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 efficacy and safety of plasma exchange(PE) in the treatment of autoimmune hemolytic anemia in children.Methods:The data from 8 hospitals in China during November 2014 to April 2017 were collected, and the clinical characteristics of PE in children with AHA were analyzed retrospectively.Results:A total of 21 children with AHA were included in the study, including 17 cases from PICU and 4 cases from pediatric kidney ward, with 11 boys and 10 girls, and the median age was 3.64(0.25, 11.10)years old, and median hospital stay was 12(4, 45)days.There were 15 cases(71.4%) with infection, 2 cases(9.5%)with autoimmune diseases, 4 cases(19.0%) with unknown.Consciousness disturbance occurred in 4 patients before replacement and recovered to normal after PE.The volume of blood decreased in two cases(9.5%) and completely relieved.There were 20 cases of anemia (95.2%), 15 cases were normal after PE, and 5 cases were improved.Jaundice occurred in 18 cases (85.7%), 12 cases were normal after PE, 6 cases were improved.Hepatosplenomegaly was found in 11 cases, 10 cases were normal after PE, 1 case was improved.After PE, the hemoglobin and red blood cell count increased, while the total bilirubin, indirect bilirubin, urea nitrogen and lactate dehydrogenase decreased, there were significant differences between pre-and post-replacement ( P<0.05). Only 1 case had allergic reaction, which was improved after symptomatic treatment, and PE was continued.After PE, 2 cases (9.5%) had complete remission, 16 cases (76.2%) had partial remission and 3 cases (14.3%) had been discharged. Conclusion:PE therapy can obviously improve the clinical symptoms and laboratory indexes of children with AHA who have failed to respond to conservative treatment.It can be used as a treatment measure for children with severe AHA and has a good safety.

Objective:To evaluate the value of p16 INK4a detected by p16 INK4a immunostaining as a new generation of cervical cytology for primary screening and secondary screening in population-based cervical cancer screening, and in improving cytological diagnosis. Methods:Between 2016 and 2018, 5 747 non-pregnant women aged 25-65 years with sexual history were recruited and underwent cervical cancer screening via high-risk (HR)-HPV/liquid-based cytological test (LCT) test in Shenzhen and surrounding areas. All slides were immuno-stained using p16 INK4a technology, among them, 902 cases were offered p16 INK4a detection during primary screening, and the remaining 4 845 cases were called-back by the virtue of abnormal HR-HPV and LCT results for p16 INK4a staining. Participants with complete LCT examination, HR-HPV test, p16 INK4a staining and histopathological examination results were included in this study. The performance of p16 INK4a in primary and secondary screening, and in assisting cytology to detect high grade squamous intraepithelial lesion [HSIL, including cervical intraepithelial neoplasia (CIN) Ⅱ or Ⅲ] or worse [HSIL (CIN Ⅱ) + or HSIL (CIN Ⅲ) +] were analyzed. Results:(1) One-thousand and ninety-seven cases with complete data of p16 INK4a and histology were included. Pathological diagnosis: 995 cases of normal cervix, 37 cases of low grade squamous intraepithelial lesion (LSIL), 64 cases of HSIL and one case of cervical cancer were found. Among them, 65 cases of HSIL (CIN Ⅱ) + and 34 cases of HSIL (CIN Ⅲ) + were detected. The positive rate of p16 INK4a in HSIL (CIN Ⅱ) + was higher than that in CINⅠ or normal pathology (89.2% vs 10.2%; P<0.01). (2) p16 INK4a as primary screening for HSIL (CIN Ⅱ) + or HSIL (CIN Ⅲ) + was equally sensitive to primary HR-HPV screening (89.2% vs 95.4%, 94.1% vs 94.1%; P>0.05), but more specific than HR-HPV screening (89.8% vs 82.5%, 87.7% vs 80.2%; P<0.05). p16 INK4a was equally sensitive and similarly specific to cytology (≥LSIL; P>0.05). (3) The specificity of LCT adjunctive p16 INK4a for detecting HSIL (CIN Ⅱ) + or HSIL (CIN Ⅲ) + were higher than that of LCT alone or adjunctive HR-HPV ( P<0.01), while the sensitivity were similar ( P>0.05). (4) p16 INK4a staining as secondary screening: p16 INK4a was significantly more specific (94.1% vs 89.7%, 91.9% vs 87.4%; P<0.01) and comparably sensitive (84.6% vs 90.8%, 88.2% vs 91.2%; P>0.05) to cytology for triaging primary HR-HPV screening. HPV 16/18 to colposcopy and triage other HR-HPV with p16 INK4a was equally sensitive (88.2% vs 94.1%; P=0.500) and more specific (88.3% vs 83.0%; P<0.01) than HPV 16/18 to colposcopy and triage other HR-HPV with LCT≥ atypical squamous cells of undetermined significance (ASCUS), and the referral rate decreased (14.0% vs 19.4%; P=0.005). Conclusions:For primary screening, p16 INK4a is equally specific to cytology and equally sensitive to HR-HPV screening. p16 INK4a alone could be an efficient triage after primary HR-HPV screening. In addition, p16 INK4a immunostaining could be used as an ancillary tool to cervical cytological diagnosis, and improves its accuracy in cervical cancer screening.

Objective To investigate the effect of multimedia technology on disease management capability in patients with chronic obstructive pulmonary disease (COPD).Methods 77 patients with COPD were randomly divided into control group ( 38 cases ) and observation group ( 39 cases ) .The control group was educated and managed on the basis of authorization education .While the observation group was cooperated with multimedia technology for COPD education and management , on the basis of authorization education .The intervention time lasted for 3 months.And the self -management capacity and quality of life of patients in the two groups were evaluated by utilizing self-management scale and St .George Respiratory Questionnaire ( SGRQ) respectively before intervention and 3 months after intervention .Results There were no statistically significant differences in self -management capacity and SGRQ score in all subjects before intervention (all P>0.05).After 3 months of intervention,the scores of self-management capacity on symptom management , daily life management , emotional management , information management and self -efficacy of the observation group were (30.71 ±6.79)points,(42.10 ±5.92)points,(39.51 ± 5.64) points,(30.92 ±6.08) points and (31.58 ±5.43) points,respectively,which were significantly higher than those in the control group [(27.76 ±4.12) points,(39.31 ±5.11) points,(36.28 ±6.38) points,(28.39 ± 4.70)points and (29.21 ±3.3)points],and the differences were statistically significant (t=-2.299,-2.207,-2.348,-2.037,-2.299,all P<0.05).The SGRQ scores of respiratory symptoms,disease effects and motion limitation of the observation group were (40.87 ±7.27) points,(41.17 ±7.15) points and (40.48 ±5.91) points, respectively,which were significantly lower than those in the control group [( 44.7 ±8.13 ) points, ( 45.21 ± 7.60)points,(43.60 ±5.87)points],and the differences were statistically significant (t=2.199,2.395,2.321,all P<0.05).Conclusion Application of advanced digital equipment and demonstration equipment to the disease education and management of patients with COPD based on patients 'needs provides effective ways and models to patients'health education ,which promotes the establishment of patients'healthy behaviors and the management of their own diseases ,and significantly improves the patients'self-management capacity and quality of life .

OBJECTIVETo explore the clinical efficacy of herbal-partitioned moxibustion on moderate and severe persistent allergic rhinitis (AR) with spleen-deficiency syndrome.

METHODSWith prospective case series study method, forty-seven patients of moderate and severe persistent AR with spleen-deficiency syndrome were treated with herbal-partitioned moxibustion at Yintang (GV 29), Shenque (CV 8), Hegu (LI 4) and Zusanli (ST 36), once every two days, three treatments a week, continuously for 8 weeks. The visual analogue scale (VAS), rhinoconjunctivitis quality of life questionnaire (RQLQ) and scores of spleen-deficiency syndrome were recorded before treatment, 2 weeks, 4 weeks and 8 weeks into treatment as well as 4 weeks after treatment; in addition, the improvement rate of each index was compared before and after treatment.

RESULTSCompared before treatment, the VAS, RQLQ and scores of spleen-deficiency syndrome were significantly reduced 2 weeks, 4 weeks and 8 weeks into treatment as well as 4 weeks after treatment (<0.05,<0.01). The efficacy was gradually increased 2 weeks, 4 weeks and 8 weeks into treatment (all<0.01). On the 8 weeks into treatment, the improved and markedly effective rate was 59.6% (28/47) for VAS, 19.1% (9/47) for RQLQ and 14.9% (7/47) for scores of spleen-deficiency syndrome; the total effective rate was all 85.1% (40/47). Compared with 4 weeks after treatment, there was no significant difference (all>0.05).

CONCLUSIONSThe herbal-partitioned moxibustion has superior efficacy for moderate and severe persistent allergic rhinitis with spleen-deficiency syndrome.

Objective This study was conducted to analyze the clinical characteristics and pituitary function of patients with primary empty sella (PES).Methods The clinical data from 123 hospitalized adult patients with PES from January 2010 to May 2016 were retrospectively studied.Results (1) The average age of the 123 (male 43,female 80) PES patients was (59.2 ± 13.6) years (ranging 24-92 years),among whom 61％ patients were in the age group between 50-69 years.(2) The symptoms of the patients included fatigue (56.1％),headache (34.1％),nausea and vomiting (17.9％),gonadal dysfunction (17.1％),visual disturbance (5.7％) and hypopituitarism crisis (3.3％).(3) Hypopituitarism was found in 66 of the 123 patients.Among them,36.6％,31.7％ and 17.1％ were central hypoadrenalism,hypogonadism,and hypothyroidism,respectively.The percentage of hypopituitarism in complete PES was significantly higher than that in partial PES (P ＜ 0.05).(4) Sixteen patients were concomitant with other autoimmune diseases including 11 patients with Graves' disease and 2 with Cushing's syndrome due to adrenal adenoma.Conclusions The incidence of hypopituitarism in PES was 53.7％,in which the pituitary-adrenal axis hypofunction was more common.An overall evaluation of the pituitary function was essential for the patients who had headache and fatigue,or with suspected PES.The patients with hypopituitarism should be given hormone replacement therapy in time and followed up afterword.

Mercaptopurine is used to treat children with acute lYmphoblastic leuKemia. Mercaptopurine can cause bone marrow suppression and liver toxicitY,threatening the lives of children, resulting in interruption or discontinuation of the chemotherapY,increasing the risK of disease recurrence. The mercaptopurine dosage regimens should be adjusted according to drug metabolizing enzYme genotYpes, detection of intra-erYthrocYtic metabolic products, and creating a phYsical model. Individualized administration should be adopted in order to improve the efficacY and safetY of mercaptopurine.

Mercaptopurine is used to treat children with acute lYmphoblastic leuKemia. Mercaptopurine can cause bone marrow suppression and liver toxicitY,threatening the lives of children, resulting in interruption or discontinuation of the chemotherapY,increasing the risK of disease recurrence. The mercaptopurine dosage regimens should be adjusted according to drug metabolizing enzYme genotYpes, detection of intra-erYthrocYtic metabolic products, and creating a phYsical model. Individualized administration should be adopted in order to improve the efficacY and safetY of mercaptopurine.

Objective To analyze the clinical characteristics of patients with L isteria septicemia for better clinical diagnosis and management of the disease .Methods A retrospective study was carried out in 13 patients with confirmed diagnosis of Listeria septicemia from July 2009 to November 2013 in West China Hospital of Sichuan University .The clinical features ,laboratory tests ,treatments and clinical outcomes were reviewed and analyzed . Results The vast majority of the 13 patients were immunocompromised or with critical organ dysfunction . The in vitro antimicrobial susceptibility testing indicated that penicillin ,ampicillin and levofloxacin were the most active agents against Listeria ,followed by imipenem ,erythromycin , ciprofloxacin and tetracycline .Only 33 .3% of the 13 Listeria isolates were sensitive to oxacillin .Eight patients were cured ,2 improved ,2 died after therapy .The remaining one patient gave up therapy .Conclusions The incidence of Listeria septicemia was associated with advanced age and presence of underlying diseases .Early etiology diagnosis and appropriate antibacterial therapy can improve the outcome of such patients .Actively treating underlying diseases helps reduce the mortality rate .

BACKGROUND:Studies have shown that exogenous bone marrow mesenchymal stem cells can settle down in lung tissue, participate in long regeneration, but few studies concerned the repair of aging lung injury. OBJECTIVE:To observe the effect of bone marrow mesenchymal stem cells on lung injury induced by D-galactose. METHODS:A total of 30 Sprague-Dawley rats were equal y divided into three groups at random:control group, aging model group and celltreatment group. To establish the aging rats, 10 rats each in the aging model group and celltreatment group were daily subcutaneously injected with D-galactose for 4 months. 3×106 bone marrow mesenchymal stem cells were transplanted via caudal vein in the celltreatment group, once a week, for 4 weeks. cellmedium of equal dose was added in the control and aging model groups. Bone marrow mesenchymal stem cells were transfected by lentiviral vectors expressing green fluorescent protein to determine the implantation of bone marrow mesenchymal stem cells in rat lung. Superoxide dismutase activity and malondialdehyde content in rat lung were measured in each group. The difference in rat lung structure was observed using hematoxylin-eosin staining in each group. RESULTS AND CONCLUSION:Bone marrow mesenchymal stem cells marked by green fluorescent protein were implanted in rats, migrated towards lung tissue and survived. Compared with aging model group, superoxide dismutase activity was apparently increased, but malondialdehyde content was obviously diminished in the celltreatment group. In each group, histopathological sections revealed that normal pulmonary alveolus was damaged in the aging model group, showing enlarged air cavity and emphysema. Lung injury was evidently repaired inthe celltreatment group. Results suggested that bone marrow mesenchymal stem cells could repair lung injury in aging rats, and exert anti-aging effects.