Women's Hospital Research Articles

Clinical algorithm reduces antibiotic use among children presenting with respiratory symptoms to hospital in central Vietnam.

To assess the safety and utility of a pragmatic clinical algorithm to guide rational antibiotic use in children presenting with respiratory infection. The effect of an algorithm to guide the management of young (< 5years) children presenting with respiratory symptoms to the Da Nang Hospital for Women and Children, Vietnam, was evaluated in a before-after intervention analysis. The main outcome was reduction in antibiotic use, with monitoring of potential harm resulting from reduced antibiotic use. The intervention comprised a single training session of physicians in the use of an algorithm informed by local evidence; developed during a previous prospective observational study. The evaluation was performed one month after the training. Of the 1290 children evaluated before the intervention, 102 (7.9%) were admitted to hospital and 556/1188 (46.8%) were sent home with antibiotics. Due to COVID-19, only 166 children were evaluated after the intervention of whom 14 (8.4%) were admitted to hospital and 54/152 (35.5%) were sent home with antibiotics. Antibiotic use was reduced (from 46.8% to 35.5%; p = 0.009) after clinician training, but adequate comparison was compromised. The reduction was most pronounced in children with wheeze or runny nose and no fever, or a normal chest radiograph, where antibiotic use declined from 46.7% to 28.8% (p < 0.0001). The frequency of repeat presentation to hospital was similar between the two study periods (141/1188; 11.9% before and 10/152; 6.6% after; p = 0.10). No child represented with serious disease after being sent home without antibiotics. We observed a reduction in antibiotic use in young children with a respiratory infection after physician training in the use of a simple evidence-based management algorithm. However, the study was severely impacted by COVID-19 restrictions, requiring further evaluation to confirm the observed effect.

Expiratory airflow at 7–8 years of age in children born extremely low birthweight from 14 years before to 14 years after the introduction of exogenous surfactant

It is unclear if expiratory airflow in survivors born extremely low birth weight (ELBW; 500-999g) has improved after the introduction of exogenous surfactant into clinical practice in 1991. The primary aim of this study was to describe the changes in airflow at 7-8 years of age of survivors born ELBW in five discrete cohorts from 14 years before to 14 years after the introduction of exogenous surfactant into clinical practice. The cohorts comprised consecutive survivors born ELBW in 1977-82 and 1985-87at the Royal Women's Hospital, Melbourne, and in 1991-92, 1997 and 2005 in the state of Victoria, Australia. Survival rates to 2-years of age for infants born ELBW in the state of Victoria rose from approximately 1-in-4 to 3-in-4 over the time of this study. Expiratory airflow measurements at 7-8 years included the forced expired volume in 1s (FEV1), converted to z-scores for age, height, sex, and race. There were 596 ELBW participants with expiratory flow data, 280 (47%) of whom had bronchopulmonary dysplasia (BPD). Overall, there was little change in zFEV1 over the 28-year period (mean change per year; 0.003, 95% CI-0.010, 0.015, P=0.67). There was, however, evidence of an interaction between BPD and year; zFEV1 in those who had BPD fell over time (mean change per year-0.019, 95% CI-0.037,-0.009, P=0.035), whereas zFEV1 improved in those who did not have BPD (mean change per year 0.021, 95% CI 0.006, 0.037, P=0.007). Contrary to recent evidence, expiratory airflow of children born ELBW has not improved with the introduction of surfactant, and may be deteriorating in those who had BPD. National Health and Medical Research Council (Australia); Victorian Government's Operational Infrastructure Support Program.

Post-partum maternal bradycardia: A case series and literature review

Background Unlike tachyarrhythmias, which are common in pregnancy, there is a paucity of data regarding maternal bradycardias. Our objective was to describe the characteristics, associated conditions, and prognosis of women who develop bradycardia post-partum. Method We conducted a retrospective chart review of patients referred to the Obstetrical Medicine service at British Columbia Women's Hospital from January 2012 to May 2020 for post-partum maternal bradycardia. Results Twenty-four patients with post-partum bradycardia were included (age 34.2 ± 4.8 years; heart rate 40.4 ± 8.1 beats per minute; blood pressure 131/72 mm Hg). Sinus bradycardia (79.2%) was the most common rhythm. Dyspnea (29.4%) and chest pain (23.5%) were common symptoms. Mean time to resolution of bradycardia was 3.6 ± 3.8 days. Associated conditions potentially explaining the bradycardia were preeclampsia (54.1%), underlying (16.7%), medications (8.3%), and neuraxial anesthesia (8.3%). Conclusions Maternal bradycardia is an uncommon condition complicating the post-partum period, that is generally self-limiting, with the majority only require clinical observation.

Pregnancy outcomes in women with adenomyosis, undergoing artificial endometrial preparation with and without gonadotropin-releasing hormone agonist pretreatment in frozen embryo transfer cycles: An RCT.

Selecting a suitable and preferable method for endometrial preparation in frozen embryo transfer (FET) cycles for women with adenomyosis is still challenging in infertility treatment. To compare 2 artificial endometrial preparation regimens with and without gonadotropin-releasing hormone agonist (GnRHa) pretreatment in women with adenomyosis undergoing FET cycles. This randomized clinical trial study was conducted on 140 adenomyosis cases who underwent FET cycles at Arash Women's hospital, Tehran, Iran from May 2020 to March 2021. Participants were randomly allocated into hormonal replacement therapy (HRT) and HRT+GnRHa pretreatment groups (n = 70/each). Endometrial preparation with 2-6 mg daily estradiol was started in the HRT+GnRHa group, taking after down-regulation with the GnRHa. Within the HRT group, the same dose of estradiol was commenced within the early follicular stage. The main (chemical and clinical pregnancy rates) and auxiliary results (twin pregnancy, miscarriage, and live birth rates) were compared between groups. The demographic characteristics and severity of adenomyosis, endometrial thickness, and pattern at starting progesterone administration were similar in the 2 groups, and triple-line endometrium was found to be the dominant pattern in both groups (p = 0.65). No significant differences were observed in chemical, clinical, and twin pregnancy rates as well as miscarriage and live birth rates between groups (p = 0.71, p = 0.81, p = 0.11, and p = 0.84, respectively). However, the total estrogen dose and duration of estrogen consumption were significantly higher in the pretreatment group (p = 0.001, and p = 0.003). These results indicated that the hormonal endometrial preparation with estrogen and progestin for FET cycles is as efficacious as a protocol involving preceding pituitary suppression with a GnRHa. Further large randomized clinical studies are required to confirm these findings.

Obstructed Hemivagina Ipsilateral Renal Agenesis (OHVIRA) Syndrome—A Retrospective Cohort Analysis of the Sabah Population

ObjectivesThe objectives of the study were to compare the demographic characteristics, presenting complaints, timeliness of diagnosis, and treatments given to all patients diagnosed with obstructive hemivagina ipsilateral renal agenesis (OHVIRA) between the adolescent group (age 10-19) and the adult group (age 20 and above) and to propose a feasible screening test consisting of routine bedside ultrasound to detect renal anomalies in addition to pelvic ultrasound during the assessment of females with gynecologic complications in resource-limited settings. Method and AnalysisWe conducted a retrospective cohort analysis of all patients with OHVIRA at our institution, Sabah Women and Children's Hospital, Malaysia, between the 2013 and 2022. Data were collected by reviewing patients’ medical notes. ResultsThere were a total of 18 patients diagnosed with OHVIRA from 2013 to 2022, aged 10-41 years old. Nine patients (50%) presented during adolescence. Most (88.9%) came with symptoms such as abdominal pain, urinary symptoms, abnormal uterine bleeding, foul-smelling vaginal discharge, and primary infertility, whereas only 2 patients (11.1%) were asymptomatic and diagnosed incidentally. Acute abdomen was more common in the adolescent group (P = .015). No significant difference was found on the side of the renal anomaly. ConclusionPresenting symptoms vary and are often mimicked other gynecologic or surgical conditions, making the diagnosis difficult and delayed. Some patients were incidentally diagnosed while being managed for other problems, and it was not uncommon to have unnecessary surgery before the correct diagnosis was made. We suggest that all female patients with abdominal and pelvic complaints should be screened for renal anomaly during pelvic scan to improve diagnostic rates.

Evaluation of Atypical Antipsychotics for the Facilitation of Weaning Sedation in Mechanically Ventilated Critically Ill Patients.

Sedatives and analgesics are commonly utilized as continuous infusions in the ICU but have complications, including an increase in mechanical ventilation days, ICU length of stay, and delirium. Atypical antipsychotics (AAPs) affect several receptors including muscarinic, histamine, and α-1 adrenergic receptors, which may allow them to act as adjunctive agents to facilitate weaning of continuous infusions. To determine if there is a decrease in sedatives/analgesics requirements with the use of quetiapine and olanzapine in mechanically ventilated critically ill patients. A single-center, retrospective study conducted at Brigham and Women's Hospital from 1/1/2018 to 12/31/2019. Patients were included if they were mechanically ventilated for at least 48 hours before and following AAP initiation, were receiving at least one sedative/analgesic by continuous infusion and received AAP for at least 48 hours. The major endpoint was the percentage of patients with ≥20% reduction in the cumulative dose (CD) of midazolam, propofol, or opioids using morphine mg equivalent (MME), 48 hours from AAP initiation. Minor endpoints included median changes in CD at 24 and 48 hours, and Richmond Agitation-Sedation Scale (RASS), and Critical Care Pain Observation Tool (CPOT) changes at 48 hours. A total of 1177 encounters were screened and 107 were included. Within the 48 hours after AAP initiation, 77.6% had ≥20% reduction in the CD of a sedative/analgesic. There was a significant reduction in propofol, no change in MME, and significant increase in dexmedetomidine median CD at 48 hours from AAP start. No difference was found in pain scores, but patients had significantly lighter sedation scores in the 48 hours after AAP initiation. A multivariate analysis showed that earlier initiation of antipsychotics was associated with a higher likelihood of achieving a 20% reduction in a sedative/analgesic. AAP use was associated with a significant reduction in sedatives/analgesics doses. Future studies are warranted to confirm the results.

Analysis of genetic variants and clinical manifestations of two children with Kabuki syndrome

To report on two children with Kabuki syndrome due to variants of the KMT2D gene and summarize their clinical and genetic characteristics. Two children who had presented at the Ningbo Women and Children's Hospital respectively on August 19 and November 10, 2021 were selected as the study subjects. Clinical data were collected. Both children were subjected to whole exome sequencing (WES), and candidate variants were validated by Sanger sequencing. Both children had featured motor and language developmental delay, facial dysmorphism and mental retardation. Genetic testing revealed that both had harbored de novo heterozygous variants of the KMT2D gene, namely c.10205del (p.Leu3402Argfs*3) and c.5104C>T (p.Arg1702*), both of which were rated as pathogenic variants based on the guidelines from the American College of Medical Genetics and Genomics (ACMG). The c.10205del (p.Leu3402Argfs*3) and c.5104C>T (p.Arg1702*) variants of the KMT2D gene probably underlay the pathogenesis in these two children. Above finding has not only provided a basis for their diagnosis and genetic counseling, but also enriched the spectrum of KMT2D gene variants.

Maternal and fetal outcomes of pregnancies associated with single versus double abnormal values in 100 gr glucose tolerance test.

Comparing maternal and fetal outcomes in pregnancies associated with single versus double abnormal values in 100 gr oral glucose tolerance test (OGTT). This cohort study was performed in Arash women's Hospital, Tehran, Iran from 2019 to 2020. Patients with normal fasting blood sugar (FBS) tests were divided into two groups according to their OGTT results. The first group had a single abnormal value in their OGTT and the second group showed two abnormal values. Both groups were followed regularly until the end of pregnancy. Our results showed higher rates of macrosomia (birth of newborns weighed over 4kg) and the need for pharmacological treatment for the management of GDM in the second group (P = 0.05). There were no differences between the two groups in terms of other maternal (polyhydramnios, shoulder dystocia, operative vaginal delivery, atony, postpartum bleeding, cesarean delivery, preeclampsia, and IUFD) and fetal outcomes (Apgar score, seizure, NICU admission, and hypoglycemia in the first 24h). We found no significant differences between pregnant women with single and double abnormal values in 100 gr OGTT regarding maternal and neonatal outcomes, except for macrosomia and need for pharmaceutical treatment.

Evaluation of prognostic prediction ability of the novel Japanese risk factor scoring system in a Japanese cohort of resectable cutaneous squamous cell carcinoma: A retrospective cross-sectional study.

Japanese patients with very high-risk cutaneous squamous cell carcinomas (cSCCs), based on the National Comprehensive Cancer Network guidelines, have been reported to display a higher cumulative incidence of relapse and disease-specific death (DSD) than those with high-risk cSCC. Therefore, prognosis prediction is crucial for Japanese patients with very high-risk cSCCs. Herein, we aimed to evaluate the prognostic prediction ability of our novel Japanese Risk Factor Scoring Systems (JARF scoring) in a Japanese cohort of cSSC patients. Data of 424 Japanese patients with resectable very high-risk cSCCs were analysed. We compared the prognostic ability of the following three staging systems: Brigham and Women's Hospital (BWH) tumour staging, number of NCCN very high-risk factors, and JARF scoring, including recurrent tumour, high-risk histological features, deep tumour invasion and lymphatic or vascular involvement as risk factors. The prognostic ability of these staging systems was evaluated according to the cumulative incidence of local recurrence (LR), regional lymph node metastasis (RLNM), DSD, and overall survival (OS). When BWH staging was used, high T stage led to significantly poor outcomes only in the cumulative incidence of RLNM (p = 0.01). The presence of very high-risk NCCN factors led to significantly poor outcomes in terms of RLNM (p = 0.03) and OS (p = 0.02). Meanwhile, a high number of risk factors in the JARF scoring system clearly led to poor outcomes in terms of LR (p = 0.01), RLNM (p < 0.01), DSD (p = 0.03), and OS (p < 0.01). The JARF scoring system may accurately predict the risk of recurrence and death in very high-risk cSCC patients in Japan.

Study on the Efficacy of "Information Platform + Self-Care Model" on the Health Status of Discharged Patients Following Vaginal Natural Orifice Transluminal Endoscopic Surgery.

To discuss the impact of the "information platform + self-care model" on the health status of discharged patients following vaginal natural orifice transluminal endoscopic surgery (vNOTES). Patients underwent vNOTES at a tertiary specialized women's and children's hospital in Chengdu. They were randomly assigned to one of two groups-the intervention group (29 patients) and the control group (29 patients). The control group received standard education after discharge, while the intervention group received guidance based on an "information platform + self-care model" on discharge; a questionnaire survey was conducted for both groups one month after discharge. The quality of life score in the intervention group was higher than that in the control group, and the difference was statistically significant (P < 0.05); the scores of the intervention group on dimensions such as vitality, general health perceptions, physical role functioning, social role functioning, emotional role functioning, and mental health, except for physical functioning (Z =0.034, P =0.973) and bodily pain (Z =1.470, P =0.141), were higher than those in the control group one month after discharge, and the difference was statistically significant (P <0.05). There was no patient (0) in the intervention group who had an unscheduled visit/admission, and there was 1 patient (3.6%) in the control group who had unscheduled visit/admission; there were no statistical differences between the two groups in the number of patients who had an unscheduled visit/admission 1 month after discharge (P =0.491). The application of the "information platform + self-care model" can, to a certain extent, improve the health status of patients following vNOTES after discharge, and it can also reduce unscheduled visits/admissions, but more research with a larger sample size is required.

Should ICSI be implemented on patients with poor-quality embryos in the previous IVF cycle?

This study was to evaluate whether Intracytoplasmic sperm injection (ICSI) can improve the quality of embryo in patients with poor-quality embryos in the previous In-vitro fertilization (IVF) cycle, which was cancelled before transfer. This was a retrospective cohort study of 178 IVF and 158 ICSI cycles for patients with poor-quality embryos in the previous IVF cycle in the Center for Reproductive Medicine, Women and Children's Hospital of Chongqing Medical University from March 2016 to June 2022. The 2 PN rate, oocyte utilization rate , high-quality embryo rate and clinical pregnancy rate were compared between the two groups. Furthermore, the implantation rate, miscarriage rate and cycle cancelation rate were measured and compared. ICSI resulted in a comparable 2 PN rate, oocyte utilization rate and cycle cancelation rate with IVF. The high-quality embryo rate of ICSI group was significantly higher than that of IVF group (5.56% vs. 2.60%, P < 0.05). Eventually, a total of 239 patients performed embryo transfer. ICSI resulted in a significantly higher clinical pregnancy rate (55.56% vs. 40.98%, P < 0.05) compared with IVF, however, there were no notable differences in miscarriage rate and implantation rate. The present study suggested that ICSI significantly improved the high-quality embryo rate and clinical pregnancy of the patients with poor-quality embryos in the previous IVF cycle. Prospective randomized controlled trials are needed to further verify.

Association between normal, abnormal thyroid hormones and diabetes mellites retinopathy in patients with type 1, 2 and 3 diabetes in the Anbar city

Diabetes is a type of disease that affects the rest of the body's functions. The study was conducted at Al-Ramadi Teaching Hospital for Women and Children for the period from 2021-2022. Our study aimed to investigate the relationship between the three types of diabetes (T2DM, gestational diabetes and T1DM). The study found that age affects disease severity levels in addition to weight, where the effect was less in type 2 and gestational diabetes. For fats, there was no strong effect in increasing diabetes. With regard to low-density lipids, it has been shown that it directly affects the development of the disease, because triglyceride levels have a strong and direct influence on the development of diabetes, especially type 1 and type 2. Cumulative glucose testing: Sugar and insulin have been linked to disease. In this study, when performing Pearson's correlation analysis of the relationship between TSH and some biochemical tests, there was a strong correlation between TSH, age, weight, T3, RBS, HbA1c and insulin, while there was no correlation for TSH with lipids, T4 and other tests. These results indicate the importance of thyroid screening for diabetic patients.

Breastfeeding Experiences of Mothers with Babies Admitted to the University Teaching Hospital Neonatal Intensive Care Unit Lusaka, Zambia

Purpose: The main objective was to explore the breastfeeding experiences of mothers with babies admitted to the Neonatal Intensive Care Unit (NICU) at University Teaching Hospital (UTH) Women and Newborn Hospital (WNBH), Lusaka, Zambia.&#x0D; Methodology: A qualitative phenomenological transcendental (descriptive) design using unstructured in-depth interviews with mothers of babies admitted to the NICU at UTH Women and Newborn, Lusaka, Zambia was used to explore the experiences. All the interviews were recorded and then transcribed thereafter analysed using thematic analysis.&#x0D; Findings: Findings revealed that breastfeeding in NICU was breastfeeding in a restricted environment as mothers had inadequate time for breastfeeding and bonding. Mothers perceived the NICU to be a painful and scary place. The breastfeeding support was perceived as good breastfeeding support while some mothers perceived the support as inadequate or no breastfeeding support. Nevertheless, mothers had alternative support options while breastfeeding in a restricted environment and the options included praying to God Almighty, strengthening oneself and peer support.&#x0D; Unique contribution to theory, practice and policy: The study concluded that separation of mothers from their babies was a source of pain and NICU was not a conducive environment for breastfeeding. Mothers need more time with their babies so as to promote breastfeeding and bonding.

The risk factors and impact of subchorionic hematoma in the first trimester in IVF twin pregnancies: a prospective cohort study.

This study aimed to identify the risk factors for subchorionic hematoma (SCH) in the first trimester of in vitro fertilization (IVF) twin pregnancies and investigate the impact of SCH on pregnancy outcomes. A prospective cohort study was conducted at Chengdu Women and Children's Central Hospital. The study recruited patients who were identified with twin pregnancies in the first trimester, undergoing IVF treatment from January 2020 to May 2021. The demographic characteristics and pregnancy outcomes were compared between the SCH and the non-SCH groups. A logistic regression analysis was used to determine the risk factors for SCH and adverse pregnancy outcomes. In the first trimester, 38% of patients developed SCH. The independent risk factors for SCH included male factor, hydrosalpinx, polycystic ovary syndrome (PCOS), previous miscarriage, and adenomyosis. With respect to the pregnancy outcomes, only the rate of twin pregnancy loss before 20 gestational weeks was significantly higher in the SCH group than in the non-SCH group. After adjusting for the confounding factors, the presence of SCH diminished the ovarian reserve, and previous miscarriage was independently related to twin pregnancy loss before 20 gestational weeks. This may be the first study to evaluate the risk factors of SCH in twin pregnancies who underwent IVF-ET/FET treatment, which may provide some theoretical basis for clinical practice in the future. Furthermore, it was found that the occurrence of SCH was associated with the loss of both pregnancies before 20 gestational weeks. Therefore, these patients should be offered increased surveillance and timely treatment.

Clinical characteristics of severe pre-eclampsia in a single tertiary referral center of Xiamen City

Objective: To explore the key points for preventing and reducing severe pre-eclampsia (SPE) and its severe complications in the tertiary medical referral system of a second-tier city by analyzing the clinical characteristics of SPE. Methods: The clinical data of 341 patients with SPE who terminated pregnancy in Women and Children's Hospital, School of Medicine, Xiamen University, from January 1, 2020 to December 31, 2022 were retrospectively analyzed, and the pre-eclampsia (PE) risk factors, clinical characteristics and severe complications of SPE between the patients referred from primary hospitals (referral group) and the patients received regular prenatal care in the tertiary referral center (central group) were compared, as well as the influence of the referral timing on the maternal and perinatal outcomes. Results: Among the 341 cases of SPE, 92 cases were in the referral group and 249 cases were in the central group. (1) Analysis of PE risk factors: there was no statistical difference in the proportion of risk factors of PE between these two groups [75.0% (69/92) vs 71.9% (179/249); χ2=0.328, P=0.567]. (2) Analysis of clinical features: the gestational ages at the PE early warning factors onset, at the PE first symptom onset and at SPE diagnosed, pregnancy terminated and onset of SPE severe complications in the referral group were significantly earlier than those in the central group (all P<0.05), the proportions of terminating pregnancy before 32 weeks of gestation, between 32 and 34 weeks of gestation, intensive care unit (ICU), neonatal ICU hospitalization and fetal growth restriction in single pregnancies were higher than those in the central group, while the live birth rate was lower than that in the central group (all P<0.05). (3) Analysis of SPE severe complications: the rates of SPE severe complications in the referral group was higher than that in the central group [28.3% (26/92) vs 13.7% (34/249); χ2=9.885, P=0.002]. Among them, the rates of placental abruption [7.6% (7/92) vs 2.8% (7/249); χ2=3.927, P=0.048] and still birth [6.5% (6/92) vs 0.4% (1/249); χ2=9.656, P=0.002] in the referral group were significantly higher than those in the central group. (4) Analysis of referral timings: the timings included referral after onset of SPE severe complications (9.8%, 9/92), referral after SPE diagnosed (63.0%, 58/92), referral after detection of SPE early warning signs (20.7%, 19/92) and referral after detection of PE risk factors (6.5%, 6/92). The gestational ages at SPE diagnosed and pregnancy terminated in group of referral after onset of SPE severe complications and group of referral after SPE diagnosed were significantly earlier than those in group of referral after detection of PE early warning signs and group of referral after detection of PE risk factors (P<0.05). The earlier the referral, the higher the live birth rates (P<0.05). Conclusions: The tertiary referral center of the second-tier city plays an important role in reducing the maternal and perinatal damage of PE. The timing of referral in primary medical institutions is the key point of reducing the occurrence of SPE severe complications and maternal, perinatal damage of PE. It is necessary for medical institutions of all levels in all regions to improve the ability of early identification and early intervention for PE, to enhance the awareness of SPE and its severe complications prevention and control. Primary medical institutions should especially pay attention to raise the consciousness of PE risk factors and early warning signs, and to improve the ability of PE risk factors and early warning signs screening.

Indications, Efficacy, and Complications of Pediatric Bronchoscopy: A Retrospective Study at a Tertiary Center.

Background Bronchoscopy is an essential procedure for evaluating, diagnosing, and treating pediatric respiratory diseases. In this study, we demonstrate the indications and contraindications of bronchoscopy done in a tertiary referral hospital, Al Qassimi Woman's and Children's Hospital (AQWCH) in Sharjah, United Arab Emirates (UAE), in order to achieve better service. This study aims to evaluate patients' characteristics, diagnostic and therapeutic indications, and complications of bronchoscopy. Material and method This retrospective chart review included children aged between one day and 13 years, admitted to AQWCH, who underwent bronchoscopy (rigid or flexible) procedures between January 2018 and December 2019. All patients were identified by using a computerized search of hospital discharge diagnosis, which was codified as "pediatric bronchoscopy, flexible, rigid, bronchoalveolar lavage". The main study outcome measure was to evaluate patients' characteristics, diagnostic or therapeutic indications, bronchoalveolar lavage (BAL) analysis, as well as complications of bronchoscopy at AQWCH. Results There were 72 pediatric bronchoscopies (rigid and flexible) performed in patients aged less than 13 years old; the reason for bronchoscopy procedure was diagnostic in 51% and both diagnostic and therapeutic in 49%. Cough was the most common symptom (n=53; 74%), and chest recession was the most common clinical finding (n=46; 64%). Foreign body aspiration was the main indication (n=23; 32%), followed by stridor (26%). Consolidation was the most common radiological finding. Foreign body was the common finding, seen in 25% of bronchoscopies, followed by tracheomalacia in 17%. The suspected diagnosis was confirmed in 89%, and management change was needed in 54% of patients. The main complication during the procedure was desaturation (26%), and cough was the main post-bronchoscopy complication (14%). BAL was done for 28 (39%) patients, in which BAL culture was positive in 75%.Rigid bronchoscopy was done when foreign body aspiration was suspected based on positive history in 70%, abnormal physical examination in 60%, and chest X-ray abnormalities in 39% of patients. Sensitivity and specificity for patient history, physical examination, and chest X-ray were 80% and 83%, 66% and 60%, and 40% and 66 %, respectively. Conclusion Bronchoscopy is an important tool for evaluating, diagnosing, and treating pediatric respiratory diseases. While it is a safe procedure, it still needs a careful selection of patients as it is invasive.

P-265 The inner cell mass (ICM) hatching levels of blastocyst before vitrification associated with clinical pregnancy rates after single embryo transfer in PGT-A cycles

Abstract Study question Is there an association between ICM hatching levels and clinical pregnancy rate after single blastocyst transfer (SET) in preimplantation genetic testing for aneuploidy (PGT-A) cycles? Summary answer A blastocyst with ICM hatching level ≤ 50% has a better clinical pregnancy rate than that in a blastocyst with ICM hatching level &amp;gt; 50%. What is known already The zona pellucida (ZP) breaching and trophectoderm (TE) herniating by laser assisted hatching before blastocyst stage is commonly used in blastocyst biopsy. The degree of hatching levels of ICM and TE is different between blastocysts before vitrification. However, completely hatched embryos may be more fragile due to the biopsy and vitrification/ warming processes and thus more susceptible to potential cellular damage prior to transfer. For the moment, no published studies have explored the entire set of information on morphological evaluation of biopsied blastocyst before vitrification including TE, ICM hatching levels, and clinical outcomes. Study design, size, duration A retrospective study including 578 PGT-A cycles with SET was conducted at Lee Women's Hospital between January 2020 and May 2022 (CS1-21156). The women age &amp;lt;20 or &amp;gt; 45 years were excluded in this study. The vitrification of expanded blastocysts on day 5 or day 6 was performed after TE biopsy. The hatching levels before vitrification were classified according the degree of TE or ICM hatching out from ZP. Participants/materials, setting, methods The groups of TE hatching levels were divided into (1) without hatching, (2) ≤25% hatching, (3) &amp;gt;25% &amp;lt;100% hatching and (4) hatching out. The groups of ICM hatching levels were divided into (1) ≤50% and (2) &amp;gt;50% hatching. The primary outcome measure was the clinical pregnancy rate. Statistical analysis was performed using the generalized estimating equations (GEE), Spearman’s correlation, Kruskal-Wallis test, Fisher's exact test and c2 test. Main results and the role of chance The average of women age was 36.8 ± 4.4 (24-45) years. The overall clinical pregnancy, miscarriage and ongoing rates after SET were 65.4% (378/578), 10.3% (39/378) and 58.5% (338/578), respectively. Spearman's correlation analysis indicated that the TE hatching levels, the ICM hatching levels and the ICM grade were associated with the clinical pregnancy rate (p &amp;lt; 0.01). According to multivariate regression analysis, the ICM hatching level ≤ 50% (OR: 1.863, 95% CI: 1.034-3.358, p = 0.038) and ICM grade A (OR: 1.662, 95% CI: 1.037-2.667, p = 0.035) were positively associated with clinical pregnancy probability. No significantly associations were found between women age, embryo day, TE hatching levels and clinical pregnancy rate (P &amp;gt; 0.05) after multivariate regression analysis. The clinical pregnancy rate in the blastocyst with ≤ 50% hatching (68.7% (328/477) ) was significantly higher than that in the blastocyst with &amp;gt; 50% hatching (49.5%, 50/101; p &amp;lt; 0.001). Furthermore, the blastocyst with grade A and ≤ 50% hatching had a highest clinical pregnancy rate (76.9% (93/121)) and the blastocyst with grade B and &amp;gt; 50% hatching had a lowest clinical pregnancy rate (46.3%, 38/82; p &amp;lt; 0.001). The abortion rates between all groups were no significantly difference. Limitations, reasons for caution A smaller sample size in the group of ICM hatching &amp;gt; 50% and further study with a larger sample size was needed to investigate putative impacts on clinical outcomes after SET. Wider implications of the findings These results demonstrate that a blastocyst with high degree of ICM herniating after biopsy and vitrification protocols decreased the clinical pregnancy probability. Selecting a biopsied blastocyst with either low ICM hatching level and grade A morphology for SET has a best pregnancy outcomes. Trial registration number not applicable

Circadian Rhythm of Voided Volume, Maximum Flow Rate, and Voiding Time Evaluated by Toilet Uroflowmetry in Hospitalized Women With Nocturia

To clarify the circadian rhythm of urination in hospitalized women with nocturia measured by toilet uroflowmetry and its age-related change. We evaluated 2602 urinations of 58 female patients (age, 68.4±15.2 years) who were hospitalized in our institution for urological disease. We assessed voided volume (VV) as averages of every hour by generalized linear mixed models with an identity link function to adjust for personal bias and age. Maximum flow rate and voiding time were analyzed by the same method after adjustment for age, personal bias, and VV. We also compared these circadian rhythms between women <70 and ≥70 years. VVs in the nighttime were significantly higher than that from 06:00-07:00 (205.6±11.7ml). Maximum flow rates in the afternoon were significantly higher than that from 06:00-07:00 (18.8±0.93ml/sec). Voiding time showed no statistically significant difference between the values at any time of day and that from 06:00-07:00. We also showed that the circadian rhythm of VV becomes less clear in the elderly women (P interaction=.0057). However, no significant difference was found in the maximum flow rate and voiding time regarding the pattern of the circadian rhythm between women <70 and ≥70 years old. The present study clearly showed a circadian rhythm of VV and maximum flow rate in hospitalized women with nocturia. In addition, the pattern of the circadian rhythm of VV was attenuated in women ≥70 years old.

P-518 The effect of inactivated SARS-CoV-2 vaccination on the outcome of the first frozen-thawed embryo transfer cycle

Abstract Study question Is there an effect of inactivated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination on the outcome of the first frozen-thawed embryo transfer(FET) cycle. Summary answer Inactivated SARS-CoV-2 vaccination did not affect the outcome of the first FET cycle, including clinical pregnancy rate, early miscarriage rate and newborns’ birth weight. What is known already SARS-CoV-2 vaccination can significantly reduce the risk of severe disease and death after SARS-CoV-2 infection. However, due to the lack of vaccine safety data, the infertile population who plan to undergo ART treatment have high concerns about the safety of vaccine vaccination. To date, there are merely few researches aimed to determine the impact of inactivated SARS-CoV-2 vaccination on reproductive and neonatal outcomes of women attempting FET. Study design, size, duration This was a retrospective cohort study of patients who underwent the first FET cycle in the Reproductive Center of Ningbo Women and Children Hospital from November 1st 2021 to December 19th 2022. All patients were followed up until January 19th 2023. Patients whose age was &amp;gt;40 years old were excluded. The patients were organized into groups based on age, anti-Müllerian hormone (AMH) levels, antral follicle count (AFC), body mass index (BMI), and vaccination or not. Participants/materials, setting, methods Patients fully vaccinated with two doses of Sinopharm or Sinovac inactivated vaccines(Group A, n = 452) were compared with unvaccinated patients(Group B, n = 452) who were matched by age, AMH, AFC and BMI. The baseline characteristics and clinical outcomes of each group were compared.SPSS version 26.0 (SPSS Inc., USA) was used for all data analyses. Main results and the role of chance There were no statistically significant differences in age, AMH, AFC, BMI, infertility duration, infertility type, infertility causes, fertilization type, ovarian stimulation protocol, number of oocytes retrieved(9.24 vs 9.92, p = 0.102), endometrial preparation protocol, endometrial thickness(9.40 vs 9.29mm, p = 0.344), embryo stage, number of embryos for transfer(1.4 vs 1.42, p = 0.589) between two groups. No difference was found between vaccinated and unvaccinated patients in clinical pregnancy rate(55.31% vs 57.52%, p = 0.502), early miscarriage rate(10.4% vs 11.54%, p = 0.681). The newborns’ birth weight were comparable between two groups(2971.44 vs 3156.83g, p = 0.66). Limitations, reasons for caution This is a single-center retrospective study and further accumulated data is warranted to validate the findings. Because of the short follow-up time, some patients are still pregnant, hence we await live birth outcomes. Wider implications of the findings These findings contribute to the evidence regarding the reproductive safety of inactivated SARS-CoV-2 vaccination for fertility-seeking women, and it can provide further theoretical reassurance for doctors and patients to vaccinate before pregnancy. Trial registration number not applicable

Assessment of Need for Improved Identification of a Culprit Drug in Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis

Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) is a severe hypersensitivity reaction. Identifying a culprit drug is critical for patient care, yet identification is based on clinical judgment. Data are limited on the accuracy in or approach to identifying a culprit drug. To evaluate patient allergy list outcomes, current approaches in identifying culprit drugs, and potential methods of improving culprit drug identification. This retrospective cohort study spanned 18 years (January 2000 to July 2018), was conducted at Brigham and Women's Hospital and Massachusetts General Hospital (Boston), and included patients with clinically and histologically confirmed cases of SJS/TEN overlap and TEN. This study descriptively analyzed potential culprits to SJS/TEN, patients' allergy lists, and currently used approaches that led to those lists. It then tested the theoretical contribution of incorporating various parameters to allergy list outcomes. Of 48 patients (29 women [60.4%]; 4 Asian [8.3%], 6 Black [12.5%], 5 Hispanic [10.4%], and 25 White [52.1%] individuals; median age, 40 years [range, 1-82 years]), the mean (SD) number of drugs taken per patient at disease onset was 6.5 (4.7). Physicians labeled 17 patients as allergic to a single culprit drug. Comparatively, 104 drugs were added to allergy lists across all patients. Physicians' approaches relied largely on heuristic identification of high-notoriety drugs and the timing of drug exposure. Use of a vetted database for drug risk improved sensitivity. Algorithm for Drug Causality for Epidermal Necrolysis scoring was discordant in 28 cases, labeling an additional 9 drugs missed by physicians and clearing 43 drugs labeled as allergens by physicians. Human leukocyte antigen testing could have potentially affected 20 cases. Consideration of infection as a culprit was limited. The results of this cohort study suggest that currently used approaches to identify culprit drugs in SJS/TEN are associated with overlabeling patients allergic to likely nonculprit drugs and less commonly missed possible culprit drugs. Incorporation of a systematized unbiased approach could potentially improve culprit drug identification, although ultimately a diagnostic test is necessary.