Large Sample Research Articles

SCARF2 is a target for chronic obstructive pulmonary disease: Evidence from multi-omics research and cohort validation.

Age-related chronic inflammatory lung diseases impose a threat on public health, including idiopathic pulmonary fibrosis (IPF) and chronic obstructive pulmonary disease (COPD). However, their etiology and potential targets have not been clarified. We performed genome-wide meta-analysis for IPF with the largest sample size (2883 cases and 741,929 controls) and leveraged the summary statistics of COPD (17,547 cases and 617,598 controls). Transcriptome-wide and proteome-wide Mendelian randomization (MR) designs, together with genetic colocalization, were implemented to find robust targets. The mediation effect was assessed using leukocyte telomere length (LTL). The single-cell transcriptome analysis was performed to link targets with cell types. Individual-level data from UK Biobank (UKB) were used to validate our findings. Sixteen genetically predicted plasma proteins were causally associated with the risk of IPF and 6 proteins were causally associated with COPD. Therein, genetically-elevated plasma level of SCARF2 protein should reduce the risk of both IPF (odds ratio, OR = 0.9974 [0.9970, 0.9978]) and COPD (OR = 0.7431 [0.6253, 0.8831]) and such effects were not mediated by LTL. Genetic colocalization further corroborated these MR results of SCARF2. The transcriptome-wide MR confirmed that higher expression level of SCARF2 was associated with a reduced risk of both. However, the single-cell RNA analysis indicated that SCARF2 expression level was only relatively lower in epithelial cells of COPD lung tissue compared to normal lung tissue. UKB data implicated an inverse association of serum SCARF2 protein with COPD (hazard ratio, HR = 1.215 [1.106, 1.335]). The SCARF2 gene should be a novel target for COP.

P-775 What is the potential of cervicovaginal mucus as a biomarker for identifying the fertile window and the effectiveness of AI-enhanced prediction for scalability and accessibility?

Abstract Study question What is the potential of cervicovaginal mucus as a biomarker for identifying the fertile window and the effectiveness of AI-enhanced prediction for scalability and accessibility? Summary answer Cervicovaginal mucus is a reliable biomarker for the fertile window. AI Foundation models show promise in enhancing this method’s scalability and predictability. What is known already The timing of ovulation corrosponds to the fertile window. Although modern methods of ovulation detections yield high accuracies, they often require the purchase of sensors/equipment which creates a barrier to those in low-resource settings. Natural fertility awareness based methods, such as CVM monitoring, eliminate this problem, but there are limited recent large-scale studies validating cyclical CVM changes. Digitising CVM monitoring could remove the subjectivity of the interpretation of symptoms. Despite the advances of AI in other FABM areas, limited work has been done on computer vision models for CVM evaluation, which could revolutionise accessibility and scalability, particularly in low-resource settings. Study design, size, duration The study involved analysis of self-reported CVM characteristics data from over 57,000 individuals; largest sample size used in any study investigating the use of CVM as a biomarker. Furthermore, a dataset of CVM images were collected from the public survey and labeled manually (n = 13). The study included retrospective and pilot components, employing statistical analyses like ANOVA, chi-squared, and Spearman correlation, and AI techniques like zero-shot learning for binary segmentation of CVM from smartphone-captured images Participants/materials, setting, methods Self-reported CVM data was obtained from a fertility tracking app and analysed using ANOVA and chi-squared tests to identify and validate findings of cyclical variations, and correlation with lifestyle data. Zero-shot learning was employed using foundation models. An ethically-reviewed survey was generated to collect images for subsequent model training Images from the survey were segmented using the Grounding DINO and the SAM. The surface area and elasticity extracted are used to determine the fertility score. Main results and the role of chance In individuals with 28-day cycles, CVM showed significantly higher quality during the ovulatory phase, marked by increased elasticity (p = 0.00001), amount (p = 0.00001)), and lubricative texture (p < 0.0001), when compared to both the follicular and luteal phases. However, variations in individuals with longer, irregular cycles of over 35 days length, were less pronounced. Age was found to significant positive correlation with overall CVM quality (r = 0.06, p < 0.0001), while no significant correlations were observed with smoking (r = 0.11, p = 0.23), alcohol consumption (r = 0.13, p = 0.17), or BMI (r = 0.006, p = 0.41)). Zero-shot learning for segmentation showed improved accuracy in detecting and extracting CVM from images, with precision of 0.867 and F1 score of 0.929, highlighting the model’s ability to correctly distinguish between CVM patterns corresponding to fertile and infertile status. The intersection over union score suggested consistent model performance. Overall, CVM emerged as a scalable fertility biomarker in typical menstrual cycles, with AI models showing potential for enhancing prediction accuracy and scalability. Limitations, reasons for caution The study’s limitations include its reliance on self-reported CVM data and the potential bias in the foundation models as there was no fine-tuning, due to a small dataset (n = 13). Additionally, the effectiveness of CVM as a biomarker in irregular menstrual cycles and subfertility requires further exploration. Wider implications of the findings Automated analysis of CVM can be a low-cost, scalable (potentially to millions, via mobile application), non-invasive method for fertility awareness. Our findings highlight the potential of AI in empowering fertility awareness, especially in low-resource settings with little access to reproductive healthcare, thus contributing to global health equity. Trial registration number n/a

P-755 Effect of female age and specific cycle characteristics on success in modified natural frozen-thawed single euploid embryo transfer cycles (mNC/FET)

Abstract Study question Does the age of woman and specific cycle characteristics impact the success of modified natural frozen-thawed single euploid embryo transfer cycles (mNC/FET)? Summary answer The success rate of mNC/FET cycles is similar in all age groups. As the LH level increased ( above 23.5ng/dL) the success was significantly increased. What is known already The success of frozen embryo transfer can depend on various factors such as the patient’s age, the number of transferred embryos, the duration of embryo culture, and the method used to prepare the endometrium (Holschbach et al. 2023). However, there is currently insufficient evidence in the literature about the effect of age and cycle characteristics on the effectiveness of mNC/FET cycles in patients who have received single top and good quality euploid embryos. Study design, size, duration This study, conducted at Istanbul Memorial Hospital, ART and Reproductive Genetics Center, is a retrospective, single-centre analysis of 583 cycles of euploid mNC/FET in women aged 22-44 years. The study period was from July 2017 to January 2024. The cycles were divided into two groups based on the age of the women. Group A (n = 408) included women under the age of 38, while Group B (n = 175) included women aged 38 or above. Participants/materials, setting, methods The study investigated success predictors in mNC/FET with top and good-quality embryos. Excluded were women with recurrent pregnancy losses, recurrent implantation failure, high BMI (>35kg/m2), uterine/endometrial problems, severe male infertility, and autoimmune diseases. The mNC/FET success was a pregnancy lasting 12 weeks or more. The analysis included patient demographics and cycle outcomes. Chi-square, t-tests, and Mann-Whitney U tests assessed variables with a p-value < 0.005, indicating statistical significance. Main results and the role of chance No significant demographic differences were observed between the two groups, except for AMH levels. AMH levels were significantly higher in younger group than older group (3.02 ng/ml vs. 1.96 ng/ml, p = 0.000). The mNC/FET success rates were similar, with 76% in the younger group and 73% in the older group. Estradiol levels the day before trigger day were significantly higher in older group (278.02 pg/ml vs. 237.84pg/ml, p = 0.028). Both groups had similar mean LH levels (32.50 IU/L and 32.41 IU/L, respectively), estradiol levels and endometrial thickness on the trigger day. In the younger group, LH rise was observed later, follicular phase was longer, and embryo transfer day was later than the older group (p = 0.001). Univariate regression analysis revealed that increased LH level was an important independent variable in achieving mNC/FET success, with a 1.001-fold increase (p = 0.043). The LH levels of 23.5 IU/L or higher predicted high mNC/FET success with 60% sensitivity and 43% specificity based on the Receiver Operating Characteristic curve. (AUC: 0.606, %95 CI 0.540-0.671, p = 0.002). Prolonged infertility duration and previous ET failures reduced mNC/FET success by 0.889 and 0.544-fold, respectively (p = 0.002, p < 0.001). Higher β-hCG levels on days 14 and 16 increased mNC/FET success by 1.038-fold and 1.008-fold, respectively (p < 0.001). Limitations, reasons for caution Our study has limitations as it was retrospective. Prospective randomized studies are needed to evaluate the differences between the young (age <38) and old patient groups (age ≥38) based on mNC/FET success. The association between LH rise and mNC/FET success needs verification with a larger sample. Wider implications of the findings The mNC/FET success rates are similar in young (age <38) and old patient groups (age ≥38). However, prolonged infertility duration and previous failed ET cycles decreased the success of mNC/FET. Additionally, It is important to schedule trigger time after the optimum LH rise, which is 23.5 IU/L or higher. Trial registration number not applicable

P-424 Placental extracellular matrix remodelling in pregnancies by oocyte donation shows similarities with preeclamptic placenta: a pilot study

Abstract Study question Do stromal alterations occur during placentation upon heterologous assisted reproductive techniques (ART) and are they associated with a higher risk of developing preeclampsia? Summary answer The remodelling of extracellular matrix molecules, key for vascularization and immunity, is altered in pregnancies from oocyte donation and resembles the miss-regulations observed in preeclampsia. What is known already Preeclampsia represents one of the main causes of maternal and perinatal morbidity, affecting 2-8% of spontaneous pregnancies. Its incidence increases two times upon homologous ART and up to four times upon oocyte donation, however the underlying factors are still unknown. Preeclampsia is characterized by high blood pressure and endothelial cell dysfunction, but its pathogenesis is multifactorial relying on vascular, metabolic and immune alterations. All these elements are tightly influenced by the extracellular matrix (ECM) that, during an uneventful pregnancy, is remodelled to support an efficient placentation and immunotolerance. Despite its key functions, little is known regarding ECM remodelling in preeclampsia. Study design, size, duration This is an observational pilot study conducted over a 12 months period. Four groups were included: 1) pregnant women that underwent homologous ART (n = 7; HOM); 2) pregnant women that underwent oocyte donation (n = 10; OD); 3) women that conceived spontaneously affected by PE (n = 7); and 4) uneventful spontaneous pregnancies (n = 8; control group CTRL). Participants/materials, setting, methods For each patient placental samples have been collected upon delivery and processed to perform molecular and proteomic analysis by real time PCR and immunohistochemistry The statistical differences among the groups have been evaluated by the ANOVA and Mann-Whitney tests. Main results and the role of chance We focused our study on specific ECM elements known to modulate angiogenesis and immunity, two key players in preeclampsia occurrence. Our data indicated first that collagen I, collagen IV and Multimerin-2, important components of the vessel wall that contribute to vessel stabilization and efficiency, are significantly decreased in OD compared to HOM group (coll I P = 0.04; coll IV P = 0.043; Multimerin-2 P = 0.036). Next, we analyzed EMILIN-2 and versican, two ECM components exerting not only angiogenic but also immunomodulatory functions. We found that EMILIN-2 is decreased in OD compared to CTRL placentas (P = 0.043), whereas versican undergoes an opposite regulation, being slightly increased in the OD placentas (P = 0.045). We observed an analogous mis-regulation when comparing PE to the CTRL group, suggesting that these stromal alterations may take part in the establishment of a microenvironment more prone to preeclampsia onset and associate with the higher risk related to OD pregnancies. We also found that some features of ECM remodelling seem to be strongly associated with OD. Precisely, our data denoted that the glycoprotein tenascin-C decreased specifically in OD patients, while was comparable between HOM, PE and CTRL groups (P = 0.042). Limitations, reasons for caution The main limitation of this pilot study is the restricted number of patients. Further investigations on a larger sample and prospective cohort of patients might provide more robust data. Wider implications of the findings Our data highlighted for the first time that the placental stroma undergoes an altered remodelling in OD and PE pregnancies. We envision that a deep characterization of ECM will help better understanding of the mechanisms behind the pathogenesis of preeclampsia with possible implications for prediction and prevention. Trial registration number N/A

P-328 Uterine Fluid microbiome composition in fertile controls and infertile women

Abstract Study question Is the microbiome of the Uterine Fluid (UF) related to outcomes of frozen-thawed blastocyst transfer? Summary answer Microbiome of UF collected by double-sheated catheter shows Lactobacilli as the most abundant species but does not relate to outcomes of frozen-thawed blastocyst transfer. What is known already The microbiome of UF has been described to be largely dominated (>90%) by Lactobacilli and has been shown to be markedly associated with the outcomes of embryo transfer. Nonetheless, previous reports have not collected UF by avoiding vaginal/cervical contamination through a double-sheated catheter. Study design, size, duration Observational study conducted at Fondazione IRCCS Ca’Granda Ospedale Maggiore Policlinico and IRCCS Ospedale San Raffaele, Milan, Italy. n = 13 fertile controls underwent UF sampling in the pre-receptive (LH + 2) and receptive (LH + 7) phase of a monitored natural cycle and n = 48 infertile women underwent UF sampling on day LH + 7 of the monitored natural cycle preceding that of their first frozen-thawed blastocyst transfer. UF was sampled by aspiration with a double-sheated catheter (commonly used for embryo transfer. Participants/materials, setting, methods Microbiome analysis was conducted following the Illumina protocol for V3-V5 regions of the 16S rRNA and using the Illumina MiSeq instrument. Raw sequencing data processing encompassed quality controls, and QIIME 2 scripts were employed to obtain taxonomic abundances (taxonomic levels L2-L7). Alpha (within sample), and beta (among samples) diversity and differential expression at taxonomic level (using limma, Bioconductor library) were calculated. Main results and the role of chance UF microbiome analysis showed lack of separation between samples from the two Centres, confirming the reproducibility of the technique. UF microbiome was also found to be stable throughout the menstrual cycle, with no diversity observed between LH + 2 and LH + 7 samples in the population of fertile controls (p = 0.9, Adonis test on beta diversity; confirmed by differential abundance tests based on linear regression models at taxonomic levels). UF of fertile controls showed Lactobacillus Helveticus as the most abundant species (16.2%), followed by other Lactobacilli (unspecified) (12.1 %), Lactobacillus Iners (11.8%), Streptococcus (unspecified) (6.8%), Bifidobacterium (4.7%) and Gardnerella (1.9 %). In women who achieved successful implantation after FET, the most abundant species was L. Helveticus (58.1%) followed by L. Iners (9.8%), Acinetobacter lwoffii (5.9%) and other Lactobacilli (unspecified) (4.0%). No statistically significant differences were found in linear regression comparisons at taxonomic level with UF of women with failed implantation, in whom most abundant species were L. Helveticus (50.4%, p = 0.11), L. Iners (15.8%, p = 0.95), other Lactobacilli (unspecified) (13.7%, p = 0.17) and Garnderella (6.5%, p = 0.19). The proportion of Lactobacillus- dominated (>90%) samples was 50% (n = 10/20) in infertile women achieving successful implantation and 46% (n = 13/28) in infertile women with failed implantation (p = 0.8). Limitations, reasons for caution These results are preliminary and only include the first n = 48 patients of the total n = 249 patients that will be enrolled. A larger sample is required to further investigate possible relations between UF microbiome composition and implantation outcomes. Wider implications of the findings As UF microbiome was found to be stable between cycle phases and it is non-invasively collected, it could be analysed in the same cycle in which ET is scheduled. This might increase accuracy compared to current tests for endometrial receptivity, that have to be performed in the cycle before ET. Trial registration number RF-2019-12369460

P-507 Prediction of clinical efficacy of PGT-A based on maternal age and embryo quality in patients with recurrent implantation failure (RIF) or recurrent pregnancy loss (RPL)

Abstract Study question Can the utility of PGT-A be predicted by selecting embryos based on both maternal age and embryo quality in patients with RIF or RPL? Summary answer The predictive value of PGT-A can potentially be determined by assessing maternal age and embryo quality of experiencing patients with RIF or RPL. What is known already Embryo quality and euploid status are crucial determinants in selecting embryos for euploid embryo transfer to achieve a successful pregnancy. This is because embryos with high morphological scores may still exhibit aneuploidy, making morphologic evaluation alone limited. This limitation is particularly important in patients with a history of RIF and RPL. Aneuploidies occur during meiosis in the embryo and increase significantly with age, becoming a major contributor to implantation failure, leading to unsuccessful pregnancies, miscarriages, and congenital birth defects. Study design, size, duration This retrospective study, conducted at a single center, assessed embryo quality in 927 blastocysts derived from 221 cases of patients with RIF and 863 blastocysts derived from 204 cases of patients with RPL. The study spanned from January 2022 to November 2023. Blastocysts were scored using the KIDScore provided by the Embryoscope® time-lapse system (Vitrolife, Göteborg, Sweden) following the manufacturer’s protocols and subsequently underwent next-generation sequencing (NGS)-based PGT-A. Participants/materials, setting, methods A total of 927 RIF and 863 RPL patients’ blastocysts were analyzed, resulting in 256 and 242 euploid embryos, respectively, using NGS. Euploid embryos were classified by morphokinetics (good quality and medium quality) and maternal age groups (≤35, 36-37, 38-39, 40-41, 42-43, 44-45, ≥46). In RIF, 62.9% (161/256) of euploid embryos were classified as good quality, and 37.1% as medium quality. In RPL, 59.1% (143/242) were classified as good quality, and 40.9% as medium quality. Main results and the role of chance The euploid embryo rate decreases in both good- and medium-quality embryos as the patient’s age increases. For RIF patients: ≤35 (47.1% and 22.7%), 36-37 (46.7% and 19.8%), 38-39 (37.5% and 16.4%), 40-41 (37.5% and 11.5%), 42-43 (31.8% and 10.0%), 44-45 (0% and 11.1%), ≥46 (0% and 0%). For RPL patients: ≤35 (46.0% and 25.4%), 36-37 (45.9% and 25.0%), 38-39 (43.8% and 15.1%), 40-41 (27.9% and 18.0%), 42-43 (26.3% and 11.7%), 44-45 (0% and 12.5), ≥46 (0% and 0%). Moreover, ongoing pregnancy or live birth rates also decrease as the patient’s age increases, while the miscarriage rate increases. For RIF patients: ≤35 (57.8% and 16.1%), 36-37 (50.0% and 18.8%), 38-39 (46.2% and 25.0%), 40-41 (43.5% and 28.6%), 42-43 (36.4% and 33.3%), 44-45 (0% and 100%). For RPL patients: ≤35 (59.5% and 12.0%), 36-37 (52.0% and 18.8%), 38-39 (47.8% and 31.3%), 40-41 (43.5% and 37.5%), 42-43 (40.0% and 42.9%), 44-45 (0% and 100%). However, embryo transfer was not possible for those over 46 due to all embryos being aneuploidy. Therefore, PGT-A is valuable for patients under 42, proves beneficial for reducing the abortion rate, and achieving a high pregnancy rate for those aged 42-43, and should be considered for patients over 44. Limitations, reasons for caution This data is from a retrospective study, and well-designed prospective studies with data from multiple centers, larger samples, and extended study periods are needed to validate the current results. Additionally, obtaining information on demographic characteristics, detailed embryo information, and overall clinical outcomes can further enhance the current results. Wider implications of the findings These findings suggest that individualizing each case based on both maternal age and embryo quality is helpful in predicting the utility of PGT-A. Such personalized considerations can result in significant benefits for patients by optimizing outcomes, reducing cycle times, and consequently lowering related costs. Trial registration number not applicable

P-546 Do patients undergoing PGT-M benefit from the Duostim protocol?

Abstract Study question Do patients undergoing PGT-M benefit from the Duostim protocol? Summary answer PGT-M patients benefit because luteal phase stimulation is as effective as follicular phase stimulation in generating transferable embryos, thereby increasing the chances of treatment success. What is known already Patients undergoing PGT-M often require a larger number of embryos for pregnancy, with 25-50% deemed ineligible for transfer based on the disease indication (recessive, dominant, or sex-linked). DuoStim emerges as a valuable strategy for improving outcomes in poor responders. Progress in blastocyst culture, genetic testing, and vitrification motivates clinicians to optimize ovarian reserve exploitation through tailored stimulation protocols. Luteal Phase Stimulation (LPS) finds success in poor prognosis or oncological cases within DuoStim, a protocol widely used for poor prognosis patients necessitating both Follicular Phase Stimulation (FPS) and LPS. The potential benefits of DuoStim for PGT-M patients remain unexplored. Study design, size, duration Retrospective controlled case-control study conducted with paired FPS- and LPS-derived cohorts of oocytes collected in the same ovarian cycle (DuoStim). The study included 26 patients aged 36.53 ± 4,59 years old, undergoing DuoStim with the indication of PGT-M between July 2022 and October 2023. Participants/materials, setting, methods FPS and LPS were performed using the same daily dose of recombinant gonadotropins in an antagonist protocol. All zygotes underwent blastocyst culture, trophectoderm biopsy, vitrification, and subsequent thawing of one unaffected euploid blastocyst for transfer. The primary outcome was the mean number of transferable blastocysts (not affected euploid ones) obtained per oocyte retrieval from paired FPS- and LPS-derived cohorts. Secondary outcomes included the mean number of oocytes, blastocysts and implantation and pregnancy rates. Main results and the role of chance FPS and LPS were comparable regarding the mean number of mature oocytes collected (7.73 ± 4.27 vs. 7.57 ± 4.56) and the mean number of blastocysts obtained (3.27 ± 2.40 vs. 2.50 ± 1.98). The mean number of transferable blastocysts per retrieval were similar (FPS: 1.21 ± 1.31 vs. LPS: 0.78 ± 0.91). No significant differences in implantation or ongoing pregnancy rates were observed after transfers of euploid single blastocysts derived from FPS or LPS: 70.0% (7/10) vs. 57.14% (4/7). Three patients out of the 26 (11.54%) had transferable embryos only in the luteal phase. Limitations, reasons for caution Our findings warrant additional assessment through studies involving larger sample sizes. While our preliminary data indicate comparable implantation/pregnancy rates for PGT-M blastocysts from both FPS and LPS, further investigation is essential, especially in populations beyond those with a reduced number of usable blastocysts Wider implications of the findings These data underscore that oocytes obtained from LPS are as competent as those derived from FPS. Patients with unaffected euploid embryos solely due to FLS would not have had any transfer without DuoStim. This protocol could be advantageous for women abroad or with time constraints, potentially reducing dropout rates. Trial registration number Not applicable

Assessment of Use of Subcutaneous Mastectomy with Silicon Prostheses as Treatment of Early Breast Cancer

Abstract Background Breast cancer is the most common cancer among women and the second most common cause of cancer death in the United States. Approximately 268,600 new breast cancer diagnoses and 41,760 cancer- related deaths in the U.S. were estimated for 2019. SSM (skin sparing mastectomy) is defined as a simple or radical surgery with modified minimal incisions that retain the widest possible coverage and sub-cutaneous breast groove but dry the NAC, flaws of previous biopsies and/or scarring caused by diagnostic percutaneous biopsies. Access to the armpit for a possible sentinel-node biopsy or axillary dissection is obtained through the same incision. An additional incision may be necessary to perform the reconstructive procedure (e.g., microsurgical axillary anastomosis). Objective To study the risks and benefits of use subcutaneous mastectomy with silicon prosthesis as treatment of early breast cancer: as regards the impact of radiotherapy administration on implant, psychological impact, operative time and post-operative complications including complication of silicon, effect on wound healing. Patients and Methods This prospective interventional study was conducted at tertiary care hospital at the general surgery department in Ain Shams University hospitals and Misr University for Science and Technology (MUST) hospital and from November 2021, till July 2022 and performed on total 15 females suffering from stage I-II infiltrating breast carcinomas. Results The current study revealed that mean ±SD of age of the studied cases was 46.3±7.4. Regarding tumor site, LOQ was the most frequent (40.0%), followed by UIQ (33.3%), then UOQ (20.0%) and lastly LIQ (6.7%). Concerning T grades, T1 was in (46.7%), while the remaining (53.3%) were T2. Concerning N grades, N0 was in (73.3%), while the remaining (26.7%) were N1. Sentinel lymph nodes done in 73.3% of cases. As regards operative characteristics, Axillary clearance done in less than half of cases (46.7%), while nipple sparing achieved in less than quarter of cases (20.0%). As regards post-mastectomy treatment, majority of cases (86.7%) received hormonal therapy, adjuvant radiotherapy to axilla was (46.7%), chemotherapy (33.3%), while immunotherapy was (6.7%). As regards postoperative side effects, Pain was the most frequent postoperative side effect; detected in (33.3%) of cases, followed by seroma (20.0%), then flap necrosis (13.3%), and the least frequent was hematoma (6.7%). As regards postoperative patients’ satisfaction, mean ±SD of Postoperative patients’ satisfaction was 7.3±1.5 with range 5.0 − 10.0. Near half of the studied cases (46.7%) had 7.0 − 8.0 satisfaction grade. Conclusion Skin-sparing mastectomy (SSM) and nipple-sparing mastectomy (NSM) with immediate subcutaneous silicon implantation are an acceptable and safe method for breast reconstruction. It offers a number of advantages including ease of dissection for surgeons, improved symmetry, and low complication rates. With improvements in surgical techniques in preserving mastectomy skin flap viability, the traditionally higher rates of complications in subcutaneous implants may be outdated. The present study can burden the knowledge and shed some light on future prospective studies with larger sample sizes to evaluate a cost benefit analysis and patient and surgeon assessment of outcomes to directly compare with traditional submuscular single- or 2- stage implant-based reconstruction.

P-601 Monitoring reproductive hormones during ovarian stimulation: performance and usability of a self-operated at-home urine test

Abstract Study question How effective and user-friendly is a non-invasive, patient-operated urine test (Kinder) in tracking reproductive hormone levels during ovarian stimulation (OS) treatment in an IVF cycle? Summary answer Urinary E1-3G correlates well with blood E2 levels and ovarian follicle development. Patients found it easy and stress-free to perform the urine test at home. What is known already Monitoring blood reproductive hormone levels during OS is a widely accepted practice to ensure the optimal ovarian response to gonadotropin treatment, timing of oocyte maturation triggering and mitigating hyperstimulation risk. However, conventional blood testing is invasive, necessitating patients to travel to clinics for blood sampling, adding to their overall burden. Previous studies have revealed a robust correlation between blood E2 levels, and its corresponding urinary metabolites E1-3G. Kinder is a portable device designed for quantifying urinary E1-3G, allowing patients to conduct tests in the privacy of their homes, and for many obviating the need to travel substantial distances for monitoring. Study design, size, duration This is a prospective, single-cohort, study of Caucasian patients (28-34 years), conducted at Fertility Specialists of Western Australia in Perth, Australia, where patients may travel vast distances for treatment. Twenty-five patients were enrolled from Aug 2022-Aug 2023, and performed home urine tests utilizing the Kinder device in parallel with clinic scheduled blood (ELISA) and ultrasound tests. The primary end point of the study was the correlation between urinary and blood reproductive hormone concentrations (E1-3G). Participants/materials, setting, methods Spearman and Pearson correlation coefficients (CC) and 95% confidence intervals were calculated for E1-3G and E2, and E1-3G/E2 and follicle development (total volume of ovarian follicles by ultrasound). To assess patient acceptability patient-reported outcomes (PRO) were assessed using the State Trait Anxiety Inventory (STAI) questionnaire. Further, patient-reported experiences (PRE) were evaluated through the System Usability Scale (SUS) questionnaire, along with assessing their likelihood to recommend Kinder to their friends or family undergoing IVF treatment. Main results and the role of chance Upon analysing 100 concurrent urine and blood samples from 25 patients, a robust correlation was found between E1-3G and E2 levels (Spearman CC: 0.818, 95% CI: 0.680-0.904; Pearson CC: 0.847, 95% CI: 0.712-0.939). Additionally, we observed a moderate correlation between E1-3G levels and ovarian volume (Spearman CC: 0.701, 95% CI: 0.556-0.805; Pearson CC: 0.670, 95% CI: 0.519-0.781, n = 72), resembled the correlation between E2 levels and ovarian volume (Spearman CC: 0.874, 95% CI: 0.804-0.920; Pearson CC: 0.849, 95% CI: 0.770-0.902, n = 75). PRE: 22 out of 23 patients who completed the survey confirmed that they would definitely, or probably, recommend Kinder. The mean SUS score (91.4) signified an excellent user experience. PRO: Anxiety levels were not affected by use of Kinder (STAI score below threshold of 42.38) in 18/20 patients who completed three STAI surveys (first one before and second one after the initial Kinder test; third one after the third/fourth Kinder test). Although 2/20 patients reported a STAI score of 49 in the final survey, suggesting increased anxiety, both affirmed in the PRE survey that they “will definitely recommend Kinder”, suggesting that the elevated STAI score can be attributed to the overall IVF treatment rather than the use of Kinder itself. Limitations, reasons for caution The sample size is relatively small, necessitating further multi-centre studies with a larger sample size to validate the findings. Wider implications of the findings The results suggest an acceptable interchangeability between at-home urine E1-3G and at-clinic blood E2 monitoring hormone levels during OS treatment. A digital health approach, combining tele-counselling, remote at-home hormone monitoring, and follicle tracking, could reduce patient burden and save many patients the inconvenience of travelling large distances for cycle monitoring. Trial registration number ACTRN12622000488707

Clinical efficacy of different therapeutic strategies in patients with spontaneous rupture of the esophagus: a multicenter retrospective cohort study.

The therapeutic strategy for patients with spontaneous rupture of the esophagus includes surgical repair, endoscopic therapy, supportive care, and others. However, no evidence exists to direct clinical decision-making regarding the choice of operative and nonoperative management. The aim of this study was to determine the clinical efficacy of different therapeutic strategies in both general and stratified patients. This study retrospectively analyzed a consecutive cohort of 101 patients at nine tertiary referral hospital centers in China. Patients were divided into operative and nonoperative groups based on the initial treatment. Short-term outcomes, including 90-day mortality, length of hospital stay, and postoperative leakage were compared. Subgroup analysis was performed based on treatment timing and Pittsburgh perforation severity score (PSS). Of 101 patients, 60 (58.4%) underwent operative management. A significant difference of 90-day mortality between operative and nonoperative groups was observed (15.0% vs. 34.1%, P=0.031). Operative management tend to yield similar therapeutic benefits in timely (OR, 0.250; 95% CI, 0.05-1.14, P=0.073) and delayed (OR, 0.42; 95% CI, 0.12-1.47, P=0.175) treatment groups. Based on PSS stratification, operative management significantly decreased the risk of 90-day mortality (OR, 0.211; 95% CI, 0.064-0.701; P=0.011) for patients in low- and moderate-risk groups but may be detrimental for patients in high-risk group (OR, 1.333; 95% CI, 0.233-7.626; P=0.746). Operative management might be superior to nonoperative management for low- and moderate-risk patients with spontaneous rupture of the esophagus. However, for patients at high risks, operative management might not provide additional benefits compared with nonoperative management. Further research involving larger sample sizes is required for accurate patient stratification and conclusive evidence-based guideline.

P-205 Exploring the influence of platelet rich plasma (PRP) versus PRP with hyaluronic acid on endometrial thickness (ET) and IVF outcome: a pilot study

Abstract Study question What is the impact of sub-endometrial instillation of PRP versus PRP with hyaluronic acid on ET and IVF outcome defined by positive and clinical pregnancy Summary answer PRP with hyaluronic acid group had more endometrial thickness with better vascularity and better pregnancy outcomes as compared to normal PRP What is known already Receptive endometrium is the end result of an interplay of a myriad of cytokines, adhesion molecules growth factors etc. Defect in these can result in thin endometrium. Sub endometrial PRP instillation has been attempted in such cases with promising results and acts by stimulating cell growth and angiogenesis These actions are enhanced by hyaluronic acid along with its antiadhesive effect. PRP with hyaluronic acid has been used previously in orthopedics, dermatology but not documented in thin endometrium. Most of previous studies have focused on endometrial thickness and no comparison has been done between PRP and PRP with hyaluronic acid. Study design, size, duration A retrospective observational study was conducted at Gunjan IVF WORLD Ghaziabad, from January 2022 to Dec 2023. Total 215 patients between the age group of 21-50 years with thin endometrium (ET < 7mm) with zone 2 or less vascularity with at least 1 good quality blastocyst for transfer were selected. They were subjected to hysteroscopic sub endometrial PRP instillation or instillation of PRP with hyaluronic acid Participants/materials, setting, methods Women with diverse reasons for infertility were divided into 2 groups - those receiving PRP (87 subjects) vs PRP with hyaluronic acid (128 subjects). PRP was activated by adding 0.1 ml of Calcium Chloride in 0.9 ml of PRP. Hyaluronic acid (80IU/ML) was added to PRP in the ratio of 1:5. The two groups were compared for positive pregnancy defined as βhCG >100 mIU/ml, clinical pregnancy defined as visualization of gestational sac and endometrial thickness Main results and the role of chance 112 of 215 (52.09%) women had positive pregnancy outcomes (βhCG >100 mIU/ml). Of the 112 subjects having positive outcomes, 40 (35.71%) belonged to normal PRP group and 72 (64.28%) belonged to PRP with hyaluronic acid group. Clinical pregnancy was seen in 37 (33.03%) in normal PRP group and 70(62.5%) in PRP with hyaluronic acid group. Mean βhCG was significantly higher in PRP with hyaluronic acid group (p = 0.013). Mean endometrial thickness was also higher in PRP with hyaluronic acid group (p = 0.05). The findings of the study suggest that PRP with hyaluronic acid has much better results in patients with thin endometrium in terms of not only the endometrial thickness but it also translates into better pregnancy rates. Limitations, reasons for caution 1. Patient pool from limited geographical area. 2. More Randomized controlled trials with larger sample size required to assess efficacy of Platelet rich plasma with hyaluronic acid. 3. The results were analyzed only up to clinical pregnancy and not ongoing pregnancy or live birth rates Wider implications of the findings 1. PRP with hyaluronic acid can be a boon to patients having thin endometrium who otherwise would have sub optimal IVF outcomes 2. Study can encourage larger randomized controlled trials in this direction especially in cases of intrauterine adhesions. Trial registration number not applicable

P-517 The effects of various female infertility factors on endometrial receptivity

Abstract Study question Is there a correlation between different female infertility factors and displaced window of implantation? Summary answer Patients with decreased ovarian reserve and endometriosis have higher risk in experiencing displaced window of implantation. What is known already Numerous studies substantiate that infertility stems from various etiology, including ovulatory dysfunction, male factors, tubal disease, endometriosis, uterine factors...etc. MicroRNAs (miRNAs) play a crucial role in initiating these infertility-related disorders and influencing biological processes like gametogenesis, embryogenesis, ovarian, uterine or endometrial condition. Notably, miRNAs regulate endometrial receptivity, suggesting optimal embryo transfer timing during IVF treatment by identifying the window of implantation (WOI). In recognition of this significant function, MIRA, a molecular testing solution that predicts endometrial receptivity for patients undergoing frozen embryo transfer (FET) by targeting miRNA biomarkers, was developed in hopes of bolstering success rate for personalized embryo transfer. Study design, size, duration This study aims to identify if there is a correlation seen between female infertility factors and the WOI. We enrolled a total of 96 patients who demonstrated successful pregnancy outcomes following personalized embryo transfer. The patients’ personalized embryo transfer timing recommendations were assessed based on their miRNA expression profiles using MIRA. Concurrently, the participants’ underlining infertility diseases were classified according to diagnoses guidelines provided by Taiwan’s Ministry of Health and Welfare. Participants/materials, setting, methods Six categories of female infertility diseases were included: decreased ovarian reserve, tubal, endometriosis, uterine abnormalities (excluding myoma and adenomyosis), polycystic ovary syndrome (PCOS), and myoma factors. Infertile factors such as unexplained, aneuploid oocyte (PGT), male factors, and adenomyosis were excluded due to limited sample size. Statistical analysis of endometrial stages and disease categories involved calculating percentage of the window of implantation (WOI) versus displaced WOI (either pre- or post-receptive) within the six types of diseases. Main results and the role of chance Our result showed that overall, 64.58% of 96 patients have a receptive window of implantation. Compared to this baseline, polycystic ovary syndrome (66.67%) does not elevate the risk of displaced endometrial stages. However, patients with decreased ovarian reserve and endometriosis are more likely to display displaced window of implantation, with average rates of 57.14% and 55.56% WOI respectively. Notably, patients with uterine abnormalities (84.62%) and myoma (87.5%) factors exhibit a lower likelihood of having a displaced WOI. The WOI percentage caused by tubal factors is slightly lower at 76.19%. In conclusion, these preliminary findings establishes that categories of female infertility diseases have discernible effects on patients’ WOI. As patients with certain infertility factors, such as decreased ovarian reserve and endometriosis, demonstrated a greater risk in experiencing displaced WOI, patients that fall under these categories could further benefit from utilizing endometrial receptivity testing to determine the optimal timing for their embryo transfer to potentially improve their reproductive outcomes and facilitate shared decision-making (SDM) in patient’s embryo transfer process. Limitations, reasons for caution While this result offers a preliminary overview for the correlation between endometrial stages and female infertility diseases, we cannot confirm whether these conclusions reached statistical significance due to the limitation of data. Wider implications of the findings Further investigation into the specific reasons for the discernable WOI patterns in different diseases is warranted in larger sample sizes to offer more personalized and robust clinical information supporting IVF treatments. Trial registration number ’not applicable’

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

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

P-466 The effect of Virtual Reality technology (VR) during oocyte pick up (OPU) in 100 IVF/ICSI patients - A randomised controlled trial (RCT)

Abstract Study question Does VR technology improve patient experience in terms of nervousness, nausea, pain, and total experience as well as consumption of painkillers during the OPU procedure? Summary answer The use of VR technology seems to have a positive influence on patient experience during OPU. No effect was seen regarding consumption of painkillers. What is known already In recent years, the VR technology has received increasing attention for its suggested calming and pain-relieving effect during medical procedures. Thus, a previous study using VR technology in women undergoing hysteroscopy showed a significant difference in anxiety compared to women not using VR. We previously performed a small pilot study in patients undergoing OPU. That study suggested that VR technology had a positive effect on patients before OPU in terms of level of relaxation and stress. Importantly, in the pilot project patients solely used the VR technology before the OPU procedure. Study design, size, duration This RCT included a cohort of 100 IVF/ICSI patients undergoing OPU. Patients were computer randomized into two groups: an intervention group (VR) and a control group (no VR) during OPU. Randomization was performed on the day of ovulation induction. The study was conducted from April 2023 to December 2023 in a public university affiliated fertility clinic. Participants/materials, setting, methods 10 minutes before the OPU procedure the VR headset was placed and remained in place during OPU in the intervention group. The control group was treated according to the standard procedure of the unit. Both groups answered a questionnaire, including 14 questions using VAS (Visual Analog Scale) before and after OPU regarding nervousness, nausea, pain and total experience. Moreover, blood pressure, heart rate, saturation, and consumption of medication was recorded. Main results and the role of chance The study showed that the use of VR technology in women undergoing OPU significantly (P = 0.01) lowered the patient’s systolic blood pressure before the procedure. Moreover, the study showed a trend towards a reduction in nervousness and consumption of painkillers. The comments of the patients regarding their total experience of the effect of VR were in favour of VR usage and several patients would choose VR technology for a possible future OPU. Limitations, reasons for caution The patient experience might have differed if the same nurse participated during all the OPUs. To find a possible significant effect of VR usage as regards nervousness and consumption of painkillers a future larger sample size is required. Wider implications of the findings The use of VR technology during OPU might be considered as a supplement for patients during OPU. Trial registration number NCT05826938

The Impact of Teaching Aids on The Academic Performance of Learners in Natural Science

This qualitative study explores the impact of teaching aids on the academic performance of seventh-grade natural science learners at a selected school in the Kunene Region. The research focuses on understanding how instructional aids affect student comprehension, engagement, and overall academic achievement. A purposive sampling technique was used to select 10 seventh-grade students and two science teachers for semi-structured interviews, providing in-depth insights into their experiences with teaching aids in the classroom. Data were analyzed thematically, revealing key subthemes that illustrate the positive effects of teaching aids on learning outcomes. Results indicate that teaching aids, such as charts, models, and laboratory equipment, enhance understanding of concepts, increase student engagement, improve academic performance, promote critical thinking, and foster collaborative learning. However, the study acknowledges a significant limitation: its focus on a single region, which limits the generalizability of the findings to other contexts. Recommendations for educators and policymakers include investing in a variety of teaching aids, incorporating interactive learning techniques, and fostering collaborative learning environments. The study also suggests further research with larger sample sizes, across multiple regions, and using quantitative methods to validate and expand on these findings. Additionally, a longitudinal approach to understanding the long-term impact of teaching aids on educational outcomes is proposed as an area for future study. The insights gained from this study contribute to the ongoing discourse on effective teaching practices and underscore the importance of providing adequate resources to support natural science education.

Long-term retention and survival of cemented implant-supported zirconia and metal-ceramic single crowns: A retrospective study.

To evaluate the effect of different cement types on the incidence of failure and loss of retention of zirconia and metal-ceramic single crowns (SCs) cemented on implant abutments. We placed 567 implant-supported SCs in 358 patients and retrospectively evaluated long-term retention for up to 12.8 years. The frameworks were made from metal alloy (n = 307) or zirconia (n = 260). SCs were cemented with permanent (glass-ionomer cement; n = 376) or semipermanent cement (zinc oxide non-eugenol cement; n = 191) on standardized (n = 446) or customized (n = 121) abutments. Kaplan-Meier curves were used to calculate the incidence of decementation. Differences between survival curves were assessed with log-rank tests. Cox-regression analysis was performed to evaluate multiple risk factors. Of the 567 SCs, 22 failed because of technical complications and four because of implant loss. Loss of retention was observed in 50 SCs. Analysis revealed a 7% probability of loss of retention for zirconia and 16% for metal-ceramic SCs after 10 years (p = .011). After 5 years, loss of retention was higher for standardized abutments than for customized abutments (p = .014). The probability of loss of retention was higher with semipermanent than with permanent cement (p = .001). Cox-regression analysis revealed semipermanent cement as the only significant risk factor for SC failure (p = .026). In contrast to semipermanent cement, permanent cement provides acceptable long-term retention of cemented implant-supported SCs. These possible positive effects of customized abutments have to be controlled with larger sample sizes.

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

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

Is Culex modestus a New Usutu virus vector?

Usutu virus is an emerging pathogen transmitted by mosquitoes. Culex modestus mosquitoes are widespread in Europe, but their role in disease transmission is poorly understood. Recent data from a single infectious mosquito suggested that Culex modestus could be an unrecognized vector for Usutu virus. In this study, our aim was to corroborate this finding using a larger sample size. We collected immature Culex modestus from a reedbed pond in Flemish Brabant, Belgium, and reared them in the laboratory until the third generation. Adult females were then experimentally infected with Usutu virus in a blood meal and incubated at 25 °C for 14 days. The presence of Usutu virus in the saliva, head and body of each female was determined by plaque assay and quantitative real-time reverse-transcription polymerase chain reaction (qRT-PCR). The transmission efficiency was 54% (n = 15/28), confirming that Belgian Culex modestus can experimentally transmit Usutu virus.Graphical

A retrospective study of adjuvant albumin-bound paclitaxel plus S-1 after D2 gastrectomy versus oxaliplatin plus S-1 in gastric cancer

Adjuvant oxaliplatin plus S-1 (SOX) chemotherapy for gastric cancer (GC) after D2 gastrectomy has been proven effective. There has yet to be a study that evaluates adjuvant nanoparticle albumin-bound paclitaxel (nab-paclitaxel) plus S-1. In this single-center, retrospective study, GC patients after D2 gastrectomy received either nab-paclitaxel plus S-1 (AS group) or SOX group were recruited between January 2018 and December 2020 in The First Affiliated Hospital of Zhejiang University. Intravenous nab-paclitaxel 120 mg/m2 or 260 mg/m2 and oxaliplatin 130 mg/m2 were administered as eight 3 week cycle, especially in the AS and SOX group. Patients received S-1 twice daily with a dose of 40 mg/m2 in the two groups on days 1–14 of each cycle. The end points were disease-free survival (DFS) rate at 3 years and adverse events (AEs). There were 56 eligible patients, 28 in the AS group and 35 in the SOX group. The 3 year DFS rate was 78.0% in AS group versus 70.7% in SOX group (p = 0.46). Subgroup analysis showed that the patients with signet-ring positive in the AS group had a prolonged DFS compared with the SOX group (40.0 vs. 13.8 m, p = 0.02). The diffuse-type GC or low differentiation in the AS group was associated with numerically prolonged DFS compared with the SOX group, but the association was not statistically significant (p = 0.27 and p = 0.15 especially). Leukopenia (14.3%) were the most prevalent AEs in the AS group, while thrombocytopenia (28.5%) in the SOX group. Neutropenia (7.1% in AS group) and thrombocytopenia (22.8% in SOX group) were the most common grade 3 or 4 AEs. In this study analyzing past data, a tendency towards a greater 3 year DFS was observed when using AS regimen in signet-ring positive patients. AS group had fewer thrombocytopenia compared to SOX group. More studies should be conducted with larger sample sizes.

Effectiveness of Zhuang medicine medicated thread moxibustion on human xanthelasma – a case series

Rationale: Xanthelasma, characterized by yellowish plaques around the eyelids due to lipid deposits, is typically treated through invasive methods like laser therapy or surgery, which often leads to scarring and dyspigmentation. This case series investigates the potential of Zhuang medicine medicated thread moxibustion as a less invasive alternative. Patient Concerns: Three female patients, aged 34, 45, and 55, presented with non-tender, soft yellow plaques near the medial canthi of both upper eyelids. The lesions varied in size and had been present for durations ranging from 6 months to 2 years. These patients expressed concerns about the pain and potential adverse reactions associated with conventional treatments, opting instead for an alternative approach. Diagnoses: Each patient was diagnosed with xanthelasma based on clinical evaluation. Standard diagnostic tests returned normal results, confirming the absence of underlying systemic issues. Interventions: The treatment regimen involved Zhuang medicine medicated thread moxibustion applied at 10-day intervals for a total of three sessions. This traditional method was selected due to its minimally invasive nature. Outcomes: After the first session, patients experienced mild edema, which resolved within 24 h. A significant reduction in the size of the plaques was observed after the second session, and by the third session, there was complete resolution of the plaques. Throughout the treatment and follow-up period of 3 months, no adverse reactions or recurrence of the xanthelasma was noted. Lessons: This case series suggests that Zhuang medicine medicated thread moxibustion could be a safe and effective alternative for the treatment of xanthelasma, avoiding the complications associated with more invasive conventional methods. Further research involving larger sample sizes is recommended to validate these preliminary findings and possibly integrate this method into broader clinical practice.