BACKGROUND:Exosomes,as a type of extracellular vesicle,have become a key medium for cell-to-cell communication due to their nanoscale size and enrichment of various bioactive substances.The study of exosome secretion regulation not only has important scientific value,but also has broad application prospects in clinical practice,and is of great significance for promoting medical progress and improving human health.OBJECTIVE:To review the biological characteristics,biological functions,biogenesis process and biochemical regulation mechanism of exosomes,and to explore the application prospects of exosomes in disease diagnosis,treatment and vaccine development,so as to provide theoretical basis and reference for basic research and clinical transformation of exosomes.METHODS:The first author searched PubMed and CNKI databases in October 2024 for relevant literature published from January 2010 to October 2024.Key words were"exosomes,biological functions,biogenesis,secretion or release,regulatory mechanisms,application prospects"in Chinese and English.Finally,92 articles were included for analysis.RESULTS AND CONCLUSION:The secretion level of exosomes can be regulated through physical or biochemical means.Exosomes show broad application prospects in the fields of disease diagnosis,treatment,and vaccine development,and may play a key role in the treatment of cardiovascular and cerebrovascular diseases as well as cancer.This review provides valuable information for the clinical translation and application research of exosomes,helping to promote future progress in exosome research and application.

BACKGROUND:Exosomes,as a type of extracellular vesicle,have become a key medium for cell-to-cell communication due to their nanoscale size and enrichment of various bioactive substances.The study of exosome secretion regulation not only has important scientific value,but also has broad application prospects in clinical practice,and is of great significance for promoting medical progress and improving human health.OBJECTIVE:To review the biological characteristics,biological functions,biogenesis process and biochemical regulation mechanism of exosomes,and to explore the application prospects of exosomes in disease diagnosis,treatment and vaccine development,so as to provide theoretical basis and reference for basic research and clinical transformation of exosomes.METHODS:The first author searched PubMed and CNKI databases in October 2024 for relevant literature published from January 2010 to October 2024.Key words were"exosomes,biological functions,biogenesis,secretion or release,regulatory mechanisms,application prospects"in Chinese and English.Finally,92 articles were included for analysis.RESULTS AND CONCLUSION:The secretion level of exosomes can be regulated through physical or biochemical means.Exosomes show broad application prospects in the fields of disease diagnosis,treatment,and vaccine development,and may play a key role in the treatment of cardiovascular and cerebrovascular diseases as well as cancer.This review provides valuable information for the clinical translation and application research of exosomes,helping to promote future progress in exosome research and application.

Objective To understand the nursing practice of prone position ventilation for patients with moderate to severe acute respiratory distress syndrome(ARDS)in intensive care unit(ICU)in Shandong province,so as to provide basis for standardizing the nursing practice process of prone position ventilation and carrying out training for hospitals.Methods A self-made questionnaire was used,and convenience sampling was adopted.From September 15th to November 5th,2023,ICU nurses were selected from various hospital levels in Shandong province to investigate the obstructive factors of prone ventilation implementation,the weak links in nursing practice and status,and the occurrence of complications.Results A total of 1 188 questionnaires were collected,of which 991 were valid.92.8%(920/991)of nurses had performed prone position ventilation.The biggest obstacle to the implementation of prone position ventilation was the complexity of patient treatments and multiple devices involved[74.6%(686/920)].Regarding the status of training,90.5%(897/991)of nurses had received training on prone position ventilation and 77.0%(763/991)of nurses felt that training was needed.As for pre-operation assessment,more than 80.0%of nurses evaluated patients'vital signs,airway and secretions and so on,among which the evaluation awareness of analgesia was the worst[81.6%(751/920)].As for the main points of implementation,only 14.0%(129/920)of nurses chose the opposite side of the most important pipeline as the turning direction;48.6%(447/920)of nurses chose the anti-Trendelenburg position;36.3%(334/920)of nurses chose to ventilate≥12 hours.Facial edema[81.7%(752/920)],skin pressure injury[78.9%(726/920)]and eye complication[75.8%(697/920)]were the top 3 most frequent complications.Conclusions ICU nurses'prone position ventilation practices were generally line with the nursing team standard for prone position of adult mechanically ventilated patients and the best evidence recommendation,and needs to be further standardized in aspects of turning direction,position management,ventilation duration,and enteral nutrition management.It is recommended that nursing managers at all levels of hospitals further improve the quality of nursing practice of prone position ventilation according to relevant evidence-based evidence and the actual situation of hospitals.

Objective:To evaluate the effectiveness of a rotation training program for primary care general practitioners (GPs) in Taizhou, China, designed around three core competencies.Methods:A longitudinal study was conducted. A total of 111 primary care GPs participating in the 1st to 5th sessions of the Taizhou GP rotation training program at Taizhou Hospital (the designated training center) in Zhejiang Province from July 2022 to December 2024 were included. Based on the World Organization of Family Doctors (WONCA) competency model, combined with literature review and expert consultation, 15 potential training components were identified. A needs assessment survey among primary care GPs was then conducted, leading to the finalization of three core competencies for the training: ①Evidence-based management of common diseases, frequently-occurring diseases, and common symptoms; ②Early identification, management, and referral of critically ill patients; ③Chronic disease management and health promotion capabilities. A 4-month full-time immersion training program was structured around these competencies, comprising three phases: theoretical training (1 week), clinical comprehensive skills training (14 weeks), and primary care practice training (1 week). Assessments included a pre-and post-training theoretical knowledge test and a final clinical assessment. The final assessment utilized a three-station Objective Structured Clinical Examination (OSCE) evaluating patient consultation, clinical reasoning & decision-making, and clinical procedural skills. A self-administered satisfaction survey was also distributed post-training.Results:The 111 participants were predominantly aged 30-49 years (72.1% (80/111)), held bachelor′s degrees (87.4% (97/111)), were licensed physicians (78.4% (87/111)), and had junior or intermediate professional titles (87.4% (97/111)). Post-training theoretical scores were significantly higher than pre-training scores (76.26±7.00 vs. 69.94±6.40, t=-10.45, P<0.001). All participants 100%(111/111) passed the final OSCE assessment. The mean scores for the OSCE stations were: patient consultation 85.99±7.30, clinical reasoning & decision-making 82.72±7.61, and clinical procedural skills 89.60±5.65. Satisfaction rates were 100.0% (111/111) for the overall program, the three-phase design, the core competency training content, theoretical training, clinical skills training, and clinical rotation departments. Satisfaction was 98.2% (109/111) for the 4-month full-time duration, 99.1% (110/111) for the "2+X" clinical rotation model (2 weeks each in General Practice and Emergency Medicine+elective rotations in 4 other departments), and 97.3% (108/111) for the primary care practice base. Conclusions:The competency-based rotation training program for primary care GPs in Taizhou effectively enhanced participants′ theoretical knowledge and clinical practical skills, and achieved high levels of participant satisfaction. This model offers valuable insights for optimizing primary care GP training in similar settings.

Objective:To analyze the clinical characteristics of patients with pregnancy-related chronic pain visiting the pain clinic.Methods:The number of pregnant patients who completed a pregnancy registration at the Obstetrics and Gynecology Hospital Affiliated to Nanjing Medical University from 2022 to 2024 was collected. The medical records were reviewed to identify the patients who visited the department of pain of our hospital due to chronic pain related to pregnancy. The clinical characteristics such as the visiting situation, gestational weeks, age and types of pain were analyzed.Results:From 2022 to 2024, the total number of registered pregnant patients was 64, 818, of which, 2, 224 cases visited the pain clinic, and the annual proportions of pregnancy-related chronic pain visits were 2.540%, 3.836% and 3.889% respectively. Among the patients who attended the clinic, 77.97% were pregnant (5.82% in early pregnancy, 41.93% in mid-pregnancy, and 52.25% in late pregnancy), and 21.03% were postpartum patients. A total of 83.72% were aged 20-34 yr. The types of pain were pelvic girdle pain (40.96%), limb joint pain (28.82%), low back pain (14.16%), cervical spondylosis (3.64%), peripheral nerve entrapment syndrome (3.42%), headache (2.97%), chest and back pain (2.79%), pelvic and perineal pain (1.66%), neuralgia (0.94%) and other pains (0.63%).Conclusions:From 2022 to 2024, the proportion of registered pregnant women at our hospital who visited to the pain clinic due to pregnancy-related chronic pain increases year by year. The common types of pain are pelvic girdle pain, limb joint pain and low back pain.

Sonodynamic therapy（SDT）has garnered significant attention in cancer treatment modalities due to its superior tissue penetration capabilities，non-invasive approach，and controllability. SDT operates by utilizing sonosensitizers and ultrasound-responsive devices to induce the production of reactive oxygen species（ROS）under ultrasound stimulation，thereby eliciting immunogenic cell death（ICD）in tumor cells and the release of damage-associated molecular patterns，which in turn trigger an immune response against the tumor.However，the tumor microenvironment often results in a relatively weak immune response post-cancer treatment. To address this issue，extensive research is being conducted on combining SDT with immunotherapy，particularly focusing on immune checkpoint blockade（ICB）therapies. This review synthesizes the mechanisms of SDT，its integration with immunotherapy，especially ICB therapies，and the current state of research，with the objective of providing strategic guidance for the advancement of sonodynamic immunotherapy.

Although tumor immunotherapy has transformed cancer treatment，its efficacy against solid tumors remains limited by the immunosuppressive tumor microenvironment，inefficient drug delivery，and off-target toxicity. Engineered bacterial therapy has recently attracted considerable interest as a promising therapeutic strategy owing to its capacity for selective tumor colonization and immunomodulation. Meanwhile，ultrasound technology provides a non-invasive，spatially precise，and real-time controllable means to improve the performance and applicability of bacterial-mediated therapies. This review summarizes recent advances in ultrasound-regulated bacterial therapy for cancer immunotherapy. Beginning with an examination of the mechanisms through which engineered bacteria modulate antitumor immunity，it is followed by an elucidation of how ultrasound technology exploits its biological effects and spatiotemporal control capabilities to simultaneously enhance bacterial therapy's safety/efficacy and enable tumor treatment visualization，thereby activating systemic immune responses. Finally，current challenges and future directions for clinical translation are critically discussed. In conclusion，ultrasound-regulated bacterial therapy represents an emerging interdisciplinary approach with the potential to overcome key limitations in solid tumor immunotherapy.

Purpose To explore the application value of auto-prescription technique in CT portal venography and liver volume measurement.Materials and Methods A total of 180 patients who underwent contrast-enhanced abdominal CT in the First Affiliated Hospital of Dalian Medical University from April to November 2022 were prospectively collected and randomly divided into two groups,with 90 cases in each group.Group A(experimental group)was scanned with auto-prescription technique.Group B(conventional group)was scanned with 120 kVp,and the other imaging parameters kept the same as group A.In group A,the correlation between body mass index and tube voltage(kVp)recommended by auto-prescription technique was analyzed.The following values were compared between group A and group B,including the volume CT dose index,dose length product,CT value of portal vein and liver,standard deviation,contrast-to-noise ratio(CNR),image quality and subjective score of automatic segmentation.The liver volumes of group A and B were measured by Liver Segmentation software.The volumes measured by automatic segmentation software(Vsoft)were recorded,and then were compared with those segmented manually(gold standard)(Vstnd).Results Compared with group B,the volume CT dose index and dose length product in group A decreased by 22%and 25%(t=-4.654,-5.403,both P<0.05),respectively.The CT value and CNR of portal vein and liver in group A were higher than those in group B(t=4.857-6.011,all P<0.05).There was no significant difference in standard deviation,Vstnd and Vsoft between group A and group B(P>0.05).The consistency of subjective scores between the two observers was good(ICC=0.773-0.856,all P<0.05).The subjective scores of two-dimensional and three-dimensional images,as well as the automatic software segmentation scores in group A were higher than those in group B(Z=897.500,1 287.500,912.721,all P<0.05).The recommended kVp value in group A was positively correlated with body mass index(r=0.674,P<0.001).Conclusion The application of auto-prescription technique in CT portal venography can ensure the image quality,measure the liver volume accurately,and reduce the patient's radiation dose individually.

Objective To evaluate the effect of remimazolam on the incidence of postoperative delirium(POD)in elderly lung cancer patients undergoing thoracoscopic surgery.Methods A total of 114 elderly patients who underwent unilateral thoracoscopic lung surgery at the Affiliated Hospital of Xuzhou Medical University from October 2024 to April 2025 were recruited in this trial.Patients were randomly assigned to remimazolam group(group R)and propofol group(group P).Anesthesia induction and maintenance were performed with remimazolam and propofol,respectively.In R group,0.5 mg of flumazenil was intravenously injected at the end of the surgery for specific antagonism.The incidence of delirium and Quality of Recovery-15(QoR-15)scores on the first and third postoperative days were compared between the two groups.Intraoperative hemodynamic parameters,total opi-oid dosage,fluid balance,tracheal tube extubation time after surgery,and the incidence of adverse reactions were recorded.Results There were no statistically significant differences between the groups in the incidence of POD or in QoR-15 scores(P>0.05).Compared with group P,patients in group R had a shorter extubation time(P<0.05),more stable hemodynamics,lower incidences of intra-operative hypotension and bradycardia,and reduced requirement for vasoactive drugs(P<0.05).The consumption of rescue analgesics in the post-anesthesia care unit(PACU)was also lower in group R(P<0.05).No significant differences were observed between the groups in the amounts of sufentanil and remifentanil administered,fluid balance,bispectral index(BIS)values,or the inci-dence of nausea and vomiting(P>0.05).Conclusion In elderly patients undergoing elective thoracoscopic sur-gery,remimazolam-based induction and maintenance of anesthesia did not significantly alter the incidence of POD or compromise postoperative recovery quality compared with propofol.However,the remimazolam group required fewer vasoactive agents and exhibited a shorter tracheal extubation time.

Objective:To review the application of internet cognitive behavioral therapy (CBT) in perinatal women with negative emotions, point out the limitations of existing studies, and put forward development suggestions for future research.Methods:Using the Scope review guide published by Joanna Briggs Institute as the methodological framework, eight Chinese and English databases including China National Knowledge Infrastructure (CNKI), Wanfang, PubMed and Web of Science were searched until July 1, 2024, and the literatures were collected and analyzed.Results:A total of 18 literatures were included. The interventionists of internet cognitive behavioral therapy were mostly psychologists; the intervention methods were mostly in the form of partial participation of therapists, and the intervention platforms were mostly websites. The intervention content was centered on mental health education, emotional monitoring, cognitive reconstruction, behavioral activation training, and problem solving. There were 15 studies that demonstrated that internet cognitive behavioral therapy was effective, and three studies showed that internet cognitive behavioral therapy was not effective in improving negative emotions in perinatal women, but perinatal women responded to treatment.Conclusions:The Internet cognitive behavioral therapy can effectively improve the negative emotions of perinatal pregnant women, but the long-term effect is not clear. Future studies can expand the sample size and follow up the effect for a long time.