Prenatal diagnosis in multiple gestation: 20 Years' experience with amniocentesis

Three hundred and thirty-nine cases of multiple gestation underwent prenatal diagnosis by amniocentesis. The spontaneous abortion rate (to 28 weeks) in this group was 3.57 per cent compared with our singleton abortion rate of 0.60 per cent. The perinatal mortality rate (PMR) and prematurity rate were not different from the singletons, and compared favourably with the PMR reported in the literature for multiple gestations which did not undergo any intervention during pregnancy. This increased abortion rate following amniocentesis may only represent the increased natural loss rate in multiple gestations, and not indicate any increased risk added by the procedure.     

Prognosis of fetuses with a cystic hygroma

This paper reports our experience with 55 fetuses identified in utero to have a cystic hygroma. The outcome of fetuses with an isolated cystic hygroma, cystic hygroma with non-immune hydrops, and cystic hygroma with multiple anomalies was evaluated. Approximately two-thirds of karyotypes were aneuploid, and a strong association of septation and aneuploidy existed. Only five cases, four of which had isolated hygromas, came to term and resulted in live births. Two of these involved small non-septated lesions which resolved in utero.     

Comparative study of the chemistry and structure of gorgonian and antipatharian coral skeletons

The comparative morphology of the axial skeleton was studied in representatives of 5 reef-dwelling gorgonian families and 2 antipatharian genera by electron and light microscopy. Comparative axial histochemistry, amino acid composition and the physico-chemical character of the protein were also studied. Evidence obtained indicates that collagen is a widespread and prominent structural feature of the gorgonian axial skeleton. Aromatic crosslinkage (sclerotization) also appears to be of widespread, if not universal occurrence in these animals. Sclerotization is equally characteristic of the black coral skeletons studied, but this material does not contain collagen. Its unusual composition, structure, and reactivity is discussed.     

The relationship between demographic/educational parameters and perceptions,knowledge and earthquake mitigation in Israel

Perceptions, knowledge and mitigation are factors that might play a role in preventing injury and loss of life during a major earthquake.² Little is known about the relationships between different demographic and educational parameters and these factors. A national representative sample of 495 adults was investigated in order to determine the relationship between demographic and educational parameters in terms of the perceived threat, perceived coping, knowledge and mitigation of earthquakes in Israel. Compared to females, males perceived the threat of earthquakes to be lower (t=3.183, p=0.002), manifested higher levels of perceived coping (t=2.55, p=0.011), and had higher levels of earthquake related knowledge (t=2.047, p=0.041). We conclude that there are gender differences in perceptions and knowledge regarding earthquakes.     

Cross-sectional survey methods to assess retrospectively mortality in humanitarian emergencies

Since the rates and causes of mortality are critical indicators of the overall health of a population, it is important to evaluate mortality even where no complete vital statistics reporting exists. Such settings include humanitarian emergencies. Experience in cross-sectional survey methods to assess retrospectively crude, age-specific, and maternal mortality in stable settings has been gained over the past 40 years, and methods appropriate to humanitarian emergencies have been developed. In humanitarian emergencies, crude and age-specific mortality can be gauged using methods based on the enumeration of individuals resident in randomly selected households—frequently referred to as a household census. Under-five mortality can also be assessed through a modified prior birth history method in which a representative sample of reproductive-aged women are questioned about dates of child births and deaths. Maternal mortality can be appraised via the initial identification of maternal deaths in the study population and a subsequent investigation to determine the cause of each death.     

The significance of a small, level-3 'semi evacuation' hospital in a terrorist attack in a nearby town

Terrorist attacks can occur in remote areas causing mass-casualty incidents MCIs far away from level-1 trauma centres. This study draws lessons from an MCI pertaining to the management of primary and secondary evacuation and the operational mode practiced. Data was collected from formal debriefings during and after the event, and the medical response, interactions and main outcomes analysed using Disastrous Incidents Systematic Analysis through Components, Interactions and Results (DISAST-CIR) methodology. A total of 112 people were evacuated from the scene-66 to the nearby level 3 Laniado hospital, including the eight critically and severely injured patients. Laniado hospital was instructed to act as an evacuation hospital but the flow of patients ended rapidly and it was decided to admit moderately injured victims. We introduce a novel concept of a 'semi-evacuation hospital'. This mode of operation should be selected for small-scale events in which the evacuation hospital has hospitalization capacity and is not geographically isolated. We suggest that level-3 hospitals in remote areas should be prepared and drilled to work in semi-evacuation mode during MCIs.     

The Mussel Watch concept

The use of bivalves as sentinel organisms for collectives of marine pollutants is evaluated with data from the U.S. Mussel Watch, 1976–1978. The utilization of soft parts and of the shells are compared for metals and plutonium. Finally, the need for a global mussel watch, emphasizing the analyses of chlorinated hydrocarbon biocides in the tropics and southern hemisphere, is presented.     

Noninvasive prenatal screening for patients with high body mass index: Evaluating the impact of a customized whole genome sequencing workflow on sensitivity and residual risk

Objective

Women with high body mass index (BMI) tend to have reduced fetal fraction (FF) during cell-free DNA-based noninvasive prenatal screening (NIPS), causing test failure rates up to 24.3% and prompting guidelines that recommend aneuploidy screening other than NIPS for patients with significant obesity. Because alternatives to NIPS are only preferable if they perform better, we compared the respective sensitivities at different BMI levels of traditional aneuploidy screening and a customized whole-genome sequencing NIPS.

Method

The relationship between FF, aneuploidy, and BMI was quantified from 58 105 patients screened with a customized NIPS that does not fail samples because of low FF alone. Expected analytical sensitivity as a function of aneuploidy and BMI (eg, trisomy 18 sensitivity when BMI = 35) was determined by scaling the BMI- and aneuploidy-specific FF distribution by the FF- and aneuploidy-specific sensitivity calculated from empirically informed simulations.

Results

Across all classes of obesity and assuming zero FF-related test failures, analytical sensitivity for the investigated NIPS exceeded that of traditional aneuploidy screening for trisomies 13, 18, and 21.

Conclusion

Relative to traditional aneuploidy screening, a customized NIPS with high accuracy at low FF and a low test-failure rate is a superior screening option for women with high BMI.