1.Mechanisms of Qiaobai cold compress solution in improving acne vulgaris based on transcriptomics and experiment
Zhenjiang XIE ; Weina ZHU ; Liangliang CAO ; Fuqiong ZHOU ; Shupan ZHANG ; Bingwen ZHOU ; Yinsheng CHEN ; Wen LI ; Ying ZHAO
China Pharmacy 2026;37(4):425-430
OBJECTIVE To investigate the mechanism by which Qiaobai cold compress solution (QBCS) improves acne vulgaris (AV) based on transcriptomics and animal experiments. METHODS Rats were randomly divided into a blank control group ( n =6) and a modeling group ( n =30). AV models were established in the modeling group by topical application of oleic acid to the inner surface of both ears, combined with subcutaneous injection of Cutibacterium acnes suspension into the auricle. Successfully modeled rats were further divided into the model group, positive control group (Tretinoin cream, 0.045 g/kg), and QBCS low-, medium-, high-dose groups [3.55, 7.11, 14.22 g/kg (calculated by the amount of crude drug) ] , with 6 rats in each group. Rats in each d rug group were treated with the corresponding drugs once daily for 14 consecutive days. After the final administration, changes in the appearance of the ears and histopathological changes in the ear tissues were observed, and serum levels of inflammatory factors, including tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and IL-1β, were measured. Auricular tissues from the blank control group, model group and QBCS medium-dose group were collected for transcriptome sequencing. Differential expressed genes (DEGs) were screened and subjected to Kyoto Encyclopedia of Genes and Genomes pathway enrichment analysis, followed by validation using real-time quantitative polymerase chain reaction and Western blot assay. RESULTS Compared with the model group, rats in all QBCS groups showed alleviated auricular acne symptoms, with reduced epidermal thickening, sebaceous gland hyperplasia, and inflammatory cell infiltration. Serum levels of TNF-α (except for the QBCS low-dose group), IL-6 (except for the QBCS low-dose group) and IL-1β were significantly decreased ( P <0.05). A total of 590 DEGs were identified (blank control group vs. model group), and 596 DEGs were identified (model group vs. QBCS medium-dose group). Above DEGs (blank control group vs. model group) were mainly enriched in Toll-like receptor (TLR) and nuclear factor-kappa B (NF-κB) signaling pathways, etc. Validation experiments showed that, compared with model group, low-, medium- and high-dose of QBCS reduced, to varying degrees, the mRNA expression of TNF-α, TLR2, interferon-γ and CXC chemokine ligand 8 in the auricular tissues of AV rats, increased the mRNA expression of peroxisome-proliferator-activated receptor gamma and tumor protein 53, and inhibited the phosphorylation of NF-κB p65 protein as well as the expressions of TLR2 and myeloid differentiation primary response protein 88(MyD88) ( P <0.05). CONCLUSIONS QBCS can alleviate auricular inflammation and skin lesions in AV rats. This effect may be related to inhibition of the TLR/MyD88/NF-κB signaling pathway, thereby suppressing the expression of downstream inflammatory factors such as TNF-α.
2.Volatile Component Differences in Xihuangwan Prepared with Natural and Artificial Musk Based on Non-targeted and Targeted Metabolomics
Jing WANG ; Fangzhu XU ; Li MENG ; Qizhen ZHU ; Huanjun ZHAO ; Caina YU ; Xuelian CHEN ; Hui GAO ; Zimin YUAN
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(8):194-201
ObjectiveHeadspace solid-phase microextraction-gas chromatography-mass spectrometry(HS-SPME-GC-MS) and GC-triple quadrupole MS(GC-QqQ-MS) in combination with non-targeted and targeted metabolomics were employed to systematically analyze the chemical composition differences of Xihuangwan prepared with natural musk and artificial musk, and establish an identification system for them. MethodsThe volatile components of 9 batches of Xihuangwan samples from 8 manufacturers were analyzed by HS-SPME-GC-MS non-targeted metabolomics, and identified by comparing their MS data with the National Institute of Standards and Technology(NIST) spectral library. Orthogonal partial least squares-discriminant analysis(OPLS-DA) was used to identify differential volatile components of Xihuangwan prepared with natural musk and artificial musk. Additionally, GC-QqQ-MS targeted metabolomics was applied to quantify the levels of α-pinene, β-elemene, muscone, dehydroepiandrosterone, bornyl acetate, and octyl acetate in 27 batches of samples from 9 manufacturers. Cluster analysis, principal component analysis(PCA), and partial least squares-discriminant analysis(PLS-DA) were conducted to further explore the differences in volatile components between Xihuangwan samples prepared with natural musk and artificial musk. ResultsNon-targeted metabolomics identified 291 volatile compounds in Xihuangwan, including alkanes, esters, alkanes, alcohols, ketones, naphthalenes and others. OPLS-DA analysis revealed distinct separation between Xihuangwan samples containing artificial musk(A1, C1, D1, E1, F1, G1, I1) and those containing natural musk(H1, H3). A total of 30 differential metabolites were identified. The relative contents of these 30 differential metabolites were visualized using a radar chart, revealing significant differences in the levels of octanol, borneol acetate and muscone. Cluster analysis and PCA results from targeted metabolomics indicated that Xihuangwan could be classified into two distinct groups:one composed of natural musk(H1, H3) and the other of artificial musk, sample H2. PLS-DA identified muscone, octyl acetate, and dehydroepiandrosterone as key differential volatile components. Although no significant difference was observed in the content of octyl acetate between the two groups, statistically significant differences were found for muscone and dehydroepiandrosterone(P<0.05). ConclusionMuscone and dehydroepiandrosterone can be used for the differentiation of Xihuangwan samples containing natural musk from those containing artificial musk. This study systematically and comprehensively analyzed the differences in the types and contents of major volatile components in Xihuangwan prepared with natural musk and artificial musk, providing a scientific basis for quality evaluation and control of Xihuangwan.
3.Volatile Component Differences in Xihuangwan Prepared with Natural and Artificial Musk Based on Non-targeted and Targeted Metabolomics
Jing WANG ; Fangzhu XU ; Li MENG ; Qizhen ZHU ; Huanjun ZHAO ; Caina YU ; Xuelian CHEN ; Hui GAO ; Zimin YUAN
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(8):194-201
ObjectiveHeadspace solid-phase microextraction-gas chromatography-mass spectrometry(HS-SPME-GC-MS) and GC-triple quadrupole MS(GC-QqQ-MS) in combination with non-targeted and targeted metabolomics were employed to systematically analyze the chemical composition differences of Xihuangwan prepared with natural musk and artificial musk, and establish an identification system for them. MethodsThe volatile components of 9 batches of Xihuangwan samples from 8 manufacturers were analyzed by HS-SPME-GC-MS non-targeted metabolomics, and identified by comparing their MS data with the National Institute of Standards and Technology(NIST) spectral library. Orthogonal partial least squares-discriminant analysis(OPLS-DA) was used to identify differential volatile components of Xihuangwan prepared with natural musk and artificial musk. Additionally, GC-QqQ-MS targeted metabolomics was applied to quantify the levels of α-pinene, β-elemene, muscone, dehydroepiandrosterone, bornyl acetate, and octyl acetate in 27 batches of samples from 9 manufacturers. Cluster analysis, principal component analysis(PCA), and partial least squares-discriminant analysis(PLS-DA) were conducted to further explore the differences in volatile components between Xihuangwan samples prepared with natural musk and artificial musk. ResultsNon-targeted metabolomics identified 291 volatile compounds in Xihuangwan, including alkanes, esters, alkanes, alcohols, ketones, naphthalenes and others. OPLS-DA analysis revealed distinct separation between Xihuangwan samples containing artificial musk(A1, C1, D1, E1, F1, G1, I1) and those containing natural musk(H1, H3). A total of 30 differential metabolites were identified. The relative contents of these 30 differential metabolites were visualized using a radar chart, revealing significant differences in the levels of octanol, borneol acetate and muscone. Cluster analysis and PCA results from targeted metabolomics indicated that Xihuangwan could be classified into two distinct groups:one composed of natural musk(H1, H3) and the other of artificial musk, sample H2. PLS-DA identified muscone, octyl acetate, and dehydroepiandrosterone as key differential volatile components. Although no significant difference was observed in the content of octyl acetate between the two groups, statistically significant differences were found for muscone and dehydroepiandrosterone(P<0.05). ConclusionMuscone and dehydroepiandrosterone can be used for the differentiation of Xihuangwan samples containing natural musk from those containing artificial musk. This study systematically and comprehensively analyzed the differences in the types and contents of major volatile components in Xihuangwan prepared with natural musk and artificial musk, providing a scientific basis for quality evaluation and control of Xihuangwan.
4.Effects and mechanisms of combined exposure to noise and microwave on hippocampal structure and function in mice
Chunxue LU ; Lei SHI ; Yue WANG ; Yanhui HAO ; Xuelong ZHAO ; Yang LI ; Hongyan ZUO ; Liqian ZHU
Journal of Environmental and Occupational Medicine 2026;43(4):419-426
Background Co-exposure to noise and microwave radiation occurs frequently. The central nervous system has been identified as a sensitive target organ for both noise and microwave exposure individually, and the underlying mechanisms remain poorly understood. The specific biological effects resulting from co-exposure to these two factors have yet to be fully elucidated. Objective To clarify the effects of co-exposure to noise and microwave on neurobehavior and hippocampal tissue structure, and to explore the underlying mechanism through the assessment of serum cytokines. Methods C57BL/6N mice were selected and randomly assigned to a blank control group, a noise group, a microwave group, and a combined noise & microwave exposure group. To establish the exposure models, the noise group was subjected to broadband noise at 100 dB for 2 h, while the microwave group received radiation at a central frequency of 9.375 GHz with an average power density of 12 mW·cm−2 and a specific absorption rate of 2.58 W·kg−1 for 15 min. Open field and tail suspension tests assessed anxiety-like emotional behaviour; novel object recognition and Y-maze tests evaluated cognitive function. Histological changes in hippocampal tissue were examined using haematoxylin and eosin (HE) staining, and Nissl staining under light microscopy. Serum cytokine levels were measured using radioimmunoassay and enzyme-linked immunosorbent assay (ELISA). Results After 3 d of exposure, the noise, microwave, and combined exposure groups showed significant reductions in exploration frequency, duration, and distance within the central zone of the open field test compared to the control group (P < 0.01); the combined exposure group exhibited increased ratios of peripheral-to-central exploration time and distance (P < 0.05). After 7 d of exposure, compared with the control group, the noise group maintained a decrease in central zone exploration time (P < 0.01), while the combined exposure group showed persistent decline across all central zone metrics (P < 0.05) and elevated peripheral-to-central ratios (P < 0.05); compared to the microwave group, the combined exposure group showed significant less time in the central zone (P < 0.05) and higher peripheral-to-central ratios (P < 0.05). Regarding behaviour and cognition, compared with the control group, the combined exposure group showed increased immobility time in the tail suspension test after 3 d of exposure (P < 0.01). At this interval, all exposure groups demonstrated reduced frequency and duration of novel object recognition (P < 0.05), with the combined exposure group showing a marked decrease in novel arm exploration time (P < 0.01). After 7 d of exposure, compared with the control group, the noise group showed reduced novel object recognition frequency (P < 0.05), and both the noise and microwave groups exhibited decreased novel arm exploration time (P < 0.05). Pathological alterations including an increased number of hyperchromatic nuclei and depleted Nissl bodies were observed in the CA3 and DG regions across all exposure groups with the most severe lesions observed in the combined exposure group. Serum levels of central nervous system-specific protein β (S-100β), glial fibrillary acidic protein (GFAP), and corticosterone (CORT) were significantly elevated in all exposure groups compared with the control group (P < 0.05). Aquaporin-4 (AQP4) levels increased in the combined exposure group (P < 0.05), while CXC chemokine ligand 10 (CXCL10) levels rose in both the noise and combined groups compared with the control group (P < 0.05). Specifically, S-100β and CXCL10 levels in the combined exposure group were higher than those in the microwave group (P < 0.05); moreover, levels of S-100β, GFAP, CORT, AQP4, and CXCL10 in the combined exposure group were significantly higher than those in the noise group (P < 0.05). Conclusion Combined exposure to noise and microwave radiation induces pathological changes in the hippocampus of mice, increases levels of serum stress hormones and neuro-specific biomarkers. These impairments are more severe than those observed following single-factor exposure. The underlaying mechanism may be related to systemic stress response, neuronal damage, astrocyte activation, and changes in blood-brain barrier permeability, leading to emotional behavioral abnormalities and cognitive decline.
5.The Structure and Function of The YopJ Family Effectors in The Bacterial Type III Secretion System
Ao-Ning LI ; Wen-Bo LI ; Yu-Ying LU ; Min-Hui ZHU ; Yu-Long QIN ; Yong ZHAO ; Zhao-Huan ZHANG
Progress in Biochemistry and Biophysics 2026;53(3):516-533
The Type III Secretion System (T3SS) serves as a pivotal virulence apparatus for numerous Gram-negative bacterial pathogens, enabling them to infect both animal and plant hosts. Functioning as a molecular syringe, the T3SS directly translocates bacterial effector proteins from the bacterial cytoplasm into the interior of eukaryotic host cells. These effectors are central weapons that precisely manipulate a wide spectrum of host cellular physiological processes, ranging from cytoskeletal dynamics to immune signaling, to establish a favorable niche for bacterial survival and proliferation. Among the diverse arsenal of T3SS effectors, the YopJ family constitutes a critical group of virulence factors. Members of this family are characterized by a conserved catalytic triad structure—a hallmark of the CE clan of cysteine proteases that has been evolutionarily repurposed to confer acetyltransferase activity. A defining and intriguing feature of these enzymes is their stringent dependence on a host-derived eukaryotic cofactor, inositol hexakisphosphate (IP6), for allosteric activation. This requirement acts as a sophisticated molecular safeguard, ensuring enzymatic activity only within the appropriate host environment, thereby preventing detrimental effects on the bacterium itself. While seminal studies on individual members such as Yersinia’s YopJ and Salmonella’s AvrA have provided deep mechanistic insights, a systematic and integrative understanding of the structure-function relationships across the entire family remains fragmented. Key questions persist regarding how a conserved catalytic core has diverged to recognize distinct host substrates in different kingdoms of life. To address this gap, this article provides a systematic review of the YopJ family, focusing on three interconnected aspects: their structural features, their catalytic mechanism, and their divergent immunosuppressive strategies in animal versus plant hosts. By conducting a comparative analysis of the sequences and resolved three-dimensional structures of three representative members (e.g., HopZ1a, PopP2, AvrA), we elucidate regions of significant variation embedded within the conserved core catalytic architecture. These variable regions, often involving surface loops and substrate-binding interfaces, are crucial determinants of target specificity and functional specialization. The functional divergence of this effector family is most apparent when comparing their modes of action in different hosts. In animal hosts, YopJ-family effectors primarily sabotage innate immune signaling pathways. They achieve this by acetylating key serine and threonine residues within the activation loops of critical kinases in the MAPK and NF‑κB pathways. This post-translational modification blocks the phosphorylation and subsequent activation of these kinases, leading to potent suppression of inflammatory cytokine production. Conversely, in plant hosts, the strategy broadens to dismantle the two-tiered plant immune system. YopJ homologs target a more diverse set of substrates, including immune-associated receptor-like cytoplasmic kinases (RLCKs), microtubule networks via tubulin acetylation (which disrupts cellular trafficking and signaling), and transcription factors central to defense gene regulation. This multi-target approach effectively suppresses both Pattern-Triggered Immunity (PTI) and Effector-Triggered Immunity (ETI). In conclusion, this synthesis aims to deepen the mechanistic understanding of YopJ family-mediated pathogenesis by integrating structural biology with cellular function across host kingdoms. Elucidating the precise molecular basis for substrate selection—how conserved platforms achieve target diversity—is a major frontier. Furthermore, this knowledge provides a vital theoretical foundation for developing novel anti-virulence strategies. Targeting the conserved IP6-binding pocket or the catalytic acetyltransferase activity itself represents a promising avenue for designing broad-spectrum inhibitors that could disarm this critical family of bacterial effectors, potentially offering new therapeutic approaches against a range of pathogenic bacteria.
6.Study on the effects and mechanisms of Lycium ruthenicum Murr. in improving sleep
Ming QIAO ; Yao ZHAO ; Yi ZHU ; Yexia CAO ; Limei WEN ; Yuehong GONG ; Xiang LI ; Juanchen WANG ; Tao WANG ; Jianhua YANG ; Junping HU
China Pharmacy 2026;37(1):24-29
OBJECTIVE To investigate the effects and mechanisms of Lycium ruthenicum Murr. in improving sleep. METHODS Network pharmacology was employed to identify the active components of L. ruthenicum and their associated disease targets, followed by enrichment analysis. A caffeine‑induced zebrafish model of sleep deprivation was established , and the zebrafish were treated with L. ruthenicum Murr. extract (LRME) at concentrations of 0.1, 0.2 and 0.4 mg/mL, respectively; 24 h later, behavioral changes of zebrafish and pathological alterations in brain neurons were subsequently observed. The levels of inflammatory factors [interleukin-6 (IL-6), IL-1β, IL-10, tumor necrosis factor-α (TNF-α)], oxidative stress markers [superoxide dismutase (SOD), malondialdehyde (MDA), glutathione peroxidase (GSH-Px), catalase (CAT)], and neurotransmitters [5- hydroxytryptamine (5-HT), γ-aminobutyric acid (GABA), glutamic acid (Glu), dopamine (DA), and norepinephrine (NE)] were measured. The protein expression levels of protein kinase B1 (AKT1), phosphorylated AKT1 (p-AKT1), epidermal growth factor receptor (EGFR), B-cell lymphoma 2 (Bcl-2), sarcoma proto-oncogene,non-receptor tyrosine kinase (SRC), and heat shock protein 90α family class A member 1 (HSP90AA1) in the zebrafish were also determined. RESULTS A total of 12 active components and 176 intersecting disease targets were identified through network pharmacology analysis. Among these, apigenin, naringenin and others were recognized as core active compounds, while AKT1, EGFR and others served as key targets; EGFR tyrosine kinase inhibitor resistance signaling pathway was identified as the critical pathway. The sleep improvement rates in zebrafish of LRME low-, medium-, and high-dose groups were 54.60%, 69.03% and 77.97%, 开发。E-mail:hjp_yft@163.com respectively, while the inhibition ratios of locomotor distance were 0.57, 0.83 and 0.95, respectively. Compared with the model group, the number of resting counts, resting time and resting distance were significantly increased/extended in LRME medium- and high-dose groups (P<0.05). Neuronal damage in the brain was alleviated. Additionally, the levels of IL-6, IL-1β, TNF-α, MDA, Glu, DA and NE, as well as the protein expression levels of AKT1, p-AKT1, EGFR, SRC and HSP90AA1, were markedly reduced (P<0.05), while the levels of IL-10, SOD, GSH-Px, CAT, 5-HT and GABA, as well as Bcl-2 protein expression, were significantly elevated (P<0.05). CONCLUSIONS L. ruthenicum Murr. demonstrates sleep-improving effects, and its specific mechanism may be related to the regulation of inflammatory responses, oxidative stress, neurotransmitter balance, and the EGFR tyrosine kinase inhibitor resistance signaling pathway.
7.Treatment Principles and Paradigm of Diabetic Microvascular Complications Responding Specifically to Traditional Chinese Medicine
Anzhu WANG ; Xing HANG ; Lili ZHANG ; Xiaorong ZHU ; Dantao PENG ; Ying FAN ; Min ZHANG ; Wenliang LYU ; Guoliang ZHANG ; Xiai WU ; Jia MI ; Jiaxing TIAN ; Wei ZHANG ; Han WANG ; Yuan XU ; .LI PINGPING ; Zhenyu WANG ; Ying ZHANG ; Dongmei SUN ; Yi HE ; Mei MO ; Xiaoxiao ZHANG ; Linhua ZHAO
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(5):272-279
To explore the advantages of traditional Chinese medicine (TCM) and integrative TCM-Western medicine approaches in the treatment of diabetic microvascular complications (DMC), refine key pathophysiological insights and treatment principles, and promote academic innovation and strategic research planning in the prevention and treatment of DMC. The 38th session of the Expert Salon on Diseases Responding Specifically to Traditional Chinese Medicine, hosted by the China Association of Chinese Medicine, was held in Beijing, 2024. Experts in TCM, Western medicine, and interdisciplinary fields convened to conduct a systematic discussion on the pathogenesis, diagnostic and treatment challenges, and mechanism research related to DMC, ultimately forming a consensus on key directions. Four major research recommendations were proposed. The first is addressing clinical bottlenecks in the prevention and control of DMC by optimizing TCM-based evidence evaluation systems. The second is refining TCM core pathogenesis across DMC stages and establishing corresponding "disease-pattern-time" framework. The third is innovating mechanism research strategies to facilitate a shift from holistic regulation to targeted intervention in TCM. The fourth is advancing interdisciplinary collaboration to enhance the role of TCM in new drug development, research prioritization, and guideline formulation. TCM and integrative approaches offer distinct advantages in managing DMC. With a focus on the diseases responding specifically to TCM, strengthening evidence-based support and mechanism interpretation and promoting the integration of clinical care and research innovation will provide strong momentum for the modernization of TCM and the advancement of national health strategies.
8.Survival analysis in hepatitis C cases aged ≥18 years in Yuxi City from 2005 to 2023
Yang LUO ; Shifu LI ; Wenbin DONG ; Jinxian ZHAO ; Ze LI ; Yongfen ZHU ; Liyue CHEN ; Ying CAI ; Xiaochun LIU ; Rusong YANG
Chinese Journal of Preventive Medicine 2025;59(8):1217-1223
To analyze all-cause mortality among hepatitis C cases aged ≥18 years in Yuxi City from 2005 to 2023 and explore the interactions of factors influencing survival time. Baseline and follow-up data for hepatitis C cases reported during this period were extracted from the Chinese National Notifiable Disease Reporting System. Survival time and related factors were assessed using the Cox proportional hazards model. Kaplan-Meier cumulative mortality risk curves were generated for treated and untreated hepatitis C cases, and interactions among subgroups of various influencing factors were examined. A total of 5 110 hepatitis C cases aged ≥18 years were reported from 2005 to 2023, encompassing 35 349.25 person-years of observation with the follow-up time duration M ( Q1, Q3) was 6.17 (2.33, 11.08) person-years. There were 763 all-cause deaths, corresponding to a mortality density of 2.16 per 100 person-years. Survival analysis showed a statistically significant difference in cumulative mortality between the treated and untreated groups (Log-rank χ2=122.033, P<0.001), with a lower risk of death observed among treated patients. Additive model analysis showed that there was a synergistic interaction between treatment status and age group, with relative excess of interaction, attributable proportions of interaction, and synergy index of 6.16 (95 %CI: 2.70-9.61), 1.83 (95 %CI: 1.46-2.30), and 0.42 (95 %CI: 0.31-0.53), respectively; and between treatment status and gender. There was a synergistic interaction between treatment status and sex, with relative excess of interaction, attributable proportions of interaction, and synergy index of 2.63 (95 %CI: 1.14-4.13), 1.56 (95 %CI: 1.19-2.06), and 0.32 (95 %CI: 0.17-0.46), respectively. The cause of death composition were 38.53% (249 cases) attributed to hepatitis C-related causes.The leading non-hepatitis C-related causes of death were cardiovascular and cerebrovascular diseases, pulmonary diseases, malignancies, drug overdose, and injuries. In conclusion, hepatitis C cases ≥18 years of age in Yuxi City had a lower cumulative mortality rate when treated than when untreated. Treatment status interacted with age and gender on patient survival, respectively. Changes in patients with concomitant cardiovascular diseases, pulmonary diseases and malignancies should be focused.
9.Evaluation of serum cotinine cut-off value for distinguishing smoking status among Chinese adults
Changming DING ; Jin YIN ; Feng ZHAO ; Yawei LI ; Ying ZHU ; Yuebin LYU ; Xiaoming SHI
Chinese Journal of Preventive Medicine 2025;59(7):1063-1068
Objective:To determine the optimal cut-off value of serum cotinine for distinguishing smoking status among Chinese adults based on a large-scale national sample.Methods:A cross-sectional study was conducted among 8 987 Chinese adults aged 20-79 years from 152 administrative counties across 31 provinces during 2017-2018. Sociodemographic characteristics, lifestyle, smoking status, and health status were collected via questionnaires and physical examinations. Blood samples were analyzed for serum cotinine levels using liquid chromatography-mass spectrometry and for blood creatinine levels using the picric acid method. Receiver operating characteristic (ROC) curve analysis was performed with serum cotinine concentration as the test variable and self-reported smoking status as the state variable. The optimal cut-off value was determined based on the maximum Youden′s index, and the bootstrap method was used for repeated sampling (2 000 times) to evaluate the confidence interval of the cut-off value. The net reclassification index (NRI) was used to evaluate the discrimination ability of the cut-off value of this study, the cut-off value of the American population 1 (total population: 3.3 μg/L, men: 4.1 μg/L, women: 3.0 μg/L) and the cut-off value of the American population 2 (the recommended value of the United States Centers for Disease Control and Prevention for the total population: 10.0 μg/L) against the smoking status of the Chinese population. Statistical analyses were conducted using IBM SPSS 27 and Python 3.11, with a significance level of α=0.05.Results:The age of the research subjects was (49.2±15.2) years. Among them, males accounted for 49.8% (4 477); smokers accounted for 28.8% (2 586); the detection rate of serum cotinine was 94.6% (8 501), and the M ( Q1, Q3) concentration of serum cotinine was 0.9 (0.3, 85.4) μg/L. The ROC curve analysis results showed that the cut-off value (95% CI) of serum cotinine in the total population was 8.8 (6.7-11.7) μg/L, with the specificity (95% CI) about 93.6%(92.7%-94.3%), the sensitivity (95% CI) about 91.0%(89.7%-92.3%) and the area under the curve (AUC) (95% CI) about 0.93 (0.92-0.94). The cut-off value (95% CI) of cotinine for males was 17.1 (8.8-21.8) μg/L, with the specificity (95% CI) about 90.7%(87.9%-92.0%), the sensitivity (95% CI) about 89.4%(88.4%-92.2%) and the AUC (95% CI) about 0.92 (0.91-0.93). The cut-off value (95% CI) of cotinine for females was 7.4 (3.3-15.0) μg/L, with the specificity (95% CI) about 95.6%(92.7%-96.8%), the sensitivity (95% CI) about 87.6%(81.6%-92.8%) and the AUC (95% CI) about 0.92 (0.87-0.95). The NRI analysis results showed that compared with the cut-off value of the American population 2, the NRI of this study′s cut-off values in the total population, males and females were 0.020 ( P=0.015), 0.033 ( P=0.015) and 0.011 ( P=0.380), respectively, indicating that this study′s cutoff value could have better classification performance in the total population and males. Compared with the cut-off value of the American population 2, the NRI of the total population in this study was 0.001 ( P=0.285). Conclusion:The serum cotinine cut-off value based on the analysis of large sample data in China is more suitable for distinguishing the smoking status of Chinese adults.
10.Analysis of ultrasound as an adjunctive diagnostic tool for eosinophilic fasciitis
Jinshui YANG ; Hong ZHANG ; Min LI ; Fei SUN ; Bo ZHOU ; Qianqian ZHAO ; Yuehua WAN ; Jian ZHU ; Jianglin ZHANG
Chinese Journal of Internal Medicine 2025;64(4):333-338
Objective:This study investigates the utility of ultrasound in diagnosing eosinophilic fasciitis (EF).Methods:A retrospective analysis was conducted on the clinical and ultrasound data of 109 EF patients seen at the center between January 1, 2006, and March 31, 2024. The diagnostic efficacy of ultrasound for EF was evaluated by comparing forearm fascia ultrasound findings among EF patients, systemic sclerosis (SSc) patients, and healthy controls (HC).Results:Among the 109 EF patients (male-to-female ratio 2.2︰1), the median age of onset was 36 (29, 48) years, with a median disease duration of 7 (3, 12) months. The study also included 20 SSc patients [median age 49 (35, 61) years] and 20 HC individuals [median age 48 (29, 54) years]. Ultrasound assessments of forearm fascia in EF patients revealed a median fascial thickness of 1.9 (1.4, 2.4) mm. The median fascial thickness was 0.8 (0.7, 0.9) mm in SSc patients and 0.7 (0.5, 0.9) mm in HC individuals. Fascial thickness in EF patients was greater than in SSc ( Z=-11.16, P<0.001) and HC groups ( Z=-11.87, P<0.001). There was a correlation between fascia thickness and C-reactive protein ( r=0.148, P=0.004), erythrocyte sedimentation rate ( r=0.143, P=0.005), and immunoglobulin G ( r=0.120, P=0.020) in EF patients. Receiver operating characteristic (ROC) curve analysis demonstrated a sensitivity of 84.0% and specificity of 95.9% for EF diagnosis, with an area under the curve (AUC) of 0.921 and a cut-off value of 1.005 mm. Conclusion:Ultrasound detection of forearm fascial thickening (>1 mm) aids in diagnosing eosinophilic fasciitis, indicating that ultrasound is a supplementary diagnostic tool for EF.

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