Body weight gain induced by atypical antipsychotics: an extension of the monocygotic twin and sib pair study

Background and objective: In our original study based on five monozygotic twin pairs and seven same‐sex sib pairs, we previously showed that genetic factors contribute to body weight gain induced by the atypical antipsychotic clozapine. We aim to study this further by including patients treated with the atypical antipsychotics olanzapine or risperidone as well as opposite‐sex sib pairs. Methods: Twin and sib pairs were identified by a telephone screening. Measured data on weight and other clinical variables were obtained cross‐sectionally and retospectively from medical records. In seven monozygotic twin pairs and 12 sib pairs (total number of patients treated: n = 38, mean age 29·5 ± 9·5, range 13·7–54·3 years), the similarity in BMI (kg/m²) change under these atypical antipsychotics (atypical ΔBMI) and upon additional inclusion of BMI change under prior antipsychotic medication (total ΔBMI) was explored. Results: For total ΔBMI we found greater similarity in antipsychotic‐induced BMI change in MZ twin pairs than in sib pairs (intrapair difference) with a heritability of h² = 0·6, but not for atypical ΔBMI, possibly because of a genetically influenced weight plateau achieved under antipsychotic medication. Conclusion: The results of the present and our previous report suggest a contribution of genetic factors in antipsychotic‐induced weight gain of 60–80%.     

钬激光治疗双胎输血综合征患者的围术期护理

总结9例钬激光治疗双胎输血综合征（twin—twin transfusion syndrome，TTTS）患者的围术期护理体会。术前做好心理护理和必要的社会支持、评估患者双胎妊娠风险及护理，术后监测生命体征、加强胎心及胎儿活动监测、密切体位观察与管理是确保TTTS患者手术取得顺利的关键。     

Pseudoamniotic Band Syndrome After Fetoscopic Laser Ablation of Placental Anastomoses for Twin‐Twin Transfusion Syndrome: Two Case Reports and Systematic Review

Pseudoamniotic band syndrome is a rare complication that occurs after invasive procedures for complicated monochorionic twins. We report 2 cases of intrauterine recipient fetal death after laser therapy for twin‐twin transfusion syndrome due to umbilical cord constriction by the amniotic band.     

Nuchal translucency thickness in monochorionic multiple pregnancies: value in predicting pregnancy outcome.

OBJECTIVES: The purpose of this study was to investigate the value of first-trimester nuchal translucency (NT) thickness in predicting the pregnancy outcome in monochorionic multiple pregnancies. METHODS: Thirty monochorionic multiple pregnancies were evaluated for NT thickness at a median gestational age of 12 weeks (range, 11-14 weeks). Information on pregnancy outcome was obtained from all cases. A poor pregnancy outcome was defined as fetal death or miscarriage before 24 weeks, development of twin-twin transfusion syndrome (TTTS), or preterm delivery before 32 weeks. RESULTS: The NT thickness was above the 95th percentile for gestational age in at least 1 fetus in 5 (17%) pregnancies, and a poor pregnancy outcome was recorded in 14 (47%) pregnancies. The overall sensitivity was 36% (5/14); specificity, 100% (16/16); positive predictive value, 100% (5/5); and negative predictive value, 64% (16/25). In pregnancies with increased compared with normal NT thickness, no significant correlation was found with the subsequent development of TTTS (1/5 [20%] versus 5/25 [20%]) and miscarriage or fetal death before 24 weeks (1/5 [20%] versus 3/25 [12%]). However, among the 20 pregnancies not complicated by TTTS or loss before 24 weeks, there was a significantly increased rate of delivery before 32 weeks in the former group (3/4 [75%] versus 1/16 [6.3%]; P = .01). CONCLUSIONS: In monochorionic multiple pregnancies, an increased NT thickness measurement had a high specificity and positive predictive value for adverse perinatal outcomes. However, the sensitivity and negative predictive value were low, with a normal NT thickness measurement poorly predicting development of complications; therefore, close sonographic follow-up should be carried out in all cases, irrespective of NT thickness.     

Prenatal Diagnosis of Spontaneous Septostomy of the Dividing Membranes in Complicated Monochorionic Diamniotic Multiple Gestations

Objective. The purpose of this series is to describe the prenatal diagnostic and management challenges of spontaneous septostomy of the dividing membrane (SSDM) in complicated monochorionic diamniotic (MoDi) pregnancies. Methods. A retrospective review of all MoDi multiple gestations referred for fetal therapy was conducted. Spontaneous septostomy of the dividing membrane was suspected if a prior invasive procedure had not been performed and the following sonographic hallmarks were identified: twins occupying the same side of the dividing membrane, twin‐twin transfusion syndrome (TTTS) with polyhydramnios in the donor's sac despite a collapsed donor bladder, and umbilical cord entanglement. Spontaneous septostomy of the dividing membrane was confirmed in all cases at the time of surgical fetoscopy, which was performed to treat an underlying condition of TTTS, selective intrauterine growth restriction (SIUGR), or the twin reversed arterial perfusion (TRAP) sequence. Results. Of 217 complicated MoDi multiple gestations without prior invasive procedures referred for possible fetal therapy, 4 (1.8%) were identified with SSDM. The mean (range) gestational age at diagnosis was 19.7 (18–20.9) weeks. Two cases were diagnosed with TTTS complicated by SSDM after both fetuses were identified on the same side of the dividing membranes (1 case) or polyhydramnios was noted in the donor's sac despite a collapsed donor bladder (1 case). Both cases had substantial preoperative fetal deterioration because of a delay in diagnosis and treatment of TTTS. The remaining 2 SSDM cases, 1 with SIUGR and 1 with the TRAP sequence, were diagnosed after umbilical cord entanglement was recognized. Conclusions. Spontaneous septostomy of the dividing membrane in MoDi gestations is a rare condition that poses diagnostic and management challenges.     

Spontaneous unilateral dizygotic twin tubal pregnancy

Spontaneous dizygotic unilateral twin tubal pregnancy is an extremely rare occurrence with a high risk for pregnancy-related mortality, and a diagnostic challenge for obstetricians. We present a case of a 27-year-old woman with spontaneous twin tubal pregnancy. Transvaginal color Doppler sonography revealed 2 separate gestational sacs within the right adnexa, each containing an embryo. Cytogenetic examination of the trophoblastic tissues confirmed the diagnosis of dizygotic twin ectopic pregnancy. Clinical signs and symptoms together with imaging studies help in the diagnosis of this rare variant of ectopic pregnancies.     

复式脉冲体外震波碎石治疗肾结石(附467例报告)

目的探讨复式脉冲HB-V型低能量体外碎石机治疗肾结石的治疗效果及并发症。方法采用复式脉冲HB-ESWL-VG型低能量碎石机治疗直径<2.0 cm的各类肾结石467例,治疗工作电压3~9 kV,平均冲击次数2 300次。结果467例肾结石患者中,上中盏结石排净率89.5%,复打率为13.2%;下盏结石的排净率81.6%,复打率为17.4%。肾盂结石粉碎率98.6%,排净率92.9%,复打率5.7%。结论复式脉冲低能量ESWL治疗肾结石,具有治疗成功率高,复打率低的优点。