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 explore the impact of multi-model adaptive statistical iterative reconstruction (ASiR-V) algorithm on radiation dose and image quality in children’s ultra-low-dose chest CT examination. Methods A total of 72 children who underwent chest CT scans at Qingdao Municipal Hospital with admissions between January 2024 and January 2025 were selected as subjects and divided into two groups using a random number table. In the control group (n = 36), the tube voltage was set at 100 kVp and the conventional filtered back projection algorithm was used. In the observation group (n = 36), the tube voltage was set at 80 kVp and images were reconstructed using 30% ASiR-V (observation group 1), 60% ASiR-V (observation group 2), and 90% ASiR-V (observation group 3), respectively. Radiation doses were recorded for each group, and both subjective and objective evaluations of image quality were conducted. Results Compared with the control group, the observation group demonstrated significantly lower volume CT dose index [(0.86 ± 0.09) mGy], dose length product [(25.90 ± 3.55) mGy·cm], and effective dose [(0.01 ± 0.001) mSv] (P < 0.05). There was no significant difference in subjective evaluation scores of image quality among the four groups (z = −2.206, P = 0.530). Additionally, Fisher’s exact test showed that the proportion of images scoring 4-5 points was higher in observation group 2 than in observation group 3 (P = 0.024). The noise value of the ascending aorta in the mediastinal window and the noise values of the right and left middle lung fields and the right and left upper lung fields in the lung window were lower in observation groups 2 and 3 than in the control group, and these values were lower in observation group 3 than in observation group 2 (P < 0.05). The signal-to-noise ratios of the ascending aorta and liver in observation groups 2 and 3 were higher than those in the control group, and the ratios were higher in observation group 3 than in observation group 2 (P < 0.05). Conclusion Reconstruction using the 60% ASiR-V algorithm for pediatric ultra-low-dose chest CT examination can ensure good image quality while reducing radiation dose and improving examination safety.

Objective To investigate the multi-target mechanisms of quercetin in treating endometriosis(EMT)through integrative network pharmacology analysis.Methods Active targets of quercetin were collected from the TCMSP database,while EMT-related differentially expressed genes(DEGs)were identified through the Gene Expression Omnibus(GEO)dataset.A comparative analysis was conducted to pinpoint potential therapeutic targets of quercetin for EMT treatment.Functional enrichment analyses were employed to investigate the biological functions associated with these targets,and a protein-protein interaction(PPI)network was conducted to identify core targets.Molecular docking and dynamics simulations were performed to validate the binding characteristics between quercetin and the core targets.The top 2 target protein pairs,HSP90AB1 and AR,exhibiting the lowest binding energy,were selected for subsequent cellular experimental validation.Human EMT-immortalized ectopic endometrial epithelial cell line 12Z(n=6,independent replicates)was subjected,and CCK-8 assay was used to determine ehe effects of quercetin on cell viability and proliferation,and the half-maximal inhibitory concentration(IC50)was calculated at 48 h after treatment.Then the 12Z cells were treated with quercetin at a concentration gradient of 0,30,60 and 90 μmol/L,the migration and invasion abilities were assessed with cell scratch and cell invasion assays.Western blotting was conducted to detect the changes in the expression of HSP90AB1 and AR proteins after different doses of treatment.Results There were 49 potential EMT-related therapeutic targets and 10 core targets identified.Functional enrichment analyses revealed that these targets were significant enriched in inflammation-related signaling pathways,including AGE-RAGE,ErbB and TNF;immune-related pathways,such as Th17 cell differentiation,T/B cell receptor signaling;angiogenesis-related pathways like VEGF;and hormonal regulatory pathways involving estrogen and GnRH.Molecular docking demonstrated that quercetin exhibited favorable binding activity(binding energy<-5 kcal/mol)with all core target proteins,with particularly strong binding energies(<-7 kcal/mol)observed for AR,EGFR,FOS,ERBB2,and HSP90AB1.Molecular dynamics simulations revealed that quercetin forms sustained hydrogen bond interactions with AR and HSP90AB1,facilitating the formation of stable complexes.CCK-8 assay,cell scratch assay,and transwell invasion assay indicated that quercetin inhibited the proliferative activity,and migrative and invasive abilities of 12Z cells in a concentration-dependent manner,with more pronounced inhibitory effects observed at 60 and 90 μmol/L quercetin(P<0.001);Western blotting revealed that treatment of 12Z cells with varying quercetin concentrations for 48 h up-regulated the expression of HSP90AB1 and AR,with the most significant increase observed at 90 μmol/L quercetin(HSP90AB1,P<0.05;AR,P<0.001).The restored expression levels of HSP90AB1 and AR showed positive correlations with the proliferative activity,migrative and invasive abilities of ectopic endometrial cells.Conclusion Quercetin effectively addresses endometriosis through multiple molecular targets and signaling pathways,and stabilization of the HSP90AB1/AR complex and subsequent protein upregulation represents a key therapeutic mechanism.

Objective:To investigate the association between sleep status and the risk for coronary heart disease in adults in Suzhou.Methods:Using the baseline and follow up information of 53 269 local residents aged 30-79 years in China Kadoorie Biobank conducted in Wuzhong District, Suzhou, 51 929 subjects were included in this study after excluding those reporting coronary heart disease, stroke and cancer at the baseline survey. A Cox proportional hazards regression model was used to analyze the association of healthy sleep score (0-3 points) and sleep factors (snoring, insomnia, long sleep duration and nap) with the risk for coronary heart disease.Results:The median follow-up time was 11.12 years, and 1 304 individuals were diagnosed with coronary heart disease during the follow-up. After adjusting for potential confounders, occasional snoring ( HR=1.20, 95% CI: 1.04-1.38), usual snoring ( HR=1.17, 95% CI: 1.02-1.33), insomnia disorder ( HR=1.41, 95% CI: 1.12-1.78), daytime dysfunction ( HR=1.56, 95% CI: 1.20-2.03) and perennial nap ( HR=1.37, 95% CI: 1.19-1.59) were associated with increased risk of coronary heart disease. Compared with those with sleep score of 0 - 1 (low sleep quality), the people with sleep score of 3 had reduced risk of coronary heart disease by 26% ( HR=0.74, 95% CI: 0.63-0.87). Stratified analysis showed that the association of healthy sleep score 3 with risk of coronary heart disease was stronger in low physically active individuals (interaction P<0.05). Conclusions:Snoring, insomnia disorders, daytime dysfunction, and perennial napping were all associated with increased risk for coronary heart disease, and keep healthy sleep mode might reduce the risk for coronary heart disease in adults.

OBJECTIVE To investigate and analyze the operational costs and current charging policies of pharmacy intravenous admixture service （PIVAS） in China， and provide a reference for promoting high-quality and sustainable development of PIVAS. METHODS Questionnaires were distributed in 30 provinces， autonomous regions， and municipalities across the country through the “Wenjuanxing” platform from May 6th to July 1st， 2022. The operational costs， charging status and suggestions of PIVAS were investigated and analyzed. RESULTS A total of 761 PIVAS participated in the survey nationwide， including 666 tertiary medical institutions， 93 secondary medical institutions， and 2 primary medical institutions. Approximately 60.58% of PIVAS had implemented a charging system that allowed charges. Among them， most PIVAS required inspection and evaluation before charging. The annual operating cost of PIVAS in China was approximately 2 098 100 yuan， with the integrated operating cost comprising 89.36% of the total， while the dispensing cost accounted for only 10.64%. Human costs emerged as the highest annual consumption （74.20%）， followed by decoration and facility maintenance costs （4.77%） and equipment acquisition costs （3.44%）. Regarding charges for different drugs nationwide， common drugs had an average charge standard of 4.39 yuan per bag while antibacterial drugs averaged 5.01 yuan per bag； hazardous drugs had an average charge of 23.17 yuan per bag， whereas parenteral nutrition solutions averaged 38.75 yuan per bag. However， the recommended average charges of the four drugs mentioned above were 6.71， 9.63， 38.35 and 44.03 yuan per bag， respectively. CONCLUSIONS At present， there is no unified inspection and evaluation standard and charging standard in China. Moreover， the current charging standard is lower than the recommended standard. It is necessary to combine operational costs and develop more reasonable and fair charging standards.

OBJECTIVE To know about the current status of medical order auditing in pharmacy intravenous admixture service （PIVAS） of medical institutions nationwide， further improve the management of medical orders in PIVAS， and reduce and eliminate the occurrence of intravenous medication administration errors. METHODS Through the questionnaire survey method， to address the problems and current situation of PIVAS medical order auditing in medical institutions nationwide， experts from each province （autonomous region， municipality directly under the central government） in the research group were responsible for organizing the PIVAS directors of relevant medical institutions in their provinces to fill in the questionnaires on medical order audit and inappropriate medical order interventions， and conduct a statistical analysis of the results. RESULTS A total of valid 751 responses were received to the PIVAS questionnaire on the review of medical prescriptions. Our PIVAS medical order audit is mainly carried out by a combination of manual and computer. The median number of medical orders were audited by PIVAS per day were 700.00-771.00； the median number of new medical orders were audited by PIVAS per day were 209.68-215.00； medical order auditing rates were 85.50%-92.44% averagely； the inappropriate doctor’s orders accounted for 1.82%-1.89% averagely； the intervention rates of inappropriate medical orders ranged 74.90%-79.41%， the success rates of intervention were 79.62%-87.28% averagely； the medication refund rates were 2.92%-3.08%. CONCLUSIONS Most of the PIVAS in China’s healthcare institutions use medical order review software to assist in the review of medical orders， and there are cases of individual PIVAS in which medical orders are not reviewed comprehensively and inappropriate orders are not intervened in， and the standards and processes of medical prescription review need to be improved. It is recommended to emphasize the pharmacist’s responsibility system， standardize the use of prescription review software； gradually expand the scope of medical order review， and adopt a multi-departmental collaborative approach so as to increase the success rate of intervention for inappropriate prescriptions and reduce the rate of PIVAS withdrawals.

Objective:To discuss the aeromedical support enhancement measures by analyzing the disease spectrum and the aeromedical characteristics of temporarily grounded flying personnel.Methods:A retrospective analysis was conducted on the clinical data of 244 flying personnel who received medical treatment at the Southern Theater Air Force Hospital from November 2011 to March 2023 and were temporarily grounded in aeromedical assessment. The flying personnel were grouped by aircraft types (fighter, trans-bomber, helicopter) and flying hours (<2 000 h and ≥2 000 h), and the spectrum of temporarily unqualified flight diseases were statistically analyzed. The disease distributions of flying personnel in different aircraft types and flying hours were compared.Results:Among the 244 flying personnel (389 person-time) who were identified as temporarily grounded by aeromedical assessment, the major specialties involved were surgery (52.5%), internal medicine (24.6%) and neuropsychiatry (14.3%). The top 10 diseases leading to temporarily grounded were cervical and lumbar spine diseases, anxiety-depression, knee joint injury (surgical treatment), anal fistula (surgical treatment), sleep disorders, joint and soft tissue injuries, hypertension, ureteral stones, achilles tendon rupture and fracture (conservative treatment). There was a significant difference in the proportion of flying personnel temporarily grounded due to anxiety-depression among different aircraft types ( P=0.014). There were no significant differences in other diseases among flying personnel in different aircraft types (all P>0.05). The proportion of temporarily grounded flying personnel due to knee joint injury in flying hours <2 000 h was higher than that in flying hours ≥2 000 h, and the difference was significant ( χ2=4.47, P=0.035). Among the 71 flying personnel who underwent repeated ground observation, 28 were identified as qualified, 22 were grounded and 21 were still temporarily grounded. Conclusions:The proportion of flying personnel temporarily grounded due to diseases is relatively high. Accurate diagnosis and treatment of diseases and aeromedical assessment are important links to promote the early return of flying personnel.

Objective:To discuss the aeromedical support enhancement measures by analyzing the disease spectrum and the aeromedical characteristics of temporarily grounded flying personnel.Methods:A retrospective analysis was conducted on the clinical data of 244 flying personnel who received medical treatment at the Southern Theater Air Force Hospital from November 2011 to March 2023 and were temporarily grounded in aeromedical assessment. The flying personnel were grouped by aircraft types (fighter, trans-bomber, helicopter) and flying hours (<2 000 h and ≥2 000 h), and the spectrum of temporarily unqualified flight diseases were statistically analyzed. The disease distributions of flying personnel in different aircraft types and flying hours were compared.Results:Among the 244 flying personnel (389 person-time) who were identified as temporarily grounded by aeromedical assessment, the major specialties involved were surgery (52.5%), internal medicine (24.6%) and neuropsychiatry (14.3%). The top 10 diseases leading to temporarily grounded were cervical and lumbar spine diseases, anxiety-depression, knee joint injury (surgical treatment), anal fistula (surgical treatment), sleep disorders, joint and soft tissue injuries, hypertension, ureteral stones, achilles tendon rupture and fracture (conservative treatment). There was a significant difference in the proportion of flying personnel temporarily grounded due to anxiety-depression among different aircraft types ( P=0.014). There were no significant differences in other diseases among flying personnel in different aircraft types (all P>0.05). The proportion of temporarily grounded flying personnel due to knee joint injury in flying hours <2 000 h was higher than that in flying hours ≥2 000 h, and the difference was significant ( χ2=4.47, P=0.035). Among the 71 flying personnel who underwent repeated ground observation, 28 were identified as qualified, 22 were grounded and 21 were still temporarily grounded. Conclusions:The proportion of flying personnel temporarily grounded due to diseases is relatively high. Accurate diagnosis and treatment of diseases and aeromedical assessment are important links to promote the early return of flying personnel.

Objective:To systematically search and summarize the best evidence for the implementation and management of parenteral nutrition in critically ill patients.Methods:Based on the evidence-based medicine evidence structure, relevant evidence on the implementation and management of parenteral nutrition in critically ill patients was searched from top to bottom in Chinese and English databases such as China National Knowledge Infrastructure (CNKI) , VIP, British Medical Journal (BMJ) Best Practice, UpToDate and so on. The search period was from January 1, 2017 to July 31, 2022. Using the quality level of evidence and grade of recommendation system of the Joanna Briggs Institute (JBI) Evidence-Based Health Care Center in Australia, two researchers conducted literature quality evaluation and evidence summary.Results:A total of 19 articles were included, including 2 clinical decisions, 3 clinical practice guidelines, 11 expert consensuses, 2 systematic reviews, and 1 retrospective case-control study. A total of 9 themes were summarized, including the establishment of a multidisciplinary team, indications for parenteral nutrition, nutritional assessment, parenteral nutrition start time, parenteral nutrition stop time, selection and evaluation of vascular pathways, selection of infusion devices, observation of infusion processes and complications, with a total of 29 best evidences.Conclusions:The safe implementation and management of parenteral nutrition support for critically ill patients is of great significance for improving patient health outcomes. Medical and nursing staff should establish a standardized evidence-based parenteral nutrition support process to improve the safety of parenteral nutrition implementation in critically ill patients.