宫颈癌患者四维能量多普勒超声血管血流参数与疾病分期的相关性分析

摘要 目的：探究宫颈癌患者四维能量多普勒超声血管血流参数与其疾病分期的相关性。方法：选择2019年8月至2022年7月于我院接受治疗的80例确诊为宫颈癌患者为研究组,另取同期入院检测的50例宫颈癌上皮内瘤变患者为CIN组,取同期确诊为子宫良性病变的50例患者为对照组,分别对其进行了四维能量多普勒超声检测,对比三组患者超声参数差异,将研究组患者按照FIGO标准区分为不同疾病分期（I期23,II期34,III期23）,对比不同分期宫颈癌患者超声参数差异,通过绘制受试者曲线（ROC）的方式评估超声参数对不同宫颈癌分期的鉴别价值。结果：研究组、CIN组和对照组之间超声血流参数PSV及RI存在显著差异,同时两两相比较同样组间差异具有统计学意义（P<0.05）;不同宫颈癌分期患者超声血流参数之间存在显著差异,以FIGO III期的PSV最高,RI最低,各组两两相比较同样差异具有统计学意义（P<0.05）;PSV对FIGO I期至FIGO II期诊断AUC为0.6829（95% CI=0.5333-0.8324,P=0.0200）,对FIGO II期至FIGO III期诊断AUC为0.7698（95% CI=0.6402-0.8995,P=0.0006）,对FIGO I期至FIGO III期诊断AUC为0.7505（95% CI=0.6072-0.8937,P=0.0036）;RI对FIGO I期至FIGO II期诊断AUC为0.9309（95% CI=0.8662-0.9957,P<0.0001）,对FIGO II期至FIGO III期诊断AUC为0.7148（95% CI=0.5804-0.8493,P=0.0063）,对FIGO I期至FIGO III期诊断AUC为0.9811（95% CI=0.9504-1.000,P<0.0001）。结论：宫颈癌患者四维能量多普勒超声血管血流参数与其疾病分期具有一定的关联,将PSV和RI指数应用于宫颈癌分期鉴别中具有较好的应用价值,具有推广应用意义。     

孕14-19+6周正常胎儿胼周动脉的超声评估

摘要 目的：探讨应用超声SlowflowHD（超低速血流成像）联合RadiantFlow（二维立体血流成像）技术评估孕14-19⁺⁶周正常胎儿胼周动脉的可行性，观察胎儿胼周动脉及分支走行，测量其长度和高度，并探讨二者与孕周及双顶径的关系。方法：纳入2022年5月-2023年3月来南京医科大学附属苏州医院进行常规超声检查的150例孕14-19⁺⁶周孕妇，在胎儿正中矢状切面上获取胎儿胼周动脉及分支的图像，测量其长度和高度，测量重复3次，取平均值，并观察胎儿胼周动脉及分支走行。所有孕妇均随访至中孕晚期（20-28周）或晚孕期行产前超声检查未见胼胝体异常及其他颅内结构异常。采用pearson相关分析和回归分析判断胎儿胼周动脉长度及高度与孕周及双顶径的关系。结果：胎儿胼周动脉长度及高度随着孕周及双顶径的增加而增加（P＜0.05）。胎儿胼周动脉长度与孕周、双顶径之间呈线性正相关，且胎儿胼周动高度与孕周、双顶径之间呈线性正相关（P＜0.05）。在孕14-19⁺⁶周中所有111病例均类"C"形走行，额前内侧动脉、额中内侧动脉、额后内侧动脉三者几乎与胎儿胼周动脉垂直，类"鸡冠"，三者显示率100%；旁中央动脉在孕14-15⁺⁶周、16-17⁺⁶周、18-19⁺⁶周显示率分别约53.1%（17/32）、88.2%（45/51）、92.8%（26/28）；楔前动脉在孕14-15⁺⁶周、16-17⁺⁶周、18-19⁺⁶周显示率分别约3.1%（1/32）、35.2%（18/51）、78.5%（22/28）。结论：应用超声SlowflowHD（超低速血流成像）联合RadiantFlow（二维立体血流成像）技术显示孕14-19⁺⁶周正常胎儿胼周动脉及分支具有可行性，胎儿胼周动脉长度和高度与孕周及双顶径呈一定的线性相关。     

系统和四维超声对胎儿器质性异常筛检价值分析

摘要 目的：探究系统及四维超声在胎儿器质性异常筛选中的应用价值。方法：回顾性分析2018年3月至2019年3月于我院接受检查的887例中晚期产妇超声检测资料,所有产妇均行系统及四维超声检测,对比系统超声、四维超声和联合检测在胎儿器质性异常筛查中的特异性、敏感性和准确性,分析上述检查方式对不同胎儿器质性异常筛查的价值。结果：（1）887例产妇共娩出899例胎儿,其中87例存在器质性异常,异常率9.68 %（87/899）,联合检测对器质性异常检出率为94.25 %（82/87）,系统超声检出率为68.97 %（60/87）,四维超声检出率为79.31 %（69/87）,联合检测明显优于单独检测（P<0.05）;（2）系统超声检测一致性为96.05 %,灵敏度为70.59 %,特异度为98.54 %,四维超声一致性为96.47 %,灵敏度为75.40 %,特异度为98.54 %,联合检测一致性为99.57%,灵敏度为96.26 %,特异度为99.90 %,对比发现联合检测一致性、灵敏度均优于单独检测。结论：系统及四维超声对胎儿器质性异常具有较好的筛查效果,联合检测筛查效果优于单独检测。     

孕中期超声联合无创产前基因筛查在检出染色体异常胎儿中的应用价值

摘要 目的：孕中期超声联合无创产前基因筛查（NIPT）在染色体异常胎儿检出中的应用价值。方法：选取2019年8月～2021年12月在石家庄市妇幼保健院产前检查的2000例孕中期孕妇,均接受超声检查和NIPT筛查。以羊水穿刺或引产后高通量测序结果为金标准,四格表法分析孕中期超声联合NIPT在染色体异常胎儿检出中的应用价值。结果：2000例孕中期孕妇中,超声检查共检出软指标异常37例,结构指标异常30例。NIPT筛查检出高风险孕妇17例,其中21-三体综合征11例、18-三体综合征6例。超声软指标和结构指标联合NIPT诊断胎儿染色体异常的灵敏度、特异度、阳性预测值、阴性预测值、漏诊率、误诊率、准确率分别为95.00%、99.95%、95.00%、99.95%、5.00%、0.05%、99.90%。结论：联合孕中期超声和NIPT可提高检出高风险染色体异常胎儿的灵敏度,降低漏诊率,对于早发现染色体异常胎儿具有重要价值,进而提高生育质量。     

小波阈值降噪的超声多普勒技术在胎儿中枢神经系统畸形筛查中的临床应用价值

摘要 目的：探究小波阈值降噪的超声多普勒技术在胎儿中枢神经系统（CNS）畸形筛查中的临床应用价值。方法：选择2018年1月-2021年1月于本院进行规范化妊娠早期超声结构筛查的1092例11-13+6周单胎妊娠孕妇,所有孕妇均进行常规超声和小波阈值降噪的超声多普勒技术的检查,并对其妊娠过程和结果进行随访。结果：1092例胎儿产后病理或超声检查显示,胎儿CNS畸形共计19例,发生率为1.74％（19/1092）。其中,露脑畸形8例,无脑畸形5例,前脑无裂畸形3例,脑膜膨出2例,脊柱裂1例。基于小波阈值降噪的超声多普勒技术对胎儿CNS畸形检出的符合率94.74%（18/19）显著高于常规超声63.16%（12/19）,差异有统计学意义（P<0.05）;且基于小波阈值降噪的超声多普勒技术检出胎儿CNS畸形的准确性、敏感度、特异度、阳性预测值、阴性预测值均显著高于常规超声,差异均均有统计学意义（P<0.05）。结论：小波阈值降噪的超声多普勒技术对妊娠早期孕妇进行规范化结构筛查更有助于及早发现胎儿CNS畸形,对降低畸形胎儿的出生率以及指导临床治疗方案的选择具有重要指导意义。     

对比分析四维容积超声及彩色多普勒超声在胎儿肺静脉异位引流诊断中的应用

摘要 目的：对比分析四维容积超声及彩色多普勒超声在胎儿肺静脉异位引流（APVC）诊断中的应用价值。方法：采用回顾性分析方法,2019年1月到2022年1月选择在本院进行诊治的胎儿肺静脉异位引流孕妇60例作为研究对象,都给予四维容积超声及彩色多普勒超声,记录影像学特征并判断诊断价值。结果：在60例孕妇中,彩色多普勒超声检查判断为胎儿肺静脉异位引流51例,诊断敏感性为85.0 %;四维容积超声检查判断为胎儿肺静脉异位引流59例,诊断敏感性为98.3 %,四维容积超声检查对胎儿肺静脉异位引流的诊断敏感性明显高于彩色多普勒超声检查（P<0.05）。彩色多普勒超声检查与四维容积超声检查诊断的特异性都为100.0%。在60例孕妇中,判断为胎儿肺静脉异位引流心上型32例,心下型28例;心上型的肺静脉引流途径为肺静脉-垂直静脉-右上腔静脉22例、肺静脉-垂直静脉-左上腔静脉10例,心下型的肺静脉引流途径为肺静脉-垂直静脉-左头臂静脉-右上腔静脉6例、肺静脉-垂直静脉-门静脉22例。合并心脏畸形32例,合并畸形率为53.3 %;有51例孕妇终止妊娠,9例孕妇继续妊娠,其中8例未经治疗者新生儿期死亡,1例在3月龄死亡。结论：相对于彩色多普勒超声,四维容积超声在胎儿肺静脉异位引流诊断中的应用可提高诊断敏感性,可有效反映肺静脉回流情况,可指导临床进行早期干预。     

产前超声孕妇血流动力学血流参数监测对中晚期胎儿宫内生长受限临床意义分析

摘要 目的：通过监测产前彩色多普勒超声心动图子宫动脉、脐动脉和大脑中动脉的血流参数,进而分析其在中晚期宫内胎儿生长受限（FGR）的临床意义。方法：以我院2020年1月-2021年12月就诊的中晚期孕妇为研究对象,其中110例为孕晚期FGR孕妇,60例为孕晚期健康孕妇,分别记录为FGR组（n=110）和对照组（n=60）,用彩色多普勒超声监测两组孕晚期孕妇的多血管（子宫动脉、脐动脉和大脑中动脉）的3个血流参数,对比两组之间血流参数的差异性;并根据Apgar评分,比较不同Apgar评分下的血流参数差异,分析子宫动脉、脐动脉和大脑中动脉的3个血流参数与宫内FGR的相关性。结果：（1）FGR组胎儿子宫动脉的3个血流参数（RI、PI、S/D）均显著高于对照组（P<0.05）;（2）FGR组胎儿脐动脉的3个血流参数（RI、PI、S/D）均显著高于对照组（P<0.05）;（3）FGR组胎儿大脑中动脉的3个血流参数（RI、PI、S/D）均显著低于对照组（P<0.05）;（4）Apgar≤7分组子宫动脉的3个血流参数（RI、PI、S/D）显著高于Apgar＞7分组,Apgar≤7分组脐动脉的3个血流参数（RI、PI、S/D）显著高于Apgar＞7分组,Apgar≤7分组大脑中动脉的3个血流参数（RI、PI、S/D）显著低于Apgar＞7分组。结论：彩色多普勒超声心动图子宫动脉、脐动脉、大脑中动脉3个血流参数（RI、PI、S/D）异常与FGR的发生密切相关,为临床筛查和诊断FGR提供有用帮助。     

高频肺部超声结合分区域扫查早期鉴别新生儿肺透明膜病及湿肺的研究

摘要 目的：探讨高频肺部超声结合分区域扫查早期鉴别新生儿肺透明膜病（HMD）及湿肺（TTN）的临床价值。方法：选取2019年1月～2020年7月因呼吸窘迫进入我院新生儿重症监护室的163例新生儿作为研究对象,患儿均接受X线和高频肺部超声检查,采用最终临床诊断作为金标准,采用受试者工作曲线（ROC）计算超声和X线诊断HMD和TTN的灵敏度、特异性、阳性预测值、阴性预测值、曲线下面积（AUC）、95％CI。结果：超声诊断HMD的灵敏度、特异性、阳性预测值、阴性预测值、AUC均高于X线检查。Z检验显示超声与X线诊断HMD的AUC存在统计学意义（Z=3.996,P=0.001）。超声诊断TTN的灵敏度、特异性、阳性预测值、阴性预测值、AUC均高于X线。Z检验显示,超声与X线诊断TTN的AUC存在统计学差异（Z=4.188,P＜0.001）。结论：高频肺部超声结合分区域扫查早期鉴别新生儿肺透明膜病及湿肺的临床价值高于X线,值得临床推广应用。     

超声联合染色体检测对胎儿心血管畸形的诊断价值

摘要 目的：探讨超声联合染色体检测对胎儿心血管畸形的诊断价值。方法：2017年6月到2020年12月选择在本院诊治的高危孕妇117例作为研究对象,所有孕妇都给予胎儿心脏超声检查与羊膜穿刺染色体检查,判断胎儿心血管畸形情况。结果：在117例孕妇中,胎儿心脏超声检出胎儿心血管畸形37例,占比31.6%,前三位主要为室间隔缺损、左上腔静脉、右锁骨下动脉。羊膜腔穿刺术检出32例染色体异常胎儿,占比27.4%,其中染色体数目异常30例,染色体结构异常2例,前三位分别为21-三体、13-三体与18-三体。超声检查胎儿心血管畸形37例中,染色体异常30例;超声检查胎儿心血管正常80例中,染色体异常2例,对比差异有统计学 意义(P<0.05)。联合诊断为胎儿心血管畸形39例,随访后确诊为胎儿心血管畸形40例,超声联合染色体检测对胎儿心血管畸形的敏感性与特异性为100.0%(39/39)和98.7%(77/78)。结论：胎儿心脏超声联合染色体检测对胎儿心血管畸形的诊断具有很高敏感性与特异性,可尽最大可能提高出生缺陷儿的检出率,有很好的应用价值。     

循环亚油酸水平与动脉粥样硬化风险的因果关联：一项两样本孟德尔随机化研究

摘要 目的：本文拟探讨遗传预测的循环亚油酸水平与不同部位动脉粥样硬化的因果关联。方法：采用两样本孟德尔随机化（Mendelian randomization, MR）研究方法,选择与亚油酸相关联的单核苷酸多态性位点（single nucleotide polymorphism, SNPs）作为工具变量（Instrument Variables, IVs）,评估遗传预测的循环亚油酸水平与不同部位动脉粥样硬化的因果关联。结果：逆方差加权法（Inverse Variance Weighted, IVW）分析结果显示,遗传预测的循环亚油酸水平与冠状动脉粥样硬化风险存在显著正相关（OR=1.32, 95% CI: 1.09-1.61, P=0.005）;循环亚油酸水平与脑动脉粥样硬化风险之间无因果关联 （OR=1.18, 95% CI: 0.63-2.23, P=0.602）。循环亚油酸水平与外周动脉粥样硬化风险存在显著负相关（OR= 0.55, 95% CI: 0.39-0.77, P=0.001）。循环亚油酸水平与其他动脉粥样硬化（不包括脑、冠状动脉和外周动脉）之间无显著的因果关联（OR=0.99, 95% CI: 0.81-1.21, P=0.916）。结论：遗传预测的循环亚油酸水平与冠状动脉粥样硬化及外周动脉硬化存在因果关联,亚油酸在动脉粥样硬化防治中的作用值得重视及进一步研究。     

超声心动图联合心电图对妊娠中期心脏畸形胎儿的诊断价值

摘要 目的：探讨超声心动图联合心电图对妊娠中期心脏畸形胎儿的诊断价值。方法：回顾性分析我院2019年1月到2021年1月出生后确诊与尸检确诊为心脏畸形的80例胎儿的临床相关指标,分析80例胎儿超声心动图检查与胎儿心电图检查结果,并分析超声心动图联合心电图对妊娠中期心脏畸形胎儿的诊断价值。结果：80例胎儿有56例出现不同程度的心电图异常现象,其中胎心早搏3例、FQRS振幅增高12例、ST段改变15例、FQRS时限增宽3例、胎心不齐4例、胎心过缓3例、胎心过速16例;80例胎儿通过尸检和出生后随访最终确定左心发育不良综合征（HLHS）4例,单心室6例,完全性心内膜垫缺损（ECD）8例,法洛四联症（TOF）14例,卵圆孔直径大于 6 mm 17例,室间隔缺损（VSD）31例,与超声心动图诊断结果对比无显著差异（P＞0.05）,超声心动图有7例漏诊;联合诊断与超声心动图和心电图对左心发育不良综合征、单心室、完全性心内膜垫缺损胎儿的诊断对比无明显差异（P＞0.05）,对法洛四联症、卵圆孔直径大于 6 mm、室间隔缺损和心脏畸形诊断总数方面联合诊断优于超声心动图和心电图单一诊断（P＜0.05）;通过不同检查的检测价值对比发现,超声心动图联合心电图检查的准确度、敏感度、特异度、阳性预测值和阴性预测值明显高于超声心动图与心电图单一检查。结论：超声心动图和心电图对于妊娠中期心脏畸形胎儿的诊断均具有重要价值。心脏畸形胎儿在妊娠中期进行心电图检查会出现异常现象,但是并不能确诊为心脏畸形,还需后续继续应用超声心动图进行检查,最终确诊胎儿是否存在心脏畸形现象。     

Nominations sought for Mindel C. Sheps Award

Abstract

The relationship between early fetal wastage or stillbirth and pregnancy spacing was examined in a population characterized by prolonged lactation, minimal nutrition, and high fertility and mortality. The highest risk of early fetal death was found among those pregnancies conceived less than twelve months after the birth of a surviving breast‐fed infant. Lactation as a possible causal factor is discussed. A significant inverse relationship was apparent for second trimester fetal deaths and pregnancy intervals, but not for third trimester deaths. This finding is surprising when one considers that fetal weight gain, and presumably nutrient demand, increases most rapidly during the third trimester.     

Utility of maternal serum total testosterone analysis for fetal gender determination in Asian elephants (Elephas maximus).

It has been shown in some species that fetal testes produce testosterone early in gestation. This study investigated the possibility that fetal testosterone may be reflected in maternal serum levels in the Asian elephant (Elephas maximus). Weekly serum samples were collected from seventeen pregnant captive Asian elephants and analyzed via radioimmunoassay (RIA) for total testosterone levels. Nine of the cows carried male fetuses and eight carried female fetuses. A non-random pattern over time (P<0.01) was observed in cows carrying either a male or female fetus. Mean maternal serum total testosterone was significantly higher in cows carrying male versus female fetuses (P<0.01). Mean trimester values indicate that first trimester values are not significantly different among male versus female groups. The second and third trimester values of cows carrying male fetuses were higher than cows carrying female fetuses, (P<0.01 and <0.05, respectively). The results of this study show that it is possible via RIA of maternal serum for total testosterone to determine the gender of calves during gestation.     

Association of Second and Third Trimester Weight Gain in Pregnancy with Maternal and Fetal Outcomes

Objective

To investigate the association between weekly weight gain, during the second and third trimesters, classified according to the 2009 Institute of Medicine (IOM/NRC) recommendations, and maternal and fetal outcomes.

Methods

Gestational weight gain was evaluated in 2,244 pregnant women of the Brazilian Study of Gestational Diabetes (Estudo Brasileiro do Diabetes Gestacional – EBDG). Outcomes were cesarean delivery, preterm birth and small or large for gestational age birth (SGA, LGA). Associations between inadequate weight gain and outcomes were estimated using robust Poisson regression adjusting for pre-pregnancy body mass index, trimester-specific weight gain, age, height, skin color, parity, education, smoking, alcohol consumption, gestational diabetes and hypertensive disorders in pregnancy.

Results

In fully adjusted models, in the second trimester, insufficient weight gain was associated with SGA (relative risk [RR] 1.72, 95% confidence interval [CI] 1.26–2.33), and excessive weight gain with LGA (RR 1.64, 95% CI 1.16–2.31); in third trimester, excessive weight gain with preterm birth (RR 1.70, 95% CI 1.08–2.70) and cesarean delivery (RR 1.21, 95% CI 1.03–1.44). Women with less than recommended gestational weight gain in the 2^nd trimester had a lesser risk of cesarean deliveries (RR 0.82, 95% CI 0.71–0.96) than women with adequate gestational weight gain in this trimester.

Conclusion

Though insufficient weight gain in the 3^rd trimester was not associated with adverse outcomes, other deviations from recommended weight gain during second and third trimester were associated with adverse pregnancy outcomes. These findings support, in part, the 2009 IOM/NRC recommendations for nutritional monitoring during pregnancy.     

Effects of Trypanosoma vivax on pregnancy of Yankasa sheep and the results of homidum chloride chemotherapy

Three groups of pregnant Yankasa ewes, made up of six ewes in each group were assigned at random to first, second and third trimester of pregnancy studies. The ewes were experimentally infected with T. vivax to study the effects of the infection on pregnancy and the results of Novidium Chemotherapy. Three pregnant uninfected ewes served as controls. Fourteen days post infection, the ewes in each trimester study, were paired by weight and assigned to two groups of three ewes each. One group was treated with Novidium while the other group remained untreated. Of the three ewes in each group, one ewe was killed humanely at 21 days post infection and another at the end of the trimester period. In the first trimester, a ewe with partial fetal resorption was observed among the untreated ewes. Fetal death in-utero and expulsion of an autolyzed fetus was observed among the treated ewes. In the second trimester, abortion and almost complete fetal resorption were observed among the untreated ewes. Fetal death in-utero and expulsion of an autolyzed fetus was observed among the treated ewes. In the third trimester, abortions were observed among the untreated ewes. Abortion of a live fetus and a case of dystocia were observed among the treated ewes. Ewes in the second and third trimesters of pregnancy were more susceptible to the infection, with ewes in the third trimester being most susceptible, as measured by the number of abortions and death of ewes. Fetuses from the untreated ewes in the three trimesters of pregnancy were lower in body weights, than the fetuses from the treated ewes. The uninfected control ewes carried the pregnancies to term. Novidium chemotherapy at 14 days post infection was not beneficial in ameliorating the pathogenicity of T. vivax infection on pregnancy in Yankasa ewes. T. vivax infection of only 14 days was enough to cause irreversible pathology in Yankasa fetuses evidenced by death of fetuses in-utero, dystocia and abortions irrespective of Novidium chemotherapy.     

Sex-specific differences in fetal and infant growth patterns: a prospective population-based cohort study

Background

The objective of this study was to assess whether sex-specific differences in fetal and infant growth exist.

Methods

This study was embedded in the Generation R Study, a population-based prospective birth cohort. In total, 8556 live singleton births were included. Fetal growth was assessed by ultrasound. During the first trimester, crown-rump-length (CRL) was measured. In the second and third trimester of pregnancy head circumference (HC), abdominal circumference (AC) and femur length (FL) were assessed. Information on infant growth during the first 2 years of life was obtained from Community Health Centers and included HC, body weight and length.

Results

In the first trimester, male CRL was larger than female CRL (0.12 SD [95% CI 0.03,0.22]). From the second trimester onwards, HC and AC were larger in males than in females (0.30 SD [95% CI 0.26,0.34] and 0.09 SD [95% CI 0.05,0.014], respectively). However, FL in males was smaller compared to female fetuses (0.21 SD [95% CI 0.17,0.26]). Repeated measurement analyses showed a different prenatal as well as postnatal HC growth pattern between males and females. A different pattern in body weight was observed with a higher body weight in males until the age of 12 months where after females have a higher body weight.

Conclusions

Sex affects both fetal as well as infant growth. Besides body size, also body proportions differ between males and females with different growth patterns. This sexual dimorphism might arise from differences in fetal programming with sex specific health differences as a consequence in later life.

     

Maternal exposure to ambient air temperature during pregnancy and early childhood pneumonia

BackgroundPneumonia has been widely recognized as the leading cause of death in children worldwide, but its etiology still remains unclear.ObjectiveWe examined the association between maternal exposure to ambient air temperature during pregnancy and lifetime pneumonia in the offspring.MethodsWe conducted a cohort study of 2598 preschool children aged 3–6 years in Changsha, China. The lifetime prevalence of pneumonia was assessed using questionnaire. We backwards estimated each child's exposure to air temperature during prenatal and postnatal periods. Multiple regression model was used to examine the association between childhood pneumonia and exposure to air temperature in terms of odd ratios (OR) and 95% confidence interval (CI).ResultsPrevalence of childhood pneumonia in Changsha was high up to 38.6%. We found that childhood pneumonia was significantly associated with prenatal exposure to air temperature, with adjusted OR (95% CI) = 1.77 (1.23–2.54) for an interquartile range (IQR) increase in temperature, particularly during the second trimester with adjusted OR (95% CI) = 2.26 (1.32–3.89). Boys are more susceptible to the risk of pneumonia due to air temperature than girls. We further observed that maternal exposure to extreme heat days during pregnancy increased the risk of pneumonia in the offspring.ConclusionsMaternal exposure to air temperature during pregnancy, particularly the second trimester, was associated with pneumonia in the children, providing the evidence for fetal origins of pneumonia.     

妊娠晚期合并急性胰腺炎患者的手术时机对妊娠结局的影响分析

目的:研究妊娠晚期合并急性胰腺炎(APIP)患者的手术时机对妊娠结局的影响。方法:回顾性分析我院2016年7月到2018年6月诊治的35例APIP患者的临床资料,依照不同手术时机分成急诊手术组19例及延期手术组16例。观察和比较两组患者的手术时间、住院时间、下床时间、妊娠结局及并发症的发生情况。结果:急诊手术组的手术时间、住院时间及下床时间均明显短于延期手术组(P0.05),产妇出现早产、剖宫产、死胎引产的不良结局发生率(15.79%)明显低于延期手术组(50.00%,P0.05),围产儿发生窒息、畸形、死亡的不良结局发生率(21.05%)显著低于延期手术组(62.50%,P0.05),产妇的术后并发症发生率(5.26%)明显低于延期手术组(31.25%,P0.05)。结论:对已确诊的妊娠晚期合并急性胰腺炎患者实施急诊手术能够显著降低妊娠晚期合并急性胰腺炎产妇及其围产儿发生不良结局的可能性,同时有效促进产妇的术后恢复并降低并发症发生率。     

Aortic Intima-Media Thickness and Aortic Diameter in Small for Gestational Age and Growth Restricted Fetuses

ObjectiveThe objective of this study is to measure aortic intima-media thickness (aIMT) and aortic diameter (AD) in appropriate for gestational age (AGA) fetuses, small for gestational age (SGA) fetuses, and intrauterine growth restricted (IUGR) fetuses.MethodsCase-control study performed between June 2011 and June 2012. Forty-nine AGA fetuses, 40 SGA fetuses, and 35 IUGR fetuses underwent concomitant measurement of aIMT and AD at a mean gestational age of 34.4 weeks.ResultsMedian aIMT was higher in fetuses with IUGR (0.504 mm [95%CI: 0.477-0.530 mm]), than in SGA fetuses (0.466 mm [95% CI: 0.447–0.485 mm]), and AGA fetuses (0.471 mm [95% CI: 0.454-0.488 mm]) (p = 0.023). Mean AD was significantly lower in fetuses with IUGR (4.451 mm [95% CI: 4.258–4.655 mm]), than in AGA fetuses (4.74 mm [95% CI: 4.63-4.843 mm]) (p = 0.028).ConclusionsGrowth restricted fetuses have a thicker aortic wall than AGA and SGA fetuses, which possibly represents preclinical atherosclerosis and a predisposition to later cardiovascular disease.     

A common genetic variant at 15q25 modifies the associations of maternal smoking during pregnancy with fetal growth: the generation R study

Objective

Maternal smoking during pregnancy is associated with fetal growth retardation. We examined whether a common genetic variant at chromosome 15q25 (rs1051730), which is known to be involved in nicotine metabolism, modifies the associations of maternal smoking with fetal growth characteristics.

Methods

This study was performed in 3,563 European mothers participating in a population-based prospective cohort study from early pregnancy onwards. Smoking was assessed by postal questionnaires and fetal growth characteristics were measured by ultrasound examinations in each trimester of pregnancy.

Results

Among mothers who did not smoke during pregnancy (82.9%), maternal rs1051730 was not consistently associated with any fetal growth characteristic. Among mothers who continued smoking during pregnancy (17.1%), maternal rs1051730 was not associated with head circumference. The T-allele of maternal rs1051730 was associated with a smaller second and third trimester fetal femur length [differences −0.23 mm (95%CI −0.45 to −0.00) and −0.41 mm (95%CI −0.69 to −0.13), respectively] and a smaller birth length [difference −2.61 mm (95%CI −5.32 to 0.11)]. The maternal T-allele of rs1051730 was associated with a lower third trimester estimated fetal weight [difference −33 grams (95%CI −55 to −10)], and tended to be associated with birth weight [difference −38 grams (95%CI −89 to 13)]. This association persisted after adjustment for smoking quantity.

Conclusions

Our results suggest that maternal rs1051730 genotype modifies the associations of maternal smoking during pregnancy with impaired fetal growth in length and weight. These results should be considered as hypothesis generating and indicate the need for large-scale genome wide association studies focusing on gene – fetal smoke exposure interactions.