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.

Healthy Sanming is a new stage, a new goal and a new station of Sanming′s reform of medical and health system. Based on the rainbow model, the author summarized and analyzed the theoretical logic, content framework and practical effectiveness of the health protection system in new era, summarized the advanced experience and practices in the construction of Healthy Sanming, and systematically interpreted the Sanming practice in Healthy China. Vertically, the macro-level of institutional integration constructed a regional healthcare mechanism to improve the protection system, the meso-level of organizational integration promoted the four-tier referral mode to build a protection network, the micro-level of the professional integration carried out in-depth medical and preventive synergy and fusion to protect the key populations, and the service integration provided life-cycle health services to consolidate the health coverage. Horizontally, the instrumental level drived health performance through the innovation of the health insurance fund and payment method, and the value level standardized and balanced the layout of resources by enhancing the primary medical service capacity. Constructing the health protection system in new era is an important initiative for the construction of healthy Sanming, public hospitals have shifted their focus from treating diseases to treating diseases and health management, the service system has shifted from the program system of health care and health to the synergy and integration of medical and preventive care, and medical insurance payment has shifted from regulating the behavior of doctors′ practice to encouraging the development of health promotion. These health transformations have resulted in a series of experiences that can inform the articulation of the reform of medical and health system with the construction of Healthy China.

Objective:To evaluate the effectiveness of the new operation mechanism of public hospitals in Sanming, so as to provide a theoretical basis for the sustainable development of the new operation mechanism for public hospitals.Methods:The data on medical income and patient costs of public hospitals in Sanming and the whole country from 2011 to 2021 were selected, structural variation analysis was used to analyze and compare the changes in the structure of medical income of public hospitals in Sanming City and the whole country, and descriptive analysis was carried out on the patient burden costs, in order to validate the effect of the new operation mechanism for public hospitals in Sanming.Results:From 2012 to 2021, the cumulative values of structure variation in medical service revenue and drug/consumable revenue of public hospitals in Sanming City were 29.58% and -32.29% respectively, better than the national figures of -0.95% and -0.68%; the annual contribution rate of structural variation in the medical service revenue and drug/consumable revenue of public hospitals in Sanming were 78.10% on average, higher than the national figure of 49.43%. From 2011 to 2021, the average increase in the average outpatient and emergency care costs per patient in public hospitals in Sanming was 4.35%, lower than the national average of 5.97%; the average increase in the average inpatient costs per patient was 3.91%, lower than the national average of 5.40%.Conclusions:The new mechanism for the operation of public hospitals in Sanming is effective and sustainable under certain policy conditions.

The reform of medical insurance payment methods is one of the important measures for Sanming City to achieve universal health. This study explored the design and implementation of DRG payment method under global budget based on the case of Sanming, in order to promote the transformation from disease treatment to health promotion. The transformation practice of Sanming City involved three aspects: concept reshaping, structural reconstruction, and functional reconstruction, which were promoted from the dimensions of goals, paths, and methods, and have achieved significant results. The author proposed three recommendations, including adhering to and improving DRG payments under global budget, attaching importance to medical quality assessment and monitoring, and designing a global budget plus composite payment method that is suitable for various health scenarios.

Liquid chromatography-multiple-reaction monitoring (LC-MRM) has been widely recognized as the golden standard for multiple components-targeted quantitative analysis of complicated matrices,with extensive applications for analysis in such fields as chemical drugs, traditional Chinese medicines and foods.Unfortunately, when facing the task of quantitatively analyzing trace chemical components in complex matrices, MRM suffers dramatically from the background noise or matrix interference, leading to undesirable sensitivity and selectivity in terms of the lower limits of quantification (LOQ) and detection (LOD).In recent years, MRM cubed (MRM3), also known as MS3 scan, has received much attention because of its unique ability to significantly improve detection selectivity and sensitivity attributing to the successive ion filtering function, enabling LC-MRM3 as an emerging analytical tool.In this review,our attention is devoted to: 1) the illustration of the principle for MRM3; 2) parameter settings; and 3) the application progress of LC-MRM3 in such fields as the pursuit of biomarkers, pharmaceutical analysis, forensic analysis, toxicological analysis, food chemistry, and environmental analysis, aiming to provide a promising analytical tool of LC-MRM3 advantageous in the quantification analysis of trace chemical components in complex matrices.

As a ligand-dependent transcription factor,retinoid-associated orphan receptor γt(RORyt)that controls T helper(Th)17 cell differentiation and interleukin(IL)-17 expression plays a critical role in the pro-gression of several inflammatory and autoimmune conditions.An emerging novel approach to the therapy of these diseases thus involves controlling the transcriptional capacity of RORyt to decrease Th17 cell development and IL-17 production.Several RORyt inhibitors including both antagonists and inverse agonists have been discovered to regulate the transcriptional activity of RORyt by binding to orthosteric-or allosteric-binding sites in the ligand-binding domain.Some of small-molecule inhibitors have entered clinical evaluations.Therefore,in current review,the role of RORyt in Th17 regulation and Th17-related inflammatory and autoimmune diseases was highlighted.Notably,the recently developed RORyt inhibitors were summarized,with an emphasis on their optimization from lead compounds,ef-ficacy,toxicity,mechanisms of action,and clinical trials.The limitations of current development in this area were also discussed to facilitate future research.

Objective:To investigate the risk factors of acute lung injury (ALI) caused by Staphylococcus aureus infection, and to construct a risk warning model. Methods:Patients with Staphylococcus aureus infection confirmed by sputum or blood culture admitted to the Affiliated Hospital of Jiangnan University from January 1, 2020 to May 10, 2022 were enrolled and divided into ALI group and non-ALI group. The age, smoking status, C-reactive protein (CRP), procalcitonin (PCT), neutrophil-to-lymphocyte ratio (NLR), albumin, oxygenation index and other clinical data were compared between the two groups. Univariate analysis was performed by using independent sample t test and chi-square test. Binary logistic regression analysis was used to screen the independent risk factors of ALI caused by Staphylococcus aureus infection, and a risk warning model was constructed. The receiver operator characteristic (ROC) curve was used to evaluate the predictive ability of the model. Results:There were 96 cases of Staphylococcus aureus infection, including 68 cases (70.8%) in ALI group, of which 41 cases (60.3%) were positive in sputum culture and 27 cases (39.7%) were positive in blood culture. Compared with the non-ALI group, the proportion of patients aged ≥60 years in ALI group was lower (58.8%(40/68) vs 64.3%(18/28)), the proportion of smoking was higher (58.8%(40/68) vs 35.7%(10/28)), and the differences were both statistically significant ( χ2=0.76 and 0.03, respectively, both P<0.05). The levels of CRP, PCT and NLR in the ALI group were all higher than those in non-ALI group, while oxygenation index and albumin level were both lower, and the differences were all statistically significant ( t=-5.28, -3.46, -9.87, 12.83 and 3.08, respectively, all P<0.05). Binary logistic regression analysis showed that CRP (odds ratio ( OR)=1.973, 95% confidence interval (95% CI) 0.956 to 2.989), PCT ( OR=3.734, 95% CI 1.014 to 13.746), NLR ( OR=1.152, 95% CI 1.058 to 2.254) and albumin ( OR=1.527, 95% CI 1.110 to 2.102) were independent risk factors for ALI caused by Staphylococcus aureus infection. The areas under the ROC curve of CRP, PCT, NLR, albumin and the risk warning model constructed from the combination of four risk factors were 0.69, 0.81, 0.83, 0.78 and 0.93, respectively. The sensitivities were 65.14%, 89.91%, 84.40%, 56.88% and 98.17%, respectively. The specificities were 62.37%, 60.22%, 65.59%, 80.64% and 93.55%, respectively. The accuracy of the effectiveness test of the risk warning model was 84.97%. Conclusions:CRP, PCT, NLR and albumin are the independent risk factors for ALI caused by Staphylococcus aureus infection. The risk warning model based on the above factors has a good early warning effect on ALI caused by Staphylococcus aureus infection.

Abstract OBJECTIVE To develop a vancomycin individualized dosing-assisted decision platform suitable for practical clinical application scenarios and provide individualized dosing recommendations for the rational use of vancomycin. METHODS Based on the vancomycin population pharmacokinetic model that had been constructed and verified to be feasible, the vancomycin individualized assisted decision-making platform was developed by using Idea2019, JDK1.8, ETL and other software tools. The platform development had gone through three main stages, included ①requirement analysis; ②design stage; ③software testing and optimization. RESULTS The vancomycin individualized assisted decision-making platform, which was successfully developed and applied, had the advantages of simple page, perfect function and convenient operation, and was divided into four main modules according to functions, namely retrieval module, information module, concentration prediction module and reporting module. The platform could connect to the hospital intranet platform to automatically obtain patient information, medication information and blood concentration test results, and calculate individual pharmacokinetic parameters for subsequent concentration prediction based on the embedded population pharmacokinetic model, combined with individual parameters. The concentration prediction module incorporated the Bayesian feedback method with patient medication information, drug concentration measurement results and relevant covariate parameter values, took the guideline-recommended trough concentration and AUC range as the target value, calculated the individualized drug administration scheme that met the target concentration range, and set up custom simulation functions considering the actual clinical application scenarios, which was of more popularization and application value. CONCLUSION Based on the vancomycin population pharmacokinetic model that has been successfully constructed in the previous stage, with the assistance of Idea2019, JDK1.8, ETL and other software tools, a vancomycin individualized dosing-assisted decision platform has successfully constructed, which can more efficiently and conveniently assist monitoring pharmacists to provide individualized dosing advice for clinical use of vancomycin.

OBJECTIVE To analyze the key points of information disclosure management of national drug and cosmetic sampling and testing, and to provide reference for the drug administration of China. METHODS Literature research and data analysis were conducted. By consulting relevant literature and searching the public information of drugs and cosmetics sampling and testing, and the disclosure data of the sampling and testing information from 2019-2021 was summarized, the management strategy of sampling and testing information disclosure system of Chinese drugs and cosmetics was studied. RESULTS China’s drug and cosmetics sampling and testing had established an active information disclosure system focusing on the disclosure of unqualified products and the exchange of product quality and risk information as the main body, which played an important role in promoting the transformation and application of regulatory achievements and enhancing the credibility of the government. CONCLUSION For the national drug and cosmetic sampling and testing, regulation system on disclosure of information should be further enhanced, a standardized and orderly information disclosure resource integration system should be established, and the new credit-based supervision mechanism with credit repair system tools must be constructed.

With the development of synthesis technology, modified messenger RNA (mRNA) has emerged as a novel category of therapeutic agents for a broad of diseases. However, effective intracellular delivery of mRNA remains challenging, especially for its sensitivity to enzymatic degradation. Here, we propose a polyphenol-assisted handy delivery strategy for efficient in vivo delivery of IL-10 mRNA. IL-10 mRNA binds to polyphenol ellagic acid through supramolecular binding to yield a negatively charged core, followed by complexing with linear polyetherimide and coating with bilirubin-modified hyaluronic acid to obtain a layer-by-layer nanostructure. The nanostructure specifically up-regulated the level of IL-10, effectively inhibited the expression of inflammatory factors, promoted mucosal repair, protected colonic epithelial cells against apoptosis, and exerted potent therapeutic efficacy in dextran sulfate sodium salt-induced acute and chronic murine models of colitis. The designed delivery system without systemic toxicity has the potential to facilitate the development of a promising platform for mRNA delivery in ulcerative colitis treatment.