bluuebunny/crossref_metadata_2025 huggingface dataset:
P-744 A new hysteroscopic-assisted mock embryo transfer (HAMET) to predict success in ART cycles
Authors: Manzi A , Tabanelli C , Ferraretti A  P , Balicchia B , Rossi S , Magli M  C , Gianaroli L
Published: July 2024

Study question

Could HAMET increase pregnancy rates in predicted and unexpected difficult transfer patients?

Summary answer

Data of this study show a strong correlation between HAMET and pregnancy rates.

What is known already

Mock embryo transfer is regularly performed to adequately plan the correct strategy for positioning embryos inside the uterus of patients predicted to have difficult access to uterine cavity procedure.

Study design, size, duration

This is a single-center, observational, retrospective study conducted at S.I.S.Me.R. center in Bologna, Italy. 1184 consecutive diagnostic hysteroscopies were performed for patients suffering for primary or secondary infertility before ART. All patients from 18 to 49 years old underwent a mock embryo transfer performed with 10 to 15 μl of methylene blue dye. Diagnostic hysteroscopy was performed immediately after mock embryo transfer to assess if the dye has entered the uterine cavity.

Participants/materials, setting, methods

Out of the 1184 patients who underwent hysteroscopy, in 617 patients 1118 transfers were executed after IVF-ICSI cycles. Patients were subdivided in: group A where whole cavity including fundus was filled by blue; group B where cavity but not fundus was filled by methylene blue; group C patients with partial captation or with no captation at all of dye. The difficulty of mock embryo-transfer (scale 1 to 3) was also recorded by the physician.

Main results and the role of chance

the results of 1118 transfers are summarized in the table below.

While patients with whole cavity plus fundal captation (group A) had the highest implantantion rate (IR) compared to group B and C, reflecting the same difference in the clinical pregnancy rate (CPR), the live birth rate (LBR) was statistically superior only for group A when compared to group B.

Limitations, reasons for caution

Main limitation of these findings is the absence of control group.

Wider implications of the findings

HAMET is able to predict which patients have the higher chances to achieve a pregnancy and, even more important, a term pregnancy. The use of HAMET it is also useful to assess the capability of physicians to enter the uterine cavity when the cervical canal route is not regular.

Trial registration number

not applicable
P-047 Sperm moving pattern analysis with artificial intelligence solution predicts aneuploidy ratios of zygotes
Authors: Mun Young L , Yun Dong G , Jin Y , Min Jung C , Yu Jin K , Sangyong J , Jung Jae K , Jin Young P , Hoon J , Dea Keun K , Lee J  H
Published: July 2024

Study question

Can an analysis of sperm movements with artificial intelligence predict aneuploidy ratios of zygotes?

Summary answer

And sperm movement patterns analyzed by AI diagnosis predicted the aneuploidy ratios of zygotes.

What is known already

Sperm motilities present a specific pattern like strength, strength with curving, curving only and none progressive et al. Sperm movement patterns are determined by the sperm neck protein which is the centromere protein. Also, this centromere protein of the sperms was involved in the chromosome segregation in the zygote.

Study design, size, duration

A total of 8,000 clinical participants were recruited by CHA Infertility Center Seoul Station and 5 videos were taken from the semen sample of each participant. Machine learning with sperm moving clip for the diagnosis algorithm predicted aneuploidy ratios of fertilized embryos.

Participants/materials, setting, methods

We used YOLO_v8 and EfficientNet algorithm on the extracted sperm movement trajectory image to classify sperm into classes according to their motion pattern. This information was combined with the age of the patient to predict the possibility of infertility by analyzing the association with aneuploidy ratios of zygotes using deep learning model.

Main results and the role of chance

Deep learning AI algorithm utilized diagnosis for unexplained male infertility. No strength moving sperm pattern has shown association with male origin aneuploidy after fertilization. Especially high ratios of cycle moving sperm significantly increased the aneuploidy ratios in the zygote. But paternal aging has no correlation with aneuploidy ratios in the embryo. AI diagnosis have a 0.9 accuracy score. It is expected that the AI solution generated through this system can help overcome the problem of finding the cause of male infertility by predicting aneuploidy ratios of zygotes.

Limitations, reasons for caution

This study is designed for and performed with a minimum number of sperm move data. For clinical application, further mass data was set-up to increase accuracy of diagnosis.

Wider implications of the findings

Our AI solution was constructed to predict the possibility of aneuploidy ratios in the zygote by analyzing and classifying the movement patterns of sperm. Therefore, sperm movement-based AI diagnosis solution can be applied to define unexplained male infertility.

Trial registration number

non-clinical trials
P-210 A new insight into the effects of systemic lupus erythematosus on oocyte and embryo development and female fertility
Authors: Mao R
Published: July 2024

Study question

Does SLE affect oocyte and embryo development and female fertility in female patients?

Summary answer

Patients with SLE present worse outcomes in oocyte and embryonic development, thus yielding compromised female fertility and clinical pregnancy.

What is known already

Systemic lupus erythematosus (SLE) is often associated with adverse reproductive outcomes. However, it’s currently unclear regarding the role of SLE in oocyte and embryonic development. Also, it’s controversial whether SLE hurts fertility. There is a lack of comprehensive understanding and assessment of fertility in patients with SLE.

Study design, size, duration

This study retrospectively investigated oocyte and embryo development, ovarian reserve, and clinical outcomes in SLE patients who underwent in vitro fertilization (IVF) treatment from January 2013 to September 2022 at the University Hospital.

Participants/materials, setting, methods

In this study, we collected data from 34 SLE patients who were previously diagnosed and in remission for a total of 44 IVF cycles and matched 102 infertile women with a total of 148 IVF cycles by Propensity Score Matching (PSM) of 1:3 ratio. We then evaluated baseline characteristics, ovarian reserve, IVF laboratory outcomes, and clinical outcomes between the two groups.

Main results and the role of chance

After PSM matching, baseline characteristics including age, infertility types, and duration, as well as infertility causes overall coincided between the two groups. Anti-müllerian hormone (AMH) was significantly lower in the SLE group vs comparison (1.9 vs. 3.3 ng/mL, P=0.001). The SLE group performed a significant reduction in available embryo rate (76.6% vs. 86.0%, P=0.001), good-quality blastocyst formation rate (35.1% vs. 47.0%, P=0.003), and blastocyst formation rate (51.0% vs. 67.7%, P=0.001) compared to the comparison. As for clinical outcomes, the implantation rate in the SLE group was notably lower (37.9% vs. 54.9%, P=0.022). The CLBR following every embryo-transfer procedure was distinctly lower (41.2% vs 68.6%, P=0.016) in the SLE group vs comparison. Also, the conservative and optimal CLBRs following every complete cycle procedure were significantly reduced in the SLE group vs the comparison (P=0.001, both)

Limitations, reasons for caution

It’s a retrospective and single-center study, which is relevant to an inevitable risk of bias. Due to its special population selection, the sample size of this study is quite small.

Wider implications of the findings

This study provides data support to explore further the impact of SLE or other autoimmune diseases on female fertility, and it also calls for more attention to be given to these special patients by reproductive physicians. Comprehensive fertility assessment and individualized fertility guidance are recommended for patients with SLE.

Trial registration number

TJ-IRB20211280
P-295 Impact of septate uteri on pregnancy and neonatal outcomes of IVF/ICSI–frozen embryo transfer
Authors: Su Z
Published: July 2024

Study question

What is the impact of septate uteri on reproductive and neonatal outcomes of IVF/ICSI–frozen embryotransfer?

Summary answer

septate uteri are associated with lower birthweight and worse fertility outcomes including lower Intrauterine implantation rate and lower live birth rates.

What is known already

Several studies have investigated the negative effects of septate uteri on pregnancy outcomes.However, an all-round and definitive conclusion has not been reached yet owing to the relatively low incidence of the disease and theheterogeneity of study populations, especially among women undergoing ART.

Study design, size, duration

This was a retrospective cohort study including 149 women with septate uteri and 13921 women with a normal uterus who underwent first frozen-thawed embryo transfer cycles of IVF/ICSI from january 2016 to December 2022. We compared reproductive outcomes.

Participants/materials, setting, methods

Reproductive outcomes of women with septate uteri were studied through propensity score-matched comparisons (patients with septate uterus respectively along with corresponding control group without uterine malformations). We also comparedpregnancy and neonatal outcomes.

Main results and the role of chance

Compared to the matched control group, women with septate uterus had asignificantly lower LBR(37.58% versus 50.56%, odds ratio (OR) 1.698 [95% CI: 1.161, 2.484], P = 0.006) and Intrauterine implantation rate(36.31% versus 45.67%, odds ratio (OR) 1.474 [95% CI: 1.06, 2.06], P = 0.021)

Limitations, reasons for caution

This was a single-centre, retrospective study in which neonatal data were extracted fromparental questionnaires. In patientswith uterine malformations, the number of babies with birth defects and twin pregnancies was relatively small, limiting the power of thestudy.

Wider implications of the findings

Compared to patients with a normal uterus, women with septate uterus have poorer reproductive outcomes. Pregnant women with a septate uterus need to be managed as high-risk pregnancies and followed withappropriate obstetric review.

Trial registration number

not applicable
P-417 Transmyometrial embryo transfer as a reliable alternative to challenging transcervical embryo transfer
Authors: Kothari T
Published: July 2024

Study question

Can transmyometrial embryo transfer be a reliable alternative to challenging transcervical embryo transfer

Summary answer

In selected cases, where transcervical embryo transfer is impossible, transmyometrial embryo transfer is a suitable alternative.

What is known already

Transmyometrial embryo transfer (TMET) can be a last resort option for challenging transcervical embryo transfer (ET). Indications for TMET include; failure to access the uterus transcervically due to previous cervical surgery, stenosed cervix which will not dilate or due to challenging cervical anatomy. This technique is done by passing a long needle through the myometrium to enter the uterine cavity. This can be a less traumatic option than multiple attempts at ET with the added consequences of using a tenaculum. This centre has been performing TMET since 2004.

Study design, size, duration

This was a retrospective audit looking at TMET cases from 2004 to 2023. 125 cases were recorded and reviewed.

Participants/materials, setting, methods

The results are from a single centre unit which receives referrals for TMET from outside units. This was an audit and cases were initially found by reviewing all cases of embryo transfer from 2004. Where TMET had been recorded, the notes were then collected to ascertain patient demographics, reasons for transmyometrial embryo transfer, embryo grading and pregnancy outcomes.

Main results and the role of chance

Since 2004, 125 cases of TMET were recorded. 16 notes were excluded as there was unclear documentation on the type of embryo transfer, leaving 109 cases. There were 23 positive pregnancy tests, 6 documented scans showing a fetal heart at 7 weeks and three documented live births. Indication for TMET was mainly a failure to enter the uterine cavity due to stenosed cervix. In all cases of TMET, patient’s had undergone multiple attempts at accessing the uterine cavity, along with multiple attempts at hysteroscopy and dilatation. Only after trying all other options was TMET used, and mainly as a last resort measure. All cases were planned and used frozen blastocysts. There were no complications to TMET. Due to the last resort nature of TMET and the reasons for undergoing assisted reproductive technology it is unlikely these pregnancies were by chance.

Limitations, reasons for caution

Due to the length of time this centre has been doing TMET the documentation from the earlier cases was poor and births could have been missed due to poor follow up. Training in TMET is difficult due to the low numbers per year.

Wider implications of the findings

TMET remains a safe and reliable alternative option when facing a challenging transcervical embryo transfer and should be used as a last resort measure.

Trial registration number

not applicable
P-574 Anti-Müllerian hormone: A novel marker for ovarian torsion?
Authors: Siegler Y , Gutzeit O , Justman N , Bachar G , Wolfovitz A , Shahak G , Fainaru O
Published: July 2024

Study question

Can measuring plasma AMH levels assist in diagnosing ovarian torsion?

Summary answer

AMH levels show fluctuations during the acute phase of ovarian torsion, potentially aiding in clinical diagnosis.

What is known already

Anti-Müllerian Hormone (AMH), a measure of the ovarian follicular reserve, might fluctuate upon ovarian ischemia as per the “burnout theory,” where ovarian ischemia triggers primordial follicle recruitment and increased follicular growth. Accordingly, ultrasound indicators of ovarian torsion include the presence of small follicles at the ovarian periphery. Our hypothesis suggests that ovarian ischemia from torsion could alter serum AMH levels, offering diagnostic value.

Study design, size, duration

A prospective observational study was conducted in a single tertiary care center between 2021-2023. The study analyzed serum AMH levels in 17 patients aged 12-45 admitted with acute abdominal pain and undergoing diagnostic laparoscopy due to suspected ovarian torsion. Patients with AMH levels below the 5th percentile were excluded.

Participants/materials, setting, methods

Patients with suspected ovarian torsion underwent diagnostic laparoscopy based on clinical and sonographic criteria. Peripheral blood samples collected upon admission and on the first postoperative day were used to measure plasma AMH levels. AMH levels were compared between patients with confirmed ovarian torsion and those without this diagnosis.

Main results and the role of chance

Demographic characteristics were similar between the groups. Patients diagnosed with ovarian torsion showed higher pre- and postoperative AMH levels than those without torsion (4.33∓1.58 vs. 2.8∓1.28 ng/ml, p = 0.08 and 4.16∓1.52 vs. 2.71∓1.3 ng/ml, p = 0.09, respectively), but these differences were not statistically significant. However, the change in AMH levels from pre- to postoperative was more significant in patients with ovarian torsion compared to those without (0.66∓0.34 vs. 0.21∓0.18, p = 0.01).

Limitations, reasons for caution

• Small study size

• High variability in basal AMH levels in women of reproductive age

Wider implications of the findings

These results suggest that ovarian ischemia might influence AMH secretion, potentially serving as part of diagnostic evaluations. Ongoing studies aim to validate AMH as a biomarker for ovarian torsion, aiming to reduce unnecessary surgeries, lower patient risks, and minimize healthcare costs.

Trial registration number

0151-21-RMB
P-631 Extended letrozole regimen versus routine letrozole regimen in women with polycystic ovary syndrome undergoing their first ovulation induction cycle
Authors: Zhu X
Published: July 2024

Study question

Whether an extended letrozole regimen could result in a higher ovulatory rate than a routine regimen in PCOS women undergoing their first ovulation induction cycle.

Summary answer

PCOS women using the extended letrozole regimen failed to obtain a statistically higher rate of ovulation in comparison with the routine letrozole regimen.

What is known already

Letrozole has become the first-line agent for ovulation induction, however, nonresponsive cycles occurred in 10-58.8% of PCOS women during their ovulation induction therapy with letrozole alone. The extended letrozole regimen has been demonstrated to be a feasible method for inducing ovulation in those nonresponders. However, whether it could be applied to all the PCOS women as a first choice in the induction of ovulation remains to be explored.

Study design, size, duration

This is a prospective randomized controlled trial including 148 women with PCOS undergoing their first ovulation induction cycle with letrozole from January 2021 to October 2022.

Participants/materials, setting, methods

Participants were randomly assigned to receive an extended letrozole regimen (5 mg letrozole daily for 7 days) or a routine regimen(5 mg letrozole daily for 5 days) for one treatment cycle. Ovulation rate was the primary outcome. Secondary outcomes included the clinical pregnancy rate, the number of preovulatory follicles, the rate of multiple pregnancies.

Main results and the role of chance

The ovulation rate among women receiving a 7-day regimen was slightly higher than the rate with a 5-day regimen, but it did not reach a statistical significance in both the intention-to-treat analysis (90.54%[67/74]vs. 82.43%[59/74], P = 0.065) and per-protocol analysis (90.54%[67/74]vs. 84.29%[59/70], P = 0.257). The number of preovulatory follicles was nearly identical in the two groups (1.39±0.62 vs.1.37±0.59, P = 0.956), and no cases of ovarian hyperstimulation syndrome were observed. In the per-protocol analysis, the rates of clinical pregnancy (20.27%[15/74]vs.16.95%[10/70], P = 0.343) and live birth (13.51%[10/74]vs.11.43%[8/70], P = 0.976) did not differ significantly between treatment groups. Moreover, all the conceptions were singletons without neonatal defects.

Limitations, reasons for caution

The major concern of the current research is its single-centre and open label nature. Additionally, the limited number of lean PCOS women with a mean body mass index of 23-25 kg/m2 enrolled in our trial also restrict the generalizability of our findings.

Wider implications of the findings

Letrozole 5-day regimen remains to be the first choice for PCOS women undergoing ovulation induction therapy. Additional prospective trials with a larger sample size and different subgroups of PCOS are needed to assess the ovulatory effects of different letrozole treatment duration.

Trial registration number

ChiCTR2100042082
P-665 High FSH level impairs VEGF secretion by thawed human ovarian tissue
Authors: Einenkel R , Schallmoser A , Sänger N
Published: July 2024

Study question

How does a high FSH level as related to POI (premature ovarian insufficiency) affect VEGF secretion by thawed human ovarian tissue?

Summary answer

After thawing, the high FSH concentration of 175mIU/mL (10ng/mL) significantly decreased VEGF secretion by human ovarian tissue by 25.6%. 17.5mIU/mL did not change VEGF secretion.

What is known already

Cryopreservation of ovarian cortical tissue has become an important method in fertility preservation. However, 70% of the follicles do not survive the reimplantation process due to an insufficient blood supply and oxidative stress.

Human ovarian tissue secretes angiogenic factors, including VEGF, spontaneously. Its regulation by FSH is not known although 50% of the reimplantation patients show increased FSH levels (>25mIU/mL) due to POI.

Study design, size, duration

Provided a signed consent, biopsy punches of ovarian cortical tissue from 8 patients undergoing fertility preservation were studied. Slow freezing and thawing was applied as in the intern routine instructions.

Participants/materials, setting, methods

Human ovarian cortical tissue was cultured in full medium at 37 °C for 48h after thawing in presence or absence of 17.5mIU/mL (1ng/mL) or 175mIU/mL (10ng/mL) recombinant human FSH. VEGF-A secretion was measured by ELISA. The expression of VEGF-A, HIF-1α and FSHR was assessed by immunohistofluorescence per follicle. The effect of FSH was assessed by one-way-ANOVA with Tukey’s post test. The effect of culture or follicular maturation stage was analyzed by t test.

Main results and the role of chance

After thawing, VEGF secretion recovers and rises over time. The addition of 175mIU/mL FSH significantly impaired VEGF-A expression compared to untreated ovarian tissue (p = 0.016). The analysis of 481 follicles showed similar results of FSH affecting VEGF-A expression by immunostaining. In particular, primordial follicles expressed significantly less VEGF-A compared to growing follicles (primary+secondary; p < 0.0001). 48h tissue culture significantly increased VEGF-A expression in primordial follicles (p = 0.0041). The addition of the high FSH level significantly decreased VEGF-A expression in growing follicles (p = 0.0005).

Limitations, reasons for caution

Although VEGF-A is a key factor in angiogenesis, more factors are known to affect angiogenesis. The direct effect on angiogenesis should be evaluated. Moreover, the conditions in tissue culture may not represent those after reimplantation.

Wider implications of the findings

High FSH levels, as seen in patients with POI, might impair ovarian VEGF expression and angiogenesis. Hormone replacement therapy (HRT) might be endorsed before and during ovarian tissue reimplantation. More clinical and biological data are required to understand the regulators of angiogenesis after ovarian tissue reimplantation adequately.

Trial registration number

not applicable
P-667 The RANK-RANKL-OPG System - A new player in Oocyte Maturation
Authors: Yerushalmi G  M , Yung Y , Bakish T , Orvieto R , Hourvitz A
Published: July 2024

Study question

Does the RANK-RANKL-OPG system play a role in oocyte maturation and ovulation?

Summary answer

RANKL, a new ovulatory gene expressed by cumulus and mural granulosa cells activates RANK receptors in oocytes, promoting oocyte maturation through oocyte-granulosa cell communication.

What is known already

The receptor activator of nuclear factor-kB (RANK), its ligand RANKL, and the soluble decoy osteoprotegerin (OPG) system are known due to their role in bone biology, the immune system, and other tissues. It was recently shown that RANKL was a highly upregulated gene in our ovulation-associated gene library of cumulus cells (CCs) from mature and non-mature oocytes. However, its ligand, RANK was undetected in both samples. The goal of this study was to elucidate the expression and function of the RANK-RANKL-OPG system in the ovary during the preovulatory period, and ovulation.

Study design, size, duration

In vitro and in vivo experiments using mice and human oocytes and granulosa cells.

Participants/materials, setting, methods

RANKL regulation experiments involve granulosa cells isolated from follicular fluid as well as mice oocytes. Analysis included cell culture, qPCR, and western blot. To examine RANK-RANKL-OPG function upon ovulation and oocyte maturation, super-ovulated mice and human oocytes were used.

Main results and the role of chance

We demonstrated for the first time that RANK mRNA is expressed in murine oocytes. Moreover, RANKL expression was demonstrated in human MGCs and CCs and is regulated by hCG/LH and PGE2. The addition of RANKL peptide, to the murine and human oocyte during IVM procedure, induces the maturation of GV oocytes. OPG (natural RANKL inhibitor) injection to mice during super-ovulation reduced oocyte maturation rate.

Limitations, reasons for caution

Animal model results may not fully translate to humans. Additional studies are needed to confirm the effects of RANKL/RANK-OPG system on fertility and long-term health.

Wider implications of the findings

Our observations suggest that RANKL expressed by granulosa cells acts on the RANK receptor found in the oocyte and plays an important role in oocyte-granulosa cell communication activating oocyte maturation. This research contributes to new insights in understanding pre-ovulatory processes and may improve the procedure of in vitro maturation (IVM).

Trial registration number

not applicable
Sharks Violate Rensch's Rule for Sexual Size Dimorphism
Authors: Gayford J H , Sternes P C
Published: July 2024

Synopsis

Systematic trends in body size variation exist in a multitude of vertebrate radiations, however their underlying ecological and evolutionary causes remain poorly understood. Rensch's rule describes one such trend—in which the scaling of sexual size dimorphism (SSD) depends on which sex is larger. Where SSD is male-biased, SSD should scale hyperallometrically, as opposed to hypoallometrically where SSD is female-biased. The evidence for Rensch's rule is mixed, and comes from a small subset of total vertebrate diversity. We conducted the first empirical test of Rensch's rule in sharks, seeking to confirm or refute a long-hypothesied trend. We find that sharks violate Rensch's rule, as the magnitude of SSD increases with body size despite sharks predominantly exhibiting female-biased SSD. This adds to a growing literature of vertebrate clades that appear not to follow Rensch's rule, suggesting the absence of a single, conserved scaling trend for SSD amongst vertebrates. It is likely that selection associated with fecundity results in the “inverse Rensch's rule” observed in sharks, although additional studies will be required to fully reveal the factors underlying SSD variation in this clade.
Reputations and Change in International Relations
Authors: Baser Ekrem T
Published: July 2024

Reputations for resolve are critical in international relations for deterring adversaries and reassuring partners. However, a state’s resolve is unobservable and can change unbeknownst to its audience. How does the possibility of unobserved change impact reputation dynamics? I provide a theory of long-run reputations with changing resolve via a formal model covering conflict and cooperation domains. In the model, the possibility that current reputations are based on outdated information makes the audience extend the benefit of the doubt to states with poor reputations. This leads to states building or spending their reputations depending on their current reputations. Importantly, when damaged reputations can be rebuilt, states with better reputations face stronger temptations to spend them. Thus, reputations constrain states with poor reputations the most. Further, because demonstrations of resolve improve reputations, which, in turn, reduce incentives for future demonstrations of resolve, there is a cyclical rhythm to conflict and cooperation. A major implication is that a state’s behavior changes with its reputation even if its resolve is unchanged and the stakes are identical. Reputational enforcement works, but the price is occasional breaches of trust. These results also settle a few long-standing controversies in the IR-reputation literature.
Systematic in vitro optimization of antimicrobial peptides against Escherichia coli
Authors: Shukri Ali , Carroll Amanda C , Collins Ryan , Charih Francois , Wong Alex , Biggar Kyle K
Published: July 2024

Objectives

Antimicrobial resistance is a growing concern and claims over 1 million lives per year. The discovery of new antimicrobial drugs is expensive and often generates low profitability, with very low success rates. One way to combat this is by the improvement of known antimicrobials, such as antimicrobial peptides (AMPs). The aim of this study was to improve the antimicrobial activities of two known AMPs, UyCT3 and indolicidin, with the use of peptide libraries and growth curves.

Methods

Peptide permutation libraries were synthesized for two AMPs, indolicidin and UyCT3, which included 520 peptides. These peptides were subsequently tested against MG1655-K12, to which subsequent peptide design was performed, then tested against three clinically Gram-negative relevant drug-resistant isolates. Best-performing candidates were subjected to a haemolysis assay for toxicity validation.

Results

Single amino acid permutations of UyCT3 and indolicidin were sufficient to inhibit growth of MG1655-K12, and subsequent generations of peptide design were able to inhibit growth of clinical isolates at concentrations as low as 5 µM. Our best-performing AMP, UyCT3I5A, W6Y, K10I, F13I, was not seen to be toxic towards sheep RBCs.

Conclusions

The efficacy of the AMPs improved with the use of our peptide library technology, whereby an AMP was found that inhibited bacterial growth of clinical Gram-negative isolates 4-fold better than its WT counterpart.
A postmortem case report involving fentanyl, desalkylgidazepam, and bromazolam
Authors: Ballotari Marco , Truver Michael T , Dhoble Leena R , Kinsey Amy M , Hoyer Jennifer L , Chronister Chris W , Goldberger Bruce A
Published: July 2024

The emergence of new psychoactive substances (NPS) and the number of new chemically diverse substances in the global illicit drug market have significantly increased over the last few years. Designer benzodiazepines are some of the most misused NPS worldwide, contributing to both nonfatal and fatal drug overdose cases. The use of desalkylgidazepam and bromazolam has recently emerged, and their prevalence has been internationally reported. In this study, we quantified desalkylgidazepam and bromazolam using gas chromatography coupled with mass spectrometry (GC–MS) in the postmortem specimens of a subject found deceased due to suspected drug overdose. A 24-year-old white male with a history of drug use was found unresponsive and not breathing in his home with drug paraphernalia nearby. A yellow powdery substance and prescription tablets were also found at the scene. The GC–MS analysis of the postmortem blood and urine samples confirmed the presence of fentanyl, desalkylgidazepam, and bromazolam. The desalkylgidazepam concentration was 1100 ng/mL in the blood, which was higher than previous reports in the literature, and estimated to be 89 ng/mL in the urine. The bromazolam concentration was 352 ng/mL in the blood and estimated to be 398 ng/mL in the urine. Additionally, fentanyl was detected in the blood (11 ng/mL), and fentanyl, norfentanyl, and gabapentin were detected in the urine. The present study aims to provide the toxicological community with information regarding a fit-for-purpose analysis of two NPS benzodiazepines.
Total third-degree variation for noise reduction in atomic-resolution STEM images
Authors: Kawahara Kazuaki , Ishikawa Ryo , Sasano Shun , Shibata Naoya , Ikuhara Yuichi
Published: July 2024

Scanning Transmission Electron Microscopy (STEM) enables direct determination of atomic arrangements in materials and devices. However, materials such as battery components are weak for electron beam irradiation, and low electron doses are required to prevent beam-induced damages. Noise removal is thus essential for precise structural analysis of electron-beam-sensitive materials at atomic resolution. Total square variation (TSV) regularization is an algorithm that exhibits high noise removal performance. However, the use of the TSV regularization term leads to significant image blurring and intensity reduction. To address these problems, we here propose a new approach adopting L2 norm regularization based on higher-order total variation. An atomic-resolution STEM image can be approximated as a set of smooth curves represented by quadratic functions. Since the third-degree derivative of any quadratic function is 0, total third-degree variation (TTDV) is suitable for a regularization term. The application of TTDV for denoising the atomic-resolution STEM image of CaF2 observed along the [001] zone axis is shown, where we can clearly see the Ca and F atomic columns without compromising image quality.
Chronic pancreatitis of jejunal ectopic pancreas: a rare cause of chronic abdominal pain
Authors: Smith Sonya Ann , Savage Jack , Roetger Nicholas , Moar Xavier
Published: July 2024

Ectopic pancreas (EP) is an uncommon, congenital focus of pancreatic tissue that is discontinuous with the principal pancreas. A 62-year-old female underwent multiple investigations for chronic epigastric pain. EP was identified intra-operatively. On retrospection, earlier imaging showed a thickened segment of jejunum with inflammation of the surrounding small bowel mesentery, suggestive of jejunal EP pancreatitis. Histology confirmed ectopic pancreatic tissue, with sections of the EP showing evidence of previous acute and chronic pancreatitis. When no cause for chronic abdominal pain is found, diagnostic laparoscopy should be considered, and the small bowel inspected, to further investigate for rare causes of abdominal pain, such as EP.
TeV afterglow from GRB 221009A: photohadronic origin?
Authors: Sahu Sarira , Medina-Carrillo B , Páez-Sánchez D I , Sánchez-Colón G , Rajpoot Subhash
Published: July 2024

Gamma-ray burst (GRB), GRB 221009A, a long-duration GRB, was observed simultaneously by the Water Cherenkov Detector Array (WCDA) and the Kilometer Squared Array (KM2A) of the Large High Altitude Air Shower Observatory (LHAASO) during the prompt emission and the afterglow periods. Characteristic multi-TeV photons up to 13 TeV were observed in the afterglow phase. The observed very high-energy (VHE) gamma-ray spectra by WCDA and KM2A during different time intervals and in different energy ranges can be explained very well in the context of the photohadronic model with the inclusion of extragalactic background light models. In the photohadronic scenario, interaction of high-energy protons with the synchrotron self-Compton (SSC) photons in the forward shock region of the jet is assumed to be the source of these VHE photons. The observed VHE spectra from the afterglow of GRB 221009A are similar to the VHE gamma-ray spectra observed from the temporary extreme high-energy peaked BL Lac (EHBL), 1ES 2344+514 only during the 11th and the 12th of August, 2016. Such spectra are new and have been observed for the first time in a GRB.
Comparative sperm morphology of 15 species of limpet (Mollusca: Patellogastropoda: Lottioidea) and correlation with current systematics and phylogenies
Authors: Hodgson Alan N , Buckland-Nicks John
Published: July 2024

The spermatozoa of 14 species (four genera) of Lottiidae and one species of Acmaeidae are described by transmission electron microscopy. All have ect-aquasperm, which are relatively small, morphologically simple, free-swimming sperm produced by species with external fertilization. Based on the size, shape and structure of the nucleus and acrosome, as well as features of the mid-piece, several morphological sperm ‘types’ are recognized within the species of Lottioidea described by the present and several previous studies. Sperm morphology largely supports current taxonomy as well as systematic and phylogenetic relationships. However, the morphology of the sperm of Lottia dorsuosa suggests that its generic status should be re-examined. The sperm morphology of Niveotectura pallida (formerly Acmaea pallida) is more similar to that of species of Tectura than of Acmaea mitra, supporting the current placement of N. pallida in the Lottiidae. This result is at odds with the close relationship between N. pallida and A. mitra indicated by recent phylogenies based on molecular data.
Comparison of Post-Operative Analgesia of Caudal versus Dorsal Penile Nerve Blocks for Pediatric Patients Undergoing Hypospadias Repair
Authors: El-Mansoury Yasser Mohamed , Ibrahim Sherif Farouk , El-Fawal Sanaa Mohammed , Habib Mariam Kamal
Published: July 2024

Background

Hypospadias is the second most common congenital disorder in males after cryptorchidism, but it is the most common penile congenital malformation. It is an abnormality of anterior urethral and penile development in which the urethral opening is ectopically located on the ventral aspect of the penis proximal to the tip of the glans penis, which, in this condition, is splayed open. The urethral opening may be located as far down as in the scrotum or perineum. The penis is more likely to have associated ventral shortening and curvature, called chordee, with more proximal urethral defects.

Aim of the Work

The aim of this study is to compare the effectiveness of penile block versus caudal block using bupivacaine on the quality of analgesia after hypospadias repair in pediatrics.

Methodology

This prospective randomized comparative clinical study was conducted in Ain Shams University Hospitals; Pediatric Surgery Unit. It included 30 male patient aged (1–8) years, ASA I or II patients undergoing hypospadias (distal penile and mid penile) repair. They were divided into two groups: Group P: Penile block (n = 15) received dorsal penile nerve block by using the subpubic approach technique. Group C: Caudal block (n = 15) received caudal epidural block using a 22-G needle in the lateral decubitus position.

Results

There was statistically high significant difference between the two groups in postoperative MAP and HR (p value <0.001) but no statistically significant difference between them in Spo2. FLACC pain scores were significantly lower in group C compared with group P at PACU and 3 hours postoperative (p value <0.001) but no statistically significant difference between them at 6, 9 and 12 hours postoperative. Also, The time for first rescue analgesia was significantly longer in caudal group compared with penile group (P < 0.001) and the total analgesia consumption was also significantly lower (P < 0.001) in group C compared with group P. Postoperative time of ambulation was significantly lower (P < 0.001) in group P compared with group C.

Conclusion

The current study revealed that Caudal block provided significantly prolonged postoperative analgesia, reduced the postoperative analgesic requirements and prolonged time of ambulation as compared with Penile block in pediatric patients undergoing hypospadias repair.
Safety and Efficacy of Combined Dexmedetomidine and Bupivacaine versus Bupivacaine Alone in Caudal Block in Pediatric Patients Undergoing Lower Abdominal Surgery
Authors: Salama Hala Gomaa , AlAnsary Adel Mohamad , Kamal El-Din Doaa Mohammed , Eldawy Mahmoud Ramadan
Published: July 2024

Background

Lower abdominal surgeries are one of the most frequently performed surgical procedures in the pediatric population. Using optimal analgesic regimen provide safe and effective analgesia, reduce postoperative stress response and accelerate recovery from surgery. Regional anesthetic techniques are commonly used to facilitate pain control in pediatric surgical procedures. The most commonly used techniques in pediatrics is caudal block.

Objective

To evaluate the analgesic effect of dexmedetomidine when given caudally as an adjuvant to caudal block vs bupivacaine alone in caudal block for children undergoing lower abdominal surgeries.

Methods

The study was conducted on 88 randomly chosen patients in Ain Shams University Hospitals after approval of the medical ethical committee. Patients were divided randomly into two groups; each group consisted of 44 patients. After preoperative assessment and obtaining baseline vital data, all patients received general anesthesia. Group BD who would receive caudal dexmedetomidine and Group B who would receive caudal block with Bupivacaine.

Results

There was a highly statically significance between groups according to time to first analgesic requirement (hrs). This table show statically significance difference between groups according to number of paracetamol doses in first 24h. While a statically significant difference between the two groups according to PACERO score. The sedation score was higher in group BD compared to group B. Also a statically significance difference between two groups according to FLACC scale at 8h and 12h. The duration of adequate analgesia (FLACC pain score 4 or less) was significantly higher in group BD compare to group B.

Conclusion

Dexmedetomidine 1 mcg/kg, when used as an adjuvant to caudal anesthesia, can significantly prolong the duration of postoperative analgesia. It is better than bupivacaine alone in caudal block at similar doses in controlling postoperative pain.
Prognostic Value of Neurological Manifestations Related to COVID-19 Positive Patients: Observational Cross-Sectional Study
Authors: Nashed Sherif Wadie , Elsersi Mayar Hassan , AbdelRahman Tamer Nabil , Abd elMaqsoud Abd elQader Ahmed Abd elRazek
Published: July 2024

Background

COVID-19 is an infectious disease caused by severe acute respiratory syndrome coronavirus. Corona virus affects the central nervous system in various different ways either through a retrograde transfer via the olfactory epithelium or through the cribriform bone and reaches the brain directly in seven days’ time or due to disruption of blood brain barrier which occurs during the viremia phase of illness and the virus will enter the brain directly. Another postulated mechanism is the invasion of peripheral nerve terminals by COVID-19 which then gains entry to the CNS through the synapse connected route.

Objective

To determine the prevalence of neurological symptoms and complications in COVID-19 patients and if we can use the neurological symptoms and its relevance as prognostic factors for disease severity.

Patients and Methods

This was a cross sectional study that was conducted on COVID-19 positive patients admitted to isolation ICU Ain Shams University Hospital through 4 months.

Results

The present study aimed to provide a comprehensive overview of neurologic manifestations associated with SARS-CoV-2 infection and to describe the clinical course and outcomes of COVID-19 patients with neurologic manifestations. Our results highlight the broad spectrum of neurological manifestations associated with SARS-CoV- 2 infection: the majority of neurologic manifestations were altered mental status (27.7%), anosmia (13.8%) followed by headache (12.5%).

Conclusion

the neurological manifestations are common in Covid-19 patients. There is an association between the presence of neurological manifestations and mortality.
Wide-Awake Local Anesthesia No Tourniquet (WALANT) versus Regional Anesthesia with Tourniquet for Hand Flexor Tendon Repair Surgeries in Adults
Authors: Kamaly Ayman Mokhtar , Amin Mohammed Salwa Omar El-Khatab , Ahmed Shaker Mohammed Khaled Abdelhameed , Metri Bakhtan Mina Bakhtan
Published: July 2024

Background

Flexor tendon injuries represent a significant percentage of admissions in emergency departments in Egypt. A bloodless surgical field is important to perform a hand surgery. Traditionally, a tourniquet is used for hemostasis, and the standered anesthetic techniques utilized in hand surgery were general anesthesia, intravenous regional anesthesia, or brachial plexus block. Recently the evolving Wide-Awake Local Anesthesia No Tourniquet (WALANT) technique where patient is operated on under local anesthesia and hemostasis is achieved via adrenaline could be a better choice. Aim of this work is to compare the intraoperative pain scores, induction time, operating time, blood loss, postoperative pain scores, and patient satisfaction with WALANT versus supraclavicular brachial plexus block (SC-BPB ) with tourniquet, in patients undergoing flexor tendon repair.

Patients and Methods

In the current study 52 patients who underwent flexor tendon intervention were divided randomly into two groups, each group consisting of 26 patients. Group A: Patients in this group received WALANT. Group B: Patients in this group received SC-BPB with a tourniquet applied to the arm.

Results

Intraoperative Wong-Baker Faces scale revealed no statistically significant difference in intraoperative pain scores in both groups, except during injection (p = 0.04). Tourniquet-related pain was reported in 23% of patients of SC-BPB group (p = 0.001). Induction time was significantly shorter in WALANT (p < 0.01) but time needed to obtain sufficient hemostasis is significantly more in WALANT than SC-BPB (p < 0.01) while surgical time was similar in both groups (p = 0.538). Blood loss in spite of being minimal it was statistically significant higher in WALANT (p < 0.01).

Conclusion

WALANT anesthesia was found to be better alternative to SC-BPB in flexor tendon repair surgeries in adults being more simple technique and no need for special skills or ultrasound device, less time consumed in induction and less injection pain also no tourniquet-related pain, intraoperative active motion of the hand is preserved facilitating surgical technique, better effect on postoperative analgesia and more patient and surgeon satisfaction.
Retrospective Analysis of Paraparalysis/Paraparesis Post Aortic Aneurysm Endovascular Repair
Authors: Hashem Elrifay Amr Mohamed Mohamed , Mohamed Hassan Alaa Eid , Ali Badr Naglaa Mohammad , Hefney Sameh Salem , Elsayed-Awad Hamdy , Ahmed Youssef Ahmed Monier
Published: July 2024

Objective

Paralysis post TEVAR is a challenging complication, this study discusses its incidence, Risk factors, clinical outcome, reversibility, protective strategy and associated mortality.

Methods

Retrospective study Conducted on patients underwent thoracic and thoracoabdominal aortic Aneurysm Endovascular Repair in Last 11 years (January 2012 till June 2022) in single center as regard incidence, personal history, medical and surgical risk factors, preventive strategies, reversibility of paralysis and associated mortality. Data was obtained from records; paralysis was diagnosed through clinical examination immediately after emergence from anesthesia and frequently post operatively in SICU or even word and after discharge in follow-up outpatient clinic visits.

Results

A study carried on 137 patients, 15 patients of them developed lower limb paralysis with incidence of 10.9%, 3 patients of them (23.1%) developed paralysis immediately post operative, 4 patients developed paralysis in day 1 post operative (30.8%). And the rest of patients developed delayed onset paralysis (more than 24 Hour post procedure), The latest one developed paralysis 26 days post operative, 8 of paralyzed patients had spinal cord imaging (MRI) 4 of them (50%) didn’t show any abnormality and 3 of them (37.5%) showed spinal cord ischemia and 1 patient didn’t tolerate the MRI machine so the study was discontinued. According to reversibility, 9 patients had complete reversal of their motor and sensory symptoms to the baseline preoperative status. 2 patients had partial reversal of their symptoms, and 4 patients had persistent symptoms without any improvement despite the routine management that included elevating MAP and draining CSF to less than 10 mmHg in order to maintain spinal cord perfusion pressure at level of 80 mmHg and giving naloxone. Data showed 12 out of 81 patients (14.8%) who had functioning spinal drain developed paralysis. Duration of procedure is the most affecting risk factor on paralysis, patients with mean duration of 270 minutes had higher risk of paralysis.

Conclusion

Prediction of paralysis post TEVAR is still difficult and data analysis showed that the duration of procedure is the only statistically significant variable that we can rely on.