Trajectories of serum HBsAg during treatment and association with HBsAg loss in children with HBeAg-positive chronic hepatitis B: a latent class trajectory analysis.

BACKGROUND: The change of serum hepatitis B surface antigen (HBsAg) during treatment are associated with HBsAg loss. However, little is known about the trajectory patterns of HBsAg in early treatment and their relationship with subsequent HBsAg loss. This study aimed to identify trajectories of HBsAg in children with HBeAg-positive chronic hepatitis B (CHB) and investigate the association between trajectory patterns and HBsAg loss. METHODS: A retrospective study was conducted on 166 treatment-naive children with HBeAg-positive CHB. Latent class trajectory analysis was used to identify trajectory groups of serum HBsAg. Cox proportional hazard model was used to assess the association between HBsAg trajectory groups and HBsAg loss. RESULTS: The median follow-up time was 20.70 (12.54, 34.17) months, and HBsAg loss occurred in 70(42.17%) of all study participants. Using latent class trajectory analysis, HBeAg-positive CHB patients were classified into three trajectory groups: trajectory 1 (sustained stability, 24.70%), trajectory 2 (slow decline, 38.55%), and trajectory 3 (rapid decline, 36.75%), respectively. The median decline levels of HBsAg at the 3-month and 6-month follow-ups were the highest in trajectory 3 (1.08 and 3.28 log10 IU/ml), followed by trajectory 2 (0.27 and 1.26 log10 IU/ml), and no change in trajectory 1. The risk of achieving HBsAg loss was higher in both trajectory 2 (HR, 3.65 [95% CI, 1.70-7.83]) and trajectory 3 (HR, 7.27 [95% CI, 3.01-17.61]), respectively. CONCLUSION: Serum HBsAg levels during early treatment can be classified into distinct trajectory groups, which may serve as an additional predictive indicator for HBsAg loss in HBeAg-positive CHB children.

Association between multimorbidity of pregnancy and adverse birth outcomes: A systemic review and meta-analysis.

Multimorbidity (≥2 co-existing conditions) in pregnancy is a significant public health issue with a rising prevalence worldwide. However, the association between pregnancy multimorbidity and adverse birth outcomes is unclear. So, this review assessed the association between pregnancy-multimorbidity and adverse birth outcomes (preterm birth, abnormal birth weight, neonatal mortality, and stillbirth). Relevant peer-reviewed papers in PubMed, Web of Science, Elsevier/ScienceDirect, and Google Scholar were systematically search from January 1990 to March 2023. We used the random-effects model to calculate the multimorbidity pooled odds ratio, quantified heterogeneity using I2 statistics, and performed subgroup and sensitivity analyses in Stata version 17. The review protocol is registered with PROSPERO (CRD42023421336). The meta-analysis included 21 observational studies involving 6,523,741 pregnant women. The overall pooled odds of pregnancy multimorbidity associated with adverse birth outcomes were 3.11(2.14-4.09), 3.76(2.56-4.96) in Europe, 3.38(1.18-5.58) in North America, and 2.94(0.78-5.09) in Asia. Pregnant women with psychological and physical multimorbidity had increased odds of 5.65(1.71-9.59) and 2.75(1.71-9.58), respectively, for adverse birth outcomes. Pregnancy multimorbidity was associated with preterm birth 4.28(2.23-6.34), large gestational age (>90 percentile) 3.33(1.50-5.17), macrosomia (≥4000 g) 2.16(0.34-3.98), and small gestational age (<10th percentile) 3.52(1.54-5.51). There is substantial variance in the odds of pregnancy multimorbidity by type of comorbidity and type of adverse birth outcome, attributed to differences in the healthcare system by geographical location. Therefore, prioritizing pregnant women with multimorbidity is crucial for effective and integrative interventions.

Comparative genomic analysis and functional investigations for MCs catabolism mechanisms and evolutionary dynamics of MCs-degrading bacteria in ecology.

Microcystins (MCs) significantly threaten the ecosystem and public health. Biodegradation has emerged as a promising technology for removing MCs. Many MCs-degrading bacteria have been identified, including an indigenous bacterium Sphingopyxis sp. YF1 that could degrade MC-LR and Adda completely. Herein, we gained insight into the MCs biodegradation mechanisms and evolutionary dynamics of MCs-degrading bacteria, and revealed the toxic risks of the MCs degradation products. The biochemical characteristics and genetic repertoires of strain YF1 were explored. A comparative genomic analysis was performed on strain YF1 and six other MCs-degrading bacteria to investigate their functions. The degradation products were investigated, and the toxicity of the intermediates was analyzed through rigorous theoretical calculation. Strain YF1 might be a novel species that exhibited versatile substrate utilization capabilities. Many common genes and metabolic pathways were identified, shedding light on shared functions and catabolism in the MCs-degrading bacteria. The crucial genes involved in MCs catabolism mechanisms, including mlr and paa gene clusters, were identified successfully. These functional genes might experience horizontal gene transfer events, suggesting the evolutionary dynamics of these MCs-degrading bacteria in ecology. Moreover, the degradation products for MCs and Adda were summarized, and we found most of the intermediates exhibited lower toxicity to different organisms than the parent compound. These findings systematically revealed the MCs catabolism mechanisms and evolutionary dynamics of MCs-degrading bacteria. Consequently, this research contributed to the advancement of green biodegradation technology in aquatic ecology, which might protect human health from MCs.

Association of whole blood copper, zinc, calcium, magnesium, and iron with non-alcoholic fatty liver disease in overweight and obese children. / å ¨è¡€é“œã€é”Œã€é’™ã€é•ã€é“ä¸Žè¶ é‡è‚¥èƒ–å„¿ç«¥éžé ’ç²¾æ€§è„‚è‚ªè‚ç— çš„å ³è”.

OBJECTIVES: Non-alcoholic fatty liver disease (NAFLD) is a common metabolic disorder in overweight and obese children, and its etiology and pathogenesis remain unclear, lacking effective preventive and therapeutic measures. This study aims to explore the association between whole blood copper, zinc, calcium, magnesium and iron levels and NAFLD in overweight and obese children aged 6 to 17 years, providing a scientific basis for the prevention and intervention of early NAFLD in overweight and obese children. METHODS: A cross-sectional study design was used to collect relevant data from overweight and obese children who visited the Hunan Children's Hospital from January 2019 to December 2021 through questionnaire surveys. Fasting blood samples were collected from the subjects, and various indicators such as blood glucose, blood lipid, and mineral elements were detected. All children were divided into an overweight group (n=400) and a NAFLD group (n=202). The NAFLD group was divided into 2 subgroups according to the ALT level: A non-alcoholic fatty liver (NAFL) group and a non-alcoholic steatohepatitis (NASH) group. Logistic regression analysis was used to analyze the association between minerals (copper, zinc, calcium, magnesium, and iron) and NAFLD, NAFL and NASH. RESULTS: A total of 602 subjects were included, of whom 73.6% were male, with a median age of 10 (9, 11) years, and a body mass index (BMI) of 24.9 (22.7, 27.4) kg/m2. The intergroup comparison results showed that compared with the overweight group, the NAFLD group had higher levels of age, BMI, diastolic blood pressure (DBP), systolic blood pressure (SBP), triglyceride (TG), low density lipoprotein (LDL), alanine transaminase (ALT) and aspartate aminotransferase (AST), and lower level of high density lipoprotein (HDL). The NAFL group had higher levels of age, BMI, DBP, SBP, ALT, and AST, and lower levels of HDL compared with the overweight group. The levels of age, BMI, DBP, SBP, TG, LDL, ALT, and AST of NASH were higher than those in the overweight group, while the level of HDL was lower than that in overweight group (all P<0.017). After adjusting for a variety of confounders, the OR of NAFLD for the highest quantile of iron was 1.79 (95% CI 1.07 to 3.00) compared to the lowest quantile, and no significant association was observed between copper, zinc, calcium, and magnesium, and NAFLD. The subgroup analysis of NAFLD showed that the OR for the highest quantile of iron in children with NAFL was 2.21 (95% CI 1.26 to 3.88), while no significant association was observed between iron level and NASH. In addition, no significant associations were observed between copper, zinc, calcium, and magnesium levels and NAFL or NASH. CONCLUSIONS: High iron level increases the risk of NAFLD (more likely NAFL) in overweight and obese children, while copper, zinc, calcium, magnesium, and other elements are not associated with the risk of NAFLD in overweight and obese children.

Association of adipocytokine pathway gene polymorphisms with NAFLD in obese children. / è„‚è‚ªç»†èƒžå› å­é€šè·¯åŸºå› å¤šæ€æ€§ä¸Žè‚¥èƒ–å„¿ç«¥éžé ’ç²¾æ€§è„‚è‚ªæ€§è‚ç— çš„å ³è”.

OBJECTIVES: Non-alcoholic fatty liver disease (NAFLD) has significant genetic susceptibility. Adipocytokines play a crucial role in NAFLD development by participating in insulin resistance and hepatic steatosis. However, the association between adipocytokine pathway genes and NAFLD remains unclear. This study aims to explore the association of gene polymorphisms in the adipocytokine pathway and their interactions with NAFLD in obese children. METHODS: A case-control study was conducted, dividing obese children into NAFLD and control groups. Peripheral venous blood (2 mL) was collected from each participant for DNA extraction. A total of 14 single nucleotide polymorphisms (SNP) in the adipocytokine pathway were genotyped using multiplex PCR and high-throughput sequencing. Univariate and multivariate Logistic regression analyses were used to assess the association between SNP and NAFLD in obese children. Dominant models were used to analyze additive and multiplicative interactions via crossover analysis and Logistic regression. Generalized multifactor dimensionality reduction (GMDR) was used to detect gene-gene interactions among the 14 SNPs and their association with NAFLD in obese children. RESULTS: A total of 1 022 children were included, with 511 in the NAFLD group and 511 in the control group. After adjusting for age, gender, and BMI, multivariate Logistic regression showed that PPARG rs1801282 was associated with NAFLD in the obese children in 3 genetic models: heterozygote model (CG vs CC, OR=0.58, 95% CI 0.36 to 0.95, P=0.029), dominant model (GG+CG vs CC, OR=0.62, 95% CI 0.38 to 1.00, P=0.049), and overdominant model (CC+GG vs CG, OR=1.72, 95% CI 1.06 to 2.80, P=0.028). PRKAG2 rs12703159 was associated with NAFLD in 4 genetic models: heterozygous model (CT vs CC, OR=1.51, 95% CI 1.10 to 2.07, P=0.011), dominant model (CT+TT vs CC, OR=1.50, 95% CI 1.10 to 2.03, P=0.010), overdominant model (CC+TT vs CT, OR=0.67, 95% CI 0.49 to 0.92, P=0.012), and additive model (CC vs CT vs TT, OR=1.40, 95% CI 1.07 to 1.83, P=0.015). No significant multiplicative or additive interaction between PPARG rs1801282 and PRKAG2 rs12703159 was found in association with NAFLD. GMDR analysis, adjusted for age, gender, and BMI, revealed no statistically significant interactions among the 14 SNPs (all P>0.05). CONCLUSIONS: Mutations in PPARG rs1801282 and PRKAG2 rs12703159 are associated with NAFLD in obese children. However, no gene-gene interactions among the SNP are found to be associated with NAFLD in obese children.

Successful administration of low-dose almonertinib in a patient with lung adenocarcinoma after osimertinib-induced interstitial lung disease: a case report and literature review.

Osimertinib, the third generation epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI), is the standard treatment for nonsmall cell lung cancer with EGFR mutation. However, osimertinib-induced interstitial lung disease (OsiILD) is considered to be a serious adverse event, so some patients will have to discontinue the use of osimertinib due to OsiILD. Almonertinib is a novel third-generation EGFR-TKI. We herein report a patient who developed OsiILD after the use of osimertinib and then switched to almonertinib for further treatment with success. This is the first report of a successfull rechallenge with low-dose almonertinib after OsiILD. We also reviewed the literature to explore the possible risk factors and the subsequent treatment of OsiILD, suggesting that low-dose almonertinib may be an option for follow-up treatment of OsiILD.

Comparison of hospital delivery costs between cesarean section and natural delivery and analysis of influencing factors. / å‰–å®«äº§ä¸Žè‡ªç„¶åˆ†å¨©è€ ä½é™¢è´¹ç”¨çš„æ¯”è¾ƒä¸Žç›¸å ³å› ç´ åˆ†æž.

OBJECTIVES: The increasing costs of hospital delivery have increased the economic burden of pregnant women, and the mode of delivery is the main factor affecting the costs of hospital delivery. This study aims to explore the difference in costs between cesarean section and natural delivery, and to provide reference for controlling the increase of hospital delivery costs. METHODS: The data of inpatient delivery in the Hunan Maternal and Child Health Care Hospital from January 2016 to December 2020 were selected to compare the total inpatient costs and average daily costs of cesarean section and natural delivery. The linear trend model was used to analyze the trend change of inpatient delivery costs and the generalized linear model was used to analyze the influential factors for inpatient delivery costs. RESULTS: The average hospitalization costs of cesarean section (10 447.25 yuan) were higher than that of natural delivery (5 567.95 yuan), and the average daily costs of cesarean section (1 902.57 yuan) were higher than those of natural delivery (1 666.40 yuan). There was no significant increase or decrease in trend for cesarean section, while the average annual growth rate of the costs of natural delivery was 11.79%. The main factors affecting the hospitalization costs of cesarean section and natural delivery included age, occupation, medical insurance, route of admission, length of stay, premature delivery and complications (all P<0.05). CONCLUSIONS: The total hospitalization costs and average daily costs of cesarean section are higher than those of natural delivery, but the costs of natural delivery show a faster growth trend, and the hospitalization costs of cesarean section and natural delivery should be controlled by targeted measures.

Association of insulin signaling pathway-related gene polymorphisms and gene-gene interactions with MAFLD in obese children. / èƒ°å²›ç´ ä¿¡å·é€šè·¯ç›¸å ³åŸºå› å¤šæ€æ€§å’ŒåŸºå› -åŸºå› äº¤äº’ä½œç”¨ä¸Žè‚¥èƒ–å„¿ç«¥MAFLDçš„å ³è”.

OBJECTIVES: Insulin signaling pathway plays an important role in metabolic associated fatty liver disease (MAFLD), however, the association between polymorphisms of genes related to insulin signaling pathway and MAFLD remains unclear. This study aims to investigate the association between insulin signaling pathway-related gene polymorphisms and gene-gene interactions with MAFLD susceptibility in obese children so as to provide scientific basis for further study of genetic mechanism. METHODS: A total of 502 obese children with MAFLD who admitted to Hunan Provincial Children's Hospital from September 2019 to October 2021, were recruited as a case group, and 421 obese children with non-MAFLD admitted during the same period were recruited as a control group. Socio-demographic information, preterm birth history, eating habits, and exercise status of the subjects were collected by inquiry survey, and anthropometric information was collected by physical measurement. At the same time, 2 mL of venous blood was collected to extract DNA, and the polymorphism of insulin signaling pathway-related genes (5 representative candidate genes, 12 variants) was detected. Multivariate Logistic regression analysis was used to investigate the association between insulin signaling pathway-related gene polymorphisms and MAFLD in obese children. RESULTS: After adjusting for confounder factors, INS rs3842748 was significantly associated with the risk of MAFLD in obese children in allele, heterozygous, and dominant models [OR and 95% CI 1.749 (1.053 to 2.905), 1.909 (1.115 to 3.267), 1.862 (1.098 to 3.157), all P<0.05]; INS rs3842752 was significantly associated with the risk of MAFLD in obese children in heterozygous and dominant models [OR and 95% CI 1.736 (1.028 to 2.932), 1.700 (1.015 to 2.846), all P<0.05]. NR1H3 rs3758674 was significantly correlated with the risk of MAFLD in obese children in allele model [OR and 95% CI 0.716 (0.514 to 0.997), P<0.05]. SREBP-1c rs2297508 was significantly associated with the risk of MAFLD in obese children in allele and dominant models [OR and 95% CI 0.772 (0.602 to 0.991) and 0.743 (0.557 to 0.991), all P<0.05]. SREBP-1c rs8066560 was significantly associated with the risk of MAFLD in obese children in allele, heterozygous, and dominant models [OR and 95% CI 0.759 (0.589 to 0.980), 0.733 (0.541 to 0.992), 0.727 (0.543 to 0.974), all P<0.05]. NR1H3 rs3758674 mutant C and SREBP-1c rs2297508 mutant G had interaction in the development of MAFLD in obese children [OR and 95% CI 0.407 (0.173 to 0.954), P<0.05]. CONCLUSIONS: The INS, NR1H3, and SREBP-1c gene polymorphisms in the insulin signaling pathway are associated with the susceptibility of MAFLD in obese children, but the functions and mechanisms of these genes need to be further studied.

[A cross-sectional study on the prevalence rate and influencing factors of non-alcoholic fatty liver disease in overweight/obese children]. / è¶ é‡/è‚¥èƒ–å„¿ç«¥éžé ’ç²¾æ€§è„‚è‚ªè‚ç— æ‚£ç— çŽ‡åŠå ¶å½±å“å› ç´ çš„æ¨ªæ–­é¢ç ”ç©¶.

OBJECTIVES: To investigate the prevalence rate of non-alcoholic fatty liver disease (NAFLD) in overweight/obese children who visit a hospital, and to explore the influencing factors of NAFLD, in order to provide a basis for the prevention of NAFLD in overweight/obese children. METHODS: Overweight/obese children who visited Hunan Children's Hospital from June 2019 to September 2021 were recruited. The prevalence rate of NAFLD was examined. Logistic regression analysis was used to explore the factors influencing the development of NAFLD [non-alcoholic fatty liver (NAFL) and non-alcoholic steatohepatitis (NASH)]. Receiver operating characteristic curve analysis was used to evaluate the predictive value of the influencing factors for NAFL and NASH. RESULTS: A total of 844 overweight/obese children aged 6-17 years were enrolled. The prevalence rate of NAFLD in overweight/obese children was 38.2% (322/844), among which the prevalence rates of NAFL and NASH were 28.8% (243/844) and 9.4% (79/844), respectively. Multivariate logistic regression analysis showed that the increase of waist-to-hip ratio (WHR) and low high-density lipoprotein cholesterol (HDL-C) were associated with the development of NAFL and NASH (P<0.05). The receiver operating characteristic curve analysis showed that the combined measurement of WHR and HDL-C had a predictive value for NAFL (area under the curve: 0.653, 95%CI: 0.613-0.694), and for NASH (area under the curve: 0.771, 95%CI: 0.723-0.819). CONCLUSIONS: The prevalence rate of NAFLD in overweight/obese children who visit a hospital is high. WHR and HDL-C are associated with the development of NAFLD and the combined measurement of WHR and HDL-C has a certain value for predicating the development of NAFLD.

The detoxification activities and mechanisms of microcystinase towards MC-LR.

Microcystins (MCs) are the most common and toxic cyanotoxins that are hazardous to human health and ecosystems. Microcystinase is the enzyme in charge of the initial step in the biodegradation of MCs. The characterization, application conditions, and detoxification mechanisms of microcystinase from an indigenous bacterium Sphingopyxis sp. YF1 towards MC-LR were investigated in the current study. The microcystinase gene of strain YF1 was most similar to Sphingomonas sp. USTB-05 and contained a CAAX-family conversed abortive Infection (ABI) domain. The microcystinase was successful obtained and purified by overexpression in Escherichia coli. The highest degradation rate of MC-LR was 1.0 µg/mL/min under the optimal condition of 30 â„ƒ, pH 7, 20 µg/mL MC-LR, and 400 µg/mL microcystinase. The MC-degrading product was identified as linearized MC-LR, which possessed a much lower inhibitory activity against protein phosphatase 2A than MC-LR. Microcystinase interacted with MC-LR via amino acid residues involved in through the formation of conventional Hydrogen Bond, Pi-Pi T-shapes, Van der Waals force, and so on. The optimal MC-degrading condition of pure microcystinase and its detoxification mechanisms against MC-LR were revealed. The toxicity of purified linearized MC-LR was explored for the first time. These findings suggest that pure microcystinase may efficiently detoxify MCs and it is promising in the bioremediation of MC-polluted environments.

Influencing factors and risk prediction model for cervical cancer recurrence. / å®«é¢ˆç™Œå¤å‘çš„å½±å“å› ç´ åŠé£Žé™©é¢„æµ‹æ¨¡åž‹.

OBJECTIVES: Cervical cancer is the most common malignant tumor in the female reproductive system worldwide. The recurrence rate for the treated cervical cancer patients is high, which seriously threatens women's lives and health. At present, the risk prediction study of cervical cancer has not been reported. Based on the influencing factors of cervical cancer recurrence, we aim to establish a risk prediction model of cervical cancer recurrence to provide a scientific basis for the prevention and treatment of cervical cancer recurrence. METHODS: A total of 4 358 cervical cancer patients admitted to the Hunan Cancer Hospital from January 1992 to December 2005 were selected as research subjects, and the recurrence of cervical cancer patients after treatment was followed up. Univariate analysis was used to analyze the possible influencing factors. Variables that were significant in univariate analysis or those that were not significant in univariate analysis but may be considered significant were included in multivariate Cox regression analysis to establish a cervical cancer recurrence risk prediction model. Line graphs was used to show the model and it was evaluated by using receiver operating characteristic (ROC) curves, calibration plots, and decision curve analysis. RESULTS: Univariate analysis showed that the recurrence rates of cervical cancer patients with different age, age of menarche, parity, miscarriage, clinical stage, and treatment method were significantly different (all P<0.05). Multivariate Cox regression analysis showed that RR=-0.489×(age≥55 years old)+0.481×(age at menarche >15 years old)+0.459×(number of miscarriages≥3)+0.416×(clinical stage II)+0.613×(clinical stage III/IV)+0.366×(the treatment method was surgery + chemotherapy) + 0.015×(the treatment method was chemotherapy alone). The area under the ROC curve (AUC) of the Cox risk prediction model for cervical cancer recurrence constructed was 0.736 (95% CI 0.684 to 0.789), the best prediction threshold was 0.857, the sensitivity was 0.576, and the specificity was 0.810. The accuracy of the Cox risk model constructed by this model was good. From the clinical decision curve, the net benefit value was high and the validity was good. CONCLUSIONS: Patient age, age at menarche, miscarriages, clinical stages, and treatment methods are independent factors affecting cervical cancer recurrence. The Cox proportional hazards prediction model for cervical cancer recurrence constructed in this study can be better used for predicting the risk of cervical cancer recurrence.

Greenness surrounding schools and adiposity in children and adolescents: Findings from a national population-based study in China.

BACKGROUND: Previous studies have indicated that exposure to green space may benefit human health. However, the available evidence concerning the effects of greenness, especially school-based greenness, on pediatric obesity is scarce. OBJECTIVE: To explore the association between school-based greenness and adiposity in children and adolescents in China. METHOD: We conducted a nationwide cross-sectional study of 56,620 children and adolescents (aged 6-18 years) in seven provinces/municipalities across China. School-based greenness was assessed using satellite-derived Normalized Difference Vegetation Index (NDVI) and Soil Adjusted Vegetation Index (SAVI) within 100-, 500-, and 1000-m circular buffers around each school's address. Generalized linear mixed regression models were used to estimate associations of greenness with BMI z-scores (zBMI), waist circumference, and prevalent overweight/obesity. We also explored the potential mediating role of ambient air pollution and physical activity in the greenness-adiposity associations. RESULT: In the adjusted model, an IQR increase in NDVI-1000m was associated with lower zBMI (ß: -0.11, 95% confidence interval[CI]: -0.13,-0.09) and waist circumference (ß: -0.64, 95%CI: -0.78,-0.50). Consistently, an IQR increase in NDVI-100m, NDVI-500m, NDVI-1000m was associated with 7-20% lower odds of overweight/obesity in the adjusted models. Air pollutants mediated 6.5-29.1% of the association between greenness and zBMI. No significant mediation effect was observed for physical activity. CONCLUSION: Higher school-based greenness levels were associated with lower zBMI, waist circumference, and lower odds of overweight and obesity in children and adolescents. Ambient air pollutants may partially mediate the greenness-adiposity associations.

Prevalence and risk factors of postpartum depression in the Middle East: a systematic review and meta-analysis.

BACKGROUND: Postpartum depression (PPD) is a common social health problem that affects not only the mother and newborn, but extends to other family members as well as various aspects of their lives. This systematic review and meta-analysis aims to identify the prevalence and risk factors of postpartum among the women in Middle East countries. METHODS: We searched published articles from Web of Science, EMBASE, PubMed and Cochrane electronic databases to establish study articles. Articles regarding postpartum depression prevalence and associated factors among women in the Middle East were included in this systematic review and meta-analysis. A random-effect model was used for estimation of pooled postpartum depression prevalence with a 95% confidence interval (CI) and forest plot. Presence of heterogeneity was checked by Cochran's (Q) test, and funnel plots and Egger's statistical tests were used to assess publication bias. RESULTS: A total of 15 studies were included in this systematic review. The studies were conducted in different countries of the Middle East between 2006 and 2020, nine of the included studies were cross-sectional studies and six were cohort studies. The overall pooled estimate of the prevalence of postpartum depression in the Middle East mothers was very high 27% (95% CI 0.19-0.35). The common risk factors reported based on our review were poor economic, pregnancy associated complications, low education, unplanned pregnancy, housewife, inadequate social support from family members and the feeding by formula. Poor economic and complication during pregnancy presented a significant relationship regarding postpartum depression in meta-analysis. CONCLUSIONS: The prevalence of postpartum depression in the Middle East was higher than other regions of the world. In response to this, we recommend an increase of routine screening for depression during postpartum in this area. Furthermore, it might be necessary to integrate mental health with maternal health care in clinical practice during the postpartum.

Pregnancy complications among nulliparous and multiparous women with advanced maternal age: a community-based prospective cohort study in China.

BACKGROUND: This study aimed to evaluate the incidence rates and risks of pregnancy complications among nulliparous and multiparous women with advanced maternal age (AMA, ≥35 years) in China. METHODS: We performed a community-based prospective cohort study of 10,171 pregnant women in selected two sub-districts and 11 towns of Liuyang from 2013 to 2015. All subjects were followed up from the first prenatal care (at ≤12 weeks) to delivery, and risks of pregnancy complications were compared by parity and maternal age groups. RESULTS: Among nulliparas, women with AMA showed significantly increased risks for gestational hypertension (OR 8.44, 95%CI 1.68-2.88), preeclampsia/eclampsia (OR 9.92, 95%CI 4.87-18.78), premature rupture of membrane (OR 6.84, 95%CI 2.00-17.69), as compared to women in the 20-29-year age group. Among multiparas with AMA, increased risks were found for gestational diabetes mellitus (OR 3.29, 95%CI 1.76-5.94), anemia (OR 1.85, 95%CI 1.25-2.69), polyhydramnios (OR 3.29, 95%CI 1.56-6.64), premature rupture of membrane (OR 5.14, 95%CI 2.12-12.29), and preterm labor (OR 1.89, 95CI 1.42-2.50). CONCLUSIONS: Women with AMA were associated with increased risks of pregnancy complications, and complications with increased risks differed in nulliparas and multiparas. Women with AMA should be identified as a high-risk group in clinical practice.

Changes in breast milk lutein concentrations and their associations with dietary lutein intake: a 12-week prospective analytical study.

We aimed to investigate the trends of breast milk lutein concentrations at different times and their relationship with dietary lutein intake during the 12 weeks after delivery. Breast milk samples were collected from thirty-seven mothers at 4, 8 and 12 weeks postpartum. A HPLC detection method was used to measure breast milk lutein concentrations. Dietary intake was assessed using an FFQ, and then dietary lutein intake was calculated. The correlations between dietary lutein intake and breast milk lutein concentrations during lactation were investigated by Pearson's correlation coefficient. General linear regression models were used to evaluate the optimal regression equation. The mean values of dietary lutein intake at 4, 8 and 12 weeks postpartum were 5·22 (sd 3·60), 7·28 (sd 4·30) and 7·33 (sd 4·24) mg/d, respectively. The mean values of breast milk lutein concentrations at 4, 8 and 12 weeks postpartum were as follows: 46·41 (sd 41·36), 57·96 (sd 40·00) and 62·33 (sd 30·10) µg/l, respectively. Breast milk lutein concentrations were positively associated with dietary lutein intake at 4 weeks postpartum (r 0·527, P < 0·05), which was consistent with the positive correlations observed at 8 and 12 weeks postpartum (r 0·444, P < 0·05; r 0·468, P < 0·05) by the sensitivity analysis. Increased dietary lutein intake can increase the concentration of lutein in the breast milk, and women are recommended to increase their dietary intake of green leafy vegetables and fruits that are rich in lutein during the pregnancy and postpartum periods.

Prevalence and risk factors of impaired fasting glucose and diabetes among Chinese children and adolescents: a national observational study.

The prevalence of impaired fasting glucose (IFG) and diabetes mellitus (DM) has reportedly increased significantly among Chinese children and adolescents. We aimed to examine the prevalence of IFG and DM, the disparities in sex and region and related risk factors among Chinese children and adolescents. A total of 16 434 Chinese children aged 6-17 years were selected from a national cross-sectional survey, and fasting glucose was measured for all participants. Overall, mean fasting plasma glucose (FPG) concentration was (4·64 (sd 0·51)) mmol/l, and the prevalence of DM and IFG was 0·10 and 1·89 %, respectively. Compared with girls, boys had higher FPG concentration (4·69 v. 4·58 mmol/l, r 0·107, P<0·001) and IFG prevalence (2·67 v. 1·07 %, r φ 0·059, P<0·001). Compared with rural children and adolescents, urban children and adolescent had higher FPG concentration (4·65 v. 4·62 mmol/l, r 0·029, P<0·001) and DM prevalence (0·15 v. 0·05 %, r φ 0·016, P<0·01). In addition, self-reported fried foods intake and overweight/obesity were positively associated with IFG, and the proportion of consuming fried foods more than or equal to once per week and overweight/obesity prevalence in boys and urban children and adolescents were significantly higher than girls and rural children and adolescents, respectively (P<0·05). Although the prevalence of IFG and DM was relatively low in Chinese children and adolescents, sex and region disparities were observed, which may be associated with differences in overweight/obesity prevalence and dietary factors.

[Factors associated with introduction of solid, semi-solid or soft foods among infants aged 6-8 months in poor rural areas in Hunan Province in 2015].

OBJECTIVE: To describe the rate of and identify the factors associated with introduction of solid, semi-solid or soft foods among infants aged 6-8 months in poor rural areas. METHODS: A total of 1449 rural infants aged 6-8 months in 30 poor counties of Wuling Mountains and Luoxiao Mountains in Hunan Province were selected by probabilityproportional-to-size sampling( PPS) in August 2015. And designed questionnaires were used to collect information of infants feeding in the past 24 h and information of personal and family. The rate of introduction of solid, semi-solid or soft foods among infants aged 6-8 months was calculated according to WHO Indicators for Assessing Infant and Young Child Feeding Practices. Logistic regression analysis were used to analyze factors influencing introduction of solid, semi-solid or soft foods on infants aged 6-8 months. RESULTS: 95. 4%( 1382/1449) of infants aged 6-8 months received solid, semi-solid or soft foods. Multi factors analysis showed that Tujia ethnic infants( OR = 2. 32, 95% CI1. 55-3. 47) and main caregivers' unqualified feeding knowledge( OR = 1. 39, 95% CI1. 10-1. 75) were risk factors of introduction of solid, semi-solid or soft foods. CONCLUSION: Most infants aged 6-8 months in poor rural areas received solid, semi-solid or soft foods. Infants who were Tujia ethnic or with unqualified caregivers ' feeding knowledge had higher risk of introduction of solid, semi-solid or soft foods.

The Application of a Moldable Skin Barrier in the Self-Care of Elderly Ostomy Patients.

The quality of ostomy directly affects the stoma patient's quality of life. This study investigated the application of a moldable skin barrier in the self-care of elderly stoma patients after colostomy for colorectal cancer. A total of 104 elderly stoma patients (65-79 years) who underwent colostomy because of colorectal cancer were randomly divided into an experimental group (56 cases) receiving a moldable skin barrier and a control group (48 cases) receiving a conventional skin barrier. The information on peristomal irritant dermatitis occurrence, the satisfaction of self-care, and related care costs were collected 1 month after patients were discharged from the hospital. The overall incidence of irritant dermatitis was significantly lower (p = .01), the self-care satisfaction score was significantly higher (p = .02), and the cost for leakage-proof cream (p < .001) was significantly lower in the experimental group than in the control group. In contrast, no significant differences in the cost of ostomy equipment and the barrier replacement interval were observed. In conclusion, a moldable skin barrier can reduce the incidence of irritant dermatitis in elderly stoma patients, improve their self-care satisfaction, and reduce the cost of leakage-proof cream use compared with the conventional stoma skin barrier.

[Factors associated with taking Yingyangbao efficiently among infants and young children aged 6-24 months in poor rural areas of Hunan Province, China].

OBJECTIVE: To describe the status and identify factors associated withtaking Yingyangbao efficiently among infants and young children aged 6- 24 months in poor rural areas. METHODS: A total of 7481 rural infants and young children aged between6 and 24 months in 25 poor counties of Wuling Mountains and Luoxiao Mountains in Hunan Province were selected by Probability-Proportional-to-Size Sampling( PPS), and designed questionnaires to collect infants and young children's information of personal, family and taking Yingyangbao. Non-conditional Logistic regression analysis was used to analyze the factors associated with taking Yingyangbao among infants and young children aged 6- 24 months. RESULTS: The findings indicated that 90. 4%( 6762 /7481) of infants and young children had got Yingyangbao, and 69. 2%( 4677 /6762) of infants and young children took Yingyangbao efficiently, 62. 5%( 4677 /7481) of all investigative infants and young children took Yingyangbao efficiently. The result of multivariate non-conditional logistic regression analysis showed that, compared with 6- 11 months, 12- 17 and18- 24 months were protective factors of infants and young children took Yingyangbao efficiently( OR = 0. 839, 95% CI 0. 735- 0. 959. OR = 0. 854, 95% CI 0. 748-0. 974). Compared with Han ethnic, Miao, Tujia, Dong and other minority ethnic were risk factors of infants and young children took Yingyangbao efficiently( OR = 1. 243, 95%CI 1. 07- 1. 443. OR = 2. 352, 95% CI 2. 008- 2. 755. OR = 1. 801, 95% CI 1. 453-2. 233. OR = 1. 675, 95% CI 1. 192- 2. 355). Compared with father with primary school education or below, father with senior high school education and educated to university level or above were protective factors of infants and young children took Yingyangbao efficiently( OR = 0. 774, 95% CI 0. 618- 0. 970. OR = 0. 570, 95% CI 0. 428-0. 760). Compared with famer father, worker or cadre father was risk factor of infants and young children took Yingyangbao efficiently( OR = 1. 279, 95% CI 1. 104- 1. 482). Compared with parents as caregivers, grandparents as caregivers was protective factor of infants and young children took Yingyangbao efficiently( OR = 0. 651, 95% CI 0. 581-0. 729). Compared with taking Yingyangbao with no adverse reaction, taking Yingyangbao with adverse reaction was risk factor of infants and young children took Yingyangbao efficiently( OR = 2. 759, 95% CI 2. 346- 3. 245). CONCLUSION: The rate of taking Yingyangbao efficiently among infants and young children in poor rural areas is low. The risk factors of infants and young children taking Yingyangbao efficiently include lower in age( months), of minority ethnic, of father with lower education, of father who is worker or cadre, of parents as caregiver, and of taking Yingyangbao with adverse reaction.

[Therapeutic effect of one-day outpatient on gestational diabetes mellitus patients].

OBJECTIVE: To study the effect of one-day outpatient intervention on gestational diabetes mellitus (GDM) patients, and to explore the pregnancy outcome relevant to GDM patients and their fetus.
 Methods: The GDM patients were divided into two groups according to their own intention to the one-day outpatient. According to systematic sampling method, we chose 200 GDM patients from the above 2 groups, respectively. The 200 GDM patients in the control group were matched the observation group with the age and gestational age, then the pregnancy outcome was tracked.
 Results: The control level and success rate for the two hours blood sugar after breakfast and hemoglobin A1c (HbA1c) in the observation group were better than those in the control group (P<0.001). The maternal complication rate (46.50%) and neonatal complication rate (21.50%) in the observation group were lower than those in the control group (71.50%, 41.50%; P<0.001). The maternal complications rate of fetal distress, premature and the neonatal complications rate of fetal macrosomia, neonatal respiratory distress syndrome (NRDS), low weight, congenital heart disease, neonatal pneumonia, and rate in neonatal NICU were significantly lower than those in the control group (P<0.05).
 Conclusion: One-day outpatient intervention could control blood sugar effectively, reduce the maternal and neonatal complications. It is worth promoting.