bluuebunny/crossref_metadata_2025 huggingface dataset:
Rapidly scalable and low-cost public health surveillance reporting system for COVID-19
Authors: Jayaraj Vivek Jason , Ng Chiu-Wan , Hoe Victor Chee-Wai , Chong Diane Woei-Quan , Rampal Sanjay
Published: January 2024

Objective

Data-driven innovations are essential in strengthening disease control. We developed a low-cost, open-source system for robust epidemiological intelligence in response to the COVID-19 crisis, prioritising scalability, reproducibility and dynamic reporting.

Methods

A five-tiered workflow of data acquisition; processing; databasing, sharing, version control; visualisation; and monitoring was used. COVID-19 data were initially collated from press releases and then transitioned to official sources.

Results

Key COVID-19 indicators were tabulated and visualised, deployed using open-source hosting in October 2022. The system demonstrated high performance, handling extensive data volumes, with a 92.5% user conversion rate, evidencing its value and adaptability.

Conclusion

This cost-effective, scalable solution aids health specialists and authorities in tracking disease burden, particularly in low-resource settings. Such innovations are critical in health crises like COVID-19 and adaptable to diverse health scenarios.
Advising parents when their child has a fever: a phenomenographic analysis of nurses’ perceptions when working at a telephone helpline, at primary care or at a paediatric emergency department in Sweden
Authors: Westin Emma , Gustafsson Ingrid L , Svensson Anders , Sund-Levander Märta , Elmqvist Carina
Published: January 2024

Objectives

To describe nurses’ perceptions of advising parents when their child has a fever.

Design/method

Inductive, descriptive study with a qualitative, phenomenographic approach.

Participants and setting

A purposive sampling was used. To be included, the 24 online interviewed nurses had to have experience advising parents of febrile children between birth and 5 years of age. They were recruited from three different parts of the healthcare system from four regions in the south of Sweden.

Results

The nurses described advising parents when their child has a fever as four different kinds of balancing acts: balancing between the parents’ story and objective assessment, balancing between listening and teaching, balancing between self-confidence and trust in the expert, and balancing between independence and having someone by one’s side.

Conclusions

Giving advice to parents when their child has a fever is a process where the nurse needs to listen, assess and give advice based on the situation. This requires a correct assessment that depends on the parents’ story. Creating a trusting relationship is perceived as necessary for parents to assimilate the advice that is provided. What dominates are the nurses’ perceptions of the inner qualities required to achieve a balance in the process, for example, the importance of experience and security in their professional role, while it is also necessary to get support from colleagues.
Non-indicated initiation of proton pump inhibitor and risk of adverse outcomes in patients with underlying chronic kidney disease: a nationwide, retrospective, cohort study
Authors: Kim Seong Geun , Cho Jeong Min , Han Kyungdo , Joo Kwon-Wook , Lee Soojin , Kim Yaerim , Cho Semin , Huh Hyuk , Kim Minsang , Kang Eunjeong , Kim Dong Ki , Park Sehoon
Published: January 2024

Objective

Evidence related to the risk of kidney damage by proton pump inhibitor (PPI) initiation in patients with ‘underlying’ chronic kidney disease (CKD) remains scarce, although PPI use is generally associated with acute interstitial nephritis or incident CKD. We aimed to investigate the association between PPI initiation and the risk of adverse outcomes in patients with CKD in the absence of any deterministic indications for PPI usage.

Design

Retrospective observational study.

Setting

Korea National Health Insurance Service database from 2009 to 2017.

Participants

A retrospective cohort of new PPI and histamine H2-receptor antagonists (H2RA) users among people with CKD. Patients with a history of gastrointestinal bleeding or those who had an endoscopic or image-based upper gastrointestinal tract evaluation were excluded.

Primary and secondary outcome measures

The study subjects were followed to ascertain clinical outcomes including mortality, end-stage kidney disease (ESKD), myocardial infarction and stroke. The HRs of outcomes were measured using a Cox regression model after adjusting for multiple variables. We applied an inverse probability of treatment weighting (IPTW) model to control for residual confounders.

Results

We included a total of 1038 PPI and 3090 H2RA users without deterministic indications for treatment. IPTW-weighted Cox regression analysis showed that PPI initiation was more significantly associated with a higher ESKD risk compared with that of H2RA initiation (adjusted HR 1.72 (95% CI 1.19 to 2.48)), whereas the risks of mortality or cardiovascular outcomes were similar between the two groups. In the subgroup analysis, multivariable Cox regression analysis showed that the association between PPI use and the progression to ESKD remained significant in non-diabetic and low estimated glomerular filtration rate (<60 mL/min/1.73 m2) groups (adjusted HR 1.72 (95% CI 1.19 to 2.48) and 1.63 (95% CI 1.09 to 2.43), respectively).

Conclusions

Initiation of PPI administration may not be recommended in patients with CKD without deterministic indication, as their usage was associated with a higher risk of ESKD.
Protocol for the combined cardiometabolic deep phenotyping and registry-based 20-year follow-up study of the Inter99 cohort
Authors: Bjørnsbo Kirsten Schroll , Brøns Charlotte , Aadahl Mette , Kampmann Freja Bach , Friis Bryde Nielsen Camilla , Lundbergh Bjørn , Wibaek Rasmus , Kårhus Line Lund , Madsen Anja Lykke , Hansen Christian Stevns , Nørgaard Kirsten , Jørgensen Niklas Rye , Suetta Charlotte , Kjaer Michael , Grarup Niels , Kanters Jørgen , Larsen Michael , Køber Lars , Kofoed Klaus Fuglsang , Loos Ruth JF , Hansen Torben , Linneberg Allan , Vaag Allan
Published: January 2024

Introduction

The population-based Inter99 cohort has contributed extensively to our understanding of effects of a systematic screening and lifestyle intervention, as well as the multifactorial aetiology of type 2 diabetes (T2D) and cardiovascular disease. To understand causes, trajectories and patterns of early and overt cardiometabolic disease manifestations, we will perform a combined clinical deep phenotyping and registry follow-up study of the now 50–80 years old Inter99 participants.

Methods and analysis

The Inter99 cohort comprises individuals aged 30–60 years, who lived in a representative geographical area of greater Copenhagen, Denmark, in 1999. Age-stratified and sex-stratified random subgroups were invited to participate in either a lifestyle intervention (N=13 016) or questionnaires (N=5264), while the rest served as a reference population (N=43 021). Of the 13 016 individuals assigned to the lifestyle intervention group, 6784 (52%) accepted participation in a baseline health examination in 1999, including screening for cardiovascular risk factors and prediabetic conditions. In total, 6004 eligible participants, who participated in the baseline examination, will be invited to participate in the deep phenotyping 20-year follow-up clinical examination including measurements of anthropometry, blood pressure, arterial stiffness, cardiometabolic biomarkers, coronary artery calcification, heart rate variability, heart rhythm, liver stiffness, fundus characteristics, muscle strength and mass, as well as health and lifestyle questionnaires. In a subsample, 10-day monitoring of diet, physical activity and continuous glucose measurements will be performed. Fasting blood, urine and faecal samples to be stored in a biobank. The established database will form the basis of multiple analyses. A main purpose is to investigate whether low birth weight independent of genetics, lifestyle and glucose tolerance predicts later common T2D cardiometabolic comorbidities.

Ethics and dissemination

The study was approved by the Medical Ethics Committee, Capital Region, Denmark (H-20076231) and by the Danish Data Protection Agency through the Capital Region of Denmark’s registration system (P-2020-1074). Informed consent will be obtained before examinations. Findings will be disseminated in peer-reviewed journals, at conferences and via presentations to stakeholders, including patients and public health policymakers.

Trial registration number

NCT05166447.
Secular trend of gout incidence in the UK: an age-period-cohort analysis
Authors: Ye Jing , Zhang Yuqing , Zhang Weiya , Doherty Michael , Lu Na , Zeng Chao , Lei Guanghua , Wei Jie , Ding Xiang
Published: January 2024

Objectives

The incidence of gout in the UK appears to have declined since 2013; however, whether such a trend occurred across participants born in different years (ie, birth cohort) is unknown. We aimed to examine the effects of the birth cohort on gout incidence using an age-period-cohort (APC) model.

Design

Cross-sectional study.

Setting

Nationwide data from the UK primary care database.

Participants

Individuals between 30 and 89 years of age were included. We excluded individuals who had gout history when entering the database and individuals with less than 1 year of continuous follow-up between 1 January 1999 and 31 December 2019.

Primary and secondary outcome measures

Gout was identified using READ codes assigned by general practitioners. The incidence of gout between 1999–2013 and 2011–2019 was analysed with APC model.

Results

The incidence of gout between 1999 and 2013 increased with birth cohorts. Compared with those born in 1949–1953 (reference), the age-adjusted and period-adjusted rate ratios (RRs) of incident gout increased from 0.39 (95% CI 0.34 to 0.46) in participants born in 1910–1914 to 2.36 (95% CI 2.09 to 2.66) in participants born in 1979–1983 (p for trend <0.001). In contrast, the incidence of gout between 2011 and 2019 decreased with birth cohorts. Compared with those born in 1949–1953 (reference), the age-adjusted and period-adjusted RRs of incident gout declined from 2.75 (95% CI 2.30 to 3.28) in participants born in 1922–1926 to 0.75 (95% CI 0.65 to 0.87) in participants born in 1976–1980 but then increased slightly to 0.95 (95% CI 0.77 to 1.17) in participants born in 1985–1989.

Conclusions

The gout incidence between 1999 and 2013 in the UK increased with the birth cohorts and then decreased between 2011 and 2019 except for those born after 1980. Future monitoring is needed to help identify aetiological factors and guide preventive and treatment strategies for gout.
Perceptions and determinants of oral health care among Iranian pregnant women: a qualitative study
Authors: Abdollahi Monireh , Tehrani Hadi , Mahdizadeh Mehrsadat , Nemati-Karimooy Atefeh , Gholian-aval Mahdi
Published: January 2024

Objectives

This study aimed to gain a comprehensive understanding of the determinants that influence oral healthcare behaviours among Iranian pregnant women.

Study design

Qualitative study.

Setting

Comprehensive health service centres.

Participants

A sample consisting of all people involved in the process of oral care during pregnancy, 18 pregnant women, 7 midwives/healthcare workers, 3 supervisors of prenatal care services and 3 dentists) were purposefully sampled in terms of demographic characteristics.

Methods

The qualitative content analysis study conducted 31 semistructured individual interviews in 2022, utilising MAXQDA V.10.

Results

The participants identified 3 main categories and 11 subcategories: individual and physiological determinants (care needs, perceived importance, motivation, oral health literacy and inherent pregnancy limitations), organisational determinants (costs, access to equipment and services, review of service delivery process and professional behaviour) and social-cultural determinants (educational services and support from family and friends).

Conclusions

The results can be used in interventions to improve oral healthcare for pregnant women. This study highlights the importance of addressing individual, organisational and social-cultural determinants to improve oral healthcare during pregnancy.
‘Effects of a home-based bimodal lifestyle intervention in frail patients with end-stage liver disease awaiting orthotopic liver transplantation’: study protocol of a non-randomised clinical trial
Authors: Wijma Allard G , Bongers Bart C , Annema Coby , Dekker Rienk , Blokzijl Hans , van der Palen Job AM , De Meijer Vincent E , Cuperus Frans JC , Klaase Joost M
Published: January 2024

Introduction

Patients with end-stage liver disease awaiting orthotopic liver transplantation (OLT) are generally classified as frail due to disease-related malnutrition and a progressive decline in musculoskeletal and aerobic fitness, which is associated with poor pre-OLT, peri-OLT and post-OLT outcomes. However, frailty in these patients may be reversable with adequate exercise and nutritional interventions.

Methods and analysis

Non-randomised clinical trial evaluating the effect of a home-based bimodal lifestyle programme in unfit patients with a preoperative oxygen uptake (VO2) at the ventilatory anaerobic threshold ≤13 mL/kg/min and/or VO2at peak exercise ≤18 mL/kg/min listed for OLT at the University Medical Center Groningen (UMCG). The programme is patient tailored and comprises high-intensity interval and endurance training, and functional exercises three times per week, combined with nutritional support. Patients will go through two training periods, each lasting 6 weeks.

The primary outcome of this study is the impact of the programme on patients’ aerobic fitness after the first study period. Secondary outcomes include aerobic capacity after the second study period, changes in sarcopenia, anthropometry, functional mobility, perceived quality of life and fatigue, incidence of hepatic encephalopathy and microbiome composition. Moreover, number and reasons of intercurrent hospitalisations during the study and postoperative outcomes up to 12 months post OLT will be recorded. Finally, feasibility of the programme will be assessed by monitoring the participation rate and reasons for non-participation, number and severity of adverse events, and dropout rate and reasons for dropout.

Ethics and dissemination

This study was approved by the Medical Research Ethics Committee of the UMCG (registration number NL83612.042.23, August 2023) and is registered in the Clinicaltrials.gov register (NCT05853484). Good Clinical Practice guidelines and the principles of the Declaration of Helsinki will be applied. Results of this study will be submitted for presentation at (inter)national congresses and publication in peer-reviewed journals.

Trial registration number

NCT05853484.
Awareness, experiences and perceptions regarding genetic testing and the return of genetic and genomics results in a hypothetical research context among patients in Uganda: a qualitative study
Authors: Ochieng Joseph , Kwagala Betty , Barugahare John , Möller Marlo , Moodley Keymanthri
Published: January 2024

Background

Genetic testing presents unique ethical challenges for research and clinical practice, particularly in low-resource settings. To address such challenges, context-specific understanding of ethical, legal and social issues is essential. Return of genetics and genomics research (GGR) results remains an unresolved yet topical issue particularly in African settings that lack appropriate regulation and guidelines. Despite the need to understand what is contextually acceptable, there is a paucity of empirical research and literature on what constitutes appropriate practice with respect to GGR.

The study assessed patients’ awareness, experiences and perceptions regarding genetic testing and the return of GGR results in a hypothetical context.

Methods

This cross-sectional study employed a qualitative exploratory approach. Respondents were patients attending the medical outpatient unit of Mulago National Hospital. Three deliberative focus group discussions involving 18 respondents were conducted. Data were analysed through thematic analysis.

Results

Three main themes and several subthemes were identified. Most respondents were aware of genetic testing, supportive of GGR and receiving results. However, only a few had undergone genetic testing due to cost constraints. They articulated the need for adequate information and genetic counselling to inform decision-making. Privacy of results was important to respondents while others were willing to share results.

Conclusion

There was general awareness and support for GGR and the return of results. Stigmatisation emerged as a barrier to disclosure of results for some. Global health inequity impacts access and affordability of genetic testing and counselling in Africa and should be addressed as a matter of social justice.
HomozygousSMAD6variants in two unrelated patients with craniosynostosis and radioulnar synostosis
Authors: Luyckx Ilse , Walton Isaac Scott , Boeckx Nele , Van Schil Kristof , Pang Chingyiu , De Praeter Mania , Lord Helen , Watson Christopher Mark , Bonthron David T , Van Laer Lut , Wilkie Andrew O M , Loeys Bart
Published: January 2024

Background

SMAD6encodes an intracellular inhibitor of the bone morphogenetic protein (BMP) signalling pathway. Until now, rare heterozygous loss-of-function variants inSMAD6were demonstrated to increase the risk of disparate clinical disorders including cardiovascular disease, craniosynostosis and radioulnar synostosis. Only two unrelated patients harbouring biallelicSMAD6variants presenting a complex cardiovascular phenotype and facial dysmorphism have been described.

Cases

Here, we present the first two patients with craniosynostosis harbouring homozygousSMAD6variants. The male probands, both born to healthy consanguineous parents, were diagnosed with metopic synostosis and bilateral or unilateral radioulnar synostosis. Additionally, one proband had global developmental delay. Echocardiographic evaluation did not reveal cardiac or outflow tract abnormalities.

Molecular analyses

The novel missense (c.[584T>G];[584T>G], p.[(Val195Gly)];[(Val195Gly)]) and missense/splice-site variant (c.[817G>A];[817G>A], r.[(817g>a,817delins[a;817+2_817+228])];[(817g>a,817delins[a;817+2_817+228])], p.[(Glu273Lys,Glu273Serfs*72)];[(Glu273Lys,Glu273Serfs*72)]) both locate in the functional MH1 domain of the protein and have not been reported in gnomAD database. Functional analyses of the variants showed reduced inhibition of BMP signalling or abnormal splicing, respectively, consistent with a hypomorphic mechanism of action.

Conclusion

Our data expand the spectrum of variants and phenotypic spectrum associated with homozygous variants ofSMAD6to include craniosynostosis.
Pulmonary artery diameter ratio as a prognostic indicator of congenital diaphragmatic hernia
Authors: Miyake Yuichiro , Koga Hiroyuki , Nojiri Shuko , Yamada Shunsuke , Ochi Takanori , Miyano Go , Lane Geoffrey J , Yamataka Atsuyuki , Okazaki Tadaharu
Published: January 2024

Background

Following on from an earlier study published in 2008 about left pulmonary artery (LPA) flow measured on serial echocardiography being strongly prognostic in left-sided congenital diaphragmatic hernia (CDH) and the ratio of LPA to right pulmonary artery (RPA) diameters being a simple and reliable indicator for commencing nitric oxide (NO) therapy, the ratio of LPA:RPA diameters (PA ratio or PAR) was hypothesized to possibly reflect cardiopulmonary stresses accompanying CDH better.

Methods

Subjects with isolated left-sided CDH treated between 2007 and 2020 at a single pediatric surgical center were recruited and classified according to survival. Data obtained retrospectively for subject demographics, clinical course, LPA/RPA diameters, and PAR were compared between survivors and non-survivors. The value of PAR for optimizing the prognostic value of PA diameter data in CDH were analyzed with receiver operating characteristic (ROC) curve analysis.

Results

Of 65 subjects, there were 54 survivors (82.3%) and 11 non-survivors (17.7%); 7 of 11 non-survivors died before surgical repair could be performed. Mean PAR for survivors (0.851±0.152) was significantly higher than for non-survivors (0.672±0.108) (p=0.0003). Mean PAR for non-survivors was not affected by surgical repair. Characteristics of survivors were: LPA ≥2 mm (n=52 of 54; mean PAR=0.866±0.146) and RPA ≥3 mm (n=46 of 54; mean PAR=0.857±0.152). Non-survivors with similar LPA and RPA diameters to survivors had significantly lower mean PAR. ROC curve cut-off for PAR was 0.762. Subjects with high PAR (≥0.762) required high-frequency oscillatory ventilation/NO less than subjects with low PAR (<0.762) (p=0.0244 andp=0.0485, respectively) and subjects with high PAR stabilized significantly earlier than subjects with low PAR (1.71±0.68 days vs 3.20±0.87 days) (p<0.0001).

Conclusions

PAR would appear to be strongly correlated with clinical outcome in CDH and be useful for planning management of cardiopulmonary instability in CDH.
Generalized linearly varying deceleration parameter solutions of higher dimensional universe in f(R,T) theory
Authors: Çalar Halife
Published: January 2024

In this paper, generalized Friedmann–Robertson–Walker universe for Strange Quark Matter (SQM) and Normal Matter (NM) coupled with Domain Wall (DW) in form perfect fluid have been investigated in [Formula: see text] modified theory. [Formula: see text] function has been assumed as [Formula: see text] and Modified Field Equations (MEFEs) have been attained. The MEFEs of the constructed model do not allow solutions of open and closed FRW universe. Obtained modified field equations of higher dimensional flat FRW universe have been solved by using Linearly Varying Deceleration Parameter (LVDP) suggested by Akarsu and Dereli [Int. J. Theor. Phys. 51, 612 (2012)]. Pressure and energy density of the matter distributions for the Linearly Expansion Model (LEM) and Constant Expansion Model (CEM) have been attained as decreasing values by the cosmic time t and constant [Formula: see text] in [Formula: see text] gravity. But for the Exponential Expansion Model (XEM), these quantities have been obtained as time-independent. It is found out that the domain wall behaves like invisible matter when [Formula: see text] due to negative domain wall tension ([Formula: see text]) for SQM with DW of LEM. Strange quark matters for LDW and CDW models behave like cold dark matter when [Formula: see text] and [Formula: see text], respectively. One can say that SQM with DW for LEM and CEM may cause the expansion of the universe in these special situations. Also, solutions of XEM have shown that domain wall matter behaves like stiff matter when [Formula: see text]. All solutions of the constructed model in [Formula: see text] theory have been reduced to General Relativity (GR) theory solutions by assuming [Formula: see text]. Finally, all solutions obtained have been discussed in detail.
Natural History of Reproductive Complications (Menstruation, Including Cancer, and Menopause)
Authors: Hart Roger
Published: January 2024

A lifelong reproductive health plan is recommended for women with PCOS, with a focus on preconception risk factors including prevention of weight gain and optimisation of fertility. Metabolic risk factors, diabetes, cardiovascular disease, and sleep disorders are all increased in PCOS and screening and management is recommended. PCOS should be considered a high-risk condition in pregnancy with women identified and monitored. An increased premenopausal risk of endometrial cancer should be recognised. Depressive and anxiety symptoms are significantly increased and should be screened for in all women with PCOS, with psychological assessment and therapy as indicated. Shared decision making, self-empowerment and integrated models of care should be developed, funded, and evaluated. Supported healthy lifestyle remains vital throughout the lifespan in PCOS, with a strong focus on overall health, prevention of weight gain and if required on weight management. Combined oral contraceptive pills are first line pharmacological treatment for menstrual irregularity and hyperandrogenism, with no specific recommended preparation, and a preference for lower dose preparations and those with less side-effects. Metformin is recommended primarily for metabolic, although it is not routinely recommended for use in pregnant women with PCOS.
What Can We Do to Build an Inclusive Clinic?
Authors: Blake Debbie , Nicholson Helen
Published: January 2024

It is fair to say, building an Inclusive environment within a busy and diverse multidisciplinary fertility team, is filled with daily challenges. It requires commitment to a vision, a strategic plan, ongoing training, and the practice of many soft skills. And for many small to medium resourced clinics, this can feel a little like trying to feed a whole family on $25 a day - a lot of effort and resources required. In this joint presentation, Helen and Debbie investigate the meaning of inclusion, and share the enthusiasm they developed along their clinic’s journey, of rising to this challenge. It will include sources of inspiration, examples of action, and affordable budget-minded tools available to clinics of all sizes. At the heart of this undertaking, this counsellor and scientific collab, contend the notion that team success, is based on building the concept of “Whakapapa”, or a sense of belonging.
Interdisciplinary Team - How to Make It Work?
Authors: Tse Astor , Bik Hui Kam
Published: January 2024

The philosophy of interdisciplinary teams in infertility centers is a fundamental aspect of the reproductive medicine Centre’s approach to patient care. It aims to delve into the core principles and beliefs that underpin the philosophy of interdisciplinary teams in Union Hospital’s infertility center, shedding light on the critical role they play in optimizing treatment outcomes and patient satisfaction.

The art of interdisciplinary teams’ centers on the recognition that infertility is a complex and multi-faceted issue that requires a comprehensive approach involving professionals from diverse disciplines. At our Centre, the foundation of this philosophy lies in the belief that by combining the expertise and perspectives of specialists in reproductive endocrinology, embryology, andrology, genetics, psychology, and nursing, patients can receive the highest standard of holistic care.

The primary goal of the interdisciplinary team is to provide individualized care that is tailored to each patient’s unique needs and circumstances. This involves a synergistic collaboration among team members to ensure a thorough evaluation of the patient’s reproductive health, addressing not only the physical aspects but also the emotional and psychological aspects of their infertility journey. By integrating a range of perspectives, the team aims to provide comprehensive, evidence-based assessments and treatment plans.

Furthermore, we emphasize the importance of continuous communication and coordination among team members. Regular team meetings and case discussions allow for the exchange of ideas, insights, and knowledge, ultimately leading to more informed decision making and improved treatment outcomes. The interdisciplinary team ethos also fosters a supportive and compassionate environment, where patients feel heard, valued, and understood throughout their treatment journey.

Interdisciplinary team infertility centre also embraces the utilization of cutting-edge technologies and diagnostic tools. By integrating advancements in reproductive medicine, such as genetic testing and personalized treatment protocols, the team can offer patients the most effective and innovative options available.

In conclusion, the philosophy of interdisciplinary teams in infertility centers is rooted in the belief that by bringing together professionals from diverse disciplines, patients can receive tailored, comprehensive care that addresses the entirety of their infertility journey. It emphasizes collaboration, communication, and the utilization of advanced technologies, ultimately leading to enhanced treatment outcomes, patient satisfaction, and overall reproductive well-being.
Select the Right Biopsy Needle for You and Your Embryos
Authors: Malhotra Keshav
Published: January 2024

Biopsy pipettes come in multiple versions, and precision, choice and control are essential. Pipettes are specially designed and polished to minimize damage and protect cell membranes during PGT procedures.

Characteristics of some pipettes are

• Internal diameter range: from 15 μm to 35 μm

• 15 μm for polar body biopsy

• 25 μm for trophectoderm biopsy

• 30 to 35 μm for blastomere biopsy

The pipettes should be manufactured with quality assured materials that are MEA and endotoxin (LAL) tested. All stages of production should be controlled, from the raw materials to the final product. Every single pipette should be checked for dimensions to minimise LOT-to-LOT variation. Some pipettes are made of borosilicate glass that helps prevent the risk of oil clogging the inner surface. All pipettes should have heat polished bases to ensure longevity of seals in your pipette holder. Choosing the exact micropipette tool best suited to your needs ensures a successful outcome.
Sample Loading - The Critical Step of Biopsy
Authors: Chi Ling
Published: January 2024

Failed or poor sample loading following trophectoderm cells sampling can ruin all efforts made before by causing DNA amplification failure, false positive or false negative genetic testing results, and false mosaic reports.

In this lecture, all steps involved in the sample loading procedure will be addressed and discussed in detail, including solutions needed, identification, PCR tube setup, washing, and loading.
Ovarian Aging - Quality and Quantity
Authors: Cedars Marcelle
Published: January 2024

The ovary ages uniquely to other organs and despite an increase in longevity and health, the age of menopause, cessation of ovarian reproductive function, has not changed for over 100 years. What causes the demise of such a vital organ and how does it impact fertility and health. So called “ovarian reserve”-the number of oocytes available in a single cycle – is a strong driver for assessing “ovarian age”. But does quantity equate to “quality” and fertility potential? We will discuss ovarian aging and its impact on fertility, spontaneous and assisted. Additionally, what do we know about how the process of ovarian aging impacts general health. Cardiovascular disease (CVD) is the leading cause of mortality in women in the United States. Compared with age-matched men, premenopausal women are protected against CVD, yet this difference dissipates after menopause. Hypogonadism underlies the shared increased CVD risk seen in menopause, primary ovarian insufficiency (POI), and hypogonadotropic hypogonadism. Early menarche and PCOS have also been associated with CVD risk factors, highlighting the importance of mediators other than deficient estrogen in the underlying etiology of this female-specific increased risk. And yet, women with PCOS present a unique population. Beginning early in life, these women have increased markers of cardiovascular risk. And yet, data regarding actual cardiovascular events, in this population, are mixed. If these individuals, with long-standing exposure to dyslipidemia and insulin resistance, are not at risk, is there some protective mechanism associated with PCOS? Might there be an underlying mechanism for prolongation of reproductive function and potential protection from long-standing exposure to cardiovascular risk factors. And might the converse be true so that women with accelerated loss of reproductive function, would be at increased long-term health risk. Identification of women at risk, and in need of early intervention, is critical to living healthy lives.
The Enlightenment of Evolutionary Medicine
Authors: Hsueh Aaron J.
Published: January 2024

Darwin’s evolution theory serves as the basis to understand biology and medicine. In addition to fossil evidence used by Darwin and his contemporaries, advances in genomics allowed the tracing of gene sequences. Understanding human evolution further allowed us to re-evaluate our body’s maladaptation due to rapid environmental and cultural changes, including anxiety, fever, pain, vomiting as well as menstrual blood loss, increases in reproductive tissue cancers, and dystocia in human females. The talk will discuss the relationship between evolution and acute infectious diseases, including HIV resistance, and why the new coronavirus is not man-made. We will further discuss the relationship between evolution and chronic diseases, including why many modern people are obese and our increased risk of diabetes. Cancer development can be explained as somatic cell evolution, starting from cancer stem cell mutations to developing resistance against cancer therapies. Applying evolutionary concepts in medical research, one can discover new hormones and receptors based on their co-evolution, and the development of bionics based on unique characteristics evolved in diverse organisms. Beyond biology, Darwin’s theory explains the evolution of languages and memes such as currencies and religions. During future evolution, the application of artificial intelligence and big data algorithms could guide our “free will”.
Chronic Infection in Recurrent Pregnancy Loss
Authors: Kimura Fuminori
Published: January 2024

In the present study, the effects of chronic endometritis (CE) on implantation and pregnancy outcomes, the effects of CE on endometrial function, and the effects of progesterone as a treatment for CE were examined.

It was found that the pregnancy rate and live birth rate were significantly lower in CE patients in a prospective study. When patients were diagnosed with CE, not only were the pregnancy rate and live birth rate significantly lower, but the miscarriage rate was higher in a retrospective study.

Next, the presence of chronic deciduitis (CD) in the miscarriage specimen was determined in patients diagnosed with or without CE before pregnancy. CD was determined when the presence of clusters of plasma cells or five or more plasma cells in the decidua. CD was found in more than half of CE, but not found in Non-CE before pregnancy.

In in vitro study, we revealed the secretions of TNF[Formula: see text], IL1[Formula: see text], and IL6 per cell were significantly higher in CE. The rate of Th1 was greater and it of Th2 was significantly lower in CE, and those of Tregs and Th17 were not different. Both PRL and IGFBP1, decidualized markers, showed significant decreases in secretion with CE, and conversely, the number of cells was significantly higher in the CE group.

Based on the results of bench studies, we hypothesized that an altered administration route and increased dosage of progestogen may improve clinical outcomes. The clinical outcomes of patients who underwent single frozen-thawed blastocyst transfer were examined for each hormone replacement therapy. It was found that using a progesterone vaginal suppository in combination with an oral progestin for hormone replacement improved the live birth rate, but not the miscarriage rate in CE patients when compared with using an oral progestin alone.
Approaches to Help Older Women in ART
Authors: Morimoto Yoshiharu
Published: January 2024

Ancient Chinese emperors sent messengers to the whole country and explored an elixir of life. Determent of aging has been an ultimate hope for humans for a long period. In the modern era, aging become a hot topic to be solved according to longevity. Equality of both sexes in society contributed to the late marriage and start of making children. There happen adverse effects to being conceived in the aged ovaries. The quality and quantity become impaired by the ovarian aging process. In the artificial reproductive treatment, the obtained number of oocytes in ovarian hyperstimulation diminishes in aged women. The aging impairs quality both in the nucleus and cytoplasm. Chromosomal and genetic abnormalities increase lower implantation and higher abortion. In aged women, PGT-A may be effective to effective treatment. On the other hand, aging affects organelles in the cytoplasm of oocytes by protein metabolic dysregulations. Especially it induces mitochondria dysfunction. Mitochondria are called a “powerhouse” and have an essential role in oogenesis and embryogenesis. There exist 200,000-40,000 mitochondria DNA copies in the mature oocytes. Mitochondria dysfunction causes maturation arrest of oocytes, fertilization failure, late cleavage, and fragmented embryos.

We have two strategies to solve this problem by enhancement of mitochondrial function. One is the holistic approach. Reactive oxygen species (ROS) or free radicals impair mitochondrial function. Also, mitochondria themselves are known to produce ROS. We measure Diacron-Reactive Oxygen Metabolites (d-Rom) and biological antioxidant potential (BAP) that are predictors of systemic ROS level and antioxidant competence, respectively. Another method is a cell-engineering approach. We have conducted autologous mitochondria transfer into mature oocytes. The quality of the oocytes and embryos were dramatically improved by this method, and we obtained 13 healthy children.
Impact of Paternal Age on Reproduction
Authors: Wu Gwo-Jang
Published: January 2024

The increase in the age of life, the delay in the age of marriage and the increase in income, the increase in living standards lead to the delay in the time of childbearing age, and therefore, the long-term impact of male age on the children born to the development is affected by certain molecular biochemical diagnostic tools trapped by the authoritative information at the front end with the advancement of science and technology, so that we understand the impact of aging on men from deep fascial cells and mutations in chromosomal genes caused by mental maturation. The offspring affected by the long-term genetic diseases, such as the Y chromosome, epigenetic or genetic de-novo mutation can lead to changes after pregnancy, such as premature birth, miscarriage, stillbirth, and underweight children, as well as genetic diseases such as bone underdevelopment and blood disorders such as acute leukemia because of the father’s age. As for the development of the central nervous system, as for the behaviour, it may lead to an increase in the proportion of schizophrenia, affective psychosis, and an increase in the proportion of autism, which may be that we will do large-scale research in the future, and use animal experiments or molecular biology and chemistry to confirm his rapid turn and understand the cause of his actual illness, as a future medical policy and male infertility treatment, as well as some important theoretical basis and basis for consultation in our infertility clinic.
Failed Fertilization in ART: What are the Causes and Methods to Improve Fertilization
Authors: Adiga Satish Kumar
Published: January 2024

Introduction of clinical ICSI made a revolution in achieving higher fertilization in ART programs. However, ICSI does not completely eliminate the risk of fertilization failure as total fertilization failure (TFF) occurs in 1-3% of ICSI cycles. TFF leads to unexpected premature termination of the ART treatment, inflicting a substantial psychological and financial burden on patients. The potential reasons for TFF include inability of the oocyte to activate the cascade of fertilization events, suboptimal oocytes or sperm quality, and technical issues in performing ICSI. Specifically, oocyte-related factors include oocyte cytoplasmic immaturity caused by insufficient protein synthesis or aberrant signalling pathways, spindle abnormalities, and defective proteins involved in fertilization. Sperm-related factors are primarily associated with abnormalities in the structure, expression, and localization pattern of PLC[Formula: see text]. Several laboratory approaches involving pharmacological agents help in activation of the oocytes thereby prevent the fertilization failure. However, as of now, there is no conclusive evidence to demonstrate the benefit of artificial oocyte activation hence, TFF following ICSI remains an ongoing and significant challenge in ART laboratory.
Environmental Exposures: Impact on Male Fertility
Authors: Hart Roger
Published: January 2024

It is recognised that male health has a significant impact on male reproductive capacity. These health-related associations may begin before birth. For instance, a man’s sperm count is negatively impacted if his mother smoked during pregnancy, and health trajectories through childhood and adolescence into adulthood may influence male reproductive capacity in later life. Further, other factors such as the age of man at the time of conception may influence the health of their offspring.

Of further relevance is the fact that studies have shown a relationship between adult reproductive function and longer-term health outcomes. For instance, adverse associations have been demonstrated between most semen parameters, and other markers of testicular function, with the presence of metabolic syndrome. It has further been shown that there exist an association between erectile dysfunction and future adverse cardiovascular events.
Reproductive Outcomes for Children Born Following ICSI - Australia Data
Authors: Catford Sarah
Published: January 2024

Since its introduction for male factor infertility, the use of intra-cytoplasmic sperm injection (ICSI) has increased. Given the strong genetic basis of male infertility, the risk of transmitting infertility to future generations is concerning. Furthermore, offspring health is affected by paternal health and sperm quality, irrespective of genetic causes of infertility. Concerns regarding the use of ICSI include the heritability of infertility, the effects of poor-quality spermatozoa on offspring health, and the potential for the technique itself to induce epigenetic changes with long-term health effects. Given the prevalence of male infertility and the widespread use of ICSI, understanding the possible adverse health effects is an important clinical and public health issue. Additionally, the mechanisms responsible for potential adverse health outcomes remain unclear and efforts to separate the effects of paternal infertility from treatment factors are necessary. This session will present current literature on the reproductive health of children conceived using ICSI with an emphasis on Australian data. The results of an Australian study evaluating the reproductive health of a cohort of young men conceived with ICSI will be presented. The findings of this study, the largest to date globally, contribute to a limited pool of knowledge on the reproductive function of men conceived with ICSI and the collective understanding of the overall health of adults conceived with ICSI.
Freezing Low Numbers of Sperm
Authors: Latif Haroon Khan
Published: January 2024

Azoospermia, a condition defined by a complete lack of sperm in the ejaculate, presents a significant reproductive challenge for many infertile men worldwide. In recent years, Microsurgical Sperm Extraction (Micro-TESE) has emerged as an innovative surgical technique, allowing clinicians to retrieve viable sperm directly from the testicular tissues of patients diagnosed with this condition.

A crucial aspect of optimizing the reproductive potential of the extracted sperm lies in the subsequent preservation techniques employed. This study delves deep into one such technique, sperm vitrification. As opposed to the traditional slow freezing methods, vitrification offers a rapid-cooling approach that effectively sidesteps the formation of potentially damaging ice crystals, thereby maintaining the structural and functional integrity of the sperm. The survival rates of sperm post-thawing, when subjected to vitrification, have been found to be commendably high, with figures often exceeding 60%. This is a promising statistic, particularly when dealing with minuscule sperm quantities as retrieved in Micro-TESE.

However, the importance of sperm freezing transcends azoospermic scenarios. A broader and crucial indication for sperm freezing is fertility preservation, particularly poignant for cancer patients on the brink of undergoing treatments like chemotherapy or radiation, which could jeopardize their reproductive future. For these individuals, the opportunity to freeze their sperm offers a chance to father biological offspring post-recovery.

By allowing multiple in vitro fertilization (IVF) attempts without necessitating recurrent surgical interventions, sperm cryopreservation, especially using vitrification, amplifies the chances of achieving biological parenthood. This is pivotal for both azoospermic individuals and cancer patients, safeguarding their dreams of family amidst medical adversities.

In conclusion, the efficacy of vitrification, especially in the context of limited sperm counts, has the potential to reshape the landscape of male infertility treatments, offering a glimmer of hope for numerous affected individuals and their partners.
Troubleshooting in an IVF Laboratory
Authors: Malhotra Keshav
Published: January 2024

In the realm of assisted reproductive technology, troubleshooting within an in vitro fertilization (IVF) laboratory is of paramount importance to ensure successful outcomes. FMEA is a proactive methodology used to identify potential failure modes in laboratory processes, assess their possible effects, and prioritize interventions to prevent or mitigate them. In the context of IVF, FMEA aids in recognizing critical steps prone to errors, such as sample mishandling or equipment malfunctions. By quantifying the probability and severity of failures, FMEA allows laboratories to allocate resources judiciously and implement corrective measures that reduce the likelihood of adverse events. Root cause analysis (RCA) is a retrospective technique employed to delve into the underlying causes of anomalies or failures that have already occurred. In the IVF laboratory, RCA helps uncover the root reasons for unsuccessful procedures, like embryo implantation failure. This analysis aids in identifying both immediate triggers and underlying systemic issues, paving the way for targeted improvements to enhance overall success rates. By plotting key performance indicators over time, IVF laboratories can detect deviations from established norms. This enables swift corrective actions before deviations result in compromised outcomes. Control Charts thus offer a dynamic tool for monitoring laboratory processes, maintaining consistency, and swiftly addressing unexpected fluctuations. By systematically preventing potential failures, investigating root causes, and dynamically monitoring processes, IVF laboratories can improve their success rates, enhance patient experiences, and contribute to the advancement of assisted reproductive technologies.