1.Peyton's Four-Step Teaching Method for Intestinal Ultrasound Training: Efficacy and Practical Implications
Zihan NIU ; Xiaoyan ZHANG ; Zhaojue WANG ; Qingli ZHU ; Mengsu XIAO ; Li MA ; Yudi HE ; Wenbo LI
Medical Journal of Peking Union Medical College Hospital 2026;17(2):591-596
To evaluate the application value of the Peyton four-step teaching method in the standardized training of intestinal ultrasound and compare it with traditional teaching methods, so as to provide an optimized approach for clinical ultrasound training. Participants from the Department of Ultrasound at Peking Union Medical College Hospital between September 2024 and March 2025 were randomly assigned to either the traditional group or Peyton group. The traditional group followed the conventional "lecture- demonstration-practice" model, while the Peyton group implemented the standardized "demonstration-deconstruction-comprehension-execution" four-step approach. All training focused on standard intestinal ultrasound scanning techniques. After the training, the operational skills were independently evaluated by the instructors. To verify the reproducibility of the teaching method, the participants in traditional teaching group received additional Peyton method training after the initial assessment and underwent a second evaluation. A total of 18 participants were included in this study, with 9 in the traditional teaching group and 9 in the Peyton teaching group. Participants in the Peyton group demonstrated significantly higher scores than those in the traditional group at every anatomical site assessed (all The Peyton four-step method is significantly more effective than traditional teaching in improving residents' intestinal ultrasound skills, demonstrating its suitability as the preferred approach for standardized training programs.
2.Establishment of a high-risk medication list and preventive and therapeutic measures for drug-induced hypofi-brinogenemia based on the Delphi method
Xiao WEN ; Le CAI ; Ning LIU ; Ao GAO ; Man ZHU
China Pharmacy 2026;37(7):848-853
OBJECTIVE To establish a high-risk medication list and preventive and therapeutic measures for drug-induced hypofibrinogenemia, and to provide a reference for the prevention and treatment of this condition. METHODS By integrating domestic and international case reports, retrospective case-control studies, and spontaneous adverse drug reaction reporting databases, 19 domestically marketed high-risk drugs for drug-induced hypofibrinogenemia were identified. Based on the clinical characteristics and mechanisms of these drugs, relevant risk factors were systematically reviewed, and existing treatment options were summarized, leading to the preliminary development of recommended preventive and therapeutic measures. A two-round Delphi consultation was conducted to evaluate, revise, and ultimately reach consensus on the preliminary findings, using a mean importance score of ≥3.5 points for indicators and a coefficient of variation <0.3 as screening criteria. RESULTS The coefficient of expert authority for both rounds of expert consultation was 0.904. In the first round, the Kendall coordination coefficients (Kendall’s W ) for the high-risk medication list and the proposed preventive and therapeutic measures were 0.390 and 0.223 ( P <0.05), respectively. In the second round, the Kendall’s W were 0.227 and 0.200 ( P <0.05), respectively. After two rounds of expert consultation and discussion, 11 high-risk drugs for drug-induced hypofibrinogenemia, represented by hemocoagulase and certain anti-infective agents, were ultimately identified, along with 5 preventive and therapeutic measures spanning the entire process of “pre-medication assessment, intra-medication monitoring, and bleeding event management”. CONCLUSIONS This study has established a scientific and reliable high-risk medication list, and corresponding preventive and therapeutic measures for drug-induced hypofibrinogenemia, providing a theoretical basis and practical support for the early identification, stratified management, and precise intervention of this condition.
3.Study on the improving mechanism of Yifei xuanfei jiangzhuo formula on vascular dementia model rats based on the GRB2/ERK/CRLS1 pathway
Guifeng ZHUO ; Wei CHEN ; Xiaomin ZHU ; Yulan FU ; Jinzhi ZHANG ; Lin WU
China Pharmacy 2026;37(7):877-882
OBJECTIVE To explore the improvine mechanism of Yifei xuanfei jiangzhuo formula (YFXF) on vascular dementia (VAD) model rats based on the growth factor receptor-bound protein 2 (GRB2)/extracellular signal-regulated kinase (ERK)/cardiolipin synthase 1 (CRLS1) pathway. METHODS VAD rat model was established by permanent bilateral common carotid artery ligation. Forty-eight successfully modeled rats were randomly divided into the model group (normal saline), donepezil hydrochloride group (positive control group, 0.2 g/kg), and YFXF low- and high-dose groups (12.18 and 24.36 g/kg, calculated based on the total amount of crude drug), respectively. In addition, a sham operation group (normal saline) was set up. There were 12 rats in each group. Daily intragastric administration of drug or normal saline was performed for 30 consecutive days. After the last administration, the spatial cognitive ability of the rats was evaluated, the pathological morphology of the hippocampus was observed, the contents of tumor necrosis factor-α (TNF-α) and interleukin-4 (IL-4) in serum were detected, the expression levels of GRB2/ERK/CRLS1 pathway-related proteins and the mRNA levels of GRB2, CRLS1, NADH dehydrogenase subunit 1(ND1), Tafazzin (TAZ), phospholipid scramblase 3(PLSCR3) and the ATP content in hippocampal tissue were measured. RESULTS Compared with the sham operation group, the escape latency of rats in the model group was significantly prolonged ( P <0.05), and the number of crossing platform was significantly reduced ( P <0.05), while the number of pyramidal cells and Nissl bodies in the hippocampus decreased sharply; the content of TNF-α in serum was significantly increased ( P <0.05), and the content of IL-4 was significantly decreased ( P <0.05); the expression levels of GRB2 and CRLS1 proteins, the phosphorylation level of ERK protein, the relative expression levels of GRB2, CRLS1,ND1, TAZ, and PLSCR3 mRNA, and the content of ATP in hippocampal tissue were significantly decreased ( P <0.05). Compared with the model group, the above pathological changes in the hippocampal tissue of each administration group were alleviated, and the quantitative indicators were significantly restored ( P <0.05). CONCLUSIONS YFXF may improve hippocampal neuron injury in VAD rats by activating the GRB2/ERK/CRLS1 pathway, maintaining cardiolipin homeostasis, and improving mitochondrial energy metabolism.
4.In Vitro Anti-psoriatic Effect of Kangfuxin Liquid via Inhibiting Cell Proliferation and Migration Ability and Blocking JAK3/STAT3 Signaling Pathway
Shuai LI ; Xuan LIU ; Wenyan TANG ; Zhenqi WU ; Chunhui CHEN ; Dadan QIU ; Yi XU ; Chenggui ZHANG ; Jianquan ZHU ; Jiali ZHU
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(10):123-133
ObjectiveThis paper aims to explore the in vitro anti-psoriasis activity and potential mechanism of Kangfuxin liquid (KFX liquid), providing experimental evidence for the anti-psoriasis effect of KFX liquid. MethodsFirstly, the uninduced human immortalized keratinocyte cells (HaCaT cells) were divided into seven groups, namely the control group and KFX liquid groups with different doses (5, 10, 20, 40, 80, 160 g·L-1). After being treated with different concentrations of KFX liquid, the effect of KFX liquid on the normal cell proliferation was detected by using the cell counting kit-8 (CCK-8) method. Secondly, the uninduced HaCaT cells were divided into six groups, namely the control group and recombinant human interleukin-7A (rh-IL-7A) groups with different doses (5, 10, 50, 100, 120 g·L-1). After being treated with different concentrations of recombinant human interleukin-17A (rh IL-17A) liquid, the effect of rh IL-17A on cell proliferation was detected. The optimal induction concentration was screened. Then, normal HaCaT cells were divided into a control group and KFX liquid groups with different doses (5, 10, 20, 40, 80, 160 g·L-1). Except for the control group, the other groups established psoriasis cell models with the optimal induction concentration of rh IL-17A. After being treated with different concentrations of KFX liquid, the effects of KFX liquid on the psoriasis-like HaCaT cell proliferation were investigated. Finally, the uninduced HaCaT cells were divided into six groups, namely the control group, rh IL-17A group, methotrexate (MTX) group, and KFX liquid groups with different doses (20, 40, 80 g·L-1). Except for the control group, the other groups used the optimal induction concentration of rh IL-17A to establish psoriasis cell models. After being treated with different drugs, the cell migration levels were detected through scratch assays, and real-time quantitative polymerase chain reaction (Real-time PCR) was used to detect the relative mRNA expression levels of Ki-67 antigen (Ki67), S100 calcium-binding protein A7 (S100A7), S100 calcium-binding protein A8 (S100A8), and S100 calcium-binding protein A9 (S100A9), thereby comprehensively evaluating the in vitro anti-psoriasis activity of KFX liquid. By detecting the relative mRNA expression levels of interleukin-1β (IL-1β), interleukin-6 (IL-6), and chemokine-20 (CXCL-20) inflammatory-related factors in psoriasis-like HaCaT cells and the protein expression levels of Janus kinase 3 (JAK3), phosphorylated Janus kinase 3 (p-JAK3), signal transducer and activator of transcription 3 (STAT3), and phosphorylated signal transducer and activator of transcription 3 (p-STAT3), the mechanism was explored. ResultsCompared with that of control group, when treated with 80 g·L-1 KFX liquid for 72 h (P<0.05) and at different times with 160 g·L-1 KFX liquid, the HaCaT cell proliferation activity was significantly affected (P<0.01), while the other concentrations of KFX liquid had no significant differences in cell morphology and cell proliferation activity at different times, indicating that the KFX liquid is relatively safe for HaCaT cells and has no obvious toxic side effects. Compared with that of control group, when treated with different concentrations of rh IL-17A for 24 h, the HaCaT cell proliferation activity was significantly enhanced, and the cell activity was the strongest when the concentration was 100 μg·L-1 (P<0.05), with a density close to 100% and intact cell morphology, indicating that 100 μg·L-1 is the optimal concentration for inducing HaCaT cell proliferation. The results of the KFX liquid treatment on rh IL-17A-induced psoriasis-like cells show that the KFX liquid not only effectively inhibits the rh IL-17A-induced psoriasis-like HaCaT cell proliferation activity (P<0.01), but also significantly reduces the migration ability of rh IL-17A-induced psoriasis-like HaCaT cells (P<0.01), and the relative mRNA expression levels of Ki67, S100A7, S100A8, and S100A9 (P<0.01). Moreover, the KFX liquid can significantly reduce the relative mRNA expression levels of IL-1β, IL-6, and CXCL-20 in rh IL-17A-induced psoriasis-like cells (P<0.01), and significantly inhibit the phosphorylation levels of JAK3 and STAT3 proteins (P<0.05, P<0.01). ConclusionThe KFX liquid has no obvious toxicity to uninduced HaCaT cells. It can inhibit rh IL-17A-induced psoriasis-like HaCaT cell proliferation, reduce the cell migration ability, and has good in vitro anti-psoriasis activity. Its action mechanism may be related to downregulating the expression levels of inflammation-related cytokines in the JAK3/STAT3 signaling pathway and inhibiting the phosphorylation levels of JAK3 and STAT3 proteins.
5.Construction, Validation, and Application of Diagnostic Model Integrating Traditional Chinese and Western Medicine for Coronary Artery Stenosis Complicated with Cardiovascular-kidney-metabolic Syndrome
Shidian ZHU ; Yanlin LIU ; Fuming LIU
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(10):170-181
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.
6.Preparation of Triptolide-Chuanxiong Rhizoma Extract Ethanol Transfersomes and Analysis on Its in Vitro Anti-inflammatory Mechanism
Ling TAO ; Zhiyan WAN ; Yidan LIU ; Zhe LI ; Zhenzhong ZANG ; Weifeng ZHU ; Yongmei GUAN
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(10):210-218
ObjectiveTo prepare triptolide-Chuanxiong Rhizoma extract ethanol transfersomes(TP-CX@TESs), conduct its quality evaluation, and investigate its in vitro anti-inflammatory efficacy and the underlying mechanisms. MethodsTP-CX@TESs was prepared via the ultrasonic injection method. With encapsulation efficiency and particle size as evaluation indicators, Box-Behnken design-response surface methodology(BBD-RSM) was employed to optimize the formulation process. The TP-CX@TESs prepared under the optimal process was characterized and evaluated for in vitro transdermal performance. A lipopolysaccharide(LPS)-induced RAW264.7 cell inflammation model was established. After 24 h of drug intervention, the levels of inflammatory factors such as nitric oxide(NO), interleukin-6(IL-6), and tumor necrosis factor-α(TNF-α) in the cell supernatant were detected. Western blot was used to determine the protein expression levels of Janus kinase 2(JAK2), signal transducer and activator of transcription 3(STAT3), and α7 nicotinic acetylcholine receptor(α7nAChR), and real-time fluorescence quantitative polymerase chain reaction(Real-time PCR) was applied to measure the mRNA expression levels of JAK2, STAT3, the encoding gene of α7nAChR(CHRNA7), and nuclear transcription factor-κB(NF-κB). ResultsResults of BBD-RSM showed that the optimal formulation for preparing TP-CX@TESs was as follows:egg yolk lecithin content of 2.3%, ethanol volume fraction of 30%, and ratio of polysorbate-80 to egg yolk lecithin of 2∶5. Microscopic characterization revealed that TP-CX@TESs exhibited a spherical-like structure with a particle size of (105.60±3.85) nm, a polydispersity index of 0.19±0.03, and a Zeta potential of (-15.89±0.98) mV. The encapsulation efficiencies of triptolide, ferulic acid, and ligustilide were (76.88±4.40)%, (78.84±4.40)%, and (65.88±0.06)%, respectively. Both in vitro release and transdermal penetration of triptolide, ferulic acid, and ligustilide in TP-CX@TESs all followed the first-order kinetic model, showing a certain sustained-release property. Experimental results in RAW264.7 cells indicated that TP-CX@TESs significantly inhibited the release of NO, TNF-α, and IL-6(P<0.01), remarkably upregulated the protein expression levels of STAT3 and α7nAChR(P<0.01), increased the mRNA expression level of CHRNA7, and significantly downregulated the mRNA expression level of NF-κB(P<0.05, P<0.01). ConclusionThe optimized formulation process of TP-CX@TESs is simple and feasible, along with favorable in vitro release property, good transdermal permeability, and excellent in vitro anti-inflammatory activity, the mechanism is related to the inhibition of NF-κB.
7.Historical Evolution and Key Information Research on Classic Formula Puji Xiaoduyin
Lianchao ZHU ; Lyuyuan LIANG ; Jing TANG ; Jialei CAO ; Ziming XU ; Huizhen ZHANG ; Zhidan GUO ; Rongze MA ; Zhengshao ZHANG ; Bingqi WEI ; Xiubo DU ; Bingxiang MA
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(10):238-247
Puji Xiaoduyin, a specialized formula for the swollen-head epidemic, was recorded in the Catalogue of Ancient Classical Formula (the Second Batch)-Han Medicine, published in September 2023. It had been inherited and developed by medical experts of successive generations and passed down to this day. This paper sorted out the historical evolution of this formula using bibliometric methods. It also comprehensively analyzed key information on the formula name, historical origin, drug dosage, herb origin, processing methods, decocting methods, function, and clinical applications. Additionally, this paper analyzed the application of this formula in both modern and ancient times. Results showed that the formula was first recorded as "Puji Xiaodu Yinzi" in LI Dongyuan's Proven Formulas written by LI Gao from the Jin dynasty. The medicinal composition and dosage were: Scutellariae Radix and Coptidis Rhizoma (20.65 g each), Ginseng Radix et Rhizoma 12.39 g, Scrophulariae Radix, Citri Reticulatae Pericarpium, and Glycyrrhizae Radix et Rhizoma (8.26 g each), Forsythiae Fructus, Arctii Fructus, Isatidis Radix, and Lasiosphaera Calvatia (4.13 g each), Bombyx Batryticatus and Cimicifugae Rhizoma (2.891 g each), Bupleuri Radix and Platycodonis Radix (8.26 g each). These medicines were grounded to fine powder. One dose, including 20.65 g of the powder, was mixed with 600 mL of water and decocted to 300 mL. After abandoning slag, the medicine should be taken warm frequently. In the formula, Bombyx Batryticatus is stir-fired. With the effect of dispersing wind and clearing heat, removing stagnation and dissipating mass, the formula is specialized in swollen-head epidemic, pestilence, red and swelling head, face, and neck, dry mouth and tongue, as well as other diseases resulting from toxic heat stagnated in the upper jiao. The formula is widely used in treating diseases involving the respiratory, dermal, ophthalmologic, otolaryngologic, and nervous systems. The formula is most frequently used for respiratory diseases, with a wide range of symptoms including parotitis/mumps (66 times), followed by tonsillitis (28 times). In conclusion, the broadly applied formula has accurate efficacy and great development value.
8.In Vitro Anti-psoriatic Effect of Kangfuxin Liquid via Inhibiting Cell Proliferation and Migration Ability and Blocking JAK3/STAT3 Signaling Pathway
Shuai LI ; Xuan LIU ; Wenyan TANG ; Zhenqi WU ; Chunhui CHEN ; Dadan QIU ; Yi XU ; Chenggui ZHANG ; Jianquan ZHU ; Jiali ZHU
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(10):123-133
ObjectiveThis paper aims to explore the in vitro anti-psoriasis activity and potential mechanism of Kangfuxin liquid (KFX liquid), providing experimental evidence for the anti-psoriasis effect of KFX liquid. MethodsFirstly, the uninduced human immortalized keratinocyte cells (HaCaT cells) were divided into seven groups, namely the control group and KFX liquid groups with different doses (5, 10, 20, 40, 80, 160 g·L-1). After being treated with different concentrations of KFX liquid, the effect of KFX liquid on the normal cell proliferation was detected by using the cell counting kit-8 (CCK-8) method. Secondly, the uninduced HaCaT cells were divided into six groups, namely the control group and recombinant human interleukin-7A (rh-IL-7A) groups with different doses (5, 10, 50, 100, 120 g·L-1). After being treated with different concentrations of recombinant human interleukin-17A (rh IL-17A) liquid, the effect of rh IL-17A on cell proliferation was detected. The optimal induction concentration was screened. Then, normal HaCaT cells were divided into a control group and KFX liquid groups with different doses (5, 10, 20, 40, 80, 160 g·L-1). Except for the control group, the other groups established psoriasis cell models with the optimal induction concentration of rh IL-17A. After being treated with different concentrations of KFX liquid, the effects of KFX liquid on the psoriasis-like HaCaT cell proliferation were investigated. Finally, the uninduced HaCaT cells were divided into six groups, namely the control group, rh IL-17A group, methotrexate (MTX) group, and KFX liquid groups with different doses (20, 40, 80 g·L-1). Except for the control group, the other groups used the optimal induction concentration of rh IL-17A to establish psoriasis cell models. After being treated with different drugs, the cell migration levels were detected through scratch assays, and real-time quantitative polymerase chain reaction (Real-time PCR) was used to detect the relative mRNA expression levels of Ki-67 antigen (Ki67), S100 calcium-binding protein A7 (S100A7), S100 calcium-binding protein A8 (S100A8), and S100 calcium-binding protein A9 (S100A9), thereby comprehensively evaluating the in vitro anti-psoriasis activity of KFX liquid. By detecting the relative mRNA expression levels of interleukin-1β (IL-1β), interleukin-6 (IL-6), and chemokine-20 (CXCL-20) inflammatory-related factors in psoriasis-like HaCaT cells and the protein expression levels of Janus kinase 3 (JAK3), phosphorylated Janus kinase 3 (p-JAK3), signal transducer and activator of transcription 3 (STAT3), and phosphorylated signal transducer and activator of transcription 3 (p-STAT3), the mechanism was explored. ResultsCompared with that of control group, when treated with 80 g·L-1 KFX liquid for 72 h (P<0.05) and at different times with 160 g·L-1 KFX liquid, the HaCaT cell proliferation activity was significantly affected (P<0.01), while the other concentrations of KFX liquid had no significant differences in cell morphology and cell proliferation activity at different times, indicating that the KFX liquid is relatively safe for HaCaT cells and has no obvious toxic side effects. Compared with that of control group, when treated with different concentrations of rh IL-17A for 24 h, the HaCaT cell proliferation activity was significantly enhanced, and the cell activity was the strongest when the concentration was 100 μg·L-1 (P<0.05), with a density close to 100% and intact cell morphology, indicating that 100 μg·L-1 is the optimal concentration for inducing HaCaT cell proliferation. The results of the KFX liquid treatment on rh IL-17A-induced psoriasis-like cells show that the KFX liquid not only effectively inhibits the rh IL-17A-induced psoriasis-like HaCaT cell proliferation activity (P<0.01), but also significantly reduces the migration ability of rh IL-17A-induced psoriasis-like HaCaT cells (P<0.01), and the relative mRNA expression levels of Ki67, S100A7, S100A8, and S100A9 (P<0.01). Moreover, the KFX liquid can significantly reduce the relative mRNA expression levels of IL-1β, IL-6, and CXCL-20 in rh IL-17A-induced psoriasis-like cells (P<0.01), and significantly inhibit the phosphorylation levels of JAK3 and STAT3 proteins (P<0.05, P<0.01). ConclusionThe KFX liquid has no obvious toxicity to uninduced HaCaT cells. It can inhibit rh IL-17A-induced psoriasis-like HaCaT cell proliferation, reduce the cell migration ability, and has good in vitro anti-psoriasis activity. Its action mechanism may be related to downregulating the expression levels of inflammation-related cytokines in the JAK3/STAT3 signaling pathway and inhibiting the phosphorylation levels of JAK3 and STAT3 proteins.
9.Construction, Validation, and Application of Diagnostic Model Integrating Traditional Chinese and Western Medicine for Coronary Artery Stenosis Complicated with Cardiovascular-kidney-metabolic Syndrome
Shidian ZHU ; Yanlin LIU ; Fuming LIU
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(10):170-181
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.
10.Preparation of Triptolide-Chuanxiong Rhizoma Extract Ethanol Transfersomes and Analysis on Its in Vitro Anti-inflammatory Mechanism
Ling TAO ; Zhiyan WAN ; Yidan LIU ; Zhe LI ; Zhenzhong ZANG ; Weifeng ZHU ; Yongmei GUAN
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(10):210-218
ObjectiveTo prepare triptolide-Chuanxiong Rhizoma extract ethanol transfersomes(TP-CX@TESs), conduct its quality evaluation, and investigate its in vitro anti-inflammatory efficacy and the underlying mechanisms. MethodsTP-CX@TESs was prepared via the ultrasonic injection method. With encapsulation efficiency and particle size as evaluation indicators, Box-Behnken design-response surface methodology(BBD-RSM) was employed to optimize the formulation process. The TP-CX@TESs prepared under the optimal process was characterized and evaluated for in vitro transdermal performance. A lipopolysaccharide(LPS)-induced RAW264.7 cell inflammation model was established. After 24 h of drug intervention, the levels of inflammatory factors such as nitric oxide(NO), interleukin-6(IL-6), and tumor necrosis factor-α(TNF-α) in the cell supernatant were detected. Western blot was used to determine the protein expression levels of Janus kinase 2(JAK2), signal transducer and activator of transcription 3(STAT3), and α7 nicotinic acetylcholine receptor(α7nAChR), and real-time fluorescence quantitative polymerase chain reaction(Real-time PCR) was applied to measure the mRNA expression levels of JAK2, STAT3, the encoding gene of α7nAChR(CHRNA7), and nuclear transcription factor-κB(NF-κB). ResultsResults of BBD-RSM showed that the optimal formulation for preparing TP-CX@TESs was as follows:egg yolk lecithin content of 2.3%, ethanol volume fraction of 30%, and ratio of polysorbate-80 to egg yolk lecithin of 2∶5. Microscopic characterization revealed that TP-CX@TESs exhibited a spherical-like structure with a particle size of (105.60±3.85) nm, a polydispersity index of 0.19±0.03, and a Zeta potential of (-15.89±0.98) mV. The encapsulation efficiencies of triptolide, ferulic acid, and ligustilide were (76.88±4.40)%, (78.84±4.40)%, and (65.88±0.06)%, respectively. Both in vitro release and transdermal penetration of triptolide, ferulic acid, and ligustilide in TP-CX@TESs all followed the first-order kinetic model, showing a certain sustained-release property. Experimental results in RAW264.7 cells indicated that TP-CX@TESs significantly inhibited the release of NO, TNF-α, and IL-6(P<0.01), remarkably upregulated the protein expression levels of STAT3 and α7nAChR(P<0.01), increased the mRNA expression level of CHRNA7, and significantly downregulated the mRNA expression level of NF-κB(P<0.05, P<0.01). ConclusionThe optimized formulation process of TP-CX@TESs is simple and feasible, along with favorable in vitro release property, good transdermal permeability, and excellent in vitro anti-inflammatory activity, the mechanism is related to the inhibition of NF-κB.

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