Which intervention is optimal to control blood glucose and improve physical performance in the elderly living with type 2 diabetes mellitus? A network meta-analysis.

BACKGROUND AND OBJECTIVES: This study aimed to find the optimal intervention available to both control blood glucose and improve physical function in the geriatric population with T2DM. METHODS AND STUDY DESIGN: A systemic review and network meta-analysis (NMA) was conducted to assess and rank the comparative efficacy of different interventions on glycosylated hemoglobin A1c (HbAc1), fasting blood glucose (FBG), muscle mass, grip strength, gait speed, lower body muscle strength, and dynamic balance. A total of eight databases were searched for eligible randomized controlled trials (RCTs) that the elderly aged more than 60 years or with mean age ≥ 55 years, the minimal duration of the RCT intervention was 6 weeks, and those lacking data about glycemic level and at least one indicator of physical performance were excluded. The Cochrane risk of bias tool was used to assess the bias of each study included. Bayesian NMA was performed as the main results, the Bayesian meta regression and the frequentist NMA as sensitivity analysis. RESULTS: Of the 2266 literature retrieved, 27 RCTs with a total of 2289 older adults were included. Health management provided by health workers exerts beneficial effects that is superior to other interventions at achieving glycemic control, but less marked improvement in physical performance. Exercise combined with cognitive training showed more pronounced improvement in muscle strength, gait speed, and dynamic balance, but ranked behind in decreasing the HbAc1 and FBG. CONCLUSIONS: Personalized health management combined with physical and cognitive training might be the optimal intervention to both accomplish glycemic control and improvement of physical performance. Further RCTs are needed to validate and assess the confidence of our results from this NMA.

Efficacy of Huaiqihuang granules as adjuvant therapy for bronchial asthma in children: a real-world study. / æ§æžé»„é¢—ç²’è¾ åŠ©æ²»ç–—å„¿ç«¥æ”¯æ°”ç®¡å“®å–˜ç–—æ•ˆçš„çœŸå®žä¸–ç•Œç ”ç©¶.

OBJECTIVES: To study the efficacy of Huaiqihuang granules as adjuvant therapy for bronchial asthma in children. METHODS: A multicenter, prospective, and registered real-world study was performed for the children, aged 2-5 years, who had a confirmed diagnosis of bronchial asthma in the outpatient service of 21 hospitals in China. Among these children, the children treated with medications for long-term asthma control (inhaled corticosteroid and/or leukotriene receptor antagonist) without Huaiqihuang granules were enrolled as the control treatment group, and those treated with medications for long-term asthma control combined with Huaiqihuang granules were enrolled as the combined treatment group. The medical data of all children were collected. Outpatient or telephone follow-up was performed at weeks 4, 8, 12, 20, 28, and 36 after treatment, including asthma attacks and rhinitis symptoms. A statistical analysis was performed for the changes in these indices. RESULTS: There was no significant difference in the frequency of asthma attacks or rhinitis attacks between the two groups before treatment (P>0.05). After treatment, the combined treatment group had significantly lower frequencies of asthma attacks, severe asthma attacks, and rhinitis attacks compared with the control treatment group (P<0.05). There was no signification difference in the incidence rate of adverse reactions between the two groups (P=0.667). CONCLUSIONS: Huaiqihuang granules in addition to medications for long-term asthma control can alleviate the symptoms of bronchial asthma and rhinitis and improve the level of asthma control in children with bronchial asthma, with good safety and little adverse effect. Citation.

Should recommendations about starting inhaled corticosteroid treatment for mild asthma be based on symptom frequency: a post-hoc efficacy analysis of the START study.

BACKGROUND: Low-dose inhaled corticosteroids (ICS) are highly effective for reducing asthma exacerbations and mortality. Conventionally, ICS treatment is recommended for patients with symptoms on more than 2 days per week, but this criterion has scant evidence. We aimed to assess the validity of the previous symptom-based cutoff for starting ICS by establishing whether there was a differential response to budesonide versus placebo for severe asthma exacerbations, lung function, and asthma symptom control across subgroups identified by baseline asthma symptom frequency. METHODS: We did a post-hoc analysis of the 3 year inhaled Steroid Treatment As Regular Therapy (START) study, done in 32 countries, with clinic visits every 3 months. Patients (aged 4-66 years) with mild asthma diagnosed within the previous 2 years and no previous regular corticosteroids were randomised to receive once daily, inhaled budesonide 400 µg (those aged <11 years 200 µg) or placebo. Coprimary outcomes for this analysis were time to first severe asthma-related event (SARE; hospital admission, emergency treatment, or death) and change from baseline in lung function after bronchodilator. Interaction with baseline symptom frequency was investigated, with patients grouped by more than two symptom days per week and two or fewer symptom days per week (divided into no days to 1 day, and more than 1 day to 2 days). Analysis was done by intention to treat. FINDINGS: Of 7138 patients (n=3577 budesonide; n=3561 placebo), baseline symptom frequency was 0-1 days per week for 2184 (31%) participants, more than 1 and less than or equal to 2 symptom days per week for 1914 (27%) participants, and more than 2 symptom days per week for 3040 (43%) participants. For budesonide versus placebo, time to first SARE was longer across symptom frequency subgroups (hazard ratios 0·54 [95% CI 0·34-0·86] for 0-1 symptom days per week, 0·60 [0·39-0·93] for >1 to ≤2 symptom days per week, 0·57 [0·41-0·79] >2 symptom days per week, pinteraction=0·94), and the decline in postbronchodilator lung function was less at 3 years' follow-up (pinteraction=0·32). For budesonide versus placebo, severe exacerbations requiring oral or systemic corticosteroids were reduced (rate ratio 0·48 [0·38-0·61] 0-1 symptom days per week, 0·56 [0·44-0·71] >1 to ≤2 symptom days per week, and 0·66 [0·55-0·80] >2 symptom days per week, pinteraction=0·11), prebronchodilator lung function was higher, and symptom-free days were more frequent (p<0·0001 for all three subgroups), with no interaction by symptom frequency (prebronchodilator pinteraction=0·43; symptom-free days pinteraction=0·53). Similar results were noted when participants were classified by any guidelines criterion as so-called persistent versus so-called intermittent asthma. INTERPRETATION: In mild recent-onset asthma, once daily, low-dose budesonide decreases SARE risk, reduces lung function decline, and improves symptom control similarly across all symptom subgroups. The results do not support restriction of inhaled corticosteroids to patients with symptoms on more than 2 days per week and suggest that treatment recommendations for mild asthma should consider both risk reduction and symptoms. FUNDING: AstraZeneca.

Pediatric allergy and immunology in China.

Over the past 30 years, China has enjoyed rapid economic development along with urbanization at a massive scale that the world has not experienced before. Such development has also been associated with a rapid rise in the prevalence of allergic disorders. Because of the large childhood population in the country, the burden of childhood allergic disorders has become one of the major challenges in the healthcare system. Among the Chinese centers participating in the International Study of Asthma and Allergies in Childhood, the data clearly showed a continuing rise in the prevalence of asthma, allergic rhinitis, and atopic eczema. However, the discipline of pediatric allergy in mainland China is still in its infancy due to the lack of formal training program and subspecialty certification. Clinicians and researchers are increasingly interested in providing better care for patients with allergies by establishing pediatric allergy centers in different regions of the country. Many of them have also participated in national or international collaborative projects hoping to answer the various research questions related to the discipline of pediatric allergy and immunology. It is our hope that the research findings from China will not only improve the quality of care of affected children within this country but also the millions of patients with allergies worldwide.

Formoterol as reliever medication in asthma: a post-hoc analysis of the subgroup of the RELIEF study in East Asia.

BACKGROUND: As-needed formoterol can effectively relieve asthma symptoms. Since budesonide/formoterol is available as maintenance and reliever therapy in Asia, formoterol is now being used as-needed, but always with concomitant inhaled corticosteroids. The objective of this analysis was to assess the safety and efficacy of formoterol therapy in patients in East Asia (China, Indonesia, Korea, the Philippines and Singapore) with asthma. METHODS: Post-hoc analyses of data from the East Asian population of the RELIEF (REal LIfe EFfectiveness of Oxis® Turbuhaler® as-needed in asthmatic patients; study identification code: SD-037-0699) study were performed. RESULTS: This sub-group comprised 2834 randomised patients (formoterol n = 1418; salbutamol n = 1416) with mean age 35 years; 50.7% were male. 2678 patients completed the study. There was no significant difference in the total number of adverse events (AEs) reported in the formoterol and salbutamol groups (21.3% vs 20.9% of patients; p = 0.813), nor in the total number of serious AEs and/or discontinuations due to AEs (4.6% vs 5.5%, respectively; p = 0.323). Compared with salbutamol, formoterol was associated with a significantly longer time to first exacerbation (hazard ratio 0.86; p = 0.023) and a 14% reduction in the risk of any exacerbation (p < 0.05). Relative to salbutamol, mean adjusted reliever medication use throughout the study was significantly lower in the formoterol group (p = 0.017) and the risk of increased asthma medication use was 20% lower with formoterol (p = 0.005). CONCLUSIONS: Among patients with asthma in East Asia, as-needed formoterol and salbutamol had similar safety profiles but, compared with salbutamol, formoterol reduced the risk of exacerbations, increased the time to first exacerbation and reduced the need for reliever medication.

[Epidemiological survey of children asthma prevalence in Beijing urban area].

OBJECTIVE: To explore the prevalence, diagnosis and management of childhood asthma in Beijing urban area. METHODS: Multi-stage, stratified and random cluster sampling was used to recruit children born during November 1, 1995 to October 31, 2010 from Beijing or other provinces but residing in Beijing for over half a year. The same screening questionnaires for the third national epidemiological survey of children's asthma were distributed to parents of children at schools, kindergartens and communities during October 2010 to March 2011. Asthmatic children were picked among the screening-positive children based on on-the-spot inquiries, physical examinations, medical records and supporting test results. Further survey of asthmatics was carried out to investigate the diagnosis and treatment status of childhood asthma and other associated allergic diseases. All data required double entry by Epi-Info 3.5.3 software and were processed by SPSS 19.0. RESULTS: Among a total of 14 085 questionnaires, 13 513 were completed with a response rate of 95.94%. And 497 (3.68%) children were diagnosed with typical (n = 451, 3.34%) and cough variant (n = 46, 0.34%) asthma. Among them, 40.64% (202/497) were newly diagnosed and 59.36% (295/497) had been previously diagnosed with asthma. The prevalence of asthma was higher in boys than in girls (4.80% (345/1790) vs 2.40% (152/6323), χ(2) = 54.446, P < 0.01). The asthma prevalence of preschoolers (3 - < 7 years old) was the highest (5.05% (180/3563)). In the past two years, the symptoms of 69.42% (345/497) children persisted and the current two-year prevalence of asthma was 2.55% (345/13513). Among the 295 children with previous asthma, only 46.44% (137/295) received inhaled corticosteroids according to the Global Initiative for Asthma (GINA) and 82.37% (243/295) of them used antibiotics. CONCLUSIONS: The prevalence of asthma is 3.68% in children under 14 years old in Beijing urban area and it varies in children with different genders and ages. A considerable number of children are not diagnosed or treated properly. And the management of asthma requires further improvement.

Gut microbiota and risk of polycystic ovary syndrome: Insights from Mendelian randomization.

Background: Polycystic ovary syndrome (PCOS) is a multifaceted endocrine and metabolic syndrome with complex origins and pathogenesis that has not yet been fully elucidated. Recently, the interconnection between gut microbiota and metabolic diseases has gained prominence in research, generating new insights into the correlation between PCOS and gut microbiota composition. However, the causal link between PCOS and gut microbiota remains relatively unexplored, indicating a crucial gap in current research. Methods: We conducted a two-sample Mendelian randomization analysis using summary statistics obtained from the MiBioGen Consortium's extensive genome-wide association studies (GWAS) meta-analysis, focusing on the gut microbiota. Summary statistics for PCOS were acquired from the FinnGen Consortium R7 release data. Various statistical approaches, including inverse variance weighted, MR-Egger, maximum likelihood, weighted model, and weighted median, have been employed to investigate the causal association between the gut microbiota and PCOS. Additionally, we performed a reverse causal analysis. Cochran's Q statistic was used to assess the heterogeneity of the instrumental variables. Regarding the relationships between PCOS and specific genera within the gut microbiota, a significance level of P < 0.05 was observed, but only when q ≥ 0.1. Results: Our analysis revealed that specific microbial genera, namely Bilophila (P = 4.62 × 10-3), Blautia (P = 0.02), and Holdemania (P = 0.04), displayed a protective effect against PCOS. Conversely, the presence of the Lachnospiraceae family of bacteria was associated with a detrimental effect on PCOS (P = 0.04). Furthermore, reverse Mendelian randomization analysis confirmed the significant influence of Lachnospiraceae on PCOS. No significant variations in instrumental variables or evidence of horizontal pleiotropy were observed. Conclusions: The results revealed a definitive causal link between PCOS and the presence of Bilophila, Blautia, Holdemania, and Lachnospiraceae in the gut microbiota. This discovery could provide pivotal insights, leading to novel preventive and therapeutic approaches for PCOS.

Family-centered care management strategies for term and near-term neonates with brief hospitalization in a level III NICU in Shenzhen, China during the time of COVID-19 pandemic.

BACKGROUND: Adopting the family-centered care (FCC) approach in the neonatal care has been shown to improve breastfeeding rate and parental satisfaction. To minimize the transmission of COVID-19, family visit in neonatal intensive care unit (NICU) was suspended in China. In order to maintain the benefits of FCC, the Hong Kong University-Shenzhen Hospital NICU modified FCC strategies. We evaluated the effects of new strategies and aimed to share our results and experience with other NICUs during the COVID-19 pandemic. METHODS: Using prospectively collected hospital databases, we retrospectively compared the demographic and clinical data of neonates, rates of breastfeeding at discharge, nosocomial infection and parental satisfaction one month before (open group) and after (closed group) the implementation of alternative FCC management strategies when family visit was suspended during COVID-19 pandemic. RESULTS: During the COVID-19 pandemic, we organized a multidisciplinary task force and adopted strategies of triage and screening, management of suspected infants, and breastfeeding promotion with effective communication. The nosocomial infection rate and parental satisfaction for open and closed groups (144 and 108 term and near-term neonates with brief hospitalization, respectively) were not different (1% vs. 0%, p = 1.00; 98.6 vs. 98.8, p = .80; respectively). Breastfeeding rate at discharge decreased but the difference was not significant (74% vs. 80%, p = .29). CONCLUSIONS: In our experience, in term and near-term neonates with brief hospitalization, the alternative FCC strategies maintained high parental satisfaction without increased nosocomial infection rate, but strong support for breastfeeding was needed. Through multidisciplinary collaboration, the continuation of "modified" FCC in a level III NICU is feasible in the context of COVID-19 pandemic with reduced family visitation and participation in the care.

The Inhaled Steroid Treatment As Regular Therapy in Early Asthma (START) study 5-year follow-up: effectiveness of early intervention with budesonide in mild persistent asthma.

BACKGROUND: The Inhaled Steroid Treatment as Regular Therapy in Early Asthma (START) study enrolled 7241 patients aged 5 to 66 years with recent-onset, mild persistent asthma to assess early intervention with the inhaled corticosteroid budesonide on long-term asthma control. OBJECTIVE: The open-label phase of the START study was included to determine the effect on lung function and asthma control of adding budesonide to the reference group patients who had not initially received inhaled corticosteroids. METHODS: Patients were randomized to double-blind treatment with budesonide, 200 mug (those aged < 11 years) or 400 mug once daily, or placebo plus the usual asthma therapy for 3 years, after which all patients received 2 years of open-label treatment with budesonide once daily. RESULTS: During the full 5-year study period, postbronchodilator FEV(1) percent predicted decreased, irrespective of randomized treatment during the double-blind phase, by an average of 2.22% (SE, 0.15%). However, patients with inhaled budesonide in the double-blind phase had a significantly lower risk (odds ratio, 0.61; P < .001) of a severe asthma-related event during the full 5-year study period than those in the reference group. Moreover, patients in the reference group used more additional asthma medications during both the open-label and double-blind phases. CONCLUSIONS: In mild persistent asthma early intervention with inhaled budesonide was associated with improved asthma control and less additional asthma medication use.

Prevalence of asthma among Chinese adolescents living in Canada and in China.

BACKGROUND: Studies of the prevalence of asthma among migrating populations may help in identifying environmental risk factors. METHODS: We analyzed data from Vancouver, Canada, and from Guangzhou, Beijing and Hong Kong, China, collected during phase 3 of the International Study of Asthma and Allergies in Childhood. We subdivided the Vancouver adolescents according to whether they were Chinese immigrants to Canada, Canadian-born Chinese or Canadian-born non-Chinese. We compared the prevalence of asthma and wheezing among Chinese adolescents born in Canada, Chinese adolescents who had immigrated to Canada and Chinese adolescents living in China. RESULTS: Of 7794 Chinese adolescents who met the inclusion criteria, 3058 were from Guangzhou, 2824 were from Beijing, and 1912 were from Hong Kong. Of 2235 adolescents in Vancouver, Canada, 475 were Chinese immigrants, 617 were Canadian-born Chinese, and 1143 were Canadian-born non-Chinese. The prevalence of current wheezing among boys ranged from 5.9% in Guangzhou to 11.2% in Canadian-born Chinese adolescents. For girls, the range was 4.3% in Guangzhou to 9.8% in Canadian-born Chinese adolescents. The prevalence of ever having had asthma ranged from 6.6% to 16.6% for boys and from 2.9% to 15.0% for girls. Prevalence gradients persisted after adjustment for other environmental variables (odds ratios for ever having had asthma among Canadian-born Chinese compared with native Chinese in Guangzhou: 2.72 [95% confidence interval 1.75-4.23] for boys and 5.50 [95% confidence interval 3.21-9.44] for girls; p < 0.001 for both). Among Chinese adolescents living in Vancouver, the prevalence of ever wheezing increased with duration of residence, from 14.5% among those living in Canada for less than 7 years to 20.9% among those living their entire life in Canada. The same pattern was observed for the prevalence of ever having had asthma, from 7.7% to 15.9%. INTERPRETATION: Asthma symptoms in Chinese adolescents were lowest among residents of mainland China, were greater for those in Hong Kong and those who had immigrated to Canada, and were highest among those born in Canada. These findings suggest that environmental factors and duration of exposure influence asthma prevalence.

[Effects of 2-n-nonyl-1,3-dioxolane as an enhanceron transdermal absorption of Salvia miltiorrhiza gel].

OBJECTIVE: To choose the most suitable concentration of 2-n-nonyl-1,3-dioxolane as a penetration enhancer in tanshinone gel preparation. METHOD: In vitro, transdermal absorption was studied using improved Frans equipment and rats skin. Tanshinone II A was tested by HPLC. RESULT: The 4.0% concentration of 2-n-nonyl-1,3-dioxolane enhanced the transdermal absorption significantly in the preparation. CONCLUSION: 2-n-nonyl-1,3-dioxolane was a new effective permeaton enhancer.

Effects of early intervention with inhaled budesonide on lung function in newly diagnosed asthma.

STUDY OBJECTIVES: Asthmatic patients lose lung function faster than normal subjects. The effectiveness of early intervention with inhaled corticosteroids on this decline in lung function is not established in recent-onset disease. DESIGN: The Inhaled Steroid Treatment as Regular Therapy in Early Asthma study was a randomized, double-blind study in 7,165 patients (5 to 66 years old), with persistent asthma for < 2 years to determine whether early intervention with low-dose inhaled budesonide prevents severe asthma-related events and the decline in lung function. Patients received budesonide (200 mug qd for children < 11 years old and 400 mug qd for others) or placebo for 3 years in addition to usual asthma medications. RESULTS: Treatment with budesonide significantly improved prebronchodilator and postbronchodilator FEV(1) percentage of predicted and reduced the mean declines from baseline for postbronchodilator FEV(1) at 1 year and 3 years: - 0.62% and - 1.79% for budesonide and - 2.11% and - 2.68% for placebo, respectively (p < 0.001). The decline was more marked for male patients, active smokers, and patients > 18 years old, and the smallest treatment effects were in adolescents. CONCLUSIONS: Long-term, once-daily treatment with low-dose budesonide improved both prebronchodilator and postbronchodilator FEV(1) in patients with recent-onset, persistent asthma, and reduced the loss of lung function over time.

Prevalence and Treatment of Children's Asthma in Rural Areas Compared with Urban Areas in Beijing.

BACKGROUND: The prevalence of childhood asthma has been increasing in China. This study aimed to compare the prevalence, diagnosis, and treatment of asthmatic children from urban and rural areas in Beijing, China. METHODS: Schools, communities, and kindergartens were randomly selected by cluster random sampling from urban and rural areas in Beijing. Parents were surveyed by the same screening questionnaires. On-the-spot inquiries, physical examinations, medical records, and previous test results were used to diagnose asthmatic children. Information on previous diagnoses, treatments, and control of symptoms was obtained. RESULTS: From 7209 children in rural areas and 13,513 children in urban areas who completed screening questionnaires, 587 children were diagnosed as asthma. The prevalence of asthma in rural areas was lower than in urban areas (1.25% vs. 3.68%, χ2 = 100.80, P < 0.001). The diagnosis of asthma in rural areas was lower than in urban areas (48.9% vs. 73.9%, χ2 = 34.6, P < 0.001). Compared with urban asthmatic children (56.5%), only 35.6% of rural asthmatic children received inhaled corticosteroids (P < 0.05). The use of bronchodilators was also lower in rural areas than in urban areas (56.5% vs. 66.4%, χ2 = 14.2, P < 0.01). CONCLUSION: The prevalence of asthma in children was lower in rural areas compared with children in the urban area of Beijing. A considerable number of children were not diagnosed and inadequately treated in rural areas.

Current understanding and therapy of asthma workshop summary.

The prevalence of asthma has increased globally in the past 2 decades. To address this critical issue, a workshop on "Current Understanding and Therapy of Asthma" was recently held in Beijing, as a part of the 10th International Conference of the Society of Chinese Bioscientists in America (SCBA). Several pertinent topics were addressed by leading experts from China, Taiwan, Japan and the US, which include epidemiology, the molecular genetic mechanism, pathogenesis, treatment and prevention of asthma. This article highlights the issues presented and discussed in this ground-breaking symposium emphasizing this important public health problem in the Chinese population.

[Prevalence of allergic respiratory disorders and skin prick test in Beijing urban and suburban children: a comparative study].

OBJECTIVE: To investigate the prevalence of allergic respiratory disorders and allergens in Beijing urban and suburban children. METHODS: Using the International Study of Asthma and Allergies in Childhood Phase III Protocol, a questionnaire survey was conducted among 7,077 junior middle school students, 3,531 males and 3,546 females, aged 13-14, of 11 urban schools and 10 suburban schools in Beijing by random cluster sampling. Skin prick test with 13 common allergens was conducted among 2,126 from the 7,077 students by random cluster sampling. RESULTS: The prevalence rates of anamnestic asthma, asthma in recent 12 months, asthma after exercise in recent 12 months, and dry cough during night in recent 12 months were 12.4%, 7.2%, 25.6%, and 19.3% respectively in the urban students; all significantly higher than those in the suburban students (4.5%, 4.3%, 12.5%, and 8.3% respectively, all P < 0.01). The rates of anamnestic nasal symptoms without common cold, present nasal symptoms without common cold, and those nasal symptoms complicated with itching eyes and lacrimation were 41.6%, 35.6%, and 10.3% respectively in urban students, and 21.3% all significantly higher than those in the suburban students (21.3%, 12.3%, and 3.3% respectively, all P < 0.05). The positive rates of the 13 main allergens were significantly higher in the urban students than in the suburban students (all P < 0.01). The positive rate of Dermatophagoides farinae and D. pteronyssinus, cat hair, and Blatella germanica were 20.4%, 16.9%, 10.8%, and 11.0% respectively in the urban students, all significantly higher than those in the suburban students (3.7%, 2.7%, 3.7%, and 2.7% respectively, all P < 0.01). CONCLUSION: The prevalence rates of allergic disorders have been increased in comparison with those in the last decade in Beijing junior middle school students, especially those in the urban area and may be due to the changes of environments and living styles.

[Comparative analysis of the state of asthma prevalence in children from two nation-wide surveys in 1990 and 2000 year].

OBJECTIVE: To find out the prevalence change of asthma in children aged 0 - 14 years during the ten years. METHODS: A nationwide randomized survey, covering 27 cities, 27 identical cities/municipalities were chosen for comparison which were divided into 6 sections: mid-south, southwest districts, east-China section, northeast, northwest and north-China districts. RESULTS: Surveys were exclusively in the urban areas, including a population of 287,329 children aged 0 - 14 years in 2000 and 399,193 children in 1990. 4301(1.50%) were screened out as asthma associated children in 2000. Among them 3540(82.31%) children, aged 3 years or more, were diagnosed as asthma of children; 761 (17.69%) as asthma of infants and young children aged less than 3 years; In 1990, 3625 (0.91%) were diagnosed as asthma, and in which 2691 (74.23%) were children aged 3 years or more, other 934 (25.77%) were aged less than 3 years; And male predominate female [the prevalence of male and female are 1.85% (2 733/147 969) and 1.13% (1568/139,360), the rate is 1.74:1.00 in 2000, the prevalence of male and female are 1.08% (2265/210,137) and 0.72% (1360/189,056), the rate is 1.67:1.00 in 1990]. About 90% asthmatic children had onset of wheezing before 6 years old [90.30% (3884/4301) in 2000, and 95.26% (3453/3625) in 1990]. The prevalence of the average asthma of all the 0 - 14 years old asthma population (including asthma of older children and of infants) in 1990 and 2000 is 0.91% and 1.50% respectively. The current prevalence has increased by 64.84%. There was statistically significant difference in asthma prevalence among the 27 cities, in 2000 bring the highest in Shanghai (483/14,468) and Chongqing (374/11,200), both are 3.34%, and the lowest in Lhasa (35/6676), is 0.52%. In 1990, the highest in Chongqing (199/7651) is 2.60%, the lowest in Lhasa (14/15,360) is 0.09%. Two surveys showed that more than 95% patients were treated with antibiotics, and about 35.41% (1523/4301) with the inhaled glucocorticosteroid in 2000, in 1990 it is very rarely. CONCLUSIONS: There has been a significant increasing trend (64.84%) of asthma prevalence during the ten years. >From the data of present survey it was inferred that there has been quite some improvement in the accuracy of diagnosis and in the practice of steroid inhalation therapy by the pediatricians in different cities, but we must generalize the GINA hardly and improve the quality of asthmatic children's lives.

[Relationships between the diameters of Bacille Calmette-Guerin scars and asthma, atopy in urban and rural Beijing children].

OBJECTIVE: To compare the diameters of Bacille Calmette-Guerin (BCG) scars between asthmatic (allergic) students and normal students, and to compare the diameters of BCG scars in children in rural Beijing area with those in urban Beijing area, and to compare the prevalence of asthmatic (allergic) symptoms and atopy between rural and urban Beijing students. METHODS: Sampled by cluster-random Method, 819 urban school children and 1 044 rural school children aged 13 - 14 years were recruited for the Beijing arm of the phase III international study of asthma and allergies in childhood. The children answered the core questionnaires, and underwent skin prick test for 13 allergens, and were checked for BCG scars on their arms. RESULTS: (1) In both rural and urban Beijing students, the mean diameters of BCG scars in those with asthma (allergy) (asthma ever, wheeze ever, current wheeze within 12 months, hay fever ever, repeated rash ever, eczema ever, allergic rhinitis, atopy, high-sensitivity or were diagnosed asthma) were (7.0 +/- 2.1) mm-(8.8 +/- 2.8) mm, which were not significantly different from those of (7.2 +/- 2.7) mm-(8.2 +/- 2.2) mm in normal students (P > 0.05). (2) Compared to the urban students, the mean diameter of BCG scars in the rural students was (8.2 +/- 2.3) mm, significantly larger than that of (7.3 +/- 2.9) mm in the urban students (P < 0.01). The prevalence of asthma (allergy) (asthma ever, wheeze ever, current wheeze within 12 months, hay fever ever, repeated rash ever, eczema ever, allergic rhinitis, atopy, high-sensitivity or diagnosed asthma) were 0.6% - 11.4% in the rural Beijing students, significantly lower than that of 3.1% - 35.7% in urban Beijing schoolchildren (P < 0.01). CONCLUSIONS: The diameters of BCG scars were not significantly different between asthmatic (allergic) students and normal students. The diameters of BCG scars in the rural students were significantly larger than those in the urban students. The prevalence of asthma and allergy in the rural children were significantly lower than that in the urban students. The results suggest that there is difference in immunity between rural and urban children from early life, which may be caused by the different living environments.

[Prevalence of respiratory and atopic disorders in Chinese school children].

OBJECTIVE: To compare the prevalence of respiratory and atopic disorders, and to assess the role of atopy in the development of asthma in Chinese school children from Beijing, Guangzhou, and Hong Kong. METHODS: Community-based random samples of school children aged 9 approximately 11 years from three Chinese cities (Beijing, Guangzhou and Hong Kong) were recruited for study using the International Study of Asthma and Allergies in Childhood (ISAAC) Phase II protocol. Subjects were studied by parental questionnaires (n = 10 902), skin-prick tests and skin examination (n = 3 479). RESULTS: The prevalence rates of current wheeze, speech limiting wheeze, rhinoconjunctivitis and flexural dermatitis were significantly higher in Hong Kong than in Beijing and Guangzhou. The atopy rate was also higher in Hong Kong (41.2%) than in Beijing (23.9%) and Guangzhou (30.8%). Atopy was strongly correlated with current wheeze (OR = 7.74; 95% CI = 5.70 approximately 10.51). Subgroup analyses of children from Hong Kong revealed that children born in mainland China who had subsequently migrated to Hong Kong had a significantly lower rate of allergic symptoms and atopy than those born in Hong Kong. CONCLUSION: The prevalence of asthma, allergic diseases and atopy was highest in school children from Hong Kong. Atopic sensitizations is an important factor associated with asthma in Chinese children.

[Exhaled nitric oxide levels in school children of Beijing].

OBJECTIVE: To learn the normal values of exhaled nitric oxide (eNO) in children. METHOD: School children in Beijing from 11 to 18 years of age were included in the study. All the students were assigned into two groups: normal group and abnormal group (with allergic disease) according to the International Study of Asthma and Allergy in Childhood questionnaires. eNO, peak expiratory flow rate and sensitization were measured. RESULT: Totally 395 students were screened out as normal subject (male: 177, female: 218). The eNO level was not significantly different between genders (P > 0.05), but was associated positively with age in both male and female group (P = 0.008 and P = 0.05 respectively) and associated with height in male students (P = 0.02). The geometric mean value of eNO was 11.22 ppb (parts per billion, ppb = 10(9)) in children aged from 11 to 14 years and 14.13 ppb in children aged from 14 to 18 years, with 95% confidence interval 4.17 - 30.20, 5.50 - 36.31 ppb. The eNO level was significantly increased in children who "ever had asthma or wheezing" (n = 68), and children who "ever had rhinitis" (n = 96) compared with normal subjects (P = 0.001 and P = 0.008). The geometric mean value of eNO was 16.98 ppb in children with positive skin prick test and was significantly increased as compared with children with negative skin prick test with eNO level at 11.75 ppb (P = 0.001). CONCLUSION: eNO level varied between 10.72 ppb and 13.80 ppb in normal children 11 - 18 years of age, and was positively associated with age and height, but not with gender. eNO level increased significantly in children with wheezing and atopy.