BACKGROUND & AIMS: BACKGROUND:Choline is essential for fetal brain development, and it is not known whether a typical American diet contains enough choline to ensure optimal brain development. OBJECTIVE:The study was undertaken to determine whether supplementing pregnant women with phosphatidylcholine (the main dietary source of choline) improves the cognitive abilities of their offspring. DESIGN:In a double-blind, randomized controlled trial, 140 pregnant women were randomly assigned to receive supplemental phosphatidylcholine (750 mg) or a placebo (corn oil) from 18 wk gestation through 90 d postpartum. Their infants (n = 99) were tested for short-term visuospatial memory, long-term episodic memory, language development, and global development at 10 and 12 mo of age. RESULTS:The women studied ate diets that delivered ∼360 mg choline/d in foods (∼80% of the recommended intake for pregnant women, 65% of the recommended intake for lactating women). The phosphatidylcholine supplements were well tolerated. Groups did not differ significantly in global development, language development, short-term visuospatial memory, or long-term episodic memory. CONCLUSIONS:Phosphatidylcholine supplementation of pregnant women eating diets containing moderate amounts of choline did not enhance their infants' brain function. It is possible that a longer follow-up period would reveal late-emerging effects. Moreover, future studies should determine whether supplementing mothers eating diets much lower in choline content, such as those consumed in several low-income countries, would enhance infant brain development.

背景与目标： 背景：胆碱对胎儿脑部发育至关重要，尚不清楚典型的美国饮食中是否含有足够的胆碱以确保最佳的脑部发育。
目的：本研究旨在确定孕妇补充磷脂酰胆碱（胆碱的主要饮食来源）是否能改善其后代的认知能力。
设计：在一项双盲，随机对照试验中，从怀孕18周到产后90天，随机分配了140名孕妇接受补充磷脂酰胆碱（750毫克）或安慰剂（玉米油）。他们的婴儿（n = 99）在10和12个月大时接受了短期视觉空间记忆，长期情境记忆，语言发展和整体发展的测试。
结果：这些妇女所研究的饮食中，食物中的胆碱/日摄入量约为360毫克/天（孕妇的推荐摄入量约为80％，哺乳期妇女的推荐摄入量约为65％）。磷脂酰胆碱补充剂的耐受性良好。在全球发展，语言发展，短期视觉空间记忆或长期情境记忆方面，各组没有显着差异。
结论：孕妇食用含适量胆碱饮食的磷脂酰胆碱不能增强婴儿的脑功能。较长的随访期可能会显示出较晚出现的影响。此外，未来的研究应确定补充食用胆碱含量低得多的饮食的母亲（如在几个低收入国家食用的饮食）是否会增强婴儿的大脑发育。

BACKGROUND & AIMS: Milk (Similac), sucrose (12% wt/vol), or water were delivered to crying normal newborns once per minute for 5 minutes, in a volume of 0.1 mL/delivery. Milk and sucrose markedly reduced infant crying, and this calm persisted during the 3 minutes after substance delivery. Infants who received water were only marginally quieted, and this calm did not persist. Despite quieting agitated infants, milk did not cause them to bring their hands to their mouths during the period of milk treatment, whereas infants who received sucrose did bring their hands to their mouths. These data demonstrate that milk effectively quiets human newborns, that its quieting effects endure, and that the mechanisms that quiet and that underlie hand-in-mouth engagement are separable and independent.

背景与目标： 每分钟一次将牛奶（Similac），蔗糖（12％wt / vol）或水分5次输给哭泣的正常新生儿，持续5分钟，每次输注0.1 mL。牛奶和蔗糖显着减少了婴儿的哭泣，这种平静在药物输送后的3分钟内持续存在。刚喝水的婴儿只有一点点安静下来，这种平静并没有持续下去。尽管使躁动不安的婴儿安静下来，但是在进行乳汁治疗期间，牛奶并未使他们把手伸到嘴里，而接受蔗糖的婴儿却使把手伸到了嘴里。这些数据表明，牛奶有效地使人的新生儿安静，其安静效果得以持久，并且安静和作为亲手参与的基础的机制是可分离且独立的。

BACKGROUND & AIMS: -2

背景与目标： -2

BACKGROUND & AIMS: :Coronary artery fistula with giant coronary artery ectasia is a rare abnormal CHD. Multidetector CT is useful for the diagnosis. Early diagnosis and surgery are recommended.

背景与目标： ：冠状动脉瘘伴巨大冠状动脉扩张是一种罕见的冠心病异常。 Multidetector CT对诊断很有用。建议及早诊断和手术。

BACKGROUND & AIMS: At the Unit of Nutritional Rehabilitation of La Plata Children's Hospital "Sor María Ludovica" an inventory was designed to observe in outpatient clinics certain behaviors allowing an early detection of disorders in mother-child link. We evaluate a sample of 50 mothers with their children between 1 and 24 months presenting moderate or severe undernutrition of primary cause, as well as 50 mothers with their children of the same age, sex, social and economical level of the experimental group who never presented undernutrition. This inventory, which has the following parts, was applied1) verbal maternal behaviour, 2) affective maternal behavior, 3) child's hygiene, 4) stimulation of development, 5) participation of other persons in child's care, 6) consistency between mother's discourse and attitudes. The inventory has been sensitive to the proposed objective, showing a highly significant difference when correlate mother-well nourished child and mother-undernourished child.

背景与目标： 拉普拉塔儿童医院“ SorMaríaLudovica”的营养康复科设计了一个清单，目的是在门诊诊所观察某些行为，以便及早发现母婴联系方面的疾病。我们评估了50名母亲在1至24个月内表现出中度或严重营养不良的母亲的样本，以及50名母亲与他们的年龄，性别，社会和经济水平相同但从未出现过的实验组的母亲营养不良。该清单包括以下部分：1）口头的孕产妇行为，2）情感的孕产妇行为，3）儿童的卫生，4）促进发育，5）其他人参与儿童保育，6）母亲的话语与态度。该清单对拟议的目标很敏感，当将母亲营养丰富的孩子和母亲营养不良的孩子相关联时，清单显示出非常显着的差异。

BACKGROUND & AIMS: :Face processing in mothers is linked to mother-infant social communication, which is critical for parenting and in turn for child development. Neuroimaging studies of child maltreatment-exposed (CME) mothers are sparse compared to studies of mothers with postpartum depression, which have suggested blunted amygdala reactivity to infant stimuli. We expected to see a similar pattern in CME mothers. Based on broader studies in trauma-exposed populations, we anticipated increased amygdala reactivity to negative adult face stimuli in a comparison task in CME mothers given heightened evaluation of potential threat. We examined Neuroimaging studies of mothers with childhood maltreatment exposure (CME) (18-37 years old), who performed infant (N = 45) and/or adult (N = 46) face processing tasks. CME mothers exhibited blunted bilateral amygdala reactivity to infant faces. There was no between-group difference in amygdala reactivity to adult faces. In infant and adult face processing tasks regardless of CME, superior temporal gyrus activation was increased for negative-valence stimuli. Our preliminary findings suggest that childhood maltreatment alters maternal processing of infant social cues, a critical skill impacting infant socioemotional development.

背景与目标： ：母亲的脸部处理与母婴社会沟通有关，这对于养育子女和继而对孩子的成长至关重要。与对产后抑郁症母亲的研究相比，对遭受儿童虐待的母亲的神经影像学研究稀疏，这表明杏仁核对婴儿刺激的反应迟钝。我们希望在继续医学教育的母亲中也能看到类似的情况。根据对遭受创伤的人群进行的更广泛研究，我们预期在CME母亲的比较任务中，鉴于潜在威胁的评估增加，杏仁核对成年面部负刺激的反应性会增加。我们检查了患有儿童虐待（CME）（18-37岁）的母亲的神经影像学研究，这些母亲执行了婴儿（N = 45）和/或成人（N = 46）的面部处理任务。芝商所的母亲表现出对婴儿脸的双侧杏仁核反应迟钝。杏仁核对成年面部的反应性没有组间差异。在不考虑CME的婴儿和成人面部处理任务中，针对负价刺激增加了上颞颞回激活。我们的初步发现表明，儿童期虐待改变了母亲对婴儿社交线索的处理，这是影响婴儿社会情感发展的一项关键技能。

BACKGROUND & AIMS: :The aim of the current work was to evaluate the physicochemical, rheological, molecular, thermal and sensory properties of complementary food (CF) formulations prepared with quinoa (Chenopodium quinoa Willd.) flour (QF). It was observed that QF addition significantly affected the physicochemical and rheological properties of CF formulations, resulting in higher protein and crude fiber, but lower total sugar contents and increased storage (G') and loss (G″) modulus values. The glass transition temperature decreased due to QF addition. The FTIR spectra revealed the presence of aromatic amino acids derived from QF. GC, GC-MS and GC-O analyses revealed the presence of 50 aroma and 23 aroma-active compounds, among which aldehydes, alcohols and ketones were the most prevalent group of compounds. The formulation with 8% QF received the highest sensory scores. QF could be used to improve the physicochemical, rheological, thermal and sensory properties of CF products.

背景与目标： ：当前工作的目的是评估用藜麦（藜麦藜麦（Chenopodium quinoa Willd。））面粉（QF）制备的辅食（CF）制剂的理化，流变，分子，热和感官特性。观察到QF的添加显着影响CF制剂的物理化学和流变性质，导致更高的蛋白质和粗纤维，但是更低的总糖含量以及增加的储能（G'）和损失（G''）模量值。由于添加了QF，玻璃化转变温度降低了。 FTIR光谱显示存在源自QF的芳香族氨基酸。 GC，GC-MS和GC-O分析显示存在50种香气和23种香气活性化合物，其中醛，醇和酮是最常见的化合物。 QF为8％的配方获得最高的感官评分。 QF可用于改善CF产品的理化，流变，热和感官性能。

BACKGROUND & AIMS: BACKGROUND:Diagnostic Exome Sequencing (DES) has been shown to be an effective tool for diagnosis individuals with suspected genetic conditions. CASE PRESENTATION:We report a male infant born with multiple anomalies including bilateral dysplastic kidneys, cleft palate, bilateral talipes, and bilateral absence of thumbs and first toes. Prenatal testing including chromosome analysis and microarray did not identify a cause for the multiple congenital anomalies. Postnatal diagnostic exome studies (DES) were utilized to find a molecular diagnosis for the patient. Exome sequencing of the proband, mother, and father showed a previously unreported maternally inherited RNA binding motif protein 10 (RBM10) c.1352_1353delAG (p.E451Vfs*66) alteration. Mutations in RBM10 are associated with TARP syndrome, an X-linked recessive disorder originally described with cardinal features of talipes equinovarus, atrial septal defect, Robin sequence, and persistent left superior vena cava. CONCLUSION:DES established a molecular genetic diagnosis of TARP syndrome for a neonatal patient with a poor prognosis in whom traditional testing methods were uninformative and allowed for efficient diagnosis and future reproductive options for the parents. Other reported cases of TARP syndrome demonstrate significant variability in clinical phenotype. The reported features in this infant including multiple hemivertebrae, imperforate anus, aplasia of thumbs and first toes have not been reported in previous patients, thus expanding the clinical phenotype for this rare disorder.

背景与目标： 背景：外显子诊断测序（DES）已被证明是诊断患有可疑遗传疾病的个体的有效工具。
病例介绍：我们报告了一个男婴，其出生时有多种异常，包括双侧发育不良的肾脏，left裂，双侧滑石和双侧拇指和第一脚趾缺失。包括染色体分析和微阵列在内的产前检查并未发现多种先天性异常的原因。产后诊断外显子组研究（DES）用于为患者寻找分子诊断。先证者，母亲和父亲的外显子组测序显示以前未报告的母体遗传RNA结合基序蛋白10（RBM10）c.1352_1353delAG（p.E451Vfs * 66）改变。 RBM10中的突变与TARP综合征有关，TARP综合征是一种X连锁隐性疾病，最初被描述为具有等角锥虫，房间隔缺损，Robin序列和持续性左上腔静脉的基本特征。
结论：DES为预后不良的新生儿建立了TARP综合征的分子遗传学诊断，该患者传统的检测方法无法提供信息，并且可以为父母提供有效的诊断和未来的生育选择。其他报道的TARP综合征病例在临床表型上显示出显着的变异性。先前的患者尚未报道该婴儿的报道特征，包括多发性半椎，肛门无孔，拇指发育不全和第一脚趾发育不全，因此扩大了这种罕见疾病的临床表型。

BACKGROUND & AIMS: :The authors wish to make a correction to Section 2 [...].

背景与目标： ：作者希望对第2节[...]进行更正。

BACKGROUND & AIMS: AIM:Levels of infant and child mortality in many developing countries remain unacceptably high, and they are disproportionably higher among high-risk groups such as newborn and infant of multiple births, particularly in countries where advanced medical cares are available only at regional referral levels with limited access by the poor rural women and children. This study examined the relationship between high-risk infant of multiple birth and infant mortality in Bangladesh. METHODS:The analysis uses information on 7001 childbirths in 5 years preceding the 2004 Bangladesh Demographic and Health Survey to examine the relationship between multiple birth and infant mortality using multivariate analysis, controlling for child's sex, birth order, prenatal care, delivery assistance; mother's age at child birth, nutritional status, education level; household living conditions and several other risk factors. RESULTS:Results indicate that children born multiple birth were more than six-times as likely to die during infancy as those born singletons (hazard ratio = 6.51; 95% confidence interval: 4.10, 10.36). Controlling for all other risk factors does not change the strength and direction of the relationship (hazard ratio = 6.18; 95% confidence interval: 3.65, 10.46). Receiving prenatal care and access to safe drinking water are associated with lower risk. CONCLUSION:Multiple births are strongly negatively associated with infant survival in Bangladesh independent of other risk factors. This evidence suggests that improving maternal and child health at the community level, screening for high-risk pregnancies and making referral services for these conditions more accessible to the rural women and children will be key to improving child survival in Bangladesh.

背景与目标： 目的：在许多发展中国家，婴儿和儿童的死亡率仍然很高，令人难以接受，在新生儿和多胎婴儿等高危人群中，婴儿和儿童的死亡率却高得不成比例，特别是在只有在地区转诊时才可获得高级医疗的国家贫穷的农村妇女和儿童获得的机会有限。这项研究检查了孟加拉国多胎高危婴儿与婴儿死亡率之间的关系。
方法：该分析使用2004年孟加拉国人口与健康调查之前5年中7001名分娩的信息，通过多变量分析检查多胎与婴儿死亡率之间的关系，控制孩子的性别，出生顺序，产前保健，分娩辅助;母亲的出生年龄，营养状况，教育程度；家庭生活条件和其他几个危险因素。
结果：结果表明，多胎出生的婴儿死于婴儿的可能性是单胎死亡的六倍以上（危险比= 6.51； 95％置信区间：4.10，10.36）。控制所有其他风险因素并不会改变关系的强度和方向（危险比= 6.18； 95％置信区间：3.65、10.46）。接受产前检查和获得安全饮用水与较低的风险相关。
结论：孟加拉国多胎出生与婴儿存活率呈强烈负相关，而与其他危险因素无关。这些证据表明，改善社区一级的妇幼健康，筛查高危妊娠以及使农村妇女儿童更容易获得针对这些疾病的转诊服务，将是改善孟加拉国儿童生存的关键。

BACKGROUND & AIMS: INTRODUCTION:Early life is a critical developmental window coinciding with the establishment of a community of neonatal gut microbes which are vitally important for immune development. The composition of this microbial community is affected by multiple factors. AREAS COVERED:The effect of pre-pregnancy and pregnancy maternal health, maternal nutrition, pregnancy disorders such as gestational diabetes, maternal antibiotic usage, delivery mode, infant feeding, and infant antibiotic usage on gut microbial composition are outlined along with the potential impact of associated microbiota differences on infant health. EXPERT OPINION:Recent developments in understanding what shapes our microbiota indicates that the greatest impact on infant gut microbiota composition during the first year of life is seen with the mode of delivery, infant diet, and infant antibiotic usage. Current data is insufficient to fully establish the role of apparently less important factors such as maternal health on microbiota development although their impact is likely smaller. Technological advances will allow for improved understanding of underlying mechanisms by which specific microbes impact on infant health, which in time will enable full appreciation of the role of the gut microbiota in early life development.

背景与目标： 简介：早期生命是一个至关重要的发展窗口，这与建立新生儿肠道微生物群落相一致，而新生儿肠道微生物对于免疫发育至关重要。该微生物群落的组成受多种因素影响。
覆盖的区域：概述了孕前和孕期孕产妇健康，孕产妇营养，妊娠疾病（如妊娠糖尿病），孕产妇抗生素使用，分娩方式，婴儿喂养和婴儿抗生素使用对肠道微生物组成的影响，以及孕激素的潜在影响。相关的微生物群差异对婴儿健康的影响。
专家意见：最近了解微生物菌群形状的进展表明，分娩方式，婴儿饮食和婴儿抗生素的使用对生命的第一年对婴儿肠道菌群组成的影响最大。尽管母体健康对微生物群发育的影响可能较小，但目前的数据不足以完全确立诸如母亲健康等看似不太重要的因素的作用。技术的进步将使人们更好地了解特定微生物对婴儿健康的影响的潜在机制，这将使人们充分认识到肠道菌群在早期生命发展中的作用。

BACKGROUND & AIMS: OBJECTIVE:To determine whether maternal or paternal use of cocaine, opiates, or marijuana during conception and pregnancy and postnatally increases the risk of sudden infant death syndrome (SIDS) during the first year of the infant's life. This is an important issue and may prove useful in further decreasing the rate of SIDS. METHODS:A case-control study was conducted consisting of 239 infants who died of SIDS in southern California between 1989 and 1992, and 239 healthy infants who were matched on the basis of birth hospital, date of birth, age, and sex. Specific drug use at the period of conception, during pregnancy and breastfeeding, and in the presence or vicinity of the infant was ascertained by telephone for the white, African American, Hispanic, Asian American, and Pacific Islander case and control fathers and mothers. RESULTS:Maternal recreational drug use during pregnancy was not associated with the risk of SIDS after adjusting for maternal smoking during pregnancy (adjusted odds ratio [OR] = 2.0; 95% confidence interval [CI], 0.6-6.5). There were statistically significant differences between case and control fathers' use of marijuana during conception (OR = 2.2; 95% CI, 1.2-4.2; P =.01), during pregnancy (OR = 2.0; 95% CI, 1.0-4.1; P =.05), and postnatally (OR = 2.8; 95% CI, 1.1-7.3; P =.04) and the risk of SIDS, while adjusting for paternal smoking and alcohol use. CONCLUSIONS:There was no association between maternal recreational drug use and SIDS. Paternal marijuana use during the periods of conception and pregnancy and postnatally were significantly associated with SIDS. The role of paternal psychoactive drug use, especially the relationship between marijuana and SIDS, is an understudied area; however, before any definitive role for the father can be confirmed, these findings should be investigated and replicated in future studies.

背景与目标： 目的：确定在怀孕和怀孕期间以及产后出生时母亲或父亲使用可卡因，鸦片或大麻，以及产后增加婴儿出生后第一年发生婴儿猝死综合症（SIDS）的风险。这是一个重要的问题，可能有助于进一步降低小岛屿发展中国家的比率。
方法：进行了一项病例对照研究，该研究由1989年至1992年在南加州的239名死于小岛屿发展中国家的婴儿以及根据出生医院，出生日期，年龄和性别相匹配的239名健康婴儿组成。通过电话确定白人，非裔美国人，西班牙裔，亚裔美国人和太平洋岛民病例以及对照父母的电话，确定在受孕期间，怀孕期间和母乳喂养期间以及在婴儿存在或附近时的特定药物使用情况。
结果：在调整孕妇吸烟后，孕妇在怀孕期间使用娱乐性药物与SIDS的风险无关（校正比值比[OR] = 2.0； 95％置信区间[CI]，0.6-6.5）。在怀孕期间，病例父亲和对照组父亲使用大麻的统计学差异显着（OR = 2.2； 95％CI，1.2-4.2； P = .01），怀孕期间（OR = 2.0； 95％CI，1.0-4.1； 95％CI，1.0-4.1；或7％）。 P = .05）和产后（OR = 2.8； 95％CI，1.1-7.3； P = .04）和SIDS风险，同时针对父亲吸烟和饮酒进行了调整。
结论：孕产妇休闲药物使用与小岛屿发展中国家之间没有关联。在怀孕，怀孕和产后期间使用父本大麻与SIDS显着相关。父亲使用精神活性药物的作用，特别是大麻与小岛屿发展中国家之间的关系，是一个尚未充分研究的领域；但是，在确定父亲的任何确定角色之前，应对这些发现进行调查，并在以后的研究中加以复制。

BACKGROUND & AIMS: BACKGROUND:To reach the Millennium Development Goals for health, influential international bodies advocate for more resources to be directed to the health sector, in particular medical treatment. Yet, health has many determinants beyond the health sector that are less evident than proximate predictors. AIM:To assess the relative importance of major socioeconomic determinants of population health, measured as infant mortality rate (IMR), at country level. METHODS:National-level data from 152 countries based on World Development Indicators 2003 were used for multivariate linear regression analyses of five socioeconomic predictors of IMR: public spending on health, GNI/capita, poverty rate, income equality (Gini index), and young female illiteracy rate. Analyses were performed on a global level and stratified for low-, middle-, and high-income countries. RESULTS:In order of importance, GNI/capita, young female illiteracy, and income equality predicted 92% of the variation in national IMR whereas public spending on health and poverty rate were non-significant determinants when adjusted for confounding. In low-income countries, female illiteracy was more important than GNI/capita. Income equality (Gini index) was an independent predictor of IMR in middle-income countries only. In high-income countries none of these predictors was significant. CONCLUSIONS:The relative importance of major health determinants varies between income levels, thus extrapolating health policies from high- to low-income countries is problematic. Since the size, per se, of public health spending does not independently predict health outcomes, functioning health systems are necessary to make health investments efficient. Potential health gains from improved female education and economic growth should be considered in low- and middle-income countries.

背景与目标： 背景：为实现卫生领域的千年发展目标，有影响力的国际机构主张将更多资源用于卫生部门，特别是医疗领域。但是，卫生领域除了卫生部门以外还有许多决定因素，远没有最近的预测因素那么明显。
目的：在国家一级评估人口健康的主要社会经济决定因素的相对重要性，以婴儿死亡率（IMR）衡量。
方法：根据2003年世界发展指标，从152个国家/地区获得的国家级数据用于对IMR的五种社会经济指标进行多元线性回归分析：公共卫生支出，国民总收入/人均，贫困率，收入平等（基尼系数）和年轻人女性文盲率。在全球范围内进行了分析，并针对低，中，高收入国家进行了分层。
结果：按重要性排序，国民总收入/人均，年轻女性文盲和收入平等预测了全国IMR的92％差异，而在进行混杂因素调整后，公共卫生和贫困率支出是不重要的决定因素。在低收入国家，女性文盲比人均国民总收入更重要。收入平等（基尼指数）仅是中等收入国家对IMR的独立预测指标。在高收入国家，这些预测指标都不重要。
结论：主要健康决定因素的相对重要性因收入水平而异，因此从高收入国家向低收入国家推断健康政策是有问题的。由于公共卫生支出的规模本身并不能独立地预测卫生结果，因此运作有效的卫生系统对于提高卫生投资的效率是必不可少的。在低收入和中等收入国家，应考虑通过改善女性教育和经济增长带来的潜在健康收益。

BACKGROUND & AIMS: INTRODUCTION:High-grade vesicoureteral reflux (VUR) in infants is associated with congenital renal abnormalities, recurrent UTI, and bladder dysfunction. Endoscopic treatment (ET) is a well-established method in children with low to moderate reflux grades, but there is a lack of randomised controlled trials regarding the use of ET versus continuous antibiotic prophylaxis in infants with high-grade VUR. OBJECTIVE:This study aimed to determine whether high-grade VUR in infants can be treated with endoscopic injection and whether ET is superior to antibiotic prophylaxis in the treatment of VUR. MATERIALS AND METHODS:This prospective, randomised, controlled, multicentre, 1-year follow-up trial comprised 77 infants (55 boys, 22 girls) <8 months of age with VUR grade 4-5 (n = 30/n = 47). Of the infants, 52 (68%) had bilateral VUR. Thirty-nine were randomised to antibiotic prophylaxis and 38 to ET (with prophylaxis until resolution). Voiding cystourethrogram, ultrasound, renal scintigraphy, and free voiding observation were performed at study entry and after 1 year to evaluate VUR grade, and renal and bladder function. RESULTS:VUR grade ≤2 was seen in 22 (59%) infants in the endoscopy group and eight (21%) in the prophylaxis group at follow-up (p = 0.0014). The success rate in the endoscopy group was 100% in unilateral grade 4, falling to 31% in bilateral grade 5 (p = 0.0094). Correspondingly, the results in the prophylaxis group were 40% in grade 4 down to 0% in bilateral grade 5 (p = 0.037) (Table). Logistic regression analyses identified ET, VUR grade 4, unilaterality, and low residual urine at baseline as positive predictors of VUR down-grading to ≤2 (area under ROC curve 0.88). In four patients with reflux resolution after one injection, dilating reflux recurred at the 1-year follow-up. One patient had a UTI possibly related to ET. In our material four patients required re-implantation, of whom one was obstructive after injection. DISCUSSION:The opportunity to offer even small infants with high-grade VUR an alternative, minimally invasive treatment option is a great advance in paediatric urology. In this high-risk group, bilateral VUR grade 5 stands out with its poor bladder function and low chance of resolution. The recurrence rate of dilating VUR after successful ET is consistent with previous studies. The limitations are the relatively small number of patients and the short follow-up. CONCLUSION:High-grade VUR in infants can be treated with injection therapy and the resolution rate is higher than that of prophylaxis treatment. The complication rate is low and VUR grade 4, unilaterality, and low residual urine are favourable for the resolution and down-grading of VUR.

背景与目标： 简介：婴儿高级别膀胱输尿管反流（VUR）与先天性肾脏异常，复发性尿路感染和膀胱功能障碍有关。对于低至中度反流级别的儿童，内镜治疗（ET）是一种行之有效的方法，但是对于高级别VUR的婴儿使用ET与持续预防抗生素的关系，尚缺乏随机对照试验。
目的：本研究旨在确定内镜下注射是否可以治疗婴儿中高级别的VUR，以及在VUR的治疗中，ET是否优于抗生素预防。
材料与方法：这项前瞻性，随机，对照，多中心，为期1年的随访研究纳入了77个婴儿（55个男孩，22个女孩）<8个月大且VUR为4-5级（n = 30 / n = 47）。 。在婴儿中，有52名（68％）患有双侧VUR。 39名被随机分配至抗生素预防性治疗，38名被随机分配至ET（预防性治疗直至消退）。在研究开始时和1年后进行了膀胱膀胱心电图，超声检查，肾闪烁显像和自由排尿观察，以评估VUR等级以及肾和膀胱功能。
结果：在随访中，内窥镜检查组的22名（59％）婴儿中观察到VUR≤2，而预防组中的8例（21％）观察到VUR≤2（p = 0.0014）。内窥镜检查组的成功率在单侧4级中为100％，在双侧5级中降至31％（p = 0.0094）。相应地，预防组的结果从4年级的40％降至双边5年级的0％（p = 0.037）（表）。 Logistic回归分析确定ET，VUR 4级，单侧性和基线尿液残留低是VUR降级至≤2的阳性预测指标（ROC曲线下面积为0.88）。一例注射后有4例反流消退的患者，在1年的随访中再次发生了扩张性反流。一名患者的尿路感染可能与ET有关。在我们的材料中，四名患者需要重新植入，其中一名在注射后阻塞。
讨论：有机会为小婴儿提供高级别的VUR，这是儿科泌尿外科的一大进步。在这一高危人群中，双侧VUR 5级膀胱功能差且解决机会低，因此脱颖而出。成功的ET后扩张VUR的复发率与以前的研究一致。局限性在于患者人数相对较少且随访时间短。
结论：婴幼儿高危型VUR可以通过注射疗法治疗，其分辨率高于预防性治疗。并发症发生率低，VUR 4级，单侧性和残留尿少有利于VUR的分解和降级。

BACKGROUND & AIMS: :Presurgical infant orthopedics (PSIO) is done to reduce the size of the cleft defect along with improving the arch alignment and nasolabial aesthetics in patients with cleft lip and palate, leading to an improvement of nasolabial aesthetics allowing for a tidier and more aesthetic reparative procedure and postsurgical scar. Since the 2000s, clear aligners have slowly and steadily treaded their way as an acceptable orthodontic modality, with their usage and acceptability increasing considerably over the past decade. Thus, from the knowledge gathered in its 10 years working with 3-dimensional (3-D) diagnosis, treatment planning, and 3-D Printing services, Compass 3D (Belo Horizonte, Brazil) developed the OrthoAligner NAM system. This case series highlights one of the world's first documented cases of PSIO treated with a series of clear aligners.

背景与目标： ：进行术前婴儿矫形术（PSIO）可以减少唇裂和pa裂患者的唇裂的大小，并改善弓形排列和鼻唇美学，从而改善鼻唇美学，从而使整形手术和整形手术更加美观和术后疤痕。自2000年代以来，透明矫正器已逐渐稳定地成为可接受的正畸治疗方式，在过去十年中，其用途和可接受性大大提高。因此，Compass 3D（巴西贝洛哈里桑塔，巴西）利用在10年间从事3维（3D）诊断，治疗计划和3D打印服务所积累的知识，开发了OrthoAligner NAM系统。本案例系列重点介绍了世界上最早记录的PSIO案例，该案例使用一系列清晰的对准器进行了处理。