Birth of twins using in vitro matured oocytes and cryopreserved semen from a male with carcinoma of the penis

Semen cryopreserved from a male prior to treatment for carcinoma of the penis was used for intra-cytoplasmic sperm injection (ICSI) of in vitro matured (IVM) oocytes, resulting in the birth of healthy, non-identical twin girls.     

Long-term follow-up data from the Shunt Design Trial

Background: A previously reported multicenter randomized trial assessed whether 2 new shunt valve designs would reduce shunt failure rates compared to differential pressure valves. The study did not show a significant difference in the time to first shunt failure. Patients entered the trial between October 1, 1993, and October 31, 1995. The primary results were based on the patients' status as of October 31, 1996 (a minimum follow-up of 1 year). This report describes the late complications based on the patients' most recent follow-up. Methods: Three hundred and forty-four hydrocephalic children at 12 North American and European centers were randomized to 1 of 3 valves: a standard differential pressure valve; a Delta valve (PS Medical-Medtronic) or a Sigma valve (NMT Cordis). Patients were followed until their first shunt failure. Shunt failure was defined as shunt surgery for obstruction, overdrainage, loculation or infection. If the shunt did not fail, follow-up was continued until August 31, 1999. Results: One hundred and seventy-seven patients had shunt failure. Shunt obstruction occurred in 131, overdrainage in 13, loculated ventricles in 2 and infection in 29. The overall shunt survival was 62% at 1 year, 52% at 2 years, 46% at 3 years, 41% at 4 years. The survival curves for the 3 valves were similar to those from the original trial and did not show a survival advantage for any particular valve. Conclusions: Prolonged follow-up to date does not alter the primary conclusions of the trial: there does not appear to be one valve that is clearly the best for the initial treatment of pediatric hydrocephalus.     

Substituting warfarin products: what's the source of the problem?

Many clinicians have expressed concerns about the bioequivalence of warfarin products, and data suggest that substituting warfarin products may increase the risk of major bleeding and thromboembolic complications. Anecdotal reports and some retrospective studies have reported differences in anticoagulation control after a warfarin product substitution. But the best available evidence-prospective, randomized, blinded clinical trials-has failed to validate these observations. Indeed, interpatient and intrapatient variability in anticoagulation control observed before and after warfarin product substitution is very similar. So, while differences in product standardization, bioavailability, and bioequivalence make a convenient explanation, the problem lies elsewhere. Perhaps poor communication, fractionated systems of care, and errors are the culprits.     

The accuracy of optical scanning: influence of convergence and die preparation

The purpose of this study was to determine the reliability of the data acquisition and modeling process of laser and white light scanners by evaluating the reproducibility of digitized simulated crowns with different convergences. A secondary purpose was to analyze the influence of die preparation by testing this hypothesis with a set of dies without ditching compared with a set with well-defined margins. Ditching or trimming the die defines the position of the margin and acts as a guide to gingival contour when the restoration is being waxed. Two light scanners (a white light optical scanner [Steinbichler Gmbh, Neubeuern, Germany] and red laser light scanner [TurboDent System, Taichung, Taiwan]) were evaluated. Two sets of simulated crowns were fabricated as cone frustrum models with a total occlusal convergence (TOC) of 0°, 5°, 10°, 15°, 20°, and 25° and a 9-mm base and 3-mm height using a precision milling machine and computer-aided design/computer-aided manufacturing (CAD/CAM) technique. One set of the dies was ditched immediately below the finish line to enhance marginal definition. Each die was optically digitized five times directly with the two different measuring systems. The area of each triangle in the scan that is occlusal to the margin line was calculated and summed to produce the final surface area measurement provided. The digitizing error was compared with the computed surface area of the original master die sets and compared with a paired t-test (df=4; 95% CI). There was no difference in accuracy of the untrimmed dies between the two systems evaluated. We also did not find any difference in the 0° (p=0.12) and 5° degree (p=0.21) groups among the ditched dies. However, when the TOC exceeded 5°, there was a significant difference between the two groups, with the laser groups having a smaller error percentage. Three-dimensional light scanning was not affected by the convergence angle except in the 0°-5° range. Trimming the dies greatly affected the accuracy of scanning.     

Cross-cultural comparison of levels of childbirth-related fear in an Australian and Swedish sample

Background

research, conducted predominately in Scandinavian countries, suggests that a substantial number of women experience high levels of fear concerning childbirth which can impact on birth outcomes, the mother-infant relationship and the ongoing mental health of the mother. The prevalence of childbirth-related fear (CBRF) is not well known outside of the Nordic nations. This study aimed to examine the prevalence of CBRF in two rural populations (Sweden and Australia) and to pilot a short, easy-to-administer measurement tool.

Methods

a questionnaire assessing a range of childbirth-related issues was administered to women in the first trimester across two rural populations in Sweden (n=386) and Australia (n=123). CBRF was measured using the Fear of Birth Scale (FOBS) a two-item visual analogue scale.

Findings

close to 30% of women from the Australian and Swedish samples reported elevated levels of CBRF in the first trimester. A previous negative birth experience and less than positive attitudes to their current pregnancy and birth were predictive of high levels of fear. Swedish women with high levels of fear indicated a preference for caesarean section as the mode of birth in this pregnancy. A higher proportion (19%) of Australian women indicated that they would prefer an elective caesarean section, compared with only 8.8% of the Swedish sample; however, this was not related to high levels of fear. Preference for caesarean section was related to CBRF in the Swedish sample but not in the Australian sample.

Conclusion

the high proportion of women identified with CBRF suggests a need for monitoring of women during pregnancy, particularly those with a previous negative birth experience. The FOBS developed for this study could be used as a screening tool to identify women who require further investigation. Further cross-cultural research is needed to explore the role of fear in women’s preference for caesarean section.