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Xuebijing injection (XBJ) has increasingly been used for sepsis in China. We aimed to evaluate the methodological quality and summarize the evidence regarding the effectiveness of XBJ combined with ulinastatin (UTI) for sepsis from systematic reviews/meta-analyses (SRs/MAs).From the inception to May 23, 2021, eight databases were searched to screen the SRs/MAs of XBJ combined with UTI in the treatment of sepsis. Methodology Quality of Systematic Reviews 2 (AMSTAR-2) was used to evaluate the quality of the methods. Grading of Recommendation,Assessment, Development, and Evaluation (GRADE) was used in the assessment of evidence quality.Seven SRs/MAs on XBJ combined with UTI treatment for sepsis were included. The AMSTAR-2 showed that the methodological quality of all included SRs/MAs was rated as critically low. According to the evaluation results of GRADE, 30% (13/44), 30% (13/44), and 40% (18/44) were rated to be of moderate, low, and critically low quality, respectively. Descriptive analysis results showed that XBJ combined with UTI was an effective treatment modality for sepsis.All included SRs/MAs showed that XBJ combined with UTI was more effective than UTI alone in the treatment of sepsis on the basis of conventional treatment, but the reliability of the results was limited due to the disadvantages of lower methodological quality and higher risk of bias in the included SRs/MAs. Further high-quality clinical studies and SRs/MAs are recommended to verify whether XBJ combined with UTI is more effective than UTI alone.

Background: It is known that nonalcoholic steatohepatitis (NASH) has been more and more popular in clinical practice. Apart from lifestyle modification, pharmacological therapy treating NASH has still been limited and insufficient. A growing number of studies demonstrated that Shugan Jianpi (SGJP) formula, as a kind of Chinese herbal medicine prescription, could improve blood lipid indexes, liver function, and other clinical measures in NASH patients. Nevertheless, there still has been a lack of study to systematically assess the efficacy and safety of SGJP formula treating NASH. Therefore, it is necessary to conduct this systematic review and meta-analysis. Methods: A systematic literature search for articles up to December 2021 will be performed in following electronic databases: MEDLINE, Embase, the Cochrane Library, China National Knowledge Infrastructure, Chinese Scientific Journals Database Database, Chinese Biomedical Database, Chinese Biomedical Literature Service System, and Wanfang Database. Inclusion criteria are randomized controlled trials of SGJP formula applied on NASH patients. The primary outcome measures will be liver function, blood lipid indexes, ultrasound, or radiological imaging examination. The safety outcome measures will be adverse events and kidney function. RevMan 5.3 software will be used for data synthesis, sensitivity analysis, subgroup analysis, and risk of bias assessment. A funnel plot will be developed to evaluate reporting bias. Stata 12.0 will be used for meta-regression and Egger tests. We will use the Grading of Recommendations Assessment, Development and Evaluation system to assess the quality of evidence. Discussion: This study will provide a high-quality synthesis of the efficacy and safety of SGJP for NASH patients. Ethics and dissemination: This systematic review does not require ethics approval and will be submitted to a peer-reviewed journal. Trial registration number: PROSPERO CRD42021259097.

Background: A growing number of studies suggest that Gualou Xiebai Banxia (GLXBBX) decoction, a well-known Chinese herbal formula, has beneficial effects on eliminating angina pectoris symptoms and improving condition of stable angina pectoris (SAP) patients. However, whether this treatment is effective and safe for SAP or not, evidence supporting the effectiveness and safety of this treatment is still incomplete. Besides, there is lack of systematic review to assess the detailed situation (including risk of bias and methodology) of current related clinical studies. This study aimed to evaluate the effectiveness and safety of GLXBBX in treating SAP. Methods: The major databases (MEDLINE, Embase, the Cochrane Library, China National Knowledge Infrastructure (CNKI), Chinese Scientific Journals Database (VIP) Database, Chinese Biomedical Database (CBM), Chinese Biomedical Literature Service System (SinoMed), and Wanfang Database) were searched from inception to March 2019. Randomized controlled trials (RCTs) of GLXBBX alone or combined with conventional drugs against conventional drugs for SAP were identified. Two assessors reviewed each trial independently. The methodological quality of the eligible studies was evaluated according to the Cochrane Collaboration's tool for assessing risk of bias. Both the data extraction and the literature quality screening evaluation were conducted independently by 2 researchers. Result: Totally 17 clinical RCTs were included in this study, involving 1676 patients. Due to the high probability of bias of the included studies, it was inappropriate to undertake a meta-analysis. Thus, we only conducted a systematic review and mainly discussed the methodology and limitation of the included studies. Conclusion: Although the current evidence prompted that GLXBBX might benefit SAP patients in improvement of angina pectoris, ECG, and blood lipid on a certain extent, this systematic review revealed no definite conclusion about the application of GLXBBX for SAP due to the poor methodological quality, high risk of bias, and inadequate reporting on clinical data. More rigorous, multicenter, sufficient-sample, and double-blind randomized clinical trials are warranted.

Background: It's known that coronary heart disease (CHD) patients after percutaneous coronary intervention (PCI) was significantly associated with anxiety and depression symptoms. Several studies have showed that Xinkeshu tablet (XKS), a kind of Chinese herbal medicine, could effectively improve post-PCI postoperative mood disorders in CHD patients. However, the intensity of evidence has been poor, limiting the further clinical application of XKS to patients above. This systematic review and meta-analysis will assess the effectiveness and safety of studies of XKS in CHD patients with anxiety and depression symptoms after PCI.

Background Nearly half of the heart failure (HF) patients have been classified as HF with preserved left ventricular ejection fraction (HFpEF) and the prevalence has been increasing over time. The subject of this study is to assess the clinical effectiveness and safety of Baduanjin exercise (BDJE), as a kind of traditional Chinese exercises, for HFpEF patients. Methods A systematic literature search for articles up to September 2020 will be performed in following electronic databases: PubMed, Embase, the Cochrane Library, China National Knowledge Infrastructure (CNKI), Chinese Scientific Journals Database (VIP) Database, Chinese Biomedical Database (CBM), Chinese Biomedical Literature Service System (SinoMed) and Wanfang Database. Inclusion criteria are randomized controlled trials of BDJE applied on HFpEF patients. The primary outcome measures will be exercise capacity (cardiopulmonary exercise test or 6-minute walking test) and quality of life. The secondary outcomes will be as the following: blood pressure, heart rate, echocardiography, endothelial function, arterial stiffness and hypersensitive C-reactive protein and N-Terminal pro-B-type natriuretic peptide. The safety outcome measures will be adverse events, liver and kidney function. RevMan 5.3 software will be used for data synthesis, sensitivity analysis, subgroup analysis and risk of bias assessment. A funnel plot will be developed to evaluate reporting bias. Stata 12.0 will be used for meta-regression and Egger tests. We will use the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to assess the quality of evidence. Conclusion The study will give an explicit evidence to evaluate the effectiveness and safety of BDJE for HFpEF patients. Ethics and dissemination This systematic review does not require ethics approval and will be submitted to a peer-reviewed journal. Trial registration number PROSPERO CRD42020200324.

Objective : To assess the clinical efficacy and safety of Zhibitai, as a kind of natural lipid-lowering Chinese medicine, in treating coronary heart disease patients with hyperlipemia Methods : A systematic literature search for articles up to July 2020 will be performed in following electronic databases: PubMed, Embase, the Cochrane Library, China National Knowledge Infrastructure, Chinese Scientific Journals Database Database, Chinese Biomedical Database, Chinese Biomedical Literature Service System, and Wanfang Database. Inclusion criteria are randomized controlled trials of Zhibitai applied on coronary heart disease patients with hyperlipemia. The primary outcome measures will be serum lipid levels (including total cholesterol, triglyceride, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol) and acute cardiovascular events. The secondary outcome measures will be inflammatory factors (high sensitive C-reactive protein, interleukin-6, etc), safety index (liver function, renal function, etc), and adverse events. RevMan 5.3 software will be used for data synthesis, sensitivity analysis, meta-regression, subgroup analysis, and risk of bias assessment. A funnel plot will be developed to evaluate reporting bias and Egger tests will be used to assess funnel plot symmetries. We will use the grading of recommendations assessment, development, and evaluation system to assess the quality of evidence. Trial registration number PROSPERO CRD42018103341.

Background: Stable angina pectoris (SAP) is one of the most common symptoms of coronary heart disease. Chinese herbal medicine (CHM) has been used to treat SAP increasingly due to its less side effects. The subject of this study is to explore the effectiveness and safety of Gualou Xiebai Banxia (GLXBBX) decoction as a kind of CHM for SAP. Methods: A systematic literature search for articles up to June 2018 will be performed in following electronic databases: PubMed, Embase, the Cochrane Library, China National Knowledge Infrastructure, Chinese Scientific Journals Database, Chinese Biomedical Database, Chinese Biomedical Literature Service System (SinoMed), and Wanfang Database. Inclusion criteria are randomized controlled trials of modified GLXBBX decoction applied on patients with SAP. The primary outcome measures will be coronary heart disease-related clinical evaluation (frequency of acute attack angina, severity of angina pectoris, electrocardiographic changes, and amount of nitroglycerin) and adverse events. RevMan 5.3 software will be used for data synthesis, sensitivity analysis, metaregression, subgroup analysis, and risk of bias assessment. A funnel plot will be developed to evaluate reporting bias and Egger tests will be used to assess funnel plot symmetries. We will use the Grading of Recommendations Assessment, Development and Evaluation system to assess the quality of evidence. Results: This systematic review study will provide an evidence of GLXBBX decoction for SAP. Conclusion: The study will give an explicit evidence to evaluate the effectiveness and safety of GLXBBX decoction for SAP. Ethics and dissemination: This systematic review does not require ethics approval and will be submitted to a peer-reviewed journal. PROSPERO registration number: CRD 42018094538.

Rationale Occult breast cancer (OBC) is a rare type of breast cancer without any symptoms in the breast and is often presented with initial symptoms of axillary lymph node metastasis or other metastases. The low incidence rates of OBC make it a great challenge to diagnose and cure. Patient concerns Our case was a 58-year-old female affected by dizziness and fatigue for nearly a month. Blood tests revealed anemia and thrombocytopenia, and pathological results of a bone marrow biopsy confirmed the metastatic carcinoma. Diagnoses It was diagnosed as an OBC based on the positive immunohistochemical staining of cytokeratin (CK) and gross cystic disease fluid protein-15 (GCDFP-15). Interventions Doctor advised her to check whether the bone metastases existed in order to choose an appropriate treatment. It is highly regrettable that the patient gave up all treatments and left the hospital. Outcomes Recently, we conducted a telephone follow-up and received that the patient only took tramadol and other painkilling drugs to alleviate the pain caused by cancer. Lessons The current case inferred that symptoms of anemia and thrombocytopenia should not be ignored for the diagnosis of OBC, and bone marrow biopsy is useful in reducing the rates of misdiagnosis and missed diagnosis of OBC.