Publications by authors named "Wei-Li Yan"

45 Publications

Efficacy and safety of interferon α-2b spray for herpangina in children: a randomized, controlled trial.

Int J Infect Dis 2021 Apr 17. Epub 2021 Apr 17.

Department of Infectious Diseases, Children's Hospital of Fudan University, Shanghai, China. Electronic address:

Objectives: The treatment of acute herpangina is inconsistent. We aim to evaluate the effectiveness and safety of interferon α-2b spray versus Ribavirin for the disease.

Methods: A randomized, controlled trial was conducted in eight hospitals in China between 2016 and 2018. 668 patients (1-7 years old) were randomized into experimental group (treated with Interferon α-2b spray) or control group (received Ribavirin Aerosol). Body temperature returned to normal within 72 hours and remained for 24 hours was the primary outcome; release of oral herpes and adverse events were the secondary outcomes.

Results: (1) The average age of onset was 2.5 years old. (2) After 72 hours' treatment, body temperature of 98.5% patients in experimental group and 94.3% in control group returned to normal and lasted for 24 hours (P = 0.004). The differences were greater at 48 hours' treatment (95.2% vs. 85.9%, P < 0.001) and at 24 hours (77.5% vs. 66.5%, P = 0.001). (3) The rate of improved oral herpes in experimental group were higher than that in control group (46.7% vs.37.1%, P = 0.011). No adverse reaction occurred.

Conclusions: Local application of recombinant interferon α-2b spray showed better efficacy for acute herpangina in children. It was safe for use.
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http://dx.doi.org/10.1016/j.ijid.2021.04.049DOI Listing
April 2021

Folic Acid Supplementation in Chinese Peri-conceptional Population: Results from the SPCC Study.

Biomed Environ Sci 2020 Aug;33(8):557-565

Children's Hospital of Fudan University, Shanghai 201102, China;Shanghai Key Laboratory of Birth Defect, Shanghai 201102, China.

Objective: To determine the prevalence and determinants of folic acid (FA) supplementation in Chinese couples planning for pregnancy and in women during early pregnancy.

Methods: This was a cross-sectional study based on the Shanghai PreConception Cohort (SPCC) study. Data on FA supplementation and socio-demographic features were collected using questionnaires. Couples visiting clinics for pre-pregnancy examination and pregnant women at < 14 gestational weeks were recruited in Shanghai, China, between March 2016 and September 2018.

Results: Among the pregnancy planners, 42.4% (4,710/11,099) women and 17.1% (1,377/8,045) men used FA supplements, while 93.4% (14,585/15,615) of the pregnant women used FA supplements. FA supplement use was higher in female pregnancy planners who were older ( : 1.13, 95% : 1.08-1.18), had higher education ( : 1.71, 95% : 1.53-1.92), and were residing in urban districts ( : 1.06, 95% : 1.01-1.11) of FA supplementation; female pregnancy planners with alcohol consumption ( : 0.95, 95% : 0.90-0.99) had lower odds of FA supplementation. In early pregnancy, women with higher educational level ( : 1.04, 95% : 1.03-1.06), who underwent pre-pregnancy examination ( : 1.02, 95% : 1.01-1.03) had higher odds of using an FA supplement; older aged ( : 0.99, 95% : 0.98-0.99), and multigravida ( : 0.97, 95% : 0.96-0.98) had lower odds of FA supplementation.

Conclusion: Although the majority of pregnant women took FA supplements, more than half of the women planning for pregnancy did not. Urgent strategies are needed to improve pre-conception FA supplementation.
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http://dx.doi.org/10.3967/bes2020.074DOI Listing
August 2020

Maternal periconceptional folate status and infant atopic dermatitis: A prospective cohort study.

Pediatr Allergy Immunol 2021 Jan 7;32(1):137-145. Epub 2020 Aug 7.

Department of Clinical Epidemiology, Children's Hospital of Fudan University, Shanghai, China.

Background: Maternal folate status is linked with the risk of allergic disorders including atopic dermatitis (AD) in children, but findings remain inconclusive. We aim to assess the relationship between maternal folate status in early gestation and early-onset infant AD, based on a prospective mother-child cohort study.

Methods: Pregnant women were recruited at 12-14 weeks of gestation. Red blood cell folate (RBC folate) and serum folate concentrations were examined at enrollment. Periconceptional folic acid supplementation was investigated through a self-administered questionnaire. The primary outcome was AD incidence before 6 months of age, diagnosed according to Williams' criteria. Multivariate logistic regression was used to evaluate associations of maternal folate status with infant AD by adjusting parental and child covariates.

Results: In total, 107 (23.4%) of 458 infants developed AD before 6 months, with more male infants affected (P = .002). Higher maternal RBC folate levels (per 100 ng/mL) were associated with an increased risk of AD (adjusted odds ratio [aOR] 1.16, 95% confidence interval [CI] 1.04-1.31). An RBC folate level ≥620 ng/mL was associated with increased infant AD by 91% (aOR 1.91, 95% CI 1.09-3.36). However, associations were not observed for maternal serum folate at early gestation or periconceptional folic acid supplement intakes.

Conclusions: We provide the first evidence that higher maternal RBC folate concentrations during early gestation are associated with increased early-onset infant AD. Our findings support the importance of maintaining appropriate folate levels during the periconceptional period to reduce the risk of AD in infants.
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http://dx.doi.org/10.1111/pai.13321DOI Listing
January 2021

Peripheral perfusion index percentiles for healthy newborns by gestational age and sex in China.

Sci Rep 2020 03 6;10(1):4213. Epub 2020 Mar 6.

Children's Hospital of Fudan University, Shanghai, China.

Peripheral perfusion index (PPI) percentiles for newborns serve as an important observation tool in clinical practice, but research pertaining to reference ranges are lacking. The aim of this study was to establish PPI percentiles for healthy newborns by gestational age and sex at 24-48 hours of life. We conducted an observational study and examined PPI values at 24-48 hours of life in 3814 asymptomatic newborns born between 35 and 41 weeks gestation who did not need medical treatment from June 1, 2016 to May 31, 2017 at two maternity hospitals in Shanghai. Linear regression analysis was carried out on the associations between PPI values and variables such as gestational age, sex, and birthweight. Pre-ductal PPI values linearly increased with gestational age (β: 0.072; 95% CI: 0.037, 0.107; P = 0.000). Post-ductal PPI values were also mainly related to gestational age (β: 0.051; 95% CI: 0.018, 0.085; P = 0.003). Smoothed reference curves for pre- and post-ductal PPI values by gestational age and sex were derived from LMS Chart Maker. Our study is the first study to establish PPI percentiles curves for healthy newborns by gestational age and sex at 24-48 hours of life. Further research is required for the implementation of PPI curves into clinical practice.
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http://dx.doi.org/10.1038/s41598-020-60741-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7060175PMC
March 2020

Epidemiologic Features of Kawasaki Disease in Shanghai From 2013 Through 2017.

J Epidemiol 2020 Oct 21;30(10):429-435. Epub 2019 Sep 21.

Heart Center, Children's Hospital of Fudan University.

Background: We sought to investigate epidemiologic features of Kawasaki disease (KD) in Shanghai from 2013 through 2017 and identify risk factors for coronary artery lesions (CAL).

Methods: As in our previous three surveys, a set of questionnaires and diagnostic guidelines for KD were sent to 50 hospitals providing pediatric medical care in Shanghai. Medical records of KD patients diagnosed from January 2013 through December 2017 were retrospectively analyzed. Multivariate logistic regression analysis was performed to identify risk factors for CAL.

Results: A total of 4,452 cases were enrolled. Male-to-female ratio was 1.7:1. The incidence of KD was 68.8 to 107.3 per 100,000 children aged <5 years from 2013 to 2017. Age at onset ranged from 15 days to 14.0 years (median: 1.8 years). KD occurred more frequently in spring and summer. Of 4,325 patients (97.0%) receiving intravenous immunoglobulin (IVIG), 362 (8.4%) were resistant to initial IVIG. CAL occurred in 406 (9.1%) patients, including 118 (2.7%) with medium aneurysms and 31 (0.7%) with giant aneurysms. Recurrent cases were 60 (1.3%). No death was found in this survey. Higher platelet levels, lower albumin levels, male sex, incomplete KD, IVIG resistance, and receiving initial IVIG ≤4 days or >10 days, were independently associated with CAL.

Conclusions: The incidence of KD in Shanghai had substantially increased while the proportion of CAL had substantially decreased as compared with our previous surveys. Higher platelet levels, lower albumin levels, male sex, incomplete KD, IVIG resistance, and receiving initial IVIG ≤4 days or >10 days, were risk factors for CAL.
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http://dx.doi.org/10.2188/jea.JE20190065DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7492704PMC
October 2020

Static cut-points of hypertension and increased arterial stiffness in children and adolescents: The International Childhood Vascular Function Evaluation Consortium.

J Clin Hypertens (Greenwich) 2019 09 7;21(9):1335-1342. Epub 2019 Aug 7.

Department of Epidemiology, School of Public Health, Shandong University, Jinan, China.

Pediatric elevated blood pressure (BP) and hypertension are usually defined using traditional BP tables at the 90th and 95th percentiles, respectively, based on sex, age, and height, which are cumbersome to use in clinical practice. The authors aimed to assess the performance of the static cut-points (120/80 mm Hg and 130/80 mm Hg for defining elevated BP and hypertension for adolescents, respectively; and 110/70 mm Hg and 120/80 mm Hg for children, respectively) in predicting increased arterial stiffness. Using data from five population-based cross-sectional studies conducted in Brazil, China, Korea, and New Zealand, a total of 2546 children and adolescents aged 6-17 years were included. Increased arterial stiffness was defined as pulse wave velocity ≥sex-specific, age-specific, and study population-specific 90th percentile. Compared to youth with normal BP, those with hypertension defined using the 2017 American Academy of Pediatrics guideline (hereafter referred to as "percentile-based cut-points") and the static cut-points were at similar risk of increased arterial stiffness, with odds ratios and 95% confidence intervals of 2.35 (1.74-3.17) and 3.07 (2.20-4.28), respectively. Area under the receiver operating characteristic curve and net reclassification improvement methods confirmed the similar performance of static cut-points and percentile-based cut-points (P for difference > .05). In conclusion, the static cut-points performed similarly well when compared with the percentile-based cut-points in predicting childhood increased arterial stiffness. Use of static cut-points to define hypertension in childhood might simplify identification of children with abnormal BP in clinical practice.
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http://dx.doi.org/10.1111/jch.13642DOI Listing
September 2019

Reliability and validity of the translated Chinese version of Autism Spectrum Rating Scale (2-5 years).

World J Pediatr 2019 Feb 16;15(1):49-56. Epub 2018 Nov 16.

Department of Neurology, Children's Hospital of Fudan University, No. 399 Wanyuan Road, Minhang District, Shanghai, 201102, China.

Background: Early autism screening is of great value, but there is lack of a screening tool of early age (2-5 years) in China. The Autism Spectrum Rating Scale (ASRS, 2-5 years) is a newly developed autism screening tool in the USA. This study aimed to evaluate the reliability and validity of the translated Chinese version of ASRS (C_ASRS) in Chinese children population before its application in China for early autism screening.

Methods: Caregivers of general children aged 2-5 years from 17 kindergartens and autism spectrum disorder (ASD) cases from five special education schools in five cities were recruited to complete the C_ASRS. 1910 valid questionnaires from kindergarteners and 192 from ASD cases were included for analyses.

Results: The item reliability (Cronbach's alpha) was more than 0.80 in the screening scale and DSM-5 scale, and 0.51-0.81 in the treatment scale. ASD cases scored higher on total score and most subscales compared to the kindergarteners (Cohen's d ranging from 1.34 to 3.37). C_ASRS showed good discriminatory validity with an area under the receiver operating characteristic curve of 0.850 (95% confidence interval: 0.819-0.881). The cutoff ≥ 60 achieved sensitivity of 65.63% and specificity of 85.63% in discriminating autism children from the general population.

Conclusion: The results indicate that C_ASRS (2-5 years) could be used as an early level-2 screening tool for autism screening in China and should be further revised for level-1 screening.
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http://dx.doi.org/10.1007/s12519-018-0201-3DOI Listing
February 2019

Waist-to-height ratio remains an accurate and practical way of identifying cardiometabolic risks in children and adolescents.

Acta Paediatr 2018 Mar 22. Epub 2018 Mar 22.

Department of Clinical Epidemiology, Children's Hospital of Fudan University, Shanghai, China.

Aim: We evaluated how effectively the waist-to-height ratio (WHtR) identified cardiometabolic risk (CMR) in children and adolescents, compared with the tri-ponderal mass index, percentage of body fat and other obesity indexes.

Methods: Eligible subjects were recruited from three metropolitan regions of China from May 2013 to June 2014. Subjects with at least three of the following abnormalities - hypertension, dyslipidemia, elevated fasting blood glucose and central obesity - were defined as CMR1 and children with at least two were defined as CMR2. The area under the curve (AUC) of the receiver operating characteristic curve was used to compare how effectively obesity indexes predicted CMR.

Results: We recruited 3556 subjects aged 7-18 years. All five obesity indexes showed good, comparable performances in identifying CMR and the AUCs ranged from 0.89 to 0.90 for CMR1 and 0.83 to 0.85 for CMR2. The cut-off of 0.467 for WHtR achieved a sensitivity of 0.91 and specificity of 0.80 for predicting CMR1, with the best cut-offs being 0.463 for boys and 0.469 for girls.

Conclusion: The WHtR was a superior and practical screening tool for detecting CMR in this paediatric population, as it provided comparable accuracy to other methods and just required a simple calculation.
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http://dx.doi.org/10.1111/apa.14323DOI Listing
March 2018

Prostate ultrasound imaging: evaluation of a two-step scoring system in the diagnosis of prostate cancer.

Discov Med 2017 12;24(134):295-303

Department of Ultrasound, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, China.

Rationale And Objectives: This study aims to investigate the feasibility and performance of a two-step scoring system of ultrasound imaging in the diagnosis of prostate cancer.

Material And Methods: 75 patients with 888 consecutive histopathologically verified lesions were included in this study. Step 1, an initial 5-point scoring system was developed based on conventional transrectal ultrasound (TRUS). Step 2, a final scoring system was evaluated according to contrast-enhanced transrectal ultrasound (CE-TRUS). Each lesion was evaluated using the two-step scoring system (step 1 + step 2) and compared with only using conventional TRUS (step 1).

Results: 888 lesions were histologically verified: 315 of them were prostate cancer from 46 patients and 573 were benign prostatic hypertrophy (BPH) from 29 patients. According to the two-step scoring system, 284 lesions were upgraded and 130 lesions were downgraded from step 1 to step 2 (this means using step 2 to assess the results by step 1). However, 96 cases were improperly upgraded after step 2 and 48 malignant lesions were still missed after step 2 as score-1. For the two-step scoring system, the sensitivity, specificity, and accuracy were 84.7%, 83.2%, and 83.7%, respectively, versus 22.8%, 96.6%, and 70.4%, respectively, for conventional TRUS. The area under the ROC curve (AUC) for lesion diagnosis was 0.799-0.952 for the two-step scoring system, versus 0.479-0.712 for conventional TRUS. The difference in the diagnostic accuracy of the two-step scoring system and conventional TRUS was statistically significant (P<0.0001).

Conclusion: The two-step scoring system was straightforward to use and achieved a considerably accurate diagnostic performance for prostate cancer. The application of the two-step scoring system for prostate cancer is promising.
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December 2017

Exploring the relationship of peripheral total bilirubin, red blood cell, and hemoglobin with blood pressure during childhood and adolescence.

J Pediatr (Rio J) 2018 Sep - Oct;94(5):532-538. Epub 2017 Nov 4.

Nanjing Medical University, School of Public Health, Department of Epidemiology, Nanjing, China. Electronic address:

Objective: Total bilirubin is beneficial for protecting cardiovascular diseases in adults. The authors aimed to investigate the association of total bilirubin, red blood cell, and hemoglobin levels with the prevalence of high blood pressure in children and adolescents.

Methods: A total of 3776 students (aged from 6 to 16 years old) were examined using cluster sampling. Pre-high blood pressure and high blood pressure were respectively defined as the point of 90th and 95th percentiles based on the Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents. Both systolic and diastolic blood pressure were standardized into z-scores.

Results: Peripheral total bilirubin, red blood cell and hemoglobin levels were significantly correlated with age, and also varied with gender. Peripheral total bilirubin was negatively correlated with systolic blood pressure in 6- and 9-year-old boys, whilst positively correlated with diastolic blood pressure in the 12-year-old boys and 13- to 15-year-old girls (p<0.05). Higher levels of red blood cell and hemoglobin were observed in pre-high blood pressure and high blood pressure students when compared with their normotensive peers (p<0.01). The increases in red blood cell and hemoglobin were significantly associated with high blood pressure after adjusting for confounding factors. The ORs (95% CI) of each of the increases were 2.44 (1.52-3.92) and 1.04 (1.03-1.06), respectively. No statistical association between total bilirubin and high blood pressure was observed (p>0.05).

Conclusion: Total bilirubin could be weakly correlated with both systolic and diastolic blood pressure, as correlations varied with age and gender in children and adolescents; in turn, the increased levels of red blood cell and hemoglobin are proposed to be positively associated with the prevalence of high blood pressure.
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http://dx.doi.org/10.1016/j.jped.2017.07.018DOI Listing
June 2019

Pulse Oximetry and Auscultation for Congenital Heart Disease Detection.

Pediatrics 2017 Oct;140(4)

Children's Hospital of Fudan University, Shanghai, China; and

Objectives: Pulse oximetry (POX) has been confirmed as a specific screening modality for critical congenital heart disease (CCHD), with moderate sensitivity. However, POX is not able to detect most serious and critical cardiac lesions (major congenital heart disease [CHD]) without hypoxemia. In this study, we investigated the accuracy and feasibility of the addition of cardiac auscultation to POX as a screening method for asymptomatic major CHD.

Methods: A multicenter prospective observational screening study was conducted at 15 hospitals in Shanghai between July 1, 2012, and December 31, 2014. Newborns with either an abnormal POX or cardiac auscultation were defined as screen positive. All screen-positive newborns underwent further echocardiography. False-negative results were identified by clinical follow-up, parents' feedback, and telephone review. We assessed the accuracy of POX plus cardiac auscultation for the detection of major CHD.

Results: CHD screening was completed in all 15 hospitals, with a screening rate of 94.0% to 99.8%. In total, 167 190 consecutive asymptomatic newborn infants were screened, of which 203 had major CHD (44 critical and 159 serious). The sensitivity of POX plus cardiac auscultation was 95.5% (95% confidence interval 84.9%-98.7%) for CCHD and 92.1% (95% confidence interval 87.7%-95.1%) for major CHD. The false-positive rate was 1.2% for detecting CCHD and 1.1% for detecting major CHD.

Conclusions: In our current study, we show that using POX plus cardiac auscultation significantly improved the detection rate of major CHD in the early neonatal stage, with high sensitivity and a reasonable false-positive rate. It provides strong evidence and a reliable method for neonatal CHD screening.
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http://dx.doi.org/10.1542/peds.2017-1154DOI Listing
October 2017

Pulse oximetry could significantly enhance the early detection of critical congenital heart disease in neonatal intensive care units.

Acta Paediatr 2016 Nov 20;105(11):e499-e505. Epub 2016 Sep 20.

Pediatric Heart Center, Children's Hospital of Fudan University, Shanghai, China.

Aim: Limited data have been available regarding critical congenital heart disease (CHD) screening in neonatal intensive care unit (NICUs). This study evaluated the feasibility of screening for CHD by adding pulse oximetry (POX) to clinical evaluation in a NICU in Shanghai, China.

Methods: We screened 4128 eligible consecutive NICU admissions using POX plus clinical evaluation. Infants with positive screening results were then evaluated with echocardiography. Those with negative screening results were put under observation, and they also underwent echocardiography if their oxygen saturation fell below 95% on room air during hospitalisation.

Results: This enhanced procedure detected 19 critical CHD cases, and seven of these diagnoses would have been delayed if POX had not been incorporated into the screening strategy. This means that the addition of POX increased the detection rate of critical CHD from 63.2 to 100%. The false-positive rate of critical CHD screening using POX plus clinical evaluation was higher in NICU patients with high morbidity rates.

Conclusion: When pulse oximetry screening was added to clinical evaluation, it increased the number of critical CHD cases that were detected in our NICU. This method could provide a useful screening protocol for critical CHD cases.
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http://dx.doi.org/10.1111/apa.13553DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5095792PMC
November 2016

Treatment of kaposiform hemangioendothelioma and tufted angioma.

Int J Cancer 2016 10 28;139(7):1658-66. Epub 2016 Jun 28.

College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

This meta-analysis was to evaluate the efficacy of current treatment modalities for kaposiform hemangioendothelioma and tufted angioma. A systematic review was performed using PubMed (Medline), Web of Science and Embase for clinical studies. The outcome was measured by pooled response rate with 95% confidence intervals (CIs), together with heterogeneity, subgroup analysis, sensitivity analysis and publication bias. Fifteen studies with 244 participants were included in this analysis. Vincristine therapy exhibited a relatively higher response rate (0.72; 95%CI, 0.64-0.79) compared with other therapies including systemic corticosteroid (0.27; 95%CI, 0.17-0.36), interferon (0.36; 95%CI, 0.24-0.48), radiotherapy (0.49; 95%CI, 0.26-0.73), embolization (0.66; 95%CI, 0.48-0.83), aspirin/ticlopidine (0.42; 95%CI, 0.06-0.78) and sirolimus (0.57; 95%CI, 0.00-0.10), in treating KHE/TA. Subgroup analysis indicated that the efficacy of systemic corticosteroids therapy was age-related. The pooled response rate was 0.15 (95%CI, 0.08-0.23) for participants 3.5 months of age and older compared with 0.35 (95% CI, 0.26-0.44) for participants less than 3.5 months. Regarding side effects, systemic corticosteroids treatment was 0.32 (95%CI, 0.15-0.50), vincristine modality was 0.16 (95%CI, 0.08-0.24) and interferon therapy was 0.28 (95%CI, 0.13-0.43). In conclusion, as one of the first reviews evaluating the effect of common therapies in the treatment of KHE/TA, our meta-analysis displayed that vincristine was more effective. Thus, vincristine was the most effective, providing evidence supporting the use of vincristine as a first-line therapy for KHE/TA.
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http://dx.doi.org/10.1002/ijc.30216DOI Listing
October 2016

[The application of genetic risk score in genetic studies of complex human diseases].

Yi Chuan 2015 12;37(12):1204-10

Department of Clinical Epidemiology, Children's Hospital of Fudan University, Shanghai 201102, China.

Complex diseases such as cardiovascular disease, type 2 diabetes, essential hypertension, asthma, obesity and cancer have spread across the globe and become the predominant cause of death. There are growing concerns over the role of genetic susceptibility in pathogenesis of complex diseases. However, the related susceptibility genes and sequence variations are still unknown. To elucidate the genetic basis of complex diseases, researchers have identified a large number of genetic variants associated with complex diseases through genome-wide association studies (GWAS) and candidate gene studies recently. The identification of these causal and/or associated variants promotes the development of approaches for complex diseases prediction and prevention. Genetic risk score (GRS), an emerging method for exploring correlation between single nucleotide polymorphisms (SNPs) and clinical phenotypes of complex diseases, integrates weak effects of multiple SNPs and dramatically enhances predictability of complex diseases by gene polymorphisms. This method has been applied successfully in genetic studies of many complex diseases. Here we focus on the introduction of the computational methods and evaluation criteria of GRS, enumerate a series of achievements through GRS application, discuss some limitations during application, and finally prospect the future of GRS.
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http://dx.doi.org/10.16288/j.yczz.15-228DOI Listing
December 2015

[Construct validity of the Autism Spectrum Rating Scale of the Revised Chinese Version].

Zhongguo Dang Dai Er Ke Za Zhi 2015 Dec;17(12):1282-5

Department of Neurology, Children's Hospital of Fudan University, Shanghai 201102, China.

Objective: To investigate the construct validity of the Autism Spectrum Rating Scale of Revised Chinese Version (RC-ASRS).

Methods: Seven hundred and one children aged 6-12 years old were recruited from one primary school in the Minhang District of Shanghai. The parents of the children completed the RC-ASRS questionnaire. Mpuls 6.0 Software was used to conduct the construct validity analysis.

Results: A total of 671 questionnaires (95.7%) were retrieved, involving 368 boys (54.8%) and 303 girls (45.2%). The 3 factor structure of the RC-ASRS had better model fitting indices, 0.051 for root mean square error of approximation (RMSEA), 0.889 for comparative fit index (CFI) and 0.884 for Tucker-Lewis index (TLI), compared with the original ASRS, 0.060 for RMSEA, 0.829 for CFI and 0.823 for TLI.

Conclusions: The RC-ASRS may serve as a reliable and valid tool for screening autistic symptoms in China.
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December 2015

Differential Effect of the Ratio of Right Ventricular Volume to Left Ventricular Volume in Children with Repaired Tetralogy of Fallot.

Cardiology 2016 5;133(3):135-40. Epub 2015 Nov 5.

Department of Radiology, Children's Hospital of Fudan University, Shanghai, PR China.

We aimed to compare the diagnostic value of indexed right ventricular end-diastolic volume (RVEDVi) and the ratio of right ventricle volume to left ventricle volume (RV/LV ratio) in prediction of the severity of pulmonary regurgitation (PR) expressed as the PR fraction (PRF) after surgery of tetralogy of Fallot (TOF). Forty-one patients with repaired TOF were included in the study. RVEDVi, LVEDVi, RV/LV ratio, PRF and ejection fraction were measured with magnetic resonance imaging. A PRF of more than 20% was considered significant. The predictive capability of two markers (RVEDVi and RV/LV ratio) for significant PR was compared using multivariate linear regression analysis and receiver operating characteristic (ROC) analysis. Both the RV/LV ratio and RVEDVi showed a correlation with PRF (r = 0.526/0.321, p = 0.001/0.041) in the correlation analysis, but in multivariate regression analysis the only independent predictor of PRF was the RV/LV ratio (F = 14.890, p = 0.001). ROC analysis revealed that a better discrimination of significant PR (>20%) from slight types (=20%) PR can be reached with the RV/LV ratio than RVEDVi (AUC = 0.805/0.709, p = 0.01). The RV/LV ratio was better than RVEDVi at differentiating mild from moderate PR (p = 0.006 vs. p = 0.153), and proved superior over RVEDVi in predicting PR based on the PRF criterion.
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http://dx.doi.org/10.1159/000441291DOI Listing
September 2016

Epidemiologic Features of Kawasaki Disease in Shanghai From 2008 Through 2012.

Pediatr Infect Dis J 2016 Jan;35(1):7-12

From the *Pediatric Heart Center, Children's Hospital of Fudan University; †Pediatric Heart Center, Shanghai Children's Medical Center; and ‡The Speciality of Cardiovascular Disease, Children's Hospital of Shanghai Jiaotong University, Shanghai, China.

Background: This study was to investigate the epidemiologic trends of Kawasaki disease (KD) and coronary arterial lesions (CALs) in Shanghai from 2008 through 2012.

Methods: Data were collected by using the network of the KD research group established during the first survey in Shanghai to conduct the third survey, covering the period from 2008 through 2012. Clinical records of 2304 patients with acute KD were retrospectively reviewed. Epidemiologic features of KD were investigated. Univariate and multivariate analyses were performed to identify the risk factors for CAL in patients with KD. The data were compared with the previous 2 surveys covering the periods from 1998 to 2002 and 2003 to 2007, respectively.

Results: The average incidence of KD was 30.3 to 71.9 per 100,000 children aged 0-4 years from 2008 through 2012. Age at onset ranged from 32 days to 11.7 years (median: 2.3 years). The occurrence of KD was more common in summer and spring. A total of 365 (15.9%) cases developed CAL defined as ectasia or aneurysm. Male, age ≤ 1 year, intravenous immunoglobulin (IVIG) unresponsiveness, a smaller administrative dosage and the delayed administration of IVIG (>10 days) were independent risk factors for CAL. The occurrence of CAL seemed less frequent in patients who received IVIG within 5 days after onset of illness.

Conclusions: The incidence of KD in children has increased over time, and the development of CAL decreased in the past 5 years in Shanghai. Earlier treatment with IVIG (<5 days) was associated with reduced CAL among patients with KD.
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http://dx.doi.org/10.1097/INF.0000000000000914DOI Listing
January 2016

Parental factors affecting the circumcision of non-Muslim Chinese boys include education and family history.

Acta Paediatr 2015 Dec 19;104(12):e569-76. Epub 2015 Oct 19.

Chinese Traditional Medical Hospital affiliated to Xinjiang Medical University, Urumqi, Xinjiang Uygur Autonomous Region, China.

Aim: This study investigated the prevalence of circumcision among non-Muslim schoolboys in Urumqi, China, and how acceptable their parents found the practice.

Methods: A convenient cluster sample of non-Muslim schoolboys (n = 3614) aged six to 15 years of age and 873 mothers and 927 fathers completed self-administered questionnaires. We compared the consistency of the circumcision status reported by students and their parents and analysed the factors that influenced the parents to have their child circumcised.

Results: The mean age at circumcision was 8.3 years and the adjusted prevalence was 46.2%. Up to 45.4% of fathers and 66% of mothers with uncircumcised sons were willing to circumcise their sons after receiving further information on circumcision. Mothers were more likely to support circumcision if they had higher education levels and higher family income, were employed as government officials and had family members who had been circumcised, including their husband. Fathers were more likely to support circumcision if they were highly educated and had been circumcised themselves.

Conclusion: The prevalence and acceptability of circumcision were higher than expected in this traditional schoolboy population in Urumqi, China. Factors that increased parental support for circumcision included high education and the father being circumcised.
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http://dx.doi.org/10.1111/apa.13142DOI Listing
December 2015

Pulse oximetry with clinical assessment to screen for congenital heart disease in neonates in China: a prospective study.

Lancet 2014 Aug 22;384(9945):747-54. Epub 2014 Apr 22.

Paediatric Heart Centre, Children's Hospital of Fudan University, Shanghai, China; Shanghai Key Laboratory of Birth Defects, Shanghai, China. Electronic address:

Background: Several pioneering studies have provided evidence for the introduction of universal pulse oximetry screening for critical congenital heart disease. However, whether the benefits of screening reported in studies from high-income countries would translate with similar success to low-income countries is unknown. We assessed the feasibility and reliability of pulse oximetry plus clinical assessment for detection of major congenital heart disease, especially critical congenital heart disease, in China.

Methods: We did a pilot study at three hospitals in Shanghai to assess the accuracy of pulse oximetry plus clinical assessment for detection of congenital heart disease. We made a data collection plan before recruitment. We then undertook a large, prospective, and multicentre screening study in which we screened all consecutive newborn babies (aged 6-72 h) born at 18 hospitals in China between Aug 1, 2011, and Nov 30, 2012. Newborn babies with positive screen results (either an abnormal pulse oximetry or abnormal clinical assessment) were referred for echocardiography within 24 h of screening. We identified false-negative results by clinical follow-up and parents' feedback. We calculated sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios for pulse oximetry alone, and in combination with clinical assessment, for detection of major and critical congenital heart disease.

Findings: In the pilot study, 6785 consecutive newborn babies were screened; 46 of 49 (94%) cases of asymptomatic major congenital heart disease and eight of eight (100%) cases of asymptomatic critical disease were detected by pulse oximetry and clinical assessment. In the prospective multicentre study, we screened 122,738 consecutive newborn babies (120,707 asymptomatic and 2031 symptomatic), and detected congenital heart disease in 1071 (157 critical and 330 major). In asymptomatic newborn babies, the sensitivity of pulse oximetry plus clinical assessment was 93·2% (95% CI 87·9-96·2) for critical congenital heart disease and 90·2% (86·4-93·0) for major disease. The addition of pulse oximetry to clinical assessment improved sensitivity for detection of critical congenital heart disease from 77·4% (95% CI 70·0-83·4) to 93·2% (87·9-96·2). The false-positive rate for detection of critical disease was 2·7% (3298 of 120,392) for clinical assessment alone and 0·3% (394 of 120,561) for pulse oximetry alone.

Interpretation: Pulse oximetry plus clinical assessment is feasible and reliable for the detection of major congenital heart disease in newborn babies in China. This simple and accurate combined method should be used in maternity hospitals to screen for congenital heart disease.

Funding: Key Clinical Research Project sponsored by Ministry of Health, Shanghai Public Health Three-Year Action Plan sponsored by Shanghai Municipal Government, and National Basic Research Project of China.
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http://dx.doi.org/10.1016/S0140-6736(14)60198-7DOI Listing
August 2014

CA19-9 and CA242 as tumor markers for the diagnosis of pancreatic cancer: a meta-analysis.

Clin Exp Med 2014 May 3;14(2):225-33. Epub 2013 Mar 3.

Department of Nuclear Medicine, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Rd., Shanghai, 200040, People's Republic of China.

Pancreatic cancer has the worst prognosis of any gastrointestinal cancer, with the mortality approaching the incidence. Early detection is crucial for improving patient prognosis. We therefore performed a meta-analysis to evaluate and compare the sensitivity and specificity of CA19-9 and CA242 in pancreatic cancer. We searched PubMed, EMBASE, and the Cochrane Library for studies that evaluated the diagnostic validity of CA19-9 and CA242 between January 1966 and March 2011. Meta-analysis methods were used to pool sensitivity and specificity and to construct a summary receiver-operating characteristic (SROC) curve. A total of 11 studies that included 2,316 patients who fulfilled all of the inclusion criteria were considered for analysis. The pooled sensitivities for CA242 and CA19-9 were 0.719 (95 % confidence interval [CI] 0.690-0.746) and 0.803 (95 % CI 0.777-0.826), respectively. The pooled specificities of CA242 and CA19-9 were 0.868 (95 % CI 0.849-0.885) and 0.802 (95 % CI 0.780-0.823), respectively. The diagnostic odds ratio (DOR) estimate was significantly higher for CA242 (16.261) than for CA19-9 (15.637). Our meta-analysis showed that CA242 and CA19-9 could play different roles in the diagnosis of pancreatic cancer. Although the sensitivity of CA242 is lower than that of CA19-9, its specificity is greater.
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http://dx.doi.org/10.1007/s10238-013-0234-9DOI Listing
May 2014

[Effects of arsenic trioxide combined with bortezomib on proliferation and apoptosis of K562 cells and their mechanism].

Zhongguo Shi Yan Xue Ye Xue Za Zhi 2012 Dec;20(6):1361-4

Department of Hematology, Qingdao Municipal Hospital, Qingdao 266071, Shandong Province, China.

This study was aimed to investigate the effect of arsenic trioxide (As(2)O(3)) alone and in combination with bortezomib (Bor) on proliferation and apoptosis of leukemia cell line K562, and to analyze the potential mechanism. K562 cells were treated with different concentrations of As(2)O(3) or Bor (alone or combination) for 24, 48 h. MTT method was used to detect the cell proliferation. After K562 cells were treated with 0.5 µmol/L As(2)O(3) alone or in combination with 10 nmoL/L Bor, the apoptosis rate and cell cycle were measured by flow cytometry, and the activity of NF-κB was analyzed by SP immunohistochemistry. The results indicated that the different concentrations of As(2)O(3) and Bor could inhibit the K562 cell proliferation in a time- and dose-dependent manners (P < 0.05). The IC(50) of Bor and As(2)O(3) in 48 h were 20 nmol/L and 0.6 µmol/L respectively. When K562 cells were treated with As(2)O(3) or Bor alone for 24 h, the apoptotic rate of K562 cells increased, and the apoptotic rate in combination group was higher than that in As(2)O(3) or Bor group. The cells were apparently arrested in G(2)/M phase in Bor group and G(0)/G(1) phase in As(2)O(3) group. The activity of NF-κB decreased significantly in As(2)O(3) or Bor group (P < 0.05), this effect was most significant in the combination group (P < 0.01). It is concluded that both As(2)O(3) and Bor can inhibit the proliferation and induce apoptosis of K562 cells, a synergistic effect can be observed when a low dose of As(2)O(3) combined with low dose of Bor. The different cell cycle block site and the decrease of activity of NF-κB may be one of the mechanisms underlying their synergic effect.
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December 2012

[Effects of hyperbaric oxygenation combined with As(2)O(3) on proliferation of K562 cells and associated mechanism].

Zhongguo Shi Yan Xue Ye Xue Za Zhi 2012 Aug;20(4):863-6

Department of Hematology, Qingdao Municipal Hospital, Shandong Province, China.

This study was aimed to explore the effects of hyperbaric oxygenation (HBO) alone or combined with As(2)O(3) on proliferation, apoptosis and expression of HIF-1a, VEGF, caspase-3 mRNA of K562 cells, and the molecular mechanism of As(2)O(3) enhancing the anti-leukemic effect of HBO so as to provide a scientific basis for clinical treatment of chronic myeloid leukemia. The effects of drugs on proliferation of K562 cells was assayed by MTT method, the apoptosis rate of K562 cells was detected by flow cytometry with Annexin V/PI double staining, the expressions of HIF-1a, VEGF, caspase-3 mRNA of K562 cells were determined by real-time quantitative PCR. The results showed that as compared with As(2)O(3) alone, HBO combined with As(2)O(3) could increase inhibitory rate of K562 cell proliferation, and enhance apoptotic effect, obviously down-regulate expressions of HIF-1a and VEGF mRNA, up-regulate expression of caspase-3 mRNA. The effect of HBO combined with As(2)O(3) was higher then effect of As(2)O(3) alone, and their effects were synergistic (P < 0.05). It is concluded that HBO combined with As(2)O(3) can increase the expression of caspase 3 mRNA and decrease the expression of HIF-1a and VEGF mRNA, which may be one of molecular mechanisms underlying their synergistic antileukemia efficacy.
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August 2012

[Advances in genome-wide association studies on essential hypertension].

Yi Chuan 2012 Jul;34(7):793-809

School of Public Health, Xinjiang Medical University, Urumqi 830054, China.

Since the first genome-wide association study was reported in 2007, hypertension has attracted numerous studies to identify its genetic basis. The first part of the current review summarizes the genetic loci associated with blood pressure/ hypertension identified by genome-wide association studies (GWAS) from January 2007 to September 2011, by race and chromosomal location. In the second part, we stress several important points in GWAS methodology, for example, selecting high-quality phenotypes and using multi-stage study design to increase the power studies to identify loci with minor effect. For statistical analysis, besides multiple testing correction and replication of the GWAS that have been introduced in previous reviews, computer-based genotype imputation has been described for its advantages in compensating GWAS genotyping failures. Although GWAS identifies many unknown genetic variants and improves our understanding for the pathogenesis of hypertension, the loci related to blood pressure / hypertension are common sequence variations with minor effect. The association studies are difficult to be replicated in different populations. Further studies are expected including extensive functional studies and fine mapping using advanced techniques, such as whole genome exon sequencing and pathway analysis, as well as epigenetic study to elucidate the etiology of human essential hypertension.
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http://dx.doi.org/10.3724/sp.j.1005.2012.00793DOI Listing
July 2012

[The effect of oral alpha-lipoic acid in overweight/obese individuals on brachial-ankle pulse wave velocity and supine blood pressure: a randomized, crossover, double-blind, placebo-controlled trial].

Zhonghua Liu Xing Bing Xue Za Zhi 2011 Mar;32(3):290-6

Department of Epidemiology & Statistics, School of Public Health, Xinjiang Medical University, Urumqi, China.

Objective: To investigate the effect of oral alpha-lipoic acid (ALA) supplement on brachial-ankle pulse wave velocity (baPWV), supine systolic blood pressure (SBP) and diastolic blood pressure (DBP) in overweight/obese individuals. An 8-week double-blind, randomized, placebo-controlled and cross-over trial with a 4-week washout between cross-over periods.

Methods: Sixty-three males and 40 females aged 22 - 57 years old who met the inclusion criteria as (1) Han ethnicity; (2) 20 - 60 years old; (3) BMI ≥ 25 kg/m(2) and having at least one of the following risk factors: borderline hypertension (130 mm Hg ≤ SBP < 140 mm Hg and/or 85 mm Hg ≤ supine DBP< 90 mm Hg), dyslipidemia (fasting total cholesterol ≥ 5.2 mmol/L or HDL-C < 1.04 mmol/L), or impaired fasting glucose (6.1 mmol/L ≤ fasting glucose < 7.0 mmol/L); (4) Not on any antioxidant vitamin supplement. They were randomly assigned to Group 1 or Group 2 in a 1:1 ratio balanced for gender. Group 1 received 8 weeks ALA (1200 mg/day) followed by 4-week washout period and followed by another 8 weeks placebo; while Group 2 received 8 weeks placebo (1200 mg/day) followed by 4-week washout period, and followed by ALA treatment for 8 weeks. BaPWV and supine blood pressure were measured at the beginning of 1(st) phase and 2(nd) phase and at the endpoint of the whole trial. Mixed effect linear regression model was performed to compare the change of baPWV and supine blood pressure between ALA group and placebo group.

Results: BaPWV decreased -33.03 cm/s ± 130.70 cm/s for ALA group and increased 5.66 cm/s ± 139.89 cm/s for placebo group, supine systolic blood pressure decreased -4.09 mm Hg ± 9.18 mm Hg for ALA group and -2.32 mm Hg ± 8.16 mm Hg for placebo group. Supine diastolic blood pressure decreased -1.29 mm Hg ± 6.55 mm Hg for ALA group and -0.48 mm Hg ± 6.63 mm Hg for placebo group. These three mix-effect models did not show significant effect of ALA treatment after adjustment on baseline values, sex, age, treatment sequence or period.

Conclusion: The current trial did not provide evidence that oral intake of ALA for 8 weeks had significant effects on lowering baPWV, supine systolic blood pressure or supine diastolic blood pressure.
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March 2011

[Waist circumference reference values for screening cardiovascular risk factors in Chinese children and adolescents aged 7 - 18 years].

Zhonghua Liu Xing Bing Xue Za Zhi 2010 Jun;31(6):609-15

National Institute for Nutrition and Food Safety, Chinese Center for Disease Control and Prevention, Beijing 100021, China.

Objective: To explore the optimal threshold values of waist circumference (WC) in detecting the risk on cardiovascular (CV) among the Chinese children and adolescents.

Methods: Association of WC and CV risk factors were studied among 65 898 children and adolescents aged 7 - 18 years whose data were pooled from nine studies carried out in China. Receive-operating characteristic analysis (ROC) and logistic regression were employed to derive optimal age- and sex-specific waist circumference references for predicting the CV risk factors.

Results: A slight increasing trend of CV risk factors was observed starting from the 75th percentile of waist circumference in the study population, while a remarkable increasing trend occurred from the 90th percentile. The optimal waist circumference thresholds for predicting high blood pressures were at the 75th percentile for both boys and girls, and at the 90th percentiles it could detect at least two of the above three CV risk factors. In comparison with children whose waist circumference was below the 75th percentile, the odds ratio of two CV risk factors doubled among children with waist circumference between 75th and 90th percentile, and increased by 6 times among children with waist circumference above the 90th percentile. The trend of high blood pressure increasing remained significant with waist circumference after having been stratified by BMI category.

Conclusion: The 75th and the 90th percentile of WC appeared to be the optimal cut-off points for predicting an increased and a substantially increased risk of CV factors in Chinese children and adolescents.
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June 2010

Fluorine-18 deoxyglucose positron emission tomography, magnetic resonance imaging and bone scintigraphy for the diagnosis of bone metastases in patients with lung cancer: which one is the best?--a meta-analysis.

Clin Oncol (R Coll Radiol) 2011 Jun 20;23(5):350-8. Epub 2010 Nov 20.

Department of Orthopaedics, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, China.

Aims: To carry out a meta-analysis to compare fluorine-18 deoxyglucose ((18)FDG) positron emission tomography (PET), magnetic resonance imaging (MRI) and bone scintigraphy imaging for the diagnosis of bone metastases in patients with lung cancer.

Materials And Methods: MEDLINE, EMBASE, Scopus and other databases were searched for relevant original articles published between January 1995 and January 2010. Inclusion criteria were as follows: (18)FDG PET, MRI or (99m)Tc-MDP bone scintigraphy was carried out to detect bone metastases in patients with lung cancer; sufficient data were presented to construct a 2×2 contingency table; histopathological analysis and/or close clinical and imaging follow-up and/or radiographic confirmation by multiple imaging modalities were used as the reference standard. Two reviewers independently extracted data. META-DiSc was used to obtain pooled estimates of sensitivity, specificity, diagnostic odds ratio (DOR), summary receiver operating characteristic (SROC) curves and the *Q index.

Results: In total, 14 articles that consisted of 34 studies fulfilled all inclusion criteria. On a per-patient basis, the pooled sensitivity estimates for PET, MRI and bone scintigraphy were 91.9, 80.0 and 91.8%, respectively. The sensitivity for PET and bone scintigraphy were significantly higher than for MRI (P<0.05). There was no significant difference between PET and bone scintigraphy (P>0.05). The pooled specificity estimates for PET, MRI and bone scintigraphy were 96.8, 90.6 and 68.8%, respectively. The specificity for PET was significantly higher than for MRI and bone scintigraphy (P<0.05), and the specificity for MRI was significantly higher than for bone scintigraphy (P<0.05). The pooled DOR estimates for PET, MRI and bone scintigraphy were 365.5, 53.8 and 34.4, respectively. The DOR for PET was significantly higher than for MRI and bone scintigraphy (P<0.05). There was no significant difference between MRI and bone scintigraphy (P>0.05). The SROC curve for PET showed better diagnostic accuracy than for MRI and bone scintigraphy. The SROC curve for MRI was better than for bone scintigraphy. The *Q index estimates for PET, MRI and bone scintigraphy were 0.933, 0.903 and 0.857, respectively. The *Q index for PET and MRI were significantly higher than for bone scintigraphy (P<0.05). There was no significant difference between PET and MRI (P>0.05). On a per-lesion basis, the pooled sensitivity estimates for PET, MRI and bone scintigraphy were 95.0, 83.8 and 71.5%, respectively. The sensitivity for PET was significantly higher than for MRI and bone scintigraphy (P<0.05), and the sensitivity for MRI was significantly higher than for bone scintigraphy (P<0.05). The pooled specificity estimates for PET, MRI and bone scintigraphy were 94.6, 96.3 and 91.0%, respectively. The specificity for MRI was significantly higher than for PET and bone scintigraphy (P<0.05), and the specificity for PET was significantly higher than for bone scintigraphy (P<0.05). The pooled DOR estimates for PET, MRI and bone scintigraphy were 431.9, 158.1 and 9.0, respectively. The DOR for PET was significantly higher than for MRI and bone scintigraphy (P<0.05) and the DOR for MRI was significantly higher than for bone scintigraphy (P<0.05). The SROC curve for PET and MRI showed better diagnostic accuracy than for bone scintigraphy. There was no significant difference between PET and MRI. The *Q index estimates for PET, MRI and bone scintigraphy were 0.953, 0.962 and 0.778, respectively. The *Q index for PET and MRI were significantly higher than for bone scintigraphy (P<0.05). There was no significant difference between PET and MRI (P>0.05).

Conclusion: (18)FDG PET was found to be the best modality to detect bone metastasis in patients with lung cancer, both on a per-patient basis and a per-lesion basis; MRI had the highest specificity on a per-lesion basis. For the subgroup analysis of (18)FDG PET, PET/computed tomography was shown to be better than PET and there were no significant differences between using (68)Ge and computed tomography for attenuation correction on a per-patient basis.
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http://dx.doi.org/10.1016/j.clon.2010.10.002DOI Listing
June 2011

A meta-analysis of 18FDG-PET, MRI and bone scintigraphy for diagnosis of bone metastases in patients with breast cancer.

Skeletal Radiol 2011 May 22;40(5):523-31. Epub 2010 May 22.

Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China.

Objective: To perform a meta-analysis comparing the diagnostic value of (18)FDG-PET, MRI, and bone scintigraphy (BS) in detecting bone metastases in patients with breast cancer.

Materials And Methods: MEDLINE, EMBASE, Scopus, ScienceDirect, SpringerLink, Web of Knowledge, EBSCO, and the Cochrane Database of Systematic Review databases were searched for relevant original articles published from January 1995 to January 2010. Inclusion criteria was as follows: (18)FDG-PET, MRI or (99m)Tc-MDP BS was performed to detect bone metastases (the number of published CT studies was inadequate for meta-analysis and therefore could not be included in this study); sufficient data were presented to construct a 2 × 2 contingency table; histopathological analysis and/or close clinical and imaging follow-up for at least 6 months were used as the reference standard. Two reviewers independently assessed potentially eligible studies and extracted relevant data. A software program called "META-DiSc" was used to obtain the pooled estimates for sensitivity, specificity, diagnostic odds ratio (DOR), summary receiver operating characteristic (SROC) curves, and the *Q index for each modality.

Results: Thirteen articles consisting of 23 studies fulfilled all inclusion criteria. On a per-patient basis, the pooled sensitivity estimates for MRI (97.1%) were significantly higher than those for PET (83.3%) and BS (87.0%; P <0.05). There was no significant difference between PET and BS (P <0.05). The pooled specificity estimates for PET (94.5%) and MRI (97.0%) were both significantly higher than those for BS (88.1%; P <0.05). There was no significant difference between PET and MRI (P >0.05). The pooled DOR estimates for MRI (298.5) were significantly higher than those for PET (82.1%) and BS (49.3%; P <0.05). There was no significant difference between PET and BS (P >0.05). The SROC curve for MRI showed better diagnostic accuracy than those for PET and BS. The SROC curve for PET was better than that for BS. The*Q index for MRI (0.935), PET (0.922), and BS (0.872) showed no significant difference (P ≥0.05). On a per-lesion basis, the pooled sensitivity estimates for BS (87.8%) were significantly higher than those for PET (52.7%; P <0.05). The pooled specificity estimates for PET (99.6%) were significantly higher than those for BS (96.1%; P <0.05).The pooled DOR estimates for PET (283.3) were significantly higher than those for BS (66.8%; P <0.05). The SROC curve for PET showed better diagnostic accuracy than that for BS. The*Q index for PET (0.941) was significantly higher than that for BS (0.893; P <0.05).

Conclusion: Magnetic resonance imaging was found to be better than (18)FDG-PET and BS for diagnosis of bone metastases in patients with breast cancer on a per-patient basis. On a per-lesion basis, (18)FDG-PET had lower sensitivity, higher specificity, a higher DOR, and a higher *Q index than BS.
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http://dx.doi.org/10.1007/s00256-010-0963-8DOI Listing
May 2011

Waist circumference reference values for screening cardiovascular risk factors in Chinese children and adolescents.

Biomed Environ Sci 2010 Feb;23(1):21-31

National Institute for Nutrition and Food Safety, Chinese Center for Disease Control and Prevention, Beijing, 100050 China.

Objectives: To explore the optimal threshold values of waist circumference (WC) for detecting cardiovascular (CV) risk factors among Chinese children and adolescents.

Methods: Association of WC with CV risk factors was studied among 65,898 children aged 7-18 years whose data were pooled from nine previous studies in China. CV risk factors in this study included hypertension (blood pressure above 95 percentile levels), dyslipidemia (with one or more of the following three indexes: TG > or = 1.7 mmol/L, TC > or = 5.18 mmol/L, and HDL-C < or = 1.04 mmol/L) and elevated glucose level (fasting plasma glucose > or = 5.6 mmol/L). Receive-operating characteristic analysis (ROC) and logistic regression were employed to derive optimal age- and sex-specific waist circumference references for predicting CV risk factors.

Results: A slight increasing trend of CV risk factors was observed starting from the 75th percentile of waist circumference in the study population, while a remarkable increasing trend occurred from the 90th percentile. The optimal waist circumference thresholds for predicting high blood pressures were at the 75th percentile for both boys and girls, which was at the 90th percentiles for detecting at least two of the above three CV risk factors. In comparison with children with waist circumference below the 75th percentile, the odds ratio of two CV risk factors doubled among children with waist circumference between the 75th and the 90th percentile, and increased by 6 times among children with waist circumference above the 90th percentile. The trend of high blood pressure increasing with waist circumference remained significant after having been stratified by BMI category.

Conclusion: The 75th and the 90th percentiles of WC are the optimal cut-off points for predicting an increased and a substantially increased risk of CV factors in Chinese children and adolescents, respectively.
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http://dx.doi.org/10.1016/s0895-3988(10)60027-xDOI Listing
February 2010

Does Helicobacter pylori infection play a role in iron deficiency anemia? A meta-analysis.

World J Gastroenterol 2010 Feb;16(7):886-96

Renji Hospital, Shanghai Jiaotong University School of Medicine, 1630 Dongfang Road, Shanghai 200127, China.

Aim: To perform a meta-analysis of observational studies and randomized controlled trials (RCTs) on the association between Helicobacter pylori (H. pylori) and iron deficiency anemia (IDA).

Methods: A defined search strategy was used to search Medline, Embase, the Cochrane Library, Clinical Trials, Cochrane Central Register of Controlled Trials, Premedline and Healthstar. Odds ratio (OR) was used to evaluate observational epidemiology studies, and weighted mean difference (WMD) was used to demonstrate the difference between control and intervention groups.

Results: Fifteen observational studies and 5 RCTs were identified and used for calculation. The pooled OR for observational studies was 2.22 (95% CI: 1.52-3.24, P < 0.0001). The WMD for hemoglobin (HB) was 4.06 g/L (95% CI: -2.57-10.69, P = 0.01), and the WMD for serum ferritin (SF) was 9.47 mug/L (95% CI: -0.50-19.43, P < 0.0001). Results were heterogeneous for all comparisons.

Conclusion: This meta-analysis on observational studies suggests an association between H. pylori and IDA. In RCTs, eradication of H. pylori can improve HB and SF levels but not significantly.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2825337PMC
http://dx.doi.org/10.3748/wjg.v16.i7.886DOI Listing
February 2010

[13C breath tests: a useful tool to quantify hepatic reserve function].

Zhonghua Gan Zang Bing Za Zhi 2009 Apr;17(4):318-20

Department of Nuclear Medicine, Institute of Clinical Nuclear Medicine, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China.

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April 2009