RELATIONSHIP OF CARDIOVASCULAR RISK MARKERS IN CHILDREN SGAAND AGA

INTRODUCTION: Children born preterm usually experience an initial growth restriction, suggested to be caused by the immature organs and an inadequate nutritional intake.After this initial growth faltering, healthy preterm born children, and especially those born after 32 gestational weeks, usually fall back to the reference growth curve, following that of term born babies. For children born SGA, 80 % will experience a relative catch-up growth within the rst 6 months of life. OBJECTIVE: Role of different risk proles for children being born preterm vs being born SGA and early iron supplementation affect later cardiovascular risk RESULT: In Placebo group, 4.6(0.5) patients had Fasting glucose (mmol/L), 2.9(2.3-3.5) patients had Fasting insulin(µU/mL), 0.59(0.4-0.7) patients had HOMA-IR, 4.5(0.7) patients had Cholesterol(mmol/L), 0.58(0.2) patients had Triglyceride(mmol/L), 2.8(0.6) patients had LDL(mmol/L), 1.5(0.3) patients had HDL(mmol/L), 0.63(0.4) patients had ApoB(g/L and 0.20(0.1-0.6) patients had hs-CRP(mg/L). In Iron supplements group, 4.4(0.5) patients had Fasting glucose(mmol/L), 2.7(2.0-3.8) patients had Fasting insulin(µU/mL), 0.54(0.4-0.8) patients had HOMA-IR, 4.3(0.8) patients had Cholesterol(mmol/L), 0.59(0.3) patients had Triglyceride(mmol/L), 2.8(0.6) patients had LDL(mmol/L), 1.5(0.4) patients had HDL(mmol/L), 0.61(0.3) patients had ApoB(g/Land 0.24(0.2-0.8) patients had hs-CRP(mg/L). CONCLUSION: This literature showing that there is progression of these risk factors as children enter early adolescence. Further longer longitudinal studies are needed to elucidate the mechanisms responsible for progression of cardio-metabolic risk factors from infancy to adolescence in SGAand LGAsubjects.

Performance of Cell-Free DNA Screening for Fetal Common Aneuploidies and Sex Chromosomal Abnormalities: A Prospective Study from a Less Developed Autonomous Region in Mainland China

To evaluate the performance of noninvasive prenatal screening (NIPS) in the detection of common aneuploidies in a population-based study, a total of 86,262 single pregnancies referred for NIPS were prospectively recruited. Among 86,193 pregnancies with reportable results, follow-up was successfully conducted in 1160 fetuses reported with a high-risk result by NIPS and 82,511 cases (95.7%) with a low-risk result. The screen-positive rate (SPR) of common aneuploidies and sex chromosome abnormalities (SCAs) provided by NIPS were 0.7% (586/83,671) and 0.6% (505/83,671), respectively. The positive predictive values (PPVs) for Trisomy 21, Trisomy 18, Trisomy 13 and SCAs were calculated as 89.7%, 84.0%, 52.6% and 38.0%, respectively. In addition, less rare chromosomal abnormalities, including copy number variants (CNVs), were detected, compared with those reported by NIPS with higher read-depth. Among these rare abnormalities, only 23.2% (13/56) were confirmed by prenatal diagnosis. In total, four common trisomy cases were found to be false negative, resulting in a rate of 0.48/10,000 (4/83,671). In summary, this study conducted in an underdeveloped region with limited support for the new technology development and lack of cost-effective prenatal testing demonstrates the importance of implementing routine aneuploidy screening in the public sector for providing early detection and precise prognostic information.

Assessment of a laboratory critical risk result notification protocol in a tertiary care hospital and their use in clinical decision making

Introduction: Communication of laboratory critical risk results is essential for patient safety, as it allows early decision making. Our aims were: 1) to retrospectively evaluate the current protocol for telephone notification of critical risk results in terms of rates, efficiency and recipient satisfaction, 2) to assess their use in clinical decision making and 3) to suggest alternative tools for a better assessment of notification protocols. Materials and methods: The biochemical critical risk result notifications reported during 12 months by routine and STAT laboratories in a tertiary care hospital were reviewed. Total number of reports, time for the notification and main magnitudes with critical risk results were calculated. The use of notifications in clinical decision making was assessed by reviewing medical records. Satisfaction with the notification protocol was assessed through an online questionnaire to requesting physicians and nurses. Results: Critical result was yielded by 0.1% of total laboratory tests. Median time for notification was 3.2 min (STAT) and 16.9 min (routine). The magnitudes with a greater number of critical results were glucose and potassium for routine analyses, and troponin, sodium for STAT. Most notifications were not reflected in the medical records. Overall mean satisfaction with the protocol was 4.2/5. Conclusion: The results obtained indicate that the current protocol is appropriate. Nevertheless, there are some limitations that hamper the evaluation of the impact on clinical decision making. Alternatives were proposed for a proper and precise evaluation.

Clinician’s opinion about critical risk results proposed by the Croatian Chamber of Medical Biochemists

Introduction: It has been recommended that each laboratory modify their critical result reporting practices to reflect the clinical needs of their patient populations. The aim of this survey was to assess how well critical laboratory values defined by the Croatian Chamber of Medical Biochemists (CCMB) correspond to the needs of the physicians at University hospital “Sveti Duh” (Zagreb, Croatia). Materials and methods: We conducted a survey among physicians from five departments in our hospital. Physicians were asked general questions about critical risk results (if and how they want to be informed). A list of critical risk results defined by the CCMB was offered and physicians were asked to revise the existing critical risk results and suggest adding new parameters. Obtained data were presented as numbers. Where the number of observations was low, ratios were used. Results: Survey response rate was 43% (52/121). Majority (48/52) wants to be informed of critical risk results, either personally (31/48) or through a colleague (32/48). They prefer to be informed about critical risk results of prothrombin time, platelet count, haemoglobin, glucose, creatinine, sodium and potassium. Revisions in the CCMB critical risk result list are proposed by 13 out of 48 physicians. Neonatologists approved the CCMB’s list. Conclusions: Although most critical risk results defined by the CCMB correspond well to the needs of the physicians in our hospital, some revisions are necessary to meet the particular needs of individual departments. Communication of critical risk results to those who have requested laboratory testing is highly appreciated practice.

Non-invasive Prenatal Testing (NIPT)

Non-invasive prenatal testing (NIPT) is a screening test that can determine if a pregnancy is at high risk for the common aneuploidies by analyzing cell-free fetal DNA in the maternal bloodstream. The screening includes trisomy 21, trisomy 18, and trisomy 13, with the option of screening for sex chromosome aneuploidy and fetal sex. Traditionally this testing is offered to women that are at high risk for these aneuploidies, most commonly women of advanced maternal age. Individuals that receive a high risk result on NIPT should be offered diagnostic testing to confirm the result. New forms of NIPT have recently emerged, however the use of this technology as a screening test for other genetic conditions is not currently recommended by national professional society guidelines. Patients should be counseled and consented for NIPT, as this is an optional screening test. This review contains 2 tables, and 39 references. Keywords: NIPT, non-invasive prenatal testing, aneuploidy, Down syndrome, trisomy 18, trisomy 13, Turner syndrome, microdeletions, diagnostic testing

Study on Shutdown Fire PRA for Nuclear Power Plant

Fire Probabilistic Risk Assessment (PRA) is one of the main methods of fire safety analysis for nuclear power plants (NPPs). At present, the fire PRA under the at-power condition has been widely studied, while the research on the low power and shutdown condition (LPSD) is quite limited. Therefore, in this paper, a second generation NPP on the east coast of China is taken as the research target, and the analysis methods are based on the latest LPSD fire PRA theory in report NUREG/CR-7114. This paper studies the initiating events and ignition frequencies of fire PRA considering the real conditions in LPSD, and established LPSD Fire PRA model, finally obtained the quantitative risk result of the core damage caused by the fire According to the results of this LPSD fire PRA, the fire risk-significant sources and fire risk weakness are found out and the improvement suggestions have been promoted.

An evidence- and risk-based approach to a harmonized laboratory alert list in Australia and New Zealand

Individual laboratories are required to compose an alert list for identifying critical and significant risk results. The high-risk result working party of the Royal College of Pathologists of Australasia (RCPA) and the Australasian Association of Clinical Biochemists (AACB) has developed a risk-based approach for a harmonized alert list for laboratories throughout Australia and New Zealand. The six-step process for alert threshold identification and assessment involves reviewing the literature, rating the available evidence, performing a risk analysis, assessing method transferability, considering workload implications and seeking endorsement from stakeholders. To demonstrate this approach, a worked example for deciding the upper alert threshold for potassium is described. The findings of the worked example are for infants aged 0–6 months, a recommended upper potassium alert threshold of >7.0 mmol/L in serum and >6.5 mmol/L in plasma, and for individuals older than 6 months, a threshold of >6.2 mmol/L in both serum and plasma. Limitations in defining alert thresholds include the lack of well-designed studies that measure the relationship between high-risk results and patient outcomes or the benefits of treatment to prevent harm, and the existence of a wide range of clinical practice guidelines with conflicting decision points at which treatment is required. The risk-based approach described presents a transparent, evidence- and consensus-based methodology that can be used by any laboratory when designing an alert list for local use. The RCPA-AACB harmonized alert list serves as a starter set for further local adaptation or adoption after consultation with clinical users.