bluuebunny/crossref_metadata_2025 huggingface dataset:
What do voters want from their legislators? evidence from ghana
Authors: Ofosu George Kwaku
Published: July 2024

Legislators make trade-offs when allocating their time and resources to their multiple tasks of representation, legislation, executive oversight, and constituency service. Furthermore, they must decide how much effort to exert or the balance to strike when undertaking a specific function. Existing research provides limited insights into citizens’ preferences over these officeholder multifaceted decisions in sub-Saharan Africa. I offer novel insights into citizens’ preferences using a conjoint survey experiment of Ghanaians to address this knowledge gap. My findings are threefold. First, I find that citizens put more ‘weight’ on constituency-related activities than parliamentary work. Second, in the constituency, citizens value political representation activities more than constituency services. Third, they weigh public-good-oriented constituency services higher than private ones. The research contributes to our understanding of citizen–legislator accountability relationships in sub-Saharan Africa.
Long-term Outcomes of Poly-4-Hydroxybutyrate (P4HB) in Aesthetic Breast Surgery
Authors: Sinclair Nicholas R , Adams William P
Published: July 2024

Background

Over the past decade, the use of poly-4-hydroxybutyrate (P4HB) in aesthetic breast surgery has grown in popularity. Published data on long-term outcomes, however, is scarce.

Objectives

The purpose of this study was to assess long-term outcomes with utilization of P4HB in various aesthetic breast procedures.

Methods

A retrospective review of all patients undergoing breast procedures with P4HB was performed by the senior author between July 2012 and March 2022. All patients with greater than 1 year of follow-up were evaluated, including demographics, surgical indications, complications, secondary procedures, and patient satisfaction. A Kruskal-Wallis test was performed to assess the stability of satisfaction over time.

Results

A total of 248 patients were evaluated. The mean follow-up length was 2.9 years (range, 1-9.3 years). The most common surgical indication was breast ptosis, which comprised 68% (n = 167) of patients. The overall complication rate was 8.0% (n = 20), with an unplanned reoperation rate of 2.8% (n = 7). Across the entire study population, the mean satisfaction score was 3.42 out of 4. When satisfaction scores were compared to follow-up length, Kruskal-Wallis test demonstrated no statistical differences (H = 18.2, P = .89, degrees of freedom [df]= 2), suggesting stability of satisfaction over time.

Conclusions

This study presents the senior author’s entire experience with P4HB across a wide range of aesthetic breast procedures. With an average follow-up length of almost 3 years, P4HB appears to be a both safe and effective tool to support soft tissue in aesthetic breast surgery. Further, high patient satisfaction appears stable.

Level of Evidence: 4
Love bites: males of lizards prefer to mate with conspecifics, but do not disdain parthenogens
Authors: Galoyan Eduard A , Sopilko Natalia G , Kovalyeva Anna V , Nikolaev Oleg D , Iryshkov Eugene S , Kropachev Ivan I , Brinev Ilya A , Girnyk Anastasiya E , Arakelyan Marine S
Published: July 2024

Parthenogenesis has been discovered in a great number of reptiles, indicating that parthenogens can outcompete bisexual species and hybridize with them. This raises intriguing questions: how do parthenogenetic species coexist with gonochoristic relatives, and what outcome does this coexistence produce? To answer these two questions, we studied relationships between male rock lizards, Darevskia valentini, and parthenogenetic Darevskia armeniaca. We compared social and sexual reactions of males to females of their own species and parthenogenetic D. armeniaca and vice versa. We found that females of both species basked together with males and demonstrated mostly submissive behaviour. Females of D. valentini were less aggressive towards males in the mixed-species population than in the single-species population, suggesting female competition for males. The proportion of successful and unsuccessful mating attempts with females of bisexual and unisexual species was equal, and we found no significant differences in male reactions to bisexual and unisexual females in sympatry. The proportion of females bearing mating scars on their venters and the number of these scars per female were greater in the bisexual species. This indicates that females of the bisexual species were more attractive than parthenogenetic females as mating partners to males. We found no triploid hybrids among the offspring of parthenogenetic females that mated with males in the mixed population. Our findings suggest that parthenogenetic species might outcompete bisexual species by mating with males and integrating into the social system.
846 Implant Waste and Associated Costs in Trauma and Orthopaedic Surgery: A Systematic Review
Authors: Ali Fi , Musbahi O , Sadiq M , Lewis T , Doyle R , Al Omran Y
Published: July 2024

Aim

Trauma and orthopaedic (T&O) surgery relies heavily on medical devices of different unrecyclable materials. This specialty generates significant metalwork wastage through implants, screws, nails and plates, placing a large economical strain on healthcare. Finding sustainable solutions is vital given globally increasing life expectancies and heavier dependency on invasive interventions, such a knee or hip arthroplasties. Our primary outcome is to quantify implant wastage across the literature, and secondarily investigate the associated costs.

Method

PRISMA guidelines were followed in the design, conduct and reporting. We searched through three databases (Scopus, PubMed and Embase) using MeSh terms including “implant waste” and “trauma and orthopaedic surgery”. We included observational and randomised controlled trials reporting patients undergoing T&O surgery, where the wastage or associated costs was provided.

Results

Our final analysis included 15 articles, screened from a total of 2,145 articles. 25,025 procedures were included, but there was limited and unmatched data. Implant waste ranged, occurring in 0.8%-25.1% procedures and costing on average $167,139.13. Screws and nails were amongst the most wasted material (up to 91% and 48% respectively), however intramedullary nails were the greatest cost contributor, making up to 47.6% of total wastage cost. Up to 95% of waste was attributable to human error.

Conclusions

Balancing implant wastage and hospital costs with patient safety is a challenge for many T&O subspecialties. The largest factors contributing to waste were human factors, such as surgeon or staff error, miscommunication and changing decision. We hope this review will inform future guidelines in encouraging implant waste mindfulness.
140 Overall Impact of Varying Plastic Surgery LA Trauma Theatre Availability on Service Delivery in a Medium-Sized Plastic Surgery Department – a Single Centre Multi-Cycle Review
Authors: Kidd T , Wood B , Lancerotto L , Mughal F
Published: July 2024

Aim

Access to a dedicated local anaesthetic (LA) trauma facility outside standard theatres is a useful tool in the management of surgical trauma. An efficient cost-effective service should provide a see and treat delivery, wherever possible. We analysed the impact of altering service availability on the time between referral and surgical intervention, the time between surgical review and surgical intervention, and overall hospital services. We used this information to establish a pragmatic benchmark for service delivery.

Method

Between 2020 and 2023, key data was analysed for 5 separate cycles with differing levels of dedicated LA outpatient trauma theatre availability: 100%, 50%, 40%, 37%, 30%. 100% capacity represented two-sessions per day that ran Monday-Friday.

Results

Falling below 40% capacity caused a significant increase in the proportion of LA plastic surgery cases being performed in CEPOD or other theatres. 100% and 50% capacity saw similar distribution of theatre location. Once LA theatre capacity falls below 50%, this results in a significant delay between referral and day of surgery and a significant delay between senior review and day of surgery.

Conclusions

Demonstrates that dedicated LA trauma theatre availability of one half-day session daily can be a reasonable and pragmatic level of service provision for similar departments. Lower availability results in disruption to services, including higher main theatres utilisation, greater hospital bed expenditure, and increasing rates delay/cancellation. Increases towards 100% availability have little significant benefit. While this benchmark is specific to the caseload of the single unit, the analysis methods offer a replicable strategy for similar services.
609 Addressing Fears of Prospective International Medical Graduates (IMGs) Joining the NHS: An Online Course to Improve Equality, Diversity, and Inclusion in the NHS
Authors: Rahman K R , San N T , Mahmood A , Brahmbhatt K , WongSikHee J , Bowrey D
Published: July 2024

Aim

The aim of this project was to identify the biggest fears of IMGs regarding the NHS and address those fears via a locally designed online course, ultimately promoting equality, diversity, and inclusion in the NHS.

Method

The course was created after consultation with IMGs working in the NHS, and the content was based on the Higher-Level Outcomes (HLOs) of the Foundation Programme. The course was divided into 4 sessions, delivered weekly. Each session had an initial presentation followed by an interactive question answer segment, had 3 faculty personnel, and lasted 2 hours. A good laptop with internet connection was all that was needed for the course.

Results

In total, 699 participants registered for the course. About 92% of them had never attended similar courses before, and about 73% has never worked in the NHS. Lack of knowledge of the NHS system (32%) and medico-legal issues (25%) were the biggest fears of prospective IMGs regarding working in the NHS.

Post course feedback revealed that their confidence about working in the NHS increased by 30% after this course. Their confidence in working on-calls and building portfolio has also increased after the course by almost 26%. 78% participants said their biggest fear was addressed by this course. The question answer segment was rated helpful by 92% of participants.

Conclusions

This study illustrated that we could promote equality, diversity, and inclusion in the NHS by addressing the biggest fear of IMGs of not knowing the NHS system, using low resource, interactive online courses.
1112 Breast Cancer After Breast Augmentation (BCABA): A National Multicentre Collaborative Study of Patient Management and Outcomes
Authors: Manor K , Shah S , Shaker H , Bydder M , Dave R , Harvey J , Kirwan C , Baker B
Published: July 2024

Aim

The incidence of breast cancers diagnosed in patients that have previously had cosmetic breast augmentation is increasing. The presence of an implant at diagnosis poses management challenges. The largest UK series to date reports 49 patients from the iBRA study. We aimed to establish current UK practice encompassing both breast conserving surgery (BCS) and mastectomy +/- reconstruction, and its safety profile.

Method

A national multicentre collaborative model was used, with a steering committee from the NWBRC. Women diagnosed with breast cancer (invasive or non-invasive) from 2012 onwards with pre-existing implant augmentation were identified and data was recorded on REDCapâ. Outcomes were pathology and imaging findings, surgery performed, complications, and recommended adjuvant treatments. Recruitment will end in January 2024.

Results

An interim analysis representing 80% study accrual to date was performed. 24 collaborators from 23 UK units participated, identifying 144 women (median age 51 years, IQR 44-58). 124(86%) presented symptomatically and 20(14%) via screening. 103(72%) underwent BCS with 23(22%) requiring further excision. 84(82%) retained an implant and 98% of these patients were recommended for adjuvant radiotherapy. 41(28%) had mastectomy; 22(54%) had reconstruction (21 implant-based reconstruction, 1 autologous). Of the entire cohort, 6 patients returned to theatre within 90 days for a complication, and 3 lost an implant.

Conclusions

This is the largest reported series of these patients worldwide. There are wide variations in standard of care. Early analysis suggests that re-excision rates for patients undergoing BCS may be higher in this group. Complication rates are comparable to national standards.
297 Exploring Risk Factors for Acute Kidney Injury in Patients Undergoing Cardiac Surgery
Authors: Abelian E , Bhandari M , Purmessur R , Ali J
Published: July 2024

Aim

Acute Kidney Injury (AKI) is an important complication following cardiac surgery that has been associated with adverse outcomes. The aim of this work was to investigate the incidence and risk factors for AKI in patients undergoing cardiac surgery at our centre.

Method

This is a retrospective analysis of 1441 patients who underwent elective or urgent (but not emergency) cardiovascular surgery with use of cardiopulmonary bypass over a 1-year period. Our exclusion criteria were heart transplant, single CABG, congenital repairs or patients on dialysis or renal transplant pre-operatively. Data analysis was performed in R studio.

Results

The mean age of the patients was 67.7 years. Mean creatinine from a 7-day period before surgery was 90µmol/L compared with the mean peak post operative creatinine of 127 µmol/L (95% CI 33-42, p-value <0.05). As defined by the KDIGO AKI stages, 27% developed an AKI stage 1, 11% developed AKI stage 2 and 1% AKI stage 3. The following variables correlated strongly (P-value <0.001) with post-operative risk of AKI: The comorbidities of diabetes, smoking, and peripheral vascular disease; pre-operative medications: diuretics, calcium channel blockers and SGLT-2 inhibitors and receiving FFP or RBC transfusion postoperatively.

Conclusions

AKI is a common complication following cardiac surgery. Having an insight into the risk factors for AKI allows an opportunity for intervention preoperatively and can also highlight patients that may require extra vigilance in the perioperative period to reduce its incidence, which may lead to an improvement in outcomes following surgery.
1011 A Rare Case of Left Sided Hemiparesis Following a Pneumatic Gun-Shot Injury to Left Anterior Chest Wall in a 13-Year-Old Boy
Authors: Wijesundara A , Samarakoon K , Panapitiya N , Aathavan B
Published: July 2024

Introduction

Even though pneumatic weapons rarely cause severe direct trauma, pellet embolisation can lead to unexpected, catastrophic events.

Case Report

A 13-year-old, previously healthy boy was injured by an accidentally fired pneumatic gun, while playing with his twin brother. He sustained a penetrating wound to left anterior chest wall and resultant bleeding was self-limiting.

He was hospitalised within 15minutes. On admission, he was hemodynamically stable with normal Respiratory, Cardiovascular and Neurological system findings. Entry wound measuring 5*5 mm was present at 5th intercostal space just left to the sternum. No exit wound was detected. Initial chest radiograph and ultra-sound abdomen and chest were normal. 2D echocardiogram revealed only a very thin layer(3mm) of pericardial effusion.

Four hours later, He developed a focal seizure followed by left sided hemiparesis. Urgent NCCT brain and carotid artery duplex showed a high dense pellet in right internal carotid artery at the level of petrous temporal bone and hypo-dense Middle Cerebral Artery (MCA) suggestive of right MCA thrombosis.

He was transferred to a tertiary care centre. Interventional radiological and endo-vascular attempts of pellet retrieval have been failed. Ischemic stroke pursued with worsening cerebral oedema; thus decompression craniotomy was performed on day 3. He is currently being rehabilitated in a specialised centre.

Conclusions

High degree of suspicion should be maintained on the possibility of projectile embolisation, in pneumatic gun-shot injuries, especially in the absence of an exit wound. Extensive early investigations should be performed to localise the projectile and retrieval should be planned.
385 Surgical and Oncological Anal Cancer Outcomes at a Regional Tertiary Centre
Authors: Delaney M , Qureshi M
Published: July 2024

Aim

There is little data in the UK about anal cancer outcomes. Our aim was to look at the rates of residual and recurrent disease following surgical or oncological treatment as well as the correspondence with the resection margin.

Method

A retrospective review of those who were diagnosed with anal cancer between 1/1/2017 and 1/1/2022. We reviewed their grade of cancer, the treatment received, the resection margin following surgery, and their outcomes.

Results

95 patients were included. 84 patients received treatment with the aim of cure and 11 patients received palliation from diagnosis. Of those treated with an intent to cure, 61.9% of patients had no residual disease or disease recurrence, 17.9% of patients had residual disease and 20.2% had recurrence (10.7% local; 1.2% regional; 8.3% distant). 29.8% of this patient group have died. 54.1% of those with residual or local recurrence had salvage surgery. 30.8% had a positive margin. 100% of patients with a positive margin at salvage surgery have now died compared to 55.5% of those with a negative margin. 8 patients were treated with local excision for T1 disease. 62.5% had a R1 resection margin. Following further treatment 0% have had disease reoccurrence.

Conclusions

The survival rate of this group of patients is 62.1%. Despite having a negative resection margin at salvage surgery, long-term survival is poor. Compared with local excision of T1 disease, despite a positive or negative margin, survival is 100% in this group.
Rapid synthesis of olivine NaMnPO4
Authors: Xiao Han , Fang Haisheng
Published: July 2024

There are only limited methods available to synthesize metastable olivine NaMnPO4, and these methods all involve a time-consuming process. Herein, we report a rapid synthesis of olivine NaMnPO4, and the results show that the formation of olivine NaMnPO4 highly depends on the Na/Mn/P ratio and the pH of the reaction system, and pure olivine NaMnPO4 can be hydrothermally synthesized for only 1 h under appropriate conditions. This communication provides an efficient process for synthesis of olivine NaMnPO4.
Infective endocarditis and spondylodiscitis—impact of sequence of surgical therapy on survival and recurrence rate
Authors: Weber Carolyn , Misfeld Martin , Diab Mahmoud , Saha Shekhar , Elderia Ahmed , Marin-Cuartas Mateo , Luehr Maximilian , Yagdiran Ayla , Eysel Peer , Jung Norma , Hagl Christian , Doenst Torsten , Borger Michael A , Kernich Nikolaus , Wahlers Thorsten
Published: July 2024

OBJECTIVES

To date, there are no standardized treatment algorithms or recommendations for patients with infective endocarditis (IE) and concomitant spondylodiscitis (SD). Therefore, our aim was to analyse whether the sequence of surgical treatment of IE and SD has an impact on postoperative outcome and to identify risk factors for survival and postoperative recurrence.

METHODS

Patients with IE underwent surgery in 4 German university hospitals between 1994 and 2022. Univariable and multivariable analyses were performed to identify possible predictors of 30-day/1-year mortality and recurrence of IE and/or SD.

RESULTS

From the total IE cohort (n = 3991), 150 patients (4.4%) had concomitant SD. Primary surgery for IE was performed in 76.6%, and primary surgery for SD in 23.3%. The median age was 70.0 (64.0–75.6) years and patients were mostly male (79.5%). The most common pathogens detected were enterococci and Staphylococcus aureus followed by streptococci, and coagulase-negative Staphylococci. If SD was operated on first, 30-day mortality was significantly higher than if IE was operated on 1st (25.7% vs 11.4%; P = 0.037) and we observed a tendency for a higher 1-year mortality. If IE was treated 1st, we observed a higher recurrence rate within 1 year (12.2% vs 0%; P = 0.023). Multivariable analysis showed that primary surgery for SD was an independent predictor of 30-day mortality.

CONCLUSIONS

Primary surgical treatment for SD was an independent risk factor for 30-day mortality. When IE was treated surgically 1st, the recurrence rate of IE and/or SD was higher.
O-024 Age affects ultrasound markers of endometrial receptivity in artificial cycles
Authors: Fuentes A , Moliner B , Cirillo P , Castillo J C , Alcaraz B , Martínez M , Moral P , Bernabeu R , Bernabeu A
Published: July 2024

Study question

Are ultrasound markers of endometrial receptivity affected by patient age in artificial cycles?

Summary answer

Maternal age is linked to certain ultrasound markers such as a larger uterus, reduced endometrial compaction and lower uterine peristalsis.

What is known already

The decline in fertility in advanced age women has traditionally been linked to low oocyte quantity and quality. However, recent studies indicate that age may also affect endometrial aspects, influencing implantation and live birth rates. Advanced age can lead to impaired decidualization, increased fibrosis and decreased expression of progesterone and estradiol receptors.

This study aims to investigate the influence of age on ultrasound factors related to implantation in patients undergoing embryo transfer in artificial cycles.

Study design, size, duration

Retrospective study of 452 patients undergoing frozen embryo transfer with artificial cycle, between January 2017 and December 2023.

Participants/materials, setting, methods

Ultrasound markers were evaluated, including assessment of uterine pathology, endometrial thickness before and after the onset of progesterone and uterine peristalsis. Serum progesterone level was also analysed. Spearman correlation and multivariate linear regression were used for analysis, adjusting for uterine factors. Subgroup analysis was performed for patients aged ≥45 years.

Main results and the role of chance

Age correlated inversely with endometrial compaction (S range: 0.3–0.2; p = 0.01) and uterine peristalsis (S range: −0.3–0.1; p < 0.001) and positively with uterus length (S range: 0.2–0.3; p < 0.001) and fibroids. Multivariate linear regression confirmed independent associations (R=.45; p < 0.001). Logistic regression in patients aged ≥45 revealed associations with uterine peristalsis (OR 0.7, 95%CI 0.5–0.9; p = 0.04) and uterus length (OR 1.03; 95%CI 1.01-1.06) but not with endometrial compaction (p = 0.103).

Limitations, reasons for caution

The main limitation of the study is its retrospective nature. Being a study based on daily clinical practice, the group of patients can be heterogeneous, which may have influenced the results. Studies with a homogeneous control group are needed to corroborate our findings.

Wider implications of the findings

Our findings indicate that advanced maternal age affects uterine ultrasound factors, potentially influencing endometrial receptivity in artificial treatments. This may be useful to inform patients of their prognosis and to perform better clinical counseling, as well as to explore different therapeutic strategies in older patients.

Trial registration number

not applicable
O-085 Oocyte cryopreservation: a comprehensive analysis of live birth rate by age and indication of treatment provides reassurance for young cancer patients
Authors: Kirshenbaum M , Wale P , Lantsberg D , Gardner D , Stevens J , Agresta F , Stern K
Published: July 2024

Study question

Does the outcome of oocyte cryopreservation vary across different age groups and treatment indications, i.e. cancer diagnosis, other medical conditions or non medical fertility preservation?

Summary answer

Live birth rate (LBR) is significantly influenced by a woman's age, although not by indication of treatment.

What is known already

OC is increasingly applied in assisted reproduction, although little is about the outcomes, including livebirth according to indication.

Study design, size, duration

Retrospective cohort study analyzing all OC and subsequent warmed oocyte cycles in two fertility centers - Melbourne IVF and the Royal Women’s Hospital, Melbourne, Australia, between the years 2014 to 2022.

Participants/materials, setting, methods

Women undergoing autologous IVF treatment using vitrified and warmed oocytes. Outcome of stimulation cycles and warmed oocyte cycles were assessed according to women’s age at OCP (≤ 35 years, 35-40 years and ≥ 40 years) and treatment indication- cancer diagnosis, other medical conditions and non medical.

Main results and the role of chance

2689 women underwent a total of 3801 cycles of OC, comprising 702 cycles for cancer diagnosis (18.6%), 1146 cycles for other medical (30.5%), and 1953 cycles for non-medical (50.9%). Regardless of indication, younger age groups exhibited a higher median number of mature oocytes: <35 (11, 8-17), 35-40 (9, 6-11), and >40 (6, 3-9) (H(2)=15.1, p < 0.05).

Among 582 warmed oocytes cycles, the >40 group demonstrated lower rate cycles with at least one good-quality blastocyst (76.7%) compared to 35-40 (87.1%) and <35 (87.2%), p < 0.05. Cumulative live birth rates (cLBR) were also lower in the >40 age group (14.9%) compared to 35-40 (34.9%) and <35 (46.5%), p < 0.01.

When analyzing cycles by indication, patients with cancer had lower oocyte survival rate (80.8% vs 84.8% in other medical and 82.1% in non medical, p < 0.01). Nonetheless, no differences in rate of cycles with at least one good quality embryo rates (cancer diagnosis 87.2%, other medical 82.1% and non medical 89.3%, p = 0.06). Patients with cancer diagnosis had higher clinical miscarriage rate (25%) compared with other medical (7%) and non medical (10.5%), p < 0.01. However, cLBR did not differ between the indication groups (29.7% in cancer diagnosis, 35% in other medical and 38.1% in non medical, p = 0.5.

Limitations, reasons for caution

Retrospective data collection.

Wider implications of the findings

Our study offers comprehensive data that may assist patients desiring OC, and provides reassurance that even with a cancer diagnosis, outcomes are as favorable as those having non-medical OC. Given the substantial impact of age, health care providers should, when possible, advise to complete this procedure at a young age.

Trial registration number

Not applicable
P-762 Discovery and quantification of microplastics in human cumulus granulosa cells
Authors: Weina L , Yena H , Liang H , Huan Z , Gang L , Ge L
Published: July 2024

Study question

The impact of microplastics (MPs) on human health has received increasing attention; their accumulation in female reproductive system and possible harms have not been quantified.

Summary answer

This study firstly reveals the contamination of human cumulus granulosa cells and follicular fluid by MPs and the effects of these contaminants on ART outcomes.

What is known already

MPs are ubiquitous in soil, sea, air, fresh water, and other environments. MPs are ingested by humans through the food chain, air and direct contact, resulting in various health problems, such as endocrine disruption, immune disturbance and reproductive toxicity. MPs exposure has been found to have a great impact on females, as MPs may accumulate in the ovaries and reduce the number of follicles, ovarian size, pregnancy rate, embryo production and fertility. To date, one study has found evidence of MPs in human placentas for the first time, but MPs contamination in other human reproductive systems has not been identified.

Study design, size, duration

The inclusion criteria comprised female patients of infertile couples excluding male factors who visited the outpatient department of the Reproductive and Genetic Hospital of CITIC-Xiangya between January 2019 and January 2021.We randomly selected 16 women who met the criteria and assessed their CCs and follicular fluid samples for the presence of MPs.

Participants/materials, setting, methods

In the present study, 16 cumulus granulosa cell samples and 2 follicular fluid samples were collected, and MPs were detected via pyrolysis-gas chromatography/mass spectrometry (Py-GC/MS).

Main results and the role of chance

MPs were detected in both cumulus granulosa cells and follicular fluid, with an average abundance of 313.14±246.69 mg/kg in cumulus granulosa cellsand 12.88±15.54 mg/kg in follicular fluid. Polyethylene terephthalate was the predominant polymer in cumulus granulosa cells. There were no significant differences in the IVF fertilization rates, ICSI fertilization rates, IVF good-quality embryo rates, or ICSI good-quality embryo rates between the high-MP group and low-MP group. However, embryos in the high-MP group exhibited a lower normal cleavage rate than did those in the low-MP group, while the embryos in the high-MP group exhibited a greater proportion of noncleavage than did those in the low-MP group.

Limitations, reasons for caution

It is not clear how long these particles may persist in the human body. The method we used can detect only the concentration of MPs but not the size of MP particles. Moreover, our method cannot be used to quantify smaller-diameter nanoplastics, which are considered to pose greater risks.

Wider implications of the findings

This is the first study in which MPs were identified and characterized in human ovarian granulosa cells, providing reference data for evaluating their toxicity to the human female reproductive system.

Trial registration number

Not applicable
O-100 Chronic endometritis - research and practice
Authors: McQueen D
Published: July 2024

Chronic endometritis is an inflammation of the endometrium characterized by the presence of plasma cells. Plasma cells can be identified on H&E and CD138 immunohistochemical staining by their characteristic appearance. There is a large body of evidence supporting the association between chronic endometritis and recurrent pregnancy loss (RPL), with a prevalence of approximately 30% among women with RPL (McQueen 2021). A limitation of the current literature, however, is heterogeneity of diagnostic criteria utilized and there is no consensus on the exact definition or number of plasma cells required. The treatment of chronic endometritis is oral antibiotic therapy and removal of any associated uterine pathology such as retained pregnancy tissue. Studies show that a single course of antibiotics has a cure rate of 60-94% when endometrial biopsies are repeated following treatment (Johnson 2010, McQueen 2014). Following antibiotic treatment, if resolution of chronic endometritis confirmed, women with RPL have improved live birth rates (Kimura 2019; Pirtea 2021).
P-471 Anxiety, depression, and body image among infertile women with and without polycystic ovary syndrome
Authors: Jannink T
Published: July 2024

Study question

Do women with PCOS undergoing fertility treatment experience higher anxiety and depression symptoms, along with lower body appreciation, compared to those without PCOS?

Summary answer

Having PCOS was not associated with symptoms of anxiety and depression, but was associated with somewhat lower body appreciation.

What is known already

PCOS has been associated with a higher chance to develop mental health problems, like anxiety, and body image concerns. The International Guidelines on PCOS recommend that all women with PCOS should routinely be screened for anxiety and depressive disorders. In most studies in this field, the comparison group included healthy women without fertility problems.

Study design, size, duration

We conducted a cross-sectional survey study between May 2021 and July 2023, using an online questionnaire. We informed women about this study at fertility clinics in the Netherlands through posters and leaflets and on the websites of the Dutch patient organizations Freya and Stichting PCOS.

Participants/materials, setting, methods

This study included women with infertility, with and without PCOS, undergoing fertility treatment. Women completed the Hospital Anxiety and Depression Scale and the Body Appreciation Scale-2. Primary outcomes were clinically relevant symptoms of anxiety and depression (scores>11), and BAS-2 scores. Secondary outcomes were mean anxiety and depression scores, along with scores of 8 and higher. Dichotomous and continuous outcomes were analysed using logistic and linear regression analyses adjusted for age, BMI, and duration of infertility.

Main results and the role of chance

A total of 1025 women currently undergoing infertility treatment participated, of whom 502 (49.0%) had PCOS and 523 (51.0%) had other infertility diagnoses. We found self-reported clinically relevant symptoms of anxiety in 33.1% of women with PCOS and in 31.0% of women with other infertility diagnoses (adjusted OR: 0.99, 95% CI 0.74 – 1.31). Clinically relevant symptoms of depression were reported in 15.5% of women with PCOS versus 14.5% of women with other infertility diagnoses (adjusted OR: 1.04, 95% CI 0.71 – 1.50). Women with PCOS reported slightly less body appreciation (adjusted mean difference: -1.34, 95% CI -2.32 to -0.36).

Limitations, reasons for caution

Results are based on self-report and may have been affected by sampling bias.

Wider implications of the findings

Although guidelines recommend screening women with PCOS, feelings of anxiety and depression can be present in any woman undergoing fertility treatments. We advise fertility clinics to be aware of women’s mental health issues and to offer support accordingly, as a part of routine care.

Trial registration number

not applicable
O-120 The role of CatSper in male infertility - from bench to bedsite and back
Authors: Strünker T
Published: July 2024

Infertility is on the rise, but the underlying causes still remain mostly unknown. In fact, for about one third of infertile men, semen parameters are within reference limits. This so called ‘unexplained male infertility’ seems to rest on elusive functional defects of the sperm undetectable by semen analysis, precluding early diagnosis of the infertility and evidence-based treatment by medically assisted reproduction (MAR). As a result, affected couples often experience failed MAR attempts, subjecting the ‘healthy’ female to recurring medical risks. We set out to gain insight into the pathomechanisms underlying unexplained male infertility. To this end, we systematically assessed the function of the sperm-specific multisubunit CatSper-channel complex in sperm of 2,300 men undergoing a fertility workup at our center, using a simple motility-based ‘CatSper-Test’ combined with [Ca2+]i fluorimetric and electrophysiological recordings. Thereby, we identified a group of men with normal semen parameters, but defective CatSper function. These men or couples failed to conceive naturally and upon MAR via intrauterine insemination and in vitro fertilization. Intracytoplasmic sperm injection (ICSI) was, ultimately, required to conceive a child. We revealed that the defective CatSper function was caused by variations in CATSPER genes. Moreover, we unveiled that CatSper-deficient human sperm were unable to undergo hyperactive motility and, therefore, failed to penetrate the egg coat. Thus, we provide the experimental evidence that sperm hyperactivation is required for human fertilization, explaining the infertility of CatSper-deficient men and need of ICSI for medically assisted reproduction. Finally, our study also revealed that defective CatSper function and ensuing failure to hyperactivate represents the most common cause of unexplained male infertility known thus far and that this sperm channelopathy can readily be diagnosed, enabling future evidence-based treatment of affected couples.
O-169 Advances in oocyte freezing: implications for donors, recipients, counsellors and clinics
Authors: Hudson N
Published: July 2024

Much of the attention given to the introduction of oocyte vitrification has focused on the implications for autologous freezing – i.e. freezing by those who wish to store their own eggs for later use. Such debates have considered, for example, the individual motivations of freezers and the ethics and practicalities of state and employer funding. Much less attention has been given to the impact of egg vitrification on the landscape of egg donation. Whilst use of frozen eggs for donation varies by country and clinic, data show that in general the practice is growing; with Spain an early and enthusiastic adopter within Europe.

The advent of egg vitrification has led to or accelerated a number of changes in the landscape of donation. More efficient and reliable freezing allows clinics to ‘batch’ eggs and store them for potential use by multiple recipients thereby increasing clinic revenue. Vitrification can also facilitate the creation of a store of eggs and associated donor profiles; providing more choice for recipients at the time of treatment and giving rise to the emergence of commercial egg banks within Europe. There have also been changes to the regulatory landscape catalyzed by the introduction of oocyte vitrification; for example, a recent extension to legal storage periods in the UK in response to the newly established technical potential. In a broader sense, the possibility to vitrify and store eggs has developed at a time when fertility treatment in general is rapidly transforming and commercializing; with the introduction of a range of novel and highly commercialized practices in the same period: e.g. methods of gamete/donor selection which use AI and expanded carrier screening for donors. The management and use of frozen eggs has therefore developed along a different sociotechnical trajectory to that of frozen sperm; acquiring differing meanings, practices and moral, cultural and economic value in the process.

In this talk, I draw on data from a recent, large-scale study of egg donation in Europe to consider how oocyte vitrification maybe reshaping the landscape of egg donation. I consider how changing practices associated with vitrification (egg batching and banking, for example) may be reconfiguring how egg donation is constructed and perceived by those involved, as well as how it is regulated. Specifically, I consider the implications that an increase in use of frozen eggs raises for donors, recipients, clinics and their staff, including counsellors.
O-170 The next generation of adolescents will consider more and more multiparenthood, poliparenthood
Authors: Leunens L
Published: July 2024

Although there are a variety of ways in which people navigate their intimate lives, theories of human development and intimacy often implicitly assume a preference for monogamy to be universal (Seltzer, 2000; Conley et al., 2017; Moors et al., 2017). While many people around the globe indeed engage in serial monogamy, remarkable transformations in relationship and family demography have occurred over the past several decades (Glick, 1988; Fisher, 1989; Finkel et al., 2014; Foster, 2016, in Moors et al. 2021) Studies show that 1 out of 6 people (16.8%) desire to engage in polyamory, and 1 out of 9 people (10.7%) have engaged in polyamory at some point during their life. (Moors et al 2021). Besides seeking hypotheses on the reason for this change away from the monogamous relationship form, and based on these data, we can try to make a prediction about the willingness of people to also consider parenthood in consensual non-monogamous or polyamorous relationships and thus engage in polyparenthood in the future.

In the fertility centre too, we are past an era in which heterosexual infertile couples form the majority of our patient population. The need for donor material is increasing, although demand grossly exceeds supply. In addition, in many countries donor anonymity is still enshrined in law, which poses a problem for a growing number of acceptors. Many patients desire information about the donor and an increasing number of patients anticipate the perspective of the future child, which has a right to know its origins. Other patients wish the donor would also include parental involvement, and fundamentally desire the genitor to be a co-parent for their child at some point. As a result, some patients seek refuge in non-regulated open donation arrangements outside the fertility clinic. Indeed, internet websites dedicated to facilitating contact between individuals who want to meet people with the common aim of having a child are mushrooming. Such websites make elective co-parenting accessible to large numbers of people, including both singles and those with partners. Furthermore, these websites are not restricted to LGBTQ+ individuals; heterosexual men and women can also become members and contact potential reproductive partners who may be of a different sexual orientation to themselves.

This could trigger a paradigm shift in the fertility clinic; is co-parenting, multi-parenting and poly-parenting the future? It could resolve problems of donor shortage, and the often difficult search for roots still faced by donor-conceived children as a consequence of donor anonimity.

At Brussels IVF, we anticipated this paradigm shift and developed a procedure to counsel candidates for co-parenting. Welfare of the child is the guiding principle leading to a joint parenting project worked out together with the co-parents. This procedure and counseling topics to be addressed by the fertility centre will be presented.
O-282 Detection and elimination of malignant cells from cryopreserved testis and ovarian tissue?
Authors: Jahnukainen K
Published: July 2024

For young patients receiving treatments that might impair their reproductive functions, gonadal tissue cryopreservation emerges as a technique to preserve their future fertility. The reimplantation of cryopreserved prepubertal gonadal tissue is currently the most promising strategy for restoring fertility in these individuals. There have been reports of successful births after autotransplanting ovarian tissue harvested at peri-puberty. In males, although autotransplantation of testicular tissue has not yet led to the production of viable sperm, successful reproduction has been documented in primate studies following such procedures.

The preservation of gonadal tissue in the setting of cancer introduces concerns regarding the potential for malignant cell contamination, leading to worries about the future reimplantation of contaminated tissue. Recent analysis shows significant contamination rates with cancer cells in cryopreserved gonadal tissues from children with leukemia and lymphoma — 37% in testicular tissues and 12% in ovarian tissues. The risk of contamination extends beyond hematological cancers with documented cases of cancer cell contamination in ovarian tissue from patients with apparently localized sarcoma, and detection of neuroblastoma cells in cryopreserved testicular tissue. Such significant contamination rates prompt discussions about harvesting tissue post-chemotherapy, although gonadotoxic treatments may adversely affect the quality of the cryopreserved germ cells.

Emerging diagnostic techniques, especially molecular methods, are being investigated for their ability to more accurately detect residual maliganat disease. While traditional histology and immunohistochemistry have been the norm, their sensitivity is relatively low. More precise molecular-genetic techniques, such as Polymerase Chain Reaction (PCR) and Reverse Transcriptase-quantitative PCR, demonstrate greater sensitivity. Moreover, advanced methods like next-generation sequencing offer even higher precision in detecting minimal residual disease. Xenotransplantation of gonadal tissue into immunodeficient animals may also provide some insights as a preclinical method for relapse prediction. Future research is essential to refine these diagnostic techniques to achieve the necessary sensitivity for clinical application.

This presentation aims to explore the current knowledge on gonadal tissue contamination rates for both hematological cancers and solid tumors in prepubertal patients and to review strategies for decontaminating gonadal tissues. A critical examination of existing knowledge gaps will be conducted with the objective of identifying secure methods for fertility restoration in cancer survivors.
O-288 Pro
Authors: Vassena R
Published: July 2024

Currently and globally, the majority of ART treatments are performed either fully in the private medical sector or are partially subsidized in the public sector but with common treatments spill-over to the private sector; countries where there is sufficient public coverage of ART are in fact rare. While private clinics and hospital have been the norm in ART for decades, in recent years the field has undergone significant consolidation, and this has resulted in an influx of large financial players such as private equity (PE) firms. The results are a series of mergers and acquisitions that are shaping the geography of ART provision.

In this debate, I will take on the “pro” side and I will highlight the scholarship around the changes in care brought about by PE ownership of medical practices, bringing examples from branches of medicine such as dermatology, dentistry, long term care or Ob&Gyn that have experienced market consolidation in the last decades. I will show that available evidence indicate that the change in ownership to PE of private medical practices is associated with an increase in the number of patients treated and a net increase in payments to clinicians. Moreover, PE ownership has been repeatedly associated with a perception of higher quality care by patients, while clinical KPIs have not gotten worse and, if anything, have improved. This is usually due to greater intentional focus on standardization and quality control, streamline and protocolization of treatments, and centralization of certain administrative areas.

I will further argue that, in large PE owned networks, best practices tend to be enhanced by peer to peer sharing and central medical boards, while centralization and digitalization of patient data collection favors research and development in a field that sorely lacks public funding for reproductive research.