Determining the longer-term health effects of air pollution has been difficult owing to the multitude of potential confounding variables in the relationship between air pollution and health. Air pollution in many areas of South Asia is seasonal, with large spikes in particulate matter (PM) concentration occurring in the winter months. This study exploits this seasonal variation in PM concentration through a natural experiment.This project aims to determine the causal effect of PM exposure during pregnancy on pregnancy and child health outcomes.We will use an instrumental variable (IV) design whereby the estimated month of conception is our instrument for exposure to PM with a diameter less than 2.5 μm (PM2.5) during pregnancy. We will assess the plausibility of our assumption that timing of conception is exogenous with regard to our outcomes of interest and will adjust for date of monsoon onset to control for confounding variables related to harvest timing. Our outcomes are 1) birth weight, 2) pregnancy termination resulting in miscarriage, abortion, or still birth, 3) neonatal death, 4) infant death, and 5) child death. We will use data from the Demographic and Health Surveys (DHS) conducted in relevant regions of Bangladesh, India, Nepal, and Pakistan, along with monthly gridded data on PM2.5 concentration , precipitation data (0.5°×0.5° resolution), temperature data (0.5°×0.5°), and agricultural land use data (0.1°×0.1° resolution).Data access to relevant DHSs was granted on June 6, 2021 for India, Nepal, Bangladesh, August 24, 2021 for Pakistan, and June 19 2022 for the latest DHS from India.If the assumptions for a causal interpretation of our instrumental variable analysis are met, this analysis will provide important causal evidence on the maternal and child health effects of PM2.5 exposure during pregnancy. This evidence is important to inform personal behavior and interventions, such as the adoption of indoor air filtration during pregnancy as well as environmental and health policy.DERR1-10.2196/35249 South Asia is experiencing some of the highest levels of ambient air pollution globally. In cross-country comparisons of fine particulate matter with a diameter less than 2.5 μm (PM2.5), Bangladesh has emerged as the country with the highest population-weighted levels, Pakistan has the second highest levels, India has the third highest levels, and Nepal has the 12th highest levels .3 [3) [3) [Our study focuses on air pollution in the Indo-Gangetic Plain (IGP), which stretches across Bangladesh, Nepal, India, and Pakistan. Pollution levels in the IGP are even higher than those in the study region in general. For instance, in the Indian part of the IGP, the annual mean PM2.5 concentration is above 100 μg/m3 [3) , and mor [3) [3) . In the  [3) [3) . Substan [3) [3) .3, pollution during the monsoon period is mostly around 50 μg/m3, and even heavily polluted cities such as Delhi occasionally record levels below 30 μg/m3 [Annual mean PM2.5 levels disguise substantial seasonal variation in pollution in the IGP. While the winter months of October-February are characterized by high pollution reaching levels of over 150 μg/m30 μg/m3 ,10.Seasonal variation in PM2.5 levels is particularly salient for the study of effects of pollution on pregnancy outcomes. Depending on the month of conception, fetuses experience very different levels of in utero exposure, which affects birth and child health outcomes. Moreover, exploiting seasonal variation provides a potent research design for identifying the causal effects of prenatal pollution exposure.By now, it is well established that exposure to increased PM2.5 levels during the prenatal period is associated with a range of negative child health outcomes. Air pollution has been linked to preterm birth -13, low However, the associations between negative child health outcomes and particulate matter have not been consistent across the literature. A 2017 systematic review did not find clear evidence of an association with the risk of preterm birth or term low birth weight . There iOur study furthers the understanding of PM2.5 on pregnancy and child health outcomes in South Asia. Our study aims to (1) determine whether exposure to higher PM2.5 concentrations during pregnancy reduces the birth weight of the child; (2) determine whether exposure to higher PM2.5 concentrations during pregnancy increases the risk of neonatal, infant, and child death; (3) determine whether exposure to higher PM2.5 concentrations during pregnancy increases the risk of a pregnancy terminating in a miscarriage, abortion, or still birth; and (4) understand in which trimesters of pregnancy PM2.5 exposure most strongly reduces birth weight and increases the risk of neonatal, infant, and child death.The primary data set for this observational study is the Demographic and Health Surveys (DHSs) conducted in Bangladesh, India, Nepal, and Pakistan . The DHSAccess to the DHS is public but needs to be requested. We obtained access to the DHS data on June 6, 2021 for India, Nepal, and Bangladesh and on August 24 for Pakistan.This research is a secondary data analysis of fully anonymized data and does not require ethics approval, as per University of Oxford institutional research ethics policy .The DHS codebook  provides details on the file structure, computation of additional variables, and in-depth descriptions of all variables contained in the data sets .We impute the date of conception for all births within the last 5 years by subtracting the duration of an average pregnancy (40 weeks) from the date of birth reported in the DHS. The instrumental variable we construct is month of conception, a factor variable (1-12) indicating the calendar month when the pregnancy began. We also generate similar variables for each trimester of the pregnancy, using analogous procedures and assuming a length of 12.33 weeks  for each trimester.Prenatal PM2.5 exposure will be computed by matching the respondents’ cluster’s GPS locations with gridded pollution data to obtain location-specific estimates of ambient PM2.5 exposure during each pregnancy. The computed measures include the following:3 (weighted)Mean PM2.5 exposure during the pregnancy, measured in units of 10 μg/m3 Median PM2.5 exposure during the pregnancy, measured in units of 10 μg/m3 10th, 25th and 75th, and 90th percentile monthly PM2.5 exposure during pregnancy, measured in units of 10 μg/m3 Maximum monthly PM2.5 exposure during pregnancy, measured in units of 10 μg/m3 (weighted)Cumulative PM2.5 exposure over the whole pregnancy period, measured in units of 10 μg/mNumber of high or low PM2.5 exposure months over the whole pregnancy period 3 (weighted)Mean PM2.5 exposure over the whole pregnancy period relative to the annual location-specific average, measured in units of 10 μg/mAll exposures with “weighted” in brackets are weighted by the fraction of the month that the pregnancy covers (between 0 and 1). For median, percentiles, minimum, and maximum exposure partial months are included.For each trimester of the pregnancy, the following measures are computed:3 (weighted)Mean PM2.5 exposure during each trimester of the pregnancy, measured in units of 10 μg/m3 (weighted)Cumulative PM2.5 exposure over each trimester of the pregnancy, measured in units of 10 μg/mNumber of high or low PM2.5 exposure months over the whole pregnancy period 3 (weighted)Mean PM2.5 exposure over the whole pregnancy period relative to the annual location-specific average, measured in units of 10 μg/mUsing gridded temperature and precipitation data, we compute the mean temperature and precipitation for each trimester of the pregnancy, the mean over the whole pregnancy, and the mean over the neonatal period, infancy, and childhood.We generate a variable for monsoon onset to account for spatiotemporal variation in weather patterns that could influence the timing of conception, pollution, and harvest. Using daily precipitation data and a previously validated method , we geneThe following outcome variables will be considered:Birth weight Low birth weight Very low birth weight Extremely low birth weight low, very low, or extremely in the following way: low birth weight is defined as weight<2500 g, very low birth weight as weight<1500 g, and extremely low birth weight as weight<1000 g (according to the WHO’ definition [Birth weight (in g) is a continuous variable, and the additional aforementioned birth weight variables (2)-(4) are binary variables derived from the continuous variable. We generate binary variables for finition ).Note that all variables referenced by the short variable name  are directly from the DHS data set. All other variables are imputed or are obtained from additional non-DHS data sets.The rate of pregnancy termination resulting in miscarriage, abortion, or still birth per 1000 pregnancies  is the primary outcome.Pregnancy termination will be calculated as a rate per 1000 pregnancies (and PM2.5 exposure of these pregnancies will be computed from the imputed conception date to the point of pregnancy termination).The following outcome variables will be considered:Neonatal death rate per 1000 children Infant death rate per 1000 children Child death rate per 1000 children The following explanatory variables will be considered:Mean PM2.5 exposure during the pregnancy (weighted)Median PM2.5 exposure during the pregnancy 10th, 25th and 75th, and 90th percentile monthly PM2.5 exposure during pregnancy Maximum monthly PM2.5 exposure during pregnancy Cumulative PM2.5 exposure over the whole pregnancy period (weighted)Number of high or low PM2.5 exposure months over the whole pregnancy period, including partial monthsMean PM2.5 exposure over the whole pregnancy period relative to the annual location-specific average (weighted)All of the above PM2.5 variables, but computed separately for each trimester of the pregnancyPM2.5 exposure is a continuous variable (our instrument) that is created by using the month of conception to instrument for the exposure during each trimester or the whole pregnancy .Following are the covariates for the main models:Preceding birth intervalBirth order (hwidx)Maternal age at birth of the childSex of the child (b4)Twin birthMean temperature during the pregnancy or for each trimesterMean precipitation during the pregnancy or for each trimesterMonsoon onsetPercentage of land used for rice cultivationPreceding birth interval is an unordered factor variable that indicates the time difference in months between the current and the previous birth . Birth order is a factor variable where 1 indicates the most recent birth. Maternal age provides the age (in years) of the respondent at each of child birth in the data set. Sex of the child is a binary variable. Twin birth is a binary variable. Mean temperature and precipitation are derived from gridded monthly values at the respondent’s location and averaged over the pregnancy period. Monsoon onset is a discrete variable (1-365/366) indicating the day of the year when the monsoon starts. Rice fraction is a continuous variable (0-1) for the percentage of land used for rice cultivation at the respondent’s location.The following are additional covariates for robustness checks:Respondent's education level (v106/v133)Wealth index (v190/v191)Respondent's age (v012)Respondent’s height (v438)Altitude (v040)Religion (v130)Ethnicity or caste (v131)Marital status (v501)Region and primary sampling unit Type of cooking fuel used in the household (v161)Total number of children ever born (v201)Antenatal care visit in the first trimester (m13)Received toxoid injections during pregnancy (m1)Took iron tablets or syrup during pregnancy (m45)Took antimalarial drugs Husband’s occupation (v705)Smoking (v464)Education and the wealth indicators are available both as categorical and continuous variables, age, height (in cm), and altitude (in m) are continuous. Religion and ethnicity or caste are factor variables with country-specific levels. Marital status is a factor variable. Region and primary sampling unit are factor variables, and cooking fuel is a proxy for indoor air pollution and is a factor variable indicating the type of fuel used for cooking inside the house. Number of births is continuous. Antenatal care visit is a binary variable indicating whether a care visit took place in the first trimester. The variables for toxicoid injections, antimalarial drugs, and iron tablets or syrups are binary variables indicating whether the respondent received these medicines during pregnancy. Husband’s occupation is a factor variable with standardized categories across countries. Smoking is a continuous variable indicating the number of cigarettes smoked in the last 24 hours by the respondent.We have restricted our sample to mothers who have children born within the last 5 years (v208). This is because day of birth (hw16) is only recorded for these children, which gives us more precision for our exposure estimates . We further restrict the sample to all mothers with at least 2 births within the last 5 years to exploit variation in timing of multiple births from the same mothers. This allows us to control for observed and unobserved individual differences between mothers. We also exclude all respondents where de facto and de jure regions of residency differed.DHS surveys are cleaned by a professional team, and we do not expect many outliers. In some questions, implausible values are already flagged in the data; for instance, if the recorded age of death is a time point after the date of the interview, the value is flagged in B13. In such instances, we will not include these data points in our analysis.P values are <.05.We have not assessed statistical power to detect our minimum effect sizes. We will conclude that the analysis supports our hypotheses if both the effect sizes are larger than the minimum effects specified under “effect sizes” below, and the respective The following is an overview of our analytic strategy:The sample will be restricted to respondents with multiple births, who reside in the IGP.The IVs (joint estimation of the first and second stage) will be run: use of the month of conception to instrument for PM2.5 exposure during pregnancy; use of instrument and covariates to predict pregnancy and child health outcomesRobustness checks: is the exclusion restriction plausible, that, after adjusting for all time-invariant confounders at the level of the mother (through mother-level fixed effects) as well as temperature and precipitation during the pregnancy period, the month of conception affects birth outcomes through no channel other than PM2.5 exposure?Details of the analysis steps are as follows:We include all respondents in Bangladesh, Nepal, Pakistan, and India whose survey cluster GPS coordinates fall within the boundaries of the IGP. The boundaries of the IGP were obtained from a previous study . We alsoWe will estimate our models with an instrumental variables (IV) estimator using the R package fixest. We will use interactions of month of conception indicators with regional fixed effects to instrument for location-specific effects of month of conception on PM2.5 exposure during pregnancy . Modeling location-specific effects of month of conception on PM 2.5 exposure is important to satisfy the monotonicity assumption required of the IV estimator. We have defined regions on the basis of level 2 administrative boundaries, and we will check for robustness using other definitions of regions. We will also control for the date of the monsoon onset in the year of conception (as well as the interaction between monsoon onset and the share of rice grown at the respondents’ location). The second stage of the IV estimation uses the predicted PM 2.5 values from the first stage to estimate the effect of PM 2.5 exposure on our outcomes. Our regression model includes mother fixed effects, which account for any time-invariant mother-specific unobservable factors. To account for aggregate time-varying factors, we will include birth year fixed effects. Our specification controls for temperature and precipitation, which are observable factors that may be correlated with both the month of conception and birth weight. We also have included birth-level covariates that correlate with birth outcomes, including preceding birth interval, birth order, maternal age at the birth of each child, twin birth, and sex of the child. We have 3 sets of outcomes:Birth weight: a continuous variable (primary outcome) and binary outcomes low, very low, or extremely low birth weight (secondary outcome).Miscarriage, abortion, or still birth: pregnancies terminating in the first, second, and third trimesters . These are provided as rates per 1000 births.Neonatal, infant, and child mortality: outcomes for neonatal, infant, and child death. These are provided as rates per 1000 children.We will use multiple tests to assess the robustness of our estimates and the plausibility of the exclusion restriction. To test for differences between subgroups, we will rerun the main models as follows: (1) by including only urban or rural respondents , (2) by including only households working in agricultural or nonagricultural professions , (3) including only wanted or unwanted pregnancies (v367) since desired and undesired pregnancies may have different seasonal patterns. We will also run the models without restricting ourselves to mothers with multiple births but including all mothers and controlling for the covariates described above (since we cannot use mother-level fixed effects in this case). Finally, we also assess how our estimates change when we use the month of birth instead of the month of conception as the instrument.Variables that violate the assumption of homoscedasticity or of normality (as determined by a Kolmogorov-Smirnov test) will be transformed . 3 increase in PM2.5 concentration [A recent meta-analysis reported that increased pollution is associated with an 11% increase in median risk for low birth weight (mainly from US studies) ; thus, wntration . The lowWe will use different PM2.5 concentration measures described above to assess robustness of our findings. Since the incidence of preterm births is positively associated with pollution (but we do not know which births are preterm), we can assess the reliability of our results to assuming a more conservative, imputed pregnancy duration of <40 weeks for all pregnancies. We will draw upon regional statistics on gestational length when doing so. We may also include different constructs for measuring pollution—for example, fire counts from satellite data—to evaluate the robustness to an alternative way of capturing pollution exposure.Data cleaning and processing have been completed. This study has also been preregistered in the Open Science Foundation registries . Data analysis began in August 2021.Our study will test the hypothesis that exposure to higher concentrations of PM2.5 during pregnancy reduces the birth weight of the child, and that exposure to high concentrations during pregnancy increases the risk of neonatal, infant, and child death as well as the risk of a pregnancy terminating in a miscarriage, abortion, or still birth. We will also investigate during which trimester the negative effects of PM2.5 (if any) on pregnancy outcomes are most pronounced.This study makes several contributions to the literature. First, we draw upon a novel data set with globally consistent monthly PM2.5 concentrations. The unavailability of such monthly resolved PM2.5 data sets for the IGP has thus far been an impediment to the study of health effects over the entire area. Second, while other studies have investigated effects of more short-term exposures, such as wildfires ,33 whoseWe are aware of several factors that may limit the validity of our results. First, while we can carefully control for individual-level factors and time-varying seasonal factors we cannot exclude with certainty that our instrument (month of conception) does not influence our outcome variables through channels other than PM2.5 exposure. Second, PM2.5 exposure is variable across small geographic scales, which we cannot capture. Besides ambient air pollution, respondents may also experience indoor air pollution, which is a second important pollution source, which we cannot directly measure. However, we control for household-level factors to account for unobserved household-level confounders. Exposure measurement in our study is thus limited both by the scale of the PM2.5 data as well as the systematic random displacement of GPS coordinates in the DHS survey (used to deidentify respondent’s locations). Third, we infer the month of conception based on the duration of an average pregnancy (40 weeks). However, we do not know the actual length of the pregnancy periods of our respondents, which may lead to incorrect estimation of PM2.5 exposure of the individual pregnancies. Since pollution is associated with shorter gestational period, our estimates of PM2.5 exposure are likely to be upward biased and may misclassify the trimester during which the exposure occurred. We seek to address this bias by making more conservative assumptions for an average pregnancy duration. Fourth, we cannot distinguish between preterm and term births owing to unknown length of the gestational period. Thus, we are unable to disentangle the mechanism underlying low birth weight. Low birth weight at term could be the result of PM2.5 exposure. Alternatively, PM2.5 may increase the risk of premature birth, which, on average, results in lower birth weight .Air pollution is a major contributor to the global disease burden. While deaths due to indoor air pollution have been declining , ambientFuture work should expand this study’s approach and investigate the effect of PM2.5 on pregnancy outcomes in regions other than South Asia. The use of natural experiments, such as seasonal variation in PM2.5 or discontinuities in exposure on small spatial scales, could allow researchers to provide evidence on the causal effects of PM2.5 during pregnancy in different contexts, countries, and regions. In addition, future work would benefit from the availability of more reliable measures of gestational length to obtain precise measures of length of exposure. Finally, remotely sensed PM2.5 data, which are spatially and temporally more granular and incorporate high-resolution ground measurements or measurements from wearable sensors, could provide more accurate data on respondents’ actual exposure.


The composition and structure of the obtained new magnetically recyclable ternary nanocomposites were completely characterized by X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FT-IR), Raman spectroscopy, Brunauer–Emmett–Teller (BET) specific surface area analysis, vibrating sample magnetometery (VSM), diffuse reflectance spectroscopy (DRS), field emission scanning electron microscopy (FE-SEM), energy dispersive X-ray (EDX) spectroscopy and transmission electron microscopy (TEM). This novel magnetically recyclable heterogeneous fullerene-modified catalyst was tested for the H2O2-assisted photocatalytic degradation of MB dye under visible light. The results show that about 95% of the MB  was degraded by the Ag3PO4/Fe3O4/C60 nanocomposite within 5 h under visible light irradiation. The catalytic performance of the Ag3PO4/Fe3O4/C60 nanocomposite was then examined for 4-nitrophenol (4-NP) reduction using NaBH4. This new nanocomposite showed that 4-NP was reduced to 4-aminophenol (4-AP) in 98% yield with an aqueous solution of NaBH4. In both photocatalytic and catalytic reactions, the Ag3PO4/Fe3O4/C60 nanocomposite exhibited higher catalytic activity than pure Ag3PO4. Moreover, the Ag3PO4/Fe3O4/C60 nanocomposite could be magnetically separated from the reaction mixture and reused without any change in structure. The antibacterial activity of the nanocomposites was also investigated and they showed good antibacterial activity against a few human pathogenic bacteria.In this work, fullerene-modified magnetic silver phosphate (Ag 3PO4/Fe3O4/C60) nanocomposites prepared by a hydrothermal route were used as photocatalysts/catalysts for the efficient degradation and reduction of MB dye and 4-nitrophenol, respectively.Fullerene-modified magnetic silver phosphate (Ag In animals, longer-term exposure to high levels of nitrophenol cause damages to the heart, kidneys, liver and lungs. It is therefore very important to find innovative and cost-effective ways for the complete removal of organic pollutants and for monitoring water safety.3,4 One way is the production of catalysts to eliminate water contamination, either in the dark or in visible light. Certainly, due to their high efficiency and promising economy, semiconductor-based catalytic and photocatalytic technologies have opened up new opportunities to control pollutants and deal with their effects.5–10 To date, various metal oxides, sulfides, carbon compounds and composite materials have been investigated for the development of effective photocatalysts.11–15Today, water pollution is one of the main problems that human beings encounter. Every day, human activities lead to the release of contaminant substances and waste into the rivers, lakes, groundwater aquifers and oceans. This contamination affects the aquatic environmental quality for various uses and human consumption.3PO4), a new photocatalyst with an extremely high photooxidative capability for O2 generation from water splitting. This is due to its highly positive VB position, low toxicity and superior photodegradation rate of organic dyes, which is dozens of times faster than the surface level of commercial TiO2 under visible light irradiation.16–24 Unfortunately, because of its low structural stability, it is possible for Ag3PO4 to be photochemically decomposed to Ag if no sacrificial reagent is involved.25 Increasing both the stability and the catalytic activity of pure Ag3PO4 by coupling Ag3PO4 with other materials has been proven to be an effective strategy.26 Many Ag3PO4-based composites, such as Ag3PO4/CeO2,27 Ag3PO4/Fe3O4/GO,28 AgX/Ag3PO4 ,29 Ag3PO4/TiO2,30 CdS/Ag3PO4,31 Ag3PO4/MoS2/GR,32 Ag3PO4/Bi2WO6,33 Ag3PO4/BiVO4,34 Ag3PO4/LaFeO3,35 Ag3PO4/Co3O4,36 Ag3PO4/CoFe2O4,37 Ag3PO4/AgI/MWCNTs,38 TiO2/Ag3PO4/GR,39 P25/Ag3PO4/GO,40 g-C3N4 nanorod/Ag3PO4  is known as an excellent electron acceptor with an appropriate band gap of 1.7–1.9 eV, and thus can lead to rapid photoinduced charge separation and relatively slow charge recombination.47,48 A C60 molecule has a closed shell configuration consisting of 30 bonding molecular orbitals with 60 p electrons, which is advantageous for shuttling and transporting electrons.49,50 Moreover, this unique structure endows C60 with many other intriguing characteristics, which mainly include its excellent exciton mobility, high thermal stability, low density, strain-tunable semiconducting characteristics, moderate elastic modulus and high bending flexibility.51,52 From the perspective of the excellent properties of C60, hybridizing C60 with Ag3PO4 should be beneficial for improving the photocatalytic performance of Ag3PO4. However, separation and recycling of the binary Ag3PO4/C60 composite is difficult and severely limits its potential applications. To overcome this problem, coupling with magnetic materials e.g. Fe3O4 is highly desirable. Such magnetic composite catalysts can be easily recovered by a magnet and reused for catalytic reactions several times without any considerable reduction in catalytic efficiency.Carbon materials have potential applications in many fields of environmental pollution control due to their special properties, such as their higher specific surface area, superior electronic characteristics, confinement effects and strong physical/chemical stability.60 towards the photochemical performance of hybridized Ag3PO4/Fe3O4/C60 composites. The structural characteristics of Ag3PO4/Fe3O4/C60 with a varied C60 content were first studied, then their performances were evaluated by the visible light photocatalytic degradation of MB dye and the catalytic reduction of 4-nitrophenol (4-NP). Based on the characterization and photocatalytic/catalytic results, possible mechanisms were proposed. The results of this work demonstrate that hybridizing C60 with Ag3PO4 could improve the separating efficiency of photoinduced electrons and holes, which resulted in the enhanced photocatalytic activity of Ag3PO4/Fe3O4/C60 composites. The antibacterial activity of the nanocomposites was also investigated.In the present work, we explored the role of C2.2.1.ii) diammonium sulfate hexahydrate ((NH4)2FeSO4·6H2O), iron(iii) ammonium bisulfate dodecahydrate (NH4Fe(SO4)2·12H2O), sodium borohydride (NaBH4), absolute ethanol, disodium hydrogen phosphate (Na2HPO4), silver nitrate (AgNO3), 4-nitrophenol, 2-nitrophenol, 4-nitroaniline, 2-nitroaniline, hydrogen peroxide  and methylene blue . The reagents were purchased from Merck and used as received. Fullerene  was purchased from Sigma-Aldrich. Double distilled deionized water was used for the experiments. All glassware was properly washed with distilled water and dried in an oven.All chemicals were reagent grade and were used without further purification, such as iron at 180 °C for 20 h. Subsequently, the autoclave was cooled to room temperature naturally. The as-obtained black samples were centrifuged, washed with deionized water and ethanol three times, and dried at 70 °C for 3 h. To prepare the Ag3PO4/Fe3O4/C60 (wt 5%) nanocomposite, a mixture of 0.2 g of the Fe3O4 nanoparticles dispersed in 5 ml deionization water, 1 mmol of Na2HPO4·12H2O, 3 mmol of AgNO3 and 10 ml of C60 toluene solution (1 g L−1) were stirred for 30 min. After sonication for 30 min, the homogenized suspension was transferred into a 50 ml Teflon-lined stainless steel autoclave, sealed and maintained at 180 °C for 20 h. The autoclave was then naturally cooled to room temperature and the resulting precipitate was separated by a magnet, washed with deionized water several times, dried at 60 °C and used for further characterization. It was then transferred to a 50 ml autoclave and heated at 180 °C for 20 h. Subsequently, the autoclave was cooled to room temperature naturally. The product was collected by applying an external magnetic field, washed several times with absolute ethanol and distilled water, and finally dried at 70 °C for 3 h. The samples with 10 and 20 wt% of C60 were prepared in a similar manner. For comparison, the pure Ag3PO4 nanostructure was synthesized according to the typical synthesis described above with Fe3O4 and C60 being absent. The obtained samples with 5, 10 and 20 wt% of C60 and pure Ag3PO4 are denoted as m-APO/C60(5), m-APO/C60(10), m-APO/C60(20) and APO, respectively.The Fe2.3.60 photocatalyst using a 400 W high pressure mercury lamp as an irradiation source, with a cool water circulating filter to absorb the near IR and a UV light cut-off filter to avoid direct photolysis of the organic dyes (λ ≥ 420 nm). In a typical experiment, 0.05 g of the m-APO/C60 photocatalyst was added to 50 ml of MB (25 mg L−1) to perform the photocatalytic degradation. Before irradiation, the solution was stirred for 30 min to achieve an adsorption–desorption equilibrium of the dye on the photocatalyst surface. It was then subjected to visible light irradiation in the presence of H2O2. At given time intervals, 2 ml aliquots of the reaction solution were sampled, and the catalyst was immediately separated from the suspension by an external magnetic field. The residual MB concentration was determined using a UV-Vis spectrophotometer.Photocatalytic degradation of the aqueous solution of methylene blue (MB) was carried out in the presence of the m-APO/C2.4.60 nanocomposites, the reduction of 4-nitrophenol (4-NP) to 4-aminophenol (4-AP) by sodium borohydride (NaBH4) in aqueous solution was used as the model reaction. In a typical catalytic reaction, 3 ml of an aqueous solution of 4-NP (0.2 mM) and 0.7 ml of an aqueous solution of NaBH4 (20 mM) were mixed in a standard quartz cell with a 1 cm path length, then 2.5 mg of the synthesized nanocomposite was added to the reaction mixture. Immediately afterwards, the catalysts were transferred to a standard quartz cell while the nitrophenol concentration in the reaction mixture was monitored by UV-visible absorption spectra, recorded with a time interval of 2 min in a scanning range of 200–800 nm at ambient temperature. After the completion of the reaction, in order to perform the recycling experiment, the catalyst was recovered first by an external magnet and then by centrifugation. The precipitate was washed repeatedly with deionized water and absolute ethanol in consecutive washing cycles. After washing and placing in a furnace in order to remove adsorbed impurities, the catalyst was used directly for the recycling test. After each cycle, the resulting catalyst was collected and detected by atomic absorption spectroscopy to determine the content of the synthesized nanocomposites.In order to explore the catalytic performance of the synthesized m-APO/C2.5.Bacillus cereus (PTCC 1015) and Staphylococcus aureus (1431)) and Gram-negative bacteria (Escherichia coli (PTCC 1330) and Klebsiella pneumoniae (PTCC 1290)) using a modified Kirby–Bauer disk diffusion method.53 Bacteria were cultured for 18 h at 37 °C in a nutrient agar medium and then adjusted with sterile saline to a concentration of 1 × 106 cfu ml−1. Bacterial suspensions in Petri dishes (8 cm) containing sterile Mueller-Hinton agar (MA) were cultured using a sterile cotton swab. The compounds were dissolved in water and sterile paper discs of 6 mm thickness were saturated with 30 μl of the samples and placed onto agar plates which had previously been immunized with the tested microorganisms. Amikacin (30 μg per disk) for Gram-negative and penicillin (10 μg per disk) for Gram-positive were used as positive controls. After incubation at 37 °C for 24 h, the inhibition zone diameter was measured using a meter ruler and the mean value for each organism was recorded and expressed in millimeters.The antibacterial activity of the synthesized nanoparticles was evaluated against strains of Gram-positive bacteria (2.6.−1 using KBr pellets. The XRD patterns of the samples were obtained on an X-ray diffractometer (Rigaku D/Max C III) using Ni-filtered Cu Kα radiation (λ = 1.5406 Å). UV-Vis diffuse reflection spectroscopy (DRS) was performed on a Snico S4100 spectrophotometer over the spectral range of 200–1000 nm using BaSO4 as the reference. The shapes and morphologies of the samples were observed by a MIRA3 TESCAN field emission scanning electron microscope (FESEM) equipped with a link energy-dispersive X-ray (EDX) analyzer. The particle size was determined by a CM120 transmission electron microscope (TEM) at an accelerating voltage of 80 kV. TEM samples were prepared by dropping the ethanol dispersion onto a carbon coated copper grid. A PHS-1020 PHSCHINA instrument was used to measure the Brunauer–Emmett–Teller (BET) surface areas of the samples at liquid nitrogen temperature (77 K). Magnetic measurements were carried out at room temperature using a vibrating sample magnetometer  with a maximum magnetic field of 10 kOe. Raman spectroscopy was performed using a SENTERRA (2009) dispersive Raman microscope from BRUKER (Germany) with a laser wavenumber of 785 nm. UV-Vis spectra of the aqueous solutions during the reaction were recorded using a Cary 100 double beam spectrophotometer operated at a resolution of 2 nm using quartz cells with path length of 1 cm.FT-IR spectra were recorded on a Shimadzu FT-IR 8400S spectrophotometer in transmission mode from 4000 to 400 cm3.3.1.3PO4, Ag3PO4/Fe3O4/C60 (wt 5%), Ag3PO4/Fe3O4/C60 (wt 10%) and Ag3PO4/Fe3O4/C60 (wt 20%) are abbreviated as APO, m-APO/C60(5), m-APO/C60(10) and m-APO/C60(20), respectively. In the as-prepared m-APO/C60 samples, no other impurities could be observed. It was found that the as-prepared catalysts exhibited intense and sharp diffraction peaks ascribed to cubic crystal systems for Ag3PO4 (JCPDS card no. 84-0511) and Fe3O4 (JCPDS card no. 75-0449). No diffraction peaks corresponding to C60 were observed in the m-APO/C60 nanocomposites, which may be due to the relatively low diffraction intensity of C60 and the high dispersion of the small amount of C60 in the sample. The average grain sizes of the as-prepared m-APO/C60(5), m-APO/C60(10) and m-APO/C60(20) nanocomposites were calculated to be 31.75 nm, 27.76 nm and 24.86 nm, respectively, based on the Debye–Scherrer formula:54DXRD = 0.9λ/(β cos θ), where DXRD is the average crystallite size, λ is the wavelength of Cu Kα radiation, β is the full-width at half-maximum of the chosen diffraction peak and θ is the Bragg angle.The composition and crystal structures of the as-prepared samples were investigated by XRD, as shown in 3O4, APO, m-APO/C60(5), m-APO/C60(10), m-APO/C60(20) and pure C60. In the case of Fe3O4 (−1 are related to the Fe(iii)–O and Fe(ii)–O bond of spinel-type Fe3O4 oxide. For the Ag3PO4 sample in ca. 1011 and 552 cm−1 are the characteristic stretching and bending vibrations of PO43− groups, respectively. The FT-IR spectra of the m-APO/C60 samples in 43− group stretching vibration mode at 1011 cm−1 as well as the featured absorption bands of Fe3O4 in the 400–600 cm−1 range. These findings confirm the coexistence of Ag3PO4 and Fe3O4 in the m-APO/C60 nanocomposites, in agreement with the XRD results. In all samples, the peaks at 1615 and 3250 cm−1 are attributed to the typical stretching vibrations of the –OH group of adsorbed water. In addition, the FT-IR spectrum of the pure C60 sample in −1, ascribed to the internal modes of C60.55 Therefore, the characteristic weak bands of the C60 component in the m-APO/C60 nanocomposites are hardly observed. To confirm the strong combination between the C60 and APO/Fe3O4 nanoparticles, we also investigated whether C60 can leach from the m-APO/C60 hybrid system in toluene solution. The color of the toluene solution turned purple after adding C60 and sonicating at room temperature for 15 min. However, no color change was observed when using the as-obtained m-APO/C60 composites under the same conditions. These results clearly show that the loaded C60 clusters in the hybrid system could not be extracted by an excellent solvent (toluene), suggesting the formation of a strong interaction between the C60 clusters and APO/Fe3O4.of Fe3O4 , the two60(5) sample. This sample displays a characteristic C60 band at 1302 cm−1, as well as the characteristic bands of Ag3PO4 and Fe3O4 at 601 and 493 cm−1, respectively.56 Thus, this observation confirms the presence of C60 molecules in the nanocomposites.Raman spectroscopy is a powerful nondestructive tool to characterize the significant structural changes in the carbon nanostructures during nanocomposite synthesis. 3PO4, C60, Fe3O4 and the m-APO/C60(5) nanocomposite are shown in 3PO4 C60, Fe3O4 and the m-APO/C60(5) nanocomposite. As shown in 3PO4 consists of near spherical particles with diameters in the range of 50–100 nm, which are slightly agglomerated. 60 and 3O4 consists of small, fine nanoparticles with sizes of 20–30 nm. From 60(5) nanocomposite still retains the spherical morphology of Ag3PO4, and the distribution of C60 and Fe3O4 nanoparticles in the Ag3PO4 matrix is homogeneous. Compared to Ag3PO4, m-APO/C60 is more scattered. 60 nanocomposites with 10 and 20 wt% of C60. The particle size of the m-APO/C60 nanocomposites decreased slightly after modifying with C60. This may be due to the presence of C60 between the m-Ag3PO4/Fe3O4 nanoparticles. SEM images of the m-APO/C60 nanocomposites with different amounts of C60 indicated that the presence of C60 had a large effect on the size of the APO nanoparticles, and as the size of particles became smaller, the amount of C60 increased.SEM images showing the morphologies and microstructural features of Ag60(5) composites was further investigated by EDX analysis. 60(5) with the corresponding EDX elemental mappings. The presence of Ag, C, Fe, O and P elements can be confirmed by their peaks in the EDX elemental spectrum. The corresponding elemental mappings show that the Ag, C, Fe, O, and P elements are uniformly distributed over the nanocomposite, confirming the homogeneity of the sample. The Fe and C elements were from Fe3O4 and C60, and the results further indicate that the Fe3O4 and C60 particles were successfully coupled with APO.The composition of the as-prepared m-APO/C60, Fe3O4 and m-APO/C60(5) samples were further investigated by TEM, and the results are shown in 3PO4 sample in 60 sample was formed from plate-like particles which were loosely aggregated. From the TEM image in 3O4 was formed of very fine and agglomerated sphere-like nanoparticles with an average diameter of about 20 nm. The accumulation of these nanostructures can be attributed to the magnetic dipole interaction between them and the great surface energy due to their nanoscopic size. TEM images of the m-APO/C60(5) nanocomposite are shown in 60(5) particles are similar to those of the pure components. The morphology of the prepared nanocomposite was sphere-like (APO/C60(5)) and plate-like (C60), and the particle size distribution was narrow (from ∼20 nm to ∼40 nm) with an average particle size of 30 nm. From the images, it can be clearly seen that many spherical APO and Fe3O4 particles with sizes of about 15–20 nm were well-coupled with the C60 nanoplates. It is reasonable to assume that C60 clusters were successfully incorporated into the m-APO/C60 samples while retaining their special structures.The shape and particle size of the as-synthesized APO, C3O4 and m-APO/C60 nanocomposites was investigated by VSM at room temperature. The magnetization curves of the prepared nanocomposites of the m-APO/C60(5), m-APO/C60(10) and m-APO/C60(20) nanocomposites and pure Fe3O4 are shown in Mr) and coercivity field (Hc) values of the pure Fe3O4 sample and the m-APO/C60 nanocomposites in 60(5) and m-APO/C60(20) nanocomposites had superparamagnetic properties while the m-APO/C60(10) nanocomposite had ferromagnetic properties, compared to Fe3O4, which had values of Mr = 3.68 emu g−1 and Hc = 31.46 Oe, showing strong ferromagnetic properties. All catalysts were collected in the inner flank of the beaker after 30 s in the presence of an external magnetic field  nanocomposite was 55.461 m2 g−1 (see 60(5) nanocomposites were centered at 1.26 nm and 0.212 cm3 g−1, respectively. The isotherm in 4 hysteresis loop for the m-APO/C60(5), m-APO/C60(10) and m-APO/C60(20) nanocomposites. The BET surface area values for the m-APO/C60(5), m-APO/C60(10) and m-APO/C60(20) nanocomposites were higher than those for pure APO and m-APO  nanocomposites were expected to have higher photocatalytic activity.Nitrogen adsorption–desorption experiments were used to evaluate the pore size and structure of the samples. The porosity and specific surface area were determined using the Barrett–Joyner–Halenda (BJH) method and the BET equation, respectively. g−1 see . The pornd m-APO .59 It ca60 nanocomposites with different C60 mass ratios. It can be seen in 60 nanocomposites show strong absorption bands above 300 nm, which are assigned to the intrinsic band gap absorption of APO. Compared to APO, the m-APO/C60 nanocomposites show more intensive absorption over the whole visible light region, consistent with the gray color of the samples, relating to the presence of C60 molecules. The band gap energy (Eg) of the samples can be obtained from the following formula: (αhν)1/2 = B(hν − Eg), where α, ν and B are the absorption coefficient, light frequency and proportionality constant, respectively. As shown in hν extrapolated to α = 0 gives the band gap energy. Based on UV-DRS spectroscopy studies, the band gaps were estimated to be 2.75 eV, 2.60 eV, 2.72 eV and 2.70 eV for pure APO, m-APO/C60(5), m-APO/C60(10) and m-APO/C60(20), respectively. Among them, the m-APO/C60(5) nanocomposite had lower band gaps.3.2.60 Among them, TiO2 is one of the best, due to its non-toxicity, suitable stability and high photocatalytic activity.61 However, TiO2 is responsive only to UV light, which accounts for no more than 4% of the solar spectrum, greatly limiting its photocatalytic efficiency and suitable applications. Developing a novel photocatalyst with efficient visible light absorption and excellent stability remains a great challenge. The m-APO/C60 nanocomposites prepared in this study can be an appropriate candidate. The photocatalytic activity of the m-APO/C60 nanocomposites was evaluated by the degradation of methylene blue (MB) dye in aqueous solution under visible light irradiation and at room temperature. The UV-Vis spectral changes of the MB aqueous solution over the m-APO/C60(5) photocatalyst is plotted in C0 − C)/C0] × 100%, where C is the concentration of the reactant after irradiation at time t and C0 is the concentration of the MB dye after adsorption–desorption equilibrium. 60(5), m-APO/C60(10), m-APO/C60(20) and pure APO under identical experimental conditions. The degradation efficiencies (%) of these photocatalysts were found to be 95%, 89%, 80% and 33%, respectively, within 300 min under visible light irradiation. To determine the photocatalytic degradation kinetics of MB degradation, the pseudo first order model was used: ln(C0/C) = kt, where C0 and C are the dye concentrations before and after visible light irradiation, respectively, k is the pseudo first order rate constant, and t is the reaction time. As shown in k values for the degradation of MB over the m-APO/C60(5), m-APO/C60(10), m-APO/C60(20) and pure APO catalysts were determined to be 1.03 × 10−2, 7.70 × 10−3, 5.30 × 10−3 and 1.20 × 10−3 min−1, respectively. The results indicate that the photocatalytic activity of APO could be improved by the incorporation of Fe3O4 nanoparticles and C60 molecules. From the photocatalytic activity results, it can be further confirmed that the low optimal molar ratio of m-Ag3PO4/C60 was good for increasing surface active sites and photocatalytic performance.The photocatalytic degradation of organic contaminants has attracted considerable attention because of its potential to solve serious environmental difficulties such as aquatic pollution and printing/textile wastewater, and the associated toxicity and perturbation to aquatic life. Various photocatalysts have been successfully developed for environmental remediation.60 particles, which act as effective electron acceptors.62 C60 is a conjugated structure in which the charge carriers act as massless fermions, leading to unique charge transfer properties. Therefore, the photogenerated electrons of APO could transfer easily from the CB band to the C60 particles. As a result of the extreme inhibition of the photogenerated electrons and holes, the photocatalytic activity is enhanced. The electrons on the surface of C60 can react with the dissolved H2O2 to produce hydroxyl radicals, while the holes are scavenged by the adsorbed water or OH− to form ˙OH radicals. Finally, these active species could oxidize the MB molecules adsorbed on the active sites of m-APO/C60 through electrostatic attraction or π–π stacking, resulting in dye degradation and production of CO2, H2O, etc., as acquitted materials  and efficiencies of 4-NP reduction in the presence of different samples. Among these, the samples containing the prepared nanocomposite catalysts exhibited the best catalytic performance  by excess NaBHformance .4 was 20 mM while the overall concentration of 4-NP was 0.2 mM. Considering the higher concentration of NaBH4 compared to that of 4-NP, it is logical to assume that the concentration of BH4− remains constant during the reaction. Thus, pseudo first order kinetics could be used to evaluate the kinetics of the catalytic reaction. The absorbance of 4-NP is proportional to its concentration in solution, and the absorbance at time t (A) and time t = 0 (A0) are equivalent to the concentration at time t (C) and time t = 0 (C0). The rate constant (k) could be obtained from the linear plot of −ln(C/C0) versus the reduction time in minutes. As shown in C/C0) versus time plots indicate a good linear correlation. The results show that the catalytic activity of the m-APO-C60(5) nanocomposite is higher than those of pure APO4, modified m-APO/C60(10) and m-APO/C60(20), m-APO, APO-C60(5) and APO/C60(10).In this reduction process, the overall concentration of NaBH4, corresponding to a significant change in the solution color from light yellow to yellow-green due to the formation of the 4-nitrophenolate ion. In the absence of the m-APO/C60(5) nanocomposite catalyst (2.5 mg), the absorption peak at about 400 nm remained unchanged for a long time, indicating that the NaBH4 itself could not reduce the 4-nitrophenolate ion without a catalyst. In the presence of the m-APO-C60(5) nanocomposite catalyst and NaBH4, 4-NP was reduced and the intensity of the absorption peak at about 400 nm decreased progressively as time passed, and after almost 16 min disappeared completely. Meanwhile, a new absorption peak with increasing intensity appeared at about 295 nm. This peak was attributed to the typical absorption of 4-amino phenol (4-AP).60. According to the results, it was evident that as the m-APO-C60 content (>20%) increased, the catalytic activity deteriorated, highlighting the important role of the loading percentage and intimate contact between C60 and Ag3PO4/Fe3O4 in determining catalytic efficiency. This means that with higher amounts of C60, the number of active catalytic reaction sites decreases, causing a negative influence on the catalytic processes. The excessive amount of C60 may cover the active sites at the Ag3PO4/Fe3O4 surface and also hinder the contact with 4-NP. Furthermore, from the catalytic activity results, it can be concluded that the low optimal molar ratio of m-APO/C60 is conducive to increasing the number of active surface sites and enhancing catalytic performance. The highest catalytic performance of the m-APO/C60 composite can be attributed to the intimate contact between Ag3PO4/Fe3O4 and C60, which facilitates electron transfer. A probable mechanism for the reduction of 4-NP to 4-AP in the presence of m-APO-C60 is shown in 3O4 in the composites caused them to be magnetically separable during the catalytic reactions. Recyclability is a very important parameter to assess how practical and reusable the catalyst is. Therefore, the recovery and reusability of the m-APO-C60(5) catalyst was determined for the reduction of 4-NP under the present reaction conditions. After the reaction was completed, the m-APO/C60(5) nanocomposite was separated from the reaction mixture by an external magnet. The catalyst was washed with water and ethanol several times, then dried and reused for the next reaction. Three consecutive catalyst recoveries were performed showing a good catalytic activity  nanocomposite is stable under the reaction conditions and is not affected by the reactants.For up to three catalytic cycles, no significant loss in activity was observed, indicating that the as-prepared catalyst was stable and efficient for the reduction of nitro compounds. As observed in 3.4.Bacillus cereus, Staphylococcus aureus, Klebsiella pneumonia and Escherichia coli using the disk diffusion method. The results of the antibacterial activity tests for pure APO, m-APO/C60(5), m-APO/C60(10) and m-APO/C60(20) are shown in 60(5) nanocomposite has a relatively good antibacterial activity compared to pure APO, i.e. the bacteria cells were killed at a concentration of 10 mg ml−1. The highest activity was obtained for the m-APO/C60(5) nanocomposite against B. cereus, while the lowest activity was observed for m-APO/C60(5) against E. coli. The biosynthesized m-APO/C60(5) nanocomposite exhibited a greater antimicrobial activity towards Gram-positive microorganisms than Gram-negative ones. The results showing the antibacterial activity of the m-APO/C60(5) nanocomposite with different concentrations are presented in 60(5) nanocomposite has different antibacterial activity with different concentrations. It also represents the inhibition zone of these bacteria. The highest activity was obtained for the m-APO/C60(5) (1.25 mg ml−1) nanocomposite against S. aureus, while the lowest activity was observed for the m-APO/C60(5) (0.625 mg ml−1) nanocomposite against K. pneumonia and B. cereus. The potential antimicrobial activities presented by the m-APO/C60(5) nanocomposite have made it a promising candidate for a novel generation of antimicrobials. The clear mechanism of the m-APO/C60(5) nanocomposite’s interaction with bacteria is not well known. However, several main mechanisms underpin the biocidal properties of the m-APO/C60(5) nanocomposite against microorganisms. Firstly, the m-APO/C60(5) nanocomposite attaches to the negatively charged cell surface, altering the physical and chemical properties of the cell membrane and the cell wall, and disturbing important functions such as permeability, osmoregulation, electron transport and respiration.64 Secondly, the m-APO/C60(5) nanocomposite can cause further damage to bacterial cells by permeating the cell and interacting with DNA, proteins and other phosphorus- and sulfur-containing cell constituents.65 Thirdly, the m-APO/C60(5) nanocomposite releases silver ions, generating an amplified biocidal effect which is size- and dose-dependent.66The antibacterial activity of the samples was analyzed against four bacteria, including 4.60 nanocomposites were synthesized using a facile and effective hydrothermal route. The synthesized m-APO/C60 nanocomposites were spherical, 30 nm in size and crystalline in nature, and exhibited absorptions at ∼300–620 nm. The m-APO/C60(5) nanocomposite had a band gap of about 2.6 eV. Its photocatalytic activity was much higher than that of pure Ag3PO4 or those of the other nanocomposites for degrading methylene blue. The results showed a 95% degradation of methylene blue (MB) (25 mg L−1) within 5 h in the presence of the Ag3PO4/Fe3O4/C60 nanocomposite and H2O2. In addition, this new nanocomposite showed an 98% reduction of 4-nitrophenol (4-NP) (0.2 mM) with excess NaBH4. The formed m-APO/C60 nanocomposites were quite stable, showed good antibacterial activity and were utilized as catalysts for the reduction of several aromatic nitro compounds (98% reduction of 4-NP) into their corresponding amino derivatives. It is expected that this kind of m-APO/C60 nanocomposite would provide new insights for the design and construction of high performance photocatalysts for eliminating environmental pollution damage. This nanocomposite can easily be removed using an external magnet and prevents the secondary pollution of water. The nanocomposites are therefore both economically and environmentally friendly, and they could be a good option for eliminating water contaminants.In this study, m-APO/CThere are no conflicts of interest to declare.


The purpose of this study is to evaluate the accuracy of prenatal MRI in diagnosing choledochal cysts (CDC), evaluate the sensitivity and specificity of MRI signs in the diagnosis of fetal CDC, and first compare the trend of size of CC between prenatal and postpartum.  A total of 18 fetal who were diagnosed with CDCs through prenatal MRI were enrolled in the study. We summarized and analyzed the prenatal clinical data and prognosis information of prenatal and postpartum surgery, then compared the sensitivity, specificity, and diagnostic accuracy of various signs of MRI and postpartum MRCP diagnosis of CC. Finally, we tried to compare the earliest prenatal detection of common bile duct cysts with the size of surgery, and calculated the growth rate of common bile duct cysts for the first time.  All 18 patients were delivered in our institution. Among these patients, 14 were confirmed with CDCs after postpartum surgery, two patients had CDCs that disappeared, and two patients were confirmed with cystic biliary atresia (CBA) through the Kasai operation. Furthermore, 13 patients with CDCs and two patients with CBA underwent MRCP before the operation, and one patient with CDCs ruptured at birth and underwent ultrasound diagnosis. The sensitivity and diagnostic compliance of prenatal MRI signs for the location were higher when compared to postnatal MRCP (100% vs. 76.9% and 83.3% vs. 66.7%): the cyst was located at the porta hepatis, which was higher than the lowest edge of the liver, and parallel to the hepatoduodenal ligament.  Prenatal MRI is higher than that of US for diagnosing CDCs, specifically in identifying the location of the cyst and confirming the origin of the cyst. The length, width, and size of the CDC become slightly bigger in our study. Choledochal cysts (CDC), also known as “congenital biliary dilatation,” account for approximately 1% of all benign biliary tract diseases. The incidence of CDCs in the Asian population is 1 : 1,000 and is lower than that in Western countries   providedFortunately, the diagnosis of CDCs has gradually turned from after birth to prenatal due to the accuracy of prenatal ultrasounds (US). In the prenatal US, fetal CDCs have been described as follows: anechoic cysts located in the right upper quadrant of the abdomen, the subhepatic, or the region of the porta hepatis, with no septum, and these are connected to the gallbladder or hepatic ducts . The latAt the same time, fast magnetic resonance imaging (MRI) was considered a useful tool for evaluating fetal abdominal disorders . MacKenzThe aim of the present study was to use prenatal MRI to define the features of CDCs and analyze the relationship among the prenatal MRI findings, the postnatal MRCP, and outcomes. This study also aimed to evaluate the key MRI findings of fetal CDCs in order to improve the diagnosis accuracy of prenatal MRI.Guangzhou Women and Children's Medical Center Ethics Committee approved (NO 2015090860) this study. The adverse effects of these MRI examinations were fully explained to each patient, and all patients in the present study provided signed informed consent. Fetal MRI was usually limited to cases in which the US results were indeterminate. In consideration of the importance of follow-up and the special advantages of US, serial US and postnatal magnetic resonance cholangiopancreatography (MRCP) examinations were necessary to observe the disease progress after the diagnosis of CDCs by prenatal MRI. Between January 2009 and September 2019, 26 patients were diagnosed with CDCs by fetal MRI after ultrasounds found fetal abdominal cysts. The inclusion criteria were as follows: (1) the prenatal care, delivery, and postpartum treatment were carried out in our institution with the appropriate perinatal counseling and management; (2) all prenatal and postnatal medical records were complete; (3) all pregnant women in the study were informed about the safety of the examinations and the possible complications of the operation and provided signed informed consent. The exclusion criteria were as follows: (1) in addition to CDCs, any cases of severe malformations, such as severe fetal cardiac malformation; (2) pregnant women or fetuses who were not available for follow-up; and (3) parents who refused the study of their babies. Those cases which could not be followed up (7 cases) and those without postpartum imaging data were excluded (1 case). Among these 18 patients, 2  patients' postnatal US revealed that the cyst was not any more visible. 2  patients were confirmed with cystic biliary atresia (CBA) through intraoperative cholangiography, and 14  were confirmed with CDCs after postpartum surgery .The clinical charts were reviewed. Clinical parameters, including the gestational age on the diagnosis of the CDC  and birth, birth weight, mode of delivery, date of MRCP after birth and date of surgery, symptoms at the time of operation, surgical procedures performed, and postoperative outcome data were collected and analyzed. The follow-up duration was measured from the definitive surgery to the last clinical assessment.As a preparation for the fetal MRI, the pregnant women were informed not to eat or drink three hours before the examination. An attempt was made to choose a time when the fetus was not active for the MRI examination. All fetal MRI and postnatal MRCP examinations were performed on an Achieva 1.5 T MRI scanner . The fetal MRI was performed with the following scanning sequences: (1) T1-weighted imaging (WI): repetition time (TR) was 159 ms, echo time (TE) was 5.3 ms, the field of view (FOV) was 405 × 364 × 90 mm, and the matrix was 232 × 165; (2) T2-WI: TR was 15,000 ms, TE was 120 ms, the FOV was 400 × 400 × 75 mm, and the matrix was 248 × 217.As a preparation for the postnatal MRCP, all children fasted for 4–6 hours and were given 0.5 ml/kg of 10% chloral hydrate before the examination. The MRCP was performed when the children were asleep, using a 5-channel phased-array heart parallel acquisition coil. The MRCP was performed with the following scanning sequences (1) axial fast gradient echo (FFE) T1WI: TR was 10 ms and TE was 4.6 ms; (2) single-shot TSE T2-WI: TR was 375.8–661.6 ms, and TE was 80 ms; (3) coronal 2D-balance fast field echo (2D-BFFE) T2-WI: TR was 4.0–7.1 ms, TE was 1.99–3.60 ms, the thickness was 5 mm, and there was no layer spacing; (4) 3D-TSE T2-WI: TR was 1,165.7–1,272.0 ms, TE was 650 ms, layer thickness was 0.8 mm, there was no layer spacing, and the matrix was 200 × 200.The MRI and MRCP results were, respectively, reanalyzed by two radiologists, who have six and ten years, respectively, of experience in analyzing fetal and pediatric MRI examinations, and were blinded to the diagnosis and postnatal outcomes. The routine prenatal MRI imaging focused on the following signs in these subjects: Sign A: the cyst was located at the porta hepatis A1; Sign P-values are indicated.The statistical analysis was performed using SPSS 23.00 . A significance was achieved at the 0.05 level. Only significant A statistical diagnostic test was used to calculate the sensitivity, specificity, and diagnostic compliance of each diagnosis by prenatal MRI and postnatal MRCP.k-s normality test was used to test the continuous variables: the length, width, and area of the CDC and gallbladder. The continuous variables data were presented as mean ± standard deviation (SD). If the data followed the normal distribution, the differences were compared by paired Student's t-test. If the data did not follow the normal distribution, the independent sample rank-sum test was used to compare the differences.After the diagnosis of the CDC, the investigators attempted to estimate the trend size of the cyst and gallbladder in two MRI examinations. The The 18 fetuses were diagnosed with CDCs by MRI, with a mean gestational age of 28.2 ± 5.2 weeks (21–38 weeks). The prenatal screening of trisomy 21 and 18 in all cases revealed a low risk. All 18 fetuses were delivered in our institution . The clinical data are listed in There was a total of 14 cases of CDC, with a mean gestational age on diagnosis  and at birth of 28.6 ± 5.5 weeks (21–38 weeks) and 38.9 ± 1.1 weeks (37–40 weeks), respectively. Six (42.9%) cases were detected in the second trimester, and eight (57.1%) were detected in the third trimester. There were six (42.9%) cases of routine delivery and eight (57.1%) of cesarean sections. The mean newborn weight was 3,439.9 ± 278.6 g, which ranged within 2,760–3,800 g. Among the newborns, six (42.9%) were male, and eight (57.1%) were female. The mean age of children with CDCs who underwent MRCP was 94.1 ± 147.5 days, which ranged within 3–480 days, while one case where the CDC ruptured after birth only underwent US.Ten (71.4%) cases exhibited symptoms before surgery, including seven (50.0%) cases of jaundice, three (21.4%) of vomiting and abdominal distension, and two (14.3%) of abdominal mass. All 14 patients with CDCs underwent surgery at the mean age of 105.6 ± 149.4 days (3–480 days). Among these cases, 11 (78.6%) cases were confirmed as type I CDC, and three (21.4%) were confirmed as type IV CDC. Six (42.9%) cases underwent laparotomy, and eight (57.1%) underwent open surgery of Roux-en-Y biliary reconstruction. The average duration of MRCP and operation was 19.4 ± 34.1 days (0–120 days). The follow-up period varied within 9–84 months after birth, with an average period of 48.9 ± 26.2 months.Location (Signs A and C), size, and shape: Sign B was mainly determined by the size of the CDC. The maximum diameter of 85.7% (12/14) of the CDC was less than 3.0 cm, and 92.9% (13/14) of the CDC had an edge higher than the lowest edge of the liver. The shape of the CDC was oval or round, which was similar to the other fetal cyst in the abdomen.Biliary origin (Sign D–F): Sign D had the highest sensitivity (100%) and diagnostic accuracy (88.9%) among all signs in the prenatal diagnosis. In one case, the cyst was connected to the gallbladder, but this was subsequently confirmed to be the back fold of the gallbladder Figures A1–2A2. ITapered sign: this has the lowest sensitivity among all the prenatal MRI and postnatal MRCP  in the CDC diagnosis.Characteristics of the cyst: all these signs were negative in all the prenatal MRI.Type of Todann: in the prenatal MRI, 17 (94.4%) cases were diagnosed as type I CDC, and 1 (5.6%) was diagnosed as type IV CDC.The diagnostic accuracy of CDCs was 77.8% (14/18) in the prenatal MRI and 86.7% 13/15) in the postnatal MRCP. The sensitivity, specificity, and diagnostic accuracy of each sign are calculated and summed up in Tables /15 in tht-test was conducted.2, respectively, at the prenatal MRI, and 5.1 ± 2.0 cm, 3.5 ± 1.8 cm, and 20.6 ± 18.6 cm2, respectively, at the postnatal MRCP. The differences in length, width, and size of the CDC at the prenatal MRI and postnatal MRCP were statistically significant (P ≤ 0.001). The length, width, and size of the CDC were larger in cases that underwent postnatal MRCP when compared to cases that underwent prenatal MRI. In order to eliminate the effect of these intervals, the area of the cyst was divided by the interval time . The mean of the growth area of the CDC was 0.2 ± 0.4 cm2.The length, width, and size of the CDC: the mean length, width, and size of the CDC were 2.3 ± 0.8 cm, 1.7 ± 0.4 cm, and 0.7 ± 0.3 cm2, respectively, at the prenatal MRI, and 1.4 ± 0.7 cm, 0.8 ± 0.3 cm, and 1.2 ± 0.9 cm2, respectively, at the postnatal MRCP. The differences in length, width, and size of the gallbladder in prenatal MRI and postnatal MRCP were not statistically significant (P > 0.005). This infers that the size of the gallbladder did not change over time.Size of the gallbladder: the mean of the length, width, and size of the gallbladder was 1.0 ± 0.3 cm, 0.7 ± 0.2 cm, and 0.7 ± 0.3 cmThe size of cysts and gallbladder was calculated according to the prenatal MRI and postnatal MRCP results. The length, width, and size of the CDC and gallbladder followed the normal distribution, and a paired Student's Five types of CDCs have been described according to Todani classifications. Type I cysts constitute 80%–90% of CDCs , and typSpontaneous perforation of CDCs is rare in children , 20. TheThe present “gold standard” for the diagnostics and stages of CDCs is MRCP . HoweverThe prenatal MRI could indicate the location and source of all CDCs, which were located in the hepatic hilum and originated from bile ducts. The maximum diameter of fetal CDC may be an interesting sign to identify CDCs from other abdomen cysts in the prenatal stage. The maximum diameter of CDCs was 4.6 cm, and 85.6% of these cases were <3 cm within 21–38 weeks of gestation (mean: 28 weeks of gestation). As the size of the CDC increased, the specificity of these three signs decreased to 76.9%, 38.4%, and 23.0%, respectively, in the postnatal MRCP.The incidence that shows that the CDC communicates with the intrahepatic bile duct or with the bile duct and gallbladder in the prenatal MRI was the same as that in the postnatal MRCP. However, this was also the most difficult MRI sign to confirm in the prenatal diagnosis. The thickness of the fetal MRI was 4–6 mm, and the connection of the cyst and bile duct and gallbladder could only be revealed in one to two slices in each sequence. In the situation, it is hard for the radiologist to confirm the real connection and to determine whether there was a pancreaticobiliary maljunction of fetal CDCs. A folder gallbladder and large cyst would compress the gallbladder, leading to a misdiagnosis, which is similar to Case 5.Wong et al.  reportedAt present, it is difficult to differentiate between CDCs and cystic biliary atresia (CBA), as both are cystic dilatations of the biliary tree . CBA is For patients who have no jaundice, and those who do not have an increase in cyst size, elective excision at a later age is advocated . HoweverFetal abdominal cystic lesions are relatively common and have an incidence of 1/1,000 . The abnThere were several limitations to the present study. First, the sample size was too small to make broad generalizations. Second, not all fetal abdomen cyst patients with fetal MRI were chosen for comparison, and the other cyst outcomes were not compared. Third, the present study was a retrospective study. These diagnostic criteria should be used for prospective studies.In conclusion, the diagnostic accuracy of prenatal MRI for CDCs is higher than that of US. Fetal MRI is better than ultrasound in showing the cyst position and relationship with the biliary tract. Of all the signs, the cyst is the highest sensitivity and specificity above the lower edge of the liver and connected to the intrahepatic bile duct. For the first time, we evaluated the daily growth rate of common bile duct cysts from fetal to preoperative period, and we found that the length, width, and size of the CDC may become larger over time.


To investigate the function of the human glymphatic system (GS) in patients with spontaneous intracerebral haemorrhage (sICH) using diffusion tensor imaging analysis along with the perivascular space (DTI-ALPS). t-tests and paired t-tests were performed to analyse the difference in ALPS scores between patients and HCs, as well as that between the lesion side and contralateral side. Pearson correlation analysis was used to observe the relationship between disease duration and GS function.  Twenty patients with sICH and 31 healthy controls (HCs) were recruited for DTI and susceptibility-weighted imaging scanning. The diffusivity along the perivascular spaces, as well as the projection fibres and association fibres, was evaluated separately. The DTI-ALPS index of each subject was also calculated. Two-sample p < 0.01, t = −5.77), and it was also significantly lower than that of the ipsilateral side of HCs . No significant differences were found in the DTI-ALPS index on the nonlesion side between patients and HCs  or between the left and right cerebral hemispheres of HCs . The DTI-ALPS index of the lesion side in patients with sICH was significantly correlated with disease duration .  The DTI-ALPS index on the lesion side was significantly lower than that of the contralateral side in patients with sICH ( The present study confirmed that GS dysfunction on the ipsilateral side of the lesion is impaired in patients with haemorrhagic stroke, indicating that the GS may be a separate system in the left and right cerebral hemispheres. The DTI-ALPS index can reflect disease duration. These findings have significant implications for understanding sICH from a new perspective. Spontaneous intracerebral haemorrhage (sICH) refers to a nontraumatic intraparenchymal haemorrhage caused by spontaneous rupture of cerebral blood vessels . Compareβ) [The glymphatic system (GS) was first discovered by Iliff et al.  through β) , tau proβ) , lipids β) , proinflβ) . The PVSGS is involved in the pathological process of stroke, including brain oedema, blood–brain barrier (BBB) disruption, immune cell infiltration, neuroinflammation, and neuronal apoptosis . Some stWe recruited a convenience sample of 23 hospitalized patients with sICH. All patients received conservative treatment, and magnetic resonance imaging (MRI) was performed on each patient one month later. The inclusion criteria were as follows: (i) haemorrhage lesion located in the left cerebral hemisphere, and it is at least three slices away from the slice of measured ROI, (ii) no severe cerebral white matter lesions, (iii) no history of head trauma, and (iv) no comatose state a week before and after MRI administration. Patients with one of the following conditions were excluded: (i) MRI revealing lesions in the brain parenchyma other than haemorrhage, (ii) the haemorrhage is too large that it would affect DTI metrics measurement, (iii) cognitive impairment, and (iv) history of neuropsychiatric disease. Thirty-three healthy volunteers were selected as healthy controls (HCs). Inclusion criteria for HCs were as follows: (i) age and sex matched with participants in the patient group, (ii) no symptoms and signs of any neurological disease, and (iii) no history of drug use, alcohol abuse, or mental illness. The exclusion criteria were as follows: (i) intracerebral lesions detected by routine MRI scans and (ii) neurological diseases or a family history of genetic diseases.This study was performed in accordance with the tenets of the Helsinki Declaration and was approved by the local Ethics Committee of Xuzhou Affiliated Hospital, Xuzhou Medical University. Written informed consent was obtained from all subjects before participation in the study.2, FOV = 256 × 256 mm2, number of diffusion gradient directions = 64, b value = 1000, and providing voxels of 3 mm × 2 mm × 2 mm. The enhanced gradient echo T2∗ weight angiography (ESWAN) sequence was used for the acquisition of susceptibility-weighted imaging (SWI) data, with the following parameters: TR/TE = 44.5 ms/5.5 ms, bandwidth = ±41.67 kHz, slice thickness/slice spacing was 2 mm/0 mm, and the reversal angle was 15°. In addition, all patients underwent T2WI (TR/TE = 4968 ms/172.2 ms), DWI (TR/TE = 4880 ms/77.3 ms), and FLAIR (TR/TE = 9000 ms/94 ms) scans, with the same FOV = 240 × 240 mm2, slice thickness/slice spacing = 6.0 mm/1.5 mm, and the same number of slices = 18.All subjects underwent 3.0 Tesla MRI scanning  with an eight-channel head coil. Each subject was stabilized with comfortable foam pads to minimize head movement and wore earplugs to prevent the influence of noise during scanning. High-resolution T1-weighted images (T1WIs) were acquired by using a three-dimensional- (3D-) T1 brain volume (BRAVO) sequence, which provided isotropic voxels of 1 mm × 1 mm × 1 mm; repetition time (TR), 7 ms; echo time (TE), 3 ms; field of view (FOV), 256 mm × 256 mm; number of slices, 192; and flip angle, 12°. DTI data were obtained using the following parameters: TR/TE = 9000/90 ms, matrix = 128 × 128 mmhttps://www.mristudio.org/). Briefly, the steps were as follows: (i) raw DTI data of a single individual were imported into the software; (ii) automatic image registration was performed; and (iii) the diffusion tensor was calculated, including a colour-coded fractional anisotropy (FA) map and diffusivity in the directions of the x-axis, y-axis, and z-axis. The direction of the PVS is perpendicular to the ventricle wall. This direction is also perpendicular to the direction of the projection fibres as well as the association fibres  and the x-axis diffusivity in the area of the association fibres (Dxxassoc) to the average value of the y-axis diffusivity in the area of the projection fibres (Dyyproj) and the z-axis diffusivity (Dzzassoc) of the association fibres area. More specifically, this relationship is defined as follows: DTI-ALPS index = mean /mean . A lower ratio represents less water diffusivity along the PVS, indicating reduced GS activity.Subsequently, the DTI-ALPS index was calculated by using the DTI parameters measured above. According to a study by Taoka et al. , this inhttp://www.itksnap.org), and the volume of each haemorrhage was automatically generated. Each individual volume obtained from each radiologist was averaged as the final result.The haemorrhagic lesions were delineated manually by two radiologists on individual high-resolution T1WI images using ITK-SNAP  statistics were used to assess interobserver agreement for DTI parameter measurements. A two-sample p = 0.87) or sex (p = 0.24) between participants in the sICH and HC groups. The disease duration was 21-155 (55.6 ± 38.8) days. The haemorrhage volume was 7.4-33.2 (23.92 ± 6.67) mm3  and 31 HCs  were included in the present study. No significant difference was found in age (.67) mm3 .p < 0.001) was found for the DTI-ALPS calculation of all patients. The DTI-ALPS index of the patient's lesion side (left side) was 1.11 ± 0.23, and the DTI-ALPS index of the contralateral side (right side) was 1.64 ± 0.41. The DTI-ALPS index of the left and right cerebral hemispheres of the HCs was 1.67 ± 0.19 and 1.63 ± 0.19, respectively. The DTI-ALPS index on the lesion side was significantly lower than that of the contralateral side ; in addition, DTI-ALPS index on the lesion side was significantly lower than that of the ipsilateral side of the HCs   or between the left and right cerebral hemispheres of HCs    . No sign= −0.83) . For cor= 0.537) .The main goal of the current study was to determine the pathological changes in the GS in patients with sICH by means of DTI analysis. The most obvious findings to emerge from this study were that (i) impaired GS function was revealed on the lesion side in patients with sICH, (ii) the DTI-ALPS index can reflect the disease duration, and (iii) no obvious change was found in the DTI-ALPS index on the nonlesion side in patients with sICH. The current data highlight the importance of the GS in understanding the pathophysiological mechanisms of sICH from a new perspective.https://www.home-for-researchers.com). It is wrapped by the astrocyte foot process and filled with CSF [The loose fibrous matrix of the PVS provides a low resistance pathway for CSF-ISF flow and plays an important role in brain fluid transport. Physiological factors, such as arterial pulsation, respiration, and CSF pressure gradient, facilitate CSF entry into the subarachnoid space, allowing it to enter the deep structure of the brain along the PVS. CSF is then mediated by AQP4 into the brain tissue space and promotes the flow of ISF back to the subarachnoid CSF through the PVS and to the surrounding veins within the overall flow. Finally, the metabolites and toxic proteins of CSF flow to the cervical lymph nodes and peripheral lymphatic system through the meningeal lymphatic vessels, which play a key role in maintaining the balance of CSF-ISF and removing metabolic wastes in the brain . The PVSwith CSF , 15. Botwith CSF , 22. Theβ [https://www.home-for-researchers.com). Meanwhile, the abnormal structure and function of GS also accelerate the pathological development of different types of stroke [At present, it is still a challenge to determine GS biomarkers in humans. Recently, DTI-ALPS, proposed by Taoka et al. , was recβ , tau proβ , lactateβ , iron [2β , and proβ , accumulβ . The funf stroke . TherefoInterestingly, we found no significant difference in DTI-ALPS on the same side (right side) between participants in the HC and sICH groups, but it was significantly reduced on the lesion side, which indicated that GS function decreased on the ipsilateral side of the lesion but not on the contralateral side. In previous studies, the DTI parameters were only measured in the left cerebral hemisphere because the subjects were right-handed , 18. DesFurthermore, the DTI-ALPS index was revealed to be significantly associated with disease duration in the current study. A previous study demonstrated that the occurrence and development of neurological disease can lead to GS dysfunction; conversely, the abnormal structure and function of the GS can also accelerate the development of the disease . In otheSeveral limitations should be noted. (i) We only investigated patients with left hemisphere haemorrhagic stroke and did not recruit patients with right-sided sICH; (ii) although we obtained positive results, our sample size was still not very large; (iii) the ROI was placed manually; (iv) ICH-related clinical scores were not collected; and (v) it would be better to perform longitudinal studies to observe the changes in DTI-ALPS before and after sICH treatment.The present study was designed to determine the relationship between GS function and sICH by using DTI-ALPS, and it proved that GS dysfunction is closely associated with pathophysiological changes in haemorrhagic stroke. The DTI-ALPS index can reflect the disease duration of sICH. Furthermore, this study found that GS function decreased on the ipsilateral side of the lesion but not on the contralateral side, indicating that the GS may be a separate system in the left and right cerebral hemispheres, respectively. Overall, these findings have significant implications for the understanding of sICH from a new perspective. In the future, longitudinal studies should be conducted in which a large sample of patients and patients with sICH in the left/right cerebral hemispheres are included.