Research progress on risk factors and identification tools for child abuse / 中国学校卫生

Abstract@#Child abuse is a global public health problem, which has emerged as a neglected yet pressing issue in global development. Early and accurate identification of abuse at a lower-age group is of great significance for treatment, which might reduce the risk of re-maltreatment and promote children s physical and mental health development. Therefore, by reviewing the clinical characteristics, risk factors and existing abuse identification and screening tools of child abuse, the study aims at providing basic evidence for the development of child abuse risk identification tools and the establishment of child maltreatment system in China, so as to take timely intervention measures to prevent adverse outcomes or reduce their severity.

Novel mutation of type-1 insulin-like growth factor receptor (IGF-1R) gene in a severe short stature pedigree identified by targeted next-generation sequencing

Insulin-like growth factor receptor (IGF-1R) deficiency is a rare form of short stature, and is difficult to clinically diagnose. Targeted next-generation sequencing (NGS) allows for the rapid and inexpensive assessment of short stature. We identified mutations in the pedigree of a Chinese boy with severe short stature using targeted NGS; we then assessed the clinical characteristicsand evaluated the efficacy of growth hormone therapy. NGS analysis revealed a novel heterozygous missense mutation in exon3 (c.926C>T, p.S309L) of the type-I IGF-1R gene in the proband, which was inherited from the mother. The proband, mother and grandfather suffered from severe growth failure. After recombinant human growth hormone therapy, the patient’s growth rate increased. The novel missensemutation in IGF-1R (c.926C > T, p.S309L) is associated with severe short stature in Chinese individuals. Targeted NGS may enable efficient diagnosis and genetic consultation of children with short stature.

Serum regucalcin is a useful indicator of liver injury severity in patients with hepatitis B virus-related liver diseases

Regucalcin is a soluble protein that is principally expressed in hepatocytes. Studies of regucalcin have mainly been conducted in animals due to a lack of commercially available kits. We aimed to develop an enzyme-linked immunosorbent assay (ELISA) to quantify serum regucalcin in patients with hepatitis B virus (HBV)-related disease. High-titer monoclonal antibodies and a polyclonal antibody to regucalcin were produced, a double-antibody sandwich ELISA method was established, and serum regucalcin was determined in 47 chronic hepatitis B (CHB) patients, 91 HBV-related acute-on-chronic liver failure (HBV-ACLF) patients, and 33 healthy controls. The ELISA demonstrated an appropriate linear range, and high levels of reproducibility, sensitivity, specificity, accuracy, and stability. The median serum regucalcin concentrations in HBV-ACLF and CHB patients were 5.46 and 3.76 ng/mL, respectively (P<0.01), which were much higher than in healthy controls (1.72 ng/mL, both P<0.01). For the differentiation of CHB patients and healthy controls, the area under curve (AUC) was 0.86 with a cut-off of 2.42 ng/mL, 85.7% sensitivity, and 78.8% specificity. In contrast, the AUC of alanine aminotransferase (ALT) was lower (AUC=0.80, P=0.01). To differentiate ACLF from CHB, the AUC was 0.72 with a cut-off of 4.26 ng/mL, 77.0% sensitivity, and 61.2% specificity while the AUC of ALT was 0.41 (P=0.07). Thus, we have developed an ELISA that is suitable for measuring serum regucalcin and have shown that serum regucalcin increased with the severity of liver injury due to HBV-related diseases, such that it appears to be more useful than ALT as a marker of liver injury.

Prevalence and environmental impact factors of somatization tendencies in eastern Chinese adolescents: a multicenter observational study / Prevalência e fatores ambientais de tendências de somatização em adolescentes do leste chinês: um estudo observacional multicêntrico / Prevalencia y factores de impacto ambientales en las tendencias somatización con adolescentes de la China oriental: un estudio observacional multicéntrico

The aim of this study is at examining the prevalence and impact factors of adolescent somatization tendencies (ST) across three eastern Chinese provinces. A multicenter school-based cross-sectional study was conducted in these provinces from 2015 to 2016. The sample included 11,153 middle-school students aged 13-18 years, who were randomly selected using a multi-phase stratified cluster sampling technique. We also designed a multicenter school-based case-control study to evaluate the potential environmental impact of ST factors on this population. The overall positive rate of ST among the eastern Chinese adolescents was 12.1%. Somatic symptoms score (SSS) and positive ST rate were higher in females than males. Additionally, the SSS and positive ST rate for the 18-year-old group were significantly higher than in other age groups. In comparison to those in urban areas, adolescents in rural areas had significantly higher SSS and positive ST rate. Multiple conditional regression analyses revealed that family medical history, anxiety and depression scores; superstitious beliefs; left-behind adolescents; teacher-student support; family conflict; and family independence and achievement orientation were significantly linked to ST in adolescents. The models also indicated family medical history was the strongest impact factor to adolescent ST, even though ST were prevalent in the three studied eastern Chinese provinces. Gender, age, and dwelling differences were very significant in the SSS and positive ST rate in adolescents. This study concludes that adolescent ST are influenced by multiple environments.

O objetivo deste estudo é examinar a prevalência e fatores de impacto de tendências de somatização (TS) em adolescentes em três províncias do leste da China. Um estudo transversal multicêntrico baseado em escolas foi realizado nessas províncias de 2015 a 2016. A amostra incluiu 11.153 estudantes entre 13 e 18 anos que foram selecionados aleatoriamente usando uma técnica de amostragem estratificada por clusters multi-fase. Também elaboramos um estudo caso-controle multicêntrico baseado em escolas para avaliar o impacto ambiental potencial de fatores de TS nessa população. A taxa positiva geral de TS entre adolescentes do leste chinês foi de 12,1%. O escore de sintomas somáticos (SSS) e taxa positiva de TS foram mais altos entre mulheres do que homens. Adicionalmente, o SSS e taxa positiva de TS para o grupo de 18 anos foram significativamente mais altos do que em outros grupos etários. Em comparação com os habitantes de áreas urbanas, adolescentes de áreas rurais tiveram SSS e taxa positiva de ST significativamente mais altos. Análises de regressão múltipla condicional revelaram que o histórico de saúde da família; scores de ansiedade e depressão; crenças supersticiosas; adolescentes deixados para trás; apoio de professores a estudantes; conflito familiar; e independência familiar e orientação para sucesso estavam significativamente relacionadas a TS em adolescentes. O modelo também indicou que o histórico de saúde da família era o fator de impacto mais forte para TS em adolescentes, ainda que TS sejam prevalentes nas três províncias do leste da China estudadas. Gênero, idade e diferenças residenciais foram muito significativos para o SSS e taxa positiva de TS entre adolescentes. Este estudo conclui que TS entre adolescentes são influenciadas por múltiplos ambientes.

El objetivo de este estudio fue examinar la prevalencia y factores de impacto de las tendencias de somatización adolescentes (TS) en tres provincias orientales chinas. Se realizó un estudio trasversal multicéntrico, basado en escolares de estas provincias de 2015 a 2016. La muestra incluyó a 11.153 estudiantes de secundaria, con edades comprendidas entre los 13-18 años, que fueron seleccionados aleatoriamente, usando a técnicas de muestreo multifase estratificado por conglomerados. También se diseñó un estudio multicéntrico escolar de caso-control para evaluar el potencial impacto ambiental de factores TS en esta población. La tasa positiva general de TS entre adolescentes chinos orientales fue un 12,1%. El marcador de síntomas somáticos (SSS, por sus siglas en inglés) y tasa positiva de TS fueron más altos en mujeres que en hombres. Asimismo, las tasas SSS y TS positiva para el grupo de 18 años de edad fueron significativamente más altas que en otros grupos de edad. En comparación con quienes vivían en áreas urbanas, los adolescentes en áreas rurales contaban con tasas significativamente más altas de SSS y TS positivas. Los análisis de regresión múltiple condicional revelaron que el historial médico familiar, los marcadores de ansiedad y depresión; creencias supersticiosas; adolescentes a la zaga respecto al resto del grupo; el apoyo profesor-estudiante; conflictos familiares; e independencia familiar, así como la orientación de logros estuvieron vinculados a las TS en adolescentes. Los modelos también indicaron que el historial médico familiar fue el impacto más fuerte para las TS en adolescentes, a pesar de que las TS fueron prevalentes en las tres provincias chinas estudiadas. El género, edad, y las diferencias de vivienda fueron muy significativas en la tasas de SSS y TS positivas en adolescentes. Este estudio llega a la conclusión de que las TS adolescentes estaban influenciadas por múltiples entornos.

Clinical study of dextromethorphan in treatment of patients with poststroke pseudobulbar affect symp-toms / 实用医学杂志

Objective To evaluate the clinical effect of dextromethorphan and its effect on daily living of patients with poststroke pseudobulbar affect. Methods Sixty patients with poststroke pseudobulbar affect admitted in our hospital from May 2013 to October 2016 were enrolled. Then they were randomly divided into the control group and the treatment group,with 30 patients in each group.Patients in the control group were treated with fluox-etine therapy and patients in the treatment group were treated with dextromethorphan therapy.The center for neuro-logic study lability scale(CNS-LS)and activity of daily living(Barthel index,BI)before and 30 days after the treat-ments in the two groups had been accessed. Results Thirty days after the treatment,CNS-LS of the treatment group had obvious improvement compared with that before treatment(P < 0.01),but CNS-LS of the control group had no obvious improvement compared with that before treatment(P > 0.05). And significant improvement has been found 30 days after the treatment between the two groups(P<0.01).Furthermore,significant difference was found on BI between these two groups(P<0.05).Conclusions Dextromethorphan is effective in treatment of pa-tients with poststroke pseudobulbar affect and it can improve the activity of daily living of these patients.

The effect of breaking blood expelling stasis combined with edaravone on brain edema around hematoma and neurological function in patients with acute hypertensive intra-cerebral hemorrhage / 中国中西医结合急救杂志

Objective To observe the clinical effects of breaking blood expelling stasis method of traditional Chinese medicine (TCM) combined with edaravone on patients with acute hypertensive intra-cerebral hemorrhage and preliminarily discuss its protection mechanism on this disease. Methods Ninety-two patients with hypertensive intra-cerebral hemorrhage within 72 hours after occurrence admitted to Zengcheng District People's Hosipital of Guangzhou from May 2013 to December 2017 were enrolled, they were divided into conventional therapy group and combined treatment of TCM and western medicine group by random numbers produced by a computer, 46 cases in each group. The conventional therapy group was treated with conventional therapy, and the combined treatment of TCM and western medicine group was treated with conventional therapy, additionally the treatment of Poxue Zhuyu decoction (the ingredients of the decoction: leech 10 g, gradfly 10 g, rhubarb 15 g, cattail pollen 5 g, trichosanthes fruit 10 g, radix notoginseng 5 g, colla plastri testudinis 10 g, grassleaf sweetflag rhizome 10 g, ground beetle 3 g, dried lacquer 3 g, peach seed 10 g) and edaravone for 10 days. The levels of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) in serum were tested by enzyme-linked immunosorbent assay (ELISA) before and 7 days after treatment in the two groups; and the differences in National Institutes of Health stroke scale score (NIHSS) before and 14 days, 90 days after treatment as well as the changes of brain edema around the hematoma 14 days after treatment were compared between the two groups, and the incidence of adverse reaction was observed. Results After treatment, the levels of TNF-α, IL-6 and intra-cerebral hemorrhage quantities in the two groups were all decreased compared with those before treatment, and the degrees of decrease of TNF-α and cerebral hemorrhage volume in combined treatment of TCM and western medicine group were more significant than those in the conventional treatment group [TNF-α (ng/L): 21.00±6.10 vs. 29.40±11.33, cerebral hemorrhage volume (mL): 5.23±0.60 vs. 8.50±0.64, both P <0.05]. The IL-6 in the two groups were recovered to approximately normal levels after the treatment (ng/L: 13.60±5.36 vs. 15.40±6.13, P > 0.05). With the prolongation of therapeutic time, the scores of NIHSS of the two groups were significantly lowered than those before treatment, and the degree of reduction in the combined TCM and western medicine group on 90 days after treatment was more obvious than that of the conventional treatment group (4.34±0.67 vs. 7.73±0.61, P < 0.05). The volumes of edema around hematomas were increased after treatment in the two groups, but the degree of increase in combined treatment of TCM and western medicine group was slower than that of the conventional group (cm3: 7.57±0.64 vs. 10.16±0.60, P < 0.05). There was no statistical significant difference in the incidence of adverse reactions in comparison between the combined treatment of TCM and western medicine group and conventional therapy group [18.2% (8/44) vs. 20.5% (9/44), P > 0.05]. Conclusions Using breaking blood expelling stasis and edaravone for treatment of acute hypertensive intra-cerebral hemorrhage can accelerate the absorption of brain hematoma and improve the neurological function, and its mechanism may be relevant to the inhibition of some inflammatory factors.

Hydrocolloid dressing in preventing nasal trauma secondary to nasal continuous positive airway pressure in preterm infants / 世界急诊医学杂志（英文）

BACKGROUND: Continuous positive airway pressure (CPAP) with nasal devices (nCPAP) is widely used in the respiratory management of newborns. The present study aimed to compare the incidence of nasal trauma secondary to nasal continuous positive airway pressure (nCPAP) protected with or without hydrocolloid dressing in preterm infants. METHODS: This prospective controlled study was performed in the neonatal intensive care unit (NICU) of the Children's Hospital of Hunan Province from March 1, 2010 to June 31, 2010. A total of 65 infants, 46 males and 19 females, were recruited in this study. Their average gestational age was 32.6 weeks (range 28–37 weeks). The infants were randomly divided into clinical trial group (group A, n=33) and control group (group B,n=32). Paraffin oil was smeared around the nostrils before inserting prongs in group B; the infants in group A were covered on the infant's nostrils surface with hydrocolloid dressing (hydrocolloid dressing, 1.8 mm thick, 90029T, 3M Company, Minnesota, USA) with a size of 2–3 cm cutting two holes adapted to the nose and nostrils. The nostrils of those infants were inspected daily during nCPAP support until they were weaned off nCPAP. RESULTS: Nine infants (2 in group A and 7 in group B) developed nasal injury during nCPAP support. The Chi-square test revealed that there was a statistically significant difference (P=0.01) in the incidence of nasal injury between groups A and B. CONCLUSION: The study demonstrated that hydrocolloid dressing significantly decreased the incidence and the severity of nasal injury.

Investigation of the characteristics of HCV genotypes of Han and Korean in Yanbian area of Jilin province / 中华实验和临床病毒学杂志

<p><b>OBJECTIVE</b>To investigate the characteristics of HCV genotypes of Han and Korean in Yanbian area of Jilin Province.</p><p><b>METHODS</b>The HCV RNA load and genotypes of the 119 chronic hepatitis C patients in Yanbian area of Jilin Province were determined by real-time PCR and LiPA. The differences of the HCV genotypes in Han and Korean cases, in severity of the diseases, in HCV-RNA load, and in the relation with type 2 diabetes mellitus were analyzed.</p><p><b>RESULTS</b>There was no significant difference in the distribution of each HCV genotype between Han and Korean patients (P > 0.05) with chronic hepatitis C. The difference between HCV genotype and HCV-RNA load was not significant (P > 0.05). With and without type 2 diabetes mellitus in these patients. The distribution of HCV genotype was also not significantly different (P > 0.05). The type 1b of HCV genotype in the moderate to severe chronic hepatitis C patients accounted for 58.06%. It was different compared with mild chronic hepatitis C patients (P < 0.05).</p><p><b>CONCLUSION</b>1) The type 1b is the most popular HCV genotype in Yanbian area of Jilin Province, type 2a is the second and there are still a few other genotypes. 2) There is no significant difference in the distribution of HCV genotypes between Han and Korean cases. 3) The HCV genotypes has nothing to do with the load of HCV-RNA. 4) The distribution of HCV genotypes in chronic hepatitis C patients with and without diabetes mellitus is not significantly different. 5) Type 1b of HCV infection is relatively severe.</p>