Persistence of Dioxin TCDD in Southern Vietnam Soil and Water Environments and Maternal Exposure Pathways with Potential Consequences on Congenital Heart Disease Prevalence in Vietnam

Waterlogged soils and submerged sediments in wetlands and agricultural lands used for rice paddies and aquaculture have anaerobic conditions that slow and prevent the photo and microbial degradation of dioxin TCDD (2,3,7,8-tetracholorodibenzo-p-dioxin), enabling it to persist in environments for long periods. Over 1.6 million ha of land in southern Vietnam were sprayed with 2,4,5-T herbicides (e.g. Agent Orange) contaminated with dioxin TCDD during the Vietnam War (1961-1971);45% of these ha received four or more spray flight missions. Dioxins are endocrine disrupters and may induce cardiovascular disease, growth, and developmental defects, diabetes, hormonal dysfunctions and disruptions, certain cancers, and chloracne. Outpatient screening clinic 2020 data on Vietnamese children suspected of congenital heart disease (CHD) showed the childhood CHD prevalence rate in Vietnam of 13.356/1000, significantly elevated compared to the Asian CHD prevalence rate of 3.531/1000. CHD prevalence rate differences between North Vietnam (2.541/1000) and south of the 17th parallel (10.809/1000) were significant. Vietnamese farmers, especially pregnant women whose occupations involve daily contact with soil and sediments where dioxin TCDD persists in the environment may be at risk of dioxin accumulation from dermal exposure and bioaccumulation via diet. There is an urgent need for funded longitudinal genetic and clinical studies to assess CHD and other organ system childhood malformations due to in utero TCDD exposure. We recommend an integrated research design involving 1) site-specific locations that received high volumes and multiple spray loads of herbicides during the Vietnam War;2) soil sampling of submerged and waterlogged soils and sediments where TCDD may not have degraded;3) production areas of agriculture, fisheries, and other aquatic products;4) risk assessment dioxin levels in foods where TCDD is likely to bioaccumulate;5) child-bearing age and pregnant women with potentially high sensitivity to long-term low dose exposure, and 6) men and women in occupations that are in daily contact with contaminated soil and sediments as part of their job routines.

Parity and Risk of Ovarian Cysts： Cross-Sectional Evidence from the Dongfeng-Tongji Cohort Study

Little is known about the association between parity and the risk of ovarian cysts. The aim of this study was to examine the association between parity and the risk of ovarian cysts among a population of Chinese women. A total of 20 502 women aged 45–86 years from the Dongfeng-Tongji Cohort study completed baseline questionnaires, medical examination and provided baseline blood samples. Participants were categorized into four groups according to parity（one, two, three, and four or more live births）. Logistic regression models were used to investigate the association between parity and the risk of ovarian cysts. The prevalence of ovarian cysts in the study population was 4.0%（816/20 502）. Increasing parity was associated with decreasing risk of ovarian cysts without adjustment for any covariates and after age-adjusted model（P〈0.001）. After adjusting for potential confounders, women who had had four or more live births had lower risk of ovarian cysts（OR： 0.51; 95% CI： 0.27–0.96） compared with women who had had one live birth. There was a consistent but non-significant decreased risk of ovarian cysts for women who had had two, and three live births（OR： 0.85; 95% CI： 0.68–1.05） and（OR： 0.84; 95% CI： 0.59–1.20） respectively compared with women who had had one live birth. It was concluded that higher parity was associated with decreasing risk of ovarian cysts in this population of Chinese women. These findings could be helpful in decision making in clinical practice for gynecologists when evaluating women suspected to have ovarian cysts.

Complications Related to Transcatheter Occlusion of Atrial Septal Defect with Amplatzer Septal Occluder in Children

Objectives To investigate the causes, theraputic and preventive methods of com- plications associated with transcatheter occlusion of at- rial septal defect ( ASD) using the Amplatzer septal oc- cluder (ASO) in children. Methods 289 cases un- derwent transcatheter closure of ASD with ASO. Com- plications occurred in 9 cases. The complications in procedure included systemic circulatory systemic air embolism in 2, pulmonary air embolism in 1, pericar- dial tamponade in 1, ASO malposition requiring emer- gency surgical removal in 1, transient atrial extrasysto- les in 1 and sizing balloon rupture in 1 case. 2 cases with postoperative complications were found in the fol- low-up studies. These included perforation of mitral valve and ASO partially dislodged. In this study, 5 children with intraoperative complication received e- mergency therapy including surgical intervention, and others needed only follow-up, as the complications were transient or asymptomatic. Results There were no children death in this study. The 5 cases who re- ceived treatment were completely healing, and the oth- ers with intra - procedure complications were also had no sequela existed. Cases with mitral valve and ASO partially dislodged were still in follow-up studies, as the 2 patients having no symptoms. Conclutions Air embolism were occurred easily in atrial septal defect cases who received ASO therapy. Complications mainly caused by inappropriate operative procedure and some complications needed emergency treatments. Follow-up studies were important to cases with transcatheter oc- clusion therapy.