Computer-assisted surgical planning and intraoperative guidance in fetal surgery: a systematic review

Fetal surgery has become a clinical reality, with interventions for twin-to-twin transfusion syndrome (TTTS) and spina bifida demonstrated to improve outcome. Fetal imaging is evolving, with the use of 3D ultrasound and fetal MRI becoming more common in clinical practise. Medical imaging analysis is also changing, with technology being developed to assist surgeons by creating 3D virtual models that improve understanding of complex anatomy, and prove powerful tools in surgical planning and intraoperative guidance. We introduce the concept of computer-assisted surgical planning, and present the results of a systematic review of image reconstruction for fetal surgical planning that identified six articles using such technology. Indications from other specialities suggest a benefit of surgical planning and guidance to improve outcomes. There is therefore an urgent need to develop fetal-specific technology in order to improve fetal surgical outcome. © 2015 The Authors. Prenatal Diagnosis published by John Wiley & Sons Ltd.     

Rapid and radical amniodrainage in the treatment of severe twin–twin transfusion syndrome†

We have evaluated the role of a rapid and radical method of amniodrainage in the treatment of severe twin–twin transfusion. The outcome of 15 patients with severe twin–twin transfusion for which a amniodrainage was performed by means of a vacuum bottle system was compared with the outcome of 15 patients with a similar condition, matched for gestational age at the time of the initial procedure and drained using a standard procedure. In the study group the amniodrainage ended when no amniotic fluid could be aspirated, whereas the women in the standard group were drained with a syringe system and the fluid was removed until the deepest amniotic fluid pool was <8 cm. At the initial procedure, the mean volume of amniotic fluid drained was significantly (p<0.05) higher (3252 vs 2153 ml) and the length of the procedure significantly (p<0.001) shorter (21 vs 41 min) in the study group than in the standard group. The mean post-procedure amniotic fluid index was significantly (p<0.001) smaller (2.9 vs 7.7 cm) after radical amniodrainage than after the standard amniodrainage. The mean number of procedures was significantly (p<0.001) lower (1.5 vs 5.6) in the study group compared to the standard group. In the study group the mean placental thickness increased significantly (p<0.001) from 9 mm before the procedure to 49 mm after, and the overall perinatal survival rate was 80% and the proportion of pregnancies with at least one survivor was 93%. The present data indicate that early, rapid and radical amniodrainage is an effective and low-cost therapy for severe twin–twin transfusion syndrome. Compared to the standard amniodrainage technique it also appears to reduce the need for multiple procedures. Copyright © 2001 John Wiley & Sons, Ltd.     

Cathode ray tube glass recycling: an example of clean technology.

In this study the use of 'cleaned' end of life (EOL) cathode ray tube (CRT) glass as a raw material in ceramic glazes is described. At present, the recycling and industrial utilization of CRT, a glass material from TV and computer sets, is a subject of intense research with particular regard to the so-called open-loop recycling, namely cycles different from that of the origin. However, the use of CRT glass as a secondary raw material is strictly related to the demand of high-quality raw material. The good preliminary results reached by introducing clean TV and PC monitor panel and cone glass into ceramic glaze formulations pushed research toward the setting-up of a base glaze that is exploitable for the production of pigmented, silk-screened and flame-hardened glazes (products used industrially for coating floor tiles). The aesthetic and chemical characterization of the tiles glazed by this product showed an extremely similar behaviour to originals that did not contain CRT glass. The good technical results achieved have been supported by the life cycle assessment analysis, which has demonstrated a reduction of the environmental impact of the CRT glass-containing ceramic glaze with respect to the standard one.     

Sex-specific effects of parasites on telomere dynamics in a short-lived passerine—the blue tit

The pollination syndrome concept implies that flowers evolved with particular sets of characteristics, such as colors, shapes, orientations, and rewards, as a means of attracting pollinators. However, these traits may have also evolved to deter unwanted visitors. The North American genus Penstemon exhibits a great floral diversity that is mainly associated with bumblebee and hummingbird pollination. Evolutionary shifts from insect pollination to hummingbird pollination have occurred in Penstemon repeatedly, but some species maintain mixed-pollination systems and intermediate floral traits between bee- and hummingbird-pollination modes. The apparently intermediate floral traits of species with mixed-pollination systems might be potentially acting to deter bumblebee foragers. Then, bird-flower traits might be selected with increased hummingbird visitation over evolutionary time might, resulting in specialization to and the evolution of floral traits present in hummingbird-pollinated species. Here, we modified bee-pollination floral traits in Penstemon gentianoides with a mixed pollination system, to resemble hummingbird-pollination traits, and measured the effects of trait modification on bumblebee foraging behavior and plant female reproductive fitness. Our results showed that reduction in the width of the corolla tube and the absence of the corolla lip negatively affects bumblebee visitation and their efficiency as pollinators, and that the synergistic interaction of both traits enhanced the “anti-bee” effect. We conclude that acquisition of floral traits that resemble those of hummingbird-pollination enables Penstemon plant species to deter bumblebee visits.

     

The legal frameworks that govern fetal surgery in the United Kingdom,European Union,and the United States

The specialty of fetal surgery or fetal intervention is one of the most exciting emerging fields of modern medicine. It is made possible by decades of major developments in antenatal imaging, obstetric anaesthesia, fetal medicine, paediatric surgery, and of course by the bold and novel practitioners willing to take new steps to advance the field. Beginning in the 1970s, it has now reached a stage of maturity where there are several established in utero procedures and countless clinical trials and studies to develop more. But what is the legal situation that fetal surgeons find themselves in? What are the rights and legal protections for the fetus and the mother, both of which are arguably the patient? This article will address this question, discussing and summarising the current legal frameworks governing fetal surgery in the jurisdictions of the United Kingdom, European Court of Human Rights, and the United States of America as well as discuss what the future may hold and how researchers and physicians in the specialty can best navigate the legal environment.     

Diurnal vertical migration of an estuarine cladoceran,Podon polyphemoides,in the Chesapeake Bay

Populations of the marine cladoceran Podon polyphemoides (Leuckart) in the Chesapeake Bay (USA) zooplankton typically occur in large patches, extending the length of the estuary. These patches are characterized by well defined maxima, which do not move seaward during a given season. During the day, the bulk of the population is situated in the upper part of the two-layered estuarine circulation, where it is subjected to transport by net non-tidal seaward current. One mechanism for maintaining the population within the estuary is provided by the diurnal behavior of the podonids, which migrate to deeper water during the night. The landward advection of the deeper currents, thus, helps to counterbalance seaward population loss during the day. The extent of the vertical movement of the population can be modified by various environmental factors, but a suggestive correlation with light was found. It is thought that the downward component of the migration is due to passive sinking.