Source | People’s Daily Health Client

Author | Health Times reporter Zhou Xuejin

Editor | Hu Xin

Read the synopsis: Talking about the current maternal-fetal medical consultation center for fetal heart disease, Yihua He, director of the Beijing Anzhen Hospital’s Maternal-fetal Medical Consultation Center for Cardiology, felt a little emotional: “We see fresh little lives on the screen every day, and we also face many families every day. Worries and troubles. In fact, when a family of children gathered in front of us and asked whether this little life could successfully come to the world, we were wondering whether we could provide the family with more comprehensive and three-dimensional reference information. Of course, only It is not enough to rely on the strength of one department.” “We have a mother exchange group. Yesterday I saw a mother from Qinghai telling her story in the group. She was diagnosed with congenital heart disease in the fetus in early February this year and induced labor locally in mid-to-late March. She blamed herself and kept saying, “If I went to a big city to see it, maybe there would be a turnaround”.” Before the outpatient service of He Yihua at the Cardiology Maternal and Fetal Medical Consultation Center of Beijing Anzhen Hospital, a young prospect who came from Guizhou for treatment Mother Wang Xiaoxiao (pseudonym) said that the baby’s heart development was found to be abnormal during the birth check-up at the local hospital. The doctor suggested that the couple come to Beijing to see Director He for the baby. After speaking, Wang Xiaoxiao touched her belly lovingly with one hand, and tightly grasped her husband’s hand with the other. my country is a populous country and a country with a high incidence of birth defects. According to statistics from the “China Birth Defect Prevention Report 2012”, the incidence of birth defects in my country is about 5.6%. Based on the 16 million births in the country, there are about 900,000 new birth defects every year. “We must have a concept. When the fetus is diagnosed with congenital heart disease, don’t panic.” He Yihua said that in 2011, congenital heart disease accounted for 26.7% of all monitored cases. In the past 10 years, congenital heart disease has consistently ranked first in the incidence of perinatal birth defects among pregnant women in my country, and the proportion of total birth defects is higher than that of other birth defects. “This disease requires detailed classification and evaluation, and some fetuses have good treatment effects and can be self-healed.” Approximately 6 out of every 1,000 newborns suffer from congenital heart disease “People often ask me what is the cause of congenital heart disease. I can only say that there is no one-to-one etiological discovery of congenital heart disease. This is a result of environmental, autoimmune, genetic background, and psychological pressure. Complex results caused by the influence of multiple factors.” Facing the reasons for the rapid growth of congenital heart disease in recent years, He Yihua said, “The environment, autoimmunity, etc. are high-risk factors that lead to congenital heart disease, but the most important It’s the increase in the prenatal detection rate.” Congenital heart disease has a broad spectrum, including hundreds of specific types, and the symptoms vary greatly. Those with the mildest symptoms will have no symptoms for life, and those with severe symptoms will have severe symptoms at birth, such as hypoxia, shock, etc. There are many ways to classify congenital heart disease, which can be divided into structural abnormalities and non-structural abnormalities from the structure; genetic syndromes can be divided into genetic syndromes and non-genetic syndromes. He Yihua introduced that for pregnant women, they may pay more attention to classification based on prognosis. From the prognostic point of view, congenital heart disease can be divided into those with a good prognosis, which do not require surgery or require treatment with a good prognosis; those with a poor prognosis, which can only establish a single mechanism cycle; and those with extremely poor prognosis, often Manifested as malignant arrhythmia, heart failure, etc.

Due to the special physical condition of pregnant women, various examinations during pregnancy are limited. “CT examination is radioactive and cannot be used during pregnancy. The heart rate of the fetus is relatively fast, so the resolution of MRI in the detection of fetal heart is not high. At present, it is the most suitable for prenatal detection of fetal congenital heart disease. The most effective method is ultrasound testing. Taking Anzhen Hospital as an example, the prenatal detection rate of fetal congenital heart disease can reach 96%.”

Generally speaking, for high-risk groups, ultrasound testing can be performed within 15 to 16 weeks of pregnancy, but if you want to see more clearly and make a more accurate diagnosis, 20 to 24 weeks is a better observation window. Similarly, non-high-risk groups can also be observed in more detail during the 20 to 24 weeks of pregnancy.

“In my country, about 6 out of every 1,000 newborns suffer from congenital heart disease. The prevention of congenital heart disease requires a’tertiary prevention’ strategy.”

The first is to remove the cause of primary prevention. As the most direct cause of congenital heart disease cannot be found at present, primary prevention is difficult to achieve, and the effect is not ideal. “Neural tube malformation was ranked first in the entire birth defect disease 15 years ago, but because it has primary prevention measures to remove the cause, such as taking folic acid, the birth defect of neural tube malformation has been greatly reduced. Malformations are only ranked 6th in the incidence of perinatal birth defects in pregnant women.”

The so-called secondary prevention is to make a clear diagnosis before delivery. “At present, secondary prevention mainly relies on ultrasound diagnosis. In fact, ultrasound diagnosis is very effective, almost 100% of the abnormalities in the heart structure can be detected. However, due to problems such as medical equipment and operator experience, the detection results in various regions exist. A certain difference.”

The tertiary prevention is to use various methods to diagnose and treat children who have congenital heart disease early to reduce the harm of congenital heart disease and improve the treatment effect of the child so that the child can recover health as soon as possible.

“In recent years, some scholars have also put forward the concept of’zero-level prevention’, that is, genetic testing before marriage.” He Yihua said, “At present, because of the high complexity of the disease, the complicated pathogenic factors, and the birth treatment The technical requirements are high, and the effects of multiple levels of reasons have led to unsatisfactory prevention effects at all levels.”

He Yihua is instructing doctors to perform ultrasound diagnosis for pregnant women. Photo courtesy of the interviewee.

Interdisciplinary Maternal and Fetal Medical Consultation Center for Fetal Heart Disease

On the eighth floor of the outpatient department of Anzhen Hospital, before eight o’clock, the front door of the fetal heart disease maternal-fetal medical consultation center was full. The people waiting for medical treatment raised their heads, and the eyes on the masks stared at the electronic screen on the wall for fear of missing their names. From time to time, someone would look around the loudspeakers and pace back and forth in the hall.

Every day, people all over the country stand in front of the consultation center with worry but hope.

Speaking of the current Maternal and Fetal Medical Consultation Center for Fetal Heart Disease, He Yihua sighed: “We see fresh little lives on the screen every day, and we also face the worries and distress of many families every day. In fact, being a family member When we surrounded us and asked whether this little life could successfully come to the world, we wondered whether we could provide families with more comprehensive and three-dimensional reference information. Of course, relying only on the strength of a department is far from enough. ”

He Yihua’s team is in a remote consultation. Photo courtesy of the interviewee.

Beginning in the second half of 2012, He Yihua’s team hired a researcher to conduct a half-year survey among various departments. From six in the morning until five in the afternoon, the investigator will record the information he saw and heard that day, including the information he communicated with the doctor every night.

After communicating with doctors and investigators in various departments for more than half a year, He Yihua has become more aware that whether a child can be born smoothly requires comprehensive evaluation by multiple departments such as gynecology, obstetrics, pediatrics, and pediatric surgery. It requires a combination of imaging, genetic counseling, etc. Multiple materials. After the discussion, not only can provide more decision-making information to the family, but also deepen the mutual understanding and communication between various disciplines. To explore and solve the same problem, you can also run in more tacit understanding between the teams.

“We must do our best to break through the barriers between congenital heart disease prevention, screening, diagnosis and treatment, and let doctors in this logical chain have a cross-perspective macro-thinking, knowing the’upstream’ and “Downstream” does not stick to the cross-section of a single subject.” He Yihua said, “I and the hospital leaders applied for the establishment of a consultation center, and they are very supportive. Now our consultation center has developed into an interdisciplinary comprehensive consultation center.” Since 2013 Since the establishment of the Maternal and Fetal Medical Consultation Center for Fetal Cardiology in 1999, it has provided diagnosis and treatment services for over 40,000 patients.

He Yihua’s team is in a remote consultation. Photo courtesy of the interviewee.

“Artificial Intelligence + Remote Network Technology” Solve the Problem of Imbalance between Supply and Demand in Primary Medical Care

“Compared to the number of fetus groups that need to be checked, there are still too few doctors with high diagnostic levels.” He Yihua said, “However, we now also provide a set of corresponding solutions, which is’artificial intelligence + remote network technology’. .”

At this stage, there are still gaps in medical resources between my country’s regions and between urban and rural areas. Many grassroots areas are restricted by technical equipment, personnel experience and other reasons, and cannot provide local pregnant women with medical services and medical advice comparable to those in major cities. According to a report from the Central Broadcasting Corporation, some provinces and cities have not included the free pre-pregnancy health check and other work funds into the financial budgets at all levels or the budget is small, resulting in a low level of intervention for birth defects. In some provinces, the pre-pregnancy check-up rate in rural areas is less than 25%.

Hospitals in Beijing, Shanghai, Guangzhou and Shenzhen or some other eastern coastal areas have a high level of diagnosis, but there is still a major problem of imbalance between supply and demand in terms of the annual demand for fetal heart examinations.

He Yihua introduced that artificial intelligence screening technology is still being used within a certain range. Doctors and patients in various regions can input relevant medical data and information into the corresponding technical background to understand whether the prognosis of the fetus is good. In addition, it can also pass The corresponding equipment performs the diagnosis of fetal congenital heart disease. At this stage, the accuracy rate of artificial intelligence screening has reached 87%, which is higher than the average detection level of 43% in Europe and the United States. “Of course, we do not regard technology as the’gold standard’, but supplement it with manual review. We are still strengthening collaboration and learning in human-computer interaction.”

The consultation center has formed a remote collaboration network with nearly 200 hospitals across the country. Realize the interconnection and data sharing between cooperative hospitals through remote network technology. On the large smart screen of the consultation center, ultrasound diagnostic images of fetuses in collaborative hospitals can be synchronized. Local doctors can communicate with the consultation center through the remote network at any time when they encounter doubts.

“Artificial intelligence and remote networks can be collectively referred to as’appropriate technologies at the grassroots level.’ For us, we want to sink high-quality medical resources and medical services to the grassroots. Through these grassroots accessible technologies, the broadest Demand groups.”

He Yihua’s team is in a remote consultation. Photo courtesy of the interviewee.

Learn to tolerate, life is a miracle

Years of life in diagnosing fetal congenital heart disease also made He Yihua and her team think about a question: What perspective should we look at imperfect life.

“Some fetuses can be treated similarly to normal children after birth, but many parents are pursuing the “perfection” of their children. No matter how much work we do, it will not help. Of course, each family’s expectations and economic conditions are different. We also understand.”

“Parents will worry about the pressure that their children will face in their future work and life, the incomprehensible vision of others, and even the mockery of their children’s defects. In fact, each of us is’imperfect’, and there are known or unknowable defects. The most important thing is how we view “Imperfect Life” and “Imperfect Life”.”

There is a movie called “Miracle Boy”, which tells the inspirational story of Ogi, a boy born with facial defects. Augie was taught at home by his parents because of facial defects. In the fifth grade, he was given the opportunity to study in a regular school. Ogi, who was new to school, was ridiculed and bullied by his classmates because of his looks, but with the help of his father, mother, sister, teacher and friends, he finally found confidence and used his actions to change the views of others.

“I know that there is a ‘8772’ band composed of patients with rare diseases in Beijing. These children get together because of rare diseases but love music. They have released albums and held their own concerts. I think these A child just changed a window to look at the world. They are very sunny and have their own stable happiness.”

“Perhaps, for you and me, if you learn to be tolerant, life is a miracle.” He Yihua’s face was firm, her eyes gleaming.

However, scientists in the UK have linked the consumption of red meat, such as beef, lamb and pork, to impaired heart function, including smaller ventricles, poor heart function, and arteries. harder. The scientists studied nearly 20,000 people, and found that high consumption of red and processed meat was linked to three different cardiovascular health conditions. Processed meats, such as sausages and bacon, are those that have been preserved by smoked or salted, processed or added chemical preservatives. There is some evidence that red meat alters gut microbiota, leading to higher levels of certain metabolites in the blood, which in turn is associated with a higher risk of heart disease. Previous studies have shown a link between high consumption of red and processed meats, which may increase the likelihood of cardiovascular disease. Hamburger lovers may have to consider switching to a variety of plant-based alternatives that are now more common on supermarket shelves, as well as better for the environment. Last month, a team of researchers from Canada linked the risks of cardiovascular disease, like heart attack and stroke, to the consumption of processed meat. Additionally, a 2018 study found that regular consumption of red meat could increase the levels of chemicals that cause cardiovascular disease by more than 10 times. Study author Dr Zahra Raisi-Estabragh of Queen Mary University, London, said: “Previous studies have shown a link between high consumption of red meat and an increased risk of heart attack or death. died from heart disease. We examined the relationship between meat consumption and cardiovascular health imaging measures for the first time. This may help us understand the underlying mechanism of the previously observed association with cardiovascular disease ”. The long-term study investigating the contribution of genes and the environment to the development of health problems included 19,408 participants from UK Biobank. The researchers examined the association between self-reporting of red meat and processed meat consumption and heart anatomy and function. Three types of heart health measures were analyzed, one of which is blood vessel elasticity, a marker of good health. The analysis is adjusted for other factors that may affect the association, including age, sex, education, smoking, alcohol, exercise, high blood pressure, high cholesterol, diabetes and only body mass number (BMI). The researchers found that high consumption of red and processed meats was associated with a decrease in cardiovascular health indicators of all the measures studied. People who eat more meat have smaller ventricles, poor heart function, and stiffer arteries, all of which are signs of poor heart health. Specifically, people who eat more meat have smaller ventricles, poor heart function, and stiffer arteries, all of which are signs of poor heart health. For comparison, the researchers also examined the relationships between heart-imaging measurements and eating oily fish, which is known to be good for heart health. They found that as the consumption of oily fish increased, heart function improved and the arteries more elastic. Dr Raisi-Estabragh said: “The findings support previous observations of the association between red meat consumption and processed meat and heart disease, and provide an understanding of heart structure and function. , blood vessel. It is thought that these factors may be the reason for the observed association between red meat and heart disease. For example, maybe eating more red meat leads to increased cholesterol in the blood and this in turn causes heart disease. Our research shows that these factors play a role in the relationship between meat intake and heart health, but they are not all. The study did not look at replacement mechanisms, the authors note, and admitted that it does not actually cause cardiac dysfunction. “This is an observational study and cannot assume the cause, but overall, it seems plausible that people limit their intake of red and processed meats for cardiovascular health reasons,” said Dr. Raisi-. Estabragh said. The research is being presented at the ESC 2021 Preventive Cardiovascular Conference, an online scientific conference of the European Heart Association (ESC). Dr. Shireen Kassam, a hematologist and senior lecturer at King’s College Hospital, who was not involved in the study, said observational data valuable for several decades indicate eating red and processed meats. increased risk of development and death from coronary heart disease and heart disease. “It’s no surprise that participants who consumed the most meat had evidence of impaired heart function and blood vessels,” she said. Research confirms that we must avoid questioning the role of red and processed meat in the diet and act on these research findings. By focusing on effective public health messages to assist people in eliminating these foods from their diet and replacing them with healthier plant protein sources. This will not only improve human health but also benefit the environment. Huong Giang (Source: dailymail)

Cholesterol gives cell membranes strength and flexibility, and plays a vital role in the production of hormones, vitamin D, and fat digestion. Therefore, it can be said that cholesterol plays an important role in almost all bodily activities. Illustration In fact, there are two main types of cholesterol: low density lipoprotein (LDL – bad cholesterol) and high density lipoprotein (HDL – good cholesterol). When LDL levels rise, it can cause plaque buildup in the arteries, leading to heart disease and stroke. Conversely, high levels of HDL in the blood help reduce the risk of cardiovascular disease and stroke, helping to excrete excess cholesterol from the body. Since cholesterol does not interact well with the blood, it is transported by low density lipoprotein (LDL) and high density (HDL) particles. The ideal cholesterol threshold for most adults is total cholesterol below 200 mg / dL, LDL below 100 mg / dL and HDL above 60 mg / dL. Illustration Normally, the liver makes all the cholesterol the body needs to function. However, the body can also absorb cholesterol through the consumption of animal products. When you consume more cholesterol from animals, your body compensates for it by lowering the amount of cholesterol naturally. Conversely, when the cholesterol supplied by the diet is low, the body will increase its natural cholesterol production to ensure that there is always an adequate amount of this important substance. In fact, cholesterol in the body comes from food sources only about 20%, the rest is produced by the liver. Besides, cholesterol in the diet also has a partial impact on the ratio of LDL and HDL in the body. LDL index increases, HDL index drops low, alarming the risk of cardiovascular disease. Therefore, eating cholesterol-rich foods will significantly increase cholesterol levels in the body is a complete misconception. About 80% of cholesterol in the body is produced in the liver, not from food that we tolerate on a daily basis. People who are overweight or obese are more likely to have high cholesterol in their blood. However, thin people can still have high cholesterol. Thin people also need to worry about increased blood cholesterol. Illustration In addition, people with unhealthy lifestyles, very sedentary, with some genetic disorders, the elderly … may also be at risk of hypercholesterolemia in the blood. Create a regular and healthy living routine for yourself. It is important to understand cholesterol in order to have the right diet. In fact, cholesterol is not quite a harmful substance, it is also a natural substance that is essential for health.

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U.S. researchers found a corresponding decrease in size and body mass for babies when the baby’s mother consumed less than 200 milligrams of caffeine per day – about two cups of coffee – which is believed to increase the risk to the fetus. Smaller birth sizes can put babies at higher risk of obesity, heart disease and diabetes later on.

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The team was led by Katherine L. Grantz, of the Internal Population Health Research Department at nih’s Eunice Kennedy Shriver National Institute of Child Health and Human Development. Dr Grantz said: “Until we learn more, the results show that you need to be cautious in limiting or completely eliminating those drinks that contain caffeine during pregnancy. Mothers should also consult a doctor about the consumption of caffeine during pregnancy”.

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Previous studies have pointed to a link between consuming more caffeine (more than 200 milligrams of caffeine per day) during pregnancy with young children compared to gestational age (pregnancy stage) or having a risk of limiting growth in the uterus – located in the lowest 10th percentimal segment for babies of the same gestational age. However, studies of moderate daily caffeine consumption (200 milligrams or less) during pregnancy have showed different results.

Some found a similar increased risk for underweight babies and poor birth results, while others found no such link. The current study authors note that many previous studies do not take into account other factors that may affect the birth size of babies, such as changes in caffeine content in different drinks and mothers smoking during pregnancy.

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For their study, scientists analyzed data of more than 2,000 racially and ethnically diverse women at 12 medical facilities who were enrolled between 8 and 13 weeks of pregnancy. The women do not smoke and do not have any health problems before pregnancy. Between the 10th and 13th weeks of pregnancy, the women were given a blood sample that was then analyzed for caffeine and paraxanthine, a compound produced when caffeine decomposes in the body. These people also said they consumed drinks containing caffeine daily (coffee, tea, soda and energy drinks) in the past week – once when they signed up and periodically throughout pregnancy.

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Compared to babies born to women who did not have or did not have a minimum blood caffeine concentration, the babies were born to women with the highest blood caffeine levels at birth who were 84 grams (about 3 ounces) lighter on average, 0.44 cm (about 0.17 in) shorter, and had a head circumfervity less than 0.28 cm (about 0.11 inches).

Based on women’s own estimates of the drinks they drank, women who consumed about 50 milligrams of caffeine a day (equivalent to half a cup of coffee) had babies 66 grams (about 2.3 ounces) lighter than babies born to those who did not use caffeine. Similarly, babies born to caffeine consumers also have thigh rings smaller than 0.32 cm (about 0.13 inches).

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Caffeine is believed to cause blood vessels in the uterus and placenta to shrink, which can reduce the amount of blood supply to the fetus and inhibit development. Likewise, researchers believe caffeine may have the potential to disrupt fetal stress hormones, put babies at risk of rapid weight gain after birth and cause obesity, heart disease and diabetes later on. They also concluded their findings suggested that even moderate caffeine consumption may be associated with a decrease in fetal development.

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