The human body is composed of organic and inorganic substance. Under normal conditions, it carries out synthesis and catabolism in an orderly manner to maintain health throughout the whole life. Metabolism is the main theme of life and influenced by multiple factors such as genetics, diet, sleep, exercise, environment, and diseases. Brain damage is a manifestation of various acute and chronic diseases. Intellectual impairment, learning difficulties, memory regression, psychiatric and behavioral abnormalities, epilepsy, and paralysis are often the main or early symptoms of nutritional metabolic disorders. Among acquired factors, imbalances in nutrients such as sugar, vitamins, amino acids, fatty acids, and minerals can lead to common metabolic abnormalities and inflammatory diseases. Among congenital factors, many inherited metabolic disorders usually lead to neuropsychiatric disorders, such as amino acid, organic acid, and fatty acid metabolic disorders, as well as mitochondrial and lysosomal diseases. Clues can be found through routine examinations, electrophysiology, and imaging.Metabolic studies could be performed using molecular diagnostic techniques for the analysis of blood amino acid and acylcarnitine profiles, fatty acid profiles, urine organic acid profiles, chromosomes, and genes. For potential underlying causes, internal metabolic environment can be improved by individualized dietary, nutritional, symptomatic treatment, and lifestyle intervention. Effective prevention and treatment of diseases can help patients get to normal social life.

Glutamine is the most abundant and versatile free amino acid in the human body, playing various physiological effects in energy metabolism and the maintenance of health. Under normal physiological conditions, glutamine can be synthesized endogenously from glutamate and ammonia catalyzed by glutamine synthetase. However, in hypercatabolic states such as severe burns and major trauma, endogenous synthesis becomes insufficient, rendering glutamine a conditionally essential amino acid. As an important energy substrate for enterocytes and immune cells, glutamine plays a key role in protecting the integrity of the gastrointestinal mucosal barrier, modulating immune function, and mitigating oxidative stress. Glutamine is a key therapeutic nutrient for glutamine synthetase deficiency. For inherited metabolic disorders, such as mitochondrial diseases, glutamine demonstrates effective therapeutic effects. This article systematically explores the potential therapeutic value of glutamine in glutamine synthetase deficiency and rare diseases associated with mitochondrial dysfunction and reviews the evidence-based applications of glutamine in severe trauma and burns, radiotherapy-induced oral mucositis in head and neck cancer, the perioperative period of elective gastrointestinal surgery, sickle cell disease, and short bowel syndrome, aiming to provide updated and comprehensive evidence-based references for clinical practice.

Riboflavin, also known as vitamin B₂,is a synthetic precursor of flavin mononucleotide (FMN) and flavin adenine dinucleotide (FAD). It is one of the key regulatory molecules for energy metabolism and redox balance in the body. The importance of riboflavin has expanded from traditional nutrient functions to the prevention and treatment of multiple diseases. Riboflavin metabolic disorders are classified into nutritional riboflavin deficiency and inherited defects in riboflavin metabolic pathway. The patients manifest a complex spectrum of diseases involving multicomponent defects of riboflavin transport, coenzyme synthesis and mitochondrial delivery. This article systematically reviews the pathogenesis, genetic defects, clinical phenotypes, laboratory examinations, diagnosis and treatment of riboflavin metabolic disorders, aiming to ameliorate the strategies of prevention and treatment, thereby improving clinical prognosis.

S-adenosylmethionine (SAM), a natural endogenous compound discovered in 1953, is the principal methyl donor in mammalian cells. It is synthesized most abundantly in the liver. SAM plays a central role in maintaining cell growth, differentiation, and functional homeostasis by participating in the methylation of DNA, RNA, and proteins, polyamine synthesis, and the provision of glutathione precursors. Its metabolism involves a complex regulatory network encompassing the methionine cycle, folate cycle, and methionine salvage pathway. In clinical applications, the effect of SAM in treating liver diseases such as intrahepatic cholestasis and alcoholic liver disease is well-established. In oncology, dysregulation of SAM homeostasis has been proposed as a diagnostic or prognostic biomarker for malignancies including liver and lung cancer. Experimental studies indicate that SAM showed anti-cancer effects in various models, such as gastric cancer, breast cancer, glioblastoma, and melanoma, by reversing the aberrant methylation of oncogenes and intervening in multiple signaling pathways. It can also produce synergistic effects when combined with chemotherapy or immunotherapy. SAM has been shown to alleviate chemotherapy-induced liver injury. In inherited metabolic disorders, SAM has been confirmed to improve neurological symptoms in patients with methionine adenosyltransferase deficiency. It also serves as an effective adjunctive treatment strategy for refractory depression. Although SAM holds broad application prospects in multiple diseases, current clinical evidence remains insufficient, necessitating more comprehensive studies to fill mechanistic gaps and provide high-level clinical evidence.

Cobalt, a natural transition metal element, is an essential trace element for human, which mainly exists in the form of cobalamin (vitamin B₁₂) and participates in multiple physiological activities in the human body. For common conditions, cobalamin is used to treat vitamin B₁₂ deficiency and megaloblastic anemia. For rare diseases, patients with vitamin B₁₂-responsive methylmalonic acidemia often require lifelong high-dose cobalamin injections. Due to the excellent structural strength, wear resistance and great biocompatibility, cobalt and its alloys have been widely used in medical devices such as artificial joints and dental restoration materials in recent years. However, in the human body, toxic effects of cobalt with large amounts and long-term accumulation are gradually attracting the attention of the medical community. In the medical perspective, this article aims to state the physiological effects, pharmacological effects and clinical applications of cobalt, as well as the potential toxicity and possible mechanisms of cobalt accumulation, providing a reference for the rational use in clinical practice.

Creatine deficiency syndromes are a group of rare diseases caused by defects in creatine transporters, guanidinoacetate methyltransferase, or arginine-glycine amidinotransferase. These defects lead to brain creatine deficiency, impaired energy production, and reduced neural signal transmission function, resulting in neurological and psychiatric disorders such as intellectual disability, epilepsy, and behavioral abnormalities. With advances in molecular genetics and metabolomics, the genetic mechanisms and biochemical characteristics of creatine deficiency syndromes have been clarified. However, the clinical phenotypes are non-specific, and available therapies are limited. The diagnosis and management are difficult. This paper provides a detailed review of the pathogenesis, classification, clinical manifestations, laboratory investigations, and advances in diagnosis and treatment of creatine deficiency syndromes, aiming to provide a theoretical basis for clinical practice and to promote precise prevention and treatment.

Objective To investigate the status of sedentary behavior and its underlying risk factors in postoperative colorectal cancer patients. Method A total of 190 postoperative colorectal cancer patients diagnosed at Huai'an Second People's Hospital between March 2023 and March 2025 were included in the present study. Data were collected using the following instruments: a general information questionnaire, the international physical activity questionnaire (IPAQ), the self-rating depression scale (SDS), the self-rating anxiety scale (SAS), the social support rating scale (SSRS), the nutritional risk screening 2002 (NRS 2002), the numeric rating scale (NRS) for pain, and the cancer fatigue scale (CFS). Logistic regression analysis was employed to identify the factors regarding sedentary behavior in these patients. Result Of the 190 questionnaires distributed, 186 were returned(97.89%). Of them, 112 (60.22%) exhibited sedentary behavior. according to the results of logistic regression analysis, it was revealed that unmarried (OR=2.472,95%CI=1.503-4.067,P<0.001), with 3 or more type of chronic diseases (OR=2.440,95%CI=1.925-3.093,P<0.001), stage Ⅲ (OR=2.680,95%CI=1.420-5.058,P=0.001), with poor differentiation tumor (OR=2.214,95%CI=1.788-2.742,P<0.01), with a permanent stoma (OR=2.401,95%CI=1.748-3.299,P<0.001), receiving chemotherapy (OR=2.423,95%CI= 1.686-3.482,P<0.001), with stoma complications (OR=3.080,95%CI=1.616-5.870,P<0.001), higher SDS score (depression) (OR=2.192,95%CI=1.487-3.232,P<0.001), higher SAS score (anxiety) (OR=2.230,95%CI=1.177-4.225,P<0.05), higher NRS score (pain) (OR=2.044,95%CI= 1.308-3.196,P<0.05), and higher CFS score (cancer-related fatigue) (OR=2.512,95%CI=1.591-3.966,P<0.001). Higher SSRS score (social support) was identified as an independent protective factor (OR=0.378,95%CI=0.172-0.830,P<0.05). Conclusion Sedentary behavior is prevalent in postoperative colorectal cancer patients. Being unmarried, chronic disease history, tumor stage and differentiation, with a permanent stoma and related complications, chemotherapy, depression, anxiety, pain, cancer-related fatigue (CFS) score are revealed as the independent risk factors for sedentary behavior. Social support is identified as the protective factor. Comprehensive intervention strategies targeting these factors could help mitigate sedentary behavior and promote prognosis in patients with postoperative colorectal cancer.

Objective To explore a perioperatively nutritional management model for surgical critically ill patients based on Bloom's Taxonomy, optimizing clinical diagnosis and treatment processes, conduct teaching practices to standardize nutritional therapy procedures and enhance the clinical competencies of standardized residency training trainees. Method Based on the four-dimensional classification system of factual knowledge, conceptual knowledge, procedural knowledge, and metacognitive knowledge from the Bloom Taxonomy of Educational Goals (Revised Edition), and tailored to the characteristics of surgical critically ill patients, a systematic clinical nutrition treatment approach was constructed and implemented. In 2025, a teaching practice was conducted among 40 surgical and critical care residency trainees (grades 2022-2024) at Beijing Tongren Hospital, Capital Medical University, and the teaching outcomes were evaluated. An evaluation system consisting of formative assessment, summative assessment and qualitative assessment was applied to assess the teaching outcomes. Result Through the integration of clinical cases with the four-dimensional knowledge framework in the diagnosis, treatment, and teaching of surgical critical illness, the model effectively addresses issues such as fragmented knowledge and weak clinical reasoning regarding nutritional therapy. Trainees demonstrated significant improvement systematically mastering nutritional therapy, developing relevant clinical reasoning skills, and enhancing autonomous learning abilities. Conclusion Nutrition-related diagnosis and treatment planning based on Bloom's Taxonomy of Educational Objectives can precisely match the clinical nutritional needs of critically ill surgical patients. Following the structured integration of four-dimensional knowledge and the delivery of targeted clinical nutrition therapy training, more than 90% of participants grasped key concepts including "perioperative nutrition for critically ill surgical patients" (P<0.05). Their mastery of basic course knowledge improved significantly compared with pre-class levels (P<0.001), and 75% of learners mastered core content such as "fundamental procedures for implementing teaching based on Bloom's Taxonomy" (P<0.001). Bloom's Taxonomy provides a replicable and promotable reference for clinical practice and teaching in critical surgical care.

Objective To explore the risk factors for the deterioration of nutritional status in patients with non-small cell lung cancer(NSCLC), construct a nomogram prediction model and verify its predictive value. Method Convenience sampling was used to select 312 lung cancer patients admitted to the Affiliated Cancer Hospital of Nantong University from June 2019 to June 2025. The patients were divided into a modeling group (212 cases) and a validation group (100 cases) at a 7:3 ratio. With the occurrence of nutritional deterioration as the dependent variable, univariate analysis was performed on the modeling group to screen for statistically significant variables, which were then included in a multivariate binary Logistic regression to develop a nomogram model for predicting nutritional deterioration, and the model was validated using the validation group. Result In the modeling group, 212 patients with NSCLC were obtained, and 75 of them experienced deterioration of nutritional status (35.38%). Multivariate results age (OR=1.982), comorbidity index (OR=1.640), pre-existing digestive system diseases (OR=1.694), poor self-assessed nutritional intake (OR=1.507), TNF-α (OR=2.059), and IL-6 (OR=2.342) became risk factors for the deterioration of nutritional status in patients with non-small cell lung cancer (P < 0.05). Body mass index(BMI)of 18.5-24.0 kg/m² (OR=0.787)/BMI > 24.0 kg/m² (OR=0.739) became a protective factor for the deterioration of nutritional status in patients with NSCLC (P < 0.05). Nomogram prediction model logit (P)=2.538+0.684 (age) +0.495 (comorbidity index) +0.527K (pre-existing digestive system diseases) + (-0.239) K (BMI between 18.5 and 24.0 kg/m²) + (-0.239) K (BMI>24.0 kg/m²) +0.410K (self-assessed nutritional intake) +0.722 (TNF-α) +0.851 (IL-6). The analysis results of the receiver operating characteristic(ROC) curve showed that the AUC of the modeling group and the validation group was 0.82 (95%CI was 0.78-0.86) and 0.78, respectively, and the (95%CI was 0.72-0.83) . The calibration curve is close to the reference curve, and the decision analysis curve shows that the model's decisions can benefit patients. Conclusion The occurrence of nutritional deterioration in patients with NSCLC is related to the patients' age, comorbidity index, pre-existing digestive system diseases, body mass index, self-rated nutritional intake, TNF-α and IL-6. Based on the above indicators, a nomogram prediction model is constructed, which can better predict the occurrence of nutritional deterioration in patients with NSCLC. It can provide a basis for early prevention of deterioration in clinical nutritional status.

Objective This study aimed to evaluate the effect of Bifidobacterium lactis V9 (B. lactis V9) on preventing anthracycline-induced cardiotoxicity in breast cancer patients. Method From June 2023 to September 2025, breast cancer patients who underwent anthracycline-based chemotherapy after surgery at the People's Hospital of Inner Mongolia Autonomous Region were enrolled. According to the random number table method, the patients were randomly divided into an observation group (50 cases) and a control group(51 cases). The observation group received a standardized anthracycline chemotherapy regimen combined with B. lactis V9, while the control group was given the same standardized chemotherapy regimen plus a matched placebo. Both groups received four treatment cycles, with each cycle lasting 21 days. The incidence of abnormal 12-lead electrocardiograms before and after treatment was recorded in both groups. Additionally, changes in N-terminal pro-brain natriuretic peptide (NT-proBNP), creatine kinase (CK), creatine kinase isoenzyme (CK-MB), and left ventricular ejection fraction (LVEF) via routine echocardiography were detected and documented at three time points: before the first cycle of treatment, after the 2nd cycle, and after the 4th cycle. Result At the end of treatment, the incidence of ECG abnormalities was higher in the control group than in the observation group, and the difference was statistically significant (54.90% vs 24.00%, P < 0.05). Intra-group comparisons of NT-proBNP levels before and after treatment showed no significant changes in either group (P >0.05); however, after 4 treatment cycles, NT-proBNP levels in the observation group were lower than those in the control group, and the difference was statistically significant (P < 0.05).CK levels in the observation group first decreased and then increased, however, there was no statistically significant difference between the two groups compared to the control group (P >0.05). There were no significant changes in CK-MB levels between or within the two groups (P >0.05). During the treatment period, LVEF levels in the observation group first decreased and then increased, whereas LVEF levels in the control group decreased compared to pre-treatment levels (P < 0.05). After 4 treatment cycles, the LVEF levels in the observation group were higher than those in the control group (P < 0.05). Conclusion B. lactis V9 may offer some degree of benefit in preventing anthracycline-induced cardiac toxicity in breast cancer patients undergoing chemotherapy.

Objective To investigate the correlation of preoperative body composition indicators on postoperative hypoproteinemia in patients with gastrointestinal cancer, so as to provide evidence for the assessment and intervention of nutritional risk during the perioperative period. Method A retrospective analysis was conducted on 245 patients who underwent radical surgery for gastrointestinal malignancies at Nanjing First Hospital between December 2023 and July 2025. Preoperative body composition data were obtained using bioelectrical impedance analysis (BIA). Relevant laboratory indicators were recorded both preoperatively and postoperatively. Factors influencing the occurrence of postoperative hypoproteinemia in patients with gastrointestinal malignancies were identified. The predictive ability of these factors was evaluated using the receiver operating characteristic (ROC) curve, and the stability of the prediction was validated using Bootstrap with 1000 resampling iterations. Result Among the 245 patients who underwent radical gastrointestinal surgery, 183 (75%) developed hypoproteinemia within 48 hours postoperatively. Multivariate logistic regression analysis indicated that the skeletal muscle mass index (SMI) was an independent influencing factor for postoperative hypoproteinemia (P<0.05). The area under the ROC curve (AUC) for SMI in predicting postoperative hypoproteinemia was 0.713 (95%CI=0.635-0.790), with a Bootstrap validation value of 0.712, demonstrating good stability of the predictive indicator. According to the Youden index, the optimal cutoff value of SMI for predicting postoperative hypoproteinemia was 7.4 kg/m² (sensitivity 79.2%, specificity 56.5%). Conclusion SMI measured by BIA has predictive value for postoperative hypoalbuminemia, and an SMI < 7.4 kg/m² may serve as a reference cut-off point for identifying high-risk individuals.

Objective To establish a symptom network for lung cancer patients during chemotherapy, providing a theoretical basis for formulating symptom management plans in the later stage. Method A total of 205 lung cancer patients admitted to our hospital from January 2023 to February 2025 were selected as the subjects of this study using the convenience sampling method. General information questionnaires and the Chinese version of the Anderson symptom scale were used to conduct questionnaire surveys on them. Data analysis was carried out through exploratory factor analysis and network analysis. Result A total of 194 valid questionnaires were retrieved in this study, with an effective rate of 94.63%. The incidence of symptoms during chemotherapy in lung cancer patients ranges from 11.34% to 80.41%. The top three symptoms with the highest incidence rates are cough (80.41%), nausea (79.38%), and distress (76.80%). In terms of severity, the top three were fatigue (3.88±1.56), sadness (3.31±1.63), and cough (3.27±1.58) in sequence. Results of symptom network analysis indicated that the top three pairs with the strongest correlation among symptoms were sadness and fatigue (r = 0.76), dyspnea and chest tightness (r = 0.72), as well as pain and numbness (r = 0.71). Centrality analysis indicated that sadness (r_s = 7.43), nausea (r_s = 6.73), and cough (r_s = 6.65) exhibited the highest strength centrality values. Furthermore, betweenness centrality analysis identified sadness as a core bridging symptom (r_s = 5.69), suggesting its critical role in connecting distinct symptom clusters. Conclusion Patients with lung cancer undergoing chemotherapy have a significant symptom burden. Sadness, cough, and nausea have a strong effect on the multi-dimensional symptom network and need to be regarded as core intervention targets. Intervention measures for grief can effectively reduce the severity of the entire symptom network, while early intervention for coughing and nausea can alleviate the burden of symptom management for patients.

Objective To analyze the current research status, hotspots, and development trends in gastrostomy care, based on Chinese and English literature. Method Relevant gastrostomy care was retrieved from the Web of Science Core Collection and the China National Knowledge Infrastructure. CiteSpace software was used to conduct a visual analysis of the external and internal characteristics of the literature. Result A total of 298 English-language articles and 212 Chinese-language articles were included. The annual number of English publications increasing trend, while the opposite trend was observed for Chinese publications. English articles formed a relatively close collaboration networks of authors and institutions, with cross-regional and cross-country cooperation. In contrast, Chinese research collaborations exhibited weaker core strength, scattered regional distribution, and sparse institutional collaboration. Chinese and English literature involved 147 and 383, with 5 and 14 high-frequency keywords, Research hotspots include symptom management, decision-making, transitional care, and digital technology empowerment. Conclusion For future gastrostomy care, efforts should strengthen multidisciplinary collaboration, psychological support, and digital interventions. A comprehensive system covering the perioperative period, chemotherapy phases, and home care rehabilitation phase should be established to enhance nutritional support outcomes and quality of life of gastrostomy patients.

Objective To explore the predictive value of serum chemokine ligand 20 (CCL20) and forkhead box D1 (FOXD1) for relapse and metastasis in cervical cancer patients after radiotherapy and chemotherapy. Method From March 2021 to February 2024, 134 patients with cervical cancer who underwent radiotherapy and chemotherapy in Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine, Hebei Province were designated as the study group. They were grouped into a relapse group (n=38) and a non-relapsing group (n=96) based on whether they had relapse or metastasis. Meanwhile, 130 patients with benign cervical lesions were served as the lesion group. Another 100 healthy individuals who underwent physical examination were served as the control group. ELISA method was used to detect serum CCL20 and FOXD1. The clinical pathological features, as well as serum CCL20 and FOXD1, were compared between the relapse and non-relapsing groups. Multivariate logistic regression was used to explore the influencing factors of relapse and metastasis in cervical cancer patients after radiotherapy and chemotherapy. ROC curve was used to explore the predictive value of serum CCL20 and FOXD1 for relapse and metastasis in cervical cancer patients after radiotherapy and chemotherapy. Decision curve (DCA) analysis for predicting the clinical value of the model. Result Serum CCL20 and FOXD1 levels showed a gradient increase (study group> lesion group> control group, P<0.05). The relapse group had higher proportions of tumor stage Ⅳ, lymph node metastasis, infiltration depth ≥1/2, and levels of serum CCL20 and FOXD1 than the non-relapse group (P<0.05). All these factors were independent risk factors for recurrence and metastasis after chemoradiotherapy (P<0.05). The area under the curve (AUC) values of serum CCL20, FOXD1, and their combination in predicting relapse and metastasis in cervical cancer patients after radiotherapy and chemotherapy were 0.844, 0.859, and 0.936, respectively. The combination was better than the individual predictions (Z _{combination - CCL20}=2.887, Z _{combination - FOXD1}=2.241, P=0.004, P=0.025). The results of DCA curve analysis showed that when the high-risk threshold was 0.04 to 0.98, the net benefit rate of the combined prediction of serum CCL20 and FOXD1 for recurrence and metastasis of cervical cancer patients after radiotherapy and chemotherapy was higher than that predicted by a single indicator. Conclusion The expression levels of CCL20 and FOXD1 in the serum of cervical cancer patients were significantly elevated, and the combined detection may have higher predictive value for recurrence and metastasis after chemoradiotherapy in cervical cancer patients.

Objective To explore the effect of interventional therapy combined with enteral nutrition and chemotherapy on the clinical efficacy and quality of life of patients with recurrent ovarian cancer complicated with intestinal obstruction under multidisciplinary cooperation mode. Method The clinical data of 60 patients with recurrent ovarian cancer complicated with intestinal obstruction treated at Beijing Meizhong Airui Cancer Hospital from January 2021 to August 2023 were retrospectively collected. Treatment plans were formulated for all patients within the framework of the MDT mode, and treatment involved the placement of a intestinal obstruction catheter combined with enteral nutrition and chemotherapy. The therapeutic efficacy on intestinal obstruction, anti-tumor efficacy, as well as nutritional indicators, quality of life, and safety before and after treatment were observed. Result After treatment, the total effective rate for intestinal obstruction relief in the 60 patients was 86.67% (52/60), the objective response rate (ORR) was 46.67% (28/60), and the disease control rate (DCR) was 76.67% (46/60). The abnormal rate of hemoglobin was 71.67% (43/60) before treatment and decreased to 40.00% (24/60) after treatment; the abnormal rate of albumin was 83.33% (50/60) before treatment and decreased to 31.67% (19/60) after treatment, with statistically significant differences (P<0.05). Compared with before treatment, the scores of all dimensions of the European Organization for Research and Treatment of Cancer quality of life questionnaire core 30 (EORTC QLQ-C30) improved after treatment (P<0.05). During treatment, the main adverse reactions included myelosuppression in 28 cases (46.67%), nausea and vomiting in 22 cases (36.67%), diarrhea in 12 cases (20.00%), and abnormal liver function in 8 cases (13.33%). All symptoms were alleviated after symptomatic treatment, and no treatment-related deaths occurred. Conclusion Under the MDT mode, the combination of interventional therapy, enteral nutrition, and chemotherapy for the treatment of recurrent ovarian cancer complicated with intestinal obstruction suggests that this comprehensive treatment regimen helps alleviate obstructive symptoms and improve patients’ nutritional indicators and quality of life.

Objective To investigate the predictive value of the pretreatment C reactive protein-albumin-lymphocyte (CALLY) index for malnutrition due to dysphagia and survival prognosis in patients with laryngeal carcinoma undergoing postoperative radiotherapy. Method Retrospective collection of 102 laryngeal cancer patients who received postoperative radiotherapy at Jingmen People's Hospital from January 2019 to December 2021. The CALLY index was calculated from pretreatment laboratory parameters. The optimal cut-off value for predicting malnutrition was determined by receiver operating characteristic (ROC) curve analysis, and patients were accordingly stratified into low-CALLY group (n=52) and high-CALLY group (n=50). Baseline characteristics were compared. Logistic regression was used to analyze factors associated with malnutrition. The median follow-up time was 33.05 (9.65,60.01) months. In the low CALLY group, there were 36 deaths and 32 relapses; in the high CALLY group, there were 28 deaths and 22 relapses. The Kaplan-Meier method and Cox proportional hazards models were employed to assess the correlation between the CALLY index and overall survival (OS) as well as progression-free survival (PFS). Result The area under the ROC curve (AUC) of the CALLY index for predicting malnutrition was 0.942, with an optimal cut-off value of 1.382. The incidence of malnutrition was significantly higher in the low-CALLY group (64.5% vs 26.0%, P<0.001). Multivariate logistic regression identified that after adjusting for factors such as age, body mass index, ECOG-PS score, smoking history, alcohol consumption history, and resection margin status, a low CALLY index was an influencing factor for malnutrition (OR=0.507, 95%CI=0.295-0.870, P=0.014). Survival analysis revealed that the low-CALLY group had significantly shorter OS and PFS (P<0.001). Multivariate Cox analysis confirmed that after adjusting for factors such as age, tumor differentiation degree, margin status, TNM stage, and smoking history, a low CALLY index was an independent protective factor for both OS (HR=0.644,95%CI=0.509-0.816, P<0.001) and PFS (HR=0.669,95%CI=0.508-0.880, P=0.004). Conclusion The CALLY index may serve as a potential biomarker for identifying dysphagia-related malnutrition and unfavorable survival outcomes in patients with laryngeal carcinoma undergoing postoperative radiotherapy, and may provide a reference for clinical risk stratification and individualized management.

Chemotherapy-induced taste alteration (CITA) is one of the most common but often ignored side effects in cancer treatment. The change or loss of taste perception not only directly affects the patients' eating experience, but also seriously damages the patients' nutritional status and treatment through the chain reaction of "dysgeusia-decreased appetite-insufficient nutritional intake-weight loss-impaired immune function, tolerance, and quality of life". The incidence of CITA is high. CITA is not determined by one single factor, but is the result of the combined effects of treatment-related factors (chemotherapy drugs, chemotherapy cycles), patients' own characteristics (gender, age), concomitant symptoms (oral mucositis, dry mouth, nausea, etc.) and psychosocial factors (lack of social support, anxiety). As an essential trace element for the human body, zinc plays an irreplaceable role in the renewal, signal transduction, and repair of taste buds cells, while whether zinc supplements have a certain effect on CITA has attracted widespread attention from researchers. This review systematically summarizes the epidemiological status of CITA, the core role of zinc in taste physiology, the pathological mechanisms of zinc deficiency and taste damage caused by chemotherapy. It also comprehensively analyzes the evidence of clinical research on zinc intervention in CITA in recent years, looking forward to focusing on research directions and providing scientific basis for evaluation and treatment of CITA.

Diabetic ketoacidosis (DKA) is one of the most severe acute complications of diabetes, characterized by insidious onset, rapid progression, and high mortality risk. Of particular concern is the potential occurrence of "euglycemic DKA" in patients receiving sodium-glucose cotransporter 2 (SGLT2) inhibitor therapy or using insulin pumps, which poses a significant challenge to traditional monitoring strategies centered on hyperglycemia as the core warning signal, carrying a substantial risk of missed diagnosis. Against this backdrop, continuous ketone monitoring (CKM), as an emerging wearable technology, offers new possibilities for the early identification and tiered management of DKA risk. Unlike traditional fingerstick blood or urine ketone tests that only provide sporadic, non-continuous static values, CKM utilizes a subcutaneous sensor to continuously monitor interstitial fluid beta-hydroxybutyrate (BHB) concentrations, dynamically reflecting ketone body fluctuations and providing reference for intervention decisions through threshold alerts and trend information. The recent international expert consensus on CKM published in Lancet Diabetes & Endocrinology suggests that CKM holds promise as a valuable adjunctive tool in diabetes management, with potential priority applications in individuals with recurrent DKA, elderly or frail patients, those using SGLT2 inhibitors, and certain users of automated insulin delivery systems. Based on this expert consensus, this article interprets the application background, technical principles, clinical application scenarios, threshold settings, and future research directions of CKM, aiming to provide a reference for its rational clinical application and subsequent research, thereby facilitating the transition of diabetes management from a traditional "glucose-centric" model towards a comprehensive early warning system that considers multidimensional metabolic risks.