Background: Sitting height and leg length are the useful indicators for the linear growth evaluation of children and adolescents, but the growth reference standards of the two indicators have not been reported. Objective: To study and formulate the growth reference of sitting height and leg length of Chinese children and adolescents aged 0-18 years. Design: A cross-sectional survey. Methods: Stature and sitting height of 92,494 healthy urban children aged 0-18 years were measured in two national surveys in 2005 in China—The National Survey on the Physical Growth and Development of Children in the Nine Cities of China (NSPGDC) and The Chinese National Survey on Students' Constitution and Health (CNSSCH). Leg length was calculated by height minus sitting height. Growth reference standards of sitting height and leg length were constructed using the LMS method. Main outcome measures: Reference values of sitting height and leg length. Results: The percentile and the Z-scores reference values of sitting height and leg length for Chinese boys and girls aged 0-18 years were shown and their growth charts were drawn. Sitting height increased about 14 cm, 6 cm and 4 cm during the first, second and third year after birth, respectively. After that, the annual increment of sitting height is nearly 2-3 cm. Then the increments became slightly higher at 11-13 years for boys and 9-11 years for girls and gradually became smaller and smaller. Sitting height nearly stopped increasing at the age of 17 years for boys and 15 years for girls. Leg length increased respectively about 11-12 cm and 6.5 cm during the first and second year after birth, then the annual increment was 4-5 cm during 2-5 years, and leg length stopped increasing nearly at 15 years for boys and 13 years for girls. Conclusion: The growth reference standards of sitting height and leg length were formulated, which provide more data and reference for perfecting the growth evaluation system of children and adolescents in China.

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Abstract Background Trends in growth and development of children and adolescents are considered to be a "biological standard of living conditions", reflecting a combination of genetic trajectories, environmental factors centered on nutrition and disease, and socio-economic circumstances. Differences in growth and developmental velocity exist between individuals. Objective To construct an equation for predicting maturity offsets from longitudinal data on height, sitting height, and weight to assess the physiological maturity level of individuals. Design Cohort study. Methods According to the Shanghai Longitudinal Growth and Development Study (SLGDS), data were collected from healthy children aged 6.0-14.0 years who had more than four measurements of height, sitting height, and weight with an interval of at least 11 months between each data acquisition. Boys had at least one measurement before 10 years of age and after 12 years of age, and girls had at least one measurement before 9 years of age and after 11 years of age. Fourteen variables of age, height, weight, sitting height and their interactions and ratios were selected for the construction of prediction equations. Correlation analysis and Lasso method were applied to select predictors by gender, and stepwise regression was used to construct the equations. The predictive performance of the equations were evaluated by R2, standard error of estimate (SEE), and Bland-Altman analysis. Main outcome measures Maturity offset［chronological age at the time of measurement-age at Peak Height Velocity (aPHV)］. Results In the SLGDS, 580 children met the inclusion and exclusion criteria. The modeling sample was 439 (180 boys and 259 girls) and the validation sample was 141 (56 boys and 85 girls). Differences in overall measurements between two samples of boys and girls were not significant. The difference was statistically significant in the shorter follow-up duration for boys' modeling sample and the longer duration for girls' modeling sample. Three of the 14 variables were included in the equations for both of boys (age, sitting height, and BMI) and girls (age, sitting height, and quetelet index).Conclusion The maturity offset equations in Shanghai children based on age, sitting height, and BMI for boys, and age, sitting height, and quetelet index for girls were better than the current internationally used maturity offset equations.

Abstract：Heart rate recovery (HRR) index showed the rate of decline in the heart rate (HR) after the cessation of an exercise test. HRR abnormal after exercise was one of the commonly used techniques that predicted cardiovascular events and mortality prediction of cardiovascular disease and its main effective independent risk factor of cardiovascular events. An attenuated HRR, which was defined as the inadequate decline in HR immediately after exercise, attributable to defects in sympathetic withdrawal and parasympathetic reactivation or both. Extensive clinical evaluation of HRR had been performed in the assessment of cardiac autonomic functions in patients with coronary artery disease (CAD), heart failure (HF), hypertension, diabetes mellitus (DM), metabolic syndrome (MS) and obesity, obstructive sleep apnea syndrome (OSAS), rheuma-tological diseases, chronic obstructive pulmonary disease (COPD) and pulmonary hypertension. Studies have indicated a hope of possible modifications of abnormal HRR with pharmacological therapy and exercise training to interventions for improving autonomic function.

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Objective：We have upgraded the data analysis pipeline (Fudan pipeline 1.0) to Fudan pipeline 2.0 for high throughput sequencing which established in 2015. The purpose of this study is to compare the turn around time and accuracy of these two pipelines. Methods：In this study, 112 continuous samples from neonatal intensive care unit were recruited. Both Fudan pipeline 1.0 and 2.0 were used for the data analysis. We compared the results of preliminary analysis, time-consuming, and the accuracy between these two pipelines. And the main features of the Fudan pipeline 2.0 are explained in detail. Results：On the comparison of preliminary data analysis results, the variations to manual analysis step of Fudan pipeline 2.0 (an average of 25 variants) was significantly less than that of Fudan pipeline 1.0 (an average of 210 variants). On the comparison of efficiency, the turn around time of Fudan pipeline 2.0 (19.8h) was significantly shorter than that of Fudan pipeline 1.0 (78.8h). The diagnosis coincidence rate of Fudan pipeline 2.0 is 63.6% (7/11) for positive cases, and 84.2% (85/101) for negative cases with manual review. Conclusion：This study clearly shows the efficient, accurate and automated of Fudan pipeline 2.0 for genetic diagnosis with large sample size.

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Objective: To investigate the consistency between the Greulich-Pyle method and the China 05 method for assessing bone age in normal children, and to compare the assessment results with the chronological age. Methods: All subjects, collected from 5 primary and secondary schools in Xuhui and Jing'an districts of Shanghai, were taken with orthotopic left-handed DR digital radiography, and two experts performed the GP method and the China 05 method, respectively. Pearson's analysis was used to analyze the correlation of the two methods and Kappa analysis was used to test the consistency of differences between the assessment results and the chronological age. Results: A total of 4,151 students, including 2,184 males and 1,967 females, completed the bone age sampling from December 2015 to October 2016. Pearson's analysis showed two assessment results were highly correlated in general and by developmental stages(r=0.888-0.988, P<0.000 1). The correlation coefficient r between the two methods and the chronological age ranged from 0.487 to 0.851 (P<0.001 for both). Kappa analysis showed the Kappa values were below 0.5 for both boys and girls in general and by age. The GP method values were less than that of the China 05 method (P<0.000 1) for males before the age of 10 and females before the age of 9. Assessment results of the two methods were basically the same for females at the age of 9 (P> 0.05) and the GP method values were greater than that of the China 05 method (P< 0.000 1) for males and females after the age of 9. The China 05 results were closer to the chronological age for both sexes. Conclusion: The consistency between the two methods of bone age assessment is low for normal children and adolescents, and the assessment of maturity status should be combined with other growth indicators. In this sample, the China 05 method was slightly better than the GP method.

Background Sitting height/leg length ratio (SH/LL) and Sitting height/height ratio (SH/H) are the important indicators of body proportion assessment. Their scientific assessment will supply valuable information in clinical practices, but the detailed data on their growth reference standards have not been reported. Objective To construct the SH/LL and SH/H growth charts for Chinese children and adolescents from birth to 18 years. Design A cross-sectional survey. Methods Stature and sitting height of 92 494 healthy urban children aged 0-18 years were measured in two national surveys in 2005 in China, which named The National Survey on the Physical Growth and Development of Children in the Nine Cities of China and The Chinese National Survey on Student's Constitution and Health. Leg length was calculated by height minus sitting height and the SH/LL ratio and SH/H ratio were calculated. Growth reference standards of SH/LL and SH/H were constructed using the LMS method. Main outcome measures Reference values of SH/LL and SH/H. Results The Z-scores growth charts of SH/LL and SH/H (-3SD, -2SD, -1SD, Median, +1SD, +2SD, +3SD) were constructed. The median of SH/LL declined from birth (2.00) to 13 years in boys (111) and to 11 years in girls (1.13), then increased slightly to the age of 18 (1.16 in boys and 1.18 in girls). A similar growth pattern was found in the SH/H, that is, the median of SH/H was 0.67 at birth and declined to the lowest point (0.53) with age, then increased slightly to 0.54 at 18 years old. Conclusions The growth charts of SH/LL and SH/H are used in assessing body proportions for Chinese children and adolescent individuals, and they could be used in conjunction with the growth charts of height, weight for Chinese children aged 0-18 years.

Background Menarche is an important sign for girls to enter the late stage of puberty, and it is also the last opportunity for girls' height intervention. As menarche is affected by many factors and has great individual differences, correcting understanding and mastering the growth pretention and characteristics of girls at menarche can provide reference for the final height evaluation and intervention of girls with different menarche age in clinical practice. Objective To analyze the age, bone age (BA) and physical development characteristics of girls at menarche to explore the clinical evaluation method of predicting final height (PAH) after menarche.DesignCross-sectional survey. Methods We retrospectively collected the data of girls with menarche time, physical measurement and X-ray of bone age who visited the Department of Growth and Development of Children's Hospital Affiliated to Capital Institute of Pediatrics from 2008 to 2018. We excluded the cases with the interval between menarche time and visit time longer than 3 months, with clear diseases affecting children's growth and development, with clear etiology causing secondary central precocious puberty or peripheral precocious puberty, and those previously treated by growth hormone or Gonadotropin-Releasing hormone inhibitors. According to the inclusion and exclusion criteria above, three professional pediatricians screened medical records in paper or in electronic forms, extracted and chose data, and finally entered all selected data into Epidata database by a single person. The chronological age, bone age, HtSDS, HtSDS _BA, predicted final height (PAH) and predicted growth potential were calculated according to the pre-defined methods. The menarche age was divided by interval of 1 year, and the BA at menarche was divided by interval of 0.5 year. Main outcome measures BA at menarche, PAH and predicted growth potential. Results a. MA of 694 girls was 10.7±1.1 years and BA at menarche was 12.4±0.6 years. The average MA of different groups varied from 8.5 to 13.2 years, but the BA at menarche was stable, ranging from 12.4 to 12.8 years. b. The BA at menarche was closely related to their growth level. The youngest MA group had the most advanced BA and highest HtSDS. For example, the BA of 8-year-old MA group was 3.8±0.5 years advanced and their HtSDS was 2.60±1.32 while the BA of 13-year-old MA group was 0.7±0.7 years behind, and their HtSDS was -1.05±0.59. However, the average HtSDS _BA of different MA groups ranged from -1.17 to -0.68, with few differences between groups. c. The PAH-Ht of girls after menarche was 7.3±2.6 cm which was highly negatively correlated with BA at menarche ( r=-0.960, P<0.001). The average PAH-Ht of girls decreased from 12.7 cm to 4.0 cm when the BA at menarche increased from 11.0 to 13.0 years ( F=1,194.393, P<0.001). d. According to the formula of PAH we derived from this study ( R²=0.992), we can calculate the cut-off point of height at menarche in accordance with different PAH. When the BA at menarche is 12 years, for example, the height at menarche should be higher than 139.8 cm with PAH higher than 150 cm, and the height at menarche should be higher than 151.3 cm with PAH higher than 160 cm. Conclusion The BA of girls at menarche is relatively stable. BA is a reliable index to predict menstruation and evaluate the growth level of girls. For girls after menarche, BA can also accurately predict their growth potential.

Background：Implementation research refers to systematically integrating evidencebased practice into clinical scenarios to improve the quality and effectiveness of healthcare services and bridge the gap between evidence and clinical practice. However, this type of research has not received much attention. Objective：To develop implementation strategies of the recommendations for venous access devices (VADs) selection in hospitalized children from Clinical Practice Guideline on Infusion Therapy in Children, to evaluate the impact of evidence implementation on patient outcomes, the evidencebased practice behaviors of healthcare workers, and organization environment changes in the hospital, and to identify conflicts between recommendations and clinical practice in different clinical settings. Design：Implementation study. Methods：We developed strategies to promote evidence implementation at Children's Hospital of Fudan University from four perspectives: dissemination, implementation process, integration, and capacity building. These strategies, along with correspongding individualized action plans, were applied in the VAD selection for children's infusion therapy. The implementation process and outcomes were evaluated from four aspects: reach, effectiveness (or efficacy), adoption, and implementation according to the REAIM framework. Main outcome measures：VAD selection error rate, and compliance of VAD selection among nurses. Results：The implementation period was from May 30, 2022, to October 30, 2022. We enrolled 2,343 patients in the intervention group and 2,309 patients in the control group. （1）Reach: During the implementation period, 4, 652 pediatric patients met the inclusion criteria. Out of these, 2, 343 patients received the implementation strategy and individualized action plan. (2) Effectiveness: Among the hospitalized children in the 10 wards, there was no statistically significant gender difference between the two groups. However, there were significant differences in patient age, emergency admission status, surgical status, and department. After adjusting for age, emergency admission status, surgical status, and department, compared to the control group, the intervention group had a 25% reduction in VAD selection error rate (OR=0.745, 95%CI: 0.6120.906). There was no statistically significant difference in the incidence of extravasation/infiltration between the control and intervention groups (OR=1.070, 95%CI: 0.8221.393). The nurses' knowledge level in VAD selection was significantly higher in the intervention group (83.9±12.4) compared to that of the control group (56.0±13.1). Compliance rate of five audit indicators was 100% before, during, and after implementation, compliance rate of four indicators significantly improved before, during, and after implementation, compliance rate of seven indicators showed no statistically significant difference before, during, and after implementation. (3) Adoption: During the implementation period, all 10 wards selected by cluster random sampling (100%) fully participated in the strategy implementation and adopted all 17 pieces of evidence (100%). Multiple rounds of course training (4 hours each) and practical training (3 hours each) were conducted to help nurses understand the implementation strategies and action plans, and all 214 nurses (100%) completed the training courses. (4) Implementation: The study developed six implementation strategies, achieving an 83.3% completion rate. The costeffectiveness index of peripheral intravenous catheter (PIVC) infusion materials before and after the intervention was 2.1>0, indicating that the intervention led to cost savings. Conclusion：The process evaluation of the guideline recommendations indicated a positive result across the four domains of reach, effectiveness (or efficacy), adoption, and implementation based on the REAIM framework. However, a moderate result was indentified in the compliance evaluation of nurses' VAD selection behavior in the effectiveness domain.

The Appraisal of Guidelines for Research & Evaluation (AGREE) instrument has been the important standard for Clinical Practice Guideline appraisal, since released in 2003. The second version, AGREEⅡ was released in 2009. Some domestic researchers has translated and used the instruments. We want to explain each items of AGREE Ⅱ detailedly through appraising Chinese Clinical Practice Guidelines, hoping to provide reference for the domestic researchers understanding and using AGREEⅡ appropriately.

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Background：Constructing language development milestones and collecting milestone data are not only key steps in language development monitoring, but also the preliminary basis for the development of language screening and diagnostic tools. Objective：To construct language development milestones for Chinese-speaking children aged 0 to 5.5 years, providing a reference basis for language development screening and diagnostic tool development. Design：Cross-sectional survey. Methods：Based on existing developmental assessment tools and literature, a language development milestone item pool was established through expert consultation and cognitive interviews. From October 2022 to November 2022, 1,976 children aged 0 to 6 years were sampled from five provinces including Zhejiang, Sichuan, Liaoning, Jiangxi, and Hainan. Using stratification by urban and rural areas, gender, and age groups, developmental milestone data were collected through parent reports in both primary care settings (age <36 months) and kindergartens (age ≥36 months). The characteristics of language development milestones for children in different age groups were analysed descriptively using an item response theory model. Data comparisons were conducted between the data collected in the current study for Chinese-speaking children and data obtained from other published research on English-speaking children. Main outcome measures：Response rate, different item function, model fit, and estimated developmental age of each item when passing probabilities is 25%, 50%, and 75%. Results：A total of 63 language development milestone items were included in the item pool. After data cleaning, 1 659 children were included in the data analysis, including 827 boys and 832 girls, with an average age of (2.5±1.9) years. The response rate for all 63 language milestones was higher than 99%. Three items showed different item function based on maternal education, and 14 items showed poor model fit. Conclusions：The language development milestones for Chinese-speaking children aged 0 to 5.5 years established using the item response theory model provide a clear description of the language development trajectory of native Chinese-speaking children. This work offers valuable empirical data for the future development of language development evaluation tools for Chinese-speaking children, clinical monitoring of language development, and research into related neural mechanisms.

Background: Great heterogeneity exists in studies on the relationship between adolescents' mental health and 24-h movement consisting of sleep, sedentary behavior, and physical activity. Therefore, it is difficult to obtain high-quality evidence synthesis sufficient to guide clinical practice. Objective: To summarize and evaluate the current status of research on the relationship between 24-hour movement (sleep, sedentary behavior, and physical activity) and mental health in children and adolescents, as well as the problems in research design, so as to provide a reference for future research. Design: Scoping review. Methods: PubMed, Embase, Web of Science, and CNKI databases were searched from the inception to September 28, 2022, with the keywords of sleep, sedentary behavior, physical activity, 24-h movement, mental health, and adolescents to identify research on the correlation or causal inference between 24-h movement and mental health in healthy children and adolescents. Data extraction forms for movement type, measurement methods, classification of measurement items, and specific item measurement were gradually refined in the process of data extraction and synthesis after reading the text title, abstract, and full text for screening. Main outcome measures: Study types and measurement instruments for the relationship between 24-h movement and mental health in adolescents. Results: A total of 927 articles were retrieved from the English and Chinese databases, and after de-duplication, initial screening and full-text screening, 55 articles were finally included with 45 (82%) cross-sectional studies and 10 prospective cohort studies; 47 (85%) subjective reports and 8 objective monitoring articles. For sleep, 54 described sleep duration and 4 assessed sleep quality, sleep latency, daytime sleepiness, and sleep disruption. For sedentary behavior, there were 50 subjective reports, 5 objective reports, and 46 studies about screen exposure. For physical activity, hours of moderate-to-vigorous physical activity were assessed in 47 subjective reports and 8 objective reports. A total of 32 studies focused on depression, 9 on anxiety, 5 on stress, and 35 on other mental health outcomes (positive mood, behavioral problems, life satisfaction or health-related quality of life, mental illness and symptoms, emotion regulation skills, and cell phone addiction). Forty-four papers explored the correlation between 24-h movement and mental health, 8 papers explored changes in the structure of 24-h movement using isochronous substitution models, and 3 explored mediators of 24-h movement affecting mental health. Conclusions: There are few studies on the association between 24-h movement and mental health in adolescents, and the measurement tools used need to be standardized. In the future, isochronous substitution models or real-world intervention studies are needed to find the recommended 24-h movement packages that can maximize the health effects of the movement and are easy to achieve at the same time.

Background：The Swanson, Nolan, and Pelham, version scale (SNAP-Ⅳ) is the most widely used assessment tool for evaluating the core symptoms of attention-deficit/hyperactivity disorder (ADHD) in children. However, there is still a lack of systematic review of the measurement properties of the SNAP-Ⅳ scale, which may introduce bias and potentially affect the assessment validity of the measurement tool. Objective：To evaluate the measurement properties of the SNAP-Ⅳ based on the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN), and to provide evidence-based measurement instrument recommendations for the screening, diagnosis and efficacy evaluation of children with ADHD. Design：Systematic review. Methods：Related literature was systematically searched in databases of China National Knowledge Infrastructure (CNKI), Wanfang Database, VIP Database, China Biomedical Literature Database (CBM), PubMed, Cochrane Library, EMBASE, and Web of Science from the inception to April 21, 2022. Two reviewers independently screened the literature, and the measurement properties of the SNAP-Ⅳ scale were objectively evaluated according to the COSMIN manual. Main outcome measures：Content validity and internal consistency of the SNAP-Ⅳ scale. Results：A total of 14 studies involving 6 language versions were included. The content validity of the SNAP-Ⅳ scale was rated as "sufficient" (moderate quality evidence) in terms of relevance, comprehensiveness, and comprehensibility. However, there was no reported content on the development of the SNAP-Ⅳ scale. The parent and teacher versions of the SNAP-Ⅳ scale showed "sufficient" internal consistency (high-quality evidence). There was no high-quality evidence indicating "insufficient" measurement properties. The overall recommendation was classified as level A. Conclusion：The SNAP-Ⅳ scale is recommended for the screening, diagnosis, and treatment evaluation of children with ADHD, and its results can be considered reliable.

Objective:To establish the growth standard curves of weight/head circumference ratio and length/head circumference ratio for Chinese newborns, in order to provide reference for the comprehensive assessment of physical growth at birth. Methods:Singleton live births with gestational age of 24-42 weeks were investigated in thirteen cities including Beijing, Harbin, Xi'an, Shanghai, Nanjing, Wuhan, Guangzhou, Fuzhou, Kunming, Tianjin, Shenyang, Changsha and Shenzhen from June 2015 to November 2018, and those newborn babies who were not healthy or whose mothers had high health risk were excluded. Percentile reference values and growth curves of weight/head circumference ratio and length/head circumference ratio of newborn infants with gestational age of 24-42 weeks were established by the Generalized Additive Model for Location, Scale and Shape (GAMLSS). Results:A total of 24,375 neonates with gestational age of 24-42 weeks were included in this study, with 13,197 males and 11,178 females. Weight/head circumference ratio presented a rapid increase by gestational age, and length/head circumference ratio showed an increase below 37 weeks of gestation but no obvious increase above 37 weeks. The 3rd, 10th, 25th, 50th, 75th, 90th and 97th percentile reference values and growth curves of weight/head circumference ratio and length/head circumference ratio were obtained for male and female neonates with gestational age of 24-42 weeks. Weight/head circumference ratios of males in all gestational ages were slightly higher than those of females, with the differences of 0.21 to 0.37 kg/m at the 10th, 50th and 90th percentile curves. There was no substantial differences for length/head circumference ratio between males and females, with the difference of -0.01 to 0.01 in all gestational ages at the 10th, 50th and 90th percentile curves. The fitted values of weight/head circumference ratio were very close to the observed values at main empirical percentile curves, and the fitted values of length/head circumference ratio were consistent with the observed values above 32 weeks of gestation but slightly different from the observed values below 32 weeks of gestation. Conclusion:Based on contemporary, nationally representative, large sample data, this study established standardized reference values and growth curves of weight/head circumference ratio and length/head circumference ratio for Chinese newborn infants with 24-42 weeks of gestation, which might be useful for clinical practice and scientific research.

Objective：To re-determine items difficulty order of the Fudan Chinese version gross motor function measure(GMFM), and to compare the responsiveness and precision with the GMFM-66, in order to improve the items difficulty order of the GMFM to suit children with cerebral palsy in all age groups better. Methods：The data used for the analysis in this study were from children and adolescents with cerebral palsy undergoing rehabilitation therapy and education in rehabilitation center of Children's hospital of Fudan University and other 21 cooperative units in Shanghai Children's Rehabilitation Cooperative Group from 2001 to 2017. Each one of the cases had at least one time GMFM assessment and was diagnosed as cerebral palsy after 18 months. GMFM assessment was performed by a designated therapist or physician in a quiet, independent, well-lit room using Fudan Chinese version GMFM-88.The GMFM-66 score was derived from GMAE (version 1.0). Each GMFM-88 item was converted into three sub-items, and the GMFM-88 was converted into GMFM-264 containing 264 test items, with a score point (0, 1) for each. The rating scale model in Rashi analysis was used to analyze the GMFM-264 test results and 264 items, and generate the improved Fudan Chinese GMFM scale items difficulty order.Stratified random sampling method was used to determine the subjects included in the analysis of responsiveness and precision, and the difference in the scores of GMFM-264 and GMFM-66 were used to compare the responsiveness and precision of two score methods by comparing each assessment results of the below 3-year-old group and the above 6-year-old group. Results：A total of 3 498 GMFM assessment results of 1 198 children with cerebral palsy were included in the analysis. Among them, 801 were males. The average age was (4.5±3.8) years old when they had their first assessment. Rasch analysis showed that the unsuitable items of the total items was 2.3% in GMFM-264 tiny items, indicating that most of the items in this scale have good unidimensionality and form improved Fudan Chinese version items difficulty order containing 264 tiny items. In the <3 year old group, the responsiveness and precision of GMFM-264 was significantly higher than that of GMFM-66. Conclusion：The improved Fudan Chinese GMFM items difficulty order expands the target pool for the development of gross motor intervention in children with cerebral palsy combined with standardized assessment, and improves the responsiveness and precision of GMFM in children with cerebral palsy, especially infants with cerebral palsy. The result+ provide a basic model and data for the further promotion of intelligent function assessment and intervention systems for children with cerebral palsy.