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.

Objective To investigate the distribution and antimicrobial resistance profiles of clinical isolates in Xi'an No.3 Hospital from 2019 to 2023.Methods Clinical isolates were collected from January 1,2019 to December 31,2023.Antimicrobial susceptibility testing was carried out according to a unified protocol of China Antimicrobial Resistance Surveillance Network using Kirby-Bauer method or automated systems.The data were interpreted according to the breakpoints released by the Clinical and Laboratory Standards Institute(CLSI)in 2023.Results A total of 6 621 clinical isolates were collected from 2019 to 2023,including 1 569(23.7％)strains of Gram-positive bacteria and 5 052(76.3％)strains of Gram-negative bacteria.The prevalence of methicillin-resistant S.aureus,S.epidermidis and other Staphylococcus species(except SS.pseudintermedius and S.schleiferi)was 39.0％,62.3％,and 74.4％,respectively.Methicillin-resistant strains showed much higher resistance rates to most of other antimicrobial agents than methicillin-sensitive strains.No Staphylococcus strains were found resistant to vancomycin or linezolid.E.faecium strains demonstrated much higher resistance rates to most antimicrobial agents tested than E.faecalis.The prevalence of linezolid-resistant E.faecalis and vancomycin-resistant E.faecium was 0.9％and 0.4％,respectively.The prevalence of penicillin-nonsusceptible strains(PISP+PRSP)was 5.8％in nonmeningitis S.pneumoniae isolates.The prevalence of ESBL-producing E.coli,K.pneumoniae,and P.mirabilis in Enterobacterales was 48.5％,37.8％,and 47.2％,respectively.Among Enterobacterales strains,K.pneumoniae had the highest resistance rate to imipenem(18.2％)and meropenem(17.9％).Other Enterobacterales were highly sensitive to carbapenems.The resistance rates of P.aeruginosa to imipenem and meropenem were 22.5％and 19.5％,respectively.The resistance rates of A.baumannii to imipenem and meropenem were 65.0％and 71.6％,respectively.Conclusions Antibiotic resistance is still serious in this hospital.Nearly half of the strains of E.coli,K.pneumoniae and P.mirabilis produced ESBLs.K.pneumoniae and A.baumannii showed high resistance rates to carbapenems.Antimicrobial resistance surveillance should be performed appropriately.Relevant departments need to strengthen cooperation to curb the spread of drug-resistant bacteria.

Objective:To compare the mortality of patients with septic shock in the intensive care unit of the emergency department of Beijing Chaoyang Hospital in 2012 and 2022, and analyze the risk factors affecting the prognosis of patients in each year.Methods:According to the diagnostic criteria of septic shock, 82 patients with septic shock admitted to the ICU of the emergency department of Beijing Chaoyang Hospital in 2012 and 52 patients with septic shock admitted to the ICU in 2022 were included. The clinical data of patients in each year and the related indicators that may affect the prognosis were compared. The risk factors of death in patients with septic shock in each year were screened by multivariate logistic regression analysis, and the predictive value of risk factors on death was evaluated by receiver operating characteristic (ROC) curve.Results:In 2012, 30 patients with septic shock died and 52 survived. The fatality rate was 36.59%. In 2022, 16 patients with septic shock died and 36 survived, with a fatality rate of 30.77%. There was significant difference in mortality between 2012 and 2022 (χ 2=6.805, P=0.009). In 2012 and 2022, the mortality of septic shock patients with different gender, age and Sequential Organ failure assessment (SOFA) score had statistical significance ( P<0.05). Multivariate logistic regression analysis showed that gender ( OR=1.554, P=0.037), lactic acid ( OR=1.062, P=0.035) and SOFA score ( OR=1.199, P=0.028) were the risk factors affecting the prognosis of patients in 2012, gender ( OR=1.234, P=0.028), total cholesterol ( OR=1.358, P=0.028) and SOFA score ( OR=1.388, P=0.034) were the risk factors affecting the prognosis of patients in 2022. ROC curve analysis results showed that SOFA score had higher sensitivity and specificity in predicting death of septic shock patients in 2012 (all P<0.05), and lactic acid, total cholesterol and SOFA score had higher sensitivity and specificity in predicting death of septic shock patients in 2022 (all P<0.05). Conclusions:The case fatality rate of septic shock patients in 2022 is lower than that in 2012, the morbidity and mortality rate of male patients are still higher than that of female patients, and the case fatality rate of patients increases with age. SOFA score was an independent risk factor for the prognosis of septic shock patients in 2012 and 2022.

Objective:To explore the relationship between urinary cadmium levels and thyroid hormone levels in people aged 40-89 years old in selected areas of China.Methods:Based on the "Investigation of the Impact of Soil Quality of Agricultural Land on Human Health in Typical Areas" project from October 2019 to August 2020, a multi-stage stratified random sampling method was used to include 6 588 middle-aged and older adults aged 40-89. Demographic characteristics, dietary frequency and disease status were collected through the questionnaire and physical examination. Urinary cadmium and urinary creatinine were detected by random midstream urine. Fasting venous blood was collected for the detection of Triiodothyronine (T3) and Thyroxine (T4). The linear mixed effects model was used to explore the association of urine cadmium levels with thyroid hormone levels. Its dose-response relationship was explored by using the restricted cubic spline.Results:The age of the subjects was (63.48±12.18) years, with males accounting for 51.28%. The M ( Q 1,Q 3) of urinary cadmium level, T3 and T4 was 2.48 (1.36, 4.42) μg/g·creatinine, (1.96±0.51) nmol/L and (113.75±29.11) nmol/L, respectively. The linear mixed effects model showed that the changes of T3 and T4 were 0.027 (0.009, 0.044) nmol/L and 2.019 (1.084, 2.953) nmol/L for each one-unit increase (natural logarithm transformed) of urinary cadmium. The restricted cubic spline showed that there was a positive nonlinear association between urinary cadmium and T3 as well as T4 (all Pnonlinear<0.05). Conclusion:In selected areas of China, the urinary cadmium level of middle-aged and older adults aged 40-89 years is positively associated with T3 and T4.

Objective To investigate the effect of monitor unit(MU)optimization on volumetric modulated arc therapy(VMAT)for nasopharyngeal carcinoma(NPC).Methods Totally 21 NPC patients confirmed pathologically at some hospital from October 2022 to March 2023 were selected retrospectively,and for each patient a double-arc VMAT plan named base was designed without using the monitor unit objective(MUO)tool and optimized by the photon optimization algorithm.With the parameter kept constant,Plan base was reoptimized with only the MUO tool by regulating its Maximum MU to 30％of the total MU of Plan base and setting Strength values as 50,80 and 100 respectively to obtain Plan S50,S80 and S100.Plan base was compared with Plan S50,S80 and S100 in terms of dose distributions of the target volumes and organs at risk(OARs),MU,beam-on time and γ pass rate.SPSS 17.0 software was used for statistical analysis.Results In Plan S100 only 4 patients had a decrease of more than 4％in theD98％to the PCTV2 target volume compared with that in Plan base.In Plan S80 only 2 patients had a decrease of between 3％and 4％in the Dmax to PGTV and PGTVnd and D98％to PCTV2 when compared with those in Plan base,and most of the dosimetric parameters to the other target volumes had the changing amplitudes lower than 2％.When compared with Plan base,Plan S50,S80 and S100 all increased theDmaxto the brainstem significantly(all P＜0.05),with the maximum increment not exceeding 1.5％.In Plan S50 the D502％and Dmean to the right and left parotid glands were lowered,and in Plan S80 there were decreases found in the Dmean to the right and left parotid glands andD50％to the left parotid gland,with statistically significant differences(P＜0.001),and in Plan S100 the D50％and Dmean to the right and left parotid glands and the Dmax to the spinal cord increased significantly when compared with those in Plan base(all P＜0.05).In Plan S80 and S100 the V40 of the thyroid relatively rose statistically when compared with that in Plan base(P＜0.05).In Plan S50,S80 and S100 the MU was decreased by 5.1％,21.5％and 30.9％respectively when compared with that in Plan base,and the average beam-on time of all the four plans was kept within 2.5 min.γ pass rates increased sequentially for Plan base,S50,S80 and S100 under 1％/1 mm conditions.Conclusion In NPC VMAT MU optimization effectively decreases the planned MU and improves γ pass rates under 1％/1 mm conditions while ensuring the dose to the target volume and OAR protection.[Chinese Medical Equipment Journal,2025,46(2):56-62]

Objective To analyze the changes and clinical significance of aqueous humor stromal cell-de-rived factor-1(SDF-1),macrophage chemoattractant protein-1(MCP-1)and soluble adhesion molecule CD44(sCD44)in patients with diabetic cataract(DC).Methods A total of 80 patients with DC admitted to the hos-pital from January 2021 to January 2023 were selected as the DC group,and 40 patients with simple cataract during the same period were selected as the age-related cataract group.According to the stage of cataract,DC patients were divided into group A(incipient stage,32 cases),group B(intumescent stage,26 cases)and group C(mature stage and over mature stage,22 cases).According to the presence or absence of macular ede-ma after treatment,the patients were divided into occurrence group(20 cases)and non-occurrence group(60 cases).The levels of SDF-1,MCP-1 and sCD44 in each group were detected by enzyme-linked immunosorbent assay.The receiver operating characteristic curve and area under the curve(AUC)were used to analyze the value of SDF-1,MCP-1 and sCD44 levels in the diagnosis of DC.Results The levels of SDF-1,MCP-1 and sCD44 in the DC group were higher than those in the age-related cataract group(P<0.05),and the levels of SDF-1,MCP-1 and sCD44 in the A,B and C groups increased sequentially(P<0.05).The level of MCP-1 in the occurrence group was higher than that in the non-occurrence group(P<0.05).The AUC of MCP-1,sCD44 and SDF-1 in the diagnosis of DC was 0.869,and the diagnostic efficiency was better.Conclusion The changes of aqueous SDF-1,MCP-1 and sCD44 levels are related to the stage of cataract in DC patients.Dynam-ic monitoring of these three indexes,especially MCP-1,is helpful to judge the condition and prognosis of DC patients.

Objective:To evaluate the diagnostic value of image enhancement endoscopy (IEE) for sinonasal malignant tumors.Methods:Patients with nasal neoplasms at the Department of Otorhinolaryngology Head and Neck Surgery at Beijing Tongren Hospital from January 2019 to December 2021 were examined using white light endoscopy (WLE) and IEE. Targeted biopsy was performed after image collection, and the images were analyzed by two blinded observers. Pathological diagnosis was compared with endoscopic findings. Diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated, and P<0.05 was statistically significant. Kappa(k) was employed to assess consistency between endoscopic and histopathological diagnoses. The vascular patterns of sinonasal malignancy were compared with Ni endoscopic classification.Results:This study ultimately included 193 patients with nasal tumors, and 41 cases (21.24%, 41/193) were comfirmed histopathologically with sinonasal malignancies. WLE correctly diagnosed 18 cases (43.90%, 18/41), while IEE diagnosed 28 cases (68.29%, 28/41). Among the 41 malignancies, 28 cases (68.29%, 28/41) showed patchy/punctate patterns and tortuous vessels (Ni type Ⅴ). All 14 squamous epithelium-derived malignancies (34.15%, 14/41) had Ni type Ⅴ vessels. Of 27 non-squamous malignancies, 14 cases (34.15%, 14/41) were Ni type Ⅴ, 7 cases (17.07%, 7/41) were false negatives, 6 cases (14.63%, 6/41) that their vessels were obscured by necrotic tissue. Compared to WLE, IEE had higher sensitivity (80.00% vs 51.42%), specificity (98.68% vs 96.69%), PPV (93.33% vs 78.26%), NPV (95.51% vs 89.57%), diagnostic consistency (95.16% vs 88.17%), and κ value (0.832 vs 0.554). Conclusions:IEE improves the endoscopic diagnosis of sinonasal malignancies. Ni type Ⅴ is suitable for the diagnosis of malignant tumors of squamous epithelial malignant tumors.

OBJECTIVE: This study aimed to explore the interplay between the life-course body mass index (BMI) trajectories and insulin resistance (IR) on incident diabetes. METHODS: This longitudinal cohort included 2,336 participants who had BMI repeatedly measured 3-8 times between 1989 and 2009, as well as glucose and insulin measured in 2009. BMI trajectories were identified using a latent class growth mixed model. The interplay between BMI trajectories and IR on diabetes was explored using the four-way effect decomposition method. Logistic regression and mediation models were used to estimate the interaction and mediation effects, respectively. RESULTS: Three distinct BMI trajectory groups were identified: low-stable ( n = 1,625), medium-increasing ( n = 613), and high-increasing ( n = 98). Both interaction and mediation effects of BMI trajectories and IR on incident diabetes were significant ( P < 0.05). The proportion of incident diabetes was higher in the IR-obesity than in the insulin-sensitivity (IS) obesity group (18.9% vs. 5.8%, P < 0.001). After adjusting for covariates, the odds ratios (95% confidence intervals) of the IR, IS-obesity, and IR-obesity groups vs. the normal group were 3.22 (2.05, 5.16), 2.05 (1.00, 3.97), and 7.98 (5.19, 12.62), respectively. IR mediated 10.7% of the total effect of BMI trajectories on incident diabetes ( P < 0.001). CONCLUSION We found strong interactions and weak mediation effects of IR on the relationship between life-course BMI trajectories and incident diabetes. IS-obesity is associated with a lower risk of incident diabetes than IR-obesity.
Humans ; Insulin Resistance ; Body Mass Index ; Male ; Female ; Middle Aged ; China/epidemiology* ; Adult ; Longitudinal Studies ; Incidence ; Diabetes Mellitus/epidemiology* ; Aged ; Obesity/epidemiology* ; Diabetes Mellitus, Type 2/epidemiology* ; East Asian People

Objective:To explore the relationship between urinary cadmium levels and thyroid hormone levels in people aged 40-89 years old in selected areas of China.Methods:Based on the "Investigation of the Impact of Soil Quality of Agricultural Land on Human Health in Typical Areas" project from October 2019 to August 2020, a multi-stage stratified random sampling method was used to include 6 588 middle-aged and older adults aged 40-89. Demographic characteristics, dietary frequency and disease status were collected through the questionnaire and physical examination. Urinary cadmium and urinary creatinine were detected by random midstream urine. Fasting venous blood was collected for the detection of Triiodothyronine (T3) and Thyroxine (T4). The linear mixed effects model was used to explore the association of urine cadmium levels with thyroid hormone levels. Its dose-response relationship was explored by using the restricted cubic spline.Results:The age of the subjects was (63.48±12.18) years, with males accounting for 51.28%. The M ( Q 1,Q 3) of urinary cadmium level, T3 and T4 was 2.48 (1.36, 4.42) μg/g·creatinine, (1.96±0.51) nmol/L and (113.75±29.11) nmol/L, respectively. The linear mixed effects model showed that the changes of T3 and T4 were 0.027 (0.009, 0.044) nmol/L and 2.019 (1.084, 2.953) nmol/L for each one-unit increase (natural logarithm transformed) of urinary cadmium. The restricted cubic spline showed that there was a positive nonlinear association between urinary cadmium and T3 as well as T4 (all Pnonlinear<0.05). Conclusion:In selected areas of China, the urinary cadmium level of middle-aged and older adults aged 40-89 years is positively associated with T3 and T4.

Objective:To compare the clinical and laboratory characteristics and survival between Chinese and Western patients with myelodysplastic neoplasms (MDS) .Methods:Clinical and laboratory data were collected from 1,464 primary adult patients diagnosed with MDS at the Institute of Hematology & Blood Diseases Hospital from August 2016 to June 2024. Collected data were retrospectively analyzed and compared with 2,191 patients from the International Working Group for the Prognosis of Myelodysplastic Syndromes (IWG-PM) .Results:Chinese patients were significantly younger (median age: 56 years vs. 72 years, P<0.001) and experienced more severe hematopenia ( P<0.001) compared with patients from the IWG-PM. Further, Chinese patients exhibited a higher percentage of isolated del (20q), +8, and complex karyotypes as well as a lower percentage of normal karyotypes, del (5q), and -Y ( P<0.001). Higher U2AF1, NRAS, and NPM1 mutation rates and lower ASXL1, SF3B1, and RUNX1 mutation rates were observed in Chinese patients than in participants from the IWG-PM ( P<0.05). No significant difference in overall survival (OS) was found between the two groups (median OS: 48 [95% CI: 40 - 56]months, vs. 45[95% CI: 40 - 49] months; P=0.449). Among participants aged ≤45 years, Chinese patients demonstrated more trisomy 8 ( P=0.070) and U2AF1 mutation ( P<0.001) and higher 4-year OS rate compared with those from the IWG-PM (75.5% vs. 62.1%, P=0.001). Among participants aged ≥70 years, Chinese patients exhibited more complex karyotypes but fewer del (5q) as well as more NPM1 but less SF3B1 and TET2 compared with those from the IWG-PM ( P<0.05). Chinese patients demonstrated shorter survival (median OS: 20 [95% CI: 13 - 27] months vs. 37 [95% CI: 32 - 42] months, P<0.001) . Conclusion:Chinese and Western MDS patients differ in age of onset, clinical features, and cytogenetic or molecular genetic abnormalities, with significant differences persisting in age-matched groups. Although the OS is similar, disparities exist in survival for younger and older patients between the two populations.