Analysis of Pediatric Surgical Disease Spectrum in a Tertiary Hospital.

Objective: To analyze the main disease composition of children hospitalized in pediatric surgery, explore the correlation between disease types and gender, and provide a reference for hospital management and pediatric disease prevention. Methods: Using ICD-10 codes as the classification standard for disease diagnosis, a statistical analysis was conducted on the disease composition of children hospitalized in the Pediatric Surgery Department of the Second Affiliated Hospital of Xi'an Jiaotong University from January 1, 2015, to December 31, 2015, followed by the establishment of a clinical database. A total of 1647 male patients and 817 female patients were enrolled in the study, resulting in a male-to-female ratio of 2:1. The age range of the patients spanned from 0 to 18 years, with a marked imbalance in patient distribution among the various age groups. Statistical analysis was conducted using SPSS version 18.0 software. A chi-square test was performed to analyze the differences in the composition of disease systems and the composition of major diseases in terms of sex and age. Results: Pediatric patients were admitted with complex and diverse diseases in 2015, involving 15 systems of the human body and 400 diseases. Digestive system diseases, tumors, congenital malformations, and genitourinary system diseases were the top four diseases accounting for 83.5% of all pediatric cases. 561 patients were aged 0 years, accounting for 22.3% of all cases, while 1,801 patients fell within the 0-5 years age group, constituting 73.1% of the total. The differences in disease system composition among different sex and age groups of pediatric surgical inpatients were statistically significant (P = .001). There are statistically significant differences in the length of hospital stay and hospitalization costs among pediatric surgical inpatients in different age groups (P = .001). Conclusion: To strengthen the diagnosis and treatment of pediatric surgical diseases, we should strengthen the construction of key departments, optimize the consultation process according to the characteristics of children's disease spectrum, and improve the level of diagnosis and treatment of pediatric surgical diseases.

[Effects of DNMT3A gene mutations on prognosis of patients with acute myeloid leukemia: a meta-analysis].

OBJECTIVE: To evaluate the effects of DNMT3A gene mutation on prognosis of patients with acute myeloid leukemia (AML) by a meta-analysis. METHODS: Methods of Cochrane systematic review was followed by 7 databases,including PubMed, Embase, Ovid, CNKI, CBM, WanFang Data and VIP, were searched for peer-reviewed articles related to DNMT3A gene mutations and prognosis of patients with AML.Then manual retrieval was applied into literature references. After the evaluation of quality and extract of clinical trialliterature data, Stata 11.0 was employed to perform meta-analysis. RESULTS: Seven randomized controlled trials involving 1493 cases were included in the meta-analysis. The prognosis of patients with DNMT3A mutations and without DNMT3A mutations was compared. There was no statistically significant difference in complete remission(CR) rate (OR=1.034, 95%CI: 0.596~1.796, P=0.905 between two groups, but the overall survival (OS（HR=1.990, 95%CI: 1.463~2.510, P=0.000 and disease free survival (DFS) (HR= 2.840, 95%CI: 1.063~4.613, P=0.002) of patients without DNMT3A mutations were longer than those with DNMT3A mutation. CONCLUSION: DNMT3A gene mutation is an independent risk factor of poor prognosis of patients with acute myeloid leukemia.

[Association between the distribution of feeding index and physical development of infants and young children aged 6-35 months in rural areas of Lhasa in 2010].

OBJECTIVE: Using infant and child feeding index (ICFI) to evaluate the relationship between infant feeding and physical development indicators in rural areas of Lhasa. METHODS: In July and August 2010 in the rural areas of Lhasa, the multi-stage cluster random sampling method was adopted to select 540 Tibetan children who were between 6 to 35 months of age. There were 70, 79 and 391 cases in 6 to 8, 9 to 11 and 12 to 35-month-old group respectively. The basic status of infants, information about breastfeeding and complementary feeding were collected by using designed questionnaires. Their height and weight were measured to calculate the children's weight for age Z-score (WAZ), height for age Z-score (HAZ) and weight for height Z-score (WHZ) and assess feeding index score (out of 17 scores) and analyze the relationship between feeding index and HAZ, WAZ and WHZ. RESULTS: The mean ICFI score of 540 cases was 8.90 ± 2.82.It was 6.84 ± 3.16, 8.16 ± 2.78 and 9.41 ± 2.55 for 6 to 8, 9 to 11 and 12 to 35-month-old infants respectively. There was significant difference between the different month group (F = 30.99, P < 0.05).For the three month groups, the scores of WAZ were 0.10 ± 1.18, -0.09 ± 1.20 and -0.38 ± 0.96; HAZ were -0.60 ± 1.68, -1.02 ± 1.72 and -1.30 ± 1.30; WHZ were 0.62 ± 1.23, 0.69 ± 0.96 and 0.43 ± 0.95 respectively. The ICFI scores of 9 to 11, 12 to 35 and 6 to 35-month-old infants were positively correlated with HAZ (correlation coefficients were 0.25,0.12 and 0.09 respectively, all P values <0.05). There was no correlation with WAZ (correlation coefficients were 0.15,0.08 and 0.03 respectively, all P values >0.05) and WHZ (correlation coefficients were -0.08, -0.02, and -0.07 respectively, all P values >0.05). There were no correlation between ICFI score with HAZ, WAZ and WHZ for 6 to 8 month-old infants (correlation coefficient were 0.06,0.16 and -0.07 respectively, all P values >0.05). CONCLUSION: To some extent, the feeding index can effectively reflect the growth status of these infants and can serve as a comprehensive assessment of feeding situations among Tibetan children in rural areas of Lhasa.

[Analysis on growth and malnutrition status of Tibetan children aged 0 to 35 months in rural Lhasa in 2010].

OBJECTIVE: To understand the growth and malnutrition status of Tibetan children aged 0 to 35 months in rural Lhasa in 2010. METHODS: Cross-sectional study and multistage sampling design were used to randomly select sampling units. A total of 640 children were studied. Height and weight were measured and nutritional status was evaluated with WHO reference in 2006 using Z-scores. Z-scores of weight-for-age (WAZ), Z-scores of height-for-age (HAZ) and Z-scores of weight-for-height (WHZ) were analyzed. RESULTS: At the age of 18 - 35 months, the children in rural Lhasa were 3.0 cm shorter as compared to the China national length reference. At the age of 6 - 11, 12 - 17 months, weight ((8.84 ± 1.23) and (10.20 ± 1.08) kg) and length ((70.45 ± 4.46) and (76.73 ± 4.78) cm) of boys were significantly higher than girls (weight: (8.42 ± 1.30) and (9.59 ± 1.26) kg; length: (67.61 ± 3.98) and (74.25 ± 4.50) cm) (all P values < 0.05). WAZ and HAZ were -0.17 ± 1.11 and -1.11 ± 1.46, respectively. The HAZ of 18 - 23 months children (-1.51 ± 1.24) was significantly different from the HAZ of 0 - 5, 6 - 11, 12 - 17 months children (HAZ: -0.75 ± 1.50, -0.83 ± 1.72, -1.07 ± 1.55, respectively) (all P values < 0.05), comparison with the HAZ of 24 - 29, 30 - 35 months children (HAZ: -1.41 ± 1.25, -1.24 ± 1.05), the results showed that there were no significant difference (all P values > 0.05), HAZ of 18 - 23 months children was the lowest. The prevalence of stunting, underweight, and wasting were 24.6% (155/630), 5.4% (33/616) and 1.0% (6/608), respectively. The malnutrition of boys was more serious than that of girls, the stunting of 18 - 23 and 24 - 29 months children had reached 35.0% (36/103) and 29.1% (25/86), respectively. CONCLUSION: The growth and development status of children in rural Lhasa under 3 years old was poor, and the malnutrition of local children should not be ignored with variations by gender and months of age.

[Mercury Distribution of Benthonic Animals and Response to Mercury in Sediments in Caohai Wetland, Guizhou Province].

Caohai wetland is a National Nature Reserve. Benthic animals were collected from the deep-water area in the middle of Caohai Lake and the shallow-water area in the surrounding marshes, and mercury and methyl mercury distributions in the benthic animals were analyzed and discussed. The risk of mercury pollution was evaluated. The concentrations of total mercury and methyl mercury in the benthonic animals were in the range of 0.51-46.55 ng·g-1 with an average of 7.82 ng·g-1 and 0.04-27.71 ng·g-1 with an average of 4.31 ng·g-1, respectively. This was lower than reports from other natural reserves. By contrast, the total mercury and methyl mercury in the benthic animals in summer were higher than in other seasons, which was consistent with the characteristics of methyl mercury distribution in sediments but opposite to the spatial distribution characteristics of total mercury in sediments. The methyl mercury contents in Cipangopaludina cathayensis were positively correlated with the content of methyl mercury in the sediments (r=0.52, P<0.05). The results showed methylation and the bioavailability of mercury in sediments from the shallow-water area were obviously higher than those from the deep-water area in the middle of Caohai Lake. The difference in organic matter content of the sediment or the wet-dry alternation (flooding-receding-flooding) in the surrounding shallow marshes was suspected to be associated with the obvious difference. The high enrichment coefficient of total mercury and methyl mercury in benthic animals were sufficient to raise the risk of mercury contamination in the aquatic food chain in the wetland.

Prevalence and possible risk factors of low bone mineral density in untreated female patients with systemic lupus erythematosus.

Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by chronic inflammation. Different studies have shown decreased bone mineral density (BMD) in patients with SLE. The objective of this study was to investigate the prevalence and possible risk factors of low BMD in untreated female patients with SLE in Chinese population. A total of 119 untreated female patients with SLE were included. BMD was measured at lumbar spine and at total hip by dual-energy X-ray absorptiometry. The associations between decreased BMD and demographic variables, clinical variables, and bone metabolism variables were analyzed. These SLE patients had the following characteristics: mean age was 32.6 ± 11.9 years, mean disease duration was 22.1 ± 34.5 months, and mean SLEDAI was 11.4 ± 5.4. Osteopenia was present in 31.1% of the patients and osteoporosis in 8.5%. A significant negative association between low density lipoprotein cholesterol (LDL-c) and BMD at the lumbar spine (correlation coefficient = -0.242; P = 0.023) and total hip (correlation coefficient = -0.259; P = 0.019) was shown. These results seem to indicate that increased LDL-c may be an important risk factor for low BMD at lumbar spine and total hip in untreated female SLE patients.

[Ethnic differences on nutritional status of children under 3 years old in poor counties of the western China].

OBJECTIVE: To explore the ethnic differences on nutritional status of children under three years old, in the western areas of China and to identify the affecting factors. METHODS: 14 072 children under the age of three years and their mothers were recruited, using the proportion population sampling method in 45 counties in the western areas of China. Height and weight were used as the measurement on nutrition of children. RESULTS: Height and weight of children with Han, Uyghur, Tibetan and Zhuang ethnicities were all lower than the WHO standards and with differences on height and weight among them. There were also ethnic differences on the status of malnutrition. Prevalence rates of stunting were 14.7%, 20.3%, 26.9% and 26.5% for Han, Uyghur, Tibetan and Zhuang ethnicities, respectively. Prevalence rates of underweight were 6.1%, 10.7%, 6.8% and 15.5% among the Han, Uyghur, Tibetan and Zhuang ethnicities, respectively. The prevalence rates of wasting were 4.2%, 5.3%, 2.9%, 8.9%, and of under nutrition were 19.2%, 25.5%, 30.3% and 36.5% for the Han, the Uyghur, the Tibetan and the Zhuang ethnicities, respectively. When factors as family size, years of schooling of parents, family numbers, sex, age (months), mother's height and weight, ways of feeding and sources of family income etc. were adjusted, children with Uyghur, Tibetan, Zhuang and other ethnicities were still presented more malnutrition than the children with Han ethnicity. CONCLUSION: There were differences on malnutrition status of children under the age of three years among the studies on different ethnicities. Undernutrition was less than nutritional status, seen in children of the Han nationality than other minority ethnicities. Ethnicity seemed to be related to differences in the nutritional status of children in western China while children of the Han nationality would be better than other minorities on nutritional status if they were in same living conditional.

[Investigation on the unintentional injuries among rural children in Shaanxi province].

OBJECTIVE: To investigate the current status of unintentional injuries among rural children aged 0 - 12 years in Shaanxi. METHODS: Using a three-stage stratified random sampling method to study the status of unintentional injuries among 4668 children aged 0 - 12 years old during the period of 2010 in rural areas of Shaanxi province. RESULTS: The overall incidence of injure was 27.3%, with boys as 28.7% and girls as 25.6% respectively (χ(2) = 5.91, P = 0.015). Age differences in unintentional injuries rate were also significant (χ(2) = 9.91, P = 0.007), with children under 0 - 3 years old having the highest rate of injuries, followed by 7 - 12 and 4 - 6 year-olds. Falls took the leading type of accident among both sexes and all age groups. Poorer the family economic situation was, higher the incidence of unintentional injuries appeared. CONCLUSION: Falls was the leading cause of unintentional injuries among rural children in Shaanxi province, with age 0 - 3 year group appeared the highest to suffer unintentional injuries. Unintentional injuries were associated with the economic status of the families.

[Study on the current status and risk factors of spontaneous abortion of women at reproductive age in rural areas of Xianyang district, Shaanxi province].

OBJECTIVE: To study the current status and risk factors of spontaneous abortion of women at reproductive age in rural areas of Shaanxi province. METHODS: Pregnant women who lived in Changwu and Bin counties of Shaanxi province were interviewed on their former reproductive history and being followed on the outcomes of pregnancy from 2002 to 2005. RESULTS: There were 5844 pregnant women under study with a total number of 9638 pregnancies including 1153 spontaneous abortive episodes. Among the pregnant women in rural areas of Shaanxi province, the ratio between spontaneous abortion and pregnancies was 12.0% and the spontaneous abortion rate(SAR) was 13.6%. Ratio between the number of women who had experienced spontaneous abortion and the total number of women under survey was 16.4 %. The risks of having spontaneous abortion would increase among women who were aged > or =30 years and those with more than 3 pregnancies. CONCLUSION: To reduce the incidence of spontaneous abortion among rural area women, the approaches should include: strengthening the family planning management, reducing of the frequency of pregnancy, extending the pregnancy interval and avoiding advanced ageing pregnancies.

[Epidemiological features of spontaneous abortion among reproductive Tibetan women living at high altitudes areas].

OBJECTIVE: To study the status of spontaneous abortion among reproductive Tibetan women aged 15 - 49 years. METHODS: A cross-sectional survey was conducted on reproductive history of Tibetan women and the sample was chosen under the stratified multistage cluster random sampling technique. RESULTS: A total number of 3741 women were studied with a total number of 10,245 pregnancies. There were 386 spontaneous abortions reported with an incidence rate of 3.9%. Women living in the urban area had a higher rate than living in the rural areas. Women living in area where altitudes were above 4500 m, had a 2-time risk of having spontaneous abortion than those living in areas below 3500 m. The risk of having spontaneous abortion increased among women aged > or = 35 and those with more than 3 pregnancies. CONCLUSIONS: High altitude could contribute to the increase of spontaneous abortions incidence, suggesting that improvement of maternal care and nutrition and reduction of the frequency of pregnancy had important roles to play in reducing the incidence of spontaneous abortion among Tibetan women. Despite the fact that retrospective study on reproductive history could underestimate the incidence of spontaneous abortion, the incidence rate among Tibetan women might not be much higher than women living in the lowland areas.

[Assessment on nutritional status among children under 3 years using anthropometry in 40 counties of western China].

OBJECTIVE: To assess nutritional status among children younger than 3 years in 40 counties of western China, using anthropometry. METHODS: With cross-sectional study and random sampling, a survey with a sample size of 7252 was conducted in 40 counties of western China on children under 3 years old. Height and weight were measured and nutrition status was evaluated with WHO/NCHS reference using Z scores. RESULTS: SD of height for age (HA) and weight for age (WA) were 1.10 - 1.30 and 1.06 - 1.40, respectively and SD of WAZ for infants varied. The distribution of HA Z and WAZ shifted downward to 1 unit and 0.4 unit for distribution of weight for height (WHZ). The prevalence of stunting, underweight and wasting were 23.0%, 22.6% and 7.5% respectively. The prevalence rates were low among those yourger than 3 months. Stunting and underweight increased sharply after 6 months and reached 20% - 30%. Significant correlation was found between underweight and stunting or wasting with coefficients of 0.815 and 0.636, respectively. No correlation was found between stunting and wasting. CONCLUSION: The nutrition status adversely affected children as a whole but not only for individuals. There was a higher prevalence of malnutrition mainly on low height to children. Weight for age must be interpreted cautiously because of the inability of this indicator in distinguishing stunting and wasting just by itself. Assessment by anthropometry called for accurate information on age and measurement of height and weight.

[The introduction of complementary food of children under the age of three years in Tibet of China].

OBJECTIVE: To understand the feeding status of Tibetan children aged below three years old. METHODS: Cross-sectional study and randomly sampling were used. The information on complementary food was obtained through the recollection from mother of the child. Data of complementary food of Tibet children was compared with those of the children from the surveys of nine cities in China and 40 poor counties in western China. RESULTS: One thousand six hundred and fifty-five children were studied. The findings indicated that the age of introduction of Zanba (a kind food of mixture of highland barley flour and butter) was 1.98 months after birth and the age of introduction of egg and meat was about 8 - 9 months. Boys were fed with Zanba earlier than girls but there was no significant difference in the introduction of other complementary food between sexes. Urban children were introduced with complementary food earlier than rural children, and children in the agricultural region earlier than those in the pasturing region. The proportion of no introduction of any complementary food by the age of 4 months was about 10.6% for urban children, but 21.7% for rural children while 14.2% for children in the agricultural region and 30.9% for children in the pasturing region. The proportion of no introduction of complementary food was 11.5% for Tibetan children compared with 45.2% for the children of 40 poor counties in western China. The proportions of introduction of the following complementary foods were 89.1% for Zanba, 22.1% for egg, 29.1% for fresh milk, 23.5% for meat, 17.5% for vegetable, 0.75% for bean products, 1.03% for fish and 3.35% for chicken respectively. CONCLUSIONS: The main complementary foods for Tibetan children included Zanba, milk, mutton and beef. There was a small amount of vegetable in diet. The introduction of bean, chicken and fish was not common. Early and monotony seemed to be the character of introduction of complementary food for Tibetan children. Improving introduction of complementary food is important in enhancing the nutritional status of Tibetan children.

[Analysis on the prevalence of anemia among children under 3-year-old in 5 provinces in Western China].

OBJECTIVE: To understand the prevalence of anemia in children living in poor rural villages in western China and to find out related factors affecting hemoglobin level of children so as to search for proper intervention. METHODS: 3747 children under 3 years old and their families were studied using stratified random sampling in 40 counties in western China. Databases were set up, and data logically checked by Epi 6.0 software. All the data were input with duplication method and analyzed by SPSS 10.0 software. RESULTS: The prevalence of anemia of children under 3-year-old was 32.7% in 40 counties with significant difference among provinces with the highest in Guizhou province (43.5%). The lowest was in Ningxia and Qinghai provinces, which was 20%. The prevalence of anemia of children was relatively high in 6 and 18 months of age after birth, but declining when children grew older. Many factors were associated with children's anemia, viz. feeding pattern, age, diarrhea, family income, nationality, mother with anemia and drinking clean water etc. CONCLUSION: Interventions as popularizing knowledge of appropriate feeding, drinking clean water and decreasing the prevalence of common diseases including diarrhea would decrease the prevalence of anemia of local children.