Gut microbial communities are likely remodeled in tandem with accumulated physiological decline during aging, yet there is limited understanding of gut microbiome variation in advanced age. Here, we performed a metagenomics-based enterotype analysis in a geographically homogeneous cohort of 367 enrolled Chinese individuals between the ages of 60 and 94 years, with the goal of characterizing the gut microbiome of elderly individuals and identifying factors linked to enterotype variations. In addition to two adult-like enterotypes dominated by Bacteroides (ET-Bacteroides) and Prevotella (ET-Prevotella), we identified a novel enterotype dominated by Escherichia (ET-Escherichia), whose prevalence increased in advanced age. Our data demonstrated that age explained more of the variance in the gut microbiome than previously identified factors such as type 2 diabetes mellitus (T2DM) or diet. We characterized the distinct taxonomic and functional profiles of ET-Escherichia, and found the strongest cohesion and highest robustness of the microbial co-occurrence network in this enterotype, as well as the lowest species diversity. In addition, we carried out a series of correlation analyses and co-abundance network analyses, which showed that several factors were likely linked to the overabundance of Escherichia members, including advanced age, vegetable intake, and fruit intake. Overall, our data revealed an enterotype variation characterized by Escherichia enrichment in the elderly population. Considering the different age distribution of each enterotype, these findings provide new insights into the changes that occur in the gut microbiome with age and highlight the importance of microbiome-based stratification of elderly individuals.
Aged ; Aged, 80 and over ; Female ; Humans ; Male ; Middle Aged ; Bacteroides ; China ; Diabetes Mellitus, Type 2/microbiology* ; Escherichia coli/classification* ; Gastrointestinal Microbiome/genetics* ; Metagenomics ; East Asian People

Surgical resection is an important method for treating liver cancer,and postoperative liver failure caused by insufficient liver remnant volume is a key factor limiting the success rate of surgical resection.The portal vein embolization(PVE),through artificially obstructing the portal vein,can induce liver volume enlargement,thus,providing theoretical support for preventing postoperative death due to liver failure.In recent years,many innovations and studies on the limitations of PVE,especially on the problem of postoperative insufficient growth rate of liver tissues,have been made by experts both at home and abroad.In view of this,this paper,through summarizing the relevant literature on PVE,makes a detailed review concerning the clinical application and research progress of PVE.

Objective:To construct a debriefing and reflection training program for nursing undergraduate interns, and to provide a basis for implementing such a program and improve the practical clinical skills of the interns.Methods:Based on competency theory, the draft of the debriefing and reflection training program for undergraduate nursing interns was constructed through literature review and expert conference discussion. Delphi expert consultation was conducted from August to October 2024, and the final version of the program was established based on the experts' opinions. The weight of each indicator was determined using the analytic hierarchy process. Excel 2019 was used for data entry, and SPSS 19.0 was used for data analysis.Results:Two rounds of expert consultation were conducted, with a questionnaire recovery rate of 100.00% for both. The experts consulted in the second round had an authority coefficient of 0.861, a coefficient of variation for each index of 0.048 to 0.237, and a Kendall's concordance coefficient of 0.137 ( P<0.05). The final program included 5 primary indicators, 16 secondary indicators, and 73 tertiary indicators. Conclusions:The debriefing and reflection training program for undergraduate nursing interns proposed in this study has high scientifical validity and reliability. It can provide a reference for debriefing and reflection training of nursing undergraduate interns in China, thereby cultivating qualified clinical nursing talents.

Objective: To investigate the differential expression of Yes-associated protein(YAP) in the healthy control group and in patients with rheumatoid arthritis(RA), and to explore its correlation with the progression of the disease. Methods: Three cases each of synovial membranes from the healthy control group and RA group were selected for RNA-sequence detection to identify differentially expressed genes. Data and laboratory indicators from 50 healthy control cases and 150 RA patients who met the criteria were collected. ELISA was used to detect the expression of YAP in the serum of each group, and then its correlation with other laboratory indicators in RA patients was analyzed. The receiver operating characteristic curve was applied to explore the diagnostic efficacy of the related risk factors for RA. Results: Expression of 14-3-3-gama, which regulated the disease process, was significantly down-regulated in the synovial membranes of RA patients compared to normal synovial membranes; YAP expression was significantly up-regulated in rheumatoid arthritis fibroblast-like synoviocytes compared to healthy controls and was correlated with haematological sedimentation, C-reactive protein, interleukin(IL)-1, IL-4, IL-6, IL-10, rheumatoid factor, anti-cyclic citrullinated polypeptide antibody, interferon alpha, tumour necrosis factor alpha, protein electrophoresis α1 globulin, protein electrophoresis alpha2 globulin, disease activity scores, disease activity index, and patient-reported outcome had correlations(P0.05); multifactor Logistic regression analysis showed that YAP expression was an independent influencing factor for the prognosis of RA patient. Conclusion YAP is differentially expressed between the healthy control group and RA group, which shows a significant positive correlation with the disease activity of RA, potentially becoming a new target for clinical treatment of RA.

Objective To conduct a scope review of the factors that influence the occupational grief in nurses in order to provide a reference for future interventional research on the occupational grief in nurses.Methods Based on the framework of scope review report,a systematic search was conducted across multiple databases,including China National Knowledge Infrastructure(CNKI),Wanfang Data,VIP,SinoMed,Cochrane Library,Embase,Scopus,PubMed,Web of Science and EBSCO,for relevant literature published from the inception of databases to 8th April,2025(updated after revision).The retrieved literature was screened,evaluated,analysed and summarised.Results A total of 12 articles were included in the study.The factors that influenced occupational grief of nurses were identified in seven dimensions:demographics,personal experience,psychological state,education and training,patient-related factors,career environment and supporting factors.The identified dimensions comprised a total of 27 influencing factors.Conclusion Occupational grief among nurses is common.Grief is influenced by multiple factors,including demographics,personal experience,psychological state,educational background,patient-related factors,career environment and supporting systems.Nurses and nursing administrators should attach great importance to occupational grief,identify the adverse emotions early,and provide effective intervention strategies in a timely manner.

Objective:To construct a debriefing and reflection training program for nursing undergraduate interns, and to provide a basis for implementing such a program and improve the practical clinical skills of the interns.Methods:Based on competency theory, the draft of the debriefing and reflection training program for undergraduate nursing interns was constructed through literature review and expert conference discussion. Delphi expert consultation was conducted from August to October 2024, and the final version of the program was established based on the experts' opinions. The weight of each indicator was determined using the analytic hierarchy process. Excel 2019 was used for data entry, and SPSS 19.0 was used for data analysis.Results:Two rounds of expert consultation were conducted, with a questionnaire recovery rate of 100.00% for both. The experts consulted in the second round had an authority coefficient of 0.861, a coefficient of variation for each index of 0.048 to 0.237, and a Kendall's concordance coefficient of 0.137 ( P<0.05). The final program included 5 primary indicators, 16 secondary indicators, and 73 tertiary indicators. Conclusions:The debriefing and reflection training program for undergraduate nursing interns proposed in this study has high scientifical validity and reliability. It can provide a reference for debriefing and reflection training of nursing undergraduate interns in China, thereby cultivating qualified clinical nursing talents.

Objective To conduct a scope review of the factors that influence the occupational grief in nurses in order to provide a reference for future interventional research on the occupational grief in nurses.Methods Based on the framework of scope review report,a systematic search was conducted across multiple databases,including China National Knowledge Infrastructure(CNKI),Wanfang Data,VIP,SinoMed,Cochrane Library,Embase,Scopus,PubMed,Web of Science and EBSCO,for relevant literature published from the inception of databases to 8th April,2025(updated after revision).The retrieved literature was screened,evaluated,analysed and summarised.Results A total of 12 articles were included in the study.The factors that influenced occupational grief of nurses were identified in seven dimensions:demographics,personal experience,psychological state,education and training,patient-related factors,career environment and supporting factors.The identified dimensions comprised a total of 27 influencing factors.Conclusion Occupational grief among nurses is common.Grief is influenced by multiple factors,including demographics,personal experience,psychological state,educational background,patient-related factors,career environment and supporting systems.Nurses and nursing administrators should attach great importance to occupational grief,identify the adverse emotions early,and provide effective intervention strategies in a timely manner.

Objective:To investigate the diagnostic value of nucleic acid matrix-assisted laser desorption ionization-time of flight mass spectrometry（MALDI-TOF MS）in sputum smear-negative patients with nontuberculous Mycobacterial（NTM）pulmonary disease.Methods:Clinical data of 123 patients suspected of NTM pulmonary disease admitted in Public Health Clinical Center Affiliated to Shandong University between July 2022 and November 2023 were retrospectively analyzed. Bronchoalveolar lavage fluid（BALF）specimens were collected for MALDI-TOF MS assay and MGIT 960 culture. The diagnostic efficacy of MALDI-TOF MS for NTM pulmonary disease in patients with negative sputum smears for acid-fast bacilli was evaluated with receiver operating characteristic（ROC）curve. Statistical analysis was performed using SPSS 26.0 software and MedCalc statistical software.Results:Diagnosis of NTM pulmonary disease was finally confirmed in 66 out of the 123 suspected patients. It took 8 to 24 h for MALDI-TOF MS to identify NTM species and resistance. By MALDI-TOF MS，72 NTM strains were identified，with the Mycobacterium avium complex being the most prevalent（34 strains，47.22%），followed by the Mycobacterium abscessus complex（13 strains，18.06%）；resistance to macrolides was detected in 6 cases，while no resistance to aminoglycosides was found. It took 9 to 45 days for BALF MGIT 960 culture to identify NTM，and took 7 to 15 days for NTM typing and drug sensitivity testing. By BALF MGIT 960 culture，28 NTM strains were identified；and 1 case was found to be resistant to macrolides. Using confirmed diagnosis as the gold standard，MALDI-TOF MS demonstrated higher sensitivity，negative predictive value，and agreement rate compared to MGIT 960 culture（84.85% vs. 42.42%，81.13% vs. 56.32%，80.49% vs. 62.60%， χ2=25.667，8.998，9.664， P<0.05 or <0.01）. The area under ROC curve（AUC）for MALDI-TOF MS was significantly higher than that of MGIT 960 culture（0.801 vs. 0.642， Z=3.300， P=0.001）. Conclusion:Compared to MGIT 960 culture，MALDI-TOF MS exhibits superior diagnostic efficiency in detecting NTM pulmonary disease in patients with acid-fast bacilli smear-negative sputum，with advantage of rapidly identifying NTM species and resistance.

Objective:To retrospectively analyze the clinical phenotype and pathogenic variants in patients with Progressive myoclonus epilepsy (PME).Methods:Clinical data and results of genetic testing for 11 patients diagnosed with PME at the Department of Neurology, the First Affiliated Hospital of Zhejiang University School of Medicine from June 2017 to December 2022 were collected and analyzed.Results:All of the patients, including 4 males and 7 females, had predominant action myoclonus. Three patients had myoclonus as the initial manifestation, whilst eight were diagnosed through genetic testing, including three cases with NEU1 gene variants, two with EPM2A gene variants (1 was novel), one with MT- TK gene variant, one with ATN1 gene variant, and one with CSTB gene variant. No pathogenic variant was identified in the remaining three cases. Among the eight patients with a genetic diagnosis, three were diagnosed with sialidosis, two with Lafora disease, one with Dentatorubral-pallidoluysian atrophy (DRPLA), one with Unverricht-Lundborg disease (ULD), and one with Myoclonic epilepsy with ragging red fibers (MERRF). Conclusion:Compared with pediatric patients, adult patients with PME represent a distinct subtype with slower progression and milder cognitive impairment.

Objective To investigate the effect of a three-tier delirium care management process in patients with acute stroke in neurology intensive care unit(NICU).Methods A total of 50 patients with acute stroke admitted to the NICU of the Fourth Hospital of Changsha from May to September 2021 were assigned to the control group.The patients in the control group received routine NICU nursing care to prevent delirium.Another 50 patients with acute stroke admitted to the NICU from December 2021 to April 2022 were assigned to the trial group.They were managed with the three-tier delirium nursing management process on top of the routine NICU nursing care for the control group.The incidence of ICU delirium(DICU),duration of DICU,length of stay in NICU and the incidence of delirium-related adverse events were compared between the two groups.The degree of delirium and cognitive function before and after the intervention were compared between the two groups as well.Results The trial group had significantly shorter duration of DICU and NICU stay(both P<0.05)and lower incidence rate of delirium-related adverse events(P<0.05)compared to the control group.After the intervention,the trial group showed significantly lower scores on the intensive care delirium screening checklist(ICDSC)and significantly higher scores of cognitive function compared to those of the control group(both P<0.05).Conclusion The three-tier delirium nursing management process can lower the occurrence of delirium in NICU patients with acute stroke,shorten the NICU stay,reduce the safety risk in nursing,and improve the cognitive function.