Debates persist regarding the efficacy and safety of azvudine, particularly its real-world outcomes. This study involved patients aged ≥60 years who were admitted to 25 hospitals in mainland China with confirmed SARS-CoV-2 infection between December 1, 2022, and February 28, 2023. Efficacy outcomes were all-cause mortality during hospitalization, the proportion of patients discharged with recovery, time to nucleic acid-negative conversion (T _NANC), time to symptom improvement (T _SI), and time of hospital stay (T _HS). Safety was also assessed. Among the 5884 participants identified, 1999 received azvudine, and 1999 matched controls were included after exclusion and propensity score matching. Azvudine recipients exhibited lower all-cause mortality compared with controls in the overall population (13.3% vs. 17.1%, RR, 0.78; 95% CI, 0.67-0.90; P = 0.001) and in the severe subgroup (25.7% vs. 33.7%; RR, 0.76; 95% CI, 0.66-0.88; P < 0.001). A higher proportion of patients discharged with recovery, and a shorter T _NANC were associated with azvudine recipients, especially in the severe subgroup. The incidence of adverse events in azvudine recipients was comparable to that in the control group (2.3% vs. 1.7%, P = 0.170). In conclusion, azvudine showed efficacy and safety in older patients hospitalized with COVID-19 during the SARS-CoV-2 omicron wave in China.

Cushing's syndrome(CS),an endocrine disorder resulting from excessive glucocorticoid se-cretion by the adrenal cortex,poses significant challenges to both diagnosis and treatment.The diagnostic process involves comprehensive evaluation,combining laboratory tests and imaging studies for screening,quali-fication,and localization.Surgical intervention remains the primary treatment approach,although pharmacologi-cal therapy also plays a crucial role.With an increasing understanding of the pathogenesis of CS,more potential targets for orphan drug development have been discovered.This article summarizes the current status of diagnosis and treatment for CS and provides an outlook on future research directions.

Objective To study the immunoadjuvant effects of chitosan oligosaccharide(COS),including the immune activation and the triggering of lysosomal escape,and to explore whether COS can be used as an adjuvant for attenuated live bacteria vector vaccines.Methods 1)Mouse macrophages RAW264.7 cells were cultured with COS at 0 mg/mL(the control group)and 0.1-4 mg/mL for 24 h and the effect on cell viability was measured by CCK8 assay.Mouse macrophages RAW264.7 were treated with COS at 0(the control group),1,2,and 4 mg/mL for 24 h.Then,the mRNA expression levels of the cytokines,including IFN-γ,IL-10,TGF-β,and TLR4,were determined by RT-qPCR assay.2)RAW264.7 cells were treated with 1 mL of PBS containing different components,including calcein at 50 μg/mL,COS at 2 mg/mL,and bafilomycin A1,an inhibitor,at 1 μmol/mL,for culturing.The cells were divided into the Calcein group,Calcein+COS group,and Calcein+COS+Bafilomycin A1 group accordingly.Laser scanning confocal microscopy was used to observe the phagocytosis and the intracellular fluorescence distribution of calcein,a fluorescent dye,in RAW264.7 cells in the presence or absence of COS intervention to determine whether COS was able to trigger lysosomal escape.3)LM?E6E7 and LI?E6E7,the attenuated Listeria vector candidate therapeutic vaccines for cervical cancer,were encapsulated with COS at the mass concentrations of 0.5 mg/mL,1 mg/mL,2 mg/mL,4 mg/mL,and 8 mg/mL.Then,the changes in zeta potential were measured to select the concentration of COS that successfully encapsulated the bacteria.Phagocytosis of the vaccine strains by RAW264.7 cells was measured before and after LM?E6E7 and LI?E6E7 were coated with COS at 2 mg/mL.Results 1)CCK8 assays showed that,compared with the findings for the control group,the intervention of RAW264.7 cells with COS at different concentrations for 24 h was not toxic to the cells and promoted cell proliferation,with the difference being statistically significant(P＜0.05).According to the RT-qPCR results,compared with those of the control group,the COS intervention up-regulated the mRNA levels of TLR4 and IFN-γ in RAW264.7 cells,while it inhibited the mRNA expression levels of TGF-β and IL-10,with the most prominent effect being observed in the 4 mg/mL COS group(P＜0.05).2)Laser scanning confocal microscopy revealed that the amount of fluorescent dye released from lysosomes into the cells was greater in the Calcein+COS group than that in the Calcein group.In other words,a greater amount of fluorescent dye was released from lysosomes into the cells under COS intervention.Furthermore,this process could be blocked by bafilomycin A1.3)The zeta potential results showed that COS could successfully encapsulate the surface of bacteria when its mass concentration reached 2 mg/mL.Before and after the vaccine strain was encapsulated by COS,the phagocytosis of LM?E6E7 by RAW264.7 cells was 5.70%and 22.00%,respectively,showing statistically significant differences(P＜0.05);the phagocytosis of LI?E6E7 by RAW264.7 cells was 1.55%and 6.12%,respectively,showing statistically significant differences(P＜0.05).Conclusion COS has the effect of activating the immune response of macrophages and triggering lysosomal escape.The candidates strains of coated live attenuated bacterial vector vaccines can promote the phagocytosis of bacteria by macrophages.Further research is warranted to develop COS into an adjuvant for bacterial vector vaccine.

【Objective】 To explore the chain mediation model of psychological capital and coping efficacy on the relationship between organizational support and competence of university psychological commissioners. 【Methods】 We recruited 366 college psychological commissioners to complete the questionnaire survey regarding organizational support, competence of psychological commissary, psychological capital, and coping efficacy. 【Results】 ① Organizational support was positively correlated with the competence of psychological commissioners (r=0.61, P<0.01), psychological capital (r=0.59, P<0.01), and coping efficacy (r=0.57, P<0.01). The competence of psychological commissioners had a positive correlation with psychological capital (r=0.61, P<0.01) and coping efficacy (r=0.63, P<0.01). There was a positive correlation between psychological capital and coping efficacy (r=0.72, P<0.01). ② Psychological capital and coping efficacy had a chain mediating effect between organizational support and competence of psychological commissioners. The proportion of indirect effect was 43.76%. 【Conclusion】 Organizational support influences the competence of psychological commissioners, which can be predicted via the chain mediating path between psychological capital and coping efficacy.

Objective:To investigate the correlation between enhanced CT features and clinicopathological features of renal clear cell carcinoma.Methods:The clinicopathological data of 33 patients with renal clear cell carcinoma after radical operation in the Third People′s Hospital of Huzhou from January 2015 to January 2019 were analyzed retrospectively.The relationship between enhanced CT signs and pathological features was analyzed by speraman correlation analysis.Results:The pathological findings showed that there were 17 cases of capsule invasion and 16 cases of no capsule invasion, and there were statistically significant differences in lesion diameter, CT enhancement difference and enhancement rate between the two groups[(7.74±1.85)cm vs.(4.15±1.41)cm, (30.19±10.00)HU vs.(48.25±24.12)HU, (70.7±22.6)% vs.(137.0±86.6)%, t=-6.239, 2.841, 3.050, P=0.000, 0.008, 0.005]. There were statistically significant differences in lesion diameter and enhancement rate between patients with vascular tumor thrombus (12 cases) and without vascular tumor thrombus(21 cases)[(7.86±2.35)cm vs.(4.93±1.79)cm, (70.0±19.9)% vs.(121.0±81.7)%, t=-4.025, 2.074, P=0.000, 0.046], but there was no statistically significant difference in CT enhancement difference[(30.78±11.71)HU vs.(43.62±22.63)HU, t=1.823, P=0.078]. Spearman correlation analysis showed that there was a moderate negative correlation between CT enhancement difference and capsule invasion and vascular carcinoma thrombus( r=-0.593, -0.540, P=0.000, 0.001). The diameter of the lesion was positively correlated with capsule invasion( r=0.781, P=0.000). Conclusion:The diameter, CT enhancement difference and enhancement rate of renal clear cell carcinoma are different.The larger the diameter of the lesion and the smaller the enhancement difference indicate the capsule invasion and vascular carcinoma thrombus.

Objective To investigate the effect of combining electroacupuncture with nerve mobilization to improve lower extremity motor function after sciatic nerve injury. And to document any changes in mRNA and protein expression of Ras-related C3 botoxin substrate 1. Methods 180 New Zealand rabbits were randomly divided into a normal control group, a model control group, an electroacupuncture group, a nerve mobilization group, and an elec-troacupuncture combined with nerve mobilization group, each of 36. Sciatic nerve injury was modelled using the clam-ping method in all except the normal control group. The control group had no intervention, while the nerve mobiliza-tion group, the electroacupuncture group and the combined group were treated with nerve mobilization, and/or elec-troacupuncture applied to the rabbit analogue of the jiaji acupoint. After 1, 2, and 4 weeks of treatment, toe reflex scores and modified Tarlov scores were used to assess any functional recovery. After 1, 2, and 4 weeks of treatment, 12 of the rabbits in each group were sacrificed and the sciatic nerve and the L4-L6 segments of the spinal cord were re-sected. The expression of Ras-related C3 botoxin substrate 1 mRNA and protein was detected using the polymerase chain reaction and western blotting. Results Sciatic nerve function and the expression of Ras-related C3 botoxin sub-strate 1 mRNA in the spinal cords and sciatic nerves of the three treatment groups were significantly higher than in the model control group at all three time points, but significantly lower than in the normal control group. The combined group′s results were significantly better than with electroacupuncture or nerve mobilization alone. After 1, 2, and 4 weeks of treatment, the average expression of Ras-related C3 botoxin substrate 1 protein in the spinal cords of the three treatment groups was significantly higher than the model control group′s average, but significantly lower than that of the normal control group at the same time point. After 1 week of treatment the average expression of Ras-related C3 botoxin substrate 1 protein in the spinal cords of the combined group was significantly higher than that in the group receiving electroacupuncture alone. After 2 and 4 weeks it was also significantly higher than the nerve mobilization group′s aver-age. After 1 week of treatment, the average expression of Ras-related C3 botoxin substrate 1 protein in the sciatic nerves of all three treatment groups was significantly lower than that of the control group. However, 1 and 3 weeks later the av-erage protein expression in the sciatic nerves was significantly higher than in the model control group, but significantly lower than in the normal control group at the same time points. The combined group′s average was then significantly higher than those of the groups receiving electroacupuncture or nerve mobilization alone at the same time point. Conclusion Nerve stimulation combined with electroacupuncture applied to the jiaji acupoint can promote the regener-ation of axons after sciatic nerve injury. The mechanism may be related to up-regulation of the Ras-related C3 botoxin substrate 1 gene and protein expression in the injured sciatic nerve and corresponding spinal cord segments.