Background Prior epidemiological studies suggest that exposure to pyrethroid insecticides may adversely affect children’s respiratory health. However, only limited studies are currently available on this topic in China. Objective To explore the association between exposure to pyrethroid insecticides and pulmonary function in children in Shanghai. Methods From August 2019 to January 2020, a cross-sectional study was conducted, recruiting 163 healthy school-aged children (aged 5–12 years) from Shanghai Children’s Hospital, Shanghai Jiao Tong University School of Medicine. Basic information, including age, height, weight, and family income, was collected. Urine samples from the children were collected and were analyzed for the levels of three pyrethroid insecticide metabolites: 3-phenoxybenzoic acid (3-PBA), cis-3-(2,2-dichlorovinyl)-2,2-dimethylcyclopropane carboxylic acid (CDCCA), and trans-3-(2,2-dichlorovinyl)-2,2-dimethylcyclopropane carboxylic acid (TDCCA). Gas chromatography-tandem mass spectrometry (GC-MS/MS) was used for the analysis. Spirometry was used to assess pulmonary function and recorded following parameters: peak expiratory flow (PEF), forced expiratory flow between the 25th and 75th percentiles of forced vital capacity (FEF_25-75), forced expiratory volume in one second (FEV₁), forced vital capacity (FVC), and FEV₁/FVC. Multiple linear regression and restricted cubic spline models were used to evaluate the associations between urinary pyrethroid insecticide metabolite levels and pulmonary function parameters. Results The study included 163 school-aged children, with an average age of (7.04 ± 2.08) years and an average body mass index (BMI) of (16.04 ± 2.72) kg·m⁻²; 75 (46.01%) of the participants were boys. The detection rates of 3-PBA, TDCCA, and CDCCA in urine were 85.28%, 17.79%, and 4.91%, respectively. The median creatinine-adjusted 3-PBA concentration was 0.150 μg·g⁻¹. After adjusting for confounders such as height, BMI, sex, age, delivery mode, annual family income, and maternal education level, the multiple linear regression model showed that urinary 3-PBA levels were negatively associated with both FVC [β=−0.030, 95% confidence interval (CI): −0.058, −0.003; P=0.031] and FEV₁ (β=−0.032, 95%CI: −0.064, 0.000; P=0.04998). The final restricted cubic spline model showed a nonlinear association between urinary 3-PBA levels and FVC, FEV₁, PEF, and FEF_25-75（P for nonlinear < 0.05；P for overall < 0.05）. Conclusion The level of pyrethroid insecticide exposure in school-aged children in Shanghai is relatively high. The urinary 3-PBA concentration is negatively associated with pulmonary function, indicating potential adverse effects of pyrethroid insecticide exposure on respiratory health of school-aged children.

Myocardial fibrosis is a serious cause of heart failure and even sudden cardiac death. However, the mechanisms underlying myocardial ischemia-induced cardiac fibrosis remain unclear. Here, we identified that the expression of sterile alpha and TIR motif containing 1 (SARM1), was increased significantly in the ischemic cardiomyopathy patients, dilated cardiomyopathy patients (GSE116250) and fibrotic heart tissues of mice. Additionally, inhibition or knockdown of SARM1 can improve myocardial fibrosis and cardiac function of myocardial infarction (MI) mice. Moreover, SARM1 fibroblasts-specific knock-in mice had increased deposition of extracellular matrix and impaired cardiac function. Mechanically, elevated expression of SARM1 promotes the deposition of extracellular matrix by directly modulating P4HA1. Notably, by using the Click-iT reaction, we identified that the increased expression of ZDHHC17 promotes the palmitoylation levels of SARM1, thereby accelerating the fibrosis process. Based on the fibrosis-promoting effect of SARM1, we screened several drugs with anti-myocardial fibrosis activity. In conclusion, we have unveiled that palmitoylated SARM1 targeting P4HA1 promotes collagen deposition and myocardial fibrosis. Inhibition of SARM1 is a potential strategy for the treatment of myocardial fibrosis. The sites where SARM1 interacts with P4HA1 and the palmitoylation modification sites of SARM1 may be the active targets for anti-fibrosis drugs.

Hemorrhagic fever with renal syndrome(HFRS)is a zoonotic disease caused by hantavirus.Inflammatory cytokine storm is closely associated with HFRS development.This review describes the anti-inflammatory and pro-inflammatory cytokines,and findings from clinical studies of these cytokines in patients with HFRS,to provide a comprehensive understanding of the roles of cyto-kines in renal syndrome hemorrhagic fever,and a reference for clinical diagnosis and assessment of the condition.

Objective To construct a cloud-based platform for healthcare-associated infection(HAI)management based on multi-source data fusion and data visualization,and evaluate its application effectiveness.Methods A ter-tiary first-class cancer hospital was selected as the research object.Aligned with graded hospital accreditation stan-dards and based on grid-based management and responsibility zone mode,a platform was constructed in 2023 with low-code technology,multi-source data fusion,and visualization function.The self-comparison method was adopted to compare occurrence of HAI before and after the operation of the platform.A questionnaire survey was adopted to assess the experience and workload reduction feelings of full-time and part-time infection surveillance and control profe-ssionals using the platform.Results 81.56％of the surveyed respondents believed that the platform could re-duce the workload of infection surveillance and control.Compared with before the trial operation,the hospital achieved an annual reduction of 11 200 yuan in paper costs,with associated labor savings of approximately 4 482.5 hours.The incidence of HAI cases in the whole hospital decreased from 0.67％to 0.45％.The pathogen detection rate before therapeutic use of antimicrobial agents increased from 51.26％to 71.54％.Differences were both statis-tically significant(both P＜0.05).The detection number and proportion of carbapenem-resistant Pseudomonas aeruginosa(CRPA)and extended-spectrum β-lactamase-producing Klebsiella pneumoniae(ESBL-KP)in HAI cases decreased(54.55％vs 36.47％and 51.14％vs 32.50％,respectively,both P＜0.05).Conclusion The construc-tion and application of smart HAI management cloud-based platform can reduce cost,improve management quality,and provide a theoretical basis and technical paradigm for the construction of smart HAI management system.

Hemorrhagic fever with renal syndrome(HFRS)is a zoonotic disease caused by hantavirus.Inflammatory cytokine storm is closely associated with HFRS development.This review describes the anti-inflammatory and pro-inflammatory cytokines,and findings from clinical studies of these cytokines in patients with HFRS,to provide a comprehensive understanding of the roles of cyto-kines in renal syndrome hemorrhagic fever,and a reference for clinical diagnosis and assessment of the condition.

Objective To construct a cloud-based platform for healthcare-associated infection(HAI)management based on multi-source data fusion and data visualization,and evaluate its application effectiveness.Methods A ter-tiary first-class cancer hospital was selected as the research object.Aligned with graded hospital accreditation stan-dards and based on grid-based management and responsibility zone mode,a platform was constructed in 2023 with low-code technology,multi-source data fusion,and visualization function.The self-comparison method was adopted to compare occurrence of HAI before and after the operation of the platform.A questionnaire survey was adopted to assess the experience and workload reduction feelings of full-time and part-time infection surveillance and control profe-ssionals using the platform.Results 81.56％of the surveyed respondents believed that the platform could re-duce the workload of infection surveillance and control.Compared with before the trial operation,the hospital achieved an annual reduction of 11 200 yuan in paper costs,with associated labor savings of approximately 4 482.5 hours.The incidence of HAI cases in the whole hospital decreased from 0.67％to 0.45％.The pathogen detection rate before therapeutic use of antimicrobial agents increased from 51.26％to 71.54％.Differences were both statis-tically significant(both P＜0.05).The detection number and proportion of carbapenem-resistant Pseudomonas aeruginosa(CRPA)and extended-spectrum β-lactamase-producing Klebsiella pneumoniae(ESBL-KP)in HAI cases decreased(54.55％vs 36.47％and 51.14％vs 32.50％,respectively,both P＜0.05).Conclusion The construc-tion and application of smart HAI management cloud-based platform can reduce cost,improve management quality,and provide a theoretical basis and technical paradigm for the construction of smart HAI management system.

To promote the development of extracellular vesicles of herbal medicine especially the establishment of standardization, led by the National Expert Committee on Research and Application of Chinese Herbal Vesicles, research experts in the field of herbal medicine and extracellular vesicles were invited nationwide with the support of the Expert Committee on Research and Application of Chinese Herbal Vesicles, Professional Committee on Extracellular Vesicle Research and Application, Chinese Society of Research Hospitals and the Guangdong Engineering Research Center of Chinese Herbal Vesicles. Based on the collation of relevant literature, we have adopted the Delphi method, the consensus meeting method combined with the nominal group method to form a discussion draft of "Consensus statement on research and application of Chinese herbal medicine derived extracellular vesicles-like particles (2023)". The first draft was discussed in online and offline meetings on October 12, 14, November 2, 2022 and April and May 2023 on the current status of research, nomenclature, isolation methods, quality standards and research applications of extracellular vesicles of Chinese herbal medicines, and 13 consensus opinions were finally formed. At the Third Academic Conference on Research and Application of Chinese Herbal Vesicles, held on May 26, 2023, Kewei Zhao, convenor of the consensus, presented and read the consensus to the experts of the Expert Committee on Research and Application of Chinese Herbal Vesicles. The consensus highlights the characteristics and advantages of Chinese medicine, inherits the essence, and keeps the righteousness and innovation, aiming to provide a reference for colleagues engaged in research and application of Chinese herbal vesicles at home and abroad, decode the mystery behind Chinese herbal vesicles together, establish a safe, effective and controllable accurate Chinese herbal vesicle prevention and treatment system, and build a bridge for Chinese medicine to the world.

Objective To investigate the protective effects of apigenin (API) on the balance of Treg/Th17 cells mediated by the miR-181a-5p/SOCS3 signal pathway in a rat model of rheumatoid arthritis (RA). Methods Wistar rats were randomly divided into control,collagen induced arthritis (CIA),API,API+knockdown control (API+sh-NC),and API+SOCS3 knockdown (API+sh-SOCS3) groups. Inflammatory symptoms of arthritis were evaluated using the arthritis index score and gross observations of paw swelling. Pathological injury to the rat synovium was observed using HE staining. The levels of Th17-related cytokines interleukin (IL)-17A and IL-6 and Treg-related cytokines tumor growth factor (TGF)-β and IL-10 in rat serum were detected using ELISA. The proportions of CD4+IL17A+Th17 cells and CD25+Foxp3+Treg cells in the rat spleen were determined using flow cytometry. The expression of miR-181a-5p and SOCS3 in the synovial tissue of rats was detected using real-time fluorescence quantitative PCR (RT-qPCR) and Western blotting. Dou-ble-luciferase reporter gene experiment was used to verify the combination of miR-181a-5p and SOCS3. Results Compared with the con-trol group,in CIA group,paw swelling and pathological injury of ankle synovium were aggravated,arthritis index score,serum IL-17A and IL-6 levels and CD4+IL-17A+cells in spleen cells were significantly increased,while serum TGF-β and IL-10 levels and CD25+Foxp3+cells in spleen cells were significantly decreased (all P<0.05). Compared with CIA group,paw swelling and pathological injury of ankle synovium in API group and API+sh-NC group were improved,arthritis index score,IL-17A and IL-6 levels in serum and CD4+IL-17A+cells in spleen cells were significantly decreased,while TGF-β and IL-10 levels in serum and CD25+Foxp3+cells in spleen cells were sig-nificantly increased (all P<0.05). Compared with the control group,the expression of miR-181a-5p in the synovial tissue of the CIA group was significantly increased,and the expression of SOCS3 mRNA and protein was significantly decreased (all P<0.05). Compared with the CIA group,the expression of miR-181a-5p in the synovial tissue of the API group was significantly decreased,and the expression of SOCS3 mRNA and protein was significantly increased (all P<0.05). Compared with API group and API+sh-NC group,API+sh-SOCS group paw swelling and pathological injury of ankle synovium were aggravated,arthritis index score,serum IL-17A and IL-6 levels and CD4+IL-17A+cells in spleen cells were significantly increased,while serum TGF-β and IL-10 levels and CD25+Foxp3+cells in spleen cells were signifi-cantly decreased (all P<0.05). Compared with the mimics NC group,the relative luciferase activity of HEK-293T cells transfected with SOCS3-WT in the miR-181a-5p mimics group decreased significantly (P<0.05);however,there was no significant difference in the rel-ative luciferase activity of HEK-293T cells transfected with SOCS3-MUT (P>0.05). Conclusion Apigenin can improve the imbalance of Treg/Th17 cells in RA by downregulating the expression of miR-181a-5p and upregulating the expression of its downstream target gene SOCS3,thus improving joint injury induced by RA.

Objective To investigate the protective effects of apigenin (API) on the balance of Treg/Th17 cells mediated by the miR-181a-5p/SOCS3 signal pathway in a rat model of rheumatoid arthritis (RA). Methods Wistar rats were randomly divided into control,collagen induced arthritis (CIA),API,API+knockdown control (API+sh-NC),and API+SOCS3 knockdown (API+sh-SOCS3) groups. Inflammatory symptoms of arthritis were evaluated using the arthritis index score and gross observations of paw swelling. Pathological injury to the rat synovium was observed using HE staining. The levels of Th17-related cytokines interleukin (IL)-17A and IL-6 and Treg-related cytokines tumor growth factor (TGF)-β and IL-10 in rat serum were detected using ELISA. The proportions of CD4+IL17A+Th17 cells and CD25+Foxp3+Treg cells in the rat spleen were determined using flow cytometry. The expression of miR-181a-5p and SOCS3 in the synovial tissue of rats was detected using real-time fluorescence quantitative PCR (RT-qPCR) and Western blotting. Dou-ble-luciferase reporter gene experiment was used to verify the combination of miR-181a-5p and SOCS3. Results Compared with the con-trol group,in CIA group,paw swelling and pathological injury of ankle synovium were aggravated,arthritis index score,serum IL-17A and IL-6 levels and CD4+IL-17A+cells in spleen cells were significantly increased,while serum TGF-β and IL-10 levels and CD25+Foxp3+cells in spleen cells were significantly decreased (all P<0.05). Compared with CIA group,paw swelling and pathological injury of ankle synovium in API group and API+sh-NC group were improved,arthritis index score,IL-17A and IL-6 levels in serum and CD4+IL-17A+cells in spleen cells were significantly decreased,while TGF-β and IL-10 levels in serum and CD25+Foxp3+cells in spleen cells were sig-nificantly increased (all P<0.05). Compared with the control group,the expression of miR-181a-5p in the synovial tissue of the CIA group was significantly increased,and the expression of SOCS3 mRNA and protein was significantly decreased (all P<0.05). Compared with the CIA group,the expression of miR-181a-5p in the synovial tissue of the API group was significantly decreased,and the expression of SOCS3 mRNA and protein was significantly increased (all P<0.05). Compared with API group and API+sh-NC group,API+sh-SOCS group paw swelling and pathological injury of ankle synovium were aggravated,arthritis index score,serum IL-17A and IL-6 levels and CD4+IL-17A+cells in spleen cells were significantly increased,while serum TGF-β and IL-10 levels and CD25+Foxp3+cells in spleen cells were signifi-cantly decreased (all P<0.05). Compared with the mimics NC group,the relative luciferase activity of HEK-293T cells transfected with SOCS3-WT in the miR-181a-5p mimics group decreased significantly (P<0.05);however,there was no significant difference in the rel-ative luciferase activity of HEK-293T cells transfected with SOCS3-MUT (P>0.05). Conclusion Apigenin can improve the imbalance of Treg/Th17 cells in RA by downregulating the expression of miR-181a-5p and upregulating the expression of its downstream target gene SOCS3,thus improving joint injury induced by RA.

Objective:To analyze the hospitalization costs of delivery for postpartum women with different delivery methods, ages and comorbidities or complications, for references for medical institutions and medical insurance management departments to develop payment and compensation standards for inpatient delivery.Methods:The first page of medical records of hospitalized delivery women admitted to 8 large tertiary hospitals in Beijing from January 2018 to December 2021 were selected. Descriptive analysis was made on the mode of delivery, age, hospitalization expenses and cost structure of puerpera, as well as the hospitalization expenses of puerpera with different complications or complications. Wilcoxon rank sum test, Kruskal-Wallis H test, and Chi-squared test were used to statistically compare the level and structure differences between groups. Results:A total of 23 320 pregnant women were included, with an average age of 32.3 years. There were 13 605 cases of natural delivery and 9 715 cases of caesarean section. The median cesarean section rate in the right age group (<35 years old) and the elderly group (35-50 years old) were 36.73% and 56.58%, respectively, and the median hospital expenses were 5 865 yuan and 7 042 yuan, respectively. The median hospital expenses for natural delivery and caesarean section were 4 452 yuan and 10 033 yuan, respectively. The highest proportion of hospitalization expenses for natural delivery and cesarean section were treatment expenses (23.45%) and medicine expenses (29.19%), respectively. The median of hospitalization cost for women with≥2 comorbidities or complications (6 736 yuan) was higher than that for women with 1 comorbidities or complications (5 794 yuan).Conclusions:The hospitalization cost of cesarean section was significantly higher than that of natural delivery and the rate of cesarean section and the cost of delivery in women aged 35 and above were higher than those under 35 years old. The structure of hospitalization cost was different in different delivery modes, and the complications or complications had a greater impact on the average hospitalization expenses.