To map and describe studies available in the literature about mobile applications to support parents in newborn care and data from applications accessible in online stores.ndroid and iOS, in October and December 2021, and applications with content to support parents of newborns were selected.This is a scoping review following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines. The searches were carried out in theses and dissertations databases and portals, in September 2021, and articles, theses, and dissertations were included. An independent search was performed in online stores of applications for operating systems AA total of 5,238 studies and 757 applications were found, and of these, 16 and 150, respectively, composed the sample. The topics discussed in the studies were: care, breastfeeding, fever, identification of neonatal diseases, child growth and development. In the applications, the themes found were care, breastfeeding, growth, immunization, development, sleep, tips, and guidelines.Applications are important support tools for parents, as they are an innovative means and accessible to a large part of the population. Main representative of the evolution of mobile telephony, the smartphone has as its main operating systems the Android and the Iphone Operating System (iOS).The use of mobile applications (Apps), among parents, to receive information and education about their children’s health, is more and more popular, and the use of computer technology is being increasingly accepted and used by society, can be used to optimize results and reduce health risks in educational programs,4,5, as well as to understand the determinants that promote newborns’ (NB) health.Such a scenario collaborates for the construction of a new modality of health care, and the literature shows that Apps, including the information generated from them,6.Currently, the almost universal use of smartphones has presented a transformative potential for health care, as it allows users instant access to information through Apps, which have great potential to support health, facilitating access to information and communication between professionals and patients has been gaining prominence, due to the possibility of interventions and behavior change, through health promotion, self-management of diseases or conditions, data monitoring, and provision of information and communication,7.Mobile health  as a medical and public health practice supported by mobile devices. As an ally, mobile technology should be used for training users, as a source of information for parents, and for continuity of care, considering the large number of births, including premature births, and the importance of providing health care and home care.App-based interventions available for smartphones have become an increasingly valuable resource for disease prevention. Thus, knowledge of the already available Apps to support parents of newborns is required, as well as the studies conducted in this field, to encourage professional practice and guide parents on this topic.Nursing is present in the care of newborns and their families at all levels of care and the experience of these professionals in the development of mobile Apps contributes to safe care and care practice and the increasing inclusion of health professionals in the construction and validation is apparent. There is a variety of purposes in the development and use of the App and health researchers have focused on this theme, bringing to light its benefits, presenting results such as theses and dissertations linked to graduate programs in nursing in Brazil and in the world.In this context, the growing number of smartphone Apps availableAiming at contributing to the consolidation of knowledge regarding the development and availability of mobile Apps as a support strategy for parents of newborns, the objective of this research was to map and describe available studies in the literature about mobile applications to support parents in caring for the newborn and app data accessible in online stores. and registered in Open Science Framework (OSF), available at https://osf.io/vtyce/, and conducted with methodological rigor, recommended by the Joanna Briggs Institute (JBI), following the recommendations of the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist. Scoping reviews are not intended to assess the quality of available evidence but aim to map the main concepts that support a research area, involving a systematic procedure.This is a scoping review whose protocol was publishedAndroid and iOS, to identify the Apps that addressed the theme to support NB parents.The structure of this review took place in two phases, the first being a search in databases and the second applied in online mobile devices stores. The first phase was subdivided into six stages: 1) identification of the question and study objective; 2) identification of relevant studies that would allow the extent and comprehensiveness of the review’s purposes; 3) selection of studies, according to predefined criteria; 4) data mapping; 5) summarization of results, through a qualitative analysis in relation to the objective and question; 6) presentation of results. For the second phase, an independent search was carried out in the mobile App virtual stores, through smartphones, with operating system Android and iOS?The elaboration of the guiding question was based on the mnemonic structure PCC  proposed by the JBI, with Population (P) being newborn, parents and family; Concept (C), studies addressing mobile applications in the field of neonatology; Context (C), care for newborns. Following this organization, the research question was elaborated: Which mobile applications, developed to support parents in newborn care, exist in the literature or are available in online smartphone stores with the operating systems To ensure the reliability of the process, the searches and selection of scientific productions and applications were carried out by two independent investigators, who standardized the sequence of procedures and, after completing the sample recruitment, compared their findings to check for discrepancies in the sample obtained. A third investigator was called in cases of non-agreement.PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, Scopus, Latin American and Caribbean Literature on Health Sciences (LILACS), Excerpta Medica dataBASE (Embase), Cochrane Library, Google Scholar, Scielo, Portal of the Virtual Health Library (VHL) were used, as well as those in the gray literature (dissertations and theses), through the Portal of Theses and Dissertations from Latin America and the Catalog of Theses and Dissertations of the Coordination for the Improvement of Higher Education Personnel (CAPES).Studies available in an electronic publication in the databases Medical Subject Headings (MeSH), and CINAHL Headings, using the Boolean operators “AND” and “OR” were consulted.The databases were searched through the CAPES platform on the Federated Academic Community (CAFe) portal on September 16, 2021, using the “advanced search” feature. Controlled and uncontrolled descriptors in Health Sciences (DeCS), The strategy integrated descriptors crossed with each other in Portuguese and English, as well as uncontrolled descriptors .Original scientific articles and reviews, either descriptive or analytical, quantitative, or qualitative, theses and dissertations electronically available in full, which dealt with the theme and without time or language limitations, were chosen. Findings addressing NB, premature infants and children, parents and professionals were also included, as well as studies bringing other support tools besides the App. Scientific productions in editorial format, letter to the editor, opinion articles and advertisements were excluded; gamified apps, for the exclusive use of professionals, with an exclusive child theme, and duplicate documents were computed only once. requirements and adapted for the present review, comprising: author, year, methodological design, main results, parent support theme and usability area, and description of the App’s content.The fourth stage consisted of reading the title and abstract, to identify whether they answered the research question. After this reading, the pre-selected studies were read in full to confirm inclusion in the final sample and made up the fifth stage, which consisted of completing and evaluating the data collection instrument. The instrument was based on the JBIAndroid, on October 28, and iOS, on December 26, 2021, according to the protocol. Thus, the Apps available in those stores were also the results of this review, which had as an inclusion criterion addressing support content for parents of newborns. The apps covering newborns, infants, and information for parents and professionals were also included. The exclusion criteria adopted were: not being available for download in free or paid forms, gamified App, unrelated to the theme, exclusive for professionals and product sales. The Apps found twice, during the search with different terms and stores, were counted only once.In the second phase, independently of the search in the databases, searches were carried out in online mobile app stores for smartphones with operating systems Android and 272 in the system iOS. This stage of the research was also carried out by two independent investigators, simultaneously, to avoid selection bias. A total of 150 Apps with themes related to support to newborns’ parents were chosen.In each virtual store, the searches took place using the term “newborn”. Then, a second search was performed with the term “premature” individually. This choice was due to the specificity of meeting the search criteria in online stores. All Apps found were downloaded, 485 of which being found in the operating system For data collection, an instrument consisting of ten variables about the App was used: operating system; country/state in which it was produced; language; year of update in the virtual store; parent support theme; indicative rating of the content; entity licensed to use the application; type of access (open or paid); accessibility for people with disabilities; number of downloads. It should be noted that such variables were used because they are information about the App that can be obtained and are available in the App itself and/or in the online store.Then, in the sixth stage, the data from the studies and applications were interpreted separately, with the studies being compared and based on theoretical knowledge and data extracted from mobile applications entered a spreadsheet and then exported to the R program, version x64 4.0.0. For this analysis, descriptive statistics were used, expressed by absolute and relative frequencies.There was no need for ethical appreciation, as the study analyzed secondary and already publicly available data. It should be noted that the copyright of the cited studies was respected.Preferred Reporting Items for Systematic Review and Meta-Analyses (Prism) was used, which was adapted for this study –25, fever,27, child development, growth, and identification of neonatal diseases. In addition, 11 scientific productions were presented in the form of articles and 5 dissertations and were published between 2017 and 2021.The narrative synthesis of the 16 studies selected points to the main theme addressed: support for the parents of NBs, care of NBs-21,25,27, United States of America.26, United Kingdom, Netherlands, Singapore, Australia, Thailand, Iran, Uganda, New Zealand, and Spain , were mapped, described, and elected. Of these, 91.33% are rated as containing no restrictions for use, 31.32% are available and can be accessed in Portuguese, 54% had the last update in the year 2021, 10.66% have more than 1,000,000 downloads, and only 6.66% have charged content access.It should be noted that, in neonatology, childcare, in a way, generates uncertainty,18,21 and domestic care,17,19–21, and breastfeeding,23,25 are highlighted, findings that converge with Apps available in online stores (23.99% and 18% respectively). Most of the Apps analyzed, related to baby care, refer to daily care, for personal records and tasks such as bathing, changing diapers, feeding, among others. Fever.27, child development, growth, and identification of neonatal diseases were also support themes identified in the studies.Among the themes identified, care for the NB in different contexts, involving hospital and quality care in the family context is essential for the NB’s healthy growth and development. Scientific evidence indicates that preventive practices can significantly reduce neonatal morbidity and mortality, including basic care such as providing warmth, hygiene, and exclusive breastfeeding.Information about daily care is a useful tool for the parents’ effective participation, being useful to optimize knowledge and take care of their child after hospital discharge,17,20. During the NB’s hospitalization, the parents also state that the use of the App, together with a bundle of care, helps to gain knowledge and significant confidence to enable them to care for their babies in the NICU and, consequently, antedate hospital discharge.Many parents say the App facilitates the quick and reliable retrieval of essential information–21 to greater interaction, such as monitoring growth and development and identifying neonatal diseases remotely, care with nutrition, sleep and hygiene, vaccination and growth curve. Parental participation in care, guided by the use of an App, based on scientific evidence, can help reduce the hospitalization rate and improve the quality of care.The literature shows that some Apps are also being developed to support parents of preterm infants, who need specific care after hospital discharge, ranging from App guidance on care,25,34,35.In their turn, BF apps provide specific instructions on breastfeeding, as well as important information involving the family and self-management tools for breastfeeding mothers, and 92% of mothers had complications in breastfeeding, including difficulty, pain, and concern about the amount of milk. Thus, information and support for breastfeeding mothers is vital to encourage breastfeeding.The main factors indicative of initial difficulties with the breastfeeding technique are inadequate latching (25.0%), the baby’s response to contact with the breast (26.1%), and problems with the breast (28.3%),38.The practice of breastfeeding can also be influenced by the participation and knowledge of fathers, and the greater the knowledge about the benefits of breastfeeding, associated with support and involvement, the better the practice of women who provide breast milk to their children, as a well-informed father/mother becomes a key element in the maintenance and success of breastfeeding about time, duration of feeding, and a reminder of breastfeeding time,24, observations about child behavior and baby care, location of milk collection points, lactation rooms, and public spaces favorable to breastfeeding–35. Advances in the testing of Apps are still required, in what regards breastfeeding, especially related to content, acceptability, effectiveness, usability, clarity regarding standardization in operational development, validation by women, and all these based on scientific evidence,34.Apps related to breastfeeding, in general, aim to provide support information to the woman and allow the creation of a profile with a diary of personal records,27 and identification of neonatal diseases were developed to provide simple language, focusing on the integration of parents in care and decision-making,27, highlighting the importance of Patient- and Family-Centered Care–28,30. It is known that developing a support and information App for parents, with themes that can cause stress and without exacerbating their fear or anxiety is a challenge.The mobile Apps that offer support to parents regarding care in case of fever,30; however, in the App available in online stores, selected in this study, only 4% had these resources. Although some health professionals have suggested making videos of NB procedures available, many parents have stated that watching such material would be disturbing or alarming. It should be noted that some Apps allow parents to interact with health professionals and this leads to a sense of safety in the postnatal period and brings greater satisfaction to users,16,30.The audiovisual resources in the App are important tools,22–25 with the participation of users and validated by them, had good acceptance of use,24,26,30.The Apps that were built by health professionals, based on scientific evidence,. In addition to this discussion, it is necessary to evaluate Apps as a support tool for parents that can be used in the long term, since monitoring the child’s growth and development is an important indicator of quality of life and child health. Therefore, in Apps with an area for home use, those related to child growth (10%) and development are highlighted (21.99%).The studies focus on the feasibility and acceptability of mobile Apps, although it is necessary to advance in the evaluation of their effectivenessBased on the mapped evidence, it is possible to state that health professionals are increasingly engaged in the development of health-related Apps and, considering the number of downloads, parents are increasingly accessing this technology. Sharing this health information strengthens the practice of evidence-based care for newborns.The scoping review method was adopted for allowing the selection of different types of studies, enriching the findings and highlighting the applications developed to support the parents of newborns. It is clarified that the review has limitations regarding searches in online stores. Therefore, there are App differences from a smartphone to another, in what regards the operating system and the update of these mobile devices.The present study allowed mapping and describing the mobile Apps available to support NB parents. These are important support tools, as they are an innovative means and a method capable of generating interest, besides being accessible to most of the population, due to the widespread use of mobile devices connected to the Internet.Knowledge of the technology of Apps available to parents of NBs by nursing professionals can significantly contribute to engagement and guidance on the use of these Apps in NB care, expanding the quality of nursing care in the maternal and child area.It should also be highlighted that it is important and necessary that new Apps developed by health professionals are based on scientific evidence and validated by peers in what regards content, semantics, functionality and usability, and viewing their potential to be integrated into professional practice, even allowing optimization of communication between nurses and parents of newborns from the perspective of care.


Dear colleagues and friends,It is with great joy that we celebrate the 65th anniversary of the founding of Acta Biochimica et Biophysica Sinica (ABBS). Looking back at the development of ABBS, we are filled with immense pride and gratitude.ABBS is a professional academic journal supervised by the Chinese Academy of Sciences (CAS) and sponsored by the Center of Excellence in Molecular Cell Science , which has evolved in the last 65 years from a Chinese vernacular journal to an English journal with international impact. The Journal was founded as Acta Biochimica Sinica in 1958 by Professor Yinglai Wang, who served as the first Editor-in-Chief. In 1961, the Journal was renamed as Acta Biochimica et Biophysica Sinica (ABBS), with the aim of developing into an authoritative journal in the research field of biochemistry and biophysics in China. In the early years of its establishment, the Journal published a number of important scientific achievements, such as the preliminary research results on synthetic crystalline bovine insulin between 1961 and 1964, and a series of research papers on “Kinetics of irreversible modification of enzyme activity” by Professor Chen-Lu Tsou in 1965. These scholarships witnessed the beginning and development of biochemistry in China and promoted the progress of biochemistry and biophysics in China.In 1998, as one of the most influential academic journals in China, ABBS became one of the first Chinese vernacular journals to be indexed in Medline database and SCIE database, which was an important milestone for the journal. To adapt to the rapid progress of scientific research in China and to enhance further international exchange, ABBS was converted to a monthly English journal in 2004. This change significantly promoted the international dissemination of Chinese scientific research works. In 2005, ABBS established a partnership with Blackwell Publishing Asia Ltd, which opened the mode of global publication and distribution for the journal, and took the lead in starting the online version of the journal. ABBS became one of the first few journals in China to explore international cooperation in publishing and marketing. In 2009, ABBS set up a cooperative relationship with Oxford University Press and published the journal simultaneously in both print and electronic versions. In doing so, the subscribers of ABBS have covered most of the developed countries and regions including Europe, the United States, and Japan, as well as more than 30 developing countries. Through these international collaborations, ABBS has achieved tremendous development and accelerated the international dissemination of Chinese research works.The Open Access (OA) publishing model has brought new opportunities for the prosperity of academic journals, and also provided a possibility for Chinese scientific and technological journals to explore the way to grow and develop independently. In 2022, ABBS, as the first academic journal, started the journey of returning back to China to publish independently. With the SciEngine, a full-process digital publishing platform provided by Science Press, ABBS started OA publishing and distribution by itself. The Journal has accomplished the localization of the whole publishing process covering content production, publication, distribution, and data storage, and kept the trend of stable development. This paved a new path for the development of Chinese scientific journals.Over the past 65 years, ABBS has been adhering to the missions of serving the scientific community and providing a professional, friendly and high-quality publication platform for scientific researchers to publicize and disseminate their works. At present, ABBS has grown into a professional academic journal with international influence. In the last 5 years, the Journal has published more than 940 scientific papers with nearly 4000 authors from more than 600 research institutions in 25 countries and regions worldwide; furthermore, the research content of the papers has covered hot research areas such as protein science, RNA regulation, epigenetics, DNA damage repair, tumor metabolism and immunity, enzyme structure and function regulation, cell signaling pathways, and cell death and apoptosis, and much more. The Journal has reached over 300,000 views and downloads per year, and 60% of the readers are international researchers.To meet the new opportunities and challenges in the future, ABBS will continue to commit to the original missions of the journal: to actively promote the publication and dissemination of cutting-edge research works in biochemistry and biophysics, and to provide a high-level, high-quality professional publication platform with better services and supports to the scientific community.On the occasion of the 65th anniversary of ABBS, as the current Editor-in-Chief of ABBS, I would like to express my sincere gratitude to CAS and CEMCS for their full supports, and to the former Editor-in-Chiefs, the members of the past and current Editorial Boards, all the reviewers, and all the researchers who have supported and cared about the development of ABBS for their selfless dedication, tireless efforts, and valuable contributions. Only because of you, ABBS has flourished over the past 65 years. I sincerely hope that ABBS will continue to receive your fondness and support, and I look forward to working together to further promote the development of biochemistry and biophysics in China.To celebrate ABBS’ 65th anniversary, ABBS has organized and published two special issues: the current issue focusing on cancer biology and the next issue focusing on liquid-liquid separation. These review articles cover the main research hotspots in these fields, summarizing the research progresses in recent years and providing the authors’ perspectives on future developmental directions. We hope that readers will benefit from these two special issues in their future research work.


For decades, researchers of different areas, ranging from artificial intelligence to computer vision, have intensively investigated human-centered data, i.e., data in which the human plays a significant role, acquired through a non-invasive approach, such as cameras. This interest has been largely supported by the highly informative nature of this kind of data, which provides a variety of information with which it is possible to understand many aspects including, for instance, the human body or the outward appearance. Some of the main tasks related to human analysis are focused on the body , the hands , the head , or the face . Additional tasks are based on non-corporal elements, such as motion  and clothes . Unfortunately, privacy issues severely limit the usage and the diffusion of this kind of data, making the exploitation of learning approaches challenging. In particular, privacy issues behind the acquisition and the use of human-centered data must be addressed by public and private institutions and companies.Thirteen high-quality papers have been published in this Special Issue and are summarized in the following: four of them are focused on the human face , two on eye image analysis (eye status classification and 3D gaze estimation), five on the body , and two on the outward appearance (transferring clothing styles and fashion-oriented image captioning). These numbers confirm the high interest in human-centered data and, in particular, the variety of real-world applications that it is possible to develop.Transportation Security Administration Passenger Screening Dataset (TSA-PSD). The task of 3D human pose estimation is addressed in [The human body represents one of the most investigated elements in the literature and in our Special Issue. In , the autessed in , where aessed in , the autAnother topic investigated in this Special Issue is human face analysis. In particular, the published papers address different topics, including the problem of machine interaction using voice commands and facial movements , 3D faceFinally, two papers focus on the problem of outward appearance and fashion. In particular, Fontanini et al.  propose The main goal of this Special Issue is to improve the communication between companies and researchers belonging to both private and public institutions regarding the opportunities (and limitations) of the use of human-centered data in the development of future artificial intelligence applications. The above-mentioned papers contribute to stimulating new ideas, motivations, and methodologies that can shape the future of this area, also outlining potential future industrial applications and prospective trends. Again, we remark on the importance of the proper use of data concerning humans, which must be compliant with privacy and ethical regulations.


Five national urban agglomerations are selected according to the Fourteenth Five-Year Plan, namely the Yangtze River Delta, the Pearl River Delta, Beijing-Tianjin-Hebei, the Middle reaches of the Yangtze River, and Chengdu-Chongqing. The study on synergistic effects of such national strategic planning urban agglomerations, defined as coordinated degrees, and their time-series trends from 2016 to 2021 is significant for the practice of the national "double carbon" goal. Spatial differentiation of coordinated degree in five agglomerations is analyzed based on the Theil Index, along with regional linkage strength of coordinated degree under the gravity model. Conclusions include: (1) a downward trend is shown from 2016 to 2021 for the coordinated degree, along with the Pearl River Delta is the best among the five agglomerations; (2) the Middle reaches of the Yangtze River is the highest, followed by the Pearl River Delta and the Yangtze River Delta of coordinated degree in 2021; (3) the main cause of downwards in coordinated degree combined by a stable decline in carbon emissions and fluctuating increase in pollutants; (4) intra-regional differences in the Yangtze River Delta and the Middle reaches of the Yangtze River are relatively large, compared with the smallest in the Pearl River Delta measured by Theil Index; (5) coefficients of variation are relatively higher in the Middle reaches of the Yangtze River and the Yangtze River Delta, followed by the Beijing-Tianjin-Hebei, the Pearl River Delta and Sichuan-Chongqing urban. Consequently, countermeasures are proposed from the perspective of government, including technology and regional cooperation, policy innovation by overall coordination, synergy promotion by technological innovation, and regional synergy by win-win cooperation. The CPC Central Committee and The State Council issued Opinions of The State Council on the Complete, Accurate, and Comprehensive Implementation of the new Development Concepts and the Work of Achieving Peak Carbon Neutrality on September 22, 2021 :T:TTB=1Rab represents the regional linkage strength of the Coordinated Degree of Pollution and Carbon Reduction between urban agglomerations a and b; Sda and Sdb represent the Coordinated Degree of Pollution and Carbon Reduction in urban agglomerations a and b; Tab represents the distance between urban agglomeration (unit: km); K is the gravitational constant, usually 1.The spatial linkage gravity model ,18,19 isThe results obtained by Eqs  to 9) a a9) are The Thiel index of the Coordinated Degree of the two urban agglomerations in the Yangtze River Delta and the Middle reaches of the Yangtze River is above 0.5, indicating that the regional differences in carbon reduction synergy are large. This may be due to the reason that the urban agglomerations in the Yangtze River Delta and the Middle reaches of the Yangtze River contain more provinces and cities, including 26 and 31 cities respectively, and the inter-provincial connection is not close enough, making integration and coordination tough. Therefore, the discrepancy between the Coordinated Degree of Pollution and Carbon Reduction is significantly greater than that of the other three urban agglomerations. The Yangtze River Delta and the Middle reaches of the Yangtze River have relatively fast economic development. In particular, the Yangtze River Delta urban agglomeration plays a demonstration role in regional economic innovation and multi-industrial integration and strengthens its ties through inter-regional economic cooperation, trade exchanges, and preferential policies. Consequently, the difference in Coordinated Degree between urban agglomerations and other urban agglomerations is smaller than that between different prefecture-level cities within urban agglomerations.The Theil Indexes of Coordinated Degree of Pollution and Carbon Reduction in Beijing-Tianjin-Hebei, Pearl River Delta, and Chengdu-Chongqing urban groups are all less than 0.33, indicating that there is little difference in the collaborative governance of Pollution and Carbon Reduction within the region, which is speculated to be due to the relatively small number of cities covered by them, the small geographical distance within the urban groups, the similar regional culture, the similar development path, the sharing of regional resources, and the frequent inter-regional connections, so the differences in the collaborative governance of Pollution and Carbon Reduction are small. Among them, the Theil Index of Coordinated Degree of Pollution and Carbon Reduction in the Pearl River Delta is the smallest, which is between 0.168–0.180. This may be because the Pearl River Delta urban agglomeration only includes nine cities: Guangzhou, Foshan, Zhaoqing, Shenzhen, Dongguan, Huizhou, Zhuhai, Zhongshan, and Jiangmen, and it has the smallest regional coverage area, with well-developed transportation networks such as roads and railways and convenient coordination. That’s why it is the most closely connected. As an urban agglomeration highly open to the outside world and under the jurisdiction of one province, the Pearl River Delta is superior to the Yangtze River Delta and Beijing-Tianjin-Hebei region in terms of resource integration and coordination. The latter region is under the jurisdiction of multiple provinces and cities, and the operation of integration and coordination is more complicated. This factor enables the Pearl River Delta to better conduct collaborative governance of Pollution and Carbon Reduction under unified planning and arrangement, give play to the merits of diverse cities, cooperate, and promote the virtuous cycle of urban agglomeration.From the longitudinal analysis, the Theil Index of the Coordinated Degree of Pollution and Carbon Reduction in the Yangtze River Delta, the Middle reaches of the Yangtze River, the Pearl River Delta, and the Sichuan-Chongqing urban agglomerations show a trend of first rising and then declining in the past 6 years, indicating that the differences of the Coordinated Degree of Pollution and Carbon Reduction in these urban agglomerations show a trend of decreasing gradually, while the variation trend of the Theil Index of the Coordinated Degree of Pollution and Carbon Reduction in the Beijing-Tianjin-Hebei urban agglomerations is opposite, and the discrepancies of regional governance increase. On the whole, the contribution rate of intra-regional differences is about 83%, much higher than the contribution rate of inter-regional differences. Consequently, the difference in the Coordinated Degree of urban agglomerations in Pollution and Carbon Reduction is mainly caused by intra-regional differences.Eq  is used The spatial linkage gravity model is applied to calculate the regional linkage degree of the collaborative governance of Pollution and Carbon Reduction within the five national urban agglomerations, and the results are shown in From the analysis of In this paper, based on the definition of the synergy of Pollution and Carbon Reduction, as well as the accounting model of the Coordinated Degree of Pollution and Carbon Reduction constructed and the statistical data from 2016 to 2021, the Coordinated Degree of Pollution and Carbon Reduction of five national urban agglomerations is calculated, and its dynamic trend and spatial distribution are analyzed. Furthermore, the spatial differentiation of Pollution and Carbon Reduction degree in five urban agglomerations is analyzed, and the regional linkage strength of the Coordinated Degree of Pollution and Carbon Reduction among five urban agglomerations is deduced. The findings include:First, on the whole, compared with the Coordinated Degree of the five urban agglomerations from 2016 to 2020, the average annual fluctuation range of the Coordinated Degree of the five national urban agglomerations in 2021 is smaller, falling between 17.71% to 21.31%. Additionally, the urban agglomeration of the Middle reaches of the Yangtze River has the highest degree of Pollution and Carbon Reduction in 2021, followed by the Pearl River Delta and the Yangtze River Delta.Second, from the perspective of time series analysis, the Coordinated Degree of Pollution and Carbon Reduction in the five urban agglomerations show a downward trend on the whole. From 2016 to 2018, it showed a fluctuation trend of first decreasing and then increasing, and from 2019 to 2021, it presented a steady decline. From the horizontal comparison of the five urban agglomerations, compared with other urban agglomerations, which maintained a stable trend and then declined, the Pearl River Delta urban agglomerations had a peak of 1.662 in 2018, reflecting the high coordination of this economic development region.Third, by further analyzing the internal composition of the coordination degree of Pollution and Carbon Reduction of the five urban agglomerations, namely the variation trend of the total amount of pollutants and carbon emissions, it can be concluded that when the coordination degree of Pollution and Carbon Reduction of the five major national urban agglomerations decreases overall, which is mainly caused by the comprehensive effect of steady decreases of the total amount of carbon emissions and the increases of the total amount of pollutants. Besides, although the total amount of pollutant emissions increase due to industry expansion and other reasons these years, the government has put forward documents to reduce pollutants to guarantee environmental sustainability. Therefore, the technology of garbage disposal should be improved to whittle down the coordinated degree.Fourth, the analysis of the intra-regional differences in the coordination degree of Pollution and Carbon Reduction in the five national urban agglomerations shows that there are large intra-regional differences in the Yangtze River Delta and the Middle reaches of the Yangtze River. The Theil index is above 0.5, which may be because the Yangtze River Delta and the Middle reaches of the Yangtze River contain more provinces and cities, including 26 and 31 cities respectively, and the inter-provincial connection is not close enough. Therefore, it is tough to integrate and coordinate. The Theil indexes of the other three urban agglomerations are less than 0.33, with subtle differences within the region. Among them, the Theil index of the Pearl River Delta urban agglomeration is the smallest, ranging from 0.168 to 0.180 in the five years from 2016 to 2021, which may be due to the small number of prefecture-level cities and the smallest regional coverage area, as well as the developed and convenient coordination of road, railway, and other transportation networks.Fifth, the Middle reaches of the Yangtze River and the Yangtze River Delta urban agglomerations have a higher level of coefficient of variation, which may be caused by the wide regional coverage area, large differences in transportation network systems, and large differences in resource allocation. The coefficient of variation of Coordinated Degree in Beijing-Tianjin-Hebei urban agglomeration is the second, and the Pearl River Delta and Sichuan-Chongqing urban agglomeration have low levels of variation, which may be related to the fact that the number of cities in the Pearl River Delta and Sichuan-Chongqing urban agglomeration is only 9 and 16, convenient for integration and coordination.The results of the above study show that: the Coordinated Degree of the five national urban agglomerations is low, there is a great discrepancy in the Coordinated Degree within urban agglomerations, and a deeper mechanism of action has yet to emerge. The collaborative governance of Pollution and Carbon Reduction should be made in the direction of policy, science, technology, etc., and promote the improvement of environmental quality and high-level economic quality.Pollution and Carbon Reduction have the same target, and target synergy is the key to deciding the policy system of collaborative governance. Given the low coordination degree caused by the independent and different modes of collaborative governance systems for Pollution and Carbon Reduction in urban agglomerations, it is essential to effectively implement the national " Carbon peak, Carbon neutrality" goals, improve the system and mechanism for environmental pollution control and addressing climate change, and innovate the coordinated policy system for Pollution and Carbon Reduction targets in urban agglomerations. The Beijing-Tianjin-Hebei city cluster should give full play to the guiding role of government policies, strengthen the reduction of carbon emissions and realize the green transformation of economic and social development. The Yangtze River Delta urban agglomerations should improve climate change investment and financing policies, and strengthen the spatial linkages within urban agglomerations. The Pearl River Delta urban agglomeration should further improve its environmental management mechanism, and innovate coordinated incentive policies for Pollution and Carbon Reduction.Encourage foreign investment to invest in low-carbon green high-tech enterprises, introduce, learn, and absorb foreign advanced manufacturing technologies. In terms of environmental pollution control, set up a special research and development fund for the collaborative treatment of Pollution and Carbon Reduction technologies, carry out research and development of key technologies, and improve the scientific and technological innovation mechanism for the collaborative treatment of Pollution and Carbon Reduction in urban agglomerations, to provide a strong scientific and technological guarantee for realizing the synergy between Pollution and Carbon Reduction. In terms of resource utilization, promote the application of existing successful experiences and technologies in reducing pollution and carbon, strengthen the research and development and application of collaborative regulation technologies, optimize the selection of technological routes for Pollution and Carbon Reduction, and improve resource utilization efficiency.Since greenhouse gases and pollutant emissions are of the same root, same origin, and all industries and fields within urban agglomerations are responsible for environmental pollution and greenhouse gases, all urban agglomerations should, based on their regional advantages and the concept of coordinated development, adopt coordinated governance strategies for Pollution and Carbon Reduction based on local conditions, and jointly promote the high-quality integrated development of the regional economy.Specifically, the Beijing-Tianjin-Hebei urban agglomeration should promote green manufacturing in the industrial field, accelerate the green transformation of steel, petrochemical, building materials, and other industries, and strictly control the construction of projects with high energy consumption and high emissions. The Yangtze River Delta urban agglomeration should optimize the allocation of regional human capital, strengthen cooperation among cities, and promote the continuous improvement of ecological environment quality. The Pearl River Delta urban agglomeration should continuously strengthen cooperation in industrial restructuring, industrial transfer, energy conservation, clean energy replacement, and technological upgrading. The Chengdu-Chongqing urban agglomeration should advocate the green, high-end, and intelligent development of traditional industries such as steel, machinery, chemical industry, and building materials, and concentrate on ecological protection, green economy, and resource recycling as an innovation ecosystem. The Middle reaches of the Yangtze River urban agglomeration should inherit the advantages of industrial gradient transfer. Concerted efforts ought to be made to bring in scientific and technological innovation factors and to stimulate high-end and high-quality enterprises to go global.S1 Appendix(XLS)Click here for additional data file.


Numerous interrelationships are known in the literature that have the final effect of unmasking or influencing various pathologies. Among these, the present article aims to discuss the connection between systemic lupus erythematosus (SLE) and the human microbiome. The main purpose of this work is to popularize information about the impact of dysbiosis on the pathogenesis and evolutionary course of pediatric patients with SLE. Added to this is the interest in knowledge and awareness of adjunctive therapeutic means that has the ultimate goal of increasing the quality of life. The means by which this can be achieved can be briefly divided into prophylactic or curative, depending on the phase of the condition in which the patient is. We thus reiterate the importance of the clinician acquiring an overview of SLE and the human microbiome, doubled by in-depth knowledge of the physio-pathogenic interactions between the two , with the target objective being that of obtaining individualized, multimodal and efficient management for each individual patient. Being defined as a multisystemic inflammatory disease, juvenile systemic lupus erythematosus (SLE) presents a peak incidence during puberty 12.6 years) and an increased activity compared to the adult form. The evaluation of the activity of the disease is mainly done by measuring the specific antibodies represented by anti-nuclear (ANA) and, respectively, anti-double-stranded DNA (anti-ds-DNA) antibodies. Therefore, pediatric SLE (pSLE) needs a more aggressive therapeutic with the aim of preventing or limiting damage. These characteristics proved to be much more pronounced in the age groups under 5–7 years, where the low frequency of ANA stands out, which is doubled by the low titer of anti-ds-DNA and an increased rate of neuropsychiatric symptoms in contrast to renal and musculoskeletal damage. Regarding the determining factors of the condition, single genetic mutations (identified in >7% of the subjective), but also the combination of genetic predisposition and disturbing environmental factors (“aggressors”), can be incriminated in the development of SLE 2.6 years. PharmacThe microbiome–host inter-relationship is in continuous evolution parallel to that of the human body since the intrauterine period and until the age of senescence, an aspect that validates the involvement of the former in various physio-pathological processes . The main ways in which the microbiota exerts effects on the body in all stages of life are represented by influencing the metabolic balance, modulating the synthesis and absorption of vitamins (by this means regulating functions such as coagulation) or imprinting the balance of T helper lymphocytes 1/2/17) and regulatory T cells. To these, the ability to influence intestinal maturation and the diversity of food digestion products such as short-chain fatty acids  is added. The latter exert their functions on the integrity of the intestinal barrier (being an important source of energy), the inflammatory balance, as well as body weight. Unlike the components of the external environment that must cross certain barriers  to interact with the internal environment, the endogenous microbiota can facilitate homeostasis imbalances much more easily, dictated by an inversion of the ratio (“dysbiosis”) beneficial bacteria/ harmful bacteria . Thus, t and reguWe performed a narrative review of the specialized literature using the PubMed, ScienceDirect and Oxford Academic databases to identify relevant articles related to how dysbiosis can influence the emergence and evolution of autoimmunity among pediatric patients with SLE. Searches focused on keywords and phrases frequently used to describe SLE, dysbiosis and the main directions to follow in their support and modulation , as well as terms useful in directing to information about the pathogenesis of SLE and pathophysiological mechanisms behind the microbiome–immune system interaction . Thus, we brought together in the same review current topics intensively studied in medical research that include the human microbiome and ways of modulating it with the aim of maintaining the balance of harmful bacteria/beneficial bacteria. We have chosen to practically exemplify this presentation of information by making a correlation between dysbiosis and organic diseases, with an emphasis on the description of the implications in the potentiation and management of autoimmunity (respectively of SLE). Broadly speaking, the inclusion criteria concerned study groups made up of children (0–18 years); although, where clinical exploration was limited, we chose to include results obtained on adult groups or murine models, with the aim of covering the informational bias. The present work is therefore a crossroad of the current information regarding the pathogenesis, diagnosis and management of SLE described from the perspective of a less exploited causal relationship with dysbiosis, especially in pediatric practice.With a high mortality rate, both in comparison with the general population and with the adult form of the pathology, juvenile SLE represents approximately 15–20% of all lupus cases, with an incidence of 0.36–2.5 and a prevalence of 1.89–34.1 per 100,000 children [Regarding the complications of SLE, especially lupus nephritis, Hiraki LT. et al. objectify an increased proportion of positive cases in the research group , with a distribution dependent on the patient’s age, gender and demographic location. Thus, a 4.5 times higher prevalence is reported in girls compared to boys . SimilarThe factors that increase the risk of developing complications are not yet fully defined, but it is unanimously accepted that they are part of the large family of genetic and environmental factors. This hypothesis complicates the work of research professionals because research in the field of the human microbiome has similarities with that of molecular epidemiology or the genome, but the results are much more variable in time and space , individual architecture, component genes and diet-dependent drugs, such as antibiotics, infections or foreign substances, all of which lead to imprinting the health of the subject by influencing the metabolism ,11,12.The physio-pathological cascade encountered in SLE is a multivalent one, the homeostasis of the internal environment being disturbed on various levels, among which we note the impact of genetic factors such as mutations , polymorphisms or aneuploidy that can determine family aggregates prone to certain diseases. While monogenic SLE  is caused by disruption of the genes involved in the complement pathway , nucleic acid metabolism, apoptosis and immune tolerance reflected on the activity of B and T lymphocytes, the majority of SLE cases meet a coexistence of the involvement of genetics and additional factors in shaping the etiology. The genetic component can partly explain the division of the risk of the disease depending on sex, with current research emphasizing the pivotal role of the X chromosome in the pathogenesis, an aspect certified by the escalation of up to 14 times the cases of SLE in the male population diagnosed with Klinefelter syndrome compared to boys that have a normal karyotype . The genetic factors are doubled by the epigenetic component, the understanding of which is useful in order to elucidate the discrepancy between SLE incidents in homozygous twins, represented by DNA methylation, post-translational histone modification and the presence of non-coding micro-RNA sequences ,14,15.In the pathogenesis of SLE, both innate and adaptive immunity are disrupted, resulting in the production of antigen–antibody complexes, activation of dendritic cells, abnormalities of phagocytes, overexpression of interferon (IFN) type 1, cytokines such as interleukin (IL)-1, IL -2, IL-4, IL-6, IL-8, IL-10, IL-17, IL-18, IL-21, IL-23 and activation of T-helper cells ,17. The In this study, the diagnostic lines follow two entities concurrently, namely SLE and systemic microbiota confined to various sites in the body. For an easier understanding, we will present in the following  the mainThe human microbiota, as we stated previously, is divided according to the sites of interest, the disruption of its homeostasis mainly in response to changes in environmental factors, diet or antibiotic therapy, with the effect of increasing the risk of atopy, autoimmunity, heart diseases or malignancy ,27. EverStreptococcus, Staphylococcus, Propionibacteria, lactic bacteria and Bifidobacterium) proved to be an important prebiotic, probiotic and vector of vertical bacterial transmission, modulating Bifidobacterium/Firmicutes balance, with the cessation of breastfeeding leading to the maturation of the intestinal microbiota with the inversion of the ratio of the two, in detriment of Bifidobacterium. Antepartum, intrapartum or postnatal antibiotic therapy, as well as antifungal therapy, also lead to the reduction of Bifidobacterium, Bacteroides and Actinobacteria species, promoting the dominance of Enterococcus, Clostridium, Proteobacteria and Firmicutes. A benefit of natural food is the objective of a reduced rate of colonization with Escherichia coli, Clostridium difficile, Bacteroides and lactobacilli. Last but not least, the type of birth and the gestational age seem to influence dysbiosis in the same way as previously described, being thus preferable to natural birth that promotes fetal insemination with vaginal bacteria, to the detriment of cesarean surgery, considered a trigger factor for imbalance [Taking the intestinal microbiota  whose relationship with the maternal component is intensively studied as a model, Kim H. et al. have brought to attention, in addition to the impact played by living in the vicinity of pets, the influence of the prenatal and perinatal period in shaping the predisposition towards certain pathologies. In this sense, in addition to its role in nutrition and the maternal–fetal emotional bond, breast milk . From the point of view of the identified microorganisms, a discrepancy was objectified between the regions affected by SLE and the unaffected skin areas, which was characterized by the increase of the genus vibacter .Staphylococcus, Corynebacterium, Dolosigranulum, Moraxella, Haemophilus, Neisseria) of the upper and lower respiratory tract, which was considered a sterile structure until recently [Having a diminished immune defense during childhood, especially at the level of the mucous membranes, objectified by the increased incidence of various pathologies in the respiratory sphere, maintaining the balance of microorganisms that usually or occasionally colonize the respiratory tract  represents a topic of interest in current pediatric practice by proving its involvement both in its maturation and in the regulation of immunity. And at this level, the type of birth, nutrition and antibiotic therapy, in addition to seasonal influences, vaccination, history of respiratory tract infections, living together with siblings, frequenting collectives and exposure to smoke have been shown to have a dynamic imprint on the microbial balance  during the evolutionary course of children with recurrent respiratory diseases [Being the well-known connection between the intestine and the lungs, the current specialized literature recommends the maintenance of balance and the modulation of the former . Microorganisms present at this level are Lactobacillus, Bifidobacteriaceae, Gardnerella vaginalis, Actinobacteria, Prevotella, Enterobacter, Streptococcus, Proteobacteria and Bacteroides, whose fragile balance is incriminated in the pathogenesis of bacterial vaginitis, pelvic inflammatory disease, hysteromyoma, endometriosis, adenomyosis, transmission infection sexual or those with the human papillomavirus, which can evolve into cervical dysplasia [Bacteroides, Escherichia and Shigella) [Lactobacillus, Bifidobacterium, Faecalibacterium, pathogenic microorganisms characteristic of sexually transmitted diseases, Enterobacteriaceae, Escherichia coli, Ureoplasma, Prevotella, Corynebacterium, Enterococcus and Staphylococcus aureus, microorganisms whose balance imprints the development of inflammatory conditions, male fertility and even the risk of malignancy in the prostate [The genitourinary tract is made up of the urinary system  in close connection with the genital organs  and the digestive tract, especially at the level of the external openings. Thus, the microbiota of the three systems, although individual for each one, can show similarities, potentiating each other. In the female sex, the main organs whose bacteriological study is easy are the vagina and the uterus, which have structures that show variable colonization through a retrograde mechanism, hematogenous transmission or the seminal fluid, which, after the onset of puberty, is dependent on the phases of the menstrual cycle and the presence/absence of possible pregnancies, and which are separated from each other by the cervical mucus plug that acts as a barrier to the ascent of pathogens  . In boysprostate .While the colonization of the urethra mostly respects the bacterial species identified at the level of the genital system, we emphasize here the need to know the variations of the bladder microbiome and urinary pH, depending on age and pathogen, respectively. A good diagnosis of these leads to the prophylaxis and optimal treatment of renal lithiasis or urinary tract infections, thus eliminating the risk of long-term complications such as the chronicity of the condition, renal scars or resistance to antibiotics ,57,58,59Streptococcus, Staphylococcus, Fusobacterium, Veillonella, Haemophilus, Escherichia coli, Pseudomonas and Lactobacillus), viruses  and fungi  [Starting from the upper orifice, the microbial components that populate the oral cavity of children are in constant evolution, the key moments of which are birth , with the dental eruption and the finalization of the dentition, being, however, also influenced by diet, type of birth, environmental factors, ethnic or geographic belonging, genetic determinants and horizontal transmission from the people with whom they interact ,60. Thusococcus) .Streptococcus , Lactobacillus, Bacteroidetes, Vaillonella, Candida albicans, Prevotella, Limnohabitans, Rothia, Neisseria, Pasteurella stomatis, Spirochaets or Campylobacter, doubled by a decrease in the abundance of Actinomyces, Corynebacterium, Haemophilus, Eikenella, Ramlibacter, Mucilaginibacter, Proteobacteria, Pseudomonas, Moraxellaceae, Fusobacterium and Firmicutes, which are currently intensively studied components, the variety of which proves to be different even in comparison with first-degree relatives and is the basis of the development of new biomarkers used in microbiota research, but also of the current principles of its modulation, through food means or substitution  [The main diseases in which the microbiome of the oral cavity plays an essential role are certified to be dental caries that appeared during early childhood, inflammatory bowel diseases , post-infectious irritable bowel syndrome, celiac disease, diabetes, autism, Henoch–Schonlein purpura, Wiskott–Aldrich , appendicitis and sleep apnea syndrome. In their production, the main microorganisms incriminated are  matter) ,64,65,66 matter) .Helicobacter pylori (H. pylori) infection, but also in chronic gastritis, duodenal ulcer or carcinogenesis, conditions in which the microbiota has been shown to have an altered diversity compared to the batches of control subjects, with part of its components showing causal relationships with the incriminated pathologies  [H. pylori and gastric dysbiosis among duodenal ulcer patients, Zheng W. et al. postulated that in this situation, the character of infected/uninfected has the potential to modulate the community of genotoxic bacteria present at the level of the microbiota [H. pylori, possibly through the interaction with the metabolism of bile acids  [H. pylori, doubled by the negative impact of the infection and the development of antibiotic resistance, it is necessary to know alternative therapies such as probiotics based on Limosilactobacillus reuteri, a Gram-positive bacterium resistant to gastric and bile juice, which maintains homeostasis in the environment by inhibiting the development of pathogenic species, while at the same time increasing adherence and therapeutic efficiency by improving digestive symptoms [With reference to the stomach, the main lines of research regarding bacterial colonization include its modification in  marker) ,69,70. Acrobiota . A role ic acid) . Due to symptoms .Dysbiosis at the intestinal level has been shown to be involved in multiple pathologies, starting from local ones , osteoarticular (osteoarthritis), skin , vascular (atherosclerosis or thrombosis), chronic renal, hepatic, pulmonary  and metabolic  and culminating with those in the neuropsychiatric sphere  or neoplastic , with all these processes being under the empire of the main axes formed by intestine and lung, brain, heart or skin ,74,75,76Firmicutes/Bacteroidetes, overwhelmed by the escalation of species such as Rhodococcus, Eggerthella, Klebsiella, Prevotella, Eubacterium and Flavonifractor and the reduction Lactobacillaceae, which is a dysbiosis that leads to the potentiation of the chronic inflammatory response and the decrease of immune tolerance, with the increase of anti-double-stranded DNA antibodies and possible imprinting of renal function [Clostridium ATCC BAA-442, Atopobium rimae, Shuttleworthia satelles, Actinomyces massiliensis, Bacteroides fragilis and Clostridium leptum in samples collected from patients positive for SLE, compared to healthy subjects, with their levels decreasing after treatment [Sphingomonas), which interferes with the digestion and absorption of proteins, the data regarding the model of change in diversity between positive subjects for SLE and healthy controls is contradictory to other studies with similar themes in the literature, which is possibly due to the influence of age and gender differences between the groups. Research in the gastrointestinal field associates the disturbance of the balance of amino acids and fatty acids with symptoms such as abdominal distension, pain, nausea, vomiting and anorexia, which were found in the clinical picture of SLE. The biological profile reveals an increased prevalence of lipid metabolism disturbances, with bile acids  being strongly correlated with the SLEDAI score, an aspect doubled by the discordance identified between the metabolites present in the serum and those detected in the feces [Taking the microbiome–SLE relationship as a model, a first change objectified by current studies is the inversion of the relationship function ,80. Chenreatment . The maihe feces ,88,89,90Lactobacillus, Bifidobacterium, Akkermansia faecal and Ruminococcus) and the degree of activity of the disease or the modulation of the constituents of the immune response by being involved in maintaining the homeostasis of the intestinal barriers and optimizing regulatory T cells [Although it targeted a group of subjects over 18 years old, we consider it appropriate to discuss the results of the work done by Liu F. et al.  with ref T cells . The lin T cells ,91.Regarding the clinical picture of subjects with SLE, Visitación N. et al. postulate, through the study of changes in the cardiovascular system in relation to the intestinal microbiota in murine models, the link between this and the development of endothelial dysfunction, vascular inflammation and hypertension . Lupus nRuminococcus gnavus strain from subjects with lupus to produce alteration of intestinal permeability through the action on zonulin, at the same time documenting the reversal of the process upon initiation of treatment with larazotide acetate (zonulin antagonist) [Another direction worthy of consideration is represented by the effects of the anti-rheumatic medication used in the treatment of SLE on the intestinal microbiota, but also by the impact of vitamin D deficiency on the composition of the microbiome, the viability of the intestinal epithelial barriers and autoimmunity  ,95. Alsoagonist) ,97.In addition to the standard therapy used in SLE and adapted to pediatric criteria, which includes glucocorticoids, antimalarials, nonsteroidal anti-inflammatory substances, immunosuppressants and biological agents directed against B cells, modern medicine also brings to the fore new approaches such as the impact played by dietary principles and supplementation with probiotics/prebiotics or symbiotics, but also the role of fecal matter transplantation from a healthy donor in the regulation of intestinal homeostasis or future directions that still require certification through human studies ,99.Firmicutes/Bacteroidetes ratio, just as vitamin A promotes the development of lactobacilli, and starch interacts with pathogens, improving mortality and de-escalating inflammation [Lactobacillus in the probiotic treatment of SLE and also underline the strong correlation between it and the dietary components [The basic characteristic necessary for any microenvironment to survive is its ability to reach the level of symbiosis that can confer some resistance to colonization due in part to the efficient use of nutrients, thus impoverishing the resources needed by pathogens . Occupyiammation ,100. Conammation . Wang X.mponents .Lactobacillus strains on renal function and mortality reduction in lupus nephritis, but also in the reversal of the IL-10/IL-6 ratio, which is a marker of inflammation, the results being objective in a discordant, gender-dependent manner [Bacteroides fragilis, where the range of action also includes effects on the expression of CD1d, CD86 and the balance between helper T lymphocytes 17 and regulatory T lymphocytes [Mu Q. et al. have demonstrated, in murine models, the benefit brought by supplementation with t manner . Similarphocytes . Adminisphocytes .Lactobacillus and Bifidobacteria [Lactobacillus helveticus, Bifidobacterium infantis and Bifidobacterium bifidum, for 60 days, which is a finding doubled by the increase in the Firmicutes/Bacteroidetes ratio (insignificant difference compared to placebo) and the reduction of a number of 13 operational taxonomic units incriminated as possibly pathogenic [Thus, summarizing the specialized literature of Esmaeili SA. et al. concludes that the main bacteria intended to restore immunological tolerance by acting on the pro-inflammatory–anti-inflammatory balance, competitive exclusion and antibacterial action are strains of bacteria . In a sithogenic .Clostridium difficile infection, is gaining more and more interest regarding its use in the management of autoimmune diseases  and intestinal dysbiosis. Although still lagging behind in terms of research, benefiting so far from little interest, an aspect highlighted by the limited presence of human studies in contrast to those on animal models, it is important to know the advantages of its use, but also the interactions with pharmacological substances, such as antibiotics or laxatives, which can disrupt success rates [Transplantation of large feces, introduced into clinical practice for the purpose of treating ss rates ,109,110.ss rates . Modern ss rates ,112.In conclusion, both the study of SLE and that of the internal microenvironment represent two vast research subjects, both found at the pediatric age. The challenge in this stage is represented by the escalation of the pathogenic process of lupus, objectified by more aggressive clinical manifestations and increased mortality in contrast to the adult population. At the other pole of interest, we find the microbiome, a structure of a complexity comparable to that of the human genome, which is in continuous development starting from the intrauterine period until the age of senescence. Numerous studies in the recent literature link the microbial balance to the pathogenesis of SLE, an aspect intensively researched but still incompletely certified. Therefore, given the fragility and increased variability of the microbiota that can be modulated by various exogenous or endogenous factors, but also the connection between it and SLE, we consider it necessary for the clinician to acquire an “overall view” in order to reduce the burden induced by the disease in especially on the child, whose existence is under the sign of continuous discovery and change that must, as much as possible, take place in a natural course. The present work is considered by the authors to be a point of intersection of research on the stated themes, being centered on the succinct description of the main defining aspects regarding the two entities, diagnostic criteria and principles of locating and optimal collection of evidence, and the way in which they can influence each other and the potential impact of adjunctive therapeutic means to pharmacological ones in the evolutionary course of SLE, an aspect that will open new horizons in future research, also emphasizing the vast involvement of microbial disturbances in multiple systemic diseases.


Dear Editor,,On using spirometry, El-Moatasem and AbbassThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.The authors have no conflict of interest to declare.Not applicable.The author constructed the manuscript, reviewed the literature, wrote and approved the final draft, and is responsible for the content and similarity index of the manuscript.


Art therapy entails a therapeutic relationship that allows the expression and exploration of mental and spiritual needs through art Bell, . It inteArt therapy can contribute to the knowledge, recognition and appropriation of one's own spirituality. This is a necessary part of the discovery process for those on the path of transcendence, leading the individual to (re)discover a broader meaning for existence , using resources such as imagination, symbolism, and metaphors. This context facilitates communication, reorganization of internal contents, meaningful emotional expression, and deepening of internal knowledge, freeing the ability to think and creativity , intrapersonally (toward self-acceptance and meaning), interpersonally (by connecting with others and one's environment), and transpersonally , inner emptiness and anxiety are some of the constraints that prevent individuals, children and adults of all ages from expressing themselves creatively Cocco, . CreativSpirituality provides meaning to our lives by enhancing our consciousness of the most personal elements of our existence, material body, environment, and the divine Bell, . CreatinThe meaning-making process and the self-affirmation of personal and societal values and ideas can help us understand spirituality. This domain of human experience can be explored through artistic representation, enabling people to direct their interest to the spiritual side of the creative experience. An integrative person-centered approach is a foundation for giving spirituality the same care and attention as other physical and psychological realities. It is acknowledged to have a large and decisive influence on recovery, healing, growth, and positive therapeutic outcomes. Art-based spiritual care, therefore, lends legitimacy to the care of the most vulnerable people and contributes to a caring culture focused on spiritual development. Additional research in a broader set of cultures and populations is needed to better understand the effectiveness of art therapy interventions in spiritual growth. Furthermore, conceptual clarity and consensus on terminology will be important in art-based spiritual care both in clinical and community settings.All authors listed have made a substantial, direct, and intellectual contribution to the work and approved it for publication.


Following the significant changes in healthcare systems over the last century, the role of pre-hospital emergency medical services (EMS) has been drawn against numerous challenges. In view of this, the present study aims to reflect on the trend of change in the role of pre-hospital EMS to meet new situations and needs, thereby providing a clear picture of this process.Respecting the intricate concept of development and the major changes in Iran’s healthcare system, this study was fulfilled using situational analysis (SA), developed by Clarke (2018), in Iran within 2022–2023. For this purpose, the data were collected through semi-structured, in-depth individual interviews with four faculty members, two managers involved in EMS, and six highly skilled EMS personnel in various positions. Moreover, the relevant articles published from 1950 to 2023 were reviewed. The data analysis was then performed via SA in the form of open coding as well as simultaneous analysis through three types of maps, viz., situational, social worlds/arenas, and positional maps, along with constant comparative analysis.Pre-hospital EMS in Iran has thus far had two turning points from 1970 to 2023, wherein academic components, need for equipment and resources, in conjunction with basic needs in the modern society, have been the main propellers. As well, the complexity of care for non-communicable diseases (NCDs), demand for managed care, and technological advancement has gradually resulted in further development in EMS. This trend describes the EMS situation in Iran from 1973 to 2023, as well as the EMS emergence stages, quantitative growth and infrastructure, and clinical education development in 2002–2023, indicating the lack of funding and inadequate scientific infrastructure in proportion to the population receiving such services.Considering the trend of change in the approaches adopted by healthcare systems across the world, and given the breakthroughs in nursing and medicine, along the education of professionals during the last thirty years, the descriptions of duties and performance in EMS have moved from primary care and patient transfer to specialized services and outpatient care. In addition, the cultural context specific to Iran, the challenges of women working in EMS centers, the disconnection of service providers, namely, the Iranian Red Crescent Society (IRCS) Relief and Rescue Organization (R&RO), Iran’s National Police Force (INPF), and Iran’s National Medical Emergency Organization (INMEO), as well as lack of resources and equipment, and the geographical distribution of human resources (HRs) based on population dispersion, are thus among the significant issues facing pre-hospital EMS in this country. Pre-hospital emergency medical services (EMS) are known as the key element in healthcare systems around the world, since they play a vital role in medical teams , 2. The Notably, EMS emerged in developed countries in the 1970s. With the trend of change in the role of EMS from 1973 to 2023 worldwide, it has accordingly moved from primary care and patient transfer to specialized services and outpatient care . In 1973Having a population of about 88 million in southwestern Asia, Iran is a member of the World Health Organization (WHO) in the Eastern Mediterranean region –14. CurrThis study utilized grounded theory (GT) as a qualitative method with reference to situational analysis (SA), developed by Clarke 2018). Originating from GT, SA could thus make it possible to identify and describe the situational and positional complexities of social worlds and arenas through mapping . As heal8. OriginThis SA was conducted in Iran with the participation of pre-hospital EMS personnel in the related centers, the Medical Emergency and Accident Management Center (MEAMC) at the universities of medical sciences, the specialty boards , the Iranian EMS Association (IEMSA), and teachers at the schools of nursing and paramedical sciences, including the personal experiences and archives of Javad Malekzadeh, as one of the influential people in the last six decades of nursing in Iran, who has been working on policymaking, management, education, and research in this field from 1951 to 2019 (before and after the Islamic Revolution), and five key people of his era. Inclusion criteria included: willingness to participate in the study and having at least 10 years of work experience in various fields of pre-hospital emergency. Exclusion criteria: unwillingness to participate in the study or withdrawal from the study during the interview.In total, 12 participants, varying in terms of gender, age, and academic degrees, were recruited , and the National Library and Archives of Iran (NLAI), including available statistics, government documents, international reports and historical information, the articles related to INMEO and the Iranian Nursing Organization (INO), and the studies about the role of EMS published from 1950 to 2023 in the databases of Web of Science, Scopus, and ScienceDirect, as well as the memos on the role of EMS.Upon answering each question, some follow-ups such as, The analysis and initial coding of the data retrieved from each interview were performed before the next one. With regard to the qualitative data obtained from the interviews and the existing documents, the memos were thus analyzed after the data conversion. Data analysis was performed by the first author. In this case, like GT, simultaneous data analysis was done together with data collection, coding, and classification as a constant comparative process, and memoing. Although SA, developed by Clarke (2018), was similar to the Straussian approach for open and axial coding, it lacked selective coding and an axial variable to explain the theory. Along with the axial coding, the analysis was fulfilled via a triple approach of data mapping, using situational, social worlds/arenas, and positional maps. According to these data, theoretical elements, including situational maps , social worlds/arenas maps , and positional maps  were obtained.To establish the robustness of the study findings, the four stringent evaluative criteria , proposed by Lincoln and Guba (1985) were implemented. With regard to the credibility of the findings, all codes extracted from each interview were shared and checked with the interviewees and then modified if necessary. Besides, over one year was devoted to data collection and analysis. To enhance the confirmability of the findings, the transcribed interviews together with the codes and categories extracted were reviewed, and then approved by the second and third authors as well as a faculty member outside the research team. For the dependability of the findings, the research stages and processes were recorded and reported as precisely as possible step by step. There were also attempts to observe maximum diversity in the participants in terms of service delivery location, EMS role, work experience, and job position, which helped augment the credibility and then the transferability of the findings. To check the accuracy of the documents, the historical data obtained from the primary sources were compared, and supplementary interviews were further conducted with informants. Considering the external criticism of the documents, library documents as the secondary sources and their details were compared with other sources (such as interviews and other documents) and analyzed. Regarding the internal criticism of such documents and the authenticity and validity of their content, given that the primary sources were still available, historical informants were also recruited.In this study, the trend of change in the role of EMS in Iran over the last century was described by SA, using situational, social worlds/arenas, and positional maps. The description of the situation of the role of EMS in Iran from 1973 to 2023 included the following steps, viz., EMS emergence, quantitative growth and infrastructure, and clinical education development in Iran in 2002–2023, indicating the lack of funding and inadequate scientific infrastructure in proportion to the population receiving EMS.To better understand the situation, the frequency distribution plot of EMS according to the last-twenty-year trend was exploited Fig. . Here, tBefore 1973, there was no formal education program for EMS in Iran. According to the available documents, the collapse of the roof of the main hall of the MIA terminal building, where 16 people lost their lives and 11 individuals were injured, was the stimulus to establish EMS in Iran. After that, a team of Iranian physicians were sent to the United States to study EMS, who then returned after six months with two highly skilled EMS educators, Jim Patterson and Max. Following a public call for people having a high school diploma and holding an entrance exam, they selected the best and employed them as EMS technicians, completing an intensive six-month training course. Therefore, EMS officially started in 1975 under the title, Emergency Information Center (EIC) . As high…at that point in time, you could simply take part in such courses with all types of high school diplomas. My hometown had three centers for the whole province, and there were three ambulances. As I remember, another support was a rescue worker who was also an ambulance driver…Based on the interviews and the existing documents, the EMS equipment and infrastructure, particularly the physical settings, developed at three time periods as follows:Starting new political relations with other countries, including those in the Point Four Program (as the United States policy announced by President Harry S. Truman in 1949) and the Central Treaty Organization (CENTO), between 1948 and 1978, as well as membership in the WHO, overshadowed Iran’s situation with the urgency of change. In this global situation, corresponding to the Second, Third, and Fourth Economic Development Plans (EDPs), Iranian oil exports instigated economic growth. Such political and economic changes in the government accordingly pave the ground for the establishment of EMS infrastructure , 27, so The EMS resources and equipment have been thus exploited in Iran for about thirty years (1975–2002). As well, higher public awareness and the prevalence of NCDs  gradually raised the need for specialized personnel for primary care and patient transfer, which demanded a platform for the scientific development of pre-hospital EMS.At this period, due to the severe shortage of personnel across Iran, the healthcare system focused on supplying EMS personnel to provide the required services. Currently, after about half a century, more than 20000 EMS personnel and experts, with Associate’s and Bachelor’s degrees, are working in INMEO, but this is far from the standard indicators in proportion to the growing population, the fleet of ambulances, and EMS centers .In this sense, Participant No. 9 stated that:“…. There were only three emergency center and five American ambulances in Mashhad, which were used less due to high fuel consumption… “With the onset of making EMS a subject of academic study in Iran (2002), medical equipment was improved and the fleet of ambulances was renewed. In 1999, the first Air medical emergency center launched in Tehran. As well, the Communication and Operation Command Center (COCC)  was organized in a more specialized manner . During From the start of the EMS in Iran, receiving the missions was in a traditional (wireless), analog form. Following technological advancement and the digitalization of Iran’s healthcare system, the algorithm of telephone triage, ambulance management, and patient information documentation changed due to the use of a software program, called ASAYAR, but the previous system was maintained for further support  Fig. 3)3).In this sense, Participant No. 6 stated that:… “We had heard that there were light helicopters in the emergency that were used in very rare cases ….”With the merger of the universities of medical sciences and their affiliated hospital in Iran, the former Ministry of Health (MOH) was formed under the name, Ministry of Health, Treatment, and Medical Education (MOHTME) in 1986 . AccordiIn this sense, Participant No. 6 stated that:“… From 1995 onwards, the type of activities became more and more advanced and there was a lot of focus on learning intubation in the system, and in the way that there are currently protocols and instructions and sometimes the right to prescribe medicine, it was not like that at that time. The type of activities moved towards becoming more professional, and in general, our dealings with clients have become more professional and ethical …”Upon the graduation of the pre-hospital EMS personnel, holding academic degrees, the healthcare and clinical services became gradually more scientific and specialized. The activities of the EMS personnel accordingly moved from simple and basic tasks, such as primary care and patient transfer to more advanced scientific and specialized ones, i.e., primitive and advanced CPR, working with equipment such as an electroshock and an automated external defibrillator (AED), telemedicine, coding patients with heart attacks and strokes, etc. . This le…we were in charge of transferring the patients at that time. We thus went to Jorjani School for taking a short six-month course, and then entered the emergency department due to a severe shortage of personnel. These days, those who are coming here have university education and academic degrees. Some equipment such as AED is available in our base, and we have learned to work with them…In these maps, the actions of people both as individuals and as members of social worlds could be examined in the current discourses. To plot it, the collective entities or social worlds in the arenas could be thus addressed, so that the collective agents and arenas of commitment and discourse could be further analyzed in a situation . The hisThe influential people of these organizations in the government system accordingly have bureaucratic and supervisory power to develop programs and perform roles in the healthcare field. Currently, MOHTME is the heart of funding EMS education, which is more important than that for other organizations.Another key issue in the related organizational groups is the close and direct relationship between the Fire Department, IRCS R&RO, and Iran’s National Police Force (INPF) and the pre-hospital EMS personnel. In such a way, the Fire Department puts out the fire, releases the injured inside the city, and IRCS R&RO helps in natural disasters to rescue the injured on the road . This bePositional maps illustrate a deep understanding of the data in the adopted and unadopted positions, which are organized based on the differences, conflicts, and concerns about various issues . The keyA.Prevalence of NCDs, indicating the high demand for EMS in the societyB.Specialization of pre-hospital EMSC.Lack of equipment and resources There is also a shortage of EMS personnel with academic degrees in Iran, so that the national standard is one urban base with one active ambulance for every 20000 people and one road base with one operating ambulance in each city with a population of less than 20000. Besides, the number of standard personnel in each base is 9 people. The official statistics released by INMEO have also filed 1300 urban centers for 63 million urban population and 1700 road centers. This shows the lack of 3150 urban centers and 3300 road centers for the current position of Iran to be close to the national standards . TherefoThe above positional map displays that the healthcare system policymakers working on service provision, particularly in the pre-hospital field, need to make operational decisions to improve the quality of care to clients by categorizing different levels of pre-hospital care and changing the standards, to be compatible with the complexities of current expected care and the new economy of systems.It is clear that the role of EMS in Iran and the world has undergone significant changes over the years due to various factors, including political relations, establishment of laws and regulations, crises, education development, technological advancement, and infrastructure improvements , 37.The emergence of EMS in Iran was initially due to the collapse of the roof of the main hall of MIA terminal building in 1973. However, for about thirty years, there were no significant changes in EMS education or medical equipment, and no academic education was established for pre-hospital EMS. After the Islamic Revolution and the Iran-Iraq War, there was a small growth in the number of rescue workers, and the dire need for more advanced nursing and healthcare services during the war paved the ground for pre-hospital EMS .However, it was not until after 2002 that Iran began to create a more suitable situation for changes in the role of EMS by developing pre-hospital EMS education and renovating the fleet of ambulances and medical equipment , 39.One significant factor affecting the role of EMS was the development of EMS education, which led to the graduation of pre-hospital EMS personnel with academic degrees, making clinical care more scientific , 40–42. It is worth noting that the structure and composition of Iran's pre-hospital EMS are different from that of other countries, with two people present in the role of EMS personnel and a physician providing aids via phone calls and consultations, while in other countries, pre-hospital EMS is met by a team of physicians, EMS personnel, and nurses. This distinction can have a significant effect on the expected EMS type and performance , 46, 47.Like in many other countries, pre-hospital EMS personnel in Iran face a range of challenges. Some of these challenges include: Lack of resources: Despite recent improvements in the fleet of ambulances and medical equipment, there is still a lack of resources in some areas, especially in rural and remote regions , 36, 48.Like other countries in the world, the role of EMS in Iran became vital due to the prevalence of NCDs, trauma triage in accidents, crises, and the high demands in the society; however, the roots of inadequate EMS and the related reasons in Iran have their own similarities and differences with those in the world.Considering the trend of change in the approaches adopted by healthcare systems across the world, and given the breakthroughs in nursing and medicine, along with the education of professionals during the last thirty years, the descriptions of duties and performance in EMS has moved from primary care and patient transfer to outpatient care and specialized services. However, sufficient EMS infrastructure has not been developed in terms of postgraduate education. In addition, the cultural context specific to Iran, the challenges of women working in EMS centers, the disconnection of service providers, namely, IRCS R&RO, INPF, and INMEO, lack of resources and equipment, and the geographical distribution of human resources based on population dispersion, are thus among the significant issues facing pre-hospital EMS in this country.To make more progress and reach a balanced development in the role of EMS, there is a need for a scientific review of the high-level courses of pre-hospital EMS, in parallel with the clarity of the role and the position of the Associate’s and Bachelor’s degrees as an urgency of change, which should be established by analyzing all situational maps. Given the economic pressure and the lack of EMS, continuously affecting Iran’s healthcare system, nursing managers and policymakers should attempt to strengthen the legal structures, executive regulations, and the standards appropriate to Iran’s situation as soon as possible to develop the role of EMS. Furthermore, there is a need to keep thinking about pre-hospital EMS teams in new situations.Getting permissions to interview the top-level managers in Iran’s healthcare system was not possible in this study, so they were not recruited. Additionally, some archives and library documents could not be reviewed due to their historical age.


Active euthanasia is currently permitted in Netherlands, Belgium, Colombia, Luxembourg, Canada, Australia and India. Assisted suicide is allowed in Switzerland, Germany, South Korea, Japan, as well as in the states of Washington, Oregon, Colorado, Hawaii, Vermont, Montana, California of the USA.The right to die is considered to be a basic human right. In 2018, 2,357 euthanasia procedures were carried out in Belgium, most of them for the elderly. Factors that contribute to the decision to euthanize older people are: existential crisis; loss of autonomy, dignity and control; worry about future loss of autonomy, dignity, and control; lack of understanding of the processes of dying; concerns about medical intervention and treatment at the end of life; increasing disunity between generations; decline of people’s spiritual culture and religious faith. In the Netherlands, euthanasia is allowed from the age of 12, sometimes for infants up to two years old. Some countries allow assisted suicide of the mentally ill.The possibility of suicide for people «who are tired of life» is discussed.Investigation of the ethical aspects of the role of a psychiatrist in the commission of assisted suicideIn order to study ethical aspects of the role of a psychiatrist in assisted suicide, the materials of the Department of bioethics of UNESCO and the positions of the legislation of a number of countries were studied.The decision about euthanasia is taken by a commission of 3 doctors, one of whom is a psychiatrist.According to psychiatrists, the desire to die in a patient with a mental disorder should be considered the same as the desire of a patient with cancer.The role of psychiatrists in euthanasia and assisted suicide is reversed. These are: the study of assisted suicides, assistance in their implementation and popularization, determination of legal capacity to permit suicide, creation of a psychotherapeutic space and providing psychological assistance to patients in the process of dying, writing of a prescription for a lethal drug, consulting patients and their families.The role of psychiatrists in Russia is to prevent suicides and treat patients with suicidal tendencies. Assistance by a psychiatrist in the suicide is a critical problem in psychiatry.None Declared


The National School of Rehabilitation, Integration and Recovery in Mental Health was established in 2011 at Ono Academic College. Its operation is supervised and funded by the Department of Rehabilitation in the Mental Health Division of the Israel Ministry of Health. The School offers courses for a broad variety of mental health professionals and others involved in the mental health field (service users and family members) to promote professional competencies, social cohesion, learning from experience, and to advance mental health rehabilitation. In recent years, the School has become increasingly involved in multiculturalism, providing special courses and workshops for both the Palestinian-Arab and ultra-Orthodox Jewish sectors in Israel. The School is based on the belief in the ability of service users to recover, integrate, and live meaningful lives in the community. This belief is consistent with values of the recovery approach . The School is constantly in dialogue with the community, and provides training for interventions that promote recovery, as well as social cohesion in the field of psychiatric rehabilitation.To describe the process of foundation, implementation, and outcomes of the unique model of the School; to discuss the multicultural and social opportunities and challenges; to portray major elements of the school methodology and practice.Work model presentation through qualitative analyses of social and academical processes, alongside quantitative descriptive data.Every year, 700 students from various helping professions in the field of psychiatric rehabilitation study at the School, as well as service users. The school operates as a bridge between academy and the field and encourages learner and staff diversity, joint learning, and discourse. Over 30 courses are conducted annually including evidence-based intervention courses such as IMR, and training courses such as knowledge by experience, supervision, rehabilitation coordinators, etc. In addition, unique courses are given, such as eating disorders, DBT, and social cognitive intervention training with multicultural adaptations. Lastly, the school offers consultation in implementing interventions within services.The working model of the School operates under the framework and values of recovery, social integration and cohesion, and multiculturalism. To this day, the School offers courses, symposiums, conferences, and professional publications, to educate for values of recovery and community inclusion, alongside improving the quality of services.None Declared