Objective
To investigate the association between mid‐trimester residual cervical length (CL) and the risk of preterm birth in pregnancies after abdominal radical trachelectomy (RT).
Design
...Retrospective cohort study.
Setting
University hospital.
Population
A total of 33 deliveries after 22 weeks’ gestation in 30 women who underwent abdominal RT including prophylactic cervical cerclage and perinatal care between January 2002 and May 2016.
Methods
The association between mid‐trimester residual CL (the distance between the cerclage and the external cervical os) and gestational age at delivery was investigated. Receiver–operating characteristics (ROC) curve analysis was performed to estimate the optimal cut‐off values of the mid‐trimester residual CL for the prediction of preterm birth.
Main outcome measures
Preterm birth before 34 weeks’ gestation.
Results
Mid‐trimester residual CL showed a significant correlation with gestational age at delivery (r = 0.36, P < 0.05). There was a significant difference in residual CL between women who did and those who did not give birth before 34 weeks (P < 0.05). Mid‐trimester residual CL < 13 mm was a good predictor of birth before 34 weeks, with a sensitivity of 67%, specificity of 75%, positive predictive value of 55% and negative predictive value of 86% (area under ROC curve, 0.75).
Conclusions
Mid‐trimester residual CL is significantly correlated with gestational age at delivery. Residual CL assessment could be used to reassure physicians and women that there is only a small chance of preterm birth in pregnancies after abdominal RT.
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Mid‐trimester residual cervical length is a good predictor of preterm birth after radical trachelectomy.
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Mid‐trimester residual cervical length is a good predictor of preterm birth after radical trachelectomy.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
2.
Finances and returns for robotic dairies Salfer, J.A.; Minegishi, K.; Lazarus, W. ...
Journal of dairy science,
September 2017, 2017-Sep, 2017-09-00, 20170901, Volume:
100, Issue:
9
Journal Article
Peer reviewed
Open access
Automatic milking systems (AMS) became commercially available in the early 1990s. These systems provide flexibility and improve the lifestyle of farmers installing them. Because of the larger capital ...cost per kilogram of milk produced, observational studies in Europe and simulation studies have shown AMS to be less profitable than milking parlor systems, although previous findings are somewhat mixed. Improved performance of newer generations of AMS, better facility design to accommodate cow behavior, and better management of these facilities have the potential to make AMS more profitable. Wage rates are also increasing and sourcing high-quality milking labor is challenging. We developed partial budget simulations to model profitability of AMS compared with parlor systems for 120-, 240-, and 1,500-cow farms. Both the 120-cow and 240-cow AMS were more profitable than the parlor systems. However, the 1,500-cow parlor system was more profitable than the AMS. Breakeven labor analysis of the 1,500-cow system showed that at a wage inflation rate of 1% and a 0.91 kg/d lower milk production with the AMS system, the breakeven labor rate was $27.02/h. If the farm is able to achieve similar milk production between the 2 systems and wage inflation averages 3% over the 30-yr time horizon, the breakeven wage rate drops to $17.11/h. The major management factors that influenced the net annual impact were changes in milking labor cost and milk production. Another significant factor affecting net annual impact was the economic life of the AMS. An economic life of 13 yr or longer was required for an AMS to have a consistently positive net annual impact (depending on milk production per cow and labor cost). For every 227-kg increase in daily milk production per AMS, net annual income increased approximately $4,100. Cost-effective ways to optimize milk per AMS are to minimize attaching and milking times and to optimize milking settings.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
STUDY QUESTION
What are the reproductive and obstetric outcomes in patients undergoing radical abdominal trachelectomy (RAT) for early-stage cervical cancer?
SUMMARY ANSWER
When RAT was performed ...before a pregnancy achieved with fertility treatments, pregnancy rate of 36.2% was obtained and 71.4% of these women gave birth at ≥32 weeks of gestation.
WHAT IS KNOWN ALREADY
Reproductive and obstetric outcomes after radical vaginal trachelectomy (RVT) are well documented; however, these outcomes after RAT have not been well studied.
STUDY DESIGN, SIZE, DURATION
This is a retrospective cohort study of patients at a single institution who underwent RAT and became pregnant. Reproductive and obstetric outcomes of 114 patients who had undergone RAT from September 2002 to December 2010 were investigated.
PARTICIPANTS/MATERIAL, SETTING, METHODS
Women of reproductive age with early-stage cervical cancer who wished to preserve their fertility were documented.
MAIN RESULTS AND THE ROLE OF CHANCE
Patients' median age was 33 years (25–40 years). A total of 31 pregnancies were achieved in 25 patients and 6 patients had 2 pregnancies. Eighteen of 25 patients (72.0%) had infertility problems; 17 patients conceived with IVF-embryo transfer and 1 patient with intrauterine insemination. The pregnancy rate among patients who wished to conceive was 36.2% (25/69). Among 31 pregnancies in 25 patients, 4 patients had first trimester miscarriage and 1 patient had second trimester miscarriage. Excluding the five patients who miscarried and the five ongoing pregnancies, all the 21 patients had deliveries by Cesarean section. Four patients had a preterm birth in the second trimester and 17 patients delivered in the third trimester. Of the 17 pregnancies that reached the third trimester, 2 (11.8%) were preterm births between 29 and 32 weeks, 11 (64.7%) were delivered between 32 and 37 weeks and 4 (23.5%) at ≥37 weeks of gestation.
LIMITATIONS, REASONS FOR CAUTION
Because of the retrospective data collection, not all pregnancies may have been recorded.
WIDER IMPLICATIONS OF THE FINDINGS
Prospective multicenter studies are needed to determine if the results shown in this retrospective cohort can be generalized to all patients with early-stage cervical cancer who wish to undergo the fertility-sparing RAT procedure.
STUDY FUNDING/COMPETING INTEREST(S)
There was no funding for this study. No conflicts of interest.
This paper used farm income tax returns (Schedule F) data from 62 dairy farmers who milked 200 cows or fewer in western and central Maryland and southwestern Pennsylvania (hereafter, the mid-Atlantic ...region) to assess the relative financial performance of management-intensive grazing (MIG) and confinement dairy operations over the 15-yr period from 1995 through 2009. Data were not available from all farmers in all years; on average, the sample analyzed contained 11 MIG farms and 26 confinement farms. Management-intensive grazing operators were more profitable on a per hundredweight, per cow, and per acre basis, and no less profitable on a whole-farm basis. Even though the confinement operators had higher gross income than MIG operators, their expenses exceeded those of MIG operators. Profits of MIG operations were less variable as well, so that MIG operators faced less income risk. Increased reliance on grazing has other benefits as well. Grazing seems to be a much healthier practice for dairy cows. Veterinary, breeding, and medicine costs per cow are much less for cows that are pastured than those raised in confinement systems. Because they are healthier, cows that are grazed can be milked longer (or culled less frequently). As a result, MIG operators have a larger number of higher quality animals for sale (e.g., bred heifers). Management-intensive operations are also less labor intensive. Reductions in crop production and in the time cows spend in the barn led to significant reductions in field work and cleaning operations in the barn. Costs of hired labor were thus substantially lower in MIG operations than in confinement operations. Land requirements likely impose the principal limitation on the size of intensive grazing operations. In the mid-Atlantic, for instance, grazing operations need 1.5 to 2.0 acres of pasture for every dairy cow/calf equivalent to provide sufficient grass to support a dairy operation. Pasture land for MIG operators must be contiguous to the milking parlor and located no farther than a cow can walk to and from twice a day. That requirement likely limits the maximum size of an intensive grazing operation, especially in areas where land prices and rents are high, as they are in much of the mid-Atlantic.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
To update the evidence for the efficacy of biological disease-modifying antirheumatic drugs (bDMARDs) in patients with rheumatoid arthritis (RA) to inform European League Against Rheumatism (EULAR) ...Task Force treatment recommendations.
MEDLINE, EMBASE and Cochrane databases were searched for phase III or IV (or phase II, if these studies were lacking) randomised controlled trials (RCTs) published between January 2013 and February 2016. Abstracts from the American College of Rheumatology and EULAR conferences were obtained.
The RCTs confirmed greater efficacy with a bDMARD+conventional synthetic DMARD (csDMARD) versus a csDMARDs alone (level 1A evidence). Using a treat-to-target strategy approach, commencing and escalating csDMARD therapy and adding a bDMARD in cases of non-response, is an effective approach (1B). If a bDMARD had failed, improvements in clinical response were seen on switching to another bDMARD (1A), but no clear advantage was seen for switching to an agent with another mode of action. Maintenance of clinical response in patients in remission or low disease activity was best when continuing rather than stopping a bDMARD, but bDMARD dose reduction or 'spacing' was possible, with a substantial proportion of patients achieving bDMARD-free remission (2B). RCTs have also demonstrated efficacy of several new bDMARDs and biosimilar DMARDs (1B).
This systematic literature review consistently confirmed the previously reported efficacy of bDMARDs in RA and provided additional information on bDMARD switching and dose reduction.
The strain dependence of T c and I c for the GdBCO coated conductor was measured at 77 and 4.2 K in magnetic fields. T c decreased with increasing applied tensile strain. For the I c measurements, ...the magnetic field was applied in the direction parallel to the c-axis (perpendicular to the tape surface). I c in fields was degraded with increasing strain, and the strain dependence of I c increased with increasing magnetic field. The ratio of the I c degradation at 4.2 K was smaller than that at 77 K. These results mean that the T c degradation is one of the reasons for I c degradation at 77 K at least. Further, in order to understand the strain effect at 4.2 K, the internal strain of the GdBCO coated conductor under tensile strain was measured using synchrotron radiation. It was found that the strain behavior for the a-axis is different from that for the b-axis. This result suggests that the strain dependence of I c for GdBCO coated conductors under external tensile strain is related with the T c degradation behavior of the crystal.
Internally reinforced Nb 3 Sn strands with CuNb-reinforcing stabilizer have been developed for realizing a compact high-field superconducting magnet. The Rutherford flat cables composed of sixteen ...strands were made with a 0.8 mm diameter CuNb/Nb 3 Sn strand. The designed critical current of the CuNb/Nb 3 Sn Rutherford flat cable is I c = 1890 A at 13 T and 4.2 K in case of an ordinary heat-treatment at 670 for 96 h, which is two times higher than an operation current desired for safety margin. In addition, mechanical characteristics for CVD-processed YBa 2 Cu 3 O 7 (YBCO) coated-conductor tapes were measured at 4.2 K in fields up to 18 T. It was found that YBCO tape exhibits the irreversible strain 0.5% and the irreversible stress 1140 MPa for the critical current at 4.2 K and 18 T for B//c. The cabling-and-react+prebending-processed CuNb/Nb 3 Sn Rutherford flat cables and CVD-processed YBCO tapes will be used as a react-and-wind method for the development of a 20 T superconducting magnet with a wide room temperature bore. We design a 20 T-440 mm warm-bore superconducting magnet consisting of YBCO inner coils, middle coils, and NbTi outer coils, which has the coil parameters of inner diameter 480 mm, outer diameter 1283 mm, and coil height 1302 mm. Since the coil inductance is estimated to be 232 H, the magnetic stored energy is 94 MJ at an operation current 900 A. An energy-saving 47 T hybrid magnet can be constructed in combination with a wide-bore 20 T superconducting outsert and a 15 MW-27 T water-cooled resistive insert.
The government of Japan started a selective vaccination programme to prevent mother‐to‐infant infection by hepatitis B virus (HBV) since January 1986. The effect of the programme on first‐time blood ...donors has not been examined in detail. Data of first‐time blood donors aged 16–25 years from 1996 to 2007 were extracted from the Japanese Red Cross (JRC) donors' database. Principal component analysis (PCA) was used to visualize the birth‐year‐dependent group of rate of HBV‐positive donors. According to the birth of year, donors were divided into four groups by PCA. After the start of the programme, donors born in 1986–1989 comprised a single group. Before the start of the programme, three groups (1980, 1981–1984 and 1985) were identified. Although a significant time‐dependent decrease in the rate of HBV‐positive donors was observed before the start of the programme, a significant difference in the rate of HBV‐positive donors was observed around the start of the programme by regression analysis for 16–19‐year‐old first‐time blood donors. The selective vaccination programme has been effective to prevent the vertical transmission of HBV from the analysis of first‐time blood donors. On the other hand, vaccination of blood donors should be considered to reduce the risk of post‐transfusion HBV infection, because the horizontal transmission increases in HBV‐positive blood donors.
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