Preparation Protocol Research Articles

A study on the related influencing factors of the quality of bowel preparation and the compliance of middle-aged and elderly patients for colonoscopy

Objective Quality of bowel preparation and patient compliance are among the most important indicators to assess the quality of colonoscopy. To investigate the independent factors associated with the quality of bowel preparation in subjects undergoing colonoscopy and its impact on compliance. Methods A total of 329 patient records were collected and were divided into an adequate bowel preparation group (272 cases) and an inadequate bowel preparation group (57 cases), or a compliant group (260 cases) and a non-compliant group (69 cases), based on bowel preparation quality or compliance. The quality of bowel preparation is evaluated using the Boston Bowel Preparation Scale. The comfort level of subjects during bowel preparation is assessed using the Kolcaba General Comfort Questionnaire (GCQ). Subjects’ compliance was assessed according to a self-developed compliance questionnaire. Prediction analyses were conducted to identify factors associated with the quality of bowel preparation and compliance. Results Age, bowel preparation duration, history of bowel inadequacy, and laxative dosage showed statistical differences between the adequate and inadequate bowel preparation groups (p < 0.05). Age, bowel preparation duration, and laxative dosage were independent influencing factors of bowel preparation quality. Correlation analysis showed that GCQ scores were significantly negatively correlated with age, bowel preparation duration, laxative dose, defecation frequency, and colonoscopy duration (r < 0, p < 0.05), and positively correlated with sleep duration (r > 0, p < 0.05). In addition, age, gender, bowel preparation duration, and laxative dosage showed statistical differences between the compliant and non-compliant groups (p < 0.05). Logistic regression analysis revealed that age, bowel preparation duration, and laxative dosage were independent influencing factors of bowel preparation compliance. Age and bowel preparation duration were independent influencing factors for bowel preparation adequacy and compliance. Conclusions Age, bowel preparation duration, and laxative dosage are independent influencing factors for bowel preparation adequacy and compliance among patients undergoing colonoscopy at the First Affiliated Hospital, School of Medicine, Zhejiang University. It is recommended that a one-day low-residue diet combined with a 2000 mL laxative dosage be used as the bowel preparation protocol for the general colonoscopy population.

Design of blue-emitting adenosine monophosphate-copper nanocluster: Detection of Vitamin B2 in real samples

We demonstrate a simple preparation protocol for the synthesis of novel adenosine monophosphate-stabilized copper nanoclusters (AMP-Cu NCs). Synthesis parameters are optimized to reach the best fluorometric signal. The prepared Cu NCs show characteristic blue emission at 430 nm, which is related to the presence of Cu13 metal cores. Three distinct lifetime components are identified and the metallic feature of the NCs is proven by X-ray photoelectron spectroscopy. The stability and the long-term storage of the AMP-Cu NCs were investigated by pH- and time-dependent measurements. Besides the synthesis and characterization, a possible liquid fluorescent assay method is also developed for the detection of the biologically important Vitamin B2 in complex real samples by with 2.01 ± 0.31 μM detection limit. For the real samples, the yeast and dietary supplements were selected, where the detected concentration of Riboflavin was in good agreement with the expected amount in these complex chemical systems.

Assessing the efficacy of an innovative diagnostic method for identifying 5 % variants in somatic ctDNA

BackgroundLiquid biopsy is considered a complementary and recently also an alternative method to surgical biopsy. It allows for the acquisition of valuable information regarding the potential presence of tumors, particularly through the analysis of circulating tumor DNA (ctDNA). CtDNA is a fraction of circulating free DNA (cfDNA) that can be extracted from various tissues, with blood being the most readily available. ResultsTo maximize the yield of plasma separation, specific Streck tubes are recommended for blood collection. The MagPurix CFC DNA Extraction Kit can be used for cfDNA extraction, and the TWIST Library Preparation protocol can be optimized for further analysis. Next-generation sequencing (NGS) can be employed to compare somatic and germline lineages, enabling the identification of somatic variants with a Variant Allele Frequency (VAF) of 5 % or higher, which are absent in the germline lineage. ConclusionThis analysis helps in the assessment of recurrence, analysis, and monitoring of cancer tissue.

Manybody interferometry of quantum fluids.

Characterizing strongly correlated matter is an increasingly central challenge in quantum science, where structure is often obscured by massive entanglement. It is becoming clear that in the quantum regime, state preparation and characterization should not be treated separately-entangling the two processes provides a quantum advantage in information extraction. Here, we present an approach that we term "manybody Ramsey interferometry" that combines adiabatic state preparation and Ramsey spectroscopy: Leveraging our recently developed one-to-one mapping between computational-basis states and manybody eigenstates, we prepare a superposition of manybody eigenstates controlled by the state of an ancilla qubit, allow the superposition to evolve relative phase, and then reverse the preparation protocol to disentangle the ancilla while localizing phase information back into it. Ancilla tomography then extracts information about the manybody eigenstates, the associated excitation spectrum, and thermodynamic observables. This work illustrates the potential for using quantum computers to efficiently probe quantum matter.

Adiabatic quantum imaginary time evolution

We introduce an adiabatic state preparation protocol which implements quantum imaginary time evolution under the Hamiltonian of the system. Unlike the original quantum imaginary time evolution algorithm, adiabatic quantum imaginary time evolution does not require quantum state tomography during its runtime and, unlike standard adiabatic state preparation, the final Hamiltonian is not the system Hamiltonian. Instead, the algorithm obtains the adiabatic Hamiltonian by integrating a classical differential equation that ensures that one follows the imaginary time evolution state trajectory. We introduce some heuristics that allow this protocol to be implemented on quantum architectures with limited resources. We explore the performance of this algorithm via classical simulations in a one-dimensional spin model and highlight essential features that determine its cost, performance, and implementability for longer times, and compare to the original quantum imaginary time evolution for ground-state preparation. More generally, our algorithm expands the range of states accessible to adiabatic state preparation methods beyond those that are expressed as ground states of simple explicit Hamiltonians. Published by the American Physical Society 2024

Multidisciplinary Experience for Gluteal Fat Grafting.

Gluteal fat grafting, colloquially known as Brazilian Butt Lift, has experienced a significant rise in popularity in recent years. Despite this increase, potential complications associated with the procedure have also been observed, necessitating a thorough examination of the current practices and outcomes. This study collected experiences of a multidisciplinary group of surgeons through a detailed survey sent in April 2022. This study aimed to shed light on the practices employed by these surgeons, the frequency and types of complications they encounter, and the overall outcomes of their procedures. Of the 100 surgeons surveyed, 86 responded. The study identified that pulmonary fat embolism (PFE) was the most serious complication, with fatality due to PFE recorded at a rate of 1:23,878. Liposuction site seromas were the most common complications, with an overall rate of 2.45%. Although there were no overall differences in complications between plastic and non-plastic surgeons, plastic surgeons were found to have a sixfold increase in the odds of experiencing a liposuction seroma. The survey also revealed substantial practice variations, particularly regarding fat preparation methods, recipient-site preparation, antibiotic use, and postoperative care protocols. Despite known complications, a strong tendency to continue performing these procedures was observed among surgeons, demonstrating the sustained demand and acceptance of the procedure. This study underscores the need for continued surveillance and research to enhance the safety and effectiveness of gluteal fat grafts. The experiences and data gathered from practicing surgeons provide valuable insights, paving the way for refining techniques, building consensus, and facilitating informed discussions with patients about the risks and benefits of the procedure. This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

A 6-minute protocol, combining mental imagery practices and breathing exercises, promotes hand-grip strength in firefighters: a series of "N-of-1" trials.

To carry out their victim rescue and fire-fighting missions, firefighters perform high levels of physical exertion and among them strenuous muscular activity. A specific mental preparation protocol that could induce better strength performance throughout their 24-hour schedule is a major issue for firefighters. This case report aims to examine whether a 6-minute Intervention combining mental imagery practices and breathing exercises, specifically designed to be used while travelling between the fire station and the mission site, would be able to promote maximum strength performance. A series of three Single Case Experimental Designs (SCED) was conducted in single blind design to investigate the effects of repeated challenge-withdrawals between the Intervention and the Baseline on the maximum voluntary isometric contraction (MVIC) strength of the hand-grip. Data analyses revealed that 62.5% to 100% of the hand-grip strength values during the Intervention periods were greater than or equal to the maximum data point recorded in the Baseline periods. The effect sizes of these highlighted increases of the hand-grip strength performance revealed by the percentage of non-overlapping data (PND) were 75% i.e., moderately effective on average. Such a "psyching-up" practice before an upcoming muscular activity can promote muscular strength in firefighters. These results have led French firefighter departments to integrate the teaching of these practices into the initial instruction of firefighters, and remains to be confirmed by a randomised control trial.

Different endometrial preparation protocols on first frozen-thawed embryo transfer outcomes after hysteroscopic polypectomy: A retrospective cohort study.

To evaluate the optimal endometrial preparation protocol for frozen-thawed embryo transfer (FET) following hysteroscopic polypectomy. This was a retrospective clinical cohort study involving 464 patients who underwent their first FET after polyp resection between January 2021 and July 2023. The cohorts were categorized into three groups: the natural cycle (NC) group (n = 139), the ovarian induction (OI) group (n = 117), and the hormone replacement therapy (HRT) group (n = 208). In the initial unadjusted analysis, both NC and OI cycles exhibited similar pregnancy rates but were associated with significantly higher implantation rate (56.5%, 57.1% vs 42.0%, P < 0.001), clinical pregnancy rate (73.4%, 74.4% vs 57.2%, P = 0.001), and ongoing pregnancy rate (OPR; 67.6%, 63.2% vs 51.0%, P = 0.005) compared to the HRT group. Additionally, the three groups demonstrated comparable abortion rate (7.8%, 14.9% vs 10.9%, P = 0.299). After adjusting for potential confounders in the multiple logistic regression model, the HRT protocol resulted in a 54% significantly lower OPR compared to the NC protocol (adjusted odds ratio [aOR] = 0.46, 95% confidence interval [CI]: 0.28-0.77; P = 0.003). Meanwhile, the OPR difference between the OI protocol and the NC protocol remained insignificant (OI vs NC: aOR = 0.62, 95% CI: 0.35-1.12; P = 0.112). The ovulatory-FET scheme (NC and OI) following hysteroscopic polyp resection displayed promising clinical outcomes compared with HRT-FET scheme. The regimen without exogenous estrogen administration should be prioritized for endometrial preparation protocol after polypectomy.

Treatment of endometriosis with mifepristone mediated by nanostructured lipid carriers.

Mifepristone, a progesterone receptor antagonist, was initially used to terminate early pregnancy. As scientific research advanced, it emerged to be effective in the treatment of various tumors and tumor-like conditions such as endometriosis. Despite the therapeutic potential of mifepristone, its therapeutic effect is still far from ideal because the drug is difficult to dissolve and to accumulate in the target tissue sites. To address this issue, mifepristone-loaded nanostructured lipid carriers (Mif-NLC) were prepared by a simple solvent diffusion method and their anti-endometriosis performance and mechanisms were initially investigated. By optimizing the preparation protocol, we obtained uniform and spheroidal Mif-NLC with an average particle size of 280nm. The encapsulation rate and drug loading capacity were 64.67% ± 0.15% and 2.7% ± 0.014%, respectively, as measured by UV spectrophotometry. The in vitro release kinetics indicated that mifepristone was released from NLC in a sustained-release manner. Compared with free mifepristone, Mif-NLC exhibited enhanced cellular uptake and inhibition of invasion activity in primary mesenchymal cells of endometriosis. A certain reduction in the size of endometriotic cysts was observed in animals compared to controls. The induction of autophagy via Mif-NLC may serve as the molecular mechanism underlying this effect. Furthermore, observation of uterine structures showed negligible toxic effects. This suggested that mifepristone encapsulated in NLC can improve its bioavailability and anti-endometriosis efficacy, which provided a new strategy for the treatment of endometriosis.

Optimization of Mycobacterium tuberculosis DNA processing prior to whole genome sequencing

The process of whole genome sequencing of the Mycobacterium tuberculosis complex is dependent on complete the inactivation of the strain and subsequent DNA extraction. The objective of this study was to optimise the two steps.Firstly, the efficacy of Triton X-100 as a solvent for the inactivation step was evaluated. This solvent has been demonstrated to be effective in killing bacteria and is less toxic than the previously employed chloroform. For the extraction step, two lysis methods were evaluated: enzymatic (B1 protocol) and mechanical (B2 protocol). For whole genome sequencing, the Nextera XT DNA library preparation protocol was performed for both the B1 and B2 protocols. Subsequently, each library was subjected to whole-genome sequencing. The results demonstrated that heat lysis inactivation with Triton was effective, with no bacteria remaining viable following this treatment. The enzymatic and mechanical extraction protocols yielded comparable results in terms of DNA quantity and quality. The sequencing results showed that there was no significant difference in read depths between the two protocols. In conclusion, for MTBC strains, we recommend the use of our Triton inactivation method, which meets biosafety expectations.

Mitigating Temporal Fragility in the XY Surface Code

An important outstanding challenge that must be overcome in order to fully utilize the XY surface code for correcting biased Pauli noise is the phenomenon of fragile temporal boundaries that arises during the standard logical state-preparation and measurement protocols. To address this challenge we propose a new logical state-preparation protocol based on locally entangling qubits into small Greenberger-Horne-Zeilinger-like states prior to making the stabilizer measurements that place them in the XY-code state. We prove that in this new procedure O(n) high-rate errors along a single lattice boundary can cause a logical failure, leading to an almost quadratic reduction in the number of fault configurations compared to the standard state-preparation approach. Moreover, the code becomes equivalent to a repetition code for high-rate errors, guaranteeing a 50% code-capacity threshold during state preparation for infinitely biased noise. With a simple matching decoder we confirm that our preparation protocol outperforms the standard protocol in terms of both threshold and logical error rate in the fault-tolerant regime where measurements are unreliable and at experimentally realistic biases. We also discuss how our state-preparation protocol can be inverted for similar fragile-boundary-mitigated logical-state measurement. Published by the American Physical Society 2024

Ionic liquid based surfactant-free microemulsion as a new protocol for preparation of visible light active poly(methyl methacrylate)/TiO2 nanocomposite

The practical application of sensitized TiO2 nanocomposites is very satisfying due to their high photon utilization in visible light, simple recovery without affecting the photocatalytic performance, high energy efficiency, low potential environmental risk, and low operational costs. The objective of this study is developing the ionic liquid (IL)-based surfactant-free microemulsion, as a soft template, for preparation of a novel type of sensitized poly(methyl methacrylate)/TiO2 nanocomposite (PMMA/TiO2/IL). For this purpose, a series of visible light-responsive PMMA/TiO2/IL transparent nanocomposites were prepared in microemulsion composed of methyl methacrylate monomer, 1-buthyl-3-methylimidazolium tetrafluoroborate ([bmim][BF4]), and 1-buthanol as amphi-solvent. Techniques such as diffuse reflectance spectroscopy (DRS)), attenuated total reflectance-fourier transform infrared (ATR-FTIR) spectroscopy, atomic force microscopy (AFM), field emission scanning electron microscopy (FE-SEM), and energy dispersive X-ray analysis (EDX) were used to characterize prepared nanocomposites. Photocatalytic degradation of methyl orange dye under visible light illumination, as an application in wastewater treatment, with the investigation of the influence of TiO2 content in the nanocomposite, pH, and nanocomposite reusability on photodegradation efficiency was studied and maximum value of 93.9% obtained at optimum conditions. The FESEM analysis indicated that the utilization of a relatively low amount of ionic liquid and also in absence of the surfactant ensures the monodispersity of the visible light sensitized TiO2 nanoparticles in the polymer matrix.

P-613 Natural cycles monitoring for frozen embryo transfers: is it beneficial to start immediately after ovarian stimulation?

Abstract Study question Are there more advantages in performing frozen embryo transfer (FET) immediately after ovarian stimulation or in delaying it by at least one menstruation? Summary answer In natural cycles, timing of frozen embryo transfer does not affect clinical pregnancy rates, but immediate transfer is associated with higher rates of cycle cancellation. What is known already In order to achieve a reduced time to pregnancy and avoid additional stress for the couple, some Centers initiate FETs immediately, i.e. on the first menstrual cycle after ovarian stimulation. However, the detrimental effect of hormonal stimulation on ovarian function and endometrial receptivity may persist in the following cycle and immediate FETs may increase the possibility of cycle cancellation and reduce pregnancy rate. Available evidence on this subject, mainly focused on endometrial preparation with hormonal replacement therapy (HRT), showed contrasting results. Moreover, studies on FETs performed on natural cycles are lacking. Study design, size, duration This is a retrospective study conducted at the Infertility Unit of the Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico in Milan, Italy. A large amount of single FETs, performed between 2014 and 2021, was considered and was then divided in two groups according to their timing (immediate or delayed). The primary outcome was to assess the clinical pregnancy rate (CPR); secondary outcomes were live birth rate (LBR) and the cycle cancellation rate. Participants/materials, setting, methods True natural cycles (T-NC) and modified cycles with the use of triggered ovulation (M-NC) protocols for endometrial preparation were pursued in women with regular menses; otherwise, HRT was used. Immediate FET was defined when performed on the first menstruation following ovarian stimulation (i.e. withdrawal bleeding occurring after ovarian stimulation or after a failed fresh embryo transfer). Delayed FETs included those performed after at least two menstruations. Only the first transfer after ovarian stimulation was considered. Main results and the role of chance A total of 5,765 FET cycles were included in the study. FET cycles were achieved through T-NC in 4,477 cases (78% of all FETs), of which 364 were immediate and 4,113 were delayed. M-NC cycles accounted for 1% of the total amount of FETs and HRT protocols were pursued in 11% of cases. The analysis showed no impact of FET timing on CPR both in the whole cohort and in the subgroups based on different endometrial preparation protocols. Focusing on T-NC cycles, the CPR in the immediate group was comparable to that of the postponed group (29 vs. 32% respectively, OR 0.90 [95% CI 0.71 - 1.14]). On the other hand, LBR in T-NC cycles was significantly lower in the immediate group than in the delayed group (20% vs. 25% respectively, OR 0.74 [95% CI 0.56 - 0.96]). Consequently, immediate FETs resulted to be associated with a significantly higher rate of pregnancy loss (31% vs. 21% respectively, p = 0.03). Furthermore, cycle cancellation occurred more frequently in the immediate T-NC group, compared with the delayed group (18% vs. 12% respectively, p = 0.003). Similar results were observed in HRT cycles (15% in immediate FETs vs. 7% in delayed FETs, p = 0.08). Limitations, reasons for caution The retrospective nature of this study involves a risk of selection bias. Moreover, the reason for cycle cancellation was not always available; thus, these data were not included in the analysis. Lastly, these outcomes are only applicable to a similar cohort, that is Centers following a non-elective freeze-all policy. Wider implications of the findings This is the largest investigation on T-NC FETs and is among the very few studies providing separate results on different endometrial preparation protocols. Evidence from this study is in line with some previous retrospective analyses and in contrast with others. Thus, randomized controlled trials are needed to confirm these results. Trial registration number not applicable

P-563 Improved diagnosis in PGT-A samples with intermediate sex chromosomes copy number changes by adding ploidy and contamination analysis

Abstract Study question Does triple analysis of aneuploidy, ploidy and contamination improve the diagnosis in samples with intermediate copy number changes for the X and the Y chromosomes? Summary answer PGT-A with additional ploidy and contamination analysis improves the diagnosis of samples with intermediate sex chromosomes copy number changes, reducing non-informativity and the re-biopsy need. What is known already Next Generation Sequencing (NGS) in Preimplantation Genetic Testing for Aneuploidies (PGT-A) identifies chromosomal aneuploidies in trophectoderm (TE) biopsies. However, diagnosis limitations exist when the TE biopsy displays intermediate copy number changes for the X and the Y chromosomes, observed in ∼0.3% of biopsies. Few explanations are plausible, including mosaicism for the sex chromosomes, presence of exogenous DNA contamination or triploidy. A second TE biopsy (re-biopsy) could be recommended to obtain a conclusive result. However, additional Single Nucleotide Polymorphism (SNP) analysis to determine the ploidy status of the embryo and the presence of contamination in the biopsy can be an alternative. Study design, size, duration In this retrospective study, the impact on the diagnosis of SNPs analysis with a target panel was evaluated in PGT-A samples showing intermediate copy number changes for the X and the Y chromosomes. A total of 21 TE biopsies from January to December 2023 were included in the study. Participants/materials, setting, methods The TE biopsies were analysed using NGS with a proprietary protocol for library preparation, Ion Chef and Ion S5 System instruments for sequencing and a proprietary bioinformatics pipeline (v2.0) for 24-chromosomes aneuploidy testing. A re-biopsy was analysed in 8 embryos using the same protocol. Eighteen original biopsies were retrospectively evaluated for ploidy and contamination using an Ion AmpliSeq Custom Panel including SNPs (Thermo Fisher Scientific, USA) and a proprietary algorithm (v1.0) for data analysis. Main results and the role of chance The 21 TE biopsies displaying intermediate copy number changes for the X and the Y chromosomes were initially diagnosed as non-informative and candidates for re-biopsy to rescue diagnosis. A total of 8 embryos were re-biopsied (38.1%): 6 re-biopsies (75.0%) showed the same intermediate sex chromosomes copy number changes suggesting a triploid status of the embryo, 1 re-biopsy (12.5%) showed trisomy 22 suggesting DNA contamination in the original biopsy and, 1 re-biopsy (12.5%) displayed a mosaic monosomy X/XY suggesting a diploid-mosaic status of the embryo. In 18 original TE biopsies (85.7%), an additional ploidy and contamination analysis was done: 10 samples were triploid (55.6%), 6 samples showed DNA contamination (33.3%) and 2 samples were diploid (11.1%). In 5 embryos, the re-biopsy with the aneuploidy testing had been done: (i) in 4 triploid embryos the re-biopsies showed the same intermediate copy number changes for the sex chromosomes than the original biopsy, confirming the triploid status of the embryo; (ii) in 1 diploid embryo the re-biopsy showed a mosaic monosomy X/XY, confirming the diploid status and the sex chromosome mosaicism of the embryo. From the 21 embryos initially non-informative, only the 6 contaminated ones remained non-informative and candidates for re-biopsy (33.3%). Limitations, reasons for caution The limited number of samples with both analysis, ploidy/contamination by SNPs in the original sample and aneuploidy by NGS in the re-biopsy precluded to drawn stronger conclusions. This double-check would reinforce the benefit of doing additional ploidy/contamination analysis in these specific cases. Wider implications of the findings A high incidence of samples with intermediate sex chromosomes copy number are triploid, some have exogenous DNA contamination, and few are real mosaics for the sex chromosomes. Additional ploidy and contamination analysis could improve the PGT-A diagnosis and decrease mosaicism and non-informativity rates, reducing the embryos that would need re-biopsy. Trial registration number Not applicable

P-410 A modified artificial cycle-frozen embryo transfer(mAC-FET) protocol with evidence of corpus luteum(CL) formation as determined by serum relaxin-2 in early pregnancy :a prospective proof-of-concept study

Abstract Study question Can a mAC-FET protocol for endometrial preparation in ovulatory patients lead to formation of a CL as evidenced by serum relaxin-2 in the pregnant patients? Summary answer CL forms in the mAC-FET protocol as serum relaxin-2 in early pregnancy was comparable to that in spontaneous conception.Late luteal rise of relaxin-2 wasn’t demonstrated. What is known already Clinical evidence points to increased incidence of preeclampsia in pregnancies by AC-FET cycles compared to ovulatory FET cycles-natural cycle(NC) and mNC. The absence of CL and it’s secretory products like relaxin-2 is a contributing factor. FET protocols for endometrial preparation in ovulatory patients need to be optimised. NC/mNC-FET protocols need frequent monitoring. Also there is a temporal variability between LH/hCG and progesterone levels. We studied a mAC-FET protocol in ovulatory patients with a delayed start(day3-5 of the cycle),low dose transdermal 17β estradiol gel to see the formation of CL as elucidated by the presence of serum relaxin-2 in early pregnancy. Study design, size, duration A proof-of- concept prospective study was conducted at a tertiary centre (July2023-Dec2023). Serum relaxin-2(R&amp;D/Quantikine/ELISA) was determined in 4 groups of patients- Group-A. mAC-FET(n = 34) 1.On the day of start of progesterone 2.Post-ET day5-9 (along with serum progesterone) 3.In pregnancy(6-9 weeks of gestation) Group-B. AC-FET(n = 8) 1.On the day of start of progesterone 2.In pregnancy(6-9 weeks) Group-C. Spontaneous conception (n = 9) 1.In pregnancy(6-9 weeks) Group-D. Infertility patients ( n = 24) 1.Preovulatory. All patients were ≤40 years with a BMI ≤30kg/m2. Participants/materials, setting, methods In the AC-FET cohort-oral estradiol 6mg/day was started from day1/2 of the cycle. When endometrial thickness was&amp;gt;7mm,progesterone&amp;lt;1ng/ ml then intramuscular progesterone was started- 50mg/day-3 days,100mg on day4-the day of ET(Day-3 embryos) and continued every alternate day.Progesterone gel was added post-ET. In the mAC-FET cohort-17β transdermal estradiol gel(0.06%) 3mg/day was started from day3-5,rest of the protocol was similar. Statistical analysis was performed using appropriate non-parametric tests.Pearson coefficient(r) was used to assess linear-relationship.Two-tailed P&amp;lt;.05 indicated statistical significance. Main results and the role of chance Mean age and BMI of the patients with mAC-FET was 33.3±4.7 years and 24.4±3.7 kg/ m2 which was comparable across all groups (P=.14,P=.52 respectively). Clinical pregnancy rate in the mAC-FET group was 52.94%(18/34). 3 patients had an early abortion. Baseline relaxin-2 levels, median[Interquartile range(IQR)] were comparable- AC-FET cohort-9.1pg/mL(8.6-16.8), mAC-FET cohort-11.5pg/mL(9.6-13.7) and the infertility cohort-10.9pg/mL(8.4-14.5) (P=0.74) The primary outcome was the comparable levels of serum relaxin-2, in early pregnancy in the mAC-FET group and spontaneous conception group - median (IQR) 449.8pg/mL(73.1-492.3) and 487.9pg/mL(419.1-497.8) respectively (P=.12) The relaxin-2 levels, in early pregnancy in the mAC-FET group were significantly higher than the AC-FET group median(IQR) 449.8pg/mL(73.1-492.3) and 7.9pg/mL(7.8-9.5) respectively (P=.0005). As secondary outcomes, we studied the late luteal rise of relaxin-2 in the mAC-FET group and the relationship of late luteal progesterone with relaxin-2 in early pregnancies in the mAC-FET cohort. A late luteal rise of relaxin-2 was not demonstrated in the mAC-FET cohort. The serum relaxin-2, on the day of start of progesterone and on day5-9 post ET- median(IQR) 11.5pg/mL(9.6-13.7) and 11.4pg/mL(9.0-18.5), respectively was comparable (P=.18). The relationship between serum relaxin-2 in early pregnancy and the progesterone levels on day5-9 post ET in the mAC-FET cohort was not significant r = -.059 (P=.07) Limitations, reasons for caution This was a small proof- of-concept single centre study. Due to the limited numbers and short duration of the study, we could not compare efficacy, cancellation rates and pregnancy outcomes of the mAC-FET protocol with other FET protocols. Wider implications of the findings The mAC-FET protocol studied for endometrial preparation was similar to the AC -FET protocol regarding monitoring,flexibility and consistent progesterone exposure with the added advantage of the presence of the CL.This may decrease the risk of maternal/neonatal complications. Larger studies are needed to confirm it’s efficacy and impact on pregnancy outcomes. Trial registration number Not Applicable

Enhanced Recovery after Surgery Protocol (ERAS) versus Standard Protocol for Undergoing Radical Cystectomy in an Egyptian Population

Abstract Background bladder cancer has been one of the commonest cancer. The gold standard for treatment of muscle invasive bladder cancer is radical cystectomy with pelvic lymphadenectomy and associated with considerable morbidity and mortality and healthcare cost. Enhanced recovery after surgery (ERAS) protocols are multimodal perioperative care pathways designed to achieve early recovery after surgical procedures. Aim and Objectives The aim of this study was to compare between the standard preoperative bowel preparation (SP) and ERAS protocol in terms of postoperative length of stay (LOS) and postoperative morbidity. Subjects and Methods This was a prospective randomized study was conducted in Ain shams university hospital – Alexandria university hospital involving fifty (50) patients were randomly divided into two equal groups twenty-Five (25) patient in group A follow ERAS protocol and twenty-Five (25) patients in group B following standard protocol. The duration of the study ranged from 6-12 months. Results There was statistically significant difference found between group A and group B regarding the studied parameters ( Readmission in 30 days, Ileus, Vomiting, and UTI) while there was no statistically significant difference between them regarding (early mobilization, urine leakage, dehesince and DVT), there was no statistically significant difference found between group A and group B regarding (Length of stay). Conclusion In patients undergoing radical cystectomy, enhanced recovery protocol is considered as a safe procedure and not associated with any increase in intraoperative and postoperative complications compared to standard protocol. The length of hospital stay was shorter in ERAS group.

The effect of gonadotropin-releasing hormone agonist downregulation in conjunction with hormone replacement therapy on endometrial preparation in patients for frozen-thawed embryo transfer.

To investigate the effects of combining gonadotropin-releasing hormone agonist (GnRHa) downregulation with hormone replacement therapy (HRT, GnRHa-HRT) on the clinical outcomes of patients undergoing frozen-thawed embryo transfer (FET). In this retrospective study, we included patients who had FET between January 2018 and December 2022. They were categorized into HRT and GnRHa-HRT groups based on the endometrial preparation protocol. The study compared the clinical outcomes of patients in two groups. Possible factors affecting clinical outcomes were analyzed using univariate analysis. To analyze the impact of two endometrial preparation methods on clinical outcomes, multifactorial logistic regression was performed. The rates of clinical pregnancy (47.31% vs. 59.60%), embryo implantation (37.58% vs. 49.65%), biochemical pregnancy (52.36% vs. 64.31%), and early abortion (7.07% vs. 10.77%) were statistically different between the two groups (p < 0.05). Analysis using multifactorial logistic regression showed that there was a 1.65-fold increase in clinical pregnancy rates (OR = 1.65, 95% CI: 1.29-2.12, p < 0.001) and a 1.55-fold increase in embryo implantation rates (OR = 1.55, 95% CI: 1.27-1.90, p < 0.001) in the GnRHa-HRT group when compared to the HRT group. For blastocyst transfer, the clinical pregnancy and implantation rates of the GnRHa-HRT group were significantly higher than those of the HRT group (OR = 1.75, 95% CI: 1.30-2.37, p < 0.001; OR = 1.73, 95% CI: 1.35-2.21, p < 0.001). In FET cycles, leuprorelin (as a GnRHa) downregulation combined with HRT may improve the clinical outcome of patients compared to the HRT cycle, especially for the clinical pregnancy and embryo implantation rates of patients with blastocyst transfer.

P-780 Bone health in Danish children aged 7-10 years born after assisted reproductive technology with frozen and fresh embryo transfer

Abstract Study question Is bone health in children conceived after frozen embryo transfer (FET) different from children conceived after fresh embryo transfer (fresh-ET) and natural conception (NC)? Summary answer FET-children had higher bone mineral density (BMD) and bone mineral content (BMC) compared to fresh-ET-children. Insulin-like-growth-factor-I (IGF-I) levels and lean bodymass were similar between groups. What is known already Children conceived after assisted reproductive technology (ART) with FET have a higher average birthweight (BW) and increased risk of being born large-for-gestational-age (LGA) while children born after fresh-ET are more often born small-for-gestational-age (SGA). In general, BW is a determinant of BMD and BMC in childhood with LGA being associated with higher BMD and BMC compared to children born appropriate-for-gestational-age. The relationship between BW and BMD and BMC may be mediated by IGF-I levels and lean bodymass as IGF-I is an important regulator of muscle and bone development. Bone health in children born after ART is scarcely explored. Study design, size, duration This study was part of the large Danish cohort study “Health in Childhood following Assisted Reproductive Technology” (HiCART) which included 606 singletons (292 boys) born in Denmark between 2009 and 2013. The children were conceived after FET (n = 200), fresh-ET (n = 203) and NC (n = 203) and matched for birth year and sex. The study examinations were performed from January 2019 to September 2021. Participants/materials, setting, methods The children underwent a clinical examination at 7-10 years of age with anthropometric measurements, pubertal staging, a fasting blood sample and a whole-body dual-energy x-ray absorptiometry-scan (DXA). Anthropometric measurements and circulating growth factors were converted to standard deviation scores (SDS) using Danish reference material. The study groups were compared pairwise using univariate linear regression and multiple linear regression adjusting for relevant confounders including sex, age, puberty, maternal pregestational BMI, breastfeeding and BW (SDS). Main results and the role of chance Children conceived after FET had significantly higher BW (SDS) (mean, SD: 0.20 SDS, 1.09) compared to children conceived after fresh-ET (-0.22 SDS, 1.00), mean difference: 0.42 SDS (95% CI: 0.21; 0.62) and NC (-0.16 SDS, 1.09), mean difference: 0.35 SDS (95% CI: 0.14; 0.57). In the adjusted model, children born after FET had significantly higher total BMD (g/cm2) (mean difference 0.01, 95% CI: 0.00; 0.03) and size-adjusted BMC (BMC/height, g/m) (mean difference 0.21, 95% CI: 0.01; 0.40) compared to children born after fresh-ET. There was no significant difference in total BMD or BMC/height when comparing FET and fresh-ET to NC children, respectively. There was a trend towards higher lean bodymass (g) in children born after FET and lower lean bodymass in children born after fresh-ET compared to NC children, however this did not reach the level of significance. IGF-I (SDS), IGF-binding-protein-3 (SDS) and serum calcium (mmol/L) levels were comparable between the groups. In the entire cohort, there was a significantly positive correlation between BW (SDS) and size-adjusted BMC (BMC/height, g/m) (b: 0.21, 95% CI: 0.14; 0.27) and total lean bodymass (g) (b: 755, 95% CI: 531; 978), while a significantly negative correlation with IGF-I (SDS) (b: -0.07, 95% CI: -0.13; -0.01). Limitations, reasons for caution The study was powered to detect a clinically relevant difference in BMI (SDS), the primary outcome. Hence, secondary analyses are exploratory by nature. We have no information regarding endometrial preparation protocol in the FET-cycles which may bias the results. Multiple testing may increase our risk of type I errors. Wider implications of the findings Reassuringly, BMD and size-adjusted BMC in children born after ART with FET and fresh-ET were comparable to NC children. Potential determinants of BMD and BMC (IGF-I and lean bodymass) were also similar. Increased BMD and size-adjusted BMC in FET compared to fresh-ET suggests that the different BW-profiles play a role. Trial registration number NCT03719703

P-405 Effects of intrauterine perfusion of autologous platelet-rich plasma on recurrent implantation failure in frozen-thawed embryo transfer: a meta-analysis of randomized controlled trials

Abstract Study question We aimed to evaluate the effect of the platelet-rich plasma （PRP) on pregnancy outcomes in patients with RIF undergoing frozen-thawed embryo transfer (FET). Summary answer Intrauterine infusion of PRP might have more beneficial effects on pregnancy outcomes in RIF patients undergoing FET. What is known already Immunological therapies are of great interest to specialists in reproductive medicine. The immune therapies use intrauterine infusion (i.e., PRP, PBMC, G-CSF, and hCG) for endometrial immunomodulation. Despite the limited number of publications available, the results are encouraging. In the network meta-analysis, PRP, PBMC, C-GCSF, and hCG administration all significantly increased embryo implantation and clinical pregnancy compared to controls. Additionally, PRP administration resulted in a higher live birth rate than the control. This year, more research has focused on PRP as an innovative method to treat RIF. Study design, size, duration Medline, Embase, and Cochrane Controlled Register of Trials (CENTRAL) were searched from inception to July 29, 2023. The randomized controlled trials (RCTs) reporting on pregnancy outcomes of women with RIF who were administered PRP undergoing FET were included. We conducted a meta-analysis where possible using a fixed effects model. The Cochrane Handbook was used to assess the risk of bias for RCTs. Binary outcomes were pooled using risk ratio (RR) with 95% confidence intervals (CIs). Participants/materials, setting, methods Seven RCTs were included with 1,014 RIF women. The final number of women analyzed was 508 with intrauterine infusion PRP and 506 without it. Main results and the role of chance Meta-analysis showed that compared to the controls, the women who received PRP had a significantly higher embryo implantation rate (n = 2, risk ratio (RR) 2.34, 95% CI 1.65 to 3.32; P &amp;lt; 0.00001, I2 = 0%), biochemical pregnancy rate (n = 5, RR 1.94, 95% CI 1.60 to 2.36; P &amp;lt; 0.00001, I2 = 0%), clinical pregnancy rate (n = 7, RR 2.31, 95% CI 1.89 to 2.82; P &amp;lt; 0.00001, I2 = 0%), ongoing pregnancy rate (n = 3, RR 2.70, 95% CI 1.79 to 4.05, P = 0.0004, I2 = 31%), and multiple pregnancy rate (n = 3, RR 2.67, 95% CI 1.07 to 6.68, P = 0.04, I2 = 0%). However, PRP was not attributable to reduce the miscarriage rate (n = 3, RR 1.15, 95% CI 0.40 to 3.35; P = 0.80, I2 = 0%). Limitations, reasons for caution The proportion of small-sample studies included has to some extent affected the validity of the results. There were some variations regarding the PRP preparation process, which may result in a variable composition and concentrations of its different contents. Wider implications of the findings Intrauterine infusion PRP in patients with RIF who underwent FET may improve the pregnancy outcomes assessed in RCTs, including clinical pregnancy and ongoing pregnancy. Therefore, we suggest that PRP be included in endometrial preparation protocols. Trial registration number not applicable

P-318 Reproductive ageing: the seed, the soil, or both?

Abstract Study question Is it all about the embryo? Can a single euploid blastocyst transfer sustain reproductive outcomes in women with advanced reproductive age? Summary answer Despite euploid embryo transfer, endometrial senescence appears to play a crucial role in determining reproductive success, particularly in older patients undergoing in vitro fertilization (IVF). What is known already Advanced reproductive age significantly impairs oocyte and embryo quality. Effective crosstalk and synchronization between embryo and endometrium are pivotal for successful pregnancies, both in vivo and in vitro. Implantation failure remains a persistent challenge in IVF, exacerbated by delayed family planning trends. The transfer of euploid blastocysts through preimplantation genetic testing for aneuploidy (PGT-A) is a potential strategy to address implantation issues, decrease miscarriages, and shorten time-to-pregnancy. However, a significant proportion of IVF treatments remain unsuccessful, suggesting critical factors beyond the embryo. Study design, size, duration This retrospective study analyzed 457 single euploid blastocyst transfers performed by two doctors at a private IVF center from January to November 2023. Inclusion criteria encompassed cases with PGT-A indications (advanced maternal age, repeated implantation failure, recurrent pregnancy loss, etc.) or cases where embryo biopsy was patient-requested. The primary outcome was ongoing pregnancy rate (OPR), with secondary outcomes including pregnancy rate (PR) and clinical pregnancy rate (CPR). Participants/materials, setting, methods Participants were categorized into four groups: Group 1 (&amp;lt; 35 years old; N = 100), Group 2 (35-37 years old; N = 102), Group 3 (38-40 years old; N = 118), and Group 4 (&amp;gt; 41 years old; N = 87). A control group (oocyte donation; N = 50) with single euploid embryo transfers showed a mean recipient age of 43 years. Donors were always less than 32 years old. Endometrial preparation protocols were consistent across all groups. Chi-square test was used to compare groups. Main results and the role of chance Among the 457 transfers analyzed, with a mean female age of 37 years, the overall PR was 71.3%, CPR was 64.8%, and OPR was 60.2%. Groups showed no differences in demographic variables and cycle parameters. Group 1 demonstrated higher PR (83.3%), CPR (78.4%), and OPR (73.5%) compared to Group 2 (PR 70.9%, p = 0.034; CPR 66%, p = 0.047; OPR 62.1%, p = 0.081), Group 3 (PR 68.2%, p = 0.009; CPR 61.2%, p = 0.005; OPR 56.6%, p = 0.008), and Group 4 (PR 65%, p = 0.002; CPR 56.1%, p &amp;lt; 0.001; OPR 51.2%, p = 0.001). Furthermore, the control group (oocyte recipients) showed significantly lower PR (68%, p = 0.031), CPR (54%, p = 0.002), and OPR (46%, p &amp;lt; 0.001) compared to Group 1, but not with the other groups. These findings demonstrate that even with euploid embryos originating from young donors, older women exhibited lower pregnancy rates than young women transferring single euploid blastocysts from their own oocytes and similar rates compared to those with advanced reproductive age transferring their own euploid blastocysts, implying that endometrial ageing may disproportionately influence IVF treatment outcomes. Limitations, reasons for caution The retrospective design introduces inherent bias, notably selection bias and unmeasured confounders. This preliminary data did not account for male infertility factors and their impact on embryo quality. Wider implications of the findings Reproductive aging appears to be influenced by factors beyond the embryo itself, especially in women above 35 years. Further research is warranted to elucidate the causes and impact of reproductive aging on implantation potential, aiming to refine clinical practices and enhance the success of IVF treatments. Trial registration number not applicable