Several types of arthritis share the common feature that the generation of inflammatory mediators leads to joint cartilage degradation. However, the shared mechanism is largely unknown. H2BK120ub1 was reportedly involved in various inflammatory diseases but its role in the shared mechanism in inflammatory joint conditions remains elusive. The present study demonstrated that levels of cartilage degradation, H2BK120ub1, and its regulator WW domain-containing adapter protein with coiled-coil (WAC) were increased in cartilage in human rheumatoid arthritis (RA) and osteoarthritis (OA) patients as well as in experimental RA and OA mice. By regulating H2BK120ub1 and H3K27me3, WAC regulated the secretion of inflammatory and cartilage-degrading factors. WAC influenced the level of H3K27me3 by regulating nuclear entry of the H3K27 demethylase KDM6B, and acted as a key factor of the crosstalk between H2BK120ub1 and H3K27me3. The cartilage-specific knockout of WAC demonstrated the ability to alleviate cartilage degradation in collagen-induced arthritis (CIA) and collagenase-induced osteoarthritis (CIOA) mice. Through molecular docking and dynamic simulation, doxercalciferol was found to inhibit WAC and the development of cartilage degradation in the CIA and CIOA models. Our study demonstrated that WAC is a key factor of cartilage degradation in arthritis, and targeting WAC by doxercalciferol could be a viable therapeutic strategy for treating cartilage destruction in several types of arthritis.

Traditional Chinese medicine (TCM) is an ancient medical system distinctive and effective in treating cancer, depression, coronavirus disease 2019 (COVID-19), and other diseases. However, the relatively abstract diagnostic methods of TCM lack objective measurement, and the complex mechanisms of action are difficult to comprehend, which hinders the application and internationalization of TCM. Recently, while breakthroughs have been made in utilizing methods such as network pharmacology and virtual screening for TCM research, the rise of machine learning (ML) has significantly enhanced their integration with TCM. This article introduces representative methodological cases in quality control, mechanism research, diagnosis, and treatment processes of TCM, revealing the potential applications of ML technology in TCM. Furthermore, the challenges faced by ML in TCM applications are summarized, and future directions are discussed.

Spine fracture and dislocation are common traumatic spinal conditions that often require surgical intervention due to compromised spinal stability. Surgical approaches include anterior, posterior, and combined anterior-posterior spinal procedures. According to the specific surgical requirements, patients may be placed in the prone position or repositioned between prone and supine positions during surgery. Intraoperative repositioning has become an essential step in patient positioning. However, during repositioning, patients with spinal fracture and dislocation are at increased risk for complications such as hemodynamic instability, nerve injury, and pressure injuries to the skin and soft tissue. Notably, due to the instability of the spinal cord, even minor manipulations can further exacerbate the damage, potentially leading to severe outcomes like paraplegia. Although the current clinical guidelines provide instructive recommendations for standard position, there remains no specific protocols for intraoperative repositioning in patients with spine fracture and dislocation. With a concern for the lack of clinical studies on positioning techniques, risk prevention, and operational norms for special patients, no applicable guidelines or standards are available. A consensus was required to provide clinical reference, meet the requirements of surgical treatment, and minimize the safety risks of patients caused by improper placement of positions. Professional Committee of Operating Room Nursing of Shaanxi Nursing Association organized experts in nursing management and operating room nursing from major hospitals across China to formulate Expert consensus on intraoperative repositioning for patients with spinal fracture and dislocation ( version 2025). The consensus provides 11 recommendations covering pre-repositioning preparation, intraoperative maneuvers, and post-repositioning observation, aiming to provide references for clinical standardization of the intraoperative repositioning process and protection of patients′ safety.

Traditional Chinese medicine(TCM)is an ancient medical system distinctive and effective in treating cancer,depression,coronavirus disease 2019(COVID-19),and other diseases.However,the relatively abstract diagnostic methods of TCM lack objective measurement,and the complex mechanisms of action are difficult to comprehend,which hinders the application and internationalization of TCM.Recently,while breakthroughs have been made in utilizing methods such as network pharmacology and virtual screening for TCM research,the rise of machine learning(ML)has significantly enhanced their inte-gration with TCM.This article introduces representative methodological cases in quality control,mechanism research,diagnosis,and treatment processes of TCM,revealing the potential applications of ML technology in TCM.Furthermore,the challenges faced by ML in TCM applications are summarized,and future directions are discussed.

Spine fracture and dislocation are common traumatic spinal conditions that often require surgical intervention due to compromised spinal stability. Surgical approaches include anterior, posterior, and combined anterior-posterior spinal procedures. According to the specific surgical requirements, patients may be placed in the prone position or repositioned between prone and supine positions during surgery. Intraoperative repositioning has become an essential step in patient positioning. However, during repositioning, patients with spinal fracture and dislocation are at increased risk for complications such as hemodynamic instability, nerve injury, and pressure injuries to the skin and soft tissue. Notably, due to the instability of the spinal cord, even minor manipulations can further exacerbate the damage, potentially leading to severe outcomes like paraplegia. Although the current clinical guidelines provide instructive recommendations for standard position, there remains no specific protocols for intraoperative repositioning in patients with spine fracture and dislocation. With a concern for the lack of clinical studies on positioning techniques, risk prevention, and operational norms for special patients, no applicable guidelines or standards are available. A consensus was required to provide clinical reference, meet the requirements of surgical treatment, and minimize the safety risks of patients caused by improper placement of positions. Professional Committee of Operating Room Nursing of Shaanxi Nursing Association organized experts in nursing management and operating room nursing from major hospitals across China to formulate Expert consensus on intraoperative repositioning for patients with spinal fracture and dislocation ( version 2025). The consensus provides 11 recommendations covering pre-repositioning preparation, intraoperative maneuvers, and post-repositioning observation, aiming to provide references for clinical standardization of the intraoperative repositioning process and protection of patients′ safety.

The network of laughter/smile production and propagation in the brain is not yet fully understood.In this paper,we report two cases of medically refractory epilepsy patients with stereotactic EEG implantation,in which smiles(without pleasurable emotions and motor awareness)and laughter(with situationally incompatible pleasurable emotions)were repeatedly induced by electrical stimulation in the left precentral gyrus,and the right insular short gyrus,respectively.This phenomenon reflects the existence of distinct and linked emotional and behavioral networks for laughter.

Objective To observe the value of ultrasonic parameters for predicting whether patients with cesarean scar pregnancy(CSP)would benefit from ultrasound-guided suction curettage alone.Methods Totally 140 CSP patients diagnosed by transvaginal ultrasound and initially treated with ultrasound-guided suction curettage alone were prospectively recruited and categorized into benefited group(n=103)and non-benefited group(n=37)according to bleeding during suction curettage and prognoses.The ultrasonic manifestations of CSP were observed,and the thickness of chorionic villi at the scar,as well as of residual myometrium of the anterior wall in the lower segment of the uterus,also the maximum diameter of the gestational sac were measured and compared between groups,and the parameters with quantitative data being statistically different between groups were converted into categorical predictor through analyzing of the receiver operating characteristic(ROC)curves and the optimal cut-off values.The independent predictors were selected among ultrasonic features and categorical predictor variables being statistically different between groups using multivariate logistic regression,and a combined predicting model was then constructed,and the predicting efficacy of the combined model and each categorical predictor alone was assessed according to the area under curve(AUC)and then were compared.Results Compared with non-benefited group,the gestational weeks in benefited group were smaller(P＜0.05),and the percentages of rich blood supply and the presence of embryos and fetal heartbeats were lower,with thinner chorionic villi at the scar,thicker residual myometrium and smaller maximal diameter of the gestational sac in benefited group(all P＜0.05).ROC curves analyses yielded the best cut-off value for dichotomy of chorionic villi thickness at the scar was 4.7 mm,of residual myometrium thickness was 1.8 mm and of the maximum diameter of the gestational sac was 29 mm,respectively,and then categorical predictor variable were obtained.Multivariate logistic regression showed that the transformed categorical predictors,i.e.the thickness degree of the chorionic villi at the scar,the thickness degree of the residual muscle layer and the size degree of the gestational sac,were all independent predictors of whether CSP patients would benefit from ultrasound-guided suction curettage alone(all P＜0.05).The AUC of the combined predicting model was 0.918,higher than that of each transformed categorical predictor alone(all P＜0.05).Conclusion The thickness of the chorionic villi at the scar ≤4.7 mm,the thickness of the residual muscle layer＞1.8 mm and the maximum diameter of the gestational sac≤29 mm were all independent predictors of CSP patients would benefit from ultrasound-guided suction curettage alone,and the predicting efficacy of the combined model was higher than that of each alone.

Objective To investigate the risk factors for postoperative pulmonary embolism in patients with spontaneous cerebral hemorrhage,and construct and verify the nomogram model.Methods A retrospective cohort study was conducted on 558 patients admitted in the First Affiliated Hospital of Chongqing Medical University and the Three Gorges Hospital Affiliated to Chongqing University.And 393 of them who hospitalized from January 2015 to January 2021 were assigned into a modeling group,and the other 165 patients from February 2021 to January 2023 into a validation group.Univariate and multivariate stepwise logistic regression analyses were used to screen out the risk factors associated with pulmonary embolism after spontaneous cerebral hemorrhage surgery.Then a nomogram model was build based on these factors and verified.Results Based on age,blood loss,Glasgow coma scale(GCS)score,surgical treatments,levels of fibrin degradation products,D-dimer and hemoglobin,plasma osmolality,and deep vein thrombosis,a risk model of pulmonary embolism was built.Receiver operating characteristic(ROC)curve analysis showed the model had good discriminability for the presence of pulmonary embolism,and the area under the curve(AUC)value was 0.908.Hosmer-Lemeshow goodness-fit test indicated that the model had a good fit to the verification set(Chi-square=14.805,df=8,P=0.063),the correction curve was close to the ideal curve,and the prediction probability of the model was close to the actual occurrence probability,suggesting the model having good accuracy.Decision curve analysis revealed that the established nomogram model can get benefits under a large range of threshold probabilities.Conclusion We develop a prediction model for postoperative pulmonary embolism in patients with spontaneous cerebral hemorrhage after surgical treatment,which shows good prediction performance in both the training and validation groups,and can be used for accurate,prompt and quick identification for the occurrence of pulmonary embolism in clinical practice.

This study was designed to explore whether overexpression of HMBOX1 inhibits COPD-induced infiltration and pulmonary macrophage activation by regulating NF-κB/CCL2 signaling pathway.Forty Wistar rats were randomly divided into control group,chronic obstructive pulmonary disease group(COPD group),COPD+control overexpression group(COPD+ov-NC group)and chronic COPD+HMBOX1 overexpression group(COPD+ov-HMBOX1 group),with 10 rats in each group.The COPD model was established by continuous cigarette incense and intermittent intratracheal injection of lipopolysaccharide,wihle the HMBOX1 overexpression treatmet was carried out by intratracheal instillation of HMBOX1 overexpressing adenovirus.Western blot was used to detect the expression of HMBOX1,p-NF-κB and NF-κB proteins in lung tissue of rats;RT-qPCR was used to detect the mRNA expression of HMBOX1 and CCL2 in rat lung tissue;HE staining was used to observe the pathological changes of lung tissue in rats;ELISA was applied to detect the levels of TNF-α,MIP-2,IL-1β and IL-10 in serum and BALF of rats.Furthermore,the ratio of CD11b+F4/80+cells in lung tissue of rats was detected by immunofluorescence,while the ratio of F4/80+MHC Ⅱ+cells and F4/80+CD80+cells in lung tissue of rats was detected by flow cytometry.In control group,the alveolar structure of rats was intact,and no inflammatory cell infiltration was found.In COPD group and COPD+ov-NC group,a large number of inflammatory cells infiltrated into the lung tissue and alveolar structure was damaged.In COPD+ov-HMBOX1 group,there were fewer inflammatory cells infiltrated in lung tissue,and the damage of alveolar structure was alleviated.Compared with the control group,the mRNA and protein expression of HMBOX1 in lung tissue,the levels of IL-10 in serum and BALF,the levels of TNF-α,MIP-2 and IL-1β in serum and BALF,CD11b+F4/80+cells,F4/80+MHC Ⅱ+cells and F4/80+CD80+cells in lung tissue of rats in COPD and COPD+ov-NC groups were significantly decreased.HMBOX1 overexpression could revers the changes mentioned above in the two COPD groups.Taken together,overexpression of HMBOX1 can alleviate COPD-induced airway inflammation and lung injury,and its mechanism may be related to inhibiting infiltration and abnormal activation of macrophages in lung tissue mediated by activation of NF-κB/CCL2 signaling pathway.

Objective:To investigate the current status of surgical intervention after conversion therapy for advanced gastric cancer.Methods:The retrospective cross-sectional investigation study was conducted. The investigation was conducted on clinicians who were qualified for the diagnosis and treatment of gastric cancer in 161 hospitals nationwide from December 11 to 22,2023. The questionnaire of "Survey on the Current Status of Surgical Intervention after Conversion Therapy for Advanced Gastric Cancer" was designed and distributed through WeChat based on the software platform of Wenjuanxing. Count data were expressed as absolute numbers and percentages.Results:(1) Results of the questionnaire. Of the 233 clinicians, the percentage of completed questionnaires, recovered questionnaires, and valid questionnaires were all of 100.00%(233/233). (2) Basic information of clinicians. Of the 233 clinicians, there were 213 males and 20 females. The numbers of clinicians aged ≤30 years, 31-40 years, 41-50 years, and >50 years were 1, 47, 109, and 76, respectively. The numbers of surgeons, internists, radiotherapists, and pathologists were 193, 36, 3, and 1, respectively. The numbers of chief physicians, deputy chief physicians, attending physicians, and resident physicians were 133, 75, 21, and 4, respectively. The numbers of clinicians with years of practice as >20 years, 11-20 years, 6-10 years, and ≤5 years were125, 88, 19, and 1, respectively. The numbers of clinicians from provincial-level tertiary general hospitals, provincial-level tertiary specialized oncology hospitals, municipal-level tertiary hospitals, and tertiary hospitals of B and below were 102, 58, 59, and 14, respectively. (3) Conversion therapy of advanced gastric cancer. Of the 233 clinicians, there were 54.94%(128/233) of clinicians whose units had admitted more than 100 gastric cases per year, 81.97%(191/233) of clinicians whose units had experience in surgical resection after conversion therapy of advanced gastric cancer, 66.52%(155/233) of clinicians whose units had proportion of successful surgical resection after conversion therapy of advanced gastric cancer exceeded 5%, and 51.50%(120/233) of clinicians whose units had the proportion of laparoscopic exploration+peritoneal lavage cytology to clarify the tumor stage at the initial diagnosis ≤10%. (4) Strategy selection after conversion therapy for advanced gastric cancer. Of the 233 clinicians, 63.52%(148/233) of them routinely mentioned to patients that they might be able to obtain chance of surgery after conversion therapy. There were 85.41%(199/233), 79.83%(186/233), and 68.67%(160/233) of clinicians considering possible risks as drug resistance, subsequent chemotherapy-immunotherapy or radiotherapy and other related adverse reactions and aggravation of distant toxicity, and distant organ metastasis for advanced gastric cancer patients to continue palliative care after conversion therapy. There were 85.41%(199/233), 50.21%(117/233), and 18.45%(43/233) of clinicians considering choices as multi-disciplinary treatment to evaluate the follow-up treatment strategy, laparoscopic exploration to clarify the possibility of surgery, and continuing the original program of palliative care for follow-up treatment of patients with advanced gastric cancer after conversion therapy. There were 97.85%(228/233) of clinicians considering re-evaluating the possibility of surgical resection when the tumor volume was significantly reduced after conversion therapy. (5) Selection of beneficiary population, treatment modality, and time point of evaluation of benefit for patients undergoing conversion surgery for advanced gastric cancer. A further questionnaire survey was conducted on the 228 clinicians who chose "to consider re-evaluating surgical resection when the volume of tumor reducted significantly after conversion therapy for advanced gastric cancer". There were 94.74%(216/228) of clinicians considering advanced gastric cancer patients with high expression of programmed death receptor ligand 1 as beneficiary population of conversion therapy. There were 82.46%(188/228) of clinicians considering advanced gastric cancer patients with liver oligometastases as beneficiary population of conversion therapy. There were 53.07%(121/228) of clinicians considering two-drug chemotherapy+immunotherapy regimen as preferred for HER2-negative patients, there were 67.54%(154/228) of clinicians considering chemotherapy + trastuzumab + immunotherapy regimen as preferred for HER2-positive patients. There were 83.33%(190/228) of clinicians considering resection treatment after 3-6 cycles of conversion therapy. There were 94.74%(216/228) of clinicians choosing enhanced computed tomography scan to evaluate the efficacy. In terms of tumor sign for laparoscopic surgery after conversion therapy, there were 92.54%(211/228) of clinicians choosing significant shrinkage of the primary focus and its surrounding lymph nodes from baseline. There were 63.16%(144/228) of clinicians choosing surgery after 3-4 weeks of drug withdrawal, and 57.02%(130/228) of clinicians considering to achieve R 0 resection. In terms of patients achieving pathologic complete remission (pCR) after surgery, there were 64.04%(146/228) of clinicians believing that postoperative treatment should be continued for 6-8 cycles of therapy followed by maintenance therapy up to 1 year. For patients with non-pCR, there were 59.65%(136/228) of clinicians believing that 6-8 cycles of postoperative maintenance therapy should be continued until 1 year. Conclusion:Most clinicians in China consider R 0 resection after conversion therapy for patients with advanced gastric cancer, followed by 6-8 cycles of treatment and maintenance therapy for another year.