The in utero diagnosis and management of alloimmune thrombocytopenia

A case is presented in which percutaneous umbilical sampling (PUBS) was utilized in the second and third trimesters for the diagnosis and management of a pregnancy at risk for neonatal alloimmune thrombocytopenia (NAIT).     

Activities of alkaline phosphatase in first trimester chorion biopsy tissue

We have determined the activity of alkaline phosphatase in chorionic villous tissue obtained in the first trimester of pregnancy, in order to obtain the normal range of values as a prerequisite for application to the prenatal diagnosis of the rare bone disease hypophosphatasia. The activities found were a combination of intestinal and liver/bone/kidney types; traces of placental type were present in only one sample.     

Assessment and management of fetal agenesis of the corpus callosum

Prenatal counselling for fetal agenesis of the corpus callosum is difficult as the prognosis until now has been so uncertain. We have reviewed the current world English literature to provide the best probabilistic information for prospective parents. In total, there are 70 cases where the diagnosis was made prenatally. The diagnosis of apparently isolated agenesis of the corpus callosum (in the absence of other sonographically detectable anomalies) appears to carry an excellent prognosis, with an 85 per cent chance of a normal developmental outcome and a 15 per cent risk of handicap. Fetal karyotyping is recommended as there is a 1 in 10 risk of aneuploidy. If other anomalies are detected prenatally, the outcome is very poor. Termination of pregnancy is advised in these circumstances.     

A survey of diagnostic amniocenteses in Oxford from 1974–1981

A survey was conducted of the results of mid-trimester diagnostic amniocenteses in the Oxford Region from 1974 to 1981. The survey used data relating to all 4357 singleton pregnancies in which an amniocentesis was performed during this period. Follow-up information on outcome was obtained in respect of 4284 (98 per cent) pregnancies. A cell culture to determine karyotype and an alpha-fetoprotein determination was carried out in all cases. From 1974 to 1981 amniocenteses became increasingly common, rising from 2 to 32 per 1000 births. The most common indication for amniocentesis was a high risk of a chromosome abnormality–56 per cent of all amniocenteses. Within this group advanced maternal age was responsible for 89 per cent of the cases. The next most common indication was a high risk of a neural tube defect (37 per cent of all amniocenteses)–in 1974 a raised maternal serum alpha-fetoprotein level accounted for only 4 per cent of these; by 1981 this had risen to 67 per cent. There were seven false-positive and 132 true-positive diagnoses of neural tube defect; since 1981, with the introduction of amniotic fluid acetylocholinesterase determination as a secondary diagnostic test for neural tube defects, there have been no further false-positive diagnoses. In 1981 76 per cent of women aged 35 years or more did not have an amniocentesis. It is not known to what extent this was due to not offering women in this age group amniocentesis or to women not accepting such an offer.     

Factors associated with multiple-pass procedures during chorionic villus sampling: A video analysis

Multiple placental passes during chorionic villus sampling (CVS) increase the risk of fetal loss; however, specific factors that predispose to repeat aspiration have not been delineated. To identify anatomic and technical variables associated with multiple-pass procedures, a detailed review of 205 videotaped CVS procedures (single pass = 163; multiple pass = 42) was performed, blinded to pregnancy outcome. The route of sampling did not influence the need for multiple aspiration attempts (transabdominal—30/ 135; transcervical—12/70), nor was placental location alone discriminatory. However, the combination of a posterior placenta and uterine retroversion was observed more frequently in the multiple-pass cohort (8/42 vs. 9/163; p<0.05). In transabdominal cases, suboptimal needle placement (e.g., perpendicular to the placental long axis) was more common in the initial aspiration of a multiple-pass procedure (21/30 vs. 38/105;p<0.01), while limited penetration of the catheter tip (e.g., just inside the placental edge) characterized a majority of multiple-pass cases in the transcervical subset (7/12 vs. 3/58; p<0.0001). A case-control cohort was constructed to evaluate the impact of these technical variables on sampling efficacy, independent of the influence of uterine position and placental site. In that analysis, suboptimal location and/or orientation of the sampling device remained characteristic of multiple-pass cases. We conclude that further reduction in the frequency of multiple-pass procedures might be achieved by consistent placement of the device tip in the central placental mass. Unlike amniocentesis, where any point of amnion entry will suffice, this technical nuance should be emphasized with CVS to maximize the single-pass success rate.     

Population growth, management and environmental degradation in China

Environmental problems in China can be divided into two large classes: pollution and destruction of natural environment. Environmental degradation is particularly serious in areas with rapid population growth. In this paper, some of China's major environmental problems, particularly those concerned with land, forests, and continental waters are introduced in order to see how population growth and management have affected these resources over the past few decades. It is also explained how the Chinese plan to cope and eventually solve these problems.     

陆地生态系统的恢复--模拟全球变化所引起的酸性输入减少和海盐输入增加的影响

到2010年<哥德堡议定书>正式实施时,欧洲自20世纪70年代末以来已减少的酸化硫和氮释放量将进一步减少.这里我们论述了通过使用应用于3个大型"清洁雨"实验(即分别在挪威里斯达尔谢伊阿[Risdalsheia],瑞典耶德松[Gardsjon]以及丹麦克洛斯特海泽[Klosterhede]的所谓"屋顶实验")的酸化模型MAGIC讨论恢复酸化陆地生态系统的结果.<哥德堡议定书>的实施将启动通过重建盐基饱和恢复上述3处土壤的进程.恢复率较低,在今后30年中,盐基饱和增加不足5%.气候引发的风暴严重性的加剧将增加海盐输入生态系统的量.这将为土壤提供额外的碱阳离子,并使恢复速度翻一番,同时还将随着沉积的碱阳离子与存储在土壤中的酸性交换导致高海盐输入之后的强酸性脉动.因此,酸化集水区土壤和径流的进一步恢复将取决于酸沉积下降的数量和速率,在近岸系统的情况下,还取决于海盐输入事件的频率和强度.     

An Integrated Assessment of Climate Change and the Accelerated Introduction of Advanced Energy Technologies - An Application of MiniCAM 1.0

We report results from the application of an integrated assessment model, MiniCAM 1.0. The model is employed to explore the full range of climate change implications of the successful development of cost effective, advanced, energy technologies. These technologies are shown to have a profound effect on the future magnitude and rate of anthropogenic climate change. We find that the introduction of assumptions developed by a group of ‘bottom-up’ modelers for the LEESS scenarios into a ‘top-down’ model, the Edmonds-Reilly-Barns Model, leads to ‘top down’ emissions trajectories similar to those of the LEESS. The cumulative effect of advanced energy technologies is to reduce annual emissions from fossil fuel use to levels which stabilize atmospheric concentrations below 550 ppmv. While all energy technologies play roles, the introduction of advanced biomass energy production technology is particularly important. The consideration of all greenhouse related anthropogenic emissions, and in particular sulfur dioxide, is found to be important. We find that the consideration of sulfur dioxide emissions coupled to rapid reductions in carbon dioxide emissions leads to higher global mean temperatures prior to 2050 than in the reference case. This result is due to the short-term cooling impact of sulfate aerosols, which dominates the long-term warming impact of CO₂ and CH₄ in the years prior to 2050. We also show that damage calculations which use only mean global temperature and income may be underestimating damages by up to a factor of five. Disaggregating income reduces this to a factor of two, still a major error. Finally, the role of the discount rate is shown to be extraordinarily important to technology preference.