Association of caesarean delivery with offspring health outcomes in full-cohort versus sibling-comparison studies: a comparative meta-analysis and simulation study.

BACKGROUND: Full-cohort and sibling-comparison designs have yielded inconsistent results about the impacts of caesarean delivery on offspring health outcomes, with the effect estimates from the latter being more likely directed towards the null value. We hypothesized that the seemingly conservative results obtained from the sibling-comparison design might be attributed to inadequate adjustment for non-shared confounders between siblings, particularly maternal age at delivery. METHODS: A systematic review and meta-analysis was first conducted. PubMed, Embase, and the Web of Science were searched from database inception to April 6, 2022. Included studies (1) examined the association of caesarean delivery, whether elective or emergency, with offspring health outcomes; (2) simultaneously conducted full-cohort and sibling-comparison analyses; and (3) reported adjusted effect estimates with 95% confidence intervals (95% CIs). No language restrictions were applied. Data were extracted by 2 reviewers independently. Three-level meta-analytic models were used to calculate the pooled odds ratios (ORs) and 95% CIs for caesarean versus vaginal delivery on multiple offspring health outcomes separately for full-cohort and sibling-comparison designs. Subgroup analyses were performed based on the method of adjustment for maternal age at delivery. A simulation study was then conducted. The simulated datasets were generated with some key parameters derived from the meta-analysis. RESULTS: Eighteen studies involving 21,854,828 individuals were included. The outcomes assessed included mental and behavioral disorders; endocrine, nutritional and metabolic diseases; asthma; cardiorespiratory fitness; and multiple sclerosis. The overall pooled OR for estimates from the full-cohort design was 1.14 (95% CI: 1.11 to 1.17), higher than that for estimates from the sibling-comparison design (OR = 1.08; 95% CI: 1.02 to 1.14). Stratified analyses showed that estimates from the sibling-comparison design varied considerably across studies using different methods to adjust for maternal age at delivery in multivariate analyses, while those from the full-cohort design were rather stable: in studies that did not adjust maternal age at delivery, the pooled OR of full-cohort vs. sibling-comparison design was 1.10 (95% CI: 0.99 to 1.22) vs. 1.06 (95% CI: 0.85 to 1.31), in studies adjusting it as a categorical variable, 1.15 (95% CI: 1.11 to 1.19) vs. 1.07 (95% CI: 1.00 to 1.15), and in studies adjusting it as a continuous variable, 1.12 (95% CI: 1.05 to 1.19) vs. 1.12 (95% CI: 0.98 to 1.29). The severe underestimation bias related to the inadequate adjustment of maternal age at delivery in sibling-comparison analyses was fully replicated in the simulation study. CONCLUSIONS: Sibling-comparison analyses may underestimate the association of caesarean delivery with multiple offspring health outcomes due to inadequate adjustment of non-shared confounders, such as maternal age at delivery. Thus, we should be cautious when interpreting the seemingly conservative results of sibling-comparison analyses in delivery-related studies.

Research progress on the relationship between serum uric acid and sarcopenia / 公共卫生与预防医学

Objective With the deepening of population aging, sarcopenia has become an important public health problem affecting the health and quality of life of the elderly population. As the end-product of purine metabolism in human body, uric acid has dual effects of anti-oxidation, pro-oxidation and pro-inflammatory reaction , which affects the occurrence and development of sarcopenia to a certain extent. This paper reviews the research progress of serum uric acid and sarcopenia. Methods PubMed database, Web of Science core collection database, Embase database, China National Knowledge Infrastructure (CNKI) and Wanfang database were searched for literatures on the relationship between serum uric acid (SUA) level and sarcopenia up to February 7, 2022, and then reviewed. Results A total of 4 epidemiological studies were found on serum uric acid levels and the risk of sarcopenia. Among them, 3 studies found that SUA within a certain level range was a protective factor for sarcopenia, and 1 study suggested that the risk of sarcopenia increased with the increase of SUA levels. There was a gender difference between serum uric acid level and sarcopenia risk. Conclusion At present, the results of studies on the relationship between serum uric acid levels and the risk of sarcopenia are still controversial, which may be caused by the different effects of uric acid in human body. In the future , more extensive and in-depth studies are needed to investigate the relationship between the two.

Gestational Diabetes Mellitus as an Effect Modifier of the Association of Gestational Weight Gain with Perinatal Outcomes: A Prospective Cohort Study in China.

The association of gestational weight gain (GWG) with perinatal outcomes seems to differ between women with and without gestational diabetes mellitus (GDM). Whether GDM is an effect-modifier of the association has not been verified. This study aimed to assess the modifying effect of GDM on the association of GWG with perinatal outcomes. Data on 12,128 pregnant women (3013 with GDM and 9115 without GDM) were extracted from a prospective, multicenter, cohort study in China. The associations of total and trimester-specific GWG rates (GWGR) with perinatal outcomes, including small size for gestational age, large size for gestational age (LGA), preterm birth, cesarean delivery, and gestational hypertension disorders, were assessed. The modifying effect of GDM on the association was assessed on both multiplicative and additive scales, as estimated by mixed-effects logistic regression. As a result, total GWGR was associated with all of the perinatal outcomes. GDM modified the association of total GWGR with LGA and cesarean delivery on both scales (all p < 0.05) but did not modify the association with other outcomes. The modifying effect was observed in the third trimester but not in the first or the second trimester. Therefore, maternal GWG is associated with perinatal outcomes, and GDM modifies the association with LGA and cesarean delivery in the third trimester.

Adherence to Cancer Prevention Guidelines and Endometrial Cancer Risk: Evidence from a Systematic Review and Dose-Response Meta-analysis of Prospective Studies / Journal of the Korean Cancer Association, 대한암학회지

Purpose@#The evidence of adherence to cancer prevention guidelines and endometrial cancer (EC) risk has been limited and controversial. This study summarizes and quantifies the relationship between adherence to cancer prevention guidelines and EC risk. @*Materials and Methods@#The online databases PubMed, Web of Science, and EMBASE were searched for relevant publications up to June 2, 2020. This study had been registered at PROSPERO. The registration number is CRD42020149966. Study quality evaluation was performed based on the Newcastle-Ottawa Scale. The I2 statistic was used to estimate heterogeneity among studies. Egger’s and Begg’s tests assessed potential publication bias. Summary hazard ratios (HRs) and 95% confidence intervals (CIs) for the relationship between adherence to cancer prevention guidelines score was assigned to participants by summarizing individual scores for each lifestyle-related factor. The scores ranged from least healthy (0) to most healthy (20) and the EC risk was calculated using a randomeffects model. @*Results@#Five prospective studies (four cohort studies and one case‑cohort study) consisted of 4,470 EC cases, where 597,047 participants were included. Four studies had a low bias risk and one study had a high bias risk. Summary EC HR for the highest vs. lowest score of adherence to cancer prevention guidelines was 0.54 (95% CI, 0.40 to 0.73) and had a high heterogeneity (I2=86.1%). For the dose-response analysis, an increment of 1 significantly reduced the risk of EC by 6%. No significant publication bias was detected. @*Conclusion@#This study suggested that adherence to cancer prevention guidelines was negatively related to EC risk.

Prognostic factors of colorectal cancer and establishment of colorectal cancer prognosis model / 中华医学图书情报杂志

The factors influencing the prognosis of colorectal cancer were studied after its characteristic variables were screened by stepwise logistic regression analysis, Bayesian model averaging analysis, and LASSO regression a-nalysis respectively. A model of colorectal cancer prognosis was established according to the artificial neural net-work classification algorithm for the assessment of colorectal cancer. The highest accuracy was detected in the model of colorectal cancer prognosis established by Bayesian model averaging analysis combined with artificial neural net-work classification algorithm.

Research progress in pharmacological effects of Uncaria Hook on Alzheimer disease models / 药学学报

The most common neurodegenerative disease, Alzheimer disease (AD) constitutes the majority of all senile dementia cases. Extending life expectancy contributes to the increased incidence of AD, which is a serious threat to the quality of life of the elderly. The etiology and pathogenesis of AD are not absolutely clear. There are various kinds of hypotheses, such as abnormal phosphorylation of tau proteins, amyloid-beta protein toxicity, gene mutation, degeneration of cholinergic system, neuroinflammation, oxidative stress. Based on the above-mentioned theories, lots of studies of Uncaria Hook have been conducted in Alzheimer disease models. In this paper, we reviewed the latest research of Uncaria Hook on Alzheimer disease models to provide reference for further development of Uncaria Hook's medicinal potential.

Advance in studies on neuroprotective mechanism of Uncariae Ramulus Cum Uncis / 中国中药杂志

The Uncariae Ramulus Cum Uncis is a commonly used traditional Chinese medicine. In recent years, many studies have revealed its prominent neuroprotection function. The active ingredients in Uncariae Ramulus Cum Uncis could protect the nervous system in a multi-path and multi-target manner. Uncariae Ramulus Cum Uncis shows the neuroprotective effect by resisting oxidation, scavenging free radicals, modulating neurotransmitters and their related receptors, regulating the inflammatory factors and their related pathways, attenuating neuron apoptosis, reducing intracellular Ca2+ overloads and mitigating neurodegeneration. In this paper, the authors summarized the advance in studies on neuroprotective mechanisms of Uncariae Ramulus Cum Uncis.

[The situation of stomatological basic research supported by National Natural Science Foundation of China in the past decade].

OBJECTIVE: To review the situation of stomatological research projects supported by National Natural Science Foundation of China (NSFC) and to analyze the status of stomatological research and obtained achievements in the past decade. METHODS: The internet-based science information system of NSFC together with Yearbook of Chinese Stomatology was served as the basis of data collection. All of the data were arranged and analyzed by Excel. RESULTS: A total of 866 projects and 234.4054 billion Yuan were supported by NSFC during the past decade, and they were increasing continuously. The average supportive strength of each single project was also enhanced. The percentage of projects supported by the NSFC for young scientists accounted for the biggest proportion. The approved projects of stomatology were covering an increasingly wide area of the subjects. The projects number of different areas kept growing, and further investigations were done in these projects. The areas number were from 10 increasing to 26. CONCLUSIONS: With the support of NSFC, great progress has been made in stomatology, and the interdisciplinary research between stomatology and other disciplines is more active.

Clinical manifestations and gene analysis of 2 Chinese children with cystic fibrosis / 中华儿科杂志

<p><b>OBJECTIVE</b>Cystic fibrosis (CF) is rare in Chinese mainland. We present two cases of CF patients diagnosed by gene analysis. Their clinical manifestations and genetic mutation features are analyzed in this article. It will be of special interest to pediatricians in recognition of CF.</p><p><b>METHOD</b>The clinical material of two CF patients who were diagnosed by gene analysis was retrospectively analyzed.</p><p><b>RESULT</b>The first patient is a 13-year-old girl. She had a complaint of recurrent fever and cough for 6 months, expectoration for 2 months and hemoptysis for 20 days. After 3 months of her birth, she was operated on for bullae of lung. She was susceptible to upper respiratory tract infection. There was no family history of recurrent wheeze and other special diseases. Aspergillus fumigatus specific IgE was at grade 3 and aspergillus fumigatus IgG was high. Pseudomonas aeruginosa was positive in sputum culture. Sweat testing was performed and Na+ was higher. Pulmonary CT indicated bronchiectasis. Nasal sinus CT showed optical density of soft tissue within maxillary sinus and chronic bilateral sinusitis. The electron microscopy of cilia suggested immobile cilia syndrome. A heterozygotic mutation (263T > G, 2909G > A) was found after CFTR genetic mutation analysis. Both her parents were carriers. She was treated with inhalation of nebulized hypertonic saline and postural drainage for a long time. And she got better during a follow up period of 1 year. The second patient was a 10-year-old girl who complained of recurrent expectoration for 3 years and shortness of breath for half a year. She had a history of sinusitis and steatorrhea. The family history was normal. Both the lipase and insulin level in blood serum was lower.Pseudomonas aerugino and Aspergillus fumigatus were both positive in sputum culture. Aspergillus fumigatus IgE was normal. Pulmonary CT indicated bronchiolitis and bronchiectasis. Nasal sinus CT showed bilateral maxillary sinusitis. CFTR genetic mutation analysis revealed a homozygous mutation (3196C > T). Her parents and relatives did not participate in this study. Unfortunately, this child died of respiratory failure 3 months after discharge.</p><p><b>CONCLUSION</b>CFTR gene mutation was a main cause of CF. Common symptoms are those of bronchiectasis, pancreatitis and sinusitis. The two Chinese patients were diagnosed by gene analysis. One had a heterozygous mutation (263T > G, 2909G > A) and the other had a homozygous mutation (3196C > T), not ΔF508 which is common in western countries.</p>

Efficacy and safety of the thrombolytic therapy with urokinase after systemic-pulmonary shunt / 中国医学科学院学报

<p><b>OBJECTIVE</b>To evaluate the efficacy and safety of thrombolytic therapy with urokinase after systemic-pulmonary shunt.</p><p><b>METHODS</b>Six patients who had thrombosis after systemic-pulmonary shunt were enrolled in this study. At the background of administration of the heparin at a dose of 0.2-0.3 U x kg(-1) min(-1), urokinase was intravenously administered with a loading dose of 15-20 U x kg(-1) x min(-1) and a locked time period of 30 minutes, and then the dose was incessantly decreased to 4-10 U x kg(-1) x min(-1). In addition to echocardiography (ECG), arterial partial pressure of oxygen/inspired oxygen fraction (PaO2/FiO2), fibrinogen, activated partial thromboplastin time, and prothrombin time were determined to assess the clinical efficacy and side effects.</p><p><b>RESULTS</b>The thrombolytic therapy with urokinase showed clinical effectiveness within 1 or 2 hours in all 6 patients. Efficiency of this therapy reached 100% during 12 to 24 hours. In 5 patients, the PaO2/FiO2 were over 50% higher than the early postoperative values. One patient received a second operation due to the excessively increased pulmonary blood flow. In 2 patients, pleural and mediastinal drainages increased when the thrombolytic therapy with urokinase began; however, they decreased after the urokinase dosages were adjusted.</p><p><b>CONCLUSION</b>It is feasible to use the thrombolytic therapy with proper dosage of urokinase after systemic-pulmonary shunt.</p>

Relationship between polymorphisms of FCGR2B and susceptibility of children idiopathic thrombocytopenic purpura / 中国实验血液学杂志

The aim of study was to investigate the relationship between polymorphisms of FCGR2B232 1/T oligonucleotide and the susceptibility of children with idiopathic thrombocytopenic purpura (ITP). DNA from 76 patients with ITP and 37 controls was extracted. The SNPs of FCGR2B-232 was detected by polymerase chain reaction (PCR) combined with direct sequencing. The genotype distribution and allele frequency among different groups were compared. The results showed that the genotype (I/I, I/T, T/T) of FCGR2B-232 were 55.3%, 42.1%, and 2.6% in 76 patients with ITP, while 81.1%, 18.9%, 0% in 37 controls. The allele frequencies of FCGR2B-232 in patients with ITP were 76.3% (I232) and 23.7% (T232), but 90.5% and 9.5% in controls. There were significant differences in genotype distributions between the ITP patients and controls (chi(2) = 7.45, = 0.024). The enrichment in Thr232 allele carrier was also significant among the ITP patients as compared with the controls (chi(2) = 7.18, p = 0.007, odds ratio 3.47). There were also significant differences in allele frequencies between the ITP patients and controls [chi(2) = 6.54, p = 0.011, odds ratio 2.97, 95% CI (1.25 - 7.05)]. It is concluded that the polymorphisms of FCGR2B-232 significantly correlates with the susceptibility of children suffering from ITP. The minor Thr232 allele may be a risk genetic factor to ITP children.

Galectin-7 is associated with bronchial epithelial cell apoptosis in asthmatic children / 中华儿科杂志

<p><b>OBJECTIVE</b>It is supposed that bronchial epithelial cells responses to the environmental stimuli are different between asthmatic and non-asthmatic individuals, which contribute to the pathogenesis of asthma. These different responses produce different mediators. If differential gene expressions are found in bronchial epithelial cells of asthmatic and non-asthmatic individuals after the same stimuli in vitro, and these genes are overexpressed in asthmatic children in vivo, then it is concluded that these genes may be associated with asthma. Therefore the authors analyzed the differential gene expressions in the bronchial epithelium cells of asthmatic and non-asthmatic children after RSV infection in vitro. Among these genes, Galectine-7 (lectin, galactoside-binding, soluble, 7, Galectin-7) was 8 times up-regulated in asthmatic children. Galectine-7 was associated with skin keratinocyte apoptosis. The authors hypothesized that Galectin-7 may also be associated with bronchial epithelial cell apoptosis in asthmatic children. The aim of this study was to understand the role of Galectine-7 in bronchial epithelial cell apoptosis in asthma.</p><p><b>METHODS</b>The bronchial mucosae of one asthmatic child and one non-asthmatic child were obtained by biopsy and cultured in vitro. The bronchial epithelial cells were infected by RSV. The differential gene expressions were analyzed with micro array. Among those differentially expressed genes, Galectin-7 was 8 times up-regulated in asthmatic children. The bronchial mucosae from 10 asthmatic children and 17 non-asthma children were investigated for cell DNA break, Galectine-7 and mRNA expression, Caspase-3 expression by TUNEL, hybridization in situ and immunochemistry. Image analysis was used for quantitative assessment.</p><p><b>RESULTS</b>Galectine-7 gene was 8 times up-regulated in bronchial epithelial cells from asthmatic children after RSV infection in vitro. Galectin-7 and mRNA were overexpressed in bronchial epithelial cells in asthma in vivo. Bronchial epithelial cell apoptosis increased in asthma in vivo.</p><p><b>CONCLUSION</b>Galectin-7 may be associated with bronchial epithelial cell apoptosis in asthma.</p>

Effects of Helicobater Pylori Infection on Henoch-Schonlein Purpura with Renal Impairment in Children / 实用儿科临床杂志

Objective To evaluate the relationship between Henoch-Schonlein purpura (HSP) accompanying renal impairment and helicobater pylori(Hp) infection.Methods This study consisted of 304 patients with HSP.The patients were divided into 2 groups(group A and group B) based on Hp infection or not(91 cases in group A and 213 cases in group B).Compared with the rates of accompanying renal impairment in 2 groups.And observed the recovery from renal impairment between the patients who were turned into negative(group C)and patients still were positive after the anti-Hp therapy(group D).Numeration data were analyzed by ?2 test.Results Group A which was with Hp infected,the accompanying renal impairment ratio was 65.9%.Group B which was without Hp infected,the ratio was 35.2%.There was significant difference between 2 groups(?2=24.378 P

Dead Reasons and Related Factors of 42 Cases with Acute Leukemia in Chinldren / 实用儿科临床杂志

Objective To explore the dead reasons and related factors of acute leakemia(AL)in children.Methods The clinical data of 42 dead cases of children with AL,who were admitted to Guangzhou Children's Hospital between Jan.1999 and Mar.2007 were reviewed.Nineteen cases were boys,23 cases were girls;the aging from 4 months to 12 years old and 5 months.Of 42 children,21 cases were acute lymphoblastic leukemia(ALL),18 cases were acute myeloid leukemia(AML),3 cases were unclassified AL.Results Ten out of 12 early-dead cases died of bleeding.Among 30 cases who received chemotherapy,4 cases died of bleeding,others of myelosuppression combined with infection,14 of whom died from sepsis,3 cases with fungal infection,1 case with virus infection,4 cases with unknown pathogens.Sixteen children relapsed among those who got remission,half of them relapsed within 1 year since diagnosed.Treatment-related mortality(TRM)was 90%(27 out of 30 cases).The main causes of TRM were infection and hemorrhage.Hyperleukocytosis and bleeding were 2 risk factors related to early death in new-diagnosed children.Conclusions More emphasizes should be put on bleeding tendency during early treatment in children with AL and treatment of infection complications during induction chemotherapy to reduce TRM.