Background: Knee osteoarthritis (KOA), also known as degenerative osteoarthritis, is a common and frequently occurring disease in orthopedics with cartilage degeneration as the pathogenic cause and articular bone hyperplasia as the sign. Many studies have confirmed that KOA can be effectively treated by traditional Chinese medicine (TCM) external treatment. So we take advantage of the method of network meta-analysis to systematically compare the efficacy and safety of different types of TCM external treatment for the KOA. Methods: We will research on external treatment of KOA by traditional Chinese medicine using randomized controlled trials (RCTs) in search database (EMBASE, PubMed, Web of Science, Chinese National Knowledge Infrastructure [CNKI], Weipu database [VIP], Wanfang, and China BioMedical Literature [CBM]). The data and evidence obtained will be processed using Stata 15.0 and WinBUGS 1.4.3. Results: We will evaluate the efficacy and safety of traditional Chinese medicine external treatment for the knee osteoarthritis in this study. Conclusion: This study will provide a new regimen for KOA treatment. It has extremely high reference value. INPLASY registration number: INPLASY2020120001. DOI number : 10.37766/inplasy2020.12.0001.

Background: Knee osteoarthritis (KOA) is a leading cause of chronic pain and disability, and as such, it poses a significant economic burden. Traditional Chinese medicine (TCM), as well as complementary and alternative medicine, can offer safe and effective treatments for KOA. Cangxitongbi (CXTB) capsule is a Chinese patented medicine for KOA treatment and has a remarkable curative effect. This article evaluated the effects and mechanisms of CXTB in protecting joint cartilage in vivo.Methods: The KOA model was constructed in rats using the modified Hulth method. CXTB (35 mg/kg) was administered intragastrically for 4 weeks. Hematoxylin and eosin (HE) staining of the knee articular were performed to evaluate the efficiency of CXTB. Western blot analysis, quantitative polymerase chain reaction (qPCR), and enzyme-linked immunosorbent assay (ELISA) were used to investigate the protective mechanisms of CXTB in joint cartilage.Results: CXTB effectively improved the morphological structure of the cartilage and bone in the knee joint by enhancing autophagy and regulating the expression of related protease and inflammatory factors. Furthermore, CXTB downregulated the expression of the long non-coding RNA (lncRNA) Hox transcript antisense intergenic RNA (HOTAIR) and inhibited the activation of the p38MAPK pathway. Conversely, overexpression of lncRNA HOTAIR suppressed the protective effects of CXTB on the knee joint.Conclusions: CXTB capsules can protect the knee articular cartilage in rats through the lncRNA HOTAIR/p38MAPK pathway.

Background: It is well known that morning blood pressure surge increases the risk of myocardial events in the first several hours post-awakening. This meta-analysis was performed to compare the antihypertensive efficacy of morning and bedtime dosing on decreasing morning blood pressure surge. Methods: Articles in 4 databases about clinical trials of ingestion time of antihypertensive drugs were searched and performed a meta-analysis to evaluate the different effects on morning blood pressure and absolute blood pressure (BP) reduction from baseline of between bedtime administration (experimental group) and morning awaking administration (control group). Results: The aim of this study is to compare the antihypertensive efficacy of morning and bedtime dosing on decreasing morning blood pressure surge. Conclusions: The bedtime will provide evidence support for clinicians and patients for reducing morning blood pressure surge. Ethics and dissemination: This study does not require ethical approval.

Background: Knee osteoarthritis (KOA) is a disease with a high incidence in elderly patients and traditional Chinese medicine has a significant effect on the treatment of KOA. Cangxitongbi capsule (CXTB) is a traditional Chinese medicine for KOA treatment and has a remarkable curative effect. The purpose of this article is to investigate the mechanism of CXTB in protecting joint cartilage on KOA rats.Methods: A total of 30 male Sprague-Dawley rats were randomly assigned into five groups: control group; model group; low-, mid-, and high-dose CXTB groups (17.5, 35, and 70 mg/mL). KOA models were made by modified Hulth method except the control group. After pharmacological administration for 4 weeks, knee articular cartilages were observed by hematoxylin and eosin (HE) staining and evaluated by Mankin score. Western blot and reverse transcription-polymerase chain reaction (RT-PCR) were used to detect the concentration of ADAMTS-5. The peripheral blood of the rats was collected to detect content of interleukin-1 beta (IL-1β) and tumor necrosis factor-alpha (TNF-α) by enzyme-linked immunosorbent assay (ELISA). Results:The morphological structure of cartilage in the 3 CXTB groups was significantly improved compared with the model group, and the improvement positively correlated with the drug dosage (P<0.05).Compared with the model group, the expression levels of ADAMTS-5 of the 3 CXTB groups was obviously decreased (P<0.05). Furthermore, the upstream targets of ADAMTS-5, including IL-1β and TNF-α were down-regulated in the 3 CXTB groups (P<0.05).Conclusions: Knee joint cartilage on KOA model rats is protected by CXTB via down-regulation of ADAMTS-5. The upstream targets of ADAMTS-5, IL-1β and TNF-α, were also down-regulated by CXTB.

Aim of the Study. The present study was designed to interpret the immunoregulatory effect of Bushen Hemai (BSHM) granules to improve renal damage in ageing spontaneously hypertensive rats (SHRs). We focused on regulation of the Th17 cell/Treg balance and explored the targets of BSHM granules. Methods. Blood pressure and urine biochemical indices were recorded. Renal blood flow was evaluated by renal ultrasonography. Transmission electron microscopy (TEM) and HE staining were used to assess kidney and spleen morphology. Renal fibrosis was assessed using Masson staining. Serum levels of IL-6, IL-10, and IL-17A were measured using ELISAs. The density of RORγ and Foxp3 in the spleen was observed by immunofluorescence staining. The levels of Th17 cells and Tregs in blood were detected via flow cytometry. Transcriptome sequencing was performed to screen the targets of BSHM granules in hypertensive kidneys. Results. BSHM granules decreased SBP by 21.2 mm·Hg and DBP by 8.8 mm·Hg in ageing SHRs ( P < 0.05 ), decreased the levels of urine mALB, β2-Mg, and NAG ( P < 0.01 ), and improved renal blood flow and arteriosclerosis. BSHM granules increased IL-10 expression ( P < 0.05 ) while decreasing IL-6 ( P < 0.01 ) and IL-17A ( P < 0.05 ) levels. BSHM granules improved Foxp3 density and the number of Tregs ( P < 0.01 ) and reduced RORγt density and the number of Th17 cells ( P < 0.01 ). Transcriptome sequencing identified 747 differentially expressed (DE) mRNAs in kidneys after BSHM treatment. GO analysis suggested that BSHM granules act through immunoregulation. Conclusions. BSHM granules attenuated hypertensive renal damage in ageing SHRs, by significantly increasing Tregs and decreasing Th17 cells.