Background: In recent years, systematic reviews/meta-analyses (SRs/MAs) of Chinese herbal medicine (CHM) for psoriasis have continuously emerged. Their methods and evidence quality, however, are yet to be evaluated, and whether their conclusions can provide clinicians with reliable evidence is still debatable.Objectives: This overview aims to evaluate the methodological quality, risk of bias, and reporting quality of relevant SRs/MAs, as well as the current evidence of CHM for treating psoriasis.Methods: We searched nine electronic databases from their respective time of establishment to January 20, 2021, as well as the reference lists of the included SRs/MAs, protocol registries, and gray literature. Two reviewers independently used the following: A Measurement Tool to Assess Systematic Reviews (AMSTAR) 2, Risk of Bias in Systematic Reviews (ROBIS), the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA), and Grades of Recommendations, Assessment, Development and Evaluation (GRADE) to evaluate the methodological quality, risk of bias, reporting quality, and evidence quality of the included SRs/MAs.Results: This review included 14 SRs/MAs involving 45 outcomes, of which 12 (85.71%) SRs/MAs had a very low quality evaluated by AMSTAR 2 and 7 (50.00%) SRs/MAs had a high risk of bias assessed by ROBIS. The protocol and registration and funding statements were the major reporting flaws according to the PRISMA checklist. The evaluation with the GRADE system demonstrated no outcome of high-quality evidence, and inconsistent efficacy evaluations were found in this overview. Only 15 (33.33%) outcomes were moderate-quality evidence, supporting the claim that CHM plus Western medicine (WM) was superior to WM. Generally low quality of evidence showed no difference in the incidence of adverse events between the combined therapy and WM. However, the conclusion that CHM was superior to WM cannot be drawn due to the inconsistent results.Conclusion: Despite that CHM has the potential benefit and safety in the adjuvant treatment of psoriasis, the conclusion should be treated with caution because of the generally low quality of methodology and evidence. In the future, high-quality randomized controlled trials (RCTs) should be carried out, and the quality of relevant SRs should also be improved to promote their clinical application.

Biological targeted therapy serves as a new alternative treatment for psoriasis due to its minimal side effects. This study is aimed at examining the drug effectiveness and safety of risankizumab and ustekinumab for psoriasis treatment, so as to provide a reference for clinical decision-making. Databases from Embase, Web of Science, PubMed, and Cochrane Library were gathered, starting from inception to March 1, 2022, for randomized controlled trials regarding risankizumab and ustekinumab for psoriasis treatment. All retrieved articles were carefully selected in strict accordance with a set of inclusion and exclusion criteria. Stata 15.0 and RevMan 5.4 were applied to perform meta-analysis and risk of bias assessment. A total of two trials with three NCTs were selected, with 384 participants in the risankizumab group and 140 participants in ustekinumab. Meta-analysis showed that in the long-term and short-term PASI100, risankizumab was more effective than ustekinumab ( RR = 2.27 , 95% CI (1.77, 2.90), p < 0.05 ; RR = 2.33 , 95% CI (1.75, 3.08), p < 0.05 ). In PASI90, RR = 1.77 , 95% CI (1.54, 2.03), and p < 0.05 and RR = 1.72 , 95% CI (1.48, 2.00), and p < 0.05 . In short-term PASI75, RR = 1.23 , 95% CI (1.13, 1.34), and p < 0.05 . In sPGA of 0, the results at week-16 and week-52 showed that risankizumab was significantly more effective than ustekinumab ( RR = 2.24 , 95% CI (1.67, 3.01), p < 0.05 ; RR = 2.30 , 95% CI (1.80, 2.95), p < 0.05 ). Risankizumab was significantly more effective than ustekinumab in improving the quality of life and PSS scores ( RR = 1.48 , 95% CI (1.26, 1.75), p < 0.05 ; RR = 2.01 , 95% CI (1.41, 2.85), p < 0.05 ). Nevertheless, risankizumab and ustekinumab did not show significant difference in the incidence of adverse responses ( RR = 1.02 , 95% CI (0.75, 1.39), p > 0.05 ). Risankizumab was more effective than ustekinumab for the treatment of psoriasis. The adverse reactions of both risankizumab and ustekinumab were similar and could be tolerated. Risankizumab might be a better alternative option for their treatment.

Background: The pathogenesis of chronic spontaneous urticaria (CSU) is not clear, but its occurrence is closely related to the immune state of the body, that is, the balance of T cell subsets. Previous studies have confirmed that the dynamic imbalance of Th1/Th2 cells in CD4+T cell subsets of T cell subsets is closely related to the pathogenesis of CSU, but there are few studies on the relationship between the dynamic imbalance of Th17/Treg cells in CD4+T cell subsets and the pathogenesis of CSU. The purpose of this study is to evaluate the relationship between Th17/Treg cells expression in peripheral blood and CSU, so as to provide a reference basis for the pathogenesis of CSU. Methods: PubMed, Embase, CENTRAL, Web of Science, China Biology Medicine Database, China National Knowledge Database, Wan Fang Database, and Chongqing VIP Database will be searched to collect case-control studies and cohort studies evaluating the relationship between Th17/Treg cells expression in peripheral blood and CSU. The search time limits will be from the establishment of the database to December 2020. The meta-analysis will be carried out with the RevMan V.5.3 statistical software. The quality of all included studies will be evaluated by the Newcastle-Ottawa scale. Results: The results of this study will comprehensively evaluate the Th17/Treg cells expression levels in peripheral blood of patients with CSU, and provide a reference basis for the pathogenesis of CSU. Conclusion: The findings of this study may provide new evidence for the relationship between Th17/Treg cells balance in peripheral blood and CSU. OSF registration number: DOI 10.17605/OSF.IO/S8MYW

Background: Psoriasis is a chronic recurrent dermatological disease that patents always suffer from different comorbidities. Chinese herbal medicine (CHM) has been commonly used in the treatment of psoriasis for a long history. Previous systematic reviews (SRs)/meta-analyses (MAs) have shown that CHM may benefit patients with psoriasis. This overview aims to summarize the evidence from published SRs/MAs for clinical application and to provide several directions for future researches. Methods: Nine electronic databases (Medline, Embase, Cochrane Library, AMED, CINAHL, CBM, CNKI, VIP Database, Wanfang Databases) will be searched from their inceptions to September 2020 without language restrictions. At least 2 reviewers will independently conduct the study selection, data extraction, and quality assessment. The methodological quality, risk of bias, reporting quality, and evidence quality will be respectively evaluated by the Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR 2), the Risk of Bias in Systematic Reviews, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. Results: The results of this overview will be submitted to a peer-reviewed journal for publication. Conclusions: We expect to compile current evidence from published SRs/MAs of CHM for patients with psoriasis in an accessible and useful document. Ethics and dissemination: This study is a protocol for an overview of SRs/MAs that did not involve individual data. Thus, ethical approval is not required. OSF Registration number: DOI 10.17605/OSF.IO/VC654

Rationale:Spontaneous coronary artery dissection is a highly unusual cause of acute coronary disease. It is a result of a hematoma formation within the outer third of the tunica media,with subsequent expansion leading to compression of the true lumen and resultant myocardial ischemia.Patient concerns:We present a case of a middle-aged woman presenting with chest pain with acute anterior myocardial infarction, who did not reveal any of the cardiovascular risk factors. Finally,when pressed further about her past history, the patient revealed she had been taking oral contraceptives for the past 2 years.Diagnoses:The diagnosis is usually confirmed by coronary angiography, but it has some limitations. If necessary, intravascular ultrasound (IVUS) may help in further examinations to reduce the incidence of erroneous diagnosis or missed diagnosis.Interventions:There is no guiding suggestion for the treatment of SCAD. The main treatment methods are 3 aspects: conservative internal medical treatment, stent implantation, coronary artery bypass grafting. The treatment strategy depends mainly on the patienst’ clinical symptoms, the hemodynamic state, and the position and quantity of the dissection. In this case,we used stent implantation treatment originally and then we resorted to medical treatment.Outcomes:After careful review and analysis, coronary arteriography results was able to prove the existence of the spiral shaped dissection. We then resorted to medical treatment and her symptoms were gradually relieved.Lessons:SCAD should be suspected in young to middle-aged women with chest pain symptoms, particularly during the perinatal period or for subjects who use oral contraceptives. Doctors should be able to obtain a detailed past history and analyze coronary angiography results carefully.