BackgroundContinuous glucose monitoring systems (CGMS) are widely used in diabetes care, but their reliability for standardized food glycemic index (GI) measurement remains unclear. Most previous studies used capillary blood rather than venous glucose as the reference.ObjectiveThis study aimed to verify the consistency between the CGMS and standardized venous sampling methods for measuring postprandial incremental area under the curve (IAUC) and GI values.MethodsThis study was conducted in accordance with the Chinese GI testing standard WS/T 652–2019. Three measurement methods were compared: venous sampling (Method A), CGMS with all data points adopted (Method B), and CGMS data aligned with the standard venous time points (Method C). One-way analysis of variance (ANOVA) and Lin’s concordance correlation coefficient (CCC) were used for statistical analysis. The Parkes Error Grid analysis was employed to ascertain the clinical acceptability of glucose discrepancies within low, medium, and high concentration strata.ResultsThe 12 enrolled participants (six males and six females) had a mean age of 29.50 ± 10.12 years, mean BMI of 21.5 ± 1.7 kg/m2, mean HbA1c of 5.07 ± 0.21%, and all lipid, glycemic, hepatic and renal function indicators were within normal reference ranges. For 120-min IAUC, the mean values were 186.93 ± 87.29 (Method A), 166.00 ± 76.46 (Method B) and 164.24 ± 77.48 (Method C). ANOVA showed no significant inter-method difference (F = 1.178, p = 0.311). CCC analysis with Method A as the reference revealed good agreement: CCC = 0.8818 (95% CI: 0.8068–0.9289) for A vs. B and CCC = 0.8727 (95% CI: 0.7921–0.9234) for A vs. C, with a high Pearson’s ρ (>0.91) and bias correction factors (Cb, >0.95 fot both). For GI values (n = 12 for each method), the mean values were 55.07 ± 15.57 (Method A), 54.28 ± 12.24 (Method B) and 53.68 ± 15.04 (Method C). ANOVA showed no significant inter-method difference (F = 0.028, p = 0.972), and CCC analysis indicated moderate agreement (CCC ≈ 0.79) with minimal systematic bias (Cb > 0.97).ConclusionCGMS methods demonstrate good-to-moderate concordance with standardized venous testing for IAUC and GI determination. CGMS may represent a feasible, non-invasive alternative for food GI evaluation in nutritional and diabetes-related research among healthy individuals.

BACKGROUND & AIMS:Malnutrition is a significant health issue in hospital settings, with persistent diagnostic challenges. Despite the Global Leadership Initiative on Malnutrition (GLIM) criteria providing a standardised approach, nationwide validation and implementation remain limited. We aimed to estimate the national prevalence of GLIM-defined malnutrition among Chinese adult inpatients and assess the predictive value of the GLIM criteria for short-term clinical outcomes. METHODS:We conducted the China Nutrition Fundamental Data 2022 project among adult inpatients from 322 sites across 31 provinces in China between February and October 2023. Malnutrition was defined using the GLIM criteria through a standardised two-step process. The clinical outcomes included discharge outcomes, length of stay, hospitalisation costs, and 30-day mortality. We used logistic and multiple linear regression analyses to examine the association between malnutrition severity and clinical outcomes. RESULTS:The final analysis included 61,283 individuals. Malnutrition was prevalent in 24.6 % of the inpatients (moderate malnutrition: 13.8 %; severe malnutrition: 10.8 %). A dose-response relationship was observed between malnutrition severity and adverse clinical outcomes: moderate and severe malnutrition increased the risk of ineffective discharge outcomes by 1.533 (95 % CI: 1.362-1.725) and 2.200 (1.958-2.473) times, respectively, and 30-day mortality by 1.875 times (1.408-2.496) and 3.065 (2.332-4.028) times, respectively. Additionally, moderate and severe malnutrition were linked to a 0.97-day and 1.20-day increases in hospital stays, respectively. CONCLUSIONS:Malnutrition is prevalent among adult Chinese inpatients and strongly associated with adverse clinical outcomes. GLIM-based assessments and interventions are essential to reduce the burden of malnutrition.

Malnutrition substantially contributes to adverse clinical outcomes. However, no national survey has been conducted to characterize its epidemiology in hospital settings in China. We conducted the China Nutrition Fundamental Data 2020 project among a multistage stratified cluster sample of adult inpatients from 291 study sites across 30 provinces, autonomous regions and municipalities (except for Hong Kong, Macao, Taiwan Province, and the Xizang Autonomous Region, please see MATERIALS AND METHODS for details of the causes) of China to generate reliable data on the prevalence of malnutrition and explore the associated risk factors. We collected information on participants’ sociodemographic characteristics, physical examinations, and laboratory test results. Malnutrition was defined according to the Global Leadership Initiative on Malnutrition (GLIM) criteria. The standardized prevalence of malnutrition was calculated, and factors associated with malnutrition were examined using logistic regression analyses. We included 54,652 individuals with seven systemic diseases who completed all the survey documents in the final analysis. The overall prevalence of malnutrition was 12.5

Background Globally, there is limited literature exploring the relationship between nutritional risk screening, nutritional assessment, nutritional intervention, and HDL-C levels. This study analyzes the relationship between HDL-C levels, nutritional risk screening, assessment, and intervention among newly admitted patients in Jiangsu Province. Methods Between October 2020 and June 2021, this study randomly selected 23 hospitals from 12 cities in Jiangsu Province using a stratified cluster sampling method. For nutritional assessment, the study used NRS2002 for risk screening. Results 4,190 patients were assessed, revealing a low HDL-C prevalence rate of 30.7%. The prevalence exhibited an "N" shaped distribution with age. The prevalence of low HDL-C among patients assessed at nutritional risk was 34.6%, 1.228 times higher than that of patients without nutritional risk. In terms of nutritional assessment, patients with constipation, severe infection, chronic kidney disease, fever, high CRP, and hypoalbuminemia significantly increased risks of low HDL-C by 1.432, 2.496, 1.543, 3.056, 1.794, and 2.703 times, respectively. Patients with a history of esophageal stricture, malignant tumors, and closed head injuries reduced the risks of low HDL-C by 60.9, 23.3, and 78.8%, respectively. Additionally, patients with nausea and vomiting, pancreatic insufficiency, severe infection, fever, and hypoalbuminemia decreased HDL-C levels by 0.156 mmol/L, 1.465 mmol/L, 0.403 mmol/L, 0.301 mmol/L, and 0.250 mmol/L, respectively. Regarding nutritional intervention, compared to patients who did not receive intervention, those receiving parenteral nutrition significantly lowered HDL-C levels at 1.014 mmol/L, with an increased risk of low HDL-C by 2.048 times. All Ps <0.05. Conclusion Nutritional risk, nausea and vomiting, constipation, pancreatic insufficiency, severe infection, chronic kidney disease, fever, high CRP, hypoalbuminemia, and receiving parenteral nutrition are associated with lower HDL-C levels in patients. A history of esophageal stricture, malignant tumors, and closed head injury is associated with higher HDL-C levels in patients.

为探讨医学专业学位研究生人文素养培养的可行模式,该研究对22名医学专业研究生导师和74名医学专业学位研究生实施导师团队言传身教的人文素养培养模式,通过对导师、研究生及患者进行问卷调查对比人文素养培养前后的相关情况来评估培养效果.该模式实施后,导师和研究生的共情能力、倾听能力都有所提升,职业认同感也更强,而且研究生同患者的关系也更和谐.研究发现,实施导师团队言传身教的人文素养培养模式不仅成本较低而且高效、可行,可为临床研究生人文素养的培养提供参考.

Objective:In response to the National Health and Medical Commission’s clinical nutrition specialty quality improvement project,to rely on the medicalQuality ManagementSystem（QMS）,apply intelligent management to realize the homogenization of medical quality of clinical nutritionand evaluate effectiveness. Method:Update the management indicators in time through the release of information platform, special quality control training, and monthly indicator reporting,for a series of homogeneous education for 75 provincial quality control units. Results:（1）TheNutritional Risk Screening（NRS）process was standardized,while the management department was unified（Information Office/Department100%） and the awareness of medical personnel was improved.（2）The average NRS rate of inpatient was significantly increased（z=3.429,P ＜ 0.01）. Conclusion:The integration of intelligent management and QMS contribute to the accurate implementation of specialist quality improvement projects. The homogeneous practice of medical quality management methods can effectively guarantee the continuous improvement of specialist diagnosis and treatment technology and service quality.

神经源性肠道功能障碍(neurogenic bowel dys-function,NBD)指各类原因所致的支配肠道的神经功能受到影响,导致肠功能丧失或缺失的疾病[1].其临床体征主要表现为患者便秘,或大便失禁、腹痛、腹胀等,严重影响其生存质量和原发疾病预后康复[2-4].因胃肠功能障碍症状较为突出,NBD患者营养不良风险相应增加,异常胃肠蠕动给营养治疗带来一定难度,治疗途径、支持时机、制剂选择等均尚存疑惑.目前主要综合中西药物、物理因子等方法采取治疗并展开研究[1],对于营养支持的病例研究鲜见.本文报告1例成年女性NBD患者,以序贯营养治疗为干预思路,评估治疗效果以期提供借鉴.

目的:了解我国医疗机构肠内营养制剂的临床供给、应用及需求现状.方法:经过循证检索及多次专家讨论后制定调查表,以全国二级及以上综合或专科医院为调查对象,各省质控中心指导各级医院临床营养科负责人填写.结果:共有592家医院参与本次调查,涉及全国30个省/直辖市.目前院内肠内营养制剂仍以肠内营养药品为主,获批的FSMP主要为进口和婴幼儿产品,粉状成品使用率最高,61.5％的医院仍使用未获得FSMP注册批号的固体/液体饮料.57.6％的医院表示目前FSMP产品不能满足临床需求,其中肿瘤、肾病、糖尿病、创伤、感染、手术及其他应激状态、胃肠道吸收障碍/胰腺炎是需求前五的疾病或状态.结论FSMP市场占有率低,肠内营养药品、FSMP、固体/液体饮料三者共存局面或将持续.亟需加快成人型特定全营养配方食品上市,提升国产FSMP产品市场占有率,推动临床营养学科发展,促进个体化营养管理落地.

多囊卵巢综合征(PCOS)是育龄期女性最常见的妇科内分泌疾病之一.生酮饮食(KD)是一种以低碳水化合物、高脂肪、适量蛋白质为特点的饮食结构.2019年专家组组织了妇科专家和营养专家共同制定并发布了《生酮饮食干预多囊卵巢综合征中国专家共识(2018年版)》.鉴于近5年KD治疗在安全性和应用范围方面出现了大量新的临床数据,专家组决定对《生酮饮食干预多囊卵巢综合征中国专家共识(2018年版)》进行修订和数据更新.主要更新内容有:①更新中国PCOS患病率研究数据;②增加PCOS中的代谢综合征与饮食干预临床证据;③增加KD改善PCOS的循证证据及中国临床研究证据;④增加KD对与PCOS相关代谢综合征影响的循证医学证据;⑤提供短期和长期KD有效性和安全性证据;⑥增加低能量生酮饮食(LCKD)在PCOS中的应用及安全性证据;⑦增加PCOS治疗常用药物联合KD干预效果的证据;⑧完善KD干预PCOS的适应证、禁忌证、不良反应及对策;⑨完善KD中食物种类的选择及操作方法建议.

Background: To collect the published trials of probiotics in the treatment of diarrhea and to strictly evaluate and systematically analyze the efficacy of probiotics use for the prevention and treatment of patients with diarrhea. Methods: We searched domestic and foreign literature published between January 2016 and July 2022 to find randomized control trials that used probiotics to treat diarrhea. Only studies published in English were considered. The quality of the included literatures was assessed by using the methods provided in the Cochrane Handbook. Valid data were extracted and analyzed by meta- analysis using the Software RevMan5.2. Results: Total 16 trials and 1585 patients were included. The results of the meta- analysis showed that in comparison with the simple Western medicine treatment group or placebo, the added use of probiotics could improve stool frequency, stool morphology, and related irritable bowel syndrome symptoms. Conclusion: The added use of probiotics can further improve clinical outcomes in the patients with diarrhea; however, the implementation of larger and higher quality clinical trials is necessary to verify this conclusion.

近年来,我国公立医院逐渐迈向以智慧医院建设为基础、以医疗质量为生命、以人为本的质量效益型道路,竞相出现的医疗质量管理系统、人力资源管理系统等信息平台,大大提高了医疗资源和诊疗服务的管理效率,促进了医疗水平的整体提升.本文着眼于国内医疗质量管理体系和人力资源管理系统的建设成果,总结分析各独立体系所缺乏的客观性、全面性、精准性和有效性.通过对二者联动的优势探索,提出专科质量管理系统与卫生人力资源之间协同发展的建议.旨在以同质化管理为目标,探索以"人才质量"为切入点的质控指标体系建设,论证人才管理与医疗质量管理深度融合的理论可行性.

随着互联网技术的快速发展,我国公立医院逐步迈向信息化和智慧化建设进程.然而传统数据中心常面临诸多瓶颈,导致智慧化发展受阻.本研究围绕"以人民健康为中心"的医疗需求,论证"整体、安全、统一"的信息系统建设道路.以模块化系统建设方式,探索智慧医疗平台、智慧管理平台、智慧服务平台的创新建设.通过对比平台建设前与投入应用后的相关数据,分析评价实践效果.2018年至今,试点专科规范化诊疗流程路径清晰完整,患者的医疗服务需求满足程度持续提升,专科医疗质量控制效果明显改善,可见智慧医疗一体化服务平台收效颇丰.建议在保障信息安全的基础上,加强统一运维管理和高效成果转化.以专科医疗质量管理体系作推广实践,实现区域医疗服务质量的同质化提升.

目的 对社区老年人进行隐性饥饿与营养不良评估,并进行口服营养补充(ONS)干预,了解老年人隐性饥饿和营养不良发生率,观察营养干预效果.方法 对248例老年人进行微型营养评定、隐性饥饿量表评估、体格测量和体成分检测,选择其中40例存在隐性饥饿与营养不良的老年人随机分成干预组和对照组,每组20例,对照组进行营养知识教育,干预组在对照组基础上进行ONS干预,共12周,比较2组营养摄入量及干预前后体格指标、体成分指标的变化情况.结果 老年人营养不良及隐性饥饿发生率为31.5％(78/248).干预组每天膳食脂肪、蛋白质、锌、维生素A、维生素B1和B2的平均摄入量及优质蛋白占比明显高于对照组(P<0.05).干预12周后,干预组体质量、BMI、体脂肪、血浆总蛋白、白蛋白水平均较干预前升高(P<0.05).结论 31.5％的社区老年人存在营养不良和隐性饥饿;ONS有利于改善老年人营养状况、提高骨骼肌质量和血浆蛋白水平.

目的 探讨以患者需求为导向的护理方案对糖尿病患者的临床实践评价.方法 选取2019年6月至2021年3月江苏省连云港市第二人民医院收治的糖尿病患者90例为研究对象,采用奇偶法将患者分为对照组和观察组,各45例.对照组采用传统护理措施,观察组开展以需求为导向的护理模式,比较两组血糖水平及生活质量.结果 干预后,观察组空腹血糖、餐后2 h血糖均低于干预前,且观察组低于对照组,差异有统计学意义(P＜0.05);两组生活质量各维度评分均高于干预前,且观察组高于对照组,差异有统计学意义(P＜0.05).结论 对糖尿病患者采取以需求为导向的护理模式的临床应用价值较高,稳定患者的血糖指标,促进患者自我护理管理能力的提升,提高了患者的生活质量.

目的 调查分析我国三级医疗机构营养科专业人才队伍情况,提出针对性建议.方法 从国家医疗质量管理与控制信息网选取1283家三级医疗机构调研临床营养专业技术人员数据,应用频数、构成比等进行描述性统计分析.结果 三级医疗机构营养科专业技术人员数量不足且分布不均衡,高层次人才比例偏低.医床比1:556.91,技床比1:841.30,医技比1.51:1,护床比1:1031.31,均未达到文件标准,营养科医师严重缺编.结论 应加强营养科专业人员教育和高层次人才培养,建立规范化培养体系,明确营养科职称评定和岗位技能考核制度,不断扩增专业人才数量,提升临床营养诊疗能力.

目的 旨在探讨非酒精性脂肪肝(NAFLD)患者血清铁蛋白水平与肝脏硬度之间的关系.方法 回顾性分析2019年6月 ～2020年12月NAFLD患者340例,健康对照组50例,分别进行人口统计学和生化分析,包括年龄、体重指数、血清转氨酶水平、胆红素、空腹血糖、血脂和血清铁蛋白水平的测定,并分析所有患者及健康对照组的瞬时弹性成像(TE)检测结果.结果 NAFLD患者血清铁蛋白水平分别为241.8(133.9,309.8)ng/ml,与健康对照组118.8(54.4,267.8)ng/ml比较,差异有统计学意义(P=0.000).NAFLD患者中轻度和中重度肝硬变患者的血清铁蛋白水平分别为236.8(123.1,285.5)ng/ml和270.0(234.7,469.9)ng/ml,差异有统计学意义(P=0.000).男性轻度和中重度肝硬变患者血清铁蛋白分别为255.2(195.9,343.8)ng/ml和299.0(240.2,490.4)ng/ml,差异有统计学意义(P=0.027).女性轻度和中重度肝硬变患者血清铁蛋白分别为124.9(54.2,236.6)ng/ml和248.5(198.9,352.8)ng/ml,差异有统计学意义(P=0.002).根据ROC曲线,男性超过479.9ng/ml和女性超过269.0ng/ml的血清铁蛋白可以鉴别90％的中重度肝硬变病例,特异性为90％.男性和女性血清铁蛋白87.0ng/ml和32.5ng/ml可排除中重度肝硬变,敏感度为94％.结论 本研究发现NAFLD患者血清铁蛋白水平与肝脏硬度之间呈显著相关,存在通过检测血清铁蛋白水平来预测中重度肝纤维化的可能性.

Background: An electronic system that automatically collects medical information can realize timely monitoring of patient health and improve the effectiveness and accuracy of medical treatment. To our knowledge, the application of artificial intelligence (AI) in medical service quality assessment has been minimally evaluated, especially for clinical nutrition departments in China. From the perspective of medical ethics, patient safety comes before any other factors within health science, and this responsibility belongs to the quality management system (QMS) within medical institutions. Objective: This study aims to evaluate the QMS for clinical nutrition in Jiangsu, monitor its performance in quality assessment and human resource management from a nutrition aspect, and investigate the application and development of AI in medical quality control. Methods: The participants for this study were the staff of 70 clinical nutrition departments of the tertiary hospitals in Jiangsu Province, China. These departments are all members of the Quality Management System of Clinical Nutrition in Jiangsu (QMSNJ). An online survey was conducted on all 341 employees within all clinical nutrition departments based on the staff information from the surveyed medical institutions. The questionnaire contains five sections, and the data analysis and AI evaluation were focused on human resource information. Results: A total of 330 questionnaires were collected, with a response rate of 96.77% (330/341). A QMS for clinical nutrition was built for clinical nutrition departments in Jiangsu and achieved its target of human resource improvements, especially among dietitians. The growing number of participating departments (an increase of 42.8% from 2018 to 2020) and the significant growth of dietitians (t(93.4)=-0.42; P=.02) both show the advancements of the QMSNJ. Conclusions: As the first innovation of an online platform for quality management in Jiangsu, the Jiangsu Province Clinical Nutrition Management Platform was successfully implemented as a QMS for this study. This multidimensional electronic system can help the QMSNJ and clinical nutrition departments achieve quality assessment from various aspects so as to realize the continuous improvement of clinical nutrition. The use of an online platform and AI technology for quality assessment is worth recommending and promoting in the future.

Objective: To critically evaluate the Quality Management System (QMS) for Clinical Nutrition (CN) in Jiangsu. Monitor its performance in quality assessment as well as human resource management from nutrition aspect. Investigate the appliance and development of Artificial Intelligence (AI) in medical quality control.Data Source: The study source of this research was all the staffs of 70 Clinical Nutrition Department (CND) of the tertiary hospitals in Jiangsu Province, China. These departments are all members of the Quality Management System of Clinical Nutrition in Jiangsu (QMSNJ).Methods: An online survey was conducted on all 341 employees within all these CNDs based on the staff information from the surveyed medical institutions. The questionnaire contains 5 aspects, while data analysis and AI evaluation were focused on human resource information. Results: 330 questionnaires were collected with the respondent rate of 96.77%. The QMS for CN has been build up for CNDs in Jiangsu, which achieved its target in human resource improvements, especially among dietitians. The increasing number of participated departments (42.8%) and the significant growth of dietitians (p=0.02, t=-0.42) are all expressions of the advancements of QMSNJ.Conclusion: As the first innovation of an online platform for QM in Jiangsu, JPCNMP has been successfully implemented among QMS from this research. This multidimensional electronic system can help QMSNJ and CND achieve quality assessment from various aspects, so as to realize the continuous improvement of clinical nutrition. The instrument of online platform, as well as AI technology for quality assessment is worth to be recommended and promoted in the future.

临床营养质量对巩固疾病治疗效果,确保患者安全具有重要意义.分析指出江苏省临床营养质控工作存在覆盖范围不全面、质控指标有差距等不足,总结江苏省临床营养质控中心工作实践,从管理构架、质控指标、质控同质化和质控信息化4个方面,阐述了营养质控工作经验,为我国临床营养工作开展提供了参考.

Adrenocortical carcinoma (ACC) is a rare malignancy with dismal prognosis. Hypoxia is one of characteristics of cancer leading to tumor progression. For ACC, however, no reliable prognostic signature on the basis of hypoxia genes has been built. Our study aimed to develop a hypoxia-associated gene signature in ACC. Data of ACC patients were obtained from TCGA and GEO databases. The genes included in hypoxia risk signature were identified using the Cox regression analysis as well as LASSO regression analysis. GSEA was applied to discover the enriched gene sets. To detect a possible connection between the gene signature and immune cells, the CIBERSORT technique was applied. In ACC, the hypoxia signature including three genes (CCNA2, COL5A1, and EFNA3) was built to predict prognosis and reflect the immune microenvironment. Patients with high-risk scores tended to have a poor prognosis. According to the multivariate regression analysis, the hypoxia signature could be served as an independent indicator in ACC patients. GSEA demonstrated that gene sets linked to cancer proliferation and cell cycle were differentially enriched in high-risk classes. Additionally, we found that PDL1 and CTLA4 expression were significantly lower in the high-risk group than in the low-risk group, and resting NK cells displayed a significant increase in the high-risk group. In summary, the hypoxia risk signature created in our study might predict prognosis and evaluate the tumor immune microenvironment for ACC.