Objective
The main aim of this study was to investigate the perinatal outcomes of dichorionic twin pregnancies complicated by selective fetal growth restriction (sFGR).
Design
Retrospective cohort ...study.
Setting
Tertiary reference centre.
Population
Dichorionic twin pregnancies complicated by sFGR between 2000 and 2019 in St George's University Hospital.
Methods
Regression analyses were performed using generalised linear models and mixed‐effects generalised linear models where appropriate to account for pregnancy level dependency in variables. Time to event analyses were performed with mixed‐effects Cox regression models.
Main outcome measures
Stillbirth, neonatal death or neonatal unit admission with morbidity in one or both twins.
Results
A total of 102 (of 2431 dichorionic twin pregnancies) pregnancies complicated by sFGR were included in the study. The Cochrane–Armitage test revealed a significant trend for increased adverse perinatal outcome rates with more severe forms of umbilical artery flow impedance, i.e. reversed, absent, positive with resistant flow and positive flow without resistance. A multivariable model including maternal and conception characteristics had poor predictive accuracy for stillbirth (area under the curve: 0.68, 95% confidence interval CI 0.55–0.81) and composite adverse perinatal outcomes (area under the curve: 0.58, 95% CI 0.47–0.70). When umbilical artery Doppler parameters were added to the models, the area under the curve values improved to 0.95 (95% CI 0.89–0.99) and 0.83 (95% CI 0.73–0.92) for stillbirth and composite adverse perinatal outcomes, respectively.
Conclusion
In dichorionic twin pregnancies complicated by sFGR, the umbilical artery Z‐scores were associated with both intrauterine death and adverse perinatal outcomes.
Linked article: This article is commented on by Laura Sarno, pp. 201 in this issue. To view this mini commentary visit https://doi.org/10.1111/1471-0528.17600
Management of breast cysts revisited Bhate, R. D.; Chakravorty, A.; Ebbs, S. R.
International journal of clinical practice (Esher),
February 2007, Letnik:
61, Številka:
2
Journal Article
Recenzirano
Summary
The aim of this study was to evaluate the role of mammography and the outpatient follow up in the management of breast cysts. Prospective data was collected in 203 women from July 2000 to ...July 2005. All women had an ultrasound scan and aspiration. One hundred and seventy‐six women above 35 years had a mammogram. All women were followed up 4–6 weeks later. Women with M3 or M4 mammography or with suspicious ultrasound findings on initial clinical visit were investigated further; 96.53% presented with a lump in the breast. Aspiration was performed in all women. Three patients had a residual lump on 4–6 week follow up. One was found to be benign and two were revealed to have cancer. The mammogram findings in these two patients were M3 and they would have merited further investigation anyway. In total 176 patients had a mammogram and a departmental ultrasound scan of the breasts of which 41 patients required further investigations following which cancer was found in nine patients (4.4%). Mammography is an important tool in the management of breast cysts. Outpatient follow up did not contribute significantly to the care of these patients.
A large hydropower potential lies in the Himalayan region due to perennial rivers. North east India, especially Arunachal Pradesh, is blessed with Brahmaputra and its tributaries which makes it a ...rich hydropower potential state. Heavy sediment laden rivers are the main challenge to tap hydropower in this region. Orifice spillways are the obvious choice as they serve the dual function of flood disposal and flushing of sediment through the reservoir. The crest of the spillway is provided as near to the river bed as possible with high head over spillway crest. This arrangement, due to high head over crest, is susceptible to cavitation damage due to very high velocity flows. Cavitation damage and its prevention are of increasing concern in designing and operating high head spillways. Proper design of spillway leading to acceptable pressures for all operating conditions, improvement of spillway surface, use of cavitation resistant materials and aeration of the flow are few techniques to prevent the cavitation erosion on the spillway surface. Three high head spillway case studies where the head over spillways is more than 50 m and spillway surface is prone to cavitation damage due to high velocity of the order of 30 to 50 m/s are discussed. This paper describes the choice of cavitation prevention method depending upon hydraulic and functional constraints of particular case.
To create an in vitro cell culture model to predict the M/P (concentration of drug in milk/concentration in maternal plasma) ratios of therapeutic drugs viz. rifampicin, theophylline, paracetamol, ...and aspirin.
An in vitro cell culture model using CIT3 cells (mouse mammary epithelial cells) was created by culturing the cells on transwells. The cells formed an integral monolayer, allowing only transcellular transport as it happens in vivo. Functionality of the cells was confirmed through scanning electron microscopy. Time wise transfer of the study drugs from plasma to milk was studied and compared with actual (in vivo) M/P ratios obtained at reported tmax for the respective drugs.
The developed model mimicked two important intrinsic factors of mammary epithelial cells viz. secretory and tight-junction properties and also the passive route of drug transport. The in vitro M/P ratios at reported tmax were 0.23, 0.61, 0.87, and 0.03 respectively, for rifampicin, theophylline, paracetamol, and salicylic acid as compared to 0.29, 0.65, 0.65, and 0.22, respectively, in vitro.
Our preliminary effort to develop an in vitro physiological model showed promising results. Transfer rate of the drugs using the developed model compared well with the transfer potential seen in vivo except for salicylic acid, which was transferred in far lower concentration in vitro. The model has a potential to be developed as a non-invasive alternative to the in vitro technique for determining the transfer of therapeutic drugs into breast milk.
Role of respiration in plant growth remains an enigma. Growth of meristematic cells, which are not photosynthetic, is entirely driven by endogenous respiration. Does respiration determine growth and ...size or does it merely burn off the carbon depleting the biomass? We show here that respiration of the germinating rice seed, which is contributed largely by the meristematic cells of the embryo, quantitatively correlates with the dynamics of much of plant growth, starting with the time for germination to the time for flowering and yield. Seed respiration appears to define the quantitative phenotype that contributes to yield via growth dynamics that could be discerned even in commercial varieties, which are biased towards higher yield, despite considerable susceptibility of the dynamics to environmental perturbations. Intrinsic variation, irreducible despite stringent growth conditions, required independent validation of relevant physiological variables both by critical sampling design and by constructing dendrograms for the interrelationships between variables that yield high consensus. More importantly, seed respiration, by mediating the generation clock time via variable time for maturation as seen in rice, directly offers the plausible basis for the phenotypic variation, a major ecological stratagem in a variable environment with uncertain water availability. Faster respiring rice plants appear to complete growth dynamics sooner, mature faster, resulting in a smaller plant with lower yield. Counter to the common allometric views, respiration appears to determine size in the rice plant, and offers a valid physiological means, within the limits of intrinsic variation, to help parental selection in breeding.
Introduction:
Boswellia serrata has been used in traditional medicine for treatment of inflammatory diseases since antiquity. However human kinetic studies are lacking for this. Hence to better ...elucidate its effects in humans and determine its optimal dosing, this study was planned.
Material and Methods: Twelve healthy adult men volunteers were given capsule Wok Vel
TM containing 333 mg of Boswellia Serrata Extract, orally, after a seven days washout period. Venous blood samples were drawn through indwelling canula from each volunteer prior to drug administration and at 30, 60, 120, 150, 180, 210, 240, 300, 360, 480, 600, 720, 840 minutes after drug administration. Plasma obtained after centrifuge was analyzed to measure concentration of 11-Keto β-Boswellic Acid (KBA) by HPLC. Various kinetic parameters were then calculated from the plasma concentrations.
Results: The results are expressed as mean ± Standard Error of Mean. The peak plasma levels (2.72 × 10
–3 ± 0.18 μmoles/ml) of BSE were reached at 4.5 ± 0.55 h. The concentration declined with a mean elimination half life of 5.97 ± 0.95 h. The apparent volume of distribution averaged 142.87 ± 22.78 L and the plasma clearance was 296.10 ± 24.09 ml/min. The AUC
0– was 27.33 × 10
–3 ± 1.99 μmoles/ml h.
Conclusion: Elimination half life of nearly six hours suggests that the drug needs to be given orally at the interval of six hours. The plasma concentration will attain the steady state after approximately 30 hours. BSE is a safe drug and well tolerated on oral administration. No adverse effects were seen with this drug when administered as single dose in 333 mg.
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