Oncolytic viruses can selectively infect and kill tumor cells.Since China's first oncolytic virus product re-combinant human 5 adenovirus H101 was approved for market in 2005,four oncolytic virus products have entered the market globally.More than 200 clinical trials of oncolytic virus therapies have been conducted worldwide.However,the number of globally approved indications for oncolytic virus products remains limited,and the potential patient populations and therapeutic mechanisms require further clinical investigation.To further optimize the clinical trial design of oncolytic virus products in China,this consensus was developed based on the"Guiding principles for clinical trial design of oncolytic virus drugs(trial version)"issued by the National Medical Products Administration(NMPA).Based on the medicine method,from the perspective of the mechanism of action of oncolytic virus,development indication,clinical application mode,clinical trial biology and pharmacodynamic detection,etc.,multidisciplinary expert meeting discussion and ques-tionnaire survey were carried out based on the considerations and related contents of the current clinical trial design of oncolytic virus.After three rounds of opinion collection,combing and summarizing,the"Chinese expert consensus on the key points of oncolytic virus clinical trial design(2024 edition)"was formed,aiming to provide references for sponsors and re-searchers of clinical trials of oncolytic virus products in China,help related products quickly go to market,and achieve new breakthroughs in tumor treatment.

Objective:To investigate the effect and mechanism of ginkgo acid(GA)on hepatic fibrosis in rats.Methods:CCl4 and TAA were used to construct rat liver fibrosis model,and GA or combined ferroptosis inhibitor(Fer-1)was given to intervene.The liver tissue and serum of rats were obtained and histopathologically evaluated by HE,Masson and Sirius red staining,respecively.The expression of HA,LN,Ⅳ-C and PC-Ⅲ in serum were detected by Elisa and the expression of GPX4 and FTH1 were detected by Western blot.Results:HE staining showed that,com-pared with TAA and CCl4 groups,the fibrosis level of GA group was significantly decreased.The results of Masoon and Sirius red staining showed that compared with TAA and CCl4 groups,the rate of collagen fibers in liver of GA group was significantly decreased(P＜0.05).Elisa results showed that compared with TAA and CCl4 groups,the levels of HA,LN,Ⅳ-C and PC-Ⅲ in serum of rats in GA group were significantly decreased(P＜0.05).After the intervention of GA com-bined with Fer-1,Western blot results showed that compared with TAA and CCl4 groups,the expression of GPX4 and FTH1 in liver of rats in GA group were significantly increased(P＜0.05).Compared with GA group,GPX4 and FTH1 levels in Fer group were significantly decreased(P＜0.05);The histopathological results showed that compared with GA group,the rate of liver collagen fibers in Fer group was significantly increased(P＜0.05).Conclusion:GA has anti-hepatic fi-brosis effect,which is associated with inducing ferroptosis.

Objective:Exploring gut microbiota alterations in gastric cancer and precancerous lesions and their As-sociation with the PI3K/AKT/mTOR signaling pathway.Methods:According to the propensity score matching"proximity method"with a ratio of 1∶1∶1,45 patients with gastric intraepithelial neoplasia(GIN)(precancerous group),45 patients with gastric cancer(gastric cancer group),and 45 healthy individuals(health examination center)(control group)were se-lected as the research subjects.High-throughput sequencing of 16S rRNA was used to detect intestinal flora.By oper-ating the taxonomic unit(OTU),the α diversity analysis,β diversity analysis,colony structure differences,and linear dis-criminant effect analysis(LEfSe)of the three groups of intestinal flora were compared,and the PI3K/AKT/mTOR signal-ing pathway in the three groups of feces were compared.The correlation between intestinal flora and PI3K/AKT/mTOR signaling pathway was analyzed using Pearson's method.Results:A total of 572 different OTUs were obtained from fecal sample sequencing,of which 287 were shared by three groups.Principal component analysis showed that there were statistically significant differences between three groups(P＜0.05).There was no significant difference in the Chao,Shannon,Simpson,and Observed indices among the three groups(P＞0.05).The species abundance and com-position of intestinal flora in the gastric cancer group were relatively dispersed,while those in the control group were closer.The precancerous group was in the middle,and there were statistically significant differences between the three groups(P＜0.05).The LEfSe significance analysis showed that at the phylum level,the abundance of Actinobacte-ria and Firmicutes in the gastric cancer group and precancerous group was lower than that in the control group,and the gastric cancer group was lower than the precancerous group.However,the abundance of Proteobacteria,Campylobac-teria,and Bacteroidetes increased,and the gastric cancer group was higher than the precancerous group;At the genus level,the abundance of Escherichia coli-Shigella in the gastric cancer group was higher than that in the control group,while the abundance of Bacteroides was lower than that in the control group,with statistically significant differences(P＜0.05).The levels of PI3K mRNA,AKT mRNA,and mTOR mRNA in the gastric cancer group and precancerous group were higher than those in the control group,and the precancerous group was higher than the control group,with sta-tistically significant differences(P＜0.05).Pearson correlation analysis showed that Enterobacteriaceae,Escherichia coli-Shigella were positively correlated with PI3K mRNA,AKT mRNA,and mTOR mRNA,while Bacteroides was negatively correlated with them.Conclusion:The diversity,structure,and abundance of gut microbiota are associated with the occurrence and progression of precancerous lesions in gastric cancer.Enterobacteriaceae,Escherichia coli-Shigella,and PI3K/AKT/mTOR signaling pathway gene expression are all associated to some extent,which can provide a refer-ence for clinical diagnosis of precancerous lesions,understanding the development mechanism of gastric cancer,and early intervention.

Objective:Exploring the role and mechanism of CHMP4C in regulating necroptosis during gastric can-cer development and progression.Method:The expression of CHMP4C in pan-cancer was analyzed by bioinformatics methods,and the expression of CHMP4C was detected in human normal gastric epithelial cells and GC cell lines by RT-qPCR and Western blot.Overexpression or knockdown of CHMP4C was performed in GC cell lines,and the effects of CHMP4C on the growth and proliferation of GC cells were detected using CCK-8 and clone formation assays.The CCK-8 experiment and Hoechst/PI double staining experiment were used to detect the changes in GC cell mortality and PI positive cell ratio after treatment with the necroptsis inducer TSZ or inhibitor necrostatin-1(Nec-1).Western blot assay was used to detect the protein and phosphorylation levels of RIPK1,RIPK3,and MLKL in GC cells.Result:CHMP4C was upregulated in GC tissues and cells.The CCK-8 and clone formation experiments showed that overex-pression of CHMP4C significantly improved the proliferation ability and colony formation efficiency of GC cells,while knockdown of CHMP4C significantly weakened GC cells.Moreover,the results of CCK-8 and Hoechst 33342/PI double staining experiments showed that upregulated CHMP4C could inhibit TSZ induced GC cell death;Nec-1 can reverse the decrease in GC cell viability caused by CHMP4C knockdown.Western blot experiment showed that the levels of p-RIPK1,p-RIPK3,and p-MLKL were significantly decreased in overexpressing cells,while they were increased in knockdown cells.After treatment with Nec-1,the expression levels of these three proteins decreased in knockdown cells.Conclusion:CHMP4C may promote GC progression by negatively regulating necroptosis through inhibiting the phosphorylation of the RIPK1/RIPK3/MLKL signaling pathway,suggesting that it is expected to be a potential target for GC therapy.

Objective:Elucidating causal links between gut microbiota and breast malignancies using mendelian randomization(MR)to Identify specific causal microbial taxa.Methods:Genome-wide association studies(GWAS)summary statistics on gut microbiota and breast malignancies,MiBioGen studied GWAS(N=18473)as exposure samples,and GWAS(N=123579)of breast malignancies in the IEU Open GWAS database as outcome samples.The in-verse variance weighted(IVW),weighted median and MR-Egger methods were used to analyze the MR statistical re-suits.Results:Increased abundance of Pasteurellales increased the risk of breast malignancy(IVW PFDR＜0.05,OR=1.21,95％Cl:1.07～1.36),heterogeneity test and pleiotropy test showed no effect on causality,and the"leave-one-out"method showed that the identified causal association was not driven by any single instrumental variable.The causal relationship is positive.Conclusion:Elevated abundance of pasteurellales in the gut microbiota is associated with an increased risk of breast malignancies

Objective:This study aimed to evaluate the application effect of opioid-free anesthesia(OFA)in modified radical mastectomy for breast cancer.Methods:80 patients undergoing unilateral modified radical mastec-tomy were randomly divided into two groups:general anesthesia group(G group)and OFA group(O group).The G group received general anesthesia with opioid drugs and a laryngeal mask,while the O group received general anes-thesia with intravenous lidocaine combined with thoracic paravertebral nerve block and a laryngeal mask.The average arterial pressure(MAP)and heart rate(HR)of the patients were recorded at the time of admission(T0),induction(T1),start of surgery(T2),gland resection(T3),and admission to the recovery room(T4).The surgical time,awakening time,ex-tubation time,and getting out of bed time were recorded.The VAS score at 2 hours(T5),6 hours(T6),and 12 hours(T7)after surgery,as well as the systemic immune-inflammatory index(SII)before surgery(T8),6 hours after surgery(T9),and 12 hours after surgery(T10)were recorded.The occurrence of postoperative nausea and vomiting(PONV)and post-mastectomy pain syndrome(PMPS)were recorded.The occurrence of adverse events such as poor nerve block effect,pneumothorax,hematoma,and local anesthetic toxicity were also recorded.Results:The MAP and HR of the O group were more stable than those of the G group during surgery(P＜0.05).The awakening time,extubation time,and getting out of bed time in the O group were earlier than those in the G group(P＜0.05).The VAS and SII values after surgery were significantly lower in the O group than in the G group(P＜0.05).The incidence of PONV was also signifi-cantly decreased(P＜0.05).In addition,no adverse events such as pneumothorax,hematoma,or local anesthetic toxic-ity occurred in the O group.Conclusion:Pioid-free anesthesia is safe and effective in modified radical mastectomy for breast cancer,shortening recovery time,time to first flatus,and time to ambulation,while alleviating postoperative pain,systemic inflammatory response,perioperative hemodynamic fluctuations,and the incidence of postoperative nau-sea and vomiting.

Chronic constipation is a common functional bowel disorder that significantly impacts patients'quality of life and mental health.The Surgical Diagnosis and Treatment Guidelines for Constipation were first published in 2008 and revised in 2017,respectively,and have contributed to the growth of constipation surgery in China.With a deeper understanding of the underlying mechanisms and advancements in minimally invasive surgical techniques,the branch has again assembled multidisciplinary experts to enhance the diagnosis and treatment system.Based on the latest local and global evidence and utilizing the GRADE system to assess the quality of evidence and strength of recommendations,they have developed the Guidelines for Surgical treatment of constipation(2025 Edition).The new edition systematically updates information on causes,diagnostic methods,and non-surgical and surgical treatment options for constipation.It clearly defines surgical indications and principles for procedure selection,emphasizing personalized treatment and evidence-based decision-making.This guideline aims to standardize diagnosis and treatment,improve clinical decision-making,and promote consistency and effectiveness in surgical approaches for treating constipation.

Obesity is a major global public health challenge and a leading cause of multiple metabolic disorders,including hypertension and diabetes.In China,more than half of the adult population is overweight or obese.While anti-obesity pharmacotherapies(such as GLP-1 receptor agonists)and bariatric surgery have both advanced rapidly,strategies for integrating these two modalities remain unclear.In particular,controversies persist regarding surgical eligibility after drug discontinuation,and standardized clinical guidelines are lacking.In July 2025,the International Federation for the Surgery of Obesity and Metabolic Disorders released the world's first statement focusing on"metabolic bariatric surgery after pharmacotherapy-induced weight loss",which emphasizes the chronic disease model of obesity management and clarifies the synergistic relationship between pharmacotherapy and surgery.This article interprets the statement from the perspectives of treatment strategies,surgical eligibility,and drug-surgery coordination,aiming to provide evidence-based reference for clinicians and to promote standardized,integrated obesity management.

Complex rectal cancer often requires extended multivisceral resection beyond the total mesorectal excision plane or lateral lymph node dissection(LLND)beyond the conventional range.Owing to the deep pelvic location,limited operating space,and complex local anatomy,conventional open or laparoscopic surgery is associated with restricted visualization,technical difficulty,and increased surgical risk.With the advancement of robot-assisted surgical technology,its high-definition three-dimensional vision,articulated robotic arms with multiple degrees of freedom,and ergonomic improvements effectively overcome the limitations of traditional laparoscopy,allowing precise manipulation in narrow pelvic spaces.These advantages have made robotic surgery increasingly valuable in complex rectal cancer procedures such as LLND and multivisceral resection.This review summarizes recent literature and the authors'clinical experience to discuss the feasibility,advantages,and limitations of robotic-assisted rectal cancer surgery.

Laparoscopic intersphincteric resection(ISR)represents a key technique for achieving maximal sphincter preservation in ultra-low rectal cancer.Based on 400 cases of surgical experience,this study proposes a series of systematic strategies addressing some major technical challenges of ISR.To facilitate precise dissection of the intersphincteric space,a"knife-edge position transanal-priority"approach was adopted,improving exposure and reducing the risk of circumferential margin positivity.To prevent and reduce anastomotic leakage,ISR combined with the modified Bacon(Turnbull-Cutait)delayed anastomosis was introduced as a"stoma-free but safe"alternative.For large anastomotic disruptions,a stoma-therapist-involved management protocol with transanal"U-shaped"repair was implemented to promote healing.Furthermore,a transabdominal levatorplasty was explored to enhance pelvic floor support and improve postoperative continence.Our initial experience suggests that,these strategies contribute to optimizing the balance between oncological radicality and functional preservation,offering a practical and individualized pathway for sphincter-saving surgery in ultra-low rectal cancer.