The efficacy and safety of Niaoduqing granules in the treatment of diabetic kidney disease: a systematic review and meta-analysis.

Background: Diabetic nephropathy (DN) is the main cause of chronic kidney disease (CKD) and end-stage renal failure (ESRF), and the control of disease progression and adverse events during treatment needs to be improved. Objective: This study aimed to systematically evaluate the clinical efficacy and safety of Niaoduqing granules (NDQG) in the treatment of diabetic kidney disease (DKD). Method: Randomized controlled trials (RCTs) of NDQG for DKD from Chinese and English databases up to 31 August 2022 were included. The quality of the literature was assessed using the risk of bias tool of the Cochrane Handbook. At a 95% confidence interval (CI), relative risk (RR) and Cohen's d were used for the categorical and continuous variables, respectively, and Stata 16.0 software was used for statistical analysis. A funnel plot and Egger's tests were used to assess publication bias. Result: A total of 4,006 patients were included in 52 RCTs, including 1,987 cases in the control group and 2,019 cases in the treatment group. Compared with conventional treatment (CT), combined NDQG therapy is more effective in improving clinical efficiency [RR = 1.23, 95% confidence interval (1.17, 1.29), p < 0.001, I 2 = 53.17%], kidney function (urinary albumin excretion rate [SMD = -0.90, 95% CI (-1.14, -0.66), p < 0.001, I 2 = 78.19%], 24hUTP levels [SMD = -0.81, 95% CI (-1.08, -0.55), p < 0.001, I 2 = 87.08%], blood urea nitrogen [SMD = -0.54, 95% CI (-0.69, -0.39), p < 0.01, I 2 = 77.01%], SCr [SMD = -0.68, 95% CI (-0.90, -0.45), p < 0.001, I 2 = 89.97%], CCr [SMD = 0.76, 95% CI (0.10,1.42), p = 0.02, I 2 = 95.97%], and Cys-C [SMD = -1.32, 95% CI (-2.25, -0.40), p = 0.01, I 2 = 93.44%]), the level of glucose metabolism (fasting blood glucose [SMD = -0.18, 95% CI (-0.38, 0.03), p = 0.10, I 2 = 71.18%] and HbA1c [SMD = -0.42, 95% CI (-0.86, -0.02), p = 0.06, I 2 = 81.64%]), the level of lipid metabolism (total cholesterol [SMD = -0.70, 95% CI (-1.01, -0.39), p < 0.001, I 2 = 86.74%] and triglyceride [SMD = -0.61, 95% CI (-0.87,-0.36), p < 0.001, I 2 = 80.64%]), inflammatory factors (Hs-CRP [SMD = -1.00, 95% CI (-1.54, -0.46), p < 0.001, I 2 = 86.81%], IL-18 [SMD = -1.25, 95% CI (-1.58, -0.92), p < 0.001, I 2 = 0], and TNF-α [SMD = -1.28, 95% CI (-1.64, -0.91), p < 0.001, I 2 = 75.73%]), and indicators of oxidative stress (malondialdehyde [SMD = -0.88, 95% CI (-1.22, -0.54), p < 0.001, I 2 = 66.01%] and advanced oxidation protein products [SMD = -0.92, 95% CI (-1.85, 0.00), p < 0.001, I 2 = 90.68%]). In terms of improving uric acid [SMD = -1.59, 95% CI (-3.45, 0.27), p = 0.09, I 2 = 94.67%], 2hPG [SMD = -0.04, 95% CI (-0.61, 0.53), p = 0.89, I 2 = 84.33%], HDL-C [SMD = 0.71, 95% CI (0.02, 1.40), p = 0.04, I 2 = 87.43%], Hb [SMD = 0.11, 95% CI (-0.10, 0.32), p = 0.32, I 2 = 0.00]), and superoxide dismutase [SMD = 1.32, 95% CI (0.44, 2.20), p < 0.001, I 2 = 93.48%], the effect is not obvious. Adjuvant treatment with NDQG did not increase the incidence of adverse reactions in the control group [SMD = 0.98, 95% CI (0.71, 1.34), p = 0.89, I 2 = 1.59%]. Obvious publication bias was detected by funnel plot and Egger's test. Conclusion: Our meta-analysis showed that adjuvant treatment with NDQG has more advantages than conventional treatment alone in the DKD treatment, which could improve clinical efficiency, kidney function, the level of glucose metabolism, the level of lipid metabolism, inflammatory factors, and oxidative stress indicators. At the same time, it also showed that NDQG are relatively safe. However, more high-quality studies are needed to provide more reliable evidence for clinical use. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022373726, identifier CRD42022373726.

Invigorating spleen, replenishing qi and tonifying kidney method treatment of traditional Chinese medicine for myasthenia gravis: A protocol for systematic review and meta-analysis.

BACKGROUND: Myasthenia gravis (MG) is an autoimmune disease related to the production of autoantibodies. It is mediated by antibodies against acetylcholine receptor (AChR), muscle specific kinase (MuSK) or other AChR related proteins in the postsynaptic muscle membrane, which interfere with the transmission of signals at the neuromuscular junction, resulting in clinical symptoms of skeletal muscle weakness and fatigue, leading to the occurrence and development of MG. At present, the incidence rate of Mg is increasing year by year. At present, the method of invigorating spleen, replenishing qi and tonifying kidney in traditional Chinese medicine has been widely used in the clinical treatment of MG, and the effect is good. The purpose of this study was to systematically evaluate the efficacy and safety of the method of invigorating the spleen, supplementing qi and tonifying the kidney in the treatment of MG. METHODS: We will search from the following eight databases: PubMed, Cochrane Library, EMBASE, Web of Science, CNKI, Sinomed, Wanfang, and Vip. All randomized controlled trial (RCT) literature has been searched and classified since the establishment of the database to date. In this study, two researchers independently screened and evaluated the quality of the retrieved literature. Cochrane risk bias assessment tool was used to evaluate the risk of bias. The meta-analysis uses RevMan 5.3 software provided by Cochrane Collaboration Network for meta analysis. RESULTS: This study compared the main outcome indicators: clinical response rate, recurrence rate, incidence of adverse reactions, quantitative myasthenia gravis score (QMG). Secondary outcomes were clinical absolute score, quality of life score (QOL), levels of inflammatory factors such as IL-6, IL-10, and serum acetylcholine receptor antibody (AChR-Ab) levels. CONCLUSION: The purpose of this study was to evaluate the efficacy and safety of the method of invigorating the spleen, supplementing qi and tonifying the kidney in treating MG, and to provide evidence based medicine.

Clinical efficacy and safety of astragalus injection combined with ACEI/ARB in the treatment of diabetic kidney disease: Protocol for a systematic review and meta-analysis.

BACKGROUND: Kidney disease is a common complication of diabetes and the main cause of end-stage renal disease. Astragalus (Huangqi) injection in combination with angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARBs) have been widely used for the treatment of diabetic kidney disease (DKD) in China. However, no supporting evidence yet exists with regard to the safety and effectiveness of this approach. Here a protocol is outlined for use in systematic evaluation of the safety and effectiveness of astragalus injection combined with ACEI/ARB for the treatment of DKD. METHODS: Randomised controlled trials will be retrieved from 8 scientific databases, including PubMed, Web of Science, EMBASE database, Cochrane Library, China National Knowledge Infrastructure, Wanfang, China Biomedical Literature CD-ROM Database and China Science Journal Database. Ongoing clinical trial databases will also be searched for studies published from the time of establishment of each database to September 1, 2022. that will include the Chinese Clinical Trial Registration Centre (www.chictr.org.cn/), the World Health Organisation International Trial Registration Platform (https://www.who.int/clinical-trials-registry-platform), Google Scholar (https://scholar.google.com/), Baidu Scholar (https://xueshu.baidu.com), etc. The main outcome indicators included urinary albumin excretion rate or 24-hour urinary albumin excretion rate, and renal function (blood urea nitrogen, serum creatinine concentration). The secondary outcome indicators mainly include the following 4 aspects: blood sugar, blood pressure, blood lipid levels and adverse events. Two researchers will independently select and extract data from randomized controlled trials and determine risks of bias. Meta-analysis will be performed using Revman5.4 then the quality of evidence from randomized clinical trials will be assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) System tool. RESULTS: This review will be the first to summarize meta-analysis results regarding the efficacy and safety of Huangqi injection combined with ACEI/ARB when administered during any stage of diabetic nephropathy rather than during only a single stage of the disease. DISCUSSION: It will provide high-quality guidance for the treatment of diabetic kidney disease and provide patients with more treatment options.

Clinical efficacy and safety of Xuefu Zhuyu decoction in the treatment of diabetic kidney disease: A protocol for systematic review and meta-analysis.

BACKGROUND: Diabetic kidney disease (DKD) is one of the common complications of diabetes, the most crucial cause of end-stage renal disease, and a significant cause of death in diabetes patients. In recent years, Xuefu Zhuyu decoction has also been widely used in treating diabetic nephropathy. However, there need to be more systematic reviews that comprehensively describe the effectiveness and safety of Xuefu Zhuyu decoction in treating DKD. Therefore, we will conduct a systematic review and meta-analysis to evaluate the indicators of Xuefu Zhuyu decoction in the treatment of DKD to provide evidence-based support. METHODS: Eligible published randomized controlled trials from January 2005 to October 2022 will be obtained by searching PubMed, Cochrane Library, EMBASE, Web of Science, CNKI, Wanfang, and VIP in Chinese and English. The Cochrane Collaboration Risk of bias tool will be used for methodological quality assessment and risk of bias. The meta-analysis will be performed using Cochrane RevMan 5.4 software. RESULTS: This study will compare the following indicators: the primary outcomes: urinary albumin excretion rate and urea nitrogen. Secondary outcomes: blood creatinine; 24 hours urine protein quantification; glycosylated hemoglobin; fasting blood glucose; 2-hour postprandial blood glucose; total cholesterol; triglycerides; total effective rate; incidence of adverse events. CONCLUSION: The results of this systematic review will provide an objective, evidence-based basis for judging the efficacy and safety of Xuefu Zhuyu decoction in treating DKD.

A risk prediction score model for predicting occurrence of post-PCI vasovagal reflex syndrome: a single center study in Chinese population.

BACKGROUND: The vasovagal reflex syndrome (VVRS) is common in the patients undergoing percutaneous coronary intervention (PCI). However, prediction and prevention of the risk for the VVRS have not been completely fulfilled. This study was conducted to develop a Risk Prediction Score Model to identify the determinants of VVRS in a large Chinese population cohort receiving PCI. METHODS: From the hospital electronic medical database, we identified 3550 patients who received PCI (78.0% males, mean age 60 years) in Chinese PLA General Hospital from January 1, 2000 to August 30, 2016. The multivariate analysis and receiver operating characteristic (ROC) analysis were performed. RESULTS: The adverse events of VVRS in the patients were significantly increased after PCI procedure than before the operation (all P< 0.001). The rate of VVRS [95% confidence interval (CI)] in patients receiving PCI was 4.5% (4.1%-5.6%). Compared to the patients suffering no VVRS, incidence of VVRS involved the following factors, namely female gender, primary PCI, hypertension, over two stents implantation in the left anterior descending (LAD), and the femoral puncture site. The multivariate analysis suggested that they were independent risk factors for predicting the incidence of VVRS (all P < 0.001). We developed a risk prediction score model for VVRS. ROC analysis showed that the risk prediction score model was effectively predictive of the incidence of VVRS in patients receiving PCI (c-statistic 0.76, 95% CI: 0.72-0.79, P < 0.001). There were decreased events of VVRS in the patients receiving PCI whose diastolic blood pressure dropped by more than 30 mmHg and heart rate reduced by 10 times per minute (AUC: 0.84, 95% CI: 0.81-0.87, P < 0.001). CONCLUSION: The risk prediction score is quite efficient in predicting the incidence of VVRS in patients receiving PCI. In which, the following factors may be involved, the femoral puncture site, female gender, hypertension, primary PCI, and over 2 stents implanted in LAD.

Enhancing Corrosion and Wear Resistance of AA6061 by Friction Stir Processing with Fe78Si9B13 Glass Particles.

The AA6061-T6 aluminum alloy samples including annealed Fe78Si9B13 particles were prepared by friction stir processing (FSP) and investigated by various techniques. The Fe78Si9B13-reinforced particles are uniformly dispersed in the aluminum alloy matrix. The XRD results indicated that the lattice parameter of α-Al increases and the preferred orientation factors F of (200) plane of α-Al reduces after friction stir processing. The coefficient of thermal expansion (CTE) for FSP samples increases at first with the temperature but then decreases as the temperature further increased, which can be explained by the dissolving of Mg and Si from ß phase and Fe78Si9B13 particles. The corrosion and wear resistance of FSP samples have been improved compared with that of base metal, which can be attributed to the reduction of grain size and the CTE mismatch between the base metal and reinforced particles by FSP, and the lubrication effect of Fe78Si9B13 particles also plays a role in improving wear resistance. In particular, the FSP sample with reinforced particles in amorphous state exhibited superior corrosion and wear resistance due to the unique metastable structure.