Accurate measurement of body temperature is critical for the assessment of a newborn’s general well-being. In nursery settings, the gold standard rectal thermometry has been replaced by the axillary method. However, evidence pertaining to the agreement between axillary and rectal thermometry in the newborn is controversial. In this cross-sectional study, the agreement between axillary and rectal temperature in newborns, as well as the effects of neonatal, maternal and environmental factors on this agreement were investigated.mean difference between axillary and rectal temperatures was compared in stable term and preterm newborns using paired t-test for the means of differences, Pearson correlation coefficient (r), and the Bland-Altman plot. Stepwise multivariate regression assessed predictors of this difference in the overall group and by gestational age categories.The r = 0.5, p = 0.000) and had similar overall means but differed in 34–36 weeks gestation newborns (p = 0.01). Correlation between both methods increased with advancing gestational age being highest in term newborns . Bland-Altman plots revealed good agreement in gestational ages above 29 weeks. The difference between measurements increased with Cesarean delivery , but decreased with advancing chronological age , and with gestational age .The study included 118 newborns with gestational ages ranging from 29 to 41 weeks, median birth weight of 2980 grams (IQR: 2321.3-3363.8). Axillary and rectal temperatures correlated significantly (In clinically stable term and preterm infants, axillary thermometry is as reliable as rectal measurement. Predictors of agreement between the two methods include gestational age, chronological age and mode of delivery. Further studies are needed to confirm this agreement in sick newborns and in extremely premature infants. Body temperature is an essential vital sign that reflects the wellbeing of a newborn. Temperature variation can be an indication of maladaptation to the external environment, as well as a sign of serious illness. Hence, accurate measurement of a newborn’s body temperature is critical for early detection of serious conditions, and for appropriate and timely intervention or treatment. Rectal thermometry, the gold standard method of temperature measurement is more invasive than skin or tympanic thermometry , and hasA systematic search of the literature for studies comparing axillary and rectal thermometry in the newborn reveals one systematic review  that ideIn view of the existing controversy, we conducted this study that aims at assessing the agreement between axillary and rectal thermometry in term and preterm neonates of different gestational ages, as well as identifying the neonatal, maternal or environmental factors that may affect this agreement.This was an observational, cross-sectional study conducted in the Normal Nursery and Neonatal Intensive Care Unit (NICU) of the American University of Beirut Medical Center (AUBMC), Lebanon. Between December 2012 and July 2013, all newborns who were admitted to the Normal Nursery or NICU were screened for inclusion in the study. Neonates whose age was less than six hours were excluded, as well as those who suffered from any of the following conditions: critical clinical status, necrotizing enterocolitis, disseminated intravascular coagulation, bleeding disorders or thrombocytopenia, immunodeficiency, intraventricular hemorrhage, congenital anomalies, therapeutic-induced hypothermia, neurologic disorders, and rectal pathology such as rectal injury, imperforate anus, or rectal surgery.Neonates satisfying the inclusion criteria were subjected to axillary and rectal temperature measurements after obtaining parental written informed consent. For each neonate, one paired temperature recording was performed in the same sequence by the same investigator (MN): one axillary temperature reading (less invasive method) followed immediately by one rectal temperature reading (more invasive method), using the same digital thermometer Welch Allyn® Sure Temp® Plus Model 690 , according to the manufacturer’s instructions for proper device use. Rectal measurements were obtained by gentle insertion of the rectal probe two centimeters into the rectum.Newborn’s Clinical Risk Index for Babies (CRIB) Score [For each neonate the following data were collected: gestational age, chronological age, gender, birth weight, birth length, head circumference, mode of delivery, mode of maternal anesthesia, resuscitation at delivery and type of resuscitation; admission status and type of placement . For newborns who were admitted to NICU, we also recorded the B) Score  along wi0/7 to 366/7 weeks), early preterm (>28 to < 34 weeks), and very small preterm (≤28 weeks). Our primary outcome was the mean difference between axillary and rectal measurements. Sample size calculation was carried for the entire cohort taking into consideration the minimum number of subjects to be recruited from the subgroup of very small preterm newborns while maintaining at least 80% power, since the number of preterm infants born at or below 28 weeks of gestation is small compared to the other gestational age categories. Considering a desirable mean maximum difference between axillary and rectal temperature of <0.3°C, and a mean difference in standard deviation (SD) of <0.5°C (the quoted accuracy of most mercury-in-glass thermometers) [Neonates were divided into four categories according to their gestational age: term ≥37 weeks), late preterm  , the samr) to investigate the correlation between the two methods. Analysis was done separately for term, late and early preterm newborns. No such analysis was conducted for the very small preterm neonates below 29 weeks of gestation since none met our inclusion criteria during the study conduct. To assess predictors of the difference between the axillary and rectal temperatures, we carried out stepwise multivariate regression analyses, with the outcome being the difference in temperature between the two methods, and the independent variables being those that showed significance at the bivariate association, as well as variables of clinical importance . To build the model, the entry level of significance was set at 0.1 and the level of retaining variables in the model was set at 0.2.We used paired t-test to compare the means (SD) of differences between axillary and rectal measurements, and Pearson correlation coefficient  between 29 and 33 weeks, 30 (25%) between 34 and 36 weeks, and 63 (53%) were equal or above 37 weeks of gestation. Newborns below 29 weeks of gestation could not be recruited because of exclusion criteria. The birth weight ranged between 1,185 and 4,305 grams with a median (IQR) of 2980 (2321.3-3363.8) grams; 60 (50.8%) neonates were males. The cohort’s baseline characteristics are further summarized in Table r = 0.6, p = 0.000). Interestingly, the strength of the correlation increased steadily with advancing gestational age, from 0.2 at 29–32 weeks to 0.6 at term gestation , p = 0.03, it decreased significantly with increasing chronological age , p = 0.001; and with more maturity at birth , p = 0.008. The Bland-Altman plots revealed good agreement between the two methods in the overall cohort  but differ with respect to the degree of agreement between the two methods. Whereas we found good agreement, Falzon et al. had poor agreement between the two types of measurements with 95% of axillary measurements falling within 2.5-3°C range around respective paired rectal measurements, using the Bland-Altman method. Additionally, axillary temperatures were consistently lower than rectal ones, with a mean (SD) difference of 0.38(0.76)°C and wide variability. To note, this study included children from birth to 4 years of age but did not provide specific information relating to the subgroup of neonates.Our findings agree with those of Falzon et al.  who repor = 0.77) and better agreement with digital rectal thermometry than abdominal skin temperature (r = 0.56). In contrast to our study, Helder et al. found that the correlation between skin and rectal measurements were best for infants with the lowest birth weight  in the first days of life [In a larger study that included 282 NICU infants born between 24 and 43 weeks gestation, Helder et al. [e r = 0.5. In conte r = 0.5. In contThis study provides reassuring evidence regarding the accuracy of axillary thermometry in nursery settings. In newborns at or above 29 weeks gestation that are clinically stable, axillary thermometry is a reliable method for assessing the general well-being of the newborn, therefore guiding decision-making. However, further studies are needed to confirm its accuracy in sick newborns who are clinically unstable and in very small preterm infants less than 29 weeks of gestation.This study was approved by the Institutional Review Board of the American University of Beirut.


The NKSS has recently been translated into Dutch version. The reliability and validity were also assessed. However, there is no Simplified Chinese version of New Society Knee Scoring System (SC-NKSS) for Chinese population.The SC-NKSS was translated from the original English version following international guidelines. All patients undergoing total knee arthroplasty (TKA) between September 2012 and September 2013 were invited to participate in this study. Finally, a total of 105 did so. Patients (preoperative and postoperative) completed the Chinese version of NKSS, Oxford Knee Score (OKS), the Medical Outcomes General Health Survey (SF-36) and Visual analog scale (VAS). Psychometric testing of reliability, construct validity, content validity were conducted.r =−0.78; p < 0.01), VAS , Physical Function (PF) , Body Pain (BP)  and General Health (GH)  of SF-36 domains.All the 105 participants completed the questionnaires and no floor or ceiling effects were checked. Internal consistency was excellent with Cronbach’s alpha coefficient ranging from 0.71 to 0.85. Test-retest reliability was satisfactory with an intraclass correlation coefficient of 0.92 . Construct validity was demonstrated to correlate well with the Chinese version of OKS (The SC-NKSS was well accepted and demonstrated acceptable psychometric properties in mainland China.The online version of this article (doi:10.1186/s12891-015-0854-1) contains supplementary material, which is available to authorized users. Osteoarthritis (OA) is the most common joint disease and a major public health problem throughout the world , 2. SincRecently, the NKSS has been designed to be completed by both physicians and patients . The objIt is well known that TKA is the most effective intervention to improve the quality of life for patients with the terminal stage of osteoarthritis . China hThe translation and cross-cultural adaptation of the original NKSS were performed according to international guidelines , 18  were invited to participate in this study. A total of 105 patients with a diagnosis of knee osteoarthritis were recruited from the orthopaedic department in our hospital during the time from September 2012 to September 2013  and the VAS score for pain were used to compare with the SC-NKSS. The OKS was widely used to evaluate the outcome of knee, it contains 12 items , with sum score ranging from 0 (worst) to 48 (best) , 14. TheData acceptability was based on these criteria: normal distribution, no significant floor or ceiling effects (i.e. less than 15 % of participants achieved the highest or lowest scores). The time needed to complete the questionnaire was also recorded. No difficulties answering the questions, and no issues with missing or multiple responses.The test-retest reliability of the SC-NKSS was assessed by 50 patients who were randomly selected from the sample of 105 patients. One week later, they were asked to complete the questionnaire again under similar condition and return it after they finished. The intraclass correlation coefficient (ICC) (two-way random effects model) was calculated to quantify test-retest reliability . A valuer = 0–0.20), fair (0.21–0.40), moderate (0.41–0.60), very good (0.61–0.80) or excellent (0.81–1.0) [Until now, there has been no so-called “gold standard” to optimally reflect the status of the knee , 16. Sim.81–1.0) . The cor“Leisure recreational activities” are always understood as activities of playing card or watching TV and so on, in mainland China, these activities always require people to sit indoor. Therefore, the expert committee reached a consensus to use “go for a walk” instead of “leisure recreational activities” in our study. The distance measure of “a block” is unpopular in mainland China, so are “Inch” and “LBS”, therefore, the expert committees reached a consensus to use “100 m” instead of “a block”, centimetre instead of “inch”,“kilogram” instead of “LBS” in our study.There were no floor or ceiling effects in the target population, which indicated a good distribution for the SC-NKSS. The average completing questionnaires time was 428.7 ± 24.2 s. All participants completed the questionnaire without any difficulties and no issues with missing or multiple responses.Fifty participants completed the questionnaire again. Mean score of the retest was 82.08 ± 18.01, which was similar to the former result (78.42 ± 16.07). The ICC between the two sessions was 0.92 , which demonstrated exceptional test-retest reliability. We also found that the Cronbach alpha coefficient was 0.90 , which indicated excellent internal consistency for the overall SC-NKSS (Table Pearson’s coefficients are shown in table The Knee Society Clinical Rating System appeared in 1989 and has become the most popular method for tracking and reporting outcomes of TKA , 26. TheThere were no ceiling or floor effects in our study, which demonstrated that the distribution of the SC-NKSS was satisfactory. All patients in our study completed the questionnaire without any difficulties, which indicated the questionnaire had good cultural acceptability.In our study, the interval time between the first and second test was 1 week. This was suitable to assess the test-retest reliability, because it was long enough to prevent recall but short enough to ensure that clinical changes had not occurred , 21. TheThe OKS was designed to evaluate the pain and physical function of patients who had undergone TKA, and the VAS objectively reflects the patients’ subjective perception of pain. Previous studies have demonstrated the validity and reliability of the simplified Chinese versions of the OKS and VAS –14; therThe construct validity was also assessed by comparing the SC-NKSS with the SF-36 subscale. The results demonstrated that correlations between the SC-NKSS and the PF, BP and GH of SF-36 were significant. As expected, the correlations between the SC-NKSS and the RP, VT, SF, RE and MH were weak. These results are similar to the construct validity of NKSS of the Dutch version , demonstWe also notice that there are some limitations in our study. First, we did not examine the responsiveness of SC-NKSS, therefore, the SC-NKSS couldn’t completely reflect improvement of patients who receivedTKA, and we plan to address it in a subsequent prospective study. Second, all patients in the sample had severe knee osteoarthritis and were awaiting TKA. Patients with mild to moderate knee osteoarthritis were not included in the study, which might result in a lower score. Third, most of our patients were from the south of China, which may not adequately represent the whole Chinese population, and we plan to make a multiple centre study in the subsequent study.The English version of the NKSS has been translated into a simplified Chinese version and has been shown to be reliable, valid and internally consistent. The SC-NKSS is easy to understand and complete. Our results suggest that the SC-NKSS is a good method for the surgeon to assess the expectations, satisfaction and physical activities of patients before and after TKA. However, its validity and reliability need further research with a larger population.


To address the two urgent issues nowadays of protecting the environment and achieving energy sustainability, it is of strategic importance on a global scale to replace oil-dependent vehicles with electric drive vehicles (EDVs). Numerical simulation and optimization are essential to simulate the actual hardware and minimize the development procedure and cost. Accurate and efficient modeling, control, and optimization technologies have been the indispensable tools. EDVs have been continuously improved owing to the advancement of systematic control and power management, energy systems, batteries, and pack technologies, as well as economic and policy incentives, public awareness of energy sustainability/affordability, and environmental concerns. The primary goal of this special section is to provide timely solutions to technological and economic challenges in modeling, simulation, control, and optimization of EDVs. The accepted papers cover a range of different aspects of modeling, control, and optimization technologies for electric vehicles. A brief summary of them is given as follows.Most of papers are used to investigate the control and power management for EDVs. C. Lin and X. Cheng investigated a traction control strategy with an efficiency model in a distributed driving electric vehicle. S. Zhang et al. studied the optimal control strategy for a dual-motor coupling propulsion electric bus. The dynamic programming is applied to find the optimal control strategy including upshift threshold, downshift threshold, and power split ratio between the main motor and auxiliary motor. To improve the regenerative braking performance, J. Peng et al. provided a hierarchical control strategy for the cooperative braking system of an electric vehicle with separated driven axles. P. Lebeau et al. explored the possible integration of electric vehicles in urban logistics operations. A fleet size and mix vehicle routing problem with time windows for electric vehicles has been developed. In particular, an energy consumption model was integrated in order to consider variable range of electric vehicles. J.-J. Hwang et al. presented a novel charging strategy for fuel cell/battery electric vehicles. In comparison to the conventional switch control, a fuzzy control approach was employed to enhance the battery's state of charge (SOC).In terms of the batteries and grouping technology, S. Barcellona et al. proposed a simple method to investigate the effect of the duty cycle on the batteries lifetime through tests performed on different cells for different kinds of cycle. In this way, a generic complex cycle could be seen as a composition of elemental cycles by means of Rainflow procedures. Consequently, the ageing due to any cycle could be estimated starting from the knowledge of simpler cycles from their research results. For the research field of energy systems and networks, L. Niu and D. Zhang analyzed the actual operational data of electric taxis in Shenzhen, China. An electric taxis charging guidance model was established and guides the charging based on the positions of taxis and charging stations with adaptive mutation particle swarm optimization. The simulation results showed that electric taxis could be evenly distributed to the appropriate charging stations according to the charging pile numbers in charging stations after the charging guidance.In summary, the included seven papers cover the topics of modeling, control, and optimization technologies in EDVs with the new research achievements; we hope and are sure that the readers of this special issue could find valuable references to their research on EDVs.


Therapeutic strategies for patent ductus arteriosus (PDA) in very preterm infants remain controversial. To identify infants likely to benefit from treatment, we analysed the efficacy of a first course of ibuprofen in small-for-gestational age (SGA) newborns.This single-centre retrospective study included 185 infants born at 24+0–27+6 weeks of gestation with haemodynamically significant PDA, who were treated by intravenous ibuprofen (Pedea): 10 mg/kg on day one and 5 mg/kg on days two and three. Birth weight and gestational age (GA) were analysed with reference to the standard deviations from the Olsen growth curve to define GA-specific Z-scores for birth weights. The efficacy of treatment was evaluated by echocardiography 48 hours after the last dose of ibuprofen. The primary outcome was failure of the first course of ibuprofen associated in a composite criterion with the most severe outcomes.The risk of treatment failure increased according to a continuous gradient in SGA neonates. A higher risk was observed on multiple regression analysis .There is a linear relationship between infant birth weight and PDA treatment: the failure rate of a first course of ibuprofen increases with increasing degree of growth restriction. However, more than two-thirds of infants delivered before 28 weeks of gestation or with a birth weight <1750 g develop patent ductus arteriosus (PDA), a heart condition that requires either pharmacological or surgical closure of the ductus arteriosus  and presmaturity . Howevermaturity  and gestmaturity ; howeverWe conducted a single-centre retrospective study to analyse the success of a first course of ibuprofen to close significant PDA in infants born 24+0–27+6 weeks of gestation according to their degree of intrauterine growth restriction.st January 2005 and 31st December 2009 were eligible for this study. The Institutional Review Board (Comité de Protection des Personnes Ile de France III) stated: “This research was found to conform to generally accepted scientific principles and research ethical standards and to comply with the laws and regulations of France, where the research was performed.” Written informed consent from the patients or parents was unnecessary for this retrospective study. Inclusion criteria were: GA of 24+0–27+6 weeks, echocardiographic evidence of haemodynamically significant left-to-right shunting across the PDA, and initiation of at least one course of intravenous ibuprofen (Pedea®). Echocardiographic criteria indicating the need for PDA treatment were ductus arteriosus diameter >1.5 mm and at least two of the following criteria: left atrial-to-aortic root ratio >1.5, pulsatile flow in the ductus arteriosus, or retrograde/absent diastolic flow in the anterior cerebral artery or descending aorta. Exclusion criteria were: major congenital malformations including congenital heart defects other than PDA, genetic or chromosomal abnormalities, death before determining ductus arteriosus status, and PDA in a clinical setting that precluded ibuprofen therapy .All live newborns admitted to the Cochin-Port Royal Hospital neonatal intensive care unit  between 1All medical data were collected retrospectively from medical records. Medical records were compiled prospectively as part of routine neonatal care and were regularly validated by the clinical team. Birth weights were expressed in relation to GA in terms of standard deviations (SD) from Olsen growth curves . Z-scoreThe management of PDA remained the same throughout the study period in our unit. Infants born before 28 weeks of gestation were routinely assessed by echocardiography during the first 48 hours of life . Intravenous ibuprofen was administered in three doses at 24-hour intervals: 10 mg/kg on day one and 5 mg/kg on days two and three. Echocardiography was performed before the first dose of ibuprofen and 48 hours after the last dose according to the unit’s standard policy.If the first course of ibuprofen failed and the patient presented no contraindications to ibuprofen, a second course of ibuprofen was administered at the same doses. In the presence of a contraindication to ibuprofen, or if after failure of the second course of ibuprofen, PDA was treated surgically.The primary outcome was failure of the first course of ibuprofen associated with the most severe outcomes in a composite criterion: surgery, necrotising enterocolitis, intestinal perforation, and dopamine and furosemide treatment during the first course of ibuprofen. Success of the PDA closure was defined as no flow in the ductus arteriosus on echocardiography performed 48 hours after the last dose of ibuprofen.Obstetric and neonatal characteristics were initially studied as a function of birth weight across the GA spectrum. The relationship between the characteristics of ibuprofen therapy and the degree of growth restriction was also studied. For descriptive univariate analyses, all statistical tests were two-tailed, and p<0.05 was considered significant. Statistical analysis was designed to identify potential confounders in the relationship between ibuprofen efficacy and growth restriction. This relationship was studied by using a logistic regression model, adjusted for obstetric and neonatal variables selected in the univariate analyses. The first step of our model considered only treatment failure and degree of growth restriction defined by GA-specific Z-scores. This basic relationship was expressed in terms of a crude OR and did not include any potential confounders. The next step analysed the same relationship and gradually included the confounders derived from the univariate analyses described above in order to determine whether the relationship between failure of the first course of ibuprofen and growth restriction was independent of potential confounders. Associations were quantified according to odds ratios (ORs) and 95% confidence intervals (CIs). The Hosmer-Lemeshow test was used to assess the validity of the model and the adequacy of the data; it validated the number of confounders included in our model and excluded multicollinearity. A composite endpoint was also defined, comprising the most severe outcomes including failure of the first course of ibuprofen, surgery, necrotising enterocolitis, intestinal perforation and use of dopamine or furosemide during the first course of ibuprofen. Dopamine was infused for persistent systemic hypotension and furosemide for persistent oliguria.Statistical analysis was performed with SPSS V.15.0 .This study included 185 patients . Fifty-fReview of obstetric data revealed no cases of chorioamnionitis for the most severely growth-restricted infants, but their mothers presented pre-eclampsia in about 95% of cases . The stu3, or clotting disorders. Serum creatinine and platelet count were determined before each dose of ibuprofen.Higher baseline serum creatinine before initiating the first course of ibuprofen were observed in patients with lower GA. No statistically significant differences in terms of treatment characteristics were observed between the various birth weight groups . TreatmeIn this study population, 136 patients experienced the most severe outcomes included in the composite criterion: 90 patients with Z-scores > -0.5 SD (69%), 29 patients with Z-scores -0.5 – -1.5 SD (78%), and 17 patients with Z-scores < -1.5 SD (94%). The risk of a severe outcome after a first course of ibuprofen therapy tended to increase as the patient’s birth weight decreased (with respect to their GA) .The baseline characteristics of the infants in the three groups of GA-specific Z-scores for birth weight are summarised in The first course of ibuprofen failed in 101 patients (55%) in this population. The relationship between failure of the first course of ibuprofen and SGA was studied by means of a logistic regression model .Regression analysis revealed an increased risk of failure of the first course of ibuprofen therapy for the smallest patients. Development of the regression model revealed a significant gradient: as birth weight for gestational age decreased, the risk of failure of a first course of ibuprofen increased. This association was expressed in terms of the OR in our logistic regression. OR values gradually increased as variables were progressively added to the regression model, demonstrating that the more the logistic regression was adjusted, the more a low Z-score influenced the risk of failure of the first course of ibuprofen.To the best of our knowledge, this is the first study to describe the impact of SGA on the treatment of haemodynamically significant PDA in extremely preterm infants. This cohort included 185 infants, 55 of whom had a GA-specific Z-score for birth weight < -0.5 SD. The risk of failure of the first course of ibuprofen increased with the degree of growth restriction, reaching a maximum 12.8-fold higher risk of failure, according to a gradient that intensified with regression adjustments.Birth weight SDs were classified into three categories to reflect the continuous pathological effect of being small-for-gestational age on mortality. This classification avoided a cut-off effect and revealed a gradient for the primary outcome, supporting the validity of the main results and regression models. Even if, at first, epidemiologic studies described preterm infants growth restriction using a −2 SD (or 10th centile) cut-off for SGA, more recent studies proved that this definition is no more appropriate because it inadequately describes the risks associated with foetal growth restriction ,5.Haute Autorité de Santé  guidelines, based on pharmacological data [One of the strengths of this study was the definition used for significant PDA, based on precise echocardiographic criteria. All data were collected prospectively as part of a routine neonatal care and were regularly validated by the clinical team, resulting in fewer missing data and the collection of more reliable data. Treatment protocols in the department did not change during the study period. The dose regimen complied with the cal data ,13, and cal data .Previous studies only used birth weight, unrelated to GA, to analyse the effect of ibuprofen therapy . StudiesThe overall incidence of haemodynamically significant PDA treated with at least one course of ibuprofen in our population was 54%. Our descriptive analyses are consistent with those reported in the literature; this rate was comparable to that observed in infants weighing <1 kg, 55% of whom received medical treatment for PDA . The oveMultiple mechanisms contribute to patent ductus arteriosus closure . These mOur descriptive analyses highlighted the confounding variables used to build our regression models, and the Hosmer-Lemeshow test demonstrated the validity of our models and partly excluded multicollinearity. The regression analysis showed that the association between growth restriction and failure of the first course of ibuprofen was independent of the confounding variables .The first course of ibuprofen tended to be discontinued more frequently in infants with GA-specific birth weights < -1.5 SD, probably because of the more cautious attitude adopted by the medical team in these patients. This criterion was entered into our regression model to control for the potential confounding effect of variations in the approach adopted by the clinicians.Despite the low statistical power of this study, due to the limited sample sizes, especially for the smallest infants, statistical analysis supported the results in this homogeneous population, as this study is one of the few examining birth weight Z scores in extremely preterm infants and PDA treatment as the main outcome.This lack of power resulted in large confidence intervals; however, the main results demonstrated at least a 2-fold risk of treatment failure.The results of this study support the hypothesis that PDA treatment strategies in very preterm infants may be adapted to their birth weight SD. Previous clinical trials have speculated that increasing the dose of ibuprofen may increase PDA closure rates ,18,19; hIn conclusion, we analysed the effects of ibuprofen with respect to birth weight for gestational age. This constitutes an original approach, as previous studies have assessed birth weight or gestational age without considering small-for-gestational age patients. Our results indicate that PDA treatment strategies in very preterm infants may be adapted to their birth weight standard deviation, as this study showed decreasing birth weight standard deviations were associated with higher failure rates of the first course of ibuprofen. These results need to be confirmed in larger, multicentre cohorts. However, we suggest that prospective studies on the PDA closure therapeutic strategies in extremely preterm infants should be analysed according to GA-specific birth weight subgroups.


Short birth intervals are known to have negative effects on pregnancy outcomes. We analysed data from a large population surveillance system in rural Bangladesh to identify predictors of short birth interval and determine consequences of short intervals on pregnancy outcomes.a priori knowledge from literature review. An adjusted mixed effects logistic regression model was then used to determine the effect of up to 21-, 21-32-, 33-44- and 45-month and higher birth-to-birth intervals on pregnancy outcomes controlling for confounders selected through a directed acyclic graph.The study was conducted in three districts of Bangladesh – Bogra, Moulavibazar and Faridpur . We used data between January 2010 and June 2011 from a key informant surveillance system that recorded all births, deaths and stillbirths. Short birth interval was defined as an interval between consecutive births of less than 33 months. Initially, risk factors of a short birth interval were determined using a multivariate mixed effects logistic regression model. Independent risk factors were selected using We analysed 5,571 second or higher order deliveries. Average birth interval was 55 months and 1368/5571 women (24.6%) had a short birth interval (<33 months). Younger women (AOR 1.11 95% CI 1.08-1.15 per year increase in age), women who started their reproductive life later  and those who achieve higher order parities were less likely to experience short birth intervals . Women who were socioeconomically disadvantaged were more likely to experience a short birth interval  and a previous adverse outcome was an important determinant of interval . Very short birth intervals of less than 21 months were associated with increased stillbirth rate  and neonatal mortality (AOR 2.28 95% CI 1.28-4.05).Birth spacing remains a reproductive health problem in Bangladesh. Disadvantaged women are more likely to experience short birth intervals and to have increased perinatal deaths. Research into causal pathways and strategies to improve spacing between pregnancies should be intensified.The online version of this article (doi:10.1186/s12884-014-0427-6) contains supplementary material, which is available to authorized users. Short birth intervals, defined as the time between two births, are known to have negative effects on maternal, perinatal and neonatal outcomes as well as on child health, though the precise mechanisms are poorly understood . Short iNeonatal and infant mortality is highest for birth to pregnancy intervals of 18 months and is slightly increased for birth to pregnancy intervals of 18–27 months . The mosCorresponding with increasing levels of contraceptive use over the past 30 years (from 7 per cent in 1975 to 54 per cent by 2000) . HoweverMother’s age at first birth, parity, previous birth interval, mother’s working status, gender composition of the living children, and mass media are also described as determinants of birth intervals -13.National strategies focused on family planning, reproductive health and safe motherhood have been well described  and are The study was conducted in nine unions (the lowest administrative level in Bangladesh) in three districts of Bangladesh – Bogra, Moulavibazar and Faridpur. The districts and unions represent part of a cluster randomised controlled trial of a community intervention to improve maternal and neonatal health described in detail elsewhere -16. OnlySince 2004, a key informant surveillance system has been used in the study areas to record all births, neonatal deaths, and deaths of women of reproductive age . 500 traThe current analysis was restricted to births taking place between January 2010 and June 2011. Observations were included if data on birth interval, pregnancy outcome and other predictors were complete.We defined adverse pregnancy outcomes as the total number of stillbirths and neonatal deaths per 1,000 births. Perinatal mortality is comprised of the sum of stillbirths and deaths in the first week of life per 1,000 births. The neonatal mortality rate is presented as the number of newborn infants dying before reaching 28 days of age, per 1,000 live births and the early neonatal mortality rate as the number dying before reaching 7 days of age, per 1,000 live births.Age was defined as the age of the mother at the time of the previous birth. Parity was defined as the number of times that a woman has given birth, regardless of whether the child was born alive or not. Maternal religion was categorised as either Muslim or other religion which included Hinduism and Christianity. The number of household assets was counted using a standard list of household items that included electricity, radio/tape recorder, fan, TV, fridge, phone, generator and bicycle and then dichotomised as ‘up to 3’ or ‘4 or more’ assets. Educational attainment was classified as either none/ primary only or one or more years in secondary or higher education.Our data did not include the outcome of the immediately preceding pregnancy but did include the total number of pregnancies, miscarriages or abortions, stillbirths and live births for every mother as reported at the time of interview. These data were used to identify previous adverse pregnancy outcomes defined as a miscarriage or abortion, stillbirth or neonatal death resulting from any previous pregnancy.Potential determinants of a short birth interval were chosen for inclusion in the statistical model and were arrived at a priori through a review of the literature. These included maternal age, parity, age at first pregnancy, maternal religion, education, household assets, tea garden residence and a history of a previous adverse pregnancy outcome. In examining the determinants of short birth interval we defined the outcome as an interval between consecutive births of any outcome (live or stillborn) of less than 33 months, corresponding to World Health Organisation recommendations. Initially, a univariate analysis was performed to determine the associations between individual predictors and short birth interval. A multivariate mixed effects logistic regression model, including all potential determinants of a short birth interval was then used to arrive at individually adjusted estimates. We assessed multicollinearity by calculating variance inflation factors (VIF). The VIF for parity was 3.60 and for age was 3.89, which indicates some, but acceptable collinearity. Given that we were interested in their joint effect, we kept both in the model. A likelihood ratio statistic was used to determine whether to include age and parity as a continuous or a categorical variable. Results indicate it was more appropriate to treat age as a discrete variable and parity as a categorical variable. The Receiver Operating Characteristic (ROC) was used to ascertain the predictive quality of the multivariate model.Next, we evaluated short birth intervals as a determinant of an adverse pregnancy outcome. For this, birth interval was categorized as an interval between consecutive births of any outcome (live or stillborn) of <21 months, 21–32 months, 33–44 months and 45 months or longer, corresponding to birth to pregnancy intervals of less than one year, 1–2 years, 2–3 years and 3 or more years under the assumption of 9 months gestation.We identified potential confounders based on a review of the literature. A Directed Acyclic Graph (DAG) was then used to assist in the selection of appropriate confounders by modelling the relationships between potential confounders, short birth interval and stillbirth or neonatal death [see Additional file The DAG was drawn in Dagitty, an online tool . All anaThis study uses data gathered as part of a larger cluster randomised trial of a community intervention. Community consent was acquired for intervention implementation and all monitoring activities. Individual informed consent was obtained before each interview. The current analyses were not subject to specific ethical review as they fall within the scope of the trial and monitoring activities that were approved by the University College London research ethics committee (identification number 1488/001) and the ethical review committee of the Diabetic Association of Bangladesh.In the period January 2010-June 2011, 9,797 deliveries were registered with 5,911 second or higher order deliveries. The average birth interval was 4 years and 7 months (55 months). The average age of first pregnancy was 18.4 years and the average age of delivery 26.4 years (Table We checked for data completeness and 340 observations (5.8%) had missing data. 330 observations had a missing birth interval and 10 observations missed other covariates . Neonatal mortality was higher among those cases with missing data and younger age, lower parity, previous adverse outcomes, Christian or Hindu religion and higher education groups were overrepresented [see Additional file 1,368 women (24.6%) had a birth interval shorter than 33 months. The determinants of short birth intervals are described in detail in Table Compared to birth intervals of 45 months or longer, birth intervals of less than 21 months were associated with a greater than two-fold increased risk of adverse pregnancy outcome (AOR 2.23 95% CI 1.51-3.29), as well as increased risk of perinatal mortality , stillbirth , neonatal mortality (AOR 2.28 95% CI 1.28-4.05) . A previous adverse outcome may have a “scarring” effect, because it causes women to rush into a next pregnancy (replacement) without properly recovering from the previous pregnancy. Women who experience a short birth interval may be subject to other factors that could result in clustering of adverse pregnancy outcomes, such as reduced access to health facilities which could reduce both access to family planning as well as delivery and perinatal care. A study by Saha ogeneity .et al. demonstrated that replacement level fertility has almost been achieved in women who are better educated and socioeconomically better off, while replacement level fertility has not been achieved yet for the less well-off [Our observations confirm that the risk of a short birth interval is highest for those least well-off, both in terms of household assets and tea garden residence. Analysis of BDHS data also indicates that birth intervals are shortest and the difference between desired spacing and actual birth interval is biggest for the least well-off . Differewell-off .Very short birth-to-pregnancy intervals of 18 months or shorter are associated with elevated risk of infant, neonatal and perinatal mortality, low birth weight, small size for gestational age, and pre-term delivery -6. A birThe purpose of observational studies is to inform intervention, policy and practice. Our findings suggest that women from poor socioeconomic backgrounds and women who experienced an adverse previous pregnancy should receive particular attention from family planning programs in rural Bangladesh. Post-partum counselling including family planning counselling for bereaved mothers who experienced an adverse outcome is likely to be important in addressing short birth intervals and their consequences. An approach that may have potential in targeting women from poor socioeconomic backgrounds is community mobilisation through women’s groups on reproductive and women’s health. The approach has been shown to be effective at improving maternal and neonatal health, especially for the most marginalised women ,24,25.Birth spacing remains an issue that deserves urgent attention in Bangladesh. Disadvantaged women are more likely to experience short birth intervals and suffer their consequences. Further research should look into causal pathways as well as strategies to improve spacing between pregnancies whilst efforts to prevent adverse pregnancy outcomes, an important determinant of birth spacing, should be intensified.


Yang-Xu constitution using a body constitution questionnaire (BCQ) and clinical blood variables. A BCQ was employed to assess the clinical manifestation of Yang-Xu. The logistic regression model was conducted to explore the relationship between BC scores and biomarkers. Leave-one-out cross-validation (LOOCV) and K-fold cross-validation were performed to evaluate the accuracy of a predictive model in practice. Decision trees (DTs) were conducted to determine the possible relationships between blood biomarkers and BC scores. According to the BCQ analysis, 49% participants without any BC were classified as healthy subjects. Among them, 130 samples were selected for further analysis and divided into two groups. One group comprised healthy subjects without any BC (68%), while subjects of the other group, named as the sub-healthy group, had three BCs (32%). Six biomarkers, CRE, TSH, HB, MONO, RBC, and LH, were found to have the greatest impact on BCQ outcomes in Yang-Xu subjects. This study indicated significant biochemical differences in Yang-Xu subjects, which may provide a connection between blood variables and the Yang-Xu BC.Traditional Chinese medicine (TCM) formulates treatment according to body constitution (BC) differentiation. Different constitutions have specific metabolic characteristics and different susceptibility to certain diseases. This study aimed to assess the Traditional Chinese medicine (TCM) formulates treatment under the guidance of the holistic concept according to constitution differentiation  . Thus, tYin-Yang are two opposite, complementary, and exchangeable aspects of nature. The classification of Yin-Yang is usually the first step of Zheng classification in TCM. Yin mainly refers to the organs and Yang to the functions. In healthy status, Yin-Yang is in balance. Disease occurs after a disturbance in Yin-Yang or disharmony in the organs caused by pathogenic or climatic and environmental factors. Treatment aims to expel or suppress the causes and restore balance [ balance . Body co balance , 6, 7. T balance –15. Yin-Xu, Yang-Xu, and Stasis [ Yang-Xu and BCQ using these blood clinical variables.The developed BCQ consists of 44 items, which are divided into three imbalanced BC scales, namely,d Stasis , 10, 12.d Stasis . Resultsd Stasis , 14. Howd Stasis . The sysd Stasis , 16–18. Healthy volunteers of mostly young subjects (age ranging from 20 to 39 years) were recruited between March 2013 and June 2013 from the Taipei Veterans General Hospital . This study complied with the Declaration of Helsinki and was approved by the Institutional Review Board . A Chinese medical doctor, Yii-Jeng Lin , with a degree in medicine, a license as a Chinese physician, and more than 6 years of clinical experience, explained the details of the study to the subjects and solicited written informed consent from each subject. Subjects who had taken any medicine, dietary supplement, or Chinese medicine within the previous month were excluded from the study. A total of 192 subjects  were recruited. The characteristics of the participants are shown in  Yang-Xu, Yin-Xu, and Stasis were evaluated using the BCQ [ Yang-Xu, Yin-Xu, and Stasis. This study used 26 biomarkers as the BCQ indicators.Three types of data were collected including the BCQ responses, biomarkers, and clinical records of a Chinese medical doctor (CMD). The BC was assessed from the self-reported BCQ responses and by the CMD. Clinical manifestations of the BCQ –12, whil Yang-Xu, Yin-Xu, and Stasis according to the BCQ responses were classified as abnormal. The CMD also deemed subjects with two or more clinical manifestations among Yang-Xu, Yin-Xu, and Stasis as abnormal. People without any constitutions of Yang-Xu, Yin-Xu, and Stasis were taken as normal. Finally, 130 participants including 88 normal individuals and 42 abnormal subjects were selected according to the BCQ results.People with simultaneous clinical manifestations ofThis study hypothesized that the underlying predisease or sub-healthy conditions might modify BC. Such conditions include poor nutrition, sub-healthy endocrine problems, and minimal inflammation. In view of this, the nutritional , endocrine , inflammation status  and renal function  were evaluated at routine check-up. Routine clinical chemical analysis of fasting blood samples was conducted by Union Clinical Laboratory, which has been accredited by the College of American Pathologists Laboratory Accreditation Program (LAP number 6979606). The 26 biomarkers were albumin (ALB), alanine transaminase (ALT), aspartate transaminase (AST), blood urea nitrogen (BUN), creatinine (CRE), cortisol (CORS), fasting blood glucose (Glu-AC), high-density lipoprotein cholesterol (HDLC), low-density lipoprotein cholesterol (LDLC), luteinizing hormone (LH), thyroid-stimulating hormone (TSH), high-reactive C-reactive protein (HSCRP), dehydroepiandrosterone (DHEAS), and red blood cell (RBC) count, white blood cell (WBC) count, hemoglobin (HB), hematocrit (HCT), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), platelet (PLT), neutrophil (NEUT), lymphocyte (LYMPH), monocyte (MONO), eosinophil (EO), and basophil (BASO). Yang-Xu [ Yin-Xu [ Stasis were assessed using the BCQ [ Yang deficiency [ Yin deficiency [ Stasis [ Yang deficiency , a score exceeding 31 indicated Yang-Xu BC; for Yin deficiency , a score exceeding 30 indicated Yin-Xu BC; and for Stasis , a score exceeding 27 indicated Stasis BC. The higher the score, the greater the deviation of the BC. In a previous research, the BCQ had Cronbach's confidence α ranging from 0.55 to 0.88, with the intraclass correlation coefficients (ICC) exceeding 0.7 [The body constitution questionnaire (BCQ) was provided by Professor Yi-Chang Su, Ph.D., School of Chinese Medicine, China Medical University, Taichung, Taiwan. The physiological states of Yang-Xu , 9, Yin-[ Yin-Xu , 11, and the BCQ . The queficiency , 19 itemficiency , and 16 [ Stasis . Some itding 0.7 . Yang-Xu is characterized by slow, weak, and faint pulses; Yin-Xu rapid and wiry pulses in float position and weak pulses in deep position; and Stasis sluggish pulses as well as asking about subjects' background. Each subject gave a score of 1 to 4 in each BC. The higher score indicated a higher level of the BC.In this study, The Chinese medical doctor, Dr. Yii-Jeng Lin, was responsible for making the diagnosis according to Chinese medicine theory and blinded to BCQ results. The major method of diagnosis was to take the patient's pulse caused by heartbeat.A logistic regression model was conducted to explore the relationship between BC scores and blood biomarkers , 20. ThePart A. Pooled logistic regression model isPart B. Separated logistic regression model is as follows: Female is Male isK-fold cross-validation were conducted to examine the performance of the logistic regression model in this study [Cross-validation (CV) is a better model evaluation method which is mainly used to assess how accurate a predictive model will perform in practice. Leave-one-out cross-validation (LOOCV) and is study .Decision trees were conducted to mine the possible relationship between 26 biomarkers and BC scores. Unlike the logistic regression model, a decision tree could suggest cut-off points when treating all factors as categorical variables and make a decision in the end. The deviance is employed to prune the full tree into a smaller tree without losing accuracy. Thus, the final model is formed –21.A total of 192 healthy subjects volunteered to participate in this study. The characteristics of the subjects are summarized in  Yang-Xu subjects and 32.2 ± 7.5 in female Yang-Xu subjects. The CMD score was 2.0 ± 0.9 in male and 1.9 ± 0.8 in female Yang-Xu subjects, respectively . For further analysis, more specific data, including those “without any BC” which represented the healthy subjects and those “with all three BCs” which represented the sub-healthy subjects, were extracted. Among them, 49% without any BC were classified as healthy subjects, and 39% have more than one BC . The detβg. On the contrary, the separated logistic regression model was more flexible in estimating errors, ε0 and ε1, and the coefficients of predictors could vary. The pooled model was separated by gender; the model for male subjects was referred to as Model 1 while that for female subjects was referred to as Model 2. The error rate of the separated model was about 11.5%, which was less than that of the pooled model, about 23%. BC scores showed different trends for male and female subjects. Female had higher Yang-Xu and BC scores than male. Thus, the use of the separated logistic regression model was much reasonable than that of the pooled one.The logistic regression model was further conducted to explore the relationship between the BC scores and clinical blood biomarkers. The pooled logistic regression model assumed that the errors of male and female were the same and gender affected only the interception of the model, that is, P, was 77.8%. In other words, without using any model, the worst accuracy could be 77.8%. The BCQ male model (Model 1) gave a probability of correctly indicating a participant's status by taking the BCQ into consideration, P value is 0.0049, which was less than the alpha level at 0.05. Hence, it can be concluded that Model 1 can significantly reduce the error rate when the logistic regression model was used for prediction. Same as Model 1, Model 2  showed a P of 55.2% and P value of about 0.0000 at 0.05 alpha level represented that Model 2 can also significantly reduce the error rate when using the logistic regression model for prediction.Originally, the probability of participants in normal, K-fold cross-validation to evaluate the performance of the aforementioned logistic regression models, both methods showed that the error rate went up to around 0.41 with standard deviation of 0.11. This means that the error rate in this study is high. Hence, although logistic models can explain the relationship between BC scores and biomarkers, the prediction is not as good as expected. Hence, a decision tree is proposed to solve the problem.When using LOOCV and  BCQ decision tree, shows the full model. Obviously, some leaves are redundant. Deviance was introduced to prune the full tree. After choosing tree size four, Figure  S2 shows that it maintains the relative high accuracy. Therefore, the final model is shown as in Figure  S1, a Yang-Xu subjects.A total of 192 subjects  were recruited by the Center for Traditional Medicine of Taipei Veterans General Hospital. This pilot study was approved by the Institutional Review Board, and only participants aged between 20 and 39 years were included to avoid complicated parameters, such as aging and chronic inflammation. To evaluate the difference between sub-healthy status and healthy status, 88 participants without any BC were defined as healthy individuals, and 42 participants with three BCs were defined as sub-healthy subjects. BC in TCM represents the physical and physiological attributes of an individual. Different constitutions have specific metabolic characteristics and different susceptibility to certain diseases [ Yang-Xu subjects classified according to BCQ, the results showed normal CRE, TSH, RBC, and HB levels but all lower than those of non-Yang-Xu subjects, while LH and MONO levels of Yang-Xu subjects are higher than those of non-Yang-Xu subjects. It is interesting that the six blood biomarkers, TSH, CRE, and LH, which are all regulated by estrogen, showed different levels in Yang-Xu female and male subjects (Supplementary Table S2).InYang-Xu constitution implies a diminishing energy level in the physiological functioning of body. These individuals may experience symptoms including fatigue, nausea, dizziness, nasal congestion and allergy, mood swings, shortness of breath, chills, loose stool, and large volume of urine. Moreover, some diseases are significantly positively correlated with Yang-Xu [ Yang-Xu –13. Crea Yang-Xu , 23. Low Yang-Xu , 25.Yang-Xu group expressed lower levels of TSH, T3, and T4 [α, IL-6, IL-8, IL-10, and IL-18 were all significantly higher in Yang-Xu subjects [Thyroid-stimulating hormone (TSH) released by the pituitary in the brain informs the thyroid gland to secrete thyroxin (T4), which must then be converted into the active thyroid hormone, triiodothyronine (T3). Pituitary dysfunction in chronic fatigue syndrome may have a variety of causes, including viruses, bacteria, stress, toxins, inflammation, and mitochondria dysfunction. These problems could result in low normal TSH levels along with low normal T4 and T3 levels. Many studies also found that compared with the normal control group, the kidney-, and T4 , 27. In , and T4 , 29. Hem, and T4 , 31. MONsubjects . These csubjects , 34. The Yang-Xu, Yin-Xu, and Stasis, from the results of BCQ. The subjects without any BC are denoted as normal. Thus, 32.29% of participants are eliminated. In this case, the proposed model can accurately represent the situation among those participants, almost 40% of relationship between biomarkers and BC scores.In data transformation, we rewrote the BCQ-model with the subjects having three BCs, Yang-Xu constitution for bridging the gap between Chinese medicine theory and BCQ. A more convincing digital parameter for personalized diagnosis remains to be performed with a larger sample size. To our knowledge, this study is the first report of using clinical blood variables to investigate Yang-Xu classified by the BCQ.This study used biochemical parameters to accessSupplementary Table S1. A detailed classification of BCQ.Yang-Xu vs. Non-Yang-Xu subjects in males and females (I); Yang-Xu vs. Non-Yang-Xu subjects by BCQ (II).Supplementary Table S2. Comparison of the selected parameters of Supplementary Figure S1. The full model of BCQ.Supplementary Figure S2. Relative high accuracy when tree size four is chosen.


P < 0.001, P = 0.001, and P = 0.015, resp.). Large for gestational age children showed higher high sensitivity C-reactive protein levels (P < 0.001) than small for gestational age. High birth weight is associated with higher levels of high sensitivity C-reactive protein, body mass index, waist circumference, and skinfolds. Large for gestational age altered high sensitivity C-reactive protein and promoted additional risk factor for atherosclerosis in these school children, independent of current nutritional status.Studies have shown associations of birth weight with increased concentrations of high sensitivity C-reactive protein. This study assessed the relationship between birth weight, anthropometric and metabolic parameters during childhood, and high sensitivity C-reactive protein. A total of 612 Brazilian school children aged 5–13 years were included in the study. High sensitivity C-reactive protein was measured by particle-enhanced immunonephelometry. Nutritional status was assessed by body mass index, waist circumference, and skinfolds. Total cholesterol and fractions, triglycerides, and glucose were measured by enzymatic methods. Insulin sensitivity was determined by the homeostasis model assessment method. Statistical analysis included chi-square test, General Linear Model, and General Linear Model for Gamma Distribution. Body mass index, waist circumference, and skinfolds were directly associated with birth weight ( Environmental factors acting early in life influence the risk of developing adult cardiovascular disease (CVD). Birth weight and/or infant weight and accelerated weight gain during childhood are associated with an increased risk of these disorders . Recent Thus, both high sensitivity C-reactive protein (hs-CRP) and low birth weight have emerged as predictors of CVDs, but the relationship between these two variables is still unclear. Thinness at birth or during infancy and accelerated body mass index (BMI) gain during childhood/adolescence are associated with a proinflammatory/prothrombotic state in adult life. An altered inflammatory state could be one link between small newborn/infant size and adult cardiovascular disease .Study has shown that low birth weight is associated with higher concentrations of hs-CRP in adults , but stuTherefore, the objective of this study was to further investigate the relationship between hs-CRP and birth weight and other risk factors  for cardiovascular disease in school children in southern Brazil.We conducted a population-based cross-sectional study in the city of Garibaldi, south Brazil. The city has currently 30,165 inhabitants and 21 elementary public schools with a total of 1,464 students 5–10 years old. Data was collected between 2011 and 2012, after approval of the Research Ethics Committee of the Institute of Cardiology of RS. All parents signed an informed consent and all children agreed to participate.Sample size was determined according to the study by Rondó et al. (2013) , which iAnthropometric measurements were repeated three times, nonconsecutively, and mean values were used in the analyses. Participants should be barefoot and wearing light clothes (shorts for boys and shorts and t-shirts for girls). Weight was measured using a digital scale (Techline) with a variation of 100 g. For height measurements, children stood in vertical position, with feet parallel and with the heels, shoulders, and buttocks touching the wall, and a stadiometer with accuracy of 0.1 cm was used.BMI, determined as weight in kilograms divided by height in meters squared, was used to assess the nutritional status, based on the BMI-for-age standards determined by the World Health Organization (WHO)  and valuFor measurement of the waist circumference (WC), children were placed in standing position, with the abdomen relaxed and arms along the body. The measuring tape was positioned around the natural waist line, in the narrower region between the thorax and the pelvis, at the midpoint between the last rib and the iliac crest, with a firm but not compressive force. The measurement was made at the time of expiration . Body coAll measures were performed by a registered dietitian (CB) and two previously trained undergraduate nutrition students.Parents or caretakers were asked to bring birth registrations on the day of the scheduled interview, for collection of information on birth weight and gestational age at birth. Birth weight was categorized as proposed by the WHO , with thBirth weight according to gestational age was classified according to the curve developed by Lubchenco et al. (1963) : small fμUI/mL), both measured in fasting, and dividing by 22.5 [Blood was collected according to the protocol provided by the Brazilian Society of Cardiology  and was  by 22.5 .The statistical analyses were performed with the Statistical Package for the Social Sciences (SPSS), version 21.0. The chi-square test was used for categorical variables. All data sets were tested for normality with Kolmogorov Smirnov Test. Variables with normal distribution were analyzed with one-way ANOVA, and asymmetric variables were analyzed with Mann-Whitney test. For regression analyses with control of confounding factors, linear models were used for data with normal distribution, and linear models with gamma distribution were used for asymmetric variables. The best adjusted model between all anthropometric variables was verified by the Akaike information criteria. Statistical significance was set at alpha <0.05.A total of 612 school children were evaluated. Of those, 572 presented complete data and were included in this study. Mean age of the participants was 8.6 (±1.46) years, and 51.5% were male. Analysis of maternal age at birth showed that 16.7% of the school children were born to teenage mothers, and 86.1% were Caucasian.The prevalence of school children with very low and low birth weight was 7.7% and 5.6%, respectively, and 86.8% had adequate birth weight. The frequency of school children born SGA was 2,1%, AGA 79.6% and LGA was 18.2%.P < 0.001). The maternal age and ethnicity did not differ significantly with the hs-CRP (P < 0.001). The same was observed for the waist circumference and skinfolds  (A higher proportion of boys than girls (23.7% versus 12.5%) had LGA  .P < 0.001, P = 0.03, and P = 0.02, resp.). Other biochemical parameters analyzed showed no statistically significant differences . The association between hs-CRP levels and LGA was also present after adjusting for gender, body mass index, waist circumference, and skinfolds (P < 0.001)  .The results observed in the evaluation of school children in southern Brazil showed that high birth weight is associated with higher levels of high sensitivity C-reactive protein, body mass index, waist circumference, and skinfolds.The prevalence of school children born with LGA was 18.2%, and the prevalence of school children born SGA was 2.1%. Scientific evidences around the world have shown concern with the increasing prevalence of low birth weight, which has been associated with several health complications. However, the present study highlights that high birth weight may also be related to several complications shown by anthropometric, metabolic, inflammatory, and biochemical results, thus contributing to the early development of the cardiovascular risk factors in school children. This represents a new association between birth weight and early outcomes associated with overweight, dyslipidemia, and metabolic and inflammatory changes. Singhal et al.  showed tHowever, the association between birth weight and BMI contradicts considerable evidence that a high birth weight programs less susceptibility rather than greater susceptibility to cardiovascular disease (CVD) risk factors , 17. PreThe analysis of birth weight and metabolic indicators showed higher values of glycaemia, insulin, and HOMA-IR in the children with LGA, but this association was not significant when BMI was considered a controlling factor. Factors related to obesity, such as the accumulation of abdominal fat and hyperinsulinemia, are also associated with the thrombogenic and inflammatory profile. Atherogenic, thrombogenic, and inflammatory metabolic changes contribute to a higher risk of coronary heart disease in obese children and adolescents, with accumulation of fat in the abdominal area . It is kHigh levels of inflammatory markers such as IL-6, tumor necrosis factor, and CRP are related to general and abdominal obesity. Children with overweight and obesity have higher concentrations of serum CRP, which supports the hypothesis of a relationship between childhood obesity and the presence of systemic inflammatory substances . InflammOur results showed that levels of hs-CRP in school children at school age are significantly higher in cases of LGA. However, in a cohort study , an inveThinness at birth and/or in infancy is associated with higher fibrinogen, hs-CRP in adulthood. Both in-utero influences and greater adiposity due to BMI gain in childhood/adolescence could be implicated consolidating the need to prevent excessive BMI gain in childhood .All anthropometric markers measured in this study  were increased in the participants who were LGA when compared to SGA. Similar results were found in the study of Rondó et al. , who desInfancy is understood as a critical period for the development of obesity for many reasons, but primarily because infants are experiencing food transitions, establishment of eating habits, and, too often, the early development of excess adiposity. Recently, more evidence has become available regarding the associations of early weight status and rapid growth with obesity and related problems in later life , 31. ForBody measures, specifically in the pediatric phase, change according to growth and development. The evaluation of the normality of these measures becomes complex but represents an important tool for evaluating the growth and nutritional status of children and adolescents. In this age group, nutritional changes usually reflect on growth, so that anthropometric parameters are important indicators for the assessment of nutritional status .High birth weight and/or in infancy is associated with higher levels of high sensitivity C-reactive protein, BMI, WC, and skinfolds. Large for gestational age altered high sensitivity C-reactive protein and promoted additional risk factor for atherosclerosis in these school children, independent of current nutritional status.


Variation in birth registration criteria may compromise international comparisons of fetal and infant mortality. We examined the effect of birth registration practices on fetal and infant mortality rates to determine whether observed differences in perinatal and infant mortality rates were artifacts of birth registration or reflected true differences in health status.A retrospective population-based cohort study was done using data from Canada, United States, Denmark, Finland, Iceland, Norway, and Sweden from 1995–2005. Main outcome measures included live births by gestational age and birth weight; gestational age—and birth weight-specific stillbirth rates; neonatal, post-neonatal, and cause-specific infant mortality.Proportion of live births <22 weeks varied substantially: Sweden (not reported), Iceland (0.00 %), Finland (0.001 %), Denmark (0.01 %), Norway (0.02 %), Canada (0.07 %) and United States (0.08 %). At 22–23 weeks, neonatal mortality rates were highest in Canada (892.2 per 1000 live births), Denmark (879.3) and Iceland (1000.0), moderately high in the United States (724.1), Finland (794.3) and Norway (739.0) and low in Sweden (561.2). Stillbirth:live birth ratios at 22–23 weeks were significantly lower in the United States (79.2 stillbirths per 100 live births) and Finland (90.8) than in Canada (112.1), Iceland (176.2) and Norway (173.9). Crude neonatal mortality rates were 83 % higher in Canada and 96 % higher in the United States than Finland. Neonatal mortality rates among live births ≥28 weeks were lower in Canada and United States compared with Finland. Post-neonatal mortality rates were higher in Canada and United States than in Nordic countries.Live birth frequencies and stillbirth and neonatal mortality patterns at the borderline of viability are likely due to differences in birth registration practices, although true differences in maternal, fetal and infant health cannot be ruled out. This study emphasises the need for further standardisations, in order to enhance the relevance of international comparisons of infant mortality.The online version of this article (doi:10.1186/s12887-015-0430-8) contains supplementary material, which is available to authorized users. The infant mortality rate is a key population health indicator and commands widespread public attention since it reflects economic development, social equity, and health care services within a population . It’s reThe popularity of the infant mortality indicator notwithstanding, international variations in birth registration laws and practices have the potential to bias comparisons of infant mortality. Problems can arise from differential registration of live births and stillbirths, especially births occurring at the borderline of viability , and/or their classification as stillbirths versus live births –8 have sWe examined variations in infant and fetal mortality rates based on birth registration practices at the borderline of viability, and the potentially differential classification of stillbirths and live births. We compared Canada and the United States to the Nordic countries because of the reported low levels of perinatal and infant mortality in the Nordic countries and their widely known emphasis on egalitarian ideals , lesser We used data for the period 1995 to 2005 from Canada, the United States and all five Nordic countries . We obtained reported counts of live births, stillbirths, neonatal deaths (0–27 days after birth) and post-neonatal deaths (28–364 days) by gestational age (GA) and birth weight (BW) from the vital registration systems or birth registries of each country. The gestational age categories that we examined included <22, 22–23, 24–25, 26–27, 28–31, 32–36, 37–41, ≥42 weeks and unknown gestational age, and birth weight categories included <500, 500–749, 750–999, 1000–1499, 1500–1999, ≥2000 grams and unknown birth weight. We also obtained reported counts of neonatal, post-neonatal, and infant deaths by cause of death . In addition, we collected and contrasted the rules and registration requirements for stillbirths and live births for each country.We obtained birth cohort linked live birth-infant death and fetal death data files for Canada from the vital registration files of Statistics Canada through an agreement between the Public Health Agency of Canada and Statistics Canada (which grants permission to the Agency to use this data). We excluded data from Ontario because of data quality concerns . We obtaGestational age in Canada was based on the best clinical estimate of pregnancy duration as reported on the birth registration , while iWe calculated the reported proportion of live births at each gestational age and birth weight category, and neonatal mortality rates by gestational age and birth weight. Similar analyses were carried out for stillbirth and post-neonatal mortality rates. Gestational age—and birth weight-specific stillbirth:live birth ratios (stillbirths per 100 live births) were also calculated to assess any proclivity towards labeling live births as stillbirths near the threshold of viability. Other comparisons included contrasts of cause of infant death, perinatal mortality and feto-infant mortality.For all contrasts of interest, we calculated mortality rate ratios and 95 % confidence intervals to determine the magnitude and statistical significance of observed differences. We used Finland as the reference group for these calculations, as it had a reasonably large number of live births and mortality rates that were not outliers relative to other Nordic countries. We assessed the statistical significance of differences in rate ratios using 95 % confidence intervals and based on a test of heterogeneity of the odds ratios .The manuGestational age and birth weight criteria for the registration of live births and stillbirths differed internationally. Countries such as Canada, the United States, Denmark, Finland, Iceland and Sweden required live birth registration for “any product of conception that shows signs of life at birth,” while Norway required registration of live births at a gestational age ≥16 weeks. Canada, Finland and Iceland required registration for stillbirths with a gestational age at delivery of ≥20 weeks or a birth weight ≥500 g; these criteria were ≥20 weeks or ≥350 g in the United States. The stillbirth registration criterion for fetal deaths was ≥16 weeks in Norway and ≥28 weeks in Sweden (until 2008), while Denmark changed its criterion from ≥28 weeks to ≥22 weeks in 2004. Canada, Denmark, Iceland and Sweden required stillbirth registration following medical pregnancy termination if birth weight and gestational age criteria for stillbirth were satisfied, whereas the United States, Finland and Norway required reporting of such cases as pregnancy terminations but not as stillbirths  the United States as compared with the Nordic countries (Table P < 0.05). The mortality rate patterns were similar at 24–25 weeks between countries, but differed at later gestational ages. At 37–41 weeks gestation, neonatal mortality rates were lowest in Iceland, highest in Denmark and not significantly different among the other countries ; similar rates were observed in Canada and Denmark. Rates in Finland (794.3 per 1000 live births) were lower and similar to rates in the United States and Norway, while Sweden’s rates were significantly lower than in any other country  higher and U.S. rates were 96 % (95 % CI 93–99) higher than those in Finland  have been reported from the United States but not from the Nordic countries. Our study cannot provide a definitive explanation for the observed differences in the frequency and mortality of live births at the borderline of viability and at very early gestation. More detailed studies are required to assess the value of international comparisons of fetal and infant mortality and to make such comparisons more meaningful.


Adolescent pregnancy and childbirth are associated with increased risk and challenges for both mothers and birth outcomes. To investigate the associations of growth change over time with parenting factors and to compare the differences between children born to adolescent and adult mothers in Taiwan. The dataset retrieved from Taiwan birth cohort study (TBCS) was collected by interviews using structured questionnaires, birth certificate and Passport of Well-baby Care of each child. Changes in body weight, body height and head circumference from birth to 18 months, as well as other variables were assessed by statistical analysis.There were 4.13% births born to adolescent mothers in 2005. Higher ratios of breastfeeding and working were found among adult mothers (p<0.001). Significantly higher percentage of adolescent mothers caregave their infants up to 18 months (p<0.001). Children born to adolescent mothers were associated with statistically significant lower body weight (p<0.001), body height (p<0.001) and head circumference (p<0.001) in spite of velocity and slop of growth patterns were similar over time. Breastfeeding did not significantly affected growth rate during the first 6 months. Generalized estimated equation models showed that gender and preterm birth were predictive factors for birth outcomes (both p<0.001) and correlated to changes over time.Adolescent childbearing was associated with preterm birth and lower body weight, body height and head circumference from birth to 18 months. The changes in growth and development among children born to adolescent mothers remain to be followed and evaluated with the TBCS. Pregnancy and fertility rate of teens have been decreasing in the past decade in Taiwan. Of all teens aged less than 19 who became pregnant, 20% delivered a live infant and the rate was approximately 8 births per 1000 teenage girls (ages 15-19), or 3.6% of all birth in 2005  . There is also increased risk for premature delivery and LBW births, which could pose a threat to poorer developmental outcomes among young children (-). Children of adolescent mothers are at risk for future developmental and behavioral problems, increased risks of developmental delay, decreased self-sufficiency and continued cognitive/behavioral problems (-). Some studies have shown that factors such as greater maternal education and more favorable living conditions are likely to improve growth and developmental outcomes for those children .Infant growth is not only affected by health related practices, such as breastfeeding and smoking, but also predisposing factors consisted of infant sex, birth order, and degree of intra-uterine constraint -17. SlowStudies have shown that total duration of breastfeeding is associated with slower growth in the first year of life and can contribute to the protective effects of breastfeeding against overweight and obesity -34. The Children of 2005 birth cohortThis was a longitudinal study using the dataset from a population-base Taiwan Birth Cohort Study (TBCS) that covered a total of 24,200 pairs of mothers and newborns from the time of birth in 2005 until December of 2007 . This TBData collectionData was collected by trained research assistants with the use of a structured questionnaire at home interviews. The first and secondary home interviews with the 24,200 post-partum women were conducted at 6, 12 and 18 months after their deliveries during the period from June 2005 to December 2007. A total of 21,248 women completed interviews, giving a response rate of 87.8%. Information related to birth characteristics, including birth weight, birth order, gender, gestational age, head circumference, birth number (singleton or multiple pregnancy), method of delivery, patterns of infant feeding and caregiving status were obtained. st, 6th, 12th, 18th, 24th, 30th and 36th month) documented for all children up to 6 years old on a free-of-charge basis by National Health Insurance Program in Taiwan. The effects of breastfeeding on growth in infancy were analyzed by repeated measurements of child growth up to 18 months. The weights and lengths or heights were measured by trained nurses and recorded to the nearest 100g and millimeter (mm), respectively. Feeding practice was described by a categorical variable and included as a time-dependent variable to assess its association with growth rate.All of the weight and length or height measurements were retrieved from Child Health Handbook, in which records of periodic health examinations  version 9.2 for Windows . Categorical variables are presented as a count and percentage and compared with a Chi-squared test or Fisher's exact test. Continuous variables are summarized by a mean and standard deviation and compared with a two-tailed independent samples t-test and results reported at a 0.05 significance level. Means, medians, standard deviations, frequencies and percentages were calculated for descriptive data. Trend and differences in growth for body weight, body height and head circumference between babies born to adolescent and adult mothers were analyzed using repeated measure ANOVA and Z test statistics which is comparable across ages and provides a more sensitive assessment of deviations of growth. The longitudinal associations between variables and the change of growth with time from birth to 18 months old were analyzed using fitted generalized estimating equation (GEE) models. SAS PROC GENMOD was used for logistic regression analysis to evaluate the association between growth and each of the dependent variables.Infants born to adolescent mothers accounted for 4.13% of births in 2005 as revealed from TBCS dataset . No signth month (p<0.001). Conversely, 64.7% of adolescent mothers have been the main caregivers for their infants up to 18 months old, which was statistically significantly higher than adult mothers. The average maternal ages at the time of giving birth of adolescent and adult mothers were 19.1±1.1 and 29.3±4.5 years, respectively. Although the vast majority of adolescent and adult mothers with singleton births stopped breastfeeding when their children were 18 months of age (96.7% and 93.5%), significant difference was detected for those were still breastfeeding between the two groups . Moreover, adult mothers had significantly higher educational level in comparison to adolescent mothers (p<0.001). Higher ratio of breastfeeding and more working women were found among adult mothers at 18The growth patterns of infants born to adolescent and adult mothers, displayed in figure 1 indicate that the velocity and slop of growth were similar in terms of body weight (BW), body height (BH) and head circumference (HC) from birth to 18 months, although the significant differences existed in each stage . The BW The association between breastfeeding, daytime caregiving and growth from birth to 18 months old was assessed and depicted in Figure 2. Growth rates were significantly affected by breastfeeding in the first 6 months. Aside from both variables of breastfeeding and mother as the daytime caregiver were associated with lower growth of infants in all measures, the difference in weight velocity from 12-18 months was significant. GEE models were used to estimate the growth in terms of BW, BH and HC and the changes of growth from birth to 18 months old as functions of predictors. The results indicated that child gender, gestational age, method of delivery, and breastfeeding at 18 months were significant predictors that contributed to growth change -V. Male Adolescent mothers were negatively associated with birth BW, BH and HC; however, the predictive power no longer existed over the time. Breastfeeding was negatively associated with growth change with age . Cesarean sections were positively correlated with the changes in BW  and BH , however, negatively correlated to HC . The variable of mother as the primary daycare caregiver negatively contributed the change in BW  and no significant effect on BH and HC. Multiple births and educational levels were not significantly associated with the growth changes.In this study, the population-representative TBCS dataset was used to examine whether children bone to adolescent mother or adult mother were associated with growth changes over the first 18 months of life. The findings of higher incidence of LBW and prematurity among children born to adolescent mothers than their peers born to adult mothers were consistent to a previous report, although some discrepancies existed due to grouping of different age ranges . During Our finding added to the understanding that the general higher educational level among adult mothers was likely to associate with higher breastfeeding rate, higher work engagement and lower caregiving at daytime. Furthermore, the mean age of adolescent mothers was 19±1.1 years old which was closer to adults than adolescents. They were more likely to have a wanted pregnancy and might be not associated with negative parenting behaviors in spite of lower birth outcomes.With the use of GEE models in this study, child gender and gestational age were found to be predictive factors for birth outcomes in terms of BW, BH and HC and correlated changes over time. Adolescent mother was a predictive factor for newborns with lower BW, BH and HC. However, environmental factors, such as socioeconomic status, disadvantaged background, co-residence with other supportive family, and overall parenting quality that identified as more important predictors than maternal age for developmental outcomes in large-scale studies were not evaluated in our study (-).According to the study of 5 birth cohorts, weight gain from 0-24 months had the strongest relationships with schooling outcomes followed by birth weight . The autOur findings indicate that the duration of breastfeeding did not contribute to greater percentage of growth, which is consistent with previous studies showing that breastfeeding is associated with slower growth in the first year of life (-). Mothers as the caregivers at daytime did not predict better infant growth in our study. Since the home environment and family resources such as mothers of adolescent mothers, adolescent fathers, family income and other determinative factors may also affect specific caregiving behaviors that were not assessed in this study, we were unable to draw further conclusion to what extent was infant growth influenced by mothers’ caregiving , 48.This population-based cohort study has several strengths. The dataset provides a large national sample allowing these findings can be generalized to the entire Taiwan. The longitudinal nature of the data providing with the information over a period of time is better for assessing causal relationships than cross-sectional designs. There were some limitations of this study that must be addressed. In this paper we analyzed the physiological measurements; however, many environmental exposures  and genetic variants associated with several different outcomes were not evaluated. Some potentially relevant factors, such as maternal pre-pregnancy body mass index, gestational weight gain, and gestational diabetes that may be related to postpartum growth were not available. Apart from breastfeeding, insufficient data were collected for complementary feeding, so we are unable to address potential nutritional explanations for the growth change that was manifest toward the end of the second year of life . Teen prIt is more difficult for adolescent mothers to engage in a mature and sensitive manner with their children as a consequence of they face more risk factors. All of these issues can affect outcomes of the infants of adolescent mothers. The first year postpartum is a particular challenging period for adolescent mothers, as they cope with distinctive personal and social changes . Althoug


A 26-year-old young man underwent orthotopic liver transplantation (OLT) for primary sclerosing cholangitis (PSC). He was a known case of PSC since one year before. During this period, he developed jaundice and pruritus and also bloody diarrhea. Colon biopsy was in favor of ulcerative colitis. His laboratory tests showed high serum ALT and AST activities and very high level alkaline phosphatase and GGT. CT of the liver depicted a hypo-attenuated cyst in the right anterosuperior part of the liver, with the possibility of infection or abscess formation.The explanted liver was large and green. Serial cut sections of the liver showed dilated biliary ducts, some of which contained bile sludge. One of the slices revealed a cystic structure with thin membrane . WHAT IS YOUR DIAGNOSIS?DIAGNOSIS: INCIDENTAL LIVER HYDATID CYST IN AN EXPLANTED LIVER WITH PSCEchinococcus granulosus larva, most commonly can be found in countries of the Middle East, Eastern Europe, Africa, Latin America and China [Hydatid cyst, caused by nd China .etc.The most common sites of infection are liver (59%–75%) and lung 27%) . Inciden7% . InciTo the best of our knowledge, no case of incidental hepatic hydatid cyst has been reported after liver transplantation. After this incidental finding thorough investigation of the past history of the patient we found that he grew up in a farm in Ardebil province in close contact with sheep. In the pre-operative CT, the cyst was detected; however, because of its intra-biliary duct location, it was incorrectly diagnosed as a bile duct dilation secondary to PSC. Fortunately, the cyst was intact and the patient did not develop any complications. It is worthy to note that all serologic tests for hydatid cyst performed after OLT were negative.As a conclusion, in endemic areas of the world hydatid cyst should be considered in the differential diagnosis list of any cyst of the liver.


Preterm birth is associated with abnormal respiratory functions throughout life. The mechanisms underlying these long-term consequences are still unclear. Shortening of telomeres was associated with many conditions, such as chronic obstructive pulmonary disease. We aimed to search for an association between telomere length and lung function in adolescents born preterm. Lung function and telomere length were measured in 236 adolescents born preterm and 38 born full-term from the longitudinal EPIPAGE cohort. Associations between telomere length and spirometric indices were tested in univariate and multivariate models accounting for confounding factors in the study population. Airflows were significantly lower in adolescents born preterm than controls; forced expiratory volume in one second was 12% lower in the extremely preterm born group than controls (p<0.001). Lower birth weight, bronchopulmonary dysplasia and postnatal sepsis were significantly associated with lower airflow values. Gender was the only factor that was significantly associated with telomere length. Telomere length correlated with forced expiratory flow 25–75 in the extremely preterm adolescent group in univariate and multivariate analyses . We evidenced an association between telomere length and abnormal airflow in a population of adolescents born extremely preterm. There was no evident association with perinatal events. This suggests other involved factors, such as a continuing airway oxidative stress leading to persistent inflammation and altered lung function, ultimately increasing susceptibility to chronic obstructive pulmonary disease. Consequently, we measured TL in the prospective EPIPAGE (Etude EPIdémiologique sur les Petits Ages Gestationnels) cohort of adolescents born very preterm and looked for correlations between the findings and spirometric indices in this population.The respiratory consequences of preterm birth are not limited to the neonatal period and preterm birth is associated with respiratory morbidity throughout life. Children and young adults born very or extremely preterm ,2, even controls , with nocontrols , or contcontrols –6. Howevcontrols . This sucontrols . Oxidaticontrols , in partcontrols . Telomercontrols , neurodecontrols , coronarcontrols  and typecontrols . Severalcontrols –15. In tcontrols . TL is py status . This suy status . In keepy status ,18, we bThe study was approved by the local ethics committee . Study population was part of the EPIPAGE cohort, used for a prospective observational population-based study including all births between 22 and 32 completed weeks of gestation, and two reference groups of children born between 33 and 34, and 39 and 40 weeks of gestation, respectively, in 1997 in nine French region . The met1, functional residual capacity by plethysmography (FRC), total lung capacity (TLC), residual volume (RV), forced expiratory flow 50 (FEF50) and forced expiratory flow 25–75 (FEF25-75) were measured.LFT were performed according to the recommendations of the American Thoracic Society/European Respiratory Society task force . FVC, FESaliva was collected with an Oragene DNA Self-Collection Kit OG-500 . Genomic DNA was extracted according to the manufacturer’s protocol and quantified with a spectrophotometer. TL was assessed by a real-time quantitative polymerase chain reaction (PCR)-based assay as previously described . Detailswww.lungfunction.org) were used to compute % of predicted and Z-score values of spirometric indices, except for the FEF50 values. Principal analyses were performed using Z-score values according to recent guidelines [th and 3rd percentiles of the distribution. FEF50 values are expressed as % of those predicted according to Zapletal [Data are expressed as medians and interquartile ranges (IQR). GLI 2012 lung function regression equations from the Global Lungs Initiative/ERS Task Force (TF-2009-03)  were significantly lower in preterm-born adolescents than term-born controls, with the lowest values in the extremely preterm-born group  had an obstructive pattern defined as a FEV1/FVC Z-score below -1.64. Expressing LFT values as percentages of predicted values did not change the results . As in our study, Kajantie et al. did not find any association between TL and GA at birth in 3 independent Finnish cohorts, including one large birth cohort of 1894 adults [In our population, telomeres were significantly longer in girls than in boys, in agreement with previous reports ,34. We a4 adults . Laganov4 adults . Convers4 adults . They al4 adults . This as4 adults . Regardi4 adults . A more 4 adults . Two oth4 adults . Similar4 adults .per se may be an independent risk factor for a persistent biological stress throughout life that may lead to both continuing airway disease and inflammation, and also to a consecutive accelerated shortening of telomeres progressively later in life. The work performed by Filippone et al. corroborates our results [in vivo [in vitro  and in [in vivo . All of [in vivo , whereas[in vivo . Compare[in vivo . Shorten[in vivo . Two bio[in vivo .We evidenced an association between telomere length and airflow abnormalities in a population of adolescents born extremely preterm. This accelerated shortening of telomeres do not seem to be associated with perinatal events, and suggest that other factors are involved, such as a persistent airway inflammation.S1 Fig36B4 Ct values among all DNA samples: the distribution was nearly normal. The samples with extreme values were excluded from the analysis (2.5% on each side of the distribution).This graph shows the distribution of (TIFF)Click here for additional data file.S1 FileTable A: Perinatal factors among included and non-included eligible subjects; Table B: LFT parameters expressed as %ages of predicted values according to group of gestational age; Table C: LFT parameters and perinatal history among ex-preterm adolescents; Table D: Telomere length and lung function parameters as dichotomous variables.(DOCX)Click here for additional data file.