Late Appearance Research Articles

A random forest-based analysis of cassava mosaic disease-related factors affecting the on-farm livelihoods of cassava farmers

This study aimed to identify key CMD-related factors affecting Cameroon cassava farmers’ incomes originating from both the sale of cassava cuttings (V215) and the sale of cassava roots (V216). To achieve this, nine CMD-related variables were used to independently train two Random Forest models. These models were later employed for regression-based prediction of both financial targets V215 and V216. The Random Forest (RF)-based mean absolute percentage error for targets V215 and V216 were 0.19 and 1.25 respectively. The RF-based mean Gaussian deviance for targets V215 and V216 were 0.07 and 0.51 respectively. Based on RF feature importance scores (RFFI), the top 3 factors affecting income originating from the sale of cassava cuttings were found to be: late appearance of symptoms as a difficulty associated with regular field monitoring (RFFI of 0.2594), removal of infected plants as a method of controlling frequent occurrence of viral diseases in respondents’ cassava fields (RFFI of 0.1633) and lack of healthy planting material due to frequent occurrence of viral diseases in respondents’ cassava fields (RFFI of 0.1495). Also, the top 3 factors affecting income originating from the sale of cassava roots were found to be: the replacement of infected plants with healthy cuttings as a method of controlling the frequent occurrence of viral diseases in respondents’ cassava fields (RFFI of 0.1974), decrease in yield due to frequent occurrence of viral diseases in respondents’ cassava fields (RFFI of 0.1530) and poor plant growth due to frequent occurrence of viral diseases in respondents’ cassava fields (RFFI of 0.1388).

Data-Driven Phenotyping of Presymptomatic Type 1 Diabetes Using Longitudinal Autoantibody Profiles.

To characterize distinct islet autoantibody profiles preceding stage 3 type 1 diabetes. The T1DI (Type 1 Diabetes Intelligence) study combined data from 1,845 genetically susceptible prospectively observed children who were positive for at least one islet autoantibody: insulin autoantibody (IAA), GAD antibody (GADA), or islet antigen 2 antibody (IA-2A). Using a novel similarity algorithm that considers an individual's temporal autoantibody profile, age at autoantibody appearance, and variation in the positivity of autoantibody types, we performed an unsupervised hierarchical clustering analysis. Progression rates to diabetes were analyzed via survival analysis. We identified five main clusters of individuals with distinct autoantibody profiles characterized by seroconversion age and sequence of appearance of the three autoantibodies. The highest 5-year risk from first positive autoantibody to type 1 diabetes (69.9%; 95% CI 60.0-79.2) was observed in children who first developed IAA in early life (median age 1.6 years) followed by GADA (1.9 years) and then IA-2A (2.1 years). Their 10-year risk was 89.9% (95% CI 81.9-95.4). A high 5-year risk was also found in children with persistent IAA and GADA (39.1%) and children with persistent GADA and IA-2A (30.9%). A lower 5-year risk (10.5%) was observed in children with a late appearance of persistent GADA (6.1 years). The lowest 5-year diabetes risk (1.6%) was associated with positivity for a single, often reverting, autoantibody. The novel clustering algorithm identified children with distinct islet autoantibody profiles and progression rates to diabetes. These results are useful for prediction, selection of individuals for prevention trials, and studies investigating various pathways to type 1 diabetes.

Primitive purine biosynthesis connects ancient geochemistry to modern metabolism.

An unresolved question in the origin and evolution of life is whether a continuous path from geochemical precursors to the majority of molecules in the biosphere can be reconstructed from modern-day biochemistry. Here we identified a feasible path by simulating the evolution of biosphere-scale metabolism, using only known biochemical reactions and models of primitive coenzymes. We find that purine synthesis constitutes a bottleneck for metabolic expansion, which can be alleviated by non-autocatalytic phosphoryl coupling agents. Early phases of the expansion are enriched with enzymes that are metal dependent and structurally symmetric, supporting models of early biochemical evolution. This expansion trajectory suggests distinct hypotheses regarding the tempo, mode and timing of metabolic pathway evolution, including a late appearance of methane metabolisms and oxygenic photosynthesis consistent with the geochemical record. The concordance between biological and geological analyses suggests that this trajectory provides a plausible evolutionary history for the vast majority of core biochemistry.

Imaging spectrum of acute invasive sinonasal mucormycosis in patients with COVID-19: A pictorial review

The advent of severe acute respiratory syndrome coronavirus (SARS-CoV) during the latter half of 2019 brought a new face to the global medical scenario. With a rising trend in COVID infectivity and the concomitant use of steroids in its management, it emerged as a risk factor for the development of acute invasive fungal infections of the paranasal sinus in these patients. In India, the medical scenario turned towards a rise in the number of fulminant mucormycosis infections in post-COVID patients. This infection caused rapid invasion via the perineural pathway and extensive angioinvasion, which led to an increase in morbidity and mortality. Early diagnosis of this infection became crucial to ward off any preventable complications. This pictorial review focuses on the varied early and late imaging appearances on Computed Tomography (CT) and Magnetic Resonance Imaging (MRI), keeping the focus on MR imaging to make the diagnosis, to know the extent of the infective process, diagnose early complications and for surgical planning.

Biophysical mechanisms of myocardium sodium channelopathies.

Genetic variants of gene SCN5A encoding the alpha-subunit of cardiac voltage-gated sodium channel Nav1.5 are associated with various diseases, including long QT syndrome (LQT3), Brugada syndrome (BrS1), and progressive cardiac conduction disease (PCCD). In the last decades, the great progress in understanding molecular and biophysical mechanisms of these diseases has been achieved. The LQT3 syndrome is associated with gain-of-function of sodium channels Nav1.5 due to impaired inactivation, enhanced activation, accelerated recovery from inactivation or the late current appearance. In contrast, BrS1 and PCCD are associated with the Nav1.5 loss-of-function, which in electrophysiological experiments can be manifested as reduced current density, enhanced fast or slow inactivation, impaired activation, or decelerated recovery from inactivation. Genetic variants associated with congenital arrhythmias can also disturb interactions of the Nav1.5 channel with different proteins or drugs and cause unexpected reactions to drug administration. Furthermore, mutations can affect post-translational modifications of the channels and their sensitivity to pH and temperature. Here we briefly review the current knowledge on biophysical mechanisms of LQT3, BrS1 and PCCD. We focus on limitations of studies that use heterologous expression systems and induced pluripotent stem cells (iPSC) derived cardiac myocytes and summarize our understanding of genotype-phenotype relations of SCN5A mutations.

Rotation plays a role in the generation of magnetic fields in single white dwarfs

ABSTRACT Recent surveys of close white dwarf binaries as well as single white dwarfs have provided evidence for the late appearance of magnetic fields in white dwarfs, and a possible generation mechanism, a crystallization and rotation-driven dynamo has been suggested. A key prediction of this dynamo is that magnetic white dwarfs rotate, at least on average, faster than their non-magnetic counterparts and/or that the magnetic field strength increases with rotation. Here we present rotation periods of ten white dwarfs within 40 pc measured using photometric variations. Eight of the light curves come from TESS observations and are thus not biased towards short periods, in contrast to most period estimates that have been reported previously in the literature. These TESS spin periods are indeed systematically shorter than those of non-magnetic white dwarfs. This means that the crystallization and rotation-driven dynamo could be responsible for a fraction of the magnetic fields in white dwarfs. However, the full sample of magnetic white dwarfs also contains slowly rotating strongly magnetic white dwarfs which indicates that another mechanism that leads to the late appearance of magnetic white dwarfs might be at work, either in addition to or instead of the dynamo. The fast-spinning and massive magnetic white dwarfs that appear in the literature form a small fraction of magnetic white dwarfs, and probably result from a channel related to white dwarf mergers.

Surgical management of mediastinal mature cystic teratoma of the elderly remaining asymptomatic

BackgroundMediastinal teratoma is an uncommon disease, nevertheless they represent the most common mediastinal germ cell tumors. It may grow silently for several years and remain undiagnosed until the occurrence of a complication.AimThe main aim of this article is to illustrate the silent evolution of an anterior mediastinal teratoma for over 70 years without presenting any notable complications.Case presentationWe present the case of a 70-year-old female, treated for hypertension referred to our department for managing a voluminous mediastinal mass, discovered fortuitously by a general practitioner in a chest X-ray. The anamnesis didn’t relate any chest pain, cough, dyspnea nor hemoptysis. The clinical examination, in particular pleuropulmonary, was unremarkable. The workup (Chest X-Ray and CT scan) demonstrated a voluminous pleural mass at the expense of the right mediastinal pleura, rounded in shape, with calcified wall and fluid content. Blood tests did not demonstrate eosinophilia, and hydatid IgG serology was negative. serum human chorionic gonadotropin (hCG) and alpha fetoprotein (AFP) levels were found to be normal. The patient subsequently underwent a right posterolateral thoracotomy with resection of the lesion. The mass was dissected very carefully and then resected in toto. The macroscopic and microscopic histological examination demonstrated a mature cystic teratoma. Surgical resection was an adequate treatment and the prognosis was excellent for the patient.ConclusionCystic mature teratomas are rare thoracic tumors, often recognized by radiological examination. This article relates the silent evolution that a teratoma could have, and the late appearance of symptoms that it could have.

P-42 A delayed diagnosis of MEN1 syndrome

Abstract Introduction Multiple endocrine neoplasia 1 (MEN 1) is a rare autosomal dominantly inherited syndrome that results from mutations in the MEN1 gene. It is characterized by multiple tumors of endocrine glands and some other tissues. Early diagnosis is crucial for optimal management. Here we present a patient with delayed diagnosis and preventable metastatic disease. Clinical Case A 46-year-old male patient who was referred from gastroenterology clinic to our outpatient clinic following distal pancreatectomy. The postoperative pathology was reported as a well-differentiated neuroendocrine tumor (NET) with 3 focuses (60 mm, 9 mm and 2.5 mm in size). Six months ago, he underwent to Magnetic Resonance Imagination (MRI) of the abdomen because of abdominal pain and 17 kg weight loss in a year, that revealed a 69×67 mm cystic lesion in the tail of the pancreas (Figure 1A). Laboratory and physical examinations were in accordance with a nonfunctioning lesion (Table 1). The findings of the Gallium-68 DOTATATE PET/CT suggested residual and metastatic disease during follow-up (At the level of the pancreatic corpus, increased uptake was detected in two lesion sites adjacent to liver segment 3 and in various nodular lesion areas, the largest of which was approximately 20 mm in diameter, adjacent to the duodenum and pancreas (Figure 1B and 1D). No increased uptake was observed in the pancreas and these lesions in preoperative FDG/PET (Figure is not shown). The patient was consultated by oncology clinic and 177-Lutetium-DOTATATE and octreotide treatments were started. Parathyroidectomy and total thyroidectomy 7 years ago was noted in the patient's medical history. Persisting hypercalcemia and elevated PTH were also remarkable in laboratory testing (Table 2). The patient didn't apply to endocrinology clinic after parathyroidectomy and hypercalcemia had been overlooked for 7 years. Further investigation revealed a nonfunctioning 4 mm diameter pituitary lesion (Figure 1C). So the diagnosis of multiple endocrine neoplasia type 1 was suspected. Genetic test detected a c.784-2A>G spice site variant in MEN1 gene in heterozygous form. The patient denied a family history for MEN 1 but he reported that his father died at the age of 40 and his uncle at the age of 39 due to an illness of unknown origin, and two sons of the same uncle were followed up for parathyroid disease. Family screening and genetic counseling were recommended. Surgery of the remaining parathyroid glands and implantation in the forearm and thymectomy were planned. Conclusion MEN syndromes are rare and hypercalcemia is generally the initial presentation. Persistence of hypercalcemia following parathyroidectomy should be warning, and the possibility of MEN -1 syndrome should also be kept in mind even in the lack of family history. As in the presented case, diagnosis may be delayed due to late appearance of symptoms of other components, especially nonfunctional pancreaticoduodenal tumors.Figure 1.MRI and Ga-68 PET/CT images of the patientA: A 69×67 mm cystic lesion in the tail of the pancreas B: Increased Gallium-68 DOTATATE uptake at the level of the pancreatic corpus adjacent to liver segment 3 (SUVmax: 67.90) C: A nonfunctioning 4 mm diameter lesion in the right half of the pituitary D: Increased uptake of Gallium-68 DOTATATE in nodular lesions adjacent to the duodenum and pancreas (SUVmax: 31.09) Table 1.Laboratory results of the patientACTH: Adrenocorticotropic hormone, FSH: follicle stimulating hormone, LH: luteinizing hormone, IGF-1: Insülin-like growth factor, TSH: Thyroid stimulating hormone, 1 mg DST: dexamethasone suppression test Table 2.Calcium and PTH levels of the patient before parathyroidectomy and following parathyroidectomy*Before parathyroidectomy ** Following parathyroidectomy PTH: Parathyroid hormone

Hepatitis C Virus and the Host: A Mutual Endurance Leaving Indelible Scars in the Host's Immunity.

Hepatitis C virus (HCV) has spread worldwide, and it is responsible for potentially severe chronic liver disease and primary liver cancer. Chronic infection remains for life if not spontaneously eliminated and viral persistence profoundly impairs the efficiency of the host's immunity. Attempts have been made to develop an effective vaccine, but efficacy trials have met with failure. The availability of highly efficacious direct-acting antivirals (DAA) has created hope for the progressive elimination of chronic HCV infections; however, this approach requires a monumental global effort. HCV elicits a prompt innate immune response in the host, characterized by a robust production of interferon-α (IFN-α), although interference in IFN-α signaling by HCV proteins may curb this effect. The late appearance of largely ineffective neutralizing antibodies and the progressive exhaustion of T cells, particularly CD8 T cells, result in the inability to eradicate the virus in most infected patients. Moreover, an HCV cure resulting from DAA treatment does not completely restore the normal immunologic homeostasis. Here, we discuss the main immunological features of immune responses to HCV and the epigenetic scars that chronic viral persistence leaves behind.

The cerebrospinal fluid soluble TREM‐1 concentration in Alzheimer’s Disease (AD) and Mild Cognitive Impairment (MCI)

AbstractBackgroundThe most prevalent form of dementia in the world is Alzheimer Disease (AD), a common neurodegenerative condition. Amyloid peptides, phosphorylated tau proteins, and neuroinflammation are the disease’s hallmarks. Finding new biomarkers that can assist in early AD detection is crucial due to the late appearance of the disease symptoms. Triggering receptor expressed on myeloid cell 1 (TREM‐1) is hypothesized that may contribute to the development of AD by causing neuroinflammation. Due of its significance in inflammatory responses, it has been regarded as a promising biomarker. Literature data indicate that TREM‐1 could be potential biomarker of AD severity. Therefore the purpose of our research was to measure the concentration of soluble TREM‐1 in cerebrospinal fluid of AD and MCI patients and non‐demented controls and compare it with classical AD biomarkers.MethodThe concentrations of TREM‐1 were measured in cerebrospinal fluid (CSF) of 20 AD patients and 15 MCI patients as well as 11 non‐demented controls using multiplexing method. Classical biomarkers, such as Aβ‐42, Aβ‐42/Aβ‐40, tau and pTau181 were assessed by immunoenzyme assays.ResultTREM‐1 concentrations were significantly higher in AD and MCI patients in comparison to non‐demented controls. Moreover, in MCI patients, the levels of this protein were significantly higher than in AD patients. Additionally, increased CSF levels of TREM‐1 correlated positively with Tau, pTau181 in the whole study group.ConclusionFindings of our research suggest that TREM‐1 could be early indicator of AD pathology. However, follow‐up studies on larger study group are needed.

Development and application of a droplet digital PCR assay for the detection of Fusarium oxysporum f. sp. cubense tropical race 4 from different biological samples

AbstractFusarium wilt of banana, caused by the pathogen Fusarium oxysporum f. sp. cubense tropical race 4 (Foc TR4), is a threat to food security as it affects the global banana industry. Control of this pathogen is complex due to the lack of resistant banana or plantain genotypes, lack of effective commercial fungicides, the production of chlamydospores, late appearance of symptoms in infected plants, high adaptability of the pathogen to diverse soil conditions and the polycyclic nature of the disease. Currently, the management strategy for Foc TR4 is exclusion and eradication, which is costly for the producer and the environment because the plants are treated with glyphosate and the affected area is quarantined for a long time. Thus, the development of early detection strategies for Foc TR4 from environmental samples and asymptomatic tissues with low inoculum concentration is essential; this would enable restriction of pathogen spread and minimize the environmental impact by eradication only in areas with accurate data of the pathogen's presence. In this study, three different PCR technologies (conventional PCR, quantitative PCR and droplet digital [dd] PCR) were evaluated for Foc TR4 detection in complex environmental samples. We report the development of a sensitive and specific ddPCR primer/probe set and protocols that can be used as a tool for Foc TR4 detection from symptomatic and asymptomatic plant tissue without prior DNA extraction. The limits of detection in drainage waters, footbaths and soil samples were evaluated using artificial inoculation assays. Finally, environmental samples from Foc TR4‐affected fields were analysed.

DEVELOPMENT OF MALE REPRODUCTIVE STRUCTURES IN <i>CAMPANULA ALLIARIIFOLIA</i> (CAMPANULACEAE)

A cytoembryological study of the formation of microsporangium wall and the development of pollen grains in Campanula alliariifolia Willd. was carried out. A significant similarity in the structure of male embryonic structures in this species with the other representatives of Campanulaceae was revealed, namely: simultaneous formation of tetrads of microspores, bicellular pollen grains with relatively large vegetative cell, cellular secretory tapetum, bilayered endothecium. Characteristic features of this species are as follows: the absence of placentoids which indicates its evolutionary advancement, since the placentoids are characteristic of the most primitive representatives of the family; long-term, in comparison with previously studied species of the family, preservation of the tapetum, namely up to the opening of the anther, in the form of a cord of deformed tapetal cells located in a row and tightly adjacent to each other; relatively late appearance of fibrous bands.

Ethics of Social Robotics: Individual and Societal Concerns and Opportunities

Focus on the ethics of a given technology tends to lag far behind its development. This lag has been particularly acute in the case of artificial intelligence, whose accelerated deployment in a wide range of domains has triggered unprecedented attention on the risks and consequences for society at large, leading to a myriad of ethics regulations, which are difficult to coordinate and integrate due to their late appearance. The very nature of social robots forces their deployment to occur at a much slower pace, providing an opportunity for a profound reflection on ethics, which is already happening in multidisciplinary teams. This article provides a personal view of the ethics landscape, centered on the particularities of social robotics, with the main issues being ordered along two axes (individual and societal) and grouped into eight categories (human dignity, human autonomy, robot transparency, emotional bonding, privacy and safety, justice, freedom, and responsibility). This structure stems from the experience of developing and teaching a university course on ethics in social robotics, whose pedagogical materials are freely available.

Changes of optical coherence tomographic hyperreflective foci in rhegmatogenous retinal detachment patients after successful surgery

PurposeTo assess the changes of hyperreflective foci (HRF) in rhegmatogenous retinal detachment (RRD) patients after successful reattachment surgery. MethodsTwenty-nine macula-off RRD eyes with successful reattachment surgery were retrospectively analyzed. Optical coherence tomography (OCT) was used to image macular regions and measure HRF in outer retina and inner retina at 0.5, 1, 3, 6, 12 months after surgery. The relationships between HRF and photoreceptor layer status, visual outcomes were evaluated. ResultsAfter retinal reattachment, HRF mainly distributed at the location where external limiting membrane (ELM) or inner and outer segment (IS/OS) line was disrupted. The HRF numbers in outer and inner retina were greater in eyes with discontinuous IS/OS line than eyes with continuous IS/OS line (all p<0.05). In the outer retina, HRF increased in the initial three months after retinal reattachment, and then decreased gradually after 3 months (p<0.05). The HRF number in the outer retina at postoperative 0.5 months was associated with favorable visual outcomes at 6 and 12 months (r=-0.487, p =0.025; r=-0.626, p=0.005, respectively), nevertheless, the HRF number at 3 months was correlated with poor visual results at 6 and 12 months (r=0.441, p =0.017; r=0.477, p=0.019, respectively). ConclusionHRF mainly occurred near the site where ELM or IS/OS line was injured after retinal reattachment. In the outer retina, the number of HRF gradually increased in the first 3 months and then gradually decreased. The early appearance of HRF in the outer retina was associated with a good visual prognosis, while the late appearance may suggest a less favorable visual outcome.

Neonatal osteomyelitis: A case series

Background: Osteomyelitis in the neonatal age group is a rare entity. Its presentation and progression are quite different from osteomyelitis in adults, adolescents, and even children. Due to vague clinical features and the late appearance of changes on X-rays, the diagnosis often gets missed. Additionally, there is a risk of permanent damage to bones and joints. Case Presentation: Our experience of 3 such interesting cases showed the diagnostic dilemma involved in neonatal osteomyelitis. All 3 cases presented as cellulitis or subcutaneous abscess initially as x-ray changes appeared late (7-10 days after onset of disease). All the babies needed surgical debridement. The average duration of antibiotics given was 35.5 days. No residual sequelae were reported for up to 2 years. Conclusion: Neonatal osteomyelitis needs a high index of suspicion especially in late-onset neonatal sepsis or prolonged septicemia. This case series emphasizes the need for a low threshold for suspicion and early treatment to avoid permanent disability.

Convergent evolution of defensive appendages – a lithobiomorph-like centipede with a scolopendromorph-type ultimate leg from about 100 million-year-old amber

Centipedes are predatory representatives of the group Myriapoda and important components of the soil and leaf-litter fauna. The first pair of trunk appendages is modified into venom-injecting maxillipeds in all centipedes. The number of trunk appendage pairs varies between the different groups of centipedes, from 15 pairs as apparently ancestral (plesiomorphic) condition, up to 191 pairs. The last pair of trunk legs can be used for different tasks in centipedes, e.g. mechano-sensation, defense, or stridulation. Many morphological details are also known from fossil centipedes, but especially the oldest fossils are often fragmentary and the fossil record in general is rather scarce. Especially the late appearance of lithobiomorphans in Cenozoic ambers is notable, though some not formally described lithobiomorph-like specimens from Cretaceous amber from Myanmar have been published. We present here a new specimen from Cretaceous Kachin amber, Myanmar with a lithobiomorph-type of morphology, Lithopendra anjafliessae gen. et sp. nov. The very large ultimate leg appears to have been used for defence and is, in relative proportions, larger than in any known lithobiomorphan, only comparable to that in scolopendromorphans. With this, the specimen presents a mixture of characters, which are in the modern fauna only known from two different centipede groups. We discuss the implications of this new fossil, also concerning events of convergence in this lineage.

O-180 What is the true potential of 1PN embryos? A report on utilisation and live birth rates following PGT-A and biparental testing

Abstract Study question What is the developmental potential of monopronuclear (1PN) embryos, and does allowing their use only after confirming biparental inheritance offer a clinical solution for them? Summary answer 1PN embryos demonstrate clear utilisation, euploidy, and live birth rates, that warrant their routine culture, and use following biparental inheritance testing, in the clinical setting. What is known already Embryos only displaying a single pronuclei (1PN) are widely regarded to be abnormal and not suitable for clinical use. It is therefore common practice to discard these embryos following fertilisation check. However, 1PN embryos have shown the ability for normal blastocyst development, albeit at a decreased rate, and the ability to produce live births. To bridge the gap between discarding an “abnormal” 1PN embryo, and the knowledge that it can result in a live birth, our clinic utilises PGT-A with biparental inheritance testing to assess the fitness of a 1PN embryo for transfer. Study design, size, duration A retrospective analysis was performed of 5010 1PN embryos derived from IVF (2612) or ICSI (2398) insemination at Genea clinics across Australia between January 2017 and November 2022. Blastocyst development, euploidy, parental inheritance, pregnancy, and live birth rates were analysed. Participants/materials, setting, methods Embryos were defined as being 1PN by the appearance of one pronuclei at fertilisation check 16-18 hours post insemination. Time lapse footage was reviewed on day 3 of culture to eliminate the late appearance of a second pronucleus. Suitable embryos underwent trophectoderm biopsy for PGT-A and biparental inheritance testing. Only euploid embryos with confirmed biparental inheritance were available to patients for frozen embryo transfer. Main results and the role of chance 1PN embryos derived from ICSI insemination were found to have a significantly lower blastocyst development potential of 17.4% compared to 33.7% for IVF embryos (p &amp;lt; 0.0001). The utilisation rate was also significantly lower at 8.1% for ICSI vs 21.2% for IVF (p &amp;lt; 0.0001). The IVF embryos showed a higher rate of euploidy following PGA-T testing, 50.9% for IVF vs 37.9% for ICSI (p &amp;lt; 0.0001). Uniparental inheritance, an indication the 1PN appearance was caused by parthenogenesis, was only observed in 6.7% of the total embryos tested, with IVF embryos having a considerably lower rate of 1.8% vs 20.5% for ICSI (p &amp;lt; 0.0001). There was no significant difference between the 2 groups for pregnancy rate or live births, following single embryo transfer, with 58.6% for IVF vs 62.9% for ICSI (p = 0.6) and 39.6% for IVF vs 45.7% for ICSI (p = 0.5) respectively. These levels were comparable to normally fertilised (2PN) euploid embryos across Genea clinics in the same time period. During the study period there have been 175 1PN embryos transferred that has resulted in 69 live births from embryos that otherwise would have been discarded. Limitations, reasons for caution The use of timelapse imaging from the time of insemination for ICSI embryos, as opposed to 16-18 hours post insemination for IVF embryos may play a role in the type of 1PN embryos that are being identified in each group. Wider implications of the findings This study demonstrates that not all 1PN embryos are abnormal and their routine use in the clinical IVF lab in conjunction with appropriate testing should be re-evaluated. Trial registration number not-applicable

Zirabia cylindrica comb. nov. provides evidence of Doyleales in the Jurassic.

In recent years, Doyleales have played an important role in the discussion and exploration of seed plant relationships and the origin of angiosperms. This order comprises a diversity of recently described genera with cupule-bearing compound ovulate cones recovered from Early Cretaceous deposits in North America and Asia. Their relatively late appearance in the fossil record, stratigraphically near the appearance of angiosperms in the Early Cretaceous, has been noteworthy. Here, we report a new genus of Doyleales, Zirabia gen. nov. from the Early Jurassic of Iran, that was originally described as the ginkgophyte Karkenia. We reinvestigated material previously assigned to Karkenia cylindrica from the Lower Jurassic of the Zirab locality, Alborz Mountains, northern Iran. The studied specimen features a main axis bearing helically to irregularly arranged bract-cupule complexes, each composed by a long laminar bract subtending and sheathing a cupule stalk that bears a single-seeded cupule with a dorsal protrusion. The morphological features of this taxon do not conform with those of Karkenia, and suggest affinities with Doyleales rather than Ginkgoales. Within Doyleales, this fossil has a unique combination of characters indicating that it is a new genus within the order; thus, a new combination is erected, Zirabia cylindrica. Our results indicate that Doyleales is significantly older than previously thought, with their stratigraphic range now extending from the Lower Jurassic to the Cretaceous. The Early Jurassic occurrence of Doyleales provides important data on the emergence of seed-enclosing structures seen in seed plants throughout the Mesozoic.

Abdominal visceral tuberculosis: a malignancy mimic.

The purpose is to discuss abdominal tuberculosis mimicking malignancy involving the abdominal viscera. TB of the abdominal viscera is common, especially in countries where tuberculosis is endemic and in pockets of non-endemic countries. Diagnosis is challenging as clinical presentations are often non-specific. Tissue sampling may be necessary for definitive diagnosis. Awareness of the early and late disease imaging appearances of abdominal tuberculosis involving the viscera that can mimic malignancy can aid detecting TB, providing a differential diagnosis, assessing extent of spread, guiding biopsy, and evaluating response.

Abstract #1413009: Post Snake Bite Panhypopituitarism – Delay in Diagnosis or Delayed Presentation

Panhypopituitarism is a condition of inadequate or absent production of the anterior pituitary hormones. Simmonds’ disease was first described in 1914 by the German pathologist Simmond. Post snake bite panhypopituitarism is a described entity. Hypopituitarism following Russell’s viper bite was first reported in 1976 by Eapen et al in three adults from Kerala in South India. Most of the cases are diagnosed long after the snake bite, and this delay has been attributed to clinical inertia and lack of awareness. But on careful analysis of the case reports, it is found that at least a few of them started having symptoms after a latent period, which can be up to 5 years. We present 7 cases of post snakebite hypopituitarism, which were diagnosed late, but also had a delayed onset of symptoms. 7 patients, who were diagnosed to have post snake bite hypopituitarism between May 2020 and May 2022 were studied. All patients were male. The type of snake, the complications and treatment initially given were studied, and then the time of onset of symptoms of hormonal deficiencies was collected. All patients underwent relevant hormonal tests, including dynamic tests and imaging for pituitary. All patients were male, all were bitten by Russels viper, all had hypotension after the bite and required blood transfusions and hemodialysis. The mean duration from the snake bite to the diagnosis was 7.75 years. The onset of symptoms was also delayed, with symptoms occurring an average 4.25 years after the snake bite. All patients had symptoms of hypogonadism, which was the first symptom to occur in 5 out of 7 patients. Lethargy, tiredness, weakness were present in all and appeared next, a mean of 6 months later. Symptoms of adrenal insufficiency appeared in all patients, a mean of 2.5 years later. Adrenal crisis occurred in patients, a mean of 13 months later. On hormonal evaluation all patients had panhypopituitarism, (low FSH/LH Testosterone, Cortisol, IGF1, and FT4). MRI done showed empty sella in 5 patients and small anterior pituitary in 2 patients. Hypopituitarism is an important sequel of Russell’s viper bite in South India. A high degree of suspicion is needed to diagnose this condition following Russell’s viper bite. Contrary to our earlier understanding of post snake bite hypopituitarism, the pituitary damage is not a single time event, but a gradual loss of pituitary function initiated by the snake bite, which results in a delayed appearance of symptoms. The sequence of loss of pituitary hormone functions- Gonadotropin- GH-Thyrotropin-ACTH also points to the same fact. The possible explanation is drawn from the analogy of Sheehan’s syndrome presenting late, where the late presentation is due to an autoimmune destruction, initiated by the snake bite (Anti pituitary antibody positive). The delay in diagnosis is at least contributed by the late appearance of panhypopituitarism, and the diagnosis should be considered in all patients with significant viper bite, presenting with symptoms suggestive of panhypopituitarism, however late may the onset of symptoms be.