Imaging features, clinical characteristics and neonatal outcomes of pregnancy luteoma: A case series and literature review.

INTRODUCTION: This study aimed to investigate the imaging features, clinical characteristics and neonatal outcomes of pregnancy luteoma. MATERIAL AND METHODS: We retrospectively analyzed patients with pregnancy luteoma admitted to the First Affiliated Hospital of Sun Yat-sen University between January 2003 and December 2022. We recorded their imaging features, clinical characteristics and neonatal outcomes. Additionally, we reviewed relevant studies in the field. RESULTS: In total, 127 cases were identified, including eight from our hospital and 119 from the literature. Most patients (93/127, 73.23%) were of reproductive age, 20-40 years old, and 66% were parous. Maternal hirsutism or virilization (such as deepening voice, acne, facial hair growth and clitoromegaly) was observed in 29.92% (38/127), whereas 59.06% of patients (75/127) were asymptomatic. Abdominal pain was reported in 13 patients due to compression, torsion or combined ectopic pregnancy. The pregnancy luteomas, primarily discovered during the third trimester (79/106, 74.53%), varied in size ranging from 10 mm to 20 cm in diameter. Seventy-five cases were incidentally detected during cesarean section or postpartum tubal ligation, and 39 were identified through imaging or physical examination during pregnancy. Approximately 26.61% of patients had bilateral lesions. The majority of pregnancy luteomas were solid and well-defined (94/107, 87.85%), with 43.06% (31/72) displaying multiple solid and well-circumscribed nodules. Elevated serum androgen levels (reaching values between 1.24 and 1529 times greater than normal values for term gestation) were observed in patients with hirsutism or virilization, with a larger lesion diameter (P < 0.001) and a higher prevalence of bilateral lesions (P < 0.001). Among the female infants born to masculinized mothers, 68.18% (15/22) were virilized. Information of imaging features was complete in 22 cases. Ultrasonography revealed well-demarcated hypoechoic solid masses with rich blood supply in 12 of 19 cases (63.16%). Nine patients underwent magnetic resonance imaging (MRI) or computed tomography (CT), and six exhibited solid masses, including three with multi-nodular solid masses. CONCLUSIONS: Pregnancy luteomas mainly manifest as well-defined, hypoechoic and hypervascular solid masses. MRI and CT are superior to ultrasonography in displaying the imaging features of multiple nodules. Maternal masculinization and solid masses with multiple nodules on imaging may help diagnose this rare disease.

Ultrasound in the prediction of birthweight discordance in dichorionic twins.

INTRODUCTION: Large birthweight discrepancy has been identified as a risk factor for perinatal morbidity and mortality in twin pregnancies. However, it remains unclear whether such discordance can be predicted by various biological indices with specific cut-off values, and how these depend on the gestational age. We aimed to determine the most effective way to predict large birthweight discordance at various gestational ages. MATERIAL AND METHODS: A retrospective cohort study of dichorionic twins, live-born between 2008 and 2018, was conducted. Discordances in biparietal diameter, head circumference, humerus and femur length, abdominal circumference, and estimated fetal weight were calculated-([larger twin - smaller twin] / larger twin) × 100%-and compared between those with and without a large birthweight discordance (≥20%). Receiver operating characteristic curves were constructed to analyze the predictive characteristics of each parameter. RESULTS: Of 598 dichorionic twin pregnancies included, 83 (13.9%) had a birthweight discordance ≥20%. Group differences in biparietal diameter and head circumference discordance were the earliest to emerge (before 20 weeks of gestation), but became insignificant after 36 weeks, followed by humerus and femur length, estimated fetal weight discordance (after 20 weeks), and abdominal circumference discordance (after 28 weeks). The best predictors (with cut-off values) were discordance in biparietal diameter ≥7.8% at <20 weeks, head circumference ≥4.5% at 20-23+6  weeks, humerus length ≥4.5% at 24-27+6  weeks, and estimated fetal weight discordance (≥11.6% at 28-31+6  weeks, ≥10.5% at 32-35+6  weeks, and ≥15.0% ≥36 weeks), with sensitivity and specificity of 52%-77% and 69%-82%, respectively. CONCLUSIONS: Different predictors and cut-off values may be useful for predicting large inter-twin birthweight discordance in dichorionic twins at different gestational ages. It is more accurate to use biparietal diameter and head circumference discordance in the early second trimester, humerus length discordance in the late second trimester, and estimated fetal weight discordance in the third trimester.

How to Integrate Labor Disruption into an Economic Impact Evaluation Model for Postdisaster Recovery Periods.

Evaluating the economic impacts caused by capital destruction is an effective method for disaster management and prevention, but the magnitude of the economic impact of labor disruption on an economic system remains unclear. This article emphasizes the importance of considering labor disruption when evaluating the economic impact of natural disasters. Based on the principle of disasters and resilience theory, our model integrates nonlinear recovery of labor losses and the demand of labor from outside the disaster area into the dynamic evaluation of the economic impact in the postdisaster recovery period. We exemplify this through a case study: the flood disaster that occurred in Wuhan city, China, on July 6, 2016 (the "7.6 Wuhan flood disaster"). The results indicate that (i) the indirect economic impacts of the "7.6 Wuhan flood disaster" will underestimate 15.12% if we do not consider labor disruption; (ii) the economic impact in secondary industry caused by insufficient labor forces accounts for 42.27% of its total impact, while that in the tertiary industry is 36.29%, which can cause enormous losses if both industries suffer shocks; and (iii) the agricultural sector of Wuhan city experiences an increase in output demand of 0.07% that is created by the introduction of 50,000 short-term laborers from outside the disaster area to meet the postdisaster reconstruction need. These results provide evidence for the important role of labor disruption and prove that it is a nonnegligible component of postdisaster economic recovery and postdisaster reduction.

Chromosomal aneuploidies and copy number variations in posterior fossa abnormalities diagnosed by prenatal ultrasonography.

OBJECTIVE: To explore the genetic aetiology of fetal posterior fossa abnormalities (PFAs). METHODS: This study involved cases of PFAs that were identified by prenatal ultrasonographic screening and confirmed postnatally between January 2012 and January 2016. Conventional cytogenetic analyses and chromosomal microarray analysis were performed, and chromosomal aneuploidies and copy number variations (CNVs) were identified. RESULTS: Among 74 cases included in this study, 8 were of Blake's pouch cyst; 7, Dandy-Walker malformation; 11, vermian hypoplasia; 32, enlarged cisterna magna; and 16, cerebellar hypoplasia. The rates of nonbenign chromosomal aberrations (including chromosomal aneuploidies, pathogenic CNVs, and variants of unknown significance) were 2/8 (25.0%), 2/7 (28.5%), 8/11 (72.7%), 7/32 (21.9%), and 6/16 (37.5%), respectively. Cases were also classified as isolated PFAs (30/74), PFAs with other central nervous system (CNS) abnormalities (13/74), or PFAs with extra-CNS structural abnormalities (31/74). No fetuses with isolated PFAs or PFAs accompanied by other CNS abnormalities exhibited chromosomal aneuploidies or pathogenic CNVs. The rate of pathogenic chromosomal aberrations in the remaining fetuses was 17/31 (22.9%). CONCLUSION: The combined use of chromosomal microarray analysis and karyotype analysis might assist the prenatal diagnosis and management of PFAs, with extra-CNS structural abnormalities being detected by ultrasonography.

Spectrums and Outcomes of Adnexal Torsion at Different Ages.

OBJECTIVES: To investigate the role of ultrasound in the preoperative diagnosis of adnexal torsion and describe its histological spectrum and outcomes at different ages. METHODS: This study comprised a retrospective investigation of a data set that included 195 female patients with clinically suspected adnexal torsion between January 2010 and July 2015. Each patient received a detailed pelvic ultrasound examination by an experienced ultrasound examiner, and a definitive diagnosis was achieved via surgery. The accuracy of an ultrasonic diagnosis of adnexal torsion was assessed. The patients were divided into three groups: female children and adolescents, fertile women, and postmenopausal women. The size, type, histological spectrum, and outcome of adnexal torsion in the different groups were also described. RESULTS: The sensitivity, specificity, and accuracy of ultrasound were 0.84, 0.77, and 0.81, respectively. There were significant differences in the presence of ultrasonic hallmarks among the true positive, false positive, and false negative cases of adnexal torsion. Ovarian torsion was identified in 94 cases, and isolated tubal torsion was identified in 15 cases. The most common histologic diagnoses of the pediatric group and the other two groups were a normal ovary and teratoma, respectively. The most common histologic diagnoses in the cases of isolated tubal torsion were mesosalpinx cyst and oviduct inflammation. CONCLUSIONS: Ultrasonography plays an important role in the preoperative diagnosis of adnexal torsion. Despite ovarian involvement in most of the cases, isolated oviduct torsion was not uncommon. The spectrum of histological diagnoses varied among the age groups.

Prenatal diagnosis of four-vessel umbilical cord with supernumerary vein varix: A case report and literature review.

Four-vessel umbilical cord with two arteries and two veins, and fetal intra-abdominal umbilical vein varix are rare fetal vascular pathologies, associated with congenital anomalies and an adverse perinatal outcome, respectively. We report a case of a healthy male neonate born at a gestational age of 38 weeks, five days, after prenatal sonographic diagnosis of a four-vessel umbilical cord with a supernumerary vein varix. To the best of our knowledge, this is the first case with this combination.

Date-independent parameters: an innovative method to assess fetal cerebellar vermis.

The objectives of this paper were to identify gestational age-independent parameters for cerebellar vermis (CV) evaluation and examine their use in CV integrity assessments. Using three-dimensional ultrasonography, we obtained the following measurements from 217 pregnant women carrying 18-37-week-old fetuses: the largest area of the CV, vermal craniocaudal distance (VCC), vermal anterior to posterior diameter, and vermal perimeter (VP). In addition, fetal growth parameters (biparietal diameter, head circumference femoral length [FL], humeral length, transverse cerebellar diameter, and abdominal circumference) were evaluated. The ratios of the CV dimensions to each other and to the fetal growth parameters were calculated. Ratios showing no significant correlation with gestational age and acceptable internal validity in subsequent bootstrap analyses were chosen. The normal ranges of the specific parameters were compared with cases identified with posterior fossa anomalies (PFA). The ratios VP/FL (mean 1.20, SD 0.09), VCC/FL (mean 0.36, SD 0.03), and VCC/VP (mean 0.3, SD 0.03) were chosen using our protocol. These parameters were not significantly different between normal fetuses and those with PFA and an intact vermis. However, VP/FL and VCC/FL values were abnormal in cases of hypoplastic vermis or vermian agenesis, while the VP/VCC value was abnormal only in cases of vermian agenesis. The VP/FL, VCC/FL, and VCC/VP ratios are gestational age-independent parameters in evaluation of CV integrity.

Prenatal evaluation of the conus medullaris position in normal fetuses and fetuses with spina bifida occulta using three-dimensional ultrasonography.

OBJECTIVES: This study aimed to assess the fetal conus medullaris (CM) position with three-dimensional (3D) ultrasonography and its use in detecting and diagnosing spina bifida occulta (SBO). METHODS: We examined 150 normal fetuses (gestational age, 20-38 weeks) and 14 fetuses with SBO. All fetuses underwent prenatal 3D ultrasonography, and the CM position in relation to the vertebral body was evaluated using volume contrast imaging. Intra- and inter-observer agreements were assessed using weighted kappa. The correlation between gestational age and CM level was determined by linear regression analysis. RESULTS: Operators successfully located the CM position in 145 cases. The CM was at L3 or higher in all normal group cases. A linear relationship was noted between gestational age (X) and CM position (Y) (Y = 0.118X + 6.011, R(2) = 0.679, P < 0.001). The weighted kappa values for intra- and inter-observer agreement were 1.0 and 0.788, respectively. The CM was located at L3 in one case and lower than L3 in 13 cases in the SBO group. All values were below the fifth percentile for the normal group. CONCLUSIONS: Three-dimensional ultrasonography may accurately determine the CM vertebral level. Prenatal evaluation of the CM position may improve the detection and diagnosis of SBO.

Gonadotropin-releasing hormone agonist contributes to the successful implementation of in vitro fertilization in a patient with cervical endometriosis: a case report.

This is a case report of a nulliparous young woman who suffered from prolonged menstruation and infertility for 1 year. Magnetic resonance imaging and a transvaginal ultrasound examination revealed cervical endometriosis. Treatment with a gonadotropin-releasing hormone agonist stopped the abnormal bleeding and enabled investigators to conduct a hysterosalpingogram, which suggested bilateral hydrosalpinx. Subsequently, the patient underwent in vitro fertilization and had a live birth after frozen-thawed embryo transfer with gonadotropin-releasing hormone agonist pretreatment.

Influence of sulfamethoxazole on anaerobic digestion: Methanogenesis, degradation mechanism and toxicity evolution.

Sulfamethoxazole (SMX), one of the most widely used sulfonamides antibiotics, is frequently detected in the livestock wastewater. Currently, the focus needs to shift from performance effects to understanding of mechanisms and intermediate toxicity analysis. Our study found that SMX (0.5, 1, and 2 mg/L) stimulated methane production by promoting the process of acetogenesis and homo-acetogenesis. Since 1 mg/L SMX could inhibit the transformation of butyric acid, thus, the stimulation of methane was weak under this condition. Under anaerobic conditions, acetate kinase (AK) and cytochrome P450 enzymes (CYP450) continued to participate in SMX degradation. The increase in SMX concentration affected the release of metabolic enzymes, causing changes in SMX degradation pathways. Based on the main biotransformation products, five biotransformation pathways were proposed, the major transformation reactions including hydroxylation, hydrogenation, acetylation, deamination, oxidation, the elimination of oxygen atoms on sulfonyl, isoxazole ring and NS bond cleavage. Toxicity prediction analysis showed that the toxicities of most SMX transformation products were lower than that of SMX.

Impact of atmospheric thermodynamic structures and aerosol radiation feedback on winter regional persistent heavy particulate pollution in the Sichuan-Chongqing region, China.

Potential relationships among heavy air pollution, weather conditions, and meteorological effects are unclear and require further investigation, especially for areas with complex terrains, such as the Sichuan Basin (SCB), one of the most polluted regions in China. In this study, air pollution in the SCB was examined and 18 regional persistent heavy pollution events (RPHEs) were identified for the winters of 2014-2018. The average persistent period of the RPHEs was 8.89 days, and the number of affected cities was 17. Based on ground-based observations, CALIPSO satellite data, reanalysis data, and backward trajectory calculations, the synergistic effects of the thermodynamic structures, synoptic circulations and the radiative feedback of aerosols on the formation of RPHEs were revealed. The results can be summarized as follows: (1) An abnormal warming center, attributing to the warm southerly advection in the upper layer and the cold air dammed by the topography near the surface, always presented around 800-700 hPa to form a deep stable layer. (2) The diurnal variations in vertical motions triggered by the thermodynamic structures could regulate the pollution episodes. During the daytime, pollutants accumulated rapidly and thoroughly mixed under the control of sinking airflow from 800 hPa layer to the ground. At night, pollutants sometimes slowly diffused when weak ascending airflow appeared. (3) Forced by the stable layer and topography of the Tibetan Plateau, the local circulation was confined within SCB, resulting in the intensive mixing of local emissions and transport pollutants from other regions. This situation could be maintained for a long time with stable synoptic circulation in winter, leading to the formation of RPHEs. (4) The pollution episodes were featured with multi-layer pollutants above SCB according to the CALIPSO observations, including the local anthropogenic aerosols near the surface, dust aerosols originating from the Taklamakan Desert, and biomass burning aerosols from Southeast Asia. Solar absorption aerosols, including black carbon and dust above the region, could cause meteorological feedback, making the vertical layer more stable and enhancing the persistence and intensity of the pollution episodes. This study highlights the appreciable effects of synoptic circulations on the vertical thermodynamic structures of the atmosphere and air quality, and raises the understanding of the environmental and climate impacts of RPHEs in complex terrains.

Comparison of ovarian torsion between pregnant and non-pregnant women at reproductive ages: sonographic and pathological findings.

BACKGROUND: Differences in the ultrasonographic features and histological diagnosis of ovarian torsion in pregnant and non-pregnant women have not been defined. A better characterization of these features may help improve the accuracy of preoperative diagnosis. The present study aimed to compare the clinical characteristics, sonographic findings, operative procedures, and histological spectrum of ovarian torsion in pregnant and non-pregnant women. METHODS: This was a retrospective investigation of female patients at reproductive age with ovarian torsion between January 2010 and May 2017. Each patient received a detailed preoperative ultrasound, and the diagnosis was confirmed by surgery. The clinical characteristics, ultrasonic features, operative procedures, and histological diagnosis of ovarian torsion were retrieved from medical records and were compared in non-pregnant and pregnant patients according to the method of conception. RESULTS: The overall preoperative ultrasonic detection rate of ovarian torsion was 0.84, which was significantly different between pregnant and non-pregnant women. The presence of ovarian edema and abnormal adnexal positions also differed between pregnant and non-pregnant women. The ultrasonic features were not significantly different between the two pregnant sub-groups. The most common histologic diagnoses in the pregnant group and the non-pregnant group were a normal ovary and teratoma, respectively. The incidence of ovarian neoplasm was significantly lower in pregnant women. There were significant differences in the surgical procedures between the groups based on neoplastic or non-neoplastic lesions. CONCLUSIONS: Ovarian edema, absence/decreased blood flow in the ovary, and the whirlpool sign were reliable ultrasonic markers for ovarian torsion at reproductive ages. The preoperative ultrasonic detection rate of ovarian torsion was higher in pregnant women, and ovarian edema was more common. The clinical features of ovarian torsion in pregnant women were similar, independent of the method of conception. In women with ovarian torsion, the incidence of non-neoplastic lesions was more frequent in pregnant women, whereas neoplastic lesions were more common in non-pregnant women. Ultrasonography provides useful parameters for the preclinical diagnosis of ovarian torsion to improve patient management.

The dual effect of vegetation green-up date and strong wind on the return period of spring dust storms.

Vegetation phenology changes have been widely applied in the disaster risk assessments of the spring dust storms, and vegetation green-up date shifts have a strong influence on dust storms. However, the effect of earlier vegetation green-up dates due to climate warming on the evaluation of dust storms return periods remains an important, but poorly understood issue. In this study, we evaluate the spring dust storm return period (February to June) in Inner Mongolia, Northern China, using 165 observations of severe spring dust storm events from 16 weather stations, and regional vegetation green-up dates as an integrated factor from NDVI (Normalized Difference Vegetation Index), covering a period from 1982 to 2007, by building the bivariate Copula model. We found that the joint return period showed better fitting results than without considering the integrated factor when the actual dust storm return period is longer than 2years. Also, for extremely severe dust storm events, the gap between simulation result and actual return period can be narrowed up to 0.4888years by using integrated factor. Furthermore, the risk map based on the return period results shows that the Mandula, Zhurihe, Sunitezuoqi, Narenbaolige stations are identified as high risk areas. In this study area, land surface is extensively covered by grasses and shrubs, vegetation green-up date can play a significant role in restraining spring dust storm outbreaks. Therefore, we suggest that Copula method can become a useful tool for joint return period evaluation and risk analysis of severe dust storms.