Trace elements and vitamins are essential micronutrients for metabolism.Micronutrients deficiency results in adverse effects on human body,and brings huge challenge to clinical nutrition therapy.To normalize micronutrients application in clinical practice,European Society for Clinical Nutrition and Metabolism(ESPEN)published ESPENpractical short micronutrient guideline on January 2024.Based on previous version published in 2022,current guideline shortens the interpretation of biochemical and physical mechanisms,focuses on micronutrients deficiency and inflammation,recommends the methods of micronutrients assessment and supplementation in different statuses during clinical practices.This paper summarizes specific recommendations and comments for domestic peers to communicate,and provides reference for the management of micronutrient therapy in China.

Based on the correlation between brain and kidney, this article discussed the scientific connotation of tonifying kidney therapy in treating diabetes mellitus in the elderly complicated with cognitive impairment. Kidney-related theory originates from the viscera-related theory of TCM. The brain is the sea of marrow, and the marrow is born of essence, which originates from the qi and blood of the five internal organs, and its root lies in the kidney. Kidney stores essence, governs bone and marrow, and connects with brain, and "kidney-essence-marrow-brain" form a system, which is closely related with each other. The kidney is full of essence and the brain is full of marrow, and the brain is full of intelligence, thus exerting the physiological function of "the brain is the house of wisdom". Both of them depend on each other physiologically, give birth to each other, and affect each other pathologically. Based on the theory of kidney and brain, from the physiological characteristics of old patients' weakness, aging and kidney-qi weakness, and the development trend of diabetes-related encephalopathy caused by "thirst-quenching for a long time, forgetfulness and palpitation", the core therapeutic methods of tonifying kidney, replenishing marrow and brain to treat senile diabetes complicated with cognitive impairment were introduced, and then the basis for the treatment of diabetic cognitive impairment by tonifying kidney was provided from the modern microscopic study of brain and kidney.

Objective:To investigate the influence of nutritional therapy on short-term efficacy of gastric cancer patients with malnutrition after radical gastrectomy.Methods:The prospec-tive randomized control study was conducted. The clinicopathological data of patients with malnutri-tion after radical resection of gastric cancer who were admitted to the Zhongshan Hospital of Fudan University from December 2020 to December 2022 were selected. Based on random number table, all patients were allocated into the nutritional therapy group and the control group. Patients in the nutritional therapy group were given dietary guidance and daily oral nutrition supplements for 90 days after discharge, while patients in the control group were only given the same dietary guidance. Observation indicators: (1) grouping situations of the enrolled patients; (2) follow-up; (3) comparison of nutritional indicators at 90 days after discharge; (4) comparison of inflammation and physical function indicators at 90 days after discharge; (5) comparison of clinical outcome indicators at 90 days after discharge. Measurement data with normal distribution were expressed as Mean± SD, and independent sample t test was used for comparison between groups. Measurement data with skewed distribution were expressed as M(IQR), and non-parameter rank sum test was used for comparison between groups. Count data were expressed as absolute numbers or percentages, and chi-square test was used for comparison between groups. Comparison of ordinal data was conducted using the chi-square test. Results:(1) Grouping situations of the enrolled patients. A total of 187 patients were selected for eligibility. There were 131 males and 56 females, aged (65±12)years. Of the 187 patients, there were 95 patients in the nutritional therapy group and 92 patients in the control group, respectively. The gender (male, female), age, cases with cardiovascular complications, cases with respiratory complications, cases with diabetes, surgical methods (partial gastrectomy, total gastrectomy), tumor staging (Ⅰ stage, Ⅱ stage, Ⅲ stage), body mass, body mass index (BMI), skeletal muscle index, albumin (Alb), hemoglobin (Hb), neutrophil-to-lymphocyte ratio (NLR), 6-minutes walking distance, grip strength were 68, 27, (64±12)years, 21, 4, 7, 59, 36, 17, 27, 51, (59±11)kg, (21.5±3.1)kg/m 2, (42±7)cm 2/m 2, (39±5)g/L, (112±25)g/L, 2.3(8.0), (456±97)m, (29±8)kg in patients of the nutritional therapy group, versus 63, 29, (66±13)years, 22, 3, 9, 56, 36, 14, 24, 54, (58±11)kg, (21.1±2.9)kg/m 2, (42±7)cm 2/m 2, (39±4)g/L, (111±26)g/L, 2.2(8.4), (459±98)m, (29±8)kg in patients of the control group, showing no significant difference in the above indicators between the two groups ( χ2=0.21, t=-1.29, χ2=0.09, 0, 0.35, 0.03, 0.51, t=0.80, 0.85, 0.19, 0.14, 0.16, Z=-0.28, t=-0.17, 0.43, P>0.05). (2) Follow-up. All 187 patients were followed up for 90 days after surgery. During the follow-up period, all patients had good compliance and were able to follow the dietary guidance. Five patients in the nutrition therapy group experienced diarrhea and nausea adverse reactions, which were relieved after symptomatic treatment. No adverse reactions were found in the control group. (3) Comparison of nutritional indicators at 90 days after discharge. The body mass, body mass loss, BMI, skeletal muscle index, Alb, Hb were (58±10)kg, 2(6)kg, (21.0±2.9)kg/m 2, (41±7)cm 2/m 2, (41±4)g/L, (125±18)g/L in patients of the nutritional therapy group, versus (56±10)kg, 3(6)kg, (20.4±2.7)kg/m 2, (39±7)cm 2/m 2, (41±4)g/L, (121±21)g/L in patients of the control group. There were significant differences in body mass loss and skeletal muscle index between the two groups ( Z=-4.70, t=2.39, P<0.05), and there was no significant difference in body mass, BMI, Alb, and Hb ( t=1.30, 1.51, 0.80, 1.32, P>0.05). (4) Comparison of inflammation and body function indicators at 90 days after discharge. The NLR, 6-minutes walking distance, grip strength were 2.1(5.1), (478±99)m, and (33±9)kg in patients of the nutritional therapy group, versus 2.2(5.7), (465±96)m, (30±8)kg in patients of the control group. There was a significant difference in grip strength between the two groups ( t=2.08, P<0.05), and there were no significant difference in NLR and 6-minutes walking distance ( Z=-1.28, t=0.91, P>0.05). (5) Comparison of clinical outcome indicators at 90 days after discharge. The quality of life score and readmission rate were (79±14)points, 4.2%(4/95) in patients of the nutritional therapy group, versus (78±16)points, 6.5%(6/92) in patients of the control group, showing no significant difference in the above indicators between the two groups ( t=0.58, χ2=0.14, P>0.05). Conclusion:Nutritional therapy with daily oral nutrition supplements can improve the short-term nutritional status and body function of patients with malnutrition after radical gastrectomy for gastric cancer.

ObjectiveTo explore the effect and possible mechanism of Shenqi Pills （肾气丸） on cognitive impairment and hippocampal glucose energy metabolism in type 2 diabetes mellitus （T2DM）. MethodsSixty C57BL/6 mice were randomly divided into control group， model group， rosiglitazone group and Shenqi Pills low-， medium- and high-dose groups， with 10 mice in each group. T2DM model was induced by a high-fat diet combined with intraperitoneal injection of streptozotocin in all the groups except for the control group. After successful modeling， the high-， medium-， and low-dose Shenqi Pills groups were given 2.08， 1.04， and 0.52 g/（kg·d） of Shenqi Pills granules by gavage respectively， while the rosiglitazone group was given 3 mg/（kg·d） of rosiglitazone tablets by gavage， and the control group and model group were gavaged with 10 ml/（kg·d） of distilled water， all for 8 consecutive weeks. The body weight and fasting blood glucose （FBG） level were recorded every two weeks. The Morris water maze test was performed on the 8th week of medication. After 8-week medication， oral glucose tolerance test （OGTT） and fasting insulin level were measured， hippocampal glucose energy metabolism-related products were quantitatively detected by liquid chromatography tandem mass spectrometry， and KEGG annotation analysis was performed. ResultsCompared to those measured at the same timepoints in the control group， the body mass on week 6 and 8， as well as the FBG level on week 2， 4， 6 and 8 in the model group increased； the blood glucose level at 0， 30， 60 and 120 minutes of the OGTT test increased， while fasting insulin level after 8-week medication decreased. The escape latency of the model group was significantly prolonged on the 3rd and 4th days， and the escape latency time increased， while the total swimming distance， platform quadrant residence time and the number of platform crossings decreased （P＜0.05 or P＜0.01）. Compared to those measured at the same timepoints in the model group， the body mass on week 6 in the low-dose Shenqi Pills group， on week 6 and 8 in the medium- and high-dose groups， and on week 8 in the rosiglitazone group were significantly reduced； the FBG levels in all the Shenqi Pills groups and rosiglitazone group on week 6 and 8 decreased， while fasting insulin levels increased. In the OGTT test， blood glucose in the medium-dose group of Shenqi Pills at all timepoints decreased； in the Morris water maze test， the escape latency period of the medium- and high-dose Shenqi Pills groups was shortened on the 3rd and 4th days， while the escape latency time was reduced， and the total swimming distance， platform quadrant residence time， and number of platform crossings increased in the medium-dose Shenqi Pills group （P＜0.05 or P＜0.01）.The medium-dose Shenqi Pills showed best effect， therefore it was selected for the targeted quantitative detection of metabolites. The medium-dose Shenqi Pills group could regulate the disorder of glucose metabolism in the hippocampus of T2DM mice， and 13 differential metabolites were found，up-regulating α-ketoglutarate and 3-phosphoglyceric acid， and down-regulating fumaric acid， glutamatic acid， lactatic acid， inosine， malic acid， adenine， fructose 1,6-diphosphate and others. KEGG annotation of differential metabolites suggested that Shenqi Pills was closely related to the regulation of glucose metabolism disorder and insulin resistance in the hippocampus region of T2DM model mice， as well as neurodegenerative diseases and ABC transport， hypoxia-inducible factor 1 （HIF）， forkhead transcription factor （FoXO） and cyclic adenosine monophosphate （cAMP） signaling pathways. ConclusionShenqi Pills can improve learning and memory abilities and cognitive impairment in T2DM mice， and may act its role by regulating glucose energy metabolism in the hippocampus of T2DM.

The European Society for Clinical Nutrition and Metabolism (ESPEN) online released the latest practical guideline on clinical nutrition in cancer on 15th March, 2021. The new practical guideline is shortened from the ESPEN guideline on nutrition in cancer patients in 2017 for easier use in clinical practice and provides 43 recommendations (without changes compared with the previous guidelines), combined with the diagnosis and treatment flow diagram, on general principles of nutritional therapy for cancer patients and individualized nutritional therapy strategies. Therefore, this new practical guideline is a practical tool for all professionals including physicians, dieticians, nutritionists and nurses in clinical practices.

Postoperative ileus (POI), one of the most common postoperative complications, impacts digestive function through neural reflex and intestine inflammation, and severely influences the therapeutic effect as well as the long-term outcome of the patients. As a major component of comprehensive peri-operative therapies, nutrition support treatment provides necessary daily energy and nutrient support for the patients, effectively prevents POI and promotes digestive motility. Therefore, the authors further elaborate on nutrition support treatment for postoperative ileus based on the latest research worldwide.

With the development and progress in the concepts and techniques of perioperative management, especially the latest reports of clinical trials, the prospect of prevention and treatment of postoperative ileus (POI) is promising. Proper nutritional support therapy, optimized surgical and anesthetic treatment, individualized fluid management, timely psychosocial intervention, and active anti-inflammation and traditional Chinese medicine treatment can effectively reduce occurrence of POI. Nevertheless, how to optimize and combine perioperative treatments to comprehensively prevent and treat POI still needs further study.

With the development and progress in the concepts and techniques of perioperative management, especially the latest reports of clinical trials, the prospect of prevention and treatment of postoperative ileus (POI) is promising. Proper nutritional support therapy, optimized surgical and anesthetic treatment, individualized fluid management, timely psychosocial intervention, and active anti-inflammation and traditional Chinese medicine treatment can effectively reduce occurrence of POI. Nevertheless, how to optimize and combine perioperative treatments to comprehensively prevent and treat POI still needs further study.

Objective To study the expression and clinical significance of stem cell markers CD44 and CD90 in ovarian cancer tissue.Methods A total of 45 ovarian cancer patients received surgery resection were col-lected into the study group,45 patients received hysteromyomectomy were collected into the control group. Immunohistochemical method was used to detect the expression of stem cell markers CD44 and CD90 in the o-varian tissue of two groups,then the relationships between the expression of CD44,CD90 and 1 year survival rate were analyzed.Results The positive rates of CD44 and CD90 in the study group were 64.44% and 68.89%,which were significant higher than those of 0.00% and 0.00% in the control group.The positive rates of CD44 in tissues of clinical staging Ⅲ - Ⅳ stage,histological grade G2+G3 stage and with lymph node metastasis were 86.36%,88.46%,88.24% respectively,which were significant higher than 43.48%,31.58%, 50.00% inⅠ - Ⅱ period clinical stage,histological grade G1 phase and without lymph node metastasis.The positive rates of CD90 in tissues of clinical staging Ⅲ - Ⅳ stage,histological grade G2+ G3 stage and with lymph node metastasis were 90.91%,92.31%,88.24% respectively,which were significant higher than 47.83%,36.84%,57.14% inⅠ - Ⅱ period clinical stage,histological grade G1 phase and without lymph node metastasis,the differences had statistical significance(P<0.05).Follow-up was conducted for 45 cases of pa-tients with ovarian cancer,the survival rate of CD44 positive patients was 62.07%,less than patients with CD44 negative expression 87.50%,the survival rate of CD90 positive patients was 64.52%,less than patients with CD90 negative expression 85.71%,but the differences had no statistical significance(P>0.05).Conclu-sion T he expression of stem cell markers CD44 and CD90 might be involved in the occurrence and develop-ment of ovarian cancer,metastasis and infiltration process,and the expression level of the two markers could be used as clinical assessment of biological indicators of prognosis.

Objective To observe the effect of comprehensive rehabilitation combined with home-based direction on spastic cerebral palsy.Methods 42 children with spastic cerebral palsy were divided into treatment group (n=21) and control group (n=21). The treatment group accepted comprehensive rehabilitation and home adjusted. Their parents participated in the rehabilitation and received home-based direction.The control group resigned the rehabilitation for poverty or other reasons, without home adjusted. They were assessed with Gross Motor Function Measure (GMFM-88) and Activities of Daily Living of Cerebral Palsy before and 6 months after treatment. Results The scores of GMFM-88 and Activities of Daily Living of Cerebral Palsy improved in the treatment group after treatment (P<0.05), and improved more in the treatment group than in the control group (P<0.05). Conclusion Rehabilitation training combined with home-based direction could improve the gross motor function and activities of daily living in children with spastic cerebral palsy.