Practical placental examination for obstetricians

Placental examination can simply be performed immediately in delivery room by obstetricians in which takes only few minutes. The evaluation should be done step by step, starting from umbilical cord, membranes, and disk. Indications for placental examination are divided into maternal, fetal, and placental indications. The submitted placenta for further evaluation by pathologist can be kept in refrigerator or fixed in buffered formalin

p53 suppresses type II endometrial carcinomas in mice and governs endometrial tumour aggressiveness in humans

Type II endometrial carcinomas are a highly aggressive group of tumour subtypes that are frequently associated with inactivation of the TP53 tumour suppressor gene. We show that mice with endometrium-specific deletion of Trp53 initially exhibited histological changes that are identical to known precursor lesions of type II endometrial carcinomas in humans and later developed carcinomas representing all type II subtypes. The mTORC1 signalling pathway was frequently activated in these precursor lesions and tumours, suggesting a genetic cooperation between this pathway and Trp53 deficiency in tumour initiation. Consistent with this idea, analyses of 521 human endometrial carcinomas identified frequent mTORC1 pathway activation in type I as well as type II endometrial carcinoma subtypes. mTORC1 pathway activation and p53 expression or mutation status each independently predicted poor patient survival. We suggest that molecular alterations in p53 and the mTORC1 pathway play different roles in the initiation of the different endometrial cancer subtypes, but that combined p53 inactivation and mTORC1 pathway activation are unifying pathogenic features among histologically diverse subtypes of late stage aggressive endometrial tumours

Direct resin composite restoration of endodontically-treated permanent molars in adolescents: bite force and patient-specific finite element analysis

Objective: To evaluate the influence of three levels of dental structure loss on stress distribution and bite load in root canal-treated young molar teeth that were filled with bulk-fill resin composite, using finite element analysis (FEA) to predict clinical failure. Methodology: Three first mandibular molars with extensive caries lesions were selected in teenager patients. The habitual occlusion bite force was measured using gnathodynamometer before and after endodontic/restoration procedures. The recorded bite forces were used as input for patient-specific FEA models, generated from cone-beam computed tomographic (CT) scans of the teeth before and after treatment. Loads were simulated using the contact loading of the antagonist molars selected based on the CT scans and clinical evaluation. Pre and post treatment bite forces (N) in the 3 patients were 30.1/136.6, 34.3/133.4, and 47.9/124.1. Results: Bite force increased 260% (from 36.7±11.6 to 131.9±17.8 N) after endodontic and direct restoration. Before endodontic intervention, the stress concentration was located in coronal tooth structure; after rehabilitation, the stresses were located in root dentin, regardless of the level of tooth structure loss. The bite force used on molar teeth after pulp removal during endodontic treatment resulted in high stress concentrations in weakened tooth areas and at the furcation. Conclusion: Extensive caries negatively affected the bite force. After pulp removal and endodontic treatment, stress and strain concentrations were higher in the weakened dental structure. Root canal treatment associated with direct resin composite restorative procedure could restore the stress-strain conditions in permanent young molar teeth

Diabetic fetopathy associated with bilateral adrenal hyperplasia and ambiguous genitalia: a case report

<p>Abstract</p> <p>Introduction</p> <p>Many fetal malformations can occur because of maternal diabetes. However, ambiguous genital organs have never been reported as an associated finding in the literature. This is the first report of associated ambiguous genital organ and bilateral adrenal hyperplasia in a case of diabetic fetopathy.</p> <p>Case presentation</p> <p>A 19-year-old Thai primigravida with familial history of diabetes mellitus (DM) was diagnosed as having gestational DM type 2, based on 100 g oral glucose tolerance test, and was poorly controlled with insulin injections. Delayed targeted ultrasonography at 28 weeks gestation revealed multiple fetal anomalies. The woman underwent low transverse cesarean section at 30 weeks gestation due to preterm labor and transverse lie. The newborn with ambiguous genitalia was delivered but expired after birth. Autopsy findings revealed alobar holoprosencephaly, a prominent forehead, hypotelorism, an absent nose, absent bilateral ears, median cleft lip and palate, preaxial polydactyly of the right hand, accessory spleens, single umbilical artery, markedly enlarged adrenal glands and ambiguous external genitalia The subsequent fetal chromosomal study revealed 46,XX.</p> <p>Conclusion</p> <p>We describe a case of diabetic fetopathy with classic facial malformation and preaxial hallucal polydactyly which has been proposed as a marker of diabetic embryopathy. Bilateral adrenal hyperplasia with ambiguous genitalia, an uncommon associated anomaly, was also identified. It is controversial whether adrenal hyperplasia can be a novel feature of diabetic fetopathy or just a coincidental finding. Further observation and adequate investigation are needed in such cases.</p

Fatigue testing of weldable high strength steels under simulated service conditions

There have been concerns over the effect of Cathodic Protection (CP) on weldable high strength steels employed in Jack-up production platform. The guidance provided by the Department of Energy HSE on higher strength steels, based on previous work, was to avoid overprotection as this could cause hydrogen embrittlement. However, the tests conducted so far at UCL for the SE702 type high strength steels (yields strength around 690 MPa) have shown that the effect of over protection on high strength steels may not be as severe as previously thought. For this thesis, SE702 high strength steels have been investigated in more detail. Thick (85mm) parent and ground welded plates were tested under constant amplitude in air and seawater with CP. Tests were also conducted on Thick (40mm) T-butt welded plates under variable amplitude loading in air and seawater with two CP levels (-800mV and -1050mV). Different backing materials (ceramic and metallic) for the welding process of the T-butt plates were also investigated. The variable amplitude sequences employed were generated using the Jack-up Offshore Standard load History (JOSH). The fatigue results are presented as crack growth and S/N curves. They were compared to the conventional offshore steel (BS 4360 50D). The results suggested that the fatigue life of the high strength steels was comparable to the BS 4360 50D steels. The effect of increasing the CP was found to be detrimental to the fatigue life but the effect was not large. The effect of CP was less noticeable in T-butt welded plates. However, in general, the effect of overprotection is not as detrimental to the Jack-up steels as previously thought. The load histories generated by JOSH were found to have some unfavourable characteristics. The framework is based on Markov Chain method and pseudo-random number generator for selecting sea-states. A study was carried out on the sequence generated by JOSH. The generated sequences were analysed for their validity for fatigue testing. This has resulted in recommendations on the methods for generating standard load histories