Prenatal Diagnosis of Congenital Heart Disease and Voluntary Termination of Pregnancy: A Population-Based Study in Qingdao, China.

Objective: The outcomes of fetuses with isolated congenital heart disease (CHD) diagnosed prenatally have not been investigated in a population-based study in China. This population-based study aimed to evaluate the rate of voluntary termination of pregnancy after the prenatal diagnosis of isolated CHD in Qingdao, China. Methods: This was a population-based retrospective study in which data were collected from all pregnant women in Qingdao (eastern China) from August 2018 to July 2020; fetal data, maternal data and data on pregnancy outcomes were extracted from medical records regarding prenatal diagnosis of CHD. The inclusion criteria were as follows: pregnant women or their husbands who had a household registration in Qingdao and who underwent regular prenatal screening in Qingdao. The exclusion criterion was the failure to sign an informed consent form. Counseling for all parents of fetuses with CHD was provided by a multidisciplinary team of experienced pediatric cardiologists, obstetricians, geneticists, etc. According to the type and severity of CHD, the pregnancy termination rate was analyzed. Results: Among the 126,843 pregnant women, 1299 fetuses with a prenatal diagnosis of CHD were included in the study. Among the included fetuses, 1075 were diagnosed with isolated CHD, and the overall pregnancy termination rate was 22.8%. Termination rates varied according to the complexity of CHD (low complexity vs moderate complexity, P=0.000; low complexity vs high complexity, P=0.000; moderate complexity vs high complexity, P=0.000), with rates of 6.0% for low complexity, 54.2% for moderate complexity, and 99.1% for high complexity. The decision to terminate the pregnancy in cases of isolated CHD was unrelated to maternal age (P=0.091) but was related to gestational age (p=0.000). Conclusion: In Qingdao, 99.1% of parents whose fetuses were diagnosed with isolated high-complexity CHD chose to voluntarily terminate the pregnancy. The pregnancy termination rate increased with increasing complexity of prenatally diagnosed CHD.

Case report: Extravascular catheter migration in a child: A rare complication of the totally implantable venous access device.

BACKGROUND: Totally implantable venous access devices (TIVADs) are widely used to gain intermittent central venous access, such as in patients who need long-term chemotherapy, total parenteral nutrition, and long-term antibiotic treatment. At present, there are many complications associated with the use of these devices. Complete extravascular migration of TIVADs via the internal jugular vein is a very rare and potentially serious condition, especially in children. CASE PRESENTATION: A 1-year-old girl needed palliative chemotherapy because of hepatoblastoma complicated by inferior vena cava thrombosis. A TIVAD was implanted through the right internal jugular vein with a routine heparin flushing tube. On the second day after the operation, a pale bloody liquid was drawn out from the device and the chest X-ray was checked to confirm that the position of the catheter was normal. On the third day after the operation, however, the patient's right respiratory sound was weakened on physical examination and auscultation. Fluoroscopy showed that the tip of the catheter was located in the right thoracic cavity, and there was a large amount of effusion in the right thoracic cavity. The pleural effusion was removed, the TIVAD was replaced again, and the child was discharged 2 days later. CONCLUSIONS: Following TIVAD implantation, if abnormalities are found, in addition to chest X-ray, saline flush and echocardiography should be performed to determine the position of the catheter and rule out extravascular migration of the catheter to avoid irreparable consequences.

Glycemic index, glycemic load, and lung cancer risk: A meta-analysis of cohort and case-control studies.

OBJECTIVE: Glycemic index (GI) or glycemic load (GL) has been investigated in the field of cancer research for several years. However, the relationship between GI or GL and lung cancer risk remains inconsistent. Therefore, this study aimed to summarize previous findings on this relationship. METHODS: PubMed, Embase, Scopus, Web of Science databases, and Cochrane Library were searched by July 2021. This review was conducted in accordance with the PRISMA guidelines. A fixed or random-effects model was adopted for meta-analysis to compute the pooled relative risks (RR) and their corresponding 95% confidence intervals (CIs). Subgroup analyses, sensitivity analyses, and publication bias analyses were also performed. RESULTS: In total, nine articles were included, with four case-control studies and five cohort studies, including 17,019 cases and 786,479 controls. After merging the studies, pooled multivariable RRs of lung cancer based on the highest versus the lowest intake were 1.14 (95%CI: 1.03-1.26) and 0.93 (95%CI: 0.84-1.02) for GI and GL. Results persisted in most stratifications after stratifying by potential confounders in the relationship between GI and lung cancer risk. There was a non-linear dose response relation for GI with lung caner risk. CONCLUSION: GI typically has a positive relationship with lung cancer risk. However, no associations between GL and lung cancer risk were observed based on current evidence, suggesting that this issue should be studied and verified further to substantiate these findings.

Mediterranean Diet Patterns in Relation to Lung Cancer Risk: A Meta-Analysis.

Background: We systematically quantified the currently inconclusive association between Mediterranean diet patterns and the risk of lung cancer. Methods: We searched the PubMed, Cochrane, Database of Abstracts of Reviews of Effects (DARE) and Web of Science electronic databases to identify relevant articles published before October 2021. We used the Newcastle-Ottawa scale to assess the quality of the published research and a random-effects model to estimate the aggregate hazard ratios and 95% CIs. As a result of significant heterogeneity, we performed subgroup analysis, meta-regression analysis, and sensitivity analysis. Where data were available, we also performed a dose-response analysis. Results: Nine articles were included in the meta-analysis. The meta-analysis showed that there was a significant negative correlation between Mediterranean diet patterns and the risk of lung cancer in the general population with a hazard ratio of 0.82, a 95% CI of 0.74-0.92, and a high heterogeneity (I 2 = 59.9%, P < 0.05). As a result of the significant heterogeneity, we conducted subgroup analysis, meta-regression analysis, and sensitivity analysis and found that the study design was the source of the heterogeneity. Subgroup analysis and sensitivity analysis showed that the final results did not change very much, the sensitivity was low and the results were relatively stable. The dose-response relationship showed that, based on the lowest Mediterranean diet score (0 points), for every three-point increase, the risk of lung cancer was reduced by 9%. Conclusion: The evidence in this meta-analysis shows that there is a significant negative correlation between Mediterranean diet patterns and the risk of lung cancer, suggesting that Mediterranean diets are a protective factor in lung cancer.

Simultaneous Percutaneous Interventional Treatment of Atrial Septal Defects and Pulmonary Valve Stenosis in Children Under the Guidance of Transoesophageal Echocardiography Alone: Preliminary Experiences.

OBJECTIVE: To investigate the efficacy and safety of simultaneous percutaneous interventional treatment of atrial septal defects (ASDs) and pulmonary valve stenosis (PS) in children under the guidance of transoesophageal echocardiography (TEE) alone. METHODS: Eleven children with ASD combined with PS who were treated at our hospital between March 2015 and March 2019 were recruited, including 4 males and 7 females. Preoperative transthoracic echocardiography showed that all patients had type II ASDs of the foramen ovale subtype, with a maximum diameter of 12.9 ± 2.7 mm (9.0-18.0 mm). The guiding principle of septal occluder selection is that the diameter of the occluder should be 2-4 mm larger than the maximum diameter of the ASD. The pressure gradient across the pulmonary valve in patients with PS was 54.7 ± 5.8 mmHg (47.0-64.0 mmHg), and a balloon with a diameter 1.2-1.4 times the diameter of the pulmonary valve annulus was used for dilatation. Effective dilatation was repeated 2-3 times. All children underwent ASD occlusion and PS balloon dilatation through the femoral vein under TEE guidance without radiation or contrast agents. The patients underwent PS balloon dilatation first, followed by ASD occlusion. The treatment effect was evaluated by TEE immediately after the procedure, and the patients were followed up regularly. RESULTS: All patients underwent successful simultaneous ASD occlusion and PS balloon dilatation through the femoral vein under the guidance of TEE alone. The pressure gradient across the pulmonary valve immediately after the procedure was 21.3 ± 1.8 mmHg (19.0-25.0 mmHg) (P < 0.01). No shunt was detected at the atrial septum level. The patients were followed for 3.0 ± 1.4 years (1.0-5.0 years) after the procedure. The atrial septal occluders were in the normal position in all of the patients, and there was no arrhythmia, hemolysis, or residual shunting. The pressure gradient across the pulmonary valve at 1 month after the procedure was 18.5 ± 3.3 mmHg (P < 0.01). CONCLUSION: Simultaneous percutaneous interventional treatment of ASD and PS in children under the guidance of TEE alone is not only safe and effective but also prevents trauma caused by extracorporeal circulation and surgical incision and damage caused by X-ray and contrast agents. The surgical sequence included first performing PS balloon dilatation, followed by ASD occlusion.

Association between sarcopenia and cognitive function in older Chinese adults: Evidence from the China health and retirement longitudinal study.

Background: Sarcopenia and cognitive impairment are the most common causes of disability in the aging population. The potential role of sarcopenia in the development of cognitive impairment remains poorly understood. A cross-sectional analysis was performed using nationally representative data to evaluate associations between sarcopenia and cognition in China. Methods: We included 2,391 participants (35.63% female) who were at least 60 years of age in 2015 from the China Health and Retirement Longitudinal Study (CHARLS). Muscle strength, appendicular skeletal mass (ASM), and physical performance measurements, were measured to diagnose sarcopenia according to the Asian Working Group for Sarcopenia 2019 (AWGS2019). Cognitive function was assessed by 10 items in the Telephone Interview for Cognitive Status (TICS-10), delayed word recall, and graph drawing. Based on cognitive score tertiles, data were divided into three groups. Multiple linear and logistic regression models were used to assess the relationship between sarcopenia and cognition. Results: The prevalence of possible sarcopenia was 27.16% for men and 27.46% for women. Cognitive decline was significantly associated with sarcopenia status (ß = -0.88, p < 0.001) and negatively associated with components of sarcopenia in male group. The results remained consistent in male after further adjusting for creatinine, uric acid, blood sugar, etc. Low cognitive function in female was only associated with low muscle strength (ß = -0.85, p = 0.02). In addition, participants with possible sarcopenia had greater risk of cognitive decline than those without sarcopenia (OR = 1.41; 95% CI: 1.06-1.87). However, the same association was not significant in female group. Conclusion: We suggest that sarcopenia might be associated with cognition function, with possible sarcopenia being significantly associated with higher cognition risk in China population, which providing a further rationale for timely recognition and management of sarcopenia.