Early markers of neurodevelopmental disorders based on general movements for very preterm infants: study protocol for a multicentre prospective cohort study in a clinical setting in China.

INTRODUCTION: Very preterm (VPT) infants may experience varying degrees of neurodevelopmental challenges. Lack of early markers for neurodevelopmental disorders may delay referral to early interventions. The detailed General Movements Assessment (GMA) could help us to identify early markers for VPT infants at risk of atypical neurodevelopmental clinical phenotype in the very early stage of life as soon as possible. Preterm infants with high risk of atypical neurodevelopmental outcomes will have the best possible start to life if early precise intervention in critical developmental windows is allowed. METHODS AND ANALYSIS: This is a nationwide, multicentric prospective cohort study that will recruit 577 infants born <32 weeks of age. This study will determine the diagnostic value of the developmental trajectory of general movements (GMs) at writhing and fidgety age with qualitative assessment for different atypical developmental outcomes at 2 years evaluated by the Griffiths Development Scales-Chinese. The difference in the General Movement Optimality Score (GMOS) will be used to distinguish normal (N), poor repertoire (PR) and cramped sychronised (CS) GMs. We plan to build the percentile rank of GMOS (median, 10th, 25th, 75th and 90th percentile rank) in N, PR and CS of each global GM category and analyse the relationship between GMOS in writhing movements and Motor Optimality Score (MOS) in fidgety movements based on the detailed GMA. We explore the subcategories of the GMOS list, and MOS list that may identify specific early markers that help us to identify and predict different clinical phenotypes and functional outcomes in VPT infants. ETHICS AND DISSEMINATION: The central ethical approval has been confirmed from the Research Ethical Board of Children's Hospital of Fudan University (ref approval no. 2022(029)) and the local ethical approval has been also obtained by the corresponding ethics committees of the recruitment sites. Critical analysis of the study results will contribute to providing a basis for hierarchical management and precise intervention for preterm infants in very early life. TRIAL REGISTRATION NUMBER: ChiCTR2200064521.

Correlation between compliance in patients with anti-hypertensive therapy and blood pressure control.

This paper aims to understand the blood pressure control status for hypertension patients, and discuss the relationship between social support, medication compliance and blood pressure for hypertensive patients. The survey objective was the hypertensive patients in chronic disease management system in Xinxiang city. The survey was conducted as the questionnaire survey filled by objectives. Social support rating scale and medication therapy compliance questionnaire was utilized to evaluate the patients' social support and medication therapy compliance. 1095 patients in medication were investigated, the blood pressure of 66.6% investigated objectives was controlled at target levels (<140/90 mmHg), 70.0% investigated objectives have good medication therapy compliance; the overall social support score for hypertensive patients in medication was (40.01±6.54) points, the subjective support score, objective support score and support utilization degree score were respectively (24.43±4.61) points, (8.59±2.59) points and (7.00±2.06) points; Rank correlation coefficient of Spearman illustrated that the support utilization rating evaluation was apparently correlated to medication therapy compliance (rs=0.88, P<0.01); multivariate analysis proved that the protective factors for medication therapy compliance were the high support utilization rate (OR 1.62; 95%CI 1.19~2.05), long hypertensive duration (5~10 years: OR 2.01, 95%CI 1.42~2.73; more than 10 years: OR 1.46, 95%CI 1.01~1.99) and high average monthly household income (OR 2.03, 95%CI 1.45~2.69); Risk factor for blood pressure control were male (OR 0.61, 95% CI 0.47~0.79) and high hypertensive grade (OR 0.31, 95%CI 0.19~0.44); The protective factors for blood pressure control was good medication therapy compliance (OR 1.54, 95%CI 1.22~1.89), (average P<0.05). It required to build effective social support system, increase patients' social support utilization degree, emphasized the intervention on low average monthly household incomes, male higher rate, higher hypertensive degree, and further improve the medication therapy compliance and hypertensive control rate of hypertensive patients.

Associations of CYP4A11 gene-gene and gene-smoking interactions with essential hypertension in the male eastern Chinese Han population.

OBJECTIVES: The aim of this study was to investigate the impact of CYP4A11 single-nucleotide polymorphisms (SNP), additional gene-gene and gene-environment interactions on essential hypertension (EH) risk. METHODS: A total of 1648 participants (788 males, 860 females), with a mean age of 56.1 ± 14.1 years old, were selected, including 820 EH patients and 828 normotension subjects. Logistic regression was performed to investigate association of SNPs within CYP4A11 gene with high DBP, high SBP and EH risk, and generalized multifactor dimensionality reduction (GMDR) was used to analyze the gene-gene interaction and gene-smoking interaction. RESULTS: Logistic regression analysis showed that EH risk was significantly higher in carriers of C allele of the rs1126742 polymorphism than those with TT genotype (TC+CC versus TT, adjusted OR (95%CI) = 1.56 (1.24-1.91). In addition, we also found that EH risk was also significantly higher in carriers of G allele of the rs3890011polymorphism than those with CC genotype (CG+ GG versus CC, adjusted OR (95%CI) = 1.31 (1.15-2.03). GMDR analysis indicated a potential gene-gene interaction between rs1126742 and rs3890011 and a gene-environment interaction between rs1126742 and smoking. We found that subjects with TC or CC of rs1126742 and CG or GG of rs3890011genotype have the highest EH risk, OR (95%CI) was 2.52 (1.28-3.57). Smokers with TC or CC of rs1126742 genotype have the highest EH risk, OR (95%CI) was 2.20 (1.28-3.40). CONCLUSIONS: Gene-gene interaction between rs1126742 and rs3890011 and gene-environment interaction between rs1126742 and smoking were associated with increased EH risk.