Objective:To investigate the impact of immunosuppressive therapy on the severity of SARS-CoV-2 infection and cytokine levels in pediatric patients with kidney diseases.Methods:A retrospective analysis was conducted on the clinical data of 40 hospitalized pediatric patients who were diagnosed with SARS-CoV-2 infection at the 900th Hospital of PLA Joint Logistic Support Force from December 2022 to February 2023. Based on their immunosuppressive status prior to SARS-CoV-2 infection, these patients were categorized into immunosuppressive group and non-immunosuppressive group. Independent sample t-tests, Mann-Whitney U tests, and χ2 test were employed to compare the clinical baseline characteristics and laboratory data, the severity of SARS-CoV-2 infection, and the levels of cytokines between the 2 groups. Results:Among the 40 patients, 11 were in the immunosuppressive group (aged 13 (8, 14) years, 9 males and 2 females) and 29 in the non-immunosuppressive group (aged 2 (1, 4) years, 15 males and 14 females). In the immunosuppressive group, 2 were asymptomatic cases, 8 were mild cases, and 1 was moderate case, and there was no severe or critical cases. In the non-immunosuppressive group, 8 were mild cases, 5 were moderate, 15 were severe cases, 1 was critical case, and no asymptomatic cases. The underlying diseases in the immunosuppressive group included nephrotic syndrome (6 cases), IgA vasculitis nephritis (2 cases), lupus nephritis (1 case), post-renal transplantation (1 case), and renal failure (1 case), with a mean total immunosuppression score (TIS) of (3.6±1.4) points. In the non-immunosuppressive group, 2 patients had a history of epilepsy, and the remaining 27 cases had no underlying conditions, all with TIS scores of 0. Compared to the children in the non-immunosuppressive group, those in the immunosuppressive group were more likely to exhibit asymptomatic or mild infection, with lower risks of severe disease, cytokine storm, fever, and cough, but a higher risk of fatigue ( OR=1.22, 2.66, 0.48, 0.12, 0.12, 0.13, 1.22; 95% CI 0.93-1.62, 0.99-7.15, 0.33-0.70, 0.03-0.57, 0.03-0.57, 0.03-0.65, 0.93-1.62; all P<0.05). The levels of cytokine IL-6, interferon-α and interferon-γ in the immunosuppressive group were all lower than those in the non-immunosuppressive group ( Z=2.23, 2.51, 2.92, respectively; all P<0.05). Conclusion:Pediatric patients with kidney diseases receiving appropriate immunosuppressive therapy may mitigate the severity of SARS-CoV-2 infection by suppressing the expression of cytokines.

Objective To analyze the deployment of policy instruments and the distribution of stakeholder engagement in provincial policies on nursing assistant training and management.Methods The relevant policy texts on nursing assistant training and management were systematically searched and collected from the official websites of provincial governments and their direct departments,CNKI,and the PKU Law Database.A two-dimensional framework of policy instruments-stakeholder was constructed,and the content analysis was used to classify,encode and quantify policy clauses.Results The study encompassed 20 provincial-level nursing assistant training and management policies,yielding a total of 359 codes.Within the policy instruments dimension,environmental,supply,and demand instruments constituted 66.30％,28.97％,and 4.74％,respectively.In terms of stakeholders,the management-side accounted for 56.55％,providers and trainers for 18.11％each,partners for 5.01％,and demand-side for 2.23％.Both management-side and trainers engaged with 3 policy instruments,providers with 2,and partners and demand-side with one each.Conclusion In the provincial nursing assistant training and management policies,there are differences in the deployment of policy instruments,and the distribution of stakeholders is uneven.Managers should pay attention to publicity guidance and platform construction,improve incentive mechanisms and training programs,and innovate cooperation models with stakeholders,as well as strengthen communication and exchange.

Objective To systematically evaluate the influencing factors for antiretroviral therapy(ART)discontinuation in Chinese human immunodeficiency virus(HIV)/acquired immuno deficiency syn-drome(AIDS)patients.Methods A computer-based search was conducted in PubMed,Web of Science,Em-base,The Cochrane Library,CNKI,Wanfang,VIP,and China Biology Medicine(CBM)databases for studies on influencing factors of ART discontinuation in Chinese HIV/AIDS patients from the establishment of the databases to August 2024.Meta-analysis was performed on the included studies by using Stata16.0.Results A total of 17 studies were included.Meta-analysis showed that the following factors were associated with ART discontinuation:male gender(OR=1.301,95%CI:1.099-1.540),age≥50 years(OR=1.212,95%CI:1.109-1.324),unmarried/divorced/widowed marital status(OR=1.198,95%CI:1.060-1.354),education level was or below senior high school(OR=1.778,95%CI:1.508-2.096),infection route was in-travenous drug use(OR=2.420,95%CI:1.989-2.945),baseline CD4 cell count>500 cells/μL(OR=1.157,95%CI:1.020-1.313),tuberculosis co-infection before ART(OR=1.559,95%CI:1.398-1.739),hepatitis B co-infection before ART(OR=1.554,95%CI:1.305-1.851),AIDS-related symptoms occur be-fore ART(OR=1.245,95%CI:1.148-1.351),time from diagnosis to treatment initiation≥365 days(OR=1.449,95%CI:1.301-1.615),initial treatment regimen containing zidovudine(OR=1.573,95%CI:1.206-2.052),treatment at county-level or lower institutions(OR=1.204,95%CI:1.153-1.257),exist drug adverse reactions(OR=7.043,95%CI:3.142-15.786),and compliance education(OR=0.182,95%CI:0.094-0.352).Conclusion There are multiple factors influencing ART discontinuation in Chinese HIV/AIDS patients.Early identification of individuals at risk of discontinuation and targeted interventions are nec-essary to promote their maintenance of ART.

Osteoradionecrosis of the jaws (ORNJ) is among the most severe oral complications following radiotherapy for head and neck tumors. It is essentially a form of pathological necrosis of the jawbone induced by radiation therapy. ORNJ is defined as bone damage, primarily characterized by inflammation and necrosis, occurring in the jawbone within the irradiated area and accompanied by soft tissue injury, persisting for more than 3 months without spontaneous healing. Diagnosis requires exclusion of other potential etiologies, including primary tumor recurrence, medication-related osteonecrosis, and radiation-induced neoplasms of the jawbone, etc. In this review, recent advances in the epidemiology, risk factors, diagnosis, classification and staging, dosimetric parameters, pathogenesis, treatment, and prevention of radiation-induced osteonecrosis of the jaws were summarized.

Objective To investigate the expression of Excision repair cross-complementation group 6-like(ERCC6L)in non-small cell lung cancer(NSCLC),and evaluate its prognostic value.Methods From September 2016 to 2019,144 cases of NSCLC tissues and adjacent tissues(non-tumor tissues at least 5 cm away from cancerous tissues)were admitted.The expression of ERCC6L protein in NSCLC tissues and their adjacent tissues were detected using immunohistochemistry(IHC)method.The clinicopathological data of patients with high and low expression of ERCC6L were compared,and the Kaplan-Meier curves and Cox proportional hazards regression model were used to evaluate the relationship between ERCC6L expression and overall survival(OS)of NSCLC patients.Results The data of IHC staining showed that high expression of ERCC6L was detected in 42.4％(61/144)of NSCLC tissues,which was higher than in their adjacent tissues(37.7,％,37/144)(x2=8.909,P＜0.05).High expression of ERCC6L was frequently detected in poorly differentiated carcinoma(x2=38.660,P＜0.001),T2/T3 stage(x2=6.528,P=0.011)and TNM stage Ⅲ(x2=12.522,P＜0.05).In addition,patients with high expression of ERCC6L had higher rates of lymph node metastasis(x2=5.802,P＜0.05),lymphovascular invasion(x2=29.899,P＜0.05)and pleural invasion(x2=7.942,P＜0.05)than those with low expression(P＜0.05).Survival analysis revealed that patients with high expression of ERCC6L had a worse prognosis than those with low expression,and the 5-year overall survival(OS)rate of two patient groups was 44.8％and 70.5％,respectively(x2=15.919,P＜0.05).Univariate and multivariate Cox regression analysis demonstrated that high expression of ERCC6L(HR=2.106,95％CI=1.087-4.079,P＜0.05)was an independent prognostic factor for NSCLC patients.Conclusion High expression of ERCC6L is closely correlated to tumor aggressive features,and it might be a valuable prognostic biomarker for NSCLC patients.

Objective To investigate the expression of Excision repair cross-complementation group 6-like(ERCC6L)in non-small cell lung cancer(NSCLC),and evaluate its prognostic value.Methods From September 2016 to 2019,144 cases of NSCLC tissues and adjacent tissues(non-tumor tissues at least 5 cm away from cancerous tissues)were admitted.The expression of ERCC6L protein in NSCLC tissues and their adjacent tissues were detected using immunohistochemistry(IHC)method.The clinicopathological data of patients with high and low expression of ERCC6L were compared,and the Kaplan-Meier curves and Cox proportional hazards regression model were used to evaluate the relationship between ERCC6L expression and overall survival(OS)of NSCLC patients.Results The data of IHC staining showed that high expression of ERCC6L was detected in 42.4％(61/144)of NSCLC tissues,which was higher than in their adjacent tissues(37.7,％,37/144)(x2=8.909,P＜0.05).High expression of ERCC6L was frequently detected in poorly differentiated carcinoma(x2=38.660,P＜0.001),T2/T3 stage(x2=6.528,P=0.011)and TNM stage Ⅲ(x2=12.522,P＜0.05).In addition,patients with high expression of ERCC6L had higher rates of lymph node metastasis(x2=5.802,P＜0.05),lymphovascular invasion(x2=29.899,P＜0.05)and pleural invasion(x2=7.942,P＜0.05)than those with low expression(P＜0.05).Survival analysis revealed that patients with high expression of ERCC6L had a worse prognosis than those with low expression,and the 5-year overall survival(OS)rate of two patient groups was 44.8％and 70.5％,respectively(x2=15.919,P＜0.05).Univariate and multivariate Cox regression analysis demonstrated that high expression of ERCC6L(HR=2.106,95％CI=1.087-4.079,P＜0.05)was an independent prognostic factor for NSCLC patients.Conclusion High expression of ERCC6L is closely correlated to tumor aggressive features,and it might be a valuable prognostic biomarker for NSCLC patients.

Objective To analyze the deployment of policy instruments and the distribution of stakeholder engagement in provincial policies on nursing assistant training and management.Methods The relevant policy texts on nursing assistant training and management were systematically searched and collected from the official websites of provincial governments and their direct departments,CNKI,and the PKU Law Database.A two-dimensional framework of policy instruments-stakeholder was constructed,and the content analysis was used to classify,encode and quantify policy clauses.Results The study encompassed 20 provincial-level nursing assistant training and management policies,yielding a total of 359 codes.Within the policy instruments dimension,environmental,supply,and demand instruments constituted 66.30％,28.97％,and 4.74％,respectively.In terms of stakeholders,the management-side accounted for 56.55％,providers and trainers for 18.11％each,partners for 5.01％,and demand-side for 2.23％.Both management-side and trainers engaged with 3 policy instruments,providers with 2,and partners and demand-side with one each.Conclusion In the provincial nursing assistant training and management policies,there are differences in the deployment of policy instruments,and the distribution of stakeholders is uneven.Managers should pay attention to publicity guidance and platform construction,improve incentive mechanisms and training programs,and innovate cooperation models with stakeholders,as well as strengthen communication and exchange.

Objective:To investigate the impact of immunosuppressive therapy on the severity of SARS-CoV-2 infection and cytokine levels in pediatric patients with kidney diseases.Methods:A retrospective analysis was conducted on the clinical data of 40 hospitalized pediatric patients who were diagnosed with SARS-CoV-2 infection at the 900th Hospital of PLA Joint Logistic Support Force from December 2022 to February 2023. Based on their immunosuppressive status prior to SARS-CoV-2 infection, these patients were categorized into immunosuppressive group and non-immunosuppressive group. Independent sample t-tests, Mann-Whitney U tests, and χ2 test were employed to compare the clinical baseline characteristics and laboratory data, the severity of SARS-CoV-2 infection, and the levels of cytokines between the 2 groups. Results:Among the 40 patients, 11 were in the immunosuppressive group (aged 13 (8, 14) years, 9 males and 2 females) and 29 in the non-immunosuppressive group (aged 2 (1, 4) years, 15 males and 14 females). In the immunosuppressive group, 2 were asymptomatic cases, 8 were mild cases, and 1 was moderate case, and there was no severe or critical cases. In the non-immunosuppressive group, 8 were mild cases, 5 were moderate, 15 were severe cases, 1 was critical case, and no asymptomatic cases. The underlying diseases in the immunosuppressive group included nephrotic syndrome (6 cases), IgA vasculitis nephritis (2 cases), lupus nephritis (1 case), post-renal transplantation (1 case), and renal failure (1 case), with a mean total immunosuppression score (TIS) of (3.6±1.4) points. In the non-immunosuppressive group, 2 patients had a history of epilepsy, and the remaining 27 cases had no underlying conditions, all with TIS scores of 0. Compared to the children in the non-immunosuppressive group, those in the immunosuppressive group were more likely to exhibit asymptomatic or mild infection, with lower risks of severe disease, cytokine storm, fever, and cough, but a higher risk of fatigue ( OR=1.22, 2.66, 0.48, 0.12, 0.12, 0.13, 1.22; 95% CI 0.93-1.62, 0.99-7.15, 0.33-0.70, 0.03-0.57, 0.03-0.57, 0.03-0.65, 0.93-1.62; all P<0.05). The levels of cytokine IL-6, interferon-α and interferon-γ in the immunosuppressive group were all lower than those in the non-immunosuppressive group ( Z=2.23, 2.51, 2.92, respectively; all P<0.05). Conclusion:Pediatric patients with kidney diseases receiving appropriate immunosuppressive therapy may mitigate the severity of SARS-CoV-2 infection by suppressing the expression of cytokines.

Osteoradionecrosis of the jaws (ORNJ) is among the most severe oral complications following radiotherapy for head and neck tumors. It is essentially a form of pathological necrosis of the jawbone induced by radiation therapy. ORNJ is defined as bone damage, primarily characterized by inflammation and necrosis, occurring in the jawbone within the irradiated area and accompanied by soft tissue injury, persisting for more than 3 months without spontaneous healing. Diagnosis requires exclusion of other potential etiologies, including primary tumor recurrence, medication-related osteonecrosis, and radiation-induced neoplasms of the jawbone, etc. In this review, recent advances in the epidemiology, risk factors, diagnosis, classification and staging, dosimetric parameters, pathogenesis, treatment, and prevention of radiation-induced osteonecrosis of the jaws were summarized.

Objective:To explore the effects of simulated microgravity on carotid oxidative stress and anti-oxidative stress in rats by using a rat tail-suspension model to simulate the hemodynamic changes caused by microgravity.Methods:Twelve healthy adult male Sprague-Dawley rats were completely randomized into control group and simulated suspension group, with 6 rats in each group. The rats in control group were fed in standard laboratory environment and could move freely. The feeding environment of the simulated suspension group rats was the same as that of the control group, and the tail suspension was maintained for 4 weeks. The differentially expressed genes in carotid tissue were obtained by transcriptome sequencing, and analyzed by volcano plot, Venn diagram and heatmap. The differentially expressed genes were further analyzed by Gene Ontology and the Kyoto encyclopedia of genes and genomes. Dihydroethidium staining was used to detect the content of reactive oxygen species in rat carotid artery. Western blotting was used to detect the expression changes of pro-oxidative stress factor nicotinamide adenine dinucleotide phosphate oxidase 4 and anti-oxidative stress factors Kelch-like ECH-associated protein-1, nuclear factor-E2 related factor 2, heme oxygenase-1, and nicotinamide adenine dinucleotide phosphate quinone oxidoreductase-1 in each group. The contents/activities of malondialdehyde, superoxide dismutase, catalase, reduced glutathione and oxidized glutathione in each group were detected using the thiobarbituric acid method, 4-[2-(2-methoxy-4-nitrophenyl)-3-(4-nitrophenyl)tetrazol-2-ium-5-yl]benzene-1,3-disulfonate sodium method and colorimetry.Results:Compared with the rats in control group, the wet weight of soleus muscle and the ratio of the wet weight of soleus muscle to body weight in simulated suspension group rats were decreased ( t=19.98, 17.34, both P<0.001), and the differences were significant. Eighty differentially expressed genes related to oxidative stress were screened by transcriptional sequencing (52 up-regulated and 28 down-regulated), which were closely related to vascular remodeling pathways, including cyclic guanosine monophosphate-protein kinase G signal pathway, mitogen-activated protein kinase signal pathway, phosphoinositide 3-kinase-Akt signal pathway, protein processing in endoplasmic reticulum and lipid metabolism and atherosclerosis-related signal pathways. These genes were mainly involved in response to antioxidant defense, chaperone-mediated autophagy, stress fiber, contractile actin filament bundle, actin filament bundle, growth factor activity, chaperone binding and cytokine activity. Compared with the control group, the levels of reactive oxygen species ( t=3.83, P=0.028) and malondialdehyde ( t=8.75, P<0.001) in the simulated suspension group were significantly increased. The protein expression of nicotinamide adenine dinucleotide phosphate oxidase 4 ( t=11.49 , P<0.001) was significantly increased, with statistical significance. The activities of antioxidant stress related factors superoxide dismutase ( t=6.44, P=0.001), catalase ( t=6.83, P=0.001), and the ratio of reduced glutathione to oxidized glutathione ( t=3.46, P=0.003), and nuclear factor-E2 related factor 2 ( t=28.18, P<0.001), heme oxygenase-1 ( t=8.03, P<0.001), and nicotinamide adenine dinucleotide phosphate quinone oxidoreductase-1 ( t=9.71, P<0.001) were significantly decreased, the protein expression of Kelch-like ECH-associated protein-1 ( t=5.06, P<0.001) was increased, and the differences were statistically significant. Conclusions:Simulated microgravity can enhance the level of carotid oxidative stress in rats, including promoting the expression of pro-oxidative stress-related factors and suppressing the activity of anti-oxidative stress pathways. Their combined action will lead to the oxidative stress injury of carotid arteries. This process may be one of the key mechanisms involved in the remodeling of arterial structure and function induced by simulated microgravity.