Treatment Of Twins Research Articles

Twins as a Minority: A Minority Building Perspective

Not all numerical minorities classify as ‘minorities’ in any political or legal sense, even when they possess easily definable biological or social characteristics. Twins are an example of such a group. The article discusses minorities as the result of minority building, i.e., a process through which some specific human characteristic becomes the basis of group identity, networking, mobilization, and claims on rights and recognition. It presents some of the existing discourse and research on twins as a biological and social category. Subsequent sections inspect twins’ potential claims and mobilization. Many of the claims refer to our culture’s treatment of twins as one social unit, and to the assumption of a ‘special bond’ between them. Although probably not a biological reality, it is a strong social reality with effect on twins’ lives. The idea of the ‘special bond’ conflicts with the prevailing Western discourse on individual personhood and agency. Not unlike other such efforts, a possible twins’ activism would need to find a balance between essentialist and constructionist definitions of the group. The essentialist discourse is part of the claimed problem, but at the same time, it may be necessary in order to legitimate the minority’s claim for recognition. Twins are hardly a repressed minority, but there are specific situations in which they could claim for recognition and more sensitivity.

Antenatal Corticosteroids and Neonatal Outcomes in Twins: A Systematic Review and Meta-analysis.

To assess whether antenatal corticosteroid treatment is associated with improved neonatal outcomes in twins. We searched MEDLINE, PubMed, EMBASE, and the Cochrane Library, from inception through August 12, 2021. We did not search ClinicalTrials.gov because our inclusion criteria were restricted to nonrandomized studies. Records (n=7,802) were screened in Rayyan by two independent reviewers. We included all nonrandomized studies that compared antenatal corticosteroid treatment with no treatment in twins. Our outcomes of interest were neonatal mortality, respiratory distress syndrome (RDS), intraventricular hemorrhage, bronchopulmonary dysplasia, necrotizing enterocolitis, periventricular leukomalacia, and retinopathy of prematurity. We used the ROBINS-I tool (Risk Of Bias In Non-randomised Studies - of Interventions) to assess risk of bias. We performed random-effects meta-analyses of estimates from studies without critical risk of bias due to confounding, and reported summary adjusted odds ratios (aORs) and 95% CIs. Eighteen cohort studies (that reported on 33,152 neonates) met inclusion criteria. Sixteen studies restricted to preterm gestational ages, and 11 defined exposed neonates based on an optimal corticosteroid administration-to-birth interval. Limitations due to confounding and selection bias were common concerns for the risk-of-bias assessments (n=14 at critical or higher), and 11 studies did not account for clustering within twin pairs in their analyses. All included studies had at least moderate risk of bias. Meta-analysis showed that antenatal corticosteroid administration was associated with lower odds of neonatal mortality (aOR 0.59, 95% CI 0.43-0.80, I2 69%, five studies, 20,312 neonates) and RDS (aOR 0.70, 95% CI 0.57-0.86, I2 67%, seven studies, 20,628 neonates) in twins. Results were inconclusive for the other outcomes. Evidence from nonrandomized studies suggests antenatal corticosteroids are associated with lower incidence of neonatal mortality and RDS in twins. PROSPERO, CRD42020205302.

Antenatal Corticosteroids and Outcomes in Preterm Twins.

To estimate whether improvement in outcomes from antenatal corticosteroid treatment in extremely and very preterm twins is similar to that observed in singletons, and to investigate whether antenatal corticosteroid treatment has different effects according to chorionicity or birth order. This population-based study was based on an analysis of data collected by the Neonatal Research Network of Japan from 2003 to 2015 of neonates weighing 1,500 g or less at birth, from gestational ages of 24 0/7 to 31 6/7 weeks of gestation. After propensity score matching, univariate logistic and interaction analyses were performed to compare short-term (neonatal period) and medium-term (3 years of age) outcomes of the children of mothers who received antenatal corticosteroids with those of children of mothers who did not receive antenatal corticosteroids. We focused on differences between singletons and twins, between monochorionic and dichorionic twins and between the first and second twin. The study comprised 23,502 singletons and 6,546 twins. Antenatal corticosteroid treatment was associated with significant decreased short-term neurologic outcomes in both singletons and twins. However, antenatal corticosteroid treatment was associated with significantly decreased mortality (odds ratio [OR] 0.61; 95% CI 0.53-0.70), respiratory distress syndrome (OR 0.71, 95% CI 0.67-0.76), and cerebral palsy (OR 0.85, 95% CI 0.72-0.99) in singletons but not in twins (OR 0.89, 95% CI 0.68-1.17; OR 0.99, 95% CI 0.87-1.12; and OR 0.82, 95% CI 0.61-1.11, respectively). No association was found between chorionicity and the efficacy of antenatal corticosteroid treatment on outcomes. Further, no association was found between birth order and the efficacy of antenatal corticosteroid treatment on outcomes, except for periventricular leukomalacia and necrotizing enterocolitis (interaction: P=.02 and P=.04, respectively). Antenatal corticosteroid treatment in twins was associated with a beneficial effect on short-term neurologic outcomes only, without improvement in other short-term and medium-term outcomes. There was no difference related to chorionicity.

OC22.02: Contribution of the Solomon technique in the treatment of Twin–twin transfusion syndrome: a single centre experience

OC22.02: Contribution of the Solomon technique in the treatment of Twin–twin transfusion syndrome: a single centre experience

EP21.15: Treatment of Twin–twin transfusion syndrome with selective laser ablation

EP21.15: Treatment of Twin–twin transfusion syndrome with selective laser ablation

Molecular Structure and Crystal Packing of n-Type Semiconducting Material 3′,3′-(1,4-Phenylene)bis{2′-(4′′-trifluoromethyl)phenyl}acrylonitrile

The exact molecular structure and the crystal packing of the n-type semiconducting material 3′,3′-(1,4-phenylene)bis{2′-(4′′-trifluoromethyl)phenyl}acrylonitrile was determined by a single crystal X-ray diffraction with twin treatment technique. The air-stable product was crystallized from dichloromethane-hexane mixed solution. The solid-state structure is the example of a typical π-π stacking with side intermolecular CN–H short contact networks.

130: Disparity in post-treatment maternal circulating magnesium sulfate levels between twin and singleton gestation: Is this the missing link between plurality and adverse outcome?

130: Disparity in post-treatment maternal circulating magnesium sulfate levels between twin and singleton gestation: Is this the missing link between plurality and adverse outcome?

Treatment of twin–twin transfusion syndrome

Twin–twin transfusion syndrome is characterized by unequal blood exchange from the donor twin to the recipient co-twin through placental vascular anastomoses. Treatment of twin–twin transfusion syndrome consists of serial amnioreduction, septostomy, laser photocoagulation of placental vessels and umbilical cord occlusion of the apparently sick twin. Amnioreduction reduces maternal discomfort due to polyhydramnios and improves fetal circulation by reducing amniotic fluid pressure on the placenta. Septostomy equalizes amniotic fluid pressure between the two gestational sacs. Laser therapy interrupts intertwin blood shunting and restores two independent circulations. Umbilical cord occlusion is offered when signs of imminent death are present, such as hydrops and cardiac failure. Laser therapy is associated with increased neonatal survival rates and lower risk of adverse outcomes compared with other treatments.

Use of embryo transfer seven days after artificial insemination or transferring identical demi-embryos to increase twinning in beef cattle1

Our objectives were to determine pregnancy rate, fetal loss, and number of calves born in beef cattle after a fixed-time transfer of an embryo 7 d after a fixed-time artificial insemination (TAI) of cows (Exp. 1) and after transfer of 2 demi-embryos into a single heifer recipient (Exp. 2). In Exp. 1 after synchronization of ovulation, during 2 yr, 297 suckled beef cows were assigned randomly to 1 of 3 treatments: 1) on d 2 cows received a single TAI (TAI-2; n = 99), 2) a fixed-time direct transfer, frozen and thawed embryo placed in the uterine horn ipsilateral to the ovary containing a corpus luteum (CL) on d 9 embryo transfer (ET-9; n = 99), or 3) cows received TAI on d 2 and a frozen and thawed direct transfer embryo placed in the uterine horn ipsilateral to the ovary containing a CL on d 9 (TWIN) treatments (n = 99). Fetal number and viability were determined with ultrasonography at 33 to 35 d and 90 to 100 d after insemination. In Exp. 2, 74 crossbred recipient heifers were assigned randomly to receive either 1) a single whole fresh embryo (WHOLE; n = 37) or 2) 2 identical fresh demi-embryos (SPLIT; n = 37) in the uterine horn ipsilateral to the CL 7 d after an observed estrus. Ultrasonography was used on d 33, 69, and 108 to determine presence and number of embryos or fetuses. Palpation per rectum was used to determine pregnancy status on d 180 of gestation and number of live calves was recorded at birth. In Exp. 1 pregnancy rates on d 30 to 35 were greater (P < 0.05) for TWIN- (48.5%) and TAI-2- (47.5%) than for ET-9- (33.3%) treated cows. Of the 48 pregnant cows in the TWIN treatment, 21 were twin pregnancies whereas there was 1 twin pregnancy in the TAI-2 treatment. As a result, TWIN cows had more fetuses (P < 0.05) as a proportion of all treated cows (69.7%) than TAI-2- (48.5%) or ET-9-(33.3%) treated cows, and cows in the TWIN treatment gave birth to more (P < 0.01) calves (n = 55) compared with cows in the ET treatment (n = 23) whereas cows in the TAI-2 treatment (n = 40) were intermediate. In Exp. 2 heifers receiving SPLIT (81.1%) had greater (P < 0.05) pregnancy rates on d 33 than heifers receiving WHOLE (40.5%). Of the SPLIT heifers that were confirmed pregnant at d 33 after transfer, 57% were gestating twin fetuses. Embryonic or fetal loss from d 33 to birth was greater (P < 0.01) in heifers in the SPLIT treatment (40.0%) compared with the WHOLE treatment (0.0%), but number of calves per female treated was greater (P < 0.05) in heifers in the SPLIT treatment (75.0%) compared with heifers in the WHOLE treatment (40.5%). We conclude that transferring an embryo into a cow 7 d after TAI did not increase the pregnancy rate in Exp.1. However, transferring 2 demi-embryos into a single heifer recipient increased pregnancy rate at 33 d of gestation whereas both methods of inducing twinning resulted in a greater number of calves per female treated. In addition, embryonic or fetal loss associated with unilateral twin pregnancies in heifers occurred at rates greater than those associated with single-fetus pregnancies.

Radiofrequency ablation as a minimally invasive procedure in the treatment of twin reversed arterial perfusion sequence in twin pregnancy

Twin reversed arterial perfusion sequence is a rare anomaly of monochorionic multiple pregnancies affecting 1 of 35,000 pregnancies and 1% of monochorionic twin pregnancies. In this condition the affected twin has lethal malformations including poor or absent heart development and is reversely perfused by a structurally normal co-twin. We report a case of a 21-year-old woman with a monochorionic twin pregnancy affected by twin reversed arterial perfusion sequence. This case highlights the therapeutic options and the management by radiofrequency ablation, which has been shown to be an easy and reliable technique with a high success rate compared with technically demanding fetoscopic procedures.

Ultrasound hip joint screening in newborn infants. Is twin pregnancy a risk factor for dysplasia?

This study aimed at investigating whether twin pregnancy is a risk factor for congenital dysplasia of the hip. From 1987 until 1994 the hips of 3739 (1902 male, 1837 female) newborn were examined by ultrasound (screening) according to Graf's technique. We compared the results of twins and the other newborn (non-twins). The examinations were performed by 19 physicians. 73 (2%) of the newborn were twins (29 male, 44 female). In the group of 3666 non-twins we found the types of hip IIa (alpha < 55 degrees) to IV (Graf's classification) in 237 (6.5%) newborn: 136 (3.7%) right side/183 (5.0%) left side. Only 2 (2.7%) of the 73 twins showed these types of hip. We found 4% (149/3739) breech presentations at birth in the entire group. 3.9% (141/3666) in the group of non-twins and 11% (8/73) cases in the twin group. 5.2% (190/3666) of the non-twins and 2.7% (2/73) of the twins required a treatment with abduction orthosis or Pavlik harness. This report shows that the types of hip IIa (alpha < 55 degrees); IIc; D; IIa, IIb and IV according to Graf and a required treatment in twins was significantly not more frequent than in the other newborn (non-twins), although twins showed more often a breech presentation at birth. The different kind of breech position in twins (hips and knees in flexion, legs and feet parallel) and non-twins (hips in flexion, knees in extension) could be one reason for these results. Besides, non-twins assume their breech position earlier than twins with a consecutively longer period of time of mechanical stress on the hips.

Treatment of twin reversed arterial perfusion sequence by septostomy and amniodrainage: a case report

An acardiac fetus is the most severe malformation seen in humans. It is an extremely rare complication, occurring in approximately 1% of all monozygotic twin gestations, with an incidence of about 1 in 35,000 births. This malformation happens as a result of the syndrome of reversed arterial perfusion of the acardiac twin from the other normal fetus (pump twin), due to the presence of arterio-arterial anastomoses in a monochorionic placenta. Several obstetric and perinatal complications have been associated to this anomaly and several treatments have been proposed to reduce the morbimortality of the pump twin. There's no report in MEDLINE about the treatment of twin gestations with acardiac fetus through septostomy. The present article reports a case of reversed arterial perfusion sequence complicated by polyhydramnios diagnosed at 19th week of pregnancy, treated with septostomy and serial amniodrainage. This case presented it demonstrate favorable development of the gestation, with labor happening at 35 weeks gestation and pump twin presenting good vitality conditions. In cases with no major factors of bad prognosis, septostomy combined with amniodrainage could be an interesting therapeutic option for a safe and efficacious management of selected cases of TRAP sequence.

Sequential selective laser photocoagulation of communicating vessels in twin-twin transfusion syndrome

Objective. We have previously described the selective laser photocoagulation of communicating vessels (SLPCV) technique for the treatment of twin–twin transfusion syndrome (TTTS). Because TTTS is t...

Liver transplantation after stem cell transplantation with the same living donor in a monozygotic twin with acute myeloid leukemia

Two monozygotic twins from a Swedish, nonconsanguine family-with concordant acute myeloid leukemia and similar morphological and cytogenetic changes, but with additional changes in one twin, suggestive of clonal evolution-are described. Twin I relapsed 4 months after completion of treatment, while twin II was still on treatment and was transplanted with stem cells from the human leukocyte antigen-identical father. An early relapse after transplantation was treated with donor lymphocyte infusions, but twin I relapsed again and died 8 months after stem cell transplantation (SCT). On relapse of twin I, treatment of twin II was reconsidered and consolidation was intensified with SCT in CR1 with peripheral blood stem cells from the father. Due to irreversible liver failure caused by severe venoocclusive disease, a living, related liver transplantation from the father was performed on day +84 post-SCT. Minimal immunosuppression was required, and graft rejection did not occur. The patient was in complete remission 29 months after SCT and 25 months after liver transplantation.

Umbilical cord transection in twin-reverse arterial perfusion syndrome with the use of a coaxial bipolar electrode (Versapoint®)

Umbilical-cord occlusion has been proposed for the treatment of twin–reverse arterial perfusion syndrome (TRAP). Transection of the umbilical cord is necessary in patients with monoamniotic or 'pseudomonoamniotic'TRAP to avoid subsequent cord entanglement and demise of the pump twin. We present a case of TRAP in which the umbilical cord was successfully ligated with suture and transected with the Versapoint®electrode.

Encoprese e constipação em gêmeos: um estudo de caso em ludoterapia comportamental

Relato de tratamento em ludoterapia comportamental de gêmeos (4 anos) onde uma das crianças apresentava encoprese secundária retentiva e a outra apresentava constipação. O tratamento consistiu em avaliação (entrevista e observação), linha de base (padrão de defecação) e intervenções (habituação comportamental, treino intestinal, monitoramento através de gráficos e biblioterapia). Em relação à linha de base, o padrão de defecação dos gêmeos quadruplicou. Foram discutidos os fatores que possibilitaram a mudança no padrão de defecação dos gêmeos e a importância de se investigar os fatores responsáveis pelas diferenças individuais em quadros de encoprese.

Reviewing Twinship in Africa

This article serves as an introduction to the existing literature on twinship in African contexts, as well as an introduction to the articles in this special issue of Ethnology. The authors note that the paradoxical nature of twinship for social structure has been a staple of the literature on Africa since the work of Isaac Schapera in the 1920s, but was made more central to the discipline by Evans-Pritchard (1956) and by Turner (1969). The articles in this issue revitalize and resituate the debate about multiple births, bringing to it a social-historical consciousness as well as an understanding of contemporary ritual. This is particularly important since cultural analyses of multiple births now languish in anthropology while multiple births themselves, through new reproductive technologies and media coverage, have become increasingly prominent. (Twinship, literature review, Africa, ritual practice) The unusual event of twin births has called for explanations and inspired stories in many times and places. For example, in the Old Testament story of Esau and Jacob, twins represented the possibility of social divisiveness: peoples ... [who] shall be divided. By portraying the junior twin's divinely predicted but socially anomalous ascendance (cf. Southall 1972:83) as the inheritor of his father's blessing, twinship here provides a venue for reflection on the meaning of primogeniture. Similarly, in the well-known essay on twins in The Ritual Process, Turner (1969) argues that distinctive interpretations of twinship in Africa reflect the structurally disruptive position of two born out of a single body into the social position of one (cf. Schapera 1927). These two may therefore be treated as one ritually or may literally be made into one by more drastic means. Other interpretations and stories about twins relate to other visions of the world and the problems that arise for those who hold such visions. For example, in the thirteenth century, during the time of Thomas Aquinas, concerns about proper social groupings of people based on religious belief and practices were played out in debates about baptism and whether twin-born children had two souls or one (Schwartz 1996:50; cf. Evans-Pritchard 1956:156 for a Nuer opinion on this question). In a more recent example, Schwartz (1996:21) argued that many Europeans and North Americans are, due to the proliferation of facsimiles reproduced in Western society, preoccupied with duplication and authenticity. This preoccupation, along with anxiety over the perceived loss of strong family ties, has contributed to an obsessive searching for past twins in singleton births. Such explanations for twin births and the treatment of twins (present or vanished) are not only socioculturally specific but are transformative over time. The essays that follow all consider how contextual specificities have been changing in four contemporary African societies in Cameroon (Kedjom), Niger (Mawri Hausa), and Nigeria (northern Igbo, Ekiti Yoruba). TWINSHIP STUDIES While anthropological and art historical studies of twinship in Africa have enjoyed several periods of intensive study, particularly in the 1920s (Carey 1925; Hall 1928; Schapera 1927; Thomas 1921), the late 1960s, and early '70s (Abraham 1972; Brain 1969; Chappel 1974; Granzberg 1973; Houlberg 1973; Imperato 1975; Kilson 1973; Mobolade 1971; Segy 1970; Sirota 1967; Southall 1972; Thompson 1971; Turner 1969), little has been published more recently (cf. Diduk 1993; Gufler 1996; Pison 1992) on African twinship in either discipline.(1) Medical studies of twins in Africa also cluster around certain dates, notably the 1960s (Bulmer 1960; Hollingsworth and Duncan 1966; Knox and Morley 1960; Nylander 1969; Nylander and Corney 1969), although intermittent publications span a broader period (Creinin and Keith 1989; Jaffar et al. 1997; Nylander 1969, 1970; Ouaidou and van de Walle 1987). How can we understand the apparent dearth of anthropological and art historical studies in the 1990s? …

Orthodontic, genetic, and periodontal considerations in the treatment of impacted maxillary central incisors: A study of twins

Treatment of twins each with one impacted maxillary central incisor and a mesiodens is described. Treatment included rapid expansion, extraction of the mesiodens, surgical exposure of the impacted central incisor, and its forced eruption. The impacted incisor was brought into functional position in one patient but was lost in the other because of insufficient root length and high mobility. Orthodontic, genetic, and periodontal considerations of these 2 cases are evaluated. (Am J Orthod Dentofacial Orthop 2000;117:68-74)

Differential maternal treatment of twins: Does temperament make a difference?

Differential maternal treatment of twins: Does temperament make a difference?

Applying principles of individual, family and group psychotherapy to the treatment of twins

Psychotherapy for groups composed of twin dyads offers insight not otherwise encountered with other therapeutic modalities such as family, peer group and individual therapy. In particular, in the context of a group composed of pairs of twins, the therapist has the opportunity to explore the process of sibling rivalry, as well as perceptions of separateness and self-other identity. Moreover, interaction between the twins permits the therapist to evaluate areas of family and sibling conflict; interaction between the twin and a peer reveals interpersonal skills; finally, interaction between a twin and the therapist discloses material pertaining to individuation issues. This form of psychotherapy is a valuable method for the evaluation and treatment of twins.