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High-dose melphalan (HDM) plus autologous stem cell transplant (ASCT) remains a standard-of-care treatment approach for eligible patients with newly diagnosed multiple myeloma (NDMM) based on demonstrated superiority in terms of progression-free survival (PFS) versus nontransplant approaches. Very high rates of minimal residual disease (MRD)-negative responses are also being seen with novel triplet and quadruplet induction regimens plus HDM-ASCT. However, recent clinical trials have shown no overall survival benefit with transplant versus nontransplant approaches. Furthermore, HDM is associated with several important downsides, including acute and long-term toxicities, transient decreases in quality of life, the need for hospitalization, an increased mutational burden at relapse, and an elevated risk of second primary malignancies. In this context, given the highly heterogeneous nature of MM in the NDMM patient population, as well as the continued emergence of novel agents and treatment approaches, there is an increasing rationale for considering deferred HDM-ASCT approaches in selected patients. Approaches under investigation include MRD-adapted therapy and the use of novel immune-based therapies as alternatives to HDM-ASCT. Ongoing developments in understanding the pathobiology and prognostic factors in NDMM, plus immune profiling and routine MRD evaluation, will result in novel, HDM-sparing treatment paradigms, enabling further improvement in patient outcomes. [ABSTRACT FROM AUTHOR]

Objectives: To perform a nationwide study of quadrichorionic quadriamniotic (QCQA) quadruplet pregnancies and to compare the pregnancy outcome in those undergoing fetal reduction with non‐reduced quadruplets and dichorionic diamniotic (DCDA) twin pregnancies from the same time period. Methods: This was a retrospective Danish national register‐based study performed using data from the national Danish Fetal Medicine Database, which included all QCQA quadruplets and all non‐reduced DCDA twin pregnancies with an estimated due date between 2008 and 2018. The primary outcome measure was a composite of adverse pregnancy outcomes, including pregnancy loss or intrauterine death of one or more fetuses. Secondary outcomes included gestational age at delivery, the number of liveborn children, preterm delivery before 28, 32 and 37 gestational weeks and birth weight. Data on pregnancy complications and baseline characteristics were also recorded. Outcomes were compared between reduced and non‐reduced quadruplet pregnancies, and between DCDA pregnancies and quadruplet pregnancies reduced to twins. A systematic literature search was performed to describe and compare previous results with our findings. Results: Included in the study were 33 QCQA quadruplet pregnancies, including three (9.1%) non‐reduced pregnancies, 28 (84.8%) that were reduced to twin pregnancy and fewer than three (6.1%) that were reduced to singleton pregnancy, as well as 9563 DCDA twin pregnancies. Overall, the rate of adverse pregnancy outcome was highest in non‐reduced quadruplets (66.7%); it was 50% in quadruplets reduced to singletons and 10.7% in quadruplets reduced to twins. The proportion of liveborn infants overall was 91.1% of the total number expected to be liveborn in quadruplet pregnancies reduced to twins. This was statistically significantly different from 97.6% in non‐reduced dichorionic twins (P = 0.004), and considerably higher than 58.3% in non‐reduced quadruplets. The rates of preterm delivery < 28, < 32 and < 37 weeks were decreased in quadruplets reduced to twins compared with those in non‐reduced quadruplet pregnancies. Quadruplets reduced to twins did not achieve equivalent pregnancy outcomes to those of DCDA twins. Conclusion: This national study of QCQA quadruplets has shown that multifetal pregnancy reduction improves pregnancy outcome, including a decreased rate of preterm delivery and higher proportion of liveborn children. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Nonlinear energy transfer between wind waves in a gravity wave spectrum plays a pivotal role in the evolution of waves and was included as one of the source term (named nonlinear source term) in the third-generation (3G) wave models. The main objective of this paper is to compute the energy distribution due to nonlinear quadruplet wave–wave interactions for observed wave spectrum. This is achieved by utilizing cubic spline technique to fit and represent the theoretical as well as the measured spectra at given location. This technique is further incorporated into Gauss–Legendre Quadrature Method (GLQM) [1-2] for computing the nonlinear source term. Results were illustrated and validated for the theoretical as well as measured spectra (single- or multi-peaked spectrum) without compromising the accuracy of the method. The significance of this work includes an improvement in the computational efficiency of the method up to 65 % by employing optimal set of points of input spectrum (using a procedure discussed) without affecting the nonlinear results of the original one. GLQM (spline fitted spectra) is suitable for deep and finite water depths. Also, this work does not adhere to any assumptions for the tail factor, as the measured spectrum is directly fitted using splines. [ABSTRACT FROM AUTHOR]

Multiple myeloma (MM) remains an incurable disease. In Australia, patients receive sequential lines of novel agent (NA)‐based lines of therapy (LOTs), including proteasome inhibitors, immunomodulatory drugs and CD38‐targeting monoclonal antibodies within the constraints of the pharmaceutical benefits scheme. We propose that induction with a quadruplet incorporating all three drug classes and dexamethasone at diagnosis is the best approach to gain disease control. [ABSTRACT FROM AUTHOR]

Plain language summary Infertility is a common reproductive system problem; modern science has promoted assisted reproduction techniques as an alternative for these cases. High-order pregnancies it is estimated to occur in 90% of the cases due to assisted reproductive techniques, which often lead to numerous complications. A 33-year-old woman, who desired pregnancy, but had a history of infertility underwent artificial insemination, conceiving successfully quadruplets without any perinatal or maternal complications. Knowledge of maternal history and proper management of assisted reproductive techniques in addition to adequate prenatal follow-up are necessary for a successful pregnancy.

Introduction. A significantly increased frequency of multiple pregnancies including more than two fetuses is a consequence of using assisted reproductive technologies and ovulation stimulations. However, such pregnancies remain poorly investigated. Aim: to study the course and perinatal outcomes of quadruplet pregnancies.Materials and Methods. 7 pregnant women with quadruplets were examined. A comprehensive examination, including fetometry, monitoring of the cervical length, Doppler examination, and treatment of all complications were performed for all pregnant women. Results. Quadruplet pregnancy belongs to the peak risk group for the frequency of multiple gestational complications: cervical incompetence (85.7 %), anemia (71.4 %), preeclampsia (57.1 %), fetal growth retardation (71.4 %), premature birth (100.0 %), massive bleeding during delivery (33.3 %), extremely low birth weight newborns (30.8 %), respiratory disorders (100.0 %), intraventricular hemorrhages (38.5 %).Conclusion. Women with quadruplet pregnancies should be monitored and give a birth in level 3 perinatal centers. Delivery should be preferentially performed by caesarean section. The data obtained additionally underline that as few as a single embryo should solely transferred.

Background: To solve infertility, modern science has promoted assisted reproduction techniques such as in vitro fertilization, ovulation induction, and artificial insemination. Quadruple-type multiple pregnancies occur in 1 of every 500,000 pregnancies, and it is estimated that 90% occur due to assisted reproductive techniques, which often lead to numerous complications. Case presentation: Here we present a case of a 33-year-old woman, who desired pregnancy, but had a history of primary infertility diagnosed by hysterosalpingography, and endometriosis, which was treated by fulguration and medical management. Concomitantly, the patient was anovulatory. To fulfill her wish, she underwent homologous artificial insemination, after treatment, she successfully conceived quadri-chorionic quadri-amniotic infants, who were born at 37.2 weeks, without perinatal or maternal complications. Conclusion: This paper presented the parameters of prenatal care, appropriate management approach, and successful resolution without maternal–fetal complications despite the inherent risks of this type of pregnancy. Plain language summary: Infertility is a common reproductive system problem; modern science has promoted assisted reproduction techniques as an alternative for these cases. High-order pregnancies it is estimated to occur in 90% of the cases due to assisted reproductive techniques, which often lead to numerous complications. A 33-year-old woman, who desired pregnancy, but had a history of infertility underwent artificial insemination, conceiving successfully quadruplets without any perinatal or maternal complications. Knowledge of maternal history and proper management of assisted reproductive techniques in addition to adequate prenatal follow-up are necessary for a successful pregnancy. [ABSTRACT FROM AUTHOR]

The objective of this paper is to describe the design of an innovative and low-cost diplexer for Ka-band multi-beam satellite applications. The device is based on the use of two quadruplets to implement a number of transmission zeros (TZs) thus obtaining high-selectivity quasi-elliptic transfer functions. The resulting diplexer structure is particularly flexible in terms of layout, does not require tuning and has an excellent high-power behavior. In addition to theory, we compare the results of our simulations with the measurements obtained with a manufactured breadboard. The comparison shows excellent agreement thereby fully validating both the design procedure, and the new diplexer structure.

Cattle are a monotocous species, despite naturally conceived multiple births are sometimes observed. Although the number of twins has consistently increased, triplet and quadruplet pregnancies represent 0.015% and 0.004% of the total births, respectively. Multiple births are the result of multiple ovulation and/or the spontaneous cleavage of one fertilized oocyte, which is known as monozygotic (MZ) twinning. In cattle, approximately 5% to 14% of all twin births are MZ, and births with more than two MZ calves are extremely rare. Monozygotic animals are genetically identical, and those derived from two or more zygotes are genetically different. Furthermore, the presence of placental vascular anastomosis can result in foetal chimerism. Notwithstanding, animals born as single calves can be chimeras when one of the foetal twins dies undetected in utero. Here, we used DNA testing to study the zygotic condition of an unusual female quadruplet born from a Braford cow bred in a multi‐sire natural mating system without hormone stimulation. Two tissues with different embryological origin were sampled to test zygosity and possible chimerism. The results showed an identical genotype, confirming they all originated in an MZ pregnancy and suggesting the lack of chimerism in all animals. The use of MZ twins in breeding and selection systems provides an alternative to the conventional progeny testing. Some works have suggested a genetic background of MZ twins in humans. This female and her daughters could be the founders of a lineage to study the possible inheritance of MZ multiple births in cattle. [ABSTRACT FROM AUTHOR]

In the existing works of person re-identification (ReID), batch hard triplet loss has achieved great success. However, it only cares about the hardest samples within the batch. For any probe, there are massive mismatched samples (crucial samples) outside the batch which are closer than the matched samples. To reduce the disruptive influence of crucial samples, we propose a novel isosceles contraint for triplet. Theoretically, we show that if a matched pair has equal distance to any one of mismatched sample, the matched pair should be infinitely close. Motivated by this, the isosceles constraint is designed for the two mismatched pairs of each triplet, to restrict some matched pairs with equal distance to different mismatched samples. Meanwhile, to ensure that the distance of mismatched pairs are larger than the matched pairs, margin constraints are necessary. Minimizing the isosceles and margin constraints with respect to the feature extraction network makes the matched pairs closer and the mismatched pairs farther away than the matched ones. By this way, crucial samples are effectively reduced and the performance on ReID is improved greatly. Likewise, our isosceles contraint can be applied to quadruplet as well. Comprehensive experimental evaluations on Market-1501, DukeMTMC-reID and CUHK03 datasets demonstrate the advantages of our isosceles constraint over the related state-of-the-art approaches. [ABSTRACT FROM AUTHOR]

A Personal Health Knowledge Graph (PHKG) facilitates the efficient integration of potential diagnostic clues from patients' electronic health records with medical knowledge, establishing diagnostic reasoning paths and ensuring accurate, individually interpretable results in the diagnosis of pelvic masses. [ABSTRACT FROM AUTHOR]

A Personal Health Knowledge Graph (PHKG) facilitates the efficient integration of potential diagnostic clues from patients' electronic health records with medical knowledge, establishing diagnostic reasoning paths and ensuring accurate, individually interpretable results in the diagnosis of pelvic masses.

Hashing methods have been widely used for large-scale image retrieval. Learning deep hashing networks with a pairwise loss or a triplet ranking loss has become a common framework. The pairwise loss and triplet ranking loss, respectively, focus on preserving the pairwise similarity and the relative similarity ordering. In this paper, we design a quadruplet loss that can fully explore the similarity relation between image pairs to decrease the intraclass variation and increase the interclass variation. Moreover, we propose a deep architecture based on quadruplet loss and optimal adaptive margins for learning hash codes. Extensive experimental results show that our method achieves state-of-the-art performance on several benchmark image retrieval datasets. [ABSTRACT FROM AUTHOR]

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Explicit solution is derived for the exact synthesis of cross-coupled quadruplet filters with a real-frequency zero pair. Through a comparison of two-port S-parameters of the low-pass prototype circuit with the canonical generalized Chebyshev insertion loss function, a univariate quadratic function is formulated, and all element values of the circuit are explicitly expressed in terms of the designated zero and in-band ripple levels. The analytical expression of the sidelobe attenuation level is also obtained in terms of the zero, and vice versa. Results are checked against those from the existing literature. [ABSTRACT FROM AUTHOR]

Introduction. Testicular cancer and a multiple birth are both rare events, and the risk of testicular cancer is increased in twins. In Lithuania, only five quadruplets have been recorded since the middle of the 20th century. In this report, we present two rare events in one family: testicular cancer in two brothers of a quadruplet (three brothers and a sister). Case description. Both patients were diagnosed at 21 years of age and died within two years from the diagnosis despite treatment. The third symptomless brother did not have testicular pathology. We also review the risk factors associated with testicular cancer, and the proposed hypotheses how a multiple birth results in an increased risk. The most consistent risk factors for testicular cancer are cryptorchidism, prior history of testicular cancer, and a positive familial history. According to different studies, the risk of testicular cancer in twins is higher from 22% to 30%, compared to the general population. Conclusions. To our knowledge, we have presented the first case of testicular teratoblastoma in brothers of a quadruplet.

Although data processing technology continues to advance at an astonishing rate, computers with brain-like processing capabilities still elude us. It is envisioned that such computers may be achieved by the fusion of neuroscience and nano-electronics to realize a brain-inspired platform. This paper proposes a high-performance nano-scale Complementary Metal Oxide Semiconductor (CMOS)-memristive circuit, which mimics a number of essential learning properties of biological synapses. The proposed synaptic circuit that is composed of memristors and CMOS transistors, alters its memristance in response to timing differences among its pre- and post-synaptic action potentials, giving rise to a family of Spike Timing Dependent Plasticity (STDP). The presented design advances preceding memristive synapse designs with regards to the ability to replicate essential behaviours characterised in a number of electrophysiological experiments performed in the animal brain, which involve higher order spike interactions. Furthermore, the proposed hybrid device CMOS area is estimated as 600\ \mu \textm^2 in a 0.35\ \mu \textm process—this represents a factor of ten reduction in area with respect to prior CMOS art. The new design is integrated with silicon neurons in a crossbar array structure amenable to large-scale neuromorphic architectures and may pave the way for future neuromorphic systems with spike timing-dependent learning features. These systems are emerging for deployment in various applications ranging from basic neuroscience research, to pattern recognition, to Brain-Machine-Interfaces. [ABSTRACT FROM PUBLISHER]

Introduction. Testicular cancer and a multiple birth are both rare events, and the risk of testicular cancer is increased in twins. In Lithuania, only five quadruplets have been recorded since the middle of the 20th century. In this report, we present two rare events in one family: testicular cancer in two brothers of a quadruplet (three brothers and a sister). Case description. Both patients were diagnosed at 21 years of age and died within two years from the diagnosis despite treatment. The third symptomless brother did not have testicular pathology. We also review the risk factors associated with testicular cancer, and the proposed hypotheses how a multiple birth results in an increased risk. The most consistent risk factors for testicular cancer are cryptorchidism, prior history of testicular cancer, and a positive familial history. According to different studies, the risk of testicular cancer in twins is higher from 22% to 30%, compared to the general population. Conclusions. To our knowledge, we have presented the first case of testicular teratoblastoma in brothers of a quadruplet. [ABSTRACT FROM AUTHOR]

Background: The goal of induction therapy for multiple myeloma (MM) is to achieve adequate disease control. Current guidelines favor triplet (bortezomib-lenalidomide-dexamethasone; VRd) or quadruplet regimens (daratumumab, bortezomib-thalidomide-dexamethasone; D-VTd). In the absence of a direct comparison between two treatment regimens, we conducted this study to compare the outcomes and safety of VRd and D-VTd., Methods: Newly diagnosed MM patients aged ＞18 years who underwent induction therapy followed by autologous stem cell transplantation (ASCT) between November 2020 and December 2021 were identified. Finally, patients with VRd (N=37) and those with D-VTd (N=43) were enrolled., Results: After induction, 10.8% of the VRd group showed stringent complete remission (sCR), 21.6% showed complete response (CR), 35.1% showed very good partial response (VGPR), and 32.4% showed partial response (PR). Of the D-VTd group, 9.3% showed sCR, 34.9% CR, 48.8% VGPR, and 4.2% PR (VGPR or better: 67.6% in VRd vs. 93% in D-VTd, P=0.004). After ASCT, 68.6% of the VRd group showed CR or sCR, while 90.5% of the D-VTd group showed CR or sCR (P=0.016). VRd was associated with an increased incidence of skin rash (P=0.044). Other than rashes, there were no significant differences in terms of adverse events between the two groups., Conclusion: Our study supports the use of a front-line quadruplet induction regimen containing a CD38 monoclonal antibody for transplant-eligible patients with newly diagnosed MM.

Background: Heterotopic pregnancy (HP) is a condition characterized by the coexistence of multiple fetuses at two or more implantation sites. It occurs in 1% of pregnancies after assisted reproductive techniques (ART). Presence of triplet intrauterine pregnancy with ectopic gestational sac is one of the rarest forms of HP. Ectopic pregnancy is implanted in the ampullary segment of the fallopian tube in 80% of cases. Most of the patients present with acute abdominal symptoms due to rupture of the tube.Case Presentation: This article reports a case of quadruplet heterotopic pregnancy after intracytoplasmic sperm injection (ICSI) with an ampullary ectopic pregnancy and intrauterine triplet pregnancies. The ruptured ampullary pregnancy was emergently managed by right salpingectomy. This was followed by embryo reduction at 12 + 6 weeks and successful outcome of intrauterine twin pregnancy. [ABSTRACT FROM AUTHOR]

Se presenta el caso clínico de una fémina con embarazo múltiple, obesa, hipertensa y con antecedente de riesgo obstétrico, quien estuvo durante más de una semana en el Hospital Materno de Palma Soriano hasta su traslado para el Ginecoobstétrico "Mariana Grajales Coello" de Santiago de Cuba, donde se detectaron una exagerada ganancia ponderal (17,5 kg) y grandes posibilidades de aparición de preeclampsia, que al producirse a las 31,3 semanas, obligó a interrumpir la gravidez. Por medio de una cesárea se extrajo a las 4 niñas, cuya madre evolucionó satisfactoriamente luego de haber permanecido ingresada en la Unidad de Cuidados Intensivos durante 72 horas.Tha case report of a hipertensive obese woman with multiple pregnancy and obstetric risk history is presented, who was for over a week in Palma Soriano Maternity Hospital until she moved to "Mariana Grajales Coello" Gynecoobstetric Hospital of Santiago de Cuba, where an exaggerated weight gain (17,5 kg) and a high potential for developing pre-eclampsia were detected, which occurred at 31,3 weeks and forced to interrupt the pregnancy. By means of caesarean section 4 girls were extracted, whose mother made good progress after her admission to the Intensive Care Unit for 72 hours.

The article describes the chromosome constitution of hetersexual cattle quadruplets and a mother that gave birth. Topics discussed include the study involved a native Deshi cow that gave birth to quadruplet calves in Kanjialshi, India on March 1, 2013, the cytogenetic evaluation being done on the cattle through HALNAN protocol-based in-vitro whole blood lymphocyte culture, and results proved the connection of the chimeric ratio towards gender distribution of the newborn calves.

Ultrawideband (UWB) is defined by the Federal Communications Commission (FCC) for short-range high-capacity wireless communications. We propose and numerically demonstrate a novel scheme of all-optical UWB pulse generation based on parametric processes in cascaded periodically poled lithium niobate (PPLN) waveguides. The commonly used UWB pulses known as derivatives of the Gaussian pulse are considered to be the combination of overshoots and undershoots. As parametric amplification produces overshoots and parametric attenuation creates undershoots, it is expected that UWB pulses can be generated in the optical domain based on parametric processes. By use of sum-frequency generation (SFG) providing parametric attenuation and cascaded second-harmonic generation and difference-frequency generation (SHG + DFG) offering parametric amplification, PPLN-based UWB pulse generation is suggested and implemented. In addition to UWB monocycle and doublet, UWB triplet, quadruplet, and quintuplet are also obtained. The waveforms and radio frequency (RF) spectra of all generated UWB pulses are calculated, with the results showing that all obtained RF spectra meet the UWB definition (FCC, part 15). The operation performance is studied, indicating that the proposed PPLN-based UWB pulse generation has good stability to the UWB pulse wavelength. [ABSTRACT FROM AUTHOR]

Objective: We report a case of conjoined twins in a trichorionic quadruplet pregnancy after ovulation induction with clomiphene citrate for anovulation. Methods: The diagnosis of a trichorionic quadruplet pregnancy was made in routine ultrasound at 11 weeks’ gestation. Results: Conjoined twinning was thoracopagus and presented with increased nuchal translucency. Selective termination of the conjoined twins was performed with potassium chloride injection. The patient delivered 2 healthy infants after an uneventful follow-up. Conclusion: Monozygotic twinning has increased with widespread usage of ovulation induction agents and assisted reproductive techniques. Early detection of conjoined twinning and chorionicity is essential for an optimal obstetric management and outcome. Copyright © 2008 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Objective: To examine the effect of the 1998 Society for Assisted Reproductive Technology/American Society for Reproductive Medicine (SART/ASRM) Practice Committee recommendation to limit the number of embryos transferred on high order multiple births (HOMB) due to assisted reproduction technology (ART) and ovulation induction (OI) in the United States. Setting: None. Design: Analysis of U.S. natality files, and U.S. Centers for Disease Control and Prevention (CDC) and ASRM/SART registry reports. Setting: None. Patient(s): None. Intervention(s): None. Main Outcome Measure(s): Number and ratio of twin, triplet, and quadruplet or higher order (quadruplet/+) multiple births. Percentage of HOMB due to ART, OI, natural conception, and unexplained. Result(s): Between 1998 and 2003, the number of twin births (number of live-born infants in twin deliveries) in the United States increased 17%, and the number of HOMB was unchanged. Since 1998, total births due to ART increased 67%, twin births increased 65%, triplet births deceased 8%, and quadruplet/+ births decreased 35%. The ratio of twin, triplet, and quadruplet/+ births to total ART births decreased 2%, 45%, and 61% respectively. In 2003, the estimated percentages of multiple births due to ART and OI were twins 16% and 21%, triplets 45% and 37%, and quadruplets/+ 30% and 62%, respectively. Conclusion(s): Following publication of the SART/ASRM recommended limits on number of embryos transferred, the ratio of HOMB births to total ART births decreased substantially; however, U.S. HOMB did not decrease due to a 67% increase in total ART births and an increase in triplet births from OI. [Copyright &y& Elsevier]

Abstract: The French Commissariat à l’Energie Atomique (CEA) began the construction of the Laser Megajoule (LMJ), a 240 beams laser facility, at the CEA Laboratory CESTA near Bordeaux. The LMJ will be a cornerstone of the CEA “Programme Simulation”, similar to LLNL “NIF” facility. The LMJ is designed to deliver 2MJ of 0.35μm light to targets for high energy density physics experiments and to ultimately obtain ignition and propagating burn with DT targets in the laboratory. The scientific conception and system design was completed in 1999 and was followed by the Demonstration of an Engineering Prototype which was achieved in early 2003 with operation of one beam of the Ligne d’Intégration Laser (LIL) at CESTA, with 9.5kJ of UV light (0.35μm) in less than 9ns from a single laser beam. The construction phase of the LMJ facility was initiated in March 2003 with the start of work on the building and the target chamber. This paper will present a summary of 2004 LIL results and a description of LMJ, which is expected to demonstrate first light performance through 240 beams by 2009. [Copyright &y& Elsevier]

It is well documented that maternal morbidity and neonatal morbidity and mortality increase alike in high-order multiple (HOM) births. There have, however, been few reports concerning the costs of maternal and neonatal medical care associated with HOM births. This is the first such report on the situation in Japan. All triplet and quadruplet pregnancies managed at this institution from before 16 weeks’ gestation, and delivered at no earlier than 22 weeks’ gestation, between 1997 and 2002 were included. Prophylactic cervical ligature, hospitalization to prevent premature labor from 23 weeks’ gestation until delivery, and delivery by cesarean section, were all routine for HOM pregnancies. All women with singleton and twin pregnancies, who underwent in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) and also delivered their babies at no earlier than 22 weeks’ gestation at this institution, between 1997 and 2002, were also examined as controls. Prophylactic cervical ligature, preventive hospitalization, and cesarean section were not routine in the control group. The average gestational ages at delivery in singleton ( n = 58), twin ( n = 21), triplet ( n = 14) and quadruplet ( n = 1) pregnancies, were 39.4, 35.6, 31.9 and 25.1 weeks, respectively ( P < 0.001 by anova). Birthweights were 2886 ± 425 g, 2117 ± 623 g, 1430 ± 373 g, and 633 ± 77 g (mean ± SD), respectively ( P < 0.001). The average inpatient medical care cost for mother and child(ren), from maternal admissions after 12 weeks’ gestation to the discharge of all family members from hospital, was ¥703 279 yen (∼US$5861), ¥4 903 270 (∼US$40 861), ¥11 810 327 (∼US$98 419), and ¥44 961 000 (∼US$374 675), respectively ( P < 0.001). The present study outlined the high costs of medical care for HOM pregnancies. Not only from a medical viewpoint, but also from the viewpoint of medical costs, it is important to avoid HOM pregnancies as a result of infertility treatment. (Reprod Med Biol 2004; 3: 159–164) [ABSTRACT FROM AUTHOR]

Consideration is given to the nonlinear theory of elastic waves with cubic nonlinearity. This nonlinearity is separated out, and the interaction of four harmonic waves is studied. The method of slowly varying amplitudes is used. The shortened and evolution equations, the first integrals of these equations (Manley–Rowe relations), and energy balance law for a set of four interacting waves (quadruplet) are derived. The interaction of waves is described using the wavefront reversal scheme [ABSTRACT FROM AUTHOR]

Background: Twins and triplets are at higher risk of cerebral palsy than singletons. This study investigated the degree of risk for cerebral palsy in twins, triplets and quadruplets, and identified factors associated with the increased risk.Methods: The subjects were recruited from the Kinki University Twin and Higher Order Multiple Births Registry.Results: The subjects were 705 twins pairs (1410 twins), 96 sets of triplets (287 triplets excluding one infant death), and 7 sets of quadruplets (27 quadruplets excluding one infant death), who were born after 1977. The prevalence of cerebral palsy was 0.9% among 1410 twins, 3.1% among 287 triplets, and 11.1% among 27 quadruplets. Furthermore, the risks of producing at least one child with cerebral palsy were 1.5%, 8.0%, 42.9% in twin, triplet, quadruplet pregnancies, respectively. After adjusting for each associated factor using logistic regression, the risk of cerebral palsy was significantly associated with decrease in gestational age and asphyxia. The odds ratio indicated that infants whose gestational age was < 32 weeks were 20 times more likely to develop cerebral palsy than infants whose gestational age was > or = 36 weeks.Conclusions: The prevalence of cerebral palsy in triplets and quadruplets was higher than that in twins. Lower gestational age was associated with a greater risk of cerebral palsy. [ABSTRACT FROM AUTHOR]

Objective: Medical knowledge graph (KG) is attracting attention from both academic and healthcare industry due to its power in intelligent healthcare applications. In this paper, we introduce a systematic approach to build medical KG from electronic medical records (EMRs) with evaluation by both technical experiments and end to end application examples.Materials and Methods: The original data set contains 16,217,270 de-identified clinical visit data of 3,767,198 patients. The KG construction procedure includes 8 steps, which are data preparation, entity recognition, entity normalization, relation extraction, property calculation, graph cleaning, related-entity ranking, and graph embedding respectively. We propose a novel quadruplet structure to represent medical knowledge instead of the classical triplet in KG. A novel related-entity ranking function considering probability, specificity and reliability (PSR) is proposed. Besides, probabilistic translation on hyperplanes (PrTransH) algorithm is used to learn graph embedding for the generated KG.Results: A medical KG with 9 entity types including disease, symptom, etc. was established, which contains 22,508 entities and 579,094 quadruplets. Compared with term frequency - inverse document frequency (TF/IDF) method, the normalized discounted cumulative gain (NDCG@10) increased from 0.799 to 0.906 with the proposed ranking function. The embedding representation for all entities and relations were learned, which are proven to be effective using disease clustering.Conclusion: The established systematic procedure can efficiently construct a high-quality medical KG from large-scale EMRs. The proposed ranking function PSR achieves the best performance under all relations, and the disease clustering result validates the efficacy of the learned embedding vector as entity's semantic representation. Moreover, the obtained KG finds many successful applications due to its statistics-based quadruplet. where Ncomin is a minimum co-occurrence number and R is the basic reliability value. The reliability value can measure how reliable is the relationship between Si and Oij. The reason for the definition is the higher value of Nco(Si, Oij), the relationship is more reliable. However, the reliability values of the two relationships should not have a big difference if both of their co-occurrence numbers are very big. In our study, we finally set Ncomin = 10 and R = 1 after some experiments. For instance, if co-occurrence numbers of three relationships are 1, 100 and 10000, their reliability values are 1, 2.96 and 5 respectively. [ABSTRACT FROM AUTHOR]

Objective: To describe the occurrence and management of conjoined twins (CTs) in a trichorionic quadruplet pregnancy after the transfer of three embryos obtained by intracytoplasmic sperm injection (ICSI) that had undergone assisted zona hatching (AZH) using a noncontact laser. Design: Case report. Setting: Private and public IVF centers. Patient(s): A 38-year-old nulliparous woman. Intervention(s): IVF, diagnosis by two-dimensional, three-dimensional, and four-dimensional ultrasound, selective termination at 12 weeks gestation. Main Outcome Measure(s): Clinical follow-up and delivery. Result(s): After diagnosis, counselling, and selective termination, the subsequent prenatal course was uneventful, and two healthy boys were delivered by elective cesarean section at 38 weeks gestation. Conclusion(s): Monozygotic twinning (MZT) and CTs could complicate multifetal pregnancies obtained by assisted reproduction techniques. The relationship between CTs, IVF, and AZH should be better studied to fully understand the mechanisms that lead to MZT (with the possible role of AZH) and CTs in MZT, in particular. Three-dimensional and four-dimensional ultrasound improve prenatal assessment of the condition. Selective embryo reduction is a safe procedure for the management of these pregnancies. [Copyright &y& Elsevier]