Background. Ginkgo biloba leaf preparations (GLPs) are widely used in ischemic stroke, and uncertainty remains regarding their clinical efficacy. To evaluate systematically the clinical efficacy and safety of GLPs in the treatment of ischemic stroke, we examine evidence from randomized controlled trials (RCTs). Methods. We examine studies published prior to November 2021 that were found from searching the following sources: PubMed, China National Knowledge Infrastructure (CNKI), WANFANG DATA, Chongqing VIP (CQVIP) databases, and Chinese Biomedical Literature (CBM). We evaluated the quality of the included references according to the Cochrane Manual of Systematic Evaluation and Meta-analysis (MA) performed using RevMan 5.2 software. Results. We included a total of 13 RCTs with clinical therapeutic effects, the National Institute of Health Stroke Scale (NIHSS), Barthel Index (BI), hemorheology index, and adverse reaction index as evaluation criteria. There were 631 cases in the observation group and 629 cases in the control group. MA results showed the following: NIHSS WMD = −3.89, 95% CI: [−4.22, −3.56], I² = 19%, < 0.00001. This index is often used with nerve injury and can also be used to judge the recovery of nerve function. A lower score means less nerve damage and a better chance of recovery. The BI results were WMD = 11.30, 95% CI: [9.83, 12.77], I² = 7%, < 0.00001. This index was used to assess patients’ ability to take care of themselves, with a higher score indicating a stronger ability to live independently. Clinical effective rate results were WMD = 3.79, 95% CI: [2.49, 5.78], I² = 0%, < 0.00001, and this measure can be used to evaluate the effect of treatment clearly and objectively. Hemorheological index results show that plasma viscosity has WMD = −0.16, 95% CI: [−0.20, −0.12], I² = 40%, < 0.00001 and fibrinogen (FIB) has WMD = −1.13, 95% CI: [−1.23, −1.04], I² = 0%, < 0.00001. Plasma viscosity is mainly related to the amount of fibrinogen, and fibrinogen degradation is an important function of the fibrinolytic system. The imbalance of the fibrinolytic system plays an important role in the pathogenesis of cerebral infarction. Fibrinogen is a risk factor of ischemic cerebrovascular disease. Studies have shown that the infarct size of patients with secondary cerebral infarction after CEREBRAL infarction is correlated with their FIB level. In addition, FIB elevation is also one of the risk factors for early infarction after thrombolysis. Therefore, FIB can be used as a detection index for the prevention of cerebral infarction recurrence adverse reactions. Our MA results for FIB show WMD = 0.81, 95% CI: [0.38, 1.73], I² = 0%, = 0.58, and RR < 1. Conclusion. The existing clinical evidence shows that GLP has a good therapeutic effect on patients with ischemic stroke and can improve their hemorheology indices. In addition, GLP is shown to be relatively safe.

Background: Unlike chemical drugs with a single or a few kinds of active compounds, traditional Chinese medicines (TCMs)uses herbal formulas composed of numerous kinds of chemical constituents. Therefore, TCM clinical trials require unique and stricter standards for collecting, preserving, and transporting fecal samples than those used for chemical drugs. Unfortunately, there are no special standards for processing fecal samples in TCM clinical trials.Methods: We invited interdisciplinary experts within TCM clinical trials and gut microbiome research to help formulate this standard. After more than a year’s in-depth discussion and amendments, we achieved a standard via expert interviews, literature research, questionnaire surveys, and public opinion solicitation. This standard has been reviewed and approved by the Standards Office of China of the Association of Chinese medicine.Results: We established a sample information processing method prior to TCM clinical sample collection, which is adapted to the unique features of TCM. The method formulates detailed processing requirements for TCM information in addition to the factors that may disturb the gut microbiome. We also constructed a set of methods for collecting, preserving, and transporting fecal samples that meet the characteristics of TCM. These methods formulate detailed operating specifications on the collection approaches, storage conditions, transportation requirements, and management of fecal samples.Conclusions: This standard guides the information processing prior to sample collection and the standard operating procedures for the collection, preservation, and transportation of fecal samples in TCM clinical trials, which also can be used as a reference by clinicians and researchers in modern medicines.

Context: The gut microbiota plays a significant role in metformin efficacy and therapeutic response. However, studies often have produced inconsistent outcomes. Objective: To gain a more comprehensive understanding of the transformation of gut microbiota in persons with diabetes and the subsequent modifications following metformin intervention. Data Sources: Seven databases were searched, from the inception of each database up to October 30, 2024. The raw sequence reads of 9 available datasets were downloaded from the National Center for Biotechnology Information (NCBI). Study Selection: The process of selecting and assessing papers for this study was meticulously managed by 2 authors, working independently to screen and evaluate each publication. Data Extraction: For the data extraction phase, a standardized form was employed, capturing critical details. Data Synthesis: Metformin significantly boosts the presence of Akkermansia and short-chain fatty acid (SCFA)-producing bacteria, such as Pseudobutyrivibrio, Oribacterium, and Anaerotruncus, and it simultaneously diminishes pathogenic bacteria, including Enterobacillus, Gemmobacter, Shinella, Klebsiella, and Enterocloster. In addition, Bifidobacterium and Blautia were increased in patients with type 2 diabetes (T2D) but restored to near normal levels by metformin, and this alteration is region-specific. Conclusion: Our analysis delivers more concrete evidence regarding the shifts in gut microbiota following metformin treatment, significantly enriching our understanding of the interplay between gut microbiome dynamics and the management of T2D.

Background: Traditional Chinese patent medicines (TCPMs) have been widely used to treat carotid atherosclerotic plaque (CAP) in China. However, systematic evaluation of the clinical efficacy of TCPMs for CAP is still unknown, and the comparative efficacy of different TCPMs is unclear. Objectives: This study aims to compare and rank the effectiveness and safety of different TCPMs in treating CAP using a Bayesian network meta− analysis (NMA). Methods: This NMA was performed according to the Preferred Reporting Items for Systematic Reviews and Meta− Analyses (PRISMA) Extension Statement. Eight databases were searched from their inception to August 2023 for randomized controlled trials (RCTs). The articles regarding eligibility and extracted data were screened independently by two authors. The Cochrane Risk of Bias tool was used to evaluate quality and bias. The change of carotid artery intimal− medial thickness (IMT), carotid maximal plaque area, carotid atherosclerotic plaque Course score, serum lipid levels, CRP, and adverse events rate (AER) were used as outcomes. Data from each RCTs were first pooled using random− effect pairwise meta− analyses and illustrated as odds ratios (ORs) or standardized mean differences (SMDs) with 95% confidence interval (CI). NMAs were performed using Stata17.0 software and the GeMTC package of R software to evaluate the comparative effectiveness of TCPMs, and displayed as ORs or SMDs with 95% CI. A Bayesian hierarchical random− effects model was used to conduct NMAs using the Markov Chain Monte Carlo algorithm. The GRADE partially contextualised framework was applied for NMA result interpretation. Results: NMA included 27 RCT trials with 4131 patients and nine types of TCPMs. Pairwise meta− analyses indicated that Conventional Western medicine (CWM) + TCPM was superior to CWM in reducing the IMT (SMD: − 1.26; 95% CI − 1.59 to − 0.93), the carotid maximal plaque area (SMD − 1.27; 95% CI − 1.71, − 0.82) and the carotid atherosclerotic plaque Course score (SMD − 0.72; 95% CI 95% CI − 1.20, − 0.25). NMAs demonstrated that CWM + Jiangzhiling pill (JZL) with SUCRA 70.6% exhibited the highest effective intervention for reducing IMT. CWM + SXBX (Shexiang baoxin pill) was superior to other TCPMs in reducing the carotid maximal plaque area (83.0%), the atherosclerotic plaque Course score (92.5%), TC (95.6%) and LDL (92.6%) levels. CWM + NXT (Naoxintong capsule), CWM + XS (Xiaoshuang granules/enteric capsule), and CWM + ZBT (Zhibitai) were superior to other CPMs in improving TG (90.1%), HDL (86.1%), and CRP (92.6%), respectively. No serious adverse events were reported. Conclusions: For CAP patients, CWM + XSBX was among the most effective in reducing carotid maximal plaque area, atherosclerotic plaque Course score, TC and LDL levels, and CWM + JZL was the most effective in reducing IMT. Overall, CWM + XSBX may be considered an effective intervention for the treatment of CAP. This study provides reference and evidence for the clinical optimization of TCPM selection in CAP treatment. More adequately powered, well− designed clinical trials to increase the quality of the available evidence are still needed in the future due to several limitations.

Introduction: Berberine, a natural alkaloid from plants of the genus Coptis, shows significant lipid-lowering effects clinically. However, its exact mechanism in lipid metabolism is not fully understood. Sigma-1 receptor probes offer advantages such as strong in vivo applicability, non-invasiveness, high quantitative accuracy, and real-time visualization, which can enhance pharmacological research when combined with experimental validation. Objective: This study investigates the mechanism by which berberine improves lipid metabolism in ApoE−/− mice using Sigma-1 receptor probes. Methods: ApoE−/− hyperlipidemic mice were used as the model. Berberine treatment effects on lipid profiles were measured. Hepatic lipid metabolism was evaluated with Oil Red O staining. Sigma-1 receptor expression in mouse tissues was analyzed using [ ¹⁸ F]FBFP probe, Western blot, and related technology. Results: After 6 weeks of treatment, berberine significantly reduced serum total cholesterol and low-density lipoprotein cholesterol levels, ameliorated hepatic lipid deposition, and upregulated the expression of hepatic Sigma-1 receptor in hyperlipidemic ApoE−/− mice. Conclusion: Berberine effectively improved dyslipidemia and hepatic lipid deposition in hyperlipidemic mice, which may be related to the modulation of hepatic Sigma-1 receptor expression, though the precise mechanism requires further validation.

Introduction: Spleen-strengthening and phlegm-resolving (SSPR) herbal therapy, a classical core approach in traditional Chinese medicine (TCM) has been widely applied to treat residual dizziness (RD) after canalith repositioning procedures for benign paroxysmal positional vertigo. This systematic review aims to comprehensively evaluate its clinical efficacy and safety. Methods: We searched eight electronic databases for randomized controlled trials (RCTs) investigating SSPR therapy for RD from database inception to 5 May 2026. The quality of methodology was evaluated by the Cochrane Risk of Bias tool (ROB 2.0). Meta-analysis was conducted using RevMan 5.4 and Stata 18.0. Results: Thirty-seven RCTs (2,794 participants) were included. Compared with standard of care (SOC) alone, SSPR therapy significantly reduced dizziness handicap inventory (DHI) scores [MD = −9.24, 95% CI: (−10.98, −7.50), p < 0.00001], visual analogue scale (VAS) scores [MD = −1.32, 95% CI: (−1.71, −0.93), p < 0.00001], and TCM syndrome scores [SMD = −1.84, 95% CI: (−2.49, −1.20), p < 0.00001], while achieving higher dizziness resolution rate and clinical effective rate. Furthermore, SSPR therapy plus SOC combination compared with SOC, yielded greater reductions in DHI scores [MD = −9.33, 95% CI: (−11.45, −7.21), p < 0.00001], VAS scores [MD = −1.39, 95% CI: (−2.20, −0.58), p = 0.0008], TCM syndrome scores [SMD = −1.39, 95% CI: (−1.97, −0.81), p < 0.00001], and recurrence rate, while elevating dizziness resolution rate and clinical effective rate. No severe adverse events were reported in the studies that reported safety outcomes. Conclusion: SSPR therapy appears effective in improving RD symptoms and may reduce recurrence rates. However, its safety remains uncertain due to incomplete reporting of adverse events across the included studies. Given the limitations of the included studies, high-quality, large-sample RCTs are still required for rigorous verification. Systematic Review Registration: http://www.crd.york.ac.uk/PROSPERO/ , identifier CRD420251024692.