Search

Phenolic compounds are among the endocrine disruptors which are widely used in daily life products. Studies in laboratory animals showed reproductive and developmental effects. In spite of widespread exposure to phenols, only few studies examined their effects on human development. This study was designed to investigate the relationship between antenatal phenol exposure and birth outcomes in a Chinese obstetric population. Four hundred ninety-six mother-infant pairs recruited from the Laizhou Wan prospective birth cohort in northern China between 2010 and 2013 were included in the study. We measured two phenol metabolites in maternal urine at delivery and examined their associations with birth outcomes including birth weight, crown–heel length, head circumference, gestational age, and ponderal index. Median levels of bisphenol A (BPA) and triclosan (TCS) in urine were 1.07 and 0.50 μg/g creatinine, respectively. After adjusting for confounders, a 10-fold increase in BPA levels was associated with a 0.63 cm [95% confidence interval (CI): 0.25 to 1.01] increase in birth length among boys, but not among girls. No associations were found between TCS levels and any birth outcomes. The positive association of prenatal low-level BPA exposures with anthropometric measures observed among boys, suggests gender differences in the response to antenatal phenol exposure. Given the variability in urinary phenol levels reported during pregnancy, our findings based on levels of the target biomarkers in a single urine sample need to be confirmed in additional studies. [ABSTRACT FROM AUTHOR]

Introduction: To date, there have only been provisional recommendations about the appropriate gestational weight gain in twin pregnancies. This study aimed to contribute evidence to this gap of knowledge. Material and methods: Using a cohort of 10 603 twin pregnancies delivered between 2000 and 2015 in the state of Hessen, Germany, the individual and combined impact of maternal body mass index and gestational weight gain on maternal and neonatal outcomes was analyzed using uni‐ and multivariable logistic regression models. The analysis used newly defined population‐based quartiles of gestational weight gain in women carrying twin pregnancies (Q1: <419.4 g/week [low weight gain], Q2–Q3: 419.4–692.3 g/week [optimal weight gain], Q4: >692.3 g/week [high weight gain]) and the World Health Organization body mass index classification. Results: Pre‐pregnancy body mass index ≥25 kg/m2 was associated with significantly increased rates of cesarean deliveries (aOR1.2, 95% CI: 1.01–1.41) and pregnancy‐induced hypertensive disorders (aOR 1.53, 95% CI: 1.11–2.1) but not with any adverse neonatal outcome. Perinatal mortality (aOR 2.23, 95% CI: 1.38–3.6), preterm birth (aOR 1.88, 95% CI: 1.58–2.25), APGAR′5 < 7 (aOR 1.61, 95% CI: 1.19–2.17) and admissions to the neonatal intensive care unit (aOR 1.6, CI: 1.38–1.85) were increased among women with low gestational weight gain. Rates of cesarean deliveries were high in both women with low (aOR 1.25, 95% CI: 1.05–1.48) and high gestational weight gain (aOR 1.17, 95% CI: 1.01–1.35). A high gestational weight gain was also associated with higher rates of hypertensive disorders in pregnancy (aOR 2.32, 95% CI: 1.79–3.02) and postpartum hemorrhage (aOR 1.72, 95%CI: 1.12–2.63). The risk of preterm birth, low Apgar scores and NICU admissions showed a converse linear relation with pre‐pregnancy body mass index in women with low gestational weight gain. Conclusions: In twin pregnancies, nonoptimal weekly maternal weight gain seems to be strongly associated with maternal and neonatal adverse outcomes. Since gestational weight gain is a modifiable risk factor, health care providers have the opportunity to counsel pregnant women with twins and target their care accordingly. Additional research to confirm the validity and generalizability of our findings in different populations is warranted. [ABSTRACT FROM AUTHOR]

Background: Previous epidemiological evidence mainly focused on the adverse effects of prenatal exposure to pyrethroid insecticides (PYRs) on respiratory health during childhood. It remains unclear whether the PYR exposures can also impact on children's lung function.Objectives: To explore the potential effects of prenatal PYR exposures on lung function in a population of Chinese children.Methods: This study included 233 mother-child dyads from the Laizhou Wan Birth Cohort (LWBC), Shandong province, northern China, between September 2010 and December 2013. Three metabolites of PYRs [3-phenoxybenzoic acid (3-PBA), and cis- and trans-(2,2-dichlorovinyl)-2,2-dimethylcyclopropane-1-carboxylic acid (cis-DCCA and trans-DCCA)] were measured using gas chromatography-mass spectrometry (GC-MS) in maternal urine samples collected at recruitment. Lung function was assessed with spirometry in children aged 6-8 years. Multivariable linear regression and generalized linear models (GLMs) assessed the associations of prenatal PYR exposures with lung function in children.Results: Among the PYR metabolites, 3-PBA (81.5%) were most frequently detected, followed by trans-DCCA (55.4%) and cis-DCCA (21.9%). The 3-PBA concentration was associated with a 1% decrease in FEV1/FVC in the highest quartiles of exposure compared to the lowest quartile, with a potential dose response association (p-trend = 0.085). Our findings provide a suggestive effect modification by sex, with girls being more susceptible than the boys (p-trend = 0.011). However, there were no associations between the trans-DCCA concentration and lung function parameters.Conclusion: Prenatal 3-PBA concentrations were associated with a modest decrease in FEV1/FVC among school-aged children, and the association was slightly more pronounced for the girls than for the boys. [ABSTRACT FROM AUTHOR]

Few studies have examined the adverse birth sizes of preconception exposure to organophosphate pesticides (OPs) in women undergoing in vitro fertilization (IVF). We investigated the relationship of preconception OP exposure with birth sizes among Chinese women undergoing IVF. This study included 302 couples seeking infertility treatment in the China National Birth Cohort Study, from Shanghai, China, who gave birth to singleton infants between 2018 and 2021. Clinical data were collected from medical records. We measured the concentrations of six nonspecific dialkyl phosphates (DAP) metabolites of OPs [diethylthiophosphate (DETP), diethylphosphate (DEP), diethyldithiophosphate (DEDTP), dimethyldithiophosphate (DMTP), dimethylphosphate (DMP), and dimethyldithiophosphate (DMDTP)] in maternal urine. DMDTP and DEDTP were precluded from further analyses due to the low detection rates. Generalized linear models (GLMs) and weighted quantile sum (WQS) regression analyses were performed to examine the individual and joint effects of OP exposures on gestational age, birth weight, body length, and ponderal index. Odder ratio (OR) of preterm birth were estimated using logistic regression models. Women in the highest as compared with lowest quartile of DEP had shorter gestational age (β = - 0.68; 95% CI = −1.24, −0.11). The association was modified by sex, with boys showing larger decreases in gestational age (β = - 0.86; 95% CI = −1.60, −0.13). No associations were found between other DAP metabolites and birth sizes. Results from linear models with individual DAP metabolites were corroborated by the WQS regression where DEP had the largest contribution to the overall mixture effect on gestational age (weight = 0.70). Moreover, DEP concentration was associated with an elevated risk of preterm birth (OR = 1.35, 95% CI = 1.11, 2.25). Preconception DEP concentration was associated with shortened gestational age and increased risk of preterm birth, and the association was more pronounced among boys than girls. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the effects of the association between first trimester vitamin D (VitD) concentrations and increased prepregnancy body mass index (BMI) on early fetal growth restriction (FGR). Methods: This retrospective cohort study included 15,651 women with singleton pregnancy who delivered at the International Peace Maternity and Child Health Hospital between January 2015 and November 2016. Women were classified in two groups based on their serum 25(OH)D vitamin levels status: VitD sufficient (SUFF) group and VitD insufficient or deficient (INSUFF/DEF). The cut-off point for VitD concentration was 50.00 nmol/L. Comparisons were made between women with normal prepregnancy body weight (BMI 18.5–23.9 kg/m2) and overweight and obese (OWO) women (BMI > 24.0 kg/m2). Early FGR was defined as first-trimester gestational age-adjusted crown-rump length (CRL) in the lowest 20th centile of the population. Multivariate logistic regression was used to evaluate the association between maternal serum 25(OH)D levels and prepregnancy BMI with first trimester CRL and early FGR. Results: In VitD INSUFF/DEF group, the first trimester CRL was decreased (P = 0.005), and the risk of early FGR was increased by 13% (95% CI 1.04–1.24, P = 0.004) compared to the VitD SUFF group. In OWO group, the first trimester CRL was also significantly decreased (P < 0.0001), and the risk of early FGR was significantly increased by 58% (95% CI 1.40–1.78, P < 0.001) compared with normal weight group. Furthermore, there was a significant combined effect of maternal VitD concentrations and OWO on CRL (P for interaction = 0.02) and the risk of early FGR (P for interaction = 0.07). Conclusion: Sufficient first trimester serum 25(OH)D concentration was a protective factor for early fetal growth, especially among OWO mothers. Chinese Clinical Trial Registry (Registration number: ChiCTR1900027447 with date of registration on November 13, 2019-retrospectively registered). [ABSTRACT FROM AUTHOR]

Animal experiments have revealed that pyrethroids (PYRs) exposure could affect semen quality, however evidence on humans being is limited and controversial. To explore the potential effects of environmental PYRs exposure on semen quality in reproductive age men. We conducted a cross-sectional study of 346 men who planned to conceive and addressed to hospital for preconception examination. PYRs exposure was assessed by analyzing PYRs urinary metabolites [3-phenoxybenzoic acid (3PBA), trans- and cis-3-(2,2-Dichlorovinyl) −2,2-dimethylcy clopropane carboxylic acid (TDCCA and CDCCA)] levels using gas chromatography-mass spectrometry. Semen quality was assessed by a computer-aided semen analyzer. For a detection rate of 99.7%, 76.6%, and 22.0%, the median levels (μg/g creatinine) of PYRs metabolites were 0.46 for 3PBA, 0.38 for TDCCA and under detection limit for CDCCA. Linear regression models found negative associations between 3PBA and sperm morphology (β = −2.12, 95% CI: −4.02 to −0.22) as well as between TDCCA and log-transformed total sperm count (β = −0.09, 95% CI: −0.16 to −0.01). In logistic regression models, men with the highest quartile of 3PBA had higher risk of poor semen quality (having below-reference semen parameter, OR = 2.40, 95% CI: 1.26 to 4.54; having below-reference sperms morphology, OR = 3.08, 95% CI: 1.10 to 8.60) compared to men in the lowest quartile. Our study suggests that environmental PYRs exposure might adversely affect semen parameters of reproductive age men in Shanghai, China. Further studies are needed to confirm our findings and demonstrate a causal relationship between PYRs exposure and semen quality. • Human PYRs exposure is widespread in both developed and developing countries. • Animal experiments reveal that PYRs exposure could affect semen quality, but evidence on humans being is limited. • We assess the effects of environmental PYRs exposure on semen quality in 346 reproductive age men. • Environmental PYRs exposure might adversely affect semen quality of reproductive age men in Shanghai, China. [ABSTRACT FROM AUTHOR]

Epidemiological studies have reported potential effects of individual paraben or bisphenol exposure on lung function, but few studies have estimated their joint effects. We conducted a cross sectional survey to investigate the associations of parabens and bisphenols exposure with lung function in 205 children aged 5–12 years from Shanghai, China. Urinary concentrations of six parabens [methyl-, ethyl-, propyl-, butyl-, benzyl-, and heptyl-paraben (MeP, EtP, PrP, BuP, BzP, and HeP)] and seven bisphenols [bisphenol A (BPA), bisphenol AF (BPAF), bisphenol AP (BPAP), bisphenol B (BPB), bisphenol P (BPP), bisphenol S (BPS), and bisphenol Z (BPZ)] were assessed by the high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS). Lung function, including forced expiratory volume in 1 s (FEV 1), forced vital capacity (FVC), FEV 1 /FVC, peak expiratory flow (PEF), and forced expiratory flow between 25% and 75% of forced vital capacity (FEF 25–75%), was further measured. Linear regression, bayesian kernel machine regression (BKMR), and weighted quantile sum regression (WQS) evaluated the individual and joint relationships of the parabens and bisphenols with the lung function parameters. Further, the analysis was stratified by child sex. Parabens (MeP, EtP, PrP, and BuP) and bisphenols (BPA, BPAP, BPB, and BPS) with detection rates >75% were included for analyses. In linear regressions, parabens (MeP, PrP, and BuP) were generally negatively associated with FEV 1 , FVC, PEF, and FEF 25–75% , but no associations for bisphenols were found. The association of parabens with lung function was more pronounced in girls. The aforementioned negative associations between parabens and lung function were confirmed by both the BKMR and WQS, with MeP being considered most heavily weighing chemical. Our findings suggested that exposure to parabens, either individuals or as a mixture, were associated with decreased lung function in children aged 5–12 years, and these associations were stronger among girls. Considering the cross-sectional study design, large longitudinal studies are warranted to confirm our findings. [ABSTRACT FROM AUTHOR]

Prostaglandins are implicated in the labor process, yet the precise role and regulation of the prostaglandin pathway remains to be elucidated. The first step in the pathway is cleavage of membrane phospholipids by phospholipase A2 (PLA2). Previous work demonstrated upregulation of secretory PLA2 (sPLA2)-IIA with labor in human myometrium, and recent evidence shows that there are numerous PLA2 isoforms. The present study investigates the potential of additional sPLA2 isoforms during pregnancy and labor. Real-time reverse transcriptase–polymerase chain reaction (RT-PCR), Western blotting, and immunohistochemistry were used to determine sPLA2 expression and localization. Results show the presence of sPLA2-IID in amnion, chorion, placenta, decidua, and myometrium. Expression of sPLA2-IID in decidua was significantly decreased in term labor compared to nonlabor patients, whereas no significant labor-associated changes were observed in other gestational tissues. Secretory PLA2-IID was localized within chorion fibroblasts, placenta trophoblasts, decidual cells, and in myometrial smooth muscle cells. In primary decidual cell cultures, interleukin (IL) 10 (IL-10) increased sPLA2-IID messenger RNA (mRNA) expression, while IL-1β had no effect on sPLA2-IID mRNA expression. In conclusion, decreased expression of sPLA2-IID in the decidua at labor indicates that it is unlikely to contribute to increased prostaglandin production during labor. However, increased expression of sPLA2-IID, induced by IL-10, suggests that sPLA2-IID may play an important anti-inflammatory role at the maternal–fetal interface. Nevertheless, precise functions of sPLA2-IID within the human uterus remain to be determined. [ABSTRACT FROM AUTHOR]

Impact: The study highlights significant declines in risky transportation-related behaviors among US high school students from 2007 to 2023., Competing Interests: Competing interests: The author declares no competing interests. Ethical statement: Because publicly available, anonymized data were used, the institutional review board of Xinhua Hospital, Shanghai Jiao Tong University School of Medicine deemed the study exempt from review., (© 2025. The Author(s), under exclusive licence to the International Pediatric Research Foundation, Inc.)

Impact Statement: Although there was an overall decreasing trend in the mean sodium intake and excess sodium intake, dietary sodium intake remained suboptimal in US youth., Competing Interests: Competing interests: The authors declare no competing interests. Ethical statement: NHANES was approved by the National Center for Health Statistics Research Ethics Review Board and written consent was obtained from participants’ parent. Because the data are publicly available and anonymized, institutional review board approval was not required for this study., (© 2025. The Author(s), under exclusive licence to the International Pediatric Research Foundation, Inc.)

Background: Trace elements (TEs) are essential nutrients for the human body and have a significant impact on fertility and hormone levels in women of reproductive age, underscoring the importance of understanding sociodemographic variations in their concentrations within this population., Objective: To investigate the socio-demographic factors influencing blood concentrations of four essential TEs, including iron, zinc, copper, and selenium among women of reproductive age., Methods: A cross-sectional analysis of women aged 20-44 years was performed using the National Health and Nutrition Examination Survey, 1999-2018. Serum iron data were analyzed for 9211 women across 10 cycles, while serum copper, zinc, and selenium data were available for 1027 women across 3 cycles. Generalized linear and logistic regressions examined the individual associations of socio-demographic factors, including age, race and ethnicity, education, and poverty index ratio, with iron, zinc, copper, and selenium concentrations treated as continuous and categorical outcomes, respectively. A qualitative heatmap explored the joint associations between the socio-demographic factors and the four essential TEs., Results: Reduced iron concentrations and increased risks of insufficiency occurred in older, Black, low-education, or low-income women. Black women were more likely to have lower zinc and selenium concentrations and an increased risk of zinc insufficiency but higher copper concentrations. The qualitative heatmap found that older, Black, low-education, and low-income women generally had lower concentrations of the four TEs, particularly iron (β = -0.10; p < 0.01)., Conclusions: Socially disadvantaged women are more likely to present with lower TE concentrations, and these specific population groups should be targeted by replenishment planning by public health initiatives.

Impact: There is variability in healthy behaviors among children and children from lower socioeconomic status households were less likely to exhibit healthy behaviors and maintain a healthy lifestyle., Competing Interests: Competing interests: The authors declare no competing interests. Ethical approval and consent to participate: Because publicly available anonymized data were used, the institutional review board of Xinhua Hospital, Shanghai Jiao Tong University School of Medicine deemed this study exempt from review., (© 2024. The Author(s), under exclusive licence to the International Pediatric Research Foundation, Inc.)

We reported a pediatric case of necrotizing pneumonia due to macrolide-resistant Mycoplasma pneumoniae, an uncommon presentation of a common disease. Acquisition of resistance does not increase virulence, but it leads to more difficult treatment and potential complications. Macrolide-resistant M. pneumoniae requires extended antibiotic therapy with the addition of a second-line agent and an immunomodulator to promote clinical improvement with minimal sequelae., (© 2024 Wiley Periodicals LLC.)

Mycoplasma pneumoniae (MP) is an important cause of community-acquired pneumonia in children and young adolescents. Despite macrolide antibiotics effectiveness as a first-line therapy, persistence of fever and/or clinical deterioration sometimes may complicate treatment and may even lead to severe systemic disease. To date, there is no consensus on alternative treatment options, optimal dosage, and duration for treating severe, progressive, and systemic MP pneumonia after macrolide treatment failure. Macrolide-resistant MP pneumonia and refractory MP pneumonia are the two major complex conditions that are clinically encountered. Currently, the vast majority of MP isolates are resistant to macrolides in East Asia, especially China, whereas in Europe and North America, whereas in Europe and North America prevalence is substantially lower than in Asia, varying across countries. The severity of pneumonia and extrapulmonary presentations may reflect the intensity of the host's immune reaction or the dissemination of bacterial infection. Children infected with macrolide-resistant MP strains who receive macrolide treatment experience persistent fever with extended antibiotic therapy and minimal decrease in MP-DNA load. Alternative second-line agents such as tetracyclines (doxycycline or minocycline) and fluoroquinolones (ciprofloxacin or levofloxacin) may lead to clinical improvement after macrolide treatment failure in children. Refractory MP pneumonia reflects a deterioration of clinical and radiological findings due to excessive immune response against the infection. Immunomodulators such as corticosteroids and intravenous immunoglobulin (IVIG) have shown promising results in treatment of refractory MP pneumonia, particularly when combined with appropriate antimicrobials. Corticosteroid-resistant hyperinflammatory MP pneumonia represents a persistent or recrudescent fever despite corticosteroid therapy with intravenous methylprednisolone at standard dosage., Conclusion:  This report summarizes the clinical significance of macrolide-resistant and refractory MP pneumonia and discusses the efficacy and safety of alternative drugs, with a stepwise approach to the management of MP pneumonia recommended from the viewpoint of clinical practice., What Is Known: • Although MP pneumonia is usually a benign self-limited infection with response macrolides as first line therapy, severe life-threatening cases may develop if additional treatment strategies are not effectively implemented. • Macrolide-resistant and refractory MP pneumonia are two conditions that may complicate the clinical course of MP pneumonia, increasing the risk for exacerbation and even death., What Is New: • This report summarizes the clinical relevance of macrolide-resistant and refractory MP pneumonia and discusses the efficacy and safety of alternative drug therapies. • A practical stepwise approach to the management of MP pneumonia is developed based on a comprehensive analysis of existing evidence and expert opinion., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: The association of sleep onset time and duration with cardiometabolic health is not well characterized., Methods and Results: This study included 6696 adults aged 20 to 80 years from the NHANES (National Health and Nutrition Examination Study) 2015 to 2018. Participants were categorized into 9 groups according to the cross-tabulation of sleep onset time (<22:00 [early], 22:00-23:59 [optimal], and ≥24:00 [late]) and duration (<7 hours [insufficient], 7-8 hours [sufficient], and ≥9 hours [excessive]), with optimal sleep onset time and sufficient duration as the reference. The primary outcomes included hypertension, hypertriglyceridemia, low high-density lipoprotein cholesterol, hyperglycemia, central obesity, and metabolic syndrome. Inappropriate sleep onset time and sleep duration were associated with increased odds of hypertension, hypertriglyceridemia, and metabolic syndrome, especially among participants aged 40 to 59 years. Compared with men reporting optimal onset and sufficient duration, men reporting optimal onset with excessive duration (odds ratio [OR]: 2.01 [95% CI, 1.12-3.58]) and late onset with insufficient duration (OR, 1.74 [95% CI, 1.13-2.68]) had higher odds of metabolic syndrome. Compared with women reporting optimal onset and sufficient duration, women reporting optimal onset and insufficient duration (OR, 1.61 [95% CI, 1.11-2.32]) and early onset and excessive duration (OR, 2.16 [95% CI, 1.30-3.57]) had higher odds of hypertension, and women reporting late onset and excessive duration (OR, 5.64 [95% CI, 1.28-6.77]) were at the highest odds of hypertriglyceridemia., Conclusions: Late sleep onset as well as insufficient or excessive sleep duration are associated with adverse cardiometabolic outcomes, particularly in participants aged 40 to 59 years.

Objective: To compare the clinical appearance of "no residual disease" to the histological assessment of the same tissue when treated with PlasmaJet®. To determine if the treated tissue with a clinical appearance of "no residual disease" demonstrated histologically apparent damage to underlying structures., Aim: The main aims of the study were to compare the clinical appearance of 'no residual disease' to the histological assessment of the same tissue and to assess whether treatment with PlasmaJet® to produce a clinical appearance of 'no residual disease' causes no histologically apparent damage to the underlying structures., Method: This prospective cohort study was conducted in Liverpool Women's NHS Foundation Trust between January 2019 and June 2020. Women with a diagnosis of advanced or presumed advanced stage ovarian cancer were approached and 20 women were recruited into the study. Tissue samples were collected from women with stage 3 or 4 ovarian cancer at either primary or interval debulking surgery., Results: The clinical appearance of no residual disease was confirmed histologically in 84 % (n = 16) of cases. Fat was the only underlying tissue seen damaged in 21 % (n = 4) of cases. Bowel resection with stoma formation was needed in one case (5.26 %)., Conclusion: PlasmaJet® ablated the malignant tissue in majority of the cases without causing any significant damage to the underlying tissue, it also reduced the need for stoma formation. This is a small study with encouraging results. PlasmaJet® could be a valuable tool in ovarian cancer surgery, it potentially could reduce the need for bowel surgery and allow treatment of significant mesenteric disease with reduced morbidity for the patient., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Competing Interests: Intérêts concurrents: Aucun déclaré.

Perfluoroalkyl substances (PFASs) constitute an environmentally persistent and widespread class of anthropogenic chemicals that have been used in industrial and commercial applications in the USA and around the world. Animal studies suggested its toxic impact on lung development, but the adverse effect of PFAS exposure on childhood pulmonary function has not been clearly determined. We investigated the potential cross-sectional association of environmental PFAS exposures with pulmonary function in 765 adolescents aged 12-19 years from the US National Health and Nutrition Examination Survey (NHANES) 2007-2012. Exposure to PFASs was estimated by measuring serum concentrations, and pulmonary function was assessed by spirometry. Linear regression and weighted quantile sum (WQS) regression were performed to estimate the associations of individual chemicals and chemical mixtures with pulmonary function. Median concentrations of PFOA, PFOS, PFNA, and PFHxS (detection frequencies > 90%) were 2.70, 6.40, 0.98, and 1.51 ng/mL, respectively. No associations were found between the four individual congeners and Σ 4 PFASs and the pulmonary function measures in total adolescents. Sensitive analyses were further conducted stratified by age (12-15 and 16-19 years) and sex (boys and girls). In adolescents aged 12-15 years, PFNA was negatively associated with FEV 1 :FVC (p-trend = 0.007) and FEF 25-75% (p-trend = 0.03) among girls, while PFNA was positively associated with FEV 1 : FVC (p-trend = 0.018) among boys. No associations were found among adolescents aged 16-19 years, either boys or girls. The aforementioned associations were confirmed when further applying WQS models, and PFNA was identified to be the most heavily weighing chemical. Our results suggested that environmental exposure to PFNA may affect pulmonary function among adolescents aged 12-15 years. Given the cross-sectional analysis and less consistent results, further replications of the association in large prospective cohort studies are warranted., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: We compared birth injuries for spontaneous vaginal (VD) and caesarean section (CS) deliveries in preterm and term pregnancies., Methods: A retrospective cohort study was conducted in a single tertiary center, between January 1st, 2007, and December 31st, 2017. The study included 62330 singleton pregnancies delivered after 24 0/7 weeks gestation. Multivariable analyses compared trauma at birth, birth hypoxia and birth asphyxia in term and preterm deliveries, stratified by mode of birth, VD versus CS. Main outcome measure was trauma at birth including intracranial laceration and haemorrhage, injuries to scalp, injuries to central and peripheral nervous system, fractures to skeleton, facial and eye injury., Results: The incidence of preterm deliveries was 10.9%. Delivery of preterm babies by CS increased from 37.0% in 2007 to 60.0% in 2017. The overall incidence of all birth trauma was 16.2%. When stratified by mode of delivery, birth trauma was recorded in 23.4% of spontaneous vaginal deliveries and 7.5% of CS deliveries (aOR 3.3, 95%CI 3.1-3.5). When considered all types of birth trauma, incidence of trauma at birth was higher after 28 weeks gestation in VD compared to CS (28-31 weeks, aOR 1.7, 95% CI 1.3-2.3; 32-36 weeks, aOR 4.2, 95% CI 3.6-4.9; >37 weeks, aOR 3.3, 95% CI 3.1-3.5). There was no difference in the incidence of birth trauma before 28 weeks gestation between VD and CS (aOR 0.8, 95% CI 0.5-1.2). Regarding overall life-threatening birth trauma or injuries at birth with severe consequences such as cerebral and intraventricular haemorrhage, cranial and brachial nerve injury, fractures of long bones and clavicle, eye and facial injury, there was no difference in vaginal preterm deliveries compared to CS deliveries (p > 0.05 for all)., Conclusion: CS is not protective of injury at birth. When all types of birth trauma are considered, these are more common in spontaneous VD, thus favoring CS as preferred method of delivery to avoid trauma at birth. However, when stratified by severity of birth trauma, preterm babies delivered vaginally are not at higher risk of major birth trauma than those delivered by CS., Competing Interests: The authors have declared that no competing interests exist.

Competing Interests: Competing interests: None declared.

Competing Interests: Competing interests: None declared.

Objective This retrospective cohort study analyzes risk factors for abnormal pre-pregnancy body mass index and abnormal gestational weight gain in twin pregnancies. Methods Data from 10 603/13 682 twin pregnancies were analyzed using uni- and multivariable logistic regression models to determine risk factors for abnormal body mass index and weight gain in pregnancy. Results Multiparity was associated with pre-existing obesity in twin pregnancies (aOR: 3.78, 95% CI: 2.71 - 5.27). Working in academic or leadership positions (aOR: 0.57, 95% CI: 0.45 - 0.72) and advanced maternal age (aOR: 0.96, 95% CI: 0.95 - 0.98) were negatively associated with maternal obesity. Advanced maternal age was associated with a lower risk for maternal underweight (aOR: 0.95, 95% CI: 0.92 - 0.99). Unexpectedly, advanced maternal age (aOR: 0.98, 95% CI: 0.96 - 0.99) and multiparity (aOR: 0.6, 95% CI: 0.41 - 0.88) were also associated with lower risks for high gestational weight gain. Pre-existing maternal underweight (aOR: 1.55, 95% CI: 1.07 - 2.24), overweight (aOR: 1.61, 95% CI: 1.39 - 1.86), obesity (aOR: 3.09, 95% CI: 2.62 - 3.65) and multiparity (aOR: 1.64, 95% CI: 1.23 - 2.18) were all associated with low weight gain. Women working as employees (aOR: 0.85, 95% CI: 0.73 - 0.98) or in academic or leadership positions were less likely to have a low gestational weight gain (aOR: 0.77, 95% CI: 0.64 - 0.93). Conclusion Risk factors for abnormal body mass index and gestational weight gain specified for twin pregnancies are relevant to identify pregnancies with increased risks for poor maternal or neonatal outcome and to improve their counselling. Only then, targeted interventional studies in twin pregnancies which are desperately needed can be performed., Competing Interests: Conflict of Interest The authors declare that they have no conflict of interest., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ).)

Background: Per- and polyfluoroalkyl substances (PFAS) are believed to impair early neurodevelopment and disrupt thyroid hormone (TH) levels. However, there are limited epidemiological data on the neurodevelopmental effects in infancy of prenatal PFAS exposure and the potential mediating effects of TH., Objectives: To evaluate potential associations between prenatal PFAS exposure and early neurodevelopmental deficiencies, and assess mediator effects of TH., Methods: From 2010 to 2013, 274 mother-infant pairs were recruited to the Laizhou Wan Birth Cohort in China. Ten PFAS and five TH were measured in cord serum. Developmental quotient (DQ) from 5 domains (adaptive, social, language, gross and fine motor) was assessed using Gesell Developmental Schedules for each child at 1 year of age. The associations between PFAS and DQs were evaluated using multivariable linear regressions. TH-mediated effects of PFAS on DQs were calculated by mediation analyses., Results: Among our study population, PFAS exposures were common and associated with DQ decrement in infants. For each 10-fold increase in PFBS concentrations, gross motor and adaptive DQ decreased by 8.56 (95%CI: -15.15, -1.97) and 5.87 (95%CI: -8.07, -3.67) points, respectively. TSH mediated 12.90% of the association of PFBS with gross motor DQ and FT4 explained 19.63% of the association of PFBS with adaptive DQ. The negative association was also found between PFHxS exposure and gross motor DQ (β = 8.14, 95%CI: -15.39, -0.98)., Conclusions: PFBS and PFHxS were negatively associated with early neurodevelopment, especially consistent in gross motor domain. The associations were partly explained by TSH and FT4., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background and Objectives: Acute urologic complications, including bladder and/or ureteric injury, are rare but known events occurring at the time of caesarean section (CS). Delayed or inadequate management is associated with increased morbidity and poor long-term outcomes. We conducted this study to identify the risk factors for urologic injuries at CS in order to inform obstetricians and patients of the risks and allow management planning to mitigate these risks. Materials and Methods: We reviewed all cases of urological injuries that occurred at CS surgeries in a tertiary university centre over a period of four years, from January 2016 to December 2019. To assess the risk factors of urologic injuries, a case-control study of women undergoing caesarean delivery was designed, matched 1:3 to randomly selected women who had an uncomplicated CS. Electronic medical records and operative reports were reviewed for socio-demographic and clinical information. Descriptive and univariate analyses were used to characterize the study population and identify the risk factors for urologic complications. Results: There were 36 patients with urologic complications out of 14,340 CS patients, with an incidence of 0.25%. The patients in the case group were older, had a lower gestational age at time of delivery and their newborns had a lower birth weight. Prior CS was more prevalent among the study group (88.2 vs. 66.7%), as was the incidence of placenta accreta and central praevia. In comparison with the control group, the intraoperative blood loss was higher in the case group, although there was no difference among the two groups regarding the type of surgery (emergency vs. elective), uterine rupture, or other obstetrical indications for CS. Prior CS and caesarean hysterectomy were risk factors for urologic injuries at CS. Conclusions: The major risk factor for urological injuries at the time of CS surgery is prior CS. Among patients with previous CS, those who undergo caesarean hysterectomy for placenta previa central and placenta accreta are at higher risk of surgical haemostasis and complex urologic injuries involving the bladder and the ureters.

Rationale: Although bronchiectasis is conventionally considered a chronic pulmonary disease of adulthood, knowledge of pediatric bronchiectasis not related to cystic fibrosis started to emerge. Limited information in this field is available and the management is based on expert opinion., Patient Concerns: An 8-year-old girl admitted for 7 days history of wet cough, purulent fetid sputum, shortness of breath and low-grade fever. The wet cough has presented for the past 4 years, during which she had frequent hospitalization for recurrent lower respiratory tract infections., Diagnosis: Chest high-resolution computerized tomography revealed diffuse bronchial dilations accompanied by inflammation in the bilateral lung fields. Microbiologic investigation for bronchoalveolar lavage fluid was positive for Pseudomonas aeruginosa., Interventions: With a working diagnosis of bronchiectasis with secondary pulmonary infection, sensitive cefoperazone-sulbactam was administrated for 14 days with gradual improvement of clinical symptoms. Bronchoscopy washing substantially soothed the symptoms, reducing the cough and sputum volumes., Outcomes: The child was discharged after 14 days, and treated on long-term prophylactic antibiotic use (amoxicillin-clavulanic acid, 20 mg/kg/d, ≥ 4 weeks)., Lessons: Although bronchiectasisis are condition in childhood, the diagnosis is suspected in children with persistent wet or productive cough, and should be confirmed by a chest high-resolution computerized tomography scan. Antibiotics and airway clearance techniques represent the milestones of bronchiectasis management although there are only a few guidelines in children.

Foreign body (FB) aspiration is a common and serious problem in childhood as it requires early recognition and treatment to avoid potentially lethal consequences. This study aimed to characterize the clinical and epidemiological features of airway FBs in a pediatric Chinese population.A retrospective review of medical records of children aged 0 to 14 years who attended with a diagnosis of FB aspiration the Shanghai Children's Hospital between January 2013 and December 2017 was carried out. Descriptive analysis was used to assess patient's demographics, clinical, radiographic, bronchoscopic findings, time to presentation, and characteristics of the FBs.Among the 200 patients included in the study, 92% were under 3 years of age, with a peak incidence of FB aspiration occurring between 1 and 2 years old. The male to female ratio was about 2.6:1. Twenty-three percent of the patients were admitted within 24 hours of the event, 40% within 1 week, 30% within 1 month, and 7% more than 1 month after aspiration. The most common presenting symptoms of laryngotracheal FBs were cough, dyspnea, and wheezing; those of bronchial FBs were cough, decreased air entry, and wheezing. Chest X-ray was normal in four-fifths of the children with laryngotracheal FBs, whereas most common abnormal X-ray findings in children with bronchial FBs were mediastinal shift, obstructive emphysema, and pneumonia. There was a trend that in children younger than 2 years FBs were more frequently found in the left bronchus, whereas in older children FBs were more frequently found in the right bronchus. Ninety-three percent of the removed FBs were organic materials such as food items and the most frequently aspirated FBs were peanuts. Flexible bronchoscopy was performed in 82.5% of the patients, while rigid bronchoscopy or direct laryngoscopy in 17.5% of the patients. Four patients were subjected to thoracic surgery and 1 died during rigid bronchoscopy due to acute respiratory failure.FBs is a frequent pathology among Chinese children. Tracheobronchial FBs should be strongly suspected in young children who have sudden onset of cough and wheezing episode, even when physical and radiographic evidence is absent.

Background: The Chinese postpartum custom of "doing the month" characterized by generous social support available through the traditional cultural practices was considered to protect women from postpartum depression in early puerperium., Methods: This study used data from the Shanghai Birth Cohort, a study of 2615 postpartum women from Shanghai, China, that was conducted between 2013 and 2016. Detailed information on the traditional "doing the month" practices and the on the Edinburgh Postnatal Depression Scale scores was collected from questionnaires administered on the 42nd day after childbirth. Logistic regression models were used to examine the association between the adopting traditional puerperium practices and postpartum depression., Results: The estimated prevalence of postpartum depression in women from the Shanghai area in China was 11.8% (n = 308) at six weeks postpartum. Women who went outside their homes during the first month postpartum showed higher risks of postpartum depression compared with those who never left the house (1-2 times: OR = 1.9, 95% CI = 1.4-2.4; 3-5 times: OR = 2.3, 95% CI = 1.5-3.5; ≥6 times: OR = 2.5, 95% CI = 1.2-5.1). Women with average sleep of 6 h or less per night were more likely to suffer from postpartum depression compared with those who slept 8 h (6 h: OR = 1.7, 95% CI = 1.2-2.4; less than 6 h : OR = 3.3, 95% CI = 2.2-5.0). Women who opened the house windows most of the time exhibited decreased risks of postpartum depression compared to those who never or rarely opened the windows (often: OR = 0.6, 95% CI = 0.4-0.9; always: OR = 0.4, 95% CI = 0.3-0.7)., Conclusions: Our results suggested that not all the activities of "doing the month" provided protection against developing PPD. This study emphasized the need for flexibility to fit and adjust the ritual into the modern life to enhance the positive effects of traditional practices on maternal health., (Copyright © 2019 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.)

Active living is relevant for healthy child development and disease prevention. In 2011-2012 new Canadian Physical Activity and Sedentary Behaviour Guidelines were developed for children under four and 5-17 years of age. This cross-sectional study assessed children's adherence to the national guidelines, using a large sample of Alberta children ages 2-4 and 5-13 years in 2013. The proportions of children achieving the average daily duration of physical activity and screen time recommended were determined, and child and parental predictors of non-achievement were identified. Participants were 631 parent and child dyads. Data were collected by parental reports of physical activity and screen time during weekdays, and analysed using univariate and multivariate techniques (p < 0.05). Logistic regression models were used to examine factors associated with children's non-achievement of physical activity and screen time recommendations while adjusting for covariates. Sixty-two percent of children aged 2-4 and 26% of children aged 5-13 did not meet physical activity time recommendations, and 64% of children aged 2-4 and 23% of children aged 5-13 exceeded the maximum screen time recommendation. Several associations between parental age and education with non-achievement were observed but associations were not consistent across age groups or behaviours. Among preschoolers, those with middle-age parents were more likely to not achieve physical activity recommendations. Evidence of high non-achievement of the recommendations among children 2-4 years highlights the need for increased programming targeting preschool children. Further research is required to identify modifiable risk factors that may inform future health promotion efforts.