Purification of Waste-Generated Biogas Mixtures Using Covalent Organic Framework's High CO2 Selectivity.

Development of crystalline porous materials for selective CO2 adsorption and storage is in high demand to boost the carbon capture and storage (CCS) technology. In this regard, we have developed a ß-keto enamine-based covalent organic framework (VM-COF) via the Schiff base polycondensation technique. The as-synthesized VM-COF exhibited excellent thermal and chemical stability along with a very high surface area (1258 m2 g-1) and a high CO2 adsorption capacity (3.58 mmol g-1) at room temperature (298 K). The CO2/CH4 and CO2/H2 selectivities by the IAST method were calculated to be 10.9 and 881.7, respectively, which were further experimentally supported by breakthrough analysis. Moreover, theoretical investigations revealed that the carbonyl-rich sites in a polymeric backbone have higher CO2 binding affinity along with very high binding energy (-39.44 KJ mol-1) compared to other aromatic carbon-rich sites. Intrigued by the best CO2 adsorption capacity and high CO2 selectivity, we have utilized the VM-COF for biogas purification produced by the biofermentation of municipal waste. Compared with the commercially available activated carbon, VM-COF exhibited much better purification ability. This opens up a new opportunity for the creation of functionalized nanoporous materials for the large-scale purification of waste-generated biogases to address the challenges associated with energy and the environment.

Modulating cultivation regimes of Messastrum gracile SVMIICT7 for biomass productivity integrated with resource recovery via hydrothermal liquefaction.

The present study was designed to assess Messastrum gracile SVMIICT7 potential in treating dairy wastewater (autoclaved (ADWW) and raw (DWW)) with relation to nutrient removal, in-vivo Chl-a-based biomass, and bio-oil synthesis. Chlorophyll a fluorescence kinetics revealed improved photochemical efficiency (0.639, Fv/Fm) in M. gracile when grown with DWW. This may be owing to enhanced electron transport being mediated by an effective water-splitting complex at photosystem (PSII) of thylakoids. The increase in ABS/RC observed in DWW can be attributed to the elevated chlorophyll content and reduced light dissipation, as evident by higher values of ETo/RC and a decrease in non-photochemical quenching (NPQ). M. gracile inoculated in DWW had the highest Chl-a-biomass yield (1.8 g L-1) and biomolecules while maximum nutrient removal efficiency was observed in ADWW (83.7% TN and 60.07% TP). M. gracile exhibited substantial bio-oil yield of 29.6% and high calorific value of 37.19 MJ kg-1, predominantly composed of hydrocarbons along with nitrogen and oxygen cyclic compounds. This research offers a thorough investigation into wastewater treatment, illustrating the conversion of algal biomass into valuable energy sources and chemical intermediates within the framework of a biorefinery.

Rationally construction of 2D & 3D material on h-BN @ SnO2/TiO2 micro-sphere enables for photocatalytic debasement of textile cloth dyes in waste water treatment.

Affordable and swiftly available h-BN@SnO2/TiO2 photocatalysts are being developed through an easy hydrothermally approach was used urea as boric acid precursors. With their constructed photo catalysts, the effect of h-BN@SnO2/TiO2 has been investigated under the assessment of Adsorption agents utilizing X-ray diffraction pattern (XRD), Scanning electron microscopy, Energy dispersive spectroscopic analysis (SEM/EDS), transmission electron microscopy (TEM), high resolution transmission electron microscopy (HR-TEM), and Burner Emit Teller (BET) isotherm testing methods, which also indicated that SnO2/TiO2 and h-BN have been tightly bound together. Because turquoise blue (TB) and Methyl orange (MO) fabric dyes can be found in the industrial wastewater being processed, the photo catalytic degradation process happens to be applied. According to the advantageous linkages of h-BN@SnO2/TiO2 photocatalysts, fantastic efficacy in breakdown towards hazardous compounds has been found. For the decomposition of Turquoise blue (TB) and Methyl orange (MO), the h-BN@SnO2/TiO2 catalysts proved the best performance stability (0.0386 min-1 and 1.524min-1) but were significantly 22 times quicker. Optical catalysis has additionally demonstrated extraordinary resilience and durability throughout five reprocessed efforts. On top of that, an approach enabling photocatalytic breakdown of harmful substances upon h-BN@SnO2/TiO2 has been presented.

Use of modern technologies for promoting health at the population level in India.

India, with a population of 1.4 billion, faces health equity challenges due to inaccessible public health systems, particularly in rural areas. Modern technologies like the internet and mobile phones are being used to bridge this gap, enhancing health equity by disseminating vital health information. Health Technology Assessment (HTA) evaluates these technologies, influencing healthcare policy and improving health outcomes. Key strategies include digital health hubs, mobile health units, public-private partnerships, and digital tools for community health workers. To scale these interventions, capacity building, infrastructure development, community engagement, and monitoring are required. Policymakers are urged to prioritize investments in health technologies based on evidence, considering cost-effectiveness, health outcomes, and health equity. Addressing data privacy and security is crucial. Future research should focus on technology-based interventions for maternal and child health.

Technologies that empower women for better access to healthcare in India - A scoping review.

Women from low- and middle-income countries face challenges in accessing and utilising quality healthcare. Technologies can aid in overcoming these challenges and the present scoping review is aimed at summarising the range of technologies used by women and assessing their role in enabling Indian women to learn about and access healthcare services. We conducted a comprehensive search from the date of inception of database till 2022 in PubMed and Google Scholar. Data was extracted from 43 studies and were thematically analysed. The range of technologies used by Indian women included integrated voice response system, short message services, audio-visual aids, telephone calls and mobile applications operated by health workers. Majority of the studies were community-based (79.1%), from five states (60.5%), done in rural settings (58.1%) and with interventional design (48.8%). Maternal and child health has been the major focus of studies, with lesser representation in domains of non-communicable and communicable diseases. The review also summarised barriers related to using technology - from health system and participant perspective. Technology-based interventions are enabling women to improve awareness about and accessibility to healthcare in India. Imparting digital literacy and scaling up technology use are potential solutions to scale-up healthcare access among women in India.

Techno-economic feasibility of a recycling plant for the extraction of metals and boehmite from hazardous petroleum spent catalysts.

Petroleum spent hydroprocessing catalysts are hazardous solid waste, the efficient recycling of which is a serious challenge to refineries. However, information on the economic feasibility of spent catalysts recycling plants is scarce, which is critical for environmental authorities and decision-makers. In this work, an innovative recycling scheme targeting hydrometallurgical recovery of base metals (Ni, Mo, and V) and transforming low-value Al residue into a high-value boehmite (γ-AlOOH) as the key product was considered an efficient way to beneficiate the hazardous spent hydroprocessing catalysts. A preliminary techno-economic evaluation of such a recycling scheme was performed to assess the feasibility of the proposed recycling scheme. The recovery cost (valuable metals and boehmite) and potential revenue were estimated to study the economics of the process. The preliminary results have suggested that the recycling scheme is economically feasible with a high internal rate of return (IRR) of 12.3%, a net present value of 38.6 million USD, and a short payback period of 8.7 years. Furthermore, a sensitivity analysis (± 10%) conducted on key parameters showed that the selling prices of the finished products and the cost of chemicals were the most important factors affecting plant economics. Overall, the recycling scheme was sustainable and avoided landfilling of spent catalysts as the residue can be beneficiated into a high-value product. The results from the economic feasibility study are likely to assist the stakeholders and decision-makers in making investment and policy decisions for the valorization of spent hydroprocessing catalysts.

Review of MR spectroscopy analysis and artificial intelligence applications for the detection of cerebral inflammation and neurotoxicity in Alzheimer's disease.

INTRODUCTION: Magnetic resonance spectroscopy (MRS) has an emerging role as a neuroimaging tool for the detection of biomarkers of Alzheimer's disease (AD). To date, MRS has been established as one of the diagnostic tools for various diseases such as breast cancer and fatty liver, as well as brain tumours. However, its utility in neurodegenerative diseases is still in the experimental stages. The potential role of the modality has not been fully explored, as there is diverse information regarding the aberrations in the brain metabolites caused by normal ageing versus neurodegenerative disorders. MATERIALS AND METHODS: A literature search was carried out to gather eligible studies from the following widely sourced electronic databases such as Scopus, PubMed and Google Scholar using the combination of the following keywords: AD, MRS, brain metabolites, deep learning (DL), machine learning (ML) and artificial intelligence (AI); having the aim of taking the readers through the advancements in the usage of MRS analysis and related AI applications for the detection of AD. RESULTS: We elaborate on the MRS data acquisition, processing, analysis, and interpretation techniques. Recommendation is made for MRS parameters that can obtain the best quality spectrum for fingerprinting the brain metabolomics composition in AD. Furthermore, we summarise ML and DL techniques that have been utilised to estimate the uncertainty in the machine-predicted metabolite content, as well as streamline the process of displaying results of metabolites derangement that occurs as part of ageing. CONCLUSION: MRS has a role as a non-invasive tool for the detection of brain metabolite biomarkers that indicate brain metabolic health, which can be integral in the management of AD.

Green waste immobilized Ag/Cu feather like Bi-matrix on garment dye decomposes and their bio-efficacy.

This paper describes a simple phyto-remediation of feather-like silver/copper bi-matrix (BMs) was constructed by employing pommagrant waste peel (PWP) extract as crucial role of reducing agent and chelating agents. Numerous strategies, including UV-Visible, XRD, SEM-EDX, and TEM and BET isotherm were used to analysis the optical, structural, surface area and functional properties. Ag/Cu BPNMs of TEM characterization shows feather-like architectural features with constrained size and shape. The Ag/Cu co-catalytic nanoparticles have a particle size of 34-64 nm. The photocatalytic efficiency of Ag/Cu BMs was investigated using a garment dye, Congo red (CR), at successive time intervals under halogen lamp exposure. For Ag/Cu bimetallic nanoparticles, the photocatalytic degradation rate was recorded to be 100% after 40 min which is caused by adsorption of Congo red dye molecules on Ag/Cu and their degradation by reactive oxygen species (ROS). ROS are free hydroxyl radicals such as •OH and O2• ions that have high oxidizing capacity. The developed Ag/Cu BMs shown effective bacteriostatic action against many infections.

Pyto-Architechture of Ag, Au and Ag-Au bi-metallic nanoparticles using waste orange peel extract for enable carcinogenic Congo red dye degradation.

Ecologically inspired to develop silver, gold and silver/gold bimetallic nanoparticles from discarded orange peel extract. The plant-derived compounds included in discarded orange peel extract have been accountable for the development of Ag, Au and Ag-Au bimetallic nanoparticles, that might be used in the biosynthetic process. The qualitative assessment of developed silver, gold and silver/gold bimetallic nanoparticles has been performed by UV-visible, XRD pattern, FT IR analysis, TEM/HRTEM, EDX and BET isotherm analysis. In this investigation, the photocatalytic effect of developed silver, gold and silver/gold bimetallic nanoparticles on Congo red dye breakdown efficiency was achieved at 96%, 94%, and 99.2%, respectively. Due to prolonged electron-hole recombination process was investigated using UV irradiation and reused for up to 5 consecutive runs without significant loss of photocatalytic activity. Moreover, silver, gold, and silver/gold bimetallic nanoparticles manufactured in an environmentally benign manner could potentially contribute to the ecological cleanup.

Biorefinery-centric ethanol and oleochemical production employing Yarrowia lipolytica and Pichia farinosa.

The research examined the capabilities of Yarrowia lipolytica (YL) and Pichia farinosa (PF) in converting sugars to ethanol and oleochemicals. Lipid, ethanol, protein yield and gene-expressions were analysed at different substrate concentrations (3 to 30 g/L) with glucose, food waste, and fermentation-effluent. Optimal results were obtained at 20 g/L using both synthetic carbon with 4.6 % of total lipid yield. Lauric and Caprylic acid dominance was noted in total lipid fractions. Protein accumulation (6 g/L) was observed in glucose system (20 g/L) indicating yeast strains potential as single-cell proteins (SCP). Fatty-acid desaturase (FAD12) and alcohol dehydrogenase (ADH) expressions were higher at optimum condition of YL (1.15 × 10-1, 3.8 × 10-2) and PF (5.8 × 10-2, 3.8 × 10-2) respectively. Maximum carbon reduction of 87 % depicted at best condition, aligning with metabolic yield. These findings highlights promising role of yeast as biorefinery biocatalyst.

Hexavalent chromium waste removal via bioelectrochemical systems - a life cycle assessment perspective.

Bioelectrochemical systems (BESs) such as microbial fuel cells (MFCs) present numerous benefits for the removal and recovery of heavy metals from industrial and municipal wastewater. This study evaluated the life cycle environmental impact of simultaneous hexavalent chromium (Cr(vi)) removal and bioelectricity generation in a dual chamber MFC. Results indicate a global warming potential (GWP) of -0.44 kg carbon dioxide (CO2)-eq. per kg of chromium recovered, representing a total saving of up to 97% in comparison with existing technologies for the treatment of Cr(vi) laden wastewater. The observed savings in GWP (kg CO2-eq.) reduced to 61.8% with the removal of the allocated credits from the MFC system's life cycle. Of all the various sub-systems considered within the chromium waste treatment plant, the MFC unit and the chromium metal recovery unit had the largest impact in terms of GWP (kg CO2-eq.), non-renewable energy use (NREU) (MJ primary), and mineral extraction (MJ surplus). A statistical analysis of the results showed that an increase in chemical oxygen demand (COD) was associated with a reduction in GWP (kg CO2-eq.), NREU (MJ primary), and terrestrial ecotoxicity (kg triethylene glycol equivalents into soil (TEG soil)-eq.). The life cycle assessment (LCA) output showed a high sensitivity to changes in the materials and construction processes of MFC reactors, indicating the need for further research into sustainable materials for MFC reactor construction. The observed interaction effects of process variables also suggest the need for combined optimization of these variables. Analysis with other types of metals is also important to further demonstrate the practical viability of metal removal through MFCs.

Pilot study of machine learning in the task of distinguishing high and low-grade pediatric hydronephrosis on ultrasound.

PURPOSE: Hydronephrosis is a common pediatric urological condition, characterized by dilation of the renal collecting system. Accurate identification of the severity of hydronephrosis is crucial in clinical management, as high-grade hydronephrosis can cause significant damage to the kidney. In this pilot study, we demonstrate the feasibility of machine learning in differentiating between high and low-grade hydronephrosis in pediatric patients. MATERIALS AND METHODS: We retrospectively reviewed 592 images from 90 unique patients ages 0-8 years diagnosed with hydronephrosis at the University of Chicago's Pediatric Urology Clinic. The study included 74 high-grade hydronephrosis (145 images) and 227 low-grade hydronephrosis (447 images). Patients were excluded if they had less than 2 studies prior to surgical intervention or had structural abnormalities. We developed a radiomic-based artificial intelligence algorithm incorporating computerized texture analysis and machine learning (support-vector machine) to yield a predictor of hydronephrosis grade. RESULTS: Receiver operating characteristic analysis of the classifier output yielded an area under the curve value of 0.86 (95% CI 0.81-0.92) in the task of distinguishing between low and high-grade hydronephrosis using a five-fold cross-validation by kidney. In addition, a Mann-Kendall trend test between computer output and clinical hydronephrosis grade yielded a statistically significant upward trend (p<0.001). CONCLUSIONS: Our findings demonstrate the potential of machine learning in the differentiation between low and high-grade hydronephrosis. Further studies are warranted to validate our findings and their generalizability for use in clinical practice as a means to predict clinical outcomes and the resolution of hydronephrosis.

In vitro and in silico analysis proving DPP4 inhibition and diabetes-associated gene network modulation by a polyherbal formulation: Nisakathakadi Kashaya.

Dipeptidyl-peptidase IV (DPP4) inhibitors are an important class of anti-diabetic drugs recognised for their systemic biological actions. Polyherbal preparations like Ayurveda formulations are considered to be ideal sources for discovering novel DPP4 inhibitors owing to their rich phytochemical composition. The current study reports the DPP4 inhibitory potential of a clinically established Ayurvedic anti-diabetic formulation Nisakathakadi Kashaya (NK) using in vitro assay and substantiates it by identifying potential bioactives responsible for DPP4 inhibition using computational biology tools. NK showed a dose-dependent DPP4 inhibition with an IC50 of 2.06 µg GAE/mL, and the molecular docking and simulation studies showed three compounds, namely Terchebin, Locaracemoside B and 1,2,4,6 Tetra o Galloyl Beta D Glucose having stable interactions with DPP4 similar to the standard drug Vildagliptin. Further, for the reason that polyherbal formulations exert a network pharmacology mode of action, in silico analysis was carried out to identify the other putative phytochemical-protein networks modulated by NK. The complex pharmacological network of the formulation was explored further using a subnetwork of diabetes proteins and their relationship with diabetes-associated comorbidities. A number of key targets like TNFα, TGFß1, SOD1, SOD2, AKT1, DPP4 and GLP1R were identified in the protein-protein interaction network that is vital to diabetic progression and complications. A combination of in vitro and in silico methods allowed us to prove the DPP4 inhibition potential of NK as well as provided insights into the possible pharmacological networking through which NK potentially exerts its systemic effect in diabetes management.Communicated by Ramaswamy H. Sarma.

The LUAA Gundeti Technique for Bilateral Robotic Ureteral Reimplantation: Lessons Learned over a Decade for Optimal (Resolution, Urinary Retention, and Perioperative Complications) Trifecta Outcomes.

Background: Ureteral reimplantation is the gold standard treatment for high-grade vesicoureteral reflux (VUR) in pediatric patients. Robot-assisted laparoscopic extravesical ureteral reimplantation (RALUR-EV) using the LUAA technique has emerged as a viable alternative to traditional open and laparoscopic surgical correction. Objective: To evaluate the outcomes, reflux resolution, urinary retention, and complications associated with bilateral RALUR-EV for primary VUR using the LUAA Gundeti technique in pediatric patients. Design setting and participants: A retrospective study was conducted at a single academic center, involving 34 consecutive pediatric patients who underwent RALUR-EV for bilateral VUR management between December 2008 and December 2022. The study included only patients who were evaluated with postoperative voiding cystourethrogram (VCUG). Surgical procedure: The LUAA extravesical ureteral reimplantation technique was performed, involving the identification and mobilization of the ureter, creation of a peritoneal window, dissection close to the neurovascular bundle, Y dissection at the ureterovesical junction, detrusorotomy, detrusorrhaphy with advential inclusion, and apical alignment suture. Measurements: The primary outcome was radiographic resolution of VUR on VCUG. The secondary outcomes included urinary retention and Clavien-Dindo grade III complications. Results and limitations: The overall radiographic resolution rate was 85.2%, with success rates of 76.7%, 75%, and 96.7% across the three distinct patient cohorts. The overall Clavien-Dindo grade III complication rate was 5.8%, and transient urinary retention was 8.8%. Resolution of urinary retention occurred within 7-28 d. The study's limitations include the small sample size, single-center design, and retrospective nature. Conclusions: The LUAA technique demonstrates sustainable outcomes for VUR resolution with a low incidence of transient urinary retention and complications. A thorough understanding of pelvic anatomy is essential for successful dissection and minimization of the risk of complications. Further studies are needed to evaluate the effectiveness of different approaches in reducing the incidence of transient urinary retention following bilateral extravesical reimplantation. Patient summary: In this study, we examined the results of the Gundeti LUAA surgical technique for treating primary vesicoureteral reflux in children. We identified various essential modifications that increase the likelihood of achieving favorable outcomes.

Experimental safety testing confirms that the NSAID nimesulide is toxic to Gyps vultures in India.

Population declines of Gyps vultures throughout South Asia were caused by unintentional poisoning by the NSAID diclofenac, which was subsequently banned. However, other vulture-toxic NSAIDs are available, including nimesulide, which, in experiments carried out in South Africa, was shown to be toxic to Gyps vultures. We report on safety-testing of nimesulide carried out on Himalayan Griffons G. himalayensis. We gave two vultures a dose of nimesulide by oral gavage at the maximum level of exposure, with two controls dosed with benzyl alcohol. In the two tested birds, plasma nimesulide concentrations peaked after six hours, while serum uric acid concentrations increased steadily up until 24 h post-treatment, after which both birds died, displaying severe visceral gout. The control birds showed no adverse clinical or biochemical signs. We confirm that nimesulide is toxic to Gyps vultures. Veterinary use of nimesulide should be banned in all Gyps vulture range countries in the region.

In situ self-induced electrical stimulation to plants: Modulates morphogenesis, photosynthesis and gene expression in Vigna radiata and Cicer arietinum.

Specific stimuli to plants influence intracellular and intercellular communications, activation of ion channels, gene expression, growth and development. The functional role of self-induced in situ electrical stimuli at the rhizosphere of the plant by placing electrode assembly in a defined circuit mode was studied on the growth and development of Vigna radiata and Cicer arietinum plants. Experiments were designed with three-circuit mode configurational variations (CC-P, OC-P and SC-P) and compared with the relative performance of control system (non-potential). The plants cultivated under the in situ electrical stimuli (low-current) showed a marked influence on growth and photosynthetic performance of the plants. CC-P operation showed improved vegetative growth, characterized by increased roots, shoots and biomass along with accelerated plant growth from seed germination to vegetation, flowering and pod formation leading towards earlier and more robust flowering compared to control system. Plants also showed higher aquaporin gene expression levels in CC-P operation. The control operation showed 10 days additional maturation time compared to CC-P operation. The strategy can be beneficially applied to augment the bioremediation capacity of complex pollutants with reference to phytoremediation or constructed wetland systems where the plant and its roots are the main enabler apart from agriculture applications specific to nursery-raised or transplanted plants.

Mortal Dangers of Adult-Onset IgA Vasculitis.

IgA vasculitis (IgAV), previously known as Henoch Schoenlein purpura (HSP), is a leukocytoclastic vasculitis subtype predominantly amongst the pediatric patient population involving IgA dominant immune complex deposits attacking small vessel walls. While it oftentimes follows upper respiratory infections and presents with palpable purpuras, IgAV can also present in the adult patient population and lead to systemic inflammation. In this case report, we present the case of an adult-onset IgAV complicated via gastrointestinal perforation, acute kidney injury secondary to IgA nephritis, and circulatory shock. A review of prognosis, complicating factors, and treatment methods was also conducted for reported adult-onset IgAV with an aim to elucidate similarities and differences to pediatric-onset IgAV. While there is no unified treatment approach, glucocorticoids and immunosuppressors such as rituximab have been observed to be an effective protocol.

In vitro fertilisation for unexplained subfertility.

BACKGROUND: In vitro fertilisation (IVF) is a treatment for unexplained subfertility but is invasive, expensive, and associated with risks. OBJECTIVES: To evaluate the effectiveness and safety of IVF versus expectant management, unstimulated intrauterine insemination (IUI), and IUI with ovarian stimulation using gonadotropins, clomiphene citrate (CC), or letrozole in improving pregnancy outcomes. SEARCH METHODS: We searched following databases from inception to November 2021, with no language restriction: Cochrane Gynaecology and Fertility Register, CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL. We searched reference lists of articles and conference abstracts. SELECTION CRITERIA: Randomised controlled trials (RCTs) comparing effectiveness of IVF for unexplained subfertility with expectant management, unstimulated IUI, and stimulated IUI. DATA COLLECTION AND ANALYSIS: We followed standard Cochrane methods. MAIN RESULTS: IVF versus expectant management (two RCTs) We are uncertain whether IVF improves live birth rate (LBR) and clinical pregnancy rate (CPR) compared to expectant management (odds ratio (OR) 22.0, 95% confidence interval (CI) 2.56 to 189.37; 1 RCT; 51 women; very low-quality evidence; OR 3.24, 95% CI 1.07 to 9.8; 2 RCTs; 86 women; I2 = 80%; very low-quality evidence). Adverse effects were not reported. Assuming 4% LBR and 12% CPR with expectant management, these would be 8.8% to 9% and 13% to 58% with IVF. IVF versus unstimulated IUI (two RCTs) IVF may improve LBR compared to unstimulated IUI (OR 2.47, 95% CI 1.19 to 5.12; 2 RCTs; 156 women; I2 = 60%; low-quality evidence). We are uncertain whether there is a difference between IVF and IUI for multiple pregnancy rate (MPR) (OR 1.03, 95% CI 0.04 to 27.29; 1 RCT; 43 women; very low-quality evidence) and miscarriage rate (OR 1.72, 95% CI 0.14 to 21.25; 1 RCT; 43 women; very low-quality evidence). No study reported ovarian hyperstimulation syndrome (OHSS). Assuming 16% LBR, 3% MPR, and 6% miscarriage rate with unstimulated IUI, these outcomes would be 18.5% to 49%, 0.1% to 46%, and 0.9% to 58% with IVF. IVF versus IUI + ovarian stimulation with gonadotropins (6 RCTs), CC (1 RCT), or letrozole (no RCTs) Stratified analysis was based on pretreatment status. Treatment-naive women There may be little or no difference in LBR between IVF and IUI + gonadotropins (1 IVF to 2 to 3 IUI cycles: OR 1.19, 95% CI 0.87 to 1.61; 3 RCTs; 731 women; I2 = 0%; low-quality evidence; 1 IVF to 1 IUI cycle: OR 1.63, 95% CI 0.91 to 2.92; 2 RCTs; 221 women; I2 = 54%; low-quality evidence); or between IVF and IUI + CC (OR 2.51, 95% CI 0.96 to 6.55; 1 RCT; 103 women; low-quality evidence). Assuming 42% LBR with IUI + gonadotropins (1 IVF to 2 to 3 IUI cycles) and 26% LBR with IUI + gonadotropins (1 IVF to 1 IUI cycle), LBR would be 39% to 54% and 24% to 51% with IVF. Assuming 15% LBR with IUI + CC, LBR would be 15% to 54% with IVF. There may be little or no difference in CPR between IVF and IUI + gonadotropins (1 IVF to 2 to 3 IUI cycles: OR 1.17, 95% CI 0.85 to 1.59; 3 RCTs; 731 women; I2 = 0%; low-quality evidence; 1 IVF to 1 IUI cycle: OR 4.59, 95% CI 1.86 to 11.35; 1 RCT; 103 women; low-quality evidence); or between IVF and IUI + CC (OR 3.58, 95% CI 1.51 to 8.49; 1 RCT; 103 women; low-quality evidence). Assuming 48% CPR with IUI + gonadotropins (1 IVF to 2 to 3 IUI cycles) and 17% with IUI + gonadotropins (1 IVF to 1 IUI cycle), CPR would be 44% to 60% and 28% to 70% with IVF. Assuming 21% CPR with IUI + CC, CPR would be 29% to 69% with IVF. There may be little or no difference in multiple pregnancy rate (MPR) between IVF and IUI + gonadotropins (1 IVF to 2 to 3 IUI cycles: OR 0.82, 95% CI 0.38 to 1.77; 3 RCTs; 731 women; I2 = 0%; low-quality evidence; 1 IVF to 1 IUI cycle: OR 0.76, 95% CI 0.36 to 1.58; 2 RCTs; 221 women; I2 = 0%; low-quality evidence); or between IVF and IUI + CC (OR 0.64, 95% CI 0.17 to 2.41; 1 RCT; 102 women; low-quality evidence). We are uncertain if there is a difference in OHSS between IVF and IUI + gonadotropins with 1 IVF to 2 to 3 IUI cycles (OR 6.86, 95% CI 0.35 to 134.59; 1 RCT; 207 women; very low-quality evidence); and there may be little or no difference in OHSS with 1 IVF to 1 IUI cycle (OR 1.22, 95% CI 0.36 to 4.16; 2 RCTs; 221 women; I2 = 0%; low-quality evidence). There may be little or no difference between IVF and IUI + CC (OR 1.53, 95% CI 0.24 to 9.57; 1 RCT; 102 women; low-quality evidence). We are uncertain if there is a difference in miscarriage rate between IVF and IUI + gonadotropins with 1 IVF to 2 to 3 IUI cycles (OR 0.31, 95% CI 0.03 to 3.04; 1 RCT; 207 women; very low-quality evidence); and there may be little or no difference with 1 IVF to 1 IUI cycle (OR 1.16, 95% CI 0.44 to 3.02; 1 RCT; 103 women; low-quality evidence). There may be little or no difference between IVF and IUI + CC (OR 1.48, 95% CI 0.54 to 4.05; 1 RCT; 102 women; low-quality evidence). In women pretreated with IUI + CC IVF may improve LBR compared with IUI + gonadotropins (OR 3.90, 95% CI 2.32 to 6.57; 1 RCT; 280 women; low-quality evidence). Assuming 22% LBR with IUI + gonadotropins, LBR would be 39% to 65% with IVF. IVF may improve CPR compared with IUI + gonadotropins (OR 14.13, 95% CI 7.57 to 26.38; 1 RCT; 280 women; low-quality evidence). Assuming 30% CPR with IUI + gonadotropins, CPR would be 76% to 92% with IVF. AUTHORS' CONCLUSIONS: IVF may improve LBR over unstimulated IUI. Data should be interpreted with caution as overall evidence quality was low.