Retrospective Case-control Study Research Articles

Heritability of sudden cardiac death in Thoroughbred racehorses.

Sudden cardiac death (SCD) is an important cause of exercise-associated fatalities in Thoroughbred racehorses. Equine deaths share similarities with fatalities in human athletes that result from inherited cardiac disease. Whilst genetic causes have been postulated in horses, these have not been confirmed and heritability of SCD has not previously been estimated in Thoroughbred racehorses. To determine the heritability of SCD in a sample population of Thoroughbred racehorses. Retrospective case-control study. Steward and post-mortem reports of Thoroughbred racehorses in Australia between 2007 and 2020 were reviewed to identify horses with SCD. Control horses were randomly selected from races in which SCD occurred or from races on the date of the case fatality. A five-generation integrated pedigree chart was collected for each horse. Estimates of heritability were obtained using an animal model in the ASReml-R program with variance components estimated assuming SCD was normally distributed, and on the logit transformed scale. Inbreeding coefficients were calculated and the risk of producing SCD-affected progeny was calculated for stallions that sired ≥5 individuals in the case-control population. Ninety-three horses with SCD and 465 control horses were identified. Heritability on the underlying scale was 0.15 ± 0.09 (logit animal) and 0.24 ± 0.12 (normal animal). Inbreeding coefficients were not significantly different between groups. Of the 16 first generation sires that appeared ≥5 times in the case-control data set, two sires more frequently produced affected progeny (OR 7.95-10.41). Challenges in definitively confirming SCD may lead to misclassification of some cases. Some control horses may have not been exposed to environmental influences of SCD. Case numbers are low and the studied population may not represent the entire Thoroughbred genetic pool. The heritability of SCD in this population was relatively low. However, individual stallions appear more likely to produce affected progeny. Further studies are required to understand the genetic and environmental influences that contribute to disease expression.

Effect of Antiseizure Medication on the Salience Network in Patients with Epilepsy with Generalized Tonic-Clonic Seizures Alone

This study aimed to investigate the effects of antiepileptic drugs on salience network regions in patients with epilepsy with generalized tonic-clonic seizures alone (EGTCSa). A retrospective observational case-control study was performed on 40 patients diagnosed with epilepsy with EGTCSa and 40 healthy age-matched controls. In LORETA, a voxel-by-voxel analysis between regions from the salience network was performed for both hemispheres, specifically between the anterior cingulate (BA 32 and BA 24) and the sublobar insula (BA 13). Subsequently, a Wilcoxon rank-sum test (the Mann-Whitney U test) was conducted for the equality of medians in the transformation matrix. A comparison was then made between each region of interest as defined by the salience network and the controls. Marked differences were found in the brain regions assessed in patients with EGTCSa treated with valproic acid and carbamazepine compared to the control group; few differences in patients treated with levetiracetam; and no difference was found in the group without treatment compared with those in the control group. These results suggest that ASMs can influence cognitive processes, which provide novel insights toward understanding the neural mechanisms underlying the effects of ASMs administration.

Pharmacomechanical Thrombectomy and Catheter-Directed Thrombolysis, with or without Iliac Vein Stenting, in the Treatment of Acute Iliofemoral Deep Vein Thrombosis

Background: This study aims to evaluate and compare the outcomes and clinical efficacy of pharmacomechanical thrombectomy (PMCT) plus catheter-directed thrombolysis (CDT) and PMCT combined with CDT and venous stenting in managing acute iliofemoral deep vein thrombosis (DVT), while also assessing the long-term safety and efficacy of these interventions. Methods: A retrospective case–control study spanning 3 years involved 112 patients presenting with acute symptomatic iliofemoral deep vein thrombosis (DVT), each with a symptom duration of less than 14 days. Patients were consecutively categorized into two groups based on individual clinical indications: PMCT + CDT vs. PMCT + CDT + venous stent. Statistical analyses were conducted to compare clinical features and outcomes between the two groups. Additionally, patients were followed up for 24 months post-treatment, during which quality of life (QoL) and severity of post-thrombotic syndrome (PTS) were analyzed. Results: In this retrospective study, we analyzed a total of 112 consecutive patients, with 63 patients undergoing PMCT + CDT and 49 patients undergoing PMCT + CDT + venous stent. Between the two groups, regarding primary outcomes at 6 months, there was no difference in the observed cumulative patency rates, standing at 82.5% for PMCT + CDT and 81.6% for PMCT + CDT + stent. Survival analyses for primary, primary-assisted, and secondary patency yielded comparable results for PMCT + CDT, with p-values of 0.74, 0.58, and 0.72, respectively. The two-year patency rate was high in both groups (85.7% for PMCT + CDT vs. 83.7% for PMCT + CDT + stent). Additionally, during the follow-up period, there were no statistically significant differences observed in the incidence of PTS or the average Villalta score between the two groups. At 24 months post-intervention, the incidence of post-thrombotic syndrome (PTS) was 11.1% in the PMCT + CDT group and 22% in the PMCT + CDT + stent group (p = 0.381). Both treatment arms of the study groups experienced bleeding complications during the thrombolysis therapy; in the PMCT + CDT group, there were three cases of gastrointestinal bleeding, compared to two cases in the PMCT + CDT + stent group (p = 0.900). Additionally, there was one intracranial hemorrhage in the PMCT + CDT group and two in the PMCT + CDT + stent group. Conclusions: Pharmacomechanical thrombectomy (PMCT) combined with catheter-directed thrombolysis (CDT) therapy has shown significant efficacy in alleviating leg symptoms and reducing the occurrence of post-thrombotic syndrome (PTS), including the incidence of moderate-to-severe PTS. On the other hand, the utilization of PMCT + CDT + stent therapy, tailored to individual patients’ clinical and venous conditions, may enhance long-term venous patency and lead to superior outcomes, including improved quality of life parameters.

Predictive modeling of lower extreme deep vein thrombosis following radical gastrectomy for gastric cancer: based on multiple machine learning methods.

Postoperative venous thromboembolic events (VTEs), such as lower extremity deep vein thrombosis (DVT), are major risk factors for gastric cancer (GC) patients following radical gastrectomy. Accurately predicting and managing these risks is crucial for optimal patient care.This retrospective case‒control study involved 693 GC patients from our hospital who underwent radical gastrectomy. We collected plentiful and comprehensive clinical indicators including a total of 49 baseline, preoperative, surgical and pathological clinical data. Using univariate logistic regression, we identified potential risk factors, followed by feature selection through the Boruta algorithm. We then constructed the final predictive model using multivariate logistic regression and evaluated it using receiver operating characteristic (ROC) curve analysis, calibration plots, decision curve analysis, and other methods. Additionally, we applied various machine learning techniques, including decision trees and random forests, to assess our model's predictive strength.This retrospective case‒control study involved 693 GC patients from our hospital who underwent radical gastrectomy. We collected plentiful and comprehensive clinical indicators including a total of 49 baseline, preoperative, surgical and pathological clinical data. Using univariate logistic regression, we identified potential risk factors, followed by feature selection through the Boruta algorithm. We then constructed the final predictive model using multivariate logistic regression and evaluated it using receiver operating characteristic (ROC) curve analysis, calibration plots, decision curve analysis, and other methods. Additionally, we applied various machine learning techniques, including decision trees and random forests, to assess our model's predictive strength.Univariate logistic analysis revealed 14 risk factors associated with postoperative lower limb DVT. Based on the Boruta algorithm, six significant clinical factors were selected, namely, age, D-dimer (D-D) level, low-density lipoprotein, CA125, and calcium and chloride ion levels. A nomogram was developed using the outcomes from the multivariate logistic regression analysis. The predictive model showed high accuracy, with an area under the curve of 0.936 in the training set and 0.875 in the validation set. Various machine learning algorithms confirmed its strong predictive capacity. MR analysis revealed meaningful causal relationships between key clinical factors and DVT risk.Based on various machine learning methods, we developed an effective predictive diagnostic model for postoperative lower extremity DVT in GC patients. This model demonstrated excellent predictive value in both the training and validation sets. This novel model is a valuable tool for clinicians to use in identifying and managing thrombotic risks in this patient population.

Therapeutic management of peritonsillar abscess during COVID-19.

The purpose of this study is to examine the effects of the Covid-19 pandemic and lockdown policies in Germany on frequency and treatment of peritonsillar abscess at a tertiary referral center in Germany. This retrospective case-control study analyzed all cases of peritonsillar abscess treated from 03/01/2018 until 08/30/2022 at Augsburg ENT University Hospital, Germany, through abscess tonsillectomy and/ or incisional drainage. Data was collected and correlated to Covid-19 Stringency Index using codes based on the Institute for Hospital Remuneration System in Germany. After excluding 303 cases, 975 abscess tonsillectomy and incisional drainage cases were studied, with the first German lockdown serving as cutoff date. Treatment algorithm was maintained regardless of co-infection with Covid-19. A total of 174 patients received abscess tonsillectomy as therapy, while 801 patients underwent incisional drainage. Before the first German lockdown, 452 patients received incisional drainage. Since the pandemic, 349 cases of incisional drainage were registered (OR = 0.54, 95%-CI [0.27-0.86], p = 0.04), despite no significant change in the percentage of peritonsillar abscess of all ENT emergencies. The mean age at presentation with PTA was 39.8 years, and the rate of relapse was 4.0%. The study found no association between the scale of policy measures and treatment (OR = 1.00, 95%-CI [0.99-1.01], p = 0.52). The results indicate that, despite the reduction in capacities due to Covid-19, the proportion of patients with peritonsillar abscess treated through abscess tonsillectomy increased at Augsburg ENT University Hospital since the first German lockdown. Hospitalization times could still be reduced with comparable relapse rates.

A clinical predictive model identifies pediatric patients at risk for eosinophilic esophagitis

BackgroundIdentifying children needing endoscopic evaluation for suspected eosinophilic esophagitis (EoE) is crucial for prompt diagnosis and management. AimsWe aimed to develop a clinical prediction tool to distinguish children with EoE from children without the disease before endoscopy. MethodsWe conducted a retrospective case-control study of children undergoing upper endoscopy at a tertiary care center. Clinical characteristics before endoscopy were extracted from 380 EoE cases and 380 controls without EoE. We built a predictive model for case-control status and performed age-stratified analyses. ResultsAfter multivariable analysis, history of adaptive eating behaviors, food allergy, food impaction, male sex, and regurgitation were independently associated with EoE, and abdominal pain and failure to thrive with control status (AUC 0.81). Food allergy and male sex were predictors of EoE across all ages. Regurgitation and adaptive eating behaviors were specific to EoE in early (0–5 years) (AUC 0.74) and middle childhood (6–11 years) (AUC 0.82), while dysphagia and food impaction were specific to EoE in the adolescence (12–17 years) (AUC 0.87). ConclusionWe determined age-specific clinical features that predict EoE with good discrimination in a pediatric population before endoscopy. Validation of this model in an independent population can confirm the utility of this tool.

Nasogastric and Endotracheal Tubes as Risk Factors for Sinusitis in Critically Ill Children: A Retrospective Case-control Study

Nasogastric and Endotracheal Tubes as Risk Factors for Sinusitis in Critically Ill Children: A Retrospective Case-control Study

Specific tibial landmarks to improve to accuracy of the tibial cut during total knee arthroplasty. A case control study.

More personalized alignment techniques in total knee arthroplasty (TKA) have recently been described particularly for the young and active patients. Performing the ideal tibial cut might be challenging with a conventional ancillary. Therefore the aims of this study were: (1) to describe specific tibial landmarks to optimize the tibial cut in TKA; (2) to compare the accuracy of the tibial cut with these landmarks compared to a conventional technique. This retrospective case-control study compared primary TKAs performed using a conventional technique with extramedullary guide associated with specific tibial landmarks. For each case, one control patient was matched based on body mass index (BMI), age, preoperative Hip Knee Ankle (HKA) angle, and Medial Proximal Tibial Angle (MPTA). All control patients were operated by the same surgeon and similar conventional technique but without landmarks. The MPTA target was to reproduce preoperative deformity with a 3° of varus limit. 34 TKA were included in each group. There was no preoperative difference between both groups. Mean age was 63years old ± 8. Mean BMI was 32kg/m2 ± 5. Mean HKA was 170.6° ± 2.5. Mean MPTA was 85.1° ± 2.3. The radiographic assessment was performed preoperatively and at 2months: HKA, mechanical Medial Distal Femoral Angle (mMDFA), MPTA, tibial slope, restoration of the joint line-height. The tibial landmarks corresponded to the line of insertion of the deep medial collateral ligament fibers extended to the capsular insertion above the Gerdy tubercle. The postoperative MPTA was significantly more varus (87.2° ± 1.6 in landmark group versus 88.3° ± 2.2; p = 0.027) and closer to preoperative bone deformity in landmark group (p = 0.002) with significantly less outliers than in the conventional group. There was no significant difference between both groups postoperatively for HKA (175.4° ± 2.3 versus 175.9° ± 2.5; p = 0.42); mMDFA (88.9° ± 2.3 versus 88.2° ± 2.1; p = 0.18); tibial slope (82.6° ± 1.9 versus 82.4° ± 2.6; p = 0.67), the restoration of the joint line-height (1.5mm ± 2 versus 1.8mm ± 2; p = 0.56). Specific tibial landmarks during TKA can be used to increase the accuracy of the tibial cut when using personalized alignment techniques in TKA. IV.

Radiogenomics of Intrahepatic Cholangiocarcinoma: Correlation of Imaging Features With BAP1 and FGFR Molecular Subtypes.

Clinical research has shown unique tumor behavioral characteristics of BRCA-associated protein-1- (BAP1-) and fibroblast growth factor receptor (FGFR)-mutated intrahepatic cholangiocarcinomas (CCAs), with BAP1-mutated tumors demonstrating more aggressive forms of disease and FGFR-altered CCAs showing more indolent behavior. We performed a retrospective case-control study to evaluate for unique imaging features associated with BAP1 and FGFR genomic markers in intrahepatic CCA (iCCA). Multiple imaging features of iCCA at first staging were analyzed by 2 abdominal radiologists blinded to genomic data. Growth and development of metastases at available follow-up imaging were also recorded, as were basic clinical cohort data. Types of iCCA analyzed included those with BAP1, FGFR, or both alterations, as well as cases with low mutational burden or mutations with low clinical impact, which served as a control or "wild-type" group. There were 18 cases in the FGFR group, 10 with BAP1 mutations, and 31 wild types (controls). Cases with BAP1 mutations showed significantly larger growth at first year of follow-up (P = 0.03) and more frequent tumor-associated biliary ductal dilatation (P = 0.04) compared with controls. FGFR-altered cases showed more infiltrative margins compared with controls (P = 0.047) and demonstrated less enhancement between arterial to portal venous phases (P = 0.02). BAP1 and FGFR groups had more cases with stage IV disease at presentation than controls (P = 0.025, P = 0.006). Compared with wild-type iCCAs, FGFR-mutated tumors often demonstrate infiltrative margins, and BAP1 tumors show increased biliary ductal dilatation at presentation. BAP1-mutated cases had significantly larger growth at first-year restaging.

The coagulation status in women of endometriosis with stage IV

BackgroundEndometriosis is considered as a systemic disease with the presence of proinflammatory cytokines in the circulation, which drives hypercoagulable state of endometriosis. Currently, endometriosis is classified into four stages: I (minimal), II (mild), III (moderate) and IV (severe). The aim of this study is to investigate the correlations between inflammatory markers and coagulation factors in patients diagnosed of endometriosis with stage IV.MethodsThis retrospective case–control study included 171 endometriosis patients with stage IV and 184 controls. Continuous data were expressed by mean ± standard deviation. Mann–Whitney U and χ2 tests were used to compare the medians and frequencies among the groups. Spearman analysis was conducted to determine the correlation among the measured parameters. The diagnostic values of the parameters differentiating endometriomas were tested by receiver operating characteristic (ROC) curve.ResultsThe time of activated partial thromboplastin time (APTT) was decreased and the concentration of fibrinogen (FIB) and neutrophil-to-lymphocyte ratio (NLR) were increased in women of endometriosis with stage IV. The APTT were negatively correlated with NLR while the concentrations of FIB were positively correlated with NLR. The ROC analysis showed that the Area under the curve (AUC) of FIB was 0.766 (95% confidence interval:0.717–0.814) with sensitivity and specificity reaching 86.5 and 60.9%, respectively. The AUC of CA125 and CA199 was 0.638 (95% confidence interval: 0.578–0.697), 0.71 (95% confidence interval: 0.656–0.763) with sensitivity and specificity reaching 40.9 and 91.8%, 80.7 and 56.5% respectively. The combination of these factors showed the highest AUC of 0.895 (0.862–0.927) with sensitivity of 88.9% and specificity of 77.7%.ConclusionIn the present study, we found that inflammatory factors showed significant correlation with APTT or FIB in endometriosis with stage IV. Moreover, the coagulation factors combined with CA125 and CA199 were more reliable for identifying the endometriosis with stage IV.

416 The Impact of Pancreas Transplantation on Secondary Diabetic Complications: A Systematic Review

Abstract Aim Pancreas transplantation (PT) provides diabetic cure for patients with complicated Type 1 Diabetes Mellitus (T1DM). We aimed to examine the impact of PT on secondary diabetic complications, including retinopathy, neuropathy, and cardiovascular disease. Method A database search using MedLINE for publications up to April 2023 was conducted employing MeSH terms ‘Pancreas Transplantation’ AND ‘Diabetes Mellitus, Type 1’ AND ‘Diabetic Retinopathy’ OR ‘Heart Disease’ OR ‘Cardiovascular Diseases’ OR ‘Peripheral Vascular Disease’ OR “Amputation’ OR ‘Neuropathy.” Results 223 articles were screened, with 172 excluded as per study design (total included 51). 64.7% (n=33) of studies were retrospective case control studies, 35.3% (n=18) of studies were retrospective cohort studies. A total of 5616 patients with a mean of 99.1 (SD± 262.4) simultaneous kidney transplant (SPK) patients and 48.2 (SD± 262.4) pancreas transplant alone (PTA) patients per article were studied. All articles examining diabetic retinopathy concluded that retinopathy improved or stabilized. 69% (n=11) of papers demonstrated no significant change to visual acuity. An equal number of articles (n=4) demonstrated increased peripheral nerve conduction velocity after SPK and PTA. 40% (n=2) of articles examining vibration perception studies demonstrated an increase post-transplantation. Improvements in cardiac events incidence, metabolic factors, and heart structure were seen in 79% (n=15) of cardiovascular articles. Conclusions Despite significant heterogeneity in outcome measures observed, PT provides benefits in mitigating the complication profile of T1DM. Standardised outcome measurement should be adopted to allow assessment of the impact of beta-cell replacement with the potential for objective evidence reversibility of secondary complications.

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

P-502 Mosaic embryos result in equivalent live birth rates when compared to euploid embryos following frozen embryo transfer

Abstract Study question Are mosaic embryos associated with a lower live birth rate (LBR) than euploid embryos? Summary answer In this adequately powered study, mosaic embryos had nearly identical LBR and similar miscarriage rates (MR) when compared to euploid embryos. What is known already While prior data has suggested that mosaic embryos result in almost half the LBR and three-fold higher MR than euploid embryos, all prior data supports mosaic embryo transfers as safe with acceptable LBRs. Recent studies have suggested a revised selection criteria choosing either euploid or mosaic embryos for transfer based on embryo grade, day of freeze, low level (LL) versus high level (HL) mosaicism and segmental versus whole chromosome mosaicism. Given the lower LBR reported with mosaics, we initially offered double embryo transfer (DET). We initiated this study to assess our LBR, MR, aneuploidy and DET outcomes with mosaics. Study design, size, duration This was a retrospective case-control cohort study. All mosaic embryos (51) that underwent frozen embryo transfer (FET) between January 2020 and June 2023 were compared to all euploid embryos (706) among all patients with tested embryos that underwent FET in the same time frame. Our Power analysis confirmed that with the 14:1 ratio of 706/51 euploid/mosaic embryos this study is sufficiently powered to exclude a > 20% lower LBR following mosaic transfer. Participants/materials, setting, methods All patients seen at our IVF center undergoing FET of mosaic or euploid embryos tested with next generation sequencing during the study period were included. Primary outcome was LBR. Further comparison included age, MR, twin rate, freeze day and grade. Embryos were further analyzed for HL versus LL mosaicism, segmental or whole chromosomal mosaicism, freeze date and grade. Statistics employed chi-squared for categorical and student t-test for continuous data with significance set at p < 0.01 Main results and the role of chance Mosaic embryos resulted in nearly identical LBR when compared to euploid embryos, 26/51(50.9%) versus 359/706(50.85%). Implantation rate was also equivalent, 29/51(54.6%) and 376/706(53.3%). Both biochemical pregnancy [mosaics, 8/45(17.8%) versus euploid 127/683(18.6)], and MR [mosaics 3/29(10.3%) versus euploids 24/373(6.4%)] were not significantly different. Among mosaic embryos, the LBR in LL versus HL mosaics were 17/28 (60.7%) and 9/23 (39.1%), respectively. LBR following segmental only versus whole chromosomal defects were 14/27(51.9%) and 11/24(45.8%). LBR following Day 5 versus Day 6/7 freeze were 10/22(45.5%) and 16/29(55.2%) and LBR for favorably graded embryos were 19/34(55.9%) versus fair to poor graded 7/17(41.2%). None of these achieved statistical significance. While Mosaic embryos were transferred in significantly older patients (37.6 vs 36.1 p < 0.01), there was no difference in mean age associated with LBR (36.1 vs 36.3 p =.4). Additionally, there was no statistically significant difference in LBR between age groups, <35yo 143/259(55.2%), 35-37yo 96/202(47.5%), 38-40yo 96/207(46.4%) or > 40yo 50/90(55.6%) among tested embryos. DET was performed more often with mosaic 19/45 (42.2%) than euploid embryos 36/683 (5.3%) p < 0.001, resulting in significantly higher twin births/LB 5/22 (23.8%) versus 6/356 (1.7%) p < 0.001. All DET data sets included the 13 DETs where one euploid and one mosaic embryo were transferred. Limitations, reasons for caution Our small mosaic numbers may have kept the higher LBR with LL, segmental and good quality mosaic embryos from achieving statistical significance, and may be too small to confirm a higher MR with mosaics. Prospective trials are needed to confirm which euploid or mosaic embryo should be selected for transfer. Wider implications of the findings Given the equivalent LBR, mosaic embryos should be used for transfer prior to repeating IVF retrieval for euploids. The high rate of twin delivery following mosaic DET suggests only eSET should be utilized with any tested embryos. Larger prospective trials are needed to further refine euploid versus mosaic embryo selection criteria. Trial registration number not applicable

P-369 DuoStim could be a proper option for women seeking fertility preservation for non-medical reasons

Abstract Study question Is Duostim a suitable option for women who wish to preserve fertility for social reasons? Summary answer Providing the option of DuoStim is an efficient way to expand the cohort of vitrified oocytes in women seeking fertility preservation for non-medical reasons. What is known already A growing number of reproductive-age women are choosing to postpone motherhood, giving rise to the concept of reproductive autonomy. Numerous strategies aim to refine ovarian stimulation protocols. DuoStim, entailing dual ovarian stimulations and retrievals within one menstrual cycle, proves advantageous for those with diminished ovarian reserve or facing cancer. To our knowledge, this is the first study offering DuoStim for social preservation. Study design, size, duration Retrospective controlled case-control study conducted with paired follicular phase stimulation (FPS) and luteal phase stimulation (LPS) derived cohorts of oocytes collected in the same ovarian cycle (DuoStim). The study included 160 patients aged 36.85 ± 3.3 years old, who underwent DuoStim for social egg freezing from October 2018 to September 2023. The primary outcome was the number of MII oocytes retrieved per cycle and secondary outcomes included stimulation duration and gonadotropin dose. Participants/materials, setting, methods FPS and LPS were performed using the same daily dose of recombinant gonadotropins in an antagonist protocol. Oocyte retrieval was performed 36 hours after triggering with gonadotropin-releasing hormone agonist triptorelin acetate (0,2 mg) after the FPS. Luteal phase stimulation protocol began on the 5th day after ovarian puncture using dual trigger, followed by a second oocyte retrieval. Mature oocytes were vitrified 2 hours later following the Kitazato® protocol. Main results and the role of chance Stimulation duration and gonadotropin dose were lower during Follicular Phase Stimulation (FPS) vs. Luteal Phase Stimulation (LPS) (10.8 ± 1.5 days vs. 13.0 ± 2.3, P < 0.05 and 2,487.9 ± 580.8 vs. 3,264.0 ± 942.7, P < 0.05). The number of retrieved oocytes was comparable between the two groups (4.78 ± 3.0 vs. 5.32 ± 3.7; P = 0.15). The mean number of MII oocytes acquired in the LPS group exceeded that in the FPS group (4.16 ± 3.0 vs. 3.58 ± 2.3; P = 0.054), indicating a tendency towards more MII oocytes in the LPS group without achieving statistical significance. A total of 110 patients (69.29%) obtained the same or a greater number of MII during the LPS compared to the FPS. Limitations, reasons for caution Although DuoStim is acknowledged as an option to obtain a greater number of eggs in certain situations, the evidence supporting its utility in social fertility preservation is still limited. It is crucial to recognize the inherent biases in observational retrospective studies. Wider implications of the findings DuoStim could be an advantage for women who live abroad or those who dispose of short periods of time for oocyte vitrification, also potentially reducing the drop-out rate. Trial registration number not applicable

P-630 Assessing Bologna and POSEIDON criteria as predictors of PGT-A in Poor Ovarian Response: A comparative analysis

Abstract Study question Do Bologna or POSEIDON criteria more accurately predict PGT-A outcomes in poor ovarian response, considering aneuploidy rates and clinical outcomes? Summary answer Comparing Bologna and POSEIDON criteria highlights higher aneuploidy rates in Bologna patients, with no significant differences in mosaicism rate or clinical outcomes in either group. What is known already Ovarian reserve stands out as the primary factor influencing reproductive senescence. Approximately 9-24% of individuals undergoing ovarian stimulation are categorized as ‘low-responders’. Key indicators of Poor Ovarian Response (POR) include age, antral follicle count (AFC), Anti-Müllerian Hormone (AMH), and response to controlled ovarian stimulation. While some studies link ovarian reserve to embryo quality, others dispute any correlation with embryo abnormalities. The Bologna criteria classify patients meeting at least two of the following: advanced maternal age, low AFC, and AMH. The more precise POSEIDON criteria combine these factors, forming four distinct groups for classification. Study design, size, duration We conducted a retrospective case-control study, examining PGT-A results of 2740 embryos derived from 797 IVF cycles conducted in our clinic between 2021 and 2022. Trophoectoderm biopsies, taken at D + 5/6, underwent Next-Generation Sequencing. Embryos were vitrified and transferred after analysis. Regarding the interpretation of the results, embryos with ≤25% cells aneuploids were considered euploid, between 25% and 50% were classified as mosaic and those with >50% cells were considered aneuploid. Participants/materials, setting, methods All patients used their own oocytes. Bologna and POSEIDON criteria were used for the classification of POR and non-POR patients. Univariate analysis was performed using Pearson’s chi-square statistical test for categorical variables and binary logistic regression to compare the rates of aneuploidy and embryonic mosaicism, pregnancy rate miscarriage, ongoing pregnancy rate and implantation rate with the above variables taking into account possible confounding factors. Main results and the role of chance Patient ages ranged from 22 to 47 years, with a mean of 38.9 years. In Bologna groups, mean ages were 41.15 years for Bologna and 38.43 years for the control. For POSEIDON: 32.47 group I, 39.85y group II, 32.11y group III, 40.41y group IV and 38.24y control group of the classified by POSEIDON criteria. The mean AFC was 10.95 and the AMH value was 13.15pmol/L. Among 797 cycles, 59.16% (449/797) met POR criteria by POSEIDON, distributed across groups: 1.19% (9/797) in group I, 1.32% (10/797) in group II, 22.66% (172/797) in group III and 33.99% (258/797) in group IV. Using Bologna criteria, 17.74% (486/797) were classified as POR. Our findings reveal that individuals identified with POR by Bologna criteria exhibit a significantly elevated incidence of embryo aneuploidy (78.8% POR patients vs. 59.9% control patients; p = 0.004). However, no such distinction was observed when employing the POSEIDON criteria for classification. In terms of embryo mosaicism, no notable differences were detected between POR and non-POR patients under both Bologna and POSEIDON criteria. Furthermore, no significant variations in clinical data were observed between the two groups, even after correcting for maternal age. Limitations, reasons for caution The study is constrained by the inherent limitations of a retrospective design and a restricted sample size. Moreover, the complexity and heterogeneity involved in classifying patients with POR contribute to additional challenges in the interpretation of results. Wider implications of the findings The study indicates that diminished ovarian reserve does not significantly augment the probability of embryo aneuploidies. Particularly noteworthy is the observation that young women with low ovarian reserve do not exhibit an increased susceptibility to aneuploidies. This finding holds implications for understanding reproductive outcomes among ovarian reserve variations. Trial registration number No aplicable

P-291 In women with endometriosis, effective treatment of chronic endometritis with antibiotics lowers serum CA-125 levels

Abstract Study question To evaluate the effect of chronic endometritis treatment on serum CA-125 levels in women with endometriosis. Summary answer Cure of chronic endometritis leads to a reduction in serum Ca-125 levels in women with endometriosis. What is known already Endometriosis is a chronic inflammatory disease characterized by the ectopic growth of endometrial tissue outside the uterine cavity. It is hypothesized that the disease exerts direct inflammatory effects on the ovaries, fallopian tubes, and the eutopic endometrium. In endometriosis, CA-125 levels are often elevated. Literature reports a frequent coexistence of endometriosis and chronic endometritis (CE) in women undergoing hysterectomy for benign indications. CE, characterized by macroscopic and histological alterations of the endometrium, was present in 38.5%-42.3% of women with endometriosis, compared to lower prevalence rates in controls infertile patients without endometriosis, supporting a potential etiopathogenic link between endometriosis and CE. Study design, size, duration This retrospective case-control study was conducted at the Department of Obstetrics and Gynecology, University of Bari. The study included 51 patients suffering of both ovarian endometriosis and CE. The primary objective was to investigate whether CE cure modifies serum CA-125 levels among women with ovarian endometriosis. The secondary objective was to assess any modifications in the size of endometriotic cysts following the cure of CE. Recruitment period was from September 2021 to February 2023. Participants/materials, setting, methods All patients received antibiotic therapy (100 mg of doxycycline, twice daily for ten days) and, the following month, hysteroscopy with control biopsy. Of these, 36 women were cured of chronic endometritis (Group A), while 15 women showed persistent disease (Group B). Endometriosis was diagnosed by transvaginal ultrasound and chronic endometritis through hysteroscopy, histology, and immunohistochemistry for CD138. Serum CA-125 levels were measured before antibiotic therapy and approximately 3 months later. Main results and the role of chance The primary outcome was to compare the change in CA-125 values between women cured of chronic endometritis and women with persistent disease. There were no statistically significant differences in baseline characteristics between the groups (p=ns). The majority of patients in both groups had a single ovarian endometrioma and the micropolypoid endometrial appearance was the predominant finding of chronic endometritis observed during hysteroscopy in both Groups. In Group A, the mean CA-125 value significantly decreased after antibiotic therapy from 58.56 U/mL (± 32.45) to 38.25 U/mL (± 17.31) (p < 0.001). No significant changes in CA-125 values were observed in Group B before and after antibiotic therapy (69.70 ± 27.42 versus 67.47 ± 24.52 U/mL, p=ns). The absolute change in CA-125 values was significantly greater in terms of reduction in Group A compared to Group B (-20.31 ± 27.09 versus -2.13 ± 12.51 U/mL; p = 0.02). Adjustment for confounders in a multivariable regression model revealed that the cure of chronic endometritis was independently associated with a significant decrease in absolute serum CA-125 levels (p = 0.006). Cyst size did not significantly change after antibiotic therapy in both groups (p=ns). Limitations, reasons for caution The main weakness of our study is that CA-125 was only measured once before and once after treatment of CE with a course of antibiotics. Moreover, our study does not allow for inferences regarding the impact of the observed reduction in serum CA-125 on the subjective symptoms related to endometriosis. Wider implications of the findings Our study constitutes the first demonstration that effective treatment of CE results in a significant decrease in a non-invasive marker of endometriosis, CA-125 supporting the emerging concept that the endometriosis might have an infectious origin. Trial registration number not applicable

O-191 Delayed fetal growth in pregnant women with polycystic ovary syndrome using serial ultrasonographic biometry

Abstract Study question To investigate the effect of maternal polycystic ovary syndrome (PCOS) on intrauterine growth and perinatal outcome of offspring. Summary answer Maternal PCOS might have an adverse impact on fetal growth, represented by serial biometric measurements, and consequently lower the birth weight. What is known already Women with PCOS often have low fertility and high risk of certain pregnancy complications, including miscarriage, gestational diabetes mellitus (GDM), hypertensive disorders of pregnancy (HDP) and preterm birth (PTB). In addition, the offspring of PCOS mothers are susceptible to short- and long-term health consequences, such as metabolic diseases and neuropsychiatric disorders. And the suboptimal intrauterine environment caused by maternal PCOS condition might be the origin of impaired long-term health of the offspring. Study design, size, duration A total of 1153 pregnant women with pregestational diagnosis of PCOS and 1383 non-PCOS controls were included in the retrospective case-control study for clinical record and ultrasonographic database at women’s hospital, school of medicine, Zhejiang university over a 6-year period. Participants/materials, setting, methods Maternal demographic data, fetal biometric measurements with ultrasound, obstetrical and neonatal outcomes were analyzed. A meta-analysis of birth weight in PCOS offspring in the literature was performed to assess the relationship between the maternal PCOS and neonatal growth. Main results and the role of chance After adjustment for potential confounding variables, we found that biparietal diameter (BPD) and femur length (FL) were notably smaller in fetuses of women with PCOS than controls across the entire gestation. This effect still existed after excluding three major pregnancy complications of PCOS, including GDM, HDP and PTB. Although other fetal biometry including estimated fetal weight and birth weight in PCOS offspring were comparable with controls in our study, the meta-analysis of 22 studies showed that the birth weight in offspring of women with PCOS was lower than controls (WMD -37.813, 95%CL [-69.713, -5.913]), especially for offspring in South America (WMD -84.69, 95%CL [-166.69, -2.68]). Limitations, reasons for caution First, data of other fetal parameters like abdominal and head circumference was scanty. Second, neonatal anthropometric parameters apart from the birth weight were not included. Lastly, we did not have the long-term follow-up results of the offspring to explore the potential effect of delayed fetal biometry in their later life. Wider implications of the findings More attention needs to be paid to the smaller-than-average fetuses in PCOS mothers, and proper management may be needed during and after pregnancy. Further studies are needed to confirm the intrauterine growth pattern of the PCOS offspring and its clinical significance in the neonatal period and beyond. Trial registration number N/A

P-358 Fertility preservation outcome in patients with onco-hematological malignancies versus solid tumor neoplasms

Abstract Study question Do women diagnosed with onco-hematological malignancies exhibit poorer response to ovarian stimulation in comparison to those with localized neoplasms? Summary answer There are no significant differences between women undergoing fertility preservation for onco-hematological malignancies compared to those with solid tumor malignancies. What is known already Oocyte cryopreservation is now considered the first choice for fertility preservation in post-pubertal women scheduled for gonadotoxic anticancer treatments. Patients with onco-hematological diseases, such as leukemia or lymphoma, encounter unique challenges due to their aggressiveness and multi-organ nature, potentially impacting ovarian function. Conversely, patients with solid malignancies may experience more favorable outcomes, as the impact on their reproductive function is likely less severe. However, comparative data on oocyte cryopreservation outcomes in both groups remain limited, hence further research is essential to guide personalized fertility preservation counselling. Study design, size, duration This is a single center case-control retrospective study that included data collected from 142 patients who underwent oocyte cryopreservation in our center between 2013 to 2023. Laboratory exams, ovarian stimulation and oocyte retrieval were all performed in our center. Participants/materials, setting, methods The main group of patients (or group 1) comprised 71 women with onco-hematological malignancies such as leukemia and lymphoma. Patients from group 1 were matched for age and study period in a 1:1 ratio with solid malignancies (group 2), such as breast cancer. Gynecological tumors were excluded. Significance was considered with a p < 0.05. Data are reported as median [interquartile range - IQR] or number (percentage). Main results and the role of chance In both groups, the mean age at oocyte cryopreservation was 30 years [25-34]. Only a minority of patients were undergoing estroprogestin therapy (10% in group 1 vs. 19% in group 2) (p=ns). Menstrual cycles were found to be regular in 88% and 90% of patients respectively (p=ns). Stimulation protocols were also comparable: 48% and 55% underwent GnRH antagonist, and the remaining underwent progestin-primed ovarian stimulation (p=ns). Duration of stimulation and total dose of gonadotropins did not differ between the two groups. Ovarian stimulation was interrupted due to inadequate response in two patients in the onco-hematological group and one in the control group (p=ns). At oocyte retrieval, the number of oocytes retrieved was 12 [7 - 18] and 15 [7-20] respectively (p=ns), and the number of cryopreserved oocytes was 10 [6-15] and 13 [7-15], respectively (p=ns). This result aligns with the antral follicle counts (AFC) detected before ovarian stimulation: 18 [12 - 24] vs. 20 [12 - 26], respectively (p=ns). However, a notable difference was found in anti-Mullerian hormone (AMH) levels, being 1.96 ng/mL [1.14 - 3.10] in onco-hematological patients and 3.11 ng/ml [1.52 - 4.52] in control patients (p = 0.01). Limitations, reasons for caution This is a retrospective, monocentric study with patients selected from a 10-year period. Wider implications of the findings When planning fertility preservation in women with systemic diseases like cancer, relying solely on AMH levels to estimate ovarian response to stimulation may be limited. In this scenario, AFC proves more reliable. Further evidence is needed to understand the clinical meaning of the lower AMH in onco-hematological cancer patients. Trial registration number NA

P-293 Influence of the endometrial microbiota composition on the clinical outcomes of egg donation PGT-A cycles with controlled endometrial receptivity

Abstract Study question Does the endometrial microbiota composition and diversity influence embryo implantation and pregnancy evolution in assisted reproduction treatment (ART) cycles? Summary answer Endometrial microbiota composition influences ART success. Detection of endometrial pathogens is associated with poor outcomes whereas sterile endometria show the highest pregnancy and live-birth rates What is known already The endometrial microbiota has emerged as a possible influencing factor in the results of ART. Recent research suggests its impact on female reproductive health, particularly in patients with chronic endometritis (CE), where the presence of microbial pathogens associated with this condition has been linked to infertility. In turn, the bioregulatory role of species of Lactobacillus in this tissue has been explored, although its essentiality or benefit for female reproductive function continues to be topics of debate. Study design, size, duration This is a case-control retrospective study analysing for the first time the influence of the endometrial microbiota composition on the clinical outcomes of 220 women undergoing egg donation cycles with Preimplantation Genetic Testing for Aneuploidy (PGT-A) and controlled endometrial receptivity between March 2016 and April 2021 in IVF-Life Alicante (Spain). ART results after the transfer of a single euploid blastocyst in the WOI of patients with different endometrial microbiota profiles were analysed and compared. Participants/materials, setting, methods Presence of 18 microbial CE pathogens and 4 Lactobacillus species was determined by high-throughput qPCR (MicrobioMap®, iGLS) in endometrial samples obtained during the WOI of a hormone replacement therapy cycle. In all cases, PGT-A by next generation sequencing (NGS) (EmbryoMap, Vitrolife) and study of endometrial receptivity by gene expression analysis (ER Map, iGLS) were performed. Clinical outcomes (β-hCG+, β+ and live birth, LB) in relation to the endometrial microbiota profile were analysed and compared. Main results and the role of chance In the study, 31.8% of patientś endometria were identified without microbial detection, 40% exclusively with Lactobacillus, 13.2% with pathogens only, and 15% with both. Clinical results revealed significant differences in β+ rates among the groups (p < 0.05). The absence of microorganisms was associated with higher success rates (β + 72.9%), while the presence of pathogens significantly reduced pregnancy success (β + 41.4%). A similar trend was observed in LB rates, although it did not reach statistical significance (44.3% and 24.1%, respectively). The presence of Lactobacillus alongside pathogens improved clinical outcomes (β + 57.6% LB 48.5%). Interestingly, exclusive presence of Lactobacillus showed lower implantation rates than patients without microbial detection (β + 58%). These findings highlight the impact of microbial composition on the clinical outcomes of ART cycles, underlining the association between endometrial microbiota patterns and pregnancy success. Limitations, reasons for caution This study is constrained by its retrospective nature, emphasizing the need for further validation through randomized controlled trials, non-selection studies, or other investigative approaches to confirm the extent of any clinical benefits. Endometrial biopsies were obtained transcervically, while executed with utmost care, risk of contamination cannot be completely excluded. Wider implications of the findings The composition and diversity of the endometrial microbiota is key for ART success. A sterile endometrial environment offers optimal conditions for implantation and pregnancy. The study highlights the potential of Lactobacillus in counteracting the negative impact of pathogenic presence. Trial registration number not applicable

Risk Factors for Breast Cancer among Indian Women: A retrospective case-control study

Risk Factors for Breast Cancer among Indian Women: A retrospective case-control study