Objective: To investigate the association between cysteine level and lumbar spine (LS) bone mineral density (BMD) among children with cerebral palsy, so as to provide a basis for bone health enhancement among children with cerebral palsy. Methods: A total of 149 children aged 10-18 with cerebral palsy who were admitted to the G city Social Welfare Institute (Luogang District) from January 2023 to January 2024. Basic demographic characteristics of children with cerebral palsy were extracted from medical records system. Cysteine levels were measured using the enzyme cycling method. LS BMD of the children was determined by specialized rehabilitation physicians using dual energy X ray absorptiometry, and the corrected BMD Z -scores for LS were calculated. Non restrictive cubic splines and segmented multiple linear regression were employed to analyze the correlation between cysteine levels and age specific height Z -scores (HAZ scores) for LS BMD in children with cerebral palsy. Results: The median cysteine concentration in children with cerebral palsy was 9.13(8.42, 10.30)μmol/L, with significantly higher levels in spastic type children [9.28(8.53，10.49)μmol/L] compared to non spastic types [8.64(7.89，9.66)μmol/L]( Z=-2.46，P <0.05). The median LS BMD HAZ score was -1.07( -2.10 , -0.16), and the detection rate of decreased bone mass was 29.5%. There was an "L" shaped association between serum homocysteine concentration and LS BMD HAZ score in children with cerebral palsy. When serum homocysteine concentration was below 8.7 μmol/L, a significant negative correlation was observed between LS BMD HAZ score and serum homocysteine concentration ( B=-0.32, 95%CI =-1.06 to -0.15, P <0.05). Conclusions The significant negative correlation between cysteine levels and LS BMD in children with cerebral palsy at lower cysteine concentrations, which suggests a potentially higher sensitivity to the influence of homocysteine than healthy children and adolescents, warranting attention even if not reaching the standard of hyperhomocysteinemia.

Objective: To investigate the correlation of emotional and behavioral problems with sleep problems in children with cerebral palsy, so as to provide reference for intervention of emotional and behavioral problems in children. Methods: A cross sectional survey was conducted, and 402 children aged 6-18 with cerebral palsy who were adopted by social welfare institutions in Guangzhou City from January 2023 to January 2024 were selected to investigate their full time nurses. The Parents Strengths and Difficulties Questionnaire (SDQ) was used to assess the emotional and behavioral problems of children with cerebral palsy, and the Children s Sleep Habits Questionnaire (CSHQ) was used to assess sleep problems. Multiple linear regression analysis was used to analyze the correlation between the sleep problem of children with cerebral palsy and the emotional and behavioral problems. Results: The prevalence of emotional and behavioral difficulties among children with cerebral palsy was 15.7%. The median sleep problem score of children with emotional and behavioral problems [37.0(36.0, 41.0)] was significantly higher than that of children without emotional and behavioral [35.0(34.0, 36.0)] ( Z =-5.74, P <0.01). The results of multiple linear regression analysis showed that after adjusting covariables such as age, gender, cerebral palsy classification, language retardation, visual impairment and epilepsy, the total sleep problem score of children with cerebral palsy was positively correlated with the total difficulty score ( β= 0.28, 95%CI =0.17-0.34, P <0.05). Conclusions Sleep problems in children with cerebral palsy are associated with emotional and behavioral difficulties. Understanding of the management of sleep problems in children with cerebral palsy should be enhanced to reduce the incidence of emotional and behavioral problems in children with cerebral palsy.