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Wet electrostatic precipitators have demonstrated a robust capability for removal of particulate matter by minimizing back corona and particle re-entrainment of fine particles. The absence of studies investigating the removal of black carbon particles using a wet electrostatic precipitator requires additional development/investigations. Among the operational parameters of wet electrostatic precipitators, particle residence times (1s) and the amount of electrostatic energy transferred to the exhaust gas is important to determine the removal efficiencies of wet electrostatic precipitators. This article reports the removal efficiency of black carbon, total particulate matter, and various particle sizes using different operating conditions in a full-scale hexagonal wet electrostatic precipitator column with sequential cleaning. The exhaust gas cleaned during the experiments was produced by a 2 MW marine engine operated on heavy fuel oil. Three key parameters, voltage-current characteristics, transferred electrostatic energy to the exhaust gas, and particle residence times were varied to evaluate their effects on removal efficiencies. The wet electrostatic precipitator was able to remove from 42.7 to 97.2 % of the particulatematter and 44.8 to 95.9 % of black carbon particles by varying the electrical energy input to the gas stream (5-262 J/m3) and the particle residence time (0.3-1.8 s). A change in particle residence time (0.3 to 0.95 s) showed an overall removal increase of 31.7 % and revealed removal efficiency gaps of up to 24.1 % between particle sizes. By investigating removal efficiencies of different particle sizes and black carbon content it was found that the best fit was achieved for sizes between 0.02-0.77 μm, indicating a black carbon size range in this order. The study indicates a similar removal efficiency between black carbon and particulate matter could be achieved and that the main focus for improvement of black carbon removal should be found in the particle range between 0.02-0.77 μm. Implication statementThe manuscript describes a small efficient system for removal of particle matter and black carbon particles from the exhaust gas generated by a ship engine. This manuscript is especially interesting for the International Maritime Organization (IMO) and its sub-committee on Pollution Prevention and Response (PPR). The IMO is the law-maker/the united nations specialized agency with responsibility for atmospheric pollution by ships in international waters. The IMO agreed in 2011 on an investigation plan to gather information and to find possible black carbon control measures for future regulations, which to some extent can be delivered through this article.

Purpose: We investigated whether hepcidin and erythroferrone (ERFE) could complement the Athlete Biological Passport (ABP) in indirectly detecting a 130 mL packed red blood cells (RBCs) autologous blood transfusion. Endurance performance was evaluated.Methods: Forty-eight healthy men (n = 24) and women (n = 24) participated. Baseline samples were collected weekly followed by randomization to a blood transfusion (BT, n = 24) or control group (CON, n = 24). Only the BT group donated 450 mL whole blood from which 130 mL RBCs was reinfused four weeks later. Blood samples were collected 3, 7, 14, 21 and 28 days after donation, and 3, 6, and 24 hours and 2, 3, and 6 days following reinfusion. In the CON group samples were collected with the same frequency. Endurance performance was evaluated by a 650-kCal time trial (n = 13) before and one and six days after reinfusion.Results: A time×treatment effect existed (P < 0.05) for hepcidin and ERFE. Hepcidin was increased (P < 0.01) ~110 and 89% six and 24 hours after reinfusion. Using an individual approach (99% specificity, e.g. allowing 1:100 false-positive), sensitivities, i.e. true positives, of 30% and 61% was found for hepcidin and ERFE, respectively. For the ABP, the most sensitive marker was Off-hr score ([Hb] (g·L-1) - 60 × √RET%) (P < 0.05) with a maximal sensitivity of ~58% and ~ 9% following donation and reinfusion, respectively. Combining the findings for hepcidin, ERFE and the ABP yielded a sensitivity across all time-points of 83% following reinfusion in BT. Endurance performance increased 24 hours (+6.4%, P < 0.01) and six days following reinfusion (+5.8%, P < 0.01).Conclusions: Hepcidin and ERFE may serve as biomarkers in an anti-doping context following an ergogenic, small-volume blood transfusion.

Preoperative resuscitation strategies in patients with hip fracture (HF) are lacking. We aimed to investigate fluid-responsiveness, peripheral perfusion index (PPI) and blood volume (BV)-status in patients with HF undergoing resuscitation in the preoperative phase.In a prospective observational study, we evaluated preoperative fluid-responsiveness, indices of perfusion and BV before and after lumbar epidural analgesia in 50 patients with HF shortly after admittance.Initially, 18 (36%) patients were fluid-responsive (≥10% increased SV in response to 250 ml fluid bolus) and 13 (26%) presented hypovolaemia (deviation of measured BV from estimated BV ≤ 0.9). According to fluid-responsiveness, no difference in absolute values of cardiac index (CI) (2.7 L [2.1-3.3] vs. 2.8 L [2.3-3.4], p = .5) was seen, but cardiac output (CO) rose significantly in the hypovolaemic patients: 9% [5-18] vs. 1% [-3-7], p = .004. After epidural analgesia, 26 (52%) patients were again fluid-responsive and 15 (30%) were hypovolaemic. CI was now significantly lower in fluid-responsive patients (2.2 L [1.7-2.7] vs. 2.9 L [2.3-3.5], p = .001). Prior to epidural analgesia, no significant trend towards hypovolaemic patients having lower indices of perfusion was seen. After epidural analgesia, more patients with hypovolaemia presented with PPI≤1.5 (8 (53%) vs. 3 (9%), p = .001) and absolute values of PPI were also significantly lower if IBV was low (1.4 [0.9-3.2] vs. 3.2 [2.4-4.8], p = .01). PPI correlated with hypovolaemia after epidural analgesia (rho 0.4 [0.1-0.7], p = .007).Preoperative fluid-responsivity in HF patients might be attributable to elements of hypovolaemia and sympathetic compensatory ability conjointly, confounding the use of SV-guided resuscitation. PPI could be associated with BV, which may support clinicians during perioperative haemodynamic optimisation.

Shale reservoirs are characterized by having low permeability which prevents the fluid components from moving freely in the reservoir. Shale producers therefore often face challenges getting representative fluid samples. This paper shows the composition of fluids in a low permeability reservoir can be estimated using the theory of chemical reaction equilibria, and in some cases can replace the need for a physical sample.It is assumed that chemical equilibrium determines the relative stability of carbon number (CN) fractions in a shale fluid and that the distribution of components can be calculated by solving a reaction equilibrium. Known fluid compositions are used to establish Gibbs’ energy of formation as a function of temperature for each CN fraction across the fluids. Given this trained Composition Estimation Model, only temperature, pressure and GOR (gas-oil ratio) are required to estimate a fluid composition.The method has been tested on US shale fluids. Fluids from the Eagle Ford and Permian Basin fields have been used to train the model, making it possible to predict other Eagle Ford and the Permian Basin shale fluid compositions. The model was also evaluated on a fluid from another tight formation in the Texas area. The fluid samples cover reservoir temperatures between 160-320°F, and the fluid GORs range from 2,400 to 8,200 Scf/Stb and saturation pressures from 3,700 to 5,600 psia.

The present essay is devoted to a discussion and analysis of Dunhuang (敦煌) manuscript P. 3181 which features a meditation text attributed to the Buddhist saint and Chan Buddhist (Chin. chanzong 禪宗) patriarch Bodhidharma (d. c. 530). It is noteworthy because it represents a stage in the development of Chinese Buddhism in which local practitioners of meditation became increasingly influenced by Daoist beliefs and practices. As such, the manuscript under discussion documents the conflation of Chan Buddhism, Buddhist meditation generally conceived, and Daoist practices for the circulation of vital energy of the kind one later encounters in the tradition of internal alchemy (Chin. neidan 內丹). In the course of this presentation, the focus will be on Dunhuang, and how medical beliefs and practices, many of which derived from Daoism, were incorporated into the various systems of belief and practice of local Buddhism.

When it comes to mercury (Hg) there are strict regulation around health, safety and environment, and the level of Hg in discharge water. Further, Hg can potentially compromise the integrity of materials anywhere in the flow path of the produced fluid. Real-time onsite Hg monitoring presents health hazard from exposure to Hg and can also be economically prohibitive. Therefore, it is desirable to be able to reliably simulate Hg partitioning between the vapor, liquid hydrocarbon, and water phases. It is further of interest to evaluate potential Hg condensation when the produced fluid flows from the reservoir through flow lines and passes through process equipment. Commercial compositional reservoir, process and flow simulators employ models with different levels of complexity. It is desirable to be able to make consistent simulations across various simulation platforms using the same equation of state models and model parameters. In this work we present self-contained sets of parameters for use with the original formulations of the Peng-Robinson modification from 1978 and the Soave-Redlich-Kwong equations of state. We aim at using the lowest possible level of complexity of binary interaction parameters. We further give the acentric factors for the original Peng-Robinson equations of state from 1976 giving the same results as when using the Peng-Robinson modification from 1978. The model covers various hydrocarbon components and inorganic gases, H2O, and common hydrate inhibitors. The work is based upon and ties together the experimental and modelling work of others and supplemented with new model parameters where required. We further summarize the accuracy of the model and briefly touch upon how the model extrapolates beyond the limits of data used in this work.

This paper established a transient electric field model of a high-voltage high-frequency (HVHF) transformer based on circuit-field coupling analysis. As the key component of power electronic transformers (PETs), the operating conditions of the HVHF transformer are determined by the converter circuit containing it. To find out the electrical stress withstood by the solid insulation, it is essential to model the transient electric field while considering the circuit model of the converter. The circuit model of the converter and the 3-D transient electric field model based on the finite element method (FEM) are built in ANSYS. The voltage and current waveforms on both primary and secondary sides of the HVHF transformer obtained from the converter model are coupled to the transient electric model as the excitations. Based on the established model, a case study of a 60 kHz HVHF transformer used for the dual active bridge (DAB) converter is investigated, and the electric field characteristics of the insulation are analyzed. The electric field distribution inside and on the surfaces of the insulation is present, and magnitude values of the highest electrical stress inside and on the surfaces of the insulation are identified. The theoretical verification is carried out based on the grid convergence index (GCI) method and it verifies the accuracy of the proposed model. This model could be used to calculate the overvoltage capacity of the HVHF transformers in various power electronics applications and it is an essential step in building the digital twin model of the HVHF transformer.

The steel-concrete interface (SCI) is a complex, multi-phase and multi-scale system. It is widely known to influence the performance and long-term durability of concrete structures. However, a fundamental understanding of its properties and effects on corrosion initiation of embedded reinforcing steel remains elusive. This is attributed to its complicated heterogeneity and time-dependent nature, exacerbated by the lack of suitable techniques for systematic and detailed characterisation. This paper, prepared by members of the RILEM Technical Committee 262-SCI, critically reviews available information regarding current methods (laboratory or field-based) for characterising local properties of the SCI that have been identified as governing factors affecting corrosion initiation. These properties include characteristics of the steel such as mill scale and rust layers, and characteristics of the concrete such as interfacial voids, microstructure and moisture content. We evaluated over twenty methods and summarised their advantages, applications and limitations. The findings show a severe lack of well established, non-destructive techniques that are suitable for direct monitoring of the SCI at a representative scale with sufficiently high resolution (spatial, temporal), particularly for moisture related aspects. Several promising novel techniques with significant potential for further development and application were identified and discussed. Finally, we provide several recommendations for future research needs that are required to advance this critically important topic., Materials and Structures, 55 (4), ISSN:1359-5997, ISSN:0025-5432, ISSN:1871-6873

The pharmaceutical industry is currently implementing new manufacturing principles and modernizing the related processing solutions. A key element in this development is implementation of process analytical technologies (PAT) for measuring product quality in a real-time mode, ideally for a continuously operating processing line. Near-infrared (NIR) spectroscopy is widely used for this purpose, but has limited use for low concentration formulations, due to its inherent detection limit. Light-induced fluorescence (LIF) spectroscopy is a PAT tool that can be used to quantify low concentrations of active pharmaceutical ingredient, and recent development of instrumentation has made it available for in-line applications. In this study, the content of tryptophan in a dynamic powder flow could be measured as low as 0.10 w/w % with LIF spectroscopy with good accuracy of RMSEP = 0.008 w/w %. Both partial least squares regression and support vector machines (SVM) were investigated, but we found SVM to be the better option due to non-linearities between the calibration test and the in-line measurements. With the use of SVM, LIF spectroscopy is a promising candidate for low concentration applications where NIR is not suitable.

Background: Statins and low-dose aspirin have been associated with a reduced breast cancer (BC) incidence, but results are inconsistent. Based on emerging evidence that parity, a protective factor for breast cancer, and these drugs modulate immunity, we hypothesized that the association between drug use and breast cancer risk may differ by parity. Objectives: To assess the associations of statin and low-dose aspirin use with BC incidence according to parity in French and Danish cohorts. Methods: We conducted two cohort studies, using data from the French E3N study and a Danish nationwide population-based cohort, respectively. From E3N, 51,482 women, mean age 65.5 years, were enrolled in 2005 and followed until 2014. Data on parity (here full-term pregnancies), drug use, and incident BC were acquired from questionnaires, a drug reimbursement database, pathology verified self-reports and the national cause-of-death registry, respectively. From nationwide health registries, we included all Danish women free of BC and aged 45 years in 2000-2005 (n=198,575), with follow-up to 2014. Use of the exposure drugs were defined as at least two reimbursements/filled prescriptions. In both cohorts, multivariable-adjusted Cox regression was used to compute hazard ratios (HR) for drug exposure, treated as time-varying lagged variables, and BC risk stratified by parity (0, 1, 2, 3+). Results: In E3N and Denmark, 1,878 and 5,436 incident BC cases occurred in a mean follow-up of 8.5 and 11.5 years, respectively. At the end of follow-up, 35% and 19% of E3N and 16% and 8% of the Danish cohort had been exposed to statins and low-dose aspirin, respectively. In E3N, effect modification was observed between parity and statins, but not low-dose aspirin. For statins, the HRs for use vs no use were 1.29 (0.97-1.72), 1.27 (0.99-1.65), 1.08 (0.91-1.27), and 0.76 (0.61-0.95) among women with 0, 1, 2, and 3+ full-term pregnancies, respectively (p-het=0.005). The corresponding estimates for low-dose aspirin were: 1.17 (0.80-1.71), 0.81 (0.54-1.20), 1.13 (0.90-1.43), and 1.22 (0.93-1.61; p-het=0.6). In contrast, the Danish data did not suggest any effect modification. HRs for use vs no use of statins were 0.82 (0.60-1.13), 1.05 (0.80-1.37), 0.91 (0.75-1.10), and 1.09 (0.83-1.44) among women with parity of 0, 1, 2, and 3+, respectively (p-het=0.3). For low-dose aspirin HRs were: 1.09 (0.75-1.59), 0.79 (0.54-1.15), 1.04 (0.82-1.32), and 0.99 (0.71-1.40; p-het=0.8). Conclusions: We observed effect modification by parity for the association between statins and breast cancer risk in the French but not the Danish cohort. Whether the age difference between the cohorts explains the inconsistent results should be explored. Citation Format: Julie A. Schmidt, Agnès Fournier, Manon Cairat, Aurélie Mailhac, Henrik Sørensen, Marc Gunter, Deirdre Cronin-Fenton. Parity, Use of Statins and Low-dose Aspirin, and Breast Cancer Risk – data from two large cohort studies [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-03-17.

Background Return-to-work (RTW) after breast cancer may be challenging for breast cancer survivors, especially those who experience adverse effects. Neuropathies are common adverse effect of taxane-based chemotherapy. Single nucleotide polymorphisms (SNPs) in genes related to taxane metabolism and transport, neural function, and neural- or DNA-repair may influence the risk of taxane-induced adverse effects, potentially impacting patient recovery and RTW. We examined the association of such SNPs with RTW in premenopausal breast cancer survivors. Methods We used Denmark’s nationwide population-based health registries to ascertain data on premenopausal women aged 18‒55 years diagnosed with non‒distant metastatic breast cancer during 2007‒2011, who were candidates for adjuvant combination chemotherapy including cyclophosphamide and docetaxel. Only women employed at diagnosis were included. We collected archived tumor tissue from nationwide pathology departments and genotyped 26 SNPs in 20 genes using TaqMan assays. For each SNP, we categorized the women as wildtype, homozygote or heterozygote. Follow-up continued from the date of primary surgery to the first of RTW (defined as 4 consecutive weeks of work), recurrence, maternity leave/childbirth, other malignancy, retirement, death, emigration or 25th September 2017. We computed the cumulative incidence of RTW and used Cox regression models to calculate unadjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of RTW. Results We included 1,963 women. Women who were homozygotes for the phase 1 metabolizer CYP3A5 rs776746 (n=15) had lower cumulative incidence of RTW than wildtypes (n=1,600) and heterozygotes (n=249), 7%, 25% and 17% at six months, 57%, 87% and 88% at two years, and 82%, 94% and 94% at end of follow-up, respectively. Compared with wildtypes, CYP3A5 rs776746 homozygotes had delayed RTW throughout follow-up (HR 0-10 years: 0.48, 95% CI: 0.26, 0.86). No other SNPs were associated with RTW. Conclusions Among 26 SNPs, CYP3A5 rs776746 was associated with delayed RTW after breast cancer among premenopausal women. Our findings may help identify women at risk of a poor clinical course, who may benefit from enhanced supportive care during treatment and follow-up. Citation Format: Cathrine Hjorth, Per Damkier, Tore B. Stage, Søren Feddersen, Stephen Hamilton-Dutoit, Bent Ejlertsen, Timothy L. Lash, Henrik Bøggild, Henrik Sørensen, Deirdre Cronin-Fenton. The impact of single nucleotide polymorphisms on return-to-work after taxane-based chemotherapy in breast cancer [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P5-03-11.

Background: The effects of vasoconstriction on cardiac stroke volume (SV) and indices of peripheral and intestinal perfusion are insufficiently described.Methods: In a non-randomized clinical study, 30 patients undergoing elective rectal surgery were exposed to modulation of preload. The primary endpoint was intestinal perfusion (flux), measured by single-point laser Doppler flowmetry. Secondary endpoints were central cardiovascular variables obtained by the LiDCO rapid monitor, the peripheral perfusion index (PPI) derived from the pulse oximetry signal and muscle (StO2) and cerebral oxygenation (ScO2) determined by near-infrared spectroscopy. Results: For the whole cohort (n = 30), administration of Phenylephrine during HUT induced a median [IQR] increase in SV by 22% [14–41], p =.003 and in mean arterial pressure (MAP) by 54% [31–62], p 2 and ScO2 or flux. In patients who were preload dependent during HUT (stroke volume variation; SSV >10%; n = 23), administration of phenylephrine increased SV by 29% [12–43], p =.01 and MAP by 54% [33–63], p p =.05, while PPI, StO2 and ScO2 remained unchanged. For non-preload dependent patients (SSV n = 7), no changes in hemodynamic indices were seen besides an increase in MAP by 54% [33–58], p =.002. Conclusion: The reflection of vasoconstrictive modulation of preload in systemic cardiovascular variables and indices of perfusion was dependent on preload responsiveness. Administration of phenylephrine to increase preload did not appear to compromise organ perfusion.

This piece has partly been written in response to a series of claims put forward by Robert Sharf almost a decade ago in his article Art in the Dark in which he argues that the Buddhist caves in Dunhuang (and elsewhere in China and Central Asia) were not for worship, but were created as a sort of ancestral memorials, or decorated mausoleums meant to be left in the dark. Given that the implications of such reading of Buddhist cave-art in the Sinitic cultural-sphere would surely have a profound impact on our overall understanding of Buddhist ritual practices and cave-art, should Sharf’s readings turn out to be correct, the evidence and speculations he uses as underpinnings for his line of argument in particular merit closer scrutiny. Moreover, as he touches upon a range of other related issues, all of which concern Buddhist ritual practices one way or another, it seems worthwhile to devote a lengthier essay to a more detailed discussion.

To determine whether a severe mesenteric traction syndrome (MTS) leads to increased surgical stress, endothelial dysfunction, and postoperative morbidity in a cohort in which all patients received a single dose of methylprednisolone.Preoperatively administered corticosteroids lower the incidence of severe MTS and may also attenuate surgical stress and endothelial damage associated with the development of severe MTS, ultimately lowering the postoperative morbidity.This exploratory study analyzed prospectively collected data from 45 patients all receiving 125 mg methylprednisolone. No control group was included. The severity of MTS was graded intraoperatively, and postoperative morbidity was assessed blinded. Blood samples for plasma prostacyclin (PGIPatients undergoing either open liver surgery (n = 23) or Whipple's procedure (n = 22) were included. No differences were found in postoperative morbidity between patients developing and not developing severe MTS. Surgery led to significantly increased plasma levels of biomarkers indicative of surgical stress and endothelial damage. Further, patients developing severe MTS had increased levels of PGIThis exploratory study found that surgery was associated with a pro-inflammatory response and damage to the endothelium. However, no differences were found between patients developing severe MTS and patients developing moderate/no MTS in biomarkers of surgical stress, endothelial damage, or postoperative morbidity. Corticosteroids may therefore attenuate the endothelial damage in patients developing severe MTS. However, as this was an exploratory study, these findings must be confirmed in future randomized controlled studies.

The paper describes a fast and approximate 1D simulation algorithm for calculating the percent recovery that can be obtained from an oil reservoir if gas injection is carried out at a pressure lower than the minimum miscibility pressure. The algorithm is based on the Method of Characteristics. While a conventional 1D reservoir simulation of a gas injection scenario may take minutes or even hours, the proposed algorithm allows a full evaluation of the recovery to be completed within seconds. To make the method numerically robust, a number of approximations were needed. The result is an extremely fast algorithm that not only provides a good estimate of the recovery obtained by gas injection, but also gives a good visualization of how the gas displaces the oil.

Large Eddy Simulations (LES) of the flow in repeating arrangements of staggered rectangular winglet pairs are presented to get a better understanding of the detailed flow and heat transfer enhancing mechanisms. Simulations are performed for various geometrical configurations with the winglet height h and longitudinal pitch distance L p being varied in the ranges h / H ∈ [ 0.3 ; 0.7 ] and L p / H ∈ [ 3 ; 7 ] at Re = u b H / ν = 700 and Pr = 0.71 . The results show that three different types of vortices are generated by the winglet pairs: main longitudinal vortices, corner vortices and induced vortices, with the main longitudinal vortices being the main contributor to heat transfer enhancement. It is found that the heat transfer and pressure loss increase with increasing winglet height and decrease with increasing longitudinal pitch distance. The winglet height proves to have the highest impact on both the heat transfer and pressure loss. Furthermore, the results show that local heat transfer can effectively be increased on the fin side by utilising smaller winglet heights. For higher winglet heights local heat transfer is observed to be more equally distributed on both sides. Overall, pressure loss increments f / f 0 between 3.3 and 33.5 and heat transfer enhancements Nu / Nu 0 between 2.2 and 4.6 are found. When introducing the performance factor η = ( Nu / Nu 0 ) / ( f / f 0 ) 1 / 3 as a measure for heat transfer enhancement relative to pressure loss, the optimal geometries generally have a combination of lower winglet heights and higher longitudinal pitch distances.

14 reservoir fluids from the Middle East and Gulf of Mexico were used to investigate whether cubic equations (SRK EoS) are capable of modeling published asphaltene data with and without gas injection or if it requires more complex equations of state. Each fluid had published data for: 1) fluid composition, 2) routine PVT/EOR data, 3) amount of asphaltene (wt% in STO), and 4) asphaltene onset pressure data with and without gas injection. The starting point for the model developments was a reservoir fluid composition. The models were first tuned to match routine and EOR PVT data. For Asphaltene modeling, the heavy components were subsequently split into an asphaltene and a non-asphaltene part. EoS parameters were assigned to the asphaltene components to accurately simulate measured asphaltene onset pressures. The development of an asphaltene model for a selected fluid was also compared between SRK, CPA, and PC-SAFT EoS. This study shows that it is possible to obtain a good match of both PVT data and asphaltene onset pressure data for all 14 fluids with the SRK EoS. Using optimized EoS parameters obtained from this study, a model simulating the asphaltene behavior of a fluid can in most cases be developed by adjusting only the Tc of the asphaltene component to match an asphaltene data point. For fluids with a high asphaltene content, further tuning may still be required, but the optimized parameters provide a very good starting point. A step-by-step guide is provided which shows how to develop a model that gives a good match of asphaltene onset pressure data with the SRK equation. An equally good match could be achieved by the CPA and PC-SAFT equations, but these two more complex equations provided no advantage over the simpler SRK equation and the tuning was found to be more cumbersome.

Objective: To study the occurrence of major congenital abnormalities in offspring of women with type 1 and type 2 diabetes and investigate the association between glycated haemoglobin (HbA1c) and major congenital malformations. Design: Register-based study Population: All singletons born alive from January 1, 2000–December 31, 2015 in the North Denmark and Central Denmark regions of Denmark and their mothers. Methods: We used data from Danish health registers and the LABKA database. Logistic regression models were used to compute crude and adjusted prevalence odds ratios (cORs and aORs) with 95% confidence intervals (CIs) for major congenital malformations overall and for subtypes, by type of maternal pre-existing diabetes and HbA1c levels. Main Outcome Measures: Major congenital malformations (overall and specific subtypes). Results: Among 314,245 infants included, 2,020 (0.64%) had mothers with type 1 diabetes and 498 (0.16%) had mothers with type 2 diabetes. We found an aOR of 2.9 (95% CI: 2.5, 3.5) and 1.9 (95% CI: 1.3; 2.8) for major malformations for type 1 and type 2 diabetes, respectively. The highest occurrence was for major congenital heart diseases. For both type 1 and type 2 diabetes, the prevalence of major congenital malformations increased with higher levels of maternal HbA1c. Mothers with type 1 diabetes had higher risks than those without diabetes irrespective of HbA1c, and women with HbA1c levels ≥9.5% had 8 times the odds of major congenital malformations [aOR 8.7 (95% CI: 5.4; 14.5)]. Conclusions: The prevalence of major congenital malformations progressively increased with poorer glycemic control during pregnancy.

Monitoring cerebral perfusion is important for goal-directed anesthesia. Taking advantage of the supply of the supraorbital region and Glabella from the internal carotid artery (ICA), we evaluated changes in cutaneous blood flow using laser speckle contrast imagining (LSCI) as a potential method for indirect real-time monitoring of cerebral perfusion. Nine patients (8 men, mean age 70 years) underwent eversion carotid endarterectomy under local anesthesia. Cutaneous blood flow of the forehead was monitored using LSCI. During clamping of the common carotid artery (CCA), ipsilateral supraorbital region and Glabellas cutaneous blood flow dropped from 334 ± 135 to 221 ± 109 AU (p = 0.023) (AU: arbitrary flux units) and from 384 ± 151 to 276 ± 107 AU (p = 0.023), respectively, whilst the contralateral supraorbital region cutaneous blood flow remained unchanged. The supraorbital cutaneous blood flow did not change significantly following reperfusion of the external carotid artery (ECA) (221 ± 109 to 281 ± 154 AU; p = 0.175) and ICA (281 ± 154 to 310 ± 184 AU; p = 01). A comparable trend for Glabella followed ECA (276 ± 107 to 342 ± 170 AU; p = 0.404) and ICA (342 ± 170 to 352 ± 191 AU; p = 01) reperfusion. In patients undergoing carotid endarterectomy under local anesthesia, LSCI of the supraorbital and Glabella regions reflected clamping of the CCA but did not distinguish reperfusion of the ICA from that of the ECA.