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Objective To examine the potential value of routine measurement of cervical length in singleton low-risk pregnancies at 37 weeks of gestation in the prediction of onset and outcome of labor. of < 20, 21-30, 31-40 and 41-50 mm. In the pregnancies with spontaneous onset of labor the incidence of Cesarean section for failure to progress increased from 3.6% to 6. 0%, 6.4% and 11.8% for cervical lengths of < 20, 21-30, 31-40 and 41-50 mm, respectively Methods

A 29 year old woman with difficult to control acromegaly and a pituitary macroadenoma responded to pegvisomant therapy and subsequently conceived with her first cycle of in-vitro fertilization and intra-cytoplasmic sperm injection. Pregnancy was complicated by gestational diabetes, pituitary gland enlargement and deteriorating visual fields. Conservative management with elective cesarean section was performed at 32 weeks gestation. A healthy boy was delivered who remains developmentally normal at 1 year. This complex case required intricate care by a multidisciplinary team and is likely to represent the first in many cases of assisted conception on pegvisomant therapy for active acromegaly. Keywords Case reportA 29 year old Caucasian woman was diagnosed with acromegaly following a two year history of secondary amenorrhea, change in physical appearance and sweating. The diagnosis was confirmed with an oral glucose tolerance test and radiological imaging that demonstrated a 2.2 cm pituitary tumor compressing the optic chiasm. A bi-temporal visual field defect was confirmed using binocular Goldman perimetry.Over a four-year period, she underwent four transphenoidal hypophysectomies and received 53 Gy radiotherapy. Despite a reduction in tumor size (Fig. 1) and the use of somatostatin analogues, she failed to achieve biochemical cure and her insulin-like growth factor-I (IGF-I) level remained persistently high (96-120 nmol/L; normal range 16-52 nmol/L). Hydrocortisone and thyroxine replacement was required for pituitary deficiency.She was desperate to conceive and was counseled on the effect of pregnancy on acromegaly and the risks of pituitary tumor enlargement. After failing to conceive with clomifene therapy she was referred to the assisted conception unit. Her husband was discovered to be oligoasthenozoospermic and they were counseled for in-vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI).To achieve control of her acromegaly, she was started on daily subcutaneous injections of 20 mg pegvisomant, a highly selective growth hormone receptor (GHR) antagonist, and octreotide was discontinued. Her IGF-I subsequently normalized for the first time in 5 years.Pituitary down regulation was achieved with a GnRH analogue and she required four days of 300 IU recombinant FSH which was increased to 450 IU on day five of stimulation for a further 11 days for super-ovulation. She produced a total of 14 follicles and transvaginal ultrasound-guided oocyte Springer

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Background:The World Health Organization guidelines provide suggestions on early recognition and treatment of severe dengue (SD); however, mortality in this group can be high and is related both to disease severity and the treatment complications.Subjects and Methods:In this prospective observational study, we report our results where standard therapy (ST) was enhanced by Intensive Care Unit (ICU) supportive measures that have proven beneficial in other conditions that share similar pathophysiology of capillary leak and fluid overload. These include early albumin for crystalloid-refractory shock, proactive monitoring for symptomatic abdominal compartment syndrome (ACS), application of a high-risk intubation management protocol, and other therapies. We compared outcomes in a matched retrospective cohort who received ST.Results:We found improved outcomes using these interventions in patients with the most devastating forms of dengue (ST+ group). We could demonstrate decreased positive fluid balance on days 1–3 and less symptomatic ACS that necessitated invasive percutaneous drainage (7.7% in ST+ group vs. 30% in ST group, P = 0.025). Other benefits in ST+ group included lower intubation and positive pressure ventilation requirements (18.4% in ST+ vs. 53.3% in ST, P = 0.003), lower incidence of major hemorrhage and acute kidney injury, and reduced pediatric ICU stays and mortality (2.6% in ST+ group vs. 26% in ST group, P = 0.004).Conclusion:Children with SD with refractory shock are at extremely high mortality risk. We describe the proactive application of several targeted ICU supportive interventions in addition to ST and could show that these interventions resulted in decreased resuscitation morbidity and improved outcomes in SD.

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We have presented in this paper the survey of the parallel machines that are marketed today. The survey includes the latest machines available from Kendell Square Research, Thinking Machines Corporation, MasPar Computer Corporation, NCUBE Corporation, Sequent Computer Systems and Parsytec. We have provided the topology, architecture, cache coherence, synchronization and performance in MFLOPs for each of the machines subject to the availability of information.

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