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To evaluate the pathological changes of the placenta to determine the mechanism underlying placenta-derived fetal growth restriction (FGR) and investigate its influence on neonatal outcomes. Study design: This retrospective case-control study included 120 singleton pregnancies with FGR as well as 120 gestational age-matched controls. We compared the placental pathological findings and neonatal outcomes according to the presence of placental malperfusion. Results: The FGR group demonstrated lower placental weight (350.8 ± 118.8 vs. 436.1 ± 109.7g, P <.0001), smaller chorionic plate area (157.7 ± 48.0 vs. 201.5 ± 53.4 cm2, P <.0001), and higher rate of villous change lesions (84.2% vs. 52.5%, P <.0001) than the control group. FGR neonates with placental malperfusion had a higher rate of adverse neonatal outcomes (87.1% vs. 63.2%, P =.0175). Conclusion: Small placentas and placental malperfusion reflected in villous changes are associated with FGR. FGR neonates with placental malperfusion are more susceptible to adverse neonatal outcomes. [ABSTRACT FROM AUTHOR]

This study aimed to compare obstetrical complications and neonatal outcomes between monochorionic and dichorionic discordant twin pregnancies. We enrolled 296 patients with twin pregnancy who delivered at Busan Paik Hospital between January 2014 and December 2017. The prevalence of obstetrical complications, neonatal mortality between monochorionic and dichorionic twins was compared. We also investigated whether there is a difference in neonatal outcome and neonatal morbidity between monochorionic discordant twins without monochorionic-specific complications and dichorionic discordant twins. The risk of fetal death in utero (13.2 versus 5.2%, p =.025) and inter twin birth weight discordance (35.1 versus 20.8%, p =.031) is increased in monochorionic twins than in dichorionic twins. However, no difference was noted in obstetrical complication and neonatal mortality and morbidity between two groups. Among twin pregnancies with intertwin birth weight discordance, after excluding fetal death in utero and monochorionic specific complication, there was no difference in obstetrical complication and neonatal mortality and morbidity according to chorionicity. There was no difference in neonatal morbidity between monochorionic twins and dichorionic twins when comparing larger neonates and smaller neonates of each group. Risk of birth weight discordance is higher in monochorionic twin but no significant difference was observed in maternal outcomes, neonatal mortality and morbidity between noncomplicated monochorionic and dichorionic discordant twins. [ABSTRACT FROM AUTHOR]

Fetal growth restriction (FGR) is the failure of the fetus toachieve its genetically determined growth potential, which increasesrisks for a variety of genetic diseases, such as type 2 diabetes mellitus, coronary artery disease, and stroke, during the lifetime. The dysregulation of DNA methylationis known to interact with environmental fluctuations, affect gene expressions comprehensively, and be fatal to fetus development in specific cases. Therefore, we set out to find out epigenetic and transcriptomic alterations associated with FGR development. We found a set of differentially expressed genes associated with differentially methylated regions in placentae and cord blood samples. Using dimensional reduction analysis, the expression and methylation variables of the epigenetically altered genes classified the FGR samples from the controls. These genes were also enriched in the biological pathways such as metabolism and developmental processes related to FGR. Furthermore, three genes of INS, MEG3, and ZFP36L2 are implicated in epigenetic imprinting, which has been associated with FGR. These results strongly suggest that DNA methylation is highly dysregulated during FGR development, and abnormal DNA methylation patterns are likely to alter gene expression. [ABSTRACT FROM AUTHOR]

This study tested the impacts of two-game features, (1) letterboxing (i.e., earning six stamps from hidden places) and (2) external rewards (i.e., giveaways), in order of understanding the gamification on tourist psychological outcomes in a maze park. A total of 1,203 participants were divided into four conditions through a field experiment, resulting from the factorial combination of the letterboxing and the external rewards. The main effects of letterboxing that trigger intrinsic motivations appear to be significant on tourist psychological outcomes. Moreover, the results indicate that there are significant interaction effects between letterboxing and rewards on tourist flow. [ABSTRACT FROM AUTHOR]

Clinical performance of the Momguard non-invasive prenatal test (NIPT) was evaluated in a cohort of Korean pregnant women. The foetal trisomies 21, 18 and 13 (T21, T18 and T13) were screened by low-coverage massive parallel sequencing in the maternal blood. Among the 1011 confirmed samples, 32 cases (3.2%) had positive NIPT results. Of these positive cases, 20 cases of T21, all cases of T18 and two cases of T13 had concordant karyotype findings. Only one case out of the remaining 979 negative NIPT samples showed a false negative result. The overall sensitivity and specificity of Momguard to detect the three chromosomal aneuploidies were 96.8% and 99.8%, respectively. Momguard is a clinically useful tool for the detection of T21, T18 and T13 in singleton pregnancy. However, as other NIPT tests, it carries the risk of false positive and false negative results. Hence, the genetic counsellors should provide these limitations to the examinees.Impact StatementWhat is already known on this subject? The NIPT approach using massive parallel sequencing (MPS) showed high sensitivity and specificity in various clinical studies. These results are based on analysis systems using their own bioinformatics algorithms.What the results of this study add? When this NIPT technology was introduced in Korea, the first biological specimens collected in Korea were transported overseas for processing in overseas laboratories and analysed by other country's analysis methods. We needed our own NIPT algorithm and developed Momguard NIPT for the first time in Korea. This study attempted to evaluate this Momguard NIPT protocol prospectively in a large number of samples obtained from three Korean hospitals.What the implications are of these findings for clinical practice and/or further research? The overall sensitivity and specificity to identify T13, T18 and T21 were 96.8% and 99.8%, respectively. These accuracy values were comparable to that of other studies. From this study, we found that Momguard is a clinically useful tool for the detection of three chromosomal aneuploidies. However, as other NIPT tests, it carries the risk of false positive and false negative results. Hence, the genetic counsellors should provide these limitations to the examinees. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to compare obstetrical complications and neonatal outcomes between monochorionic and dichorionic discordant twin pregnancies.Study Design: We enrolled 296 patients with twin pregnancy who delivered at Busan Paik Hospital between January 2014 and December 2017. The prevalence of obstetrical complications, neonatal mortality between monochorionic and dichorionic twins was compared. We also investigated whether there is a difference in neonatal outcome and neonatal morbidity between monochorionic discordant twins without monochorionic-specific complications and dichorionic discordant twins.Results: The risk of fetal death in utero (13.2 versus 5.2%, p = .025) and inter twin birth weight discordance (35.1 versus 20.8%, p = .031) is increased in monochorionic twins than in dichorionic twins. However, no difference was noted in obstetrical complication and neonatal mortality and morbidity between two groups. Among twin pregnancies with intertwin birth weight discordance, after excluding fetal death in utero and monochorionic specific complication, there was no difference in obstetrical complication and neonatal mortality and morbidity according to chorionicity. There was no difference in neonatal morbidity between monochorionic twins and dichorionic twins when comparing larger neonates and smaller neonates of each group.Conclusions: Risk of birth weight discordance is higher in monochorionic twin but no significant difference was observed in maternal outcomes, neonatal mortality and morbidity between noncomplicated monochorionic and dichorionic discordant twins. [ABSTRACT FROM AUTHOR]

Introduction: Dural sinus malformations, which are characterized by massively dilated dural sinuses, are one of the etiologies of an intracranial fetal cystic mass. Thrombi within these dural sinus malformations can develop while in-utero, and can be visualized by ultrasound in fetal life. Definitive postnatal diagnosis requires an autopsy. Case Report: We report two thrombosed fetal dural sinus malformations which are prenatally suspected during the second trimester with ultrasonography and postnatally confirmed with autopsy. Conclusion: Prenatal ultrasound images and fetal autopsy findings can be useful to establish the prenatal diagnosis of thrombosed dural sinus malformation. [ABSTRACT FROM AUTHOR]

Objective: We aimed to assess the impact of antenatal MgSO4 therapy given to women with PPROM before 32 weeks' gestation on latency, maternal outcomes, perinatal outcomes, and neurodevelopmental outcomes.Methods: We undertook a retrospective cohort observational study of 184 singleton pregnancies complicated by PPROM at 23°-316 weeks who were hospitalized and received magnesium therapy for tocolysis (MgSO4 group) or did not receive tocolytic therapy (no MgSO4 group) between 2005 and 2013. Furthermore, patients were subdivided into two groups based on the gestational age at the onset of PPROM (23°-276 weeks' gestation and 28°-316 weeks' gestation).Results: We included 184 women, of whom 143 received magnesium therapy and 41 did not. The latency period was significantly longer in the MgSO4 group compared with no MgSO4 group (7.9 ± 9.0 versus 4.0 ± 6.0 days, p = .0017). Antenatal magnesium therapy was significantly associated with decreased stillbirth (1.4% versus 14.6%, p = .0012) and perinatal mortality (7% versus 19.5%, p = .0375) without significant increase in the risk of neonatal morbidities and chorioamnionitis. However, neonates who were exposed to antenatal MgSO4 were associated with higher Mg levels (3.63 ± 1.05 mg/dl versus 2.13 ± 0.48 mg/dl, p < .0001) and phosphate levels (6.90 ± 1.36 mg/d versus 6.40 ± 1.01 mg/dl, p = .0459) than those who were not exposed. Neonates who were exposed to MgSO4 showed significantly reduced risks of IVH (20.4% versus 58.3%; RR, 0.35; 95%CI, 0.17-0.71) and PVL (27.8% versus 58.3%; RR, 0.48; 95%CI, 0.25-0.91) in the subgroup of 23°-276 weeks' gestation. And the incidence of developmental delay in the subgroup of 23°-276 weeks' gestation was significantly lower in the MgSO4 group (6.5% versus 36.4%; RR, 0.18; 95%CI, 0.05-0.69). However, there were no significant differences in the development of IVH, PVL, and developmental delay between the two groups for patients in the subgroup of 28°-316 weeks' gestation. A similar trend was observed for cerebral palsy, with 22.2% of unexposed children affected compared with only 7.0% of exposed children (RR, 0.31; 95%CI, 0.10-1.00).Conclusions: Antenatal magnesium therapy in women with PPROM before 32 weeks' gestation could prolong latency period, allowing for corticosteroid benefit. Moreover, MgSO4 showed fetal neuroprotective effects for neonatal IVH and PVL, and for developmental delay in infancy while prolonging latency. However, these benefits were primarily limited to the subgroup of 23°-276 weeks' gestation and prolonged in utero exposure to MgSO4 was associated with bone mineralization in the neonates. [ABSTRACT FROM AUTHOR]

Kaposiform hemangioendothelioma (KHE) is a locally aggressive vascular tumor that usually occurs in soft tissues of the extremity and rarely in the retroperitoneum. We report a unique case of isolated massive fetal ascites attributed to KHE, involving the retroperitoneum and multiple visceral organs, along with the Kasabach–Merritt phenomenon.We suspect that retroperitoneal KHE might have caused massive fetal ascites because of its high potential to invade the lymphatic vessels aggressively in the retroperitoneal space, which possibly permits intestinal lymph leakage into the peritoneal cavities. [ABSTRACT FROM AUTHOR]

This study aims to investigate a hybrid gravity base foundation to support offshore wind tower. A new hybrid gravity base foundation considered in this study has five component piles, referred to as ‘piled gravity base foundation’. The three-dimensional finite element analyses were carried out for the piled gravity base foundation subjected to a combined load with a lateral load and overturning moment. The parametric analyses were undertaken varying the loading height and direction, the rigidity of the piled gravity base foundation, the field soil layers, and the clay strength. Overall, the response of the piled gravity base foundation was significantly influenced by the interaction between the cone base piles and the surrounding soil. The increased strength of the soil led to a significant reduction of the pile and gravity base foundation responses, in terms of the bending moments, axial forces, lateral displacements, and rotations. [ABSTRACT FROM PUBLISHER]

We investigate dietary intake and lifestyle patterns of atopic children and adolescents (N= 539) by obesity level using a national survey of South Korea. Intakes of calcium, iron, and vitamin C in the underweight group were less than those of other groups. The frequency of drinking milk of the overweight group was higher than that of the normal weight group. Majority of the subjects had not applied nutrition labeling in food choices, had no experience of nutrition education, and were vitamin D deficient. In conclusion, most of the atopic subjects had little knowledge of nutrition and were vitamin D deficient. [ABSTRACT FROM AUTHOR]

Purpose:Drugs that blockade interaction between programmed cell-death protein 1 (PD-1) and its ligand (PD-L1) are promising. Immune-related adverse events (irAEs) might be associated with favorable clinical outcomes, and thyroid dysfunction is one of the most common irAE. We evaluated the association of thyroid dysfunction during PD-1 blockade with the treatment efficacy in patients with non-small cell lung cancer (NSCLC). Experimental Design:A total 58 patients with stage IV NSCLC treated with PD-1 blockade were enrolled. Patients were categorized into thyroid dysfunction and euthyroid groups. Overall survival (OS) and progression-free survival (PFS) of the two groups were compared. Patients, tumor, and medication factors were adjusted using Cox proportional hazard modeling. Objective response rate (RR) and durable control rate were assessed according to the severity of thyroid dysfunction. Results:OS [median 118.0 (73.0-267.0) vs. 71.0 (28.0-160.0) days, log-rankP= 0.025] and PFS [118.0 (73.0-267.0) vs. 61.0 (28.0-130.0), log-rankP= 0.014] were longer in the thyroid dysfunction group. After adjustment, thyroid dysfunction was an independent predictive factor for favorable outcome [adjusted HR = 0.11 (95% CI) 0.01-0.92 for overall death; 0.38 (0.17-0.85) for disease progression]. The severity of thyroid dysfunction was associated with durable control rate (Pfor trend = 0.008). Conclusions:Thyroid dysfunction during PD-1 blockade is associated with treatment response and could provide supplementary information for immune monitoring in patients with advanced NSCLC. [ABSTRACT FROM PUBLISHER]