Ongoing pregnancy rates in single euploid frozen embryo transfers remain unaffected by female age: a retrospective study.

RESEARCH QUESTION: Is female age a significant factor in the likelihood of an ongoing pregnancy in single euploid frozen embryo transfers (FET)? DESIGN: Retrospective study of 1923 single euploid FET cycles in 1464 women, either in a natural cycle or a hormone replacement therapy cycle. The primary outcome was the ongoing pregnancy rate (OPR). RESULTS: There were 990 (51.48%) ongoing pregnancies among 1923 included transfers. The OPR were 51.4%, 49.1%, 53.3% and 52.3% for women aged ≤35, >35-≤37, >37-≤40 and >40 years at oocyte retrieval (OCR), without a significant trend for decreasing OPR (P = 0.679). No significant differences in female age at embryo transfer (P = 0.609) and female age at OCR (P = 0.816) were found between the groups (ongoing pregnancy versus no pregnancy or miscarriage). Women who received good-quality embryos (P < 0.001), had a lower body mass index (BMI) (P < 0.001), had achieved at least one pregnancy previously (P < 0.001), and underwent natural cycle endometrial preparation (P < 0.001) were more likely to achieve an ongoing pregnancy. Multivariable regression analysis (adjusted for BMI, embryo quality and endometrial preparation) did not show a significant effect of female age at OCR on achieving an ongoing pregnancy. Compared with women aged ≤35 years, none of the age groups had significantly higher or lower OPR. A multinomial regression analysis showed that BMI, embryo quality and endometrial preparation were associated with miscarriage/no pregnancy versus ongoing pregnancy (P = 0.001, 0.001 and 0.001, respectively). Female age had no significant association with either outcome. CONCLUSIONS: Female age in itself does not have a substantial impact on the OPR in single euploid FET cycles, but the OPR is impacted significantly by embryo quality, BMI, previous parity, and a natural cycle endometrial preparation protocol.

Psychological Impact and Quality of Life in Adults With Tinnitus: A Cross-Sectional Study.

BACKGROUND: Tinnitus may directly or indirectly influence professional, personal, and leisure activities and disrupt family and social relationships in severe cases. This study aimed to explore the impact of tinnitus on the quality of life (QoL) and psychological well-being among Saudi Arabian adults. METHODS: This study used a cross-sectional design to collect data from adults experiencing tinnitus. Data collection took place between September 5, 2023 and October 7, 2023 at King Khalid University, Abha, Saudi Arabia. The study involved adults aged 18 to 65 with tinnitus. Participants were recruited from audiology clinics. A multi-stage stratified random sampling method was used to recruit the study participants. The severity of tinnitus handicap was assessed using the 25-item Tinnitus Handicap Inventory (THI) questionnaire. THI consists of 25 items divided into functional, emotional, and catastrophic subscales. The total score ranges from 0 to 100, with higher scores indicating greater tinnitus-related handicap. THI scores are categorized into 0-16, 18-36, 38-56, 58-76, and 78-100. RESULTS:  A total of 163 participants were included in this study. The largest age group category was 18-29 years, comprising 57.05% (n = 93) of the sample. The study included a slightly higher percentage of female participants (65.03%, n = 106). More than three-fifths (61.96% ) of the participants were from the Western Region (n = 101), 91.40% (n = 149) were Saudi nationals, 55.21% (n = 90) were single, 67.5% (n = 110) had university education, 46.0% (n = 75) had income less than 500 SAR, 44.78% (n =73) was employed, and 74.23% (n = 121) did not smoke. Tinnitus hurts emotions and QoL. The largest proportion of the studied patients with tinnitus faced catastrophic handicaps (24.5%, n = 40), and nearly equal proportions experienced mild and moderate handicaps (23.3%, n = 38 and 23.9%, n =39, respectively). Severe handicap was reported in 15.3% (n = 25), while a slight effect was reported in (12.9%, n = 21). Tinnitus affected their hearing (36.81%, n = 60); interfered with daily life (33.74%, n = 55), social activities (30.06%, n = 49), social relationships (29.45%, n = 48), and concentration (37.42%, n = 61); caused fatigue (38.04%, n = 62) and sleep disturbances (36.81%, n = 60); and prevented them from enjoying life (25.77%, n = 42). Tinnitus caused anger (47.85%, n = 78), confusion (42.94%, n = 70), anxiety (43.56%, n = 71), feeling unsafe (33.74%, n = 55), desperation (36.81%, n = 60), frustration (30.06%, n = 49), being upset (38.04%, n = 62), experiencing depression (30.67%), and challenges in coping with stress (31.29%). There was a significant association between the THI score and region of residence (p = 0.02), income (p = 0.041), occupation (p = 0.013), and smoking (p = 0.014). CONCLUSIONS: Our research underscored the profound impact of tinnitus on the QoL among adults in Saudi Arabia. A significant portion of the studied patients faced catastrophic handicaps, emphasizing the severity of the condition. These findings underscore the multifaceted and far-reaching consequences of tinnitus, highlighting the need for comprehensive support and management strategies tailored to the unique sociodemographic factors influencing individuals' experiences.

How to identify patients who would benefit from delayed-matured oocytes insemination: a sibling oocyte and ploidy outcome study.

STUDY QUESTION: Which patients might benefit from insemination of delayed-matured oocytes? SUMMARY ANSWER: Delayed-matured oocytes had a ≥50% contribution to the available cohort of biopsied blastocysts in patients with advanced maternal age, low maturation, and/or low fertilization rates. WHAT IS KNOWN ALREADY: Retrieved immature oocytes that progress to the MII stage in vitro could increase the number of embryos available during ICSI cycles. However, these delayed-matured oocytes are associated with lower fertilization rates and compromised embryo quality. Data on the ploidy of these embryos are controversial, but studies failed to compare euploidy rates of embryos derived from delayed-matured oocytes to patients' own immediate mature sibling oocytes. This strategy efficiently allows to identify the patient population that would benefit from this approach. STUDY DESIGN, SIZE, DURATION: This observational study was performed between January 2019 and June 2021 including a total of 5449 cumulus oocytes complexes from 469 ovarian stimulation cycles, from which 3455 inseminated matured oocytes from ICSI (n = 2911) and IVF (n = 544) were considered as the sibling controls (MII-D0) to the delayed-matured oocytes (MII-D1) (n = 910). Euploidy rates were assessed between delayed-matured (MII-D1) and mature sibling oocytes (MII-D0) in relation to patients' clinical characteristics such as BMI, AMH, age, sperm origin, and the laboratory outcomes, maturation, fertilization, and blastocyst utilization rates. PARTICIPANTS/MATERIALS, SETTING, METHODS: A total of 390 patients undergoing IVF/ICSI, who had at least one metaphase I (MI) or germinal-vesicle (GV) oocyte on the day of oocyte collection (Day 0), which matured in 20-28 h after denudation were included. MI and GV oocytes that matured overnight were inseminated on the following day (Day 1, MII-D1) by ICSI. Only cycles planned for preimplantation genetic testing for aneuploidy using fresh own oocytes were included. MAIN RESULTS AND THE ROLE OF CHANCE: Fertilization (FR) and blastocyst utilization rates were significantly higher for MII-D0 compared to delayed-matured oocytes (MII-D1) (69.5% versus 55.9%, P < 0.001; and 59.5% versus 18.5%, P < 0.001, respectively). However, no significant difference was observed in the rate of euploid embryos between MII-D0 and MII-D1 (46.3% versus 39.0%, P = 0.163). For evaluation of the benefit of inseminating MI/GV oocytes on D1 per cycle in relation to the total number of biopsied embryos, cycles were split into three groups based on the proportion of MII-D1 embryos that were biopsied in that cycle (0%, 1-50%, and ≥50%). The results demonstrate that patients who had ≥50% contribution of delayed-matured oocytes to the available cohort of biopsied embryos were those of advanced maternal age (mean age 37.7 years), <10 oocytes retrieved presenting <34% maturation rate, and <60% fertilization rate. Every MII oocyte injected next day significantly increased the chances of obtaining a euploid embryo [odds ratio (OR) = 1.83, CI: 1.50-2.24, P < 0.001] among MII-D1. The odds of enhanced euploidy were slightly higher among the MII-D1-GV matured group (OR = 1.78, CI: 1.42-2.22, P < 0.001) than the MII-D1-MI matured group (OR = 1.54, CI: 1.25-1.89, P < 0.001). Inseminating at least eight MII-D1 would have >50% probability of getting a euploid embryo among the MII-D1 group. LIMITATIONS, REASONS FOR CAUTION: ICSI of MII-D1 was performed with the fresh or frozen ejaculates or testicular samples from the previous day. The exact timing of polar body extrusion of delayed-matured MI/GV was not identified. Furthermore, the time point of the final oocyte maturation to MII for the immature oocytes and for the oocytes inseminated by IVF could not be identified. WIDER IMPLICATIONS OF THE FINDINGS: The results of this study might provide guidance to the IVF laboratories for targeting the patient's population who would benefit from MII-D1 ICSI without adhering to unnecessary costs and workload. STUDY FUNDING/COMPETING INTEREST(S): No external funding was received for this study. There are no conflicts of interest to be declared for any of the authors. There are no patents, products in development, or marketed products to declare. TRIAL REGISTRATION NUMBER: N/A.

Motility-induced shear thickening in dense colloidal suspensions.

Phase transitions and collective dynamics of active colloidal suspensions are fascinating topics in soft matter physics, particularly for out-of-equilibrium systems, which can lead to rich rheological behaviours in the presence of steady shear flow. Here the role of self-propulsion in the rheological response of a dense colloidal suspension is investigated by using particle-resolved Brownian dynamics simulations. First, the combined effect of activity and shear in the solid on the disordering transition of the suspension is analyzed. While both self-propulsion and shear destroy order and melt the system if critical values are exceeded, self-propulsion largely lowers the stress barrier needed to be overcome during the transition. We further explore the rheological response of the active sheared system once a steady state is reached. While passive suspensions show a solid-like behaviour, turning on particle motility fluidises the system. At low self-propulsion, the active suspension behaves in the steady state as a shear-thinning fluid. Increasing the self-propulsion changes the behaviour of the liquid from shear-thinning to shear-thickening. We attribute this to clustering in the sheared suspensions induced by motility. This new phenomenon of motility-induced shear thickening (MIST) can be used to tailor the rheological response of colloidal suspensions.

Sibling oocytes cultured in a time-lapse versus benchtop incubator: how time-lapse incubators improve blastocyst development and euploid rate.

The aim was to study whether a limited exposure of embryos outside the incubator has an effect on embryo development, blastocyst quality and euploid outcomes. This retrospective study was performed at ART Fertility Clinics, Abu Dhabi, United Arab Emirates (UAE) between March 2018 and April 2020 and included 796 mature sibling oocytes that were split randomly between two incubators after intracytoplasmic sperm injection (ICSI): an EmbryoScope™ (ES) incubator and a benchtop incubator, G185 K-SYSTEMS (KS). The fertilization, cleavage, embryo/blastocyst qualities, useable blastocyst and euploid rates were assessed to evaluate the incubator performance. In total, 503 (63.2%) mature oocytes were cultured in the EmbryoScope and 293 (36.8%) in the K-SYSTEMS. No differences were observed in fertilization rate (79.3% vs 78.8%, P = 0.932), cleavage rate (98.5% vs 99.1%, P = 0.676) and embryo quality on Day 3 (P = 0.543) between both incubators, respectively. Embryos cultured in the EmbryoScope, had a significantly higher chance of being biopsied (64.8% vs 49.6%, P < 0.001). Moreover, a significantly higher blastocyst biopsy rate was observed on Day 5 in the EmbryoScope (67.8% vs 57.0%, P = 0.037), with a highly significant increased euploid rate (63.5% vs 37.4%, P = 0.001) and improved blastocyst quality (P = 0.008). We found that exposure of embryos outside the incubator may negatively affect the in vitro blastocyst development and euploid rate on Day 5.

Antimüllerian hormone (AMH) and age as predictors of preimplantation genetic testing for aneuploidies (PGT-A) cycle outcomes and blastocyst quality on day 5 in women undergoing in vitro fertilization (IVF).

PURPOSE: The objective of this study was to investigate whether women with diminished ovarian reserve who planned for PGT-A exhibit a lower number of blastocysts for biopsy, ploidy outcomes, and blastocyst quality on day 5, regardless of age. METHODS: A retrospective analysis was performed between March 2017 and July 2020 at ART Fertility Clinics Abu Dhabi, including couples that were triggered for final oocyte maturation in an ovarian stimulated cycle planned for PGT-A. Patients were stratified into four AMH groups: < 0.65 ng/ml, 0.65-1.29 ng/ml, 1.3-6.25 ng/ml, and > 6.25 ng/ml; four age categories: ≤ 30, 31-35, 36-40, and > 40 years. MAIN RESULTS AND THE ROLE OF CHANCE: A total of 1410 couples with a mean maternal age of 35.2 ± 6.4 years and AMH of 2.7 ± 2.6 ng/ml were included. In a multivariate logistic regression analysis, controlling for age, the chance of having at least one blastocyst biopsied/stimulated cycle (1156/1410), the chance of having at least one euploid blastocyst/stimulated cycle (880/1410), and the chance of having one euploid blastocyst once biopsy was performed (880/1156) were affected in all patients with AMH < 0.65 ng/ml [AdjOR 0.18[0.11-0.31] p = 0.008)], [AdjOR 0.18 [0.11-0.29] p < 0.001], and [AdjOR 0.34 [0.19-0.61] p = 0.015] as well as in patients with AMH 0.65-1.29 ng/ml (AdjOR 0.52 [0.32-0.84] p < 0.001), (AdjOR 0.49 [0.33-0.72] p < 0.001), and (AdjOR 0.57 [0.36-0.90] p < 0.001), respectively. In a multivariate linear regression analysis, AMH values did not affect blastocyst quality (- 0.72 [- 1.03 to - 0.41] p < 0.001). CONCLUSION: Irrespective of age, patients with diminished ovarian reserve (AMH < 1.3 ng/ml) have a lower chance of having at least one blastocyst biopsied and lower chance of having at least one euploid blastocyst per ovarian stimulated cycle. Blastocyst quality was not affected by AMH values.

Assessing humoral immune response after two doses of an inactivated SARS-CoV-2 vaccine (CoronaVac) in healthcare workers.

OBJECTIVES: During COVID-19 pandemic, the absence of immunity in the population left them susceptible to infection with SARS-CoV-2; healthcare workers (HCWs) being in the highest risk group. This study intends to assess and follow up the humoral immunity in HCWs vaccinated with an inactive virus vaccine (CoronaVac). STUDY DESIGN: This is a prospective observational study. METHODS: A total of 1072 HCWs were investigated for the presence of immunoglobulin G antibodies to the receptor-binding domain of the S1 subunit of the spike protein of SARS-CoV-2 after vaccination. Blood samples were obtained after 28 days of the first dose, 21 days of the second dose, and 3 months after the second dose. Detection of antispike antibodies was performed by the chemiluminescent microparticle immunoassay method (SARS-CoV-2 IgG II Quant, Abbott, Ireland). The results greater than or equal to the cutoff value of 50.0 AU/mL were reported as positive. RESULTS: Four weeks after the first dose of vaccine, antispike antibodies were detected in 834/1072 (77.8%) of HCWs. Seropositivity was higher among females (84.6%) than males (70.6% p < 0.001) and was found to be highest in both women and men between the ages of 18-34 years. Antispike antibodies were detected in 1008 of 1012 (99.6%) after 21 days of the second dose and in 803 of 836 (96.1%) after 3 months of the second dose. CONCLUSIONS: CoronaVac was found to be highly immunogenic after two consecutive doses performed 28 days apart to HCWs; however, the immunogenicity declined significantly (p < 0.001) after 3 months following the second dose of vaccine.

Effectiveness of erector spinae plane block in patients with percutaneous nephrolithotomy.

BACKGROUND: Percutaneous nephrolithotomy operation is a minimally invasive surgical procedure for the treatment of kidney stones. AIM: This study aimed to evaluate the effectiveness of ultrasound-guided erector spinae plane block (ESPB) on analgesic consumption in patients who underwent percutaneous nephrolithotomy. SUBJECTS AND METHODS: The data of 60 cases who underwent percutaneous nephrolithotomy operation between 01.01.2020 January and 12.01.2020 were retrospectively analyzed. Hemodynamic parameters, verbal analogue scale adjectives, total morphine consumption, additional analgesic and antiemetic need, duration of hospitalization, and patient satisfaction score were compared in patients who had ESPB and did not have block. RESULTS: Demographic data and hemodynamic parameters were similar between the two groups. Verbal rating scale values were lower for Group I at 2, 6, 12, and 24 h (P < 0.05). Patient satisfaction score was significantly higher in Group I over 24 h (P = 0.039). Total morphine consumption at postoperative 2nd, 6th, and 24th h was less than that of Group II (P < 0.05). Analgesia consumption in postoperative 24 h of group I was less than that of Group II (P = 0.001). The amount of fentanyl given intraoperatively was significantly higher in Group II (P = 0.001). Nausea and vomiting rates were significantly lower for Group I (P = 0.002). CONCLUSION: Ultrasound-guided ESPB reduced postoperative morphine consumption and the rate of nausea and vomiting.

Who Trusts the WHO? Heuristics and Americans' Trust in the World Health Organization During the COVID-19 Pandemic.

Objective: Why do some Americans trust the World Health Organization (WHO) during the COVID-19 pandemic, but others do not? To date, there has been no examination of trust in the WHO. Yet the global nature of the pandemic necessitates expanding our scholarship to international health organizations. We test the effects of partisanship, ideology, the cooperative internationalist foreign policy orientation, and nationalism on trust in the WHO and subsequently examine how this trust relates to preventive health behavior. Methods: Multivariate analysis of original survey data from a representative sample of Americans. Results: Democrats, liberals, and those with a strong cooperative internationalist foreign policy orientation are more likely to trust the WHO's competence and integrity in responding to the COVID-19 pandemic while Republicans, conservatives, and nationalists are less likely. Even though trust in the Centers for Disease Control (CDC) has the largest impact on preventive health behaviors, trust in the competence of the WHO is also an important factor. These results remain robust after controlling for other covariates. Conclusion: Pandemic politics in the United States is polarized along party and ideological lines. However, our results show that a fuller understanding Americans' political trust and health behaviors during COVID-19 requires taking the international dimensions of the pandemic seriously.

Segmental duplications and monosomies are linked to in vitro developmental arrest.

PURPOSE: To verify which genetic abnormalities prevent embryos to blastulate in a stage-specific time. METHODS: A single center retrospective study was performed between April 2016 and January 2017. Patients requiring Preimplantation Genetic Testing for Aneuploidies (PGT-A) by Next Generation Sequencing (NGS) were included. All embryos were cultured in a time-lapse imaging system and single blastomere biopsy was performed on day 3 of development. Segmental duplications and deletions as well as whole chromosome monosomies and trisomies were registered. Embryo arrest was defined if the embryo failed to blastulate 118 h post-injection. A logistic regression model was applied using the time to blastulate as the response variable and the different mutations as explanatory variables. A p value < 0.05 was considered significant. RESULTS: Of the 285 biopsied cleavage stage embryos, 103 (36.1%) were euploid, and 182 (63.9%) were aneuploid. There was a significant difference in the developmental arrest between euploid and aneuploid embryos (8.7% versus 42.9%; p = 0.0001). Segmental duplications and whole chromosome monosomies were found to have a significant effect on developmental arrest (p = 0.0163 and p = 0.0075), while trisomies and segmental deletions had no effect on developmental arrest. In case of segmental duplications, an increase of one extra segmental duplication increases the odd of arrest by 159%. For whole chromosome monosomies, the odd will only increase by 29% for every extra chromosomal monosomy. Both chromosomal abnormalities remained significant after adding age as an explanatory variable to the model (p = 0.014 and p = 0.009). CONCLUSION: Day 3 cleavage stage embryos with segmental duplications or monosomies have a significantly decreased chance to reach the blastocyst stage.

Innovative Organic MEH-PPV Heterojunction Device Made by USP and PVD.

An Al/p-Si/poly[2-methoxy-5-(2-ethylhexoxy)-p-phenylenevinylene] (MEH-PPV)/Ag organic heterojunction has been prepared using homemade ultrasonic spray pyrolysis (USP) equipment for deposition of the organic thin film and physical vapor deposition (PVD) for the metallic contacts. The organic layer produced on glass was analyzed by optical and morphological methods. The bandgap of the organic thin film was found to be ~ 2.03 eV with a thickness of around 140 nm, using ultraviolet-visible (UV-Vis) and scanning electron microscopy (SEM) characterization, respectively. The amorphous nature of the MEH-PPV polymer was confirmed by its x-ray diffraction pattern. To determine the electrical parameters, the heterojunction based on MEH-PPV was characterized by current-voltage (I-V) and capacitance-voltage (C-V) measurements in the dark at room temperature. The ideality factor and barrier height of the organic heterojunction were found to be 3.6 eV and 0.56 eV to 0.59 eV, respectively, with an average series resistance of 94.39 Ω, based on the I-V characteristics. The barrier height was also calculated based on the capacitance-voltage measurements, yielding slightly different results due to the applied frequencies of 10 kHz ( ϕ B = 0.50 ) and 1 MHz ( ϕ B = 0.74 ) , respectively.

The alpha-2 receptor agonist dexmedetomidine attenuates vancomycin­induced acute kidney injury.

OBJECTIVE: This study was conducted to evaluate the protective effect of dexmedetomidine on nephrotoxicity and the mechanism of renoprotection following vancomycin-induced nephrotoxicity in rats. METHODS: Thirty-two albino Wistar rats were divided into four groups. The control group received intraperitoneal (IP) physiological saline solution, the vancomycin (VMC) group received IP 200 mg/kg vancomycin, the dexmedetomidine (DEX) group received IP 5 µg/kg dexmedetomidine, and the vancomycin and dexmedetomidine (VMC+DEX) group received IP 200 mg/kg vancomycin followed by IP 5 µg/kg dexmedetomidine 20 min after the vancomycin injection. On the 8th day of the experiment, histopathological and biochemical parameters were assessed. RESULTS: Creatinine levels were significantly higher in VMC and VMC+DEX groups. The endothelin-1 level was significantly higher in VMC group. Nitric oxide levels were statistically lower in VMC and VMC+DEX groups. Histopathologic assessments revealed that the extent of renal damage was significantly higher in group VMC (n = 4 with damage of Grade 3) compared to group VMC+DEX (n = 0 with damage of Grade 3). CONCLUSION: It was determined that dexmedetomidine can reduce the extent of renal damage by preventing the elevation of vasoconstrictor agents (Tab. 2, Fig. 1, Ref. 36).

The clinicians´ dilemma with mosaicism-an insight from inner cell mass biopsies.

STUDY QUESTION: How reliable are cleavage stage and trophectoderm (TE) biopsies compared to inner cell mass (ICM) biopsies? SUMMARY ANSWER: The reliability of TE biopsy compared to ICM biopsy is almost perfect, but only substantial between cleavage stage biopsy and ICM biopsy. WHAT IS KNOWN ALREADY: One of the prevailing reasons for implantation failure is presumed to be chromosomal aneuploidy in human preimplantation embryos. Preimplantation genetic testing for aneuploidies (PGT-A) has been introduced into assisted reproduction in an effort to increase pregnancy rates. Increasing evidence indicates that genetic results obtained following blastomere or TEbiopsy may not accurately reflect the true genetic status of the embryo due to the presence of embryonic mosaicism, and therefore the reliability of PGT is highly controversial. STUDY DESIGN, SIZE, DURATION: This was an observational descriptive study, performed in a private infertility centre from August 2016 to January 2017. PARTICIPANTS/MATERIALS, SETTING, METHODS: The mean female age was 33.9 years, ranging from 24 to 46 years, and the mean number of biopsied embryos per couple was 2.2 (range 1-7 embryos). Blastomere biopsies had been performed at cleavage stage on Day 3 (D3) due to the turnover time of genetic testing and the inability to cryopreserve embryos in accordance with the local law governing ART. To confirm the genetic results in embryos not chosen for transfer, additional biopsies of the TE at blastocyst stage (BLASTO-TE) as well as of the ICM (BLASTO-ICM) were performed on D5. Only surplus blastocysts, which had not been selected for transfer and were not cryopreserved in accordance with the law governing ART, had been included. MAIN RESULTS AND THE ROLE OF CHANCE: Comparison of all biopsies (D3/BLASTO-ICM/BLASTO-TE) per embryo demonstrated that 50 (59.5%) out of 84 embryos showed concordance in all three results (= full concordance). Thirty-four (40.4%) embryos had at least two discordant results between the three biopsies, regardless of whether the embryo diagnosis (aneuploid/euploid) was discordant or not, or in aneuploid embryos, whether the chromosomal patterns were inconsistent. Nine (= 10.7%) embryos had complete discordance between all three biopsies. False positive results between D3/BLASTO-TE, D3/BLASTO-ICM and BLASTO-TE/BLASTO-ICM were 26.4%/30.2% and 7.5%, respectively, while the Kappa agreement between the different approaches was 0.647, 0.553 and 0.857, respectively. Therefore the reliability of D3/BLASTO-TE, D3/BLASTO-ICM and BLASTO-TE/BLASTO-ICM can be interpreted as substantial, as moderate and as almost perfect. LIMITATIONS, REASONS FOR CAUTION: The limitation of this study is the possible bias in the concordance/discordance rate because embryos that had been selected for transfer did not undergo biopsy on D5. WIDER IMPLICATIONS OF THE FINDINGS: The obvious discordance between the three different approaches for PGT-A underlines the limitations of genetic testing and highlights the importance of ongoing research in order to improve the accuracy of PGT-A results. Until then reproductive specialists will continue to make challenging decisions on whether to transfer or discard an embryo in light of current evidence questioning the reliability of genetic results. STUDY FUNDING/COMPETING INTEREST(S): This study was supported by Igenomix. The funder provided support in the form of salary for R.C. The co-author R.C. is an employee of Igenomix. She participated in the blinded analysis of the samples; however the final data collection and statistical analysis of the results, as well as the decision to publish, was taken by B.L, I.E. and H.F. The authors B.L., I.E., A.L., A.B., A.A., N.D. and H.F. have no competing interests. The funder did not have any additional role in the study design, data collection and analysis, decision to publish or preparation of the manuscript. The commercial affiliation of R.C. did not play any role in the study. TRIAL REGISTRATION NUMBER: This study was approved by the Ethics Committee of IVIRMA Middle East Fertility Clinic, Abu Dhabi, UAE (Research Ethics Committee IVI-MEREFA009a/2017).

Surgeons' preferences and anxiety levels in paediatric adenotonsillectomy: European perspective.

OBJECTIVE: This study assessed the preferences of surgeons regarding surgical modalities used for adenotonsillectomy, and determined anxiety levels related to the adenotonsillectomy procedure. METHODS: A 10-question survey created by the authors was administered to 413 ENT specialists attending the 4th Congress of Otorhinolaryngology Head and Neck Surgery, held in October 2017 in Barcelona, Spain. RESULTS: Cold knife dissection was the preferred surgical modality for both adenoidectomy and tonsillectomy. Most participants reported encountering one to five patients with post-tonsillectomy bleeding throughout their entire career. The mean anxiety levels during surgery and the 10-day post-operative period were 3.39 ± 2.14 and 4.18 ± 2.63, respectively (p < 0.05). There was a significant negative correlation between anxiety level and surgeon's experience (p < 0.05). CONCLUSION: Cold dissection is still the preferred surgical modality for adenotonsillectomy, while both suture ligation and electrocautery are used for haemostasis. Paediatric adenotonsillectomy is likely to generate anxiety in ENT surgeons, and the possibility of secondary post-tonsillectomy bleeding increases the anxiety levels of surgeons in the post-operative period.

Comparison of myotoxic effects of levobupivacaine, bupivacaine and ropivacaine: apoptotic activity and acute effect on pro-inflammatory cytokines.

We investigated the myotoxic effects of bupivacaine, ropivacaine and levobupivacaine on rat skeletal muscle and compared its apoptotic activity and acute effects on pro-nflammatory cytokines. We divided 40 Wistar albino rats into four equal groups. Rats were injected intramuscularly with 0.5% bupivacaine (group B), 0.5% ropivacaine (group R), 0.5% levobupivacaine (group L) or 0.9% normal saline (group SF). Animals were sacrificed on the second day after the injection. TNF-α, IL-1 and IL-6 levels were examined in muscle tissue using immunohistochemistry and immunofluorescence. Apoptotic cells were visualized by terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assay. We found that levobupivacaine caused the lowest TNF-α, IL-1 and IL-6 expression levels, while the bupivacaine group caused the highest level compared to the other two agents. The greatest number of apoptotic cells was found in the bupivacaine group. Bupivacaine was more myotoxic than other anesthetic agents and increased apoptosis. The number of TUNEL positive apoptotic cells was lowest in the SF group. The greatest IL-1 immunoreactivity was found in the bupivacaine group. Bupivacaine and ropivacaine produced greater IL-6 expression than the SF group. Bupivacaine and ropivacaine caused greater TNF-α expression than the SF group, whereas the immunoreactivity of TNF-α was similar in the bupivacaine and ropivacaine groups.

Plasma levels of endothelial cell-specific molecule-1 and pentraxin-3 in idiopathic sudden sensorineural hearing loss.

OBJECTIVES: To evaluate the plasma levels of endothelial cell-specific molecule-1 (ESM-1) and pentraxin-3 (PTX-3) in patients with idiopathic sudden sensorineural hearing loss, and to compare the pre- and post-treatment levels in patients responsive and non-responsive to therapy. METHODS: The study included 108 subjects: 51 with idiopathic sudden sensorineural hearing loss and 57 controls. For ESM-1 and PTX-3 analyses, blood samples were collected before and three months after treatment initiation in the idiopathic sudden sensorineural hearing loss group and once for the control group. Treatment response was evaluated three months after therapy initiation with pure tone audiometry, and the patients were divided into two groups: responsive and non-responsive to treatment. RESULTS: Serum ESM-1 levels were significantly higher in the idiopathic sudden sensorineural hearing loss group than the control group, whereas the difference was not significant for PTX-3. In the responsive and non-responsive groups, ESM-1 and PTX-3 levels were not statistically different before and after treatment. CONCLUSION: To our knowledge, this is the first study investigating plasma ESM-1 and PTX-3 levels in idiopathic sudden sensorineural hearing loss. Increased plasma ESM-1 levels may confirm endothelial dysfunction involvement in idiopathic sudden sensorineural hearing loss pathogenesis, which could be associated with vascular impairment.

What Drives Embryo Development? Chromosomal Normality or Mitochondria?

OBJECTIVE: To report the arrest of euploid embryos with high mtDNA content. DESIGN: A report of 2 cases. SETTING: Private fertility clinic. PATIENTS: 2 patients, 45 and 40 years old undergoing IVF treatment. INTERVENTIONS: Mature oocytes were collected and vitrified from two ovarian stimulations. Postthaw, survived mature oocytes underwent fertilization by intracytoplasmic sperm injection (ICSI). Preimplantation genetic screening (PGS) and mitochondrial DNA (mtDNA) copy number were done using next generation sequencing (NGS). The only normal embryo among the all-biopsied embryos had the highest "Mitoscore" value and was the only arrested embryo in both cases. Therefore, the embryo transfer was cancelled. MAIN OUTCOME MEASURES: Postthaw survival and fertilization rate, embryo euploidy, mtDNA copy number, and embryo development. RESULTS: In both patients, after PGS only 1 embryo was euploid. Both embryos had the highest mtDNA copy number from all tested embryos and both embryos were arrested on further development. CONCLUSIONS: These cases clearly demonstrate the lack of correlation between mtDNA value (Mitoscore) and chromosomal status of embryo.