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Abstract Background To investigate the joint associations between various body fat distribution parameters and high blood pressure (HBP) using the Bayesian Kernel Machine Regression (BKMR) model in school-aged children. Methods A diverse sample of 7 ∼ 17 years old (N = 1423; 50.25% boys) was recruited for this study. Fat distribution parameters for multiple body parts, including trunk, legs, android region, and gynoid region fat percentage were measured. HBP was defined as either systolic or diastolic blood pressure exceeded age-, sex- and height-specific 95th percentiles. The chi-square test was utilized to compare differences between groups. The BKMR model was employed to analyze the joint effects of body fat indicators on HBP while accounting for potential confounders. Weighted Quantile Sum (WQS) model was used to characterize the relative weights of each body fat distribution parameter for HBP. Additionally, stratified analyses were performed by sexes and overweight/non overweight groups. Results HBP prevalence was 46.86% and 35.10% for overweight and obese (OB) boys and girls, and was 17.96% and 17.28% for non-overweight and obese (non-OB) boys and girls, respectively. Increased fat percentages of trunk, android, and gynoid parts are associated with a higher risk of HBP, while increased fat percentage of the leg was associated with lower HBP risk. Android fat percentage contributed the most HBP risk in OB boys (weight = 0.34), OB girls (weight = 0.39), and non-OB girls (weight = 0.56). Leg fat percentage had significant protective effect on HBP for non-OB boys (weight=-0.22) and OB boys (weight=-0.44), while gynoid fat percentage had significant protective effect for OB girls (weight=-0.27). Conclusions Fat distribution of various body parts have inconsistent roles and directions in their association with HBP risk in children of different sex and weight status. We recommend that children of different sexes and weight statuses be provided with body-part-specific exercise recommendations for optimal chronic disease prevention and control benefits.

Abstract Background Maternal stress is a potential factor affecting fetal growth, but it is unknown whether it directly affects fetal growth restriction. This study aims to investigate the association between pre-pregnancy maternal stress with small for gestational age (SGA). Methods This study used a population-based retrospective cohort analysis to examine the association between pre-pregnancy maternal stress and SGA in offspring. Data were extracted from the National Preconception Health Care Project (NPHCP), conducted between 2010 and 2012, which encompassed preconception health-related information from 572,989 individuals across various regions in China. Logistic regression models were used to assess the associations between pre-pregnancy maternal stress variables and the risk of SGA. In addition, Synthetic Minority Over-sampling Technique (SMOTE) and Propensity Scores (PS) methods were used to enhance the model’s ability to the associations between pre-pregnancy maternal stress and SGA. Results Pre-pregnancy maternal stress was significantly associated with an increased the risk of SGA in offspring (OR 1.35, 95% CI 1.20 to 1.51, P 0.05). Specially, individuals with lower socio-economic status that characterized by below high school education levels (OR = 1.45, 95% CI: 1.23 to 1.70), farmer occupation (OR = 1.33, 95% CI: 1.15 to 1.55, P = 0.002), rural residence (OR = 1.38, 95% CI: 1.22 to 1.56, P

ObjectivesTo mitigate the incidence of misdiagnosis and distinguish between gastric fundic tumors (GFTs) and thickened diaphragmatic crura (TDC).Materials and methodsComputed tomographic enterography (CTE) data from 3844 cases and computed tomographic gastrography (CTG) data from 4351 cases were retrospectively analyzed. A total of 105 cases were selected and categorized into three groups: 47 cases with TDC examined via CTE, 31 with adenocarcinoma, and 27 with gastrointestinal stromal tumors (GIST) examined via CTG. Inter-group differences in age, sex distribution, mass dimensions, mass-stomach interface (MSI), chief complaints, gastric underlying diseases, and enhancement patterns were analyzed.ResultsThe misdiagnosis rate of TDC as a tumor by radiologists is approximately 1.2% (47/3844). Age (p

Background: Artificial light at night (ALAN) has been increasingly recognized as a potential environmental risk factor for mental health issues. However, no meta-analyses have been conducted to summarize the findings. This study aimed to evaluate the pooled associations between outdoor and indoor ALAN exposures and the risk of depression. Methods: Adhering to the PRISMA guideline, we conducted systematic searches across PubMed, Web of Science, EMBASE, Cochrane, and Ovid databases for studies published before May 1st, 2024. Results: A total of 7 studies (5 for outdoor ALAN and 2 for indoor ALAN) with a combined total of 560,219 participants were included in the meta-analysis. Specifically, a 1 nW/cm2/sr increase in outdoor ALAN was associated with a 0.43% (95% CI: 0.21%, 0.65%) increase in depression risk. Meanwhile, a 1 lux increase in indoor ALAN was associated with a 3.29% (95% CI: 0.85%, 5.79%) increase in depression risk. No potential heterogeneity was observed for outdoor ALAN exposure and indoor ALAN exposure. Subgroup analyses for outdoor ALAN indicated that development level, sample size, age group, sex, study design, modality of depression assessment, or adjustment of sleep-related variables in models may not be potential sources of heterogeneity. Sensitivity analyses confirmed the robustness of the findings, while evidence of publication bias was observed for studies on outdoor ALAN. Conclusions: Our findings suggest that both outdoor and indoor ALAN exposures are associated with increased risk of depression. These results underscore the importance of considering outdoor and indoor ALAN in public health strategies aimed at reducing depression risk. Nevertheless, further studies with prospective design are still warranted considering the limited study numbers.

Abstract Background The relationship between lean body mass (LBM) and blood pressure (BP) is controversial and limited. This study investigated the associations between LBM indexes and BP in adults of different ages and with varying body fat distribution. Methods The data for the present analysis was obtained from a cross-sectional survey of 1,465 adults (50.7% males) aged 18–70 years conducted in Beijing, China. Regional LBM and fat distribution, including fat mass (FM) and android to gynoid fat ratio (AOI), were assessed using a dual-energy X-ray bone densitometer. Generalized Liner Model (GLM) was employed. Confounders, including age, sex, height, weight, smoking, and alcohol use, were evaluated through questionnaires and physical examinations. Results Males had higher rates of hypertension (11.19% vs. 4.92%) and prehypertension (21.57% vs. 14.59%) than females. The mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) were 122.04 mmHg and 76.68 mmHg. There were no significant associations between LBM and DBP (p > 0.05). However, arms LBM (β = 1.86, 95% CI: 0.77, 2.94) and trunk LBM (β = 0.37, 95% CI: 0.01, 0.73) were significantly associated with SBP. The association of LBM on DBP was stronger with increasing ages, and stronger in females than in males (p

Background: The causal connection between morning diurnal preference and psychiatric disorders remains enigmatic. Using bidirectional two-sample Mendelian randomization (MR), we aim to explore the potential causal associations between morning diurnal preference and seven prominent psychiatric disorders. Methods: MR is a genetic epidemiological method that leverages genetic variants as instrumental variables to infer causal associations between exposures and outcomes. We obtained morning diurnal preference data from genome-wide association study (GWAS) datasets and identified 252,287 individuals as morning people. Psychiatric disorder data were sourced from the FinnGen consortium R9 dataset. Our primary analysis used the inverse-variance weighted (IVW) approach to evaluate the overall causal effect by combining the estimates from each genetic variant. Addition analyses, including weighted median, MR-Egger regression, weighted mode, and simple mode techniques were conducted to ensure robustness. Results: Being a morning person is related to reduced odds of multiple psychiatric disorders, including depression or dysthymia (OR: 0.93, 95% CI: 0.88, 0.999), anxiety disorders (OR: 0.90, 95% CI: 0.84, 0.96), self-harming behaviors (OR: 0.87, 95% CI: 0.76, 0.99), substance-use disorders (OR: 0.81, 95% CI: 0.71, 0.93), alcohol dependence (OR: 0.82, 95% CI: 0.73, 0.92), alcohol use disorders (OR: 0.85, 95% CI: 0.76, 0.94), acute alcohol intoxication (OR: 0.86, 95% CI: 0.76, 0.96), schizophrenia (OR: 0.77, 95% CI: 0.65, 0.92), and schizophrenia or delusion (OR: 0.80, 95% CI: 0.70, 0.92). Alcohol dependence (OR: 0.97, 95% CI: 0.94, 0.999) and alcohol use disorders (OR: 0.96, 95% CI: 0.94, 0.99) were also related to a lower morning diurnal preference. Conclusions: Our study provides evidence that being a morning person is a protective factor for various psychiatric disorders from a genetic perspective. The results provide insights for potential targeted interventions to improve mental wellbeing.

Abstract Background Phthalate esters (PAEs) are known to have hormone-like properties, and there is a growing trend of children expressing a gender identity different from assigned sex. However, there has been limited research in the potential links between PAEs exposure and gender identity. Methods A total of 571 children (278 boys) completed the follow-up from Oct 2017 to Oct 2020 in Childhood Blood Pressure and Environmental Factors (CBPEF) cohort in Xiamen, China. Urinary PAE metabolites were measured at three time of visits using ultraperformance liquid chromatography-tandem mass spectrometry. The Children’s Sex Role Inventory scale was used to assess gender identity (masculinity, femininity, androgyny and undifferentiated), and Tanner definition was used to define puberty timing. Generalized linear models and log-binomial regression were used to assess the relationships between PAEs exposure, gender trait scores and gender identity. Results Overall, the concentration of most PAEs in more than 90% of participants was above the limit of detection values. In visit 1, there were 10.1% boys with femininity and 11.3% girls with masculinity; while these figures increased to 10.8% and 12.3% during follow-up, respectively. Early puberty onset accounted for 24.8% and 25.6% among boys and girls. Long-term exposure to mono-2-ethylhexyl phthalate (MEHP) (β = 1.20, 95%CI = 0.13, 2.28), mono-2-ethyl-5-hydroxyhexyl phthalate (MEHHP) (β = 1.25, 95%CI = 0.22, 2.28) and mono-2-ethyl-5-oxohexyl phthalate (MEOHP) (β = 1.40, 95%CI = 0.24, 2.56) was associated with the increased differences of femininity trait scores in boys who enter puberty earlier, prolonged exposure to di(2-ethylhexyl) phthalate (DEHP) might also have such a positive impact (β = 1.38, 95%CI = 0.36, 2.41). For gender identity, persistent exposure to low molecular weight phthalates (LMWP) was negatively associated with undifferentiated type among boys entering puberty earlier (RR = 0.18, 95%CI = 0.05, 0.75, P 1 for their femininity. Conclusion Long-term exposure to PAEs increase the femininity trait scores in boys with early onset of puberty. Although the mechanisms remain to be determined, environmental pollution might have subtle, yet measurable effects on childhood gender identity. Reducing these chemicals exposure has important public implications on gender development.

BackgroundBeyond the direct effect of COVID-19 infection on young people, the wider impact of the pandemic on other infectious diseases remains unknown. ObjectiveThis study aims to assess changes in the incidence and mortality of 42 notifiable infectious diseases during the pandemic among children and adolescents in China, compared with prepandemic levels. MethodsThe Notifiable Infectious Disease Surveillance System of China was used to detect new cases and fatalities among individuals aged 5-22 years across 42 notifiable infectious diseases spanning from 2018 to 2021. These infectious diseases were categorized into 5 groups: respiratory, gastrointestinal and enterovirus, sexually transmitted and blood-borne, zoonotic, and vector-borne diseases. Each year (2018-2021) was segmented into 4 phases: phase 1 (January 1-22), phase 2 (January 23-April 7), phase 3 (April 8-August 31), and phase 4 (September 1-December 31) according to the varying intensities of pandemic restrictive measures in 2020. Generalized linear models were applied to assess the change in the incidence and mortality within each disease category, using 2018 and 2019 as the reference. ResultsA total of 4,898,260 incident cases and 3701 deaths were included. The overall incidence of notifiable infectious diseases decreased sharply during the first year of the COVID-19 pandemic (2020) compared with prepandemic levels (2018 and 2019), and then rebounded in 2021, particularly in South China. Across the past 4 years, the number of deaths steadily decreased. The incidence of diseases rebounded differentially by the pandemic phase. For instance, although seasonal influenza dominated respiratory diseases in 2019, it showed a substantial decline during the pandemic (percent change in phase 2 2020: 0.21, 95% CI 0.09-0.50), which persisted until 2021 (percent change in phase 4 2021: 1.02, 95% CI 0.74-1.41). The incidence of gastrointestinal and enterovirus diseases decreased by 33.6% during 2020 but rebounded by 56.9% in 2021, mainly driven by hand, foot, and mouth disease (percent change in phase 3 2021: 1.28, 95% CI 1.17-1.41) and infectious diarrhea (percent change in phase 3 2020: 1.22, 95% CI 1.17-1.28). Sexually transmitted and blood-borne diseases were restrained during the first year of 2021 but rebounded quickly in 2021, mainly driven by syphilis (percent change in phase 3 2020: 1.31, 95% CI 1.23-1.40) and gonorrhea (percent change in phase 3 2020: 1.10, 95% CI 1.05-1.16). Zoonotic diseases were not dampened by the pandemic but continued to increase across the study period, mainly due to brucellosis (percent change in phase 2 2020: 0.94, 95% CI 0.75-1.16). Vector-borne diseases showed a continuous decline during 2020, dominated by hemorrhagic fever (percent change in phase 2 2020: 0.68, 95% CI 0.53-0.87), but rebounded in 2021. ConclusionsThe COVID-19 pandemic was associated with a marked decline in notifiable infectious diseases in Chinese children and adolescents. These effects were not sustained, with evidence of a rebound to prepandemic levels by late 2021. To effectively address the postpandemic resurgence of infectious diseases in children and adolescents, it will be essential to maintain disease surveillance and strengthen the implementation of various initiatives. These include extending immunization programs, prioritizing the management of sexually transmitted infections, continuing feasible nonpharmaceutical intervention projects, and effectively managing imported infections.

BackgroundAn accelerated epidemiological transition, spurred by economic development and urbanization, has led to a rapid transformation of the disease spectrum. However, this transition has resulted in a divergent change in the burden of infectious diseases between urban and rural areas. The objective of our study was to evaluate the long-term urban-rural disparities in infectious diseases among children, adolescents, and youths in China, while also examining the specific diseases driving these disparities.Methods and findingsThis observational study examined data on 43 notifiable infectious diseases from 8,442,956 cases from individuals aged 4 to 24 years, with 4,487,043 cases in urban areas and 3,955,913 in rural areas. The data from 2013 to 2021 were obtained from China's Notifiable Infectious Disease Surveillance System. The 43 infectious diseases were categorized into 7 categories: vaccine-preventable, bacterial, gastrointestinal and enterovirus, sexually transmitted and bloodborne, vectorborne, zoonotic, and quarantinable diseases. The calculation of infectious disease incidence was stratified by urban and rural areas. We used the index of incidence rate ratio (IRR), calculated by dividing the urban incidence rate by the rural incidence rate for each disease category, to assess the urban-rural disparity. During the nine-year study period, most notifiable infectious diseases in both urban and rural areas exhibited either a decreased or stable pattern. However, a significant and progressively widening urban-rural disparity in notifiable infectious diseases was observed. Children, adolescents, and youths in urban areas experienced a higher average yearly incidence compared to their rural counterparts, with rates of 439 per 100,000 compared to 211 per 100,000, respectively (IRR: 2.078, 95% CI [2.075, 2.081]; p < 0.001). From 2013 to 2021, this disparity was primarily driven by higher incidences of pertussis (IRR: 1.782, 95% CI [1.705, 1.862]; p < 0.001) and seasonal influenza (IRR: 3.213, 95% CI [3.205, 3.220]; p < 0.001) among vaccine-preventable diseases, tuberculosis (IRR: 1.011, 95% CI [1.006, 1.015]; p < 0.001), and scarlet fever (IRR: 2.942, 95% CI [2.918, 2.966]; p < 0.001) among bacterial diseases, infectious diarrhea (IRR: 1.932, 95% CI [1.924, 1.939]; p < 0.001), and hand, foot, and mouth disease (IRR: 2.501, 95% CI [2.491, 2.510]; p < 0.001) among gastrointestinal and enterovirus diseases, dengue (IRR: 11.952, 95% CI [11.313, 12.628]; p < 0.001) among vectorborne diseases, and 4 sexually transmitted and bloodborne diseases (syphilis: IRR 1.743, 95% CI [1.731, 1.755], p < 0.001; gonorrhea: IRR 2.658, 95% CI [2.635, 2.682], p < 0.001; HIV/AIDS: IRR 2.269, 95% CI [2.239, 2.299], p < 0.001; hepatitis C: IRR 1.540, 95% CI [1.506, 1.575], p < 0.001), but was partially offset by lower incidences of most zoonotic and quarantinable diseases in urban areas (for example, brucellosis among zoonotic: IRR 0.516, 95% CI [0.498, 0.534], p < 0.001; hemorrhagic fever among quarantinable: IRR 0.930, 95% CI [0.881, 0.981], p = 0.008). Additionally, the overall urban-rural disparity was particularly pronounced in the middle (IRR: 1.704, 95% CI [1.699, 1.708]; p < 0.001) and northeastern regions (IRR: 1.713, 95% CI [1.700, 1.726]; p < 0.001) of China. A primary limitation of our study is that the incidence was calculated based on annual average population data without accounting for population mobility.ConclusionsA significant urban-rural disparity in notifiable infectious diseases among children, adolescents, and youths was evident from our study. The burden in urban areas exceeded that in rural areas by more than 2-fold, and this gap appears to be widening, particularly influenced by tuberculosis, scarlet fever, infectious diarrhea, and typhus. These findings underscore the urgent need for interventions to mitigate infectious diseases and address the growing urban-rural disparity.

Abstract Objective: The relationships between childhood weight self-misperception and obesity-related factors particularly health markers have not been extensively discussed. This study aims to examine the associations between weight self-misperception and obesity-related knowledge, attitudes, lifestyles and cardio-metabolic markers among Chinese paediatric population. Design: Cross-sectional study. Setting: Data sourced from a national survey in Chinese seven provinces in 2013. Participants: Children and adolescents aged 5–19 years. Results: Of the total 14 079 participants, there were 14·5 % and 2·2 % participants over-estimated and under-perceived their weight, respectively. Multi-variable logistic regression was applied to calculate OR and 95 % CI (95 % Cl) of obesity-related behaviours and cardio-metabolic markers by actual and perceived weight status. Individuals who perceived themselves as overweight/obese were more likely to have prolonged screen time, insufficient dairy intake and over sugar-sweetened beverages consumption (all P < 0·05), regardless of their weight. Furthermore, actual overweight/obese individuals had higher odds of abnormal cardio-metabolic markers, but a smaller magnitude of association was found among weight under-estimators. Among non-overweight/obese individuals, weight over-estimation was positively associated with abdominal obesity (OR: 10·49, 95 % CI: 7·45, 14·76), elevated blood pressure (OR: 1·30, 95 % CI: 1·12, 1·51) and dyslipidemia (OR: 1·43, 95 % CI: 1·29, 1·58). Conclusions: Weight over-perception was more prevalent than under-estimation, particularly in girls. Weight over-estimators tended to master better knowledge but behave more unhealthily; both weight over-perception and actual overweight/obesity status were associated with poorer cardio-metabolic markers. Future obesity intervention programmes should additionally pay attention to the population with inaccurate estimation of weight who were easily overlooked.

Abstract Background Infectious diseases pose a significant risk to the health and well-being of children and adolescents, and can even be life-threatening. Thus, our study aimed to explore the effectiveness of health education based on the social-ecological model in improving the knowledge of infectious diseases among this vulnerable population. Methods This study was a school-based intervention conducted in seven Chinese provinces in 2013, involving a total of 26,591 children and adolescents in the intervention group and 24,327 in the control group. The intervention group received a comprehensive health intervention based on the social-ecological model (SEM) over six months, which included a supportive environment, health education on infectious diseases, guidance on self-monitoring infectious disease-related behaviors, and other measures. Data on infectious disease-related knowledge and other characteristics were collected through questionnaires. The main outcome measure will be the difference in the effectiveness of health education regarding infectious diseases in children and adolescents between baseline and post-intervention. A mixed-effects regression model was used to calculate the odds ratio (OR) and 95% confidence interval (95% CI) to assess the impact of infectious disease-related interventions on the participants. Results We utilized a socioecological model as the foundation for a six-month health education program on infectious diseases targeting children and adolescents in the intervention group. At the individual and community levels, the correct rate of health behavior related to infectious diseases in the intervention group was higher than that in the control group (P

Background: Early onset of puberty could have significant impacts on childhood health, but the extent to which it was affected by phthalate esters (PAEs) and sex hormone disruption was not understood. The aim of this study is to investigate the associations between exposure to PAEs and sex hormone disruption and early onset of puberty in children. Methods: A longitudinal cohort study was conducted in China from May 2017 to Oct 2020, involving 740 children during consecutive visits. The onset of puberty was evaluated using Tanner definition, and early puberty was defined as an onset age less than the first 25 %, with cut-offs of 10.33 and 8.97 years for boys and girls, respectively. Serum testosterone (TT), estradiol (E2) and urinary PAE metabolites were measured during three visits. Generalized linear models were used to explore the associations between PAE and sex hormones with the age of puberty onset, while log-binomial regressions were applied to assess the associations of persistent exposure to PAEs and sex hormones with early pubertal onset. Results: Approximately 86.0 % of boys and 90.2 % of girls completed puberty onset from pre-puberty, and more than 95 % of participants had PAE concentrations higher than the limit of detection. Boys showed higher exposure to PAE pollutants and higher TT levels. Persistent exposure to PAEs was positively associated with early pubertal onset in girls (ARR = 1.97, 95 %CI = 1.12, 3.46). Moreover, persistent exposure to PAEs and E2 had synergistic associations with early pubertal onset in both boys (ARR = 4.77, 95 %CI = 1.06, 21.54) and girls (ARR = 7.07, 95 %CI = 1.51, 33.10). However, PAEs and TT had antagonistic associations only in boys (ARR = 0.44, 95 %CI = 0.07, 2.58). Conclusion: Long-term exposure to PAEs might increase the risk of early pubertal onset, and it appears to work in synergy with E2, while in antagonism with TT in boys’ early pubertal onset. Reducing PAEs exposure might promote pubertal health.

Microbial communities are an important component of mangrove ecosystems. In order to reveal the diversity of endophytic fungi in the mangrove ferns Acrostichum speciosum and A. aureum in China, the internal transcribed spacer (ITS) regions of endophytic fungi in four plant tissues (leaves, petioles, roots, and rhizomes) from three locations (Zhanjiang, Haikou, and Wenchang) were sequenced. The richness, species composition, and community similarity were analyzed. The main results are as follows: the dominant fungi in A. speciosum and A. aureum belonged to the phyla Ascomycota and Basidiomycota, accounting for more than 75% of the total identified fungi; in terms of species composition at the operational taxonomic unit (OTU) level, the endophytic fungi in A. aureum were more diverse than those in A. speciosum, and the endophytic fungi in rhizomes were more diverse than in other tissues. In Zhanjiang, both A. speciosum and A. aureum showed the richest diversity of endophytic fungi, both at the OTU classification level and in terms of species composition. Conversely, the richness of endophytic fungi in the samples of A. speciosum from Wenchang and Haikou is extremely low. The regional differences in dominant fungi increase with the degrading of taxonomic levels, and there were also significant differences in the number of unique fungi among different origins, with Zhanjiang samples having a larger number of unique fungi than the other locations. There were significant differences in the dominant fungi among different tissues, with Xylariales being the dominant fungi in rhizomes of A. speciosum and Hypocreales being the dominant fungi in the petioles, roots, and rhizomes of A. aureum. Overall, the community similarity of endophytic fungi among locations is moderately dissimilar (26–50%), while the similarity between tissues is moderately similar (51–75%). The low diversity of endophytic fungi could be one of the main reasons for the endangerment of A. speciosum. The protection of the diversity of endophytic fungi in the underground parts of A. speciosum is essential for the conservation of this critically endangered mangrove fern.

IntroductionWe aimed to investigate the association between greenness around schools, long-term gaseous air pollution exposure (SO2 and CO), and blood pressure in children and adolescents.MethodsFrom 2006 to 2018, a total of 219,956 Chinese children and adolescents aged 7–17 years in Beijing and Zhongshan were included in this longitudinal study. Annual average concentrations of SO2 and CO and the mean values of normalized difference vegetation index around schools were calculated. We used the generalized estimation equation model, restricted cubic spline model, and Cox model to analyze the health effects.ResultsAmong all the subjects, 52,515 had the first onset of HBP. During the follow-up, HBP's cumulative incidence and incidence density were 23.88% and 7.72 per 100 person-year respectively. Exposures to SO2 and CO were significantly associated with SBP [β = 1.30, 95% CI: (1.26, 1.34) and 0.78 (0.75, 0.81)], DBP [β = 0.81 (0.79, 0.84) and 0.46 (0.44, 0.48)] and HBP [HR = 1.58 (1.57, 1.60) and 1.42 (1.41, 1.43)]. The risks of HBP attributed to SO2 and CO pollution would be higher in school-aged children in the low greenness group: the attributable fractions (AFs) were 26.31% and 20.04%, but only 13.90% and 17.81% in the higher greenness group. The AFs were also higher for normal-BMI children and adolescents in the low greenness group (AFs = 30.90% and 22.64%, but 14.41% and 18.65% in the high greenness group), while the AFs were not as high as expected for obese children in the low greenness group (AFs = 10.64% and 8.61%), nor was it significantly lower in the high greenness group (AFs = 9.60% and 10.72%).DiscussionGreenness could alleviate the damage effects of SO2/CO exposure on the risks of HBP among children and adolescents, and the benefit is BMI sensitivity. It might offer insights for policymakers in making effective official interventions to prevent and control the prevalence of childhood HBP and the future disease burden caused by air pollution.

Abstract Aimed to investigate the associations between different growth patterns with high blood pressure, and further examine the mediation effect of BMI between growth patterns and high blood pressure among children and adolescents. A total of 31581 children and adolescents aged 7–18 years were selected based on the stratified cluster sampling method. Logistics regression models were used to calculate the odds rations (ORs) and 95% confidence interval (95%CI) of the association between different growth patterns and high blood pressure. Mediation effect analyses were applied to estimate the effect of BMI on the increase of blood pressure levels in different growth patterns. In different sex and ages, compared to reference group of normal growth, blood pressure levels and prevalence of high blood pressure of the catch‐up growth were higher, but that of the catch‐down growth were lower. The prevalence of high blood pressure was 11.69%, 16.06%, and 9.68% in normal growth, catch‐up growth, and catch‐down growth, respectively. In total, compared with the normal growth pattern, the ORs (95%CI) of high blood pressure, high systolic blood pressure and high diastolic blood pressure in the catch‐up growth were 1.171(1.073,1.280), 1.110(1.001,1.230) and 1.141(1.025,1.270) (p

BackgroundCardiovascular health (CVH) in children and adolescents, which might be largely influenced by parental behaviors, may affect the incidence of cardiovascular diseases in adulthood. However, few studies have been conducted to explore the associations between parental behaviors and CVH status of offspring in China.MethodsData were obtained from a cross-sectional survey conducted in Chinese children and adolescents aged 7–18 years old, with a total of 10,043 parent–offspring pairs included. Parental behaviors included moderate to vigorous physical activity (MVPA), dietary behaviors, and weight status. The CVH status of offspring was consulted by The American Heart Association, including seven factors. The associations between parental behaviors and CVH status of offspring were evaluated by multilevel logistic regression. Stratified analyses were conducted to explore the potential modifying influence of sociodemographic factors.ResultsMost of the offspring had five ideal CVH factors; only 21.04% had six to seven ideal CVH factors. Parental unhealthy behaviors were associated with high odds of nonideal CVH status of offspring. Parental overweight/obesity, insufficient MVPA, and unhealthy dietary behaviors could increase the odds of owning one to three ideal CVH factors in offspring, with corresponding odds ratios (ORs) (95% confidence interval) of 1.61 (1.32–1.96), 1.31 (1.10–1.56), and 2.05 (1.43–2.94), respectively. There was a dose–response relationship between parental single unhealthy behavior and the odds of nonideal CVH status in offspring (P-trend

Background: The structural similarity between sex hormones and exogenous phthalates (PAEs) enabled them as disrupters in regulating childhood blood pressure (BP). We aim to explore the association of sex hormones homeostasis and PAEs metabolites with childhood high BP (HBP). Methods: A cohort study was conducted with 1416 children aged 7–13 years at baseline and with 824, 819, and 801 children completing three waves' follow up. Serum testosterone (TT) and estradiol (E2) in children during three consecutive waves of surveys were measured by radioimmunoassay, and then TT/E2 ratio calculated as TT divided by E2 were used to represent sex hormones homeostasis. Seven urinary PAEs metabolites were measured in children of first wave. The BP Z-Scores and HBP across waves were obtained by sex, age, and height specific percentiles. Log-binomial regression models with adjusted risk ratios (aRR) after adjusting for confounders were utilized. Results: The prevalence of HBP at the baseline survey was 25.5%, and increased from 26.3% in the first wave of survey to 35.0% in the third wave of survey. PAEs were negatively correlated with E2, while positively correlated with TT and TT/E2 ratio. A positive association of the serum TT levels, TT/E2 ratio, and total PAEs was found with HBP prevalence (in wave 1, 2 and 3 with TT (aRR): 1.63, 1.37 and 1.45; with TT/E2: 1.63, 1.42 and 1.20; with PAEs: 1.40, 1.32 and 1.32), persistent HBP (with TT (aRR): 2.19; TT/E2: 2.16; PAEs: 2.57), occasional HBP (with TT (aRR): 1.94; TT/E2: 1.72; PAEs: 1.38), and new HBP incidence (with TT (aRR): 1.44; TT/E2: 1.57; PAEs: 1.67), but E2 had a negative association with HBP phenotypes (HBP prevalence in wave 1, 2 and 3 (aRR): 0.77, 0.93, and 1.10; persistent HBP: 0.47; occasional HBP: 0.96; new HBP incidence: 0.81). The E2 and PAEs had antagonistic effects on HBP risks in children, particularly in girls and those with high BMI group, but the TT levels, TT/E2 ratio and PAEs had synergistic effects on HBP risks in children, particularly in boys and those with high BMI group. Conclusion: Exogenous PAEs exposure and endogenous sex hormones homeostasis disruption independently increase the risks of HBP. Moreover, the exogenous PAEs exposure could disrupt the endogenous sex hormones homeostasis in children, thereby combinedly increased risks of childhood HBP.

Abstract Background Blueberry (Vaccinium spp.) is characterized by the production of berries that are smaller than most common fruits, and the underlying mechanisms of fruit size in blueberry remain elusive. V. corymbosum ‘O’Neal’ and ‘Bluerain’ are commercial southern highbush blueberry cultivars with large- and small-size fruits, respectively, which mature ‘O’Neal’ fruits are 1 ~ 2-fold heavier than those of ‘Bluerain’. In this study, the ontogenetical patterns of ‘O’Neal’ and ‘Bluerain’ hypanthia and fruits were compared, and comparative transcriptomic analysis was performed during early fruit development. Results V. corymbosum ‘O’Neal’ and ‘Bluerain’ hypanthia and fruits exhibited intricate temporal and spatial cell proliferation and expansion patterns. Cell division before anthesis and cell expansion after fertilization were the major restricting factors, and outer mesocarp was the key tissue affecting fruit size variation among blueberry genotypes. Comparative transcriptomic and annotation analysis of differentially expressed genes revealed that the plant hormone signal transduction pathway was enriched, and that jasmonate-related TIFYs genes might be the key components orchestrating other phytohormones and influencing fruit size during early blueberry fruit development. Conclusions These results provided detailed ontogenetic evidence for determining blueberry fruit size, and revealed the important roles of phytohormone signal transductions involving in early fruit development. The TIFY genes could be useful as markers for large-size fruit selection in the current breeding programs of blueberry.

BackgroundMetabolically healthy obesity (MHO) is a group of subjects with overweight/obesity who present a metabolically healthy profile; however, associated factors are complex and are far from completely understood. The aim of the current study was to estimate the prevalence of different metabolic body size phenotypes and investigate the associated factors in Chinese children and adolescents.MethodsA cross-sectional survey was conducted of 12,346 children and adolescents aged 7–18 years from seven provinces in China in 2013. Anthropometric, blood pressure, and biochemical measurements were obtained. A multi-component questionnaire covering demographic, neonatal, and lifestyle characteristics was administered. The classification of metabolic body size phenotype based on three definitions was compared. With metabolically healthy with normal weight (MHNW) as a reference group, logistic regression analyses were used to estimate the potential effects of associated risk factors, with adjustment for age, sex, single-child status, and residence area.ResultsThe prevalence of MHNW, MHO, metabolically unhealthy with normal weight (MUNW), and metabolically unhealthy overweight/obesity (MUO) phenotype was 68.6%, 2.0%, 26.4%, and 3.0%, respectively. There were 39.3% MHO and 60.7% MUO among obese participants and 72.2% MHNW and 27.8% MUNW among those with normal weight. Compared to cardiometabolic risk factor (CMRF) criteria and metabolic syndrome (MetS) component definition, the application of the 2018 consensus-based definition may identify more children with abnormal cardiovascular risks, independent of weight status. Compared to younger children, older-aged adolescents were positively associated with higher risks of MUNW (odds ratio (OR) = 1.38, 95% CI = 1.27–1.50) and MUO (OR = 1.29, 95% CI = 1.04–1.60), while factors positively associated with MHO were younger age, single-child status, urban residence, high birth weight, prolonged breastfeeding duration, parental overweight/obesity status, long screen time, and less physical activity.ConclusionThere were still a high proportion of children and adolescents at high cardiometabolic risk in China. Our findings reinforce the need for cardiometabolic risk prevention in children and adolescents irrespective of their weight statuses, such as parental educational programs and healthy lifestyle interventions.

BackgroundThis study aims to evaluate the effectiveness of the trial of national multicentric school-based health lifestyles intervention toward childhood obesity on the KBP at individual, family and schools' levels.MethodsThe national trial was a multi-centered, cluster-controlled trial, which was conducted in seven provinces from September 2013 to February 2014, aiming at preventing childhood overweight and obesity. Integrated intervention strategies focused on changing specific practice related to energy intake and expenditure, such as decreasing the consumption of sweetened fizzy drinks, increasing the consumption of vegetables, ensuring proper protein intake, reducing sedentary practice including screen time, and maintaining at least 1 h of moderate to vigorous physical activity. A total of 27,477 children and adolescents in the control group and 30,997 in the intervention group were recruited with a mean follow-up period of 6.7 months. The binomial response mixed-effects model was used for assessing the effects of the national school-based health lifestyles intervention on obesity-related KBP at students individual, parents' and schools' levels.ResultsChildren and adolescents in the intervention group mastered better obesity-related knowledge, and they had higher correct response rates to all questions about obesity-related knowledge compared to the control group (P < 0.05). In terms of obesity-related belief, individuals in the intervention group was more motivated than the control group, participants in the intervention group had higher correctness of 71.18, 52.94, and 56.60% than the control group of 68.61, 49.86, and 54.43%, (P < 0.05). In addition, healthier habits of eating breakfast and drinking milk every day were observed in the intervention group. For the beliefs toward obesity, parents of the intervention group had higher correctness than the control group. At the same time except for the fruit consumption, other obesity-related practice in the intervention group were healthier than the control group (P < 0.05). Except for some beliefs and practice, the intervention effect at the parent level was not significant in other aspects.ConclusionThe obesity-related knowledge and beliefs of children and adolescents got improved significantly. However, the effects on the knowledge, beliefs and certain practices of their parents and school administrators failed to reach significance.

IntroductionThe relationship between the characteristics of puberty growth and the stature (height and overweight and obesity) in late adolescence was not clear. We aimed to explore the effects of puberty growth patterns on the stature in late adolescence.MethodsA total of 13,143 children from a longitudinal cohort from 2006 to 2016 in Zhongshan city of China were included. The Preece–Baines growth curve was fitted for each individual child, and the age at peak height velocity (APHV), peak height velocity (PHV), and age at take-off (TOA) were obtained from the Preece–Baines model. To compare the difference in height in late adolescence (at 18 years old) at different pubertal height growth patterns (height spurt timing, intensity, and duration), the height at baseline was matched by using the propensity score matching. The log-binomial model was applied to assess the association between the three pubertal height growth patterns (timing, intensity, and duration) and overweight and obesity status in late adolescence, controlling the urbanity and body mass index (BMI) at baseline.ResultsAfter matching the baseline height, boys and girls in three pubertal patterns with early timing (P < 0.01), small intensity (P < 0.01), and short duration (P < 0.01) of height spurt had the lowest final height in the late adolescence. A 16% increase and 45% increase of risk for overweight and obesity were significantly associated with the early APHV in boys and girls, respectively, relative risk (RR) in boys, 1.16(95% confidence interval, CI: 1.03–1.30), P = 0.011; RR in girls, 1.45(1.21–1.75), P < 0.001. A 21% increase and 59% increase of risk for overweight and obesity were significantly associated with small PHV in boys and girls, respectively, RR in boys, 1.21(1.07–1.36), P < 0.001; RR in girls, 1.59(1.30–1.95), P < 0.001; and an 80% increase of risk for overweight and obesity with small spurt duration in girls (RR = 1.80; 95% CI: 1.49, 2.18; P < 0.001).ConclusionPubertal growth patterns, including earlier puberty onset timing, smaller puberty intensity, and shorter puberty spurt duration, had a positive association with lower height risks and higher overweight and obesity risks in late adolescence.

Objectives: To compare the clinical outcomes in terms of structure and function between the insertion of a transjugular intrahepatic portosystemic shunt (TIPS) created with the Viabahn ePTFE covered stent/bare metal stent (BMS) combination and the Fluency ePTFE covered stent/BMS combination. Methods: A total of 101 consecutive patients who received a TIPS from February 2016 to August 2018 in our center were retrospectively analyzed. Sixty-four subjects were enrolled in the Viabahn group and 37 were enrolled in the Fluency group. The geometry characteristics of the TIPS were calculated, and the associated occurrence of shunt dysfunction, survival, overt hepatic encephalopathy, and variceal rebleeding were evaluated. Results: The technical success rate was 100%. After the insertion of the TIPS, the rate of shunt dysfunction during the first 3 months was significantly different between the Viabahn and Fluency groups (1.6% and 13.5%, respectively; p ​= ​0.024). Multivariate analysis indicated that the angle of portal venous inflow (α) was the only independent risk factor for shunt dysfunction (hazard ratio ​= ​1.060, 95% confidence interval ​= ​1.009–1.112, p ​= ​0.020). In addition, 3 months after the TIPS insertion, the α angle distinctly increased from 20.9° ​± ​14.3°–26.9° ​± ​20.1° (p ​= ​0.005) in the Fluency group but did not change significantly in the Viabahn group (from 21.9° ​± ​15.1°–22.9° ​± ​17.6°, p ​= ​0.798). Conclusions: Shunt dysfunction was related to the α angle owing to the slight effect on the α angle after the implantation of the TIPS. The Viabahn ePTFE covered stent/BMS combination was more stable in structure and promised higher short-term stent patency compared with the Fluency ePTFE covered stent/BMS combination.

BackgroundRare studies investigated the associations between sugar-sweetened beverage (SSB) consumption with depressive and social anxiety symptoms among children and adolescents, particularly in different stratification of body composition, which was our purpose.MethodsA cross-sectional survey of children and adolescents aged 7–17 years was conducted in Beijing, China, in 2020, with an average age of 12.07 (SD: 3.09) years. Children's Depression Inventory (CDI) questionnaires and social anxiety scale for children (SASC) were completed in the baseline questionnaires. SSB consumption and body composition were assessed using child-reported questionnaires and a GE Healthcare Lunar iDXA dual-energy X-ray bone densitometer. Multivariate logistic regression was used to assess the associations between SSB consumption with depressive and social anxiety symptoms. Confounders were evaluated by child-reported and parental questionnaires, including age, sex, parental educational attainment, maternal smoking status, single-child status, BMI, incomes, fruit consumption, physical activity, screen time, and the frequency of fried food consumption. Stratified analyses were performed to explore whether the associations were influenced by body composition.ResultsA total of 1,311 children and adolescents, including 658 boys and 653 girls, were included in the final analysis. There were 13.96 and 29.75% of the study population with depressive and social anxiety symptoms, respectively. Overall, about 63.77% of the children and adolescents consumed SSB, and the average SSB intake was 0.35 servings per day. In the fully adjusted model, compared to participants who did not consume SSB each day, SSB consumption of ≥1 servings/day was positively associated with depressive symptoms [odds ratio (OR) = 2.28, 95% CI = 1.30–4.01] and social anxiety (OR = 1.10, 95% CI = 0.69–1.77), though the latter did not reach statistical significance. When individuals had higher body fat or lower fat-free mass (FFM) or muscle, the ORs of depressive symptoms were more evident among children and adolescents who drank SSB for ≥1 servings/day (P < 0.05).ConclusionHigher consumption of SSB could be associated with increased OR of depressive symptoms in children and adolescents. The association remained robust, especially in groups with higher body fat or lower fat-free mass or muscle.

Background: There was growing interest in endocrine disrupting chemicals that might have effect on the obesity epidemic, but few studies on the association of phthalates (PAEs) with childhood overweight and obesity in China based on longitudinal cohort study were available, which was the purpose of the present study. Methods: A nested case-control study was conducted in a prospective cohort of 2298 children aged 7–13 years from October 2017 to October 2020 with five waves visits in Xiamen city, China. A total of 829 children remained in the first wave of follow up with collection of urine for measuring seven PAEs metabolites, including mono-methyl phthalate (MMP), mono-ethyl phthalate (MEP), mono-n-butyl phthalate (MBP), mono-iso-butyl phthalate (MiBP), mono-2-ethylhexyl phthalate (MEHP), mono-2-ethyl-5-oxohexyl phthalate (MEOHP) and mono-2-ethyl-5-hydroxyhexyl phthalate (MEHHP), utilizing ultra high performance liquid chromatography-triple quadrupole mass spectrometry. Overweight and obesity, defined by WHO classifications, were allocated to the cases group, and those of all normal weight and matched cases with normal weight in each wave of follow-up as two control groups. Logistic regression models after adjusting for confounders were utilized to analyze the effect of PAEs on overweight and obesity in children with divided four groups based on the quartile distribution of each and total PAEs concentration. Results: The detection rates of children for each PAEs metabolite were 99.4% for MMP, 99.4% for MEP, 99.8% for MBP, 54.5% for MEHP, 84.4% for MEOHP, 99.9% for MEHHP, and 97.2% for MiBP. The geometric mean of concentrations of PAEs, MMP, MEP, MBP, MEHP, MEHHP, and MiBP were 310.085, 34.658, 9.127, 166.347, 7.043, 3.400, 18.571, and 24.093 (ng/ml), respectively. The total PAEs and seven metabolites concentrations were positively associated with childhood BMI Z-Scores with statistically significant slope rates and correlation coefficients, and were higher in the cases group than those in two controls groups in each wave of follow-up. The PAEs concentrations in the cases group was 5.90 (95 %CI: 5.79, 6.01) ng/ml in the first wave of survey, which was higher than those normal controls group (5.68 (95 %CI: 5.61, 5.75) ng/ml, P

As a manifestation of metabolic syndrome in the liver, non-alcoholic fatty liver disease (NAFLD) has become the top cause of liver disease in many countries. Recent studies have shown that intestinal microbiota disorder plays an important role in the occurrence and development of NAFLD and that regulating intestinal microbiota provides a new option for NAFLD treatment. In addition, research indicates that risk of NAFLD increases as body mass index rises, and interventions that reduce body weight and change diet can help to lower the incidence of NAFLD. Studies have found that 919 syrup may effectively treat NAFLD in rats by improving liver function and lipid metabolism and regulating body weight and feed intake, however, its potential toxicity and the specific mechanism by which it controls this disease require further exploration. This study assesses both the toxicity of 919 syrup and its regulatory effect on the appetite-related Ghrelin pathway and intestinal microbiota of rats with NAFLD. Results indicate that 919 syrup has no obvious side-effects on body weight, feed intake, blood glucose level, hepatorenal function, and liver tissue structure of normal rats. Moreover, 919 syrup can reverse abnormal changes to expression of Ghrelin pathway genes related to appetite in both the brain and stomach and repair alterations to the intestinal microbiota in rats with NAFLD. This herbal medicine is a safe and promising therapeutic drug for the treatment of NAFLD.

Background: Parental health status had a potential influence on offspring health. This study aimed to investigate the separate associations between paternal and maternal cardiovascular health statuses and the prevalence of childhood overweight and obesity in the offspring.Methods: Data were from a cross-sectional study conducted in seven provinces or cities of China in 2013. A total of 29,317 children aged 6–18 years old and their parents, making up 9,585 father-offspring pairs and 19,732 mother-offspring pairs, were included in the final analysis. Information on parental cardiovascular health status factors (dietary behaviors, body mass index (BMI), smoking, physical activity, hypertension, and diabetes mellitus) was obtained from the structured self-administrated questionnaires. Based on the health status factors, we then generated an ideal cardiovascular health (iCVH) score. The overweight and obesity of children were defined using age- and sex-specific cutoffs based on the International Obesity Task Force criteria. A multilevel log-binomial regression model was used to assess the association between parental cardiovascular health status and prevalence of childhood overweight and obesity in the offspring.Results: The prevalence of pediatric overweight and obesity was 22.0% in the father-offspring subset and 23.8% in the mother-offspring subset, respectively. Fathers with ideal BMI, non-smoking, and absence of hypertension and diabetes, and mothers with ideal BMI, ideal physical activity, and absence of hypertension and diabetes were found to be associated with lower prevalence of overweight and obesity in the offspring. The prevalence of offspring overweight and obesity was significantly decreased with the parental iCVH scores increased. Each additional increase in paternal and maternal iCVH factor was associated with a 30% and 27% lower prevalence of overweight and obesity in the offspring. Compared with children whose parental iCVH scores ≤ 3, offspring whose fathers or mothers met all six iCVH factors had 67% [prevalence ratio (PR): 0.33, 95%CI: 0.25–0.42] and 58% (PR: 0.42, 95%CI: 0.29–0.62) lower prevalence of overweight and obesity, respectively.Conclusions: Parental adherence to iCVH status was associated with a lower prevalence of pediatric overweight and obesity in offspring. Our findings support the intervention strategy that parents should involve in the obesity intervention program for children.

Introduction: To examine the geographical variation in change in the levels of physical fitness from 2005 to 2014 among Chinese children and adolescents.Methods: A total of 663,813 children 7 to 18 years of age with physical fitness data in 2005, 2010 and 2014, participated in the study. Physical fitness was assessed using six components, and their standardized scores were aggregated to form a summary physical fitness indicator (PFI).Results: Over the study period, there was an increase in the proportion of high PFI (from 15.3% in 2005 to 19.0% in 2014, Ptrend < 0.05) and a decrease in the proportion of low PFI (from 30.6 to 29.8%, Ptrend < 0.05). Children and adolescents in the eastern provinces of China showed a high proportion of high PFI with an increasing trend over time, while those in the western provinces had a high proportion of low PFI with a decreasing trend over time (P < 0.05).Conclusions: The comprehensive physical fitness among Chinese children showed an improved trend from 2005 to 2014. Region-specific interventions with priority policies could be useful to sustainably narrow geographical variation in Chinese children, especially in the western provinces.

Cytoplasmic p27 plays an important role in regulating the cell cycle. Recent studies have revealed p27 protein translocation from the nucleus to the cytoplasm in many tumour cells. The aim of this study was to investigate the role and molecular mechanisms of cytoplasmic p27 in the progression of nasopharyngeal carcinoma (NPC) and to explore its prognostic value. We found increased cytoplasmic p27 expression by immunohistochemistry in NPC tissues, and its expression level was significantly correlated with the T classification and TNM clinical stage of NPC. The survival rate was significantly lower for NPC patients with cytoplasmic p27 immunopositivity than for NPC patients with cytoplasmic p27 immunonegativity, and cytoplasmic p27 was an independent risk factor that affected the prognosis of patients with NPC. Cytoplasmic p27 promoted the proliferation, cell cycle progression, migration, and invasion of NPC cells, increased Bim-1 and Twist1 protein levels, and decreased RhoA-GTP level. Collectively, these findings suggest that cytoplasmic relocalization of p27 is involved in the pathogenesis of NPC and is closely related to the unfavourable prognosis of patients with NPC. Therefore, cytoplasmic p27 might be a useful prognostic factor and potential therapeutic target for patients with NPC.

Abstract Background The future of combined immunotherapy (a PD-1/PD-L1 plus a CTLA-4 antagonist) is very bright. However, besides improving efficacy, combined therapy increases treatment-related adverse events (TRAEs). Also, the clinical application is limited in some solid tumors. Methods This paper purports to investigate the TRAEs for the combined immunotherapy aiming for a more appropriate utilization of immune checkpoint inhibitors (ICIs) in clinical practice through a meta-analysis. Results A total of 17 eligible studies covering 2626 patients were selected for a meta-analysis based on specified inclusion and exclusion criteria. The incidence rates of any grade and grade 3 or higher TRAEs were 88% (95%CI, 84–92%) and 41% (95%CI, 35–47%), respectively. The overall incidence of any grade TRAEs leading to discontinuation of treatment was 20% (95%CI, 16–24%). The incidence rate of treatment related deaths was 4.3‰ (95%CI, 1.4‰-8.4‰). Analysis showed that NIVO1 + IPI3 cohort had higher incidences of grade 3 or higher TRAEs (RR = 1.77, 95%CI, 1.34–2.34, p

Background: Obesity has become a serious problem threatening the health of children and adolescents, and China's one-child policy has affected family structure and parenting practice, which may result in several adverse health outcomes. The present study aims to investigate the association between single-child status and the risk of abdominal obesity in Chinese adolescents and also to compare the differences in the risk of unideal energy-related behaviors.Methods: Data were obtained from a school-based cross-sectional survey conducted in seven provinces of China, in 2012. A total of 31,291 students aged 7–17 years were recruited in this study. Anthropometric measurements were conducted to assess height and waist circumference, and questionnaires were used to obtain information of single-child status, parental educational attainment, parental weight status, and offspring energy-related behaviors. Multivariate logistic regression models were used to estimate the odds ratio (OR) and 95% confidence intervals (95% CI) of single-child status and odds of childhood abdominal obesity and energy-related behaviors.Results: The prevalence of abdominal obesity was 18.2% in single children, which was higher than that of non-single children (13.7%). The prevalence was also higher in single children in different sex and residence subgroups. Logistic regression models showed that single children had 1.33 times (OR: 1.33, 95% CI: 1.24–1.43, P < 0.001) higher odds of abdominal obesity compared to non-single children. Single children had 1.08 times higher odds of physical inactivity (OR: 1.08, 95% CI: 1.03–1.14, P = 0.004), 1.13 times higher odds of excessive sugar-sweetened beverages (SSBs) consumption (OR: 1.13, 95% CI: 1.05–1.23, P = 0.002), and 1.08 times more likely to eat out (OR: 1.08, 95% CI: 1.02–1.13, P = 0.006). Those associations were more remarkable in single girls.Conclusion: Being a single child may be associated with a higher odds of childhood abdominal obesity and unhealthy energy-related behaviors. Future interventions and strategies to prevent abdominal obesity should focus on this high-risk population.

Introduction: Few studies have examined the association between the individual-, family-, and school-level ecological correlates and physical fitness among Chinese children and adolescents, which is the purpose of the present study.Methods: A total of 157,168 children and adolescents, 10-18 years of age, with physical fitness data in 2014, participated in the study. Physical fitness was assessed, using six tests: forced vital capacity, standing long jump, sit and reach, body muscle strength, 50-m dash, and endurance running. Scores were aggregated to form a summary physical fitness indicator (PFI), which was then classified into five levels: low, low-middle, middle, middle-high, and high. Each option of individual-, family-, and school-level measures were constructed into a positive or negative correlate of physical fitness and then accumulated as a composite ecological score.Results: Among the 20 individual-, family-, and school-level correlates, 18 were found to be significantly associated with PFI, with high PFI levels being correlated with the positive group of correlates and low PFI levels correlated with the negative group of correlates (p < 0.05). High scores of ecological correlates were associated with a high level of PFI [adjusted odds ratio (OR) = 1.06, 95% CI: 1.06, 1.07)] whereas low scores were associated with a low level of PFI (OR = 0.95, 95% CI:0.95, 0.95). The ecological correlates at the individual, school- and family-levels were shown to be significantly related to high PFI among Chinese children and adolescents aged 10-18 years with different ORs of 5.97 (95% CI: 5.51, 6.47), 3.94 (3.66, 4.24), and 1.25 (1.19, 1.31). The PAR% of 20 cumulative factors effects due to the negative and positive responses for low PFI levels were 35.9 and 16.1%, and, for high PFI levels, were 15.3 and 24.1%, among Chinese children and adolescents, respectively. Compared with the correlates at family and school levels, the correlates at individual levels had the largest PAR%.Conclusion: Individual-, family-, and school-multilevel factors had a significant cumulative association with either improving or worsening aspects of physical fitness. Individual level factors remain at the core of physical fitness improvement. Comprehensive policies and measures are urgently needed to enhance the physical fitness of Chinese children and adolescents through involving further individual and environmental factors.

Agricultural soils are known as nitrous oxide (N2O) sources due to the input of nitrogen (N) fertilizer and livestock faecal excretion. However, few studies have explored the responses of N2O microbial emission pathways and their related functional guilds to long-term soil fertilization regimes. This study examined the effects of four 38-year long-term fertilization treatments (control with no-fertilizer (CK); inorganic N fertilizer (N); manure (M); inorganic N fertilizer with manure (MN)) on the N2O levels generated from nitrification and denitrification, as well as on the nitrifiers and heterotrophic denitrifiers. The acetylene inhibition method was used to determine the microbial pathways of the N2O emissions and molecular biological techniques (cloning, high-throughput sequencing and quantitative PCR) were performed to investigate the nitrifier and denitrifier responses. The organic fertilization demonstrably increased the N2O emissions from nitrification and the abundance of canonical ammonia oxidizers and complete ammonia oxidizers (clade B), but distinctly decreased the abundance of clade A. Combined with the results that strong and positive relationships were detected between the abundance of bacterial amoA genes and N2O content produced from nitrification. We proposed that organic fertilizer applications stimulated the generation of N2O from nitrification dominated by the Nitrosospira cluster 3 lineage of AOB. In contrast, the amount of N2O produced by denitrification was appreciably stimulated by chemical N fertilization, compared to organic fertilization. Strong and positive relationships were detected between the nirK-type denitrifying gene abundances and the N2O emissions generated from denitrification. This suggested that single N fertilizer additions appreciably stimulated N2O production from denitrification dominated by the nirK lineage of the Rhizobiales. These results indicated that chemical N and organic fertilizers stimulated N2O emissions from denitrification and nitrification, respectively, which were dominated by the Nitrosospira cluster 3 lineage of AOB and the nirK lineage of Rhizobiales, respectively.

Objective: To evaluate the associations between single-child status and metabolic syndrome (MS) and to identify the highest risk group of MS among single children.Methods: Differences in participants' characteristics by sex were examined by Student's t-test for continuous variables and Pearson's chi-squared test for categorical variables. Multivariate logistic regression analysis was performed to estimate the odds ratios (OR) and 95% confidence intervals (CI) for MS and its components according to the single-child status. Radar maps were used to compare the composition of different components in MS.Results: In total, 11,784 (5,880 boys) children and adolescents were included in this study, with a mean age of (11.3 ± 3.1) years. MS was observed in 7.1% of participants, with a higher prevalence in boys (8.2%) than girls (5.9%) (P < 0.05). The prevalence of MS, elevated blood pressure and abdominal obesity in single children were higher than that in children with siblings, particularly in boys (P < 0.001). Elevated risk of abdominal obesity was observed in single children [boys (1.56, 95% CI: 1.31, 1.85), girls (1.40, 95% CI: 1.19, 1.63)], however, increased ORs of elevated blood pressure and metabolic syndrome were observed in single-child boys only (1.19, 95% CI: 1.01, 1.40 and 1.76, 95% CI: 1.34, 2.31, respectively). Results showed that a statistically significant association between single child status and MS was mainly observed in urban boys (2.04, 95% CI: 1.33, 3.12) and rural boys (1.50, 95% CI: 1.05, 2.15), but not in girls. Among all the combinations of MS, two combinations were significantly associated with the single-child status, including the combination of elevated blood pressure, abdominal and low HDL-C (1.45, 1.04, 2.04) and the combination of elevated blood pressure, abdominal obesity, low HDL-C and hypertriglyceridemia (2.04, 1.40, 3.06) (P < 0.05).Conclusions: The present study found that single children and adolescents had a higher risk of MS, elevated blood pressure and abdominal obesity. The associations were stronger in urban boys. Further attention should be directed to the prevention and control strategies targeting the high-risk population of MS.

Background: Proprotein convertase subtilisin/kexin type 9 (PCSK9) regulates serum LDL cholesterol (LDL-C) levels by facilitating the degradation of the LDL receptor (LDLR) and is an attractive therapeutic target for hypercholesterolemia intervention. Herein, we generated a novel fully human antibody with favourable druggability by utilizing phage display-based strategy. Methods: A potent single-chain variable fragment (scFv) named AP2M21 was obtained by screening a fully human scFv phage display library with hPCSK9, and performing two in vitro affinity maturation processes including CDR-targeted tailored mutagenesis and cross-cloning. Thereafter, it was transformed to a full-length Fc-silenced anti-PCSK9 antibody FAP2M21 by fusing to a modified human IgG1 Fc fragment with L234A/L235A/N297G mutations and C-terminal lysine deletion, thus eliminating its immune effector functions and mitigating mAb heterogeneity. Findings: Our data showed that the generated full-length anti-PCSK9 antibody FAP2M21 binds to hPCSK9 with a KD as low as 1.42 nM, and a dramatically slow dissociation rate (koff, 4.68 × 10−6 s−1), which could be attributed to its lower binding energy (-47.51 kcal/mol) than its parent counterpart FAP2 (-30.39 kcal/mol). We verified that FAP2M21 potently inhibited PCSK9-induced reduction of LDL-C uptake in HepG2 cells, with an EC50 of 43.56 nM. Further, in hPCSK9 overexpressed C57BL/6 mice, a single tail i.v. injection of FAP2M21 at 1, 3 and 10 mg/kg, dose-dependently up-regulated hepatic LDLR levels, and concomitantly reduced serum LDL-C by 3.3% (P = 0.658, unpaired Student's t-test), 30.2% (P = 0.002, Mann-Whitney U-test) and 37.2% (P = 0.002, Mann-Whitney U-test), respectively. Interpretation: FAP2M21 with potent inhibitory effect on PCSK9 may serve as a promising therapeutic agent for treating hypercholesterolemia and associated cardiovascular diseases.

Abstract Objective To analyze the prognostic value of programmed death factor ligand 1 (PD-L1) in colorectal cancer. Methods Electronic databases, such as PubMed, Web of Science, Embase, and Cochrane library, were searched to identify studies evaluating the PD-L1 expression and overall survival (OS) in these patients. Afterwards, the relevant data were extracted to perform the meta-analysis. Results A total of 3481 patients were included in 10 studies. The combined hazard ratio (HR) was 1.22 (95%CI = 1.01–1.48, P = 0.04), indicating that high expression of PD-L1 was significantly correlated with poor prognosis of colorectal cancer. Apropos of clinicopathological features, the merged odds ratio (OR) exhibited that highly expressed PD-L1 was firmly related to lymphatic invasion (OR = 3.49, 95%CI = 1.54–7.90, P = 0.003) and advanced stage (OR = 1.77, 95%CI = 1.41–2.23, P

Soil acidification has become increasingly serious due to anthropogenic activities (e.g., fertilization) throughout the world. Examining the effects of soil acidification on bacterial and fungal communities in acidic crop soils provides valuable insights for revealing the potential role of microbes in soil quality and crop yield. Here, a total of 18 samples with pH varied from 4 to 7 were collected from agricultural regions in the Jiaodong Peninsula, Shandong Province, China. High-throughput sequencing analysis was used to determine the composition and diversity of the bacterial and fungal communities. The results revealed that the α-diversity of the bacterial community was significantly decreased as the soil acidification increased, while that of fungal communities exhibited little response to soil acidification, thus indicating that bacteria rather than fungi respond sensitively to soil acidification. Principal component analysis (PCA) and canonical correlations analysis (CCA) further corroborated that pH is an essential predictor for controlling the distribution of microbial communities, and it also could alter other exchangeable base cation (e.g., EH+, EAl3+, EK+, ENa+, ECa2+, and EMg2+) contents to further drive the microbial community patterns.

Inhibition of proprotein convertase subtilisin/kexin type 9 (PCSK9) has become an attractive therapeutic strategy for lowering low-density lipoprotein cholesterol (LDL-C). In this study, a novel high affinity humanized IgG1 mAb (named h5E12-L230G) targeting the catalytic domain of human PCSK9 (hPCSK9) was generated by using CDR-grafting, alanine-scanning mutagenesis, and saturated site-directed mutagenesis. The heavy-chain constant region of h5E12-L230G was modified to eliminate the cytotoxic effector functions and mitigate the heterogeneity. The biolayer interferometry (BLI) binding assay and molecular docking study revealed that h5E12-L230G binds to the catalytic domain of hPCSK9 with nanomolar affinity (KD = 1.72 nM) and an extremely slow dissociation rate (koff, 4.84 × 10−5 s−1), which interprets its quite low binding energy (−54.97 kcal/mol) with hPCSK9. Additionally, h5E12-L230G elevated the levels of LDLR and enhanced the LDL-C uptake in HepG2 cells, as well as reducing the serum LDL-C and total cholesterol (TC) levels in hyperlipidemic mouse model with high potency comparable to the positive control alirocumab. Our data indicate that h5E12-L230G is a high-affinity anti-PCSK9 antibody candidate with an extremely slow dissociation rate for favorably treating hypercholesterolemia and relevant cardiovascular diseases.

With the development of silicon integration technology, the network-on-chip (NoC) proposes a scalable communication architecture that can improve system performance. Future multi-core chips are expected to be heterogeneous and hierarchical in nature. Inter-frequency interference will occur between various 2.4-GHz wireless network communication cores integrated on the same chip, resulting in lower network throughput and higher communication latency. This article solves the problem of wireless co-channel mutual interference from the two aspects of time domain and frequency domain and designs a heterogeneous platform based on NoC architecture to achieve more stable parallel communication of multiple wireless co-frequency networks without mutual interference. When the system detects the interference, this article uses the chirped fractional Fourier transform to filter out the interference signal before the signal arrives and then spreads the frequency. According to the results, the method improves the anti-interference ability of the network and the utilization of spectrum resources. Compared with the traditional carrier sense multiple access method, the spectrum-aware channel cooperation method proposed in this article reduces the data average transmission delay by 0.02 s and the data packet reception rate is increased by about 30%, which provides a certain reference value for future wireless multi-core communication.

The expression of Programmed cell Death Ligand 1 (PD-L1) is observed in many malignant tumors and is associated with poor prognosis including Gastric Cancer (GC). The relationship between PD-L1 expression and prognosis, however, is controversial in GC. This paper purports to use a meta-analysis to investigate the relationship between PD-L1 expression and prognosis in GC. For this study, the following databases were searched for articles published from June 2003 until February 2017: PubMed, EBSCO, Web of Science and Cochrane Library. The baseline information extracted were: authors, year of publication, country where the study was performed, study design, sample size, follow-up time, baseline characteristics of the study population, pathologic data, overall survival (OS). A total of 15 eligible studies covering 3291 patients were selected for a meta-analysis based on specified inclusion and exclusion criteria. The analysis showed that the expression level of PD-L1 was associated with the overall survival in GC (Hazard Ratio, HR = 1.46, 95%CI = 1.08-1.98, P = 0.01, random-effect). In addition to the above, subgroup analysis showed that GC patients with deeper tumor infiltration, positive lymph-node metastasis, positive venous invasion, Epstein-Barr virus infection positive (EBV+), Microsatellite Instability (MSI) are more likely to expression PD-L1. The results of this meta-analysis suggest that GC patients, specifically EBV+ and MSI, may be prime candidates for PD-1 directed therapy. These findings support anti-PD-L1/PD-1 antibodies as a kind of immunotherapy which is promising for GC.