Nano hydrogel-based oxygen-releasing stem cell transplantation system for treating diabetic foot.

The employment of stem cells and hydrogel is widespread in contemporary clinical approaches to treating diabetic foot ulcers. However, the hypoxic conditions in the surrounding lesion tissue lead to a low stem cell survival rate following transplantation. This research introduces a novel hydrogel with superior oxygen permeability and biocompatibility, serving as a vehicle for developing a stem cell transplantation system incorporating oxygen-releasing microspheres and cardiosphere-derived stem cells (CDCs). By optimizing the peroxidase fixation quantity on the microsphere surface and the oxygen-releasing microsphere content within the transplantation system, intracellular oxygen levels were assessed using electron paramagnetic resonance (EPR) under simulated low-oxygen conditions in vitro. The expression of vascularization and repair-related indexes were evaluated via RT-PCR and ELISA. The microspheres were found to continuously release oxygen for three weeks within the transplantation system, promoting growth factor expression to maintain intracellular oxygen levels and support the survival and proliferation of CDCs. Moreover, the effect of this stem cell transplantation system on wound healing in a diabetic foot mice model was examined through an in vivo animal experiment. The oxygen-releasing microspheres within the transplantation system preserved the intracellular oxygen levels of CDCs in the hypoxic environment of injured tissues. By inhibiting the expression of inflammatory factors and stimulating the upregulation of pertinent growth factors, it improved the vascularization of ulcer tissue on the mice's back and expedited the healing of the wound site. Overall, the stem cell transplantation system in this study, based on hydrogels containing CDCs and oxygen-releasing microspheres, offers a promising strategy for the clinical implementation of localized stem cell delivery to improve diabetic foot wound healing.

Trends in urban/rural inequalities in physical growth among Chinese children over three decades of urbanization in Guangzhou: 1985-2015.

BACKGROUND: Great growth inequalities between urban and rural areas have been reported in China over the past years. By examining urban/rural inequalities in physical growth among children < 7 years old over the past three decades from 1985 to 2015 in Guangzhou, we analyzed altering trends of anthropometric data in children and their association with economic development during the period of rapid urbanization in Guangzhou. METHODS: The height, body weight and nutrition status of children under 7 years old were obtained from two successive cross-sectional surveys and one health surveillance system. Student's t-test, Spearman's rank-order correlation and polynomial regression were used to assess the difference in physical growth between children in urban and rural areas and the association between socioeconomic index and secular growth changes. RESULTS: A height and weight difference was found between urban and rural children aged 0-6 years during the first two decades of our research (1985-2005), which gradually narrowed in both sex groups over time. By the end of 2015, elder boys (age group ≥5 year) and girls (age group ≥4 year) in rural areas were taller than their counterparts in urban areas (p < 0.05).The same trend could be witnessed in the weight of children aged 6 years, with a - 1.30 kg difference (P = 0.03) for boys, and a - 0.05 difference (P = 0.82) for girls. When GDP increased, the gap in boys' weight-for-age z-score (WAZ from 0.25 to 0.01) and height-for-age z-score (HAZ from 0.55 to 0.03) between urban and rural areas diminished, and disappeared when the GDP per capita (USD) approached 25,000. In either urban or rural areas, the urbanization rate and GDP were positively associated with the prevalence of obesity (all R > 0.90 with P < 0.05) and negatively correlated with the prevalence of stunted growth (all R < -0.87 with P < 0.05). CONCLUSION: Growth inequalities gradually decreased with economic development and urbanization, while new challenges such as obesity emerged. To eliminate health problems due to catch-up growth among rural children, comprehensive intervention programs for early child growth should be promoted in rural areas.

[Neuropsychological development of late preterm infants and early term infants at the age of 1 year: a follow-up study].

OBJECTIVE: To study the level of neuropsychological development in late preterm infants and early term infants at the age of 1 year. METHODS: A total of 1 257 children with a corrected age of 1 year were enrolled as subjects. According to gestational age at birth, they were divided into an early preterm group (28-33+6 weeks), a late preterm group (34-36+6 weeks), an early term group (37-38+6 weeks), and a full-term group (39-41+6 weeks). Gesell Developmental Schedules were used to assess the neuropsychological development of the children, and the groups were compared in terms of neuropsychological development at the age of 1 year. RESULTS: There were significant differences in the developmental quotients of the five functional areas (adaptability, gross motor, fine motor, language and social ability) between the four groups at the age of 1 year (P<0.05), and the full-term infants had the highest development quotients, followed by the early term infants, the late preterm infants, and the early preterm infants (P<0.05). The full-term infants had the lowest rate of developmental delay in each functional area, while the early preterm infants had the highest rate (P<0.05). Compared with the full-term infants, the early term infants had a higher risk of developmental delay in adaptability (OR=1.796, P<0.05), and the late preterm infants had a higher risk of developmental delay in adaptability (OR=2.651, P<0.05) and fine motor (OR=2.679, P<0.05), while the early preterm infants had a higher risk of developmental delay in adaptability (OR=4.069, P<0.05), fine motor (OR=3.710, P<0.05), and social ability (OR=3.515, P<0.05). CONCLUSIONS: The risk of neuropsychological developmental delay decreases with the increase in gestational age in children at the age of 1 year, with a dose-response effect. There are varying degrees of developmental delay in early term infants and late preterm infants, and health care follow-up for early term infants and late preterm infants should be taken seriously.

Syphilis-attributable adverse pregnancy outcomes in China: a retrospective cohort analysis of 1187 pregnant women with different syphilis treatment.

BACKGROUND: Syphilis is responsible for a substantial burden of preventable adverse outcomes in pregnancy. The purpose of this study was to compare the frequency of adverse pregnancy outcomes among syphilis-seropositive women who received different treatment regimens at different times in Guangzhou, China. METHODS: Pregnant women with syphilis infection who received prenatal and delivery services in Guangzhou between January 2014 and December 2016 were included. Association between treatment status and the composite adverse outcomes (preterm birth, infant smaller than gestational age, stillbirth, and spontaneous abortion) was estimated. RESULTS: Of 1187 syphilis-seropositive pregnant women included in the analysis, 900 (75.8%) syphilis-seropositive pregnant women received treatment, and 287(24.2%) did not receive treatment. Adverse pregnancy outcomes were observed among 16.3% (147/900) of women with treatment and 33.8% (97/287) of women without treatment. Syphilis-seropositive pregnant women treated with one or two courses of penicillin had a similar risk of adverse pregnancy outcomes (adjusted RR = 1.36, 95% CI: 0.94-1.96). Adverse outcomes were more common among women whose non-treponemal serum test titer was >1:8 and received treatment after 28 weeks compared to before 28 weeks (adjusted RR = 2.34, 95% CI: 1.22-4.48). CONCLUSIONS: Women who received one course of penicillin and women who received two courses of penicillin had a similar risk of adverse pregnancy outcomes. Syphilis treatment before 28 weeks of pregnancy is critical. Strategies to promote high-quality prenatal services are needed.

New screening approach to detecting congenital syphilis in China: a retrospective cohort study.

BACKGROUND: Diagnosis of congenital syphilis (CS) is not straightforward and can be challenging. This study aimed to evaluate the validity of an algorithm using timing of maternal antisyphilis treatment and titres of non-treponemal antibody as predictors of CS. METHODS: Confirmed CS cases and those where CS was excluded were obtained from the Guangzhou Prevention of Mother-to-Child Transmission of syphilis programme between 2011 and 2019. We calculated sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) using receiver operating characteristics (ROC) in two situations: (1) receiving antisyphilis treatment or no-treatment during pregnancy and (2) initiating treatment before 28 gestational weeks (GWs), initiating after 28 GWs or receiving no treatment for syphilis seropositive women. RESULTS: Among 1558 syphilis-exposed children, 39 had confirmed CS. Area under the curve, sensitivity and specificity of maternal non-treponemal titres before treatment and treatment during pregnancy were 0.80, 76.9%, 78.7% and 0.79, 69.2%, 88.7%, respectively, for children with CS. For the algorithm, ROC results showed that PPV and NPV for predicting CS were 37.3% and 96.4% (non-treponemal titres cut-off value 1:8 and no antisyphilis treatment), 9.4% and 100% (non-treponemal titres cut-off value 1:16 and treatment after 28 GWs), 4.2% and 99.5% (non-treponemal titres cut-off value 1:32 and treatment before 28 GWs), respectively. CONCLUSIONS: An algorithm using maternal non-treponemal titres and timing of treatment during pregnancy could be an effective strategy to diagnose or rule out CS, especially when the rate of loss to follow-up is high or there are no straightforward diagnostic tools.

Can a Multi-Component Intervention Improve Pediatric Service Delivery in Guangzhou?

Background: Accessible, equitable, and efficient pediatric service is critical to achieve optimal child health. This study aimed to evaluate the effectiveness of a multi-component intervention on the pediatric health system over two different periods in Guangzhou. Methods: Based on the World Health Organization (WHO) "six building blocks" model and Donabedian's "Structure-Process-Outcomes" framework, an intervention package was developed to increase financial and human resouce investment to strengthen basic health care and strive for a better quality of pediatric care. This multi-component intervention package was conducted in Guangzhou to improve the pediatric service delivery during two stages (2011-2014 and 2016-2019). The main outcome indicators were the changes in the allocation of pediatricians and pediatric beds, pediatric service efficiency, and the impact of pediatricians on child mortality. Results: We found that pediatricians per 1,000 children (PPTC) and pediatric beds per 1,000 children (PBPTC) increased from 1.07 and 2.37 in 2010 to 1.37 and 2.39 in 2014, then to 1.47 and 2.93 in 2019, respectively. Infant mortality rate (IMR) and under-5 mortality rate (U5MR) dropped from 5.46‰ and 4.04‰ in 2010 to 4.35‰ and 3.30‰ in 2014 then to 3.26‰ and 2.37‰ in 2019. The Gini coefficients of PPTC and PBPTC decreased from 0.48 and 0.38 in 2010, to 0.35 and 0.28 in 2014, then to 0.35 and 0.22 in 2019, respectively, representing the improvement of pediatric resources distribution according to service population. However, equalities in the spatial distribution were not improved much. The average efficiency of pediatric service fluctuated from 2010 to 2019. A unit increase in PPTC was associated with an 11% reduction in IMR and a 16% reduction in U5MR. Conclusions: Findings suggest this multi-component intervention strategy is effective, particularly on the reduction of child mortality. In future, more rigorous and multi-faceted indicators should be integrated in a comprehensive evaluation of the intervention.

Associations of Weight-Adjusted Body Fat and Fat Distribution with Bone Mineral Density in Chinese Children Aged 6-10 Years.

Although obesity is considered osteoprotective, the effects of body fat and fat distribution on bone tissue after adjusting for the effects of body weight remain uncertain. This study evaluated the relationships between fat mass, fat distribution, and bone mineral status beyond its weight-bearing effect. We recruited 466 children aged 6-10 years in China. Dual-energy X-ray absorptiometry was used to determine the bone mineral density (BMD) and bone mineral content (BMC) in the total body and total body less head (TBLH), as well as the fat mass (FM) and percentage fat mass (%FM) of the total and segmental body. Weight-adjusted measures of FM and %FM were derived using the residual method. After adjusting for the effects of covariates, we observed statistically significant, dose-dependent negative relationships between the TBLH·BMD/BMC and various weight-adjusted measures of body fat (p for trend: <0.001-0.038). For each standard deviation increment in the weight-adjusted total body, TBLH, trunk and limbs, the size-adjusted BMC decreased approximately 9.44, 9.28, 8.13, and 6.65 g in boys, respectively, and by approximately 13.74, 13.71, 7.84, and 12.95 g in girls, respectively. Significant inverse associations between FM accumulation in the total body and most body parts with the BMD/BMC were observed in both boys and girls after adjusting for weight and potential confounders.

Relationship Between Plasma Copper Concentration and Body Fat Distribution in Children in China: a Cross-Sectional Study.

This study aimed to explore the association of the plasma copper concentration with body fat distribution and the potential mediating effect of inflammation status in children. A total of 454 children were recruited in this study. Dual-energy X-ray absorptiometry was applied to measure the fat mass (FM) and fat mass percentages (FM%) at whole body, trunk, appendicular, android, and gynoid regions. Android to gynoid fat mass ratio and fat mass to lean mass (FM/LM) ratio at whole body, trunk, and appendicular sites were calculated. Plasma copper concentration was measured via inductively coupled plasma mass spectrometry. C-reactive protein (CRP) was determined by ELISA. After adjusting for covariates, multiple linear regression analyses showed that, for every additional unit increase in the plasma copper concentration, the FM, FM%, and FM/LM at whole body and subregions increased by 0.030-0.472 kg (P < 0.001-0.019), 0.013-1.04% (P = 0.007-0.042), and 0.021-0.030 (P < 0.001), respectively. Mediating analysis suggested that CRP significantly mediated 22.0-30.6% (P < 0.001) of the estimated association of copper with FM% and FM/LM at whole body and limbs. Thus, children with higher plasma levels of copper tended to have a higher regional and overall body fat deposition, and this relationship was partly mediated by inflammatory status.

Cohort protocol: Guangzhou High-Risk Infant Cohort study.

INTRODUCTION: Despite the increase in the survival rate of high-risk infants (HRIs) worldwide, the prevalence of motor and neurodevelopmental sequelae in such newborns has not shown concomitant improvement. Meanwhile, there are few cohorts that explore factors related to the development of HRIs in China. Therefore, the Guangzhou High-Risk Infant Cohort (GHRIC) has been designed to examine the complex relationships among a myriad of factors influencing growth and development in such children. METHODS AND ANALYSIS: The GHRIC study is a prospective cohort study that by the year 2023 will enrol an estimated total of 3000 HRIs from Guangzhou Women and Children's Medical Center (GWCMC) in Guangzhou, China. This study is designed to assess the growth and cognitive characteristics of HRIs and the risk factors affecting their development and prognoses. Data on risk factors, neurodevelopmental and cognitive-function evaluations, laboratory results, and specimens will be collected and analysed. Information on perinatal and clinical interventions for these infants will also be recorded during regular follow-up visits until age 6. ETHICS AND DISSEMINATION: The protocol for this study has been approved by the Research Ethics Committee of GWCMC, which accepted responsibility for supervising all of the aspects of the study (No. 2017102712). Study outcomes will be disseminated through conference presentations, peer-reviewed publications, the Internet and social media. TRIAL REGISTRATION NUMBER: ChiCTR-EOC-17013236.

The Effect of Different Treatment Regimens and Multiple Risk Factors on Adverse Pregnancy Outcomes among Syphilis-Seropositive Women in Guangzhou: A Retrospective Cohort Study.

BACKGROUND: To eliminate mother-to-child transmission of syphilis, the Chinese government recommends a treatment regimen that slightly differs from the World Health Organization- (WHO-) recommended treatment. However, little is known about their difference in efficacy. This study is aimed at comparing the effect of China-recommended and WHO-recommend treatment regimens on adverse pregnancy outcomes (APOs) and at examining associated risk factors of APOs among syphilis-seropositive women. METHODS: Using the syphilis registry data, we retrospectively collected data from 4488 syphilis-infected pregnant women in Guangzhou during 2011-2018. Multivariate analyses were used to investigate the association between treatment regimens and APOs (ectopic pregnancy, spontaneous abortion, stillbirth, preterm birth or low birth weight, newborn smaller than gestational age, congenital syphilis, and infant death) and the association between risk factors and APOs. RESULTS: Of 3474 participants, 27.3% had at least one APO. Compared to those receiving WHO-recommended treatment, women who received China-recommended treatment were less likely to have APOs (odds ratio (OR) 0.47, 95% confidence interval (CI) 0.38-0.57), whereas those who received no treatment had 1.6 times higher odds of experiencing APOs. One common risk factor across different APOs was high levels of log2-transformed toluidine red unheated serum test (TRUST) titers before treatment (OR 1.14, 95% CI 1.10-1.19). China-recommended treatment was effective in reducing APOs for those with TRUST ≥ 1 : 8 (OR 0.21, 95% CI 0.14-0.29) and those with TRUST < 1 : 8 (OR 0.62, 95% CI 0.50-0.77). CONCLUSIONS: Syphilis-seropositive women receiving China-recommended treatment had lower odds of APOs, especially when TRUST titers before treatment were high. Findings can be used to guide health professionals to reduce APOs among syphilis-infected mothers and promote nationwide use of China-recommended treatment.

Clinical and molecular characteristics of carnitine-acylcarnitine translocase deficiency: Experience with six patients in Guangdong China.

Carnitine-acylcarnitine translocase deficiency (CACTD) is a rare autosomal recessive disorder of mitochondrial fatty acid oxidation that occurs due to mutations in the SLC25A20 gene. Severe CACTD results in neonatal or infantile sudden death. Herein, we reported six patients with CACTD diagnosed based on biochemical and molecular findings from 5 unrelated families in Guangdong from 2016 to 2017. Among them, five patients presented with hypotonia, nonketotic hypoglycemia, and arrhythmia 2 days after birth, while the other patient presented with respiratory distress, hypotonia, and arrhythmia. Five of the patients died in the neonatal period. Blood acylcarnitine concentrations determination from dried blood spots (DBS) were measured by tandem mass spectrometry (MS/MS). The SLC25A20 and CPT2 gene sequences were analyzed by direct Sanger sequencing. SLC25A20 gene analysis revealed a c.199-10T>G (IVS2-10T>G) homozygous variants in four unrelated patients and a novel mutation c.199-10T>G/c.719-8_c.719-1dupCCCACAG compound heterozygous variants in twins. This report describes the clinical characteristics, biochemical findings and molecular analysis of SLC25A20 gene of patients with CACTD in Guangdong. And our results show that the c.199-10T>G is likely the most common variant of CACTD in Guangdong population as it accounts for 83% (10/12) of the observed mutant alleles. Individuals with the c.199-10T>G genotype had a severe CACTD phenotype.

Effectiveness of a Kindergarten-Based Intervention for Preventing Childhood Obesity.

BACKGROUND AND OBJECTIVES: Interventions to prevent childhood obesity targeting school age children have mostly reported limited effectiveness, suggesting such prevention programs may need to start at an earlier age, but evidence has been scarce. We reported a pilot study aiming to demonstrate the feasibility of a multifaceted intervention for preschool children and to provide a preliminary assessment of the effectiveness. METHODS: This nonrandomized controlled trial recruited children aged 3 to 6 years from 6 kindergartens in Guangzhou, China. Based on the preference of the School and Parents Committees, 4 kindergartens (648 children) received a 3-component intervention (training of kindergarten staff, initiating healthy curriculum for children, and close collaboration between families and kindergartens) over 12 months, while the other 2 kindergartens (336 children), serving as controls, received routine health care provision. Outcome measures were the changes in BMI z score between baseline and the end of 12 months, and the prevalence of postintervention children who were overweight or obese. RESULTS: By 12 months, children within the intervention group had a smaller BMI z score increase (0.24) compared to the control (0.41), with a difference of -0.31 (95% CI -0.47 to -0.15). The prevalence of overweight or obesity was also lower among the intervention group at the end of the study (OR: 0.43, 95% CI 0.19 to 0.96), adjusted for baseline status. CONCLUSIONS: Our results indicated a multicomponent health behavior intervention might be effective in reducing the prevalence of obesity, but the longer term effects will need confirmation from randomized controlled trials.

[Epidemiological study on the trend of accidental deaths among children under five in Guangzhou, 2001 - 2010].

OBJECTIVE: To study the trend of accidental death among children under 5 years of age. METHODS: A survey on accidental death among children was performed in Guangzhou to compare the data from the national monitoring program on the deaths under five in the same period during 2001 - 2010. Data on mortality and causes of injures were adjusted by missing reports. RESULTS: Mortality rates on injuries were decreasing annually from 2001 to 2010. Comparing with 2001, the magnitude of the drop in mortality among the 0, 1 - 4 and under 5 year groups were 72.02%, 77.17% and 74.66% respectively, with statistically significant differences (P = 0.000). During the 10 years of observation, data showed a dropping trend (P = 0.000) of the mortalities on drowning, traffic accident, suffocation and falling, especially on drowning and suffocation. The main causes of death were suffocation in the 0 year group, drowning in the 1-2-year group, traffic accident and poisoning in the 3-year group, traffic accident and falling in the 4-year group. The accidental deaths happened in 'C area' which including Huadu, Conghua, Zengcheng, Panyu and Nansha, with the total proportion of accidental death in Guangzhou as 75.69%. CONCLUSION: The mortality of accidental deaths among children under 5 years of age in Guangzhou had been decreasing during 2001 - 2010, mainly owing to the practice of intervention programs on drowning and suffocation, suggesting the necessity of integrating the health education programs on accidental injury with the healthcare management system in children in the country, focusing on the suburban and county levels where economy was relatively undeveloped or with more floating population.

[Study on the status of unintentional injuries in children under age 7 in Guangzhou].

OBJECTIVE: To understand the prevalence and distribution of unintentional injuries in children under age 7 in Guangzhou. METHODS: Data was descriptively analyzed from the Guangzhou Unintentional Injuries Surveillance System among 470 770 children under age 7 living scatter or collectively. RESULTS: The incidence rates of unintentional injuries among children in Guangzhou was 1.48%, among which the incidence rates were: living scatter as 1.11% living collectively as 1.66%, living in urban areas as 1.36% in rural as 2.52%. In order, the proportion of main causes of children's unintentional injuries were as follows: falls (70.54%), animal injuries (8.48%), burn and scald (5.75%), blunt force injuries (3.92%), and road traffic injuries (RTIs) (3.48%). The main body parts being injured were head and face (60.00%), wrist and hand (15.48%), knee and leg (11.70%), elbow and forearm (4.54%), shoulder and arm (2.99%). The degrees of children's unintentional injuries were as follows: mild impairment (85.35%), moderate impairment (9.12%), and severe impairment (0.57%). Places that the patients went were as follows: hospital outpatient department or emergency room (49.66%), inpatient department or ICU (2.06%), home and kindergarten (43.34%). CONCLUSION: The overall incidence rate of children's unintentional injuries under age 7 in Guangzhou was 1.48%, with main causes as fall, animal injuries, burn and scald, blunt force injuries, and RTIs. There were considerable differences of characteristics and distributions on age and areas among the patients.