Objective: To understand the current status, international cooperation, research hotspots, and development trends of nutritional studies on patients with head and neck cancer from 2014 to 2024, and to predict future research trends. Methods: The Web of Science Core Collection database was searched to retrieve nutritional studies on patients with head and neck cancer from January 2014 to March 2024. The type of studies were “articles,” the language was English, CiteSpace 6.1 R6 software was used to conduct the bibliometric analysis, and the results were visualized to form a scientific knowledge map. Results: A total of 1 528 documents were retrieved, with a linear increase in the number of annual publications. The country with the highest number of publications was the United States, and the institution with the highest number of publications was the University of Queensland, with closer collaboration between authors and institutions. The most frequently cited publication was a set of nutrition guidelines, and the highest-impact articles were mainly concerned with performing percutaneous endoscopic gastrostomy. Keyword analysis showed that quality of life, radiotherapy, and weight loss were the keywords of highest interest. The keyword cluster analysis resulted in 17 clusters, which were divided into five main categories: head and neck cancer, treatment, outcome results, intervention modalities, and rehabilitation. Body composition, enteral nutrition, and accelerated postoperative rehabilitation were persistent research hotspots. Keyword highlighting revealed that “enhanced recovery after surgery” has been the focus of research in the last two years, with “index” and “model” emerging as theme words. Conclusion The number of publications in the literature related to nutrition for patients with head and neck cancer has increased annually over the past 10 years. The research hotspots mainly focus on the quality of life and weight loss during radiotherapy, the content and application prospect of body composition assessment, different modes of nutritional support interventions and enteral nutritional tube feeding routes, and perioperative nutritional management in enhanced recovery after surgery. The potential clinical value of preoperative nutritional intervention under the concept of enhanced recovery and the construction of new types of nutritional index are the trends of future research.

Objective To explore the effect of a phased rehabilitation training programme to relieve shoulder dys-function in patients after neck dissection and to provide effective solutions for postoperative shoulder joint function recov-ery of patients.Methods This study has been reviewed and approved by the Ethics Committee,and informed consent has been obtained from patients.A phased rehabilitaiton training programme for the shoulder after neck dessection was developed through literature review and discussion,and 70 eligible patients from Hospital of Stomatology,Sun Yat-sen University from December 2020 to April 2021 were selected and randomly divided into the test group and control group(35 patients in each group).The control group underwent motor rehabilitation training from 6 weeks postoperative to 1 year after surgery,such as shoulder mobility and coordination training and small range of motion training of the neck,while the test group took part in a rehabilitation training program that included familiarization maneuver training,protective rehabilitation,exercise rehabilitation,and resistance training in the following four stages:preoperative,postop-erative general anesthesia and awake until the removal of stitches,the removal of stitches until 6 weeks after surgery,and 6 weeks after surgery until 1 year after surgery.The frequency of training in both groups was at least 3 days per week,and the length of each training session was 10-15 min.The intensity of exercise was 2-3 points on the Borg Conscious Ex-ercise Intensity Scale(i.e.,mild-to-moderate tachypnea or fatigue).The neck dissection injury index(NDII)was used to evaluate the quality of life related to shoulder joint function at four time points:preoperative,postoperative 3 months,postoperative 6 months,and postoperative 12 months.The higher the score,the better the quality of life.Results 28 cases in the test group and 32 cases in the control group completed a one-year follow-up.At 3 and 6 months postopera-tive,the NDII of the test group was significantly higher than that of the control group[3 months postoperative:test group(93.48±9.36)vs.control group(80.00±11.34)(P＜0.001),6 months postoperative:test group(98.21±4.76)vs.control group(90.70±9.12)(P＜0.001)];12 months after surgery,the NDII of the test group(97.23±4.88)was still higher than that of the control group(96.33±4.49),but the difference was not statistically significant(P=0.458).The difference in NDII scores among subjects at 3,6,and 12 months after surgery was statistically significant in each group(P＜0.001).Conclusion The application of the phased rehabilitation training method in neck dissection patients has a feasibility and could improve the quality of life of patients'shoulder joint function within 6 months after surgery.

Objective:To explore the clinical manifestations and genotype of an infant with hyperuricemia, pulmonary hypertension, renal failure in infancy, and alkalosis syndrome (HUPRAS).Methods:Clinical data of the patient were collected. Peripheral blood samples from the patient and his parents were acquainted for whole exome sequencing. The filtrated variants were verified by Sanger sequencing. The pathogenicity of the variants was predicted by bioinformatic tools.Results:The patient is a male infant of 6 months old, carrying two missense variants in the SARS2 allele: a paternal inherited c.1205G>A (p. Arg402His) and a maternal inherited c.680G>A (p. Arg227Gln). The two variants were in extremely low population frequencies. The pathogenetic prediction tools categorized them as deleterious. Arg402 and Arg227 were highly conserved in evolution. The variants led to changes in the hydrogen bonds and hydrophobicity of seryl-tRNA synthetase encoded by SARS2.Conclusions:c.1205G>A (p. Arg402His) and c.680G>A (p. Arg227Gln) are the possible causative variants of the HUPRA syndrome.

Objective:To report on a case of Kabuki syndrome (KS) due to a novel variant of KMT2D gene. Methods:A child diagnosed with KS at the Fujian Children′s Hospital on July 25, 2022 was selected as the study subject. Whole exome sequencing was carried out for the child and her parents. Candidate variant was validated by Sanger sequencing and bioinformatic analysis.Results:The child, a 4-month-old female, had presented with distinctive facial features, growth retardation, cardiac malformations, horseshoe kidney, hypothyroidism, and recurrent aspiration pneumonia. Whole exome sequencing revealed that she has harbored a heterozygous c. 6285dup (p.Lys2096Ter) variant of the KMT2D gene. Sanger sequencing confirmed that neither of her parents had carried the same variant. The variant was previously unreported, and may result in a truncated protein and loss of an enzymatic activity region. The corresponding site of the variant is highly conserved. Based on the guidelines from the American College of Medical Genetics and Genomics (ACMG), the variant was classified as pathogenic (PVS1+ PS2+ PM2_Supporting). Conclusion:The c. 6285 dup variant of the KMT2D gene probably underlay the KS in this child.

Spirit of Great Physician, puts forward relevant requirements on the moral standards and humanistic qualities that doctors should possess. By tracing the formation background of Spirit of Great Physician, analyzing its rich ideological connotation, reflecting on the needs of contemporary society for medical ethics on the basis of the medical ethics standard of Spirit of Great Physician, combining the background of social development and medical reform in the new era, as well as the moral dilemma in the medical environment, this paper proposed that contemporary society should take the combination of the internal requirements of "moral self-discipline" and the external constraints of "moral heteronomy" as the new path of medical ethics construction. The purpose of this study was to provide theoretical reference for improving the construction system of contemporary medical ethics, enhancing the moral character of medical staff and building a good medical environment.

ObjectiveTo visually analyze the research hotspots and future development trends in the field of rehabilitation of chronic respiratory diseases domestic and overseas in the last decade. MethodsLiteratures about rehabilitation of chronic respiratory disease from 2011 to 2021 were retrieved. The Physiotherapy Evidence Database (PEDro) was used to access the quality of the literatures, and CiteSpace 5.8.R3 was used to analyze the number of publications and keywords. ResultsA total of 2 477 English articles and 3 308 Chinese articles were included. The overall volume of literature published in the field of rehabilitation of chronic respiratory diseases domestic and overseas showed a fluctuating increase. A total of 63 English articles met the requirement of medium-high quality with a score of four to nine on the PEDro scale, and the overall average score was 5.44. A total of 78 domestic articles scored five to eight, and the overall average score was 5.21. Domestic research in this field mainly focused on the pulmonary rehabilitation methods for patients with chronic obstructive pulmonary disease (COPD) and their effects on patients' quality of life and lung function, the process of development of heart-related diseases complicated by COPD, and the effects of nursing interventions, community rehabilitation and health education for chronic respiratory diseases, and exploration of precise pulmonary rehabilitation assessment, etc. In contrast, foreign countries mainly studied the physical activity and exercise capacity of patients with chronic respiratory diseases, emphasizing the self-management of patients, and focused on the cross-sectional research of other diseases such as combined aortic stenosis, and made "physical activity" and "exercise" as the frontier of research. ConclusionOverseas pulmonary rehabilitation programmes involve a wide range of chronic respiratory diseases, requiring multidisciplinary teamwork, strengthening patient self-management at home and focusing on changes in physical activity, motor function and quality of life after exercise, while the focus is on pulmonary rehabilitation in hospitalized COPD patients, also including the role of traditional Chinese exercise in China.

ObjectiveTo explore the effect of exercise on the postural control and muscular function around the ankle in patients with functional ankle instability (FAI) with meta-analysis. MethodsRandomized controlled trials about therapeutic exercise for FAI published before December, 2021 were searched from PubMed, EBSCO, SPORTdiscus, Medline, Science Direct, Springlink, Web of Science, Embase CNKI, VIP and Wanfang Data. The quality and evidence grades of the researches were evaluated by two researchers, and the outcomes were analyzed with RevMan 5.4. ResultsFourteen randomized controlled trials were finally included, involving 434 subjects. Compared with no exercise intervention, therapeutic exercise might significantly improve the movement of center of pressure whether with eye-open or eye-closed (eye-open, SMD = -0.28, 95%CI -0.46 to -0.09, P = 0.003; eye-closed, SMD = -0.24, 95%CI -0.40 to -0.09, P = 0.001); while therapeutic exercise might also enhance the activation of the peroneus longus before dynamic task (SMD = 0.38, 95%CI 0.05 to 0.71, P = 0.03), and activation of the peroneus longus (SMD = 0.53, 95%CI 0.16 to 0.90, P = 0.005) and tibialis anterior (SMD = 0.47, 95%CI 0.10 to 0.84, P = 0.01) after dynamic task. There was neither significant difference in the activation of the tibialis anterior (SMD = 0.48, 95%CI -0.14 to 1.11, P = 0.13), nor the peak torque ratio of eversion to inversion isokinetic strength (SMD = -0.15, 95%CI -0.46 to 0.16, P = 0.340) before dynamic task between the two groups. ConclusionTherapeutic exercise can decrease movement of center of pressure, enable anticipatory contraction of peroneus longus before dynamic tasks and compensatory contraction of peroneus longus and tibialis anterior after tasks, to make it easier to deal with external interference, maintain articular stability and prevent re-injury.

OBJECT IVE To evaluate the application effect of the whole cour se medication management mode led by pharmacists in rheumatic immune diseases. METHODS A total of 122 patients treated with tacrolimus or cyclosporine in the department of rheumatology and immunology of Wuhan No. 1 Hospital from 2018 to 2020 were selected as the study subjects. Among them ，44 cases in the control group were under the traditional supervision mode ；78 patients in the observation group adopted the whole course medication management mode led by pharmacists ，that was ，individual pharmacists and specialist clinical pharmacists cooperated and led ，and not only participated in the whole process of drug treatment but also involved in the whole process of therapeutic drug monitoring （TDM）. On the basis of the control group ，the division of labor and cooperation among medical，pharmaceutical and nursing parties were strengthened ，and the homogeneous supervision was carried out for the outpatients and inpatients from admission to discharge . The daily dose of medication ，the rate of reaching the standard of blood drug concentration ，the incidence of problematic samples （the sample was calculated by the number of times ），the average hospitalization days ，the re-admission rate within 6 months after discharge ，the medication compliance score and the patient ’s satisfaction rate were compared between the two groups. RESULTS In the control group ，53 times of TDM were performed ， including 18 times of tacrolimus monitoring and 35 times of cyclosporine monitoring ；in the observation group ，123 timesof TDM were performed ，including 55 times of tacrolimus monitoring and 68 times of cyclosporine monitoring. The daily dose of tacrolimus ，the daily dose of cyclosporine ，the rate of reaching the standard of cyclosporine blood drugconcentration，the inc idence of problematic samples ，the rate of re-admission within 6 months after discharge ， the medication compliance score and the patient ’s satisfaction rate in the observation group were significantly better than those in the control group （P＜0.05）. CONCLUSIONS It can effectively improve the effect of the quality of pharmaceutical care to implement whole course and homogeneous medication management led by pharmacists and provide precise drug guidance for patients with rheumatic and immune diseases.

Objective: To understand the incidence and influencing factors of postoperative constipation in patients with malignant tumors who undergo oral and maxillofacial surgery and construct a constipation risk prediction model to provide a reference for the prevention and treatment of postoperative constipation. Methods: The data of 191 patients who underwent oral and maxillofacial malignant tumor surgery at the Affiliated Stomatological Hospital of Sun Yat sen University from June 2019 to June 2020 were analyzed retrospectively. The independent influencing factors were selected via univariate analysis and logistic multivariate regression analysis, a risk prediction nomogram was established, and the prediction model was evaluated by the area under the ROC curve. Both internal and external use the C index to verify the accuracy of the model. Results : Among 191 patients, 52 (27.23%) had postoperative constipation. Univariate analysis showed that a preoperative secret history of defecation, total energy intake, tracheotomy, smoking, drinking, operation duration, bleeding volume, bed time, eating homogenate diet, sex, surgical repair method, use of probiotics, T-stage of cancer and food intake may be the influencing factors of postoperative constipation in patients with oral and maxillofacial malignant tumors (P<0.05). Multivariate analysis showed that repair method, bed time and sex were independent risk factors for postoperative constipation in patients with oral and maxillofacial malignant tumors (P<0.05). The repair method was a fibular myocutaneous flap with a long bed time, and male patients were prone to constipation after surgery. The c-index values in the training group and the verification group were 0.882 and 0.953, respectively. The area under the ROC curve of the training group was 0.909 (95%CI: 0.850-0.968), and the area under the ROC curve of the verification group was 0.893 (95%CI: 0.787-0.999). The nomogram showed good discrimination ability. Conclusion The repair method, bed time and sex are independent risk factors for postoperative constipation in patients with oral and maxillofacial malignant tumors. The risk prediction model has good discrimination ability.

Objective:To summarize the case management of promoting the rehabilitation of oral and maxillofacial function of a patient with gingival cancer.Methods:The patient took the obturator prosthesis and orofacial myofunctional therapy to promote the rehabilitation of oral and maxillofacial function. The key points of nursing included: nursing of obturator prosthesis, orofacial myofunctional therapy, psychological nursing and evaluation of oral and maxillofacial function rehabilitation.Results:after one year of case management, the total score of the Chinese version of the obturator functioning scale was 18 points, the mouth opening was 4cm, and the speech distinctness was 98%. The quality of life of the patient was good.Conclusions:When the obturator prosthesis and orofacial myofunctional therapy are taken, all-round cooperation of the medical staff of different specialties from the perioperative period to the discharge follow-up should be strengthened in order to promote the rehabilitation of oral and maxillofacial function.