Wastewater-based epidemiology has emerged as a transformative surveillance tool for estimating substance consumption and monitoring disease prevalence, particularly during the COVID-19 pandemic. It enables the population-level monitoring of illicit drug use, pathogen prevalence, and environmental pollutant exposure. In this perspective, we summarize the key challenges specific to the Chinese context: (1) Sampling inconsistencies, necessitating standardized 24-hour composite protocols with high-frequency autosamplers (≤ 15 min/event) to improve the representativeness of samples; (2) Biomarker validation, requiring rigorous assessment of excretion profiles and in-sewer stability; (3) Analytical method disparities, demanding inter-laboratory proficiency testing and the development of automated pretreatment instruments; (4) Catchment population dynamics, reducing estimation uncertainties through mobile phone data, flow-based models, or hydrochemical parameters; and (5) Ethical and data management concerns, including privacy risks for small communities, mitigated through data de-identification and tiered reporting platforms. To address these challenges, we propose an integrated framework that features adaptive sampling networks, multi-scale wastewater sample banks, biomarker databases with multidimensional metadata, and intelligent data dashboards. In summary, wastewater-based epidemiology offers unparalleled scalability for equitable health surveillance and can improve the health of the entire population by providing timely and objective information to guide the development of targeted policies.
China/epidemiology* ; Humans ; Wastewater/analysis* ; COVID-19/epidemiology* ; Public Health ; Wastewater-Based Epidemiological Monitoring ; SARS-CoV-2

Objective To investigate the expression of T cell subsets in the spleen of BTBR T+Itpr3tf autistic mouse at 4,8,and 12 weeks of age,and to determine the optimal age for studying the relationship between immune abnormalities and autism in BTBR autistic mice.Methods It randomly selected 5～6 male BTBR mouse at 4 weeks,8 weeks,and 12 weeks of age and C57BL/6J mouse of the same gender at corresponding ages for the three-box social interaction test,the self-grooming test,and the marble-burying test;Single cell suspensions were prepared from the spleens of mouse at 8 and 12 weeks of age,and flow cytometry was used to detect 8 subsets of T cells(TH 1,TH2,TH17,TC1,TC2,TC17,TFH,and Treg).Results Compared with C57BL/6J mouse of the same age,BTBR mouse at 4 weeks,8 weeks,and 12 weeks of age showed a decrease in social time(P＜0.001),an increase in grooming time(P＜0.01,P＜0.001),and an increase in the number of marbles buried(P＜0.01,P＜0.001)in BTBR mouse at 8 weeks and 12 weeks of age.As well,the expression of TH 1(P＜0.001),TH2(P＜0.01),TC 1(P＜0.05),TC2(P＜0.001),and TFH(P＜0.01)cells in 8-week-old BTBR mouse were significantly increased,while the expression of Treg(P＜0.001)cells were significantly decreased;The expression of TH 1(P＜0.01),TH2(P＜0.01),TH 17(P＜0.05),TC1(P＜0.01),TC2(P＜0.001),TC 17(P＜0.01),and TFH(P＜0.001)increased in 12-week-old BTBR mouse,while the expression of Treg(P＜0.05)cells decreased.At different age stages(P＜0.050)the ratio of TH 1/Treg and TC 1/Treg in 8-week-old BTBR mouse were significantly higher than those in 12 week old mouse,while the TC 17/Treg ratio decreased.Conclusions BTBR mouse at different developmental stages exhibit varying degrees of abnormal increase in Teff/Treg ratio.Based on result of behavioral test,it is recommended to use 8-week-old BTBR mice for research on autism and immune abnormalities.

Objective:To relate the changes in electroencephalography (EEG) signals after a spinal cord injury (SCI) with functional independence.Methods:The EEG data describing ninety SCI patients in both open and closed eye states were compared with those collected from 45 healthy counterparts. The SCI patients′ EEG data were correlated with their spinal cord independence measure (SCIM) scores at corresponding time points. The SCI patients were divided into a cervical SCI group (SCI-C group) and a non-cervical SCI group (SCI-NC group), with 45 cases in each group. The difference in EEG data between them and its correlation with the SCIM scores were also compared and analyzed.Results:In the eyes-open state, the EEG power in the frontal, central, temporal, and right occipital regions of the SCI group was lower than among the control group, on average. There were significant differences in the δ and θ low-frequency bands. The α1 band power in the frontal and right parietal regions was significantly higher in the SCI group, on average. With the eyes closed the δ band power in the right prefrontal, frontal, left central, and temporal regions of the SCI group was lower than among the control group, while the α1 band power in the right prefrontal, frontal, central, and parietal regions was significantly higher. The reactivity to eye opening of the α1 band in the right prefrontal, frontal, central, parietal, and temporal regions was less in the SCI patients compared to healthy subjects. Among the SCI patients, higher EEG power in the β2 band of the right frontal lobe and the α2 and β bands of the right temporal lobe was significantly positively correlated with higher SCIM scores during the eyes-open measurements. And the higher EEG power in the α2 band of the prefrontal and frontal lobes, the β2 band of the frontal lobe, the α2 band of the right central region, the α2 and β bands of the temporal lobe, and the α2 and β2 bands of the occipital lobe was significantly positively correlated with higher SCIM scores during the eyes-closed state. The subgroup analysis showed that the δ band power in the left temporal lobe and the α2 band power in the parietal lobe were lower among the SCI-C compared with the SCI-NC patients in the eyes-open state. With the eyes closed, the δ band power in the left frontal, left parietal, and left temporal lobes and the α2 band power in the frontal, central, parietal, temporal, and right occipital lobes was significantly lower in the SCI-C group compared to the SCI-NC group, on average. The reactivity to eye opening of the δ band in the temporal lobe, the α2 band in the left prefrontal, frontal, central, parietal, temporal, and right occipital lobes, and the β2 band in the right parietal and left occipital lobes was less in the SCI-C group than in the SCI-NC group ( P≤0.05). Among the SCI-C patients, higher EEG power in the β1 and β2 bands of the right temporal lobe with the eyes open was significantly positively correlated with higher SCIM scores. With the eyes closed, higher EEG power in the α2 and β1 bands of the right prefrontal lobe was significantly positively correlated with higher SCIM scores. Among the SCI-NC patients, higher EEG power in the δ band of the prefrontal lobe, the β1 and β2 bands of the left prefrontal lobe, and the δ bands of the frontal, central, right parietal, and right temporal lobes during the eyes open measurements was significantly positively correlated with higher SCIM scores. Conclusions:The EEG power of cervical and non-cervical SCI patients shows characteristic changes which correlate with their functional independence.

Human Respiratory Stem Cells (RSCs) play a crucial role in the maintenance, repair and regeneration of the respiratory system. As a novel therapeutic method, stem cell therapy is a popular research direction in the medical field. And with the in-depth research on the mechanism of pneumonia caused by respiratory infections in recent years, the use of RSCs to explore pneumonia caused by respiratory infections and its therapeutic strategies has become a hot topic. In this paper, we firstly outlined the types of RSCs, summarized the mechanism of pneumonia caused by respiratory tract infections, discussed the advantages of RSCs application and the progress of culture differentiation, and elaborated the therapeutic exploration of RSCs in pneumonia caused by respiratory tract infections.

Objective To understand the current situation of healthcare-associated infection(HAI)in China,pro-vide data support and decision-making basis for formulating scientific and effective strategies for HAI prevention and control.Methods A nationwide cross-sectional survey on HAI was conducted among various types and levels of medical institutions in China according to a unified protocol of bedside surveys and case investigations.Results In 2024,a total of 5 736 medical institutions and 2 751 765 patients were surveyed.Among them,34 889 HAI cases were identified,with a prevalence rate of 1.27％.The number of HAI episodes was 38 032,and case prevalence rate was 1.38％.The prevalence rate of HAI in medical institutions in different regions of China ranged from 0.66％to 2.35％.Among medical institutions of different scales,those with a bed capacity of ≥900 had the high-est incidence of HAI,reaching 1.65％.The most common infection site was the lower respiratory tract(44.66％),followed by the urinary tract(12.94％),surgical site(9.32％),upper respiratory tract(7.02％),and bloodstream infection(5.78％).The top 3 departments with the highest HAI rates were the general intensive care unit(10.02％),department of neurosurgery(5.51％),and department(group)of hematology(5.34％).A total of 23 238 strains of HAI pathogens were detected,with 10 714 strains(46.10％)from lower respiratory tract speci-mens.The top 5 detected strains were Klebsiella pneumoniae(14.76％),Pseudomonas aeruginosa(13.33％),Escherichia coli(12.79％),Acinetobacter baumannii(9.23％),and Staphylococcus aureus(7.88％).231 944 pa-tients underwent class Ⅰ incision surgery were monitored,with 1 647 cases experienced surgical site infection,and the prevalence rate of surgical site infection was 0.71％.The number of patients who should undergo pathogen de-tection(patients receiving therapeutic and therapeutic combined prophylactic antimicrobial agents)was 715 179,while the actual number was 480 492,with a pathogen detection rate of 67.18％.425 225 patients received patho-genic detection before treatment,with a detection rate of 59.46％.Conclusion The overall HAI prevalence in Chi-na is lower,showing disparities among medical institutions of different regions and scales.Therefore,precise imple-mentation of measures is necessary for HAI prevention and control,with a focus on high-risk institutions and high-risk departments,key areas,and critical procedures.All levels of medical institutions should continuously reduce the incidence of HAI by strengthening monitoring,standardizing the use of antimicrobial agents,and reinforcing basic HAI prevention and control measures.

Cervical spinal cord injury without fracture-dislocation (CSCIWFD) is referred to as a special type of cervical spinal cord injury characterized by traumatic spinal cord dysfunction and no significant bony structural abnormalities on imagines. Duo to the high risk of missed diagnosis during the initial consultation, CSCIWFD may lead to progressive neurological deterioration or even complete paralysis, severely impacting patients′ prognosis. Currently, there are no established consensuses over the diagnosis and treatment of CSCIWFD, such as the lack of evidence-based standards for indications of non-surgical treatment and risk of secondary neurological injury, as well as debates over the optimal timing for surgical intervention and indications for different surgical approaches. To address these issues, the Spine Trauma Group of the Orthopedic Branch of the Chinese Medical Doctor Association organized experts in the relevant fields to formulate Diagnosis and treatment guideline for acute cervical spinal cord injury without fracture- dislocation in adults ( version 2025) . Based on evidence-based medicine and the principles of scientific rigor and clinical applicability, the guidelines proposed 11 recommendations covering terminology, diagnosis, evaluation treatment, and rehabilitation, etc., aiming to standardize the management of CSCIWFD.

Objective:To relate the changes in electroencephalography (EEG) signals after a spinal cord injury (SCI) with functional independence.Methods:The EEG data describing ninety SCI patients in both open and closed eye states were compared with those collected from 45 healthy counterparts. The SCI patients′ EEG data were correlated with their spinal cord independence measure (SCIM) scores at corresponding time points. The SCI patients were divided into a cervical SCI group (SCI-C group) and a non-cervical SCI group (SCI-NC group), with 45 cases in each group. The difference in EEG data between them and its correlation with the SCIM scores were also compared and analyzed.Results:In the eyes-open state, the EEG power in the frontal, central, temporal, and right occipital regions of the SCI group was lower than among the control group, on average. There were significant differences in the δ and θ low-frequency bands. The α1 band power in the frontal and right parietal regions was significantly higher in the SCI group, on average. With the eyes closed the δ band power in the right prefrontal, frontal, left central, and temporal regions of the SCI group was lower than among the control group, while the α1 band power in the right prefrontal, frontal, central, and parietal regions was significantly higher. The reactivity to eye opening of the α1 band in the right prefrontal, frontal, central, parietal, and temporal regions was less in the SCI patients compared to healthy subjects. Among the SCI patients, higher EEG power in the β2 band of the right frontal lobe and the α2 and β bands of the right temporal lobe was significantly positively correlated with higher SCIM scores during the eyes-open measurements. And the higher EEG power in the α2 band of the prefrontal and frontal lobes, the β2 band of the frontal lobe, the α2 band of the right central region, the α2 and β bands of the temporal lobe, and the α2 and β2 bands of the occipital lobe was significantly positively correlated with higher SCIM scores during the eyes-closed state. The subgroup analysis showed that the δ band power in the left temporal lobe and the α2 band power in the parietal lobe were lower among the SCI-C compared with the SCI-NC patients in the eyes-open state. With the eyes closed, the δ band power in the left frontal, left parietal, and left temporal lobes and the α2 band power in the frontal, central, parietal, temporal, and right occipital lobes was significantly lower in the SCI-C group compared to the SCI-NC group, on average. The reactivity to eye opening of the δ band in the temporal lobe, the α2 band in the left prefrontal, frontal, central, parietal, temporal, and right occipital lobes, and the β2 band in the right parietal and left occipital lobes was less in the SCI-C group than in the SCI-NC group ( P≤0.05). Among the SCI-C patients, higher EEG power in the β1 and β2 bands of the right temporal lobe with the eyes open was significantly positively correlated with higher SCIM scores. With the eyes closed, higher EEG power in the α2 and β1 bands of the right prefrontal lobe was significantly positively correlated with higher SCIM scores. Among the SCI-NC patients, higher EEG power in the δ band of the prefrontal lobe, the β1 and β2 bands of the left prefrontal lobe, and the δ bands of the frontal, central, right parietal, and right temporal lobes during the eyes open measurements was significantly positively correlated with higher SCIM scores. Conclusions:The EEG power of cervical and non-cervical SCI patients shows characteristic changes which correlate with their functional independence.

Human Respiratory Stem Cells (RSCs) play a crucial role in the maintenance, repair and regeneration of the respiratory system. As a novel therapeutic method, stem cell therapy is a popular research direction in the medical field. And with the in-depth research on the mechanism of pneumonia caused by respiratory infections in recent years, the use of RSCs to explore pneumonia caused by respiratory infections and its therapeutic strategies has become a hot topic. In this paper, we firstly outlined the types of RSCs, summarized the mechanism of pneumonia caused by respiratory tract infections, discussed the advantages of RSCs application and the progress of culture differentiation, and elaborated the therapeutic exploration of RSCs in pneumonia caused by respiratory tract infections.

OBJECTIVE: Microcirculatory disturbance is pathologically critical to acute pancreatitis (AP), which can be effectively alleviated by traditional Chinese medicine (TCM) formulas that activate blood flow. However, there has been no evidence-based research to date. Therefore, a well-designed systematic review and meta-analysis is necessary to elucidate the therapeutic transformative benefit of improving microcirculation during AP. This study aims to confirm the therapeutic efficacy of TCM formulas and explore the potential mechanisms underlying their effects on AP treatment. METHODS: Studies from eight databases including Pubmed, Embase, Web of Science, Cochrane Library, CNKI, CBM, Wanfang, and Chinese VIP, were screened for the eligible randomized controlled trials (RCTs). The APACHE II score and effectiveness rate were set as primary outcomes, while mortality rate, complications, total hospital stays, serum amylase recovery time, the time until the disappearance of abdominal pain, microcirculation indicators, and inflammation indicators were chosen as secondary outcomes. A systematic review and meta-analysis were subsequently conducted. Network pharmacology analysis was performed to analyze potential bioactive components with relevant targets of the core herbs included in the TCM formulas for activating blood flow. RESULTS: A total of 51 RCTs (n = 3 721) were included. Compared with conventional western medical treatments alone, TCM groups were associated with lower APACHE II score (SMD =  - 1.36, 95% CI: -2.01 to - 0.71, P = 0.000) and higher effectiveness rate (RR: 1.22, 95% CI: 1.18 to 1.26, P = 0.000). Furthermore, the formulas for activating blood flow demonstrated significant efficacy in improving both microcirculation and inflammation indicators. Additionally, six core Chinese herbal medicines including Rhei Radix et Rhizoma with the highest frequency, Aurantii Fructus Immaturus, Paeoniae Radix Rubra, Bupleuri Radix, Salviae Miltiorrhizae Radix et Rhizoma, and Corydalis Rhizoma were filtered out from the adopted TCM formulas. Finally, 166 shared targets between the six herbs and AP were identified. KEGG analysis indicated that lipid and atherosclerosis pathway is highly related to microcirculation. CONCLUSION TCM formulas for activating blood flow significantly improve microcirculation and alleviate AP. Further high-quality, well-designed RCTs and deep mechanism exploration are required.

BACKGROUND: While emotional distress, encompassing anxiety and depression, has been associated with negative clinical outcomes, its impact across various clinical departments and general hospitals has been less explored. Previous studies with limited sample sizes have examined the effectiveness of specific treatments (e.g., antidepressants) rather than a systemic management strategy for outcome improvement in non-psychiatric inpatients. To enhance the understanding of the importance of addressing mental health care needs among non-psychiatric patients in general hospitals, this study retrospectively investigated the impacts of emotional distress and the effects of early detection and management of depression and anxiety on hospital length of stay (LOS) and rate of long LOS (LLOS, i.e., LOS >30 days) in a large sample of non-psychiatric inpatients. METHODS: This retrospective cohort study included 487,871 inpatients from 20 non-psychiatric departments of a general hospital. They were divided, according to whether they underwent a novel strategy to manage emotional distress which deployed the Huaxi Emotional Distress Index (HEI) for brief screening with grading psychological services (BS-GPS), into BS-GPS ( n = 178,883) and non-BS-GPS ( n = 308,988) cohorts. The LOS and rate of LLOS between the BS-GPS and non-BS-GPS cohorts and between subcohorts with and without clinically significant anxiety and/or depression (CSAD, i.e., HEI score ≥11 on admission to the hospital) in the BS-GPS cohort were compared using univariable analyses, multilevel analyses, and/or propensity score-matched analyses, respectively. RESULTS: The detection rate of CSAD in the BS-GPS cohort varied from 2.64% (95% confidence interval [CI]: 2.49%-2.81%) to 20.50% (95% CI: 19.43%-21.62%) across the 20 departments, with a average rate of 5.36%. Significant differences were observed in both the LOS and LLOS rates between the subcohorts with CSAD (12.7 days, 535/9590) and without CSAD (9.5 days, 3800/169,293) and between the BS-GPS (9.6 days, 4335/178,883) and non-BS-GPS (10.8 days, 11,483/308,988) cohorts. These differences remained significant after controlling for confounders using propensity score-matched comparisons. A multilevel analysis indicated that BS-GPS was negatively associated with both LOS and LLOS after controlling for sociodemographics and the departments of patient discharge and remained negatively associated with LLOS after controlling additionally for the year of patient discharge. CONCLUSION Emotional distress significantly prolonged the LOS and increased the LLOS of non-psychiatric inpatients across most departments and general hospitals. These impacts were moderated by the implementation of BS-GPS. Thus, BS-GPS has the potential as an effective, resource-saving strategy for enhancing mental health care and optimizing medical resources in general hospitals.
Humans ; Retrospective Studies ; Male ; Length of Stay/statistics & numerical data* ; Female ; Middle Aged ; Adult ; Psychological Distress ; Inpatients/psychology* ; Aged ; Anxiety/diagnosis* ; Depression/diagnosis*