Objective:To investigate the effects of early enteral and parenteral nutrition support on the growth, development, and metabolomics of low-birth-weight newborns.Methods:Ninety low-birth-weight newborns admitted to Hangzhou Maternity and Child Health Care Hospital from April 2022 to April 2024 were included in this retrospective study. They were randomly divided into a control group ( n = 45) and an intervention group ( n = 45) according to different intervention methods. The control group received routine traditional nutritional support, while the intervention group received early enteral and parenteral nutrition support. Data were collected on the growth and development status of the newborns, as well as their feeding conditions. Gastric fluid pH value, frequency of bowel sounds, and level of direct bilirubin were recorded. Physical condition was also assessed. The Neonatal Behavioral Neurological Assessment (NBNA) was used to evaluate the neurobehavioral status of the newborns. Additionally, the incidence of complications was recorded for both groups, and metabolomic changes were analyzed. Results:After intervention, the control group exhibited a time to regain birth weight of (20.67 ± 8.31) days, a time to reach a body weight of 2.0 kg of (53.57 ± 12.51) days, a lowest recorded body weight of (1.32 ± 0.21) kg, a body weight loss percentage of (12.31 ± 5.52)%, and a body weight gain of (15.02 ± 2.30) g/(kg/d). In contrast, the intervention group demonstrated a time to regain birth weight of (14.31 ± 5.62) days, a time to reach a body weight of 2.0 kg of (39.21 ± 9.32) days, a lowest recorded body weight of (1.01 ± 0.17) kg, a body weight loss percentage of (7.84 ± 4.92)%, and a body weight gain of (17.74 ± 3.94) g·kg?1·d?1. All differences between the two groups were statistically significant ( t = 4.28, 9.96, 7.69, 4.05, 4.11, all P < 0.001). The difference in the lowest body weight day between the two groups of children was not statistically significant ( P > 0.05). After intervention, the control group had an initial oral feeding duration of (8.30 ± 1.37) days, with a vomiting frequency of (10.25 ± 2.20) times, a daily milk intake of (35.38 ± 3.94) mL, a gastric fluid pH value of (3.85 ± 0.20), bowel sounds of (4.94 ± 0.97) times/minute, and a direct bilirubin level of (41.98 ± 25.76) mmol/L. In contrast, the intervention group showed an initial oral feeding duration of (4.01 ± 0.76) days, a vomiting frequency of (5.61 ± 1.24) times, a daily milk intake of (43.54 ± 4.07) mL, a gastric fluid pH value of (3.41 ± 0.12), bowel sounds of (5.86 ± 1.11) times/minute, and a direct bilirubin level of (28.98 ± 18.10) mmol/L. The differences between the two groups were statistically significant ( t = 18.36, 12.32, 9.66, 12.65, 4.18, 2.77, all P < 0.05). After intervention, the control group had a body length of (40.32 ± 1.84) cm, a body weight of (1.47 ± 0.55) kg, and a head circumference of (29.21 ± 1.07) cm. The intervention group had a body length of (45.00 ± 2.16) cm, a body weight of (1.83 ± 1.03) kg, and a head circumference of (30.14 ± 1.35) cm. The differences between the two groups were statistically significant ( t = 11.06, 2.06, 3.62, all P < 0.05). At 40 weeks of corrected gestational age post-intervention, the control group had a NBNA score of (30.11 ± 2.41), whereas the intervention group had an NBNA score of (34.52 ± 2.82). The difference between the two groups was statistically significant ( t = 7.97, P < 0.05). The number of patients experiencing common complications in the intervention group was lower than that in the control group [8 (17.78%) vs. 28 (62.22%), χ2 = 18.51, P < 0.05]. The control group had glycine levels of (94.07 ± 19.78) μmol/L, valine levels of (99.53 ± 13.42) μmol/L, homocysteine levels of (10.87 ± 4.43) μmol/L, cystatin levels of (233.71 ± 35.02) μmol/L, and methionine levels of (20.54 ± 4.67) μmol/L. The intervention group had glycine levels of (79.21 ± 17.54) μmol/L,valine levels of (88.70 ± 12.96) μmol/L, homocysteine levels of (13.68 ± 7.66) μmol/L, cystatin levels of (256.54 ± 35.49) μmol/L, and methionine levels of (22.97 ± 5.49) μmol/L. The differences between the two groups were statistically significant ( t = 3.77, 3.89, 2.13, 3.07, 2.26, all P < 0.05). Conclusions:Early enteral and parenteral nutritional support for low-birth-weight infants can restore their growth and development status, improve feeding conditions, enhance gastrointestinal function, and improve levels of metabolomic-related indicators.

Objective To conduct a multidimensional and multi-level evaluation of the comprehensive clinical value of empagliflozin in the treatment of type 2 diabetes mellitus.Methods Based on the National Essential Medicines List(2018 Edition),dapagliflozin was selected as the control.A comprehensive clinical evaluation index system was established through literature review,focus group interviews and in-depth expert interviews,encompassing six dimensions:safety,efficacy,economy,suitability,innovation,and accessibility.The Delphi method and hierarchical direct weighting method were used to screen indicators and determine their weights.Evidence for each indicator was collected and integrated both qualitatively and quantitatively through literature research,real-world studies,and pharmacoeconomic evaluations.Experts scored the indicators based on the collected evidence,and a total score for the comprehensive clinical evaluation of empagliflozin was calculated by combining these scores with indicator weights,followed by a comparative analysis with dapagliflozin.Results A comprehensive clinical evaluation of empagliflozin in the treatment of type 2 diabetes mellitus was successfully established,consisting of 6 primary indicators,14 secondary indicators,and 41 tertiary indicators.The overall evaluation score for empagliflozin was 90.35,and 89.47 for dapagliflozin.Conclusion The comprehensive clinical value of empagliflozin in the treatment of type 2 diabetes mellitus is slightly higher than that of dapagliflozin.This finding can serve as a reference for rational clinical drug use and related decision-making.

Objective:To investigate the effects of early enteral and parenteral nutrition support on the growth, development, and metabolomics of low-birth-weight newborns.Methods:Ninety low-birth-weight newborns admitted to Hangzhou Maternity and Child Health Care Hospital from April 2022 to April 2024 were included in this retrospective study. They were randomly divided into a control group ( n = 45) and an intervention group ( n = 45) according to different intervention methods. The control group received routine traditional nutritional support, while the intervention group received early enteral and parenteral nutrition support. Data were collected on the growth and development status of the newborns, as well as their feeding conditions. Gastric fluid pH value, frequency of bowel sounds, and level of direct bilirubin were recorded. Physical condition was also assessed. The Neonatal Behavioral Neurological Assessment (NBNA) was used to evaluate the neurobehavioral status of the newborns. Additionally, the incidence of complications was recorded for both groups, and metabolomic changes were analyzed. Results:After intervention, the control group exhibited a time to regain birth weight of (20.67 ± 8.31) days, a time to reach a body weight of 2.0 kg of (53.57 ± 12.51) days, a lowest recorded body weight of (1.32 ± 0.21) kg, a body weight loss percentage of (12.31 ± 5.52)%, and a body weight gain of (15.02 ± 2.30) g/(kg/d). In contrast, the intervention group demonstrated a time to regain birth weight of (14.31 ± 5.62) days, a time to reach a body weight of 2.0 kg of (39.21 ± 9.32) days, a lowest recorded body weight of (1.01 ± 0.17) kg, a body weight loss percentage of (7.84 ± 4.92)%, and a body weight gain of (17.74 ± 3.94) g·kg?1·d?1. All differences between the two groups were statistically significant ( t = 4.28, 9.96, 7.69, 4.05, 4.11, all P < 0.001). The difference in the lowest body weight day between the two groups of children was not statistically significant ( P > 0.05). After intervention, the control group had an initial oral feeding duration of (8.30 ± 1.37) days, with a vomiting frequency of (10.25 ± 2.20) times, a daily milk intake of (35.38 ± 3.94) mL, a gastric fluid pH value of (3.85 ± 0.20), bowel sounds of (4.94 ± 0.97) times/minute, and a direct bilirubin level of (41.98 ± 25.76) mmol/L. In contrast, the intervention group showed an initial oral feeding duration of (4.01 ± 0.76) days, a vomiting frequency of (5.61 ± 1.24) times, a daily milk intake of (43.54 ± 4.07) mL, a gastric fluid pH value of (3.41 ± 0.12), bowel sounds of (5.86 ± 1.11) times/minute, and a direct bilirubin level of (28.98 ± 18.10) mmol/L. The differences between the two groups were statistically significant ( t = 18.36, 12.32, 9.66, 12.65, 4.18, 2.77, all P < 0.05). After intervention, the control group had a body length of (40.32 ± 1.84) cm, a body weight of (1.47 ± 0.55) kg, and a head circumference of (29.21 ± 1.07) cm. The intervention group had a body length of (45.00 ± 2.16) cm, a body weight of (1.83 ± 1.03) kg, and a head circumference of (30.14 ± 1.35) cm. The differences between the two groups were statistically significant ( t = 11.06, 2.06, 3.62, all P < 0.05). At 40 weeks of corrected gestational age post-intervention, the control group had a NBNA score of (30.11 ± 2.41), whereas the intervention group had an NBNA score of (34.52 ± 2.82). The difference between the two groups was statistically significant ( t = 7.97, P < 0.05). The number of patients experiencing common complications in the intervention group was lower than that in the control group [8 (17.78%) vs. 28 (62.22%), χ2 = 18.51, P < 0.05]. The control group had glycine levels of (94.07 ± 19.78) μmol/L, valine levels of (99.53 ± 13.42) μmol/L, homocysteine levels of (10.87 ± 4.43) μmol/L, cystatin levels of (233.71 ± 35.02) μmol/L, and methionine levels of (20.54 ± 4.67) μmol/L. The intervention group had glycine levels of (79.21 ± 17.54) μmol/L,valine levels of (88.70 ± 12.96) μmol/L, homocysteine levels of (13.68 ± 7.66) μmol/L, cystatin levels of (256.54 ± 35.49) μmol/L, and methionine levels of (22.97 ± 5.49) μmol/L. The differences between the two groups were statistically significant ( t = 3.77, 3.89, 2.13, 3.07, 2.26, all P < 0.05). Conclusions:Early enteral and parenteral nutritional support for low-birth-weight infants can restore their growth and development status, improve feeding conditions, enhance gastrointestinal function, and improve levels of metabolomic-related indicators.

Objective To conduct a multidimensional and multi-level evaluation of the comprehensive clinical value of empagliflozin in the treatment of type 2 diabetes mellitus.Methods Based on the National Essential Medicines List(2018 Edition),dapagliflozin was selected as the control.A comprehensive clinical evaluation index system was established through literature review,focus group interviews and in-depth expert interviews,encompassing six dimensions:safety,efficacy,economy,suitability,innovation,and accessibility.The Delphi method and hierarchical direct weighting method were used to screen indicators and determine their weights.Evidence for each indicator was collected and integrated both qualitatively and quantitatively through literature research,real-world studies,and pharmacoeconomic evaluations.Experts scored the indicators based on the collected evidence,and a total score for the comprehensive clinical evaluation of empagliflozin was calculated by combining these scores with indicator weights,followed by a comparative analysis with dapagliflozin.Results A comprehensive clinical evaluation of empagliflozin in the treatment of type 2 diabetes mellitus was successfully established,consisting of 6 primary indicators,14 secondary indicators,and 41 tertiary indicators.The overall evaluation score for empagliflozin was 90.35,and 89.47 for dapagliflozin.Conclusion The comprehensive clinical value of empagliflozin in the treatment of type 2 diabetes mellitus is slightly higher than that of dapagliflozin.This finding can serve as a reference for rational clinical drug use and related decision-making.

BACKGROUND:Magnesium and magnesium-based materials have good biocompatibility,stable osteogenic properties,and biological activities such as vascularization and immune regulation,and show a broad application prospect in stomatology.OBJECTIVE:To summarize the mechanism of magnesium-based materials in the treatment of oral diseases in terms of osteogenesis,angiogenesis,and immunomodulation,and to review the application prospects of magnesium and magnesium-based materials in the field of oral diseases in recent years.METHODS:Chinese search key words were"magnesium,magnesium alloys,magnesium-based metals,fractures,implants,restorations,endodontics,periodontitis,periodontal disease,cysts,oral cancer."English search key works were"magnesium,magnesium-based alloy,fracture,facial bone fractures,denture,dental implant,restorative dentistry,pulpitis,periodontitis,periodontal diseases,oral cancer."The articles were retrieved on CNKI,WanFang,PubMed,and Web of Science databases.By analyzing and reading literature for screening,84 articles were finally included for review.RESULTS AND CONCLUSION:Magnesium and magnesium-based materials can be used as bone internal fixation devices for jaw fracture or orthognathic surgery.Due to the special biological properties of magnesium,it can not only ensure stable osteogenesis,but also avoid the possibility of secondary surgery,which has the potential to be widely used.In the field of bone regeneration in stomatology,magnesium,relying on its superior biological properties,shows better mechanical properties and antibacterial properties than existing clinical materials,providing more options for the development and application of materials in this field.With the help of the biological activity of magnesium,magnesium-based coating materials give full play to the anti-inflammatory and antioxidant effects,further promote implant bone bonding and soft tissue integration,and have great application prospects in implant surface modification and promoting implant stability.Although magnesium has been involved in maxillofacial intraoral soft tissue regeneration and treatment,dental tissue engineering,there are still a lot of gaps.To ensure the stable biological characteristics of magnesium,it is usually necessary to add other alloys or carry out magnesium surface modification.However,the biological evaluation system of degradable metal implants is not perfect at present.The clinical application of magnesium in oral diseases still needs to be further clarified in the future.

BACKGROUND:Magnesium and magnesium-based materials have good biocompatibility,stable osteogenic properties,and biological activities such as vascularization and immune regulation,and show a broad application prospect in stomatology.OBJECTIVE:To summarize the mechanism of magnesium-based materials in the treatment of oral diseases in terms of osteogenesis,angiogenesis,and immunomodulation,and to review the application prospects of magnesium and magnesium-based materials in the field of oral diseases in recent years.METHODS:Chinese search key words were"magnesium,magnesium alloys,magnesium-based metals,fractures,implants,restorations,endodontics,periodontitis,periodontal disease,cysts,oral cancer."English search key works were"magnesium,magnesium-based alloy,fracture,facial bone fractures,denture,dental implant,restorative dentistry,pulpitis,periodontitis,periodontal diseases,oral cancer."The articles were retrieved on CNKI,WanFang,PubMed,and Web of Science databases.By analyzing and reading literature for screening,84 articles were finally included for review.RESULTS AND CONCLUSION:Magnesium and magnesium-based materials can be used as bone internal fixation devices for jaw fracture or orthognathic surgery.Due to the special biological properties of magnesium,it can not only ensure stable osteogenesis,but also avoid the possibility of secondary surgery,which has the potential to be widely used.In the field of bone regeneration in stomatology,magnesium,relying on its superior biological properties,shows better mechanical properties and antibacterial properties than existing clinical materials,providing more options for the development and application of materials in this field.With the help of the biological activity of magnesium,magnesium-based coating materials give full play to the anti-inflammatory and antioxidant effects,further promote implant bone bonding and soft tissue integration,and have great application prospects in implant surface modification and promoting implant stability.Although magnesium has been involved in maxillofacial intraoral soft tissue regeneration and treatment,dental tissue engineering,there are still a lot of gaps.To ensure the stable biological characteristics of magnesium,it is usually necessary to add other alloys or carry out magnesium surface modification.However,the biological evaluation system of degradable metal implants is not perfect at present.The clinical application of magnesium in oral diseases still needs to be further clarified in the future.

Objective:To construct an evaluation index system for rural order-oriented general practice residents based on Entrustable Professional Activities (EPAs) and conduct an empirical analysis. ?Methods:A mixed-methods study design was adopted (November 2022-April 2023). The preliminary draft of the index system was developed through literature review and group discussions, then refined and improved via two rounds of expert consultation using the Delphi method. The analytic hierarchy process (AHP) was applied to determine the weight of each index. Meanwhile, questionnaires were distributed to 181 participants, including general practitioners from general hospitals, general practitioners from community hospitals, and general practice residents. The scores of the three groups regarding the importance and feasibility of the indices were compared. Ten general practitioners of the above three types were selected for semi-structured interviews on their cognitive and practical aspects of the system. ?Results:The positive coefficients of the two rounds of expert consultation were 16/17 and 16/16, respectively. The expert authority degree was >0.70, and the test of coordination coefficient was statistically significant ( P<0.05). Finally, an index system consisting of 20 first-level indices and 56 second-level indices was established. In terms of weight, among the first-level indices,"EPA1: Information Acquisition"had the highest weight (0.11), while"EPA12: Clinical Research"had the lowest (0.02). Among the second-level indices, "Medical History Taking" and "Physical Examination" under EPA1 had the highest weight (both 0.056), while "Healthcare for Patients with Severe Mental Illness" and "Healthcare for Disabled and Handicapped Populations" under EPA15 had the lowest (both 0.003). The 181 participants gave scores ranging from 4.49 to 4.92 for the importance of the 20 first-level indices and from 4.16 to 4.81 for their feasibility. Only for" EPA19: Common Diseases in Primary Care and Health Management", the feasibility score given by general practitioners from community hospitals was higher than that from general hospitals ( t=2.157, P=0.032); no statistically significant differences were observed among the groups for the other indices ( P>0.05).The interview results showed that general practitioners have a relatively high level of recognition for this system, but there is still room for improvement in its practical application.? Conclusions:The evaluation index system for rural order-oriented general practice residents constructed based on EPAs has high reliability, and it is consistently recognized by different types of general practitioners. It can provide a reference for the cultivation of post competency of this group.?

Objective:To investigate the clinical characteristics and independent risk factors of severe disease in patients with anti-nuclear matrix protein (NXP) 2 antibody-positive juvenile dermatomyositis (JDM).Methods:A retrospective cohort study was conducted, including 219 anti-NXP2 antibody-positive JDM patients admitted to 23 children′s hospitals across China from July 2011 to July 2023. Patients were classified into severe and non-severe groups based on classification criteria for severe dermatomyositis. Demographic characteristics, clinical manifestations, and laboratory parameters were compared between the 2 groups using independent sample t-test, Mann-Whitney U test, or χ2 test. Univariate and multivariate Logistic regression analyses were performed to identify risk factors for severe disease. The receiver operating characteristic curve was employed to calculate optimal cut-off values. Results:Among the 219 patients, 108 were male and 111 were female, with an age at onset of 6.3 (3.5, 9.4) years. The severe group comprised 69 patients, and the non-severe group 150 patients. The severe group had significantly higher rates of fever, heliotrope rash, subcutaneous edema, periorbital edema, anti-Ro52 antibody positivity, as well as elevated levels of ferritin-to-albumin ratio (FAR), creatine kinase (CK), aspartate aminotransferase (AST), and lactate dehydrogenase (LDH) (all P<0.05). Multivariate analysis identified anti-Ro52 antibody positivity ( OR=13.26, 95% CI 1.37-128.29) and elevated FAR ( OR=1.90, 95% CI 1.09-2.31) as independent risk factors for severe anti-NXP2 antibody-positive JDM (both P<0.05). Receiver operating characteristic curve analysis revealed that a FAR cutoff value of 6.82 predicted severe disease with an area under the curve of 0.87 (95% CI 0.81-0.94, P<0.001), sensitivity of 0.85, and specificity of 0.70. All patients received glucocorticoid therapy, and the severe group received higher proportions of steroid pulse therapy, cyclophosphamide, mycophenolate mofetil, intravenous immunoglobulin, biologics, and adjuvant treatments compared to the non-severe group (all P<0.05). In terms of outcomes, 2 patients (2.9%) in the severe group died (due to neurological involvement and intestinal perforation, respectively), while the remaining patients achieved complete clinical response or remission. All patients in the non-severe group achieved remission. Conclusions:The primary clinical features of anti-NXP2 antibody-positive JDM included fever, heliotrope rash, subcutaneous edema, periorbital edema, anti-Ro52 antibody positivity, and elevated levels of CK, AST, LDH, and FAR. Furthermore, anti-Ro52 antibody positivity and a FAR>6.82 were identified as independent risk factors.

Objective:To construct an evaluation index system for rural order-oriented general practice residents based on Entrustable Professional Activities (EPAs) and conduct an empirical analysis. ?Methods:A mixed-methods study design was adopted (November 2022-April 2023). The preliminary draft of the index system was developed through literature review and group discussions, then refined and improved via two rounds of expert consultation using the Delphi method. The analytic hierarchy process (AHP) was applied to determine the weight of each index. Meanwhile, questionnaires were distributed to 181 participants, including general practitioners from general hospitals, general practitioners from community hospitals, and general practice residents. The scores of the three groups regarding the importance and feasibility of the indices were compared. Ten general practitioners of the above three types were selected for semi-structured interviews on their cognitive and practical aspects of the system. ?Results:The positive coefficients of the two rounds of expert consultation were 16/17 and 16/16, respectively. The expert authority degree was >0.70, and the test of coordination coefficient was statistically significant ( P<0.05). Finally, an index system consisting of 20 first-level indices and 56 second-level indices was established. In terms of weight, among the first-level indices,"EPA1: Information Acquisition"had the highest weight (0.11), while"EPA12: Clinical Research"had the lowest (0.02). Among the second-level indices, "Medical History Taking" and "Physical Examination" under EPA1 had the highest weight (both 0.056), while "Healthcare for Patients with Severe Mental Illness" and "Healthcare for Disabled and Handicapped Populations" under EPA15 had the lowest (both 0.003). The 181 participants gave scores ranging from 4.49 to 4.92 for the importance of the 20 first-level indices and from 4.16 to 4.81 for their feasibility. Only for" EPA19: Common Diseases in Primary Care and Health Management", the feasibility score given by general practitioners from community hospitals was higher than that from general hospitals ( t=2.157, P=0.032); no statistically significant differences were observed among the groups for the other indices ( P>0.05).The interview results showed that general practitioners have a relatively high level of recognition for this system, but there is still room for improvement in its practical application.? Conclusions:The evaluation index system for rural order-oriented general practice residents constructed based on EPAs has high reliability, and it is consistently recognized by different types of general practitioners. It can provide a reference for the cultivation of post competency of this group.?

Objective:To investigate the clinical characteristics and independent risk factors of severe disease in patients with anti-nuclear matrix protein (NXP) 2 antibody-positive juvenile dermatomyositis (JDM).Methods:A retrospective cohort study was conducted, including 219 anti-NXP2 antibody-positive JDM patients admitted to 23 children′s hospitals across China from July 2011 to July 2023. Patients were classified into severe and non-severe groups based on classification criteria for severe dermatomyositis. Demographic characteristics, clinical manifestations, and laboratory parameters were compared between the 2 groups using independent sample t-test, Mann-Whitney U test, or χ2 test. Univariate and multivariate Logistic regression analyses were performed to identify risk factors for severe disease. The receiver operating characteristic curve was employed to calculate optimal cut-off values. Results:Among the 219 patients, 108 were male and 111 were female, with an age at onset of 6.3 (3.5, 9.4) years. The severe group comprised 69 patients, and the non-severe group 150 patients. The severe group had significantly higher rates of fever, heliotrope rash, subcutaneous edema, periorbital edema, anti-Ro52 antibody positivity, as well as elevated levels of ferritin-to-albumin ratio (FAR), creatine kinase (CK), aspartate aminotransferase (AST), and lactate dehydrogenase (LDH) (all P<0.05). Multivariate analysis identified anti-Ro52 antibody positivity ( OR=13.26, 95% CI 1.37-128.29) and elevated FAR ( OR=1.90, 95% CI 1.09-2.31) as independent risk factors for severe anti-NXP2 antibody-positive JDM (both P<0.05). Receiver operating characteristic curve analysis revealed that a FAR cutoff value of 6.82 predicted severe disease with an area under the curve of 0.87 (95% CI 0.81-0.94, P<0.001), sensitivity of 0.85, and specificity of 0.70. All patients received glucocorticoid therapy, and the severe group received higher proportions of steroid pulse therapy, cyclophosphamide, mycophenolate mofetil, intravenous immunoglobulin, biologics, and adjuvant treatments compared to the non-severe group (all P<0.05). In terms of outcomes, 2 patients (2.9%) in the severe group died (due to neurological involvement and intestinal perforation, respectively), while the remaining patients achieved complete clinical response or remission. All patients in the non-severe group achieved remission. Conclusions:The primary clinical features of anti-NXP2 antibody-positive JDM included fever, heliotrope rash, subcutaneous edema, periorbital edema, anti-Ro52 antibody positivity, and elevated levels of CK, AST, LDH, and FAR. Furthermore, anti-Ro52 antibody positivity and a FAR>6.82 were identified as independent risk factors.