Categorical Variables Research Articles

Association of Dose of Inhaled Corticosteroids and Frequency of Adverse Events.

Inhaled corticosteroids (ICS) are the cornerstone of asthma treatment and significantly improve morbidity and mortality. Adverse effects of oral corticosteroids are well documented, but less is known about ICS. We conducted observational studies in adults with asthma using two different UK nationwide datasets: Clinical Practice Research Datalink (CPRD) Aurum and CPRD GOLD. The exposure was incident ICS; the outcomes were major adverse cardiac events (MACE), arrhythmia, pulmonary embolism (PE) and pneumonia over 12-months. Our main analyses used a cohort method with stabilized inverse probability treatment weighting to balance confounding between exposed and unexposed patients. Secondary analyses included nested case-control studies, and self-controlled case series. ICS was treated both as a categorical and continuous variable. Absolute risk was estimated using weighted flexible parametric models. From 162,202 patients in our main cohort, there was an association with all outcomes at medium daily ICS dose or higher (HR, 95%CI at 201-599mcg: MACE=2.63, 1.66-4.15, arrhythmia=2.21, 1.60-3.04, PE=2.10, 1.37-3.22, pneumonia=2.25, 1.77-2.85; at ≥600mcg: MACE=4.63, 2.62-8.17, arrhythmia=2.91, 1.72-4.91, PE=3.32, 1.69-6.50, pneumonia=4.09, 2.98-5.60). There were no associations with lower doses of ICS. Secondary analyses produced similar results. The number needed to harm (95%CI) using 12-months of ICS 201-599mcg: MACE=473 (344-754), arrhythmia=567 (395-1006), PE=1221 (744-3388) and pneumonia=230 (177-327) and using ICS ≥600mcg: MACE=224 (148-461), arrhythmia=396 (228-1523), PE=577 (309-4311), pneumonia=93 (69-141). Short-term use of low dose ICS was not associated with adverse effects. Moderate-high daily ICS doses were associated with an increased risk, but low-frequency, of cardiovascular events, pulmonary embolism and pneumonia. It is important for clinicians to adhere to guideline recommendations to use the lowest effective ICS dose.

Is Cardiac Surgery Safe During Pregnancy? A 40-Year Single-Institution Experience

BackgroundLimited data exist to characterize maternal and fetal outcomes during pregnancy undergoing cardiac operations using cardiopulmonary bypass. MethodsA retrospective review was performed of all pregnant individuals who underwent cardiac surgery using cardiopulmonary bypass at a single center from 1978 to 2023. Descriptive statistical analysis was performed, with a median reported for continuous variables and incidence for dichotomous variables. ResultsTwenty-nine pregnant patients with a median age of 28 years (interquartile range [IQR], 25-32 years) years underwent cardiac surgery using cardiopulmonary bypass at a median gestation of 25 weeks (IQR, 16-29 weeks). Surgery was performed in the first trimester for 3 patients (10%), second trimester for 16 (55%), and third trimester for 10 (35%). Procedures were emergent in 15 (52%) and urgent in 14 (48%). There was 1 (3%) maternal death 2 days after mechanical aortic valve thrombectomy and 5 (17%) fetal losses. Fourteen patients who underwent cardiac surgery using cardiopulmonary bypass with continuing pregnancy experienced a 29% fetal mortality rate, and 7 patients underwent delivery before surgery and experienced 14% fetal mortality. Among cases of fetal loss, surgery was performed at a median of 25 weeks (IQR, 21-26 weeks) compared with a median of 23 weeks (IQR, 20-29 weeks) in cases without fetal loss (P = .55). ConclusionsCardiac surgery during pregnancy was associated with low maternal mortality but significant fetal mortality. This single-institution series supports consideration of cesarean delivery before cardiopulmonary bypass procedures if the fetus is of a viable gestational age to minimize mortality.

Being Smarter with Dummies: Using Bayes Factors for Hypothesis Tests Involving Dichotomous Variables

Being Smarter with Dummies: Using Bayes Factors for Hypothesis Tests Involving Dichotomous Variables

Efficacy, acceptability and tolerability of second-generation antipsychotics for behavioural and psychological symptoms of dementia: a systematic review and network meta-analysis

BackgroundBehavioural and psychological symptoms of dementia (BPSD) are highly prevalent in people living with dementia. Second-generation antipsychotics (SGAs) are commonly used to treat BPSD, but their comparative efficacy and acceptability...

Predictors of confidence in research: a cross-sectional survey of pharmacists in the north of England.

Pharmacist-led research is key to optimizing medicines use and improving pharmacy services, yet it is not yet widely embedded into careers. This study aims to identify predictors of confidence in meeting the research learning outcomes in the Royal Pharmaceutical Society (RPS) Post-Registration Foundation and Core Advanced curricula, to provide targeted recommendations for building research capability and capacity within the profession. The study was a cross-sectional electronic survey, distributed to eligible pharmacists in March 2023 (n = 253). The survey gathered demographic information, research experience, and self-reported confidence in meeting the research learning outcomes in the RPS Post-Registration Foundation and Core Advanced curricula. Pre-determined independent variables were analysed using two binomial logistic regression models (one per curriculum) to identify predictors of the dichotomous variable: confidence with meeting all research learning outcomes in that curriculum. Participants were more likely to self-report as confident (versus not confident) with meeting all research learning outcomes in a curriculum if they had recent experience (within the previous 12 months) of research or research-related activities, held a postgraduate research qualification, had undertaken research training outside of a postgraduate qualification, discussed research in their appraisal, or worked in the hospital sector. Conversely, male gender, years practicing, and protected time for research did not predict confidence. A targeted approach, including improving access to research methods training, experience-based learning, mentorship, and linking research projects to key organizational objectives, could be the key to developing research capability and capacity across all sectors and career stages.

Examining the "White Health Advantage" Effect among Latinos in the United States.

There is consensus regarding the socio-political roots of the concept of race (and ethnicity) in the United States (US). However arbitrary, the US societal constructions of race have meant racial/ethnic minorities experience disproportionate health burdens. The present study examined the so-called "white health advantage" effect in a large sample of US respondents, comparing Latinos (non-White and White) with non-Latino Whites. This cross-sectional study used deidentified data from the Dynata Global COVID Symptoms map project, collected between July 7-14, 2020 (n = 135,075). A dichotomous health status variable was created with respondents answering yes/no to any COVID-19 symptoms (difficulty breathing, coughing, fatigue, fever, and loss of taste or smell). We included relevant predisposing (age, gender, number of children, race, ethnicity, marital status, and education) and enabling factors (housing conditions, income, employment status, business ownership, and number of cars owned - a proxy measure for wealth). Multivariate logistic regression models showed significant differences in health status (as measured by COVID-19 symptoms) when comparing Latinos (non-White, White) and non-Latino Whites. For instance, higher socioeconomic status had a protective effect only among non-Latino Whites. In turn, being married/living with a partner was only associated with COVID-19 symptoms among White Latinos, indicating that the apparent benefits of this "improving" socio-political location are somewhat limited. Our study found significant differences in COVID-19 symptoms when comparing Latinos (non-White, White) and non-Latino Whites. Our findings underscore the importance of further examining health outcomes by racial identities of US Latinos, which can help inform future health equity efforts.

Epidemiological, Demographic, and Clinical Characteristics of Von Willebrand Disease Patients in Zahedan City, Iran: A Descriptive Study.

Background:Von Willebrand disease (VWD) is one of the most common coagulative diseases, so identifying the effective factors in preventing this complication is essential. The study aimed to evaluate the frequency of demographic and epidemiological findings in VWD patients referred to a hospital in Zahedan, Iran. Materials and Methods: This study was performed on 76 patients with VWD referred to Hazrat Ali-Asghar Hospital in Zahedan City, Sistan, and Baluchestan province. After obtaining consent from the patients, the demographic information and clinical symptoms of the disease were recorded. All statistical analyses were performed using SPSS 22.0 software. All descriptive data were expressed as mean ±SD and percent (%) depending on the continuous and dichotomous variables. A P-value ≤0.05 was considered significant statistically. Results:The present study results showed that the highest age group of VWD patients at the time of disease diagnosis was in the age group 1-5 years (47.3%), and most patients had type III VWD (80.3%). It was also found that 67.1% of patients had a positive family history and their parents' consanguineous marriage (77.6%). The most common complaints were epistaxis (88.15%), cutaneous bleeding (78.94%), and oral cavity bleeding (61.84%), respectively. Conclusion: Due to the high prevalence of VWD in consanguineous marriages and an increase in adverse complications and symptoms in VWD patients, proper diagnosis and screening at an early age, especially in people with family history, is essential. Efforts are needed to develop national registries and widely provide the required and available basic services for diagnosis and treatment.

Efficacy and Safety of Modafinil for Treatment of Amphetamine-Type Stimulant Use Disorder: A Systematic Review and Meta-Analysis of Randomized Placebo-Controlled Trials: Efficacité et innocuité du modafinil pour le traitement des troubles liés à l'usage de stimulants de type amphétamine : revue systématique et méta-analyse d'essais randomisés contrôlés par placebo.

Amphetamine-type stimulants (ATSs) are related to significant harm worldwide, with limited effective pharmacological treatments for ATS use disorder (ATSUD). Modafinil has been explored as a potential treatment for ATSUD. This systematic review and meta-analysis (PROSPERO ID: CRD42023388487) aimed to evaluate the efficacy and safety of modafinil for the treatment of ATSUD. A comprehensive search of major indexing sources and trial registries, from inception to search date, was conducted on February 15, 2023, and updated on October 31, 2023. Eligible studies were randomized placebo-controlled trials (RCTs) of modafinil in individuals meeting the criteria for the Diagnostic and Statistical Manual of Mental Disorders, fourth and fifth editions, diagnoses of ATSUD. Eligible studies were assessed for risk of bias, using the Cochrane Risk of Bias tool. The primary outcome included the effect of modafinil on ATS use. Secondary outcomes included retention in treatment, ATS craving, treatment discontinuation due to adverse events (AEs), and serious AEs. Subgroup analysis by modafinil dose was conducted where appropriate. Risk ratio (RR) or Peto's odds ratio (OR) was calculated for the meta-analysis of dichotomous variables and standardized mean difference (SMD) was calculated for the random-effect meta-analysis of continuous variables. Five RCTs (N = 451 participants) were included. Modafinil did not significantly impact ATS use (RR = 0.99; 95% CI, 0.97 to 1.02; p = 0.655), retention in treatment (RR = 1.02; 95% CI, 0.91 to 1.14; p = 0.799), ATS craving (SMD = -0.36; 95% CI, -1.19 to 0.47; p = 0.398), or treatment discontinuation due to AEs (Peto's OR = 0.48; 95% CI, 0.20 to 1.14; p = 0.100). These results were consistent across subgroup analyses. More episodes of serious AEs were reported in the modafinil group than in the placebo group, at higher doses (Peto's OR = 4.80; 95% CI, 1.18 to 19.56, p = 0.029). There is currently no evidence suggesting that modafinil has a statistically significant effect on efficacy outcomes in populations with ATSUD. Continued research into effective treatments and harm reduction strategies for ATSUD is essential.

The impact of urbanization on health depends on the health metric, life stage and level of urbanization: a global meta-analysis on avian species.

Stressors associated with urban habitats have been linked to poor wildlife health but whether a general negative relationship between urbanization and animal health can be affirmed is unclear. We conducted a meta-analysis of avian literature to test whether health biomarkers differed on average between urban and non-urban environments, and whether there are systematic differences across species, biomarkers, life stages and species traits. Our dataset included 644 effect sizes derived from 112 articles published between 1989 and 2022, on 51 bird species. First, we showed that there was no clear impact of urbanization on health when we categorized the sampling locations as urban or non-urban. However, we did find a small negative effect of urbanization on health when this dichotomous variable was replaced by a quantitative variable representing the degree of urbanization at each location. Second, we showed that the effect of urbanization on avian health was dependent on the type of health biomarker measured as well as the individual life stage, with young individuals being more negatively affected. Our comprehensive analysis calls for future studies to disentangle specific urban-related drivers of health that might be obscured in categorical urban versus non-urban comparisons.

Association between obstructive sleep apnea and temporomandibular disorders: A meta-analysis.

Obstructive sleep apnea (OSA) is a very common condition in patients with temporomandibular disorders (TMD). However, there is little evidence of a connection between them. The aim of this systematic review and meta-analysis is to assess the association between OSA and TMD in adult population. Case-control, cross-sectional and cohort studies on the association between TMD and OSA were searched in the EMBASE, LILACS, LIVIVO, PubMed/MEDLINE, Scopus, Web of Science, Google Scholar, Open Grey and Pro Quest databases. TMD should be assessed using Research Diagnostic Criteria (RDC/TMD) or Diagnostic Criteria (DC/TMD) and OSA using polysomnography (PSG) and/or a validated questionnaire. The risk of bias was evaluated using the Joanna Briggs Institute Critical Assessment Checklists; and an association meta-analysis was performed. The effect measure included the odds ratio (OR) in dichotomous variables and a 95% confidence interval (CI). Certainty of evidence was determined by analysing groups using the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Out of the 1024 articles screened, 7 met the inclusion criteria for the qualitative synthesis, and 6 for quantitative analysis. All articles were classified at low risk of bias. A positive association with OSA was found in patients with TMD (OR = 2.61; 95% CI = 2.31, 2.95). A significant association was also found irrespective to the OSA diagnostic methods applied (for studies using PSG + validated questionnaires: OR = 2.74; 95% CI = 2.11, 3.57; for studies using validated questionnaires only: OR = 2.55; 95% CI = 2.22, 2.92). GRADE was moderate. Patients with TMD presented a significant association with OSA regardless of the OSA diagnostic method (PSG and/or validated questionnaires). OSA screening should be part of the TMD examination routine. Furthermore, due to the different OSA assessment methods used and the small number of studies included, there is a need to include a larger number of studies using PSG to better elucidate this association.

Prospective multicenter study of the epidemiological features of emergency patients with overdose of over-the-counter drugs in Japan.

To investigate the epidemiological characteristics of patients presenting to the emergency department with an overdose of over-the-counter (OTC) drugs. A questionnaire survey was conducted to examine the sociodemographic characteristics of patients with OTC drugs overdoses visiting emergency departments at eight sites across the country. The patients were divided into "habitual" and "nonhabitual" groups according to their history of OTC drugs overdose. Student's t-test or Welch's t-test was performed for numerical variables, and Pearson's χ 2 test was performed for dichotomous and nominal variables between the two groups. Of the 124 patients included in this study, 79% were women. The habitual (26.6%) and the nonhabitual (73.4%) groups showed no differences in sex, occupation, cohabitants, history of mental illness, or history of alcohol consumption or smoking; however, those in the habitual group were significantly younger. The proportion of OTC drugs obtained from physical stores was higher in the habitual group, whereas the nonhabitual group used more household medicines. Suicide and self-harm were more common reasons for overdose in the nonhabitual group. Antipyretic analgesics were significantly more common in the nonhabitual group, whereas antitussive expectorants and antihistamines were significantly more common in the habitual group. This is the first multicenter study to determine the status of OTC drugs overdose patients treated at emergency departments of medical facilities in Japan. To prevent new overdoses of OTC drugs, continued detailed epidemiologic studies of patient backgrounds and drug acquisition routes, and investigation of the components of OTC drugs that cause dependency are necessary.

Utility of Torso Imaging for Elderly Patients Sustaining Ground-Level Falls

IntroductionComputed tomography (CT) of the torso has become increasingly common for assessment of fall patients in the emergency department. Some data suggest that older adults (≥65) may benefit from torso imaging more than younger patients. We sought to evaluate the usage and utility of CT imaging for elderly patients presenting after ground-level falls (GLFs) from 1 meter or less at our level 1 trauma center. MethodsPatients ≥18 presenting with GLF in 2015-2019 were included. Data were obtained through chart and trauma registry review. Descriptive statistics were used to summarize the use of CT imaging for patients younger than versus older than 65 y old. Three multivariate logistic regression models with age as a continuous, binary (<65 versus ≥65), or categorical (in multiples of 5) variable were used to investigate whether age is associated with an increased identification of traumatic injury not previously suspected or known based on physical exam (PE) or plain radiograph after GLF. ResultsA total of 522 patients <65 and 673 patients ≥65 y old were included. Older patients were significantly more likely to receive screening chest radiograph, screening pelvic radiograph, brain CT, and neck CT (all P < 0.001), but not torso (chest, abdomen, and pelvis) CT (P = 0.144). On multivariate logistic regression, age was not significantly associated with an increased odds of identification of traumatic injury after torso CT (continuous: adjusted odds ratio [aOR] = 1.01, 95% confidence interval [CI] = 0.99-1.03, P = 0.379; binary: aOR = 0.86, 95% CI = 0.46-1.58, P = 0.619; categorical: aOR = 1.03, 95% CI = 0.94-1.14, P = 0.453). A positive PE was the only variable associated with significantly increased odds of having an abnormal torso CT scan in all models. Only two patients ≥65 y old had injuries identified on torso CT in the context of a negative PE and negative screening imaging. ConclusionsThe rate of torso injury identification in patients sustaining GLF is not associated with age, but is strongly associated with positive PE findings. In the subset of elderly GLF patients without positive torso PE findings, more conservative use of CT imaging could decrease health-care utilization costs without compromising patient care.

Multimodal prehabilitation and postoperative outcomes in upper abdominal surgery: systematic review and meta-analysis

The impact of multimodal prehabilitation on postoperative complications in upper abdominal surgeries is understudied. This review analyzes randomized trials on multimodal prehabilitation with patient and hospital outcomes. MEDLINE, Embase, CINAHL, and Cochrane CENTRAL were searched for trials on prehabilitation before elective (non-emergency) abdominal surgery. Two reviewers independently screened studies, extracted data, and assessed study quality. Primary outcomes of interest were postoperative pulmonary complications (PPCs) and all-cause complications; secondary outcomes included hospital and intensive care length of stay. A meta-analysis with random-effect models was performed, and heterogeneity was evaluated with I-square and Cochran’s Q test. Dichotomous variables were reported in log-odds ratio and continuous variables were presented as mean difference. Ten studies (total 1503 patients) were included. Odds of developing complications after prehabilitation were significantly lower compared to various control groups (− 0.38 [− 0.75– − 0.004], P = 0.048). Five studies described PPCs, and participants with prehabilitation had decreased odds of PPC (− 0.96 [− 1.38– − 0.54], P < 0.001). Prehabilitation did not significantly reduce length of stay, unless exercise was implemented; with exercise, hospital stay decreased significantly (− 0.91 [− 1.67– − 0.14], P = 0.02). Multimodal prehabilitation may decrease complications in upper abdominal surgery, but not necessarily length of stay; research should address heterogeneity in the literature.

Student Attendance Patterns as Actionable Early Warning Indicators of High School Graduation Outcomes: Findings from an Urban Alternative Charter School

Background: Students who fail to complete high school, on average, have less earnings, pay fewer taxes, and require increased government expenditures compared to those who do reach this milestone. Especially in urban jurisdictions, this can lead to reduced municipal fiscal health. Alternative high schools have been one intervention employed to improve the outcomes of students who have previously dropped out. Also, in recent decades, early warning indicator (EWI) systems have been put in place to flag students who are at risk for not completing school. However, the current EWI metrics for student attendance are insufficient for the population that attends alternative high schools. Methods: Administrative data were obtained from an alternative charter high school in a large urban city in the northeast United States (n = 224). Logistic regression analyses were conducted to test the utility of traditional EWI operationalizations of student attendance against more targeted measures, with student graduation serving as a dichotomous outcome variable. Results: Of the models tested, the model that flagged student non-attendance as missing consecutive days three or more times during the first 12 weeks of school had the greatest explanatory power (McFadden’s R2 = 0.301) and best overall model fit. Conclusions: Traditional definitions of attendance are less useful in schools doing re-engagement work, and more targeted indicators serve as more effective EWIs in these settings.

Clinical Management of Facemasks for Early Treatment of Class III Malocclusion: A Survey among SIDO Members.

To evaluate whether there are differences among orthodontists in the clinical management of facemask treatment for early treatment of Class III malocclusion, a survey consisting of 16 questions was conducted among members of the Italian Society of Orthodontics (SIDO). Sixty percent of the respondents were Specialists in Orthodontics (S) whereas 40% were General Dentists practicing Orthodontics (GD). Descriptive statistics were calculated to summarize the collected data. Differences in answers between S and GD were assessed with the Fisher's exact test for dichotomous variables, chi-square test for qualitative variables, and Mann-Whitney test for ordinal variables. A total of 151 clinicians participated in this survey. As for treatment timing, about 80% of the participants reported treating Class III patients with RPE and facemask between 5 and 8 years of age. Most of the participants requested the patients to wear the facemask in the afternoon and at night for a period of 9 or 12 months with recommended forces of 500 g per side. Comparisons between S and GD showed that S preferred the Petit facemask whereas GD favored the Delaire's type facemask (Fisher's Exact test, p = 0.0005). S and GD also differed significantly in their judgment of the most critical time of treatment, which for the majority of GD was the initial period but for the S was the final period (Chi-square test p = 0.0188). This survey showed that the facemask is not well received by the patients who, along with their parents, express concerns regarding its tolerability.

Efficacy and safety of acupuncture for cognitive impairment in Alzheimer's disease: a systematic review and meta-analysis.

To systematically evaluate the efficacy of acupuncture in the treatment of cognitive impairment in Alzheimer's disease (AD) by meta-analysis, in order to provide evidence-based evidence for the application of acupuncture therapy in the clinical process of AD. From the establishment of the database to December 31, 2022, China Biomedical Literature Database (CBM), China National Knowledge Network (CNKI), VIP database, WanFang Database, Pubmed, Embase and Cochrane Library Database were systematically searched. To collect published randomized controlled clinical trials (RCTS) of acupuncture in the treatment of cognitive impairment in AD. The subjects in the intervention group were given acupuncture alone or combined with other treatments the same as the control group; the control group received conventional Western medicine treatment. The main outcome indicators of the study were cognitive function assessment of subjects, including: Simple Mental State Examination Scale (MMSE), Assessment of daily Living Ability Scale (ADL), Alzheimer's Disease Cognitive Function Assessment Scale (ADAS-Cog), TCM syndrome score (SDSD), Montreal Cognitive Test (MoCA), Secondary outcome indicators were the occurrence of adverse reactions. Literature screening, data extraction, and quality evaluation of the included literature were performed independently by two researchers, according to bias risk assessment tools recommended in the Cochrane manual. Data were analyzed by RevMan5.3 software. Dichotomous variables were represented by risk ratio (OR) and 95% CI, and continuity variables were represented by mean difference (MD) and 95% CI. For heterogeneity analysis, when P > 0.1 and I 2 ≤ 50%, fixed effect model was applied. When P ≤ 0.1 and I 2 > 50%, the random effects model is applied. A total of 1,172 eligible subjects were included in 18 RCTS, including 595 in the intervention group and 577 in the control group. The results of meta-analysis are as follows: acupuncture intervention group improved MMSE [MD = 1.67, 95% CI (0.94, 2.41), P < 0.00001], ADL [MD = -1.18, 95% CI (-3.09, 0.72), P = 0.22], ADAS-Cog [MD = 3.31, 95% CI (5.84, 0.78), P = 0.01], SDSD [MD = 2.40, 95% CI (3.53, 1.26), P < 0.0001], MoCA [MD = 4.80, 95% CI (3.74, 5.86), P = 0.04] were better than the control group. No serious adverse reactions related to acupuncture were observed in the intervention group, and the incidence and severity of adverse reactions were lower than those in the control group, with statistical significance [OR = 0.17, 95% CI (0.04, 0.67), P = 0.01]. Existing data show that acupuncture therapy has certain advantages in improving cognitive dysfunction and improving self-care ability of patients with Alzheimer's disease. However, due to the small number of RCTS and cases evaluating the efficacy of acupuncture, and the possibility of measurement bias and selectivity bias in included studies, it is still unable to conduct high-intensity demonstration on its effectiveness. Further large-scale, high-quality randomized, double-blind controlled trials are needed to evaluate its efficacy. https://inplasy.com/inplasy-2021-12-0125/, identifier: INPLASY2021120125.

P-119 Factors affecting male-to-female ratio at birth in IVF/ICSI cycles

Abstract Study question Are there any factors during an IVF cycle that can influence the ratio of male or female preimplantation embryos? Summary answer Semen preparation technique significantly influences the male-female ratio of newborns through IVF-ICSI with a greater proportion of boys with gradients and girls with swim up. What is known already Although some works have related the fertilization technique or the transfer of blastocysts with the male-female ratio in those born through assisted reproduction, there are limited studies that investigate the relationships of the various factors involved during an IVF/ICSI cycle with the ratio male-female at birth. Furthermore, the number of studies that looked at the effect of embryo morphokinetics in sex ratio at birth, produced contradictory results. Study design, size, duration Retrospective, multicenter study at seven reproductive units belonging to the same center in Spain. The study included 202 patients who underwent IVF/ICSI treatment between January 2022 and December 2022, ensuring that 100% implantation was obtained. All cycles were accomplished with time-lapse, and the transfers were performed at the blastocyst stage. The sex was confirmed at birth. Participants/materials, setting, methods Sex ratios of 223 live births were compared regarding to fertilization method (IVF or ICSI), age, culture medium, embryo morphokinetics (t2, t3, t4,t5,tM,tSB,tBc,cc2,s2), twinship, origin of oocytes and sperm, embryo quality and sperm preparation technique (swim-up vs gradients). The Student’s T test was used for metric variables and the χ2 test for dichotomous variables (p &amp;lt; 0.05). To assess if the rest of the metric variables influenced sex, the Kolmogorov-Smirnov test and the Pearson test were used. Main results and the role of chance 223 live births were obtained: 181 single births after the transfer of one blastocyst and 42 double births of the same sex after the transfer of two blastocysts. Among the 223 newborns included in the study, a statistically significant predominance (p &amp;lt; 0.05) of males was found: 58.3% (95%CI:51.8-64.8%) of boys (n:130) compared to 41.7% (95%CI:35.2-48.2%) of girls (n :93). The mean age of the patients was 38.3 years (SD: 4.87), with no significant differences found regarding the sex ratio, as well as with the fertilization technique (p = 0.937), culture medium (p = 0.096), twinning (p = 0.222), the origin of the oocytes (p:0.608), the origin of the semen (p:0.721) and embryo quality (P:0.186). A statistically significant relationship was found between the sex of the newborn and the semen preparation technique (62.1% of male with gradients versus 32.1% with swim up, p:0.003), which was confirmed using a multivariate binary logistic regression model (p:0.0200). Analyzing each of the parameters obtained from the time lapse with respect to the sex of the newborns in a univariate manner with Student’s T for independent samples no significant differences were found in the division times studied or in the times of the cell cycle and synchrony. Limitations, reasons for caution The main limitation is the necessity of a larger sample size and to further investigate the reasons for these results. Further studies with standardized culture conditions and well-justified inclusion criteria are needed to reach robust and reliable conclusion. Wider implications of the findings While the study needs for more extensive sample size for future research, is the first time to suggest that method of sperm preparation may have an impact on the sex ratio at birth. Understanding which factors within ART process can affect sex ratio remain important considerations. Trial registration number not applicable

Utilization of Ureteral Access Sheath in Retrograde Intrarenal Surgery: A Systematic Review and Meta-Analysis.

Background and Objectives: This paper evaluates the efficacy and safety of ureteral access sheath (UAS) utilization in retrograde intrarenal surgery (RIRS). Materials and Methods: We searched PubMed, Embase, and the Cochrane Library up to 30 August 2023. The inclusion criteria comprised English-language original studies on RIRS with or without UAS in humans. The primary outcome was SFR, while the secondary outcomes included intraoperative and postoperative complications, the lengths of the operation and the hospitalization period, and the duration of the fluoroscopy. Subgroup analyses and a sensitivity analysis were performed. Publication bias was assessed using funnel plots and Egger's regression tests. Dichotomous variables were analyzed using odds ratios (ORs) with 95% confidence intervals (CIs), while mean differences (MDs) were employed for continuous variables. Results: We included 22 studies in our analysis. These spanned 2001 to 2023, involving 12,993 patients and 13,293 procedures. No significant difference in SFR was observed between the UAS and non-UAS groups (OR = 0.90, 95% CI 0.63-1.30, p = 0.59). Intraoperative (OR = 1.13, 95% CI 0.75-1.69, p = 0.5) and postoperative complications (OR = 1.29, 95% CI 0.89-1.87, p = 0.18) did not significantly differ between the groups. UAS usage increased operation times (MD = 8.30, 95% CI 2.51-14.10, p = 0.005) and fluoroscopy times (MD = 5.73, 95% CI 4.55-6.90, p < 0.001). No publication bias was detected for any outcome. Conclusions: In RIRS, UAS usage did not significantly affect SFR, complications, or hospitalization time. However, it increased operation time and fluoroscopy time. Routine UAS usage is not supported, and decisions should be patient-specific. Further studies with larger sample sizes and standardized assessments are needed to refine UAS utilization in RIRS.

Radiologic-Pathologic Correlation: Is There an Association Between Contrast-Enhanced Mammography Imaging Features and Molecular Subtypes of Breast Cancer?

This study aims to assess the correlation between imaging features of contrast-enhanced mammography (CEM) and molecular subtypes of breast cancer. This is a retrospective single-institution study of patients who underwent CEM from December 2019 to August 2023. Each patient had at least one histologically proven invasive breast cancer with a core biopsy performed. Patients with a history of breast cancer treatment and lesions not entirely included in the CEM images were excluded. The images were interpreted using the American College of Radiology Breast Imaging Reporting and Data System (ACR BI-RADS) lexicon for CEM, published in 2022. Different imaging features, including the presence of calcifications, architectural distortion, non-mass enhancement, mass morphology, internal enhancement pattern, the extent of enhancement, and lesion conspicuity, were analyzed. The molecular subtypes were studied as dichotomous variables, including luminal A, luminal B, HER2, and basal-like. The association between the imaging features and molecular subtypes was analyzed with a Fisher's exact test. Statistical significance was assumed when the p-value was <0.05. A total of 31 patients with 36 malignant lesions were included in this study. Sixteen lesions (44.4%) were luminal A, four lesions (11.1%) were luminal B, 10 lesions (27.8%) were HER2, and six (16.7%) were basal-like subtypes. The presence of calcifications was associated with the HER2 subtype (p=0.024). Rim-enhancement on recombined images was associated with a basal-like subtype (p=0.001). Heterogeneous enhancement on recombined images was associated with non-basal-like breast cancer (p=0.027). No statistically significant correlation was found between other analyzed CEM imaging features and molecular subtypes. CEM imaging features, including the presence of calcifications and certain internal enhancement patterns, were correlated with distinguishing breast cancer molecular subtypes and thus may further expand the role of CEM.

Mortality Risk of Low BMI in Life Insurance Applicants.

-This study seeks to quantify the mortality effect of low levels of body mass index (BMI) on life insurance applicants who, based on their laboratory profile and other information, appear to be suitable for life insurance coverage. -It has been demonstrated that low BMI is associated with higher mortality risk than normal or near-normal BMI. -Data were collected from over 4.7 million life insurance applicants with available BMI tested between 1995 and 2021, and vital status was assessed via the Social Security Death Master File. Cox models treating BMI as continuous and as a categorical variable were constructed, controlling for age, and split by sex after excluding those with laboratory or biometric test results, which were far enough outside the normal range to imply elevated mortality. -Models treating BMI as a continuous variable and allowing an interaction term for age showed that low BMI was strongly associated with mortality at ages 50 and above in both sexes. In the categorical models, only the lowest category of BMI (below the 1st percentile) in men aged 40-60, the lowest 2 categories (below the 5th percentile) in women aged 40-60, and the lowest 3 categories (below the 10th percentile) in those aged 60-80 years, were significantly associated with elevated mortality. No elevated mortality was detected in those under age 40 with low BMI. -Based on this study, low BMI is associated with elevated mortality in otherwise healthy applicants, but this association is dependent on age.