Influence of perinatal factors on full-term low-birth-weight infants and construction of a predictive model

BACKGROUND Being too light at birth can increase the risk of various diseases during infancy.AIM To explore the effect of perinatal factors on term low-birth-weight(LBW)infants and build a predictive model.This model aims to guide the clinical management of pregnant women’s healthcare during pregnancy and support the healthy growth of newborns.METHODS A retrospective analysis was conducted on data from 1794 single full-term pregnant women who gave birth.Newborns were grouped based on birth weight:Those with birth weight<2.5 kg were classified as the low-weight group,and those with birth weight between 2.5 kg and 4 kg were included in the normal group.Multiple logistic regression analysis was used to identify the factors influencing the occurrence of full-term LBW.A risk prediction model was established based on the analysis results.The effectiveness of the model was analyzed using the Hosmer–Leme show test and receiver operating characteristic(ROC)curve to verify the accuracy of the predictions.RESULTS Among the 1794 pregnant women,there were 62 cases of neonatal weight<2.5 kg,resulting in an LBW incidence rate of 3.46%.The factors influencing full-term LBW included low maternal education level[odds ratio(OR)=1.416],fewer prenatal examinations(OR=2.907),insufficient weight gain during pregnancy(OR=3.695),irregular calcium supplementation during pregnancy(OR=1.756),and pregnancy hypertension syndrome(OR=2.192).The prediction model equation was obtained as follows:Logit(P)=0.348×maternal education level+1.067×number of prenatal examinations+1.307×insufficient weight gain during pregnancy+0.563×irregular calcium supplementation during pregnancy+0.785×pregnancy hypertension syndrome−29.164.The area under the ROC curve for this model was 0.853,with a sensitivity of 0.852 and a specificity of 0.821.The Hosmer–Leme show test yieldedχ^(2)=2.185,P=0.449,indicating a good fit.The overall accuracy of the clinical validation model was 81.67%.CONCLUSION The occurrence of full-term LBW is related to maternal education,the number of prenatal examinations,weight gain during pregnancy,calcium supplementation during pregnancy,and pregnancy-induced hypertension.The constructed predictive model can effectively predict the risk of full-term LBW.

Perinatal and early life risk factors for inflammatory bowel disease

AIM:To investigate associations between perinatal risk factors and subsequent inflammatory bowel disease (IBD) in children and young adults.METHODS:Record linked abstracts of birth registrations,maternity,day case and inpatient admissions in a defined population of southern England.Investigation of 20 perinatal factors relating to the maternity or the birth:maternal age,Crohn's disease (CD) or ulcerative colitis (UC) in the mother,maternal social class,marital status,smoking in pregnancy,ABO blood group and rhesus status,pre-eclampsia,parity,the infant's presentation at birth,caesarean delivery,forceps delivery,sex,number of babies delivered,gestational age,birthweight,head circumference,breastfeeding and Apgar scores at one and five minutes.RESULTS:Maternity records were present for 180 children who subsequently developed IBD.Univariate analysis showed increased risks of CD among children of mothers with CD (P=0.011,based on two cases of CD in both mother and child) and children of mothers who smoked during pregnancy.Multivariate analysis confirmed increased risks of CD among children of mothers who smoked (odds ratio=2.04,95% CI=1.06-3.92) and for older mothers aged 35+ years (4.81,2.32-9.98).Multivariate analysis showed that there were no significant associations between CD and 17 other perinatal risk factors investigated.It also showed that,for UC,there were no significant associations with the perinatal factors studied.CONCLUSION:This study shows an association between CD in mother and child;and elevated risks of CD in children of older mothers and of mothers who smoked.

Perinatal Factors of Developmental Attention Deficit Hyperactivity Disorder in Children

Background: Attention deficit hyperactivity disorder is a common pediatric neurobehavioral disorder often treated in the primary care setting. It shows a high and chronic level of inattention, impulsivity/hyperactivity and/or both, and can affect more than 2 million school-age children. The researchers are not sure about the exact causes of the disorder, but it seems that apart from genetic factors, perinatal factors seem to dynamically contribute to the development of the disorder. Purpose: The aim of this review was to investigate the perinatal and obstetric factors related to the development of the attention deficit hyperactivity disorder in childhood. Method: An online review of English language studies published from 2002 to 2020, using the Embase, PsychINFO, PubMed and Google Scholar databases. From 1100 studies only 17 were included in the review since they met the inclusion criteria. Conclusions: The results of the review showed that apart from heredity and genetic factors, various conditions in pregnancy or the mother’s way of life in pregnancy, adverse conditions in labor and infancy can contribute on their own or in combination to the development of the attention deficit hyperactivity disorder in childhood. Obstetric vigilance to detect risk factors in pregnancy in combination with the prevention of obstetric complications is the key in preventing attention deficit hyperactivity disorder.

Socio-Medical and Demographic Factors Associated with Perinatal Mortality in a Southern Benin Health Zone Hospital in 2020: A Case-Control Study

Background: Perinatal mortality remains a major public health concern in developing countries such as Benin. To better steer response interventions, this study was carried out in southern Benin with the aim of identifying the demographic and socio-medical factors linked to perinatal mortality. Methods: The case-control study, held from January 1 to December 31, 2020, covered 154 targets, including 77 cases of neonates deceased within the perinatal period and 77 live-born control neonates selected on a one-for-one basis. Univariate analysis using the McNemar test and logistic regression were used to identify risk factors for perinatal mortality, at a 5% threshold of significance. Results: Sahoué/mina ethnicities, only associated socio-demographic characteristic, increased the risk of perinatal death by 2.47 times (p = 0.008). Mother’s age, education, occupation, marital status, and household size were not associated (p > 0.05). Risk of death was increased 2.5 times when the mother was referred (p = 0.007), 3.3 times when she came from a hard-to-reach locality (p Conclusion: Although attention must also be paid to referral and access to care, this study identifies antenatal consultation as the main target of any intervention to reduce perinatal mortality.

Influencing factors of the neurodevelopment of high-risk infants

Background High-risk infants refer to newborns exposed to high-risk factors in the prenatal, natal or postnatal period. High-risk infants are at high risk of developmental retardation, and early identification of developmental abnormalities plays a vital role in improving high-risk infants' quality of life.Aims To describe the neurodevelopment of high-risk infants aged less than 1 year old, and to analyse the incidences and influencing factors of neurodevelopmental abnormalities in order to provide a basis for neurodevelopment monitoring and management of highrisk infants.Methods High-risk infants born between January 2016 and December 2016 in the maternity and infant health hospitals of three districts in Shanghai were followed up.The Gesell Developmental Scale was used to assess the neurodevelopmental level at the time of recruitment(0-2 months) and at 9 months. Univariate and multivariate analyses of the influencing factors were conducted.Results 484 high-risk infants(male 51 %, female 49%)with an average gestation age of 36.5±2.2 weeks were recruited. At the time of recruitment, the average age was2.1(0.8) months, and the developmental quotient(DQ)scores of full-term high-risk infants in motor(t=3.542,p=0.001), cognitive(t=3.125, p=0.002), language(t=3.189, p=0.002) and social(t=3.316, p=0.001) areas were higher than those of preterm infants. The incidences of developmental abnormalities of full-term high-risk infants in motor(χ~2 =9.452, p=0.002), cognitive(χ~2=6.258, p=0.012), language(χ~2 =12.319, p =0.001) and social(χ~2 =6.811, p=0.009) areas were lower than the preterm infants. At 9 months, there was no difference in the DQ scores and incidences of developmental abnormalities in four areas between full-term and preterm high-risk infants, and the incidence of developmental abnormalities was around 10%.Conclusion The incidence of neurodevelopmental abnormalities in high-risk infants aged less than 1 year old is high. Preterm birth and parental bad habits are significant factors affecting the neurodevelopment.Monitoring and early interventions help to improve highrisk infants' neurodevelopment.

Seroprevalence of <i>Brucella</i>Antibodies and Risk Factors Associated with Human Brucellosis in High-Risk Occupational Groups of the Noun Division in the West Region of Cameroon

Brucellosis is an anthropozoonotic disease with an important public health impact. Although the transmission of Brucella from animals to humans can occur in different epidemiological settings of sub-Saharan African countries, little data has been published on human brucellosis. This study aimed to detect Brucella antibodies and the risk factors associated to brucellosis among high-risk occupational groups of people in the Noun Division of Cameroon. For this study, a structured questionnaire was used to assess risk factors associated with human brucellosis. Thereafter, blood samples were collected from high-risk occupational groups of people in four villages. Plasma was extracted from each sample and Brucella antibodies were detected using Rose Bengal Plate Test (RBPT) and indirect Enzyme-Linked Immunosorbent Assay (i-ELISA). Of the 273 participants enrolled, the overall seroprevalence of Brucella antibodies was 12.45% with RBPT and 10.26% with i-ELISA test. This seroprevalence was significantly (P = 0.04;X2 = 9.73) higher among livestock herdsmen (15.8%), slaughterhouse workers (9.8%), butchers (4.8%), participants having no educational level (14.3%) and those experiencing above 5 years of risky activity (15%). Raw milk consumption (OR: 4.8;P = 0.001), no formal education (OR: 6.4;P = 0.03) and assistance of animal during parturition (OR: 7.2;P < 0.0001) appeared as factors that may increase the risk of Brucella infections. The detection of Brucella antibodies indicates the risk of human brucellosis in some groups of people of the Noun division. Consuming unpasteurized milk, participating in parturition and lacking knowledge on brucellosis appeared as risk factors associated with human brucellosis in western Cameroon. It raises the need of developing and implementing control measures for human and animal brucellosis.

AIDS-Related High-Risk Behaviors and Affecting Factors of Men Who Have Sex with Men (MSM) in China's Mainland

Objectives: To describe and analyze HIV/AIDS/STD-related high risk behaviors and affecting factors of men who have sex with men (MSM) in China's Mainland~ Methods: 426 self-administered or interview-based questionnaires collected from MSM were analyzed with SPSS or SAS Systems. Results: Of the MSM, four-fifths had engaged in oral-genital intercourse, about half had engaged in anal intercourse, and in the past year more than two-fifths had casual sexual partner(s).Very few maintained monogamous sexual relationships, and nearly half also had intercourse with women. One fourth had previously been diagnosed with a venereal diseases. One HIV+individual was found among the 40 who reported having been tested for HIV. Only two men consistently used condoms among the one-third who had ever used condoms, despite almost universal knowledge of HIV and its transmission. Conclusions: MSM in China's Mainland are very sexually active, highlighting the possibility of a serious HIV epidemic that may be directly spread to the female population. However,AIDS interventions targeting MSM face severe obstructions resulting from cultural bias and other factors.

A Case-control Study on High-risk Factors for Newborn Hearing Loss in Seven Cities of Shandong Province

To investigate the high-risk factors for newborn hearing loss and to provide information for preventing the development of hearing loss and delaying its progression, from May 2003 to June 2006, neonates who failed to pass the universal newborn hearing screening （UNHS） were referred to Jinan Newborn Hearing Screening and Rehabilitation Center from 7 newborn hearing screening centers in seven cities of Shandong province. One-to-one pair-matched case-control method was employed for statistical analysis of the basic features of definitely identified cases. High-risk factors relating to the bilateral hearing loss were evaluated by univariate and multivariate Logistic regression analysis. Our results revealed that 721 transferred newborns who didn＇t pass the heating screening received audiological and medical evaluation and 367 were confirmed to have hearing loss. Of them, 177 neonates with hearing loss who met the matching requirements were included in the study as subjects. Univariate analysis showed that high-risk factors related to hearing loss incuded age of father, education backgrounds of parents, parity, birth weight, gestational weeks, craniofacial deformity, history of receiving treatment in neonatal intensive care unit （NICU）, neonatal disease, family history of otopathy and family history of congenital hearing loss. Multivariate Logistic regression analysis revealed that 4 independent risk factors were related to bilateral hearing loss, including parity （OR=16.285, 95% CI 3.379--78,481）, neonatal disease （OR=34;968, 95% CI 2.720 449.534）, family history of congenital hearing loss （OR=69.488, 95% CI 4.417--1093.300） and birth weight （OR=0.241, 95% CI 0.090--0.648）. It is concluded that parity, neonatal disease and family history of heating loss are the promoting factors of bilateral hearing loss in neonates and appropriate intervention measures should be taken to deal with the risk factors.

Prevalence, Risk Factors and Outcome of Preterm Premature Rupture of Membranes at the Bamenda Regional Hospital

Background: Preterm premature rupture of membranes (PPROM) is one of the most common complications of pregnancy. It is one of the leading identifiable cause of preterm deliveries, and an important cause of maternal and perinatal morbidity and mortality. The aim of this study was to determine the prevalence of PPROM, to identify its associated factors and to evaluate the early outcome (within 72 hrs after delivery) following PPROM at the Bamenda Regional Hospital (BRH). Methods: A cross-sectional study was conducted in March and April 2020. Three hundred and eighty-seven women who delivered at the labour room of the BRH were included in this study. Interviewer-administered questionnaires were used to obtain data. The cases of PPROM were women who had lost amniotic fluid continuously before hospitalisation and whose gestational age was between 28 weeks + 0 days and 36 weeks + 6 days. Descriptive statistics followed by logistic regression analyses were conducted with level of significance set at p-value <0.05. Results: Among the 387 participants included in the study, 19 had PPROM giving a prevalence of 4.91%. Of 57 preterm deliveries, PPROM accounted for 33.33% (n = 19). The statistically significant independent factors associated with lower odds of PPROM were the age groups 20 - 29 years (aOR = 0.07, 95% CI: 0.01 - 0.42, p = 0.003) and ≥30 years (aOR = 0.01, 95% CI: 0.001 - 0.14, p = 0.001), and attending ANC ≥ 4 times (aOR = 0.23, 95% CI: 0.06 - 0.84, p = 0.026). Whereas, having a multiple pregnancy (aOR = 39.72, 95% CI: 7.19 - 219.33, p < 0.001), urinary tract infection during pregnancy (aOR = 104.86, 95% CI: 12.25 - 897.90, p < 0.001), genital tract infections during pregnancy (aOR = 17.34, 95% CI: 2.67 - 112.56, p = 0.003), and having a history of preterm delivery (aOR = 27.65, 95% CI: 1.76 - 434.15, p = 0.018) were associated with a higher likelihood of PPROM. The study revealed that 10.53% (n = 2) of women who had PPROM had an unfavourable outcome. Babies born by mothers who had PPROM were more likely to have an unfavourable outcome (OR = 14.44, 95% CI: 5.42 - 38.48, p < 0.001). Conclusion: Preterm premature rupture of membranes considerably causes perinatal morbidity and mortality, and thus optimum obstetric and medical care is essential for the reduction of the complications related to it.

Perinatal Stroke and Apparent Life-Threatening Event: A Case Report

To analyze how the multidisciplinary clinical, biohumoral, instrumental approach to ALTE (Apparent Life Threatening Event) episode may discover cardiovascular disease in the newborn. Introduction: In the first year of life ALTEs concern 0.8% of access to Pediatric Emergency Department. The cause of apparent life-threatening events (ALTEs) in infants reflects a differential diagnosis that includes an array of congenital or acquired disorders. Approximately 10% - 25% of ap-parent life-threatening events may remain unexplained following a thorough evaluation. Case re-port: B. E., a 2-month-old child, in wellbeing, shortly before meal, during sleep, was not responsive to repeated stimulations;he was hypotonic and unresponsive. About 15 minutes later, he pre-sented a normal tone and state of consciousness. Evaluating the referred symptoms, diagnostic protocol for ALTE was started;the Angio-MRI brain performed as second line analysis showed a focal gliotic lesion at left striatal area. The cardiological evaluation with echocardiography detected a pervium foramen ovale (PFO), with minimum shunt left-right direction. At least, biohumoral tests revealed protrombin gene heterozygosis mutation. Conclusion: Apparent Life-Threatening Events are first manifestation of stroke in infant. Discussion: This report discloses how the multidisciplinary clinical approach is essential in ALTE. The exact management of ALTE patients is very important in situations like this, when the concomitant disease is rare. In fact, arterial stroke incidence in children > 28 days of life is estimated between 1.2 and 7.9 cases/100,000 child-ren/year. However, in the last 20 years, we observed an increased incidence of stroke, probably related to two main causes: a greater attention for this disease and a major survival of children with pathology that arrange for stroke thanks to a better prevention. In conclusion, it’s a fundamental multidisciplinary approach even in following months after the events.

Analysis of clinicopathological features and prognostic factors of breast cancer brain metastasis

BACKGROUND Breast cancer(BC)has become the most common malignancy in women.The incidence and detection rates of BC brain metastasis(BCBM)have increased with the progress of imaging,multidisciplinary treatment techniques and the extension of survival time of BC patients.BM seriously affects the quality of life and survival prognosis of BC patients.Therefore,clinical research on the clinicopathological features and prognostic factors of BCBM is valuable.By analyzing the clinicopathological parameters of BCBM patients,and assessing the risk factors and prognostic indicators,we can perform hierarchical diagnosis and treatment on the high-risk population of BCBM,and achieve clinical benefits of early diagnosis and treatment.AIM To explore the clinicopathological features and prognostic factors of BCBM,and provide references for diagnosis,treatment and management of BCBM.METHODS The clinicopathological data of 68 BCBM patients admitted to the Air Force Medical Center,Chinese People’s Liberation Army(formerly Air Force General Hospital)from 2000 to 2022 were collected.Another 136 BC patients without BM were matched at a ratio of 1:2 based on the age and site of onset for retrospective analysis.Categorical data were subjected to χ^(2) test or Fisher’s exact probability test,and the variables with P<0.05 in the univariate Cox proportional hazards model were incorporated into the multivariate model to identify high-risk factors and independent prognostic factors of BCBM,with a hazard ratio(HR)>1 suggesting poor prognostic factors.The survival time of patients was estimated by the Kaplan-Meier method,and overall survival was compared between groups by log-rank test.RESULTS Multivariate Cox regression analysis showed that patients with stage Ⅲ/Ⅳ tumor at initial diagnosis[HR:5.58,95% confidence interval(CI):1.99–15.68],lung metastasis(HR:24.18,95%CI:6.40-91.43),human epidermal growth factor receptor 2(HER2)-overexpressing BC and triple-negative BC were more prone to BM.As can be seen from the prognostic data,52 of the 68 BCBM patients had died by the end of follow-up,and the median time from diagnosis of BC to the occurrence of BM and from the occurrence of BM to death or last follow-up was 33.5 and 14 mo,respectively.It was confirmed by multivariate Cox regression analysis that patients with neurological symptoms(HR:1.923,95%CI:1.005-3.680),with bone metastasis(HR:2.011,95%CI:1.056-3.831),and BM of HER2-overexpressing and triple-negative BC had shorter survival time.CONCLUSION HER2-overexpressing,triple-negative BC,late tumor stage and lung metastasis are risk factors of BM.The presence of neurological symptoms,bone metastasis,and molecular type are influencing prognosis factors of BCBM.

Perinatal events and the risk of developing primary sclerosing cholangitis

AIM: To investigate whether perinatal events, intrauterine or postpartum, are associated with the development of primary sclerosing cholangitis (PSC) later in life. METHODS: Birth records from 97 patients with adult PSC in Sweden were reviewed. Information on perinatal events including medications and complications during pregnancy, gestation length, birth weight and length were collected. Two control children of the same sex were selected for each subject. Conditional multiple logistic regression was used to assess associations of the perinatal measures with development of PSC. RESULTS: No significant associations were found between gestational age, birth length, breastfeeding, and the majority of medical complications including infections or medication during pregnancy for the mothers or postpartum for the children. Vaginal bleeding and peripheral oedema showed associations with PSC, with matched odds ratios of 5.70 (95% CI, 1.13-28.83) and 2.28 (95% CI, 1.04-5.03), respectively. CONCLUSION: The associations of vaginal bleeding and oedema with subsequent PSC cannot readily beexplained, so our fi ndings do not strongly support the hypothesis of a signifi cant role of perinatal events as a risk for the development of PSC later in life.

Large Population Screening Identified the Main Risk Factors of Stroke in Shashi District of Jingzhou City

Objective: This paper aims to screen and analyze the current status of high-risk stroke patients in Shashi District of Jingzhou City and the exposure levels of related risk factors, and provides suggestions as the references for prevention and treatment of stroke. Methods: Using cluster sampling, on-site investigations were conducted on 1060 permanent residents aged 40 years and over at 3 townships and 2 communities in Shashi District of Jingzhou City from January 2018 to December 2018. Risk assessment of stroke is based on the stroke risk screening form. Statistical analysis was performed by using SPSS 22.0 software. Results: After making a stroke risk assessment, a total of 313 high-risk stroke patients were screened, and the detection rate was 29.53%. The exposure rate of risk factors from high to low was hypertension (70.93%), dyslipidemia (46.33%), less physical exercise (46.01%), diabetes (36.10%), overweight (33.55%), smoking (33.23%), family history of stroke (24.92%), atrial fibrillation or valvular heart disease (7.35%). There are statistically significant differences among all risk factors between the high-risk group and middle and low-risk groups (P Conclusion: The detection rate of high-risk stroke patients in Shashi District of Jingzhou City is high. Hypertension, dyslipidemia and less physical exercise are the main risk factors of stroke occurrence and recurrence in the region. The prevention and treatment of risk factors for stroke should be strengthened to control the incidence and recurrence rate of stroke.

Prevalence and Determinants of High-risk HPV Infection among 11549 Women from an Opportunistic Screening in Hubei Province

High-risk human papillomavirus (hrHPV) infection plays an important role in the development of cervical intraepithelial neoplasia and cervical cancer.A total of 11 549 women were enrolled from the Maternal and Child Health Hospital of Hubei Province.Each participant accepted hrHPV testing and completed a self^administered questionnaire about basic information and potential risk factors.The univariable and multivariable logistic regression model was used to explore the associations between variants and hrHPV infection.Our results showed that hrHPV prevalence was 16.09% in Hubei Province,among which,hrHPV was more likely to be positive in women aged 51 years or above (OR=1.65,95% CI:1.28-2.14),and in women who had symptoms of bleeding after intercourse (OR=1.32,95% CI:1.17-1.50),had first sexual intercourse at the age of 18 years or below (OR=1.33,95% CI:1.07-1.64),had at least three male sexual partners (OR=2.50,95% CI:2.07-3.03),and who had been diagnosed with sexually transmitted infections (OR=1.50,95% CI:1.12-2.03).Married women (OR=0.66,95% CI:0.55-0.78) and women who frequently used condoms (OR=0.75,95% CI:0.67-0.84) had a relatively lower hrHPV prevalence.This study confirms that hrHPV infection was associated with age,marital status,symptoms of intercourse bleeding,history of sexually transmitted infections,and sex-related behaviors.Above all,this study provides a baseline database prior to obtaining vaccinations for dynamic tracking of the changes in hrHPV prevalence.

Detection of Asymptomatic Carotid Artery Stenosis in High-Risk Individuals of Stroke Using a Machine-Learning Algorithm

Objective Asymptomatic carotid stenosis(ACS)is closely associated to the incidence of severe cerebrovascular diseases.Early identifying the individuals with ACS and its associated risk factors could be beneficial for primary prevention of stroke.This study aimed to investigate a machine-learning algorithm for the detection of ACS among high-risk population of stroke based on the associated risk factors.Methods A novel model of machine learning was utilized to screen the associated predictors of ACS based on 30 potential risk factors.The algorithm of this model adopted a random forest pattern based on the training data and then was verified using the testing data.All of the original data were retrieved from the China National Stroke Screening and Prevention Project(CNSSPP),including demographic,clinical and laboratory characteristics.The individuals with high risk of stroke were enrolled and randomly divided into a training group and a testing group at a ratio of 4:1.The identification of carotid stenosis by carotid artery duplex scans was set as the golden standard.The receiver operating characteristic(ROC)curve and the area under the curve(AUC)was used to evaluate the efficacy of the model in detecting ACS.Results Of 2841 high risk individual of stroke enrolled,326(11.6%)were diagnosed as ACS by ultrasonography.The top five risk fectors contributing to ACS in this model were identified as family history of dyslipidemia,high level of lowdensity lipoprotein cholesterol(LDL-c),low level of high-density lipoprotein cholesterol(HDL-c),aging,and low body.

Diagnosis and treatment discussion of congenital factor VII deficiency in pregnancy:A case report

BACKGROUND Congenital factor VII deficiency(FVIID)is a rare autosomal recessive genetic disorder.The clinical manifestations of this deficiency vary greatly.Predicting the risk of bleeding during and after childbirth of pregnant women with congenital FVIID is difficult.Recombinant factor VIIa is the most common replacement therapy for FVIID.However,no unified diagnosis and treatment plan for pregnant women with congenital FVIID has been established.CASE SUMMARY We report the clinical history of a pregnant woman who was considered to have congenital FVIID.Recombinant factor VIIa was prophylactically administered to the pregnant woman at the time of cervical fully opening.She successfully delivered a live infant without any complications,such as postpartum hemorrhage,neonatal abnormalities,and so on.CONCLUSION Prophylaxis of recombinant factor VIIa during delivery can effectively reduce the incidence of postpartum hemorrhage among pregnant women with congenital FVIID associated with a high risk of bleeding.

Prenatal and perinatal risk factors for solid childhood malignancies: A questionnaire-based study

Importance:Childhood solid tumors account for the highest proportion of childhood cancers and are one of the leading causes of death in childhood.However,their pathogenesis is unclear.Objective:To explore prenatal and perinatal risk factors for solid malignancies in children.Methods:We enrolled 71 consecutive pediatric patients (44 boys and 27 girls;median age,30 months) with solid tumors who were diagnosed and treated at our center from January 2013 to December 2016 as the case group.We also enrolled 211 age-and residence-matched healthy children (ratio of approximately 3:1 with the case group) as the control group.We conducted a questionnaire-based survey with the parents of these 282 children.Univariate and multivariate conditional logistic regression analyses of the collected data were performed.Results:Confirmed solid malignancies included neuroblastoma (n =32),rhabdomyosarcoma (n =18),retinoblastoma (n =7),renal tumors (n =3),and other tumors (n =11).Risk factors for solid childhood tumors in the univariate analysis were the parents' age,gravidity,parity,abortion history,vaginal bleeding,family history of malignancy,and prenatal use of folic acid or hematinics/iron supplements (P ＜ 0.05),and those in the multivariate analysis were higher parity (odds ratio [OR],2.482;95％ confidence interval [CI],1.521-4.048),family history of malignancy (OR,3.667;95％ CI,1.679-8.009),and prenatal use of hematinics/iron supplements (OR,2.882;95％ CI,1.440-5.767).In contrast,use of prenatal folic acid was protective (OR,0.334;95％ CI,0.160-0.694).Interpretation:A family history of malignancy,use of prenatal hematinics/iron supplements,and higher parity are risk factors for solid childhood tumors,whereas use of prenatal folic acid is a protective factor.

Relationship of high-risk HPV infection with MEKK3 and NF-κB expression in cervical intraepithelial neoplasia tissue

Objective:To study the relationship of high-risk human papilloma virus (HPV) infection with mitogen-activated protein kinase/extracellular signal-regulated kinase 3 (MEKK3) and nuclear factorκB (NF-κB) expression in cervical intraepithelial neoplasia tissue.Methods:125 cases of cervical biopsy specimens between May 2013 and March 2016 were collected. The cervical inflammation specimens, cervical intraepithelial neoplasia specimens and cervical cancer specimens were included in inflammation group, CIN group and malignant group respectively. HPV-DNA typing detection kits were used to determine HPV typing, immunohistochemical kits were used to determine MEKK3 and NF-κB protein expression, and fluorescent quantitative PCR kits were used to determine the mRNA expression of MEKK3, NF-κB and downstream molecules.Results: MEKK3 and NF-κB protein expression in high-risk HPV-positive cervical tissue were significantly higher than those in high-risk HPV-negative cervical tissue (P<0.05), and MEKK3, NF-κB, Bcl-2, XIAP, Bmi-1, TGF-β and Vimentin mRNA expression in high-risk type HPV-positive cervical tissue were significantly higher than those in high-risk HPV-negative cervical tissue (P<0.05);Bcl-2, XIAP, Bmi-1, TGF-β and Vimentin mRNA expression in tissue with positive MEKK3 and NF-κB expression were significantly higher than those in tissue with negative MEKK3 and NF-κB expression (P<0.05).Conclusions:High-risk HPV infection will increase the expression of proliferation genes Bcl-2, XIAP and Bmi-1 as well as invasion genes TGF-β and Vimentin in cervical intraepithelial neoplasia tissue through MEKK3/NF-κB pathway.

妊娠合并肥厚型心肌病的围产儿结局和发生围产儿并发症的危险因素分析

目的:探讨妊娠合并肥厚型心肌病(HCM)患者的围产儿结局和发生围产儿并发症的危险因素。方法:回顾性分析2000年1月至2022年12月于上海交通大学医学院附属仁济医院产科心脏病监护中心收治的100例妊娠合并HCM患者的临床资料。分析纳入研究患者发生围产儿并发症的情况,包括流产、早产、小于胎龄儿、新生儿窒息、新生儿心脏畸形、围产儿死亡等发生率。采用单因素和多因素Logistic回归分析妊娠合并HCM患者发生围产儿并发症的独立危险因素。结果:①患者平均年龄为29.21±4.41岁,平均入院孕周为34.46±6.43周,有心肌病家族史16例(16%);梗阻性HCM 21例(21%),非梗阻性HCM 79例(79%);心电图检查结果异常91例(91%),主要以ST-T改变为主(77例,77%),心脏超声检查室间隔增厚平均为19.39±6.13 mm。②100例HCM患者的100次妊娠中,流产6例(6%),新生儿存活94例(94%),其中剖宫产91例(91%)、顺产3例(3%)。围产儿并发症主要为早产儿39例(39%),另外发生小于胎龄儿5例(5%)、新生儿窒息3例(3%)、新生儿心脏畸形2例(2%),无围产儿死亡。③单因素Logistic回归分析发现,孕前心功能≥Ⅱ级、左心房内径增大、合并肺动脉高压是妊娠合并HCM患者发生围产儿并发症的危险因素(OR>1,P<0.05)。多因素Logistic回归分析发现,孕前心功能≥Ⅱ级是预测妊娠合并HCM患者发生围产儿并发症的独立危险因素(OR 6.270,P<0.05)。结论:妊娠合并HCM可导致围产儿不良结局,重视妊娠合并HCM患者的风险评估及孕期管理,尽早发现危险因素,及时干预,可降低围产儿并发症的发生。