Accuracy and capability of tri-ponderal mass index in assessing cardio-metabolic risk factors in Chinese children and adolescents aged 3 to 17 years, compared with body mass index / 中华医学杂志(英文版)

BACKGROUND@#Tri-ponderal mass index (TMI) has been reported to be a more accurate estimate of body fat than body mass index (BMI). This study aims to compare the effectiveness of TMI and BMI in identifying hypertension, dyslipidemia, impaired fasting glucose (IFG), abdominal obesity, and clustered cardio-metabolic risk factors (CMRFs) in 3- to 17-year-old children.@*METHODS@#A total of 1587 children aged 3 to 17 years were included. Logistic regression was used to evaluate correlations between BMI and TMI. Area under the curves (AUCs) were used to compare discriminative capability among indicators. BMI was converted to BMI- z scores, and accuracy was compared by false-positive rate, false-negative rate, and total misclassification rate.@*RESULTS@#Among children aged 3 to 17 years, the mean TMI was 13.57 ± 2.50 kg/m 3 for boys and 13.3 ± 2.33 kg/m 3 for girls. Odds ratios (ORs) of TMI for hypertension, dyslipidemia, abdominal obesity, and clustered CMRFs ranged from 1.13 to 3.15, higher than BMI, whose ORs ranged from 1.08 to 2.98. AUCs showed similar ability of TMI (AUC: 0.83) and BMI (AUC: 0.85) in identifying clustered CMRFs. For abdominal obesity and hypertension, the AUC of TMI was 0.92 and 0.64, respectively, which was significantly better than that of BMI, 0.85 and 0.61. AUCs of TMI for dyslipidemia and IFG were 0.58 and 0.49. When 85th and 95th of TMI were set as thresholds, total misclassification rates of TMI for clustered CMRFs ranged from 6.5% to 16.4%, which was not significantly different from that of BMI- z scores standardized according to World Health Organization criteria.@*CONCLUSIONS@#TMI was found to have equal or even better effectiveness in comparison with BMI in identifying hypertension, abdominal obesity, and clustered CMRFs TMI was more stable than BMI in 3- to 17-year-old children, while it failed to identify dyslipidemia and IFG. It is worth considering the use of TMI for screening CMRFs in children and adolescents.

Comparison of clinical features of pneumocystis pneumonia complicated with acute respiratory failure between human immunodeficiency virus-infected patients and non-human immunodeficiency virus-infected immunocompromised patients / 中华传染病杂志

Objective:To compare the clinical characteristics and analyze the prognostic factors between human immunodeficiency virus (HIV)-infected patients and non-HIV-infected immunocompromised patients with pneumocystis pneumonia (PCP) complicated with acute respiratory failure (ARF) in intensive care unit (ICU).Methods:The clinical data of patients with PCP complicated with ARF admitted in ICU of The First Affiliated Hospital of Zhengzhou University and The Sixth People′s Hospital of Zhengzhou City between May 2018 and October 2020 were retrospectively reviewed. All subjects were divided into HIV-infected group and non-HIV-infected immunocompromised group. General characteristics and underlying diseases of patients in the two groups were analyzed. Laboratory parameters, treatment and outcomes between two groups were compared. Independent sample t test, Mann-Whitney U test and chi-square test were used for statistical analysis, and univariate and multivariate logistic regression models were used to identify the risk factors for the clinical outcome. Results:A total of 129 PCP complicated with ARF patients were enrolled, including 75 HIV-infected patients and 54 non-HIV-infected immunocompromised patients. Only 10.7%(8/75) patients of HIV-infected group received anti-retroviral therapy (ART), but none of the patients in either groups had previously received trimethoprim-sulfamethoxazole (TMP-SMX) for PCP prophylaxis. Acute physiology and chronic health evaluation (APACHE) Ⅱ score of HIV-infected group was 18.7±6.0, which was higher than that in non-HIV-infected immunocompromised group (13.1±4.4) when admitted in ICU ( t=-5.45, P<0.001). Hypoproteinemia was common in both groups. Ninety-six percent (72/75) of HIV-infected patients had CD4 + T lymphocyte counts lower than 200/μL and 84.0%(63/75) of patients had CD4 + T lymphocyte counts even lower than 50/μL, while 5.74%(31/54) of patients in non-HIV-infected immunocompromised group had CD4 + T lymphocyte counts lower than 200/μL. The CD4 + /CD8 + T lymphocyte counts ratio was 0.05(0.02, 0.12) in HIV-infected group, which was lower than that in non-HIV-infected immunocompromised group (0.96(0.64, 1.44)), and the difference was statistically significant ( Z=-9.16, P<0.001). The length of ICU stay and hospital stay of non-HIV-infected immunocompromised patients were 10.0(7.0, 14.0) days and 18.0(11.8, 32.5) days, respectively, which were both longer than those in HIV-infected patients (7.0(4.0, 9.0) days and 13.0(7.0, 23.0) days, respectively), and the differences were both statistically significant ( Z=-3.58 and -2.73, respectively, both P<0.050). The hospital mortality of HIV-infected patients was 57.3%(43/75), which was significantly higher than that in non-HIV-infected immunocompromised patients (38.9%, 21/54) ( χ2=4.27, P=0.039). Multivariable logistic regression identified that lactic dehydrogenase (LDH), C-reactive protein (CRP) and APACHE Ⅱ score were the risk factors for the clinical outcome of HIV-infected patients (odds ratio ( OR)= 1.006, 1.015 and 1.736, respectively, all P<0.050). The partial pressure of oxygen in arterial blood/fractional concentration of inspiratory oxygen (PaO 2/FiO 2), LDH and CD4 + T lymphocyte counts were the risk factors for the clinical outcome of non-HIV infected immunocompromised patients ( OR=0.970, 1.008 and 0.989, respectively, all P<0.050). Conclusions:PCP patients with ARF are critically ill with high mortality rate. LDH, CRP and APACHEⅡscore are predictors for prognosis of HIV-infected patients with PCP, while PaO 2/FiO 2, LDH and CD4 + T lymphocyte counts are predictors for prognosis of non-HIV infected immunocompromised patients with PCP.

Primary malignant melanoma of the lung: a case report and literature review / 中国医师杂志

Objective:To analyze and summarize the clinical features, diagnosis and treatment of primary malignant melanoma of the lung (PMML).Methods:To report a confirmed case. And searched the keywords " malignant melanoma, primary, lung" from the databases of CNKI, Weipu, Wanfang and PubMed, then reviewed the relevant literature.Results:A 65-year-old male admitted to the First Affiliated Hospital of Zhengzhou University with the complaint of frequent coughs with bloody sputum for 2 months. Computed tomography (CT) showed a large space-occupying lesion in the upper lobe of the right lung and to be a hyper metabolic tumor by positron emission tomography-CT. The pathological biopsy of the mass confirmed a malignant tumor cell, immunohistochemical results showed S-100(+ ), SOX-10(+ ), HMB45(+ ), MelanA(-), AE1/AE3(-), CK5/6(-), Ki-67(40%). The patient died after 3 months of diagnosis because of refusing any further therapy. There were 36 papers searched from mentioned databases reported 41 Chinese patients with PMML. And we analyzed the clinical data of 42 cases (include the present case) and discussed the diagnosis and treatment while referring to the existing literatures.Conclusions:PMML is extremely rare, and difficult to differentiate from lung cancer, A diagnosis of PMML is based on the combination of clinical, imaging characteristics and pathological outcomes. The choice of treatment is an aggressive surgical approach, combined with radiation therapy and chemotherapy. Because of high degree of malignancy, powerful capacity for invasiveness and recurrence, the overall prognosis is poor.

Clinical and genetic analysis of a Chinese pedigree affected with Smith-Lemli-Opitz syndrome / 中华医学遗传学杂志

OBJECTIVE@#To explore the clinical phenotype and pathogenic variants in a Chinese pedigree affected with Smith-Lemli-Opitz syndrome.@*METHODS@#Peripheral blood samples were collected from five members, including two affected ones, from the pedigree for the extraction of genomic DNA. Whole exome sequencing was carried out, and candidate variants were verified by Sanger sequencing as well as reverse transcription sequencing at the RNA level.@*RESULTS@#The proband and another affected child from the pedigree showed mental retardation, dyskinesia, microcephaly, micrognathia, anteverted nares, and 2/3 toe syndactyly. The proband also had hypospadia, single upper incisor, and lower serum cholesterol level. Both children were found to harbor a paternally derived c.278C>T (p.T93M) variant and a maternally derived c.907G>A (p.G303R) variant of the DHCR7 gene. Both were known pathogenic mutations.@*CONCLUSION@#The compound heterozygous mutations of c.278C>T (p.T93M) and c.907G>A (p.G303R) of the DHCR7 gene probably underlay the disease in this pedigree. Above finding has enabled early diagnosis and treatment of Smith-Lemli-Opitz syndrome.

Study on the status of low vision among students of Beijing in 2017 / 中华流行病学杂志

Objective@#The purpose of this study was to describe the status quo and related factors on low vision (LV) among students of Beijing.@*Methods@#All the students in Beijing were included as the subjects of interest, based on the reference of the Chinese National Survey on Students’ Constitution and Health.@*Results@#The overall rate of LV among students in Beijing was 58.6% in 2017, with 61.6% in females, higher than 55.9% in males. LV also appeared higher in urban than in rural areas. The rates of LV appeared as 46.8%, 78.0%, 89.0%, 71.0%, in students from primary, middle, high or vocational high schools, respectively. Rates on light, moderate or severe LV were 8.4%, 17.8% and 32.5%, respectively.@*Conclusions@#The overall rate of LV among students in Beijing was considered high. Students in preschool, in 4-6 grades and the 2nd grade of middle schools, were at the key stages of developing vision-related problems. Factors as heavy load on homework, lack of outdoor activities and 'limit of vision space’ as well as incorrect reading behavior during puberty, need to be of concern.

Association between obesity and DNA methylation among the 7-16 year-old twins / 中华流行病学杂志

Objective On whole-genome scale,we tried to explore the correlation between obesity-related traits and DNA methylation sites,based on discordant monozygotic twin pairs.Methods A total of 90 pairs of 6-17 year-old twins were recruited in Chaoyang district,Yanqing district and Fangshan district in Beijing in 2016.Information on twins was gathered through a self-designed questionnaire and results from physical examination,including height,weight and waist circumference of the subjects under study.DNA methylation detection was chosen on the Illumina Human Methylation EPIC BeadChip.R 3.3.1 language was used to read the DNA methylation signal under quality control on samples and probes.Ebayes function of empirical Bayes paired moderated t-test was used to identify the differential methylated CpG sites (DMCs).VarFit function of emp irical Bayes paired moderated Levene test was used to identify the differentially variables CpG sits (DVCs) in obese and normal groups.Results According to the obesity discordance criteria,we collected 23 pairs of twins (age range 7 to 16 years),including 12 male pairs.A total of 817 471 qualified CpG loci were included in the genome-wide correlation analysis.According to the significance level of FDR set as ＜0.05,no positive sites would meet this standard.When DMC CpG site cg05684382,with the smallest P value (1.26E-06) as on chromosome 12,the DVC CpG site cg26188191 with the smallest P value (6.44E-06) appeared in CMIP gene on chromosome 16.Conclusions In this study,we analyzed the genome-wide DNA methylation and its correlation with obesity traits.After multiple testing corrections,no positive sites were found to have associated with obesity.However,results from the correlation analysis demonstrated sites cg05684382 (chr:12) and cg26188191 (chr:16) might have played a role in the development of obesity.This study provides a methodologic reference for the studies on discordance twins related problems.

Association between obesity and DNA methylation among the 7-16 year-old twins / 中华流行病学杂志

Objective On whole-genome scale,we tried to explore the correlation between obesity-related traits and DNA methylation sites,based on discordant monozygotic twin pairs.Methods A total of 90 pairs of 6-17 year-old twins were recruited in Chaoyang district,Yanqing district and Fangshan district in Beijing in 2016.Information on twins was gathered through a self-designed questionnaire and results from physical examination,including height,weight and waist circumference of the subjects under study.DNA methylation detection was chosen on the Illumina Human Methylation EPIC BeadChip.R 3.3.1 language was used to read the DNA methylation signal under quality control on samples and probes.Ebayes function of empirical Bayes paired moderated t-test was used to identify the differential methylated CpG sites (DMCs).VarFit function of emp irical Bayes paired moderated Levene test was used to identify the differentially variables CpG sits (DVCs) in obese and normal groups.Results According to the obesity discordance criteria,we collected 23 pairs of twins (age range 7 to 16 years),including 12 male pairs.A total of 817 471 qualified CpG loci were included in the genome-wide correlation analysis.According to the significance level of FDR set as ＜0.05,no positive sites would meet this standard.When DMC CpG site cg05684382,with the smallest P value (1.26E-06) as on chromosome 12,the DVC CpG site cg26188191 with the smallest P value (6.44E-06) appeared in CMIP gene on chromosome 16.Conclusions In this study,we analyzed the genome-wide DNA methylation and its correlation with obesity traits.After multiple testing corrections,no positive sites were found to have associated with obesity.However,results from the correlation analysis demonstrated sites cg05684382 (chr:12) and cg26188191 (chr:16) might have played a role in the development of obesity.This study provides a methodologic reference for the studies on discordance twins related problems.

Relationship between unintentional injury and health risk behaviors among adolescents / 中华行为医学与脑科学杂志

Objective To identify the effect of health risk behaviors on accidental injury of adoles-cents.Then analyze the strength and approach of the health risk behaviors. Methods Cluster sampling on various stages and strata methods was adopted. The adolescents from grade one to three in junior school students and grade one to three in senior high school students completed the questionaire. A total of 4408 students were surveyed and 4309 samples were valid. Path analysis was used to understand how factors could influence injury incidence. Results The incidence of adolescent injury was 15.53%. Statistical differences were found between genders (male 17.77%,female 13.36%,χ2=15.91, P<0.01),education levels (junior high school 17.36%,senior high school 13.99%,χ2=11.45, P<0.01) and cities ( Beijing 12.97%,Zhongs-han 17.95%,χ2=20.33, P<0.01) . Those who got injured were found with more health risk behaviors. Health risk behavior was the direct influencing factor to injury,as well as a possible risk factor to multiple injuries. Conclusion Health risk behaviors can strongly affect adolescent injury,and can be an indicator. Reducing health risk behaviors is important in adolescent injury prevention.

The association between uric acid levels and cardiovascular metabolic disorders and non - alcohol fatty liver disease among obese children / 中华实用儿科临床杂志

Objective To observe the prevalence of hyperuricemia(HUA)among obese children,and to ex-plore the association between uric acid(UA)levels and cardiometabolic risk factors,acanthosis nigricans and non - al-cohol fatty liver disease(NAFLD). Methods By using representative sampling method,1 753 obese children aged 6 -17 years old from 18 schools in 3 districts of Beijing(Xicheng,Haidian,Miyun)were selected to participate in the clini-cal examinations,including anthropometric measurements(height,weight)and blood pressure. Serum biochemical pa-rameters were assessed,including fasting plasma glucose(FPG),total cholesterol(TC),triglyceride(TG),high - densi-ty lipoprotein cholesterol(HDL - C),low - density lipoprotein cholesterol(LDL - C)and UA. Acanthosis nigricans and B - model ultrasonography of the liver were conducted. Results The prevalence of hypertension,impaired fasting glu-cose,dyslipidemia,acanthosis nigricans,and NAFLD among these 1 753 obese children was 33. 6%(589 cases), 66. 5%(1 156 cases),54. 3%(943 cases),23. 3%(408 cases),and 17. 0%(298 cases),respectively. The preva-lence of HUA was 40. 70%(714 / 1 753 cases),with 50. 17%(581 / 1 158 cases)in boys and 22. 34%(133 / 595 ca-ses)in girls. There was a significant increase in body mass index,systolic blood pressure,diastolic blood pressure, FPG,TG and LDL - C with the increase of UA,but there was a decrease in HLD - C with the increase of UA(all P ﹤0. 05). In boys,the adjusted odds ratios( OR)and 95% CI of the highest quartile of UA for hypertension,impaired fasting glucose,dyslipidemia,acanthosis nigricans,and NAFLD were 1. 16(0. 77 - 1. 74),1. 34(0. 90 - 1. 99),1. 29 (0. 89 - 1. 87),1. 89(1. 17 - 3. 04),and 1. 71(1. 03 - 2. 84),respectively;in girls,the adjusted OR and 95% CI of the highest quartile of UA for hypertension,impaired fas-ting glucose,dyslipidemia,acanthosis nigricans,and NAFLD was 0. 70(0. 40 - 1. 24),0. 60(0. 40 - 1. 00),1. 69(1. 04 - 2. 70),1. 67(0. 80 - 3. 49),and 1. 33(0. 48 - 3. 66),re-spectively. Conclusions The prevalence of HUA is relatively high in obese children and there is a strong association between UA and some car-diovascular metabolic disorders,acanthosis nigricans and NAFLD.

Prevalence of deliberate self-harm and its relation with suicidal behaviors among students in middle schools in Beijing / 中华流行病学杂志

Objective To understand the prevalence of deliberate self-harm in middle school students in Beijing,and explore the relationship between self-harm and suicidal behaviors.Methods An anonymous self-administered questionnaire survey was conducted among 5 807 students selected through cluster random sampling from grade 9 to grade 12 in 16 middle schools in Beijing.Results Among the surveyed middle school students,35.6％ reported that they once had self-harm behaviors,7.0％ reported often had self-harm behaviors in the past 30 days before the survey.More girls reported self-harm behaviors than boys did.And the prevalence of self-harm behaviors was highest in girls in grade 8 and in boys in grade 9.The students in key senior high schools,or living with single or remarried parents were the risk population to have self-harm behaviors.Higher suicide behavior reporting rate was correlated with higher self-harm behavior reporting rate.Compared with students who reported no self-harm behaviors during the past month,the suicide behavior reporting rate in students reporting self-harm behaviors increased by 5.7-12.3 times.Conclusion Deliberate self-harm behaviors were associated with suicide behaviors among middle school students in Beijing.Early psychological intervention and life education should be carried out among middle school students in order to find risk population and save their life.

Trends on the prevalence rates of obesity and cardiometabolic among children and adolescents in Beijing, during 2004-2013 / 中华流行病学杂志

<p><b>OBJECTIVE</b>To analyze the trends on the prevalence rates of obesity and cardiometabolic among children and adolescents in Beijing, during 2004-2013.</p><p><b>METHODS</b>Data was collected from three cross-sectional studies among children and adolescents, aged 7-17 years old in Beijing. Two studies in 2004 and 2013 were conducted in general population, and one was among obese children in 2007. Data on anthropometric measurements including weight, height, and age was collected from all the subjects. The obese children from all three studies underwent a clinic examination that containing blood pressure, fasting plasma glucose, lipid profile (TC, TG, LDL-C, HDL-C), and acanthosis nigricans. Liver transaminases detection (ALT and AST) and liver ultrasound examination were performed in obese children from surveys in 2007 and 2013.</p><p><b>RESULTS</b>The prevalence of severe obesity increased from 1.86% in 2004 to 4.17% in 2013, with an annual increase rate as 0.26%. The proportion of severe obesity in obesity increased from 18.92% in 2004 to 25.15% in 2013. After adjusting for age and gender, the prevalence of IFG, hypertriglyceridemia and low HDL-C in both obese children and adolescents increased during 2004-2013 (all P < 0.05). The prevalence rates of hypertension, dyslipidemia, hypertriglyceridemia, and acanthosis nigricans in severe obese children were higher than those in moderate obesity. The proportion of children with 2 or more cardiometabolic risk factors in severe obese children was higher than in moderate obese children.</p><p><b>CONCLUSION</b>The prevalence rates of obesity and cardiometabolic risk factors among children and adolescents in Beijing showed an increase during 2004-2013.</p>

Early prenatal diagnosis for a family affected with X-linked spondyloepiphyseal dysplasia tarda family / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>X-linked spondyloepiphyseal dysplasia tarda (SEDL) is a rare osteochondrodysplasia caused by mutations of SEDL gene, which usually onset in late childhood without systemic complications. In this study, we have provided prenatal diagnosis for an affected family with a combined strategy including direct sequencing, fetal-sex identification and microsatellite linkage analysis.</p><p><b>METHODS</b>Two amniotic fluid samples from carrier gravida and 7 blood samples from individuals in this SEDL pedigree were obtained. Genomic DNA was extracted from the samples using standard phenol-chloroform method. SRY and AMEL genes were employed to assess fetal sex. Microsatellite DXS16 was genotyped for linkage analysis. A pathogenic mutation of the SEDL gene was identified by bi-directionally direct sequencing of the third exon as well as its exon/intron boundaries.</p><p><b>RESULTS</b>Two male fetuses were confirmed by fetal-sex assessment. The mutation of the SEDL gene was identified as a nucleotide substitution of the splice acceptor site in intron 2, IVS2-2A>C. DNA sequencing indicated that one fetus is hemizygote carrying the mutation, whilst another is not a carrier. Linkage analysis was identical with the sequencing results. Follow-up also confirmed the result of prenatal diagnosis.</p><p><b>CONCLUSION</b>Fetal-sex assessment combined with microsatellite linkage analysis and bi-directionally direct sequencing is a more accurate and ready strategy for prenatal diagnosis of families affected with SEDL.</p>

Dietary habits of school-age children and its associations with blood pressure level in Beijing, China / 中华预防医学杂志

<p><b>OBJECTIVE</b>To study the dietary habits of school-age children in urban and rural districts and their association with blood pressure levels in Beijing, China.</p><p><b>METHODS</b>A stratified, randomly clustered sampling design was used, 29 primary and secondary schools from four urban districts and three rural districts in Beijing were randomly selected in 2004. 20 638 children aged 6-18 years old were surveyed, and 19 072 of them provided completed usable data. The weight, height and blood pressure of the subjects were measured according to standard method.10 food-groups' information was collected by a semi-quantitative food frequency questionnaire. The relationship between different dietary habits and the blood pressure levels in school children was analyzed by multiple linear regression model.</p><p><b>RESULTS</b>The prevalence of obesity among children in urban area (12.2%, 1 218/9 984) was higher than that in rural area (6.7%, 609/9 088) (χ(2) = 4.62, P < 0.05) , whereas the prevalence of hypertension among children in urban area (8.0%, 799/9 984) was lower than that in rural area (8.9%, 809/9 088) (χ(2) = 167.32, P < 0.05) . The diastolic blood pressure (DBP) among children was (65.7 ± 8.6) mmHg (1 mmHg = 0.133 kPa) in urban area and (67.0 ± 8.7) mmHg in rural area, respectively (F = 86.44, P < 0.05) , and the systolic blood pressure (SBP) among children was (103.4 ± 12.2) mmHg in urban area and (104.3 ± 11.6) mmHg in rural area, respectively (F = 11.33, P < 0.05) . Factor analysis revealed 4 dietary habits labeled prudent habit, protein habit, high-fat and high-calorie habit and vegetables and fruits habit. The 4 dietary habits' variance contribution rate respectively was 24.7%, 14.6%, 14.0%, 8.9%, and the 4 dietary habits totally reflect 62.2% characteristics of the 10 food-groups.In urban area, prudent habit was inversely associated with DBP (β' = -0.026, P < 0.05) , Protein habit was inversely associated with both children's SBP (β' = -0.018, P < 0.05) and DBP (β' = -0.030, P < 0.05) .In rural area, prudent habit was associated with children's SBP (β' = -0.050, P < 0.05) and DBP (β' = -0.039, P < 0.05) .</p><p><b>CONCLUSIONS</b>The dietary habits of school age children varied by sociodemographic characters in Beijing. The prudent habit and protein habit may decrease the children's blood pressure levels.</p>