Assessment of serum vitamin D levels in children aged 0-17 years old in a Chinese population: a comprehensive study.

Vitamin D deficiency and insufficiency pose global public health challenges, yet research on serum vitamin D levels in the 0-17-year-old age group in southeastern China remains limited. This study aimed to fill this gap by investigating serum 25(OH)D levels in children in the region aged 0-17 years, contributing crucial data for understanding vitamin D nutritional status. Liquid chromatography‒mass spectrometry/mass spectrometry (LC‒MS/MS) technology was used. Vitamin D testing was integrated into routine diagnostic procedures for 11,116 children in Wujiang District, Suzhou City. Among the 0-17-year age group, comprising 6348 boys and 4768 girls, the prevalence of serum 25(OH)D deficiency and insufficiency was 21.4% and 31.0%, respectively. The median serum 25(OH)D concentration was 29.72 ng/mL (21.84-39.84 ng/mL) in boys compared to 28.48 ng/mL (20.65-39.23 ng/mL) in girls. Seasonal variations were observed, with median serum 25(OH)D concentrations of 29.02 ng/mL (20.73-39.72 ng/mL) in spring, 28.79 ng/mL (21.53-39.37 ng/mL) in summer, 30.12 ng/mL (22.00-39.70 ng/mL) in autumn, and 28.58 ng/mL (19.97-39.46 ng/mL) in winter. Statistically significant differences were noted in the serum 25(OH)D levels during autumn and winter. In conclusion, the rate of adequate vitamin D levels in local children was 47.5%, revealing a relatively high prevalence of vitamin D deficiency (21.4%) and insufficiency (31.0%), especially during the post-preschool period. Advocating for vitamin D supplementation in children is crucial for ensuring adequate vitamin D support.

Prenatal MRI assessment of mediastinal shift angle as a feasible and effective risk stratification tool in isolated right-sided congenital diaphragmatic hernia.

OBJECTIVES: To develop a mediastinal shift angle (MSA) measurement method applicable to right-sided congenital diaphragmatic hernia (RCDH) in fetal MRI and to validate the predictive value of MSA in RCDH. METHODS: Twenty-seven fetuses with isolated RCDH and 53 controls were included in our study. MSA was measured on MRI axial image at the level of four-chamber view of the fetal heart. The angle between the sagittal midline landmark line and the left boundary landmark line touching tangentially the lateral wall of the left ventricle was used to quantify MSA for RCDH. Appropriate statistical analyses were performed to determine whether MSA can be regarded as a valid predictive tool for postnatal outcomes. Furthermore, predictive performance of MSA was compared with that of lung area to head circumference ratio (LHR), observed/expected LHR (O/E LHR), total fetal lung volume (TFLV), and observed/expected TFLV (O/E TFLV). RESULTS: MSA was significantly higher in the RCDH group than in the control group. MSA, LHR, O/E LHR, TFLV, and O/E TFLV were all correlated with postnatal survival, pulmonary hypertension (PH), and extracorporeal membrane oxygenation (ECMO) therapy (p < 0.05). Value of the AUC demonstrated good predictive performance of MSA for postnatal survival (0.901, 95%CI: (0.781-1.000)), PH (0.828, 95%CI: (0.661-0.994)), and ECMO therapy (0.813, 95%CI: (0.645-0.980)), which was similar to O/E TFLV but slightly better than TFLV, O/E LHR, and LHR. CONCLUSIONS: We developed a measurement method of MSA for RCDH for the first time and demonstrated that MSA could be used to predict postnatal survival, PH, and ECMO therapy in RCDH. CLINICAL RELEVANCE STATEMENT: Newly developed MRI assessment method of fetal MSA in RCDH offers a simple and effective risk stratification tool for patients with RCDH. KEY POINTS: • We developed a measurement method of mediastinal shift angle for right-sided congenital diaphragmatic hernia for the first time and demonstrated its feasibility and reproducibility. • Mediastinal shift angle can predict more prognostic information other than survival in right-sided congenital diaphragmatic hernia with good performance. • Mediastinal shift angle can be used as a simple and effective risk stratification tool in right-sided congenital diaphragmatic hernia to improve planning of postnatal management.

Diagnostic Accuracy of the Eating Assessment Tool-10 (EAT-10) in Screening Dysphagia: A Systematic Review and Meta-Analysis.

The Eating Assessment Tool-10 (EAT-10) is used worldwide to screen people quickly and easily at high risk for swallowing disorders. However, the best EAT-10 cutoff value is still controversial. In this systematic review and meta-analysis, we estimated and compared the diagnostic accuracy of EAT-10 cutoff values of 2 and 3 for screening dysphagia. We searched the PubMed, Web of Science, EMBASE, Cochrane Library, CNKI, WANFANG, and VIP databases from May 2008 to March 2022. The meta-analysis included 7 studies involving 1064 subjects from 7 different countries. Two studies were classified as high quality and five studies as medium quality. With an EAT-10 cutoff value of 2, using flexible endoscopic evaluation of swallowing or video fluoroscopic swallowing study as the gold standard, the pooled sensitivity, specificity, positive and negative likelihood ratios, and diagnostic odds ratio were 0.89 (95% confidence interval [CI] 0.82-0.93), 0.59 (95% CI 0.39-0.77), 2.17 (95% CI 1.38-3.42), 0.19 (95% CI 0.13-0.29), and 11.49 (95% CI 5.86-22.53), respectively. When a cutoff of 3 was used, these values were 0.85 (95% CI 0.68-0.94), 0.82 (95% CI 0.65-0.92), 4.84 (95% CI 1.72-13.50), 0.18 (95% CI 0.07-0.46), and 26.24 (95% CI 5.06-135.95), respectively. Using EAT-10 cutoff values of 2 and 3, the areas under the curve were 0.873 (95% CI 0.82-0.93) and 0.903 (95% CI 0.88-0.93), respectively, showing good diagnostic performance. EAT-10 can be used as a preliminary screening tool for dysphagia. However, a cutoff of 3 is recommended for EAT-10 due to better diagnostic accuracy.

Gain-of-function mutations in ALPK1 cause an NF-κB-mediated autoinflammatory disease: functional assessment, clinical phenotyping and disease course of patients with ROSAH syndrome.

OBJECTIVES: To test the hypothesis that ROSAH (retinal dystrophy, optic nerve oedema, splenomegaly, anhidrosis and headache) syndrome, caused by dominant mutation in ALPK1, is an autoinflammatory disease. METHODS: This cohort study systematically evaluated 27 patients with ROSAH syndrome for inflammatory features and investigated the effect of ALPK1 mutations on immune signalling. Clinical, immunologic and radiographical examinations were performed, and 10 patients were empirically initiated on anticytokine therapy and monitored. Exome sequencing was used to identify a new pathogenic variant. Cytokine profiling, transcriptomics, immunoblotting and knock-in mice were used to assess the impact of ALPK1 mutations on protein function and immune signalling. RESULTS: The majority of the cohort carried the p.Thr237Met mutation but we also identified a new ROSAH-associated mutation, p.Tyr254Cys.Nearly all patients exhibited at least one feature consistent with inflammation including recurrent fever, headaches with meningeal enhancement and premature basal ganglia/brainstem mineralisation on MRI, deforming arthritis and AA amyloidosis. However, there was significant phenotypic variation, even within families and some adults lacked functional visual deficits. While anti-TNF and anti-IL-1 therapies suppressed systemic inflammation and improved quality of life, anti-IL-6 (tocilizumab) was the only anticytokine therapy that improved intraocular inflammation (two of two patients).Patients' primary samples and in vitro assays with mutated ALPK1 constructs showed immune activation with increased NF-κB signalling, STAT1 phosphorylation and interferon gene expression signature. Knock-in mice with the Alpk1 T237M mutation exhibited subclinical inflammation.Clinical features not conventionally attributed to inflammation were also common in the cohort and included short dental roots, enamel defects and decreased salivary flow. CONCLUSION: ROSAH syndrome is an autoinflammatory disease caused by gain-of-function mutations in ALPK1 and some features of disease are amenable to immunomodulatory therapy.

Performance of Passive Muscle Stiffness in Diagnosis and Assessment of Disease Progression in Duchenne Muscular Dystrophy.

The aim of this study was to evaluate the performance of passive muscle stiffness in diagnosing and assessing disease progression in Duchenne muscular dystrophy (DMD). Boys with DMD and age-matched controls were recruited. Shear wave elastography (SWE) videos were collected by performing dynamic stretching of the gastrocnemius medius (GM). At ankle angles from plantar flexion (PF) 30° to dorsiflexion (DF) 20°, the shear modulus of the GM was measured for each 10° of ankle movement. Shear modulus at each ankle angle was compared between the DMD and control group. Correlation between passive muscle stiffness and motor function grading was also analyzed. A total of 26 patients with DMD and 20 healthy boys were enrolled. At multiple stretch levels, passive muscle stiffness of the GM was significantly higher in patients with DMD than in those in the control group (all p values <0.05). The shear modulus of GM at an ankle angle of DF 10° had the largest area under the receiver operating characteristic curve in differentiating DMD patients from normal subjects (AUC = 0.902, 95% confidence interval: 0.814-0.990). Motor function grading was a significant determinant of passive muscle stiffness at an ankle angle of DF 10° (B = 21.409, t = 3.372, p = 0.003). Passive muscle stiffness may potentially serve as a useful non-invasive tool to monitor disease progression in DMD patients.

Ultrasonic Assisted Extraction of Paclitaxel from Taxus x media Using Ionic Liquids as Adjuvants: Optimization of the Process by Response Surface Methodology.

(1) Background: Ionic liquids (ILs) are considered "green" solvents and have been widely used in the extraction and separation field in recent years; (2) Methods: In this study, some common ILs and functionalized magnetic ionic liquids (MILs) were used as adjuvants for the solvent extraction of paclitaxel from Taxus x media (T. x media) using methanol solution. The extraction conditions of methanol concentration, IL type and amount, solid-liquid ratio, extraction temperature, and ultrasonic irradiation time were investigated in single factor experiments. Then, three factors of IL amount, solid-liquid ratio, and ultrasonic irradiation time were optimized by response surface methodology (RSM); (3) Results: The MIL [C4MIM]FeCl3Br was screened as the optimal adjuvant. Under the optimization conditions of 1.2% IL amount, 1:10.5 solid-liquid ratio, and 30 min ultrasonic irradiation time, the extraction yield reached 0.224 mg/g; and (4) Conclusions: Compared with the conventional solvent extraction, this ultrasonic assisted extraction (UAE) using methanol and MIL as adjuvants can significantly improve the extraction yield, reduce the use of methanol, and shorten the extraction time, which has the potentiality of being used in the extraction of some other important bioactive compounds from natural plant resources.

Assessment of the effect of short-term factors on surgical treatments for hypertensive intracerebral haemorrhage.

BACKGROUND: Hypertension is the most common cause of intracerebral haemorrhages (ICHs), yet the short-term impact factors associated with hypertensive intracerebral haemorrhages (HICHs) in patients who undergo different surgical treatments are still unknown. MATERIALS AND METHODS: All consecutive patients with acute HICHs admitted to our hospital from January 2012 to March 2015 were enrolled in the study. Patients were either randomly divided or assigned according to their family's preference into three groups (those undergoing minimally invasive aspiration, keyhole craniotomy or haematoma aspiration with extended pterional and decompressive craniotomy). Patients' information and clinical characteristics were collected to identify risk factors influencing the short-term effects of the procedures. RESULTS: There were significant differences among the groups: haematoma aspiration with extended pterional and decompressive craniotomy was the optimal method, resulting in fewer complications, higher Glasgow Outcome Scale (GOS) scores and better short-term outcomes. Surgical treatment, Glasgow Coma Scale (GCS) scores, haemorrhage volume and degree of midline shift were risk factors for the short-term effects associated with HICH. CONCLUSIONS: Haematoma aspiration with extended pterional and decompressive craniotomy is suitable for treating HICH patients. Surgical treatment, GCS score, haemorrhage volume and degree of midline shift influence the short-term effects observed following HICH surgery.

Novel sequencing-based strategies for high-throughput discovery of genetic mutations underlying inherited antibody deficiency disorders.

Human inherited antibody deficiency disorders are generally caused by mutations in genes involved in the pathways regulating B-cell class switch recombination; DNA damage repair; and B-cell development, differentiation, and survival. Sequencing a large set of candidate genes involved in these pathways appears to be a highly efficient way to identify novel mutations. Herein we review several high-throughput sequencing approaches as well as recent improvements in target gene enrichment technologies. Systematic improvement of enrichment and sequencing methods, along with refinement of the experimental process is necessary to develop a cost-effective high-throughput resequencing assay for a large cohort of patient samples. The Hyper-IgM/CVID chip is one example of a resequencing platform that may be used to identify known or novel mutations in patents with various types of inherited antibody deficiency.

A custom 148 gene-based resequencing chip and the SNP explorer software: new tools to study antibody deficiency.

Hyper-IgM syndrome and Common Variable Immunodeficiency are heterogeneous disorders characterized by a predisposition to serious infection and impaired or absent neutralizing antibody responses. Although a number of single gene defects have been associated with these immune deficiency disorders, the genetic basis of many cases is not known. To facilitate mutation screening in patients with these syndromes, we have developed a custom 300-kb resequencing array, the Hyper-IgM/CVID chip, which interrogates 1,576 coding exons and intron-exon junction regions from 148 genes implicated in B-cell development and immunoglobulin isotype switching. Genomic DNAs extracted from patients were hybridized to the array using a high-throughput protocol for target sequence amplification, pooling, and hybridization. A Web-based application, SNP Explorer, was developed to directly analyze and visualize the single nucleotide polymorphism (SNP) annotation and for quality filtering. Several mutations in known disease-susceptibility genes such as CD40LG, TNFRSF13B, IKBKG, AICDA, as well as rare nucleotide changes in other genes such as TRAF3IP2, were identified in patient DNA samples and validated by direct sequencing. We conclude that the Hyper-IgM/CVID chip combined with SNP Explorer may provide a cost-effective tool for high-throughput discovery of novel mutations among hundreds of disease-relevant genes in patients with inherited antibody deficiency.

Effects of a pain education program on nurses' pain knowledge, attitudes and pain assessment practices in China.

The purpose of this study was to develop, implement, and evaluate the impact of a Pain Education Program (PEP) for nurses in China. The effects of PEP were measured in a quasi-experimental design. A total of 196 nurses who met the inclusion criteria from five nursing units in two teaching hospitals participated in the study. Randomization took place at the hospital level to select experimental and control groups. The research intervention was the PEP, which had two components: (1) to educate nurses about pain management and (2) to implement daily pain assessment by using the Changhai Pain Scale. The duration of PEP was five weeks and intervention methods included focused education, group activity, and individual instruction. After the baseline data were collected, PEP was implemented in the experimental group. The control group (n=90) received no intervention, and the experimental group (n = 106) received six hours of focused education training. During the fourth and fifth weeks of the training program, the researcher and the faculty instructed nurses in five nursing units on how to use the Changhai Pain Scale to assess patients' pain levels and demonstrated how to document pain condition in the nursing records. Nurses in both groups filled out a set of questionnaires, which included a background information form and the Nurses' Knowledge and Attitude Survey form, before the PEP (T1), at one month after the PEP (T2), and at three months after the PEP (T3). Nurses in the experimental group who received the PEP had a significant improvement in their pain knowledge and attitudes. Their scores on the Nurses' Knowledge and Attitude Survey increased from 15.67 at T1 to 26.13 at T2 and 35.14 at T3. The scores of nurses in the control group were unchanged (from 15.20 at T1 to 14.29 at T2 and 14.93 at T3, P>0.05). In addition, experimental group nurses had an improvement in pain assessment. The percentage of nurses who correctly used the Changhai Pain Scale to assess patients' pain intensity increased significantly after the PEP, and the increased usage of the assessment tool between experimental and control groups also shows a statistical difference in trend (chi(2)=93.281, P<0.001). The PEP has been demonstrated to be effective in improving nurses' pain knowledge, attitudes, and assessment.

Oral health knowledge, attitudes and behaviour of adults in China.

OBJECTIVES: To describe oral health behaviour, illness behaviour, oral health knowledge and attitudes among 35-44 and 65-74-year-old Chinese; to analyse the oral health behaviour profile of the two age groups in relation to province and urbanisation, and to assess the relative effect of socio-behavioural risk factors on dental caries experience. METHODS: A total number of 4,398 35-44-year-olds and 4,399 65-74-year-olds were selected by multistage stratified cluster random sampling which involved 11 provinces in China. Data were collected by self-administered structured questionnaires and clinical examinations (WHO criteria). RESULTS: 32% of the 35-44-year-olds and 23% of the 65-74-year-olds brushed at least twice a day but only 5% used fluoridated toothpaste; 30% and 17% respectively performed 'Love-Teeth-Day' recommended methods of tooth brushing. A dental visit within the previous 12 months was reported by 25% of all participants and 6% had a dental check-up during the past two years. Nearly 15% of the subjects would visit a dentist if they experienced bleeding from gums; about 60% of the subjects paid no attention to signs of caries if there was no pain. Two thirds of the urban residents and one fifth of the rural participants had economic support for their dental treatment from a third party, either totally or partially. Significant variations in oral health practices were found according to urbanisation and province. At age 35-44 years 43% of participants had daily consumption of sweets against 28% at age 65-74 years. Dental caries experience was affected by urbanisation, gender, frequency, time spent on and method of tooth brushing. Knowledge of causes and prevention of dental diseases was low with somewhat negative attitudes to prevention observed. CONCLUSION: Systematic community-based oral health promotion should be strengthened and preventive-oriented oral health care systems are needed, including promotion of further self-care practices and the use of fluoridated toothpaste.

[Analysis on oral health care utilization and expenditure of residents in Beijing].

OBJECTIVE: To analyze the dental care utilization and expenditure of residents in Beijing, and to provide some basis on the policy of oral health insurance system. METHODS: A cross-sectional survey was conducted among 1,517 subjects (urban area) and 1,878 subjects (rural area) of all age groups in Beijing selected by stratified, clustering, random sampling. The data of oral health care utilization and expenditure were collected in their home. RESULTS: The number of the people who visited a dentist in a year were low both in urban area and in rural area, but the expenditure for oral health care per visit were quite high. The value of utilization of dental care in rural residents was 1/3 of that in urban residents, while the value of expenditure in rural people was about 1/2 of that in urban people. 2.07% incomes of rural residents were used for dental care per year, the corresponding value of urban residents was 1.77%. There was significant difference on the expenditure among those with different demographic, socio-economic backgrounds. CONCLUSIONS: The expenditure for oral health care was high in Beijing, which accounted for quite a lot in average incomes per year. The burden of expenditure for dental care on rural residents was heavier than that on urban residents. The level of expenditure for dental care could provide some references for oral health insurance system in Beijing.