OBJECTIVEThis paper is to explore the relationships between the occurrence of structural birth defects and environmental risk factors on birth defects.

METHODSA survey was conducted by using a population-based case control study. A total number of 388 structural birth defects, which were detected after 28 weeks' gestational age to 7th day after birth in various hospitals were recruited in Wuxi from 2002 to 2004. The control group consisted of 1607 normal live births born in the same period. Multiple logistic regression model was used to analyze relationships between environmental risk factors and occurrence of structural birth defects after controlling women's education level and childbearing age.

RESULTSAmong those factors which affected birth defects, the exposure to toxic substances in working environment was the highest risk factor, with OR value as 5.37 (95 % CI : 3.60-7.99). Suffering from reproductive tract infections, high fever during first trimester gestation, and taking potential teratogenic drugs such as hypnotics and anti-convulsion drug agents, might significantly increase the risk of structural birth defects, with OR values (95% CI) as 3.38 (1.33-8.56), 3.57 (1.73-7.37) and 2.75 (1.57-4.83) respectively. However, the correlation between oral contraceptives intake within six months before pregnancy and risk of birth defects had no statistical significance. In addition, pollution of the residential environment, staying up all night and raising pets at home, had relatively lower association with birth defects, with OR values (95% CI) as 2.28 (1.75-2.98), 1.96 (1.21-3.18) and 2.50 (1.66-3.76) respectively, yet with a higher proportion of exposure to those factors in pregnant women. There was a significant increase in occurrence risks of birth defects with increase in the number of exposure to environmental risk factors. OR values for having one, two, three kinds of environmental risk factors were 1.60, 4.32 and 10.23 respectively.

CONCLUSIONThe common structural birth defects were affected by a number of environmental risk factors. There was also a dose-response relationship between the number of environmental risk factors and occurrence risks of structural birth defects noticed in our study.

Air Pollution ; adverse effects ; Case-Control Studies ; Congenital Abnormalities ; etiology ; Female ; Humans ; Logistic Models ; Maternal Exposure ; adverse effects ; Pregnancy ; Risk Assessment ; Risk Factors

BACKGROUNDBenign cicatricial airway stenosis (BCAS) is a life-threatening disease. While there are numerous therapies, all have their defects, and stenosis can easily become recurrent. This study aimed to investigate the efficacy and complications of nonstent combination interventional therapy (NSCIT) when used for the treatment of BCAS of different causes and types.

METHODSThis study enrolled a cohort of patients with BCAS resulting from tuberculosis, intubation, tracheotomy, and other origins. The patients were assigned to three groups determined by their type of stenosis: Web-like stenosis, granulation stenosis, and complex stenosis, and all patients received NSCIT. The efficacy and complications of treatment in each group of patients were observed. The Chi-square test, one-factor analysis of variance (ANOVA), and the paired t -test were used to analyze different parameters.

RESULTSThe 10 patients with web-like stenosis and six patients with granulation stenosis exhibited durable remission rates of 100%. Among 41 patients with complex stenosis, 36 cases (88%) experienced remission and 29 cases (71%) experienced durable remission. When five patients with airway collapse were eliminated from the analysis, the overall remission rate was 97%. The average treatment durations for patients with web-like stenosis, granulation stenosis, and complex stenosis were 101, 21, and 110 days, respectively, and the average number of treatments was five, two, and five, respectively.

CONCLUSIONSNSCIT demonstrated good therapeutic efficacy and was associated with few complications. However, this approach was ineffective for treating patients with airway collapse or malacia.

Adult ; Bronchoscopy ; Cicatrix ; Female ; Humans ; Intubation, Intratracheal ; adverse effects ; Male ; Tracheal Stenosis ; etiology ; therapy ; Tracheostomy ; adverse effects ; Tuberculosis ; complications

Objective:To observe the effects of bundled pulmonary rehabilitation on static pulmonary function, cardiopulmonary exercise function and inflammatory factors in patients with moderate or severe stable chronic obstructive pulmonary disease (COPD).Methods:Sixty moderate or severe COPD patients in stable phase from December 2017 to October 2018 in Affiliated Zhongshan Hospital of Dalian University were selected. The patients were divided into control group and rehabilitation group by random digits table with 30 cases each. The patients of control group received routine medicine therapy, and the patients of rehabilitation group received bundled pulmonary rehabilitation besides routine medicine therapy. Pulmonary function, cardiopulmonary exercise function and inflammatory factors in each group were tested before treatment and 3, 6 month after treatment.Results:In control group, there were no statistical differences in the pulmonary function, including the forced expired volume in one second (FEV 1), FEV 1 as percentage of predicted (FEV 1%pred), FEV 1/forced vital capacity (FVC); cardiopulmonary exercise function, including the peak load, peak VO 2, peak VO 2 as percentage of predicted (peak VO 2% pred), peak VO 2/kg, peak VE 3 and 6 months after treatment compared with those before treatment ( P>0.05); in rehabilitation group, there were no statistical differences in the indexes 3 months after treatment compared with those before treatment ( P>0.05), the indexes 6 months after treatment were significantly improved compared with those before treatment and 3 months after treatment ( P < 0.05). In control group, the C-reactive protein (CRP) and interleukin (IL-6) before treatment and 3 months after treatment and tumor necrosis factor-α (TNF-α) before treatment and 3, 6 months after treatment had no significant difference ( P > 0.05); the CRP and IL-6 6 months after treatment were significantly lower than those before treatment and 3 months: (5.48 ± 0.91) mg/L vs. (6.26 ± 0.99) and (6.09 ± 0.97) mg/L, (9.17 ± 1.04) ng/L vs. (10.83 ± 1.79) and (10.29 ± 1.53) ng/L, P < 0.05. In rehabilitation group, the CRP, IL-6 and TNF-α 3 and 6 months after treatment were significantly lower than previous phase: (5.21 ± 0.87) and (5.67 ± 0.91) mg/L vs. (6.15 ± 0.92) mg/L, (8.56 ± 1.17) and (10.03 ± 1.61) ng/L vs. (11.06 ± 2.01) ng/L, (7.16 ± 1.33) and (8.05 ± 1.62) ng/L vs. (8.97 ± 2.05) ng/L, P < 0.05. In rehabilitation group, the CRP, IL-6 and TNF-α before and after treatment were negatively correlated with pulmonary function (FEV 1, FEV 1% pred and FEV 1/FVC) and cardiopulmonary exercise function (peak load, peak VO 2, peak VO 2% pred, peak VO 2/kg and peak VE) ( r=- 0.641 to - 0.884, P < 0.01). Conclusions:Bundled pulmonary rehabilitation in patients with moderate or severe stable COPD can improve pulmonary function and cardiopulmonary exercise function and reduce inflammatory factors.

Purpose: Nowadays most children with congenital heart disease (CHD) are expected to survive to adulthood. The healthcare focus needs to pay close attention to the important developmental tasks during their growth process. The women with CHD face some challenges in their critically developmental stages during pregnancy, delivery, and even motherhood. The lived experience of being a mother needs to be further concerned. This study aimed to explore the lived experience of first-time mothers with CHD. Methods: Descriptive phenomenological design was adopted. Semi-structured interviews were conducted from April to August 2018 with 11 primiparous women with CHD, who were recruited from the pediatric and adult cardiology outpatient departments at a medical center and who had a child aged between 6 months and 3 years. Giorgi's phenomenological analysis method was employed. Results: Six main themes arose from the analysis: (1) recognizing pregnancy risks, (2) performing self-care for health, (3) building self-worth from my baby, (4) adapting to postpartum life and adjusting priorities, (5) enjoying being a first-time mother, and (6) the factors contributing to success in high-risk childbirth. Conclusions The experiences that occurred prior to and after labor that were identified in this study can assist women with CHD to more capably prepare for and understand the process of becoming a mother, including recognition of the importance of a prepregnancy evaluation. The findings of this study can help women with CHD to better understand the path to becoming a mother and prepare themselves for the challenges that lie ahead.

OBJECTIVETo study the center effect discrepancy in the multi-center clinical trials.

METHODSTwo groups of data collected from the multi-center clinical trials were used. Data were processed by covariance analysis and Meta-analysis.

RESULTSIn the covariance analysis, the discrepancy of the center effect values indicated statistical significance. Through Meta-analysis on fixed effect model, the discrepancy in one heterogeneity test showed no statistical significance (P > 0.05) while the inter-group discrepancy of the merged effect values drawn from analysis based on fixed effect model having statistical significance (P < 0.05). In the random effect model, the discrepancy in one heterogeneity test showed statistical significance (P < 0.05) while the inter-group discrepancy of the merged effect values drawn from analysis based on random effect model having no statistical significance (P > 0.05).

CONCLUSIONSStudies on multi-center random controlled clinical trials, when statistical significance was found in the interaction discrepancy between the inter-center and the center-group relation, the merged effect values should be compared and analyzed by an appropriate statistic model based on the heterogeneous test results from the Meta-analysis. However, if the result from covariance analysis and the one from Meta-analysis did not agree to each other, the results drawn from the Meta-analysis were reliable.

Data Collection ; Humans ; Multicenter Studies as Topic ; methods ; Randomized Controlled Trials as Topic ; methods

BACKGROUNDNeural tube defects are the most common human birth defects. The causes are multifactorial with complex genetic and environmental factors, although the exact genetic causes are unknown. This research was conducted to study the frequency of Msx2 gene polymorphisms in 59 women with a history of pregnancy with a neural tube defect and in 73 healthy controls. We aimed to determine the effect of this genetic polymorphism on the incidence of neural tube defects in the Han Chinese population.

METHODSWe studied 59 mothers with at least one previous child with a neural tube defect (the case group) and 73 case-control subjects during the same period, from Shanxi Province, China. We analyzed the genotypic distributions and allele frequencies of Msx2 C386T polymorphisms in DNA samples from the case and control groups. A three-dimensional protein model was predicted using Swiss-Pdb Viewer software version 4.0. Disease association was analyzed using chi-square tests.

RESULTSSignificant differences were observed in the genotypes and allele frequencies of the Msx2 C386T allele between the case and control groups (CT: 32% vs. 15%, P = 0.0073 and TT 15% vs. 4%, P = 0.013, respectively). Logistic regression analysis showed that the C386T mutation is a potential risk factor for neural tube defects (P < 0.05; OR: 3.466; 95%CI: 1.831 - 6.560). Three-dimensional structure prediction revealed that the Msx2 C386T mutation results in a threonine substitution for methionine at position 129 of exon 2, which might lead to structural mutations or dysfunctions in the protein encoded by Msx2.

CONCLUSIONMaternal Msx2 C386T gene polymorphisms were associated with fetal neural tube defects in Han Chinese women in Shanxi Province.

Adult ; Asian Continental Ancestry Group ; genetics ; China ; Female ; Homeodomain Proteins ; chemistry ; genetics ; metabolism ; Humans ; Neural Tube Defects ; epidemiology ; genetics ; Polymerase Chain Reaction ; Polymorphism, Single Nucleotide ; genetics ; Pregnancy ; Protein Structure, Secondary ; Young Adult

Esophagustype cervical spondylosis is easily misdiagnosed or missed diagnosed for its lower incidence. The pathological basis manily concerned with compression of osteophyte for esophageal and tracheal wall and local inflammatory reaction. The diagnosis of disease is generally not difficult. Especially dynamic esophagogram could not only show degree of cervical degeneration and osteophyte shape, but also could clearly observe location and degree of osteophytosis indenting esophageal and tracheal. Recently, the treatment of esophagustype cervical spondylosis has been the focus of attention. It is generally believed that conservative treatment could alleviate disease but could not cure it. More and more scholars tend to treat disease by surgical resection of osteophyte to relieve compression for esophagus, and clinical symptoms could obviously improved. However, long-term follow up is lack, and further follow-up effect is lack of powerful support, anddifferent treatment methods and surgical procedures are lack of comparative research.

OBJECTIVETo provide evidence for more accurate diagnosis of birth defects based on the pathoanatomy of congenital malformations.

METHODSData used in this study were obtained from Luliang City Hospital and three county hospitals of Shanxi province between February 2004 and March 2006. Autopsy and pathological examination of 160 dead fetuses and stillbirths were performed. Photos of dead fetuses and stillbirths were taken, tissues were cut into sections for pathological examination under microscope, all pathological information was recorded, and percentage of birth defects was calculated.

RESULTSThe proportion of dead fetuses and stillbirths with or without congenital malformations was 84.4% (135/160) and 15.6% (25/160), respectively. There were 16 categories of major external and internal birth defects in 135 cases of such defects. Congenital heart defects, anencephaly and spina bifida had a higher prevalence rate in the study period. The prevalence rate of non-malformation death and birth defects < 28 gestational weeks and internal anomalies > or = 28 gestational weeks was 14.61% (61/4175) and 17.25% (72/4175), respectively. A total of 413 in situ anomalies were found in 135 cases of autopsy. Spina bifida, anencephaly, congenital heart defects, aplasia or accessory lobe of lung, renal agenesis and dysplasis and congenital hydrocephaly were more closely associated with severe malformations than with mitis malformations. The cases of dead fetuses and stillbirths with multiple malformations (> or = 2 in situ anomalies) had a higher proportion (74.1%), whereas those with isolated malformations had a lower proportion (25.93%).

CONCLUSIONThe occurrence of congenital malformations in different embryonic developmental stages affects multiple organs. Postmortem examination of internal and multiple malformations of fetal deaths and stillbirths can provide more accurate diagnostic information for birth defects.

Cause of Death ; China ; epidemiology ; Congenital Abnormalities ; diagnosis ; epidemiology ; Female ; Humans ; Infant, Newborn ; Male ; Population Surveillance ; Pregnancy ; Stillbirth

BACKGROUNDTherapeutic approaches for tracheal stenosis caused by the formation of exuberant granulation tissues usually include electrocautery, mechanical dilation, laser therapy, argon plasma coagulation (APC), cryotherapy and stent placement. However, restenosis after stent insertion remains a significant limitation. We examined the efficacy of three different approaches, including induction of mechanical lesions, APC performed with different powers or durations and cryotherapy, to identify the method that limited the formation of granulation tissue.

METHODSTwelve specially bred research mongrel dogs were divided into three groups. In group 1 (four dogs) mild (procedure 1; two dogs) or moderate (procedure 2; two dogs) damage was induced mechanically. Group 2 (six dogs) received APC at different powers or durations (procedure 3: 30 W, 1 cm/s; procedure 4: 30 W, 2 cm/s; procedure 5: 25 W, 3 cm/s). Group 3 (two dogs) received cryotherapy (procedure 6: two freeze-thaw cycles of 30 seconds). Uncovered self-expandable metallic stents were inserted in all dogs to maintain a continuous stimulus to the trachea mucosa. Dogs were monitored for 4 weeks and the relationship between granulation tissue proliferation and method used was analyzed.

RESULTSIn group 1, granulation tissue growth increased with more severe mechanical damage. The growth of granulation tissue in group 2 was more pronounced than in group 1, and both dogs in procedure 3 died because of severe stenosis. In this group, the formation of granulation tissue decreased with decreasing power and duration. In group 3, no obvious granulation tissue was found at week 4.

CONCLUSIONSLesions and stimuli from a foreign body (the stent) are two important factors that lead to overgrowth of granulation tissue. Thermal lesions, such as APC, seem to induce greater granulation tissue growth and cartilage damage compared with mechanical and cryotherapy lesions. Cryotherapy in combination with mechanical dilation may be a safe and effective treatment method for managing tracheal stenosis caused by the formation of granulation tissue.

Animals ; Bronchoscopy ; methods ; Cryotherapy ; Dogs ; Granulation Tissue ; pathology ; Laser Coagulation ; methods ; Stents ; Tracheal Stenosis ; therapy

This study was purposed to investigate the clinical significance of serum thymidine kinase 1 (STK1) level change in acute myeloid leukemia (AML). Peripheral blood samples of 60 newly diagnosed AML patients were collected and the STK1 levels were determined by enhanced chemiluminescent dot-blot method before and at two weeks after start of inductive treatment and in consolidatory treatment. Using non-parametric test, the differences between groups were analyzed. Then the correlation between STK1 level and clinical characteristics was explored by a way of chi-square test. The results indicated that the serum TK1 level in complete remission (CR) or partial remission (PR) AML patients decreased in varying degree as compared to pretreatment (P < 0.05), while there was no significant difference of TK1 level in non-remission (NR) ones (P > 0.05). The serum TK1 level in CR patients remained low level but increased noticeably after relapse into progressive disease (P < 0.05). A significant correlation was found between STK1 level and chromosomal abnormalities, serum LDH level as well as whether had fever in de novo AML patients (P < 0.05). It is concluded that the serum TK1 level change may be applied for reflecting the aggressiveness of disease, monitoring the clinical response to chemotherapy, evaluating the prognosis and predicating the relapse risk. The decrease of TK1 level suggests effective treatment and tumor burden reduction, while its increase indicate poor prognosis and relapse risk.
Adolescent ; Adult ; Aged ; Case-Control Studies ; Female ; Humans ; Leukemia, Myeloid, Acute ; blood ; Male ; Middle Aged ; Thymidine Kinase ; blood ; Young Adult