With the continuous development of society, a large number of new chemicals are continuously emerging, which presents a challenge to current risk assessment and safety management of chemicals. Traditional toxicology research methods have certain limitations in quickly, efficiently, and accurately assessing the toxicity of many chemicals, and cannot meet the actual needs. In response to this challenge, computational toxicology that use mathematical and computer models to achieve the prediction of chemical toxicity has emerged. In the meantime, as researchers increasingly pay attention to understanding the interaction mechanisms between exogenous chemical substances and the body from the system level, and multiomics technologies develop rapidly such as genomics, transcriptomics, proteomics, and metabolomics, huge amounts of data have been generated, providing rich information resources for studying the interactions between chemical substances and biological molecules. System toxicology and network toxicology have also developed accordingly. Of these, network toxicology can integrate these multiomics data to construct biomolecular networks, and then quickly predict the key toxicological targets and pathways of chemicals at the molecular level. This paper outlined the concept and development of network toxicology, summarized the main methods and supporting tools of network toxicology research, expounded the application status of network toxicology in studying potential toxicity of exogenous chemicals such as agricultural chemicals, environmental pollutants, industrial chemicals, and foodborne chemicals, and analyzed the development prospects and limitations of network toxicology research. This paper aimed to provide a reference for the application of network toxicology in other fields.

Psoriasis vulgaris is notoriously difficult to treat and prone to recurrence. Traditional Chinese medicine （TCM）， however， has shown considerable efficacy in mitigating or suppressing such recurrence. The underlying reason lies in the TCM concept of "latent pathogens"， which are prone to be reactivated by external pathogenic factors， thereby triggering relapse. At the early stage of recurrence， manifestations of "latent fire" often appear externally. If treatment is not thorough， the condition may shift into a state of "stalemate between healthy Qi and pathogenic factors"， in which the disease appears on the skin but is rooted in deeper pathological layers， remaining unresolved and accumulating internally. Over time， blood stasis arises from fire， and the fire further congeals due to stasis， leading ultimately to recurrent flare-ups. This aligns with the modern immunological concept of "immunological memory" mediated by tissue-resident memory T cells （T_RM） in the skin， which corroborates the TCM view of "latent fire inducing blood stasis". The interaction between T_RM and keratinocytes （KC） parallels the entanglement of latent fire and latent stasis， both of which are deeply entrenched and difficult to resolve. The core pathogenesis of recurrent psoriasis vulgaris lies in "latent fire causing blood stasis". The hallmark is the deep concealment and persistence of latent fire and stasis， which linger and await an opportunity to reemerge. Based on this understanding， Xijiao Dihuangtang is employed to cool the blood， resolve stasis， and eliminate latent pathogens， and treatment is tailored according to the disease stage through three-phase syndrome differentiation. In the progressive stage， both exterior and interior are treated， with emphasis on clearing latent fire. In the stationary stage， the focus shifts to dispelling latent stasis and simultaneously regulating the Zang-fu organs. In the regressive stage， efforts are made to prevent the retention of latent pathogens and to strengthen healthy Qi. Accordingly， drugs effective in dispersing wind and clearing heat， pungent-moistening and dredging the collaterals， and tonifying deficiency and moistening dryness are often employed to achieve optimal outcomes. The precise mechanisms by which Xijiao Dihuangtang treats recurrent psoriasis vulgaris remain to be fully elucidated. Current research suggests it may intervene in the recurrence process through inhibiting KC proliferation via the PI3K/Akt/mTOR signaling pathway and glycolysis， regulating the Th1/Th2 and Th17/Treg cell balances to restore immune homeostasis， suppressing inflammatory cytokine production to alleviate the inflammatory response， modulating angiogenesis-related factors， such as vascular endothelial growth factor A （VEGF-A） and matrix metalloproteinase-9 （MMP-9）， to control disease progression， and restructuring the gut microbiota to modulate systemic immunity and thereby influence the course of disease recurrence.

OBJECTIVE: Anemoside B4 (AB4), the most abundant triterpenoidal saponin isolated from Pulsatilla chinensis, inhibited influenza virus FM1 or Klebsiella pneumoniae-induced pneumonia. However, the anti-SARS-CoV-2 effect of AB4 has not been unraveled. Therefore, this study aimed to determine the antiviral activity and potential mechanism of AB4 in inhibiting human coronavirus SARS-CoV-2 in vivo and in vitro. METHODS: The cytotoxicity of AB4 was evaluated using the Cell Counting Kit-8 (CCK8) assay. SARS-CoV-2 infected HEK293T, HPAEpiC, and Vero E6 cells were used for in vitro assays. The antiviral effect of AB4 in vivo was evaluated by SARS-CoV-2-infected hACE2-IRES-luc transgenic mouse model. Furthermore, label-free quantitative proteomics and bioinformatic analysis were performed to explore the potential antiviral mechanism of action of AB4. Type I IFN signaling-associated proteins were assessed using Western blotting or immumohistochemical staining. RESULTS: The data showed that AB4 reduced the propagation of SARS-CoV-2 along with the decreased Nucleocapsid protein (N), Spike protein (S), and 3C-like protease (3CLpro) in HEK293T cells. In vivo antiviral activity data revealed that AB4 inhibited viral replication and relieved pneumonia in a SARS-CoV-2 infected mouse model. We further disclosed that the antiviral activity of AB4 was associated with the enhanced interferon (IFN)-β response via the activation of retinoic acid-inducible gene I (RIG-1) like receptor (RLP) pathways. Additionally, label-free quantitative proteomic analyses discovered that 17 proteins were significantly altered by AB4 in the SARS-CoV-2 coronavirus infections cells. These proteins mainly clustered in RNA metabolism. CONCLUSION Our results indicated that AB4 inhibited SARS-CoV-2 replication through the RLR pathways and moderated the RNA metabolism, suggesting that it would be a potential lead compound for the development of anti-SARS-CoV-2 drugs.

Humans ; Aged ; Lung Diseases ; Pneumonia/drug therapy* ; Adrenal Cortex Hormones/therapeutic use* ; Pulmonary Disease, Chronic Obstructive/drug therapy* ; Administration, Inhalation ; Community-Acquired Infections/drug therapy*

Objective:To report the long-term outcomes of Chinese rectal cancer patients after adopting a Watch and Wait (W&W) strategy following neoadjuvant therapy (NAT).Methods:This multicenter, cross-sectional study was based on real-world data. The study cohort comprised rectal cancer patients who had achieved complete or near complete clinical responses (cCRs, near-cCRs) after NAT and were thereafter managed by a W&W approach, as well as a few patients who had achieved good responses after NAT and had then undergone local excision for confirmation of pathological complete response. All participants had been followed up for ≥2 years. Patients with distant metastases at baseline or who opted for observation while living with the tumor were excluded. Data of eligible patients were retrospectively collected from the Chinese Wait-and-Watch Data Collaboration Group database. These included baseline characteristics, type of NAT, pre-treatment imaging results, evaluation of post-NAT efficacy, salvage measures, and treatment outcomes. We herein report the long-term outcomes of Chinese rectal cancer patients after NAT and W&W and the differences between the cCR and near-cCR groups.Results:Clinical data of 318 rectal cancer patients who had undergone W&W for over 2 years and been followed up were collected from eight medical centers (Peking University Cancer Hospital, Fudan University Shanghai Cancer Center, Sun Yat-sen University Cancer Center, Shanghai Changhai Hospital, Peking Union Medical College Hospital, Liaoning Cancer Hospital, the First Hospital of Jilin University, and Yunnan Cancer Hospital.) The participants comprised 221 men (69.4%) and 107 women (30.6%) of median age 60 (26-86) years. The median distance between tumor and anal verge was 3.4 (0-10.4) cm. Of these patients, 291 and 27 had achieved cCR or near-cCR, respectively, after NAT. The median duration of follow-up was 48.4 (10.2-110.3) months. The 5-year cumulative overall survival rate was 92.4% (95%CI: 86.8%-95.7%), 5-year cumulative disease-specific survival (CSS) rate 96.6% (95%CI: 92.2%-98.5%), 5-year cumulative organ-preserving disease-free survival rate 86.6% (95%CI: 81.0%-90.7%), and 5-year organ preservation rate 85.3% (95%CI: 80.3%-89.1%). The overall 5-year local recurrence and distant metastasis rates were 18.5% (95%CI: 14.9%-20.8%) and 8.2% (95%CI: 5.4%-12.5%), respectively. Most local recurrences (82.1%, 46/56) occurred within 2 years, and 91.0% (51/56) occurred within 3 years, the median time to recurrence being 11.7 (2.5-66.6) months. Most (91.1%, 51/56) local recurrences occurred within the intestinal lumen. Distant metastases developed in 23 patients; 60.9% (14/23) occurred within 2 years and 73.9% (17/23) within 3 years, the median time to distant metastasis being 21.9 (2.6-90.3) months. Common sites included lung (15/23, 65.2%), liver (6/23, 26.1%), and bone (7/23, 30.4%) The metastases involved single organs in 17 patients and multiple organs in six. There were no significant differences in overall, cumulative disease-specific, or organ-preserving disease-free survival or rate of metastases between the two groups (all P>0.05). The 5-year local recurrence rate was higher in the near-cCR than in the cCR group (41.6% vs. 16.4%, P<0.01), with a lower organ preservation rate (69.2% vs. 88.0%, P<0.001). The success rates of salvage after local recurrence and distant metastasis were 82.1% (46/56) and 13.0% (3/23), respectively. Conclusion:Rectal cancer patients who achieve cCR or near-cCR after NAT and undergo W&W have favorable oncological outcomes and a high rate of organ preservation. Local recurrence and distant metastasis during W&W follow certain patterns, with a relatively high salvage rate for local recurrence. Our findings highlight the importance of close follow-up and timely intervention during the W&W process.

Objective:To explore the focus of ethical governance in the field of artificial intelligence(Al)in medicine.Methods:By comprehensively reviewing relevant literature to compare the relevant laws and regulations of the field of AI in medicine between China and foreign countries,analyze the governance focus of potential ethical issues,and propose the corresponding governance strategies.Results:At present,the laws,regulations,and regulatory systems related to the field of AI in medicine in China need to be improved.The emphasis of ethical governance should focus on core issues such as protecting privacy rights,ensuring the transparency and fairness of algorithms,clarifying the demarcation and allocation of responsibilities,and clarifying public perceptions and attitudes.Conclusion:The government and all sectors of society should actively learn from international legislative experience,and build an omnidirectional and multi-level ethical governance system from the aspects of policy formulation,legal framework,scientific research,and technological research and development by strengthening top-level design,improving policies and regulations,attaching importance to public feedback,and strengthening interdisciplinary cooperation.

Objective:To report the long-term outcomes of Chinese rectal cancer patients after adopting a Watch and Wait (W&W) strategy following neoadjuvant therapy (NAT).Methods:This multicenter, cross-sectional study was based on real-world data. The study cohort comprised rectal cancer patients who had achieved complete or near complete clinical responses (cCRs, near-cCRs) after NAT and were thereafter managed by a W&W approach, as well as a few patients who had achieved good responses after NAT and had then undergone local excision for confirmation of pathological complete response. All participants had been followed up for ≥2 years. Patients with distant metastases at baseline or who opted for observation while living with the tumor were excluded. Data of eligible patients were retrospectively collected from the Chinese Wait-and-Watch Data Collaboration Group database. These included baseline characteristics, type of NAT, pre-treatment imaging results, evaluation of post-NAT efficacy, salvage measures, and treatment outcomes. We herein report the long-term outcomes of Chinese rectal cancer patients after NAT and W&W and the differences between the cCR and near-cCR groups.Results:Clinical data of 318 rectal cancer patients who had undergone W&W for over 2 years and been followed up were collected from eight medical centers (Peking University Cancer Hospital, Fudan University Shanghai Cancer Center, Sun Yat-sen University Cancer Center, Shanghai Changhai Hospital, Peking Union Medical College Hospital, Liaoning Cancer Hospital, the First Hospital of Jilin University, and Yunnan Cancer Hospital.) The participants comprised 221 men (69.4%) and 107 women (30.6%) of median age 60 (26-86) years. The median distance between tumor and anal verge was 3.4 (0-10.4) cm. Of these patients, 291 and 27 had achieved cCR or near-cCR, respectively, after NAT. The median duration of follow-up was 48.4 (10.2-110.3) months. The 5-year cumulative overall survival rate was 92.4% (95%CI: 86.8%-95.7%), 5-year cumulative disease-specific survival (CSS) rate 96.6% (95%CI: 92.2%-98.5%), 5-year cumulative organ-preserving disease-free survival rate 86.6% (95%CI: 81.0%-90.7%), and 5-year organ preservation rate 85.3% (95%CI: 80.3%-89.1%). The overall 5-year local recurrence and distant metastasis rates were 18.5% (95%CI: 14.9%-20.8%) and 8.2% (95%CI: 5.4%-12.5%), respectively. Most local recurrences (82.1%, 46/56) occurred within 2 years, and 91.0% (51/56) occurred within 3 years, the median time to recurrence being 11.7 (2.5-66.6) months. Most (91.1%, 51/56) local recurrences occurred within the intestinal lumen. Distant metastases developed in 23 patients; 60.9% (14/23) occurred within 2 years and 73.9% (17/23) within 3 years, the median time to distant metastasis being 21.9 (2.6-90.3) months. Common sites included lung (15/23, 65.2%), liver (6/23, 26.1%), and bone (7/23, 30.4%) The metastases involved single organs in 17 patients and multiple organs in six. There were no significant differences in overall, cumulative disease-specific, or organ-preserving disease-free survival or rate of metastases between the two groups (all P>0.05). The 5-year local recurrence rate was higher in the near-cCR than in the cCR group (41.6% vs. 16.4%, P<0.01), with a lower organ preservation rate (69.2% vs. 88.0%, P<0.001). The success rates of salvage after local recurrence and distant metastasis were 82.1% (46/56) and 13.0% (3/23), respectively. Conclusion:Rectal cancer patients who achieve cCR or near-cCR after NAT and undergo W&W have favorable oncological outcomes and a high rate of organ preservation. Local recurrence and distant metastasis during W&W follow certain patterns, with a relatively high salvage rate for local recurrence. Our findings highlight the importance of close follow-up and timely intervention during the W&W process.

Objective To assess the effect of different postoperative body positions on respiratory func-tion of patients undergoing shoulder arthroscopy under general anesthesia with interscalene brachial plex-us block.Methods Seventy patients undergoing arthroscopic repair of the supraspinatus tendon were ran-domly allocated to a supine position group and a group with a 30° head elevation.Patients in both groups were in a horizontal position before anesthesia,and diaphragm movement was measured under B-ultrasound as baseline.Promptly after removal of the endotracheal tube upon arrival at the anesthe-sia recovery room,the supine group was conducted blood gas analysis,and monitored heart rate,res-piration,non-invasive arterial blood pressure and blood oxygen saturation,wearing a mask for oxygen supplementation,while the group with a 30° head elevation was given identical nursing procedures af-ter the bed's head was elevated 30°.Then right after entering the anesthesia recovery room,as well as 5 and 15 minutes after deoxygenation,the oxygen partial pressure(PaO2),carbon dioxide partial pressure(PaCO2)and percutaneous oxygen saturation(SpO2)were recorded and compared between the two groups.Moreover,the diaphragmatic movements during deep breathing before nerve block and pri-or to discharge from the anesthesia recovery room were measured,and such adverse reactions as hypox-emia,labored breathing and glossoptosis were observed.Results Compared with the supine position group,a significant increase in the average PaO2 and SpO2 15 minutes after deoxygenation,diaphrag-matic movement during deep breathing and comfort was observed in the group with a 30° head eleva-tion,but a significant decrease in the incidence of postoperative laboured breathing and glossoptosis.However,no significant differences were found between the two groups in the incidence of hypoxemia and the average PaO2,PaCO2 and SpO2 immediately after entering the anesthesia recovery room and 5 minutes after deoxygenation.Conclusion Elevating the head of the bed by 30° enhances respiratory function in patients undergoing shoulder surgery with general anesthesia intubation and intermuscular groove brachial plexus block,compared to the supine position.Although no significant reduction in hy-poxemia incidence is observed,there is a notable relief of adverse reactions such as laboured breath-ing and glossoptosis,which makes patients feel more comfortable.Therefore,such posture care is wor-thy of application in clinical practice.

Objective To generate and identify the Itgbl1(integrin beta-like)promoter-driven Cre knock-in mouse line.Methods Itgbll-Cre knock-in mice were generated using clustered regularly interspaced short palindromic repeats(CRISPR)/CRISPR-associated protein 9(Cas9)gene editing.The Itgbl1-Cre mice were crossed with the Cre reporter ROSALSL-tdTomato)mice to detect the expression profile of Cre activity.The tdTomato expression pattern across tissues and cell-specific markers were used to identify the cell types of Itgbl1-expressing cells and their progeny.Results and Conclusion tdTomato was specifically expressed in mucous acinar cells of the sublingual gland,pancreatic islet cells,and gastric endocrine cells.In addition,tdTomato expression was also found in some of the neurons of the retina and brain,as well as in a few cells in the serosal layer of the intestine,articular cartilage,periosteum,and bone marrow.The first Itgbl1-Cre recombinase transgenic mouse line was established,which can specifically label the mucous acinar cells of the sublingual gland.

Objective:To construct a predictive model based on preoperative heat shock protein 90 alpha (HSP90 alpha) and lymphocyte count/monocyte ratio (LMR), for prediction of the textbook outcome (TO) of intrahepatic cholangiocarcinoma after surgery, and evaluate the predictive value of the model.Methods:Retrospective analysis of data from 210 patients with intrahepatic cholangiocarcinoma admitted to Chengde Central Hospital from January 2022 to December 2023, including 122 males and 88 females, aged (61.3±5.5) years. The patients were randomly divided into a training set (147 cases) and a validation set (63 cases) according to a ratio of 7: 3. According to whether the patients achieved TO after surgery, the patients in the training set were divided into a TO group ( n=39) and a non-TO group ( n=108). The conditions of tumor length < 5 cm, lymph node metastasis, large vessel invasion, preoperative HSP90α decrease, and preoperative LMR increase were compared between the two groups. Based on the training set, univariate and multivariate logistic regression were used to analyze the influencing factors of postoperative TO in patients with intrahepatic cholangiocarcinoma. Based on multi-factor results, R 4.3.0 software was used to construct a prediction model for TO. The model was evaluated by receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DSA). Results:Multivariate logistic regression analysis showed that the tumor diameter < 5 cm ( OR=1.917, 95% CI: 1.104-4.024), no lymph node metastasis ( OR=2.489, 95% CI: 1.030-3.619), and no invasion of large vessels ( OR=2.565, 95% CI: 2.097-5.093), the decrease of HSP90α before surgery ( OR=3.161, 95% CI: 2.536-5.358), and the increase of LMR before surgery ( OR=2.088, 95% CI: 1.454-4.262) were the influencing factors for patients TO achieve postoperative TO (all P<0.05). A correlation nomogram model was built based on the above indicators. The area under the curve of the model predicting the postoperative TO of the patients in the training set and the test set were 0.875 (95% CI: 0.782-0.938) and 0.860 (95% CI: 0.767-0.912), respectively, indicating good predictive value of the model. The calibration curve was basically consistent with the standard curve, indicating that the model has good consistency and accuracy. DCA results showed that the models had good clinical net benefit in the threshold probability range of 0.1~0.8. Conclusion:The nomogram model based on perioperative HSP90α and LMR has good accuracy and clinical applicability in predicting the possibility of achieving TO after surgery for cholangiocarcinoma, which can provide a reference for clinical treatment.