Birth defects are associated with multiple modifiable and nonmodifiable risk factors. Obstetrics providers should work with patients to minimize their risk of birth defects if modifiable risk factors are present and to appropriately counsel patients when nonmodifiable risk factors are present.

BackgroundCiliated hepatic foregut cyst (CHFC) is a rare cystic lesion most commonly identified in segment 4 of the liver that arises from the embryonic foregut. The classic histologic pattern is comprised of 4 distinct layers (inner ciliated epithelial lining, smooth muscle, loose connective tissue, fibrous capsule). Although rare, cases of metaplastic and malignant epithelial lining have been described in CHFC.MethodsWe report 6 additional cases of CHFC, one of which had gastric metaplasia of the cyst lining, and review all reported cases of CHFC in the English literature. We describe the clinicopathologic analysis of 6 cases, with selective immunohistochemical analysis on 1 case with gastric metaplasia.ResultsCases occurred in 4 women and 2 men (average age 55 years, range 42 to 67 years). Cysts ranged in size from 0.7 to 17 cm (average 7.2 cm) and were grossly tan-pink to white with blood-filled contents. The majority were located in segment 4 of the liver, however 2 were located in the porta hepatis. Tumor serologies (CA19-9 and/or CEA) were performed in 3 cases; 1 case demonstrated elevated CA19-9, and 2 cases had laboratory values within normal limits. All cases showed the classic histologic findings, however one case additionally had extensive gastric metaplasia.ConclusionsIn conclusion, CHFC is a rare diagnostic entity that should be considered in the differential diagnosis for cystic hepatic lesions, particularly those located in segment 4 of the liver. Metaplasia and squamous carcinoma can occur, therefore complete surgical excision is the recommended treatment.Electronic supplementary materialThe online version of this article (doi:10.1186/s13000-015-0321-1) contains supplementary material, which is available to authorized users.

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A freeze-all strategy is beneficial in high responders but not in intermediate or low responders, thus refuting the idea that freeze-all cycles are preferable for all patients.

Importance The idea that pregnant women suffer from deficits in memory is widespread but poorly documented in obstetrical literature. Objective To review available psychology literature on the subject of cognitive changes in pregnancy in order to guide the prenatal care provider on how to counsel pregnant women. Evidence Acquisition An extensive review of PubMed and PsycINFO databases was conducted to gather and analyze relevant studies on cognitive changes in pregnancy. Results A large body of literature examining basic science and animal studies support the effects of pregnancy hormones in remodeling brain architecture and neural function. However, studies in humans are hampered by small sizes, heterogeneous methodology, and varying definitions of memory. Nevertheless, the consensus among researchers is that pregnancy does confer deficits in working memory relative to nonpregnant controls. Conclusions and Relevance Cognitive effects of pregnancy are likely small, and the impact on daily life is debatable. Further research is needed to determine whether these effects may confer an advantage to parous women comparable to that seen in lower mammals. Target Audience Obstetricians and gynecologists, family physicians. Learning Objectives After reading this article, readers should be better able to explain prior research into the incidence of brain-related changes brought on by pregnancy; identify different types of cognition and memory that may be affected by pregnancy; and anticipate questions and appropriately counsel pregnant patients about concerns regarding cognitive changes.

Congenital heart disease (CHD) occurs in 4-13 per 1000 births in the United States. While many risk factors for CHD have been identified, more than 90% of cases occur in low-risk patients. Guidelines for fetal cardiac screening during the second trimester anatomy ultrasound have been developed by the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) in order to improve antenatal detection rates and to standardize the fetal cardiac screening examination. Patients found to be at increased risk of CHD because of risk factors or an abnormal screening examination should be referred for second trimester fetal echocardiography. Recently, 3D and 4D ultrasound techniques are being utilized to enhance detection rates and to better characterize cardiac lesions, and several first trimester ultrasound screening markers have been proposed to identify patients at increased risk of CHD. However, detection rates have not improved significantly due to limitations such as cost, access, and training that are associated with new technologies and screening methods. The most cost effective way to improve detection rates of CHD may be to standardize screening protocols across practices according to established guidelines and to have a low threshold for referral for fetal echocardiography.

This paper presents a study piloted on highway assets Category 2 defects. Imminent hazards on highway road networks are significantly accelerated by structural deterioration of highway infrastructures. The inspection and maintenance strategy for highway infrastructure requires continuous improvements to reduce high occurrence of defective highway assets. Combined risk-based inspection (RBI) and stochastic (STOC) techniques is considered in this investigation to give an in-depth understanding of highway asset maintenance response. Appropriate data information is extracted from Network Maintenance Management System and complementary information elicited from maintenance experts as well as recommended standards. Safety inspections piloted within the period of 5 years is evaluated using the projected RBI-STOC approach. The RBI incorporates the consequences and likelihood of the defects and the combined STOC techniques utilised defines the actual maintenance interval operated. The RBI-STOC approach proposes reclassification of highway asset defect repair intervals, appropriate maintenance task response and efficient maintenance prioritisation of highway assets in equivalence with contribution to system average mean time to repair and downtime.

Objective: The aim of the study was to review the role of hormone therapy in menopausal patients with breast cancer and gynecologic malignancies. Methods: We searched MEDLINE (via PubMed) using a combination of keywords and database-specific subject headings for the following concepts: menopause, hormone therapy, and cancer. Editorials, letters, case reports, and comments were excluded, as were non-English articles. Additional references were identified by hand-searching bibliographies of included articles. The searches yielded a total of 1,484 citations. All citations were imported into EndNote X9, where they were screened by the authors. Results: In breast cancer survivors, systemic hormone therapy is not recommended, whereas local low-dose estrogen therapy may be considered after discussion with the patient's oncologist. Among endometrial cancer survivors, hormone therapy is considered safe in low-risk cancers but should be avoided in high-risk subtypes. For survivors of epithelial ovarian cancer and cervical cancer, hormone therapy can be considered, but should be avoided in women with estrogen-sensitive histologic subtypes. Conclusions: The risks of hormone therapy should be assessed on an individual basis, with consideration of age, type of hormone therapy, dose, duration of use, regimen, route, and prior exposure. Systemic hormone therapy is not recommended in breast cancer survivors, whereas vaginal low-dose estrogen appears safe. Hormone therapy may be used by endometrial, cervical, and ovarian cancer survivors with low-risk, non-estrogen-receptor–positive subtypes. Video Summary: http://links.lww.com/MENO/A516.