Objective:There are significant differences in the distribution of gut microbiota among different populations in different regions.This study mainly explores the structure and distribution of gut microbiota between cow's milk protein allergy（CMPA）children and healthy children in Xiamen,Fujian,and further explores the correlation between gut microbiota and the occurrence and development of CMPA.Methods:Fecal samples have been collected from 30 children with CMPA diagnosed at Xiamen Children’s Hospital from June 2022 to March 2023,and fecal samples from 30 healthy children of the same age have also been collected.The structure and distribution of gut microbiota between the two groups were analyzed using 16S rDNA gene sequencing and bioinformatics analysis.Results:The structure and distribution of gut microbiota between CMPA children and healthy children were quite different.There were no significant differences in α diversity index between groups（ P>0.05）.The analysis of similarities test results showed that there was a significant difference in the distribution of gut microbiota between two groups（ R=0.037, P<0.05）.The β diversity index from PCA showed that there was a significant difference in bacterial community structure between two groups（ P<0.05）.Compared with healthy children,the abundance of Akkermansia in CMPA children was significantly decreased and the abundance of Corynebacterium was significantly increased in CMPA children.LEfSe showed that Proteobacteria were mainly enriched in CMPA children,while Lachnospiraceae were mainly enriched in healthy children.In addition,KEGG analysis showed that the top enrichment of 20 pathways,such as Fructose and mannose metabolism,was significantly decreased in CMPA children（ P<0.05）.COG analysis showed that the enrichment of pathways such as Galactose mutarotase and related enzymes was significantly decreased in CMPA children（ P<0.05）,while the enrichment of pathways including Predicted metal-sulfur cluster biosynthetic enzyme and other two pathways was significantly increased（ P<0.05）. Conclusion:There are significant differences in the structure and distribution of gut microbiota between CMPA children and healthy children,suggesting that a strong correlation between the occurrence and development of CMPA and the gut microbiota.

Metabolic acidosis is a prevalent complication in patients undergoing maintenance hemodialysis(MHD).The maintenance of acid-base balance in MHD patients primarily relies on the total alkali supply in the dialysate.Achieving an optimal concentration of dialysate bicarbonate(DBIC)is crucial to prevent metabolic acidosis before subsequent hemodialysis sessions while avoiding metabolic alkalosis after the current session.Inad-equate correction or overcorrection of pre-dialysis metabolic acidosis has been associated with unfavorable patient outcomes;however,there is currently a lack of guidelines or expert consensus regarding DBIC concentration.This study addresses the epidemiology of metabolic acidosis in MHD patients,explores the relationship between DBIC concentration and acid-base disorders,and discusses recent advancements in determining the ideal DBIC concentration,providing valuable insights for formulating scientifically sound and personalized DBIC dialysis prescriptions.

Objective:To investigate the relationship between non-alcoholic fatty liver disease(NAFLD) and hepatic fibrosis and skeletal muscle mass in patients with type 2 diabetes mellitus(T2DM).Methods:A total of 685 T2DM patients diagnosed at the Endocrinology department of Lanzhou University First Hospital, from April 2022 to May 2023, were divided into NAFLD and Non-NAFLD groups, and the NAFLD group was further categorized into fibrosis and non-fibrosis based on aspartate aminotransferase(AST) /alanine aminotransferase(ALT) level. The differences in appendicular skeletal muscle mass(ASM), appendicular skeletal muscle mass index(ASMI), and the prevalence of muscle mass loss were compared across groups. The correlations between ASMI and NAFLD, as well as liver fibrosis were analyzed by binary logistic regression.Results:Among male T2DM patients, those with NAFLD had lower ASMI levels and a higher prevalence of muscle mass reduction compared to non-NAFLD group. Among female T2DM patients, those with NAFLD had lower levels of ASM and ASMI, and a higher prevalence of muscle mass reduction compared to non-NAFLD group. ASMI levels in both male and female T2DM patients were independently negatively correlated with NAFLD risk( OR=-0.696, 95% CI 0.579-0.837; OR=-0.757, 95% CI 0.629-0.911). In NAFLD patients, ASM and ASMI levels were lower in those with liver fibrosis compared to those without fibrosis; however, the prevalence of muscle mass reduction did not differ significantly. Among male NAFLD patients, ASMI levels were independently negatively correlated with the risk of liver fibrosis( OR=-0.726, 95% CI 0.537-0.983), while no correlation was found in female patients. Conclusion:Reduced muscle mass is independently associated with the risk of NAFLD in both male and female T2DM patients. In males, reduced muscle mass is also independently related to the risk of liver fibrosis.

Purpose: This study aims to elucidate the longitudinal alterations in frailty and health-related quality of life experienced by elderly patients undergoing surgical treatment for esophageal cancer. Additionally, it seeks to ascertain the impact of preoperative frailty on postoperative health-related quality of life over time. Methods: 131 patients were included in the prospective study. Patients' frailty and health-related quality-of-life were assessed utilizing the Tilburg and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 at preoperative, 1 week, 1 month, and 3 months, postoperatively. Statistical analyses were performed using generalized estimating equations, repeated-measures analysis of variance, and linear mixed models (LMMs). Results: Out of 131 patients, 28.2% had frailty before surgery, and the prevalence of frailty consistently higher after surgery compared with baseline (67.9%, 51.9%, and 39.7%). There was no significant change in frailty scores in preoperative frail patients within 3 months following surgery (p = .496, p < .999, p < .999); whereas in preoperative non-frail patients, the frailty scores increased at 1 week (p < .001) and then decreased at 1 month (p = .014), followed by no change at 3 months. In addition, preoperative frail patients had significantly worse global quality-of-life (β = −4.24 (−8.31; −.18), p = .041), physical functioning (β = −9.87 (−14.59; −5.16), p < .001), role functioning (β = −10.04 (−15.76; −4.33), p = .001), and social functioning (β = −8.58 (−15.49; −1.68), p = .015), compared with non-frail patients. Conclusions A significant proportion of participants exhibited a high prevalence of preoperative frailty. These patients, who were preoperatively frail, exhibited a marked reduction in health-related quality-of-life, a more gradual recovery across various functional domains, and an increased symptom burden during the follow-up period. Therefore, it is crucial to meticulously identify and closely monitor patients with preoperative frailty for any changes in their postoperative physiology, role, and social functioning.

Trimethylamine N-oxide (TMAO) is an intestinal flora metabolite produced in the liver by the oxidation of trimethylamine (TMA) by hepatic enzymes. Recently, it has been found that plasma TMAO levels play an important role in the development and progression of osteoporosis. This review has presented the physiological functions and metabolic processes of TMAO, and its effects on the development and progression of osteoporosis through oxidative stress and inflammation. Plasma TMAO levels are influenced by diet as well as medications, which provides a new perspective and target for the treatment and prevention of osteoporosis.

Objective:To analyze the preliminary explorations and practical effects of strengthening the process management of nursing special projects in a tertiary general hospital, so as to explore the refined management strategy of hospital projects and provide reference for improving the management level of the research project.Methods:This article takes a series of refined measures taken by the hospital in the process management of nursing special projects from August 2016 to August 2021 as the research example, including setting up subject directions around key disciplines, setting application conditions at different levels, standardizing selection procedures, strengthening mid-term assessments, strictly controlling final acceptance, establishing integrity files, and promoting the transformation of scientific achievements, etc. and these measures are deeply analyzed and discussed.Results:Through a series of measures, the hospital nursing team has significantly improved in terms of research paper publication, patent authorization, approval of projects above the bureau level, and nursing specialties ranking of Chinese hospital Science and Technology Evaluation Metrics (STEM) in the past six years.Conclusions:By strengthening the process management of nursing special research project, the construction level of nursing disciplines has been significantly improved, and the development of nursing disciplines has been greatly promoted.

Objective:To explore the clinical value of 18F-fluoromisonidazole (FMISO) PET/CT hypoxia imaging in early response to heavy ion radiotherapy in patients with non-small cell lung cancer(NSCLC). Methods:From April 2018 to January 2021, the 18F-FMISO PET/CT images of 23 NSCLC patients (19 males, 4 females; age (64.9±10.3) years) who received heavy ion radiotherapy in Shanghai Proton and Heavy Ion Center were retrospectively analyzed. The evaluation parameters included tumor volume (TV), tumor to background ratio (TBR) before and after radiotherapy. Patients were divided into hypoxia group and non-hypoxia group with the baseline TBR value≥1.4 as hypoxia threshold. Wilcoxon signed rank test was used to compare the differences of TV and TBR before and after radiotherapy in 2 groups. Results:Of 23 NSCLC patients, 17 were hypoxia and 6 were non-hypoxia. Compared with the baseline, TV after the radiotherapy (59.44(22.86, 99.43) and 33.78(8.68, 54.44) cm 3; z=-3.05, P=0.002) and TBR after the radiotherapy (2.25(2.09, 2.82) and 1.42(1.24, 1.67); z=-3.39, P=0.001) of the hypoxia group were significantly lower, while TV (16.19(6.74, 36.52) and 8.59(4.38, 25.47) cm 3; z=-1.57, P=0.120) and TBR (1.19(1.05, 1.27) and 1.10 (0.97, 1.14); z=-1.89, P=0.060) of the non-hypoxia group decreased with no significant differences. Conclusions:Hypoxic NSCLC tumors are sensitive to heavy ion radiation. Compared with non-hypoxic tumors, hypoxic tumors respond more quickly, and a significant reduction in TV can be observed early after radiotherapy. Heavy ion radiation can significantly improve tumor hypoxia.

Objective:To understand the clinical application of diet management evidence during dialysis in maintenance hemodialysis (MHD) patients, analyze facilitators/barriers and develop intervention strategies, so as to provide reference for the conversion of evidence-based evidence into clinical practice.Methods:From January to February 2022, 131 persons related to diet management of MHD patients during dialysis were selected from Suzhou Hospital Affiliated to Nanjing Medical University (Suzhou Municipal Hospital) by convenience sampling, including 3 hemodialysis doctors, 7 hemodialysis nurses, and 121 MHD patients. We introduced 7 pieces of evidence of diet management for MHD patients during dialysis, developed 17 review indicators based on the evidence, and conducted a clinical status review. Based on the review results, we conducted an analysis of facilitators and barriers.Results:The clinical compliance rate of 17 review indicators ranged from 0 to 71.29%. The standardized scores of patients' diet management knowledge, beliefs, and behaviors were 26.00%, 61.88%, and 67.82%, respectively, while the standardized scores of medical and nursing diet management knowledge, beliefs, and behaviors were 42.20%, 68.00%, and 64.00%, respectively. The facilitators included the high validation importance and feasibility of each item in the evidence, the willingness of medical and nursing staff and patients to learn about diet management knowledge, the availability of ordering services in the cafeteria, the availability of a hemodialysis information system, and the pre dialysis evaluation and post dialysis evaluation stages. Barriers mainly included unclear explanation of evidence items, lack of practical details, lack of ways to learn diet management knowledge, single form of education channels, conflicts with patients' traditional dietary habits, difficulty in obtaining food that met the requirements of the conditions, lack of a comprehensive diet management process, lack of diet management teams, and lack of evaluation standards for diet management and lack of practical guidance.Conclusions:The evidence of diet management during dialysis in MHD patients has not yet been effectively translated into clinical practice. An evidence-based practice plan should be constructed based on the analysis of facilitators/barriers and intervention strategies to shorten the gap between clinical practice and evidence.

Objective:To analyze the clinical outcome of nasal symptoms in patients with pituitary lesions after transsphenoidal surgery by microscope.Methods:A perspective study was performed; 53 patients with pituitary lesions treated by transsphenoidal microsurgery in our hospital from March 2012 to January 2013 were enrolled. Sinonasal outcome test (SNOT)-22 was used to evaluate the nasal symptoms in these patients before surgery, and 1 week, 1 month and 4 months after surgery; Toyota and Takagi (T&T) olfactometer was used to evaluate the olfaction before surgery, and 1 week and 4 months after surgery.Results:Among the 53 patients, 47 were with pituitary adenoma and 6 were with Rathke cysts. The common postoperative nasal symptoms included olfactory disorder, nasal obstruction, runny nose, pain in the nasal cavity and dizziness. The total scores and 5-items scores of SNOT-22 in patients 1 week and 1 month after surgery were significantly higher as compared with those before surgery ( P<0.05); there were no significant differences in these scores between before surgery and 4 months after surgery ( P>0.05). The incidence of olfactory disorder in patients 1 week and 4 months after surgery was significantly higher than that before surgery ( P<0.05); the incidence of olfactory disorder in patients 4 months after surgery was decreased as compared with that 1 week after surgery, without significant difference ( P>0.05). Conclusion:Olfactory disorder can occur to some extent after transsphenoidal approach with slow recovery, which deserves the attentions.

In this paper, combined with the characteristics of rotational learning of dermatologists, we have taken various measures such as improving the scientific research training system, strengthening the awareness of scientific research, optimizing the teaching mode, adding new assessment mechanism, hand-in-hand teaching and other measures to realize the close combination of clinical and scientific research, and lay a solid foundation for the cultivation of high-quality innovative talents in dermatology.