Objective: To systematically characterize the developmental trajectory and interdisciplinary integration of intelligent diagnosis in traditional Chinese medicine (TCM) through quantitative topic evolution analysis, we addressed the fragmentation of existing research and clarified the long-term research structure and evolutionary patterns of the field. Methods: A topic evolution analysis was performed on Chinese-language literature pertaining to intelligent diagnosis in TCM. Publications were retrieved from the China National Knowledge Infrastructure (CNKI), Wanfang Data, and China Science and Technology Journal Database (VIP), covering the period from database inception to July 3, 2025. A hybrid segmentation approach, based on cumulative publication growth trends and inflection point detection, was applied to divide the research timeline into distinct stages. Subsequently, the latent Dirichlet allocation (LDA) model was used to extract research topics, followed by alignment and evolutionary analysis of topics across different stages. Results: A total of 3 919 publications published between 2003 and 2025 were included, and the research trajectory was divided into five stages based on data-driven breakpoint detection. The field exhibited a clear evolutionary shift from early rule-based systems and tongue-pulse image and signal analysis (2006 – 2010), to machine-learning-based syndrome and prescription modeling (2011 – 2015), followed by deep-learning-driven pattern recognition and formula association (2016 – 2020). Since 2021, research has increasingly emphasized knowledge-graph construction, multimodal integration, and intelligent clinical decision-support systems, with recent studies (2024 – 2025) showing the emergence of large language models and agent-based diagnostic frameworks. Topic evolution analysis further revealed sustained cross-stage continuity in syndrome modeling and prescription association analysis, alongside the progressive consolidation of integrated intelligent diagnostic platforms. Conclusion By identifying key technological transitions and persistent core research themes, our findings offer a structured reference framework for the design of intelligent diagnostic systems, the construction of knowledge-driven clinical decision-support tools, and the alignment of AI models with TCM diagnostic logic. Importantly, the stage-based evolutionary insights derived from this analysis can inform future methodological choices, improve model interpretability and clinical applicability, and support the translation of intelligent TCM diagnosis from experimental research to real-world clinical practice.

BACKGROUND:At present,domestic and foreign studies mainly focus on the comparison of different operation methods for intertrochanteric fracture of femur and the risk of failure in proximal femoral nail antirotation operation.There are few studies on the prognosis of hip function of affected limb after proximal femoral nail antirotation.OBJECTIVE:To analyze the influencing factors of poor hip function recovery in elderly patients with intertrochanteric fracture after proximal femoral nail antirotation surgery,and to construct a score system for predicting hip function after surgery and explore its value.METHODS:A total of 150 patients with intertrochanteric fracture of femur who received proximal femoral nail antirotation surgery in the Affiliated Hospital of Xuzhou Medical University from June 2021 to June 2023 were selected and divided into groups according to the Harris hip function score during postoperative follow-up.A score ≥80 was considered as the good group,and a score＜80 was considered as the poor group.Univariate and binary regression analyses were used to explore the risk factors leading to postoperative hip dysfunction.A score scale was established according to the risk factors.The value of this scoring system in predicting hip function after proximal femoral nail antirotation was investigated by using receiver operating characteristic curve.RESULTS AND CONCLUSION:(1)Among the 150 patients,according to the Harris score standard of the affected hip joint at 1 year follow-up,there were 52 cases in the group with poor functional recovery and 98 cases in the group with excellent functional recovery,with an unsatisfactory rate of 34.7％.(2)The results of univariate comparison between the two groups showed that there were significant differences in age,bone mineral density,number of preoperative underlying complications,type of lateral wall,position of spiral blade,quality of reduction and time of first exercise after surgery between the poor group and the good group(P＜0.05).(3)The results of binary Logistic regression analysis showed:Age ≥75 years old(OR=2.834),osteoporosis(OR=3.002),number of preoperative basic complications＞2(OR=4.024),lateral wall rupture(OR=2.999),position difference of spiral blade(OR=4.025),and time to exercise for the first time after surgery＞4 weeks(OR=3.153)were independent risk factors for hip dysfunction after proximal femoral nail antirotation for the intertrochanteric fractures(P＜0.05);poor reduction quality(OR=1.026)was not an independent risk factor(P＞0.05).(4)Based on the results of binary regression analysis,a score system for predicting good hip function after surgery was established.Receiver operating characteristic curve analysis showed that the threshold for predicting poor hip function after surgery was 4.5 points;the area under the curve was 0.797;the sensitivity was 83.7％and the specificity was 65.4％.(5)These results suggested that age ≥75 years old,osteoporosis,number of preoperative basic comorbidities＞2,lateral wall rupture,poor position of spiral blade,and first time out of bed exercise＞4 weeks after intertrochanteric fracture were risk factors for hip dysfunction after proximal femoral nail antirotation.The establishment of a score prediction system can provide reference value for early clinical identification of high-risk patients with postoperative hip dysfunction,and is conducive to guiding early clinical intervention,adopting more personalized treatment and rehabilitation programs,and promoting the recovery of hip function in patients after surgery.

OBJECTIVE To explore the intervention mechanism of Shangke Lengtongtie on cold hyperalgesia in KOA mice based on the HMGB1/CXCL12/CXCR4 signaling axis.METHODS Monosodium iodoacetate(MIA)was used for the intra-articular injec-tion into the knee joint to establish mice model of knee osteoarthritis(KOA).Peripheral blood monocytes were extracted from mice,cultured,and then reinfused into the tail vein of the mice.Subsequently,in vivo animal imaging was used to observe the recruitment sites of these monocytes.The cold hyperalgesia threshold was measured at various time points in each group of mice.Hematoxylin and eosin(HE)staining was used to evaluate the level of synovial pathological changes.ELISA was employed to detect the expression of in-flammatory factors IL-1β,TNF-α,and pain mediators CGRP and Substance P in mouse serum.Western blot and qPCR methods were used to detect the protein and gene expression of cold hyperalgesia-related indicators such as TRPA1,TRPM8,HMGB1,CXCL12,CXCR4,Collagen Ⅰ,and Netrin-1 in synovial tissue,as well as DCC in dorsal root ganglia(DRG)tissue.RESULTS In vivo ima-ging showed that after the monocytes were reinfused into KOA mice,they were recruited to the knee joint area,with the HMGB1 group exhibiting a greater recruitment of circulating monocytes at the knee joint.Additionally,compared to the control group,the KOA group and HMGB1 group showed inflammatory pathological changes in the synovium,increased expression of serum inflammatory factors and pain mediators,reduced cold hyperalgesia threshold,and upregulated protein and gene expression of cold hyperalgesia-related indica-tors in synovial and DRG tissues.The changes were more significant in the HMGB1 group compared to the KOA group(P<0.05).Af-ter treatment with Shangke Lengtongtie or GL intervention,synovial inflammation was alleviated,serum inflammatory factors and pain mediators decreased,cold hyperalgesia threshold increased,and the upregulation of cold hyperalgesia-related indicator protein and gene expression levels was significantly reversed(P<0.05).CONCLUSION Shangke Lengtongtie exerts a beneficial effect on the mitigation of synovitis and cold hyperalgesia in KOA mice,a therapeutic mechanism that possibly mediated through the inhibition of the HMGB1/CXCL12/CXCR4 signaling axis.

OBJECTIVE To explore the effectiveness and possible mechanism of Shangke Lengtong Patch in treating knee osteo-arthritis with cold-dampness arthralgia obstruction.METHODS A total of 70 patients who met the inclusion criteria of knee osteoar-thritis with cold-dampness arthralgia obstruction in the Orthopedics Department of Affiliated Hospital of Nanjing University of Chinese Medicine from November to December 2024 were randomly divided into an experimental group and a control group,with 35 cases in each group.During the treatment,1 case dropped out of the experimental group,3 cases dropped out of the control group,and 1 case was discontinued.The experimental group was treated with Shangke Lengtong Patch,and the control group was treated with Compound Nanxing Zhitong Ointment.The WOMAC scores and TCM syndrome scores of the two groups before and after treatment were compared to comprehensively evaluate the clinical efficacy.The changes in the expression levels of CGRP,substance P,HMGB1,IL-1β,CX-CL12,and CXCR4 in the serum of the two groups were detected by ELISA.RESULTS After 3,7,and 14 d of treatment,the WOMAC scores and TCM syndrome scores of the two groups were significantly reduced(P<0.05,P<0.01),and the score of aggrava-ted cold in the experimental group was better than that in the control group at 7 d of treatment(P<0.05);after 14 d of treatment,the expression levels of CGRP,substance P,HMGB1,IL-1β,CXCL12,and CXCR4 in the serum of the two groups were significantly re-duced(P<0.05),and there was no statistical difference between the two groups.CONCLUSION Shangke Lengtong Patch can sig-nificantly relieve the pain symptoms of knee osteoarthritis patients with cold-dampness arthralgia obstruction and improve the joint func-tion of patients.It may improve synovial inflammation by inhibiting the HMGB1/CXCL12/CXCR4 pathway,thereby exerting a thera-peutic effect.

OBJECTIVE To explore the effectiveness and possible mechanism of Shangke Lengtong Patch in treating knee osteo-arthritis with cold-dampness arthralgia obstruction.METHODS A total of 70 patients who met the inclusion criteria of knee osteoar-thritis with cold-dampness arthralgia obstruction in the Orthopedics Department of Affiliated Hospital of Nanjing University of Chinese Medicine from November to December 2024 were randomly divided into an experimental group and a control group,with 35 cases in each group.During the treatment,1 case dropped out of the experimental group,3 cases dropped out of the control group,and 1 case was discontinued.The experimental group was treated with Shangke Lengtong Patch,and the control group was treated with Compound Nanxing Zhitong Ointment.The WOMAC scores and TCM syndrome scores of the two groups before and after treatment were compared to comprehensively evaluate the clinical efficacy.The changes in the expression levels of CGRP,substance P,HMGB1,IL-1β,CX-CL12,and CXCR4 in the serum of the two groups were detected by ELISA.RESULTS After 3,7,and 14 d of treatment,the WOMAC scores and TCM syndrome scores of the two groups were significantly reduced(P<0.05,P<0.01),and the score of aggrava-ted cold in the experimental group was better than that in the control group at 7 d of treatment(P<0.05);after 14 d of treatment,the expression levels of CGRP,substance P,HMGB1,IL-1β,CXCL12,and CXCR4 in the serum of the two groups were significantly re-duced(P<0.05),and there was no statistical difference between the two groups.CONCLUSION Shangke Lengtong Patch can sig-nificantly relieve the pain symptoms of knee osteoarthritis patients with cold-dampness arthralgia obstruction and improve the joint func-tion of patients.It may improve synovial inflammation by inhibiting the HMGB1/CXCL12/CXCR4 pathway,thereby exerting a thera-peutic effect.

BACKGROUND:At present,domestic and foreign studies mainly focus on the comparison of different operation methods for intertrochanteric fracture of femur and the risk of failure in proximal femoral nail antirotation operation.There are few studies on the prognosis of hip function of affected limb after proximal femoral nail antirotation.OBJECTIVE:To analyze the influencing factors of poor hip function recovery in elderly patients with intertrochanteric fracture after proximal femoral nail antirotation surgery,and to construct a score system for predicting hip function after surgery and explore its value.METHODS:A total of 150 patients with intertrochanteric fracture of femur who received proximal femoral nail antirotation surgery in the Affiliated Hospital of Xuzhou Medical University from June 2021 to June 2023 were selected and divided into groups according to the Harris hip function score during postoperative follow-up.A score ≥80 was considered as the good group,and a score＜80 was considered as the poor group.Univariate and binary regression analyses were used to explore the risk factors leading to postoperative hip dysfunction.A score scale was established according to the risk factors.The value of this scoring system in predicting hip function after proximal femoral nail antirotation was investigated by using receiver operating characteristic curve.RESULTS AND CONCLUSION:(1)Among the 150 patients,according to the Harris score standard of the affected hip joint at 1 year follow-up,there were 52 cases in the group with poor functional recovery and 98 cases in the group with excellent functional recovery,with an unsatisfactory rate of 34.7％.(2)The results of univariate comparison between the two groups showed that there were significant differences in age,bone mineral density,number of preoperative underlying complications,type of lateral wall,position of spiral blade,quality of reduction and time of first exercise after surgery between the poor group and the good group(P＜0.05).(3)The results of binary Logistic regression analysis showed:Age ≥75 years old(OR=2.834),osteoporosis(OR=3.002),number of preoperative basic complications＞2(OR=4.024),lateral wall rupture(OR=2.999),position difference of spiral blade(OR=4.025),and time to exercise for the first time after surgery＞4 weeks(OR=3.153)were independent risk factors for hip dysfunction after proximal femoral nail antirotation for the intertrochanteric fractures(P＜0.05);poor reduction quality(OR=1.026)was not an independent risk factor(P＞0.05).(4)Based on the results of binary regression analysis,a score system for predicting good hip function after surgery was established.Receiver operating characteristic curve analysis showed that the threshold for predicting poor hip function after surgery was 4.5 points;the area under the curve was 0.797;the sensitivity was 83.7％and the specificity was 65.4％.(5)These results suggested that age ≥75 years old,osteoporosis,number of preoperative basic comorbidities＞2,lateral wall rupture,poor position of spiral blade,and first time out of bed exercise＞4 weeks after intertrochanteric fracture were risk factors for hip dysfunction after proximal femoral nail antirotation.The establishment of a score prediction system can provide reference value for early clinical identification of high-risk patients with postoperative hip dysfunction,and is conducive to guiding early clinical intervention,adopting more personalized treatment and rehabilitation programs,and promoting the recovery of hip function in patients after surgery.

OBJECTIVE To explore the intervention mechanism of Shangke Lengtongtie on cold hyperalgesia in KOA mice based on the HMGB1/CXCL12/CXCR4 signaling axis.METHODS Monosodium iodoacetate(MIA)was used for the intra-articular injec-tion into the knee joint to establish mice model of knee osteoarthritis(KOA).Peripheral blood monocytes were extracted from mice,cultured,and then reinfused into the tail vein of the mice.Subsequently,in vivo animal imaging was used to observe the recruitment sites of these monocytes.The cold hyperalgesia threshold was measured at various time points in each group of mice.Hematoxylin and eosin(HE)staining was used to evaluate the level of synovial pathological changes.ELISA was employed to detect the expression of in-flammatory factors IL-1β,TNF-α,and pain mediators CGRP and Substance P in mouse serum.Western blot and qPCR methods were used to detect the protein and gene expression of cold hyperalgesia-related indicators such as TRPA1,TRPM8,HMGB1,CXCL12,CXCR4,Collagen Ⅰ,and Netrin-1 in synovial tissue,as well as DCC in dorsal root ganglia(DRG)tissue.RESULTS In vivo ima-ging showed that after the monocytes were reinfused into KOA mice,they were recruited to the knee joint area,with the HMGB1 group exhibiting a greater recruitment of circulating monocytes at the knee joint.Additionally,compared to the control group,the KOA group and HMGB1 group showed inflammatory pathological changes in the synovium,increased expression of serum inflammatory factors and pain mediators,reduced cold hyperalgesia threshold,and upregulated protein and gene expression of cold hyperalgesia-related indica-tors in synovial and DRG tissues.The changes were more significant in the HMGB1 group compared to the KOA group(P<0.05).Af-ter treatment with Shangke Lengtongtie or GL intervention,synovial inflammation was alleviated,serum inflammatory factors and pain mediators decreased,cold hyperalgesia threshold increased,and the upregulation of cold hyperalgesia-related indicator protein and gene expression levels was significantly reversed(P<0.05).CONCLUSION Shangke Lengtongtie exerts a beneficial effect on the mitigation of synovitis and cold hyperalgesia in KOA mice,a therapeutic mechanism that possibly mediated through the inhibition of the HMGB1/CXCL12/CXCR4 signaling axis.

Objective To investigate the feasibility of monitoring the baseline of motor evoked potentials immediately following tracheal intubation without the administration of muscle relaxants in lumbar spine surgery.Methods A prospective study was conducted at Xuzhou Central Hospital,involving a total of 156 patients who were scheduled for Transforaminal Lumbar Interbody Fusion.These patients were randomly divided into two groups:a control group consisting of 72 cases(33 males and 39 females)and an observation group consisting of 75 cases(37 males and 38 females).The control group underwent monitoring of motor evoked potentials(TceMEP)baseline after spinal exposure during the operation,while the observation group had immediate monitoring of TceMEP baseline after tracheal intubation without muscle relaxants.Hemodynamic changes,intubation satisfaction,and operation time during tracheal intubation were compared between the two patient groups.Additionally,the baseline success rate,stimulation threshold,sensitivity,and specificity of TceMEP were compared between the two groups.Results There were no significant differences in hemodynamic changes and intubation satisfaction between the two patient groups during tracheal intubation(P＞0.05).The control group had an intubation time of(6.52±1.22)min,while the observation group had a significantly longer intubation time of(9.44±0.84)min(P＜0.05).The baseline success rate of TceMEP in the observation group was 100%,with an average stimulation threshold of(225.00±22.13).In contrast,the control group had a baseline success rate of 84.72%and an average stimulation threshold of(342.01±31.07)V for TceMEP monitoring prior to nailing procedures.The success rate of monitoring TceMEP after nailing in the control group was 93.06%,whereas it reached 100%in the observation group,demonstrating a statistically significant difference between the two groups(P＜0.05).There were no statistically significant differences in sensitiv-ity and specificity between the two groups for TceMEP monitoring results(P＞0.05).Conclusions The success rate of monitoring TceMEP baseline immediately after tracheal intubation without muscle relaxation is higher,with a smaller stimulation threshold.There were no differences in sensitivity and specificity compared to the baseline moni-toring of TceMEP after spinal exposure during the operation.

OBJECTIVE To investigate the improvement effect and potential mechanism of “Layers adjusting external application” paste on synovial fibrosis （SF） in rats with knee osteoarthritis （KOA）. METHODS Male SD rats were randomly divided into sham operation group， KOA group and Layers adjusting external application group， with 8 rats in each group. KOA model was induced by the anterior cruciate ligament disruption method in KOA group and Layers adjusting external application group. Fourteen days after modeling， the Layers adjusting external application group was given “Layers adjusting external application” paste [Sanse powder （8 g for every 100 cm2）， Compound sanhuang ointment （5 g for every 100 cm2）] on the knee joint， 8 h every day， for 28 d in total. After the last administration， the degree of synovitis and fibrosis in rats was observed， and Krenn scoring was performed in each group. The expressions of collagen Ⅰ， high mobility group protein B1 （HMGB1） and phosphorylated nuclear factor-κB p65 （p-NF-κB p65） were detected in the synovial membrane； the contents of interleukin-1β （IL- 1β）， IL-6 and tumor necrosis factor-α （TNF-α） in serum as well as the expressions of fibrosis-related and HMGB1/Toll-like receptor 4 （TLR4）/NF-κB signaling pathway-related proteins and mRNA were detected in synovial tissue. RESULTS Compared with the sham operation group， the synovial lining cells in the KOA group showed significant proliferation and disordered arrangement， the inflammatory cell infiltration and collagen fiber deposition were obvious； the positive expressing cells of collagen Ⅰ， HMGB1 and p-NF-κB p65 were increased significantly； the contents of IL-1β， IL-6 and TNF-α in serum， the expressions of fibrosis-related protein （transforming growth factor-β， collagen Ⅰ， tissue inhibitor of metalloproteinase 1， α-smooth muscle actin） and their mRNA as well as theexpressions of HMGB1， TLR4 protein and their mRNA， the expressions of p-NF-κB p65 protein and NF-κB p65 mRNA were all increased significantly in synovial tissues of rats （P＜0.01）. Compared with the KOA group， the pathological changes in the synovial tissue of rats in Layers adjusting external application group were significantly improved， and the above quantitative indicators were significantly reversed （P＜0.05 or P＜0.01）. CONCLUSIONS “Layers adjusting external application” paste could significantly improve SF in KOA rats， the mechanism of which may be associated with the inhibition of the activation of HMGB1/ TLR4/NF-κB signaling pathway.

BACKGROUND:Many studies have shown that total hip arthroplasty will improve low back pain in patients with hip-spine syndrome.However,there are few studies on the relationship between postoperative low back pain improvement and changes in spinal-pelvic sagittal parameters.This study aims to reveal their connections between the two. OBJECTIVE:To explore the relationship between the improvement of low back pain and changes in the spinal-pelvic sagittal parameters in patients with hip-spine syndrome after total hip arthroplasty. METHODS:A retrospective analysis was performed on the clinical and imaging data of 93 end-stage hip disease patients who underwent primary total hip arthroplasty and combined with low back pain and were admitted to Affiliated Hospital of Xuzhou Medical University from January 2019 to January 2022.Spinal-pelvic sagittal parameters were measured on lateral lumbar X-rays before surgery and 1 year at the last follow-up:pelvic incidence,pelvic tilt,sacral slope,lumbar lordosis,pelvic incidence-lumbar lordosis(difference between pelvic incident angle and lumbar lordosis angle).Visual analog scale score,Oswestry disability index,and hip Harris score were recorded before and 1 year after arthroplasty.The patients were divided into two groups according to whether the change in visual analog scale scores 1 year after surgery reached the minimal clinically important difference for low back pain treatment,including 45 cases in the low back pain unimproved group and 48 cases in the low back pain improved group.The preoperative general data of patients,differences in spinal-pelvic sagittal parameters,Oswestry Disability Index and hip Harris score before and after surgery were compared between the two groups. RESULTS AND CONCLUSION:(1)There was no significant difference in age,gender,surgical side,body mass index,and etiology between the two groups(P>0.05),and they were comparable.(2)There was no significant difference in visual analog scale scores before surgery(P>0.05).The visual analog scale scores of the low back pain improved group were lower than those of the low back pain unimproved group 1 year after surgery(P<0.01).(3)At 1 year after surgery,the lumbar lordosis of the low back pain unimproved group was significantly smaller than that before surgery,while the lumbar lordosis of the low back pain improved group was significantly smaller than that before surgery(P<0.01).At the same time,the pelvic incidence-lumbar lordosis mismatch in the low back pain unimproved group was greater than before surgery,while the pelvic incidence-lumbar lordosis mismatch in the low back pain improved group was smaller than before surgery,with significant differences between the two groups(P<0.01).There was no significant difference in the changes of other spinal-pelvic sagittal parameters between the two groups(P>0.05).(4)Preoperative lumbar Oswestry disability index and hip Harris score were not significantly different between the two groups(P>0.05).At 1 year after surgery,Oswestry disability index of the low back pain improved group was lower than that of the low back pain unimproved group and the hip Harris score was higher than that of the low back pain unimproved group(P<0.05).(5)The results showed that the improvement of low back pain was related to changes in spinal-pelvic sagittal parameters in patients with hip-spine syndrome after total hip arthroplasty,showing reduced lumbar lordosis and pelvic incidence-lumbar lordosis mismatch.Moreover,patients with improved low back pain after surgery had better functional scores,indicating that total hip arthroplasty improved spinal alignment and spinal-pelvic sagittal balance.For patients with hip-spine syndrome,a total hip arthroplasty performed before the onset of lumbar disease can have a favorable effect on the lumbar spine.