Association of obesity and menarche SNPs and interaction with environmental factors on precocious puberty.

BACKGROUND: Obesity is an important cause for the precocious or early puberty. However, the association between obesity-related loci and the risk of precocious puberty as well as the effect of gene-environment interaction are unclear, especially in the Chinese children population. METHODS: This was a case-control study using baseline data from two cohorts and hospital cases in China. 15 SNPs loci and several environmental factors were included in the analysis of 1201 participants. Chi-square test and logistic regression were used to analyze the association between SNPs and precocious puberty. Additionally, exploratory factor analysis was conducted on 13 environmental variables, and then to explore their interaction with genes on precocious puberty. RESULTS: The effect allele C of rs571312, and G of rs12970134 MC4R were associated with precocious puberty in girls with obesity. Regarding the gene-environment interaction, we found that when girls were in the high socioeconomic status, the rs571312 (OR: 3.996; 95% CI: 1.694-9.423) and rs12970134 (OR: 3.529; 95% CI: 1.452-8.573) risk genotypes had a greater effect on precocious puberty. CONCLUSIONS: The obesity risk gene polymorphisms MC4R rs571312 and rs12970134 were associated with precocious puberty in Chinese girls with obesity, and girls with risk genotypes and high socioeconomic status should be given extra attention. IMPACT: This is the first study that identified the association between rs571312 and rs12970134 of MC4R gene and precocious puberty in Chinese children. We found that when girls were in the high socioeconomic status, the risk genotypes of rs571312 and rs12970134 had a greater effect on precocious puberty. The results of this study have great public health implications. It is recommended that girls who are in high socioeconomic status and have a high genetic risk for early sexual maturity should closely monitor their pubertal development and consider early intervention strategies.

Association of Traditional dietary pattern with early and precocious puberty: a population-based cross-sectional study.

BACKGROUND: Precocious puberty is an endocrine disease that is diagnosed by sex, age, and Tanner stage of puberty. This study aimed to investigate the association between various dietary patterns and early or precocious puberty, especially Traditional dietary patterns, which have been rarely investigated. METHODS: A total of 4085 primary school students in grades 1-3 (6-9 years) completed individual characteristic surveys, health examinations, and food frequency questionnaires (FFQs). Physical examinations were also conducted to assess obesity and pubertal onset. Traditional, Westernized, and Protein dietary patterns were determined by factor analysis, and their associations with pubertal onset were analyzed by multiple logistic regression analysis. RESULTS: Compared to the other two patterns, children who predominant the Traditional dietary pattern were protectively associated with precocious puberty (OR = 0.72, 95% CI = 0.55, 0.94), even after adjusting the confounders (OR = 0.66, 95% CI = 0.48, 0.89). Neither the Westernized nor Protein dietary pattern demonstrated an association with pubertal onset. The Traditional dietary pattern was negatively associated with children's weight status, classified by body mass index (BMI), and was positively associated with parental education. The maternal education and the Protein dietary pattern were negatively related. CONCLUSIONS: Traditional dietary patterns were protective associated with early and precocious puberty among Chinese children. IMPACT: The Traditional dietary pattern was protective associated with early puberty or precocious puberty in children, as found in large-scale population-based public health research. Current research primarily focuses on Westernized dietary patterns, and we studied Traditional dietary patterns to further explore the influence of food on children's puberty development. We discovered that children's preference for Traditional dietary patterns is protective of pubertal development, which implies that society and parents can benefit from diet guidance to protect children's natural development during adolescence.

Sex-specific difference in phenotype of Kabuki syndrome type 2 patients: a matched case-control study.

BACKGROUND: Kabuki syndrome (KS) is a monogenic disorder leading to special facial features, mental retardation, and multiple system malformations. Lysine demethylase 6A, (KDM6A, MIM*300128) is the pathogenic gene of Kabuki syndrome type 2 (KS2, MIM#300867), which accounts for only 5%-8% of KS. Previous studies suggested that female patients with KS2 may have a milder phenotype. METHOD: We summarized the phenotype and genotype of KS2 patients who were diagnosed in Shanghai Children's Medical Center since July 2017 and conducted a 1:3 matched case-control study according to age and sex to investigate sex-specific differences between patients with and without KS2. RESULTS: There were 12 KS2 cases in this study, and 8 of them matched with 24 controls. The intelligence quotient (IQ) score of the case group was significantly lower than that of the control group (P < 0.001). In addition, both the incidence of intellectual disability (ID) (IQ < 70) and moderate-to-severe ID (IQ < 55) were significantly higher in the case group than those in the control group. No sex-specific difference was found in the incidence of ID or moderate-to-severe ID between the female cases and female controls, whereas there was a significant difference between male cases and male controls. Furthermore, the rate of moderate-to-severe ID and congenital heart disease (CHD) was significantly higher in the male group than that in the female group. CONCLUSIONS: Our results showed that a sex-specific difference was exhibited in the clinical phenotypes of KS2 patients. The incidence of CHD was higher in male patients, and mental retardation was significantly impaired. However, the female patients' phenotype was mild.

Genotypic and phenotypic features of dyslipidemia in a sample of pediatric patients in China.

BACKGROUND: Dyslipidemia, especially hypercholesterolemia is of significant clinical interest. Precise diagnosis is not paid enough attention to about the management of pediatric patients with hypercholesterolemia, which is especially apparent in China. Given this, we designed this study to confirm the specific molecular defects associated with hypercholesterolemia using whole-exome sequencing (WES) to be helpful for precise diagnosis and treatment. METHODS: Pediatric patients were enrolled using specific criteria and their clinical information were recorded for later evaluation in conjunction with the WES completed for each of these patients. RESULTS: Our criteria allowed for the initial enrollment of 35 patients, 30 of whom (aged 1.02-12.99 years) underwent successful genetic sequencing and clinical investment. Positive results were obtained in 63.33% (19/30) of these patients. We identified 25 variants in 30 pediatric patients with persistent hypercholesterolemia, seven of them were novel and variants in LDLR and ABCG5/ABCG8 ranks first and second, respectively. Further analysis revealed that the levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), apolipoprotein B (ApoB) and lipoprotein (a) were higher in patients with positive genetic results. CONCLUSION: Our study enriched the genetic and phenotypic spectra for hypercholesterolemia in young patients. Genetic testing is important for the prognostics and treatment of pediatric patients. Heterozygous ABCG5/8 variants may be underestimated in pediatric patients with hypercholesterolemia.

Higher greenspace exposure is associated with a decreased risk of childhood asthma in Shanghai - A megacity in China.

Inconsistent evidence exists about whether exposure to greenspace benefits childhood asthma. Previous studies have only focused on residential or school greenspace, and no research has combined greenspace exposures at both homes and schools to determine their link with childhood asthma. A population-based cross-sectional study was conducted among 16,605 children during 2019 in Shanghai, China. Self-reported questionnaires were used to collect information on childhood asthma and demographic, socioeconomic and behavioural factors. Environmental data including ambient temperature, particulate matter with aerodynamic diameter less than 1 µm (PM1), enhanced vegetation index (EVI), and normalized difference vegetation index (NDVI) were collected from satellite data. Binomial generalized linear models with a logit link were carried out to evaluate the association between greenspace exposure and children's asthma, as well as the effect modifiers. An interquartile range increment of whole greenspace (NDVI500, NDVI250, EVI500, and EVI250) exposure was associated with a reduced odds ratio of children's asthma (0.88, 95% CI: 0.78, 0.99; 0.89, 95% CI: 0.79, 1.01; 0.87, 95% CI: 0.77, 0.99; and 0.88, 95% CI: 0.78, 0.99, respectively) after controlling potential confounders. Low temperature, low PM1, males, vaginal delivery, suburban/rural area, and without family history of allergy appeared to enhance the greenspace-asthma association. Increased greenspace exposure was associated with a lower risk of childhood asthma, and the association was modified by a range of socio-environmental factors. These findings add to the body of evidence on the benefits of biodiversity and supporting the promotion of urban greenspace to protect children's health.

TDDFusion: A Target-Driven Dual Branch Network for Infrared and Visible Image Fusion.

In the field of image fusion, the integration of infrared and visible images aims to combine complementary features into a unified representation. However, not all regions within an image bear equal importance. Target objects, often pivotal in subsequent decision-making processes, warrant particular attention. Conventional deep-learning approaches for image fusion primarily focus on optimizing textural detail across the entire image at a pixel level, neglecting the pivotal role of target objects and their relevance to downstream visual tasks. In response to these limitations, TDDFusion, a Target-Driven Dual-Branch Fusion Network, has been introduced. It is explicitly designed to enhance the prominence of target objects within the fused image, thereby bridging the existing performance disparity between pixel-level fusion and downstream object detection tasks. The architecture consists of a parallel, dual-branch feature extraction network, incorporating a Global Semantic Transformer (GST) and a Local Texture Encoder (LTE). During the training phase, a dedicated object detection submodule is integrated to backpropagate semantic loss into the fusion network, enabling task-oriented optimization of the fusion process. A novel loss function is devised, leveraging target positional information to amplify visual contrast and detail specific to target objects. Extensive experimental evaluation on three public datasets demonstrates the model's superiority in preserving global environmental information and local detail, outperforming state-of-the-art alternatives in balancing pixel intensity and maintaining the texture of target objects. Most importantly, it exhibits significant advantages in downstream object detection tasks.

Association of childhood asthma with intra-day and inter-day temperature variability in Shanghai, China.

OBJECTIVES: Short-term temperature variability (TV) is associated with the exacerbation of asthma, but little is known about the relative effects of intra- and inter-day TV. We aimed to assess the relative impacts of intra- and inter-day TV on childhood asthma and to explore the modification effects by season. METHODS: A quasi-Poisson generalized linear regression model combined with a distributed lag nonlinear model was adopted to evaluate the nonlinear and lagged effects of TV on childhood asthma in Shanghai from 2009 to 2017. Intra- and inter-day TV was measured with diurnal temperature range (DTR) and temperature changes between neighboring days (TCN), respectively. RESULTS: Increased DTR was associated with the elevated relative risk (RR) of daily outpatient visits for childhood asthma (DOVCA) in both the whole year (RRlag0-14 for the 99th percentile: 1.264, 95% confidence interval (CI): 1.052, 1.518) and cold season (RRlag0-12 for the 99th percentile: 1.411, 95% CI: 1.053, 1.889). Higher TCN in the warm season was associated with the increased RR of DOVCA (RRlag0-14 for the 99th percentile: 2.964, 95% CI: 1.636, 5.373). The number and fraction of DOVCA attributed to an interquartile range (IQR) increase of TCN were higher than those attributed to DTR in both the whole year period and warm season. However, the number and fraction of DOVCA attributed to an IQR increase of DTR were greater than those attributed to TCN in the cold season. CONCLUSIONS: Our results provide novel evidence that both intra- and inter-day TV might be a trigger of childhood asthma. Higher DTR appeared to have greater impacts on childhood asthma in the cold season while an increase in TCN seemed to have bigger effects in the warm season.

Exposure to antibiotics and precocious puberty in children: A school-based cross-sectional study in China.

Foods and water can be contaminated with antibiotics in China, which may affect children's health, but evidence on antibiotic exposure with precocious puberty (PP) is limited. This study explored the association of antibiotic exposure with PP in a school-based setting. A cross-sectional study with multistage stratified cluster random sampling was conducted in Zhongshan City, Guangdong Province and Qufu City, Shandong Province in China from October 11 to December 5, 2019. A first-morning urine sample was collected to detect antibiotic exposure. We detected 33 of 45 types of antibiotics from eight categories in 928 primary school children aged 6-12 years using HPLS-MS/MS. Detection rate of antibiotics was stratified by sex, study site, and BMI. The Tanner stages were assessed by professional pediatricians from local hospitals. PP is defined as the onset of secondary characters before 8-year-old or menarche before 10-year-old for girls and before 9-year-old for boys. Multivariable logistic regression was performed to examine the association between antibiotic exposure and PP after adjusting potential confounders. The overall detection rate of antibiotics was 93.0% in 928 children. We found the detection rate of tetracyclines and fluoroquinolones in children with PP was significantly higher than that of children with normal puberty (41.4% vs 29.9%, 56.8% vs 50.6%, respectively, all p < 0.05). Both fluoroquinolones (odds ratio (OR): 1.835, 95% confidence interval (CI): 1.066-3.158) and tetracyclines (OR: 2.120, 95% CI: 1.175-3.825) were associated with increased OR of PP after adjusting sex, age, BMI, study site, and family income. Specifically, compared to the values less than the limits of detection, low concentration of ofloxacin from fluoroquinolones (OR: 2.056, 95% CI: 1.091-3.875) and high concentration of chlortetracycline (OR: 3.027, 95% CI: 1.126-8.140) and tetracycline from tetracyclines (OR: 2.756, 95% CI: 1.167-6.506) were associated with increased OR of PP. Exposure to antibiotics, especially fluoroquinolones and tetracyclines was positively associated with precocious puberty.

Environmental Exposure and Childhood Atopic Dermatitis in Shanghai: A Season-Stratified Time-Series Analysis.

BACKGROUND: Childhood atopic dermatitis (AD) is an inflammatory skin disease which sometimes predisposes to allergies. Environmental factors (low humidity, irritants, etc.) are prominent causative triggers of AD. OBJECTIVES: This study aims to explore the effects of both meteorological factors and air pollutants on childhood AD, and the modification effects by season in Shanghai, China. METHODS: Quasi-Poisson generalized linear regression model, combined with a distributed lag nonlinear model was used to examine the nonlinear and lagged effects of environmental factors on childhood AD from 2009 to 2017 in Shanghai. We also performed a season-stratified analysis to determine the modification effects of environmental exposure by season on childhood AD. RESULTS: There were 1,043,240 outpatient visits for childhood AD in total, at 3 major pediatric hospitals. Low temperature and relative humidity (RH), and high daily temperature difference (DTD) and air pollutants (i.e., NO2) increased the relative risks (RRs) of outpatient visits for childhood AD in the whole year. In the cold season, an increased risk of outpatient visits for childhood AD was associated with low RH (RR 2.26, 95% CI 1.69-3.02) and high NO2 (1.11, 95% CI 1.06-1.17). In the warm season, outpatient visits for childhood AD were associated with low temperature (3.49, 95% CI 3.22-3.77), low RH (1.89, 95% CI 1.74-2.06), high DTD (1.41, 95% CI 1.31-1.53), and high NO2 (1.05, 95% CI 1.03-1.06). CONCLUSIONS: This study suggests that environmental exposure may be a key trigger for outpatient visits for childhood AD with apparent seasonal effects. Tailored preventive strategies to avoid environmental triggers of childhood AD should be developed.

Effects of childhood obesity and related genetic factors on precocious puberty: protocol for a multi-center prospective cohort study.

BACKGROUND: Childhood obesity has important effects on the onset and development of puberty. Although a number of studies have confirmed the relationship between obesity and precocious puberty, little is known about the pleiotropic genes of obesity and precocious puberty and the interaction between genes and environment. There are four objectives: (1) to analyze the incidence of precocious puberty in the general population in China; (2) to verify the direct effect of obesity on children's precocious puberty using a variety of methods; (3) to verify the effect of obesity and its risk gene polymorphism on precocious puberty in a prospective cohort study; and (4) to analyze the interaction effect of genes and environment on pubertal development. METHODS: We will conduct a multi-center prospective cohort study in three cities, which are selected in southern, central, and northern China, respectively. Primary schools in these cities will be selected by a stratified cluster random sampling method. Primary school students from grade 1 to grade 3 (6 to 10 years old) will be selected for the cohort with extensive baseline data collection, including assessment of pubertal development, family demographic information, early development, sleep pattern, dietary pattern, and physical activity. Participants will be followed up for at least three years, and long-term follow-up will depend on future funding. DISCUSSION: The findings of this multicenter prospective population-based cohort study may expand previous related puberty development research as well as provide important information on the mechanism of early puberty. Targeted interventions can also be developed to improve adolescent health problems related to puberty development based on the available evidence. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04113070 , prospectively registered on October 2, 2019.

Antibiotic exposure and risk of overweight/obesity in school children: A multicenter, case-control study from China.

BACKGROUND: Although the use of antibiotics during early life has been associated with increased risk of adipogenesis, effect of antibiotic exposure from various sources, including food or drinking water, on adiposity in children is largely unknown. OBJECTIVE: To investigate associations between urinary biomarkers of multiple antibiotics and risk of adipogenesis in school children. METHODS: This case-control study recruited 410 overweight/obese school children aged 6-9 years and 410 controls from Shandong and Guangdong Province, China, matched on sex, age and school. Diagnosis of overweight and obesity was based on body mass index-based criteria derived from national data. Urinary concentrations of 45 antibiotics from 8 categories (macrolides, ß-lactams, tetracyclines, fluoroquinolones, sulfonamides, phenicols, lincosamides, and quinoxalines), including 6 human antibiotics (HAs), 6 antibiotics preferred as HAs (PHAs), 16 veterinary antibiotics (VAs), and 17 antibiotics preferred as VA (PVAs), were measured by ultra-performance liquid chromatography coupled to triple-quadrupole tandem mass spectrometry. Conditional logistic regression analyses were used to assess odds ratios (ORs) of childhood overweight/obesity in relation to urinary antibiotic concentrations. RESULTS: A total of 32 antibiotics were found in urine samples with an overall detection frequency of 92.93 %. Children with overweight/obesity have higher veterinary antibiotic levels than those with normal weight. Compared with undetected levels of antibiotics, the multivariable-adjusted ORs (95 % confidence interval) of overweight/obesity for high levels of antibiotics divided according to median values were 1.63 (1.02, 2.62) for florfenicol, 1.62 (1.04, 2.54) for phenicols, and 1.41 (0.97, 2.04) for sum of VAs and PVAs. These associations predominantly existed in boys and remained significant in florfenicol after FDR multiple testing correction (FDR adjusted p < 0.05). CONCLUSION: Exposure to certain antibiotic for veterinary use mainly from food or drinking water was associated with an increased risk of adipogenesis in children. Further studies are needed to confirm our findings and clarify the underlying mechanisms.

Infrared Small Target Detection Based on Weighted Local Coefficient of Variation Measure.

Robust infrared (IR) small target detection is critical for infrared search and track (IRST) systems and is a challenging task for complicated backgrounds. Current algorithms have poor performance on complex backgrounds, and there is a high false alarm rate or even missed detection. To address this problem, a weighted local coefficient of variation (WLCV) is proposed for IR small target detection. This method consists of three stages. First, the preprocessing stage can enhance the original IR image and extract potential targets. Second, the detection stage consists of a background suppression module (BSM) and a local coefficient of variation (LCV) module. BSM uses a special three-layer window that combines the anisotropy of the target and differences in the grayscale distribution. LCV exploits the discrete statistical properties of the target grayscale. The weighted advantages of the two modules complement each other and greatly improve the effect of small target enhancement and background suppression. Finally, the weighted saliency map is subjected to adaptive threshold segmentation to extract the true target for detection. The experimental results show that the proposed method is more robust to different target sizes and background types than other methods and has a higher detection accuracy.

Improved LDTW Algorithm Based on the Alternating Matrix and the Evolutionary Chain Tree.

Dynamic time warping under limited warping path length (LDTW) is a state-of-the-art time series similarity evaluation method. However, it suffers from high space-time complexity, which makes some large-scale series evaluations impossible. In this paper, an alternating matrix with a concise structure is proposed to replace the complex three-dimensional matrix in LDTW and reduce the high complexity. Furthermore, an evolutionary chain tree is proposed to represent the warping paths and ensure an effective retrieval of the optimal one. Experiments using the benchmark platform offered by the University of California-Riverside show that our method uses 1.33% of the space, 82.7% of the time used by LDTW on average, which proves the efficiency of the proposed method.

Quality and efficiency of a standardized e-handover system for pediatric nursing: A prospective interventional study.

AIM: This study examined the effect on pediatric nursing handover quality and efficiency when a standardized e-handover system was implemented. BACKGROUND: Handover quality is an important aspect of nursing quality management; however, handover quality among nursing staff is poor. METHODS: A prospective interventional study was carried out in a general pediatrics ward from December 2019 to November 2020. The tools included a standardized e-handover system. The intervention strategies included workflow remodeling and employee training on oral handover using the standardized e-handover system. RESULTS: The omission frequency of critical handover elements decreased from 47.32% to 2.94% (p < .01), among which the omission frequencies of nine out of 16 key elements significantly decreased. Integrity also showed improvement. Specifically, the integrity of five types of critical information was significantly improved, including vital signs, signs and symptoms, laboratory test results, radiologic examination results, and treatment regimen (2.00 vs. 5.00, p < .01; 3.00 vs. 5.00, p < .01; 3.00 vs. 5.00, p < .01; 5.00 vs. 5.00, p = .009; 3.00 vs. 4.00, p < .01, respectively). Information accuracy was 100%. Workflow and efficiency significantly improved, communication duration with patient/family during work hours significantly increased (24.00 vs. 56.00, p < .01), and prehandover preparation duration significantly decreased (32.00 vs. 2.50, p < .01). Nurse handover satisfaction showed improvement (56.88 ± 15.08 vs. 74.31 ± 9.22, p < .01). CONCLUSION: The standardized e-handover system effectively improved nurse handover quality, optimized workflow, increased work efficiency, and promoted teamwork. IMPLICATIONS FOR NURSING MANAGEMENT: Standardized e-handover systems have great potential for ensuring the safety of pediatric patients and improving the quality of handover.

Breastfeeding duration modified the effects of neonatal and familial risk factors on childhood asthma and allergy: a population-based study.

BACKGROUND: Childhood asthma and allergic diseases are a significant global problem. There are inconsistent findings on the associations of delivery mode, the number of children in the household and breastfeeding with childhood asthma and allergic diseases. We assessed these associations and examined whether breastfeeding modified the effects of neonatal and familial risk factors on childhood asthma and allergic diseases. METHODS: A population-based cross-sectional study was conducted in Shanghai, China. A total of 17 primary schools were randomly selected from 13 districts of Shanghai in this study. The International Study of Asthma and Allergies in Childhood questionnaire was adopted to assess the childhood asthma and allergic diseases. Multivariable logistic regression models were used to evaluate the associations between neonatal and familial factors and childhood asthma and allergic diseases, and to examine the modification effects of breastfeeding on the associations assessed. RESULTS: Of 10,464 primary school children aged 6-11 years, the overall prevalence of childhood asthma, allergic rhinitis, urticaria, food allergy and drug allergy was 13.9, 22.7, 15.3, 8.1 and 4.6%, respectively. Male sex, high socioeconomic status, cesarean section delivery, only one child in the household and having family history of allergy were associated with increased odds ratio (OR) of childhood asthma and allergic diseases while longer breastfeeding duration (> 6 months) was inversely associated with these diseases. Longer breastfeeding duration also attenuated the OR of neonatal and familial risk factors on childhood asthma and allergic diseases. For instance, the adjusted OR of childhood asthma in the group of vaginal delivery and breastfeeding duration > 6 months was lowest (0.78, 95% confidence interval: 0.66, 0.92). CONCLUSIONS: Longer breastfeeding duration was inversely associated with childhood asthma and allergic diseases, and also reduced the OR of neonatal and familial risk factors on these diseases. Giving the prevalence of childhood asthma and allergic diseases is rapidly rising across the globe, these findings may have important clinical and public health implications.

Using a cartoon questionnaire to improve consent process in children: a randomized controlled survey.

OBJECTIVE: The aim of the study was to evaluate the effectiveness of an audio and animated cartoon questionnaire (AACQ) at improving consent process in child for biospecimen donation. METHODS: A multi-center randomized and controlled survey was performed at two pediatric hospitals in China from 2019 to 2020. Children aged from 7 to 18 years in the pediatric surgery wards were invited to investigate the participants' willingness and attitudes for donating biospecimens. A total of 264 children, including 119 in the AACQ group and 145 in the TQ group, and 67 parents of children were analyzed. A separate knowledge test was acquired in the questionnaires. RESULTS: Our findings showed that the response rate of the AACQ group (89.85%) was significantly higher than that of the TQ group (68.44%; p < 0.001). AACQ can improve the child's understanding, increase children's engagement in biospecimen donation, reduced the differences in selected characteristics affecting children understanding, and enhanced their risk awareness of donating biospecimens. We also found that increasing pain and privacy disclosure were the most popular concern among children for the refusal to donate biospecimens. CONCLUSIONS: AACQ is an effective and standardized tool of content delivery to children from the surgical wards. Children who fully understood of biospecimen donation are suggested to participate in the consent signing. IMPACT: Using audio and animated cartoon questionnaire is a more effective and standardized tool of content delivery to children. This study expanded the use of an animated cartoon to a children's survey. Audio and animated cartoon questionnaire (AACQ) can improve the child's understanding, increase children's engagement in biospecimen donation compared to text questionnaire (TQ) group, and enhanced their risk awareness of donating biospecimens. More AACQ should be used with children in the future to effectively deliver content to children and improve children's participation in the survey.

Cohort Profile: The Shanghai Sleep Birth Cohort Study.

BACKGROUND: Sleep disturbances in women occur frequently throughout pregnancy. Previous studies have demonstrated that the increasing incidence of physiological and psychological illness is concurrent with increasing sleep deprivation and poor sleep quality in adults and children. OBJECTIVES: The Shanghai Sleep Birth Cohort Study (SSBCS) was established to examine the effect of sleep disturbances during the third trimester on emotional regulation of mothers; to assess the effect of maternal sleep during pregnancy on the growth and development of children; and to explore the influence of children's sleep characteristics on physical and social-emotional development. POPULATION: The study was conducted in the Renji Hospital in Pudong New District, Shanghai from May 2012 to July 2013. Women and their newborns who met the inclusion criteria and agreed to participate in this study were recruited to the SSBCS. METHODS: The follow-up visits for children were conducted at the age of 42 days, 3, 6, 9, 12, 18, and 24 months, and 3, 4, and 6 years. Data on demographic factors, physical examination, sleep assessment, developmental and psychiatric assessment, diet records, and biological samples were collected throughout the study. PRELIMINARY RESULTS: A total of 277 pregnant women were recruited to the study; the response rate was 64.3%. 37.9% of the pregnant women had poor sleep quality and 12.0% suffered from depression. Infant sleep patterns changed during the first year of life, but most sleep characteristics showed little variation from 6 to 12 months. CONCLUSIONS: The SSBCS is an on-going prospective cohort study with follow-up to 6 years. The detailed data on demographic factors, sleep assessment, physical examinations, neurodevelopmental and psychiatric assessment, diet records, and biological samples make this research platform an important resource for examining the potential effects of sleep characteristics on both maternal and child health.

Artificial intelligence-assisted reduction in patients' waiting time for outpatient process: a retrospective cohort study.

BACKGROUND: Many studies suggest that patient satisfaction is significantly negatively correlated with the waiting time. A well-designed healthcare system should not keep patients waiting too long for an appointment and consultation. However, in China, patients spend notable time waiting, and the actual time spent on diagnosis and treatment in the consulting room is comparatively less. METHODS: We developed an artificial intelligence (AI)-assisted module and name it XIAO YI. It could help outpatients automatically order imaging examinations or laboratory tests based on their chief complaints. Thus, outpatients could get examined or tested before they went to see the doctor. People who saw the doctor in the traditional way were allocated to the conventional group, and those who used XIAO YI were assigned to the AI-assisted group. We conducted a retrospective cohort study from August 1, 2019 to January 31, 2020. Propensity score matching was used to balance the confounding factor between the two groups. And waiting time was defined as the time from registration to preparation for laboratory tests or imaging examinations. The total cost included the registration fee, test fee, examination fee, and drug fee. We used Wilcoxon rank-sum test to compare the differences in time and cost. The statistical significance level was set at 0.05 for two sides. RESULTS: Twelve thousand and three hundred forty-two visits were recruited, consisting of 6171 visits in the conventional group and 6171 visits in the AI-assisted group. The median waiting time was 0.38 (interquartile range: 0.20, 1.33) hours for the AI-assisted group compared with 1.97 (0.76, 3.48) hours for the conventional group (p < 0.05). The total cost was 335.97 (interquartile range: 244.80, 437.60) CNY (Chinese Yuan) for the AI-assisted group and 364.58 (249.70, 497.76) CNY for the conventional group (p < 0.05). CONCLUSIONS: Using XIAO YI can significantly reduce the waiting time of patients, and thus, improve the outpatient service process of hospitals.

A prospective cohort study of cord blood 25(OH)D3 and food allergies in 6-month-old Chinese infants.

BACKGROUND: Vitamin D is closely related to childhood allergic diseases, such as food allergies, atopic dermatitis, and asthma. However, it is unclear whether vitamin D status in the cord blood from mothers is related to food allergies in infants. OBJECTIVE: We performed a prospective cohort study on the relationship between the cord blood vitamin D [i.e., 25-hydroxyvitamin D3(25(OH)D3)] level and infant food allergies. METHODS: This study selected 741 newborns to observe until 6 months of age and used open oral food challenges (OFCs) to diagnose their food allergies. Cord blood and 6-month serum 25(OH)D3 levels of the infants were measured by liquid chromatography-tandem mass spectrometry. RESULTS: The proportion of children with cord blood 25(OH)D3 deficiency (< 20 ng/mL) was 86.27%. Cord blood vitamin D was positively correlated with the supplementation frequency of egg yolk, multivitamins, calcium, and docosahexaenoic acid (DHA) during pregnancy and the mother's age. No significant difference was found in the cord blood 25(OH)D3 level between summer born and winter born infants (p = 0.465). After adjusting for seasonal factors, the risk of food allergies in the 25(OH)D3 non-deficiency group was 2.72 times that of the 25(OH)D3 deficiency group. Infants in the 25(OH)D3 non-deficiency group ≥20 ng/mL) had a higher risk of allergies compared with the deficiency group (< 20 ng/mL) (RR = 2.49). CONCLUSIONS: Cord blood 25(OH)D3 is associated with infant food allergies. Maintaining 25(OH)D3 in maternal cord blood at a low level may be conducive to the prevention of infant food allergies.

Study of genetic correlation between children's sleep and obesity.

Laboratory and epidemiological studies have shown that short sleep time is associated with obesity. In this study, we conducted a post-GWAS analysis to test genetic correlation between children's sleep and obesity due to linkage disequilibrium (LD) SNPs, shared genes and pathways. Our analysis showed that genetic heritability was 0.14 (p-value = 0.0005) and 0.41 (p-value = 1.18E-24) for children's sleep and obesity, respectively, but genetic correlation due to LD SNPs was insignificant. Gene associations at children's GWAS were measured based on SNP associations and ranked by their uniform score (U-score). After adjusting for gene size, measured as the number of independent SNPs, children's sleep and obesity GWAS had significant gene correlation (r = 0.23). Pathway enrichment analysis showed that "Suz12 target genes" was the significant pathway for both children's sleep and obesity; pathways were significantly shared among top enriched pathways with an OR of 8.1-59.4; and significant correlation coefficient of pathway U-score was r = 0.36. Analysis of sleep time and obesity GWAS variants for all ages in the NHGRI-EBI GWAS Catalog also presented significant pathway correlation (r = 0.30). The "PAX3-FOXO1 target genes" was the significant pathway for all-age obesity phenotype and ranked as the second top associated pathway for all-age sleep time. Our study suggested that genetic correlation of children's sleep time and obesity is attributed to genes with pleiotropy effects and common pathway regulations that may contain only weak SNP associations.