In recent years, with the in-depth research on intestinal microecology, probiotics, probiotics, synbiotics, fecal bacteria transplantation and other microecological therapies have become new clinical treatment and intervention methods.The occurrence and development of some chronic diseases are closely related to the disorder of intestinal flora.Therefore, in clinical practice, the treatment and adjuvant treatment of chronic diseases related to intestinal flora disorder with the method of intestinal microecology will bring better treatment options and clinical prognosis.How to better regulate intestinal flora to bring more benefits to such patients, as well as what kind of microecologics and treatment methods are the primary problems and challenges in the intervention of chronic diseases with microecologics.Based on the current trend of intestinal microecological intervention in chronic diseases, this article proposedthe microecological intervention strategy, in order to improve theunderstanding of this topic. Key words: Intestinal microecology; Chronicdisease; Microecological preparation; Intervention strategy

Objective To explore the clinical application of intracavitary electrocardiogram in positioning of PICC catheter tip through inferior vena cava and summarize the change rule of electrocardiographic wave during the PICC process. Methods 60 patients who couldn′t receive PICC through precava were recruited from a tertiary hospital and assigned into the intervention group and the control group randomly. Patients in the control group received PICC through inferior vena cava and X-ray was used to confirm the positioning of PICC catheter tip. Patients in the intervention group were checked by intracavitary electrocardiogram. Success rates were compared and the change rule of electrocardiographic wave during the PICC process was summarized. Results The success rate was 100% in the intervention group and 86.7% in the control group. All patients in the intervention group showed the typical change of intracavitary electrocardiogram. Conclusions Intracavitary electrocardiogram can promote success rate of PICC through inferior vena cava and reduce the side effect. It is of great value to generalize intracavitary electrocardiogram in clinical application. Key words: Intracavitary electrocardiogram; PICC through inferior vena cava; Positioning of PICC catheter tip

Objective To investigate the effects of vitamin D3 supplementation combined with standardized hypoglycemic regimen on islet β cell function and macroangiopathy of T2DM patients. Methods A total of 192 patients with type 2 diabetes mellitus were selected and randomly divided into control group and observation group with 96 patients in each group. Patients in two groups were given standardized hypoglycemic regimen, and the observation group was treated with vitamin D3 supplementation in addition. The changes of the indexes of body examination, glycolipid metabolism, islet β cell function and macrovascular complications before and 6 months after treatment were compared between the two groups. Results After 6 months of treatment, BMI, SBP, TG, FBG, FINS, HbA1c and HOMA-IR decreased, while HOMA-β increased in both groups (P<0.05). Compared with the control group, the serum levels of 25 (OH) D increased, and vaspin and CRP decreased significantly after 6 months of treatment in the observation group (P<0.05). CIMT and other indicators showed no significant difference. 25 (OH) D was negatively correlated with FBG, FINS, vaspin and CRP, and positively correlated with 1PH and ISI (P<0.05). Conclusion Vitamin D3 is closely related to T2DM and its macrovascular complications, but it has not been found that vitamin D3 supplementation can further improve islet β cell function and macrovascular complications in patients with T2DM. Key words: Type 2 diabetes; Vitamin D; Islet Cell Function; Macroangiopathy; Vaspin

Autoantibodies are related to occurrence of some types of severe hypertriglyceridemia. Researches showed that autoantibodies of lipoprotein lipase, glycosylphosphatidylinositol-anchored high-density lipoprotein binding protein 1 and apolipoprotein C-Ⅱ could induce hypertriglyceridemia. This review focused on hypertriglyceridemia induced by autoantibodies and its treatment. Key words: Hypertriglyceridemia; Autoantibody; Glycosylphosphatidylinositol-anchored high-density lipoprotein binding protein 1; Lipoprotein lipase; Apolipoprotein C-Ⅱ

Objective To explore the clinical effect of applying standard process management in early enteral nutrition support for elderly patients with gastric cancer after operation. Methods A total of 142 elderly patients with gastric cancer in our hospital were randomly divided into control group(n=71) treated with the traditional nursing of enteral nutrition and intervention group(n=71) adopting the standardized process management, and then enteral nutrition tolerance, complications, nutritional status and recovery of gastrointestinal function were compared between the two groups. Results There was no significant difference in age, sex and preoperative nutritional condition and operation situation between the two groups(P>0.05). The incidence of nutritional intolerance and the cost of nutritional support were lower than those in the control group(P 0.05) . Conclusions Standardized process management of early enteral nutrition after operation could significantly improve the tolerance of enteral nutrition, meanwhile, it has positive significance in promoting rapid recovery of elderly patients with gastric cancer. Key words: Standardization; Enteral nutrition; Elderly; Gastric cancer

Objective To analyze the occurrence and clinical significance of hypophosphatemia after moderate-to-major abdominal surgery. Methods A total of 120 patients who had received moderate to major abdominal surgery and then transferred to the intensive care unit (ICU) from January 2008 to October 2018 were retrospectively analyzed. The peri-operative parameters of serum inorganic phosphate and calcium levels were recorded and analyzed. The incidence of hypophosphatemia after the operation was calculated. The effect of phosphorus-supplement infusion on the complications and mortality within 30 days after the operation were observed. Results After moderate-to-major surgery, the phosphorus concentration significantly decreased [(1.21±0.27) vs. (0.83±0.24)mmol/L, P<0.05]; the incidence of hypophosphatemia was 58.3%, especially in patients with nutritional risk assessed before the operation. The post-operative complications were less in the phosphorus-supplement infusion group than in the control group (17.5% vs. 41.3%, P=0.028). Conclusion The incidence of hypophosphatemia is relatively high after moderate-to-major abdominal surgery, especially in patients with nutritional risks. The treatment of phosphorus-supplement infusion can benefit the patients in their short-term prognosis. Key words: Hypophosphatemia; Critically ill; Nutritional risk

Objective To explore the high-risk factors of metabolic bone disease(MBD)in premature infants by retrospective analysis of the clinical data so as to provide evidence for optimal clinical management. Methods Clinical data of premature infants with birth weight 500 IU/L and blood phosphorus <1.5 mmol/L were selected as MBD group and premature infants with birth weight <1 500 g were selected randomly as non-MBD group. General data, pulmonary surfactant, continuous positive airway pressure, mechanical ventilation, start time of enteral nutrition, parenteral nutrition (PN) time, breast feeding time and breast milk fortifier adding, drug usage, hospitalization time and complications were recorded and compared between the two groups. Results A total of 440 premature infants with birth weight <1 500 g were admitted to the hospital during the study period. 58[13.2%(58/440)] infants were enrolled in the MBD group, among which infants with birth weight <1 000 g accounting for 56.9%(33/58). High birth weight (OR=0.62, 95% CI: 0.389-0.990) was an independent protective factor of MBD in premature infants. The higher the birth weight, the lower the risk of MBD in premature infants. The longer duration of breast feeding time(OR= 2.191, 95% CI: 1.628-2.950), later initial time of enteral feeding(OR=2.695, 95% CI: 1.710-4.248), longer duration of PN(OR=6.205, 95% CI: 3.359-11.463) time, longer duration of respiratory supporting time(OR=1.046, 95% CI: 1.026-.067), longer hospital stay time(OR=1.703, 95% CI: 1.109-2.615) and small for gestational age(OR=2.965, 95% CI: 1.163-5.658) were independent risk factors of MBD in premature infants. The duration of PN was the most important independent risk factor of MBD in premature infants(OR=6.205, 95% CI: 3.359-11.463). Conclusion Multiple factors can lead to MBD of premature infants. The high birth weight is an independent protective factor of MBD and the duration of PN is the most important independent risk factor of MBD in premature infants. Key words: Premature infant; Metabolic bone disease; High risk factor

Objective To describe the characteristics of radiation induced mucositis in patients with head and neck cancer (HNC) during radiotherapy, and analyze the effect of radiation induced mucositis on diet patterns and weight change and the influencing factors for radiation induced mucositis. Methods Patients with HNC treated with radiotherapy in one cancer hospital were recruited. Data were collected before, during and at the end of the radiotherapy, which included radiation induced oral and pharyngeal mucositis, pain during eating, diet patterns and weight. Results Two hundred and two patients were completely investigated and 43.5% and 34.2% of the patients suffered from moderate to severe(≥grade 2) oral mucositis and pharyngeal mucositis, respectively during the radiotherapy. At the end of radiotherapy, 53.5% and 51.5% of the patients suffered from moderate to severe oral mucositis and pharyngeal mucositis (≥grade 2), respectively. Oral and pharyngeal mucositis were significantly correlated with pain during eating, diet patterns and weight(P<0.05). Tumor site was the main reason that affected the severity of mucositis(Wald χ2=26.033, 14.216; P<0.001). Conclusion Radiation induced mucositis was gradually aggravated with radiotherapy progress, which is closely related to pain during eating, change of diet patterns and weight loss. The severity of mucositis is related to the tumor site. Measures should be taken to strengthen the management of adverse reactions and nutritional status of patients. Key words: Head and Neck Cancer; Radiation Induced Mucositis; Pain; Diet Pattern; Weight

Objective To explore the intervention effect of low-dose vitamin D on glucose metabolism of patients with impaired glucose regulation. Methods A total of 196 subjects receiving oral glucose tolerance test were enrolled in this study, including individuals with normal glucose tolerance (NGT group, n=67) and individuals with impaired glucose regulation (IGR group, n=129). The IGR group was divided into intervention group (n=64)and non-intervention group (n=65) according to vitamin D intervention (for 1 year) performed or not. Clinical data and biochemical parameters were collected. Results The level of serum 25(OH)D3 was significantly lower in the IGR group than that of normal control group (P<0.05). After 1 year of low-dose vitamin D intervention, insulin sensitivity increased and insulin resistance decreased in the intervention group as compared with non-intervention group. Diabetes developed less frequently in the intervention group (25 of 64 [39.1%]) compared with non-intervention group (30 of 65 [46.2%]). But there was no significant different in diabetes prevalence between the two groups. Conclusions Vitamin D intervention can improve insulin sensitivity and reduce insulin resistance in patients with impaired glucose regulation. Low dose vitamin D can improve the abnormal glucose metabolism outcome in patients with impaired glucose regulation. Key words: vitamin D; 25(OH)D3; type 2 diabetes mellitus; insulin secretion