Using a new human milk fortifier to optimize human milk feeding among very preterm and/or very low birth weight infants: a multicenter study in China.

BACKGROUND: Human milk fortifier (HMF) composition has been optimized recently. But clinical evidence of its safety and efficacy is limited in Chinese population. The aim of this study was to evaluate effects of a new HMF in growth, nutritional status, feeding intolerance, and major morbidities among very preterm (VPT) or very low birth weight (VLBW) infants in China. METHODS: VPT/VLBW infants admitted from March 2020 to April 2021 were prospectively included in the experimental (new HMF, nHMF) group, who received a new powdered HMF as a breast milk feeding supplement during hospitalization. Infants in the control group (cHMF) admitted from January 2018 to December 2019, were retrospective included, and matched with nHMF group infants for gestational age and birth weight. They received other kinds of commercially available HMFs. Weight gain velocity, concentrations of nutritional biomarkers, incidence of major morbidities, and measures of feeding intolerance were compared between the two groups. RESULTS: Demographic and clinical characteristics of infants in nHMF and cHMF groups were comparable. Weight gain velocity had no significant difference between the nHMF (14.0 ± 3.5 g/kg/d) and the cHMF group (14.2 ± 3.8 g/kg/d; P = 0.46). Incidence of morbidities, including necrotizing enterocolitis, bronchopulmonary dysplasia, retinopathy of prematurity, culture-confirmed sepsis, and feeding intolerance during hospitalization between nHMF and cHMF, were similar (all P-values > 0.05). The time to achieve full enteral feeding [13.5 (10, 21) days] in the nHMF group was significantly shorter than that in the cHMF group [17 (12, 23) days, HR = 0.67, 95%CI: 0.49, 0.92; P = 0.01]. Compared with cHMF group, the decrease of blood urea nitrogen level over time in nHMF group was smaller (ß = 0.6, 95%CI:0.1, 1.0; P = 0.01). CONCLUSIONS: The new HMF can promote growth of preterm infants effectively without increasing the incidence of major morbidity and feeding intolerance. It can be used feasible in Chinese VPT/VLBW infants. TRIAL REGISTRATION: This study was registered on ClinicalTrials.gov (NCT04283799).

Cleidocranial Dysplasia Causing Respiratory Distress in Neonates: A Case Report and Literature Review.

Cleidocranial dysplasia (CCD; OMIM 119600) is a rare autosomal dominant skeletal dysplasia, which is mainly characterized by persistently open or delayed closure of fontanelle, patent skull sutures, abnormal clavicles, pectus excavatum, short stature, supernumerary teeth, and sinus and middle ear infections. It is caused by Runt-related transcription factor 2 (RUNX2; OMIM 600211) mutations. Herein, we present a rare case of CCD with neonatal respiratory distress, who had abnormal midfacial features and wide fontanelle. Also, pectus excavatum was noted. He was transferred to our department, administered standard medical treatment, and discharged after 4 weeks. Therefore, we recommend the early suspicion and identification of this rare inherited disease to adequate treatment.

Preoperative Vitamin D Deficiency Is Associated With Higher Vasoactive-Inotropic Scores Following Pediatric Cardiac Surgery in Chinese Children.

The relationship between vitamin D and cardiovascular health in children remains unclear. Vitamin D deficiency (VDD) is supposed to be a potential risk factor associated with poorer outcomes after congenital heart disease (CHD) surgery. The maximum vasoactive-inotropic use after cardiac surgery is considered to be a good predictor of adverse outcomes. We aimed to assess the correlation between preoperative VDD and the maximum vasoactive-inotropic score (VISmax) at 24 h postoperatively. Nine hundred children with CHD were enrolled in this study, and preoperative total serum 25-hydroxyvitamin D [25(OH)D] concentrations were measured by liquid chromatography-tandem mass spectrometry. Related demographic and clinical characteristics were collected. A total of 490 boys (54.4%) and 410 girls (45.6%) with a mean age of 1 year (range: 6 months-3 years) were enrolled. The median 25(OH)D level was 24.0 ng/mL, with 32.6% of patients having VDD [25(OH)D < 20 ng/mL]. The univariate analysis indicated that VDD [odds ratio (OR): 2.27; 95% confidence interval (CI): 1.48-3.50] is associated with a risk of increased VISmax at 24 h postoperation. Multivariate analysis revealed that VDD (OR: 1.85; 95% CI: 1.09-3.02), a Risk-adjusted Congenital Heart Surgery score of at least three points (OR: 1.55; 95% CI: 1.09-2.19), and cardiopulmonary bypass time (OR: 1.02; 95% CI: 1.01-1.02) were independently associated with an increased VISmax within 24 h after cardiac surgery. VDD in pediatric patients before cardiac surgery is associated with the need for increased postoperative inotropic support at 24 h postoperation.

Gender-Specific Longitudinal Association of Sleep Duration with Blood Pressure among Children: Evidence from CHNS 2004-2015.

PURPOSE: We conducted this study to add the evidence regarding the gender-specific association between sleep duration and blood pressure (BP) in children. METHODS: A secondary analysis was performed among 1000 children aged 7-13 years, who had at least two rounds of survey records in China Health and Nutrition Survey through 2004-2015. Generalized estimating equation was used to explore the gender-specific association of sleep duration with BP. The subgroup analysis was applied in those participants with normal weight. RESULTS: The time trend of decreasing sleep duration, along with increasing BP level, was observed in each age group during the survey period. Short sleepers (<9 hours per day) have higher level of both systolic BP (SBP) and diastolic BP (DBP) than long sleepers in girls (all p < 0.05). By contrast, only SBP was higher in short sleepers among boys (p < 0.05). There was gender difference in the association between sleep duration and DBP (p for interaction <0.05). The stratification analysis showed that short sleep duration could consistently predict a higher level of diastolic BP (DBP) in both crude (ß = 2.968, 95% CI: 1.629, 4.306) and adjusted models (ß = 1.844, 95% CI: 0.273, 3.416) only in girls. Sleep duration was also analyzed as continuous variable, and the very similar associations were observed. Moreover, the established associations can be verified among children with normal weight. CONCLUSIONS: There was a time trend of decreasing sleep duration alongside increasing BP among children from 2004 to 2015. Short sleep duration was independently associated with increased DBP; however, only girls were susceptible to the association.

Children's Sleep May Depend on Maternal Sleep Duration During Pregnancy: A Retrospective Study.

BACKGROUND: Animal studies suggested that maternal sleep during pregnancy was associated with sleep pattern in offspring; however, it has not been clear in human populations. AIM: Our study discusses the relationships of maternal sleep duration with sleep characteristics in their offspring through an epidemiological study. METHODS: A retrospective cross-sectional study including 6236 mother-child dyads was conducted in 31 preschools in May 2019, in Shanghai, China. Information regarding maternal sleep duration in three trimesters of pregnancy was collected retrospectively. Children's current sleep characteristics were evaluated through the Children's Sleep Habits Questionnaire (CSHQ). Linear regressions and logistic regression models were applied to estimate ß and adjusted odds ratios with 95% confidence intervals (95% CI). RESULTS: Maternal sleep duration was positively associated with childhood sleep duration, which was shown in the first (ß=0.113), second (ß=0.131), and third trimesters (ß=0.088). Meanwhile, insufficient maternal sleep duration could increase the risk of children's short sleep duration (first trimester: AOR=1.25; second trimester: AOR=1.33; third trimester: AOR=1.33). Maternal sleep duration was also associated with childhood CSHQ score: ß=-0.308, -0.392, and -0.300 for the first, second, and third trimesters, respectively. Similarly, insufficient maternal sleep duration could predict childhood sleep disturbance as AOR=1.28 in the second trimester and AOR=1.26 in the third trimester. CONCLUSION: Our findings established a relationship between maternal sleep during pregnancy and their children's sleep pattern through a population-based epidemiology study. Poor childhood sleep was found when their mother experienced less sleep duration during pregnancy, especially in the second and third trimesters.

The association between 25-hydroxyvitamin D levels and children's sleep-wake patterns: a prospective cohort study.

OBJECTIVE: To explore the association between vitamin D in cord blood or in venous blood and children's sleep-wake patterns at two years of age. METHODS: Data were from 209 children in a birth cohort, Shanghai Sleep Birth Cohort Study (SSBC). 25-Hydroxyvitamin D (25(OH)D) was assessed in cord blood and venous blood samples at two years of age by electrochemiluminescence immunoassay. Children's sleep-wake patterns were measured with the Brief Infant Sleep Questionnaire (BISQ) and Acti-Watch at two years of age. RESULTS: The prevalence of vitamin D deficiency (defined as <50 nmol/L) was 50.4% in cord blood and 28% at two years of age. The cord blood 25(OH)D level was not significantly associated with children's sleep at two years of age. Children with 25(OH)D deficiency at two years old had shorter reported and actigraphic night sleep duration (NSD) and total sleep duration (TSD) than those with normal 25(OH)D concentration. 25(OH)D level at two years old was positively associated with night and total sleep duration (ßreported-NSD = 0.6, p = 0.011; ßreported-TSD = 0.6, p = 0.029; ßactigraphic-NSD = 0.82, p = 0.003; ßactigraphic-TSD = 0.78, p = 0.006), but was not associated with daytime sleep duration. There was no significant association between 25(OH)D level with night waking duration and midpoint of sleep either measured subjectively or objectively. CONCLUSION: We found that not cord blood 25(OH)D level but two-year-old 25(OH)D level was associated with children's sleep-wake patterns at two years of age. These findings suggest more attention should be paid to the assessment of 25(OH)D levels in children with short sleep duration.

Hypoxia-induced ARHGAP26 deficiency inhibits the proliferation and migration of human ductus arteriosus smooth muscle cell through activating RhoA-ROCK-PTEN pathway.

The Rho family plays crucial roles in O2 -induced vasoconstriction, cell proliferation, and migration. Rho GTPase-activating protein 26 (ARHGAP26) is a GTPase-activating protein for the small GTPases of the Rho family. Our previous studies have demonstrated that ARHGAP26 expression was significantly downregulated in patent human ductus arteriosus (DA) tissue. However, its role underlying the maintenance of DA patency is unclear. In this study, patent (fetal) and constricted (newborn) mouse DA tissues were harvested to confirm the differences in the levels of expression of ARHGAP26. Human DA smooth muscle cells (DASMCs) were isolated and cultured in vitro and used to test the function of ARHGAP26. The expression of ARHGAP26 was significantly lower in patent (fetal) than constricted (newborn) mouse DA. ARHGAP26-knocked-down human DASMCs showed reduced proliferation and migration, which are both crucial to anatomic closure of DA. Moreover, after culturing under hypoxic conditions, the expression of ARHGAP26 in human DASMCs was significantly lower and hypoxia-induced ARHGAP26 deficiency activated the phosphorylation level of phosphatase and tensin homolog (PTEN) in DASMCs by mediating the activity of RhoA and RhoA-associated kinase 1 (ROCK1). Use of Y27632, an inhibitor of ROCK which further reduces the phospholipid activity of PTEN can reverse the inhibitory effect of PTEN on the proliferation and migration of human DASMCs. This provides insight into the molecular regulation of the RhoA-ROCK-PTEN pathway in DA smooth muscle cells, which may be a suitable therapeutic target or diagnostic biomarker for perinatal DA tone management.

Sleep Habits, Sleep Problems, Sleep Hygiene, and Their Associations With Mental Health Problems Among Adolescents.

BACKGROUND: Studies in adults suggested that sleep could be a significant contributor to mental health. However, little is known about their relationship in adolescents. OBJECTIVE: The present study aimed to examine the overall associations of full-spectrum sleep behaviors, including sleep habits, sleep problems, and sleep hygiene, with mental health problems among adolescents in Shanghai, China. DESIGN: A stratified, cluster random sample of 4,823 adolescents aged 11 to 20 years participated in a cross-sectional survey. The Adolescent Sleep Disturbance Questionnaire and the modified Adolescent Sleep Hygiene Scale were used to examine sleep behaviors. The Strengths and Difficulties Questionnaire was used to evaluate mental health problems. RESULTS: Five sleep variables were found to be associated with adolescents' mental health. The five factors covered three sleep domains: sleep habits (later bedtime during weekdays), sleep problems (maintaining sleep difficulties, disorders of arousal), and sleep hygiene (poor emotion at bedtime, unstable sleep schedule). CONCLUSIONS: The clinical significance of the findings lies in the emphasis of comprehensive screening of sleep in the predicting, diagnosis, nursing, and intervention of adolescents' mental health problems.

Dental age assessment in 7-14-year-old Chinese children: comparison of Demirjian and Willems methods.

Several approaches have proven be valuable in estimating dental age in children. The Demirjian method, based on crown and root calcification, is the most frequently used tool. The Willems method is a modification of the Demirjian method. There are few studies regarding to compare the application of the two methods in China. This study aims to apply the two methods in a Han population as well as identify if there are some differences between two methods in estimating dental age versus chronological age. Nine hundred forty-one orthopantomograms of 410 boys and 531 girls between seven and 14 years of age were selected from our patient records database with defined standard, and the Demirjian and Willems methods of dental age estimation were applied. The seven left mandibular teeth were scored and calculated in order to obtain the Demirjian and Willems estimated dental ages. It is suggested that the Demirjian method overestimated chronological age by 1.68 years for boys and 1.28 years for girls. The discrepancy between the Demirjian estimate and the chronological age was most frequently observed between 1 and 3.5 years for boys and between 1 and 2 years for girls. While it is indicted that the Willems method overestimated chronological age by 0.35 years for boys and underestimated the age by 0.02 years for girls. The discrepancy between chronological age and Willems estimated age was most frequently observed between -0.5 and 0.5 years for boys and between -1 and 0.5 years for girls. It is demonstrated that the Willems method was more accurate in estimating dental age than the Demirjian method, with a mean absolute error of 0.98 years for boys and 0.93 years for girls. As a result, it is highly recommended that the Willems method should be applied when estimating dental age in Chinese Han population, further modifications to the method are suggested.

[Layer-dependent multi-constrained algorithms based on improved level set for segmentation of teeth MRI-UTE image].

OBJECTIVE: To introduce algorithms for effective segmentation of teeth MRI-UTE image. METHODS: To construct second-segmentation algorithm process based on layer-dependent multi-constrained method. Firstly, a level set method was used to segment the initial boundary from the region determined by user in the reference slice. Secondly, both crown and root of the tooth were segmented by the improved level set method which took the information of the former layer's result as constraint conditions. Finally, the improved level set based on the information of the former and later layer's results was executed for the second time to improve the accuracy of segmentation, in which, the parameter of the overlapping ratio was considered. RESULTS: The accuracy was 86.98% for the first-segmentation and was increased to 88.35% for the second-segmentation. Compared to the two other methods, the accuracy of the algorithms provided was improved significantly (P < 0.05). CONCLUSIONS: The proposed algorithms can effectively achieve the segmentation of teeth MRI-UTE image and has a great improvement on accuracy.

Predictors of consistent condom use based on the Information-Motivation-Behavior Skill (IMB) model among senior high school students in three coastal cities in China.

BACKGROUND: High prevalence of risky sexual behaviors and lack of information, skills and preventive support mean that, adolescents face high risks of HIV/AIDS. This study applied the information-motivation-behavioral skills (IMB) model to examine the predictors of consistent condom use among senior high school students from three coastal cities in China and clarify the relationships between the model constructs. METHODS: A cross-sectional study was conducted to assess HIV/AIDS related information, motivation, behavioral skills and preventive behaviors among senior high school students in three coastal cities in China. Structural equation modelling (SEM) was used to assess the IMB model. RESULTS: Of the 12313 participants, 4.5% (95% CI: 4.2-5.0) reported having had premarital sex and among them 25.0% (95% CI: 21.2-29.1) reported having used a condom in their sexual debut. Only about one-ninth of participants reported consistent condom use. The final IMB model provided acceptable fit to the data (CFI = 0.981, RMSEA = 0.014). Consistent condom use was significantly predicted by motivation (ß = 0.175, P < 0.01) and behavioral skills (ß = 0.778, P < 0.01). Information indirectly predicted consistent condom use, and was mediated by behavioral skills (ß = 0.269, P < 0.05). CONCLUSIONS: The results highlight the importance of conducting HIV/AIDS preventive health promotion among senior high school students in China. The IMB model could predict consistent condom use and suggests that future interventions should focus on improving motivation and behavioral skills.

Substance use, risky sexual behaviors, and their associations in a Chinese sample of senior high school students.

BACKGROUND: Given the higher prevalence of risky sexual behaviors and substance use, adolescents and youths are at risk for HIV. Despite its importance, however, to the best of our knowledge, there are only a few researches on risky behaviors in Chinese adolescents/youths. The present study aimed to describe the prevalence of sexual and substance use behaviors among a Chinese sample of senior high school students. And more specifically, the associations of socio-demographic factors and substance use with risky sexual behaviors were examined in the sample. METHODS: A cross-sectional study was conducted in 10 senior high schools. A total of 2668 senior high school students aged 15.17 to 23.42 years participated in the survey. A self-administrated questionnaire was used to collect information on sexual and substance use behaviors. RESULTS: The percentages of students who ever had sexual intercourse in lifetime or during last three months were 7.0% and 5.1%, respectively. Among the participants with sexual intercourse during last three months, 42.1% ever had unprotected sexual intercourse and 49.4% had intercourse with two or more partners. Multivariate logistic regression analyses showed that cigarette smoke and illicit drug use were related to unprotected sexual intercourse (defined as "sexual intercourse without condom use") and younger age of first sexual intercourse was related to multiple-partner sexual intercourse. CONCLUSIONS: HIV/sexual transmitted infection (STI) health education and prevention are necessary among the Chinese adolescents, particularly among those adolescents with experience of sexual intercourse and/or substance use, which has a long-term beneficial to the control of HIV/STI in China.

Social, psychological, and environmental-structural factors determine consistent condom use among rural-to-urban migrant female sex workers in Shanghai China.

BACKGROUND: To determine potential social, psychological, and environmental-structural factors that may result in motivating female sex workers (FSWs), who are rural-to-urban migrants, and their paying partners in Shanghai, China to promote consistent condom use (CCU). METHODS: A cross-sectional study was conducted in five districts of Shanghai, including three suburbs and two downtown locales. We adopted a cluster randomized sampling method to obtain 20 geographic sites, which consisted of 1 or more communities/villages proximal to a location where FSWs were accessible. Five hundred four FSWs from 132 Xitou Fang (shampoo wash rooms), massage parlors, and hair salons who explicitly provided sexual services were enrolled in the study. Each participant completed a questionnaire survey and interview aimed to collect information on the perceptions and behaviors of individuals associated with a risk for human immunodeficiency virus/acquired immunodeficiency syndrome(HIV/AIDS),self-efficacy at negotiating safe sex,and the physical, social, and policy environment of the establishments where they worked. RESULTS: The percentage of FSWs who reported consistent condom use with their paying partners was 63.3%. Controlling for socio-demographic characteristics in multivariate analyses, environmental-structural support (OR, 3.96; CI, 2.52-6.22) for condom use was the most significant positive predictor of CCU among FSWs and their regular paying partners. A high perception of susceptibility and risk of HIV/AIDS (OR, 1.96; CI, 1.25-3.01), a high perception of benefits on condom use to protect themselves (OR, 2.06; CI, 1.32-3.22), and high safe sex self-efficacy (OR, 2.52; CI, 1.64-3.85) also play important roles on CCU based on multivariate analyses. CONCLUSIONS: Environmental-structural factor support for condom use, in addition to social, psychological, and individual cognitive factors are significant predictors of CCU among FSWs, which should be assessed and addressed in research and interventions related to HIV/AIDS prevention among FSWs in China.

A study of HIV/AIDS related knowledge, attitude and behaviors among female sex workers in Shanghai China.

BACKGROUND: China is currently facing a rapid and widespread increase in human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS). The activities of female sex workers (FSWs) have contributed to the mounting epidemic of HIV/AIDS and other sexually transmitted diseases (STDs). Therefore, this study aimed to assess the HIV/AIDS-related knowledge, attitude and risk behaviors among FSWs operating in Shanghai China. METHODS: A cross-sectional study was conducted in five districts of Shanghai, including three suburbs and two downtown locales. We adopted a cluster randomized sampling method to obtain ten geographic sites which consisted of one or more communities/villages proximal to a location where FSWs were accessible. A total of 324 FSWs from 109 Xitou Fang, massage parlors and hair salons who explicitly provided sexual services were enrolled in the study. Each participant completed a questionnaire survey and interview aimed to collect information on the individual's knowledge, attitude, and behaviors associated with risk for HIV/AIDs. RESULTS: The overall correct answer rate of HIV/AIDS-related knowledge was 60.8%, and the knowledge of FSWs from downtown areas was significantly higher than those from suburban areas (P < 0.05). The percentage of FSWs who reported having experiences in commercial sexual services without the use of condoms was 33.6%. Condom slippage or breakage was reported as having occurred at least once by 51.2% of the FSWs. FSWs from suburban areas were found to more often engage in high-risk behaviors, including oral and anal sex, than those from downtown areas (P < 0.001). Many of the FSWs (65.7%) reported having non-client sexual partners (most were identified as boyfriends or husbands); however, condom usage with these partners were lower (34.3%). CONCLUSIONS: Based on the findings from our survey, we advise that promotion of HIV/AIDS-related knowledge be targeted towards FSWs in Shanghai, especially those operating in the suburbs. HIV prevention efforts, such as urging constant condom usage with both clients and steady partners, should be sustained and reinforced among the female sex workers population.

Study on peer-led school-based HIV/AIDS prevention among youths in a medium-sized city in China.

HIV/AIDS epidemic is crucial in China; however, few studies were performed on youths. This study was performed to examine the effectiveness of peer-led HIV prevention intervention on HIV-related knowledge, attitudes and behaviour intention in senior high-school students in San-ming, a medium-sized city in Fujian province. Three thousand and sixty-eight students completed self-administered questionnaires before and after intervention, of which 981 students (the intervention group) accepted peer-led HIV/AIDS prevention intervention and others (the control groups) continued the usual teacher-led health education curriculum. Significant increases were observed in the intervention group in HIV-related knowledge, in attitudes and in behaviour intention after intervention. The results of this research also indicated an inconsistent level of HIV/AIDS knowledge and attitude among students, with a significant gender, health education history and style difference in session delivery. More concerted efforts in HIV prevention are needed to improve young people's sexual health.