bluuebunny/crossref_metadata_2025 huggingface dataset:
496 Necrotising Fasciitis Within a Single Centre: A 5 Year Retrospective Review
Authors: Ejaz M , Sarwar U
Published: July 2024

Aim

Necrotising Fasciitis (NF) is a rapidly progressing soft tissue infection that necessitates prompt diagnosis and management. This study examined NF cases over a 5-year period at Bradford Royal Infirmary and those referred from local hospitals to enhance patient care and outcomes.

Method

Cases coded as “Necrotising Fasciitis” between April 2018 and January 2023 were retrospectively reviewed using electronic records. These encompassed patients transferred for plastic surgery input and those admitted under various specialties. Data on risk factors, admission details, surgical interventions, microbiology results, and outcomes were collected. Microbiology results included histology, tissue, swabs and blood cultures if sent.

Results

A total of 50 cases were identified - 33 male and 17 female patients with a mean age of 53 (range of 25-93). The mean Laboratory Risk Indicator for Necrotising Fasciitis (LRINEC) score was 8.6 prior to debridement. Of the 13 cases with histological confirmation, 2 were calculated as low risk and 2 as intermediate. Tissue cultures showed 21 cases with E. Coli and/or Mixed Anaerobes (Type 1) and 8 with Group A Strep and/or Staph Aureus (Type 2). 4 cases did not require debridement, while others needed an average of 2.3 debridements. 23 of the 45 patients required reconstruction by the local plastics team. 37 patients of the total 50 were discharged, 3 self-discharged and 10 died acutely (22.2% mortality rate).

Conclusions

While the LRINEC score is a valuable indicator for NF, histology demonstrates its limitations. It is an adjunct, not a substitute, to clinical diagnosis, ensuring accurate management and preventing misdiagnosis.
611 Hydrogel Vue Spacer in Prostate Cancer Radiotherapy for Patients with Inflammatory Bowel Disease (IBD): Pilot Study
Authors: Hayyawi I , Alani A , Ahmed I , AlHasso A
Published: July 2024

Introduction

Patients with Inflammatory Bowel Disease and those with previous rectal surgery may have challenges when undergoing prostate radiotherapy due to increased rectal toxicity after radiotherapy which may preclude them from having radiotherapy for their prostate cancer. We need solutions that can minimize rectal toxicity while maintaining the efficacy of radiotherapy for patients. We report on our experience using SpaceOAR Hydrogel Spacer as a solution to minimize the radiation dose to the rectum and reduce toxicities.

Aim

To assess the benefits of SpaceOAR Hydrogel spacers following radiotherapy in patients who are at risk than average of rectal toxicity.

Method

We collected data from patients with IBD or previous rectal/bowel surgery who received radical radiotherapy with SpaceOAR Vue™ Hydrogel from period between Sep/2021 and Sep/2022. Data was collected including age, stage, baseline PSA, Gleason score, number of endoscopic assessment required and need for any surgical/medical intervention within one-year after completion of their radiotherapy.

Results

16 patients were included in the study with one year follow up. The range of age is (62-82 years), the dose of radiotherapy varies between 6000-7400Gy and the initial PSA range was (6.1-89). 8 patients required endoscopic assessment within 1 year of treatment (As a part of their normal follow-up). was normal in all patients except in 3 patients who has mild colitis. Biochemical control at one year was excellent.

Conclusions

Results demonstrated that the use of Hydrogel spacer in patients with IBD or previous bowel surgery undergoing radical prostate cancer radiotherapy is safe and is a reasonable strategy.
45 Skin Preparation in Arthroscopic Surgery – Are There Environmental Savings to Be Made?
Authors: Kutuzov V , Cornish E , Andrews H , Kapoor A , Jain N
Published: July 2024

Background

The environmental impact of surgery is concern that has been raised in recent years. Operating theatres have been found to create up to 230kg of waste per day. There is a need to reduce surgical waste whilst maintaining patient safety. This study assessed the waste and CO2 production associated with two accepted skin preparation techniques.

Method

Groups consisted of two consultant surgeons, both performing 5 arthroscopic procedures. Surgical skin preparation was performed with disposable ChloraPrep™ sticks or bottled Hydrex 0.5% solution with red dye. Annual waste and CO2 production was assessed via modelling.

Results

The disposable group generated a total of 876g of net waste compared to 1727g in the solution group. Waste per surgical case was 134.6g (SD 14.97) in the disposable group compared to 328.8g (SD 86.09) in the solution group. The disposable group produced significantly less waste than the solution group (P <0.0069). In 2022, a total of 514 arthroscopies were performed at our institution (134 shoulder, 380 knee). Modelling using the research group data provided estimated annual waste in both groups; 225.132kg in the ChloraPrep™ stick group compared to 443.839kg in the Hydrex 0.5% solution group, with Kg CO2 production of 241.79-701.57 Kg and 476.68-1383.13 Kg in each group respectively.

Conclusions

This study demonstrates that choice of skin preparation in arthroscopy can significantly reduce waste and CO2 production, without a significant increase in cost.
796 Integrating Sustainability in Surgical Practice – the Student MedAID London Way
Authors: Sarela S , Asim N , Sheriff V , Samsudeen N , Mazzoleni A
Published: July 2024

Aim

Recognizing the imperative need for sustainable healthcare education given only 2-5% of students have had exposure within their degree, Student MedAID London (SMAL) was established to promote global health awareness by redistributing excess medical supplies and fostering a platform for increasing insight into this field.

Method

Volunteers actively engage with local healthcare providers to secure excess medical equipment, employing a screening process to ensure responsible donations. Teaching series, such as "Learn with Med-Aid" and online seminars, delve into global health topics often overlooked in medical school curriculum. This methodology offers a unique opportunity to integrate sustainability principles into the education of future surgeons.

Results

Social media and seminar engagement increased by 62% respectively since establishment in 2021, attracting over 1000+ followers across social media channels. The demographic has expanded beyond London medical students to include young healthcare professionals from across the UK and the USA. Furthermore, SMAL has acquired substantial storage space for medical donations and made successful donations to Tripoli Hospital in Lebanon. Notably, 90% of seminar attendees expressed a strong desire for more events, alongside 50% reporting it increased their confidence in global health and sustainability.

Conclusions

As the future generation of healthcare professionals increasingly expresses a heightened interest in sustainable practice, SMAL's endeavours uniquely underscore the profound impact that sustainability can have on surgical education. By raising awareness and actively engaging in the redistribution of medical supplies, the organization sets the stage for a paradigm shift towards more environmentally conscious healthcare initiatives in surgery.
1147 Long Term Outcomes Following Combined Liver-Kidney Transplantation
Authors: Hennessy C , Monbaliu D
Published: July 2024

Aim

Combined liver kidney transplant (CLKTx) is the mainstay of treatment for concurrent liver failure and end stage renal failure. The use of CLKTx has increased markedly since the introduction of the MELD (Model for End Stage Liver Disease) score for liver allocation. In this study we examined the long-terms outcomes of 25 years of CLKTx in our centre.

Method

From a database of all transplants from 1997 – 2022, 158 recipients of CLKTx were identified. Primary outcomes of interest were mortality and graft failure. Data was analysed in R studio and GraphPad prism.

Results

Overall patient survival was 89% at 1 year, 87% at 2 years, 81% at 5 years, 72% at 10 years and 50% at 20 years. The 20-year patient survival with a pre-transplant (preTx) MELD of <20 was 52%, with a preTx MELD of >20 associated with significantly lower 20-year patient survival of 26% (P<0.05). Death censored (dc) liver graft survival was 99% at 1 year, 98% at 2 years, 97% at 5 years and ten years, and 88% at 25 years. A donor age of <40 showed 20-year liver graft survival (dc) of (100%), which was significantly greater than the donor age >40 group (72%, P<0.05). Death censored kidney graft survival was 96% at 1 year, 95% at 2 and 5 years, 92% at ten years and 84% at twenty years post Tx.

Conclusions

We report favourable long-term outcomes following 25 years of CLKTx. Predictors for better long-term patient and graft survival include pre transplant MELD score and donor age.
37 Evaluation of Prophylactic Negative Pressure Wound Therapy Versus Standard Surgical Dressings on Wound Outcomes in Posterior Spinal Surgery Patients: A Systematic Review and Meta-Analysis
Authors: Rathore Ahmed , Baliga Santosh , Lennox Liam , Bickerton Melanie
Published: July 2024

Aim

Negative pressure wound therapy has frequently been used in a variety of surgical specialities, yet its effectiveness as a prophylactic therapy in spinal surgery remains unclear. A comprehensive systematic review and meta-analysis was performed, incorporating the most recent evidence, addressing this paucity in the literature.

Method

A systematic search of the literature from inception to June 2023 was conducted using the following databases: Ovid Medline, EMBASE, Cochrane Register of Controlled Trials (CENTRAL) and Web of Science. All included studies assessed primary wound closure for posterior spinal surgical incisions. Evidence was quality assessed and outcomes of interest were meta-analysed using odds ratios, comparing negative pressure wound therapy and standard dressing groups.

Results

Seven studies (n = 1319, mean age = 59.9 years, 55.8% male) were included. Patients with negative pressure dressings had a reduced risk of surgical site infection (odds ratio = 0.45, 95% CI 0.29 to 0.72, p < 0.001). Wound dehiscence approached significance favouring negative pressure dressings (odds ratio = 0.53, 95% CI 0.26 to 1.06, p = 0.07). Patients requiring a return to theatre for wound related complications showed no significant difference between groups (odds ratio = 0.66, 95% CI 0.37 to 1.18, p = 0.16).

Conclusions

Negative pressure wound therapy reduces the risk of surgical site infection in posterior spinal surgery patients. Given that surgical site infection in spine surgery is associated with significant morbidity and financial costs, implementation of prophylactic negative pressure wound therapy for this patient demographic may be beneficial.
358 Driving Endovascular Solutions for Abdominal Aortic Aneurysms: A 9-Year International Experience with the Fenestrated Anaconda Endograft
Authors: Jubouri M , Surkhi A O , Tan S , Williams I M , Bashir M
Published: July 2024

Aim

Endovascular aortic repair (EVAR) has become the mainstay treatment for abdominal aortic aneurysms and is associated with optimal outcomes. However, there remains a risk of complications requiring reintervention. Several EVAR devices exist commercially, yet, the Fenestrated Anaconda™ (FA) has demonstrated outstanding results. This study aims to presents a 9-year cross-sectional international analysis of custom-made FA outcomes.

Method

Patient data was collected prospectively in 27 countries over 9 years and stored in an international registry. This was later retrieved and analysed retrospectively.

Results

A total of 5058 patients received the FA endograft. This was indicated either due to complex anatomy for competitor devices (n = 3891, 76.9%) or based on surgeon preference (n = 1167, 23.1%). Overall, the FA was utilised to rescue 2987 (59%) failed previous EVARs. The predominant device category and proximal ring stent configuration were bifurcate (83.6%) and standard (64.5%). Most devices were delivered within 6-8 weeks (55.4%) of diagnosis and 95% came with a prototype. As for clinical outcomes, both survival and TVP were 100% during the first 6 postoperative years but dropped to 77.1% and 81% thereafter. A sac regression of 0-30% was observed in 4772 (94.3%) patients over the first 4 years, whilst all patients had 20-45% sac regression in years 5-9 of follow-up. No cases of endograft migration or reintervention were recorded. All clinical outcomes were further stratified by indication group.

Conclusions

The custom-made FA endograft features a highly unique and innovative design which enables it to treat highly complex aortic anatomy while achieving favourable results.
CA125 outperforms NT-proBNP in the prediction of maximum aerobic capacity in heart failure with preserved ejection fraction and kidney dysfunction
Authors: Núñez-Marín Gonzalo , Palau Patricia , Domínguez Eloy , de la Espriella Rafael , López Laura , Flor Cristina , Marín Paloma , Lorenzo Miguel , Miñana Gema , Bodí Vicent , Sanchis Juan , Núñez Julio
Published: July 2024

Background

Heart failure with preserved ejection fraction (HFpEF) often coexists with chronic kidney disease (CKD). Exercise intolerance is a major determinant of quality of life and morbidity in both scenarios. We aimed to evaluate the associations between N-terminal pro-B-type natriuretic peptide (NT-proBNP) and carbohydrate antigen 125 (CA125) with maximal aerobic capacity (peak VO2) in ambulatory HFpEF and whether these associations were influenced by kidney function.

Methods

This single-centre study prospectively enrolled 133 patients with HFpEF who performed maximal cardiopulmonary exercise testing. Patients were stratified across estimated glomerular filtration rate (eGFR) categories (<60 ml/min/1.73 m2 versus ≥60 ml/min/1.73 m2).

Results

The mean age of the sample was 73.2 ± 10.5 years and 56.4% were female. The median of peak VO2 was 11.0 ml/kg/min (interquartile range 9.0–13.0). A total of 67 (50.4%) patients had an eGFR <60 ml/min/1.73 m2. Those patients had higher levels of NT-proBNP and lower peak VO2, without differences in CA125. In the whole sample, NT-proBNP and CA125 were inversely correlated with peak VO2 (r = −0.43, P < .001 and r = −0.22, P = .010, respectively). After multivariate analysis, we found a differential association between NT-proBNP and peak VO2 across eGFR strata (P for interaction = .045). In patients with an eGFR ≥60 ml/min/1.73 m2, higher NT-proBNP identified patients with poorer maximal functional capacity. In individuals with eGFR <60 ml/min/1.73 m2, NT-proBNP was not significantly associated with peak VO2 [β = 0.02 (95% confidence interval −0.19–0.23), P = .834]. Higher CA125 was linear and significantly associated with worse functional capacity without evidence of heterogeneity across eGFR strata (P for interaction = .620).

Conclusions

In patients with stable HFpEF, NT-proBNP was not associated with maximal functional capacity when CKD was present. CA125 emerged as a useful biomarker for estimating effort intolerance in HFpEF irrespective of the presence of CKD.
Cardiac mechanics and the risk of atrial fibrillation in a community-based cohort of older adults
Authors: Inciardi Riccardo M , Wang Wendy , Alonso Alvaro , Soliman Elsayed Z , Selvaraj Senthil , Gonçalves Alexandra , Zhang Michael J , Chandra Alvin , Prasad Narayana G , Skali Hicham , Shah Amil M , Solomon Scott D , Chen Lin Yee
Published: July 2024

Aims

Assessment of cardiac structure and function improves risk prediction of new-onset atrial fibrillation (AF) in different populations. We aimed to comprehensively compare standard and newer measures of cardiac structure and function in improving prediction of AF in a cohort of older adults without history of AF and stroke.

Methods and results

We included 5050 participants without prevalent AF and stroke (mean age 75 ± 5 years, 59% women, and 22% Black) from the Atherosclerosis Risk in Communities (ARIC) study who underwent complete two-dimensional echocardiography, including speckle-tracking analysis of the left ventricle (LV) and left atrium (LA). We assessed the association of cardiac measures with incident AF (including atrial flutter) and quantified the extent to which these measures improved model discrimination and risk classification of AF compared with the CHARGE-AF score. Over a median follow-up time of 7 years, 676 participants developed AF (incidence rate 2.13 per 100 person-years). LV mass index and wall thickness, E/e′, and measures of LA structure and function, but not LV systolic function, were associated with incident AF, after accounting for confounders. Above all, LA reservoir strain, contraction strain, and LA minimal volume index (C-statistics [95% confidence interval]: 0.73 [0.70, 0.75], 0.72 [0.70, 0.75], and 0.72 [0.69, 0.75], respectively) significantly improved the risk discrimination of the CHARGE-AF score (baseline C-statistic: 0.68 [0.65, 0.70]) and achieved the highest category-based net reclassification improvement (29%, 24%, and 20%, respectively).

Conclusion

In a large cohort of older adults without prevalent AF and stroke, measures of LA function improved the prediction of AF more than other conventional cardiac measures.
Frailty Was Associated With Atmospheric NO2 Levels: A Geospatial Approach
Authors: Gonzalez-Bautista Emmanuel , Román-Pérez Susana , Manrique-Espinoza Betty Soledad , Salinas-Rodríguez Aaron , Santos-Luna René
Published: July 2024

Background

Recent evidence has linked air pollution with frailty, yet little is known about the role of NO2 in this association. Our aim was to assess the association between frailty and NO2 air concentrations in Mexican older adults.

Methods

We used georeferenced data from the population-based Nutrition and Health Survey in Mexico (NHNS) 2021, representative of national and subnational regions, to measure a frailty index based on 31 health deficits in adults aged 50 and older. Air pollution due to NO2 concentrations was estimated from satellite images validated with data from surface-level stations. Maps were produced using Jensen’s Natural break method. The association of frailty and NO2 concentrations was measured using the frailty index (multivariate fractional response logit regression) and a frailty binary variable (frailty index [FI] ≥0.36, multivariate logit regression).

Results

There was a positive and significant association of the frailty index with the NO2 concentrations, adjusting for age, sex, urban and rural area, years of education, socioeconomic status, living arrangement, particulate matter smaller than 2.5 microns, and indoor pollution. For each standard deviation increase in NO2 concentrations measured 10 years before the survey, the odds of being frail were 15% higher, and the frailty index was 14.5% higher. The fraction of frailty attributable to NO2 exposure ranged from 1.8% to 23.5% according to different scenarios.

Conclusions

Frailty was positively associated with exposure to NO2 concentrations. Mapping frailty and its associated factors like NO2 air concentrations can contribute to the design of targeted pro-healthy aging policies.
Are Older Adults More Prosocial Than Younger Adults? A Systematic Review and Meta-Analysis
Authors: Li Duo , Cao Yuan , Hui Bryant P H , Shum David H K
Published: July 2024

Background and Objectives

Prosociality refers to voluntary behaviors that intend to benefit others. Most of the existing literature suggests that older adults tend to act more prosocially compared to younger adults, whereas some studies show that older adults might not be that prosocial under certain conditions. The current study aimed to summarize the mixed findings and quantify the age difference in prosociality by conducting a qualitative systematic review and a quantitative meta-analysis.

Research Design and Methods

Literature search was conducted based on 5 databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed and this review was registered at PROSPERO (CRD42022333373).

Results

Based on the qualitative synthesis of 51 studies, older adults (n = 109,911) were more prosocial than younger adults (n = 68,501). The meta-analysis of 46 studies further supported this age effect (Hedges’ g = 0.31, 95% confidence interval [0.24, 0.37]), and this age effect might be moderated by the types of prosociality. We discovered a moderate age effect in sharing (Hedges’ g = 0.53), but a nonsignificant age effect in helping (Hedges’ g = 0.11), comforting (Hedges’ g = −0.20), or mixed prosociality (Hedges’ g = 0.15). Additionally, the age effect was only significant when older adults had higher socioeconomic status than younger adults.

Discussion and Implications

Future research should develop more comprehensive measures of prosociality, examine more variables that influence aging and prosociality, and investigate the neural mechanism(s) of prosociality to achieve a thorough understanding of the age difference in prosociality.
O-059 ART in PCOS
Authors: Dhillon Pai R , Pai A
Published: July 2024

Polycystic Ovarian Syndrome affects an estimated 8 – 13% of women of reproductive age (WHO).

It is the commonest cause of anovulation and infertility. The high AMH, LH, Insulin resistance and hyperandrogenism seen in PCOS women contributes to infertility along with poor oocyte quality and reduced endometrial receptivity.

ART procedures are recommended as the third line of treatment after ovulation induction, IUI or ovarian drilling.

Prior to IVF, metabolic assessment and lifestyle adjustments with weight management must be done. Adjuvant agents such as metformin melatonin, myoinositol and Vitamin-D have been tried to improve IVF outcomes.

Mild stimulation is an option in patients as high risk for ovarian hyperstimulation syndrome (OHSS).

Conventional stimulation with low dose FSH, GnRH antagonist down regulation, agonist trigger with freezing of all embryos, significantly reduces risk of OHSS without compromising cumulative live birth rates.

Adjustments for stimulation protocols may need to be made for BMI, insulin resistance and AMH. In vitro maturation can be considered in patients with prior severe OHSS, though the results may be inferior.

ART in PCOS patients is challenging and even after pregnancy is achieved, there may be a higher risk of adverse obstetric outcomes.
P-688 Fertility and age at childbirth in polycystic ovary syndrome: results from a longitudinal population-based cohort study
Authors: Forslund M , Melin J , Tay C  T , Loxton D , Teede H , Joham A
Published: July 2024

Study question

How does fertility differ between women with and without polycystic ovary syndrome (PCOS), and which factors are associated with advanced maternal age?

Summary answer

Women with PCOS have less births. PCOS was associated with advanced maternal age, with later diagnosis associated with double the rate of advanced maternal age.

What is known already

PCOS affects 12% or 140 million women globally. Women with PCOS have broad features including ovulatory disturbances and increased infertility; however, few studies have explored reproductive outcomes in PCOS at the end of reproductive age. In the general population advanced maternal age, defined as giving birth after age 35 years, is associated with increased risk of pregnancy complications and reduced fertility. A recent register-based study found increased risk of advanced maternal age in women with PCOS, yet PCOS prevalence was underreported, and the study did not adjust for important confounders.

Study design, size, duration

Prospective cohort study. Women with (n = 981) and without (n = 13 266) self-reported PCOS diagnosis were compared during a 25-year follow-up.

Participants/materials, setting, methods

Women randomly selected from the general population and included in the prospective Australian Longitudinal Study on Women’s Health were assessed with surveys every third year from 1996 (age 18-23 years) to 2021 (age 43-48 years).

Main results and the role of chance

Overall 9.9% of women reported having PCOS and by 43-48 years, those with PCOS had less births (1.7 ±1.3 vs. 1.9 ±1.2, p < 0.001), and more were nulliparous, 23% vs. 18%, p = 0.003. They were older than women without PCOS at their first, and second childbirth (29.5 ±5.49 vs. 28.8 ±5.48 years and 32.1 ±5.16 vs. 31.1 ±5.00 years, p < 0.001 for both).

PCOS was associated with increased odds of advanced maternal age at first childbirth, adjusted odds ratio (aOR) 1.34 (95% confidence interval 1.04-1.75), whereas type 2 diabetes (aOR 0.68 (0.61-1.10)) or hypertension (aOR 0.82 (0.61-1.10)) were not associated with advanced maternal age. Within the PCOS group, a late PCOS diagnosis was associated with increased odds of advanced maternal age, aOR 2.05 (1.24-3.40).

Limitations, reasons for caution

All outcomes were self-reported.

Wider implications of the findings

Women with PCOS have lower parity. Later diagnosis is associated with increased odds of advanced maternal age at first childbirth. Given poor reproductive outcomes with increased maternal age, we highlight the importance of earlier diagnosis, patient education and implementation of a reproductive life-plan to optimize attainment of aspirational family size.

Trial registration number

not applicable
P-708 melatonin alleviates circadian rhythm disruption-induced enhanced luteinizing hormone pulsatility and ovarian dysfunction in vivo and in vitro
Authors: Li Y , Huang W , Pei T
Published: July 2024

Study question

Is melatonin deficiency a reversible cause of abnormal pattern of luteinizing hormone (LH) pulsatility and ovarian dysfunction caused by circadian rhythm disruption (CRD)?

Summary answer

Melatonin could rescue the augmented LH pulsatility and reproductive abnormalities caused by CRD.

What is known already

Melatonin, mainly synthesized and released by pineal gland, engages in regulating circadian rhythms. When circadian rhythms are disrupted, the nocturnal productions of melatonin are suppressed. Evidence suggests that circadian rhythm disruption (CRD) is associated with reproductive dysfunctions, while melatonin plays a vital role for female reproduction as a free radical scavenger and a neuroendocrine regulator. The gonadotrophin-releasing hormone (GnRH) drives pulsatile luteinizing hormone (LH) secretion, which is also essential for fertility.

Study design, size, duration

We used 90 CBA/CaJ mice to establish the chronic jet-lag model in which mice were exposed to an 8 hr time shift every 3 days. After 8 weeks of jet-lag induction, some of the mice were given melatonin treatment for 4 weeks. Furthermore, we used a perfusion system in vitro to mimic the process of CRD-induce high-frequency GnRH pulses stimulation of LβT2 gonadotrope cells.

Participants/materials, setting, methods

Repetitive tail-tip blood collection was used to evaluate the pattern of LH pulsatility. Blood plasma samples were collected from 4 mice at 4-hour intervals to measure levels of melatonin. Follicular development was evaluated by ovarian histology. Reproductive hormones was detected by ELISA. Immunohistochemistry and western blot were used to detect the expression of melatonin receptor 1A (MT1). The LβT2 cells were exposed to pulsatile GnRH at high pulse frequencies to mimic augmented pulsatile GnRH stimulation.

Main results and the role of chance

CRD mice exhibited reproductive-endocrine dysfunction, including irregular estrous cycles, reduced number of corpus lutea (CL), and decreased levels of estradiol and progesterone. Additionally, CRD enhanced the frequency and amplitude of LH pulsatility and pituitary LH beta-subunit expression. Melatonin administration alleviated these CRD-induced reproductive abnormalities and reversed the augmented LH pulsatility. The expression of MT1 decreased in the anterior pituitaries of CRD mice but increased after melatonin treatment, indicating the essential role of MT1 in melatonin’s reversal of CRD-induced enhanced LH pulsatility.

Limitations, reasons for caution

Further research is needed to validate the applicability and safety of these findings in humans.

Wider implications of the findings

The results suggest that melatonin may be a beneficial option for patients with reproductive-endocrine abnormalities, particularly those with circadian rhythm disruption.

Trial registration number

82101719
O-103
Authors: Dalla Zuanna G , Castiglioni M
Published: July 2024

In the mid-1970s, when women born immediately after the Second World War were at full reproductive age, the demographic transition in Europe could be considered concluded. Birth and death rates were around 10 per thousand (a quarter compared to a century earlier), fertility was around two children per woman, and the differences in fertility between countries were modest.

It seemed like the end of a path towards a new demographic stability. In reality, for subsequent cohorts, things continue to change: fertility in many countries declines, while differences between countries grow. The fertility of women born around 1980 in Europe is not far from two children for France and Northern Europe, around 1.6 children in Central and Eastern Europe, around 1.4 children in Southern Europe. Although these differences may seem minimal, the medium-long term consequences on age distributions are enormous.

It would be wrong, however, to say that no similar patterns of fertility exist after the end of the demographic transition. First of all, as already mentioned, there are strong similarities between countries and regions of the same geographical area: Italian fertility patterns, for example, are similar to those of other countries on the northern shore of the Mediterranean, such as Spain, Portugal, Greece and the Balkan states.

Furthermore, all European countries share a progressive increase in the age at birth, both of the first and subsequent children, while late fertility (35+ years of age) increases greatly. The differences between countries are far from irrelevant. However, the variability between countries has been progressively decreasing for thirty years now.

These changes in reproductive behaviours are intertwined with other important changes in Europe's natural demography. The most important is undoubtedly aging, determined by the lengthening of the average lifespan, especially by the spectacular increase in survival beyond fifty years of age. This phenomenon has also been very diversified among European states, less accentuated in particular in Eastern Europe and Russia.

The imbalances in the age structure of the population generated by the joint effect of low birth rates and high survival of the elderly are attenuated by consistent and growing immigration flows from poor countries, where – contrary to what happened in Europe – the working age population grows. These population movements are accompanied by those within Europe, in particular from Eastern and Balkan countries to the other part of the continent.

The future prospects of European demography are traced starting from this global description, underlining in particular what can reasonably be predicted about reproductive behaviour.
O-111 Premature ovarian insufficiency: new data and updated guidance
Authors: Panay N , Anderson R , Bennie A , Cedars M , Davies M , Ee C , Gravholt C H , Kalantaridou S , Kallen A , Kim K , Misrahi M , Nappi R , Rocca W , Ruan X , Teede H , Vermeulen N , Vogt E , Vincent A
Published: July 2024

Premature ovarian insufficiency (POI) presents a significant challenge to women's health, with significant implications both physically and emotionally. Despite its life-altering impact, there remain substantial unknowns in the causes this condition and how to optimally manage its various sequelae While such unknows provide direction for future research, they also underscore the need for clinical guidance.

In 2015, under the auspices of ESHRE, a group of experts evaluated the existing best evidence and published the first European guideline on the management of premature ovarian insufficiency. The update of this Guideline was performed in an international collaboration of experts representing American Society for Reproductive Medicine (ASRM), International Menopause Society (IMS), and the Centre for Research Excellence in Women’s Health in Reproductive Life (CRE WHiRL).

The recent update of the POI guideline covers 40 clinical questions on diagnosis of the condition, the different sequelae, including musculoskeletal health, cardiovascular health, neurological health, sexual function and general well being, and treatment options, including hormone therapy. The list of clinical questions was expanded from the questions included in the guideline from 2015. Based on a scoping survey and appreciation of emerging knowledge of POI, questions were added on the role of AMH in the diagnosis of POI, fertility preservation, muscle health, and specific considerations for hormone treatment in iatrogenic POI. Additionally, the topic on complementary treatments was extended with specific focus on non-hormonal treatments and lifestyle management options.

The draft guideline published for stakeholder review includes a total of 142 recommendations. One third of these recommendations were formulated as good practice points. Of the evidence-based recommendations, almost 80% were formulated as strong recommendations, even if the evidence base for most evidence-based recommendations was limited to observational data (level very low or low), supporting a call for future research.

The guideline group hope that the new POI Guideline will improve the clinical management of this devastating condition.
O-113 Non-invasive evaluation of embryo metabolic activity through hyperspectral microscopy
Authors: Dunning K
Published: July 2024

Current approaches for assessing embryo quality are subjective (morphology) or invasive (biopsy) and are not always predictive of live birth. Development of an accurate and non-invasive method to assess embryo quality would likely improve IVF success.

We have taken a different approach towards developing a non-invasive diagnostic for embryo quality: optical imaging. We use low levels of light to illuminate the embryo and obtain spatial information on cell metabolism as well as biophysical properties of the embryo. Here I will present our work showing that hyperspectral imaging can be used to accurately discriminate between euploid and aneuploid mouse embryos, and in light sheet mode, able to generate 3D metabolic maps of developing embryos. Importantly, we show that this form of imaging is safe: compared to embryos that were not imaged, hyperspectral imaged embryos had similar, and not significantly different, pregnancy and implantation rates, with offspring weight at weaning also comparable.

Another potential optical approach to assess embryo quality is digital holographic imaging. To date, little attention has been paid to the physical parameters of an embryo and whether these could be markers of embryo quality. One such physical parameter is refractive index. We have shown that digital holographic microscopy is able to measure very small changes in refractive index between good and poor-quality mouse embryos.

Importantly, these optical approaches occur in the absence of stains or exogenous tags. Used alone, or in combination, such optical approaches may prove beneficial in developing an accurate, non-invasive diagnostic for embryo quality.
O-116 Fertility in transmasculine people
Authors: Van Mello N
Published: July 2024

Transgender and gender diverse (TGD) people apply for gender-affirming care at any age to manage gender identities or expressions that differ from the gender socially attributed to their sex assigned at birth. Gender-affirming hormonal treatment (GAHT) and gender-affirming surgery (GAS) may alter reproductive function and/or anatomy, limiting future reproductive options to varying degrees, if persons have the wish to either give birth and, or to become a biological parent. The desire to have children in TGD people does not differ from that of the cis population.

In those persons assigned female at birth but who identify as male or genderdivers medical transition often comprises testosterone to induce masculinisation. The effect of testosterone on the uterus and ovaries and further reproductive outcome has not been fully clarified so far. There are several histological studies showing ovarian cortical and stromal changes following testosterone exposure, it is uncertain what the consequences for future fertility may be. It seems there is persistent activity in folliculogenesis by the descriptions of follicle count, distribution and oocyte retrieval. However, there are studies showing a negative effect on fertilization rate in presence of testosterone. Reports on successful ovarian stimulation, fertilizations, pregnancies and live births have been published, with and without testosterone discontinuation.

In this lecture an overview will be given of the recent literature and guidelines on fertility outcome in TGD people assigned female at birth, specifically the effect of medical transition. Recommendations on counseling and ways of fertility preservation will be discussed.
O-124 What is the role of tubal surgery in the era of ART?
Authors: Watrelot A
Published: July 2024

Role of Tubal surgery in the era of art

Tubal surgery is not very popular these days due ti the amazing important and successes of ART. However:

• access to IVF is far for granted in a many countries for financial, cultural or religious reasons

• ivf is not always successful

• tubal surgery is sometimes necessary before ivf in case of hydrosalpinx and conservative surgery may be discussed being in some cases a very valid option.

• recently subtle tubal abnormalities has been studied and demonstrate their importance in infertility

Therefore it seems important to redefine the place of tubal surgery, taking in account the fact that ivf doctors have usually no surgical skills, and that surgeons with tubal skills are not numerous nowadays.

It is also important to recall the principles of tubal surgery: tubes are complex and fragile organs and deserved to be preserved. That is possible is the principles of microsurgery (today done by laparoscopy) are applied: magnification, selective hemostasis, irrigation, gentle handling of the tube with atraumatic instrumentation and microsutures when needed. A special attention must be observed when adhesions are present which is very often the case. Meticulous adhesiolysis and prevention of recurrence are essential.

If careful selection of cases and appropriate technique are used then we may expect very good results in term of pregnancy, similar which was is obtain with ivf

It seems very important to teach these principles of tubal surgery in medical school and to have at least one reproductive surgeon in every ART team.
O-195 Decreased embryo developmental potential and lower cumulative pregnancy rate in males with multiple morphological abnormalities of the sperm flagella
Authors: Long R , Jin L , Zhu L
Published: July 2024

Study question

Is there any association between the multiple morphological abnormalities of the sperm flagella (MMAF) patients and the comprehensive outcomes of assisted reproductive technology (ART) cycles?

Summary answer

Patients with MMAF presented compromised ART outcomes, including lower embryo developmental potential and impaired clinical outcomes, compared with the cohort of oligoasthenospermia.

What is known already

Several studies have reported a positive intracytoplasmic sperm injection (ICSI) outcome in the MMAF cohort, and others have opposite opinions. The association between MMAF and ART outcomes is still controversial and open for debate. Furthermore, the neonatal outcomes and the information regarding the mutations of MMAF patients were incomplete.

Study design, size, duration

A retrospective cohort study of MMAF patients was performed at a reproductive medicine center in China between January 2014 and July 2022.

Participants/materials, setting, methods

Thirty-eight MMAF individuals were recruited based on a typical MMAF phenotype (abnormal sperm flagella, including short, absent, coiled, bent, and/or irregular flagella) and 131 couples with male infertility undergoing in vitro fertilization (IVF)/ICSI treatments over the same period were included as the control pool. Whole exome sequencing (WES) was performed to confirm the genetic pathogenesis of MMAF.

Main results and the role of chance

Pathogenic variants in known genes of DNAH1, DNAH11, CFAP43, FSIP2, and SPEF2 were identified in MMAF patients. The ART outcomes, including the fertilization rate, 2PN cleavage rate, blastocyst formation rate, and available blastocyte rate, were all significantly lower in the MMAF group than those in the control group (P<0.05). Moreover, the CLPR in the MMAF group was lower than that in the control group according to the embryo transfer times (68.6% vs. 86.5%, P=0.033) and complete cycles (66.7% vs. 84.2%, P=0.020), while no significant differences were found in the neonatal outcomes.

Limitations, reasons for caution

The sample size was limited due to the low incidence of MMAF and WES was not performed in all MMAF patients. Further exploration of the potential genetic mutations or underlying mechanisms in patients without identified mutations was needed. Moreover, long-term follow-up of neonates needs to be addressed in the future.

Wider implications of the findings

The current study identified the causative genetic mutations which were partly obligated to the pathogenesis of MMAF and presented the relationship between MMAF and compromised ART outcomes. These results may provide evidence support for clinicians in genetic counseling and clinical instruction in specific MMAF patients.

Trial registration number

the National Key Research & Development Program of China (2021YFC2700603)
O-240 Embryo assessment: the Istanbul consensus revised
Authors: Coticchio G , Ahlström A , Arroyo G , Balaban B , Campbell A , De Los Santos Molina M  J , Ebner T , Gardner D , Kovacic B , Lundin K , Magli C , Mcheik S , Morbeck D , Rienzi L , Sfontouris I , Vermeulen N , Alikani M
Published: July 2024

Study question

What are the current recommended criteria for morphological assessment of oocytes, zygotes and embryos?

Summary answer

The present ESHRE/Alpha Scientists in Reproductive Medicine consensus document provides several novel recommendations to assess oocyte and embryo morphology and rank embryos for transfer.

What is known already

A previous Alpha Scientists in Reproductive Medicine / ESHRE consensus on oocyte and embryo morphological assessment was published in 2011. After more than a decade, a thorough review and update was needed.

Study design, size, duration

A working group consisting of Alpha Scientists in Reproductive Medicine executive board members and ESHRE Special interest group of Embryology members formulated recommendations on oocyte and embryo morphological assessment.

Participants/materials, setting, methods

The working group included 17 internationally recognized experts with extensive experience in clinical embryology. Seven members represented Alpha Scientists in Reproductive Medicine and 8 members represented ESHRE, in addition to two methodological experts from the ESHRE central office. Based on a systematic literature search and discussion of existing evidence, the recommendations of the Istanbul Consensus (2011) were reassessed and, where appropriate, updated based on consensus within the working group. After stakeholder review, the final version will be approved by the working group, the Alpha executive board and the ESHRE Executive Committee.

Main results and the role of chance

This updated consensus paper provides 20 recommendations focused on the timeline of preimplantation developmental events and morphological criteria for oocyte, zygote, and embryo assessment. Based on duration of embryo culture, recommendations are given on the frequency and timing of assessments to ensure safety and effectiveness.

Limitations, reasons for caution

Several criteria relevant to oocyte and embryo morphology have not been well studied, leading to either a recommendation against their use for grading or for use in ranking rather than grading. Future updates may require further revision of these recommendations.

Wider implications of the findings

This document provides embryologists with clear advice on best practices when assessing oocyte and embryo quality based on the most recent evidence.
O-285 Incompatible gametes: implications for infertility diagnosis and treatment
Authors: Kekäläinen J
Published: July 2024

Sperm face intense selection in the female reproductive tract (FRT), and in humans usually only very few out of up to hundreds of millions of sperm cells can eventually proceed to the vicinity of an unfertilized oocyte. Traditionally, it has been thought that the primary function of female-induced sperm selection is to eliminate poor-quality sperm from reaching the oocyte. However, recent studies have demonstrated that in many species (including humans) FRT also mediate mate choice at the level of the gametes, which frequently bias fertilization towards the male, which is genetically compatible with the female. Furthermore, emerging evidence indicates that sperm phenotypic and genotypic variation within single ejaculates may allow gamete-level mate choice to act also among high-quality (‘healthy’) sperm and bias fertilization towards genetically compatible sperm haplotypes. I argue that both of these cellular-level mate choice processes can have important consequences for deeper understanding of the mechanistic basis of fertilization and infertility.
P-079 Bilateral versus unilateral orchidopexy: IVF/ICSI-ET outcomes
Authors: Liu S , Fan L
Published: July 2024

Study question

Does unilateral and bilateral cryptorchidism infertility have an impact on IVF/ICSI-ET results?

Summary answer

Unilateral and bilateral orchidopexy do not affect the final live birth rate in IVF.

What is known already

A study was compared ICSI-ET outcomes between bilateral and unilateral cryptorchidism in NOA patients. Although 90.36% of their study population have undergone orchidopexy to improve their conditions at around 9 to 10 years old, the fertilization rates of bilateral and unilateral cryptorchidism group were only at 46.8% and 46.5% respectively, which were slightly below the average ICSI fertilization rate. The other study showed that patients of bilateral cryptorchidism had lower implantation rate. Apart from the mentioned study, no other study has attempted to evaluate the IVF/ICSI-ET outcomes in infertile men who had undergone orchidopexy.

Study design, size, duration

A retrospective cohort study at a tertiary hospital, including a total of 99 infertile men who underwent orchidopexy to treat cryptorchidism and subsequently underwent their first IVF/ICSI-ET cycle from January 2014 to January 2022.

Participants/materials, setting, methods

Men are divided into unilateral fixation group and bilateral fixation group based on the laterality of the cryptorchidism and testicular fixation surgery they have received. Choose fertilization rate and live birth rate as parameters for evaluating the results.

Main results and the role of chance

The sperm concentration and viability were significantly higher in unilateral orchidopexy group than in bilateral orchidopexy group (28.09 ± 27.99 vs 7.99 ± 14.68, P=0.001; 33.34 ± 22.52 vs 11.95 ± 17.85, P=0.001). Unilateral orchidopexy group showed lower demand for ICSI (66.07% vs 95.35%, P<0.001). Interestingly, both groups exhibited similar rates of fertilization, clinical pregnancy, live birth and birth defect. Boy birth ratio was lower in bilateral orchidopexy group as compared to unilateral orchidopexy group (27.27% vs 58.62%, P=0.026).

Limitations, reasons for caution

This study was limited in that the data source captured only patients from a single medical center, which could lead to selection bias, small sample size and limited external validity to the findings.

Wider implications of the findings

Our study suggested that blastocyst-stage ET is a good strategy for patients with history of orchidopexy.

Trial registration number

not applicable