Except for global developmental delay (GDD) caused by certain metabolic diseases with clear causes, rehabilitation treatment is the main treatment for GDD. Vitamin D plays an important neuroprotective role in regulating the development and differentiation of nerve cells by affecting neurotrophic factors; however, there is no study on the clinical effect of vitamin D supplementation on children with GDD.
To explore the clinical effects of vitamin D supplementation at different doses on the rehabilitation of children with GDD.
A total of 110 children with GDD who were hospitalized for the first time in the Department of Rehabilitation of the Third Affiliated Hospital of Zhengzhou University from September 2020 to June 2022 were selected as the study subjects and divided into the conventional group (n=38), 400 U group (n=37) and 1 200 U group (n=35) using a randomized block grouping method. The conventional group only received conventional rehabilitation; 400 U/d of vitamin D was given orally on the basis of conventional rehabilitation to the 400 U group; 1 200 U/d of vitamin D was given orally on the basis of conventional rehabilitation to the 1 200 U group. Basic data such as sex and age at consultation were collected from the children in the 3 groups; serum 25-hydroxyvitamin D [25 (OH) D] level and the score of Gesell scale for developmental quotient (DQ) in 5 functional areas of adaptive ability, gross motor ability, fine motor ability, linguistic competence, and social competence were measured at the time of admission and at the end of 3 courses of rehabilitation. The number of adverse events during the hospitalization of the children and the incidence of adverse events were recorded, and the above data were analyzed and compared.
The comparison of the 3 groups of children in sex, place of residence, season of birth, mode of delivery, age of consultation, birth body mass, birth gestational age, and main reason for consultation showed no statistically significant difference (P>0.05). Before treatment, there was no statistically significant difference in 25 (OH) D level and DQ value of each functional area of Gesell scale among the 3 groups of children (P>0.05). After treatment, children in the 1 200 U group had higher blood 25 (OH) D levels, Gesell scale DQ values for gross motor ability, fine motor ability, and linguistic competence than those in the conventional group (P<0.05). During the first and second course of rehabilitation, the incidence of adverse events in the 3 groups of children showed no statistically significant difference (P>0.05) ; in the third course of rehabilitation, the incidence of adverse events in the 1 200 U group was significantly lower than that in the conventional group.
Supplementation with 1 200 U of vitamin D is beneficial to the rehabilitation outcome of children with GDD and reduces the incidence of adverse events during rehabilitation.
Central precocious puberty (CPP) is a common endocrine disease in children, which shows an increasing trend year by year in recent years. It can be divided into fast-progressing central precocious puberty (RP-CPP) and slow-progressing central precocious puberty (SP-CPP) through pubertal development. RP-CPP has great harm, but it is difficult to distinguish it from SP-CPP in early clinical stage, mainly relying on the progress of adolescent development and bone age during follow-up. At present, there is a lack of effective laboratory indicators to predict RP-CPP.
To investigate the relationship between luteinizing hormone (LH) /follicle-stimulating hormone (FSH) ratio and pubertal development.
CPP girls aged 4-10 years old (n=380) admitted to the Children's Hospital Affiliated to Zhengzhou University from January 2020 to May 2022 were regression selected and divided into RP-CPP group (n=130) and SP-CPP group (n=250 cases) according to indicators such as puberal development process. Clinical characteristics of the two groups were compared and analyzed. Univariate and multivariate Logistic regression analysis of the influencing factors of RP-CPP was performed, and ROC curve of LH/FSH ratio on the predictive value of RP-CPP was drawn.
The height, weight, BMI, IGF-1, difference between bone age and actual age, bilateral ovarian volume, LH base value, estradiol level, LH base value /FSH base value, and LH peak /FSH peak value of girls in RP-CPP group were all higher than those in SP-CPP group, with statistical significance (P<0.05). Regression analysis showed that CPP patients progressed to RP-CPP related serological indexes when LH base value and LH peak /FSH peak were detected. LH base /FSH base value and LH peak /FSH peak were positively correlated with height, IGF-1, LH base value, estradiol level, LH peak, ovarian volume and bone age (P<0.05). ROC curve showed that the LH base /FSH base value and LH peak /FSH peak value were more sensitive and specific than other indexes to the predictive value of RP-CPP. When the LH base /FSH base value was 0.63, the Yoden index reached a maximum of 0.258 (sensitivity 43.1%, specificity 82.7%, AUC=0.644). When the LH peak /FSH peak was 1.39, the maximum Jorden index was 0.276 (sensitivity 74.6%, specificity 53.0%, AUC=0.655). The combined prediction model is better than the single index prediction model (AUC=0.668). The basal gonadotropin levels of children without clinical intervention were analyzed after 6 months of follow-up. It was found that the height increase, ΔLH, ΔFSH, bone age increase and ovarian volume increase in RP-CPP group were significantly higher than those in SP-CPP group after 6 months of follow-up, and the difference was statistically significant (P<0.05) .
LH base /FSH base value and LH peak /FSH peak are early predictors of RP-CPP. When LH/FSH base value ≥0.63 or LH peak/FSH peak ≥1.39, the possibility of RP-CPP should be considered, and the combined predictive value of the two indicators is better than that of a single indicator. It can be used as an auxiliary reference index for clinical application of gonadotropin-releasing hormone analogue therapy.
Adverse childhood experiences (ACEs) are traumatic events or situations that individuals may experience during their childhood. Children living with prolonged and persistent adverse experiences may have lifelong effects on their physical and mental health. Most studies in Europe and the United States confirm that ACEs increase the risk of hypertension in adulthood. However, the association between different types of ACEs and hypertension in adulthood remains controversial. This study provides a comprehensive review of studies on the association between different types of ACEs and hypertension, which explores the effects of ACEs on hypertension in adulthood and potential mechanisms. This study also summarizes the current status of studies on ACEs and hypertension. It presents a prospective view of providing a basis for improving the early childhood developmental environment and preventing hypertension in adulthood.
