Female BMI Research Articles

Anterior cruciate ligament reconstruction in the over-50s. A prospective comparative study between surgical and functional treatment

IntroductionIn patients aged over-50 years, although data are sparse, results of anterior cruciate ligament (ACL) surgery are good if selection is correctly performed. However, non-operative treatment is usually proposed for this age group, as patients generally prefer just to scale down their sports activities. Non-operative results are acceptable, but with a high risk of residual instability, secondary lesions and lifestyle alteration. The main aim of the present study was to compare results between surgical versus non-surgical treatment of ACL tear in over-50 year-olds. Secondary objectives comprised assessing prognostic factors for poor functional outcome, and comparing the 2 groups epidemiologically to identify clinical decision-making factors. The study hypothesis was that results are comparable between operative and non-operative treatment of ACL tear. Material and methodThree hundred twenty patients were followed up prospectively: 92 non-surgical (NS group) and 288 surgical (S group). Classical epidemiological data were collected. Clinical laxity, differential laximetry, KOOS, IKDC, Tegner and ACL-RSI scores and radiologic assessment were collected pre- and postoperatively, as were intraoperative data. Early and late complications were collected. ResultsAll patients were followed up. Patients were principally female, and were older, less athletic, with more stable knee and less severe functional impact in the NS group. Functional scores improved in both groups, and especially in group S, where sports scores were also better. In the NS group, laximetry at follow-up correlated with preoperative marked pivot-shift (p=0.024). Severe differential laxity was predictive of poor IKDC score (p=0.06). In the S group, laximetry at follow-up correlated with preoperative explosive pivot-shift (p<0.001), lateral meniscal lesion (p=0.007), use of hamstring tendon (p=0.007), and non-operated early complications (p=0.004). Factors for poor global KOOS score in group S comprised female gender (p<0.001), high BMI (p<0.001) and skiing (p=0.038). Factors for poor Tegner scores comprised skiing or team sport (p<0.05), isolated moderate medial osteoarthritis (p=0.01), and non-operated early complications (p=0.022). Factors for poor IKDC score comprised female gender (p=0.064), and non-operated early complications (p=0.019). Complications did not differ between groups. Discussion/ConclusionResults were satisfactory in both groups, with significant improvement in functional scores, but were better in group S. For NS patients, pivot sport was barely feasible and sports activity scores decreased. In case of severe laxity at diagnosis, surgical treatment should be proposed. Level of evidenceIII; non-randomized prospective comparative series.

O-153 Is paternal age associated with timing, stage, morphology, and implantation of the competent blastocyst: a multicenter cohort study

Abstract Study question Is age of men undergoing assisted reproductive technology associated with timing, stage, morphology, and implantation of the competent blastocyst? Summary answer Advanced paternal age was associated with reduced development speed and level of hCG in the competent blastocysts in COS treatments. What is known already We have shown that for every one-year increase in women’s age there is a 5% reduced probability that the competent blastocyst is in an advanced development stage. Likewise, we have shown that the initial hCG rise is associated with women’s age with the youngest women having the lowest hCG level. It is unknown whether the age of men undergoing ART treatment is associated with the timing (day 5 or 6), the development stage, morphology, and the early implantation of the competent blastocyst. Study design, size, duration This is a multicenter historical cohort study based on data from 16 private and university-based public fertility clinics where 7246 men and women, between 2014 and 2018, underwent controlled ovarian stimulation (COS) or Frozen-thawed Embryo Transfer (FET) with a single blastocyst transfer resulting in a singleton pregnancy. These data were linked to the Danish Medical Birth Registry, resulting in inclusion of 4842 men with a partner giving birth. Participants/materials, setting, methods Exposure (age) and outcome data (blastocyst timing (day 5 or 6), development stage (3-6), inner cell mass (ICM)(A,B,C), trophectoderm (TE)(A,B,C) and hCG were collected from the database, Danish Medical Data Center. All COS cycles (IVF and ICSI) and FET cycles (natural and substituted), were included. Exclusion criteria were cycles with pre-implantation genetic testing, donated oocytes and semen. The analyses were adjusted for female age, female smoking, female BMI, diagnosis and clinic. Main results and the role of chance The adjusted association between paternal age and transfer day in COS treatments showed that for every increase of one year, men had a 6% increased probability that the competent blastocyst was transferred on day 6 compared to day 5 (OR 1.06, 95% CI (1.00;1.13). The mean difference in hCG values when comparing paternal age group 30-34, 35-39 and 40-45 with the age group 25-29 in those receiving COS treatment, all showed significantly lower adjusted values for older men. In FET treatments, none of the investigated associations reached statistical significance. Limitations, reasons for caution The blastocyst morphology was subjectively assessed, and information bias may have influenced the results. However, adjusting for clinic takes the potential influence of variation in embryo scoring between clinics into consideration. Wider implications of the findings We hypothesize that the later transfer (day 6) in female partners of older men is likely to be due to longer time spent by the oocyte to repair fragmented DNA of the sperm cells, which should be a focus of future research in men. Trial registration number “not applicable”

P–665 Influence of premature progesterone elevation on embryo development

Abstract Study question Does a serum progesterone level higher than 1.3 ng/mL on the day of ovulation trigger have an impact on blastocyst development? Summary answer Elevated progesterone level has no significant impact on top blastocyst rate, usable blastocyst rate and on morphokinetics. What is known already Premature elevation of progesterone level on the day of ovulation trigger prior to IVF is common and causes a decrease in endometrial receptivity. A freeze all strategy is then recommended. However, cumulative live birth rates have also been described as lower in cases of high progesterone levels. Study design, size, duration This was a retrospective bicentric cohort follow-up study, including 1150 IVF/ICSI cycles performed between 2016 and 2018 with at least 1 day–5 blastocyst available for transfer or freezing. Among these cycles, 524 were performed with use of a time-lapse system (Embryoscope). Serum Progesterone level was measured on the day of ovulation trigger, and a value &amp;gt;1.3 ng/ml was used to identify premature progesterone elevation. Participants/materials, setting, methods The cycles were divided into 2 groups according to serum progesterone level: 1335 cycles were allocated in the normal progesterone group (P &amp;lt; 1,3) and 215 in the progesterone premature elevation group (P &amp;gt; 1.3). Patient’s characteristics, ovarian stimulation characteristics, IVF cycles characteristics and embryology parameters were anonymously recorded and compared between the 2 groups. Main results and the role of chance Female age, smoking status, AFC and AMH levels were comparable between the 2 groups. Female BMI was significantly higher in the P &amp;lt; 1,3 than in the P &amp;gt; 1.3 group (26.1 versus 24.7 kg/m² respectively). Total FSH dose, estradiol level, number of follicles &amp;gt;11mm and number of retrieved oocytes were significantly higher in the P &amp;gt; 1.3 group than in P &amp;lt; 1.3 group No difference was observed between the 2 groups in terms of top blastocyst rate per mature oocyte and usable blastocyst rate per mature oocyte. When morphokinetic analysis was available, time to blastulation was the only significantly different parameter between the 2 groups (110.4 hours in P &amp;lt; 1.3 versus 107.9 hours in P &amp;gt; 1.3, p = 0.04). Cumulative live birth rate per cycle was not statistically different between the two groups (23.1% for P &amp;lt; 1.3 versus 28.7% for P &amp;gt; 1.3) (p &amp;gt; 0.05). Limitations, reasons for caution The retrospective design of the study should lead to careful analysis of the results. The progesterone threshold refers to a specific assay, and should not be generalized to other assays. Wider implications of the findings: Premature elevation of serum progesterone level on the day of ovulation trigger does not seem to affect embryo developmental competence. This further supports the relevance of freeze all strategy in this situation. Trial registration number Not applicable

P–246 Oocyte degeneration after ICSI is not an indicator of live birth in young women

Abstract Study question To investigate whether oocyte degeneration after intracytoplasmic sperm injection (ICSI) is an indicator for predicting the cumulative live birth rate. Summary answer The presence of oocyte degeneration after ICSI is not an indicator for predicting the cumulative live birth rate per OPU cycle in young women. What is known already Oocyte degeneration may be associated with decreased embryo quality for embryo development kinetics was disturbed. No differences in clinical outcomes such as implantation rate or clinical pregnancy rate were found in fresh embryo transfer cycles in retrospective studies. Study design, size, duration This was a retrospective cohort study, including all the oocyte retrieval cycles from young women who underwent ICSI from January 2018 to December 2019 at the Reproductive Medicine Center of the First Affiliated Hospital of Sun Yat-sen University. Participants/materials, setting, methods The inclusion criteria were as follows: female age was younger than 35 years; the first or second oocyte retrieval cycles ;the number of oocyte retrieval was between 8 and 20; all the cycles performed fresh embryo transfer on day 3 after insemination. Cycles with at least one oocyte degenerated after ICSI were defined as the oocyte degeneration group (OD group), and cycles with no oocyte degenerated after ICSI were defined as the non-OD group Main results and the role of chance There were no significant differences with regards to implantation rate (38.5% vs 35.1%, P = 0.302), clinical pregnancy rate (54.9% vs 50.3%, P = 0.340), and live birth rate per OPU cycle (47.0% vs 42.9%, P = 0.395) between OD and non-OD groups. Initial gonadotropin dosage, E2 level on hCG day and the number of matured oocytes appeared to be independent risk factors for OD, after adjustment for female age, female BMI, duration of gonadotropin administration, FORT, number of retrieved oocytes and different technicians. The adjusted odds ratio of live birth rate per OPU cycle were similar in subgroups with different oocyte degeneration rates. The ongoing pregnancy/live birth rate per transfer in FET cycles was not significantly different between OD group and non-OD groups (38.8% vs 43.9%, P = 0.439). The cumulative live birth rate per OPU cycle was also comparable between the OD group and non-OD group (63.4% vs 64.8%, P = 0.760). Limitations, reasons for caution The time interval for the follow-up was not long enough for all the frozen embryos to be transferred. Moreover, the retrospective nature of the study introduces the potential to include confounding variables that may bias our results, although we performed multiple logistic regression analysis to minimize these effects. Wider implications of the findings: The presence of oocyte degeneration is not an indicator for predicting the cumulative live birth rate per OPU cycle in young women. Initial gonadotropin dosage, E2 level on hCG day and the number of matured oocytes appeared to be independent risk factors for oocyte degeneration. Trial registration number none

O-221 Stage and morphology of the competent blastocyst are associated with pregnancy and birth outcomes; a multicenter cohort study

Abstract Study question Do stage and morphology of the competent blastocyst associate with initial hCG rise, gestational age, preterm birth, child birth weight, length, and child sex? Summary answer Higher stage, TE- and ICM-scores associated with higher hCG-rise; ICM- and TE-scores associated with length at birth, and higher stage and TE-score associated with boys. What is known already Many studies have focused on the developmental stage and morphology of the blastocysts in order to find biomarkers of competence to improve the efficacy of assisted reproduction technology treatment. In contrast, the associations between blastocyst assessment score parameters (individually or by combined score) and perinatal outcome have only been reported in few and smaller single center studies, and conflicting results have been presented. In the present study, we focused on the in vitro cultured blastocyst leading to a live birth and how the stage and morphology of these competent blastocysts relate to implantation and birth outcomes. Study design, size, duration Multicenter historical cohort study based on exposure (blastocyst stage (1-6) and morphology (trophectoderm (TE) and inner cell mass (ICM): A,B,C)) and outcome data (serum human chorionic gonadotrophin (hCG), gestational age, preterm birth, child weight, length, and sex) from women undergoing single blastocyst transfer resulting in singleton pregnancy and birth. Data from 16 private and university-based facilities for clinical services and research from 2014 to 2018 was included. Participants/materials, setting, methods 7246 women, who underwent ovarian stimulation or Frozen-thawed-Embryo-Transfer with single blastocyst transfer resulting in singleton pregnancy were identified. Linking to the Danish Medical Birth Registry resulted in a total of 4842 women with live birth being included. Initial serum hCG value (IU/L) (11 days after transfer), gestational age (days), preterm birth (%) child weight (grams), length (cm) and sex. The analyses were adjusted for female age, BMI, smoking, center, diagnosis, parity, gestational age and sex. Main results and the role of chance Higher mean initial hCG was consistently positively associated with higher developmental stage (p &amp;lt; 0.001), TE (p &amp;lt; 0.001) and ICM score (p = 0.02); for stage 6, TE (A) and ICM (A): 508.4, 436.5 and 428.5 IU/L, respectively. No differences between blastocyst morphology (stage, TE, ICM), gestational age (mean 276.6 days), preterm birth (8.3%) and birth weight (mean 3461.7 gram) were statistically significant. While stage showed no association with length at birth (mean 51.6 cm), length at birth between blastocysts with a TE score C and a TE score A were statistically significant (mean difference 0.5 cm (0.07;0.83)) as was the length at birth between blastocysts with an ICM score B and C compared to score A, mean differences respectively 0.2 cm (0.02;0.31) and 0.5 cm (0.03;0.87). Stage and TE, but not ICM were associated with the sex of the child. Blastocysts transferred with stage score 5 compared to blastocysts transferred with score 3 had a 33% increased probability of being a boy (OR 1.33 (1.08;1.64)). Further, TE score B blastocysts compared to TE score A blastocysts had a 28% reduced probability of being a boy (OR 0.72 (0.62;0.82)). Limitations, reasons for caution The assessment scores of the blastocystś stage and morphology were based on subjective evaluation, and information bias may have influenced the results. By adjusting for center, we took the potential variation in scoring between clinics into considerations. Wider implications of the findings Stage and morphology of the competent blastocyst was associated with initial hCG rise suggesting an effect on implantation, which may be used in routine, everyday information to women and couples on the day of blastocyst transfer. Trial registration number j.nr.: VD-2018-282

One step further: randomised single-centre trial comparing the direct and afterload techniques of embryo transfer.

What are the differences in ease of use between two different embryo transfer (ET) techniques: the preload direct approach and the afterload approach. The afterload technique seems to reduce the rate of difficult ETs. Numerous published trials now document that the ET procedure has an impact on pregnancy and delivery rates after IVF. Difficult transfers should be avoided, as they reduce implantation and pregnancy rates. Preload direct ETs with soft catheters under ultrasound guidance is currently considered the best procedure. However, when using soft catheters, it is not known which technique is preferable or which one should be implemented to reduce the operator factor. This prospective randomised unblinded controlled clinical trial, included 352 ultrasound-guided ETs assigned to either direct ET or afterload ET, between September 2017 and March 2019. The sample size was calculated based on the historical rate of difficult ETs encountered between 2014 and 2015 with a direct ET procedure. The inclusion criteria were women 18-38 years old, with BMI between 18 and 28, receiving a single-thawed blastocyst transfer. The exclusion criteria were use of testicular sperm and preimplantation genetic testing (PGT) cycles. The primary outcome was the rate of difficult or suboptimal transfers defined as: advancement of the outer sheath (specific for the direct transfer), multiple attempts, use of force, required manipulation, use of a stylet or tenaculum, dilatation, or use of a different catheter. The secondary outcome was clinical pregnancy rate. A total of 352 frozen ETs were randomised, with 176 patients in each group. The two arms were homogeneous for female and male age, female BMI, duration of infertility, secondary infertility, previous deliveries or miscarriages, myomas, previous surgery to the uterine cavity, cycle day at ovulation trigger, freeze all cycles, first transfers, indication for treatment, endometrial preparation protocol and duration, endometrial thickness, and blastocyst grade at vitrification. Across the entire population, 85 (24.1%) ETs were defined as difficult. The rate of difficult transfers was significantly higher in the direct ET group than in the afterload group: 68 (38.6%) versus 17 (9.7%), respectively (OR 0.17, 95% CI 0.09-0.30, P < 0.001). The mean percentage in the rate of difficult transfers per operator was 22.5% (SD ± 14.5%), of which 36.1% (SD ± 23.4%) were in the direct group compared with 8.6% (± 8.2%) in the afterload group (P < 0.001). The difficult transfer rate among operators varied from 0 to 43.8% (0-77.8% in the direct group and 0 to 25.0% in the afterload group). The clinical pregnancy rates (42.0% vs 48.3%, P = 0.239 in the direct and afterload groups, respectively) were not significantly different between the groups. There were 18 experienced operators who participated in the trial. Conclusions about the pregnancy rate should not be generalised, since the sample analysis was not performed on this outcome and, although clinically relevant, the difference was not significantly different. The rate of difficult transfers was significantly higher in the direct ET group compared with the afterload ET group, although a wide variation was observed among operators. Further studies regarding the association between transfer technique and ART outcomes are required. No specific funding was sought and there are no competing interests. NCT03161119. 5 April 2017. 26 September 2017.

Acute and persistent symptoms in non-hospitalized PCR-confirmed COVID-19 patients

Reports of persistent symptoms after hospitalization with COVID-19 have raised concern of a “long COVID” syndrome. This study aimed at determining the prevalence of and risk factors for acute and persistent symptoms in non-hospitalized patients with polymerase chain reaction (PCR) confirmed COVID-19. We conducted a cohort study of non-hospitalized participants identified via the Danish Civil Registration System with a SARS-CoV-2-positive PCR-test and available biobank samples. Participants received a digital questionnaire on demographics and COVID-19-related symptoms. Persistent symptoms: symptoms > 4 weeks (in sensitivity analyses > 12 weeks). We included 445 participants, of whom 34% were asymptomatic. Most common acute symptoms were fatigue, headache, and sneezing, while fatigue and reduced smell and taste were most severe. Persistent symptoms, most commonly fatigue and memory and concentration difficulties, were reported by 36% of 198 symptomatic participants with follow-up > 4 weeks. Risk factors for persistent symptoms included female sex (women 44% vs. men 24%, odds ratio 2.7, 95% CI 1.4–5.1, p = 0.003) and BMI (odds ratio 1.1, 95% CI 1.0–1.2, p = 0.001). In conclusion, among non-hospitalized PCR-confirmed COVID-19 patients one third were asymptomatic while one third of symptomatic participants had persistent symptoms illustrating the heterogeneity of disease presentation. These findings should be considered in health care planning and policy making related to COVID-19.

P635 Assessment of sarcopenia and nutritional status in a cohort of patients with Crohn’s disease

Abstract Background Altered body composition may negatively impact on the clinical outcome and quality of life of patients with IBD. Sarcopenia, defined as a progressive loss of skeletal muscle mass and function, is commonly observed in patients with IBD and can be reliably assessed by computed tomography (CT) which allows accurate and reproducibile quantification of both abdominal adipose tissues (subcutaneous and visceral), as well as skeletal muscles. We aimed to assess the prevalence of sarcopenia in Crohn’s disease (CD) patients undergoing contrast-enhanced CT(CECT). We further investigated the associations of sarcopenia with visceral fat parameters, disease severity and surgery Methods 40 CD patients (22F, aged 44±16 yrs; BMI 20.8±3.7) who underwent CECT for clinical assessment were retrospectively enrolled. CECT was performed using a 64-rows multi-detector equipment after i.v. injection of non ionic iodinated contrast media with a tailored scan delay. Demographic and clinical data were collected at the date of abdominal CT. Clinical outcome included the rate of surgery within one year. The skeletal muscle index (SMI) at the level of third lumbar vertebra was used to assess sarcopenia defined as a SMI&amp;lt;38.5cm2/m2 in women and &amp;lt;42cm2/m2 in men (Fig1).Clinical malnutrition was defined by a BMI&amp;lt;18.5 kg/m2, while visceral obesity as a visceral fat area ≥130cm2 Results Mean duration of disease was 117 months ± 84. Most patients 60% had a moderate-severe clinical activity based on Harvey Bradshaw index (HBI) &amp;gt;8, whereas 35% had a mild activity (HBI 5–7) and 5% were in remission (HBI&amp;lt;5). Overall, 17(42.5%) patients were sarcopenic. In detail, 14 out of 22 (63.6%) females and only 3 out of 18 (16.6%) males (p=0.04). The majority (65%) had moderate activity of inflammation with a mean of HBI 9.2 ± 1.6. Malnutrition occurred in 41,2% sarcopenic patients with a mean BMI of 16.5±3.75. A significant correlation was observed between BMI and sarcopenia (r=0.4,p&amp;lt;0.001). A total of 25 (62.5%) patients underwent surgery within one year. Among them, 40% patients were sarcopenic, while 60% non sarcopenic (p=0.7). In the total population the mean of visceral fat was 48,03±58.04 and only 4 patients had a visceral fat area ≥104 cm2. The ratio between visceral fat and subcutaneous fat area (VFA/SFA) was 0,57±0.5. The correlation between SMI and visceral fat was significant (r=0.4,p=0.02),while it was not significant with VFA/SFA (p=0.7). For all IBD patients, univariate analysis revealed that female sex (p=0.002) and low BMI (p=0.003) were significantly associated with sarcopenia Conclusion Approximately 42.5%CD patients were sarcopenic. Female sex and low BMI were significantly associated with sarcopenia but this latter did not correlate with the clinical outcome

A systematic review and meta-analysis on the incidence of osteoporosis and fractures after liver transplant.

Following liver transplant (LT), osteoporosis is a severe complication that causes morbidity. However, the incidence and risk factors of osteoporosis and fractures have not been well described. Single-arm meta-analysis of studies reporting osteopenia, osteoporosis, and fractures post-LT was performed with meta-regression for study period. Dichotomous variables, continuous variables and time-to-event variables were pooled in odds ratio, weighted mean difference and hazard ratio, respectively. For risk factors with limited data, a systematic review of literature was conducted. There was a significant increase in both osteoporosis and fractures compared to non-LT patients. Osteopenia, osteoporosis and incident fractures were newly diagnosed in 34.53% (CI: 0.17-0.56, n=301), 11.68% (CI: 0.05-0.24, n=1251) and 20.40% (CI: 0.13-0.30, n=4322) of LT patients, respectively. Female gender (P=0.017) increased risks of osteoporosis but not older age and BMI. Older age, lower pre-LT bone mineral density (BMD), presence of bone disease pre-LT were significant risk factors for fractures but not female gender, post-menopausal state, BMI, smoking and alcohol. There is a high incidence of skeletal complications post-LT. Older age, lower pre-LT BMD and presence of bone disease pre-LT are significant risk factors that are associated with incident fractures physicians should be cognisant of in liver transplant recipients.

POS1197 IN DEPTH IDENTIFICATION OF RISK FACTORS FOR SEVERE COVID-19, REQUIRING HOSPITALIZATION, IN PATIENTS WITH INFLAMMATORY RHEUMATIC DISEASES: RESULTS OF A DUTCH NESTED CASE CONTROL STUDY (PRELIMINARY RESULTS)

Background:Several risk factors for severe COVID-19 have been identified1. An important question is whether in addition to these generic risk factors, patients with a potentially altered immune response, either by disease (inflammatory rheumatic diseases (IRDs)) or use of immunomodulatory agents (IA), carry a higher or lower risk of severe COVID-19. In addition, several other potential risk factors for severe COVID-19 have been suggested, such as vitamin D status and specific medication (NSAIDs, ACE-inhibitors)2.Objectives:To identify risk factors for severe COVID-19, requiring hospitalization, in patients with IRDs.Methods:Multicenter, unmatched nested case control study in four rheumatology centers in the Netherlands. Cases are IRD patients requiring hospitalization for COVID-19 between March 1st 2020 and May 31st 2020. Control patients are IRD patients not hospitalized for COVID-19 within this period and were included in a 1:4 ratio. Patient-, disease- and treatment characteristics were extracted (still ongoing) from electronic patient files, and a questionnaire was used to collect additional data (e.g. on behavioral aspects). Potential risk factors for severe COVID-19 were analyzed using unconditional logistic regression, corrected for confounders.Results:77 cases and 198 controls were included. 26 case patients died as a result of COVID-19, 14 were admitted to the ICU. Crude ORs for female sex, age, BMI and presence of one or more comorbidities were 0.46 (95% CI 0.27-0.29), 1.1 (95%CI 1.0-1.1), 1.0 (95%CI 0.98-1.1) and 3.0 (95%CI 1.7-5.2) respectively. Table 1 displays corrected OR, highlighted when OR &lt;0.5/&gt;2.0. Corrected ORs were not significantly increased for any IRD, but a trend for gout was present. Use of hydroxychloroquine (HCQ) shows a protective effect, while use of other csDMARDs than methotrexate or HCQ leads to a higher risk of severe COVID-19. Trends were present for increased risk for rituximab (RTX), glucocorticoids and ACE inhibitors, and protective effect for IL-6R blockers.Conclusion:The outcomes of this study are in agreement with other research regarding risk of severe COVID-19 related to IRDs and use of IA1. The suggested increased risk of severe COVID-19 in RTX use is of concern and should be monitored closely. Strengths of this study include low bias due to behavioral effects as only cases early in the pandemic were included, completeness of the determinants of interest and ultimately, it provides answers to a relevant and urgent question.

Altered alcohol consumption during COVID-19 pandemic lockdown

BackgroundSince the onset of the COVID-19 pandemic in December 2019, many countries around the world have imposed lockdown measures in order to reduce virus spread. Social isolation is known to have a significant psychological impact, potentially triggering alcohol misuse in adults. In our study, we aimed to investigate the effect of COVID-19 lockdown measures on alcohol consumption in adults in Bavaria.MethodsIn this cross-sectional study, we enrolled 2067 participants, with 1961 young adults (mean age 23.3 ± 4.1) and 106 mature adults (mean age 66.7 ± 9.7). Participants were asked to complete a standardized questionnaire, semi-quantitatively evaluating the alcohol drinking behaviour before and during the pandemic lockdown.ResultsAfter implementation of lockdown, the alteration of alcohol consumption was significantly different between young and mature adults (p < 0.001). Among young adults, 42% reported unchanged drinking behaviour compared to 76% in the mature adult group; 44% of young adults reported to drink less compared to only 7% of mature adults. An increase in alcohol consumption was only reported by 14% of young adults and 17% of mature adults. Interestingly, in the entire cohort, the change of alcohol intake was most pronounced among moderate drinkers (> 0 to < 5 drinks/week) in both age groups (p < 0.001). Ordinal logistic regression revealed female sex, low BMI and younger age to be associated with a decrease in number of self-reported drinks/week.ConclusionThe COVID-19 pandemic lockdown significantly affected alcohol drinking behaviour. Further studies exploring long-term effects on potential alcohol misuse and the relevance on public health are warranted.Trial registrationThe study was retrospectively registered at ClinicalTrials.gov (NCT04361877) on April 24, 2020.

Is a ‘culture of plus-size women’ the independent effect of neighborhood disadvantage on female BMI? A cross-sectional study in two Chilean Municipalities

Research has shown that neighborhood disadvantage has an effect on BMI that is independent of individual disadvantage, much more pronounced in women than in men. The mechanisms that explain this gender-specific effect are not yet clear. Since women's body size dissatisfaction is closely linked to gender differences in BMI inequalities, the independent effect of neighborhood disadvantage on female BMI may relate to a local culture of acceptance of female large bodies, that could influence women's parameters for body size dissatisfaction. This study explored how the relation between female BMI, neighborhood income, individual income and education is influenced by body size dissatisfaction in a random sample of 882 women aged 20–60 that reside in two Chilean Municipalities. Data have a two level structure (women nested in 17 neighborhoods); it was collected by direct survey, height and weight were measured with portable instruments. Disadvantaged neighborhoods house mainly poor and low educated women, whereas the wealthier ones were inhabited mostly by affluent women with postsecondary education. The proportion of women without a husband/partner and with more than three children in disadvantaged neighborhoods was higher than better off areas. Multilevel linear regression showed that neighborhood disadvantage had an effect on female BMI that was independent of women's income and education, which was explained by body size dissatisfaction. The mean BMI for body size satisfaction among women in disadvantaged neighborhoods was 2 kg/m2 higher than in affluent areas, which suggests that a ‘culture of plus-size women’ would emerge in urban clusters of poverty. The findings signal that neighborhood effects on BMI would relate to the socioeconomic polarization of urban areas, with marked concentrations of poverty and wealth, and might be explained by the psychosocial pathways associated to social disadvantage that act in addition to the effects of material conditions to influence people's health.

When One Autoimmune Condition Predisposes You to Another!

Introduction: Lymphocytic hypophysitis (LYH) is an autoimmune condition in which pituitary gland is infiltrated by lymphocytes, plasma cells and macrophages. It is more common in pregnant and postpartum women, presenting with headache, visual field changes and one or more pituitary hormone impairment.Case Presentation: 32year-old female recently diagnosed with RA complicated by uveitis, presented to our facility with headache, shortness of breath, blurred vision and dysphagia. MRI head revealed a 1.9cm sellar mass with suprasellar extension displacing the optic chiasm. There was clear thickening of the pituitary stalk which raised suspicion for autoimmune hypophysitis. Exam in the ED revealed an anxious female wit hypertension, tachycardia and BMI 30. The rest of the physical exam was unremarkable. Her pituitary gonadal axis workup revealed panhypopituitarism with TSH 0.01uIU/ml, FSH <0.3Miu/ml, LH <0.3mIU/ml, ACTH <5pg/ml, IGF-1 31ng/ml and prolactin 14.4ng/ml. She was started on prednisone 50mg daily and on levothyroxine 150mcg daily. On day 2, she developed polyuria and the work up revealed a serum sodium of 146 meq/L, serum osmolality 315mOsm/kg, urine osmolality 281mOsm/kg and urine output 5.6L in 24hrs. The diagnosis of DI was made and she was started on desmopressin. On day 7, the serum sodium normalized and she did not require any other dose of desmopressin. On the day of discharge, a repeat MRI head was done which showed reduced enhancement of the pituitary which was reassuring.Discussion: LYH is a neuroendocrine disorder characterized by autoimmune inflammation of the pituitary gland with various degrees of pituitary dysfunction. Associated autoimmune diseases are seen in 18%– 50% of cases of AH. The most commonly-associated disease is autoimmune thyroid disease (15%–25%), while concurrent autoimmune conditions including RA are reported as well. Homogenous symmetrical enlargement of the pituitary gland, a thickened non deviated stalk, and a prompt, intense and homogenous enhancement of the mass after gadolinium contrast are the characteristic findings on MRI. Spontaneous resolution is the usual course and surgery is indicated only when the symptoms of sellar compression are serious and progressive.Conclusion: LYH is predominantly a disease of young females. We present this case in order to create awareness about the co-existence of LH with other autoimmune conditions and its usual course of regression with steroids.

Prevalence and associated factors of fatigue in autoimmune myasthenia gravis

Fatigue is usually defined as a subjective perception of lacking energy, mentally or physically, with a difficulty sustaining voluntary activities. It is a common symptom of many diseases and most likely has a multifactorial cause. In myasthenia gravis (MG), fatigue has a high prevalence and is correlated with female sex and disease severity. However, no large scale studies have been performed. Therefore, we aimed to evaluate fatigue in the Dutch participants (n = 420) of the Dutch-Belgian Myasthenia Patient Registry using an online survey. Additional information was obtained on mood, sleep, coping, quality of life, disease severity, physical activities and medication. Severe fatigue was present in 62% with a mean score of 37.1 ± 13.2 points. Fatigue severity and prevalence increased significantly with disease severity. A positive correlation was found for female gender, BMI, disease severity and depressive symptoms. A negative correlation was found for strenuous physical activities and older age. The strong association with disease severity suggests that fatigue should be recognized as an element of the symptomatology of MG. The observed association between strenuous activity and fatigue and differences in coping style between fatigued and non-fatigued patients warrant future clinical trials on exercise and cognitive behavioral therapy.

Predictive Factors forLive Birth in Fresh In Vitro Fertilization/Intracytoplasmic Sperm Injection Treatment in Poor Ovarian Reserve Patients Classified by the POSEIDON Criteria.

The mechanisms underlying poor ovarian response (POR) in assisted reproductive technology remain unclear, there is no consensus on the management of poor responders, the POSEIDON stratification classifies infertility patients into “expected” or “unexpected” groups to provide a more nuanced picture of POR, but few researchers have discussed the independent predictive factors (smoothed plots and the threshold effect) for live birth in POR patients classified by the new criteria. We conducted a retrospective cohort study using clinical data from 6,580 POR patients classified by the POSEIDON criteria in the First Affiliated Hospital of Zhengzhou University, and explored the live birth based on the results before and after the threshold inflection point of each independent influencing factor. Among 6,580 poor ovarian reserve patients classified by the POSEIDON criteria, 1,549 (23.54%) had live births, and 5,031 (76.46%) did not have live births. Multivariate logistic regression analysis showed that female age (OR 0.901; 95% CI 0.887~0.916; P < 0.001), body mass index (OR 0.963; 95% CI 0.951~0.982; P < 0.001), antral follicle counting (OR 1.049; 95% CI 1.009~1.042; P < 0.001) and controlled ovarian hyperstimulation protocol were independent factors predicting live birth in patients with POR. The threshold effect analysis found that the inflection point of female age was 34 years old, and when age was > 34 years old, the probability of live birth in POR patients dropped sharply (OR 0.7; 95% CI 0.7~0.8; P < 0.001). The inflection point of BMI was 23.4 kg/m2, and BMI had a negative correlation with live birth (OR 0.963; 95% CI 0.951~0.982; P < 0.001). The threshold inflection point of AFC was 8n. Female age, BMI, AFC and COH protocol were independent predictive factors associated with live birth in POR patients classified by the POSEIDON criteria. The smooth curve fit and threshold effect analyses provide clinical management strategies for these patients. In addition, the early-follicular-phase long-acting GnRH-agonist long protocol seems to have a higher live birth rates than other protocols. It is worth highlighting that BMI should be considered as well in the POSEIDON criteria.

Effects of interleukin-1 antagonism and corticosteroids on fibroblast growth factor-21 in patients with metabolic syndrome

Fibroblast growth factor-21 (FGF21) is elevated in patients with the metabolic syndrome. Although the exact underlying mechanisms remain ill-defined, chronic low-grade inflammation with increased Interleukin-(IL)-1β expression may be responsible. The aim of this study was to investigate effects of two different anti-inflammatory treatments (IL-1 antagonism or high-dose corticosteroids) on FGF21 in patients with the metabolic syndrome. This is a secondary analysis of two interventional studies in patients with obesity and features of the metabolic syndrome. Trial A was an interventional trial (n = 73) investigating short-term effects of the IL-1 antagonist anakinra and of dexamethasone. Trial B was a randomized, placebo-controlled, double-blinded trial (n = 67) investigating longer-term effects of IL-1 antagonism. In total, 140 patients were included in both trials. Median age was 55 years (IQR 44–66), 26% were female and median BMI was 37 kg/m2 (IQR 34–39). Almost half of the patients were diabetic (45%) and had increased c-reactive protein levels of 3.4 mg/L. FGF21 levels correlated with fasting glucose levels, HOMA-index, C-peptide levels, HbA1c and BMI. Short-term treatment with anakinra led to a reduction of FGF21 levels by − 200 pg/mL (95%CI − 334 to − 66; p = 0.004). No effect was detectable after longer-term treatment (between-group difference: − 8.8 pg/mL (95%CI − 130.9 to 113.3; p = 0.89). Acute treatment with dexamethasone was associated with reductions of FGF21 by -175 pg/mL (95%CI − 236 to − 113; p < 0.001). Anti-inflammatory treatment with both, IL-1 antagonism and corticosteroids reduced FGF21 levels at short-term in individuals with the metabolic syndrome.Trial registration: ClinicalTrials.gov Identifiers NCT02672592 and NCT00757276.

PREDICTORS OF THE SUPERNOVA (SUPERNORMAL VASCULAR AGING) PHENOMENON IN POPULATION-BASED SAMPLE

Objective: It is known that chronological age can be different from biological age. Supernormal vascular aging (SUPERNOVA) - can be diagnosed in subjects who present an exceptionally low arterial stiffness for their age. The aim of our study was to identify the factors associated with the SUPERNOVA in subjects from population-based Saint Petersburg sample. Design and method: As a part of all-Russian epidemiology survey ESSE-RF random sampling of 1600 Saint-Petersburg inhabitants stratified by age and sex was recruited. Anthropometry, blood pressure measurement and fasting blood-tests: glucose, lipids, C-reactive protein, insulin was performed according to standard protocols. HOMA IR was used as a marker of insulin resistance. Carotid–femoral pulse wave velocity (PWV) was performed by SphygmoCor (AtCor). SUPERNOVA phenomenon was detected in case of equal or less than 10 percentile of PWV for healthy individuals in each age group [European Heart Journal. 2010. Vol. 31. P. 2338–2350]. Results: PWV was performed in 524 individuals, SUPERNOVA was revealed in 55 (10.5%). Cardiovascular (CV) risk predictors were compared in different age groups. In the group of people 25–39 years old, there were no significant differences in CV risk factors between subjects with the SUPERNOVA and other persons. In the group of 40–49 years old, individuals with SUPERNOVA had significantly lower SBP (p = 0.036), BMI (p = 0.042), HDL (p = 0.021) comparing with others. In the 50–59 years old, among SUPERNOVA subjects there were more often females (p = 0.029), significantly lower were: SBP (p = 0.032), BMI (p = 0.009), HDL (p = 0.002), HOMA IR (p = 0.039) and higher adiponectin (p = 0.045). In the oldest age group: 60–69 years old, those with SUPERNOVA also had significantly lower SBP (p = 0.006) and DBP (p = 0.005), total cholesterol (p = 0.009), LDL (p = 0.016), triglycerides (p = 0.025) and significantly higher adiponectin (p = 0.014). Conclusions: It seems that at young age the presence of the SUPERNOVA phenomenon is not determined by the presence of traditional CV risk factors. Starting from middle age (&gt; = 40 years old) such factors as female gender, SBP, BMI, HDL and adiponectin is associated with supernormal vascular aging. In the oldest group the levels of both SBP and DBP, lipids acquire the greatest importance for the presence of SUPERNOVA.

Asymptomatic Bacteriuria among Pregnant Women Attending Tertiary Care Hospital in Lucknow, India

Introduction: Asymptomatic bacteriuria (ASB) is the presence of actively multiplying bacteria within the urinary tract with absence of any symptoms, resulting in adverse pregnancy outcomes. This research study was done in order to review prevalence, antimicrobial susceptibility profile, and factors associated with ASB occurring in female patients who are pregnant and being treated at a tertiary care hospital in Lucknow, India. Method and Materials: This is a cross-sectional study done among 216 pregnant women attending a hospital for antenatal check-ups. Clean catch midstream urine samples were collected and examined microscopically, and semi-quantitative culture was done on blood agar and MacConkey agar. Isolates were identified by colony morphology and biochemical tests, and antimicrobial susceptibility testing was done by using the Kirby-Bauer method. Results: Of the 216 pregnant women, 36 (16.7%) tested positive for ASB. The female gestational period, haemoglobin level, and BMI were significantly associated with ASB. Logistic regression also showed that higher haemoglobin level was less likely to ASB (AOR = 0.42, 95% confidence interval: 0.202–0.88, p = 0.021). The predominant and usual isolates were E. coli (n = 22, 61.1%), followed by Cons (n = 6, 16.7%), and S. aureus (3, 8.3%). All Gram-negative isolates were mostly sensitive to most of the drugs like piperacillin-tazobactam, cefepime, nitrofurantoin, and meropenem but were 100% resistant to ampicillin. Similarly, Gram-positive isolates were sensitive to ampicillin, vancomycin, linezolid, and nitrofurantoin but 100% resistant to co-trimoxazole. Conclusion: The present study shows the existence of ASB was 16.7% among women who are pregnant. Pregnancy duration, haemoglobin level, and BMI were significantly associated with ASB. The isolates identified more frequently were E. coli (61.16%), Cons (16.7%), and S. aureus (8.3%). All isolates which were Gram-negative were mostly sensitive to most of the drugs but were 100% resistant to ampicillin. Similarly, Gram-positive isolates were sensitive to most of the drugs but 100% resistant to co-trimoxazole.

Substantial Weight Gain in Adulthood Is Associated with Lower Probability of Live Birth Following Assisted Reproduction

BackgroundOverweight and obesity among women have been associated with lower success of assisted reproduction technologies (ARTs). However, the relation of adolescent body weight and adult weight change to ART outcomes is not well understood. ObjectivesOur objective was to evaluate the associations of female BMI (in kg/m2) at 18 y and weight change from 18 y to current age with ART outcomes. MethodsWe included 486 women in a prospective cohort at the Massachusetts General Hospital Fertility Center (2004–2018) who underwent 863 ART cycles. At study entry, height and weight were measured by research personnel. Women recalled their weight at 18 y. Restricted cubic splines were used to evaluate the associations between BMI at 18 y and weight change since 18 y and ART outcomes adjusting for age, race, education, smoking, and height and accounting for the correlated cycles within women. ResultsWomen had a median (range) BMI of 20.6 (14.8 to 36.4) at 18 y and 23.3 (16.1 to 45.8) at study entry. The median (range) weight change since 18 y was 7.4 kg (−12.1 to 60.1 kg). There was no association between BMI at 18 y and clinical ART outcomes. Long-term weight change had a nonlinear association with live birth such that higher weight gain since 18 y (particularly ≥15 kg) and weight loss were both associated with lower odds of live birth. The negative association between weight change and live birth was stronger in women ≥22.5 kg/m2 at 18 y such that each 10-kg increase was associated with a 30% (6%, 48%) lower odds of live birth. ConclusionsWeight gain in adulthood is negatively associated with ART success, particularly among women who were heavier at 18 y. These results add to the growing literature supporting the benefits of preventing weight gain in adulthood on female fertility.

Perturbations of morphogenesis at the compaction stage affect blastocyst implantation and live birth rates

Do perturbations of embryo morphogenesis at compaction affect blastocyst development and clinical outcomes in assisted reproduction cycles? Cell exclusion and extrusion, i.e. cell disposal occurring respectively before or during morula compaction, affect blastocyst yield and quality, as well as rates of pregnancy and live birth. Despite its pivotal role in morphogenesis for blastocyst organisation and cell fate determination, compaction at the morula stage has received little attention in clinical embryology. Time lapse technology (TLT) allows detailed morphokinetic analysis of this developmental stage. However, even in the vast majority of previous TLT studies, compaction was investigated without a specific focus. Recently, we reported that compaction may be affected by two clearly-distinct patterns of cell disposal, exclusion and extrusion, occurring prior to and during compaction, respectively. However, the crucial question of the specific relevance of partial compaction for embryo development and competence in ART has remained unanswered until now. This study involved the assessment of laboratory and clinical outcomes of 2,059 morula stage embryos associated with 1,117 ICSI patients, who were treated with minimal stimulation and single vitrified-warmed blastocyst transfer (SVBT) from April 2017 to March 2018. Patterns of morula compaction were assessed and analyzed in relation to embryonic and clinical outcomes. Following ICSI, time-lapse videos were analysed to annotate morphokinetic parameters relevant to both pre- and post-compaction stages. According to their morphokinetic history, morulae were classified as: (I) fully compacted morulae (FCM); (II) partially compacted morulae (PCM), showing cells (a) excluded from the compaction process from the outset (Exc-PCM), (b) extruded from an already compacted morula (Ext-PCM), or (c) showing non-compacted cells arisen from both patterns (Exc/Ext-PCM). The number of excluded/extruded cells was also annotated. Possible correlations of compaction patterns with 13 morphokinetic parameters, abnormal cleavage, blastocyst yield and morphological grade, clinical and ongoing pregnancy rates, and live birth rate were evaluated. Other factors, such as patient and cycle characteristics, possibly associated with compaction patterns and their outcomes, were investigated. Full compaction was observed in 39.0% of all embryos. However, partially compacted morulae (PCM) showing excluded (Exc-PCM), extruded (Ext-PCM) cells, or indeed both phenotypes (Exc/Ext-PCM) were frequently detected (24.8%, 16.6%, and 19.6%, respectively) and collectively (61%) exceeded fully compacted morulae. Blastomere exclusion or extrusion affected one or several cells, in different proportions. In comparison to FCM, the developmental pace of the three PCM groups, observed at 13 developmental stages starting from pronuclear fading, was progressively slower (P < 0.0001). Developmental delay at post-compaction stages was more pronounced in the group showing both patterns of partial compaction. Blastomere exclusion and/or extrusion had a large negative impact on blastocyst development. In particular, rates of blastocyst formation and cryopreservation were very low in the Ext-PCM and Exc/Ext-PCM groups (P < 0.0001). Rates of blastocysts with ICM or TE of highest quality (Grade A) were severely affected in all PCM groups (P < 0.0001). In 1,083 SVBTs, blastocysts derived from all PCM groups produced much lower clinical pregnancy, ongoing pregnancy, and live birth rates (P < 0.0001). All three patterns of partial compaction emerged as factors independently associated with live birth rate, even after multivariate logistic regression analysis including maternal/paternal age, female BMI, and number of previous embryo transfers as possible confounding factors. The retrospective design of the study represents a general limitation. This large-scale study represents a further important demonstration of embryo plasticity and above all indicates new robust morphokinetic parameters for improved algorithms of embryo selection. This study was exclusively supported by the participating institutions. The authors have no conflicts of interest to declare. NA.