An Objective Measure to Evaluate Actual Body Shape among Children and Adolescents in China

Objective The purpose of this study was to explore an objective measure to assess actual body shape of children and adolescents in China.Methods Based on the Chinese National Survey on Student’s Constitution and Health(CNSSCH)in2005,210 927 children and adolescents'(7-18 years)body height,body weight,chest circumference,sitting height,chest circumference-height ratio,chest circumference-sitting height ratio,chest circumference-low limb ratio,and sitting height-low limb ratio measurements were used to develop an objective measure by using transformation variables and explored factor analysis(EFA).Discrimination power of the objective measure was evaluated based on BMI reference and Receiver Operating Characteristic curves(ROC).Results The objective measure included four dimensions scores:transverse dimension(TD)indicating weight and chest circumference;length dimension(LD)indicating height and sitting height;transverse-length ratio dimension(TLD)indicating chest circumference-height ratio,chest circumference-sitting height and chest circumference-low limb ratio;proportion dimension(PD)indicating sitting height-low limb ratio.The whole dimension(WD)indicating the whole body shape was showed by the average of four dimensions scores.Four dimensions and WD scores were approximately80 in children and adolescents with normal weight,and higher than those of overweight,obesity,and underweight(all P-values0.001).Areas under ROC of overweight and obesity compared with normal weight ranged from 0.88 to 1.00 for scores of TD,TLD,and WD.Conclusion The objective measure which included four dimensions was explored,and TD,TLD,and WD had significant discrimination power.     

模拟教学在继续医学教育中的应用探讨

目前,模拟技术在院校医学教育和毕业后医学教育以及其他医疗卫生专业人员的个人训练和评估中有广泛的应用,模拟技术能给各种技术水平的医疗卫生专业人员提供安全、有效的实践机会,帮助他们学会治疗患者所需的临床技能.有越来越多的研究证实了模拟技术对于医疗卫生专业人员的培训效果.然而,在继续医学教育领域,模拟技术还未得到广泛的应用.     

Perinatal mortality rate in the Netherlands compared to other European countries: A secondary analysis of Euro-PERISTAT data

Objective

the poor perinatal mortality ranking of the Netherlands compared to other European countries has led to questioning the safety of primary care births, particularly those at home. Primary care births are only planned at term. We therefore examined to which extent the perinatal mortality rate at term in the Netherlands contributes to its poor ranking.

Design

secondary analyses using published data from the Euro-PERISTAT study.

Setting and participants

women that gave birth in 2004 in the 29 European regions and countries called 'countries' included in the Euro-PERISTAT study (4,328,441 women in total and 1,940,977 women at term).

Methods

odds ratios and 95% confidence intervals were calculated for the comparison of perinatal mortality rates between European countries and the Netherlands, through logistic regression analyses using summary country data.

Main outcome measures

combined perinatal mortality rates overall and at term. Perinatal deaths below 28 weeks, between 28 and 37 weeks and from 37 weeks onwards per 1000 total births.

Findings

compared to the Netherlands, perinatal mortality rates at term were significantly higher for Denmark and Latvia and not significantly different compared to seven other countries. Eleven countries had a significantly lower rate, and for eight the term perinatal mortality rate could not be compared. The Netherlands had the highest number of perinatal deaths before 28 weeks per 1000 total births (4.3).

Key conclusions

the relatively high perinatal mortality rate in the Netherlands is driven more by extremely preterm births than births at term. Although the PERISTAT data cannot be used to show that the Dutch maternity care system is safe, neither should they be used to argue that the system is unsafe. The PERISTAT data alone do not support changes to the Dutch maternity care system that reduce the possibility for women to choose a home birth while benefits of these changes are uncertain.     

Iterative deconvolution of simultaneous 99mTc and 201Tl projection data measured on a CdZnTe-based cardiac SPECT scanner

We present a method of correcting self-scatter and crosstalk effects in simultaneous technetium-99m/thallium-201 stress/rest myocardial perfusion (single photon emission computed tomography) SPECT scans. The method, which is in essence a hybrid between the triple energy window method and scatter modelling, is based on a model of spatial and spectral distribution of projection counts in several selected energy windows. The parameters of the model are determined from measurements of thin rod sources in air when no in-object scatter or attenuation effects are present. The model equations are solved using the iterative maximum likelihood expectation maximization algorithm in the projection space to find estimates of the primary photopeak counts of both radionuclides. The method has been developed particularly for a novel dedicated cardiac camera based on CdZnTe pixellated detectors, although it can also be adapted to a conventional scintillator camera. The method has been validated in anthropomorphic phantom experiments. Significant improvement in defect contrast has been observed with only moderate increase in image noise. The application of the method to patient data is illustrated.     

Progranulin is a chemoattractant for microglia and stimulates their endocytic activity

Mutations resulting in progranulin haploinsufficiency cause disease in patients with a subset of frontotemporal lobar degeneration; however, the biological functions of progranulin in the brain remain unknown. To address this subject, the present study initially assessed changes in gene expression and cytokine secretion in rat primary cortical neurons treated with progranulin. Molecular pathways enriched in the progranulin gene set included cell adhesion and cell motility pathways and pathways involved in growth and development. Secretion of cytokines and several chemokines linked to chemoattraction but not inflammation were also increased from progranulin-treated primary neurons. Therefore, whether progranulin is involved in recruitment of immune cells in the brain was investigated. Localized lentiviral expression of progranulin in C57BL/6 mice resulted in an increase of Iba1-positive microglia around the injection site. Moreover, progranulin alone was sufficient to promote migration of primary mouse microglia in vitro. Primary microglia and C4B8 cells demonstrated more endocytosis of amyloid β1-42 when treated with progranulin. These data demonstrate that progranulin acts as a chemoattractant in the brain to recruit or activate microglia and can increase endocytosis of extracellular peptides such as amyloid β.     

Contribution of antibodies against IA-2β and zinc transporter 8 to classification of diabetes diagnosed under 40 years of age

OBJECTIVE

We investigated whether measuring autoantibodies against zinc transporter 8 (ZnT8A) and IA-2β (IA-2βA) may improve classification of new-onset type 1 diabetic patients based on detection of autoantibodies against insulin (IAA), GAD (GADA), and IA-2 (IA-2A). In addition, we studied the correlation of IA-2βA and ZnT8A with other biological and demographic variables.

RESEARCH DESIGN AND METHODS

Circulating autoantibodies were determined by liquid-phase radiobinding assays from 761 healthy control subjects and 655 new-onset (<1 week insulin) diabetic patients (aged 0–39 years) with clinical type 1 diabetes phenotype consecutively recruited by the Belgian Diabetes Registry.

RESULTS

At diagnosis, IA-2βA and ZnT8A prevalences were 41 and 58%, respectively. In IAA-negative, GADA-negative, and IA-2A–negative patients, one IA-2βA–positive and eleven ZnT8A-positive individuals were identified at the expense of eight and seven additional positive control subjects (1%), respectively, for each test. ZnT8A or IA-2βA screening increased (P < 0.001; McNemar) the number of patients with ≥2 antibodies both under (from 78 to 87% for ZnT8A and 82% for IA-2βA) and above age 15 (from 51 to 63% for ZnT8A and 56% for IA-2βA) versus 0% in control subjects. IA-2βA and ZnT8A were preferentially associated with IA-2A, and with younger age at diagnosis. Unlike ZnT8A, IA-2βA levels were positively correlated with HLA-DQ8 and negatively with HLA-DQ2. ZnT8A could replace IAA for classification of patients above age 10 without loss of sensitivity or specificity.

CONCLUSIONS

ZnT8A, and to a lesser degree IA-2βA, may usefully complement GADA, IA-2A, and IAA for classifying insulin-treated diabetes under age 40 years.It is sometimes difficult to distinguish type 1 diabetes from other forms of the disease solely on clinical grounds—especially in adults—because of the large age-dependent heterogeneity in terms of severity of the initial clinical phenotype and the underlying insulitis and β-cell loss (1–3). The final classification of an individual as a type 1 diabetic patient relies heavily on the detection of antibodies against islet cell autoantigens (1). To this end, antibodies against insulin (IAA), the 65 kDa isoform of glutamate decarboxylase (GADA), insulinoma-associated antigen 2 (IA-2A), and as yet incompletely identified cytoplasmic antigens (ICA) have been widely used (4–8). About 10% of patients presenting with clinical features of type 1 diabetes are scored negative for these four types of antibodies, but the overrepresentation of the HLA-DQ2/DQ8 high-risk genotype in these individuals with idiopathic type 1 diabetes suggests that at least some of them have an immune-mediated disease process (1,9). Recently, antibodies against IA-2β/phogrin (IA-2βA; a protein with 79% homology to IA-2 in the protein tyrosine phosphatase domain [10–12]) and against zinc transporter 8 (ZnT8A; an isoform largely confined to pancreatic β-cells [8,13]) have been proposed as independent immune markers of type 1 diabetes (13–15).The aim of the current study was to measure IA-2βA and ZnT8A in a registry-based representative group of type 1 diabetic patients diagnosed under age 40 years and in healthy control subjects, with the following aims: 1) to improve the diagnosis of immune-mediated type 1 diabetes by increasing the number of autoantibody-positive patients (higher diagnostic sensitivity) and/or the number of patients with at least two different autoantibody specificities, a condition that is extremely rare in absence of diabetes (3) (higher diagnostic specificity); 2) to investigate associations of these additional autoantibodies with established antibody markers and with demographic (age and sex) and genetic (HLA-DQ) characteristics that have previously been correlated to some extent with differences in prevalence or levels of autoantibodies, diabetes incidence, or clinical severity of diabetes (1–4,9,16–19) to further document disease heterogeneity and patient subcategories; and 3) to search for markers that may advantageously replace IAA, an autoantibody test influenced by insulin treatment, with low sensitivity for onset after age 15 years and with generally only modestly elevated levels in case of positivity (3,7,19). These investigations are also relevant for the identification of preclinical subjects who may be enrolled in prevention studies in the future (13–15).