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 explore the impact of number of positive regional lymph nodes (nPRLN) in N1 stage on the prognosis of non-small cell lung cancer (NSCLC) patients. Methods Patients with TxN1M0 stage NSCLC who underwent lobectomy and mediastinal lymph node dissection from 2010 to 2015 were screened from SEER database (17 Regs, 2022nov sub). The optimal cutoff value of nPRLN was determined using X-tile software, and patients were divided into 2 groups according to the cutoff value: a nPRLN≤optimal cutoff group and a nPRLN>optimal cutoff group. The influence of confounding factors was minimized by propensity score matching (PSM) at a ratio of 1 : 1. Kaplan-Meier curves and Cox proportional hazards models were used to evaluate overall survival (OS) and lung cancer-specific survival (LCSS) of patients. Results A total of 1316 patients with TxN1M0 stage NSCLC were included, including 662 males and 654 females, with a median age of 67 (60, 73) years. The optimal cutoff value of nPRLN was 3, with 1165 patients in the nPRLN≤3 group and 151 patients in the nPRLN>3 group. After PSM, there were 138 patients in each group. Regardless of before or after PSM, OS and LCSS of patients in the nPRLN≤3 group were superior to those in the nPRLN>3 group (P<0.001). N1 stage nPRLN>3 was an independent prognostic risk factor for OS [HR=1.52, 95%CI (1.22, 1.89), P<0.001] and LCSS [HR=1.72, 95%CI (1.36, 2.18), P<0.001]. Conclusion N1 stage nPRLN>3 is an independent prognostic risk factor for NSCLC patients in TxN1M0 stage, which may provide new evidence for future revision of TNM staging N1 stage subclassification.

[摘 要] 目的：评估术前血清糖类抗原19-9（CA19-9）水平在Ⅱ~Ⅲ期结直肠癌术后发生异时性腹膜转移（mPM）中的预测和预后作用。方法： 回顾性分析2019年1月至2024年1月于山东第一医科大学第一附属医院肿瘤中心收治的Ⅱ～Ⅲ期结直肠癌患者临床病理信息，包括术前CA19-9和癌胚抗原（CEA）水平。采用ROC曲线及曲线下面积（AUC）评估其诊断效能。采用单因素与多因素Logistic回归及Cox比例风险回归模型分别识别风险因素与预后因素。通过倾向性评分匹配，比较CA19-9升高组和正常组无病生存期（DFS）及无腹膜转移生存期（PMFS）差异，使用Log-rank检验进行生存分析。结果： 本研究共纳入286例患者，术前CA19-9升高与黏液腺癌组织类型（P = 0.005）、T4分期（P < 0.001）、淋巴结转移（P = 0.02）、术前CEA升高（P = 0.024）、神经侵犯（P = 0.02）、低分化程度（P = 0.045）显著相关。升高的CA19-9水平对mPM的预测准确性优于CEA（AUC：0.73，95% CI：0.61~0.85 vs AUC：0.64，95% CI：0.55~0.73）。多因素Logistic回归分析显示，术前CA19-9升高是发生mPM的独立预测因子（OR = 5.59，95% CI：2.00~15.58，P = 0.001）。CA19-9升高患者的中位DFS[54.27个月 vs 未达到（NR），HR = 3.55，95% CI：1.96~6.44，P < 0.001]与PMFS（NR vs NR，HR = 6.93，95% CI：3.25~14.76，P < 0.001）显著缩短。倾向性评分匹配后，DFS（54.27个月 vs NR，HR = 4.26，95% CI：1.40~12.98，P = 0.006）与PMFS（NR vs NR，HR = 4.28，95% CI：1.19~15.34，P = 0.015）均维持显著性差异。多因素Cox回归分析显示，针对PMFS，术前CA19-9升高是患者不良预后的独立因素（HR = 3.70，95% CI：1.55~8.83，P = 0.003）。结论： 术前血清CA19-9升高是Ⅱ～Ⅲ期结直肠癌患者术后发生mPM的敏感生物标志物，可提供独立的风险预测和预后分层。

ObjectiveTo explore the correlation between the occurrence of cardiovascular events in rheumatoid arthritis（RA） and traditional Chinese medicine（TCM） syndrome. MethodsThe cross-sectional study selected 6713 RA patients from 122 centres nationwide， in which general information such as name， gender， age， height， body weight， and course of disease were collected by completing a questionnaire； patients were classified into eight types of syndrome according to the information of their four examinations，i.e. wind-dampness obstruction syndrome， cold-dampness obstruction syndrome， dampness-heat obstruction syndrome， phlegm-stasis obstruction syndrome， stasis-blood obstructing collateral syndrome， qi-blood deficiency syndrome， liver-kidney insufficiency syndrome， and qi-yin deficiency syndrome. According to the occurrence of cardiovascular events， they were divided into the occurrence group and the non-occurrence group， and the condition assessment data and laboratory examination indexes were recorded. The test of difference between groups was used to analyse the possible risk factors for the occurrence of RA cardiovascular events， and binary logistic regression was used to analyse the correlation between TCM syndromes and RA cardiovascular events. ResultsA total of 6713 RA patients were included， including 256 cases in occurrence group and 6457 in non-occurrence group. There was no statistically significant difference between groups in terms of height， gender， insomnia， appetite， white blood cell（WBC）， hemoglobin（HGB）， platelets（PLT）， rheumatoid factor（RF）， anti-cyclic peptide containing citrulline（CCP）， alanine aminotransferase（ALT）， aspartate aminotransferase（AST）， γ-glutamyl transpeptidase（GGT）， urea creatinine（CREA）， and glucose（GLU）（P＞0.05）. The TCM syndromes between groups showed significant statistic differences（P＜0.05）. Patients in occurrence group had longer disease duration， heavier body weight， and older age； more severe conditions such as disease activity（DAS-28）， number of painful joints（TJC）， number of swollen joints（SJC）， health questionnaire scores（HAQ）， visual analog scores（VAS）， restlessness， and fatigue； higher blood sedimentation rate（ESR）， low-density lipoprotein（LDL-C）， triglyceride（TG）， total cholesterol（TC）， D-Dimer， and lower high-density lipoprotein（HDL-C）（P＜0.05）. The distribution of syndrome types showed that dampness-heat obstruction syndrome accounted for the largest proportion of patients in both groups and was higher in RA cardiovascular events. Logistic regression analysis showed that the occurrence of RA cardiovascular events was strongly associated with dampness-heat obstruction syndrome［OR=5.937， 95%CI （4.434， 7.949）， P＜0.001］. ConclusionThe occurrence of RA cardiovascular events were associated with TCM syndromes， and the probability of cardiovascular events in the RA patients with dampness-heat obstruction syndrome was 5.937 times higher than patients with other TCM syndromes.

Objective To investigate the value of cranial CT cisternal grading combined with D-dimer(D-D)and Glasgow Coma Scale(GCS)score in predicting the short-term postoperative prog-nosis of patients with severe traumatic brain injury.Methods A total of 165 patients with severe trau-matic brain injury who were treated in the hospital from January 2019 to May 2024 were selected as study subjects,all underwent craniotomy surgery.Postoperative follow-up was conducted for 3 months to analyze the differences in clinical data and preoperative indicators such as cranial CT cisternal grad-ing,D-D levels,and GCS scores between patients with poor and good prognosis.The value of cranial CT cisternal grading,D-D levels,and GCS scores in predicting short-term postoperative poor prognosis in patients with severe traumatic brain injury was also analyzed.Results Compared with patients with good prognosis,patients with poor prognosis had higher proportion of age,cranial CT cisternal grading of Ⅰ to Ⅱ,D-D levels,and GCS scores＜6(P＜0.05).There were no statistically significant differences in C-reactive protein,prothrombin time,activated partial thromboplastin time,international normalized ratio,total cholesterol,triglycerides,high-density lipoprotein cholesterol,and low-density lipoprotein cholesterol levels between patients with poor and good prognosis(P＞0.05).Cranial CT cisternal grading,D-D levels,and GCS scores were influencing factors for short-term postoperative poor prognosis in patients with severe traumatic brain injury(P＜0.05).The area under the curve for poor prognosis by three indicators in combination was 0.941(95％CI,0.906 to 0.975),which was higher than the area under the curve for the individual predictions of cranial CT cisternal grad-ing,D-D levels,and GCS scores(P＜0.05).Conclusion The influencing factors for short-term postoperative prognosis in patients with severe traumatic brain injury include cranial CT cisternal grading,D-D levels,and GCS scores.The model based on these three indicators has certain appli-cation value in predicting patient prognosis.

ObjectiveTo explore the impact of exogenous chitosan on the growth and metabolism of Glycyrrhiza uralensis Fisch. (G. uralensis) and to improve the quality of cultivated G. uralensis for both medicine and food and aid in the increase in the content of effective components in G. uralensis.MethodsIn this study, whole G. uralensis plants were treated with exogenous chitosan, and comprehensive analyses of secondary metabolites and proteins were conducted using liquid chromatography with tandem mass spectrometry and isobaric tag for relative and absolute quantitation, respectively. Effects of chitosan induction on endogenous hormones of G. uralensis were analyzed using an enzyme-linked immunosorbent assay. Gene ontology function annotation and Kyoto Encyclopedia of Genes and Genomes pathway annotation were conducted to study the effect of chitosan induction on the proteome.ResultsChitosan induction significantly increased the levels of flavonoids in G. uralensis; however, the variation in triterpenoids was not substantial. Biological processes, including photosynthesis, secondary metabolism, and abiotic stress responses, were significantly enriched. Additionally, the photosynthetic pathway, photosynthesis-antenna protein pathway, and plant hormone signal transduction pathway were significantly enriched. In the flavonoid biosynthesis pathway, the upstream-related enzyme phenylalanine ammonia-lyase (PAL) and the downstream-related enzymes chalcone synthase (CHS), polyketide reductase (PKR), chalcone isomerase (CHI), and vestitone reductase (VR) were significantly upregulated.ConclusionsOur findings suggest that chitosan induction may promote the tricarboxylic acid (TCA) cycle, and the TCA cycle enhancement significantly upregulated PAL, CHS, PKR, CHI, and VR, the five key enzymes involved in flavonoid synthesis of G. uralensis, indicating that chitosan induction activated the entire metabolic pathway associated with flavonoids in G. uralensis. Our findings provide a reference for improving the quality of cultivated G. uralensis from the perspective of pharmacodynamic components.

Background and Objectives: The Fractional Flow Reserve and Intravascular UltrasoundGuided Intervention Strategy for Clinical Outcomes in Patients with Intermediate Stenosis (FLAVOUR) trial demonstrated non-inferiority of fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) compared with intravascular ultrasound (IVUS)-guided PCI. We sought to investigate the cost-effectiveness of FFR-guided PCI compared to IVUS-guided PCI in Korea. Methods: A 2-part cost-effectiveness model, composed of a short-term decision tree model and a long-term Markov model, was developed for patients who underwent PCI to treat intermediate stenosis (40% to 70% stenosis by visual estimation on coronary angiography).The lifetime healthcare costs and quality-adjusted life-years (QALYs) were estimated from the healthcare system perspective. Transition probabilities were mainly referred from the FLAVOUR trial, and healthcare costs were mainly obtained through analysis of Korean National Health Insurance claims data. Health utilities were mainly obtained from the Seattle Angina Questionnaire responses of FLAVOUR trial participants mapped to EQ-5D. Results: From the Korean healthcare system perspective, the base-case analysis showed that FFR-guided PCI was 2,451 U.S. dollar lower in lifetime healthcare costs and 0.178 higher in QALYs compared to IVUS-guided PCI. FFR-guided PCI remained more likely to be cost-effective over a wide range of willingness-to-pay thresholds in the probabilistic sensitivity analysis. Conclusions Based on the results from the FLAVOUR trial, FFR-guided PCI is projected to decrease lifetime healthcare costs and increase QALYs compared with IVUS-guided PCI in intermediate coronary lesion, and it is a dominant strategy in Korea.

Objective: To explore the feasibility of synthetic magnetic resonance imaging (syMRI) combined with clinicopathological characteristics for the pre-treatment prediction of chemoradiotherapy (CRT) response in advanced nasopharyngeal carcinoma (ANPC). Materials and Methods: Patients with ANPC treated with CRT between September 2020 and June 2022 were retrospectively enrolled and categorized into response group (RG, n = 95) and non RGs (NRG, n = 32) based on the Response Evaluation Criteria in Solid Tumors (RECIST) 1.1. The quantitative parameters from pre-treatment syMRI (longitudinal [T1] and transverse [T2] relaxation times and proton density [PD]), diffusion-weighted imaging (apparent diffusion coefficient [ADC]), and clinicopathological characteristics were compared between RG and NRG. Logistic regression analysis was applied to identify parameters independently associated with CRT response and to construct a multivariable model. The areas under the receiveroperating characteristic curve (AUC) for various diagnostic approaches were compared using the DeLong test. Results: The T1, T2, and PD values in the NRG were significantly lower than those in the RG (all P < 0.05), whereas no significant difference was observed in the ADC values between these two groups. Clinicopathological characteristics (Epstein–Barr virus [EBV]-DNA level, lymph node extranodal extension, clinical stage, and Ki-67 expression) exhibited significant differences between the two groups. Logistic regression analysis showed that T1, PD, EBV-DNA level, clinical stage, and Ki-67 expression had significant independent relationships with CRT response (all P < 0.05). The multivariable model incorporating these five variables yielded AUC, sensitivity, and specificity values of 0.974, 93.8% (30/32), and 91.6% (87/95), respectively. Conclusion SyMRI may be used for the pretreatment prediction of CRT response in ANPC. The multivariable model incorporating syMRI quantitative parameters and clinicopathological characteristics, which were independently associated with CRT response, may be a new tool for the pretreatment prediction of CRT response.

Background and Objectives: The Fractional Flow Reserve and Intravascular UltrasoundGuided Intervention Strategy for Clinical Outcomes in Patients with Intermediate Stenosis (FLAVOUR) trial demonstrated non-inferiority of fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) compared with intravascular ultrasound (IVUS)-guided PCI. We sought to investigate the cost-effectiveness of FFR-guided PCI compared to IVUS-guided PCI in Korea. Methods: A 2-part cost-effectiveness model, composed of a short-term decision tree model and a long-term Markov model, was developed for patients who underwent PCI to treat intermediate stenosis (40% to 70% stenosis by visual estimation on coronary angiography).The lifetime healthcare costs and quality-adjusted life-years (QALYs) were estimated from the healthcare system perspective. Transition probabilities were mainly referred from the FLAVOUR trial, and healthcare costs were mainly obtained through analysis of Korean National Health Insurance claims data. Health utilities were mainly obtained from the Seattle Angina Questionnaire responses of FLAVOUR trial participants mapped to EQ-5D. Results: From the Korean healthcare system perspective, the base-case analysis showed that FFR-guided PCI was 2,451 U.S. dollar lower in lifetime healthcare costs and 0.178 higher in QALYs compared to IVUS-guided PCI. FFR-guided PCI remained more likely to be cost-effective over a wide range of willingness-to-pay thresholds in the probabilistic sensitivity analysis. Conclusions Based on the results from the FLAVOUR trial, FFR-guided PCI is projected to decrease lifetime healthcare costs and increase QALYs compared with IVUS-guided PCI in intermediate coronary lesion, and it is a dominant strategy in Korea.

ObjectiveTo investigate the characteristics of mitochondrial translational initiation factor 2 （MTIF2） gene methylation and its association with the development and progression of hepatocellular carcinoma （HCC）. MethodsMethSurv and EWAS Data Hub were used to perform the standardized analysis and the cluster analysis of MTIF2 methylation samples， including survival curve analysis， methylation signature analysis， the association of tumor signaling pathways， and a comparative analysis based on pan-cancer database. The independent-samples t test was used for comparison between two groups； a one-way analysis of variance was used for comparison between multiple groups， and the least significant difference t-test was used for further comparison between two groups. The Cox proportional hazards model was used to perform the univariate and multivariate survival analyses of methylation level at the CpG site. The Kaplan-Meier method was used to investigate the survival differences between the patients with low methylation level and those with high methylation level， and the Log-likelihood ratio method was used for survival difference analysis. ResultsGlobal clustering of MTIF2 methylation showed that there was no significant difference in MTIF2 gene methylation level between different races， ethnicities， BMI levels， and ages. The Kaplan-Meier survival curve analysis showed that the patients with N-Shore hypermethylation of the MTIF2 gene had a significantly better prognosis than those with hypomethylation （hazard ratio ［HR］=0.492， P<0.001）， while there was no significant difference in survival rate between the patients with different CpG island and S-Shore methylation levels （P>0.05）. The methylation profile of the MTIF2 gene based on different ages， sexes， BMI levels， races， ethnicities， and clinical stages showed that the N-Shore and CpG island methylation levels of the MTIF2 gene decreased with the increase in age， and the Caucasian population had significantly lower N-Shore methylation levels of the MTIF2 gene than the Asian population （P<0.05）； the patients with clinical stage Ⅳ had significantly lower N-Shore and CpG island methylation levels of the MTIF2 gene than those with stage Ⅰ/Ⅱ （P<0.05）. Clinical validation showed that the patients with stage Ⅲ/Ⅳ HCC had a significantly lower methylation level of the MTIF2 gene than those with stage Ⅰ/Ⅱ HCC and the normal population （P<0.05）. ConclusionN-Shore hypomethylation of the MTIF2 gene is a risk factor for the development and progression of HCC.