Relationship between body mass index and sexual development in Chinese children / 中华儿科杂志

Objective: To investigate the relationship between body mass index (BMI) and sexual development in Chinese children. Methods: A nationwide multicenter and population-based large cross-sectional study was conducted in 13 provinces, autonomous regions and municipalities of China from January 2017 to December 2018. Data on sex, age, height, weight were collected, BMI was calculated and sexual characteristics were analyzed. The subjects were divided into four groups based on age, including ages 3-<6 years, 6-<10 years, 10-<15 years and 15-<18 years. Multiple Logistic regression models were used for evaluating the associations of BMI with sexual development in children. Dichotomous Logistic regression was used to compare the differences in the distribution of early and non-early puberty among normal weight, overweight and obese groups. Curves were drawn to analyze the relationship between the percentage of early puberty and BMI distribution in girls and boys at different Tanner stages. Results: A total of 208 179 healthy children (96 471 girls and 111 708 boys) were enrolled in this study. The OR values of B2, B3 and B4+ in overweight girls were 1.72 (95%CI: 1.56-1.89), 3.19 (95%CI: 2.86-3.57), 7.14 (95%CI: 6.33-8.05) and in obese girls were 2.05 (95%CI: 1.88-2.24), 4.98 (95%CI: 4.49-5.53), 11.21 (95%CI: 9.98-12.59), respectively; while the OR values of G2, G3, G4+ in overweight boys were 1.27 (95%CI: 1.17-1.38), 1.52 (95%CI: 1.36-1.70), 1.88 (95%CI: 1.66-2.14) and in obese boys were 1.27 (95%CI: 1.17-1.37), 1.59 (95%CI: 1.43-1.78), and 1.93 (95%CI: 1.70-2.18) (compared with normal weight Tanner 1 group,all P<0.01). Analysis in different age groups found that OR values of obese girls at B2 stage and boys at G2 stage were 2.02 (95%CI: 1.06-3.86) and 2.32 (95%CI:1.05-5.12) in preschool children aged 3-<6 years, respectively (both P<0.05). And in the age group of 6-10 years, overweight girls had a 5.45-fold risk and obese girls had a 12.54-fold risk of B3 stage compared to girls with normal BMI. Compared with normal weight children, the risk of early puberty was 2.67 times higher in overweight girls, 3.63 times higher in obese girls, and 1.22 times higher in overweight boys, 1.35 times higher in obese boys (all P<0.01). Among the children at each Tanner stages, the percentage of early puberty increased with the increase of BMI, from 5.7% (80/1 397), 16.1% (48/299), 13.8% (27/195) to 25.7% (198/769), 65.1% (209/321), 65.4% (157/240) in girls aged 8-<9, 10-<11 and 11-<12 years, and 6.6% (34/513), 18.7% (51/273), 21.6% (57/264) to 13.3% (96/722), 46.4% (140/302), 47.5% (105/221) in boys aged 9-<10, 12-<13 and 13-<14 years, respectively. Conclusions: BMI is positively correlated with sexual development in both Chinese boys and girls, and the correlation is stronger in girls. Obesity is a risk factor for precocious puberty in preschool children aged 3-<6 years, and 6-<10 years of age is a high risk period for early development in obese girls.

Clinical and genetic features of Kallmann syndrome: an analysis of 5 cases / 中国当代儿科杂志

Kallmann syndrome (KS) is a rare pediatric disease with major manifestations of olfactory dysfunction and hypogonadotropic hypogonadism. Five children (4 boys and 1 girl) with KS reported in this article were aged between 6 months and 19 years at the time when they attended the hospital. All the children had the clinical manifestation of hypogonadotropic hypogonadism; in addition, three children had olfactory dysfunction (two were found to have olfactory bulb dysplasia on magnetic resonance imaging), one had cleft lip and palate, and one had micropenis and cryptorchidism with right renal agenesis during infancy. All the five children had normal karyotype and their parents had normal clinical phenotypes. The uncle of one child had underdeveloped secondary sexual characteristics and olfactory disorder since childhood. High-throughput sequencing found two known heterozygous missense mutations in the FGFR1 gene, i.e., c.1097C>T(p.P366L) and c.809G>C(p.G270A), in two children. One child had a novel frameshift mutation, c.1877_1887/p.S627Tfs*6, in the KAL1 gene; this deletion mutation caused a frameshift in base sequence and produced truncated proteins, which led to a significant change in protein structure, and thus it was highly pathogenic. It is concluded that KS has great clinical and genetic heterogeneity and can be accompanied by incomplete dominant inheritance and that gene detection helps with the diagnosis of this disease.

Orthogonal factor analysis of metabolic syndrome components in children and adolescents in the Xiaoshan District of Hangzhou, China / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the relationship between various metabolic syndrome (MS) components in children and adolescents and to explore its potential pathophysiological mechanism.</p><p><b>METHODS</b>A total of 1 550 children and adolescents aged 7-14 years from the Xiaoshan District of Hangzhou, China were enrolled in March 2010. The anthropometric parameters such as height, weight, waist circumference (WC), and hip circumference, as well as blood pressure, were measured; after adjustment for age and sex, body mass index z score (BMI-z), waist circumference z score (WC-z), waist-to-hip ratio (WHp), and waist-to-height ratio (WHt) were calculated. Fasting blood samples were collected for determination of fasting plasma glucose (FPG), total cholesterol (CHOL), triglyceride (TG), high-density lipoproteins (HDL), and low-density lipoproteins (LDL). Principal component analysis was used for extraction of factors.</p><p><b>RESULTS</b>Principal component analysis revealed 5 uncorrelated factors that cumulatively explained 77.76% of the observed variance. Adiposity factor, which accounted for 23.56% of the variance, was the primary factor; it consisted of 3 variables, i.e., WC-z, WHt, and BMI-z, in which WC-z had the highest loading. The remaining factors identified were blood lipid factor 1 (TG, CHOL, and LDL), blood pressure factor, blood lipid factor 2 (TG and HDL), and blood glucose and WHp factor (FPG and WHp).</p><p><b>CONCLUSIONS</b>More than one pathophysiological mechanism could account for the development of MS in children and adolescents. Obesity, especially central obesity, is the most important factor in the development of MS. Dyslipidemia may not fully explain insulin resistance; they may work together in MS.</p>

Effects of gonadotropin releasing hormone analog and growth hormone on height in girls with idiopathic central precocious puberty / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To determine the effect of gonadotropin releasing hormone agonist (GnRHa), by itself alone or in combination with recombinant human growth hormone (rhGH), on height in young girls (bone age≥10 years) with idiopathic central precocious puberty (ICPP).</p><p><b>METHODS</b>Eighty girls with ICPP (9.0±0.7 years old) from six medical centers across Southeast and Southwest China participated in this study. They were allocated to treatment with GnRHa+rhGH (n=31) and GnRHa (n=49) respectively. Girls in the GnRHa+rhGH group (bone age 11.18 ±0.53 years) were treated with GnRHa for 25.29±6.92 months and rhGH for 12.87±7.02 months. Girls in the GnRHa group (bone age 11.03 ±0.50 years) were treated with GnRHa for 25.96±8.95 months. The height standard deviation for bone age (HtSDS-BA), predicted adult height, near-adult height and net height increase before and after treatment were recorded for girls in both groups.</p><p><b>RESULTS</b>HtSDS-BA was significantly improved after treatment for both groups (P<0.01) and the HtSDS-BA value was superior in the GnRHa+rhGH group over the GnRHa group (P<0.01). Values in near adult height (157±6 cm vs 157±4 cm), net height increase after treatment (4.68 cm vs 3.89 cm), and predicted adult height after drug withdrawal (161±5 cm vs 158±5 cm) were higher in the GnRHa+rhGH group than the GnRHa group, but the differences were not significant.</p><p><b>CONCLUSIONS</b>Both GnRHa plus rhGH and GnRHa alone can improve the near adult height in girls with ICPP with a bone age ≥10 years to a similar extent. Adult height predicted based on bone age in ICPP girls following drug withdrawal is usually overestimated and precautions should be taken when this parameter is used.</p>

A clinical follow-up study of premature thelarche in infants under two years of age / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To investigate the clinical status and natural course of premature thelarche (PT) in infants under 2 years of age and to analyze the predictive factors for regression of thelarche.</p><p><b>METHODS</b>The clinical and laboratory data of 863 infants under 2 years of age, who visited the department of endocrinology in our hospital due to PT between October 2009 and September 2010, were analyzed. A a longitudinal follow-up study was performed.</p><p><b>RESULTS</b>Of the infants under 2 years of age with isolated PT, 89.3% showed a regression before the age of 3 years (mean 17±5.6 months), 10.7% had recurrent or persistent thelarche, with no regression after the age of 3 years, and some even developed into central precocious puberty. The independent predictive factors for regression of thelarche were Tanner stage at the first visit and whether baseline estradiol level had increased.</p><p><b>CONCLUSIONS</b>PT in infants under 2 years of age is not rare in the clinical setting, and it usually runs a self-limited course, subsiding before the age of 3 years. However, regular follow-ups should be performed for infants aged over 2 years with persistent thelarche.</p>

Non-high-density-cholesterol as a predictor of non-lipid cardiovascular disease risk factors in obese children / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To investigate the role of non-high density lipoprotein cholesterol (non-HDL-C) in the assessment of cardiovascular disease (CVD) risk factors such as hypertension, pre-diabetes and diabetes in obese children.</p><p><b>METHODS</b>According to the presence of complications (hypertension, pre-diabetes and diabetes), 810 children with central obesity were divided into two groups: one group with complications (n=499) and one group without complications (n=311). One hundred and sixty-four age- and sex-matched children served as the control group. Logistic regression analysis and receiver operating characteristic (ROC) curves were used to analyze the detection of non-lipid CVD risk factors by seven lipid markers.</p><p><b>RESULTS</b>The prevalence rates of hypertension and pre-diabetes were significantly higher in obese children with high non-HDL-C concentrations (≥3.76 mmol/L). After adjusting for waist circumference Z-scores, the area under the ROC curve for non-HDL-C was 0.680 to detect non-lipid CVD risk factors, while the areas for low-density lipoprotein cholesterol, total cholesterol and apoprotein B were 0.659, 0.669 and 0.647 respectively.</p><p><b>CONCLUSIONS</b>Compared with the other lipid markers, non-HDL-C is a better predictor for non-lipid CVD risk factors in obese children. Measurement of non-HDL-C concentations is recommended for obese children.</p>

Research on X-linked growth hormone deficiency and related genes / 中华医学遗传学杂志

Growth hormone deficiency (GHD) is a common cause of dwarfism. Most GHD patients are sporadic, whilst 5%-30% are of familial type. X-linked GHD patients are relatively rare. We hereby provide a literature review and report on our latest findings of the disease.

Relationship between dyslipidemia and early vascular lesions in obese children and adolescents / 中华儿科杂志

<p><b>OBJECTIVE</b>Obese children and adolescents are often complicated with the abnormalities of lipid and glucose metabolism, which are often associated with adulthood hypertension, diabetes and cardiovascular disease. In this study, the blood lipids, blood pressure and carotid arterial intima-media thickness (IMT) in obese children and adolescents were measured to investigate the relationship between the dyslipidemia and early vascular lesions.</p><p><b>METHOD</b>A total of 580 obese children and adolescents aged from 7 to 17 years of age were enrolled from 3 hospitals from Jan. 2008 to Sept. 2009. They were divided into 2 groups according to their blood lipoid levels. Ortholiposis group included 100 males and 52 females with a mean age of 10.47 years and a mean body mass index (BMI) of 28.28 kg/m(2). Dyslipidemia group included 305 males and 123 females with a mean age of 10.83 years and a mean BMI of 27.60 kg/m(2). Physical examination, and measurement of blood lipid, glucose and liver enzyme were taken. Carotid IMT was measured for 285 subjects.</p><p><b>RESULT</b>(1) Hypertension was found in 12.5% (19/152) and 20.1% (86/428) patients in ortholiposis and dyslipidemia groups, respectively, with a significant difference (χ(2) = 4.362, P = 0.037). The OR was 1.760 with 95% confidence interval of 1.030 - 3.008. Higher prevalence of hypertension was found in patients with dyslipidemia. (2) The left, right and mean common carotid IMTs of dyslipidemia group were higher than those of ortholiposis group without significant difference (all P > 0.05). The left, right and mean internal carotid IMTs in dyslipidemia group were (0.66 ± 0.15) mm, (0.65 ± 0.15) mm and (0.65 ± 0.15) mm, respectively while these in ortholiposis group were (0.62 ± 0.13) mm, (0.60 ± 0.13) mm and (0.61 ± 0.12) mm, respectively (P < 0.05 for all). (3) Bivariate correlation analysis showed that systolic blood pressure was positively correlated with age, BMI, BMI Z score, waist circumference, hip circumference, uric acid, alanine transaminase, triglyceride, fasting insulin and insulin resistance index (P < 0.05 for all). Moreover, mean carotid and internal carotid IMTs were positively correlated with age, BMI, waist circumference, hip circumference, and triglyceride (all P < 0.05). Multiple linear regression analysis showed that hip circumference and insulin resistance index were independent determinants of systolic pressure. Waist circumference was independent determinant of mean common and internal carotid IMT and triglyceride was independent determinants of mean internal carotid IMT.</p><p><b>CONCLUSION</b>(1) Vascular lesions, including hypertension and thicker tunica intima are common in obese children and adolescents. (2) Vascular lesions are closely related with dyslipidemia, and waist circumference and hypertriglyceridemia are the risk factors.</p>

Clinical analysis of 13 cases with growth hormone deficiency combined with pituitary stalk interruption / 中华儿科杂志

<p><b>OBJECTIVE</b>To analyze the clinical characteristics of the patients with pituitary stalk interruption syndrome (PSIS), and to achieve better comprehension of this disease.</p><p><b>METHOD</b>Data of 13 patients with PSIS were retrospectively analyzed for the clinical, laboratory and imaging features.</p><p><b>RESULT</b>All the 13 patients (9 male, 4 female) had the chief complaint of growth retardation, 81.5 - 135.0 cm in body height, which were minus two standard deviations below the average of the normal children of same age and same sex. GH stimulated peak levels were all below 5 microg/L; Among them, one was accompanied by delayed sexual development, one by central diabetes insipidus, one was complicated with central hypothyroidism and one was accompanied by central adrenocortical hypofunction.</p><p><b>CONCLUSION</b>The most remarkable clinical manifestations of patients with PSIS were growth retardation, partial or complete adenohypophyseal dysfunction. MRI revealed absence of pituitary stalk or anterior pituitary hypoplasia with ectopic posterior pituitary gland.</p>

Prevalence of nonalcoholic fatty liver disease and metabolic syndrome in obese children / 中华儿科杂志

<p><b>OBJECTIVE</b>The incidences of nonalcoholic fatty liver disease (NAFLD) and metabolic syndrome (MS) are very high in obese children, and insulin resistance may be the key point linking them together. Debates still remain as to whether NAFLD could be a component of MS. Some researchers reported that NAFLD was a composition of MS, while the others stated that NAFLD was an independent predicting factor of MS. Here we analyzed the prevalence of NAFLD and MS in 308 obese children who came to our endocrinology department from June 2003 to September 2006, and we also evaluated the relationship between NAFLD and MS in this group of obese children.</p><p><b>METHOD</b>Totally 308 obese children aged from 9 to 14 years with mean age of (10.7 +/- 2.6) years were enrolled. Two hundred and thirty one were males, and 77 were females. Body mass index (BMI), waist circumference (WC), biochemical indicators, liver B-mode ultrasound examination, oral glucose tolerance test (OGTT) and insulin releasing test were performed for all of the cases. The incidences of NAFLD including simple nonalcoholic fatty liver (SNAFL) and nonalcoholic steatohepatitis (NASH) as well as MS were calculated. Three subgroups were selected according to the diagnostic criteria: Group 1: OCWLD (obese children without liver disorder), Group 2: SNAFL and Group 3: NASH. The prevalence of MS, components of MS, free insulin, whole body insulin sensitivity index (WBISI), homeostasis model of insulin resistance (HOMA(IR)) were compared among these three subgroups.</p><p><b>RESULT</b>(1) Among all the obese children, the prevalence of NAFLD, SNAFL, NASH and MS was 65.9% (203), 45.5% (140), 20.5% (63) and 24.7% (76) respectively. Among all the MS children, the prevalence of NAFLD was 84.2% (64/76). The prevalence of MS was 29.3% (41/140) in SNAFL group and 36.5% (23/63) in NASH group, which was significantly higher than that of OCWLD group 11.4% (12/105) (P < 0.05), but no significant difference was found between SNAFL group and NASH group (P > 0.05). Moreover, there were significantly higher incidences in NASH group concerning every component of MS (hypertension, hyperlipidemia, hyperglycemia) compared with that of OCWLD group. The incidence of hypertension in SNAFL was significantly higher than that of OCWLD group. And the incidence of hyperlipidemia was markedly increased in NASH group compared with SNAFL group. NAFLD group had higher free insulin and more severe IR compared with that of OCWLD group. When OCWLD developed to SNAFL and NASH, free insulin and IR deteriorated calculated by HOMA-IR and WBISI. However there was no significant difference between NAFLD and MS children concerning free insulin and IR.</p><p><b>CONCLUSION</b>The prevalence of NAFLD and MS hits high in obese children. The prevalence of NAFLD was very high among children with MS and NAFLD and MS shared the common mechanism of IR. The higher prevalence of MS and higher frequencies of MS components were tightly associated with the development of NAFLD and severity of IR.</p>

Clinical value of hepatic fibrosis parameters and serum ferritin in obese children with nonalcoholic fatty liver disease / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To determine the clinical value of hepatic fibrosis parameters and serum ferritin (SF) in obese children with nonalcoholic fatty liver disease.</p><p><b>METHODS</b>One hundred and one obese children aged 6-15 years and 30 healthy children aged 9-14 years were enrolled in the study. Body mass index (BMI), waist circumference (WC), alanine aminotransferase (ALT), aspartate aminotransferase (AST), hepatic fibrosis parameters including hyaluronic acid (HA), laminin (LN), serum type III procollagen (PCIII) and type IV collagen (CIV), serum ferritin and hepatic B-ultrasonography were assessed. All subjects were divided into 4 subgroups: simple obese children (SOC), simple nonalcoholic fatty liver (SNAFL), nonalcoholic steatohepatitis (NASH) and control group. ALT, AST, hepatic fibrosis parameters and serum ferritin were compared in these four groups.</p><p><b>RESULT</b>Compared with control group, the serum levels of HA and PCIII increased significantly in SOC group (P <0.05); Serum levels of HA, PCIII, SF, ALT and AST also elevated markedly in SNAFL group and NASH group compared with those in control group. PCIII, SF, ALT, AST increased stepwise as the disease developed from SOC to SNAFL and NASH (P <0.05). SF was correlated with PCIII, ALT and AST (r=0.33,0.63,0.69,P <0.05) and PCIII was well related to ALT and AST (r=0.55,0.56,P <0.05). There were only 6 cases with SF >301 microg/L among all obese children, they were all NASH. The average levels of HA, CIV, PCIII, ALT, AST of these 6 cases were significantly higher than those of other NASH children.</p><p><b>CONCLUSION</b>Among all hepatic fibrosis parameters, serum PCIII level is an early and sensitive indicator of NAFLD and is correlated with the disease progress. SF may be also involved in early injury of fatty liver and the process of NAFLD.</p>

Study on the relationships of childhood obesity and the duration of sleep as well as insulin resistance / 中华流行病学杂志

<p><b>OBJECTIVE</b>To investigate the relationships of childhood obesity and the duration of sleep as well as insulin resistance.</p><p><b>METHODS</b>Two hundred and sixty-nine simple obese children aged from 7 to 15 years with body mass index(BMI) over 23 and 120 normal healthy children were recruited in this study. Obese children were divided into three groups: Group A: 23 < or = BMI < 25; Group B: 25 < or = BMI < 30; Group C: BMI > or = 30. Duration of sleep was calculated according to the reported sleeping hours during working days and weekends. Oral glucose tolerance test and insulin releasing test were performed in all obese children. Seventy of the 120 healthy children received fasting plasma glucose (FBG) and fasting insulin (FINS) detection. Homeostasis model assessment-insulin resistance (HOMA-IR) and islet beta cell secreting index (HOMA-IS) were calculated.</p><p><b>RESULTS</b>The duration of sleep was shorter in all 3 obese groups than that in the control group and the levels of FBG, FINS and HOMA-IR were higher (P < 0.05). The levels of HOMA-IS in Group B and C were higher than that in the control group (P < 0.05), while HOMA-IS did not show much difference among the 3 obese groups and between Group A and the control group (P > 0.05). Logistic analysis showed that the duration of sleep was related to childhood obese (P < 0.05). Results from multiple linear regression model analysis showed that BMI bore a relation to HOMA-IR and HOMA-IS (P < 0.05), as well as one unit increase in BMI accompanied with 0.261 and 11.054 increase in HOMA-IR and HOMA-IS, respectively.</p><p><b>CONCLUSION</b>Children with shorter duration of sleep were susceptible to become obese. A significant correlation did exist between BMI and insulin resistance.</p>

Metformin hydrochloride ameliorates adiponectin levels and insulin sensitivity in adolescents with metabolic syndrome / 中华儿科杂志

<p><b>OBJECTIVES</b>Metabolic syndrome (MS) in adolescents was reported to be closely associated with cardiovascular diseases in adulthood. However, no unified treatment measure for MS in adolescents is currently available. The aim of this study was to measure the changes of serum adiponectin levels, insulin sensitivity and other biochemical markers after metformin therapy in adolescents with MS, which might provide some information for set up a unified therapeutic measure for MS in adolescents.</p><p><b>METHODS</b>In this study, 348 moderately or severely obese adolescents and 24 non-obese healthy adolescents matched in age and sex were enrolled. The obese group included 208 males and 140 females aged from 7 to 16 years (11.5 +/- 2.1 years). Oral glucose tolerance test and biochemical markers measurement were done to all these subjects. Whole body insulin sensitivity index (WBISI), homeostasis model assessment-insulin resistance (HOMA-IR) and fasting serum adiponectin were compared among 36 adolescents with MS (who had two or three abnormalities of hyperglycosemia, hypertension or dyslipidemia), 61 simple obese subjects without abnormality of biochemical markers and 24 healthy controls. Moreover, the changes of WBISI, HOMA-IR and adiponectin levels in 20 cases with MS after metformin therapy for 3 months were measured.</p><p><b>RESULTS</b>(1) HOMA-IR in control group (1.3), simple obese group (2.3) and MS group (4.9) increased by turns (F = 54.08, P < 0.001). WBISI and serum adiponectin in control group, simple obese group and MS group decreased by turns with significant difference [89.6, 22.8 and 10.7, F = 30.06; (7.1 +/- 2.6), (5.9 +/- 1.9), (2.8 +/- 0.9) mg/L, F = 64.93; P < 0.01 for all]. (2) HOMA-IR after metformin therapy decreased [5.7 (1.9-12.4) vs. 2.9 (0.9-7.4), t = 5.05, P < 0.01]; while the serum adiponectin levels increased with significant differences [(3.0 +/- 0.9) mg/L vs. (6.1 +/- 1.9) mg/L, t = 6.19, P < 0.01]. Systolic blood pressure [(132.4 +/- 7.5) mm Hg vs. (116.6 +/- 9.1) mm Hg, t = 8.36, P < 0.01], 2-hour glucose [(8.2 +/- 2.9) mmol/L vs. (5.3 +/- 1.0) mmol/L, t = 3.96, P < 0.01], triglyceride [(2.8 +/- 1.2) mmol/L vs. (1.3 +/- 0.9) mmol/L, t = 4.22, P < 0.01], total cholesterol [(4.9 +/- 0.6) mmol/L vs. (4.0 +/- 0.6) mmol/L, t = 4.72, P < 0.01], alanine aminotransferase [80.5 (29.0-286.0) U/L vs. 56.0 (23.0-163.0) U/L, t = 3.80, P < 0.01].</p><p><b>CONCLUSION</b>Insulin sensitivity in adolescents with MS was lower than that of simple obese group. Metformin can improve or ameliorate adiponectin levels, insulin sensitivity and some clinical markers.</p>

Nonalcoholic steatohepatitis in obese children: the prevalence and possible mechanism / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To investigate the prevalence of nonalcoholic steatohepatitis (NASH) in obese children and its possible mechanism.</p><p><b>METHODS</b>Three subgroups were classified according to their body mass index (BMI) in 123 obese children with BMI over 23 aged 7 to 16:34 cases with BMI> or =31 group; 57 cases with 25< or =BMI<30 group; 32 cases with 23< or =BMI<25 group. Ultrasonographic and biochemical parameters including serum alanine aminotransferase (ALT), serum aspartate aminotransferase (AST), serum cholesterol, serum triglyceride, serum uric acid and free glucose to free insulin ratio (FGIR) were assayed. Twenty four children suspected as benign acanthosis nigricans underwent skin biopsy and its association with nonalcoholic steatohepatitis was also discussed.</p><p><b>RESULTS</b>Ninety-nine children (80.49 %) showed abnormal hepatic sonograms and 54 were diagnosed as NASH with the prevalence of 43.90%. Compared with the other two groups, BMI> or =31 group was significantly higher in prevalence of abnormal hepatic sonograms, NASH, decreased FGIR and risk of benign acanthosis nigricans (P<0.01). Fifty-four children diagnosed as NASH showed significantly higher incidence of hyperlipidemia, insulin resistance and higher body mass index as compared with 24 subjects without fatty liver changes. In 54 NASH children, 20(37.04%) had benign acanthosis nigricans. By bivariate analysis, ALT and AST were correlated well with BMI, cholesterol, triglyceride and FGIR (r(s)=0.413, 0.290, 0.379, -0.477, P<0.01; r(s)=0.359, 0.349, 0.348, -0.369, P<0.01).</p><p><b>CONCLUSION</b>There is a high prevalence of nonalcoholic steatohepatitis in simple obese children and high incidence of benign acanthosis nigricans in NASH subjects. BMI> or=30 is a high risk factor of being NASH. Severe disturbance of lipid metabolism and insulin resistance may be involved in the mechanism of NASH.</p>

Effect of recombinant human growth hormone on glucose metabolism in children with growth hormone deficiency / 中华儿科杂志

<p><b>OBJECTIVE</b>Numerous studies in children with growth hormone deficiency (GHD) show that recombinant human growth hormone (rhGH) treatment results in significant catch-up growth, but some papers reported that the children who underwent rhGH therapy might be at increased risk of diabetes. The aim of this study was to investigate the effects of rhGH treatment on blood glucose and insulin metabolism in children with GHD and the relationship between growth hormone (GH) and glucose homeostasis.</p><p><b>METHODS</b>In this study, 44 children with GHD treated with rhGH [0.1 U/(kgxd)] and age- and sex-matched 20 healthy children were enrolled. The GHD group included 28 males and 16 females aged from 4.5 to 16.5 years (mean 10.4 +/- 2.6 years), including 18 cases of complete GHD and 26 cases of partial GHD. The sexual development stage of all subjects was in Tanner I. Oral glucose tolerance tests (OGTT) were done, and body mass index (BMI), serum insulin-like growth factor-1 (IGF-1) level and insulin resistance by homeostasis model (HOMA-IR) were measured at the time of diagnosis and every 3 months after rhGH therapy. Continuous glucose monitoring system (CGMS) was applied for two cases with hyperglycemia.</p><p><b>RESULTS</b>(1) Fasting glucose and IGF-1 levels increased since 3 months of treatment and did not decrease since then. The levels of fasting glucose and IGF-1 at every time points of rhGH therapy were higher than the levels at the time of diagnosis (F = 6.81, P < 0.01; F = 7.31, P < 0.01, respectively). HOMA-IR and fasting insulin levels were increased since 3 and 9 months of treatment (P = 0.001 and P = 0.021, respectively). They decreased after 12 months of therapy and the levels at 18 months of therapy were similar to that at diagnosis. (2) Pearson correlation analysis showed that HOMA-IR was positively correlated with BMI, IGF-1 and the duration of treatment (r = 0.251, 0.437, 0.281, P < 0.01, respectively). The curve between HOMA-IR and duration of therapy was similar with parabola and the quadratic equation obtained was as follows: HOMA-IR = 1.5048 + 0.2177 x duration of therapy (months)-0.0103 x duration of therapy (months)(2) (r(2) = 0.147, F = 14.16, P < 0.01). (3) Two cases had transitory hyperglycemia. Their fasting glucose levels were all higher than 7.1 mmol/L. The glucose levels returned to normal after 1 month and 5 days respectively. OGTT and CGMS showed that their plasma glucose levels were normal after rhGH therapy was applied again.</p><p><b>CONCLUSION</b>The children who underwent rhGH therapy may be at increased risk of insulin resistance (especially during the first year) and the therapy may even induce transitory glucose metabolic disorder in a very small proportion of patients. Circulating IGF-1 may participate in the control of insulin sensitivity and play an important role in the hormonal balance between GH and insulin. It may be necessary to monitor glucose metabolism and IGF-1 for all children who are treated with rhGH therapy.</p>

Studies on chemical constituents in seeds of Taxus mairei II / 中国中药杂志

<p><b>OBJECTIVE</b>To study the chemical constituents in seeds of Taxus mairei.</p><p><b>METHOD</b>Preparative HPLC, TLC and spectroscopic analyses were used to isolate and elucidate the chemical constituets in the plant.</p><p><b>RESULT</b>Seven taxane diterpenoids were isolated from the seeds of T. mairei and identified as taxinine A(1), 9-deacetyltaxinine(2), 9-deacetyltaxinine E(3), 2-deacetyltaxinine(4), taxezopidine G(5), 2-deacetoxytaxinine J(6), 2-deacetoxytaxuspine C(7).</p><p><b>CONCLUSION</b>Except compounds 5,6, all the compounds were obtained from seeds of this plant for the first time.</p>

Comparison of methods to detect insulin resistance in obese children and adolescents / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To explore the practical and sensitive index for insulin resistance in obese children and adolescents.</p><p><b>METHODS</b>An oral glucose tolerance test and insulin releasing test were performed in 126 obese (divided into 3 groups according their BMI) and 25 normal children. The ratio of fasting plasma glucose to fasting plasma insulin (FBG/FINS), homeostasis model assessment-insulin resistance (HOMA-IR), homeostasis model assessment-insulin activity index (IAI), whole body insulin sensitivity index (WBISI) and area under curve of glucose and insulin (AUCBG, AUCINS) were calculated.</p><p><b>RESULT</b>There were no significant differences in fasting plasma glucose levels, while significant differences existed in fasting plasma insulin, the ratio of fasting plasma glucose to fasting plasma insulin,homeostasis model assessment-insulin resistance, homeostasis model assessment-insulin activity index, whole body insulin sensitivity index, area under curve of glucose, area under curve of insulin and AUCINS/AUCBG among these four groups. Whole body insulin sensitivity index (WBISI) reflected the sensitiveness of the insulin earlier than that of homeostasis model assessment-insulin resistance and homeostasis model assessment-insulin activity index.</p><p><b>CONCLUSION</b>Whole body insulin sensitivity index seems to be a better index for insulin resistance for obese children.</p>

The E-selectin,P-selectin and ICAM-1 expression at different time points after focal brain ischemic-reperfusion in rats / 中国药理学通报

Aim To study the expression of P-selectin,E-selectin and ICAM-1 and the migration of leukocyte at different time points after focal brain ischemia-reperfusion,and explore the role of cell adhesion molecules in cerebral ischemia-reperfusion damage.Methods The model of focal cerebral ischemia-reperfusion was established with the occluding suture as described by Longa.Sham operation was performed without inserting the suture.Rats were decapitated under anesthesia at 4,8,12,24,and 48 h after ischemia-reperfusion.Brains were immediately removed and samples were handled for following application.Morphological changes of the brain tissue were observed through hematoxylin-eosin staining.The positive expressions of P-selectin,E-selectin,and ICAM-1 were observed and located using immunohistochemistry and immunofluorescent histochemistry technique,respectively.The expressions of P-selectin, E-selectin and ICAM-1 in infracted cortex were measured quantitively with Flow cytometry.The activities of myeloperoxidase in the infracted hemispheres represented the migration of leukocytes were detected through biochemical method.Results The positive cells of P-selectin,E-selectin,and ICAM-1 expressed at the same position of microvessels in the infracted hemisphere were significantly increased after ischemia-reperfusion.Compared with the sham operation group(P-selectin:(4.99?0.08) channel,E-selectin:(4.17?0.13) channel,ICAM-1:(4.17?0.13) channel),the expressions of P-selectin,E-selectin,and ICAM-1 at I/R 4 h((5.46?0.09) channel,(4.60?0.14) channel,(4.56?0.12) channel),I/R 8 h((5.87?0.24) channel,(5.08?0.14) channel,(5.41?0.22) channel),I/R 12 h((6.48?0.18) channel,(5.72?0.18) channel,(5.66?0.16) channel),I/R 24 h((7.16?0.11) channel,(6.09?0.09) channel,(5.61?0.09) channel), and I/R 48 h((5.82?0.28) channel,(5.37?0.25) channel,(5.27?0.16) channel) were increased(P