Prognostic factors for residual occult disease in shave margins during partial mastectomy

Breast Cancer Research and Treatment - Shave margins have been shown to decrease positive final margins in partial mastectomy. We investigated prognostic factors associated with residual disease in...     

Fetal Echocardiographic Measurements and the Need for Neonatal Surgical Intervention in Tetralogy of Fallot

Background

This study aimed to evaluate fetal echocardiographic measurements at the time of the first fetal echocardiogram as predictors of neonatal outcome for tetralogy of Fallot (TOF).

Methods

The study reviewed all infants with a prenatal diagnosis of TOF from January 2004 to June 2011. Aortic valve (AoV), pulmonary valve (PV), main pulmonary artery (MPA), left and right pulmonary artery diameters, and ductus arteriosus flow were evaluated on fetal echocardiograms, and associations between the fetal echocardiogram and the neonatal echocardiogram measurements and outcomes were assessed.

Results

The study identified 67 TOF patients who had an initial fetal echocardiogram at a mean gestational age of 25.0 ± 5.2 weeks. Patients with absent PV syndrome or major aortopulmonary collaterals were excluded from the study, as were those without anterograde pulmonary blood flow at the first fetal echocardiogram. Of the remaining 44 patients, 10 were ductal dependent and required neonatal surgery. Infants who were ductal dependent had lower fetal PV (?5.38 ± 2.95 vs. ?3.51 ± 1.66; p < 0.05) and MPA (?3.94 ± 1.66 vs. ?2.87 ± 1.04; p < 0.05) z-scores. A fetal PV z-score of ?5 predicted ductal dependence with 78 % sensitivity and 87 % specificity, and a PV z-score of ?3 showed 100 % sensitivity and 34 % specificity (p < 0.001). Fetuses with a reversed left-to-right flow across the ductus arteriosus (DA) were more likely to be ductal dependent (odds ratio, 25; p < 0.001) than those who had normal ductal flow.

Conclusions

In TOF, fetal PV and MPA z-scores and direction of the DA blood flow predict neonatal ductal dependence. Patients with fetal PV z-scores lower than ?3 or any left-to-right flow at the level of the DA should be admitted to a center where prostaglandin is available.     

Temperature variations recorded during interinstitutional air shipments of laboratory mice

Despite extensive guidelines and regulations that govern most aspects of rodent shipping, few data are available on the physical environment experienced by rodents during shipment. To document the thermal environment experienced by mice during air shipments, we recorded temperatures at 1-min intervals throughout 103 routine interinstitutional shipments originating at our institution. We found that 49.5% of shipments were exposed to high temperatures (greater than 29.4 degrees C), 14.6% to low temperatures (less than 7.2 degrees C), and 61% to temperature variations of 11 degrees C or more. International shipments were more likely than domestic shipments to experience temperature extremes and large variations in temperature. Freight forwarders using passenger airlines rather than their own airplanes were more likely to have shipments that experienced temperature extremes or variations. Temperature variations were most common during stopovers. Some airlines were more likely than others to experience inflight temperature extremes or swings. Most domestic shipments lasted at least 24 h, whereas international shipments lasted 48 to 72 h. Despite exposure to high and low temperatures, animals in all but 1 shipment arrived alive. We suggest that simple measures, such as shipping at night during hot weather, provision of nesting material in shipping crates, and specifying aircraft cargo-hold temperatures that are suitable for rodents, could reduce temperature-induced stress. Measures such as additional training for airport ground crews, as previously recommended by the American Veterinary Medical Association, could further reduce exposure of rodents to extreme ambient temperatures during airport stopovers.