Preterm delivery is a leading cause of neonatal mortality and morbidity. History of spontaneous preterm birth is the greatest risk factor for another preterm delivery. So, every effort should be made to prevent the recurrence of preterm delivery in this vulnerable group. This study aimed to evaluate the predictive ability of the anterior uterocervical angle and cervical length in preterm birth.0/7 and 24 0/7 weeks, second between 24 1/7 and 32 0/7 weeks, and the third was between 32 1/7 and 36 6/7 weeks. The correlation between both measures and the prediction of preterm birth among study participants was the primary outcome of the study. Neonatal outcome among the study patients was a secondary measure of outcome.This was a prospective cohort study that included 70 patients with a history of spontaneous preterm birth. Ultrasound measurements of cervical length and anterior uterocervical angle were set to be measured for each patient at three visits; first between 16 nd visit, the two measures were significantly different between those who delivered at term and those with preterm delivery with the cervical length being significantly shorter in the preterm arm  and uterocervical angle being significantly bigger among the same arm . A uterocervical angle > 89.8° at the second visit predicted preterm birth with 81.8% sensitivity and 70.8% specificity while cervical length ≤ 3.22 cm at the second visit predicted preterm birth with 68.1% sensitivity and 62.5% specificity. Multivariant logistic regression analysis showed that uterocervical angle > 89.8° at the second visit increased the odds ratio for preterm birth by 9.The incidence of preterm birth among study participants was 31.41%. Cervical length and uterocervical angle showed progressive decrease and increase respectively throughout pregnancy. At the 2Uterocervical angle can be a useful ultrasound marker for the prediction of preterm birth among high risk patients. A cutoff value of 89.8° can be used as a threshold above which prophylactic measures such as cervical cerclage or progesterone therapy can be provided.NCT05632003 (First posted date: 30/11/2022). Annually, nearly one million babies die due to adverse events caused by prematurity . PretermThe etiology behind preterm birth is poorly understood. It’s believed to be multi-factorial with obstetric, environmental, demographic, and genetic factors likely to be involved in the pathophysiology either separately or synergistically . Along tPreterm infants are at increased risk of a wide range of complications as respiratory distress syndrome, necrotizing enterocolitis, and neonatal sepsis. Long term morbidities such as sensory and motor deficits, cognitive impairment, and behavioral complications are more common in babies who were born preterm compared with those who were born at term . ConsequPreventive measures can be offered to patients who are at high risk of preterm labor and so, screening for these patients in asymptomatic women is crucial . Many prCervical length assessment in the second trimester through transvaginal ultrasound assessment is a strong predictor for spontaneous preterm birth. Cervical length ≤ 25 mm at 22 + 0 to 24 + 6 weeks of gestation has been associated with 37.3% sensitivity, 92.2% specificity, 17.8% positive predictive value, and 97.0% negative predictive value for the prediction of spontaneous preterm birth at < 35 weeks of gestation . The AntOur study aims to compare between sonographic measurements; the cervical length and the uterocervical angle regarding their ability to predict spontaneous preterm birth.This prospective observational study was conducted at Ain Shams University Maternity Hospital during the period from January 2022 to December 2022. Before the initiation of the study, approval of the Ethical Committee of the Faculty of Medicine, Ain Shams University was obtained . Using the PASS II program for sample size calculation; setting power at 90% and α – error at 0.05 and according to previous literature, the expected sensitivity of Uterocervical angle and Cervical length for prediction of preterm birth was 86% and 28% respectively with 27% incidence of preterm birth ; a minimAge of the included participants ranged from 18 to 35 years. Normal fetal growth pattern by fetal biometry and estimated fetal weight was a prerequisite for inclusion in the study. Patients with risk factors for preterm delivery apart from the past history of spontaneous preterm birth as medical disorders associated with uteroplacental insufficiency, congenital uterine anomalies, congenital fetal malformations, preterm pre-labor rupture of membranes, polyhydramnios, and those with threatened abortion or antepartum hemorrhage during the present pregnancy were excluded from the study. Moreover, patients who had cervical cerclage during the present pregnancy and those with history of cervical trauma  were also excluded from the study.0/7 to 24 0/7 weeks of gestation, the second between 24 1/7 and 32 0/7 weeks of gestation, and the third between 32 1/7 and 36 6/7 weeks of gestation. For each patient, a minimum of 4 weeks between each visit was ensured. As our patients were recruited from 16 – 24 weeks of gestation, not all of them had early scans to depend on it for gestational age calculation. We depended on the date of last menstrual period for calculation of gestational age and estimated gestational age obtained from the ultrasound performed at the first visit corresponded to menstrual dating.Informed consent was taken from study participants before enrollment and after a thorough explanation of the purpose of the study. All patients included in the study were recruited at 16 – 24 weeks of gestation when history taking, physical examination, and detailed anomaly scan were done to ensure that each patient met our inclusion / exclusion criteria. Cervical length and uterocervical angle were set to be measured on three occasions; the first between 16 The cervical length was measured as follows; a sagittal view of the cervix was required, the cervical canal with the surrounding mucosa was identified, the isthmus wasn’t included, visualization of both external and internal os was ensured, the image was magnified to a degree that the cervix occupied 50–75% of it, and measurement was taken by placing the calipers between the external and the internal os . As for The correlation between both measures and prediction of preterm birth before completed 37 weeks of gestation among study participants was the main target of the study. Neonatal outcome among the study patients was a secondary measure of outcome.Regarding the statistical analysis, quantitative variables were presented using mean and standard deviation, qualitative variables were presented using count and percentage. Student t-test was used to compare quantitative variables between two independent groups, Chi square test was used for qualitative variables, Mann Whitney test was used to compare the two arms of the study for abnormally distributed quantitative variables, Fisher’s Exact or Monte Carlo correction was used for correction for chi-square when more than 20% of the cells have expected count less than 5, ROC curve analysis was used to compare the predictive ability of the two measures and determine the best cut off value with the highest sensitivity and specificity for each measure, Logistic regression analysis was done to measure the ability of different factors for prediction of preterm birth, and P value less than or equal to 0.05 was considered statistically significant.st and 2nd visits while only 52 patients attended the 3rd visit; the 18 patients who didn’t attend the third visit delivered preterm with 5 patients had a very early preterm delivery before the start of the visit, and 13 patients delivered either early preterm or late preterm ie after the start of the visit .The study was conducted at Ain Shams University Maternity Hospital. 77 patients were enrolled in the study; 7 patients were excluded after enrollment with 4 patients refused to adhere to the study protocol, 2 patients developed membrane rupture and one patient had threatened abortion. Seventy patients attended both 10/7 to 33 6/7 weeks), and 10 cases had late preterm birth (34 0/7 to 36 6/7 weeks) (Table 1).Among the study participants, the incidence of preterm birth was 31.4%; out of the 22 cases who delivered preterm, 5 cases had a very early preterm birth (before 32 weeks), 7 cases had an early preterm birth ; this can be attributed to the nature of the study participants being low risk patients with no risk factors for preterm delivery . GründleThe neonatal outcomes among the study participants were assessed; there was a significant difference between the two arms of the study with 85.4% of the neonates from the term arm being discharged within 24 h versus 18.2% of the neonates from the preterm arm. Neonatal mortality was present in 31.8% of the neonates from the preterm arm while none of the term neonates suffered neonatal mortality; Four out of these seven neonatal mortalities were due to respiratory distress syndrome while the remaining three suffered from neonatal sepsis. Algameel et al., assessed the outcome of late preterm newborns in Upper Egypt; 52.9% of the late preterm newborns were admitted to the neonatal intensive care unit . Such a st and 2nd visits. During the second visit, the predictive accuracy for both measures increased; however, the uterocervical angle retained higher sensitivity, specificity, PPV, and NPV (Table ) The multivariant logistic regression analysis showed that during the 2nd visit, cervical length less than 3.22 mm was associated with an odds ratio of 2.4 for spontaneous preterm birth while anterior uterocervical angle > 89.8 was associated with an odds ratio of 9 for spontaneous preterm birth among study participants. The overlapping CI for AUC indicate that the AUCA may not be consistently outperforming CL, however AUCA might provide better prediction according to the point estimate. This may be elucidated with further studies with larger sample size. Our results were similar to those obtained by Khamees et al., who assessed the diagnostic performance of both cervical length and uterocervical angle at three visits; 30 – 32, 32 +1 – 34, and 34+1 – 36 +1 weeks, the diagnostic performance of uterocervical angle was similar to our results at the second visit but with higher cutoff value (105° vs 89.9°) [0/7 to 23 6/7 weeks for prediction of spontaneous preterm birth; compared with the results obtained from our 1st visit, a similar AUC was obtained (0.78 vs 0.75) but a higher cutoff value for prediction of spontaneous preterm birth (95° vs 81°), however, higher sensitivity and lower specificity compared to our study were reported which can be attributed to much higher sample size and lower incidence of spontaneous preterm birth among study participants (972 vs 70) and ( 9.6% vs 31.4%) respectively [The predictive accuracy of both cervical length and uterocervical angle for preterm birth was assessed; the ROC curve showed a bigger area under the curve (AUC) for the uterocervical angle at both 1PV Table  The mults 89.9°) . This hiectively . The twoectively , 20. Lueectively . The higectively . In contectively . The valRegarding progesterone therapy, only 8 patients (11.4%) from the study cohort had cervical length less than 25 mm during the follow up visits and consequently received progesterone therapy; a higher sample size is needed for better evaluation of the effect of progesterone in patients with short cervix.n = 52) delivered preterm; a bigger sample size will be needed in future studies to determine a cutoff value for the uterocervical angle for patients who are between 32 and 37 weeks.Our study was not without limitations; we weren’t able to determine a cutoff value for those who attended the third visit due to the fact that only 4 patients from those who attended the third visit (Uterocervical angle appears to be a good predictor for spontaneous preterm birth among patients with history of spontaneous preterm birth. Combination of both cervical length and anterior uterocervical angle as screening tests for preterm birth among high risk patients may provide better predictive accuracy than cervical length alone.Anterior uterocervical angle is a useful ultrasound marker which can be incorporated in the screening workup of pregnant women with history of previous spontaneous preterm birth. A cutoff of 89.8° can be used in future studies to evaluate whether prophylactic treatment for women with past history of preterm birth will be effective in reducing the incidence of preterm birth in such high risk cohort.


When limited to the seven trials that used ultrasound, the beneficial effects of MMS were demonstrated: risk ratios of 0.87  for LBW, 0.90  for preterm birth and 0.9  for SGA. Sensitivity analyses indicated consistency in the results. These results, together with recent analyses demonstrating comparable effects of MMS (vs. IFA) on maternal anaemia outcomes, strengthen the evidence to support a transition from IFA to MMS programmes in low‐ and middle‐income countries.Meta‐analyses consistently have found that antenatal multiple micronutrient supplementation (MMS) compared with iron and folic acid (IFA) alone reduce adverse birth outcomes. In 2020, the World Health Organization (WHO) placed a conditional recommendation for MMS and requested additional trials using ultrasounds to establish gestational age, because the evidence on low birthweight (LBW), preterm birth and small for gestational age (SGA) was considered inconsistent. We conducted meta‐analyses to determine if the effects of MMS on LBW, preterm birth and SGA differed by gestational age assessment method. Using data from the 16 trials in the WHO analyses, we calculated the effect estimates of MMS versus IFA on birth outcomes (generic inverse variance method and random effects model) stratified by method of gestational age assessment: ultrasound, prospective collection of the date of last menstrual period (LMP) and confirmation of pregnancy by urine test and recall of LMP. The effects of MMS versus IFA on birthweight, preterm birth and SGA appeared consistent across subgroups with no evidence of subgroup differences  has a conditional recommendation for antenatal multiple micronutrient supplements (MMS) noting ultrasound to assess gestational age should be used in future trials. These meta‐analyses of the 16 trials informing the WHO guidelines showed that the benefits of MMS versus iron and folic acidsupplements on low birthweight, preterm birth and small for gestational age births were not different in subgroups of trials using different gestational age assessment methods. In trials that performed ultrasounds for gestational age assessment, the benefits of MMS on birth outcomes were demonstrated. These analyses strengthen the evidence for the transition to MMS in antenatal care programmes in low‐ and middle‐income countries. World Health Organization (WHO) has a conditional recommendation for antenatal multiple micronutrient supplementation (MMS) noting ultrasound to assess gestational age should be used in future trials.These meta‐analyses of the 16 trials informing the WHO guidelines showed that the benefits of MMS versus iron and folic acid on low birthweight, preterm birth and small‐for‐gestational‐age were not different in subgroups of trials using different gestational age assessment methods.In trials that performed ultrasounds for gestational age assessment, the benefits of MMS on birth outcomes were demonstrated.These analyses strengthen the evidence for the transition to MMS in antenatal care programmes in low‐ and middle‐income countries. This coIn describing the additional research needed, WHO noted that ‘Evidence on the effects of MMS on the component parts of LBW is inconsistent and controlled clinical trials are needed in which early pregnancy ultrasound is used to establish gestational age with certainty, to understand where the effect on LBW is derived’  of the last menstrual period (LMP) and confirmation of pregnancy by a urine test.3.Group 3—gestational age assessed by a recall of the date (1st day) of the LMP.We categorized the methods used for gestational age assessment into:We then conducted meta‐analyses of the effect of MMS versus IFA on LBW (birthweight less than 2500 g), preterm birth (births before 37 weeks of gestation) and SGA  in each study arm for each trial on the three outcomes of interest, and then calculated the pooled effect of MMS versus IFA for each outcome: overall, stratified into three subgroups , and stratified into two subgroups  of gestational age assessment.The main analysis included all trials, consistent with 2020 WHO guidelines comparison 1 . Subsequently, we conducted a sensitivity analysis limited to the trials that used UNIMMAP supplements in the intervention arm, following the same trial selection as used for the WHO guidelines . We repeated the same sensitivity analyses, but added the West trial  to calculate the overall and subgroup pooled effect estimates  of MMS from individually randomized and cluster‐randomized trials, using the generic inverse variance methods, as per the methodology used for the 2020 WHO guidelines  included for analysis  and the direction of the effect estimates was the same (consistently pointing towards a risk reduction). When limited to the seven trials that used ultrasound for gestational age assessment, MMS versus IFA resulted in a RR of 0.87  for LBW, 0.90  for preterm birth and 0.90  for SGA.A summary of the meta‐analysis results, including overall analyses, subgroup analyses with three groups and subgroup analyses with two groups, is presented in Table The two best methods 1 and 2) have a similar RR for preterm birth; when results for these two methods were combined , MMS versus IFA resulted in a RR of 0.91  for preterm births, RR of 0.89  for LBW and 0.98  for SGA. The forest plots of the subgroup analyses for each of the three outcomes are presented in Figures  and 2 haThe results of the sensitivity analyses limited to the trials that provided UNIMMAP supplements in the intervention arm can be found in Supporting Information: Appendix Table The West 2014 . This observation also applies to the pooled estimates from the trials that used the two best methods for gestational age assessment (ultrasound and prospective collection of date of LMP with confirmation of pregnancy by urine test), where benefits are evident for preterm birth .4.When the evidence is limited to the trials that provided UNIMMAP in the intervention arm, the results remained consistent in both sensitivity analyses.The present analyses, based on the data extracted from the 16 trials used for the 2020 WHO guidelines . It is noteworthy that the latest estimated coverage of early (first trimester) ANC visits in low‐income countries was only 24%  of the 1st day of the LMP. This method is based on the assumption that the average menstrual cycle is 28 days in length with ovulation occurring on Day 14, and pregnancy is assumed to last 280 days from the 1st day of the LMP. It has varying levels of accuracy among different populations, and several limitations such as uncertainty of the date due to recall bias, variations in the timing of ovulation and bleeding that can occur for other reasons other than menses  of the 1st day of the LMP can lead to more errors in the estimation of gestational age, which can affect the estimated prevalence of preterm birth or SGA. Assessment of birthweight is not dependent on gestational age measurements, so there may be less error in estimates of this outcome than is the case for preterm births or SGA. However, it should be noted that errors in any method used to assess gestational age (or weight) were expected to be the same in both MMS and IFA groups of a masked randomized clinical trial. The potential nondifferential measurement error for outcomes  would bias the results towards the null  could lead to meaningful benefits. The latest global estimates indicate that 20.5 million livebirths have a birthweight of less than 2500 g, and 91% of these are born in LMICs, mainly southern Asia (48%) and sub‐Saharan Africa (24%)  and was graded as low‐certainty evidence, but was nonetheless interpreted as ‘daily iron may reduce the risk of low‐birth‐weight neonates’  and was graded as high‐certainty evidence  in reducing the risk of adverse birth outcomes were more pronounced in those 11 trials—a finding made more relevant by new estimates for the burden of LBW globally. These results provide new evidence to support the validity of findings from existing trials, challenging the need for new efficacy trials using ultrasound for gestational age assessment and providing further support for a transition from IFA to MMS programmes in LMICs. Future convenings of the WHO guideline development group should consider these findings, in addition to other recent analyses demonstrating comparable effects of MMS (vs. IFA) on maternal anaemia outcomes (Gomes et al., Filomena Gomes, Robert E. Black, Parul Christian and Emily R. Smith conceptualized and designed the analyses. Filomena Gomes and Ziaul Rana extracted the data. Filomena Gomes carried out the analyses and drafted the manuscript. All authors contributed to the interpretation of the analyses, critically revised the manuscript, and approved its final version.The authors declare no conflict of interest.Supporting information.Click here for additional data file.


This data report aims to provide summary statistics of current GWASs on PTB in a Japanese population for future meta-analyses of genetics and PTB with larger sample sizes.Preterm birth (PTB), defined as the birth of a baby at <37 weeks of gestation, is known to be the main cause of neonatal morbidity and mortality. Here, we report genetic associations between preterm birth and gestational age in a Japanese population. We conducted a genome-wide association study (GWAS) of 384 cases who delivered prematurely and 644 controls and considered gestational age as a quantitative trait in 1028 Japanese women. Unfortunately, we were unable to identify any significant variants associated with PTB or gestational age using the current sample. We also examined genetic associations previously reported in European populations and identified no associations, even with the genome-wide subthreshold ( The genes associated with preterm birth, defined as birth before 37 weeks of gestation and a main cause of infant mortality, have yet to be identified in the Japanese population. Such genes have been identified in European populations. Natsuhiko Kumasaka at the National Center for Child Health and Development in Tokyo, Japan, and co-workers conducted a genome-wide association study of preterm birth or weeks of gestation using blood samples from over a thousand women. However, they found no significant associations, even when they examined regions centered on genes identified in previous studies. Identifying associated genes could help to identify and reduce risks to infants. The authors note that their data could be included in meta-analyses that combine the results of many studies and recommend further studies with larger sample sizes. The percentage of PTB in Japan was 3.71% between 1979 and 1983 but increased to 4.77% between 2009 and 20142. Although the rate of PTB in Japan is lower than that worldwide, it is clear that PTB is closely associated with morbidity and mortality in immature infants, and elucidating the cause of PTB is of interest. Many maternal and fetal characteristics have been associated with PTB, including maternal demographic characteristics, nutritional status, pregnancy history, infection, and biological and genetic markers3. However, 31–50% of PTB are due to spontaneous onset of labor, making it difficult to identify the cause4. The association between PTB and genetic variants has been reported previously. It was reported that women whose mothers or sisters had a history of PTB were 55% more likely to deliver prematurely than those with no family history of PTB5, and that genetic factors accounted for 34% of delivery timing in twin analysis6. Moreover, it was reported that maternal and fetal genetic factors influenced gestational age7. Recently, several genome-wide association studies (GWASs) on PTB have been conducted. The largest study, in which the EBF1, EEFSEC, AGTR2, WNT4, ADCY5, and RAP2G loci were associated with gestational week, and the EBF1, EEFSEC, and AGTR2 loci were associated with PTB, was reported in 2017 and used a discovery dataset from 23andMe comprising over 40 thousand women of European ancestry8. In addition, a genome-wide association study (GWAS) of the Finnish population in 2019 reported a novel association between the SLIT2 locus and PTB9. Although a few GWASs on PTB and gestational age have been reported, no GWASs have been conducted in an Asian population, including the Japanese population. Therefore, in this study, we conducted a GWAS of PTB and gestational age to identify related variants in a Japanese population.Preterm birth (PTB) is defined as delivery at <37 weeks of gestation. The estimated global PTB rate was 9.8% in 2000 and increased to 10.6% in 2014, ranging from 13.4% in North Africa to 8.7% in EuropeWe collected 1158 samples of postpartum maternal blood from Keio University Hospital between 2011 and 2020. This study was approved by the Keio University School of Medicine Ethics Committee (20100154) and the Institutional Review Board of the National Research Institute for Child Health and Development (406) and was conducted in accordance with the ethical standards outlined in the 1964 Helsinki Declaration and later amendments. All women provided written informed consent.10. The VCF file was converted from Illumina strands to reference sequence strands (GRCh37) using bcftools 1.911. The VCF files were converted from GRCh37 to GRCh38 using CrossMap 0.6.0 (default: no option)12.Of the 1158 samples, 80 medically-indicated PTB samples, such as those from women with multiple pregnancies and placenta previa, were excluded. After excluding these 80 samples, analysis was performed, as shown in the flowchart .After removing 13 samples by sample QC, we also filtered out low-quality variants by applying the following conditions. For variant call rates, the PLINK command with the “--missing” option was used, and 42,469 variants in the VCF files of ver1.0 and 65,843 variants in the VCF files of ver1.1 were removed because these variants had call rates less than 0.98. For Hardy–Weinberg equilibrium (HWE), the PLINK command with the “--hardy” option was used, and 408 variants in the VCF files of ver1.0 and 624 variants in those of ver1.1 were removed . Beagle software was used to estimate the genotype dosages for the GWASs, and the variants with DR2 > 0.7 were retained. We also filtered out low-quality imputed variants by applying the Hardy–Weinberg equilibrium (HWE) test with a p > 0.001 and minor allele frequency (MAF) > 0.001.After removing low-quality variants by variant QC, the resultant VCF files of ver1.0 and ver1.1 were transformed into a form that conforms to Beagle 5.4 (default: no option)After removing low-quality variants by variant QC, we checked the genetic relatedness. For the detection of relatedness, the PLINK command with the “--genome --min 0.1875” option was used, and 37 pairs were indicated to show relatedness. Of these 37 pairs, 7 pairs (14 samples) were from the same person who delivered twice: one delivery was a term birth and the other was a preterm birth. Of these pairs, 7 samples from the preterm birth were used for the subsequent analysis. Twenty-one pairs (42 samples) were from the same person who delivered twice, and both were term births. In these pairs, 21 samples with higher sample call rates were used for the subsequent analysis. The remaining 9 pairs (18 samples) were not from the same person. In those pairs, 9 samples with higher sample call rates than the other samples were used for the subsequent analysis. In summary, by analyzing relatedness, 37 samples were unrelated and used for the subsequent analysis. After filtering based on genetic relatedness, a total of 1028 samples and 11,183,581 variants were analyzed.By using the resultant file, detection of population stratification was conducted by using principal component analysis (PCA)  and the preterm-birth group  (Supplementary Fig. p < 5.0 × 10–8.GWASs were independently performed for both preterm birth as a binary trait and gestational age as a continuous trait by using PLINK 1.90 beta. In the analysis of preterm birth, the phenotype data were divided into two groups: the term-birth group (control group; p < 5.0 × 10–8 (Fig. p < 5.0 × 10–8 (Fig. A GWAS of PTB was conducted, and no SNPs were identified as significant at 0–8 Fig. . Then, a0–8 Fig. . Thus, i0–8 Fig. .Fig. 1Map < 10–6. Odds ratios of known SNPs8 associated with PTB and effect sizes of SNPs8 associated with gestational age were compared to those from our study (Supplementary Fig. The regions centered on SNPs known to be associated with PTB and gestational age were examined Fig. . None ofWe conducted a GWAS in a Japanese population and were unable to identify any significant variants associated with PTB and gestational age. We also examined variants around the variants known to be associated with PTB and gestational age reported previously, but no significant variants were confirmed. There are a couple of reasons that could explain these negative findings in this study. Although we excluded samples from medically-indicated PTBs in this study, we did not completely focus on spontaneous PTB because the sample size was expected to be extremely small. The sample size of this study was much smaller than that of other studies. Further studies with larger sample sizes and detailed clinical information are indispensable to detect significant genetic variants associated with PTB and gestational age in the Japanese population.Supplementary Figure 1Supplementary Figure 2Supplementary Figure 3Supplementary Figure 4Supplementary Figure 5Supplementary Table 1Supplementary Figure Legends


Atkinsoniella Distant, 1908 includes 99 valid species worldwide. Here, three new species from China are described and illustrated: Atkinsoniellastenopyga, A.wangi, and A.yingjiangensisspp. nov. An updated checklist of the known Atkinsoniella species worldwide based on the data of previous literature and studied materials is also provided. All the type specimens of three new species are deposited at the Institute of Entomology, Guizhou University, Guiyang, China.The sharpshooter genus  Atkinsoniella is a relatively large genus of the subfamily Cicadellinae. It was established by A.decisa (type species) and A.maculata. Atkinsoniella, proposed 15 new combinations and 13 synonyms, described 10 new species, and confirmed 26 valid species of this genus. Thereafter, new species were described successively.The genus Atkinsoniella species from China, including 33 new species, two Chinese new records, 12 new synonyms, and proposed Curvufacies Kuoh, 1993 as a new synonym of Atkinsoniella. Subsequently, 2 new species from China and Pakistan were described  and Yunnan-Guizhou Plateau (Yunnan Province) of China are provided. The checklist of all known Atkinsoniella species worldwide and the three new species is updated.To date, 99 valid species were described worldwide, of which 89 species occurred in China, and a few were scattered in Bay of Bengal, Bhutan, India, Indonesia, Kingdom of Bhutan, Laos, Malay Islands, Malaysia, Myanmar, Nepal, Pakistan, Philippines, Thailand, and Vietnam . In thisGUGC).The specimens were collected by sweeping (27–35 sweeps per collecting event) on shrubs and weeds using 2.5 m insect sweep nets on day-light and off-set sun by using a 500W high-pressure mercury lamps; all materials were preserved in absolute ethanol and stored at -20 °C in the laboratory. The abdomens of specimens were detached and soaked in 10% NaOH solution, boiled for 1–3 min, rinsed with water to remove traces of NaOH, and transferred to glycerol for further dissection, photography and preservation. The habitus and male genitalia were photographed using a KEYENCE VHX-6000 digital camera and a Nikon Eclipse Ni-E microscope, respectively. Adobe Photoshop 2020 was used to edit compiled photos. The length of the body was measured from the vertex to the rear of the forewings using a KEYENCE VHX-6000 digital camera. The morphological terminology is adapted from Taxon classificationAnimaliaHemipteraCicadellidaeDistant, 19083E2E5085-7F3F-59E9-B2C3-D12DAF74212FAtkinsoniella Distant, 1908: 235.Soibanga Distant, 1908: 236.Curvufacies Kuoh, 1993: 38.Atkinsonielladecisa Distant, 1908.Palaearctic, Oriental.Taxon classificationAnimaliaHemipteraCicadellidaeJiang & Yangsp. nov.899B50EA-1F85-58FD-BB79-849F315A9FF1https://zoobank.org/325305A3-840F-480C-B5CF-1F5FC86957C5Crown and thorax canary yellow and greyish white in dorsal view; a small subcircular black spot at apex of head and basal margin medially, and interocular width 2× wider than long; eyes fuscus; ocelli greyish white with narrow black border; forewing light orange; face off-white, frontoclypeus median with a broad yellowish white longitudinal; thorax and abdomen yellowish white in ventral view; legs orangish with pretarsi black or dark brown.Anterior margin of crown broadly rounded and convex, and median length of crown shorter than interocular width. Ocelli nearest to midline and posterior margin than eyes, lateral area concave, each ocellus further from the other than to the adjacent eye. Face with frontoclypeus flat medially; muscle impressions distinct and extend to the tip of crown; clypeal sulcus blurred in the median; anteclypeus longitudinally gibbous. Pronotum wider than head, anterior margin arcuately convex, posterior margin with medially concave. Scutellum with medial transverse depression. Forewings with distinct apical membranous area, base of second cells more proximal than third cells transversely.Male pygofer narrowly rounded posteriorly and convex dorsally, posterior half long scoop-shaped with macrosetae; pygofer processes slender and strongly sclerosed, base broad with microsetae; bending dorsad from basal one-third and then extending straightly, tip acute and exceeding dorsal margin posteriorly of pygofer. Subgenital plates in ventral view convex and short with one row of macrosetae uniseriate obliquely, long dense mid microsetae, and posterior half with long and short microsetae dispersedly with apex rounded. Aedeagus stubby and straight, with posterior margin truncate and dorsal margin concave subbasally, one protuberance at base ventrally articulating with paraphysis, and concave at the articulation with paraphysis apically; paraphysis long and thick, apical portion intumescent, apex bifurcated and articulating with aedeagus. Connective Y-shaped; style slender, with tip tapered and curved.stenopyga, referring a narrow pygofer shape.The specific epithet is the combined noun of stenos and tail from Greek, Length of male 7.8–8.0 mm.Holotype: ♂, Motuo, Tibet, China, 18 August 2020, coll. Xian-Yi Wang. Paratype, 1♂, same data as holotype.A.thaloidea Young, 1986, A.flavipenna Li & Wang, 1992, A.uniguttata Li, 1993, and A.bowa Yang, Meng & Li, 2017 in appearance, but can be easily differentiated from these species by the following characteristics: (1) pygofer slender; (2) aedeagus stubby with posterior margin truncate; and (3) two pointed dentate protrusions at the apex of the paraphysis incurved dorsally and embracing.This species is similar to China (Tibet).Taxon classificationAnimaliaHemipteraCicadellidaeJiang & Yangsp. nov.15EA130B-EC1B-5D7C-94B7-F133A2B19756https://zoobank.org/89195CDF-6EDC-4BF0-AEDB-A7508F9A9795Crown, thorax and forewings orange in dorsal view; crown with a black spot at anterior margin medially and a smaller black spot at posterior margin medially; eyes off-white or dark brown; ocelli off-white with black border; forewings orange, with apical membranous area darker; face, thorax and abdomen in ventral view, legs orange.Crown with anterior margin rounded prominently, and interocular width 2× wider than long. Ocelli nearest to midline and posterior margin than eyes, lateral area concave, each ocellus slightly further from the other one than to the adjacent eye. Face with a nodular protrusion in the center, frontoclypeus flat medially, muscle impressions distinct and extending to the tip of crown, clypeal sulcus distinct medially. Pronotum broader than head, anterior margin protruding roundly, posterior margin with medially concave. Scutellum convex anterior and posterior to transverse depression, with transverse depression arcuate, a large black spot near each basal angle in some specimens. Forewings with four apical cells, the base of the second cells more basal than third cells transversely, apical membranous area distinct.Male pygofer slender, posterior portion tilted dorsad and posterior margin round, posterior half with macrosetae; pygofer process lamellate, base with several macrosetae, bending dorsad from basal one-third, posterior one-third portion lamellate broadly and tortile backward and apex acute. Subgenital plates broad at base, posterior half narrow and bent dorsally, one row of macrosetae uniseriate obliquely in the median, lateral area with long dense microsetae, apical half with short microsetae dispersedly. Aedeagus broad at base, posterior half constricted and tilted dorsad, tip swordlike, ventral margin protuberant at the articulation with the tip of paraphysis and concave subbasally; paraphysis dilated apically and constricted subapically, apex bifurcated and articulating with aedeagus. Connective V-shaped. Style wide at base and tapered at tip, apex acute.The new species is named after the family name of collector Xian-Yi Wang.Length of male 7.9–8.0 mm.Holotype: ♂, Tongmai, Tibet, China, 18 August 2020, coll. Xian-Yi Wang. Paratypes, 1♂ (light trapped) +11♂♂, same data as holotype; 1♂, Tongmai, Tibet, China, 19 August 2020, light trapped, coll. Xian-Yi Wang.A.curvata Zhang & Kuoh in appearance and male genitalia, but can be distinguished from the latter by the following characteristics: (1) crown with a black spot in the median of the anterior margin, and the smaller black spot at the basal margin medially narrower than the width between the ocelli, but the latter only with a large V-shaped black spot below the ocelli; (2) pygofer of the new species slender overall, with posterior margin rounded, while pygofer of the latter slender at apical one-third, with the posterior margin truncate; (3) aedeagus of the new species tilted dorsally at the posterior half, while aedeagus of the latter straight overall; and (4) connective of the new species V-shaped, but connective of the latter Y-shaped.This species is similar to China (Tibet).Taxon classificationAnimaliaHemipteraCicadellidaeJiang & Yangsp. nov.C2F1BBF5-AAE6-5C59-9787-451AE04E75A4https://zoobank.org/6FD2EA20-B2DA-442B-B50E-A35F91051243Head and thorax dark orange in dorsal view; crown with a black spot at the anterior margin medially, basal margin with a black spot below each ocellus, and lateral margin with a black spot anterior to each antennal ledge; eyes dark brown; ocelli gray; pronotum with two small black spots abreast in the center, and posterior area with two large black spots transversely; scutellum with a large triangular black spot at each basal, and the base of the two spots linked; forewings black, with three longitudinal grayish white stripes, apical membranous area dark brown; face dark orange; thorax black in ventral view; legs grayish white.Crown with anterior margin convex roundly, median length of crown approximately equal to half of interocular width, concave lateral area of ocelli. Ocelli located at the line of anterior eyes, each ocellus slightly further from the other one than to the adjacent eye. Face with frontoclypeus flat in the median, muscle impressions and clypeal sulcus distinct. Pronotum wider than head, anterior margin convex roundly and posterior margin concave. Scutellum with transverse depression slightly posterior to the median. Forewings with apical membranous area not obvious, base of the second and third cells almost aligned transversely.Male pygofer narrowly rounded posteriorly, tip oblique dorsally, dorsal margin with lamellar prominence at basal one-third, with macrosetae in posterior half and microsetae in the median dispersedly; pygofer processes with microsetae at base, arising basiventrally on each side and extending dorsolateral posteriorly of pygofer, apex acute and exceeding posterior margin of pygofer. Subgenital plates broad at base and constrictive at tip, with one row of macrosetae uniseriate obliquely, long microsetae on lateral area, short microsetae on posterior half. Aedeagus slender, bent dorsally at tip and curved ventral, ventral margin with a horned protuberance basically articulating with paraphysis; paraphysis wide subapically, with two lamellate bulges at tip, apex uncinate and articulating with aedeagus. Connective Y-shaped. Style narrow at posterior portion, apex curved and exceeding the tip of connective.The name of the new species is derived from Yingjiang where the type specimens were collected.Length of male 8.0–8.1 mm.Holotype: ♂, Yingjiang, Yunnan, China, 25 June 2019, coll. Tie-Long Xu. Paratypes, 2♂♂, same data as holotype.A.limba Kuoh, 1991 in male genitalia, but markedly differ in the following characteristics: (1) pronotum with two small black spots abreast in the center and two large black spots transversely at posterior area; (2) apex of the pygofer process exceeding the posterior margin of the pygofer; (3) aedeagus concave obviously at the ventral margin basally; and (4) paraphysis inflated subapically and posterior margin Λ-shaped in ventral view.This species is similar to China (Yunnan).Atkinsoniellaalbimacula Yang & Li, 2002Atkinsoniellaalbimacula Yang & Li, 2002a: 556.Distribution. China (Yunnan).Atkinsoniellaalbipenna Yang, Meng & Li, 2017Atkinsoniellaalbipenna Yang, Meng & Li, 2017: 219.Distribution. China .Atkinsoniellaalcmena Tettigoniellaalcmena Distant, 1908: 219.Atkinsoniellaalcmena (Distant): Young, 1986: 96.Distribution. China (Tibet), India.Atkinsoniellaalternata Young, 1986Atkinsoniellaalternata Young, 1986: 100.Distribution. China .Atkinsoniellaangula Kuoh, 1992Atkinsoniellaangula Kuoh, 1992: 126.Distribution. China .Atkinsoniellaanabella Young, 1986Atkinsoniellaanabella Young, 1986: 107.Distribution. Bhutan, India, Nepal.Atkinsoniellaatrata Yang, Meng & Li, 2017Atkinsoniellaatrata Yang, Meng & Li, 2017: 207.Distribution. China (Yunnan).Atkinsoniellaatronotata Kollaatronotata Distant, 1918: 10.Atkinsoniellaatronotata (Distant): Young, 1986: 96.Distribution. India.Atkinsoniellaaurantiaca Cai & Kuoh, 1995Atkinsoniellaaurantiaca Cai & Kuoh, 1995: 89.Distribution. China .Atkinsoniellabeaka Yang, Meng & Li, 2017Atkinsoniellabeaka Yang, Meng & Li, 2017: 218.Distribution. China (Yunnan).Atkinsoniellabella Tettigoniabella Walker, 1851: 778.Atkinsoniellabella : Young, 1986: 96.Distribution. India, Nepal.Atkinsoniellabiundulata Meng, Yang & Ni, 2010Atkinsoniellabiundulata Meng, Yang & Ni, 2010: 42.Distribution. China (Yunnan).Atkinsoniellabowa Yang, Meng & Li, 2017Atkinsoniellabowa Yang, Meng & Li, 2017: 206.Distribution. China (Yunnan).Atkinsoniellabrevistyla Yang & Li, 2004Atkinsoniellabrevistyla Yang & Li, 2004: 757.Distribution. China .Atkinsoniellachangae Yang, Meng & Li, 2017Atkinsoniellachangae Yang, Meng & Li, 2017: 240.Distribution. China (Yunnan).Atkinsoniellacontrariuscula Cicadellacontrariuscula Jacobi, 1944: 44.Atkinsoniellacontrariuscula (Jacobi): Young, 1986: 97.Atkinsoniellafurcata Zhang & Kuoh, 1993: 15.Distribution. China .Atkinsoniellacurvata Zhang & Kuoh, 1993Atkinsoniellacurvata Zhang & Kuoh, 1993: 13.Distribution. China .Atkinsoniellacuspidata Meng, Yang & Ni, 2010Atkinsoniellacuspidata Meng, Yang & Ni, 2010: 45.Distribution. China (Yunnan).Atkinsoniellacyclops Tettigoniellacyclops Melichar, 1914: 127.Atkinsoniellacyclops (Melichar): Young, 1986: 97.Distribution. China , Indonesia, Nepal.Atkinsonielladactylia Yang & Li, 2000Atkinsonielladactylia Yang & Li, 2000: 410.Atkinsoniellatrinotata Cai & He, 2002: 147.Distribution. China .Atkinsonielladecisa Distant, 1908Atkinsonielladecisa Distant, 1908: 236.Distribution. India.Atkinsonielladivaricata Yang, Meng & Li, 2017Atkinsonielladivaricata Yang, Meng & Li, 2017: 205.Distribution. China .Atkinsonielladormana Li, 1992Atkinsonielladormana Li, 1992: 345.Distribution. China .Atkinsonielladubia Young, 1986Atkinsonielladubia Young, 1986: 104.Distribution. China (Tibet), Bhutan.Atkinsonielladuna Yang, Meng & Li, 2017Atkinsonielladuna Yang, Meng & Li, 2017: 236.Distribution. China .Atkinsoniellaexpanda Yang, Meng & Li, 2017Atkinsoniellaexpanda Yang, Meng & Li, 2017: 214.Distribution. China (Yunnan).Atkinsoniellafishtaila Yang, Meng & Li, 2017Atkinsoniellafishtaila Yang, Meng & Li, 2017: 221.Distribution. China (Hubei).Atkinsoniellafistular Naveed & Zhang, 2018Atkinsoniellafistular Naveed & Zhang, 2018: 286.Distribution. Pakistan.Atkinsoniellaflavilega Yang, Meng & Li, 2017Atkinsoniellaflavilega Yang, Meng & Li, 2017: 242.Distribution. China (Yunnan).Atkinsoniellaflavipenna Li & Wang, 1992Atkinsoniellaflavipenna Li & Wang, 1992: 95.Distribution. China .Atkinsoniellaflexa Kuoh, 1992Atkinsoniellaflexa Kuoh, 1992: 127.Distribution. China (Yunnan).Atkinsoniellafuripygofera Yang & Meng, 2011Atkinsoniellafuripygofera Yang & Meng in Yang, Meng & Li, 2011: 765.Distribution. China (Yunnan).Atkinsoniellafuscopenna Yang & Li, 2004Atkinsoniellafuscopenna Yang & Li, 2004: 756.Distribution. China (Tibet).Atkinsoniellagoosenecka Yang, Meng & Li, 2017Atkinsoniellagoosenecka Yang, Meng & Li, 2017: 222.Distribution. China .Atkinsoniellagrahami Young, 1986Atkinsoniellagrahami Young, 1986: 105.Atkinsoniellanigroscuta Zhang & Kuoh, 1993: 11.Atkinsoniellafurcula Yang & Li, 2002b: 40.Distribution. China .Atkinsoniellagregalis Kollagregalis Distant, 1908: 226.Atkinsoniellagregalis (Distant): Young, 1986: 97.Distribution. India, Myanmar.Atkinsoniellaguttata Kuoh, 1992Atkinsoniellaguttata Kuoh, 1992: 125.Distribution. China .Atkinsoniellaheae Yang, Meng & Li, 2017Atkinsoniellaheae Yang, Meng & Li, 2017: 238.Distribution. China (Tibet).Atkinsoniellaheiyuana Li, 1992Atkinsoniellaheiyuana Li, 1992: 348.Atkinsoniellarubra Kuoh & Cai in Cai & Kuoh, 1994: 14.Distribution. China , Vietnam.Atkinsoniellahuangi Yang & Zhang, 2000Atkinsoniellahuangi Yang & Zhang, 2000: 187.Distribution. China .Atkinsoniellahupehna Young, 1986Atkinsoniellahupehna Young, 1986: 118.Atkinsoniellaobliqua Zhang & Kuoh, 1993: 14.Distribution. China .Atkinsoniellainsignata Tettigoniatrilineata Melichar, 1902: 132.Tettigoniellatrilineatainsignata Haupt, 1924: 306.Tettigellachinensis Metcalf, 1955: 264.Atkinsoniellainsignata (Haupt): Young, 1986: 97.Atkinsoniellalonginotata Kuoh, 1992: 124.Distribution. China .Atkinsoniellajavana Kollajavana Melichar, 1914: 124.Atkinsoniellajavana (Melichar): Young, 1986: 97.Distribution. Indonesia.Atkinsoniellajini Yang, Meng & Li, 2017Atkinsoniellajini Yang, Meng & Li, 2017: 199.Distribution. China (Tibet).Atkinsoniellalatior Young, 1986Atkinsoniellalatior Young, 1986: 113.Distribution. China .Atkinsoniellalii Yang & Zhang, 2000Atkinsoniellalii Yang & Zhang, 2000: 186.Distribution. China (Yunnan).Atkinsoniellalimba Kuoh, 1991Atkinsoniellalimba Kuoh, 1991: 20.Distribution. China (Fujian).Atkinsoniellaliui Yang, Meng & Li, 2017Atkinsoniellaliui Yang, Meng & Li, 2017: 241.Distribution. China (Tibet).Atkinsoniellalonga Yang, Meng & Li, 2017Atkinsoniellalonga Yang, Meng & Li, 2017: 212.Distribution. China (Yunnan).Atkinsoniellalongiaurita Yang, Meng & Li, 2017Atkinsoniellalongiaurita Yang, Meng & Li, 2017: 202.Distribution. China (Yunnan).Atkinsoniellalongiuscula Feng & Zhang, 2015Atkinsoniellalongiuscula Feng & Zhang, 2015: 281.Distribution. China .Atkinsoniellamalaisei Young, 1986Atkinsoniellamalaisei Young, 1986: 102.Distribution. China (Yunnan), Myanmar.Atkinsoniellamediofasciola Yang & Li, 2002Atkinsoniellamediofasciola Yang & Li, 2002b: 40.Distribution. China .Atkinsoniellamembrana Yang, Meng & Li, 2017Atkinsoniellamembrana Yang, Meng & Li, 2017: 213.Distribution. China (Yunnan).Atkinsoniellamotuoensis Meng, Yang & Ni, 2010Atkinsoniellamotuoensis Meng, Yang & Ni, 2010: 47.Distribution. China (Tibet).Atkinsoniellamultiseta Yang, Meng & Li, 2017Atkinsoniellamultiseta Yang, Meng & Li, 2017: 226.Distribution. China (Yunnan).Atkinsoniellamungphuensis Kollamungphuensis Distant, 1908: 225.Atkinsoniellamungphuensis (Distant): Young, 1986: 97.Distribution. India, Myanmar.Atkinsoniellastenopyga Jiang & Yang, sp. nov.Distribution. China (Tibet).Atkinsoniellanigra Kuoh & Cai, 1994Atkinsoniellanigra Kuoh & Cai in Cai & Kuoh, 1994: 13.Distribution. China (Yunnan).Atkinsoniellanigricephala Li, 1992Atkinsoniellanigricephala Li, 1992: 349.Distribution. China .Atkinsoniellanigridorsum Kuoh & Zhuo, 1996Atkinsoniellanigridorsum Kuoh & Zhuo, 1996: 2.Distribution. China .Atkinsoniellanigripennis Yang & Li, 1999Atkinsoniellanigripennis Yang & Li, 1999: 2.Distribution. China (Yunnan).Atkinsoniellanigriscens Yang & Li, 2004Atkinsoniellanigriscens Yang & Li, 2004: 756.Distribution. China .Atkinsoniellanigrisigna Li, 1992Atkinsoniellanigrisigna Li, 1992: 344.Atkinsoniellachloritta Yang & Li, 2002a: 558.Distribution. China .Atkinsoniellanigrita Zhang & Kuoh, 1993Atkinsoniellanigrita Zhang & Kuoh, 1993: 12.Atkinsoniellabimanculata Cai & Shen, 1998: 43.Distribution. China .Atkinsoniellanigrominiatula Cicadellanigrominiatula Jacobi, 1944: 44.Atkinsoniellanigrominiatula (Jacobi): Young, 1986: 97.Distribution. China .Atkinsoniellanigrosteaka Li & Wang, 1994Atkinsoniellanigrosteaka Li & Wang, 1994: 27.Distribution. China (Tibet).Atkinsoniellaopponens Tettigoniaopponens Walker, 1851: 757.Tettigoniellabellona Distant, 1908: 212.Tettigoniellamarpessa Distant, 1908: 215.Kollacanidia Distant, 1908: 226.Kollamaculifrons Schmidt, 1911: 295.Kollamaculifronssimilis Schmidt, 1911: 296.Kollatrimaculata Schmidt, 1911: 297.Tettigoniellacuprea Melichar, 1914: 128.Kollatigrina Distant, 1918: 9.Kollamelichari China, 1935: 305.Atkinsoniellaopponens : Young, 1986: 97.Atkinsoniellatriguttata Zhang & Kuoh, 1993: 9.Distribution. China , India, Indonesia, Laos, Malay Islands, Malaysia, Myanmar, Nepal, Pakistan, Philippines, Thailand, Vietnam.Atkinsoniellapeaka Yang, Meng & Li, 2017Atkinsoniellapeaka Yang, Meng & Li, 2017: 237.Distribution. China (Jiangxi).Atkinsoniellapunica Yang & Li, 2002Atkinsoniellapunica Yang & Li, 2002a: 556.Distribution. China (Yunnan).Atkinsoniellarecta Yang, Meng & Li, 2017Atkinsoniellarecta Yang, Meng & Li, 2017: 209.Distribution. China (Yunnan).Atkinsoniellarectangulata Yang, Meng & Li, 2017Atkinsoniellarectangulata Yang, Meng & Li, 2017: 210.Distribution. China (Yunnan).Atkinsoniellarhomboida Yang, Meng & Li, 2017Atkinsoniellarhomboida Yang, Meng & Li, 2017: 216.Distribution. China (Yunnan).Atkinsoniellarinkihonis Tettigoniarinkihonis Matsumura, 1912: 36.Atkinsoniellarinkihonis (Matsumura): Young, 1986: 97.Curvufaciessordidula Kuoh, 1993: 39.Atkinsoniellatylata Yang & Li, 1999: 1.Distribution. China .Atkinsoniellarubrostriata Kuoh, 1992Atkinsoniellarubrostriata Kuoh, 1992: 123.Distribution. China (Yunnan).Atkinsoniellarufistigma Yang, Meng & Li, 2017Atkinsoniellarufistigma Yang, Meng & Li, 2017: 233.Distribution. China (Yunnan).Atkinsoniellasteelei Young, 1986Atkinsoniellasteelei Young, 1986: 109.Distribution. India.Atkinsoniellasulphurata Tettigoniellasulphurata Distant, 1908: 216.Atkinsoniellamaculata Distant, 1908: 236.Bhandaratetraspila Jacobi, 1944: 41.Atkinsoniellasulphurata (Distant): Young, 1986: 97.Atkinsoniellatetramaculata Zhang & Kuoh, 1993: 7.Atkinsoniellastigma Zhang & Kuoh, 1993: 8.Distribution. China , India, Indonesia, Myanmar.Atkinsoniellathalia Tettigoniellathalia Distant, 1918: 2.Atkinsoniellathalia (Distant): Young, 1986: 97.Atkinsoniellarubrivenosa Kuoh & Zhuo, 1996: 3.Distribution. China , Bay of Bengal, India, Myanmar, Pakistan, Thailand.Atkinsoniellathaloidea Young, 1986Atkinsoniellathaloidea Young, 1986: 117.Distribution. China , Myanmar.Atkinsoniellatiani Yang, Meng & Li, 2017Atkinsoniellatiani Yang, Meng & Li, 2017: 230.Distribution. China (Yunnan).Atkinsoniellatransifasciata Yang, Meng & Li, 2017Atkinsoniellatransifasciata Yang, Meng & Li, 2017: 215.Distribution. China (Yunnan).Atkinsoniellatridentata Yang & Li, 2011Atkinsoniellatridentata Yang & Li in Yang, Meng & Li, 2011: 766.Distribution. China (Yunnan).Atkinsoniellatripunctata Dmitriev, 2020Atkinsoniellatrimaculata Li, 1992: 347.= Atkinsoniellatripunctata Dmitriev, 2020: 7.Distribution. China .Atkinsoniellatuberostyla Yang, Meng & Li, 2017Atkinsoniellatuberostyla Yang, Meng & Li, 2017: 225.Distribution. China (Yunnan).Atkinsoniellauniguttata Li, 1993Atkinsoniellauniguttata Li, 1993: 40.Atkinsoniellavalida Feng & Zhang, 2015: 283.Distribution. China .Atkinsoniellavariata Young, 1986Atkinsoniellavariata Young, 1986: 110.Distribution. China , Nepal.Atkinsoniellavesta Kollavesta Distant, 1908: 224.Atkinsoniellavesta (Distant): Young, 1986: 97.Distribution. India, Pakistan.Atkinsoniellawangi Jiang & Yang, sp. nov.Distribution. China (Tibet).Atkinsoniellawarpa Yang, Meng & Li, 2017Atkinsoniellawarpa Yang, Meng & Li, 2017: 203.Distribution. China .Atkinsoniellawui Yang, Meng & Li, 2017Atkinsoniellawui Yang, Meng & Li, 2017: 200.Distribution. China .Atkinsoniellaxanthoabdomena Yang, Meng & Li, 2017Atkinsoniellaxanthoabdomena Yang, Meng & Li, 2017: 232.Distribution. China (Yunnan).Atkinsoniellaxanthonota Kuoh, 1994Atkinsoniellaxanthonota Kuoh in Cai & Kuoh, 1994: 12.Distribution. China (Yunnan).Atkinsoniellaxanthovena Yang & Li, 2002Atkinsoniellaxanthovena Yang & Li, 2002c: 176.Distribution. China .Atkinsoniellaxanthovitta Kuoh, 1994Atkinsoniellaxanthovitta Kuoh in Cai & Kuoh, 1994: 11.Distribution. China (Yunnan).Atkinsoniellaxinfengi Yang, Meng & Li, 2017Atkinsoniellaxinfengi Yang, Meng & Li, 2017: 223.Distribution. China (Yunnan).Atkinsoniellayani Yang, Meng & Li, 2017Atkinsoniellayani Yang, Meng & Li, 2017: 235.Distribution. China (Yunnan).Atkinsoniellayingjiangensis Jiang & Yang, sp. nov.Distribution. China (Yunnan).Atkinsoniellayunnanana Yang, Meng & Li, 2017Atkinsoniellayunnanana Yang, Meng & Li, 2017: 229.Distribution. China (Yunnan).Atkinsoniellazaihuai Yang & Meng, 2011Atkinsoniellazaihuai Yang & Meng in Yang, Meng & Li, 2011: 766.Distribution. China (Yunnan).Atkinsoniellazhangmuensis Yang, Meng & Li, 2017Atkinsoniellazhangmuensis Yang, Meng & Li, 2017: 227.Distribution. China (Tibet).Atkinsoniellazizhongi Jiang & Yang, 2022Atkinsoniellazizhongi Jiang & Yang in Jiang, Li, Yu & Yang, 2022: 5Distribution. China .


Colloid cysts are benign tumors usually located at the level of the foramen of Monro and account for approximately 1% of all intracranial tumors. Endoscopic surgical treatment represents the approach of choice for removal of these tumors and is usually preferred over transcortical or transcallosal microsurgical approaches. Our purpose is to demonstrate the feasibility of endoscopic removal of colloid cysts using a novel aspiration and fragmentation system, currently designed for evacuation of cerebral hematomas.We performed an evaluation of the results obtained in patients with symptomatic colloid cysts of the third ventricle operated on using an endoscopic neuroevacuation system  between April 2020 and April 2022. Instrumentation and surgical technique are described in detail. All patients underwent postoperative MRI to assess the extent of cyst removal.Five patients were included in our study. The predominant symptom at onset was headache. No intraoperative complications related to the technology in use occurred. The surgical time for the cyst removal was significantly shorter than removal via a standard endoscopic technique (80 vs. 120 min). Removal was complete, both content and capsule of the cyst, in all patients. In all cases there was a complete regression of the previously complained symptoms.The Artemis Neuro Evacuation Device has proved to be effective and safe in removal of colloid cysts of the third ventricle and may be proposed as a possible alternative or as a complement of the standard instruments routinely used in neuroendoscopy. In asymSurgical removal is the preferred treatment for symptomatic patients with a colloid cyst of the third ventricle. In the past, microsurgical resection through a transcallosal or transcortical approach has been the most common approach for removal of these lesions –6. In thMore recently, a novel aspiration and fragmentation system  has been designed for minimally invasive endoscopic evacuation of intracerebral hemorrhages. Indeed, this system takes advantage of standard cranial neuroendoscopy concepts and applies them to the removal of intracerebral hematomas, such as for Stereotactic Intracerebral Hemorrhage Underwater Blood Aspiration (SCUBA) technique. We considered these characteristics appropriate even for endoscopic removal of colloid cysts.The purpose of this study is to assess the safety and feasibility of using this endoscopic neuroevacuation system for the removal of colloid cysts of the third ventricle.2.2.1.The Artemis Device is a single-use straight device with diameters from 1.5 to 2.8 mm. The handle of the device is connected to a vacuum pump via flexible tubing. A maximum pressure of 29 in Hg (98.2 kPa) with a flow rate of 0.8 standard cubic feet per minute can be generated, while a knob on the pump permits a fine-controlling aspiration.This system provides powerful and controlled aspiration that, together with its built-in fragmentation mechanism, allows a safe, gentle, precise, and constant removal of the blood clot. All the components of the system are physician controllable. In this way, if the surgeon notices that an artery or a vein are in the path of the tip, suction pressure can be easily adjusted to minimize the risk of iatrogenic vascular injury, both to the thalamostriate vein and the choroid plexus.The hematoma must extrude into the tip of the device cannula, under aspiration, before the fragmentation mechanism, an inner rotating toothed shaft can act. The high-torque rotation of that inner shaft allows the clot fragmentation, only inside the lumen of the cannula, for a continuous aspiration without clogging. All technical details about this system are summarized in 2.2.We retrospectively evaluated 5 patients operated on for colloid cysts of the third ventricle with an endoscopic approach associated with the use of the Artemis Device between April 2020 and April 2022. Institutional review board approved the study and a written consent was collected from all patients undergoing the procedure. All patients underwent preoperative imaging by contrast-enhanced MRI.The surgical procedure involved a purely endoscopic transforaminal approach, following the standard technique to access the lateral ventricle through Kocher's point. The access varied between the right or left sides depending on the location of the cyst relative to the roof of the third ventricle and the size of the foramina of Monro and the lateral ventricles.Through a small incision in the frontal region, a precoronaric burr hole was created and a 19 French introducer peel-away sheath was inserted to access the lateral ventricle. Then, a Storz 6-degree viewing angle rigid LOTTA Neuroendoscope  or, alternatively, an Aesculap 0-degree rigid MINOP Neuroendoscope , was inserted.Once the cyst was in view, a 2.8 mm or 2.1 mm Artemis Device was introduced into the ventricle through the working channel of the rigid endoscope . In our All procedures were performed by experienced senior surgeons with expertise in endoscopic ventricular surgery. At the conclusion of the surgery, the extent of cyst removal, including the capsule and intracystic content, was evaluated.A postoperative MRI was obtained within 72 h after surgery and 3 months later, to confirm the absence of residual cysts and assess ventricular size.3.In this study, we treated 5 patients, who had colloid cysts of the third ventricle, via an endoscopic surgical approach assisted by the Artemis Device. The patients, all female, had a mean age of 45 years (range 28–65).In all cases, the main symptom at onset was headache, with two patients also complaining of nausea and vomiting, one patient with short-term memory impairment and difficulty concentrating at work, and one patient with gait disturbances.All patients came to our outpatient clinic with a contrast-enhanced brain MRI, as prescribed by their primary care physician or neurologist. The average cyst size was 12 mm (range 9–15), and hydrocephalus or ventriculomegaly was observed in 4 out of 5 patients. Although occasionally the contents of the cyst may be firm, in all our cases the contents were soft.The average duration of the procedure was approximately 80 min, representing an important reduction in operative time compared to the average of 120 min required for the previous five colloid cyst removals performed using standard endoscopic techniques.In all cases, the entire procedure of removing the cyst and its contents was performed with the Artemis, without the need to use grasping forceps, scissors or other conventional instrumentation through the working channel of the endoscope.There were no intraoperative complications, with minor venous bleeding easily controlled through saline irrigation and bipolar coagulation. In no case was it necessary to convert the endoscopic procedure to craniotomy.The procedure was well tolerated and safe for all patients. Postoperative and 3-month follow-up MRIs demonstrated complete removal of the cyst, including both the content and the capsule, in all patients, with reduction of ventriculomegaly. In 3 of 5 cases, MRI at 1-year follow-up showed complete removal of the cyst and regression of ventriculomegaly.Immediate improvement in headache symptoms was observed in all patients, and those with cognitive or gait impairments experienced progressive recovery in the following months. The average length of hospital stay was 4 days (range 3–5).A summary of all patient information is provided in 3.1.3.1.1.A 28-year-old female patient presented to our outpatient clinic complaining of headache for approximately two years and, for the past six months, short-term memory deficits and difficulty keeping focused while working.Contrast-enhanced MRI revealed a 10.5 mm colloid cyst of the third ventricle, slightly deviated to the left of the midline, resulting in significant enlargement of the lateral ventricles, particularly on the left side –C.The patient underwent a minimally invasive endoscopic procedure with left frontal access for complete removal of the cyst, assisted by the Artemis Device . PostopeThis case represented our first experience using the Artemis Device for colloid cyst removal. As can be appreciated in the video, we were immediately able to assess the comfort and ease of use of this device in removing both the capsule and the mucinous contents in order to achieve a truly complete removal of the cyst.The patient was discharged on the third postoperative day with complete resolution of her headache. At a three-month follow-up appointment, the patient reported significant improvement in her previously experienced memory and concentration deficits, leading to notable enhancements in her work performance.3.1.2.A 43-year-old female patient presented to our clinic with a history of worsening headache over the past year, accompanied by nausea and unsteady gait.After neurologic consultation, she underwent a contrast-enhanced MRI showing a colloid cyst of the third ventricle of 15 mm in size, causing obstruction of both foramina of Monro and consequent hydrocephalus –C.The patient underwent cyst removal using a right frontal endoscopic approach assisted by the Artemis Device. On endoscopic view, the cyst was largely hidden below a narrow foramen of Monro and therefore removal was more challenging .The video clearly depicts the unfavorable position of the cyst. In this case, the suction system provided by the Artemis allowed us to bring the cyst into a favorable position to be more easily fragmented and suctioned. Additionally, the device's adjustable suction power helped prevent damage to the thalamostriate vein, demonstrating its efficacy and safety.Postoperative MRI confirmed complete removal of the cyst accompanied by an initial reduction in ventricular size –F.The patient was discharged on the third postoperative day with no headache. At the three-month outpatient follow-up, the patient reported complete recovery of walking stability.4.Innovation and technology in neurosurgery are advancing rapidly, leading to the introduction of a growing number of tools aimed at assisting surgeons and improving surgical outcomes.By the development of appropriate tools, there has been great interest in pure endoscopic treatment of colloid cysts because of their midline and intraventricular location, cystic shape, and absence of major bleeding –9.The goal of colloid cyst resection is the complete excision of the colloid cyst capsule and its contents to prevent future recurrence.In the past, the most common approach for surgical resection of colloid cysts involved a craniotomy and microsurgical resection through a transcallosal, transcortical, or subfrontal approach. Studies on microsurgical colloid cyst resection have shown a high success rate in terms of cyst removal with low recurrence rates, thanks to the larger workspace, availability of surgical instrumentation, and bimanual surgical dissection , 4, 9.Simple suction of the colloid without complete removal of the cyst wall often results in recurrence, at a rate up to 80% , 9, 10.However, the risks and complications associated with the resection of the colloid cyst wall should not be overlooked due to its close proximity to important deep venous tributaries, the fornices, and the hypothalamus . For thiIn this regard, for colloid cysts firmly attached to the tela choroidea or located in the middle-posterior third of the roof of the third ventricle, Iacoangeli et al. proposed a combined transforaminal-transchoroidal approach using scissors, bipolar coagulator, or a deflated Fogarty catheter as a dissector, exploiting both working channels of the rigid endoscope . Anyway,In alternative, Chibbaro et al. proposed an anterior trans-frontal endoscopic approach to reach the roof of the cyst and detach it from the tela choroidea more easily and safely. In this way, they stated a total cyst removal rate of 86.2% .Rangel-Castilla suggested that an estimated entry point of 4 cm perpendicular to the midline and 4.5 cm anterior to the coronal suture can be used in patients with ventriculomegaly . For thiAnyway, the anterior trans-frontal approach is criticized. Due to an angle of the foramen of Monro of about 20° to the sagittal plane, in order to gain complete visualization of the lesion, it is necessary to push the endoscope medially, resulting in compression of the anterior column of the fornix and the anterior septal vein .The optimal outcomes in endoscopic removal of intraventricular lesions are influenced not only by the characteristics of the lesion itself, including its location, size, density, and vascularity, but also by the accessibility of advanced endoscopic devices.The Artemis Neuro Evacuation Device is a low-profile aspiration and fragmentation system that was designed initially for intraventricular hemorrhage evacuation and later for deep-seated intraparenchymal hemorrhage evacuation. It has also been proposed for other conditions such as cerebellar hemorrhages, acute subdural and epidural hematomas, abscesses and pituitary adenomas –19. HoweIn 2016 Tan et al. described the advantages of the Apollo System  for the minimally invasive evacuation of intraventricular hemorrhages, which is a similar use of the device to ours . The ApoBased on our successful experience using the Artemis Device in five procedures for endoscopic removal of intraventricular hematomas, we have decided to expand its use for the removal of other intraventricular lesions, including colloid cysts. Our decision to utilize the Artemis Device for endoscopic removal of colloid cysts is based on our prior experience with the standard technique for removing these lesions.In all our clinical cases, the cysts were not firmly attached to the tela choroidea or located in the middle or posterior third of the roof of the third ventricle, eliminating the need for a transchoroidal or anterior frontal approach.In any case, if the cyst is not strongly attached to the tela choroidea, the controlled suction provided by the Artemis Device causes the cyst to detach from the superiorly placed tela and protrude into the Monro. If a small residual fragment remains, it can be visualized using a 30-degree endoscope and, if feasible, removed.In fact, the Artemis Device allows the transchoroidal approach not to be performed except when the cyst is attached medio-posteriorly to the roof of the third ventricle.Indeed, although using a good endoscopic surgical equipment, we noticed that with the use of standard endoscopic instruments, such as scissors, forceps, and mono- or bipolar coagulation systems, cyst removal was rather challenging and not always complete, both in terms of removing the capsule and mucinous content, also lacking a precise, safe and effective suction system. In this regard, Souweidane proposed a No. 6 French plastic endotracheal catheter with adjustable suction for the removal of solid intraventricular tumors, highlighting the advantages of transparency in distinguishing the tumor from other structures during aspiration . HoweverActually, this new technology allowed us to safely remove the cyst without “digging” beyond the cyst borders, thus avoiding without iatrogenic vascular or parenchymal damage.By incorporating both aspiration and fragmentation functions into one device, the Artemis brings the bimanual advantages of microsurgery to endoscopic procedures. Additionally, compared to traditional endoscopic surgical techniques, this neuroevacuation device overcomes the limitations of piecemeal removal of the cyst's capsule and solid contents through its effective fragmentation system. Its equally effective suction function, equipped with a precise pressure control system, provides a viable alternative to other systems proposed by different authors, such as flexible nitinol stone retrieval baskets, endotracheal tubes, or central venous cannulas. Actually, the choice among these systems depends heavily on the surgeon's preference or the available equipment , 22.As in brain tumor surgery, the use of aspirators and scissors has been gradually replaced by the advent of ultrasonic aspirators, we believe that the Artemis Device has the potential to play a crucial role in the endoscopic removal of colloid cysts, either as a standalone device or in combination with conventional instrumentation.However, future multi-center studies are needed to further investigate its impact on long-term clinical outcomes.


To assess in utero exposures associated with leukocyte telomere length (LTL) at birth and maternal LTL in a primarily Latinx birth cohort.Mothers and newborns were recruited postnatally before 24 h of life. Newborn LTL was collected via heelstick at birth and maternal LTL was collected postnatally. LTL was determined by quantitative PCR. Using a longitudinal design, we evaluated associations between neonatal and maternal LTL and appropriate maternal gestational gain as indicated by the American College of Obstetrics and Gynecology (ACOG).n = 386) and maternal LTL was 1.54 ± 0.26 T/S (n = 58). Independent risk factors for shorter LTL at birth included longer gestational duration  and maternal gestational weight gain below ACOG recommendations .Mean infant LTL was 2.02 ± 0.30 T/S (Gestational weight gain below ACOG recommendations may adversely impact neonatal health in Latinx infants as indicated by shorter LTL at birth. Telomeres, a biomarker of mitotic replicative history in somatic cells , shortenThere is significant LTL variability at birth . Most stPrevious studies have found race/ethnicity to be a significant factor impacting LTL at birth , 34, 39.As shorter LTL at birth is associated with long-term adverse health outcomes , 43, 51,Data were collected from the Telomere at Birth (TAB) cohort, a longitudinal study of mothers and babies recruited postnatally at UCSF Benioff and Zuckerberg San Francisco General Hospitals to assess how intrauterine exposures impact LTL. Eligibility criteria for maternal enrollment included English or Spanish speaking, no history of active illicit drug use and plans to stay in the San Francisco Bay Area for the foreseeable future. Eligibility criteria for infant enrollment included > 32 weeks gestational age, no contraindications for breastfeeding, in the newborn or intensive care nursery without any imminent surgery or chronic disease condition including possibility of HIV infection or COVID-19. All study procedures were approved by the Institutional Review Board (IRB) at the University of California, San Francisco (UCSF) and all patients signed informed consent for their and their children’s participation. There were no financial competing interests associated with this research. All methods were carried out in accordance with relevant guidelines and regulations (Declaration of Helsinki).Eligible study participants were screened via electronic medical record review in both hospitals and subsequently approached prior to 24-h postpartum when the California Genetic Newborn Screen is routinely conducted. Bilingual research coordinators explained all study procedures to potential participants. Participants were subsequently interviewed using a one-page questionnaire to collect information on exposures in pregnancy including dietary ones , defined as all sodas, fruit juices and sweetened teas, and 100% fruit juice intake during pregnancy), smoking/second hand smoke exposure and weight gain in pregnancy. Demographic and household information was also collected including race/ethnicity, marital status, smoking history and exposure to secondhand smoke. Self-reported medical conditions and health history were also collected including diagnoses in pregnancy such as gestational diabetes mellitus and hypertension, age of menarche and the medical record was used to confirm all diagnoses. Centers for Disease and Control (CDC) growth curves were used to calculate newborn percentiles and Z scores . All datDNA was extracted from the dried blood spots (DBS) on Whatmann 903 cards with the QIAamp DNA Investigator kit  and eluted in 50 ml ATE buffer. The DBS were collected between August 2016 to March 2020, stored at -80ºC and batch-extracted in November 2020. The DNA yields from DBS are too low to be accurately measured by OD260/OD280. Instead, based on our experience, we used 8 ul of extracted DNA. The values from the single-copy genes were within the standard curve, confirming that we had used the proper amount of input DNA.DNA was stored at -80ºC and LTL assays were performed between November to December of 2020. The telomere qPCR primers were tel1b [5'-CGGTTT(GTTTGG)5GTT-3'], used at a final concentration of 100 nM, and tel2b [5'-GGCTTG(CCTTAC)5CCT-3'], used at a final concentration of 900 nM. The single-copy gene (human beta-globin) qPCR primers were hbg1 [5'-GCTTCTGACACAACTGTGTTCACTAGC-3'], used at a final concentration of 300 nM, and hbg2 [5'-CACCAACTTCATCCACGTTCACC-3'], used at a final concentration of 700 nM. The final reaction mix consisted of the following: 20 mM Tris-hydrochloride, pH 8.4; 50 mM potassium chloride; 200 μM each deoxyribonucleotide triphosphate; 1% dimethyl sulfoxide; 0.4 × SYBR green I; 22 ng Escherichia coli DNA; 0.4 Units of platinum Taq DNA polymerase , and approximately 6.6 ng of genomic DNA per 11 µl reaction. A threefold serial dilution of a commercial human genomic DNA  containing 26, 8.75, 2.9, 0.97, 0.324 and 0.108 ng of DNA was included in each PCR run as the reference standard. The quantity of targeted templates in each sample was determined relative to the reference DNA sample by the maximum second derivative method in the Roche LC480 program. The reaction was carried out in a Roche LightCycler 480 in 384-well plates, with triplicate wells for each sample. Dixon Q test was used to exclude outliners from the triplicates. The average of the T and S triplicate wells after outliner removal was used to calculate the T/S ratio for each sample. The same reference DNA was used for all PCR runs. The PCR efficiencies of the T and S reactions were 88.4% ± 4.1% and 91.4% ± 3.9% respectively.The thermal profile for telomere (T) consisted of denaturing at 96ºC for 1 min followed by 30 cycles of denaturing at 96ºC for 1 s and annealing or extension at 54ºC for 60 s with fluorescence data collection. The thermal profile for a single copy gene (S) consisted of denaturing at 96ºC for 1 min followed by 8 cycles of denaturing at 95ºC for 15 s, annealing at 58ºC for 1 s, and extension at 72ºC for 20 s, followed by 35 cycles of denaturing at 96ºC for 1 s, annealing at 58ºC for 1 s, extension at 72ºC for 20 s, and holding at 83ºC for 5 s with data collection. We adapted the assay from the Cawthon 2002 study . The aveWe evaluated whether the LTL data was normally distributed using a QQ plot graphical plot which confirmed LTL normal distribution. We conducted bivariate analyses using t-tests to evaluate the association between maternal and child LTL and dichotomous parental characteristics such as maternal high school education, Latinx parental ethnicity, paternal age (≤ 35 years and > 35 years), maternal smoking (yes/no), maternal mental illness pre-gestation or during pregnancy, maternal pre-existing or gestational hypertension, age of menstruation onset (≤ 12 years and > 12 years), and weight gain during pregnancy (≤ 40 lbs and > 40 lbs).Parental categorical variables that were assessed in relation to child or maternal LTL included maternal education, marital status, parental race, maternal age , maternal diabetes , sugar-sweetened beverage (SSB) consumption  SSB consumption, high (> 4/week) SSB consumption), pre-pregnancy maternal body mass index (BMI) , American College of Obstetrics and Gynecology (ACOG) [Dichotomous child variables included gender (M/F), Apgar at 5 min , birth type , child birth weight Z-score , child birth length Z-score , and head circumference . Student t-tests were used to ascertain child and maternal LTL in relation to dichotomous variables. Similarly, categorical child characteristics such as gestational age , Apgar at 1 min , and child birth weight , macrosomic (>4000 grams)) were assessed using one-way analysis of variance tests.Linear regression and Pearson’s correlation coefficient was used to assess the relationship between continuous variables such maternal LTL and the following continuous variables: maternal age, SSB intake, pre-pregnancy BMI, weight gain in pregnancy (lbs), age of menstruation onset, parity, gestational age, child birth weight (grams), birth weight Z-score, birth length Z-score, Apgar score at 1 min, Apgar score at 5 min, and head circumference (cm).Regressions and Pearson’s correlation coefficient was also performed to assess the association between child LTL and the variables mentioned above.p < 0.10 in bivariate analyses or potential biological plausibility were included in multivariable models.Multivariable linear regression models were used to assess independent predictors of maternal LTL and child LTL. Variables with statistical significance of n = 351) included birthweight Z score, SSB weekly consumption, maternal Latina ethnicity, maternal age at menarche, gestational age, pre-existing or gestational mental illness and ACOG weight gain during pregnancy  and maternal pre-pregnancy BMI. A smaller model (n = 151) included paternal Latino ethnicity in addition to the aforementioned variables . The second model was significantly smaller as there was a sizable percentage of missing data for the second model as fewer families provided ethnicity information on fathers. We decided to run this smaller model to evaluate the potential role of paternal ethnicity on infant LTL.We constructed two multivariable models of child LTL. One larger model (n = 54), we included the continuous variables parity, SSB consumption per week, maternal age, maternal pre-pregnancy BMI, gestational weight gain in pregnancy and the dichotomous variable maternal high school education (high school diploma/no high school diploma).In the maternal LTL model . Similarly, mothers who gained less than the ACOG recommended weight gain for pregnancy had infants with shorter LTL (1.95 ± 0.24 T/S) compared with mothers who gained the recommended or above the recommended amount  although the difference did not meet statistical significance (Table p < 0.05).Mothers with a history of mental illness had shorter infant LTL (1.96 ± 0.28 T/S) than mothers with no history (2.03 ± 0.30 T/S), although this relationship was not statistically significant (P = 0.04) (Table P = 0.02). Larger head circumference was associated with longer newborn LTL but the results trended towards statistical significance.We found few child level variables that were associated with longer LTL at birth Table . Female 4) Table  as did nP = 0.02) (Table For the 58 mothers with leukocyte telomere length (LTL) measured postnatally, mean LTL was 1.54 ± 0.26 T/S (Table N = 359) of newborn LTL including maternal Latina ethnicity, maternal mental illness during pregnancy, age of menarche, maternal pre-pregnancy BMI, weight gain in pregnancy based on ACOG recommendations, maternal diabetes mellitus , newborn sex, gestational age, birth weight Z-score, and maternal SSB consumption per week, three variables were associated with newborn LTL (Table p = 0.01). Longer gestational duration compared with shorter gestation was associated with shorter LTL 0.01; p < 0.01). Mothers with weight gain below the ACOG recommendation also had newborns with shorter LTL . (Table In multivariable model N = 59 of newN = 156), two variables were associated with shorter newborn LTL. Increased gestational age was associated with shorter LTL 0.01; p < 0.01) and mothers with weight gain below the ACOG recommendation similarly were associated with shorter newborn LTL 0.04; p < 0.01) (results not shown). Paternal Latino ethnicity of South American/Caribbean/Spanish/Portuguese origin was associated with longer LTL in newborns but the results trended to statistical significance  (results not shown). Similar to the above larger model of newborn LTL, male sex was associated with shorter LTL compared with female newborns although the results trended towards statistical significance .In a smaller model of newborn LTL including paternal Latino ethnicity categories , maternal age, parity, maternal education, weight gain within, below or above ACOG recommendations and pre-pregnancy BMI with a sample size (n = 54) including maternal parity, SSB weekly consumption (servings), maternal age, education level and pre-pregnancy BMI, increasing maternal age was associated with a decreased maternal postnatal LTL  (Table p = 0.046)  is associated with a reduction in newborn infant LTL. We found the longest infant LTL to be from the normal weight gain category, providing evidence at the cellular level of the integrity of these ACOG recommendations. Our studies confirm findings from another group that found shorter fetal LTL with inadequate gestational weight gain earlier in gestation . MaugeriIn addition to our observations of negative LTL effects from inadequate gestational weight gain, other adverse maternal and neonatal outcomes are related to high and low gestational weight gain , and appMaternal educational disparities often track with health outcomes (both for mothers and children), as education level is a good proxy of overall socioeconomic status . In our n = 54) had a 5.1% difference between male and female newborns [Similar to previous findings in Latinx newborns , in thisnewborns . Other Unewborns , 53 or anewborns  and a stnewborns . It is pnewborns  more proPrevious studies have demonstrated significant differences in racial background and LTL in infants , 25, 49.As Latinx ethnicity comprises heterogeneous population groups with different racial backgrounds, we sought to further categorize place of origin within our diverse cohort of Latinx families. We found longer LTL of infants from fathers with Caribbean, South American, Spanish or Portuguese backgrounds although the results only trended to statistical significance. It is possible that this group reflects the African ancestry of the Caribbean origin fathers, who comprised about 20% of our Latinx fathers. Black African and African-Americans have longer LTL than non-Hispanic whites in many other studies in adults , 57, 65,Overall, our study did not replicate the association between adverse maternal health exposures in pregnancy and shorter LTL in neonates, possibly due to the relative homogeneity of our sample in terms of socio-demographics and the absence of common chronic health conditions.Other studies have found that maternal stress during pregnancy is associated with decreased maternal LTL  and infaWe also did not find any association with SSB consumption in pregnancy and child or maternal LTL. From previous studies, including some of our own, sugar-sweetened beverage (SSB) consumption has been shown to be associated with shorter LTL in early childhood, adolescence, and adulthood , 37, 68 We also did not find any association between parental age and infant LTL. Other studies have shown positive associations between paternal age and children’s LTL , 31, 71,Future studies could evaluate the role of maternal gestational gain on telomere length in other tissue types such as placental and umbilical cord that could better elucidate pathways between maternal health in pregnancy and neonatal outcomes. Longitudinal measurements of placental LTL could help elucidate whether gestational gain at certain time periods in pregnancy were of particular significance. Other studies have suggested that DNA methylations patterns may mediate the relationship between parental phenotypes and infant LTL and as such future infant LTL studies could also include evaluation of DNA methylation . In this