Prognostic accuracy of factors associated with poor outcome in prenatally diagnosed sacrococcygeal teratoma: A systematic review and meta-analysis

Several factors associated with poor outcome in patients with prenatally diagnosed sacrococcygeal teratoma (SCT) have been found. However, the prognostic accuracy of these factors has not been well established. Therefore, we aimed to systematically review the prognostic accuracy of factors associated with poor outcome in these patients. We queried Search Premier, COCHRANE Library, EMCARE, EMBASE, PubMed, ScienceDirect, and Web of Science databases to identify studies regarding patients with prenatally diagnosed SCT. Poor outcome was defined as termination of pregnancy (TOP), intrauterine fetal death (IUFD), or perinatal death. We estimated the odds ratio of factors associated with poor outcome. Eleven studies (447 patients) were included. Overall mortality, including TOP, was 34.9%. Factors associated with poor outcome in fetuses with prenatally diagnosed SCT were cardiomegaly, hypervascular tumor, solid tumor morphology, fetal hydrops, and placentomegaly. A tumor volume to fetal weight ratio (TFR) of >0.12 before a gestational age of 24 weeks is predictive of poor outcome. The prognostic accuracy of factors associated with poor outcome in fetuses prenatally diagnosed with SCT seems promising. Factors associated with cardiac failure such as cardiomegaly, hypervascular tumor, solid tumor morphology, fetal hydrops, placentomegaly, and TFR >0.12 were found to be predictive of poor outcome.     

Perioperative fetal hemodynamic changes in twin-twin transfusion syndrome and neurodevelopmental outcome at two years of age

Objective

To investigate whether perioperative fetal hemodynamic changes in twin-to-twin transfusion syndrome (TTTS) are associated with neurodevelopmental impairment (NDI) at two years.

Methods

Doppler parameters of three sonograms (day before, first day after and 1 week after laser surgery for TTTS) were assessed for correlation with neurodevelopmental outcome at two years (2008-2016). NDI was defined as: cerebral palsy, deafness, blindness, and/or a Bayley-III cognitive/motor developmental test-score > 2SD below the mean.

Results

Long-term outcome was assessed in 492 TTTS survivors. NDI was present in 5% (24/492). After adjustment for severe cerebral injury (present in 4%), associated with NDI were: middle cerebral artery peak systolic velocity (MCA-PSV) >1.5 multiples of the median (MoM) 1 day after surgery (odds ratio [OR] 4.96; 95% confidence interval [CI]: 1.17-21.05, P = .03), a change from normal umbilical artery pulsatility index (UA-PI) presurgery to UA-PI >p95 postsurgery (OR 4.19; 95% CI: 1.04-16.87, P = .04), a change from normal to MCA-PSV >1.5MoM (OR 4.75; 95% CI: 1.43-15.77, P = .01).

Conclusion

Perioperative fetal hemodynamic changes in TTTS pregnancies treated with laser are associated with poor neurodevelopmental outcome. Prospective research on the cerebrovascular response to altered hemodynamic conditions is necessary to further understand the cerebral autoregulatory capacity of the fetus in relation to neurodevelopmental outcome.     

Mammalian community characteristics on surface mine lands in Pennsylvania

Mammalian communities were studied on 10 surface mines over a four year period. The size and composition of these communities varied among the different areas. The size, composition, and spatial distribution of these mammalian communities were related to the structure of the plant community, and native plant species were of greater importance in determining size and composition of these communities than were those used in reclamation.     

Foraminifera as bioindicators in coral reef assessment and monitoring: the FORAM Index. Foraminifera in Reef Assessment and Monitoring

Coral reef communities are threatened worldwide. Resource managers urgently need indicators of the biological condition of reef environments that can relate data acquired through remote-sensing, water-quality and benthic-community monitoring to stress responses in reef organisms. The FORAM (Foraminifera in Reef Assessment and Monitoring) Index (FI) is based on 30 years of research on reef sediments and reef-dwelling larger foraminifers. These shelled protists are ideal indicator organisms because: Foraminifers are widely used as environmental and paleoenvironmental indicators in many contexts; Reef-building, zooxanthellate corals and foraminifers with algal symbionts have similar water-quality requirements; The relatively short life spans of foraminifers as compared with long-lived colonial corals facilitate differentiation between long-term water-quality decline and episodic stress events; Foraminifers are relatively small and abundant, permitting statistically significant sample sizes to be collected quickly and relatively inexpensively, ideally as a component of comprehensive monitoring programs; and Collection of foraminifers has minimal impact on reef resources.USEPA guidelines for ecological indicators are used to evaluate the FI. Data required are foraminiferal assemblages from surface sediments of reef-associated environments. The FI provides resource managers with a simple procedure for determining the suitability of benthic environments for communities dominated by algal symbiotic organisms. The FI can be applied independently, or incorporated into existing or planned monitoring efforts. The simple calculations require limited computer capabilities and therefore can be applied readily to reef-associated environments worldwide. In addition, the foraminiferal shells collected can be subjected to morphometric and geochemical analyses in areas of suspected heavy-metal pollution, and the data sets for the index can be used with other monitoring data in detailed multidimensional assessments.     

Creating sustainable environmental health conditions by redefining municipal roles and responsibilities: experiences from Tunisia and Ecuador

The multiple and interlinked problems that plague most peri-urban communities can only be successfully addressed and resolved if roles and responsibilities of all actors in the urban setting are redistributed. This will require fundamental changes in the way municipalities work and define their accomplishments. Behaviour needs to change at all levels, beginning with public sector institutions responsible for communities. Without changes at the municipal level, requisite changes at the community level to remedy the root causes of environment-related illness, do not occur. Public sector institutions and communities, working as partners with clearly defined roles and responsibilities, and, most importantly, with mutual trust, can together make real progress toward improving health and well-being in peri-urban settlements. This article discusses two recent projects sponsored by the Environmental Health Project of the U.S. Agency for International Development (USAID): an 18-month pilot project to improve peri-urban environmental health in two cities in Tunisia, and a project in Ecuador to support the Ministry of Health in combating cholera in affected provinces. The following examples, methodology, and results may be useful to officials and donor organizations in designing environmental health projects.     

Assessment of contamination and biomarker responses in two species of herons on the St. Lawrence river

This study was undertaken to validate potential biomarkers of exposure and effects due to chemical contaminants in breedingcolonies of the Great Blue Heron and the Black-crowned Night-Heron on the St. Lawrence River. Eggs and fledglings from both species were collected from many colonies along theRiver. The fledglings from colonies in freshwater and brackishwater were more contaminated by mercury and PCBs than those from estuarine and gulf colonies. With respect to fledglings ofthe two heron species, some morphometric and blood biochemicalmeasurements, including plasma thyroid hormones and retinol, were significantly different among colonies. Significant differences were also observed in liver retinoids, EROD and porphyrins among colonies. The results of this study suggestthat plasma retinoids and thyroid hormones are good biomarkersof exposure and effects, and are sufficiently sensitive to reflect local and regional variations in contamination. Along with the measure of contaminants in egg and plasma, they constitute non-invasive biomarkers which represent an importantcriteria for long term monitoring of wildlife species. It is concluded that the Great Blue Heron is an appropriate sentinelspecies in the surveillance network for the St. Lawrence River.     

Infant feeding in emergencies

Recent experience of emergency relief operations in middle-income countries has shown that infant feeding issues can greatly complicate attempts to protect infant health. The two main problems are: how to protect and support breastfeeding in communities where it is no longer the norm and how to assist artificially fed infants without exposing them to the dramatically increased risks associated with artificial feeding under disaster conditions. This article explores the underlying issues and makes a number of recommendations for policy and programmes.