Ms 6.4 earthquake. Results show that the LURR time sequence fluctuated around 1.0 for many years and reached significant high peaks at the beginning of 2020. More importantly, this evolution correlates well with the LURR time series calculated by using the Benioff strain of small earthquakes within the circular region of 300 km radius centered at the epicenter. The underlying physics of the changes should be caused by the fluid infiltration derived from pre-seismic rock dilatancy. The corresponding volume variations in the crust could be found in the geophysical observation time series in the same neighborhoods.The observation of electromechanical coupling might be used as an important tool to detect pre-seismic changes associated with the preparation of earthquakes. This paper attempts to study the electromechanical coupling process before the large earthquakes by using the load/unload response ratio (LURR) approach in which the geo-electric data and Benioff strain of small earthquakes were adopted as the data input. The variation of Coulomb failure stress induced by earth tides on the fault surface of the mainshock is applied to differentiate the loading and unloading stages. Using this technique, we test the geo-electric data recorded at the Hotan observatory near the epicenter of 2020 Yutian  Since Sobolev in 19752 reported the abnormal change of ground electric current before Kamchatka earthquake, VAN group from Greece also has carried out a series of observations and studies on the abnormal variation of geo-electric field3. Moreover, they reported that the Seismic Electric Signal (SES) has been extracted from the continuous geo-electric field data by them, which triggered a series of discussions in the field of earthquake prediction4. In order to explain the electric field changes prior to earthquakes, scientists have proposed many hypotheses, such as electrokinetic effect, seismoelectric effect, piezoelectric effect, etc., but there is still no unified view6.In recent decades, some geophysical observation data have recorded the abnormal variations of electromagnetic field in the seismogenic region prior to earthquakes7. Corwin and Morrison8 investigated the medium-to-short-term pre-seismic variations in electric field  preceding two earthquakes in central California. Zhao and Qian9 detected the impending-earthquake precursors in geo-electric data before the Tangshan main shock of 1976 in China. Sarlis10 analyzed the statistical significance of earth’s electric field variations in Greece and Japan. From these studies, however, it is difficult to construct the physical correlation between the geo-electric anomalies and earthquake.Presently, the observations of pre-seismic anomalies are mostly obtained by using the statistical approach from the observation of the original curve11 have found that the Load/unloading response ratio (LURR) might be applied to explore nonlinear mechanical process associated with earthquake preparation via groundwater level and the pre-seismic changes were explained by dilatancy. This may provide an opportunity for detect pre-seismic electric field changes. The LURR approach was firstly devised by Yin et al.12 in 1995 and widely applied to retrospective earthquake prediction practices15. The variation of LURR reflects the dynamical changes of stress state of a rock system . The epicenter was located at the eastern end of the West Kunlun Orogenic belt at the junction of the Northwest Tibetan Plateau and Tarim Basin near the southwest end of the Altun Tagh fault zone, which is the east branch of Ashikule fault , an 24. These fault zones mainly consist of left-lateral strike-slip faults. However, in the western margin of the plateau, the Indian plate has subducted under the Eurasian plate in the Pamir area, and it has reached the central plains in terms of earthquake depth. Therefore, the NNW-trending Karakoram fault is a dextral strike-slip fault.The Indian plate subducts in a northward extrusion toward the Eurasian plate, and the ancient rock mass pushes under the block of Tarim Basin causing crustal shortening and uplift of the Qinghai–Tibet Plateau. The lower crust material is dragged eastward and this causes the formation of internal east–west tension, a south–north compression stress environment, and movement from the east to the extrusion, resulting in inhomogeneity in the plateau. Strike-slip faults with a dominant direction of thousands of kilometers are caused, resulting in several fault zones such as the Altun Tagh, Kunlun, and Karakax1,O2 and potential electrodes A1, A2, B1, B2), so Hotan observatory can produce six channels of observation data. The specific length of each distance electrodes is shown in Table Hotan observatory is located at the northern foot of the Kunlun Mountains and the southern edge of the Taklimakan Desert, which can provide geophysical observation data for the study of the tectonic movement of the Qinghai-Tibet block. A ZD9A-II geo-electric field monitoring system,with an orthogonal “L” shape array including three direction , is installed at the observatory. Each measurement direction includes long and short distance electrodes  caused by solar and lunar tidal forces on the seismic fracture plane. We used Benioff strain and Hotan electric field observation data as response variables to calculate LURR anomaly evolution characteristics and regional stress field variation before the occurrence of the earthquake in the source region, respectively.P and R represent load and response respectively, the response rate X can be rewritten as:R represents the change in response R caused by the load variable ΔP. When the strength a medium to withstand is much greater than the load, Assuming  E and its related parameters as response quantity as follows:Ei represents seismic energy, "+" and "−" represent loading and unloading respectively. m can be 0, 1/3, 1/2, 2/3, or 1. When m = 1, Em represents seismic energy. When m = 1/3 or 2/3, Em represents the linear and plane scales of the seismogenic region, respectively. When m = 1/2, Em represents the Benioff strain. When m = 0, the Y value corresponds to the number of earthquakes occurring during the loading and unloading process.The traditional LURR based on seismic energySince the geo-electric field observation data are vector observations, the average value of the absolute values of electromagnetic observation data within a period of time is taken as the response quantity, and the LURR is defined as:Ei represents the geo-electric field data with a period of 8 ~ 24 h in the time period. N+ and N− represent the number of geo-electric data in the loading and unloading stage in a calculation time window respectively. To avoid the strong fluctuation of LURR time series caused by too few earthquakes, the calculation time window usually contains multiple loading and unloading cycles.In Eq. , Ei reprMs 6.4 earthquake in the Xinjiang region of northwest of china compared with traditional LURR based on Benioff strain release. The raw data of geo-electric field in Hotan observatory were displayed in Fig. As a retrospective study, we apply the LURR approach to the geo-electric field near the Yutian Ms 6.4 earthquake based on the Benioff strain as response quantity. Data are from the earthquake catalog of CENC. Specific calculation parameters are as follows: the duration of the catalog was from June 1, 2015 to December 31, 2020, and the Benioff strain (m = 1/2) for small earthquakes with a magnitude of 0–4.0 within a radius of 300 km from the epicenter was used as the response quantity. Results show that there was no significant anomaly in the Yutian area from 2016 to 2018 . The time window is 0.5 year and the spatial window 80 km radius which slide at a step of 0.25degree in both longitude and latitude. The internal friction coefficient used to evaluate CFS is 0.4 and the value of LURR greater than 1.0 is plotted at the center location by using the 2D bilinear interpolation of Matlab.In Fig. The results showed that there was no significant anomaly in Yutian region in the second half of 2019 Fig. a, but th26, GNSS  at MIT (GAMIT)/Global Kalman filter (GLOBK)29 of the GPS velocity field associated with mainland China. Results show that the directions of the GPS velocity field within 200 km in the south and 300 km in the north of the profile are in NNE and NNW or N directions, respectively  and the expansion is full in the seismic zone.34, the number of cracks generated in the rock experiment at this stage was significantly higher than that in the unloading stage (Fig. 36.LURR of geo-electric field is based on the premise that the expansion of rock volume caused by the cracks generated in critical state of earthquake can change geo-electric field near the focal area. In particular, new cracks were not generated in the solid medium during the loading and unloading process, the number of cracks remained unchanged Fig. a, and thage Fig. c. At theage Fig. d. Theref37. Anomalous changes in the electric field often occur in the late seismogenic stage38, and hence, the peak value of electric field anomaly may be later than that of the LURR of the Benioff strain as the response quantity.Our calculation results display that the LURR has very significant prediction value. As shown in Fig. By calculating the ratio between the geo-electric field during the loading and unloading phase induced by earth tides, we found that this approach might detect the electromechanical coupling process preceding the occurrence of a large earthquake. For Yutian 6.4 earthquake in Xinjiang region, the LURR value of four geo-electric field observation channels exceed 1.02 and the anomalies can last several months. These changes might be caused by infiltration of fluids in the pre-seismic dilatancy. Comparing the LURR time series derived from the Benioff strain and geo-electric data, the significant electromechanical coupling process can be observed prior to the final mainshock. Combination of geodetic time series, we can eliminate more interference information for detecting the upcoming large earthquake. Although more data testing is needed to approve the approach, the results of this paper show that geo-electric field could be used as a feasible physical field to evaluate seismic hazard.


To examine the association between gestational age, telomere length (TL) and rate of shortening in newborns.Genomic DNA was isolated from buccal samples of 39 term infants at birth and one year and 32 preterm infants at birth, term-adjusted age (40 weeks post-conception) and age one-year corrected for gestational duration. Telomere length was measured by quantitative real-time PCR. Demographic and clinical data were collected during clinic or research visits and from hospital records. Socioeconomic status was estimated using the deprivation category (DEPCAT) scores derived from the Carstairs score of the subject’s postal code.At birth, preterm infants had longer telomeres than infants born at term. However, there was no difference in telomere length between preterm infants and term infants at one year of age, implying that the rate of telomere shortening was greater in pre-term than term infants. Interestingly, TL at age 40 weeks post-conception in preterm infants was significantly longer than term infant TL at birth, suggesting that time since conception is not the only factor that affects rate of shortening. Several factors, including sex, fetal growth restriction, maternal age, maternal booking body mass index (BMI), mother education level and DEPCAT score, also differed between the preterm and term groups.Preterm infants have longer telomeres than term infants at birth. In the studied cohort, the rate of telomere shortening was greater in the premature group compared with the term infants. This finding agrees with previous studies using cord blood, suggesting that the longer TL in premature infants detected at birth do not persist and demonstrating that use of saliva DNA is acceptable for studies of telomere dynamics in infants. However, that the TL at age 40 weeks post-conception in preterm is longer than term infants at birth suggests that biological factors other than time since conception also affect rate of shortening. Preterm birth is defined by the World Health Organization as birth before 37 completed weeks of gestation . BetweenTelomeres are repetitive DNA sequences (TTAGGG repeats) located at the ends of chromosomes . In mostet al. [et al. [Studies of TL in preterm infants suggest that preterm infants have longer telomeres than term infants and that telomere shortening is more rapid in preterm infants than term. Friedrich et al.  observed [et al.  found thThe current study extends these findings by measuring telomere length of buccal DNA from a cohort of preterm infants (n = 32) collected at birth, term age, and one year and term infants (n = 39) at birth and one year. We compared maternal and birth characteristics, socioeconomic and health factors, telomere length and telomere length shortening between the two groups and within groups. To our knowledge, this is the first study to compare telomere length from buccal samples in preterm and full-term infants at these time points and longitudinally.p < 0.05) and the preterm infants had lower birth weight Z-scores indicating fetal growth restriction (p < 0.05). Neither paternal age nor incidence of identified maternal chronic illness differed between the term and preterm groups. The average age of the mothers of preterm infants was 31.6 years and of term infants was 35.3 years  -6.3 to -1.3, p = 0.004). The mothers of preterm infants had a higher body mass index (BMI) > 30; p = 0.009). Of mothers of preterm infants, 31.4% smoked cigarettes during pregnancy compared with 5.1% of mothers of term infants (p = 0.004). Mothers of term infants were more likely to have attended post-secondary school (p < 0.001), and to live in a postal code sector ascribed a deprivation category score (DEPCAT) greater than or equal to 3 .Saliva samples were obtained for telomere length analysis from 35 preterm infants and 39 term infants. The maternal and infant characteristics differed between the two groups . There wp < 0.005, n = 36 and 23, respectively for term and preterm infants; p = 0.022, n = 36 and 31, respectively for term and preterm infants). The difference between telomere length at birth and term-adjusted age for the preterm infants was not significant . By one year corrected full term age, however, telomere lengths between the term and preterm groups were no longer significantly different  and term (n = 30) infants) and post-natal telomere shortening was more rapid in the preterm group , this is not the case when using the birthweight z-score , suggesting that the correlation between birth weight and TL is due to the very high correlation between GA and birthweight. The correlation between the telomere length at birth and one year for all infants was 0.55 . This was likely driven by the term infants because the correlation between telomere length at birth and one year of age for term infants was 0.634  but was lower  and not statistically significant (p = 0.126) in preterm infants.Telomeres were significantly shorter in both the term and the preterm groups at one year of age compared with birth (p = 0.029 n = 56). Maternal chronic illness was associated with shorter telomeres at birth if analysis was limited to preterm infants . and remained associated after adjusting for gestational age . This was not observed if analysis was limited to term infants . The age of the mothers of preterm infants at birth was positively associated with telomere length at birth  and term-adjusted age . These results were robust to adjustment for gestational age . Maternal age also remained significantly associated with telomere length at birth and corrected term-adjusted age after including maternal chronic illness  or maternal education in the models . The full models for TL at birth or term-adjusted age in preterm infants are shown in z-scored birth weight was used in lieu of gestational age , maternal chronic illness was significantly associated with shorter telomeres at birth when analysis was limited to preterm infants . Maternal chronic illness remained marginally associated with shorter telomeres at birth after adjusting for gestational age  or z-scored birth weight .Preterm infants had longer telomeres at birth than term infants. After adjusting for gestational age across the entire cohort, maternal chronic illness was negatively associated with telomere length at birth . Lower birthweight was associated with longer telomeres , but this was not observed when z-scored birthweight was used .Statistically significant associations between the variables examined and TL at age one were only observed for the preterm group. Gestational age was negatively associated with telomere length  nor Henckel et al. (2018) found statistically significant differences in telomere length measured from samples taken approximately at age 10 or 14.9 years, respectively. Indeed, in our study, the difference in telomere length between the samples collected at one year of age did not differ between the term or preterm groups in this study. The sample size was sufficient to detect longer telomeres in the preterm group at birth (term), term-adjusted (preterm) or one year at a medium effect size d (0.65) with a 5% Type I error and power of 0.80. While this is not the first study to examine telomere length in buccal samples from preterm infants [A few studies have compared differences in telomere length in groups of children or adolescents born prematurely or at term , 62. Nei infants , this iset al. [et al. [Evidence suggests that the intrauterine environment influences newborn TL and our study confirms that maternal health is associated with TL among preterm but not (in our study) in term births. TL in cord blood from infants born to mothers experiencing high psychosocial stress during pregnancy were shorter than infants born to low-stress mothers –66. Anotet al.  and Okud [et al. . This fiAdditional research examining the relationship between environment and TL in neonates, especially those born prematurely, is needed. Although still relatively small, our study consists of one of the largest cohorts with TL measured longitudinally at birth and one year for term and preterm infants and term-adjusted age for preterm infants. Our findings indicate more rapid TL shortening in preterm infants, perhaps reflecting that birth occurred prior to a late term burst of growth and cellular replication. Future research should aim to identify the biological processes behind these findings.A cohort of 50 preterm infants (< 32 weeks gestation) and 40 term control infants (37–42 weeks gestation) were recruited during the first week of age from the Simpson Centre for Reproductive Health, Edinburgh, UK Royal Infirmary of Edinburgh as previously described . Most ofSaliva for DNA was collected from the preterm infants at birth; at term-adjusted age); and at one year corrected; and from term infants at birth and one year of age. Samples were collected from preterm infants within a median of 3 days (interquartile range (IQR) of 1.75–4 days from birth) and term infants within a median of 2 days (IQR of 1–2.3 days) from birth. Saliva was collected using the Oragene DNA (OG-250) kits and saliva sponges CS-1 and extracted using prepIT-2LP . DNA was quantified using the Qubit 2.0 Fluorometer  and stored at -20°C until received by the Notterman laboratory, where it was stored at -80°C.16 and a 79-mer containing sequence from the 36B4 gene were used to construct standard curves to determine absolute telomere length and number of diploid genomes copies, respectively. TL and single copy gene qPCR assays were performed on separate plates. Each sample was assayed in triplicate and the results averaged. Individual TL was determined by dividing the telomere length per genome by 92, the number of telomeres per diploid genome. Each plate contained DNA from a cell line with a relatively short telomere length (3C167b) [TL was measured by absolute quantitative real-time PCR (qPCR) –75. Two (3C167b)  and a fi(3C167b) . These w(3C167b) , 74. Hum(3C167b) , 74. ThePower analysis was performed with G*Power version 3.1.9.6 , 79 and S1 Table(DOCX)Click here for additional data file.S2 Table(DOCX)Click here for additional data file.S3 Table(DOCX)Click here for additional data file.S4 Table(DOCX)Click here for additional data file.S5 Table(DOCX)Click here for additional data file.


Data from the China Neonatal Network currently shows that the survival rate of very preterm infants in China has improved in recent years. However, due to the unequal economic and medical development of each city in China, the national data do not completely represent the level of neonatal care in the metropolitan areas. Though many studies have published their short- or long-term survival, very few have described the care practices and the course of stay of these neonates in detail. Our objective was to examine the survival and clinical practices among preterm infants born at <24 weeks’ gestational age (GA) in a high-income city in China, from 2015 to 2021.Retrospective study of preterm infants <24 weeks GA in a level 3 neonatal intensive care unit in China, over a period of 7 years (2015–2021). Care practices in neonatal intensive care units (NICU) and short- and long-term survival were measured.OR = 2.007, 95% CI, 1.031 to 3.906, P < 0.05) increased the risk of death, while the increase in gestational age , antenatal use of steroids , and premature rupture of membranes  could decrease the risk. No or mild neurodevelopmental impairment in surviving infants was 76.9% (10 of 13).A total of 32 periviable infants were included, with a median GA of 23.0 weeks and mean (SD) birth weight of 497 (94) g; 17 infants (53.1%) were female. While none of the infants born at 21 weeks of gestation survived until discharge, the survival rates were 25.0% (3 of 12) for infants born at 22 weeks and 58.8% (10 of 17) at 23 weeks. Antenatal corticosteroids were used in 56.3%, and 100% were vaginal birth. In the delivery room, surfactant was prescribed for 46.9% of the infants, and postnatal dexamethasone (≥2 courses) was prescribed to 61.5% of the infants. Logistic regression analysis showed that Apgar score at 5 minutes (Although the survival rate of periviable infants was shown to be improved in our study, there is still much room for improvement, and active follow-up information should be conducted. According to the current definition of premature birth in China, babies who are born below 28 weeks of gestational age (GA) are defined as aborted babies, not infants . With adThis retrospective cross-sectional study was carried out at the neonatal intensive care unit (NICU) of the Shenzhen Maternity & Child Healthcare Hospital. This unit has 72 incubators, serves as a level III NICU with approximately 1,500 newborn admissions per year, and is one of the largest perinatology centers in Shenzhen city, China. This is a retrospective observational study evaluating neonates of gestational ages <24 weeks born at the Shenzhen Maternity & Child Healthcare Hospital over a 7-year period from 1 January 2015–31 December 2021.Neonates who died in the delivery room were excluded from the analysis. The gestational age was determined by the best obstetric estimate based on the first obstetric ultrasound and the first day of the last normal menstrual period. Morbidity and mortality rates were retrieved from the hospital discharge records.The Shenzhen Maternity and Child Healthcare Hospital Institutional Ethical Committee approved the collection and usage of the clinical information for research purposes and waived the requirement for informed consent [SFYLS No. (2019)-119].All data related to the neonatal period, including sociodemographic characteristics and obstetric characteristics  were retrieved from the medical records of the NICU. The characteristics of neonates, i.e., sex, birth weight (BW), GA, surfactant treatment, ventilation mode, patent ductus arteriosus (PDA) and early onset neonatal sepsis, intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), bronchopulmonary dysplasia (BPD), and retinopathy of prematurity (ROP) were recorded. All infants were examined by cranial magnetic resonance imaging (MRI) at post menstrual age (PMA) 37–40 weeks. All infants survived to discharge were followed up after discharge.Antenatal steroid treatment was considered if at least one dose of dexamethasone was given 12 h before delivery. Survivors were defined as neonates who survived to the time of discharge. BPD was defined as oxygen dependency at 36 weeks of corrected age . IVH werU-test was applied for comparisons between two groups. Pearson's χ2 test or Fisher's exact test was applied in analyses of categorical variables. After adjustment for some possible confounding factors, the risk factors for mortality of periviable infants were evaluated using multiple logistic regression. In all analyses, P < 0.05 was taken to indicate statistical significance. The analysis was performed using SPSS statistical software version 26.0 .Continuous variables of normal distribution were expressed as the mean (±) standard deviation, and T-test was used for comparison between groups; categorical variables are expressed as number of cases and percentages. In analyses of abnormally distributed data, median  was used, and the Mann–Whitney +0–23+6 gestational age and admitted to NICU for active care were included in the study . All infants were born by vaginal and 18 (56.3%) of the infants were exposed to antenatal corticosteroids. There was a statistically significant difference in the antenatal steroid treatment, preterm premature rupture of membrane (pPROM) rates, and Apgar score at 1 min between survivors and nonsurvivors (P < 0.05). The baseline characteristics of the enrolled neonates are summarized in A total of 32 neonates born at 21While none of the infants born at 21 weeks of gestation survived until discharge, the survival rates were 25.0% for infants born at 22 weeks and 58.8% for those born at 23 weeks. A total of 13 infants survived (40.6%), and 13 of 21 (61.9%) who received active care survived. Eight of these 32 infants died on the first day, 6 died between days 1 and 7, 2 died between days 7 and 27, and 3 died between days 28 and 65. Of the infants, 15 (46.9%) used a surfactant in the delivery room. Of the survivors, two (15.4%) were classified as having severe IVH (grade 3 or 4), five (38.4%) had ROP (stage ≥3), and 10 (76.9%) had BPD. The percentages of infants who had NEC (Grade ≥2) at 22 and 23 weeks of gestation were 25.0% and 11.1%, respectively. Three infants used oxygen after discharge in total. Care practices and morbidities for the infants according to gestational age are shown in OR 0.287, 95% CI, 0.106–0.778, P < 0.05). On the other hand, survival was predicted by the Apgar score after 5 min  and preterm prelabor rupture of membranes   .The survival rate was higher during 2020–2021 (52.6%) than during 2015–2019 (23.1%). Follow-up data with assessments at October 20, 2022, were collected for 13 infants. The proportions of motor retardation and speech delay in the evaluated infants were lower during 2020–2021 than during 2015–2019, whereas the proportion of blindness increased since one infant suffered from retinal hemorrhage .In our single-center retrospective study, the survival rates of the periviable births <24 weeks was 40.6%, and considering active treatment was 61.9%. They are similar to that reported in Japan  ; howeverSuch variations may be associated with differences in willingness to provide active obstetrical and neonatal care for infants at the lowest GA. Infants that were born during the 22nd week of gestation had received resuscitation and active treatment after birth, so it is in the United States , 13. In Differing clinical practices also contribute to the variability in survival rates.Isayama  reportedThe lower rate of NEC in our center than others reported , 13 coulTo our knowledge, hypothermia is a common problem, especially if delivered with less than 28 weeks gestation, which was associated with the increase of neonatal mortality and morbidities . The meaThe main strength of our study is that it had reported in detail the various clinical practices related to the neonates born <24 weeks and discussed the differences between our practices and those reported, which has rarely been addressed before. In addition, it had tried to explore the various risk factors for mortality, and more importantly, it shows the short- and long-term outcomes of these neonates. However, this study has its limitations. It was a retrospective study and had not reported on the stillbirth rates and delivery room deaths. A relatively small sample size might result in imprecise estimates.Survival rate and clinical practices in this study differed from other centers. The data presented here provide evidence that a series of clinical improvement measures in the early postnatal life might have helped improve the survival rate of periviable infants. Although the survival rate of periviable infants was shown to be improved in this study, there is still much room for improvement.


PLR had the second-highest AUC value (0.682) and the best score in terms of sensitivity (70%) and sensibility (69%) . Lastly, MLR had the lowest significant AUC score (0.607) and lowest sensitivity/sensibility. The significant cut-off values for the inflammatory scores were 9.0 for NLR, 9.8 for dNLR, 250 for PLR, and 4.07 for MLR. After evaluating the importance of these inflammatory scores, further clinical applications should be conducted to confirm the results and improve therapy and care to reduce the burden of premature deliveries.In many countries, preterm birth, defined as birth before 37 completed weeks of gestation, is the primary cause of infant death and morbidity. An increasing body of research suggests that inflammation  plays a significant role in inducing preterm labor or developing pregnancy problems that lead to premature birth. Consequently, the purpose of this research was to determine the predictive value of the Neutrophil-Lymphocyte Ratio (NLR), derived Neutrophil-Lymphocyte Ratio (dNLR), Monocytes-to-Lymphocyte Ratio (MLR), Platelets-to-Lymphocyte Ratio (PLR), Systemic immune-inflammation index (SII), and systemic inflammatory response index (SIRI), for premature delivery. A retrospective study analyzed a total of 243 eligible pregnancies that resulted in a preterm birth during 2020 and 2021. A control group without a history of preterm birth was matched by age and trimester of laboratory analysis at a 1:1 ratio. Although the number of comorbidities was similar among study groups, the body-mass index estimated for the week of gestation was significantly higher among the patients from the prematurity group, as well as the prevalence of urinary tract infections and smoking. Laboratory data showed that patients with a preterm birth had significantly higher white blood cell count and monocytes, but significantly lower lymphocytes, platelets, and hemoglobin. The NLR, dNLR, PLR, and MLR scores showed to be significantly higher among patients from the prematurity group, but SII and SIRI were not significantly different between the study groups. It was observed that the AUC values of NLR, dNLR, PLR, and MLR were higher than 0.600, respectively NLR had the highest value among the tested scores (AUC = 0.694) and the highest sensitivity in this study (71%). The highest sensibility was achieved by dNLR, with 70%, and an AUC value of 0.655 ( Preterm birth, defined as the onset of birth before 37 weeks of gestation, is a significant difficulty in obstetrics due to an estimated risk of 5 to 15 percent of all pregnancies resulting in preterm birth, which imposes a high cost on healthcare mostly owing to prolonged hospitalization, increased number of investigations performed, neonatal morbidity and death ,3,4. In Preterm birth might be medically induced owing to maternal or fetal indications, but about 70% occur spontaneously for no obvious reason . The prePredictive scores and forecasting tools have been widely implemented to aid in physicians’ decision-making processes by calculating the risk of a patient developing various outcomes ,16,17,18The research was conducted as an observational study at the Department of Obstetrics and Gynecology from the Victor Babes University of Medicine and Pharmacy in Timisoara, Romania. The study was designed as a retrospective cohort, with a data collection period spreading from the 1st of January 2020 until the 31st of December 2021. The study was approved by the Ethics Committee of the “Victor Babes” University of Medicine and Pharmacy and by the Ethics Committee of the Timisoara Municipal Hospital as the administrating institution of the patient database, being approved on the 19th of May 2022 with the code E-2814. The current study aimed to analyze pregnant women with a history of preterm birth; therefore, we screened for all preterm births that occurred during the study period and included the adult patients that gave consent for data analysis with complete personal records. Incomplete digital or paper records, missing laboratory analysis, lack of consent, and underage patients were excluded from the study. Cases that presented with infections and inflammatory diseases were excluded from the study to avoid confounding factors. Other exclusion criteria comprised the use of anti-inflammatory and corticosteroid therapy during the sampling period, that might influence the biological parameters of the pregnant women and the computed inflammatory scores.Using a convenience sampling method, it was determined for a 99% confidence level, a margin of error of 5%, and a population proportion of 10% premature births in the population of women of reproductive age, that a sample totaling 240 patients provides the minimum requirements for sufficient statistical power. Besides the reference group of pregnant women who gave birth prematurely, a control group without a history of preterm birth was matched by age and trimester of laboratory analysis at a 1:1 ratio and included in the current study for comparison, having the same inclusion criteria . Premature birth was defined as a birth that occurred before 37 weeks of gestation, according to the World Health Organization guidelines . The inft-test. A Kaplan–Meier curve was plotted for the probability of prematurity, while the Cox regression identified the hazard ratio for prematurity. A multiple logistic regression analysis was performed to calculate the risk (OR) for prematurity using the NLR, PLR, MLR, SII, and SIRI as predictors, adjusted by variables with significant differences between the two study groups. Using the receiver operating characteristic (ROC) curve approach, the prediction performance of the risk of preterm birth was evaluated by calculating the area under the curve (AUC) and its associated significance value. Using Youden’s index, the appropriate cut-off values for inflammatory indices were calculated.The statistical analysis was performed with IBM SPSS v.27 , while the significance threshold was set for an alpha value of 0.05. The absolute and relative frequencies of categorical variables were computed and compared using the Chi-square and Fisher’s tests. The comparison of mean rank differences among nonparametric variables was performed with the Mann–Whitney U-test. Parametric continuous variables that followed a normal distribution were compared by mean and standard deviation with the Student’s 2 vs. 22.4 kg/m2, p-value < 0.001). The number of comorbidities did not differ significantly between the study groups, although pregnant women in the prematurity group had a significantly higher proportion of urinary tract infections during the current pregnancy that resulted in a premature birth . Additionally, since the study was conducted during the COVID-19 pandemic, it was observed that a higher proportion of patients in the prematurity group had COVID-19 during the pregnancy period . Lastly, from the background analysis, there were significantly more smoking patients in the prematurity group as compared to the full-term group . The study comprised 486 patients analyzed for changes in biological parameters during the pregnancy period in order to determine the predictive role of various inflammatory scores computed from the basic serum biomarkers. Patients were split into two equally matched study groups, a reference group of 243 pregnant women who gave birth prematurely and 243 pregnant women who gave birth at full term. The background analysis presented in p-value < 0.001). Regarding the inflammatory scores calculated for each study group, it was observed that NLR , dNLR , PLR , and MLR  scores were significantly higher among those who had a preterm birth.p-value = 0.009), with the highest sensitivity in this study (71%). The highest sensibility was achieved by dNLR, with 70%, and an AUC value of 0.655 . PLR had the second-highest AUC value (0.682) and the best score in terms of sensitivity (70%) and sensibility (69%) . Lastly, MLR had the lowest significant AUC score (0.607) and lowest sensitivity/sensibility values among the statistically significant scores . SII and SIRI scores had computed AUC values below 0.600 without statistical significance.The ROC analysis and the computed areas under the curve are presented in p-value < 0.001) for an NLR score over 9.0 . The risk was 3.13 times higher when a dNLR score surpassed the cut-offcut-off value of 9.8 . The PLR risk was the highest among the calculated scores, with an HR of 4.07 , over the threshold of 250 . Lastly, an MLR score higher than 0.70 posed a 1.96 times higher risk for premature pregnancy . The SII and SIRI scores were eliminated from the probability analysis since they did not show significant results.The univariate Cox regression analysis described in The current study identified that the NLR, dNLR, PLR, and MLR scores showed to be significantly higher among patients who gave birth prematurely, but SII and SIRI were not significantly different between the study groups. NLR had the highest value among the tested scores and the highest sensitivity in this study (71%). Similar to our results, several investigations assessed the inflammatory scores for premature membrane rupture, a prelude to preterm delivery. NLR and PLR were discovered to be considerably greater in the PPROM group compared to the control group; nevertheless, sepsis was more prevalent in the PPROM group. PLR levels were substantially associated with an increased risk of preterm premature rupture of membranes, while the cut-off value in our analysis was 250, whereas, in the other study, it was 117 .NLR is involved in inflammatory processes since the differentiation of leukocyte subtypes is an immunological response that occurs in settings characterized by systemic inflammation. As a consequence of this, the NLR has the propensity to change in a variety of systemic inflammatory disorders. Numerous studies have shown that an elevated NLR has both a prognostic and a predictive value in malignancies ,29. AddiCurrent research has emphasized the efficacy of the NLR in predicting preterm birth in conjunction with other events occurring during pregnancy. Regarding other pathologies, one study found that a model including cervical length and NLR had a greater diagnostic and prognostic value for preterm birth than cervical length alone or other systemic inflammatory indicators such as CRP and leukocyte levels . AnotherAlthough our study did not specifically create a prediction model as an association of multiple inflammatory markers that correlated with the risk of preterm labor, a recent research described that the correlation between NLR, hemoglobin, and platelet distribution width (PDW) marker successfully forecasts premature delivery . The scoPLR is a marker that started to be used in clinical practice since it has been shown to accurately predict thrombotic events and inflammatory illnesses. A strong relationship between higher PLR and severe outcomes in cardiovascular illnesses and lower survival in malignancies such as endometrial cancer was revealed by a number of studies that were conducted in the past ,37. PLR Other recent studies attempted to determine the role of inflammatory scores such as MLR and SIRI, but for different outcomes, such as mortality in COVID-19 patients. It was observed that MLR and SIRI scores above the threshold of 0.69, respectively 2.2 were predicting with significant accuracy the mortality in hospitalized patients with severe SARS-CoV-2 infection ,39. MorePrevious studies have thoroughly documented the role of comorbidities and infections during the pregnancy period as significant risk factors for giving birth prematurely ,41,42. AAlthough several studies have reported that SARS-CoV-2 infection during pregnancy is associated with a dangerously higher inflammatory status calculated by the NLR and PLR scores as significant predictors for preterm birth ,47, someEven though inflammatory scores such as NLR and PLR have a significant prediction value for premature birth in our research, other studies found important limitations of these scores, but for different outcomes, such as mortality. For example, the poor accuracy of PLR in determining in-hospital mortality during a short period of follow-up may be due to the kinetic fluctuation of the platelet count, implying possibly the influence of the drop in lymphocyte count, which is an independent predictor of death, and time might be a confounding variable, it was hypothesized that PLR’s prediction improved the closer it was to the given result. Nevertheless, in forecasting mortality, PLR is shown to be less reliable than NLR ,51.Starting with the retrospective nature of the investigation, this article contains various disadvantages. Since data were collected from a single clinic, the group analyzed may be more homogeneous and less generalizable to the larger population. Another limiting factor of the retrospective design was that blood samples could not be drawn at specific moments to exclude some confounding factors, as it could be done in a prospective study. In addition, we could not rule out the influence of certain therapies on the observed inflammatory marker outcomes. There are still biological indicators that have not been fully investigated, but they could be able to better predict the fate of the pregnancy and enable better care. Since anemia was more common in the studied patients who gave prematurely in this study, future research should investigate predictive scores based on hemoglobin levels, red blood cell count, and other red blood cell parameters.The inflammatory scores NLR, dNLR, PLR, and MLR measured throughout the second and third trimesters of pregnancy exhibited a high predictive value for preterm delivery. Future clinical research should study techniques to diminish the impacts associated with high levels of these indices in order to enhance therapies and management in order to lessen the burden of preterm.


Diffusion tensor imaging (DTI) is an image-guided tool, especially in brain tumor resection surgery. Neuroimaging tools are essential for operative planning, particularly for maximizing tumor resection and, at the same time, preserving brain function. In this systematic review, we discuss the utilization of DTI in brain tumor resection, by looking into its ability to assess the perioperative approach, as well as evaluating its benefits for successful surgery. The present study proposes to use DTI as a vital neuroimaging tool for preoperative planning in brain tumor resection surgery.The diffusion tensor imaging technique has been recognized as a neuroimaging tool for in vivo visualization of white matter tracts. However, DTI is not a routine procedure for preoperative planning for brain tumor resection. Our study aimed to systematically evaluate the effectiveness of DTI and the outcomes of surgery. The electronic databases, PubMed/MEDLINE and Scopus, were searched for relevant studies. Studies were systematically reviewed based on the application of DTI in pre-surgical planning, modification of operative planning, re-evaluation of preoperative DTI data intraoperatively, and the outcome of surgery decisions. Seventeen studies were selected based on the inclusion and exclusion criteria. Most studies agreed that preoperative planning using DTI improves postoperative neuro-deficits, giving a greater resection yield and shortening the surgery time. The results also indicate that the re-evaluation of preoperative DTI intraoperatively assists in a better visualization of white matter tract shifts. Seven studies also suggested that DTI modified the surgical decision of the initial surgical approach and the rate of the GTR in tumor resection surgery. The utilization of DTI may give essential information on white matter tract pathways, for a better surgical approach, and eventually reduce the risk of neurologic deficits after surgery. Preoperative planning in brain surgery plays a significant role in the successful outcome of the surgery, which eventually improves patients’ quality of life. Furthermore, preoperative planning in neurosurgery maximizes tumor resection, while preserving the brain’s neurological functions . DiffusiIn previous studies, DTI was utilized in brain tumor patients, mainly to classify the tissue’s characteristics and understand the effects of tumor growth on the microstructural integrity of the surrounding brain tissue ,5,6. BesThus, this systematic review investigates the effectiveness and benefits of utilizing DTI as a single neuro-navigation tool for brain tumor resection. The present review also compared DTI intervention group with non-DTI group. Finally, the present study evaluated the modification of the preoperative planning based on the DTI data findings, the re-evaluation of intraoperative DTI, and the best surgical approach.Two independent researchers conducted a systematic search using the National Centre for Biotechnology Information (PubMed) and Scopus electronic databases. The preferred reporting items for systematic reviews and meta-analyses guidelines (PRISMA) were used as the reporting guidelines  Supplem and follThe article search was conducted between the earliest record and 27 January 2022. Search terms used included ‘brain neoplasm or brain cancer or brain lesion or brain tumour or brain tumor’ and ‘surgery approach or surgery operation or surgery planning or surgery process or surgical procedure’ and ‘DTI or diffusion tensor imaging or diffusion tensor tractography or tractography or fiber tracking or fibre tracking’; and the full advanced search used for each database can be found in Consensus for eligibility was reached through discussion and using the PICOS strategy, as summarized in The inclusion and exclusion criteria were also screened. The papers were limited to adult humans aged >17 years old, and the articles were written in English. No limitation was set for sample size and year of publication. Second, we excluded articles that also utilized other imaging modalities, such as computed tomography (CT), positron emission tomography (PET), ultrasound, navigated transcranial magnetic stimulation (nTMS), fMRI, and other diffusion-weighted techniques, i.e., high angular resolution diffusion imaging (HARDI). However, magnatice resoncance imaging (MRI) were included. Review papers, systematic review papers, and technical notes were also excluded. Seventeen studies fulfilled all the criteria for the systematic review, out of 2270 publications. The detailed flow processes of article selection for this systematic review are presented in n = 9) [n = 8) [Based on the quality assessment tools published by the National Heart, Lung, and Blood Institute, these studies were assessed as reasonable and fair . This syn = 9) ,23,24,25 [n = 8) ,30,31,32n = 360) compared to female patient recruitment (n = 283). The age range for these studies was 1 to 87 years old, and we included five studies [The sample size ranged from 8 to 230 participants, including controlled participants. The total number of patients reviewed was 877, with 234 control patients, with slightly more male patient recruitment , comparisons were made of the assessment of preoperative, intraoperative, and postoperative effects on visual impairment caused by the compression of the optic chiasm. The control group recruited were patients diagnosed with other diseases. They claimed that patients with an abnormal visual impairment score had optic chiasm compression. For the control group, the visual examinations recorded normal visual status in preoperative and postoperative periods, revealing that the fibers crossing the optic chiasm were without any alterations . In addiNimsky et al. (2005), Hajiabadi et al. (2006), Aibar-Duran et al. (2020), and Maesawa et al. (2010) investigated preoperative tractography and intraoperative tractography ,23,24,27The assessment of fiber trajectories of the tumor patient preoperatively or intraoperatively can result in the modification of initial surgical planning. Seven studies discussed these changes. Romano et al. (2009) delineated that the preoperative DTI depicted an inaccurate shifting of the central white matter tract, and that revision of surgical planning was needed to determine the resection margin. The study concluded that MR-tractography modified the planned surgical procedure in nearly 82 percent of cases . SimilarResearch conducted by Faust and Vajkoczy (2016) revealed not the modification of surgical planning, but the predetermined surgical approach based on the location of the tractography of optic radiation tracts in relation to the tumor. Temporal tumor growth effects on optic radiation caused fixed pattern displacement, and these patterns provided a potential entry point for surgical tumor resection .In contrast to these real studies, Alexopoulous et al. (2019) performed a stimulation of neurosurgeons’ decision-making in preoperative surgical planning. Two blinded neurosurgeons analyzed preoperative DTI and MRI scan imaging and determined the surgical decision for the brain tumor resection. However, after analyzing DTI tractography data on a few of their patients, they discovered that this technique had no effect on the surgical strategy. Nonetheless, it did corroborate the resection decision to move from total resection to subtotal resection, initially solely based on MRI, resulting in better surgical results . SimilarThe surgical outcome was assessed to evaluate GTR and the patients’ postoperative neurological function. In the present study, several of the selected papers reported their achievements based on the increasing decision rate in deciding the total gross resection of the patients ,26,27,29The present study discussed the utilization of DTI in brain tumor preoperative planning, to evaluate the benefits of DTI and its significance for successful neurosurgery. We found a specific selection of articles that used only DTI neuroimaging for preoperative, intraoperative, and postoperative assessment, aside from routine MRI scanning. These selected studies highlighted a few points. First of all, DTI is the only tool for in vivo visualization of white matter tract pathways, and it may aid in understanding the anatomy, architecture, and microstructure of the tracts, as well as localizing tumors involving the fiber tracts ,30,31,32We compared the interventions in DTI and control groups, to assess their efficacy. This comparison showed that the most DTI utilizing group had better surgical decision outcomes on total gross resection. Furthermore, the postoperative neurological deficits were mostly improved and required less time for neurosurgery compared to the control group ,23,25,28Preoperative tractography was utilized for surgical planning, so that a proper plan could be executed. Robust analysis of the white matter tract tractography pattern, colors, and fiber pathways would benefit a neurosurgeon, as additional information is essential. The characterization and criteria of white matter tract microstructure interaction with the different types of the tumor would give an initial suggestion on how the surgical approach should be assigned ,10. In aIn this review, we analyzed all types of tumors and grouped them into HGG, low-grade gliomas (LGG), and metastasis. Different types of tumors may have different interactions and effects on the fiber tract, which may necessitate surgical intervention ,4. UnlikIntraoperatively navigated tractography gives a more precise fiber tracking depiction than preoperative tractography, and it has the advantage of shortening the surgery time . In addiIntraoperative DTI assessment contributes to successful awake-surgery, plus any preoperative error can be corrected intraoperatively ,33. AlthAs shown by Hajiabadi et al. and Voets et al., DTI fiber tracking could predict the postoperative deficit ,31. A stThe act of modification and re-evaluation of surgical plans indicates more information is required, and the utilization of DTI should have been done routinely. Most studies had to re-evaluate the planned surgical process in the intraoperative courses ,27. BaseDTI tractography, as an essential tool in neurosurgery care and treatment, still raises questions, as there is no reliable standard . Some fiWe should point out some limitations of our studies, by recognizing the small sample sizes of the selected studies. The DTI and tractography analysis processes have some limitations. The standardization of the fractional anisotropy and angle threshold could be hard to achieve due to edema and infiltration surrounding the tumor . The conWe have reviewed some of the benefits of utilizing DTI in neurosurgery, ensuring that many more will be discovered in the future. There are pros and cons to using DTI, mainly regarding its utilization as a single technique. Past and ongoing studies on DTI have shown the effects of DTI’s usage perioperatively and postoperatively. It can give essential information on the related white matter tract pathways and their relation to the tumors’ features, for a better surgical approach; and to a certain extent, potentially decreases the neurological deficit in patients’ quality of life. We can conclude that preoperative DTI has given us important information on fibers, and eventually, could help in evaluating operative planning, based on the evidence when compared to the non-DTI group. Intraoperative DTI, as well as intraoperative navigated DTI, should be used, and validation of the functional white matter tract would be possible with the aid of intraoperative subcortical stimulation and neurophysiological assessment, as collecting as much information as possible about the surrounding tissue of the tumor could assist in alleviating the postoperative deficit. However, more studies are needed, and applications need to be performed and validated, mainly on the use of DTI quantitative parameters, to help with neurosurgery resection. So that artefacts and complications may be controlled and managed in the future, the DTI technique should be used as a routine neuroimaging procedure, mainly in any neurosurgery and diseases that could potentially damage the white matter tract fibers.


PTB), the leading cause of perinatal mortality. The aim of the study is to investigate the likelihood of a causal relationship between the maternal vaginal microbiota composition and neonatal lung and intestinal microbiota profile at birth, in cases of SPPTB. The association between the lung and/or meconium microbiota with the subsequent development of bronchopulmonary dysplasia (BPD) was also investigated. Maternal vaginal swabs, newborns’ bronchoalveolar lavage fluid (BALF)  and first meconium samples were collected from 20 women and 23 preterm newborns with gestational age ≤ 30 weeks . All the samples were analyzed for culture examination and for microbiota profiling using metagenomic analysis based on the Next Generation Sequencing (NGS) technique of the bacterial 16S rRNA gene amplicons. No significant differences in alpha e beta diversity were found between the neonatal BALF samples of SPPTB group and the MIPTB group. The vaginal microbiota of mothers with SPPTB showed a significant difference in alpha diversity with a decrease in Lactobacillus and an increase in Proteobacteria abundance. No association was found between BALF and meconium microbiota with the development of BPD. Vaginal colonization by Ureaplasma bacteria was associated with increased risk of both SPPTB and newborns’ BPD occurrence. In conclusion, an increase in α-diversity values and a consequent fall in Lactobacillus in vaginal environment could be associated to a higher risk of SPPTB. We could identify neither a specific neonatal lung or meconium microbiota profiles in preterm infants born by SPPTB nor a microbiota at birth suggestive of subsequent BPD development. Although a strict match has not been revealed between microbiota of SPPTB mother-infant couples, a relationship cannot be excluded. To figure out the reciprocal influence of the maternal-neonatal microbiota and its potential role in the pathogenesis of SPPTB and BPD further research is needed.The newborn’s microbiota composition at birth seems to be influenced by maternal microbiota. Maternal vaginal microbiota can be a determining factor of spontaneous Preterm Birth (SP PTB) represents the first cause of perinatal mortality and a huge public health cost in many countries, including Italy.Spontaneous preterm birth  vs. cesarean section (CS)] , 9, mate periods , 11. Thein utero and can be subsequently influenced by the exposition to the birth canal and the skin of the mother, as well as by microorganisms, introduced through ventilation or micro-aspiration (Staphylococcus sp. (Firmicutes) or Ureaplasma spp. (Tenericutes) within 7 days  .PTB cases. We investigated maternal vaginal microbiota, and neonatal lung and intestinal microbiota. We compared preterm infants born by spontaneous birth for suspected chorioamnionitis and/or premature prolonged rupture of the membranes (p-PROM) and/or preterm labor (SPPTB group) with preterm infants born by cesarean section performed for maternal or fetal medical indications, with intact membranes and in the absence of labor .The aim of the study is to investigate the role of maternal and neonatal microbiota in SPPTB and to adverse neonatal outcomes, could open to the investigation of new markers (a) in pregnancy, to select cases at higher risk of SPPTB and (b) in preterm newborns, to early identify cases at higher risk of adverse pulmonary outcomes.The identification of a specific maternal and preterm newborns microbiota signature associated to SPWe conducted a prospective observational study at the Department of Woman and Child Health of the Fondazione Policlinico Universitario A. Gemelli IRCCS of Rome , from August 2019 to August 2020. The study protocol was approved by the Institutional Ethics Committee in July 2019 . Written parental consent was obtained prior to study entry.The study population included women undergoing PTB and their preterm infants having gestational age (GA) ≤ 30 weeks, who were intubated at birth or in the first 24 h of life.PTB group) and 32 (55%) by elective C-section performed for maternal or fetal medical indications with intact membranes in the absence of labor (MIPTB group). 70% (18/26) of newborns in SPPTB group and 57% (18/32) in MIPTB group were intubated at birth or in the first 24 h of life; we estimated the possibility of studying up to 36 newborns over a period of about 12 months. The number of infants we intend to study is in line with the available literature’s evidence for a pilot study , of them 26 (45%) were born for suspected chorioamnionitis and/or p-PROM and/or preterm labor  and meconium specimens were collected. BALF were obtained after ensuring that the infant was adequately oxygenated by instilling 1 ml/kg of 0.9% sodium chloride in the endotracheal tube and suctioning the fluid into a sterile mucus trap. The first BALF sample was collected within the first 24 h of life, whereas further collections were performed on the third and seventh day of life in newborns who were still intubated.°C until further processing.Vaginal swab, BALF and meconium were stored at −80PTB infants and MIPTB ones.Data was extracted from electronic medical records. The cause of preterm birth was recorded to distinguish SP2-dependence at 36 weeks of post menstrual age), characteristics of the neonatal respiratory pathology , duration of ventilatory support , time until initiation of antibiotic therapy, number of antibiotics cycles, time until initiation of oral feeding, incidence of intraventricular hemorrhage (IVH) grade > 2°, length of stay and survival, in addition to the perinatal infectious risk factors.Data collection included both prenatal and neonatal data. Among (a) prenatal data: results of previous cultural exams of vaginal swab and/or maternal urine culture; use of antibiotics during pregnancy; prescription of intrapartum antibiotics prophylaxis; prenatal steroids prophylaxis , (b) neonatal data: gestational age at delivery, birth weight, incidence of neonatal BPD  with positive BALF culture, were also registered.The incidence of blood stream infections, defined as a positive blood culture, and pneumonia, defined as the worsening respiratory symptoms (increase of FiOvia the 2 × 300-bp paired-end protocol in the MiSeq instrument (Illumina).For each sample , bacterial DNA extraction was performed in a strictly controlled level-2 biological safety workplace using DANAGENE MICROBIOME DNA kits (Danagen-Bioted) according to manufacturer’s instructions . DNA was1 and SILVA 132 database2 were used for taxonomic ASVs’ annotation. Final data were pre-processed to remove mitochondrial sequences .Demultiplexed FastQ reads were analyzed using the QIIME2 (v.2020.6) microbiome analysis pipeline . Brieflyequences . We usedphyloseq  statistip < 0.05 as statistically significant.Statistical analysis was done using GraphPad PRISM Version 8.4.3 considering a value of U-test for non-parametric data and the Student’s t-test for parametric data.Categorical variables were compared using a two-tailed Fisher’s exact test, while the differences between the groups for continuous variables were tested by Mann-Whitney From August 2019 to August 2020, a total of 30 mothers and 35 newborns were enrolled at birth after receiving informed parental consent. Six mother-newborns couples were excluded because newborns were not intubated in the first 24 h of life. The study group consisted of 29 newborns, including 3 pairs of twins, and 26 mothers.PTB; 9 = MIPTB) and 23 neonates , were included in the final statistical analysis.Twenty-nine BALF, 29 early meconium and 26 vaginal swabs samples were analyzed. Six BALF samples were excluded due to the low bacterial biomass. A total of 20 mothers (11 = SPPTB group  and for the occurrence of premature prolonged rupture of the membranes (pPROM) which only registered in the SPPTB group (p < 0.0001). In this group of neonates, only in two cases labor was activated without rupture of the membranes. A trend in terms of lower gestational age  and of higher incidence of late-onset sepsis  was found in the SPPTB group compared to the MIPTB group. All 23 infants survived to 36 weeks’ postmenstrual age . Based on their pulmonary outcomes, the 23 infants were further classified as those who did not develop BPD  or those who later developed BPD . The demographics and clinical characteristics of patients in these two categories are shown in The demographics and clinical characteristics of infants included in the analysis are shown in A total of 38 BALF samples were collected: 23 were collected during the first 24 h of life, 10 on day 3 of life and 5 on day 7 of life.PTB and MIPTB groups in BALF specimens at day 1 post birth in intubated infants. A total of 1,146,747 high-quality sequences comprising 79 unique ASVs were obtained. All 38 sequenced samples showed yielded ≥ 1,000 sequences with a mean of 30,177 and median of 23,340, range 3,380–141,435 reads/sample. Overall, 6 main phyla were detected: Actinobacteria, Bacteroidetes, Cyanobacteria, Fusobacteria, Firmicutes, and Proteobacteria. In both groups, Firmicutes and Actinobacteria phyla prevailed and showed a comparable relative abundance average of 77 and 15% or 73 and 13% for SPPTB and MIPTB, respectively. Conversely, Proteobacteria and Bacteroidetes were less represented, and Fusobacteria and Cyanobacteria were detected only in few specimens , respectively. Three couples of twins were included in the study: one in the SPPTB and two in the MIPTB group. Brothers had different values of alpha diversities: 1.22 and 1.69 for twins in the SPPTB group; 1.35 and 0.89 and 1.29 and 0.92 for twins in the MIPTB group. Turning to Beta diversity, these samples showed a different spatial distribution highlighting the importance of other factors in the establishment of a unique microbial composition. No difference in spatial distribution of the SPPTB and MIPTB specimens was described in beta diversity analysis.Alpha diversity, measured by Shannon Diversity Index, and beta diversity, as Jaccard distance, were evaluated in SPPTB and 7 in the MIPTB group, respectively). Alpha diversity as Shannon index was computed showing no differences between days 1 and 3. At day 3 after birth the average value of Shannon index was equal to 1.80 in the SPPTB group vs. 1.61 MIPTB in the group, p = 0.65) (Ten on twenty-three newborns were still intubated on the third day after birth and a second BALF sample was collected (3 in the SP = 0.65) . LikewisPTB and 2 in the MIPTB group, respectively).The analysis was limited to the BALF samples of the first and third day of life due to the low number of BALF samples at day 7 . A total of 4,056,491 high-quality sequences comprising 7,145 unique ASVs were obtained. All 20 sequenced samples showed yielded ≥ 17,000 sequences with a mean of 202,824 and median of 224,678, range 17,214–349,108 reads/sample. After removing taxa with prevalence lower than 0.01%, a total of 3,590,745 reads were obtained 511 ASVs.In order to identify a specific microbial signature in MIPTB compared to MIPTB  suggesting that variation in bacterial population was associated with the two groups (PTB group showed an increased Pielou’s evenness (0.79 ± 0.13) in comparison with the MIPTB group (0.34 ± 0.15) that indicated an increasing prevalence of some bacterial species in the latter group (data not shown). To evaluate the similarity of microbiota profiles, Jaccard beta diversity was computed and plotted as PCoA graph. Interestingly, microbial communities appeared diversely distributed with a minimal overlap between SPPTB (red) and MIPTB (green) samples. Nonetheless, individual profiles of the two groups cluster on different spatial level as portrayed by ellipses. PERMANOVA statistic test confirmed our representation (p < 0.05) (We found that Shannon Diversity index was significantly higher in SPo groups . Particu < 0.05) .PTB and MIPTB groups showed a predominance of Firmicutes, Proteobacteria, Actinobacteria, and Bacteroidetes. However, there was a characteristic feature in the microbiota of women who have had a delivery for SPPTB vs. the microbiota in women who have had a cesarean section for MIPTB. Indeed, SPPTB group showed a significant decreasing in Firmicutes  and the consequent increasing Bacteroidetes . Intriguingly, a slight increasing in relative abundance of Proteobacteria (5.5% vs. 1.3%), rather than Actinobacteria (showing an average around 10% for both groups), was observed in MIPTB group  vaginal swabs were positive , in MIPTB group 5 out of 11 (45%) vaginal swabs were positive .Concerning vaginal swab exams, in SPUreaplasma parvum . In the no-BPD group 7 vaginal swabs were negative (47%), while, in addition to the three Ureaplasma parvum positive vaginal swabs, 2 were positive for Escherichia coli, 1 for Streptococcus agalactiae and 2 for Candida albicans. The cultures of the meconium samples were all negative.Considering BPD/No-BPD groups, 4 vaginal swabs in the BPD group (50%) and 3 in the No-BPD group (20%) were positive for PTB and MIPTB. As preterm births have been historically considered a sign of infection, we compared SPPTB cases to MIPTB cases, to understand if an adverse uterine environment could influence preterm birth and neonatal lung microbiota.The present paper aims to identify specific vaginal and neonatal lung microbiota profiles associated to the occurrence of SPPTB , while a pathological diagnosis is obtained postnatally by histological examination of the placenta and the amniochorionic membranes . A provePTB , 29.Recent studies challenged the assumption of a sterile uterine environment, demonstrating the presence of bacteria in the placenta, fetal membranes, and amniotic fluid –4. HowevPTB. Several species of Lactobacilli promote the maintenance of an acid pH and the production of antimicrobial substances.Vaginal dysbiosis is recognized as a factor that increases the risk of SPLactobacillus vaginalis, L. crispatus, L. gasseri, and L. jensenii, belonging to the Phylum of the Firmicutes. Conversely, bacteria such as Prevotella, Sneathia, Gardnerella Vaginalis, Ruminococcaceae, Parvimonas, and Mobiluncus, often associated with bacterial vaginosis and widely present in non-pregnant women of childbearing age, progressively decrease  looking for a microbial signature suggestive of spontaneous birth. However, despite differences observed in maternal vaginal swabs, we did not find in neonatal BALF samples at birth a different pattern of alpha and beta diversity and/or differences either at Phylum and Genus level, comparing SPPTB and MIPTB group.We investigated any possible cause of spontaneous birth and possible adverse uterine environment  supports the idea that microbiota composition is acquired after birth, and it is not related with the cause of preterm birth or transferred from swallowing bacteria previously translocated from uterine niche in the amniotic liquid.PTB vs. SPPTB) may, at least in part, suggest that the cause of preterm birth was not associated with infant lung microbiota composition.The absence of a specific microbial signature in the BALF samples of the two groups  and Firmicutes abundances .Ureaplasma parvum day-one BALF culture resulted significantly more prevalent in BPD group. Moreover, all neonates with positive day-one BALF were born form mother with positive vaginal swabs for Ureaplasma. This result is in line white previous studies, which associated Ureaplasma colonization in the respiratory tract with the subsequent development of BPD  and are available as BioProject number The studies involving human participants were reviewed and approved by Comitato Etico Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy. Written informed consent to participate in this study was provided by the participants’ legal guardian/next of kin. Written informed consent was obtained from the individual(s), and minor(s)’ legal guardian/next of kin, for the publication of any potentially identifiable images or data included in this article.CTi, AP, and FD conducted the statistical analysis and interpretations of results. CTi designed the study. AP, CTi, and FD wrote the manuscript with the support of CTe, SD’I, ND, ALa, GSc, and GV. FD, FM, GSa, DB, BP, and MS carried out the microbiological analysis. CTi, AP, CTe, SD’I, ND, MT, ALi, and NM collaborated in data collection. All authors read and approved the submitted version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


BackgroundUltrasound examination has been a crucial part of the evaluation of fetal health during pregnancy. It has become more accurate over the past few decades as a result of advances in radiodiagnostic imaging. While obstetric ultrasonography in the first trimester has been utilized extensively for gestational age assessment and confirmation of fetal viability, the imaging technique has seen little exposure in predicting pregnancy outcomes. This study was thus undertaken to find out any possible association between one of the first trimester parameters, i.e. crown-rump length (CRL) noted at the beginning of a pregnancy, and the birth weight of the neonate.Methodsth centile, 5th to 95th centile, or >95th centile. The women were then followed up at the hospital with standard care till the end of their pregnancy, and finally, the birth weights were noted. Data were recorded in an MS Excel spreadsheet program and analysis was performed with regard to CRL in the first trimester and birth weights using SPSS v23 (IBM Corp.).This prospective cohort study conducted at a teaching hospital in India spanning over a period of eighteen months included women with a spontaneously conceived intrauterine pregnancy at six to ten weeks period of gestation as calculated from the last menstrual period. Transvaginal sonography was performed for all such women and the CRL was noted. These CRL values were then compared to a standard nomogram and assigned to either of three categories i.e. CRL <5Resultsth centile category. No embryos with CRL >95th centile had low birth weight.Crown-rump lengths and birth weights of 104 cases were evaluated. The mean age of the study population was 26.6 years and the mean period of gestation (weeks) was 8.28 ± 1.01. The incidence of low birth weight (LBW) in the study was 22.1%. The distribution of LBW was significantly different between the three CRL categories , being considerably higher in the CRL <5ConclusionsOur study suggested a congruence between the crown-rump length of an embryo noted in the first trimester and its weight at birth, with low birth weight being a fairly common occurrence in the deficient CRL category. This study highlights the role of a carefully performed first-trimester ultrasound examination in possibly predicting an adverse pregnancy outcome such as low birth weight and the probable inherent tendency of growth restriction in fetuses that are destined to develop the same. Diagnostic ultrasonography utilizes high-frequency sound beams to produce images . NowadayWhile the use of first-trimester parameters for gestational age assessment has been vastly popular and widely used, their role in predicting pregnancy outcomes has seen limited exposure. While some investigators have found some of the first trimester ultrasound parameters including mean sac diameter (MSD), crown-rump length (CRL), yolk sac diameter (YSD), embryonic/fetal heart rate (FHR), and subchorionic hemorrhage to be possible predictors of adverse pregnancy outcomes, others have dismissed the significance of such associations ,5,6,7. TStudy designThis was a prospective cohort analytical study conducted over a period of 18 months at a government teaching hospital in Central India.Inclusion criteriaWomen with previously regular menstrual cycles who conceived spontaneously, with a period of gestation between 6 weeks to 10 weeks  were included in the study and subjected to history-taking, general physical, obstetric examination, and transvaginal sonography (TVS).Exclusion criteriaBased on the history and ultrasound evaluation, patients with gravida≥4, multifetal pregnancy, ectopic and molar pregnancies, congenital uterine anomalies, and those with a history of recurrent pregnancy loss (RPL), ovulation induction/assisted reproductive technology conception, and significant past medical, surgical, or poor obstetric history were excluded from the study.Data collectionCRL was measured in the sagittal plane as per standard protocol and precautions in units of centimeters, and percentiles were calculated based on the nomogram developed by Papaioannou et al . IndividStatistical analysisData were coded and recorded in the Microsoft Excel spreadsheet program. Data analysis was performed using SPSS v23 (IBM Corp.).A total of 120 patients were included in the study. The mean period of gestation (weeks) was 8.28 ± 1.01, while the mean age of the study population was 26.6 years. Approximately 56% of the patients in the study were nulliparous, while 44% were multiparous. The fetal pole was not visualized in seven patients at the time of TVS. Of the remaining 113 patients, 9 underwent spontaneous pregnancy losses. Thus, the birth weight results presented here are representative of 104 patients who underwent a live birth.The variable birth weight (g) was not normally distributed in the three subgroups of the variable CRL Percentile Table . Thus, nApproximately 22.1% (23 out of 104) of women gave birth to a neonate with LBW. A significant difference between the various groups in terms of distribution of LBW  was noted, with a strength of association between the two variables (Bias Corrected Cramer’s V) being 0.37  . Similar to our study, Leung et al. analyzed 2760 cases and found fetal CRL expressed as their standardized z-scores (Z-CRL) to be independent predictors of birth weight . SimilarLimitationsThe study was undertaken during the COVID-19 pandemic, which resulted in a small sample size since a large number of patients who were initially included in the study were lost to follow-up. The volume of subchorionic hemorrhage and the yolk sac morphology were not accounted for in this study. All women with gravida ≥4 and multifetal pregnancy were also excluded from the study to eliminate as many confounding factors as possible from the study.This study demonstrates an associative correlation between CRL in the first trimester with birth weights at the end of pregnancy, with the risk of LBW being appreciably higher in fetuses with small CRLs. Thus, a meticulously measured CRL could give valuable insights in predicting the growth potential and hence birth weights of neonates. This could offer a better perspective to the obstetrician for increased vigilance, and to the expecting parents for better preparedness. However, this path should be trodden carefully and only after more extensive and elaborate studies, heeding the vast plethora of factors that could possibly impact the birth weight of a neonate. A larger multi-centric study with due consideration to other factors impacting pregnancy outcomes could help corroborate the findings of this study and the utilization of CRL as an important prognostic tool.


New mothers are a particularly vulnerable group during the COVID-19 pandemic, due both to the higher depression and stress levels associated with early child care and to the risk of a COVID-19 infection. We investigated the effects of the pandemic on the childbirth experience, stress and depression levels in this population.This cross-sectional, explorative study included 1964 Austrian and German mothers who gave birth between 16.03.2020 and 01.07.2021 and completed an online survey between 18.05.2021 and 01.07.2021. This contained the Childbirth Experience Questionnaire (CEQ2), the Edinburgh Postnatal Depression Scale (EPDS), and the Perceived Stress Scale (PSS), as well as three custom-made scales: a birth risk score (risk factors for a poor birth outcome), a pandemic repercussions score , and a social support score . We computed post-hoc multilinear regression models to evaluate which factors can predict the CEQ2, PSS and EPDS scores.Mothers had a worse birth experience, perceived less stress and had more depressive symptoms during the pandemic than previously reported cohorts. The CEQ2 was predicted by the birth risk (negatively), the access to a midwife (positively) and the perception of sufficient access of the visitors in the hospital (positively)  = 155.64, p < 0.001). The PSS was predicted by the pandemic repercussions (positively), the social support (negatively), and the presence of a coping mechanism (negatively)  = 195.1, p < 0.001). The EPDS was similarly predicted by the same factors as the PSS  = 189.59, p < 0.001).Social support and strong coping mechanisms can lower the stress and depression scores. Instructing the population about how to improve these factors might be a target for future social policies.• Compared to historical cohorts, mothers who gave birth during the pandemic had a worse birth experience, and, postnatally, perceived less stress but had more depressive symptoms.• The visitors’ access to the hospital and the mother’s access to a midwife impacted the birth experience, while the social support and the coping mechanisms affected the stress and depression scores.


Preterm infants are at high risk for growth failure and childhood weight problems due to the disruption of normal intrauterine growth and nutrition. Early nutritional support and microbiome acquisition can play an important role in childhood growth.Our study examined potential postnatal indicators, including gut bacterial compositions, macronutrients, and catch-up growth, of growth pattern from infancy into early childhood.This is a retrospective study of preterm infants born < 35 weeks who were followed up in the university complex care clinic from 2012–2018. Weight and length z-scores at birth, 1, 2, 4, 6, 12 and 15 months, and body mass index (BMI) and length z-scores from 2 to 5 years of age were collected. Catch-up growths were calculated by changes in z-scores and divided into early (birth-4 months) and late (4–18 months). Postnatal nutritional data and fecal samples were collected. Fecal microbiome data obtained from 16S RNA V4 sequencing was analyzed against clinical and growth data using a regression model.160 infants included in the final analysis had birth weight and gestational age of 1,149 ± 496 grams and 28 ± 3 weeks. Early weight gain positively correlated with length z-scores but not with BMI at 2 years of age. BMI at 2 years of age strongly correlated with BMI at 3, 4, and 5 years of age. Postnatal abundance of Gammaproteobacteria was negatively associated with early growth while Bacteroides and Lactobacillus were positively associated with childhood BMI.Our findings suggest that optimal postnatal nutrition promoted early catch-up growth in weight as well as improved linear growth without influence on childhood BMI. Postnatal gut microbial colonization, which is a modifiable factor, was associated with childhood growth in preterm infants. Due to prematurity and compromised intrauterine environment, preterm infants commonly experience growth deficit, which often presents as a low birth weight for age and/or growth failure occurring shortly after birth. Combating this growth deficit is important for the long-term outcomes of these infants. The trajectory of post-natal growth of preterm infants correlates with childhood growth patterns and cognitive development . InsuffiTo assess growth from birth into late adolescence and early adulthood, the latest World Health Organization (WHO) guidelines provide seamless standards and references . PretermStaphylococcaceae and Enterobacteriaceae, and lack of Veillonella as compared to infants with appropriate growth  < 35 weeks, admitted to the level 3 academic neonatal intensive care unit (NICU) at Tampa General Hospital between January 1, 2012 to December 31, 2018, and had at least one well child visit between 2 and 5 years of age at the University of South Florida (USF) Complex Care Clinic. Exclusion criteria were congenital anomalies or chromosomal disorders. The study was approved by the USF Institutional Review Board.The data were collected from both inpatient and outpatient electronic medical records of the infants on NICU admission and outpatient care. The collected demographic and clinical information included birth weight (BW), birth gestational age (GA), gender, ethnicity, race, maternal age, intrauterine growth restriction (IUGR) and small for gestational age (SGA) status, maternal comorbidities , maternal BMI, multiple gestations, NICU length of stay (LOS), grade 3 or 4 intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), and chronic lung disease (CLD) . We collected detailed information on nutritional supports during their NICU admissions and their first 5 years of life, such as the daily caloric intake, days to full feeds, and macronutrient supplementations—protein and medium-chain triglycerides (MCT). The standard caloric concentration is 24 kcal/oz for preterm infants born < 32 weeks and daily caloric concentration > 24 kcal/oz was considered high caloric concentration.We recorded each infant’s anthropometric data from birth to 5 years of age including weekly weight and length along with their z-scores on the revised Fenton growth charts up to 2 months chronological age and on WHO growth charts thereafter, and their BMI at ages 2–5 years. For children under 5 years of age, overweight is defined as BMI greater than 1 standard deviations and obesity is defined as BMI greater than 2 standard deviations above the WHO Child Growth Standards median (n = 34) had weekly fecal samples collected during their NICU admission in an observational study approved by the University of South Florida Institutional Review Board. The inclusion criteria for this cohort are birth weight < 1,500 g or birth gestational age < 33 weeks. Infant fecal samples were collected weekly from diapers and stored immediately at −80°C until processing for DNA extraction for microbiome analysis. Stool samples collected at < 28 days and at 36-week corrected Ga (cGA) or prior to discharge were included in the final analysis. Stool samples were categorized by postnatal age at collection: during the first 14 days of life, 14–28 days of life, and at 36-week cGA.A number of the above infants  following the manufacturer’s instructions. The amount of DNA was measured with the Qubit 3.0 fluorometer . The bacterial 16S rRNA V4 gene region was amplified by polymerase chain reaction using 515F and 806R primers . The gene was then sequenced using the 2 bp × 300 bp chemistry in a paired-end manner on the Illumina Miseq platform .All the raw demultiplexed fastq files were imported in R version 4.1.0 and were analyzed by the dada2 package v1.10.1 . Brieflyt-tests and Mann–Whitney U tests were applied for normally distributed and skewed data, respectively. Because many comorbidities, such as CLD and NEC, occurred more frequently in infants born at lower birth GA and weight, we controlled for birth GA and weight in our analysis. The 95% confidence intervals were used to describe the precision of the estimates. The two-tailed statistical tests were considered significant at p < 0.05. All non-microbiome analyses were performed using IBM SPSS statistical software package . We also used SPSS to calculate the power with a linear regression model and two controlling factors (birth GA and weight) to predict childhood growth measurement with postnatal microbiome. A sample size of 34 subjects will detect an effect size of 0.3 at 0.871 power with a significance alpha level of 0.05. For Pearson correlation between BMI datasets, a sample size of 24 will detect a correlation coefficient of 0.6 at 0.901 power and alpha level of 0.05. The associations for BMI, length z-scores and weight z-scores with the microbiome were tested separately employing optimal microbiome-based association test (OMiAT) in R  or median and interquartile range (IQR) while categorical variables were described by percentages. The association between categorical variables was evaluated by the Fisher’s exact test. For continuous variables, independent samples AT) in R . OMiAT pn = 130) very-low-birth-weight  infants and 12% (n = 19) SGA  SGA .r = 0.302, p = 0.001 and r = −0.317, p = 0.001 respectively) (The mean changes in weight z scores from birth to 4 months and from 4 to 18 months were −3.53 ± 1.85 and 4.07 ± 2.29. The mean changes in length z scores from birth to 4 months and from 4 to 18 months were −3.39 ± 1.87 and 3.14 ± 1.72 respectively. Length z scores at 2 years correlated positively with the changes in weight z scores from birth to 4 months and negatively with that change from 4 to 18 months (ctively) .n = 149) at 2 years of age, 65% (n = 105) at 3 years, 25% (n = 40) at 4 years, and 15% (n = 24) at 5 years of age. At 2 years, the mean BMI was 16.1 ± 1.8 kg/m2, 11% (n = 17) of infants were overweight (BMI > 1 standard deviation above the mean), and 6% (n = 10) infants were obese (BMI > 2 standard deviations above the mean) based on the WHO definitions. Most infants  had a BMI within the healthy range at 2 years of age   . We usedr = 0.417, p = 0.001) and the correlation remains significant with controlling for birth GA and BW . BMI at 2 years of age also had positive correlations with the change in length z scores from 4 to 18 months of age  but not with the change in length z scores from birth to 4 months (The change in weight z scores from birth to 4 months did not correlate with BMI at 2 years with and without controlling for birth GA and BW. The change in weight z scores from 4 to 18 months positively correlated with BMI at 2 years of age (4 months .n = 78) were fed human milk  and 25% (n = 40) were exclusively breastfed at discharge (n = 22) receiving both protein and MCT. About a third (31%) received high caloric concentration  during NICU admission, 31% received high daily caloric intake , and 39% were discharged home with ≥24 kcal/oz feeding.About half (49%) of the infants  and caloric density  of discharge feed . There was no association between nutritional supports  and childhood BMI. We did not find any significant association between postnatal microbiome development and feeding types, caloric supports, or macronutrient supplementation.Length z scores at 2 years had a negative correlation with caloric supports measured as maximum caloric density  and maximum caloric intake  during NICU  from 0 to 14 days of age, negatively associated with the abundance of Proteus (p = 0.04) from 14 to 28 days of age and was not significantly associated with microbiome composition after 28 days of life.Using the stated regression analysis, the change in length z scores from birth to 4 months positively associated with the fecal abundances of Bacteroidales and Haemophilus  from 0 to 14 days of age, negatively associated with abundances of Gemella (p = 0.032) from 14 to 28 days of age, and negatively associated with abundance of Gammaproteobacteria, a class of Proteobacteria (p = 0.018) at 36 weeks cGA  from 0 to 14 days of age. The length z scores negatively associated with abundance of Atopobium (p = 0.027) after 28 days of age  and negatively correlated with abundance of Veillonella (p = 0.018) from 0 to 14 days of age. BMI at 2 years of age was positively associated with abundance of Streptococcus and Enterococcus  from 14 to 28 days of age and was positively associated with abundance of Lactobacillus (p = 0.035) at 36-week cGA  which decreases nutrient absorption in the colon , our finding most likely supports that decreased abundance of Prevotella limits inflammatory mechanisms involved in obesity development , activation of regulatory T cells, and promotion of anti-inflammatory mediators  can be found below: The studies involving human participants were reviewed and approved by University of South Florida IRB. Written informed consent to participate in this study was provided by the participants’ legal guardian/next of kin.JT, EM, HG, and TH designed research. JT, RJ, AL, and TH conducted research. TH and AS analyzed data. JT, AL, AS, and TH prepared the manuscript. JT, AL, and TH had primary responsibility for final content. All authors read and approved the final manuscript.