Digital and intelligent technologies serve as the core engine driving the inheritance of the essence and the innovation while upholding the fundamentals of traditional Chinese medicine（TCM）. Currently， the digital and intelligent transformation of TCM has undergone four developmental stages， exhibiting inherent characteristics such as long-term inevitability， objective standardization， and ecological evolution. By introducing quantitative metrics， digital and intelligent technologies have achieved breakthroughs in TCM knowledge inheritance and innovation， clinical diagnosis and treatment， and herbal medicine supply. The practical applicability of methodological innovations has been empirically validated， though significant disparities exist in technological adaptability and application depth across different fields. Overall， the digital and intelligent transformation of TCM remains in its nascent stage， grappling with multiple structural challenges：weak data foundations， inadequate technological adaptability， incomplete institutional frameworks， shortages of multidisciplinary talent， lagging policies and regulations， and urban-rural digital divide. In order to foster sustainable development and modernization of TCM， this paper establishes a six-dimensional collaborative governance framework of encompassing data， technology， organization， institutions， environment and ethics， which is rooted in data governance and digital governance theories. Future efforts should center on standardization， integration， and ecosystem development to build a data and technology foundation. Focus should be placed on deepening innovation and application of key TCM-specific technologies， while simultaneously strengthening interdisciplinary talent cultivation， improving institutional mechanisms and policy frameworks， and increasing support for rural areas. By adopting a people-centered and technology-empowered approach， we can overcome developmental constraints and unleash the powerful driving force of digital and intelligent technologies for the inheritance of TCM.

The establishment of modern biliary surgery system, alongside pivotal scientific paradigm shifts, has heralded a new era featured by precision, personalization, life-cycle care, and multidisciplinary management in the treatment of both benign and malignant biliary diseases. However, two formidable challenges persist in haunting the treatment of biliary diseases: (1) The refinement of surgical techniques has reached a plateau in reducing the disability associated with benign biliary conditions and in improving survival outcomes in biliary tract cancers; (2) Traditional evidence-based clinical studies have shown limited power in addressing complex dilemmas, such as determining whether to excise or preserve pathological gallbladders or selecting the optimal biliary drainage strategy. Consequently, the authors propose the conceptual framework of “biliary ecosystem”. In this model, diverse and abundant cholangiocytes represent forest, while blood vessels, nerves, and lymphatic vessels serve as nurturing soil, biliary stem cells function as seeds, bile flows like river network, and hepatocytes mark the river′s origins. Both benign and malignant biliary diseases exhibit significant spatiotemporal dynamics. The bile ducts form the “macro” environment, bile constitutes the “sub-macro” environment, and diverse cellular niches create the microenvironment. Specific pathological biliary conditions are shaped by intricate regulatory mechanisms that operate across these three tiers. Within the biliary ecosystem, cellular subpopulations exist remarkable diversity with states of homeostasis, oscillation, perturbation, or imbalance, underpinned by complex signaling networks. This holistic approach allows us to reframe and critically examine the pressing scientific issues confronting biliary tract diseases. Based on this framework, the authors distill key scientific questions and offer preliminary recommendations for embracing the paradigm shift. The authors anticipate that this conceptual model will promote interdisciplinary integration and accelerate clinical and translational researches.

Objective To investigate the regulation of LINC01667 on fatty acid binding protein 5(FABP5)and its effect on fatty acid metabolism in hepatocellular carcinoma(HCC)cells.Methods Based on the dual luciferase reporter assay,the binding ability of LINC01667 to FABP5 promoter and its regulatory effect on promoter activity were detected..In addition,the effects of overexpression of LINC01667 on the content of in-tracellular lipid droplets in HCC cells and on the cellular free fatty acid uptake capacity were detected by Nile red staining and free fatty acid uptake assay,respectively.The effect of LINC01667/FABP5 on the migration and invasion of HCC cells was observed by Transwell experiment.Results LINC01667 could bind to FABP5 promoter and up-regulate FABP5 expression(P＜0.05).Overexpression of LINC01667 could enhance the ac-cumulation of lipid droplets in HepG2 and HuH7 cells and enhance the uptake of free fatty acids(P＜0.05).After targeted inhibition of FABP5,the enhancement of free fatty acid uptake of HCC cells mediated by LINC01667 and its migration and invasion ability were significantly weakened(P＜0.01).Conclusion LINC01667 could remodel the fatty acid metabolism of HCC cells through the up-regulation of FABP5,and then promote the malignant process of HCC.

Objective:To explore the role of chemokine CX3CL1/CX3CR1 in intraperitoneal metastasis of ovarian cancer in nude mice.Methods:Fifty SPF SD female nude mice were selected and randomly divided into normal group ( n=10) , ovarian cancer model group ( n=20) and CX3CL1 group ( n=20) by random number table method. Ovarian cancer model was not established in normal group, and ovarian cancer model was established in both ovarian cancer model group and CX3CL1 group. CX3CL1 group was given intraperitoneal injection of 20 μl CX3CL1 with a concentration of 10 ng/μl to observe the survival status of nude mice. Tumor mass, tumor volume, tumor inhibition rate, ascites rate and peritoneal metastasis rate were recorded. The pathological morphology of ovarian tissue was examined by HE staining, the expression of CX3CL1/CX3CR1 in ovarian tissue was detected by Western blotting, and the correlation between the expression of CX3CL1/CX3CR1 and peritoneal metastasis rate was analyzed by point two-column correlation. Results:During the administration, the mental state, activity, food and water intake of nude mice in the normal group were good with sensitive responses. The nude mice in the ovarian cancer model group showed signs of mental fatigue, reduced activity, less food and water intake, delayed response, as well as and a hard and gradually enlarged abdomen. The mental state, activity, food and water intake of nude mice in CX3CL1 group were better than those in ovarian cancer model group, and the abdominal hardness volume was smaller compared with that in ovarian cancer model group. The survival time of normal group, ovarian cancer model group and CX3CL1 group were (14.00±0.00) , (9.24±0.67) and (12.05±0.82) d, respectively, with a statistically significant difference ( F=22.27, P<0.001) . Further pair-to-pair comparisons showed that the normal group had the longest survival time, followed by the CX3CL1 group and the ovarian cancer model group (all P<0.05) . The tumor mass of ovarian cancer model group and CX3CL1 group was (1.31±0.21) and (0.62±0.13) g, respectively, with a statistically significant difference ( t=12.49, P<0.001) . The tumor volumes were (130.47±13.45) and (70.02±7.52) mm 3, respectively, with a statistically significant difference ( t=17.54, P<0.001) . The tumor suppression rates were (0.00±0.00) % and (48.96±4.74) %, respectively, with a statistically significant difference ( t=46.19, P<0.001) , the ascites rates were 60.00% (12/20) and 25.00% (5/20) , respectively, with a statistically significant difference ( χ2=5.01, P=0.025) . The abdominal metastasis rates were 80.00% (16/20) and 50.00% (10/20) , respectively, with a statistically significant difference ( χ2=3.96, P=0.047) . The results of HE staining showed that in the normal group, the ovarian tissue structure was complete, the follicles and oocytes developed normally with good shape, and no cancerous cells were found. The ovarian structure of the ovarian cancer model group was obviously destroyed, and a large number of cancerous cells could be seen. The nucleolus were deeply stained and the number increased. Compared with the ovarian cancer model group, the pathological structure was significantly improved, and the number of cancer cells was significantly decreased in the CX3CL1 group. The CX3CL1 protein relative expression levels in normal group, ovarian cancer model group and CX3CL1 group were 2.05±0.22, 1.33±0.11 and 2.41±0.24, respectively, with a statistically significant difference ( F=9.26, P<0.001) . The CX3CR1 protein relative expression levels were 1.99±0.21, 1.34±0.14, 2.73±0.31, respectively, with a statistically significant difference ( F=8.14, P<0.001) . Further pair-to-pair comparisons showed that compared with the normal group, the relative expression levels of CX3CL1 and CX3CR1 protein in ovarian cancer model group were significantly decreased, and the relative expression levels of CX3CL1 and CX3CR1 protein were higher in CX3CL1 group (all P<0.05) . Compared with ovarian cancer model group, the relative expression levels of CX3CL1 and CX3CR1 protein in ovarian tissue of CX3CL1 group were significantly increased (both P<0.05) . Correlation analysis showed that CX3CL1 and CX3CR1 expressions were negatively correlated with peritoneal metastasis rate ( r=-0.50, P=0.024; r=-0.58, P=0.012) . Conclusions:The expression of chemokine CX3CL1/CX3CR1 is down-regulated in ovarian cancer, and CX3CL1/CX3CR1 expression is negatively correlated with peritoneal metastasis of ovarian cancer. Activation of CX3CL1/CX3CR1 can significantly inhibit peritoneal metastasis of ovarian cancer.

Chaihu Longgu Muli Decoction can be used to treat perimenopausal insomnia (PMI). It can be used either alone with modification or in combination with Western medicine or acupuncture and moxibustion and other external TCM treatment methods, which has achieved good efficacy, and can improve the symptoms of patients with difficulty falling asleep and decreased sleep quality, with good safety. The treatment of Chaihu Longgu Muli Decoction for PMI may exert its effects through multiple pathways, such as inhibiting HPA axis hyperactivity, regulating hormone and neurotransmitter levels, inhibiting oxidative stress and inflammatory responses. However, existing clinical studies suffer from issues such as small sample sizes, inconsistent research protocols, and inconsistent efficacy evaluation criteria, which require further improvement and deeper exploration of relevant mechanisms.

Obstructive sleep apnea (OSA) is an increasingly widespread sleep-breathing disordered disease, and is an independent risk factor for many high-risk chronic diseases such as hypertension, coronary heart disease, stroke, arrhythmias and diabetes, which is potentially fatal. The key to the prevention and treatment of OSA is early diagnosis and treatment, so the assessment and diagnostic technologies of OSA have become a research hotspot. This paper reviews the research progresses of severity assessment parameters and diagnostic technologies of OSA, and discusses their future development trends. In terms of severity assessment parameters of OSA, apnea hypopnea index (AHI), as the gold standard, together with the percentage of duration of apnea hypopnea (AH%), lowest oxygen saturation (LSpO₂), heart rate variability (HRV), oxygen desaturation index (ODI) and the emerging biomarkers, constitute a multi-dimensional evaluation system. Specifically, the AHI, which measures the frequency of sleep respiratory events per hour, does not fully reflect the patients’ overall sleep quality or the extent of their daytime functional impairments. To address this limitation, the AH%, which measures the proportion of the entire sleep cycle affected by apneas and hypopneas, deepens our understanding of the impact on sleep quality. The LSpO₂ plays a critical role in highlighting the potential severe hypoxic episodes during sleep, while the HRV offers a different perspective by analyzing the fluctuations in heart rate thereby revealing the activity of the autonomic nervous system. The ODI provides a direct and objective measure of patients’ nocturnal oxygenation stability by calculating the number of desaturation events per hour, and the biomarkers offers novel insights into the diagnosis and management of OSA, and fosters the development of more precise and tailored OSA therapeutic strategies. In terms of diagnostic techniques of OSA, the standardized questionnaire and Epworth sleepiness scale (ESS) is a simple and effective method for preliminary screening of OSA, and the polysomnography (PSG) which is based on recording multiple physiological signals stands for gold standard, but it has limitations of complex operations, high costs and inconvenience. As a convenient alternative, the home sleep apnea testing (HSAT) allows patients to monitor their sleep with simplified equipment in the comfort of their own homes, and the cardiopulmonary coupling (CPC) offers a minimal version that simply analyzes the electrocardiogram (ECG) signals. As an emerging diagnostic technology of OSA, machine learning (ML) and artificial intelligence (AI) adeptly pinpoint respiratory incidents and expose delicate physiological changes, thus casting new light on the diagnostic approach to OSA. In addition, imaging examination utilizes detailed visual representations of the airway’s structure and assists in recognizing structural abnormalities that may result in obstructed airways, while sound monitoring technology records and analyzes snoring and breathing sounds to detect the condition subtly, and thus further expands our medical diagnostic toolkit. As for the future development directions, it can be predicted that interdisciplinary integrated researches, the construction of personalized diagnosis and treatment models, and the popularization of high-tech in clinical applications will become the development trends in the field of OSA evaluation and diagnosis.

Objective To explore the recognition capabilities of electronic nose combined with machine learning in identifying the breath odor map of benign and malignant pulmonary nodules and Traditional Chinese Medicine (TCM) syndrome elements. Methods The study design was a single-center observational study. General data and four diagnostic information were collected from 108 patients with pulmonary nodules admitted to the Department of Cardiothoracic Surgery of Hospital of Chengdu University of TCM from April 2023 to March 2024. The patients' TCM disease location and nature distribution characteristics were analyzed using the syndrome differentiation method. The Cyranose 320 electronic nose was used to collect the odor profiles of oral exhalation, and five machine learning algorithms including random forest (RF), K-nearest neighbor (KNN), logistic regression (LR), support vector machine (SVM), and eXtreme gradient boosting (XGBoost) were employed to identify the exhaled breath profiles of benign and malignant pulmonary nodules and different TCM syndromes. Results (1) The common disease locations in pulmonary nodules were ranked in descending order as liver, lung, and kidney; the common disease natures were ranked in descending order as Yin deficiency, phlegm, dampness, Qi stagnation, and blood deficiency. (2) The electronic nose combined with the RF algorithm had the best efficacy in identifying the exhaled breath profiles of benign and malignant pulmonary nodules, with an AUC of 0.91, accuracy of 86.36%, specificity of 75.00%, and sensitivity of 92.85%. (3) The electronic nose combined with RF, LR, or XGBoost algorithms could effectively identify the different TCM disease locations and natures of pulmonary nodules, with classification accuracy, specificity, and sensitivity generally exceeding 80.00%.Conclusion Electronic nose combined with machine learning not only has the potential capabilities to differentiate the benign and malignant pulmonary nodules, but also provides new technologies and methods for the objective diagnosis of TCM syndromes in pulmonary nodules.

The establishment of modern biliary surgery system, alongside pivotal scientific paradigm shifts, has heralded a new era featured by precision, personalization, life-cycle care, and multidisciplinary management in the treatment of both benign and malignant biliary diseases. However, two formidable challenges persist in haunting the treatment of biliary diseases: (1) The refinement of surgical techniques has reached a plateau in reducing the disability associated with benign biliary conditions and in improving survival outcomes in biliary tract cancers; (2) Traditional evidence-based clinical studies have shown limited power in addressing complex dilemmas, such as determining whether to excise or preserve pathological gallbladders or selecting the optimal biliary drainage strategy. Consequently, the authors propose the conceptual framework of “biliary ecosystem”. In this model, diverse and abundant cholangiocytes represent forest, while blood vessels, nerves, and lymphatic vessels serve as nurturing soil, biliary stem cells function as seeds, bile flows like river network, and hepatocytes mark the river′s origins. Both benign and malignant biliary diseases exhibit significant spatiotemporal dynamics. The bile ducts form the “macro” environment, bile constitutes the “sub-macro” environment, and diverse cellular niches create the microenvironment. Specific pathological biliary conditions are shaped by intricate regulatory mechanisms that operate across these three tiers. Within the biliary ecosystem, cellular subpopulations exist remarkable diversity with states of homeostasis, oscillation, perturbation, or imbalance, underpinned by complex signaling networks. This holistic approach allows us to reframe and critically examine the pressing scientific issues confronting biliary tract diseases. Based on this framework, the authors distill key scientific questions and offer preliminary recommendations for embracing the paradigm shift. The authors anticipate that this conceptual model will promote interdisciplinary integration and accelerate clinical and translational researches.

Following the core outcome set standards for development(COS-STAD), this study aims to construct core outcome set(COS) for clinical research on traditional Chinese medicine(TCM) treatment of simple obesity. Firstly, a comprehensive review was conducted on the randomized controlled trial(RCT) and systematic review(SR) about TCM treatment of simple obesity that were published in Chinese and English databases to collect reported outcomes. Additional outcomes were obtained through semi-structured interviews with patients and open-ended questionnaire surveys for clinicians. All the collected outcomes were then merged and organized as an initial outcome pool, and then a preliminary list of outcomes was formed after discussion by the working group. Subsequently, two rounds of Delphi surveys were conducted with clinicians, methodology experts, and patients to score the importance of outcomes in the list. Finally, a consensus meeting was held to establish the COS for clinical research on TCM treatment of simple obesity. A total of 221 RCTs and 12 SRs were included, and after integration of supplementary outcomes, an initial outcome pool of 141 outcomes were formed. Following discussions in the steering advisory group meeting, a preliminary list of 33 outcomes was finalized, encompassing 9 domains. Through two rounds of Delphi surveys and a consensus meeting, the final COS for clinical research on TCM treatment of simple obesity was determined to include 8 outcomes: TCM symptom scores, body mass index(BMI), waist-hip ratio, waist circumference, visceral fat index, body fat rate, quality of life, and safety, which were classified into 4 domains: TCM-related outcomes, anthropometric measurements, quality of life, and safety. This study has preliminarily established a COS for clinical research on TCM treatment of simple obesity. It helps reduce the heterogeneity in the selection and reporting of outcomes in similar clinical studies, thereby improving the comparability of research results and the feasibility of meta-analysis and providing higher-level evidence support for clinical practice.
Humans ; Obesity/therapy* ; Medicine, Chinese Traditional ; Randomized Controlled Trials as Topic ; Treatment Outcome ; Drugs, Chinese Herbal/therapeutic use*

Objective To analyze the differences in distribution of traditional Chinese medicine (TCM) syndrome elements and salivary microbiota between the individuals with pulmonary nodules and those without, and to explore the potential correlation between the distribution of TCM syndrome elements and salivary microbiota in patients with pulmonary nodules. Methods We retrospectively recruited 173 patients with pulmonary nodules (PN) and 40 healthy controls (HC). The four diagnostic information was collected from all participants, and syndrome differentiation method was used to analyze the distribution of TCM syndrome elements in both groups. Saliva samples were obtained from the subjects for 16S rRNA high-throughput sequencing to obtain differential microbiota and to explore the correlation between TCM syndrome elements and salivary microbiota in the evolution of the pulmonary nodule disease. Results The study found that in the PN group, the primary TCM syndrome elements related to disease location were the lung and liver, and the primary TCM syndrome elements related to disease nature were yin deficiency and phlegm. In the HC group, the primary TCM syndrome elements related to disease location were the lung and spleen, and the primary TCM syndrome elements related to disease nature were dampness and qi deficiency. There were differences between the two groups in the distribution of TCM syndrome elements related to disease location (lung, liver, kidney, exterior, heart) and disease nature (yin deficiency, phlegm, qi stagnation, qi deficiency, dampness, blood deficiency, heat, blood stasis) (P<0.05). The species abundance of the salivary microbiota was higher in the PN group than that in the HC group (P<0.05), and there was significant difference in community composition between the two groups (P<0.05). Correlation analysis using multiple methods, including Mantel test network heatmap analysis and Spearman correlation analysis and so on, the results showed that in the PN group, Prevotella and Porphyromonas were positively correlated with disease location in the lung, and Porphyromonas and Granulicatella were positively correlated with disease nature in yin deficiency (P<0.05). Conclusion The study concludes that there are notable differences in the distribution of TCM syndrome elements and the species abundance and composition of salivary microbiota between the patients with pulmonary nodules and the healthy individuals. The distinct external syndrome manifestations in patients with pulmonary nodules, compared to healthy individuals, may be a cascade event triggered by changes in the salivary microbiota. The dual correlation of Porphyromonas with both disease location and nature suggests that changes in its abundance may serve as an objective indicator for the improvement of symptoms in patients with yin deficiency-type pulmonary nodules.