In the era of evidence-based medicine， the progress of medical science and technology has enriched medical diagnostic tools and treatment methods， but it has also led to the loss of medical warmth and the alienation of the doctor-patient relationships. William Osler emphasized that while medical technology advances， attention should also be paid to the practice of narrative medicine and the development of physician’s narrative literacy. The view of the physician he advocated reminds us that the core of medicine still lies in the narrative connection between doctors and patients， as well as a deep understanding of human nature. By exploring the relationship between Osler’s view of the physician and narrative medicine as well as physician’s narrative literacy， this paper analyzed the methods of cultivating physician’s narrative literacy， providing references for modern medical education and practice， and assisting in the harmony and unity of science and technology and humanity.

Objective:To investigate the iodine nutrition status of children aged 8-10 and pregnant women in Longxi County, Gansu Province.Methods:Descriptive epidemiological method was used to analyze the water iodine monitoring data in 2017 and the iodine deficiency disorders monitoring data from 2017 to 2023 in Longxi County (sourced from the Institute for Endemic Disease Prevention and Control of Gansu Provincial Center for Disease Control and Prevention), including the data of water iodine, salt iodine and urinary iodine levels of children aged 8 to 10 and pregnant women, and children's thyroid B-mode ultrasound examination results. Iodine nutrition was evaluated based on the "Guidelines for Monitoring Salt Iodization Projects and Determining Population Iodine Nutrition".Results:In 2017, a total of 85 water samples were collected, with a median iodine level of 1.6 μg/L, ranging from 0.2 to 10.9 μg/L. Except for one water sample with an iodine level of 10.9 μg/L, the iodine level of all other water samples was less than 10 μg/L. From 2017 to 2023, a total of 1 585 children and 718 pregnant women were monitored. The urinary iodine levels were 190.8 (120.2, 252.2), 137.0 (79.8, 195.8) μg/L, respectively. The coverage rate of iodized salt in Longxi County from 2017 to 2023 ranged from 99.4% to 100%, the consumption rate of qualified iodized salt ranged from 61.8% to 93.0%, and the qualified rate of iodized salt ranged from 62.1% to 93.0%. The median range of the urinary iodine for children in Longxi County was 125.9 to 228.5 μg/L. There was a statistically significant difference in the urinary iodine levels among children from different years ( P < 0.001). There was no statistically significant difference in urinary iodine levels among children of different genders and ages ( P > 0.05). There were statistically significant differences in the composition ratio of iodine nutrition status among children of different years, genders, and ages ( P < 0.05). The median range of urinary iodine in pregnant women was 121.0-180.5 μg/L. Except for 2017, the median urinary iodine of pregnant women in all other years was less than 150 μg/L. There were statistically significant differences in the urinary iodine levels and composition ratio of iodine nutrition status among pregnant women in different years ( P < 0.001). There was no statistically significant difference ( P > 0.05) in the urinary iodine levels and composition ratio of iodine nutrition status among pregnant women during different stages of pregnancy, and all pregnant women were iodine deficient in the early, middle, and late stages (median urinary iodine < 150 μg/L). Six hundred and sixty-five children underwent B-mode ultrasound examination, with a goiter rate ranging from 0 to 5.0%. Conclusion:From 2017 to 2023, the iodine nutrition of children aged 8 to 10 in Longxi County is in an appropriate state, while the iodine nutrition of pregnant women is in a deficiency state.

The aim of this experiment was to study the effects of different feeding modes on growth performance,blood biochemical indexes and intestinal flora of lactating Holstein male calves.Twenty-four newborn Holstein male calves with body mass of(40.00±1.01)kg and similar day old were selected and randomly divided into four groups of six calves each.The subgroups were low-milk group(LM),high-milk group(HM),high-milk milk replacer feeding group(HMR),and low-milk switching to high-milk milk replacer feeding group(CMR).The results showed that:At 45 d,the body mass of calves in the HM group was significantly higher than that of calves in the other groups(P＜0.05),and at 60 d,the body mass of calves in the HM group was significantly higher than that of calves in the LM &.CMR groups(P＜0.05).At 90 d,the body mass of calves in the LM group was significantly higher than that of calves in the HM group.Throughout the ex-perimental period,the average daily weight gain and average pellet feed intake of calves in the LM group were significantly higher than that of calves in the HM group(P＜0.05).The calf globulin level in the HMR group was significantly higher than that in the LM and HM groups(P＜0.05);the plasma immunoglobulin A level of calves in the HM group was significantly lower than that of calves in the LM and HMR groups(P＜0.05);and the plasma immunoglobulin M level of calves in the HM group was significantly higher than that of calves in the LM and CMR groups(P＜0.05),and HMR group was also significantly higher than that of LM group(P＜0.05);plasma glutathione peroxidase level of calves in HMR group was significantly higher than that of LM group(P＜0.05);plasma malondialdehyde level of calves in LM group was significantly higher than that of calves in HMR and HM groups(P＜0.05),and CMR group was also significantly higher than that of HM group(P＜0.05).Relative abundance of Thermodesulfovibrio was higher in the HM group(P＜0.05),relative abundance of Bacteroidetes in the LM group was significantly higher than that in the HMR and HM groups(P＜0.05),relative abundance of Blautia in the HM group(P＜0.05),and relative abundance of Corynebacterium in the CMR group was significantly higher than that in the LM and HM groups(P＜0.05).In summary,calves in the LM group had better weaning weights and pellet feed intake;calves in the CMR group could compensate for growth by supplemental feeding of milk replacer to obtain more optimal weaning weights and pel-let feed intake;the HMR group proved that milk-free feeding could ensure stable growth of calves;and calves in the HM group had a better pre-lactation growth performance,lower levels of oxida-tive stress,and a healthier fecal flora.

Objective:To investigate the effects of short-peptide-based enteral nutrition on nutritional status, immune function, and chemotherapy-related adverse reactions in children with acute lymphoblastic leukemia (ALL).Methods:A total of 106 children with ALL receiving chemotherapy at the Affiliated Hospital of Jining Medical University between January 2021 and April 2022 were enrolled. According to the principle of between-group baseline data matching, the patients were divided into observation group and control group by random number table method, with 53 cases in each group. All patients received chemotherapy according to the CCCG-ALL-2020 protocol established by the Multi-center Cooperative Group of the Chinese Society of Pediatric Oncology (2020). The control group received a regular diet, while the observation group received a regular diet supplemented with short-peptide-based enteral nutrition. The incidence rates of malnutrition, hypoproteinemia, hypoalbuminemia, abnormal immunoglobulin levels (IgG, IgM, IgA), and adverse reactions (liver injury, infection) were compared between both groups before chemotherapy and at the end of each of the following seven chemotherapy phases: Induction remission therapy (PVDL), Induction remission therapy (CAT), Early intensification therapy (CAT+), Consolidation therapy (HDMTX), Interim maintenance therapy, Reinduction therapy, and prior to the end of Maintenance therapy. Normally or approximately normally distributed measurement data were expressed as xˉ± s and compared by independent samples t-test. Counting data were expressed as n (%) and compared by χ2 test. Results:During the CAT phase, the incidence of malnutrition was significantly lower in the observation group than in the control group [20.8% (11/53) vs. 39.6% (21/53), χ2=4.48, P=0.034]. The incidence of hypoproteinemia was significantly lower in the observation group during HDMTX, Reinduction, Interim maintenance, and prior to the end of Maintenance therapy [47.2% (25/53) vs. 69.8% (37/53), χ2=5.60, P=0.018; 45.3% (24/53) vs. 67.9% (36/53), χ2=5.53, P=0.019; 41.5% (24/53) vs. 64.2% (34/53), χ2=5.45, P=0.020; 28.3% (15/53) vs. 54.7% (29/53), χ2=7.62, P=0.006, respectively]. The incidence of hypoalbuminemia was significantly lower in the observation group during CAT+, HDMTX, Reinduction, Interim maintenance, and prior to the end of Maintenance therapy [5.7% (3/53) vs. 22.6% (12/53), χ2=6.29, P=0.012; 9.4% (5/53) vs. 26.4% (14/53), χ2=5.19, P=0.023; 9.4% (5/53) vs. 28.3% (15/53), χ2=6.16, P=0.013; 7.6% (4/53) vs. 24.5% (13/53), χ2=5.68, P=0.017; 3.8% (2/53) vs. 18.9% (10/53), χ2=6.01, P=0.014, respectively]. For IgG, incidence was significantly lower in the observation group during Interim maintenance, Reinduction, and prior to the end of Maintenance therapy [7.6% (4/53) vs. 22.6% (12/53), χ2=4.71, P=0.030; 20.8% (11/53) vs. 39.6% (21/53), χ2=4.48, P=0.034; 11.3% (6/53) vs. 26.4% (14/53), χ2=3.94, P=0.047, respectively]. For IgM, incidence was significantly lower in the observation group during the CAT and CAT+ phases [45.3% (24/53) vs. 66.0% (35/53), χ2=4.63, P=0.032; 58.5% (31/53) vs. 77.4% (41/53), χ2=4.33, P=0.037, respectively]. For IgA, incidence was significantly lower in the observation group during Reinduction therapy and Interim maintenance [22.6% (12/53) vs. 45.3% (24/53), χ2=6.06, P=0.014; 9.4% (5/53) vs. 24.5% (13/53), χ2=4.28, P=0.038, respectively]. For liver injury, incidence was significantly lower in the observation group during the CAT, CAT+, and prior to the end of Maintenance phases [22.6% (12/53) vs. 43.4% (23/53), χ2=5.16, P=0.023; 26.4% (14/53) vs. 50.9% (27/53), χ2=6.72, P=0.010, 11.3% (6/53) vs. 26.4%(14/53), χ2=3.94、 P=0.047,respectively]. For infection, incidence was significantly lower in the observation group during the CAT+ and HDMTX phases [35.9% (19/53) vs. 56.6% (30/53), χ2=4.59, P=0.032; 24.5% (13/53) vs. 43.4% (23/53), χ2=4.21, P=0.040, respectively]. Conclusions:Short-peptide-based enteral nutrition demonstrates significant advantages in the treatment of pediatric ALL. It provides substantial support for patient treatment and recovery by improving nutritional status, modulating immune function, and reducing chemotherapy-related adverse reactions.

Root caries is a prevalent chronic oral disease with an average global prevalence of 41.5%, characterized by high incidence, low rate of treatment, and high rate of retreatment. Root caries is primarily caused by core microbiome-induced dysbiosis and has multiple risk factors, including gingival recession, root surface exposure, and salivary dysfunction. The traditional preventive measures and treatments such as fluoride, mineralizing agents, and restorative materials, are unable to restore or maintain oral microecological homeostasis. Recent studies have demonstrated that probiotics, prebiotics, synbiotics, and antimicrobial peptides may prevent and treat root caries by reversing dysbiosis. In addition, these biotherapeutics can reduce acid production by acidiferous bacteria, promote alkali production (hydrogen peroxide and ammonia) by alkali-producing bacteria, inhibit biofilm formation, decrease extracellular polysaccharide production, and suppress microbial adhesion and aggregation. It is expected to play an important role in the prevention and control of root caries. This article aims to review oral probiotics (Streptococcus oligofermentans, Streptococcus oralis subsp. dentisani, and Streptococcus salivarius), prebiotics (arginine, nitrates, and synthetic compounds), synbiotics, and antimicrobial peptides (gallic acid-polyphemusin I and LH12) to provide evidence and guidance for root caries management through microecological modulation.

T-cell acute lymphoblastic leukemia (T-ALL) is a highly aggressive hematologic malignancy with a poor prognosis, despite advancements in treatment. Many patients struggle with relapse or refractory disease. Investigating the role of the super-enhancer (SE) regulated gene ubiquitin-specific protease 20 (USP20) in T-ALL could enhance targeted therapies and improve clinical outcomes. Analysis of histone H3 lysine 27 acetylation (H3K27ac) chromatin immunoprecipitation sequencing (ChIP-seq) data from six T-ALL cell lines and seven pediatric samples identified USP20 as an SE-regulated driver gene. Utilizing the Cancer Cell Line Encyclopedia (CCLE) and BloodSpot databases, it was found that USP20 is specifically highly expressed in T-ALL. Knocking down USP20 with short hairpin RNA (shRNA) increased apoptosis and inhibited proliferation in T-ALL cells. In vivo studies showed that USP20 knockdown reduced tumor growth and improved survival. The USP20 inhibitor GSK2643943A demonstrated similar anti-tumor effects. Mass spectrometry, RNA-Seq, and immunoprecipitation revealed that USP20 interacted with hypoxia-inducible factor 1 subunit alpha (HIF1A) and stabilized it by deubiquitination. Cleavage under targets and tagmentation (CUT&Tag) results indicated that USP20 co-localized with HIF1A, jointly modulating target genes in T-ALL. This study identifies USP20 as a therapeutic target in T-ALL and suggests GSK2643943A as a potential treatment strategy.

Objective:To construct a training program for expert patients with type 2 diabetes mellitus (T2DM), so as to provide reference for T2DM education and management.Methods:Guided by the iceberg quality model, a preliminary training program was developed based on literature analysis and qualitative interviews. Using convenience sampling method, 22 experts were selected for two rounds of Delphi expert consultation from March to April 2024, and the final draft of the training program was discussed and revised based on the experts' opinions.Results:In the two rounds of expert consultation, the effective response rates of the questionnaire were 100.00% (22/22) and 95.45% (21/22), respectively, and the authority coefficient of the experts was all 0.905. The Kendall harmony coefficients ranged from 0.110 to 0.293 and 0.139 to 0.301, respectively ( P<0.05). The finalized training program included five modules of training content, assessment evaluation, training instructors, training time, and training forms. Conclusions:The constructed training program for expert patients with T2DM is scientific, reliable, and comprehensive, which can provide guidance for the next step of T2DM expert patient training.

Objective:To investigate the iodine nutrition status of children aged 8-10 and pregnant women in Longxi County, Gansu Province.Methods:Descriptive epidemiological method was used to analyze the water iodine monitoring data in 2017 and the iodine deficiency disorders monitoring data from 2017 to 2023 in Longxi County (sourced from the Institute for Endemic Disease Prevention and Control of Gansu Provincial Center for Disease Control and Prevention), including the data of water iodine, salt iodine and urinary iodine levels of children aged 8 to 10 and pregnant women, and children's thyroid B-mode ultrasound examination results. Iodine nutrition was evaluated based on the "Guidelines for Monitoring Salt Iodization Projects and Determining Population Iodine Nutrition".Results:In 2017, a total of 85 water samples were collected, with a median iodine level of 1.6 μg/L, ranging from 0.2 to 10.9 μg/L. Except for one water sample with an iodine level of 10.9 μg/L, the iodine level of all other water samples was less than 10 μg/L. From 2017 to 2023, a total of 1 585 children and 718 pregnant women were monitored. The urinary iodine levels were 190.8 (120.2, 252.2), 137.0 (79.8, 195.8) μg/L, respectively. The coverage rate of iodized salt in Longxi County from 2017 to 2023 ranged from 99.4% to 100%, the consumption rate of qualified iodized salt ranged from 61.8% to 93.0%, and the qualified rate of iodized salt ranged from 62.1% to 93.0%. The median range of the urinary iodine for children in Longxi County was 125.9 to 228.5 μg/L. There was a statistically significant difference in the urinary iodine levels among children from different years ( P < 0.001). There was no statistically significant difference in urinary iodine levels among children of different genders and ages ( P > 0.05). There were statistically significant differences in the composition ratio of iodine nutrition status among children of different years, genders, and ages ( P < 0.05). The median range of urinary iodine in pregnant women was 121.0-180.5 μg/L. Except for 2017, the median urinary iodine of pregnant women in all other years was less than 150 μg/L. There were statistically significant differences in the urinary iodine levels and composition ratio of iodine nutrition status among pregnant women in different years ( P < 0.001). There was no statistically significant difference ( P > 0.05) in the urinary iodine levels and composition ratio of iodine nutrition status among pregnant women during different stages of pregnancy, and all pregnant women were iodine deficient in the early, middle, and late stages (median urinary iodine < 150 μg/L). Six hundred and sixty-five children underwent B-mode ultrasound examination, with a goiter rate ranging from 0 to 5.0%. Conclusion:From 2017 to 2023, the iodine nutrition of children aged 8 to 10 in Longxi County is in an appropriate state, while the iodine nutrition of pregnant women is in a deficiency state.

The aim of this experiment was to study the effects of different feeding modes on growth performance,blood biochemical indexes and intestinal flora of lactating Holstein male calves.Twenty-four newborn Holstein male calves with body mass of(40.00±1.01)kg and similar day old were selected and randomly divided into four groups of six calves each.The subgroups were low-milk group(LM),high-milk group(HM),high-milk milk replacer feeding group(HMR),and low-milk switching to high-milk milk replacer feeding group(CMR).The results showed that:At 45 d,the body mass of calves in the HM group was significantly higher than that of calves in the other groups(P＜0.05),and at 60 d,the body mass of calves in the HM group was significantly higher than that of calves in the LM &.CMR groups(P＜0.05).At 90 d,the body mass of calves in the LM group was significantly higher than that of calves in the HM group.Throughout the ex-perimental period,the average daily weight gain and average pellet feed intake of calves in the LM group were significantly higher than that of calves in the HM group(P＜0.05).The calf globulin level in the HMR group was significantly higher than that in the LM and HM groups(P＜0.05);the plasma immunoglobulin A level of calves in the HM group was significantly lower than that of calves in the LM and HMR groups(P＜0.05);and the plasma immunoglobulin M level of calves in the HM group was significantly higher than that of calves in the LM and CMR groups(P＜0.05),and HMR group was also significantly higher than that of LM group(P＜0.05);plasma glutathione peroxidase level of calves in HMR group was significantly higher than that of LM group(P＜0.05);plasma malondialdehyde level of calves in LM group was significantly higher than that of calves in HMR and HM groups(P＜0.05),and CMR group was also significantly higher than that of HM group(P＜0.05).Relative abundance of Thermodesulfovibrio was higher in the HM group(P＜0.05),relative abundance of Bacteroidetes in the LM group was significantly higher than that in the HMR and HM groups(P＜0.05),relative abundance of Blautia in the HM group(P＜0.05),and relative abundance of Corynebacterium in the CMR group was significantly higher than that in the LM and HM groups(P＜0.05).In summary,calves in the LM group had better weaning weights and pellet feed intake;calves in the CMR group could compensate for growth by supplemental feeding of milk replacer to obtain more optimal weaning weights and pel-let feed intake;the HMR group proved that milk-free feeding could ensure stable growth of calves;and calves in the HM group had a better pre-lactation growth performance,lower levels of oxida-tive stress,and a healthier fecal flora.