Disorders of Sex Development in Individuals Harbouring MAMLD1 Variants: WES and Interactome Evidence of Oligogenic Inheritance

Mastermind-like domain-containing 1 (MAMLD1) has been shown to play an important role in the process of sexual development and is associated with 46,XY disorders of sex development (DSDs). However, the causative role of MAMLD1 variations in DSDs remains disputable. In this study, we have described a clinical series on children from unrelated families with 46,XY DSD harbouring MAMLD1 variants. Whole exome sequencing (WES) was performed for each patient. WES data were filtered using common tools and disease customisation algorithms, including comparison against lists of known and candidate MAMLD1-related and DSD-related genes. Lastly, we investigated the hypothesis that MAMLD1-related DSD may follow an oligogenic mode of inheritance. Forty-three potentially deleterious/candidate variants of 18 genes (RET, CDH23, MYO7A, NOTCH2, MAML1, MAML2, CYP1A1, WNT9B, GLI2, GLI3, MAML3, WNT9A, FRAS1, PIK3R3, FREM2, PTPN11, EVC, and FLNA) were identified, which may have contributed to the patient phenotypes. MYO7A was the most commonly identified gene. Specific gene combinations were also identified. In the interactome analysis, MAMLD1 exhibited direct connection with MAML1/2/3 and NOTCH1/2. Through NOTCH1/2, the following eight genes were shown to be associated with MAMLD1:WNT9A/9B, GLI2/3, RET, FLNA, PTPN11, and EYA1. Our findings provide further evidence that individuals with MAMLD1-related 46,XY DSD could carry two or more variants of known DSD-related genes, and the phenotypic outcome of affected individuals might be determined by multiple genes.

Age-Dependent Changes in the Plasma Proteome of Healthy Adults

OBJECTIVE

Human blood plasma is a complex that communicates with most parts of the body and reflects the changes in the state of an organism. Identifying age-related biomarkers can help predict and monitor age-related physiological decline and diseases and identify new treatments for diseases.

METHODS AND PARTICIPANTS

In this study, TMT-LC-MS/MS was utilized to screen differentially expressed plasma proteins in 118 healthy adults of different ages. Participants were divided into three groups: 21-30 years of age (Young), 41-50 years of age (Middle) and ≥60 years of age (Old).

RESULTS

The number of differentially expressed proteins in the comparisons of Young vs Middle, Middle vs Old and Young vs Old were 82, 22 and 99, respectively. These proteins were involved in numerous physiological processes, such as "negative regulation of smooth muscle cell proliferation" and "blood coagulation". Moreover, when Young was compared with Middle or Old, "complement and coagulation cascades" was the top enriched pathway by KEGG pathway enrichment analysis. Functional phenotyping of the proteome demonstrated that the plasma proteomic profiles of young adults were strikingly dissimilar to those of the middle-aged or older adults.

CONCLUSIONS

The results of this study mapped the variation in the expression of plasma proteins and provided information about possible biomarkers/treatments for different age-related functional disorders.

[Clinical phenotype and gene analysis of 86 cases of 5 alpha reductase deficiency]

Objective: Molecular genetics and clinical phenotypic characteristics of 5 alpha reductase deficiency were analyzed. Methods: The genetic results and clinical features classied as Prader grade of external genitalia of 86 children with SRD5A2 mutation seen from 2007 to 2017 at Department of Endocrinology of Beijing Children's Hospital were analyzed, and the mutation differences in different were compared regions according to the literatures. Results: Among the 86 children, 15 had were homozygous mutations, accounting for 17%, and 71 cases of compound heterozygous mutations accounted for 83%. Totally 172 alleles mutations in this series. The mutation was mainly located on exon 1 and exon 4, in which the mutation frequency of exon 1 was 23.8% (41/172), and the frequency of exon 4 mutation was 55.8% (96/172). A total of 19 mutation types of the SRD5A2 gene in this group were detected, of which 5 were new mutations (p.A228F, p.E57D, p.V124D, p.A117D, p.E197K); 65 patients had p.R227Q mutation, accounting for 76%, while 31 had p.Q6* mutation, accounting for 36%. Other rare types such as p.R246W, p.R103* and so on were also seen in the present study, there was no significant difference between north China and south China (P>0.05). The clinical phenotypes of p.R227Q variation varied, mainly in Prader 3-4, accounting for 82%, while (Prader 0-1) were less, accounting only 2%. The variation of p.Q6* was mainly manifested in Prader 3, accounting for 50%. p.R246Q mainly presented Prader 3. The variation of p.G203S appeared to have Prader 2 and Prader 4-5, accounting for 20% and 73% respectively. There was no significant difference in clinical phenotype corresponding to each protein type (P>0.05) . Conclusion: Among the 86 children have identified 19 SRD5A2 mutation types, p.R227Q is a hotspot mutation in Chinese. Variations at different types may have different clinical phenotypes, while the same variations may have different clinical features. There was no significance different in the variation types between the north and the south.

[Gender selection and postoperative follow-up analysis in 85 children with 46, XY disorders of sex development]

Objective: To understand the gender selection and prognosis of children with 46, XY disorders of sex development (DSD) after surgery, and to provide reference for future clinical decision-making. Methods: Data of 85 (80 males and 5 females) postoperative patients with 46, XY DSD with follow-up age of 6(4,11) years who were treated at the Department of Endocrinology, Genetics and Metabolism of Beijing Children's Hospital Affiliated to Capital Medical University during the period from September 2009 to April 2018 were retrospectively analyzed. The patients were grouped based on diagnosis. The basis of postoperative gender selection, patient satisfaction and related factors, gender characteristics, and adolescent development were analyzed. The Pre-school Activities Inventory or the Children's Sex Role Inventory were used in the analysis of gender tendency. Mann-Whitney U test was used to compare postoperative gender satisfaction of different factors. The Kruskal-Wallis method was used to compare the postoperative gender satisfaction of each group. Fisher's test was used to compare the follow-up status of male children over 11 years old in each group. Results: Among the 85 patients, 62 individuals were raised as girls after birth, 9 were facultative and 14 as boys. According to the diagnosis, there were 31 individuals in group 1 (with 5α-reductase deficiency), 11 individuals in group 2 (with androgen insensitivity syndrome), 9 individuals in group 3 (with NR5A1 gene mutation), 4 individuals in group 4 (with hypergonadotropic gonadal dysplasia), and 30 indiviudals in group 5 (with unclear diagnosis and normal human choionic gonadotophin test). Among the 71 children who were raised as girls or facultative children after birth, 66 selected as boys, and 5 continued as girls (among them, 3 individuals were female with passive selection, and 2 individuals of testicular dysplasia with uterus in group 4 and 5 were female with active selection). Among the 71 patients faced with gender selection, only one was unsatisfied, that was a postoperative female. There was no significant difference in postoperative gender satisfaction among different disease diagnoses, surgical age and penis length (χ(2)(H)=6.007, P=0.199; Z=-0.860, P=0.390; Z=-0.438, P=0.661). Fifty-nine of the 85 cases completed the gender tendency scale test and 46 cases (78%) were consistent. In the male patients, 45 cases were consistent. Thirteen inconsistent patients (22%) were female or facultative after birth who were 5 years old or older. There was no stigmatization noticed in the inconsistent patients' daily life and school social settings. There were 22 male patients aged 11 years and older. They were 13(12,16) years old. Fourteen (64%) individuals' penile length reached the normal minimum, 15 (68%) individuals' testicular volume were equal or more than 4 ml, 16 (73%) individuals' sex hormones entered puberty levels, 12 (55%) individuals had been spermatorrhea, the age of first spermatorrhea was (13.3±2.4) years. They were satisfied and adaptable after surgery. There was no significant difference in the above indicators among the groups (χ²=2.999, P=0.694; χ²=7.278, P=0.086; χ²=5.597, P=0.358; χ²=6.904, P=0.127). Conclusions: The appropriate gender of 46, XY DSD patients was selected according to gonadal status after diagnosis. Regardless the diagnosis, the age of operation and the length of the penis at the first diagnosis, male patients were satisfied with the gender after the operation. A few of patients were inconsistent with the results of gender tendency scale test who were raised as girls or facultative children after birth, and they required sustained special attention. Some of the children showed natural adolescent development in males, and the prognosis may be ideal.

The diagnosis of cystinosis in patients reveals new CTNS gene mutations in the Chinese population

Background Cystinosis is a rare autosomal-recessive disorder caused by a defective transport of cystine across the lysosomal membrane. Previous studies have mapped cystinosis to the CTNS gene which is located on chromosome 17p13, and various CTNS mutations have been identified to correlate them with this disease. Methods We analyzed six patients from five unrelated families who were diagnosed with cystinosis in our hospital. We described the diagnostic procedures for all the patients and proposed alternative therapies for cystinosis patients instead of using cysteamine, an orphan drug which was commercially unavailable in China. Moreover, genetic analysis of all patients' samples was carried out to identify novel CTNS gene mutations. Results and conclusions The patients in this study were followed up from 1 to more than 10 years to monitor their growth and development, which indicated that the alternative therapies we used were helpful to ameliorate the complications of the cystinosis patients without cysteamine. Furthermore, by sequencing the patients' genome, we identified novel mutations in the CTNS gene including: c.477C > G (p.S159R), c.274C > T (p.Q92X) and c.680A > T (p.E227V); these mutations were only observed in cystinosis patients and had never been reported in any other populations, suggesting they might be specific to Chinese cystinosis patients.

[Clinical analysis of thyroid cancer in 62 children]

Objective: To analyze the clinical characteristics and prognosis of thyroid cancer in children. Methods: Clinical data of 164 children (60 boys, 104 girls) with space-occupying lesions of the thyroid who were hospitalized in Beijing Children's Hospital Affiliated to Capital Medical University from July 2006 to December 2017 were collected. Sixty-two children with thyroid cancer were reviewed respectively and followed up by telephone. Results: From July 2006 to December 2017, children with thyroid cancer accounted for 37.8% (62/164) of children with space-occupying lesions of the thyroid. The number of children with space-occupying lesions of the thyroid every 2 years was 13, 21, 19, 33, 38, 41, and the number of children with thyroid cancer every 2 years was 2, 5, 3, 8, 21, 23. One out of 62 thyroid cancer was follicular thyroid cancer, the others were papillary thyroid cancer, neck mass was the chief complaint in 60 of 62 patients. Two cases were brought to hospital with respiratory tract oppression as the chief complaint. Forty-eight cases got long-term follow-up by telephone, over 50 percent of cases received follow-up for more than 2 years, the median follow-up time was 2.63 years (0.25-8.67 years), most of these patients had favorable prognoses. Hypothyroidism (98%) and hypocalcemia (33%) were main long-term complication. Hypothyroidism recovered well after thyroxine replacement therapy, and in only 5 children hypocalcemia was spontaneously relieved, the average remission time was 1.9 months, the longest time for recovering from hypocalcemia was 6 months; the other cases responded well when they were treated as secondary hypoparathyroidism, with no hypocalcemia symptoms. Nine children had distant metastasis after operation, the average recurrence time was 12.8 months, and the latest relapsing time was 2 years. The overall prognosis was good, the longest follow-up period was 8 years and no death was found. Conclusions: Pediatric space-occupying lesions of the thyroid and thyroid cancer are rising during the last 12 years. Hypothyroidism and hypocalcemia are main long-term complications after surgery, the children cases recovered well, the remission of hypocalcemia was achieved not later than 6 months. The overall prognosis of childhood thyroid cancer was good, without death within the follow-up period.

[Interleukin-1β and C-reactive protein level in plasma and gingival crevicular fluid in adolescents with diabetes mellitus]

OBJECTIVE

Cytokines produced by various cells are strong local mediators of inflammation. Interleukin-1beta (IL-1β) and C-reactive protein (CRP) play essential roles in the development and progression of diabetes mellitus (DM). Thus periodontal diseases could be related to DM via the same mediators of inflammation. To evaluate plasma and gingival crevicular fluid (GCF) levels of IL-1β and CRP in adolescents with DM to further investigate whether DM has an impact on the levels of inflammation factors at an early stage, and to analyze the risk of developing periodontal diseases in adolescents with DM.

METHODS

A total of 121 adolescents aged from ten to sixteen years were enrolled, 41 adolescents diagnosed with diabetes mellitus were collected in the DM group, and 80 nondiabetic adolescents as the control group. The periodontal indices of each individual were recorded, including plaque index (PLI), modified bleeding index (mBI), probing depth (PD) and attachment loss (AL). GCF and intravenous blood samples were collected, and CRP and IL-1β levels were detected by enzyme-linked immunosorbent assay (ELISA).

RESULTS

(1) PLI of DM group and control group were 1.23±0.05 and 0.95±0.04 separately, with significant difference (P=0.001). DM group and control group had mBI of 0.80±0.08 and 0.51±0.06 separately, with significant difference (P=0.003). Attachment loss was found in none of the subjects. PDs of DM group and control group were (2.37±0.51) mm and (2.31±0.05) mm separately, and there was no significant difference. (2) CRP in GCF was only detectable in partial of the individuals, with a detectable rate of 22.9% (11/48) in total. The detectable rate of CRP in GCF was significantly higher in DM group (38.5%) than that in control group (4.5%, P=0.006). The plasma level of CRP in DM group [0.23 (0.15, 1.89) mg/L] was higher than that in control group [0.19 (0.12, 4.18) mg/L], but without significance (P=0.776). (3) The plasma levels of IL-1β in DM group and control group were (14.11±0.57) ng/L and (14.71±0.50) ng/L separately, but there was no significance (P=0.456). GCF levels of IL-1β in DM group and control group were (12.91±1.95) μg/L and (17.68±3.07) μg/L, without significant difference (P=0.185).

CONCLUSION

Periodontitis was not observed in adolescents with DM at an early stage. However, the rising levels of periodontal indices and CRP in GCF, might indicate that adolescents with DM have a higher risk of developing periodontal diseases in the future.

Clinical and Molecular Spectrum of Glutamate Dehydrogenase Gene Defects in 26 Chinese Congenital Hyperinsulinemia Patients

OBJECTIVE

To characterize the genotype and phenotype of Chinese patients with congenital hyperinsulinism (CHI) caused by activating mutations in GLUD1, the gene that encodes mitochondrial enzyme glutamate dehydrogenase (GDH).

METHODS

The clinical data of glutamate dehydrogenase hyperinsulinism (GDH-HI) patients were reviewed, and gene mutations were confirmed by whole exome sequencing (WES) and Sanger DNA sequencing.

RESULTS

Twenty-six patients with GDH-HI heterozygous missense mutations were identified from 240 patients diagnosed as congenital hyperinsulinism over past 15 years. The median age at onset was 8 months (range: 1 day of life to 3 years). Seizure disorder was common in our cohort of patients (23/26). Four patients had normal serum ammonia levels; the median serum concentration was 101 μmol/L (range: 37-190 μmol/L). Hypoglycemic symptoms could be triggered by fasting or protein meals in all patients while blood glucose could be well controlled in all patients with diazoxide. Dosage of diazoxide could be reduced by protein restriction. Attempts to lower ammonia levels failed with different therapies such as protein restriction, benzoate, or N-carbamoyl glutamate. In follow-up, 15 of 26 patients had normal intelligence. Eleven patients developed epilepsy at the age of 6 months to 11 years. De novo mutations in GLUD1 were found in 24 cases, and dominant inheritance was observed in the other two; all were heterozygous. A total of 35% (9/26) patients carried c.1493C>T (p.S445L) mutation.

CONCLUSIONS

Phenotypic heterogeneity of GDH-HI patients was observed within the Chinese cohort in the present study. The fact that most patients had a GLUD1 p. S445L mutation implies that this site could be a hotspot in Chinese patients. A high frequency of GDH-HI with normal ammonia has been reported in this study. Hence, GLUD1 mutational analysis may be an important method to differential diagnosis of GDH-HI from other diazoxide-responsive CHI in Chinese patients.

Permanent neonatal diabetes caused by abnormalities in chromosome 6q24

BACKGROUND

Methylation defects at chromosome 6q24 usually induce transient neonatal diabetes mellitus. There are few reports of permanent neonatal diabetes mellitus caused by abnormalities of 6q24. We report the first case of permanent neonatal diabetes mellitus to be associated with confirmed methylation defects at chromosome 6q24.

CASE REPORT

A baby girl, small for her gestational age, was found to have high blood glucose 1 day after birth, with no systematic congenital anomalies. She showed no remission of diabetes and has hitherto been reliant on insulin (now aged of 5.5 years), which supports a diagnosis of permanent neonatal diabetes mellitus. The single nucleotide polymorphism array and highly polymorphic short tandem repeat analysis identified paternal uniparental disomy of chromosome 6, and a genome-wide analysis ruled out mutations in coding and non-coding regions.

CONCLUSION

This report expands the varieties of neonatal diabetes known to be induced by methylation defects at chromosome 6q24, and suggests that the diagnostic evaluation of permanent neonatal diabetes mellitus should be expanded to include testing for 6q24.

[Effect of the use of antibiotics controlled by clinical pharmacist in patients with diabetic ketoacidosis]

Objective: To analyze the effect of the use of antibiotics intervened by clinical pharmacist in diabetic ketoacidosis (DKA) patients. Method: This was a prospective clinical study with a historical control group.The group 1 was the control group which was not intervened for antibiotics use from January 2010 to November 2012. The group 2 was the intervention group treated from December 2012 to June 2016. Group 1 was divided into group 1a which included newly-onset diabetes patients and group 1b which included long standing diabetes patients. Group 2 was divided into the similar group 2a and group 2b.Clinical pharmacist supervised the implementation of terms to restrict the use of antibiotics.Changes of the rate of antibiotics use, the length of time of antibiotics use, hospital stay, the cost of antibiotics, etc.were compared. Result: In group 1a and group 2a, the rate of antibiotics use was 85%(107/126) and 31%(58/190)(χ(2)=25.787), the length of time of antibiotics use was 11(7-18)d and 6(4-10)d (U=1 507), the hospital stay was 23(18-27)and 20(6-24)d(U=8 177) , the cost of antibiotics was 1 615(1 000-2 970)and 1 080(504-1 932) yuan ( U=1 783), the differences had statistical significance(P<0.05). In group 1b and group 2b, the rate of antibiotics use was 97% (33/34) and 48% (23/48)(χ(2)=14.222), the length of time of antibiotics use was 8(6-12)d and 5(4-7)d (U=180), the hospital stay was 15(10-21)and 12(8-16)d (U=580), the cost of antibiotics was 2 200(1 356-3 100)and 1 600(705-2 200) yuan (U=223), the differences had statistical significance(P<0.05). Conclusion: Clinical pharmacist intervened use of antibiotics was effective in reducing the use of antibiotics and financial burden.

Efficacy and safety of domestic leuprorelin in girls with idiopathic central precocious puberty: a multicenter, randomized, parallel, controlled trial

Background:

In central precocious puberty (CPP), the pulse secretion and release of gonadotropin-releasing hormone (GnRH) are increased due to early activation of the hypothalamic-pituitary-gonadal axis, resulting in developmental abnormalities with gonadal development and appearance of secondary sexual characteristics. The CPP without organic disease is known as idiopathic CPP (ICPP). The objective of the study was to evaluate the clinical efficacy and safety of domestic leuprorelin (GnRH analog) in girls with ICPP.

Methods:

A total of 236 girls with ICPP diagnosed from April 2012 to January 2014 were selected and were randomized into two groups. One hundred fifty-seven girls in the test group were treated with domestic leuprorelin acetate, 79 girls in the control group were treated with imported leuprorelin acetate. They all were treated and observed for 6 months. After 6-month treatment, the percentage of children with peak luteinizing hormone (LH) ≤3.3 U/L, the percentage of children with peak LH/peak follicle stimulating hormone (FSH) ratio <0.6, the improvements of secondary sexual characteristics, gonadal development and sex hormone levels, the change of growth rate of bone age (BA) and growth velocity, and drug adverse effects between two groups were compared.

Results:

After the treatment, the percentage of children with a suppressed LH response to GnRH, defined as a peak LH ≤3.3 U/L, at 6 months in test and control groups were 96.80% and 96.20%, respectively, and the percentage of children with peak LH/FSH ratio ≤0.6 at 6 months in test and control groups were 93.60% and 93.70%, respectively. The sizes of breast, uterus and ovary of children and the levels of estradiol (E₂) were significantly reduced, and the growth rate of BA was also reduced. All the differences between pre- and post-treatment in each group were statistically significant (P < 0. 05), but the differences of the parameters between two groups were not significant (P > 0.05).

Conclusions:

Domestic leuprorelin is effective and safe in the treatment of Chinese girls with ICPP. Its effectiveness and safety are comparable with imported leuprorelin.

Correlation between blood glucose fluctuations and activation of oxidative stress in type 1 diabetic children during the acute metabolic disturbance period

BACKGROUND

Studies have shown that complications in type 1 diabetes mellitus (T1DM) in children are mainly due to oxidative stress (OS). Lipid peroxidation is the main marker of OS and iso-prostaglandin is a reliable biomarker of lipid peroxidation in type 2 diabetes mellitus (T2DM). However, there have been few studies on OS in T1DM children with hyperglycemia and glucose fluctuations.

METHODS

We prospectively enrolled 23 newly diagnosed T1DM patients and 23 age and sex matched healthy controls in Beijing Children's Hospital from May 2010 to January 2011. They were treated with continuous subcutaneous insulin injection (CSII) and monitored by continuous glucose monitoring system (CGMS). Twenty-four-hour urine samples were collected to measure the concentration of 8-iso prostaglandin F2a (8-isoPGF2α). Samples taken from diabetic children were collected at days 8 to 10 after insulin treatment. Intraday glucose fluctuations were assessed by mean amplitude of glucose excursions (MAGE), largest amplitude of glycemic excursions (LAGE), standard deviation of blood glucose (SDBG) and number of glycemic excursions (NGE). The correlations between glucose parameters and the index of oxidative stress were analyzed.

RESULTS

Urine 8-isoPGF2α in the T1DM group was higher than that in the control group ((967.70±412.68) ng vs. (675.23±354.59) ng, P = 0.019). There was a correlation between urine 8-isoPGF2a level and MAGE (r = 0.321, P = 0.039), a significant correlation between low-density lipoprotein and urine 8-isoPGF2a level (r = 0.419, P = 0.03). There was no significant correlation between urine 8-isoPGF2α level and blood pressure, glycosylated hemoglobin (HbA1c), fasting C-peptide or other lipid indices.

CONCLUSION

A correlation between urine 8-isoPGF2a levels and MAGE and low-density lipoprotein was found in children newly diagnosed with T1DM.

[Survey on the levels of lipids in school-aged children of Beijing, Tianjin, Hangzhou, Shanghai, Chongqing and Nanning cities]

OBJECTIVE

To investigate the lipid levels of Han ethnicity Chinese children at school-age, to provide objective data for the formulation of prevention and management strategy regarding dyslipidemia among children and adolescents.

METHODS

20 191 children (with 10 669 boys and 9522 girls) aged 7 to 16 years old from 6 representative geographical areas, including Beijing, Tianjin, Hangzhou, Shanghai, Chongqing and Nanning, were surveyed in a randomly selected clustered sample in China. Data on fasting blood triglyceride (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) levels were measured. Non-high-density lipoprotein cholesterol (non-HDL-C) levels were calculated with data collection, entry, and collation were under the same criteria.

RESULTS

(1) In the 7 - 16 year-old group, TG (P(95)) fluctuated between 1.26 mmol/L and 1.88 mmol/L, while TC (P(95)) was between 4.80 mmol/L and 5.46 mmol/L. LDL-C (P(95)) was between 2.67 mmol/L and 3.27 mmol/L while non-HDL-C (P(95)) was between 3.36 mmol/L and 3.91 mmol/L, suggesting that age did not seem to be an affecting factor for the lipid level (P > 0.05). The level of HDL-C (P(5)) fluctuated between 1.08 mmol/L and 0.83 mmol/L, and the dependability analysis on HDL-C and age showed statistically significant difference (P < 0.01, r = -0.274). (2) In the 7 - 9 year-old group, the levels of TG, TC, LDL-C and non-HDL-C of boys were lower but the HDL-C level was higher than in girls. However, in the 10-16 year-old group, the levels of five lipids of boys were all lower than in girls, with all the differences statistically significant (P < 0.05). (3) The levels of TG, TC, LDL-C and non-HDL-C in the obese group were significantly higher than those in non-obesity group, as HDL-C was significantly lower than in non-obese group (P < 0.01). Incidence rates of single and multiple dyslipidemia in obese group were significantly higher than in non-obese group (P < 0.01). (4) Grouped by region, the abnormal rates of TG were descending, with the ranking as North (10.4%), Midwest (9.7%) and East (8.3%), while the abnormal rates of TC were descending with the ranking as Midwest (6.0%), North (5.2%) and East (4.8%). The abnormal rates of LDL-C were descending as the ranking of North (3.1%), East (2.6%) and Midwest (0.9%), with the abnormal rates of non-HDL-C were descending as Midwest (6.5%), North (4.2%) and East (3.6%). The abnormal rates of HDL-C were descending as Midwess (14.2%), North (5.7%) and East (5.5%). All the differences in the above-said items were statistically significant (P < 0.05). (5) According to the standards of hyperlipidemia formulated by the American Academy of Pediatrics, the incidence rates of abnormal TG, TC, LDL-C, non-HDL-C, HDL-C were 9.4%, 5.4%, 2.2%, 4.8%, 8.6% respectively.

CONCLUSION

(1) Levels of lipids were affected by many factors, but age was not one of them in children and adolescents. However, HDL-C was declining along with the increase of age, to some extent. (2) Girls had a relatively protective tendency through the increasing HDL-C level when they entered the puberty years. (3) Lipids levels in non-obese group were significantly better than the obese group. (4) The lipids levels of children and adolescents in the Eastern region of the country were better than that in the northern and mid-western areas.

A new mutation in the thyroid hormone receptor gene of a Chinese family with resistance to thyroid hormone

BACKGROUND

Resistance to thyroid hormone (RTH) is a dominant inherited syndrome of reduced tissue responsiveness to thyroid hormone. It is usually due to mutations located at the ligand-binding domain and adjacent hinge region of the thyroid hormone receptor β (TRβ). We report the clinical and laboratory characteristics and the genetic analysis of a patient with this rare disorder and his family members.

METHODS

The clinical presentations and changes of thyroid function tests (TFTs) including magnetic resonance imaging (MRI) of pituitary and other laboratory tests were analysed. TFTs of his family's members were detected as well. Direct DNA sequencing of the TRβ gene was done for those with abnormal TFTs.

RESULTS

The RTH child had goiter, irritability, aggressiveness, and sudoresis. His TFTs showed high levels of circulating free thyroid hormones (FT(4) and FT(3)) and normal thyroid-stimulating hormone (TSH) concentrations. He felt worse when treated as hyperthyroidism (Grave disease) with thiamazole and his clinical presentations got improved obviously when treated as RTH with bromocriptine without obvious advert effect. We identified a novel missense mutation, A317D, located in exon 9 of the gene of this boy and his mother. His mother had not any clinical presentation, but having abnormal TFTs results.

CONCLUSIONS

This patient reported here was concordant with the criteria of RTH. The feature is dysfunction of hypothalamus-pituitary-thyroid axis. A novel mutation was found in the TRβ, A317D, of this family. This research verified the phenomena that there is a clinical heterogeneity within the same mutation of different RTH patients.

Phenylbutyric acid prevents rats from electroconvulsion-induced memory deficit with alterations of memory-related proteins and tau hyperphosphorylation

Electroconvulsive therapy has been commonly applied in the treatment of refractory depression, but its cognitive side effects are noticed and restrict its application. The molecular mechanisms underlying the side effects remain elusive, and there is no efficient prevention. By employing a recognized electroconvulsive shock (ECS) rat model, we found in the present study that ECS induced spatial memory deficits with simultaneous decreases in synaptic proteins of N-methyl-D-aspartate receptor 2A/B (NR2A/B) and postsynaptic density 95 (PSD95), the immediate early gene c-Fos and cAMP response element binding (CREB) proteins, all of which are memory-related proteins. ECS also caused tau hyperphosphorylation at multiple Alzheimer-related phosphorylation sites with activation of glycogen synthase kinase-3beta (GSK-3beta), Akt and phospho-PKR-like endoreticulum (PERK), and inhibition of protein phosphatase-2A (PP)-2A. Intraperitoneal injection of phenylbutyric acid (PBA), an aromatic short chain fatty acid with the functions of molecule chaperon, prevented rats from the ECS-induced memory deficits, alterations of the memory-associated proteins, and tau hyperphosphorylation. Our data suggest that PBA may be potentially used for attenuating the side effects caused by electroconvulsive therapy.

[The prevalence of diabetes in children and adolescents of Beijing]

OBJECTIVE

To study the prevalence of Diabetes mellitus (DM) in children and adolescents and to describe the characteristics on age, gender and district distribution of schoolchildren, in Beijing.

METHODS

A cross-sectional screening program the fasting capillary blood glucose (FCBG) was carried out in 19,593 schoolchildren in 7 areas of Beijing from March to October, 2004. According to the WHO diagnostic criteria: DM was set as FCBG < or = 6.1 mmol/L, impaired fasting glucose (IFG) was set as 5.6 mmol/L < or = FCBG < 6.1 mmol/L.

RESULTS

The total aggregate age-adjusted prevalence rates of DM and IFG were 5.7 per thousand and 13.5 per thousand, respectively. The prevalence rates of DM and IFG in males were significantly higher than that in females (7.7 per thousand vs. 3.6 per thousand and 26.8 per thousand vs. 11.3 per thousand. DM X2 = 12.27, P = 0.0005; IFG X2 =47.29, P = 0.0000). Among seven districts, East District had the highest prevalence rates of DM and IFG, 8.9 per thousand and 27.4 per thousand (companied high obesity 28.68%) while Ping-Gu District having the lowest ones as 2.0 per thousand and 7.5 per thousand (obese 12.75%) respectively (X2 = 13.75, and X2 = 32.65, P = 0.0002 and P < 0.0001). The DM prevalence rates between districts ranged from 2.0 per thousand to 8.9 per thousand, X2 = 18.94, P = 0.004 and the IFG prevalence of districts ranged from 7.5 per thousand to 27.4 per thousand (X2 = 52.05, P < 0.0001). The prevalence rates of DM among different age groups increased with age, with the highest prevalence of IFG on the 10-14 age group. Among boys, the highest prevalence rates of DM and IFG fell in the 15-18 and 10-14 age groups respectively while the highest prevalence rates on both DM and IFG among girls were in the same age group 10-14.

CONCLUSION

The high prevalence rates on DM and IFG were seen in Beijing and showed significant discrimination on age, gender and district distribution. More developed urban district and males had a higher prevalence, companied by higher obesity prevalence. Age seemed to be a high risk factor on DM for boys while the puberty development seemed a high risk factor for girls.