ObjectiveTo analyze the infection characteristics of human respiratory syncytial virus (HRSV) among children hospitalized with acute lower respiratory tract infection (ALRTI) in a specialized pediatric hospital in Shanghai, so as to provide evidence-based support for optimizing the prevention and control strategies and clinical diagnosis and treatment of respiratory tract infections in children in this region. MethodsA retrospective analysis was performed to the clinical and etiological data of 29 260 children hospitalized for ALRTI in Shanghai Children’s Hospital from January 2021 to December 2024. HRSV and 12 other common respiratory pathogens were detected with multiplex polymerase chain reaction (PCR) and capillary electrophoresis. Demographic and clinical data were collected for statistical analyses. A total of2 412 cases with positive HRSV were divided into the severe group and the non-severe group. Clinical characteristics between the two groups were compared using the Mann-Whitney U test and the chi- square (χ²) test. Additionally, the related influencing factors of severe HRSV infection were explored. ResultsThe overall positivity rate of HRSV from 2021 to 2024 was 8.24% (2 412/29 260), with statistically significant differences observed across the four years (χ²=389.42, P<0.001). The highest positivity rate was in 2021 (14.76%), with a high prevalence throughout the year. In 2022, when non-pharmaceutical interventions (NPIs) were implemented, the HRSV positivity rate was the lowest (4.93%), with a winter-dominant epidemic pattern. In 2023, after the NPIs were lifted, the HRSV positivity rate showed a slight rebound (8.14%), presenting a double-peak pattern. In 2024, the HRSV positivity rate slightly decreased compared to that in 2023 (6.29%), exhibiting a winter and spring-dominant epidemic pattern. Among the hospitalized children with ALRTI, the HRSV positivity rate in males (8.85%) was higher than that in females (7.51%), and the difference was statistically significant (χ²=17.33, P<0.001). Age distribution showed that 82.26% (1 984/2 412) of HRSV infections occurred in children aged 3 years old and below. Besides, as age increased, the infection rate of HRSV showed a gradually decreasing trend (P<0.001). Among the 2 412 children with HRSV infection, the proportion of severe cases was 22.31% (538/2 412), while the non-severe cases accounted for 77.69% (1 874/2 412). Compared with non-severe cases, severe cases were more frequently presented with high fever, longer duration of wheezing, as well as higher rates of underlying diseases or co-infection with Mycoplasma pneumoniae (P<0.001). ConclusionThe prevalence intensity of HRSV varied yearly from 2021 to 2024. After the removal of NPIs in 2023, a slight rebound with a double-peak epidemic pattern was observed. HRSV remained a common pathogen in children hospitalized for ARLTI, and children aged 3 years old and below constituted the highest proportion for infection. Compared with non-severe cases, those with severe HRSV infections were more prone to presenting with high fever and a longer duration of wheezing. Children with positive HRSV who had underlying diseases or co-infection with Mycoplasma pneumonia were more likely to develop severe conditions.

Kupffer cells (KCs), as residents and sentinels of the liver, are involved in the formation of hepatic fibrosis (HF). However, the biological functions of circular RNAs (circRNAs) in KCs to HF have not been determined. In this study, the expression levels of circRNAs, microRNAs, and messenger RNAs (mRNAs) in KCs from a mouse model of HF mice were investigated using microarray and circRNA-Seq analyses. circDcbld2 was identified as a candidate circRNA in HF, as evidenced by its up-regulation in KCs. Silver staining and mass spectrometry showed that Wtap and Igf2bp2 bind to cirDcbld2. The suppression of circDcbld2 expression decreased the KC inflammatory response and oxidative stress and inhibited hepatic stellate cell (HSCs) activation, attenuating mouse liver fibrogenesis. Mechanistically, Wtap mediated the N ⁶-methyladenosine (m6A) methylation of circDcbld2, and Igf2bp2 recognized m6A-modified circDcbld2 and increased its stability. circDcbld2 contributes to the occurrence of HF by binding miR-144-3p/Et-1 to regulate the inflammatory response and oxidative stress. These findings indicate that circDcbld2 functions via the m6A/circDcbld2/miR-144-3p/Et-1 axis and may act as a potential biomarker for HF treatment.

Objective To investigates the diagnostic value of infrared thermography-based skin temper-ature monitoring for lower extremity arterial disease(LEAD)in patients with diabetic foot.Methods A total of 160 patients with diabetic foot admitted to the hospital from March 2023 to December 2024 were selected as the research subjects and divided into the LEAD group(n=120)and the non-lesion group(n=40)based on the diagnostic results of color Doppler ultrasound.Spearman analysis was used to evaluate the correlation be-tween the relative temperature of diabetic foot ulcer(DFU)wounds measured by infrared thermography and the diameter and blood flow of lower limb arteries.Stepwise logistic regression analysis was performed to i-dentify the influencing factors of LEAD and subgroup analysis was conducted based on the presence or absence of infection.Receiver operating characteristic(ROC)curve analysis was used to assess the diagnostic efficacy of DFU wound relative temperature for LEAD and lower limb arterial atherosclerotic plaques,lumen stenosis,and lumen occlusion.Results There were statistically significant differences between the two groups in DFU wound temperature,skin temperature at the same site on the healthy side,DFU wound relative temperature,ankle brachial index(ABI),C-reactive protein(CRP),uric acid,and the peak velocity(PSV)and pulsatility index(PI)levels of the femoral artery,popliteal artery,and dorsalis pedis artery,as well as the proportions of lower limb arterial atherosclerotic plaques and lumen stenosis(P＜0.05).Spearman analysis showed that the relative temperature of DFU wounds was negatively correlated with PSV of the femoral artery,popliteal arter-y,and dorsalis pedis artery,and positively correlated with PI(P＜0.05).Univariate logistic regression analy-sis indicated that ABI,DFU wound relative temperature,uric acid,and the PSV and PI of the femoral artery,popliteal artery,and dorsalis pedis artery were influencing factors for LEAD(P＜O.05).Multivariate logistic regression analysis revealed that DFU wound relative temperature and uric acid were influencing factors for LEAD in diabetic foot(P＜0.05).Subgroup analysis showed that DFU wound relative temperature was an in-fluencing factor for LEAD in diabetic foot(P＜0.05),and there was no interaction between diabetic foot in-fection and the relationship between DFU wound relative temperature and LEAD in diabetic foot(P＞0.05).The area under the curve(AUC)for predicting LEAD using DFU wound relative temperature was 0.923,with the cut-off temperature being 5.4 ℃.The AUCs for predicting lower limb arterial atherosclerotic plaques,lumen stenosis,and lumen occlusion were 0.720,0.657,and 0.554,respectively,with the cut-off temperatures being 5.6,6.3,and 4.6 ℃,respectively.Conclusion DFU wound surface relative temperature of infrared thermog-raphy can effectively diagnose LEAD in diabetic foot.

Objective To observe the improvement effect and mechanism of emodin on lipopolysaccharide(LPS)-induced podocyte injury.Methods Human glomerular podocytes were used as the study object,and they were randomly divided into the blank control group,the LPS group,the emodin low-,medium-,and high-dose groups,and the emodin+lysophosphatidic acid[LP A,RhoA/RhoRho-associatedcoiled-coil kinase(ROCK)activator]group.Cell counting kit 8(CCK8)and 5-ethynyl-2'-deoxyuridine(EdU)staining were applied to detect the proliferation of glomerular podocytes,Transwell assay was used to test the migration of glomerular podocytes,flow cytometry was used to detect apoptosis of glomerular podocytes,and enzyme-linked immunosorbent assay(ELISA)was used to detect the levels of inflammatory factors tumor necrosis factor α(TNF-α),interleukin(IL)-1β,and IL-18 in the supernatant of glomerular podocytes,and the protein expression levels of RhoA and ROCK in glomerular podocytes were determined by Western Blot.Results The optical density(OD)450nm,EdU positive cell rate and migration number of glomerular podocytes in the LPS group were lower than those in the blank control group,and the apoptosis rate,the levels of TNF-α,IL-1β and IL-18 in the supernatant,as well as the protein expression levels of RhoA and ROCK in the cells were higher than those in the blank control group,the differences being statistically significant(P＜0.05);the OD450nm,EdU positive cell rate and migration number of glomerular podocytes in the emodin low-,medium-,and high-dose groups were higher than those in the LPS group,while the apoptosis rate,levels of TNF-α,IL-1 β and IL-18 in supernatant,as well as RhoA and ROCK protein expression levels in cells were reduced compared with those in the LPS group,the differences being statistically significant(P＜0.05);the OD450nm and EdU positive cell rate and migration number of glomerular podocytes in LPA group were lower than those of emodin high-dose group,while the apoptosis rate,levels of TNF-α,IL-1 βand IL-18 in supernatant,as well as RhoA and ROCK protein expression levels in cells were higher than those of emodin high-dose group,the differences being all statistically significant(P＜0.05).Conclusion Emodin can improve LPS-induced podocyte injury,and its mechanism of action may be related to the inhibition of RhoA/ROCK signaling pathway.

Objective To investigate the profile of common oral diseases in the Inner Mongolia region and the im-pact on local residents,and to obtain a clear picture of technology availability for local oral physicians and their needs for oral medical training.This will provide an important basis for optimizing the content of continuing educa-tion program and the direction of counterpart assistance in order to improve the technical level of local oral physi-cians and the practicality of oral medical teaching.Methods The study selected oral physicians from the Inner Mongolia region as subjects and designed a questionnaire to explore the current status of oral diseases and the training needs of oral physicians in this area.The chi-square test or Fisher's exact probability method was used for statistical testing.Results Data collected from the survey questionnaires of 181 oral physicians in the Inner Mongolia region indicated that 56.83%of physicians were engaged in routine oral medicine,reaching 56.83%.Dental caries and peri-odontitis were the most common oral diseases in the region(70.37%and 65.74%respec-tively).The most common impacts of these diseases on patients were pain and discomfort.In terms of clinical skills,diagnostic imaging skills,oral examination skills and root canal therapy were the most important as the ob-jective of training there were 70.17%of respondents expressed expectation to get the learning and training opportu-nity for new technologies and methods.Conclusions Continuing education programs and specific targeted assistance projects should focus on strengthening basic professional training for dental practitioners in Inner Mongolia and the promotion of capacity building in the field of healthcare and promotion of oral health in the region.

The irrational use of Chinese patent medicines （CPM） is becoming more and more prominent， which makes the demand for clinical practice guidelines of CPM gradually increase. In order to make domestic scholars understand the latest developments and existing problems of the CPM guidelines， and promote its development， this paper introduced the concept of CPM guidelines， summarized the characteristics of the two development modes， namely “taking CPM as the key” and “taking disease/syndrome as the key”， and analyzed the current methodological status of developing and reporting CPM guidelines. Based on the existed problems， three suggestions have been put forward to optimize the quality of CPM guidelines， which were clarifying the target users and scope of CPM guidelines， establishing an open and transparent mechanism of the personnel involvement and process steps， and formulating implementable and operable recommendations for the use of CPM.

This paper summarized the key points and methods in terms of the establishment of the guideline working group and the management of conflict of interests， trying to provide reference for the development of clinical practice guidelines for Chinese patent medicine （CPM）. The establishment of the working group is the first important step for developing CPM guidelines. Considering the characteristics of the clinical practice guidelines for CPM， this study suggests that the three key elements of ‘multidisciplinarity’， ‘clinical relevance’ and ‘geographical representativeness’ should be put focus on when forming the working group. The guideline advisory committee， clinical expert group， evidence systematic evaluation group， secretary group and the external review group should be established. All group members should clarify the conflict of interest， and the process and management method of the conflict of interest should be clearly reported.

The identification of clinical questions for clinical practice guidelines of Chinese patent medicine （CPM） is important for subsequent evidence retrieval， evaluation of evidence quality， formation of recommendations. This paper described a methodological proposal for the identification of clinical questions for CPM guidelines to highlight the characteristics of Chinese patent medicine and reflect its effect in specific stage of the disease. Considering four aspects， namely， the drug of Chinese patent medicine （D）， the specific disease stage （S）， comparison （C）， and specific outcome （O）， DSCO framework has been proposed to formulate the clinical questions. Multi-source information through scientific research， policy or standard documents， and clinical data are suggested for collecting clinical questions， and clear selection criteria should be set to finalize the clinical questions to be addressed by the guideline. In addition， the above process needs to be transparently and publicly reported in order to ensure the clarity and completeness of the guidelines.

The retrieval and evaluation of evidence is the basis for the development of clinical practice guidelines for Chinese patent medicine. As traditional Chinese medicine has a different development trajectory and utilization characteristics from modern medicine， there is certain differences in terms of evidence composition， retrieval and integration.This paper discussed multi-source body of evidence on Chinese patent medicine based on modern evidence-based medicine and ancient medical literature， and summarized the retrieval strategy as well as the possible problems and solving methods. For different types of evidence on Chinese patent medicine， the corresponding evaluation tools have been recommended， and the order to integrate the evidence based on the quality of the evidence from high to low is suggested. Finally， a multi-source based evidence retrieval-evaluation-integration scheme for Chinese patent medicine has been formed， which will provide a methodological reference for practitioners in the development of clinical practice guidelines for Chinese patent medicine.

Recommendations for Chinese patent medicine （CPM） based on key information on rational drug use are one of the important conditions for enhancing guideline enforceability as well as facilitating guideline implementation. In this study， we discussed in detail of the key information on the rational use of CPM in five aspects， which are dosage， drug discontinuation， drug-drug and drug-food interactions， safety and economy. Following the process of multi-source search， synthesis and prioritization， it is suggested to collect key information on the rational use of CPM from a multi-source search of drug instructions， policy documents， literature， and clinical experts' experiences. Then the searched information should be summarized and prioritized with the principle that taking drug instructions as the basis and other-sources information for check and supplementation. Finally， methodological recommendations for the retrieval and synthesis of key information on rational drug use in guideline recommendations has been formed.