseases. Tianma Gouteng decoction has been commonly used in clinical practice for patients with essential hypertension. It is important to update the search and evaluation to provide the best available evidence for essential hypertension. Here, we provide a protocol to evaluate the efficacy and safety of Tianma Gouteng decoction (TGD) for essential hypertension. Methods: Retrieve literature on the TGD treatment for essential hypertension in the databases including PubMed, Cochrane Library, EMBASE, Chinese Biomedical database (CBM), Chinese National Knowledge Infrastructure (CNKI), Wanfang database, and Chinese Science and Technology Periodical database (VIP) on computer. The literature to be collected will be those published from the time when the respective databases were established to January 2018. The therapeutic effects according to the blood pressure (BP) will be accepted as the primary outcomes. We will use RevMan V.5.3 software as well to compute the data synthesis carefully when a meta-analysis is allowed. Results: This study will provide a high-quality synthesis of current evidence of TGD for essential hypertension from several aspects including BP, life quality, heart rate, and adverse events. Conclusion: The conclusion of our systematic review will provide evidence to judge whether TGD is an effective intervention for patient with essential hypertension. PROSPERO registration number: PROSPERO CRD 42018082319.

Background: Atrial fibrillation (AF) is a most common cardiac arrhythmia in clinical practice. In China, Wenxin Keli (WXKL) therapy is a common treatment for AF, but its effects and safety remain uncertain. This protocol is to provide the methods used to assess the effectiveness and safety of WXKL for the treatment of patients with AF. Methods: We will search comprehensively the 4 English databases EMBASE, the Cochrane Central Register of Controlled Trials (Cochrane Library), PubMed, and Medline and 3 Chinese databases China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), and Chinese Science and Technology Periodical database (VIP) on computer on March 2018 for the randomized controlled trials (RCTs) regarding WXKL for AF. The therapeutic effects according to the sinus rhythm and p-wave dispersion (Pwd) will be accepted as the primary outcomes. We will use RevMan V.5.3 software as well to compute the data synthesis carefully when a meta-analysis is allowed. Results: This study will provide a high-quality synthesis of current evidence of WXKL for AF. Conclusion: The conclusion of our systematic review will provide evidence to judge whether WXKL is an effective intervention for patient with AF. PROSPERO registration number: PROSPERO CRD 42018082045.

Background: Insomnia is a highly widespread sleep disorder in the general population. Electroacupuncture (EA) has been widely received attention as a potential treatment for primary insomnia. However, few previous studies are available to report that EA is a beneficial therapeutic approach to primary insomnia. In addition, there is no critical systematic review or meta-analysis published regarding the effectiveness of this treatment. Here, we provide a protocol to systematically evaluate the efficacy and safety of EA for primary insomnia. Methods: The reference lists of included studies for relevant randomized controlled trials and 8 electronic databases will be systematically searched by 2 review authors in January 2018, including 4 English databases (PubMed, EMBASE, Cochrane Central Register of Controlled Trials and Cumulative Index to Nursing and Allied Health Literature) and 4 Chinese databases (Chinese National Knowledge Infrastructure, Chinese Biomedical Literature Database, VIP Database, and Wanfang Database). The primary outcomes will be assessed according to the Pittsburgh Sleep Quality Index. Data synthesis will be computed with the use of RevManV5.3 software when a data-analysis is allowed. Methodological quality will be evaluated with the risk of bias according to Cochrane Handbook. Results: This study will provide a high-quality synthesis of current evidence of EA for primary insomnia. Conclusion: The conclusion of this systematic review will provide evidence to judge whether EA is an effective therapeutic intervention for patient with primary insomnia.

Background: Sudden cardiac arrest (SCA) is one of the most common critical illnesses encountered in clinical practice. Shenfu injection (SFI) has received extensive attention as an alternative therapy that can effectively maintain the autonomic circulation function after cardiopulmonary resuscitation. However, the mechanism of SFI is not yet fully understood. In addition, there has been no systematic review or meta-analysis of SFI in the treatment of patients with return of spontaneous circulation after SCA. Herein, we describe the protocol of a proposed study based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines that aims to systematically evaluate the efficacy and safety of SFI in patients with return of spontaneous circulation after SCA. Methods: Two researchers will search 9 electronic databases (PubMed, Medline, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, Chinese VIP Information, Wanfang, and Chinese Biomedical Database) to identify all studies that meet the inclusion criteria and were published before July 2018. After information extraction and methodological quality evaluation, we will use Stata 13.0 software (STATA Corporation, College Station, TX, USA) to synthesize the data. The primary outcomes will be the survival rate and Glasgow Coma Scale. Results: The data synthesis results will objectively illustrate the efficacy and safety of SFI in patients with return of spontaneous circulation after SCA. Conclusion: The findings will provide a reference for the use of SFI in the treatment of patients with return of spontaneous circulation after SCA. Registration: PROSPERO (registration number: CRD42018104230).

Cardio/cerebral-vascular diseases seriously threaten human health and are the leading cause of death. As such, there is great interest in identifying a potential mechanism that controls the development process of cardio/cerebral vascular diseases. Present studies demonstrate that inflammasomes play an important role in the process of ischemic cardio/cerebral vascular diseases (ICCVDs). Among the pathological process of ICCVDs, inflammasomes activated the sterile inflammatory response that accelerated the development of diseases and aggravated the acute lesion of tissue. As the most thoroughly studied inflammasome, the NLRP3 inflammasome has been proven to be a potential therapeutic target for ICCVDs. In this review, we summarized the mechanisms of Chinese herbal medicine which can affect ICCVDs via the regulation of the NLRP3 inflammasome. Our study discovers that active compounds of Chinese medicines have a negative effect on NLRP3 in different ICCVDs models. Astragaloside IV may influence the receptor of the cell membrane to inhibit NLRP3 activation. Resveratrol, colchicinesis, salvianolic acid B, chrysophanol and sulforaphane may directly damage the formation of NLRP3 by inhibiting ASC or Caspase-1. Most of the active natural compounds can negatively regulate the downstream products of NLRP3 inflammasome such as IL-18 and IL1 β . In addition, Chinese medicines such as sinomenine, ruscogenin, resveratrol, arctigenin and cepharanthineas may downregulate NLRP3 inflammasome by inducing autophagy activation. Due to the advantages of multi-target effects, Chinese herbal medicine can be treated as a splendid therapy for ICCVDs by inhibiting NLRP3 inflammasome.

Background: Stress urinary incontinence (SUI) is a widespread complaint in the adult women. Electroacupuncture has been widely applied in the treatment of SUI. But its efficacy has not been evaluated scientifically and systematically. Therefore, we provide a protocol of systematic evaluation to assess the effectiveness and safety of electroacupuncture treatment on women with SUI. Methods: The retrieved databases include 3 English literature databases, namely PubMed, Embase, and Cochrane Library, and 3 Chinese literature databases, namely Chinese Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), and Wanfang Database. The randomized controlled trials (RCTs) of the electroacupuncture treatment on women with SUI will be searched in the above-mentioned databases from the time when the respective databases were established to December 2017. The change from baseline in the amount of urine leakage measured by the 1-hour pad test will be accepted as the primary outcomes. We will use RevMan V.5.3 software as well to compute the data synthesis carefully when a meta-analysis is allowed. Results: This study will provide a high-quality synthesis to assess the effectiveness and safety of electroacupuncture treatment on women with SUI. Conclusion: The conclusion of our systematic review will provide evidence to judge whether electroacupuncture is an effective intervention for women with SUI. PROSPERO registration number: PROSPERO CRD42017070947

Background: Stress urinary incontinence (SUI) is a widespread complaint in the adult women. Electroacupuncture has been widely applied in the treatment of SUI. But its efficacy has not been evaluated scientifically and systematically. Therefore, we provide a protocol of systematic evaluation to assess the effectiveness and safety of electroacupuncture treatment on women with SUI. Methods: The retrieved databases include 3 English literature databases, namely PubMed, Embase, and Cochrane Library, and 3 Chinese literature databases, namely Chinese Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), and Wanfang Database. The randomized controlled trials (RCTs) of the electroacupuncture treatment on women with SUI will be searched in the above-mentioned databases from the time when the respective databases were established to December 2017. The change from baseline in the amount of urine leakage measured by the 1-hour pad test will be accepted as the primary outcomes. We will use RevMan V.5.3 software as well to compute the data synthesis carefully when a meta-analysis is allowed. Results: This study will provide a high-quality synthesis to assess the effectiveness and safety of electroacupuncture treatment on women with SUI. Conclusion: The conclusion of our systematic review will provide evidence to judge whether electroacupuncture is an effective intervention for women with SUI.

BACKGROUND:Atrial fibrillation (AF) is the most clinically common cardiac arrhythmia. Chinese herbal medicine (CHM) has been widely applied in the treatment of AF, However, to our knowledge, there has been no systematic review and meta-analysis of randomized controlled trails (RCTs) regarding the effectiveness of this treatment. Therefore, we provide a protocol to evaluate the effectiveness and safety of CHM for AF. METHODS:The databases reviewed to collect RCTs related to CHM treatment for AF will be as follows: 3 English literature databases, which are PubMed, Embase, and Cochrane Library, and 3 Chinese literature databases, which are CBM, CNKI, and Wanfang. The data collection in the above-mentioned databases will be from the time when the respective databases were established to December 2017. The maintenance of sinus rhythm and p-wave dispersion will be accepted as the primary outcomes. Quality of life (QOL), such as QOL scale embolic events, bleeding events, and symptom improvement (such as chest distress, palpitations, etc) will be measured as secondary outcomes. Two reviewers will independently screen the titles, abstracts, or even full texts, and extract data. Methodological quality will be evaluated according to the Cochrane risk of bias. All analyses will be applied by RevMan (version 5.3). RESULTS:The results of study will be disseminated via both international conference and peer-review journal. CONCLUSION:The conclusion of our systematic review will provide evidence to judge whether CHM is an effective intervention for patient with AF.

Background: Vertebrobasilar insufficiency vertebrobasilar (VBIV) is a serious nerve disease and many old people suffer from it. Acupuncture has been widely applied in the treatment of VBIV. However, to our knowledge, there has been no systematic review or meta-analysis of randomized controlled trails regarding the effectiveness of this treatment. Here, we provide a protocol to evaluate the effectiveness and safety of acupuncture for VBIV. Methods: Relevant randomized controlled trials in 5 databases (EMBASE, PubMed, the Cochrane Central Register of Controlled Trials [Cochrane Library], Chinese Biomedical Literature Database [CBM], China National Knowledge Infrastructure [CNKI]) will be comprehensively searched by 2 researchers in December 2017. The clinical efficacy will be accepted as the primary outcomes. We will also use RevMan V.5.3 software to compute the data synthesis carefully when a meta-analysis is allowed. Results: This study will provide a high-quality synthesis of current evidence of acupuncture for VBIV from several aspects including clinical efficacy, the blood flow velocity of the left vertebral artery (LVA), the right vertebral artery (RVA), the basilar artery (BA)and adverse events. Conclusion: The conclusion of our systematic review will provide evidence to judge whether acupuncture is an effective and safety intervention for patient with VBIV.

Ethnopharmacological relevance: Herbal medicines including Tanshinone IIA (TanIIA) and Astragaloside IV (AsIV) are widely used in Asia as therapeutic agents for cardiovascular diseases, due to their complementary roles and shared properties based on the theory of traditional Chinese medicine and pharmacological researches. However, the underlying pathological mechanisms for their efficacy are still unclear. In addition, the compatibility or incompatibility of the herbal medicines when administered with other herbal remedies or with prescription drugs is unknown.Aim of the study: We aimed to investigate the compatibility of TanIIA and AsIV in protecting cardiomyocytes against hypoxia-induced injury.Materials and methods: Cultured cardiomyocytes were stimulated in hypoxia condition, in the absence or presence of the two herbal compounds, TanIIA and AsIV. Indicators were determined by cytotoxicity assay, quantitative PCR, ELISA, flow cytometry assay, immunofluorescence staining and western blot.Results: Either TanIIA alone or the combined herbal compounds inhibited hypoxia-triggered chemokines production including CCL2/5/19, CXCL2 and Transwell assay-indicated monocyte/macrophage recruitment, cytokines production including TNF-alpha and IL-6. While AsIV alone or the combined herbal compounds attenuated hypoxia-induced cell apoptosis indicated by decreased Annexin V+ cells and the ratio of Bax/Bcl-2, but no significant effect of the herbal compounds was observed in modulating cell apoptosis following both hypoxia and TNF-a stimulation. As an anti-apoptotic factor, stress granule formation was further enhanced by AsIV alone or the combined herbal compounds in hypoxia or heat shock stress. Moreover, immunoblotting analysis indicated that stress-responsive mitogen-activated protein kinases (MAPK) pathways including the phosphorylation of ERK1/2, p38 and JNK were inhibited while the phosphorylation of Akt in phosphatidylinositol 3-kinase (PI3K)-Akt pathway for cell survival was restored by the herbal compounds. Among these results, the combination of TanIIA and AsIV comprised most of the beneficial properties tested, although their combination did not improve the maximal effects achieved by any of the compounds alone.Conclusions: Taken together, these data suggest a compatibility of TanIIA and AsIV in protecting cardiomyocyte against hypoxia-induced injury.

Background: Insomnia is a widespread complaint in the general population. Wendan decoction has been widely applied in the treatment of primary insomnia. However, to our knowledge, there has been no systematic review or meta-analysis of randomized controlled trails regarding the effectiveness of this treatment. Here, we provide a protocol to evaluate the efficacy and safety of Wendan decoction for primary insomnia. Methods and analysis: Relevant randomized controlled trials in 5 English databases [EMBASE, the Cochrane Central Register of Controlled Trials (Cochrane Library), PubMed, the Allied andComplementaryMedicine Databases (AMED), and the Cumulative Index to Nursing and Allied Health Literature (CINAHL)], 4 Chinese databases [Chinese Biomedical Literature Database (CBM), Chinese Medical Current Content (CMCC), China National Knowledge Infrastructure (CNKI), and Wanfang Database] will be comprehensively searched by 2 researchers in October 2017. The therapeutic effects according to the Pittsburgh Sleep Quality Index (PSQI) will be accepted as the primary outcomes. We will use RevMan V. 5.3 software as well to compute the data synthesis carefully when a metaanalysis is allowed. Results: This study will provide a high-quality synthesis of current evidence of Wendan decoction for primary insomnia from several aspects including PSQI, the total scores of the Insomnia Severity Index (ISI), syndrome according to standards for assessing Traditional Chinese medicine and adverse events. Conclusion: The conclusion of our systematic review will provide evidence to judge whether Wendan decoction is an effective intervention for patient with primary insomnia. Ethics and dissemination: The outcomes of this systematic review will offer implications of the use of Wendan decoction treatment for primary insomnia patients. This knowledge informing recommendations will be provided by researchers who are interested in the treatment of primary insomnia. The results of this study will be disseminated through presentation at a conference and publication of the data in a peer-reviewed journal. PROSPERO registration number: PROSPERO CRD 42017065664.

Background: Vertebrobasilar insufficiency vertebrobasilar (VBIV) is a serious nerve disease and many old people suffer from it. Acupuncture has been widely applied in the treatment of VBIV. However, to our knowledge, there has been no systematic review or meta-analysis of randomized controlled trails regarding the effectiveness of this treatment. Here, we provide a protocol to evaluate the effectiveness and safety of acupuncture for VBIV. Methods: Relevant randomized controlled trials in 5 databases (EMBASE, PubMed, the Cochrane Central Register of Controlled Trials [Cochrane Library], Chinese Biomedical Literature Database [CBM], China National Knowledge Infrastructure [CNKI]) will be comprehensively searched by 2 researchers in December 2017. The clinical efficacy will be accepted as the primary outcomes. We will also use RevMan V.5.3 software to compute the data synthesis carefully when a meta-analysis is allowed. Results: This study will provide a high-quality synthesis of current evidence of acupuncture for VBIV from several aspects including clinical efficacy, the blood flow velocity of the left vertebral artery (LVA), the right vertebral artery (RVA), the basilar artery (BA) and adverse events. Conclusion: The conclusion of our systematic review will provide evidence to judge whether acupuncture is an effective and safety intervention for patient with VBIV.

Autophagy is an evolutionarily conserved degradation process which eliminates dysfunctional proteins and cytoplasmic components to maintain homeostasis for cell survival. Increasing evidence has demonstrated the modulatory role of autophagy in ischemic heart diseases (IHDs). Traditionally, this process has been recognized as having protective functions, such as inhibiting atherosclerosis progression and reducing cell death during the ischemic phase. However, recent studies have suggested its dual roles in myocardial ischemia/reperfusion (MIR) injury. Excessive autophagy may play a deleterious role in cardiac function, due to overwhelming clearance of cellular constituents and proteins. Hence modulation of autophagy to increase cardiomyocyte survival and improve cardiac function is meaningful for the treatment of IHD. Chinese herbal medicine, including extractive compounds and patented drugs, has shown its potential role in treating IHD by addressing autophagy-related mechanisms. This review summarizes the updated knowledge on the molecular basis and modulatory role of autophagy in IHD and the recent progress of Chinese herbal medicine in its treatment.