Small Incidence Research Articles

Sci-Thur AM: Planning - 02: Validation of XiO's eMC module using Gafchromic EBT3 films and triple channel dosimetry.

The aim of this study is to validate the electron Monte Carlo module implemented in XiO, a treatment planning system commercialized by Elekta CMS inc. Two types of phantoms were investigated: homogeneous water phantoms with irregular surfaces and phantoms containing slab and 3D heterogeneities. The phantoms were CT scanned, and dose to water calculations were performed in the eMC module using 2 ×2 × 2 mm2 voxels and a mean relative statistical uncertainty of 0.5%. Concurrently, Gafchromic EBT3 film measurements were performed in the same phantoms. To obtain reliable absolute dose readings from the films, a new method using triple channel dosimetry in the Film QA Pro software was developed. The accuracy of the proposed method was determined empirically and an uncertainty of ±1.5% was found over the range [75, 800] cGy. Dose comparisons between film and simulations were done using an in-house MATLAB program. XiO's eMC module provides accurate dose distributions in the presence of surface irregularities and slab heterogeneities for 12 MeV beams. In the presence of 3D heterogeneities, the percent dose difference comparisons highlighted the need to perform 3D gamma comparisons. In conclusion, the electron Monte Carlo module offered in the XiO treatment planning system is promising and could greatly improve the accuracy of clinical dose calculations. The validation of the software is ongoing, notably concerning more complex phantom geometries. Small field calculations, oblique incidences and cutout factors will also be investigated.

Glints from particulate media and wavy surfaces

Glints are bright light spots created by particulate media like cirrus clouds, glaciers, and wavy water surfaces. They are seen around the specular reflection angle. In this paper, the glints from such scattering/reflecting media are described in a unified manner through the probability density for facet tilts. Various kinds of these probability densities for wavy surfaces are defined and classified. The concept of the differential scattering cross section (DSCS) for rough surfaces instead of the conventional bidirectional reflectance distribution function (BRDF) is introduced for characterization of the glints. The simple equations connecting the DSCS and the probability densities for facet tilts are derived. It is shown that the glints from particulate media and wavy surface are very similar at small incidence angles and they are significantly different at slant incidence.

Which stages of thymoma benefit from adjuvant chemotherapy post-thymectomy?

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'Which stages of thymoma benefit from adjuvant chemotherapy post thymectomy?' Altogether more than 150 papers were found using the reported search, of which only eight represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated; these studies have mainly reported the survival and recurrence rates of post-thymectomy patients who received adjuvant radiotherapy or chemoradiotherapy, and adjuvant radiotherapy alone was only used in a small group of patients in these studies. We did not find any randomized controlled trials comparing adjuvant chemotherapy with chemo/radiotherapy and, due to a very small incidence of this tumour, it is unlikely to see any trials in future. Studies were mainly retrospective or institutional reports and showed that, despite the high sensitivity of this tumour to chemotherapy agents and the use of chemotherapy as one of the main treatment modalities in the advanced stages of thymoma, current data are not supporting postoperative chemotherapy as a sole adjuvant treatment in advanced stages of thymoma. We conclude that, in patients with thymoma, surgical resection with or without radiation therapy is the gold standard treatment for early-stage disease (I and II). Adjuvant radiotherapy/chemoradiotherapy should be considered for Masaoka stage III (A and B) or above, and it is also advised to add adjuvant therapy for all patients with cortical fenestration, even in stages I and II. But there is no evidence that chemotherapy alone improves the survival in patients with completely resected stage III and IV thymomas and thymic carcinoma. In patients with extra-radiation field disease, however, the use of chemotherapy can potentially improve survival but no follow-up data on this group of patients are available.

Effect of loop electrosurgical excision procedure on outcome of subsequent fertility and pregnancy

Objective To investigate the effects of cervical loop electrosurgical excision procedure (LEEP) to fertility and pregnancy outcome of patients with cervical intraepithelial neoplasia (CIN).Methods 20 inpatients of CIN from January 2009 to August 2011 were given the LEEP treatment,as the observation group,while other 20 healthy pregnant women randomly selected within the same period of the pregnancy out-patient hospital treatment without history of gynecological surgery,were observed as the control group,the observed pregnancy rate and pregnancy outcome were examined.Results The pregnancy rate of the observation group of 20 patients was 85％ (17/20),preguancy rate was 90％ (18/20) in the control group,there was no significant difference (P＞ 0.05).Cesarean section rate of the observation group was significantly higher than that in the control group (P＜0.05),and there was also no significant difference in abortion incidence,incidence of preterm premature,rupture of membranes incidence and the incidence of small for gestational age (SGA) children in two groups(P＞0.05),no neonatal deaths occurred in the patients of two groups.Conclusion LEEP has no significant effect on the fertility of the CIN patients,without increasing the abortion rate,the rate of preterm birth,premature rupture of membranes,and incidence of SGA children. Key words: Loop electrosurgical excision procedure (LEEP); Cervical intraepithelial neoplasia; Fertility; Pregnancy outcome

The Monad: The Hegemony of Personality—Eric Williams and the Post Independence Imagination of Trinidad, 1956–1981

THE POST-INDEPENDENCE POLITICS OF Trinidad and Tobago (Trinidad) presents an opportunity to examine hegemony from a uniquely narrow perspective: the hegemony of one - the monad. This describes the phenomenon of individuals who, coming to power at crucial moments, are able to impose an extraordinary amount of authority over the citizens of the small states of which they have acquired control.This phenomenon is not unique to the Caribbean. In Stalin's Russia, Thatcher's Britain, and Reagan's America, individuals have defined nations, and created enduring perceptions of national characters. However, given the nature of those societies, they continue to evolve. In the Caribbean, the evolutionary trajectory, at least in Trinidad, seems cathexised, and the society continues to almost involuntarily manifest the characteristics it internalised from the intimate relationship with its founding (father) figure, its first prime minister, Dr Eric Williams. Given the heterogeneity of the Trinidadian population, there are several competing narratives and imaginative trajectories - Indo, French-Creole, Afro, and Colonial. The trajectory on which this essay focuses is that which has come to be known as the 'Creole' historical narrative - that is, the point of view which foregrounds the Afro-Creole historical experience, of which Williams was the apotheosis.1Trinidad fortuitously provides a theatre where this dynamic can be observed in some detail. The historical and environmental particularities include its small size, its small population, its variety and relatively brief history, and the paucity of pre-existent traditions, which made the (illiterate and oppressed) inhabitants receptive to originary narratives and identity discourses. The nature of its social and economic development up to the middle of the twentieth century, defined by the plantation system, saw the majority of the small population densely packed into a few populated areas: the plantations and two towns at the north and south ends of the island. The symbolic mechanics of hegemony - the non-verbal, institutional, visual and symbolic languages of government and dominant culture - thus had a sizeable, captive population to affect.The colonisation of Trinidad began only in the last few years of the eighteenth century. The Spanish Cedula of Population in 1783 saw several groups rapidly imported into an untamed frontier. After Emancipation in 1834, indentured Indians provided the cheap, resident labour needed to keep the plantations alive between 1845 and 1917. Institutions were weak, embryonic or nonexistent in the Crown Colony system, where authority and power resided largely in a single individual, the British governor. By the end of the nineteenth century, at least four distinct, settled, and competing sets of interests inhabited Trinidad. These were the formerly enslaved black working class and their middle-class and mixed-race interlocutors, Indian indentured labourers and formerly indentured Indians who had decided to remain in the island, the white Creole groups, and the colonial administration.By 1956, when the independence dispensation was being shaped, Crown Colony government and social dynamics persisted - the control of the one individual in whom all power resided. Naturally, this situation was not without critics or challenges. A small, determined group of educated black, mixed-race and white Creoles had constantly challenged the government. The challenges ranged from the benign reform movements of the nineteenth century to the more violent Water Riots of 1903, and many similar, smaller incidents. Simultaneously, the unschooled urban masses were slowly evolving into consciousness - there were plantation disturbances in the late nineteenth century, and links with organised labour in Britain from the early twentieth century provided urban proletarian labour organisation and a medium for political aspirations after World War I.All these factors created an apt situation for the ascendancy of the monad. …

Dynamic Behavior of Materials

The dynamic behavior of materials is a subject of everincreasing interest to the technical community owing to applications ranging from shock and blast to crash, impact and ballistics. Hence, it has relevance to government, industry and academia. The enhanced interest in dynamic behavior is evident from the increase in the number of papers in Experimental Mechanics on this topic, as well as expansion of the Dynamic Behavior sessions at the SEM annual conferences. Since inauguration of the SEM Dynamic Behavior Technical Division in 2005, presentations on this topic at the annual conference have increased from two sessions (~10 papers) in 2005 to two tracks (~150 papers) in 2009 and 2010. This level of interest prompted the EM editor to suggest a special issue to address current issues on the dynamic behavior of materials. This special issue of Experimental Mechanics includes nine papers addressing topics of immediate interest to this technical community. The papers were selected from the written papers submitted to the Dynamic Behavior track at the 2010 SEM Annual Conference on Experimental and Applied Mechanics, Indianapolis, IN, USA, June 7–10, 2010. The major subject areas are: 1) Advancements in high strain rate testing, 2) Dynamic response of various materials, 3) Dynamic failure and fracture, and 4) Modeling of dynamic events. Hopkinson/Kolsky bar techniques are the most commonly used method for characterizing the high strain rate response of materials. Current dynamic testing methods can be linked to the pioneering work of Hopkinson [1] and Kolsky [2] in applying stress wave experiments to evaluate dynamic material response, and to Lindholm and co-workers [3] in reducing this technique to practice. They [3] developed a methodology for deriving the stress–strain response of a material using transient pulse shapes acquired from strain gages on both bars. The strain rate range for traditional Kolsky bar systems ranges from 10 s to 10 s. Higher strain rates can be achieved by reducing the specimen size and the bar diameter [4]. Small (fewmm or sub-millimeter) diameter Kolsky bar systems have been developed which extend the strain rate range beyond 100,000 s. However, strain gage measurement of the longitudinal stress waves in the bars becomes impractical at the small scale. The paper by Casem, Grunschel and Schuster, in this special issue of Experimental Mechanics, demonstrates the feasibility of optical techniques for replacing traditional strain gage measurements in miniaturized systems. The dynamic tension or compression response of materials is readily obtained with traditional Kolsky bar systems. Pure shear data can also be obtained with a torsion bar. This is detailed in the paper by Hokka, et al. on the high strain rate torsion response of ultra-fine grained aluminum. Modifications to traditional Kolsky bar systems have expanded the types of high strain rate tests that can be conducted using these systems. For example, Anton and Subhash [5] used a modified bar system with a small diameter incident bar to measure dynamic Vickers hardness for brittle materials. Nie, Chen, et al. [6] conducted dynamic flexural strength tests on glass through implementation of a four-point bend configuration in the Hopkinson bar. Nie and Chen also devised a ring-on-ring technique for measuring the dynamic equibiaxial flexural strength of glass at temperatures up to K.A. Dannemann (*) Southwest Research Institute, San Antonio, TX, USA e-mail: kdannemann@swri.org

Small (<2.5 micron) particulate matter concentration of ambient air and early death in Hungary

The small (<2.5 micron) particulate matter concentration of ambient air is constantly measured and estimated over Europe, based on the recommendations of the WHO and the Council of Europe. Concentration of small size particulate matter has been found to be very high in Central and Eastern Europe, including central and eastern regions of Hungary. Epidemiologic evidence indicates strong direct correlation between small size particulate matter pollution and incidences of cardiopulmonary disease and lung cancer. As compared to Slovakia or the Czech Republic and after correction for population size, Hungary has the highest number of years of life lost due to small size particulate matter pollution related cardiopulmonary disease and lung cancer.

Who has Jurisdiction of The Air During an International Health Crisis?

Abstract Despite the attacks of September 11th and other subsequent terrorist attacks, the world community, as a whole, seemingly fails to comprehend the high risk of a biological health incident. Not only can an infectious disease cause significantly more damage than any number of physical terrorist attacks combined, but the relative ease with which an outbreak can occur is frightening. Such biological health threats are compounded by the possibility that such outbreaks may result from the lack of malicious intent. Thus, the question becomes more of a matter of when, not if, a major outbreak will occur. The global population needs to be aware of the imminent threat that a biological outbreak poses, especially during international travel. Because of the imminent nature of a likely biological disaster, countries need to be well prepared to handle such situations. History has shown that even the most developed and technologically advanced countries have failed at controlling extreme biological situations. The increasing charge of international flight travel further magnifies the fragile nature of global health. A small incident with a single patient can snowball quickly into a world-wide pandemic, well before anyone is even aware of a problem. As a result, countries have a vital interest in regulating international flight patterns and follow various rules and regulations in order to promote safe and efficient air travel. This paper examines the different legal issues and authorities that would come into play and then provides recommendations to address biologically threatening situations.

Lateral Laparoscopic Approach to Pancreatic Tail Insulinomas

ABSTRACT Pancreatic endocrine tumors are relatively rare lesions and laparoscopic surgery is being increasingly used, especially for insulinomas because of their relatively small size and low incidence of malignancy. Laparoscopic approach to pancreatic tumors has been described in the supine position, transomentally via the lesser sac with anterior stomach retraction. We propose a simplified lateral laparoscopic approach to insulinomas localized preoperatively to the tail or distal body of pancreas. Four patients with pancreatic tail insulinomas underwent laparoscopic surgery between November 2006 and February 2008. Diagnosis was confirmed by fasting sugar, insulin and proinsulin assays. Lesions were localized by multiphasic CT scan/MRI scan and endoscopic ultrasound. All these cases had definitely identifiable enhancing lesions in the distal body/tail in relation to the splenic hilum that appeared accessible by a lateral approach. Except for the first case which was done through the traditional supine approach, the other cases were done by the lateral approach. The patients were positioned right lateral with a kidney bridge. Four subcostal ports were placed and the left colon and spleen with pancreatic tail were mobilised in the same fashion as for splenectomy or adrenalectomy. Tumors were easily identifiable corresponding to the imaging studies. Laparoscopic enucleation was successfully completed in all four patients with lesions in the tail of pancreas, one by the traditional approach and other three by the proposed lateral approach. One patient had associated splenectomy because of the proximity of the lesion to the splenic vessels. Two patients had minor pancreatic leak managed conservatively. The left lateral transperitoneal laparoscopic approach to insulinomas located in the tail of pancreas is feasible and safe. The procedure can be done with ease by surgeons who are familiar with adrenalectomy and splenectomy. How to cite this article Thomas JK, Abraham D, Joseph P, Paul MJ. Lateral Laparoscopic Approach to Pancreatic Tail Insulinomas. World J Endocr Surg 2012;4(1):3-7.

Ecological analysis of social risk factors for Rotavirus infections in Berlin, Germany, 2007–2009

BackgroundSocioeconomic factors are increasingly recognised as related to health inequalities in Germany and are also identified as important contributing factors for an increased risk of acquiring infections. The aim of the present study was to describe in an ecological analysis the impact of different social factors on the risk of acquiring infectious diseases in an urban setting. The specific outcome of interest was the distribution of Rotavirus infections, which are a leading cause of acute gastroenteritis among infants and also a burden in the elderly in Germany. The results may help to generate more specific hypothesis for infectious disease transmission.MethodsWe analysed the spatial distribution of hospitalized patients with Rotavirus infections in Berlin, Germany. The association between the small area incidence and different socio-demographic and economic variables was investigated in order to identify spatial relations and risk factors. Our spatial analysis included 447 neighbourhood areas of similar population size in the city of Berlin. We included all laboratory-confirmed cases of patients hospitalized due to Rotavirus infections and notified between 01/01/2007 and 31/12/2009. We excluded travel-associated and nosocomial infections. A spatial Bayesian Poisson regression model was used for the statistical analysis of incidences at neighbourhood level in relation to socio-demographic variables.ResultsAltogether, 2,370 patients fulfilled the case definition. The disease mapping indicates a number of urban quarters to be highly affected by the disease. In the multivariable spatial regression model, two risk factors were identified for infants (<4 year olds): Rotavirus incidence increased by 4.95% for each additional percent of unemployed inhabitants in the neighbourhood (95% credibility interval (CI): 3.10%-6.74%) and by 0.53% for each additional percent of children attending day care in the neighbourhood (95% CI: 0.00%-1.06%). We found no evidence for an association with the proportion of foreign residents, population density, the residential quality of accommodations and resident changes in the neighbourhood.ConclusionsNeighbourhoods with a high unemployment rate and high day care attendance rate appear to be particularly affected by Rotavirus in the population of Berlin. Public health promotion programs should be developed for the affected areas. Due to the ecological study-design, risk pathways on an individual patient level remain to be elucidated.

Surface Texturing with Hemispherical Cavities to Improve Efficiency in Silicon Solar Cells

Improvement of solar-cell efficiency at a minimum possible cost addition is constantly sought, and this is often achieved at incremental percentage steps. Among a number of alternatives, antireflective coatings and surface texturing are the most prominent. This paper presents an alternative texturing method of crystalline silicon in an attempt to improve the efficiency of photon transmission through the surface and collection in the bulk. The method relies on anisotropic etching of bulk silicon and requires only a single oxide mask and two etching steps with a KOH or TMAH aqueous solution. The surface texture consists of smooth hemispherical cavities, which do not demand a lithographic mask or intricate technology processes to obtain the hemispherical cavities. This method can be applied to increase the profile area of the originally flat frontal surface exposed to light and consequently increase the effective width of the depletion region. The latter implies a higher probability of photon collection, contributing to the improvement of the conversion efficiency of the device. The textured nontilted silicon solar-cell transmittance under small solar incidence angles at dawn and sunset is improved compared to a flat surface, increasing the photocurrent.

J051054 二重反転形軸流ポンプ後段翼車の低回転数設計

An application of contra-rotating rotors, in which a rear rotor is in tandem with a front one and these rotors rotate in the opposite direction each other, has been proposed against a demand for developing higher specific speed axial flow pump. However, our prototype rear rotors designed with the conventional method under the same rotational speed as the front rotor have revealed several problems; the head is not satisfied even at the design flow rate, cavitation inception is observed on the rear rotor despite of the head increase of front rotor and so on. In the present study, to solve these problems, three new rear rotors are designed based on the reduced speed design with taking account of information from the previous studies. One of them, which considers the outlet flow distribution of front rotor as well as the control of secondary flow with the different maximum camber position from hub to tip and the small incidence angle for better cavitation performance, is found to show the best performance in the numerical simulations. An experimental validation is carried out for this rotor, showing that the rotor satisfies the design specifications with higher total efficiency than the existing rotor at the design flow rate. Discussions on off-design performances are also made based on the measured performance data.

Multirooted- Bilateral Maxillary and Mandibular First and Second Premolars- A Rare Anatomical Variation

Introduction: A thorough understanding of root canal anatomy and morphology is required for achieving high levels of success in endodontic treatment. The possible anatomic configurations of premolars are well documented in the literature, except for the small incidence of bilateral multi-rooted maxillary and mandibular premolars with three canals. Objective: To report a rare case of bilateral morphological root aberrations in maxillary and mandibular first and second premolars in a female patient. Case report: A 36 yrs old female patient was evaluated for painful maxillary left I st and II nd premolars. Physical examination revealed no alteration or apparent mental retardation. Panoramic and periapical X-rays revealed multiple roots and canals in maxillary and mandibular I st and II nd premolars. This article reports and discusses the treatment recommendations for an unusual occurrence of three canals in both the first and second maxillary premolars in the same patient drawing particular attention to radiographic interpretation and access management. Conclusion: Findings emphasize the importance of radiographic assessment for diagnosing multiple roots which might present unusual characteristics such as multiple and bilateral appearance. The absence of a syndrome should not be used to rule out the possible manifestation of this morphologic variation.

Highly Active Antiretroviral Treatment (HAART) for the Prevention of HIV Mother to Child Transmission (PMTCT) at Roosevelt Hospital's Infectious Diseases Clinic in Guatemala: The Role of (LPV/r) Standard Dose

Introduction: The transmission of HIV from mother to child is reported from 30% to 40% without any intervention [1]. When all the measures for prevention are implemented, including treatment with HAART (Highly Active Antiretroviral Treatment), the rate of infection can be reduced between 1% and 2% [2]. In Guatemala, the statistics demonstrated an estimated of 20,000 women living with HIV virus infection during the period of 2009. In this scenario, mother to child HIV transmission is an important public health fact. In preliminary reports, there is strong evidence of the impact of preventing mother to child transmission with Lopinavir/Ritonavir in Guatemala is showing a small incidence of new HIV infections and good tolerance [3,4]. Objective: To evaluate the effect of HAART with Lopinavir/Ritonavir on the prevention of mother to child transmission (PMCT) in HIV-positive pregnant women at Roosevelt Hospital in Guatemala City. Methods: A retrospective cohort analysis study. The detection of pregnant HIV positive women and the follow up period was from January 2003 to December 2009, and a total of 219 women completed the follow up time. The HIV diagnosis and follow up for the child was made with molecular testing and antibody testing up to 18 months of age or until testing was negative. Adherence was quantified by pill counts. The interventions where offered to all the women in the cohort. Results: Regarding the pregnancy outcome, the study cohort gave a rate of abortion of 2.3%; 10.6% of preterm births and 79.6% normal births. Of the 202/219 children born, there was a 1.4% rate of transmission (n = 3). The three infected children were born from mothers with high basal viral loads (xxx C/mL or higher). There were no serious adverse events related to antiretroviral therapy with Lopinavir/Ritonavir, with a 6.1% of non serious adverse events, most of them of gastrointestinal type, and anemia. Conclusions: The rate of transmission of HIV from mother to child was low in this population (1.4%), comparable to findings from similar studies [4]. Lopinavir/Ritonavir was well tolerated in this cohort and no serious adverse events in this population were reported.

Analysis of urban cleanness agents' workstation on the appearance of Work Related Musculoskeletal Disorders

This study had as objective to evaluate the workstation of the responsible for the collection of urban garbage in relation to the factors associates with the appearance or aggravation of WMRD, as well as identifying signals and symptoms of these illnesses in the related professionals. For this, was developed a form with open and closed questions, that approached item relative to the identification of the searched, to the organization and execution of the work and to the signals and symptoms of WMRD, e that was applied in 44 agents in a company of collection of urban residues in a Brazilian metropolis. As the results can be evidenced that between the factors that the cleanness' agents are susceptible to the appearance of WMRD can detach the lack of orientation of these professionals as the positions adopted in the work, the lack of training and qualification, as well as the repetitivity of tasks and not use of individual protection equipment. However, yet with the existence of innumerable factors of risk, evidenced a small incidence of pain.

Total Thyroidectomy Versus Subtotal ThyroidectomyIn Multinodular Goitre– Our Experience

Introduction Total thyroidectomy for the management of benign Multinodular goiter is controversial and since the development of other subspecialties, it adds to further confusion. The present study aims to retrospectively compare the efficacy and morbidity of total thyroidectomy and subtotal thyroidectomy. Methods A total of 170 patients with multi nodular goiter were assigned to have either total thyroidectomy (n=100) or subtotal thyroidectomy (n=70) based on preoperative evaluation, FNAC and indications for surgery. Complications and hospital stay were also noted. Results There was no significant difference in the rate of major complications between the two procedures. There was no significant difference in distribution of post operative compl9ocations among the groups. Temporary hypoparathyroidism resulted in 37 (22%) patients in total out of which 28 (28%) belonged to total thyroidectomy group and 9 (13%) belonged to the subtotal thyroidectomy group respectively which was statistically insignificant. No permanent or temporary recurrent laryngeal nerve palsy was noted. Hematoma 2 (3%) and stitch granuloma 3 (4%) was recorded in Subtotal group. Incidental papillary carcinoma was noted in 10 (6%) patients with total thyroidectomy. Recurrence was noted in 20 (298%) of patients and 7 were taken up for further surgery and the rest managed with L-Thyroxine. 80% of the total thyroidectomies were devoid of any complications as compared to only 54.28% of subtotal Thyroidectomies without complications. Conclusion Subtotal thyroidectomy provides an unpredictable outcome and the risk of permanent complications is not less than or at par with total thyroidectomy, so there appears little or none logical reason to recommend subtotal thyroidectomy. In our experience total thyroidectomy is radical but a definitive treatment method without the risk of recurrence with a small incidence of major complications as that of a less radical procedure.

340: Does maternal glycemia influence the distribution of fetal fat in the third trimester?

of fetal fat in the third trimester? Clare O’Connor, Nadine Farah, Vicky O’Dwyer, Bernard Stuart, Mairead Kennelly, Michael Turner The Coombe Women and Infants University Hospital, School of Medicine & Medical Science UCD Centre For Human Reproduction, Dublin, Ireland, Coombe Women and Infants University Hospital, UCD Centre for Human Reproduction, Dublin, Ireland, Coombe Women & Infants University Hospital, UCD Centre for Human Reproduction, Dublin, Ireland, Coombe Women & Infants University Hospital, UCD Centre for Human Reproduction, Dublin, Ireland, Coombe Women and Infants University Hospital, UCD Centre for Human Reproduction, Dublin, Ireland OBJECTIVE: We studied the relationship between maternal glycemia at 28 weeks gestation and fetal adiposity measured using ultrasound in the third trimester. STUDY DESIGN: After Gestational Diabetes Mellitus(GDM) was excluded by a diagnostic Oral Glucose Tolerance Test (OGTT) at 28 weeks gestation, healthy women with a singleton pregnancy were recruited at their convenience. Consent was obtained. Sonographic fetal soft tissue measurements were used to assess adiposity at 28 and 37 weeks. Gestational weight gain (GWG) was measured. Statistical analysis included multiple regression. RESULTS: In the 231 women studied the mean age was 30.6 years. 41.1% (n 95) were primigravidas. The mean early pregnancy BMI was 28.2 kg/m2. Maternal glucose levels correlated with the fetal abdominal subcutaneous tissue measurements (r 0.2; p 0.014) and abdominal circumference (AC), (r 0.1; p 0.04). Maternal glucose levels did not correlate with the fetal mid-thigh muscle thickness and mid-thigh subcutaneous tissue measurements. Fasting and 1 hour post prandial OGTT levels were significantly associated with AC and abdominal subcutaneous tissue measurements. Glucose levels at 2 and 3 hours post prandial correlated with increased abdominal subcutaneous tissue but not with fetal AC (Table). There was no significant association between gestational weight gain (GWG) and fetal adiposity. CONCLUSION: Recent studied have shown that higher maternal glucose levels short of GDM were associated with large for gestational age babies and neonatal adiposity. Our study shows that in women who do not have GDM, higher maternal glucose levels at 28 weeks gestation appear to influence the distribution of fetal fat as well as the amount of fat. The lifelong impact of intrauterine programming by maternal glycemia on the distribution of fetal fat remains uncertain. 341 Fetal loss rates from intrauterine fetal transfusion: a prospective tertiary center study Colin Walsh, Noirin Russell, Stephen Carroll, Rhona Mahony, Shane Higgins, Fionnuala McAuliffe, Peter McParland National Maternity Hospital, Maternal-Fetal Medicine, Dublin, Ireland, National Maternity Hospital, Obstetrics and Gynaecology, Dublin, Ireland, National Maternity Hospital, Obstetrics and Gynaecology, Dubin, Ireland, UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, Dublin, Ireland OBJECTIVE: To examine perinatal outcomes following intrauterine fetal red cell transfusion (IUT) in a single tertiary obstetric unit over a 15-year period. STUDY DESIGN: This is a prospective study of all IUTs performed at the National Maternity Hospital, Dublin, which is Irelands largest fetal medicine center. Eligible cases were identified from a prospectively collated hospital transfusion register; the clinical details for each case were extracted and recorded onto a computerized database. Women undergoing IUT for alloimmune thrombocytopenia, non-immune fetal hydrops or parvovirus infection were excluded. The cord insertion was the preferred site for IUT, with the intra-hepatic vein and free cord loop reserved for cases where the cord insertion was inaccessible. RESULTS: Between January 1996 and December 2010, 262 intrauterine transfusions were performed in our unit, of which 244 (93%) were undertaken for red cell alloimmunisation, involving 97 pregnancies. The majority of women (84%, 81/97) had anti-D antibodies, with a smaller incidence of anti-Kell (12%), anti-c (3%) and anti-E (1%) antibodies. Affected women underwent a median of 3 (IQR 2-4) IUT procedures. The median gestation at first IUT was 27 (IQR 25-31) weeks. In total, there were 3 intrauterine fetal deaths and 4 early neonatal deaths in this cohort, giving a perinatal mortality rate of 7% and a survival rate of 93%. There were 3 perinatal losses directly related to the transfusion (all in women with anti-D antibodies), giving an overall procedure-related loss rate of 1.2% (3/244) per procedure. Two women had in utero fetal demise within 48 hours of the IUT, at 25 weeks 29 weeks respectively. The third loss was early neonatal demise following emergency CS for fetal bradycardia due to cord hematoma at 32 weeks gestation. CONCLUSION: Intrauterine fetal transfusion is a safe procedure, associated with a low (1.2%) rate of procedure-related fetal loss, when performed by experienced practitioners in a national referral center. Poster Session II Diabetes, Labor, Medical-Surgical-Disease, Obstetric Quality & Safety, Prematurity, Ultrasound-Imaging www.AJOG.org

A multimodal approach to eye melanoma: patterns of care and related complications

We describe the results of multimodal treatment of uveal and conjunctival melanomas. A retrospective analysis was performed on 54 patients treated with a multimodal approach between 2003 and 2008 in a single institution. Main outcome measures were survival, enucleation rate, local tumor control, visual function preservation and complications associated with treatments. The median follow-up was 33.4 months. The 5-year overall survival was 95.3%, the local recurrence was 3.7% and the 5-year enucleation was 9.4%. Vision preservation was achieved in 84% of cases. Observed complications were cataract, retinal detachment, diplopia, glaucoma, retinopathy, optic neuropathy and scleral necrosis. A careful consideration of treatment of uveal melanoma in this study allowed us to obtain the survival rates and visual outcomes similar to previously published results, with a very small incidence of complications. the results must be interpreted in the light of recent findings on the genetic pattern of uveal melanoma.

Response to commentary on “The Driver Behaviour Questionnaire as a predictor of accidents: A meta-analysis”

Tunnels have a unique driving environment; thus, a small incident in a tunnel may result in severe consequences and a high probability of secondary crashes. Fortunately, studies have found that adopting safe driving behavior in a tunnel minimizes the severe outcomes of an incident. Therefore, implementing driver-oriented safety policies and conducting public awareness campaigns that emphasize safe behavior when driving through tunnels are essential. However, before devising policies and campaigns on the right issues, it is necessary to understand drivers' current level of knowledge regarding tunnel safety, their habits, behavioral intentions, and psychological condition while driving through tunnels. To achieve this objective, a sample of 841 responses was collected from China using a questionnaire survey consisting of fifty-two items. The results showed that several gaps exist in drivers' knowledge regarding tunnel safety and equipment. Drivers often adopt inappropriate habits and behaviors while driving through tunnels. Also, the tunnel environment has a significant influence on the psychological condition of the drivers. Moreover, drivers' demographic characteristics significantly affect their knowledge, reported habits and behavioral intentions, and psychological condition. The authorities and safety analysts could employ the suggestions highlighted in the present study for improving tunnel safety.

Patient‐related risk factors for implant therapy. A critique of pertinent literature

Treatment planning for dental implants involves the assessment of patient-related risk factors prior to formulation of a treatment plan. The aim of this review was to assess relevant literature and provide evidence-based information on the successful surgical placement of dental implants. An electronic search of Medline, PubMed and the Cochrane Databases of Systematic Reviews was undertaken using a combination of MeSH terms and keywords. A handsearch was also performed and cross-referenced with articles cited in papers selected. The primary study parameter was implant failure. Forty-three studies were selected based on specific inclusion criteria. Many studies contain confounding variables, numbers in subcategories are often too small for meaningful statistical analysis, and follow-up times vary and are often short-term. There are many risk factors which the clinician is required to know and understand to advise patients, and consider in planning and treatment provision. Consistent evidence exists to show an increased failure rate with smokers, a history of radiotherapy and local bone quality and quantity. Weaker evidence exists to show a higher incidence of peri-implant disease in patients with a history of periodontitis-related tooth loss. Lack of evidence precludes definitive guidelines for patients with autoimmune disorders where expert opinion recommends caution. Osteoporotic patients show acceptable survival rates; however patients on oral bisphosphonates show a small incidence but high morbidity from osteonecrosis of the jaw. Emerging evidence suggests that there is a correlation between genetic traits and disruption of osseointegration.