To evaluate the microstructural changes of the orbital optic nerve in thyroid-associated ophthalmopathy (TAO) patients with or without dysthyroid optic neuropathy (DON) using diffusion tensor imaging (DTI) and investigate whether DTI can be used to detect DON.59 bilateral TAO patients with (n= 23) and without DON  who underwent pretreatment DTI were included and 118 orbits were analyzed. The clinical features of all patients were collected. DTI parameters, including mean, axial, and radial diffusivity  and fractional anisotropy (FA) of the intra-orbital optic nerve for each orbit were calculated and compared between the DON and non-DON groups. ROC curves were generated to evaluate the diagnostic performance of single or combined DTI parameters. Correlations between DTI parameters and ophthalmological characteristics were analyzed using correlation analysis.Compared with non-DON, the DON group showed decreased FA and increased MD, RD, and AD (P < 0.01). In the differentiation of DON from non-DON, the MD was optimal individually, and the combination of the four parameters had the best diagnostic performance. There were significant correlations between the optic nerve’s four DTI metrics and the visual acuity and clinical active score (P < 0.05). In addition, optic nerve FA was significantly associated with the amplitude of visual evoked potentials (P = 0.022).DTI is a promising technique in assessing microstructural changes of optic nerve in patients with DON, and it facilitates differentiation of DON from non-DON eyes in patients with TAO. Although accounting for only 3%–8% of thyroid-associated ophthalmopathy (TAO) , dysthyrThe existing diagnostic criteria for DON are primarily based on clinical signs and symptoms, which are neither sensitive nor specific. Barrett et al.  suggesteDiffusion tensor imaging (DTI) can directly detect subtle microstructural alterations of nerves  by quantTherefore, we aimed to investigate the microstructural changes in the optic nerves of TAO patients with and without DON using DTI and identify an imaging marker of the optic nerve to facilitate early diagnosis of DON. We also attempted to explore the relationship between DTI measurements and clinical characteristics.The study was approved by the Institutional Review Board of our hospital. TAO patients with or without DON were enrolled from the Ophthalmology or Endocrinology Department of our hospital. Written informed consents were obtained from all participants.The diagnosis of TAO was based on the Bartley diagnostic criteria  and the DON was diagnosed based on the following criteria with a and at least two indicators of b: a) a prerequisite history of TAO; and b) at least two of the following abnormal visual functions: unexplained decreased visual acuity (VA) <0.8; visual field defects (mean deviation in Humphrey perimetry <-10 dB); or relative afferent pupillary defects, impairment of color vision, abnormal pattern-visual evoked potentials , as well as evident apical crowding in orbital CT.The exclusion criteria were as follows: 1) concurrence of other neurological or ophthalmologic diseases that could influence visual function ; 2) signs of severe corneal exposure ; 3) steroid therapy, radiotherapy, or surgical decompression; 4) inadequate image quality; and 5) exclusion of DON for the TAO group.131I treatment and smoking, duration of Graves’ disease, TAO and/or DON , ophthalmologic assessment and current serologic levels of thyroid hormones and thyroid autoantibodies were collected. MRI examination was performed within three days for DON and one week for TAO before any initial treatment.Clinical features, including demographic characteristics, history of Every patient underwent a complete ophthalmologic examination. Visual acuity, intraocular pressure (IOP), the degree of proptosis, mean deviation and pattern standard deviation of the visual field test, and average thickness of the peripapillary retinal nerve fiber layer were documented. VEP measurements (performed on pattern stimulation), including the amplitude and absolute latency of P100 (in ms) were collected. Additionally, the clinical activity score (CAS) was assessed based on the classical signs of inflammation. The CAS is comprised of seven items, including spontaneous retrobulbar pain, pain on attempted up- or down-gaze, redness of the eyelids, redness of the conjunctiva, swelling of the eyelids, inflammation of the caruncle and/or plica, and conjunctival edema.via electrochemiluminescence immunoassay performed on a Cobas 6000 Analyzer . Reference ranges were defined as follows: FT3, 2.0‐4.4 pg/mL; FT4, 9.32‐17.09 ng/L; TSH, 0.27‐4.2 mIU/mL; TRAb, <1.58 IU/L; TGAb, <115 IU/mL; and TPO‐Ab, <34 IU/mL. Serum was collected on the day of visiting the clinician, and the MRI examination was performed within the following one week.Serum levels of free triiodothyronine (FT3), free thyroxine (FT4), thyroid-stimulating hormone (TSH), thyrotropin receptor antibody (TRAb), thyroglobulin autoantibody (TGAb), and thyroid peroxidase antibody (TPO-Ab) were measured MR examinations were performed on a 3T scanner  with a 32Ch head coil. Participants were asked to remain still and keep their eyes closed during the scanning. Conventional MRI of the brain and orbit was performed to exclude brain and other optic visual pathway diseases.2. The acquisition time was approximately 6 min 40 s, with 78 axial slices covering the whole brain.For DTI, a single-shot echo-planar imaging sequence  was applied with 64 non-collinear directions with b = 0 and 1000 s/mmwww.mristudio.org)  as follow1) DTI computation: read the raw DTI data in a DICOM format. Additionally, the user visually inspected the individual images and discarded the corrupted images form possible motion-related phase errors.2) Diffusion tensor calculation and visualization: the diffusion tensor-derived parameters including fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD) and radial diffusivity (RD) were calculated with multivariate linear fitting.3) Fiber tracking: fibers were constructed using the Fiber Assignment by Continuous Tracking (FACT) approach, the fiber tracking started at the center of each voxel having a fractional anisotropy (FA) value greater than 0.2 and terminated at voxels where FA is lower than 0.3 or the tract turning angles between two eigenvectors to be connected by the tracking were above 70°.4) Label interested nerve fiber bundle: the tract of each segment of the visual pathway were drawn on color-coded maps and real-time edited by operation tools including: AND (intersection), OR (union), and NOT (exclusion).Finally, each tract pathways of interest were selected, diffusion-related parameters  and an anisotropy index  are studied for each part of visual pathway.All statistical analyses were performed with the SPSS statistical software package  and MedCalc . A significance level of P <0.05 was considered statistically significant, and all p values were based on two-tailed tests.The two groups’ parameters were compared using Mann-Whitney U test for continuous variables and chi-square tests for categorical variables. Interclass correlation coefficients (ICC) for DTI parameters were calculated for all the enrolled patients to evaluate the two neuroradiologists’ measurement consistency. The Kolmogorov– Smirnov test was conducted to test the normality of DTI parameters. Independent-samples t-tests were used to compare the DTI measurements. Pearson’s correlation coefficient tests were used to analyze the association between DTI parameters and ophthalmologic variables. Receiver operating characteristic (ROC) curves of the DTI parameters (single or combined) were used to evaluate the diagnostic efficiency of discriminating patients with and without DON.Fifty-nine bilateral TAO patients were included in this study. They were classified into the DON  and non-DON  groups. In total, 46 and 72 eyes from the DON and non-DON groups, respectively, were included in the analysis.The degree of inter-observer agreement between the two operators for measuring all DTI parameters was good to excellent (ICC > 0.822) Table 2.The diagnostic performances of DTI parameters are shown in As shown in The detection of early visual function impairment of DON is often challenging due to overlapping symptoms with other conditions and the subjective-nature of existing auxiliary diagnostic tools . We propClinically, a diagnosis of DON is suspected only when distinctive signs, such as decreased visual acuity, occur; however, these signs can overlap with other symptoms and lag behind the really onset of optic nerve damage. Although many other ophthalmologic-psychophysical or electrophysiological markers have been applied, these different methodologies tend to capture different aspects of the disease process and often render false-positive results. Especially in patients with bilateral DON, clinical features such as an afferent pupillary defect or color testing are less useful, whereas the widespread used optical coherence tomography is limited to retinal assessment.In the current study, most of the general clinical measures, including the serum markers of thyroid function, disease duration, and most ophthalmic tests showed no distinct difference between the DON and non-DON groups. In consistent with the findings of Ponto et al. , we founOptic nerve imaging using DTI directly characterizes the directional nature of water motion and reflects subclinical axonal and neuronal loss. It is more sensitive to pathologic changes of nerve fibers, even when no abnormalities are seen on conventional imaging modalities . This stWe found that MD was the single best diagnostic index  among the four DTI parameters, which indicated that the eigenvalues might be more sensitive than FA in quantifying pathology . HoweverAdditionally, we found that DTI measures were correlated with visual acuity and CAS, suggesting that optic neuropathy progression is related to visual acuity and CAS in DON. The CAS represents TAO activity, and a higher score indicates that the disease is at an inflammatory stage. Along with the increased AD, RD, and MD, which reflect enhanced water diffusion, this suggests that inflammation-mediated optic neuritis may play a role in developing neuropathy during TAO. This may partially explain why a large dose of methylprednisolone is recommended as the first-line therapy for DON. In the study by Naismith et al , increasOur study has several limitations. First, the population size was relatively small, which may affect the statistical power; thus, it is difficult to conclude the accuracy of DTI to predict the progression of TAO patients with and without DON. Second, this study applied multi-parametric DTI; future studies using advanced post-processing such as non-Gaussian (diffusion kurtosis) modeling or K-means clustering algorithms may provide additional insights. Third, this was a single-center study, and results from large, multi-center are need to support the role of DTI in the clinical diagnosis of DON. Last, lack of “gold standard” of the pathologic changes of optic nerve, such as histological or immunohistological analyses, making the results is a little less convincing.In summary, DTI measurements within the intra-orbital optic nerve can detect microstructural changes of optic nerves and effectively distinguished TAO with DON from non- DON. With additional data from future larger-scale longitudinal validation studies, DTI measures could prove useful in combination with other imaging and non-imaging biomarkers in identifying patients with TAO at greatest risk for DON and monitoring the effects of treatments administered during the preclinical stage. Moreover, the correlation between DTI parameters of the optic nerve and ophthalmic tests suggests that these parameters play a role as disease indicators. This has significant implications for the study of patients in the early stages of neuropathy, permitting an earlier diagnosis and initiation of medical treatment and enabling clinicians to better manage DON.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.The studies involving human participants were reviewed and approved by the institutional review board of Tongji hospital. The patients/participants provided their written informed consent to participate in this study.JZ and BL: was involved in the conception and design of the study. PL, BL, H-yW, L-hZ, LC, QX-W, and GY: were involved in the data collection. JZ and PL: were involved in the analysis and interpretation of the data. PL: wrote the first draft of the manuscript. JZ, BL, and Gh-J: revising the article critically for important intellectual content. All authors read and approved the final paper.This work was supported by grants from the Youth Program of the National Natural Science Foundation of China (No. 82102004), National Natural Science Foundation of China (No. 81771793), 3D Printing Scientific Research Project Foundation of Guangdong Second Provincial General Hospital (3D-A2021013), Medical Science and Technology Research Foundation of Guangdong Province (A2021220) and the Young Science Foundation of Guangdong Second Provincial General H ospital (2019-QNJJ-01).The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Iatrogenic pseudoaneurysm is common vascular complications of angiographic procedures. Patients with uncomplicated pseudoaneurysms can be managed with ultrasound‐guided techniques. However, for complicated pseudoaneurysms, surgical repair of the artery is mandatory. We report a case of successful repair of complicated pseudoaneurysm using an access‐site closure device, Perclose ProGlide™ without a surgical approach. Management of a pseudoaneurysm with a Perclose ProGlideTM could be an option for the treatment when the pseudoaneurysm has a wide neck or complicated features, which is less invasive and costless. A pseudoaneurysm can develop at any arterial site used for arterial puncture. The most common site for pseudoaneurysm development is the femoral artery, which is used as access for percutaneous‐based diagnostic and interventional procedures. Uncomplicated pseudoaneurysms can usually be managed with ultrasound‐guided compression or percutaneous thrombin injection. However, for complicated pseudoaneurysms and those failing nonsurgical management, surgical repair of the artery is needed.We herein report a case of successful repair of complicated pseudoaneurysm using an access‐site closure device, Perclose ProGlide™ (Abbott Vascular Inc.) without a surgical approach.2A 72‐year‐old man consulted our division because of a femoral artery pseudoaneurysm. The patient had undergone endovascular treatment for left subclavian artery stenosis, for which the access site was the right femoral artery, 4 days before the consultation. Three days after the procedure, the patient complained of right lower quadrant pan, and a blood test showed a decreased hemoglobin (Hb) level from 12.9 to 9.0 g/dl. Computed tomography (CT) was then performed, revealing right‐sided retroperitoneal hematoma extending from the right femoral access site, suggesting a pseudoaneurysm with extravasation Figure .Although duplex echo‐guided compression was performed, follow‐up CT, the next day showed worsening retroperitoneal hematoma and progression of anemia Hb 7.2 g/dl). On that day, systolic blood pressure temporarily dropped to 90 mmHg, but after a transfusion of red blood cells, blood pressure and heart rate stabilized at 122/78 mm Hg and 68 beats/min, respectively. Therefore, the previous team consulted our division. Duplex echo Video  showed a g/dl. OnBecause there was no sign of infection and the patient condition was stable, we decided to perform endovascular repair using Perclose ProGlide™ on the cardiovascular surgery standby. To confirm the location of the pseudoaneurysm, we performed angiography using a contralateral femoral approach and punctured the pseudoaneurysm just below the skin near the previously punctured skin mark under duplex echo guidance. Subsequently, a 0.035‐inch polymer‐coated guidewire  was directly inserted into the pseudoaneurysm. And then, we navigated the guidewire inside the pseudoaneurysm to cross the aneurysmal neck and get into the true lumen of the right iliac artery Figure . After gAfter the endovascular procedure, no recurrence of pseudoaneurysm was observed, and the patient was discharged on postoperative day 4.3Iatrogenic pseudoaneurysm is one of the most common vascular complications of cardiac and peripheral angiographic procedures. The incidence of pseudoaneurysm after interventional procedure ranges from 2% to 6%.For complicated pseudoaneurysm, defined as cases with hemodynamic instability, extensive skin, and subcutaneous damage, or soft tissue infection, the common treatment strategy is open surgical repair.In the literature, only one report has described two cases of successful pseudoaneurysm repair with Perclose ProGlide™.We summarized 6 points of the indication for the management of a pseudoaneurysm with a Perclose ProGlide™; (1) hemodynamic stabilization is possible, (2) the pseudoaneurysm has a wide neck that a guidewire can pass, (3) there is no infectious sign, (4) difficult case to use thrombin injection, (5) it needs under cardiovascular surgery stand‐by, and (6) cardiovascular team discussion organized by both highly experienced cardiovascular physicians and surgeons should be held before the procedure.4Management of a pseudoaneurysm with a Perclose ProGlide™ could be an option for the treatment when the pseudoaneurysm has a wide neck or complicated features, which is less invasive and costless. To conduct this procedure, cardiovascular surgery standby is needed in case of the failure of the procedure, and it is also preferred that the patient condition is stable.The author Tetsuo Yamaguchi is an assistant operator of the procedure and preparation of figures. The author Hideomi Fujiwara is an assistant operator of the procedure and preparation of figures. The author Masanari Kuwabara involved in brief summary of the contribution.The authors declare no potential conflict of interest.Written informed consent was obtained from the patient to publish this report in accordance with the journal's patient consent policy.Video S1Click here for additional data file.Video S2Click here for additional data file.Video S3Click here for additional data file.Video S4Click here for additional data file.Video S5Click here for additional data file.Video S6Click here for additional data file.


It has been hypothesized that fetal prematurity or Intrauterine Growth Restriction (IUGR) could be related to the presence of factor V of Leiden mutation. This mutation is associated with a higher incidence of pregnancy difficulties that can result in preterm birth. The frequency of Leiden mutation was investigated in the group of newborns with a low birth weight below 1500 g over a six-year period from 2015 to 2020. During this period, 339 newborns were tested, of which 42 newborns with V Leiden mutation (12.4%) were detected. The average of its occurrence frequency in the Czech population was determined as 5.0% based on published studies. In our research, the occurrence of the V Leiden mutation was found significantly higher in newborns under 1500 g. At the same time, we did not demonstrate an increased frequency of births at lower gestational weeks, lower birth weight, or an association with sex in newborns with a positive diagnosis of the Leiden V factor. The Leiden mutation  is the most common hereditary cause of thrombophilia in the European population, caused by the resistance of activated haemocoagulation factor V to its inhibitor—activated protein C (APC resistance). This mutation was first described in 1993 .The prevalence in the US and European general populations is 3–8% for the factor V Leiden mutation [The prevalence of heterozygotes in the population is reported to be around 5% in the Czech population, while homozygotes are about 1/5000 ,5,6,7,8.Studies have shown an increased risk of thromboembolism in pregnancy, the puerperium, oral contraceptives, and individuals with the Leiden Factor V mutation ,11,12,13LM is a major cofactor of Budd–Chiari syndrome developing during pregnancy ,15.Circulating microparticles may contribute to the development of thrombosis in carriers of LM .The occurrence of the mutation is associated with the risk of premature births and recurrent spontaneous abortions , while no effect on the incidence of preeclampsia in mothers, foetal hypotrophy, placental dysfunction, foetal IUGR and placental abruption has been demonstrated .The Neonatology Department of the Hospital Ceske Budejovice is one of 12 perinatology centers in the Czech Republic, with a yearly average of 2480 newborns, of which 282 (11.4%) are premature, and 81 (3.3%) are under 1500 g.The determination of the frequency of the mutated factor V Leiden allele in newborns with a birth weight below 1500 g over a six-year period from 2015 to 2020. A higher frequency of this thrombophilia was predicted in this group of newborns.The frequency of the Leiden mutation was retrospectively determined in neonates born with a birth weight of less than 1500 g. This genetic testing was done with the informed written consent of the mother; neonates of both sexes were examined.® SNP Genotyping Assay C__11975250  and LightCycler® 480 II instrument .A venous blood sample without clotting was taken from each neonate in a quantity of 0.5–1 mL into Vacutainer tubes with EDTA, stored in the refrigerator and processed within three days of collection. DNA extraction was performed automatically using a Magcore HF16 device and MagCore Genomic DNA Whole Blood Kit . Mutant and wild-type allele determination was performed using a Real Time PCR kit TaqManInitially, the investigation process was started with the prior informed consent of the mother; subsequently, a study was created where we focused on the analysis of statistical data to verify the validity of the performed examinations. Ethical approval was requested from the ethics committee of Hospital Ceske Budejovice, a.s.The feasibility of the study was approved by the Ethics Committee of the Hospital Ceske Budejovice, a.s., on 28 January 2022 under the number 102/22.The statistical program R was used for the statistical evaluation of the study.t-test. The χ2 test was used to determine the deviation from the Hardy–Weinberg law (p > 0.05).Patient cohorts were compared using the Welch Two Sample t-test.The frequency of occurrence was determined by a one-sample As a reference value for the prevalence of the Leiden V factor in the Czech population, we used published data ,7,8. TheThose whose mothers refused molecular genetic testing for thrombophilic mutations in their offspring;Those who were transferred to another lower type of health care facility before blood was drawn for testing, and those who died before reaching 1500 g.Newborns who met the criterion of <1500 g were born between 23 + 5 gestational weeks and 35 + 1 gestational weeks with birth weights ranging from 470 g to 1500 g inclusive . Of the Gestational age, birth weight at birth and sex were assessed for all newborns . A knownData collection over a six-year period from 2015 to 2020 allowed us to evaluate the results of molecular genetic testing for factor V Leiden mutation in selected newborns. During the period in question, a total of 339 newborns were examined for the above-mentioned indications. The V Leiden mutation occurred during the studied 6 years in 42 newborns, which is 12.4% of the studied cohort with a 95% confidence interval of mean CI =  .The homozygote occurred only once, the other were only heterozygotes found.The expression of the relationship of LM positivity to gestational age is given in p = 0.983).The data showed that the prevalence of factor V Leiden mutation and gestational age at the time of delivery were independent (p = 0.996).The relationship of LM positivity to birth weight is shown in p = 0.574)  .In our study, newborns who had a birth weight below 1500 g were examined for the occurrence of V Leiden mutation. The collection of blood samples from newborns was performed when they reached the weight of 1500 g. It could influence the results due to neonatal mortality. This fact would merit a deeper analysis to see if there is an increased frequency of Leiden mutation in newborns under 1500 g who died in the neonatal period compared to the general population.t-test for comparison of our data with the national reference mean illustrates a significant difference between both groups (p = 0.0002). Consequently, we concluded that the risk of occurrence of the Leiden mutation in newborns under 1500 g is approximately 2.5 times higher. Certainly, this risk should not be overlooked later in life, especially in women, when other cumulative risks are present. The economic benefit of factor V Leiden screening in women prior to contraceptive use in the Czech Republic would be cost-effective [The Leiden mutation is a disease that does not pose an immediate threat to newborns. The increased risk occurs later in women using oral contraceptives. Our research shows the risk of that occurrence. A one-sample ffective . If it iWe focused on the results of thrombophilic mutation V Leiden in newborns with a low birth weight below 1500 g, in whom we could expect an increased incidence of this mutation. We found 12.4% of the incidence over the six-year period where only one was homozygote mutation while the others were heterozygote mutations. We observed a 2.48-fold increase in mean risk compared to the frequency reported in the Czech population. The Leiden mutation was detected at an increased rate in the group of premature newborns with a birth weight below 1500 g.At the same time, we did not demonstrate an effect of the Leiden mutation on gestational age, birth weight or sex.


Maternal and child mortality remains a major public health problem in Ethiopia. Improving short birth interval practice is a main strategy to reduce neonatal mortality, maternal mortality, adverse pregnancy outcomes, high fertility rate, and enhance economic development efforts. However, there has been limited study done regarding short birth intervals in the study area. Therefore, this study aimed to assess short birth intervals and associated factors among women who gave birth in the last three years in Dembecha district, Northwest Ethiopia, 2019.A community-based cross-sectional study was conducted among 880 reproductive-age multipara mothers using a stratified cluster sampling technique. The data were collected by face-to-face interviews through pretested and semi-structured questionnaires. Bivariable and multivariable logistic regression model was fitted. Variables with a p-value ≤0.05 were considered statistically significant factors. Adjusted odds ratio with a 95% confidence interval was used to report the association between predictors and the outcome variable.The prevalence of short birth interval was found to be 43.4% . Husband education (able to read and write) , wealth index (lowest quartile) ,age at first marriage (15–17 years old) [AOR: 1.65,,and non-use of contraceptive [AOR: 8.78,  were statistically significant variables.The study revealed that the prevalence of short birth intervals among multipara women is found to be high. Husband education, wealth index, urban residence, age at first marriage, and non-use of contraceptives were variables significantly associated with short birth intervals. Hence, to overcome the problem the focus should be on increasing family planning utilization, avoiding early marriage, strengthening paternal education, and improving family income. Birth interval is the length of time between two successive live births . AccordiWorldwide, around 25% of births occur at intervals of less than 24 months. About 33% of short birth intervals occur in Central Asian States and it is 57% in Sub-Saharan Africa . In EthiStudies suggested that women who have experienced a short birth interval were prone to several health problems. The problems inflict harm on both mothers and their children. Some of the health problems faced by the mother include: antepartum hemorrhage, anemia, premature rupture of membrane, postpartum hemorrhage, failure of vaginal birth after caesarian delivery, uterine rupture, and maternal death ,6,12–14.Short birth interval i.e. <24 months) increases the infant mortality by 60% as compared to birth intervals of 4–5 years. This is due to an increment of foliate depletion, low birth weight, malnourishment, small for gestational age, suboptimal breastfeeding due to pregnancy overlap, sibling competition, and preterm delivery  months i,8,15. A In addition to health-related complications, a short birth interval is one of the contributing factors for an increment of the total fertility rate and challenges the developmental efforts of a country .Though tIn Ethiopia, there are limited studies done on short birth intervals, particularly in the study area. Therefore, understanding birth interval and its determinants is critical for a country like Ethiopia to design and improve child spacing programs which in turn will improve maternal and child health. Hence, this study was aimed to reveal the prevalence and factors associated with short birth intervals in Dembecha district.A community-based cross-sectional study was conducted from September 20 to October 20, 2019 in Dembecha district. Dembecha district is located in the West Gojjam zone of Amhara Regional State, Northwest Ethiopia,350 km away from Addis Ababa, the capital city of Ethiopia, and 215 km away from Bahir Dar, the capital city of Amhara Regional State. The town has 4 urban and 31 rural kebeles, which are the smallest administrative units of the country. According to the population projection of Ethiopia from 2014–2017, for all regions, the total population of Dembecha district was estimated to be 151,023. Among these, 75,464 were females .The sample size was determined by a single population proportion formula by taking 51.2% proportion of short birth intervals from a previous study conducted in the Oromia region , a 95% cRefers to an interval less than 33 months of a birth interval between the birth of the last child and the immediately preceding live birth to the mother ,19.It is defined as the child born immediately prior to a subsequent child .Those respondents who scored at least 60% of the knowledge questions about a short birth interval correctly were considered knowledgeable .Those respondents who scored above the mean in answering the attitude questions were taken as having a negative attitude towards a short birth interval .Data were collected by face-to-face interviews using a semi-structured and pre-tested questionnaire which was first prepared in English and translated to Amharic and then translated back to English. Nine BSc midwifery degree holders were involved in the data collection while two MSc holders supervised the data collection process in each cluster. Before data collection, written informed consent was obtained from study participants who were over the age of 18 years. Whereas, for those participants who were under the age of 18 years, written informed consent was obtained from their parents/guardians and verbal assent was obtained from study participants for participation. Throughout the course of the data collection, regular meetings were held among the data collectors, supervisors, and the principal investigator. The collected data were reviewed and checked for completeness before data entry and the incomplete data were discarded.The outcome variable for this study was a short birth interval. In this study, only the last birth interval was measured and the last birth was within the last three years to reduce recall bias. This was measured by assessing the length of time between the preceding birth and the current (last) birth. The participants’ answers were categorized according to the WHO-recommended birth interval (33 months) and coded 1 if the birth interval was <33 months and 0 if the birth interval was ≥33 months.The knowledge level of the respondents was assessed using 8 items. The respondents’ level of knowledge about birth interval was reported as good knowledge if the study participants correctly responded to more than or equal to 60% of knowledge assessment tools. The attitude of respondents was assessed using 17 items and categorized as positive if they responded below the mean of attitude-related items.Data were entered into Epi Info version 7.1.5.2 and exported to Statistical Package for Social Science (SPSS) version 20 for analysis. Bivariable and multivariable logistic regression was used to determine factors associated with short birth intervals. Variables with a P-value of less than 0.2 in the bivariable analysis were included in the multivariable logistic regression to adjust for possible confounders. A p-value ≤ 0.05 with a 95% confidence interval for the adjusted odds ratio was used to determine the level of significance.Ethical clearance was obtained from the School of Midwifery under the delegation of the Ethical Review Board of the University of Gondar. A formal letter of cooperation was written to each selected kebeles by Dembecha district health office. Written informed consent was obtained from study participants who were over the age of 18, and assent was obtained from those participants who were under the age of 18, after they had been informed about the objective of the study. In the consent, statements about the potential risk, benefit, and confidentiality were included. Accordingly, the Ethics committee approval was obtained for this written consent..A total of 895 mothers were eligible in the selected kebeles; from which, 880 participants responded or participated in the study, making a response rate of 98.3%. The median age of the respondents was 34 years with an IQR of 8 years. Half (50.1%) of the total participants had no formal education .th (87%) of respondents had antenatal (ANC) follow-ups for the index child. Most of the respondents 590 (67%) delivered their index child at the health institutions. About 568 (66.9%) of the respondents breastfed their child for 24 months and above .More than half (53.4%) of mothers were first married at the age of 15–17 years. A parity of four was seen in 525 (59.7%) of the participants. Four hundred eleven (46.7%) study participants have 3 or 4 alive children. More than half 465 (52.8%) of respondents delivered their index child in the age range of 20–29 years. Over 3/4nd above .((More than three fourths (87.2%) of the respondents had information about short birth intervals, and the main source of information for the majority (66.3%) of the respondents was health care providers. Among the respondents who have information on birth intervals, 67.3% of them mentioned that a short birth interval was considered when it was less than 33 months . From th with 95% CI: and the median birth interval of this study was 36 months with an IQR of 8 months.On bivariable analysis, maternal age, maternal occupation, husband education, residence, wealth index, duration of breastfeeding the index child, age at first marriage, maternal age at delivery of index child, family planning use before conceiving last child, the survival of index child and knowledge of the study participants were significantly associated with a short birth interval at a p-value <0.2. However, husband’s education, wealth index, residence, age at first marriage, and non-use of contraceptives were the factors associated with the outcome variable in multivariable logistic regression.Accordingly, women whose husbands could only be able to read and write were 2.81 times more likely to have short birth intervals compared to those women whose husbands completed college education and above . Likewise, being in the lowest wealth quartile was 3.75  times more likely to have a short birth interval as compared with those in the highest wealth quartile.This study revealed that women who first married at the age of 15–17 years were 1.65 times more likely to have a short birth interval compared to women who married at the age of 18 years and above . Similarly, the odds of having a short birth interval was 3.2 times higher among urban residences  compared with rural residences. Moreover, women who did not use contraceptives were 8.78 times more likely to have short birth intervals as compared to women who used contraceptives  .This study tried to assess the prevalence and factors associated with short birth intervals among women who gave birth in the last three years in Dembecha district.In our study, about 43.4% of women had short birth intervals . This finding is comparable with the study conducted in Debre Markos town which is 40.9% . But, thThis study’s result was lower than the result of studies conducted in Hosanna 57.6%) , Oromia % , OromiIn this study, women whose husbands could read and write but had not completed primary or above level of education were 2.81 times more likely to have short birth intervals after the index child compared to those women whose husbands completed their college education and above. This finding is supported by a study conducted in Dabat district . The posWomen residing in an urban area were 3.2 times more likely to have short birth intervals than women residing in rural areas. The possible reason might be that most rural women breastfeed their newborns exclusively for a longer period than urban women do. Hence, they might benefit from lactational amenorrhea. This reasoning is supported by a study conducted in Niger, which suggested that the median duration of exclusive breastfeeding was only one week amongst urban women contrary to two months among rural women .Women from the families within the lowest quartile were 3.75 times more likely to have a short birth interval than their highest quartile counterparts. This finding is in line with the studies conducted in Arba Minch district in Ethiopia, Bangladesh, and Nepal ,19,26. TThis study showed that women who didn’t use postpartum contraceptives after the index child were 8.78 times more likely to have short birth intervals compared to contraceptive users. This finding is supported by studies conducted in Oromia, south pastoral community, and Dabat district ,6,27.The age of mothers at first marriage had a statistically significant association with short birth intervals. This study revealed that women who married at the age of 15–17 years were 1.65 times more likely to have short birth intervals than women who married at the age of 18 years or above. Similar findings were found in the studies conducted in Bangladesh and Nepal ,26. The This study acknowledged some important possible limitations that should be considered when interpreting the results. As some of the questions are sensitive, social desirability bias might be present, and since they responded to previous birth interval periods, recall bias might be introduced. There might be also a social desirability bias on the declaration of the sex of their child. Lastly, as the reported sex ratio is too low and the percentage of children who died is likely also too low, there could be an omission of male children who died.Short birth interval practice is high in the study area. Factors like, women’s husbands who can only be able to read and write compared to more education, non-use of contraceptives, women found in the lowest wealth quartile, first marriage at 15–17 years, and urban residence were significantly associated with short birth intervals. Therefore, actions should be taken to increase family planning utilization, avoid early marriage, and strengthen paternal education to reduce short birth intervals.S1 Table(DOCX)Click here for additional data file.S1 File(SAV)Click here for additional data file.S1 Appendix(DOCX)Click here for additional data file.


Compared to the non-apparent DR group, the concentrations of seven apolipoproteins were elevated in advanced NPDR/PDR . No significant differences were observed in apolipoprotein concentrations between patients with non-apparent DR and healthy controls (n = 17). In conclusion, the AH concentrations of apolipoproteins AI, AII, CI, CIII, D, E, and H increased in advancing stages of DR, suggesting their role in the pathogenesis of DR, which deserves further examination.An imbalance of plasma apolipoproteins has been linked to diabetic retinopathy (DR); however, there is scarce information regarding their presence in the aqueous humor (AH) and their role in DR. Here, we aimed at analysing the relationship between apolipoprotein concentrations in human AH and the severity of DR. Concentrations of apolipoproteins were measured retrospectively in patients with type 2 diabetes mellitus (T2DM) without DR ( Diabetic retinopathy (DR) is the leading cause for vision loss in the working-age population . ClassicApolipoproteins are important structural components of plasma lipoproteins . BesidesSeveral epidemiological studies revealed that changes in plasma apolipoprotein concentrations are linked to microvascular pathologies in type 1 and type 2 diabetes mellitus (T2DM) –16. Morein vivo [α2-macroglobulin [Although the involvement of apolipoproteins has been described in several diseases, there barely exists any information regarding the presence and function of apolipoproteins in the healthy human retina and in the pathogenesis of DR. Proteomics studies reveal that Apo AI, Apo AIV, Apo E, and Apo J are the major apolipoproteins in the mouse retina . Apo E kin vivo . Furtherglobulin . And impglobulin . Regardiglobulin , as wellglobulin . In anotglobulin . While tConsequently, in this study we aimed at analysing the relationship between apolipoproteins in human AH and the presence and severity of DR. We hypothesize that apolipoprotein levels are altered in early and late stages of the disease. In the present study, we therefore aimed at determining the concentrations of apolipoproteins in the AH of diabetic patients without and with different stages of DR in order to determine stage-specific changes.This retrospective study included 50 patients with T2DM, without or with different stages of DR. Samples of AH of patients undergoing cataract surgery were obtained at the beginning of surgery in the Clinic for Vitreoretinal Diseases, Berner Augenklinik, in Bern, Switzerland. Exclusion criteria included type 1 DM, presence of other ocular disease with the exception of cataract, history of any systemic malignant, vascular or inflammatory comorbidity , presence of a neurodegenerative disease, systemic treatments involving corticosteroids, or immunomodulatory drugs, intravitreal or panretinal laser photocoagulation treatment within six months prior to surgery, vitreous hemorrhage, uveitis, glaucoma, or any concomitant retinal pathology. Additionally, AH samples from 17 healthy controls were also analyzed.n = 23), mild to moderate NPDR , and advanced NPDR/PDR . Assessment of the DR stage was performed on the same day as collection of the biological samples.The stage of DR was independently determined by a graduated ophthalmologist blinded to the study protocol prior to the cataract surgery. This determination was made based on the results of dilated stereo biomicroscopy of the anterior and posterior segments of the eye, macular optical coherence tomography (OCT), and wide field fundus images (Optos®), according to the International Clinical Diabetic Retinopathy Disease Severity Scale . Ocular This study was approved by the local Ethics Committee of the University of Bern (Ref. no 152/08) and performed in fully compliance of the tenets of the Declaration of Helsinki (1964). General informed consent was obtained from all study participants before sample extraction for the use of their biological material and clinical data.μl) were collected by anterior chamber tap via aspiration through a 30-gauge needle and stored at -80°C until analysis. The samples were analyzed simultaneously using a multiplex system. Briefly, magnetic microspheres tagged with a fluorescent label and coupled to a specific antibody were added to the samples. Biotinylated detection antibodies and Streptavidin R-Phycoerythrin were added afterwards and the signal was detected by a flow cytometer equipped with two lasers that detect the microsphere type and quantify the amount of bound antigen. Samples were analyzed with the Bio-Plex Pro™ Human Apolipoprotein Assay Panel , which includes the analytes Apo AI, Apo AII, Apo B, Apo CI, Apo CIII, Apo D, Apo E, Apo H, and Apo J. The plates were read using the Bio-Plex Flexmap 3D system with xPONENT 4.2 software . All procedures were performed following manufacturer's instructions in a blinded manner by an experienced technician.AH samples (200–250 Results are expressed as mean ± standard deviation (SD) as well as median and IQR 25–75 (ng/ml), unless stated otherwise . Outlierp value <0.05 was considered to be significant (two-sided testing). To control the risk of introducing type I errors as a result of multiple comparisons, we applied the Holm correction, which progressively adapts the threshold for rejecting the null hypothesis. The statistical analyses were performed using the open-source software R  and SPSS .The Shapiro-Wilk test was applied to determine normal distribution of the data. Since the data did not show a normal distribution, the nonparametric Kruskal-Wallis test was used for intergroup comparison of continuous data and the chi-square test of independence was used to evaluate variables measured at a nominal level. A Diabetic patients were classified into non-apparent DR (no visible diabetic changes), mild/moderate NPDR  and its receptors [In the present study, Apo AI and Apo H were found to be two of the most abundant apolipoproteins in the AH and showed significant differences between absence of diabetic retinopathy, mild to moderate NPDR and advanced NPRD/PDR. Our results are consistent with a previous publication which reported that Apo H and Apo AI are the most upregulated apolipoproteins in the VF of patients with PDR compared to healthy controls . In the eceptors , 40. Apoeceptors . The fineceptors  found theceptors , 43. Eveeceptors . Howevereceptors , 43. DetFurthermore, the apolipoprotein concentrations in diabetic patients with nonapparent DR were compared to healthy controls. Our results showed that the highest concentrations of apolipoproteins in heathy subjects are Apo H, Apo J, and Apo AI. This result confirms a previous proteomic study in the retinas of C57BL/6 J mice that described Apo AI, Apo AIV, Apo J, and Apo E as the major apolipoproteins . Even thThe present study was focused on determining the differences in apolipoprotein levels on a local level and therefore, serum apolipoprotein concentrations and serum lipids were not measured. Hence the retinal local regulation is probably driven by the retinal glia, i.e. Müller cells  and thusAmong the strengths of this study, we refer to a standardized DR severity assessment  based onIn conclusion, we found that the AH concentrations of apolipoproteins AI, AII, CI, CIII, D, E, and H to be increasing with the progress of DR compared to type 2 DM without DR and healthy controls, suggesting their potential role in the pathogenesis of this disease, which deserves further examination. From a pathophysiological perspective, the upregulation of Apolipoprotein AI may be an attempt to downregulate inflammation, while that of Apolipoprotein H could aim at compensating the overexpression of vascular endothelial growth factor.


Globally, the incidence of necrotizing enterocolitis (NEC) varies between 6 and 15% of all neonates admitted to the neonatal intensive care unit (NICU). Though necrotizing enterocolitis is a multifactorial and life-threatening disease, low birth prematurity is the single cause. Therefore, determining the time to presentation and its predictors of necrotizing enterocolitis were the main goals of this investigation.An institution-based retrospective follow-up study was conducted among 747 low birth weight (LBW) neonates admitted to the neonatal intensive care unit of Felege Hiwot comprehensive specialized Hospital from 1 January 2017 to 30 December 2019. The sample size was calculated by using the STATA package. Data were entered into Epi data version 3.1 and exported to STATA version 14 for analysis. The log-rank test and the Kaplan–Meier estimator were used to display the survival probability and differences between groups. At a significance threshold of 5%, Cox proportional hazard regression was performed to determine the net independent predictors of necrotizing enterocolitis.CI: 0.67, 1.14) with a 6.8%  proportion of necrotizing enterocolitis among low birth weight neonates. Preeclampsia , premature rapture of membrane , perinatal asphyxia , gestational age between 28 and 32 weeks , and birth weigh less than 1,000 g [AHR; 5.45 (95% CI: 3.84–9.12) were the independent predictors of necrotizing enterocolitis.The overall incidence rate was 0.86 per 1,000 person-days (95% Within the first 1–7 days of a newborn’s life, necrotizing enterocolitis was most common. It was discovered that preeclampsia, premature rupture of membrane, perinatal asphyxia, gestational age of 28–32 weeks, and birth weight less than 1,000 g were predictors of its occurrence. Necrotizing enterocolitis (NEC), particularly in preterm and low birth weight neonates (LBW), is a common life-threatening condition in newborns , 2. Its From the newborns delivered in the world, 6–15% of newborns develop necrotizing entercolitis .Necrotizing enterocolitis remains a challenging condition for neonatologists worldwide due to the uncertain pathophysiology and potential treatment options that might raise the morbidity and fatality rate by as much as 50% , 9. It iThe study was conducted at the NICU of Felege Hiwot comprehensive specialized hospital (FHCSH), Amhara regional state, Northern Ethiopia, from 1 April to 1 May 2021, by retrospectively recruiting those LBW neonates, who were admitted from 1 January 2017 to 30 December 2019. Felege Hiwot comprehensive specialized hospital is found in Bahir Dar City, which is the capital city of Amhara regional state and is located 565 km from the capital of Ethiopia.It is one of the referral hospitals in the region and provides tertiary-level neonatal services. More than 5 million people have been served annually. It is organized into different service areas, such as term, preterm, isolation, and procedure rooms with Kangaroo Mother Care and maternal waiting rooms. The NICU ward has 75 neonatal beds with an average annual admission of 3,500 neonates and 900 LBW neonates. Currently, a total of 35 nurses and 12 physicians are working in the NICU, according to the 2021 report.An institution-based retrospective follow-up study was conducted.All LBW neonates who were hospitalized in the NICU of FHCSH between 1 January 2017 and 31 December 2019.The study population included all LBW neonatal records admitted between 1 January 2017 and 31 December 2019, with a gestational age of more than 28 weeks.Low birth weight neonatal charts with incomplete data and not found at the time of data collection were excluded.The STATA version 14 software was used to calculate the sample size by considering the following statistical assumptions: two-sided significant level of 5%, power of 80%, survival probability in the exposed (55%) and non-exposed (45%) groups, survival probability (0.5), the proportion of withdrawal (10%), and one-to-one exposed-to-non-exposed ratio (1:1). Finally, 846 was the calculated sample size for this study.A simple random sampling technique was used to select the LBW neonates’ charts. The LBW neonatal charts were obtained from the medical record office of the FHCSH registration logbook by reviewing the 3-year data from 1 January 2017 to 30 December 2019. The total number of low birth weight neonatal admissions to the NICU over 3 years was actively courted by looking through the Federal Ministry of Registration logbook. A total of 2,716 LBW neonates charts were obtained over these years. The Medical Registration Numbers of the neonates were picked up from the charts and entered into Microsoft Excel 2010 spreadsheets. Then, a computer-generated random numbering system in excel was used to select 846 LBW neonates charts. Finally, the LBW neonate’s charts were chosen following the eligibility requirements by a simple random sampling technique.Necrotizing enterocolitis: it is a condition diagnosed by clinical and radiographic findings and classified according to modified Bell’s criteria .Event: low birth weight neonates diagnosed with necrotizing enterocolitis.Censored: low birth weight neonates without necrotizing enterocolitis.The standardized national neonatal and delivery room registration book served as the inspiration for the data extraction checklist. The content of the checklist incorporates socio-demographic characteristics, predictors of maternal and neonatal, the status of LBW neonates, date of admission, and date of occurrence of an event or censored. The data were retrospectively reviewed by two BSc nurses.p < 0.25 in the bivariate analysis was included in the multivariate Cox proportional hazard regression. The survival time was computed by subtracting the first date of admission from the last date of occurrence of necrotizing enterocolitis (event) or censoring. Finally, the adjusted hazard ratio (AHR) with a 95% confidence interval and p < 0.05 was used to measure the strength of association and identify statistical significance.The data were checked for completeness and consistency before being coded and entered into Epi-data version 3.1, and then exported to STATA version 14 for cleaning and analysis. Continuous data were reported either as mean [standard deviation (SD)] or median [interquartile range (IQR)] after checking for the normality distribution, by the Shapiro–Wilk test, and categorical data were described with frequency and proportion. The outcomes of each participant were dichotomized into failure or censored and the incidence density rate was calculated for the entire study period. The Kaplan–Meier survival curve was used to estimate survival time for those neonates with necrotizing enterocolitis and log-rank tests were employed to evaluate the survival curves of a different categorical explanatory variable. The Schoenfeld residual test and graphical techniques were used to test the necessary assumption of the Cox-proportional hazard regression model. In addition, the Cox-Snell residuals and global fit tests were used to evaluate the overall model adequacy and fineness, respectively. After checking the multi-collinearity and interaction term, each independent predictor variable with a A standardized data collection checklist was used. For the purpose of reorganizing the checklist per registration system in FHCSH, 5% of LBW neonatal charts were updated before data collection. The supervisor and the data collectors received the 1-day training. Five percent of the charts underwent the pre-test. Finally, the researchers have examined all the information gathered to ensure its accuracy and consistency.From the total 846 LBW neonatal charts reviewed, 84.5% fulfill the enrollment criteria of the study and were considered in the final analysis. Out of the total charts, 409 (54.8%) were male charts. The median weight of the LBW neonates was 1,800 g with an interquartile range (IQR) of 650 g. A majority, 571 (67.4%) of LBW neonates at admissions were less than 24 h of age, and a median gestational age of all LBW neonates was 34 weeks with IQR of 5 weeks. Most (85.8%) of mothers were aged between 18 and 35 years and 442 (59.2%) were residing outside Bahir Dar city .From all the reviewed carts, 692 (92.6%) were diagnosed with an additional medical case; the most common one includes sepsis (66.7%), hypothermia (43.2%), respiratory distress syndrome (30.1%), jaundice (11.9%), perinatal asphyxia (PNA) (9.1), NEC (6.8), congenital heart disease (3.1%), and others  .The majority of 456 (61%) women gave birth through spontaneous vaginal delivery. Most of the women had antenatal care (ANC) follow-up at nearby health institutions 661 (88.5%). Of all the mothers enrolled in the study, 15.3, 11, and 5.2% were diagnosed with the obstetric problems preeclampsia, pre-mature rupture of membranes (PROM), and antepartum hemorrhage (APH), respectively. Less than 10% of the mothers were also diagnosed with medical problems, such as HIV, anemia, and chronic hypertension. In this study, 460 (61.6%) women had ≥ 2 pregnancies and 456 (61%) gave birth .CI: 5.2, 8.9). In this study, a total of 747 LBW neonates were retrospectively followed for 5,905.7 person-days with an overall incidence rate of 0.86/1,000 person-days    .In the current study, the incidence rate of NEC among LBW neonates within the first 24 h was 0.83/1,000 person-days and 1–7 days accounted for 1.48/1,000 person-days observations. Similarly, the incidence rate of NEC for LBW neonates with gestational ages of 28–32, 32–37, and ≥ 37 weeks was 1.91, 0.46, and 0.33/1000 person-days observation, respectively .CI: 20.01, 24.81) with SD ± 1.23; while, those LBW neonates from non-preeclamptic women had a mean survival time of 25.91 days  with SD ± 0.36 and the difference was statistically significant at the log-rank test   .CI: 20.84, 25.71) with SD ± 1.24, laid below the Kaplan–Meier graph of those LBW neonates delivered by women who did not face PROM with a mean survival time of 25.66 days  with SD ± 0.38, and the difference was statistically significant at the log-rank test (p = 0.008)  .CI: 46.45, 77.79) than its counterpart with a survival rate of 89.19% . The mean survival time for neonates with PNA was 18.13 days  with SD ± 1.45 and the difference was statistically significant at the log-rank test (p = 0.000)  .CI: 20.74, 24.14) with SD ± 0.87, 26.46 days  with SD ± 0.40, and 27.05 days  with SD ± 0.57, respectively  SD ± 0.01, 74.47%  SD ± 0.05 for birth weight , and 71.29%  SD ± 0.10 for birth weight less than  respectively with the Kaplan–Meier graph difference was statistically significant at the log-rank test (p = 0.000)  was 94.78% (95% = 0.000) .In the bivariate Cox regression, the sex of the neonate, preeclampsia, PROM, APH, maternal anemia, sepsis, jaundice, Respiratory distress syndrome, PNA, Congenital heart disease, maternal age, gestational age, and birth weight were found to be significant predictors. While in the adjusted final Cox regression preeclampsia, PROM, PNA, gestational age, and birth weight had an association with NEC.AHR; 1.92 (95% CI: 1.03–3.58)]. Low birth weight neonates delivered by PROM mothers were 2.36  times more likely to have NEC at any time than LBW neonates delivered by non-PROM mothers. At any time, the risk of developing NEC in LBW neonates diagnosed with PNA was 4.05  times more likely to have NEC than those LBW neonates without PNA. Low birth weight neonates with a gestational age between 28 and 32 weeks were 3.59 times as likely to have NEC at any time as LBW neonates with a gestational age > 37 weeks . In addition, low birth weight neonates born with birth weights of less than 1,000 g were 5.45 times as likely to have NEC at any time as LBW neonates weighing between 1,500 and 2,500 g  (This study showed that the hazard of developing NEC in the LBW neonates delivered by preeclamptic mothers was 1.92 times higher risk than that of LBW neonates delivered by non-preeclamptic mothers [4–9.12)] .p > 0.05) and all of covariates simultaneously . This showed that the proportional hazard assumption met the criteria . This was consistent with the findings of the United Kingdom study (7.5%)  , and Poly (7.5%) . Howevery (7.5%)  and the y (7.5%) . This coy (7.5%) ; additioy (7.5%) , 21, andy (7.5%) . The varBased on this finding, preeclampsia, PROM, PNA, gestational age of 28–32 weeks, and birth weight less than 1,000 g remain the best predictors of NEC. The hazard of having NEC in the LBW neonates delivered by preeclamptic mothers was 1.92 times higher risk than in LBW neonates delivered by non-preeclamptic mothers. This was also similar to an observational prospective study conducted at Uludag University . This miFurthermore, this study found that the risk of NEC in LBW neonates born by PROM mothers was 2.36 times higher than for those neonates born by non-PROM mothers. This study was also supported by a retrospective follow-up study conducted in Saudi Arabia  and ChilFurthermore, the risk of developing NEC in preterm neonates with a gestational age between 28 and 32weeks was 3.59 times higher than that of term neonates, and also those neonates with birth weight less than 1,000 g were 5.45 times riskier to have NEC at any time as LBW neonates weighing between 1,500 and 2,500 g. This also supported studies conducted in Germany and Stockholm , 30. TheThe sample size was calculated by considering statistical assumptions in the STATA package, survival probability in the exposed group 55% and in the non-exposed group = 45%, and the survival probability = 0.5, hence the absence of a similar study in Ethiopia. Some important predictor variables were missed since the study was a chart review.In this follow-up study, the highest rate of occurrence of necrotizing enterocolitis was seen within 1–7 days of neonatal life. The major predictor variables of its time to occurrence were found to be preeclampsia, PROM, PNA, gestational age of 28–32 weeks, and birth weight less than 1,000 g. Hence, stakeholders, such as the Federal Ministry of Health, Regional health Bauru, and health professionals should work on the prevention of above predictor variables to decrease the occurrence of NEC, especially in early neonatal life.The original contributions presented in this study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.The studies involving human participants were reviewed and approved by Institutional review board (IRB) of Bahir Dar University, College of Medicine and Health Science. Written informed consent from the participants’ legal guardian/next of kin was not required to participate in this study in accordance with the national legislation and the institutional requirements. Written informed consent was obtained from the minor(s)’ legal guardian/next of kin for the publication of any potentially identifiable images or data included in this article.TA, MF, AY, AA, and AT had made substantial contributions to conceptualization, methodology, and data curation. TA, TB, GK, BW, TT, GA, KE, and YA actively participated in the write-up, formal analysis, and drafting of the article. All authors gave final approval of the version to be published, and agreed to be accountable for all aspects of the work.


Sag is an important indicator of the operational health of a transmission line, and its timely measurement is of great significance to maintain the stability and reliability of power systems. However, traditional contact measurements may be affected by the electromagnetic interference of conductors. In contrast, measurement methods without direct electrical contact with the subject provide greater portability and flexibility. This paper presents a study of a transmission line sag measurement and simulation based on non-contact electric field sensing. The finite element method was used to analyze the conductor distribution, establish the coupling relationships among the electric field, transmission line, and measurement point, propose a sag inverse calculation model, and assess the impact of the transmission line parameter on the curved drooping measurement. Simultaneously, sag measurement schemes for single-round and dual-circuit lines were designed for multi-conductive lines, and measurement array studies were conducted. The vertical component of the electric field in space measured by the array was obtained, which could be used to perform conductor sag measurement simply and efficiently. The proposed method will facilitate the monitoring of the overhead transmission line status, which is conducive to the effective operation of the entire system. The stability of power systems is a key issue. As reliable power carriers, overhead transmission lines play an important role in long-distance power transmission and distribution. They connect the power supply to the distributed network and users. Therefore, real-time overhead transmission line status monitoring is important to maintain system stability and reliability ,2.Most transmission lines are exposed to the environment and operate in challenging working conditions. Harsh weather conditions threaten line security, thereby endangering the grid ,4. When The traditional sag measurement method generally involves contact, such as tension , inclinaNon-contact measurement equipment does not directly come into contact with the electrical object or affect system operation, nor does it provide portability and flexibility or enable high-frequency measurements . The nonEvidently, the non-contact measurement method depends, to a large extent, on the accurate acquisition of the real-time parameters of the overhead transmission lines ,26,27. TTo obtain stability and reliability, the sag measurement method discussed in this study is based on the sensation of the electric field, that is, the principle of calculating line sag by measuring the electric field. Most non-contact overhead transmission line measurement methods use simple two-dimensional equivalent effects ,27. In cIn response to the aforementioned problems, this article emphasizes using the high flexibility and strong applicability of the finite element method and the characteristics of the actual state of simulating the conductor ,30. By aThis article aims to verify the principles of the measurement method based on the electric field and highlights the issues that need attention when applying the measurement method in multiple scenarios. The main contributions of this article are as follows: (1) Combined with the finite element simulation, the study not only proposes a simple, convenient, and easy-to-operate sag counter-discrimination computing model but also analyzed the impact of the transmission line parameters on the sag measurement. This is conducive to proving the sag measurement proposed and verifying the feasibility of the method. (2) Multi-scenario distribution was considered so that the proposed measurement method is more extensive and can be applied to transmission lines of any structure. Further, this measurement method only requires the vertical electric field component and the basic structure of the lines measured by the horizontal array and can simply and efficiently implement conductive sag measurements to ensure a safe and reliable transmission line operation.Before the inversion calculation and sag measurement, this study first established an electrostatic coupling model for forward calculation. The measured electric field value of the measuring point under the conductor was calculated from the parameters of the transmission line. We assume that the transmission line is suspended above the ground with a uniform load, and the conductor is simulated by a line charge located at its center.Each conductor in the overhead transmission lines is composed of multiple stranded conductors a. To avor, as shown in (1), where n0 is the number of conductor splits, r0 is the radius of sub conductor, and R is the geometric radius of sub conductor arrangementFor the bundle lines, the conductor radius can be calculated with the equivalent radius Generally, power transmission lines are erected in nearly periodic catenaries. Considering the details, the impact of the catenary on the electric field amplitude is evident. The effect of the weight on the line can be determined to obtain the basic contact mesh structure of a single-conductor catenary geometry  22]..22].Z axis [S is the sag of the conductor, d is the span length, and h is the minimum height.An approximate contact network equation was previously established, where the transmission line was located in the XZ plane and symmetrically distributed relative to the Z axis . This reλ(r’) is the wire charge density which depends on the voltage of the conductor. The integral is calculated on the curve C(r’), which defines the catenary, and M = |R| = |r − r’|, where r is the position of the measured point in space and r’ is the position of any point on the curve  and the image underground line C2(r’). The former expression then becomes:x, y, z) are the spatial coordinates of the point to be tested on the ground and  are the coordinates of any point of the wire. y’0 is the constant position of the single-direction line on the Y axis. Here, y’0 = 0.When the single conductor line is placed over a flat ground, an image line specularly symmetric to the air–ground interface plane has to be introduced to take into account the boundary conditions of the electric field and electric current in the conductive ground. The electric field over the ground is given by the superposition of the electric field generated by the actual catenary line It is enough to use the voltage of the single conductor line to obtain The measurement point discussed in this article is considered to be in the middle of the conductor, and the line span length is much greater than the minimum line height , the electric field at P is expressed as:The common practice is to assume that power line conductors are straight horizontal lines and parallel to the flat ground. The “average” height is taken between the maximum and minimum heights of the line, ignoring the sag caused by the line weight . To simph = H − S)  .Applying the same method used for a catenary single conductor line, we can calculate the electric field created by a horizontal single conductor line located at a height above the ground:We can obtain:The field created by the horizontal conductor lines is:Therefore, the electric field at point P was generated by a horizontal line on the ground, which can be expressed as:Based on the numerical analysis, we can obtain the accurate calculation of the electric field generated by a single power transmission line. However, electric fields of transmission lines can be obtained through other methods, such as finite elements, limited differentials, or charge simulation. Here, the mathematical treatment of the finite element method is more convenient and we only need to obtain an approximate solution to compare the electric field created by a single catenary with that created by a single horizontal line.Assuming that the parameters of the single line were the same, the catenary, maximum horizontal line, and minimum horizontal line were simulated and the electric field values generated by them at P were calculated. The essence of the sag inverse calculation was based on the distribution of the electric field of the line to establish the relationship between the conductor sag and electric field distribution. The sag was achieved by collecting electric field data generated on the ground during the transmission line operation.F represents the functional relationship between E and S, and F−1 represents the counter-function):From Equations (10) and (16), it can be seen that there is a monotonous incremental relationship between the electric field value and sag of the power transmission lines. Correspondingly, the sags can be deduced in reverse by measuring the electric field value, as follows  and the point position  are known, the conductive sag is calculated by measuring the electric field value.According to numerical analysis, the measured value For a single line, the measured point discussed in this article was selected under the middle of the conductor: Although there is a monotonous relationship between the conductive sag with the electric field, it is non-linear. In order to make sag measurement more convenient and easier to operate, the similar relationship between the sag and electric field can be further simplified to the calculation function without considering too much accuracy. Due to multiple large-scale operations and geometric conductor coupling state simulations, we used the finite element method for this purpose in the article. A similar functional relationship between the sag and electric field was obtained by calculating the simulation electric field values corresponding to the sag and then fitting the simulation curve . In appld was 300 m, tower height H was 20 m, and wire voltage was 110 kV. The functional relationship corresponding to the fit curve is:S is the sag and E0 is the electric field at P; moreover, a = 21.31, b = −1.871 × 104, and c = 1270.Here, the span length λ(r′) in the formula depended on the voltage of the conductor. That is, the power field strength was proportional to the wire voltage. On this basis, the density of the line charge was calculated first. The wire charging density of the unit conductor voltage was λ0(r′). Subsequently, Equation (18) becomes:y represents the sag and x represents the electric field under the unit conductor voltage.Through an analysis of the electric field, it was determined that the wire charge density A, B, and C. Among them, A is the most influential. A, B, and C are related to the configuration parameters of the transmission line. If the line configuration remains unchanged, the stronger the electric field and the greater the sag. Therefore, the sag measurement of the transmission line is also affected by the different degrees of line parameters.The sag is not only related to the electric field value but is also affected by coefficients 1 > L2 > L3, S1 = S2 = S3 = S).A smaller longitudinal distance from the wire would result in a greater electric field value. The influence of the span length on the cross-central electric field was extremely low, and the electric fields generated by the wires of different lengths were approximately identical, as the wire length was much greater than the distance from the measurement point to the wire, resulting in the wires contributing less to the electric field.The effect of the research span length on the calculated electric field can be obtained by considering the change in span .1 > L2 > L3, S1 > S2 > S3) [Let us assume that the sag decreases with decreasing span (LS2 > S3) . SubsequIn this case, the span length has a greater effect on the cross-medium-down electric field. In addition, the electric fields generated by the wires of different lengths are significantly different. A larger span length would result in a greater peak electric field being generated by the wire. Therefore, the effect of the sag is greater than that of the span .A, B, and C. Assuming that the height of the tower remained unchanged (H = 20 m), the simulated spans of different lengths and electric fields under different sags were calculated to obtain the coefficient values and analyze the relationships between the span length and coefficients. The simulation sizes of A, B, and C corresponding to different span lengths are shown in The effect of the span length on the sag measurement is mainly reflected in A, B, and C were approximately 2.04%, 3.33%, and 10.2%, respectively. A, B, and C were less affected by the span length, their values were slightly changed, and each coefficient had no evident functional relationship with the span growth.When the line was transformed in the range of 100–500 m, the maximum change rates of Therefore, when the electric field value was fixed, the wire length increased, and the corresponding sag changes were small. Thus, we can regard the sag as remaining unchanged. This simulation result is in agreement with the theoretical analysis.H1 > H2 > H3)  .The effect of the height of a single-rooted conductor tower (maximum line height) on the electric field is shown in A lower tower height would result in a stronger nearby field. This relationship is due to the decreases in the distance and the maximum height of the line, which reduces the gap between the line and P1.A, B, and C, it was assumed that the span lengths of the wires were unchanged (d = 300 m). Each parameter value can be obtained by calculating the electrical fields at different towers to analyze the relationships between the tower height and parameters. The simulation sizes of A, B, and C corresponding to different tower heights are shown in To study the effects of the tower height on A, B, and C gradually increased as the tower height increased from 12 to 28 m. The fit curves were obtained through the approximate functional relationships between the fitting coefficients and tower height  for a single-conductor catenary line , the effect of This article analyzes the effects of the line parameters on sag measurement based on the finite element simulation, which directly reflects the change of line parameters on the coefficients in Equation (19). It can be concluded that the impact of the tower height on the sag measurements was greater than the impact of the tower height differences on the sag measurements, which was in turn greater than the effect of the span length. It is worth noting that by analyzing the changing trend of the line parameters of the equation coefficients, we can verify the methods proposed. In other words, the principle of measuring sags using electric field countermeasures is feasible.There are three main distribution methods for high-voltage overhead lines: horizontal, triangular, and double-back vertical arrangements . Single-In the case of multiple conductors, the induction charge on each conductor was calculated using the potential coefficient . For theUnder normal circumstances, the voltage amplitude of each phase of the transmission line was equal, and the corner lagged by 120°. Therefore, the wire voltage changed periodically .The catenary line is equivalent to an infinitely long conductor line for simplicity . Its heieU is the effective amplitude of the wire voltage, r is an equivalent conductor radius, and h is the distance from the lowest point to the ground. iR is the distance from the center point of the equivalent guide contour on the ground.In this case, the electric field generated by the single-conductor catenary on the ground is based on the calculated electric field of an unlimited horizontal straight line:n represents the number of conductors.According to superposition technology, the electric field generated by the multi-conductor suspension lines on the ground is given as:When using an unlimited long model for inverted sag calculations, the unknown variable needs to be obtained according to the number of conductors to determine the number of measurement points and their locations.When the voltages and guide positions are determined for single-round lines, the sag calculation contains one unknown variable if the verticality of each phase wire is consistent, and three if the verticality is considered inconsistent. The sensors can be placed parallel to different positions under the horizontal ground so that a phase conductor can measure the space field, as shown in The direction of detection is generally parallel or vertical with respect to the main axis direction of the sensor because the current existing electric field sensors can only detect one- or two-dimensional power field intensities. Therefore, the vertical component of the electric field was measured in this study for simplicity and convenience.D is the horizontal distance between the wires of each phase, and h is the distance from the lowest point to the ground (AE, BE, and CE.e ground . The eleh = H − S. The electric field at P can be expressed as:If the height of the equivalent conductor to the ground is constant, then AE = CE, and the electric field at P is the vertical component of the electric field:According to symmetry, Ah, Bh, and Ch, where Ah = H − AS, Bh = H − BS, and Ch = H − CS. Here, the vertical components of the electric field at P are:If the verticality of the three-phase wire is not equal, the distances from the lowest points to the ground are Similarly, the vertical components of the electric fields at P1 and P2 are, respectively:D1 and D2 are the horizontal and vertical distances between the wires, respectively. The electric fields generated on the ground are AE, BE, and CE.In The same method is used for the horizontal arrangement. If the verticality of the three-phase wire is equal, the electric field at P is given as:nE is the vertical component of the electric field measured at the nth metering point. nF is the measurement matrix between the nth metering point and vertical values of each phase. After obtaining this information and other data, such as the voltage, the sag can be calculated by measuring the electric field component. Therefore, the measurement array can be set up, and the counter-exploring calculation of the three-phase line sag can be achieved. The connection between sag and electric field can be expressed as:n = 3.If the verticality of the three-phase wire is not equal, the vertical components of the electric fields at P1 and P2 are:When the voltages and conductors are determined for dual-round lines, the sag calculation contains one unknown variable if the vertical degree of each phase wire is consistent and six unknown variables if the verticality is considered inconsistent. The sensor can be placed in parallel at different positions on the horizontal ground under the conductor to measure the spatial field . The thrD3 is the vertical distance between the wires.AE, BE, and CE. Similar to the single-round line measurement method, the expression of the electric field at P is shown below if the verticality of the three-phase wire is equal:The electric fields generated on the ground are Y refers to the horizontal distance from the measurement point on the ground to the wire. The horizontal distances are D4, D4 + Y0, and D4 + 2Y0 (If the verticality of the three-phase wire is not equal, the vertical components of the electric fields at P1 and P2 are:D4 + 2Y0 . Figure D4 and the valid amplitudes of the voltage passes are the same (The electric field at the ground measurement point is equal to the superposition of the electric fields generated by the three-phase conductive lines on both sides of the three-phase wires that are distributed with a dual vertical arrangement. The horizontal distance of the wires between the two sides is 2the same .n = 6.In this case, the spatial field of the parallel measurement points is on the horizontal ground. Six measurement points are selected if the vertical values of the dual-round wires are considered differently. The measured electric fields at each point are similar to those in the unilateral vertical arrangement, forming a measurement array. This characteristic can be expressed as:If the sags of the wires on both sides are considered equal, the electric field only needs to be measured at one point to determine the sag, such as at P. According to symmetry, its electric field is given by:The general calculation process for multi-conductor sags is shown in nF to reduce the ill-posed characteristics and calculation error of the inversion problem.If the vertical degree of each wire is considered consistent, then a position point can be selected on the ground. The effective wire height used to calculate the sag can be obtained by measuring the vertical component of the electric field. If the verticality of each wire is considered inconsistent, then the positions on the ground equal in number to that of the conductors are selected. The effective height of each wire is determined by measuring the vertical component of the electric field at each point to calculate the wires corresponding to each sag drooping value. The position of the measurement point is generally selected according to the condition parameters of the measurement matrix In this study, we conducted research on transmission line sag measurement and its simulation based on non-contact electric field sensing. The coupling relationships among the electric field, transmission line, and measurement point were established by analyzing the electric field distribution of the ideal horizontal and actual catenary conductors. In addition, an inverse sag calculation model was proposed.The effects of the transmission line parameters, including the span length, tower height, and tower height difference, were studied according to the principle of sag measurement. It can be concluded that the effect of the tower height on the sag measurements was greater than that of the tower height difference, which was in turn greater than that of the span length. The line arrangement and sag measurement schemes of single- and dual-round lines were designed, and array research was performed for a multi-conductor line. Additionally, a multi-conductive sag measurement method was proposed. This method only requires the vertical component of the measured electric field and relative positions of the array and conductor to be determined; thus, transmission line sag measurement can be performed simply and efficiently.The method proposed in this article has the advantages of adaptability and tolerance and allows for convenient operation. Not only does the theoretical aspect of the study agree with the finite element simulation to verify its feasibility, but it also considers multi-scenario distributions and indicates that the proposed theory can be applied to transmission lines of any structure. However, it should be noted that this method is still restricted in practical applications due to limitations in the actual environment, such as the effect of the tower on the line charge and the weather on the surrounding line. We can eliminate the effects of these factor variations on the results through field calibration and periodic multiple measurements. Specific implementation options, including measurement accuracy and performance assessment, will be considered in subsequent sensor design research. In general, this approach provides a wealth of reference information for the actual research, design, development, and application of transmission lines.


Congenital chylothorax (CC) is an uncommon congenital disease. The objective of this study was to analyze the clinical features, treatment, and outcome of infants with CC in a Chinese tertiary medical center.CC was defined as a non-traumatic pleural effusion with ≥ 80% lymphocytes detected before birth or within 28 days after birth. Clinical data were collected in CC infants discharged from June 2017 to March 2021.+4 weeks (range 29+5–41 weeks) and the birth weight was 3025 g (range 1850–4250 g). Twenty-one infants were diagnosed antenatally. The median gestational age at the time of diagnosis was 30+3 weeks (range 24–36+6 weeks). Nine infants presented with hydrops fetalis; 18 were bilateral. Prenatal interventions were performed in 13 fetuses. Nine infants (38%) had birth asphyxia. Compared with the infants without hydrops fetalis, the infants with CC and hydrops fetalis had lower Apgar scores at 1 and 5 min (P < 0.05) and a lower gestational age at birth (P < 0.05). Postnatally, 17 infants required continuous pleural drainage for 10 days (range 2–30 days). Analysis of the pleural effusion showed a higher cell count, lymphocyte fraction, and protein content after enteral feeding (P < 0.05). Fifteen infants required mechanical ventilation; 9 did not require any respiratory support. Ten infants received a delayed feeding strategy and 17 received a medium-chain triglyceride (MCT) formula. Only 1 infant received octreotide therapy. Twenty-one infants survived and 3 died. The main cause of death was pulmonary dysplasia. The duration of hospital stay in survivors was 21.5 days (range 10–43) days. For infants with CC and hydrops fetalis, prenatal therapy shortened the duration of pleural drainage and the length of hospital stay (P < 0.05).A total of 24 CC infants were discharged during the study period, accounting for 67% of congenital pleural effusions. The median gestational age at birth was 36CC is the most common cause of congenital pleural effusions. The poor prognosis is mainly associated with prematurity, hydrops fetalis, and pulmonary dysplasia. Prenatal intervention may improve the outcome of infants with hydrops fetalis. Congenital chylothorax (CC) refers to the accumulation of pleural lymph fluid, which can be caused by direct leakage of lymph from the thoracic duct, or by overproduction or by obstruction of drainage . It is eCC can be detected in the fetal or neonatal period. In the fetal stage, the accumulation of pleural effusion increases intrathoracic pressure, resulting in decreased fetal swallowing of amniotic fluid, which in turn leads to polyhydramnios and preterm labor. Fetal chylothorax may also increase the risk of death and complications from lymphatic accumulation in the pleural space, which compromises lung development, and pulmonary and cardiovascular function, and leads to complications caused by loss of draining lymphatic content. Indeed, prenatal intervention might improve survival of premature infants with CC , 3. The In this study, we analyzed the demographic data, clinical features, treatment, and outcomes of CC infants over the past 4 years in the Children's Hospital of Nanjing Medical University, a tertiary children's hospital in Jiangsu province, to determine the clinical characteristics of CC.This was a retrospective study approved by the Medical Ethics Committee of the Children’s Hospital of Nanjing Medical University. All neonates (≤ 28 days of age) discharged from the Neonatal Medical Center at the Children’s Hospital of Nanjing Medical University from June 2017 to March 2021 were identified from the medical database. Infants diagnosed with a pleural effusion or chylothorax were retrospectively reviewed. The diagnosis of chylothorax was based on an analysis of the pleural effusion, in which the white blood cell count was > 1000/μL and the lymphocyte fraction ≥ 80% , 5. CC wDemographic data, perinatal management, and clinical outcomes were collected and analyzed. Perinatal management included prenatal diagnosis, prenatal intervention, intrapartum management, and postnatal therapy. Prenatal intervention included thoracocentesis (TC), thoracoamniotic shunting (TAS), and pleurodesis. Intrapartum management refers to neonatal management provided upon delivery before the umbilical cord is cut and the fetal-placental unit is still functioning. Postnatal therapy included respiratory support, effusion drainage, nutritional support, and surgical intervention.p-value < 0.05 was considered statistically significant.Data were processed using SPSS software (version 23.0). Non-normal distributed data are reported as a median (range). Count data are expressed by the number of cases and the percentage (%). The t-test was used for comparing continuous variables and the chi-square test or Fisher’s exact test was used for comparing categorical variables. All statistical tests were two-tailed and a +4 weeks (range 29+5–41 weeks) and the median birth weight was 3025 g (range 1850–4250 g). There were 11 full-term and 13 premature infants (5 < 34 weeks gestation and 1 < 32 weeks gestation). Eight infants were delivered vaginally and 16 by caesarean section. Nine infants (38%) had birth asphyxia, including 8 with mild asphyxia and 1 with severe asphyxia. The median Apgar score was 8 (range 3–10) at 1 min and 9 (range 6–10) at 5 min.A total of 52 infants with pleural effusions were collected during the study period, including 36 with congenital pleural effusions and 16 with acquired pleural effusions, of which 24 were identified as CC and 5 had acquired chylothorax. CC accounted for 67% of congenital pleural effusions and 83% of all chylothorax. Among infants with CC, 13 were males and 11 were females. The median gestational age at birth was 36+3 weeks (range 24–36+6 weeks). Nine infants (38%) presented with hydrops fetalis. Effusions were bilateral in 18 infants, unilateral in 6 infants (2 on the left and 4 on the right). Prenatal intervention was performed in 13 infants (54%). All 13 infants received TC as an initial procedure and 8 received TAS due to re-accumulation of fluid. The median interval between the first intervention to delivery was 14 days (range 3–56 days). Thirteen infants, including 2 non-survivors, had chromosome examinations antenatally that revealed no abnormalities.Twenty-one infants (88%) were diagnosed antenatally at a median gestational age at the time of diagnosis of 30P < 0.05) and gestational age at birth (P < 0.05). No differences existed with respect to other ante-, intra-, and post-partum factors. The in-hospital survival rates in infants with and without hydrops were 78% and 93%, respectively.We compared the clinical features of infants with or without hydrops, as shown in Table P < 0.05).Fourteen infants (54%) received endotracheal intubation and 2 (8%) received TC immediately after birth in the delivery room. After birth, 6 infants only received TC and 17 needed continuous pleural drainage with a median duration of 10 days (range 2–30 days). Analysis of pleural effusions before and after enteral feeding was performed in 16 and 13 infants, respectively. Pleural fluid was clear in unfed infants, but appeared creamy in fed patients. The characteristics of the pleural effusions are described in Table 2O (range 10–19cmH2O) and the median duration of MV was 7 days (range 1–16 days). Nine infants did not require any respiratory support. Six infants (25%) developed pneumothorax and 3 occurred within 24 h after birth. Surfactant instillation was provided to 7 infants (29%). All the infants with a gestational age ≤ 34 weeks at birth were treated with MV and surfactant instillation.Fifteen infants (63%) required mechanical ventilation (MV), including 4 using a high-frequency ventilator and 4 using inhaled nitric oxide. The maximal mean airway pressure was 11.3 cmHTen infants (42%) received a delayed feeding strategy. The median enteral nutrition start time was 6 days (range 5–10 days). Seventeen infants (71%) received a medium-chain triglyceride (MCT) diet at some time during the course of treatment. The patients were converted to normal formula or breastfeeding with a median time of 4 months (range 1.5–12 months) after ultrasound showing that the pleural effusion did not recur. Recurrence of pleural effusion appeared in 2 infants during conversion.Thirteen infants (54%) received albumin replacement therapy, 9 (38%) received immunoglobulins, 13 (54%) received fresh frozen plasma, and 3 (10%) received a blood transfusion. Only 1 infant received octreotide therapy (1–3 μg/kg/h) for 3 weeks. No potential adverse effects were noted.Twenty-one infants (88%) survived and 3 (12%) died. Two infants died of pulmonary dysplasia. Another infant was difficult to withdraw from the ventilator and the guardian requested to discontinue treatment; the infant died 2 days later. The mean duration of hospital stay in survivors was 21.5 days (range 10–43 days).P < 0.05).Because hydrops fetalis is a severe form of CC, we compared the clinical parameters in CC infants with hydrops fetalis who did or did not receive prenatal therapy Table . Indeed,CC can occur alone or in combination with genetic syndromes and other anomalies . The mosPrematurity, hydrops fetalis, and pulmonary dysplasia are related to a poor prognosis in infants with CC, and the most common reason for death is pulmonary dysplasia . In our The goal of prenatal interventions is to reduce the mass effects of pleural effusion, and to reduce the risk of pulmonary dysplasia. Prenatal interventions include ultrasound-guided fetal TC, TAS, and pleurodesis. Although there are no randomized controlled trials, retrospective data support that prenatal intervention improves perinatal survival , 3, 14, Postnatal management of CC includes respiratory support, pleural drainage, nutritional management, and surgery. The choice of treatment regimen depends on the response to treatment by assessing the daily amount of thoracic drainage and the degree of interference with pulmonary function .The majority of CC infants need ventilatory support to treat CC-related respiratory failure in the neonatal period. Both conventional and high-frequency ventilation have been used; however, it is difficult to compare the effectiveness of the various ventilation modes in the treatment of CC. High-frequency oscillatory ventilation (HFOV) has been suggested in severe cases because HFOV improves lung opening and volume maintenance, possibly shortening lymph flow over time . In our The purpose of nutritional management is to decrease lymphatic flow. Treatment options include a delayed feeding strategy and MCT formula. Long-chain fatty acids are transported in the form of chylomicrons by the lymphatic system. High fat intake increases lymphatic flow significantly. An MCT formula contains little-to-no fat, thus by passing intestinal lymphatic processing and are absorbed directly into the portal venous system . An MCT Octreotide is a somatostatin analogue that is also commonly used to reduce lymphatic flow. Octreotide is introduced when pleural drainage and diet modification are ineffective. The recommended therapeutic dose and response of octreotide reported in the literature are mixed, often with intravenous infusion at a starting dose of 1 μg/kg/h and gradually increasing to 10 μg/kg/h, according to the therapeutic response , 20. SidTamaoka et al.  successfStreptococcus pyogenes with immunological activity and is often used to induce aseptic inflammation of the pleura [Surgical intervention, including chemical pleurodesis, is the final treatment to cure CC. Most CC infants achieve complete remission 3–4 weeks after birth. Surgical intervention should be considered around 6 weeks when conservative treatment fails . OK-432 e pleura . In addie pleura .Our study summarized the experience of our center in the treatment of CC over the past four years. There was a higher survival rate, which may be related to improvements in prenatal diagnosis and interventions in recent years. There were some limitations in this study. First, this was a retrospective study and the data collection was incomplete. Second, we did not follow the assessment of neurologic development. Third, there were no cases of pleurodesis in our study and octreotide therapy was conducted in only one case, thus the relevant clinical experience was insufficient. We need additional prospective population-based epidemiologic, treatment and outcome data on CC.