Significant Difference In Number Research Articles

Effects of lockdown on physical activity and arrhythmia burden in patients with an implantable cardioverter-defibrillator: the COVID-19 Lockdown ICD-Carelink (CLIC) study

Abstract Background Both COVID-19 and the measures taken to control the pandemic may significantly affect cardiovascular health. The effects of a lockdown on physical activity and its potential consequences for arrhythmia burden remain largely unknown. Purpose In this study, we investigated the effect of the lockdown during the first COVID-19 wave on patients' physical activity and arrhythmia burden. Methods All patients with an ICD connected to a Carelink home-monitoring system from two Dutch hospitals were included. Anonymized data on physical activity, heart rate, and occurrence of ventricular tachycardia/fibrillation (VT/VF), and atrial fibrillation/tachycardia (AF/AT) were obtained and were compared between March-April 2020 (lockdown) and March-April 2019 (reference) within each patient. The study was approved by the local ethics committee. Results The ICDs of 531 patients registered significantly less activity during de lockdown period compared to the reference period (210±104 min vs 182±103 min, p<0.0001, Figure 1, panels A and B), while weather conditions improved (1A). Daytime and nighttime heart rates were significantly lower during lockdown compared to the reference period (71.3±9 bpm vs 72.6±9 bpm, p<0.0001 and 63.4±9 vs 63.8±9, p=0.02, respectively). AF/AT burden increased (Figure 2A) while number of VT/VF episodes decreased (2B). There was no significant difference in number of NSVT episodes. Conclusion During the lockdown in the first COVID-19 wave, the Carelink system revealed significantly less activity, increase in AF/AT burden and decrease in VT/VF episodes. Further investigation is needed to understand the relationship between physical activity and the occurrence of arrhythmias in ICD patients. Funding Acknowledgement Type of funding sources: None.

Standard Crutches vs Rolling Knee Scooters: Analysis of Patient Satisfaction and Risk of Falling after Foot and Ankle Surgery

Category: Other; Hindfoot; Midfoot/Forefoot Introduction/Purpose: Rolling knee scooters and standard crutches are commonly used following foot and ankle surgery for patients who are required to keep weight off the extremity. In all non-weight bearing situations, muscle atrophy, lack of stability, and decreased blood flow increasing the risk of clots. Postoperative falls within 30 days after surgery have been shown to significantly increase morbidity and correlate directly with age. While it is known that falls following procedures are a definitive concern and should be guarded against, there is a deficiency in reporting with regards to the use of knee scooters and the commonality of falls in the postoperative period while using them in comparison to more traditional means of ambulatory aid like crutches. Methods: From June 2021 to February 2022, 120 patients were prospectively enrolled after foot and ankle procedures at a single institution that required a non-weight bearing period of at least 2-weeks. Patients completed surveys at each post-operative visit until they were weight-bearing asking them to report ambulatory aid device utilized, level of satisfaction, time using the device, number of falls, and complications. Patient demographics, including sex, age, BMI, smoking history, co-morbidities were retrospectively collected and analyzed using descriptive statistics (means, standard deviations, ranges). The relative incidence of a fall occurring was calculated among the entire cohort, with each separate fall counting individually. A regression analysis was performed to identify any patient factors associated with the occurrence of falls. T-tests will be performed to compare the relative chance of a postoperative fall or device-related complication between patients using rolling scooters and those using crutches and assess for significance (p<.05). Results: 106 patients (59 female and 47 male) either used a rolling knee scooter or crutches. For 65 ankle procedures and 41 forefoot procedures, the average age was 51.6 +- 16.0, BMI was 28.6 +- 5.59. Regression analysis of all falls found that only age (p=0.058) was slightly, but not significantly associated with a greater fall risk. Demographic factors such as sex, BMI, procedure type (forefoot vs. hindfoot), and previous experience with the device were not associated with a greater fall risk (p>0.05). Patients were more likely to have used crutches for a previous injury compared to knee scooters (p=.006). Knee scooters were used significantly more often and had higher patient satisfaction compared to crutches (p=0.043, p=0.03). Patients using crutches reported a total of 22 falls compared to 14 total falls knee scooters (p=0.188). Overall, patients would rather use knee scooters than crutches for future foot and ankle surgeries (p=0.001). Conclusion: Both standard crutches and rolling knee scooters are safe and effective methods of non-weight bearing ambulatory aid after foot and ankle procedures. Older patients may be associated with a greater risk of falling regardless of ambulatory aid device utilized. Although there were no significant differences in number of falls between patients who used crutches vs. scooters, patients were significantly more satisfied with rolling knee scooters and more likely to use them in the future.

The effect of low doses of chlorpyrifos on blood and bone marrow cells in Wistar rats.

The aim of this study was to investigate the genotoxic potential of low doses of chlorpyrifos (CPF) on blood and bone marrow cells in adult male Wistar rats. CPF was administered by oral gavage at daily doses of 0.010, 0.015, and 0.160 mg/kg of body weight (bw) for 28 consecutive days. Positive control (PC) was administered 300 mg/kg bw/day of ethyl methane sulphonate (EMS) for the final three days of the experiment. Toxic outcomes of exposure were determined with the in vivo micronucleus (MN) assay and alkaline comet assay. The 28-day exposure to the 0.015 mg/kg CPF dose, which was three times higher than the current value of acute reference dose (ARfD), reduced body weight gain in rats the most. The in vivo MN assay showed significant differences in number of reticulocytes per 1000 erythrocytes between PC and negative control (NC) and between all control groups and the groups exposed to 0.015 and 0.160 mg/kg bw/day of CPF. The number of micronucleated polychromatic erythrocytes per 2000 erythrocytes was significantly higher in the PC than the NC group or group exposed to 0.015 mg/kg bw/day of CPF. CPF treatment did not significantly increase primary DNA damage in bone marrow cells compared to the NC group. However, the damage in bone marrow cells of CPF-exposed rats was much higher than the one recorded in leukocytes, established in the previous research. Both assays proved to be successful for the assessment of CPFinduced genome instability in Wistar rats. However, the exact mechanisms of damage have to be further investigated and confirmed by other, more sensitive methods.

Ciliochoroidal effusion and its association with the outcomes of micropulse transscleral laser therapy in glaucoma patients: a pilot study

We investigate the development of ciliochoroidal effusion following micropulse transscleral laser therapy (MPTLT) and evaluate the relationship between the early postoperative ciliochoroidal effusion (ECE) and short-term treatment outcomes. Glaucoma patients who underwent MPTLT were assessed for ciliochoroidal effusion by anterior segment optical coherence tomography (AS-OCT) at postoperative 1, 4, 12 weeks. The subjects were classified based on AS-OCT findings at postoperative 1 week into eyes with and without ECE. The absolute intraocular pressure (IOP), IOP reduction and number of antiglaucoma medications were compared between eyes with and without ECE. A total of 50 eyes were included, of which 23 (46%) developed ciliochoroidal effusion at postoperative 1 week. Almost all effusion resolved at 4 weeks. At 12 weeks, the mean IOP (SD) significantly decreased from 28.5 (12.8) mmHg to 17.8 (10.5) mmHg (p < 0.001), and the mean number of medications (SD) decreased from 4.1 (0.9) to 3.3 (1.1) (p < 0.001). Eyes with ECE had significantly greater IOP reduction (p = 0.009) and lower absolute IOP (p = 0.008) at the 4-week visit. There was no significant difference in number of medications between the groups. In conclusion, ciliochoroidal effusion was commonly observed following MPTLT. Eyes with ECE had overall greater IOP reduction during early post-operation.

Impact of post-discharge phone calls on non-urgent hospital returns < 90days following primary bariatric surgery.

IntroductionQuality of care delivery may improve patient outcomes post-bariatric surgery. We examined the quality of post-discharge phone calls (PhDC) to determine the impact on early (< 90 day) non-urgent hospital returns (NUHR) following primary bariatric surgery.MethodsA retrospective review was performed on patients who underwent Roux-en-Y-gastric bypass (RYGB) or sleeve gastrectomy (SG) in 2019. Patients were compared between presence of care coaching (Jan–June 2019) versus no care coaching (July–Dec 2019). Baseline demographics, comorbidities, psychiatric history, and PhDC were collected. Index PhDCs were coded for completeness using a scoring system and rated by call quality. Patients were stratified into NUHR versus control group (Never returns [NR]). Primary analysis examined the impact of PhDC on NUHR. Sub-analysis examined the impact of call quality. Univariate analysis was performed using Chi-square or Fisher’s exact tests. Multivariate analysis (MVA) was used to determine predictors of NUHR. A p-value of ≤ 0.05 was statistically significant.ResultsA total of 359 patients were included. Compared to the NR group (n = 294), NUHRs (n = 65) were more likely to be younger (41.3 + 12.1 versus 45.0 + 10.8 years, p = 0.024), with baseline anxiety (41.5% versus 23.5%, p = 0.003), and undergo RYGB (73.3% versus 57.8%, p = 0.031). There was a significant difference in number of PhDC in the NUHR and NR groups (p = 0.0206). Care-coached patients had significantly higher rates of high-quality phone calls (p < 0.0001) compared to non-care-coached patients. MVA demonstrated younger age (OR = 0.97, CI: 0.95–1.00; p = 0.023), anxiety (OR = 2.09, CI: 1.17–3.73; p = 0.012), RYGB (OR = 1.88, CI: 1.02–3.45; p = 0.042), and > 50% call quality versus no PhDC (OR = 0.45, CI: 0.25–0.83; p = 0.010) were independently associated with NUHRs.ConclusionHigh-quality PhDCs may play a role in mitigating NUHRs. Care coaching represents a potential intervention to decrease high rates of NUHR in primary bariatric surgery patients.

Rozov and Kessler Tendon Sutures: Common Properties and Differences

Background. The Kessler suture is one of the most common tendon repair techniques and can be found schematically in most manuals of hand surgery, along with Bunnel and Tsuge sutures. In our country, the seam proposed by V.I. Rozov, while a number of authors believe that Rozov and Kessler sutures are very similar. Both techniques, both the Rozovs suture and the Kessler suture, have a large number of modifications that differ significantly from the originals, but retain the authors names, which confuses and hinders the analysis of the use of various methods for restoring the integrity of the tendons.&#x0D; The aim to find the correct authors description of Rozovs suture and Kesslers suture, test original techniques on a tendon model, compare techniques, analyze common properties and differences.&#x0D; Methods. Information was searched in domestic and foreign publications, manuals on traumatology and orthopedics, monographs, methodical letters, materials of congresses, Internet resources. Approbation of the methods was carried out on a tendon model, which was a silicone rod with a diameter of 1 cm.&#x0D; Results. The first image of the Rozovs suture discovered by us, dates back to 1958, the original grasping technique of flexor tendon repair was proposed by I. Kessler in 1969. These techniques have a number of significant differences in the location of nodes, methods of fixation and planes of threads in the thickness of the tendon.&#x0D; Conclusion. The data of this study give reason to believe that V.I. Rozov and I. Kessler proposed two different ways of applying a tendon suture.

142. Loss of sagittal correction >3 years after adult spinal deformity surgery

<h3>BACKGROUND CONTEXT</h3> The durability of adult spinal deformity (ASD) surgery is key for cost-effective treatment. Malalignment is one of the main reasons for revision surgery. <h3>PURPOSE</h3> To investigate risk factors for loss of correction within the instrumented lumbar spine following ASD surgery. <h3>STUDY DESIGN/SETTING</h3> Retrospective cohort study of a prospective database. <h3>PATIENT SAMPLE</h3> This study included 321 ASD patients with minimum 3 -year follow-up. <h3>OUTCOME MEASURES</h3> L1-S1, L4-S1 and L1-L4 lumbar lordosis. <h3>METHODS</h3> A total of 321 patients who underwent fusion of the lumbar spine (=5 levels, LIV S1/ilium) with a revision-free follow-up =3 years were identified. Patients were stratified by the change in PI-LL from 6 weeks to 3 years postop as Maintained vs Loss > 5°. Those with a loss due to instrumentation failure (broken rod, screw pullout, etc.) were excluded before comparisons. Changes in regional and focal lordosis over time were investigated with repeated measures ANOVA and factor comparison. <h3>RESULTS</h3> Mean age 64 yrs, BMI 28 kg/m², 80% female. The baseline alignment (PI-LL=21±19°, T1PA=26±12°) was corrected to PI-LL=3±13°, and T1PA=18±10° at 3 yrs (mean 3Y follow-up: 45±11m, with 44±11 mo between early and late follow-up). Eighty-two patients (25.5%) lost >5° of PI-LL correction (mean loss 10±5°). After exclusion of patients with instrumentation failure, 52 patients (Loss) with a mean loss of correction of 8.6±2.9 were compared to 222 controls with maintained LL correction. Demographics were similar between groups (age: 63 vs 61 p=0.15; Sex: 78.4% F vs 88.5% p=0.10). There were no significant differences in use of osteotomy, 3CO, and IBF between Loss and Maintained LL (all p >0.1). There was no significant difference in number of levels fused (11 vs 12 p=0.39), rod material (CoCr 59.4% vs 58.8% p=0.34), and BMP use (88.7% vs 84.6% p=0.41) but Loss had less supplemental rod use (5.8% vs 23.4% p=0.004). Comparison between Maintained and Loss revealed a similar PI-LL mismatch at pre-op (16.7±18.7 vs 20.9±18.3 p=0.14) and final postop (1.8±12.5 vs 5.1±14.5 p=0.11) but a significantly smaller PI-LL for Loss at early postop (0.6±12.8 vs -3.5±13.7 p=0.41). Distally, Maintained had a significant improvement in L4-S1 lordosis from preop to early postop (p=0.013), with no significant difference from early to final follow-up. In contrast, patients in the Loss group had no difference in L4-S1 from preop to early postop (p=0.14), but showed a significant loss of correction at 3 years (p <0.001). Proximally, significant increase between pre and early postop in L1-L4 (all p <0.001), with Loss and Maintained reaching similar early postop value (p=0.34). However, from early postop to final follow up, Loss showed a significant decrease in proximal lordosis (p <0.001) while Maintained did not (p=0.08), corresponding with a smaller absolute L1-L4 in the Loss cohort at 3 yrs (p=0.002). Screw orientation showed a significant decrease from early to late follow-up between the L1 and S1 screws for Loss (1.3±4.1 p=0.031), without any changes across the L4-S1 segment (-0.1±2.9 p=0.97). <h3>CONCLUSIONS</h3> Approximately a quarter of patients lose an average of 10° of their 6-week correction by 3 years. Lordosis is lost proximally through the instrumentation (ie, tulip/shank angle shifts and/or rod bending), but lost distally through bone "settling" through the instrumentation itself. The use of supplemental rods and avoiding sagittal overcorrection may help mitigate this loss. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

87 Surgical Versus Conservative Management of Acute Achilles Tendon Ruptures; A Systematic Review and Meta-Analysis

Abstract Aim To compare the functional outcomes including re-rupture rates, number of participants failing to return to work or sports and scoring scales between surgical and conservative treatment in a systematic review. Method A systematic review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement (PRISMA) protocol. Studies were identified from these databases: PubMed, Cochrane and CINAHL. Risk-ratio analysis to compare rupture rates and failure to return to work/sports, whilst a standard mean difference analysis compared the functional outcome scores from both treatment groups. Results Seven randomised controlled trial studies included with a total of 486 participants involved in the trials, comprising of 245 participants for surgical intervention and 209 participants for conservative management. There is a higher re-rupture rate in the conservative group compared to the surgical group with a risk ratio (RR) of 0.38 (95% CI 0.16–0.92, P = 0.03). Statistically, there was no significant difference in number of individuals failing to return to work/sports in both treatment modalities, RR for all the three studies were 0.85 (95% CI 0.51,1.41, P = 0.52). A standardised mean analysis with an overall effect Z of 0.40 (std MD 0.09; P 0.69; 95%CI -0.35,0.53) indicate no statistically significant difference in the functional outcomes between the three different studies. Conclusions Surgical intervention only shows an advantage over conservative treatment in terms of re-rupture rates but similar results with conservative treatment when other outcomes including number of participants returning to previous activity levels, plantar flexion and functional scoring systems were assessed.

The Effects of Different Rest Interval Lengths on Acute Quarter-squat Performance in Female

The inclusion of resistance training in the athletic preparation of young athletes is associated with increased time and personal demands. This study compared the effect of different rest interval (RI) lengths on quarter-squat performance in two age groups. Sixteen girls (age 12.20 ± 0.55) and 16 women (age 23.13 ± 2.23) performed three series of 10 quarter squats (10 repetition maximum [RM] load) with different RI times (1 min, 2 min, 3 min) between the three series. Each participant was randomly tested under all the RI conditions. The number of successful repetitions, power, and speed were recorded for each set using by FitroDyne device. The women completed significantly less repetitions in the third set than in the first set for the 2-min and 1-min RIs (9.38 ± 1.54, p = .05 and 8.44 ± 2.42; p = .003, respectively). There was observed a significant decrease in mean power and speed in the 3-min RI between the first and second set and in the 1-min RI between the first and third sets. No significant differences in numbers of completed repetitions and mean power were evident in girls for any RI condition, but there was a significant decrease in mean velocity in the 2-min RI between the first and second sets in this group. These results show that recommendations for adults may be not suitable for girls; the girls’ performance in three sets of 10 quarter squats was less affected by RI than the women’s performance.

No Significant Change in MRI Abnormalities or Back Pain Prevalence in the Thoraco-Lumbar Spine of Young Elite Skiers Over a 2-Year Follow-Up.

BackgroundYoung athletes are at increasing risk for spinal column injuries due to overloading the spine with excessive sports activities, with potential development of complications later in life.PurposeThe purpose of this 2-year follow-up study of young elite skiers and non-athletes was to investigate any potential change in the thoraco-lumbar findings on MRI and to outline any change in back pain prevalence with continuing sporting activity and age.Study DesignLongitudinal cross-sectional study.MethodsMRI of the thoraco-lumbar spine was performed on 30 skiers (mean age 20 years, female 43%) and 16 non-athletes (mean age 19, female 75%), available for the 2-year follow-up. The intervertebral discs were evaluated for signal, height, bulge/herniation, and additionally according to Pfirrmann classification, and the endplates were graded according to endplate defect score. Any of the following disc findings was defined as disc degenerative change: reduced signal, reduced height, bulge, or herniation. All participants answered a specific back pain questionnaire.ResultsNo significant difference in spinal column abnormalities, nor back pain, was found between baseline and 2-year follow-up in neither skiers nor controls. There was significantly higher prevalence of disc degenerative changes in skiers (73%) than in non-athletes (44%, p=0.05). Skiers (63%) had significantly more Pfirrmann grade ≥3 discs compared to non-athletes (25%) (p=0.03). There was no significant difference in number of endplates with score ≥4 between skiers and non-athletes (50% vs 38%, p=0.40) nor in lifetime prevalence of back pain between skiers (46%) and non-athletes (40%).ConclusionThere was no significant change over time of the spinal column MRI abnormalities, nor back pain prevalence, during a 2-year follow-up of skiers and non-athletes. Young skiers had significantly higher prevalence of spine abnormalities compared with non-athletes. There was no significant difference of the back pain lifetime prevalence in skiers compared with non-athletes.

Cardiac Arrest Treatment Center Differences in Sedation and Analgesia Dosing During Targeted Temperature Management

BackgroundSedation and analgesia are recommended during targeted temperature management (TTM) after cardiac arrest, but there are few data to provide guidance on dosing to bedside clinicians. We evaluated differences in patient-level sedation and analgesia dosing in an international multicenter TTM trial to better characterize current practice and clinically important outcomes.MethodsA total 950 patients in the international TTM trial were randomly assigned to a TTM of 33 °C or 36 °C after resuscitation from cardiac arrest in 36 intensive care units. We recorded cumulative doses of sedative and analgesic drugs at 12, 24, and 48 h and normalized to midazolam and fentanyl equivalents. We compared number of medications used, dosing, and titration among centers by using multivariable models, including common severity of illness factors. We also compared dosing with time to awakening, incidence of clinical seizures, and survival.ResultsA total of 614 patients at 18 centers were analyzed. Propofol (70%) and fentanyl (51%) were most frequently used. The average dosages of midazolam and fentanyl equivalents were 0.13 (0.07, 0.22) mg/kg/h and 1.16 (0.49, 1.81) µg/kg/h, respectively. There were significant differences in number of medications (p < 0.001), average dosages (p < 0.001), and titration at all time points between centers (p < 0.001), and the outcomes of patients in these centers were associated with all parameters described in the multivariate analysis, except for a difference in the titration of sedatives between 12 and 24 h (p = 0.40). There were associations between higher dosing at 48 h (p = 0.003, odds ratio [OR] 1.75) and increased titration of analgesics between 24 and 48 h (p = 0.005, OR 4.89) with awakening after 5 days, increased titration of sedatives between 24 and 48 h with awakening after 5 days (p < 0.001, OR > 100), and increased titration of sedatives between 24 and 48 h with a higher incidence of clinical seizures in the multivariate analysis (p = 0.04, OR 240). There were also significant associations between decreased titration of analgesics and survival at 6 months in the multivariate analysis (p = 0.048).ConclusionsThere is significant variation in choice of drug, dosing, and titration when providing sedation and analgesics between centers. Sedation and analgesia dosing and titration were associated with delayed awakening, incidence of clinical seizures, and survival, but the causal relation of these findings cannot be proven.

Introducing heart rate variability monitoring combined with biomarker screening into a level IV NICU: a prospective implementation study

The aim of this study was to investigate the association between the implementation of a local heart rate variability (HRV) monitoring guideline combined with determination of inflammatory biomarkers and mortality, measures of sepsis severity, frequency of sepsis testing, and antibiotic usage, among very preterm neonates. In January 2018, a guideline was implemented for early detection of late-onset neonatal sepsis using HRV monitoring combined with determination of inflammatory biomarkers. Data on all patients admitted with a gestational age at birth of < 32 weeks were reviewed in the period January 2016–June 2020 (n = 1,135; n = 515 pre-implementation, n = 620 post-implementation). Outcomes of interest were (sepsis-related) mortality, sepsis severity (neonatal sequential organ failure assessment (nSOFA)), sepsis testing, and antibiotic usage. Differences before and after implementation of the guideline were assessed using logistic and linear regression analysis for binary and continuous outcomes respectively. All analyses were adjusted for gestational age and sex. Mortality within 10 days of a sepsis episode occurred in 39 (10.3%) and 34 (7.6%) episodes in the pre- and post-implementation period respectively (P = 0.13). The nSOFA course during a sepsis episode was significantly lower in the post-implementation group (P = 0.01). We observed significantly more blood tests for determination of inflammatory biomarkers, but no statistically significant difference in number of blood cultures drawn and in antibiotic usage between the two periods.Conclusion: Implementing HRV monitoring with determination of inflammatory biomarkers might help identify patients with sepsis sooner, resulting in reduced sepsis severity, without an increased use of antibiotics or number of blood cultures.What is Known:• Heart rate variability (HRV) monitoring might be used as an early warning system to diagnose preterm neonates at risk of developing sepsis.• It has already been shown that HRV monitoring could reduce mortality; however, there are concerns that HRV monitoring alone could lead to higher rates of blood cultures and overuse of antibiotics.What is New:• Implementing HRV monitoring with determination of inflammatory biomarkers might help identify patients with sepsis sooner, resulting in reduced sepsis severity, without an increased use of antibiotics or number of blood cultures.

Retrospective Analysis of Arterial Carbon Dioxide Level and Arterial pH Level at the Time of Initiation of Respiratory ECMO and Outcome

AbstractIntroduction Respiratory extracorporeal membrane oxygenation (ECMO) is well established and its popularity has increased during coronavirus disease 2019 (COVID-19) time. The efficacy of ECMO has been proved in refractory respiratory failure with varied etiology. More than 85,000 respiratory ECMO cases (neonatal, pediatric, adult) registered as per Extracorporeal Life support Organization (ELSO) statistics April 2022 report, with survived to discharge or transfer ranging from 58 to 73%. Early initiation of ECMO is usually associated with shorter ECMO run and better outcome. Many patient factors have been associated with mortality while on ECMO. Pre-ECMO patient pH and arterial partial pressure of carbon dioxide (paCO2) have been associated with poor outcome. We designed a retrospective study from a single tertiary care center and analyzed our data of all respiratory ECMO (neonatal, pediatric, and adult) to understand the effect of pre ECMO, paCO2, and arterial pH to ECMO outcome.Methods It is a retrospective analysis of data collected of patients with acute respiratory failure managed on ECMO from January 2010 to December 2021. Pre-ECMO (1–6 hours before initiation), paCO2, and arterial pH level were noted and analyzed with primary and secondary outcome. Primary outcome goal was survivor and discharged home versus nonsurvivor, while secondary goal was the number of ECMO days and incidence of neurological complications. The statistical analysis was done for primary outcome and incidences of neurological complications and p-value obtained by using chi-squared method. Meta-analysis was done by classifying the respiratory ECMO cases in three major category—COVID-19, H1N1 non-COVID-19, and H1N1 respiratory failure.Results The total 256 patients of respiratory failure were treated with ECMO during specified period by Riddhi Vinayak Multispecialty Hospital ECMO team. Data analysis of 251 patients (5 patients were transferred for lung transplant, hence been not included in study) done. Patients were divided on the basis of pH level less than 7.2 and more than 7.2 and analyzed for primary and secondary outcome. Similarly, patients were divided on the basis of paCO2 level of less than 45 and more than 45.Patient with pre-ECMO pH level more than 7.2 has statistically better survived extracorporeal life support (ECLS) (p-value: 0.008) and survival to discharge home (p-value: 0.038) chances. Pre-ECMO paCO2 level of less than 45 also showed better survival chance of survived ECLS (46.67 vs. 36.02) and survived to discharge home (42.22 vs. 31.06) but not statistically significant (p-value: 0.15 and 0.18, respectively). There was no significant difference in average number of ECMO days in patient survived to discharge home with paCO2 less than 45 and more than 45 (15.7 vs. 11.1 days), and also in pH more than 7.2 and pH less than 7.2 (15.8 vs. 11.6). The incidence of neurological complications was also found lower in patient with pH more than 7.2 (7.5 vs. 17.3%, p-value: 0.034) and in paCO2 level of less than 45 (4.4 vs. 12.65, p-value: 0.15).Conclusion Pre-ECMO arterial pH of more than 7.2 (statistically significant) and paCO2 of less than 45 (statistically not significant) have definitely better survival chances and have lesser incidences of neurological complications. There was no significance difference in the number of ECMO days in either group. Authors recommends early initiation of ECMO for mortality and morbidity benefits.

Morphometric Evaluation of Coccyx with Microcomputed Tomography (Micro CT) and Computed Tomography (CT) Technology

Aim: We investigated the coccyx anatomy accurately in detail by microcomputed tomography (micro CT) and computed tomography (CT) to contribute to the data related to the coccyx anatomy and the potential clinical contribution of these datas in the treatment of coccyx’s pathologies. Material and Methods: Twenty coccyges from embalmed cadavers were examined with a micro CT device. The inferior part of the sacrum and coccyx together with the surrounding soft tissue was removed safely. The tissue was scanned with a micro CT device, and all parameters were measured with micro CT image viewer programs. CT images of 29 patients without coccyx pathology were measured with OsiriX programs. Measured morphometric parameters with micro CT and CT were evaluated using statistical methods. Results: Generally, the morphometric parameters as mean values were larger in males than in females. Mean values for vertical length and coccyx width were higher for CT compared with micro CT images. Coccyx was more flat in the frontal plane in females. There were statistically significant differences between the micro CT and CT images regarding mean vertical length, width, lateral deviation angle, and sacrococcygeal angle and length of the vertebrae (p < 0.05). There were no statistically significant differences in number and width of the vertebrae (p > 0.05). Conclusion: We suggest that examining the normal coccyx morphology will help to better understand and treat the pathologic conditions of the coccyx. We believe our findings will contribute to the data related to the coccyx anatomy.

P-125 Effectiveness of IMSI technique in enhancing blastocyst formation in male factor infertility

Abstract Study question does the use of IMSI technique in sperm selection during ICSI in case of male factor enhance blastocyst formation? Summary answer The use of IMSI technique enhanced the ferritization and blastulation rates as well the blastocyst quality in comparison with the conventional ICSI technique What is known already Prior to sperm injection the morphology of the sperm cell is evaluated with high magnification Diffraction Interference Contrast (DIC) microscopy. ICSI is performed using morphologically well-shaped spermatozoa selected within the limits of the conventional ICSI inverted microscope magnification of x400. However, it became evident that the morphology of the individual spermatozoon used for microinjection into the oocyte is associated to both fertilization and pregnancy outcome.The impact of nuclear vacuoles in the head of spermatozoa on pregnancy outcome was analyzed too, showing that microinjection of vacuolated sperm reduced the pregnancy rate and was associated with a higher risk for early abortion. Study design, size, duration A prospective cohort observational randomized sibling-oocyte study A total of 300 infertile couples undergoing ICSI were included in the study from August 2020 to July 2021. Ethical approval from Alexandria University, faculty of Medicine. Participants/materials, setting, methods A total of 300 infertile couples undergoing ICSI, Male factor infertility according to the World Health Organization (WHO) criteria 2010, patients with Azoospermia.and sperm concentration less than 0.1 million/mL were excluded.The oocytes of each patient were randomly divided into two groups in 1 to 1 ratio. One group was injected with sperms selected by normal magnification (3357) oocytes and the other group was injected with sperms selected by high magnification (IMSI) technique (3384) oocytes. Main results and the role of chance Statistical results according to number of cases showed that IMSI is significantly higher than ICSI in the number of fertilized oocytes (Mean± SD was 9.46±4.10vs. 9.02 ± 4.20, P ≤ 0.001), number of blastocysts (Mean± SD was 4.74±3.42 vs. 4.47±3.27, P = 0.035) and number of good quality blastocysts (Mean± SD was 1.97±2.57 vs. 1.75±2.50, P = 0.009), with No Significant difference in the number of injected oocytes.Comparison between ICSI and IMSI according to rates related to number of oocytes. Statistical results according to rates showed that IMSI is significantly higher than ICSI in fertilization rate (Mean± SD was 84.25 ± 16.57 vs. 80.01 ± 17.95, P ≤ 0.001), and the rate of good quality blastocysts (Mean± SD was 17.04 ± 18.47 vs. 15.59 ± 18.71, P = 0.04). No Significant difference in the blastulation rate P = 0.106. Comparison between ICSI and IMSI according to total number of injected oocytes (n = 6741) Statistical results according to total number of injected oocytes showed that IMSI is significantly higher than ICSI in fertilized oocytes (83.9% vs. 80.6% P = 0.001), and blastocysts with good quality (17.4% vs. 15.7%, P = 0.05). No Significant difference in the total number of blastocysts P = 0.075. Limitations, reasons for caution implantation, pregnancy and abortion rates were not included in the study Wider implications of the findings Similar to the present result and agreement to our suggestion several studies showed higher fertilization and blastocyst formation with the use of IMSI techniques and others showed higher implantation and pregnancy rates and lower miscarriage rates.Our recommendation is to use IMSI technique during sperm selection for treating infertile couples Trial registration number not applicable

P-468 Organotypic culture of testicular tissue from infant boys with cryptorchidism

Abstract Study question Can organotypic culture support the survival and maturation of germ cells and niche-related cells within testicular tissue from infant boys with cryptorchidism? Summary answer The testicular structure and the number of germ cells were maintained during organotypic culture, whereas Sertoli cells and peritubular myoid cells (PTMCs) matured. What is known already Testicular tissue cryopreservation (TTC) is a strategy to safeguard the fertility of prepubertal boys who face a risk of infertility. Organotypic culture of immature testicular tissue from mice achieved production of spermatozoa. Similarly, the culture of human fetal gonads resulted in the generation of competent spermatids. However , in vitro spermatogenesis by organotypic culture of human prepubertal testicular tissue has not been achieved. It is also unknown whether germ cells as well as its niche-related cells, in testicular tissue from infant boys with cryptorchidism, can maintain and mature under in vitro conditions. Study design, size, duration Testicular tissue was cryopreserved from four infant boys with bilateral cryptorchidism undergoing orchidopexy (age range: 0.5-1.4 years), as part of a fertility preservation program. Culture media with and without retinoic acid were tested. Testicular fragments were harvested at 30 days and 60 days after culture and evaluated by histological assessment of tissue structure, germ cell development, and immunohistochemical staining for germ cell and somatic cell markers. Participants/materials, setting, methods Cryopreserved-thawed testicular tissue was cut into fragments (1-2 mm3) and placed on top of agarose gel stands and cultured at 34oC with 5% CO2 in Minimum Essential Medium-alpha supplemented with knockout serum replacement, human umbilical cord plasma, Activin A, hormones, growth factors, with or without retinoic acid. Immunohistochemical analyses were performed using germ cell markers (MAGE-A, GAGE, and VASA), Sertoli cell maturation markers (AMH, AR, SOX9), PTMC marker (alpha-SMA). Main results and the role of chance Following the 60-day culture, the lumen of the seminiferous tubules had developed. The number of germ cells per tubule remained stable during this period. However, no further germ cell maturation was observed. Germ cells showed different phenotypes of MAGEA, GAGE, and VASA expression with no significant difference in number. The number of SOX9-positive Sertoli cells was significantly increased from 30 days to 60 days of culture (p &amp;lt;0.0001). No difference in AMH expression was observed, while AR expression in Sertoli cells was induced during culture. Alpha-SMA expression was detected in the PTMCs surrounding the seminiferous tubules. The two different culture conditions, with and without retinoic acid in the culture media, did not affect cell survival or maturation. Limitations, reasons for caution The small number of testicular biopsies available is a limitation. Wider implications of the findings Our organotypic culture conditions support the long-term survival of germ cells in testicular tissue from infant boys with cryptorchidism. Thus, further studies are needed to induce the maturation of germ cells under similar experimental conditions. Trial registration number not applicable

P-700 Oral progestins are a good alternative to traditional antagonists in freeze all IVF cycles yielding comparable mature oocyte rate and viable embryo number

Abstract Study question May oral progestins be a good alternative to traditional antagonists in freeze all cycles and yield comparable number of mature oocytes and viable embryos? Summary answer Oral progestins are an effective alternative to antagonists in preventing premature ovulation in freeze all cycles, are more patient friendly and have a lower cost. What is known already Progestine-primed ovarian stimulation (PPOS) protocols are new protocols available for the last 5-6 years that proved to be effective in preventing premature LH surge. A recent meta-analysis by Shaogen Guan et al. including 9 studies with 1885 cycles showed that PPOS is an effective ovarian stimulation protocol and may be an alternative to antagonist in planned freeze all in vitro fertilization (IVF) cycles. Study design, size, duration Our study is retrospective cross sectional self-controlled study. We compared 2 groups of patients with 150 patients in each group undergoing IVF treatment for the period from September 2019 to November 2021 in our centre. Participants/materials, setting, methods We used oral dydrogesterone 20 mg a day from the first day of stimulation in progestine group and started cetrorelix 0.25 mg after having 2 follicles &amp;gt; 12 mm in antagonist group. "Freeze all" strategy was applied in progestine group. In antagonist group patients underwent either "freeze all" or fresh transfer. Patients aged 21-34, with antral follicle count &amp;gt; 10 were included. Patients with endometriomas and poor oocyte quality on the previous cycles were excluded. Main results and the role of chance Mean age of patients in dydrogesterone group was 27,9 and in antagonist group - 27,3. We used recombinant follicle stimulating hormone (rFSH) in patients younger than 30 years of age and combined it with human menopausal gonadotropin (HMG) in patients older than 30. For final oocyte maturation decapeptyl was used in progesterone group and either decapeptyl or human chorionic gonadotropin in antagonist group. Mean amount of rFSH used for one cycle in dydrogesterone group was 1726 IU and HMG 562,5 IU; in antagonist group 2013,7 and 665.6 IU respectively. There was no noticeable difference between total number of retrieved oocytes and in maturity rate. Mean number of retrieved oocytes was 18,3 in dydrogesterone group and 17,1 in antagonist group (p = 0.138). Mean number of mature oocytes were 13,4 (73,2%) and 13,1 (76,1%) in dydrogesterone and antagonist groups respectively (p = 0.131). We also didn't find significant difference in number of viable embryos on the day 3: 7,9 in dydrogesterone group and 8.3 in antagonist group (p = 0,321). As a secondary outcome we looked at ongoing pregnancy rate and there was also no significant difference between two groups. This number was 37,5 % in PPOS group and 35,6 % in antagonist group (p = 0,335). Limitations, reasons for caution We didn't exclude patients with severe male factor which might influence our secondary outcome. Patients with polycystic ovarian syndrome (PCOS) were included in the study mainly in the dydrogesterone group, it is known that in these patients maturity problems may happen. Use of different trigger agents may put some limitations. Wider implications of the findings We showed in our study that PPOS protocols are not inferior to traditional antagonist protocol. These protocols are more patient-friendly because of less number of injections and probably less number of ultrasound folliculometry as well as lower cost. Tablets are easy to take and patient compliance is good. Trial registration number not applicable

Understanding eligibility creep in psoriasis assessments: a survey study.

Psoriasis severity assessments for clinical trial entry may be unintentionally overestimated, especially if trial eligibility is chiefly dependent on rating of disease severity. When this results in patients with less severe phenotypes joining clinical trials it is referred to as eligibility creep. We investigated the potential impact of psychosocial incentives on psoriasis lesion severity grading. A survey was constructed and disseminated through Amazon Mechanical Turk. Participants completed two vignette-style questions prompted with a randomly allocated psychosocial incentive. Questions required participants to grade and select psoriasis lesion pictures for a fictional trial. Participants also decided whether or not to schedule re-evaluation of patients deemed ineligible at initial visit. There were 646 participants. There was no significant difference in number of total lesions selected for study inclusion between incentive groups (Kruskal-Wallis, P=0.30). In general, participants completing empathy and professional uncertainty incentives selected the most and least number of lesion pictures for trial inclusion, respectively. Participants prompted with empathy incentives had significantly greater rates of choosing to schedule a follow-up visit for ineligible patients compared to participants prompted with other incentives (69.7% versus 59.1%, Chi square P=0.046). Situations evoking empathy may contribute to eligibility creep.

Evaluation of Repellency of Stop the Bites® Botanical Pesticide to White-Tailed Deer at Corn Feeders

Stop the Bites® botanical pesticide was evaluated for repellent properties against white-tailed deer, Odocoileus virginianus (Zimmerman), at feeders with supplemental corn, Zea mays L., in Cameron County, Texas. The pesticide was tested as a ground treatment around feeders and as spray applied directly to deer as they consumed corn at supplemental feeders. With either treatment, there was no significant difference in numbers of white-tailed deer at the feeders compared to the paired nontreated check. The botanical pesticide may be useful for treatment of cattle fever ticks (Rhipicephalus microplus (Canestrini) and Rhipicephalus annulatus (Say)) on deer at supplemental corn feeders during the hunting season when ivermectin-treated corn is withdrawn, or for treatment using a remotely operated sprayer at fence crossings for tick-infested nilgai, Boselaphus tragocamelus (Pallas).

Abstract 1304: Brachytherapy dose heterogeneity primes response to immune checkpoint blockade to generate anti-tumor immunity

Abstract Purpose: The immunologic effects of radiation (RT) are influenced by dose and each may be optimized over a unique dose range. We used brachytherapy (BT) to deliver a heterogeneous RT dose within a single tumor and compared the relative capacities of BT and homogenous dose external beam radiotherapy (EBRT) to enhance the anti-tumor immune response in combination with immune checkpoint inhibition (ICI). Materials and Methods: We used syngeneic murine models of melanoma (B78) and prostate cancer (Myc-CaP). To evaluate the effect of BT on the microenvironment, mice bearing B78 tumors were randomized to receive BT (192Ir source, 2 Gy to tumor edge), sham insertion, or EBRT (2, 8, or 20 Gy). Tumors were harvested 3 days following RT and in the case of BT, punch excisions were taken from the dissected tumor 1, 3, and 5 mm from the source location for gene expression and immune cell infiltration analysis. To evaluate anti-tumor response, we randomized mice bearing B78 tumors on the right flank (~200 mm3) and left shoulder (~100 mm3) to BT alone, catheter insertion alone, BT + ICI (anti-PD-L1 and anti-CTLA-4, 200 µg IP injection days 3, 6, 9 after RT), EBRT (2 or 8 Gy) + ICI, or ICI alone. Mice bearing MyC-CaP tumors were randomized to sham insertion, BT (2 or 8 Gy to tumor edge), BT + ICI, EBRT (2, 8, or 20 Gy) + ICI, or ICI alone. Immediately following RT, mice were engrafted with a secondary tumor. Results: Using qPCR analysis, we observed statistically significant differences in gene expression of Mhc-1, Ifnβ, and Vcam between tissue locations in BT treated tumors. Furthermore, in a single tumor BT optimally engaged all three pathways while each EBRT dose only optimally engaged one. Bulk RNAseq analysis revealed unique gene expression signatures between tissue locations in BT treated tumors. We observed significant differences in number of CD8+ and FOXP3+ cells between tissue locations. In B78 tumor bearing mice, we observed a greater anti-tumor response at the secondary untreated tumor with BT + ICI (63% CR) compared to EBRT + ICI (12.5% CR). In mice bearing Myc-CaP tumors treated with BT + ICI, we observed a significant reduction in tumor growth compared to other groups and no engraftment at the secondary tumor. This effect was dependent on both CD4+ and CD8+ cells and was sensitive to BT dose. Splenocytes harvested from disease-free mice co-cultured with tumor cells showed significant increases in expression of T cell activation markers in both CD4+ and CD8+ cell populations. Conclusions: We report dose-dependent effects of RT on expression of immune susceptibility markers and immune cell infiltration in a murine tumor model. We observe that a heterogeneous dose of BT results in spatial differences in these effects within a single tumor. This spatial heterogeneity in activation of immune mechanisms may underlie a greater capacity of BT to augment anti-tumor immune response when combined with ICI, as compared to homogenous dose EBRT. Citation Format: Justin C. Jagodinsky, Wonjong Jin, Jessica M. Vera, Raghava N. Sriramaneni, Paul A. Clark, Keng-Hsueh S. Lan, Ishan Chakravarty, Noah Siegel, Raad H. Allawi, Sarah E. Emma, Ian S. Arthur, Rupak K. Das, Irene M. Ong, Jessica R. Miller, Zachary S. Morris. Brachytherapy dose heterogeneity primes response to immune checkpoint blockade to generate anti-tumor immunity [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 1304.