Nutritional support is essential for improving survival and prognosis in critical care medicine.However,traditional nutritional assessment methods have limitations such as strong subjectivity,dependence on clinical experience,lack of real-time data support,especially in complex environments such as intensive care unit(ICU).In recent years,the development of artificial intelligence(AI)technology has provided new opportunities for precise nutrition management.AI can analyze a large amount of clinical data through machine learning algorithms,monitor the physiological state of patients in real time,and dynamically adjust nutritional regimens to optimize the nutritional support effect of critically ill patients.At present,the application of AI in critical nutrition assessment mainly focuses on nutritional risk screening and tolerance assessment,but it is still in the preliminary exploration stage.The application of machine learning,deep learning and data mining technologies in the medical field provides more objective and efficient tools for nutritional assessment,such as personalized intervention by analyzing multi-dimensional data of patients(eating habits,physiological indicators,disease history,etc.).This paper analyzes the research prospect of AI in nutritional support treatment evaluation of critically ill patients,the application status,potential advantages and challenges of AI technology in nutritional assessment,focuses on the application of AI in data analysis,personalized nutrition plan formulation and clinical decision support,and discusses how to improve the effectiveness and safety of nutritional treatment by integrating multiple data sources,thus providing direction and ideas for future research.And through in-depth understanding of the application potential of AI,clinical medical staff can provide more accurate and scientific evaluation basis for nutritional support treatment of critically ill patients,and finally improve the clinical treatment effect of patients.However,widespread adoption of AI still faces challenges such as data privacy,ethical norms,algorithmic bias,and interdisciplinary collaboration.In the future,it is necessary to further optimize algorithm models,strengthen multidisciplinary cooperation(such as the collaboration of clinicians,nutritionists,and data engineers),and solve issues such as data standardization,cost-effectiveness,and patient privacy protection to achieve more accurate and personalized nutrition management strategies,ultimately improving the clinical outcomes of critically ill patients.

Nutritional support is essential for improving survival and prognosis in critical care medicine.However,traditional nutritional assessment methods have limitations such as strong subjectivity,dependence on clinical experience,lack of real-time data support,especially in complex environments such as intensive care unit(ICU).In recent years,the development of artificial intelligence(AI)technology has provided new opportunities for precise nutrition management.AI can analyze a large amount of clinical data through machine learning algorithms,monitor the physiological state of patients in real time,and dynamically adjust nutritional regimens to optimize the nutritional support effect of critically ill patients.At present,the application of AI in critical nutrition assessment mainly focuses on nutritional risk screening and tolerance assessment,but it is still in the preliminary exploration stage.The application of machine learning,deep learning and data mining technologies in the medical field provides more objective and efficient tools for nutritional assessment,such as personalized intervention by analyzing multi-dimensional data of patients(eating habits,physiological indicators,disease history,etc.).This paper analyzes the research prospect of AI in nutritional support treatment evaluation of critically ill patients,the application status,potential advantages and challenges of AI technology in nutritional assessment,focuses on the application of AI in data analysis,personalized nutrition plan formulation and clinical decision support,and discusses how to improve the effectiveness and safety of nutritional treatment by integrating multiple data sources,thus providing direction and ideas for future research.And through in-depth understanding of the application potential of AI,clinical medical staff can provide more accurate and scientific evaluation basis for nutritional support treatment of critically ill patients,and finally improve the clinical treatment effect of patients.However,widespread adoption of AI still faces challenges such as data privacy,ethical norms,algorithmic bias,and interdisciplinary collaboration.In the future,it is necessary to further optimize algorithm models,strengthen multidisciplinary cooperation(such as the collaboration of clinicians,nutritionists,and data engineers),and solve issues such as data standardization,cost-effectiveness,and patient privacy protection to achieve more accurate and personalized nutrition management strategies,ultimately improving the clinical outcomes of critically ill patients.

Objective:To analyze the therapeutic effect and safety of simultaneous integrated boost intensity-modulated radiotherapy for lung cancer brain metastases.Methods:A total of 300 patients with lung cancer brain metastases admitted to the Department of Oncology, Qingdao Municipal Hospital from March 2021 to March 2023 were selected as the study objects. The patients were divided into control group ( n=150) and study group ( n=150) by random number table method. The control group received sequential three-dimensional conformal radiotherapy, while the study group received simultaneous integrated boost intensity-modulated radiotherapy. The short-term and medium-term efficacy, target dose, and adverse reactions were compared between the two groups. Results:The short-term and medium-term total effective rates of the study group were 73.33% (110/150) and 88.67% (133/150), respectively, which were higher than those of the control group [51.33% (77/150) and 71.33% (107/150) ] ( χ2=15.46, P<0.001; χ2=14.08, P<0.001). The D min in gross tumor planning target volume and whole brain clinical planning target volume of the study group were (23.78±1.11) and (58.46±0.55) Gy, respectively, which were higher than those in the control group [ (16.67±1.08) and (53.44±0.74) Gy], with statistically significant differences ( t=56.22, P<0.001; t=66.68, P<0.001). The D mean in gross tumor planning target volume and whole brain clinical planning target volume of the study group were (44.12±0.87) and (62.19±0.57) Gy, respectively, which were higher than those in the control group [ (37.55±0.89) and (57.78±0.82) Gy], with statistically significant differences ( t=64.65, P<0.001; t=54.08, P<0.001). The total incidence of adverse reactions was 30.67% (46/150) in the study group and 36.67% (55/150) in the control group, with no significantly significant difference ( χ2=1.20, P=0.271) . Conclusion:Compared with sequential three-dimensional conformal radiotherapy, simultaneous integrated boost intensity-modulated radiotherapy has better short-term and medium-term efficacy in patients with lung cancer brain metastases. Target dose can be increased without increasing adverse reactions.

Objective:To study the clinical and CT features of the abnormal whole-course wide of eustachian tube (AWWET) with microtia and atresia(MA).Methods:The clinical and CT data of 19 patients (20 ears) from January 2017 to December 2021 with AWWET with MA were retrospectively analyzed, including 15 males and 4 females. The age ranged from 5 to 16 years, with an average of 9.5 years. 50 patients with common MA without wide eustachian tube(ET) as a case control group, including 32 males and 18 females.The age ranged from 5 to 16 years, with an average of 9.2 years. 20 patients (40 ears) who had normal ear CT for tinnitus, otalgia as a normal control group, including 12 males and 8 females. The age ranged from 5 to 16 years, with an average of 12.5 years. We measured the dimension and length of the bony portion of the ET, the total length, the angle between the bony portion and the cartilage portion, and the horizontal angle of ET on CT imagings, and compared with 40 normal ears by SPSS 27.0 software.Results:According to the relationship between AWWET and tympanum, patients were divided into the communicated group and the blocked group. A male predominance, left ear predominance, with high incidence of hemifacial microsomia exhibited in both groups. AWWET was presented as a widened lumen on CT. In 11 ears (4 ears in the communicated group, 7 ears in the blocked group), ETs bifurcated, the upper bony tube extended to the sphenoid body, the lower part continued down to cartilaginous ET and opened onto the nasopharynx, with"mastoid-like"pneumatization of the sphenoid body in 6 ears. The middle ear deformity in case group was more serious than MA control group, especially the blocked group. The incidence of otitis media in the communicated group was lower than that in the MA control group, and 4 cases in the blocked group had effusion in the ET. Compaired with normal ear, the bony ET elongated significantly in the AWWET groups, and the whole course of ET was significantly shortened, specially in the blocked group. The angle between the bony ET and the cartilaginous ET was decreased and the horizontal angle of the ET increased in the AWWET groups, the difference was considered to indicate statistical significance( P<0.05). Conclusions:AWWET with MA is rare, a male predominance, left ear predominance, and with high incidence of hemifacial microsomia. The middle ear deformity is more serious than common MA, especially in the blocked group. The incidence of otitis media in the communicated group is significantly lower than that in the common MA, and the blocked group may be accompanied by ET inflammation.

Objective:To construct an evaluation system for clinical nurse research ability training based on the Kirkpatrick model, and provide methods and strategies for clinical nurse research ability training.Methods:Based on literature review and group discussion, the item pool of an evaluation system for clinical nurse research training was constructed using the Kirkpatrick model as the theoretical framework. Using the Delphi method, two rounds of expert consultation were conducted on 17 experts to determine the final evaluation system.Results:In both rounds of expert consultation, 17 questionnaires were distributed, and 17 valid questionnaires were collected. The effective recovery rate of the questionnaires was 100%. After two rounds of expert consultation, the significance tests for the Kendall coordination coefficients of the first, second, and third level indicators were all P<0.05. The expert authority coefficients for the first and second rounds of expert consultation were 0.840 and 0.895, respectively. The evaluation system for clinical nurse research ability training established after two rounds of consultation included four first-level indicators, 11 second-level indicators, and 40 third-level indicators. Conclusions:The evaluation system for clinical nurse research ability training based on the Kirkpatrick model has reliable results, and experts have high levels of enthusiasm, coordination, and authority. It can be used as a tool for evaluating clinical nurse research ability training.

Rotavirus(RV) is currently the leading cause of severe diarrhea in infants and young children worldwide, and RV has been found to recognize and bind to histo-blood group antigens(HBGAs) through its structural protein VP8, and the FUT2 gene determines the expression of HBGAs in epithelial tissues and secretion in body fluids.Individuals with loss of functional enzyme activity due to mutations in the FUT2 gene, called non-secretors, are unable to express and secrete HBGAs in the mucosa and body fluids, and non-secretors have been found to be resistant to diarrhea caused by RV.Studies have shown that microbial composition is genetically regulated by the host, and hundreds of genetic loci are involved in regulating the composition of human gut microbes, including FUT2.Sterile animal models reduce the rate of RV infection, suggesting that intestinal bacteria are associated with the process of RV infection.These studies reveal that secretory status directly influences individual susceptibility to RV, and its effect on gut microbial composition indirectly modulates human susceptibility to RV.This article reviews the correlation between FUT2 and gut microbial composition with RV susceptibility, with the aim of opening new avenues for personalized prevention and treatment of RV infection.

Objective:To investigate the detection of myocardial bridge in civil aviation pilots and whether there is abnormal ventricular repolarization in the pilots with myocardial bridge, and to explore the effect of myocardial bridge on ventricular repolarization.Methods:Retrospective study was used to analyze the data of submaximal treadmill exercise test in 2019 for the civil aviation pilots aged ≥40. Pilots with cardiovascular diseases affecting ventricular repolarization were excluded. The resting electrocardiogram before exercise and 1 min QT interval after exercise were measured, and the QT dispersion (QT d) was calculated. The pilots were divided into myocardial bridge group and control group according to whether myocardial bridge was detected. The positive rate of treadmill exercise test and the incidence of ventricular extrasystole were compared between the pilots in myocardial bridge group and control group. The QT/RR slope was statistically analyzed in the pilots received 24 h electrocardiogram monitoring. Results:A total of 243 pilots were enrolled, including 242 males and 1 female. Among the 243 cases, 27 cases of myocardial bridge pilots were detected, and the myocardial bridge was mainly found in the anterior descending branch of left coronary artery (25/27, 92.6%). The 24 h dynamic electrocardiogram was examined in 17 cases, 6 cases were in the myocardial bridge group and 11 cases were in the control group. The total flying hours of the myocardial bridge group was longer than that of the control group ( Z=2.29, P=0.022); the positive rate or suspected positive rate of submaximal treadmill exercise test and the incidence of ventricular extrasystole in the myocardial bridge group were higher than those in the control group, and the differences were significant ( χ2=52.74, 5.78, P<0.001, =0.016); the 1 min QT d in the convalescent phase of the treadmill exercise test in the myocardial bridge group was longer than that in the control group, and the difference was significant ( Z=-2.20, P=0.028). The average frequency of 24 h ventricular extrasystole, QT e/RR slope and QT a/RR slope in the myocardial bridge group were higher than those in the control group, and the differences were significant ( t=2.37, 4.26, 2.51, P=0.034, <0.001, =0.024). Conclusions:Pilots with myocardial bridge may have prolonged ventricular repolarization and are prone to ventricular arrhythmias. In order to ensure flight safety, attention should be paid to the physical examination and flight adaptability evaluation of the pilots with myocardial bridge, especially to strengthen daily health management of the pilots with ventricular repolarization abnormalities.

Objective:To investigate the detection of myocardial bridge in civil aviation pilots and whether there is abnormal ventricular repolarization in the pilots with myocardial bridge, and to explore the effect of myocardial bridge on ventricular repolarization.Methods:Retrospective study was used to analyze the data of submaximal treadmill exercise test in 2019 for the civil aviation pilots aged ≥40. Pilots with cardiovascular diseases affecting ventricular repolarization were excluded. The resting electrocardiogram before exercise and 1 min QT interval after exercise were measured, and the QT dispersion (QT d) was calculated. The pilots were divided into myocardial bridge group and control group according to whether myocardial bridge was detected. The positive rate of treadmill exercise test and the incidence of ventricular extrasystole were compared between the pilots in myocardial bridge group and control group. The QT/RR slope was statistically analyzed in the pilots received 24 h electrocardiogram monitoring. Results:A total of 243 pilots were enrolled, including 242 males and 1 female. Among the 243 cases, 27 cases of myocardial bridge pilots were detected, and the myocardial bridge was mainly found in the anterior descending branch of left coronary artery (25/27, 92.6%). The 24 h dynamic electrocardiogram was examined in 17 cases, 6 cases were in the myocardial bridge group and 11 cases were in the control group. The total flying hours of the myocardial bridge group was longer than that of the control group ( Z=2.29, P=0.022); the positive rate or suspected positive rate of submaximal treadmill exercise test and the incidence of ventricular extrasystole in the myocardial bridge group were higher than those in the control group, and the differences were significant ( χ2=52.74, 5.78, P<0.001, =0.016); the 1 min QT d in the convalescent phase of the treadmill exercise test in the myocardial bridge group was longer than that in the control group, and the difference was significant ( Z=-2.20, P=0.028). The average frequency of 24 h ventricular extrasystole, QT e/RR slope and QT a/RR slope in the myocardial bridge group were higher than those in the control group, and the differences were significant ( t=2.37, 4.26, 2.51, P=0.034, <0.001, =0.024). Conclusions:Pilots with myocardial bridge may have prolonged ventricular repolarization and are prone to ventricular arrhythmias. In order to ensure flight safety, attention should be paid to the physical examination and flight adaptability evaluation of the pilots with myocardial bridge, especially to strengthen daily health management of the pilots with ventricular repolarization abnormalities.

Objective:To discuss the influencing factors of neonatal scalp hematoma, and provide a basis for reducing the occurrence of neonatal scalp hematoma.Methods:Retrospectively analyzed the data of 13 151 parturients and their newborn infants who delivered in the Hangzhou Women′s Hospital from January to December 2020, counted the incidence of neonatal scalp hematoma, and Logistic regression analysis was used to analyze its influencing factors.Results:Among 13 151 newborn baby, 68 cases of neonatal head hematoma occurred, the incidence was 0.52%. Vaginal delivery, forceps, intraspinal analgesia were statistically significant in the occurrence of neonatal scalp hematoma ( χ2=19.26, 19.59, 6.11, all P<0.05). Conclusions:Vaginal delivery, forceps, and intraspinal analgesia are the risk factors for neonatal scalp hematoma. Lateral perineal incision during delivery did not reduce the incidence of neonatal scalp hematoma. In this study, many cases of neonatal scalp hematoma occurred before the crown of the fetal head. Labor management, improve the rate of non-drug analgesia, promote natural delivery, early detection, early prevention, and reduce the incidence of neonatal hematoma.

【Objective】 To evaluate the appropriate optimal capacity and matching probability of the platelet donor database with known HLA/HPA genotype in Shaanxi aera, and provide data support for subsequent construction, maintenance and application of the local platelet donor database. 【Methods】 A total of 11 755 individuals from the Shaanxi Branch of China Marrow Donor Program, 401 and 249 unrelated random platelet donors in Shaanxi aera were enrolled to the population study of HLA-A, -B polymorphisms, HPA genotyping and CD36 antigen expression, respectively. The frequencies of HLA-A, -B alleles, HPA alleles and haplotypes were calculated with Arlequin 3. 5. 2. 2 software; matching probability and capacity evaluation of platelet donor database was conducted according to the phenotypic frequencies. 【Results】 The population genetic and phenotypic polymorphisms data of HLA-A, -B and HPA1-6, 10, 15, 21 in Shaanxi aera were obtained. The frequency of CD36 type Ⅰ or Ⅱ deficiency was 0.40%(1/249). According to the subsequent calculating and deriving, with a database size of 194 donors, the patient having approximate 95% probability could achieve matching of HPA1-6, 10, 15, 21 genotype. With a database size of 1500 donors, there is a 95% probability of matching at least one donor with HLA-A-B phenotype frequency >0.002 or haplotype frequency >0.001; meanwhile, the probability of matching a cross-reactive group donor should be 44.95%-97.57%. Based on database size of 8 856 and 15 033, the probabilities of matching HLA-A, -B phenotype were about 80% and 90%, respectively. 【Conclusion】 The differences in the distribution of HLA/HPA polymorphism in different regions make the establishment mode and optimal capacity of platelet donor database different. It is necessary to apply a variety of platelet matching transfusion strategies to expand the range of donor selection, thereby effectively reducing the database construction cost and resource requirements.