Evidence regarding the long-term risk of infections in preterm infants is lacking. In this study, we examined whether preterm infants developed various common childhood infections more frequently than full-term infants by the age of 2 years by analyzing data from a questionnaire completed by 67,282 mother–toddler pairs in a nationwide birth cohort study. Of the target population, 2885 (4.3%) were born prematurely. After covariate adjustment for maternal and children factors, lower respiratory tract infections appeared more frequent in preterm than in full-term infants at both 1 and 2 years . However, there was no significant difference in the frequencies of lower respiratory tract infection between preterm and full-term infants after Palivizumab administration. The risk of other common infections, such as in the upper respiratory tract infection, otitis media, urinary tract infection, gastroenteritis, herpangina, hand-foot-and-mouth disease, chickenpox, influenza virus, and adenovirus infections, was not higher in preterm than in full-term infants after covariates adjustment for maternal and children factors. These findings suggest Palivizumab prophylaxis could reduce the frequencies of lower respiratory tract infection in preterm to the same level as in full-term infants. In Japan, the preterm birth rate has remained at 5.4–5.7% since 20002. Although survival has significantly improved for extremely preterm infants, severe bacterial infectious diseases, such as sepsis, bacterial meningitis, and pneumonia, remain a cause of neonatal death and long-term complications during neonatal intensive care unit (NICU) admission3. Infections can also contribute to a lower quality of life for preterm infants after hospitalization from the NICU to home; infection-related deaths and hospitalizations increased significantly in extremely preterm infants5 who show persistently higher rates of infection-related hospital admissions until 18 years of age7. However, differences in the frequency of various common childhood infections between preterm and full-term infants have not yet been fully investigated. Several studies have reported that the frequency of viral respiratory infections in preterm infants is comparable to that of full-term infants after hospitalization9. Respiratory syncytial virus (RSV) is considered the most common cause of lower respiratory tract infection in infants. Similar to the American Academy of Pediatrics indications, Palivizumab, a humanized monoclonal antibody, has been used widely in Japan since 2002 against RSV F glycoprotein10. However, population-based data investigating the effect of Palivizumab on RSV infections after its widespread use are still lacking.In Western and developed countries, approximately 5–12% of all pregnancies result in preterm birth and this rate has not decreased over the past two to three decadesIn this research, we compared the frequency of the different common childhood infections between preterm and full-term infants by the age of 2 years, after hospitalization, using data extracted from the Japan Environment and Children’s Study (JECS). Furthermore, we assessed the effects of Palivizumab on RSV-associated infectious diseases on post-hospitalized preterm infants.The characteristics of the participants in preterm and full-term births are presented in Table p = 0.0028; OR 1.57, 95% CI 1.10–2.24, p = 0.0131; OR 1.28, 95% CI 1.12–1.46, p = 0.0004, respectively). In contrast, preterm birth was associated with decreased risks of otitis media and exanthema subitum at 1 year of age compared with full-term birth . However, after covariates adjustment by adding maternal factors (Model 1), as well as children factors such as feeding methods and attending a childcare facility (Model 2), only lower respiratory tract infections were more frequent in preterm than full-term infants at both years 1 and 2 , whereas the urinary tract infections did not show any significant difference between preterm and full-term infants at 2 years of age. In contrast, preterm birth was associated inversely with otitis media and exanthema subitem risk at 1 year of age compared with full-term birth in both Models 1 and 2, similar to the results of crude OR .Table p = 0.2731, 2 years; aORs 1.10, 95% CI 0.93–1.30, p = 0.2859). The frequency of RSV infections in preterm and full-term infants did not differ in Models 3, with no significant difference.To determine the mediating effects of RSV and lower respiratory tract infections in preterm birth, we included Palivizumab as a covariate Table ; after aThis study found that preterm infants developed lower respiratory tract infections more frequently than full-term infants by 1 and 2 years of age, however, the risks were comparable after receiving Palivizumab. The occurrence of other common childhood infections in preterm infants after hospitalization, however, was not significantly higher than that in full-term infants.2, although it counted for 4.6% in our current study, in which approximately 80% of the preterm infants were late preterm , similar to the provided data on preterm births in Japan2. Although the no response or missing data rate for extremely preterm infants might be higher, we assume that our study represents the current situation of preterm and full-term birth infants in Japan. Several studies have reported that preterm infants might have poor protection against infections owing to an overactive or poorly responsive innate immune system, suppressed chemokine production, and immature neutrophil function12. Owing to these immunological mechanisms, the vaccine response in preterm infants could be inferior to that in full-term infants14. In addition, serum immunoglobulin G (IgG) levels are lower in preterm infants because less IgG is transferred through the placenta15. Consequently, we believe that healthcare providers should be able to segregate the infections according to their higher risk in compromising the health of preterm infants, not only during NICU admission, but also after discharge.In Japan, the preterm birth rate was 5.6% in 201516. However, these studies did not show any association between the incidence of lower respiratory tract infection and Palivizumab prophylaxis. RSV is considered the most common cause of lower respiratory tract infection in children < 1 year of age17. Although the efficacy of Palivizumab in reducing RSV-related hospitalizations was well established21, our study suggests that Palivizumab administration reduced the incidence of lower respiratory tract infection in preterm infants to the same level as in full-term infants. Recently, some studies have reported that Nirsevimab, an Fc-modified monoclonal antibody against RSV with an extended half-life, was effective in preventing RSV-associated lower respiratory tract infection in healthy preterm and full-term infants23. Once Nirsevimab is approved for use, further studies on its effectiveness will be needed.In our study, only the frequency of lower respiratory tract infection remained higher in both age groups in preterm infants, after covariates adjustment for maternal and children factors. Concerning the mechanism, preterm infants might be more susceptible to lower respiratory tract inflammation owing to either bronchopulmonary dysplasia or airway hyper-responsiveness. In this context, several studies have reported that preterm infants have a higher incidence of lower respiratory tract infections, which might contribute to more treatments requiring hospitalization and higher medical costs compared with full-term infants8. Consequently, preterm infants who spent less time in the community before the age of one might have less opportunity to develop otitis media and exanthema subitum.Our data show that the incidence of otitis media and exanthema subitum by 1-year of age was lower in preterm than in full-term infants, even after adjustment for maternal and postnatal factors Table . This is24. Other studies revealed that preterm infants mounted antibody responses that were similar to those of full-term infants after vaccination25. Although there is limited information about the associations between other viral infections and preterm infants, hospitalizations due to the influenza virus infection (H1N1) were similar between preterm and full-term infants9. Studies on adenovirus, herpangina, and hand-foot-mouth disease are still lacking. However, although gastroenteritis is considered the second most common reason of postneonatal hospitalization by infection for preterm infants26, in our cohort study, there was no notable difference concerning this infection between preterm and full-term infants.In our data, there was no difference in the incidence of other infections between preterm and full-term infants up to 1 and 2 years of age even after adjustment for confounding factors  large size of the sample , (2) we recruited this sample from 15 regional centers in Japan within the past decade. Therefore, we trust that our records are illustrative of the recent Japanese mother–child pairs, and (3) we added several variables that probably impact the development of infectious diseases in children, including not only maternal characteristics, socioeconomic, and smoking history, but also maternal parity, feeding methods, and attending a childcare facility. Finally, to our knowledge, our study is the first report to present the occurrence of various common infections in preterm infants compared with full-term infants after discharge from a neonatal care facility.Several limitations also need to be considered; (1) the questionnaire regarding infections depended on the mother’s memory, and data were not obtained from medical records. In addition, the questionnaire missed information on multiple infections during the period, infection severity, or whether hospitalization was needed; and (2) the no response or missing data rate might have been higher in more preterm infants because questions about infants start after birth.In conclusion, our data show that preterm infants are at a higher risk of lower respiratory tract infection than full-term infants by 1 and 2 years of age, however, the risk was comparable after adjustment for Palivizumab administration. Nevertheless, the occurrence of other common childhood infections in preterm infants after discharge from a neonatal care facility was not significantly higher than for full-term infants.29. In brief, the JECS is a cohort study about birth, funded by the Japan government to reach all of Japan, and it includes many elements that influence the wellbeing and growth of children. The participants were enrolled in person in 15 Regional Centres throughout Japan between January 2011 and March 2014. The current study analyzed the set of data referenced by jecs-qa-20210401 (jecs-ta-20190930), which was available in April 2021. Data from 103,057 pregnancies until 3 years postnatal were included, from which we omitted records with inappropriate data for analysis, such as those with numerous participation, multiple births, miscarriages/still births, post-term delivery, missing data on gestational week, no response to or missing data on the questionnaire regarding infectious diseases, or missing data on covariates. Therefore, 67,282 mother–child pairs remained for the last examination , the Ethics Committees of all participating institutions, and the Committee of Ethics at Toyama University (no. R2022055). Finally, we obtained written informed consent from all participants.First, we gave the questionnaire for every participant autonomously to be auto-completed at trimesters one, two or three, and at 1 month, 6 months, 1 year, 1.5 year and 2 years after delivery. The questionnaire had many inquiries regarding demographic factors, socioeconomic status, lifestyle, occupation, medical history, physical and mental health, and housing conditions. We transcribed perinatal medical records from each cooperating health care provider, including gestational age and infant physical examinations of the infant at birth and at 1 month of age.The frequency of infection development in infants is regarded as the first outcome. Infections included upper and lower respiratory tract infections, otitis media, urinary tract infection, gastroenteritis, exanthema subitum, herpangina, hand-foot-mouth disease, chickenpox, influenza virus, RSV infection, and adenovirus infections. We assessed the data when the infants were at 1 and 2 years of age, through the following question: “Has your child been diagnosed with any of these infections by a physician since the last survey until the present time?”.The covariates involved in the analysis were maternal age, prepregnancy BMI, parity, history of maternal allergy, history of any physical disease, marital status, maternal employment, maternal highest education level, annual household income, maternal alcohol intake, maternal smoking history, maternal physical activity, feeding methods, attending a childcare facility at 6 months of age, and receiving Palivizumab prophylaxis.The participants were classified into preterm (< 37 weeks) and full-term (37 till < 42 weeks) birth groups according to the gestational weeks for the statistical analysis. We used t-test and chi-square to evaluate the significant difference between the two groups. We conducted multivariable logistic regression analysis to identify the relationship between preterm birth and the frequency of infant infections by the age of 1 and 2 years.30, alcohol intake, smoking history, and physical activity32. Next, we adjusted Model 2 by adding to the first model, feeding methods, and attending a childcare facility. Finally, we adjusted Model 3 by adding the inquiry regarding Palivizumab administration to the Model 2.We used the compulsory entry method to comprise covariates in the multivariable analysis. We adjusted the regression in Model 1 for maternal age, pre-pregnancy BMI, parity, history of maternal allergy, history of any physical disease, marital status, employment, highest education level, annual household income, total energy intake assessed using Food Frequency Questionnairep < 0.05, and used SAS 9.4  for statistical analyses.We present the results as crude and aORs with 95% CI, we set the significance at


With the increase in extremely low birth weight (ELBW) infants, their outcome attracted worldwide attention. However, in China, the related studies are rare. The hospitalized records of ELBW infants discharged from twenty-six neonatal intensive care units in Guangdong Province of China during 2008–2017 were analyzed. A total of 2575 ELBW infants were enrolled and the overall survival rate was 55.11%. From 2008 to 2017, the number of ELBW infants increased rapidly from 91 to 466, and the survival rate improved steadily from 41.76% to 62.02%. Increased survival is closely related to birth weight (BW), regional economic development, and specialized hospital. The incidence of complications was neonatal respiratory distress syndrome (85.2%), oxygen dependency at 28 days (63.7%), retinopathy of prematurity (39.3%), intraventricular hemorrhage (29.4%), necrotizing enterocolitis (12.0%), and periventricular leukomalacia (8.0%). Among the 1156 nonsurvivors, 90.0% of infants died during the neonatal period (≤ 28 days). A total of 768 ELBW infants died after treatment withdrawal, for reasons of economic and/or poor outcome. The number of ELBW infants is increasing in Guangdong Province of China, and the overall survival rate is improving steadily. In recent decades, the outcomes of preterm infants, especially extremely preterm  and extremely low birth weight  infants, have improved worldwide due to the use of antenatal steroids, pulmonary surfactant treatment and advances in perinatal health care, such as neonatal resuscitation, mechanical ventilation and nutritional management4. However, the mortality and morbidity vary widely across countries or regions. Generally, more improvements have been gained in developed countries or regions, such as the United States5, the United Kingdom6, Japan8 and Singapore9.Low birth weight preterm infants have a particularly high risk for morbidity and mortality10, Canada Neonatal Network (CNN)11, Neonatal Research Network of Japan (NRNJ)12, Etude Epidémiologique sur les Petits Ages Gestationnels (EPIPAGE) in France13, and EPICure in the United Kingdom14, have worked well and continuously monitored the outcomes of these infants. However, in mainland China, a similar national or provincial network has not been established. The outcomes of extremely preterm and ELBW infants observed in a large population remain unclear. Therefore, we initiated a collaborative study group including twenty-six neonatal intensive care units (NICUs) from Guangdong Province of China to perform a multicenter survey of the short-term outcomes at discharge of extremely preterm or ELBW infants from 2008 to 2017. Generally, GA and BW are the two most important indicators of the maturity for preterm infants. In a previous paper, based on GA, the outcomes of extremely preterm infants were summarized and analyzed15. Similarly, based on BW, the outcomes of ELBW infants should be demonstrated. In addition, BW was recommended to group the preterm infants by the World Health Organization and had been used in many studies. This study can be helpful for making comparisons with other studies by BW categories and benefit for continuous quality improvement plan.Available data of extremely preterm and ELBW infants are very important for family counseling and clinical practice improvement. Many neonatal networks or collaborative study groups, such as the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network (NICHD NRN) in the United StatesThe outcomes of ELBW infants can be affected by many aspects such as maternal disorders, fetal or neonatal diseases, perinatal and neonatal care etc. The most influential factors for survival may be the equipment in the NICUs and the skills of the personnel who handle the neonates. In this study, we tried to summarize and analyze the demographics of ELBW infants and their mothers; the survival rate variation among discharged years, BW categories (per 100 g) and regions, or between types of discharged hospital; the major complications of BW categories (per 100 g); the survival days (or hours) of the non-survivors, and the causes for care withdrawal.From 2008 to 2017, there were 2596 ELBW infants discharged from the participating NICUs. As there were twenty-one infants excluded for uncompleted hospitalization records, the rest 2575 ELBW infants were enrolled in this survey . Comparing with the nonsurvivor group, there were fewer infants in the survivor group with Apgar scores ≤ 3 at 1 min and ≤ 3 or 4–7 at 5 min . The survivor group had a longer hospital stay and a higher rate of receiving surfactant therapy (p < 0.001), but there was no significant difference in two or more doses of surfactant therapy. Interestingly, increasing percentage of small for gestational age (SGA) infants was found in survivor group. No significant difference in sex existed between the two groups.To clarify the perinatal factors and outcome of ELBW infants, we specifically grouped the ELBW infants based on survival, shown in Table p < 0.001), and a lower incidence of cervical incompetence (p < 0.01). Interestingly, the mothers in the survivor group had higher incidences of premature rupture of membranes (PROM) (p < 0.001), fetal distress (p < 0.05) and pregnancy-induced hypertension (PIH) syndrome (p < 0.001). Between the two groups, a similar prevalence was found in the history of pregnancy problems, mother’s age (≥ 35 years), multiple pregnancy (twins or triplets), infection in the perinatal period, gestational diabetes mellitus, and placental disease .Comparing with the nonsurvivor group, the mothers in the survivor group had a higher proportion of antenatal steroid therapy and cesarean section (both p < 0.001), and the proportion of ELBW infants among all discharged infants increased annually from 0.27% in 2008 to 0.77% in 2017  belonged to the high level, the other cities in the Pearl Delta (including ten NICUs) belonged to the medium level, and the cities outside the Pearl Delta (including five NICUs) belonged to the low level. From the low level to the high level, the overall survival rates increased sharply (p < 0.001); but this tendency was not found in incidence of ROP (any grade), NEC (any stage and stage ≥ IIb) or PVL , 63.7% for oxygen dependency at 28 days, 39.3% for any grade of retinopathy of prematurity (ROP), 29.4% for any grade of intraventricular hemorrhage (IVH), 12.0% for any stage of necrotizing enterocolitis (NEC) and 8.0% for periventricular leukomalacia (PVL). With the increase per 100 g in BW between 500 and 999 g, Chi-square test linear-by-linear association showed a significant decreasing trend in RDS, oxygen dependency at 28 days, ROP ≥ grade 3, IVH (any grade) and IVH ≥ grade III incidence, respectively .Among the 1156 nonsurvivors, 90.0% (1040 of 1156) of infants died during the neonatal period (≤ 28 days), and the other 10.0% (116 of 1156) died after the neonatal period (> 28 days). Specifically, 27.2% (314 of 1156) of infants died during the first 24 h, 16.4% (190 of 1156) on the second day, 9.4% (109 of 1156) on the third day, 15.2% (176 of 1156) during the fourth to seven days, 9.7% (112 of 1156) in the second week, 7.4% (85 of 1156) in the third week and 4.7% (54 of 1156) in the fourth week. The survival time of nonsurvivors under active treatment or withdrawal treatment were shown in Table In this study, 768 ELBW infants died after withdrawal treatment. The potential reasons were summarized and analyzed. For 35.9% (276 of 768) of infants, there were concerns about the economic burden together with the fear of poor or uncertain outcomes; for 29.6% (227 of 768) of infants, there were only fears of poor or uncertain outcomes; and for 14.7% (113 of 768) of infants, there were concerns only about the economic burden. Besides, for 1.6% (12 of 768) of infants, medical treatments were withdrawn owing to other factors, such as gender preference, and for 18.2% (140 of 768) of infants, the exact reasons were not mentioned.The outcome of ELBW infants has gradually attracted worldwide attention in recent decades. Guangdong Province locates in southern China, with a population of more than 100 million and a highly developed economy and industrialization. In this study, we confirmed that the number of ELBW infants increased rapidly from 2008 to 2017 in Guangdong Province. More importantly, the survival rate improved steadily year by year. These data provide useful information to complement the understanding of ELBW infants in developing countries.18. Similar to the reports from other countries, our study also suggested a significant increase in ELBW infants over the ten years, from 1.09 per 1000 discharged infants in 2008 to 2.62 per 1000 discharged infants in 2017. A 2.4-fold increase was noted. Although this is not a national population-based survey, it can partly reflect the situation of ELBW infants in China.From the 1990s or 2000s, the number of ELBW infants began to increase in many developed countries7. In the United States, the standardized mortality rates for infants weighing 501–750 g and 751–1000 g in 2009 were 36.6% and 11.7%, respectively19. In Korea, the survival rate of ELBW infants increased dramatically from 14.0% in 1985–1989 to 69.6% in 2010–201420. However, in China, it was reported that just half of ELBW infants survived in 201121. In our survey, the overall survival rate of ELBW infants at discharge was 55.11%. Encouraging improvement has been made, from 41.76% in 2008 to 62.02% in 2017.During the past decades, the mortality rate of ELBW infants has decreased in many developed countries or regions. In Japan, the rate of mortality and the mortality in ELBW infants during NICU were 13.0% and 17.0% in 200521. In China, specialist hospitals, such as children’s hospitals or maternal and children’s hospitals, always have better facilities and more favorable policies in neonatal care than general hospitals. As a result, a higher survival rate was noted in the specialist hospitals in our study. A similar phenomenon was found in another multicenter study from China21.Although the economy of Guangdong Province is relatively developed, the regional development is still unbalanced. In results of regional comparisons, we found that ELBW infants in economically developed regions had higher survival rates than those in less economically developing regions. This difference within Guangdong Province may be a microcosm in China. China is a multiprovincial country with unbalanced economic development. Hong Kong, a developed modern city neighboring Guangdong Province, reported higher survival rate23. Although there is still some controversy regarding the side effects24, there is a consensus that the advantages of prenatal corticosteroids outweigh the disadvantages26. Unfortunately, only 49.2% of ELBW infants’ mothers received antenatal corticosteroids in our study, but it was 80%-90% in developed countries28. Therefore, this situation urgently needs to change.Perinatal management is essential for the outcomes of ELBW infants. Many studies have shown that antenatal corticosteroids effectively decrease the mortality of preterm infants and even reduce various complications, such as RDS, NEC, IVH and ROP30, but our study showed that the incidence of PROM and PIH syndrome in the survivor group was higher than that in the nonsurvivor group. Moreover, cesarean section was more common in the survivor group. A possible explanation is that PROM or PIH syndrome could have been an early warning that attracted the attention of pregnant women and led them go to the hospital for help in time. When they were admitted to the hospital, more active medical care, such as antenatal corticosteroids, cesarean section, neonatal resuscitation and pulmonary surfactant, was given. Nevertheless, the other potential reasons still need to be further studied and analyzed.Interestingly, numerous studies have shown that PROM and PIH syndrome are high-risk factors for preterm delivery and infant death31. We can reasonably believe that the survival of ELBW infants will continue to improve with the economic development and medicine advancement in China.ELBW infants are unstable and tend to suffer various complications due to their prematurity. Without active life support, many infants die during the neonatal period, especially in the first 7 days of age, and some die due to critical illnesses despite receiving active treatments. In our study, 90.0% of nonsurviving infants died during the neonatal period, while nearly 68.3% died in the first 7 days, and the majority died after withdrawal treatment . The Papile grading system was used to grade IVH36, and PVL was defined as degeneration of white matter adjacent to the cerebral ventricles following cerebral hypoxia or brain ischemia37. Due to the definition of BPD remained inconsistent, we directly descripted and calculated the infants with “oxygen dependency at 28 days”.In this survey, surviving infants were defined as neonates who survived to the time of discharge. GA was calculated from the date of the last menstrual period or was determined by fetal ultrasound assessment. SGA was defined as newborns whose birth weight is lower than the 10th percentile of birth weight in infants of the same gender and gestational age. RDS was diagnosed in preterm infants with the onset of respiratory distress shortly after birth and a compatible chest radiograph appearanceSD) or as median and interquartile range (IQR) according to the distributions. Categorical variables were presented as counts and percentages. To compare the variation between two groups, t-tests or Mann–Whitney tests were used in continuous variables; while Pearson’s Chi‑square test was used in categorical variables and presented with odds ratio (OR) and 95% confidence intervals (CI). In addition, Chi-square tests linear-by-linear association were used to compare the survival rates among discharged years, BW categories (per 100 g), regions and the major complication among BW categories (per 100 g), respectively. To further clarify the influencing cofactors  to the outcome  of the ELBW infants, binary logistic regression was used. The test level was set at α = 0.05, and the cutoff of p < 0.05 was considered statistically significant.All statistical analyses were performed using SPSS 18.0 for Windows . Continuous variables were presented as the mean ± standard deviation (Data collection was approved by the Institutional Review Board of the Third Affiliated Hospital of Guangzhou Medical University. Written informed consent was obtained from the parents at the time of admission.


Neonates are highly susceptible to bacterial infections, which represent a major source of mortality and morbidity in this age category. It is recognized that β2 integrins play a critical role in innate immunity by mediating leukocyte vascular adhesion, transmigration and bacterial phagocytosis. Therefore, we aimed to assess if the impaired immune functions seen in newborns may derive, in part, from a transient insufficient β2 integrin expression. In the present study we measured baseline lymphocyte function-associated antigen-1 (LFA-1 or CD11a/CD18), macrophage-1 antigen (MAC-1 or CD11b/CD18) and leukocyte integrin p150-95 (CD11c/CD18) expression on cord blood, and on the third day of life in a cohort of 35 healthy neonates, compared with a control group of 12 healthy adults. For any of the three β2 integrins, the expression on polymorphonuclear cells was significantly lower on cord blood than in adults and increased from birth to day 3. We also compared superoxide radical (SR) production in these neonates with 28 non-smoking adults. SR production in response to integrin stimulation by Zymosan was significantly lower at birth than in adults, and it decreased further in the third day of life. These findings suggest that innate immune impairment in newborns may be, in part, accounted for by a lower β2 integrin expression on phagocytes in the neonatal period, but also by a functional impairment of free radical production. At the neonatal age, bacterial infections represent a relevant factor of mortality and morbidity . A critiTheir extracellular domain displays multiple receptor and adhesion sites, whereas the intracellular domain is connected to various cytoplasmic signaling pathways and alters several cell functions. LFA-1 and MAC-1, through their interaction with the intercellular adhesion molecule family , play a major role in leukocyte adhesion and emigration . MAC-1 iZymosan, a yeast extract mostly constituted of β-glucan and commonly used for in-vitro neutrophil and macrophage activation, has the property of activating integrins (mostly MAC-1) either through its lectin site when non-opsonized or through its complement-biding site when opsonized . TherefoIn this pilot study, thirty-five consecutive neonates were recruited in the immediate prenatal period on the basis of gestational age, anticipated mode of delivery, the absence of anomalies on routine echographic and serologic screening tests during pregnancy, and the absence of risk factors for perinatal infection other than preterm labor. Informed parental consent was systematically obtained. A 1.5 mL blood sample was drawn from the umbilical cord at birth, and a second one from a venous puncture on the third day of life when routine metabolic screening tests were performed. Twelve healthy 20–40-year-old adults were recruited as controls for β2 integrin expression, and twenty-eight 20–40-year-old non-smoking patients were recruited as controls for superoxide radical production.For each patient, 100 μL whole blood aliquots EDTA samples were drawn at birth and at the third day of life. They were processed within 6 h and diluted in 100 μL of phosphate-buffered saline (PBS). Samples were thus incubated on ice for 30 min after red cell lysis, adding 10 μL of one of the following monoclonal antibodies: fluorescein (FITC)-conjugated anti-CD11a , anti CD11b , anti-CD11c , anti-CD18  and FITC-conjugated anti-murine IgG  as a secondary antibody for CD11b and CD18 or isotype negative control. They were then analyzed with a BD FACS flow cytometer and Lysis II software . For each marker, the percentage of fluorescent cells was determined in the three cell populations identified by light scattering .3+ cytochrome C, 50 µL. The reaction was then blocked with 2 µL N-ethylmaleinide , the aliquots were centrifuged at 1500× g for 10 min, and the supernatant’s light absorbance was analyzed by spectrophotometry at the wavelengths of 468 and 550 nM. Negative controls were obtained by adding 10 µL superoxide dismutase  prior to Fe3+ cytochrome C. The amount of superoxide radical produced by neutrophils was calculated from the product of total superoxide production value, as determined by spectrophotometry and the neutrophil fraction measured on a routine white cell differential count.For each patient at each time point, an 800 μL sample of heparinized whole blood was processed within 6 h from puncture in order to evaluate neutrophil superoxide radical production in resting or stimulated conditions, as previously described . Brieflyt-test was used to compare the two populations’ means (“at birth” versus “at three days of life”); a two-tailed test was used to perform analysis within groups . Statistical analyses were performed with SPSS 17.0 for Windows . A p-value < 0.05 was considered as significant.Data are presented as numbers and percentages for categorical variables. Continuous variables are expressed as mean ± standard deviation (SD) if they were normally distributed. A paired sample Samples of cord blood at birth and venous blood at 3 days of life were collected from 11 term neonates delivered vaginally, 12 term neonates delivered via cesarean section, and 12 preterm neonates  delivered via cesarean section. β2 integrin expression on neutrophils, monocytes and lymphocytes in neonates (on day 0 and day 3) and in adults is reported in Neutrophils broadly expressed CD11a, CD11b and CD11c at birth. We observed a statistically significant raise from birth to day 3 for CD11a and CD11c . The monThe delivery mode  or the gestational age (term and preterm infants) seemed to have no influence on β2 integrin expression, with no significant differences.We also compared superoxide radical (SR) production in these neonates with 28 non-smoking adults . We founp < 0.01). Similarly, after PMA stimulation, neonates at birth had a lower SR production when compared to adults . Neonates at day 3 showed intermediary values.Whereas adults reached a near-maximal NADPH induction either after naked (Z) or opsonized zymosan (OZ) (18- to 26-fold induction from resting condition), neutrophils at birth showed a markedly impaired response to Z when compared to adults  but still appeared blunted when compared to the stimulation obtained in adults, although not significantly .The neonatal response to OZ at birth was much higher than that to Z . The opsonization of zymosan partially restored the NADPH response in neonates at day 3, but it remained lower than the maximal response obtained with PMA (p = 0.02) than that displayed by adults (p = 0.02) and that detected in neonates at birth (p = 0.06).At day 3, neonates showed a further decrease in NADPH inducibility after Z ; hence, supposedly, a reduced bacterial killing capacity. This defective response did not appear to be related to a minor capacity of synthesis.Indeed, after the direct activation of NADPH (the enzyme responsible for superoxide generation in phagocytes) by PMA, neonatal neutrophils showed a response actually greater than in adults. These in vitro findings suggest that the signaling pathway of NADPH activation can be less active in newborns.β2 integrins, particularly MAC-1 and LFA-1, are known to play a critical role in phagocyte activation during sepsis . We quanSimilarly, O’Hare et al. reported an increase in neutrophil CD11b expression in a cohort of preterm infants over the first week of life, but they observed a robust reactive oxygen intermediate (ROI) production after lipopolysaccharide (LPS) stimulation . HoweverZymosan, the compound we used for leukocyte stimulation, as demonstrated in the literature , is mostMoreover, β-glucan binding of this lectin site activates MAC-1 and generates a cytotoxic response in macrophages and natural killer lymphocytes towards opsonized target cells .The deficient oxidative burst we observed at birth after naked zymosan was mostly restored after pre-incubation of blood samples with adult human serum. This finding may be related either to a decreased opsonizing capacity of neonatal versus adult serum , or a miWe observed a further depression of superoxide production on day 3 that was significant after naked zymosan, and close to being significant after opsonized zymosan. This difference in NADPH activity between cord blood and venous blood at day 3 might be interpreted as a primed state of phagocytes at birth, returning to baseline at day 3.In a detailed analysis of the NADPH oxidase activity and its components from unstimulated neutrophils isolated from cord blood in neonates, Chudgar et al. demonstrated a lower amount of cytosolic components, which could contribute to the impaired neutrophil response .An alternative explanation is the presence of high serum levels of anti-oxidant substances such as bilirubin or carbon monoxide (CO), known to have immunomodulator properties, during the first days of life . It is pMorisaki et al. also determined in rats that endogenous CO attenuates endotoxin-induced adhesive responses of platelets and contributes to the amelioration of leukocyte adhesion in venules . MoreoveLimitations of this study include the lack of standardized inclusion criteria, and the small sample size, for whom we probably could not highlight differences related to gestational age or delivery mode.On the other hand, to know the normal values of these markers in healthy neonates is crucial, considering recent studies about neutrophil CD11b during infectious episodes that indicate that it could be a promising biomarker for the early diagnosis of neonatal sepsis ,34.Innate immunity plays a key role in neonatal responses, although a decreased expression level of adhesion molecules on white blood cells and impaired phagocytosis and opsonization. Our findings suggest that innate immune impairment in newborns may be, in part, accounted for by a lower β2 integrin expression on phagocytes in the neonatal period, but also by a functional impairment of free radical production. However, further studies are needed to understand if these in vitro findings are clinically relevant in vivo and play a role in susceptibility to neonatal sepsis.


P < 0.05). In addition, the severe preeclampsia preterm birth group was more harmful than the spontaneous preterm birth group. The complication rate of the severe preeclampsia preterm birth group was 10% higher than that of the spontaneous preterm birth group, and the neonatal mortality rate was 2% higher.Severe preeclampsia is accompanied by many complications, which is extremely harmful to pregnant women and fetuses. However, in the classification of preterm birth, it is generally divided into spontaneous preterm birth and therapeutic preterm birth, and insufficient attention has been paid to preterm birth in severe preeclampsia. This article aims to explore the clinical difference between preterm birth in severe preeclampsia and spontaneous preterm birth. In the experiment, this paper selected pregnant women who delivered and were treated in a hospital from April 2010 to April 2020 as cases. In terms of grouping, not only are they divided into severe eclampsia group (observation group 1), spontaneous preterm birth group (observation group 2), and general delivery group (control group) according to the cause of premature birth, but also according to the gestational age of severe eclampsia onset, preterm weeks, and other groups. Not only the clinical difference between severe preeclampsia preterm birth and spontaneous preterm birth was compared horizontally, but also the factors affecting the complications of preterm pregnant women, perinatal asphyxia rate, and mortality were longitudinally analyzed. The experimental results in this paper showed that there were significant differences in maternal complications and neonatal mortality between the severe preeclampsia preterm group and the spontaneous preterm group ( Fertility is a necessary part of human reproduction and development, but premature birth is also very likely to occur in childbirth, which is very harmful to pregnant women and newborns. The fetal lungs of neonates delivered after 34 weeks of gestation are basically mature, and the incidence of neonatal ventricular asphyxia, hyaline membrane disease, and neonatal hypoxic ischemic encephalopathy after delivery is low. Delivery after 34 weeks of gestation can effectively shorten the length of hospital stay, reduce related treatment costs, and achieve better long-term prognosis. Early treatment for preterm birth can effectively improve the survival rate of neonates, and patients with severe eclampsia are at greater risk, and early prevention is better. Therefore, research on preterm birth and spontaneous preterm birth in severe preeclampsia is necessary.P = 4.55E − 09) on chromosome 1 and rs1979081 (P = 3.72 E − 08) on AMR chromosome 8 in the AFR population to judge spontaneous preterm birth [Spontaneous preterm birth accounts for a large proportion of patients with preterm birth, and many scholars have conducted research on spontaneous preterm birth because of its greater treatability. Campbell studied a rare delayed hypersensitivity reaction called autoimmune progesterone dermatitis in spontaneous preterm labor . Hochwalrm birth . Abe is In this study, compared with the cesarean section, women with vaginal delivery will have much fewer complications, especially the symptoms of placental abruption, and vaginal delivery will be much lower than cesarean section. For neonatal asphyxia or mortality, in the presence of severe eclampsia, the neonatal mortality rate of vaginal delivery is higher than that of cesarean section. The innovations of this paper are as follows: in the study, not only the clinical characteristics of the severe preeclampsia preterm birth group and the spontaneous preterm birth group were compared and analyzed, but also the importance of regular physical examination was also studied, which plays an important role in the prevention and treatment of preterm birth in severe preeclampsia.The methods for predicting preterm birth are also different, especially for the biochemical prediction of preterm birth, which is even more diverse. For example, fFN and serum relaxin in vaginal secretions or cervical mucus are commonly used, and blood and urine routines are tested to observe whether there is obvious infection. Finally, combined with relevant medical history and combined with ultrasound to detect cervical morphological changes and cervical length shortening, it can more accurately predict premature birth, as shown in As shown in Severe antenatal eclampsia is still an important cause of threatening delivery mothers and newborns. Patients with early-onset severe preeclampsia gradually worsened after 30–32 weeks of gestation. Due to the lack of early specific diagnostic indicators, once clinical symptoms such as edema and proteinuria appear, the disease progresses rapidly and is difficult to control. Iatrogenic preterm birth is often caused by various serious complications , 14. TheD, and even disappearance or reverse of umbilical artery end-diastolic blood flow (AEDV/REDV). Current studies have shown that abnormal end-diastolic blood flow of the umbilical artery is closely related to perinatal death, intracranial hemorrhage, periventricular leukomalacia, bronchopulmonary hypoplasia, respiratory distress syndrome, necrotizing enteritis, and other neonatal organ system damage. These are among the indicators that suggest a poor intrauterine environment and predict poor perinatal outcomes [Severe preeclampsia (SPE) is one of the serious complications of obstetrics, which can cause uteroplacental hypoperfusion, vascular endothelial injury, and release of inflammatory factors, resulting in a series of clinical symptoms. Umbilical artery blood flow, as an effective indicator of placenta-fetal blood flow resistance, plays an important role in the assessment of fetal intrauterine development. In normal pregnancy, the umbilical artery-placental blood flow resistance decreased with the increase of gestational weeks, and the ultrasound showed that the ratio of peak systolic blood flow velocity to end-diastolic blood flow velocity gradually decreased. However, when some factors cause the increase of blood flow resistance in the placenta and umbilical artery, it is manifested as an abnormal increase in S/outcomes , 16. SymTermination of pregnancy is the only effective treatment for early-onset severe preeclampsia . The patIn order to reduce the error between the actual output of the BP network and the expected output to an acceptable range, it is necessary to continuously adjust the weights and thresholds of the BP neural network. Gradient descent is usually used to adjust the weights and node thresholds of the BP neural network. The following will briefly introduce the process of training BP network by gradient descent method .The input vector isn is the number of input layer units.Among them, Y and the desired output vector O, and then the output vector isq is the number of output layer units, and then the desired output vector isDetermine the output vector B.Determine the hidden layer output vector The output vector of the hidden layer isInitialize the connection weights from the input layer to the hidden layer.Initialize the connection weights from the hidden layer to the output layer.This process mainly uses the input mode to find the actual output corresponding to it.sj.Calculate the activation value of each neuron in the hidden layer wji represents the weight from the input layer to the hidden layer and θj represents the threshold of the hidden layer unit.Among them, The activation function adopts a sigmoid function, that is,sj into the activation function to obtain the output value of the hidden layer j unit asSubstitute sk of the kth unit of the output layer.Calculate the activation value θk is the output layer unit threshold.In the formula, yk.Calculate the actual output value of the kth unit of the output layer f(x) is the sigmoid activation function.In the formula, The actual input value of the network can be calculated in the previous step. If the difference between the value and the expected value is greater than the specified error, the weights and thresholds of the network are corrected . Since tThe correction error of the output layer isyk is the actual output and ok is the desired output.In the formula, The correction error of each unit in the hidden layer isThe correction amount from the output layer to the hidden layer isa > 0.In the formula, a is the learning coefficient, The correction amount from the hidden layer to the input layer isβ is the learning coefficient and 0 < β < 1.In the formula, It can be seen here that the correction amount is proportional to the learning coefficient, the error, and the input amount. The learning coefficient is generally set to 0.1∼0.8 . In ordeGeneral clinical data were collected from April 2010 to April 2022 in a total of 3470 puerperae who gave birth in the obstetrics department of a people's hospital. Among them, there were 717 cases of preterm birth, and the incidence rate of preterm birth was 20.66%. Among the preterm births, therapeutic preterm birth accounted for 45.19% and primary preterm birth was 54.81%. Severe pre-eclampsia preterm births accounted for 11.16% and spontaneous preterm births accounted for 29.77% of primary preterm births and 16% of total preterm births. Among them, intrauterine infection accounted for 34.19% of the total number of spontaneous premature births, paralyzed uterus and twin pregnancy accounted for 17.95%, and breech presentation accounted for 11.11%. Among the patients, the proportion of therapeutic preterm birth is relatively high, and the main causes of therapeutic preterm birth are early child pain, pregnancy complicated by medical and surgical diseases, multiple pregnancy, and placental factors that lead to early termination of pregnancy. There were 138 cases of spontaneous preterm birth, of which 11 died prematurely, with a mortality rate of 7.97%. Except for one case of twin-to-twin transfusion syndrome death at 36 weeks of gestation (birth weight 600 g), the gestational weeks were mainly concentrated in 28–33 weeks, the average gestational week was 31 weeks, the weight was 570–2030 g, and the average weight was 1394.5 g.p value was less than 0.05.Data processing was performed on SPSS software, and the relationship was considered significant and meaningful when the There are many causes of preterm birth, including intrauterine infection and multiple pregnancy. Moreover, patients admitted to the hospital before 32 weeks and those with preterm birth after 32 weeks usually have different causes, as shown in Intrauterine infection is the main cause of threatened preterm labor at various gestational weeks, and other causes such as uterine malformation and cervical laxity are relatively rare. Cervical cerclage at 14–16 weeks can effectively prevent late miscarriage and premature birth in patients with lax internal os.As shown in p value is less than 0.05.As shown in As shown in From As shown in As shown in After the above experiments, it was found that the week of onset, the timing of termination of pregnancy, and the mode of delivery were all related to maternal complications and neonatal survival. For this, the experimental results are as follows.As shown in As shown in As shown in This study showed that the average gestational age was prolonged by 13.63 days for cases within 30 weeks of gestational age. The average gestational week of delivery was 32.76 weeks, and the average gestational week was prolonged by 19.67 days. The average gestational week of delivery was 34.15 days, and the average gestational week was 35.16 days. Due to the small onset of gestational weeks and severe disease in cases with onset within 30 weeks of gestation, although the treatment is actively expected, the effect is limited. The fetus in the 32.76-week case has a certain viability, and the treatment effect is expected to be the best. In the case of 35.16 weeks, when the gestational age after treatment is expected to reach 34 weeks or more, the risk of continuing pregnancy is considered.Further analysis of the pregnancy outcomes of the three groups showed that the incidence rates of placental abruption, postpartum hemorrhage, liver and kidney dysfunction, and eclampsia in pregnant women with onset before 30 weeks were significantly higher than those with onset after 30 weeks. The perinatal outcomes of pregnant women with onset before 30 weeks were also worse than those after 30 weeks, especially the fetuses delivered by pregnant women with onset at 32 weeks did not have severe ventricular arrhythmias and deaths. It shows that expectant treatment does not significantly increase the occurrence of serious adverse pregnancy outcomes such as ventricular arrhythmia and death. Gestational age at delivery is the most important factor affecting neonatal survival, partly due to the discovery of premature gestational age, which is still less than 34 weeks after expectant treatment. Most cases of early-onset severe preeclampsia are extended beyond 34 weeks of gestation. When the gestational age reached 34 weeks, the incidence of serious complications of maternal childbirth, the incidence of neonatal ventricular arrhythmia, and the probability of perinatal death were significantly reduced. However, this part of the case still increased the gestational age through expectant treatment, and the extended gestational age also brought time for the completion of preparatory work before termination of pregnancy such as promoting fetal lung maturity and at the same time alleviated or improved the condition of the pregnant woman to prepare for delivery. Therefore, patients with early-onset severe preeclampsia should be treated expectantly when both maternal and fetal conditions allow. Of course, during this process, the mother and fetus should be closely monitored, and the pregnancy should be terminated in time when abnormal detection indicators indicate that it is not suitable to continue the pregnancy.P > 0.05). Studies have shown that compared with delivery by cesarean section, vaginal delivery has an increased risk of fetal distress and neonatal ventricular asphyxia, which may be related to the stress process that the fetus needs to withstand ischemia and hypoxia during the onset of labor and cesarean section effectively avoids this process. In addition, the high expectations of the newborn and the possible serious complications of the mother during the labor process also make most patients and their families request cesarean section to terminate the pregnancy, in order to reduce the risk to both mother and baby during the vaginal trial production process. In addition, this study found that cesarean section was the most important mode of pregnancy in group B  and group C , accounting for 92.31, 100.00%. In group A , there were 6 cases of vaginal delivery, accounting for 35.29%. Among them, 5 cases of multiparous women suffered from intrauterine distress, umbilical artery diastolic blood flow disappeared, and 1 case of primiparous stillbirth underwent intrauterine water balloon induction of labor. This is related to the poor control of the condition of patients with severe preeclampsia after expectant treatment, the occurrence of intrauterine stillbirth, or the request of the patients and their families to abandon the fetus due to intrauterine distress. There is a traumatic impact of choosing vaginal delivery over avoiding cesarean section on the patient. When giving up the interests of the fetus in patients with severe preeclampsia, the interests of pregnant women should be paid attention to in time.Mode of delivery in severe preeclampsia is based on obstetric indications. However, when the patient's condition is unstable, there are serious complications, the cervix is immature and the fetus cannot be delivered in a short time, and the fetal heart rate is abnormal, the cesarean section can be appropriately relaxed. In this study, cesarean section was the most common method of pregnancy termination for severe preeclampsia, accounting for 92.76%. There was no significant difference in mode of delivery between the early-onset severe preeclampsia group and the late-onset group (P < 0.05). This study shows that the younger the gestational age, the easier it is to involve various organ systems, and the occurrence of serious complications, especially the occurrence of placental abruption is closely related to the length of expectant treatment. The younger the gestational age and the longer the time to expect treatment, the higher the risk of placental abruption. The higher risk of adverse perinatal outcomes is associated with smaller gestational age at onset, smaller gestational age, and maturation of various organ systems. In addition, the placenta itself has abnormal development in patients with severe preeclampsia, so that the impaired function of the placenta cannot provide sufficient support for the needs of the fetus, which increases the risk of intrauterine growth restriction and intrauterine death. The cesarean section rate of women who gave birth within 32 weeks of gestation was significantly lower than those who gave birth after 32 weeks. It may be related to the smaller gestational age of childbirth, the small expectations of pregnant women and their families for the newborn, and the more consideration of reducing maternal injury and giving up cesarean section. The perinatal mortality rate in the vaginal delivery group was higher than that in the cesarean section group, and the reasons were analyzed. In this study, there were 3 cases of perinatal death cases of vaginal delivery before 32 weeks of gestation, and all 3 cases were delivered before 31 weeks of gestation. Among them, 1 case was delivered at 26 weeks, and the gestational age of delivery was too small, and the prognosis was poor regardless of whether cesarean section or vaginal delivery was selected. However, there was no significant difference in the incidence of maternal complications and neonatal ventricular arrhythmia between the cesarean section group and the vaginal delivery group, so the effect of the two delivery methods on pregnancy outcomes was not obvious when the pregnancy was terminated within 32 weeks. Vaginal delivery is possible under close supervision when maternal and fetal conditions permit.In this study, the incidence of all complications in the early-onset severe preeclampsia group was higher than that in the late-onset group, but only in the comparison of placental abruption and pleural effusion between the two groups was statistically significant  at least once a week. Dynamic ultrasound monitoring of intrauterine growth and amniotic fluid can reduce the incidence of perinatal death.Cases of early-onset severe preeclampsia at different gestational weeks. With the retreat of gestational weeks, complications, and neonatal mortality, and asphyxia rates have decreased, so for severe preeclampsia cases, the timing of pregnancy termination should be delayed as much as possible.Different delivery methods have a greater impact on preterm patients. Among them, the complication of severe preeclampsia in the vaginal delivery method is less than that of the cesarean section, but the neonatal mortality rate of the vaginal delivery method is higher than that of the cesarean section.Compared with spontaneous abortion, preterm women with severe preeclampsia have higher complications and neonatal mortality. Therefore, pregnant women with premature birth should pay attention to regular and regular inspections.Both severe preeclampsia preterm birth and spontaneous preterm birth have a greater impact on pregnant women and neonates. This paper focuses on the analysis of the clinical differences between the two. After research, the conclusions are as follows:However, there are not many samples in this study, so further research with large clinical samples is needed. At the same time, due to the limited sample size and the temporary unconditional long-term follow-up of all newborns, the impact of cesarean section on the late prognosis of premature infants cannot be clearly determined, so this aspect will be further studied in the follow-up research.


Notobitus meleagris, Macropes harringtonae, and Homoeocerus bipunctatus, collected from bamboo plants in Guizhou Province, China. For the first time, the damaged conditions and life histories of M. harringtonae and H. bipunctatus are described in detail and digital photographs of all their life stages are provided. Simultaneously, the mitochondrial genome sequences of three bamboo pests were sequenced and analyzed. Idiocerus laurifoliae and Nilaparvata lugens were used as outgroups, and the phylogenetic trees were constructed. The mitochondrial genomes of the three bamboo pests contained 37 classical genes, including 13 protein-coding genes (PCGs), two ribosomal RNA genes (rRNAs), 22 transfer RNAs (tRNAs), and a control region, with a total length of 16,199 bp, 15,314 bp, and 16,706 bp, respectively. The A+T values of the three bamboo pests were similar, and trnS1 was a cloverleaf structure with missing arms. The phylogenetic analyses, using the Bayesian inference (BI) and Maximum likelihood (ML), supported that N. meleagris and H. bipunctatus belonged to the Coreoidea family, whereas M. harringtonae belonged to the Lygaeoidea family with high support values. This study involves the first complete sequencing of the mitochondrial genomes of two bamboo pests. By adding these newly sequenced mitochondrial genome data and detailed descriptions of life histories, the database of bamboo pests is improved. These data also provide information for the development of bamboo pest control methods by quick identification techniques and the use of detailed photographs.Herein, we report the mitochondrial genomic characteristics of three insect pests,  N. meleagris, M. harringtonae, and H. bipunctatus, which belong to the Hemiptera (Heteroptera) order [N. meleagris. They noticed that N. meleagris have the habit of multi-male mating aggregation [N. meleagris. Adults and nymphs of N. meleagris are harmful because they suck sap through thorns. Bamboo forests were severely damaged by these pests, which killed 70% of the bamboo plants. The harmed bamboo withered, bamboo whips rotted, and dried without osmotic fluid. This led to the following year’s reduction of bamboo shoots and the decline of the forest [N. meleagris in Guizhou is becoming increasingly severe, and there are over20 insects on each bamboo shoot simultaneously. No scholars have studied the biological characteristics of M. harringtonae and H. bipunctatus before. This study is the first to report these insects’ effects on bamboo; they suck sugar and other nutrients from the bamboo rod’s basal membrane and inner wall with their piercing mouthparts, and the damaged sites often become reddish-brown or black. The bottom of the node becomes corroded and withered. M. harringtonae can cause damage to every type of bamboo. Therefore, the damage and life histories of M. harringtonae and H. bipunctatus are described in this study.Bamboo is a common plant that belongs to the Gramineae family. Bamboo resources are an essential part of the terrestrial forest ecosystem with typical characteristics of wide distribution, rapid growth, high yield, strong regeneration ability, wide use, and high economic value. Bamboo has high economic, ecological, and social benefits, and is widely used in the construction, ornamental, and food industries. Additionally, the bamboo extracts exhibited excellent anti-free radicals, antioxidant, anti-aging, antibacterial, insecticidal, lipid regulation, cardiovascular and cerebrovascular protection, and pharmacological effects . There aa) order ,4,5. At regation ,7. Many e forest . AccordiNotobitus montanus, Pirkimerus japonicus, Hippotiscus dorsalis, and Yemmalysus parallelus) have been sequenced and are available on NCBI [N. meleagris and H. bipunctatus on NCBI. This study presents the complete mitochondrial genome of three bamboo pests , which provides the basis for developing bamboo-pest gene bank data and supports prevention and management. This is the first study to investigate bamboo pests by using the mitochondrial genomes data and life histories with detailed molecular and morphological datasets. We also discuss their mitochondrial genome structures and analyze their tRNA’s shamrock structure. This study aims to provide a reference for the identification, control, and phylogenetic analysis of bamboo pests.Mitochondrial genome sequences are widely used in biogeographical, molecular, and systematic studies ,10. Mito on NCBI ,18,19. TN. meleagris, M. harringtonae, and H. bipunctatus) in Guizhou Province. The observations were madeon sunny days, at an interval of once every ten days. The damages were recorded and photographed using visual inspection and sweep net techniques [From May 2021 to August 2022, we observed the damaged conditions and occurrence regularity of three bamboo pests  were used to evaluate the quality of the raw sequences. Then, the clean sequences were assembled using MitoZ v2.4 software [Riptortus pedestris , Aeschyntelus notatus , and Geocoris pallidipennis  were used as references. The three mitogenomes were initially annotated using the MITOS web server  [The DNA quality before sequencing was evaluated using agarose (1%) gel electrophoresis. Mitogenomes were sequenced using a next-generation sequencing platform with Illumina Hiseq 2500 at BerryGenomics . BerryGenomics  and FastQC (software  with defry 2023)  with invry 2023) ,31,32. Try 2023) ,33,34. Try 2023) , and RSCry 2023)  of R 3.6ry 2023) .I. laurifoliae (Cicadellidae) and N. lugens (Delphacidae) from Auchenorrhyncha were selected as the outgroup , Coreoidea (8 species), Pentatomoidea (2 species), Reduvioidea (2 species), Fulgoroidea (1 species), and Membracoidea (1 species). The mitogenomes of outgroup . AccessiN. meleagris was significantly harmful to bamboo shoots, mainly harming them with clusters; M. harringtonae can harm whole bamboo tree, including bamboo poles and bamboo joints, and have a wide distribution range; H. bipunctatus often inhabits the growth of newly emerging leaves and feed on them. Furthermore, the insect pests of bamboo species often aggregate and harm the bamboo plants. The adults and nymphs are also harmful as they suck sap through the stylets , M. harringtonae , and H. bipunctatus  were double-stranded closed circular molecules  were encoded on the major strand (J-strand), and four PCG genes  were encoded on the minor strand (N-strand). All 13 PCGs started with ATN. The stop codon of N. meleagris is the same as that of H. bipunctatus, atp8 and nad6 had TAA as the stop codon, and the other ten had incomplete T. The stop codon of M. harringtonae is special, except for the same features as the other two sequences, nad4L had TAA as the stop codon, and nad3 had TAG as the stop codon.The mitogenomes of the three bamboo pests belong to the Hemipteran order , which iN. meleagris), 3645 (M. harringtonae), and 3664 (H. bipunctatus). In descending order, the three most abundant amino acids, Leu2, Ile, and Phe, in N. meleagris are the same as M. harringtonae. In addition, Leu2, Ile, and Met were the most abundant amino acids in H. bipunctatus  and rrnS (12S) genes on the N-strand were located between the trnL1 and trnV and the control region in the mitogenome of three bamboo pests . The totN. meleagris, M. harringtonae, and H. bipunctatus included 22 transfer RNA genes, as in most invertebrates. The total lengths of tRNAs were 1449 bp, 1439 bp, and 1446 bp, and these tRNA genes ranged from 62–75 bp. In the three sequences, the 14 tRNA genes  were encoded on the major strand (J-strand), and the eight tRNA genes  were encoded on the minor strand (N-strand) (The mitogenomes of -strand) . We foun-strand) . In addiN. meleagris), 772 bp (M. harringtonae), and 2138 bp (H. bipunctatus). The AT-rich region had the highest AT content with67.2% in N. meleagris, 79.3% in M. harringtonae, and 68.4% in H. bipunctatus, with positive AT skew (0.099–0.117) and negative CG skew (−0.329 to −0.188)  .I. laurifoliae and N. lugens) were reconstructed based on 13 PCGs using ML and BI analyses under the partitioning scheme and models selected by PartitionFinder. The two resulting trees  and two outgroups , have been reported to have harmed bamboo, but this is the first time that M. harringtonae has been reported to have harmed bamboo seriously [Homoeocerus, belonging to the Coreidae family, have previously been reported to harm only leguminous plants [H. bipunctatus collected from the bamboo plants showed normal physiological activities, such as mating and oviposition, when the species were fed with bamboo. This study describes the extent of damages and life histories of M. harringtonae and H. bipunctatus. This paper updates and supplements the data on N. meleagris, M. harringtonae, and H. bipunctatus in Guizhou. Research in 2009 showed that only two generations of N. meleagris were present in Guizhou in one year [N. meleagris were present in Guizhou in one year, and the generations overlapped significantly. Previously, no study was performed on the biological characteristics of M. harringtonae and H. bipunctatus. Our research shows that at least three generations of M. harringtonae occur in a year in Guizhou, and at least two generations of H. bipunctatus occur in a year in Guizhou. This study fills a gap in the understanding of the biological characteristics of M. harringtonae and H. bipunctatus.o plants . M. harreriously ,61. Homos plants ; howeverone year . HoweverN. meleagris, M. harringtonae, and H. bipunctatus) were sequenced and analyzed for their genome size, base content, AT nucleotide bias, AT skew, GC skew, the codon usage of protein genes, and secondary structure of tRNA. Despite differences in the sequence length of three bamboo pest species, the mitochondrial genome order of N. meleagris, M. harringtonae, and H. bipunctatus was identical and conserved with the alignment to that of known ancestral taxa regarding the organization and composition of the genome [M. harringtonae in our study has little difference with previous research. However, the positive and negative of AT skew and GC skew of rRNAs and tRNAs are opposite [In this study, three complete mitogenomes (e genome ,66,67,68opposite . The anaopposite ,70,71. TN. meleagris and H. bipunctatus belonged to the Coreoidea, and M. harringtonae belonged to the Lygaeoidea. There was no dispute on the taxonomic status, consistent with the results of morphological identification [The phylogenetic tree was constructed using 13 protein genes, and the phylogenetic relationships of 25 species were analyzed. The results showed that fication ,72,73. Tfication . However


In comparison with patients with low Apo B levels, those with elevated Apo B levels more frequently presented significant carotid plaques . Univariate regression analysis identified a strong association between the level of uric acid and increased value of Apo B in the four subgroups . The results of this nationwide registry on hypertension in Romania indicate that high Apo B may be considered as a risk factor for CVD, promoting atherosclerosis and associated with increased expression of classical markers of clinical or subclinical CVD.The present study aimed to investigate the association between apolipoprotein B (Apo B) and classical features associated with clinical or subclinical atherosclerosis. A total of 811 adult patients from the general Romanian population, included in the national SEPHAR registry on hypertension, were divided into two groups based on Apo B value (low versus high Apo B with a cut-off established at 130 mg/dL) and subsequently into four subgroups according to the cut-offs recommended by the 2021 ESC Guidelines on Cardiovascular Disease Prevention. In all patients, lipid profile, uric acid, full blood count and presence of significant carotid plaques were assessed. Apo B levels were positively correlated with proatherogenic lipids (total cholesterol, triglycerides and LDL-cholesterol,  Cardiovascular disease (CVD) remains the main cause of morbidity and mortality, accounting for almost one third of deaths worldwide ,2. In RoThe vast majority of CVDs are associated with atherosclerosis. Atherosclerosis is a process initiated early in life and remains asymptomatic for a long time. Therefore, the early detection of atherosclerotic disease before the onset of symptoms represents an important goal in modern cardiology ,6. In thAmong lipids, low-density lipoproteins (LDL) are the most important in atherogenesis, having a primary role in cholesterol transport . The modTherefore, the current study aimed to investigate the association between Apo B and classical features associated with clinical or subclinical atherosclerosis.p < 0.0001) and were more frequently male (45% vs. 31% p = 0.008). No significant difference was observed between the two groups in terms of family history of premature CVD  or personal history of premature CVD . The differences between the two groups in terms of atherosclerosis risk factors and the presence of cardiovascular and noncardiovascular comorbidities are presented in Patients with an Apo B level above 130 mg/dL were significantly older than those with levels below 130 mg/dL , as shown in In comparison with patients with low Apo B levels, those with elevated Apo B levels more frequently presented significant carotid plaques, evidenced by carotid ultrasound , fasting glucose  and glycosylated hemoglobin  in patients with Apo B values above 130 mg/dL.As expected, patients with increased values of Apo B presented significantly higher values of serum lipids  and significantly lower values of HDL-cholesterol, as shown in p < 0.0001).As shown in p < 0.0001), as shown in p > 0.05).A significant progressive increase in the percentage of patients with carotid plaques was also observed, from the subgroup with Apo B below 65 md/dL to the group with Apo B above 100 mg/dL  curve analysis . The besp < 0.0001, r = 0.84), LDL-cholesterol  and triglycerides , in parallel with an inverse proportional relationship between Apo B and HDL-cholesterol level , as shown in Univariate regression analysis showed a direct and strong relationship between Apo B and serum levels of total cholesterol (p < 0.0001).At the same time, univariate regression analysis identified a strong association between the level of uric acid and increased Apo B value, as indicated in p < 0.0001).When adding the presence of carotid plaque, creatinine serum level and HbA1c to the multiple logistic regression analysis, the power of the lipid profile and uric acid serum level for predicting Apo B level increased to 84.51%  [In the current study, we observed a positive correlation between Apo B levels and proatherogenic lipids  and a negative correlation with HDL-cholesterol. The process by which Apo B is involved in atherogenesis is complex. Apo B capture in the arterial wall is the main initiating factor in atherogenesis. This leads to the accumulation of lipids, triggering a cellular response in the arterial wall, which results in the acceleration of the lipid accumulation process via secretory sphingomyelinase, lipoprotein lipase and phospholipase A2 enzymes . In a por > 0.9) . Cho et r > 0.9) . Moreover > 0.9) . A correr > 0.9) . Since Lr > 0.9) , coupledr > 0.9) .The association between atherosclerosis markers and Apo B was also investigated in our study. We found that high levels of Apo B correlate with the presence of significant carotid plaques. These data suggest a predictive role of Apo B for carotid atherosclerotic disease even from an asymptomatic stage with, moreover, the potential to be used in screening for carotid disease. However, the results in the literature regarding the association between Apo B and carotid atherosclerosis are controversial.p = 0.001) [p = 0.01) [The analysis of a subcohort of the MultiEthnic Study of Atherosclerosis revealed an association between Apo B and the presence of atherosclerotic plaques at the carotid level. Univariate regression highlighted the fact that Apo B is one of the best predictors of the progression of carotid plaques, with a rate of 13.1 μm per year (= 0.001) . The lev= 0.001) . In a po = 0.01) .p = 0.2) [On the other hand, in another study, conducted with pediatric patients (aged between 8 and 17 years), Apo B was not associated with changes in carotid intima-media thickness, but a correlation was observed with levels of arterial stiffness . In a stp = 0.2) .Uric acid is a known marker of CVD and has been associated with different complications of atherosclerosis, such as ventricular arrhythmia and acute coronary syndromes ,28. MoreInflammation is a key player in the complex process of atherosclerosis progression, starting from the early stages of atheroma initiation to the postinfarction phase . Since uAmong women, but not men, without a history of diabetes, Apo B was significantly associated with the value of glycosylated hemoglobin over a 2-year follow-up period . In an AIn our study, an association was found between Apo B levels and fasting blood glucose values, and between Apo B and glycosylated hemoglobin, but no association between Apo B and the diagnosis of diabetes mellitus was observed. This might suggest that Apo B could be a marker of an increased risk of diabetes mellitus development or a marker of metabolic imbalance rather than a marker of diabetes mellitus per se.This study was conducted with a representative sample of the adult population in Romania arising from the Epidemiological Study on the Prevalence of Arterial Hypertension and Cardiovascular Risk in Romania (SEPHAR) IV. The selection methodology of patients was previously described in detail ,43. A ton = 713) and group 2 with high Apo B levels above 130 mg/dL (n = 98). Subsequently, the study population was divided into four risk subgroups according to the Apo B cut-offs recommended by the 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice: subgroup A with Apo B < 65 mg/dL (n = 102), subgroup B with Apo B between 65 and 80 mg/dL (n = 180), subgroup C with Apo B between 81 and 100 mg/dL (n = 221) and subgroup D with Apo B > 100 mg/dL (n = 308) [In all patients, the serum level of Apo B was determined in mg/dL using nephelometry . Based on serum Apo B levels, the patients were divided into two groups: group 1 with low Apo B levels below 130 mg/dL (n = 308) .Personal and family history of premature CVD (defined as an event at ≤55 years for men or ≤60 for women)  and demot-tests or Mann–Whitney U-tests for numerical data and chi-squared tests for categorical data. Multiple comparisons were performed using ANOVA tests to establish coefficients of variation, and a comparison of the homogeneity of the coefficients of variation was performed for each variable. Univariate regression analysis was performed to study the association between Apo B levels and biochemistry parameters. In order to test the capacity of Apo B to predict the presence of carotid plaques, we used receiver operating characteristic (ROC) analysis. The results are reported as numbers and percentages for categorical data and as mean ± standard deviation (SD) for numerical variables. The α value was set at 0.05 for statistical significance.Statistical analysis was performed using GraphPad InStat 3.10 software . Normality tests were performed for all data prior to statistical analysis. Between-group comparisons were performed using unpaired Student’s The results of this analysis of the nationwide registry on hypertension in Romania indicate that high Apo B may be considered as a risk factor for CVD, promoting atherosclerosis and associated with increased expression of classical markers of clinical or subclinical CVD. Elevated levels of Apo B are associated with an altered lipid profile, poorer glycemic control, significant carotid plaques and higher inflammatory status expressed by increased uric acid. These findings suggest that elevated Apo B is a risk factor for CVDs and is involved in different stages of atherosclerosis progression.


This study aims to evaluate neonatal and children growth outcomes of cryotransfer of embryos developed from frozen gametes [double frozen transfer (DFT)].This nested case-control study included 6,705 women who had a singleton live birth after embryo transfer at the Center for Reproductive Medicine, Shandong University, from 2008 to 2020. Of these, 745 women underwent frozen embryo transfer (FET) using embryos developed from frozen gametes (DFT). Propensity score methodology was used to balance the two groups by maternal age and body mass index (BMI) before evaluating outcomes. After age and BMI were matched using the propensity score methodology in a ratio of 1:4, the control groups enrolled 2,980 women who underwent fresh embryo transfer (ET) and 2,980 women underwent FET from fresh gametes. The children born were followed to at least 5 years of age, and some were followed up to 10 years. Neonatal outcomes and childhood growth measurements were compared among the three groups.P for trend in the models were significant. In multiple linear regression analysis of the children’s development, the height Z-score of children born from the DFT and FET group was higher than that for children from the ET group . However, childhood growth measurements including body weight Z-score and BMI Z-score were not significantly different among the three groups. In addition, the proportion of male children born from DET was higher than that from ET.The average birth weight of the DFT group  was significantly higher than the FET group  and ET group . The rate of large for gestational age (LGA) babies in the DFT and FET group was higher than that for the ET group . After adjusting for different confounder combinations in the three models, the birth weight and risk of LGA in the DFT and FET groups were still higher than in the ET group, and the values group of There is an increased risk of LGA babies associated with pregnancies conceived from DFT. Children are inclined to be taller in the future in this group than after FET. The related etiology and pathophysiology mechanisms still need to be revealed. In the future, well-designed, observational studies with in-depth collection of patients’ characteristics may shed more light on this issue. Worldwide, more than eight million children have been conceived after assisted reproductive technology (ART) . Howeverin vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) treatment , preterm birth, placenta previa, and placental abruption compared with fresh embryo transfer (ET). However, evidence from two recent meta-analyses shows some adverse obstetrics and perinatal outcomes after FET including pregnancy-induced hypertension (PIH), large for gestational age (LGA), and postpartum hemorrhage , 6. Therreatment –9. A recreatment .However, to the best of our knowledge, almost no studies have focused on the obstetric and offspring outcome from the cryotransfer of embryos developed from frozen gametes. It is interesting to speculate that there may be an accumulating effect on the offspring after double frozen transfer (DFT). The present study aimed to evaluate the effect of DFT on the outcomes of neonatal and children growth by comparing it with “single frozen transfer” FET and fresh ET in a nested case-control study.To determine whether double freezing-thawing procedures influence the short- and long-term health of offspring, we assess perinatal and neonatal outcome along with children growth of DFTs, FETs, and ETs. We conducted a single-center, retrospective, nested case-control analysis at the Center for Reproductive Medicine Affiliated to Shandong University. The study was approved by the Institutional Review Board of the Second Hospital, Cheeloo College of Medicine, Shandong University. The ethics approval document number is 2022(37). Written informed consent was obtained from patients and parents or guardians of all participants.This was a matched case-control retrospect analysis including DFT, FET and ET during April 2008 and May 2020 . Data recorded also included whether or not the infant was breastfed.A live birth was defined as the delivery of a viable infant after 28 weeks of gestational age. Low birth weight was defined as a newborn baby weighing below 2,500 g. small for gestational age (SGA) was defined as a birth weight below the 10th percentile for gender and gestational age according to the reference population. Birth weight for gender- and gestational age–specific standard score (z-score) was calculated on the basis of a Chinese reference chart . Z-scoreAll data analyses were performed using SPSS statistical software v26 and R v4.0.2. Propensity score matching was used to balance the baseline maternal characteristics among the three groups. Patients of DFT, FET and ET groups were evaluated using the propensity score methodology with nearest neighbor matching . The matching ratio was 1:4 with the matching factors referring to maternal age and BMI.Confounders were enrolled according to clinical experience and up-to-date literatures. Continuous variables were presented as mean ± standard deviation with one-way analysis of variance (ANOVA) for between-group differences. Categorical variables were expressed as frequencies and percentages, and the distribution among groups was analyzed by the chi-square test or the Fisher’s exact test. We considered P-values of <0.05 to be statistically significant. Multiple logistics and linear regression analysis were used to adjust confounders. Different regression models were adjusted for different confounder combinations (see Results). All confounders adjusted in multiple regression analysis for obstetric and perinatal parameters fertilization methods, stage of the embryo, fertilization rate, number of embryos transferred, endometrial thickness before transplanting, type of infertility, weight gain during pregnancy,parity,preterm birth, fetal gender, birth weight, gestational diabetes mellitus, (GDM), and PIH hypertensive disorder of pregnancy (HDP). All confounders were adjusted in multiple regression analysis for the height, weight, and BMI of children, including gender, age, weight gain during pregnancy, parity, endometrial thickness, before transplanting, fertilization methods, stage of the embryo, fertilization rate, type of infertility, number of embryos transferred, breastfeeding, GDM, HDP, preterm birth socio-economic status , maternal height, and maternal weight.There were 6,705 patients enrolled in this study. Among these, 745 patients were in the DFT group, and 2,980 patients were enrolled separately in FET and ET groups . The FET group had the lowest rate of vaginal delivery (27.2%) compared with DFT (31.8%) and ET (39%). The ratio of LGA was highest in the DFT group, and the FET group showed a higher LGA ratio than the ET group. Both neonatal disease and birth defect ratio were highest in the FET group.For the high ratio of donor sperm in the DFT group, a subgroup analysis, excluding the male partners age >35 years and with severe sperm deficiency or azoospermia, was carried out. The subgroup outcomes were consistent with overall outcomes , when the ET group was set as the reference in multiple regression analysis. This situation continued in the multiple regression analysis of height Z-score in the results of child development. All these outcomes demonstrated a cumulative effect of gamete cryopreservation and embryo cryopreservation.Embryo cryopreservation methods especially for blastocysts have changed from slow freezing to vitrification according to safety and efficacy of the reports over the past decade –18. VitrSeveral pathophysiological processes may play roles in the low risk of SGA and higher risk of LGA in FET cycles than that in fresh ET cycles. The first one is that increased hormone blood levels, especially high estrogen levels, might alter the timing of endometrial receptivity and exert a detrimental effect on spiral artery remodeling by the trophoblast , 21. A pHowever, as we mentioned previously, most studies show no increased risk of adverse perinatal outcome following the use of cryopreserved sperm or oocytes. In the present study, DFT group mostly involved cryotransfer of embryos from cryopreserved donor sperm. So why does gamete cryopreservation alone not exhibit an influence on perinatal outcomes, whereas the combination of gametes and embryo cryopreservation shows different outcomes from embryo cryopreservation alone? There might be a threshold for the epigenetic changes or the remodeling of epigenetics during meiosis and early embryo development  that covSome studies related to double frozen procedures include repeated cryopreservation of embryos. One situation when this may take place is when a surplus of zygotes or day 3 embryos are warmed and cultured for blastocyst development , 32. WheInterpretation of associations from observational studies is always challenging. Although we conducted a strict nested case-control study with a large sample size and adjusted for many confounders, several limitations of this study should still be noted. First, most gamete cryopreservation was of donor frozen sperm. As sperm donors are relatively young and have normal semen, there was a selection bias in the DFT population. Therefore, a subgroup analysis, excluding those male partners age >35 years and with severe sperm deficiency or azoospermia, was carried out, and the subgroup outcomes were consistent with the overall findings. Second, not all confounders were taken into accounts, owing to the retrospective nature of this study. Third, all children conceived by ART in this study were from a single medical center in Shandong, China; therefore, caution should be taken in generalizing these findings.In conclusion, there is an increased risk of LGA babies associated with pregnancies conceived from DFT. Furthermore, the children are inclined to be taller in the future in this group compared with offspring following FET. The related etiology and pathophysiology mechanisms still need to be revealed. In the future, well-designed, observational studies with an in-depth collection of patient characteristics may shed more light on this issue.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.The studies involving human participants were reviewed and approved by the Institutional Review Board of the Second Hospital, Cheeloo College of Medicine, Shandong University. The patients/participants provided their written informed consent to participate in this study.SG and LC contributed to the study concept and design. JG, YZ, and BW analyzed data and drafted the paper. TZ, LC, and Z-JC contributed to the review and the revision of the manuscript. All authors contributed to the article and approved the submitted version.The National Natural Science Foundation of China (82171692), Research Unit of Gametogenesis and Health of ART-Offspring, Chinese Academy of Medical Sciences (2020RU001), Taishan Scholars Program for Young Experts of Shandong Province (tsqn201909195), and Natural Science Foundation of Shandong Province (ZR2021QH136).The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Generations of racist and colonial policies have resulted in First Nations (FN) people being systematically over-represented in Canada’s legal system. FN researchers partnered with data scientists at the University of Manitoba to document the birth outcomes associated with experiences of prenatal incarceration among FN families.This retrospective cohort study linked whole-population administrative data from (i) Manitoba’s legal system to identify infants born to people incarcerated while pregnant, (ii) the First Nations research file to identify FN families, (iii) hospital records for birth outcomes, (iii) health and social services data for measured confounders. All Manitoba residents with a live birth (Jan 2004 - Dec 2017), and their infants, were eligible. Generalized linear models tested for differences in birth outcomes associated with experiencing incarceration while pregnant. Propensity score weights adjusted for measured confounders. Effect modification analyses tested whether associations differed between FN and all other Manitobans (AOM).FN people were more likely to experience incarceration while pregnant (n=1449) than AOM (n=278). Before propensity score adjustment, incarcerated pregnant people differed on important sociodemographic confounding characteristics from pregnant people who were not incarcerated – e.g., lower socioeconomic status, higher prevalence of pre-existing mental disorders, higher prevalence of having a previous child taken into care of family services, more likely to live in an urban setting. After propensity score adjustment, confounding characteristics were balanced between exposure groups. After adjustment, infants born to people incarcerated while pregnant were more likely to be low birth weight at term , be born preterm , be small for gestational age . Associations did not differ between FN and AOM families.Incarceration of pregnant people compromises their infant’s birth outcomes and perpetuates intergenerational systems of oppression that exacerbate health inequities. To improve the health and well-being of FN people, we must implement Calls to Action outlined by the Truth and Reconciliation Commission to redress these harms experienced by FN people.


This case report describes a patient with an enlarging and painless lump over the right acromioclavicular joint (ACJ). MRI showed a synovial cyst superior to the ACJ with a concomitant full-thickness tear of the supraspinatus. The patient underwent needle aspiration of the lump, which yielded 100ml of gelatinous fluid with no microbe growth. Despite repeated aspirations, the ACJ cyst continually enlarged beyond its initial size. This case report describes an ACJ cyst that enlarged in size after needle aspiration. The authors suggest surgical alternatives if cyst recurrence is observed after the initial attempt of aspiration. Acromioclavicular joint (ACJ) cyst is a rare condition that may occur in the elderly ,2. TheseWhile this cyst is benign, it can cause significant distress to the patient. In addition to cosmetic concerns, these cysts can also interfere with daily activities and dressing when large. ACJ cysts can be treated conservatively or surgically . There aWe present a case of a 71-year-old male with a right ACJ cyst who underwent needle aspiration of the cyst complicated by recurrence and subsequent enlargement.A 71-year-old male with no significant past medical history presented with a right shoulder lump located superior and anterior to the acromioclavicular joint, as shown in Figures A plain radiograph revealed rotator cuff arthropathy with superior migration of the right humeral head. A soft tissue swelling superior to the right acromioclavicular joint was noted Figures , 4.A MRI scan was performed. A non-contrast scan was performed as the lesion was clinically assessed to be an ACJ cyst, aiming to determine rotator cuff and joint-level pathology. MRI showed a complete full-thickness tear of the supraspinatus with a high-riding humeral head. Tendinopathy and atrophic changes were noted in the rest of the rotator cuff muscles. There was also severe acromioclavicular joint arthrosis with a synovial cyst measuring 7.6x6.2x4.7 cm (height) superior to the acromioclavicular joint Figures -7. The pManagement options were discussed with the patient. The surgical options offered included an arthroscopic rotator cuff repair with distal clavicle excision or reverse shoulder arthroplasty. However, the patient was keen on non-surgical treatment and opted for needle aspiration of the cyst. Aspiration of the cyst was performed in the outpatient setting. Clinical photographs of the ACJ cyst post-aspiration are shown in Figures The patient was reviewed 2 months later with a recurrence of the ACJ cyst. The cyst was larger compared to the first clinical presentation. Given the recurrence, surgery was recommended to the patient. However, the patient was keen on non-surgical treatment and opted for a repeat needle aspiration procedure. The repeat aspiration yielded 180ml of gelatinous fluid. Recurrence was noted less than a month later. Repeated aspirations were performed for the patient as he continued to decline surgical management for his condition. The repeated aspirations performed at subsequent 4-month interval follow-ups yielded 150mL and 300mL aspirate volumes, respectively. Despite repeated aspirations, there was a progressive enlargement of the ACJ cyst beyond the size of the initial presentation Figures , 12. SurThe ACJ cyst was first described by Craig et al. in 1984 in association with the geyser sign . Hiller ACJ cysts are rare, and the existing literature is limited to case reports and case series. Ticker et al. reported an incidence of ganglion cysts of the shoulder of 1% . The ideThere is a paucity of literature on the effectiveness of conservative management of type II ACJ cysts. A possible option is watchful waiting. There are very few cases of spontaneous resolution, and the time to resolution ranges from 2 months  to more Needle aspiration and steroid injection are common conservative treatment options. These procedures are simple to perform and provide an immediate reduction in the size of the ACJ cyst. Spinnato et al. performed ultrasound-guided intraarticular steroid injection and observed complete resolution of the ACJ cyst at the 8-month post-procedure follow-up . The maiThe current literature focuses mainly on surgical management and postoperative outcomes. Prior interventions, either surgical or non-surgical, are not well-described, and this makes it difficult to reliably-identify predictors of recurrence. In our case, needle aspiration proved to be unsuccessful. Even more critically, there was a gradual enlargement of the cyst over time, resulting in further patient distress and significant implications for future surgical management. Such a large amount of fluid makes arthroplasty challenging for soft tissue management and potential infection.There are several recommendations that the authors would like to propose based on this case and literature review. Fluid analysis of the aspirate should include cell counts, fluid cultures, and cytopathological studies in larger lesions. In addition, patients who undergo aspiration should be reviewed early to exclude infection, fistula formation, or recurrence. Finally, the authors suggest that if a cyst recurs after initial aspiration, further aspiration should not be attempted, and surgical management should be offered to the patient.ACJ cyst is a rare condition frequently associated with massive rotator cuff tears. Post-procedural risk of complications and recurrence is often weighed against the short-term therapeutic effects of needle aspiration in deciding on further conservative management. However, the possibility of continued exacerbation after recurrence, as documented in this study, should raise caution.This case demonstrates recurrence and continued cyst enlargement after needle aspiration, with implications on patient distress and potentially complicating future attempts at arthroplasty. The authors suggest that if a cyst recurs after initial aspiration, further aspiration should not be attempted, and surgical management should be offered to the patient.