1.Effect of Yangjing Tongluo Prescription on Oxidative Damage of Endometrium in Rats with Intrauterine Adhesion Based on Keap1/Nrf2/HO-1 Signaling Pathway
Jiaying CHEN ; Jing ZENG ; Zhaoling YOU ; Yonglian WANG ; Muya LIU ; Fang ZHOU ; Li TANG ; Sainan TIAN
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(4):100-108
ObjectiveTo explore the mechanisms of Yangjing Tongluo prescription (YJTL) in the treatment of intrauterine adhesion (IUA) from the perspective of oxidative stress mediated by the Kelch-like ECH-associated protein 1/nuclear factor erythroid 2-related factor 2/heme oxygenase-1 (Keap1/Nrf2/HO-1) signaling pathway. MethodsA total of 48 rats with normal estrous cycles were selected and randomly divided into a normal group (n=8) and a modeling group (n=40). An IUA rat model was established using a dual-injury method combining surgical curettage and infection. Eight rats were randomly selected from the modeling group for a pilot experiment to confirm successful model establishment. After successful modeling, the remaining 32 rats were randomly divided into a model group, a low-dose YJTL group (YJTL-L), a high-dose YJTL group (YJTL-H), and a Progynova group. Rats in the normal and model groups were administered purified water (15 mL·kg-1) by gavage daily, while rats in the YJTL-L, YJTL-H, and Progynova groups received YJTL at doses of 6.43 and 12.86 g·kg-1 and Progynova at 2.06 × 10-4 g·kg-1, respectively, for 14 consecutive days. The general condition, uterine morphology, and uterine index of the rats were monitored. Histopathological changes in uterine tissue were observed using hematoxylin-eosin (HE) staining. Serum levels of reactive oxygen species (ROS) and glutathione peroxidase (GSH-Px) were measured by enzyme-linked immunosorbent assay (ELISA). Protein expression levels of Keap1, Nrf2, and HO-1 in endometrial tissue were detected by Western blot. Immunofluorescence (IF) was used to assess the distribution of Nrf2 and HO-1, as well as the expression of Nrf2 in the cytoplasm and nucleus. ResultsCompared with the normal group, rats in the model group exhibited poor mental status and reduced mobility, markedly edematous and tortuous uterine morphology, decreased gland number, and inflammatory reactions in the endometrium, along with an increased uterine organ index (P<0.05). Serum ROS levels were significantly increased (P<0.05), while serum GSH-Px levels were significantly decreased (P<0.05). In endometrial tissue, Keap1 protein expression was increased (P<0.05), whereas Nrf2 and HO-1 protein expression was decreased. Mild nuclear translocation of Nrf2 was observed, accompanied by increased relative fluorescence intensity of nuclear Nrf2 and decreased relative fluorescence intensity of cytoplasmic HO-1. Compared with the model group, all treatment groups showed varying degrees of improvement in the above symptoms and pathological changes. Serum ROS levels were reduced (P<0.05), serum GSH-Px levels were increased (P<0.05), Keap1 protein expression in endometrial tissue was decreased, and Nrf2 and HO-1 protein expression was increased in a dose-dependent manner (P<0.05). Notably, significant nuclear translocation of Nrf2 was observed, with correspondingly increased relative fluorescence intensity of nuclear Nrf2 and enhanced relative fluorescence intensity of cytoplasmic HO-1. ConclusionYJTL may enhance antioxidant capacity and repair oxidative damage to the endometrial basal layer by regulating the Keap1/Nrf2/HO-1 signaling pathway.
2.Mechanisms of Jiangtang No. 3 Prescription in Alleviating Adipose Tissue Insulin Resistance in Diabetic Rats via TLR4/NF-κB/NLRP3 Signaling Pathway-mediated Inflammation
Tongxun WANG ; Lantian LIU ; Runqi LI ; Haoxiang LI ; Yi ZHAO ; Tian TIAN ; Rufeng MA ; Sihua GAO ; Dandan ZHAO
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(4):109-117
ObjectiveTo observe the effects of Jiangtang No. 3 prescription on inflammatory pathways and insulin resistance-related indicators in rats with type 2 diabetes mellitus (T2DM), and to elucidate its molecular mechanism in combating diabetes. MethodsA T2DM rat model was established using a high-fat diet combined with intraperitoneal injection of streptozotocin (STZ). Successfully modeled rats were randomly assigned to the model group, metformin group, and low-, medium-, and high-dose Jiangtang No. 3 prescription groups, and a normal group was also set. Daily gavage was administered for 8 weeks as follows: metformin at 0.1 g·kg-1·d-1, Jiangtang No. 3 prescription granules at 1.62, 3.24, 6.48 g·kg-1·d-1 for the respective dose groups, and sterile water for the normal and model groups. Rat body weight, fasting blood glucose (FBG), oral glucose tolerance test (OGTT), and insulin tolerance test (ITT) were measured. After drug intervention, enzyme-linked immunosorbent assay (ELISA) was used to determine serum levels of total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL), high-density lipoprotein cholesterol (HDL), non-esterified fatty acids (NEFA), interleukin (IL)-1β, IL-18, and insulin (INS). Hematoxylin-eosin (HE) staining was used to observe morphological changes in adipose tissue. Real-time quantitative PCR was used to detect the mRNA expression of Toll-like receptor 4 (TLR4), nuclear factor-κB (NF-κB), NOD-like receptor protein 3 (NLRP3), Caspase-1, IL-1β, IL-18, and gasdermin D (GSDMD) in adipose tissue. Western blot was used to measure the corresponding protein expression levels. ResultsCompared with the model group, Jiangtang No. 3 prescription groups exhibited significantly increased body weight (P<0.05, P<0.01), significantly reduced FBG (P<0.05, P<0.01), significant reductions in TC, TG, NEFA, and LDL (P<0.05, P<0.01), and a significant increase in HDL (P<0.01). Serum levels of inflammatory mediators IL-1β and IL-18 were significantly decreased (P<0.01), the homeostatic model assessment of insulin resistance (HOMA-IR) index was significantly reduced (P<0.05, P<0.01), and adipose tissue pathology was improved. The protein expression levels of TLR4, NF-κB, NLRP3, Caspase-1, IL-1β, IL-18, and GSDMD were markedly decreased (P<0.05, P<0.01), and the mRNA expression levels of these indicators were also significantly downregulated (P<0.05, P<0.01). Some effects were superior to those of the positive control drug metformin, and certain indicators exhibited dose-dependent improvements. ConclusionT2DM rats display significant inflammatory responses, disordered glucose and lipid metabolism, and insulin resistance. Jiangtang No. 3 prescription effectively suppresses inflammatory mediators, improves glucose and lipid metabolism and insulin resistance, and ameliorates pathological changes in adipose tissue. Its mechanism may be related to the regulation of the TLR4/NF-κB/NLRP3 signaling pathway in visceral adipose tissue, thereby influencing downstream inflammatory mediators.
3.Luotong Xianrong Yin Inhibits Pulmonary Injury in Idiopathic Pulmonary Fibrosis Rats by Regulating STAT3/HIF-1α-mediated Glycolysis
Dongna LI ; Hao WANG ; Chaoyi FANG ; Jiepeng WANG
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(4):118-125
ObjectiveTo investigate the characteristics and potential mechanisms of Luotong Xianrong Yin (LTXRY) in improving lung injury in rats with idiopathic pulmonary fibrosis (IPF) by regulating glycolysis. MethodsForty specific pathogen-free (SPF) Sprague-Dawley (SD) rats were randomly divided into a sham-operated group (10 mL·kg-1), model group (10 mL·kg-1), LTXRY group (15.18 g·kg-1), and nintedanib group (0.1 g·kg-1), with 10 rats in each group. The IPF rat model was established by intratracheal instillation of bleomycin. After 28 days of gavage intervention, pulmonary function was assessed. Lung pathological changes were observed by hematoxylin-eosin (HE) and Masson staining. Enzyme-linked immunosorbent assay (ELISA) was used to determine the levels of inflammatory factors, including tumor necrosis factor-α (TNF-α), interleukin (IL)-1β, and IL-6, in lung tissue. Chemiluminescence assays were employed to detect lactate content and lactate dehydrogenase activity in lung tissue. Western blot was used to measure the protein expression of transforming growth factor-β1 (TGF-β1), CollagenⅠ and CollagenⅢ to evaluate collagen deposition, as well as hexokinase 2 (HK2), pyruvate kinase M2 (PKM2), and 6-phosphofructo-2-kinase/fructose-2,6-bisphosphatase 3 (PFKFB3) to assess glycolysis levels. Network pharmacology was applied to analyze the potential targets and signaling pathways of LTXRY in IPF, and molecular docking was conducted to evaluate the binding energy between active components and potential targets. Western blot was further used to detect the expression of target- and pathway-related proteins. ResultsCompared with the sham-operated group, rats in the model group showed significantly increased main airway resistance (Rn) and respiratory system resistance (Rrs), and significantly decreased respiratory system compliance (Crs). Inflammatory infiltration and collagen deposition were observed in lung tissue, with significantly increased levels of TNF-α, IL-1β, and IL-6, as well as elevated protein expression of TGF-β1, CollagenⅠ and CollagenⅢ. Lactate content, lactate dehydrogenase activity, and the protein expression of HK2, PKM2, and PFKFB3 in lung tissue were significantly increased. Network pharmacology analysis indicated that signal transducer and activator of transcription 3 (STAT3) was a key target of LTXRY in IPF, and hypoxia-inducible factor-1 (HIF-1) was a critical signaling pathway. The expression levels of phosphorylated STAT3 (p-STAT3) and HIF-1α in lung tissue were significantly higher than those in the sham-operated group. Compared with the model group, rats in the LTXRY group showed significantly decreased Rn and Rrs and significantly increased Crs. Lung inflammatory infiltration and collagen deposition were markedly alleviated, with significantly reduced levels of TNF-α, IL-1β, and IL-6, and decreased protein expression of TGF-β1, CollagenⅠ and CollagenⅢ. Lactate content, lactate dehydrogenase activity, and the protein expression of HK2, PKM2, and PFKFB3 were significantly decreased, accompanied by markedly reduced expression of p-STAT3 and HIF-1α. ConclusionLTXRY alleviates lung tissue injury in IPF rats by regulating glycolysis mediated by the STAT3/HIF-1α signaling pathway.
4.Variations of Chemical Components in Gardeniae Fructus Before and After Being Charred Analyzed by UPLC-Q-Orbitrap MS/MS
Lan LI ; Jie HONG ; Yanan SONG ; Yilan LI ; Yun WANG ; Cun ZHANG
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(4):175-182
ObjectiveTo investigate the changes in chemical components of Gardeniae Fructus(GF) before and after being charred, providing data support for research on the material basis of GF Carbonisata(GFC). MethodsUltra-performance liquid chromatography-quadrupole-electrostatic field orbitrap high-resolution mass spectrometry(UPLC-Q-Orbitrap MS/MS) was used to conduct a comprehensive analysis of the chemical components in GF and GFC under positive and negative ion modes with Compound Discoverer 3.3 software and online database. Then, principal component analysis and partial least squares-discriminant analysis in SIMCA14.1 software were used to analyze the MS data of each sample. Based on the principle of variable importance in the projection(VIP) value>1, differential secondary and primary metabolites before and after carbonization were screened. In addition, MetaboAnalyst website was used for pathway enrichment of Kyoto Encyclopedia of Genes and Genomes(KEGG), so as to provide a reference for clarifying the processing mechanism. ResultsA total of 185 components were identified, including 96 secondary metabolites and 89 primary metabolites. These components were classified into nine categories, primarily including iridoid glycosides, flavonoids, and terpenoids, their fragmentation pathways were also analyzed. Simultaneously, multivariate statistical analysis was performed on the secondary and primary metabolites, identifying 70 and 59 differential metabolites, respectively. The secondary metabolites were enriched in two metabolic pathways, including C5-branched dibasic acid metabolism and flavonoid and flavonol biosynthesis, while the primary differential metabolites were enriched in seven pathways such as linoleic acid metabolism and tyrosine metabolism. ConclusionThe chemical components of GF change significantly after carbonization, with a significant decrease in the contents of iridoid glycosides and terpenoids such as hydroxyisogeniposide, crocin Ⅱ, crocetin, and jasminoside B. while the contents of 4-hydroxycoumarin, geniposidic acid, gentiopicroside, and gardenoside methyl ester increase significantly. This change is presumed to be associated with the enhanced cooling and hemostatic effects of the processed products. The identified key components provide a basis for elucidating the material basis underlying the efficacy changes before and after carbonization.
5.Ancient and Modern Documentation of Classic Formula Sangjuyin
Xiaofang WANG ; Lyuyuan LIANG ; Jialei CAO ; Ziming XU ; Wangju ZHOU ; Yiping WANG ; Yujie CHANG ; Ruiting SU ; Yihan LI ; Jingwen LI ; Bingqi WEI ; Bingxiang MA ; Wenli SHI
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(4):200-207
Sangjuyin, as a pungent and cooling agent with precise therapeutic effect, is a classic pungent formula for cooling relief of the epidermis, which is highly respected by medical practitioners. This formula is from the Wenbing Tiaobian written by WU Jutong in the Qing dynasty, on the basis of which subsequent medical practitioners have made additions and subtractions to apply it. The authors used the bibliometric method to systematically organize the medical books from the Qing dynasty and the Republic of China and modern literature to analyze the composition, concoction, decoction, efficacy, and previous and modern application of Sangjuyin. After examination, the drug base of this formula is basically clear. Armeniacae Semen Amarum is the dried mature seeds of Armeniaca vulgaris, family Rosaceae. Forsythiae Fructus is the dried fruit of Forsythia suspensa, family Mulleinaceae. Menthae Haplocalycis Herba is the dried above-ground part of Mentha haplocalyx, family Labiatae. Mori Folium is the dried leaves of Morus alba, family Moraceae. Chrysanthemi Flos is the dried head of Chrysanthemum morifolium, family Asteraceae. Platycodonis Radix is the dried root of Eryngium grandiflorum, family Eryngium. Glycyrrhizae Radix et Rhizoma is the dried root and rhizome of Glycyrrhiza uralensis of the Leguminosae family, and Phragmitis Rhizoma is the fresh or dried rhizome of Phragmites communis of the Gramineae family. It is recommended that the eight drugs be used in raw form as medicine. The dosage and method of decoction were converted into a modern single dosage of 7.46 g Armeniacae Semen Amarum, 5.60 g Forsythiae Fructus, 2.98 g Menthae Haplocalycis Herba, 9.33 g Mori Folium, 3.73 g Chrysanthemi Flos, 7.46 g Platycodonis Radix, 2.98 g Glycyrrhizae Radix et Rhizoma, and 11.19 g Phragmitis Rhizoma, with 400 mL water added, and the solution was boiled to obtain 200 mL, taken twice a day. Sangjuyin has the efficacy of dispersing wind and clearing heat, promoting lung and relieving cough, and it is used for treating the initial onset of wind-warmth and the evidence of evil spirits in the lungs and collaterals. Modern research has shown that Sangjuyin is often used in the treatment of cough, pneumonia, rhinitis, and other respiratory diseases, and the results of this study provide a reference for the later development of Sangjuyin.
6.Herbal Textual Research on Cynanchi Atrati Radix et Rhizoma in Famous Classical Formulas
Xiaoqi JING ; Minna GUO ; Haihua WANG ; Juan LI ; Fusheng ZHANG ; Zhilai ZHAN
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(4):208-216
This article systematically reviews and verifies the name, origin, production area, quality evaluation, harvesting, processing and other aspects of Cynanchi Atrati Radix et Rhizoma(CARR) by consulting relevant ancient and modern literature, in order to provide a basis for the development and utilization of famous classical formulas containing this herb. Through textual research, Baiwei has been the official name for CARR, though it also bears alternative names such as Chuncao, Popo Zhenxianbao, Longdan Baiwei. The mainstream base is the roots and rhizomes of Cynanchum atratum. Historical records indicate primary producing areas include Shandong, Anhui, Jiangsu, Shaanxi and Shanxi. Since the late Ming dynasty, varieties from Juxian, Yishui and Rizhao in Shandong have been highly regarded as authentic, commonly known as eastern Baiwei. Since modern times, its quality has been summarized as fine, slender, and straight fibrous roots, pale yellow exterior, whiter interior, and dryness with easy breakability are considered superior. The harvesting time before the Song dynasty was on the third day of the third lunar month, but after the Song dynasty, harvesting was possible in both spring and autumn. The initial processing methods of CARR in ancient times included drying in the shade, removing Lu(the little rhizomes which are on tap of roots), and removing mustaches, modern methods involve washing and sun-drying. During the Northern and Southern dynasties, processing methods included steaming. In the Song dynasty, drying and light stir-frying were predominant, while wine washing emerged in the Ming dynasty. Modern practices primarily involve using raw, stir-frying or honey processing. Regarding the medicinal properties of CARR, both ancient and modern texts agree it has a bitter and salty taste and is non-toxic. Records prior to the Qing dynasty predominantly describe its nature as extremely cold, while mainstream herbal texts after the Qing dynasty generally characterize it as cold. Before the Ming dynasty, there were no records of its meridian tropism. It was not until the Qing dynasty that it was recorded in the lung meridian. Modern records mainly refer to the stomach, liver, and kidney meridians. Throughout history, its main functions have been to clear heat, diuresis, nourish Yin, and replenish essence, primarily treating Yin deficiency and fever syndrome. Based on the research results, it is suggested that when developing famous classical formulas containing CARR, the dried roots and rhizomes of C. atratum can be selected as its medicinal source. If there are no specific processing requirements, raw products can be selected as medicine. If the processing requirements are specified, corresponding processed products can be selected as medicine according to the original formula requirements.
7.Active Ingredients of Traditional Chinese Medicine Regulate Ferroptosis to Inhibit Breast Cancer: A Review
Yan LIU ; Zhenyao YANG ; Chengzhi WANG ; Jiuxian LI
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(4):299-306
Breast cancer (BC), a common malignant tumor in women, is characterized by high incidence and mortality rates, posing a serious threat to women's life and health. Currently, the commonly used treatments for BC include surgery, radiotherapy, chemotherapy, molecular targeted therapy, and endocrine therapy. Although radiotherapy and chemotherapy can effectively kill tumor cells and inhibit the proliferation and differentiation of tumor cells, they can induce adverse reactions such as hematopoietic dysfunction and impaired immune function. The other treatment methods also have problems such as drug resistance, high recurrence rates, reduced quality of life, and poor clinical efficacy. Therefore, it is urgent to explore new drugs with better efficacy and lower toxicity. Ferroptosis is a form of iron-dependent, non-apoptotic programmed cell death triggered by lipid peroxidation. In recent years, ferroptosis has become a hot topic in the field of cancer treatment and has been gradually proven to effectively inhibit the proliferation and metastasis of BC cells, reduce the drug resistance of BC to chemotherapy drugs, and enhance the sensitivity of BC to radiotherapy. Traditional Chinese medicine (TCM), with multiple components, multiple targets, and mild side effects, is widely used in the treatment of BC. A large number of studies have shown that active ingredients of TCM, such as saponins, flavonoids, terpenoids, phenols, and polysaccharides, can inhibit the proliferation and metastasis of BC cells by modulating ferroptosis-related pathways. These include iron metabolism, lipid metabolism, cystine/glutamate antiporter system Xc-/glutathione/glutathione peroxidase 4, Specifically, these ingredients elevate the levels of lipid peroxidation, reactive oxygen species, malondialdehyde, and Fe2+ in BC cells, thereby inducing ferroptosis-mediated suppression of tumor progression. This article reviews the relevant literature at home and abroad in recent years, summarizes the mechanisms of ferroptosis in regulating BC and the research progress in the active components of TCM targeting ferroptosis in the intervention of BC, aiming to provide ideas for the development of new drugs for the treatment of BC.
8.Analysis of HPV Infection Characteristics and Influencing Factors for Lesion Grade in Patients with Cervical Squamous Intraepithelial Lesion and Cervical Cancer
Jingjing HAN ; Lijie ZHANG ; Ruyu CAI ; Haili LI ; He WANG ; Le DANG ; Hongda CHEN ; Ming'e LI ; Lan ZHU
Medical Journal of Peking Union Medical College Hospital 2026;17(1):156-165
To summarize the distribution characteristics of human papillomavirus(HPV) infection types in patients with cervical squamous intraepithelial lesion(SIL) and cervical cancer(CC), and to explore the impact of HPV vaccination, HPV infection types, and general clinical data on different grades of cervical lesions. Clinical data of women attending the gynecological colposcopy clinic of Shenzhen People's Hospital from January 2020 to December 2023 were retrospectively collected. Patients with HPV genotyping records and histopathologically diagnosed SIL or CC were included and divided into three groups based on pathological results: low-grade squamous intraepithelial lesion(LSIL) group, high-grade squamous intraepithelial lesion(HSIL) group, and CC group. The distribution of high-risk HPV subtypes was analyzed among the three groups, and multivariate Logistic regression was used to identify influencing factors for high-grade cervical lesions. A total of 4162 patients were included, comprising 4057 cervical SIL patients(3317 LSIL and 740 HSIL) and 105 CC patients. The overall mean age was(39.9±11.2) years. The HPV infection rate was 95.1%(3959/4162), and 25.0%(1040/4162) of patients had received HPV vaccination. Among high-risk HPV infections, HPV 52, HPV 16, HPV 58, and HPV 18 were the most common subtypes. HPV 52 had the highest infection rate in the LSIL group(27.6%), while HPV 16 was the most prevalent in the HSIL group(45.3%) and CC group(64.9%). Multivariate Logistic regression analysis showed that HPV vaccination( HPV infection is common in patients with SIL and CC, but the distribution of high-risk HPV subtypes varies among different grades of cervical lesions. It is recommended to strengthen cervical cancer screening and monitoring of key high-risk HPV infections in older and multiparous women in Shenzhen, and to continue promoting HPV vaccination.
9.From Gene Expression to Transcriptome-wide Association Study: Development and Comparison of Methodology
Kun FANG ; Guozhuang LI ; Linting WANG ; Qing LI ; Kexin XU ; Lina ZHAO ; Zhihong WU ; Jianguo ZHANG ; Nan WU
Medical Journal of Peking Union Medical College Hospital 2026;17(1):223-229
Over the past two decades, genome-wide association study(GWAS) has identified numerous genetic variants and loci associated with heritable diseases. With the gradual maturation and saturation of GWAS methodologies, transcriptome-wide association study(TWAS) offers a novel perspective by linkinggenetic phenotypes to gene expression levels. By integrating TWAS with other multi-omics analyses, researchers can gain a deeper understanding of heritable diseases. This article provides an overview of recent groundbreaking and representative TWAS methods and tools, analyzes their strengths and limitations, and discusses future trends in TWAS development.
10.Reporting Status of Clinical Practice Guideline Protocols: A Systematic Analysis
Huayu ZHANG ; Xufei LUO ; Hui LIU ; Qi ZHOU ; Yishan QIN ; Ye WANG ; Yuanyuan YAO ; Haodong LI ; Xiaohui WANG ; Yaolong CHEN
Medical Journal of Peking Union Medical College Hospital 2026;17(1):255-262
To systematically analyzed the reporting status of core elements in publicly available clinical practice guideline(hereafter referred to as "guideline") protocols published domestically and internationally over the past decade, identified existing problems, and provided evidence to inform the standardized writing and publication of future guideline protocols. A systematic search was conducted in Chinese and English databases for clinical practice guideline protocols published during the past ten years. The basic characteristics and reporting of core elements—including registration information, conflict of interest management, evidence grading, development process and timeline planning, as well as dissemination and implementation—were extracted and analyzed. Chi-square tests were performed to explore associations between protocol characteristics and the reporting of core elements. A total of 94 guideline protocols were included, of which 67 were in Chinese(71.28%) and 27 were in English(28.72%). Overall, 82.98% of the guideline protocols were registered, 92.55% reported management of conflicts of interest, 97.87% reported evidence searching, 88.30% reported evidence grading, and 89.36% described dissemination and implementation strategies. However, only 55.32% reported the guideline development process, and merely 23.40% reported timeline planning. Further analysis indicated that the reporting of registration, evidence searching, development process, and timeline planning was associated with year of publication. Differences were observed between domestic and international guidelines in reporting registration, conflict of interest management, development process, time planning, and dissemination and implementation. Guidelines intended for development exhibited higher reporting rates for registration, development process, and dissemination and implementation compared to those planned for updating or adaptation. Although current guideline protocols demonstrate relatively adequate reporting of methodological elements, deficiencies remain in development process and timeline planning. Future efforts should focus on promoting the publication and standardized reporting of guideline protocols, enhancing the international recognition of registration platforms, and strengthening the development process and timeline planning to advance the scientific rigor and transparency of guideline development.

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