Twins of powerful numbers

Objective To investigate the incidence and distribution of fetal discrepancy during the first trimester in dichorionic twins.Methods This was a prospective analysis of dichorionic twin pregnancies that underwent 11+0～ 13+6 week scan at a tertiary hospital from Sep 2008 to Oct 2010.Differences in crown-rump length (CRL),nuchal translucency ( NT),heart rate ( HR).deepest vertical pockets of amniotic fluid (DVP) for every pair of twin fetuses were calculated and expressed as absolute value and percentage of discordance.Results A total of 66 dichorionic twin pregnancies were included.The average CRL was significantly different between the larger fetus and the smaller one,which were (65.28 ±8.54)mm and (62.34 ± 8.49) mm respectively ( P ＜ 0.001).The average NT was significantly different between two fetuses,which were ( 1.56 ± 0.35) mm and (1.28 ± 0.30) mm respectively. HR and DVP were also statistically different between two fetuses ( P ＜0.001).Conclusions The growth of two fetuses in normal dichorionic twins is not uniform during the first trimester. Key words: Ultrasonography ; Twins,dizygotic ; Pregnancy trimester,first ; Growth discrepancy

Data Assimilation for Marine Ecosystem Models

Objective To analyze the pregnancy outcomes of in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) in infertility patients with adenomyosis aged less than 35 years. Methods Retrospective analysis was performed on the pregnancy outcomes of 2651 patients who underwent IVF/ICSI treatment and obtained clinical pregnancy in Reproductive Medicine Center of Nanjing Drum Tower Hospital from January 2014 to December 2017. Among them, adenomyosis group had 129 cases of adenomyosis with infertility patients; control group had 2522 cases of tubal factor infertility patients. Results 1) There were no significant differences in age, infertility duration, body mass index, number of basal sinus follicle and past reproductive histories between the two groups (P>0.05). 2) In patients undergoing IVF, the spontaneous miscarriage rate in the adenomyosis group was significantly higher than that in control group (13.79% vs. 6.96%, P=0.009). There were no significant differences in gestational age, fetal weight, and preterm delivery rate between the two groups (P>0.05). In patients undergoing ICSI, there were no significant differences in the spontaneous miscarriage rate, gestational age, fetal weight, and preterm delivery rate between the two groups (P>0.05). 3) Single pregnancy group and twin pregnancy group were compared respectively. In single pregnancy patients, the spontaneous miscarriage rate in adenomyosis group was higher than that in control group (12.05% vs. 6.31%, P=0.040). In twin pregnancy patients, gestational weeks of patients in adenomyosis group were significantly less than those in control group [(35.68±3.35) weeks vs. (36.72±1.99) weeks, P=0.002]. There were no significant differences in gestational age in single pregnancy patients between the two groups (P>0.05). There were no statistically significant differences in fetal weight and preterm delivery rates between adenomyosis group and control group, regardless of single or twin pregnancies (P>0.05). 4) In twin pregnancy patients, gestational age and fetal weight were significantly lower than those in single pregnancy patients (P<0.000 1), and preterm birth rate was significantly higher than that in single pregnancy patients (P<0.000 1). Conclusion For infertile patients less than 35 years, adenomyosis significantly increases the risk of IVF spontaneous miscarriage, but does not increase the risk of premature birth and low birth weight. Twin pregnancies significantly increased the risk of IVF/ICSI preterm birth and low birth weight in both adenomyosis and tubal infertility. Key words: Fertilization in vitro; Embryo transfer; Pregnancy outcome; Adenomyosis

To explore the prevalence, number and size of anastomoses, placenta sharing and placental cord insertion in twin-to-twin transfusion syndrome (TTTS). A total of 97 monochorionic placentas were collected from June 2013 to June 2014 during fetoscopic laser surgery or selective feticide. After eliminating 23 placentas of selective intrauterine growth restriction (sIUGR), 79 placents were analyzed. There were 24 placentas of TTTS and 32 placentas of normal monochorionic twins (McT) without complex twin preganancy. Placental sharing, placental cord insertion, angioarchitecture and diameter of vascular anastomosis were assessed by placental injection with colored dye and compared between TTTS and McT without complex twin preganancy. (1) Arterio-arterial (AA) anastomoses were detected in 37.5% of TTTS placentas versus 75.0% in normal McT placentas (P<0.01). (2) The median number of AA anastomoses in TTTS group was significantly less than that in normal group (0.0 vs 1.0, P<0.01). And the median total diameter of AA anastomoses in TTTS group was significantly smaller than that in normal group (0.00 vs 2.25 mm, P<0.01). (3) The incidence of placentas with at least one cord non-central insertion (70.8% vs 62.5%, P>0.05), velamentous insertion (25.0% vs 6.3%, P>0.05) in TTTS and normal McT had no difference respectively. The placental territory discordance (PTD) had no difference between TTTS and normal McT (0.33 vs 0.22, P>0.05). AA anastomosis occurs less frequently in TTTS placentas, supporting the concept of a protective role of AA anastomoses in TTTS. McT placentas without AA anastomosis have high risk for TTTS. The compensatory ablitiy of AA anastomosis may determine the time of TTTS onset. Non-central or velamentous cord insertion, placental sharing discordance are not risk factors for TTTS.

Background. The aim of our study was to analyse the results of ICSI procedure with respect to the number of embryos transferred 3 or 5 days after fertilization. Methods. The outcome of 1498 day 3 embryo transfers and 364 day 5 embryo (blastocyst) transfers was analysed. The percentage of implanted embryos was compared with regard to the number and quality of embryos transferred. Differences in pregnancy rate between the groups were established with the chi-square test. Results. Implantation occurred in 21.3% (320/1498) of embryos transferred to the uterus on day 3 post fertilization. In the transfer of one, two, three or four embryos, the pregnancy rate increased from 20.0% to 22.1%, 54.5% and 59.0% respectively. In the group with one or two embryos for transfer, the pregnancy rate did not change statistically significantly in correlation with embryo quality. The twin pregnancy rate after the transfer of two good quality embryos was 66.6% (8/12). The presence of at least one good quality embryo among three or four embryos transferred had a statistically significant effect on the singleton pregnancy rate (37.8% and 41.3%). The rate of multiple pregnancies remained low (18.1% and 16.6%). Increasing the percentage of good quality embryos for transfer to three or four had a greater effect on the percentage of multiple implantations (43.1% and 54.5%) than on the pregnancy rate (55.5% and 75.8%). After the transfer of 5-day-old embryos (blastocysts), implantation occurred in 37.3% (136/364) of embryos. After the transfer of one blastocyst, the pregnancy rate was 36.2% (21/58), after the transfer of two blastocysts it was 55.7% (98/176). The twin pregnancy rate after the transfer of two blastocysts amounted to 38.7%. Conclusions. The transfer of blastocyst stage embryos results in a statistically significant increase in the success of the ICSI procedure. In the transfer of two blastocysts, the rate of twin pregnancies remains equally high as in the transfer of three good quality embryos on the third post fertilization day.

本文利用EBSD技术研究了高锰钢压缩形变过程中γ→e→α′马氏体相变的晶体学特点,分析了奥氏体孪生与奥氏体晶粒取向对相变的影响.结果表明,由于α′马氏体在2个e变体的交叉处形成,而e相变区域普遍存在奥氏体形变孪晶并且e可在孪晶界上形成,因此孪生对相变起着重要的作用;而孪生的难易受奥氏体取向的影响.分析认为,低指数的{100},{111}和{110}奥氏体内因多变体同时孪生而比高指数取向容易促进e变体间的交叉从而促进α′的形成;形变使e变体数目或新取向增多,但小尺寸的e难以促进α′的形成.

Background: The Success of In-vitro fertilization (IVF) is usually linked with the number of pregnancies per IVF cycle, with less concern on the Indications of Infertility, whether a live healthy infant is born, and the maternal and fetal complications. Method: Cumulative Live Birth Rate was estimated at Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. The study involved 630 patients who received treatment from the years 2000-2008. These patients were followed from the day patients started their cycles until their discontinued the treatment, or delivered their infants and were deemed complication free. The data were analyzed using EXCEL and JMP. Patients’ ages, types of Infertility, body mass index, indications for IVF, number of cycles, ovarian protocols, pregnancies, delivery methods, number and gender of fetus, and complications. Optimistic and Conservative estimates were used. Optimistic estimates assumed that all patients whether they had 2 or more cycles had equal chances at pregnancy as these patients who had more cycles. Conservative estimate assumed that only those who had 3 or more cycles had a chance at getting pregnant. RESULTS: With the 630 patients studied, the ages who came for IVF treatment were widely distributed with a large number of the patients actually being 40 years and older (33.49%). There were surprisingly a large number of them below 35 years (41.43%) and the rest between 35 and 40 years (25.08%). Study of Indications showed that the Male factor (associated with Female factors) is the main cause (31.75%), with Endometrial Affectations (17.31%) and Tubal Ligation or Occlusion (26.19%) also being huge contributors also. The other causes such as Polycystic Ovarian Syndrome (8.73%), Maternal age (4.76%), Adenomyosis (11%) were found to be less of a causes in the study population, but were equally important. Short Ovarian Protocol showed that it had a larger percentage of successful pregnancies (75%), however its outcome was of minimal difference from that of the patients placed under the Long Ovarian Stimulation Protocols (69.35%). Twenty Five percent (25%) of the study population got pregnant, about 70% of them achieved a successful pregnancy. It was found that the mothers with less than 35 years were found to have better results at successful pregnancy (34.38%) than the other age ranges, however the differences were not statistically significant (p=0.2183). Caesarean Delivery being the most frequent (60.56%) followed by Normal Vaginal delivery (43%). The other types were not frequent. The majority of babies born were Singletons (63.16%) however a large number of Twins (36.84%) were born. The Female sex or gender was more frequent however the difference in occurrence between Male (48.70%) and Female gender (51.30%) were not statistically significant. The Maternal and Fetal Complications were no different from Natural birth and delivery. Kaplan Meier Curve shows with 1 or 2 cycles there is a 25% chance of getting pregnant, whereas with 12 to 13 cycles, there is a 70% chance of getting pregnant. The success of pregnancy with 1 or 2 cycles had a little less than 20 % chance of a successful pregnancy, compared to that of 12 to 13 cycles who has a little less than 60%. CONCLUSION: IVF can be used to overcome Infertility in women of different age groups, and Men, offering them a fair chance at pregnancy with limited and similar complications and outcomes as Natural Fertilization Pregnancies.

Objective To investigate the clinical performance of ultrasound screening for fetal structural anomalies at 11-13+6 weeks of gestation and to evaluate the relation of structural anomalies with karyotypes and copy number variations. Methods A retrospective analysis was conducted on fetuses with structural anomalies detected by ultrasound examination at 11-13+6 gestational weeks in First Affiliated Hospital of Sun Yat-Sen University from January 2013 to December 2017. Karyotype and chromosomal microarray analysis(CMA) were offered to these fetuses and ultrasound scans were repeated at 16-18 gestational weeks. All fetuses were followed up to termination or birth. Fisher's exact test was used for statistical analysis. Results A total of 362 fetuses with structural anomalies were studied including 101 (27.9%) fatal malformations, 253 (69.9%) major malformations and eight (0.2%) minor malformations. Cardiac malformation (32.6%, 118/362), central nervous system anomalies (24.9%, 90/362) and anterior abdominal wall defects (20.9%, 76/362) were the three most common abnormalities. Invasive prenatal test was performed in 107 cases including 25 fatal, 79 major and three minor malformations. Thirty (28%) out of the 107 cases had abnormal karyotypes, which were chromosomal aneuploidies (n=28) and chromosomal fragment abnormalities (n=2). Among the 99 cases received CMA, 25 had abnormal karyotypes, and copy number variations were identified in eight [three (4.05%) were pathogenic variations] out of the rest 74 with normal karyotypes. The incidence of chromosomal abnormalities in fetuses with major malformations was higher than that of fetuses with fatal malformation [32.9% (26/79) vs 12.0% (3/25), P=0.045]. Altogether, 117 cases repeated second-trimester ultrasound among which 16 (13.7%) were normal; 19 (16.2%) had cardiac defect which was discordant with the first-trimester evaluation and five (4.2%) were found to have additional malformations. Diagnosis of the other 77 cases were consistent with the first-trimester ultrasound findings. After the second-trimester ultrasound scanning, 49 pregnancies were terminated; 39 twin pregnancies and four triplet pregnancies underwent selective fetal reduction; 25 continued to delivery with good neonatal outcomes. Out of the 23 699 cases without abnormal ultrasound findings at 11-13+6 gestational weeks, 20 182 (85.2%) were successfully followed up, among which structural abnormalities were found in 178 during the second trimester and in 31 after birth. Conclusions A detailed ultrasound examination at 11-13+6 weeks of gestation is important to identify fetal structural defects. However, it could not replace the second-trimester ultrasound. There is a high risk of chromosomal abnormalities in fetuses with early-detected structural defects. CMA is able to identify pathogenic copy number variations with a relatively low detection rate. Key words: Congenital abnormalities; Chromosome aberrations; DNA copy number variations; Microarray analysis

Objective To observe the clinical features of retinopathy of prematurity (ROP) in multiple fetuses. Methods Retrospective clinical study. From December 2009 to June 2018, 758 premature or low-weight multiple fetuses (multiple fetuses group) and 2363 simultaneous single fetuses (single fetuses group) who were admitted to the Department of Ophthalmology and Neonatal Department of Dongguan People’s Hospital and underwent ROP screening were included in the study. Among the multiple pregnancy group, there were 735 twins and 23 triplets; 441 males and 317 females. The mean gestational age was 32.22±2.14 weeks, and the mean body weight was 1.69±0.43 kg. There were 202 of natural births and 556 of cesarean sections. A total of 750 cases have a history of oxygen. Among the singleton group, 1421 were males and 942 were females. The mean gestational age was 32.06±2.52 weeks, and the mean body weight was 1.70±0.46 kg. There were 1146 of natural births and 1217 of cesarean sections. A total of 2333 cases have a history of oxygen. The detection rate of multiple ROP, gestational age, birth weight, sex composition ratio, mode of birth, time of first ROP diagnosis, and severity of ROP were observed. χ2 test was used to compare the rate between groups, and t test was used to compare the mean between groups. Results Among the multiple pregnancy group, there were 68 cases (8.97%) of ROP. Among them, 64 twins (8.71%, 64/735), 4 triplets (17.39%, 4/23). Among the singleton group, there were 187 cases (7.91%) of ROP. With the increase of fetal number, the detection rate of ROP increased, but there was no significant difference (χ2=3.097, P=0.213). There was no significant difference in the detection rate of ROP between multiple fetuses and single fetuses (χ2=0.855, P=0.355). There was no significant difference in sex ratio (χ2=0.069), mode of production (χ2=1.900), birth weight (t=0.139), gestational age (t=-0.478), and time of first ROP diagnosis (t=0.371) between ROP cases of multiple fetuses and single fetuses (P=0.793, 0.168, 0.889, 0.633, 0.371). There was no significant difference in the constituent ratio of severity of ROP lesions between multiple fetuses and single fetuses (χ2=3.003, P=0.223). Conclusion There is no significant difference in ROP incidence, gestational age, birth weight, diagnosis time and severity of ROP between multiple fetuses and single fetuses under the same conditions. Key words: Retinopathy of prematurity; Pregnancy, multiple; Neonatal screening

The urgency of the problem of monochorial multiple pregnancy is due to the significant frequency of development of selective intrauterine growth-restricted (sIUGR) of the fetus. Objective : To evaluate the features of angiogenesis in women with fetal sIUGR during monochorial pregnancy. 46 pregnant women with monochorial diamniotic twins were examined: 21 women with fetal sIUGR and 25 women without gestational complications. It has been established that the implementation of fetal sIUGR in monochorial pregnancy is caused by an imbalance of the main regulators of angiogenesis, endothelial dysfunction and a decrease in the number of endothelial progenitor cells, which leads to a violation of the stabilization and integrity of the vascular endothelium.

The crystal structure of Cu-rich nanophase in reactor pressure vessel(RPV) model steel was investigated by means of HRTEM.EDS and APT methods.RPV model steel was prepared by vacuum induction furnace melting with higher content of Cu(0.6%,mass fraction).The ingot about 40 kg in weight was forged and hot rolled to 4 mm in thickness and then cut to specimens of 40 mm×30 mm.Those specimens were further heat treated by 880℃for 0.5 h water quenching and 660℃for 10 h tempering,and finally aged at 370℃for 6000 h.It was observed that the Cu atoms segregated on {110} planes ofα-Fe matrix in a period every three layers and the distortion of crystal lattice was induced by inner stress produced by the segregation of Cu atoms during the nucleation of the precipitation of Cu-rich nanophase.The inner stress in Cu-rich regions enhanced with the increase of Cu concentration as well as the enlargement in size.It was also observed that the Cu-rich regions underwent a transformation from bcc structure to 9R structure with twins by means of a shear along the {110} plane ofα-Fe matrix.Finally,the Cu-rich clusters transformed to fcc structure with further increase of Cu content.The results obtained by APT analysis show that the equivalent diameter and the number density of Cu-rich clusters are about 1—8 nm and 0.71×10~(23) m~(-3),respectively.The content of 3%—8%Ni and Mn within the Cu-rich clusters was detected.It is suggested that the growth of Cu-rich clusters was restrained by the segregation of Ni and Mn atoms on the boundaries around the Cu-rich clusters.

As the title indicates, the subject-matter of this thesis is the social relations between the Indian immigrants and the host society in the United Kingdom. The Indian immigrants in the United Kingdom which are a part of the social category 'Indians in the United Kingdom' have formed themselves into linguistic-regional communities based on the immigrants' origins in India. This community is the largest group within which all-immigrant relationships are confined. In other words it is a sociological isolate not always consciously recognised by the Immigrants themselves. The immigrants identify themselves emotionally with a smaller sub-group viz. the village-kin group. This is composed of the immigrants who see each other as relatives or as members of their village of origin in India. The closest co-operation in the extra-familial activities exist within this group. The nature and extent of an immigrant's participation or his voluntary exclusion from the activities in which the immigrant enters into relationship with the host society can be fruitfully co-related to his membership of this twin groupings i.e. the Indian community or the village-kin group. In a number of situations of contact with the host society, an individual immigrant uses his membership of the group to derive some positive advantage. The thesis is then concerned with the manner and the situations in which this is done. In the first chapter I have given an account of the field-work and the sociological issues involved in the thesis. In the second chapter I identify the Indian immigrants, through socio-cultural facts which are useful in the latter analysis and also give an account of the structural features of the Indian community. In the third chapter, I describe the settlement of Indians in the United Kingdom and also deal with problems concerning housing, overcrowding and so on. In the next chapter, which is of special importance, deals with work-situation, in which almost all immigrants come into contact with members of the host society. The first part deals with the participation of immigrants in the economic activities of the host society; the second part deals with the exclusive economic activities of the immigrants. The fifth chapter deals with mixed marriages and sex relationships between the immigrants and the members of the host society. The sixth chapter deals with immigrant leadership and the associations through which it functions. The last chapter deals with the conclusions.

epic poet celebrâtes the fame of his heroes in poetry through which he himself aspires to undying fame. Fame, for both hero and poet, defines itself against a number of negatives, from invasion or contamination by which it must work to maintain its integrity. Farne, in the sense of that word in modern English, bona fama, is antithetical to infamy, malafama : both however are the product of the same processes of noising abroad, Publishing, and wagging tongues can as easily badmouth as praise. To win fame is to win a name, but naming is also the most effective way of shaming. Public shame is the reverse of fame, and the fear of shame is a spur to the avoidance of harm to one's good name, or fame. Fame and blame are opposites, but also Siamese twins : praise-poetry and blame-poetry, oratorical \aua.atio and uituperatio, are two sides of the same coin. Fame is also prey to the more sinister forces of envy, which afflicts the justly famous and successful perhaps even more than those who enjoy unmerited success. * Proverbially inuidia is the inevitable concomitant of gloria (or fama).2 Since envy is often provoked specifically by the perception of fame (or glory), rather than of other goods in the possession of the target of envy, the poet is particularly obsessed with envy, for the only good securely possessed by the poet is the fame of his poetry, his words, whose power to endure is threatened once envy takes a hold. The poet himself also runs the risk of being accused of envy in his writings, of ill-founded and malicious backbiting or defamation, as opposed to constructive criticism. Fame and Envy are in competition

As a consequence of the obligations of the Directive Seveso III, there is a need of methods and tools that support industrial managers and the auditors, respectively, to manage and to verify the ageing status of critical equipment. Risk-Based Inspection methods (RBI) are usually used, as well as some other recommended practices (ASME, API or RIMAP). Criticalities are associated with RBI methods as these were born to optimise inspections’ costs by comparing them with safety levels, thus an effort is always necessary to adapt the method in order to manage ageing. This work describes an under-development system that supports industrial managers and auditors in controlling and managing ageing. It can be considered as a virtual sensor, made up by hardware and software. It collects information about process variables (recorded by control systems), external variables, inspection information and other data, then it processes collected information and predicts the numeric value of a performance indicator based on the approach for the ageing assessment, which was developed by an Italian working group on ageing. Based on such an indicator the prediction of the ageing state of the equipment is possible as well as its management based on the levels of industrial risk acceptance. The software is a dynamic model indicating factors that accelerate and those that slow down the degradation processes. The model is expected to build a “digital twin” of a complex plant by using a huge amount of data, which is valuable to understand how the plant will age in the next future.