School canteen construction and canteen meal provision from 2012 to 2017 in schools under the National Nutrition Improvement Program for Rural Compulsory Eudcation Students / 中国学校卫生

Objective@#To analyze changes of school canteen construction and canteen meal provision in surveilled schools after the initiation of the National Nutrition Improvement Program for Rural Compulsory Education Student (NNIPRCES), therefore to provide data basis for improving efficacy of school canteen meals.@*Methods@#From 2012 to 2017, among the 699 trial counties in 22 provinces under NNIPRCES, at least 10% of elementary schools and middle schools with each food supply model (canteen meals, enterprise meals, and family meals) were randomly selected in each county in each year. Questionnaire survey was conducted to collect school canteen construction and meal provision information. The sample size were around 8 000 to 11 000 schools every year.@*Results@#From 2012 to 2017, the proportion of schools that have canteens only, have both canteen and dining room, as well as those have canteen and dining room with tables and chairs significantly increased with years(χ 2=3 043.95, 6 383.85, 6 731.17, P<0.01). The proportion of schools having canteen increased from 59.5% in 2012 to 87.0% in 2017. The proportion of schools with canteen providing breakfast, lunch or dinner varied across years(χ 2=51.85, 144.96, 189.19, P<0.01). The varieties of food groups of three meals all significantly increased during 2012, 2014 and 2017(χ 2=702.30, 892.38, 550.55, P<0.01). The canteen construction indicators, proportion of canteens providing three meals, and food groups included in three meals all significantly differed between elementary schools and middle schools, also between schools of central area and western area(P<0.05). The changing patterns with year were significantly different in elementary schools and middle schools, and in schools of central area and western area(P<0.05).@*Conclusion@#After the implementation of NNIPRCES, canteen construction and food variety in canteen meals significantly improved during 2012 to 2017. However, there are still gaps between changes of canteen construction and canteen meal provision. It is necessary to overcome obstacles to further increase the proportion of schools with canteen offering meals and the variety of food of meals.

Analysis school absenteeism in Nutrition Improvement Program for Rural Compulsory Education Students area from 2012-2017 / 中国学校卫生

Objective@#To investigate the changes of school absenteeism among students received Nutrition Improvement Program for Rural Compulsory Education Student (NIPCES), and to provide basic data for further nutritional health improvement for rural students.@*Methods@#Among 699 NIPCES monitored counties among 22 provinces across western and central China, 10%-30% of elementary and junior high schools were randomly selected as monitoring schools within each stratification according to the food supply pattern (school canteen, company and mix) in each county, school absenteeism information were collected and analyzed from 2012 to 2017.@*Results@#The total rate of student absenteeism was 26.0 per 10 000. From 2012 to 2016, it dropped from 30.8 per 10 000 to 23.4 per 10 000 year by year, but it increased again in 2017(28.2 per 10 000). The rate of school absenteeism in the western region (29.4 per 10 000) was higher than that in the central region (21.5 per 10 000); The sick leave rate (15.0 per 10 000) of primary school students was higher than that of junior high school students (13.4 per 10 000), and the rate of personal leave absences (16.9 per 10 000) of junior high school students was higher than that of elementary school students(9.9 per 10 000); the absentees rate in mixed-food supply schools (28.5 per 10 000) was higher than that in canteen food supply schools(26.4 per 10 000), the latter was higher than that of company food supply schools(25.0 per 10 000). The rate of sick leave absenteeism was highest in December(18.4 per 10 000), and the rate of personal leave absenteeism in June was highest(14.6 per 10 000).@*Conclusion@#The rate of school absenteeism among students in the NIPCES area showed an overall downward trend year by year. The absentee rate of students varies by regions, grade, food supply patterns and school locations.

Prevalence of stunting among students under the Nutrition Improvement Program for Rural Compulsory Education Students during 2012-2017 / 中国学校卫生

Objective@#To analyze the prevalence of stunting among students received subsidies of the National Nutrition Improvement Program for rural Compulsory Education Students (NNIPRCES) during 2012-2017.@*Methods@#By using the data from 2012-2017 NNIPRCES survey, students aged 6-15 with valid height records were included. Stunting was defined according to the Screening Criteria of Malnutrition for School Age Children and Adolescents (WS/T 456—2014). To explore the association of the risk of stunting between different regions, gender or age groups in rural students.@*Results@#The prevalence of stunting among students aged 6-15 who received subsidies of NNIPRCES during 2012-2017 were 8.0%, 7.9%, 6.9%, 6.5%, 6.0% and 5.3%, declined by 2.7, 1.8, 4.0 percentage points in average, as well as in central and western region, respectively. The prevalence of stunting declined with 2.7 percentage points for boys and ,2.9 percentage points for girls. The prevalence of stunting declined most at the age of 13, with 4.0 percentage points.@*Conclusion@#The prevalence of stunting of students has declined after the implementation of NNIPRCES from 2012 to 2017. However, the total prevalence of stunting was still high and the development was unbalanced between central and western region, which requires more target intervening strategies to improve the nutritional status of students.

Temporal trend in energy and macronutrients for pilot schools involved in the Nutrition Improvement Program for Rural Compulsory Education Students in 2012-2017 / 中国学校卫生

Objective@#To evaluate temporal trend in food supply among pilot schools involved in the National Nutrition Improvement Program for Rural Compulsory Education Students (NNIPRCES).@*Methods@#Ten percent of pilot schools were randomly selected and asked to report the information on food supplies. Daily intake of energy, carbohydrates and protein for each student were calculated and compared with the reference value in Nutrition Guidelines of School Meals (WS/T 554-2017).@*Results@#Energy and protein supply increased among those pilot schools. The supply of energy increased from 1 566.5 kcal in 2012 to 1 927.4 kcal in 2017, protein increased from 49.0 g to 61.0 g. The energy ratio of fat increased from 31.9% to 34.9%, while energy ratio of carbohydrate decreased significantly (F=83.38, 128.36, 20.27 and 17.28, all P<0.05). The proportion of reasonable energy supply from carbohydrate and fat in 2017 were 17.5% and 26.8%, respectively.@*Conclusion@#The supply of energy and macronutrients in the pilot areas were unreasonable, more measures including dietary guide and monitoring need to be adopted to improve students nutrition status among rural areas.

Changing trends in school-meal catering services as part of the Nutrition Improvement Program for Rural Compulsory Education Students / 中国学校卫生

Objective@#To analyze the usage of catering software and the creation of recipes by schools, as part of the Nutrition Improvement Program for Rural Compulsory Education Students (NIPRCES) 2013-2017.@*Methods@#In each county of the 699 trial counties across 22 provinces in central and western area of China under the NNIPRCES, no less than 10% of primary and junior middle schools were randomly selected according to their catering mode (i.e., school feeding, food packages, and family feeding). School questionnaires were used to collect information concerning the schools and the creation of recipes.@*Results@#From 2013 to 2017, the utilization rate of catering software was 11.7%, 8.0%, 17.8%, 16.9%, and 14.0%, respectively with significant differences(χ 2=345.09，P<0.01). The creators of school-meal recipes included schools, the Education Bureau, hospitals and colleges, the centers of disease prevention and control. Differences were observed in the proportion of recipe creators across school type, area, and catering mode, while annual trends also varied (P<0.01), as indicated by the following proportions: 74.9%, 20.0%, 3.7%, 1.3%, respectively. Food safety was identified as the main factor that needs to be considered when creating school recipes, the proportions of which were 58.0%, 78.4%, 70.6%, and 87.4% from 2014 to 2017.@*Conclusion@#From 2013 to 2017, the utilization rate and the frequency of catering software were both relatively low, and recipe creation was in need of professional guidance. It is necessary to strengthen the popularization of catering software and improve the nutritional knowledge and skills of canteen workers to ensure the quality of school meals.

Snack consumption and the influencing factors of students participation in the Nutrition Improvement Program for Rural Compulsory Education in 2019 / 中国学校卫生

Objective@#To evaluate snack consumption and the influencing factors associated with student participation in the Nutrition Improvement Program, and to provide a scientific basis for improving the program.@*Methods@#Among the 50 monitoring counties that implemented the Compulsory Education Student Nutrition Improvement Program, two primary schools and two junior schools were randomly selected according to different food supply patterns (i.e., school, company, and mix). This study randomly selected one or two classes from each grade, which ranged from grade 3 to grade 9. A questionnaire, which addressed snack consumption and choice, was distributed to 27 374 students.@*Results@#The findings revealed that 14.0% of students from poor rural areas in central and western regions consumed snacks two or more times per day, and 21.6% of students spent 3 yuan or more on snacks each day. The top three choices of snacks included fruit and vegetables (50.6%), biscuits and bread (50.1%), and puffed food (40.0%). Students who had mothers who worked outside the home, parents who worked outside the home, who consumed corporate meals, and who had access to a small shop on campus were more likely to consume snacks one or more times per day(OR=1.35，1.19，1.11，1.51，P<0.05).@*Conclusion@#The phenomenon of snack consumption among primary and middle school students from poor rural areas in central and western regions is common, and the selection of unhealthy snacks was identified as a problem. A health education system with comprehensive support and guidance from individuals, families, schools, and society should be established to guide students to opt for healthier snacks.

Height changes among students under the National Nutrition Improvement Program for Rural Compulsory Education Students during 2012-2017 / 中国学校卫生

Objective@#To analyze the height changes among children who had received subsidies of the National Nutrition Improvement Program for Rural Compulsory Education Students (NNIPRCES) by comparing data from the year of 2012 and 2017.@*Methods@#Among 699 counties where NNIPRCES was implemented, at least 10% of elementary schools and primary middle schools with different food supply modes (school canteen meals, company meals, and mix meals) in the county were selected randomly. Forty students from one or two classes from each grade (grade 1 to grade 9) were randomly selected, to ensure equal proportion of boys and girls in each grade were surveyed, data on height from 1 655 793 students measured in 2012 were compared with 1 419 281 students measured in 2017. Height was measured by metal height pole within 0.1 cm accuracy.@*Results@#From 2012 to 2017, the average increase of height in boys and girls aged 6-15 years was 1.9 and 2.0 cm, respectively. Among them, maximum increment was found in boys at the age of 13 years and in girls at the age of 12 years, respectively, which was 3.0 and 2.8 cm. The average increase in boys from the central and western region was 2.1 and 2.2 cm, respectively, while increase in girls from the central and western region was both 2.2 cm. Compared with the results from 2012, height of boys with the 5th, 50th and 95th height percentiles in 2012 increased by 1.7, 2.0 and 2.1 cm, respectively in 2017, while the increase in girls was 2.1, 2.0 and 2.2 cm, respectively. The average increment of western students with the 5th and 95th height percentiles was higher than those of students from the central region.@*Conclusion@#The average height of students has increased after the implementation of NNIPRCES. However, the development was unbalanced between the central and western region, which requires more targeted intervening strategies to improve the nutritional status of students.

Milk consumption and associated factors in the Nutrition Improvement Programme for Rural Compulsory Education Students in 2016 / 中国学校卫生

Objective@#To investigate milk consumption and associated factors in the national pilot counties of Nutrition Improvement Programme for Rural Compulsory Education Students (NIPRCES) in 2016, and to provide basic data for milk consumption improvement.@*Methods@#Two primary and middle schools in each county were selected randomly from 50 key monitoring counties in 22 provinces in NIPRCES by three food supply modes (school-based, company-based, and others). Then 1 or 2 classes in each grade were selected randomly from grade 3 or above and junior schools. A total of 25 948 students were collected, milk consumption and related factors were investigated through student questionnaires.@*Results@#Among the students surveyed, the proportion of students drank 1 to 3 packs of milk every week was highest (45.4%), only 29.1% students drank 4 or more packets of milk per week. The proportion of children in grades 3 and 4 who drank 4 or more packets of milk per week (35.7%) was higher than that of children in grades 5 and 6 (31.8%) and junior school (22.5%)(P<0.01). The proportion of boys who drank 4 or more packs of milk per week (30.7%) was higher than girls (27.5%) (P<0.01). Multivariate Logistic regression analysis showed that boys, primary school students in grades 3 to 6, non-resident students, students with both parents or one parent at home, students who had more meals per day, students who had breakfast every day, students who took snacks or drank beverages once or more per day, students who drank 4 or more cups of boiled water were more likely to drink 4 or more packs of milk each week.@*Conclusion@#Students in poor rural areas in China lack access to milk. It is recommended that targeted measures should be taken to encourage and promote rural students to drink enough milk.

Short hairpin RNA targeting insulin-like growth factor binding protein-3 restores the bioavailability of insulin-like growth factor-1 in diabetic rats

ABSTRACT Purpose To investigate whether intracavernosal injection of short hairpin RNA for IGFBP-3 could improve erectile function in streptozotocin-induced diabetic rats. Materials and methods After 12 weeks of IGFBP-3 short hairpin RNA injection treatment, intracavernous pressure responses to electrical stimulation of cavernous nerves were evaluated. The expression of IGFBP-3 and IGF-1 at mRNA and protein levels were detected by quantitative real-time PCR analysis and Western blot, respectively. The concentration of cavernous cyclic guanosine monophosphate was detected by enzyme-linked immunosorbent assay. Results At 12 weeks after intracavernous administration of IGFBP-3 shRNA, the cavernosal pressure was significantly increased in response to the cavernous nerves stimulation compared to the diabetic group (P<0.05). Cavernous IGFBP-3 expression at both mRNA and protein levels was significantly inhibited. At the same time, cavernous IGF-1 expression was significantly increased in the IGFBP-3 shRNA treatment group compared to the diabetic group (P<0.01). Cavernous cyclic guanosine monophosphate concentration was significantly increased in the IGFBP-3 shRNA treatment group compared to the diabetic group (P<0.01). Conclusions Gene transfer of IGFBP-3 shRNA could improve erectile function via the restoration of cavernous IGF-1 bioavailability and an increase of cavernous cGMP concentration in the pathogenesis of erectile dysfunction in streptozotocin-induced diabetic rats.

Effect of long term glucocorticoid treatment on human growth hormone secretion in children and adolescents and the safety and effectiveness of recombinant human growth hormone treatment / 中国医学科学院学报

<p><b>OBJECTIVE</b>Long term glucocorticoid (prednisolone) treatment on human growth hormone (hGH) secretion in children and adolescents and to investigate the effectiveness and safety of the recombinant human growth hormone (rhGH) treatment.</p><p><b>METHODS</b>Twelve patients (age: 10.4∓1.2 years) who were treated in Peking Union Medical College Hospital from September 1999 to November 2009 were enrolled in this study. All of them had taken prednisolone with a dose of 0.5∓2.0 mg/(kg.d) for 6~18 months. Two different hGH stimulating tests was done and their growth and development was evaluated at regular intervals. Seven patients were given rhGH with a dose of 0.1 U/(kg.d) for 6~12 months to improve their growth and development after half a year of prednisolone withdrawal when their disease conditions were improved.</p><p><b>RESULTS</b>The growth speed of these 12 children decreased significantly during prednisolone treatment compared with before prednisolone treatment (1.2∓0.3cm/year vs.3.7∓1.2 cm/year,P12 months than those with a 6~12 months course (P0.05). The growth speed of seven children who received rhGH therapy for half a year were increased from 2.2∓0.1cm/year to 7.8∓0.5cm/year (P<0.05), and then to 6.9∓0.4cm/year one year later.</p><p><b>CONCLUSIONS</b>The long-term glucocorticoid treatment can decrease the hGH secretion, and thus leads to short stature and agenesis. However, the rhGH replacement can safely and effectively improve growth and development in these children after their primary diseases are improved and glucocorticoids are withdrawn.</p>

Growth and development of adolescent patients with Cushing's syndrome / 中国医学科学院学报

<p><b>OBJECTIVE</b>To elucidate the growth and development of patients with Cushing's syndrome (CS) in adolescence.</p><p><b>METHODS</b>We analyzed the clinical data of 19 patients aged under 18 with CS. We divided the patients into two groups according to the height at diagnosis. The patients under the 3rd percentile were in the short stature group (n=12), and the others in the non-short stature group (n=7). The intergroup differences in disease course, age of onset, and 24-hour urinary free cortisol were analyzed.</p><p><b>RESULTS</b>The median age at diagnosis was 13 years. The median disease course was 0.9 years. All those patients presented with typical clinical characteristics of CS. Twelve cases (63.2%) were in short stature group. The disease course of the short stature group was found significantly longer than that of the non-short stature group [(2.7∓1.7) years vs. (0.8∓0.6) years, P=0.013], but no significant difference was found in the age of onset (P=0.530) or 24-hour urinary free cortisol (P=0.919) between the two groups.</p><p><b>CONCLUSIONS</b>The data suggest that short stature is common in adolescent CS patients. The growth delay may be correlated to the disease course of CS.</p>

Magnetic resonance image of sellar region in pituitary stalk interruption syndrome in children and adolescents / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate the magnetic resonance imaging (MRI) manifestations of sellar region of children and adolescents with pituitary stalk interruption syndrome (PSIS).</p><p><b>METHODS</b>Thirty-one PSIS cases were selected from February 2001 to August 2010 in Peking Union Medical College Hospital. MRI images were collected to calculate the volume and coronary area of the pituitary based on its measured height, width, and anteroposterior diameter. The results of the measurement were retrospectively analyzed together with clinical data.</p><p><b>RESULTS</b>The patients in this study included 28 males and 3 females, aged 16.5∓3.8 years (range, 6~25 years). MRI images showed pituitary stalk rupture associated with ectopic posterior pituitary in 16 cases, significantly thinner or unclear pituitary stalk in 15 cases, in which 7 cases were found with vacuole turcica. All the 31 patients presented with reduced pituitary volume and dysfunction of anterior pituitary.</p><p><b>CONCLUSION</b>PSIS may show pituitary stalk interruption with ectopic posterior, thinning or unclear of pituitary stalk, and with a variety of anterior pituitary hormone deficiency.</p>

Clinical analysis of misdiagnosis in 70 children with primary hypothyroidism / 中国医学科学院学报

<p><b>OBJECTIVE</b>To analyze the causes of misdiagnosis of primary hypothyroidism (PH), with an attempt to reduce the misdiagnosis or mistreatment.</p><p><b>METHODS</b>Totally 70 PH children with a history of misdiagnosis but whose conditions were confirmed in Peking Union Medical College Hospital and the First Hospital of Jilin University from July 2000 to May 2009 were enrolled in this study. The clinical data were collected and the causes of misdiagnoses were analyzed.</p><p><b>RESULTS</b>Of these 70 patients, 19 were misdiagnosed as anaemia and dystrophy, 18 as pituitary tumors, 10 as adiposities, 6 as myocarditis or pericardial effusion, 4 as Downs syndrome, 3 as hepatitis, 3 as amyasthenia, 3 as cerebral palsy, 2 as cystis thyrolingualis, and 2 as congenital megacolon. The duration of misdiagnoses ranged from 6 to 72 months. The clinical manifestations of these patients were complicated, involving multiple organs and systems.</p><p><b>CONCLUSIONS</b>PH has complicated clinical manifestations and individual variations, and therefore can be easily misdiagnosed. Good knowledge, sufficient history-taking, and cautious physical examinations can help avoid misdiagnosis. Neonatal screening is helpful for diagnosis and treatment of congenital hypothyroidism.</p>

Advances in insulin like growth factor binding protein 1 in the prognosis of acute myocardial infarction / 中国医学科学院学报

Insulin-like growth factor (IGF) is closely associated with cardiovascular diseases. Low IGF-I level and high insulin-like growth factor binding protein-1 (IGFBP-1) level in serum can be used as a marker in predicting the long term morbidity and mortality of acute myocardial infarction (AMI). The article reviews the recent advances in IGFBP-1 in the prognosis of AMI.

Value of 18F fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography in diagnosis and localization of Cushing's disease / 中国医学科学院学报

<p><b>OBJECTIVE</b>To explore the value of [18F]fluoro-2-deoxy-D-glucose(18 FDG) positron emission tomography and computer tomography (PET/CT) in the qualitative diagnosis and localization of Cushing's disease.</p><p><b>METHODS</b>Totally 12 patients underwent transsphenoidal adenomectomy and were histopathologically proven to be with Cushing's disease. 18FDG PET/CT whole-body and brain scannings were performed preoperatively; meanwhile, magnetic resonance imaging (MRI) and 99mTc-octreotide examination were done in all 12 cases, and inferior petrosal sinus sampling (IPSS) were done in 6 patients.</p><p><b>RESULTS</b>The sensitivity of 18FDG in diagnosing Cushing's disease was 91.6% (11/12), but MRI was 66.7%(8/12). For the 6 patients who performed IPSS, 5 of them was diagnosed to be with Cushing's disease, and only 50% (3/6) were localized correctly in the pituitary gland.</p><p><b>CONCLUSIONS</b>18FDG PET/CT whole-body scan can exclude ectopic adrenocorticotropin-secreting tumors and localize the pituitary lesions with higher accuracy than MRI. Therefore, it is useful for suspected Cushing's disease, especially for patients their MRI and IPSS have negative or paradoxical results.</p>

Value of brain magnetic resonance imaging and tumor markers in the diagnosis and treatment of intracranial germinoma in children / 中国医学科学院学报

<p><b>OBJECTIVE</b>To evaluate the role of brain magnetic resonance imaging (MRI) and tumor markers in the cerebral spinal fluid (CSF) and serum in the diagnosis and treatment of intracranial germinoma in children.</p><p><b>METHODS</b>Totally 5 children (3 girls and 2 boys) who were treated in our hospital between January 2009 and December 2010 due to central diabetes insipidus. All patients received contrast-enhanced brain MRI at presentation and during each follow-up: meanwhile, their anterior pituitary hormones and tumor markers including human chorionic gonadotropin (hCG) and alpha fetoprotein (AFP) were also determined.</p><p><b>RESULTS</b>Three patients presented without prior evaluation, and two patients were referred to our hospital due to exaggerated disease of unknown cause. Their ages at presentation ranged from 8 years to 12 years 1 month, and the duration of symptoms at presentation was between 1 month to 78 months. All of them had polyuria and polydipsia at presentation. Except one child, the other 4 patients had growth retardation and failure in initiation of puberty. Although the growth rate and puberty development were normal during the 2-year follow-up for the excepted child, all child experienced anterior pituitary hypofunction and an increased concentration of plasma prolactin after the lesion became enlarged. Three patients had cerebral hernia, which presented in 18, 24, and 78 months, respectively. In three patients, brain MRI at presentation showed isolated pituitary stalk thickening, which further developed into massive tumor in the hypothalamus pituitary region 18-22 months later; in the remaining two patients, large brain tumor was found via MRI at their first presentations. In all five patients, the posterior pituitary gland (bright spot) disappeared on T1-weighted MRI images. CSF hCG elevated in all five patients, and serum hCG increased in four patients; the level of hCG varied with the mass size of tumor. Serum and CSF AFP increased in only one patient.</p><p><b>CONCLUSIONS</b>Patients with idiopathic central diabetes insipidus must be closely followed to identify the etiology, especially when anterior pituitary hormone deficiencies are detected. For patients with normal brain MRI results or simply isolated pituitary stalk thickening at presentation, the changes of serial contrast-enhanced brain MRI should be observed during follow-up to ensure the early detection of an evolving occult hypothalamic-stalk lesion. Determination of CSF hCG at the first presentation may be useful, because an increased CSF level of hCG precedes MRI abnormalities.</p>

Application of positron emission tomography in the clinical evaluation and treatment of hypothalamic-pituitary diseases / 中国医学科学院学报

Positron emission tomography (PET) and PET/CT are playing increasingly important roles in the clinical evaluation and treatment of tumors. As neuroendocrine tissues, the hypothalamus and pituitary gland have their unique features, and PET can be valuable in evaluating hypothalamic-pituitary diseases lesions. This article reviews the application of PET in the clinical evaluation and treatment of hypothalamic-pituitary diseases.

Safety of recombinant human growth hormone in treating children with growth hormone deficiency and idiopathic short stature / 中国医学科学院学报

Recombinant human growth hormone is generally safe in treating children with growth hormone deficiency and idiopathic short stature. However, side effects such as sodium and water retention, benign intracranial hypertension, insulin insensitivity, increasing risk of secondary neoplasm, scoliosis, and slipped capital femoral epiphysis may occur occasionally, although the overall incidence remains low.