Cumulative Outcome Research Articles

Association of cumulative methylprednisolone dosages with mortality risk from pneumonia in connective tissue disease patients

Corticosteroid is essential in the treatment regimen for connective tissue disease (CTD); however, its long-term use poses significant risks, including pulmonary infections. The relationship between cumulative corticosteroid doses and adverse pneumonia outcomes requires further investigation. This study aimed to explore the association between cumulative methylprednisolone dosages (CMD) and pneumonia mortality risks among CTD patients. We conducted a retrospective analysis of data from CTD patients treated with intravenous or oral corticosteroids across six academic hospitals over approximately five years in China. We evaluated follow-up outcomes at 30 and 90 days after the onset of pneumonia. Piecewise linear regression, Cox regression analysis, and survival analysis were employed to investigate the relationship between CMD and 30-day and 90-day mortality risks. Among 335 CTD patients with pneumonia, the mean CMD was 12 g. The 30-day and 90-day mortality rates were 25.07% and 29.55%, respectively. After adjusting for potential confounders, smooth curve fitting analysis revealed a specific nonlinear relationship between CMD and 30-day and 90-day mortality risks. Cox regression analysis indicated that the lowest pneumonia mortality risk occurred when CMD ranged from 11 to 24 g (30-day adjusted hazard ratio (aHR) 0.33, 95% CI 0.14–0.77; 90-day aHR 0.37, 95% CI 0.17–0.81). Patients in the 11–24 g CMD group demonstrated significantly lower cumulative hazard and death rates compared to both the low CMD (< 11 g) and high CMD (> 24 g) groups (P < 0.05). Furthermore, interaction testing suggested that CMD’s negative impact on pneumonia mortality risks was more pronounced in community-acquired pneumonia (CAP) compared to hospital-acquired pneumonia (P for interaction < 0.05). CMD shows a distinct nonlinear relationship with 30-day and 90-day pneumonia mortality risks, with potentially lower risks observed within the 11–24 g CMD range. Moreover, the varying impact of CMD on CAP mortality risk warrants further consideration in clinical management strategies.

Spatially varying associations between community-level predictors and COVID-19 outcomes in NYC

Abstract Background The cumulative impacts of COVID-19 on hospitalization and mortality were not uniformly distributed across New York City (NYC). To better understand potential drivers of this observed geospatial disparity, we explored the associations between community-level sociodemographic characteristics and cumulative COVID-19 hospitalizations and mortality using geographically weighted Poisson regression (GWPR). Methods Cumulative COVID-19 hospitalization and mortality rates in 177 NYC modified ZIP code tabulation areas as of Dec 2022 were taken from the NYC Department of Health and Mental Hygiene, and sociodemographic predictors were taken from the 2018 American Community Survey. GWPR was applied using both non-multiscale (single bandwidth) and multiscale (flexible bandwidth) models to assess which predictors were significant and which associations varied spatially (allowing them to potentially act as both risk and protective factors, depending on the location). Results Multiscale GWPR models outperformed non-multiscale models in rendering residual spatial autocorrelation insignificant. Although multiscale GWPR allowed flexible bandwidths for each predictor, most yielded global bandwidths, suggesting geographically consistent effects. For mortality, the percent of residents without health insurance acted solely as a risk factor. Similarly, for hospitalizations, the percent of residents with a disability acted solely as a risk factor. The percent of residents with a bachelors degree or higher acted solely as a protective factor against both outcomes. Conclusions Even when associations were allowed to vary spatially in GWPR models, we still found geographically consistent associations between many sociodemographic predictors and cumulative COVID-19 outcomes in NYC. Consistent risk factors, such as prevalence of disability, or protective factors, such as prevalence of higher education, highlight potential areas for city-wide policies to reduce the burden of future epidemics. Key messages • For cumulative COVID-19 outcomes across NYC communities, geographically consistent risk factors include disability prevalence for hospitalization and lack of health insurance for mortality. • Increasing prevalence of higher education acted as a geographically consistent protective factor against both hospitalization and mortality due to COVID-19.

Delirium and risk of incident cardiovascular events in elderly: data from a global health research network

Abstract Introduction Delirium is a common complication of acute medical disorders. A strong association between cardiovascular events and the occurrence of delirium has been recorded. Thus far, no data are available regarding the risk of incident cardiovascular events after delirium onset in older adults. Methods Using data from TriNetX, a global health federated research network, we performed a propensity score matched (PSM) analysis of older adults (age ≥65 years) admitted to the emergency department (ED) reporting delirium within two weeks, who were compared with those without delirium. We evaluated the occurrence of a composite outcome of cardiovascular events (myocardial infarction, ischemic stroke, heart failure, intracranial haemorrhage, ventricular arrhythmias, takotsubo syndrome, and atrial fibrillation) at 30 days and 1 and 3 years of follow-up. Results 4,480,229 patients were retrieved for the analysis, and 82,693 (1.8%) reported delirium. Before PSM, patients reporting delirium were older, with more prevalent comorbidities. After PSM, a total of 165,386 patients were included in the analysis (mean (SD) age 76.6 (9.0) years, 51.1% females). Throughout the entire follow-up period, the cumulative composite cardiovascular events outcome was significantly higher in patients which reported delirium [Red Line, Figure 1]. Delirium was associated with cardiovascular events at 30 days (HR 1.96, 95% CI 1.92-2.00) ,1 year (HR 1.75, 95% CI 1.72-1.78) and 3 years (HR 1.67, 95% CI 1.64-1.69) of follow-up, as well as for each of its components (Table 1). The presence of delirium was also associated with a higher risk of all-cause death and hospital access (Table 1), evaluated as secondary outcomes. In patients with delirium associated with the occurrence of incident cardiovascular events, there was a higher risk of recurrent cardiovascular events at 1 year (HR 3.11, 95% CI 2.92-3.31) and 3 years (HR 2.84, 95% CI 2.67-3.01) of follow-up. Conclusions In a large, unselected cohort of older adults admitted to ED, occurrence of delirium was associated with a higher risk of cardiovascular events, both in the short and long-term follow-up.Figure 1:Delirium and CV EventsTable 1:Cox Regression Analysis

Ultra-processed food consumption and risk of coronary heart diseases: UK Whitehall II cohort study

Abstract In recent decades, ultra-processed foods (UPFs) intake has increased drastically, sparking concerns about their potential impact on cardiometabolic diseases. However, large-scale cohort studies tracking UPF consumption at multiple time points remain limited. This study explores the prospective association between repeated measures of UPF intake and the risk of coronary heart disease (CHD), along with its secondary endpoints, within the UK Whitehall II study. The analytical sample tracked 7,138 midlife British participants without CHD from baseline. UPF consumption was measured using validated food frequency questionnaire (127 items) and classified by the NOVA system during three phases: 1991/1994 (phase 3), 1997/1999 (phase 5), and 2002/2003 (phase 7). This study assessed the onset of CHD and its secondary endpoints, including CHD and all-cause mortality, through medical exams and hospital records up to 2016 and 2021, respectively. Cox proportional hazards regression models adjusted for socio-demographics, lifestyle factors and total energy intake were used to explore the prospective association between cumulative average UPF intake (in quintiles) and CHD outcomes. During a median follow-up of 13 and 19 years, 589 cases and 1,314 deaths were documented. In multivariable adjusted cox models, the highest UPF consumption quintile versus the lowest quintile was associated with higher CHD incidence [HR:1.26; 95% Confidence Interval (CI): 1.02-1.55; p = 0.03]. Additional adjustment of total energy intake increased the CHD risk by 28% [HR:1.28; 95% CI: 1.03-1.58; p = 0.02]. No significant relationships were found between cumulative average UPF intake and CHD or all-cause mortality. In UK midlife adults, higher UPF intake is prospective associated with increased CHD risk. Although additional research is warranted, these findings emphasize the importance of public awareness and food policy interventions to reduce UPF intake for alleviating the population burden of CVD. Key messages • Our study suggests the need for increased efforts to implement population wide strategies on regulating food processing, such as taxation and front of package warning labelling of UPF. • Our study emphasizes UPF’s role in cardiovascular prevention, highlighting the need for nutrition counseling on UPF consumption for those at risk of CVD.

The Influence of Thermophysical Parameters on Thermal Runaway Characteristics for Pouch-Type Lithium-Ion Batteries

Abstract The thermal variation during the temperature rise process of batteries is closely related to multiple physical parameters. Establishing a direct relationship between these parameters and thermal runaway (TR) features under abusive conditions is challenging using theoretical equations due to complex electrochemical and thermal coupling. In this paper, a high-temperature thermal runaway model of pouch-type lithium-ion battery is established through electrical-thermal coupled approach, demonstrating a good agreement between the simulation and experimental results. The results reveal distinct trends in thermal parameters of the early temperature rise, trigger time for TR and peak temperature during TR process, for varying convective heat transfer coefficient, cell specific heat capacity, cell density and cell thermal conductivity. Across various convective heat transfer coefficients, the rates of temperature increase, moments of TR, and peak temperatures within a battery emerge as the cumulative outcomes of competing processes of the intricate exothermic secondary reactions within the battery, and the heat transfer with the surroundings. Batteries with lower heat capacity exhibit reduced thermal inertia and heightened sensitivity to temperature changes. Alterations in the thermal capacity of a battery wield a profoundly significant impact upon the moment of thermal runaway within the battery. Enhancing the thermal conductivity yields limited improvements in heat dissipation during thermal runaway primarily due to the relatively small geometrical scale of the battery. Results of this paper can provide valuable insights for size optimization design, thermal management system optimization design, thermal runaway safety warning and prevention of Lithium-ion batteries.

Emergence of mpox in the Eastern Mediterranean Region: Data assessment and implications for a public health response

IntroductionMonkeypox (mpox) is an illness caused by the MPX virus and endemic to certain African countries. Historically, sporadic outbreaks have occurred in some non-endemic areas. In 2022, a new variant emerged, clade IIb, causing a global outbreak sustained within sexual networks among men who have sex with men (MSM). To our knowledge, this is the first multi-country study examining mpox epidemiology and clinical features of the 2022–2023 outbreak caused by clade IIb across the Eastern Mediterranean Region (EMR). MethodsWe analyzed datasets of anonymous mpox case-based reports submitted to the World Health Organization (WHO) from May 2022 to December 2023 in the EMR to describe the cumulative incidence, demographics, transmission routes, and clinical outcomes. ResultsBy the end of 2022, 95 case reports were submitted to the WHO. The first case of mpox was reported in the United Arab Emirates on May 24, 2022. The highest number of cases were reported from Lebanon (27 confirmed cases). Most cases in the EMR were adult males (92 %), 60 % identifying as MSM, and 10 % living with HIV. Most reported symptoms were rash (95.4 %) and fever (69.6 %). No intensive care unit admissions or deaths were reported. ConclusionIn this study we investigated the epidemiology, clinical presentation, and outcomes of the mpox outbreak related to clade IIb in the EMR. We raise concerns about the accuracy and completeness of the data, given that the number of cases reported to the WHO from EMR countries appears to be significantly lower than the number of cases documented within the region. This discrepancy could impact the reliability of the reported figures and the region's response strategies. Despite these challenges, collaborative efforts across EMR countries have laid the groundwork for effective outbreak response, underscoring the importance of ongoing regional cooperation to enhance future preparedness strategies.

To What Extent Do Young Adults Meet the Five Needs for Independence? A Latent Class Analysis

Young adults determined five needs which must be met to transition to adulthood: support, housing, study and work, income, and well-being. This study aimed to identify and describe subgroups of young adults and determine to what extent they meet the needs for independence, and to assess relations between subgroups and demographic characteristics. We conducted secondary data analysis of a population-based questionnaire, which included 2291 young adults (M age = 20.8 years, 71% female) living in South Limburg, the Netherlands. We adopted a person-centred approach, that is, latent class analysis, and identified four classes: Thriving (39%), Lacking support and well-being (29%), Widely struggling (18%) and Financially challenged (14%). Females and non-university students/graduates had higher odds of being members of the least thriving classes. Future research should focus on how support and cumulative disadvantage affect later life outcomes. We should broaden community, educational and institutional support systems to encourage and sustain meaningful relationships.

EuMAR stakeholder engagement: an analysis of medically assisted reproduction (MAR) data collection practices in EU countries†.

What are the current national medically assisted reproduction (MAR) data collection systems across EU Member States, and how can these countries contribute to a unique, cycle-by-cycle registry for the European Monitoring of Medically Assisted Reproduction (EuMAR) project? The study identified significant variation in MAR data collection practices across Member States, with differences in data types, collection methods, and reporting requirements; the EuMAR project emerges as an opportunity to enhance data standardization and improve MAR data collection in the EU. There is a need for new approaches in MAR data collection that include long-term and cross border follow-up. The EuMAR project intends to establish a unified, cycle-by-cycle registry of data on MAR treatments in EU countries, from which accurate cumulative outcomes can be calculated. This cross-sectional study involved a survey and interviews with stakeholders from 26 EU Member States conducted in 2023 over a period of seven months. Representatives from national competent authorities and professional associations involved in MAR data collection in EU countries were invited to complete the survey and interviewed to assess current data flows, information requirements, and their interest in the EuMAR project. Half of the participating countries reported having a national MAR registry with cycle-by-cycle data (n = 13), while 31% reported having a national registry with aggregated data (n = 8) and 19% reported having no national registry (n = 5). Of the countries with a national cycle-by-cycle registry, eight countries collect identifiable data, five countries collect pseudonymized data, and one country collects fully anonymized data. Informed consent is required in 10 countries. The main advantages that participants expected from a European registry like EuMAR were the possibility of obtaining national statistics in the absence of a national registry and improving the calculation of cumulative outcomes. The results of the study are based on self-reported data, which may be subject to bias, however, the validity of the collected information was verified with different means, including follow-up calls for clarifications and sharing final transcript reports. The feasibility of the proposed data flow models will be tested in a pilot study. Despite the heterogeneity of data collection practices across EU countries, the results show that stakeholders have high expectations of the benefits that the EuMAR registry can bring, namely the improvement of data consistency, cross-border comparability, and cumulative live birth rates, leading to better information for patients, health care providers and policy makers. The EuMAR project was co-founded by ESHRE and the European Commission (101079865-EuMAR-EU4H-2021-PJ2). No competing interests were declared. N/A.

Efficacy of cumulative cisplatin dose on survival in patients with locally advanced cervical cancer treated with definitive chemoradiotherapy: multicenter study by Turkish Oncology Group

ObjectiveTo investigate the impact of cumulative cisplatin dose on clinical outcomes in locally advanced cervical cancer patients undergoing definitive chemoradiotherapy.MethodsA retrospective analysis was conducted on 654 patients with stage IB3–IVA...

Current landscape of fertility induction in males with congenital hypogonadotropic hypogonadism.

Congenital hypogonadotropic hypogonadism (CHH) is a rare reproductive disorder caused by deficient secretion or action of gonadotropin-releasing hormone (GnRH) and is a hormonally treatable form of male infertility. Both pulsatile GnRH treatment and combined gonadotropin therapy effectively induce spermatogenesis in 75%-80% of males with CHH, albeit the ejaculate does not usually approach normal semen parameters by WHO criteria. This is in some contrast to the cumulative fertility outcomes in females with CHH on gonadotropin treatment that are indistinguishable from those of reproductively normal females. Emerging data provide insights into early life determinants of male fertility (i.e., minipuberty), and research has identified key predictors of outcomes for fertility-inducing treatment in men with CHH. Such developments provide mounting evidence for tailoring approaches to maximize fertility potential in CHH, although there is no clear consensus to date on the optimal approach to fertility-inducing treatment. This review provides an up-to-date review on the current evidence underpinning therapeutic approaches for inducing spermatogenesis in males with CHH. In the absence of evidence-based clinical guidelines, this synthesis of current evidence provides guidance for clinicians working with males with CHH seeking fertility.

Long-term impact of Hurricane Maria on point-of-use drinking water quality in Puerto Rico and associated potential adverse health effects

Drinking water security in Puerto Rico (PR) is increasingly challenged by both regulated and emerging anthropogenic contaminants, which was exacerbated by the Hurricane Maria (HM) due to impaired regional water cycle and damaged water infrastructure. Leveraging the NIEHS PROTECT (Puerto Rico Testsite for Exploring Contamination Threats) cohort, this study assessed the long-term tap water (TW) quality changes from March 2018 to November 2018 after HM in PR, by innovatively integrating two different effect-based quantitative toxicity assays with a targeted analysis of 200 organic and 22 inorganic pollutants. Post-hurricane PR TW quality showed recovery after >6-month period as indicated by the decreased number of contaminants showing elevated average concentrations relative to pre-hurricane samples, with significant difference of both chemical and toxicity levels between northern and southern PR. Molecular toxicity profiling and correlation revealed that the HM-accelerated releases of certain pesticides and PPCPs could exert increased cellular oxidative and/or AhR (aryl hydrocarbon receptor)-mediated activities that may persist for more than six months after HM. Maximum cumulative ratio and adverse outcome pathway (AOP) assessment identified the top ranked detected TW contaminants (Cu, Sr, V, perfluorooctanoic acid) that potentially associated with different adverse health effects such as inflammation, impaired reproductive systems, cancers/tumors, and/or organ toxicity. These insights can be incorporated into the regulatory framework for post-disaster risk assessment, guiding water quality control and management for public health protection.

Long-term outcome of regional cooperation pathway after endoscopic submucosal dissection for early detection of new gastric cancer.

The Cancer Control Act requires the maintenance of regional cooperation pathways (RCP) for cancer treatment. In 2008, we started RCP for early detection of new gastric cancer after endoscopic submucosal dissection (ESD). In gastric cancer treatment, RCP after surgical resection had been widely used, but little is known about RCP after ESD. This study aimed to evaluate the effectiveness of RCP after ESD. This study included 465 patients on whom our RCP was implemented from 2008 to 2018. A regional family physician performed surveillance endoscopy at 3months and 1year after ESD and annually thereafter. We retrospectively evaluated the cumulative incidence and treatment outcomes of new gastric cancer and compared them with previous reports. During a median follow-up period of 70.5months (3-120months), 58 patients developed new gastric cancers, and metachronous gastric cancer was detected in 55 patients more than 1year after ESD. The 5-year cumulative incidence rate was 9.8%. Three patients did not want treatment. Among the remaining 55 patients, the initial treatment was ESD in 51 and surgical resection in 4. Eventually, 50 patients (48 in the ESD group and 2 in the surgical resection group) fulfilled the pathologic criteria for curative ESD. There were no deaths due to gastric cancer. Our study was the first to reveal the incidence of new gastric cancer after ESD using RCP. Most lesions were cured with ESD, and no patients died of gastric cancer. Therefore, we consider RCPs to be an option for surveillance after ESD.

Anti-Müllerian hormone does not predict cumulative pregnancy rate in non-infertile women following four IUI cycles with donor sperm.

To evaluate the predictive value of serum AMH for clinical pregnancy in non-infertile population undergoing intrauterine insemination with donor sperm (ds-IUI). This multicenter prospective study (ClinicalTrials.gov ID: NCT06263192) recruited all non-infertile women undergoing ds-IUI from June 2020 to December 2022 in three different fertility clinics in Spain and Chile. Indications for ds-IUI included severe oligoasthenoteratozoospermia, female partner, or single status. Clinical pregnancy rates were compared between women with AMH ≥ 1.1 and < 1.1ng/mL. The main outcome measure was the cumulative clinical pregnancy rate after up to 4 ds-IUI cycles. A total of 458 ds-IUI cycles were performed among 245 patients, of whom 108 (44.08%) achieved clinical pregnancy within 4 cycles, 60.2% of these occurring in the first attempt and 84.2% after two attempts. We found no significant differences in AMH levels or other parameters (such as age, BMI, FSH, AFC) between women who became pregnant and those who did not. Cumulative pregnancy rates and logistic regression analysis revealed that AMH ≥ 1.1ng/mL was not predictive of ds-IUI success. While a high positive correlation was observed between AFC and AMH (r = 0.67, p < 0.001), ROC curve analyses indicated that neither of these ovarian reserve markers accurately forecasts cumulative ds-IUI outcomes in non-infertile women. The findings of this multicenter study suggest that AMH is not a reliable predictor of pregnancy in non-infertile women undergoing ds-IUI. Even women with low AMH levels can achieve successful pregnancy outcomes, supporting the notion that diminished ovarian reserve should not restrict access to ds-IUI treatments in eligible non-infertile women.

P-019 Impact of severely altered sperm parameters on ICSI outcomes: A retrospective analysis of embryo morphokinetics and cumulative clinical outcomes of 10,622 embryos

Abstract Study question How do severely altered parameters in both ejaculated and surgically retrieved testicular sperm affect preimplantation embryo morphokinetics, blastocyst quality and cumulative clinical outcomes? Summary answer Severely altered semen parameters impaired fertilization, embryo morphokinetics, and blastocyst quality, but only the use of testicular sperm reduced cumulative outcomes, including live birth rates. What is known already Semen quality is a significant determinant of reproductive success. Sperm play a crucial role in embryonic genome activation and facilitate embryo progression to the blastocyst stage. Yet, comprehensive analyses of embryo developmental outcomes in cases of male factor infertility remain scarce. Limited by small study cohorts, inconsistent findings and a lack of cumulative outcomes, existing studies have failed to provide a clear understanding of the differential impacts of altered semen parameters on embryo development. Uncertainty about outcomes following the use of poor-quality or testicular sperm complicates clinical management, ultimately leaving patients without comprehensive information to make informed treatment decisions. Study design, size, duration This retrospective study evaluated 10,622 embryos derived from 1,680 patients, across 1,837 ICSI cycles. We included both autologous (n = 429) and donor oocyte (n = 1,407) cycles, performed at a single IVF center between January 2019 and August 2023. To assess differences in critical aspects of reproductive success, we compared various embryo developmental and clinical outcomes across cycles using sperm with severely altered parameters (either ejaculated or obtained through testicular sperm extraction, TESE) to those using normospermic samples. Participants/materials, setting, methods Embryos were distributed into four groups according to sperm quality and origin, as per WHO guidelines: normospermia (n = 8,798), severe oligospermia (&amp;lt;5 million/ml; n = 567), severe oligoastenospermia (&amp;lt;5 million/ml and progressive motility &amp;lt;32%; n = 716) and TESE (n = 541). We assessed differences in embryo morphokinetics using adjusted Cox survival curves. We used multivariate analyses to evaluate associations between sperm groups and clinical outcomes, adjusting for relevant confounders pertaining to patient demographics and treatment characteristics. P-values &amp;lt;0.05 were considered significant. Main results and the role of chance Compared to normospermia, altered semen parameters resulted in lower mean fertilization rates (74.5% normospermia versus 69.7% severe oligospermia, 69.1% severe oligoastenospermia and 60.6% TESE). While oligospermia and oligoastenospermia showed a negative correlation with fertilization rates (R2=-0.05, p = 0.02 and R2=-0.07, p &amp;lt; 0.0001, respectively), this trend was more pronounced for TESE (R2= -0.12, p &amp;lt; 0.0001). Embryo morphokinetics were comparable for normospermia, oligospermia and oligoastenospermia. However, TESE resulted in faster early morphokinetic patterns (tPNf, t2, t3, t4 and t5; p &amp;lt; 0.05), and similar t8, tsB, tB, with comparable cell cycle durations (s2, s3, cc2 and cc3; p &amp;gt; 0.05). Compared to normospermia, severe oligospermia had no effect on inner cell mass (ICM) (OR = 0.93, 95%CI: 0.72-1.21) nor trophectoderm (TE) quality (OR = 0.79, 95%CI: 0.58-1.06), while oligoastenospermia reduced the odds of having a good quality ICM (OR = 0.75, 95%CI: 0.58-0.97) but showed no effect on TE (OR = 0.94, 95%CI: 0.71-1.23). Notably, TESE had the most profound effect on blastocyst quality (ICM, OR = 0.68, 95%CI: 0.49-0.92; TE, OR = 0.68, 95%CI: 0.46-0.98). Following the first embryo transfer, ongoing pregnancy rates were similar across all groups, apart from TESE (R2=-0.217, p = 0.0160). Unlike the other groups (p &amp;gt; 0.05), TESE also led to decreased cumulative implantation, ongoing pregnancy, and live birth rates compared to normospermia (R2=-0.19, p = 0.03; R2=-0.23, p = 0.009; R2=-0.22, p = 0.019, respectively). Limitations, reasons for caution The primary limitation of this study is its retrospective design, which may not account for all confounders. Moreover, lifestyle factors, such as smoking or alcohol consumption were not considered. The reliance on data from a single IVF center may also restrict the generalizability of the results to a broader population. Wider implications of the findings Our findings underscore the imperative need for careful consideration of sperm quality for ICSI, highlighting the distinct challenges presented by TESE sperm for achieving reproductive success. While altered semen parameters compromised fertilization rates and embryo quality, TESE cycles were markedly less efficient, ultimately leading to reduced cumulative live birth rates. Trial registration number not applicable

P-650 Cumulative live birth rate after use of capacitation in vitro maturation in women with predicted excessive response to ovarian stimulation: an analysis of 1,563 cycles

Abstract Study question What is the cumulative live birth rate in biphasic (capacitation) in vitro maturation (CAPA-IVM) cycles in women with predicted excessive response? Summary answer The cumulative live birth rate achieved after CAPA-IVM in women with predicted excessive response was 37.8%. What is known already In vitro maturation (IVM) is an alternative infertility treatment for women at high risk of complications during conventional in vitro fertilisation with ovarian stimulation. There is debate about the merits of a newer biphasic approach (capacitation [CAPA]-IVM) versus standard IVM. At centres where it is used, CAPA-IVM has increased the maturation rate, and therefore the number of embryos available for transfer. However, there is a lack of data from large numbers of CAPA-IVM cycles, especially cumulative outcomes. Study design, size, duration This analysis included data from 1,563 individuals who underwent CAPA-IVM at a tertiary IVF center in Ho Chi Minh City, Vietnam from January 2016 to December 2023. Participants/materials, setting, methods All CAPA-IVM cycles in women with predicted excessive response (polycystic ovary syndrome or high antral follicle count) were included. Mean age was 29.6±3.5 years. Median duration of infertility was 3.3±2.5 years. CAPA-IVM was the first assisted reproductive technology in 90.5% of participants. Cumulative live birth rate was defined as the number of live births after using all embryos generated from a CAPA-IVM cycle. Main results and the role of chance Cumulative rates of clinical pregnancy, ongoing pregnancy and live birth were 54.9%, 44.4% and 37.8%, respectively. The median proportion of mature oocytes per cumulus-oocyte complex was 61.3% (IQR 50.0–73.3) and the median proportion of fertilized oocytes per cumulus-oocyte complex was 72.2% (IQR 55.6-85.7). The median total number of day-3 embryos per patient was 4.0 [IQR 3.0–7.0] and the total number of good day-3 embryos per patient was 3.0 [IQR 2.0–5.0]. The proportion of patients with no embryo was 5.2%. The number of frozen embryo transfer cycles was 1 (53.6% of patients), 2 (24.9%), 3 (7.0%), 4 (0.8%) or 5 (0.3%); 7.9% of patients had not undergone transfer of day-3 embryos at the time of analysis. Median [IQR] number of embryos and good embryos transferred was 2.0 [2.0–4.0] and 2.0 [1.0–2.0], respectively. No case of ovarian hyperstimulation syndrome recorded. Limitations, reasons for caution The characteristics of the study population (relatively young, lean women from Vietnam with predicted excessive response to ovarian stimulation) limit the external generalisability of the findings. Wider implications of the findings The cumulative live birth rate from all CAPA-IVM cycles performed in women with predicted excessive response at our centre was comparable to that of IVF. CAPA-IVM could be an alternative for this selected group of patients to avoid ovarian hyperstimulation. Trial registration number not applicable

P-781 Managing a change of provider bank in a vitrified oocyte donation program

Abstract Study question Does a change in provider bank affect the outcomes of a vitrified oocyte donation program and require laboratory and clinical adjustments? Summary answer In a vitrified oocyte donation program, a change in the provider bank does not affect patients’ outcomes nor require laboratory or clinical adjustments. What is known already Imported vitrified oocyte donation programs are a valuable strategy to provide oocyte donation treatments in settings were donor availability is low or absent. Little is known about how to a change in the provider oocyte bank should be managed in terms of laboratory or clinical adjustments in order not to jeopardize patients’ outcomes. Study design, size, duration Longitudinal cohort study conducted in a Tertiary IVF Center (Centro Scienze Natalità, IRCCS Ospedale San Raffaele, Milan, Italy) between September 2019 and October 2023. Participants/materials, setting, methods All couples undergoing their first imported vitrified oocyte donation cycle were included (n = 235). Oocytes (6 to 9 per cycle) were purchased from one bank (Bank A, Spain, EU) until December 2022 and then from a different bank (Bank B, Spain, EU) from January to October 2023. Single blastocyst-stage embryo transfer policy was adopted in all patients and the cumulative outcomes of patients treated with oocytes purchased from Bank A and Bank B were compared. Main results and the role of chance The number of provided oocytes was higher in Bank B compared to Bank A (8.0 ± 0.8 vs 6.5 ± 0.7, Mean ± SD, p &amp;lt; 0.01). Oocyte survival rates at thawing (87.2 ± 17.2 vs 91.2 ± 16.1 %, Mean ± SD), fertilization rates (75.7 ± 20.8 vs 78.4 ± 28.7, Mean ± SD) and blastulation rates (49.0 ± 28.0 vs 54.5 ± 27.5, Mean ± SD) were stable between Bank A and Bank B respectively, resulting in a higher number of blastocysts available for transfer in cycles performed with oocytes from Bank B compared to Bank A (3.5 ± 2.0 vs 2.4 ± 1.5, Mean ± SD, p &amp;lt; 0.01). Cumulative outcomes showed an improvement in cycles performed with Bank B compared to Bank A (implantation rates 73.8 % vs 62.6 %, ongoing pregnancy rates 69.8 % vs 56.3 %), despite not reaching a statistically significant difference. On multivariate logistic regression, the number of blastocysts available for transfer (OR 2.1, 1.7 -2.7 95% CI, p &amp;lt; 0.01) but not the Bank providing the vitrified oocytes (OR 0.99, 0.40 – 2.43) resulted as significant predictor of ongoing pregnancy. Limitations, reasons for caution Longer follow-up might strengthen our results, as several cycles performed with Bank B are still ongoing and cumulative live-birth rates cannot be currently calculated. In addition, the two banks used are located in the same country. Whether these results also apply to banks located in different settings needs further investigation. Wider implications of the findings Our results reassure about the possibility to manage a vitrified oocyte donation program using oocytes from different banks without jeopardizing patients’ outcomes and without the need for laboratory and clinical adjustments. Trial registration number not applicable

Early coronary angiography in NSTEMI: a regional Victorian perspective.

Current guidelines highlight a paucity of evidence guiding optimal timing for non-ST-elevation myocardial infarction (NSTEMI) in high-risk and non-high-risk cases. We assessed long-term major adverse cardiovascular events (MACEs) in NSTEMI patients undergoing early (<24 h) versus delayed (>24 h) coronary angiography at 6 years. Secondary end-points included all-cause mortality and cumulative MACE outcomes. Baseline characteristics and clinical outcomes were assessed among 355 patients presenting to a tertiary regional hospital between 2017 and 2018. Cox proportional hazard models were generated for MACE and all-cause mortality outcomes, adjusting for the Global Registry of Acute Coronary Events (GRACE) score, patient demographics, biomarkers and comorbidities. Two hundred and seventy patients were included; 147 (54.4%) and 123 (45.6%) underwent early and delayed coronary angiography respectively. Median time to coronary angiography was 13.3 and 45.4 h respectively. At 6 years, 103 patients (38.1%) experienced MACE; 41 in the early group and 62 in the delayed group (hazard ratio (HR) = 2.23; 95% confidence interval (CI) = 1.50-3.31). After multivariable adjustment, the delayed group had higher rates of MACE (HR = 1.79; 95% CI = 1.19-2.70), all-cause mortality (HR = 2.76; 95% CI = 1.36-5.63) and cumulative MACE (incidence rate ratio = 1.54; 95% CI = 1.12-2.11). Subgroup analysis of MACE outcomes in rural and weekend NSTEMI presentations was not significant between early and delayed coronary angiography (HR = 1.49; 95% CI = 0.83-2.62). Higher MACE rates in the delayed intervention group suggest further investigation is needed. Randomised control trials would be well suited to assess the role of early invasive intervention across all NSTEMI risk groups.

P-329 Evaluating Implansera, autologous platelet-derived growth factors, to improve clinical pregnancy and live birth rates in frozen embryo transfer for women with recurrent implantation failure

Abstract Study question Can Implansera, Autologous Platelet-Derived Growth Factors, serve as a promising adjuvant therapy in assisted reproductive techniques to enhance endometrial thickness and implantation rates? Summary answer Use of Implansera significantly increased clinical pregnancy and Live Birth Rate In Patients With repeated implantation failure during FET cycles. What is known already Insufficient endometrial thickness and receptivity contribute to Recurrent Implantation Failure (RIF), prompting consideration of surrogacy. Despite global rise in Frozen Embryo Transfer (FET), quest for an optimal implantation protocol persists. Recent research highlights platelet-rich plasma (PRP) as promising solution for thin endometrium and RIF cases, attributing positive outcomes to PRP’s high growth factor concentration. Recognizing the need for precise platelet and growth factor concentrations, Implansera—a specialized platelet-derived growth factor concentrate—was developed. This innovation addresses the challenge of unresponsive endometrium, offering tailored solution to maximize therapeutic efficacy and improve pregnancy outcomes for patients facing RIF issues. Study design, size, duration Conducted from May 2021 to December 2023, this prospective interventional self-controlled study focused on 21 women (aged 30-48) experiencing recurrent IVF failure due to stubborn thin endometrium. Selected after negative hysteroscopic and bacteriologic screenings, and unsuccessful pregnancies despite multiple immune therapy regimens, such as intralipid and granulocyte colony-stimulating factor infusions, steroids, and endometrial scratching. The subjects underwent Implansera treatment, aiming to address refractory thin endometrium and potentially enhance their chances of successful conception. Participants/materials, setting, methods After obtaining informed consent women with at least two previous unexplained RIF, who were candidates for frozen-thawed embryo transfer were treated with intrauterine infusion of 0.8 ml of Implansera was infused into uterine cavity in addition to standard HRT protocols 2 days before ET. Clinical pregnancy was determined by positive serum β-HCG, 2weeks after ET and presence of fetal heart beat in trans-vaginal ultrasound 5weeks after ET. Main results and the role of chance Among 21 women, 10 achieved pregnancy (47.6%), while 11 did not conceive (52.4%). Clinical outcomes varied: 1 woman (4.8%) experienced chemical pregnancy, 3 (14.3%) miscarried before 6-12 weeks, 3 (14.3%) delivered healthy full-term babies, and 3 (14.3%) are in the 24th week of uneventful gestation accounts for 28.6% cumulative successful pregnancy outcomes. Implansera treatment yielded no reported adverse effects.Implansera, prepared through a patented proprietary process, standardized to contain 6-9 times higher growth factors than peripheral blood, particularly implantation-friendly and anti-inflammatory cytokines, addresses the crucial angiogenic and anti-inflammatory requirements for successful implantation. Tailored for the cyclical demands of endometrial proliferation, secretion, and implantation phases, it efficiently restores impaired uterine environments.Beyond efficacy, Implansera’s safety, reproducibility, and effectiveness in emulating natural tissue repair and regeneration processes are noteworthy. Studies underscore the significance of creating an environment conducive to successful implantation, and Implansera’s composition aligns with these requirements. Its capacity to mimic natural processes positions it as a promising solution, offering a comprehensive approach to enhancing endometrial receptivity, thus optimizing conditions for successful pregnancies. Limitations, reasons for caution This self-controlled prospective study, albeit with small sample size and lacking randomized control group, aligns with published data in demonstrating Implansera’s benefits. Proposing larger studies, particularly with unexplained RIF, to establish Implansera as routine IVF adjuvant. Further investigations aim to identify active molecules influencing implantation and suggest targeted recommendations. Wider implications of the findings Implansera improved implantation, pregnancy, and live birth rates (LBR) in unexplained RIF patients which indicates clearly endometrial thickness and receptivity improvement and motivated us to plan randomized controlled studies to confirm the results and provide opportunity for women with unexplained RIF to conceive and deliver in lesser number of cycles. Trial registration number Not applicable

Adverse Childhood Experiences, Substance Use, and Poor Mental Health Among the U.S. Adult Population

Adverse childhood experiences (ACEs) are linked to various lifelong negative outcomes. However, there is little counseling literature on the effects of ACEs on adult mental health. Utilizing the 2021 Behavioral Risk Factor Surveillance System dataset, we examined individual ACEs and cumulative ACEs scores to quantify the relationship between ACEs and behavioral and mental health outcomes. Findings showed that 60.9% of the participants experienced at least one ACE, with nearly 1 in 6 participants reporting four or more ACEs. Childhood emotional abuse was the most prevalent form of ACE reported. Multiple logistic regression analyses adjusting for sociodemographic covariates showed that reporting any of the ACEs was significantly associated with heavy alcohol use, marijuana use, and poor mental health. Furthermore, a graded dose-response relationship was found between cumulative ACEs scores and outcome variables. The findings highlight the importance of consciously screening and considering ACEs to better assist clients with presenting behavioral and mental health issues.

The Soleymani and Collins Obstetric morbidity score (SaCOMS): A quantitative tool for measuring maternal morbidity from complex obstetric surgery such as placenta accreta spectrum (PAS)

It is currently very difficult to compare different management strategies for complex obstetric surgery, such as hysterectomy for severe Placenta Accreta Spectrum (PAS), as there is no widely accepted consensus for the classification of maternal surgical morbidity. Many studies focus on the amount of blood products transfused or admission to intensive care units (ICU). However, these are dependent on local policies and available resources. It also gives an incomplete representation of the entire ‘patient journey’ after they leave the operating room. Subsequent repeat procedures for lower urinary track damage is arguably worse from the woman’s perspective than a short stay on an intensive care unit (ICU) for observation.We suggest a version of the Clavien-Dindo morbidity classification specific to obstetrics. Then employ it to build a quantitative morbidity score which aims to reflect the whole ‘patient experience’ including the post-operative pathway. We then demonstrate the utility of this system in a cohort of women with Placenta Accreta Spectrum (PAS).The Clavien-Dindo classification was modified to reflect obstetric procedures and a quantitative morbidity measure, the Soleymani and Collins Obstetric Morbidity Score (SaCOMS), was developed based on this. Both were then validated using a survey-based consultation of a panel of experts in PAS and retrospectively applied to a cohort of 54 women who underwent caesarean hysterectomy for PAS.Clinicians with expertise in PAS believe that the Modified Obstetric Clavien-Dindo classification system and the novel SaCOMS tool can improve assessment of maternal morbidity, and better reflect the ‘patient experience’. Application of the classification system to a single-centre PAS cohort suggested that surgery by gynecologic-oncology surgeons may be associated with decreased incidence and cumulative morbidity outcomes for women with PAS, especially those with the most severe presentation.This study presents a clinically useful obstetric-specific classification system for surgical morbidity. SaCOMS also provides a quantitative reflection of the full patient- journey experienced as a result of surgical complications enabling a more patient-centered representation of morbidity.