Electron-level insight into efficient synergistic oxygen evolution catalysis at multimetallic sites in PtNiFeCoCu high-entropy alloys.

The exploration of high-quality and efficient electrocatalysts is crucial for the advancement of clean energy utilization and the development of energy conversion technologies. Recently, high-entropy alloys (HEA) have been actively explored as viable catalysts for water electrolysis due to their unique performance such as wide scope for compositional adjustments, excellent catalytic activity, and outstanding stability. However, the mechanism of synergistic oxygen evolution by HEA electrocatalysts at multiple sites has not been systematically and clearly demystified. Herein, in this paper, Pt is combined with inexpensive metals Ni, Cu, Fe, and Co to form a stable HEA structure. The synergistic catalytic mechanism of the PtNiFeCoCu HEA in the oxygen evolution reaction (OER) has been investigated, and the structure has been demonstrated to exhibit excellent hydrogen evolution reaction (HER) activity. The results suggest that the PtNiFeCoCu HEA catalyst achieved a lower overpotential of 0.44 V in the acidic OER, demonstrating that the PtNiFeCoCu HEA is a bifunctional electrocatalyst. In addition, oxygen intermediates are synergistically adsorbed on the surface of high-entropy alloys through multimetallic sites, which breaks the limitation of limited active sites. Further calculations indicated that the favorable OER activity of the catalyst originated from the strong associative coupling of the d orbitals of the synergistic metal sites to the 2p orbitals of the oxygen intermediates with enhanced synergistic effects. This work further elucidates the multisite synergistic catalysis of the PtNiFeCoCu HEA, providing a unique perspective to uncover the source of the high catalytic performance of HEA electrocatalysts.

Computational simulation-driven discovery of novel zeolite-like carbon materials as seawater desalination membranes.

Freshwater is a scarce and vulnerable resource that has never encountered such an extensive focus on a nearly worldwide scale as it does today. Recently, it has been found that desalination powered by two-dimensional (2D) carbon materials as separation membranes has significantly reduced the operational costs and complexity but presents heavy requirements for the structural stability and separation properties of the membrane materials. Here, we combined carbon materials with promising adsorption properties and zeolites characterized by a regular pore structure to obtain a zeolite-like structured carbon membrane Zeo-C and investigated the suitability of the Zeo-C membrane for seawater desalination based on the computational-simulation-driven approach. The results of molecular dynamics (MD) simulations and density functional theory (DFT) calculations revealed that the periodic pore distribution conferred favorable structural stability and mechanical strength to the Zeo-C desalination membrane. The rejection rate of Na+ and Cl- is ensured at 100% under a pressure of 40-70 MPa, and that of Na+ could reach 97.85% even though the pressure increases to 80 MPa, exhibiting superior desalination properties. The porous nature of the zeolite-like structure and the low free energy potential barrier are conducive for reliable adsorption and homogeneous diffusion of salt ions, which facilitates the acquisition of desirable water molecule permeability and salt ion selectivity. In particular, the interlinked delocalized π-network imparts inherent metallicity to Zeo-C for self-cleaning in response to electrical stimulation, thereby extending the lifetime of the desalination membrane. These studies have greatly encouraged theoretical innovations and serve as a guiding reference for desalination materials.

The effects of prenatal PM2.5 oxidative potential exposure on feto-placental vascular resistance and fetal weight: A repeated-measures study.

BACKGROUND: Feto-placental hemodynamic deterioration is a critical contributing factor to fetal growth restriction. Whether PM2.5 oxidative potential (OP) affects feto-placental hemodynamics and what impact is on estimated fetal weight (EFW) have not been fully elucidated. We sought to evaluate the association of PM2.5 OP with EFW and to explore whether feto-placental vascular impedance hemodynamic change is a possible mediator in this association. METHODS: A repeated-measures study was conducted involving sixty pregnant women with at least 26 weeks of follow-up during pregnancy in Guangzhou, China, from September 2017 to October 2018. Daily filter-based PM2.5 samples were prospectively collected from ground monitors, and estimates of OP for PM2.5 and its metallic (OPv-metal) and non-metallic constituents (OPv-nonmental) were determined by dithiothreitol assay. Ultrasound data of fetal growth and umbilical arterial resistance, including estimated fetal weight (EFW), pulsatility index, resistance index, and systolic-to-diastolic ratio, were also obtained during gestation. Generalized estimating equations and polynomial distribution lag models were applied to analyze the associations of maternal exposure to PM2.5 OP with EFW and umbilical artery indices. Causal mediation analysis was used to evaluate the mediating role of umbilical arterial resistance. RESULTS: Prenatal exposure to ambient PM2.5 OP was significantly inversely associated with EFW. The magnitudes of effects of OPv-nonmetal on EFW were larger than those of OPv-metal. Significant mediation for the relationship between PM2.5-related OP and EFW by increased impedance in the umbilical artery was observed, with the estimated percent mediated ranging from 31% to 61%. The estimated percent mediated for OPv-nonmetal was higher than those for OPv-metal. CONCLUSIONS: Findings suggest that increased impedance in the umbilical artery may be one of the potential mediators of the relationship between PM2.5 oxidative potential exposure and low fetal weight.

Risk of mother-to-child transmission of hepatitis B virus after fetal blood sampling: a report of six cases.

BACKGROUND: Hepatitis B virus (HBV) remains a major global public health problem worldwide; in endemic areas, mother-to-child transmission (MTCT) of HBV is the most common transmission route. Previous studies have shown that amniocentesis for prenatal diagnosis increases the risk of MTCT of HBV among highly viraemic mothers. However, no data is available on MTCT related fetal blood sampling (FBS) because of the paucity of cases or lack of attention. We present a case series of HBV-infected women who underwent FBS with or without antiviral therapy during pregnancy and discuss the risk of MTCT after FBS. CASE PRESENTATION: Six hepatitis B surface antigen (HBsAg)-positive pregnant women who underwent FBS for prenatal diagnosis were retrospectively reviewed. Their infants were followed up with HBV serology parameters until at least 12 months of age. Among 6 cases, two hepatitis B e-antigen (HBeAg)-positive mothers had high viral loads > 7.0 log10 IU/mL, and one of them received antiviral therapy at 26+ 3 gestational weeks and achieved an anticipated level of 4.52 log10 IU/mL before FBS, while the other one did not receive any antiviral treatment. The other 4 cases were HBeAg-negative with low viral loads. Only a child born to the HBeAg-positive mother, who had no antiviral therapy with a viral load of 7.48 log10 IU/mL before FBS, was found to have MTCT with HBsAg persistently positive from birth to 12 months of age. The other 5 children were both HBsAg-negative and HBsAb-positive at the end of follow-up. CONCLUSIONS: FBS may increase the risk of MTCT of HBV in women with HBeAg-positive and high viral loads; therefore, FBS should be avoided in this high-risk population. Maternal HBV serologic testing and awareness of the potential risk of MTCT should be recommended before FBS. Antiviral therapy may be effective to decrease the risk of MTCT after FBS in highly viraemic women.

Clinical characteristics and risk factors of mirror syndrome: a retrospective case-control study.

BACKGROUND: Mirror syndrome (MS) is a rare obstetric disorder complicated with high maternal morbidity and fetal mortality. MS is often misdiagnosed or underdiagnosed due to the low incidence and lack of awareness of its diverse features. This study aimed to summarise the etiology, clinical characteristics, and risk factors of MS among mothers with fetal hydrops. METHODS: This retrospective case-control study included 37 pregnant women with fetal hydrops in the second and third trimesters from 58,428 deliveries performed at the Third Affiliated Hospital of Sun Yat-Sen University between January 2012 and December 2020. Cases were categorized as MS and non-MS according to the presence or absence of maternal mirroring symptoms. Binary logistic regression was performed for analysis. RESULTS: Fourteen women developed MS with an overall incidence of 0.024% (14/58,428) and 37.8% (14/37) in the fetal hydrops cases. Among the 11 MS cases with known associated etiologies, seven had alpha thalassemia major. Onset of fetal hydrops was later (27.8 vs. 23.0 weeks) and the rate of placental thickening was higher (85.7% vs. 34.8%) in the MS group than in the non-MS group (P < 0.05). Regarding maternal characteristics, the MS group had higher maternal morbidity (85.7% vs. 8.7%), more weight gain (9.0 vs. 5.5 kg), higher rates of hypertension (35.7 vs. 0%) and proteinuria (64.3% vs. 4.3%), and lower levels of hemoglobin (88 vs. 105 g/L) and serum albumin (25.8 vs. 35.0 g/L) than the non-MS group (P < 0.05). Logistic regression analysis showed that onset of fetal hydrops at ≥24 weeks and placental thickening were associated with the risk of MS among fetal hydrops cases (OR 15.83, 95% CI 1.56-160.10 and OR 8.63, 95% CI 1.29-57.72, respectively). CONCLUSIONS: MS is relatively common among fetal hydrops cases in the late second and third trimesters, and alpha thalassemia major is the main etiology for fetal hydrops and also MS in this population. Complicated with high maternal morbidity, the key maternal features of MS include more weight gain, hemodilution, and hypertension. Among those with fetal hydrops, the onset time of ≥24 weeks and placental thickening are risk factors for MS.

Mother-to-child transmission of hepatitis B virus after amniocentesis: A retrospective matched cohort study.

OBJECTIVE: The objective of this study is to determine whether amniocentesis increases the risk of mother-to-child transmission (MTCT) of hepatitis B virus (HBV) and evaluate risk factors for MTCT. METHODS: One hundred forty-three hepatitis B surface antigen (HBsAg)-positive women with amniocentesis were enrolled into the amniocentesis group. Six hundred five nonamniocentesis cases were matched with amniocentesis cases based on maternal viral loads, antiviral therapy regimens, and delivery dates. MTCT of HBV was defined as HBsAg and/or DNA positivity in infants from birth to age 7 to 12 months. RESULTS: Mother-to-child transmission rate was significantly higher in HBsAg-positive women with amniocentesis than in those without amniocentesis (2.80% vs 0.50%; relative risk [RR], 5.64; 95% CI, 1.28-24.93). In the amniocentesis group, maternal HBV DNA more than or equal to 7.0 log10 IU/mL and hepatitis B e-antigen (HBeAg) positivity were associated with higher MTCT rates than maternal HBV DNA less than 7.0 log10 IU/mL (10.81% vs 0%, p = .004) and HBeAg negativity (8.16% vs 0%, p = .013), and antiviral therapy reduced MTCT rate from 14.3% to 0% (p = .554) when maternal HBV DNA was more than or equal to 7.0 log10 IU/mL. CONCLUSIONS: Amniocentesis increases the risk of MTCT in women with hepatitis B, and maternal HBV DNA more than or equal to 7.0 log10 IU/mL and HBeAg positivity are risk factors for MTCT. Antiviral therapy may be effective to prevent MTCT after amniocentesis in highly viremic mothers.

Early usage of Bakri postpartum balloon in the management of postpartum hemorrhage: a large prospective, observational multicenter clinical study in South China.

AIM: To evaluate the success rate and protocol of the Bakri balloon for postpartum hemorrhage (PPH) in the course of a prospective observational multicenter cohort study in South China. METHODS: At 20 hospitals in South China, women with postpartum bleeding who failed to respond to the first-line conservative management and received the Bakri balloon were recruited for the study. Maternal characteristics, PPH characteristics, PPH management and outcomes in regard to the Bakri balloon use were recorded. RESULTS: A total of 472 women had a Bakri balloon tamponade and 407 (86.23%) women were enrolled (67 after vaginal delivery and 340 either during or after cesarean delivery). The success rate of the Bakri balloon in this study was 91.65% (373/407 women). During vaginal deliveries, the group with a hemorrhage >2000 mL before balloon insertion had significantly more blood loss (551.67±635.17 mL vs. 242.06±313.69 mL, P=0.039) and lower maternal hemoglobin (73±21.77 g/L vs. 92.06±19.60 g/L, P=0.029) after using Bakri balloon than the group with a hemorrhage <1000 mL. Similar data were found during cesarean deliveries. The blood loss before and after balloon insertion were significantly higher in the Bakri balloon failure group (1700±1429.88 mL before and 1209.58±1139.72 mL after using the balloon) than those in the success group [918±493.92 mL before (P=0.002) and 266.57±361.60 mL after using the balloon (P=0.001)]. CONCLUSION: Rapid diagnosis or prognosis of PPH, in combination with early usage of the Bakri postpartum balloon is more effective for the management of PPH.

Intestinal obstruction due to congenital malrotation complicating a multiple pregnancy: A rare case report.

Intestinal obstruction due to congenital intestinal malrotation is usually diagnosed in neonates but may, in rare cases, occur during pregnancy. The absence of specific symptoms in combination with its low incidence makes timely detection of intestinal malrotation-related obstruction difficult in expectant mothers. We present a rare case of a 23-year-old woman with a twin pregnancy following in vitro fertilization-embryo transfer (IVF-ET) who presented with symptoms of intestinal obstruction at 22+4 weeks of gestation. This diagnosis was not confirmed by imaging and the patient was managed conservatively. Following caesarean section, she gave birth to two healthy full-term infants. During the operation, malposition of the bowel and the typical Ladd's band confirmed intestinal malrotation. This is the first report of a congential malrotation complicating a multiple pregnancy, and highlights that malrotation without volvulus can be managed conservatively.

Development of noninvasive prenatal diagnosis of trisomy 21 by RT-MLPA with a new set of SNP markers.

INTRODUCTION: Placental mRNA can now be detected in maternal whole blood, raising the possibility of using maternal blood for noninvasive prenatal diagnosis (NIPD) of trisomy 21. We aimed to identify new mRNA-single nucleotide polymorphism (mRNA-SNP) markers suitable for use in reverse-transcriptase multiplex ligation-dependent probe amplification (RT-MLPA) to develop a more reliable diagnostic method for trisomy 21 in Chinese subjects. MATERIALS AND METHODS: Using sequencing, we determined the status of SNPs in genes expressed in the placenta and calculated their heterozygote frequencies to determine which loci were suitable for use in RT-MLPA. Cell-free fetal RNA was extracted from peripheral blood samples of 246 women at 12-24 weeks of pregnancy, and the SNP loci selected were analyzed by RT-MLPA, followed by capillary electrophoresis. Karyotype analyses were used to confirm the diagnosis of trisomy 21. RESULTS: As compared with karyotype analysis, the diagnostic sensitivity and specificity of RT-MLPA were excellent (95 and 100% in different gestational weeks). CONCLUSION: The RT-MLPA technique is a suitable and reliable method for the diagnosis of trisomy 21. Use of RT-MLPA with the SNP markers described here shows good specificity, high sensitivity, and high throughput potential, making this technique suitable for NIPD in clinical practice.

[Efficacy and safety of intrauterine Bakri balloon tamponade in the treatment of postpartum hemorrhage: a multicenter analysis of 109 cases].

OBJECTIVE: To evaluate the efficacy and safety of the Bakri balloon in the treatment of postpartum hemorrhage (PPH). METHODS: A total of 109 patients with PPH who underwent Bakri balloon insertion after unsuccessful first- line medication from thirteen hospitals in Guangdong from Apr. 2013 to Oct. 2013 were recruited in this study. Bakri balloons were applied via vagina or abdomen depending on the delivery mode. The high risk factors and the causes of the PPH were analyzed. The bleeding volume of before and after placing Bakri balloon, the hemoglobin drop-out value, the interval time between the delivery and applying Bakri, the placement mode, staying time, and the complications were recorded. To stratified analyze the Bakri balloon hemostasis success rate and evaluate its safety. RESULTS: (1) The average amount of 24 hours PPH of all 109 cases was 1 523 ml. Successful hemostasis was achieved in 102 cases after Bakri balloon placement, defined as success group. In the other 7 cases, bleeding were not controlled, defined as failure group (six patients underwent hysterectomy). The overall Bakri balloon hemostasis successful rate was 93.6% (102/109), and the failure rate was 6.4% (7/109). The successful rate in cesarean section group was 94% (93/99), and in vaginal delivery group was 9/10. In the patients with placenta previa, placenta increta or scar uterus, the successful rate of Bakri balloon hemostasis was 88% (45/51), 13/16 and 95% (19/20), respectively, and were slightly below the overall successful rate. (2) Data showed that PPH volume after Bakri balloon placement was significantly lower in the success group (364 ml) than that in the failure group (1 533 ml, P < 0.05). However, the hemoglobin drop-off value and the case number that need blood transfusion had no statistically significant difference (P > 0.05). (3) The Bakri balloons were placed via vagina in 38 cases, and successful hemostasis was achieved in 36 cases, with the successful rate of 95% (36/38). The balloons were placed via cesarean section incision in 71 cases, and succeeded in 66 cases, the successful rate was 93% (66/71). There was no statistically significant difference between the two approaches. The retaining time of Bakri balloon was (22.0 ± 3.0) hours in success group and (3.0 ± 1.0) hours in failure group, with statistically significant difference (P < 0.05). (4) There was no intrauterine infection occurred. Ultrasound scan after 6 weeks postpartum found no abnormal signs in pelvis. All patients were followed up for 2-6 months postpartum, no complications were found. CONCLUSION: Bakri balloon tamponade is an effective, safe, simple and quick approach in the treatment of PPH.

[Identification of risk factors related to the failure of immunization to interrupt hepatitis B virus perinatal transmission].

OBJECTIVE: To explore the factors influencing failure of an immunization to interrupt perinatal (mother-to-child) transmission of hepatitis B virus (HBV). METHODS: Between June 2006 and March 2010, a total of 1355 pregnant women testing positive for the hepatitis B surface antigen (HBsAg), at gestational weeks 20 to 42, and without use of antiviral or immunomodulatory drugs during the pregnancy were prospectively recruited to the study. The mothers were given a choice of receiving hepatitis B immunoglobulin (HBIG; three 200 IU intramuscular injections give at four-week intervals starting from gestation week 28) or not. All neonates (1360, including five sets of twins) received hepatitis B vaccine (10 mug) plus HBIG (200 IU) combined immunization within 24 h of birth, as early as possible. Peripheral venous blood samples were collected from the neonates within 24 h of birth and at 7 and 12 months of age for detection of HBV markers, including hepatitis B e antigen (HBeAg) and HBV DNA. The infants were classified according to HBV perinatal transmission status (infection group and non-infection group) and various factors (maternal-related: age, gravidity, parity; pregnancy/birth-related: threatened premature labor, complications; neonate-related: sex, birth weight, apgar score) were compared between the two groups by using non-conditional logistic regression analysis to determine their potential influence on failure of immunization to inhibit transmission. RESULTS: After 12 months of follow-up, 1.54% (21/1360) of the neonates had presented with HBV infection. Analysis of the HBV-infected neonates revealed differences in infection rates between neonates born to mothers with HBIG injection (2.22% vs. without HBIG injection: 1.11%, P less than 0.05) and caesarean section (1.35% vs. vaginal delivery: 1.73%) but neither reached statistical significance (P less than 0.05); only the practice of breastfeeding showed a significant difference for infection rate, with neonates fed artificial formula having higher infection rate (3.13%) than the breastfed neonates (0.27%, P less than 0.05). The neonate HBV infection rate was also significantly higher for neonates born to HBeAg-positive mothers (4.44% vs. HBeAg-negative mothers: 0%, P less than 0.05) and HBV DNA-positive mothers (3.13% vs. HBV DNA-negative mothers: 0%, P less than 0.05). When the mothers were stratified by serum level of HBV DNA, there was a significant difference in HBV-infected neonates born to mothers with more than or equal to 1*10(7) IU/ml(6.01% vs. 10(3)-10(6) IU/ml: 0.56% and less than 1*10(3) IU/ml: 0%, both P less than 0.05). Logistic regression analysis indicated that the independent risk factors for HBV perinatal transmission despite immunization were maternal serum HBeAg-positive status (relative risk (RR)=31.74, 95% confidence interval (CI): 3.88-259.38) and maternal HBV DNA of ≥ 107 copies/mL (RR=22.58, 95% CI: 4.75-107.40). CONCLUSION: Failure of vaccine plus HBIG to interrupt mother-to-child transmission of HBV is influenced by maternal serum HBeAg-positive status and maternal HBV DNA of ≥107 copies/mL.

Iron-selenide-based titanium dioxide nanocomposites as a novel electrode material for asymmetric supercapacitors operating at 2.3 V.

This study portrays a facile wet-chemical synthesis of FeSe2/TiO2 nanocomposites for the first time for advanced asymmetric supercapacitor (SC) energy storage applications. Two different composites were prepared with varying ratios of TiO2 (90 and 60%, symbolized as KT-1 and KT-2) and their electrochemical properties were investigated to obtain an optimized performance. The electrochemical properties showed excellent energy storage performance owing to faradaic redox reactions from Fe2+/Fe3+ while TiO2 due to Ti3+/Ti4+ with high reversibility. Three-electrode designs in aqueous solutions showed a superlative capacitive performance, with KT-2 performing better (high capacitance and fastest charge kinetics). The superior capacitive performance drew our attention to further employing the KT-2 as a positive electrode to fabricate an asymmetric faradaic SC (KT-2//AC), exceeding exceptional energy storage performance after applying a wider voltage of 2.3 V in an aqueous solution. The constructed KT-2/AC faradaic SCs significantly improved electrochemical parameters such as capacitance of 95 F g-1, specific energy (69.79 Wh kg-1), and specific power delivery of 11529 W kg-1. Additionally, extremely outstanding durability was maintained after long-term cycling and rate performance. These fascinating findings manifest the promising feature of iron-based selenide nanocomposites, which can be effective electrode materials for next-generation high-performance SCs.

Role of antenatal anxiety in the relationship between maternal exposure to nitrogen dioxide and small for gestational age: A birth cohort study.

BACKGROUND: Both Nitrogen dioxide (NO2) exposure and antenatal anxiety have individually been associated with small for gestational age (SGA). Little is known, however, about whether there is effect modification of antenatal anxiety on NO2-related SGA. METHODS: The prospective birth cohort study included 1823 mother-newborn pairs in Guangzhou, China, from January 2017 to April 2020. Exposure to NO2 during the pre-conceptional and prenatal periods was estimated using an inverse distance weighted method. Antenatal anxiety was assessed by Trait Anxiety Inventory. SGA was determined by the Chinese gestational age- and sex-specific birthweight standards. Cox proportional hazards regression models was used to estimate hazard ratios (HRs) and 95 % confidence intervals (CIs) for SGA as per 10 µg/m3 increase in NO2. Modifying effects of trait anxiety on NO2-related SGA were identified by stratified analyses, and three-dimensional response surface plots and two-dimensional heat maps. RESULTS: Each 10 µg/m3 increase in NO2 exposure during the third trimester was significantly associated with SGA risk among overall participants (HR = 1.221, 95 % CI: 1.014-1.471) and primipara (HR = 1.271, 95 % CI: 1.023-1.579). We found significant effect modification of anxiety level for NO2-related SGA in the third trimester (Pinteraction < 0.05). Pregnant women with higher levels of trait anxiety were more likely to deliver SGA newborns, particularly for those with high trait anxiety (HR = 1.781, 95 % CI: 1.007-2.945). Primiparous women were more susceptible. CONCLUSIONS: This study provides evidence that antenatal trait anxiety may modify the effects of maternal NO2 exposure on SGA risk. The third trimester could be a critical window of susceptibility.

Exploring the electrochemical properties of CuSe-decorated NiSe2 nanocubes for battery-supercapacitor hybrid devices.

Chalcogenides, a promising class of electrode materials, attracted massive popularity owing to their exciting features of high conductive nature, high capacity, rich redox activities, and structural functionalities, making them the first choice for the electrochemical energy domain. This paper reported a new NiSe2-CuSe nanocomposite prepared via a wet-chemical synthesis followed by a low-cost and simple hydrothermal reaction. The physical characterization showed cubes and nanoparticles type morphological features of NiSe2 and CuSe products, while their composite reveals a combined morphological characteristic. The electrochemical properties were tested in an aqueous solution, demonstrating that the NiSe2-CuSe nanocomposite exhibits a high capacity of 376 C g-1, low resistance, good reversibility and rate capability in a three-electrode mode than bulk counterparts. For practical aspects, a battery-hybrid supercapacitor (BHSC) is developed with NiSe2-CuSe nanocomposite, and activated carbon (AC) serves as cathode and anode in two-cell mode operation. The built NiSe2-CuSe||AC/KOH BHSC expanded the voltage to 1.8 V and delivered the highest capacitance of 148 F g-1 and 55 F g-1 from 1 to 10 A g-1, suppressing most of the previously existing literature reports. Also, our built NiSe2-CuSe||AC/KOH BHSC displayed a high-power delivery of 8928 W kg-1 at a maximum energy density of 66.6 W h kg-1 and retained 91.7% capacitance after a long way of 10,000 cycles. These outstanding results demonstrate that metal selenides can be effectively utilized as alternative electrodes with high energy, rate performance, and long-term durability for advanced energy conversion and storage devices.

[Intrauterine growth characteristics of twins and those twins discordant birthweight].

OBJECTIVE: To investigate the intrauterine growth characteristics of twins and birthweight discordant twins (discordant twins). METHODS: Total of 1010 twin pregnancies (2020 fetuses) with complete delivery records from the Department of Obstetrics and Gynecology, the First and Third Affiliated Hospital of SUN Yat-sen University between January 1, 2000 and July 31, 2010 were studied retrospectively. One handred and ninteen cases (238 fetuses) with intrapair birthweight difference ≥ 25% were determined as the discordant twins group, and the other 891 cases (1782 fetuses) with intrapair birthweight difference < 25% were identified as the concordant twins group. The singleton control group included 4042 singleton pregnancies in the same period. RESULTS: (1) Comparison of clinical data between the twins groups: the birthweight of larger-twin, smaller-twin and intrapair birthweight difference in the discordant twins group and the concordant twins group were (2090 ± 827) g, (1392 ± 592) g, (33.9 ± 9.3)%, and (2408 ± 543) g, (2191 ± 505) g, (8.9 ± 6.5)%, respectively, with significant differences (P < 0.01). The incidence of discordant twins was 11.78% (119/1010). Compared with the concordant twins group, the discordant twins group had higher proportion of monochorionic twins, and higher prevalence of pregnancy complications such as late miscarriage, abnormal umbilical insertion, twin-twin transfusion syndrome and hypertensive disorders in pregnancy (P < 0.05). (2) The characteristics of twin birthweight distribution: 1) In all the 2020 twins, 80.05% (1617/2020) fetuses had birthweight below the 50(th) percentile of the singleton control group, while 23.71% (479/2020) feeuses got birthweight below the 10(th) percentile of the singleton control group. 2) After 19(th) gestational week, the 50(th) and 90(th) percentile of all twins' birthweight were lower than those of singletons. After 38(th) gestational week, the birthweight of singletons kept increasing and reached its peak at 41(th) week, while the birthweight of twins reached its peak at 38(th) week, followed by a decline at 39 weeks, which was even lower than the 10(th) percentile of the singleton control group. 3) The distribution of birthweight of larger- and smaller-twin in the discordant twins group: 65 (54.6%, 65/119) larger-twins and one (0.8%, 1/119) smaller-twin had birthweight above the 50(th) percentile of all twins, while 5 (4.2%, 5/119) larger-twins and 97 (81.5%, 97/119) smaller-twins got birthweight below the 10(th) percentile of all twins. CONCLUSIONS: (1) The patterns of birthweight curves for each gestational week are different between twins and singletons. In order to evaluate the growth of twins, birthweight reference for twins should be employed. (2) According to the reference of twins birthweight, the most discordant twins are complicated with fetal growth restriction at least in one twin.

The Role of Amnioreduction in Emergency Cervical Cerclage with Bulging Membranes: A Retrospective Comparative Study.

The purpose of this study was to investigate the role of amnioreduction in patients who underwent emergency cervical cerclage (ECC) with bulging membranes during the second trimester. This retrospective comparative study included 46 singleton pregnant women who had cervical dilation at least 1 cm with bulging membranes beyond the external cervical os and underwent ECC at the Third Affiliated Hospital of Sun Yat-sen University between December 2016 and December 2021. Cases were categorized as amnioreduction group (n = 16) and non-amnioreduction group (n = 30) according to whether amnioreduction was performed prior to ECC. The gestational age and cervical dilation at cerclage, operative time, prolongation of pregnancy, and outcomes of pregnancy were compared between the two groups. All 46 patients underwent successful ECC excepted one case with intraoperative rupture of membrane in non-amnioreduction group. In the amnioreduction group, the cervical dilation at cerclage was larger than that in the non-amnioreduction group (4.5 ± 2.2 vs. 2.2 ± 1.2 cm, P < 0.001), and had more patients with cervical dilation ≥4 cm (50.0% vs. 10.0%, P = 0.004). However, the gestational age at cerclage, operative time, prolongation of pregnancy, gestational age at delivery were not significantly different between the two groups (22.9 ± 2.8 vs. 22.9 ± 3.2 weeks, 31.1 ± 9.2 vs. 27.9 ± 11.4 min, 21.3 ± 21.5 vs. 38.7 ± 40.2 days, 25.9 ± 4.5 vs. 28.4 ± 6.1 weeks; P > 0.05). The rates of delivery ≥28 weeks, ≥32 weeks, and live birth were 20.0% vs. 80.0%, 12.5% vs. 26.7%, 56.3% vs. 66.7% (P > 0.05) in amnioreduction group and non-amnioreduction group, respectively. In conclusion, even in cases with larger cervical dilation, the application of amnioreduction with ECC is possible to get the acceptable pregnancy outcomes. These findings suggested that amnioreduction may be a safe and feasible option to be applied before ECC, especially for those with advanced cervical dilation and bulging membranes.

Investigation Into the Predictive Potential of Three-Dimensional Ultrasonographic Placental Volume and Vascular Indices in Gestational Diabetes Mellitus.

Background: The use of ultrasonography in pregnancies complicated with gestational diabetes mellitus (GDM) can vary according to clinical practice. This study aims to compare the changes of placental volume (PV) and vascular indices measured by three-dimensional (3D) Power Doppler between pregnant women with and without GDM. Materials and Methods: This was a prospective study of singleton pregnancies who took the early nuchal translucency examination from January 2018 to September 2019. Data on PV and vascular indices including vascularization index (VI), flow index (FI), and vascularization flow index (VFI) between pregnant women with and without GDM were measured by 3D Power Doppler ultrasound machine. Univariate and multivariate logistic regression determined the association between risk factors and GDM. Receiver operating characteristic (ROC) and area under the ROC curve (AUC) were applied to evaluate the diagnostic value of different parameters for GDM. Results: Of the 141 pregnant women enrolled, 35 developed GDM and 106 did not. The maternal age and gravida in the GDM group were significantly higher than that in the non-GDM group. The PV, VI, FI, and VFI in the GDM group were significantly lower than that in the non-GDM group. There were no significant differences in other clinical parameters between the two groups. After adjustments in multivariate logistic regression analysis, significant differences were observed in VI [odds ratio (OR) = 0.98, 95% confidence interval (CI) = 0.951-1.002], FI (OR = 0.93, 955 CI: 0.86-1.00), and VFI (OR = 0.67, 95% CI = 0.52-0.87). ROC analysis indicated that the combination of maternal age, gravida, PV, and VFI was more accurate as a marker for detecting GDM than the PV, VI, FI, or VFI alone. Conclusions: The 3D ultrasonography results suggest that PV and vascular indices (VI, FI, and VFI) during the first trimester may serve as potential markers for GDM diagnosis. The combination of maternal age, gravida, and sonographic markers may have good diagnostic values for GDM, which should be confirmed by further investigations.

MiR-101-containing extracellular vesicles bind to BRD4 and enhance proliferation and migration of trophoblasts in preeclampsia.

BACKGROUND: Preeclampsia (PE) is a frequently occurring pregnancy disorder in the placenta, which results in various maternal and fetal complications. The current study aims to evaluate the role of extracellular vesicles (EVs)-encapsulated microRNA (miR)-101 in biological processes of trophoblasts in PE and its underlying mechanism. METHODS: Human umbilical cord mesenchymal stem cell (HUCMSC) and HUCMSC-derived EVs were isolated and cultured, after which EV characterization was carried out using PKH67 staining. In silico analyses were adopted to predict the downstream target genes of miR-101, and dual luciferase reporter gene assay was applied to validate the binding affinity. Furthermore, loss- and gain-of-function approaches were adopted to determine the role of miR-101 and bromodomain-containing protein 4 (BRD4) in trophoblast proliferation and invasion using EDU staining and transwell assay. In addition, a rat model of PE was established to verify the function of EV-encapsulated miR-101 in vivo. RESULTS: Placental tissues obtained from PE patients presented with downregulated miR-101 expression and upregulated BRD4 and CXCL11 expression. EV-encapsulated miR-101 from HUCMSCs could be delivered into the trophoblast HTR-8/SVneo cells, thus enhancing proliferation and migration of trophoblasts. Mechanically, miR-101 targeted and negatively regulated BRD4 expression. BRD4 knockdown promoted the proliferation and migration of trophoblasts by suppressing NF-κB/CXCL11 axis. EV-encapsulated miR-101 from HUCMSCs also reduced blood pressure and 24 h urine protein in vivo, thereby ameliorating PE. CONCLUSION: In summary, EV-encapsulated miR-101 promoted proliferation and migration of placental trophoblasts through the inhibition of BRD4 expression via NF-κB/CXCL11 inactivation.

The recycling of the expired donkey-hide gelatin pulp for N/S co-doped hollow carbon nano-spheres anode in sodium ion battery.

How to reasonably manage and reutilize the waste expired liquid medicines has always been a puzzling public concern. For this reason, the waste expired medicine of donkey-hide gelatin pulp was recycled by hydrothermal carbonization and hard template for N/S co-doped hard carbon material, and its electrochemical Na-storage performances were also evaluated. The results showed that the resultant N/S co-doped hard carbon material manifested the morphology of hollow nano-spheres with the mean diameter of about 242.3 nm and the shell thickness of about 15 nm; N and S elements evenly distributed in carbon structure by in situ co-doping. Furthermore, N/S co-doped hard carbon also delivered the satisfactory electrochemical Na-storage capacities due to the synergistic effect of the unique hollow nano-spheres with thin shell and N/S co-doping. No doubt, the results would promote the circular economy mode of waste expired medicines.