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Fetuin-A is a multifunctional glycoprotein that has been implicated in insulin resistance and bone metabolism. We assessed whether fetuin-A is associated with poor or excessive fetal growth. In the Shanghai Birth Cohort, we conducted a nested case-control study of 60 trios of small-for-gestational-age (SGA, birth weight 90th percentile) infants matched by sex and gestational age. Cord plasma concentrations of fetuin-A and fetal growth factors [insulin, proinsulin, insulin-like growth factor (IGF)-I and IGF-II] were measured. Cord plasma fetuin-A concentrations were higher in SGA (809.4 ± 306.9 μg/ml, P = 0.026) and LGA (924.2 ± 375.9 μg/ml, P < 0.001) relative to OGA (680.7 ± 262.1 μg/ml) newborns, and were not correlated to insulin, proinsulin, IGF-I and IGF-II (all P > 0.2). Higher fetuin-A concentrations were associated with increased risks of SGA [OR = 1.67 (1.08–2.58) per SD increment, P = 0.024] and LGA [OR = 2.36 (1.53–3.66), P < 0.001]. Adjusting for maternal and neonatal characteristics and fetal growth factors, the elevated risk changed little for LGA [adjusted OR = 2.28 (1.29–4.01), P = 0.005], but became non-significant for SGA (P = 0.202). Our study is the first to demonstrate that fetuin-A may be involved in excessive fetal growth. This association is independent of fetal growth factors.

Knee osteoarthritis (KOA) is one of the most common musculoskeletal disorders. Although the available evidence for its efficacy is inconclusive, acupuncture is used as an alternative therapy for KOA. The aim of this trial is to determine the efficacy of electro-acupuncture and manual acupuncture versus sham acupuncture for KOA.This is a study protocol for a randomised, three-arm, multicentre, clinical trial. A total of 480 patients with KOA will be randomly assigned to the electro-acupuncture group, the manual acupuncture group or the sham acupuncture group in a 1:1:1 ratio. All patients will receive 24 sessions over 8 weeks. Participants will complete the trial by visiting the research centre at week 26 for a follow-up assessment. The primary outcome is the success rate: the proportion of patients achieving a minimal clinically important improvement, which is defined as ≥2 points on the numerical rating scale and ≥6 points on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) function score at week 8 compared with baseline. Secondary outcomes include the numerical rating scale, WOMAC score, global patient assessment and quality of life at weeks 4, 8, 16 and 26 after randomisation.This trial may provide high-quality evidence for the efficacy of acupuncture in the treatment of KOA. The results of this study will be published in peer-reviewed journals.ClinicalTrials.gov, NCT03274713 . Registered on 20 November 2017.

Exposure to hazardous Hg can adversely affect children's neurodevelopment. However, few data are available on either Hg levels in neonates and their mothers or the impact of prenatal exposure to Hg on neonates' neurobehavioral development in the Chinese population. Therefore, this study examined Hg levels in neonates and their mothers and the relationship between prenatal exposure to Hg and neonates' neurobehavioral development in Zhoushan City, Zhejiang Province, China. Between August and October 2004, 417 women who delivered their babies at Zhoushan Women's and Children's Health Hospital, an island city in east China were invited to take part in this study. A total of 408 complete questionnaires, 405 maternal hair samples, and 406 umbilical cord samples were collected. Neonatal behavioral neurological assessments (NBNA) were conducted for 384 neonates. The geometric mean (GM) of Hg level in cord blood was 5.58 microg/L (interquartile range: 3.96-7.82 microg/L), and the GM of maternal hair Hg level was 1246.56 microg/kg (interquartile range: 927.34-1684.67 microg/kg), a level much lower than other reported fish-eating populations, indicating Hg exposure in Zhoushan city is generally below those considered hazardous. However, according to the reference dose of Hg levels (RfD 5.8 microg/L) derived by EPA, 69.9% of newborns had levels at or above the RfD, an estimated level assumed to be without appreciable harm. There was a strong correlation between maternal hair and cord blood Hg levels (r = 0.82, P < 0.01). Frequency of fish consumption was associated with hair Hg (r = 0.48, P < 0.01) and cord blood Hg levels (r = 0.54, P < 0.01). Increased prenatal Hg exposure was associated with decreased behavioral ability for males (OR = 1.235, 95%CI of OR = 1.078-1.414, P < 0.001), but not for females. Our results provide some support for the hypothesis that there is neurodevelopmental risk for males from prenatal MeHg exposure resulting from fish consumption. But the findings of this study may be due to chance, and long-term follow-up research is needed to evaluate cumulative effects of exposure to mercury.

To evaluate the effects and safety of penetrating needling on head acupoints for perennial allergic rhinitis (PAR).Eighty-one cases of PAR were randomly divided into an acupuncture group (41 cases) and a medication group (40 cases). Penetrating needling at head acupoints was adopted from Baihui (GV 20) to Qianding (GV 21) and from Shangxing (GV 23) to Shenting (GV 24) in the acupuncture group. A to tal 4-week treatment was given to the patients with 3 treatments a week. Loratadine tablet and azelastine hydrochloride nasal spray were given to the medication group continuously for 12 days. A follow-up was carried out 3 months after the treatment. The efficacy, symptom score and physical sign score, and side accidents were observed in both groups.The total effective rate was 95.1% (39/41) in the acupuncture group, which was better than 82.5% (33/40) in the medication group (P0.05). The total scores of clinical symptoms and each partial scores after the treatment, and total scores of clinical symptoms in follow-up were obviously decreased in both groups (all P0.01), the nasal obstruction score and the total scores of clinical symptoms in the acupuncture group were better than those in the medication group (P0.01, P0.05). Obvious side-effect had not been found during the treatment.Penetrating needling at head acupoints is a safe therapy for patients with PAR, and favorable effects can be found in both short term and long term.

The effects of low-level prenatal manganese (Mn) exposure on neonatal growth remain unclear. The level of fetal Mn that may be considered "safe" has never been examined.A multicenter study including 1377 mother-infant pairs was conducted from 2008 through 2009 in Shanghai. Mn concentrations were determined for both the cord and maternal serum, as well as neonatal birth weight and birth length. The ponderal index (PI) was calculated as (birth weight g/birth length cm(3))×100, and a ponderal index ≥3.17 was defined as a high ponderal index (HPI).The median serum Mn concentration was 4.0μg/L in the cord blood, and was 2.8μg/L in maternal blood. Of 1377 infants, 135 (9.8%) had a HPI. After adjusting for potential confounders, cord serum Mn was not associated with birth weight. However, there was a linear relationship between the cord serum Mn and the birth length (adjusted ß=-0.5, 95% CI=-0.7 to -0.2, p0.0001). Additionally, a nonlinear relationship was observed between the cord serum Mn and the ponderal index, and between the cord serum Mn and HPI. The ponderal index and the prevalence of HPI increased with Mn levels above 5.0μg/L (Log Mn ≥0.7). A high level of Mn in the cord (≥5.0μg/L) was associated with a higher ponderal index (adjusted ß=0.2, 95% CI=0.1 to 0.2, p0.001) and a high risk of HPI (adjusted OR=3.3, 95% CI=1.8-6.0, p0.001).Higher prenatal Mn exposure, even at a low level, is associated with a higher prevalence of HPI in a nonlinear pattern. Cord serum Mn levels less than 5.0μg/L may be considered safe with respect to neonatal ponderal index assessment.

To explore the curative effect and safety of acupuncture for mild cognitive disorders after stroke.Randomized controlled trial was adopted and one hundred cases conforming to criteria were divided into a combined acupuncture and medication group (group A) and a medication group (group B), 50 cases in each group. The basic treatment of cerebrovascular disease was applied in two groups. The group A treated was with acupuncture at Baihui (GV 20), Shenting (GV 24) and Qucha (BL 4) etc. and oral administration of Nimodipine. In group B, Nimodipine was taken orally. The treatment lasted for 3 months, the scores of Mini-Mental State Examination (MMSE), modified Hasegawa Dementia Scale (HDS-R) and Barthel Index (BI) were observed before and after treatment in two groups.The total effective rate in group A was 66.7% (32/48), which was superior to 30.4% (14/46) in group B (P0.05). The scores of MMSE, HDS-R and BI after treatment were apparently improved as compared with those before treatment in two groups (all P0.01). The improvements in group A were superior to those in group B (all P0.05). There was no adverse event reported during the treatment in two groups.Acupuncture can improve activity of daily living and has significant effect in treating mild cognition disorders after stroke without adverse reactions.

To explore the exposure level and risk factors of heavy metal among Shanghai infants in their prenatal period.A total of 1652 pregnant or puerperal women were recruited from 10 midwifery-qualified hospitals in Shanghai since October 2008 to October 2009, by the stratified cluster sampling method. They answered the questionnaire and their umbilical cord blood and serum were collected to detect the content of Pb, Hg, Mn, Cd, As and Tl. The risk factors were analyzed by single and multiple regression methods respectively.The median value of the content of Pb, Hg, Mn, Cd, As and Tl were 41.00, 1.88, 4.10, 0.03, 0.86 and 0.02 µg/L respectively. The Hg concentration of pregnant women who ate fish for 4 - 7 times per week (9.7% (160/1652)) was 2.76 µg/L, which was higher than that of pregnant women who only ate fish for 1-3 times per week (49.3% (814/1652)) and those who seldom ate fish (40.0% (661/1652)); the Hg concentration in the two groups above were 2.41 and 2.03 µg/L separately. The difference had statistical significance (χ(2) = 36.40, P0.001). Meanwhile, the concentrations of Pb and Tl in the group of pregnant women whose houses were remodeled by PVC pipe (85.0% (1404/1652)) was higher than the concentrations in group of pregnant women whose houses were remodeled by galvanized pipe (15.0% (248/1652)); the Pb concentration in the two groups above were 45.54 and 40.00 µg/L (Z = 2.54, P0.05) and the Tl concentration in the two groups above were 0.021 and 0.018 µg/L (Z = 2.97, P0.05). However, the As concentration in the group of PVC pipe remodeled was 4.33 µg/L, which was lower than that in the group of galvanized pipe (9.37 µg/L). The difference had statistical significance (Z = 3.99, P0.01). The concentrations of Mn, Cd and Tl in the groups of pregnant women whose house had been remodeled in the last 3 years (38.0% (628/1652)) were 14.78, 0.51 and 0.022 µg/L separately, which were all significantly higher than those in the groups of women whose houses' were not remodeled (62.0% (1024/1652)), whose concentrations were 11.01, 0.29 and 0.02 µg/L respectively. The differences had statistical significance (Mn: Z = 2.46, P0.05; Cd: Z = 2.38, P0.05; Tl: Z = 2.81, P0.01).The infants in Shanghai were exposed to heavy metals in their prenatal period. The main sources of the exposure were daily diet and remodeled pollution.

To observe the therapeutic effect and safety of three-step acupuncture for the secondary prevention of ischemic cerebral apoplexy.One hundred and twenty cases of first-episode ischemic cerebral apoplexy were randomly divided into an observation group and a control group according to the visiting sequence, 60 cases in each group. Both groups were treated on the basis of the routine treatment, the observation group was treated with three-step acupuncture combined with oral administration of Aspirin for six months. The threestep acupuncture includs scalp acupuncture, body point acupuncture and rehabilitation training. The control group was treated with oral administration of Aspirin alone. Six-month follow-up was done in two groups. Then the recurrence rate of ischemic cerebral apoplexy, the improvement of neurologic impairment, activity of daily living and TCM symptom scores and the safety of three-step acupuncture between two groups were compared.The recurrence rate was 10.2% (5/49) in observation group, and 16.7% (9/54) in control group. There was no significant difference between two groups (P0.05). The observation group was superior to the control group in improving the scores of the neurologic impairment, activity of daily living and TCM symptom (P0.01, P0.001). There was no severe adverse reaction in two groups except 2 cases of gastrointestinal reaction caused by oral administration of Aspirin in control group.Three-step acupuncture has a certain therapeutic effect for both treatment and the secondary prevention of ischemic cerebral apoplexy, and it is one of the safe and effective methods for treating and preventing ischemic cerebral apoplexy in clinic.

To study the effects on the expression of mGluR5 mRNA and protein levels in primarily cultured hippocampal neurons after lead exposure.Primary embryonic rat hippocampal neuronal culture was prepared. On the 3(rd) day of incubation, lead chloride solution was added into medium to produce four different lead exposure levels: 0, 1 x 10(-8) mol/L, 1 x 10(-6) mol/L, 1 x 10(-4) mol/L Pb(2+). After 10 days of incubation, the neurons were collected to measure the alteration of mGluR5 mRNA expression by real-time fluorescent quantity PCR and the expression of mGluR5 in protein level by Western blot.The studies revealed that mGluR5 mRNA expression was down-regulated after lead exposure in a dose-dependent manner. The mGluR5 mRNA expression of the lower lead-exposed neurons (Pb(2+) 10(-8) mol/L), the medium lead-exposed neurons(Pb(2+) 10(-6) mol/L), the higher lead-exposed neurons(Pb(2+) 10(-4) mol/L) were 0.724, 0.421, 0.321 times less than that of the controls, respectively. The Western blot demonstrated that mGluR5 expression in protein level should be decreased after lead exposure.The expression of mGluR5 in mRNA and protein levels should be down-regulated after lead exposure at different lead levels in a dose-dependent manner.

To explore the effects of preweaning exposure to enriched environment on hippocampal neurogenesis and the underlying mechanisms.Thirty-six 10-day-old SD rats were randomly divided into the 2 equal groups: control group and enriched environment group (EE group. From the age of 10 days to 24 days the rats received intraperitoneal injection of bromodeoxyuridine (BrdU) 50 mg/kg every other day to label the newly proliferated cells in vivo, and the rats in EE group were daily exposed to enriched environment for 20 minutes. Six rats of each group were sacrificed whren they were 24 days of age. Nuclear protein of the hippocampus was extracted to undergo Western blotting to detect the levels of calmodulin and phosphorylated CREB (cAMP response element binding). Other rats were sacrificed at the age of 63 days. Coronal cryostat sections of brain were cut. Sections at the level 3.6 mm posterior to the bregma were obtained and stained with methyl aniline blue and the number of cells in the hippocampal dentate gurus (DG) of the right hemisphere were counted using x 400 microscope. BrdU immunohistochemistry and double immunofluorescence labeling with BrdU/NeuN or BrdU/GFAP were done, and the numbers of BrdU-labeled cells and ratios of neurons and astrocytes differentiated from BrdU-labeled cells were calculated.The levels of calmodulin and phosphorylated CREB in the hippocampal nuclear extract of the EE group were 0.065 +/- 0.035 and 0.485 +/- 0.007 respectively, both significantly higher than those of the control group (0.245 +/- 0.035 and 0.220 +/- 0.014 respectively, P = 0.01 and P = 0.002). The number of cells in the DG area of right hippocampus 3.6 mm posterior to bregma of the EE group was 1580 +/- 72, significantly higher than that of the control rats (1375 +/- 62, t = -7.461, P0.01). The number of BrdU labeled cells of the EE group was 5363 +/- 487, significantly higher than that of the control group (2984 +/- 318, t = -14.177, P0.01). The ratio of neurons of the EE group was 85.0% +/- 2.8%, significantly higher than that of the control group (80.2% +/- 2.8%, t = -4.166, P0.01). The differentiation rate of astrocytes of the EE group was 4.0% +/- 0.5%, significantly higher than that of the control group (2.6% +/- 0.6%, t = -6.493, P0.01).Preweaning exposure to enriched environment can induce neurogenesis. The underlying mechanism may be that enriched environment induces the activation of calmodulin and CREB in hippocampus.

To investigate the status of mercury exposure of neonates and their mothers in Zhoushan City, and analyze the related influencing factors.From Aug to Sep, 2004, 408 neonate-mother pairs were cluster sampled at the Third People's Hospital in Dinghai region, Zhoushan City, and a further investigation for the neurobehavioral development of these children was followed up in a year. The contains of mercury of 14 kinds of fish, 5 pieces of each kind bought in markets of Dinghai region were detected.The geometric mean of cord-blood Hg was 27.81 nmol/L (5.58 microg/L), while that of hair Hg of mothers was 1246.56 microg/kg. 69.9% of pregnant women had surpassed the RfD (reference dose, 0.1 microg/kg/day) for Hg intake. There was a strong correlation between hair and cord blood Hg levels (r = 0.821). The factors influencing cord-blood Hg levels were fish dinners, dwelling time, and fathers smoking or not, while those of hair Hg were fish dinners and dwelling time. The correlation between fish dinners and the cord blood Hg as well as hair Hg were of significance (r = 0.539, 0.481 respectively), the Hg levels were higher in more fish dinners (H = 119.805, 94.384 respectively). The mean fish Hg level at Dinghai region was low (0.1 mg/kg), and no samples were higher than 0.5 mg/L. Two samples of cutlassfish and dried eel contained higher Hg than the others, belonging to a middle level (0.1-0.5 mg/kg).Hg levels in neonates and pregnant women were generally below those considered hazardous, but the safety margin was narrow for some women and supporting efforts should be made to reduce mercury exposure. The main resource of Hg was from eating fish, and it is necessary to investigate the Hg levels in large samples, as to developing the fish advisories for susceptible people.

To explore the genetic susceptibility of children to vitamin D deficiency rickets through studying the association between Vitamin D receptor (VDR) gene polymorphism and vitamin D deficiency rickets.One hundred and fifty-nine children (100 boys and 59 girls, aged 0 to 2 years), with new-onset vitamin D deficiency rickets were enrolled. The patients sampled from a community of Jiamusi City, Heilongjiang Province. Seventy-eight healthy age-matched children (46 boys and 32 girls) were used as the controls. VDR gene polymorphism (cleaved by restriction endonuclease Fok I) was analyzed by polymerase chase reaction-restriction fragment length polymorphism (PCR-RFLP). The frequencies of the VDR genotype and allele were compared between the two groups.The frequencies of FF, Ff and ff genotypes were 37%, 51% and 12% in the Rickets group, and 18%, 55% and 27% in the Control group. A significant difference was found in the frequency distribution of the VDR genotype between the two groups (chi(2)(0.01(2))=9.210, chi(2)=13.3880, P0.01). In the Rickets group, f allele frequency was lower (37% vs 54%), while the F allele was more common than the Control group (63% vs 46%).There is an association between the VDR gene Fok I polymorphism and vitamin D deficiency rickets. The individuals with the F allele are more susceptible to vitamin D deficiency rickets.