Selective Restriction Research Articles

Placental differences between uncomplicated and complicated monochorionic diamniotic pregnancies on diffusion and multicompartment Magnetic Resonance Imaging

IntroductionTwin-twin transfusion syndrome (TTTS) and selective fetal growth restriction (sFGR) are common complications in monochorionic diamniotic (MCDA) pregnancies. The Diffusion-rElaxation Combined Imaging for Detailed Placental Evaluation (DECIDE) model, a placental-specific model, separates the T2 values of the fetal and maternal blood from the background tissue and estimates the fetal blood oxygen saturation. This study investigates diffusion and relaxation differences in uncomplicated MCDA pregnancies and MCDA pregnancies complicated by TTTS and sFGR in mid-pregnancy. MethodsThis prospective monocentric cohort study included uncomplicated MCDA pregnancies and pregnancies complicated by TTTS and sFGR. We performed MRI with conventional diffusion-weighted imaging (DWI) and combined relaxometry – DWI-intravoxel incoherent motion. DECIDE analysis was used to quantify different parameters within the placenta related to the fetal, placental, and maternal compartments. ResultsWe included 99 pregnancies, of which 46 were uncomplicated, 12 were complicated by sFGR and 41 by TTTS. Conventional DWI did not find differences between or within cohorts. On DECIDE imaging, fetoplacental oxygen saturation was significantly lower in the smaller member of sFGR (p = 0.07) and in both members of TTTS (p = 0.01 and p = 0.004) compared to the uncomplicated pairs. Additionally, average T2 relaxation time was significantly lower in the smaller twin of the sFGR (p = 0.004) compared to the uncomplicated twins (p = 0.03). ConclusionMulticompartment functional MRI showed significant differences in several MRI parameters between the placenta of uncomplicated MCDA pregnancies and those complicated by sFGR and TTTS in mid-pregnancy.

Outcome following laser surgery of twin-twin transfusion syndrome complicated by selective fetal growth restriction: systematic review and meta-analysis.

The published literature reports mostly on the outcome of twin pregnancies complicated by twin-twin transfusion syndrome (TTTS) without considering whether the pregnancy is also complicated by another pathology, such as selective fetal growth restriction (sFGR). The aim of this systematic review was to report on the outcome of monochorionic diamniotic (MCDA) twin pregnancies undergoing laser surgery for TTTS that were complicated by sFGR and those not complicated by sFGR. MEDLINE, EMBASE and Cochrane databases were searched. The inclusion criteria were studies reporting on MCDA twin pregnancies with TTTS undergoing laser therapy that were complicated by sFGR and those not complicated by sFGR. The primary outcome was the overall fetal loss following laser surgery, defined as miscarriage and intrauterine death. The secondary outcomes included fetal loss within 24 h after laser surgery, survival at birth, preterm birth (PTB) prior to 32 weeks of gestation, PTB prior to 28 weeks, composite neonatal morbidity, neurological and respiratory morbidity, and survival free from neurological impairment. All outcomes were explored in the overall population of twin pregnancies complicated by sFGR vs those not complicated by sFGR in the setting of TTTS and in the donor and recipient twins separately. Random-effects meta-analysis was used to combine data and the results are reported as pooled odds ratios (OR) with 95% CI. Five studies (1710 MCDA twin pregnancies) were included in the qualitative synthesis and four in the meta-analysis. The overall risk of fetal loss after laser surgery was significantly higher in MCDA twin pregnancies with TTTS complicated by sFGR (20.90% vs 14.42%), with a pooled OR of 1.6 (95% CI, 1.3-1.9) (P < 0.001). The risk of fetal loss was significantly higher in MCDA twin pregnancies with TTTS and sFGR for the donor but not for the recipient twin. The rate of live twins was 79.1% (95% CI, 72.6-84.9%) in TTTS pregnancies with sFGR and 85.6% (95% CI, 81.0-89.6%) in those without sFGR (pooled OR, 0.6 (95% CI, 0.5-0.8)) (P < 0.001). There was no significant difference in the risk of PTB prior to 32 weeks of gestation (P = 0.308) or prior to 28 weeks (P = 0.310). Assessment of short- and long-term morbidity was affected by the small number of cases. There was no significant difference in the risk of composite (P = 0.506) or respiratory (P = 0.531) morbidity between twins complicated by TTTS with vs those without sFGR, while the risk of neurological morbidity was significantly higher in those with TTTS and sFGR (pooled OR, 1.8 (95% CI, 1.1-2.9)) (P = 0.034). The risk of neurological morbidity was significantly higher for the donor twin (pooled OR, 2.4 (95% CI, 1.1-5.2)) (P = 0.029) but not for the recipient twin (P = 0.361). Survival free from neurological impairment was observed in 70.8% (95% CI, 45.0-91.0%) of twin pregnancies with TTTS complicated by sFGR and in 75.8% (95% CI, 51.9-93.3%) of those not complicated by sFGR, with no difference between the two groups. sFGR in MCDA pregnancies with TTTS represents an additional risk factor for fetal loss following laser surgery. The findings of this meta-analysis may be useful for individualized risk assessment of twin pregnancy complicated by TTTS and tailored counseling of the parents prior to laser surgery. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Detection of Twin Pregnancies using Fetal Phonocardiogram.

Fetal phonocardiogram (fPCG), or the electronic recording of fetal heart sounds, is a safe and easily available signal that can be used to monitor fetal wellbeing. In the proposed work an attempt is made to identify twin pregnancies using fPCG data recorded from the fetus with 1/3rd power in octave band filtered output as features to train K-Nearest Neighbor (KNN) and support vector machine (SVM) classifiers. The SVM classifier with the quadratic kernel is able to identify singletons and twins with a positive predictive value of 100% and 79.1% respectively. The KNN classifier with k=10 neighbors is able to identify singletons and twins with a positive predictive value of 100% and 81.8% respectively.Clinical Relevance: Identifying twin pregnancies from singleton is an essential clinical protocol followed during late pregnancy as there may be complications like twin-twin transfusion syndrome, selective fetal growth restriction, and preterm labor in twin pregnancy [1], [2]. Ultrasound imaging is the most commonly used technique for twin pregnancy detection, though it is often not affordable or available in rural or low-income populations. Utilization of fPCG in such circumstances has immense clinical potential.

Synonymous sites for accessibility around microRNA binding sites in bacterial spot and speck disease resistance genes of tomato.

The major causes of mass tomato infections in both covered and open ground are agents of bacterial spot and bacterial speck diseases. MicroRNAs (miRNAs) are 16-21 nucleotides in length, non-coding RNAs that inhibit translation and trigger mRNA degradation. MiRNAs play a significant part in plant resistance to abiotic and biotic stresses by mediating gene regulation via post-transcriptional RNA silencing. In this study, we analyzed a collection of bacterial resistance genes of tomato and their binding sites for tomato miRNAs and Pseudomonas syringe pv. tomato miRNAs. Our study found that two genes, bacterial spot disease resistance gene (Bs4) and bacterial speck disease resistance gene (Prf), have a 7mer-m8 perfect seed match with miRNAs. Bs4 was targeted by one tomato miRNA (sly-miR9470-3p) and three Pseudomonas syringe pv. tomato miRNAs (PSTJ4_3p_27246, PSTJ4_3p_27246, and PSTJ4_3p_27246). Again, Prf gene was found to be targeted by two tomato miRNAs namely, sly-miR9469-5p and sly-miR9474-3p. The accessibility of the miRNA-target site and its flanking regions and the relationship between relative synonymous codon usage and tRNAs were compared. Strong access to miRNA targeting regions and decreased rate of translations suggested that miRNAs might be efficient in binding to their particular targets. We also found the existence of rare codons, which suggests that it could enhance miRNA targeting even more. The codon usage pattern analysis of the two genes revealed that both were AT-rich (Bs4 = 63.2%; Prf = 60.8%). We found a low codon usage bias in both genes, suggesting that selective restriction might regulate them. The silencing property of miRNAs would allow researchers to discover the involvement of plant miRNAs in pathogen invasion. However, the efficient validation of direct targets of miRNAs is an urgent need that might be highly beneficial in enhancing plant resistance to multiple pathogenic diseases.

Macronutrients modified dietary intervention in the management of overweight/obese children and adolescents: a systematic review.

The prevalence of obesity in adults and children is rapidly increasing worldwide. Obesity is among the main causes of chronic diseases and various problems, including economic consequences and they can also be affected by genetic, environmental, psychological, and socioeconomic factors. Dietary modification is a well-known and important factor in weight control, in particular, dietary macronutrient composition, food selection, dietary patterns, and energy restriction can affect weight reduction. Therefore, this systematic review aims to provide basic evidence for identifying the optimal macronutrient composition for managing obesity in Korean children and adolescents. We searched literature through an international database, studies were selected using our eligibility criteria and quality was assessed via a risk of bias tool. In our results, several studies have demonstrated that dietary macronutrient modifications affect body composition and metabolic markers in children and adolescents. In contrast, hypocaloric diets, regardless of macronutrient composition, are reportedly effective for weight loss in obese children. However, these findings were based on intervention studies that examined the association between dietary macronutrient composition and obesity in non-Korean children and adolescents. Therefore, in the future, more intervention studies are needed to elucidate this relationship and evidence between macronutrients and obesity in Korean children and adolescents.

Development of the Subject of BE going to in Grammaticalisation from the 1820s to 2010s in Comparison with BE about to

ABSTRACT This study clarifies the relaxation of selectional restrictions imposed on the subject of BE going to in relation to its increase in frequency from the 1820s to the 2010s by analysing the Corpus of Historical American English. To this end, BE about to is also analysed. Whilst the use of BE going to in the passive and there constructions is attested in the early stage of its grammaticalisation towards becoming a semi-auxiliary by previous studies, this study suggests that its use with the pronoun what in subject position was also a sign of an initial stage of grammaticalisation. It will be also shown that subjects composed of grammatical components with simple content appeared earlier than those with content-rich ones. This study also demonstrates that the frequency order of these subjects in current English corresponds to their chronological order of when the earliest token appeared in the corpus.

Subclassification of fetal growth restriction type IIa vs type IIb applied to twin-twin transfusion syndrome

Subclassification of monochorionic twins with selective fetal growth restriction (sFGR) type II into IIa vs. IIb has been proposed due to differing neonatal survival outcomes of the growth-restricted fetus after laser surgery based on preoperative Doppler findings in the middle cerebral artery (MCA) and ductus venosus (DV). There is substantial clinical overlap between sFGR and twin-twin transfusion syndrome (TTTS). To compare donor twin neonatal survival after laser surgery in cases of TTTS with concomitant donor FGR type IIa vs. IIb. This is a retrospective study of monochorionic multifetal gestations treated with laser for Stage III TTTS and concomitant donor twin FGR type II at a referral center from 2006-2021. Donor FGR type II was defined as having an estimated fetal weight (EFW) <10th percentile with persistent absent and/or reversed end diastolic velocity in the umbilical artery. Patients were then subclassified as type IIa (having normal MCA peak systolic velocities [psv] and DV Doppler waveforms) vs. type IIb (having MCA psv ≥1.5 multiples of the median and/or DV with persistent absent or reversed atrial systolic flow). We compared 30-day neonatal survival of the donor twin by FGR type IIa vs. IIb using logistic regression to adjust for relevant preoperative covariates (p<0.10 in bivariate analysis). Of 919 patients who underwent laser surgery for TTTS, 262 had Stage III donor or donor/recipient TTTS; of these, 189 (20.6%) had concomitant donor FGR type II. Twelve met exclusion criteria, yielding 177 patients (19.3%) who comprised the study cohort. Patients were subclassified as donor FGR type IIa (146 [82%]) vs. type IIb (31 [18%]). Donor neonatal survival for FGR type IIa vs. IIb was 71.2% vs. 41.9% (p=0.003). Recipient neonatal survival did not differ between the two types (p=1.000). Patients classified with TTTS and concomitant donor FGR type IIb were 66% less likely to have neonatal survival of the donor after laser surgery (adjusted OR=0.34, 95% CI 0.15-0.80; p=0.0127). The logistic regression model was adjusted for gestational age at the procedure, EFW percent discordance, and nulliparity. The c-statistic was 0.702. For patients with Stage III TTTS and concurrent donor FGR with persistent absent or reversed end diastolic velocity in the umbilical artery (i.e., FGR type II), subclassification into FGR type IIb based on elevated MCA psv and/or abnormal DV flow in the donor conveyed poorer prognosis. Although donor neonatal survival after laser surgery was lower for Stage III TTTS patients with donor FGR type IIb compared with type IIa, laser surgery for FGR type IIb in the setting of TTTS (as opposed to pure sFGR type IIb) still allows for the possibility of dual survivorship and should be offered with shared decision-making when counseling patients on management options.

Fetal Outcomes and Prognostic Factors After Radiofrequency Ablation for the Selective Reduction in Complicated Monochorionic Multiple Pregnancies

Monochorionic pregnancies are responsible for some severe complications, and selective reduction of a single fetus can improve pregnancy outcomes. This study evaluated the fetal outcomes and procedure-related prognostic factors after radiofrequency ablation (RFA) in complicated monochorionic multiple pregnancies. This prospective cross-sectional study was conducted in an academic center from June 2020 to January 2022. The participants were 70 women with monochorionic multiple pregnancies who were candidates for selective fetal reduction by RFA. All participants' demographic data, RFA-related information, and pregnancy outcomes were evaluated and reported. The RFA procedure was successful in all participants. The most frequent RFA indications were twin-to-twin transfusion syndrome following selective intrauterine growth restriction. The mean gestational age at birth was 33.60±5.62 weeks. Also, 11 (15.7%) of the cases had preterm delivery up to 30 days after RFA. The total pregnancy loss rate was 12 (17.14%), and the total fetal survival rate after RFA was 82.85%. The mean time of the RFA procedure was 130.8±83.3seconds.The procedure was conducted easily in 31 (44.2%) cases. Althoughthe meantime of RFA procedure was longer in the not-easy group, the difference in surgery time was not significant (P=.296). There was no significant relationship (P=.623) between RFA indications and the gestational age of the remained fetus at delivery. The RFA needle was passed through the placenta in 18 (25.7%) cases. The mean gestational age at the delivery time was significantly lower in this group compared to their counterparts' gestational ages without needle placental passage (P=.030). Also, there was no significant correlation between gestational age at pregnancy termination and RFA cycles (P=.219). RFA is a relatively safe and minimally invasive procedure for the selective reduction of complicated monochorionic fetuses. Althoughmortality, premature membrane rupture, and preterm delivery are the potential risk factors for the remaining co-twin. According to this study, gestational age at the time of the procedure and passing the needle through the placenta can affect the outcome. Other procedure-related factors like easy- or hard-access procedures, and the number of RFA cycles are not significantly associated with gestational age at birth.

Surveillance of pregnancy outcome of monochorionic twins at Tu Du Hospital

Background: Monochorionic twins are a high risk pregnancy and are associated with special complications that are unique to sharing a placenta and because of the hemodynamic imbalance caused by placental vascular anastomoses. Therefore, the outcome of monochorionic twins is still being researched and reported to looking for the best evidence to perform the optimal interventions.&#x0D; Objectives: To describe the outcome of monochorionic twins to determine the proportion of special complications. Moreover, exploring the rate of fetal death in uterus, premature delivery, the successful vaginal birth in complicated monochorionic twins after bipolar cord coagulation.&#x0D; Materials and Methods: Case series report of monochorionic twins which was managed pregnancy and delivered at Tu Du hospital between January 2018 and January 2019, comprised 166 cases with 81 complicated monochorionic twin pregnancies.&#x0D; Results: The series comprised 85 uncomplicated monochorionic twins (51.2%) and 81 complicated cases (48.8%) with 15% twin-twin transfusion syndrome (TTTS) and 28.3% selective intrauterine growth restriction (sIUGR). Nineteen cases of bipolar cord coagulation perfomed included seven TTTS, eight sIUGR, three cases with serious malformation, and one twin reversed arterial perfusion sequence (TRAP).&#x0D; Conclusions: TTTS and sIUGR are complications unique to monochorionic twins and diagnosed in the early stage after 23 week’s gestation. Bipolar cord coagulation is an effective procedure in complicated monochorionic pregnancies to improve pregnancy outcome.

Risk factors associated with stillbirth and adverse perinatal outcomes in dichorionic twin pregnancies complicated by selective fetal growth restriction: a cohort study.

The main aim of this study was to investigate the perinatal outcomes of dichorionic twin pregnancies complicated by selective fetal growth restriction (sFGR). Retrospective cohort study. Tertiary reference centre. Dichorionic twin pregnancies complicated by sFGR between 2000 and 2019 in St George's University Hospital. Regression analyses were performed using generalised linear models and mixed-effects generalised linear models where appropriate to account for pregnancy level dependency in variables. Time to event analyses were performed with mixed-effects Cox regression models. Stillbirth, neonatal death or neonatal unit admission with morbidity in one or both twins. A total of 102 (of 2431 dichorionic twin pregnancies) pregnancies complicated by sFGR were included in the study. The Cochrane-Armitage test revealed a significant trend for increased adverse perinatal outcome rates with more severe forms of umbilical artery flow impedance, i.e. reversed, absent, positive with resistant flow and positive flow without resistance. A multivariable model including maternal and conception characteristics had poor predictive accuracy for stillbirth (area under the curve: 0.68, 95% confidence interval [CI] 0.55-0.81) and composite adverse perinatal outcomes (area under the curve: 0.58, 95% CI 0.47-0.70). When umbilical artery Doppler parameters were added to the models, the area under the curve values improved to 0.95 (95% CI 0.89-0.99) and 0.83 (95% CI 0.73-0.92) for stillbirth and composite adverse perinatal outcomes, respectively. In dichorionic twin pregnancies complicated by sFGR, the umbilical artery Z-scores were associated with both intrauterine death and adverse perinatal outcomes.

Single fetal demise in monochorionic twins: How to predict cerebral injury in the survivor co-twin?

The aims of the study were to evaluate perinatal outcome in monochorionic (MC) twins complicated with single intrauterine fetal death, spontaneously vs after fetal therapy, and to assess antenatal events that increase the risk of cerebral injury. Historical cohort study of MC pregnancies with single intrauterine fetal death diagnosed or referred to a tertiary referral hospital (2012-2020). Adverse perinatal outcome included termination of pregnancy, perinatal death, abnormal fetal or neonatal neuroimaging and abnormal neurological development. A total of 68 MC pregnancies with single intrauterine fetal death after 14 weeks of gestation were included. Sixty-five (95.6%) occurred in complicated MC pregnancies (twin to twin transfusion syndrome: 35/68 [51.5%]; discordant malformation: 13/68 [19.1%], selective intrauterine growth restriction: 10/68 [14.7%], twin reversed arterial perfusion sequence: 5/68 [7.3%] and cord entanglement in monoamniotic twins: 2/68 [2.94%]). In 52 cases (76.5%) single intrauterine fetal demise occurred after fetal therapy and in 16 (23.5%) occurred spontaneously. Cerebral damage included 14/68 cases (20.6%): 6/68 cases (8.82%) were prenatal lesions and 8/68 cases (11.8%) were postnatal. Risk of cerebral damage tended to be higher in the spontaneous death group (6/16, 37.5%) compared to the therapy-group (8/52, 15.38%) (p = 0.07). The risk increased with gestational age at intrauterine death (OR 1.21, 95% CI: 1.04-1.41, p = 0.014) and was higher in those surviving co-twins who developed anemia (OR 9.27, 95% CI: 1.50-57.12, p = 0.016). Pregnancies complicated with selective intrauterine growth restriction tended to be at higher risk for neurological damage (OR 2.85, 95% CI: 0.68-11.85, p = 0.15). Preterm birth rate (<37 weeks of pregnancy) was 61.7% (37/60). Seven of eight postnatal cerebral lesions (87.5%) were related to extreme prematurity. Overall perinatal survival rate was 88.3% (57/68) and 7% (4/57) of children had an abnormal neurological outcome. Risk of cerebral damage in single intrauterine fetal death is especially high when it occurs spontaneously. Gestational age at single intrauterine fetal death, selective intrauterine growth restriction and anemia of the surviving co-twin are the main predictors for prenatal lesions and might be useful in parent counseling. Abnormal postnatal neurological outcome is closely related to extreme prematurity.

SARS-CoV-2 in low-income countries: the need for sustained genomic surveillance

SARS-CoV-2 in low-income countries: the need for sustained genomic surveillance

The VP in language contact: on creation event lexicalization in Canadian French

Abstract The effects of language contact on semantic and syntactic properties of verbs can be considered as not yet extensively studied. This contribution is concerned with French as a typical verb-framed language that cannot freely combine manner verbs with result-denoting arguments within the VP. Drawing on creation events, the study explores if restrictions can loosen, and lexicalization preferences change when French is in contact to a satellite-framed language like English. Judgment data from bilingual speakers of Canadian French (CaFr) are compared to data from speakers of Hexagonal French (HFr). The analysis addresses how selective copying from English is relevant for the acceptability of different VPs and considers how the factors of individual and social language dominance might influence the judgments within the CaFr group. The results show that French manner verbs and direct objects can be coerced into creation readings in both test groups as long as only the selectional restrictions of a particular verb have to be adapted. When, however, a general constraint of French has to be overridden to arrive at a creation reading, acceptability is higher in the CaFr group, who can resort to combinatorial copying from English. Furthermore, VPs in which manner is not lexicalized in the verb are somewhat more accepted in the HFr group than in the CaFr group. Within the CaFr group, certain cases of satellite framing are judged somewhat better by speakers from an English dominant region, while VPs without a manner verb reach slightly higher scores among speakers from Quebec. It is thus shown how structural and speaker-related factors can affect the acceptability of event descriptions in language contact.

Clinical practice guidelines for the antenatal management of dichorionic diamniotic twin pregnancies: a systematic review

ObjectiveThis review aimed to identify guidelines with recommendations applicable to the antenatal management of dichorionic diamniotic twin pregnancies within high-income countries, appraise their methodological quality, and discuss the similarities and variability across guidelines.MethodA systematic literature review of electronic databases was performed. Manual searches of guideline repositories and websites of professional organisations were performed to identify additional guidelines. The protocol for this systematic review was registered on PROSPERO (CRD42021248586, 25 June 2021). AGREE II and AGREE-REX tools were applied to assess the quality of eligible guidelines. A narrative and thematic synthesis described and compared the guidelines and their recommendations.ResultsTwenty-four guidelines were included, from which 483 recommendations were identified across 4 international organisations and 12 countries. Guidelines addressed eight themes and recommendations were classified accordingly: chorionicity and dating (103 recommendations), fetal growth (105 recommendations), termination of pregnancy (12 recommendations), fetal death (13 recommendations), fetal anomalies (65 recommendations), antenatal care (65 recommendations), preterm labour (56 recommendations) and birth (54 recommendations). Guidelines showed significant variability in recommendations, with conflicting recommendations regarding non-invasive preterm testing, definitions surrounding selective fetal growth restriction, screening for preterm labour and the timing of birth. Guidelines lacked a focus on standard antenatal management of DCDA twins, management of discordant fetal anomaly and single fetal demise.ConclusionsSpecific guidance for dichorionic diamniotic twins is overall indistinct and access to guidance regarding the antenatal management of these pregnancies is currently difficult. Management of discordant fetal anomaly or single fetal demise needs greater consideration.

Management of the smaller twin with impending compromise in twin pregnancies complicated by selective fetal growth restriction: a questionnaire-based study of clinical practice patterns

BackgroundIn twin pregnancies complicated by selective fetal growth restriction (sFGR), if the smaller twin is in the state of impending intra-uterine death (IUD), immediate delivery will reduce the risk of IUD of the smaller twin while exposing the larger twin to iatrogenic preterm birth (PTB). Therefore, the management options would either be to maintain pregnancy for the maturation of the larger twin despite the risk of IUD of the smaller twin or immediate delivery to prevent IUD of the smaller twin. However, the optimal gestational age of management transition from maintaining pregnancy to immediate delivery has not been established. The objective of this study was to evaluate the physician’s perspective on the optimal timing of immediate delivery in twin pregnancies complicated by sFGR.MethodsAn online cross-sectional survey was performed with obstetricians and gynecologists (OBGYN) in South Korea. The questionnaire asked the following: (1) whether participants would maintain or immediately deliver a twin pregnancy complicated by sFGR with signs of impending IUD of the smaller twin; (2) the optimal gestational age of management transition from maintaining pregnancy to immediate delivery in a twin pregnancy with impending IUD of the smaller twin; and (3) the limit of viability and intact survival in general preterm neonates.ResultsA total of 156 OBGYN answered the questionnaires. In a clinical scenario of dichorionic (DC) twin pregnancy complicated by sFGR with signs of impending IUD of the smaller twin, 57.1% of the participants answered that they would immediately deliver the twin pregnancy. However, 90.4% answered that they would immediately deliver the pregnancy in the same scenario for monochorionic (MC) twin pregnancy. The participants designated 30 weeks for DC twin and 28 weeks for MC twin pregnancies as the optimal gestational age of management transition from maintaining pregnancy to immediate delivery. The participants regarded 24 weeks as the limit of viability and 30 weeks as the limit of intact survival in general preterm neonates. The optimal gestational age of management transition for DC twin pregnancy was correlated with the limit of intact survival in general preterm neonates (p < 0.001), but not with the limit of viability. However, the optimal gestational age of management transition for MC twin pregnancy was associated with both the limit of intact survival (p = 0.012) and viability with marginal significance (p = 0.062).ConclusionsParticipants preferred to immediately deliver twin pregnancies complicated by sFGR with impending IUD of the smaller twin at the limit of intact survival (30 weeks) for DC twin pregnancies and at the midway between the limit of intact survival and viability (28 weeks) for MC twin pregnancies. More research is needed to establish guidelines regarding the optimal delivery timing for twin pregnancies complicated by sFGR.

The zero suffix in English and Italian deverbal nouns

AbstractIn this paper we bring evidence from English and Italian deverbal zero nominals (to climb&gt;the climb-ØN) that zero is a possible spell-out of a nominalizer otherwise overtly instantiated in suffixed nominals (examin-ation). We argue in favor of a Distributed Morphology approach, a separationist theory that recognizes and easily implements zero morphology with underlying syntax-semantics. Abstracting away from other theoretical trends and their foundational reasons to refrain from using zero suffixes, we address three properties that have been argued to fundamentally distinguish zero nominals from overtly suffixed nominals, with the implication that they instantiate a different word formation process: i) realization of verbal argument structure, ii) possibility of embedding verbalizing suffixes, and iii) semantic transparency in relation to the verb. By means of corpus data and two manually collected datasets of 561 English and 174 Italian zero nominals based on lexicographic information, we bring solid evidence against these claims, by arguing that: i) a great proportion of zero nominals do realize verbal argument structure, ii) the zero affix may embed verbalizing affixes within the limits of the selectional restrictions it independently imposes on its base, and iii) zero nominals present the same patterns of polysemy that suffixed nominals display. However, we show that zero nominals also present some idiosyncrasies to the extent that not all of them express compositional event readings with argument structure, a matter that deserves further research within the frame of their competition with suffixed nominals.

Rescaffolding the bundle in Afroasiatic inflection

Abstract Person, number and gender features in the Afroasiatic verbal system are sometimes prefixes, sometimes suffixes and sometimes both. This paper attempts to derive the Tamazight and Hebrew systems using syntactic tools and eschewing postsyntactic or morphological linearization rules. My point of departure is that syntactic heads contain a single feature and that features can be assembled into bundles and placed to the left or to the right of a stem by syntactic movement alone. In the simplest case, a feature is prefixal when it is merged above the verbal stem and the verbal stem remains below it and is c-commanded by it and it is a suffix when the verbal stem moves above it. The often-complex combination of prefixes and suffixes in the languages studied arises from the combination of multiple steps of movement which can target the stem alone or a category it pied pipes or is pied piped by. Allomorphy is expressed in terms of selectional restrictions and an alternative to impoverishment is proposed to handle neutralization.

A CsoR family transcriptional regulator, TTHA1953, controls the sulfur oxidation pathway in Thermus thermophilus HB8

Transcription regulation is a critical means by which microorganisms sense and adapt to their environments. Bacteria contain a wide range of highly conserved families of transcription factors that have evolved to regulate diverse sets of genes. It is increasingly apparent that structural similarities between transcription factors do not always equate to analogous transcription regulatory networks. For example, transcription factors within the copper-sensing operon repressor (CsoR)-resistance to cobalt and nickel repressor family have been found to repress a wide range of gene targets, including various metal efflux genes, as well as genes involved in sulfide and formaldehyde detoxification machinery. In this study, we identify the preferred DNA-binding sequence for the CsoR-like protein, TTHA1953, from the model extremophile Thermus thermophilus HB8 using the iterative selection approach, restriction endonuclease, protection, selection, and amplification. By mapping significant DNA motifs to the T.thermophilus HB8 genome, we identify potentially regulated genes that we validate with invitro and invivo methodologies. We establish TTHA1953 as a master regulator of the sulfur oxidation pathway, providing the first link between CsoR-like proteins and Sox regulation.

Analysis of typing conversion and perinatal outcomes in twins with selective intrauterine growth restriction of different subtypes

Objective: To retrospectively analyze the clinical data of different types of selective intrauterine growth restriction (sIUGR) pregnant women under expectant management, including the natural evolution, typing conversion and perinatal outcomes. Methods: The clinical data of 153 pregnant women with sIUGR under expected treatment in Women's Hospital, Zhejiang University School of Medicine from January 2014 to December 2018 were collected. Maternal characteristics including maternal age, gravidity, parity, method of conception, pregnancy complication, gestational age at delivery, indication for delivery, birth weight, the rate of intrauterine and neonatal death and neonatal outcomes were recorded. Pregnant women with sIUGR were divided into three types according to end-diastolic umbilical artery flow Doppler ultrasonography, and the differences of typing conversion and perinatal outcomes of sIUGR pregnant women based on the first diagnosis were compared. Results: (1) Clinical characteristics and pregnancy outcomes: among 153 pregnant women with sIUGR, 100 cases (65.3%) were diagnosed with type Ⅰ, 35 cases (22.9%) with type Ⅱ, and 18 cases (11.8%) with type Ⅲ. There were no significant differences in age, conception mode, pregnancy complications, first diagnosis gestational age, characteristics of umbilical cord insertion, delivery indications, fetal intrauterine mortality and neonatal mortality among three types of sIUGR pregnant women (all P>0.05). The average gestational age at delivery of type Ⅰ sIUGR was (33.5±1.9) weeks, which was significantly later than those of type Ⅱ and Ⅲ [(31.3±1.8), (31.2±1.1) weeks, P<0.001]. The percentage disordance in estimated fetal weight (EFW) of type Ⅰ sIUGR was significantly lower than those of type Ⅱ and type Ⅲ (P<0.001). The incidence rate of neonatal intensive care unit (NICU) admission, cerebral leukomalacia and respiratory complications of both fetus and necrotizing enterocolitis of large fetus in type Ⅰ were significantly lower than those in type Ⅱ and type Ⅲ (all P<0.05). (2) Typing conversion: in 100 cases of type Ⅰ sIUGR, 18 cases progressed to type Ⅱ and 10 cases progressed to type Ⅲ. Compared with 72 stable type Ⅰ sIUGR, those with progressed type Ⅰ sIUGR had higher incidence of NICU admission and lung disease in both fetuses, and cerebral leukomalacia and necrotizing enterocolitis in large fetus (all P<0.05). The proportion of inconsistent cord insertion was significantly higher in those type Ⅰ progressed to type Ⅲ (6/10) than in those with stable type Ⅰ (19.4%, 14/72) and type Ⅰ progressed to type Ⅱ sIUGR [0 (0/18), P=0.001]. Four cases of type Ⅱ sIUGR reversed to type Ⅰ and 6 cases reversed to type Ⅲ. Compared with type Ⅱ reversed to type Ⅰ sIUGR, those stable type Ⅱ and type Ⅱ reversed to type Ⅲ sIUGR had a higher incidence of NICU admission in large fetus (P<0.05). Two cases of type Ⅲ sIUGR reversed to type Ⅰ and 6 cases progressed to type Ⅱ. There were no significant differences in fetal serious complications in type Ⅲ sIUGR with or without doppler changes (all P>0.05). Conclusions: The different types of sIUGR could convert to each other. The frequency of ultrasound examinations should be increased for patients with the type Ⅰ sIUGR, especially when the percentage discordance in EFW is substantial or with discordant cord insersion.

Perioperative Maternal-Fetal Outcomes in the Setting of Minimally Invasive Fetal Therapy for Complex Monochorionic Pregnancies with Monitored Anesthesia Care

Introduction: Fetoscopic selective laser photocoagulation (FSLPC) and selective cord occlusion with radiofrequency ablation (RFA) can improve fetal outcomes when vascular anastomoses between fetuses cause twin-to-twin transfusion syndrome (TTTS) or selective fetal growth restriction (sFGR) in multiple gestation pregnancies with monochorionic placentation. This study analyzed perioperative maternal-fetal complications and anesthetic management in a high-volume fetal therapy center over a 4-year period. Methods: Included patients received MAC for minimally invasive fetal procedures for complex multiple gestation pregnancies between January 1, 2015, and September 20, 2019. Maternal and fetal complications, intraoperative maternal hemodynamics, medication usage, and reasons for conversion to general anesthesia, if applicable, were analyzed. Results: A total of 203 (59%) patients underwent FSLPC and 141 (41%) had RFA. Four patients (2%; rate 95% CI: 0.00039, 0.03901) undergoing FSLPC had conversion to general anesthesia. No conversions to general anesthesia occurred in the RFA group. The incidence of maternal complications was higher in those who underwent FSLPC. No aspiration or postoperative pneumonia events were observed. Medication usage was similar in FSLPC and RFA groups. Conclusion: A low rate of conversion to general anesthesia and no serious adverse maternal events were observed in patients receiving MAC.