The Efficacy of Fetoscopic Laser Surgery in Twin-Twin Transfusion Syndrome: A Preliminary Vietnamese Study.

Background: Twin-twin transfusion syndrome (TTTS) is a severe prenatal complication of monochorionic diamniotic twins (MCDA). If left untreated, TTTS is associated with a high risk of neonatal death and neurological complications. Various treatment methods for TTTS have been proposed, but fetoscopic laser surgery (FLS) is currently the primary treatment for TTTS in global fetal medicine centers. The objective of this study was to evaluate the outcome of TTTS following FLS treatment at Hanoi Obstetrics and Gynecology Hospital (HOGH), a new fetal medicine center in Vietnam. Methods: A prospective study of a series of 33 consecutive TTTS cases prior to 26 weeks of gestation subjected to FLS at HOGH in Vie-tnam between September 2019 to July 2021. Neonates were monitored for at least six months after birth. Results: The survival rate of at least one fetus reached 84.85%. No short-term neurological complications have been reported upon follow-up of the newborn up to six months after birth. There were three stillbirth cases (9.09%), one case of preterm ruptured membra-nes (PROM) (3.03%) after seven days of surgery and three cases of recurrent TTTS after surgery using the Solomon technique (25%). No maternal complications were observed. The mean gestational age at birth was 33.76 ± 4.52 weeks, with a mean interval of 12.24 ± 6.67 weeks between intervention and delivery. Nine cases (30%) were born prematurely before 32 weeks. Additionally, 60% of recipients and nearly 90% of donors weighed less than 2500 grams. Conclusions: FLS leads to high survival rates for fetuses with TTTS. FLS seems to be an effective therapeutic option for TTTS before 26 weeks of gestation.

Obstetric and Perinatal Outcomes of Dichorionic-Diamniotic Twin Pregnancies Conceived by IVF/ICSI Compared with Those Conceived Spontaneously.

Introduction: This study aimed to investigate differences in mater-nal and perinatal outcomes between dichorionic-diamniotic (DCDA) twin pregnancies between those conceived spontaneously and those conceived through in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI). Methods: This study was a single-center, retrospective cohort study. All women with DCDA twin pregnancies were considered for inclusion. Monochorionic twins and higher-order multiple pre-gnancies were excluded. All data related to maternal and perinatal outcomes were extracted from the hospital database and compared between spontaneously conceived DCDA twin pregnancies and those conceived by IVF/ICSI. Multivariable logistic regression was used to adjust for confounders to determine factors associated with maternal and perinatal outcomes. Results: Of 739 identified DCDA twin pregnancies, 483 (65.4%) were conceived through IVF/ICSI treatment (IVF/ICSI group), and 256 (34.6%) were spontaneously conceived (SC group). Women in the IVF/ICSI group were older and had fewer previous live births than women in the SC group. The women in the IVF/ICSI group had significantly higher risks of preeclampsia (adjusted odds ratio [aOR]: 2.50; 95% confidence interval [CI]: 1.12-5.55), cesarean delivery (aOR: 2.0; 95% CI: 1.27-3.17), an postpartum hemorrhage following cesarean section (aOR: 3.15; 95% CI: 1.53-6.45). The DCDA twins in the IVF/ICSI group were delivered at an earlier gestational age (36.2 vs. 36.7 weeks, p < 0.001), had slightly lower mean birth weights (2298 vs. 2367 g, p = 0.005), and required more respiratory support (aOR: 0.69; 95% Cl: 0.48-0.98) than those in the SC group. Conclusions: Our study demonstrated that women with DCDA twin pregnancies conceived through IVF/ICSI experienced more complications than those with SC DCDA twin pregnancies. Newborns in the IVF/ICSI group had a slightly lower mean birth weight and required respiratory support more frequently, but no other significant differences in perinatal outcomes or perinatal mortality were observed between the two groups.

Altered lymphocyte acetylcholinesterase activity in patients with senile dementia.

Reductions in the acetylcholinesterase (AChE) activity of certain brain areas in patients with senile dementia of Alzheimer type (SDAT) have been found to correlate with the severity of the disease, suggesting a central cholinergic lesion. Since AChE is expressed on the surface of various blood cells too, the AChE activity of lymphocytes and erythrocytes was determined to test the possibility whether the cholinergic lesion is also reflected on these readily available cells. The AChE activity of lymphocytes in SDAT and in alcoholic dementia (AD) were significantly lower as compared to those of the age-matched healthy volunteers. In contrast, there was no significant difference in the activity of lymphocyte AChE between age-matched healthy controls and patients with multi-infarct dementia of vascular origin (MID). No changes could be demonstrated in the erythrocyte AChE activities of the patients studied, and the age-matched healthy individuals, when comparing them to the healthy blood donors. The AChE activity of lymphocytes may thus be a useful marker to follow the alterations in the metabolism of acetylcholine (ACh) in the central nervous system (CNS) of different types of dementia.