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Maternal vitamin D deficiency during pregnancy elevates the risk of SGA and LBW infants in a Chinese population.

This prospective study suggested that there was an inverted-U-shaped relation between neonatal vitamin D status and neurocognitive development in toddlers. Additional studies on the optimal 25(OH)D concentrations in early life are needed.

AIM The aim of this study was to assess the cognitive and behavioural development of children with healthy birth outcomes whose mothers were exposed to prenatal stress but did not experience pregnancy complications. METHOD In this prospective study, self-reported data, including the Prenatal Life EventsChecklist about stressful life events (SLEs) during different stages of pregnancy, were collected at 32 to 34 weeks' gestation. Thirty-eight healthy females (mean age 27y 8mo, SD 2y 4mo) who were exposed to severe SLEs in the first trimester were defined as the exposed infant group, and 114 matched comparison participants were defined as the unexposed infant group (1:3). Maternal postnatal depressive symptoms were assessed with the Edinburgh Postnatal Depression Scale. The Bayley Scales of Infant Development and the Toddler Temperament Scale were used to evaluate the cognitive development and temperament characteristics of the infants with healthy birth outcomes when they were 16 to 18 months old.RESULTS A randomized block multivariate analysis of covariance showed that the mental development index scores of the infants of mothers with prenatal exposure to SLEs in the first trimester averaged seven points (95% confidence interval 3.23-10.73 points) lower than those of the unexposed infants. Moreover, the infants in the exposed group achieved higher scores for regularity (adjusted mean [SD] INTERPRETATION This study provides evidence that lower cognitive ability and less optimal worse behavioural response in infants might independently result from prenatal maternal stress.Studies carried out using animal-based models present evidence that exposure to prenatal stress may increase vulnerability to atypical cognitive and neurobehavioral development, altering the development of several brain areas (including the prefrontal cortex, hippocampus, and amygdala) and the programming of the hypothalamicpituitary-adrenal axis.1,2 A certain amount of life stress is unavoidable for humans. A substantial body of evidence, however, has linked maternal exposure to stressful life events (SLEs) during pregnancy with cognitive and behavioural development in the offspring. The early stages of pregnancy in humans, from 8 to 24 weeks' gestational age, are particularly important for development. During this period, major neurodevelopmental events occur, including the proliferation, differentiation, and migration of neurons. Several brain areas, such as the hippocampus and amygdala, are already differentiated during this period.3,4 Our previous study, and others 5,6 have shown that maternal exposure to SLEs in the first trimester is associated with adverse birth outcomes and lower general intellectual ability. It is rational to postulate that stress during the first trimester might interfere with neurodevelopmental processes, resulting in atypical cognitive and behavioural development.Ecological investigations have found that prenatal exposure to a natural disaster is associated with lower cognitive and language abilities.6 Population-ba...

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ObjectivePericardiectomy is associated with a high prevalence of morbidity and mortality. We evaluated the predictors of in-hospital complications and outcome for pericardiectomy procedure for patients with constrictive pericarditis (CP) in a single-center in China.MethodsOne-hundred sixty-five patients who underwent pericardiectomy for CP between January 1990 and December 2012 at our hospital were evaluated.ResultsThe mean age of the study cohort was 36.79 ± 18.52 years. The approach was through a median sternotomy in 91.5% of patients. Cardiopulmonary bypass was used in 14.5% (24/165 patients). Unadjusted rates of mortality and complication were approximately 5.4% and 23%, respectively. The main cause of death was severe low cardiac output syndrome. Major complications were postoperative low cardiac output syndrome, reoperation for bleeding, pneumonia, mediastinitis, chylothorax and cerebral infarction. One-year survival was 92%. One-year follow-up revealed that New York Heart Association functional class III or IV, age, intraoperative use of cardiac pulmonary bypass and hemodialysis were associated with increased mortality and morbidity.ConclusionsTotal pericardiectomy is associated with lower perioperative and late mortality, and the extent of pericardial resection should be decided according to individual conditions. Perioperative management and complete release of the thickened pericardium of the left ventricle should prevent postoperative complications.

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