Proposed clinical management of pregnancies after combined screening for pre-eclampsia at 30-34 weeks' gestation

Objective: To estimate the patient-specific risk of preeclampsia (PE) at 30-34 weeks’ gestation by a combination of maternal characteristics and medical history with multiple of the median (MoM) values of mean arterial pressure, uterine artery pulsatility index, serum the median (MoM) values of mean arterial pressure, uterine artery pulsatility index, serum placental growth factor and serum soluble fmsm-like tyrosine kinase-1 and stratify women into high-, intermediate- and low-risk management groups. Methods: This was a prospective observational study in women attending for a third-trimester ultrasound scan at 30-34 weeks as part of routine pregnancy care. Patient-specific risks of delivery with PE at <4 weeks from assessment and at <40 weeks’ of delivery with PE at <4 weeks from assessment and at <40 weeks’ gestation were calculated using the competing risks model to combine the prior risk from maternal characteristics and medical history with MoM values of MAP, UTPI, PLGF and sFLT-1. On the basis of these risks the population was stratified into high-, intermediate- and low-risk groups. Different risk cut-offs were used to vary the proportion of the population stratified into each risk category and the performance of screening for delivery with PE at <4 weeks and delivery with PE from four weeks after assessment and up to 40 weeks’ gestation (PE 4w-40GW) was estimated. Results: The study population of 8,128 singleton pregnancies included 234 (2.9%) that subsequently developed PE. Using a risk cut-off for PE at <4 weeks of 1 in 50 and a risk cut-off of 1 in 150 for PE at <40 weeks’ gestation the proportion of the population stratified into high-, intermediate- and low-risk was about 3%, 26% and 71%, respectively. The high-risk group contained 90% of pregnancies with PE at at <4 weeks and 40% of those with PE at 4w-40GW. The intermediate-risk group contained a further 49% of women with PE at 4w-40GW. In the low-risk group, none of the women developed PE at <4 weeks and only 0.3% developed PE at 4w-40GW. Conclusion: The study presents risk stratification of PE by the combined test at 30-34 weeks aiming to identify a high-risk group in need of intensive monitoring from the time of the initial assessment and up to 40 weeks’ gestation and an intermediate-risk group, in need of monitoring starting from four weeks after the initial assessment and up to 40 weeks’ gestation. All pregnancies would need to be reassessed at 40 weeks’ gestation

Emil und die Detektive: Early German sound cinema aesthetic

In 1931 Gerhard Lamprecht directed the film version of Erich Kaestner's popular novel Emil und die Detektive. A hugely successful fil

Second trimester inflammatory and metabolic markers in women delivering preterm with and without preeclampsia.

ObjectiveInflammatory and metabolic pathways are implicated in preterm birth and preeclampsia. However, studies rarely compare second trimester inflammatory and metabolic markers between women who deliver preterm with and without preeclampsia.Study designA sample of 129 women (43 with preeclampsia) with preterm delivery was obtained from an existing population-based birth cohort. Banked second trimester serum samples were assayed for 267 inflammatory and metabolic markers. Backwards-stepwise logistic regression models were used to calculate odds ratios.ResultsHigher 5-α-pregnan-3β,20α-diol disulfate, and lower 1-linoleoylglycerophosphoethanolamine and octadecanedioate, predicted increased odds of preeclampsia.ConclusionsAmong women with preterm births, those who developed preeclampsia differed with respect metabolic markers. These findings point to potential etiologic underpinnings for preeclampsia as a precursor to preterm birth

Neutron captue prompt gamma-ray activation analysis at the NIST Cold Neutron Research Facility

An instrument for neutron capture prompt gamma-ray activation analysis (PGAA) has been constructed as part of the Cold Neutron Research Facility at the 20 MW National Institute of Standards and Technology Research Reactor. The neutron fluence rate (thermal equivalent) is 1.5·10 8 n ·cm −2 ·s −1 , with negligible fast neutrons and gamma-rays. With compact geometry and hydrogen-free construction, the sensitivity is sevenfold better than an existing thermal instrument. Hydrogen background is thirtyfold lower.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/43114/1/10967_2005_Article_BF02035470.pd

High power targets for cyclotron production of 99mTc‡

Introduction Technetium-99m, supplied in the form of 99Mo/99mTc generators, is the most widely used radioisotope for nuclear medical imaging. The parent isotope 99Mo is currently produced in nuclear reactors. Recent disruptions in the 99Mo supply chain [1] prompted the development of methods for the direct accelerator-based production of 99mTc. Our approach involves the 100Mo(p,2n)99mTc reaction on isotopically enriched molybdenum using small medical cyclotrons (Ep ≤ 20 MeV), which is a viable method for the production of clinically useful quantities of 99mTc [2]. Multi-Curie production of 99mTc requires a 100Mo target capable of dissipating high beam intensities [3]. We have reported the fabrication of 100Mo targets of both small and large area tar-gets by electrophoretic deposition and subsequent sintering [4]. As part of our efforts to further enhance the performance of molybdenum targets at high beam currents, we have developed a novel target system (initially de-signed for the GE PETtrace cyclotron) based on a pressed and sintered 100Mo plate brazed onto a dispersion-strengthened copper backing. Materials and Methods In the first step, a molybdenum plate is produced similarly to the method described in [5] by compacting approximately 1.5 g of commercially available 100Mo powder using a cylindrical tool of 20 mm diameter. A pressure between 25 kN/cm2 and 250 kN/cm2 is applied by means of a hydraulic press. The pressed molybdenum plate is then sintered in a reducing atmosphere (Ar/2% H2) at 1,700 oC for five hours. The resulting 100Mo plates have about 90–95 % of the molybdenum bulk density. The 100Mo plate is furnace brazed at ~750 oC onto a backing manufactured from a disperse on strengthened copper composite (e.g. Glidcop AL-15) using a high temperature silver-copper brazing filler. This process yields a unique, mechanically and thermally robust target system for high beam power irradiation. Irradiations were performed on the GE PETtrace cyclotrons at LHRI and CPDC with 16.5 MeV protons and beam currents ≥ 100 µA. Targets were visually inspected after a 6 hour, 130 µA bombardment (2.73 kW/cm2, average) and were found fully intact. Up to 4.7 Ci of 99mTc have been produced to date. The saturated production yield remained constant between 2 hour and 6 hour irradiations. Results and Conclusion These results demonstrate that our brazed tar-get assembly can withstand high beam intensities for long irradiations without deterioration. Efforts are currently underway to determine maximum performance parameters

Measuring the psychosocial burden in women with low-grade abnormal cervical cytology in the TOMBOLA trial: psychometric properties of the Process and Outcome Specific Measure (POSM)

Background There is a need for an instrument to measure the psychosocial burden of receiving an abnormal cervical cytology result which can be used regardless of the clinical management women receive. Methods 3331 women completed the POSM as part of baseline psychosocial assessment in a trial of management of low grade cervical cytological abnormalities. Factor analysis and reliability assessment of the POSM were conducted. Results Two factors were extracted from the POSM: Factor 1, containing items related to worry; and Factor 2 containing items relating to satisfaction with information and support received and change in the way women felt about themselves. Factor 1 had good reliability (Cronbach’s alpha 0.769), however reliability of the Factor 2 was poorer (0.482). Data collected at four subsequent time points demonstrated that the factor structure was stable over time. Conclusion This study demonstrates the presence and reliability of a scale measuring worries within the POSM. This analysis will inform its future use in this population and in other related contexts

Pre-exenterative chemotherapy, a novel therapeutic approach for patients with persistent or recurrent cervical cancer

BACKGROUND: Most cervical cancer patients with pelvic recurrent or persistent disease are not candidates for exenteration, therefore, they only receive palliative chemotherapy. Here we report the results of a novel treatment modality for these patients pre-exenterative chemotherapy- under the rational that the shrinking of the pelvic tumor would allow its resection. METHODS: Patients with recurrent or persistent disease and no evidence of systemic disease, considered not be candidates for pelvic exenteration because of the extent of pelvic tumor, received 3-courses of platinum-based chemotherapy. Response was evaluated by CT scan and bimanual pelvic examination; however the decision to perform exenteration relied on the physical findings. Toxicity to chemotherapy was evaluated with standard criteria. Survival was analyzed with the Kaplan-Meier method. RESULTS: Seventeen patients were studied. The median number of chemotherapy courses was 4. There were 9 patients who responded to chemotherapy, evaluated by bimanual examination and underwent pelvic exenteration. Four of them had pathological complete response. Eight patients did not respond and were not subjected to surgery. One patient died due to exenteration complications. At a median follow-up of 11 months, the median survival for the whole group was 11 months, 3 months in the non-operated and 32 months in those subjected to exenteration. CONCLUSION: Pre-exenterative chemotherapy is an alternative for cervical cancer patients that are no candidates for exenteration because of the extent of the pelvic disease. Its place in the management of recurrent disease needs to be investigated in randomized studies, however, its value for offering long-term survival in some of these patients with no other option than palliative care must be stressed

River histories : A thematic review

Peer reviewe

Leopard syndrome

LEOPARD syndrome (LS, OMIM 151100) is a rare multiple congenital anomalies condition, mainly characterized by skin, facial and cardiac anomalies. LEOPARD is an acronym for the major features of this disorder, including multiple Lentigines, ECG conduction abnormalities, Ocular hypertelorism, Pulmonic stenosis, Abnormal genitalia, Retardation of growth, and sensorineural Deafness. About 200 patients have been reported worldwide but the real incidence of LS has not been assessed. Facial dysmorphism includes ocular hypertelorism, palpebral ptosis and low-set ears. Stature is usually below the 25th centile. Cardiac defects, in particular hypertrophic cardiomyopathy mostly involving the left ventricle, and ECG anomalies are common. The lentigines may be congenital, although more frequently manifest by the age of 4–5 years and increase throughout puberty. Additional common features are café-au-lait spots (CLS), chest anomalies, cryptorchidism, delayed puberty, hypotonia, mild developmental delay, sensorineural deafness and learning difficulties. In about 85% of the cases, a heterozygous missense mutation is detected in exons 7, 12 or 13 of the PTPN11 gene. Recently, missense mutations in the RAF1 gene have been found in two out of six PTPN11-negative LS patients. Mutation analysis can be carried out on blood, chorionic villi and amniotic fluid samples. LS is largely overlapping Noonan syndrome and, during childhood, Neurofibromatosis type 1-Noonan syndrome. Diagnostic clues of LS are multiple lentigines and CLS, hypertrophic cardiomyopathy and deafness. Mutation-based differential diagnosis in patients with borderline clinical manifestations is warranted. LS is an autosomal dominant condition, with full penetrance and variable expressivity. If one parent is affected, a 50% recurrence risk is appropriate. LS should be suspected in foetuses with severe cardiac hypertrophy and prenatal DNA test may be performed. Clinical management should address growth and motor development and congenital anomalies, in particular cardiac defects that should be monitored annually. Hypertrophic cardiomyopathy needs careful risk assessment and prophylaxis against sudden death in patients at risk. Hearing should be evaluated annually until adulthood. With the only exception of ventricular hypertrophy, adults with LS do not require special medical care and long-term prognosis is favourable