A follow-up study on the introduction of vegetables and fruits during infants aged 4-8 months in Beijing and Chenzhou City of Hunan Province / 北京大学学报(医学版)

OBJECTIVE@#To investigate the introduction of vegetables and fruits in 4-8 months old infants, and to describe the maternal and infants' characteristics associated with the introduction of vegetables and fruits.@*METHODS@#Mother-infant dyads (n=228) were recruited from 12 to 16 weeks postpartum and formally entered the study at 4 months of age. Data collected via face to face interview at 4-8 months postpartum, including the timing and types of added vegetables and fruits, as well as a variety of maternal and infant characteristics (n=204). Rank sum test and multiple linear regression were used to analyze the maternal and infant characteristics related to the introduction of vegetables and fruits.@*RESULTS@#The time of introducing vegetables was concentrated at the age of 7 months, and the time of adding fruits was mainly at 6 months. Fruits were added earlier than vegetables (P < 0.001), and the variety of the added fruits was higher than that of vegetables (P=0.045). 48% (n=98) of infants had no more than three types of fruits and vegetables at 8 months. Only 9.8% (n=20) had added more than 10 kinds of fruits and vegetables at 8 months. Green leafy vegetables were the most commonly added vegetable, and apple was the most popular fruit. Compared with women who were 35 years of age or younger, women beyond 35 years old introduced vegetables to their babies 0.6 months later. 4-month-old exclusively breastfed infants had vegetables 0.4 months later than mixed-fed infants. Women with a bachelor's degree or above added 2-3 more types of fruits and vegetables to their babies than those with junior high school education and below.@*CONCLUSION@#The adding time of fruits was earlier than that of vegetable. Apples and green leafy vegetables are commonly added. Women with lower educational backgrounds add fewer types of fruits and vegetables to their babies. Mothers who choose exclusive breastfeeding and those over 35 years of age at childbirth add vegetables to their babies later than others. They should be targeted for health promotion programs that aim to improve the intake of fruits and vegetables among infants.

Relationship between nutrients intake during pregnancy and the glycemic control effect in pregnant women with gestational diabetes mellitus / 北京大学学报(医学版)

OBJECTIVE@#To explore the relationship between nutrients intake during pregnancy and the glycemic control effect in pregnant women with gestational diabetes mellitus (GDM).@*METHODS@#Pregnant women for 25-35 gestational weeks who underwent prenatal examination and completed GDM diagnostic test in two third-class hospitals in Beijing from October 2015 to October 2017 were recruited to participate in the cohort study, and were investigated at enrollment, 2 weeks after enrollment, and delivery. The cross-sectional survey data 2 weeks after enrollment was used for this study. Among them, dietary survey used the 24 h dietary records to collect the food intake of the subjects for the past day, and the intake of energy, macronutrients and micronutrients, was calculated according to the Chinese Food Composition Table. Using the data of fasting blood glucose (FBG) collected by clinical information system and referring to the Chinese Guidelines for the Diagnosis and Treatment of Pregnancy Diabetes (2014), the GDM patients with FBG ≤5.3 mmol/L were divided into the well-control group, those with FBG >5.3 mmol/L were divided into poorly-control group, and pregnant women with normal glucose tolerance were consi-dered as the normal group. Binary Logistic regression was used to analyze the association between the nutrients intake and glycemic control effect in pregnant women with GDM.@*RESULTS@#A total of 227 pregnant women were enrolled, including 104 GDM patients and 123 normal pregnancy women. Among them, 76 subjects in the well-control group (73.1%, 76/104) and 28 subjects in the poorly-control group (26.9%, 28/104). Compared with the well-control group and the normal group, the protein intake and its energy ratio of the poorly-control group were significantly higher, while carbohydrate energy ratio was significantly lower. In terms of micronutrients, there was no significant difference between the well-control group and the poorly-control group. After adjusting for age, gestational age and physical activity level, with the well-control group as the control group, binary Logistic regression model showed that higher protein energy ratio was positively correlated with poorly glycemic control effect in pregnant women with GDM (OR=6.12, 95%CI: 1.44-25.98), while higher carbohydrate energy ratio was negatively correlated with poorly glycemic control (OR=0.54, 95%CI: 0.32-0.91).@*CONCLUSION@#Reduced protein intake and increased carbohydrate intake were associated with better glycemic control in pregnant women with GDM. It is suggested that GDM patients should adjust their dietary pattern further to achieve good glycemic control effect.

The associated factors of cesarean section during COVID-19 pandemic: a cross-sectional study in nine cities of China

BACKGROUND@#Improving and maintaining the health of mothers and newborns is indisputably a global priority, especially during a pandemic. This study intends to examine the factors associated with cesarean section (CS) during lockdown time.@*METHODS@#A total of 678 women who just gave birth within 7 days were enrolled from maternal and children hospitals in nine cities of China from April to May 2020. The delivery modes and potential influencing factors were investigated. The subgroup analysis and sensitivity analysis were used to examine the association of CS and risk factors among populations with different characteristics and to control for possible confounding, respectively.@*RESULTS@#The overall rate of cesarean delivery was 37.3%. In multi-variant model, maternal age > 30 years (OR, 95% CI = 1.71, 1.21-2.41), higher pre-gestational BMI (OR, 95% CI = 1.16, 1.10-1.23), living in regions with confirmed COVID-19 cases > 500 (OR, 95% CI = 2.45, 1.74-3.45), and excess gestational weight gain (OR, 95% CI = 1.73, 1.17-2.55) were associated with cesarean delivery. These trends of associations were not changes in sensitivity analysis and subgroup analysis. Cesarean delivery occurred more in women who got more nutrition instruction during the pandemic period in the univariant model; however, this association showed insignificance in the multiple-variant analysis.@*CONCLUSION@#A high cesarean delivery rate was found in uninfected women who experienced lockdown in their third trimester. During the COVID-19 pandemic, more medical support should be provided in severely affected regions to ensure and promote health in pregnancy.

Prediction of 3-mouth glycemic control in type 2 diabetes mellitus based on machine learning algorithm / 中华疾病控制杂志

Objective To evaluate the efficiency of Logistic regression algorithm and random forest algorithm in prediction of blood glucose control in patients with type 2 diabetes mellitus (T2DM) after 3 months, and explore the influencing factors of blood glucose control. Methods The data was extracted from baseline survey and follow-up information of patients with T2DM in Shunyi and Tongzhou Districts. The patient’s 3-month glycosylated hemoglobin which was more than 6.5% was chosen as the outcome categorical variable. The random forest algorithm and Logistic algorithm were used to establish the prediction model. The predictive efficiency was evaluated with the area under receive operating characteristic curve (AUC) and accuracy rate. Results Factors affecting the patient’s glycemic control included baseline fasting plasma glucose(P<0.001), duration of disease(P<0.001), smoking(P=0.026), static activity time(P=0.006), body mass index(overweight P=0.002, obesity P=0.011), bracelet use(P=0.028), and diabetes diet(P=0.002).The Logistic regression prediction model had an AUC of 0.738, a sensitivity of 72.9%, a specificity of 68.1%, and an accuracy of 71.2%. The random forest model had an AUC of 0.756, a sensitivity of 74.5%, a specificity of 69.5%, and an accuracy of 72.8%. Conclusions The efficiency of random forest is better than Logistic regression model, which can be applied to the prediction of blood glucose control and assist the management of diabetic patients.

Exploration of homogeneous quality management among trans-regional medical unions / 中华医院管理杂志

This paper presents some ideas and practices to realize the homogeneity quality management process within the Beijing Children Hospital Group,the largest specialized medical group in the country.This research aims at providing references and thoughts on homogeneity quality management for trans-regional medical unions in the country.

Nutrient Intakes of Pregnant Women and their Associated Factors in Eight Cities of China: A Cross-sectional Study / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>During the last 3 decades, China has dramatic changes of the dietary pattern among its citizens, particularly in urban cities. This study aimed to determine the nutrient intake status and factors associated with nutrient intakes of urban Chinese pregnant women now-a-day.</p><p><b>METHODS</b>The multistage stratified random sampling method was applied in the cross-sectional study. 479 women in three trimesters of pregnancy from eight cities of China were recruited. Nutrient intakes were evaluated with one 24 h dietary recall, and compared with the Chinese Dietary Reference Intakes (DRIs) 2013 for available nutrients.</p><p><b>RESULTS</b>Most pregnant women had imbalanced macronutrient distribution with excessive energy derived from fat. Intakes of Vitamin A, B 6, calcium, magnesium, and selenium were below Chinese Recommended Nutrient Intake (RNI) and Estimated Average Requirements (EARs) in all trimesters. Most pregnant women took more folic acid in the first trimester with a significant decrease in the second and third trimester (P < 0.05). Shortfall in iron intake was found in the third trimester whereas some women may be at the risk of excessive iron intake. Intakes of thiamin met RNI in the first trimester but were below EAR in all trimesters. Trimester phasing was positively associated with most nutrients (P < 0.05). Prepregnancy body mass index was inversely associated with energy, fat, Vitamin C, and calcium intake (P < 0.05). Educational level and household income were positively associated with folic acid intake (P < 0.05).</p><p><b>CONCLUSIONS</b>Current prenatal dietary choices of urban pregnant women in China are imbalanced in the nutrient intake when compared with national DRIs 2013, particularly in intakes of energy derived from fat and micronutrients. Appropriate dietary advice to pregnant women should promote a balanced diet with emphasis on avoidance of foods of high fat content and incorporation of foods that are good sources of the key micronutrients that are usually lacking in a regular pregnancy diet. Further research is needed to understand the eating habits and food patterns that contribute to this imbalanced diet in order to be able to effectively improve prenatal women's nutrient intake status.</p>

Chronic caffeine exposure attenuates blast-induced memory deficit in mice / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To investigate the effects of three different ways of chronic caffeine administration on blast- induced memory dysfunction and to explore the underlying mechanisms.</p><p><b>METHODS</b>Adult male C57BL/6 mice were used and randomly divided into five groups: control: without blast exposure, con-water: administrated with water continuously before and after blast-induced traumatic brain injury (bTBI), con-caffeine: administrated with caffeine continuously for 1 month before and after bTBI, pre-caffeine: chronically administrated with caffeine for 1 month before bTBI and withdrawal after bTBI, post-caffeine: chronically administrated with caffeine after bTBI. After being subjected to moderate intensity of blast injury, mice were recorded for learning and memory performance using Morris water maze (MWM) paradigms at 1, 4, and 8 weeks post-blast injury. Neurological deficit scoring, glutamate concentration, proinflammatory cytokines production, and neuropathological changes at 24 h, 1, 4, and 8 weeks post-bTBI were examined to evaluate the brain injury in early and prolonged stages. Adenosine A1 receptor expression was detected using qPCR.</p><p><b>RESULTS</b>All of the three ways of chronic caffeine exposure ameliorated blast-induced memory deficit, which is correlated with the neuroprotective effects against excitotoxicity, inflammation, astrogliosis and neuronal loss at different stages of injury. Continuous caffeine treatment played positive roles in both early and prolonged stages of bTBI; pre-bTBI and post-bTBI treatment of caffeine tended to exert neuroprotective effects at early and prolonged stages of bTBI respectively. Up-regulation of adenosine A1 receptor expression might contribute to the favorable effects of chronic caffeine consumption.</p><p><b>CONCLUSION</b>Since caffeinated beverages are widely consumed in both civilian and military personnel and are convenient to get, the results may provide a promising prophylactic strategy for blast-induced neurotrauma and the consequent cognitive impairment.</p>

Educational reform of epidemiology practice for clinical students / 基础医学与临床

Epidemiology is a discipline characterized by complicated theory and practice.How to make the practice course function better is a topic worthy of exploring in educational reform for clinical students.The article explored the‘Student-Dominated’ Model based on ‘Problem-Based Learning ’ and ‘Team Based Learning ’ in teaching process and compared the model with the traditional one ( Teacher-Dominated Model) .Suggestions were given to further improve effectiveness of epidemiology practice courses.

Mineral compositions in breast milk of healthy Chinese lactating women in urban areas and its associated factors / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Optimal mineral intakes are important for infant growth and development. However, data on mineral compositions of breast milk in Chinese women are scarce, and most were acquired before 1990. The objectives of this study were three-fold: (1) to investigate the mineral compositions of Chinese healthy mothers' breast milk in different lactation stages; (2) to explore correlations among mineral concentrations in breast milk; and (3) to explore the associated factors affecting mineral compositions in breast milk.</p><p><b>METHODS</b>The inductively coupled plasma mass spectrometry (ICP-MS) was used to analyze mineral concentrations in breast-milk of 444 healthy lactating women from three cities in China. A questionnaire was used to survey socio-demographic characteristics and pregnancy history. Food intakes by lactating women were measured using both food frequency questionnaire and one cycle of 24-hour dietary recall.</p><p><b>RESULTS</b>Mineral compositions of breast milk varied in different regions. Concentrations of most minerals were higher in the first one or two months of lactation, and then decreased with time, except for magnesium and iron. Inter-mineral correlations existed among several minerals. The calcium-to-phosphorus ratio was above 2:1 in each lactation stage. Women with caesarean section had higher concentration of iodine in the transitional milk (349.9 µg/kg) compared to women with natural delivery (237.5 µg/kg, P < 0.001). Dietary mineral intakes, supplements, food intake frequencies in the recent 6 months, maternal age and maternal BMI did not show significant correlations with concentrations of milk minerals (all P > 0.05).</p><p><b>CONCLUSIONS</b>Milk minerals decreased with time, and changed most rapidly in the first one or two months of lactation. Caesarean section might affect the iodine level in transitional milk.</p>

Effects of feeding patterns during the first four months after birth on growth and development of three to seven-year-old children / 中华围产医学杂志

Objective To explore the effects of different infants-feeding patterns on preschoolers' physical development, intelligence development and bone mineral density (BMD). Methods A total of 953 preschoolers from seven cities and two rural areas in China were recruited by multiple stage stratified cluster sampling methods from November 2011 to April 2012. Physiology measurement was performed to get their height and weight and to calculate body mass index(BMI). BMD of distal radius was measured by ultrasound BMD scanner. The intelligence quotient was assessed by Standford-Binet Test of Intelligence(Chinese Version). The demographic factors and the feeding ways were investigated by an interviewer-administered questionnaire and all subjects were divided into three groups : exclusive breastfeeding, mixed feeding and artificial feeding group. ANOVA analysis, Chi-square test and non-parametric test were used to analyze the data. Results There were 476, 335 and 142 children in exclusive breastfeeding, mixed feeding and artificial feeding groups, respectively. The exclusive breastfeeding rate in urban areas was significantly lower than that in rural areas [47.2%(343/726) vs 58.6%(133/227), χ2=9.780, P=0.008]. The height-for-age Z score and weight-for-age Z score were significantly different among children with different feeding ways (χ2=10.728 and 12.175, P=0.005 and 0.002). The children in the exclusive breast feeding group showed lower height-for-age Z score and lower weight-for-age Z score comparing with those in the mixed feeding and artificial feeding groups (all P0.05). Conclusions Feeding patterns during the first several months after birth may affect the weight, height and BMD in preschool-children, but not the intelligence development of these children.

Hyperuricaemia and blood pressure, and blood lipid and glucose / 中华健康管理学杂志

Objective To explore the correlation between hyperuricaemia and blood pressure, and blood lipid and glucose. Methods By using simple cluster sampling, 2 branch units from PetroChina Changqing Oilfield Company were selected, and all the 720 subjects with hyperuricaemia (HUA) were assigned to the HUA group; another 620 participants with normal uric acid (UA) level into the normal group. The correlation between blood uric acid and blood pressure,and blood lipid and glucose was assessed by Logistic regression. Results The odds ratio (OR) of those who had 1,2 or 3 abnormal status of hypertension,hyperlipidemia and impaired fasting glucose in the HUA group were much higher than the normal group (OR values were 4. 036,2. 562, and 4. 174, respectively). Logistic regression showed that male, systolic blood pressure ( SBP), GLU, total cholesterol ( TC), triglyceride ( TG), low-density lipoprotein cholesterol (LDL-C) were risk factors of H UA ( OR values were 7. 736,2. 309,1.721,2. 761 and 1. 411,respectively) ,while high-density lipoprotein cholesterol (HDL-C, OR = 0. 211 ) was a protective factor of HUA. Conclusions Gender,blood pressure and blood lipid may have correlation with blood UA. Multiple risk factors should be considered to improve the effectiveness of health education and health promotion.

Diagnosis and influence factor of antibody to coagulation factors in hemophilia / 中国实验血液学杂志

This study was purposed to investigate the diagnosis, typing and influencing factors of the antibody (inhibitor) to coagulation factors in hemophilia. 500 hemophilia patients were enrolled in this study. The activities of coagulation factor FVIII and FIX were tested by one stage assay. The antibodies of FVIII and FIX were detected by Bethesda assay. All data were analyzed by statistical soft SPSS 10.0. The results indicated that there were 411 cases of hemophilia A, out of which 151 cases (30.2%) showed FVIII antibody positive, the titer was 3.50 ± 2.84 Bu/ml; there were 79 cases of hemophilia B, out of which 18 cases (3.6%) showed FIX antibody positive, the titer was 2.92 ± 2.19 Bu/ml. The other 10 cases were acquired autogeneic hemophilia (2.0%). The antibody was divided into three types: high-response (3 cases), intermediate-response (47 cases), and low-response (119 cases). Among the 169 cases with antibody positive, 157 cases (92.9%) were younger than 30 years old; among 151 (89.35%) cases of hemophilia A; 138 cases (81.66%) were moderate or severe hemophilia; 166 case (98.22%) showed intermediate or low-response antibody. There were 158 cases with allogeneic antibody positive, all of which received blood transfusion. It is concluded that the moderate and low responsive antibodies are the dominant in hemophilia patients, the age of patients and transfusion frequency of blood preparation are the influencing factors. The results of this study provide the basis for the hemophilia diagnosis, antibody typing and evaluation of factors influencing hemophilia, and also suggest that the repeated transfusion of blood preparation may influence the production of antibodies.

Effects of realgar on tissue factor expression of NB4 and MR2 cells / 中国中药杂志

<p><b>OBJECTIVE</b>To investigate the effects of Realgar on procoagulant activity (PCA), tissue factor expression and tissue factor mRNA transcription in acute promyelocytic leukemia (APL) cell lines NB4 and MR2 cells.</p><p><b>METHOD</b>NB4 and MR2 cells were treated with 300 micrograms.L-1 Realgar PCA of the treated cells was detected using one-stage clotting assay. TF antigen was detected by ELISA and TFmRNA by semi-quantitive RT-PCR.</p><p><b>RESULT</b>The PCA and TF antigen level in NB4 and MR2 cells were significantly higher than that in HL-60 and K562 cells. Realgar could down-regulate the membrane PCA, TF antigen and TF mRNA transcription of NB4 and MR2 cells in a time-dependent manner.</p><p><b>CONCLUSION</b>Down-regulating TF expression and PCA of NB4 and MR2 cells by Realgar may be one of the mechanism of its improvement effect on DIC-related hemorrhage of APL patients.</p>

Gene expression profile changes in NB4 cells induced by realgar / 中华医学杂志(英文版)

<p><b>OBJECTIVES</b>To compare the gene expression profiles of acute promyelocytic leukemia cell line NB(4) before and after 12 hours of realgar treatment using cDNA microarray.</p><p><b>METHODS</b>Two cDNA probes were prepared through reverse transcription from mRNA of both untreated and realgar treated NB(4) cells. The probes were labeled with Cy3 and Cy5 fluorescence dyes individually, hybridized with cDNA microarray representing 1003 different human genes, and scanned for fluorescent intensity. The genes were screened through the analysis of the difference in two gene expression profiles.</p><p><b>RESULTS</b>The analysis of gene expression profiles indicates that 9 genes were up-regulated and 37 genes were down-regulated. Among the 9 up-regulated genes, 2 genes were involved in a proteasome degradation pathway. Some genes related to protein synthesis, signal transduction and cell receptors were down-regulated.</p><p><b>CONCLUSION</b>PSMC2 and PSMD1 genes may play an important role in the apoptosis and partial differentiation of NB(4) cells.</p>