Objective To explore the plasma ghrelin levels in children and adolescents with short stature and the role of ghrelin in growth hormone-releasing hormone-growth hormone(GHRH-GH) axis.Methods One hundred and fifty-seven children(115 male,42 female) with short stature were selected.Fasting plasma sample was extracted from 10 mL vemous blood of the children with short stature.Insulin tolerance test and arginine stimulation test was performed initially to differential diagnosis.And blood samples was divided into 3 ca-tegories:37 cases of complete growth hormone deficiency (CGHD),52 cases of partial growth hormone deficiency(PGHD) and 68 cases of idiopathic short stature(ISS) during these two growth hormone(GH)provocative tests.Controls consisted of age and gender-match 20 health children.Plasma ghrelin levels were measured by radioimmunoassay.Serum GH was detected by chemiluminescence method,and serum insulin-like growth factor-1 (IGF-1) was measured by using enzyme linked immunosorbent assay.Fasting glucose,insulin,testosterone,estra-diol,luteinizing hormone,follicle-stimulating hormone were measured.Statistical analysis were conducted by using SPSS 11.5 software.Results The fasting ghrelin levels of CGHD group were significantly lower than that of ISS group and control group(Pa0.05).The ghrelin levels were positive correlated with the stimulated GH peak(r=0.176 P0.05).Conclusion Ghrelin has an important role on GH secretion and abnormal secretion of ghrelin might be a reason of growth hormone deficiency which due to hypothalamic abnormality.

Plasma ghrelin level was measured by RIA in 49 grids with idiopathic central precocious puberty(ICPP)and 35 girls with simple premature thelarche(PT).The results showed that the plasma ghrelin level was negatively correlated with Tanner stage,bone age,Lid at 15,30 and 60 min after GnRH activation, uterus and ovary volumes.The plasma ghrelin level in the ICPP group was remarkably lower than that in the PT and control groups(both P

OBJECTIVESMetabolic syndrome (MS) in adolescents was reported to be closely associated with cardiovascular diseases in adulthood. However, no unified treatment measure for MS in adolescents is currently available. The aim of this study was to measure the changes of serum adiponectin levels, insulin sensitivity and other biochemical markers after metformin therapy in adolescents with MS, which might provide some information for set up a unified therapeutic measure for MS in adolescents.

METHODSIn this study, 348 moderately or severely obese adolescents and 24 non-obese healthy adolescents matched in age and sex were enrolled. The obese group included 208 males and 140 females aged from 7 to 16 years (11.5 +/- 2.1 years). Oral glucose tolerance test and biochemical markers measurement were done to all these subjects. Whole body insulin sensitivity index (WBISI), homeostasis model assessment-insulin resistance (HOMA-IR) and fasting serum adiponectin were compared among 36 adolescents with MS (who had two or three abnormalities of hyperglycosemia, hypertension or dyslipidemia), 61 simple obese subjects without abnormality of biochemical markers and 24 healthy controls. Moreover, the changes of WBISI, HOMA-IR and adiponectin levels in 20 cases with MS after metformin therapy for 3 months were measured.

RESULTS(1) HOMA-IR in control group (1.3), simple obese group (2.3) and MS group (4.9) increased by turns (F = 54.08, P < 0.001). WBISI and serum adiponectin in control group, simple obese group and MS group decreased by turns with significant difference [89.6, 22.8 and 10.7, F = 30.06; (7.1 +/- 2.6), (5.9 +/- 1.9), (2.8 +/- 0.9) mg/L, F = 64.93; P < 0.01 for all]. (2) HOMA-IR after metformin therapy decreased [5.7 (1.9-12.4) vs. 2.9 (0.9-7.4), t = 5.05, P < 0.01]; while the serum adiponectin levels increased with significant differences [(3.0 +/- 0.9) mg/L vs. (6.1 +/- 1.9) mg/L, t = 6.19, P < 0.01]. Systolic blood pressure [(132.4 +/- 7.5) mm Hg vs. (116.6 +/- 9.1) mm Hg, t = 8.36, P < 0.01], 2-hour glucose [(8.2 +/- 2.9) mmol/L vs. (5.3 +/- 1.0) mmol/L, t = 3.96, P < 0.01], triglyceride [(2.8 +/- 1.2) mmol/L vs. (1.3 +/- 0.9) mmol/L, t = 4.22, P < 0.01], total cholesterol [(4.9 +/- 0.6) mmol/L vs. (4.0 +/- 0.6) mmol/L, t = 4.72, P < 0.01], alanine aminotransferase [80.5 (29.0-286.0) U/L vs. 56.0 (23.0-163.0) U/L, t = 3.80, P < 0.01].

CONCLUSIONInsulin sensitivity in adolescents with MS was lower than that of simple obese group. Metformin can improve or ameliorate adiponectin levels, insulin sensitivity and some clinical markers.

Adiponectin ; blood ; secretion ; Adolescent ; Alanine Transaminase ; blood ; Blood Glucose ; drug effects ; Blood Pressure ; drug effects ; Case-Control Studies ; Child ; Cholesterol ; blood ; Fasting ; blood ; Female ; Homeostasis ; drug effects ; Humans ; Hypoglycemic Agents ; administration & dosage ; pharmacology ; Insulin ; blood ; secretion ; Male ; Metabolic Syndrome ; blood ; drug therapy ; metabolism ; Metformin ; administration & dosage ; pharmacology ; Obesity ; blood ; drug therapy ; metabolism ; Triglycerides ; blood

OBJECTIVETo evaluate the viral pathogen of pneumonia in children.

METHODSA total of 13 642 cases of children pneumonia in 3 years were enrolled in this study. Antigens of viral pathogen in respiratory excretion, including respiratory syncytial virus (RSV), type 1, 2 and 3 parainfluenza virus, type A and B influenza virus, and adenovirus were detected by direct immunofluorescence method.

RESULTSViral pneumonia accounted for 34.3% of all cases, including 25.8% cases of RSV, 4.7% of parainfluenza virus, 2.4% of type A influenza virus, 0.2% of type B influenza virus and 1.3% of adenovirus. Coinfection was found in 20 cases, in which 17 cases (85%) were infected with RSV and another virus. Positive rates of RSV in children < or = 1 year, 1 to 3 years, and >3 years were 33.1%, 19.7% and 5.1% with a significant difference (chi(2)(trend)=763.4, P < 0.001). The positive rate of adenovirus in children < or =1 year (0.7%) was significantly lower than that in children aged 1 to 3 years and in children >3 years (2.3% and 2.5%) (all P<0.01). The positive rate of type A influenza virus in children aged 1 to 3 years was higher than that in children < or =1 year (chi(2)=18.2, P<0.01). Type 1 parainfluenza virus was found in 1.2% children aged 1 to 3 years with most prevalence (P<0.05). Infection rates of type 3 parainfluenza in children < or =1 year, 1 to 3 years, and >3 years were 4.7%, 3.2% and 1.4% respectively with a significant difference (chi(2)(trend)=52.4, P<0.01). Although there were some differences of infection rate of RSV in different years, it tended to increase from November to next April with a highest rate of 62.8%. Type 3 parainfluenza virus and Type A influenza virus were almost sporadic while type A influenza virus was epidemic in August 2003 with an infection rate of 15.7%.

CONCLUSIONThe highest infection rate of viral pathogen of pneumonia in children is RSV and the follows are parainfluenza, influenza and adenovirus in turn.

Adenoviridae ; isolation & purification ; Adenovirus Infections, Human ; virology ; Adolescent ; Child ; Child, Preschool ; Female ; Humans ; Infant ; Infant, Newborn ; Male ; Orthomyxoviridae ; isolation & purification ; Orthomyxoviridae Infections ; virology ; Paramyxoviridae ; isolation & purification ; Paramyxoviridae Infections ; virology ; Pneumonia, Viral ; virology ; Respiratory Syncytial Virus Infections ; virology ; Respiratory Syncytial Viruses ; isolation & purification

OBJECTIVETo study the epidemiolgy of respiratory syncytial virus (RSV) infection in children and its relations to climate factors in Hangzhou.

METHODSMonthly positive rate of RSV in pneumonia inpatients and climate factor including mean air temperature, mean relative humidity and rainy days per month were continuously observed for 3 years. Correlation analysis for RSV positive rate and these three climate factors were performed using partial correlation, and regression methods between the positive rate and significant factor was done.

RESULTS13 642 cases were detected and 25.8% showed positive of RSV. The positive rate of RSV in children < or =1 years old, 1-3 years old, > 3 years old were 33.1%, 19.7% and 5.1% respectively with significant difference (chi2 = 763.7, P = 0.000). Rate of RSV infection was increased from December and kept in high level until May or April next year, but were varied at different years. Partial correlations between positive rate and rainy days, mean relative humidity, and mean air temperature per month were 0.32 (P= 0.066), -0.27 (P = 0.117) and -0.83 (P = 0.000) respectively. The regression equation of RSV positive rate and mean air temperature was: RSV positive rate (%) = 52.933 - 1.914 x mean air temperature (degrees C).

CONCLUSIONRSV was one of the main factors causing of pneumonia in children while the highest infectious rate was in children < or =1 year old and infectious rate reduced along with the increase of age. Low air temperature was the main factor affecting the epidemiology of RSV. RSV was prevalent both in spring and winter in Hangzhou area.

Adolescent ; Child ; Child, Preschool ; China ; epidemiology ; Climate ; Female ; Humans ; Humidity ; Infant ; Logistic Models ; Male ; Respiratory Syncytial Virus Infections ; epidemiology ; Seasons ; Temperature

OBJECTIVEThe prevalence of obesity and of type 2 diabetes mellitus in children have increased in the Chinese population over the past two decades, and thus diabetes prevention has become a major concern of public health agencies. Identification of individuals at risk for diabetes is an essential first step in designing and implementing intervention programs. Insulin resistance is the hallmark of the pathophysiology of type 2 diabetes mellitus. Subjects with hyperinsulinemia and impaired glucose tolerance are well accepted as being at high risk for diabetes. Acanthosis nigricans (AN) has been proposed as a reliable marker of hyperinsulinemia, but its utility for predicting hyperinsulinemia has not been systematically evaluated in obese children. In order to further explore the relationship between obese childhood with benign acanthosis nigricans and insulin resistance and type 2 diabetes mellitus, we examined 19 obese children with benign acanthosis nigricans.

METHODSNineteen of seventy six obese children (25%) with BMI over 25 enrolled in the Children' Hospital of Zhejiang University School of Medicine fromJune 1st to September 1st in 2003 were studied. Skin biopsies were performed in these 19 obese children with acanthosis nigricans for final diagnosis. Levels of glucose, insulin, and glucose/insulin ratio were measured on fasting blood specimens and anthropometric parameters including waist/hip ratio, fat mass, body fat percentage and body mass index were examined. Oral glucose tolerance tests were also performed in these 19 children with benign acanthosis nigricans.

RESULTSAnthropometric parameters including waist/hip ratio, fat mass, body fat percentage and body mass index as well as fasting insulin level in acanthosis nigricans group were significantly higher than that of healthy controls (P < 0.01). Fasting glucose to insulin ratio (FGIR) of these 19 obese children with benign acanthosis nigricans was 4.27 +/- 0.53, indicating apparent insulin resistance. One of them was diagnosed as type 2 diabetes mellitus and ten of them showed impaired oral glucose tolerance.

CONCLUSIONChildhood benign acanthosis nigricans is tightly associated with obesity, hyperinsulinemia, insuline resistance and type 2 diabetes mellitus, and may be used as a reliable index of insulin resistance.

Acanthosis Nigricans ; complications ; physiopathology ; Child ; Diabetes Mellitus, Type 2 ; complications ; physiopathology ; Humans ; Hyperinsulinism ; complications ; physiopathology ; Insulin Resistance ; Obesity ; complications ; physiopathology

Adiponectin ; blood ; Adolescent ; Child ; Fatty Liver ; blood ; Female ; Humans ; Male ; Obesity ; blood

Humans ; Prader-Willi Syndrome/therapy*

Medicine is a highly practical science. A high-quality clinical doctor must go through strict college education,post-graduation education and follow-up continuing education. Since the implementation of standardized resident training in 2014,great achievements have been achieved:great attention has been paid to residential training,about 500 pediatric professional training bases have been set up nationwide,and software and hardware(e.g. simulation centers and teacher training)have been upgraded. Since 2017,the state has gradually launched specialty training. In the process of promoting resident and specialty training,some problems were exposed. Hence,pediatrician training needs to be in line with the“top-level design”of national health,such as the system of tiered medical services,and family physician contract system;to handle the phases and continuity of different stages of medical education;to learn foreign excellent experience based on the national conditions of China. With good top-level design,medical and educational collaboration,learning international advanced experience based on our national conditions,a standardized medical training system with Chinese characteristics will be built,which will enhance the overall level of our medical team.

OBJECTIVEObese children and adolescents are often complicated with the abnormalities of lipid and glucose metabolism, which are often associated with adulthood hypertension, diabetes and cardiovascular disease. In this study, the blood lipids, blood pressure and carotid arterial intima-media thickness (IMT) in obese children and adolescents were measured to investigate the relationship between the dyslipidemia and early vascular lesions.

METHODA total of 580 obese children and adolescents aged from 7 to 17 years of age were enrolled from 3 hospitals from Jan. 2008 to Sept. 2009. They were divided into 2 groups according to their blood lipoid levels. Ortholiposis group included 100 males and 52 females with a mean age of 10.47 years and a mean body mass index (BMI) of 28.28 kg/m(2). Dyslipidemia group included 305 males and 123 females with a mean age of 10.83 years and a mean BMI of 27.60 kg/m(2). Physical examination, and measurement of blood lipid, glucose and liver enzyme were taken. Carotid IMT was measured for 285 subjects.

RESULT(1) Hypertension was found in 12.5% (19/152) and 20.1% (86/428) patients in ortholiposis and dyslipidemia groups, respectively, with a significant difference (χ(2) = 4.362, P = 0.037). The OR was 1.760 with 95% confidence interval of 1.030 - 3.008. Higher prevalence of hypertension was found in patients with dyslipidemia. (2) The left, right and mean common carotid IMTs of dyslipidemia group were higher than those of ortholiposis group without significant difference (all P > 0.05). The left, right and mean internal carotid IMTs in dyslipidemia group were (0.66 ± 0.15) mm, (0.65 ± 0.15) mm and (0.65 ± 0.15) mm, respectively while these in ortholiposis group were (0.62 ± 0.13) mm, (0.60 ± 0.13) mm and (0.61 ± 0.12) mm, respectively (P < 0.05 for all). (3) Bivariate correlation analysis showed that systolic blood pressure was positively correlated with age, BMI, BMI Z score, waist circumference, hip circumference, uric acid, alanine transaminase, triglyceride, fasting insulin and insulin resistance index (P < 0.05 for all). Moreover, mean carotid and internal carotid IMTs were positively correlated with age, BMI, waist circumference, hip circumference, and triglyceride (all P < 0.05). Multiple linear regression analysis showed that hip circumference and insulin resistance index were independent determinants of systolic pressure. Waist circumference was independent determinant of mean common and internal carotid IMT and triglyceride was independent determinants of mean internal carotid IMT.

CONCLUSION(1) Vascular lesions, including hypertension and thicker tunica intima are common in obese children and adolescents. (2) Vascular lesions are closely related with dyslipidemia, and waist circumference and hypertriglyceridemia are the risk factors.

Adolescent ; Blood Glucose ; metabolism ; Body Mass Index ; Cardiovascular Diseases ; etiology ; metabolism ; Child ; Dyslipidemias ; metabolism ; Female ; Humans ; Hypertension ; etiology ; metabolism ; Lipids ; blood ; Male ; Obesity ; metabolism