A population-based study exploring association of parasomnia symptoms with sleep onset delay among school-aged children.

OBJECTIVE: Parasomnia is potentially implicated in sleep pattern and sleep architecture, however, evidence is quite limited. This study aimed to investigate the association between parasomnia symptoms and sleep onset delay among children through a large epidemiological study. METHODS: Two rounds of cross-sectional studies were conducted among 21,704 children aged 3-11; one taking place in Shanghai and the other in Sanya, Hainan province. Children's sleep characteristics were evaluated using the Children's Sleep Habits Questionnaire (CSHQ). Propensity score matching was adopted to balance the difference of covariates, and the logistic regression models were implemented to examine the associations between parasomnia symptoms and sleep onset delay. RESULTS: A total of 38.2 % of children had sleep onset delay. Parasomnias, especially non rapid eye movement (NREM) and rapid eye movement (REM) parasomnia symptoms, were associated with an increased risk of sleep onset delay (Sleep Walking: OR = 1.55; Sleep Terror: OR = 1.34; Nightmare: OR = 1.37, all p˂0.001). The similar findings were observed in stratified analyses according to sleep duration, and the association was pronounced in sleep sufficiency group (Sleep Walking: OR = 1.62; Sleep Terror: OR = 1.35; Nightmare: OR = 1.35, all p˂0.001). Moreover, a dose-dependent pattern was observed, in which cumulative parasomnia symptoms were associated with increasing risk of sleep onset delay (2 symptoms: OR = 1.19; ≥3 symptoms: OR = 1.40; by comparison with ≤1 symptom). All these findings were also similarly observed in the propensity score matching sample. Moreover, the associations were generally established in both Shanghai and Sanya children. CONCLUSIONS: Parasomnia symptoms were associated with a higher risk of sleep onset delay independently of sleep duration among children. More studies are needed to enrich the current evidence, thus further clarifying the association and interaction among different sleep parameters.

Assessing causal relationships between gut microbiota and asthma: evidence from two sample Mendelian randomization analysis.

Background: Accumulating evidence has suggested that gut microbiota dysbiosis is commonly observed in asthmatics. However, it remains unclear whether dysbiosis is a cause or consequence of asthma. We aimed to examine the genetic causal relationships of gut microbiota with asthma and its three phenotypes, including adult-onset asthma, childhood-onset asthma, and moderate-severe asthma. Methods: To elucidate the causality of gut microbiota with asthma, we applied two sample Mendelian randomization (MR) based on the largest publicly available genome-wide association study (GWAS) summary statistics. Inverse variance weighting meta-analysis (IVW) was used to obtain the main estimates; and Weighted median, MR-Egger, Robust Adjusted Profile Score (MR-RAPS), Maximum likelihood method (ML), and MR pleiotropy residual sum and outlier (MR-PRESSO) methods were applied in sensitivity analyses. Finally, a reverse MR analysis was performed to evaluate the possibility of reverse causation. Results: In the absence of heterogeneity and horizontal pleiotropy, the IVW method revealed that genetically predicted Barnesiella and RuminococcaceaeUCG014 were positively correlated with the risk of asthma, while the association between genetically predicted CandidatusSoleaferrea and asthma was negative. And for the three phenotypes of asthma, genetically predicted Akkermansia reduced the risk of adult-onset asthma, Collinsella and RuminococcaceaeUCG014 increased the risk of childhood-onset asthma, and FamilyXIIIAD3011group, Eisenbergiella, and Ruminiclostridium6 were correlated with the risk of moderate-severe asthma (all P<0.05). The reverse MR analysis didn't find evidence supporting the reverse causality from asthma and its three phenotypes to the gut microbiota genus. Conclusion: This study suggested that microbial genera were causally associated with asthma as well as its three phenotypes. The findings deepened our understanding of the role of gut microbiota in the pathology of asthma, which emphasizes the potential of opening up a new vista for the prevention and diagnosis of asthma.

Association of residential greenness with chronotype among children.

BACKGROUND: The association between residential greenness and chronotype remains unclear, especially among children. The current study aimed to explore the associations between residential greenness and chronotype parameters in children and examine potential pathways for these associations. METHODS: In this cross-sectional study, 16,421 children ages 3-12 were included. Two satellite-derived vegetation indices, i.e., the normalized difference vegetation index (NDVI) and the enhanced vegetation index (EVI), were used to estimate residential greenness. The mid-sleep point on a workday (MSW) and the mid-sleep point on free days (MSF) were considered. And mid-sleep time on free days adjusted for sleep debt (MSFsc) was used as an indicator of chronotype. In addition to multivariable linear regression models, subgroup analyses were conducted to explore effect modifiers, and mediation analyses were used to explore possible mediating mechanisms of air pollutants underlying the associations. RESULTS: An interquartile range (IQR) increase in both NDVI500-m and EVI500-m was significantly associated with an earlier MSFsc of -0.061 (95 % confidence interval (CI): -0.072, -0.049) and -0.054 (95 % CI: -0.066, -0.042), respectively. Non-linear dose response relationships were discovered between greenness indices and MSFsc and MSF. The results of stratified analyses showed the effect of residential greenness on MSW was stronger among primary school children and individuals with higher household income than among kindergarten children and those with lower household income. The joint mediation effects of PM2.5, PM1, PM10, NO2, and SO2 on the associations of NDVI500-m and EVI500-m with MSFsc were 89.6 % and 76.0 %, respectively. CONCLUSIONS: Higher levels of residential greenness may have beneficial effects on an earlier chronotype in the child population, by reducing the effects of air pollutants, especially PM2.5. Our research hopes to promote the deployment of green infrastructure and healthy urban design strategies.

Independent and combined associations of multiple-heavy-metal exposure with lung function: a population-based study in US children.

Previous research has found relationships between some single metals and lung function parameters. However, the role of simultaneous multi-metal exposure is poorly understood. The crucial period throughout childhood, when people are most susceptible to environmental dangers, has also been largely ignored. The study aimed to evaluate the joint and individual associations of 12 selected urinary metals with pediatric lung function measures using multi-pollutant approaches. A total of 1227 children aged 6-17 years from the National Health and Nutrition Examination Survey database of the 2007-2012 cycles were used. The metal exposure indicators were 12 urine metals adjusted for urine creatinine, including arsenic (As), barium (Ba), cadmium (Cd), cesium (Cs), cobalt (Co), mercury (Hg), molybdenum (Mo), lead (Pb), antimony (Sb), thallium (Tl), tungsten (Tu), and uranium (Ur). The outcomes of interest were lung function indices, including the 1st second of a forceful exhalation (FEV1), forced vital capacity (FVC), forced expiratory flow between 25 and 7% of vital capacity (FEF25-75%), and peak expiratory flow (PEF). Multivariate linear regression, quantile g-computation (QG-C), and Bayesian kernel machine regression models (BKMR) were adopted. A significantly negative overall effect of metal mixtures on FEV1 (ß = - 161.70, 95% CI - 218.12, - 105.27; p < 0.001), FVC (ß = - 182.69, 95% CI - 246.33, - 119.06; p < 0.001), FEF25-75% (ß = - 178.86 (95% CI - 274.47, - 83.26; p < 0.001), and PEF (ß = - 424.17, 95% CI - 556.55, - 291.80; p < 0.001) was observed. Pb had the largest negative contribution to the negative associations, with posterior inclusion probabilities (PIPs) of 1 for FEV1, FVC, and FEF25-75%, and 0.9966 for PEF. And Pb's relationship with lung function metrics showed to be nonlinear, with an approximate "L" shape. Potential interactions between Pb and Cd in lung function decline were observed. Ba was positively associated with lung function metrics. Metal mixtures were negatively associated with pediatric lung function. Pb might be a crucial element. Our findings highlight the need for prioritizing children's environmental health to protect them from later respiratory disorders and to guide future research into the toxic mechanisms of metal-mediated lung function injury in the pediatric population.

Individual and joint association of phenols, parabens, and phthalates with childhood lung function: Exploring the mediating role of peripheral immune responses.

The functioning of the respiratory system can be interfered with by exposure to mixtures of environmental chemicals, however, the evidence is still ambiguous. We evaluated the association of exposure to mixtures of 14 chemicals, including 2 phenols, 2 parabens, and 10 phthalates, with four major lung function metrics. Based on data from the National Health and Nutrition Examination Survey 2007-2012, this analysis was conducted among 1462 children aged 6-19 years. Linear regression, Bayesian kernel machine regression, quantile-based g-computation regression, and a generalized additive model were performed to estimate the associations. Mediation analyses were performed to investigate plausible biological pathways mediated by immune cells. Our results indicated that the phenols, parabens, and phthalates mixture was negatively related to lung function parameters. And BPA and PP were identified as important contributors to negative associations with FEV1, FVC, and PEF, with non-linear relationships observed between BPA and those outcomes. The most influential factor for a probable FEF25-75 % decline was MCNP. BPA, and MCNP had an interaction effect on FEF25-75 %. The association of PP with FVC and FEV1 has been postulated to be mediated by neutrophils and monocytes. The findings offer insights into the associations of chemical mixtures with respiratory health and the possible driving mechanism, which would be of significance in adding novel evidence of the role of peripheral immune responses, as well as calling for remediation actions to be prioritized during childhood.

EFFECTS OF POST-EXTRACTION ALVEOLAR RIDGE PRESERVATION VERSUS IMMEDIATE IMPLANT PLACEMENT: A SYSTEMATIC REVIEW AND META-ANALYSIS.

OBJECTIVES: This systematic review aimed to compare the clinical data including success rates, tissue preservation, esthetic results, and patient-reported outcomes between delayed implant placement after alveolar ridge preservation (ARP) and immediate implant placement (IIP). MATERIAL AND METHODS: Both electronic and manual searches were performed for randomized controlled trials and cohort studies consisting of at least 10 cases per group and a follow-up of at least 1-year in duration. The primary outcome was the implant success rate and secondary outcomes were changes in marginal bone level (MBL), pink esthetic score (PES) and patient reported outcomes consisting of complications and satisfaction. RESULTS: A total of 12 studies were included (8 randomized controlled trials and 4 cohort studies). This review contained 456 implants placed after ARP and 459 implants placed through IIP. The results from this meta-analysis showed that the success rates of implants placed through ARP protocol (98.68%) was significantly higher than that of implants placed through IIP protocol (95.21%) (RR = 1.03; 95% CI [1.01; 1.06]; P = .008; I2 = 0%). CONCLUSION: The results from this meta-analysis and systematic review showed that implants placed through ARP protocol may demonstrate higher success rates compared to implants placed through IIP.

The associations of chronotype and social jetlag with prosocial behavior problems among Chinese adolescents.

Potential relevance between the circadian rhythm and behavioral health has got raising attention in recent years. This study aimed to examine chronotype, social jetlag and their associations with prosocial behavior problems among Chinese adolescents. A total of 4,666 middle school students aged 12-18 years were enrolled in study. Sleep characteristics were collected by the modified Chinese version of Adolescent Sleep Hygiene Scale (M-ASHS); MSFsc and mid-sleep point were calculated to determine chronotypes and social jetlag. Prosocial behavior problems were assessed by the Strength and Difficult Questionnaire (SDQ). Multivariate logistic regression was applied to analyze the relationships between chronotype and social jetlag with prosocial behavior problems. Evening chronotype was associated with higher risk of prosocial behavior problems, whether among male (OR = 1.82, 95%CI:1.27-2.61, P = .001) or female adolescents (OR = 1.83, 95%CI:1.15-2.91, P = .011). Female adolescents with social jetlag of 1-2 hours had 1.60 times the risk of prosocial behavior problems than their peers whose social jetlag was <1 h (P = .028); social jetlag ≥ 2 h was positively associated with prosocial behavior problems in both male and female adolescents (OR = 1.79 and 2.45, respectively, both P < .05). Further, the combination of intermediate chronotype and social jetlag ≥ 2 h was correlated with prosocial behavior problems only in female adolescents (OR = 3.24, 95%CI = 1.40-9.21, P = .004). Evening chronotype and higher social jetlag were risk factors for prosocial behavior problems in adolescents, especially for the female. For the promotion of prosocial behavior in adolescents, the importance of circadian rhythm should be addressed.

Hepatic AMPK signaling dynamic activation in response to REDOX balance are sentinel biomarkers of exercise and antioxidant intervention to improve blood glucose control.

Antioxidant intervention is considered to inhibit reactive oxygen species (ROS) and alleviate hyperglycemia. Paradoxically, moderate exercise can produce ROS to improve diabetes. The exact redox mechanism of these two different approaches remains largely unclear. Here, by comparing exercise and antioxidant intervention on type 2 diabetic rats, we found moderate exercise upregulated compensatory antioxidant capability and reached a higher level of redox balance in the liver. In contrast, antioxidant intervention achieved a low-level redox balance by inhibiting oxidative stress. Both of these two interventions could promote glucose catabolism and inhibit gluconeogenesis through activation of hepatic AMP-activated protein kinase (AMPK) signaling; therefore, ameliorating diabetes. During exercise, different levels of ROS generated by exercise have differential regulations on the activity and expression of hepatic AMPK. Moderate exercise-derived ROS promoted hepatic AMPK glutathionylation activation. However, excessive exercise increased oxidative damage and inhibited the activity and expression of AMPK. Overall, our results illustrate that both exercise and antioxidant intervention improve blood glucose control in diabetes by promoting redox balance, despite different levels of redox state(s). These results indicate that the AMPK signaling activation, combined with oxidative damage markers, could act as sentinel biomarkers, reflecting the threshold of redox balance that is linked to effective glucose control in diabetes. These findings provide theoretical evidence for the precise management of diabetes by antioxidants and exercise.

Molecules known as reactive oxygen species or ROS play vital roles in healthy cells. However, ROS can act as a double-edged sword: if their levels become too high, they can be harmful and interfere with many physiological processes. Indeed, diabetes, high blood pressure and many other chronic diseases are associated with imbalances in the levels of ROS in the body. To counter high ROS levels, cells have antioxidant mechanisms that reduce the excess ROS in the cell and keep the 'redox' (from reduction and oxidation) balance of the cell. Exercise and antioxidant nutritional supplements have attracted much attention as drug-free interventions for diabetes. Both strategies alter the levels of ROS in the body, with exercise increasing the levels of ROS, and antioxidant supplements reducing them. Individuals with diabetes and other metabolic health issues have different ROS levels depending on the severity of the disease, age, genetics and other factors, leading to different redox states in their cells. Thus, approaches that can accurately evaluate the redox balance status of individuals are necessary for clinicians to identify what types of exercise and antioxidant supplements are beneficial and which treatments are most appropriate for each patient. Wu, Zhao, Yan, Gao et al. examined the effects of exercise and antioxidant supplements on rats with diabetes, with the aim of identifying molecules ­ also known as biomarkers ­ that reflect the bodies' redox balance. They found that moderate exercise increased the levels of ROS in the liver, which, in turn, compensated by increasing the production of antioxidants to protect against the higher levels of ROS. This resulted in a healthy 'high-level' redox balance, in which both ROS and antioxidants levels were high in the rats. On the other hand, giving the rats antioxidant supplements decreased their levels of ROS, leading to a healthy low-level redox balance with low levels of ROS. These findings indicate that regular moderate exercise may be appropriate for people with pre-diabetes symptoms to restore a healthy redox balance. This is because the compensatory antioxidant mechanisms that kick in during exercise may be enough to counteract the excessive levels of ROS in these people. For patients with mild diabetes, exercise, antioxidant supplements, or a combination of both may be appropriate treatment, depending on their levels of ROS. Finally, patients with severe diabetes, who already have high levels of ROS, may benefit from antioxidant supplements to help reduce their excessive levels of ROS. In the future, the biomarkers identified by Wu, Zhao, Yan, Gao et al. may be used to monitor and assess the change in the redox balance status of various populations and guide personalized interventions to maintain health. Additionally, these findings provide a new strategy for precision prevention and treatment of diabetes and other metabolic diseases.

Association of Parasomnia Symptoms with Risk of Childhood Asthma and the Role of Preterm Birth.

Purpose: To examine whether parasomnia symptoms are associated with increased odds of childhood asthma and wheeze, and the role of preterm birth. Patients and Methods: The Shanghai Children's Allergy Study was cross-sectionally conducted in 31 kindergartens and 17 primary schools in Shanghai, China. After excluding the missing data of gestational week and child's age, this study included a total of 16,487 individuals with a mean age of 7.74 years and 52.4% of males. The association between parasomnia symptoms and wheeze/asthma was assessed by univariate and multivariate analyses. The interaction effects of parasomnias and preterm birth were primarily evaluated by P for multiplicative interaction, and the relative excess risk due to interaction (RERI), attributable proportion due to interaction (AP), and synergy index (SI) were also measured. Results: Parasomnias, especially rapid eye movement (REM) parasomnia symptoms, were associated with an increased risk of childhood wheeze/asthma, and the interaction between parasomnia and preterm birth exhibited an excess risk of current wheeze (RERI, 1.43; 95% CI, 0.41-2.45) and ever asthma (RERI, 0.75; 95% CI, 0.01-1.50). In the stratification analyses, the combination of parasomnia symptoms and preterm birth had higher odds of wheeze/asthma. And the odds of current wheeze (OR, 4.55; 95% CI, 1.69-12.25; p=0.003) and ever asthma (OR, 6.17; 95% CI, 2.36-16.11; p<0.001) were much higher in cumulative parasomnia symptoms plus very preterm birth. And sensitive analyses were further conducted in populations without sleep disordered breathing (SDB), and an allergen test subgroup, yielding similar results. Conclusion: Parasomnia symptoms are associated with increased odds of childhood wheeze/asthma, and the odds were even higher in premature population. The findings suggest that parasomnia symptoms, as a developmental sleep disorder, are supposed to be closely watched among children who have asthma or are at risk for asthma, and that preterm children deserve more attention.

Relationships between Sleep Duration, Timing, Consistency, and Chronotype with Myopia among School-Aged Children.

Background: The role of sleep in childhood myopia has been a research focus; however, the existing evidence is conflicting on sleep duration and timing, and as yet, no studies involve sleep consistency and chronotype. This study is done to make multiple-perspective analyses on the associations between sleep variables and myopia. Methods: A population-based cross-sectional study was conducted in Shanghai, China, which included 10,142 school-aged children (7-12 years old, 53.2% boys). The Chinese version of the Children's Sleep Habits Questionnaire (CSHQ) was used to assess sleep variables. Propensity score matching was adopted to balance the difference of covariates between nonmyopic and myopic groups. Logistic regression models were implemented to examine the associations between sleep variables and myopia. Results: Sleep duration and timing, mainly during weekdays, were correlated with myopia in a dose-dependent pattern, in which longer sleep duration was associated with decreased risk of myopia (9-10 hours/day: odds ratio (OR) = 0.87; ≥10 hours/day: OR = 0.77; by comparison with <9 hours/day); later bedtime (9 pm to 9:30 pm: OR = 1.46; 9:30 pm to 10 pm: OR = 1.51; 10 pm and after: OR = 2.08; by comparison with before 9 pm) and later wake-up time (7 am and after: OR = 1.36; by comparison with before 6:30 am) increased the risk (all P < 0.05). Moreover, longer weekend catch-up sleep duration and intermediate and evening chronotype were positively correlated with myopia, while social jetlag was associated with a lower odds of myopia. All these findings were also similarly observed in the matching sample. Conclusions: Multiple dimensions of sleep were involved in childhood myopia. In addition to sleep duration and timing, sleep consistency and chronotype were also strictly related to myopia. More studies are needed to enrich the current evidence, thus further clarifying the association between sleep and childhood myopia.

Exploring genetic association of insomnia with allergic disease and asthma: a bidirectional Mendelian randomization study.

BACKGROUND: Insomnia is highly prevalent among patients with allergic disease and asthma; however, few studies have investigated their causal relationship. We aim to explore the causal association between insomnia and allergic disease/asthma by performing bidirectional Mendelian randomization (MR) study. METHODS: Instrumental variables were constructed using single nucleotide polymorphisms (SNPs). Summary statistics for insomnia, allergic disease, and asthma were obtained from four large-scale genome-wide association studies (GWAS) of European ancestry. The pleiotropy analysis was applied by using the MR-Egger intercept test and the MR pleiotropy residual sum and outlier (MR-PRESSO) test. MR analyses were conducted by using inverse variance weighted (IVW), weighted median, and MR-Egger method. RESULTS: Based on the multiplicative random effects IVW method, the MR analysis showed that genetically predicted insomnia was causally associated with an increased risk of allergic disease [odds ratio (OR) = 1.054, 95% confidence interval (CI) = 1.031-1.078, P = 3.817 × 10-06], asthma (OR = 1.043, 95% CI = 1.010-1.077, P = 9.811 × 10-03), moderate-severe asthma (OR = 1.168, 95% CI = 1.069-1.277, P = 6.234 × 10-04), and adult-onset asthma (OR = 1.086, 95% CI = 1.037-1.138, P = 4.922 × 10-04). In bidirectional analyses, we did not find evidence supporting the reverse causality relations. CONCLUSIONS: Our MR study suggested that genetically predicted insomnia was the risk factor for allergic disease and asthma. Improving sleep quality could be one of the cornerstones in the prevention of allergic disease and asthma.

Association of delayed chronotype with allergic diseases in primary school children.

To investigate the associations of sleep midpoint for both weekdays and weekends, and chronotype, with allergic diseases, specifically asthma, allergic rhinitis, and eczema in primary school children. In this cross-sectional study, we evaluated 10409 children between 7 and 12 years of age (mean 9.21 ± 1.51 years; male 52.2%). Each allergic disease was defined as children with both diagnosed disease and current symptoms, and the reference group was described as children without any allergic symptoms. Sleep durations and mid-sleep times were calculated by reported sleep timing. Chronotype was determined by mid-sleep time on free days corrected for oversleeping. Children with allergies have shorter sleep duration and later sleep preferences. Late weekly sleep midpoints were associated with higher odds of allergies, and the odds were even higher for later weekday midpoints than their weekend counterparts. Regarding chronotype, the more evening chronotype, the higher the odds of allergic rhinitis and eczema. Additionally, effect of weekday late sleep midpoint on allergies was stronger as the participants who slept less (asthma: aOR,1.62, 95 CI%,1.25-2.10, p < .001; allergic rhinitis: aOR,2.12, 95 CI%,1.68-2.67, p < .001; eczema: aOR, 1.94, 95 CI%,1.52-2.48, p < .001). Further, the associations of chronotype with allergic rhinitis were confounded by second-hand smoking exposure. Our study, which finds an association between chronotype and the odds of three allergic diseases, hopes to improve sleep health awareness, especially in the particular population with allergic diseases, and describes the importance of evaluating modifiable behavioral factors, such as sleep habits, as a plausible factor for the prevention and treatment of allergic diseases.

[Investigation and analysis of perioperative nutritional status in patients with malignant oral and maxillofacial neoplasms complicated with diabetes mellitus].

PURPOSE: To analyze the nutritional status of patients with malignant oral and maxillofacial neoplasms complicated with diabetes mellitus during perioperative period. METHODS: Sixty-four patients with malignant oral and maxillofacial neoplasms complicated with diabetes mellitus were collected. Fasting venous blood of patients was extracted on the morning of the day before surgery and then at the 1st, 3rd and 7th day after surgery, respectively. The hemoglobin (Hb), total protein (TP), pre-albumin (PA), lymphocyte count (L), creatinine (Scr), uric acid (UA), urea nitrogen (BUN), glomerular filtration rate (EGFR_EPI_C), white blood cells (WBC) of the patients were detected. The intake of enteral nutrition on the 7th day after operation was investigated. The correlation between nutritional status and the length of stay was analyzed. SPSS 23.0 software package was used for statistical analysis. RESULTS: Compared with the indicators before surgery, the values of TP, ALB, PA, Hb were decreased significantly after surgery in all groups(P<0.05). The level of TP on postoperative day 7 was significantly higher than that on postoperative day 1 and postoperative day 3(P<0.05). The PA level on the third day after surgery was significantly lower than that on the first day after surgery(P<0.05). The Hb level on the 7th and 3rd day after surgery was significantly lower than that on the 1st day after surgery (P<0.05). The level of L decreased significantly in each group after surgery compared with the level before surgery(P<0.05), and gradually increased in each group after surgery, with significant difference among each two groups (P<0.05). Compared with preoperative value, blood Scr was significantly decreased in all groups after surgery (P<0.05), the UA level after surgery was significantly lower than the preoperative level in all groups(P<0.05), and at the 3rd day after surgery was significantly lower than at the 1st day after surgery(P<0.05). After surgery, the eGFR_EPI_c level was significantly higher than the level before surgery in all groups (P<0.05), and at the 7th day after surgery was significantly higher than at the 1st day after surgery (P<0.05). The level of WBC in all patients after surgery was significantly higher than that before surgery(P<0.05), and the level at the 3rd and 7th day after surgery was significantly higher than that at the 1st day after surgery(P<0.05). At the 7th day after surgery, the energy and protein intakes of the patients were significantly lower than the recommendations. There was positive correlation between preoperative BMI and TP, ALB levels at the 1st postoperative day and the TP level at 3rd postoperative day(P<0.05). There was no direct correlation between preoperative BMI and the length of postoperative hospital stay (P>0.05). The length of postoperative hospital stay was negatively correlated with the age and negatively with TP and ALB levels at the 1st postoperative day(P<0.05). CONCLUSIONS: Early postoperative nutritional status of patients with malignant oral and maxillofacial neoplasms complicated with diabetes mellitus decreased significantly. The energy and protein intakes of the patients are significantly lower than the recommendations. The length of postoperative hospital stay is negatively correlated with early postoperative nutritional status and age.

Melatonin inhibits embryonic rat H9c2 cells growth through induction of apoptosis and cell cycle arrest via PI3K-AKT signaling pathway.

BACKGROUND: Our recent epidemiological study revealed that maternal sleep during the periconceptional period should be involved in the risk of congenital heart disease (CHD) in offspring. Melatonin, a sleep related hormone, has been suggested to play a crucial role in embryonic development based on the emerging evidence. In this study, we set out to assess the effect of melatonin on the embryonic cardiac cell growth and to explore the underlying mechanisms. METHODS: We observed the effect of different gradient doses of melatonin as 10, 100, or 1,000 µM on cell proliferation in H9c2 embryonic rat cardiac cells. Furthermore, flow cytometry was applied to evaluate the impact on apoptosis and cell cycle. RNA-seq was conducted to screen the changes in expression of mRNA and signaling pathways. Quantitative Real-Time-PCR (qRT-PCR) was then conducted to validate the results. RESULTS: It was observed that melatonin could inhibit H9c2 cell growth, at the doses of 100 and 1,000 µM, but not at 10 µM. Moreover, melatonin ranged from 100 to 1,000 µM could instigate cell cycle arrest at G1 phase and simulate apoptosis, in a dose-dependent manner. In addition, melatonin was found to down-regulate the expression of a number of genes, which are related to heart development (SPARC, IFITM3, TNNT2, LOX), and PI3K-Akt signaling pathway activation (FN1, HSP90B1, THBS1, MFGE8, and CLU). CONCLUSIONS: Our findings suggested that high level of melatonin could be capable of inhibiting growth through the induction of apoptosis and cell cycle arrest via PI3K-AKT signaling pathway, thereby interfering with embryonic heart development. Considering this study is based on H9c2 embryonic rat cardiac cells, future additional studies using human embryonic cardiac cell are warranted.

Development of fetal growth charts in twins stratified by chorionicity and mode of conception: a retrospective cohort study in China.

BACKGROUND: Twin pregnancies continue to increase worldwide; however, the current clinical prenatal evaluation for the intrauterine growth of twins still relies on the growth standards of singletons. We attempted to establish a set of fetal biometric references for Chinese twin pregnancies, stratified by chorionicity and conception mode as spontaneously conceived monochorionic diamniotic (SC-MCDA), spontaneously conceived dichorionic diamniotic (SC-DCDA), and assisted reproductive technology dichorionic diamniotic (ART-DCDA) twins. METHODS: From 2016 to 2019, the ultrasonographic fetal biometric measurements were longitudinally collected in pregnant women, including fetal weight, biparietal diameter, head circumference, abdominal circumference, femur length, and humerus length. The linear mixed models were used to test the difference of growth patterns between groups, and the growth curve of each biometric parameter was modeled by a generalized additive model for location scale and shape. RESULTS: A total of 929 twin pregnant women and 2019 singleton pregnant women, met the inclusion criteria. Among twin pregnancies, 148 were SC-MCDA, 215 were SC-DCDA, and 566 were ART-DCDA twins. Overall, SC-DCDA twins grew faster than SC-MCDA twins, while slower than ART-DCDA twins (all P < 0.05), and all of the three groups showed significant differences comparing with singletons, especially during the third trimester. Hence, the customized fetal growth charts of each fetal biometric parameter were, respectively, constructed for SC-MCDA, SC-DCDA, and ART-DCDA twins. CONCLUSIONS: The fetal biometric trajectories demonstrated characteristic patterns according to chorionicity and conception mode. To fill the gap, we modeled fetal biometric parameters for Chinese SC-MCDA, SC-DCDA, and ART-DCDA twin pregnancies, hoping to provide a reference for the further establishment of fetal growth reference values for Chinese twin fetuses.

Prevalence of allergic diseases and associated factors among schoolaged children in Shanghai / 中国学校卫生

Objective@#To examine the prevalence of allergic diseases in schoolaged children from Shanghai and to explore related factors so as to produce epidemiological data regarding allergic diseases in children.@*Methods@#Multistage cluster sampling was used to carry out the study in Shanghai from April to June 2019. A total of 10 686 children aged 7-12 years from 17 primary schools participated in the survey. The International Study of Asthma and Allergies in Childhood (ISAAC)Scale was used to evaluate allergic diseases. Multivariate Logistic regression analysis was performed to analyze the related factors.@*Results@#The overall prevalence of allergic diseases among schoolaged children in Shanghai was 47.0%. A higher prevalence was observed among boys (50.4% vs 43.3% in girls, χ2=54.44, P<0.01). Common allergic diseases included asthma (13.9%), allergic rhinitis (18.2%), and atopic dermatitis (34.3%). The Logistic regression analysis showed that the common risk factors of asthma, allergic rhinitis and atopic dermatitis included the following:male gender (OR=1.52,1.44,1.22); mother has a bachelors degree or above (OR=1.26,1.77,1.84); family history of allergic diseases (OR=2.87,4.24,2.57); only child (OR=1.16,1.28,1.22); curtain cleaning frequency <1 time/month (OR=1.41,1.79,1.77); room not cleaned daily (OR=1.14,1.18,1.20); and dust exposure frequency ≥1 time/month (OR=1.45,1.56,1.42), all P<0.05. These three types of allergic diseases were also associated with unique risk factors that dependent on socialenvironmentalbehavioral factors.@*Conclusion@#Compared with previous data, the prevalence of allergic diseases among schoolaged children in Shanghai increased significantly in 2019. The related influencing factors involve multiple variables including demographics, environmental exposure and behavior, which warrant further exploration.

Association between breastfeeding and sleep onset delay among school aged children / 中国学校卫生

Objective@#To explore the association between exclusive breastfeeding and sleep onset delay among school aged children, and to provide a reference for promoting childhood sleep health.@*Methods@#A total of 10 686 children aged 7-12 years old were recruited from 17 primary schools in Shanghai using the multi stage sampling method from April to June 2019. The duration of sleep onset delay and exclusive breastfeeding were identified using the Children s Sleep Habits Questionnaire and a self designed questionnaire, respectively. The association between the duration of exclusive breastfeeding and the score and the risk of sleep onset delay were estimated using linear regression and a Logistic regression model, respectively.@*Results@#After adjusting for confounding factors, compared with never exclusive breastfeeding, the score of sleep onset delay decreased by 0.07, 0.08 and 0.05 in cases that involved exclusive breastfeeding for less than 3 months, 3-6 months and more than 6 months, respectively; and the odds of sleep onset delay decreased by 39.0%(OR=0.61, 95%CI=0.47-0.79), 41.1%(OR=0.59, 95%CI=0.47-0.75) and 21.1%(OR=0.79, 95%CI=0.65-0.96), respectively. Similar findings were observed in analyses stratified by gender, although the association was stronger among boys. Moreover, administration of probiotics or yogurt only improved sleep onset delay in those who were exclusively breastfed for no more than 6 months.@*Conclusion@#Longer durations of exclusive breastfeeding were associated with a lower risk of sleep onset delay among school aged children. However, exclusive breastfeeding for over 6 months diminished the protective effect that was otherwise observed on sleep onset delay.

Sleep status of children aged 3-12 years in Shanghai / 中国学校卫生

Objective@#To investigate the sleep characteristics of children aged 3-12 years old in Shanghai, and to provide a reference for improving pediatric sleep health.@*Methods@#From April to June 2019, 16 542 children aged 3-12 years old were randomly selected from 31 kindergartens and 17 primary schods in Shanghai, and a cross sectional epidemiological survey was conducted using multi stage cluster sampling. The Children s Sleep Habits Questionnaire (CSHQ) was used to evaluate sleep characteristics.@*Results@#The bedtime routine of children in Shanghai was (21:27±00:36) and (21:46±00:46) on weekdays and weekends, respectively. Corresponding wake up times were (6:52±00:28) and (7:47±00:48), total sleep duration was (9.05±1.07) and (9.52±1.17)h, and the prevalence of inadequate sleep was 81.0% and 55.4%. The average score of sleep problems was (51.56±8.04), and the prevalence of disturbed sleep was 93.5%. With advancing age, the total sleep time of children in Shanghai decreased, and the difference in weekend weekday sleep patterns increased. Furthermore, two major sleep problems were observed, namely, short sleep duration and daytime sleepiness, which became increasingly more prominent. Girls usually went to bed later on weekdays and woke up later on weekends, and a greater difference in weekend weekday sleep patterns was observed. Moreover, psychological problems such as sleep anxiety were more serious among girls.@*Conclusion@#At present, children in Shanghai have insufficient sleep time and late bedtimes. Large differences in weekend weekday sleep patterns were observed, and various sleep problems were identified. Sleep related anxiety and differences in weekend weekday sleep patterns were particularly high among girls.

How to Understand "Herd Immunity" in COVID-19 Pandemic.

The COVID-19 pandemic has been a global threat. Through rapid and effective surveillance and control, the newly confirmed patients have been fluctuated at a very low level and imported case explained most of them through March, 2020 to the present, indicating China's response has achieved a stage victory. By contrast, the epidemic of COVID-19 in other countries out of China is bursting. Different countries are adopting varied response strategy in terms of their public health system to prevent the spread. Herd immunity has been a hot topic since the outbreak of COVID-19 pandemic. Can it be a possible strategy to combat COVID-19? To fully interpret the knowledge regarding the term upon the background of COVID-19-related health crisis, we aim to systematically review the definition, describe the effective measures of acquiring herd immunity, and discuss its feasibility in COVID-19 prevention. Findings from this review would promote and strengthen the international cooperation and joint efforts when confronting with COVID-19.

Periconceptional use of cod liver oil, a vitamin D source, could decrease the risk of CHD in offspring.

OBJECTIVE: To explore if there is association between vitamin D supplementation through cod liver oil ingestion around the periconceptional period and the risk of developing severe CHD in offspring. Furthermore, we would examine the interaction between vitamin D and folic acid supplementation in the association. METHODS: A case-control study was conducted in Shanghai Children's Medical Center, in which, a total of 262 severe CHD cases versus 262 controls were recruited through June 2016 to December 2017. All children were younger than 2 years. To reduce potential selection bias and to minimise confounding effects, propensity score matching was applied. RESULTS: After propensity score matching, vitamin D supplementation seemed to be associated with decreased odds ratio of severe CHD (odds ratio = 0.666; 95% confidence intervals: 0.449-0.990) in the multivariable conditional logistic analysis. Furthermore, we found an additive interaction between vitamin D and folic acid supplementation (relative excess risk due to interaction = 0.810, 95% confidence intervals: 0.386-1.235) in the association. CONCLUSION: The results suggested that maternal vitamin D supplementation could decrease the risk of offspring severe CHD; moreover, it could strengthen the protective effect of folic acid. The significance of this study lies in providing epidemiological evidence that vitamin D supplementation around the periconceptional period could be a potential nutritional intervention strategy to meet the challenge of increasing CHD.