Distribution Of Scores Research Articles

Quality of Life of Post-Stroke Patients in Aceh, Indonesia

Introduction: The quality of life of stroke survivors is a major concern for healthcare providers due to the physical, psychological, and social issues caused by stroke. This study aims to identify the quality of life of post-stroke patients undergoing outpatient treatment at the neurology clinic of the General Hospital of South Aceh Regency, Indonesia. Methods: This research uses a cross-sectional study design with a sample of 120 respondents. All post-stroke patients undergoing treatment at the clinic were included in the study. Data were collected through face-to-face interviews at the specialized stroke clinic from January to March 2024. The research instrument used was the Indonesian version of the Stroke-Specific Quality of Life (SS-QoL) questionnaire, which has been validated. The reliability test of the SS-QoL resulted in a Cronbach’s Alpha value of 0.920. Data analysis was conducted using a descriptive approach, including frequency distribution, percentage, standard deviation, and SS-QoL scale score distribution. Results: The study found that the majority of stroke patients' quality of life was in the good category, amounting to 77.5%. The quality of life domain indicated that personality was the worst dimension (mean=3.13, SD=0.762), while family role, social role, mood, and energy were the best domains (mean=4.13, SD=0.766). Conclusion: The quality of life of stroke patients undergoing outpatient treatment at the Neurology Clinic of South Aceh General Hospital is predominantly in the good category. Interventions focusing on personality aspects need to be enhanced to further improve patients' quality of life.

The burden of adverse drug reactions reported by patients in the Dutch ADR monitor: a proof of concept

ABSTRACT Background We aimed to describe the burden of adverse drug reactions (ADRs) reported by patients participating in the Dutch ADR Monitor using a multifactorial burden measurement instrument. Methods The Dutch ADR Monitor is a cohort event monitoring system that collects information on ADR experiences, including burden. This study includes the initial data (November 2022 until May 2023). Patients were asked if experienced ADRs impacted seven domains of burden: appearance, medical treatment, daily life, fatigue, physical consequences, mental consequences, and the course of ADRs. Burden was scored from 0 to 10 on impacted domains. The distributions of these burden scores were demonstrated in Likert plots. The burden between persistent and recurrent ADRs was compared. Results Ninety-two patients reported 199 ADRs. Impacts on the domain fatigue and daily life were experienced most frequently, except for skin and subcutaneous tissue ADRs, where impacts on appearance and mental consequences were experienced most frequently. Fatigue was considered the most burdensome domain. No difference in burden was found between persistent (median = 7, IQR = 4) and recurrent ADRs (median = 6, IQR = 4, p = 0.59). Conclusions This is the first study investigating burden of ADRs on seven domains in patients with chronic diseases. Impact on the domain fatigue was considered most burdensome.

Endovascular thrombectomy for acute ischaemic stroke with established large infarct (TENSION): 12-month outcomes of a multicentre, open-label, randomised trial

Long-term data showing the benefits of endovascular thrombectomy for stroke with large infarct are scarce. The TENSION trial showed the safety and efficacy of endovascular thrombectomy in patients with ischaemic stroke and large infarct at 90 days. We aimed to investigate the safety and efficacy at 12 months of endovascular thrombectomy in patients who were enrolled in the TENSION trial. TENSION was an open-label, blinded endpoint, randomised trial done at 40 hospitals across Europe and one hospital in Canada. We included patients (aged ≥18 years) with acute ischaemic stroke due to large vessel occlusion in the anterior circulation and who had a large infarct, as indicated by an Alberta Stroke Program Early Computed Tomographic Score (ASPECTS) of 3-5 on standard-of-care stroke imaging. We randomly assigned patients (1:1) to receive either endovascular thrombectomy with medical treatment or medical treatment only up to 12 h from stroke onset. The primary outcome was functional outcome across the entire range of the modified Rankin Scale at 90 days. Here, we report the prespecified 12-month follow-up analyses for functional outcome (using the simplified modified Rankin Scale questionnaire), quality of life (using the Patient-Reported Outcomes Measurement Information System 10-item [PROMIS-10] and EQ-5D questionnaires), post-stroke anxiety and depression (using the Patient Health Questionnaire-4 [PHQ-4]), and overall survival. Outcomes (except survival) were assessed in the intention-to-treat population; the survival analysis was based on treatment received. This trial is registered with ClinicalTrials.gov, NCT03094715, and is completed. We enrolled patients between July 17, 2018, and Feb 21, 2023, when the trial was stopped early for efficacy. 253 patients were randomly assigned, 125 (49%) to endovascular thrombectomy and 128 (51%) to medical treatment only. Median follow-up was 8·36 months (IQR 0·02-12·00). Endovascular thrombectomy was associated with a shift in the distribution of scores on the modified Rankin Scale towards better functional outcome at 12 months (adjusted common odds ratio 2·39 [95% CI 1·47-3·90]). Endovascular thrombectomy was also associated with a better quality of life compared with medical treatment only, as reflected by median scores on the EQ-5D questionnaire index (0·7 [IQR 0·4-0·9] vs 0·4 [0·2-0·7]), median scores for health status on the EQ-5D questionnaire visual analogue scale (50 [IQR 35-70] vs 30 [5-60]), and median global physical health scores on the PROMIS-10 questionnaire (T-score 39·8 [IQR 37·4-50·8] vs 37·4 [32·4-44·9]); although there was not enough evidence to suggest a difference between groups in global mental health scores on PROMIS-10 (41·1 [IQR 36·3-48·3] vs 38·8 [31·3-44·7]) or the numbers of patients reporting anxiety (13 [22%] of 58 vs 15 [42%] of 36) and depression (18 [31%] vs 18 [50%]) on PHQ-4. Overall survival was slightly better in the endovascular thrombectomy group compared with medical treatment only (adjusted hazard ratio 0·70 [95% CI 0·50-0·99]). In patients with acute ischaemic stroke from large vessel occlusion with established large infarct, compared with medical treatment only, endovascular thrombectomy was associated at 12 months after stroke with better functional outcome, quality of life, and overall survival. These findings suggest that the benefits of endovascular thrombectomy in patients with an ischaemic stroke and a large infarct are sustained in the long term and support the use of endovascular thrombectomy in these patients. European Union Horizon 2020 Research and Innovation Programme.

Building a composite score for patient self-report of flare in osteoarthritis: a comparison of methods with the Flare-OA-16 questionnaire

ObjectivesThis study aims to compare methods of constructing a composite score for the Flare-OA-16 self-reported questionnaire. MethodsParticipants with knee and hip osteoarthritis (OA) completed a validated 16-item questionnaire assessing five domains of flare. Three estimation methods were compared: (i) second-order confirmatory factor analysis (CFA); (ii) logistic regression, according to the participant's self-report of flare (yes/no); and (iii) Rasch method, with weighted scores in each dimension. The distribution (floor effect [FF] and ceiling effect [CF]) were described and the known-group validity (by self-reported flare) tested by Wilcoxon rank-sum test. Similarity between the scores was analyzed by intraclass correlation coefficient (ICC) and their performance against self-report compared by areas under ROC curves (AUC). Intrascore test-retest reliability at 14 days was assessed by ICC. ResultsIn a sample of 381 participants, 247 reported having a flare. CFA showed fit indices (comparative fit index [CFI] = 0.95; root mean square error of approximation [RMSEA] = 0.08) and estimated composite mean score = 4.33(SD = 2.85) (FF = 14.9%, CF = 0%). For the logistic regression estimation, the mean composite score was 6.48 (SD = 3.13) (FF = 0%; CF = 0%). With Rasch model, the mean composite score was 4.35 (SD = 2.60) (FF = 14.9%; CF = 0%). Similarity analysis indicated a greater concordance between CFA and Rasch scores (ICC = 0.98) than between logistic regression score and the two others (ICC = 0.88 with Rasch score and 0.90 with CFA score). The AUC indicated similar performance of all methods: logistic model (AUC = 0.89 [0.85–0.92]), CFA, and Rasch model (AUC = 0.86 [0.82–0.90]). The difference between groups was significant (P < .05) for scores estimated by CFA (3.98), Rasch model (4.95), and logistic regression (4.30). The reproducibility was ICC = 0.84 (0.75–0.90) for Rasch and CFA scores and ICC = 0.78(0.66–86) for logistic model. ConclusionThree alternatives explored to build a composite score showed similar construct validity. Some metric superiority (better score distribution and reproducibility) of the Rasch model is promising for the detection of occurrence and assessment of severity of a flare in OA.

The Predictive Performance of General Surgery Milestones on Post-Graduation Outcomes.

To establish whether Accreditation Council for Graduate Medical Education Milestones predict future performance of general surgery trainees. Milestones provide bi-annual assessments of trainee progress across six competencies. It is unknown whether the Milestones predict surgeon performance after the transition to independent practice. We performed a retrospective cohort study of surgeons with complete Milestone assessments in the fourth and fifth clinical years who treated patients in acute care hospitals within Florida, New York, and Pennsylvania, 2015-2018. To account for the multiple ways in which the Milestone assessments might predict post-graduation outcomes, we included 120 Milestones features in our elastic net machine learning models. The primary outcome was risk-adjusted patient death or serious morbidity. 278 general surgeons were included in the study. Milestone assessments 6-months into the fourth clinical year displayed a normal score distribution while multicollinearity and low score discrimination at the final assessment period were detected. Individual Milestones features from the Patient Care, Professionalism, and Systems-based Practice domains were most predictive of patient-related outcomes. For example, surgeons with worse patient outcomes had significantly lower scores in Patient Care 3 when compared to surgeons with better patient outcomes (High DSM, yes: 2.86 vs. no: 3.04, P=0.011). The Milestones features that were most predictive of better patient outcomes related to intraoperative skills, ethical principles, and patient navigation and safety, measured 12-18 months prior to graduation. The development of a parsimonious set of evidence-based Milestones that better correlate with surgeon experience could enhance surgical education.

Investigating The Relationship Between Sleep Quality, Adherence to Proper Sleep Hygiene Practices, And Academic Performance Among Students.

In this correlational study, the relationship between sleep quality, sleep hygiene, and academic performance among individuals aged 17- 24 years was investigated (200) utilizing correlation. Descriptive statistics showed normal distributions for Academic Performance, Sleep Quality, and Sleep Hygiene scores. Spearman’s rho correlation analyses showed a weak negative correlation between Academic Performance and Sleep Quality (ρ = -0.184, p = 0.009), proposing that higher Sleep Quality is related to slightly lower Academic Performance. Contrarily, no significant correlation was discovered between Academic Performance and Sleep Hygiene (ρ = -0.060, p = 0.393), suggesting that sleep hygiene practices alone do not affect academic outcomes. A moderate positive correlation was seen between Sleep Quality and Sleep Hygiene (ρ = 0.484, p &lt; 0.001), underscoring that good sleep hygiene led to higher Sleep Quality. These results emphasize the complex nature of the relation between sleep-related factors and academic performance, proposing the influence of multifaceted variables beyond sleep on academic outcomes. The study suggests comprehensive approaches combine various factors to optimize both academic performance and overall well-being. Future research should explore additional variables and employ longitudinal designs to elucidate causality and refine interventions aimed at advancement of sleep and academic performance.

Reliability assessment of distal occlusion eTICI scoring.

The eThrombolysis in Cerebral Infarction (eTICI) score has been validated in proximal large artery occlusion (pLAOs). Despite the growing number of distal medium vessel occlusions (DMVOs) mechanical thrombectomies (MT) and the widespread utilization of the eTICI scoring system, its reliability and standardization for more distal occlusions have not been validated. We aim to evaluate the interrater reliability of eTICI scores in primary DMVOs. This was a retrospective analysis of a prospectively maintained database for consecutive patients with pLAO and DMVO MT at a single comprehensive stroke center from 2015 to 2022. Two fellowship-trained neurointerventionalists blindly/independently assessed digital subtraction angiograms for final eTICI, followed by consensus reads for discrepancies. 59 DMVO of 2248 thrombectomies [M3:29(50%)/M4:1(2%)/A1:3(5%)/A2:12(22%)/A3: 5(9%)/P1:7(12%)/P2:1(2%)] and 124 pLAOs of 308 thrombectomies [i-ICA:13(11%)/MCA-M1: 111(90%)] were included. The distribution of final eTICI scores was comparable between pLAO vs DMVOs (p = 0.82). The pLAO final eTICI score assessment between two readers demonstrated moderate reliability with a kappa0.77 (95%CI: 0.67-0.88), while the DMVO eTICI score assessment exhibited almost-perfect agreement with kappa 0.94 (95%CI: 0.90-0.99). The agreement between the consensus read and the original report in DMVOs was 0.86 (95% CI: 0.71-1.00) while for pLAO it was 0.83(95% CI: 0.76-0.90). The performance of eTICI was comparable amongst different DMVO territories as well as for distal vs. very distal occlusions. eTICI score exhibited comparable performance for DMVO as compared to pLAO strokes. Further studies investigating DMVO eTICI grading and clinical outcomes are warranted.

Gender Distribution of Coronary Artery Calcium Score and Degree of Stenosis Assessed by Computed Tomography Angiography in Iraqi Patients with Chest Pain

Gender Distribution of Coronary Artery Calcium Score and Degree of Stenosis Assessed by Computed Tomography Angiography in Iraqi Patients with Chest Pain

Effects of Emergent Carotid Stenting Performed before or after Mechanical Thrombectomy in the Endovascular Management of Patients with Tandem Lesions: A Multicenter Retrospective Matched Analysis.

Mechanical thrombectomy (MT) along with emergent carotid stent placement (eCAS) has been suggested to have a greater benefit in patients with tandem lesions (TL), compared with other strategies of treatment. Nonetheless, there is no agreement on whether the intracranial occlusion should be treated before the cervical ICA lesion, or vice versa. In this retrospective multicenter study, we sought to compare clinical and procedural outcomes of the 2 different treatment approaches in patients with TL. The prospective databases of 17 comprehensive stroke centers were screened for consecutive patients with TL who received MT and eCAS. Patients were divided in 2 groups based on whether they received MT before eCAS (MT-first approach) or eCAS before MT (eCAS-first approach). Propensity score matching was used to estimate the effect of the retrograde-versus-anterograde approach on procedure-related and clinical outcome measures. These included the modified TICI score 2b-3, other procedure-related parameters and adverse events after the endovascular procedure, and the ordinal distribution of the 90-day mRS scores. A total of 295 consecutive patients were initially enrolled. Among them, 208 (70%) received MT before eCAS. After propensity score matching, 56 pairs of patients were available for analysis. In the matched population, the MT-first approach resulted in a higher rate of successful intracranial recanalization (91% versus 73% in the eCAS-first approach, P = .025) and a mean shorter groin-to-reperfusion time (72 [SD, 38] minutes versus 93 [SD, 50] minutes in the anterograde approach, P = .017). Despite a higher rate of efficient recanalization in the MT-first group, we did not observe a significant difference regarding the ordinal distribution of the 90-day mRS scores. Rates of procedure-related adverse events and the occurrence of both parenchymal hemorrhage types 1 and 2 were comparable. Our study demonstrates that in patients with TL undergoing endovascular treatment, prioritizing the intracranial occlusion is associated with an increased rate of efficient MT and faster recanalization time. However, this strategy does not have an advantage in long-term clinical outcome. Future controlled studies are needed to determine the optimal treatment technique.

Somatic symptoms in the general population of Spain: Validation and normative data of the Patient Health Questionnaire-15 (PHQ-15)

ObjectiveThe Patient Health Questionnaire (PHQ-15) has been widely used to assess somatic symptoms. This study aimed to analyze the psychometric properties of the Spanish version of the PHQ-15, its structure and score distribution across demographic variables in a Spanish sample. In addition, we examined variations in somatic symptoms among different demographic subgroups. Method1495 individuals from the Spanish population answered a series of self-reported measures, including PHQ-15. To examine the factorial structure of the PHQ-15, Confirmatory Factor Analysis (CFA) was performed. Additionally, a bifactor CFA model was examined using the Exploratory Structural Equation Modeling (ESEM) framework. ResultsWomen showed more somatic symptoms than men, and younger individuals showed more somatic symptoms than the older ones. It was also revealed positive associations between somatic symptoms and levels of depression, anxiety, and suspiciousness, while negative associations were found between somatic symptoms and perceived resilience and happiness. Regarding the factorial structure of the PHQ-15, although the one-factor and bifactor models were suitable, the bifactor model underscores the presence of a robust general factor. LimitationsIt is a cross-sectional study, not including non-institutionalized individuals. ConclusionSomatic symptoms are more frequent in women and younger individuals. Furthermore, the presence of physical symptoms is associated to other psychological aspects, such as depression or anxiety. Finally, bifactor model was the most appropriate to explain the factorial structure of the PHQ-15.

INTERASPIRE a global cross-sectional survey of secondary prevention of cardiovascular disease (CVD) across six WHO regions

Abstract Introduction This survey of secondary prevention of CVD was conducted through National Societies of Cardiology across all WHO regions and included Kenya, Nigeria, Tanzania, Argentina, Colombia, Egypt, UAE, Poland, Portugal, Indonesia, China, Malaysia, Philippines and Singapore. Purpose The overall aim of INTERASPIRE was to assess the clinical implementation of risk reduction initiatives to reduce cardiovascular risk in line with lifestyle, risk factor and therapeutic targets defined in international and national guidelines on CVD prevention. Methods A consecutive sample of patients (&amp;gt; 18 and &amp;lt; 80 years) admitted to public hospitals in selected regions within each participating country with an acute ST elevation myocardial infarction (MI), Non-ST elevation MI, acute myocardial ischaemia or for elective revascularisation was identified retrospectively from medical record systems. Patients were invited to attend a clinical visit with trained research assistants at least 6 months but not more than 2 years after their event. The assessment included self-reported smoking status validated with an expired breath carbon monoxide measurement, self-reported participation in physical activity using the Godin validated questionnaire and standardised measurements of height, weight, blood pressure, blood lipids and blood glucose including an oral glucose tolerance test. Results 4548 (21.1% women) patients attended the clinical visit. 12.6% were smoking with wide variation across countries (1.9 – 27.3%). 48% of those who were smoking at the time of hospital admission had continued to smoke. 66.5% reported being sedentary with wide variation across countries (51.3 – 90.5%). 24% were obese and 40% centrally obese with a large difference between men (32.3%) and women (69.4%). 38% achieved a blood pressure target of &amp;lt; 130/80 mmHg, 19.2% achieved an LDL-C target of &amp;lt; 1.4 mmol/l and in patients with self-reported diabetes 56% achieved a target HbA1c of &amp;lt; 53 mmol/mol (7%). In those who did not report having diabetes, a further 9.8% had undetected diabetes and 26.9% impaired glucose tolerance. 48% were prescribed all four classes of cardioprotective drugs (antiplatelets, beta blockers, ACE/ARB, lipid lowering agents) with wide variation between countries (25% - 75%) and 88.3% were prescribed both antiplatelets and lipid lowering agents. Only 1219 (26.8%) were advised to attend cardiac rehabilitation with wide variation (4.5% to 58.9%) between countries. Overall only 9.0% (men 9.1%, women 9.1%) of all patients attended cardiac rehabilitation. Figure 1 shows the distribution of the INTERASPIRE Guideline Target Score. Conclusion There is substantial room for improvement in secondary prevention in patients with coronary disease globally. It is of concern that only 9% of patients received cardiac rehabilitation despite it being a Class 1 recommendation in all prevention guidelines with wide variation in advice and uptake between countries.Figure 1

The possible benefit of artificial intelligence in an organized population-related screening program : Initial results and perspective

Mammography screening programs (MSP) have shown that breast cancer can be detected at an earlier stage enabling less invasive treatment and leading to abetter survival rate. The considerable numbers of interval breast cancer (IBC) and the additional examinations required, the majority of which turn out not to be cancer, are critically assessed. In recent years companies and universities have used machine learning (ML) to develop powerful algorithms that demonstrate astonishing abilities to read mammograms. Can such algorithms be used to improve the quality of MSP? The original screening mammographies of 251 cases with IBC were retrospectively analyzed using the software ProFound AI® (iCAD) and the results were compared (case score, risk score) with acontrol group. The relevant current literature was also studied. The distributions of the case scores and the risk scores were markedly shifted to higher risks compared to the control group, comparable to the results of other studies. Retrospective studies as well as our own data show that artificial intelligence (AI) could change our approach to MSP in the future in the direction of personalized screening and could enable asignificant reduction in the workload of radiologists, fewer additional examinations and areduced number of IBCs; however, the results of prospective studies are needed before implementation.

Examining the Effect of Birth Order on Neuroticism and Extraversion among Adolescents and Young Adults

This study investigates the influence of birth order on personality traits, specifically Neuroticism and Extraversion, among adolescents and young adults. A total of 120 participants aged between 14-25 years completed a survey distribution via Google Forms. The sample was evenly split into two groups: Elder children (First-born) and Younger children (Last-born), each comprising 60 individuals. The personality traits were assessed using Neuroticism and extraversion subscales of the Neo-Five Factor Inventory (NEO-FFI, Costa &amp; McCrae, 1992). Data analysis involved the use of a two-sample Kolmogorov-Smirnov (K-S) test to compare the distribution of Neuroticism and Extraversion scores between the two birth groups. The results indicate that there is no statistically significant difference in the distribution of Neuroticism and Extraversion traits between elder and younger children. These findings contribute to understanding how birth order is not the sole influence on neuroticism and extraversion among adolescents and young adults.

PHYSICAL DEVELOPMENT CHARACTERISTICS OF CHILDREN TREATED FOR BRAIN TUMOR AND HEALTHY SIBLINGS OF CANCER PATIENTS (A PILOT STUDY)

Introduction. In families with such a child his/her siblings often live, whose development will be affected by the current stressful situation for all family members. Siblings of cancer patients appear to be a psychological vulnerable group, as they have low self-esteem, fear of death and loneliness, anxiety, anger. The study aimed to assess the level of physical development (PD) of children, treated for brain tumors, and siblings of childhood cancer survivors, in relation to stressful circumstances of living in a family with an oncological relative. Material and methods. The study involved children aged 6 to 17 years who had completed treatment for a brain tumor (BT), as well as siblings of children with various cancer types. We measured 27 boys and 36 girls with BT, the sample of siblings included 26 boys and 31 girls. To assess the compliance of the level of PD of children of both groups with age standards, for each child of a given gender and age a centile corridor was determined by body length (BL) and BMI, and individual values of signs were ranked in Z-points, using WHO standards. A detailed questionnaire was conducted to assess some characteristics of a child's family environment. Statistics analysis was performed with Statistica 12 software package. Results. For a group of children with BT, a significant shift in the distribution of PD scores along body length and BMI towards low values was found, for a group of siblings, the opposite picture was obtained – the distribution of body length and BMI scores shifted to the higher values. It has been shown that higher developmental scores in body length are significantly more common in children who are older siblings in relation to patients with BT. Conclusion. Thus, brain tumor treatment affects not only the physical development of a child, but is a factor contributing to the growth processes of the body of siblings of children with BT. Siblings of cancer patients represent a special group of children, which indicates the need to take into account the special needs of all their family members in the process of treatment and rehabilitation, as well as the incorrectness of using siblings as a control group in scientific research.

The MID50 is not insensitive to the distribution of the change score if measurement error is taken into account.

The MID50 is not insensitive to the distribution of the change score if measurement error is taken into account.

A methodology for ranking of critical links in transportation networks based on criticality score distributions

Criticality of transportation networks links is calculated through utilizing criticality metric(s) for various disruption scenarios that generally include one link removal/degradation at a time or simultaneous removal/degradation of multiple links. As also shown in this paper, single link removals do not reveal the actual criticality of link(s) due to network dependencies. Multiple simultaneous link removal scenarios can capture the network interactions; however, the results relate to the criticality ranking of scenarios than the links, e.g., the links in scenario-1 are more critical than the links in scenario-2. This paper addressed the need for a methodology that provides individual link criticality rankings based on failure scenarios. The proposed approach utilizes the distribution of the criticality scores for each link based on running traffic assignment for each failure scenario, e.g., the distribution for link #X is composed of the criticality scores of all link failure combinations that include link #X. The criticality ranking for each link is identified based on its criticality distribution's mean, coefficient of variation and skewness. The use of the proposed approach is illustrated on test networks to show that it provides robust link criticality rankings that accounts for network interactions across varying scales of link failure scenarios.

Autistic traits in youth with familial adenomatous polyposis: A Dutch-Canadian case-control study.

This study investigated the neurodevelopmental impact of pathogenic adenomatous polyposis coli (APC) gene variants in patients with familial adenomatous polyposis (FAP), a cancer predisposition syndrome. We hypothesized that certain pathogenic APC variants result in behavioral-cognitive challenges. We compared 66 FAP patients (cases) and 34 unaffected siblings (controls) to explore associations between APC variants and behavioral and cognitive challenges. Our findings indicate that FAP patients exhibited higher Social Responsiveness Scale (SRS) scores, suggesting a greater prevalence of autistic traits when compared to unaffected siblings (mean 53.8 vs. 47.4, Wilcoxon p = 0.018). The distribution of SRS scores in cases suggested a bimodal pattern, potentially linked to the location of the APC variant, with scores increasing from the 5' to 3' end of the gene (Pearson's r = 0.33, p = 0.022). While we observed a trend toward lower educational attainment in cases, this difference was not statistically significant. This study is the first to explore the connection between APC variant location and neurodevelopmental traits in FAP, expanding our understanding of the genotype-phenotype correlation. Our results emphasize the importance of clinical assessment for autistic traits in FAP patients, shedding light on the potential role of APC gene variants in these behavioral and cognitive challenges.

P-611 Quantity or quality? Comparative study on the effectiveness of recombinant, purified and mixed gonadotropins on the outcome of ICSI treatments from an embryologist perspective

Abstract Study question Are oocyte retrieval and embryo development affected by the origin of the gonadotropins used for controlled ovarian stimulation (COS), when controlling fertilization and culture conditions? Summary answer Patients stimulated with recombinant gonadotropins obtained similar number of oocytes than those using purified hormones, but more blastocysts and better embryo morphology, needing lower doses. What is known already Many authors have questioned the safety of purified urinary gonadotropins used for COS prior to an IVF treatment, and have demonstrated the presence of impurities and a high heterogeneity between batches. Another strategy involves using recombinant follicle-stimulating hormone with/without luteinizing hormone (rFSH+/-rLH) synthetized in vitro. Many studies have compared the cost-effectiveness of these drugs; however, a conclusion has not been reached. These studies have varying inclusion criteria and focus on final endpoints such as pregnancy and live birth, sometimes lacking control over the many variables introduced during the fertilization and culture procedures, which affect embryo development and potential. Study design, size, duration Preliminary retrospective observational study performed over 453 patients subjected to COS prior to autologous ICSI treatments in a private clinic over 3 years, using Time-lapse incubator. The total dose employed, the number and maturity rate of the oocytes retrieved of patients subjected to stimulation with recombinant (RH; n = 46) or mixed hormones (MH; n = 332) were compared with those using purified hormones (PH; n = 75). After ICSI, fertilization and embryo development were also compared between the three groups. Participants/materials, setting, methods The stimulation protocol was adjusted for each patient following the standard protocols of the clinic. Fertilization was performed by ICSI and embryo culture was carried out in Geri time-lapse incubators using Geri Medium (Genea Biomedx). When available (1,097 embryos), Eeva-Xtend Test was applied. Statistical analysis was performed by generalized estimating equations (significance: P≤0.05). Considered confounders include age, body mass index, days of stimulation, down-regulation protocol, and other variables relevant to embryo development. Main results and the role of chance Proper follicle stimulation was achieved with lower doses of RH (1,606.26±1,110.52 IU) than PH (2,941.73±1,011.14 IU) and MH (3,629.68±1,080.79 IU). No association was found between the use of different gonadotropins and the number of oocytes collected (Odds ratio (OR, RH vs PH)=2.51, P=0.411; OR (MH vs PH)=1.26, P=0.754) or their maturity rate (OR (RH vs PH)=2.38, P=0.328; OR (MH vs PH)=1.01, P=0.988). No significant association was found between the odds of a correct fertilization and the type of hormone used. However, the odds of reaching blastocyst stage were statistically higher for embryos from patients treated with RH: OR (RH vs PH)=1.72, P=0.006; OR (MH vs PH)=1.45, P=0.005; blastocyst rate=68.7% RH, 61.9% MH and 54.6% PH. The mean morphological classification by ASEBIR criteria of the embryos was significantly better in the RH group than in the PH group (OR = 1.55, P=0.032), but no association was found in the MH-PH comparison (OR = 1.26, P=0.092). No association was found between the type of hormone and the distribution of the Eeva-Xtend scores. Significantly lower values of the morphokinetic parameter s2 (synchrony between the second and third cell divisions) were also associated with the use of RH (OR (RH vs PH)=0.311, P=0.004). Limitations, reasons for caution The reduced sample size and the heterogeneous number of patients in the three groups limit the statistical power of the comparisons. Different hormones and brands were included in each group. Wider implications of the findings Although not altering the number of oocytes retrieved, the use of RH may improve the chances of success of ICSI cycles by increasing the number of available blastocysts. The positive outcomes paired with the lower dose needed, could make the use of recombinant hormones a cost-effective strategy. Trial registration number Not applicable

P-554 Artificial intelligence (AI) for embryo genetic risk assessment: a novel form of preimplantation genetic screening

Abstract Study question Can an AI-based embryo ploidy screening tool effectively provide a genetic risk assessment on Day 5 embryos? Summary answer AI screening results showed strong predictive value for early detection of at-risk embryos warranting confirmatory diagnostic testing, based only on time lapse video assessment. What is known already Euploid embryo transfer is the dogma of IVF success. Embryo evaluation relies extensively on diagnostic preimplantation genetic testing for aneuploidy (PGT-A) by means of trophectoderm biopsy. Though pivotal, this presents substantial practical and financial limitations. There is demand for an alternative genetic screening method that provides a quantitative embryo genetic risk assessment for patients who opt out of invasive diagnostic testing, or who intend to undergo fresh transfer. These results can provide information for understanding your aneuploidy risk for more precise prognosis counseling and testing. This is important since diagnostic tests may incur excess financial burden, inconclusive outcomes, and time-to-results. Study design, size, duration Time lapse videos (N = 5,000) were used for AI training. The AI core architecture was a video transformer model for spatio-temporal video sampling. Known ploidy and live-birth results were used as ground truth, with maternal age and embryo quality scores incorporated as input parameters during calibrated logistic regression. A blind test dataset (N = 708 embryos; euploid=352; aneuploid=356; mean ± SD patient age: 35.9 ± 5.4 years) was used to evaluate predictive accuracy. Participants/materials, setting, methods The AI outputs a scalar (1-99) that associates with euploidy likelihood. The AI’s screening value was determined by its specificity (correct prediction of aneuploid), sensitivity (correct prediction of euploid), false positive, and false negative rate. We determined optimal AI score thresholds that identified high aneuploidy and euploidy risk categories (AI score &amp;lt;33; AI score &amp;gt;66, respectively). Main results and the role of chance Specificity of the AI screening test was 83.0%, with a sensitivity of 56.0%. The false positive rate was 26.7% and the false negative rate was 29.3%. The AI’s high specificity relative to its sensitivity shows its clinical value to deselect embryos with the strongest risk of genetic abnormality, and for the prioritization of embryos for confirmatory PGT. Boxplot visualization of the full AI score distribution showed successful discrimination between aneuploid and euploid embryos (mean AI score for aneuploid and euploid were 51.3 and 43.5, respectively) with appropriately minimized overlapping of the interquartile range. The optimal AI score thresholds for detecting embryos with the highest and lowest likelihoods of euploidy were &amp;gt;66 /&amp;lt;33, respectively, representing 71% likelihood of euploidy for the &amp;gt;66 group and 72% aneuploidy for the &amp;lt;33 group. Limitations, reasons for caution The screening does not provide diagnostic genetic testing on the chromosome level. The influence of mosaicism on the false positive/negative rates was not assessed. Wider implications of the findings Results support the use of an AI ploidy screening test for effective decision-making and triage of at-risk embryos for transfer or confirmatory diagnostic testing via PGT-A. Trial registration number Not applicable

Paper 07: Race and Income Influence Patient Outcomes After Multiligament Knee Injuries

Objectives: This study aimed to assess the influence of socioeconomic status (SES) variables on patient-reported outcomes and return to work following surgery for a multiligament knee injury. Methods: We retrospectively reviewed patients at our institution who underwent multi-ligament knee reconstruction between 2012 and 2022. SES variables of interest included median household income, occupation, race, sex, and marital status. International Knee Documentation Committee (IKDC) scores were used to assess clinical outcomes. Patients reported whether they had returned to work at final follow-up. Data was available for each SES variable for a subset of the cohort. Chi-square tests and Fisher exact tests were used to compare the proportion of patients who returned to work by race, sex, income, marital status, and job type (sedentary vs. nonsedentary) and to compare the proportion of patients with sedentary jobs within each demographic variable. Mann-Whitney U tests were used to compare the distribution of IKDC scores at final follow-up across the same demographic variables. Results: There were 144 patients with multiligament knee injuries for whom data on at least 1 SES variable was available with a median final follow-up of 3.2 years. Patients were 73.2% male with an average age of 38.8 years. Overall, 26.8% of patients were married and 56.1% of patients had sedentary jobs. Of the patients who were working before surgery (63% of the total cohort), 56.0% returned to work after surgery. There was a significant difference in the proportion of patients who had sedentary jobs by income (12.5% low income vs. 50.7% high income, p&lt;.001) and who returned to work postoperatively (16.7% low income vs. 75.0% high income, p=.016). Median IKDC scores for white patients were 78.0 versus 65.5 for Black/African American patients; the score distributions in the two groups differed significantly (p=.045). Patient reported outcomes were not significantly different by sex or marital status. Conclusions: Only about half of patients returned to work after multiligament knee injury surgery. White race and higher income were predictive of better patient-reported outcomes following surgery for multiligament knee injuries. Determining the extent to which SES variables influence these outcomes may lead to improvements in rehabilitation and follow-up for diverse patients. Studies with larger cohorts are needed for a more comprehensive comparison of SES variables.