Background With China's socio-economic development, the dietary structure of Chinese residents has gradually shifted from a traditional Eastern pattern characterized by high carbohydrate intake to a relatively high-fat Western dietary model, alongside a growing burden of chronic diseases. However, dietary changes may vary across different occupational groups. Objective To analyze the long-term trends in dietary energy and three major macronutrient intake among various occupational groups aged 18-59 years in nine provinces of China from 1989 to 2018, providing a scientific basis for developing occupation-specific dietary intervention strategies. Methods Based on 11 waves of data (1989–2018) from the China Health and Nutrition Survey (CHNS), 57458 employed individuals aged 18-59 years were selected as observation subjects after applying inclusion and exclusion criteria. Joinpoint regression was used to analyze temporal trends by calculating the annual percentage change (APC) and average annual percentage change (AAPC) with 95% confidence intervals. The analysis covered the energy supply ratio from the three major macronutrients and the proportion of the participants within the acceptable macronutrient distribution ranges (AMDR) for the total occupational population and specific occupational group. Results From 1989 to 2018, the dietary structure of the occupational population in the nine provinces gradually Westernized. The carbohydrate energy supply ratio showed a decreasing trend (AAPC=−0.77%, 95%CI: −1.00%, −0.55%, P<0.05), while the fat energy supply ratio increased (AAPC=1.42%, 95%CI: 1.07%, 1.77%, P<0.05). The protein energy supply ratio remained largely unchanged (AAPC=−0.19%, 95%CI: −0.08%, 0.46%, P>0.05), and the total energy intake declined (AAPC=−0.62%, 95%CI: −0.94%, −0.30%, P<0.05). Among the occupational groups studied, white-collar workers were the first to show characteristics of dietary Westernization. Using the AMDR as the criterion, their average fat energy supply ratio first exceeded the AMDR upper limit (30%) in 1993, and their average carbohydrate energy supply ratio first fell below the AMDR lower limit (50%) in 2006, both time points being earlier than other occupational groups. Agricultural workers lagged in this transition (their average fat energy supply ratio first reached ≥30% in 2011), but their rate of increase in the fat energy supply ratio was the fastest among all occupational groups (AAPC=1.59%, 95%CI: 0.90%, 2.30%, P<0.05; P for trend comparison between groups<0.05). The other three occupational groups (blue-collar workers, service workers, and others) generally fell between these two extremes. Taking the fat energy supply ratio as an example, their AAPCs of increase were 1.02% (95%CI: 0.73%, 1.32%, P<0.05) for blue-collar workers, 0.85% (95%CI: 0.61%, 1.09%, P<0.05) for service workers, and 0.88% (95%CI: 0.58%, 1.17%, P<0.05) for others. Conclusion From 1989 to 2018, the macronutrient structure of the occupational population aged 18-59 years in nine China provinces is gradually Westernized. The energy supply ratios of carbohydrates and proteins primarily face issues of potential inadequacy, while the fat energy supply ratio is excessively high. Furthermore, the patterns of change vary among different occupational groups. It is recommended to propose personalized dietary advice tailored to specific occupations.

Climate change has evolved from an environmental issue into a global public health crisis, posing severe challenges to healthcare systems. Issues such as shifts in patient disease patterns, increased care demands for vulnerable populations, and insufficient resilience in nursing systems are becoming increasingly prominent. As the frontline of healthcare delivery, nursing practice directly confronts multiple health risks triggered by climate change. Under the Healthy China 2030 strategy, the role of nursing in addressing climate change cannot be overlooked. Therefore, this paper systematically reviewed the impacts of climate change on nursing practice and corresponding domestic and international strategies, and proposed recommendations for localized development pathways. First, strengthen climate health literacy in nursing education by integrating the climate change system into curricula and clinical practice. Second, promote nursing policy participation in global health governance to establish a climate-adaptive nursing policy system with Chinese characteristics. Finally, establish a multidisciplinary nursing research framework to foster integration among nursing science, climate science, public health, traditional Chinese medicine, and other relevant fields. This paper aims to provide theoretical foundations for constructing a climate-adaptive nursing system with Chinese characteristics, thereby advancing the coordinated development of Healthy China initiative and climate governance.

It is believed that Shengyang Yiwei Decoction （升阳益胃汤， SYD） is effective in regulating the flow of Qi （气）， and can treat various diseases caused by the disorder of the spleen and stomach Qi. In clinical practice， based on the pathological characteristics of children often having insufficient spleen， and adhering to the principle of treating different diseases with the same method， the focus is placed on the core pathogenesis of spleen and stomach Qi disharmony. We use SYD in various pediatric conditions such as allergic rhinitis， post COVID-19 condition， urethral syndrome， and dysfunctional uterine bleeding in adolescence， and emphasize the treatment is flexibly tailored to the symptoms.

Objective:To screen differential metabolites and their metabolic pathways related to osteoarthritis, and to provide clues for further study of biomarkers of osteoarthritis.Methods:Using group design, 60 male SD rats (weighting 300 - 350 g) were divided into a model group and a control group according to random number table method, with 30 rats in each group. The experimental periods were 4, 8 and 12 weeks, respectively, with 10 rats per group per period. The left knee joint of rats of the model group rats underwent modified Hulth method surgery. After 5 days, the rats were driven to move for 30 minutes a day. At the end of the experiment, 24 h urine of rats in two groups was collected. Small molecule metabolites in urine were detected by ultra-high performance liquid chromatography/quadrupole time-of-flight mass spectrometer, and the differential metabolites and metabolic pathways related to osteoarthritis were screened by multivariate statistical analysis and database comparison.Results:A total of 9 differential metabolites associated with osteoarthritis were screened out in urine. Among them, 9 metabolites were screened out at 4 weeks of the experiment. Compared with the control group, the model group had higher levels of kynurenine, citric acid, cysteic acid, malonyl carnitine, ubiquinone-2, L-cystathionine and L-aspartic acid [26 317 (19 439, 33 297) vs 3 595 (512, 23 556), 7 137 (2 901, 9 252) vs 1 854 (660, 4 754), 6 625 ± 4 468 vs 3 006 ± 2 636, 4 254 (2 949, 7 850) vs 2 223 (1 230, 3 390), 14 558 (6 605, 26 047) vs 5 908 (1 172, 10 560), 4 492 (2 541, 33 796) vs 1 038 (885, 2 938), 3 038 ± 2 282 vs 1 286 ± 1 264], while the levels of 5-L-glutamyltaurine and S-adenosylmethionine were lower (2 145 ± 658 vs 6 457 ± 5 457, 872 ± 582 vs 5 572 ± 5 362, P < 0.05). At 8 weeks of the experiment, 7 metabolites were screened out. Compared with the control group, the model group had higher levels of kynurenine, citric acid, cysteic acid, 5-L-glutamyltaurine, malonyl carnitine and ubiquinone-2, while the level of L-cystathionine was lower ( P < 0.05). At 12 weeks of the experiment, 4 metabolites were screened out. Compared with the control group, the model group had higher level of 5-L-glutamyltaurine, while the levels of kynurenine, citric acid, and cysteic acid were lower ( P < 0.05). Two metabolic pathways related to osteoarthritis were identified, namely the cysteine and methionine metabolic pathway, and the arginine and proline metabolic pathway. Among them, cysteic acid, S-adenosylmethionine and L-cystathionine belonged to the cysteine and methionine metabolic pathway, while L-aspartic acid and S-adenosylmethionine belonged to the arginine and proline metabolic pathway. Conclusions:Kynurenine, citric acid, cysteic acid and 5-L-glutamyltaurine are differential metabolites associated with osteoarthritis and may serve as urinary metabolic biomarkers for osteoarthritis. The metabolic pathways of cysteine and methionine, arginine and proline may be closely related to the occurrence and development of osteoarthritis.

Objective:To investigate clinical efficacy and safety of dupilumab in the treatment of moderate to severe atopic dermatitis (AD) complicated with asthma.Methods:A self-controlled study before and after treatment was conducted to retrospectively analyze 45 patients with moderate to severe atopic dermatitis combined with asthma who received dupilumab in the respiratory allergy clinic of North Theater Command General Hospital from January 2021 to May 2024, which age ≥12 years, including 27 males, 18 females. The treatment period was 4 to 12 months. All patients were treated with dupilumab combined with inhaled glucocorticoids and long-acting beta2-receptor agonists, as well as symptomatic drugs for atopic dermatitis. Analyze the clinical data of the patients before and after treatment, including lung function, asthma and AD-related assessment scales. Generalized estimation equation was used to analyze the simple effect of time on the repeated measurement data following non-normal distribution, and Wilcoxon signed rank test was used to compare the differences of each observation index before and after treatment.Results:Among 45 patients with moderate to severe atopic dermatitis complicated with asthma, after treatment with dupilumab, the FEV 1 increased from 2.39 (1.87, 2.83) L at baseline to 2.50 (1.84, 2.97) L 3 months after treatment ( Z=2.417, P=0.016), 2.60 (1.95, 3.14) L 6 months after treatment ( Z=2.896, P=0.004); the FEV 1pred% increased from 74.10% (67.70%, 78.75%) at baseline to 77.09% (68.40%, 80.24%) at 3 months after treatment ( Z=2.574, P=0.010), and 77.20% (71.10%, 80.72%) at 6 months after treatment ( Z=2.861, P=0.004). Meanwhile, there were statistically significant differences in the ACT and Mini-AQLQ scales at 3, 6, and 12 months after treatment compared with those before treatment (ACT score Z=3.170, 4.216, 5.723; Mini-AQLQ score Z=3.231, 4.133, 5.826; all P<0.05). The EASI scale decreased from baseline 25.90 (18.95, 33.45) to 6.20 (1.15, 8.35) at 4 months after treatment ( Z=5.842, P<0.05) and 4.90 (2.75, 8.35) at 6 months after treatment ( Z=5.841, P<0.05), 4.00 (3.15, 5.05) at 12 months after treatment ( Z=5.841, P<0.05); The scores of each scale of IGA, NRS and DLQI decreased significantly compared with the baseline after 4 months, 6 months and 12 months of treatment, and this trend became more obvious with the extension of treatment time. The differences were statistically significant (IGA score Z=6.247, 6.070, 5.946; NRS score Z=5.960, 5.893, 5.879; DLQI score Z=5.880, 5.850, 5.848; all P<0.05). During treatment, 1 patient had local adverse reactions at the injection site and 1 patient had conjunctivitis. Conclusion:Dupilumab may have a positive effect on improving the clinical efficacy of patients with moderate to severe atopic dermatitis complicated with asthma. During the 12-month observation period, this biological agent generally demonstrated good safety characteristics.

[Purpose]To analyze the incidence and mortality of lung cancer in Zhejiang cancer regi-stration areas in 2021 and trends from 2000 to 2021.[Methods]Using data from Zhejiang cancer registration areas from 2000 to 2021,the crude rate,age-standardized rate by Chinese standard population(ASRC)and the world standard population(ASRW),and composition ratio were calcu-lated to describe the incidence and mortality in 2021.Joinpoint regression was employed to ana-lyze temporal trends over the 22 years,calculating the annual percentage change(APC),average annual percentage change(AAPC),and their 95％confidence intervals(CI).[Results]The crude incidence rate of lung cancer in 2021 was 128.58/105,with an ASRC of 68.74/105,ac-counting for 24.22％of all cancers;the crude mortality rate was 51.55/105,with an ASRC of 21.58/105,constituting 27.98％of all cancer deaths.Both crude incidence rate(AAPC=5.73％,P＜0.001)and ASIRC(AAPC=4.14％,P＜0.001)of lung cancer showed significant increasing trends from 2000 to 2021.The crude mortality rate increased slowly(AAPC=1.76％,P＜0.001),while the ASMRC(AAPC=-0.40％,P=0.035)exhibited a modest decline.The increase in incidence was more pronounced in females than males,though no statistically significant difference was observed in mortality trends.The incidence rates in urban and rural areas showed similar growth trends;the crude mortality rate in rural areas was growing significantly faster than that in urban areas,and the decline in the ASRC was only statistically significant in urban areas.The incidence rate was in-creasing in all age groups.The mortality rate was declining among younger people(＜65 years old).The age group of 15～44 years old demonstrated a greater increase in incidence and a sharper decline in mortality than those aged 45 years old and above.[Conclusion]From 2000 to 2021,Zhejiang Province experienced a marked rise in lung cancer incidence with escalating disease burden.Despite severe population aging,ASRC of mortality declined steadily,reflecting effective prevention and control measures.

Objective It aims to establish data collection standards for the knowledge base of famous Traditional Chinese Medicine experts.Method A preliminary draft of the Data Collection Standards for the Knowledge Base of famous Traditional Chinese Medicine Experts was developed through literatureretrieval,expert interviews,and research group discussions.Two rounds of expert inquiries were conducted by Delphi method with 16 experts from disciplines such as medical informatics,library and information science,medical history and literature,and clinical Chinese medicine.It screened the core content through the Delphi method and formulated data collection standards.Result 59 articles were selected,and an expert inquiry form with 34 items was initially developed,including four aspects:data collection objects,data collection content,data collection and management,data collection principles and requirements.The positive coefficient of the two rounds of expert inquiry was 1,and the authoritative coefficient score was(0.94±0.06)points.The coefficient of variation of the two rounds of inquiry items were 0.113±0.043 and 0.069±0.041,respectively.The Kendall's Wcoefficients were 0.491 and 0.828,P＜0.01.Finally,a data collection standards for the knowledge base of famous Traditional Chinese Medicine experts with 31 items was formed.Conclusion The data collection content and standards of the famous doctors and experts knowledge base constructed by Delphi method have a high degree of expert recognition and consistency,which can provide standards and basis for the construction of the base in the future.

Objective:To investigate the role of reactive astrocytes expressing aromatase(ARO)in the penumbra during ischemic stroke.Methods:A mouse model of middle cerebral artery occlusion(MCAO/R)was prepared using the suture method.Western blot and immunofluorescence staining were used to observe the expression of ARO in the penumbra after ischemia reperfusion.We generated a glial fibrillary acidic protein promoter-driven aromatase knock-out(GFAP-ARO-KO)mouse model in vivo.Neurologic impairment scores,rotarod test,grip strength test and adhesive removal test on the plantar surface of the paw were performed after MCAO/R modeling.Results:In wild type mice,the expression of ARO was significantly increased in astrocytes in the penumbra after MCAO/R(P<0.01).Compared to the control group,the expression of ARO in the GFAP-ARO-KO group was significantly reduced in astrocytes in the penumbra after MCAO/R.And loss of ARO increased cerebral infarction volume and aggravated sensorimotor impair-ment.Conclusion:After ischemic stroke,reactive astrocytes in the penumbra highly express ARO and play a protective role in post-ischemia reperfusion injury.

Objective To explore the effect of Baofei Yiqi pill on immune function of patients with lung cancer.Methods A total of 100 patients with lung cancer diagnosed and treated in Leping Hospital of Traditional Chinese Medicine from September 2020 to September 2023 were selected and divided into experimental group and control group according to random number table method,with 50 cases in each group.The control group was treated with docetaxel combined with cisplatin,and the experimental group was treated with Baofei Yiqi pill on the basis of control group.Both groups were treated with 3 cycles of chemotherapy.The clinical efficacy,quality of life,changes in weight,immune function and adverse reactions were compared between two groups.Results The total response rate of experimental group was significantly higher than that of control group(x2=14.620,P＜0.001).After treatment,the Karnofsky performance status score and weight of experimental group were significantly higher than those of control group(P＜0.05),and the levels of CD3+,CD4+and CD4+/CD8+in experimental group were significantly higher than those in control group,and the levels of CD8+was significantly lower than than in control group(P＜0.05).The incidence of gastrointestinal reactions in experimental group was significantly lower than that in control group(P＜0.05).There was no significant difference in the incidence of abnormal renal function and liver function between two groups(P＞0.05).Conclusion Baofei Yiqi pill can effectively improve the immune function of patients with lung cancer,improve the quality of life of patients,reduce the adverse reactions of chemotherapy,and alleviate the disease of patients to a certain extent,which is worthy of promotion and application.

Objective:To investigate the role of reactive astrocytes expressing aromatase(ARO)in the penumbra during ischemic stroke.Methods:A mouse model of middle cerebral artery occlusion(MCAO/R)was prepared using the suture method.Western blot and immunofluorescence staining were used to observe the expression of ARO in the penumbra after ischemia reperfusion.We generated a glial fibrillary acidic protein promoter-driven aromatase knock-out(GFAP-ARO-KO)mouse model in vivo.Neurologic impairment scores,rotarod test,grip strength test and adhesive removal test on the plantar surface of the paw were performed after MCAO/R modeling.Results:In wild type mice,the expression of ARO was significantly increased in astrocytes in the penumbra after MCAO/R(P<0.01).Compared to the control group,the expression of ARO in the GFAP-ARO-KO group was significantly reduced in astrocytes in the penumbra after MCAO/R.And loss of ARO increased cerebral infarction volume and aggravated sensorimotor impair-ment.Conclusion:After ischemic stroke,reactive astrocytes in the penumbra highly express ARO and play a protective role in post-ischemia reperfusion injury.