Abstract Aims To develop a model based on clinical and ultrasound parameters to predict the risk of cesarean delivery after labor induction in near‐term twin gestations. Methods This retrospective cohort study included 189 consecutive women with twin gestations at ≥ 36.0 weeks scheduled for labor induction. The Bishop score and transvaginal ultrasonographic measurements of cervical length were obtained immediately before labor induction. Parameters studied included maternal age, height, weight, parity, gestational age, Bishop score, cervical length, epidural analgesia, method of conception, chorionicity and birth weight. Prostaglandin E 2 (dinoprostone) and oxytocin were used for labor induction. Logistic regression analysis and receiver operating characteristic curve were used to generate a predictive model for cesarean delivery. Results Fifty (26.5%) of the 189 women had cesarean deliveries. According to logistic regression analysis, maternal height ( P = 0.004), parity ( P = 0.005) and cervical length ( P = 0.016), but not Bishop score ( P = 0.920 ), were identified as independent predictors of cesarean delivery. A risk score based on a model of these three parameters was calculated for each patient. The model was shown to have an adequate goodness of fit ( P = 0.201 ) and the area under the curve was 0.722 , indicating fairly good discrimination. Conclusions Maternal height, parity and cervical length were independent parameters for predicting the risk of cesarean delivery after labor induction in twin gestations. A predictive model using these parameters may provide useful information for deciding whether or not to induce labor.
To determine whether growth rate of crown–rump length (CRL) in the first trimester is associated with abnormal birth weight. This retrospective cohort study included 680 consecutive women with singleton pregnancies who had fetal CRL measurements both at 7 + 0 - 9 + 6 weeks and subsequently at 10 + 0 - 13 + 6 weeks, which were done at least 2 weeks apart. The CRL growth rate was defined as millimeters of growth in CRL per day between the two measurements. The main outcome measures were small for gestational age (SGA) and large for gestational age (LGS) at birth. Multinominal logistic regression was used to control for confounders. SGA and LGA occurred in 6.0% and 8.5% of the population, respectively. Based on univariate analysis, the SGA group had significantly lower CRL growth rates than the AGA or LGA groups, while no significant differences in CRL growth rate were observed between the LGA and AGA groups. Maternal body mass index (BMI) differs significantly among the three groups. In the multinominal logistic regression analysis, CRL growth rate was a significant predictor of SGA neonates after adjustment for maternal BMI. However, CRL growth rate was not a significant predictor of LGA neonates in multinominal logistic regression, while only maternal BMI made a significant independent contribution. The low growth rates of CRL in the first trimester were independently associated with an increased risk of SGA. However, LGA neonates at birth do not appear to have high growth rates of CRL in the first trimester.
Abstract Background The early death and health problems of calves caused substantial economic losses in dairy industry. As the immune system has not been fully developed in the neonates, transport of passive immune substance such as immunoglobulins (Ig) from mothers to newborn calves is essential in protecting neonates from infections in their early life. Therefore, concentrations of immunoglobulins in the colostrum and serum of dairy cows are critical traits when estimating potential disease resistance of its offspring. Results Colostrum, blood and hair follicle samples were collected from the 620 Chinese Holstein cows within 24 hours after calving. The concentration of total IgG, IgG1, IgG2, IgA and IgM in both colostrum and serum were detected via ELISA methods. With GCTA software, genome-wide association studies (GWASs) were performed with 88,934 SNPs genotyped by using Illumina 50K (54,609 SNPs) and GeneSeek 150K (140,668 SNPs) chips in which 50K chip were imputed to 150K SNPs with BEAGLE. As a result, 20, 1 and 4 significant SNPs were detected associated with the concentrations of IgG2, IgA and IgM at genome-wide level (P < 3.16E–6); 11, 11, 35, 11 and 10 significant SNPs were identified associated with total IgG, IgG1, IgG2, IgA and IgM at suggestive level (P < 6.32E–5). Such SNPs were located in or proximate to (±1 Mb) 1,083 genes, which were functionally implicated in biological processes and pathways, such as immune response, negative regulation of immunoglobulin secretion, Fc-epsilon receptor and NF-kappaB signaling pathways. By combining the biological functions and the known QTL data for immune traits in bovine, 21 promising candidate functional genes were identified for immunoglobulins concentrations in colostrum and serum in dairy cattle, they were ABR, TIMM22, CRK, MYO1C, RILP, SERPINF2, AKT1, BCL11B, HHIPL1, DYNC1H1, HSP90AA1, TRAF3, KLC1, IL6, PYCARD, ITGAM, TGFB1I1, GUSB, CRCP, RABGEF1 and SBDS . Conclusions In this study, we identified 21 candidate genes related to concentrations of immunoglobulins in colostrum and serum in dairy cattle by performing GWASs. Our findings provide a groundwork for unraveling the key genes and causal mutations affecting immunoglobulins levels in colostrum and important information for genetic improvement of such traits in dairy cattle.
Rationale: Retroperitoneal dedifferentiated liposarcoma (RPDDL) is an uncommon malignancy, which often remains undetected for many years due to having adequate space in the retroperitoneal cavity and lacking clinical manifestations in the early stage of the disease. Surgical procedure is usually used as the first choice for treatment. However, it is prone to local recurrence after the operation, resulting in an unfavorable prognosis. Our aim is to draw useful lessons from the new case and provide some experience for management of the disease. Patient concerns: We describe a 55-year-old male patient who was admitted for a 3-week history of persistent dull ache of the left waist. A large mass of the left upper abdomen was palpated in physical examination. Moreover, the imaging examination revealed that the diameter of the mass was about 21 cm, and some adjacent vital organs were invaded, which brought great challenges to complete surgical resection. Diagnosis: The postoperative pathological results confirmed that the mass was RPDDL with invasion of the surrounding vital structures including pancreas, spleen, left adrenal gland, left kidney, and vasculature with tumor emboli. Interventions: Surgical resection of the mass was performed by our multidisciplinary team. The patient received chemotherapy 1 month after surgery. Outcomes: The effect of chemotherapy seemed to be unsatisfactory. Local multifocal recurrence of the tumor was considered about 2 months after surgery. Finally, he gave up any treatments and died of the disease. Lessons: Regular physical examination and ultrasound screening may detect the disease as early as possible, especially for high-risk group aged 60 to 70, which should be popularized. Incomplete resection, vascular invasion, and interruption of postoperative treatment may lead to an unfavorable prognosis. Therefore, we think that patients with the disease may benefit from complete surgical resection and uninterrupted adjuvant therapy.
To determine whether sonographic short cervix at mid-trimester is associated with an increased risk of the development of histologic chorioamnionitis and funisitis in asymptomatic women who subsequently had spontaneous preterm delivery (<37.0 weeks). This is a retrospective cohort study of 135 consecutive women with spontaneous preterm delivery before 37 weeks who underwent routine cervical length assessment between 19 and 25 weeks of gestation. Two groups of women were identified and compared: those with a mid-trimester sonographically short cervix and those without evidence of cervical shortening. Women with multiple gestation, cerclage, and indicated preterm delivery without labour were excluded. The placentas were examined histologically after delivery. The data were analyzed at cutoff cervical lengths of 25, 20, and 15 mm to define a short cervix. A short mid-trimester cervical length (<2.5 cm) was found in 9.6% (13/135) of women with spontaneous preterm delivery. Maternal demographic characteristics were not significantly different between the two groups. Women with mid-trimester cervical shortening had significantly higher rates of both histologic chorioamnionits and funisitis, as compared to women without mid-trimester cervical shortening. In multivariable linear regression, both a short cervix and histologic chorioamnionitis were significantly associated with gestational age at birth. In asymptomatic women at mid-trimester who subsequently delivered prematurely, a short cervix is associated with an increased risk of subsequent histologic chorioamnionitis and funisitis. Both a short cervix and histologic chorioamnionitis were independently associated with gestational age at birth. These data suggest that earlier gestational age at birth associated with a short mid-trimester cervix is not merely due to intra-uterine infection.
To evaluate whether an increased sonographic cervical length at mid-trimester is associated with an increased risk of failed labour induction and to compare cervical length measurements at mid-trimester and at the time of induction of labour. This is a retrospective cohort study including 518 singleton pregnant women who underwent cervical length screening between 19 and 24 weeks of gestations and underwent induction of labour at 33 completed weeks of gestations or later. Ultrasound measurements of the cervical length were performed both at mid-trimester and at the time of induction. Primary outcome was induction failed. A multivariate analysis was conducted, with control for known confounding factors associated with the failed induction of labour. Labor induction failed in 23.9 %. Women failed to induce labour had significantly longer cervical lengths at mid-trimester and at labour induction, a higher proportion of nulliparity and a higher body mass index, and earlier gestational age at induction than those who induced labour successfully. Multivariate analysis demonstrated that cervical length at mid-trimester was significantly associated with failed induction of labour after adjustment for body mass index, gestational age at induction and parity. The area under curve for the cervical length at labour induction was a significantly larger than that for the cervical length at mid-trimester. However, neither cervical length at mid-trimester nor cervical length at the time of induction was associated with the risk of Caesarean delivery in univariate and multivariate analysis. Increased cervical length at mid-trimester is independently associated with an increased risk of failed labour induction. However, cervical length at mid-trimester appeared to have a less predictive value for the risk of failed induction than that at the time of induction.
To examine the relationship between sonographic cervical length and maternal blood white blood cell count (WBC) count, as a marker of inflammation, in the third trimester and the risk of spontaneous preterm delivery in asymptomatic women with twin pregnancies. From a cohort of 362 consecutive asymptomatic women with twin pregnancies between 30 and 34 weeks of gestation who had been measured cervical length by transvaginal ultrasound and WBC count at the same time, 43 women with spontaneous preterm delivery at < 36 weeks were identified. A control group of 129 women with term deliveries closely matched for gestational age at measurements, chorionicity, and parity, was selected. Exclusion criteria were cervical cerclage, suspected twin-to-twin transfusion syndrome, and preeclampsia. Data were analysed using multivariate conditional logistic regression and Pearson's correlation analysis. Mean cervical length and mean body mass index at measurements were significantly lower in the preterm delivery group than in the term delivery group. No correlation was found between sonographic cervical length and WBC count. No association was found between WBC count and spontaneous preterm delivery at <36 weeks. Multivariate analysis, controlling for possible confounders, showed the association between the cervical length and spontaneous preterm delivery. In asymptomatic women with twin gestations, sonographically measured cervical length in the third trimester is associated with an increased risk for preterm delivery. However, a systemic inflammation implicating WBC in the third trimester may not play a role in developing a shortened cervical length and preterm delivery.
Omental cysts are rare types of intra‐abdominal lesions closely related to mesenteric and retroperitoneal cysts, all of which have the same origin from lymphatic tissue. Omental cysts are usually benign and asymptomatic, or present with atypical clinical symptoms. Thus, differentiating omental cysts from diseases of the gastrointestinal system, including the gallbladder, duodenum, pancreas and gynecologic cysts is not easy. In recent years, successful laparoscopic diagnosis and resection of mesenteric and omental cysts have been reported. Mesenteric lymphangiomas, compared to simple mesenteric cysts, have a tendency to adhere to pelvic organs, so complete resection is difficult. We report a case of an omental cyst, which had been misdiagnosed pre‐operatively as an adnexal cyst, and laparoscopically‐treated using the twisting method without injury to adjacent organs, with a review of the literatures.
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