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Compare the neonatal outcomes of two protocols of diagnosis and surveillance of pregnancies complicated by early-onset FGR in a tertiary hospital. This is a retrospective cohort study of pregnant women diagnosed with early-onset FGR between 2017 and 2020. We compared the obstetric and perinatal outcomes between two different management protocols (before and after 2019). Seventy-two cases of early-onset FGR were diagnosed in the forementioned period: 45 (62.5%) were managed according to protocol 1 and 27 (37.5%) according to protocol 2. Mean gestational age at delivery was significantly different between groups: 34.9 ± 3.1 weeks (95% CI 34.0–35.9) in group 1 and 32.3 ± 4.4 weeks (95% CI 30.4–33.9) in group 2. 74.1% (20) of newborns in group 2 were admitted in de NICU, a significant difference when compared with 46.7% of group 1. There were no statistically significant differences in the remaining serious neonatal adverse outcomes. This is the first study published comparing two different protocols of management of FGR. The implementation of the new protocol seems to have led to a decrease in the number of fetuses labeled as growth restricted and to a decrease in the gestational age of delivery of such fetuses, but without increasing the rate of serious neonatal adverse outcomes. The implementation of the 2016 ISUOG guidelines for the diagnosis of fetal growth restriction seems to have led to a decrease in the number of fetuses labeled as growth restricted and to a decrease in the gestational age of delivery of such fetuses, but without increasing the rate of serious neonatal adverse outcomes. [ABSTRACT FROM AUTHOR]

Sirolimus constitutes a safe and effective treatment for cardiac manifestations of tuberous sclerosis complex (TSC) in children but only four cases describing prenatal treatment of rhabdomyomas with mTOR inhibitors have been published. In this case, sirolimus was initiated at 26 weeks´ gestation in a pregnant woman with TSC with a fetus with a large rabdomyoma conditioning severe arrhythmia. There was a significant reduction in the tumor size with ongoing treatment and a partial reversion of the arrhythmia. m-TOR inhibitors can be considered for severe cases of fetal rhabdomyomas with poor prognosis given its potencial benefits. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the relative importance of ethnicity and socioeconomic deprivation in determining the likelihood and prevalence of placentally derived composite of adverse pregnancy outcomes (CAPO) and composite of severe adverse pregnancy outcomes (CAPO‐S). Methods: This was a single‐center retrospective cohort study of data obtained in a tertiary maternity unit. Data regarding ethnicity and socioeconomic deprivation (as measured with indices of multiple deprivation) were collected for 13 165 singleton pregnancies screened routinely in the first trimester for pre‐eclampsia using the Fetal Medicine Foundation combined risk‐assessment algorithm. CAPO was defined as the presence of one or more interrelated outcomes associated with placental dysfunction, namely, hypertensive disorders of pregnancy, preterm birth, birth weight ≤ 10th centile and stillbirth. CAPO‐S was defined as the presence of one or more of the following: hypertensive disorders of pregnancy at < 37 + 0 weeks, preterm birth at < 34 + 0 weeks, birth weight ≤ 5th centile and stillbirth at < 37 + 0 weeks. Results: The prevalence of CAPO was 16.3% in white women, 29.3% in black women and 29.3% in South Asian women. However, half (51.7%) of all CAPO cases occurred in white women. There was a strong interaction between ethnicity and socioeconomic deprivation, with a correlation coefficient of −0.223. Both ethnicity and socioeconomic deprivation influenced the prevalence of CAPO and CAPO‐S, with the contribution of ethnicity being the strongest. Conclusions: Black and Asian ethnicity, as well as socioeconomic deprivation, influence the prevalence of placenta‐mediated adverse pregnancy outcomes. Despite this, most adverse pregnancy outcomes occur in white women, who represent the majority of the population and are also affected by socioeconomic deprivation. For these reasons, inclusion of socioeconomic deprivation should be considered in early pregnancy risk assessment for placenta‐mediated CAPO. © 2024 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. This article's abstract has been translated into Spanish and Chinese. Follow the links from the abstract to view the translations. [ABSTRACT FROM AUTHOR]

Background: Medial hamstring lengthening is frequently used to correct contractures in neuromuscular conditions such as cerebral palsy. Surgical techniques vary considerably and little is known about the lengthening characteristics of muscle-tendon-units after surgical intervention. Methods: A randomized trial was performed on paired cadaver medial hamstring muscle-tendon-units comparing 'High' (proximal) versus 'Low' (distal) lengthening procedures. The paired muscle-tendon-units were subjected to tensile testing utilizing an Instron® (Instron Corporation, Canton, MA, USA) machine under controlled conditions. Prior to tensile testing, the paired semitendinosus and paired gracilis received either high or low intramuscular tenotomy. Load (N) versus displacement (mm) was recorded continuously for each test. The difference in lengthening and load at failure for intact and surgical simulation muscle-tendon-units was recorded and compared with paired t-tests. Results: Both low and high lengthenings increased the amount of lengthening achieved compared with intact controls and the lengthening was achieved at lower applied load. Low intramuscular tenotomy of the semitendinosus resulted in a 30% greater lengthening when compared with high intramuscular tenotomy. For the gracilis muscle, the low intramuscular tenotomy achieved 39% greater lengthening than the high intramuscular tenotomy and these differences were significant. Conclusion: Biomechanical testing of formalin-preserved human cadaveric medial hamstring muscle-tendon-units confirms that it is possible to achieve lengthening in continuity following an intramuscular tenotomy or fascial striping procedure. The site of the surgical procedure (high versus low) results in a different effect on the lengthening characteristics, dictated by the anatomy of the particular muscle-tendon-unit. [ABSTRACT FROM AUTHOR]

This article is the first in a series which describes maternity services in Scotland. Although part of the UK, culturally and geographically Scotland is very different and this is reflected in the way health and maternity services are planned, organised and delivered. Scotland has a mainland area of 28,269 square miles (73,217 square kilometres); including inhabited islands, it has an overall area of 30,418 square mites with a population of five million. In contrast the total area of Wales Is 20,768 square kilometres (8019 square miles) with a population of 3 million and Northern Ireland is 5,240 square miles in size and has a population of 1.69 million. England meanwhile, is 93,000 square miles In size with a population of 58 million people. So, although Scotland is 25% the size of England it only has 8.5% of the population. Not surprisingly, remote and rural health and maternity care figure greatly on the Scottish Executive Health Department agenda and a Remote and Rural Resource initiative is in place to address specific remote and rural health care issues. [ABSTRACT FROM AUTHOR]

The cavum septi pellucidi (CSP) is an important landmark in evaluation of the fetal brain, because its visualisation provides reassurance of normal central forebrain development. CC length measurements were always inferior to the 5th centile and the head circumference reduced from 13th to 5th centile. Non-visualisation of the CSP during pregnancy may stem from agenesis of the septa, lack of formation or obliteration of the space between them. [Extracted from the article]

Investigates electromigration in thin films of aluminum and aluminum alloys. Consideration of the electrical 1/frequency noise as an early indication of electromigration damage; Factors attributed to failure of very-large-scale-integration electronic devices; Employment of a phase-sensitive alternating current correlation method.

Background: Major depressive disorder (MDD) can have severe impacts on function and quality of life. Up to one third of patients will have an inadequate response to their first line of treatment, with subsequent lines of therapy associated with lower remission rates and higher relapse rates. Recently esketamine has become available for Australian patients, and this agent provides an additional treatment option for those with MDD who have had an inadequate response to two or more antidepressant therapies during the current moderate to severe depressive episode. This paper provides an expert panel's practical recommendations and clinical guidance for establishing esketamine clinics in Australia. Methods: An expert panel (n = 11) comprising psychiatrists, mental health care nurses, pharmacists, and individuals with experience establishing esketamine clinics was convened in Sydney. The panel developed practical recommendations and clinical guidance, which were then further refined. Results: Five key areas were identified: practical considerations for esketamine clinic set‐up, including multidisciplinary care considerations; patient selection; administering esketamine; adverse event management and long‐term follow‐up. Conclusions: Guidance presented in this paper should assist Australian clinicians to set up an esketamine clinic, and provide practical advice on the infrastructure and clinical requirements for treatment of patients with this agent. [ABSTRACT FROM AUTHOR]

: BackgroundTraumatic experiences associated with cardiac surgery (CS) can result in traumatic memories and posttraumatic stress disorder (PTSD). Because it is known that subjects who develop PTSD often show sustained reductions in circulating cortisol concentrations, we performed a prospective, randomized study to examine whether exogenously administered stress doses of hydrocortisone during the perioperative period of CS reduces the long-term incidence of chronic stress and PTSD symptoms.: MethodsPatients (n = 91) were prospectively randomized to receive either stress doses of hydrocortisone or standard treatment during the perioperative period of CS. Of 48 available patients at 6 months after CS, 26 had received stress doses of hydrocortisone and 22 standard treatment. Traumatic memories and PTSD symptoms were diagnosed with previously validated questionnaires.: ResultsAs compared with patients after standard therapy, patients from the hydrocortisone group had significantly lower chronic stress symptom scores (p < .05). There was no significant difference regarding the number or type of traumatic memories between the hydrocortisone and the standard treatment groups.: ConclusionsStress doses of hydrocortisone in patients undergoing CS are associated with a lower intensity of chronic stress and PTSD symptoms at 6 months after CS. [Copyright &y& Elsevier]