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With the rising global tide of obesity, gestational diabetes mellitus (GDM) burgeoned into one of the most common antenatal disorders worldwide. Macrosomic babies born to diabetic mothers are more likely to develop risk factors for cardiovascular disease (CVD) before they reach adulthood. Rodent studies in offspring born to hyperglycemic pregnancies show vascular dysfunction characterized by impaired nitric oxide (NO)-mediated vasodilation and increased production of contractile prostanoids by cyclooxygenase 2 (COX-2). Vascular dysfunction is a key pathogenic event in the progression of diabetes-related vascular disease, primarily attributable to glucotoxicity. Therefore, glucose-induced vascular injury may stem directly from the hyperglycemic intrauterine environment of GDM pregnancy, as evinced by studies showing endothelial activation and inflammation at birth or in childhood in offspring born to GDM mothers. This review discusses potential mechanisms by which intrauterine hyperglycemia programs dysfunction in the developing vasculature.

Bacterial infections, especially cholangitis, are still common complications after liver transplantation (LTx). During recent years, multiresistant enterococci have become a nosocomial problem in transplant units. The present prospective study on 26 patients, including 24 patients with chronic liver disease, demonstrated that enterococci were the predominant micro-organism involved in post-LTx bacterial infections. They were cultured in the feces and in other sites of 10 out of 13 (77%) patients who underwent extensive examinations. Ampicillin-resistant Enterococcus faecium strains were isolated in urine or feces of 2 of the 13 patients prior to LTx. Similarly, resistance to ampicillin and gentamicin, the empirically used antibiotics for patients with fever of unknown origin, was found in E. faecium strains in 3 and 2 patients, respectively. Moreover, multiresistant E. faecium and E. faecalis strains were demonstrated in 46% of the patients in the postoperative period (3 months). However, no vancomycin-resistant enterococci were isolated. The use of antibiotics within 4 months prior to LTx significantly increased the risk of developing ampicillin-resistant bacteria at the time of LTx and of infections with bacteria of enteric origin after LTx (P = 0.03 and 0.01, respectively). We conclude that stool and urine cultures performed prior to LTX may be useful for selecting prophylactic antibiotic regimens.

Due to the relatively high occupational doses associated with interventional and diagnostic fluoroscopy procedures it is important to create awareness about and to quantify the radiation environment that medical staff are exposed to. A computer program was developed to analyze dose data collected from a dosimetry system that uses active personal dosimeters to monitor staff dose in real-time, to obtain an expanded analysis of the radiation environment that clinical staff are exposed to, on a procedural basis. The analyses that are made per procedure and staff member include: accumulated dose μSv, maximum and median dose rate mSv/h, the amount of time a staff member has been exposed to radiation compared to the total fluoroscopy time and the percentage of accumulated dose from 3 different dose rate intervals, including < 0.3 mSv/h, 0.3 - 2.6 mSv/h, and < 2.6 mSv/h. The developed computer program was used to analyze dose data collected from the dosimetry system at the Karolinska University Hospital to study the radiation environment that different categories of staff are exposed to during interventional aorta aneurysm treatment procedures. The analyses have provided the ability to know where to concentrate radiation safety training in interventional and diagnostic fluoroscopy and to ensure that operating rooms are equipped with adequate radiation protection (e.g., radiation protection barriers etc.). The developed computer program and dose data collected from the dosimetry system can be appropriated for other radiation environmental studies in diagnostic x-ray imaging.

Abstract Steam Assisted Gravity Drainage (SAGD) is an in situ thermal recovery technique used at Petro-Canada's MacKay River Project. The objective of this study is to develop an analytical well test method that would allow a measure of steam chamber volume and potentially the timing and location of steam chamber coalescence. This well test method would also prove useful in determining an analytical solution for near wellbore characteristics and reservoir boundaries. A pseudo-compositional thermal simulator was used to generate reservoir pressure responses by shutting off an injector at different periods of time and monitoring the pressure fall-off while continuing with production. Confined, unconfined, and coalesced 2-dimensional sink-source well pair models, based upon the geology and drilling pattern at Petro-Canada's MacKay River Project, were used in the study. The effect of the magnitude of the vertical permeability and the vertical to horizontal permeability ratio on the shut-in pressure response was also studied so that this method could be applied to other reservoirs of differing geology. Pressure response type curves were generated and the relationships between pressure drop at the injector, shut-in time, and steam chamber volume were determined. We show that the pressure response type curves are unique for different types of SAGD wells and levels of steam chamber development. This information will aid in determining the timing of operational conversions and determining recovery factors and possibly locations of reservoir boundaries, as well as steam chamber coalescence. Introduction In a commercial SAGD project, it can be expected that as the steam chambers mature and sweep through the reservoir, the well pairs will begin to interact with each other and the steam chambers will coalesce(1). Coalescence is defined as the point at which separate adjacent steam chambers merge to form one large steam chamber. Coalescence is used for timing operational conversions to secondary recovery schemes, such as solvent injection. As a result of the planning that is required for the operational conversion, a method of measuring the volume of the steam chamber would prove useful in estimating the timing of coalescence and the subsequent operational conversions. Considering there are 25 well pairs at MacKay River, it is also necessary to know which well pairs have coalesced so as to know the well pairs in which to institute operational conversions. For this reason, a well test method for determining which well pairs have coalesced is also required. The distance to and orientation of boundaries, flow regime, near wellbore characteristics (such as skin factor), and reservoir characteristics (such as effective permeability) can be determined through conventional pressure transient analysis. Conventional horizontal well testing has four different flow regimes that can be observed in the pressure response: early time radial flow, early time linear flow, pseudo steady state radial flow, and late time linear flow(2). The analytical solution is then applied in segments to the well test based upon the flow regime indicated by the pressure response. This segmental analysis can then be used to determine the reservoir characteristics.

PROMISE, a project in the DRIVE/ATT framework, is currently implementing pilot tests of traveller information services in two European cities. The two-way PROMISE traveller information services as they are implemented in the Gothenburg pilot installation are described. Based on the Groupe Spatiale Mobile cellular network and its Short Message Service (SMS), the users may request real-time traveller information from several existing information sources, e.g., for public transport, parking availability, road traffic information and road weather forecasts.

Purpose: To quantify the change in registered patient and staff dose indicators, i.e., KAP and CAK, and to evaluate if any detrimental effects on the treatment response are introduced, by the clinical implementation of a noise reducing algorithm for neurointerventional procedures. Methods: An image processing algorithm, ClarityIQ, for the AlluraClarity (Product not yet available in the US) system has been developed by Philips (Philips Healthcare Best, The Netherlands) to achieve advanced real time noise reduction in fluoroscopy and digital subtraction angiography. With the implementation of the noise reducing algorithm, an equivalent image quality can be achieved with reduced exposure by optimizing the system settings, consequently modifying the emitted photon spectrum.A retrospective study was performed where exposure dose data with the new system settings (January–June 2012; 174 diagnostic and 138 interventional cases) was compared with data for the prior system settings (January–June 2010; 190 diagnostic and 112 interventional cases). The data was categorized according to type of diagnostic or interventional procedure. In order to evaluate the effect on the treatment response, the total number of acquisition images, duration of fluoroscopy, and total procedure time was collected. Results: The median of the total KAP and CAK (sum of frontal and lateral plane) for diagnostic and interventional procedures for the prior settings was 124 Gycm2 and 0.78 Gy, and 328 Gycm2 and 2.71 Gy, respectively. The median for diagnostic and interventional procedures with the new settings was 47 Gycm2 and 0.27 Gy, and 109 Gycm2 and 0.89 Gy, respectively. The difference in the total number of acquisition images, duration of fluoroscopy, and total procedure time was statistically negligible. Conclusion: The new system settings resulted in a significantly reduced KAP and CAK (approximately 60%), indicating reduction in both patient and staff doses, with no indication of change in treatment response. Two of the athors are employed by Philips Healthcare, Best, The Netherlands (S. Boon and M. Mauti). The project was partly financed by Philips Healthcare.