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Objectives The Pediatric Reference Intervals in China (PRINCE) was initiated to establish the reference intervals (RIs) of Chinese children, as well as to make it possible to compare the variability of biochemical markers among countries internationally. Methods Healthy participants, aged up to 20 years, from 11 provinces across China, were enrolled in PRINCE and according to a standard screening procedure, that included a questionnaire survey, physical examinations and laboratory tests. Fasting venous blood specimens were collected. All serum specimens were analyzed with Cobas C702 in the center laboratory, i.e. clinical laboratory of Beijing Children’s Hospital, with certified qualification (ISO15189). The nonparametric method recommended by Clinical Laboratory Standards Institute guidelines, was used to calculate the age- and sex-specified RIs. Results Among the 15,150 participants enrolled, 12,352 children (6,093 males and 6,259 females) were included to calculate RIs. The RIs for total protein, albumin, globulin, calcium, phosphate, potassium, sodium, chlorine, alkaline phosphatase, γ-glutamyl transpeptadase, alanine aminotransferase, aspartate aminotransferase, creatinine and urea were established by age- or sex-partitions. Most biochemical markers displayed larger variability and higher dispersion during the periods between 28 days and 1 year old, and included 4–6 age partitions commonly during 1 to Conclusions The age- and sex-specified RIs of 14 biochemical markers in PRINCE study can provide a solid reference, which will be transferred into relevant RIs for other clinical laboratory’s platforms according to the CLSI guidelines.

We aimed to establish age- and sex-dependent reference intervals for insulin-like growth factor 1 (IGF-1) based on the measurements of healthy Chinese children from the pediatric reference intervals in China study and to investigate whether body mass index (BMI) and height affect IGF-1 levels.A total of 3753 individuals with eligible blood specimens resampled from the pediatric reference intervals in China population were enrolled as reference individuals. IGF-1 levels were measured using a chemiluminescent immunoassay kit. The lower limit and upper limit values of the reference individuals were calculated by defining the 2.5th and 97.5th percentiles. The skewness-median-coefficient of variation method was used to calculate the standard deviation score (SDS) of serum IGF-1, and cubic spline curves were applied to depict a smoothed curve for each age- and sex-specific stratification of the L, M, and S parameters.Serum IGF-1 levels increased with age from the age of 1 year, peaking at around the age of 13 years in girls and 15 years in boys and then began to decline (both P.001). Before 14 years, IGF-1 levels were higher in girls than in boys at the same age, and the difference was statistically significant (P.05), but there was no significant difference in the IGF-1 levels between girls and boys aged 14 to 16 and 18 years. The Spearman correlation coefficients of height SDS, weight SDS, and BMI SDS with IGF-1 SDS were 0.29, 0.33, and 0.20, respectively (P.001).This study established age- and sex-specific normative IGF-1 data for Chinese children and adolescents between the ages of 1 and 19 years. The BMI and height SDS had no effect on IGF-1 levels in healthy children.

Objectives Pediatric Reference Intervals in China (PRINCE) is a nationwide initiative that aims to establish and validate harmonized reference intervals (RIs) for Chinese children and adolescents, in which 15,150 healthy volunteers aged up to 20 years were recruited from 11 centers to establish RIs and 7,557 children and adolescents were enrolled from 21 centers to validate RIs. Methods The complete blood cell counts (CBC) of venous whole blood were measured by hematology analyzers through Sysmex systems in different centers. Age- and sex-specific RIs were calculated according to the guidelines. Results Unlike adults with certain levels of analyte concentrations, hematological parameters of children changed through growth and development. Red blood cell counts, hemoglobin, and hematocrit increased with age, and revealed higher concentrations in boys than girls after puberty. White blood cell counts and platelet counts showed significant higher levels than adults before 2 years of age, and then gradually decreased without distinct sex differences. In addition, lymphocyte counts decreased with age while neutrophil counts showed an opposite trend. The lower and upper limits of pediatric RIs of CBC were different from those of adults. Conclusions The validation of RIs indicated that the PRINCE study provided a version of RIs suitable for most of regions in China. This first harmonized pediatric RIs of CBC across China provided a robust database to understand the dynamic changes of hematologic parameters from birth to adolescence, and will contribute to clinical diagnosis and prognosis evaluation for pediatric patients as well.

Background: Rituximab(R) added to chemotherapy(CT) prolongs survival among pediatric Burkitt’s lymphoma(BL). Data on its side effect in pediatric patients are limited. We aim to explore the therapeutic effect of different doses of R on children with BL in high-risk group and whether there is any difference in the level of immunoglobulin after treatment. Methods: We retrospectively summarize clinical data with high risk group BL treated in Beijing Children’s Hospital(BCH), baseline characteristics, treatment outcomes and serum immunoglobulin (Ig) level in different time point (before CT, end of CT, 6 months after CT, 12 months after CT)were collected. We compared the efficacy of CT combined with different doses of R and the difference of immunoglobulin level after treatment. At the same time, monitor whether the children have repeated severe infection and hepatitis B virus reactivation after treatment in the study period. Results: (1)baseline characteristics: 300 high risk group BL (256 boys,44 girls) were enrolled in this study, 300 patients were divided into 3 groups: standard CT group (R0, n=38), 6 doses of R+ CT group (R6 group, n=87) and 4 doses of R+ CT group (R4 group, n= 175). The 3-years EFS were 82%±4.9%, 91.9±2.5%, and 91.2±2.3% respectively. (2)The median level of Ig(before CT, end of CT, 6 months after CT, 12 months after CT): IgA level were 0.78g/L, 0.44g/L, 0.52g/L, and 0.69g/L. IgM level were 0.84g/L, 0.23g/L, 0.48g/L,and 0.7g/L. IgG level were 7.2g/L, 5.6g/L, 5.7g/L, and 6.6g/L. (3) Comparison the median Ig level after CT between R4 and R6 group(according to Ig level before chemotherapy, data was 1:1 matched, and 78 children were included in R4 and R6 group): IgA, IgM and IgG level in R4 group were all higher than that in R6 group after CT, and there was a statistical difference in the change trend between 2 groups in Ig A and IgM level. Conclusion: In children with high risk BL, rituximab combined with intensive chemotherapy can significantly improve the efficacy. Immune reconstitution is usually 6 months after the end of chemotherapy. There was no difference with treatment outcomes in R6 and R4 group, but the serum immunoglobulin reconstitution is faster after treatment in R4 group, IgA and IgG levels return to normal earlier.

PURPOSE Arsenic combined with all-trans retinoic acid (ATRA) is the standard of care for adult acute promyelocytic leukemia (APL). However, the safety and effectiveness of this treatment in pediatric patients with APL have not been reported on the basis of larger sample sizes. METHODS We conducted a multicenter trial at 38 hospitals in China. Patients with newly diagnosed APL were stratified into two risk groups according to baseline WBC count and FLT3-ITD mutation. ATRA plus arsenic trioxide or oral arsenic without chemotherapy were administered to the standard-risk group, whereas ATRA, arsenic trioxide, or oral arsenic plus reduced-dose anthracycline were administered to the high-risk group. Primary end points were event-free survival and overall survival at 2 years. RESULTS We enrolled 193 patients with APL. After a median follow-up of 28.9 months, the 2-year overall survival rate was 99% (95% CI, 97 to 100) in the standard-risk group and 95% (95% CI, 90 to 100) in the high-risk group ( P = .088). The 2-year event-free survival was 97% (95% CI, 93 to 100) in the standard-risk group and 90% (95% CI, 83 to 96) in the high-risk group ( P = .252). The plasma levels of arsenic were significantly elevated after treatment, with a stable effective level ranging from 42.9 to 63.2 ng/mL during treatment. In addition, plasma, urine, hair, and nail arsenic levels rapidly decreased to normal 6 months after the end of treatment. CONCLUSION Arsenic combined with ATRA is effective and safe in pediatric patients with APL, although long-term follow-up is still needed.

Background Arterial stiffness is an independent cardiovascular risk factor. However, the association between sodium/potassium intake and vascular stiffness was inconsistent. Therefore, a large community-based cross-sectional study was performed to try and achieve more definitive conclusion. Methods Urinary sodium, potassium, and creatinine levels were tested in spot urine samples during physical examinations of each recruited participant. The 24-h estimated urinary sodium excretion (eUNaE) and estimated urinary potassium excretion (eUKE) levels were determined using the Kawasaki formula (used as a surrogate for intake). Carotid intima-media thickness (IMT) and plaques were measured using ultrasound. Results In 13,523 subjects aged 18–80 years, the relationships between carotid plaques and IMT with eUNaE, eUKE and their ratios were analyzed. Overall, 30.2% of participants were diagnosed with carotid artery plaques. The ratio of estimated sodium vs. potassium excretion (Na/K ratio) of the individuals with carotid artery plaques was significantly higher than that of participants without plaque (2.14 ± 0.73 vs. 2.09 ± 0.61, P P P interaction Conclusions In this study, in which sodium intake was estimated on the basis of measured urinary excretion, high estimated excretion levels of urinary sodium and/or low estimated excretion levels of urinary potassium might be associated with an increased presence of carotid atherosclerosis in Chinese individuals.

Study on long-acting growth hormone (LAGH) therapy in Turner syndrome (TS) is a 2-year retrospective study including patients diagnosed with TS from 2018–2021. Patients were divided into four groups: Group 1 to 4 were low dose (0.1 mg/kg/ w), high-dose (0.2 mg/kg/w) LAGH, daily GH (0.38 mg/kg/w), and untreated control. The efficacy and safety data were analyzed. Seventy-five TS cases with the age 7.9±2.9 years and the bone age 6.8±2.8 years were recruited. In year 1: The change of height standard deviation score (ΔHtSDS) and height velocity (HV) in Group 2 were comparable to Group 3, both two groups were higher than Group 1. ΔHtSDS and HV in all GH treatment group were higher than untreated group. IGF1 increased in all treatment groups, only 4 cases had IGF1>3 SD. In year 2: ΔHtSDS and HV in Group 2 and 3 were comparable. Five cases had IGF1>3 SD. Correlation analysis for LAGH efficacy at year 1 indicated that baseline variables correlated with ΔHtSDS include: GH dose, CA (chronological age), and bone age (BA). The HV was positively correlated with baseline GH dose, HtSDS, IGF-1SDS and negatively correlated with baseline CA, BA, and BMI. No GH-related serious adverse effects were observed. The high-dose LAGH treatment in TS patients is effective and safe as daily GH for 2 years. The favorable prognosis factors include sufficient GH dose and early treatment. IGF1 monitoring and weight control are important.

ObjectiveTo evaluate patients’ benefits after cataract surgery and to form recommendations for Chinese national health policy decision makers and administration departments based on the quality of cataract treatments.MethodAn observational study based on real-world data source from the National Cataract Recovery Surgery Information Registration and Reporting System.ResultsA total of 14 157 463 original records were reported from 1 July 2009 to 31 December 2018. The factors that influenced the 3-day postsurgical best-corrected visual acuity (BCVA), the primary outcome, were analysed by logistic regression analysis. We found that a history of hypertension (OR=0.916) or diabetes (OR=0.912), presurgical pupil abnormality (OR=0.571) and high intraocular pressure (OR=0.578) were harmful to the postsurgical BCVA improvement (BCVA ≥6/20), while male sex (OR=1.113), better presurgical BCVA level (OR=5.996 for ≥6/12–6/60–ConclusionECCE with small incision has comparable effects on postsurgical BCVA improvement of phacoemulsification. Therefore, ECCE could be an alternative cataract surgical treatment in economically underdeveloped areas in China, provided the surgeons are adequately trained.

AIM This study aimed to determine the causal association between salt added to food and body mass index (BMI) by integrating a summary-level genome-wide association study (GWAS) data. METHODS We performed two-sample Mendelian randomisation (MR) analyses using summary statistics of GWAS. Inverse-variance weighted (IVW), maximum likelihood estimation, and random effect model were used to analyse the effect of salt added to food on BMI. A bidirectional MR analysis with BMI as the exposure and salt added to food as the outcome was also performed. RESULTS The single nucleotide polymorphisms (SNPs) were selected from the UK Biobank (n = 462 630) and a meta-analysis of 322 154 European-descent individuals. The IVW method estimate indicated that salt added to food was positively associated with BMI (β = 0.1416, SE = 0.0576, P = .0139). Results from maximum likelihood estimation (β = 0.1476, SE = 0.0363, P

Background and aims Abdominal aortic calcification (AAC) has been introduced as a good predictor of cardiovascular disease (CVD) events, but no previous study has investigated the relationship between folate levels and AAC. The present study aims to explore the relationship between red blood cell (RBC) folate, a better indicator reflecting long-term folate intake, and severe AAC in the United States (US) middle-aged and elderly population. Methods and results Cross-sectional data were derived from the National Health and Nutrition Examination Survey (NHANES) 2013–2014 of 2818 men and women aged 40 years or older. Multivariable logistic regression models were used to determine odds ratios (ORs) and 95% confidence intervals (CIs) for severe AAC of each RBC folate quintile category. The restricted cubic spline model was used for the dose–response analysis. A U-shaped dose–response relation between RBC folate and the odds of severe AAC was found after adjustment for multiple potential confounding factors, p for nonlinear = 0.0032. With the third quintile category of RBC folate as the reference, multivariable-adjusted ORs and 95% CIs of the lowest, second, fourth, and the highest quintile categories were 2.34 (1.37–4.00), 1.24 (0.70–2.19), 1.58 (0.92–2.70), and 2.26 (1.35–3.76), respectively. Conclusions Individuals with either low or high levels of RBC folate were at increased risks of severe AAC in a representative sample of US adults. While folate deficiency is widely recognized as harmful, these results highlight the need to investigate the potential adverse health outcomes of high folate level.

Objective: To compare and evaluate the palatability of two carbocysteine oral solutions (strawberry vs. mint taste) among healthy children aged 2–12 years.Methods: A randomized, triple-blind, crossover, palatability trial in 42 children aged 2–12 years. All subjects received two preparations of carbocysteine oral solutions (strawberry vs. mint) according to randomized administration sequences, and the administration process was recorded by video. The palatability assessed by emotional valences was performed using a facial action coding system by FaceReader™, which reflected the quantification degree of emotion; a positive value represents positive emotion, and a negative value represents negative emotion. At the same time, a face-to-face interview was conducted for 5- to 12-year-old participants. Then, the taste preferential rates were compared to assess the palatability of two carbocysteine oral solutions.Results: Forty-two children were enrolled in this study. Twenty children first tasted the carbocysteine oral solution mint taste and then the strawberry taste preparation (M-S sequence), while 22 children tasted the strawberry preparation first and then the mint one (S-M sequence). The emotional valence of mint preparation (−0.9 in M-S and −1.2 in S-M) was both relatively lower than that of strawberry taste (both −0.7 in M-S and S-M) in two sequences; 69.0% (29/42) of participants’ emotional valences for strawberry preparation were higher than those for mint preparation. Among 27 participants aged ≥5 years, the taste preference rate was 88.5% (23/26) for the strawberry preparation (one missing value for the taste preference), and 77.8% of participants (21/27) chose the strawberry preparation if they had to take the medicine one more time.Conclusion: The carbocysteine oral solution with strawberry taste is an appealing preparation since it was better received by children. The facial action coding system could be an effective alternative for palatability assessment of pediatric pharmaceutical products.

Accurate assessments of potassium intake in children are important for the early prevention of CVD. Currently, there is no simple approach for accurate estimation of potassium intake in children. We aim to evaluate the accuracy of 24-h urinary potassium excretion (24UKV) estimation in children using three common equations: the Kawasaki, Tanaka and Mage formulas, in a hospital-based setting. A total of 151 participants aged 5–18 years were initially enrolled, and spot urine samples were collected in the whole 24-h duration to measure the concentrations of potassium and creatinine. We calculated the mean difference, absolute and relative difference and misclassification rate between measured 24UKV and the predicted ones using Kawasaki, Tanaka and Mage formulas in 129 participants. The mean measured 24UKV was 1193·3 mg/d in our study. Mean differences between estimated and measured 24UKV were 1215·6, −14·9 and 230·3 mg/d by the Kawasaki, Tanaka and Mage formulas, respectively. All estimated 24UKV were significantly different from the measured values in all the time point (all P < 0·05), except for the predicted values from Tanaka formula using morning, afternoon and evening spot urine. The proportions with relative differences over 40 % were 87·2%, 32·5% and 47·3 % for Kawasaki, Tanaka and Mage formulas, respectively. Misclassification rates were 91·5 % for Kawasaki, 44·4 % for Tanaka and 58·9 % for Mage formula at the individual level. Our findings showed that misclassification could occur on the individual level when using Kawasaki, Tanaka and Mage formulas to estimate 24UKV from spot urine in the child population.

Critical gaps have existed in pediatric reference intervals in China. In this study, we presented the sex and age distributions of 21 laboratory analytes from childhood to adolescence, and established the corresponding continuous reference intervals based on direct samples.We used the data from the Pediatric Reference Intervals in China (PRINCE), which is a nation-wide cross-sectional study enrolling 15,150 healthy children and adolescents aged 0 -20 years from 11 centers across China. Blood samples were collected and analyzed by trained staff following standard operating procedures. Biochemical tests were performed with Cobas C702 at the central laboratory, and hematological tests were performed with Sysmex XE, XN, or XS that satisfy the national standards at each participating center. Children younger than 3 months were excluded due to high neonatal variability and insufficient samples. Continuous reference intervals were calculated using the generalized additive models for location, shape, and scale, and were validated among another 387 healthy volunteers.We provided pediatric continuous reference intervals for 21 commonly used biochemical and hematological analytes in China, and depicted the changes in analyte concentrations from 3 months to 20 years. The out-of-range values for all analytes were less than 10%, indicating a well applicability of the continuous reference intervals to the general pediatric population.This is the first comprehensive report of continuous reference intervals based on healthy Chinese children, reflecting the complex dynamic trends of analytes from infancy to adulthood. Applying continuous reference intervals to clinical practice would not only improve the laboratory test result interpretation, but also help better clinical decision making.

Background:No previous study explored the association between serum calcium levels and dyslipidemia in children. This study aimed to explore this relationship in children, based on a multicenter cross-sectional study population in China.Methods:Cross-sectional data was derived from the Pediatric Reference Intervals in China (PRINCE) study conducted between 2017 and 2018 involving 5,252 males and 5,427 females with a mean age of 10.0 ± 4.6 years. Multivariable logistic regression models were applied to calculate odds ratios (ORs), with 95% confidence intervals (CIs), for dyslipidemia of each serum calcium level and albumin-corrected calcium levels, which were sorted into quartiles. The restricted cubic spline model was fitted for the dose-response analysis. An L-shaped dose-response relation between calcium levels and the probability of dyslipidemia was found after the adjustment for multiple potential confounding factors,pfor non-linear < 0.001.Results:Using the middle category of calcium level as the reference, multivariable-adjusted ORs and 95% CIs of the lowest and the highest quartile categories were 0.96 (0.82–1.12) and 1.29 (1.12–1.48), respectively, for total serum calcium levels and 1.06 (0.91–1.23) and 1.39 (1.21–1.60) for albumin-corrected calcium levels.Conclusions:Individuals with higher levels of serum calcium were associated with increased risk of dyslipidemia in a sample of a healthy Chinese pediatric population. The association between serum calcium levels and dyslipidemia needs to be examined prospectively in future studies.

Purpose: To analyze the relationship between the severity of type 1 retinopathy of prematurity (ROP) and the level of vascular endothelial growth factor (VEGF) in aqueous fluid. Methods: The aqueous VEGF levels of 49 patients (88 eyes) with type 1 ROP were retrospectively analyzed. These eyes were categorized into three groups according to the severity of disease: aggressive retinopathy of prematurity (A-ROP), threshold of ROP (T-ROP), and type 1 pre-threshold ROP (P-T-1). The differences in aqueous VEGF levels among these three groups were compared. The relationship between the aqueous VEGF level and the retinal changes of ROP, including the vessel tortuosity in zone I, and the location and stage of the ROP lesions, were also analyzed. Results: The aqueous VEGF level of the A-ROP group was the highest among the three groups, followed by those of the T-ROP and P-T-1 groups. The aqueous VEGF level was negatively correlated with the zone and the stage of the ROP diseases, while it was positively correlated with the venous tortuosity in zone I and had no relevance with the artery tortuosity in zone I. Conclusions: The aqueous VEGF level in A-ROP was the highest in type I ROP. The location of the ROP lesions and the venous tortuosity in zone I correlated with the aqueous VEGF level and could indicate the severity of ROP.

Recovery of propylene from polypropylene (PP) purge stream is of great importance due to both more efficient conversion of the monomers and environmental protection. Herein, eight stable metal–orga...

Molecular sieving is a highly efficient method for gas separation because of its ultra-high selectivity. Nevertheless, traditional adsorbents with a molecular sieving effect can only separate a specific gas mixture due to their constant pore apertures. It is still a challenge to continuously fine-tune pore apertures at the sub angstrom scale to separate various gas mixtures in a given porous material. Herein, a temperature-responsive smart molecular gate with a precisely controllable pore size is proposed and validated for molecular recognition and separation, achieved by introducing methoxyl groups into the narrow bottleneck of a metal–organic framework (MOF). The effective aperture size of a smart molecular gate can be continuously tuned from 3.6 to 5.2 A, covering the size range of commercially important gas molecules. Consequently, the MOF with such a structure exhibits highly selective uptake of several gas mixtures, including N2/CH4, CH4/C2H4, C2H4/C3H6, C3H6/C3H8, and C3H8/i-C4H10, by controlling the opening degree of the smart molecular gate. Furthermore, to verify its practical application, C3H6/C3H8 separation performance was systematically evaluated, and excellent selectivity for C3H6/C3H8 can be achieved at room temperature. This rational design of a smart molecular gate in this work opens a new avenue for the application of smart materials for gas separation.

OBJECTIVE To examine the effect of different limits of acceptability on the Hoffmann method for selecting "healthy" populations from laboratory test data. METHODS Thyroid stimulating hormone (TSH) and free thyroxine (FT4) were measured in Shunyi Maternal and Children's Hospital of Beijing Children's Hospital. The sample size of participants of TSH and FT4 for reference intervals (RIs) establishment was 10,864 and 10,799, respectively. RIs were calculated by Hoffmann method with different acceptable deviations (α value). The validation data was collected prospectively and the out-of-range (OOR) values were calculated to examine the applicability of RIs with different acceptable deviations. The sample size for RIs validation was 880 and 867, respectively. The RIs were considered as valid when OOR was

Background: During the last decade, support to public welfare programs, development of device-dependent techniques and increased awareness of public health have all caused rapid growth in the number of cataract surgeries performed in China. However, cataract surgery outcomes and the applicability of device-dependent interventions for cataract patients nationwide are still unknown. This study aimed to evaluate the outcomes of cataract surgeries, from a health administration perspective. The data analysed were based on the National Cataract Recovery Surgery Information Registration and Reporting System. The final objective was to provide a roadmap for future health service policies for cataract surgeries. Methods: The data source of this study is the National Cataract Recovery Surgery Information Registration and Reporting System. All cataract cases receiving any surgical treatment, both in medical services and institutes nationwide, should be registered and reported online within four days of the surgery. The variables included: medical institute settings, clinical characteristics of patients, pre-surgical examinations of the cataract-operated eyes, surgical information, and post-surgical visual status. A case-control design was adopted for this study based on the data collected from the electronic registered report system. A descriptive analysis was conducted to analyse the tendency of cataract surgery in the past decade. With LogMAR transferred, the pre-surgical best-corrected visual acuity (BCVA) level was stratified to compare the BCVA improvement level before and after the surgery. The multinomial logistic regression model was used to explore the influencing factors of 3-day post-surgical BCVA improvement, and Normogram visualisation was used to predict the prognosis of cataract surgery. Findings: A total of 1,4157,463 original records were reported from July 1st 2009 to the 31st of December 2018. The mean age of the reported data was 69.7 years, with 69% of the cases in the 61-80 years group. Female accounted for 58.0%. The median of pre-surgical LogMAR transferred BCVA was 0.2, while those of the post-surgery 3-day and 3-month were 0.5 and 0.6, respectively. Cataract surgery had a very good effect on improving post-surgical BCVA. From binary logistic regression analysis, history of hypertension (OR = 0.916) or diabetes (OR = 0.912), pre-surgical pupil abnormality (OR = 0.571), high intraocular pressure (OR = 0.578) did not affect post-surgical BCVA improvement (BCVA ≥ 6/18), while male sex (OR = 1.113), better pre-surgical BCVA level (OR = 5.996 for 0.5-0.7 and OR = 2.610 for 0.2-0.4 taken ≤ 0.1 as reference), age-related cataract (OR = 1.825), and intraocular lens implantation (OR = 1.886) were statistically beneficial for post-surgical BCVA improvement. Considering the surgery types, compared with the ECCE with large incision, the ECCE with small incision (OR value = 1.810) and the phacoemulsification (OR = 1.420) significantly improved the benefit probability. Among the hospital administration affiliation, compared with the provincial medical institutions, the benefit probability of county medical institutions was doubled, with an OR value of 2.084 (95% CI 2.029-2.140). Interpretation: ECCE with small incision has comparable effects on post-surgical BCVA improvement of phacoemulsification. Therefore, it could be an alternative cataract surgical treatment in economically underdeveloped areas in China. Funding Statement: None. Declaration of Interests: All authors claimed no conflict of interest. Ethics Approval Statement: Due to the application of the electronic data from the system, we deemed and were granted ethical approval for the study plan, data management plan and an exemption of informed consent. The approval was provided by the Ethics Committee of the National Institute of Hospital Administration in China (Ethics NO. 1015).

BackgroundPrevious studies have shown that elevated trimethylamine N-oxide (TMAO) was associated with a higher risk of diabetes mellitus (DM). Little is known about the relationship between dietary intake of choline, which is a major dietary precursor for gut microbiome-derived TMAO, and DM in the general population.ObjectiveThe present study aims to explore the relationship between dietary choline intakes and DM in the United States (US) adult population.DesignCross-sectional data were derived from the National Health and Nutrition Examination Survey (NHANES) 2007-2010 of 8621 individuals aged 20 years or older. Multivariable logistic regression models were used to determine odds ratios (ORs) and 95% confidence intervals (CIs) for DM of each quartile category of energy-adjusted choline intakes. The restricted cubic spline model was used for the dose-response analysis. The receiver operating characteristic (ROC) curve was used to determine the optimal cut-off value of choline intake for predicting DM.ResultsA linear dose-response relationship between dietary choline intakes and the odds of DM was found after adjustment for multiple potential confounding factors, p for linear =0.0002. With the lowest quartile category of choline as the reference, the multivariable-adjusted ORs and 95% CIs of the second, third, and highest quartile categories were 1.22 (0.98, 1.52), 1.26 (1.01, 1.56), and 1.42 (1.15, 1.77), respectively, p for trend =0.0024. Per 100 mg/d increase in energy-adjusted choline resulted in 15% (95% CI: 7%, 22%) higher odds of DM. The ROC analysis identified an energy-adjusted choline of 331.7 mg/d as the optimal cut-off value for predicting DM, with 52.5% sensitivity and 60.7% specificity.ConclusionThis study supports a positive and linear relationship between dietary choline intake and DM in the US adult population. Further studies are warranted to replicate our findings in other populations and elucidate the potential mechanisms.

Background Statistical adjustment is often considered to control confounding bias in observational studies, especially case–control studies. However, different adjustment strategies may affect the estimation of odds ratios (ORs), and in turn affect the results of their pooled analyses. Our study is aimed to investigate how to deal with the statistical adjustment in case–control studies to improve the validity of meta-analyses. Methods Three types of adjustment strategies were evaluated including insufficient adjustment (not all preset confounders were adjusted), full adjustment (all confounders were adjusted under the guidance of causal inference), and improper adjustment (covariates other than confounders were adjusted). We carried out a series of Monte Carlo simulation experiments based on predesigned scenarios, and assessed the accuracy of effect estimations from meta-analyses of case–control studies by combining ORs calculated according to different adjustment strategies. Then we used the data from an empirical review to illustrate the replicability of the simulation results. Results For all scenarios with different strength of causal relations, combining ORs that were comprehensively adjusted for confounders would get the most precise effect estimation. By contrast, combining ORs that were not sufficiently adjusted for confounders or improperly adjusted for mediators or colliders would easily introduce bias in causal interpretation, especially when the true effect of exposure on outcome was weak or none. The findings of the simulation experiments were further verified by the empirical research. Conclusions Statistical adjustment guided by causal inference are recommended for effect estimation. Therefore, when conducting meta-analyses of case–control studies, the causal relationship formulated by exposure, outcome, and covariates should be firstly understood through a directed acyclic graph, and then reasonable original ORs could be extracted and combined by suitable methods.

Summary Antibody levels after hepatitis B virus (HBV) vaccination may be affected by suppression of the immune system due to cancer therapy. As such, childhood acute lymphocytic leukaemia (ALL) survivors are at risk of HBV infection due to immunosuppression secondary to chemotherapy. However, the hepatitis B surface antibody (HBsAb)-seropositive rate of childhood ALL survivors after chemotherapy is unknown, and the need to revaccinate HBsAb-seronegative ALL survivors is not appreciated in China. To assess the changes in HBsAb before and after chemotherapy, we retrospectively analyzed clinical data from 547 patients treated with the Chinese Children Leukaemia Group (CCLG)-ALL 2008 protocol from 1 April 2008 to 30 August 2019. The results revealed that 416 patients (76·1%) were HBsAb-seropositive at diagnosis, and at the time of the cessation of chemotherapy, 177 patients (32·4%) were HBsAb-seropositive and 370 patients (67·6%) were HBsAb-seronegative. Interestingly, 11 patients who were HBsAb-seronegative at diagnosis converted to seropositive at the time of the cessation of chemotherapy. HBsAb titres were decreased after chemotherapy (P

Low sodium and high potassium intake is reported to be a risk of hypertension. However, it is uncertain whether these associations can be generalized to those without hypertension. This study is to evaluate the associations of systolic and diastolic blood pressure (SBP and DBP, respectively) with estimated urinary sodium excretion (eUNaE), estimated urinary potassium excretion (eUKE) and their ratio (Na/K ratio) among hypertensive, normotensive, and hypotensive Chinese individuals.A large institution-based cross-sectional study was conducted at the Third Xiangya Hospital, Changsha between August 2017 and November 2018. Spot urine samples were collected to test urinary sodium, potassium, and creatinine excretions for each participant. The Kawasaki formula was used to estimate 24-hour urinary sodium and potassium excretions.A total of 26,363 eligible subjects were used to analyze the associations of blood pressure with eUNaE, eUKE, and their ratio. 27.3% (n=7,201) of participants were diagnosed with hypertension, 5.4% (n=1,427) were diagnosed with hypotension, and the remaining of 17,735 participants were normotensive. A significant increase in SBP and DBP was related to the Na/K ratio increase in hypertensive and normotensive subgroups (all ptrend0.01), but the association was not significant for DBP among hypotensive individuals (ptrend=0.58). Stronger associations of SBP with the Na/K ratio were observed in older people (pinteraction0.01) and females (pinteraction0.0001), but the same trend was not observed for DBP (pinteraction=0.10 and 0.88, respectively).High potassium and low sodium intake were further confirmed to reduce blood pressure in hypotensive, normotensive, and hypertensive individuals.

Additional file 2: Main SAS code of the simulation for scenario Ref.

Additional file 1: Supplementary materials.