Pathological evaluation of renal complications in children following allogeneic hematopoietic stem cell transplantation: a retrospective cohort study.

BACKGROUND: Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a curative therapy for hematologic malignancies and non-malignant disorders, such as aplastic anemia, fanconi anemia, and certain immune deficiencies. Post-transplantation kidney injury is a common complication and involves a wide spectrum of structural abnormalities, including glomerular (MSPGN, mesangial proliferative glomerulonephritis; FSGS, focal segmental glomerulosclerosis; MPGN, membranoproliferative glomerulonephritis; MCD, minimal change disease), vascular (TMA, thrombotic microangiopathy), and/or tubulointerstitial (TIN, tubulointerstitial nephritis; ATI, acute tubular injury). Renal biopsy is the gold-standard examination for defining multiple etiologies of kidney impairment. Although kidney injury following HSCT has been studied, little is known about the effects of allo-HSCT on renal pathology in pediatric patients. METHODS: We retrospectively analyzed renal biopsy specimens from children with kidney injury after allo-HSCT and correlated results with clinical data in the last 10 years. RESULTS: Among 25 children (18 males and 7 females), three patients had proteinuria indicating nephrotic syndrome (24-hour urinary total protein/weight > 50 mg/kg/d), nine patients had severely reduced estimated glomerular filtration rate (eGFR < 30 ml/min/1.73 m2) and four patients received kidney replacement therapy (KRT). The main pathologies identified from kidney biopsies were MSPGN (n = 12), FSGS (n = 12), MPGN (n = 5), TMA (n = 4), MCD (n = 3), diffuse glomerular fibrosis (DGF, n = 2), ATI and TIN, in isolation or combined with other pathologies. The median follow-up time was 16.5 (0.5 ~ 68.0) months. Three patients died of recurrent malignancy and/or severe infection, one child developed to end-stage renal disease (ESRD), six patients (24%) had elevated serum creatinine (SCr > 100µmol/l) and nine patients (36%) still had proteinuria. CONCLUSIONS: This study evaluates histomorphologic findings from kidney biopsies of pediatric recipients following allo-HSCT. Detailed evaluation of renal biopsy samples is helpful to elucidate the nature of renal insult, and may potentially identify treatable disease processes.

Critical window for the association between early electronic screen exposure and hyperactive behaviors in preschool children.

Electronic screens have become an integral part of modern life, accompanied with growing concerns for children's neuropsychological development. This study aimed to evaluate the associations between measures of early life screen exposure and hyperactive behaviors among preschool children. The study also aimed to investigate their cumulative effects and the critical window for these associations. A cross-sectional survey was conducted among 52 625 mother-child dyads at preschools in LongHua District of Shenzhen, China. A self-administered structured questionnaire was used to assess socio-demographic characteristics, duration of children's electronic screen exposure in each of the first 3 years following birth and the presence of current hyperactive behaviors. A series of logistic regression models were used to examine the relationship between previous screen time and current hyperactive behaviors. A crossover analysis was used to explore the critical window for a significant relationship between screen time and hyperactive behaviors. We found that exposure to electronic screens in the first 3 years of life was associated with hyperactive behaviors in preschool children. A cumulative effect was shown in children with an average daily screen time less than 60 min, with adjusted ORs increasing from 1.262 to 1.989 as screen exposure years increased from 1 to 3 years. A critical window was identified in that children in the first 2 years after birth were vulnerable to electronic screen exposure. Exposure to televisions, mobile phones, and computers were all related to elevated risks for hyperactive behaviors. In conclusion, early screen exposure appears to increase the risk for hyperactive behaviors in preschool children with the presence of a cumulative effect, a critical window and different electronic screens having similar effects.

Parent-child interactions in early life mediating association between prenatal maternal stress and autistic-like behaviors among preschoolers.

A range of studies have shown that prenatal maternal stress (PNMS) exposure is associated with offspring autistic-like behaviors, however the potential pathways remain unexplored. This study aimed to evaluate the mediating role of parent-child interactions in early life in the association between PNMS exposure and preschoolers' autistic-like behaviors. Data from 65,928 child-parent dyads were obtained via a primary caregiver-reported questionnaire administered as part of the Longhua Child Cohort Study. To strengthen confidence in the reliability of the results, the analyses were initially conducted on a random selection of 70% of the total sample, and then validated on the remaining 30% of the sample. Analysis of covariance and multiple linear models were employed to estimate the associations between PNMS exposure, parent-child interactions in early life, and children's autistic-like behaviors. The results showed that PNMS exposure was positively associated with the presence of autistic-like behaviors at preschool age. The total indirect effect of the frequency of positive parent-child interactions in early life accounted for 9.69% or 8.99% of the variance of the association. Our findings indicate that parent-child interactions in early life might function as potential mediators of the association between PNMS and the increased risk of offspring autistic-like behaviors.

Network meta-analysis of the optimal time of applying enteral immunonutrition in esophageal cancer patients receiving esophagectomy.

BACKGROUND: Enteral immunonutrition (EIN) has been extensively applied in cancer patients; however, its role in esophageal cancer (EC) patients receiving esophagectomy remains unclear. We performed this network meta-analysis to investigate the impact of EIN on patients undergoing surgery for EC and further determine the optimal time of applying EIN. METHODS: We searched PubMed, EMBASE, Cochrane library, and China National Knowledgement Infrastructure (CNKI) to identify eligible studies. Categorical data was expressed as the odds ratio with 95% confidence interval (CI), and continuous data was expressed as mean difference (MD) with 95% CI. Meta-analysis with head-to-head approach and network meta-analysis was performed to evaluate the impact of EIN on clinical outcomes using RevMan 5.3 and ADDIS V.1.16.8 software. The surface under the cumulative ranking curve (SUCRA) was calculated to rank all nutritional regimes. RESULTS: Total 14 studies involving 1071 patients were included. Meta-analysis with head-to-head approach indicated no difference between EIN regardless of the application time and standard EN (SEN); however, subgroup analyses found that postoperative EIN was associated with decreased incidence of total infectious complications (OR = 0.47; 95%CI = 0.26 to 0.84; p = 0.01) and pneumonia (OR = 0.47; 95%CI = 0.25 to 0.90; p = 0.02) and shortened the length of hospitalization (LOH) (MD = - 1.01; 95%CI = - 1.44 to - 0.57; p < 0.001) compared to SEN, which were all supported by network meta-analyses. Ranking probability analysis further indicated that postoperative EIN has the highest probability of being the optimal option in terms of these three outcomes. CONCLUSIONS: Postoperative EIN should be preferentially utilized in EC patients undergoing esophagectomy because it has optimal potential of decreasing the risk of total infectious complications and pneumonia and shortening LOH. OSF REGISTRATION NUMBER: 10.17605/OSF.IO/KJ9UY.

Critical window for the association between prenatal environmental tobacco smoke exposure and preterm birth.

Although environmental tobacco smoke (ETS) exposure is considered to be a severe public health problem and a modifiable risk factor for preterm birth (PTB), we still lack a comprehensive understanding of the PTB risk associated with trimester-specific prenatal ETS exposure. This study aimed to examine the accumulation of risk across trimester ETS exposure and the critical window of the association between maternal ETS exposure during pregnancy and PTB. A total of 63,038 mother-child pairs were involved in the analysis of the 2017 survey of Longhua Child Cohort Study. Information about socio-demographic characteristics, prenatal ETS exposure, and birth outcomes were collected using a self-report questionnaire. A series of logistic regression models were employed to assess the associations between prenatal ETS exposure and PTB. We found that maternal ETS exposure during pregnancy significantly increased the risk of PTB and this association increased with both the average level of daily ETS exposure and the number of trimesters of ETS exposure. Moreover, mothers who were initially exposed to ETS in the 1st trimester of pregnancy had significant higher risk of PTB (OR = 1.34, 95% CI: 1.25-1.44). Furthermore, mothers exposed to ETS in the 1st trimester only (OR = 1.26, 95%CI: 1.04-1.50), in both 1st and 2nd trimester (OR = 1.35, 95%CI: 1.08-1.67) and throughout pregnancy (OR = 1.35, 95%CI: 1.24-1.46) experienced a significantly high risk of PTB. Prenatal maternal ETS exposure during only the 2nd trimester also resulted in a high risk of PTB with marginal significance (OR = 1.33, 95% CI:0.78-2.13). To conclude, the 1st and early 2nd trimester might be the critical window for prenatal ETS exposure causing PTB.

Association between prenatal exposure to indoor air pollution and autistic-like behaviors among preschool children.

Indoor air pollution is a recognized risk factor for a range of negative health outcomes. This study aimed to investigate the association between maternal prenatal exposure to indoor air pollution and the presence of autistic-like behaviors among preschool children. Data were obtained from the Longhua Child Cohort Study in 2017, in which we enrolled a total of 65 317 preschool children. Associations between maternal exposure to four sources of indoor air pollution (e.g., cooking, environmental tobacco smoke (ETS), mosquito coils, and home decoration) during pregnancy and preschool children's autistic traits were analyzed using multivariate logistic regression. Our results showed that maternal exposure to indoor air pollution from four different sources during pregnancy was associated with the presence of children's autistic-like behaviors. There was dose-response relationship between the accumulative exposure to the four different indoor air pollution sources and the risk of autistic-like behaviors. Furthermore, we found a significant additive interaction between prenatal exposure to both cooking and mosquito coil incense on the risk of autistic-like behaviors. Maternal prenatal exposure to the indoor air pollution from four sources might increase with the risk of autistic-like behaviors being present among preschool children, with an additive interaction effect between some pollution sources.

A clinical model and nomogram for early prediction of gestational diabetes based on common maternal demographics and routine clinical parameters.

AIM: We aimed to develop a risk prediction model for gestational diabetes mellitus (GDM) based on the common maternal demographics and routine clinical variables in Chinese population. METHODS: Individual information was collected from December 2018 to October 2019 by a pretested questionnaire on demographics, medical and family history, and lifestyle factors. Multivariable logistic regression was performed to establish a predictive model for GDM by variables in pre- and early pregnancy. The consistency and discriminative validity of the model were evaluated by Hosmer-Lemeshow goodness-of-fit testing and ROC curve analysis. Internal validation was appraised by fivefold cross-validation. Clinical utility was assessed by decision curve analysis. RESULTS: Total 3263 pregnant women were included with 17.2% prevalence of GDM. The model equation was: LogitP = -11.432 + 0.065 × maternal age (years) + 0.061 × pre-pregnancy BMI (kg/m2 ) + 0.055 × weight gain in early pregnancy (kg) + 0.872 × history of GDM + 0.336 × first-degree family history of diabetes +0.213 × sex hormone usages during pre- or early pregnancy + 1.089 × fasting glucose (mmol/L) + 0.409 × triglycerides (mmol/L) + 0.082 × white blood cell count (109/L) + 0.669 × positive urinary glucose. Homer-Lemeshow goodness-of-fit testing indicated a good consistency between predictive and actual data (p = 0.586). The area under the ROC curve (AUC) was 0.720 (95% CI: 0.697 ~ 0.744). Cross-validation suggested a good internal validity of the model. A nomogram has been made to establish an easy to use scoring system for clinical practice. CONCLUSIONS: The predictive model of GDM exhibited well acceptable predictive ability, discriminative performance, and clinical utilities. The project was registered in clinicaltrial.gov.com with identifier of NCT03922087.

Bidirectional associations between parenting styles and conduct problems in Chinese preschool children: the Shenzhen Longhua Child Cohort Study.

The bidirectional associations between parenting styles and conduct problems in Chinese children attending preschools were rarely discussed. A study covering 171 preschools in Longhua District of Shenzhen, China was conducted among children when they first attended preschools. Parents of children reported the self-perceived parenting styles and their children's conduct problems using validated questionnaires. The bidirectional associations between parenting styles and conduct problems in children were assessed using multivariate linear or logistic regressions in both cross-sectional and cohort settings. In cross-sectional settings, the bidirectional associations were present in all dimensions of parenting styles with children's conduct problems. After 1.01 years of follow-up, increases in parenting dimensions of rejection, control attempts, and favoring subject were significantly associated with children's conduct problems at follow-up, while increases in emotional warmth of parents significantly reduced such risk. In addition, parents of children who had conduct problems at baseline but regressed to normal at follow-up showed decreased scores in negative parenting dimensions. In contrast, among children who developed conduct problems during the study period, the scores of rejection and favoring subject in their parents have increased significantly, while the scores of emotional warmth have decreased. Parent-to-child effect was similar between fathers and mothers, while child-to-parent effect was stronger in fathers than that in mothers. In order to stop the negative feedback loop between poor parenting styles and children's conduct problems, our study underscored the importance of intervention not only in parents but also in their children.

Retinal microvasculature and time to pregnancy in a multi-ethnic pre-conception cohort in Singapore.

STUDY QUESTION: Can abnormalities in retinal microvasculature representing adverse microcirculatory perfusion and inflammation shed light on the pathophysiology of female fecundability? SUMMARY ANSWER: In our prospective study, abnormalities in retinal vascular geometric morphology (i.e. sparser arteriolar fractal and larger venular bifurcation) during pre-conception phase are temporarily associated with a prolonged time-to-pregnancy (TTP). WHAT IS KNOWN ALREADY: Suboptimal retinal microcirculatory morphology has been associated with obesity, psychological stress and hypertension, all of which are known risk factors for reduced female fecundability. STUDY DESIGN, SIZE, DURATION: A total of 652 women of Chinese, Malay or Indian ethnicity 18-45 years of age and planning to conceive spontaneously within the next 12 months were recruited during the pre-conception period into the Singapore PREconception Study of long-Term maternal and child Outcomes (S-PRESTO), from February 2015 to October 2017. PARTICIPANTS/MATERIALS, SETTING, METHODS: During recruitment, we collected information on socio-demographic factors, menstrual characteristics and lifestyle behaviors and made anthropometric measurements. We assessed the following retinal microvascular features: caliber, branching angle and fractal dimension. We conducted follow-up telephone surveys to track each participant's pregnancy status at 6, 9 and 12 months after enrolment. We ascertained clinical pregnancies via ultrasonography, with TTP measured by the number of menstrual cycles required to achieve a clinical pregnancy over a 1-year follow-up. Then, we performed discrete-time proportional hazards models to estimate the fecundability odds ratio (FOR) and 95% CI for each retinal microvascular feature in association with TTP, after adjusting for major confounders, including body mass index and fasting glycemic level at study entry. MAIN RESULTS AND THE ROLE OF THE CHANCE: Among 652 recruited women, 276 (42.3%) successfully conceived within 1 year of follow-up. The mean (and SD) was 1.24 (0.05) Df for retinal arteriolar dimension fraction and 78.45 (9.79) degrees for retinal venular branching angle, respectively. Non-linear relationship testing was performed before multiple adjustment in all associations and a non-monotonic association was detected between retinal venular branching angle and TTP. Compared with women in the highest tertile of retinal arteriolar fractal dimension, women in the second tertile had a prolonged TTP (FOR: 0.68; 95% CI: 0.51-0.92), as did women in the lowest tertile (FOR: 0.73; 95% CI: 0.55-0.98). Compared with women in the middle tertile of retinal venular branching angle, women in the highest tertile had a borderline prolonged TTP (FOR: 0.75; 95% CI: 0.56-1.02). No other retinal vascular features were significantly associated with TTP. LIMITATIONS, REASONS FOR CAUTION: We were unable to adjust for other potential confounding factors such as female sexual function (e.g. frequency of sexual intercourse), which might introduce a residual bias. Moreover, even though this is a prospective cohort design, our findings can identify the temporal relationship but not necessarily infer a causal relationship between maternal microvasculature and TTP. Lastly, our study involving mainly Chinese, Malay and Indian ethnicities might not be generalizable to other races or ethnicities. WIDER IMPLICATIONS OF THE FINDINGS: Suboptimal microcirculation may lead to reduced female fecundability. In the future, in addition to conventional ultrasonographic evaluation of ovarian and uterine physiological function, assessing the retinal microvasculature might be useful for assessment of ovarian age, fertility prediction and endometrial evaluation before assisted reproductive techniques for fertility treatments. STUDY FUNDING/COMPETING INTEREST(S): This research is supported by the Singapore National Research Foundation (NRF) under its Translational and Clinical Research (TCR) Flagship Programme and administered by the Singapore Ministry of Health's National Medical Research Council (NMRC) (Singapore-NMRC/TCR/004-NUS/2008; NMRC/TCR/012-NUHS/2014) and Singapore National Medical Research Council Transition Award (NMRC TA/0027/2014). The authors have no competing interests to declare. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov, NCT03531658.

The chain mediating role of social support and stigma in the relationship between mindfulness and psychological distress among Chinese lung cancer patients.

PURPOSE: Psychological distress greatly impaired the psychological and physical well-being of lung cancer patients. Identification of protective and risk factors is a prerequisite of developing effective psychological treatment protocol. The study aims to determine the relationship of mindfulness and psychological distress and further clarify the mechanism of mindfulness against psychological distress through perceived stigma and social support among Chinese lung cancer patients. METHOD: A cross-sectional survey study involving 441 valid Chinese lung cancer patients was conducted from September 2018 to August 2019. After all validated questionnaires that measured psychological distress, level of mindfulness, social support, and perceived stigma were returned by patients, we firstly performed correlation analysis to assess the associations between mindfulness, social support, perceived stigma, and psychological distress. Then structural equation modelling analysis was conducted to further clarify the mediating effects of perceived stigma and social support on the relationship between mindfulness and psychological distress. RESULTS: According to our hypothesis and further modification, our revised model adequately fits to data. Mindfulness (ß = - 0.107, p = 0.008) and social support (ß = - 0.513, p < 0.001) had a direct effect on psychological distress. Meanwhile, mindfulness had a direct effect on perceived stigma (ß = - 0.185, p < 0.001), and perceived stigma had a direct effect on social support (ß = - 0.373, p < 0.001). Furthermore, mindfulness had also the indirect effect on psychological distress through the chain mediating role of stigma and social support among lung cancer patients. CONCLUSIONS: Mindfulness has direct negative effect on psychological distress and has also indirectly negative psychological distress through impacting social support and perceived stigma.

Association between greater residential greenness and decreased risk of preschool myopia and astigmatism.

OBJECTIVE: Rapid urbanization has led to reduced greenness in many areas, this has been linked to adverse health outcomes. The aim was to determine the association between residential greenness experienced during very early childhood with preschool myopia and astigmatism and to explore the potential mediating role of screen time on any associations. METHOD: Information regarding socio-demographic characteristics, home address, screen time during early childhood, and refraction data from vision screenings of 53,575 preschoolers from Longhua Child Cohort Study were collected via questionnaires. Residential greenness was calculated as the average of satellite-derived Normalized Difference Vegetation Index in buffers of 100, 250, and 500 m around each child's home address. Logistic and linear regression models were used to examine the relationships between residential greenness, screen time, and preschool myopia and astigmatism. RESULT: The mean (SD) age of the 53,575 preschoolers was 5.0 (0.7) years, and 24,849 (46.4%) were girls. A total of 1236 (2.3%) preschoolers had myopia and 5347 (10.0%) had astigmatism. In the adjusted model, a higher neighborhood greenness level within 100 m buffers around the home address was associated with decreased risk of myopia (adjusted odds ratios (AOR): 0.62, 95% confidence interval (CI): 0.38-0.99), and higher neighborhood greenness levels within 100, 250, and 500 m decreased the risk of astigmatism, and their AORs (95% CIs) were 0.55 (0.43-0.70) for 100 m, 0.59 (0.41-0.83) for 250 m, 0.61 (0.42-0.90) for 500 m, respectively. Greater screen time during early childhood increased the risk of myopia (AOR = 1.33) and astigmatism (AOR = 1.23). Reduction in screen time fully mediated the benefits of greater residential greenness on preschool myopia, but partially mediated that on preschool astigmatism (p < 0.05). CONCLUSION: Higher residential greenness reduces the risk of preschool myopia and astigmatism; the benefits of residential greenness were mediated through reduced daily screen time.

Comparative Effectiveness of Enhanced Patient Instructions for Bowel Preparation Before Colonoscopy: Network Meta-analysis of 23 Randomized Controlled Trials.

BACKGROUND: Various enhanced patient instructions (EPIs) have been used for bowel preparation (BP) and our previous meta-analysis also demonstrated the efficacy of EPIs in increasing the colonic polyp and adenoma detection rates; however, the optimal method for adequate BP has not yet been developed. OBJECTIVE: We performed a network meta-analysis to determine the optimal instructions. METHODS: We searched for randomized controlled trials (RCTs) comparing the effectiveness of EPIs with each other or standard patient instructions (SPIs) for BP. We performed direct and Bayesian network meta-analyses for all instructions and used the GRADE (Grading of Recommendations Assessment, Development and Evaluation) criteria to appraise the quality of evidence. RESULTS: We included 23 RCTs (7969 patients) comparing 10 different instructions. In direct meta-analyses, most of the EPIs, except visual aids and mobile apps, increased the adequate preparation rate (APR). Network meta-analyses showed that additional explanations were superior to visual aids (odds ratio [OR] 0.35, 95% CI 0.19-0.59), telephone calls (OR 0.62, 95% CI 0.37-0.99), educational videos (OR 0.79, 95% CI 0.5-0.77), and mobile apps (OR 0.33, 95% CI 0.14-0.68) with low-to-high-quality evidence; newly designed booklets (OR 3.28, 95% CI 1.59-6.16), SMS text messaging (OR 2.33, 95% CI 1.28-3.91), telephone calls (OR 1.86, 95% CI 1.03-1.78), educational videos (OR 2.33, 95% CI 1.40-3.65), and social media applications (OR 2.42, 95% CI 1.4-3.93) were superior to visual aids and mobile apps with low-to-high-quality evidence. SMS text messaging, telephone calls, and social media applications increase adherence to and satisfaction with the BP regime. Social media applications reduce the risk of adverse events (AEs). Telephone calls and social media applications increase the polyp detection rate (PDR). CONCLUSIONS: Newly designed booklets, telephone calls, educational videos, and social media applications can improve the quality of BP. Telephone calls and social media applications improve adherence to and satisfaction with the BP regime, reduce the risk of AEs, and increase the PDR. TRIAL REGISTRATION: INPLASY (International Platform of Registered Systematic Review and Meta-analysis Protocols) INPLASY2020120103; https://inplasy.com/inplasy-2020-12-0103/.

Screen time and autistic-like behaviors among preschool children in China.

Screen time is becoming increasingly common in daily life. Early and excessive screen use has raised growing concerns for children's neuropsychological development. The purpose of this study was to evaluate the association between exposure to screen time in early life and the presence of autistic-like behaviors among preschool children. 29,461 child-caregiver dyads at kindergartens in Longhua New District of Shenzhen, China, were enrolled in this cross-sectional study. Information concerning socio-demographic characteristics, frequency and duration of children's electronic screen exposure for each year since birth, and autistic-like behaviors (measured by the Autism Behavior Checklist) were collected using a self-administered structured questionnaire completed by the primary caregivers. A series of logistic regression models assessed the association between screen time and autistic-like behaviors. Results indicated that younger initial age, longer daily screen time and longer cumulative years of screen exposure since birth were associated with the presence of autistic-like behaviors at preschool age. The risk was enhanced with the increase of both daily screen time and cumulative years of screen exposure during preschool period. Moreover, the cross-over analysis indicated that the first three years following birth might be a sensitive period for children when screen exposure increases the risk of experiencing autistic-like behaviors. In conclusion, our study implied that screen exposure in early life might increase the occurrence of autistic-like behaviors among preschoolers. These findings support the need for early interventions into preschoolers' screen use, however longitudinal studies are necessary to further confirm the causal relationship between early screen time and the incidence of later autistic-like behaviors among preschool children.

Progressive muscle relaxation is effective in preventing and alleviating of chemotherapy-induced nausea and vomiting among cancer patients: a systematic review of six randomized controlled trials.

PURPOSE: Previous systematic review suggested a beneficial effect of progressive muscle relaxation (PMR) for cancer patients receiving chemotherapy. However, poor quality of eligible studies which included in previous systematic review impaired the reliability and validity of findings. The aim of the present systematic review was to further assess the value of PMR in chemotherapy-induced nausea and vomiting. METHODS: We assigned two independent investigators to search potential studies in PubMed, Cochrane Controlled Register of Trial (CENTRAL), Cumulative Index to Nursing and Allied Health Literature (CINAHL), China Biomedical Literature database (CBM), China National Knowledge Infrastructure (CNKI), and Wanfang Data database. We used data extraction sheet to extract essential information, and used the Cochrane risk of bias assessment tool to appraise the quality of eligible studies. Finally, we qualitatively summarized the results of all included studies. RESULTS: Six studies enrolling 288 patients were included finally. Of these 6 studies, three were labeled as moderate quality and the remaining studies were low quality. All included studies consistently suggested that PMR has a positive effect on chemotherapy-induced nausea and vomiting, especially on the incidence, frequency, and degree of delayed nausea and vomiting. CONCLUSION: Independent studies indicated that PMR was a beneficial approach of preventing and alleviating chemotherapy-induced nausea and vomiting among cancer patients. However, further studies enrolling other types of primary tumors should be designed in order to increase the generality of PMR because studies which were included in the present systematic review mainly considered patients with lung cancer and breast cancer. Moreover, future studies with high quality and large-scale are also warranted in order to address the limitations in the present systematic review such as poor quality and limited data of eligible studies.

Diagnostic value of contrast-enhanced harmonic endoscopic ultrasonography in predicting the malignancy potential of submucosal tumors: a systematic review and meta-analysis.

OBJECTIVES: Contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS) utilizes the second-harmonic signals from contrast microbubbles located in the vessels to improve the detectability of microcirculation. Many studies have used CH-EUS to stratify the malignancy risk of submucosal tumors (SMTs), discriminate gastrointestinal stromal tumors (GISTs) from benign SMTs, and predict the malignancy of GISTs based on the regularity of vessels or enhancing patterns. The aim of this study was to conduct a meta-analysis to evaluate the diagnostic performance of CH-EUS in the differential diagnosis of SMTs. METHODS: After searching the Medline, Embase, and Cochrane databases systematically, studies that evaluated the diagnostic accuracy of CH-EUS for the prediction of the malignancy potential of SMTs were pooled. The diagnostic accuracy was computed using a stochastic effect model. The overall test performance was summarized with the summary receiver operating characteristic curve. RESULTS: Six studies discriminated GISTs from benign lesions, and three studies discriminated low-risk from high-risk GISTs, covering a total of 354 cases of SMT. The overall accuracy of CH-EUS in predicting malignancy risk can be assessed as follows: sensitivity 0.87 (95% CI 0.82-0.91), specificity 0.82 (95% CI 0.74-0.89), positive likelihood ratio of 3.55 (95% CI 2.39-5.27), negative likelihood ratio of 0.21 (95% CI 0.13-0.33), and diagnostic odds ratio of 22.17 (95% CI 10.43-47.10). The overall area under the curve was 0.89. Subgroup analysis of the sensitivity and specificity for studies discriminating low-risk from high-risk GISTs were 0.93 (95% CI 0.77-0.99) and 0.81 (95% CI 0.63-0.93), respectively. There was evidence of significant heterogeneity, but no proof of publication bias. CONCLUSIONS: CH-EUS is an effective tool for improving the diagnostic accuracy of conventional EUS for discriminating SMTs and is superior to other imaging techniques. However, due to the limited number of well-designed control studies, we should take into consideration the uncertainty of this method when altering a treatment plan.

Maternal cooking during pregnancy may increase hyperactive behaviors among children aged at around 3 years old.

Cooking is one of the main sources of indoor air pollution in China. Given emerging evidence of a link between air pollutants and neurodevelopmental delays, we examined whether maternal experiences with cooking during gestation might increase their child's hyperactivity at 3 years of age. The participants involved 45 518 mothers of children who were newly enrolled at kindergarten in the Longhua District of Shenzhen from 2015 to 2017. The results show that maternal exposure to cooking fumes during pregnancy was related to an increased risk of their offspring having hyperactivity behaviors at the age of 3 years. Compared with pregnant mothers who never cooked, pregnant mothers who cooked sometimes, often, or always had children who showed a significantly higher hyperactivity risk. Households using cooking fuels such as coal, gas during the mothers' pregnancy, exhibited more hyperactivity behaviors in the young child when compared to those using electricity for cooking. In addition, poor ventilation during cooking, while mothers were pregnant, was found to be a significant risk factor for clinical levels of the offspring's hyperactive behaviors. Furthermore, the positive association with maternal cooking during pregnancy and their offsprings' hyperactivity was relatively consistent across strata defined by social class, education, and other covariates.

Understanding the associations among parents teaching safety rules to children, safety behaviors and unintentional injuries in Chinese preschool children.

Child unintentional injuries are one of the most prominent global health threats and parents may play a vital role in these injuries. This study thus aims to explore the associations of parents teaching safety rules with preschool children's safety behaviors and unintentional injuries. A total of 62,922 children registered at 182 kindergartens in Longhua District of Shenzhen, China during the fall semester of 2016, were included in this cross-sectional study. Their parents were invited to complete a self-administered questionnaire covering information about socio-demographics, parents teaching safety rules to children, child safety behaviors and unintentional injuries. Logistic and linear regression models were carried out to test the associations among parents teaching safety rules, child safety behaviors, and child unintentional injuries. Whether child safety behaviors mediated the relationship between parents teaching safety rules and child unintentional injuries was assessed using Hayes' PROCESS macros for SPSS. Regression analyses revealed that the higher scores of both mothers' and fathers' teaching safety rules to children were significantly associated with the reduced risks of child unintentional injuries and the modest improvements in child safety behaviors, after adjusting for potential confounders. Furthermore, mediation analysis illustrated that child safety behaviors mediated 18.1% of the association between mothers teaching safety rules and child unintentional injuries and 30.3% of the association between fathers teaching safety rules and child unintentional injuries, respectively. These findings suggest that parents teaching safety rules to children is beneficial for mitigating unintentional injury risks among Chinese preschool children through improving child safety behaviors.

Improvement of Asia-Pacific colorectal screening score and evaluation of its use combined with fecal immunochemical test.

BACKGROUND: The Asia-Pacific Colorectal Screening (APCS) score is effective to screen high-risk groups of advanced colorectal neoplasia (ACN) patients but needs revising and can be combined with the fecal immunochemical test (FIT). This paper aimed to improve the APCS score and evaluate its use with the FIT in stratifying the risk of ACN. METHODS: This prospective and multicenter study enrolled 955 and 1201 asymptomatic Chinese participants to form the derivation and validation set, respectively. Participants received the risk factor questionnaire, colonoscopy and FIT. Multiple logistic regression was applied, and C-statistic, sensitivity and negative predictive values (NPVs) were used to compare the screening efficiency. RESULTS: A modified model was developed incorporating age, body mass index (BMI), family history, diabetes, smoking and drinking as risk factors, stratifying subjects into average risk (AR) or high risk (HR). In the validation set, the HR tier group had a 3.4-fold (95% CI 1.8-6.4) increased risk for ACN. The C-statistic for the modified score was 0.69 ± 0.04, and 0.67 ± 0.04 for the original score. The sensitivity of the modified APCS score combined with FIT for screening ACN high-risk cohorts was 76.7% compared with 36.7% of FIT alone and 70.0% of the modified APCS score alone. The NPVs of the modified score combined with FIT for ACN were 98.0% compared with 97.0% of FIT alone and 97.9% of the modified APCS score alone. CONCLUSIONS: The modified score and its use with the FIT are efficient in selecting the HR group from a Chinese asymptomatic population.

Association between prenatal exposure to household inhalants exposure and ADHD-like behaviors at around 3 years of age: Findings from Shenzhen Longhua Child Cohort Study.

BACKGROUND: Prenatal exposure to air pollutants has been suggested as a possible etiologic factor for the occurrence of ADHD or ADHD-like behaviors. But we still lack a comprehensive assessment of household air pollutants exposure on the development of ADHD-like behaviors during childhood. OBJECT: We aimed to assess whether prenatal household inhalants exposure is associated with preschoolers' ADHD-like behaviors in a nonclinical population. METHODS: This study used the baseline data of the Longhua Child Cohort Study. During 2015-2017, we recruited 42,983 mothers and their kindergarten-aged children who enrolled at kindergarten in the Longhua district of Shenzhen, to obtain the demographic data and relevant exposure information through self-administrated questionnaire survey. The source of prenatal household inhalants exposure include cooking fumes, environmental tobacco smoke, mosqutio coils, home renovated and indoor burning incense. Logistic and censored least absolute deviations (CLAD) models were used to reveal the association between prenatal exposure to household air pollutants and hyperactive behaviors in child. RESULTS: We found that exposure to five types of household inhalants during pregnancy were independently associated with an increased risk of child hyperactive behaviors. Moreover, we observed a significant interaction between exposure to environmental tobacco smoke and cooking fumes during gestation on child hyperactive behaviors in CLAD models. We also found a significant joint effect between burning mosquito coils and incense during gestation for child hyperactive behaviors risk both in CLAD and Logistic models. Furthermore, a household inhalants exposure index was used to demonstrate a dose-response relationship between the cumulative effect of exposure to the five household air pollutants and child hyperactivity. CONCLUSIONS: Our results suggest that prenatal exposure to different household inhalants might increase the risk of children's hyperactive behaviors at around 3 years of age with the presence of interaction effects between some inhalants.

Association between prenatal exposure to cooking oil fumes and full-term low birth weight is mediated by placental weight.

OBJECTIVE: Evidence regarding the association between prenatal exposure to cooking oil fumes (COF) and full-term low birth weight (FTLBW) is still controversial, and the mechanism remains unclear. This study thus aims to explore the association of prenatal COF exposure with off-spring FT-LBW as well as the mediating role of placenta in their association. METHODS: A case-control study enrolling 266 pregnant women delivering FTLBW newborns (cases) and 1420 delivering normal birth weight (NBW) newborns (controls) was conducted. Information on prenatal COF exposure, socio-demographics, and obstetric conditions were collected at the Women's and Children's Hospitals of Shenzhen and Foshan in Guangdong, China. Linear and hierarchical logistic regression models were undertaken to explore the associations among COF exposure, placenta and birth weight, as well as the mediation effect of placental weight. RESULTS: After controlling for potential confounders, prenatal COF exposure was significantly associated with the higher risk of FT-LBW (OR = 1.31, 95% CI= 1.06-1.63) and the lower placental weight (ß = -0.12, 95% CI= -0.23 ~ -0.005). Compared with mothers who never cooked, those cooking sometimes (OR= 2.99, 95% CI= 1.48-6.04) or often (OR= 3.41, 95% CI= 1.40-8.34) showed a higher risk of FT-LBW, and likewise, those cooking for less than half an hour (OR= 2.08, 95% CI= 1.14-3.79) or cooking between half to an hour (OR= 2.48, 95% CI= 1.44-4.29) were also more likely to exhibit FT-LBW. Different cooking methods including pan-frying (OR= 2.24, 95% CI= 1.30-3.85) or deep-frying (OR= 1.78, 95% CI= 1.12-2.85) during pregnancy were associated with increased FT-LBW risks as well. The further mediation analysis illustrated that placental weight mediated 15.96% (95% CI: 12.81~28.80%) and 15.90% (95% CI= 14.62%~16.66%) of the associations of cooking during pregnancy and frequency of prenatal COF exposure, respectively, with FT-LBW.