Risk Profiling of the Solomon Technique versus Selective Technique of Fetoscopic Laser Surgery for Twin–Twin Transfusion Syndrome

We evaluated the outcomes and adverse events after fetoscopic laser surgery (FLS) for twin–twin transfusion syndrome (TTTS) using the Solomon technique in comparison to the selective technique. A retrospective analysis of a single-center consecutive cohort of FLS-treated TTTS using the selective (January 2010 to July 2014) and Solomon (August 2014 to December 2017) techniques was performed. Among 395 cases, 227 underwent selective coagulation and 168 underwent the Solomon technique. The incidence rates of recurrent TTTS (Solomon vs. selective: 0% vs. .9%, p = .510) and twin anemia–polycythemia sequence (.6% vs. .4%, p = .670) were very low in both groups. The incidence rates of placental abruption (Solomon vs. selective: 10.7% vs. 3.5%, p = .007) and preterm premature rupture of the membranes (pPROM) with subsequent delivery before 32 weeks (20.2% vs. 7.1%, p < .001) were higher in the Solomon group. The median birth recipient weight was significantly smaller in the Solomon group (1790 g vs. 1933 g, p = .049). The rate of survival of at least one twin was significantly higher in the Solomon group (98.2% vs. 93.8%, p = .046). The Solomon technique and total laser energy were significant risk factors for pPROM (odds ratio: 2.64, 1.07, 95% CI [1.32, 5.28], [1.01, 1.13], p = .006, p = .014, respectively). These findings suggest that the Solomon technique led to superior survival outcomes but increased risks of placental abruption, pPROM and fetal growth impairment. Total laser energy was associated with the occurrence of pPROM. Close attention to adverse events is required for perinatal management after FLS to treat TTTS using the Solomon technique.

Mono-6-Deoxy-6-Aminopropylamino-β-Cyclodextrin on Ag-Embedded SiO2 Nanoparticle as a Selectively Capturing Ligand to Flavonoids

It has been increasingly important to develop a highly sensitive and selective technique that is easy to handle in detecting levels of beneficial or hazardous analytes in trace quantity. In this study, mono-6-deoxy-6-aminopropylamino-β-cyclodextrin (pr-β-CD)-functionalized silver-assembled silica nanoparticles (SiO2@Ag@pr-β-CD) for flavonoid detection were successfully prepared. The presence of pr-β-CD on the surface of SiO2@Ag enhanced the selectivity in capturing quercetin and myricetin among other similar materials (naringenin and apigenin). In addition, SiO2@Ag@pr-β-CD was able to detect quercetin corresponding to a limit of detection (LOD) as low as 0.55 ppm. The relationship between the Raman intensity of SiO2@Ag@pr-β-CD and the logarithm of the Que concentration obeyed linearity in the range 3.4–33.8 ppm (R2 = 0.997). The results indicate that SiO2@Ag@pr-β-CD is a promising material for immediately analyzing samples that demand high sensitivity and selectivity of detection.

Sistem Kriptografi Citra Digital Pada Jaringan Intranet Menggunakan Metode Kombinasi Chaos Map Dan Teknik Selektif

Many organizations use design applications to draw the products they create. The drawings are digital files that have various formats of type and size. The images sometimes have to be protected because they are secret designs, such as the design of military vehicles, weapons and other designs. In order to secure digital data, cryptography is one of the solution, including if the data to be secured in the form of digital images. Algorithms that can be used to perform cryptography in digital image one of them is chaos map using Arnold cat map, logistics map and application of selective technique. Chaos was chosen for three reasons: sensitivity to initial conditions, random behavior, and no repetitive periods. While the application of selective technique means only encrypt some elements in the image but the effect of the whole image is encrypted. Cryptography in the image is also implemented because the organization using an intranet network to deliver its design drawings from one division to another. This allows for data tapping or exploitation of digital images while inside the intranet network. So it is necessary to develop a cryptographic system on the intranet network that has the ability to secure digital images that are in the network. The results obtained from black box testing, white box and network security testing show that the built system has been able to secure digital images when sent over the organization's intranet network. Index Terms—Cryptography, Image, Chaos Map Algorithm, Selective Technique, Intranet.

Laser Treatment of Twin–to–Twin Transfusion Syndrome

Objective: Laser ablation of all placental vascular anastomoses is the optimal treatment for twin–twin transfusion syndrome (TTTS). However, two important controversies are apparent in the literature: (a) a gap between concept and performance, and (b) controversy regarding whether all the anastomoses can be identified endoscopically and whether blind lasering of healthy placenta is justified. The purpose of this article is: (a) to address the potential source of the gap between concept and performance by analyzing the fundamental steps needed to successfully accomplish the surgery, and (b) to discuss the resulting competency benchmarks reported with the different surgical techniques. Materials and Methods: Laser surgery for TTTS can be broken down into two fundamental steps: (1) endoscopic identification of the placental vascular anastomoses, (2) laser ablation of the anastomoses. The two steps are not synonymous: (a) regarding the endoscopic identification of the anastomoses, the non-selective technique is based upon lasering all vessels crossing the dividing membrane, whether anastomotic or not. The selective technique identifies and lasers only placental vascular anastomoses. The Solomon technique is based on the theory that not all anastomoses are endoscopically visible and thus involves lasering healthy areas of the placenta between lasered anastomoses, (b) regarding the actual laser ablation of the anastomoses, successful completion of the surgery (i.e., lasering all the anastomoses) can be measured by the rate of persistent or reverse TTTS (PRTTTS) and how often a selective technique can be achieved. Articles representing the different techniques are discussed. Results: The non-selective technique is associated with the lowest double survival rate (35%), compared with 60–75% of the Solomon or the Quintero selective techniques. The Solomon technique is associated with a 20% rate of residual patent placental vascular anastomoses, compared to 3.5–5% for the selective technique (p < .05). Both the Solomon and the selective technique are associated with a 1% risk of PRTTTS. Adequate placental assessment is highest with the selective technique (99%) compared with the Solomon (80%) or the ‘standard’ (60%) techniques (p < .05). A surgical performance index is proposed. Conclusion: The Quintero selective technique was associated with the highest rate of successful ablation and lowest rate of PRTTTS. The Solomon technique represents a historical backward movement in the identification of placental vascular anastomoses and is associated with higher rate of residual patent vascular communications. The reported outcomes of the Quintero selective technique do not lend support to the existence of invisible anastomoses or justify lasering healthy placental tissue.