BACKGROUND:To examine the characteristics and factors associated with bone maturation among children aged 6-15 years in Shenzhen, stratified by sex, age, and pubertal stage. METHODS:The Evaluation and Monitoring on School-based Nutrition and Growth in Shenzhen, China' data on body mass index, body composition, bone age (BA), and biochemical examinations were analyzed. The Z-score of BA minus chronological age (ZBA-CA) was calculated for the same sex, age, and pubertal stage. RESULTS:We included 3780 students aged 6-15 years, comprising 2091 (55.3%) boys and 1689 (44.7%) girls. The proportions of children with BA advancement ≥2 years were 10.1% for boys and 9.9% for girls. We established the standard deviation curves of BA-CA for boys and girls with normal weights at different ages under different pubertal stages. Visceral fat area rank (VFA-R) and relative handgrip strength rank (RHGS-R) correlated positively with ZBA-CA at each quantile in boys, while only VFA-R correlated positively in girls. CONCLUSIONS:Bone maturation should be evaluated according to sex, age, nutritional status, and pubertal stage. VFA-R and RHGS-R were positively correlated with ZBA-CA, independent of the nutritional status. IMPACT STATEMENT:We produced the first standard deviation curves of bone age minus chronological age (BA-CA) for children aged 6-15 years, stratified by sex, age and pubertal stage, to evaluate bone maturation. Our findings revealed that body composition index might affect bone maturation independent of nutritional status. Body mass index, commonly used to evaluate obese children with advanced bone age, does not account for differences and relationship between body composition and bone maturation. These findings offer valuable insights for clinical practice to formulate targeted interventions for slowing down bone maturation and improving growth-related disorders' management in children.

Objective:Children born small for gestational age (SGA) are at a greater risk of developing insulin resistance, type 2 diabetes, and cardiovascular disease in adulthood. Gastrointestinal peptides, some secreted by intestinal L cells, regulate glucose and lipid metabolism and act on the hypothalamus to regulate energy homeostasis. The aim of this study was to explore whether gastrointestinal peptides are involved in metabolic disorders in SGA, which remains unclear.Methods:The secretion of glucagon-like peptide 1 (GLP-1) and peptide YY (PYY) were investigated in prepubertal children born SGA, the differences between catch-up growth and persistent short stature were compared, and correlation with glucose and lipid metabolism was analyzed. GLP-1, PYY, insulin-like growth factor 1, glucose, insulin, and lipid concentrations were analyzed in prepubertal children aged 4-10 years, stratified into three groups: short-SGA (SGA-s), catch-up growth SGA, and normal growth appropriate for gestational age (AGA).Results:Fasting GLP-1 and PYY concentrations were significantly lower in the SGA group than in the AGA group (p<0.05), and the GLP-1 level in infants born SGA with catch-up growth was lower than that in the SGA-s group (p<0.05). In the SGA population, GLP-1 showed a weak negative correlation with catch-up growth (r=-0.326) and positive correlation with fasting insulin (r=0.331).Conclusion:Lower GLP-1 concentrations may be associated with abnormal glucose metabolism in prepubertal children born SGA with catch-up growth. This is indirect evidence that impaired intestinal L cell function may be involved in the development of metabolic complications in SGA children.

ObjectiveThis study aimed to investigate the clinical application effect of an augmented reality (AR) plasticity model on the postoperative visual function recovery of children with concomitant exotropia.MethodsBetween September 2019 and October 2021, 28 patients with concomitant exotropia who visited Shenzhen Children’s Hospital (9 male and 19 female) were enrolled in this study. The average age of the patients was 6.4 ± 1.8 years. Postoperative rehabilitation training was conducted using a personalized AR binocular visual perception plasticity model developed based on the patient’s examination results. After 1 month, 3 months, and 6 months of training, the patients returned to the hospital for examinations of perceptual eye position, static zero-order stereopsis, dynamic first-order fine stereopsis, and dynamic second-order coarse stereopsis to compare the changes in eye position control and stereovision function.ResultsAfter 6 months of eye position training, the horizontal perception eye position of the 28 patients was significantly lower than that before training. The difference in eye position at the first and third months compared with that before training was not statistically significant (1st month: z = −2.255, p = 0.024 > 0.017; 3rd month: z = −2.277, p = 0.023 > 0.017; 6th month: z = −3.051, p = 0.002 < 0.017). The difference in vertical perceptual eye position after training compared with that before training was not statistically significant (1st month: z = −0.252, p = 0.801 > 0.017; 3rd month: z = −1.189, p = 0.234 > 0.017; 6th month: z = −2.225, p = 0.026 > 0.017). The difference in 0.8-m static zero-order stereopsis before and after training was not statistically significant (1st month: z = −2.111, p = 0.035 > 0.017; 3rd month: z = −1.097, p = 0.273 > 0.017; 6th month: z = −1.653, p = 0.098 > 0.017). The 1.5-m static zero-order stereopsis was improved after 1 month, 3 months, and 6 months of training compared with that before training (1st month: z = −3.134, p = 0.002 < 0.017; 3rd month: z = −2.835, p = 0.005 < 0.017; 6th month: z = −3.096, p = 0.002 < 0.017). Dynamic first-order fine stereopsis and dynamic second-order coarse stereopsis were measured in the 28 patients before and after training. Patients 1 and 18 had no dynamic first-order fine stereopsis before training, but both regained dynamic stereopsis after 1 month, 3 months, and 6 months of training. Patient 16 had no dynamic first-order fine stereopsis or dynamic second-order coarse stereopsis before training, but first-order and second-order stereopsis had been reconstructed after 1 month, 3 months, and 6 months of training.ConclusionConcomitant exotropia surgery improved the basic problem of eye position at the ocular muscle level, but the patient’s perceptual eye position and visual function defects at the brain visual level remained. This might partly explain the poor postoperative clinical effect. The AR plasticity model can improve patients’ horizontal perceptual eye position and multi-dimensional stereoscopic function, and its clinical effect warrants further study.

Background and objective:With a worldwide trend to earlier age of onset of puberty, the prevalence of early-onset puberty (EP) among girls has increased. The impact of EP on the pattern of linear growth and bone maturation is unclear. Accordingly, the objective of our study was to describe this pattern for girls with EP in Shenzhen, China. Methods:A total of 498 untreated girls diagnosed with EP at Shenzhen Children's Hospital, China, between January 2016 and December 2021. A total of 1,307 anthropometric measurements and 1,307 left-hand radiographs were available for analysis. Artificial intelligence (AI) was used to determine bone age (BA). Participants were classified into groups according to chronological age (CA) and BA. The pattern of linear growth (height) and progression of bone maturation was described between groups using the Lambda-Mu-Sigma (LMS) method. Published height-for-CA and height-for-BA norm references for a healthy Chinese population were used for age-appropriate comparisons. Results:The mean CA of appearance of first pubertal signs (breast buds) was 8.1 ± 0.5 years. Compared to norm-referenced data, girls with EP were significantly taller at a CA of 7-10 years. This was followed by a slowing in linear growth after a CA of 10 years, with 71 girls with EP having already achieved their target adult height. From 7 to 10 years of BA, the linear growth was slower in the EP group compared to norm-reference values. This was followed by a period of catch-up growth at 11.2 years of BA, with growth curves approaching norm-referenced values. The BA progressed rapidly from 7 to 8 years of age in about half of the girls with EP (median ΔBA/ΔCA >1.9), slowing, thereafter, until the period of catch-up growth at 11.2 years of BA. Conclusions:BA provides a more reliable reference than CA to assess growth parameters among girls with EP. Our limited data set does indicate that EP does not negatively impact final adult height. Therefore, the growth curves from our study are relevant, providing a reference for pediatricians in this clinical population and, thus, preventing over-treatment for EP.

Background: In isolated premature thelarche (IPT) girls, bone age (BA) is considered consistent with chronological age, but IPT girls requiring further investigations show another trend. We analysed BA and possible potentiating factors in girls aged 4-8 years with IPT. Methods: IPT girls aged 4-8 years hospitalized from January 2015 to April 2018 at Shenzhen Children's Hospital were divided into two groups with advanced BA of 2 years as the cutoff. Body mass index (BMI) and hormone levels were the main outcome measures, and regression analysis was used to identify independent risk factors. IPT girls were divided into subgroups seperately according to the levels of BMI standard deviation score (SDS), insulin-like growth factor-1 (IGF-1) SDS and dehydroepiandrosterone sulfate (DHEAS) SDS to compare BA. Results: Overall, 423 subjects were classified into the advanced BA (48.7%, n=206) and control groups (51.3%, n=217). The advanced BA group had significantly higher BMI SDS, DHEAS SDS, IGF-1 SDS, androstenedione and serum fasting insulin and significantly lower sex hormone binding globulin (all p<0.001). IGF-1 SDS (OR=1.642, p＜0.001) and DHEAS SDS (OR=1.125, p=0.021) were independent risk factors for advanced BA. In the multiple linear regression model, IGF-1 SDS, BMI SDS and DHEAS SDS were the strongest predictors of advanced BA, accounting for 18.9% of the variance. According to BMI, 423 patients were classified into three groups: normal weight (56.03%, n=237 ), overweight (19.15%, n=81) and obesity (24.82%, n=105). The proportion of BA advancement in obesity was significantly higher than that of normal weight (χ2=18.088, P＜0.001). In a subgroup with normal weight, higher IGF-1 SDS (p=0.009) and DHEAS SDS (p=0.003) affect BA advancement independent of BMI SDS. Conclusions: Chinese girls aged 4-8 years with IPT requiring further investigations might have significantly advanced BA. Obesity was highly associated with advanced BA. Age-specific serum IGF-1 SDS and DHEAS SDS were risk factors for BA advancement independent of BMI.

Background In isolated premature thelarche (IPT) girls, bone age (BA) is considered consistent with chronological age. However, some IPT girls confirmed by gonadotropin-releasing hormone (GnRH) stimulation test could show another trend. We analysed BA and possible potentiating factors in a selected group of girls aged 4–8 years with IPT. Methods IPT girls confirmed by GnRH stimulation test aged 4–8 years hospitalized from January 2015 to April 2018 at Shenzhen Children’s Hospital were included in this retrospective study. They were divided into two groups with advanced BA of 2 years as the cut-off. Body mass index (BMI) and hormone levels were the main outcome measures, and regression analysis was used to identify independent risk factors. IPT girls were divided into subgroups according to the levels of BMI standard deviation score (SDS), insulin-like growth factor-1 (IGF-1) SDS and dehydroepiandrosterone sulfate (DHEAS) SDS for comparisons of advanced BA. Results Overall, 423 subjects were included and classified into the advanced BA group (48.7%, n = 206) and control group (51.3%, n = 217). The advanced BA group had significantly higher BMI SDS, serum DHEAS SDS, IGF-1 SDS, androstenedione and fasting insulin and significantly lower sex hormone binding globulin (all p < 0.001). Serum IGF-1 SDS (OR = 1.926, p <0.001), BMI SDS (OR = 1.427, p = 0.001) and DHEAS SDS (OR = 1.131, p = 0.005) were independent risk factors for significantly advanced BA. In the multiple linear regression model, serum IGF-1 SDS, BMI SDS and DHEAS SDS were the strongest predictors of advanced BA, accounting for 19.3% of the variance. According to BMI, 423 patients were classified into three groups: normal weight (56.03%, n = 237), overweight (19.15%, n = 81) and obesity (24.82%, n = 105). The proportion of advanced BA in obesity group was significantly higher than those of normal weight and overweight groups ( χ 2 = 18.088, p <0.001). In the subgroup with normal weight, higher serum IGF-1 SDS ( p = 0.009) and DHEAS SDS ( p = 0.003) affected BA advancement independent of BMI SDS. Conclusions Girls with IPT confirmed by GnRH stimulation test aged 4–8 years might have significantly advanced BA. Obesity was highly associated with advanced BA. Age-specific serum IGF-1 SDS and DHEAS SDS were risk factors for BA advancement independent of BMI.

>沙漠刺猬蛋白（Desert Hedgehog,DHH）是刺猬蛋白（Hedgehog,HH）家族的成员,在睾丸发育、神经鞘形成及软骨细胞发育中至关重要 [1-4] 。自2000年Umehar报道首例DHH纯合突变导致46,XY性发育障碍（disorders of sex development,DSD）以来,其临床表现包括伴神经病变的部分性性腺发育不良（partial gonadal dysgenesis,PGD）以及伴或不伴神经病的完全性性腺发育不良（complete gonadal dysgenesis,CGD） [5-9] 。迄今

Congenital lipoid adrenal hyperplasia (CLAH) is an extremely rare and the most severe form of congenital adrenal hyperplasia. Typical features include disorder of sex development, early-onset adrenal crisis and enlarged adrenal glands with fatty accumulation.

Objective To investigate the recurrence rate of the corrected crossbite in deciduous dentition and to explore the potential influencing factors. Methods Prospective controlled clinical trial was carried out in 109 patients whose deciduous crossbite had been corrected. The recurrence rate and the potential influencing factors were investigated. Results (1) The recurrence rate in the investigation was 46. 8%. (2) The potential influencing factors included occurrence of the negative ANB angle, the posterior crossbite, the improper oral habits, the retained primary teeth and the feeding method. (3) Feeding method and retained deciduous teeth might be the most powerful factors contributed to the recurrence of the crossbite in deciduous dentition. Conclusions The recurrence rate of the crossbite in deciduous dentition was high and the mechanism of recurrence was comprehensive.

AIMTo investigate the expression of β-catenin in cornea after alkali burn and explore its role in cornea neovascularization (CNV).METHODSCNV model was established by putting filter paper with the size of 3.0mm in diameter immersed in 1mol/L NaOH solution on the left cornea of rat for 20 seconds. Twenty-five Sprague Dawley rats were randomly divided into 5 groups: post-operation 1-, 4-, 7-, 14- and 21-day groups while the right eyes as normal control group. The expression level of β-catenin protein, mRNA and VEGF were determined at the 1(st), 4(th), 7(th), 14(th) and 21(st) day following the establishment of model by RT-PCR and immunohistochemical technique.RESULTSNo expression of β-catenin immunoreactivity was detected in normal cornea. The expressions of β-catenin and VEGF both reached the peak at the 4(th) and 7(th) day and gradually decreased to near baseline 21 days later. Alteration of β-catenin and VEGF levels showed a significant positive correlation (r=0.855, P<0.05).CONCLUSIONThe levels of β-catenin are markedly related to inflammatory CNV in rat cornea after alkali burn.

AIM: To investigate the expression of aquaporins-1 (AQP-1) in cultured bovine corneal endothelial cells and to explore the role of AQP-1 in corneal endothelial fluid transport.METHODS: The bovine corneal cells were cultured in DMEM containing 200mL/L neonate bovine serum. AQP-1 expression in the bovine corneal endothelial cells was detected with immunohistochemistry method before and after treatment of the cells with aquaporin inhibitor, p-chloromercuribenzene sulfonate. The osmotic water permeability was determined by monitoring volume changes of cultured bovine corneal endothelial cells.RESULTS: Positive staining was used to reveal the AQP-1 expression in the membrane of cultured bovine (in brown color). The reading of osmotic water permeability of the cultured bovine corneal endothelial cells before treatment with p-chloromercuribenzene sulfonate was 0.044 +/- 0.005cm/s, which significantly decreased to 0.017 +/- 003cm/s after treatment (n=15).CONCLUSION: AQP-1 expressed in the membrane of cultured bovine corneal endothelial cells may play an important role in fluid transport of corneal endothelial cells. Alteration of the AQP-1 expression may cause abnormal corneal function and corneal edema.

Objective To analyze the incidence and severity of retinopathy of prematurity (ROP). Methods A retrospective analysis was conducted on 210 premature children from September 2005 to May 2008 with weight equal to or less than 2500g or a gestational age at birth of 36 weeks or less.All of the mem-bers were examined by indirect binocular ophthalmoscopy.Results ROP occurred with an incidence rate of 12.9% among 210 premature children, and above ROP stages Ⅲ occurred with an incidence rate of 3.8%, This study showed the infants were more prone to develop ROP with short geststional age, low birth weight,long time of oxygen inhalation, and severe infants diseases.Twins had a significantly higher rate of ROP (20.5%) than singleton babies(10.8%), ROP were severer in twins than singleton babies.Conclusion Short gestational age, low birth weight, long time of oxygen inhalation, severe infants diseases, and non-singleton babies were the most significant factors associated with ROP.

• Aim: To investigate the expression of aquaporins-1 (AQP-1) in cultured bovine corneal endothelial cells and to explore the role of AQP-1 in corneal endothelial fluid transport. • Methods: The bovine corneal cells were cultured in DMEM containing 200mL/L neonate bovine serum. AQP-1 expression in the bovine corneal endothelial cells was detected with immunohistochemistry method before and after treatment of the cells with aquaporin inhibitor, P-chloromercuribenzene sulfonate. The osmotic water permeability was determined by monitoring volume changes of cultured bovine corneal endothelial cells. • Results: AQP-1 expression in the membrane of cultured bovine corneal endothelial cells was revealed by positive staining (in brown color). The reading of osmotic water permeability of the cultured bovine corneal endothelial cells before treatment with P-chloromercuribenzene sulfonate was 0.044 ± 0.005cm/s, which significantly decreased to 0.017 0.003 cm/s (n = 15) after treatment. • Conclusion: AQP-1 expressed in the membrane of cultured bovine corneal endothelial cells may play an important role in fluid transport of corneal endothelial cells. Alteration of the AQP-1 expression may cause abnormal corneal function and corneal edema.