Background: In recent years, diabetic foot has become a significant cause of disability and mortality among individuals with diabetes. With the progression of time and technology, both modern medicine and traditional Chinese medicine have gradually deepened their understanding and research into diabetic foot, further enhancing the treatment methods available for this condition. To a certain extent, this can alleviate patients' pain and improve their quality of life.

Objective: To explore the mechanism of Simiao Yong’an Decoction (SYD) in the treatment of diabetic foot (DF).

Methods: Databases and software such as TCMSP, GeneCards, OMIM, and TTD were used to identify the pharmacodynamic material basis, therapeutic targets, and metabolic pathways of SYD in the treatment of DF. The serum metabolomics of SYD was integrated with network pharmacology to validate the potential active components and metabolic pathways involved in SYD’s intervention in DF.

Results: The main active components of SYD in treating DF were found to be luteolin, quercetin, and formononetin. The treatment may act through targets such as AKT1, TNF, HSP90AA1, MAPK8, and STAT3, regulating pathways including the MAPK signaling pathway, TNF signaling pathway, phosphatidylinositol signaling pathway, HIF-1 signaling pathway, and Toll-like receptor signaling pathway. The phosphatidylinositol signaling pathway was consistent with the findings from serum metabolomics analysis of SYD.

Conclusion: The phosphatidylinositol signaling pathway may be a key metabolic pathway in the intervention of DF by SYD.

Immune-mediated inflammatory diseases (IMIDs) commonly affect women of reproductive age, and concerns regarding the impact of therapeutic drugs on pregnancy outcomes, fetal development, and infant health complicate medication decision-making during pregnancy and lactation. This article reviews the latest practice guidelines and clinical studies, analyzing the impact of IMIDs disease activity on pregnancy outcomes from the perspective of immune balance. It also explains drug exposure to biologics during pregnancy based on placental transport mechanisms and maternal physiological changes. We summarize recent advances and safety data regarding the use of biologics in pregnant and lactating IMIDs patients, compare and analyze guideline recommendations for the use of different biologics during pregnancy and lactation, and propose optimal suggestions regarding the timing of drug discontinuation during pregnancy and neonatal vaccination strategies. Multidisciplinary collaboration is believed to provide effective and safe therapeutic strategies for IMIDs patients in the peri-pregnancy period to safeguard maternal and infant health.

Prediabetes is a condition where blood glucose levels have deviated from the normal range but have not yet reached the diagnostic criteria for diabetes. It represents a transitional phase between health and diabetes. Currently, there are no global guidelines for managing prediabetes. However, the use of metformin in prediabetes is largely based on clinical experience, and there is a lack of high-quality evidence-based medicine. There are uncertainties regarding its dosage and unknown adverse reactions, and its exact efficacy and safety still require further study. This article systematically reviews the current state of metformin in the treatment of prediabetic, analyzing differences in efficacy across different dosages, the guideline recommendations, clinical application experiences, potential adverse effects and irrational drug use. We aim to provide scientific basis and clinical practice guidance for the rational use of metformin in the management of prediabetes.

Background: Potentially inappropriate medications (PIMs) and omissions of medicines among older adults are increasingly popular with the aging population in China.

Objective: PIMs and omissions of medicines among older adults in the community were assessed via three distinct evaluation criteria, thus providing a basis for standardizing medication management in the elderly.

Methods: From April 2021 to June 2021, older adults in the 12 communities were selected from streets or villages in Wuhan, Yichang, Qianjiang and Zhijiang City of Hubei Province (3 streets/villages from each city by cluster sampling). PIMs and omissions of medicines among older adults were evaluated by the 2023 American Geriatrics Society (AGS) Beers Criteria, the 2014 STOPP (Screening Tool of Older Persons' Prescriptions)/START (Screening Tool to Alert to Right Treatment) Criteria, and the 2017 Chinese PIM Criteria for Older Adults.

Results: A total of 1011 eligible older adults in the community were enrolled, including 420 (43.08 %) male and 591 (57.92 %) female patients. Significant differences were detected in the number of medications across subgroups based on the sex, age, and chronic diseases (P < 0.05). Evaluated by the 2023 AGS Beers Criteria, there were 294 (29.08 %) cases of PIMs. A total of 189 (18.69 %) cases of PIMs and 229 omissions of medicines were identified by the 2014 STOPP/START Criteria. Using the 2017 Chinese PIM Criteria for Older Adults, 296 (29.28 %) cases of PIMs were screened out. Nifedipine immediate release (IR), and nifedipine were the most frequently detected drugs of PIMs by the 2023 AGS Beers Criteria, and the 2017 Chinese PIM Criteria for Older Adults, respectively. Evaluated by the 2014 STOPP/START Criteria, non-steroidal anti-inflammatory drugs (NSAIDs) were the leading type of PIMs, and type 2 diabetes mellitus (T2DM) patients without metformin treatment was the top one item of omitted medicine.

Conclusion: PIMs and omissions of medicines among older adults in the community in Hubei Province should be highly concerned, which can be effectively identified via a combination of three evaluation criteria.

Background: Heart failure (HF) bears a heavy disease burden, and vericiguat is the only guanylate cyclase stimulator proved to improve its prognosis. However, its clinical use needs a further improvement.

Objective: To evaluate the quality of the guidelines for vericiguat treatment of heart failure with reduced ejection fraction (HFrEF) using the Appraisal of Guidelines for Research & Evaluation Ⅱ (AGREE Ⅱ) instrument, thus providing references for clinical decision-making.

Methods: Clinical guidelines for vericiguat treatment of HFrEF published before 31st March, 2024 were systematically searched in online databases, including the CNKI, Wanfang, VIP, SinoMed, Cochrane Library, Pubmed, and Embase. Eligible articles were screened out by two investigators independently. Quality of the guidelines for vericiguat treatment of HFrEF was evaluated by four investigators from different professional groups using the AGREE Ⅱ instrument.

Results: A total of seven guidelines for vericiguat treatment of HFrEF were enrolled for quality evaluation. Among them, the 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure graded the highest score, followed by the 2021 CCS/CHFS Heart Failure Guidelines Update, and the 2021 ESC Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure. The Chinese Guidelines for the Diagnosis and Treatment of Heart Failure 2023 graded in a moderate level. Significant differences were observed in scores of the stakeholder involvement, rigor of development, and editorial independence. Generally, guidelines for vericiguat treatment of HFrEF shared similar contents, with a moderate quality of evidence. Except for the Chinese Guidelines for the Diagnosis and Treatment of Heart Failure 2023, and the Korean Society of Heart Failure Guidelines for the Management of Heart Failure 2023 evaluated with a stronger recommendation, the remaining guidelines for vericiguat treatment of HFrEF were equipped with a weaker recommendation.

Conclusion: Referring to guidelines with higher quality, vericiguat is an option for HFrEF patients with a short-term aggravation. Existing recommodations for vericiguat treatment of HFrEF are formulated highly dependent on the findings from the VICTORIA trial, leading to potential biases. More clinical trials are needed for validating the efficacy and safety of vericiguat in treating HFrEF.