Patients with liver cirrhosis are more susceptible to various bacterial or viral infections due to immune dysfunction. Recent studies have shown that compared with the general population， individuals with liver cirrhosis show a significant increase in the incidence rate of adverse outcomes after severe acute respiratory syndrome coronavirus 2 infection， including the progression of liver injury and the increase in mortality rate. Vaccination can reduce the incidence rates of breakthrough infections and severe coronavirus disease 2019 （COVID-19） in patients with liver cirrhosis， but such patients have low immune response and thus require booster doses to enhance immunity. This article reviews the clinical features of cirrhotic patients with COVID-19 and related management strategies， in order to provide evidence-based guidance for the clinical diagnosis and treatment of such patients.

Objective: To assess the association of family food environment with dietary and nutrition literacy among junior and senior high school students, providing a basis for nutritional health education and adolescent nutritional improvement. Methods: From January 9 to February 10, 2025, a total of 1 473 junior and senior high school students aged 12-20 were recruited by using a cluster random sampling method combined with convenient sampling from 15 provinces (municipalities and autonomous regions) across China. Data on basic demographic characteristics, home food environment, and dietary and nutrition literacy were collected by using the Food and Nutritional Literacy Questionnaire for Chinese School age Children. Multiple linear regression and Logistic regression models were employed to analyze the association of the home food environment on adolescent dietary and nutrition literacy. Results: The total score of dietary and nutrition literacy among junior and senior high school students was (65.28±9.03). The score in the cognitive domain (67.59±10.56) was higher than that in the skill domain (60.74±9.15), and the score for food preparation skills (56.60±14.28) was the lowest. Students aged 16-20, senior high school students, those for only children, non boarding students, those with urban household registration, those from wealthier families, those whose primary caregivers were parents with higher education levels, and those who previously received nutrition and health education had significantly higher dietary and nutrition literacy scores compared to their respective counterpart groups ( t/F =-8.32, -8.14, 4.76, -2.70, 7.15, 18.29, 10.68, 11.66 , all P <0.05). Multiple linear regression analysis revealed that family food environment was associated with dietary and nutrition literacy, and the model was statistically significant ( R 2=0.20, F=20.54, P <0.05). Lower availability of fruits at home in the past month and lower frequency of family communication regarding dietary and nutrition were associated with lower dietary nutrition literacy scores among junior and senior high school students ( β =-1.35, -1.67, both P <0.01). Among junior and senior high school students, lower frequency of dining out with the family, watching videos during family meals, and being urged by parents to eat more food in the past month were associated with higher scores on dietary nutrition literacy ( β =1.35, 1.13, 0.71, all P <0.01). Logistic regression model results indicated that watching videos during family meals ( OR =1.70) and family communication regarding dietary and nutrition ( OR =0.51) were significantly associated with dietary and nutrition literacy levels (both P <0.05). Conclusions The score of dietary and nutrition literacy among junior and senior high school students is relatively low, and the family food environment is a key factor. It is recommended that nutrition education and improvement initiatives for junior and senior high school students prioritize attention on children and adolescents from households with less favorable food environments.

To target the pivotal BCR/ABL oncoprotein in chronic myeloid leukemia (CML) cells, tyrosine kinase inhibitors (TKIs) are utilized as landmark achievements in CML therapy. However, TKI resistance and intolerance remain principal obstacles in the treatment of CML patients. In recent years, drug repositioning provided alternative and promising perspectives apart from the classical cancer therapies, and promoted anthelmintic mebendazole (MBZ) as an effective anti-cancer drug in various cancers. Here, we investigated the role of MBZ in CML treatment including imatinib-resistant CML cells. Our results proved that MBZ inhibited the proliferation and induced apoptosis in CML cells. We found that MBZ effectively suppressed BCR/ABL kinase activity and MEK/ERK signaling pathway by reducing p-BCR/ABL and p-ERK levels with ABL1 targeting ability. Meanwhile, MBZ directly targeted the colchicine-binding site of β-tubulin protein, hampered microtubule polymerization and induced mitosis arrest and mitotic catastrophe. In addition, MBZ increased DNA damage levels and hampered the accumulation of ataxia-telangiectasia mutated and DNA-dependent protein kinase into the nucleus. This work discovered that anthelmintic MBZ exerts remarkable anticancer effects in both imatinib-sensitive and imatinib-resistant CML cells in vitro and revealed mechanisms underlying. From the perspective of drug repositioning and multi‐target therapeutic strategy, this study provides a promising option for CML treatment, especially in TKI-resistant or intolerant individuals.

Objective To identify determinants of subtherapeutic voriconazole(VRCZ)concentrations in allogeneic hematopoietic stem cell transplantation(allo-HSCT)recipients and to develop/validate a nomogram-based risk prediction model.Methods This study retrospectively analyzed 310 VRCZ therapeutic drug monitoring(TDM)measurements from allo-HSCT recipients at 310 patients who under went allo-HSCT surgery at Hebei Yanda Ludaopei Hospital from October 2022 to October 2024 and received VRCZ for the prevention and treatment of invasive fungal infections before transplantion were selected as the study subjects.Cases were stratified into target-concentration group(0.5～5.0μg/ml)and subtherapeutic group(<0.5μg/ml).Through single factor and multiple factor Logistic regression analysis,indeipendent predictive factors forvecz plasma concentration non-compliance were screened,and a column chart prediction model(NPM)was constructed.The performance of the model was evaluateding area under the receiver operating characteristic curve(AUC),Hosmer-Lemeshow(H-L)goodness-of-fit test,and decision curve analysis(DCA).Results Among 310 VRCZ-TDM measurements,71.61%(222/310)achieved target concentrations.Multivariate analysis showed that CYP2C19 intermediate metabolite,daily dose of cyclosporine A(CSA),daily dose of VRCZ,creatinine(Cr)>97 μmol/L,albumin(Alb)and C-reactive protein(CRP)were independent influencing factors for VRCZ blood drug concentration non-compliance(Wald χ2=4.046～13.221,all P＜0.05).The nomogram demonstrated excellent discrimination,calibration(H-L goodness of fit test χ2=2.663,P=0.954),and clinical utility with net benefit across 0.05～0.96 risk thresholds.Conclusion The nomogram incorporating CYP2C19 gene phenotype,daily CSA dosing,daily VRCZ dosing,Cr levels,Alb and CRP provides a validated tool for optimizing VRCZ therapy in allo-HSCT recipients,enabling precision dosing strategies.

Objective:To explore the mediating effect of intrinsic motivation of nurses between empowering leadership and job performance, with the aim of providing a reference basis for managers to develop a scientific and effective intervention programme to improve nurses′ job performance.Methods:Convenience sampling method was used to select 1 213 clinical nurses from four tertiary general hospitals in Shandong Province, Henan Province, Yunnan Province, and Fujian Province from November to December 2023, and General Information Questionnaire, Empowering Leadership Scale, Intrinsic Motivation Scale, and Job Performance Scale were used to conduct a cross-sectional survey. AMOS26.0 software was used to test the mediating effect of intrinsic motivation of nurses between empowering leadership and job performance.Results:A total of 1 100 nurses completed the survey finally. Among them, there were 58 males and 1 042 females, 474 under 31 years old, 448 between 31-40 years old, and 178 over 40 years old.The total scores of the Empowering Leadership Scale, Intrinsic Motivation Scale, and Job Performance Scale were 49.44 ± 10.04, 82.35 ± 13.54 and 46.27 ± 6.20 in that order. Nurses' job performance were positive correlation with the empowered leadership and intrinsic motivation ( r=0.486, 0.703, both P<0.01), there was a positive correlation between nurse empowerment leadership and intrinsic motivation ( r=0.452, P<0.01). Nurses′ intrinsic motivation partially mediates the relationship between empowering leadership and job performance, accounting for 62.69% of the total effect. Conclusions:Intrinsic motivation of nurses is a mediating variable between empowered leadership and job performance. Nursing managers should focus on nurses' participation in autonomous decision-making to enhance nurses′ sense of competence and meaning at work, and mobilise their motivation to improve job performance.

BACKGROUND:Previous studies have found that growth arrest and DNA damage-inducible protein 45β(Gadd45b)is beneficial to the repair of acute cerebral ischemia,but the action mechanism is still unclear.OBJECTIVE:To investigate the effect and mechanism of Gadd45b on white matter demyelinating lesions in rats with chronic cerebral ischemia.METHODS:SD rats were randomly divided into four groups:sham operation group,model group,empty vector group,and Gadd45b overexpression group,with 15 rats in each group.Gadd45b-overexpressing lentivirus and no-load lentivirus were injected into the bilateral hippocampus and bilateral ventricles of rats.One week after lentivirus transfection,the rat model of chronic hypoperfusion cerebral ischemia was established by bilateral common carotid artery ligation.Three weeks after the bilateral common carotid artery ligation,the learning and cognitive functions of rats were evaluated by novel object recognition test.Luxol fast blue staining was used to observe the changes of myelin structure in the corpus callosum of rats.Hematoxylin-eosin staining and Nissl staining were used to observe the damage of the rat corpus callosum.Immunofluorescence staining was used to detect the expression of myelin basic protein and neurofilament protein 200 in the corpus callosum of rats.Immunofluorescence double staining was used to detect the expression of astrocyte markers GFAP/C3d and GFAP/S100A10 in rat brain tissue.ELISA was used to detect the levels of tumor necrosis factor-α and interleukin-6 in the supernatant of brain tissue.RESULTS AND CONCLUSION:(1)Gadd45b overexpression could significantly improve the learning and cognitive function of rats with chronic cerebral ischemia,and improve demyelination and pathological damage in the rat corpus callosum.(2)The results of immunofluorescence showed that Gadd45b overexpression significantly increased the expression levels of myelin basic protein and neurofilament protein 200 in the brain tissue of rats with chronic cerebral ischemia.(3)Gadd45b overexpression reduced GFAP/C3d double positive cells and increased GFAP/S100A10 double positive cells in the brain tissue of rats with chronic cerebral ischemia.(4)Gadd45b overexpression reduced the levels of tumor necrosis factor-α and interleukin-6 in the brain tissue of rats with chronic cerebral ischemia.It is concluded that Gadd45b overexpression improves cognitive dysfunction by promoting the A2 phenotype transformation of astrocytes,alleviating white matter myelin structure damage and neuroinflammation in rats with chronic cerebral ischemia.

Objective To explore the association between non-high density lipoprotein cholesterol(non-HDL-C)and total MRI burden in cerebral small vessel disease(CSVD)patients.Methods A total of 303 inpatients(≥60 years old)admitted in our department from January 2021 to July 2024 were recruited,and divided into 0-burden score group(108 cases),1-burden score group(61 cases),2-burden score group(66 cases),3-burden score group(35 cases),and≥4-burden score group(33 cases)according to the total CSVD burden.The association between non-HDL-C and to-tal MRI burden was analyzed by binary logistic regression analysis.Results The levels of TC and non-HDL-C were gradually increased with increment of 0-MRI burden score in the 0-,1-,2-,3-and ≥4-burden score groups in turn(P＜0.01).The non-HDL-C level was significantly higher in the 3-than the 0-burden score group(P=0.001),and in the 2-,3-and ≥4-than the 1-burden score group(P＜0.05).The total CSVD MRI burden was positively correlated with the non-HDL-C level(P=0.001).After adjustment of confounding factors such as age,gender,hypertension,dia-betes and hyperlipidemia,non-HDL-C was still an independent risk factor for CSVD(OR=2.869,95％CI:1.012-8.136,P=0.047).Conclusion Higher non-HDL-C is strongly associated with in-creased total CSVD MRI burden in the elderly,and it can serve as an early intervention indicator for CSVD.

Objective To explore the effect of diet therapy on alcohol-induced chronic liver injury in rats and its relationship with TLR4 pathway.Methods According to Pueraria:Poria:Amomum villosum:Pericarpium Citri Reticulatae:Codonopsis:Zingiberis Rhizoma=15∶15∶10∶10∶10∶6,the water extract of the therapeutic prescription was prepared.A total of 78 female SD rats were randomly divided into 6 groups:normal group(n=12),model group(n=18),Hugan tablet group(0.35 g·kg-1,n=12),low-,medium-and high-dose Shiliaofang groups(2,6,18 g·kg-1,n=12).Except for the normal group,the rats in each group were induced alcoholic liver disease(ALD)by gradient alcohol gavage.After 10 weeks of intervention,the changes of body weight and water intake of rats were observed.The whole blood routine,serum alanine aminotransferase(ALT),aspartate aminotransferase(AST),triglyceride(TG),total cholesterol(TC)and liver malondialdehyde(MDA)were measured.The levels of serum alcohol dehydrogenase(ADH),aldehyde dehydrogenase(ALDH),lipopolysaccharide(LPS),D-lactic acid(D-LA),tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)and interleukin-10(IL-10)were detected by enzyme-linked immunosorbent assay.HE staining was used to observe the pathological changes of liver and ileum.Oil red staining was used to observe liver fat deposition.Immunohistochemistry was used to detect the expression of ileal tight junction component occludin.Western blot was used to detect the expression of TLR4,MyD88 and NF-κB p65 protein in liver.Results Compared with the model group,the levels of WBC,LYC,TC,ALT,AST,LPS,D-LA,TNF-α and IL-6 in each diet group decreased,IL-10 increased,liver inflammatory cell infiltration and red lipid droplets decreased,intestinal villi were intact and densely arranged,the expression of occludin protein in ileum increased,and the expression of TLR4,MyD88 and NF-κB p65 protein in liver decreased.Conclusion The self-made dietotherapy prescription has a significant protective effect on chronic liver injury induced by alcohol in rats,which may be related to its down-regulation of TLR4-MyD88-NF-κB p65 protein expression and up-regulation of ileal occludin protein expression,improvement of intestinal mucosal barrier function,reduction of endotoxin entry into the liver,activation of TLR4/MyD88/NF-κB pathway,thereby reducing the second hit to the liver.This diet can be developed as a potential anti-alcoholic liver injury drug.

Objective To investigate the protective effects and potential mechanisms of the preparation of Abelmoschus manihot(L.)Medik(Jiahua Tablet)against acute radiation-induced myocardial injury,based on myo-cardial injury markers(sST2,cTnI)and oxidative stress damage-related indicators(SOD,MDA),and to provide new avenues for the prevention and treatment of radiation-induced heart disease(RIHD).Methods Sixty-nine patients with thoracic malignant tumor who received radiotherapy at the department of radiation oncology in Hospital Affiliated to Nanjing University of Chinese Medicine from December 2023 to November 2024 were enrolled in the study.Participants were randomly divided into control group(n=38)and observation group(n=31).The control group received standard radiotherapy in conjunction with conventional medications for RIHD,while the observation group was additionally administered Jiahua Tablet alongside the same regimen.Both groups took medications continuously for 1 month.Changes in serum levels of sST2,cTnI,SOD,and MDA were compared between the two groups 3 days prior to radiotherapy and 7 days after radiological therapy.Results On day 7 post-radiotherapy,the levels of sST2 and cTnI in the control group were highly elevated,showing statistically significant difference(P<0.01).In contrast,the levels of sST2 and cTnI in the observation group showed only mild elevation,and no statistically significant difference was observed(P>0.05).Between-group analysis demonstrated that post-treatment sST2 and cTnI levels in the observation group were substantially lower compared to those in the control group,indicating statistically significant difference(P<0.05).After treatment,SOD level in the control group was considerably lower compared to its pre-treatment level,and marked statistical significance was observed(P<0.01).SOD level in the observation group demonstrated a downward trend compared to baseline value,indicating no statistical significance(P>0.05).Between-group analysis demonstrated that post-treatment SOD level in the observation group was substantially elevated compared to that in the control group,indicating a highly significant disparity(P<0.05).After treatment,MDA level in the control group was considerably higher compared to its pre-treatment level,and a marked statistical significance was observed(P<0.05),whereas MDA level in the observation group showed only a mild increase compared to baseline value,with no statistically significant difference(P>0.05).Between-group analysis demonstrated that post-treatment MDA level in the observation group was substantially lower compared to that in the control group,demonstrating a remarkably statistically significant difference(P<0.01).Conclusion The preparation of Abelmoschus manihot(L.)Medik(Jiahua Tablet)effectively inhibits acute radiation-induced myocardial injury,with its potential mechanism closely linked to the suppression of oxidative stress responses.

Objective To compare the difference,agreement,and axial length measurement success rate between biometers ZW-30 and IOLMaser 700 based on swept-source optical coherence tomography for the measurement of ocular bi-ological parameters in patients with cataracts.Methods A total of 126 cataract patients(233 eyes)who were advised to undergo cataract surgery at the Department of Ophthalmology at Beijing Tongren Hospital,Capital Medical University from January to February 2024 were included in this study.Two biometers were used to measure the axial length(AL),mean keratometry(Km),anterior chamber depth(ACD),lens thickness(LT),central corneal thickness(CCT),and horizontal corneal diameter[namely,the white-to-white(WTW)distance].The axial measurement success rate of the two biometers and the difference and agreement between the parameters were calculated.Results The mean difference between ZW-30 and IOLMaster 700 was(-0.006±0.042)mm for AL,(-0.074±0.204)D for Km,(0.031±0.051)mm for ACD,(0.001±0.005)mm for CCT,and(-0.286±0.337)mm for WTW,and the differences were statistically significant(all P＜0.05).The mean difference between ZW-30 and IOLMaster 700 was(0.008±0.215)mm for LT,and the difference was not statis-tically significant(t=0.579,P=0.563).The 95％limits of agreement range was between-0.011 mm and 0.000 mm for AL,between-0.474 D and 0.326 D for Km,between-0.010 mm and 0.012 mm for CCT,between-0.068 mm and 0.131 mm for ACD,between-0.116 mm and 0.159 mm for LT,and between-0.947 mm and 0.376 mm for WTW.The intra-class correlation coefficient of all measurements ranged from 0.790 to 1.000.The AL measurement success rate of IOLMaster 700 and ZW-30 was 95.3％and 95.7％,respectively.The latter had an AL measurement success rate of 98.7％after manually marking the position of the retinal identification line.Conclusion There were statistically significant differences between ZW-30 and IOLMaster 700 in the measurement of the AL,Km,ACD,and CCT,which,however,were not clinically significant.The agreement between both was good.ZW-30 had a higher AL measurement success rate,espe-cially for the manual identification function of eyes with opacified refractive media,which can further improve the AL meas-urement success rate and provide reference for clinical work.