Safety and Efficacy of Immunization with a Late-Liver-Stage Attenuated Malaria Parasite.

Background: Currently licensed and approved malaria subunit vaccines provide modest, short-lived protection against malaria. Immunization with live-attenuated malaria parasites is an alternative vaccination strategy that has potential to improve protection.

Methods: We conducted a double-blind, controlled clinical trial to evaluate the safety, side-effect profile, and efficacy of immunization, by means of mosquito bites, with a second-generation genetically attenuated parasite (GA2) - a single knockout NF54 parasite (sporozoite form) with extended development into the liver stage.

Pathology of twin placentas with special attention to monochorionic twin placentas.

The risk of perinatal morbidity and mortality in twins is 3-7 times higher than in singletons. In comparison to dichorionic twins, monochorionic twins are at increased risk for perinatal mortality and serious morbidity. In both type of twins growth discordance can occur.

Late onset of discordant growth in a monochorionic twin pregnancy: vascular anastomoses determine fetal growth pattern and not placental sharing.

Twin-twin transfusion syndrome in monochorionic twin pregnancies has a complex and variable clinical presentation. We present the first documented case where two unidirectional arteriovenous anastomoses connecting the donor twin's larger with the recipient's smaller placental part produce late onset of discordant growth and subsequent twin-twin transfusion syndrome. We conclude that the haemodynamic effects of the anastomoses caused the observed discordant fetal development and not the unequally shared placenta.