Post-Laser Twin Anemia Polycythemia Sequence: Diagnosis, Management, and Outcome in an International Cohort of 164 Cases.

The aim of this study was to investigate the management and outcome in the post-laser twin anemia polycythemia sequence (TAPS). Data of the international TAPS Registry, collected between 2014 and 2019, were used for this study. The primary outcomes were perinatal mortality and severe neonatal morbidity. Secondary outcomes included a risk factor analysis for perinatal mortality and severe neonatal morbidity. A total of 164 post-laser TAPS pregnancies were included, of which 92% (151/164) were diagnosed antenatally and 8% (13/164) postnatally. The median number of days between laser for TTTS and detection of TAPS was 14 (IQR: 7-28, range: 1-119). Antenatal management included expectant management in 43% (62/151), intrauterine transfusion with or without partial exchange transfusion in 29% (44/151), repeated laser surgery in 15% (24/151), selective feticide in 7% (11/151), delivery in 6% (9/151), and termination of pregnancy in 1% (1/151). The median gestational age (GA) at birth was 31.7 weeks (IQR: 28.6-33.7; range: 19.0-41.3). The perinatal mortality rate was 25% (83/327) for the total group, 37% (61/164) for donors, and 14% (22/163) for recipients (p < 0.001). Severe neonatal morbidity was detected in 40% (105/263) of the cohort and was similar for donors (43%; 51/118) and recipients (37%; 54/145), p = 0.568. Independent risk factors for spontaneous perinatal mortality were antenatal TAPS Stage 4 (OR = 3.4, 95%CI 1.4-26.0, p = 0.015), TAPS donor status (OR = 4.2, 95%CI 2.1-8.3, p < 0.001), and GA at birth (OR = 0.8, 95%CI 0.7-0.9, p = 0.001). Severe neonatal morbidity was significantly associated with GA at birth (OR = 1.5, 95%CI 1.3-1.7, p < 0.001). In conclusion, post-laser TAPS most often occurs within one month after laser for TTTS, but may develop up to 17 weeks after initial surgery. Management is mostly expectant, but varies greatly, highlighting the lack of consensus on the optimal treatment and heterogeneity of the condition. Perinatal outcome is poor, particularly due to the high rate of perinatal mortality in donor twins

Arabin cervical pessary for prevention of preterm birth in cases of twin-to-twin transfusion syndrome treated by fetoscopic LASER coagulation: the PECEP LASER randomised controlled trial

Abstract Background Fetoscopic LASER coagulation of the placental anastomoses has changed the prognosis of twin-twin transfusion syndrome. However, the prematurity rate in this cohort remains very high. To date, strategies proposed to decrease the prematurity rate have shown inconclusive, if not unfavourable results. Methods This is a randomised controlled trial to investigate whether a prophylactic cervical pessary will lower the incidence of preterm delivery in cases of twin-twin transfusion syndrome requiring fetoscopic LASER coagulation. Women eligible for the study will be randomised after surgery and allocated to either pessary or expectant management. The pessary will be left in place until 37 completed weeks or earlier if delivery occurs. The primary outcome is delivery before 32 completed weeks. Secondary outcomes are a composite of adverse neonatal outcome, fetal and neonatal death, maternal complications, preterm rupture of membranes and hospitalisation for threatened preterm labour. 352 women will be included in order to decrease the rate of preterm delivery before 32 weeks’ gestation from 40% to 26% with an alpha-error of 0.05 and 80% power. Discussion The trial aims at clarifying whether the cervical pessary prolongs the pregnancy in cases of twin-twin transfusion syndrome regardless of cervical length at the time of fetoscopy. Trial registration ClinicalTrials.gov Identifier: NCT01334489 . Registered 04 December 2011

Treatment and outcome of 370 cases with spontaneous or post-laser twin anemia-polycythemia sequence managed in 17 fetal therapy centers.

OBJECTIVE: To investigate the antenatal management and outcome in a large international cohort of monochorionic twin pregnancies with spontaneous or post-laser twin anemia-polycythemia sequence (TAPS). METHODS: This study analyzed data of monochorionic twin pregnancies diagnosed antenatally with spontaneous or post-laser TAPS in 17 fetal therapy centers, recorded in the TAPS Registry between 2014 and 2019. Antenatal diagnosis of TAPS was based on fetal middle cerebral artery peak systolic velocity > 1.5 multiples of the median (MoM) in the TAPS donor and < 1.0 MoM in the TAPS recipient. The following antenatal management groups were defined: expectant management, delivery within 7 days after diagnosis, intrauterine transfusion (IUT) (with or without partial exchange transfusion (PET)), laser surgery and selective feticide. Cases were assigned to the management groups based on the first treatment that was received after diagnosis of TAPS. The primary outcomes were perinatal mortality and severe neonatal morbidity. The secondary outcome was diagnosis-to-birth interval. RESULTS: In total, 370 monochorionic twin pregnancies were diagnosed antenatally with TAPS during the study period and included in the study. Of these, 31% (n = 113) were managed expectantly, 30% (n = 110) with laser surgery, 19% (n = 70) with IUT (± PET), 12% (n = 43) with delivery, 8% (n = 30) with selective feticide and 1% (n = 4) underwent termination of pregnancy. Perinatal mortality occurred in 17% (39/225) of pregnancies in the expectant-management group, 18% (38/215) in the laser group, 18% (25/140) in the IUT (± PET) group, 10% (9/86) in the delivery group and in 7% (2/30) of the cotwins in the selective-feticide group. The incidence of severe neonatal morbidity was 49% (41/84) in the delivery group, 46% (56/122) in the IUT (± PET) group, 31% (60/193) in the expectant-management group, 31% (57/182) in the laser-surgery group and 25% (7/28) in the selective-feticide group. Median diagnosis-to-birth interval was longest after selective feticide (10.5 (interquartile range (IQR), 4.2-14.9) weeks), followed by laser surgery (9.7 (IQR, 6.6-12.7) weeks), expectant management (7.8 (IQR, 3.8-14.4) weeks), IUT (± PET) (4.0 (IQR, 2.0-6.9) weeks) and delivery (0.3 (IQR, 0.0-0.5) weeks). Treatment choice for TAPS varied greatly within and between the 17 fetal therapy centers. CONCLUSIONS: Antenatal treatment for TAPS differs considerably amongst fetal therapy centers. Perinatal mortality and morbidity were high in all management groups. Prolongation of pregnancy was best achieved by expectant management, treatment by laser surgery or selective feticide. © 2020 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology

Identification of efficient inbred testers to strengthen established heterotic groups in pearl millet (Pennisetum glaucum [L.] R. Br)

Pearl millet has two major heterotic groups, HGB (Heterotic Group B) and HGR (Heterotic Group R), each with unique genetic backgrounds and traits. Leveraging appropriate genetic resources is crucial for enhancing the potential of these heterotic groups in hybrid breeding programmes. Testers are essential in this context, determining the combining ability of new breeding lines and accurately assessing the performance and potential of parental lines in hybrid combinations. Two sets of test crosses were produced using line x tester mating design: Set 1 with six HGB testers crossed with new restorer lines and Set 2 with six HGR testers crossed with new seed parental lines, evaluated at multiple locations in India. Testers were evaluated for their effectiveness using multiple criteria, such as rank correlation analysis for line performance in hybrid combinations, discrimination ability, general combining ability, per se performance and Biplot analysis. These assessments determined their relative ranking, with HGB1-T3, HGB2-T3, HGR1-T1 and HGR2-T1 identified as efficient testers. The genetic analysis helps identify efficient testers for selecting superior genotypes, thereby enhancing heterotic group performance by incorporating appropriate new breeding material

Classification of new germplasm into existing heterotic groups of pearl millet [Pennisetum glaucum (L.) R. Br.]

The study assigned new germplasm, which includes populations and inbreds, to established heterotic groups using various approaches to broaden the existing genetic base while maintaining the heterotic pattern in pearl millet [Pennisetum glaucum (L.) R. Br.]. It utilized 13 pearl millet populations of African and Asian origins and 24 new inbred parents from ICRISAT's breeding program. Testers, both inbred and composite, were employed to categorize these materials into heterotic groups. Different sets of line × tester crosses were generated and evaluated during the rainy season at multiple locations in India. The pearl millet populations were assigned to heterotic group B (seed parental groups) (HGB1 and HGB2) and heterotic group R (pollinator parental groups) (HGR1 and HGR2) based on general combining ability (GCA) and specific combining ability effects. Composite testers were found to be more effective for the heterotic grouping of pearl millet populations. New inbred lines were classified into HGB and HGR based on GCA and hybrid performance using opposite heterotic group testers and also using genetic similarity obtained from genotype-by-sequencing data.The new germplasm classified into heterotic groups will help enhance the genetic gain for the long-term success of pearl millet hybrid breeding programs

A gradient based facile HPLC method for simultaneous estimation of antioxidants extracted from tea powder

A new simple, rapid and precise RP-HPLC method was developed for the extraction and quantitative estimation of caffeine (C), (−)-epigallocatechin gallate (EGCG), (+)-catechin(Ct), (−)-epicatechin(EC), and (−)-epicatechin gallate (ECG) (collectively named as Tea Powder Bioactives TPBAs) extracted from tea powder using different ratios of ethanol: water. The simultaneous determination of TPBAs was performed using the UV spectrophotometric method which employs the absorbance at 205 nm (λmax of caffeine and polyphenols). This method is a gradient based HPLC method with a flow rate of 0.8 mL/min using Inertsil ODS 100 × 4.6 mm, 3 μm column with methanol and ammonium dihydrogen phosphate (pH-2.8) as mobile phase. The method was validated in terms of specificity, precision, linearity, accuracy, limit of quantification (LOQ), and limit of detection (LOD). The linearity of the proposed method was investigated for concentration ranging between 0.5–60 μg/mL with regression co-efficient, R2 = 0.999–1.0. This method estimates all the TPBAs simultaneously with enhanced precision and linearity as per the ICH guidelines. Also, to confirm the individual TPBA, the antioxidant property of the each TPBA was analyzed which was commensurate with that of the previous reports

Assessment of Health Status of Successfully Treated Category I Patients under RNTCP Program, Five Years After Treatment Completion and ndash; A Retrospective Cohort Study from A Coastal District of India

"Background: Tuberculosis remains a major public health problem worldwide and also in India. Inspite of RNTCP being a comprehensive programme for effective management and control of tuberculosis, efficacy of DOTS regimen is questioned by private practitioners. Methods: A retrospective cohort study was carried out in a coastal district of India to assess the health status of successfully treated Category I patients under RNTCP program, five years after treatment completion. An interview was conducted with all the available subjects at their residence using a semi-structured pre-tested interview. Results: Out of 224 registered new sputum positive patients, 177 cases were successfully treated during the recruiting year, accounting for a success rate of 79%. Of the 177 treated patients, 118 were traceable during the study period, out of which 100 subjects had survived after 5 years and were available for the interview. Recurrence of TB was reported in 2 patients during the follow up period. Conclusion: This five years follow up study shows a good long term success rate of TB patient's treatment. Hence, it reaffirms the scientific basis of RNTCP policy of DOTS regimen to be the right strategy for TB control. [Natl J Community Med 2016; 7(5.000): 425-429