Objective:To explore the feasibility of expectant management in pregnant women with preterm premature rupture of membranes (PPROM) before 28 weeks of gestation.Methods:A retrospective analysis was conducted on the clinical data of 92 pregnant women diagnosed with PPROM before 28 weeks and delivered in Peking University First Hospital from January 2015 to March 2023. These women were divided into the termination group or expectant management group, and the latter was further divided based on whether the rupture of membranes occurred before 24 weeks or after. Clinical data of the women and neonates between the two groups and the two subgroups were analyzed. Additionally, all the subjects were divided based on the presence or absence of severe neonatal complications and clinical data of the mothers and their neonates were also analyzed. Statistical analyses were performed using t-tests, Mann-Whitney U tests, Chi-square tests, or Fisher's exact tests. Results:(1) Among the 92 women with PPROM, 53 (57.6%) chose to terminate the pregnancy, while 39 (42.4%) chose expectant management including ten twins and 29 singletons. (2) Compared to the termination group, the expectant management group had a smaller percentage of multiparous women [7.7% (3/39) vs. 32.1% (17/53), Fisher's exact test, P=0.019], greater gestational age at membrane rupture [24 +6 weeks (18-27 +6) weeks vs.21 +3weeks (14 +2-27 weeks), Z=53.14, P=0.042], and a lower incidence of oligohydramnios after membrane rupture [46.2% (18/39) vs. 84.9% (45/53), χ2=6.56, P=0.031]. (3) All of the 39 women in the expectant group gave birth before 37 weeks with the mean gestational age at delivery of 28 +1weeks (25 +1-36 +1 weeks) and 49 live born babies, among which four neonates died giving the survival rate of 91.8%(45/49). There were no statistically significant differences in gestational age at delivery or neonatal outcomes between women with membrane rupture before 24 weeks and those ruptured between 24 and 27 weeks and 6 days of gestation (all P>0.05), but the expectant duration was significantly longer in the former group [55.0 d (20.0-96.0 d) vs. 9.0 d (0.5-52.0 d ), Z=－4.95, P<0.001]. (4) The 49 neonates were further divided into with ( n=9, including the death) or without ( n=40) severe complication subgroups. Those neonates in the non-severe complication subgroup had a significantly greater gestational age at birth compared to those in the other subgroup [30 +6 weeks (27 +5-36 +4 weeks) vs. 27 +5 weeks (25 +1-31 +5 weeks), Z=－3.42, P=0.001], a longer expectant duration [42.0 d (3.0-80.0 d) vs. 19.0 d (0.5-59.0 d), Z=－2.31, P=0.021], a higher birth weight [(1 630±544) g vs. (1 069±272) g, t=4.56, P=0.009], a lower incidence of neonatal asphyxia [2/9 vs. 70.0% (28/40), Fisher's exact test, P=0.012], a shorter hospital stay [37.5 d (3.0-54.0 d) vs. 67.0 d (60.0-105.0 d), Z=－3.01, P=0.003] and a higher proportion of pregnancies completing two courses of fetal lung maturation [5/9 vs. 17.5% (7/40), Fisher's exact test, P=0.029]. (5) Among the ten twin pregnancies, all the 20 babies developed severe complication resulting a higher proportion of twins in the severe complication group than in the non-severe complication group [50% (20/40) vs. 0/9, Fisher's exact test, P=0.005]. Conclusions:For pregnant women with PPROM before 28 weeks, under the premise of informed consent and thorough evaluation, expectant management can be considered if there are no indications for immediate termination of pregnancy, to achieve a higher neonatal survival rate. However, the incidence of severe complications related to preterm infants remains high in the short term, with most having a good prognosis after treatment in the neonatal intensive care unit. Twin pregnancies and lower gestational age at birth are risk factors for severe complications in preterm infants.

Objective:To analyze the factors affecting delayed chemotherapy in children with Burkitt lymphoma (BL) and their influence on prognosis.Methods:Retrospective cohort study. Clinical data of 591 children aged ≤18 years with BL from May 2017 to December 2022 in China Net Childhood Lymphoma (CNCL) was collected. The patients were treated according to the protocol CNCL-BL-2017. According to the clinical characteristics, therapeutic regimen was divided into group A, group B and group C .Based on whether the total chemotherapy time was delayed, patients were divided into two groups: the delayed chemotherapy group and the non-delayed chemotherapy group. Based on the total delayed time of chemotherapy, patients in group C were divided into non-delayed chemotherapy group, 1-7 days delayed group and more than 7 days delayed group. Relationships between delayed chemotherapy and gender, age, tumor lysis syndrome before chemotherapy, bone marrow involvement, disease group (B/C group), serum lactate dehydrogenase (LDH) > 4 times than normal, grade Ⅲ-Ⅳ myelosuppression after chemotherapy, minimal residual disease in the interim assessment, and severe infection (including severe pneumonia, sepsis, meningitis, chickenpox, etc.) were analyzed. Logistic analysis was used to identify the relevant factors. Kaplan-Meier method was used to analyze the patients' survival information. Log-Rank was used for comparison between groups.Results:Among 591 patients, 504 were males and 87 were females, the follow-up time was 34.8 (18.6,50.1) months. The 3-year overall survival (OS) rate was (92.5±1.1)%,and the 3-year event-free survival (EFS) rate was (90.5±1.2)%. Seventy-three (12.4%) patients were in delayed chemotherapy group and 518 (87.6%) patients were in non-delayed chemotherapy group. The reasons for chemotherapy delay included 72 cases (98.6%) of severe infection, 65 cases (89.0%) of bone marrow suppression, 35 cases (47.9%) of organ dysfunction, 22 cases (30.1%) of tumor lysis syndrome,etc. There were 7 cases of chemotherapy delay in group B, which were seen in COPADM (vincristine+cyclophosphamide+prednisone+daunorubicin+methotrexate+intrathecal injection,4 cases) and CYM (methotrexate+cytarabine+intrathecal injection,3 cases) stages. There were 66 cases of chemotherapy delay in group C, which were common in COPADM (28 cases) and CYVE 1 (low dose cytarabine+high dose cytarabine+etoposide+methotrexate, 12 cases) stages. Multinomial Logistic regression analysis showed that the age over 10 years old ( OR=0.54,95% CI 0.30-0.93), tumor lysis syndrome before chemotherapy ( OR=0.48,95% CI 0.27-0.84) and grade Ⅲ-Ⅳ myelosuppression after chemotherapy ( OR=0.55,95% CI 0.33-0.91)were independent risk factors for chemotherapy delay.The 3-year OS rate and the 3-year EFS rate of children with Burkitt lymphoma in the delayed chemotherapy group were lower than those in the non-delayed chemotherapy group ((79.4±4.9)% vs. (94.2±1.1)%, (80.2±4.8)% vs. (92.0±1.2)%,both P<0.05). The 3-year OS rate of the group C with chemotherapy delay >7 days (42 cases) was lower than that of the group with chemotherapy delay of 1-7 days (22 cases) and the non-delay group (399 cases) ((76.7±6.9)% vs. (81.8±8.2)% vs. (92.7±1.3)%, P=0.002).The 3-year OS rate of the chemotherapy delay group (9 cases) in the COP (vincristine+cyclophosphamide+prednisone) phase was lower than that of the non-chemotherapy delay group (454 cases) ((66.7±15.7)% vs. (91.3±1.4)%, P=0.005). Similarly, the 3-year OS rate of the chemotherapy delay group (11 cases) in the COPADM1 phase was lower than that of the non-chemotherapy delay group (452 cases) ((63.6±14.5)% vs. (91.5±1.3)%, P=0.001). Conclusions:The delayed chemotherapy was related to the age over 10 years old, tumor lysis syndrome before chemotherapy and grade Ⅲ-Ⅳ myelosuppression after chemotherapy in pediatric BL. There is a significant relationship between delayed chemotherapy and prognosis of BL in children.

Objective:To summarize and analyze the current application status of oral mucosal graft (OMG) technique in the repair of ureteral strictures in China, and clarify the feasibility, safety and effectiveness of this technique.Methods:The 175 patients who underwent repair of ureteral stricture using oral mucosal patches from June 2015 to February 2022 were etrospectively analyzed in 14 medical centers in China, including 49 cases in Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 32 cases in Affiliated Seventh Medical Center of PLA General Hospital, 3 cases in The Second Hospital of Anhui Medical University, 6 cases in The First Affiliated Hospital of Zhengzhou University, 56 cases in Peking University First Hospital, 3 cases in Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 cases in Shanghai Sixth People' s Hospital, 4 cases in General Hospital of Estern Theater Command, 4 cases in Lanzhou University Second Hospital, 2 cases in Guizhou Province People 's Hospital, 2 cases in Peking University People' s Hospital, 5 cases in Jinzhou First People's Hospital, 5 cases in The First Affiliated Hospital of Wannan Medical College, 1 case in Shandong Provincial Hospital. In this study, 127 patients (72.6%) used lingual mucosal patches, 32(18.3%) labial mucosa, and 16(9.1%) buccal mucosa. The surgical approach for OMG ureteral reconstruction was mainly minimally invasive, with robot-assisted laparoscopy in 84 patients (48.0%), traditional laparoscopic surgery in 87 patients (49.7%), and open surgery in only 4 patients (2.3%). There were 133 males and 42 females with an average age of (35.0±17.2) years. The mean body mass index (BMI) and stenosis length were (23.1±4.1) kg/m 2 and (4.7±1.8) cm, respectively. The stricture was located in the left ureter in 116 patients, right ureter in 58 case and bilateral ureter in 1 case. The most common causes of ureteral stricture were endoscopic surgery in 88(50.3%)patients, congenital stricture in 55(31.4%)patients, failed ureteroplasty in 29(16.6%)patients, history of extracorporeal shock wave lithotripsy in 13(7.4%)patients, radiotherapy history in 3(1.7%)patients and other causes in 6(3.4%)patients. Strictures were mainly located in the upper ureter, accounting for 61.7% (108/175 cases), followed by 36.0% (63/175) at the ureteropelvic junction and 2.3%(4/175)in the middle ureter. According to the surgical methods, the patients were divided into robot-assisted laparoscopic surgery group ( n=84), traditional laparoscopic surgery group ( n=87)and open surgery group ( n=4). Subgroup analysis of patients in robot-assisted laparoscopic and traditional laparoscopic surgery groups was performed. There were no significant difference in preoperative data between the two groups except for age (32.0±18.3) years vs.(37.0±15.9)years, P=0.040], BMI[(22.5±4.3)kg/m 2 vs. (23.7±3.6)kg/m 2, P=0.028], and etiology of stenosis [endoscopic injury, 34(40.5%) vs. 53(60.9%), P=0.012]. Preoperative hydronephrosis and stricture length were assessed by CTU and ureterography. Ureterography 7-9 weeks after surgery showed patency of the reconstructed segment, or no recurrence of hydronephrosis was judged as success. Evaluate the operation method, operation time, success rate, length of OMG in repairing ureteral stricture between laparoscopic and robot-assisted groups. Results:The overall success rate of oral mucosal graft repair surgery reached 97.7%(171/175). The success rate of ureteral reconstruction in the two groups were 96.4%(81/84)and 98.9%(86/87), respectively ( P=0.351), and the difference was not statistically significant. There was no significant difference for operation time, intraoperative blood loss, and mean oral mucosal length between the robotic and laparoscopic groups[(244.7±85.8) min and (222.7±83.5)min ( P=0.116), (58.9±38.6) ml and (68.4±45.5) ml ( P=0.217), (5.0±2.0) cm and (4.6±1.5) cm ( P=0.350)], respectively.Postoperative complications were reported in 23 (13.1%) patients, such as fever, urinary leakage, lymphatic leakage, infection, but only 2 (1.4%) cases patients had complications of Clavien-Dindo score ≥ Ⅲ. The two patients developed urinary stricture after surgery with failed conservative treatment, and no urinary stricture occurred following endoscopic treatment.The short-term (three months after surgery)incidence of complications in the site where the oral mucosa was taken, such as difficulty in opening mouth, pain, and swelling, was 12.0% (21/175), and there was no significant difference for oral complications between patients harvesting different length of mucosal graft. Conclusions:Ureteroplasty with oral mucosal graft is a safe, feasible and reliable technique for ureteral reconstruction. At present, minimally invasive technology is the main surgical approach for ureteroplasty, and there is no significant difference in operation time and success rate between robotic surgery and laparoscopic surgery.

Perineal tear is a common complication of vaginal delivery and will seriously affect the quality of life of these women, if is severe. Given to there was no evidence-based clinical guideline for the prevention and management of perineal tear in China, this evidence-based guideline was developed, based on the methods of WHO handbook for guideline development. Systematic reviews were conducted according to the Cochrane handbook and GRADE was used to assess the quality and certainty of the evidence. Detailed recommendations are provided for 19 clinical questions in the prevention and management of perineal laceration, aiming to guide clinical practice and improve the quality of life of this group of women.

Objective:To explore the effects of interpregnancy interval (IPI) on pregnancy outcomes of subsequent pregnancy.Methods:A multicenter retrospective study was conducted in 21 hospitals in China. Information of age, height, pre-pregnancy weight, IPI, history of diseases, complications of pregnancy, gestational age of delivery, delivery mode, and pregnancy outcomes of the participants were collected by consulting medical records of pregnant women who had two consecutive deliveries in the same hospital during 2011 to 2018. The participants were divided into 4 groups according to IPI:<18 months, 18-23 months, 24-59 months and ≥60 months. According to the WHO′s recommendation, with the IPI of 24-59 months group as a reference, to the effects of IPI on pregnancy outcomes of subsequent pregnancy were analyzed. Stratified analysis was further carried out based on age, history of gestational diabetes mellitus (GDM), macrosomia, and premature delivery, to explore the differences in the effects of IPI on pregnancy outcomes among women with different characteristics.Results:A total of 8 026 women were included in this study. There were 423, 623, 5 512 and 1 468 participants in <18 months group, 18-23 months group, 24-59 months group and ≥60 months group, respectively. (1) The age, pre-pregnancy body mass index (BMI), history of cesarean section, GDM, gestational hypertension and cesarean section delivery rate of <18 months group, 18-23 months group, 24-59 months group and ≥60 months group were gradually increased, and the differences were statistically significant ( P<0.05). (2) After adjusting for potential confounding factors, compared with women in the IPI of 24-59 months group, the risk of premature delivery, premature rupture of membranes, and oligohydramnios were increased by 42% ( OR=1.42, 95% CI: 1.07-1.88, P=0.015), 46% ( OR=1.46, 95% CI: 1.13-1.88, P=0.004), and 64% ( OR=1.64, 95% CI: 1.13-2.38, P=0.009) respectively for women in the IPI≥60 months group. No effects of IPI on other pregnancy outcomes were found in this study ( P>0.05). (3) After stratified by age and adjusted for confounding factors, compared with women in the IPI of 24-59 months group, IPI≥60 months would significantly increase the risk of oligohydramnios for women with advanced age ( OR=2.87, 95% CI: 1.41-5.83, P=0.004); and <18 months could increase the risk of premature rupture of membranes for women under the age of 35 ( OR=1.59, 95% CI: 1.04-2.43, P=0.032). Both the risk of premature rupture of membranes ( OR=1.58, 95% CI: 1.18-2.13, P=0.002) and premature delivery ( OR=1.52, 95% CI: 1.07-2.17, P=0.020) were significantly increased in the IPI≥60 months group. After stratified by history of GDM and adjusted for confounding factors, compared with women in the IPI of 24-59 months group, IPI≥60 months would lead to an increased risk of postpartum hemorrhage for women with a history of GDM ( OR=5.34, 95% CI: 1.45-19.70, P=0.012) and an increased risk of premature rupture of membranes for women without a history of GDM ( OR=1.44, 95% CI: 1.10-1.90, P=0.009). After stratified by history of macrosomia and adjusted for confounding factors, compared with women in the IPI of 24-59 months group, IPI≥60 months could increase the proportion of cesarean section for women with a history of macrosomia ( OR=4.11, 95% CI: 1.18-14.27, P=0.026) and the risk of premature rupture of membranes for women without a history of macrosomia ( OR=1.46, 95% CI: 1.12-1.89, P=0.005). After stratified by history of premature delivery and adjusted for confounding factors, compared with women in the IPI of 24-59 months group, IPI≥60 months would significantly increase the risk of premature rupture of membranes for women without a history of premature delivery ( OR=1.47, 95% CI: 1.13-1.92, P=0.004). Conclusions:Both IPI≥60 months and <18 months would increase the risk of adverse pregnancy outcomes in the subsequent pregnancy. Healthcare education and consultation should be conducted for women of reproductive age to maintain an appropriate IPI when they plan to pregnant again, to reduce the risk of adverse pregnancy outcomes in the subsequent pregnancy.

Objective: To understand the prevalence of eating behavior problems among preschool children in rural Hunan, and to explore its determinants, so as to provide a reference for solving their eating behavior problems. Methods: A multistage stratified cluster sampling method was used to randomly select 3 288 preschool children aged 3-6 years and their caregivers from 24 kindergartens between August and November 2019. Eating behavior problems questionnaire survey and peripheral blood hemoglobin detection were conducted among the preschool children, and unconditional Logistic regression model was used to analyze the determinants. Results: The total prevalence of eating behavior problems among preschool children in rural Hunan was 66.8%(2 195/3 288), and the three most common eating behavior problems were poor appetite(40.1%, 1 317/3 288), picky eating(43.6%, 1 434/3 288), poor eating habits(44.4%, 1 460/3 288), respectively. The risk factors for general eating behavior problems included left-behind children, caregiver occupation as professional and technical staffs, average daily static activity time≥3 hours, anemia, and second-hand smoke exposure, and older age and daily moderate/high intensity activities were protective factors. In the analysis of the three most common eating behavior problems: The risk factors for poor appetite included left-behind children, anemia, and second-hand smoke exposure, and daily moderate/high intensity activities was protective factors. The risk factors for picky eating included left-behind children, caregiver occupation as professional and technical staffs, high family income, average daily static activity time≥3 hours, and daily moderate/high intensity activities was protective factors. The risk factors for poor eating habits included left-behind children, caregiver occupation as professional and technical staffs, average daily static activity time≥3 hours, and older age and daily moderate/high intensity activities was protective factors. Conclusion The prevalence of eating behavior problems among preschool children in rural Hunan was high, which is influenced by age, left-behind, caregivers occupation, family income, activities, anemia, and second-hand smoke exposure.

Objective Aims to reduce the hidden risks of laboratory biosafety,understand the status of biosafety laboratory record filing situations in Shenzhen,and also to provide scientific basis for further standardizing the management of biosafety laboratory in Shenzhen.Methods In 2017,75 laboratories in Shenzhen completed record filing were surveyed,method ologies adopted including application materials review,phone call consultation and communication,carrying out corrective ac tions based on feedback peer review suggestions and finally complete the record filing.Results The first/second level laborato ry of biosafety in shenzhen is mainly public medical institutions,followed by private hospitals.In 2017,the first three recordfiling LABS were Futian district,nanshan district and longgang district.According to the data analysis,lack of the second category of pathogenic microorganism laboratory activity project risk assessment report,and laboratory layout diagram function partition is not clear were two of the more prominent problems in the software and hardware of laboratory management respectively.Conclusions Basically,the overall record filing of Shenzhen biosafety laboratory is good,however,more measurements should be developed to deal with identified problems to further strengthen the standardized management of laboratory biosafety.

Objective: To investigate the tendency and safety of percutaneous umbilical cord blood sampling (PUBS) in prenatal screening and diagnosis, and the possibilities of avoiding unnecessary PUBS. Methods: This was a retrospective study of pregnant women who underwent PUBS for prenatal diagnosis in Peking University First Hospital from January 2015 to December 2017. Clinical indications, timing of PUBS, further investigations (chromosome karyotype, molecular genetics and pathogen testing), results, and pregnancy outcomes were collected and analyzed. One-way analysis of variance (ANOVA), Chi-square test for linear trend, Fisher's exact probability test/Cochran-Armitage analysis and Cruskal-Wallis rank-sum test were used for statistical analysis. Results: (1) A total of 412 singleton pregnancies underwent PUBS at 20-38 gestational weeks during the study period, and 379 (92.2%) of them received PUBS before 34 gestational weeks. The positive test results accounted for 10.4% (43/412). There were six (1.5%) miscarriages after PUBS. In vitro cell culture failure occurred in two cases, one in 2015 and the other in 2016. (2) Among the 412 cases, 304 (73.8%) had only one indication. Fourteen cases could be identified as high risk in the first trimester, such as advanced maternal age (AMA, >35 years), pregnant history with chromosomal abnormal fetus and one of the couples carrying abnormal genes. There were four, zero and one case receiving PUBS only for AMA in 2015, 2016 and 2017, respectively. Indications, including high risk suggested by serum screening and fetal abnormality found by ultrasound were identified in 290 cases (70.4%) in the second or third trimester. Other than AMA, there were no statistically significant differences in single indicators. The proportion PUBS with double indicators increased from 2015 to 2017 but without significant difference. AMA and positive serum screening as indicators of aneuploidy screening accounted for 7.6% (8/105) in double-indicator group and 1.9% (8/412) in all. (3) There were 363 PUBS (88.1%) performed for ultrasound abnormalities. Among them, 76.9% (280/363) only had abnormal ultrasound findings, and the percentage was decreased year by year. The other 83 cases (80 with double indicators and three with triple indicators) also presented with other indicators, including AMA, adverse pregnancy history and positive serum screening. The proportion of PUBS performed with the presence of multiple indicators tended to increase recently, but no statistically significant difference was found. All the 18 cases with abnormality diagnosed by molecular genetic testing had abnormal ultrasound findings. Conclusions Although PUBS's complications are rare, it carries some risks. The constitution of single indication has been declined every year. With the improvement of prenatal screening system and application of molecular karyotyping, the necessity of invasive prenatal diagnosis with PUBS is greatly reduced. An improvement in reasonable and standardized application of PUBS needs to be achieved.

Objective To examine the association between maternal syphilis treatmentand the adverse pregnancy outcomes.Methods Syphilis-infected pregnant women retrieved from Information System of Prevention Mother-to-child Transmission of Human Immunodeficiency Virus (HIV),Syphilis,and Hepatitis B Management in Hu'nan Province between January 2012 and December 2017 were retrospectively studied.Information of demographic characteristics,pregnancy history,and syphilis infection/treatment history among these syphilis-infected pregnant women were collected and analyzed.According to the anti-syphilis treatment situation during pregnancy,syphilis-infected pregnant women were divided into three groups:non-treatment group,non-standardized treatment group and standardized treatment group.The incidences of adverse pregnancy outcomes among the three groups were calculated.Multivariate logistic regression was used to control confounding factors and analyze the association between maternal syphilis treatment and the adverse pregnancy outcomes.The adjusted odds ratios (aOR) and 95％ confidence interval (CI) were calculated.Results Among 9 059 syphilis-infected pregnant women,13.9％ (1 262),31.3％ (2 834),and 54.8％ (4 963)were untreated,non-standardized treated and standardized treated patients,respectively.The incidences of total adverse pregnancy outcomes in the non-treatment,non-standardized treatment and standardized treatment groups were 25.5％ (322),20.8％ (589),and 16.2％ (806),respectively.The incidences of stillbirth in the three groups were 2.3％ (29),1.3％ (38),and 0.6％ (28),respectively;those of preterm birth were 12.6％(159),10.5％ (297),and 6.0％ (299),respectively;those of low birth weight were 6.4％ (81),6.2％(175),and 3.3 ％ (162),respectively;those of small for gestational age were 10.9％ (138),8.4％ (237),and 8.0％ (399),respectively;those of neonatal death were 1.3％ (17),1.0％ (28) and 0.3％ (15),respectively;those of neonatal asphyxia were 1.9％ (24),0.9％ (25),and 0.9％ (46),respectively;those of neonatal pneumonia were 0.6％ (8),0.9％ (26),and 0.6％ (32),respectively;those of birth defects were 2.8％(35),1.3％ (37),and 1.1％ (57),respectively;those of neonatal congenital syphilis were 2.5％ (31),2.4％ (69),and 0.8％ (42),respectively.Compared with standardized treatment group,maternal syphilis without treatment was associated with increased risks of total adverse pregnancy outcomes (aOR =1.73),stillbirth (aOR =4.82),preterm birth (aOR =2.52),low birth weight (aOR =1.88),neonatal death (aOR =3.29),neonatal asphyxia (aOR =2.42) and birth defects (aOR =3.26) all P ＜ 0.01;maternal syphilis with non-standardized treatment was associated with increased risks of total adverse pregnancy outcomes (aOR =1.34),stillbirth (aOR =2.54),preterm birth (aOR =1.98),low birth weight (aOR =1.84),neonatal death (aOR =2.49) and neonatal congenital syphilis (aOR =1.70,P ＜ 0.05 or 0.01).Conclusions Maternal syphilis without treatment or with non-standardized treatment would increase the risks of adverse pregnancy outcomes.It is necessary to further strengthen the early screening and early treatment for syphilis-infected pregnant women,and improve the rate of standardized treatment to reduce the occurrence of adverse pregnancy outcomes.

Objective: Hepatocyte nuclear factor 1 homeobox b (HNF1B) -associated disease is an autosomal dominant inherited disorder with a variable, multi-systemic phenotype. In China, five adult probands and one child proband with HNF1B-associated disease had been reported, whereas few fetuses are described. The aims of this retrospective study were to understand about the clinical manifestations of HNF1B-associated disease and to further improve the recognition of this disorder. Method: Four patients (3 males, 1 female) and three fetuses with HNF1B mutations were included in this study. They were admitted to our hospital from January 2013 to March 2017. HNF1B mutations were detected using targeted next generation sequencing and quantitative real-time PCR or Sanger sequencing. HNF1B heterozygous deletion of exons 1-9 was found in 4 patients and 2 fetuses, and HNF1B heterozygous missense mutation in 1 fetus. These two mutations had been reported. Two patients and 1 fetus had de novo mutations. Results of renal ultrasonography with or without magnetic resonance imaging, biochemical investigations, urine routine examination and other necessary investigations in 7 cases were analyzed. Result: Three patients were Han Chinese ethnicity, and one patient was Mongolian. In patients 1 and 4, abnormal fetal kidneys were discovered by routine ultrasonography, and the age at first feature identified in Patients 2 and 3 were 13 years and 28 years. Patient 3 had normal renal function and the remainder had reduced glomerular filtration rate. In addition, patient 4 presented with nephrotic syndrome and glycosuria, patient 2 with early onset hyperparathyroidism and renal osteodystrophy, and patient 3 with diabetes mellitus. All the 4 patients had renal structural abnormalities including bilateral multiple renal cysts, dysplasia and hyperechogenic kidneys. Only patient 3 had a positive family history of renal diseases, the remainder had a negative family history of renal diseases. In 3 fetuses, prenatal ultrasound anomalies were detected during the second trimester. These 3 fetuses had hyperechogenic kidneys with or without renal cysts. Polyhydramnios was detected in only one of the 3 fetuses. Two of the 3 fetuses had a positive family history of renal diseases. Conclusion Clinical phenotypes of HNF1B-related disease are heterogeneous, renal malformations clearly appear to be the most common manifestation, multiple renal cysts are characteristic, and patients can progress to impaired kidney function during childhood; HNF1B mutation is a differential diagnosis of fetal hyperechogenic kidneys or multiple renal cysts.