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Polycystic ovary syndrome (PCOS) is one of the most common gynecological endocrine disorders. Most pathophysiological changes of PCOS begin in the peripubertal phase, and these pathophysiological changes will continuously affect women's health in the later stages of their lives. The pathogenic mechanisms of PCOS remain unclear, involving key aspects such as the regulation of hypothalamic-pituitary function, ovarian cellular functions, androgen levels, and insulin resistance. Herein, we summarized the latest findings on the pathogenesis of PCOS from the perspectives of the genetic background, intrauterine development, neuroendocrine function, inflammatory factors, gut microbiome, and environmental factors. This review will help provide new ideas for a deeper understanding of the disease, as well as its clinical diagnosis and treatment.
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Resistencia a la Insulina , Síndrome del Ovario Poliquístico , Síndrome del Ovario Poliquístico/etiología , Síndrome del Ovario Poliquístico/fisiopatología , Síndrome del Ovario Poliquístico/metabolismo , Humanos , Femenino , Microbioma Gastrointestinal , Ovario , Sistema Hipotálamo-Hipofisario/fisiopatología , Andrógenos/metabolismoRESUMEN
Blood microbiome signatures in patients with type 1 diabetes (T1D) remain unclear. We profile blood microbiome using 16S rRNA gene sequencing in 77 controls and 64 children with new-onset T1D, and compared it with the gut and oral microbiomes. The blood microbiome of patients with T1D is characterized by increased diversity and perturbed microbial features, with a significant increase in potentially pathogenic bacteria compared with controls. Thirty-six representative genera of blood microbiome were identified by random forest analysis, providing strong discriminatory power for T1D with an AUC of 0.82. PICRUSt analysis suggested that bacteria capable of inducing inflammation were more likely to enter the bloodstream in T1D. The overlap of the gut and oral microbiome with the blood microbiome implied potential translocation of bacteria from the gut and oral cavity to the bloodstream. Our study raised the necessity of further mechanistic investigations into the roles of blood microbiome in T1D.
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Current whole slide image (WSI) segmentation aims at extracting tumor regions from the background. Unlike this, segmenting distinct tumor areas (instances) within a WSI driven by limited annotated data remains under-explored. In this paper, we formally propose semisupervised instance segmentation (Semi-IS) in WSIs. We address a key challenge: learning intra-class similarity and inter-class dissimilarity driven by unlabeled data. Specifically, we generally perceive the patch as composed of tokens (together), not the patch alone. We employ contrastive learning to develop a segmentation framework. In the SemiIS, we find that the boundaries of segmented instances are usually disturbed by noise. We jointly eliminate and preserve noise features to address this problem. We conduct extensive experiments to evaluate the effectiveness and generalizability of Semi-IS, including histopathology and cellular pathology. The results show that in clinical multi instance segmentation tasks, Semi-IS achieves almost fullsupervised state-of-the-art results with only 30% annotated data. Semi-IS can improve segmentation accuracy by about 2% on public cell pathology datasets.
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BACKGROUND: Dysregulation of bile acids (BAs), as important signalling molecules in regulating lipid and glucose metabolism, contributes to the development of non-alcoholic fatty liver disease (NAFLD). However, static BA profiles during fasting may obscure certain pathogenetic aspects. In this study, we investigate the dynamic alterations of BAs in response to an oral glucose tolerance test (OGTT) among children with NAFLD. METHODS: We recruited 230 subjects, including children with overweight/obesity, or complicated with NAFLD, and healthy controls. Serum BAs, 7-hydroxy-4-cholesten-3-one (C4) and fibroblast growth factor 19 (FGF19) were quantified during OGTT. Clinical markers related to liver function, lipid metabolism and glucose metabolism were assessed at baseline or during OGTT. FINDINGS: Conjugated BAs increased while unconjugated ones decreased after glucose uptake. Most BAs were blunted in response to glucose in NAFLD (p > .05); only glycine and taurine-conjugated chenodeoxycholic acid (CDCA) and cholic acid (CA) were responsive (p < .05). Primary BAs were significantly increased while secondary BAs were decreased in NAFLD. C4 and FGF19 were significantly increased while their ratio FGF19/C4 ratio was decreased in NAFLD. The dynamic pattern of CDCA and taurine-conjugated hyocholic acid (THCA) species was closely correlated with glucose (correlation coefficient r = .175 and -.233, p < .05), insulin (r = .327 and -.236, p < .05) and c-peptide (r = .318 and -.238, p < .05). Among which, CDCA was positively associated with liver fat content in NAFLD (r = .438, p < .05). Additionally, glycochenodeoxycholic acid (GCDCA), CDCA and THCA were potential biomarkers to discriminate paediatric NAFLD from healthy controls and children with obesity. INTERPRETATION: This study provides novel insights into the dynamics of BAs during OGTT in paediatric NAFLD. The observed variations in CDCA and HCA species were associated with liver dysfunction, dyslipidaemia and dysglycaemia, highlighting their potential roles as promising diagnostic and therapeutic targets in NAFLD.
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Objective: Evaluating changes over time in the odds of obesity according to sex. Methods: PubMed, Embase, Cochrane Library, and China National Knowledge Database were searched for relevant studies. Full-text studies evaluating the influence of sex on obesity were analyzed. We used R 3.4.3 to assess the impact of results in the selected studies, calculated pooled prevalence and odds ratio (OR) with their respective 95% confidence intervals (CIs). P<0.10 and I2>50% indicated high heterogeneity, and the random-effects model was used, otherwise, the fixed-effects model was used. Results: The included studies reported the prevalence of obesity in children covering 1987-2017 intervals. The pooled prevalence of obesity in boy and girl groups were 0.13 (95% CI: 0.08, 0.20) and 0.10 (95% CI: 0.07, 0.13). In the analysis of the boy group, the pooled OR in earlier time (1987-2013) vs. recent time (2011-2017) was 0.98 (95% CI: 0.76, 1.26). The estimated OR for girls in earlier vs. recent time was 1.01 (95% CI: 0.80, 1.28). In the analysis of studies with follow-up period ≥ 10 years, the pooled OR for obesity in earlier vs. recent time period was 0.99 (95% CI: 0.76, 1.30). For those with follow-up period < 10 years, the pooled OR in earlier vs. recent time period was 0.94 (95% CI: 0.57, 1.54). Conclusions: Comprehensive measurements are required to control obesity among children albeit with nonsignificant gender difference and time trend for obesity rates in children.
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Diabetes mellitus (DM) is a common chronic disease affecting humans globally. It is characterized by abnormally elevated blood glucose levels due to the failure of insulin production or reduction of insulin sensitivity and functionality. Insulin and glucagon-like peptide (GLP)-1 replenishment or improvement of insulin resistance are the two major strategies to treat diabetes. Recently, optogenetics that uses genetically encoded light-sensitive proteins to precisely control cell functions has been regarded as a novel therapeutic strategy for diabetes. Here, we summarize the latest development of optogenetics and its integration with synthetic biology approaches to produce light-responsive cells for insulin/GLP-1 production, amelioration of insulin resistance and neuromodulation of insulin secretion. In addition, we introduce the development of cell encapsulation and delivery methods and smart bioelectronic devices for the in vivo application of optogenetics-based cell therapy in diabetes. The remaining challenges for optogenetics-based cell therapy in the clinical translational study are also discussed.
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Diabetes Mellitus , Optogenética , Humanos , Optogenética/métodos , Diabetes Mellitus/terapia , Animales , Insulina/metabolismo , Resistencia a la Insulina , Péptido 1 Similar al Glucagón , Tratamiento Basado en Trasplante de Células y Tejidos/métodos , Células Secretoras de Insulina/metabolismoRESUMEN
AIMS: To document the prevalence of skin problems associated with insulin pump use and identify contributing factors among children with type 1 diabetes mellitus in China. METHODS: In total, 461 children were recruited from an online community (i.e., a Wechat group) of pediatric patients with T1DM. A self-developed questionnaire was filled in by parents, collecting the information on social demographics, disease, and insulin pump therapy related characteristics and skin problems. We applied the Mann-Whitney U test, Chi square test and logistic regression analysis to identify the factors associated with skin problems. RESULTS: Of the 461 responders, 308 (66.8 %) children were reported to have skin problems. More specifically, 38.8 % had pigmentation changes, 22.3 % allergy/dermatitis, 20.2 % scaring, 11.5 % pain, 10.8 % infection, 10.6 % subcutaneous lipohypertrophy, and 6.1 % lipoatrophy. Logistic regression analysis showed that independent associated factors of skin problems were the caregiver's educational level as college or above, patient having skin allergies, and using the Brand 2 insulin pump (p values < 0.05). CONCLUSIONS: The present study documents the prevalence of skin problems and identifies associated factors, such as caregiver's education, patients skin allergies, and using a specific brand of pump. Health education should address these factors in addition to the traditionally emphasized factors.
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Diabetes Mellitus Tipo 1 , Sistemas de Infusión de Insulina , Insulina , Enfermedades de la Piel , Humanos , Diabetes Mellitus Tipo 1/epidemiología , Diabetes Mellitus Tipo 1/tratamiento farmacológico , Sistemas de Infusión de Insulina/efectos adversos , Niño , Masculino , Femenino , Estudios Transversales , China/epidemiología , Prevalencia , Adolescente , Enfermedades de la Piel/epidemiología , Enfermedades de la Piel/inducido químicamente , Insulina/efectos adversos , Insulina/administración & dosificación , Insulina/uso terapéutico , Preescolar , Encuestas y Cuestionarios , Hipoglucemiantes/efectos adversos , Hipoglucemiantes/administración & dosificaciónRESUMEN
Appendicovesical fistula is a rare complication associated with appendicitis, Crohn's disease, or appendiceal tumors, posing significant diagnostic challenges. We reported a pediatric case of appendicovesical fistula that remained undiagnosed by non-contrast computed tomography, fluoroscopic voiding cystourethrography (VCUG). Although identified during cystoscopy, its connection to the fistula site could not be determined. However, the transvesical contrast-enhanced ultrasound clearly demonstrated the presence of fistula. Subsequently, laparoscopic appendectomy and bladder repair were performed successfully, leading to complete recovery in the patient. To our knowledge, this is the first reported diagnosis of appendicovesical fistula in children using contrast-enhanced ultrasound.
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Medios de Contraste , Ultrasonografía , Fístula de la Vejiga Urinaria , Humanos , Fístula de la Vejiga Urinaria/etiología , Fístula de la Vejiga Urinaria/diagnóstico por imagen , Fístula de la Vejiga Urinaria/cirugía , Ultrasonografía/métodos , Masculino , Apéndice/diagnóstico por imagen , Enfermedades del Ciego/diagnóstico por imagen , Enfermedades del Ciego/etiología , Enfermedades del Ciego/cirugía , Niño , Apendicectomía/efectos adversos , Apendicitis/diagnóstico por imagen , Apendicitis/cirugíaRESUMEN
OBJECTIVE: The objective of this study was to explore the associations between a family history of type 2 diabetes (T2D) and beta-cell function, as well as lipid profile, in pediatric patients newly diagnosed with type 1 diabetes (T1D). METHODS: A retrospective analysis was conducted on children under 14 years of age who were newly diagnosed with T1D at the Children's Hospital of Zhejiang University between August 2018 and August 2022. Clinical features, metabolic profiles, beta-cell function, and lipid profile were evaluated. RESULTS: A total of 316 children were diagnosed with new-onset T1D. Among them, 28.2% had a family history of T2D. Patients with T1D who had a family history of T2D experienced a later onset of the disease (p = 0.016), improved HOMA2-%B levels (p = 0.003), and increased concentrations of HDL-C (p = 0.005). In addition, no statistically significant differences in age at onset, HOMA2-%B levels, or HDL-C were found when assessing the interaction between family history of T2D and type of diabetes mellitus (autoimmune T1D/idiopathic T1D). CONCLUSION: A family history of T2D may contribute to the heterogeneity of T1D patients in terms of HOMA2-%B levels and lipid profile. This highlights the significance of taking into account T2D-related factors in the diagnosis and treatment of T1D.
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Diabetes Mellitus Tipo 1 , Diabetes Mellitus Tipo 2 , Células Secretoras de Insulina , Lípidos , Humanos , Diabetes Mellitus Tipo 1/sangre , Masculino , Niño , Femenino , Diabetes Mellitus Tipo 2/sangre , Estudios Retrospectivos , Células Secretoras de Insulina/metabolismo , Adolescente , Preescolar , Lípidos/sangreRESUMEN
OBJECTIVE: To characterize the phenotype spectrum, diagnosis, and response to growth-promoting therapy in patients with ACAN variants causing familial short stature. METHODS: Three families with ACAN variants causing short stature were reported. Similar cases in the literature were summarized, and the genotype and phenotype were analyzed. RESULTS: Three novel heterozygous variants, c.757+1G>A, (splicing), c.6229delG, p.(Asp2078Tfs*1), and c.6679C>T, p.(Gln2227*) in the ACAN gene were identified. A total of 314 individuals with heterozygous variants from 105 families and 8 individuals with homozygous variants from 4 families were confirmed to have ACAN variants from literature and our 3 cases. Including our 3 cases, the variants reported comprised 33 frameshift, 39 missense, 23 nonsense, 5 splicing, 4 deletion, and 1 translocation variants. Variation points are scattered throughout the gene, while exons 12, 15, and 10 were most common (25/105, 11/105, and 10/105, respectively). Some identical variants existing in different families could be hot variants, c.532A>T, p.(Asn178Tyr), c.1411C>T, p.(Gln471*), c.1608C>A, p.(Tyr536*), c.2026+1G>A, (splicing), and c.7276G>T, p.(Glu2426*). Short stature, early-onset osteoarthritis, brachydactyly, midfacial hypoplasia, and early growth cessation were the common phenotypic features. The 48 children who received rhGH (and GnRHa) treatment had a significant height improvement compared with before (-2.18 ± 1.06 SD vs. -2.69 ± 0.95 SD, p < 0.001). The heights of children who received rhGH (and GnRHa) treatment were significantly improved compared with those of untreated adults (-2.20 ± 1.10 SD vs. -3.24 ± 1.14 SD, p < 0.001). CONCLUSION: Our study achieves a new understanding of the phenotypic spectrum, diagnosis, and management of individuals with ACAN variants. No clear genotype-phenotype relationship of patients with ACAN variants was found. Gene sequencing is necessary to diagnose ACAN variants that cause short stature. In general, appropriate rhGH and/or GnRHa therapy can improve the adult height of affected pediatric patients caused by ACAN variants.
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Enanismo , Hormona de Crecimiento Humana , Adulto , Niño , Humanos , Agrecanos , Genotipo , Heterocigoto , Homocigoto , Pacientes , FenotipoRESUMEN
BACKGROUND: Alanine aminotransferase (ALT) is widely used to screen patients with hepatic diseases. However, the current reference ranges (< 50 U/L) were developed by laboratories and have not been validated in populations with a large number of healthy individuals. METHODS: This study collected venous blood and anthropometric data from a total of 13,287 healthy children aged 3 months to 18 years who underwent routine physical examinations in the Department of Pediatric Healthcare. We applied the least mean square algorithm to establish age- and sex-related reference percentiles of serum levels of transaminases. For validation, we recruited 4276 children and adolescents with obesity/overweight who underwent evaluation and metabolic tests in the hospital. Using receiver operating characteristic curves, we determined age- and sex-specific upper limit percentiles of liver enzymes for fatty liver diseases. RESULTS: This study revealed a significant correlation between serum transaminase levels and age and sex (P < 0.01). These transaminase levels exhibited age- and sex-specific patterns. Among individuals in the non-alcoholic fatty liver disease (NAFLD) cohort, elevated ALT levels displayed a positive association with clinical markers of disease severity, including homeostatic model assessment of insulin resistance, waist-hip ratio, and serum uric acid levels (P < 0.01). According to the receiver operating characteristic curves, ALT levels at the 92.58th percentile for boys and the 92.07th percentile for girls yielded the highest accuracy and specificity. CONCLUSIONS: This study provides age- and sex-specific reference ranges for ALT, aspartate aminotransferase, and γ-glutamyltransferase in Chinese children and adolescents, making it the largest population study to date. Furthermore, the study establishes a precise upper limit for ALT levels, facilitating their use in NAFLD screening. Video Abstract.
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Background: In 2020, our center established a Tanner-Whitehouse 3 (TW3) artificial intelligence (AI) system using a convolutional neural network (CNN), which was built upon 9059 radiographs. However, the system, upon which our study is based, lacked a gold standard for comparison and had not undergone thorough evaluation in different working environments. Methods: To further verify the applicability of the AI system in clinical bone age assessment (BAA) and to enhance the accuracy and homogeneity of BAA, a prospective multi-center validation was conducted. This study utilized 744 left-hand radiographs of patients, ranging from 1 to 20 years of age, with 378 boys and 366 girls. These radiographs were obtained from nine different children's hospitals between August and December 2020. The BAAs were performed using the TW3 AI system and were also reviewed by experienced reviewers. Bone age accuracy within 1 year, root mean square error (RMSE), and mean absolute error (MAE) were statistically calculated to evaluate the accuracy. Kappa test and Bland-Altman (B-A) plot were conducted to measure the diagnostic consistency. Results: The system exhibited a high level of performance, producing results that closely aligned with those of the reviewers. It achieved a RMSE of 0.52 years and an accuracy of 94.55% for the radius, ulna, and short bones series. When assessing the carpal series of bones, the system achieved a RMSE of 0.85 years and an accuracy of 80.38%. Overall, the system displayed satisfactory accuracy and RMSE, particularly in patients over 7 years old. The system excelled in evaluating the carpal bone age of patients aged 1-6. Both the Kappa test and B-A plot demonstrated substantial consistency between the system and the reviewers, although the model encountered challenges in consistently distinguishing specific bones, such as the capitate. Furthermore, the system's performance proved acceptable across different genders and age groups, as well as radiography instruments. Conclusions: In this multi-center validation, the system showcased its potential to enhance the efficiency and consistency of healthy delivery, ultimately resulting in improved patient outcomes and reduced healthcare costs.
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BACKGROUND: Throughout the COVID-19 pandemic, there has been a notable increase in the incidence of new-onset diabetes and diabetic ketoacidosis (DKA). Simultaneously, children diagnosed with type 1 diabetes (T1D) have encountered difficulties in maintaining optimal blood glucose levels. The mechanisms underpinning these correlations still remain a puzzle. We reviewed the studies that examined changes in incidence during the pandemic. These studies utilized various metrics for comparison, which encompassed the timing of data collection, diagnostic criteria, as well as the numbers and incidence rates of diabetes and DKA. We found the incidence of diabetes and DKA was higher during the pandemic. As to mechanisms, the invivo and invitro study revealed the factors such as direct viral damage, metabolic dysfunction, and immune responses all attribute to the process of T1D after suffering from COVID-19. Furthermore, we provide some useful strategies to prevent and treat children suffering from diabetes and COVID-19. CONCLUSIONS: Strong correlations have been observed between new-onset diabetes and COVID-19. Insights gleaned from clinical descriptions and basic research can offer valuable experience and recommendations for the treatment and prevention of diabetes during future pandemics.
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ABBREVIATIONS: ACOX1: acyl-CoA oxidase 1; ADH5: alcohol dehydrogenase 5 (class III), chi polypeptide; ADIPOQ: adiponectin, C1Q and collagen domain containing; ATG: autophagy related; BECN1: beclin 1; CRTC2: CREB regulated transcription coactivator 2; ER: endoplasmic reticulum; F2RL1: F2R like trypsin receptor 1; FA: fatty acid; FOXO1: forkhead box O1; GLP1R: glucagon like peptide 1 receptor; GRK2: G protein-coupled receptor kinase 2; GTPase: guanosine triphosphatase; HFD: high-fat diet; HSCs: hepatic stellate cells; HTRA2: HtrA serine peptidase 2; IRGM: immunity related GTPase M; KD: knockdown; KDM6B: lysine demethylase 6B; KO: knockout; LAMP2: lysosomal associated membrane protein 2; LAP: LC3-associated phagocytosis; LDs: lipid droplets; Li KO: liver-specific knockout; LSECs: liver sinusoidal endothelial cells; MAP1LC3/LC3: microtubule associated protein 1 light chain 3; MAP3K5: mitogen-activated protein kinase kinase kinase 5; MED1: mediator complex subunit 1; MTOR: mechanistic target of rapamycin kinase; MTORC1: mechanistic target of rapamycin complex 1; NAFLD: non-alcoholic fatty liver disease; NASH: non-alcoholic steatohepatitis; NFE2L2: NFE2 like bZIP transcription factor 2; NOS3: nitric oxide synthase 3; NR1H3: nuclear receptor subfamily 1 group H member 3; OA: oleic acid; OE: overexpression; OSBPL8: oxysterol binding protein like 8; PA: palmitic acid; RUBCNL: rubicon like autophagy enhancer; PLIN2: perilipin 2; PLIN3: perilipin 3; PPARA: peroxisome proliferator activated receptor alpha; PRKAA2/AMPK: protein kinase AMP-activated catalytic subunit alpha 2; RAB: member RAS oncogene family; RPTOR: regulatory associated protein of MTOR complex 1; SCD: stearoyl-CoA desaturase; SIRT1: sirtuin 1; SIRT3: sirtuin 3; SNARE: soluble N-ethylmaleimide-sensitive factor attachment protein receptor; SQSTM1/p62: sequestosome 1; SREBF1: sterol regulatory element binding transcription factor 1;SREBF2: sterol regulatory element binding transcription factor 2; STING1: stimulator of interferon response cGAMP interactor 1; STX17: syntaxin 17; TAGs: triacylglycerols; TFEB: transcription factor EB; TP53/p53: tumor protein p53; ULK1: unc-51 like autophagy activating kinase 1; VMP1: vacuole membrane protein 1.
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Autofagia , Enfermedad del Hígado Graso no Alcohólico , Humanos , Autofagia/genética , Enfermedad del Hígado Graso no Alcohólico/genética , Proteína p53 Supresora de Tumor , Dieta Alta en Grasa/efectos adversos , Células Endoteliales , Diana Mecanicista del Complejo 1 de la Rapamicina , Factores de Transcripción , GTP Fosfohidrolasas , Esteroles , Histona Demetilasas con Dominio de Jumonji , Proteínas de la MembranaRESUMEN
OBJECTIVE: Previous studies have reported sex differences in non-alcoholic fatty liver disease (NAFLD) among adults; however, little is known about its occurrence in children and adolescents. This study aims to examine the prevalence of NAFLD among them and investigate the relationship between sex hormones and NAFLD. METHOD: This study included 2999 obese Chinese children aged 2-18 years. We examined the prevalence of NAFLD by sex, age, and Tanner stage. The regression model and principal component analysis were used to analyze the relationship between sex hormones and NAFLD. RESULTS: The prevalence of NAFLD increased with age in both sexes, and the gender difference appeared before puberty. The prevalence in boys tended to stabilize at the age of 11 years, whereas girls reached their peak temporarily. NAFLD prevalence was positively associated with estradiol in boys (p = 0.011), but the opposite trend was observed in girls (p = 0.031). Testosterone levels decreased with the increase of NAFLD prevalence in boys (p < 0.001). Luteinizing hormone and prolactin were inversely associated with NAFLD prevalence in boys and girls, respectively. Results from the principal component analysis showed that sex hormone levels and fat distribution were important risk factors for the prevalence of NAFLD in obese children (p < 0.001). CONCLUSION: The significant difference in NAFLD prevalence between genders in obese children begins in early childhood. This distinction emerges long before puberty onset and tends to stabilize during late adolescence. Sex hormones are associated with NAFLD prevalence and are influenced by the Tanner stages and fat distribution.
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Enfermedad del Hígado Graso no Alcohólico , Obesidad Infantil , Adulto , Humanos , Femenino , Masculino , Niño , Preescolar , Adolescente , Enfermedad del Hígado Graso no Alcohólico/epidemiología , Estudios Transversales , Obesidad Infantil/epidemiología , Factores Sexuales , Hormonas Esteroides Gonadales , Prevalencia , Índice de Masa CorporalRESUMEN
AIMS: This research explores the relationships between food addiction (FA), eating behaviours, and weight status in school-aged children and adolescents, aiming to understand how FA influences weight. METHODS: By using a cross-sectional design, 426 healthy children and their parents were enroled in Eastern China. FA was assessed using the Chinese version of the Dimensional Yale Food Addiction Scale for Children 2.0 (dYFAS-C 2.0), while eating patterns were identified using latent profile analysis (LPA) derived from the Children's Eating Behaviour Questionnaire (CEBQ). Weight status was indicated by Body Mass Index Z Score (BMIZ) and waist-to-height ratio (WHtR). The associations among FA, eating patterns, and weight status were explored using structural equation modelling (SEM). RESULTS: Two eating patterns, the Responsive and the Controlled Eating Patterns, were identified. The Responsive Eating Pattern was characterized by high food responsiveness, enjoyment of food, emotional eating, fast eating, low satiety responsiveness, and food fussiness and was associated with FA and weight status (p < 0.001). The SEM results showed the Responsive Eating Pattern partially mediated the relationship between FA and weight status, with a mediation effect of 1.183 (95% CI [0.784, 1.629]) for BMIZ and 0.043 (95% CI [0.025, 0.063]) for WHtR. CONCLUSION: Increased FA is associated with a higher weight status through a specific eating behaviour pattern characterized by high responsiveness to food, emotional and rapid eating habits, and low satiety. The findings suggest that targeted interventions should take these eating behaviour patterns into account to reduce the impact of FA on weight status among children and adolescents.
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Adicción a la Comida , Niño , Humanos , Adolescente , Adicción a la Comida/diagnóstico , Adicción a la Comida/epidemiología , Estudios Transversales , Conducta Infantil/psicología , Índice de Masa Corporal , Conducta Alimentaria , Encuestas y CuestionariosRESUMEN
Microscopic examination of visible components based on micrographs is the gold standard for testing in biomedical research and clinical diagnosis. The application of object detection technology in bioimages not only improves the efficiency of the analyst but also provides decision support to ensure the objectivity and consistency of diagnosis. However, the lack of large annotated datasets is a significant impediment in rapidly deploying object detection models for microscopic formed elements detection. Standard augmentation methods used in object detection are not appropriate because they are prone to destroy the original micro-morphological information to produce counterintuitive micrographs, which is not conducive to build the trust of analysts in the intelligent system. Here, we propose a feature activation map-guided boosting mechanism dedicated to microscopic object detection to improve data efficiency. Our results show that the boosting mechanism provides solid gains in the object detection model deployed for microscopic formed elements detection. After image augmentation, the mean Average Precision (mAP) of baseline and strong baseline of the Chinese herbal medicine micrograph dataset are increased by 16.3% and 5.8% respectively. Similarly, on the urine sediment dataset, the boosting mechanism resulted in an improvement of 8.0% and 2.6% in mAP of the baseline and strong baseline maps respectively. Moreover, the method shows strong generalizability and can be easily integrated into any main-stream object detection model. The performance enhancement is interpretable, making it more suitable for microscopic biomedical applications.
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Investigación Biomédica , Microscopía , RíosRESUMEN
Background: Teratomas are the most common germ cell tumors in children, and histologically classified as mature teratomas (MTs) and immature teratomas (ITs). Preoperative IT identification can affect the surgical approach, the type of procedure, and future possible reproductive health. However, there is no complete diagnostic criterion for ITs nowadays. We aimed to establish and validate a nomogram based on clinical and computed tomography (CT) features for preoperative prediction of ITs in children. Methods: We retrospectively reviewed 519 teratoma patients from hospital I for training (n=364) and validation (n=155), and 113 patients from hospital II for external validation. Univariate and multivariate logistic regression analyses were performed on the training set to screen risk factors, including alpha-fetoprotein (AFP), age, gender, tumor site, size, tumor composition, calcification and fat. Then, a nomogram was established based on identified risk factors and validated on the validation set. The performance of the nomogram was evaluated in terms of discrimination, calibration and the clinical usefulness. Results: Multivariate logistic regression showed that tumor composition, AFP, age, calcification and fat were independent risk factors for preoperative prediction of IT. The area under the receiver operating characteristic (ROC) curves (AUCs) for the nomogram on the training set, internal and external validation set were 0.92 (0.88-0.96), 0.91 (0.84-0.97) and 0.92 (0.86-0.97), respectively. The model demonstrated sensitivity of 80%, specificity of 90% at the cut-off value of 0.262. Whatever the set, the calibration curve indicated good calibration. Decision curve analysis (DCA) curves demonstrated that the nomogram had greater net benefits than either the treat-all tactics or the treat-none tactics within a large scope of threshold. Conclusions: The nomogram established based on clinical and CT findings had the favorable accuracy for the preoperative prediction of IT, and may help in clinical decision-making and risk stratification.
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There is a lack of long-term data on the benefit of growth hormone (GH) treatment in Chinese children born small for gestational age (SGA). This study was conducted to assess the long-term efficacy and safety of GH treatment in children born SGA. One hundred and twenty prepubertal SGA children who did not achieve catch-up growth with height remained less than -2 standard deviations (SD) below gender-specific height were enrolled in this two-year, randomized, dose-comparative study followed by an extension study of up to 10 years. Daily subcutaneous injections of 0.23 mg/kg/week [low-dose (LD) group] or 0.46 mg/kg/week [high-dose (HD) group] somatropin were given for 104 weeks. Dosing in the extension study was≤0.46 mg/kg/week. The main outcome measures were change in height SD score (ΔHT-SDS), height velocity, insulin-like growth factor (IGF)-1, and IGF-1/IGF binding protein-3 (IGFBP-3) molar ratio. ΔHT-SDS at week 104 was 0.91±0.53 and 1.52±0.64 in the LD and HD groups (intergroup p<0.0001), respectively, and continued in an upward trend throughout the extension study, remaining above+2 for those who received treatment for a total of 7 years or more. At week 104, significant improvements were observed in height velocity, IGF-1 SDS, and IGF-1/IGFBP-3 molar ratio. Adult HT-SDS was -0.81±1.68 for boys and -0.82±1.05 for girls (p=0.9837). Glucose metabolism and thyroid function were within the normal reference range throughout treatment. Long-term recombinant human GH treatment was tolerable and effective at improving height in children born SGA.