[Changing prevalence of overweight and obesity among Chinese children aged 6-15 from 2009-2019].

Objective: To analyze the trends of overweight and obesity prevalence in Chinese children, aged from 6 to 15 years old among 4 provinces and cities from 2009 to 2019. Methods: Reviewed the national multi-center epidemiological survey data of children from the National Key Technology R&D Program of China during the Eleventh Five-Year Plan (2009 to 2010) and the National Key Research and Development Program of China during the Thirteenth Five-Year Plan (2017 to 2019). The participants' data were selected from four provinces,municipalities and autonomous region,including Beijing, Tianjin (Northern region), Zhejiang (Eastern region), and Guangxi (Southern region). Totally 14 597 pairs of 6-15 year-old children were surveyed. According to the body mass index (BMI) and standard deviation score (SDS) of children among different genders, ages, and regions, t test or chi-square test was used to evaluate the changes in overweight and obesity over a 10-year span. Results: Totally 7 721 pairs of boys and 6 876 pairs of girls were collectted in this study, whose mean age was (10.7±2.5) years. In the past 10 years, the overall BMISDS were 0.39±1.24 and 0.36±1.31 and the overall obesity rate were 11.8% (n=1 773) anel 12.5% (n=1 813) of children in the 4 administrative regions did not have statistically significant differences (all P>0.05). However, the overall overweight rate rose from 17.1% (n=2 496) to 19.1% (n=2 781) (χ²=18.657, P<0.01), and the average annual growth rate was 0.20%. The BMISDS in the Eastern region increased from 0.10±1.07 to 0.19±1.22 (t=-4.095, P<0.01), and the overweight rate and obesity rate increased by 3.8% (n=202) and 3.1% (n=169) respectively (both P<0.01); the BMISDS in the Northern region and the obesity rate did not have statistically significant differences(all P>0.05), but the overweight rate rose from 20.5% (n=1 233) to 22.8% (n=1 365) significantly (χ²=7.431, P<0.01); BMISDS in the Southern region was significantly decreased from 0.30±1.19 to 0.09±1.25 (t=1.426, P<0.01), and the rate of obesity decreased from 9.8% (n=315) to7.9% (n=256) (χ²=6.46, P<0.05), the overweight rate was not stafistically significant (P=0.10), respectively. The obesity rate of boys had risen from 16.4% (n=1 265) to 18.2% (1 407) (χ²=8.997, P<0.01) in the past 10 years, and the overweight rate had risen from 18.0% (n=1 393) to 20.5% (n=1 579) (χ²=14.26, P<0.01). The overweight+obesity rate rose from 34.4% (n=2 658) to 38.7% (n=2 986) (χ²=29.859, P<0.01), and the weight problem in the age group of 8 to 11 years was particularly severe (all P<0.01). The obesity rate of girls dropped from 6.8% (n=468) to 5.9% (n=406) (χ²=4.546, P<0.05), the overweight rate rose from 16.0% (n=1 103) to 17.5% (n=1 202) (χ²=5.006, P<0.05), and the overall overweight+obesity rate rose from 22.8% (n=1 571) to 23.4% (n=1 608) (χ²=0.53, P>0.05). Conclusions: The growth rate of obesity among children in China had slowed down from 2009 to 2019, but the overweight rate was still on the rise. The overall base of overweight and obesity population continued to expand. The weight problem of peri-adolescent boys was particularly prominent. The current status of obesity epidemics in different regions, ages, and genders are significantly different and had their own characteristics. It is necessary to establish a personalized prevention and control strategy.

[Pseudohypoparathyroidism and GNAS gene defects: clinical evaluation and molecular analysis in 20 children].

Objective: To analyze the patients' clinical and genetic characteristics with pseudohypoparathyroidism (PHP) and investigate the correlation between clinical phenotypes and genotypes. Methods: Twenty PHP patients were ascertained at Children's Hospital Zhejiang University School of Medicine from January 2011 to July 2020. Clinical manifestation, laboratory examination and gene test results were retrospectively analyzed. Results: In these twenty patients, eighteen cases showed resistance to parathyroid hormone (PTH) and thirteen cases had Albright's hereditary osteodystrophy (AHO) phenotype. Gene abnormalities were found in all the twenty PHP patients, which included seven patients with GNAS gene variations (six frameshifts and one missense) and thirteen patients with GNAS gene methylation defects. Moreover, twelve children with both PTH resistance and AHO phenotype were clinically diagnosed as PHP-Ⅰa, meanwhile, seven carried GNAS variations and five had methylation abnormalities with a correct diagnosis of PHP-Ⅰb. Conclusions: Patients with AHO phenotype and PTH resistance may have a high genetic diagnosis rate. Because PHP-Ⅰb clinical phenotype may be similar to PHP-Ⅰa, early genetic detection is required for the differential diagnosis. In addition, children without PTH resistance should also be followed up regularly, which may help the early diagnosis.

[Preliminary investigation of gender assignment in 46,XY disorders of sex development with severe male undermasculinisation].

Objective: To explore the feasibility of gender assignment in 46,XY disorders of sex development (DSD) with severe undermasculinisation mainly based on molecular diagnosis. Methods: A retrospective study of 45 patients of 46, XY DSD with severe undermasculinisation were admitted between November 2015 and October 2018 at Children's Hospital, Zhejiang University School of Medicine. The initial social gender were all female, of whom the external genital manifestations were Prader 0 to 2; the degree of masculinity was scored using external masculinisation score (EMS); the position and development of the gonads were examined by ultrasound, cystoscopy and laparoscopy, also including assessing the development of the Wolffian tube and the Müllerian tube. The level and ratio of testosterone to dihydrotestosterone before and after hCG stimulation were evaluated for the function of Leydig cell and 5α-reductase-2. Gender role scales and sandbox games were used to assess gender role behavior. Genital sensitivity to androgen stimulation was assessed; A panel including 163 genes related to gender development were determined by second-generation sequencing in all 45 patients. Finally, a multidisciplinary team (MDT) makes a gender assignment after a comprehensive analysis mainly based on the molecular etiological diagnosis. Results: Thirty-nine out of 45 patients (87%) had an identifiable genetic etiology, and the remaining 6 (13%) were negative for genetic testing. Forty-five patients had EMS less than or equal to 3 points. Sexual psychological assessment was performed in 39 patients, with male dominance in 24 (62%) and female dominance in 15 (38%). The gender assignment was 23 cases (51%) for male and 19 cases (42%) for female, and 3 cases (7%) were not completely determined. Conclusions: Molecular diagnosis provides a strong basis for appropriate gender assignment of 46, XY DSD children with severe undermasculinisation. Based on molecular diagnosis, each DSD should be analyzed by professional MDT to analyze the clinical symptoms/signs, gonadal development, gonad tumor risk, external genital morphology, sexual psychological assessment, potential fertility opportunities, parental views, Social and cultural factors, etc. make appropriate gender assignment.

Release of the p53-induced repression on thymidine kinase promoter by single p53-binding sequence.

Herpes simplex thymidine kinase (TK) promoter was shown to be repressed by the wild-type p53. Using a model system that the p53-binding site was linked to the thymidine kinase promoter, we demonstrated that single p53-specific binding site was sufficient to abolish the repression. On the contrary, the mutant p53 had the opposite effects on the HSV-TK promoter in BHK cells. The results suggest that the p53-binding site may act as an enhancer to regulate the gene expression in a novel way in vivo.

Effects of fluvastatin (XU 62-320), an HMG-CoA reductase inhibitor, on the distribution and composition of low density lipoprotein subspecies in humans.

We studied the effect of fluvastatin (XU 62-320), a new HMG-CoA reductase inhibitor, on the distribution of low density lipoprotein (LDL) subspecies and composition in humans. As expected, fluvastatin significantly lowered serum LDL levels (25% after 6 weeks of therapy). In addition, treatment with fluvastatin changed the LDL subspecies. In the group treated with fluvastatin, 38.5% of the individuals showed changes in the shape of LDL absorbance profile obtained from density gradient ultracentrifugation and 54% of the group showed changes in the electrophoretic mobility of the LDL bands. Of those showing changes in electrophoretic mobility, the majority (78%) shifted to slightly larger, less dense LDL after drug therapy. However, the LDL-cholesterol/apo B ratio changes were relatively small in all fluvastatin-treated individuals including the group with changes in electrophoretic mobility, confirming that HMG-CoA reductase inhibitor causes relatively small and subtle changes in the distribution of LDL subspecies.

[Quantitative analysis of stress T1-201 myocardial tomography for detecting coronary heart disease].

Quantitative stress T1-201 myocardial tomography (Bullseye) was evaluated prospectively as compared with coronary angiography in 35 patients with coronary heart disease and 10 normals, and showed a better sensitivity (94%) and specificity (90%) for detecting coronary heart disease. The number of vessels involved was evaluated precisely in 58 of 67 (87%) by Bullseye. The sensitivity and specificity of Bullseye in detecting disease in each coronary artery were 84% and 85% for the left anterior descending artery (LAD), 85% and 100% for left circumflex artery, 93% and 100% for right coronary artery. 85% of one vessel disease, 83% of two-vessel disease and 80% of three-vessel disease were recognized by Bullseye. The sensitivity of Bullseye in detecting coronary heart disease was related to the extent of coronary stenosis. The more severe the coronary stenosis is, the higher is the Bullseye's sensitivity. In detecting diseased vessels, 38% of patients with mild coronary stenosis had positive Bullseye, however, 98% of patients with severe coronary stenosis had positive Bullseye. For localization of myocardial infarction in posterior lateral wall, posterior wall and posterior septum. Bullseye is more sensitive than ECG. Thus, quantitative stress T1-201 myocardial tomography provides high diagnostic accuracy for the detection and localization of coronary heart disease.

[Value of stress TL-201 myocardial single photon emission computed tomography in the diagnosis of coronary artery disease].

Fifteen patients with angina pectoris, seventeen with postmyocardial infarction angina and ten with normal coronary arteries were studied with stress TL-201 single photon emission computed tomography (SPECT). The sensitivity and specificity of SPECT for diagnosis of coronary heart disease were 91% and 90% respectively. SPECT showed better sensitivity (84%) for detecting diseased vessels. The sensitivity of SPECT for identifying one-vessel, two-vessel and three-vessel disease were 80%, 86% and 60%. The sensitivity and specificity of demonstrating involved coronary arteries by identifying the locations of myocardial perfusion defects were 79% and 92% for left anterior descending artery, 90% and 95% for left circumflex artery and 86% and 96% for right coronary artery. For localization of myocardial infarction in the posterior wall, posterior lateral wall, and posterior septum, SPECT is more accurate then ECG. The sensitivity of SPECT in detecting individual vessel is related to the severity of coronary stenosis. The more severe the coronary stenosis, the higher the sensitivity of SPECT. In conclusion, stress SPECT is a noninvasive, highly sensitive and accurate method for detecting and localizing coronary heart disease.

[Comparison of thallium-201 images in dilated cardiomyopathy and ischemic cardiomyopathy].

Comparison of thallium-201 image between 21 patients with dilated cardiomyopathy (DCM) and 12 patients with ischemic cardiomyopathy (ICM) was made in this study. All cases had abnormal thallium images. Multiple myocardial segments presenting with patchy pattern were seen in all 21 patients with DCM. 75.0% of patients with ICM also had patchy pattern on the thallium image, but the number of patchy pattern segments on image was significantly less in ICM than in DCM (P less than 0.001); complete defects on thallium image were noted in 75.0% of patients with ICM, however, only one case with DCM had complete defect on thallium scan (P less than 0.001). When the thallium image characterized by multiple patchy pattern segments without complete defects was used as a diagnostic criterion for DCM. 95.2% of patients with DCM coincide with the criterion. When the thallium image showing complete defect was used as a diagnostic criterion for ICM, 75.0% of patients with ICM coincide with the criterion. The characteristics of thallium-201 image are useful either for diagnosis of DCM and ICM or in differentiating DCM from ICM.