Influences of superfine-grinding and enzymolysis separately assisted with carboxymethylation and acetylation on the in vitro hypoglycemic and antioxidant activities of oil palm kernel expeller fibre.

The synergistic effects of ultrafine grinding and enzymolysis (cellulase and Laccase hydrolysis) alone or combined with carboxymethylation or acetylation on the hypoglycemic and antioxidant activities of oil palm kernel fibre (OPKEF) were studied for the first time. After these synergistic modifications, the microstructure of OPKEF became more porous, and its soluble fibre and total polyphenols contents, and surface area were all improved (P < 0.05). Superfine-grinding and enzymolysis combined with carboxymethylation treated OPKEF exhibited the highest viscosity (13.9 mPa∙s), inhibition ability to glucose diffusion (38.18%), and water-expansion volume (3.58 mL∙g-1). OPKEF treated with superfine-grinding and enzymolysis combined with acetylation showed the highest surface hydrophobicity (50.93) and glucose adsorption capacity (4.53 µmol∙g-1), but a lower α-amylase-inhibition ability. Moreover, OPKEF modified by superfine-grinding and enzymolysis had the highest inhibiting activity against α-amylase (25.78%). Additionally, superfine-grinding and enzymolysis combined with carboxymethylation or acetylation both improved the content and antioxidant activity of OPEKF's bounding polyphenols (P < 0.05).

Novel insight into cGAS-STING pathway in ischemic stroke: from pre- to post-disease.

Ischemic stroke, a primary cause of disability and the second leading cause of mortality, has emerged as an urgent public health issue. Growing evidence suggests that the Cyclic GMP-AMP synthase (cGAS)- Stimulator of interferon genes (STING) pathway, a component of innate immunity, is closely associated with microglia activation, neuroinflammation, and regulated cell death in ischemic stroke. However, the mechanisms underlying this pathway remain inadequately understood. This article comprehensively reviews the existing literature on the cGAS-STING pathway and its multifaceted relationship with ischemic stroke. Initially, it examines how various risk factors and pre-disease mechanisms such as metabolic dysfunction and senescence (e.g., hypertension, hyperglycemia, hyperlipidemia) affect the cGAS-STING pathway in relation to ischemic stroke. Subsequently, we explore in depth the potential pathophysiological relationship between this pathway and oxidative stress, endoplasmic reticulum stress, neuroinflammation as well as regulated cell death including ferroptosis and PANoptosis following cerebral ischemia injury. Finally, it suggests that intervention targeting the cGAS-STING pathway may serve as promising therapeutic strategies for addressing neuroinflammation associated with ischemic stroke. Taken together, this review concludes that targeting the microglia cGAS-STING pathway may shed light on the exploration of new therapeutic strategies against ischemic stroke.

Naotaifang formula attenuates OGD/R-induced inflammation and ferroptosis by regulating microglial M1/M2 polarization through BMP6/SMADs signaling pathway.

BACKGROUND: Cerebral ischemia-reperfusion injury (CIRI), a subsequent injury caused by thrombolytic reperfusion post ischemic stroke (IS). Naotaifang (NTF) formula, a novel traditional Chinese medicine (TCM) remedy against IS, was shown to exert beneficial effects in inhibiting inflammation and inhibiting lipid peroxide synthesis in our previous research. PURPOSE: This study aimed to further explore the role of NTF in attenuating oxygen-glucose deprivation//reoxygenation (OGD/R)-induced inflammation and ferroptosis by regulating microglial M1/M2 polarization through the bone morphogenetic protein 6（BMP6）/SMADs signaling pathway. METHODS: BV2 microglia were used to establish an OGD/R model. The effects of NTF on inflammation and ferroptosis in OGD/R-injured BV2 cells were separately detected by immunofluorescence assay, fluorescent probe, DCFH-DA flow cytometry, enzyme-linked immunosorbent assay, and western-blot. RESULTS: The present results revealed that the M1 phenotype of microglia promoted the secretion of pro-inflammatory cytokines and aggravated ferroptosis and brain damage following OGD/R. However, an inhibitor of BMP6, LND-193189, reversed the aforementioned effects. Similarly, NTF promoted the shift of microglia from M1 to M2. Besides, NTF treatment effectively inhibited the expression of hepcidin, BMP6, SMADs and promoted the expression of ferroportin (FPN, SLC40A1) and γ-L-glutamyl-L-cysteinylglycine (glutathione or GSH) peroxidase 4 (GPX4). CONCLUSION: Microglial M1/M2 polarization plays a pivotal role in inflammation and ferroptosis during OGD/R. The BMP6/SMADs signaling pathway is a potential therapeutical target of inflammation and ferroptosis induced by the transformation of microglia. Moreover, NTF could alleviate inflammation and ferroptosis through the BMP6/SMADs signaling pathway in OGD/R-injured microglia.

Mitochondrial dysfunctions induce PANoptosis and ferroptosis in cerebral ischemia/reperfusion injury: from pathology to therapeutic potential.

Ischemic stroke (IS) accounts for more than 80% of the total stroke, which represents the leading cause of mortality and disability worldwide. Cerebral ischemia/reperfusion injury (CI/RI) is a cascade of pathophysiological events following the restoration of blood flow and reoxygenation, which not only directly damages brain tissue, but also enhances a series of pathological signaling cascades, contributing to inflammation, further aggravate the damage of brain tissue. Paradoxically, there are still no effective methods to prevent CI/RI, since the detailed underlying mechanisms remain vague. Mitochondrial dysfunctions, which are characterized by mitochondrial oxidative stress, Ca2+ overload, iron dyshomeostasis, mitochondrial DNA (mtDNA) defects and mitochondrial quality control (MQC) disruption, are closely relevant to the pathological process of CI/RI. There is increasing evidence that mitochondrial dysfunctions play vital roles in the regulation of programmed cell deaths (PCDs) such as ferroptosis and PANoptosis, a newly proposed conception of cell deaths characterized by a unique form of innate immune inflammatory cell death that regulated by multifaceted PANoptosome complexes. In the present review, we highlight the mechanisms underlying mitochondrial dysfunctions and how this key event contributes to inflammatory response as well as cell death modes during CI/RI. Neuroprotective agents targeting mitochondrial dysfunctions may serve as a promising treatment strategy to alleviate serious secondary brain injuries. A comprehensive insight into mitochondrial dysfunctions-mediated PCDs can help provide more effective strategies to guide therapies of CI/RI in IS.

MiR-140 promotes the progression of intracranial aneurysms by targeting BCL2L2.

To investigate the role of miR-140/BCL2L2 axis on the formation of intracranial aneurysms. The expression of miR-140 in the serum of patients with intracranial aneurysms and healthy volunteers was detected. CCK-8 assay and Annexin V-FITC/PI double staining flow cytometry were used to evaluate the effect of miR-140 knockdown on the proliferation and apoptosis of human brain vascular smooth muscle cells (HBVSMCs). Meanwhile, the relationship between miR-140 and BCL2L2 was examined. MiR-140 was found to be upregulation in intracranial aneurysm patients. MiR-140 knock-out significantly inhibited the apoptosis of HBVSMCs and promoted cell proliferation. BCL2L2 was a direct target gene of miR-140 and suppressed its expression. Knockdown of miR-140 alleviates the development of intracranial aneurysms. MiR-140/BCL2L2 axis promotes the progression of intracranial aneurysms by regulating apoptosis of HBVSMCs. Therefore, miR-140 is a potential therapeutic target for intracranial aneurysms.

[Advances in epigenetics in ischemic stroke].

Ischemic stroke is one of the main causes of death and long-term disability worldwide, which seriously affects the quality of life of patients and brings a heavy economic burden to families and society. Epidemiological studies have shown that stroke has become the second leading cause of death and major disabling disease in the world, with the characteristics of high morbidity, high recurrence, and high mortality. Epigenetic mechanism is the molecular process where gene expression and function in each cell are dynamically regulated and interconnected and a biological mechanism that changes genetic performance without changing the DNA sequence, including DNA methylation, histone modifications, and non-coding RNA. However, the research on epigenetics is currently focused on other diseases such as tumors. Recent studies have found that epigenetics has received extensive attention in the past few decades as a key factor involved in the pathophysiological process of ischemic stroke. The present study introduced the mediation of epigenetics in the induction of stroke, summarized the potential drug targets for these mechanisms in the treatment of stroke, and further explored the significance of traditional Chinese medicine(TCM) against cerebral ischemia injury based on TCM classification of stroke.

Defining health data elements under the HL7 development framework for metadata management.

BACKGROUND: Health data from different specialties or domains generallly have diverse formats and meanings, which can cause semantic communication barriers when these data are exchanged among heterogeneous systems. As such, this study is intended to develop a national health concept data model (HCDM) and develop a corresponding system to facilitate healthcare data standardization and centralized metadata management. METHODS: Based on 55 data sets (4640 data items) from 7 health business domains in China, a bottom-up approach was employed to build the structure and metadata for HCDM by referencing HL7 RIM. According to ISO/IEC 11179, a top-down approach was used to develop and standardize the data elements. RESULTS: HCDM adopted three-level architecture of class, attribute and data type, and consisted of 6 classes and 15 sub-classes. Each class had a set of descriptive attributes and every attribute was assigned a data type. 100 initial data elements (DEs) were extracted from HCDM and 144 general DEs were derived from corresponding initial DEs. Domain DEs were transformed by specializing general DEs using 12 controlled vocabularies which developed from HL7 vocabularies and actual health demands. A model-based system was successfully established to evaluate and manage the NHDD. CONCLUSIONS: HCDM provided a unified metadata reference for multi-source data standardization and management. This approach of defining health data elements was a feasible solution in healthcare information standardization to enable healthcare interoperability in China.

Molecular epidemiology and phylogenetic analysis of HA gene of influenza A(H1N1)pdm09 strain during 2010-2014 in Dalian, North China.

The objective of the present study was to evaluate the epidemiology of influenza A(H1N1)pdm09 and its hemagglutinin (HA) molecular and phylogenetic analysis during 2010-2014 in Dalian, North China. A total of 3717 influenza-like illness (ILI) cases were tested by real-time PCR and 493 were found to be positive. Out of these 493 cases, 121 were subtype influenza A(H1N1)pdm09, of which 14 cases were reported in 2010-2011, 29 in 2012-2013, and 78 in 2013-2014. HA coding regions of 45 isolates were compared to that of the vaccine strain A/California/7/09(H1N1), and a number of variations were detected. P83S, S185T, S203T, R223Q, and I321V mutations were observed in all of the Dalian isolates. Furthermore, a high proportion >71 % of the strains possessed the variation D97N and K283E. Phylogenetic analysis confirmed the close match of the majority of circulating strains with the vaccine strains. However, it also reveals a trend of strains to accumulate amino acid variations and form new phylogenetic groups.

Investigation of data representation issues in computerizing clinical practice guidelines in china.

OBJECTIVES: From the point of view of clinical data representation, this study attempted to identify obstacles in translating clinical narrative guidelines into computer interpretable format and integrating the guidelines with data in Electronic Health Records in China. METHODS: Based on SAGE and K4CARE formulism, a Chinese clinical practice guideline for hypertension was modeled in Protégé by building an ontology that had three components: flowchart, node, and vMR. Meanwhile, data items imperative in Electronic Health Records for patients with hypertension were reviewed and compared with those from the ontology so as to identify conflicts and gaps between. RESULTS: A set of flowcharts was built. A flowchart comprises three kinds of node: State, Decision, and Act, each has a set of attributes, including data input/output that exports data items, which then were specified following ClinicalStatement of HL7 vMR. A total of 140 data items were extracted from the ontology. In modeling the guideline, some narratives were found too inexplicit to formulate, and encoding data was quite difficult. Additionally, it was found in the healthcare records that there were 8 data items left out, and 10 data items defined differently compared to the extracted data items. CONCLUSIONS: The obstacles in modeling a clinical guideline and integrating with data in Electronic Health Records include narrative ambiguity of the guideline, gaps and inconsistencies in representing some data items between the guideline and the patient' records, and unavailability of a unified medical coding system. Therefore, collaborations among various participants in developing guidelines and Electronic Health Record specifications is needed in China.

The Protective Role of TLR3 and TLR9 Ligands in Human Pharyngeal Epithelial Cells Infected with Influenza A Virus.

In this study we aim to extensively investigate the anti-influenza virus immune responses in human pharyngeal epithelial cell line (Hep-2) and evaluate the protective role of Toll-like receptor (TLR) ligands in seasonal influenza A H1N1 (sH1N1) infections in vitro. We first investigated the expression of the TLRs and cytokines genes in resting and sH1N1 infected Hep-2 cells. Clear expressions of TLR3, TLR9, interleukin (IL)-6, tumour necrosis factor (TNF)-α and interferon (IFN)-ß were detected in resting Hep-2 cells. After sH1N1 infection, a ten-fold of TLR3 and TLR9 were elicited. Concomitant with the TLRs activation, transcriptional expression of IL-6, TNF-α and IFN-ß were significantly induced in sH1N1-infected cells. Pre-treatment of cells with poly I:C (an analog of viral double-stranded RNA) and CpG-ODN (a CpG-motif containing oligodeoxydinucleotide) resulted in a strong reduction of viral and cytokines mRNA expression. The results presented indicated the innate immune response activation in Hep-2 cells and affirm the antiviral role of Poly I:C and CpG-ODN in the protection against seasonal influenza A viruses.

The effect of electronic medical record application on the length of stay in a Chinese general hospital: a department- and disease-focused interrupted time-series study.

A key purpose of electronic medical records (EMR) introduced in medical institutions is to improve work efficiency. The average length of stay (LOS) is just an important indicator to evaluate work efficiency of medical care in hospitals. Recently, there have been reports about effects of EMR application on LOS in medical institutions, but they have been mostly based on the overall analysis of a region or a hospital and not of specific clinical departments and diseases or based on longer time periods. Therefore, in this study, we selected four clinical departments and four diseases with the largest number of inpatients from January 2004 to December 2012 in a Chinese 3A general hospital and used an interrupted time-series method by the departments and diseases to analyze the relationship of EMR application and LOS. Through our analyses, we concluded that, under unadjusted condition, LOS were all reduced (P < 0.001) after EMR application in four departments and for four diseases. After adjustment by gender, age or admission condition, LOS still all decreased after EMR application (P < 0.05) regardless of departments or diseases. The trend changes in LOS reversed from increasing to decreasing in the orthopedics department (coefficient: 0.016 to -0.079), the cardiovascular surgery department (coefficient: 0.007 to -0.126) and all departments overall (coefficient: 0.004 to -0.070), as well as for the intervertebral disc disorders (coefficient: 0.026 to -0.068). Furthermore, the decreasing trend gained a larger slope in the cardiology department (coefficient: -0.017 to -0.023), the neurology department (coefficient: -0.012 to -0.043) and for the coronary heart disease (coefficient: -0.010 to -0.018), the ventricular septal defect (coefficient: -0.024 to -0.059), and the cerebral infarction (coefficient: -0.031 to -0.040). Together, these findings indicate that EMR application coincided with a decrease in LOS and may have a contribution to the decrease.

Creating content modules for Chinese EHR documents and their trial implementation in Wuwei City.

Numerous and diverse paper-based health record documents are currently used in China, which are not only different from each other but are also inconsistent with national regulations. If these documents are made to be structured and electronically available, the health records information can be processed by computers to promote a shareable electronic health record (EHR) across organizations. As such, this work was intended to develop a set of content modules to be employed as reusable building blocks for converting the paper-based health records to structured EHR documents. Therefore, in this study, we developed 77 content modules based on the documents of national specifications and implemented them to Wuwei City as a trial. According to the EHR requirements of Wuwei, we added two new content modules in addition to the 77 existing content modules. We then successfully established an EHR system based on the new content modules in combination with the original content modules. This paper could contribute to the construction of structured Chinese EHR documents and provide some experiences as a reference for building EHR systems.

Building clinical data groups for electronic medical record in China.

This article aims at building clinical data groups for Electronic Medical Records (EMR) in China. These data groups can be reused as basic information units in building the medical sheets of Electronic Medical Record Systems (EMRS) and serve as part of its implementation guideline. The results were based on medical sheets, the forms that are used in hospitals, which were collected from hospitals. To categorize the information in these sheets into data groups, we adopted the Health Level 7 Clinical Document Architecture Release 2 Model (HL7 CDA R2 Model). The regulations and legal documents concerning health informatics and related standards in China were implemented. A set of 75 data groups with 452 data elements was created. These data elements were atomic items that comprised the data groups. Medical sheet items contained clinical records information and could be described by standard data elements that exist in current health document protocols. These data groups match different units of the CDA model. Twelve data groups with 87 standardized data elements described EMR headers, and 63 data groups with 405 standardized data elements constituted the body. The later 63 data groups in fact formed the sections of the model. The data groups had two levels. Those at the first level contained both the second level data groups and the standardized data elements. The data groups were basically reusable information units that served as guidelines for building EMRS and that were used to rebuild a medical sheet and serve as templates for the clinical records. As a pilot study of health information standards in China, the development of EMR data groups combined international standards with Chinese national regulations and standards, and this was the most critical part of the research. The original medical sheets from hospitals contain first hand medical information, and some of their items reveal the data types characteristic of the Chinese socialist national health system. It is possible and critical to localize and stabilize the adopted international health standards through abstracting and categorizing those items for future sharing and for the implementation of EMRS in China.

A web-based appointment system to reduce waiting for outpatients: a retrospective study.

BACKGROUND: Long waiting times for registration to see a doctor is problematic in China, especially in tertiary hospitals. To address this issue, a web-based appointment system was developed for the Xijing hospital. The aim of this study was to investigate the efficacy of the web-based appointment system in the registration service for outpatients. METHODS: Data from the web-based appointment system in Xijing hospital from January to December 2010 were collected using a stratified random sampling method, from which participants were randomly selected for a telephone interview asking for detailed information on using the system. Patients who registered through registration windows were randomly selected as a comparison group, and completed a questionnaire on-site. RESULTS: A total of 5641 patients using the online booking service were available for data analysis. Of them, 500 were randomly selected, and 369 (73.8%) completed a telephone interview. Of the 500 patients using the usual queuing method who were randomly selected for inclusion in the study, responses were obtained from 463, a response rate of 92.6%. Between the two registration methods, there were significant differences in age, degree of satisfaction, and total waiting time (P<0.001). However, gender, urban residence, and valid waiting time showed no significant differences (P>0.05). Being ignorant of online registration, not trusting the internet, and a lack of ability to use a computer were three main reasons given for not using the web-based appointment system. The overall proportion of non-attendance was 14.4% for those using the web-based appointment system, and the non-attendance rate was significantly different among different hospital departments, day of the week, and time of the day (P<0.001). CONCLUSION: Compared to the usual queuing method, the web-based appointment system could significantly increase patient's satisfaction with registration and reduce total waiting time effectively. However, further improvements are needed for broad use of the system.

The development of clinical document standards for semantic interoperability in china.

OBJECTIVES: This study is aimed at developing a set of data groups (DGs) to be employed as reusable building blocks for the construction of the eight most common clinical documents used in China's general hospitals in order to achieve their structural and semantic standardization. METHODS: The Diagnostics knowledge framework, the related approaches taken from the Health Level Seven (HL7), the Integrating the Healthcare Enterprise (IHE), and the Healthcare Information Technology Standards Panel (HITSP) and 1,487 original clinical records were considered together to form the DG architecture and data sets. The internal structure, content, and semantics of each DG were then defined by mapping each DG data set to a corresponding Clinical Document Architecture data element and matching each DG data set to the metadata in the Chinese National Health Data Dictionary. By using the DGs as reusable building blocks, standardized structures and semantics regarding the clinical documents for semantic interoperability were able to be constructed. RESULTS: Altogether, 5 header DGs, 48 section DGs, and 17 entry DGs were developed. Several issues regarding the DGs, including their internal structure, identifiers, data set names, definitions, length and format, data types, and value sets, were further defined. Standardized structures and semantics regarding the eight clinical documents were structured by the DGs. CONCLUSIONS: This approach of constructing clinical document standards using DGs is a feasible standard-driven solution useful in preparing documents possessing semantic interoperability among the disparate information systems in China. These standards need to be validated and refined through further study.

High prevalence of vitamin D and calcium deficiency among pregnant women and their newborns in Chengdu, China.

BACKGROUND: Vitamin D and calcium deficiency is common in pregnant women and newborn infants. There are few data about the prevalence of hypovitaminosis D during pregnancy and infancy in China. We assessed vitamin D status of pregnant women and their neonates in Chengdu, Sichuan province, China. METHODS: Maternal serum and cord blood levels of calcium, 25-hydroxyvitamin D [25(OH)D], alkaline phosphatase, and parathyroid hormone (PTH) were studied in 77 urban and rural mother-neonate pairs at term. RESULTS: The mean level of maternal serum 25(OH)D was 35.95+/-19.7 nmol/L, and that of cord blood 25(OH)D was 40.98+/-18.89 nmol/L. The intake of calcium and vitamin D was uniformly low, although it was higher in urban (1010+/-450 mg/d, 237+/-169 IU/d) than in rural (320+/-210 mg/d, 62+/-66 IU/d) women. Maternal serum 25(OH)D was correlated positively with cord blood 25(OH)D (r=0.94, P<0.01). CONCLUSIONS: There is a high prevalence of vitamin D and calcium insufficiency in pregnant women and neonates in Chengdu even when mothers are compliant with prenatal vitamin supplementation. Supplementation is needed to improve maternal and neonatal vitamin D and calcium nutrition.

[Selection of sentinel sites for death surveillance, using cluster or unequal probability sampling].

UNLABELLED: To compare the sampling errors from cluster or unequal probability sampling designs and to adopt the unequal probability sampling method to be used for death surveillance. Taking 107 areas from the county level in Shaanxi province as the sampling frame, a set of samples are drawn by equal probability cluster sampling and unequal probability designs methodologies. Sampling error and effect of each design are estimated according to their complex sample plans. Both the sampling errors depend on the sampling plan and the errors of equal probability in stratified cluster sampling appears to be less than simple cluster sampling. The design effects of unequal probability stratified cluster sampling, such as piPS design, are slightly lower than those of equal probability stratified cluster sampling, but the unequal probability stratified cluster sampling can cover a wider scope of monitoring population. CONCLUSIONS: Results from the analysis of sampling data can not be conducted without consideration of the sampling plan when the sampling frame is finite and a given sampling plan and parameters, such as sampling proportion and population weights, are assigned in advance. Unequal probability cluster sampling designs seems to be more appropriate in selecting the national death surveillance sites since more available monitoring data can be obtained and having more weight in estimating the mortality for the whole province or the municipality to be selected.

Harmonization of health data at national level: a pilot study in China.

OBJECTIVE: For the purpose of establishing electronic health record (EHR), business-oriented health data distributed in different systems should be integrated to focus on individuals. This study is aimed at collecting health data items that are now nationally available in various health information systems, and harmonizing them by modeling and defining the data elements. METHODS: This study followed a bottom-up strategy in data standard development. Health data items were identified and collected by referring to national health service regulations, consulting domain experts and performing field investigations. Data items were classified and modeled based on recognized domain knowledge, information standards and specifications developed by standard development organizations (SDOs) of other countries. Data elements were extracted from data items and defined according to ISO/IEC 11179 -Metadata registries (MDR) and confirmed needs. RESULTS: 1588 data items were collected from 33 recording forms that have been used nationally in health services, and were classified with a conceptual data model that was composed of 7 super classes (healthcare clients, healthcare providers, birth registry, health event/act, healthcare process, death, and others) and 15 classes (person's identification, person's socio-demographic characteristics, address, communication, provider-organization, provider-individual, birth, health event/act, observation, procedure, drug and material administration, recommendation, evaluation, expenditure, death, others). By normalizing the concepts and representations of data items, data elements were derived and defined as the attributes of classes in the data model. Data items were specified as instances of corresponding data elements. CONCLUSIONS: A large number of health data have been collected nationwide but person's life-long health record is incomplete and inconsistent now. To integrate such massive quantity of health data from various sources, a conceptual data model was established to organize data items, avoiding conflicts and duplications in between. For data consistency, data elements should be extracted from the data items and defined as attributes of classes in the data model by choosing essential metadata attributes. Treating data items as instances of well defined data elements might make data in different contexts manageable and agreeable. To be semantically unambiguous, further study should be performed to deal with the standardization of detailed medical information, and perfect the approach of data harmonization.

[Effects of different feeding types on the physical growth of infants].

OBJECTIVE: To investigate the effects of different feeding types on the physical growth of infants. METHODS: Infants who visited the children health clinics regularly were recruited for the study. They were classified into breast feeding group, bottle feeding group and mixed feeding group according to the feeding types before 4-months-old. The growth indices were measured and the WHO BMI standards were used to identify overweight and obesity. RESULTS: The body weights and lengths of the male infants with breast feeding were greater than those with other feedings in the first 3 months. The growth of the male infants with bottle feeding began to exceed the other two groups gradually from the 4 month on. The differences of weight and height are statistically significant from 10-12 month and 8-12 month respectively, compared with breast feeding group. The body weights of the female infants with bottle feeding were greater than those with other feedings except for the first month, and the differences were statistically significant from 3 to 12 month (P<0.05). The body lengths of the female infants with bottle feeding were also greater than those with other feedings except for the first two months, and the differences were statistically significant from 4 to 12 month (P<0.05). Before 3-months-old, overweight was more prevalent in the infants with breast feeding than the others. But for the infants 4-months-old and over, overweight was most prevalent in those with bottle feeding (P<0.05). The obesity rate was the highest in the infants with bottle feeding except for the 2-months-old (P<0.05). CONCLUSION: The infants with bottle feeding are exposed to a higher risk of overweight and obesity. Breast feeding may have a potential benefit in preventing infant obesity.

Web-based infectious disease reporting using XML forms.

OBJECTIVE: Exploring solutions for infectious disease information sharing among hospital and public health information systems is imperative to the improvement of disease surveillance and emergent response. This paper aimed at developing a method to directly transmit real-time data of notifiable infectious diseases from hospital information systems to public health information systems on the Internet by using a standard eXtensible Markup Language (XML) format. METHODS: The mechanism and work flow by which notifiable infectious disease data are created, reported and used at health agencies in China was evaluated. The capacity of all participating providers to use electronic data interchange to submit transactions of data required for the notifiable infectious disease reporting was assessed. The minimum data set at national level that is required for reporting for national notifiable infectious disease surveillance was determined. The standards and techniques available worldwide for electronic health data interchange, such as XML, HL7 messaging, CDA and ATSM CCR, etc. were reviewed and compared, and an XML implementation format needed for this purpose was defined for hospitals that are able to access the Internet to provide a complete infectious disease reporting. RESULTS: There are 18,703 county or city hospitals in China. All of them have access to basic information infrastructures including computers, e-mail and the Internet. Nearly 10,000 hospitals possess hospital information systems used for electronically recording, retrieving and manipulating patients' information. These systems collect 23 data items required in the minimum data set for national notifiable infectious disease reporting. In order to transmit these data items to the disease surveillance system and local health information systems instantly and without duplication of data input, an XML schema and a set of standard data elements were developed to define the content, structure and semantics of the data set. These standards make it possible to view and analyse the data accurately outside the hospital information systems in many different document formats. The paper also identified other issues involved in notifiable disease reporting in the future, such as the adoption of approved vocabulary standards and implementation problems such as the route, secure transfer, parsing, and objective identifying of the XML message. CONCLUSIONS: XML is an increasingly important standard for exchange and transmission of data between disparate applications and systems. As in its early stages of developing an interoperable health information system in China, the XML document structures could be a way to exchange the notifiable case information among interest parties on the web at present.