Background The global prevalence of obesity is on the rise and is closely associated with various chronic non-communicable diseases such as cardiovascular diseases and diabetes. There is a relative lack of long-term dynamic studies on compound obesity among occupational populations. Objective To explore the changing trends of compound obesity among different occupational groups aged 18–59 years in nine provinces (autonomous regions, municipalities) of China from 1993 to 2018, and to provide a scientific basis for formulating targeted weight management strategies for occupational populations. Methods A total of 34519 employed adults aged 18–59 years from nine waves of the China Health and Nutrition Survey in1993, 1997, 2000, 2004, 2006, 2009, 2011, 2015, and 2018 were included. Obesity types were determined according to the Chinese Adult Weight Management Guidelines. The Joinpoint regression model was used to calculate the average annual percentage change (AAPC) and annual percentage change (APC) of compound obesity rates. Results From 1993 to 2018, the age-standardized compound obesity rate among the occupational population aged 18–59 years showed an upward trend (AAPC=6.24%, 95%CI: 5.09%, 7.41%, P<0.05). The AAPCs (95%CI) for age-standardized compound obesity rates among agricultural workers, blue-collar workers, other occupational groups, service workers, and white-collar workers were 9.55% (7.51%, 11.64%), 6.18% (4.70%, 7.69%), 5.53% (2.27%, 8.90%), 4.07% (2.40%, 5.77%), and 3.89% (2.16%, 5.65%), respectively, with statistically significant differences (P<0.05). Among males, the AAPCs (95%CI) for age-standardized compound obesity rates among agricultural workers, blue-collar workers, other occupational groups, service workers, and white-collar workers were 11.52% (7.71%, 15.47%), 7.28% (6.18%, 8.40%), 5.92% (2.28%, 9.69%), 5.56% (2.11%, 9.12%), and 4.22% (2.33%, 6.15%), respectively, with statistically significant differences (P<0.05). Among females, the AAPCs (95%CI) for age-standardized compound obesity rates among agricultural workers, blue-collar workers, and white-collar workers were 7.45% (6.22%, 8.69%), 3.72% (0.84%, 6.67%), and 2.41% (0.17%, 4.70%), respectively, with statistically significant differences (P<0.05). A turning point was observed in the compound obesity rate among female white-collar workers in 2006, with an APC (95%CI) of 9.69% (5.24%, 14.33%) from 2006 to 2008, showing a statistically significant difference (P<0.05), while no significant trend was found from 1993 to 2006 (P>0.05). No significant trends were observed in the age-standardized compound obesity rates among females in other occupational groups and service workers (P>0.05). Conclusion The compound obesity rate among China's occupational population is increasing rapidly, with the growth rate among agricultural workers being particularly prominent. In 2018, male white-collar workers and female agricultural workers exhibit relatively high compound obesity rates, warranting focused attention. Although the overall growth rate among service workers is slower, the expanding workforce in this sector indicates that obesity remains a serious issue. Targeted occupational health and weight management interventions are needed in the future.

Background With rising obesity rates and earlier hypertension onset among occupational populations, there is an urgent need to elucidate the long-term cardiovascular impacts of dynamic body weight patterns. Current evidence lacks trajectory modeling studies examining occupation-specific prevention strategies. Objective To investigate the association between long-term body mass index (BMI) trajectories and incident hypertension risk in Chinese working adults, and to examine occupation-specific heterogeneity in this relationship. Methods A dynamic sub-cohort of 4 413 occupational participants was constructed from ten survey waves (1991–2018) of the China Health and Nutrition Survey (CHNS). Eligible individuals had valid key BMI records at three or more independent follow-ups before the outcome event; the individual baseline was set as the year of their first participation in the survey. Group-based trajectory modeling (GBTM) was used to identify BMI change patterns. Cox proportional hazards regression was used to calculate hazard ratios (HRs) and 95% confidence interval (CI) for hypertension incidence across trajectory groups, with stratified analysis by occupational categories. Results Among 4413 occupational participants, 1441 incident hypertension cases were reported during the follow-up window. Three long-term BMI trajectories were identified: low-stable, moderate-slowly rising, and high-rising. In Model 3 with all selected confounders adjusted, compared with the low-stable group, the moderate-slowly rising group showed a significantly higher risk of incident hypertension (HR=1.28, 95%CI: 1.12, 1.45; P < 0.001), as did the high-increasing group (HR=1.80, 95%CI: 1.45, 2.23; P < 0.001). The stratified analyses revealed occupational differences in the association. Among agricultural workers, the moderate-slowly rising group (HR=1.35, 95%CI: 1.15, 1.57) and the high-rising group (HR=2.00, 95%CI: 1.50, 2.66) both exhibited significantly increased risks of hypertension (P<0.001). Conversely, among white-collar workers, an increased risk of hypertension was observed only in the high-rising group (HR=1.97, 95%CI: 1.23, 3.17; P<0.05). Conclusion Rapid BMI escalation constitutes a significant risk factor for incident hypertension in occupational populations. Targeted long-term weight monitoring and tailored interventions are recommended for high-risk occupations.

ObjectiveTo investigate the role of interleukin （IL）-17A in acute inhalational pneumonia induced by the highly drug-resistant and hypervirulent Staphylococcus aureus strain USA300-R in mice. MethodsAn acute inhalational pneumonia model was established in mice using an aerosolized pulmonary delivery technique. RNA sequencing （RNA-seq） and enzyme-linked immunosorbent assay （ELISA） were employed to examine the expression dynamics of Il17a mRNA and IL-17A protein， respectively， in the lungs of infected mice. Il17a knockout （Il17a^-/-） mice were generated using CRISPR/Cas9 gene editing technology. The survival rate， body weight， bacterial load in lung tissue， and histopathological changes were compared between Il17a^-/- and wild-type （WT） mice following inhalational infection with USA300-R. Results12 hours after USA300-R infection， compared to pre-infection， the expression level of Il17a mRNA in lung tissue and the level of IL-17A protein in bronchoalveolar lavage fluid （BALF） increased by approximately 50-fold （P<0.01） and 6-fold （P<0.001）， respectively. Compared to WT mice， Il17a^-/- mice exhibited approximately 10-fold higher bacterial loads in lung tissue at both 12 and 24 hours post-infection （P<0.001， P<0.05）. However， they showed significantly attenuated lung histopathological injury， reduced alveolar wall thickening， markedly decreased neutrophil infiltration， and an approximately 50% improvement in survival rate （P<0.05）. ConclusionIn acute Staphylococcus aureus USA300-R inhalational pneumonia， IL-17A contributes to bacterial clearance by recruiting neutrophils； however， excessive neutrophil infiltration exacerbates pulmonary inflammation and injury， reduces survival rates， and represents a potential therapeutic target.

This paper summarizes professor WANG Shouchuan's clinical experience in treating childhood absence epilepsy based on the theory of "five zang （脏） organs storing the spirit". It is believed that dysfunction of the five zang organs in storing the spirit is the key pathogenesis of childhood absence epilepsy， proposing that the fundamental therapeutic principle is regulating the spirit by tonifying the five zang organs. Treatment is performed based on differentiation of heart， liver， spleen， lung， and kidney epilepsy. For heart epilepsy， the treatment focuses on harmonizing qi and blood and regulating heart spirit， with Yangxin Anshen Decoction （养心安神汤） or Daochi Ningshen Decoction （导赤宁神汤） selected according to deficiency or excess syndrome. For liver epilepsy， the treatment aims to subdue wind-yang and calm liver spirit， using Bugan Zhenhun Decoction （补肝镇魂汤） or Gouma Qianhun Decoction（钩麻潜魂汤） based on deficiency or excess syndrome. For spleen epilepsy， the treatment concentrates on resolving phlegm-turbidity and restoring spleen thought， employing Guipi Yangyi Decoction （归脾养意汤） or Changyu Huatan Decoction （菖郁化痰汤） in line with deficiency or excess syndrome. For lung epilepsy， the treatment focuses on expelling exogenous pathogens and consolidating lung corporeal soul， applying Yuping Gupo Decoction （玉屏固魄汤） or Xiebai Anpo Decoction （泻白安魄汤） according to deficiency or excess syndrome. For kidney epilepsy， the treatment aims to strengthen the primordial qi and replenish kidney will， with Dihuang Yuanzhi Decoction （地黄远志汤）. The self-made Dingxian Powder （定痫散） is used dynamically throughout the course， emphasizing the flexible application of decoctions， pills and syrupsis.

This paper summarizes professor WANG Shouchuan's clinical experience in treating childhood absence epilepsy based on the theory of "five zang （脏） organs storing the spirit". It is believed that dysfunction of the five zang organs in storing the spirit is the key pathogenesis of childhood absence epilepsy， proposing that the fundamental therapeutic principle is regulating the spirit by tonifying the five zang organs. Treatment is performed based on differentiation of heart， liver， spleen， lung， and kidney epilepsy. For heart epilepsy， the treatment focuses on harmonizing qi and blood and regulating heart spirit， with Yangxin Anshen Decoction （养心安神汤） or Daochi Ningshen Decoction （导赤宁神汤） selected according to deficiency or excess syndrome. For liver epilepsy， the treatment aims to subdue wind-yang and calm liver spirit， using Bugan Zhenhun Decoction （补肝镇魂汤） or Gouma Qianhun Decoction（钩麻潜魂汤） based on deficiency or excess syndrome. For spleen epilepsy， the treatment concentrates on resolving phlegm-turbidity and restoring spleen thought， employing Guipi Yangyi Decoction （归脾养意汤） or Changyu Huatan Decoction （菖郁化痰汤） in line with deficiency or excess syndrome. For lung epilepsy， the treatment focuses on expelling exogenous pathogens and consolidating lung corporeal soul， applying Yuping Gupo Decoction （玉屏固魄汤） or Xiebai Anpo Decoction （泻白安魄汤） according to deficiency or excess syndrome. For kidney epilepsy， the treatment aims to strengthen the primordial qi and replenish kidney will， with Dihuang Yuanzhi Decoction （地黄远志汤）. The self-made Dingxian Powder （定痫散） is used dynamically throughout the course， emphasizing the flexible application of decoctions， pills and syrupsis.

Objective: To investigate the incidence and independent risk factors of adverse events (AEs) associated with therapeutic plasma exchange (TPE) in patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT), and to provide evidence to support the safe use of TPE in clinical practice. Methods: This retrospective study included 167 allo-HSCT recipients who underwent a total of 385 TPE procedures between March 2022 and December 2023. Patients were divided into two groups according to the occurrence of TPE-related AEs. Baseline characteristics, plasma exchange parameters, and clinical features were collected. Univariate analysis and multivariable Firth logistic regression were performed to identify independent risk factors for AEs. Results: A total of 385 TPE procedures were performed in 167 allo-HSCT patients, and 33 patients (19.8%) experienced TPE-related AEs. Among the 33 patients who experienced AEs, allergic reactions were the most common (n=18, 54.5%), followed by blood pressure fluctuations (n=11, 33.3%) and hypocalcemia (n=4, 12.1%). Most AEs were classified as grade II (n=23, 69.7%), and no grade IV (fatal) events were observed. Univariate analysis demonstrated a significant difference in the incidence of AEs among different hematocrit (HCT) categories (<20%, 20%-30%, and>30%) (Fisher's exact test, P=0.022). Although the overall difference was statistically significant, none of the pairwise comparisons remained significant after Bonferroni correction (adjusted P>0.0167). Multivariable Firth logistic regression identified higher HCT levels, analyzed as a continuous variable (OR=1.07, 95% CI: 1.01-1.13, P=0.020), and TPE performed for cytokine release syndrome (CRS) (OR=9.21, 95% CI: 1.25-78.00, P=0.030) as potential independent risk factors for TPE-related AEs. Receiver operating characteristic (ROC) curve analysis showed that HCT had an AUC of 0.67 (95% CI: 0.57-0.77) for predicting AEs, with an optimal cutoff value of 24.5%, a sensitivity of 60.6%, and a specificity of 75.4%. Using this cutoff, the AEs rate was significantly higher in patients with HCT≥24.5% than in those with HCT<24.5% (37.7% vs 11.4%, P<0.001). Conclusion: A-mong allo-HSCT patients receiving TPE, allergic reactions were the predominant AEs. Higher HCT levels and TPE performed for CRS may be associated with an increased risk of AEs. HCT≥24.5% may help identify patients requiring intensified monitoring, although its discriminatory ability is moderate (AUC=0.67) and it should not be used as a standalone criterion for clinical decision-making. Findings regarding the CRS subgroup require validation in larger cohorts. Optimizing extracorporeal circuit priming and strengthening peri-procedural monitoring may help improve the safety of TPE.

Objective: To analyze the mortality trend of chronic respiratory diseases in Lianyungang City, Jiangsu Province from 2011 to 2024, and predict the mortality from 2025 to 2029, so as to provide the evidence for developing forward-looking prevention and control strategies and targeted intervention measures. Methods: Chronic respiratory disease death surveillance data in Lianyungang City from 2011 to 2024 were collected through the Jiangsu Chronic Disease Management Information Platform. The crude mortality was calculated and standardized using the data of the Sixth National Population Census in 2010. Average annual percent change (AAPC) was used to analyze the mortality trends of chronic respiratory diseases by gender, region, and age in Lianyungang City from 2011 to 2024. The GM (1,1) grey model was established using the crude mortality of chronic respiratory diseases from 2011 to 2024 to predict the crude mortality of chronic respiratory diseases from 2025 to 2029. Results: From 2011 to 2024, the crude mortality and standardized mortality of chronic respiratory diseases in Lianyungang City were 52.20/105 and 36.57/105, respectively. The crude mortality and standardized mortality were 53.14/105 and 43.79/105 in males, respectively, which were higher than 51.17/105 and 30.14/105 in females (both P<0.05). The crude mortality and standardized mortality were 55.62/105 and 39.85/105 in rural areas, respectively, which were higher than 38.11/105 and 24.15/105 in urban areas (both P<0.05). From 2011 to 2024, the standardized mortality of chronic respiratory diseases showed downward trends in the total population, males, females, urban areas, and rural areas (AAPC=-6.956%, -5.175%, -8.659%, -4.290%, and -7.369%, all P<0.05). The crude mortality of chronic respiratory diseases in the total population showed an upward trend with increasing age (P<0.05), reaching a peak of 1 371.20/105 in the ≥80 years group. The top two causes of chronic respiratory disease deaths were chronic obstructive pulmonary disease and bronchial asthma, with 31 792 cases and 3 254 cases, accounting for 82.40% and 8.43%, respectively. The GM (1,1) grey model prediction results showed that the crude mortality of chronic respiratory diseases in the total population from 2025 to 2029 would be 37.91/105, 36.32/105, 34.80/105, 33.34/105, and 31.95/105, respectively (average relative error=8.76%). Conclusions From 2011 to 2024, the mortality of chronic respiratory diseases in Lianyungang City showed a downward trend. The risk of death from chronic respiratory diseases was higher in males, rural areas, and the elderly. It is predicted that the mortality of chronic respiratory diseases will decrease year by year from 2025 to 2029.

Objective: To explore the immunomodulatory effect of lactoferrin and 2'-fucosyl-lactose (2'-FL) compound powder on immune function in mice. Methods: Forty female ICR mice were randomly divided into a control group and three dose groups (0.125, 0.250, and 0.750 g/kg body weight), with 10 mice in each group. The three dose groups were intragastrically administered the compound powder solution at 10 mL/kg body weight daily, while the control group received an equal volume of deionized water for 30 consecutive days. The splenic lymphocyte transformation test and delayed-type hypersensitivity test were used to measure the optical density difference and the left hind paw thickness difference, respectively. Serum hemolysin assay and antibody-forming cell assay were performed to determine the antibody volume and the number of hemolytic plaques. The peritoneal macrophage phagocytosis assay with chicken red blood cells was conducted to calculate the phagocytosis rate and phagocytic index. The natural killer (NK) cell activity assay was used to measure optical density and calculate NK cell activity. Results: Compared with the control group, the optical density difference and left hind paw thickness difference were significantly increased in the high-dose group, the peritoneal macrophage phagocytosis rate of chicken red blood cells was significantly increased in the medium-dose and high-dose groups, awhile the phagocytic index was significantly elevated in the medium-dose group (all P<0.05). There were no significant differences in antibody volume, hemolytic plaque number or NK cell activity among the four groups (all P>0.05). Conclusion Lactoferrin and 2'-FL compound powder exerts an immunomodulatory effect by enhancing cellular immunity and monocyte-macrophage function.

Objective:To retrieve and integrate the best evidence on foot offloading management for diabetic high-risk foot patients, and to provide evidence-based basis for effectively preventing the occurrence and development of diabetic foot ulcers.Methods:Clinical practice guidelines, evidence summaries, systematic reviews and expert consensus on the management of foot offloading at high risk of diabetes were searched in Chinese and English databases, domestic and foreign diabetes association websites, clinical decision websites and guideline websites, retrieval time for libraries to March 31, 2024, respectively, by the 2 researchers quality evaluation, evidence extraction, the final summary.Results:A total of 16 articles were included, including 6 guidesline, 5 expert consensuses, 1 evidence summary and 4 systematic reviews. According to the existing evidence, the best evidence of foot offloading management in patients with diabetic high-risk foot was summarized from 6 aspects: evaluation, monitoring, referral, offloading brace, exercise advice and risk factor intervention, 14 subcategories, 32 best evidences for foot offloading management in patients with high-risk diabetic foot.Conclusions:This study summarized the best evidence for foot offloading management in patients with high-risk of diabetic foot, which is convenient for the further development of clinical practice of foot offloading management in patients with high-risk of diabetes, and provides evidence-based basis for clinical medical staff to expand related research.

Objective To investigate the influence of combination of oxycodone-acetaminophen and local radiotherapy on serum cytokines in elderly patients with malignant tumor bone metastasis and cancer pain.Methods Eighty elderly patients with malignant tumor bone metastasis and cancer pain admitted to Huainan Xinhua Medical Group Xinhua Hospital from January 2020 to April 2024 were divided into control group(40 cases)and observa-tion group(40 cases)according to the order of admission.The control group received codeine combined with local radiotherapy,whereas the observation group was treated with oxycodone-acetaminophen combined with local radio-therapy.Pain relief(assessed using visual analogue scale(VAS)),daily fulminant pain occurrence frequency and occurrence of adverse reactions during treatment as well as serum cytokines[substance P(SP),prostaglandinE2(PGE2),interleukin-6(IL-6)],sleep quality(assessed using Pittsburgh sleep quality index(PSQI))and quality of life[assessed using functional assessment of cancer therapy-general(FACT-G)]before and after treatment were compared between the two groups..Results The pain relief effect in the observation group was better(P<0.05),and the daily occurrence frequency of fulminant pain was less than that in the control group(P<0.05).After treat-ment,serum levels of SP,PGE2 and IL-6 in the observation group were lower compared to those in the control group(P<0.05).The total incidence rate of bone-related events during treatment was not significantly different between the two groups(P>0.05),and the total incidence rate of adverse reactions was lower in the observation group compared to those in the control group(P<0.05).The PSQI score in the observation group after treatment was lower(P<0.05)while the scores of physiology and emotion of FACT-G were higher compared to those in the control group(P<0.05).Conclusion Oxycodone-acetaminophen combined with local radiotherapy can down-regulate the levels of serum SP,PGE2 and IL-6,relieve the pain,and improve the sleep quality and quality of life in elderly patients with malignant tumor bone metastasis complicated with cancer pain.