[Assessment of risk factors for bronchopulmonary dysplasia with pulmonary hypertension and construction of a prediction nomogram model].

Objective: To explore the risk factors of pulmonary hypertension (PH) in premature infants with bronchopulmonary dysplasia (BPD), and to establish a prediction model for early PH. Methods: This was a retrospective cohort study. Data of 777 BPD preterm infants with the gestational age of <32 weeks were collected from 7 collaborative units of the Su Xinyun Neonatal Perinatal Collaboration Network platform in Jiangsu Province from January 2019 to December 2022. The subjects were randomly divided into a training cohort and a validation cohort at a ratio of 8∶2 by computer, and non-parametric test or χ2 test was used to examine the differences between the two retrospective cohorts. Univariate Logistic regression and multivariate logistic regression analyses were used in the training cohort to screen the risk factors affecting the PH associated with BPD. A nomogram model was constructed based on the severity of BPD and its risk factors,which was internally validated by the Bootstrap method. Finally, the differential, calibration and clinical applicability of the prediction model were evaluated using the training and verification queues. Results: A total of 130 among the 777 preterm infants with BPD had PH, with an incidence of 16.7%, and the gestational age was 28.7 (27.7, 30.0) weeks, including 454 males (58.4%) and 323 females (41.6%). There were 622 preterm infants in the training cohort, including 105 preterm infants in the PH group. A total of 155 patients were enrolled in the verification cohort, including 25 patients in the PH group. Multivariate Logistic regression analysis revealed that low 5 min Apgar score (OR=0.87, 95%CI 0.76-0.99), cesarean section (OR=1.97, 95%CI 1.13-3.43), small for gestational age (OR=9.30, 95%CI 4.30-20.13), hemodynamically significant patent ductus arteriosus (hsPDA) (OR=4.49, 95%CI 2.58-7.80), late-onset sepsis (LOS) (OR=3.52, 95%CI 1.94-6.38), and ventilator-associated pneumonia (VAP) (OR=8.67, 95%CI 3.98-18.91) were all independent risk factors for PH (all P<0.05). The independent risk factors and the severity of BPD were combined to construct a nomogram map model. The area under the receiver operating characteristic (ROC) curve of the nomogram model in the training cohort and the validation cohort were 0.83 (95%CI 0.79-0.88) and 0.87 (95%CI 0.79-0.95), respectively, and the calibration curve was close to the ideal diagonal. Conclusions: Risk of PH with BPD increases in preterm infants with low 5 minute Apgar score, cesarean section, small for gestational age, hamodynamically significant patent ductus arteriosus, late-onset sepsis, and ventilator-associated pneumonia. This nomogram model serves as a useful tool for predicting the risk of PH with BPD in premature infants, which may facilitate individualized early intervention.

[Research on the association between the occurrence of spermarche and menarche and psychological distress among Chinese children and adolescents aged 9-18 years].

Objective: To analyze the association between the occurrence of spermarche and menarche and psychological distress among Chinese Han children and adolescents aged 9 to 18 years. Methods: Data were drawn from the 2019 Chinese National Survey on Students' Constitution and Health, and a total of 54 438 boys aged 11 to 18 years and 76 376 girls aged 9 to 18 years with psychological distress, spermarche/menarche records were included in the final analysis. The occurrence of spermarche/menarche was recorded by physicians, and psychological distress was classified according to the Kessler Psychological Distress Scale scores. The chi-square test was used to compare the difference between groups in the occurrence of spermarche/menarche, and the multinomial logistic regression model and stratification analysis was established to analyze the association between psychological distress and spermarche/menarche. Results: The incidence of spermarche/menarche in 2019 ranged from 6.3% to 96.5% for eight age groups of Chinese boys and 2.8% to 99.0% for ten age groups of girls. The rates of high psychological distress among boys and girls were 32.5% and 32.7%. Among boys aged 11 to 18 years, the rate of high psychological distress increased with age, with a trend test P<0.001, and the difference in the rate of high psychological distress between those who had and had not had their spermarche was not statistically significant in all age groups. Among girls aged 9 to 18 years, the rate of high psychological distress increased with age, with a trend P<0.001; the rate of high psychological distress was higher in the group with menarche at age 10 and 12 than in the group without menarche (all P<0.05). High psychological distress was positively correlated with spermarche among boys aged 13-15 years living in urban areas and hight level economic development areas (OR=1.11, 95%CI: 1.02-1.21;OR=1.18, 95%CI: 1.06-1.32). Overall, high psychological distress was positively correlated with menarche in girls aged 9-12 and 13-15 years (OR=1.33, 95%CI: 1.25-1.42; OR=1.22, 95%CI: 1.07-1.39). High psychological distress was positively correlated with menarche among girls aged 9-12 years living in different regions except for the Northeast region, in areas with different levels of economic development, and in urban and rural areas, in girls aged 13-15 years living in urban, central, and western regions, and in girls aged 16-18 years residing in the central region. Conclusions: This study found an association between the occurrence of spermarche/menarche and psychological distress among Chinese Han children and adolescents aged 9 to 18 years in 2019, which was particularly significant among girls aged 9 to 12 years and boys aged 13 to 15 years living in areas with higher levels of socioeconomic development.

[Comparison of three different measurement methods to determine resting energy expenditure in patients with decompensated hepatitis B cirrhosis].

Objective: To compare the differences to determine resting energy expenditure (REE) measured with indirect calorimetry and REE predicted by formula method and body composition analyzer in patients with decompensated hepatitis B cirrhosis, so as to provide theoretical guidance for the implementation of precision nutrition intervention. Methods: Patients with decompensated hepatitis B cirrhosis who were admitted to Henan Provincial People's Hospital from April 2020 to December 2020 were collected. REE was determined by the body composition analyzer and the H-B formula method. Results: were analyzed and compared to REE measured by the metabolic cart. Results A total of 57 cases with liver cirrhosis were included in this study. Among them, 42 were male, aged (47.93 ± 8.62) years, and 15 were female aged (57.20 ± 11.34) years. REE measured value in males was (1 808.14 ± 201.47) kcal/d, compared with the results calculated by the H-B formula method and the measured result of body composition, and the difference was statistically significant (P = 0.002 and 0.003, respectively). REE measured value in females was (1 496.60 ± 131.28) kcal/d, compared with the results calculated by the H-B formula method and the measured result of body composition, and the difference was statistically significant (P = 0.016 and 0.004, respectively). REE measured with the metabolic cart had correlation with age and area of visceral fat in men (P = 0.021) and women (P = 0.037). Conclusion: Metabolic cart use will be more accurate to obtain resting energy expenditure in patients with decompensated hepatitis B cirrhosis. Body composition analyzer and formula method may underestimate REE predictions. Simultaneously, it is suggested that the effect of age on REE in H-B formula should be fully considered for male patients, while the area of visceral fat may have a certain impact on the interpretation of REE in female patients.

[Survey of economic burden of hepatitis B-related diseases in 12 areas in China].

Objective: Less surveys on the economic burden of hepatitis B (HB)-related diseases have been conducted in China, so the socioeconomic harm caused by the diseases is not clear and the key parameters for economic evaluation of hepatitis B prevention and treatment are lacking. This study aimed to analyze the direct, indirect and intangible expenditures of hospitalized patients with HB-related diseases during hospitalization and during a year in different areas of China. Methods: The hospitals for infectious diseases and the large general hospitals in 12 areas in China were selected in the study. All the inpatients with HB-related diseases were surveyed by cluster sampling of consecutive cases. The direct expenditure included direct medical cost and direct non-medical cost. The indirect expenditure, including work loss of patients and caregivers, were calculated by using human capital method for urban and rural populations in 12 areas. The intangible expenditure were reflected by willing to pay and stochastic tournament. The influencing factors of direct and indirect costs were identified by stepwise linear multi-variation regression analysis. Results: A total of 27 hospitals in 12 areas were included in the survey. A total of 4 718 cases were surveyed, the overall response rate was 77.7%. The average hospital stay was 29.2 days (27-34) and the hospitalization expenditure was averagely 16 832.80 yuan (RMB) per case, in which the highest proportion (61.2%) was medicine fees [10 365.10 yuan (RMB)]. The average direct expenditure and indirect expenditure were consistent with the severity of illness, which were 18 336.10 yuan (RMB) and 4 759.60 yuan (RMB) respectively, with the ratio of 3.85 ∶ 1. The direct medical expenditure [17 434.70 yuan (RMB)] were substantially higher than the direct non-medical expenditure [901.40 yuan (RMB)]. It was found that the hospitalization expenses was highest in direct medical expenditure and the transportation expenses was highest in direct non-medical expenditures. Among the average indirect expenditure, the loss of income for the patients [3 832.50 yuan (RMB)] was higher than that for the caregivers [927.20 yuan (RMB)]. The total direct and indirect expenditure was highest for liver transplantation, followed by severe hepatitis, hepatocellular carcinoma and decompensated cirrhosis, acute hepatitis B, compensated cirrhosis and chronic hepatitis B. The influencing factors for both direct and indirect expenditure were high hospital level, severity of hepatitis B, living in urban area, antiviral therapy, long hospitalization and monthly income of family. For average 3.74 outpatient visits and 1.51 hospitalization, the average annual direct, indirect and intangible expenditure for HB-related diseases were 30 135.30, 6 253.80 and 44 729.90 yuan (RMB) [totally 81 119.00 yuan (RMB)], accounting for 37.3%, 7.7% and 55.0%, respectively. Of the annual direct medical expenditure [28 402.80 yuan (RMB)], which were much higher than non-medical expenditure [1 732.50 yuan (RMB)], hospitalization expenditure [26 074.20 yuan (RMB)] was higher than outpatient visit expenditure [4 061.10 yuan (RMB)]. The annual indirect expenditures for outpatient visit and hospitalization were 763.60 and 5 490.10 yuan (RMB), respectively. Of the annual intangible expenditure, the highest was that for primary hepatocellular carcinoma, followed by cirrhosis, chronic hepatitis B, severe hepatitis B, liver transplantation and acute hepatitis B. Conclusions: A heavy economic burden has been caused by HB-related diseases in China, and patients are more likely to rely on medical service rather than non-medical service. It is necessary to take effective treatment measures to prevent the adverse outcome of HB related diseases and achieve significant economic benefits. The influence of HB related diseases on mental health of the people can be reflected by an economics term, intangible expenditure.

[Application of standardization of medical care model for chronic mild lead poisoning].

OBJECTIVE: To standardize the treatment and evaluate the clinical application effectiveness of clinical pathway (CP) in chronic mild lead poisoning. METHODS: 60 patients with chronic mild lead poisoning hospitalized from Jan. 2014 to Dec.2014 were enrolled for the study group, 60 patients with chronic mild lead poisoning hospitalized from Jan.2013 to Dec.2013 were enrolled for the control group. The study group were cared according to clinical pathway, the control group received routine therapy; the clinical application effectiveness were compared between the two groups. RESULTS: No adverse drug reactions occurred in both groups. The curative ratio was significantly higher in the study group than in the control group (96.7% vs 86.0%, P<0.05) , the rate of patients' satisfaction to medical care significantly higher in the study group (98.3% vs 88.3%, P<0.05) , the rate of health education awareness higher in the study group (95.0% vs 81.7%, P<0.05) , the course of treatment shorter in the study group (3.2±0.6 vs 3.4±0.7, P<0.05) , the medical cost less in the study group (5773.5 yuan±1242.1 yuan vs 6354.7 yuan±1177.0 yuan, P<0.05) , the length of hospitalization was shorter in the study group (21.9 d±6.7 d vs 24.6 d±7.9 d, P<0.05). The variation rate of clinical pathway was 13.3% in clinical pathway group. CONCLUSION: The implementation of clinical pathway could improve the curative ratio, satisfaction, and health education awareness. The course of treatment, length of hospital stay and costs of hospitalization in the study group could be obviously shorter and less, and there is a little variation rate in the clinical pathway.

Comprehensive effect assessment of medical nutrition guidance during pregnancy towards the health of mothers and children.

OBJECTIVE: This study evaluates the effects of medical nutrition guidance provided to pregnant women to reduce pregnancy complications and occurrence of low birth-weight children and macrosomia. This guideline aims to provide the basis for improving birth delivery outcomes. MATERIALS AND METHODS: A randomized controlled method was used. A total of 261 parturient women who enrolled in regular pregnancy testing were sampled and selected. The subjects were randomly divided into experimental group (EG, n = 124) and control group (CG, n = 132). The differences in maternal health, pregnancy outcomes, and newborn health between the two groups were compared. RESULTS: Hypertensive disorders in pregnancy and gestational diabetes risks in EG were significantly lower than those in CG (p < 0.05). The cesarean section rate decreased (EG 36.29%, CG 51.50%), and the vaginal delivery rate increased (EG 63.71%, CG 51.50%). The incidence of macrosomia in EG was significantly lower than that in CG (p < 0.05). CONCLUSION: Medical nutrition guidance during pregnancy improves the perinatal outcomes of mothers and children.

Overall obesity is leveling-off while abdominal obesity continues to rise in a Chinese population experiencing rapid economic development: analysis of serial cross-sectional health survey data 2002-2010.

BACKGROUND: Obesity epidemic is related to industrialization and urbanization that have lead to changes in nutrition, lifestyle and socio-economic status. However, information on the trajectory of the obesity epidemic in populations experiencing rapid economic development is limited. We therefore investigate trends in obesity from 2002 to 2010 in a southern Chinese population experiencing world's fastest economic development. METHODS: Between 2002 and 2010 four standardized surveys were conducted in a population of 85 million residents in Guangdong, China. Multistage cluster sampling was adopted to recruit representative samples. Weight, height and waist circumference of the participants were measured in a standardized way. The analysis included residents aged between 18 and 69 years. The number of participants included in the present analysis for Surveys conducted in 2002, 2004, 2007 and 2010 were 13058, 7646, 6441 and 8575, respectively. RESULTS: From year 2002 to 2010, the age-standardized Body mass index (BMI) insignificantly changed from 21.7 kg m(-2) to 22.3 kg m(-2), and the prevalence of overweight and overall obesity from 15.8 to 16.6% (both P>0.05). The age-standardized waist circumference increased from 73.7 to 78.4 cm, and prevalence of abdominal obesity increased from 12.9 to 23.7% (both P<0.001). In urban areas, BMI and overall obesity changed little during the 8-year period (BMI increased from 22.6 to 22.7 kg m(-2) and overall obesity changed from 23.7 to 21.4%), whereas there were slight increases of the same in rural areas (BMI increased from 20.8 to 22.1 kg m(-2)and overall obesity increased from 8.2 to 13.3%). Waist circumference and abdominal obesity increased significantly in both areas, but the increase was more pronounced in rural areas (in urban area, waist circumference increased from 75.1 to 78.5 cm and abdominal obesity from 16.8 to 26.5%; in rural area, waist circumference from 72.2 to 78.3 and abdominal obesity from 8.8 to 22.0%). CONCLUSIONS: BMI and overall obesity in this population, which has experienced the world's fastest economic development over the past three decades, has been leveling-off, while waist circumference and abdominal obesity, independent predictors of cardiovascular risk, have continued to rise. Our findings suggest that obesity epidemic transition in rapidly developing populations may be much faster than what has been observed in Western countries.

Ultra-stable phosphoglucose isomerase through immobilization of cellulose-binding module-tagged thermophilic enzyme on low-cost high-capacity cellulosic adsorbent.

One-step enzyme purification and immobilization were developed based on simple adsorption of a family 3 cellulose-binding module (CBM)-tagged protein on the external surface of high-capacity regenerated amorphous cellulose (RAC). An open reading frame (ORF) Cthe0217 encoding a putative phosphoglucose isomerase (PGI, EC 5.3.1.9) from a thermophilic bacterium Clostridium thermocellum was cloned and the recombinant proteins with or without CBM were over-expressed in Escherichia coli. The rate constant (kcat ) and Michaelis-Menten constant (Km ) of CBM-free PGI at 60°C were 2,765 s(-1) and 2.89 mM, respectively. PGI was stable at a high protein concentration of 0.1 g/L but deactivated rapidly at low concentrations. Immobilized CBM (iCBM)-PGI on RAC was extremely stable at ∼60°C, nearly independent of its mass concentration in bulk solution, because its local concentration on the solid support was constant. iCBM-PGI at a low concentration of 0.001 g/L had a half-life time of 190 h, approximately 80-fold of that of free PGI. Total turn-over number of iCBM-PGI was as high as 1.1×10(9) mole of product per mole of enzyme at 60°C. These results suggest that a combination of low-cost enzyme immobilization and thermoenzyme led to an ultra-stable enzyme building block suitable for cell-free synthetic pathway biotransformation that can implement complicated biochemical reactions in vitro.

Production of biocommodities and bioelectricity by cell-free synthetic enzymatic pathway biotransformations: challenges and opportunities.

Cell-free synthetic (enzymatic) pathway biotransformation (SyPaB) is the assembly of a number of purified enzymes (usually more than 10) and coenzymes for the production of desired products through complicated biochemical reaction networks that a single enzyme cannot do. Cell-free SyPaB, as compared to microbial fermentation, has several distinctive advantages, such as high product yield, great engineering flexibility, high product titer, and fast reaction rate. Biocommodities (e.g., ethanol, hydrogen, and butanol) are low-value products where costs of feedstock carbohydrates often account for approximately 30-70% of the prices of the products. Therefore, yield of biocommodities is the most important cost factor, and the lowest yields of profitable biofuels are estimated to be ca. 70% of the theoretical yields of sugar-to-biofuels based on sugar prices of ca. US$ 0.18 per kg. The opinion that SyPaB is too costly for producing low-value biocommodities are mainly attributed to the lack of stable standardized building blocks (e.g., enzymes or their complexes), costly labile coenzymes, and replenishment of enzymes and coenzymes. In this perspective, I propose design principles for SyPaB, present several SyPaB examples for generating hydrogen, alcohols, and electricity, and analyze the advantages and limitations of SyPaB. The economical analyses clearly suggest that developments in stable enzymes or their complexes as standardized parts, efficient coenzyme recycling, and use of low-cost and more stable biomimetic coenzyme analogs, would result in much lower production costs than do microbial fermentations because the stabilized enzymes have more than 3 orders of magnitude higher weight-based total turn-over numbers than microbial biocatalysts, although extra costs for enzyme purification and stabilization are spent.

Reviving the carbohydrate economy via multi-product lignocellulose biorefineries.

Before the industrial revolution, the global economy was largely based on living carbon from plants. Now the economy is mainly dependent on fossil fuels (dead carbon). Biomass is the only sustainable bioresource that can provide sufficient transportation fuels and renewable materials at the same time. Cellulosic ethanol production from less costly and most abundant lignocellulose is confronted with three main obstacles: (1) high processing costs (dollars /gallon of ethanol), (2) huge capital investment (dollars approximately 4-10/gallon of annual ethanol production capacity), and (3) a narrow margin between feedstock and product prices. Both lignocellulose fractionation technology and effective co-utilization of acetic acid, lignin and hemicellulose will be vital to the realization of profitable lignocellulose biorefineries, since co-product revenues would increase the margin up to 6.2-fold, where all purified lignocellulose co-components have higher selling prices (> approximately 1.0/kg) than ethanol ( approximately 0.5/kg of ethanol). Isolation of large amounts of lignocellulose components through lignocellulose fractionation would stimulate R&D in lignin and hemicellulose applications, as well as promote new markets for lignin- and hemicellulose-derivative products. Lignocellulose resource would be sufficient to replace significant fractionations (e.g., 30%) of transportation fuels through liquid biofuels, internal combustion engines in the short term, and would provide 100% transportation fuels by sugar-hydrogen-fuel cell systems in the long term.