Term Twin Research Articles

Association Between Maternal Body Mass Index and Fetal Acidosis in Term Twin Pregnancies: A Retrospective Cohort Study

ObjectivesGiven the increased risk of fetal acidosis in singleton neonates born to pregnant people with an elevated BMI, our objective was to evaluate the association between pre-pregnancy/first-trimester BMI and fetal acidosis among term twin pregnancies. MethodsRetrospective study of pregnant people with twin gestation and their term infants admitted to our centre between 2014 and 2019. Using a generalized estimating equation, the association between maternal BMI and fetal acidosis was determined using odds ratios (ORs) with 95% CIs. A two-sided P < 0.05 was considered significant. ResultsA total of 275 pregnant people and 550 infants were analyzed. The number (%) of pregnancies in each BMI class were 10 (4%) underweight, 155 (56%) normal weight, 66 (24%) overweight, 22 (8%) class I, 9 (3%) class II, and 13 (5%) class III. The prevalence of maternal diabetes and hypertension was highest in class III (31%) and class II (44%), respectively. Fetal acidosis was diagnosed in 35 (6%) infants. After adjusting for confounders (maternal age, diabetes, and hypertension), infants born to those with elevated BMI did not have increased odds of fetal acidosis compared to those born to underweight and normal weight group (OR 1.29; 95% CI 0.38–4.41 for class I, P = 0.67 and OR 2.80; 95% CI 0.62–12.62 for the combined classes II and III, P = 0.18). ConclusionsMaternal BMI was not associated with fetal acidosis in term twin pregnancies. Further research is required to corroborate study findings due to small sample size.

Blockchain-secure patient Digital Twin in healthcare using smart contracts.

Modern healthcare has a sharp focus on data aggregation and processing technologies. Consequently, from a data perspective, a patient may be regarded as a timestamped list of medical conditions and their corresponding corrective interventions. Technologies to securely aggregate and access data for individual patients in the quest for precision medicine have led to the adoption of Digital Twins in healthcare. Digital Twins are used in manufacturing and engineering to produce digital models of physical objects that capture the essence of device operation to enable and drive optimization. Thus, a patient's Digital Twin can significantly improve health data sharing. However, creating the Digital Twin from multiple data sources, such as the patient's electronic medical records (EMR) and personal health records (PHR) from wearable devices, presents some risks to the security of the model and the patient. The constituent data for the Digital Twin should be accessible only with permission from relevant entities and thus requires authentication, privacy, and provable provenance. This paper proposes a blockchain-secure patient Digital Twin that relies on smart contracts to automate the updating and communication processes that maintain the Digital Twin. The smart contracts govern the response the Digital Twin provides when queried, based on policies created for each patient. We highlight four research points: access control, interaction, privacy, and security of the Digital Twin and we evaluate the Digital Twin in terms of latency in the network, smart contract execution times, and data storage costs.

A retrospective study on the physical growth of twins in the first year after birth.

This study analyzed the physical growth of small for gestational age (SGA) and appropriate for gestational age (AGA) twins up to one year after birth. Weight, length, and head circumference data of 0-1 year-old twins were collected from the Child Health Care System from 2010 to 2019. Physical data were presented as Z-scores. Five parameters - growth level of weight, body length, head circumference, growth velocity, and body proportion (weight for length) were compared in twins. A total of 3,909 cases were collected (22.61% SGA, 77.39% AGA). 1. In both groups, WAZ (Weight for age z-score), HCZ (Head circumference for age z-score), and LAZ (Length for age z-score) increased more rapidly in the first 6 months. By one year of age, WAZ, HCZ, and LAZ had reached the normal range, but none had reached the average level of normal singleton children. 2. The mean values of WAZ, HCZ, and LAZ in the AGA group were between -1 and 0, and between -2 and - 1 in the SGA group, in the first year after birth. The SGA group lagged significantly behind the AGA group. The LAZ score of SGA and AGA was lower than the WAZ and HCZ scores. 3. The proportion of preterm AGA was the largest in twins, and the growth rate of preterm AGA was the fastest. Preterm twins had greater growth potential than term twins. However, the growth level of preterm SGA was always low. 4. The WFLZ (Weight for length z-score) in each group was approximately close to 0. The WFLZ of SGA was smaller than that of AGA twins at most time points. After 4 months of age, the WFLZ of twins had a downward trend. The WFLZ of preterm SGA approached -1 at approximately 1 year old. The physical growth of SGA and AGA in twins in the first year can reach the normal range but cannot reach the average level of normal singleton children. More attention should be paid to SGA in twins, especially preterm SGA. We should give proper nutritional guidance after 4 months of age to ensure the appropriate body proportion (weight for length) of SGA in twins. www.chictr.org.cn, CTR2000034761.

Anesthetic drug concentrations and placental transfer rate in fetus between term and preterm infants, twins, and singletons.

Objective: This study aims to determine the drug concentration of etomidate, remifentanil, and rocuronium bromide for general anesthesia in fetus as well as the placental transport rate between term and preterm delivery, twins, and singleton. Study design: Sixty parturients with 72 fetuses undergoing cesarean section under general anesthesia were included. According to whether the fetus was a twin or premature, parturients were divided into Group I (term singleton), Group II (premature singleton), Group III (term twins), and Group IV (premature twins). The preoperative demographic characteristics and laboratory examination of parturients, hemodynamic indicators, the Apgar score of neonates at 1, 5, and 10min after delivery and at specific assigned values, umbilical artery blood gas analysis results, neonatal weight, and resuscitative measures were recorded. Anesthetic drug concentrations in maternal arterial (MA), umbilical arterial (UA), and umbilical venous (UV) blood were detected by Ultra Performance Liquid Chromatography Tandem Mass Spectrometry (UPLC-MS/MS). Result: No significant differences were observed in the concentrations of etomidate, remifentanil, and rocuronium bromide in MA, UV, and UA blood, or in the UV/MA and UA/UV ratios between term and preterm infants, twins, and singletons. Moreover, there was no variation in the anesthetic drug concentration among each pair of twins. Additionally, no correlation was found between the neonatal weight and the plasma concentrations of anesthetic drugs in UV and UA blood, except for remifentanil in UA blood. Conclusion: Preterm or twin deliveries do not affect the neonatal concentration of etomidate, remifentanil, and rocuronium bromide used in general anesthesia for cesarean sections. Clinical Trial Registration: www.chictr.org.cn, identifier ChiCTR2100046547.

Postpartum takotsubo cardiomyopathy complicated with severe pulmonary edema and cardiogenic shock – a case report

Introduction and aim. Takotsubo cardiomyopathy (TCM) is a rare but life-threatening illness that can affect middle aged, young and pregnant women. It is a cardiac emergency and can mimic many other life threatening conditions like myocardial infarction, acute myocarditis, peripartum cardiomyopathy or dilated cardiomyopathy and is diagnosed by exclusion. Description of the case. Here we report a rare case of takotsubo cardiomyopathy in a young 28 year old female immediately post vaginal delivery of her normal full term twin pregnancy, who was otherwise a healthy female. She went on to develop complication of left ventricular heart failure and cardiogenic shock, which were successfully managed by conservative treatment leading to a full recovery. Conclusion. Takotsubo or stress cardiomyopathy is a rare entity and often a missed diagnosis, which if caught on time and treated leads to great prognosis. Our patient made a full recovery and is living a healthy life.

Growth of twins conceived using assisted reproductive treatments up to 5 years old: a national growth cohort.

Do twins conceived through assisted reproductive treatments (ART) grow differently from naturally conceived (NC) twins in early life? Assessments at 6-8 weeks old and at school entry show that ART twins conceived from frozen embryo transfer (FET) grow faster than both NC twins and ART twins conceived from fresh embryo transfer (ET). Singletons born from fresh ET grow more slowly in utero and in the first few weeks of life but then show postnatal catch-up growth by school age, compared to NC and FET babies. Evidence on early child growth of ART twins relative to NC twins is inconsistent; most studies are small and do not distinguish FET from fresh ET cycles. This cohort study included 13528 live-born twin babies conceived by ART (fresh ET: 2792, FET: 556) and NC (10180) between 1991 and 2009 in Scotland. The data were obtained by linking Human Fertilisation and Embryology Authority ART register data to the Scottish Morbidity Record (SMR02) and Scottish child health programme datasets. Outcome data were collected at birth, 6-8 weeks (first assessment), and school entry (4-7 years old) assessments. The primary outcome was growth, measured by weight at the three assessment points. Secondary outcomes were length (at birth and 6-8 weeks) or height (at school entry), BMI, occipital circumference, gestational age at birth, newborn intensive care unit admission, and growth rates (between birth and 6-8 weeks and between 6-8 weeks and school entry). All twins in the linked dataset (born between 1991 and 2009) with growth data were included in the analysis. To determine outcome differences between fresh ET, FET, and NC twins, linear mixed models (or analogous logistic regression models) were used to explore the outcomes of interest. All models were adjusted for available confounders: gestational age/child age, gender, maternal age and smoking, Scottish Index of Multiple Deprivation, year of treatment, parity, ICSI, and ET stage. In the primary birth weight models, the average birth weight of fresh ET twins was lower [-35 g; 95% CI: (-53, -16)g] than NC controls, while FET twins were heavier [71 g; 95% CI (33, 110) g] than NC controls and heavier [106 g; 95% CI (65, 146) g] than fresh ET twins. However, the difference between FET and NC twins was not significant when considering only full-term twins (≥37 weeks gestation) [26 g; 95% CI (-30, 82) g], while it was significantly higher in preterm twins [126 g; 95% CI (73, 179) g]. Growth rates did not differ significantly for the three groups from birth to 6-8 weeks. However, FET twins grew significantly faster from 6 to 8 weeks than NC (by 2.2 g/week) and fresh ET twins (by 2.1 g/week). By school entry, FET twins were 614 g [95% CI (158, 1070) g] and 581 g [95% CI (100, 1063) g] heavier than NC and fresh ET twins, respectively. Length/height and occipital frontal circumference did not differ significantly at any time point. Although the differences between ART and NC reflect the true ART effects, these effects are likely to be mediated partly through the different prevalence of mono/dizygotic twins in the two groups. We could not explore the mediating effect of zygosity due to the unavailability of data. The confounding variables included in the study were limited to those available in the datasets. Live-born twins from FET cycles are heavier at birth, grow faster than their fresh ET and NC counterparts, and are still heavier at school entry. This differs from that observed in singletons from the same cohort, where babies in the three conception groups had similar weights by school entry age. The results are reassuring on known differences in FET versus fresh ET and NC twin outcomes. However, FET twins grow faster and are consistently larger, and more ART twins depict catch-up growth. These may lead to an increased risk profile for non-communicable diseases in later life. As such, these twin outcomes require careful evaluation using more recent and comprehensive cohorts. This study was funded by the EU H2020 Marie Sklodowska-Curie Innovative Training Networks (ITN) grant Dohartnet (H2020-MSCA-ITN-2018-812660). The authors have no competing interests to declare. N/A.

Unfortunate Accidental Twins: Two Patients with Endocarditis of a Valve-Bearing Conduit

Abstract Background Prosthetic valve endocarditis is becoming more common because many patients live long enough to experience bacteremia, while insufficient antibiotic prophylaxis eventually leads to graft infection. Valve-bearing conduit infections are the most feared because of technical challenges. Case Description Two young patients were coincidental twins in terms of diagnosis and therapy. Both underwent complete replacement of the conduit, aortic arch prosthesis, and additional strategies to reconnect the coronary ostia and the brachiocephalic trunk. Both were discharged without significant residual problems. Conclusion Even most demanding infectious problems can be solved. Thus, surgery should not be denied.

Incidence, risk factors, and outcomes of multifetal gestation: A prospective, single center study from Central India

Introduction: Multifetal pregnancies (MFPs) are high risk pregnancies and are associated with higher complications and adverse outcomes. Aims and Objectives: To assess the incidence, risk factors, comorbidities, and outcomes of MFPs. Materials and Method: This prospective, observational study was performed over a period of 12 months (December 2018 to November 2019) and involved 212 women with MFP admitted in antenatal ward and labor room of a tertiary care center located in Central India. Maternal characteristics including age, parity, gestational age, mode of delivery, and maternal comorbidities and complications were recorded. Finally, neonatal morbidity and mortality was studied. Results: The incidence of MFP was 1.25%, with that of twin and triplet pregnancy being 1.22% and 0.03%, respectively. Majority of the women belonged to the age group of 25-30 years (43.3%), were multigravida (53.3%), and had a gestational age of 34-36 weeks (41.03%). Women most commonly underwent vaginal delivery (58.01%). The predominantly comorbidity and complications were hypertensive disorders (36.8) and preterm labor (58.49%), respectively. Majority of the neonates had low birth weight (LBW, 80.3%). There was no significant difference between the first and second twin in terms of LBW (P-value &gt;0.05). Perinatal mortality was statistically associated with both prematurity and LBW (both P-values &lt;0.0001). Conclusion: Overall, MFP was associated with high maternal and perinatal morbidity and mortality. Increased parity, low SES, rural area of residence, and advancing maternal age were the major determinants of MFPs. Perinatal mortality was significantly associated with LBW and prematurity.

Incidental Intraoperative Diagnosis of Term Conjoined Twins: A Case Series.

conjoined; monozygotic twinning; siamese twins; twins.

Gestational weight gain adequacy among twin pregnancies in France.

The objective of this paper is to describe gestational weight gain (GWG), to assess the applicability of the 2009 Institute of Medicine (IOM) guidelines, and to derive a GWG adequacy classification within a French cohort. We included twins from the national, prospective, population-based JUmeaux MODe d'Accouchement(JUMODA) cohort study (2014-2015). Following the IOM approach, we selected a 'standard'population of term pregnancies with 'optimal' birthweight (≥2500 g; n = 2562). GWG adequacy (insufficient; adequate; excessive) was defined using IOM recommendations (normal body mass index[BMI]: 16.8-24.5 kg [also utilized for underweight BMI]; overweight: 14.1-22.7 kg; obese: 11.4-19.1 kg). Additionally, using the IOM approach, we determined the 25th and 75th percentiles of GWG in our standard population to create a JUMODA-derived GWG adequacy classification. GWG and GWG adequacy were described, overall and by BMI and parity. In the JUMODA standard population of term twin livebirths with optimal birthweight, mean GWG was 16.1 kg (standard deviation 6.3). Using IOM recommendations, almost half (46.5%) of the women had insufficient and few (10.0%) had excessive GWG, with similar results regardless of BMI or parity. The 25th and 75th percentiles of GWG in the JUMODA standard population (underweight: 13-21 kg; normal weight: 13-20 kg; overweight: 11-19 kg; obese: 7-16 kg) were lower than the IOM recommendations. The IOM recommendations classified a relatively high percentage of French women as having insufficient and a low percentage as having excessive GWG. Additional research to evaluate recommendations in relation to adverse perinatal outcomes is needed to determine whether the IOM recommendations or the JUMODA-derived classification is more appropriate for French twin gestations.

Breastfeeding initiation, duration, and experiences of mothers of late preterm twins: a mixed-methods study

BackgroundTwins and late preterm (LPT) infants are at an increased risk of being breastfed to a lesser extent than term singletons. This study aimed to describe the initiation and duration of any and exclusive breastfeeding at the breast for mothers of LPT twins and term twins during the first 4 months and to explore the breastfeeding experiences of mothers of LPT twins.MethodsA sequential two-sample quantitative–qualitative explanatory mixed-methods design was used. The quantitative data were derived from a longitudinal cohort study in which 22 mothers of LPT twins and 41 mothers of term twins answered questionnaires at one and four months after birth (2015–2017). The qualitative data were obtained from semi-structured interviews with 14 mothers of LPT twins (2020–2021), based on results from the quantitative study and literature. Analysis included descriptive statistics of quantitative data and deductive content analysis of the qualitative data, followed by condensation and synthesis.ResultsAll mothers of LPT twins (100%) and most mothers of term twins (96%) initiated breastfeeding. There was no difference in any breastfeeding during the first week at home (98% versus 95%) and at 1 month (88% versus 85%). However, at 4 months, the difference was significant (44% versus 75%). The qualitative data highlighted that mothers of LPT twins experienced breastfeeding as complex and strenuous. Key factors influencing mothers’ experiences and decisions were their infants’ immature breastfeeding behaviors requiring them to express breast milk alongside breastfeeding, the burden of following task-oriented feeding regimes, and the lack of guidance from healthcare professionals. As a result, mothers started to question the worth of their breastfeeding efforts, leading to changes in breastfeeding management with diverse results. Support from fathers and grandparents positively influenced sustained breastfeeding.ConclusionsMothers of LPT twins want to breastfeed, but they face many challenges in breastfeeding during the first month, leading to more LPT twins’ mothers than term twins’ mothers ceasing breastfeeding during the following months. To promote and safeguard breastfeeding in this vulnerable group, care must be differentiated from routine term infant services, and healthcare professionals need to receive proper education and training.

A Data Normalization Technique for Detecting Cyber Attacks on UAVs

The data analysis subsystem of an Unmanned Aerial Vehicle (UAV) includes two main modules: a data acquisition module for data processing and a normalization module. One of the main features of an adaptive UAV protection system is the analysis of its cyber-physical parameters. An attack on a general-purpose computer system mainly affects the integrity, confidentiality and availability of important information. By contrast, an attack on a Cyber-Physical System (CPS), such as a UAV, affects the functionality of the system and may disrupt its operation, ultimately preventing it from fulfilling its tasks correctly. Cyber-physical parameters are the internal parameters of a system node, including the states of its computing resources, data storage, actuators and sensor system. Here, we develop a data normalization technique that additionally allows us to identify the signs of a cyber-attack. In addition, we define sets of parameters that can highlight an attack and define a new database format to support intrusion detection for UAVs. To achieve these goals, we performed an experimental study of the impact of attacks on UAV parameters and developed a software module for collecting data from UAVs, as well as a technique for normalizing and presenting data for detecting attacks on UAVs. Data analysis and the evaluation of the quality of a parameter (whether the parameter changes normally, or abrupt anomalous changes are observed) are facilitated by converting different types of data to the same format. The resulting formalized CPS model allows us to identify the nature of an attack and its potential impact on UAV subsystems. In the future, such a model could be the basis of a CPS digital twin in terms of security. The presented normalization technique supports processing raw data, as well as classifying data sets for their use in machine learning (ML) analyses in the future. The data normalization technique can also help to immediately determine the presence and signs of an attack, which allows classifying raw data automatically by dividing it into different categories. Such a technique could form the basis of an intrusion detection system for CPSs. Thus, the obtained results can be used to classify attacks, including attack detection systems based on machine learning methods, and the data normalization technique can be used as an independent method for detecting attacks.

Edge Intelligence-Based Ultra-Reliable and Low-Latency Communications for Digital Twin-Enabled Metaverse

In this letter, we propose a novel digital twin scheme supported metaverse by jointly considering the integrated model of communications, computing, and storage through the employment of mobile edge computing (MEC) and ultra-reliable and low latency communications (URLLC). The MEC-based URLLC digital twin architecture is proposed to provide powerful computing infrastructure by exploring task offloading, and task caching techniques in nearby edge servers to reduce the latency. In addition, the proposed digital twin scheme can guarantee stringent requirements of reliability and low latency, which are highly applicable for the future networked systems of metaverse. For this first time in the literature, our paper addresses the optimal problem of the latency/reliablity in digital twins-enabled metaverse by optimizing various communication and computation variables, namely, offloading portions, edge caching policies, bandwidth allocation, transmit power, computation resources of user devices and edge servers. The proposed scheme can improve the quality-of-experience of the digital twin in terms of latency and reliability with respect to metaverse applications.

JOINT SOGC-CPS CLINICAL PRACTICE GUIDELINE: Guideline No. 424: Umbilical cord management in preterm and term infants.

To assess the impact of deferred (delayed) cord clamping (DCC) and umbilical cord milking in singleton and twin gestations on maternal and infant mortality and morbidity. Women who are pregnant with preterm or term singletons or twins. In preterm singletons, DCC for (ideally) 60 to 120 seconds, but at least for 30 seconds, reduces infant risk of mortality and morbidity. DCC in preterm twins is associated with some benefits. In term singletons, DCC for 60 seconds improves hematological parameters. In very preterm infants, umbilical cord milking increases risk for intraventricular hemorrhage. Searches of Medline, PubMed, Embase, and the Cochrane Library from inception to March 2020 were undertaken using Medical Subject Heading (MeSH) terms and key words related to deferred cord clamping and umbilical cord milking. This document represents an abstraction of the evidence rather than a methodological review. The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and conditional [weak] recommendations).

Associations between antenatal corticosteroid exposure and neurodevelopment in infants

It has been well recognized that antenatal administration of dexamethasone to pregnant women at risk of preterm delivery may markedly accelerate fetal maturation and reduce the risk of adverse perinatal outcomes in their preterm infants, particularly for births before 34 weeks of gestation. Since 2015, antenatal corticosteroid administration has been extended beyond 34 weeks of gestation by clinical guidelines, as it might have beneficial effects on fetal maturation and perinatal outcomes. However, concerns regarding the potential influence of antenatal corticosteroid treatment on offspring neurodevelopment have been raised. This study aimed to investigate whether maternal antenatal corticosteroid administration was associated with neurodevelopment in infants at 1 year of age. In this prospective and longitudinal birth cohort study, women were followed up throughout gestation, and their infants underwent a Bayley Scales of Infant and Toddler Development, Third Edition, screening test at 1 year of age between December 2018 and September 2020. Finally, 1609 pregnant women and 1759 infants were included in the current study. Using a generalized linear mixed model, we examined the association between antenatal corticosteroid exposure and infant neurodevelopment in cognitive, receptive communication, expressive communication, fine motor, and gross motor functions. Of the 1759 infants eligible for this study, 1453 (82.6%) were singletons. A total of 710 infants were exposed to antenatal corticosteroids, among whom 415 were dexamethasone exposed and 483 were prednisone exposed. Dexamethasone was prescribed most often in late pregnancy, whereas prednisone was often used before 8 weeks of gestation among women who conceived through assisted reproductive technology. Compared with those who had no exposure, antenatal corticosteroid exposure was associated with an increased risk of infants being noncompetent in the cognitive development domain after adjusting for conventional risk factors (adjusted risk ratio, 1.53; 95% confidence interval, 1.08-2.18; P=.017). For medication-specific exposure, those exposed vs not exposed to antenatal dexamethasone were 1.62-fold (95% confidence interval, 1.10-2.38; P=.014) more likely to be noncompetent in the cognitive development domain at 1 year. The association did not vary markedly between preterm and term infants, singletons and twins, or assisted reproductive technology-conceived and spontaneously conceived infants (all P>.05 for heterogeneity). In contrast, a null association was observed for the risk of being noncompetent in any domain of neurodevelopment with antenatal prednisone exposure at early pregnancy. Here, antenatal corticosteroid, particularly dexamethasone exposure, was markedly associated with an increased risk of infants being noncompetent in the cognitive development domain at 1 year of age. These findings may provide new information when weighing the benefits and potential risks of maternal antenatal corticosteroid administration.

Relationship of maternal factors and obstetric complications with term singleton vs term twin neonatal outcomes: A retrospective study in China

BackgroundNeonatal birth weight and length are important indicators of neonatal survival and morbidity during later life and are influenced by maternal factors and obstetrical complications. Therefore, we aimed to determine the relationship of maternal factors and obstetric complications with term singleton vs term twin neonatal outcomes in Wuhan University Renmin Hospital, Hubei, China. MethodsA total of 10517 neonatal births were recorded in a tertiary-hospital-based retrospective study and term singleton (n=7787) and termtwins (n=169) were included for data analysis. Birth weight and birth length were measured immediately after birth. Correlation, independent student t-test, and backward multiple linear regression were used for statistical analysis. ResultsWomen with singleton gestation have an increased rate of obstetric complications compared to women with twin gestation. However, a higher frequency of cesarean section and breech were found in twin gestation compared to singleton gestation. Weight before pregnancy, gestational weight gain, and gestational diabetes mellitus were significantly positive (p&lt;0.05) associated with singleton neonatal birth length and weight. In contrast, preeclampsia, placenta previa, oligohydramnios, premature rupture of membrane, breech, and multiparity had a significantly negative (p&lt;0.05) association with singleton neonatal birth length and weight. Maternal age was significantly positive (p&lt;0.05) associated with only singleton neonatal birth weight. Moreover, the nuchal cord was significantly positive (p&lt;0.05) associated with singleton neonatal birth length. On the other hand, maternal age and multiparity were significantly positive (p&lt;0.05) associated with twins’ neonatal birth length and weight. Furthermore, gestational weight gain was significantly positive (p&lt;0.05) associated with only twins’ neonatal birth weight. ConclusionIn term gestation, obstetric complications were significantly associated with singleton birth size rather than twin birth size.

A digital twin ecosystem for additive manufacturing using a real-time development platform.

Additive manufacturing is often used in rapid prototyping and manufacturing, allowing the creation of lighter, more complex designs that are difficult or too expensive to build using traditional manufacturing methods. This work considers the implementation of a novel digital twin ecosystem that can be used for testing, process monitoring, and remote management of an additive manufacturing–fused deposition modeling machine in a simulated virtual environment. The digital twin ecosystem is comprised of two approaches. One approach is data-driven by an open-source 3D printer web controller application that is used to capture its status and key parameters. The other approach is data-driven by externally mounted sensors to approximate the actual behavior of the 3D printer and achieve accurate synchronization between the physical and virtual 3D printers. We evaluate the sensor-data-driven approach against the web controller approach, which is considered to be the ground truth. We achieve near-real-time synchronization between the physical machine and its digital counterpart and have validated the digital twin in terms of position, temperature, and run duration. Our digital twin ecosystem is cost-efficient, reliable, replicable, and hence can be utilized to provide legacy equipment with digital twin capabilities, collect historical data, and generate analytics.

Comprehensive Metabolomic Profiling of Cord Blood and Placental Tissue in Surviving Monochorionic Twins Complicated by Twin-Twin Transfusion Syndrome With or Without Fetoscopic Laser Coagulation Surgery: A Retrospective Cohort Study.

Objectives: To investigate metabolomic perturbations caused by twin-twin transfusion syndrome, metabolic changes associated with fetoscopic laser coagulation in both placental tissue and cord plasma, and to investigate differential metabolites pertinent to varying fetal outcomes, including hemodynamic status, birth weight, and cardiac function, of live-born babies. Methods: Placental tissue and cord plasma samples from normal term or uncomplicated preterm-born monochorionic twins and those complicated by twin-twin transfusion syndrome treated with or without fetoscopic laser coagulation were analyzed by high-performance liquid chromatography metabolomic profiling. Sixteen comparisons of different co-twin groups were performed. Partial least squares–discriminant analysis, metabolic pathway analysis, biomarker analysis, and Spearman’s correlation analysis were conducted based on differential metabolites used to determine potential biomarkers in different comparisons and metabolites that are pertinent to neonatal birth weight and left ventricular ejection fraction. Results: These metabolomic investigations showed that the cord plasma metabolome has a better performance in discriminating fetuses among different hemodynamic groups than placental tissue. The metabolic alteration of twin-twin transfusion syndrome in these two types of samples centers on fatty acid and lipid metabolism. The fetoscopic laser coagulation procedure improves the metabolomic change brought by this syndrome, making the metabolomes of the treated group less distinguishable from those of the control and preterm birth groups. Certain compounds, especially lipids and lipid-like molecules, are noted to be potential biomarkers of this morbid disease and pertinent to neonatal birth weight and ejection fraction. Conclusions: Fetoscopic laser coagulation can ameliorate the metabolomic alteration caused by twin-twin transfusion syndrome in placental tissue and cord plasma, which are involved mainly in fatty acid and lipid-like molecule metabolism. Certain lipids and lipid-like molecules are helpful in differentiating co-twins of different hemodynamic statuses and are significantly correlated with neonatal birth weight or ejection fraction.

The Obstetrician Gynecologist’s role in the screening of infants at risk of severe plagiocephaly: Prevalence and risk factors

This study was conducted to determine the prevalence, maternal and/or neonatal risk factors for severe plagiocephaly in order to early detect and refer infants at risk. A prospective observational study was conducted, involving 4337 infants who visited the Perinatology Center at San Pietro Fatebenefratelli Hospital in Rome, evaluated following the Plagiocephaly Severity Scale of Atlanta. ©The plagiocephaly prevalence resulted 1.89%, considering moderate to severe forms. Maternal risk factors include primiparity, older age, gestational diabetes, and uterine fibromatosis. Neonatal risk factors are early term gestational age, low weight, twin pregnancy, and prolonged labor with an emergency cesarean section. Screening for severe plagiocephaly should begin antenatally. Although the low prevalence, identifying infants at risk can prevent potential permanent sequelae. We suggest a multidisciplinary approach for the management of plagiocephaly, involving the figure of the Obstetrician Gynecologist, who can highlight the risk factors ranging from obstetric and birth conditions.

双晶の体積分率に依存する流れ応力を考慮した双晶誘起塑性モデルに基づく結晶塑性解析

Recently, TWIP steels have been focused on because of their excellent ductility and strength. One approach to formulating the behavior of materials containing deformation twins in terms of crystal plasticity is a model in which each material point in the material is represented by a mixture law based on the volume fractions of the twin and matrix phase. Such kind of approach cannot express the macroscopic mechanical property more precisely because the influence of twin boundaries is neglected. In this study, the mechanical property under the existence of twin boundaries is researched by using crystal plasticity simulation. The analysis intended for a material with a laminar structure made of twin phase and matrix phase reproduces the accumulation of dislocations at twin boundaries. By investigating the influence of twin boundaries on several models with different volume fractions of each phase, the relationship between the volume fractions of the twin phase and the influence of twin boundaries was determined.