Comprehensive Outcome Research Articles

Comprehensive Management and Clinical Outcomes in Subarachnoid Hemorrhage: A Case Report

Comprehensive Management and Clinical Outcomes in Subarachnoid Hemorrhage: A Case Report

Specification and Verification for Unrestricted Algebraic Effects and Handling

Programming with user-defined effects and effect handlers has many practical use cases involving imperative effects. Additionally, it is natural and powerful to use multi-shot effect handlers for non-deterministic or probabilistic programs that allow backtracking to compute a comprehensive outcome. Existing works for verifying effect handlers are restricted in one of three ways: i) permitting multi-shot continuations under pure setting; ii) allowing heap manipulation for only one-shot continuations; or iii) allowing multi-shot continuations with heap-manipulation but under a restricted frame rule. This work proposes a novel calculus called Effectful Specification Logic (ESL) to support unrestricted effect handlers, where zero-/one-/multi-shot continuations can co-exist with imperative effects and higher-order constructs. ESL captures behaviors in stages, and provides precise models to support invoked effects, handlers and continuations. To show its feasibility, we prototype an automated verification system for this novel specification logic, prove its soundness, report on useful case studies, and present experimental results. With this proposal, we have provided an extended specification logic that is capable of modeling arbitrary imperative higher-order programs with algebraic effects and continuation-enabled handlers.

The paradox of progress: Unraveling the complex impact of e-government and business ease on economic growth in the Arab world

This research examines how the ease of doing business (EDB) and electronic government (EGOV) collectively influence economic growth in Arab countries. By applying a fixed effects model to panel data from 2004 to 2022, the study encompasses multiple Arab nations to ensure comprehensive and reliable outcomes. The analysis reveals that the combined effect of EDB and EGOV (EGOVEDB) negatively impacts economic growth, where a one percentage point increase in EGOVEDB corresponds to a 3.52 percentage point decrease in GDP. Additionally, the human development index (HDI) shows a minor negative correlation with economic growth, while foreign direct investment (FDI) shows a slight positive relationship with GDP, indicating a limited effect. These findings suggest that instead of solely focusing on implementing e-government initiatives, we should place greater emphasis on attracting investments, enhancing e-government processes (including infrastructure and regulatory frameworks), and improving HDI to promote economic growth in the Arab world.

Effect of expressway exit deceleration markings on distracted drivers in China

Expressway exit areas experience traffic diversion and complex road conditions, making them accident-prone areas. In this study, transverse and fishbone visual illusion deceleration markings were selected to optimize the induction facilities at expressway exits. The research aims to investigate the impact of these markings on the driving behavior, cognitive load, and physiological characteristics of drivers in various distracted scenarios at expressway exit areas. Furthermore, a comprehensive evaluation of each experimental scheme is conducted using the Matter-Element Extension Model. The study found that the implementation of deceleration markings can effectively enhance driver alertness and lane change awareness, enabling drivers to reduce their speed to near the speed limit in exit areas without compromising driving comfort. Compared to the situation without markings, drivers begin to decelerate approximately 600 m earlier and exit the ramp when markings are present. Fishbone deceleration markings, in contrast to transverse markings, result in lower vehicle speeds, smoother deceleration, and more effectively stimulate drivers' intention to change lanes, guiding them to make the final lane change earlier. Based on the comprehensive evaluation results, it is recommended that transverse or fishbone deceleration markings be considered in engineering practice. These markings have not produced significant effects on driver visual fatigue and driving load, with fishbone markings demonstrating superior comprehensive evaluation outcomes. These research findings can provide valuable insights for future expressway exit area marking design schemes, further enhancing driver safety.

Postoperative Complications of Radical Cystectomy and Urinary Diversion using Clavein-Dindo Classification in Tertiary Care Hospital

Background: The gold standard treatment for muscle-invasive transitional cell carcinoma of the bladder is radical cystectomy (RC) with urine diversion. The mortality and morbidity rates ranged from 0 to 9.0% and 30 to 70%, respectively in various reports. Among various classifications of complications, the Clavien–Dindo classification (CDC) is applicable to most procedures for comprehensive surgical outcome assessment. The study will be helpful to identify the potential early postoperative complications and possibly minimize the morbidity and mortality of this surgery in the future. Materials and Methods: Prospective study of 60 patients with Bladder Cancer fulfilling the inclusion criteria who underwent radical cystectomy with urinary diversion was collected from January 2023 to June 2024 at B.P. Koirala Memorial Cancer Hospital. The various demographic data and perioperative parameters were recorded. The early complications defined as the complications during hospitalization or within 30 days of surgery were enlisted and then classified according to Clavein-Dindo Classification. Data were analyzed using SPSS 25 software. Results: Many patients, 56 (93.33%) patients had some form of postoperative complications of radical cystectomy with urinary diversion. Of these, GI complications were (41.7%), infections related (21.7%), Wound related (11.7%) and others. 23 (38.33%) patients had high grade (≥ Grade III) complications. The mortality rate was 6.7%. Conclusion: Radical cystectomy is complicated surgery involving at least 2 systems in the body ie genitourinary and Gastrointestinal systems. So it is associated with higher rate of morbidity.

Faktor Penentu Pembayaran Zakat Masyarakat Islam di Negeri Terengganu

The statistics of zakat collection by the Terengganu Islamic Religious and Malay Customs Council (MAIDAM) which is increasing from year to year is a very good development for MAIDAM and the Muslim community of Terengganu. Researchers are interested in identifying the factors that influence the compliance of zakat payment by the Muslim community in Terengganu. Thus, this study aims to (i) identify the relationship between the factors of knowledge, exposure, self-efficacy, attitude, and awareness towards zakat payment and (ii) propose a model related to the relationship between knowledge, exposure, self-efficacy, attitude and understanding towards zakat payment. Using quantitative methods, a set of questionnaires developed based on previous studies were distributed to 384 people in the Terengganu Muslim community using multi-layer area sampling techniques and random sampling. The collected data was analyzed using SPSS Version 22 and Smart-PLS Version 3.2.7 software. The findings found that the factors of knowledge, exposure, self-efficacy, and attitude showed a significant relationship to the payment of zakat, while the factor of understanding did not influence respondents in paying zakat. This finding can help related parties in formulating strategies to increase the amount of zakat collection from the Muslim community in the future. However, the findings of this study are only limited to five determining factors. Hence, future research should expand its scope to encompass additional determining factors for more comprehensive outcomes. Keywords: ; ; ; ;

Beyond the Initial Insult: Clinical Characteristics and Prognosis of Heart Failure with Improved Ejection Fraction

Introduction: Heart failure with improved ejection fraction (HFimpEF) is a recently defined subtype of HF, characterized by an increase in ejection fraction (EF) after a prior diagnosis of reduced EF. There are limited data on the characteristics and outcome of this patient subset. The study aimed to investigate the clinical profile and prognosis of this patient group. Methods: HFimpEF patients from a large echocardiography database with comprehensive clinical and outcome data were evaluated for clinical characteristics and outcomes including mortality and cardiovascular hospitalizations. HFimpEF was defined as prior HF diagnosis with EF ≤40% followed by an EF increase of ≥10% to >40%. Results: The study included 2,883 patients with an EF ≤40%. 27% (777) fulfilled criteria of HFimpEF. Non-ischemic cardiomyopathy, female sex, and smaller left ventricular dimensions were associated with EF improvement. Median follow-up duration was 1,346 days. Patients with HFimpEF had a significantly improved prognosis compared to those without EF improvement. Patients with a significant improvement in the EF (≥50%) experienced a 30% lower mortality rate (HR: 0.70, 95% CI: 0.57–0.86, p < 0.001) and a decreased risk of cardiovascular hospitalizations. Conclusions: HFimpEF is a distinct clinical entity observed in 27% of patients with initially reduced EF and conveys a better prognosis. However, even with improvement, EF in most patients does not fully recover, and clinical events can still occur.

The sensitivity outcome index system for home care of elderly liver transplant patients was developed based on the Omaha problem classification system

ObjectiveBased on the Omaha problem classification system, a sensitivity outcome index system for home nursing of elderly liver transplant patients was established.MethodsThrough a comprehensive literature review and rigorous application of the Delphi method, a panel of 20 experts completed two rounds of effective letter consultation to obtain expert consensus opinions. The contents of indicators were determined based on this process, and the analytic hierarchy process was employed to confirm the weightage assigned to each indicator. Consequently, we established a sensitivity outcome index system for home care in elderly liver transplant patients.ResultsThe effective recovery rate of the questionnaire in two rounds of expert consultation was 100%, and the proportion of experts who gave opinions was 55% and 15%, respectively, indicating that the experts were highly active. The expert authority coefficients were calculated as 0.904 and 0.905, respectively, indicating a high degree of expert authority. In the second round, Kendall’s coordination coefficients for primary, secondary, and tertiary indicators were determined to be 0.419, 0.418, and 0.394 (P < 0.001), indicating that expert opinions tended to be consistent. Finally, we established a comprehensive sensitivity outcome index system comprising 4 first-level indexes, 20 s-level indexes, and 72 third-level indexes specifically designed for elderly liver transplantation patients.ConclusionThe sensitivity outcome index system of home nursing for elderly liver transplant patients can provide theoretical basis for nursing staff to build accurate individualized continuous nursing model.

Win ratio analysis of short-term clinical outcomes of focal therapy and robot-assisted radical prostatectomy for the patients with localized prostate cancer

We compared the comprehensive clinical outcomes of focal therapy (FT) and robot-assisted radical prostatectomy (RARP) in patients with localized prostate cancer (PC) using a win ratio analysis. After propensity score matching, a win ratio analysis, in which the composite endpoints of failure-free survival (FFS) and the urinary domain of the Expanded Prostate Cancer Index Composite (EPIC) were analyzed, was used for the comparison of the clinical outcomes of FT and RARP for the patients with localized PC. Seventy-two patients were included in each group after propensity score matching. FFS was not significantly different between the groups (p = 0.5044) after 36 months of follow-up. In contrast, the score of the urinary domain of the EPIC in the FT group was significantly better than that in the RARP group (p < 0.0001). The win ratio of FT per RARP was 3.39 (p < 0.0001; 95% confidence interval 2.21–5.20), suggesting a higher comprehensive outcome in the FT group than in the RARP group during short-term follow-up in single institution. Although further randomized trial with long-term follow-up would be needed for the evaluation, the win ratio would be useful to analyze the efficacy of FT according to patient preferences comprehensively.

Enhancing multilingual information retrieval: The efficacy of hybrid approaches

Multilingual Information Retrieval (MLIR) plays a crucial role in accessing information across different languages. This paper explores various techniques and tools used in Cross-Language Information Retrieval (CLIR), focusing on query translation, document translation, and hybrid approaches. Query translation employs bilingual dictionaries and machine translation systems to convert user queries from one language to another, whereas document translation involves translating documents into the query language for indexing and retrieval. Hybrid approaches combine these methods to optimize retrieval performance, leveraging the strengths of both to address their individual limitations. Our comparative analysis shows that hybrid systems consistently outperform standalone query or document translation systems, achieving higher precision, recall, and user satisfaction. For instance, hybrid systems in multilingual legal document retrieval tasks achieved precision rates of 88%, recall rates of 82%, and an F1 score of 0.85. These results underscore the effectiveness of hybrid approaches in handling the complexities of MLIR, providing more accurate and comprehensive retrieval outcomes. This study highlights the practical benefits of hybrid CLIR systems and suggests directions for future research in enhancing multilingual access to information.

Exploring the use of generative artificial intelligence in systematic searching: A comparative case study of a human librarian, ChatGPT-4 and ChatGPT-4 Turbo

The advancement of ChatGPT-powered artificial intelligence (AI) opens up new possibilities for conducting systematic reviews. This study aims to examine how ChatGPT-powered AI can assist in the steps involved in systematic reviews, and its potential and challenges. The authors utilize a comparative case study approach to examine the search-term-generation and article-retrieval capabilities among a human librarian, ChatGPT-4, and a ChatGPT-4 Turbo customized AI-Librarian Bot. The findings suggest that AI could expand the scope of search terms and queries, automating the more repetitive and formulaic aspects of the systematic-review process, while human expertise remains crucial in refining search terms and ensuring methodological rigor. Meanwhile, challenges remain for AI tools’ capacity to access subscription-based or proprietary databases and generate sophisticated search strategies. This study advocates for a synergistic model where AI augments the systematic-review process, complementing the depth and nuance provided by human expertise in achieving accurate and comprehensive research outcomes.

Building a Science of Teaching Reading and Vocabulary: Experimental Effects of Structured Supplements for a Read Aloud Lesson on Third Graders’ Domain-Specific Reading Comprehension

ABSTRACT Purpose This study contributes to the science of teaching reading and vocabulary by illustrating how a ubiquitous classroom practice – read alouds – can be enhanced by structured supplements. This experimental study examines whether and to what extent providing structured supplements can improve student comprehension outcomes by helping teachers foster discussions about academic vocabulary that support schema transfer as students make connections between known and new topics. Method A total of 80 third-grade teachers and their students (N = 965; 32% Black, 31% Hispanic, 25% white, 9 Asian, 48% Male) were randomly assigned to treatment or control conditions. Treatment students received a single social studies read aloud on the story of Apollo 11 with structured supplements while control students received the same read aloud story but without structured supplements. Students were from linguistically, economically, and ethnically diverse backgrounds. Results Effect sizes from hierarchical linear models indicated that students in the treatment condition outperformed students in the control condition on four measures of domain-specific reading comprehension: recall (ES = .17), near-transfer (ES = .17), mid-transfer (ES = .18), and content comprehension (ES = .18). Further exploratory analyses using structural equation modeling revealed that teacher language scaffolds – that is, temporary dialogic supports in which teachers went above and beyond the intervention script – explained 66% of the treatment effect on domain-specific reading comprehension. Conclusion Results from this study suggest that read alouds, when enhanced with structured supplements designed to facilitate schema transfer, can increase the amount of academic vocabulary teachers use during classroom instruction and improve their students’ ability to comprehend disciplinary texts.

Effects of a Teacher-Led Intervention Fostering Self-Regulated Learning and Reading among 5th and 6th Graders—Treatment Integrity Matters

Self-regulated learning (SRL) is a crucial competence in our rapidly changing society, yet its systematic promotion in the classroom remains limited. Addressing this gap, this study reports on a teacher-led intervention to promote SRL within reading tasks among 5th and 6th grade students. Although some interventions have been implemented to promote SRL, little attention has been paid to promoting SRL in primary schools. Building on a previous SRL intervention, the current study added cooperative learning among students and parental involvement, two aspects that are assumed to add value when fostering SRL. A randomized controlled field trial was designed to evaluate the effect of an intervention using pre-test, post-test and follow-up measures. A total of 757 students from 40 classes participated in the study. The data were analyzed using a multilevel approach. This study revealed no significant difference in SRL or reading comprehension outcomes in the post-test and the follow-up test between students of the experimental and control group. Further investigations showed that several aspects of treatment integrity had a significant impact on SRL outcome. This study encourages future SRL and reading intervention studies to assess and analyze the multiple aspects of treatment integrity.

Multinational Drug Survival Study of Omalizumab in Patients With Chronic Urticaria and Potential Predictors for Discontinuation

Treating patients with chronic urticaria using omalizumab has been shown to be safe and effective in randomized clinical trials. Multinational studies on long-term omalizumab performance in chronic urticaria in clinical practice settings are lacking, especially on drug survival. Drug survival, which refers to the length of time that patients are treated with a specific drug, is a comprehensive outcome covering effectiveness, safety, and patient and physician preferences. Furthermore, little is known about the reasons and potential predictors for omalizumab discontinuation. To investigate omalizumab drug survival as well as reasons and potential predictors for discontinuation in a large, diverse population. This international multicenter cohort study was conducted at 14 Urticaria Centers of Reference and Excellence in 10 countries, including all patients with chronic urticaria from these centers who were ever treated with omalizumab. Drug survival analysis was performed to assess time to discontinuation. Patient characteristics and treatment protocols were investigated by Cox regression analysis to identify potential predictors for omalizumab discontinuation. In 2325 patients with chronic urticaria who started omalizumab between June 2009 and July 2022, the mean (SD) age of the cohort was 42 (6) years, and 1650 participants (71%) were female. Overall omalizumab survival rates decreased from 76% to 39% after 1 to 7 years, respectively (median survival time, 3.3 [95 % CI, 2.9-4.0] years), primarily due to discontinuation from well-controlled disease in 576 patients (65%). Ineffectiveness and adverse effects were reasons for discontinuation in a far smaller proportion of patients, totaling 164 patients (18%) and 31 patients (4%), respectively. Fast treatment response was associated with higher rates of omalizumab discontinuation due to well-controlled disease (hazard ratio, 1.45 [95% CI, 1.20-1.75]), and disease duration of more than 2 years was associated with lower rates of discontinuation due to well-controlled disease (HR, 0.81 [95% CI, 0.67-0.98]). Immunosuppressive cotreatment at the start of omalizumab and autoimmune disease was associated with a higher risk for discontinuation due to ineffectiveness (HR, 1.65 [95% CI, 1.12-2.42]). The presence of spontaneous wheals (HR, 0.62 [95% CI, 0.41-0.93]) and access to higher dosages (HR, 0.40 [95% CI, 0.27-0.58) were both associated with a lower risk for discontinuation of omalizumab due to ineffectiveness. This multinational omalizumab drug survival cohort study demonstrated that treatment of chronic urticaria with omalizumab in a clinical setting is effective and safe, and well-controlled disease is the main reason for treatment discontinuation. These findings on omalizumab drug survival rates and reasons and potential predictors for discontinuation may guide patients and physicians in clinical decision-making and expectation management. These results may call for the identification of biomarkers for chronic urticaria remission in complete responders to omalizumab treatment.

Insights and Innovations: A Review of the GRAPPA 2023 Trainee Symposium.

The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) 2023 annual meeting started with the trainee symposium. This symposium showcased the exceptional research activities of dermatology and rheumatology trainees in the field of psoriatic diseases (PsDs). The following report is a summary account of the 5 oral presentations and 21 poster presentations that earned the privilege of being featured at our annual meeting. These presentations span a comprehensive spectrum, encompassing basic/translational, clinical, and outcomes research, which collectively underscore GRAPPA's profound impact on both national and international fronts in the realm of PsDs.

Mitral Annulus Disjunction: A Comprehensive Cardiovascular Magnetic Resonance Phenotype and Clinical Outcomes Study.

Clinical importance of mitral annulus disjunction (MAD) is not well established. Characterize a population of MAD all-comers diagnosed by cardiac magnetic resonance imaging (MRI). Retrospective. MAD confirmed in 222 patients, age of 49.2 ± 19.3 years, 126 (56.8%) males. 1.5 T and 3 T/steady-state free precession and inversion recovery. Clinical history, outcomes, imaging, and arrhythmia data. MAD defined as a separation ≥2 mm between left ventricular myocardium and mitral annulus. Presence and pattern of late gadolinium enhancement (LGE) were analyzed. LGE in the papillary muscles and adjacent to MAD were identified as MAD related. Ventricular arrhythmias (VA) were grouped into non-sustained ventricular arrhythmias (NSVA) or sustained. Cardiovascular death assessed. Differences between baseline characteristics were compared. Univariate regression was used to investigate possible associations between ventricular arrhythmia and cardiovascular death with characteristics associated with the severity of MAD. A multivariable logistic regression included significant variables from the univariate analysis and was performed for MAD-related and global LGE. MAD extent 5.0 ± 2.6 mm. MV annulus expanded during systole for MAD ≥6 mm. Systolic expansion associated with prolapse, billowing, and curling. LGE present in 82 patients (36.9%). Twenty-three patients (10.4%) showed MAD-related LGE by three different observers. No association of LGE with MAD extent (P = 0.545) noted. Follow-up 4.1 ± 2.4 years. No sustained VA observed. In univariable analysis, NSVA was more prevalent in patients with MAD ≥6 mm (33.3% vs. 9.9%), but this was attenuated on multivariate analysis (P = 0.054). The presence of NSVA was associated with global LGE but not MAD-related LGE in isolation (P = 0.750). Three patients died of cardiovascular causes (1.4%) and none had MAD-related LGE. None died of sudden cardiac arrest. In patients referred for cardiac MRI, mitral valve dysfunction was associated with MAD severity. Scar was not related to the extent of MAD, but associated with NSVA. The risk of sustained arrhythmias and cardiovascular death was low in this population. 4 TECHNICAL EFFICACY: Stage 2.

P-634 Medroxyprogesterone acetate as an alternative to gonadotropin-realeasing hormone antagonist in vitrified oocyte donation cycles: embryo assessment and clinical outcome

Abstract Study question Could Medroxyprogesterone Acetate (MPA) be a good alternative to gonadotropin-realeasing hormone (GnRH) antagonist in vitrified oocyte donation cycles? Summary answer MPA is a good alternative to GnRH antagonist in vitrified oocyte donation cycles, ensuring comparable embryo quality and clinical outcome. What is known already Progestin-primed ovarian stimulation (PPOS), such as oral administration MPA in the follicular phase appears to be an effective alternative to conventional protocols, as it prevents premature LH surge and ovarian hyperstimulation syndrome. The drawback of these treatments is that it requires vitrification of oocytes or embryos because the endometrium is out of phase when embryo transfer is performed. Our previous studies have shown similar oocyte retrieval rates in fertility preservation cycles and comparable clinical outcomes in fresh donation cycles. Our objective is to expand evidence on PPOS, extending its success to new populations like vitrified donation cycles. Study design, size, duration This retrospective cohort study performed at IVI Valencia compared the effect of the MPA (10 mg/day) versus ganirelix (0.25 mg/day) on egg donors undergoing ovarian stimulation whose eggs were vitrified after retrieval. Donor cycles were divided intro groups, with 495 cycles in the MPA group and 307 in the ganirelix group. After oocyte donations and warming, the artificial intelligence based embryo assessment and clinical outcome were compared and analyzed for the two study populations Participants/materials, setting, methods 497 recipients using oocytes from the MPA group and 307 from the ganirelix group were included in the study. Post-oocyte donation and warming, a follow-up of 10,108 oocytes was performed, analyzing survival, fertilization, and blastocyst development. The embryo score obtained with the deep learning based model iDAScore v2, and the ASEBIR evaluation performed by embryologists were compared between both study populations. Finally, comprehensive clinical outcome comparisons were conducted between the two study populations. Main results and the role of chance The mean number of thawed oocytes was significantly different* between the two groups (12.80±3.54 in the MPA group vs. 12.20±3.58 in the antagonist group). Survival, fertilization, and blastocyst development rates showed no significant differences (89.83%, 76.38% and 66.22% respectively in the MPA group and 88.67%, 76.75% and 64.29% in the antagonist group). However, ASEBIR embryo assessment showed a significantly higher percentage of embryos classified as A and B in MPA group* (10.5% and 58.0% respectively vs. 7.2% and 53.6%), and more C embryos* in the antagonist group (34.3% vs. 39.2%). Artificial intelligence-based embryo assessment revealed no significant differences between the two groups*, with mean evaluations being 4.97±2.60 in the MPA group and 5.07±2.68 in the antagonist group. Regarding clinical outcomes, the MPA group had significantly higher number of frozen embryos per cycle* (4.08±2.07 in the MPA group vs. 3.65±2.00 in the antagonist group) but no disparities in implantation, clinical pregnancy, ongoing pregnancy, live birth and cumulative live birth rates. A generalized estimation equation highlighted that the study group (MPA or antagonist) did not significantly impact the live birth rate, but was significantly influenced instead by the number of thawed oocytes, recipient BMI, and transferred embryo quality assessed with iDAScore*. (*p&amp;lt;.05) Limitations, reasons for caution This project is limited by its retrospective and single-center nature. Despite being the largest sample size ever reported for PPOS in vitrified donation cycles, the number of patients included could be considered low. Consequently, it would be advisable to conduct a multicenter RCT to confirm the conclusions of this study. Wider implications of the findings The administration of MPA as a gonadotropin adjuvant demonstrates clinical outcomes comparable to those achieved with ganirelix in vitrified oocyte donation cycles. Its user-friendly application encourages the wider adoption of this protocols. These promising results promote the widespread use of MPA-based protocols in vitrified oocyte donation cycles. Trial registration number not applicable

P-023 Gene expression in human sperm as biomarkers and tools for the assessment of male infertility

Abstract Study question Can gene expression as AURKA, HDAC4, and CARHSP1 be used for the diagnosis of sperm quality exploring male infertility? Summary answer The comprehensive outcome of gene expression involving AURKA, HDAC4, and CARHSP1 serves as a key to classifying sperm and predicting their functionality. What is known already Diagnostic male infertility is largely based on semen parameters according to the World Health Organization (WHO) reference values. While these parameters assess sperm quality, they do not provide insights into sperm quality and have a limited predictive value on natural fecundity, fertilization rates, and assisted reproductive technology (ART) outcomes. Study design, size, duration This prospective study investigates the gene expression involved in mitosis, epigenetic regulation, and early embryo development. From February to June 2023, we included all men aged from 20 to 60 years having sperm parameters analysis in our unit center. A total of 277 semen samples were collected, 129 (46.4%) exhibiting three normal sperm parameters according to WHO criteria. Among these, 32 samples showed oligo-astheno-teratozoospermia (OAT), while 116 samples had 1 or 2 abnormal parameters. Participants/materials, setting, methods The mRNA expression levels of three candidate genes (AURKA, HDAC4, and CARHSP1) were quantified in fresh ejaculate semen using real-time quantitative reverse-transcription polymerase chain reaction (qRT-PCR). The thresholds for the spermatozoa function index (SFI) were established by assessing the combined expression of these target genes, considering the morphology and the capability to reach a blastocyst stage. The sperm were ranked according to the concentration (million/ml), motility (%) and morphology (%). Main results and the role of chance We assess the quality of spermatozoa for three biomarkers by analyzing their mRNA expression levels. Receiver operator characteristics curves (ROC) indicate a combined index value expression. This model establishes an index threshold &amp;gt; 320 for an “over-index value,” distinguishing spermatozoa with a normal capacity, an index threshold &amp;lt; 290 for an “under-index value,” and 290 &amp;lt; index &amp;lt; 320 for an “intermediate-index value”. Among the 277, we find 112 (40.4%) have an over-expression index; 161 (58.1%) have an under-expressed index and 4 (1.4%) have an intermediate-index. Interestingly, among the 129 samples with the three normal WHO parameters, we show that 82 (63.5%) have an over-index value, 44 (34.1%) have an under-index value, and 3 (2.3%) display an intermediate-index value. In addition, all the 32 OAT samples have an under-index. These findings suggest that the OAT sperm population implies a potential epigenetic network connected with our three target genes. Furthermore, even in cases with normal sperm parameters, there may be an under-expressed index, indicating lower functionality in terms of fertilization and early embryo development. Limitations, reasons for caution The present method was validated only on ejaculate semen in men free of any chronic disease and any anti-oxidant treatment. This prospective study requires further validation in the largest population. Wider implications of the findings This study’s results could highlight understanding a chaotic early embryo development in ART and used to explore male infertility; particularly in unexplained infertility. Trial registration number not applicable

O-195 Decreased embryo developmental potential and lower cumulative pregnancy rate in males with multiple morphological abnormalities of the sperm flagella

Abstract Study question Is there any association between the multiple morphological abnormalities of the sperm flagella (MMAF) patients and the comprehensive outcomes of assisted reproductive technology (ART) cycles? Summary answer Patients with MMAF presented compromised ART outcomes, including lower embryo developmental potential and impaired clinical outcomes, compared with the cohort of oligoasthenospermia. What is known already Several studies have reported a positive intracytoplasmic sperm injection (ICSI) outcome in the MMAF cohort, and others have opposite opinions. The association between MMAF and ART outcomes is still controversial and open for debate. Furthermore, the neonatal outcomes and the information regarding the mutations of MMAF patients were incomplete. Study design, size, duration A retrospective cohort study of MMAF patients was performed at a reproductive medicine center in China between January 2014 and July 2022. Participants/materials, setting, methods Thirty-eight MMAF individuals were recruited based on a typical MMAF phenotype (abnormal sperm flagella, including short, absent, coiled, bent, and/or irregular flagella) and 131 couples with male infertility undergoing in vitro fertilization (IVF)/ICSI treatments over the same period were included as the control pool. Whole exome sequencing (WES) was performed to confirm the genetic pathogenesis of MMAF. Main results and the role of chance Pathogenic variants in known genes of DNAH1, DNAH11, CFAP43, FSIP2, and SPEF2 were identified in MMAF patients. The ART outcomes, including the fertilization rate, 2PN cleavage rate, blastocyst formation rate, and available blastocyte rate, were all significantly lower in the MMAF group than those in the control group (P&amp;lt;0.05). Moreover, the CLPR in the MMAF group was lower than that in the control group according to the embryo transfer times (68.6% vs. 86.5%, P=0.033) and complete cycles (66.7% vs. 84.2%, P=0.020), while no significant differences were found in the neonatal outcomes. Limitations, reasons for caution The sample size was limited due to the low incidence of MMAF and WES was not performed in all MMAF patients. Further exploration of the potential genetic mutations or underlying mechanisms in patients without identified mutations was needed. Moreover, long-term follow-up of neonates needs to be addressed in the future. Wider implications of the findings The current study identified the causative genetic mutations which were partly obligated to the pathogenesis of MMAF and presented the relationship between MMAF and compromised ART outcomes. These results may provide evidence support for clinicians in genetic counseling and clinical instruction in specific MMAF patients. Trial registration number the National Key Research &amp; Development Program of China (2021YFC2700603)

Designing and Validating a Comprehensive Patient-Reported Outcomes Measure for Ambulatory Cancer Settings: The Revised Edmonton Symptom Assessment System for Cancer.

Patient-reported outcomes (PROs) information has been routinely collected in Cancer Care Alberta (CCA) for years using the revised Edmonton Symptom Assessment System (ESAS-r) and Canadian Problem Checklist (CPC). There was interest in combining these into a more comprehensive single measure tailored to ambulatory cancer settings. The purpose of this study was to validate an expanded and redesigned ESAS-r called the ESAS-r Cancer. Stakeholder engagement, a review of the literature, and 2 years of CPC data collected in the cancer program informed the addition of six symptoms to the ESAS-r. To assess and validate the measure, 1,600 randomly sampled patients were mailed paper copies of the ESAS-r Cancer, ESAS-r, and a validated, comprehensive PRO measure called the Memorial System Assessment Scale-Short Form (MSAS-SF), which is often used with patients with cancer. Canonical Correlation Analysis and exploratory factor analyses were performed to assess concurrent and construct validity of the ESAS-r Cancer against ESAS-r, using MSAS-SF as the reference measure for comparison. Cronbach α was calculated to assess reliability. Four hundred and sixty-one patients (29% response rate) completed all three questionnaires. ESAS-r Cancer showed higher numerical correlation than ESAS-r and accounted for more information included on MSAS-SF, explaining slightly more variance than ESAS-r (75.2% v 73.5%). The three-dimensional factor structure of ESAS-r Cancer outperformed the two-dimensional factor structure of ESAS-r. The reliability of ESAS-r Cancer was verified and found to be slightly higher than ESAS-r (Cronbach α = .903 v .884). ESAS-r Cancer is now in use with patients throughout CCA. This valid and reliable PRO measure can be used by other cancer or specialized health care programs who wish to routinely assess common symptoms.