[Effect of accurately localized mini anterolateral thigh perforator flap in repairing medium-sized skin and soft tissue defects in fingers].

Objective: To explore the effect of accurately localized mini anterolateral thigh perforator flap in repairing medium-sized skin and soft tissue defects in fingers. Methods: The study was a retrospective observational study. From December 2019 to September 2022, 15 patients with medium-sized skin and soft tissue defects who met the inclusion criteria in fingers were admitted to the Second Affiliated Hospital of Wenzhou Medical University, including 12 males and 3 females, aged 23 to 62 years. After debridement, the wounds were all accompanied by exposed tendons, bones, vessels and nerves, with an area from 4.0 cm×3.0 cm to 8.0 cm×3.5 cm. Computed tomography angiography and color Doppler ultrasonography examinations were performed on both lower limbs of the patient before surgery to accurately locate the anterolateral thigh perforators. When the flap with area from 6.0 cm×3.0 cm to 11.0 cm×4.0 cm was harvested, the flap was thinned. The artery and vein perforators of the flap were anastomosed respectively with the digital artery and dorsal metacarpal vein. If there was avulsion injury, infection, or burn in the recipient area, the main arterial and veinous vessels carried by the skin flap was anastomosed with the radial artery and accompanying vein. The lateral thigh cutaneous nerve carried by the flap was anastomosed with the stump of the digital nerve. The types of perforators of the lateral thigh artery were observed during operation and compared with the location of the vessels before operation. After operation, the survival and adverse complication of the flap were closely observed. During follow-up, the skin flap color, texture, and shape were observed; the wound healing in donor area was observed. At the last follow-up, the two-point discriminative distance of the affected finger pulp was measured, and the function of the affected finger was evaluated using the trial standard for the evaluation of functions of upper limbs of Hand Surgery Society of Chinese Medical Association, and the interphalangeal joint movement of the affected finger was observed; the patients' complaints about the adverse effects of flap resection on lower limbs were recorded. Results: During the operation, it was observed that the perforators of the flaps in 11 patients were the descending branch of the lateral circumflex thigh artery, in two patients, the perforators of skin flaps were the oblique branch of the lateral thigh artery, and the perforators in another two patients were the transverse branch of the lateral circumflex thigh artery, which were consistent with the preoperative vascular localization. After operation, all flaps survived without vascular crisis and infection. The patients were followed up for 6-12 months, the flaps had excellent color, texture, and appearance; only linear scars remained on the donor wound. At the last follow-up, the two-point discrimination distance in the finger pulp was 7-11 mm; the affected finger function was rated as excellent in 6 cases, good in 6 cases, and fair in 3 cases; the flexion and extension function of the finger was not affected; two patients complained of numbness in the lateral thigh after excision of the skin flap, and the other 13 patients had no complain of adverse complaints. Conclusions: The perforating branch in lateral thigh region can be accurately located by computed tomography angiography and color Doppler ultrasonography, accurate positioning of perforators before operation can reduce the damage to the donor area during the incision of the flap, the appearance and function of the affected finger can be restored to the maximum extent by thinning the transplanted flap and rebuilding the finger sensation. Therefore, it is an effective and reliable way to repair the medium-sized skin and soft tissue defects of fingers with the mini thigh anterolateral perforator flap.

[Research on the association between ambient PM2.5 and its components and psychological distress among Chinese children and adolescents aged 9-18 years].

Objective: To analyze the association between exposure to ambient PM2.5 and its components [sulfate (SO42-), nitrate (NO3-), ammonium (NH4+), organic matter (OM), and black carbon (BC)] and psychological distress among school children and adolescents aged 9 to 18 years in China. Methods: Based on data from the 2019 Chinese National Survey on Students' Constitution and Health, 130 808 children and adolescents aged 9 to 18 years were included. Scoring and determination of higher psychological distress were based on the Kessler Psychological Distress Scale (K10), and annual average exposure data for air pollution were matched by survey location and time. We used a restricted cubic spline approach based on logistic regression to fit the associations between PM2.5, SO42-, NO3-, NH4+, organic matter, black carbon concentrations, and psychological distress. Logistic regression models were used to analyse different age, gender, BMI and physical activity subgroups to estimate the association between exposure to high levels of pollution and high levels of psychological distress in different subgroups. Results: The proportion of children and adolescents with high levels of psychological distress in China was 30.4%, with girls being higher than boys at 31.6% and 29.1%, respectively (P<0.05). A non-linear positive association existed between exposure to PM2.5, SO42-, NO3- and organic matter concentrations and higher psychological distress. As PM2.5, NO3-, NH4+, organic matter, and black carbon concentrations continued to rise, the increase in the risk of higher psychological distress slowed, while SO42- showed little change in the OR of psychological distress at lower concentrations but continued to rise at higher concentrations. PM2.5 and its components were statistically associated with psychological distress in the physically inactive group but not in the physically active group. The association between high levels of pollutants and high psychological distress was stronger among students aged 9 to 12 years compared with students aged 13 to 15 years and 16 to 18 years. Conclusions: The ambient pollutant PM2.5 and its components are associated with psychological distress in children and adolescents aged 9 to 18 years in China. High pollutant exposure is a risk factor for high psychological distress among physically inactive children and adolescents, and there are age differences in the association between PM2.5 and components and psychological distress.

[A comparative analysis of the clinical symptoms of benign paroxysmal positional vertigo between older and young and middle-aged patients].

Objective: To compare the differences in clinical symptoms and the time required for diagnosis of benign paroxysmal positional vertigo (BPPV) between older patients and young and middle-aged patients in the structured inquiry of dizziness history. Methods: The medical records of 6 807 patients diagnosed with BPPV from the Vertigo Database of Vertigo Clinical Diagnosis, Treatment, and Research Center of Beijing Tiantan Hospital, Capital Medical University, between January 2019 and October 2021 were retrospectively analyzed. The data included basic demographic information, clinical symptoms in a structured medical history questionnaire, and the time interval from the appearance of BPPV symptoms to diagnosis consultation. The patients were divided into the young and middle-aged group (<65 years old) and the older group (≥65 years old). The differences in clinical symptoms and consultation time were compared between these two groups. Categorical variables were represented by numbers (%), and compared using Chi-squared tests or Fisher's exact probability test for analysis; whereas, continuous variables conforming to normal distribution were represented by mean±standard deviation. Both data groups were compared and analyzed by Student's t-test. Results: The mean age of the older group was 65-92 (71±5) years, while the mean age of the middle-aged group was 18-64 (49±12) years. The incidence of vertigo (42.5% vs. 49.1%, χ2=23.69, P<0.001); vertigo triggered by changes in position of the head or body (52.4% vs. 58.7%, χ2=22.31, P<0.001); and autonomic symptoms (10.1% vs. 12.4%, χ2=7.09, P=0.008) were lower, but hearing loss (11.8% vs. 7.8%, χ2=27.36, P<0.001) and sleep disorders (18.5% vs. 15.2%, χ2=11.13, P=0.001) were higher in the older group than in the young and middle-aged group. The time from the appearance of dizziness to diagnosis was commonly longer in the older patient group than the other group (55.0% vs. 38.5%, χ2=55.95, P<0.001). Conclusions: Older patients with BPPV have more atypical symptoms and complex concomitant symptoms than young and middle-aged patients. For older patients with dizziness, positional testing is needed to confirm the possibility of BPPV even if the clinical symptoms are atypical.

[Association between different growth patterns and metabolic syndrome in children and adolescents aged 7 to 17 years].

OBJECTIVE: To analyze the association between different growth patterns and metabolic syndrome in children and adolescents aged 7 to 17 years, and to provide suggestions for the prevention and control of metabolic syndrome in Chinese children and adolescents. METHODS: Data were collected from the research project "Development and Application of Technology and Related Standards for Prevention and Control of Major Diseases among Students" of public health industry in 2012. This project is a cross-sectional study design. A total of 65 347 students from 93 primary and secondary schools in 7 provinces including Guangdong were selected by stratified cluster random sampling method. Given the budget, 25% of the students were randomly selected to collect blood samples. In this study, 10 176 primary and middle school students aged 7 to 17 years with complete physical measurements and blood biochemical indicators were selected as research objects. Chi-square test was used to compare the distribution differences of growth patterns under different demographic characteristics. Birth weight, waist circumference and blood biochemical indexes were expressed in the form of mean ± standard deviation, and the differences among different groups were compared by variance analysis. Binary Logistic regression model was used to analyze the relationship between different growth patterns and metabolic syndrome in children and adolescents aged 7 to 17 years. RESULTS: The prevalence of metabolic syndrome in children and adolescents was 6.56%, 7.18% in boys and 5.97% in girls. The risk of metabolic syndrome was higher in the catch-down growth group than in the normal growth group (OR=1.417, 95%CI: 1.19-1.69), and lower in the catch-up growth group(OR=0.66, 95%CI: 0.53-0.82). After adjusting for gender, age and so on, the risk of developing metabolic syndrome in the catch-down growth group was higher than that in the normal growth group (OR=1.25, 95%CI: 1.02-1.52), but there was no significant difference between the catch-up growth group and the normal growth group (OR=0.79, 95%CI: 0.62-1.01). Stratified analysis showed that the association between different growth patterns and metabolic syndrome was statistically significant in the 7-12 years group, urban population, and Han Chinese student population. CONCLUSION: There is a correlation between different growth patterns and metabolic syndrome in children and adolescents. The risk of developing metabolic syndrome in children and adolescents with catch-down growth is higher than that in the normal growth group, which suggests that attention should be paid to the growth and development of children and adolescents, timely correction of delayed growth and prevention of adverse health outcomes.

[Association of body fat distribution with depression and social anxiety in children and adolescents: A cross-sectional study based on dual-energy X-ray detection].

OBJECTIVE: To investigate the status of depression and social anxiety in children and adolescents, and to analyze the association between body fat distribution and depression, social anxiety in children and adolescents. METHODS: A total of 1 412 children aged 7 to 18 years in Beijing were included by stratified cluster random sampling method. Body fat distribution, including total body fat percentage (total BF%), Android BF%, Gynoid BF% and Android-to-Gynoid fat ratio (AOI), were obtained by dual-energy X-ray absorption method. Depression and social anxiety were evaluated by Children Depression Inventory and Social Anxiety Scale for Children. Multivariate linear regression and restricted cubic spline analysis were used to estimate the linear and non-linear correlation between body fat distribution and depression and social anxiety. RESULTS: 13.1% and 31.1% of the children and adolescents had depressive symptoms and social anxiety symptoms respectively, and the detection rate of depression and social anxiety in the boys and young groups was significantly lower than those in the girls and old groups. There was no significant linear correlation between total BF%, Android BF%, Gynoid BF%, AOI and depression and social anxiety in the children and adolescents. However, total BF% and Gynoid BF% had significant nonlinear correlation with depression, showing an inverted U-shaped curve relationship with the tangent points of 26.8% and 30.9%, respectively. In terms of the nonlinear association of total BF%, Android BF%, Gynoid BF% and AOI with depression and social anxiety, the change trends of the boys and girls, low age group and high age group were consistent. The overall anxiety risk HR of body fat distribution in the boys was significantly higher than that in the girls, and the risk HR of depression and social anxiety were significantly higher in the high age group than those in the low age group. CONCLUSION: There was no significant linear correlation between body fat distribution and depression and social anxiety in children and adolescents. Total BF% and depression showed an inverted U-shaped curve, mainly manifested in Gynoid BF%, and this trend was consistent in different genders and different age groups. Maintaining children and adolescents' body fat distribution at an appropriate level is the future direction of the prevention and control of depression and social anxiety in children and adolescents.

[Epidemiology and prediction of overweight and obesity among children and adolescents aged 7-18 years in China from 1985 to 2019].

Objective: To analyze and predict the epidemic trend of overweight and obesity among children and adolescents aged 7-18 years in China from 1985 to 2019. Methods: Data were collected from the Chinese National Survey on Students Constitution and Health in 1985, 1995, 2000, 2005, 2010, 2014, and 2019 with the sample size of 409 945, 204 931, 209 209, 234 420, 215 317, 214 353, and 212 711, respectively. Overweight and obesity were evaluated according to the "classification standard of the weight index value of overweight and obesity screening for Chinese school-age children and adolescents" of the Working Group on Obesity in China (WGOC). The detection rate and average annual growth rate of overweight and obesity, and single obesity among children and adolescents aged 7-18 years were calculated, and ArcGis10.6 software was used to analyze the difference in the prevalence of overweight and obesity among children and adolescents in different regions in 2019. Polynomial regression function was used to fit the prevalence and average annual growth rate of overweight and obesity, and single obesity among children and adolescents from 1985 to 2019, and to predict the prevalence of overweight and obesity and single obesity among children and adolescents in China. Results: In 2019, the total prevalence of overweight and obesity among children and adolescents aged 7-18 years in China was 23.4%, and the prevalence of single obesity was 9.6%. The prevalence of overweight and obesity among urban children and adolescents was higher than that in rural areas (25.4% vs. 21.5%), and the prevalence in boys was higher than that in girls (28.4% vs. 18.4%) (both P values<0.001). In 2019, there was a large regional disparity in the prevalence of overweight and obesity in different provinces, with the lowest in Guangdong (12.2%) and the highest in Shandong (38.9%), and the high epidemic areas were mainly concentrated in North China and Northeast China. From 1985 to 2019, the prevalence of overweight and obesity among children and adolescents aged 7-18 years in China increased from 1.2% to 23.4%, with an increase of 18.1 times, while the prevalence of obesity alone increased from 0.1% to 9.6%, with an increase of 75.6 times. The prevalence of overweight and obesity in urban boys, urban girls, rural boys and rural girls increased from 1.3%, 1.5%, 0.5%, and 1.6% in 1985 to 31.2%, 19.4%, 25.6%, and 17.4% in 2019, with an increase of 22.3, 11.7, 54.2, and 10.1 times, respectively. According to the prediction model, the prevalence of overweight and obesity among children and adolescents aged 7-18 years in China will increase from 23.4% in 2019 to 32.7% in 2030, and the prevalence of obesity alone will increase from 9.6% in 2019 to 15.1% in 2030. The growth of rural children and adolescents is obvious. By 2025, the prevalence of overweight and obesity among rural children and adolescents in China will comprehensively exceed that of urban, and there will be an "urban-rural reversal" phenomenon. At the same time, the prevalence of children's obesity in China's low, medium and high epidemic areas will also continue to increase. By 2035, the prevalence of overweight and obesity among children and adolescents in medium epidemic areas will exceed that in high epidemic areas, and there will be a "provincial reversal" phenomenon. Conclusion: From 1985 to 2019, the overweight and obesity of children and adolescents in China will continue to grow rapidly with large regional differences.

[Prevalence of unhealthy lifestyle among children and adolescents of Han nationality in China].

Objective: To explore the epidemiological characteristics and geographical distribution of unhealthy lifestyle among children and adolescents of Han nationality in China and obtain evidence for proposing the related strategies to improve the well-being of this population. Methods: Students aged 6-22 years old were selected from the Chinese National Survey on Students Constitution and Health in 2019. The prevalence of unhealthy lifestyles (physical inactivity, lack of outdoor activity, sedentary behavior, excessive screen time, sleep insufficiency, unhealthy eating behavior) between sex, residence, and age groups was calculated and compared. Multilevel logistic regression was used to explore the influencing factors of unhealthy lifestyle. Results: The prevalence of moderate-to-vigorous physical activity less than 1 h/d or 30 min/d were 82.06% and 54.69%, respectively. The prevalence of less than 2 h/d or 3 h/d of outdoor activities were 95.20% and 83.26%, respectively. The prevalence of more than 2 h/d or 3 h/d of sitting time were 50.64% and 31.92%, respectively. The prevalence of more than 2 h/d or 3 h/d of screen time were 42.02% and 27.79%, respectively. The prevalence of sleep insufficiency, excessive sugary beverages consumption (≥ 1 time/d), and insufficient consumption of eggs, milk, and breakfast (<7 d/week) were 66.49%, 20.97%, 83.36%, 70.71%, and 34.34%, respectively. The prevalence of severe sleep insufficiency, excessive sugary beverages consumption (≥ 3 times/d), and insufficient consumption of eggs, milk, and breakfast (≤2 d/week) were 27.77%, 8.21%, 47.21%, 32.36% and 9.73%, respectively. Conclusion: In 2019, unhealthy lifestyle is common among Han students aged 6-22 years in China. It is of importance to propose policies to strengthen the health education and initiatives to support healthy behaviors in Han children and adolescents. Jointly promotion on the creation of a healthy environment for Han children and adolescents, and formulation of targeted improvement measures in accordance with the epidemic characteristics in various regions are essential to improve the healthy lifestyle of this population.

[Associations between early onset of puberty and obesity types in children: Based on both the cross-sectional study and cohort study].

OBJECTIVE: To explore and analyze the relationship between early onset of puberty and different types of obesity in children, by combining large sample cross-sectional survey data with long-term longitudinal cohort data, so as to provide clues for further clarifying the health hazards of early onset of puberty and obesity prevention and control. METHODS: The research data were from the cross-sectional survey data of seven provinces(autonomous regions, municipalities) in China and the cohort data of adolescent development in Xiamen. The study first found the association between early onset of puberty and obesity by Logistic regression on the cross-sectional data, and then used Poisson regression to analyze the association between early puberty initiation and various types of obesity risk. RESULTS: In the study, 43 137 and 1 266 children were included in the cross-sectional survey and cohort survey respectively. The cross-sectional study found that among the girls aged 10-13 years, compared with the girls of the same age who did not start puberty, the body mass index (BMI)-Z score of the girls in the puberty start group was 0.5-0.8 higher, and the waist circumference Z score was 0.4-0.7 higher, and the risk of various types of obesity was higher. At the same time, the early onset of puberty was positively correlated with simple obesity, central obesity and compound obesity, the OR (95%CI) were 1.86 (1.42-2.44), 1.95 (1.65-2.32) and 1.86 (1.41-2.45), respectively. No significant association was found in boys. According to the cohort data, in girls, the risk of simple obesity was 6.00 times [RR (95%CI): 6.00 (1.07-33.60)], the risk of central obesity was 3.30 times [RR (95%CI): 3.30 (1.22-8.92)], and the risk of compound obesity was 5.76 times [RR (95%CI): 5.76 (1.03-32.30)], compared with the group without early puberty initiation, while no association between early puberty initiation and obesity was found in boys. CONCLUSION: Based on the cross-sectional survey and longitudinal cohort survey, it is confirmed that the early onset of puberty in girls may increase the risk of simple obesity, central obesity and compound obesity, while there is no significant correlation between puberty onset and obesity in boys.

[Effect of outdoor time on the incidence of myopia among primary school students in 9 provinces of China].

Objective: We aimed to assess the effects of outdoor time in preventing incident myopia among primary school students and evaluate its differences among different grades to provide evidence for policy formulation related to myopia prevention. Methods: This study is a cohort study. We investigated 6 046 grade 1 to 5 students in 9 provinces, Jiangsu, Shanghai, Fujian, Shanxi, Henan, Hunan, Gansu, Chongqing, and Guangxi. In 2019, we measured their myopia on site. In 2020, we did a follow-up visit on those students to detect the myopia incidence rate. Information regarding outdoor time and myopia-related behaviors were obtained from a questionnaire within one week of visual acuity measurement in 2020. The chi-square test and Cochran-Armitage trend test compared the differences between groups. The Cox proportional hazards risk model was used to test the relationship between outdoor time and myopia. Results: In 2020, the overall myopia incidence rate of grade 1 to 5 students in the baseline was 27.5%; while 23.0% in grades 1 and 2 students and 31.7% in grades 3 to 5 students, respectively. After controlling for covariates, for students in grade 1 to 2, those with ≥1 hour of outdoor time per day were at 0.76 (95%CI: 0.62-0.93, P=0.008) times risk of being myopia than that of students with <1 hour of outdoor time per day; while for students in grades 3 to 5, an average of ≥3 hours of outdoor time per day was required to have a significant protective effect on myopia. The students with ≥3 hours of outdoor time per day were less likely to be myopia (OR=0.75, 95%CI: 0.61-0.93, P=0.007) than those students with <3 hours of outdoor time per day. Conclusions: For grade 1 and 2 students, 1 hour of outdoor time per day could reduce the incidence of myopia, whereas for grade 3 to 5 students, 3 hours of outdoor time per day could effectively reduce the incidence of myopia. Therefore, the recommendations for outdoor time as myopia prevention should be different for different grades. The higher the grade is, the more outdoor time should be spent to reduce myopia incidence. Moreover, other factors that affect myopia's incidence should be also paid attention to, and a comprehensive approach should be adopted to prevent and control the incidence of myopia.

[Influence of vascular risk factors on seasonality of benign paroxysmal positional vertigo].

Objective: To investigate the seasonal changes of benign paroxysmal positional vertigo (BPPV) onset, and explore the relationship between vascular risk factors and the seasonal patterns of BPPV. Methods: Data of 3 886 patients subjected to vestibular function examination and diagnosed with BPPV who underwent manipulation or instrumental repositioning from January 1, 2016 to December 31, 2019 in the Department of Neurology, Beijing Tiantan Hospital were retrospectively analyzed. Demographic information and medical history of the patients were recorded. Weather temperature data of Beijing were obtained and monthly averages were calculated. The relationship between the BPPV onset and temperature and seasonality was investigated. Meanwhile, the influence of vascular risk factors on the seasonal patterns of BPPV was determined. Results: BPPV is more common in women (n=2 667). The male to female ratio of patients was approximately 1∶2, with a mean age of (55±13) years. The cases of BPPV in spring (March-May), summer (June-August), autumn (September-November) and winter (December-February) were 1 000 (25.7%), 911 (23.4%), 808 (20.8%) and 1 167 (30.0%), respectively. The peak incidence of BPPV occurred in December (n=491) and the lowest occurred in September (n=251). The number of BPPV cases diagnosed monthly was inversely correlated with mean temperature (R2=0.317; P<0.001). Patients with ≥2 vascular risk factors were at higher risk of developing BPPV in spring or winter than those without risk factors (OR=1.32, 95%CI: 1.13-1.53,P<0.001). Proportion of onset in spring or winter increased with each additional risk factor (P trend<0.001). Conclusions: BPPV often occurs in the months with low temperature (spring and winter) and the number of cases is inversely correlated with temperature. Compared with those with no vascular risk factors, patients with more vascular risk factors are more likely to develop BPPV in spring and winter.

[Epidemiological characteristics of infectious diseases of group A, B and C among Chinese students' population].

OBJECTIVE: To analyze the secular trend, ranking change, age- and regional- characteristics of leading infectious diseases among Chinese students population aged 6 to 22 years from 2008 to 2017. METHODS: Data were drawn from the national surveillance from 2008 to 2017, and the participants were students aged from 6 to 22 years who were diagnosed with notifiable infectious diseases. A total of 40 infectious diseases were classified into three groups based on national notifiable infectious diseases classification of A, B and C. The morbidity and mortality rates from infectious diseases were calculated using the numbers of students published by the ministry of education as the denominator. The age- and province-specific infectious diseases with the highest incidence were selected as the leading infectious diseases for analysis. RESULTS: From 2008 to 2017, the incidence rate, the number of cases and the number of deaths of infectious diseases among the boys aged 6-22 years in China were higher than that of the girls, and the overall trend was downward during the study period. The incidence rates in the boys and girls decreased from 2008 to 2015 with decrease of 43.4% and 40.1%, respectively. However, by 2017, the increase rate rebounded with the increases of 47.1% and 53.8%. The rebound trend was mainly caused by the increase of group C of infectious diseases. During the past decade, the top leading three diseases of groups A and B of infectious diseases were viral hepatitis, tuberculosis and dysentery in 2018, respectively, which changed to tuberculosis, scarlet fever and viral hepatitis in 2017. The top leading three infectious diseases in terms of mortality were rabies, tuberculosis, and human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) in 2008, which were transformed into HIV/AIDS, rabies, and tuberculosis in 2017. There was no significantly obvious change in the incidence and mortality order of group C of infectious diseases during the decade. In the analysis of age groups and regions, the leading infectious diseases in groups A and B transferred from viral hepatitis to scarlet fever and tuberculosis, while in group C, mumps and infectious diarrhoea almost always dominated the leading infectious diseases. But in recent years, influenza and hand-foot-and-mouth disease increased significantly in the eastern region. CONCLUSION: During the past decade, China has got remarkable achievements in the prevention and control of children infectious disease. However, the change patterns and characteristics of notifiable infectious diseases among children and adolescents show the urgent need for prevention and control of respiratory tract infectious diseases, HIV/AIDS and other sexually transmitted diseases as well as new emerging infectious diseases in China in the future. This study provides important basis for policy making of Chinese national school-based infectious disease prevention and control mechanism.

[Analysis on the law of height growth spurt in adolescence of children and adolescents in Zhongshan City].

OBJECTIVE: To analyze the characteristics of the age at peak height velocity and peak height velocity of primary and middle school students in Zhongshan City, Guangdong Province, and to explore the law of the sudden increase in adolescent height in this area, and to understand the law of height growth spurt in adolescence by longitudinal tracking of the height of children and adolescents in Zhong-shan City. METHODS: Based on the physical examination database of primary and middle school students in Zhongshan City, Guangdong Province from 2005 to 2016, individuals who had been continuously tracked for more than 6 times were selected as research samples. SITAR model was used to fit the height data of the sample population, and the age at peak height velocity and peak height velocity were calcula-ted. RESULTS: A total of 49 579 subjects were included in this study, including 26 524 boys and 26 008 urban students. The median follow-up ages of boys and girls were 7.74 and 7.72 years, respectively. The boy's height spurt peak age was (12.72±0.89) years, and later than the girls at the age of (10.98±0.95) years (t=207.639, P < 0.001), the boy's height spurt peak velocity of (10.12±1.49) cm/year, higher than the girls of (8.35±1.12) cm/year (t=150.826, P < 0.001). The gender differences of height spurt peak age and height spurt peak speed in urban and rural students were consistent with the whole sample. The height surge peak age of urban male students was earlier than that of rural male students, and the height surge peak speed of urban female students was lower than that of rural female students. CONCLUSION: The peak age of the surge of girls was earlier than that of boys, but the peak rate of the surge of girls was lower than that of boys, the peak age of urban students was earlier than that of rural students, but the peak rate of urban boys was lower than that of rural boys in Guangdong Province.

[Characteristics of serum uric acid distribution in occupation, age, gender groups and its influencing factors in physical examination subjects in Nanjing from 2012 to 2016].

Objective: To investigate the distribution of uric acid in different occupation, age and gender groups, and changes of prevalence of hyperuricemia (HUA) and its influencing factors in healthy adults who receiving physical examination in Nanjing. Methods: The study was conducted in 107 478 subjects who received physical examination from 2012 to 2016. The prevalence of HUA in different genders and different years was compared. Subjects were divided into non-HUA and HUA groups according to serum uric acid. The differences in metabolic indicators and ages between two groups were analyzed. Uric acid levels among different occupations were evaluated. A multivariate logistic regression analysis was used to estimate the odds ratios (OR) of HUA. Results: The total HUA prevalence was 14.9%, in which the prevalence of HUA in men was significantly higher than that in women [20.5%(15217/74339)vs. 2.5%(818/33139), P<0.01]. The prevalence of HUA in men sustained at a high level, while that in women trended to decrease during the five years. The prevalence of HUA increased with age in women (1.0%, 0.7%, 0.9%, 2.7%, 3.8% and 9.6% in subjects within 20-29, 30-39, 40-49, 50-59, 60-69 and ≥70 age groups, respectively, P for trend<0.01). The percentages of hypertension, hyperlipidemia and diabetes, and body mass index (BMI) in both men and women were significantly higher in HUA group than those in non-HUA group (P≤0.01). Among all occupations, subjects in health care had the lowest levels of uric acid (298±91 µmol/L) and prevalence of HUA (10.4%), while, those in public security had the highest levels of uric acid [(342±82) µmol/L] and prevalence (16.5%). Multiple logistic regression analyses revealed that males, high triacylglycerol, high cholesterol, obesity and certain occupation were significantly associated with HUA. Conclusions: The prevalence of HUA in men is significantly higher than that in women. It increased with ages in women. Subjects in health occupations had the lowest levels of uric acid and HUA prevalence, while, those in public security had the highest levels among the six occupations. Obesity, hyperlipidemia, hypertension, occupations and males are positively associated with HUA.

[Laparoscopic diagnosis of postoperative recurrence of peritoneal metastasis in gastric cancer patients and the clinical efficacy of bidirectional intraperitoneal and systemic chemotherapy].

Objective: To explore the diagnostic value of laparoscopy in the postoperative recurrence of peritoneal metastasis in gastric cancer, and to investigate the efficacy of bidirectional intraperitoneal and systemic (BIPS) chemotherapy for the recurrence. Methods: The descriptive case series study was conducted. Case inclusion criteria: (1) gastric cancer patients without synchronous distant metastasis received D2 radical gastrectomy; (2) postoperative adjuvant chemotherapy was administered; (3) no other distant metastasis except recurrence of peritoneal metastasis; (4) age of 18-75 years; (5) Eastern Cooperative Oncology Group (ECOG) performance-status score≤2; (6) pretreatment evaluation suggested that surgery and chemotherapy could be tolerated. Eight consecutive gastric cancer patients with postoperative recurrence of peritoneal metastasis who met the above criteria at Department of Gastrointestinal Surgery of Ruijin Hospital from September 2015 to September 2016 were enrolled into the study. There were 6 males and 2 females with the median age of 52 (38-68) years. They received laparoscopy or laparotomy first, and then were evaluated with reference to the Sugarbaker peritoneal cancer index (PCI) and the peritoneal metastasis classification of gastric cancer developed by the Japanese Gastric Cancer Research Association. A peritoneal access port was implanted in the subcutaneous space of the lower abdomen and the patients received chemotherapy for 21 days as a course of treatment. All the patients received intraperitoneal 20 mg/m(2) of paclitaxel (PTX) via implanted subcutaneous peritoneal access ports and intravenous 50 mg/m(2) of PTX at day 1 and day 8, meanwhile 80 mg/m(2) of Tigio was orally administered per day for 14 consecutive days, followed by 7 days of interval. Follow-up ended on December 15, 2019. Results: Of these 8 patients with recurrence of peritoneal metastasis after gastric cancer surgery, 1 case underwent laparotomy and loop stoma of terminal ileum because of complete colonic obstruction, and the remaining 7 cases underwent laparoscopy successfully and the recurrence of peritoneal metastasis was clearly diagnosed. Two patients with ovarian metastasis underwent laparoscopic bilateral adnexectomy. The median follow-up time was 17.5 (1.5 to 39.0) months, the median number of BIPS chemotherapy course was 11 (1 to 30), and the median survival time (MST) after BIPS chemotherapy was 17.0 months. The major adverse reaction in BIPS treatment was mainly myelosuppression, of which grade 3/4 leukopenia and neutropenia developed in 1 and 2 cases respectively. No BIPS-related death occurred. The MST of gastric cancer after radical gastrectomy was 40.0 months. Conclusions: Laparoscopy is a safe and feasible method for diagnosing the recurrence of peritoneal metastasis of gastric cancer. BIPS chemotherapy is effective and safe for its treatment and deserves further study.

Implications of the Revisions and Revaluation of Office/Outpatient Evaluation and Management Codes for Neuroradiology Reimbursement.

In the 2020 Final Rule, the Center for Medicare & Medicaid Services adopted a new coding structure and accepted the substantial increase in valuation for office/outpatient Evaluation and Management codes set to begin in 2021. Given budget neutrality requirements, the projected increase in reimbursement will require a reduction in the conversion factor to offset such increases. The aim is to inform neuroradiologists the impact of these proposed changes on reimbursement and the profession.

Hypomethylation of CTCFL promoters as a noninvasive biomarker in plasma from patients with hepatocellular carcinoma.

Hepatocellular carcinoma (HCC) is the third deadliest cancer in the world with high morbidity and poor prognosis. CTCFL (CCCTC-binding factor like) is a member of the cancer testis antigen (CTA) family with oncogenic properties. To demonstrate whether the hypomethylation of CTCFL promoters in plasma could be used as a noninvasive biomarker to predict poor prognosis of HCC, we extracted cell-free DNA from the plasma and detected the methylation status of CTCFL in 43 HCC, 5 liver cirrhosis and 6 benign lesion samples using methylation specific PCR (MSP). Our study indicated that the hypomethylation of CTCFL promoters in HCC plasma samples (60.4%) was significantly different from that in benign lesion plasma samples (16.7%) with a p-value of 0.043. Analysis of clinicopathological data showed that the methylation status of CTCFL promoters was significantly correlated with microvascular involvement (MVI) (p=0.001) and postoperative recurrence (p=0.031). Furthermore, clinical prognosis data of 347 HCC patients from The Cancer Genome Atlas (TCGA) database displayed that the hypomethylated group had worse overall survival than the hypermethylated group (p=0.0056). In conclusion, we provide evidence that the hypomethylation of CTCFL promoters in cell-free DNA is a biomarker for monitoring HCC patients, which can be used as a noninvasive prediction index for tumor recurrence and provide the individualized decision-making for clinicians.