Gut microorganisms are central to the intestinal microecosystem, regulating digestive functions and related to immune regulation, metabolic disorders, and nervous system development. Recent studies reveal the multifaceted interactions between micronutrients (MNs) and gut microbiota, where MNs provide essential nutrients to the intestinal flora and influence the production and absorption of various MNs through direct or indirect pathways. This article reviews the recent advances in the effects of water-soluble vitamins, fat-soluble vitamins, and micronutrients on the intestinal microecology, aiming to provide new ideas for future research.

Objective:To analyze the clinical characteristics of inconsistent symptoms and signs of dry eye in patients with Sj?gren syndrome (SS).Methods:A case-control study was performed.Thirty-eight patients (38 eyes) who visited the dry-eye outpatient department at Peking University People's Hospital were enrolled from January to October 2021.The patients were divided into a non-SS (NSS) group (25 cases, 25 eyes) and a SS group (13 cases, 13 eyes) according to without or with SS.The data of right eyes were analyzed.The patients' subjective symptoms were scored and their objective clinical parameters were evaluated.Evaluation of subjective symptoms included Ocular Surface Disease Index (OSDI), Standard Patient Evaluation of eye dryness (SPEED) Questionnaire and Dry Eye Questionnaire-5 (DEQ-5).Objective clinical parameters included Schirmer Ⅰ test (SⅠt), tear film breakup time (TBUT), SICCA ocular staining score (OSS), National Eye Institute (NEI) score, Marx line score, non-invasive tear film breakup time (NIBUT), non-invasive tear meniscus height (NITMH), meibomian gland loss area ratio, the number of corneal subepithelial nerves, total nerve length, mean nerve length, maximum nerve length, minimum nerve length, nerve curvature, and number of dendritic cells.Differences in subjective symptoms and clinical parameters were compared between the two groups, and correlation analysis between ocular symptom scores and objective clinical parameters was performed.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Peking University People's Hospital (No.RDY2020-03).Written informed consent was obtained from each subject.Results:The OSDI, SPEED and DEQ-5 scores of SS group were 10.9(2.1, 23.1), 4.0(2.0, 7.0) and 7.0(3.5, 9.5), respectively, which were significantly lower than 37.5(26.0, 64.9), 10.5(7.0, 13.0) and 13.0(6.8, 14.3) of NSS group ( Z=-2.70, -3.01, -2.14; all P<0.05).TBUT was longer in the SS group than in the NSS group, and the difference was statistically significant ( Z=-2.10, P=0.038).No significant difference was found in SⅠt, OSS, Marx line score, NIBUT, NITMH, meibomian gland loss area ratio, the number of corneal subepithelial nerves, total nerve length, mean nerve length, maximum nerve length, minimum nerve length, nerve curvature, and number of dendritic cells (all P>0.05).The OSS of nasal conjunctiva was significantly higher in the SS group than in the NSS group ( Z=-2.32, P=0.023).There were no correlations between the subjective symptoms and objective clinical parameters in NSS group (all P>0.05).The SPEED score was positively correlated with the Marx line score of upper eye lid ( rs=0.573, P=0.041) and the OSDI score was negatively correlated with the minimum nerve length ( rs=-0.606, P=0.037) in SS group. Conclusions:Patients with SS dry eye have more nasal conjunctival staining and fewer subjective symptoms than NSS dry eye patients with the same signs, which manifests as a separation of symptoms and signs.

Meniere's disease represents an idiopathic inner ear disorder characterized by endolymphatic hy-drops.Currently,the research methods for identifying genes associated with this disease mainly involve first-genera-tion sequencing and second-generation sequencing.This article reviews research on the genetic study of Meniere's disease,mainly summarizing the candidate genes with repeated pedigree validation in familial Meniere's disease,as well as those frequently reported in sporadic Meniere's disease.

Objective:To evaluate the effectiveness of the Total Nutritional Therapy (TNT) course initiated by the Chinese Society for Parenteral and Enteral Nutrition (CSPEN) over the 20 years since its implementation in China.Methods:Participants who attended the CSPEN-organized TNT course between 2005 and 2024 were randomly selected as survey subjects. A four-level questionnaire (reaction, learning, behavior, and results) was developed via expert consensus, based on the Kirkpatrick model. An electronic link to the survey, created via Wenjuanxing, was distributed to invite participants to complete the questionnaire.Results:A total of 1,548 healthcare professionals from various specialties who had received TNT course participated in the online survey. Over 93% of participants reported improvements in theoretical knowledge and 94% in enhanced clinical diagnosis and treatment capabilities. Additionally, 65.4% of participants reported a "significant" or "noticeable" increase in the frequency of nutritional screening and assessments, with the frequency of nutritional support therapy utilization increased by 91.2%. Furthermore, 52.6% of respondents perceived a "significant" or "noticeable" career advancement, particularly in professional title promotion and international academic exchanges. The TNT course also positively impacted discipline development and management: 63.6% of the trainees' hospitals established clinical nutrition departments, 58.98% opened nutrition outpatient clinics, and 56.9% formed nutrition support teams. The adoption rate of standardized procedures, such as nutritional screening, exceeded 92.5% in relevant departments.Conclusions:Over the past 20 years, the CSPEN-led TNT course has successfully established a virtuous cycle of "knowledge dissemination–practice transformation–system innovation" in China. It has played a positive role in enhancing the professional competencies of healthcare workers and promoting the development of clinical nutrition as a discipline.

Gut microorganisms are central to the intestinal microecosystem, regulating digestive functions and related to immune regulation, metabolic disorders, and nervous system development. Recent studies reveal the multifaceted interactions between micronutrients (MNs) and gut microbiota, where MNs provide essential nutrients to the intestinal flora and influence the production and absorption of various MNs through direct or indirect pathways. This article reviews the recent advances in the effects of water-soluble vitamins, fat-soluble vitamins, and micronutrients on the intestinal microecology, aiming to provide new ideas for future research.

Objective:To investigate the correlation between occupational ionizing radiation exposure and abnormal metabolic indicators, providing a basis for assessing the health risks of occupational ionizing radiation workers and establishing a risk prediction model for chronic metabolic diseases.Methods:In January 2023, 7708 individuals were randomly selected from the occupational health examination data in Zhejiang Province. After excluding 16 individuals due to record errors, 2698 on-the-job workers exposed to ionizing radiation from 2020 to 2021 were selected as the exposure group, 2027 pre-employment workers exposed to ionizing radiation from 2016 to 2022 were selected as the pre-employment control group, and 2967 non-ionizing radiation workers from 2016 to 2022 were selected as the control group. Demographic data, blood routine, urine routine, biochemical indicators, and peripheral blood lymphocyte micronucleus rate of each group were collected. One-way ANOVA and rank sum test were used for comparison of indicators. The exposure group was divided into different groups based on age, exposure duration, and body mass index (BMI), and the correlation between indicators and occupational ionizing radiation was analyzed. Lasso variable selection was conducted by constructing a penalty coefficient (λ), and a complete regression model was established.Results:There were statistically significant differences in indicators such as blood pressure, heart rate, and average hemoglobin concentration between the exposure group and the control group, as well as the pre-employment control group ( P<0.05). Through Lasso variable selection, 19 indicators including exposure length, systolic blood pressure (SBP), diastolic blood pressure (DBP), body weight, body mass index (BMI), urine pH value, red blood cell count, microscopic white blood cells, casts, absolute value of monocytes, mean corpuscular volume of red blood cells, mean hemoglobin concentration, alkaline phosphatase, albumin-to-globulin ratio, total bile acid, α-L-fucosidase, urea, creatinine, and low-density lipoprotein cholesterol (LDL-C). There were statistically significant differences in exposure length, SBP, DBP, body weight, BMI, microscopic white blood cells, casts, albumin-to-globulin ratio, total bile acid, α-L-fucosidase, urea, creatinine, LDL-C, and mean corpuscular volume of red blood cells among workers of different ages in the exposure group ( P<0.05) ; there were statistically significant differences in SBP, DBP, body weight, BMI, microscopic white blood cells, casts, albumin-to-globulin ratio, total bile acid, α-L-fucosidase, urea, creatinine, LDL-C, and mean corpuscular volume of red blood cells among workers with different exposure durations ( P<0.05) ; there were statistically significant differences in exposure length, SBP, DBP, body weight, BMI, red blood cells, microscopic white blood cells, casts, albumin-to-globulin ratio, total bile acid, α-L-fucosidase, urea, creatinine, LDL-C, absolute value of monocytes, mean corpuscular volume of red blood cells, and mean hemoglobin concentration among workers with different BMIs ( P<0.05) . Conclusion:Occupational ionizing radiation is associated with abnormal metabolic indicators such as blood pressure, heart rate, total bile acid, α-L-fucosidase, urea, and creatinine in the human body. More attention should be paid to the risk of chronic metabolic diseases among workers exposed to ionizing radiation.

Objective:To analyze the clinical characteristics of inconsistent symptoms and signs of dry eye in patients with Sj?gren syndrome (SS).Methods:A case-control study was performed.Thirty-eight patients (38 eyes) who visited the dry-eye outpatient department at Peking University People's Hospital were enrolled from January to October 2021.The patients were divided into a non-SS (NSS) group (25 cases, 25 eyes) and a SS group (13 cases, 13 eyes) according to without or with SS.The data of right eyes were analyzed.The patients' subjective symptoms were scored and their objective clinical parameters were evaluated.Evaluation of subjective symptoms included Ocular Surface Disease Index (OSDI), Standard Patient Evaluation of eye dryness (SPEED) Questionnaire and Dry Eye Questionnaire-5 (DEQ-5).Objective clinical parameters included Schirmer Ⅰ test (SⅠt), tear film breakup time (TBUT), SICCA ocular staining score (OSS), National Eye Institute (NEI) score, Marx line score, non-invasive tear film breakup time (NIBUT), non-invasive tear meniscus height (NITMH), meibomian gland loss area ratio, the number of corneal subepithelial nerves, total nerve length, mean nerve length, maximum nerve length, minimum nerve length, nerve curvature, and number of dendritic cells.Differences in subjective symptoms and clinical parameters were compared between the two groups, and correlation analysis between ocular symptom scores and objective clinical parameters was performed.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Peking University People's Hospital (No.RDY2020-03).Written informed consent was obtained from each subject.Results:The OSDI, SPEED and DEQ-5 scores of SS group were 10.9(2.1, 23.1), 4.0(2.0, 7.0) and 7.0(3.5, 9.5), respectively, which were significantly lower than 37.5(26.0, 64.9), 10.5(7.0, 13.0) and 13.0(6.8, 14.3) of NSS group ( Z=-2.70, -3.01, -2.14; all P<0.05).TBUT was longer in the SS group than in the NSS group, and the difference was statistically significant ( Z=-2.10, P=0.038).No significant difference was found in SⅠt, OSS, Marx line score, NIBUT, NITMH, meibomian gland loss area ratio, the number of corneal subepithelial nerves, total nerve length, mean nerve length, maximum nerve length, minimum nerve length, nerve curvature, and number of dendritic cells (all P>0.05).The OSS of nasal conjunctiva was significantly higher in the SS group than in the NSS group ( Z=-2.32, P=0.023).There were no correlations between the subjective symptoms and objective clinical parameters in NSS group (all P>0.05).The SPEED score was positively correlated with the Marx line score of upper eye lid ( rs=0.573, P=0.041) and the OSDI score was negatively correlated with the minimum nerve length ( rs=-0.606, P=0.037) in SS group. Conclusions:Patients with SS dry eye have more nasal conjunctival staining and fewer subjective symptoms than NSS dry eye patients with the same signs, which manifests as a separation of symptoms and signs.

Objective:To compare the efficacy of lateral placement of the intramedullary nail guide pin versus that of median placement of the intramedullary nail guide pin in the closed reduction of metaphyseal fracture of the distal tibia.Methods:A retrospective cohort study was conducted to analyze the clinical data of 48 patients with metaphyseal fracture of the distal tibia who had been admitted to Department of Trauma Orthopaedics, The Second General Hospital of Fuzhou from May 2019 to July 2023. There were 37 males and 11 females, aged (46.0±12.4) years. According to the AO classification, 37 patients were classified as type A1, and 11 ones as type A2. The patients were divided into 2 groups according to the distal positioning of the intramedullary nail guide pins during operation. In the lateral placement group of 26 patients, the distal positioning of the guide pins was located at 1/3 lateral to the articular surface of the distal tibia. In the median placement group of 22 patients, the distal positioning of the guide pins was located at the midpoint of the articular surface of the distal tibia. The operation time, intraoperative blood loss, hospital stay, fracture healing time and fracture reduction were recorded and compared between the 2 groups. Moreover, the visual analogue scale (VAS) pain score, American Orthopedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, and range of motion of the affected ankle were compared between the 2 groups, as well as within the 2 groups. The complications were compared between the 2 groups at the last follow-up.Results:There were no significant differences in the demographic data between the 2 groups, indicating comparability ( P>0.05). All patients were followed up for (19.6±4.4) months. The operation time [(81.7±17.3) min], intraoperative blood loss [(78.4±12.2) mL], hospital stay [(5.7±2.1) d] and fracture healing time [(4.3±1.1) months] in the lateral placement group were significantly less than those in the median placement group [(103.0±13.4) min, (111.4±11.7) ml, (8.6±3.5) d, and (6.1±1.3) months] ( P<0.05). There was no significant difference in the VAS pain score between the 2 groups before operation or at the last follow-up ( P>0.05). At the last follow-up, the AOFAS ankle-hindfoot score [(93.6±1.6) points], ankle dorsiflexion (17.9°±1.6°) and plantar flexion (41.9°±1.9°) in the lateral placement group were significantly better than those in the median placement group [(87.8±3.2) points, 15.1°±1.2°, and 38.5°±2.7°] ( P<0.05). In both groups, significant improvements were achieved at the last follow-up in VAS pain score, the AOFAS ankle-hindfoot score, ankle dorsiflexion and plantar flexion compared with the preoperative period ( P<0.05). The incidence of fracture angulation deformity in the lateral placement group (11.5%, 3/26) was lower than that in the median placement group (31.8%, 7/22) ( P>0.05). There was no significant difference in the incidence of complications between the lateral placement group (3.8%, 1/26) and the central placement group (18.2%, 4/22) ( P>0.05). Conclusion:In the closed reduction of metaphyseal fracture of the distal tibia, compared with median placement of the intramedullary nail guide pin, lateral placement of the intramedullary nail guide pin assisted with a Kirschner wire demonstrates advantages of more rapid and effective closed reduction of the fracture, shortened operation time, reduced intraoperative blood loss and promoted postoperative rehabilitation.

Objective:To compare the efficacy and safety of extended-field versus reduced-field radiotherapy in upper tract urothelial carcinoma (UTUC) patients after radical operation.Methods:A retrospective analysis was conducted on the data of 210 UTUC patients who underwent full-length nephrectomy and received postoperative adjuvant radiotherapy in Peking University First Hospital from January 2013 to November 2023, and follow-up continued until June 2024. According to the target area of postoperative radiotherapy, patients were divided into the extended-field radiotherapy group (127 cases) and the reduced-field radiotherapy group (83 cases). The overall survival (OS), distant metastasis free survival (DMFS), local recurrence free survival (LRFS) and adverse reactions were compared. In the same period, 114 patients with recurrent abdominal and pelvic lymph nodes who did not receive adjuvant therapy after surgery for UTUC in our center were prospectively collected, and the coverage of the reduced-field target area was analyzed. Chi square test was used to compare the clinical characteristics, Kaplan-Meier method was used to analyze survival outcomes, log-rank test was used to compare the survival rate, and Cox multivariate regression analysis was performed on the influencing factors of survival.Results:The median follow-up was 24.5 (range: 3-74) months. There were no significant differences between the extended-field and reduced-field radiotherapy groups in terms of 2-year LRFS (93.3% vs. 98.1%, P=0.156), 2-year DMFS (84.8% vs. 91.2%, P=0.176), and 2-year OS (90.4% vs. 90.7%, P=0.707). The most common toxicities of adjuvant radiotherapy were nausea and leukopenia, with significantly higher grade 1-2 incidence in the extended-field group compared to the reduced-field group ( P<0.05). According to the analysis of patients with retroperitoneal lymph node recurrence after surgery, the reduced-field target designed according to the location of the primary tumor can cover more than 90% of the postoperative metastatic lymph node area Multivariate analysis revealed that variant histology ( HR=2.180,95% CI: 1.021-4.658, P=0.044) was an independent predictor of worse DMFS, while variant histology ( HR=3.825,95% CI: 1.514-9.662, P=0.005) and T 3-4 stage ( HR=4.452,95% CI: 1.025-19.339, P=0.046) were independent predictors of poorer OS. Conclusions:Compared with extended-field radiotherapy, reduced-field radiotherapy designed based on primary tumor location significantly reduced treatment-related toxicities without compromising postoperative therapeutic efficacy, and the reduced-field can cover more than 90% of local recurrent lesions.

Objective:To evaluate the acute toxicities and related influencing factors of vertebral-body-sparing proton craniospinal irradiation (VBSpCSI) using pencil beam scanning (PBS) technology in pediatric patients, and to assess spinal growth and survival outcomes.Methods:A retrospective analysis was conducted on 70 pediatric patients treated with PBS-based VBSpCSI at Hebei Yizhou Cancer Hospital between January 2020 and December 2022, and continued to follow up until November 2023. Acute toxicities were assessed, and linear regression analysis combined with receiver operating characteristic curve were employed to investigate the dose-effect relationship between vertebral dose and toxicities. Spinal growth after radiotherapy was evaluated by measuring the Cobb angle on follow-up MRI. Overall survival (OS) and progression-free survival (PFS) were estimated using the Kaplan-Meier method.Results:The median age of patients at the time of irradiation was 6 years (range, 2-16 years). Two patients (3%) developed grade ≥3 gastrointestinal toxicities, while 7 patients (10%) experienced grade 1 radiation-induced esophagitis. The nadirs of white blood cell count (WBC), absolute neutrophil count (ANC), and absolute lymphocyte count (ALC) during treatment were significantly negatively correlated with vertebral V 5 Gy ( P=0.009, 0.006, 0.001) and vertebral V 20 Gy ( P=0.007, 0.011, <0.001). When vertebral V 5 Gy<86.5% and vertebral V 20 Gy<73.2%, the incidence of grade ≥3 myelosuppression was significantly reduced ( P<0.001, =0.001). Additionally, younger patient age (in months) and concurrent chemotherapy were also significantly associated with increased acute hematologic toxicity. Among 43 patients with MRI follow-up, no scoliosis, kyphosis, or chronic lumbosacral pain was observed. The 3-year OS and PFS rates were 95.7% and 86.4%, respectively. Conclusions:PBS-based VBSpCSI in pediatric patients demonstrates manageable acute toxicities, with a clear dose-effect relationship between vertebral V 5 Gy , V 20 Gy and hematologic toxicities, and the incidence of non-hematological toxicities remains low. No adverse effects on spinal growth or survival outcomes were observed in the short term.