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STUDY QUESTION What is the evidence to guide the management of women who wish to conceive following abdominopelvic radiotherapy (AP RT) or total body irradiation (TBI)? SUMMARY ANSWER Pregnancy is possible, even following higher doses of post-pubertal uterine radiation exposure; however, it is associated with adverse reproductive sequelae and pregnancies must be managed in a high-risk obstetric unit. WHAT IS KNOWN ALREADY In addition to primary ovarian insufficiency, female survivors who are treated with AP RT and TBI are at risk of damage to the uterus. This may impact on its function and manifest as adverse reproductive sequelae. STUDY DESIGN, SIZE, DURATION A review of the literature was carried out and a multidisciplinary working group provided expert opinion regarding assessment of the uterus and obstetric management. PARTICIPANTS/MATERIALS, SETTING, METHODS Reproductive outcomes for postpubertal women with uterine radiation exposure in the form of AP RT or TBI were reviewed. This included Pubmed listed peer-reviewed publications from 1990 to 2019, and limited to English language.. MAIN RESULTS AND THE ROLE OF CHANCE The prepubertal uterus is much more vulnerable to the effects of radiation than after puberty. Almost all available information about the impact of radiation on the uterus comes from studies of radiation exposure during childhood or adolescence. An uncomplicated pregnancy is possible, even with doses as high as 54 Gy. Therefore, tumour treatment doses alone cannot at present be used to accurately predict uterine damage. LIMITATIONS, REASONS FOR CAUTION Much of the data cannot be readily extrapolated to adult women who have had uterine radiation and the publications concerning adult women treated with AP RT are largely limited to case reports. WIDER IMPLICATIONS OF THE FINDINGS This analysis offers clinical guidance and assists with patient counselling. It is important to include patients who have undergone AP RT or TBI in prospective studies to provide further evidence regarding uterine function, pregnancy outcomes and correlation of imaging with clinical outcomes. STUDY FUNDING/COMPETING INTEREST(S) This study received no funding and there are no conflicts of interest. TRIAL REGISTRATION NUMBER N/A. [ABSTRACT FROM AUTHOR]

Skin metastasis is a rare form of ovarian carcinoma spread and is associated with widespread disease and a poor prognosis. The authors present a case of a patient, with a past history of ovarian clear cell carcinoma, who presented with subcutaneous nodules as the first sign of recurrent metastatic disease. [ABSTRACT FROM AUTHOR]

Background: Sport and exercise related injuries are responsible for about 5% of the workload in the accident and emergency (A&E) department, yet training in sports medicine is not a compulsory part of the curriculum for Higher Specialist Training.Aim: To determine how A&E medicine consultants and specialist trainees view their role and skill requirements in relation to sports medicine.Method: A modified Delphi study, consisting of two rounds of a postal questionnaire. Participants were invited to rate the importance of statements relating to the role and training of the A&E specialist in relation to sports injuries (six statements) and the need for knowledge and understanding of defined skills of importance in sports medicine (16 statements). VALUE OF RESEARCH: This provides a consensus of opinion on issues in sport and exercise medicine that have educational implications for A&E specialists, and should be considered in the curriculum for Higher Specialist Training. There is also the potential for improving the health care provision of A&E departments, to the exercising and sporting population. [ABSTRACT FROM AUTHOR]

BACKGROUND: Compared with other developed countries, the United Kingdom has exhibited less of an increase in life expectancy over the past 30 years. METHODS: We compared the chronological changes in the age-adjusted mortality rates (AMRs) from all causes or major causes, and in life expectancy in the United Kingdom and Japan between 1970 and 1997. RESULTS: In both 1970 and 1997 the AMRs for most major causes were higher in the United Kingdom than in Japan; the difference in the AMR between countries was smaller in 1970 than in 1997. The difference in the AMR from all causes between the United Kingdom and Japan in 1997 was mainly due to differences in the AMR for heart diseases. The trend for an increasing difference over time between the United Kingdom and Japan in the AMR from all causes was due to the decreased rate of AMR from heart diseases from 1970 to 1997 in the United Kingdom being lower than those from cerebrovascular diseases in same period in Japan. CONCLUSIONS: These data suggest that mortality rates could be reduced by a change in focus of the National Health Service toward an emphasis on primary rather than secondary prevention and associated clinical interventions. The greatest priority should be placed on reducing the incidence of heart disease by aggressively improving primary prevention. [ABSTRACT FROM AUTHOR]

The design of a high performance bit parallel second order IIR filter chip is described. The chip in question is highly pipelined, uses most significant digit first arithmetic and consists mainly of arrays of simple carry-save adders. It has been fabricated in 1.5 μm double level metal CMOS technology, accepts 12 bit input data and coefficient values and can operate at up to 40 megasamples per second. All data inputs and outputs are in two's complement form and the chip power consumption is 1 W. The highly regular nature of the architecture has been exploited for test pattern generation. It is shown how small, but important modifications to the basic architecture, can significantly improve testing. As a result, 100% fault coverage can be achieved using less than 1000 test vectors. The chip may be used in a cascade realisation to form a general Nth order filter. [ABSTRACT FROM AUTHOR]

School sport is a major cause of injury in the post-primary age group. The importance of primary prevention in sport has been identified; however secondary prevention of school related sport injury has not been described in Ireland. A random sample of 450 schools in Northern Ireland and the Republic of Ireland was studied using a postal questionnaire. Current management of sport injury, with particular interest in the expertise and training of teachers and coaches, was explored. Replies were received from 333 (74%) schools. There was no physical education teacher with up to date first aid training in 37% schools. Immediate care in terms of mechanisms and equipment to deal with injury was available in 35%-81% of schools responding. Correct response ranged from 65%-90% to four scenarios: commonly presenting yet potentially serious management problems. This study demonstrated deficiencies in sport injury care. In addition to concern about current training, a need for basic life support training is highlighted. These findings have implications for the prevention of school sports injuries. [ABSTRACT FROM AUTHOR]

Identifying malignant ovarian masses preoperatively in young women can prove difficult due to their nonspecific presentation in this population (1). To describe (i) the clinicopathological predictors of malignancy in surgically removed ovarian masses in women ≤ 21 years of age; (ii)the ability of three risk models to distinguish malignant (including borderline) from benign tumours. A 30-year retrospective analysis of surgically removed ovarian masses in females ≤ 21 years at the Royal Children's Hospital and the Royal Women's Hospital Melbourne. External validation of risk of malignancy scores were undertaken. These included RMI2 (Risk of Malignancy Index 2, [menopausal status, CA125 and ultrasound features]); the Papic-method (tumour markers, maximum diameter of lesion and solid component) and the PRMI (Paediatric Risk of Malignancy Index, sex hormone related symptoms, maximum diameter of largest solid component, enhancement or flow in a septum or solid papillary projection). For each model the positive predictive value (PPV), negative predictive value (NPV), sensitivity, specificity and area under the curve (AUC) were calculated. We examined 460 masses of which 383 were benign, 20 were borderline and 57 frankly malignant. Factors significantly associated with frank malignancy (compared to benign masses) were the presence of a palpable mass (73.9% versus 24.2%), precocious puberty, a larger mean diameter of the mass (15.1 cm versus 8.3 cm), presence of a solid component (91.3% versus 44.4%), multilocularity (66.7% versus 40.4%), ascites (42.9% versus 2.4%) respectively (all p < 0.05). Those with borderline tumours had an older median age compared to frankly malignant tumours (14.4 vs 18.5 years respectively) and were less likely to have a solid component or ascites (p < 0.005). Tumour markers were undertaken in 52 borderline and frankly malignant masses, and were positive in 92.0% (23/25) of germ cell malignancies, 42.8% (3/7) of sex cord stromal tumours, 80% of frankly malignant epithelial tumours (4/5) and 30.8% (4/13) of borderline tumours. The risk models RMI2 and the Papic-method had good discriminatory value in differentiating benign from malignant disease (area under the curve [AUC] 0.83 and 0.84 respectively). However, the PRMI was less discriminatory (AUC 0.62). The RMI2 model with a cut off score of 112 provided the highest predictive odds for malignancy in this population out of all three models (OR 25.3 [95% C.I. 9.0-71.1]). Pre-existing risk of malignancy indices (RMI2) and Papic show good reliability for detection of malignant ovarian disease in young females. [ABSTRACT FROM AUTHOR]