Conception and design: HZ, RZ, JH; Data acquisition: RZ, HW; Data analysis: HZ, RZ, JJ, HW; Manuscript drafting: HZ, RZ; Critical revision: All authors contributed to editorial changes in the manuscript. All authors read and approved the final manuscript. All authors have participated sufficiently in the work and agreed to be accountable for all aspects of the work.

Our study is approved by Academic Committee of the Third Affiliated Hospital of Naval Medical University (approval number: KY2024081). All participants and their legal guardians provided written informed consent. The study was carried out in accordance with the guidelines of the Declaration of Helsinki.

This research was supported by the research on the mechanism of alveolar epithelial cell-derived exosomes loaded with Isthmin-1 in regulating pulmonary capillary leakage in sepsis (2023 QN098) and the research on the mechanism of alveolar epithelial cell-derived exosomes loaded with Isthmin-1 in regulating pulmonary capillary leakage in sepsis (2023 QN008).

The authors declare no conflict of interest.

In this dissertation, the authors used AI tools to assist in literature retrieval and organization/diagram and audio/video production/code debugging and analysis/grammar proofreading and format checking, etc. The core ideas, research design, conclusions and innovations of the dissertation were all completed independently by us. We conducted a legal review and reasonable editing of the content completed with the assistance of this tool, and I assume all legal and academic ethical responsibilities for the content of this dissertation.