Global public health faces substantial challenges from malignant tumors and infectious diseases. Vaccination provides an approach for treating and preventing these diseases. Oral vaccinations are particularly advantageous in disease treatment and prevention due to their non-invasive nature, high patient compliance, convenience, cost-effectiveness, and capacity to stimulate comprehensive and adaptive immune responses. However, the overwhelming majority of oral vaccines remain in experimental development, struggling with clinical and commercial translation due to their suboptimal efficacy. Thus, enhancing scientists' understanding of the interaction between vaccines and gastrointestinal immune system, creating antigen delivery systems suitable for the gut mucosal environment, developing more potent antigenic epitopes, and using personalized combination therapies are critical for advancing the next generation of oral vaccines. This article explores the fundamental principles and applications of current oral anti-tumor and anti-infective vaccines and discusses considerations necessary for designing future oral vaccines.

Cerebral venous sinus thrombosis(CVST)is one of the significant causes of pediatric stroke.Its clinical manifestations are non-specific,including seizures,altered state of consciousness,and neurological deficits.It is usually associated with a high risk of mortality and disability.Although anticoagulation remains the first-line therapy of CVST in children,some children still experience poor prognosis.In recent years,endovascular treatment(EVT),such as mechanical thrombectomy and intrasinus thrombolysis,has emerged as a crucial therapeutic approach for CVST.This review summarized the advances in EVT for pediatric CVST,aiming to provide insights for optimizing clinical management strategies.

Objective:To prepare histatin 1 (Hst 1) and D-histatin 1 (D-Hst 1) coatings on pure titanium surfaces and to evaluate their impact on the initial adhesion and spreading of mouse bone marrow mesenchymal stem cells (mBMSC).Methods:The test pieces were divided into four groups: pure titanium, piranha solution-treated, 3-aminopropyltriethoxysilane-treated, Hst 1 modified groups or D-Hst 1 modified groups, with five pieces in each group. The surface hydrophilicity of the test pieces was detected by contact angle measurement. The surface microtopography was observed using atomic force microscopy (AFM), and the surface elemental composition was analyzed by X-ray photoelectron spectroscopy (XPS). The modification of Hst 1 on the titanium surface and the early adhesion and spreading of the third-generation normal mBMSC on Hst 1/D-Hst 1 modified group were observed using confocal laser scanning microscopy (CLSM).Results:The Hst 1 modified group had better surface hydrophilicity (contact angle 51.63°±3.80°) compared to the pure titanium group (contact angle 60.36°±4.38°). AFM observations revealed shallow mechanical scratches on the surfaces of all test pieces. CLSM and XPS elemental analysis confirmed the successful modification of Hst 1 on the titanium surface. Compared with the pure titanium group, both Hst 1 and D-Hst 1 could promoted the early adhesion of mBMSC. The Hst 1 modified group promoted the spreading of mBMSC after early adhesion, while the D-Hst 1 modified group showed no statistically significant difference in promoting mBMSC spreading compared to the pure titanium group ( P>0.05). Conclusions:The modification of Hst 1/D-Hst 1 on pure titanium surfaces using Schiff base reaction is effective. It is conducive to the early adhesion and spreading of mBMSC.

Objective To analyze in depth the job satisfaction and influencing factors of medical staff in tertiary public hospitals in Gansu Province,especially to explore the important factors affecting the survival and development of hospitals as core talents,in order to provide reference for promoting the stable development of medical staff in medical institutions in Gansu Prov-ince.Methods From July to October 2024,a random sampling method was used to select relevant personnel from tertiary public hospitals in Gansu Province for a questionnaire survey.Descriptive analysis were conducted on the collected data.Multivariate lo-gistic regression analysis was used to identify the main influencing factors of job satisfaction among medical staff.The difference is statistically significant with P＜0.05,and the test level is α=0.05.Results 1 890 questionnaires were distributed and 1 885 valid questionnaires were collected,with an effective rate of 99.74％.The overall job satisfaction score of medical staff in tertiary hospitals in Gansu Province is 3.06±0.86,which is at a moderate level.Hospitals can consider improving management models,establishing scientific,reasonable,and humane management systems,enhancing doctors'sense of belonging,and improving sat-isfaction;The satisfaction brought by salary to medical staff is higher than promotion opportunities and career development,indi-cating that a reasonable salary incentive system in hospitals,with excellent performance and compensation,can increase doctors'subjective well-being and improve satisfaction.Optimising the allocation of health human resources and appropriately in creasing personnel allocation based can help improve doctors'job satisfaction.Conclusion The overall job satisfaction of medical staff in tertiary hospitals in Gansu Province is generally satisfactory,and there are statistically significant differences in job satisfaction a-mong medical staff with different work experience,education level and monthly income(P＜0.05).When formulating policies and measures,the government pays attention to factors that affect the job satisfaction of medical personnel,optimizes the alloca-tion of health human resources,continuously improves incentive mechanisms,and improves hospital management models,enhan-cing the job satisfaction of medical staff and laying the foundation for promoting the developmrnt of provincial health talent team.

Objective:To prepare histatin 1 (Hst 1) and D-histatin 1 (D-Hst 1) coatings on pure titanium surfaces and to evaluate their impact on the initial adhesion and spreading of mouse bone marrow mesenchymal stem cells (mBMSC).Methods:The test pieces were divided into four groups: pure titanium, piranha solution-treated, 3-aminopropyltriethoxysilane-treated, Hst 1 modified groups or D-Hst 1 modified groups, with five pieces in each group. The surface hydrophilicity of the test pieces was detected by contact angle measurement. The surface microtopography was observed using atomic force microscopy (AFM), and the surface elemental composition was analyzed by X-ray photoelectron spectroscopy (XPS). The modification of Hst 1 on the titanium surface and the early adhesion and spreading of the third-generation normal mBMSC on Hst 1/D-Hst 1 modified group were observed using confocal laser scanning microscopy (CLSM).Results:The Hst 1 modified group had better surface hydrophilicity (contact angle 51.63°±3.80°) compared to the pure titanium group (contact angle 60.36°±4.38°). AFM observations revealed shallow mechanical scratches on the surfaces of all test pieces. CLSM and XPS elemental analysis confirmed the successful modification of Hst 1 on the titanium surface. Compared with the pure titanium group, both Hst 1 and D-Hst 1 could promoted the early adhesion of mBMSC. The Hst 1 modified group promoted the spreading of mBMSC after early adhesion, while the D-Hst 1 modified group showed no statistically significant difference in promoting mBMSC spreading compared to the pure titanium group ( P>0.05). Conclusions:The modification of Hst 1/D-Hst 1 on pure titanium surfaces using Schiff base reaction is effective. It is conducive to the early adhesion and spreading of mBMSC.

Cerebral venous sinus thrombosis(CVST)is one of the significant causes of pediatric stroke.Its clinical manifestations are non-specific,including seizures,altered state of consciousness,and neurological deficits.It is usually associated with a high risk of mortality and disability.Although anticoagulation remains the first-line therapy of CVST in children,some children still experience poor prognosis.In recent years,endovascular treatment(EVT),such as mechanical thrombectomy and intrasinus thrombolysis,has emerged as a crucial therapeutic approach for CVST.This review summarized the advances in EVT for pediatric CVST,aiming to provide insights for optimizing clinical management strategies.

Objective To analyze in depth the job satisfaction and influencing factors of medical staff in tertiary public hospitals in Gansu Province,especially to explore the important factors affecting the survival and development of hospitals as core talents,in order to provide reference for promoting the stable development of medical staff in medical institutions in Gansu Prov-ince.Methods From July to October 2024,a random sampling method was used to select relevant personnel from tertiary public hospitals in Gansu Province for a questionnaire survey.Descriptive analysis were conducted on the collected data.Multivariate lo-gistic regression analysis was used to identify the main influencing factors of job satisfaction among medical staff.The difference is statistically significant with P＜0.05,and the test level is α=0.05.Results 1 890 questionnaires were distributed and 1 885 valid questionnaires were collected,with an effective rate of 99.74％.The overall job satisfaction score of medical staff in tertiary hospitals in Gansu Province is 3.06±0.86,which is at a moderate level.Hospitals can consider improving management models,establishing scientific,reasonable,and humane management systems,enhancing doctors'sense of belonging,and improving sat-isfaction;The satisfaction brought by salary to medical staff is higher than promotion opportunities and career development,indi-cating that a reasonable salary incentive system in hospitals,with excellent performance and compensation,can increase doctors'subjective well-being and improve satisfaction.Optimising the allocation of health human resources and appropriately in creasing personnel allocation based can help improve doctors'job satisfaction.Conclusion The overall job satisfaction of medical staff in tertiary hospitals in Gansu Province is generally satisfactory,and there are statistically significant differences in job satisfaction a-mong medical staff with different work experience,education level and monthly income(P＜0.05).When formulating policies and measures,the government pays attention to factors that affect the job satisfaction of medical personnel,optimizes the alloca-tion of health human resources,continuously improves incentive mechanisms,and improves hospital management models,enhan-cing the job satisfaction of medical staff and laying the foundation for promoting the developmrnt of provincial health talent team.

Immune escape is one of the ten hallmarks of tumors， which plays an important role in the occurrence and development of tumors. Immune escape refers to a process where tumor cells remodel and edit the immune system through the model of immune clearance， immune balance， and immune escape to "transform" the immune cells into immunosuppressive cells in the tumor microenvironment， so as to support immune escape. The five-stage evolution is the summary of tumor pathogenesis by professor LI Jie. He believes that the gradual development of tumors follows the core pathogenesis of "deficiency-cold-toxin-obstruction-collapse"， in which "depression" runs through the whole process， and cancer toxin is the key. Based on immune editing， this paper combined phenotypic characteristics of tumor cells with the core pathogenesis of the five-stage evolution of professor LI to reveal the biological basis of malignant tumor five-stage evolution. The results indicate that the prominent change from deficiency to cold is the reduction of immune surveillance and the prominent change from toxin to obstruction is immune escape. The final stage of collapse is the outcome of immune failure. Depression is the booster of tumor immune editing. Therefore， the method of reinforcing the healthy Qi and removing toxins was proposed to regulate the immune editing and cut off the five-stage evolution of tumors. Supplementing Qi and warming Yang can reinforce the healthy Qi and restore immune surveillance. Removing toxins and dredging can reverse toxins and immune escape. The harmonizing method can maintain the dynamic balance of immune cells/immunosuppressive cells. Resolving depression can truncate tumor immune editing. Those methods can provide a certain reference for the treatment based on microscopic syndrome differentiation in traditional Chinese medicine （TCM）. In future studies， it is necessary to further explore the specific mechanism of the regulation of immune editing with the methods of supplementing Qi and warming Yang， removing toxins and dredging， their combination， and resolving depression， so as to find out specific Chinese medicines and targets and provide more sufficient evidence for the regulation of tumor immune editing by TCM.

Objective:To investigate the effect of flap combined with 3D printed microporous titanium(tantalum)prosthesis in the treatment of lower extremity soft tissue defect with large bone defect.Methods:From January 2019 to December 2020, 2 patients with large soft tissue defects on dorsal foot together with large metatarsal bone defect and 4 patients with soft tissue defects of calf with large tibial bone defect were treated. The areas of soft tissue defect were 5.0 cm×8.0 cm-15.0 cm×10.0 cm. The length of the bone defect were 3.8 cm to 7.0 cm, 5.75 cm in average. In the first stage, metatarsal bone defect or tibial bone defect was filled with vancomycin blended bone cement, meanwhile, soft tissue defect was repaired with anterolateral femoral flap(ALTF) with vascular anastomosis in 2 cases of feet, and local fascia flap was trans-positioned in 4 cases of lower extremity defects. The sizes of repairing flap were 6.0 cm×8.5 cm-16.0 cm×11.0 cm. Two to 7 months after the initial surgery, the customer designed microporous titanium prostheses were used(5 cases with microporous titanium and 1 with microporous tantalum) to repair the bone defects. The wound healing, the integration of metatarsal and tibial fractures with 3D printed microporous titanium(tantalum) prostheses, and the walking condition were observed after surgery. The follow-up lasted from 6 to 25 months, with an average of 12.7 months.Results:The wound healing in 5 patients was good. The patients stood on the foot in 2 months after surgery, started to walk with the assistance of crutch in 3 months after surgery, and took walk without assistance in 5-6 months after surgery. Good osseous integration were achieved. One diabetic patient had infection of foot wound 3 months after surgery. After removal of microporous titanium prosthesis and replacement of vancomycin blended interstitial substance of bone cement, the wound healed and the patient resumed walking.Conclusion:It is an effective method to encourage the patients to take early ambulation after the surgery for lower extremity soft tissue defect with large bone defect that was repaired by a flap and 3D printed microporous titanium(tantalum)prosthesis. Further observations are required to investigate the long-term efficacy, and the reduction of prosthesis infection rate requires further exploration.

Objective: To investigate the early diagnosis and treatment options for steroid-induced osteonecrosis of the femoral head (SONFH). Methods: Retrospective analysis was conducted in 73 patients with unilateral SONFH from January 2010 to June 2017. There were 27 males and 46 females, aged 34.26±10.35 years (range, 20-45 years). The following type of cases were included, 21 cases of ARCO I, 24 cases of IIa, 8 cases of IIb, 18 cases of IIc and 2 cases of IIIa. Patients with ARCO I were limited in weight and were treated with low molecular weight heparin sodium and ginkgo dharma drugs after excluding bleeding risk. Core decompression was performed in patients with ARCO IIa and IIb vascularized greater trochanter bone transfer was conducted in patients with IIc and IIIa. During the follow-up duration, when the ARCO I progressed to ARCO IIa and IIb, the core decompression was performed. When the ARCO IIa and IIb progressed to the ARCO IIc or IIIa, the vascularized greater trochanter bone transfer was conducted. Vascularized greater trochanter bone combined with the tantalum rod was implanted in ARCO IIIb. The femoral head reconstruction with the larger trochanter bone flap or joint replacement was performed in ARCO IIIc and above. The Harris hip score was used to evaluate the clinical outcomes. The femoral head survival curve of SONFH was drawn with the end of joint replacement. Results: All 73 patients were followed up for an average of 29 months (range, 18 to 48 months). After treatment of 21 patients with ARCO I, a total of 14 (67%) patients had no ARCO staging progress. After 6 months, three patients progressed to ARCO IIb and 4 patients progressed to ARCO IIc. All 32 patients with ARCO IIa and IIb were treated, of which 25 (78%) did not progress but 4 patients progressed to ARCO IIIa at 6 months. Only one patient progressed to ARCO IIIb at 6 months, and 2 patient progressed to ARCO IIIc at 12 months. There were 18 patients with ARCO IIc underwent treatment, of which 14 patients (78%) did not progress but 2 patients progressed to ARCO IIIa at 6 months and 2 patients progressed to ARCO IIIc at 24 months and to ARCO IV at 42 months, respectively. Two patients of ARCO IIIa, 1 patient did not progress and the other one progressed to ARCO IV at 36 months. The Harris hip score was 90.48±5.36 before treatment and 91.76±8.19 at the last follow-up. The difference was not statistically significant (t=1.231, P=0.402). The Harris hip score of patients with ARCO IIa and IIb in creased from 75.22±8.30 to 84.47±16.77 with statistically significant difference (t=5.624, P<0.001). The Harris hip score of patients with ARCO IIc and IIIa increased from 59.80±9.24 to 77.75±20.75 with statistically significant difference (t=12.033, P<0.001). Four patients eventually underwent arthroplasty. The femoral head survival rate was 98.6% at 2 years and 94.5% at 4 years. Conclusion The SONFH can be diagnosed early by screening, and is treated by different reserving hip methods according to severe stages. The short-term clinical effects are satisfied.