Objective: To investigate the correlation between sleep fragmentation and body composition/blood pressure in female students of middle school, so as to provide theoretical guidance for preventing health risks associated with sleep fragmentation. Methods: From September 2022 to December 2023, 505 female students aged 12-15 years in Nanyang City were selected through stratified cluster random sampling and conducted Pittsburgh Sleep Quality Index(PSQI) survey. Participants were divided into Q 1- Q 4 groups based on sleep fragmentation index (SFI) quartiles. Body composition and blood pressure measurements were measured by adopting body composition analyzer and traditional mercury sphygmomanometer, and data were analyzed using χ 2 tests and linear regression. Results: Significant intergroup differences for Q 1- Q 4 were observed with increasing SFI levels for body mass index(BMI), fat percentage, muscle mass, bone mass, trunk fat percentage, systolic blood pressure, diastolic blood pressure, and PSQI total scores ( F =15.25,7.33,8.38,5.97,11.24,16.85,6.87,15.73, all P <0.05). SFI showed positive correlations with BMI, fat percentage, trunk fat percentage, and blood pressure( β =0.37,0.45,0.34,0.42,0.38), but negative correlations with muscle mass and bone mass( β =-0.35,-0.48) (all P <0.05). The χ 2 trend test revealed a significant increase in hypertension detection rates with elevated SFI ( χ 2=42.75, P <0.05). The χ 2 testing demonstrated statistically significant differences in hypertension incidence among different quartiles groups ( χ 2=14.16, P <0.05). After adjusting the significance level, hypertension incidence differences remained significant between Q 1and Q 4 ( χ 2=10.77), Q 2 and Q 4 groups ( χ 2=6.28) (both P <0.008 3). Conclusions Sleep fragmentation correlates significantly with body composition and blood pressure indicators in female students of middle school. Implementing sleep fragmentation interventions is essential for safeguarding female students health in middle school.

Objective To investigate the clinical manifestations,molecular genetics and gonadal pathol-ogy characteristics of patients with disorders of sex development(DSD),and to summarize the clinical experi-ence of identifying rare diseases from common symptoms.Methods The clinical data of 416 patients with DSD diagnosed and treated in the multidisciplinary center of DSD of Guangzhou Women and Children's Medical Cen-ter from May 2018 to August 2023 were retrospectively analyzed,summarized and discussed.Results Accord-ing to chromosome karyotype,416 cases of DSD were classified into three types:92 cases(22.1％)of abnormal sex chromosome karyotype,285 cases(68.5％)of 46,XY karyotype and 39 cases(9.4％)of 46,XX karyotype.Among the 92 patients with abnormal sex chromosome karyotype,59 cases were raised as males,18 cases(30.5％)complained of short penis with hypospadias and cryptorchidism.The most common karyotype was 45,X/46,XY(58 cases,63.0％).Among the 285 patients with 46,XY karyotype,238 cases were raised as males,and 63 cases(26.5％)complained of short penis and hypospadias;47 cases were raised as females,and 13 ca-ses(27.7％)complained of inguinal mass.A total of 216 patients with 46,XY karyotype were subjected to whole exome gene detection,and 155 cases(71.8％)were found to have molecular pathogenesis with the clinical phe-notype.Among the 39 patients with 46,XX karyotype,19 cases were raised as males,and 8 cases(42.1％)com-plained of short penis and hypospadias.In the 18 cases of gonad biopsy,17 cases showed testicular tissue in go-nads.Whole exome sequencing was performed in 14 cases.NR5A1 gene heterozygous mutation,SRY gene muta-tion and SOX3 gene mutation were found in 2 cases,respectively(14.3％).Twenty cases were raised as females,and 14 cases(70.0％)complained of clitoral hypertrophy.Gonad biopsy was performed in 8 cases,with 7 cases of ovotestis(87.5％)and 1 case of NR5A1 gene heterozygous mutation(14.3％).Conclusions The etiologies of DSD are complex and diverse,and the clinical manifestations are various,which can be manifested as hypospa-dias,micropenis,cryptorchidism and other common symptoms of the urinary system.Different etiologies have dif-ferent treatment options.Therefore,chromosome karyotype,molecular genetic testing and gonadal pathology can be used to clarify the cause of disease,especially for rare diseases,improve the detection rate,reduce the rate of missed diagnosis,and ensure reasonable treatment,especially sex selection.

Objective:To evaluate the diagnostic efficacy and practicality of the Jaundice color card (JCard) as a screening tool for neonatal jaundice.Methods:Following the standards for reporting of diagnostic accuracy studies (STARD) statement, a multicenter prospective study was conducted in 9 hospitals in China from October 2019 to September 2021. A total of 845 newborns who were admitted to the hospital or outpatient department for liver function testing due to their own diseases. The inclusion criteria were a gestational age of ≥35 weeks, a birth weight of ≥2 000 g, and an age of ≤28 days. The neonate′s parents used the JCard to measure jaundice at the neonate′s cheek. Within 2 hours of the JCard measurement, transcutaneous bilirubin (TcB) was measured with a JH20-1B device and total serum bilirubin (TSB) was detected. The Pearson′s correlation analysis, Bland-Altman plots and the receiver operating characteristic (ROC) curve were used for statistic analysis.Results:Out of the 854 newborns, 445 were male and 409 were female; 46 were born at 35-36 weeks of gestational age and 808 were born at ≥37 weeks of gestational age. Additionally, 432 cases were aged 0-3 days, 236 cases were aged 4-7 days, and 186 cases were aged 8-28 days. The TSB level was (227.4±89.6) μmol/L, with a range of 23.7-717.0 μmol/L. The JCard level was (221.4±77.0) μmol/L and the TcB level was (252.5±76.0) μmol/L. Both the JCard and TcB values showed good correlation ( r=0.77 and 0.80, respectively) and agreements (96.0% (820/854) and 95.2% (813/854) of samples fell within the 95% limits of agreement, respectively) with TSB. The JCard value of 12 had a sensitivity of 0.93 and specificity of 0.75 for identifying a TSB ≥205.2?μmol/L, and a sensitivity of 1.00 and specificity of 0.35 for identifying a TSB ≥342.0?μmol/L. The TcB value of 205.2?μmol/L had a sensitivity of 0.97 and specificity of 0.60 for identifying TSB levels of 205.2 μmol/L, and a sensitivity of 1.00 and specificity of 0.26 for identifying TSB levels of 342.0 μmol/L. The areas under the ROC curve (AUC) of JCard for identifying TSB levels of 153.9, 205.2, 256.5, and 342.0 μmol/L were 0.96, 0.92, 0.83, and 0.83, respectively. The AUC of TcB were 0.94, 0.91, 0.86, and 0.87, respectively. There were both no significant differences between the AUC of JCard and TcB in identifying TSB levels of 153.9 and 205.2 μmol/L (both P>0.05). However, the AUC of JCard were both lower than those of TcB in identifying TSB levels of 256.5 and 342.0 μmol/L (both P<0.05). Conclusions:JCard can be used to classify different levels of bilirubin, but its diagnostic efficacy decreases with increasing bilirubin levels. When TSB level are ≤205.2 μmol/L, its diagnostic efficacy is equivalent to that of the JH20-1B. To prevent the misdiagnosis of severe jaundice, it is recommended that parents use a low JCard score, such as 12, to identify severe hyperbilirubinemia (TSB ≥342.0 μmol/L).

Child ; Humans ; Case-Control Studies ; East Asian People ; Genetic Predisposition to Disease/genetics* ; Methyltransferases/genetics* ; Polymorphism, Genetic ; Wilms Tumor/pathology*

Objective:To study the clinical manifestations and treatment of neonatal testicular torsion (NTT) and to summarize the experience of diagnosis and treatment.Methods:The clinical data of the patients with NTT admitted to the Department of Pediatric Urology in Guangzhou Women and Children's Medical Center from January 2015 to January 2021 were analyzed retrospectively. The data included demographic information, testicular torsion duration, clinical presentation, ultrasonography findings, surgical procedures, pathological results, follow-ups, and prognosis.Results:A total of 17 cases were enrolled in this study, and the median age was 5.2 d, ranging from 1 d to 17 d; the weight ranging from 2 800 g to 4 000 g. 11 cases of left testicular torsion and 6 cases of right testicular torsion. The median time from onset to medical attention was 3.8 d, ranging from 10 h to 15 d. The first manifestations being reported were scrotal swelling, color change, or painless mass. Emergency ultrasound revealed that the blood flow signal in the testis was significantly reduced or disappeared, and heterogeneous mass echoes were detected in the scrotum. Surgical exploration was performed in all 17 cases and confirmed to be testicular torsion. There were 15 cases of extravaginal torsion and 2 cases of intravaginal torsion. There were 6 cases of clockwise torsion and 11 cases of anticlockwise torsion. The average degree of twisted testis was 450.8°, ranging from 270° to 720°. The rate of orchiectomy was 88.2% (15/17). All patients were followed up for a minimum of 1 year postoperatively. None of the patients experienced postoperative bleeding or infection at the scrotal incision site. There were no instances of recurrent testicular torsion, and the contralateral testicles showed no abnormalities. In 2 cases where the affected testicle was preserved, ultrasound reevaluation at 6 months postoperatively revealed atrophy of the affected testicle.Conclusions:NTT is rare in clinics and lacks specificity, with a high rate of testis loss. When the newborns exhibit scrotal swelling, color change, or other abnormalities, testicular torsion cannot be ruled out, and early surgical exploration is required.

Objective: To investigate the age related changes in cervical range of motion (CROM) and its relationship with cervical spondylosis in school students aged 12-18 in Nanyang City, to provide reference for prevention, early diagnosis and treatment evaluation of cervical spondylosis. Methods: Stratified sampling was adopted in 13 counties and districts of Nanyang City and 890 students aged 12-18 were assessed for CROM using the Coda Motion Analyzer. SPSS 19.0 was used to data analyze. Results: A decreasing trend was observed in CROM among boys and girls aged 12-18 years in Nanyang. For boys aged 15 and 18 years old, higher anterior flexion ( t =2.02, 2.70), posterior extension ( t =2.01, 2.81), left flexion ( t =3.51, 2.99), right flexion ( t =5.07, 2.66), sinistral ( t =2.28, 2.92) and dextral ( t =2.91,3.60) were found compared with younger age groups ( P <0.05). Similar findings were found in girls aged 15 and 18-years old [anterior flexion ( t =2.38, 2.20), posterior extension ( t =2.09,2.02), left flexion ( t =2.33, 2.55), right flexion ( t =7.34, 4.60), sinistral ( t =3.73, 2.35) and dextral ( t =2.31, 3.99, P <0.05). Except for the right flexion, the CROM of boys in was higher than that of girls at the same age group. The prevalence of cervical spondylosis showed an increasing trend (boys: χ 2 trend =13.93, girls: χ 2 trend =12.87, P <0.05). Except for 14-year-old group, the prevalence of cervical spondylosis in girls was higher than that in boys, with significant differences observed in 15 and 17-year-old groups ( χ 2=10.35, 9.64, P <0.05). Conclusion With the increase of age, the CROM of male and female students shows a downward trend in general. The prevalence of cervical spondylosis increases with the decrease of CROM. CROM measurement is conducive to the prevention, early diagnosis and treatment of juvenile cervical spondylosis.

Objective: To compare body composition of girls aged 10 to 15 years with or without onset of menarche in Nanyang, and to provide a reliable basis for effective adolescent health care. Methods: From August to December 2020 and from March to October 2021, cluster random sampling was adopted in 13 areas of Nanyang City to select 1 523 girls. Questionnaire survey and body composition (Japan Bailida MC-180) were conducted. Results: BMI, body fat percentage, trunk fat percentage, muscle mass and bone mass of girls aged 10 to 15 years in Nanyang City gradually increased with age, the water content in the body decreased with age. BMI, fat percentage, trunk fat percentage, muscle mass and bone mass in girls experienced menarche were higher, while water content in the body was lower than those without menarche. Significant difference in BMI between the menarche and without menarche of girls were found in those aged 11 to 15 years( t =2.07, 2.03, 2.43, 2.45, 2.52, P <0.05). Significant differences in fat rate, trunk fat rate, muscle mass and bone mass between the menarche and without menarche were found in girls aged 12 to 15 years fat percentage, trunk fat percentage muscle mass bone mass( P <0.05). Among girls aged 10, 14 and 15 year old, significant difference in body water percentage were observed in the two groups of girls with or without menarche( t =2.75, 2.35, 2.37 , P <0.05). Average age at menarche showed significant urban rural differences among girls aged 10, 11 and 14 year old ( χ 2=4.34, 3.45, 6.73, P <0.05). Conclusion Changes in body composition including BMI, body fat percentage, muscle mass, bone mass and body water percentage during the transition to menarche in girls is helpful to predict menarche in girls. Age of menarche is related to nutritional status, BMI, physical exercise, snack and beverage intake.

Objective:Objectives To investigate the predictive value of color Doppler flow imaging (CDFI) for the proteinuria following pyeloplasty for congenital ureteropelvic junction obstruction (UPJO) in children.Methods:We identified a series of 206 children with a mean age of (20.0±28.8) months (1-132 months), consisted of 171 males and 35 females, diagnosed with congenital UPJO accepted pyeloplasty from January 2014 to September 2018, the preoperative mean urinary Albumin/Creatinine Ratio (ACR) was (17.3±160.1) mg/mmol and the mean β2-microglobulin/Creatinine Ratio (β2-MG/Cr) was (135.6±383.8) μg/mmol, ultrasound showed a mean renal pelvis dilatation of (3.1±1.5) cm and a mean cortical thickness of (0.3±0.1) cm, and classified as grade Ⅰ-Ⅴ according to the blood flow distribution in renal by CDFI, these children were divided into three groups of increased, decreased and unchanged blood flow according to the postoperative CDFI within 1 week, the postoperative urinary protein and renal function indexes within 1 week and 2 years were retrospectively analysed among groups.Results:Within 1 week postoperatively, an increased, decreased and unchanged blood flow occurred in 113 (54.9%), 31(15.0%), 62(30.1%) children, respectively. Urinary ACR in above mentioned groups was (112.3±400.7), (16.1±29.3), (32.7±48.4) mg/mmol, β2-MG/Cr was (887.4±6061.0), (50.2±62.7), (51.9±57.8)μg/mmol, there were significant differences among groups ( P<0.01). Contralateral hydronephrosis occurred in 21(18.6%), 4(12.9%), 8(12.9%) children, urinary N-Acetyl-β-D-glucosaminidase (NAG) was (7.5±5.2), (7.0±5.4)、(5.7±4.5) U/L, these indexes showed no significant differences among groups. There was a positive correlation between the increased blood flow level and the decreased renal pelvis dilatation (Spearman’s correlation coefficient 0.2, P<0.01), ACR (Spearman’s correlation coefficient 0.4, P<0.01) and β2-MG/Cr (Spearman’s correlation coefficient 0.3, P<0.01). After a follow up of 2 years, 67 children were diagnosed with proteinuria in this series, 51 cases of them with an increased blood flow, which had significantly higher percentage than children with a decreased (4 cases, 12.9%) or unchanged blood flow (12 cases, 19.3%). Logistic multivariate analysis indicated that early postoperative (within 1 week) increased blood flow ( OR=1.9, 95% CI 1.5-2.6), contralateral hydronephrosis ( OR=2.2, 95% CI 1.1-4.8) and urinary NAG ( OR=1.1, 95% CI 1.0-1.1) were predictive of proteinuria, the increased blood flow was independent predictor of proteinuria (Ⅰ level increased: OR=1.9, 95% CI 1.5-2.6). Conclusions:The CDFI reveals good predictive value for the postoperative proteinuria, an early marked increased blood flow postoperatively indicated risk of proteinuria in the long term.

Objective: To evaluate the safety and efficacy of tabularized urethral plate disassembly for epispadias repair in infant. Methods: From January 2016 to September 2018, 10 boys aged between 18 to 36 months old with mishaft epispadias were included. The main complaint was that the urethral opening was found on the dorsal side of the penis. Preoperative cystography revealed that 3 of them had unilateral vesicoureteral reflux (Grade Ⅰ), and white blood cells in routine urinary in all 10 patients were negative. Physical examination: the penis is short and flat, the width is 17-25 mm, average is 20.7 mm, the penis curvature is 15°-30°, average is 21.5°, and the urethral opening located on the dorsal side of the penis. The anesthesia method was selected for tracheal intubation, intravenous anesthesia combined with caudal anesthesia, and the surgical position was supine position. The surgical method: one stage of tabularized urethral plate disassembly urethroplasty: during the operation, the penile curve was corrected by free urethral plate and penile degloving. Two of them were unsatisfied with the correction of the curvature, and the ventral tunica folded was applicate. To avoid urethral plate ischemia, attention should pay to blood supply protection. The two corpus cavernosum are separated in the root, and the urethra is completely displaced to the ventral side of the cavernous body. The ventral side of the urethral under glans is shaped into a fissured that conforms to the anatomy. The prognosis and surgical choice of the midshaft epispadias were discussed combined with literature. Result: The operation time was 130-200 min with an average of 157 mins. Intraoperative hemorrhage 5-30 ml, average is 16 ml, 1 case of glans skin was black one day after surgery, with enhanced dressing change. After 1 month, the glans was local atrophy and scar formation. No skin incision infection case. After discharge from the hospital, the follow up through the internet and outpatients for 3-40 months, average is 21 months, 2 cases with urethral fistula, more surgery to repair the fistula successfully after 6 months. The penile curvature was corrected in 8 cases, and the residual curvature of 2 cases was about 10-15°, which was temporarily observed. Patients with unilateral vesicoureteral reflux preoperatively, they still suffered from vesicoureteral reflux in the 6-12 months regular review after surgery without any intervention due to white blood cell was negative in urine routine. All cases had urinary patency and no cases with urethral stricture. Conclusion Tubularized urethral plate disassembly is a effective and simple procedure that can correct the midshaft epispadias in infant.

Patients?with?acute?myocardial?infarction?(AMI)?complicated?with?acute?Stanford?type?A?aortic?dissection?after?percutaneous?coronary?intervention?(PCI)?are?critically?ill,?with?a?very?high?fatality?rate,?and?few?cases?are?successfully?treated?clinically.?A?case?with?AMI?admitted?to?the?First?Affiliated?Hospital?of?Zhengzhou?University?complicated?with?acute?left?cardiac?insufficiency?after?PCI,?Stanford?type?A?aortic?dissection,?pericardial?and?pleural?infection,?recurrent?AMI?was?reviewed.?In?the?condition?of?coexistence?of?many?diseases,?through?timely?adjustment?of?treatment?strategy?and?exploratory?application?of?drugs?to?improve?cardiac?function,?the?patient?successfully?received?operation?and?discharged?from?the?hospital.?By?presenting?the?successful?treatment?experience?of?this?case,?the?author?aims?to?improve?the?overall?treatment?of?AMI?patients?with?acute?Stanford?type?A?aortic?dissection?after?PCI.