Timing of puberty showed a dramatic decrease in the past decades,and it depends on the gene,nutrition,environment,social economics,and so on.Childhood obesity affects both the timing of puberty and sex hormone levels.However,the influence of obesity on the timing of puberty has gender differences.Current studies show that childhood obesity accelerates the onset of puberty in girls,but it still has controversy in boys.Mechanisms of concrete have not clear,may be related to the subjectivity of standard of male sexual development and the correlation of body mass index as a substitute for male obesity is poor.Through literature review at home and abroad,this article will explain the influence of obesity on the timing of puberty,sex hormone levels and its gender differences,further explore the possible mechanisms of body fat participate in starting the gonad axis,and provide new research direction on the switch for the gonad axis.

Gonadotropin-releasing hormone (GnRH) dependent precocious puberty/central precocious puberty (GDPP/CPP) is one of the common diseases of the pediatric endocrine system.CPP is mainly treated with gonadotropin-releasing hormone analogues (GnRHa) internationally.They slow the progression of bone age and improve adult height in children with CPP by inhibiting the activity of the hypothalamic-pituitary-gonadal axis and the secretion of sex hormones.In clinical practice, the populations who benefit from GnRHa treatment and the best GnRHa treatment plan still need to be investigated, and the long-term efficacy and safety evidence of GnRHa should be further improved.

Islet β cell secretion deficiency and( or) the decreased insulin sensitivity of target tissue are the important pathophysiological mechanisms of diabetes. So,detection and assessment of isletβcell function in the early stages,could be of great significance for disease severity evaluation,early intervention and prognosis of the disease. At present,the main methods of the testing and assessment ofβcell function includeβcell function evaluating indexes,pulsatile insulin secretion,insulin secretion by glucose or non-glucose secretagogues and func-tion testing by other secretions of isletβcells. Among of them,βcell functional assessment methods by detecting C-peptide( especially aspects such as 90 minutes of C-peptide testing in mixed-meal tolerance test,urinary C-pep-tide creatinine ratio) have experienced some progress in recent years.

Objective To establish the specific 16S 23S rRNA gene spacer regions map of different bacteria by PCR, RFLP(restriction fragment length polymorphism ),DNA clone and sequences analysis. Methods A pair of primer was selected from highly conserved sequences adjacent to the 16S 23S rRNA spacer region. The farget rRNA regions from 61 strains of standard bacteria and corresponding clinical isolates representing for 20 genera and 26 species were amplified by PCR,and thereafter analyzed RFLP, DNA clone and sequences analysis.Meanwhile, all the specimens were examined by bacterial culture and PCR RFLP analysis. Results 26 different standard strains presented one band,two bands,three bands and more than three bands respectively, the sensitivity of which reached 2.5 CFU and had no cross reaction to the human genomic DNA,fungus and virus.14 species could be distinguished immediately by PCR, other 10 species must be identified by further Hinf I or Alu I digestion. K.pneumoniae and E.durans differentiate only at the site of 779 th nucleotide according to the sequence analysis, and only one enzyme Xma III could discriminate them.15 specimens from 42 septicemic neonates were blood culture positive and the positive rate was 35.7%. However, 27 specimens were positive by PCR and the positive rate was 64.2%,which was significantly higher than that of the blood culture( P

Objective To analyze the relationship between dynamic change of GPI-80 and disease severity and prognosis of childhood anaphylactoid purpura. Methods Patients were collected and divided into three groups according to their clinical features: purpura group (purpura only), mixed group (purpura + arthritis + gastrointestinal bleeding) and nephritis group. There were 20 patients in each group. GPI-80 expression on the neutrophils was detected by flow cytometry during acute and regressive phases of the disease. GPI-80 expression was compared among different groups and different phases. Renal biopsies were performed in 20 nephritis patients. Results GPI-80 expression was significantly increased in all patient groups compared with that in the normal control (P 0.05). No significant difference of GPI-80 expression was found among 20 nephritis patients with different pathological patterns. Forty-two patients (10 in purpura group, 15 in mixed group, and 17 in nephritis groups) were followed up and GPI-80 expression was detected at the time of discharge and 2 weeks after discharge, the results showed that GPI-80 expression was decreased from 93.26% (?7.89%) at acute phase to 91.37% (?6.9%) at regressive phase with an average interval of 13.5 days. Most of them (35/42) further decreased to 38.44% (?7.8%) in 2 weeks after discharge. GPI-80 expression remained high in 7 patients for 2 weeks after discharge and relapsed in 5 patients within 1 month after discharge. Conclusions High GPI-80 expression is related to the severity of the disease. The decrease of GPI-80 takes place later than the improvement of clinical symptoms. Children with persistently high GPI-80 expression are likely to relapse. It seems that there is no correlation between GPI-80 expression and different pathological patterns of nephritis.

Objective To explore the relationship between obese children with benign acanthosis ni-gricans and insulin-resistant and type 2 diabetes mellitus. Methods 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 in 42 obese children with benign acanthosis nigricans, 60 cases of simple obesity and 20 healthy children controls. Glucose tolerance tests were performed in groups of obese children with benign acanthosis nigricans and simple obesity, respectively. Results Two of 42 obese children with benign acanthosis nigricans were diagnosed as type 2 diabetes mellitus. The rate of abnormal glucose tolerance and levels of blood sugar during 60 min and 120 min after glucose tolerance were significantly higher in acanthosis nigricans children than those in simple obesity (P

To report the process of diagnosis and treatment of 1 case with SRY gene mutation of 46, XY complete gonadal dysplasia, and to discuss the clinical characteristics, diagnosis and treatment of the disease.Due to clitoral enlargement for 8 months, a 9 years old girl was admitted to the Children′s Hospital Affiliated to Zhejiang University School of Medicine.Previously, she had early breast development, and suffered from high gonadotropin expression when she was 6 years and 4 months old.Physical examination: breast B3 stage, female vulva, clitoris hypertrophy, normal urethra, normal vaginal opening, slightly thick hymen ring, the development of pubic hair was 2 stages, and Prader score level 1.Laboratory data showed elevated levels of estradiol, testosterone, and human chorionic gonadotrophin.Genetic examination revealed that the chromosome karyotype was 46, XY and SRY gene detection was positive.Therefore, the patient was diagnosed with 46, XY complete gonadal dysplasia.Bilateral gonadectomy was performed, and the posto-perative pathological diagnosis was bilateral gonadoblastoma with left dysgerminoma.The tumor did not recur after che-motherapy.The etiology of early breast development needs to be carefully identified.Patients with sexual characteristics dysplasia need to accept the chromosome karyotype analysis and gene detection, and surgical exploration should be performed when necessary for a correct diagnosis as soon as possible.

Objective To evaluate the value of serum uric acid(UA)levels with reference to the age,waist circumference,and body mass index(BMI)in predicting the metabolic syndrome(MS)in obese children.Methods A total of 300 obese children,including 180 boys and 120 girls,were enrolled in this study.The height,BMI,waist and hip circumference,blood pressure,serum glucose,insulin and lipid profile in all participants were measured.Oral glucose tolerance test and insulin releasing test were performed.The boys or girls were divided into 4 groups according to the 4 quantile of UA level,respectively.The clinical characteristics and correlation of UA with the clinical indexes and MS components were compared.The binary Logistic regression analysis was applied in the risk of MS and its components for the 4 groups of obese children.The area under the receiver operating characteristic curve(ROC curve)of UA level,age,waist circumference and BMI were used to predict the MS.Results UA level was increased with the increase of age,waist circumference and BMI,and the UA level was significantly correlated with triacylglycerol,postprandial 2 h glucose(2 h PG)(r=0.196,0.174 in boys;r=0.291,0.179 in girls).In boys,the adjusted odds ratio and 95％CI of the highest quartile of UA for triglyceridemia was 2.71(95％CI:0.77-9.58);which in girls,the adjusted odds ratio and 95％CI of the highest quartile of UA for hyperglycemia,hypertension were 8.45(95％CI:1.76-40.52)and 3.93(95％CI:0.66-23.33),respectively,with significant differences.In boys,the area under the ROC curve of UA level,age,waist circumference and BMI which predict the MS were 0.652 0.626,0.621,0.62,respectively,and the differences were significant(all P<0.05).Conclusions The UA level is significantly correlated with the composition of MS,UA detection combining with reference to the age,waist circumference,and BMI is helpful for the identification of high risk groups of metabolic syndrome.

Objective: To investigate the epidemiological features of notifiable infectious diseases in Zhejiang Province in 2021, so as to provide the evidence for formulating infectious disease control measures. Methods: The data pertaining to notifiable infectious diseases reported in Zhejiang Province in 2021 were retrieved from the Infectious Disease Surveillance System of China Information System for Disease Control and Prevention. The incidence and mortality of notifiable infectious diseases in Zhejiang Province in 2021 were descriptively analyzed. Results: Totally 29 types of notifiable infectious diseases with 396 623 cases and 391 deaths were reported in Zhejiang Province in 2021, with a reported incidence of 614.28/105 and a reported mortality of 0.605 6/105, respectively. There were 93 204 cases with class B notifiable infectious diseases, with a reported incidence rate of 144.35/105 and 303 419 cases with class C notifiable infectious diseases, with a reported incidence rate of 469.92/105; while no cases with class A notifiable infectious diseases were reported. Syphilis (39.45/105), tuberculosis (37.12/105), viral hepatitis (31.90/105) and gonorrhea (26.34/105) were the four most common class B notifiable infectious diseases, and AIDS (0.477 0/105) and pulmonary tuberculosis (0.116 2/105) were the two most deadly class B notifiable infectious diseases, while hand, foot and mouth disease (192.00/105), other infectious diarrhea (184.24/105) and influenza (86.45/105) were the three most common class C notifiable infectious diseases. According to the transmission route, intestinal and respiratory infectious diseases were the two most common infectious diseases, with reported incidence rates of 384.10/105 and 133.73/105, respectively; and according to the reported region, the highest incidence of class B notifiable infectious diseases was reported in Zhoushan and Ningbo cities, and the highest incidence of class C notifiable infectious diseases was reported in Ningbo City. Totally 1 101 COVID-19 cases were reported in Zhejiang Province in 2021, including 712 confirmed cases and 389 asymptomatic cases, and no deaths occurred. Conclusions The reported incidence of notifiable infectious diseases declined in Zhejiang Province in 2021 as compared to that prior to COVID-19 epidemics, with remarkable reductions in the incidence of respiratory and intestinal infectious diseases. The management of pulmonary tuberculosis, viral hepatitis and AIDS requires to be reinforced during the containment of COVID-19, to prevent the seasonable epidemic of influenza, hand, foot and mouth disease and other infectious diarrhea in Zhejiang Province.

Nonalcoholic fatty liver disease(NAFLD)has become one of the great risks for children′s development and health, while its pathogenesis and progression characteristics are still not clear.The establishment of NAFLD specific research model can help to explore and reveal the role of related pathways in the occurrence and development of NAFLD.The existing models for the study of NAFLD in children mainly include diet-induced animal models and in vitro hepatocyte culture models.In recent years, organoids cultured from stem cells have similar spatial tissues of corresponding organs and can reproduce some functions of corresponding organs, which can be used to simulate liver inflammation and fibrosis process.In this paper, we will introduce these models and methods, focus on the construction and application of organoids, and look forward to the application of models for children NAFLD in the future.