BACKGROUND In addition to insulin resistance,impaired insulin secretion has recently been identified as a crucial factor in the pathogenesis of type 2 diabetes mellitus(T2DM).Scarce clinical data exist for pediatric T...BACKGROUND In addition to insulin resistance,impaired insulin secretion has recently been identified as a crucial factor in the pathogenesis of type 2 diabetes mellitus(T2DM).Scarce clinical data exist for pediatric T2DM.AIM To investigate the association ofβ-cell function and insulin resistance with pediatric T2DM in the first Chinese multicenter study.METHODS This multicenter cross-sectional study included 161 newly diagnosed T2DM children and adolescents between January 2017 and October 2019.Children with normal glycemic levels(n=1935)were included as healthy control subjects.The homeostasis models(HOMAs)were used to assess theβ-cell function(HOMA2-%B)and insulin resistance(HOMA2-IR)levels.The HOMA index was standardized by sex and age.We performed logistic regression analysis to obtain odds ratios(ORs)for T2DM risk using the standardized HOMA index,adjusted for confounding factors including sex,Tanner stage,T2DM family history,body mass index z-score,and lipid profile.RESULTS The male-female ratio of newly diagnosed T2DM patients was 1.37:1(OR=2.20,P=0.011),and the mean ages of onset for boys and girls were 12.5±1.9 years and 12.3±1.7 years,respectively.The prevalence of related comorbidities including obesity,elevated blood pressure,and dyslipidemia was 58.2%,53.2%,and 80.0%,respectively.The T2DM group had lower HOMA2-%B levels(P<0.001)and higher HOMA2-IR levels(P<0.001)than the control group.Both the decrease in HOMA2-%B z-score(OR=8.40,95%CI:6.40-11.02,P<0.001)and the increase in HOMA2-IR z-score(OR=1.79,95%CI:1.60-2.02,P<0.001)were associated with a higher risk of T2DM,and the decrease in HOMA2-%B z-score always had higher ORs than the increase in HOMA2-IR z-score after adjusting for confounding factors.CONCLUSION Besides insulin resistance,β-cell function impairment is also strongly associated with Chinese pediatric T2DM.Gender difference in susceptibility and high comorbidities warrant specific T2DM screening and prevention strategies in Chinese children.展开更多
Background The limited available studies have unveiled different natural histories and prognosis associated with pediatric type 2 diabetes (T2D) and adult T2D.To date,data on the clinical features,metabolic profiles a...Background The limited available studies have unveiled different natural histories and prognosis associated with pediatric type 2 diabetes (T2D) and adult T2D.To date,data on the clinical features,metabolic profiles and beta-cell function characteristics are still limited in the Chinese pediatric T2D population.Methods A total of 56 children with T2D,31 with prediabetes and 159 with obesity were recruited.Clinical characteristics,metabolic profiles,beta-cell function and insulin resistance were analyzed.Results The mean onset age of T2D was 12.35 ± 1.99 (7.9-17.8) years,and 7% of children were younger than 10 years;55% of them were male,57% had a family history of diabetes and 64% had classic symptoms,and 25% had a low or high birth weight.89% of T2D patients were obese or overweight.A total of 58% of the patients with prediabetes were male.The fast serum C-peptide level was highest in the obesity group (P < 0.001),and there was no significant difference between the T2D and prediabetes groups.The mean homeostatic model of assessment of beta-cell function was the highest in the obesity group and was lowest in the T2D group (P < 0.00 1).The T2D group had the most serious lipid metabolism disorder,with the highest levels of total triglycerides,total cholesterol,and low density lipoprotein and the lowest high density lipoprotein level among the three groups.Conclusions A younger onset age and greater male susceptibility were found in Chinese pediatric T2D patients,and there was a stepwise deterioration trend in beta-cell function among patients with obesity,prediabetes and T2D.Based on our results,together with the SEARCH study results,an early screening and intervention program for T2D is recommended in high-risk or obese Chinese pediatric populations starting at 7 years.展开更多
Background:Significant brain volume deviation is an essential phenotype in children with neurodevelopmental delay(NDD),but its genetic basis has not been fully characterized.This study attempted to analyze the genetic...Background:Significant brain volume deviation is an essential phenotype in children with neurodevelopmental delay(NDD),but its genetic basis has not been fully characterized.This study attempted to analyze the genetic factors associated with significant whole-brain deviation volume(WBDV).Methods:We established a reference curve based on 4222 subjects ranging in age from the first postnatal day to 18 years.We recruited only NDD patients without acquired etiologies or positive genetic results.Cranial magnetic resonance imaging(MRI)and clinical exome sequencing(2742 genes)data were acquired.A genetic burden test was performed,and the results were compared between patients with and without significant WBDV.Literature review analyses and BrainSpan analysis based on the human brain developmental transcriptome were performed to detect the potential role of genetic risk factors in human brain development.Results:We recruited a total of 253 NDD patients.Among them,26 had significantly decreased WBDV(<-2 standard deviations[SDs]),and 14 had significantly increased WBDV(>+2 SDs).NDD patients with significant WBDV had higher rates of motor development delay(49.8%[106/213]vs.75.0%[30/40],P=0.003)than patients without significant WBDV.Genetic burden analyses found 30 genes with an increased allele frequency of rare variants in patients with significant WBDV.Analyses of the literature further demonstrated that these genes were not randomly identified:burden genes were more related to the brain development than background genes(P=1.656e^(-9)).In seven human brain regions related to motor development,we observed burden genes had higher expression before 37-week gestational age than postnatal stages.Functional analyses found that burden genes were enriched in embryonic brain development,with positive regulation of synaptic growth at the neuromuscular junction,positive regulation of deoxyribonucleic acid templated transcription,and response to hormone,and these genes were shown to be expressed in neural progenitors.Based on single cell sequencing analyses,we found TUBB2B gene had elevated expression levels in neural progenitor cells,interneuron,and excitatory neuron and SOX15 had high expression in interneuron and excitatory neuron.Conclusion:Idiopathic NDD patients with significant brain volume changes detected by MRI had an increased prevalence of motor development delay,which could be explained by the genetic differences characterized herein.展开更多
Background The real-world exposure levels of non-therapeutic antibiotics and neonicotinoids in type 1 diabetes(T1D)children and their associations as environmental triggers through gut microbiota shifts remained unkno...Background The real-world exposure levels of non-therapeutic antibiotics and neonicotinoids in type 1 diabetes(T1D)children and their associations as environmental triggers through gut microbiota shifts remained unknown.We thus investigated the antibiotics and neonicotinoids’exposure levels and their associations with gut microbiota in pediatric T1D.Methods Fifty-one newly onset T1D children along with 67 age-matched healthy controls were recruited.Urine concentrations of 28 antibiotics and 12 neonicotinoids were measured by mass spectrometry.Children were grouped according to the kinds of antibiotics’and neonicotinoids’exposures,respectively.The 16S rRNA of fecal gut microbiota was sequenced,and the correlation with urine antibiotics and neonicotinoids’concentrations was analyzed.Results The overall detection rates of antibiotics were 72.5%and 61.2%among T1D and healthy children,whereas the neonicotinoids detection rates were 70.6%and 52.2%(P=0.044).Children exposed to one kind of antibiotic or two or more kinds of neonicotinoids had higher risk of T1D,with the odd ratios of 2.579 and 3.911.Furthermore,co-exposure to antibiotics and neonicotinoids was associated with T1D,with the odd ratio of 4.924.Antibiotics or neonicotinoids exposure did not affect overall richness and diversity of gut microbiota.However,children who were exposed to neither antibiotics nor neonicotinoids had higher abundance of Lachnospiraceae than children who were exposed to antibiotics and neonicotinoids alone or together.Conclusion High antibiotics and neonicotinoids exposures were found in T1D children,and they were associated with changes in gut microbiota featured with lower abundance of butyrate-producing genera,which might increase the risk of T1D.展开更多
Background During next generation sequencing(NGS)data interpretation in critically ill newborns,there is a potential for recognizing and reporting secondary findings(SFs).Early awareness of SFs may provide clues for d...Background During next generation sequencing(NGS)data interpretation in critically ill newborns,there is a potential for recognizing and reporting secondary findings(SFs).Early awareness of SFs may provide clues for disease prevention.In this study,we assessed the frequency of SFs in the China Neonatal Genomes Project(CNGP)participants.Methods A total of 2020 clinical exome sequencing(CES)datasets were screened for variants from a list of 59 genes recommended by the American College of Medical Genetics and Genomics(ACMG)for secondary findings reporting v2.0(ACMG SF v2.0).Identified variants were classified according to the evidence-based guidelines reached by a joint consensus of the ACMG and the Association for Molecular Pathology(AMP).Results Among the 2020 CES datasets,we identified 23 ACMG-reportable genes in 61 individuals,resulting in an overall frequency of SFs at 3.02%.A total of 53 unique variants were identified,including 35 pathogenic and 18 likely pathogenic variants.The common disease categories of SFs associated were cardiovascular and cancer disease.The SF results affected the medical management and follow-up strategy in 49(80.3%)patients.Conclusions We presented the frequency of SFs and their impact on clinical management strategies in CNGP participants.Our study demonstrated that SFs have important practical value in disease prevention and intervention at an early stage.展开更多
基金Supported by the National Key Research and Development Program of China,No.2016YFC1305302the National Natural Science Fund of China,No.81600608the Key Research and Development Program of Shandong Province,No.2017GSF18118.
文摘BACKGROUND In addition to insulin resistance,impaired insulin secretion has recently been identified as a crucial factor in the pathogenesis of type 2 diabetes mellitus(T2DM).Scarce clinical data exist for pediatric T2DM.AIM To investigate the association ofβ-cell function and insulin resistance with pediatric T2DM in the first Chinese multicenter study.METHODS This multicenter cross-sectional study included 161 newly diagnosed T2DM children and adolescents between January 2017 and October 2019.Children with normal glycemic levels(n=1935)were included as healthy control subjects.The homeostasis models(HOMAs)were used to assess theβ-cell function(HOMA2-%B)and insulin resistance(HOMA2-IR)levels.The HOMA index was standardized by sex and age.We performed logistic regression analysis to obtain odds ratios(ORs)for T2DM risk using the standardized HOMA index,adjusted for confounding factors including sex,Tanner stage,T2DM family history,body mass index z-score,and lipid profile.RESULTS The male-female ratio of newly diagnosed T2DM patients was 1.37:1(OR=2.20,P=0.011),and the mean ages of onset for boys and girls were 12.5±1.9 years and 12.3±1.7 years,respectively.The prevalence of related comorbidities including obesity,elevated blood pressure,and dyslipidemia was 58.2%,53.2%,and 80.0%,respectively.The T2DM group had lower HOMA2-%B levels(P<0.001)and higher HOMA2-IR levels(P<0.001)than the control group.Both the decrease in HOMA2-%B z-score(OR=8.40,95%CI:6.40-11.02,P<0.001)and the increase in HOMA2-IR z-score(OR=1.79,95%CI:1.60-2.02,P<0.001)were associated with a higher risk of T2DM,and the decrease in HOMA2-%B z-score always had higher ORs than the increase in HOMA2-IR z-score after adjusting for confounding factors.CONCLUSION Besides insulin resistance,β-cell function impairment is also strongly associated with Chinese pediatric T2DM.Gender difference in susceptibility and high comorbidities warrant specific T2DM screening and prevention strategies in Chinese children.
文摘Background The limited available studies have unveiled different natural histories and prognosis associated with pediatric type 2 diabetes (T2D) and adult T2D.To date,data on the clinical features,metabolic profiles and beta-cell function characteristics are still limited in the Chinese pediatric T2D population.Methods A total of 56 children with T2D,31 with prediabetes and 159 with obesity were recruited.Clinical characteristics,metabolic profiles,beta-cell function and insulin resistance were analyzed.Results The mean onset age of T2D was 12.35 ± 1.99 (7.9-17.8) years,and 7% of children were younger than 10 years;55% of them were male,57% had a family history of diabetes and 64% had classic symptoms,and 25% had a low or high birth weight.89% of T2D patients were obese or overweight.A total of 58% of the patients with prediabetes were male.The fast serum C-peptide level was highest in the obesity group (P < 0.001),and there was no significant difference between the T2D and prediabetes groups.The mean homeostatic model of assessment of beta-cell function was the highest in the obesity group and was lowest in the T2D group (P < 0.00 1).The T2D group had the most serious lipid metabolism disorder,with the highest levels of total triglycerides,total cholesterol,and low density lipoprotein and the lowest high density lipoprotein level among the three groups.Conclusions A younger onset age and greater male susceptibility were found in Chinese pediatric T2D patients,and there was a stepwise deterioration trend in beta-cell function among patients with obesity,prediabetes and T2D.Based on our results,together with the SEARCH study results,an early screening and intervention program for T2D is recommended in high-risk or obese Chinese pediatric populations starting at 7 years.
基金grants from the Science and Technology Commission of Shanghai Municipal(No.19411964400)Shanghai Municipal Science and Technology Major Project(No.2018SHZDZX01)ZJLab.
文摘Background:Significant brain volume deviation is an essential phenotype in children with neurodevelopmental delay(NDD),but its genetic basis has not been fully characterized.This study attempted to analyze the genetic factors associated with significant whole-brain deviation volume(WBDV).Methods:We established a reference curve based on 4222 subjects ranging in age from the first postnatal day to 18 years.We recruited only NDD patients without acquired etiologies or positive genetic results.Cranial magnetic resonance imaging(MRI)and clinical exome sequencing(2742 genes)data were acquired.A genetic burden test was performed,and the results were compared between patients with and without significant WBDV.Literature review analyses and BrainSpan analysis based on the human brain developmental transcriptome were performed to detect the potential role of genetic risk factors in human brain development.Results:We recruited a total of 253 NDD patients.Among them,26 had significantly decreased WBDV(<-2 standard deviations[SDs]),and 14 had significantly increased WBDV(>+2 SDs).NDD patients with significant WBDV had higher rates of motor development delay(49.8%[106/213]vs.75.0%[30/40],P=0.003)than patients without significant WBDV.Genetic burden analyses found 30 genes with an increased allele frequency of rare variants in patients with significant WBDV.Analyses of the literature further demonstrated that these genes were not randomly identified:burden genes were more related to the brain development than background genes(P=1.656e^(-9)).In seven human brain regions related to motor development,we observed burden genes had higher expression before 37-week gestational age than postnatal stages.Functional analyses found that burden genes were enriched in embryonic brain development,with positive regulation of synaptic growth at the neuromuscular junction,positive regulation of deoxyribonucleic acid templated transcription,and response to hormone,and these genes were shown to be expressed in neural progenitors.Based on single cell sequencing analyses,we found TUBB2B gene had elevated expression levels in neural progenitor cells,interneuron,and excitatory neuron and SOX15 had high expression in interneuron and excitatory neuron.Conclusion:Idiopathic NDD patients with significant brain volume changes detected by MRI had an increased prevalence of motor development delay,which could be explained by the genetic differences characterized herein.
基金supported by the National Key Research and Development Program of China(2016YFC1305302)the Clinical special project of integrated traditional Chinese and Western medicine in 2019,Shanghai Municipal Health Commission,Shanghai Municipal Administrator of Traditional Chinese Medicine.
文摘Background The real-world exposure levels of non-therapeutic antibiotics and neonicotinoids in type 1 diabetes(T1D)children and their associations as environmental triggers through gut microbiota shifts remained unknown.We thus investigated the antibiotics and neonicotinoids’exposure levels and their associations with gut microbiota in pediatric T1D.Methods Fifty-one newly onset T1D children along with 67 age-matched healthy controls were recruited.Urine concentrations of 28 antibiotics and 12 neonicotinoids were measured by mass spectrometry.Children were grouped according to the kinds of antibiotics’and neonicotinoids’exposures,respectively.The 16S rRNA of fecal gut microbiota was sequenced,and the correlation with urine antibiotics and neonicotinoids’concentrations was analyzed.Results The overall detection rates of antibiotics were 72.5%and 61.2%among T1D and healthy children,whereas the neonicotinoids detection rates were 70.6%and 52.2%(P=0.044).Children exposed to one kind of antibiotic or two or more kinds of neonicotinoids had higher risk of T1D,with the odd ratios of 2.579 and 3.911.Furthermore,co-exposure to antibiotics and neonicotinoids was associated with T1D,with the odd ratio of 4.924.Antibiotics or neonicotinoids exposure did not affect overall richness and diversity of gut microbiota.However,children who were exposed to neither antibiotics nor neonicotinoids had higher abundance of Lachnospiraceae than children who were exposed to antibiotics and neonicotinoids alone or together.Conclusion High antibiotics and neonicotinoids exposures were found in T1D children,and they were associated with changes in gut microbiota featured with lower abundance of butyrate-producing genera,which might increase the risk of T1D.
基金Shanghai Municipal Science and Technology Major Project(Grant No.20Z11900600)Clinical Research Plan of Shanghai Hospital Development Center(SHDC2020CR6028-002).
文摘Background During next generation sequencing(NGS)data interpretation in critically ill newborns,there is a potential for recognizing and reporting secondary findings(SFs).Early awareness of SFs may provide clues for disease prevention.In this study,we assessed the frequency of SFs in the China Neonatal Genomes Project(CNGP)participants.Methods A total of 2020 clinical exome sequencing(CES)datasets were screened for variants from a list of 59 genes recommended by the American College of Medical Genetics and Genomics(ACMG)for secondary findings reporting v2.0(ACMG SF v2.0).Identified variants were classified according to the evidence-based guidelines reached by a joint consensus of the ACMG and the Association for Molecular Pathology(AMP).Results Among the 2020 CES datasets,we identified 23 ACMG-reportable genes in 61 individuals,resulting in an overall frequency of SFs at 3.02%.A total of 53 unique variants were identified,including 35 pathogenic and 18 likely pathogenic variants.The common disease categories of SFs associated were cardiovascular and cancer disease.The SF results affected the medical management and follow-up strategy in 49(80.3%)patients.Conclusions We presented the frequency of SFs and their impact on clinical management strategies in CNGP participants.Our study demonstrated that SFs have important practical value in disease prevention and intervention at an early stage.
