Intermittent absent and reversed umbilical artery flows in appropriately grown monochorionic diamniotic twins in relation to proximate cord insertion: A harmful combination?

Objective

To compare the prevalence of intermittent absent or reversed end-diastolic flow (iAREDF) in the umbilical artery in appropriately grown monochorionic diamniotic (MCDA) pregnancies with and without proximate cord insertion (PCI), and to evaluate pregnancy outcome.

Methods

The prevalence of iAREDF in MCDA pregnancies with PCI (n = 11) was compared with a control group without PCI (n = 33). PCI was defined as a distance between the cord insertions below the fifth percentile. Placental sharing, number, and diameter of anastomoses were assessed by placental examination. Pregnancy outcome was evaluated.

Results

iAREDF was present in 7/11 PCI pregnancies, compared with 0/33 in the control group (P ≤ .01). All PCI pregnancies and 94% of controls had arterioarterial (AA)-anastomoses (P = .56), the diameter was larger in the PCI group, respectively 3.3 vs 2.1 mm (P = .03). Three cases with iAREDF had adverse outcome, two resulted in fetal death of which one with brain damage in the co-twin, another underwent early premature emergency section for fetal distress.

Conclusion

iAREDF occurs in a large proportion of MCDA pregnancies with PCI and is related to the diameter of the AA anastomosis. We hypothesize that iAREDF in appropriately grown MCDA twin pregnancies reflects an unstable hemodynamic balance with an increased risk for fetal deterioration. Whether outcome in these pregnancies can be improved by altered management requires further investigation.

     

Regional assessment of cadmium pollution in agricultural lands and the potential health risk related to intensive mining activities： A case study in Chenzhou City, China

The purpose of this study was to assess the extent of cadmium （Cd） contamination in agricultural soil and its potential risk for people. Soils, rice, and vegetables from Chenzhou City, Southern China were sampled and analyzed. In the surface soils, the 95% confidence interval for the mean concentration of Cd varied between 2.72 and 4.83 mg/kg （P 〈 0.05） in the survey, with a geometric mean concentration of 1.45 mg/kg. Based on the GIS map, two hot spot areas of Cd in agricultural soils with high Cd concentrations were identified to be located around the Shizhuyuan, Jinshiling, and Yaogangxian mines, and the Baoshan and Huangshaping mines, in the center of the city. About 60% of the total investigated area, where the agricultural soil Cd concentration is above 1 mg/kg, is distributed in a central belt across the region. The critical distances, at which the soil Cd concentration were increased by the mining activities, from the mines of the soils were 23 km for the Baoshan mine, 46 km for the Huangshaping mine, and 63 km for the Shizhuyuan mine, respectively. These are distances calculated from models. The Cd concentrations in rice samples ranged from 0.01 to 4.43 mg/kg and the mean dietary Cd intake from rice for an adult was 191 μg/d. Results of risk indexes showed that soil Cd concentrations possessed risks to local residents whose intake of Cd from rice and vegetables grown in soils in the vicinity of the mine was 596 μg/d.     

Australian bushfire fatalities 1900–2008: exploring trends in relation to the ‘Prepare,stay and defend or leave early’ policy

In many jurisdictions, including parts of the US, authorities often dictate mandatory evacuations of communities threatened by bushfire (wildfire). Prior to the 2009 ‘Black Saturday’ fires in Victoria, Australian fire authorities in all States advised residents to decide whether they would prepare to stay and defend homes or leave early. The clear intent of that policy was to avoid late evacuations and the risks to life that this could entail. This study re-examines evidence underpinning this policy using analyses of a database of bushfire fatalities. The database contains information on 552 civilian (non-fire fighter) fatalities obtained from print media archives at Risk Frontiers and forensic, witness and police statements contained within coronial inquest reports for all bushfire fatalities between 1901 and 2008. This data, compiled before the Black Saturday fires, clearly show the dangers of being caught outside during a bushfire and the gendered division of the circumstances of these deaths. While men have been most often killed outside while attempting to protect assets, most female and child fatalities occurred while sheltering in the house or attempting to flee. The database provides a benchmark against which the Black Saturday experience can be examined.