bluuebunny/crossref_metadata_2025 huggingface dataset:
655 Aching for Change: Musculoskeletal Pain in the Operating Room Amongst KSS Trainees
Authors: Bickerton R , Goatly G , Bowbrick Gi
Published: July 2024

Aim

Work-related injuries are common among surgeons, with some studies finding up to 70% report difficulties. Given the increasing career longevity expected from today's surgical trainees, injury prevention is more important than ever. However, ergonomics education for surgical trainees in the UK is deficient. We aimed to gauge whether current trainees in Kent, Surrey, and Sussex (KSS) experience pain whilst operating and what strategies, if any, they utilise.

Method

A questionnaire was distributed to trainees in the KSS School of Surgery collecting data on basic demographics, pain related to operating and pain management strategies.

Results

75 trainees across the KSS region responded. Mean age was 32 years (range 26-42) and median training level was ST4. General surgery (n=22), orthopaedics (n=19) and urology (n=13) were the most prevalent specialties. All trainees reported musculoskeletal pain attributed to operating, with 36% (n=27) experiencing pain “frequently” or “always”. 69% (n=52) found this pain “sometimes”, “frequently” or “always” distracted them whilst operating. The most common sites for pain were the lower back (73%), neck (49.3%), upper back (38.7%) and shoulders (37.3%). No participants had received formal ergonomics training and the majority (86.7%) had not discussed pain with their supervisors.

Conclusions

Musculoskeletal pain from operating was found to be a common issue in this cohort, with the majority reporting distraction while operating. Ergonomics is not currently addressed by any formal training programmes. We have recommended a regional training initiative for trainees in KSS to address and prevent musculoskeletal injuries.
1145 The Role of Emotional Intelligence in Surgical Leadership: A Qualitative Study
Authors: Chaudry A , Wong Z , Leighton P , Makhdoom N , Karantana A
Published: July 2024

Aim

Effective leadership is crucial in the NHS, enhancing patient safety and care quality. Surgical leaders play a vital role, addressing patient needs and managing teams (RCSEng, 2014). Emotional intelligence (EQ) is a key leadership skill, encompassing 12 competencies. However, EQ and leadership are often overlooked in medical training. This study investigates the significance of EQ in surgical leadership and aims to identify optimal methods for EQ development in surgery.

Method

The study employed semi-structured interviews (SSIs) with consultant and trainee surgeons, aiming to elucidate the influence of EQ on workplace behaviours in surgery. Ethical approval was obtained from the University of Nottingham Ethics Committee. Purposive sampling was used to select potential study participants with the aim of providing the most credible information to the study.

Results

Thematic analysis of transcribed interviews identified three overarching themes (Patients, Clinical Organisation, Surgeons) and related sub-themes. Results from 10 SSIs revealed that EQ positively affects job satisfaction, interpersonal relationships, teamwork, and mitigates burnout among surgeons. In the context of surgical leadership, EQ emerged as a catalyst for positive organisational culture change.

Conclusions

In conclusion, EQ is a crucial skill for surgical leaders, impacting various facets of their professional life. The study's findings contribute to the ongoing debate on the significance of EQ in surgery and advocate for evidence-based EQ training programmes in professional development. This research provides valuable insights for shaping effective leadership and training initiatives in the field of surgery.
156 A Survey of the Estimated Cost of Consumables Amongst UK Medical Students
Authors: Divekar O , Stephen S , d'Souza H , Pandya K , Kumar A
Published: July 2024

Aim

With increasing financial difficulties for the NHS, clinician’s awareness of the cost of consumable items utilised is vital. Unfortunately, clinician’s cost-awareness and exposure to health economics amongst students is limited. We hence undertook this survey to assess cost-awareness amongst medical students.

Method

An online questionnaire was distributed to London medical students. Participants were asked their demographic data and to estimate the cost of 10 consumable items. Each item’s actual cost was compared with the average, median and interquartile range of the estimated price. An estimate was deemed ‘correct’ if it was within 20% of the actual price.

Results

Across all items 9.63% of estimates were ‘correct’. There was no correlation between medical school or academic year and accuracy of cost-estimation. The most accurately estimated item cost was the ‘10ml syringe’ (19.55%), the least was the ‘1 litre bag of intravenous normal saline’ (0.50%). The most overestimated item cost was the ‘vial of 1.2g intravenous co-amoxiclav’ (median estimate/actual cost = 9.43), the ‘pair of standard sterile surgical gloves’ was the only underestimated item cost (median estimate/actual cost = 0.97).

Conclusions

We found a poor understanding of the cost of consumables amongst medical students. Whilst a lack of year 6 students and the London geographic limited this study, we believe this is the first large-scale survey assessing the cost of consumables amongst UK students. By providing a benchmark of current knowledge, this survey could serve as a catalyst for the inclusion of health economics in medical school, improving cost-awareness amongst students and doctors.
662 A Sustainable Laparoscopic Cholecystectomy Tray
Authors: Boag K , Maftei I , Henson A , Fletcher N , Griffiths R , Ho T , Toogood G , Peckham-Cooper A
Published: July 2024

Aim

The aim was to develop and trial a systematic methodology in order to streamline laparoscopic cholecystectomy trays across all sub-specialties in Leeds Teaching Hospitals Trust (LTHT), and to inform rationalisation principles nationally in partnership with NHS England’s sustainability team.

Method

70 laparoscopic cholecystectomies across all sub-specialties were independently observed and audited for instrument usage at LTHT from January to March 2023. The findings were summarised and a usage heatmap was developed. A subsequent ‘hackathon’ event was held in the form of a consensus session with key stakeholders from each sub-specialty to agree a proposed single instrument tray. Carbon and financial savings calculations were then undertaken to measure the impact of the changes.

Results

Audit results demonstrated an average of 112 instruments across four separate trays opened. The heat map demonstrated 42% of items were used from 0-5% of procedures. The hackathon event agreed a consolidated single tray of 65 items. With over 800 laparoscopic cholecystectomies taking place in LTHT per year predicted financial savings in sterilisation costs were over £22,000 and over 3 tonnes of CO2e annually.

Conclusions

Tray rationalisation and standardisation has significant financial and carbon savings and can be extrapolated to many types of procedures. Sustainable change is vital to meet NHS net zero targets and requires urgent attention. Stakeholder engagement was crucial to ensure changes were agreeable and would be sustained. Following the successfully trialled methodology and implementation NHS England have produced a guide for other trusts to implement similar changes.
657 Transplant Ureteric Stent Removal Using Isiris® in an Outpatient Setting
Authors: Stephens M , Strachan H , Varley R , Doherty D l , Solomon E , Moinuddin Z , van Dellen D
Published: July 2024

Aim

The risk of urological complications following kidney transplantation is reduced by the intraoperative insertion of ureteric stents. Transplant ureteric stent removal (TUSR) has traditionally been performed in theatre using flexible cystoscopy. Isiris® is a single-use flexible cystoscope. The aim is to analyse the acceptability, efficacy, and cost-effectiveness of Isiris®, for TUSR in a ward/outpatient setting.

Method

A retrospective analysis of a contemporaneously maintained database at a high-volume kidney transplant centre from January 2021 to June 2022. Data collected included clinico-demographic, operative and stent removal details including time to removal (gold-standard within 6 weeks) and refusal rates. A cost analysis was also performed based on equipment costs and NHS tariffs. TUSR was performed using Isiris® in outpatient ANP-led clinics or on wards by surgical middle grades or ANPs.

Results

345 patients were included in analysis with a median age of 54 (19-81). 99.13% were single ureteric anastamoses with 348 stents removed in total. The M:F ratio was 1.32:1. 98.85% of stents were removed using Isiris®, with a 1.15% refusal rate. 86.34% (n=297) were removed in clinic. Median dwell-time was 34 days, IQR 17.25 (25.75-43). 73.84% of stent removal was within 6 weeks. There were savings of £545.00 per stent removal, including expenses for failed Isiris TUSR, with overall savings of £154,021.20 and 86 theatre sessions freed for other activity.

Conclusions

Isiris® was acceptable and effective for TUSR. Savings were demonstrated compared to TUSR in theatre. Outpatient/ward TUSR reduces demand for theatre time, freeing theatres for other elective activities.
658 Treatment Outcomes Among Patients with Recurrent Urinary Tract Infections Using a Multidisciplinary Management approach in a Complex UTI Clinic: A 20-Months’ Experience
Authors: Chitteti P , Ekpeno I , Morris-Laverick J , Bezemer S , McCune V , Kubelka I , Nadeem M
Published: July 2024

Aim

Our aim was to assess the treatment outcomes among patients with recurrent UTIs managed in a novel multidisciplinary complex UTI clinic started by Department of Urology at a single tertiary care centre, over a 20-month period.

Method

In view of persistently increasing burden and prevalence of antibiotic resistance associated with UTIs, a multidisciplinary complex UTI clinic, is started by Urologists supported by specialist nurses and microbiologists was started in April 2021. A prospectively maintained database of 176 patients {(median age 57.4 years (14-89 years) and (Male:Female ratio of 1:10)} who were referred to our clinic, within a 20-month period was reviewed. Patient demographics, urine culture results (causative bacterial organism and antibiotic sensitivities), investigations performed, and treatment outcomes were recorded. Pre-treatment QoL (Quality of Life) and post-treatment PGI-I (Patient global impression of improvement Scale) Score were measured.

Results

Escherichia Coli (69%) was identified as the most common causative organism. 30% patients had multi-resistant bacterial organism on urine culture. Abnormal Flexible cystoscopy, Renal Tract USS, CT Urogram was reported in 14%, 13% and 11% respectively. All patients received information on general cystitis prevention measures. 46 (26%) required intra-vesical treatment (Gentamicin 12%, Amikacin 1% and Glycosaminoglycans 13%). 71% patients remained infection free on follow up. Pre-treatment 64% patients reported significant impact on their QoL. 88.6% (94) of the 106 patients, followed up after the completion of treatment had good improvement on PGI-I scale (Table 1).

Conclusions

A dedicated complex UTI clinic service with multidisciplinary treatment approach can be efficient in managing recurrent UTIs.
733 Rezum Water Vapour Thermal Therapy for Treatment of Lower Urinary Tract Symptoms: A Prospective Single-Centre Analysis
Authors: Barbour F , Breish M , Jenkins B , Sahadevan K
Published: July 2024

Aim

Benign prostatic enlargement (BPE) is a chronic disorder of the prostate with an increasing prevalence. In recent years, different minimally invasive treatment options for lower urinary tract symptoms (LUTS) secondary to BPE have been introduced. One of these technologies, Rezum, uses heat from radiofrequency generated water vapour to ablate prostatic tissue. Our study aims to investigate the safety and efficacy of Rezum through a consecutive series of patients who underwent the procedure in our department.

Method

A prospective study was conducted involving thirty-eight men with moderate-severe LUTS undergoing Rezum between January 2022 and February 2023. To measure efficacy, quantitative data was collected through pre-and post-operative international prostate symptom score (IPSS), quality of life score (QoL), simplified international index of erectile function (IIEF-5) checklists, and uroflowmetry to measure maximum flow rate (Qmax) and post-void residual (PVR). Patients were followed up to determine if there had been any side effects.

Results

The mean number of Rezum injections was 3.8 to each lateral lobe, and 0.81 to the median lobe. The results show a significant improvement in IPSS (24.1 to 9.8), QoL (4.8 to 2.0), and Qmax (10.4 to 16.8). There was no reduction in erectile function with the IIEF-5 actually slightly increasing (13.4 to 15.2).

Conclusions

Our single-centre prospective analysis shows that Rezum is a safe and effective minimally invasive treatment option for men with troublesome LUTS secondary to BPE. Rezum is a promising technology that could be offered to patients who wish to preserve their sexual function and discontinue their BPE medications.
958 Prostatic Artery Embolisation vs. Transurethral Resection for Benign Prostatic Hyperplasia: A Systematic Review and Meta-Analysis
Authors: Junaid Saleem R , Elkomos B
Published: July 2024

Background

This systematic review and meta-analysis aimed to comprehensively compare these two therapeutic approaches regarding peri-operative and post-operative outcomes.

Method

Studies reporting on peri-operative and post-operative outcomes of PAE and TURP in BPH patients were included. Meta-analyses were performed to assess differences in outcomes such as IPSS, post-void residual (PVR), maximum urinary flow rate (Qmax), Prostate volume, procedural time, and Quality of Life (QoL) scores using RevMan 5.4.Methodological assessment was done by using the Newcastle-Ottawa Scale (NOS) for observational studies.

Results

Our analysis included a total of 9 studies involving 1138 patients. The postoperative subgroup analysis revealed significant differences in IPSS (HR of 1.37 (95% CI: -2.27 to 5.01, p = 0.00001; I2 = 98%), PVR (HR 43.29 (95% CI: -10.38 to 96.96, p = 0.00001; I2 = 99%). In the comprehensive analysis, substantial heterogeneity (98%) was noted, yielding an HR of -9.58 (95% CI: -48.20 to 29.30; p = 0.00001), Prostate volume 13.94 (with a 95% CI: 9.34 to 18.54, resulting in a highly significant p-value of 0.0001 and an I2 statistic indicating 83% heterogeneity), procedural time and QoL, with an HR (54.70) CI: 23-86.39, p<0.00001, I2=96%, and HR (0.27) CI: -0.39-0.93, p<0.00001 and I2=97%, respectively, these all outcomes favoured TURP over PAE. However, post-operative Qmax, (HR -8.48 (95% CI: -13.89 to -3.07, p=0.00001 and an I2 =99%) favoring PAE over TURP. Conversely, PAE exhibited a slower but sustained improvement in QoL scores over time. Complication rates were almost same between the two groups.

Conclusions

TURP may offer a quicker improvement in BPH; however, PAE also provides a viable alternative with sustained QoL improvements and a potentially lower risk of post-operative complications. Individualized treatment decisions should consider patient preferences and clinical factors.
1256 Oncological and Urological Outcomes After Total Pelvic Exenteration – Our 10-Year Experience
Authors: Rajamoorthy S I , Uren A , Rajan K , Mubarak M , Dixon C , Jeavons F , Bose P , Lucas M , Featherstone J , Gill N , Kanda Swamy G V
Published: July 2024

Aim

Total pelvic exenteration (TPE) is a complex but potentially curative option for advanced pelvic malignancies. This study aims to evaluate long-term outcomes after TPE.

Method

Between February 2010 and February 2020, 88 patients who underwent TPE at our institution were included. Data extraction was done by retrospective examination of patient records. Incidence of perioperative complications, long-term outcomes and survival were noted.

Results

The mean age was 62.6 years (29-87 years). Colorectal malignancy (75%) was the most common indication. 63.7% of patients received chemo or radiotherapy or both pre-operatively. Median follow-up was 54 months (33.25 – 80.25 months). At 30 and 90 days, 20.5% and 8% of patients had a Grade 3 complication or above respectively. Complications related to urinary diversion were noted in 10 patients (14 events - 4 urinary leaks, 6 stoma related complications and 4 ileo-ileal anastomotic leaks). The 30- and 90-day mortality rate was 1.1% and 2.3% respectively. At 1, 3, and 5 years, overall survival was 89.8%, 64.8% and 63.6% respectively and cancer specific mortality was 5.7%, 18.2% and 31.8% respectively. Average glomerular filtration rate was 24.2 ml/min/m2 (p<0.0001), 34.1% developing new onset chronic kidney disease 3B or worse and 3.4% requiring haemodialysis. 18.2% of patients required further urological intervention. There was no statistically significant difference in ureteric stricture rates between patients undergoing surgery for recurrent disease (p=0.86) or following prior radiotherapy (p=0.81).

Conclusions

TPE appears to provide long-term survival in over 60% of patients with advanced pelvic malignancies. Long-term complications are predominantly related to the urinary diversion requiring prolonged urological follow-up.
460 Exploring Optimal Antithrombotic Strategies for Acute Limb Ischaemia: A Comprehensive Review
Authors: Nair A , Maan B S , El-Sayed T
Published: July 2024

Aim

Antithrombotic therapy is an integral part of acute limb ischaemia (ALI) management. This study aimed to systematically review the up-to-date evidence available in antithrombotic management of ALI.

Method

A systematic search (PubMed, OVID, Embase, and Google Scholar) identifying Randomised Control Trials (RCT) and observational studies following PRISMA guidelines was conducted, to report on outcomes of ALI using different antithrombotic agents.

Results

6262 studies were originally screened, after removal of duplicates 10 studies were left that fully matched our criteria. No RCT was found comparing antithrombotic agents’ efficacy. Pre-intervention anticoagulation was associated with a risk reduction of amputation and improved secondary patency in ALI treated with prosthetic bypass grafts. Regarding intra-arterial thrombolysis, a continuous heparin infusion showed no advantage. Low weight molecular heparin should be considered as an alternative to unfractionated heparin in ALI patients after arterial embolectomy. Low dose Rivaroxaban and aspirin are associated with decreased major adverse cardiovascular events and amputation incidence following revascularisation, when compared to aspirin and placebo in ALI. Ticagrelor was not superior to clopidogrel with similar bleeding rates.

Conclusions

The evidence base is inconclusive to determine a standardised guidance. ALI presentation and aetiology might be the best current guide on the antithrombotic regime choice.
497 Fast-Tracking Varicose Vein Treatment: A Post COVID Pathway for Effective Care
Authors: Lee N , Tsirigotis S , Harris M , Somaiya P
Published: July 2024

Aim

Standard treatment pathways for varicose veins (VV) consist of a referral, first clinic appointment, vascular ultrasound (VUS) and a follow-up appointment to determine eligibility for intervention. Multiple appointments cause delays in treatment. Publication of the ‘NHS 10-year long-term plan’ and post-COVID waiting lists motivated this quality improvement project combining One-Stop Venous Clinics (OSVCs) and office-based truncal venous radiofrequency ablation/sclerotherapy (OBRFA/ST). The OSVCs aim to reduce waiting time from first appointment to treatment.

Method

All VV referrals (2021-2022) were prospectively assessed and seen in a combined VUS and vascular surgeon appointment: OSVC. Suitable patients underwent OBRFA/ST. Time from referral to surgery was compared to routine practice pre-pilot, and patient satisfaction questionnaires (PSQ), assessing the five Care-Quality commission standards, were conducted.

Results

Of 639 pilot patients, 175 (27.4%) underwent OBRFA/ST. 201 (31.5%) were discharged, 204 (31.9%) did not attend (DNA’d) appointment, 24 (3.8%) were unsuitable for OBRFA/ST, and 35 (5.5%) had other outcomes. Mean age was 52.1yrs; 53.8% female, 46.2% male. Mean time to intervention fell from 315 days to 61.6 days comparing routine practice to combined approach. PSQ’s demonstrated: 98% patients felt well-informed, 98% felt safe, 96% had adequate pain management, 97% felt it was a responsive service and the overall satisfaction was 91%.

Conclusions

This project demonstrated a substantial reduction in time to treatment with this combined approach and may positively influence a new pathway standard for VV patients.
Living in Legends: Frames, Legends and the Conflict over the Hamburg Hafenstraße, 1981–1995
Authors: van der Steen Bart
Published: July 2024

During the 1980s, a conflict over eight occupied houses in the Hafenstraße in Hamburg developed into one of the most contested squatter struggles in West Germany and strongly resonated with squatters abroad. As the conflict escalated, a long-drawn-out discussion unfolded between Hamburg’s squatters, authorities, media and inhabitants over who the squatters were and how the city should deal with them. This article sets out to explain why these eight buildings became such a potent symbol for so many different groups. In order to do so, it combines social movement studies methods with folklore studies approaches and analyses the Hafenstraße as a site of legend, as a canvas onto which various actors projected societal hopes, ideals and fears. Central to this analysis are the four main legendary tropes that circulated in the 1980s: the Hafenstraße as a refuge for young dropouts, as a lawless zone, as a haven for terrorists and as indicative of the city’s governance crisis. Finally, it asks how such legends informed people’s actions and explains the importance of these tropes in the escalation and resolution of the conflict.
O-055 Understanding endometrial functionality and embryo-maternal communication via in vitro “OMICs’’ platforms
Authors: Chuva de Sousa Lopes S M
Published: July 2024

The uterus (womb) is perhaps the most fascinating organ in the human body. It undergoes cyclical regeneration of its inner layer, the endometrium, and is notoriously unreceptive to implantation, except for a short period of time known as the window of implantation (WoI), the only time when it becomes receptive to the implantation of an embryo resulting in pregnancy.

A common reason for pregnancy failure is implantation failure. Similarly, many in vitro fertilisation (IVF) treatments that do not result in a live birth fail because the embryo does not successfully implant. This is a significant challenge as there is limited understanding of the exact timing and cellular/molecular characteristics of the human endometrium during WoI.

Here I will present results on the characterisation of the WoI in humans, contextualised with results from “omics’ platforms. Moreover, we will provide 3D data on the structural development of the human uterus, paving the way to develop innovative culture platforms to investigate embryo-maternal communication.
O-057 Newly identified female mutations causing failed fertilization
Authors: Cardona Barberán A
Published: July 2024

Over the past decade, advancements in next-generation sequencing technology, alongside reduced costs, and the rising demand for infertility medical care, have resulted in the discovery of new genes and genetic variants linked to infertility conditions. Phenotypes of ICSI failure, such as oocyte maturation arrest (OMA), fertilization failure (FF) and embryo developmental arrest (EDA), can now be attributed to male or female genetic causes. This represents a transformative shift in patient treatment, allowing the identification of some cases previously classified as unexplained infertility, thereby reducing patient stress. Moreover, it facilitates personalized treatment recommendations, as well as paves the way for the exploration of novel treatment options, thus expanding research opportunities.

This talk will review the genetic causes of FF following ICSI, with the main focus on the newly identified female causes, as well as give an update on current diagnostic tests and treatment options for this infertility condition. FF after ICSI still occurs in 1-3% of ICSI cycles, primarily due to oocyte activation deficiency (OAD). Defects in the male PLCζ protein, responsible of inducing calcium oscillations during oocyte activation, have long been known as the leading cause of OAD. Recent discoveries have identified genetic variants in the male genes ACTL7A, ACTL9 and IQCN, which also reduce PLCζ protein content in sperm cells and thus, contribute to FF after ICSI. Additionally, for the first time in 2018, mutations in a female gene (WEE2) crucial for oocyte activation were identified. WEE2 is an oocyte kinase that acts downstream the calcium release during fertilization. Interestingly, genetic variants in other female genes, such as PATL2, TUBB8 and CDC20 associated mainly to OMA and TLE6 and NLRP5 associated mainly to EDA, have also been described to cause failed fertilization in some patients.

Determining whether the deficiency lies in sperm- or oocyte-related genes is crucial for tailoring the most effective treatment for FF after ICSI. For sperm-related factors, assisted oocyte activation (AOA), which consists in the artificial induction of calcium oscillations using calcium ionophores, has proven highly beneficial. However, most patients with oocyte-factors do not benefit from AOA (e.g. patients with WEE2 variants). In this regard, wild-type cRNA injection of the defected protein has been shown to rescue fertilization. A more generalist approach, such as maternal spindle transfer, which consists in replacing poor-quality oocyte cytoplasm with healthy cytoplasm from a donor oocyte, represents a potential treatment for these patients, as recently demonstrated in infertile females with repeated IVF failures. Nevertheless, further research into the safety of these procedures is needed before clinical application, and for now, gamete donation should be considered when facing female-related FF.
P-699 High levels of total FSH during COS is detrimental to oocyte development in good responders: results from a three-year retrospective, multicenter study
Authors: Karimova H , Pylypenko N , Hudkova D , Kotlyarova O , Vozniuk V , Barbakadze L , Aydin B , Dorofeyeva U
Published: July 2024

Study question

Are elevated doses of follicle stimulating hormone (FSH) detrimental to oocyte maturation and the efficacy of ovarian stimulation in good responders?

Summary answer

Elevated FSH levels reduce the number of oocytes collected from good responders. Patients receiving lower total FSH doses had optimal and higher maturation rates.

What is known already

There is an inverse relationship between the dose of exogeneous follicle stimulating hormone (FSH) and the number of oocytes retrieved. This relationship is independent of patient age or health and implies that excessive FSH doses administered during artificial reproductive technologies (ART) may be detrimental to oocyte maturation.

Study design, size, duration

This three-year retrospective, multicenter study included 1,075 oocyte donor cycles performed in three IVF clinics between January 2020 and December 2023 with at least a six-month interval between each cycle. Donors were all considered good responders and divided according to the total dose of FSH received per cycle (n = 289 cycles with <1,700 IU FSH; 400 cycles with 1,700 to 2,900 IU FSH; and 386 cycles with >2,900 IU FSH).

Participants/materials, setting, methods

The mean oocyte donor age was between 26.13 and 27.45 years old. The mean BMI for all three groups was 21. The association between the total FSH dose and serum anti-Müllerian hormone (AMH) level, follicle-to-oocyte index (FOI), number of oocytes retrieved, and oocyte maturation was assessed using the Student’s t-test (parametric) or Mann-Whitney-U test (non-parametric).

Main results and the role of chance

There were no significant differences in the mean serum AMH levels (5.31 vs. 5.27 vs. 5.13 ng/mL, respectively) and FOI (81.1 vs. 80.2 vs. 81.5, respectively) of patients who received different total doses of FSH. However, the number of oocytes retrieved from each group was inversely related to the total dose of FSH received (24.4 vs. 22.9 vs. 21.01 oocytes, respectively; p < 0.05)

Limitations, reasons for caution

Full characterization of the oocytes and their developmental potential was outside the scope of this retrospective study.

Wider implications of the findings

Gaining a better understanding of the complex interplay of gonadotropins throughout folliculogenesis can help optimize ovarian stimulation protocols to maximize the number of mature and developmentally competent oocytes recovered for clinical use.

Trial registration number

non applicable
P-724 Long-term health outcomes of 19 years follow-up of mothers conceived after oocyte donation based on the registry of a large healthcare organization
Authors: Shalev H , Wiser A , Rahav-Koren R , Roi S , Haikin-Herzberger E , Levi M , Miller N
Published: July 2024

Study question

Short term outcomes of oocyte donation (OD) pregnancies are known. Yet, long term effect of OD pregnancies on mother’s health are lacking.

Summary answer

Comparing women after OD pregnancies to spontaneous pregnancies or nulliparous women, a higher risk of thyroid diseases was found (1.41, p < 0.0001 and 2.13, p < 0.0001, respectively)

What is known already

Short term outcomes of oocyte donation pregnancies show increased risk of placental disease and pregnancy-related hypertensive disorders.

Study design, size, duration

This retrospective cohort study, conducted from 2000 to 2018, utilized the computerized records of a major healthcare provider. It compared the demographic data and long-term health outcomes of mothers who had undergone OD pregnancies with three groups: In Vitro Fertilization using autologous oocytes, spontaneously pregnancies, and nulliparous women.

Participants/materials, setting, methods

The study tracked the onset of chronic diseases from the date of delivery to the diagnosis of any chronic disease. The risk of various diseases and mortality among these groups was assessed using a Cox proportional hazards model. This model adjusted for variables such as age at the index date, number of children, body mass index (BMI), and smoking habits. Statistical significance was determined using two-sided p-values, with a threshold of P < 0.05.

Main results and the role of chance

Regarding long-term outcomes, no difference was found between mothers after oocyte donation comparted to mothers after IVF (See table 1).. When comparing oocyte donation pregnancies to mothers after spontaneous conception, mothers after oocyte donation had less lower prevalence of rheumatology diseases (6% vs 8.9%) and more higher prevalence of thyroid diseases (21.9% vs. 17.6%). However, in cox regression, taking into account smoking, number of birth and mom’s age, we only found a higher risk of thyroid diseases (OD 1.41, p < 0.0001). Lastly, oocyte donation pregnancies compared to nulliparous had more thyroid diseases (21.9% vs. 6.7%, p < 0.001), also in cox regression (OD 2.13, p < 0.0001)

Limitations, reasons for caution

The temporal aspect of chronic disease diagnosis; a diagnosis made at a specific point does not preclude the presence of the disease at an earlier time. Also, the infrequency of some conditions within our study population could have reduced the statistical power to detect differences or associations.

Wider implications of the findings

The longer-term health outcome for women conceiving after OD is reassuring, and is very similar to that of IVF children and naturally conceived children, exempt for higher risk of thyroid disease. The main recommendation should be a yearly surveillance of thyroid function.

Trial registration number

0046-18-BBL
O-168 The therapeutic potential of stem cells for ovarian rejuvenation
Authors: Seli E
Published: July 2024

Stem cells and induced pluripotent stem cells (iPSCs), hold immense promise in regenerative medicine due to their ability to differentiate into various cell types. However, in the context of ovarian rejuvenation, controversies surround the concept of post-natal oogenesis in mammals, challenging the established belief that female mammals are born with a finite pool of oocytes. Recent studies refute the presence of ovarian stem cells, sparking debates in the scientific community. The proposed use of ovarian stem cell-derived mitochondria for oocyte rejuvenation, known as AUGMENT, aimed to enhance fertility but fell short of expectations in clinical trials. Conversely, autologous stem cell ovarian transplantation (ASCOT) seems to offer a promising avenue to increase reproductive potential by replenishing ovarian function. While still under investigation, initial results show encouraging outcomes. Furthermore, recent advancements in in vitro generation of oocytes from stem cells present a groundbreaking approach to overcome infertility associated with ovarian failure. By mimicking the natural process of oogenesis, researchers aim to provide new opportunities for fertility preservation and treatment. These developments underscore the dynamic landscape of stem cell research in reproductive medicine, offering hope for addressing infertility and expanding our understanding of reproductive biology.
P-044 Increased CYP1A1 expression enhances sperm apoptosis in idiopathic infertile men
Authors: Bakhtiari M , Hemati Harsini M , Asgari R
Published: July 2024

Study question

How are the CYP1A1 and Caspase-9 genes expression and the relationship among the expression of these genes with sperm parameters in idiopathic infertile men?

Summary answer

The CYP1A1 and Caspase-9 gene expression showed a significant increase in patients in comparison with the healthy group.

What is known already

CYP1A1 (Cytochrome P450 Family 1 Subfamily A Member 1) plays a crucial role in xenobiotic metabolism induced by aryl hydrocarbon receptor (AHR). AHR, as a ligand-activated transcription factor is involved in exogenous ligand activation. CYP1A1 is one of the most essential enzymes in phase 1 of detoxification, metabolism, and bio-activation of carcinogens and is the most well-known target gene for AHR. Monooxygenase activity of CYP1A1 may lead to oxidative stress and the formation of reactive intermediates with destructive effects such as apoptosis in testicular germ cells. CYP1A1 may lead to apoptosis via Caspase-9 activation.

Study design, size, duration

In this study, we aimed to determine the CYP1A1 and Caspase-9 gene expression.

Participants/materials, setting, methods

The infertile idiopathic and healthy fertile men were selected and evaluated for sperm analysis and gene expression. The expression levels of CYP1A1 and Caspase-9 were also determined by real time PCR.

Main results and the role of chance

The sperm count, morphology and motility were significantly lower in patients compared to the control group (p < 0.05). The CYP1A1 and Caspase-9 gene expression showed a significant increase in patients in comparison with the healthy group (p < 0.05).

Limitations, reasons for caution

Further investigations of the effect of CYP1A1 and Caspase-9 expressions on infertility by using more infertile patients and also studying the effect of other important genes such as AHR can show us more accurate results.

Wider implications of the findings

Our results suggest that increased CYP1A1 and Caspase-9 expression could increase the rate of male infertility. In addition, the increase in Caspase-9 expression could lead to a reduced number of sperms and an increased infertility rate by increased apoptosis in the spermatogenic lineage.

Trial registration number

not applicable
P-084 Exome sequencing reveals the novel genetic mutations associated with teratospermia
Authors: Long S
Published: July 2024

Study question

This research aims to explore the molecular mechanisms of genetic variations in the small acrosome sperm subtype within teratospermia and its correlation with male infertility.

Summary answer

Novel gene mutations associated with teratospermia were identified, providing important insights into the genetic mechanisms underlying this condition.

What is known already

Male infertility is a substantial challenge in reproductive medicine, impacting a significant proportion of couples globally. Teratospermia, marked by abnormal sperm morphology, is a major factor in male reproductive disorders. Unraveling the genetic foundation of teratospermia is essential for comprehending the intricate molecular mechanisms governing male fertility.

Study design, size, duration

This study uses exome sequencing to investigate the genetic landscape of male infertility, particularly focusing on teratospermia. Through a comprehensive examination of the exome, our goal is to uncover novel gene mutations and understand the molecular mechanisms connecting genetic changes to abnormal sperm morphology and, consequently, male infertility.

Participants/materials, setting, methods

Sperm DNA was extracted from 55 patients with a confirmed diagnosis of teratospermia for this study. Subsequently, comprehensive exome sequencing was performed on the extracted sperm DNA to investigate potential genetic variations associated with teratospermia.Further functional studies were conducted to unveil the potential roles of mutated genes in the development of the reproductive system and spermogenesis.

Main results and the role of chance

Within the known genes associated with spermatogenic dysfunction, we identified one pathogenic/likely pathogenic variant and four variants of unknown significance, all of which have not been previously reported.Cell phenotype experiments revealed that mutations in CCDC62 and KCNU1 have specific effects on the proliferation and apoptosis of GC-2 cells.

Limitations, reasons for caution

Further molecular experiments and pathway mechanism studies are required to enhance our understanding of the observed effects and provide a more comprehensive interpretation of the findings.

Wider implications of the findings

This study unveils novel genes and pathways in teratospermia, informing diagnosis, prognosis, and potential treatments for male infertility. Exploring the genetic landscape enhances our comprehension of the complex interplay between genetics and male fertility, guiding personalized approaches in reproductive medicine.

Trial registration number

not applicable
P-101 Mitochondria-mediated apoptosis induced testicular dysfunction in bisphenol F treated rats: ameliorative effect of baicalin
Authors: Hamed M , Odetayo A
Published: July 2024

Study question

Will baicalin treatment ameliorate bisphenol F (BPF)-induced testicular dysfunction?

Summary answer

Baicalin ameliorates BPF-induced mitochondrial dysfunction-associated apoptosis

What is known already

BPF is a chemical presently considered a major replacement for bisphenol A and has been widely used in the canning and other food processing industries. However, a major limitation of this chemical is its gonadotoxic effect. Studies have shown that BPF disrupts testicular function via apoptotic signaling, although, its mechanism of action has not been fully explored. On the other hand, baicalin is an anti-apoptotic agent. Yet, none of these studies has reported the effect of baicalin on BPF-induced testicular injury

Study design, size, duration

This is a prospective experimental study using an animal model. Twenty-four sexually matured male Wistar rats of comparable weight were used for this study. All treatments were via oral gavage and lasted for 8 weeks

Participants/materials, setting, methods

Animals were acclimatized for two weeks, then randomized into 4 groups (n = 6); control: animals received 0.5 mL of corn oil as vehicle, BPF: animals received 30 mg/kg of BPF, baicalin: animals treated with 100 mg/kg of baicalin, BPF+ baicalin: animals treated with 30 mg/kg BPF and 100 mg/kg baicalin

Main results and the role of chance

: Baicalin ameliorated BPF-induced decrease in spermatogenic indices and sperm quality, circulatory levels of follicle-stimulating hormone, luteinizing hormone, and testosterone, and testicular concentrations of 3β-HSD and 17β-HSD. Also, baicalin ameliorated BPF-induced decline in testicular superoxide dismutase, catalase, total thiol, glutathione, glutathione S-transferase, and glutathione peroxidase activities and nuclear factor erythroid 2-related factor 2 concentrations. Furthermore, baicalin alleviated BPF-induced increase in testicular malondialdehyde, myeloperoxidase, TNF-α, IL-6, and NF-kB levels. These events were associated with the dampening of BPF-induced decline in NAD+/NADH and Bcl-2 activities and BPF-induced increase in Bax and caspase 3 activities by baicalin.

Limitations, reasons for caution

This study was conducted in a rat model; therefore the results of the present study should be extrapolated to humans with caution

Wider implications of the findings

The present study described the ameliorative effect of baicalin treatment on BPF-induced testicular toxicity.

Trial registration number

N/A
P-142 The developmental time to reach the blastocyst stage in the human is an indicator of diploid mono-pronuclear embryos
Authors: Tsuji H , Tokoro M , Fukunaga N , Asada Y
Published: July 2024

Study question

Is it possible to determine diploid mono-pronuclear (1PN) human embryos by the speed of development to blastocyst formation?

Summary answer

The developmental time to reach the blastocyst stage is a discrimination indicator for diploid 1PN embryos.

What is known already

We have previously reported that 80.7% of 1PN zygotes had a biparental chromosome using a Live-Cell imaging technique, and some of these developed to the blastocyst stage (Tokoro et al. ASRM 2013). Furthermore, we have reported that these blastocysts can result in a healthy live birth (Tsuji et al. ASRM 2020), and there was no effect on growth up to 5 years of age (Tsuji et al. ASRM 2023). On the other hand, it was also shown that a few of the 1PN embryos that developed into blastocysts were haploid embryos.

Study design, size, duration

This was a retrospective study that included 28 blastocysts derived from a 1PN zygote. The time period was 72 months (January 2017 to December 2022). These embryos are used for research following obtaining informed consent.

Participants/materials, setting, methods

The frequency rate of diploid embryos was compared from time of PN fading to blastocyst formation (Gardner’s classification: ≥ expansion grade 3). Two development time range groups were examined and designated: fast-developing embryos (65.7-78.7h) and slow-developing embryos (116.8-139.7h). Ploidy status was determined using whole blastocyst cells and NGS-based SNP analysis. Statistical significance was determined using Fisher’s exact test (level of P<0.05).

Main results and the role of chance

There was no significant difference in the average age (years) of the two development time groups (fast-developing embryos group; 35.5 +/- 5.5, slow-developing embryos group; 34.1 +/- 2.8).

The frequency of diploid status in 1PN embryos with fast developing embryos was 100% (14/14), and in 1PN embryos designated as having slow development, the frequency of diploid embryos was only 14.3% (2/14), haploid embryos 71.4% (10/14), and other was 14.3% (2/14). As a result, the diploid embryo rate was significantly higher in fast-developing embryos than in slow-developing embryos (P<0.001).

Limitations, reasons for caution

This study was limited to extremely fast or slow-developing embryos to see trends. It is important to study the threshold time between diploidy and haploidy in 1PN embryos.

Wider implications of the findings

These results confirmed that fast developing 1PN embryos have a high diploid rate and can be used as transferable embryos in addition to 2PN embryos. Conversely, slow developing 1PN embryos should be considered to have a lower priority for transfer because of the high rate of haploid embryos.

Trial registration number

not applicable
P-163 Does severe endometriosis (SE) have an effect on embryo morphokinetic parameters?
Authors: Ozkara G , Sezer F , Yelke H , Ozer G , Kahraman S
Published: July 2024

Study question

Does severe endometriosis (SE) have an effect on embryo morphokinetic parameters?

Summary answer

Severe endometriosis may have an effect on embryonic cell divisions and could change morphokinetic parameters of in vitro developing embryos.

What is known already

Endometriosis is one of the leading causes of infertility that affects approximately one third of women who apply for in vitro fertilization (IVF) treatment. Controversial results were reported regarding the effect of endometriosis on both morphological and dynamic characteristics of embryos so far.

Study design, size, duration

This was a retrospective comparative analysis including a total of 1280 embryos (SE: 729, Tubal factor (control): 551) of 241 patients (SE: 134, control: 107) that were incubated at Time-Lapse Monitoring System (TLM) in Memorial Sisli Hospital, ART and Reproductive Genetics Center between October 2011 and July 2023. Patients with ≥ 38 years, BMI ≥ 30 and partners having severe male factor (sperm concentration: <5 mil/ml) were excluded from the study.

Participants/materials, setting, methods

Severe endometriosis was defined as Grade III and IV according to ASRM classification. IMSI (Intracytoplasmic Morphologically Selected Sperm Injection) was performed to all oocytes. Embryos were evaluated according to Gardner’s classification. Fertilization rates were assessed using Chi-square test. Morphokinetic parameters of embryos were compared by Student’s t-test using SPSS 28.0.

Main results and the role of chance

There was a homogenous distribution in terms of female age, BMI, basal FSH, AMH levels, total and mature (MII) oocyte count between study groups. Abnormal fertilization rate was higher in SE group than controls ( 4.3% vs 2.4%, p = 0.035). All morphokinetic parameters were found significantly delayed in the SE group than in the control group (p < 0.05), however, no statistical significance was obtained in terms of tSC and tEB (p > 0.05). Duration of first, second and third embryo cell cycles (ECC1, ECC2, and ECC3), synchronization of cell divisions (S2: t4-t3) and cleavage patterns (S3: t8-t5) were also found statistically significant between SE and control groups (p < 0.05).

Limitations, reasons for caution

The major limitation of this small-sized, retrospective study is that clinical outcomes of the embryos were not assessed.

Wider implications of the findings

Delayed development was observed in the embryos of SE patients. Prospective studies with larger cohorts are needed to have a better understanding between severe endometriosis and embryo morphokinetics.

Trial registration number

Not applicable