Twin Rate Research Articles

The IL-17/IL-23 Axis and Its Genetic Contribution to Psoriatic Arthritis

Psoriatic arthritis (PsA) is a chronic inflammatory disease belonging to the family of spondyloarthropathies (SpA). PsA commonly aggravates psoriasis of the skin and frequently manifests as an oligoarthritis with axial skeletal involvement and extraarticular manifestations including dactylitis, enthesitis, and uveitis. The weight of genetic predisposition to psoriasis and PsA is illustrated by the concordance rates in monozygotic twins which clearly demonstrate that genomics is insufficient to induce the clinical phenotype. The association of PsA with several single nucleotide polymorphisms (SNPs) at the IL23R locus and the involvement of Th17 cells in the immunopathogenesis of PsA clearly put the IL-23/IL-17 axis in the spotlight. The IL-23 and IL-17 cytokines have a pivotal role in the chronic inflammation of the synovium in PsA and are also prominent in the skin lesions of those with PsA. In this review, we focus on the genetic association of the IL-23/IL-17 axis with PsA and the contribution of these master cytokines in the pathophysiology of the disease, highlighting the main cell types incriminated in PsA and their specific role in the peripheral blood, lesional skin and joints of patients. We then provide an overview of the approved biologic drugs targeting the IL-23/IL-17 axis and discuss the advantages of genetic stratification to enhance personalized therapies in PsA.

The effect of polycystic ovary syndrome without hyperandrogenism on pregnancy-related outcomes: a retrospective cohort study.

To evaluate the effect of polycystic ovary syndrome (PCOS) without hyperandrogenism on pregnancy-related outcomes. A retrospective cohort study. Reproductive Medicine Centre of Tongji Hospital. Women without hyperandrogenism undergoing their first single blastocyst transfers in frozen-thawed cycles were divided into a PCOS group and a non-PCOS group according to the Rotterdam criteria. The pregnancy-related outcomes of women with and without PCOS were compared. Propensity score matching and multiple logistic regression models were used to eliminate essential impacts on pregnancy-related outcomes. Pregnancy-related outcomes included pregnancy loss and abnormal perinatal outcomes. A total of 4083 women without hyperandrogenism met the study criteria, among whom 557 met the diagnostic criteria for PCOS. Women with PCOS had higher rates of clinical pregnancy (P=0.035) and cumulative live births (P=0.023). However, there were no significant differences in the rates of biochemical pregnancy, twins and pregnancy loss between the two groups. Among women with singleton pregnancies, the incidences of preterm birth, hypertensive disorders of pregnancy, gestational diabetes, placenta praevia, fetal malformation, macrosomia and low birthweight did not differ significantly between the two groups. The results remained unchanged even after adjustments were made for propensity score matching and multiple logistic regression analyses. Women with PCOS without hyperandrogenism may achieve higher rates of clinical pregnancy and cumulative live birth than those without PCOS, without increases in their rates of biochemical pregnancy, pregnancy loss or other abnormal perinatal outcomes. PCOS without hyperandrogenism was not associated with abnormal pregnancy-related outcomes.

113 Different doses of equine chorionic gonadotrophin on pregnancy and twin rates of Bos taurus beef heifers subjected to J-Synch protocol for fixed-time artificial insemination

The objective was to evaluate the effect of different doses of equine chorionic gonadotrophin (eCG) on pregnancy (P/AI) and twin rates of beef heifers in a progesterone and oestradiol-based treatment (J-Synch protocol) for fixed-time AI (FTAI). A total of 1,404 Bos taurus beef heifers with a body condition score 4.8±0.5 (mean±s.e.m., scale 1–8) were used in three different locations. The presence of a corpus luteum (CL) was determined by ovarian ultrasonography (5.0MHz) at the beginning of the J-Synch protocol. On Day 0, the heifers received 2mg of oestradiol benzoate (intramuscular, IM) associated with an intravaginal device containing 0.5g of progesterone. At device removal, on Day 6, 500µg of cloprostenol sodium was administered IM and the females were randomly assigned to one of two experimental groups to receive 200 (n=702) or 300 (n=702) IU of eCG (Zoetis) IM. Heifers were also tail-painted. On Day 0 females with paint rubbed-off were FTAI 64 h after device removal, and those that remained with the paint received 8 μg of buserelin acetate 64 h after device removal to be FTAI 8 h later. FTAI was performed at 64 to 72h after device removal, and pregnancy diagnosis was performed by ultrasonography 30 to 35 days after insemination. Data were analysed by logistic regression using GLMM. The results are shown in Table 1. Pregnancy rate was not different between heifers treated with 200 or 300IU of eCG (P=0.513) and was not affected by the presence of CL at the beginning of the protocol (P=0.513). Twin rate was greater in heifers treated with 300IU than with 200IU of eCG (P=0.005), and it was not affected by the presence of CL (P=0.362). Interaction between eCG treatment and presence of CL was not significant for pregnancy or twin rates (P=0.532). In conclusion, although 300IU of eCG increased the twin rate compared with 200IU, no differences were found in P/AI. We suggest that the dose of eCG in the J-Synch protocol could be adjusted to 200IU in Bos taurus beef heifers. Table 1. Pregnancy per AI (P/AI) and twin rates obtained with different doses of eCG (200 or 300IU) in a J-Synch protocol for fixed-time AI in cycling (CL) and anestrous (no CL) Bos taurus beef heifers Variable 200 IU 300 IU P-value CL no CL Total CL No CL Total eCG CL eCG×CL P/AI (%) 61.6% (135/219) 59.8% (289/483) 60.4% (424/702) 60.2% (133/221) 59.5% (286/481) 59.7% (419/702) 0.513 0.513 0.513 Twin rate (%) 3.0% (4/135) 3.5% (10/289) 3.3% (14/424) 6.8% (9/133) 9.4% (27/286) 8.6% (36/419) 0.005 0.362 0.532

Community perceptions on causes of high dizygotic twinning rate in Igbo-Ora, South-west Nigeria: A qualitative study.

Dizygotic (DZ, non-identical) twinning rates vary widely across different regions in the world. With a DZ twinning rate of 45 per 1000 live births, Igbo-Ora Community in South-west Nigeria has the highest dizygotic (DZ) twinning rate in the world. Although several postulations exist on the causes of high DZ twinning rates in Igbo-Ora, no study has yet been conclusive on a definite causative agent. Using qualitative methods, this study explored the perceptions and beliefs of Igbo-Ora residents about the causes of high DZ twinning rates. Focus group discussion sessions and key informant interviews were organized among fathers and mothers of twins, those without twins, and health care providers. Key informant interviews were also held with persons considered to be custodians of culture who may have knowledge relevant to twinning such as traditional rulers, and traditional birth attendants; as well as health care providers, mothers and fathers of twins, and adult twins. The results showed three factors featuring as the leading perceived causes of twinning in the community. These included twinning being an act of God, hereditary, and being due to certain foods consumed in the community. Contrary to reports that the consumption of a species of yam (Dioscorea rotundata) may be responsible for the DZ twinning in this Community; yam was not prioritized by the respondents as associated with twinning. In contrast, participants repeatedly mentioned the consumption of "ilasa" a soup prepared with okra leaves (Abelmoschus esculenta) with water that is obtained from the community, and "amala" a local delicacy produced from cassava (Manihot esculenta) as the most likely dietary factors responsible for twinning in the community. Since the same foods are consumed in neighboring communities that have lower rates of twinning, we conjecture that nutritional and other environmental factors may produce epigenetic modifications that influence high DZ twinning rates in Igbo-Ora community. We conclude that more directed scientific studies based on these findings are required to further elucidate the etiology of the high rate of DZ twinning in Igbo-Ora.

In vitro maturation with letrozole priming: Can it be a solution for patients with cancerophobia? A pilot study.

Objective:To investigate whether letrozole priming could be used efficiently in patients undergoing in vitro maturation (IVM) as compared with follicle-stimulating hormone (FSH) priming.Materials and Methods:This is a retrospective analysis of 63 patients who underwent IVM due to the high risk of Ovarian Hyperstimulation syndrome (OHSS) (n=39), cancerophobia (n=16), and desire for IVM after failed in vitro fertilization attempts (n=8). Forty-two patients received FSH priming and 21 patients received letrozole priming.Results:The patients who had FSH or letrozole priming were statistically similar with respect to age, body mass index, duration of infertility, basal antral follicle count, serum anti-Müllerian hormone levels, and IVM indications (p>0.05 for all). When compared with the FSH priming group, the number of germinal vesicle oocytes, metaphase II and fertilized oocytes were significantly higher (p=0.003, p=0.001, and p=0.016, respectively), but the number of metaphase I oocytes was significantly lower in the letrozole priming group (p=0.002). The patients who received FSH and letrozole priming had statistically similar rates of implantation (33.3% vs 37.0%, p=0.709), clinical pregnancy (31.5% vs 33.3%, p=0.848), twinning (1.9% vs 3.7%, p=0.611), and live birth (24.1% vs 29.6%, p=0.682).Conclusion:Potential indications for IVM include patients with increased risk for OHSS and contraindication for hyperestrogenism. Aromatase inhibitors can be used to preserve the fertility of patients with estrogen-sensitive cancers. Letrozole priming appears to be an efficient approach in patients who undergo IVM, with likely less cost than FSH priming.

Maternal age is associated with embryo splitting after single embryo transfer: a retrospective cohort study.

To determine whether maternal age has an impact on monozygotic twinning (MZT) rates in women undergoing single embryo transfer (SET). This is a retrospective cohort study analyzed for the incidence of MZT of all clinical pregnancies after a single embryo transfer was carried out between 2014 and 2018. The effect of different assisted reproductive technology (ART) parameters on the incidence of MZT was evaluated. There were a total of 8459 cycles resulting in pregnancy during the study period. Of these pregnancies, 8236 were singletons and 223 were MZT. The preterm birth rate, miscarriage rate, and cesarean section rate were higher in MZT. Birth weight and gestational age at delivery were lower and smaller. In the univariate analysis, the risk of MZT was decreased with frozen embryo transfer (ET). A nonlinear relationship was observed between maternal age and MZT. A negative relationship between maternal age and MZT was observed in the patients' age ≥ 36years. Advanced maternal age was associated with a lower rate of MZT. A threshold female age of 36years existed for lower MZT.

Double trouble? Impact of frozen embryo transfer on the monozygotic twinning rate: a retrospective cohort study from 8459 cycles.

To compare monozygotic twinning (MZT) rates in patients undergoing fresh embryo transfer (ET) and frozen embryo transfer. All clinical pregnancies after single ET carried out in our IVF center between 2014 and 2018 (n = 8459) were retrospectively analyzed for the incidence of MZT. MZT rate was compared in women who underwent fresh ET (n = 3876) and frozen ET (n = 4583). There was a total of 120 MZT identified in the fresh ET group (3.10%) and 103 MZT in the frozen ET group (2.25%), which was significant (p = 0.015). In the univariate analysis, the risk of MZT was decreased with frozen embryo transfer (OR 0.72; 95% CI, 0.55-0.94, p = 0.016) and increased with mild stimulation protocol in the fresh cycle (OR 1.90; 95% CI, 1.04-3.45, p = 0.036). Multivariable logistic regression revealed that frozen embryo transfer was associated with a significant decrease risk of MZT (adjusted OR 0.66; 95% CI, 0.46-0.90, p = 0.011). Frozen ET is associated with a lower risk of MZT.

The Evolving Landscape Of Donor Egg Treatment: Success, Women’s Choice And Anonymity

40K+ babies are born in the US annually from the use of donor gametes; ∼¼ are eggs (DE). Notably, in 2017, ∼¼ of the women > 40y that succeeded using ART did so with DE. DE is thus, common practice today as more women delay childbirth in lieu of professional/personal pursuits, causing them to “age-out” of traditional ART. DE has evolved from synching a recipient’s (REC) endometrium to a donor’s fresh retrieval (FRESH-O) + multi-embryo FRESH-ET to; (non-synchronized) frozen-embryo transfers (FROZ-ET) &/or the use of commercially-bought, frozen DE (COM-O) ± the use of PGT-A; all meant to optimize DE outcomes. We sought to examine trends over time re: psychology, cost, choice, genetics and ease. Retrospective analysis. From 1/2014-12/2019, we completed 462 DE transfers in 241 REC using a total of 163 donors (avg: 2-emb ET/REC). We analyzed donor characteristics & cycle repeats, &, over time, FRESH-O vs. COM-O, SOLE (1 REC) vs. SHARED (2 REC), FRESH-ET vs. FROZ-ET, PGT-A or not, single (SET) vs. double (DET) ET. Primary outcome was ongoing (> 8 wks) pregnancy + live birth rate (OP/LB). Stats: Chi Square was used. Of donors, 98 (60%) were FRESH-O; 65 (40%) were COM-O. 29 (30%) FRESH-O donated greater than once (REPEAT) with embryos transferred to a total of 108 REC. On average, REPEATs had 3 retrievals (range 2-6), went to 4 REC (range 2-9) & their donations resulted in 7 ETs (range 2-23) creating 84 OP/LB; 3 per donor (range 1-9). A total of 74 “genetic half-siblings” were born to 76 REC from 23 donors. Assessing oocyte & ET type, FRESH-ETs using FRESH-O compared to COM-O yielded a higher OP/LB rate (51% vs. 27% p=.0007). In FRESH-O, OP/LB rates were similar in FRESH-ET & FROZ-ET (50% vs 41%, p=.08). For all DE cycles, PGT-A use increased over time (2014-16: 0.2%, 2018-19: 13%) with no OP/LB improvement (p=.9). 2-ETs led to a higher OP/LB compared to SET (50% vs. 37%, p=.007) but had a 15% twin rate. The program trended from 2-ET to SET over 6y (2014-2019), decreasing from 42% to 19% (p<.05); SET continues to dominate. As years progressed, we trended toward SOLE over SHARED and less COM-O due to SOLE’s superior OP/LB per ET. Of note, 60/75 (80%) SOLE (17 eggs/REC) & 28/30 (93%) SHARED (10 eggs/REC) donors made at least 1 OP/LB. ART continues to evolve. As OP/LB successes have become universally acceptable, primary treatment emphasis has expanded from best-pregnancy-rate-only to include healthy baby (and mother) & meeting patient concerns: cost, timing, ease, non-family genetic siblings. Trends in practice require continuous reevaluation. Moving away from 2-ET in favor of SET is mandatory. PGT-A’s role in DE appears unnecessary except for carrier-state issues. The combo of SOLE, FRESH-O + readied REC continues to provide the best absolute OP/LB but COM-O and FROZ-ET add choice and convenience. Sharing donors, whether through FRESH-O or COM-O decreases cost & the # of supernumerary embryos but also increases the number of REC per donor, and therefore genetically-related offspring in the background of consumer testing unraveling anonymity. Donors and intended parents require full & appropriate counseling.

INTRA CAVITY FLUID WITH PREVIOUS CAESAREAN SECTION COMPROMISED CLINICAL PREGNANCY AFTER IVF/ICSI TREATMENT

Caesarean section (CS) rates are rising worldwide, the scar is considered to have impact on the subsequent pregnancy. Researchers reported a lower pregnancy rate in patients with a previous CS compared to a previous vaginal delivery, but the potential causes are still to be determined. Lawrenz et al. reported the relationship between intra cavitary fluid (ICF) with uncompromised clinical outcomes on frozen embryo transfer (FET) cycles[1]. The goal of this study was to explore whether the presence of ICF influence the pregnant outcome of patients with CS in fresh embryo transfer cycles. Retrospective cohort study. A total of 1643 women with at least one previous delivery undergoing the first in vitro fertilization / intracytoplasmic sperm injection (IVF/ICSI) cycle and had their fresh embryo transferred during January 2015 to August 2019 in a university-based hospital were enrolled for analysis. According to the previous delivery method and the ultrasound monitoring results——ICF detected on day of embryo transfer, women were separated into three subgroups, cesarean group with intra cavity fluid (CS-ICF, n=114), cesarean group without intra cavity fluid (CS-noICF, n=572) and another 957 patients without ICF were included in vaginal delivered group (VD, n=957). Main outcome was clinical pregnancy rate. Baseline characteristics data, controlled ovarian hyperstimulation procedures and pregnancy outcomes were extracted from medical databases and were compared among three groups. Potential confounders were adjusted by multivariate logistic regression analyses, including age, previous delivery times, body mass index (BMI), failed attempts of IVF, endometrium thickness, embryo quality and stage of development. Baseline characteristics and the quality of embryos transferred in the three groups were comparable. Less number of embryos were transferred in CS groups than VD group influenced by clinicians’ preference(P<0.05). There was significantly lower clinical pregnancy rate (33.3% vs 45.2%, P=0.015) and twin pregnancy rate (7.9% vs 24.5%) in CS-ICF group compared with VD group, while the rates were comparable between CS-noICF group and VD group. There is a tendency that the live birth rate in VD group is higher than that in CS-ICF group. After adjusted for all the confounding factors listed above, the presence of ICF was an independent factor associated with lower clinical pregnancy rate (OR 0.586, 95%CI 0.375-0.914, P=0.018). Age and ratio of good quality embryos were also associated with clinical pregnancy rate. It is the presence of ICF but not the isthmocele per se that significantly compromised the clinical pregnancy rate in patients with CS. CS interferes with the integrity of uterine, ICF may accompany with inflammatory cytokines and potentially pathogenic bacteria, which further disrupt the endometrial receptivity. Large prospective cohort study is required to better understand the potential mechanism and explore effective therapeutic scheme.

Twin-to-twin transfusion syndrome: an obstetric catastrophe

Twin-to-twin transfusion syndrome (TTTS) is an obstetric condition with high perinatal mortality, which develops when blood flows disproportionately from one fetus to another in a monochorionic twin pregnancy. Approximately 1 in 7 monochorionic pregnancies are affected with TTTS. The donor twin develops oligohydramnios and poor fetal growth, while the recipient twin develops polyhydramnios, heart failure and hydrops. Here we report two cases of severe TTTS in BIRDEM General Hospital 2 within a period of two years. It has been observed in different studies that, the mortality rate of both twins can be as high as 80% in TTTS depending on the stage of diagnosis and progression of the condition if untreated. In both our cases, the outcome was poor due to delayed diagnosis and lack of intrauterine therapies. So, there is an urgent need for timely diagnosis and appropriate management of this rare but complex condition which prompted us to report these two cases.&#x0D; Birdem Med J 2020; 10(3): 207-211

Trends in preterm birth in twin pregnancies in Victoria, Australia, 2007-2017.

Preterm birth is a major cause of perinatal morbidity and mortality worldwide. In many countries, the preterm birth rate in women with a multiple pregnancy is increasing, mostly due to an increase in iatrogenic preterm birth. To investigate trends in preterm birth in twin pregnancies in Victoria, Australia, in relation to maternal and perinatal complications. We conducted a retrospective population-based cohort study in all women with a twin pregnancy who delivered at or after 20weeks of gestation in the state of Victoria, Australia between 2007 and 2017. Annual spontaneous and iatrogenic preterm birth rates were calculated and trends analysed. Incidence of adverse pregnancy outcomes, maternal complications and risk factors for preterm birth were analysed. We studied 12757 women with a twin pregnancy. Between 2007 and 2017 the preterm birth rate increased from 641/1231 (52%) to 803/1158 (69%), mainly due to an increase in iatrogenic preterm birth from 342/1231 (28%) to 567/1158 (49%). This was irrespective of the presence of pregnancy complications. Our study showed neither a decrease in perinatal mortality from 28weeks of gestation nor in preterm average weekly prospective stillbirth risk. Preterm birth rates in twins in Victoria are increasing, mainly driven by an increase in iatrogenic preterm birth. This occurred both in complicated and non-complicated twin pregnancies, and has not been accompanied by reduction in perinatal mortality from 28weeks.

The influence of oxygen concentration during embryo culture on obstetric and neonatal outcomes: a secondary analysis of a randomized controlled trial.

Does oxygen concentration during 3-day embryo culture affect obstetric and neonatal outcomes? Oxygen concentration during 3-day embryo culture does not seem to affect the obstetric and neonatal outcomes measured. Atmospheric oxygen appears to be harmful during extended embryo culture. Embryo culture conditions might therefore be a potential risk factor for subsequent fetal development and the health of future children. No data are available concerning the obstetrics and neonatal outcomes after Day 3 transfer of embryos cultured under reduced and atmospheric oxygen tensions. A secondary analysis of a previous randomized controlled trial assessing clinical pregnancy outcomes was carried out. This analysis included 1125 consecutive oocyte donation cycles utilizing ICSI or IVF and Day 3 embryo transfers between November 2009 and April 2012. The whole cohort of donated oocytes from patients who agreed to participate in the study were randomly allocated (1:1 ratio) to a reduced O2 tension group (6% O2) or an air-exposed group (20% O2) based on a computer-generated randomization list. Fresh and vitrified oocytes were used for oocyte donation. Only those pregnancies with a live birth at or beyond 24 weeks of gestation were included. Day 3 embryos were cultured in an atmosphere of 5.5% CO2, 6% O2, 88.5% N2 versus a dual gas system in air. From the eligible 1125 cycles, 564 were allocated to the 6% O2 group and 561 cycles to the 20% O2 group. However, 50 and 62 cycles did not reach embryo transfer in the 6% and 20% O2 groups, respectively. No differences were found between 6% O2 and atmospheric O2 tension in the number of livebirths per embryo transfer (mean ± SD, 0.5 ± 0.7 versus 0.5 ± 0.7), pregnancy complications or neonatal outcomes. Both groups (6% and atmospheric O2) had similar single and twin delivery rates (40.8% versus 38.1% and 10.7% versus 12.3%, respectively). Preterm delivery rates and very preterm delivery rates (10.80% versus 13.24% and 1.25% versus 2.94%, respectively), birthweight (3229 ± 561 g versus 3154 ± 731 g), low birthweight (2.92% versus 2.45%), birth height (50.18 ± 2.41 cm versus 49.7 ± 3.59 cm), head circumference (34.16 ± 1.87 cm versus 33.09 ± 1.85 cm) and 1 min Apgar scores (8.96 ± 0.87 versus 8.89 ± 0.96) were also similar between 6% and atmospheric O2 groups, respectively. The number of liveborns finally analyzed is still small and not all obstetric and neonatal variables could be evaluated. Furthermore, a small proportion of the obstetric and neonatal data was obtained through a questionnaire filled out by the patients themselves. One reason for the lack of effect of oxygen concentration on pregnancy outcome could be the absence of trophectoderm cells at cleavage stage, which may make Day 3 embryos less susceptible to hypoxic conditions. Nowadays many IVF laboratories use a more physiological oxygen concentration for embryo culture. However, the benefits of using low oxygen concentration on both laboratory and clinical outcomes during embryo culture are still under debate. Furthermore, long-term studies investigating the effect of using atmospheric O2 are also needed. Gathering these type of clinical data is indeed, quite relevant from the safety perspective. The present data show that, at least in egg donation cycles undergoing Day 3 embryo transfers, culturing embryos under atmospheric oxygen concentration seems not to affect perinatal outcomes. The present project was supported by the R + D program of the Regional Valencian Government, Spain (IMPIVA IMDTF/2011/214). The authors declare that they have no conflict of interest with respect to the content of this manuscript. NCT01532193.

Şanlıurfa Yöresinde Selekte Edilen Bazı Badem (Prunus amygladus L.) Gen Kaynaklarının Meyve Özellikleri

Bu çalışma, 2017-2018 yılları arasında Şanlıurfa merkez ilçesi, Hilvan, Bozova ve Suruç ilçelerinde doğal olarak tohumdan yetişmiş çöğür badem ağaçlarının meyve özellikleri belirlenmesi amacıyla yürütülmüştür. Bölgede kendiliğinden yetişen doğal badem popülasyonu içerisinde seleksiyon kriterleri doğrultusunda ilk yıl 102 genotipin, ikinci yıl 43 genotipin bazı morfolojik ve pomolojik özellikleri tanımlanmıştır. Araştırma sonucunda tartılı derecelendirme yöntemi kullanılarak 21 genotip çiçeklenme ve kalite durumlarına göre ümitvar olarak seçilmiştir. Tam çiçeklenme dönemleri 2017 yılında 10 Mart-26 Mart tarihleri arasında gerçekleşirken; 2018 yılında 22 Şubat-21 Mart tarihleri arasında gerçekleşmiştir. Kabuklu meyve ağırlıkları 2.31-6.84 g, iç badem ağırlıkları 0.74-1.34 g, iç oranları %18.21-41.26 arasında değiştiği saptanmıştır. Kabuk kalınlıklarının 2.23-3.48 mm, çift ve ikiz iç oranının % 0, ve sağlam iç oranlarının % 60-100 arasında değiştiği tespit edilmiştir. Genotiplerin meyve şekli 18 genotipte, uzun oval, 2 genotipte kalp ve 1 genotipte elips grubunda yer almıştır. Genotipler iç rengi bakımından incelendiğinde ise l genotip açık, 7 genotip orta açık, 11 genotip koyu ve 2 ise çok koyu olarak değerlendirilmiştir.

The effect of perceptual decision-making on the interpretation of twin fetal heart rate tracings

Objective Decision-making is an integrative process during which multiple sources of available evidence are combined into a singular response. Importantly, subconscious processes occur in perceptual decisions that may influence interpretations of visually displayed data such as fetal heart rate tracings (FHRT), which are typically presented together for twins. To examine the potential impact of subconscious perceptual influences on fetal well-being, differences in assessments of FHRTs for twin gestations presented singly or paired were evaluated for baseline fetal heart rate, variability, accelerations, decelerations, and overall concern. Study design Obstetrical nurses (N = 27) assessed FHRTs from 20 twin gestations (each of which had at least one live birth with a 5-min Apgar <7) presented either on the same tracing or as singletons on separate tracings. Nurses were naïve to the fact that the fetal heart rate tracings presented in the unpaired condition were the same as those presented in the paired condition. Assessments were then compared between the two conditions. Results Each nurse participant completed ratings on five metrics for each of 20 twin gestations across two conditions (80 FHRT assessments, 400 metrics total per participant). The intraobserver impact of visual context was calculated as the frequency of changed opinions regarding an individual metric (e.g. variability) between the paired and unpaired contexts for each individual fetal heart rate. Assessments of variability (average Kappa = 0.59), decelerations (average Kappa = 0.34), and overall level of concern (average Kappa = 0.33) were moderately to heavily impacted by viewing condition (unpaired vs. paired FHRT). Analysis of interobserver agreement using intraclass correlations (two-way random effect, absolute agreement) indicates poor agreement on unpaired assessments for both accelerations (ICC = 0.01, 95% CI −0.01–0.04) and decelerations (ICC = 0.22, 95% CI 0.15–0.33). These results are mirrored in poor agreement on paired assessments for both accelerations (ICC = 0.00, 95% CI −0.01–0.03) and decelerations (ICC = 0.27, 95% CI 0.19–0.39). There was moderate agreement on overall level of concern for unpaired assessments (ICC = 0.55, 95% CI 0.44–0.67) and near moderate agreement for the paired condition (ICC = 0.45, 95% CI 0.34–0.58). Conclusions The simultaneous presentation of fetal heart rate tracings in twin gestations introduces both intraobserver and interobserver variances in the interpretation of variability, accelerations, and decelerations, likely due to the influence of subconscious perceptual decision-making. This may theoretically affect outcomes in cases in which visual information is nuanced. More research is necessary to determine whether the standard protocol of simultaneous assessment of FHRT in twins is subliminally affected by perceptual decision-making.

Metabolic and Population Effects of Winter Tick Infestations on Moose: Unique Evolutionary Circumstances?

Moose (Alces alces) have evolved to store adequate body fat to emerge from winter in adequate nutritional condition that is key to annual productivity and neonatal survival. Blood consumption by winter ticks (Dermacentor albipictus) affects survival and productivity of moose, often resulting in marked local and regional die-offs of the calf segment of the population. Concurrent with an unprecedented frequency of winter tick epizootics (> 50% calf mortality) in the northeastern United States, productivity but not mortality of adult female moose has also declined due to low rates of twinning and calving. Chronic blood loss to winter ticks affects protein and energy balance in late winter-early spring when pregnant cows are in their energy- and protein-costly 3rd trimester, and will eventually calve and lactate initially in an environment low in digestible energy and protein. To describe this dynamic, I calculated the endogenous fat and protein balance of different-sized pregnant cows by developing energy balance equations that accounted temporally for gestation, winter tick infestation, and lactation under two consumption levels. The analysis revealed the critical importance of body mass and body fat as only large cows (25% pre-winter body fat) were immune from depletion of body fat at birth in all scenarios. Mid-sized cows (20% body fat) depleted fat reserves during gestation in most scenarios, and small cows (15% body fat) in all scenarios. The infestation and forage consumption levels influenced the predicted date of fat depletion up to several weeks, and failed calving or mortal mass loss associated with rapid loss of endogenous protein was possible in mid-sized and small cows. The continual decline in demographic parameters points to reduced body mass and body fat over time, or increased numbers of mid-sized and small cows in the population. Recent research is suggestive of a self-sustaining relationship largely influenced, ironically, by quality habitat and patterns of habitat use. This regional population is confronted with a unique and sustained combination of environmental and parasitic conditions associated with a warming climate that markedly affects its survival and reproduction in quality habitat, a unique occurrence in their evolutionary history.

The role of Mn on twinning behavior and tensile properties of coarse- and fine-grained Fe–Mn–C twinning-induced plasticity steels

The twinning behavior, strain hardening and tensile properties of coarse- and fine-grained Fe-13/18/22Mn-1.0C twinning-induced plasticity (TWIP) steels were investigated by microstructural observations and mechanical tests. These steels have stacking fault energy ranging from ~27 to ~37 mJ/m2 with increasing Mn content, and thus deformation twinning is the dominant mechanism. Tensile test results show that, with increasing Mn content, the yield and tensile strengths decrease slightly for both coarse- and fine-grained steels while the ductility increases significantly, especially for coarse-grained steels. Microstructural observations indicate that, at lower strains, an increase in Mn content suppresses the formation of twins, resulting in a lower twinning rate; however, at intermediate and higher strains, even higher twinning rate is observed in higher-Mn steels. In addition, increasing Mn content enables deformation twins to form in a wider range of strain. Such a varying twinning behavior with Mn content is even more apparent for coarse-grained steels. Furthermore, the sizes of twins vary with Mn content and also with grain size: both the thickness and spacing of twins or twin bundlers increase with increasing Mn content but decrease with refining grain sizes. Moreover, increasing Mn content decreases strain-hardening rate, but allows persistent strain hardening to higher strains. These strain-hardening behaviors and tensile properties observed in the twinning-dominated Fe–Mn–C steels with different Mn contents are correlated well their microstructural evolutions.

Inducing ovulation with the GnRH analogue dephereline in a five-day progesterone-based fixed-time AI protocol improves embryo survival in anestrous dairy cows

This study compares the fertility effects of inducing ovulation using the GnRH analogue dephereline versus natural GnRH at the end of a 5-day progesterone(P4)-based protocol for fixed-time artificial insemination (FTAI) in heat-stressed and non-heat stressed anestrous lactating dairy cows. Cows were given GnRH (GnRH group, n = 676) or dephereline (DEPH group, n = 655) and inseminated 12 hours later. Based on odds ratios, pregnancy loss was 3.6 times more likely in cows carrying twins (P < 0.0001) and 0.4 times less likely in DEPH treated cows (P = 0.0005). No significant effects of treatment on the pregnancy rate were identified by binary logistic regression and the variables examined did not influence the twin pregnancy rate. In conclusion, compared to treatment with GnRH, dephereline given at the end of a 5-day P4-based protocol for FTAI reduced the risk of pregnancy loss regardless of the presence or absence of heat stress.

Correlation of Strain Path, Texture, Twinning, and Mechanical Properties in Twinning-Induced Plasticity Steel during Wire Drawing.

The effect of changing the strain path on texture development, twin kinetics, and mechanical properties in twinning-induced plasticity steel was investigated to understand twinning behavior in more detail. Among the various plastic deformation processes, the wire drawing process was selected to achieve the aims of the study. Specimens of cold-drawn TWIP steel wire under the same effective strain but with different crystallographic textures were successfully fabricated using the effect of the wire drawing direction. Electron backscatter diffraction results showed that the drawn wires using both unidirectional (UD) and reverse-directional (RD) wire drawing processes were characterized as duplex fiber textures of major <111> and minor <100>. It was found that the RD wire had a higher fraction of <111> component at both the center and surface areas compared to the UD wire, because the metal flow of the RD wire was beneficial for the development of a <111> orientation. The pronounced <111> crystallographic orientation of the RD wire activated the twinning rate and geometrically necessary dislocation density, leading to an increase in strength but a decrease in ductility. The strain path is as important as the amount of strain for strengthening the materials, especially those that are deformed by twinning.

Do state insurance mandates alter ICSI utilization?

BackgroundAssisted reproductive technology (ART) insurance mandates resulted in improved access to infertility treatments like intracytoplasmic sperm injection (ICSI). Our objective was to examine whether ART insurance mandates demonstrate an increased association with ICSI use.MethodsIn this retrospective cohort study, clinic-specific data for 2000–2016 from the Centers for Disease Control (CDC) were grouped by state and subgrouped by the presence and extent of ART state insurance mandates. Mandated (n = 8) and non-mandated (n = 22) states were compared for ICSI use and male factor (MF) infertility in fresh non-donor ART cycles with a transfer in women < 35 years. Clinical pregnancy (CPR), live birth (LBR) rates, preimplantation genetic testing (PGT), elective single-embryo transfer (eSET) and twin birth rates per clinic were evaluated utilizing Welch’s t-test. Pearson correlation was used to measure the strength of association between MF and ICSI; ICSI and CPR, and ICSI and LBR over time. Results were considered statistically significant at a p-value of < 0.05, with Bonferroni correction used for multiple comparisons.ResultsFrom 2000 to 2016, ICSI use per clinic increased in both mandated and non-mandated states. ICSI use per clinic in non-mandated states was significantly greater from 2011 to 2016 (p < 0.05, all years) than in mandated states. Clinics in mandated states had less MF (30.5 ± 15% vs 36.7 ± 15%; p < 0.001), lower CPR (39.8 ± 4% vs 43.4 ± 4%; p = 0.02) and lower LBR (33.9 ± 3.5% vs 37.9 ± 3.5%; p < 0.05). PGT rates were not significantly different. ICSI use in non-mandated states correlated with MF rates (r = 0.524, p = 0.03). A significant correlation between ICSI and CPR (r = 0.8, p < 0.001) and LBR (r = 0.7, p < 0.001) was noted in mandated states only. eSET rates were greater and twin rates were lower in mandated compared with non-mandated states.ConclusionsThere was greater use of ICSI per clinic in non-mandated states, which correlated with an increased frequency of MF. In mandated states, lower ICSI rates per clinic were accompanied by a positive correlation with CPR and LBR, as well as a trend for greater eSET rates and lower twin rates, suggesting that state mandates for ART coverage may encourage more selective utilization of laboratory resources.

The contribution of twins conceived by in vitro fertilization to preterm birth rate: observations from a quarter of century.

Objective Little information exists related to the contribution of assisted reproductive technology (ART) twins to the preterm and very preterm birth rate. We sought to examine this contribution over a period of more than two decades in a tertiary perinatal center. Methods We identified all preterm births from 1993 to 2017, born at <37 or <32 weeks' gestation, by mode of conception [in vitro fertilization (IVF) vs. non-IVF pregnancies]. We generated trend lines of the annual change of the dependent variable (% preterm birth). Results We evaluated 74,299 births, including 3934 (5.3%) preterm births at <37 and 826 (1.1%) at <32 weeks' gestation. In this period, 1019 (1.4%) twin pairs were born including 475 (46.6%) and 80 (7.8%) at <37 and <32 weeks, respectively. There were 213 (5.4%) IVF pregnancies among the preterm births at <37 weeks, including 88 (41.3%) twins. Fifteen (1.8%) births of all IVF gestations were at <32 weeks, and all were twins. Whereas the annual rate of spontaneous twins did not change, a significant increase over time exists for IVF twins (P < 0.05, R2 = 0.6). We demonstrated an increase in IVF twin births at <37 weeks but not for spontaneously conceived twins. Whereas the twin birth rate at <32 weeks did not change over time, all preterm births at <32 weeks following IVF were twins. Conclusions The risk of twins after ART increasingly contributes to preterm births at <37 weeks and ART twins are at significant risk for preterm births at <32 weeks.