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.     

Costs and carbon emissions for geopolymer pastes in comparison to ordinary portland cement

Geopolymer concrete is seen as a potential alternative to standard concrete, and an opportunity to convert a variety of waste streams into useful by-products. One key driver in geopolymer development is the desire to reduce greenhouse gas emissions from the production of concrete products. This paper presents an examination of the lifecycle cost and carbon impacts of Ordinary Portland Cement (OPC) and geopolymers in an Australian context, with an identification of some key challenges for geopolymer development. The results of the examination show that there is wide variation in the calculated financial and environmental “cost” of geopolymers, which can be beneficial or detrimental depending on the source location, the energy source and the mode of transport. Some case study geopolymer concrete mixes based on typical Australian feedstocks indicate potential for a 44–64% reduction in greenhouse gas emissions while the financial costs are 7% lower to 39% higher compared with OPC.     

Groundwater Remediation via Marcro Porous Polymer Extraction

Akzo Nobel's Macro Porous Polymer Extraction (MPPE) technology effectively removes dissolved hydrocarbons from groundwater via liquid-liquid extraction with an innovative medium. Excellent performance in removal of chlorinated, aromatic, and aliphatic solvents, coupled with simple, robust design, make MPPE an attractive process for groundwater remediation applications. Hydrocarbon-contaminated water is passed through a column packed with MPPE particles. An extraction fluid, immobilized within the polymer matrix, removes the hydrocarbons from the water. All hydrocarbons with affinity for the extraction fluid (compared to water) are removed. Regeneration is accomplished in situ with low-pressure steam. The steam volatilizes the hydrocarbons but not theimmobilized extraction fluid. Volatilized hydrocarbons are condensed and then separated from condensate by gravity. The hydrocarbon product is available for recycle or reuse. MPPE systems achieve removal efficiencies of 99.99 percent for wide varieties and combinations of aliphatic, aromatic, and chlorinated compounds. For a broad range of mass loadings and effluent requirements, especially rigorous ones, the MPPE system offers lower investment and operating costs than traditional water treatment technologies. Currently, 14 industrial units are running or under construction in the United States and Europe. Eight of these are treating groundwater.     

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.