ObjectiveFrom the perspective of cardiovascular-kidney-metabolic （CKM） syndrome， this study aims to construct and validate a diagnostic machine learning model integrating traditional Chinese and Western medicine for severe coronary artery stenosis in patients with CKM， thereby providing clinical decision-making support for patients with borderline lesions. MethodsBased on a retrospective study design， a total of 535 hospitalized patients from two independent campuses of Jiangsu Province Hospital of Traditional Chinese Medicine： the main campus （from January 2024 to August 2024） and Zidong branch （from September 2024 to December 2024） were screened. Data from the main campus were randomly divided into the training dataset （376 cases） and the internal validation dataset （95 cases） at a 4∶1 ratio， while data from Zidong branch served as the external validation dataset （64 cases）. Risk factors were analyzed and screened through literature review， expert interviews， and the least absolute shrinkage and selection operator （LASSO） algorithm. Nine machine learning algorithms were utilized to construct diagnostic models. Comparative analyses of common evaluation metrics， calibration curves， and decision curves were conducted to select the model through internal and external validation. The Shapley additive explanations （SHAP） method and two cases were utilized to help understand the operational logic of the best model. Finally， the best model was applied to patients with borderline lesions to calculate diagnostic efficacy. ResultsNine risk factors were screened by LASSO regression， such as phlegm， hematoma， stagnation， deficiency， hypertension duration， gender， arterial stiffness index （ASI）， uric acid to high-density lipoprotein cholesterol ratio （UHR）， and glycosylated hemoglobin （HbA1c）. After comparison from multiple dimensions， the light gradient boosting machine （LightGBM） was the best model， achieving area under the curve （AUC） of 0.918 （95% confidence interval （CI）： 0.890-0.945） in the training dataset， 0.885 （95%CI： 0.820-0.951） in the internal validation dataset， and 0.897 （95%CI： 0.818-0.975） in the external validation dataset. Calibration curves indicated good consistency in the predicted probabilities， while decision curve analysis showed clinical benefit when threshold probabilities were less than 90%. SHAP importance rankings were stagnation， deficiency， hematoma， HbA1c， gender， phlegm， hypertension duration， ASI， and UHR. When applied to the patients with borderline lesions， the diagnostic model achieved an AUC of 0.783 （95%CI： 0.637-0.930）， with 73% of patients with actual severe stenosis getting benefit. ConclusionGuided by clinical value， the diagnostic model integrating traditional Chinese and Western medicine established in this study demonstrates favorable performance， providing a basis for clinical diagnosis， treatment， and decision-making in patients with CKM.

ObjectiveFrom the perspective of cardiovascular-kidney-metabolic （CKM） syndrome， this study aims to construct and validate a diagnostic machine learning model integrating traditional Chinese and Western medicine for severe coronary artery stenosis in patients with CKM， thereby providing clinical decision-making support for patients with borderline lesions. MethodsBased on a retrospective study design， a total of 535 hospitalized patients from two independent campuses of Jiangsu Province Hospital of Traditional Chinese Medicine： the main campus （from January 2024 to August 2024） and Zidong branch （from September 2024 to December 2024） were screened. Data from the main campus were randomly divided into the training dataset （376 cases） and the internal validation dataset （95 cases） at a 4∶1 ratio， while data from Zidong branch served as the external validation dataset （64 cases）. Risk factors were analyzed and screened through literature review， expert interviews， and the least absolute shrinkage and selection operator （LASSO） algorithm. Nine machine learning algorithms were utilized to construct diagnostic models. Comparative analyses of common evaluation metrics， calibration curves， and decision curves were conducted to select the model through internal and external validation. The Shapley additive explanations （SHAP） method and two cases were utilized to help understand the operational logic of the best model. Finally， the best model was applied to patients with borderline lesions to calculate diagnostic efficacy. ResultsNine risk factors were screened by LASSO regression， such as phlegm， hematoma， stagnation， deficiency， hypertension duration， gender， arterial stiffness index （ASI）， uric acid to high-density lipoprotein cholesterol ratio （UHR）， and glycosylated hemoglobin （HbA1c）. After comparison from multiple dimensions， the light gradient boosting machine （LightGBM） was the best model， achieving area under the curve （AUC） of 0.918 （95% confidence interval （CI）： 0.890-0.945） in the training dataset， 0.885 （95%CI： 0.820-0.951） in the internal validation dataset， and 0.897 （95%CI： 0.818-0.975） in the external validation dataset. Calibration curves indicated good consistency in the predicted probabilities， while decision curve analysis showed clinical benefit when threshold probabilities were less than 90%. SHAP importance rankings were stagnation， deficiency， hematoma， HbA1c， gender， phlegm， hypertension duration， ASI， and UHR. When applied to the patients with borderline lesions， the diagnostic model achieved an AUC of 0.783 （95%CI： 0.637-0.930）， with 73% of patients with actual severe stenosis getting benefit. ConclusionGuided by clinical value， the diagnostic model integrating traditional Chinese and Western medicine established in this study demonstrates favorable performance， providing a basis for clinical diagnosis， treatment， and decision-making in patients with CKM.

ObjectiveTo explore the expression levels of long non-coding RNA （lncRNA） H19 and microRNA-22-3p （miR-22-3p） in the serum of patients with acute myocardial infarction （AMI） and their diagnostic value for AMI. MethodsA total of 176 AMI patients were selected as the experimental group and were divided into ST-segment elevation myocardial infarction （STEMI） group （n=95） and non-ST-segment elevation myocardial infarction （NSTEMI） group （n=81） based on their medical history and electrocardiogram. Meanwhile， 156 patients with negative angiography during the same period were selected as the control group （CON group）. The relative expression levels of lncRNA H19 and miR-22-3p in the serum of the two groups were detected by real-time fluorescence quantitative polymerase chain reaction. The diagnostic value of miR-22-3p and lncRNA H19 in AMI was evaluated by receiver operating characteristic curve （ROC） analysis. The levels of serum cardiac troponin I （cTnI）， creatine kinase （CK）， creatine kinase MB isoenzyme （CK-MB）， and high-sensitivity C-reactive protein （CRP） were detected in all study subjects. Spearman correlation analyses were used to evaluate the correlations between lncRNA H19 and miR-22-3p and cTnI， CK， CK-MB and CRP. ResultsCompared with the control group， the expression level of lncRNA H19 was upregulated and the expression level of miR-22-3p was downregulated in the AMI group （all P<0.01）； compared with the NSTEMI group， the expression level of lncRNA H19 was upregulated and the expression level of miR-22-3p was downregulated in the STEMI group （P<0.01）. The areas under the ROC curves （AUC） for the diagnosis of AMI by miR-22-3p， lncRNA H19 and their combination were 0.555， 0.977， and 0.983， respectively. lncRNA H19 was positively correlated with cTnI， CK， CK-MB and CRP （P<0.05）， and negatively correlated with left ventricular ejection fraction （LVEF） （P<0.001）； miR-22-3p was negatively correlated with cTnI， CK and CRP， and positively correlated with LVEF （P<0.05）. ConclusionThe expression level of lncRNA H19 is elevated and the expression level of miR-22-3p decreased in AMI patients， and their levels may have potential value as an auxiliary biomarker for AMI diagnosis and cardiac function assessment.

Objective:To investigate level and influencing factors of information overload of intensive care unit (ICU) patients′ decision-making agents in order to provide positive clinical interventions for improving their information overload.Methods:During March 2023 to February 2024, 302 ICU patients′ decision-making agents from the Second Affiliated Hospital of Naval Medical University of the People′s Liberation Army of China were cross-sectional surveyed by Basic Information Questionnaire, Information Overloading Scale, Decision Participation Expectancy Scale, Multidimensional Perceived Social Support Scale, State Trait Anxiety Inventory, Vickers Forest Physician Trust Scale, Decision Preparation Scale, Decision Fatigue Scale and Information Literacy Scale through convenience sampling methods.Results:In the valid 297 questionnaires, there were 172 males and 125 females in ICU patients′ decision-making agents aged 28-69(47.94 ± 8.71) years. The score of information overload was (19.65 ± 7.71), the score of perceived social support was (52.34 ± 7.87), the score of state anxiety was (60.88 ± 6.16), the score of trait anxiety was (60.09 ± 5.49), the score of physician trust was (35.34 ± 4.30), the score of preparation of decision was (27.90 ± 3.01), the score of decision fatigue was (20.61 ± 3.30), and the score of information literacy was (56.18 ± 11.46) in ICU patients′ decision-making agents. Linear regression analysis showed that age, educational level, having a common decision-maker, times of making medical decisions, type of participating in medical decision (cooperative type and proactive type), perceived social support, state anxiety, physician trust, preparation for decision making, decision fatigue and information literacy were all significant influencing factors of information overload of ICU patients′ decision-making agents ( t values were -6.76 to 7.57, all P<0.05). Conclusions:The level of information overload of ICU patients′ decision-making agents was above average. Therefore, while educating them about patients′ illness situation and inviting them to participate in decision-making, ICU medical staff should pay attention on their level of information overload, and then select simply easy communication methods and content to help them quickly understand information and make decisions according to their characteristics and information processing ability.

[Purpose]To analyze irinotecan-related adverse events(AEs)signals,to provide references for clinically safe prescribing practices.[Methods]A retrospective pharmacovigilance analysis was con-ducted using Food and Drug Administration Adverse Event Reporting System(FAERS)database from the first quarter of 2004 to the last quarter of 2024.After duplicate removal,four disproportionality analysis methods were applied:reporting odds ratio(ROR),proportional reporting ratio(PRR),Bayesian confi-dence propagation neural network(BCPNN),and empirical Bayes geometric mean(EBGM),and subgroups were analyzed by age(≥65 years old vs＜65 years old)and outcome(death vs non-death).[Results]A total of 8 456 irinotecan-related reports comprising 27 177 AEs were identified.The most frequently reported AEs included diarrhea,nausea,neutropenia,vomiting,and fatigue.Additionally,several unexpected and significant AEs signals were detected,such as cell-mediated cytotoxicity,pyomyositis,neuropathic muscular atrophy,administration site recall reaction and ischemic neuropathy.Subgroup analysis indicated that elderly patients showed higher reported frequencies of diarrhea,neutropenia and leukopenia,while younger patients had more frequent reports of nausea,vomiting and peripheral neuropathy.The median time to AEs onset was 31 d,with 49.8％occurring within the first month of treatment.[Conclusion]The AEs related to irinotecan should be paid attention to.When using irinotecan for the treatment of digestive system cancer,symptoms such as diarrhea,nausea and neutropenia should be closely monitored to reduce the risk of drug use.

Objective:To analyze the characteristics of transabdominal bowel ultrasound (TBUS) in immune checkpoint inhibitor-related colitis (IRC) and their correlation with endoscopic manifestations.Methods:A cross-sectional study was conducted. Clinical data from 10 patients with IRC treated at Peking Union Medical College Hospital from January 2022 to January 2024 were collected. The ulcerative colitis endoscopic index of severity (UCEIS) and Limberg classification were used to assess the severity of colonoscopy and TBUS examinations, respectively. Kendall's tau-b method was applied for correlation analysis between UCEIS scores and Limberg classification.Results:All the 10 patients were male with a median age of 65 years (59-74 years). The majority had lung cancer (8 patients) and all were in advanced stages, with 6 patients in stage Ⅲ and 4 in stage Ⅳ. They all received anti-programmed death 1 (PD-1) /anti-programmed death ligand 1 (PD-L1) combined with chemotherapy, among whom 2 patients were combined with anti-angiogenic drug treatment. The median time from the first immunotherapy to the onset of IRC was 1.50 (0.25-12.00) months; the median time from IRC treatment to clinical symptom relief to G1 was 2.45 (0.50-8.00) weeks. Nine patients were in the active phase, mainly G3 (8 patients) ; 1 was in the remission phase after treatment. TBUS showed that among the 9 active IRC patients, the entire colon was mainly involved (7 patients), with combined small intestine involvement (3 patients) ; the main manifestations were thickening of the bowel wall, with the thickest bowel wall being 7.0 (5.0-8.0) mm, mainly located in the sigmoid colon (3 patients) and descending colon (3 patients) ; increased bowel wall blood flow signals (Limberg classification 2-4) occurred in 7 patients; 3 active patients had perienteric fat wrapping, and 2 had blurred bowel wall stratification. The Kendall's tau-b correlation coefficient r between the entire colon UCEIS scores and Limberg classification was 0.891 ( P = 0.003), and the Kendall's tau-b correlation coefficient r between the colon segment UCEIS scores and Limberg classification was 0.690 ( P < 0.001) . Conclusion:During the active phase, the left colon of IRC is more severe in TBUS, which mainly manifests as the thickening bowel wall and increased blood flow signals, and the TBUS has good correlation with colonoscopy evaluation.

Objective To establish a high-performance liquid chromatography method to detect empagliflozin and related substances in empagliflozin bulk drug and tablets,and to provide technical support for quality control and unified monitoring of empagliflozin bulk drug and its tablets.Methods A liquid chromatography development system with the full factorial design of experiments and the Box-Behnken model was used to screen and optimize the chromatographic parameters.Related substances were detected in empagliflozin API and empagliflozin tablets from different companies with the optimized chromatographic parameters.Results The optimized chromatographic parameters were obtained:Shim-pack GIST C18-AQ column(250 mm×4.6 mm,5 μm)was used,column temperature was 15 ℃,gradient elution with water-acetonitrile as mobile phase was as below,flow rate was 1.2 mL·min-1,detection wavelength was set at 224 nm.The specificity of the method is good,with recoveries ranging from 94.8％to 101.7％,and RSD ranging from 0.5％to 3.1％.The known single impurity in APIs and tablets is less than 0.05％,any other unknown single impurity is less than 0.06％,and the total amount of impurities are less than 0.3％.The related substances of supervised sampling are under good control.Conclusion The method is reliable and robust for determining related substances of empagliflozin and its tablets.

ObjectiveTo observe the effect of Yifei Jianpi prescription on the of signal transducer and activator of transcription protein 1 （STAT1）/interferon regulatory factor 3 （IRF3） signaling pathway in a pneumonia model induced by lipopolysaccharide （LPS） and to explore the mechanism of Yifei Jianpi prescription in improving lung immune and inflammatory responses. MethodsSixty male SPF SD rats were used in this study. Ten rats were randomly assigned to the normal control group， and the remaining 50 were instilled with LPS in the trachea to establish a pneumonia model. After successful modeling， the rats were randomly divided into the model group， dexamethasone group （0.5 mg·kg^-1）， and Yifei Jianpi prescription high-dose （12 mg·kg^-1）， medium-dose （6 mg·kg^-1）， and low-dose （3 mg·kg^-1） groups， with 10 rats in each group. Treatment was administered once daily， and the normal control and model groups received the same volume of normal saline. After 14 days， flow cytometry was used to detect the classification of whole blood lymphocytes. Enzyme-linked immunosorbent assay （ELISA） was used to measure serum levels of immunoglobulin G （IgG）， immunoglobulin A （IgA）， immunoglobulin M （IgM）， and the content of tumor necrosis factor-α （TNF-α）， interleukin-8 （IL-8）， interleukin-6 （IL-6）， and interleukin-10 （IL-10） in alveolar lavage fluid （BALF）. Hematoxylin-eosin （HE） staining was used to observe lung tissue pathology and score the damage. Thymus weight， spleen weight， and wet-to-dry weight ratio （W/D） were recorded. Real-time fluorescence quantitative polymerase chain reaction （Real-time PCR） was used to detect the mRNA expression of STAT1， IRF3， IL-6， and interferon-alpha （IFN-α） in lung tissues， while Western blot was performed to assess the protein expression of STAT1， IRF3， IL-6， and IFN-α. ResultsCompared with the normal control group， the model group showed significantly increased proportion of B lymphocytes in peripheral blood， decreased proportions of NK cells and CD4⁺/CD8⁺ （P<0.05， P<0.01）， decreased serum levels of IgG and IgA， significantly increased IgM levels （P<0.01）， significantly elevated content of TNF-α， IL-6， and IL-8 in BALF， and significantly decreased IL-10 levels （P<0.01）. Lung tissue damage was evident， with significant increases in thymus and spleen weights and a higher W/D ratio （P<0.01）. The mRNA and protein expression of STAT1， IRF3， IFN-α， and IL-6 in lung tissues was significantly upregulated （P<0.05，P<0.01）. Compared with the model group， the Yifei Jianpi prescription groups showed significantly reduced proportions of B lymphocytes in peripheral blood， increased proportions of NK cells and CD4⁺/CD8⁺ ratios （P<0.05， P<0.01）， significantly increased serum levels of IgG and IgA， significantly decreased IgM levels （P<0.05， P<0.01）， significantly reduced levels of TNF-α， IL-6， and IL-8 in BALF， and significantly increased IL-10 levels （P<0.01）. Lung tissue damage was alleviated， thymus and spleen weights were significantly reduced， and the W/D ratio was markedly decreased （P<0.01）. The mRNA and protein expression of STAT1， IRF3， IFN-α， and IL-6 in lung tissues was significantly downregulated （P<0.05， P<0.01）. ConclusionYifei Jianpi prescription can alleviate lung tissue damage and improve immune and inflammatory responses in LPS-induced pneumonia rats. The mechanism may be related to the inhibition of STAT1/IRF3 signaling pathway activation.

Objective To observe the synergistic effect of Shengxian Huaxian Prescription and its disassembled prescription on pulmonary fibrosis;To explore whether its mechanism is related to regulating the STAT6/PPAR-y pathway to promote polarization of M2 type macrophages towards M1 type.Methods Ten SD rats were randomly selected from 70 rats as blank group,and the remaining rats were re-established pulmonary fibrosis model by intratracheal infusion of bleomycin.After modeling,the rats were divided into model group,positive group,Shengxian Huaxian Prescription group,Shengxian group,Tongluo group and Bushen group,with 10 rats in each group.Shengxian Huaxian Prescription group,Shengxian group,Tongluo group and Bushen group were given 12.60,7.65,3.60 and 2.25 g/kg of corresponding TCM solution,respectively;the positive group was given 0.12 g/kg of pirfenidone suspension;the blank group and the model group were given equal volume of normal saline,once a day,for consecutive 28 days.The lung function of rats was detected,the contents of IL-6 and TGF-β1 in serum were detected by ELISA,the pathological changes in lung tissue were observed by Masson staining,the expression of CD68,iNOS and CD206,Arg-1 in lung tissue were detected by immunofluorescence,the expression of SOCS1,SOCS3,STAT6,p-STAT6 and PPAR-γ in lung tissue were detected by Western blot.Results Compared with the blank group,the PEF,PIF and EF50 in model group rats significantly decreased,and the contents of serum IL-6 and TGF-β1 significantly increased,Masson staining showed a large amount of collagen fiber deposition,Ashcroft score significantly increased,CD206,Arg-1,STAT6,p-STAT6,PPAR-y protein expression significantly increased(P＜0.01),the expressions of SOCS1 and SOCS3 protein significantly decreased(P＜0.01),while the expression of CD68 and iNOS were not significantly changed(P＞0.05).Compared with the model group,the PEF,PIF and EF50 in all administration groups significantly increased,and the contents of serum IL-6 and TGF-β1 significantly decreased,collagen fiber deposition in lung tissue were decreased to varying degree,Ashcroft score significantly decreased,the expression of CD206,Arg-1,STAT6,p-STAT6 and PPAR-γ protein significantly decreased(P＜0.01),the expressions of CD68,iNOS,SOCS1 and SOCS3 protein significantly increased(P＜0.05).The above indicators showed the most significant changes in Shengxian Huaxian Prescription group,followed by Shengxian group(P＜0.01,P＜0.05).Conclusion Both Shengxian Huaxian Prescription and its disassembled prescription have anti pulmonary fibrosis effects,and their mechanism may related to regulating the STAT6/PPAR-y pathway and promoting polarization of M2 type macrophages towards M1 type.Shengxian Huaxian Prescription group has the best effect,while Shengxian group play an important role in the prescription,and the compatibility between each group has a synergistic effect.

Objective: To preliminarily develop a multidimensional blood donor role scale based on role theory and systematically compare the psychosocial characteristic differences between award-winning donors and first-time donors in Guangzhou, and to provide an empirical reference for formulating differentiated donor retention strategies. Methods: A cross-sectional survey design was adopted. A random sample of award-winning donors and concurrently sampled first-time donors yielding 1 361 valid responses collected (721 from the award group, 640 from the first-time group). Exploratory factor analysis was used to assess the scale structure. Data were post-stratified and weighted according to the gender and age distributions of the general donor population. Independent samples t-tests, multivariate analysis of covariance (MANCOVA), and generalized linear models were employed to compare dimensional scores between the two groups. A paired t-test was conducted to analyze the annual donation frequency of award-winning donors before and after receiving the award. Results: Exploratory factor analysis yielded a 5-factor structure, including Role Identity and Expectations, Role Adaptation and Maintenance, Role Environment and Experience, Role Relationships and Conflict, and Role Incentives and Rewards, with a cumulative variance contribution rate of 56.43%. The scale demonstrated good internal consistency reliability (Cronbach's α=0.906). Known-group validity test showed that award-winning donors scored significantly higher than first-time donors on Role Identity and Expectations (t=4.366, P<0.001, d=0.240), Role Adaptation and Maintenance (t=5.436, P<0.001, d=0.500), and Role Relationships and Conflict (t=4.844, P<0.001, d=0.220). These differences remained significant after controlling for selected demographic variables (MANCOVA, Wilks' λ=0.943, P<0.001). Generalized linear models suggested that donation frequency was an independent predictor for these dimensions. Additionally, the annual donation frequency of award-winning donors was slightly higher after receiving the award than before (t=2.007, P=0.045). Conclusion: The preliminary blood donor role scale demonstrates acceptable reliability and validity and can effectively distinguish groups with different donation behavior characteristics. The study reveals that award-winning donors exhibit more positive psychological characteristics across multiple role identity dimensions and maintain their donation behavior after receiving an award. External incentives and internal role identity may jointly contribute to behavioral persistence. The findings provide a preliminary reference for further exploring the formation pathways of donor role identity and developing differentiated donor retention strategies.