In recent years, electric toothbrushes have become widespread. However, injuries caused by electric toothbrushes have rarely been reported. We describe three cases of oral penetrating injuries caused by electric toothbrushes. Case 1 occurred in a disabled boy while brushing due to unexpected movement. In Case 2, a mother using an electric toothbrush had fallen when bumped by her child. Case 3 involved a man using the toothbrush while taking a bath, who slipped in the bathtub. Cases 1 and 3 were using sonic toothbrushes, and Case 2 was using an oscillating-rotating toothbrush. Electric toothbrushes can cause oral penetrating injuries and infections in the same manner as manual toothbrushes. Prevention of oral trauma requires familiarity with the form and function of electric toothbrushes. Some room for improvement remains in optimizing the form of electric toothbrushes. Intraoral injuries due to toothbrushes are common in children , 2. AdulElectric toothbrushes have also become popular in recent years, providing greater improvements in gingivitis and plaque removal compared to manual toothbrushes, improved ease of use, and also decreasing cost . Two typWhen brushing, oscillating-rotating toothbrushes have been considered safer than manual toothbrushes for surrounding hard and soft tissues, with the bristles contacting both teeth and gingivae . Sonic tA 17-year-old boy was brought to the emergency room with penetration of an electric toothbrush into the buccal mucosa. The patient had Sturge-Weber syndrome (SWS) and quadriparesis. He was receiving tegretol at 350 mg/day, zonisamide at 370 mg/day, lamotrigine at 200 mg/day, sodium valproate 5% at 24 mL/day, levocarnitine at 4000 mg/20 mL/day, diazepam at 10 mg/day, and ramelteon at 8 mg/day. He received nourishment by nasogastric tube. When his father was performing daily oral care using an electric toothbrush in the evening, the head of the toothbrush penetrated the buccal mucosa when the patient moved unexpectedly. The father initially tried to remove the head, but could not. On examination, the head of the electric toothbrush had penetrated the right buccal mucosa . Facial A 38-year-old woman presented to the oral surgery clinic with an oral injury due to an electric toothbrush. The previous night, when she was brushing with an electric toothbrush, her child had bumped into her, causing her to fall. The toothbrush had penetrated the oral cavity, and bleeding from the posterior oral cavity was initially evident. The next day, the bleeding had stopped but the pain remained, so she visited the clinic. The patient was otherwise healthy and was not on any medications. Examination revealed a deep laceration on the left side of the posterior margin of the soft palate adjacent to the uvula and palatine tonsil . The mar3/μL and a C-reactive protein level of 5.11 mg/dL, and intravenous drip infusion of ceftriaxone at 1 g/day was started  showed small lacerations with smooth boundaries, similar to those from a manual toothbrush. This might be related to the fact that sonic and manual toothbrushes show similar shapes. Conversely, the wound from the oscillating-rotating type (Case 2) showed a jagged, piercing puncture wound. Although the site was the margin of the soft palate, which was originally fluttering, there was no denying that the rotating tufts of the brush head had damaged the soft tissue.The treatment of electric toothbrush injury is the same as that for a long foreign body, including penetrating injury by a manual toothbrush , 11, 12.The reason toothbrush injury is less common in adults than in children is most likely that adults are less likely to fall. The major difference in shape between a manual toothbrush and an electric toothbrush is that the electric toothbrush typically has a longer handle. Of the present three cases, Cases 2 and 3 might not have penetrated as deeply if the handle had been shorter. This suggests that if a child falls while using an electric toothbrush, tissue penetration might tend to be deeper and the consequences could be more serious. Case 1 occurred during brushing being performed for a disabled boy. Recently, electric toothbrushes have also seen increasing use for brushing in individuals with limitations on activities of daily living and have shown effectiveness . While eIt was suggested that the following four strategies appear important for preventing accidental oral injuries caused by manual and electric toothbrushes: no brushing while taking a bath or in similar situations where the user is at heightened risk of slipping or falling; no brushing while walking in the house or concentrating on another activity; while brushing the teeth of a child, their head should be stabilized to prevent unexpected movements; and use of a manual toothbrush should be considered for brushing the teeth of a disabled individual, particularly if the individual is prone to making sudden and unexpected movements. Furthermore, regarding the form of the toothbrush to reduce accidental oral injuries, the following three recommendations were identified: shortening the electric toothbrush handle for children, since the distance to the oropharynx is shorter; making the handle of the electric toothbrush from a flexible material that might soften any injury; and using markers on the toothbrush handle that can indicate to the user the distance the toothbrush can be placed inside the mouth .In conclusion, electric toothbrushes are convenient, but, like manual toothbrushes, can cause penetrating injuries and infections and sometimes may result in more serious injuries. Preventing oral trauma requires familiarity with the form and function of the electric toothbrush. Various improvements in the form of electric toothbrushes may still be worth adopting.


Preterm birth is associated with short‐ and long‐term impairments affecting physical, cognitive, and neuropsychiatric health. These sequelae, together with a rising preterm birth rate and increased survival, make prematurity a growing public health issue because of the increased number of individuals with impaired health throughout the life span. Although a major contribution to preterm birth comes from environmental factors, it is also modestly heritable. Little is known about the architecture of this genetic contribution. Studies of common and of rare genetic variation have had limited power, but recent findings implicate variation in both the maternal and fetal genome. There is some evidence risk alleles in mothers may be enriched for processes related to immunity and inflammation, and in the preterm infant, processes related to brain development. Overall genomic discoveries for preterm birth lag behind progress for many other multifactorial diseases and traits. Investigations focusing on gene–environment interactions may also provide insights, but these studies still have a number of limitations. Adequately sized genetic studies of preterm birth are a priority for the future especially given the breadth of its negative health impacts across the life span and the current interest in newborn genome sequencing. One interpretation of the findings is that it suggests different alleles exist in people of different ancestries, and this may partly explain differences in preterm birth rates seen in different populations. However, this should also be viewed with caution. First, the individual findings in each population are not yet robust. Second, it is well known that in underpowered studies such as the subgroups here represented, even in the face of genetic homogeneity, sampling variance makes replication across studies unlikely. Nevertheless, should more secure findings of differences in the architectures across ancestral (or indeed ethnic) groups be identified, it will be important to investigate interactions with variable environmental exposures that also differ if the findings are to translate to reducing the disparity in preterm births   effect sizes do not exist, but as shown by Zhang et al. , allelesSample sizes lag behind GWASs of many complex diseases and traits, for example, increasing the sample size to include 36,989 cases and 113,075 controls when using GWAS to investigate schizophrenia resulted in the discovery of 83 novel associated loci (out of 108 associated loci found)  will likely provide sufficient power to identify hundreds of GWAS loci associated with gestational age. However, for assuring the validity of the findings for clinically relevant phenotypes, particularly very preterm birth , large‐scale (tens of thousands) targeted recruitment from clinics is likely to be needed.44.1Some investigators have studied the role of copy number variants (CNVs) in preterm birth, but few have taken a whole genome perspective, focusing instead on specific candidate CNVs. The single study we are aware of that has taken a genome‐wide approach found no specific CNV associations in the genomes of 454 mothers giving birth before 34 weeks (most of whom had spontaneous onset of labor) compared with 1,018 mothers who delivered at term, nor was there any difference in overall CNV burden between the groups  genes, involved in the metabolism of toxins, including a maternal deletion CNV of approximately 28 kb at the glutathione‐S‐transferase theta 1 (GSTT1) in spontaneous preterm birth at <37 weeks gestation  and if genuinely associated, confers a weak effect size in the typical common variant range (OR ∼1.18). Another study of 231 mothers of infants born preterm and 378 control mothers (188 infants born preterm and 391 infants born at term) observed a trend for association with maternal insertion at glutathione‐S‐transferase Mu 1 (GSTM1) and protection against preterm birth, but the primary driver of the association appeared to be acting via the fetal genome  genotype increases the risk for preterm birth  to select variants to genotype in a larger sample  . The authors next examined imputed alleles at this locus in a GWAS dataset of over 40,000 mothers ; of two variants that were testable in that dataset, one was nominally associated (P = 0.0022). Although some evidence was provided that the associated allele might confer differential endometrial fibroblast responsiveness to glucocorticoids, the associations did not replicate in two other  datasets and use of imputed data for alleles of very low frequency is not necessarily reliable. It will be necessary for this gene to obtain much stronger support before it can be decisively considered to be involved in preterm birth.A recent whole‐exome study was conducted in 17 mothers from seven Finnish multiplex families, 13 of whom had experienced spontaneous preterm birth, and 10 of them had experienced recurrent spontaneous preterm birth. A further 93 sister pairs and two sister triads were used as a “replication population.” A number of biological pathways were identified that were enriched for genes containing rare variants predicted to be damaging  number of cases of preterm premature rupture of membranes (PPROM), a subcategory of spontaneous preterm birth, as well as a small (variable) number of normal term control mothers. They reported variants in genes involved in the structural integrity of fetal membranes  based on African‐American women reported genome‐wide significant interactions between variants in COL24A1 and pre‐pregnancy body mass index on risk of preterm birth; this finding was subsequently replicated in 300 African‐American women  risk factors. Gene discovery for preterm birth is lagging behind many other multifactorial disorders, most likely because GWASs of gestational age and preterm birth have been relatively small. However, emerging evidence suggests there are a large number of alleles involved, each contributing to a small amount of population liability. Sample sizes also still need to increase to detect likely causal de novo and inherited rare genetic variants. Preliminary investigations suggest rare, deleterious genetic variants could be enriched in both mothers and offspring, although no robustly associated variants have emerged. Gene–environment studies may provide further insight, but the current findings need rigorous testing. Advancements in statistical methods, such as polygenic risk scoring may also help with prediction of preterm birth, enabling women and prospective parents to make informed lifestyle choices (Torkamani, Wineinger, & Topol, The authors state that they have no conflict of interest.


Li Zhong is president of the Artist Association of Fengxian District, Shanghai (China). An interview with Li Zhong and a series of paintings on the fight in China against the COVID‐19 pandemic area is available in Painting and epidemic.2020. «Paintings for Wuhan», Li Zhong (China) © Li Zhong through Tricontinental: Institute for Social Research. 1This is a Commentary on the impact of the current COVID‐19 pandemic on future human growth and development. Our focus is on birth weight, one measure of prenatal growth and development, and its association with later life health. We assess the possibilities from the broad biocultural sense of human growth and development, especially in relation to its social‐economic‐political‐emotional (SEPE) correlates.Mercy sent to help with the COVID‐19 crisis. The train driver said he did it because he believed the Mercy was part of suspicious activities involving the coronavirus. In addition, during the first week of April, 5G cellular communication towers in Birmingham, Liverpool and Melling, UK were burned by people claiming that 5G technology is the cause of COVID‐19. Such emotionally and ideologically driven behavior always happen during pandemics. In the year 1630, a Bubonic Plague epidemic erupted in Milan, which also was at war with Spain. Four Spaniards in Milan were arrested, convicted of spreading Plague, and sentenced to death by torture. During the Plague pandemic of 1349 the people of Strasbourg, Alsace accused Jews of poisoning the water wells. One thousand Jews were arrested, taken to the cemetery, and burned alive. These cases and others of paranoia and murder during pandemics are described by medical historian Frank M Snowden in his book, Epidemics and Society: From the Black Death to the Present  and body composition, maternal psychological stress, gestational age at delivery, mother's hemoglobin concentration, and per capita daily income of the mother or family  and that independently both lower maternal birth weight (P < .0001) and higher evening cortisol in adulthood (P = .003) predicted lower birth weight for male offspring. The associations for female offspring birth weight were not statistically significant . The second study  1.19, 2.38]). There was no statistically significant difference between nonexposed and exposed groups in terms of preterm labor  secretion is stimulated by the maternal pituitary‐adrenal stress hormones ACTH, beta‐endorphin, and cortisol. The prevalence of preterm deliveries is associated strongly with maternal stress through increased levels of maternal plasma concentrations of placental CRH, which is involved in the timing of parturition.Results from several studies suggested that the impact of maternal stress on fetal growth is strongest in the last trimester of pregnancy, when the velocity of fetal growth in weight is greatest. It is likely that last trimester fetal weight growth velocity is affected less by genetic factors and more by maternal and intrauterine environments, especially by compromised uteroplacental perfusion and excessive fetal exposure to maternal glucocorticoids , to surges in production of osteocalcin (OC), to suppression of the parasympathetic nervous system, to the acute stress response (ASR, Berger et al., Experimental evidence with rodents and clinical observations with human patients indicate that various types of physical and emotional stress cause a rapid rise in OC release into the blood stream and the initiation of the ASR, including the release of glucocorticoid hormones, such as cortisol, as well as increases in temperature, energy expenditure, heart rate, and respiration (Berger et al., In the long‐term the consequences are harmful because a chronic stress response results in permanent loss of tissue and growth stunting (Arlt & Stewart, https://peoplesdispatch.org/2020/04/20/painting‐an‐epidemic‐an‐interview‐with‐li‐zhong/.Li Zhong,《义务送药者》5Birth weight is one of the key predictors of health risks at birth and later in life. The consequences of low birth weight include greater risk for infection, poor learning, and school performance, greater risk for psychological problems, reduced adult earnings, greater risk for adult overweight, diabetes, and heart disease, and, on average, an earlier age at death. Birth weight is under very strong stabilizing selection—not too low and not too high—and is therefore a key human biological characteristic and one that continues to drive human evolution. The current COVID‐19 crisis is biocultural in nature, with major and immediate SEPE impact. Economists for the European Union predict that “…the economy of the European Union is expected to shrink by 7.4 percent in 2020. By comparison, Europe's economy declined by just 4.4 percent in 2009, the worst year of the global financial crisis” (Birnbaum, Barry Bogin: Conceptualization; formal analysis; writing‐original draft. Carlos Varea: Conceptualization; writing‐review and editing.


The divergent selection for birth weight variability was previously proven by the difference between the two selected mice lines, but the comparison with a control line made it possible to measure independently the differential response in each of the low and high birth weight variability lines. In conclusion, the genetic response was much higher for the low variability line than for the high variability line. This was extremely satisfactory given that homogeneity provides advantages in terms of animal welfare and robustness.Mus musculus) is used as an experimental animal because it is considered a suitable model for prolific species such as rabbits and pigs. Two mouse lines were divergently selected for birth weight variability with a third line of non-selected control population of the same origin as the animals starting the experiment. The objective of this study was, therefore, to compare and evaluate the differential response of each line. The animals were from the 17th generation of both low and high BW variability lines of the divergent selection experiment, including in addition animals from the control line. The dataset contained 389 records from 48 litters of the high line, 734 records from 73 litters of the low line, and 574 records from 71 litters of the control line. The studied traits were as follows: the BW, the BW variance, the BW standard deviation, the BW coefficient of variation within-litter, the weaning weight (WW), the litter size at birth and at weaning, the weight gain, and the preweaning survival. The model included the line effect jointly with the parturition number and its interaction, the linear and quadratic LS as covariates except for the LS trait itself when analyzing litter traits, as well as the pup sex when analyzing individual traits. The low line had a lower BW and WW, but a higher litter size, and greater robustness owing to a higher survival at weaning. As a model of livestock animals, the findings from this experiment led to a proposal of selection for pig production that would combine an increase in litter size with higher survival and welfare. Compared with the control line, a much higher response was observed in the low variability line than in the high line, making it extremely satisfactory given that homogeneity provides advantages in terms of animal welfare and robustness.Birth weight (BW) in animal production is an economically important trait in prolific species. The laboratory mouse ( The genetic control of the environmental variability in the search for a higher homogeneity is becoming important in current animal breeding programs ,2,3. SelFormoso-Rafferty, et al.  developeTherefore, selecting to reduce the variability is also a benefit. Divergent selected lines performed oppositely regarding several traits after selection and a comparison with a control line could clarify whether or not these selection responses were symmetric in both lines. The objective of the present study was to compare the genetic response of two divergent selected lines for birth weight environmental variability with a non-selected control line. Part of this objective was also to analyze their differences for birth weight variability, birth and weaning weights, litter size, and preweaning survival.The three experimental mice lines included the following: two lines divergently selected for birth weight (BW) environmental variability and a non-selected population used as control population. Data proceeded from the offsprings resulting from the mates between 43 males and 43 females per line of the 17th generation of a running successful divergent selection experiment conducted to modify the environmental variability of BW . Under tSimultaneously, a non-selected population (control line) with the same origin as the selected lines evolved under mating carried out randomly without sharing common grandparents to prevent inbreeding. In the control population, 29 males were mated with 2 females, and 3 males with 1 female, each resulting in 61 females having the chance of giving birth to litters. Eventually, half of the females lodged in pairs with a male of the control line  were individually lodged on day 20 after mating for handling purposes, keeping the other females lodged with the male. All the females were checked daily during the parturition period, and all the newborns from the females giving litters were individually identified and weighed at birth (BW), except stillborns, which were taken into account to register the litter size (LS) of the female at the parturition. The survival at birth (SB) was also recorded.At 21 days old, the pups from all the three lines were weaned and sexed, and the litter size (LS) in which they were born was registered. Phenotypic variance (V), standard deviation (SD) and coefficient of variation (CV) of BW within litter, weight at weaning (WW), preweaning average weight gain (WG), litter size at weaning (LSw), and survival at weaning (SW) were also registered for each pup from all the three lines and afterwards analyzed. The dataset contained 389 records from 48 litters from 37 females of the high line, 734 records from 73 litters from 42 females of the low line, and 574 records from 71 litters from 53 females of the control line. After editing, the data set contained a total of 1697 BW records and 1602 WW records from 192 litters of 132 females. The mean and standard deviation of all the traits are included in The conditions of housing and management of the animals conformed to Spanish legislation RD 53/2013, which includes the basic rules for the protection of animals during experiments and other scientific purposes . This experiment was approved by the Ethical Committee of Complutense University of Madrid and authorized by the Regional Government of Madrid (PROEX 308/14 and PROEX 224/2018). The animals were housed in the experimental facility at the Department of Animal Production of the Veterinary Faculty of the Complutense University.The BW variability , BW, WW, WG, LS, LSw, SB, and SW were analyzed using a general linear model procedure with the general following equation:p < 0.05, p < 0.01, and p < 0.001). The least square means were computed to show the observed differences between levels of relevant effects.The Statistical Analysis System software  was usedSelection intensities and effective population sizes were determined independently for each of the lines to check for possible causes in case the selection response was different in different lines. The final selection intensity was calculated as follows:The effective population sizes were computed from the individual increase in inbreeding  and fromRegarding BW, There were significant differences in WW for the line, PN, and LS quadratic covariate effects . The meaAlthough it was expected that the control line would also present an intermediate value for weaning weight, no significant differences were found at weaning between the control and the high line. The low line presented lower WW than the control line and the high line, but larger LSw. Regarding WG, there were differences for the line, parturition number, line × parturition number interaction, and LS quadratic covariate effects . The meaThe line and LS had significant effects on survival at birth and at weaning . AccordiThe success of the divergent selection experiment for environmental variability of birth weight had been proven for the selection objective  and for Regarding the positive correlated genetic response, the pups from the high line, the heterogeneous one, were higher for birth weight . TatliyeThe litter size of the control line did not perform as expected, with an intermediate value between the low and the high lines, but this could have been the effect of a slight difference in the age of the animals, which was around three months older in the control line. Argente, et al.  carried A smaller BW for the low line can be associated with a higher litter size, but having high prolificacy litters, leading to a higher number of piglets with low BW . QuiniouThe differences between lines in the weight at birth were also present at weaning, with low WW of animals in the low line, firstly because of the lower BW, but probably also owing to the higher litter size of the low line; the amount of milk the mother produces has to be distributed among more pups. Sows with larger litters produce more milk, but the extra milk is not proportional to the number of extra piglets .The observed relationship among the different traits referred to in the present study could be interesting for pig breeding programs. As consequence of increasing LS, piglets with BW below the litter average could die more than their siblings would, but if they did survive, their weight gain would eventually be similar to the rest of the litter . HoweverThe relationship between robustness and homogeneity has also been reported in other species; heterogeneous litters were reported to show higher mortality than homogeneous litters in rabbits  and pigsTraditionally, BW was an early measurable trait that attracted great interest because it had a positive genetic correlation with weights later in life . TherefoWe demonstrated that the selection for BW variability was successful and non-symmetric, mainly observed by the differences in variability parameters between the lines and the control line, with a remarkable higher response in the low line. The selection process led to a higher litter size at birth and at weaning of the low variability line than in the high variability line. These differences were attributable more to the success of the selection process in the low line than in the high line. From a practical perspective, this looks promising because modifying the variability targets the reduction of the variability and not its increase. Despite having lower birth weights and weaning weights, the low variability line is more robust, with greater litter sizes at weaning. This can be attributed to the larger litter size at birth and to a higher weaning survival, both consequences of the selection to reduce the variability of birth weight within-litter in the low line.


The cesarean section rate in Vietnam has been increasing especially in urban area. However, limited evidence identified regarding socio-demographic factors of the cesarean section birth. The objective of this study was to determine the current cesarean birth rate and the associated socio-demographic factors among mothers in Nha Trang city, south-central Vietnam.Streptococcus pneumoniae carriage survey conducted in 27 communes of Nha Trang city. From each commune, 120 mothers and their children less than 2 years old were randomly selected. Mothers were asked to answer standardized questions regarding socio-demographic information and mode of birth. Multivariate logistic regression was adopted to examine associations between socio-demographic variables and mode of birth.A community-based cross-sectional study was conducted between October and November in 2016 as part of a Of 3148 participants, the number of cesarean births was 1396 (44.3 %). Older maternal age (≥ 30 years old), having another child going to school or kindergarten, monthly income more than 644 USD, gestational weeks at birth over 42 weeks, and low (< 2500 g) or high (≥ 3500 g) birth weight were associated with higher likelihood of cesarean births.The CS rate obtained in this study was more than twice of what is recommended by the World Health Organization, which is consistent with the previous nation-wide study in Viet Nam. Further monitoring is suggested to examine the non-medical reason for the increased CS rate. Rates of cesarean section (CS) have increased dramatically over the last 30 years, especially in middle- and high-income countries –3. AlthoBetran et al.  comparedPrevious studies have investigated the determinants of increased CS rates in several Asian countries, such as China , BangladA few studies have been conducted that have examined the determinants of CS in Vietnam. For example, Loezenien et al.  conducteMost previous studies have focused on the northern part of Vietnam. Two population studies , 18 condFewer studies have been conducted in the central or southern regions of Vietnam compared with the northern region. Giang et al.  investigGiven that a preference for CS for male children might be influenced in the northern part of Vietnam by the culture of “Confucianism,” which originated in China, compared with the southern part of the country, geographical differences in several factors might contribute to variation in CS rates. In addition, more data in urban settings are needed to assess the consistency of a previous analysis of MICS data and confirm the pattern that CS rates are higher in urban settings compared with rural ones .The objective of this study was to identify the socio-demographic factors and delivery characteristics associated with CS among mothers living in Nha Trang city, Vietnam.This study was conducted in Nha Trang city, the capital of Khánh Hòa province, which is located 445 km north of Ho Chi Minh City in Vietnam. The estimated population in 2020 was 329,373 . Nha TraStreptococcus pneumoniae carriage survey conducted in Nha Trang city across 27 communes: 8 (30%) suburban and 19 (70%) urban communes. We conducted a cross-sectional survey in the 27 communes in October and November 2016. First, each community health center made a list of all children aged 4 to 11 months and 14 to 23 months and their mothers living in the commune. All newborn babies must register at CHC for free national health insurance to receive national immunization program vaccines. We used this data since these newborn children data at CHC is the most representative data for number of deliveries in Nha Trang city. Because this survey originally aimed to investigate the carriage rate of Streptococcus pneumococcus among participants, we excluded children that were born with a cleft lip or cleft palate and their mothers due to the difficulty of collecting nasopharyngeal samples. Second, children and their mothers were randomly selected from this list and invited to participate in the pneumococcal carriage survey until 120 participants per commune had been recruited. Because of the ubiquity of cell phone use in urban areas of Vietnam, trained staff from community health centers made a phone call to the candidates and invited them to participate. Home visit was made and requested to participate in the study for those who do not have mobile phone. One or two staff members visited interested mothers, explained the study, and obtained written informed consent. Upon agreement, the mother was then interviewed using a structured questionnaire requesting socio-demographic information.This study was completed as a part of a S. pneumoniae in the nasopharynx in the study area to be 0.5, to obtain the largest sample size, and required the estimate to be within 0.04 of the true value (precision) within the 95% confidence interval (CI). Based on this, the minimum sample size was calculated to be 600 for each introduction arm (6 communes). As there were six communes (clusters) in each arm, we decided to recruit 120 per communes resulting in 720 per arm, and 3240 for 27 communes.In terms of sample size calculation, we assumed the true proportion of children aged < 24 months who have n = 1219, 22.8%) refused to participate in this study, and 17% (n = 952) could not be contacted. In addition, 29 pairs were not eligible (duplicate participants or out of the eligible age range) based on the participant criteria. A total of 3148 pairs of mothers and their children participated in the survey: 1562 children were aged 4 to 11 months, and 1586 were aged 14 to 23 months.The questionnaire included socio-demographic variables, such as maternal age, educational background of the mother and the head of household, name of the commune of residence, household income in the previous month , whether the mother has another child going to school or kindergarten, and the total number of household members. Household income in the previous month (VND) was converted into US dollars . Living in suburban or urban areas was coded based on the administrative definition of the communes. Delivery information included the mode of delivery, the child’s sex and birth weight (g), gestational weeks at birth, and the date of birth. The day of delivery was calculated from the birth date of the child. Matshidze et al.  observedp < 0.05). To assess the multicollinearity of independent variables, variables that showed moderate correlations with others (r ≥ 0.4) were excluded from the final model [Binary logistic regression was performed to examine associations between socio-demographic variables and the mode of delivery. The adjusted model included variables that were independently associated with CS births in the crude analysis  followed by cephalo-pelvic disproportion (CPD) , oligohydramnios , and malposition .A total of 1396 out of 3148 births were completed by CS, resulting in a CS rate of 44.3% , and 517 (16.4%) were older than 35. A small number of mothers  had not completed primary school, while 1207 (38.3 %) had received post-secondary education. Approximately one-fifth of mothers  reported a monthly household income in the previous month higher than 644 USD. Few mothers  gave birth post-term . Approximately one-third of babies  were born weighing over 3500 g at birth, while the number of babies weighing less than 2500 g at birth was 69 (2.1%). The percentages of CS births were similar among each day of the week (ranging from 13.1 to 15.2%). The number of male babies  was slightly higher than the number of female babies .Table Rates of CS were high among women older than 35 years (59.0%), those that had completed post-secondary education (49.8%), those that had a monthly income greater than 644 USD (50.1%), and those with babies weighing over 3500 g  or under 2500 g (55.1%). The CS rate varied depending on the day of the week (ranging from 39.3 to 48.3%), but the sex of the child had no effect on the CS rate.r = 0.57), which was assumed to be a multicollinear factor. After adjustment for potential confounding factors, CS rates were higher among older women ; ≥ 35 years, AOR 2.90, 95% CI ); those with a monthly income of 644 USD or more , those giving birth after 42 weeks of gestation , those with babies weighing less than 2500 g at birth , and those with babies weighing 3500 g or more at birth .A moderate correlation was observed between the educational backgrounds of the mother and the head of household  or high (≥ 3500 g) birth weight baby.The CS rate (44.3%) observed in our study is consistent with the rate observed in a national survey of urban areas in Vietnam in 2014 . In addiMothers with higher economic status were more likely to receive CS births. The health care system was organized by the Vietnamese government in the late 1980s . CurrentContrary to a previous study reporting higher CS rates in urban areas 43%) than in suburban areas 21%) , place o% , place% than inChild sex was not associated with the CS rate in our study in contrast to findings from previous studies in Vietnam , 22. GiaOlder maternal age (≥ 30 years old), low birth weight (< 2500 g), and high birth weight (≥ 3500 g) resulted in higher CS rates. Although we did not take data on birth parity in our study, CS rates were lower for mothers that reported “having another child going to school or kindergarten.” These findings are consistent with previous studies that have been conducted in other countries , 30. Oldn = 3140) and followed a strict randomization enrollment technique. Our data included participants from urban and suburban areas across Nha Trang city.The major strength of our study was that we recruited a large number of participants , having another child, monthly income greater than 644 USD, gestational weeks at birth over 42 weeks, and low (< 2500 g) and high (≥ 3500 g) birth weight was associated with a higher likelihood of CS birth.


The cut-off point for infertility duration was 4.5 years, and the cut-off point for endometrial thickness was 0.89 cm. Infertility duration, endometrial thickness and number of embryos transferred might affect the live birth rate after frozen embryo transfer among young women. This result could help inform clinical decisions and counseling to increase the live birth rate after frozen embryo transfer among young women.In recent years, the freeze-all strategy has been widely adopted and applied. However, with the exception of age, the factors that affect the outcomes of frozen embryo transfer are still unclear. Therefore, the identification and mitigation of factors that influence the live birth rate after frozen embryo transfer is a good way to increase the “take-home-baby” rate of frozen embryo transfer. The objective of this study was to identify factors affecting the live birth rate after cleavage-stage frozen embryo transfer in young ovulatory women. This was a secondary analysis from a previously published multicenter randomized controlled trial (ChiCTR-IOR-14005406) that was originally designed to compare the live birth rate and perinatal complications after fresh embryo transfer to those after frozen embryo transfer among ovulatory women. This study was carried out using a portion of the data from the original randomized controlled trial, which included 917 young women who underwent cleavage-stage frozen embryo transfer. The 16 clinical candidate variables potentially affecting the live birth rate after frozen embryo transfer were analyzed. Univariable analysis and multivariable analysis were performed to assess the relationship between predictive factors and outcomes, with the aim of identifying independent predictors of live birth after frozen embryo transfer. In this study, the live birth rate was 53.0% (486/917). Three independent predictors were ultimately identified as the main factors affecting the live birth rate of ovulatory young women. Infertility duration [odds ratio (OR): 0.933, 95% confidence interval (CI): 0.876–0.995,  In 1983, the first successful pregnancy after frozen embryo transfer (FET) was reported, and since then, FET has become an important procedure for infertility treatment . HoweverWe recently completed a large multicenter randomized controlled trial (RCT) that compared the pregnancy outcome of fresh embryo transfer to that of FET in ovulatory women . The resin vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) cycle from March 2015 to November 2015. The original study obtained ethics approval from Ethics Committee at the Center for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong University ([2014] No. 18) and each participating center. All patients signed informed consent forms before inclusion in the study and were identified by the participant number only. We included only 917 participants who ultimately underwent the cleavage-stage frozen embryo transfer procedure (excluding those with missing data)  . The detng data) .in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) cycle. The exclusion criteria were unilateral oophorectomy history, polycystic ovary syndrome (PCOS) history, uterine abnormality, abnormal parental karyotypes, recurrent spontaneous abortion, or chronic medical conditions that contraindicated pregnancy.The inclusion criteria were as follows: ovulatory women, aged 25–35 years, who had infertility for more than 1 year, were diagnosed with tubal factor or male factor infertility, and had undergone their first All participants underwent a standard ovarian stimulation protocol and luteal phase support protocol according to a routine method. The complete details of the trial design and the main outcomes have been previously reported . Controlt-test. Qualitative variables were summarized with percentages and compared between live birth cycles and no live birth cycles by the chi-square test or Fisher's exact test. When the individual expected count was <5, we used Fisher's exact test. Then, univariate and multivariate logistic regression were used to assess the relationships between predictive factors and outcomes. Clinically relevant predictive variables and univariable analysis covariates with p < 0.15 were included in the multivariable analysis. Finally, 8 predictors were analyzed in the multivariable analysis, including the infertility duration, causes of infertility, endometrial thickness, endometrial preparation regimen for FET, LH level, number of embryos transferred, number of top-quality embryos, and oocyte fertilization method. To avoid collinearity, the variance inflation factor (VIF) was used to detect the presence of collinearity between two or more independent variables in this multivariable model. No collinearity was detected among variables. In the multivariate logistic regression analysis, independent factors were determined by a backward variable selection approach in which the least significant variable was removed one by one. Only variables with p < 0.05 were considered for inclusion in the final multivariable model. The Hosmer-Lemeshow goodness-of-fit statistic was used to examine the performance of the final model. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the performance of infertility duration and endometrial thickness in FET. The optimal cut-off points were determined using the Youden index. All statistical analyses were performed using SPSS statistics software .Live birth was the primary endpoint of the study. Sixteen candidate variables that may affect the LBR after FET were selected according to clinical experience and the literature. First, descriptive statistics and univariate analyses were performed. Continuous variables were summarized as the mean ± SD and compared between the live birth group and no live birth group by In this study, 1,803 embryos were transferred into 917 young women. The overall LBR was 53% (486/917), and the all twins birth rate was 36.8% (179/486). A total of 886 patients transferred two embryos, that the twins birth rate was 37.6% (179/476) after transfer of two frozen embryos. All first FET cycles were completed <1 year after cryopreservation.p = 0.027). The longer the infertility time was, the lower the LBR would be. Within the BMI < 25 kg/m2 and BMI ≥ 25 kg/m2 groups, there were no significant differences in BMI between the live-birth and non-live-birth subgroups. Regarding the other factors, the differences were not statistically significant between the live-birth group and non-live-birth group . A significant difference in endometrial thickness  was observed between the two groups. We observed a statistically significant difference in the LBR between FET with one frozen embryo and FET with two embryos. The LBR of the transfer of two frozen embryos was higher than that of a single transfer (53.3 vs. 32.3% p = 0.015).The embryological and clinical factors that may affect the LBR after FET cycles are shown in p = 0.313, which indicated that the data fit the model well. The multivariable logistic regression showed that infertility duration , endometrial thickness , and number of embryos transferred  were the major factors affecting the “take-home-baby” rate of FET.The results of the univariate and multivariate logistic regression analyses of predictive factors for FET pregnancy outcome are summarized in ROC curve analysis of infertility duration in FET and endometrial thickness in FET was performed for the predictive assessment of live birth . For infThis study assessed the LBR of 917 FET participants using a portion of the data from a large multicenter RCT. According to our study, in ovulating women, the infertility duration, endometrial thickness, and number of embryos transferred were important factors that affected the LBR after FET among young women.Female age was a critical factor in predicting the LBR after FET. Recently, many large studies have shown that oocyte quality is poor in women who are older than 35 years and that this age group has lower ongoing pregnancy and clinical pregnancy rates than younger women –15. In t2 were not significantly different from those of women with a BMI < 25 kg/m2 when high-quality embryos were transferred. Insogna et al. (2), normal weight (18.5–24.9 kg/m2), overweight (25.0–29.9 kg/m2), and obese (≥30.0 kg/m2) women. In contrast, a retrospective study found that obesity was associated with declines in the clinical pregnancy rate and LBR . The results showed the absence of an association between the LBR and overweight. Whether a BMI ≥ 30 kg/m2 affects the LBR among young ovulating women still needs to be confirmed in a future study.There has been controversy among recent studies regarding whether an increase in BMI has an impact on the outcome of FET. Farhi et al.  found tha et al.  studied In this study, we found that prolonged infertility was associated with a decrease in the LBR after FET. Cai et al.  and NelsEndometrial thickness is a crucial factor in determining the timing of FET. Bu et al.  found thWe observed that the LBR for natural cycles is higher than that for artificial cycles. However, we did not find a relationship between the LBR and the endometrial preparation regimen for FET after multivariate logistic regression analysis. Morozov et al.  showed tIn accordance with previous studies, the number of embryos, and number of top-quality embryos transferred affect the pregnancy outcome , 29. AccThe original data for this study were obtained from our previous RCT. All the patients were randomly assigned to the study, which should reduce the risk of bias. The relatively large sample size should lead to the most reliable and accurate results. To our knowledge, few studies addressing the factors affecting the LBR after FET, especially among young women, are available. Most publications report biochemical pregnancy or clinical pregnancy rather than live birth. We chose the LBR as the endpoint to better help guide clinical practice, and this is the first study to analyze the independent risk factors that could affect the LBR after FET in the young female population. There are also limitations in our study. The original data were from our previous RCT, in which the conditions for enrollment were strictly controlled. The original RCT selected a population of patients in whom two good embryos were transferred, which might lead to a high twin pregnancy rate. Therefore, it was difficult to represent the broader population. Thus, in the future, a large series of patients will be necessary to confirm the factors influencing the FET outcome.The datasets generated for this study are available on request to the corresponding author.The studies involving human participants were reviewed and approved by Ethics Committee at Center for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong University. The patients/participants provided their written informed consent to participate in this study.YS and Z-JC designed the trial and were in charge of the trial conduct. YP, GH, and YS designed the study. YS, HL, YP, GH, and ZW acquired the data. ZW, YP, and QW performed the statistical analyses. YP, HL, ZW, QJ, and QW interpreted the data. YP wrote the first draft of the report with inputs from GH, HL, YS, and Z-JC provided comments, participated in additional discussions, and revised the paper. All authors approved the final version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


Piezoelectric materials with the electro-mechanical coupling effect have been widely utilized in sensors, dampers, actuators, and so on. Engineering structures with piezoelectric actuators and sensors have provided great improvement in terms of vibration and noise reduction. The flexoelectric effect—which describes the coupling effect between the polarization gradient and strain, and between the strain gradient and electric polarization in solids—has a fourth-rank order tensor electro-mechanical coupling coefficient, and in principle makes the flexoelectricity existing in all insulating materials and promises an even wider application potential in vibration and noise control. In the presented work, a flexoelectric actuator was designed to actuate a simply supported beam. The electric field gradient was generated by an atomic force microscopy probe. Flexoelectric control force and moment components could be induced within the flexoelectric control layer. As flexoelectricity is size-dependent, the key parameters that could affect the actuating effect were examined in case studies. Analytical results showed that the induced flexoelectric control moment was strongly concentrated at the probe location. The controllable transverse displacement of the simply supported beam was calculated with the modal expansion method. It was found that the controllable transverse displacement was dependent on the probe location as well. In the past few decades, devices using piezoelectricity, e.g., actuators and transducers, have been invented and applied to various engineering systems and applications. Piezoelectricity is an electromechanical phenomenon which couples with the elastic and electric fields. In general, a piezoelectric material responds to mechanical forces and generates an electric charge/voltage or responds to an electric input and induces mechanical stresses or strains, which are known as the direct and converse piezoelectric effects, respectively. With the direct piezoelectric effect, Dietl et al.  proposed3) nanoribbons can sustain large strain gradients and give a rise of up to 70% enhancement of the apparent piezoelectric performance as a result of the flexoelectric effect. By studying the electromechanical behavior of graphene-based nanocomposite beams, Kishor and Kundalwal [Flexoelectricity describes the linear coupling between the electric field gradient and stress/strain or the electric polarization and strain gradient, which can be used as a complement to piezoelectricity. Compared to piezoelectricity, the flexoelectric coefficient is a fourth-rank order tensor and hence in principle exists in all insulating materials, while piezoelectricity is limited to non-centrosymmetric materials . As a grundalwal  found thundalwal  establisundalwal . Fan et undalwal ,17 studiundalwal .In the current study, the converse flexoelectric effect was proposed to actuate a simply supported beam. The electric field gradient was generated by an atomic force microscopy (AFM) probe. The purpose of this study was to examine the key parameters that may influence the electric field gradient and validate the effectiveness of flexoelectric actuators in structure actuating. The distributions of the electric field gradient, flexoelectric control moment, flexoelectric modal force, and beam transverse displacement are discussed with respect to varying the flexoelectric layer thickness and AFM probe radius.The active damping technique is usually used in engineering vibration and noise control, and the simplest active damping is to bond a piezoelectric actuating layer to a fundamental structure so that the dynamic vibration can be controlled with the specific electric input. In this study, a simply supported beam was selected as the fundamental structure. On the top surface of the beam, a flexoelectric layer was perfectly bonded, serving as a control layer as shown in fL for length, fh for thickness, and b for width) was perfectly bonded to the upper surface of the beam as a constraint surface. The electric field gradient was generated by an AFM (atomic force microscopy) probe  and the location of the probe is denoted by fx*. The elastic beam parameters were as follows: elastic beam length eL, thickness eh and width b. The radius of the AFM probe and the layer thicknesses follow that were R << fh << eh, so that the stiffness effect on the dynamic model could be neglected and the beam structure could be modelled with a pure elastic beam model. The electric input to the AFM probe is denoted by fΦ.As illustrated in fω, amplitude The electric field in this study was generated by the AFM probe on the top and the electrode layer on the bottom. Generally, the electric input is assumed to be a harmonic excitation with frequency The electric field induced by the AFM probe under the current input is estimated as ,19:(2)E3Ef3 is the electric field in the transverse direction. The electric field gradient can be derived as:Here, Here, With the stress component obtained in Equation (4), the control moment which can actuate the simply supported beam can be derived as :(5)Mxxf(In Equation (5), The dynamic response of the simply supported beam under actuating can be described in terms of transverse displacement u3k(xted beam :(7)U3k and the elastic beam was made of polypropylene. The parameters are given in Based on the converse flexoelectric effect, the induced flexoelectric stress was proportional to the electric field gradient. When the flexoelectric material was fixed, increasing the electric field gradient could be one possible way to enhance the flexoelectric effect. As mentioned before, in the current physical model the AFM probe radius and the flexoelectric patch thickness could affect the electric field gradient.In However, by decreasing the flexoelectric layer thickness while the external electric input was fixed, the electric field distribution could be affected physically. To further study the influence of the flexoelectric layer thickness, the electric field gradient when A flexoelectric control force and control moment can be induced with an inhomogeneous electric field in the flexoelectric layer and thus actuate the elastic beam structure. For the beam mode used in this study, it was the moment components causing the vibration. In In Mathematically, there are two parts in the braces in Equation (5). The first part is dependent on both the probe radius and patch thickness, and the second part is dependent on the probe radius only. As the probe radius is much smaller than the patch thickness, the second part always dominates the total value of the control moment expression. With a decrease in R, the second part increases sharply, and with a decrease in R or in thickness, the first part decreases slowly. Hence, the flexoelectric control moment can be increased with a smaller probe radius and larger layer thickness, which is consistent with the physical explanation. However, it should be noted that the conclusion was made based on the assumption that With the modal expansion method, the controllable transverse displacement of the simply supported beam can be written in terms of the modal participation factor and mode shape function. The flexoelectric modal force, which determines the modal participation factor, is examined in this section with regard to the AFM probe radius and flexoelectric patch thickness.In The process of active vibration control usually is the cancellation of the initial vibration by the induced vibration. The flexoelectric actuator can induce a control force and moment in the structure and actuate dynamic responses correspondingly. The mode 1 and mode 3 controllable transverse displacement of the simply supported beam with flexoelectric actuating is plotted in It was found that for flexoelectric actuating, the controllable transverse displacement was in micron scale with an electric input amplitude of 1 V. For the mode 1 vibration, the transverse displacements With the flexoelectric effect, a simply supported beam was actuated. It proved that with a specific electric field gradient, the flexoelectric effect was still effective in macro-scale. In the presented work, an AFM probe and an electrode layer were utilized to generate an electric field gradient. Parameters that could affect the electric field gradient were studied and it was found that decreasing the probe radius could enhance the electric field gradient. When the flexoelectric layer thickness was decreased, the minimum values of the electric field gradient increased but the maximum values stayed the same, which made the effect of layer thickness on the gradient limited. The beam actuating effect depended on both the flexoelectric control moment and the structure modes. To optimize the actuating effect, flexoelectric actuators should be located at mode-dependent locations. Considering the electric field gradient’s effects on the flexoelectric actuating, flexoelectric actuating and control can be applied to engineering structures and feedback control strategies will be developed in future studies.


Background: Infants below 28 weeks' gestation have low thyroid hormone plasma levels compared with more mature infants and this may contribute to their risk of developmental disability. We aimed at determining the effect of supplementation with levothyroxine (LT4) for extremely premature infants born below 28 weeks' gestations on neurodevelopmental outcomes at 42 months.Methods: An explanatory double-blind, randomized, placebo-controlled trial consecutively recruited 153 infants below 28 weeks' gestation from 5 neonatal units in the United Kingdom. Infants were either supplemented with LT4 started intravenously during the first 5 days after birth and then changed to oral LT4 when enteral feeds were fully established (8 μg/kg birthweight/day as a single daily dose) or given placebo until 32 weeks' corrected gestational age. Neurodevelopmental outcomes at 42 months (range 40–43) were evaluated in 59 of these infants  by using Bayley III Mental and Psychomotor Developmental Indices. Cognition outcomes was correlated with plasma free thyroxine (fT4) level at 36 weeks and diffusion tensor imaging (DTI) markers.Results: The LT4 supplemented group performed significantly better in motor, language, and cognitive function domains. The mean of the difference between each group  was motor domain 6.96 ; language domain 8.93 ; and cognition domain 6.35 . Neurodevelopmental outcome at 42 months had some associations with the trial's primary outcome , plasma fT4 level at 36 weeks , and DTI at 36 weeks with cognition outcomes (p > 0.05).Conclusion: Our data suggest that early supplementation with LT4 may improve long-term neurodevelopment in infants born below 28 weeks' gestation, but larger trials are warranted as the current reported improvements shown are not strong enough to warrant a change in practice. Among infants born at term, the disability associated with hypothyroidism in the immediate postnatal period can be prevented by giving supplementary thyroid hormone: Even mild thyroid hormone insufficiency can produce measurable, but preventable deficits in neuropsychological functions . InfantsSome steps have been taken to address this problem. A phase 1 trial of differing doses and modes of administration of thyroid hormones to 168 preterm neonates less than 28 weeks' gestation found no difference in neurodevelopmental outcomes in relation to thyroid hormone treatment at 36 months of age . A previn = 78) or placebo (n = 75) for width of the subarachnoid space, head circumference, body weight, or mortality. Although infants who received LT4 supplementation had significantly shorter leg lengths at 36 weeks' CGA (p = 0.02), there was no statistical difference when the analysis was adjusted for baseline length , assuming that the common SD is 26.0 by using a 2-group us study  that repParents were aware of the possibility of a follow-up study when they were recruited to the initial TIPIT from five tertiary level neonatal units . Mother t-test, and the difference in means presented with a 95% confidence interval. Assumptions of normality were checked by using a visual inspection of a histogram. Correlations were analyzed by using Spearman's correlation. The relationship between plasma fT4 concentrations and outcomes was explored by using an approach described by van Wassenaer et al.  and by the Medicines for Human Regulatory Agency (MHRA).Two hundred sixty-seven participants in TIPIT from 5 participating centers were assessed for eligibility, and 153 infants were recruited to this follow-up study . Among iBaseline demographic characteristics between LT4-supplemented and placebo groups in the follow-up study are shown in Neurodevelopmental outcomes at 42 months were evaluated by using Bayley's III Mental and Psychomotor Developmental Indices, which found that infants in the treated group performed significantly better in all 3 domains for motor, language, and cognitive function  and 3. CThis extension to the TIPIT trial was designed to explore the effects and mechanisms of thyroxine supplementation on neurodevelopmental outcomes. Extremely preterm infants in the supplemented group performed significantly better in all 3 domains of the Bayley's III Mental and Psychomotor Developmental Indices at 42 months. Overall, the Bayley's mean and median scores were noted to be lower compared with other preterm infant studies; however, direct comparisons are difficult to make as our population was more premature compared with some studies that included less premature infants , whereaset al. found that abnormal neurodevelopment at 18 months' corrected age was associated with lower FA values in the right posterior limb of the internal capsule (et al. have also reported that higher FA in the corpus callosum was associated with better cognitive performance at two years of corrected age (Surrogate outcomes are important elements in the evaluation of interventions. Given the complexity of long-term outcome studies, TIPIT was designed by using a single surrogate outcome: depth of subarachnoid space. This was selected because it had been validated and was associated with differences between groups defined by gestational age . The res capsule . Van Koocted age . Our stuThe assessment of exposure to thyroxine supplementation and outcomes showed a relationship between higher plasma fT4 concentrations during the weeks after birth and better neurodevelopmental outcomes at 42 months. These differences, however, only reached statistical significance for cognition composite scores and not for motor and language composite scores in the Bayley's III Mental and Psychomotor Developmental Indices. The assessment of exposure was relatively crude but is consistent with our other data. Of note, an MRI nested study of TIPIT found that infants with higher fT4 levels had lower ADC measurements at term equivalence, suggesting greater organization of the white matter consistent with increased myelination . The relet al. reported a 4.4-fold increase in the risk of disabling cerebral palsy at 2 years of age associated with low thyroid hormone levels in the early weeks of life of preterm infants born before 29 weeks' gestation (Our findings are consistent with several observational studies that have documented associations between low thyroid hormone levels in the first weeks of life and abnormal neurodevelopmental outcomes . Reuss eestation . Anotherestation . A Cochrestation . Howeverestation . It remaA limitation of this study is the large number of infants lost to follow-up at 42 months, which did not reach the sample size calculation despite every effort being made to contact the families. No significant differences in demographics were noted between the two groups. The original recruitment process was also consecutive; therefore, all mothers/parents were asked for consent to recruitment. Due to the nature of the study, 43% were excluded if infants did not consent or did not fulfil the exclusion criteria of the study protocol.This study is a randomized clinical trial specifically targeting extremely premature infants with thyroxine supplementation, and it is the third largest randomized trial of thyroid hormone supplemented to infants born below 28 weeks' gestation. MRI DTI measurements in infants with higher fT4 plasma concentrations during early life had lower ADC measurements at term equivalence, suggesting greater organization of the white matter. Future larger scale trials would seem to be justified on the basis of the results reported here; these could usefully target preterm infants on the basis of their initial thyroid hormone levels. This study suggests that early supplementation with LT4 may improve long-term neurodevelopment in infants born below 28 weeks' gestation, but larger trials are needed and the modest improvements shown are not strong enough to warrant a change in practice.


Cottus volki. The genome sequences are 16,519 and 16,536 bp in size, and the gene arrangement, composition, and size are very similar to the other sculpin mitochondrial genomes published previously. The difference between the two genomes studied is relatively high, 3.42%, which is 30% of the average interspecific divergence (8.76%) detected between seven Cottus species from the GenBank database. The data are consistent with the sedentary lifestyle in C. volki, limiting gene flow even between neighbouring rivers.The complete mitochondrial genome was sequenced in two individuals of the Volk’s sculpin  Cottus volki Taranetz 1933 is a freshwater fish inhabiting the Sea of Japan’s inland coastal rivers  sequences (control region) and morphology, the validity of C. volki was established (Shedko & Miroshnichenko C. volki had not yet been sequenced to confirm the species identity and to clarify its relationships with the other species belonging to the genus Cottus.The Volk’s sculpin Taranets . Berg (1Taranets  as well Taranets  has consC. volki (GenBank accession numbers KY563343 and KY563344) from the Alekseevka river  and Zerkal'naya river , Primorsky krai, Russia, using primers designed with the program mitoPrimer_V1  under accession numbers MIMB 33260 and MIMB 33261. The mt genome sequences are 16,519 and 16,536 bp in size; the gene arrangement, composition, and size are very similar to the sculpin fish genomes published previously. There are 564 single nucleotide and 14 length differences (some involving more than one bp) between the two haplotypes of CVO45 and CVO61; total sequence divergence (Dxy) is 0.0342 ± 0.0014.We have sequenced two complete mt genomes of Cottus and Mesocottus reveals a close affinity of C. volki to the cluster of C. czerskii + C. szanaga within the genus Cottus (Dxy) between C. volki and the cluster C. czerskii + C. szanaga is 0.0707 ± 0.0012, which is in close agreement with the average divergence between the Cottus species from the GenBank database (0.0846 ± 0.0014).Comparison of the two mt genomes now obtained with other complete mt genomes available in GenBank for the genera s Cottus . The difC. volki mt genomes now studied is relatively high, 3.42%, which is only 2.56 times less (30% of it) than the average interspecific divergence, 8.46%, detected between all seven Cottus mt genomes available in GenBank, including C. bairdii, C. czerskii, C. dzungaricus, C. hangiongensis, C. koreanus, C. reinii, and C. szanaga. The data are consistent with the sedentary lifestyle of C. volki, limiting gene flow even between neighbouring rivers (Kolpakov The difference between the two Kolpakov .


Most abortions occur due to unintended pregnancy. Unintended pregnancies are linked to poor health outcomes. Canada receives immigrants from countries with disparate sexual and reproductive health contexts which may influence abortion rates post-migration. We examined the association between abortion and region of birth and birth order among Canadian immigrants.We conducted a population-based person-years (PY) cohort study in Ontario, Canada using administrative immigration (1991–2012) and health care data (1991–2013). Associations between induced abortion and an immigrant’s region of birth were estimated using poisson regression. Rate ratios were adjusted for age, landing year, education, neighborhood income quintile and refugee status and stratified by birth order within regions.N = 846,444) were 2–5 times more likely to have an induced abortion vs. those born in the US/Northern & Western Europe/Australia & New Zealand . Caribbean , West/Middle/East African  and South American  immigrants were most likely to have an abortion. Most immigrants were less likely to have an abortion after vs. prior to their 1st birth, except South Asian immigrants . Secondary analyses included further stratifying regional models by year, age, education, income quintile and refugee status.Immigrants born in almost all world regions (Induced abortion varies considerably by both region of birth and birth order among immigrants in Ontario. Introduction – Most abortions occur due to unintended pregnancy. Unintended pregnancies are linked to poor health outcomes. Immigrants to Canada come from countries with varying access to sexual and reproductive health care which may influence abortion rates. We examined the relationship between abortion and region of birth and birth order among Canadian immigrants.Methodology - We conducted a study in Ontario, Canada using official immigration (1991–2012) and health care data (1991–2013). The relationship between abortion with an immigrant’s region of birth and number of previous children were examined.Results - Immigrants born in almost all world regions were 2–5 times more likely to have an induced abortion vs. those born in the US/Northern & Western Europe/Australia & New Zealand. Caribbean, West/Middle/East African and South American immigrants were most likely to have an abortion. Most immigrants were less likely to have an abortion after vs. prior to their 1st birth, except South Asian immigrants. Secondary analyses included further stratifying regional models by year, age, education, income quintile and refugee status.Conclusion - Rates of induced abortion are considerably different according to both region of birth and birth order among immigrants in Ontario.Over half of pregnancies in the United States are intended  of which 3% end in abortion , while tFew studies have examined induced abortions among immigrants, and none could be found in Canada, where abortions have been publicly funded since 1988 and can be obtained without restriction  or within 3 months of arrival (non-refugee immigrants). The setting of this study is the province of Ontario, the most populous province in Canada 14 million) with the highest number and proportion of immigrants, 70% of whom arrived between 1985 and 2016. Permanent resident immigrants are generally categorized into three streams  million . BrieflyPopulation-based linked administrative databases were accessed at ICES  in Toronto, Ontario to conduct this retrospective study. ICES is an independent, non-profit research institute whose legal status under Ontario’s health information privacy law allows it to collect and analyze health care and demographic data, without consent, for health system evaluation and improvement. ICES houses data on individuals eligible for coverage under the Ontario Health Insurance Plan (OHIP). OHIP provides publicly funded health care coverage at no cost to those with Canadian citizenship, permanent resident status and some temporary residents with work permits.We took a retrospective longitudinal cohort approach and enumerated all induced abortions occurring since migration  to Canada, measured per 100 person-years (PY) of follow-up time. Given our study design, we did not estimate annual abortion rates per 1000 women, as is typically seen in cross-sectional or repeated cross-sectional studies. Persons who indicated their sex to be female were included in the study if they immigrated to Canada between April 1, 1991 and December 31, 2012, were registered for OHIP and resided and were alive in Ontario for at least one year between 1 April 1991 and 31 March 2014 following arrival. For each year a female met the stated eligibility criteria and was between the ages of 15–44 years, a year of follow up time was assigned and summed in PY. Induced abortions were enumerated for females who contributed a PY of follow-up time in the year abortion(s) occurred. To examine induced abortion rates prior to a birth, the population included those who delivered up to three or more consecutive singleton births in Ontario hospitals between April 1993 and March 2014. Those who did not have all their births in Ontario were excluded from birth order analyses, along with all their children.This study does not include asylum seekers awaiting a refugee determination hearing which decides their eligibility for permanent residency. Asylum seekers are eligible for federally funded health care services while they wait for their hearing . This study also does not include migrants: with temporary (1 year) work permits who fill Canada’s short-term labour needs and are eligible for provincially funded health care; with temporary student permits who may be eligible for student health care plans; who are undocumented  who havSeveral population-based administrative databases were linked to perform this study. These datasets were linked using unique encoded identifiers and analyzed at ICES.The Ontario portion of the Immigration, Refugee and Citizenship Canada Permanent Resident Database (IRCC-PRD) contains the legal immigration records for all individuals who obtained permanent residency in Canada between January 1985 and December 2012 and intended to reside in Ontario. About 86% of individuals in the Ontario portion of the IRCC-PRD were linked to Ontario’s healthcare registry consisting of Ontarians eligible for publicly funded healthcare insurance in Ontario between April 1, 1990 and March 31, 2014 with a valid health card number. There were small standardized differences (< 0.2) between linked and unlinked individuals across nearly all sociodemographic variables and regions of birth indicating that the linked individuals were largely representative of the original IRCC-PRD .Reporting of induced surgical or pharmacological abortions in publicly funded clinics is mandatory and captured in the Canadian Institute for Health Information’s (CIHI) Discharge Abstract Database , Same-Day Surgery and the National Ambulatory Care Reporting system (NACRS - emergency department visits). Out-of-hospital abortions are captured using OHIP billing codes for surgical abortions. The CIHI DAD was also used to identify hospital births to immigrant females and their birth characteristics including birth order.The Office of the Registrar General’s Vital Statistics Death registry (1991–2013), supplemented by mortality recorded in the healthcare registry and other administrative databases was used to identify any deaths among immigrants included in the initial population. For the year in which a death occurred, follow-up time was calculated from January 1 to the date of death that year.Induced abortion (henceforth “abortion”) was defined as any surgical or pharmacologically induced termination of pregnancy in the absence of a diagnosis of spontaneous abortion. Given the single-payer health care system in Ontario and the use of population-based databases (rather than self-reported surveys), we report on all induced abortions except a minority conducted in private clinics. If two abortion procedures were recorded within 40 days of each other for a given woman, they were considered the same event and first abortion date was used. CIHI diagnosis codes and OHIP billing codes for induced abortion are described elsewhere . Late inThe exposure of primary interest was region of birth categorized using country of birth as reported in the IRCC-PRD and the United Nations geographical classification system which categorizes countries into 22 sub-regions . Sub-regWe also examined abortion rates by birth order which was defined as the complete sequence of up to three consecutive live births from the same mother since there were few females that had more than three births. At the time of each pregnancy the alive status of previous siblings was determined using the vital statistics registry and in-hospital death data. If prior siblings were not alive by the estimated conception date of the current live birth, the birth order was reduced for each subsequent live birth.Covariates as reported in the IRCC-PRD included: country of birth, age at arrival , year of arrival , education level at arrival , marital status at arrival , official language ability at arrival , refugee status  and years residing in Ontario . Residential neighborhood income quintile (1 = lowest to 5 = highest) for the year after arrival was reported in Ontario’s healthcare registry and utilized for analysis. The year after arrival was used to capture residential income quintile for immigrants arriving later in the year.Population counts and proportions were calculated for year of arrival, age of arrival, education at arrival, income quintile the year after arrival, marital status at arrival, official languages at arrival, refugee status and years residing in Ontario stratified by region of birth.For all regression analyses unadjusted and adjusted rate ratios  were estimated using Poisson regression with the outcome specified as the count of induced abortions and the offset specified as the time in years residing in Ontario since arrival for each female. Crude abortion rates (per 100 PY) and associated 95% CIs were estimated for females from each region and each country if the country population was ≥500 females. Unadjusted and adjusted rate ratios were estimated for region of birth specified as the independent variable and confounders included year of arrival, age at arrival, education at arrival, neighborhood income at arrival and refugee status. Adjusting for year and age at arrival were related to our hypothesis that pre-migration exposures may impact induced abortion after arrival. Specifically, those arriving as adults may be more likely to adhere to the sexual and reproductive health norms related to their country of birth at the time they emigrated. For those arriving younger, sexual and reproductive health norms may be shaped by both the country of origin (through their parents) as well as by the Canadian context.Persons born in the United States/ Northern & Western Europe/Australia & New Zealand were chosen as the comparator given similar levels of development. Study subjects with missing outcome and covariate data were excluded from regression analyses. We did not adjust for marital status at arrival since this is likely to become misclassified with increasing length of stay, particularly for those arriving younger and single. In secondary analyses, unadjusted and adjusted Poisson regression was conducted for each world region of birth to examine the association between abortion and each of year, age, education, income quintile  and refugee status.Birth order analyses were restricted to mothers who had three or more consecutive singleton births in Ontario between 1993 and 2012. Induced abortion rates (per 100 births) and 95% CIs were estimated for abortions occurring prior to the 1st birth, between the 1st and 2nd births  and between the 2nd and 3rd or higher births  for each region of birth. RRs and 95% CI were also estimated comparing each birth order to that prior to the 1st birth.See Table There were 846,444 immigrant females born in the 12 world regions who contributed a total of 7,985,664 person-years (PY) to these analyses . The highest abortion rate was among those born in the Caribbean  and lowest among Southern Africans   compared to non-immigrant (n = 466) women was linked to health concerns of hormonal contraceptives.Given that the majority of abortions result from unintended pregnancies , our finafter both their 2nd and 3rd births. A related phenomenon, is that of sex-selective abortion, an extreme manifestation of son preference stemming from specific forms of patriarchy  [There are two examples that may help to further elucidate the connection between pre- and post-migration sexual and reproductive health contexts. A review of the factors influencing contraceptive use in Sub-Saharan Africa  (SSA) inneality)  which maneality)    since thOur study finds that there were high rates of induced abortion among immigrants now residing in Ontario particularly for those from the Caribbean, West/Middle/East Africa and South America regardless of birth order; and from South Asia after the 1st birth and from most other regions prior to the 1st birth. Suggested strategies to reduce these inequities and unintended pregnancies will likely benefit immigrant and Canadian-born persons alike.Additional file 1: Table S1. Frequency, proportion and abortion rates (/100 PY) (95% CI) (1991–2014) by immigrant female’s countries of birth (1991–2012) (where country counts ≥500 only) and legal status of abortion in birthplace. Figure S2a. Unadjusted (open circles) and adjusted (closed circles) induced abortion rate ratios (RR) and 95% confidence intervals (CI) (1991–2014) for sociodemographic factors among immigrant females born in the Caribbean, Central America, South America and West/East/Middle Africa arriving in Ontario (1991–2012). Models adjusted for year, age, education, neighborhood income quintile and refugee status (adjusted for variable when not examined as the main sociodemographic exposure of interest). b: Unadjusted (open circles) and adjusted (black circles) induced abortion rate ratios (RR) and 95% confidence intervals (CI) (1991–2014) for sociodemographic factors among immigrant females born in South Africa, North Africa/West Asia, Central Asia and East Asia arriving in Ontario (1991–2012) and residing in Ontario for at least one year. Models adjusted for year, age, education, neighborhood income quintile and refugee status (adjusted for variable when not examined as the main sociodemographic exposure of interest). c: Unadjusted (open circles) and adjusted (black circles) induced abortion rate ratios (RR) and 95% confidence intervals (CI) (1991–2014) for sociodemographic factors among immigrant females born in South Asia, South-East Asia & Oceania Islands, Southern & Eastern Europe and United States/Northern & Western Europe/Australia & New Zealand arriving in Ontario (1991–2012) and residing in Ontario for at least one year. Models adjusted for year, age, education, neighborhood income quintile and refugee status (adjusted for variable when not examined as the main sociodemographic exposure of interest).


The lung is the second most commonly involved organ in humans by hydatid disease. Management of large pulmonary hydatid cysts is a great challenge for thoracic surgeons. Lung resections should be considered the last choice for huge pulmonary hydatid cysts when the lung expansion is not optimal after cyst removal. Here, we present a case of huge lung hydatid cyst involving the entire right lower lobe which was successfully managed by lung-preserving surgery in which the postoperative course showed gradual resolution of the involved lobe during a one-year follow-up. After the liver, the lung is considered to be the second most infected part of the body in hydatid disease –3. Sign A 28-year-old man with no past medical and family history presented with dyspnea during strenuous activities. The radiologic finding was in favor of a large cyst (20 × 18 × 14 cm) in the right hemithorax Figures . He deniIt is reported in literature that chest pain, cough, and dyspnea are the most common clinical symptoms of patients presenting with a pulmonary hydatid cyst; however, our patient developed only dyspnea regarding the fact that the size of the hydatid cyst was huge , 8. KuzuIn the aspect of treatment, surgery provides the best option for the treatment of pulmonary hydatid cysts. The most common procedure for the management of lung hydatid cysts is Barrett/Posadas' technique  . AlthougThere is no generally accepted size to define the diameter of the cyst as “huge,” although in most studies, cysts more than 10 centimeters were regarded as “giant” or “huge” cysts . In caseIndications for parenchymal resection are giant cysts occupying the entire lobe, multiple cysts, and an unexpandable lobe after the excision of the cyst. It is believed that parenchyma-preserving procedures should be preferred in most cases because the lung parenchyma that has been compressed by the cyst is healthy and would expand postoperatively . The decSignificance in our case is encountering a huge cyst in the right lower lobe which was not amenable to lobectomy due to technical aspects. Cyst walls were densely adhered to the chest wall, diaphragm, and mediastinum, and dissection of fissures was hazardous. Even after meticulous airtight closure of bronchial openings, the lower lobe did not expand. The chest tube was removed early in the postop course due to the absence of air leakage to prevent further contamination of the cavity. As the cyst cavity collapsed gradually during the follow-up period, the lower lobe was well expanded. The learning point of this case is the importance of secure bronchial opening closure in the surgical management of pulmonary hydatid cysts to prevent space infection which may complicate the postop course. Even if the remaining lobe does not expand adequately during operation, gradual expansion in the long term would be expected while there is no air leakage from it.Thoracic surgeons should be aware of unexpected difficulties in operating huge pulmonary hydatid cysts. Parenchyma-preserving surgery is advised and is considered fundamental in the surgical management of lung hydatidosis, and radical surgery can be avoided even in cases with a large hydatid cyst. Secure airtight closure of bronchial openings is invaluable in attaining such excellent results.