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 potential mechanisms of sepsis pathogenesis in intensive care unit (ICU), with a specific focus on the role of skin microbiota, and to evaluate the causal relationships between skin microbiota and ICU sepsis using Mendelian randomization (MR). METHODS: A two-sample MR analysis was performed using skin microbiota genome-wide association study (GWAS) summary data from German population cohorts as exposures, combined with ICU sepsis susceptibility and 28-day mortality GWAS summary data from the IEU OpenGWAS database as outcomes. The primary causal effect estimates were generated using the inverse variance weighted (IVW) method, supplemented by validation through MR-Egger and weighted median approaches. Heterogeneity and pleiotropy tests, along with sensitivity analyses, were conducted to evaluate the robustness of the results. RESULTS: Regarding risk of ICU sepsis, IVW analysis showed that order Pseudomonadales [odds ratio (OR) = 0.93, 95% confidence interval (95%CI) was 0.88-0.98], family Flavobacteriaceae (OR = 0.93, 95%CI was 0.90-0.96), and genus Acinetobacter (OR = 0.96, 95%CI was 0.93-0.99) were significantly negatively correlated with the risk of ICU sepsis (all P < 0.05). There was a significant positive correlation between the risk of ICU sepsis and the presence of β-Proteobacteria (OR = 1.05, 95%CI was 1.00-1.11) and Actinobacteria (OR = 1.05, 95%CI was 1.00-1.11), both P < 0.05. Regarding 28-day mortality of ICU sepsis, IVW analysis showed that phylum Bacteroidetes (OR = 0.92, 95%CI was 0.86-0.99), family Streptococcaceae (OR = 0.92, 95%CI was 0.85-0.98), family Flavobacteriaceae (OR = 0.90, 95%CI was 0.83-0.97), genus Streptococcus (OR = 0.92, 95%CI was 0.86-0.99), ASV016 [Enhydrobacter] (OR = 0.92, 95%CI was 0.87-0.98), and ASV042 [Acinetobacter] (OR = 0.92, 95%CI was 0.88-0.97) were significantly negatively correlated with the 28-day mortality of ICU sepsis (all P < 0.05); family Moraxellaceae (OR = 1.09, 95%CI was 1.00-1.18) and ASV008 [Staphylococcus] (OR = 1.08, 95%CI was 1.03-1.14) was significantly positively correlated with the 28-day mortality of ICU sepsis (both P < 0.05). Sensitivity analysis and MR-PRESSO showed no heterogeneity, pleiotropy, or horizontal pleiotropy between skin microbiota and ICU sepsis risk and 28-day mortality rate. Analysis of confounding factors showed that single nucleotide polymorphisms (SNPs) associated with relevant skin bacteria could independently and causally affect the risk of ICU sepsis or ICU sepsis related mortality rate, independent of other confounding factors. The Steiger test results indicated that the established causal relationship was not due to reverse causality. CONCLUSIONS Skin microbiota composition may influence both sepsis susceptibility and 28-day mortality in ICU settings. Family Flavobacteriaceae demonstrated protective effects against sepsis onset and mortality. These findings provide new perspectives for early detection and management strategies.
Humans ; Sepsis/mortality* ; Intensive Care Units ; Mendelian Randomization Analysis ; Microbiota ; Skin/microbiology* ; Genome-Wide Association Study ; Risk Factors ; Skin Microbiome

Objective:To construct a clinical prediction scale for focal cortical dysplasia (FCD)type Ⅱ in the malformation of cortical development (MCD) disease spectrum in children.Methods:A case-sectional study.From January 2014 to June 2019, patients who underwent surgery at the Pediatric Epilepsy Center of Peking University First Hospital and were pathologically diagnosed with MCD after surgery were enrolled and randomly divided into the training set and the validation set using random numbering.Clinical, electrophysiological, and imaging data of patients in the training set were analyzed.Variables that could predict FCD type Ⅱ were screened out using a Logistic regression model, and a rating scale was constructed.The diagnostic efficiency of the scale was validated in the validation set to determine the optimum cut-off value, and a consistency test was performed.Results:A total of 381 patients were enrolled in the study, with 260 in the training set and 121 in the validation set.Five clinical factors that exhibited a significant correlation with FCD type Ⅱ were identified in the training set through the logistic regression model: (1) age of seizure onset (<24 months); (2) lesion involving the frontal lobe; (3) epileptic spasms; (4) family history of epilepsy; (5) hippocampal atrophy ± signal change.Based on these 5 variables, the FCD type Ⅱ prediction scale was developed and validated in the validation set with an area under the curve of 0.732.The optimum cut-off value for the prediction scale was 1, at which point the Youden index was 0.384.The scale′s positive predictive value was 0.836, and the negative predictive value was 0.500.The diagnostic consistency between the pathological diagnosis and the FCD type Ⅱ prediction scale was acceptable (Kappa value=0.351), and there was no statistically significant difference between the two diagnostic methods ( P value of the McNemar test=0.065). Conclusions:The FCD type Ⅱ prediction scale has clinical practicability.The application of this scale to predict the pathological type of MCD before operation can help doctors choose the appropriate surgical strategy.

Objective To explore the application value of automatic cytomorphological analyzer in the morphological analysis of white blood cells(WBC)in peripheral blood.Methods A total of 306 venous blood samples from inpatients and outpatients were randomly selected and prepared with automatic cytomorphological analyzer for WBC pre-classification.The differences between automatic cytomorphological analyzer counting,automatic blood cell analyzer counting and manual counting were compared,and the correlation between automatic cytomorphological analyzer and manual counting method was analyzed.Results Compared with the other two methods,the automatic cytomorphologi-cal analyzer was able to detect more types of WBC,especially abnormal cells.There were no signifi-cant differences between automatic cytomorphological analyzer and manual counting method for 6 ma-ture WBC types(band neutrophils,segmented neutrophils,lymphocytes,monocytes,eosinophils,and basophils),immature cells at different stages and atypical lymphocyte counts(P＞0.05).Re-sults of the 6 mature WBC types counted by the automatic cytomorphological analyzer and manual counting had favorable correlations(r＞0.8).Conclusion The automatic cytomorphological analyzer can classify more types of WBC,provide WBC counting results that are highly consistent with manual microscopy,and the counting results of the two methods have a good correlation.

Objective To explore the application value of automatic cytomorphological analyzer in the morphological analysis of white blood cells(WBC)in peripheral blood.Methods A total of 306 venous blood samples from inpatients and outpatients were randomly selected and prepared with automatic cytomorphological analyzer for WBC pre-classification.The differences between automatic cytomorphological analyzer counting,automatic blood cell analyzer counting and manual counting were compared,and the correlation between automatic cytomorphological analyzer and manual counting method was analyzed.Results Compared with the other two methods,the automatic cytomorphologi-cal analyzer was able to detect more types of WBC,especially abnormal cells.There were no signifi-cant differences between automatic cytomorphological analyzer and manual counting method for 6 ma-ture WBC types(band neutrophils,segmented neutrophils,lymphocytes,monocytes,eosinophils,and basophils),immature cells at different stages and atypical lymphocyte counts(P＞0.05).Re-sults of the 6 mature WBC types counted by the automatic cytomorphological analyzer and manual counting had favorable correlations(r＞0.8).Conclusion The automatic cytomorphological analyzer can classify more types of WBC,provide WBC counting results that are highly consistent with manual microscopy,and the counting results of the two methods have a good correlation.

Objective:To characterize the histopathological subtypes and their clinicopathological parameters of gender and onset age by common, rare and sparse primary esophageal malignant tumors (PEMT).Methods:A total of 272 437 patients with PEMT were enrolled in this study, and all of the patients were received radical surgery. The clinicopathological information of the patients was obtained from the database established by the State Key Laboratory of Esophageal Cancer Prevention & Treatment from September 1973 to December 2020, which included the clinical treatment, pathological diagnosis and follow-up information of esophagus and gastric cardia cancers. All patients were diagnosed and classified by the criteria of esophageal tumor histopathological diagnosis and classification (2019) of the World Health Organization (WHO). The esophageal tumors, which were not included in the WHO classification, were analyzed separately according to the postoperative pathological diagnosis. The χ 2 test was performed by the SPSS 25.0 software on count data, and the test standard α=0.05. Results:A total of 32 histopathological types were identified in the enrolled PEMT patients, of which 10 subtypes were not included in the WHO classification. According to the frequency, PEMT were divided into common (esophageal squamous cell carcinoma, ESCC, accounting for 97.1%), rare (esophageal adenocarcinoma, EAC, accounting for 2.3%) and sparse (mainly esophageal small cell carcinoma, malignant melanoma, etc., accounting for 0.6%). All the common, rare, and sparse types occurred predominantly in male patients, and the gender difference of rare type was most significant (EAC, male∶ female, 2.67∶1), followed with common type (ESCC, male∶ female, 1.78∶1) and sparse type (male∶ female, 1.71∶1). The common type (ESCC) mainly occurred in the middle thoracic segment (65.2%), while the rare type (EAC) mainly occurred in the lower thoracic segment (56.8%). Among the sparse type, malignant melanoma and malignant fibrous histiocytoma were both predominantly located in the lower thoracic segment (51.7%, 66.7%), and the others were mainly in the middle thoracic segment.Conclusion:ESCC is the most common type among the 32 histopathological types of PEMT, followed by EAC as the rare type, and esophageal small cell carcinoma and malignant melanoma as the major sparse type, and all of which are mainly occur in male patients. The common type of ESCC mainly occur in the middle thoracic segment, while the rare type of EAC mainly in the lower thoracic segment. The mainly sparse type of malignant melanoma and malignant fibrous histiocytoma predominately occur in the lower thoracic segment, and the remaining sparse types mainly occur in the middle thoracic segment.

Objective To optimize the method of assay for silver sulfadiazine, and to investigate its stability in high temperature, humidity and salt environment. Methods Agilent ZORBAX SB-C₁₈ column was used in HPLC for the determination of silver sulfadiazine with acetonitrile and 0.1% phosphoric acid as mobile phase.The flowing rate was 1.0 ml/min and column temperature was 30℃. Salt spray test chamber was used to simulate the high temperature, humidity and salt environment. The silver sulfadiazine content was assayed at 0, 2, 4, 6, 8, 10, 12 weeks. Results The calibration curve was linear within the range of 4.00～20.00 μg/ml (r=0.9999). The average recovery was 101.47% (RSD=2.33%). The content of silver sulfadiazine cream began to decrease significantly after 4 weeks. Conclusion This method is convenient, accurate and reliable. It can be used for the content determination of silver sulfadiazine in the cream.The results showed that the silver sulfadiazine cream was unstable in the environment of high temperature, humidity and salt. Therefore, environmental impact should be fully considered in transportation, storage and application. For the long-distance navigation mission, protective measures should be taken for its packaging or replace it with more stable products.

Objective:To investigate the clinical characteristics, surgical methods, complications and prognosis of children younger than 1 year old who had definite epileptogenic lesions under 1 year old.Methods:A total of 14 children with definite epileptogenic lesions and underwent radical surgery in Pediatric Epilepsy Center of Peking University First Hospital from March 2017 to July 2019 were selected.Their clinical data including operation age, course of disease, etiology, physical examinations, seizure types, seizure frequency, features of interictal electrocorticography(EEG), surgical methods, antiepileptic drugs, and pathology were collected and analyzed.Postoperative efficacy was eva-luated using Engel grading.The Griffiths neurodevelopmental scale and the Peabody motor developmental scale were used to assess motor neurodevelopment.Results:The operation age of 14 children was 119 to 358 days (median: 281 days), and the course of disease ranged from 119 to 352 days (median: 266 days). The age of onset was from 0 to 135 days was (median: 7.5 days), and the postoperative follow-up time was 0.5-2.0 years(median: 1.5 years). None of the patients had seizure recurrence at the last follow-up.During the follow-up period, 1 patient had recurrence, but deve-loped no seizures anymore after drug administration.Cognitive and motor functions improved during follow-up in all children.All the children had no serious complications such as postoperative infection and hydrocephalus.Conclusions:Young children with definite epileptogenic lesions have an early onset of seizures, which has a great influence on development.Multidisciplinary preoperative evaluation shows that surgery is a safe way to terminate progression of seizures, thus helping children to well develop and reducing the use of antiepileptic drugs.

Objective:To investigate the characteristics of changes in muscle quality and strength in middle-aged and elderly patients with type 2 diabetes mellitus(T2DM).Methods:A total of 670 patients(320 males and 350 females)aged 50 years and over from the endocrinology departments of 9 hospitals in Beijing were recruited as the type 2 diabetes mellitus group(T2DM group)by using systematic random sampling, and 214(54 males and 75 females)age-matched Beijing Hospital retirees without T2DM were randomly enrolled as the control group.Body composition was measured by using bioimpedance analysis.Low muscle mass was defined as appendicular skeletal muscle mass index(ASMI)below 7.18 kg/m 2 in men and 5.73 kg/m 2 in women.Low muscle strength was defined as grip strength below 29.5 kg in men and 21.2 kg in women.Sarcopenia was defined by the presence of low muscle mass with low grip strength.Muscle quality was calculated by grip strength divided by muscle mass of the dominant upper limb, and muscle strength per mass unit was compared.Multivariate Logistic regression was used for correlation analysis. Results:The fasting blood glucose(FPG)level, the waist to hip ratio, the percentages of smokers and drinkers, and the proportions of subjects with concurrent hypertension and coronary heart disease were higher in the T2DM group than in the control group( P<0.05 or 0.01). Compared with the control group, grip strength and muscle quality decreased significantly in male T2DM patients( t=4.408 and 3.972, P<0.01). In male participants, BMI( t=-5.567, 95% CI: -0.375~-0.179, P<0.01)and glycated hemoglobin(HbA1c)( t=-2.322, 95% CI: -0.420~-0.035, P<0.05)were negatively correlated with muscle quality, while old age( OR=1.062, 95% CI: 1.023~1.103, P<0.01; OR=1.074, 95% CI: 1.027~1.122, P<0.01)and increased HbA1c level( OR=1.062, 95% CI: 1.023~1.103, P<0.01; OR=1.074, 95% CI: 1.027~1.122, P<0.01)were risk factors for low muscle strength and sarcopenia. Conclusions:Compared with non-diabetes patients, muscle quality and strength decrease significantly in middle-aged and elderly male T2DM patients.Besides aging, increased levels of HbA1c and BMI are risk factors for low muscle quality and strength.

Objective To discuss the diagnosis effect and clinical significance of thrombelastography in chronic kidney disease. Methods From June 2016 to February 2017, two hundred and seventy non-dialysis patients with chronic kidney disease ( CKD) treated in the Fourth Hospital of Hebei Medical University were divided into non-hypercoagulable group and hypercoagulable group according to TEG comprehensive coagulation index. The changes of related clinical indexes between the two groups were analyzed and the related factors affecting the differences between the two groups were studied. Results The correlation between the two groups showed that the coagulation reaction time ( R ) , coagulation formation time ( K ) and albumin in the hypercoagulable group were significantly lower than those in the non-hypercoagulable group ((4. 69±0. 94) min vs. (6. 29±1. 63) min,(0. 93±0. 13) min vs. (1. 51±0. 58) min,(27. 54±7. 81) g/L vs. (34. 26±8. 39) g/L, P= 0. 000 ) Angle angle, maximum thrombus strength ( MA ) , fibrinogen, D-dimer, platelet count, protein/creatinine and protein content in hypercoagulable group were significantly higher than those in non-hypercoagulable group((76. 76±2. 23)°vs. (68. 19±7. 65)°;(75. 13±3. 81)mm vs. (66. 35±7. 81)mm;(4. 28 ±0. 93) g/L vs. (3. 56±1. 10) g/L ;0. 4(0. 15,0. 91) mg/L vs. 0. 22(0. 12,0. 52) mg/L;(276. 03±127. 15) ×109/L vs. (198. 18±78. 46)×109/L;5430(2579,9634) mg vs. 2620(692,5286) mg;4864(2341,7712) mg/g vs. 2557(840,5805) mg/g,P<0. 05). The differences were statistically significant. There was no significant difference in prothrombin, thromboplastin time, thrombin time, total cholesterol, triglyceride, low density lipoprotein,high density lipoprotein,creatinine between the two groups ( P>0. 05) . Correlation analysis of common clinical indicators showed that the comprehensive coagulation index ( CI) was positively correlated with Angle angle,maximum thrombus strength,fibrinogen,platelet count,protein/creatinine and protein quantification (r=0. 532,0. 522,0. 307,0. 354,0. 293,0. 216,P<0. 05),was negatively correlated with coagulation reaction time,coagulation formation time and albumin (r=- 0. 462,- 0. 496,- 0. 360,P<0. 05). Logistic regression analysis showed that platelet count, albumin and fibrinogen were the influencing factors for the grouping of comprehensive coagulation index ( OR ( 95％CI ) :1. 007 ( 1. 002-1. 013 ) , 0. 868 ( 0. 827-0. 912 ) , 1. 510 (1. 042-2. 187),P<0. 05). Conclusion TEG is a more sensitive indicator to reflect the coagulation status of patients with CKD, and has a certain guiding significance for anticoagulation treatment of patients with CKD;platelet count,albumin,fibrinogen are the factors affecting coagulation function of patients.