First-trimester ultrasonic diagnosis of twin reversed arterial perfusion sequence

Twin reversed arterial perfusion (TRAP) syndrome sequence is a rare specific anomaly of twin gestation with fused placentae and umbilical anastomosis. This syndrome occurs once in very 35 000–48 000 births and has been described in the second trimester (23-29 weeks of gestation). We report on early sonographic diagnosis (10 and 12 weeks' gestation) of two cases of TRAP sequence, together with their umbilical cord Doppler studies.     

Ultrasound diagnostic features of twin reversed arterial perfusion sequence

Two cases of twin reversed arterial perfusion (TRAP) sequence with relevant ultrasound features that would help an accurate diagnosis are described. Available management options are proposed and discussed.     

Discrepancy in placental echogenicity: a sign of twin anemia polycythemia sequence

Twin anemia polycythemia sequence (TAPS) is a form of twin-to-twin transfusion syndrome that occurs very rarely and may not be diagnosed until after delivery. The condition leads to increased risk of perinatal morbidity and mortality. We present two cases of monochorionic diamniotic twins, in which the diagnosis of TAPS was made after documenting a discrepancy in the echodensities of the two portions of the placenta. Postnatal hemoglobin differences between the twins confirmed the diagnosis of TAPS. On the basis of these two cases, it appears that the heterogeneity in placental echogenicity is a sign of TAPS and Doppler measurement of middle cerebral artery peak systolic velocity is helpful for early diagnosis and management with timely delivery. © 2014 John Wiley & Sons, Ltd.     

Selective feticide of the affected twin by fetoscopic air embolism

Three twin pregnancies, each with one affected fetus (by microcephaly, haemophilia A and spina bifida respectively) were encountered. Selective feticide was performed at the patient's request by injection of filtered air into an umbilical vessel by fetoscopy. The method was successful in all three pregnancies two of which resulted in a live, healthy baby.     

Rapid and radical amniodrainage in the treatment of severe twin–twin transfusion syndrome†

We have evaluated the role of a rapid and radical method of amniodrainage in the treatment of severe twin–twin transfusion. The outcome of 15 patients with severe twin–twin transfusion for which a amniodrainage was performed by means of a vacuum bottle system was compared with the outcome of 15 patients with a similar condition, matched for gestational age at the time of the initial procedure and drained using a standard procedure. In the study group the amniodrainage ended when no amniotic fluid could be aspirated, whereas the women in the standard group were drained with a syringe system and the fluid was removed until the deepest amniotic fluid pool was <8 cm. At the initial procedure, the mean volume of amniotic fluid drained was significantly (p<0.05) higher (3252 vs 2153 ml) and the length of the procedure significantly (p<0.001) shorter (21 vs 41 min) in the study group than in the standard group. The mean post-procedure amniotic fluid index was significantly (p<0.001) smaller (2.9 vs 7.7 cm) after radical amniodrainage than after the standard amniodrainage. The mean number of procedures was significantly (p<0.001) lower (1.5 vs 5.6) in the study group compared to the standard group. In the study group the mean placental thickness increased significantly (p<0.001) from 9 mm before the procedure to 49 mm after, and the overall perinatal survival rate was 80% and the proportion of pregnancies with at least one survivor was 93%. The present data indicate that early, rapid and radical amniodrainage is an effective and low-cost therapy for severe twin–twin transfusion syndrome. Compared to the standard amniodrainage technique it also appears to reduce the need for multiple procedures. Copyright © 2001 John Wiley & Sons, Ltd.     

Prenatal diagnosis of hemoglobinopathies in twin pregnancies by double simultaneous fetoscopy

A new technique for sampling fetal blood in twin pregnancies using two fetoscopes simultaneously is described. Two fetoscopes were inserted, one after the other, into both amniotic cavities and fetal blood samples were obtained from either the chorionic plate vessels or the umbilical cord insertion area. The observation of the bright tip of the second fetoscope behind the septum using the first fetoscope assured the successful entry of the two fetoscopes into the two different amniotic sacs. This technique was performed on 15 out of 17 patients. In all patients the fetuses were at risk of β-thalassemia major. Sampling was successful in all cases. Double simultaneous fetoscopy seems to be a safe and accurate technique without technical problems or complications. The simultaneous use of two fetoscopes opens new possibilities in intrauterine fetal surgery and research.     

Genetic amniocentesis in biamniotic twin pregnancies by a single transabdominal insertion of the needle

We present a technique to aspirate amniotic fluid from both sacs in biamniotic twin pregnancies using a single abdominal insertion with a spinal needle. It was successful in 48 out of 55 cases of biamniotic twin pregnancies referred to our perinatal unit between 1985 and 1994. The single insertion technique was used when the inter-amniotic membrane was clearly evident and two separate free amniotic fluid pools could be reached by the operator with a single puncture. An adequate amount of amniotic fluid was sampled from both sacs to make a cytogenetic diagnosis in all cases. There were four fetuses with trisomy 21 in three twin pregnancies. In two cases, only one twin was affected whilst the co-twin was normal, so that a selective feticide was performed. No miscarriages due to genetic amniocentesis were reported. After 1990, all genetic amniocenteses in biamniotic twin pregnancies (except for one case due to late booking) were performed between 14 and 15 weeks of gestation and with all cases except one, it was possible to sample both twins by a single puncture. We suggest that early amniocentesis (14–15 weeks) by a single abdominal puncture could be a reliable and safe alternative to first-trimester chorionic villus sampling in twin pregnancies.     

Non-invasive prenatal testing in the management of twin pregnancies

Twin pregnancies are common and associated with pregnancy complications and adverse outcomes. Prenatal clinical management is intensive and has been hampered by inferior screening and less acceptable invasive testing. For aneuploidy screening, meta-analyses show that non-invasive prenatal testing (NIPT) through analysis of cell-free DNA (cf-DNA) is superior to serum and ultrasound-based tests. The positive predictive value for NIPT is driven strongly by the discriminatory power of the assay and only secondarily by the prior risk. Uncertainties in a priori risks for aneuploidies in twin pregnancies are therefore of lesser importance with NIPT. Additional information on zygosity can be obtained using NIPT. Establishing zygosity can be helpful when chorionicity was not reliably established early in pregnancy or where the there is a concern for one versus two affected fetuses. In dizygotic twin pregnancies, individual fetal fractions can be measured to ensure that both values are satisfactory. Vanishing twins can be identified by NIPT. Although clinical utility of routinely detecting vanishing twins has not yet been demonstrated, there are individual cases where cf-DNA analysis could be helpful in explaining unusual clinical or laboratory observations. We conclude that cf-DNA analysis and ultrasound have synergistic roles in the management of multiple gestational pregnancies.     

污水分析方法监测城市毒品滥用长期趋势

毒品滥用问题是全球广泛关注的社会问题,对城市毒品滥用情况进行长期监测具有重要意义.采用污水流行病学的方法,对大连市毒品的滥用情况进行连续长期调查.2020～2021年采集大连市22个污水处理厂的进口污水,通过气相色谱衍生化方法分析测定甲基苯丙胺、海洛因、氯胺酮、摇头丸和可卡因的生物标志物的浓度,即其尿液代谢产物甲基苯丙...     

某污水处理厂倒置A2/O工艺中制药类污染物的去除规律分析

针对西安市某污水处理厂的倒置A2/O工艺,通过对主要构筑物的布点检测,分析了污水中4种制药类污染物非那西汀、咖啡因、吉非罗齐和胆固醇的浓度变化及其去除规律.结果表明,污水厂进水中非那西汀、咖啡因、吉非罗齐和胆固醇的浓度分别为8.22、127.31、12.93和5.61μg·L-1,整个污水处理工艺中,非那西汀、吉非罗齐和胆固醇主要是被格栅、曝气沉砂池和初沉池去除,咖啡因则以生物降解为主.A2/O生物反应池中,吉非罗齐和胆固醇以厌氧生物降解为主,非那西汀和咖啡因则以好氧生物降解为主.脱水污泥中非那西汀、咖啡因、吉非罗齐和胆固醇的含量分别为0.09、2.62、12.24和0.91μg·g-1,污泥对吉非罗齐的吸附效果最为显著.污水厂出水中制药类污染物的浓度为0.17～1.98μg·L-1,出水中咖啡因的浓度偏高因而需要做进一步的三级处理.     

Long-term impact of municipal sewage irrigation on treated soil and black locust trees in a semi-arid suburban area of Iran

The effects of municipal sewage irrigation on the soil and black locust (Robinia pseudoacacia L.) tree were studied. For this purpose, two artificial black locust stands under irrigation of municipal sewage and well water were selected in south of Tehran, Iran. Data were collected using technique of systematic random sampling with 4 replicates in each stand. It was found that the growth of black locust tree, as indicated by diameter at breast height, total height, crown length, average crown diameter, basal area and volume, in sewage irrigation stand was much higher than that of well water irrigation stand (P < 0.01). Plant analysis indicated that concentrations of leaf nutrients (N, P, K, Ca, Mg, Na, Fe, Mn, Cu and Zn) were greater in sewage-irrigated trees, without toxicity to the minerals of tree leaf, than those of well waterirrigated trees, and positively correlated with their respective value in soil. Ni, Cr and Pb were not detected in leaf samples. Application of sewage resulted in a 1.5-fold increase in the concentrations of soil nutrients, Ni, Cr and Pb. Among these minerals only Pb and Ni in some soil samples exceeded the toxicity limit. The increase in pH, electrical conductivity (EC) and organic carbon of soil was also observed in sewage irrigation. Results confirm that besides the use as irrigation water, municipal sewages are also a potential source of plant nutrients. However, significant accumulation of heavy metals such as Pb and Ni in soil needs to be monitored.     

Long-term stabilization of enzyme activity by immobilizing enzyme colony in polymaleimidostyrene-modified micelles

Amperometric biosensors fabricated by immobilizing enzyme colony in polymaleimidostyrene-modified micelles exhibited good sensitivity and great long-term stability. To our knowledge, there has not been a general design for various enzyme biosensors. Enzyme micelle membrane which is different from any of other conventional immobilization methods, is an innovative way and will be a well-developed biosensor technology to provide rapid and reliable measurements. The potential of using enzyme micelle membrane to fabricate biosensors will be of great hope.