Congenital heart defects are the most prevalent type of birth defects. The association of air pollution with congenital heart defects is not well understood. We investigated a cohort of 8969 ...singleton live births in Lanzhou, China during 2010-2012. Using inverse distance weighting, maternal exposures to particulate matter with diameters ≤10 m (PM10), nitrogen dioxide (NO2), and sulfur dioxide (SO2) were estimated as a combination of monitoring station levels for time spent at home and in a work location. We used logistic regression to estimate the associations, adjusting for maternal age, education, income, BMI, disease, folic acid intake and therapeutic drug use, and smoking; season of conception, fuel used for cooking and temperature. We found significant positive associations of Patent Ductus Arteriosus (PDA) with PM10 during the 1st trimester, 2nd trimester and the entire pregnancy (OR 1st trimester = 3.96, 95% confidence interval (CI): 1.36, 11.53; OR 2nd trimester = 3.59, 95% CI: 1.57, 8.22; OR entire pregnancy = 2.09, 95% CI: 1.21, 3.62, per interquartile range (IQR) increment for PM10 (IQR = 71.2, 61.6, and 27.4 g m−3, respectively)), and associations with NO2 during 2nd trimester and the entire pregnancy (OR 2nd trimester = 1.92, 95% CI: 1.11, 3.34; OR entire pregnancy = 2.32, 95% Cl: 1.14, 4.71, per IQR increment for NO2 (IQR = 13.4 and 10.9 g m−3, respectively)). The associations for congenital malformations of the great arteries and pooled cases showed consistent patterns. We also found positive associations for congenital malformations of cardiac septa with PM10 exposures in the 2nd trimester and the entire pregnancy, and SO2 exposures in the entire pregnancy. Results indicate a health burden from maternal exposures to air pollution, with increased risk of congenital heart defects.
Background: The relationship between air borne particulate matter ≤10 m (PM10) exposure and pregnancy-induced hypertension (PIH) is inconclusive. Few studies have been conducted, and fewer were ...conducted in areas with high levels of PM10. Methods: To examine the association between PM10 and PIH by different exposure time windows during pregnancy, we analyzed data from a birth cohort study conducted in Lanzhou, China including 8 745 pregnant women with available information on air pollution during pregnancy. A total of 333 PIH cases (127 gestational hypertension (GH) and 206 preeclampsia (PE)) were identified. PM10 daily average concentrations of each subject were calculated according to the distance between home work addresses and monitor stations using an inverse-distance weighting approach. Results: Average PM10 concentration over the duration of entire pregnancy was significantly associated with PIH (OR = 1.12, 95%CI: 1.02, 1.23 per 10 g m−3 increase), PE (OR = 1.16, 95%CI: 1.03, 1.30 per 10 g m−3 increase), late onset PE (OR = 1.17, 95% CI: 1.03, 1.32 per10 g m−3 increase), and severe PE (OR = 1.25, 95% CI: 1.06, 1.48 per 10 g m−3 increase). Average PM10 during the first 12 gestational weeks was associated with the risk of GH (OR = 1.10, 95% CI: 1.00, 1.21 per 10 g m−3 increase), and PM10 exposure before 20 gestational weeks was associated with the risk of severe PE (OR = 1.14, 95% CI: 1.01, 1.30 per 10 g m−3 increase). Conclusions: We found that high level exposure to ambient PM10 during pregnancy was associated with an increased risk of PIH, GH and PE and that the strength of the association varied by timing of exposure during pregnancy.
Abstract
Background
Congenital muscular torticollis (CMT) is a common musculoskeletal disease affecting infants and young children. If CMT is not treated correctly and timely, it can lead to limited ...head and neck movements, head and neck deviation, and abnormal posture. In order to improve patients' symptoms and alleviate the negative impact of the disease on their lives, we are committed to exploring the treatment of CMT.
Methods
The general clinical and ultrasonographic data of 2599 children with CMT who received standardized treatment at Shenzhen Children’s Hospital from 2004 to 2020 were retrospectively reviewed. According to given treatment, children with CMT were divided into the physiotherapy group, physiotherapy combined with glucocorticoid treatment group, and surgical treatment group. We divided children with CMT into local mass, uniform thickening, and atrophy according to ultrasound features. General clinical information, treatment, and ultrasound examination data in each group were compared. Additionally, electronic medical records of 2344 patients admitted due to CMT in 17 tertiary children’s hospitals of China’s Futang Research Center of Pediatric Development (FRCPD) from 2015 to 2019 were retrospectively analyzed. Data on sex, age, year of admission and discharge, and treatment costs during hospitalization were extracted from the first medical record pages according to the ICD codes. The data were assessed for normality using the Kolmogorov–Smirnov test. Depending on the data distribution, they were analyzed using parametric tests, such as the t-test, or non-parametric tests. Qualitative data are expressed as percentages (%) and analyzed using the chi-square or Fisher’s exact probability test, with α = 0.05 as the test level.
P
< 0.05 was considered to be indicative of a statistically significant difference.
Results
Three types of CMT were defined based on sternocleidomastoid muscle ultrasound examination characteristics: local mass, uniform thickening, and atrophy. Age at first diagnosis was 69.21 ± 108.41 days in local mass type group, 216.85 ± 324.09 days in uniform thickening group, and 417.88 ± 739.05 days in atrophy- type group; while age at first physiotherapy use was 94.06 ± 206.49 days, 255.00 ± 430.62 days, 540.92 ± 1059.29 respectively. The children included in local mass type group have shown a high success rate of conservative treatment, with a rate of 7.5% of children underwent surgery. Age at first diagnosis was 112.44 ± 224.12 days in the physiotherapy group, 115.87 ± 144.86 days in the physiotherapy combined with glucocorticoid treatment subgroup, whereas the age at first physiotherapy use was 137.38 ± 312.11 and 196.91 ± 344.26 days respectively. In the observation period (2015–2019) the mean age at surgery for CMT in 17 tertiary children’s hospitals of the FRCPD was 50 months. Overall, 663 children with CMT were 1–2 years of age, accounting for the largest proportion (28.3%). Followed by 417 individuals (17.8%) were 7–14 years of age, indicating that there are still more children with CMT receiving surgical treatment later.
Conclusions
Early diagnosis and treatment are essential to improve the conservative treatment success rate and achieve good prognosis in children with CMT. Our team’s concept for treating CMT is as follows: after diagnosing the children, we will adopt the standardized protocol of treatment, with physiotherapy combined with the injection of glucocorticoid drugs and SCM release surgery, when needed. This program has a high conservative treatment success rate and may facilitate the achievement of better prognosis and reduced teratogenicity rate.
Importance
Morbidity and mortality of children are important indicators of the performance of the public health system in any country. In China, the children's disease spectrum has gradually changed ...in recent years. However, the gender‐ and age‐specific disease spectrum for hospitalized children under 15 years old is still unclear.
Objective
To explore the gender‐ and age‐based distribution of diseases in hospitalized children under 15 years in China.
Methods
Medical records home page data for 2016 to 2018 were collected from 18 tertiary children's hospitals in China. The gender‐ and age‐specific disease spectrum was analyzed, using the tenth revision of the International Statistical Classification of Diseases and Related Health Problems (ICD‐10).
Results
The most common diseases were those of the respiratory system (25.7% of all 2 232 142 hospitalized children). The top three diseases for boys were diseases of the respiratory system (25.6%), diseases of the digestive system (11.4%) and certain conditions originating in the perinatal period (8.6%). The top three diseases for girls were diseases of the respiratory system (25.9%), certain conditions originating in the perinatal period (10.1%), and factors influencing health status and contact with health services (9.4%). The most common diseases for children under 1 year old were certain conditions originating in the perinatal period (38.1%). For all other age groups, the most common conditions were respiratory diseases (33.8% for those aged 1–3 years, 25.2% for those aged 4–6 years, and 12.2% for those aged 7–14 years).
Interpretation
This study analyzed the medical records home pages of 18 children's hospitals to provide the first overview of the disease spectrum and its gender‐ and age‐specific distribution among children in China.
To study the factors of folic acid intake among pregnant women, and to provide the basic dates for improving the effectiveness of folic acid intervention.
A cross-section study was conducted both in ...hospital and household. Anonymous questionnaires were distributed to 2094 women in two counties of Gansu province, who were pregnant at least three months or postpartum within one year.
Only 25.4% of 2094 subjects have taken folic acid. Lack of knowledge on folic acid, the age of pregnant women, the history of birth defects, had a check in hospital before pregnant, the degree of education, planned pregnancy and the history of miscarriages were the significant influential factors for whether or not taking folic acid.
The history of childbearing and the knowledge on folic are the important factors affecting the use of folic acid supplements. Widely initiating health education on the knowledge of folic acid and advocating family planning in childbearing aged population should be taken as the most important measures.
Submerged fermentations of Monascus anka were performed with different nitrogen sources at different pH in 3 L bioreactors. The results revealed that the Monascus pigments dominated by different ...color components (yellow pigments, orange pigments or red pigments) could be selectively produced through pH control and nitrogen source selection. A large amount of intracellular pigments dominated by orange pigments and a small amount of water-soluble extracellular yellow pigments were produced at low pH (pH 2.5 and 4.0), independently of the nitrogen source employed. At higher pH (pH 6.5), the role of the nitrogen source became more significant. In particular, when ammonium sulfate was used as nitrogen source, the intracellular pigments were dominated by red pigments with a small amount of yellow pigments. Conversely, when peptone was used, intracellular pigments were dominated by yellow pigments with a few red pigments derivatives. Neither the presence of peptone nor ammonium sulfate promoted the production of intracellular orange pigments while extracellular pigments with an orangish red color were observed in both cases, with a higher yield when peptone was used. Two-stage pH control fermentation was then performed to improve desirable pigments yield and further investigate the effect of pH and nitrogen sources on pigments composition. These results provide a useful strategy to produce Monascus pigments with different composition and different color characteristics.
Monascus mycelia and pigments are promising sources of food and medicine with their potential pharmaceutical values and health-improving functions. Using high cell density fermentation of Monascus ...spp. to achieve higher mycelium and yellow pigment production is worthy to be researched. In this study, the characteristics and productivity shifting of pigments in high cell density culture of Monascus anka GIM 3.592 were investigated.
The high yield of Monascus mycelia up to 39.77 g/L dry cell weight (DCW), which was achieved by fed-batch fermentation with the feeding medium containing C, N, P and trace elements, was four times higher than that of conventional batch culture. But the total pigment production decreased by 14.6 %, which suggested non-coupled growth. Potential novel yellow pigments accumulated constantly at the late stage of the fed-batch culture, which resulted in a shift in pigment characteristics so that yellow pigments became the dominant pigments. Citrinin production was extremely low and independent of feeding ingredients.
This study provided a suitable fermentation strategy to produce functional Monascus mycelia with a high proportion of yellow pigments in high cell density culture. For the first time, it reported the pigment productivity and characteristics shifting in high cell density culture of Monascus.
Robotic surgery for rectal cancer is gaining popularity, but evidence on long-term oncological outcomes is scarce. We aimed to compare surgical quality and long-term oncological outcomes of robotic ...and conventional laparoscopic surgery in patients with middle and low rectal cancer. Here we report the short-term outcomes of this trial.
This multicentre, randomised, controlled, superiority trial was done at 11 hospitals in eight provinces of China. Eligible patients were aged 18-80 years with middle (>5 to 10 cm from the anal verge) or low (≤5 cm from the anal verge) rectal adenocarcinoma, cT1-T3 N0-N1 or ycT1-T3 Nx, and no evidence of distant metastasis. Central randomisation was done by use of an online system and was stratified according to participating centre, sex, BMI, tumour location, and preoperative chemoradiotherapy. Patients were randomly assigned at a 1:1 ratio to receive robotic or conventional laparoscopic surgery. All surgical procedures complied with the principles of total mesorectal excision or partial mesorectal excision (for tumours located higher in the rectum). Lymph nodes at the origin of the inferior mesenteric artery were dissected. In the robotic group, the excision procedures and dissection of lymph nodes were done by use of robotic techniques. Neither investigators nor patients were masked to the treatment allocation but the assessment of pathological outcomes was masked to the treatment allocation. The primary endpoint was 3-year locoregional recurrence rate, but the data for this endpoint are not yet mature. Secondary short-term endpoints are reported in this article, including two key secondary endpoints: circumferential resection margin positivity and 30-day postoperative complications (Clavien-Dindo classification grade II or higher). The outcomes were analysed according in a modified intention-to-treat population (according to the original assigned groups and excluding patients who did not undergo surgery or no longer met inclusion criteria after randomisation). This trial was registered with ClinicalTrials.gov, number NCT02817126. Study recruitment has completed, and the follow-up is ongoing.
Between July 17, 2016, and Dec 21, 2020, 1742 patients were assessed for eligibility. 502 patients were excluded, and 1240 patients were enrolled and randomly assigned to receive either robotic surgery (620 patients) or laparoscopic surgery (620 patients). 69 patients were excluded (34 in the robotic surgery group and 35 in the laparoscopic surgery group). 1171 patients were included in the modified intention-to-treat analysis (586 in the robotic group and 585 in the laparoscopic group). Six patients in the robotic surgery group received laparoscopic surgery and seven patients in the laparoscopic surgery group received robotic surgery. 22 (4·0%) of 547 patients in the robotic group had a positive circumferential resection margin as did 39 (7·2%) of 543 patients in the laparoscopic group (difference -3·2 percentage points 95% CI -6·0 to -0·4; p=0·023). 95 (16·2%) of patients in the robotic group had at least one postoperative complication (Clavien-Dindo grade II or higher) within 30 days after surgery, as did 135 (23·1%) of 585 patients in the laparoscopic group (difference -6·9 percentage points -11·4 to -2·3; p=0·003). More patients in the robotic group had a macroscopic complete resection than in the laparoscopic group (559 95·4% of 586 patients vs 537 91·8% of 585 patients, difference 3·6 percentage points 0·8 to 6·5). Patients in the robotic group had better postoperative gastrointestinal recovery, shorter postoperative hospital stay (median 7·0 days IQR 7·0 to 11·0 vs 8·0 days 7·0 to 12·0, difference -1·0 95% CI -1·0 to 0·0; p=0·0001), fewer abdominoperineal resections (99 16·9% of 586 patients vs 133 22·7% of 585 patients, difference -5·8 percentage points -10·4 to -1·3), fewer conversions to open surgery (10 1·7% of 586 patients vs 23 3·9% of 585 patients, difference -2·2 percentage points -4·3 to -0·4; p=0·021), less estimated blood loss (median 40·0 mL IQR 30·0 to 100·0 vs 50·0 mL 40·0 to 100·0, difference -10·0 -20·0 to -10·0; p<0·0001), and fewer intraoperative complications (32 5·5% of 586 patients vs 51 8·7% of 585 patients; difference -3·3 percentage points -6·3 to -0·3; p=0·030) than patients in the laparoscopic group.
Secondary short-term outcomes suggest that for middle and low rectal cancer, robotic surgery resulted in better oncological quality of resection than conventional laparoscopic surgery, with less surgical trauma, and better postoperative recovery.
Shenkang Hospital Development Center, Shanghai Municipal Health Commission (Shanghai, China), and Zhongshan Hospital Fudan University (Shanghai, China).
Microbial fermentation with immobilized cells possesses many advantages. However, this fermentation mode is restricted to the production of extracellular products. Our previous study demonstrated ...that the extractive fermentation of Monascus spp. in nonionic surfactant micelle aqueous solution can export Monascus pigments that are supposed to be mainly intracellular products to extracellular culture broth and, in the meantime, extracellularly enhance the production of yellow pigments at a low pH condition; consequently, this makes the continuous production of yellow pigments with immobilized Monascus cells feasible. In this study, immobilized-cell fermentation and extractive fermentation in Triton X-100 micelle aqueous solution were successfully combined to continuously produce Monascus yellow pigments extracellularly. We examined the effects of cell immobilization and Triton X-100 on cell growth, pigment production, and pigment composition. In the repeated-batch extractive fermentation with immobilized cells, the biomass in Ca-alginate gel beads continued to grow and reached 21.2 g/L after seven batches, and dominant yellow pigments were produced extracellularly and stable for each batch. The mean productivity of the extracellular yellow pigments reached up to 22.31 AU410 nm/day within the first four batches (13 days) and 19.7 AU410 nm/day within the first seven batches (25 days). The results also provide a new strategy for producing such intracellular products continuously and extracellularly.
The adhesion of dust particles on the surface of the dust collector tends to cause great resistance to the dust collector and affects the operating efficiency. In order to visualize particles in the ...filtration process and to grasp the mechanism of particle viscosity and sphericity on filtration performance, a numerical simulation study was conducted to investigate the deposition behavior of particles during filtration, employing FLUENT-EDEM coupling technology. By examining the deposition process, the role of particle characteristics on dust behavior within the entire filtration system was elucidated. The effects of varying particle surface energy and particle sphericity on filtration pressure drop and cake porosity were analyzed. The findings reveal that under the force of the air, particles on the surface of the filter membrane experience compaction, leading to a reduction in the porosity of the formed cake layer. The diminution of porosity serves to impede the air, consequently augmenting the pressure drop across the filtration system and hindering the operational efficacy of the dust collector. As the surface energy of the particles increases, the adhesive forces between particles are intensified, leading to an elevation in the porosity of the cake layer and a subsequent decrease in the pressure drop. When the surface energy of the particles is increased from 0.01 J/m2 to 0.04 J/m2, the porosity experiences a modest increase of only 9.1%, yet the pressure drop is significantly reduced by half, amounting to a decrease of 1594 Pa. Under high particle surface energy, as filtration air velocity increases, particles are compressed, resulting in a decrease in cake porosity and an increase in pressure drop. Concurrently, our findings indicate that as the sphericity of particles increases, their surfaces become increasingly smooth which in turn results in a decreased porosity of the cake layer and, consequently, an elevation in the filtration pressure drop.
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