Objective To present a novel method based on the image enhancement algorithm and deep learning for automatically classifying diabetic retinopathy images,and realizing the graded classification of fundus lesions.Methods An improved Retinex image enhancement algorithm was employed to preprocess the original images for significantly improving image quality and visual effect,and enhancing image clarity and contrast.Then,deep learning method was used to automatically detect and classify the degree of lesions in different periods.Results The proposed method was advantageous in improving classification accuracy,sensitivity,and specificity which were 5.4%,7.4%,and 16.6%higher than those of traditional Retinex method.Conclusion The proposed method can effectively realize the automatic detection and classification of diabetic retinopathy,which is helpful to enhance diagnostic accuracy and efficiency.

Objective:To systematically appraise and summarize existing evidence on enteral nutrition in patients receiving radiotherapy for head and neck cancer.Methods:Based on the 6S Pyramid of Evidence-based Resources, a systematic search was conducted to identify guidelines, expert consensuses, and evidence summaries related to enteral nutrition for radiotherapy patients with head and neck cancer published from January 2018 to September 2023. The search covered relevant websites of guidelines, websites of academic societies, and databases (in Chinese and English). Literature screening, quality assessment, and data extraction were performed independently by the researchers.Results:A total of 19 studies were included, consisting of 10 guidelines, 7 expert consensuses, and 2 evidence summaries. Four aspects and 67 items of best evidence on organizational management, nutritional screening and assessment, enteral nutritional intervention programs, and monitoring and follow-up were summarized.Conclusion:This study summarized the best evidence for enteral nutrition in patients receiving radiotherapy for head and neck cancer, which can inform the standardized nutritional management and promote the translation of evidence-based knowledge into practice.

Objective:To summarize the evidence on nutritional management for elderly cancer patients domestically and internationally.Methods:Literature on nutritional management of elderly cancer patients was systematically searched on databases and websites such as British Medical Journal (BMJ) Best Practice, UpToDate, Guidelines International Network, Agency for Healthcare Research and Quality, Cochrane Library, Web of Science, Embase, PubMed, China National Knowledge Infrastructure, WanFang Data, National Comprehensive Cancer Network and American Cancer Society. The search period was from January 2018 to February 2023. Three researchers evaluated the quality of the included literature, while two researchers extracted and summarized evidence.Results:A total of 10 articles were included, including two clinical decisions, four guidelines, one expert consensus, one evidence summary, and two systematic reviews. A total of 32 pieces of evidence were summarized from three aspects, consisting of nutritional risk screening and assessment, nutritional education or counseling, and nutritional intervention.Conclusions:This study summarizes the best evidence for nutritional management in elderly cancer patients. It is recommended that medical and nursing staff apply evidence based on clinical situations and patient preferences.

Objective:To summarize the evidence from guidelines, consensus and systematic reviews and provide the optimal recommendations on the management of oral and pharyngeal symptom cluster in patients with head and neck cancer during radiotherapy.Methods:National Guidelines Clearinghouse and databases such as CNKI and PubMed were searched for publications on pain management from January 2016 to March 2023, and for publications on other symptom management from the establishment of database to March 2023. Quality of included articles was evaluated, data were extracted, and evidence were synthesized.Results:We included 28 guidelines, 19 expert consensus, and 16 systematic reviews. The evidence synthesis included 144 items covering 12 aspects, namely general principles, assessment, optimizing radiotherapy plan, oral care, swallowing function intervention, nutritional management, psychosocial intervention, physical intervention, medication, other interventions, health education, and follow-up.Conclusion:Evidence about the management of oral and pharyngeal symptom cluster was adequate. Considering the interaction between various symptoms, healthcare professionals could integrate management measures and construct multimodal management plan for the management of oral and pharyngeal symptom cluster in patients with head and neck cancer during radiotherapy.

Objective:To explore the taste alterations and nutritional status of lung cancer patients during chemotherapy, and analyze the correlation between the two.Methods:From June to December 2021, continuous fixed-point sampling was used to select lung cancer inpatients receiving chemotherapy in the Department of Thoracic Medicine of Beijing Cancer Hospital, Peking University. The patients' taste alterations were evaluated using the Chemotherapy-induced Taste Alteration Scale (CiTAS), and their nutritional status was evaluated using the Nutritional Risk Screening 2002 (NRS 2002) and the Global Leadership Initiative on Malnutrition (GLIM). The patients' weight and calf circumference were also measured. Taste alterations were evaluated on the first day before chemotherapy and the eighth days (T1 to T8) of the first to fourth cycles, respectively, at a total of 8 time points. The nutritional status was evaluated at four time points, including T1, T3, T5, and T7. The correlation between taste alterations and nutritional status was analyzed using generalized estimation equations.Results:A total of 77 patients completed all evaluations. The total CiTAS scores of lung cancer patients from T1 to T8 were (4.21±0.05), (5.52±0.14), (4.67±0.08), (6.05±0.17), (4.84±0.10), (6.45±0.18), (4.97±0.10) and (6.57±0.16), respectively. At T1, T3, T5, and T7, the proportion of patients with positive nutritional risk was 10.4% (8/77), 22.1% (17/77), 26.0% (20/77) and 29.9% (23/77), respectively, and the body weight was (67.08±1.07), (66.46±1.09), (66.12±1.09), (65.88±1.09) kg, and the calf circumference was (35.00±2.31), (34.71±2.41), (34.49±2.45), (34.38±2.47) cm and the number of patients with malnutrition was 1 (1.3%), 6 (7.8%), 10 (11.3%) and 11 (11.3%), respectively. The total score of CiTAS was positively correlated with NRS 2002 score, malnutrition ratio, and weight loss, while negatively correlated with calf circumference, with statistically significant differences ( P<0.05) . Conclusions:Patients with lung cancer undergoing chemotherapy have significant taste alterations, which worsen after each cycle of chemotherapy and recover before the next cycle of chemotherapy, but cannot return to baseline levels. The nutritional status of lung cancer patients is deteriorating, with an increasing proportion of patients at nutritional risk and malnutrition, as well as a continuous decline in weight and calf circumference. Taste alterations affect the nutritional status of patients. It is suggested that attention should be paid to the management of taste alterations and nutritional intervention during chemotherapy to improve the nutritional status of patients.

To investigate the status and influencing factors of teaching training demand of nursing teachers in colleges and universities in China.Methods:This is a cross-sectional study. A total of 1 032 nursing teachers in China were selected as research objects by the convenient sampling method. General data questionnaire and Nursing Teacher Training Status and Demand Questionnaire were used to investigate them. Multiple linear regression analysis was used to explore the influencing factors of teaching training demand of nursing teachers in colleges and universities. A total of 1 032 questionnaires were distributed in this study, and 1 032 valid questionnaires were received, with an effective recovery rate of 100.0%.Results:Among the 1 032 nursing teachers, 80.9% (835/1 032) had received teaching training. Nursing teachers in colleges and universities had a high demand for teaching and training in eight aspects, including curriculum and curriculum design, clinical teaching characteristics and methods, teaching evaluation (curriculum, students, teachers) , educational theory and its application in nursing education, teaching design and lesson plan writing, specialized nursing development and core competency cultivation of clinical teachers, clinical teaching methods and skills, and commonly used teaching methods and techniques. Working years, professional titles and educational background of nursing teachers in colleges and universities were the influencing factors of teaching training demand ( P<0.05) . Conclusions:There is a high demand for teaching training of nursing teachers in colleges and universities in China, and comprehensive and targeted teaching training should be carried out to improve the overall teaching level.

Objective:To explore the relationship between pathogens in the olfactory cleft area and olfactory disorders in patients with upper respiratory inflammation (URI) during the prevention and control of 2019 novel coronavirus disease (COVID-19).Methods:A total of 234 URI patients including acute upper respiratory infection, chronic rhinosinusitis (CRS), allergic rhinitis (AR) were continuously selected from September 2020 to March 2021 in Beijing Anzhen Hospital and 98 healthy adults were enrolled as controls. The secretions from the olfactory cleft of all subjects were collected with nasal swabs under nasal endoscopy. Multiple real-time fluorescent quantitative polymerase chain reaction detection method was used to detect nucleic acids of 33 types of respiratory pathogenic microorganism. Sniffin′ Sticks olfactory test was performed on all patients with URI. URI patients with olfactory dysfunction were followed up for 9 (8, 10) months ( M ( Q1, Q3)). SPSS 20.0 software was used for statistical analysis. Results:Among the 98 controls, 9 (9.18%) were positive for pathogenic microorganisms, including 1 (1.02%) rhinovirus, 1 (1.02%) parainfluenza virus type 3, 3 (3.06%) enterovirus, 1 (1.02%) staphylococcus aureus and 3 (3.06%) Moraxella catarrhalis. Among the 234 URI patients, 111 (47.44%) had olfactory disorders and 123 (52.56%) had normal sense of smell. In the olfactory disorder group (111 cases), 38 cases (34.23%) were positive for pathogenic microorganisms, and 4 cases (3.60%) were mixed infection, including 11 cases of rhinovirus (9.91%), 5 cases of coronavirus 229E (4.50%), 2 cases of coronavirus OC43/NL63 (1.80%), 3 cases of parainfluenza virus type 1 (2.70%), 2 cases of enterovirus (1.80%), 1 case of influenza B virus type BV (0.90%), 11 cases of Staphylococcus aureus (9.91%), 7 cases of Moraxella catarrhalis (6.31%), and 1 case of Klebsiella pneumoniae (0.90%). In the normal smell group (123 cases), 18 cases (14.63%) were positive for pathogenic microorganisms, and 1 case (0.81%) was mixed infection, including 3 cases of rhinovirus (2.44%), 4 cases of coronavirus 229E (3.25%), 1 case of Influenza virus type 3 (0.81%), 3 cases of enterovirus (2.44%), 3 cases of Staphylococcus aureus (2.44%), 4 cases of Moraxella catarrhalis (3.25%), and 1 case of Klebsiella pneumoniae (0.81%). Univariate analysis between the two groups found that there were significant differences in the detection rate of pathogenic microorganisms, rhinovirus and Staphylococcus aureus between the groups (all P<0.05). The detection rate of parainfluenza virus type 1, Staphylococcus aureus, and rhinovirus were different between the patients with olfactory disorder and normal olfactory function in the three subgroups of acute upper respiratory tract infection, CRS and AR, respectively (χ 2 value was 3.88, 4.53 and 4.73, respectively, all P<0.05). During the follow-up period, among the 111 patients with olfactory disorder, 71 (63.96%) patients′ olfactory function returned to normal, 32 (28.83%) patients′ olfactory function improved but not completely returned to normal, 8 (7.21%) patients′ olfactory function did not improve. Conclusions:During the prevention and control of COVID-19, rhinovirus or Staphylococcus aureus infection or colonization of URI patients is closely related to olfactory disorders. Parainfluenza virus type 1 infection can cause relatively persistent olfactory disorders in patients with acute upper respiratory tract infection. Staphylococcus aureus and rhinovirus colonization are related to the occurrence of olfactory dysfunction in CRS and AR patients respectively.

Objective:To compare the clinical effects of discectomy combined with transpedicular dynamic stabilization and transforaminal lumbar interbody fusion (TLIF) in treating single-level lumbar disc herniation.Methods:From November 2012 to November 2015, a total of 96 patients with single-level lumbar disc herniation (disc height decreased more than 1/3, the width of the basilar part of the herniated disc >6 mm, massive disc herniation or Modic type I endplate changes) treated by discectomy combined with Dynesys dynamic stabilization (Dynesys group, n=48) or TLIF (fusion group, n=48) were enrolled. Clinical assessments included operation duration, intraoperative blood loss, MacNab score, visual analogue scale (VAS), Oswestry disability index (ODI) and rate of complications. Radiographs were evaluated for lumbar mobility, intervertebral height, etc. Results:A total of 86 patients were included in the final analysis (44 in Dynesys group and 42 in fusion group) and were evaluated after 5 years follow-up. The operation duration of Dynesys group (159.61±37.29 min) was less than that of the fusion group (177.42±39.90 min) significantly ( t=2.140, P=0.035). Intraoperative blood loss in Dynesys group (151.78±50.88 ml) was less than that in fusion group (197.74±76.55 ml) with significant difference ( t=3.293, P=0.001). At 5 years follow-up, there were 2 cases with screw loosening and 5 cases with adjacent segmental degeneration in Dynesys group without symptom. In fusion group, there were 12 cases with adjacent segmental degeneration and two of them with symptom. There were significant differences in the incidence of adjacent segment degeneration between the two groups ( χ2=4.012, P=0.045). According to the MacNab criteria, excellent or good cases accounted for 95% in Dynesys group and 93% in fusion group without significant differences ( Z=0.425, P=0.671). VAS back, VAS leg and ODI scores were improved significantly in both groups after 2 years and 5 years ( P<0.05). However, there were no significant differences between the two groups ( P<0.05). The activity of the surgical segment was 4.59°±0.48° in Dynesys group and 1.00°±0.42° in fusion group at 5 years after surgery. The height of intervertebral space in Dynesys group decreased from 11.19±2.07 mm before surgery to 9.98±2.02 mm at 2 years after surgery and to 9.86±1.64 mm at 5 years after surgery ( F=6.462, P=0.002). However, there was no statistically significant difference between the 2 and 5 years follow-up ( q=0.415, P>0.05). At 5 years after surgery, the activity of the first proximal segment in the two groups was 9.74°±3.29° and 11.69°±3.89°, respectively ( t=2.514, P=0.014). Conclusion:Both discectomy combined with dynamic stabilization and TLIF can achieve satisfied clinical effects in treating single-level lumbar disc herniation. Dynamic stabilization preserves the intervertebral activity of surgical segments and results in a lower incidence of adjacent segment degeneration compared with that in fusion surgery. Furthermore, discectomy combined with dynamic stabilization is a less invasive intervention with shorter operation duration and less blood loss compared with TLIF.

Objective:To observe the changes of nutrition impact symptoms (NIS) and fat-free mass and analyze the relationship between them in patients with head and neck cancer (HNC) during radiotherapy.Methods:A convenient sampling method was adopted to select HNC patients who received radiotherapy in the outpatient clinic of department of radiotherapy for head and neck cancer in a cancer hospital in Beijing from March 2017 to January 2020. The nutrition impact symptoms (NIS) were assessed by a nutrition impact symptoms checklist and the fat free mass was assessed by bioelectrical impedance analysis at three time points: before radiotherapy (T1), during radiotherapy (T2) and at the end of radiotherapy (T3). The Generalized Estimating Equations (GEE) was used to analyze the relationship between them.Results:A total of 542 HNC patients were included in the analysis. During radiotherapy, the patients' NIS number and score presented an increasing trend, reaching the highest level and peaked at the end of radiotherapy. The change of fat-free mass showed a decreasing trend and reached the minimum at the end of radiotherapy. Patients with higher NIS scores had more percentage loss of fat-free mass.Conclusions:During radiotherapy, patients with HNC showed an increase in NIS score and lost fat-free mass. Patients with higher NIS score lost more percentage of fat-free mass, which suggested that clinical medical staff should pay attention to NIS management and take comprehensive intervention measures in time to reduce the loss of fat-free mass.

Objective:To investigate the job stress of specialist nurses in the Operating Room, and analyze the correlation among job stress, job burnout and organizational commitment based on the job demand-control model.Methods:This study was a cross-sectional study, using random cluster sampling to select 377 specialist nurses in the Operating Room in Beijing from March to June 2017. The Job Content Questionnaire, Maslach Burnout Inventory-Human Service Survey-Chinese Version and Organizational Commitment Scale were used to investigate the job stress, job burnout and organizational commitment of specialist nurses in the Operating Room. AMOS 22.0 software was used to verify the relationship between the three.Results:Finally, data of 243 specialist nurses in the Operating Room from 30 ClassⅢ hospitals in Beijing was collected. The job demand score was (37.47±4.16) , and the lowest was 28, and the highest was 48; the job control score was (61.25±8.49) , and the lowest was 30, and the highest was 84; the job stress score was (34.21±11.05) , and the lowest was 12.96, and the highest was 81.33; the comprehensive score of job burnout was (3.36±1.26) , and the lowest was 0.9, and the highest was 6.0; the organizational commitment score was (3.66±0.91) , and the lowest was 1.33, and the highest was 5.00. Correlation analysis showed that the job stress of specialist nurses in Operating Room was positively correlated with emotional exhaustion and depersonalization ( r=0.475, 0.392; P<0.01) , and negatively correlated with organizational commitment ( r=-0.423, P<0.01) ; the organizational commitment of the specialist nurses in Operating Room was negatively correlated with emotional exhaustion and depersonalization ( r=-0.418, -0.519; P<0.01) . The results of mediating effect analysis showed that job stress could directly affect organizational commitment ( r=-0.222) , and could indirectly affect organizational commitment through job burnout ( r=-0.201) , and the indirect effect accounted for 47.5% of the total effect. The hypothetical model matched the data well, and the model could explain 34.9% of the organizational commitment variation. Conclusions:Specialist nurses in the Operating Room have high levels of job stress and job burnout. The lower the level of organizational commitment, the higher the job stress, and the higher the level of job burnout, and the lower the level of organizational commitment. It is reminded that nursing managers should set up specialist nurse positions, clarify responsibilities, rights, and benefits, and give sufficient authorization and time to relieve the job stress of specialist nurses in the Operating Room, and to reduce job burnout and improve organizational commitment.