Characterization of therapeutic antibody efficacy against multiple SARS-CoV-2 variants in the hamster model

The emergence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and onset of the coronavirus disease-19 (COVID-19) pandemic led to an immediate need for therapeutic treatment options. Therapeutic antibodies were developed to fill a gap when traditional antivirals were not available. In late 2020, the United States Government undertook an effort to compare candidate therapeutic antibodies in virus neutralization assays and in the hamster model of SARS-CoV-2 infection. With the emergence of SARS-CoV-2 variants, the effort expanded to evaluate the efficacy of nearly 50 products against major variants. A subset of products was further evaluated for therapeutic efficacy in hamsters. Here we report results of the hamster studies, including pathogenicity with multiple variants, neutralization capacity of products, and efficacy testing of products against Delta and Omicron variants. These studies demonstrate the loss of efficacy of early products with variant emergence and support the use of the hamster model for evaluating therapeutics.

Behavioural, developmental and psychological characteristics in children with germline PTEN mutations: a carer report study

BACKGROUND

PTEN is primarily known as a tumour suppressor gene. However, research describes higher rates of difficulties including intellectual disability and difficulties relating to autism spectrum conditions (ASCs) in people with germline PTEN mutations. Other psychological characteristics/experiences are less often reported and are explored in this study.

METHODS

The parents of 20 children with PTEN mutations completed an online survey exploring adaptive behaviour, ASC-associated behaviours, anxiety, mood, hypermobility, behaviours that challenge, sensory experiences, quality of life and parental wellbeing. Published normative data and data from groups of individuals with other genetic neurodevelopmental conditions were used to contextualise findings.

RESULTS

Overall levels of adaptive behaviour were below the 'typical' range, and no marked relative differences were noted between domains. Higher levels of ASC-related difficulties, including sensory experiences, were found in comparison with 'typically developing' children, with a possible peak in restrictive/repetitive behaviour; ASC and sensory processing atypicality also strongly correlated with reported joint hypermobility. A relative preservation of social motivation was noted. Anxiety levels were found to be elevated overall (and to relate to sensory processing and joint hypermobility), with the exception of social anxiety, which was comparable with normative data. Self-injurious behaviour was common.

CONCLUSIONS

Results suggest a wide range of possible difficulties in children with PTEN mutations, including elevated anxiety. Despite elevated ASC phenomenology, social motivation may remain relatively strong. Firm conclusions are restricted by a small sample size and potential recruitment bias, and future research is required to further explore the relationships between such characteristics.

Chewing analysis of horses consuming bermudagrass hay in different styles of slow feeders as compared to loose hay

Mastication is the initial phase of digestion and is crucial to equine health due to its role in saliva production and food particle reduction. Hay nets have been promoted to slow the rate of hay consumption, with many styles of slow feeders available. Limited research has shown that nets may slow consumption, but no research has examined their effect on the horse's chewing frequency and patterns. The objective of this study was to compare chew frequency (CF, total number of chews/kg consumed) and chew duration (CD, total minutes chewed/kg consumed), as well as distribution of chews over a feeding period, of horses eating bermudagrass hay in three styles of hay nets [large mesh (LM), small mesh (SM), bottom hole (BH)] as compared to a control of loose hay (CTL). Treatments were assigned in a replicated Latin square 4 × 4 using eight horses. Horses were given a 24-hr acclimation period prior to recording their chewing patterns over a 24-hr period using an automated halter fit with a pressure-sensor noseband. Results indicate that CF was not influenced by treatment. However, SM resulted in longer CD as compared to CTL (P = 0.007). Additionally, BH resulted in a higher percentage of chews completed in the first 240 min compared to SM (P = 0.039), indicating more rapid consumption. Results of this study indicate hay nets may not influence the number of chews a horse performs while masticating hay, but small mesh feeders may increase the CD and reduce early consumption rate.

Longitudinal analyses using 18F-Fluorodeoxyglucose positron emission tomography with computed tomography as a measure of COVID-19 severity in the aged, young, and humanized ACE2 SARS-CoV-2 hamster models

This study compared disease progression of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in three different models of golden hamsters: aged (≈60 weeks old) wild-type (WT), young (6 weeks old) WT, and adult (14-22 weeks old) hamsters expressing the human-angiotensin-converting enzyme 2 (hACE2) receptor. After intranasal (IN) exposure to the SARS-CoV-2 Washington isolate (WA01/2020), 2-deoxy-2-[fluorine-18]fluoro-D-glucose positron emission tomography with computed tomography (18F-FDG PET/CT) was used to monitor disease progression in near real time and animals were euthanized at pre-determined time points to directly compare imaging findings with other disease parameters associated with coronavirus disease 2019 (COVID-19). Consistent with histopathology, 18F-FDG-PET/CT demonstrated that aged WT hamsters exposed to 105 plaque forming units (PFU) developed more severe and protracted pneumonia than young WT hamsters exposed to the same (or lower) dose or hACE2 hamsters exposed to a uniformly lethal dose of virus. Specifically, aged WT hamsters presented with a severe interstitial pneumonia through 8 d post-exposure (PE), while pulmonary regeneration was observed in young WT hamsters at that time. hACE2 hamsters exposed to 100 or 10 PFU virus presented with a minimal to mild hemorrhagic pneumonia but succumbed to SARS-CoV-2-related meningoencephalitis by 6 d PE, suggesting that this model might allow assessment of SARS-CoV-2 infection on the central nervous system (CNS). Our group is the first to use (18F-FDG) PET/CT to differentiate respiratory disease severity ranging from mild to severe in three COVID-19 hamster models. The non-invasive, serial measure of disease progression provided by PET/CT makes it a valuable tool for animal model characterization.

Evaluation of a panel of therapeutic antibody clinical candidates for efficacy against SARS-CoV-2 in Syrian hamsters

The COVID-19 pandemic spurred the rapid development of a range of therapeutic antibody treatments. As part of the US government's COVID-19 therapeutic response, a research team was assembled to support assay and animal model development to assess activity for therapeutics candidates against SARS-CoV-2. Candidate treatments included monoclonal antibodies, antibody cocktails, and products derived from blood donated by convalescent patients. Sixteen candidate antibody products were obtained directly from manufacturers and evaluated for neutralization activity against the WA-01 isolate of SARS-CoV-2. Products were further tested in the Syrian hamster model using prophylactic (-24 h) or therapeutic (+8 h) treatment approaches relative to intranasal SARS-CoV-2 exposure. In vivo assessments included daily clinical scores and body weights. Viral RNA and viable virus titers were quantified in serum and lung tissue with histopathology performed at 3d and 7d post-virus-exposure. Sham-treated, virus-exposed hamsters showed consistent clinical signs with concomitant weight loss and had detectable viral RNA and viable virus in lung tissue. Histopathologically, interstitial pneumonia with consolidation was present. Therapeutic efficacy was identified in treated hamsters by the absence or diminution of clinical scores, body weight loss, viral loads, and improved semiquantitative lung histopathology scores. This work serves as a model for the rapid, systematic in vitro and in vivo assessment of the efficacy of candidate therapeutics at various stages of clinical development. These efforts provided preclinical efficacy data for therapeutic candidates. Furthermore, these studies were invaluable for the phenotypic characterization of SARS CoV-2 disease in hamsters and of utility to the broader scientific community.

P-641 Physicians’ practices towards hormone monitoring during ovarian stimulation in context of treatment with Assisted Reproductive Technology (ART). A global Survey conducted through IVFworldwide.com

Study question

What is the practice of routine hormone monitoring (HM) during ovarian stimulation (OS) in the context of ART treatment?

Summary answer

The majority of ART specialists (∼80%) use HM, along with ultrasound, for monitoring OS, especially for the prevention of ovarian hyperstimulation syndrome (OHSS).

What is known already

Ovarian stimulation (OS) is an essential part of ART and optimal monitoring is essential in order to optimize final outcome and ensure safety. Monitoring of OS can be either done with ultrasound (US) and/or hormonal monitoring in order to adjust gonadotropin dose, to trigger ovulation and to maximize success while avoiding the risk of OHSS. Clinical practice guidelines typically propose US monitoring as the cornerstone of OS monitoring during ART treatment. Although HM is practiced widely, the current attitude and practice of clinicians regarding HM has not been evaluated on a global scale.

Study design, size, duration

In a cross-sectional study carried out using a survey on current practice of blood HM, we evaluated physicians’ attitudes towards blood HM during OS in context of ART treatment. An open-access questionnaire was accessible to the members of IVF-Worldwide.com, from September 8 to October 13,2021 on IVF-Worldwide.com and was completed by 528 participants. Data analysis was performed using Excel (Microsoft Inc., USA), statistics were calculated once giving all survey entries an equal representation.

Participants/materials, setting, methods

An initial invitation and one reminder were sent to all 3845 registered members of IVF-Worldwide.com by email. In total, 528 participants answered the survey (13.7%). The survey was composed of 25 multiple-choice questions with mainly single answers. These questions asked about tests performed during any cycle monitoring visits during OS for ART treatment (blood hormone monitoring, ultrasound, timing, and frequency of prescribed tests), about monitoring to prevent OHSS as well as to adjust gonadotropin dose.

Main results and the role of chance

A total of 528 members from 88 countries responded to this web-based survey.

Most participants (87.9%) were clinicians and practiced reproductive medicine for more than 15 years (56.7%). Nearly half (46.2%) performed more than 500 oocyte aspiration cycles in their clinic annually.

Of the 528 respondents, the vast majority (98.9%) used US to monitor OS cycles during ART treatment. Hormone monitoring (HM) was widely accepted and performed by 420 (79.5%) of participants during any of the cycle monitoring visits for OS (from stimulation day 1 until the day before ovulation triggering (OT)).

Among different visits, participants most frequently monitored hormones on the day on or before the final oocyte maturation (71%) as compared with 57% on the first visit and 61% on the second and third visit during OS. The most frequent reason for HM was for prediction of OHSS (74%) and for adjusting gonadotropin dose (50%), whereas 45% of physicians considered HM for timing of OT.

Most respondents (60.7%) considered that hormones play an important role in monitoring ovarian response during OS and a 58% considered that blood hormone tests are important to guiding decision-making in preventing OHSS.

Limitations, reasons for caution

The survey was designed to represent self-reported statistics and opinions from experts in the field. It did not capture actual clinician performance or patient data.

Wider implications of the findings

Although several guidelines consider US monitoring as the cornerstone for monitoring ovarian response during OS for ART, the majority of ART specialists consider HM as essential. Good quality studies are needed to document the value of HM during OS, with respect to dose adjustment, ovulation triggering and prevention of OHSS.

Trial registration number

not applicable

O-072 Markers of cardiometabolic health of adolescents conceived through assisted reproductive technologies (ART) appear reassuring

Study question

Is the cardiometabolic health of adolescents conceived through ART worse than that of their spontaneously-conceived counterparts?

Summary answer

The majority of cardiometabolic and vascular health parameters of ART-conceived adolescents are more favourable than those of their spontaneously-conceived counterparts of similar age.

What is known already

It has been proposed that ART induces epigenetic alterations during embryonic development which could lead to cardiometabolic disease later in life. However, individuals requiring ART may themselves be metabolically less healthy than the general population, which could lead to a genetically increased risk of cardiometabolic disorders in the offspring, rather than the ART procedure. The literature pertaining to cardiometabolic health of ART-conceived offspring is contradictory, but generally suggests unfavourable cardiometabolic health parameters. With over 8 million children and adults born through ART worldwide, it is imperative to investigate whether early signs of adverse cardiometabolic differences persist into adolescence and beyond.

Study design, size, duration

The Growing Up Healthy Study (GUHS) is a prospective study that recruited 303 ART-conceived adolescents, born 1991-2001 in Western Australia. Their health parameters, including cardiometabolic factors, were assessed and compared with spontaneously conceived counterparts of similar socioeconomic background and age from the Raine Study Generation 2 (Gen2). The 2868 Gen2 participants were born 1989-1992 and are representative of the Western Australian adolescent population. At age 16-17 (2013-2017), GUHS participants replicated assessments previously completed by Gen2.

Participants/materials, setting, methods

Cardiometabolic parameters were compared between 165 GUHS (male = 50.9%) and 1690 Gen2 (male = 49.8%) adolescents. Assessments consisted of a detailed questionnaire; health and demographic parameters, anthropometric assessments; height, weight, body-mass index (BMI), waist circumference and skinfold thickness, fasting serum biochemistry, arterial stiffness and blood pressure assessment using applanation tonometry, assessment of non-alcoholic fatty liver (NAFLD) and thickness of abdominal fat compartments using ultrasonography. Chi2, Fisher’s Exact and Mann-Whitney U tests, performed in SPSS V25, examined cohort differences.

Main results and the role of chance

GUHS adolescents appeared to be healthier from a cardiometabolic perspective than their Gen2 counterparts. They were leaner, with lower BMI (median: 21.23 vs. 22.06, P = 0.004), lower waist circumference (median: 74.10 vs. 76.75 cm, P = 0.031), and thinner skinfolds (triceps median: 12.1 vs. 14.0 mm, P = 0.019, subscapular median: 10.6 vs. 11.9 mm, P < .001, mid-abdominal median: 16.0 vs. 19.9 mm, P < 0.001, supraspinal median: 10.7 vs. 13.5 mm, P < 0.001). No significant differences were detected in the following serum fasting parameters: glucose, insulin, HOMA-IR, LDL cholesterol, total cholesterol, cholesterol/HDL-ratio, triglycerides, CRP and ALT. HDL cholesterol levels were more favourable in GUHS (P < 0.001). NAFLD was present in 10.9% of GUHS vs. 15.2% of Gen2 adolescents (P = 0.174), with no difference in steatosis severity score (P = 0.309). ART offspring had less subcutaneous adipose tissue (median: 8.0 vs. 14.0 mm, P < .001), more visceral adipose tissue (median: 40.0 vs. 32.0 mm, P < 0.001), with no difference in pre-peritoneal adipose tissue (P = 0.087). Measures of arterial stiffness were lower in GUHS. Pulse wave velocity: median 6.1 vs. 6.4 m/s, P < 0.001 and heart rate corrected augmentation index: median -10.25 vs. -8.00, P = 0.006. No significant differences in blood pressure or heart rate were detected. Stratification by sex did not greatly alter the results.

Limitations, reasons for caution

Despite the substantial study size and the unique study design, we were unable to differentiate between different types of ART (e.g. IVF vs. ICSI), draw definite conclusions or relate outcomes to cause of infertility. Given the observational character of this study, causation cannot be proven.

Wider implications of the findings

In this study we did not detect any adverse effect of ART on cardiometabolic health at adolescence, in contrast to some studies. Given the lack of consensus, future well-designed and appropriately-powered studies are necessary to investigate cardiometabolic health in ART adults.

Trial registration number

not applicable

O-053 Early life factors that may influence adult male reproductive

This presentation will provide a brief overview of testicular development and will describe a critical period of development at approximately 8-14 weeks of gestation, when the testicle may be vulnerable to external influences, potentially having a negative effect on subsequent development. The talk with then describe the testicular dysgenesis syndrome hypothesis, proposed by Niels Skakkebæk, and using the presenters work within the Western Australian (Raine) Cohort will go onto demonstrate how early life exposures may influence mature testicular function. Worryingly, the presentation will describe how adolescent features of early metabolic disturbance within the Raine Cohort are already having a determinantal effect on the reproductive function of these men in late adolescence, many years before the majority are seeking paternity. 

P–593 Self-monitoring of hormones via a urine-based hormonal assay — a topical endeavour into telemedicine in medically-assisted reproduction (MAR)

Study question

How can cycle monitoring using a urine-based hormonal assay device improve current clinical practice in medically assisted reproduction (MAR)?

Summary answer

A urine-based hormonal assay has the potential to overcome the inconvenience of blood tests and reduce the frequency of appointments, waiting times and patient burden.

What is known already

Cycle monitoring via ultrasound and serum-based hormonal assays during MAR can provide information on the ovarian response and assist in optimising treatment strategies and reducing complications, such as ovarian hyperstimulation syndrome (OHSS). However, blood tests may cause inconvenience to patients due to repeated venepuncture and the need for frequent clinic appointments. Urine-based assays have been historically used by fertility specialists in clinics, but since got replaced by more practical and automated serum-based assays. Novel technology utilising rapid chromatographic immunoassay to test urinary reproductive hormones in a home setting could provide an alternative to current serum-based testing at clinics.

Study design, size, duration

A questionnaire was disseminated among 24 fertility specialists (2019–2020) on the use of ultrasound and serum-based hormone monitoring in clinical practice. In addition, the literature on the reliability of urine-based hormonal assays compared to serum-based hormonal assays during MAR was reviewed in order to examine if urine-based hormonal monitoring could be re-introduced in clinical practice using novel state-of-the-art technology.

Participants/materials, setting, methods

All 24 surveyed fertility specialists responded, representing 10 countries from across Europe, Asia and Latin America. Questions assessed the frequency and role of hormonal monitoring, the hormones tested and the drawbacks of blood tests. The PubMed search engine was used to search the Medline database for publications between 1960–2020 with (MeSH-) search terms related to cycle monitoring (e.g. fertility monitoring, controlled ovarian stimulation, ovulation confirmation) and hormonal assays (e.g. estrone–3-glucuronide or E1–3G).

Main results and the role of chance

The survey confirmed that many fertility practitioners (n = 22/24) routinely conducted hormone monitoring during MAR, primarily for guiding dose adjustments (n = 20/24) and indicating risk of OHSS (n = 20/24). The reported drawbacks of blood tests included validity of results from different service providers, long waiting times and discomfort to patients due to travelling to clinics for tests and repeated venepunctures. The hormones routinely checked were E2 (n = 22/22), P4 (n = 18/22) and LH (n = 15/22). The literature review revealed a relatively high correlation (correlation coefficients 0.85–0.95) between serum E2 and urinary E1–3G in gonadotrophin stimulated cycles (Lessing 1987, Catalan 1989, Rapi 1992 and Alper 1994). No studies assessed the correlation between serum P4 and urinary PdG or between serum LH and urinary LH in stimulated cycles. In natural cycles, the correlation coefficients between serum P4 and urinary PdG seemed to be slightly higher than those between serum E2 and urinary E1–3G (0.73–0.94 vs. 0.54–0.88) (Denari 1981, Munro 1991, Roos 2015, Stanczyk 1980). One study reported a moderate correlation coefficient (0.72) between serum and urinary LH in natural cycles (Roos 2015).

Limitations, reasons for caution

There is risk of selection-bias for fertility specialists included in survey, however, the 100% response rate is reassuring. The correlation coefficients between serum- and urine-based hormonal assay and the cost-effectiveness and time-efficiency of urinary assay should be confirmed in further clinical studies using a novel state-of-the-art remote urinary monitoring device.

Wider implications of the findings: Remote hormonal monitoring can be part of a novel digital health solution that includes remote ultrasound and tele-counselling to link clinics and patients at home. Especially during the unprecedented times of the COVID–19 pandemic, the prospect of remote monitoring system has the potential to improve patient experience during fertility treatment.

Trial registration number

Not applicable

Prenatal exposure to maternal stressful life events and earlier age at menarche: the Raine Study

STUDY QUESTION

Is there an association between prenatal exposure to stressful life events and age at menarche, and does childhood BMI mediate this association?

SUMMARY ANSWER

Girls exposed to prenatal stress had a slightly earlier age at menarche, but this association did not show a dose-response effect and was not mediated by childhood offspring BMI.

WHAT IS ALREADY KNOWN

Prenatal stress may impact on reproductive function in females including age at menarche, but human data are very limited. High childhood BMI is known to be associated with earlier age at menarche. Only one small study has measured the association between maternal stress and age at menarche and reported that childhood BMI mediated the association between maternal stress and earlier age at menarche. However, neither maternal stress nor age at menarche was prospectively recorded and the study was limited to 31 mother-daughter pairs.

STUDY DESIGN, SIZE, DURATION

The Raine Study is a large prospective population-based pregnancy cohort study (n = 1414 mother-daughter pairs) continuously followed from prenatal life through to adolescence. In the present study, we examined the association between exposure to maternal stressful life events during early, late and total gestation and age at menarche in offspring using 753 mother-daughter pairs with complete case information.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Mothers prospectively reported stressful life events during pregnancy at 18 and 34 weeks using a standardized 10-point questionnaire. Exact date of menarche was assessed using a purpose-designed questionnaire at 8, 10, 14 and 17 years of age. Complete information on exposure, outcome and confounding variables was obtained from 753 mothers-daughter pairs. Multivariate linear regression complete case analysis was used to examine associations between maternal stressful life event exposure and age at menarche. Potential selection bias was evaluated using multiple imputations (50 datasets). The mediating effects of offspring childhood BMI (ages 5, 8, or 10 years) on these associations were measured in separate sub-analyses.

MAIN RESULTS AND ROLE OF CHANCE

Most (580/753, 77%) daughters were exposed to at least one prenatal stressful life event. Exposure to maternal stressful life events during the entire pregnancy was associated with a non-linear earlier age at menarche. Exposure to one event and two or more psychological stressful events was associated with a 3.5 and 1.7-month earlier onset of puberty, respectively when compared to the reference group with no exposure maternal stressful life events. The estimates from multiple imputation with 50 datasets were comparable with complete case analysis confirming the existence of an underlying effect. No separate significant effects were observed for exposure during early or late gestation. The association between prenatal stressful events and age at menarche was not mediated by childhood BMI in the offspring.

LIMITATIONS, REASONS FOR CAUTION

Stressful life events may have affected pregnant women in different ways and self-perceived maternal stress severity may have provided a more precise estimate of gestational psychological stress. The observed non-linear U-shape of the association between maternal psychological stress and age at menarche did not reflect a dose-response. This suggests that the first exposure to prenatal stress exerts a greater effect on fetal reproductive development. A potential mechanism is via dramatic initial activation of the hypothalamic-pituitary-adrenal (HPA) axis following the first stressful life event which is greater than that observed following subsequent exposure to two or more maternal stressful life events. Whilst we adjusted for a priori chosen confounders, we cannot exclude residual confounding or confounding by factors we did not include. Maternal age at menarche was not available so the effects of familial history/genetics could not be assessed. There was a large loss due to the number of girls with no information on date of menarche and missing confounder information implying risk of selection bias and multiple imputation analyses did not fully exclude this risk (similar direction but slightly weaker estimate magnitude).

WIDER IMPLICATIONS OF THE FINDINGS

Menarche is a sentinel reproductive event and earlier age at menarche carries implications for psychological, social and reproductive health and for long-term risk of common non-communicable diseases. Understanding the factors regulating age at menarche has extensive health implications. This is the first population-based cohort study in humans to demonstrate that prenatal psychological stress might directly modify age at menarche.

STUDY FUNDING/COMPETING INTEREST(S)

Dr. Bräuner and Trine Koch's salaries were supported by Doctor Sofus Carl Emil Friis and spouse Olga Doris Friis foundation, The Danish Cancer Society (Kræftens Bekæmpelse, RP15468, R204-A12636, Denmark) and The Danish Health Foundation (Helsefonden, F-22181-23, Denmark). Martha Hickey was funded by NHMRC Practitioner Fellowships. The funding bodies played no role in the design, collection, analysis, or interpretation of data; in the writing of the manuscript; or in the decision to submit the manuscript for publication. Dr. Hart has received personal fees in his function as the Medical Director of Fertility Specialists of Western Australia and received educational sponsorship grants from MSD, Merck-Serono and from Ferring Pharmaceuticals. Dr Hart has also received personal fees from Shareholders in Western IVF outside the submitted work.

TRIAL REGISTRATION NUMBER

NA.

Specimen oriented intraoperative margin assessment in oral cavity and oropharyngeal squamous cell carcinoma

OBJECTIVE

Evaluate the oncologic outcomes and cost analysis of transitioning to a specimen oriented intraoperative margin assessment protocol from a tumour bed sampling protocol in oral cavity (OCSCC) and oropharyngeal squamous cell carcinoma (OPSCC).

STUDY DESIGN

Retrospective case series and subsequent prospective cohort study SETTING: Tertiary care academic teaching hospital SUBJECTS AND METHODS: Retrospective case series of all institutional T1-T2 OCSCC or OPSCC treated with primary surgery between January 1st 2009 - December 31st 2014. Kaplan-Meier survival estimates with log rank tests were used to compare patients based on final margin status. Cost analysis was performed for escalation of therapy due to positive final margins. Following introduction of a specimen derived margin protocol, successive prospective cohort study of T1-T4 OCSCC or OPSCC treated with primary surgery from January 1st 2017 - December 31st 2018. Analysis and comparison of both protocols included review of intraoperative margins, final pathology and treatment cost.

RESULTS

Analysis of our intra-operative tumour bed frozen section protocol revealed 15 of 116 (12.9%) patients had positive final pathology margins, resulting in post-operative escalation of therapy for 14/15 patients in the form of re-resection (7/14), radiation therapy (6/14) and chemoradiotherapy (1/14). One other patient with positive final margins received escalated therapy for additional negative prognostic factors. Recurrence free survival at 3 years was 88.4 and 50.7% for negative and positive final margins respectively (p = 0.048). Implementation of a specimen oriented frozen section protocol resulted in 1 of 111 patients (0.9%) having positive final pathology margins, a statistically significant decrease (p < 0.001). Utilizing our specimen oriented protocol, there was an absolute risk reduction for having a final positive margin of 12.0% and relative risk reduction of 93.0%. Estimated cost avoidance applying the specimen oriented protocol to our previous cohort was $412,052.812017 CAD.

CONCLUSION

Implementation of a specimen oriented intraoperative margin protocol provides a statistically significant decrease in final positive margins. This change in protocol leads to decreased patient morbidity by avoiding therapy escalation attributable only to positive margins, and avoids the economic costs of these treatments.

In utero exposure to maternal stressful life events and risk of polycystic ovary syndrome in the offspring: The Raine Study

BACKGROUND

PCOS is the most common endocrine disorder in reproductive age women. The origins of PCOS are unknown but experimental and limited human evidence suggests that greater prenatal exposure to androgens may predispose to PCOS. Experimental evidence suggests that maternal stressors may affect reproductive function in the offspring via changes in prenatal androgen exposure. In this present study, we aim to investigate whether maternal stressful life events during pregnancy are associated with polycystic ovary morphology (PCOM) or polycystic ovary syndrome (PCOS) in adolescent offspring.

METHOD

In a large population-based pregnancy cohort study (The Raine Study) continuously followed from prenatal life through to adolescence we examined the association between maternal stressful life events during pregnancy in both early and late gestation, and subsequent circulating concentrations of ovarian and adrenal androgens, PCOM and PCOS in the normal menstrual cycle of offspring age 14-16 years. Maternal stressful life events were prospectively recorded during pregnancy at 18 and 34 weeks using a 10-point questionnaire. Female offspring (n = 223) completed a questionnaire about their menstrual cycles, underwent a clinical examination for hirsutism (Ferriman-Gallwey score) and transabdominal pelvic ultrasound examination to determine ovarian morphology according to standardized criteria for classification of PCOM. Plasma samples were obtained at day 2-6 of the normal menstrual cycle for measurement of androgens. PCOM was defined according to the international consensus definition, 2003 and the evidence-based guideline for the assessment and management of PCOS, 2018. PCOS was diagnosed according to Rotterdam criteria and National Institute of Health (NIH) criteria. Multivariate linear and logistic regression analyses were used to examine the associations between maternal stressful life event exposure and ovarian morphology (PCOM), circulating ovarian and adrenal androgens (clinical and biochemical hyperandrogenism (hirsutism)) and presence of PCOS.

RESULTS

Of 223 recruited adolescent girls, 78 (35.9%) and 68 (31.3%) had PCOM by the 2003 and 2018 criteria respectively, while 66 (29.6%) and 37 (16.6%) had PCOS, using Rotterdam and NIH criteria, respectively. Most girls (141/223, 63.2%) were exposed to at least one stressful life event in early gestation and around half (121/223, 54.3%) were exposed to at least one stressful life event in late gestation. Maternal stressful life events in early gestation were associated with a statistically significant lower prevalence of PCOM when applying the 2003 criteria [adjusted odds ratio [aOR] and 95% confidence intervals (CI): 0.74 (95% CI: 0.55; 0.99)], and a similar association was detected when applying the 2018 PCOM criteria (aOR, 0.69, 95% CI: 0.50; 0.95)]. Maternal stressful life events in early gestation were also associated with lower circulating concentrations of testosterone (β = -0.05, 95% CI: -0.09; -0.004) and androstenedione (β = -0.05, 95% CI: -0.10; -0.002) in the offspring. No similar effects for PCOM or circulating androgens were detected in late gestation. No statistically significant associations between maternal stressful life events in early or late gestation with PCOS (neither Rotterdam nor NIH criteria) in adolescence were detected. The prospective collection of maternal stressful life events during both early and late gestation and direct measurement of PCOM, PCOS and circulating androgens in adolescence and key co-variates implies minimal possibility of recall, information bias and selection bias.

CONCLUSION

Maternal exposure to stressful life events in early gestation is associated with significantly reduced circulating ovarian and adrenal androgen concentrations in adolescence (testosterone and androstenedione), and an indication of fewer cases of polycystic ovary morphology (PCOM) defined by the 2003 international consensus definition and by the 2018 international evidence-based guideline, but has no effect on polycystic ovary syndrome (PCOS), diagnosed using either Rotterdam or NIH criteria.

The association between in utero exposure to maternal psychological stress and female reproductive function in adolescence: A prospective cohort study

Background

Method

Results

Conclusion

•

Animal studies suggest reproductive function is influenced by maternal stress.

•

Human evidence is sparse and inconsistent.

•

We used a population-based pregnancy cohort of 228 mother female offspring.

•

Exposure to maternal psychological stress in late gestation affects uterine volume and ovarian AFC.

[Rotational Stability of the Knee Joint 2 Years after the Anterolateral Ligament and ACL Reconstruction: Biomechanical Study]

PURPOSE OF THE STUDY Knee injuries accompanied by anterior cruciate ligament (ACL) tears can also result in rotational instability of the joint. Subsequent insufficient rotational stability after the ACL reconstruction can be a direct consequence also of injuries to lateral knee structures, specifically the anterolateral ligament (ALL). This residual postoperative rotational instability may be prevented by multiple surgical techniques. The purpose of this study was (1) to evaluate the knee stability in internal rotation after the "anatomical" single-bundle (SB) anterior cruciate ligament reconstruction together with ALL reconstruction compared to the double-bundle (DB) ACL reconstruction two years after surgery; (2) to compare the knee joint stability after the ACL and ALL reconstruction with the healthy contralateral knee joint. MATERIAL AND METHODS All the measurements were conducted by the computer navigation system. The study included 20 patients after the single-bundle ACL and ALL reconstruction and 20 patients after the double-bundle ACL reconstruction. The follow-up examination was carried out at 25 months after surgery on average (24 months at least). All measurements were performed in both the healthy and operated knee. Once the data necessary for navigation were determined, the patient remained in standing position with both feet firmly placed on the mat with intermalleolar distance of 20 cm. Then, at 30-degree flexion of the knee joints, the patient first performed the joint internal rotation by trunk torsion, followed by external rotation. Each measurement was repeated 3 times. A non-parametric t-test was used for statistical processing. RESULTS The mean internal rotation in the injured knee joint was 19.1 degrees preoperatively and 8.1 degrees postoperatively, while in the healthy knee it was 8.4 degrees. External rotation was not assessed. The reported internal rotation in the knees after DB ACL reconstruction was 9.2 degrees (p ≥ 0.05). DISCUSSION The double-bundle ACL reconstruction is a complex technique that can lead to many intraoperative and postoperative complications. Grafts harvested from both hamstrings can have an effect on the rotational stability of the joint. In order to restore the knee rotational stability with fewer potential complications, the method of choice can be the ACL reconstruction using the quadriceps femoris muscle graft and the ALL reconstruction using the gracilis muscle graft, leaving the semitendinosus tendon intact. CONCLUSIONS The obtained values reveal that the single-bundle ACL reconstruction in combination with ALL reconstruction results in the same internal rotational stability in the knee joint as the double-bundle ACL reconstruction. Similar joint rotational stability is observed in all the knee joints reconstructed with the use of these techniques and in the contralateral healthy knee joint. Key words: anterolateral ligament, anterior cruciate ligament, internal rotational stability, objective measurement.

Constraints on the K_{S}^{0}→μ^{+}μ^{-} Branching Fraction

A search for the decay K_{S}^{0}→μ^{+}μ^{-} is performed using proton-proton collision data, corresponding to an integrated luminosity of 5.6  fb^{-1} and collected with the LHCb experiment during 2016, 2017, and 2018 at a center-of-mass energy of 13 TeV. The observed signal yield is consistent with zero, yielding an upper limit of B(K_{S}^{0}→μ^{+}μ^{-})<2.2×10^{-10} at 90% C.L.. The limit reduces to B(K_{S}^{0}→μ^{+}μ^{-})<2.1×10^{-10} at 90% C.L. once combined with the result from data taken in 2011 and 2012.

Observation of Enhanced Double Parton Scattering in Proton-Lead Collisions at sqrt[s_{NN}]=8.16 TeV

A study of prompt charm-hadron pair production in proton-lead collisions at sqrt[s_{NN}]=8.16  TeV is performed using data corresponding to an integrated luminosity of about 30  nb^{-1}, collected with the LHCb experiment. Production cross sections for different pairs of charm hadrons are measured and kinematic correlations between the two charm hadrons are investigated. This is the first measurement of associated production of two charm hadrons in proton-lead collisions. The results confirm the predicted enhancement of double parton scattering production in proton-lead collisions compared to the single parton scattering production.

Clinical summary guide: reproduction in women with previous abdominopelvic radiotherapy or total body irradiation

STUDY QUESTION

What is the evidence to guide the management of women who wish to conceive following abdominopelvic radiotherapy (AP RT) or total body irradiation (TBI)?

SUMMARY ANSWER

Pregnancy is possible, even following higher doses of post-pubertal uterine radiation exposure; however, it is associated with adverse reproductive sequelae and pregnancies must be managed in a high-risk obstetric unit.

WHAT IS KNOWN ALREADY

In addition to primary ovarian insufficiency, female survivors who are treated with AP RT and TBI are at risk of damage to the uterus. This may impact on its function and manifest as adverse reproductive sequelae.

STUDY DESIGN SIZE DURATION

A review of the literature was carried out and a multidisciplinary working group provided expert opinion regarding assessment of the uterus and obstetric management.

PARTICIPANTS/MATERIALS SETTING METHODS

Reproductive outcomes for postpubertal women with uterine radiation exposure in the form of AP RT or TBI were reviewed. This included Pubmed listed peer-reviewed publications from 1990 to 2019, and limited to English language..

MAIN RESULTS AND THE ROLE OF CHANCE

The prepubertal uterus is much more vulnerable to the effects of radiation than after puberty. Almost all available information about the impact of radiation on the uterus comes from studies of radiation exposure during childhood or adolescence.An uncomplicated pregnancy is possible, even with doses as high as 54 Gy. Therefore, tumour treatment doses alone cannot at present be used to accurately predict uterine damage.

LIMITATIONS REASONS FOR CAUTION

Much of the data cannot be readily extrapolated to adult women who have had uterine radiation and the publications concerning adult women treated with AP RT are largely limited to case reports.

WIDER IMPLICATIONS OF THE FINDINGS

This analysis offers clinical guidance and assists with patient counselling. It is important to include patients who have undergone AP RT or TBI in prospective studies to provide further evidence regarding uterine function, pregnancy outcomes and correlation of imaging with clinical outcomes.

STUDY FUNDING/COMPETING INTERESTS

This study received no funding and there are no conflicts of interest.

TRIAL REGISTRATION NUMBER

N/A.

The association between in-utero exposure to stressful life events during pregnancy and male reproductive function in a cohort of 20-year-old offspring: The Raine Study

STUDY QUESTION

Is exposure to gestational stress in the critical time window for the normal differentiation and growth of male reproductive tissue associated with male reproductive function in offspring in later life?

SUMMARY ANSWER

Exposure to stressful life events (SLEs) in early, but not late gestation, are associated with reduced adult male reproductive function, consistent with the hypothesis that events during early prenatal life programme adult male reproductive function.

WHAT IS ALREADY KNOWN

Animal studies suggest that gestational stress may impact on the reproductive function of male offspring, but human evidence is sparse.

STUDY DESIGN, SIZE, DURATION

Using a prospective longitudinal cohort, we examined the association between number and type of maternal stressors during pregnancy in both early and late gestation and reproductive function in 643 male Generation 2 (offspring) at age 20 years. Mothers and their male Generation 2 (offspring) from The Raine Study participated. Mothers prospectively reported SLEs during pregnancy recorded at gestational weeks 18 and 34 using a standardized 10-point questionnaire.

PARTICIPANTS/MATERIALS, SETTING, METHODS

The 643 male Generation 2 (offspring) underwent testicular ultrasound examination and semen analysis and provided serum for reproductive hormone analysis. Multivariate linear regression analysis was used to examine associations.

MAIN RESULTS AND ROLE OF CHANCE

Of 643 recruited males, 407 (63%) were exposed to at least one SLE in early gestation. Fewer SLEs were reported in late gestation (n = 343, 53%). Maternal SLE exposure in early gestation was negatively associated with total sperm count (β = -0.31, 95% CI -0.58; -0.03), number of progressive motile sperm (β = -0.15, 95% CI -0.31; 0.00) and morning serum testosterone concentration (β = -0.04, 95% CI -0.09; -0.00). No similar effects of maternal SLE exposure in late pregnancy were detected. The large sample size and an objective detailed direct assessment of adult male reproductive function with strict external quality control for sperm quality, as well as detailed prospectively collected information on prenatal SLEs in two distinct time windows of pregnancy reported by the women in early and late gestation along with other risk factors, imply minimal possibility of recall, information bias and selection bias. When assessing our results, we adjusted for a priori chosen confounders, but residual confounding or confounding by factors unbeknown to us cannot be ruled out.

LIMITATIONS, REASONS FOR CAUTION

It is not possible to measure how SLEs impacted differently on the mother's experience or perception of stress. Resilience (coping) gradients may alter cortisol levels and thus modify the associations we observed and the mothers' own perception of stress severity may have provided a more precise estimate of her exposure.

WIDER IMPLICATIONS OF THE FINDINGS

Our findings suggest that exposure to SLEs in early, but not late gestation, are associated with reduced adult male reproductive function. Improved support for women with exposure to SLEs during pregnancy, particularly during the first trimester, may improve the reproductive health of their male offspring in later life. Intervention studies of improved pregnancy support could provide more insight into this association and more information is needed about the potential specific epigenetic mechanisms underlying this association.

STUDY FUNDING/COMPETING INTEREST(S)

The male fertility sub-study was funded by NHMRC Grant 634 457. The core management of the Raine Study is funded by University of Western Australia, Curtin University, Telethon Kids Institute, Women and Infants Research Foundation, Edith Cowan University, Murdoch University, The University of Notre Dame Australia and Raine Medical Research foundation. Dr Bräuner's salary was supported by Læge Sofus Carl Emil Friis og Hustru Olga Doris Friis foundation in Denmark. All authors declare no competing interests.

TRIAL REGISTRATION NUMBER

N/A.

Measurement of CP-Averaged Observables in the B^{0}→K^{*0}μ^{+}μ^{-} Decay

An angular analysis of the B^{0}→K^{*0}(→K^{+}π^{-})μ^{+}μ^{-} decay is presented using a dataset corresponding to an integrated luminosity of 4.7  fb^{-1} of pp collision data collected with the LHCb experiment. The full set of CP-averaged observables are determined in bins of the invariant mass squared of the dimuon system. Contamination from decays with the K^{+}π^{-} system in an S-wave configuration is taken into account. The tension seen between the previous LHCb results and the standard model predictions persists with the new data. The precise value of the significance of this tension depends on the choice of theory nuisance parameters.

Observation of New Ξ_{c}^{0} Baryons Decaying to Λ_{c}^{+}K^{-}

The Λ_{c}^{+}K^{-} mass spectrum is studied with a data sample of pp collisions at a center-of-mass energy of 13 TeV corresponding to an integrated luminosity of 5.6  fb^{-1} collected by the LHCb experiment. Three Ξ_{c}^{0} states are observed with a large significance and their masses and natural widths are measured to be m[Ξ_{c}(2923)^{0}]=2923.04±0.25±0.20±0.14  MeV, Γ[Ξ_{c}(2923)^{0}]=7.1±0.8±1.8  MeV, m[Ξ_{c}(2939)^{0}]=2938.55±0.21±0.17±0.14  MeV, Γ[Ξ_{c}(2939)^{0}]=10.2±0.8±1.1  MeV, m[Ξ_{c}(2965)^{0}]=2964.88±0.26±0.14±0.14  MeV, Γ[Ξ_{c}(2965)^{0}]=14.1±0.9±1.3  MeV, where the uncertainties are statistical, systematic, and due to the limited knowledge of the Λ_{c}^{+} mass. The Ξ_{c}(2923)^{0} and Ξ_{c}(2939)^{0} baryons are new states. The Ξ_{c}(2965)^{0} state is in the vicinity of the known Ξ_{c}(2970)^{0} baryon; however, their masses and natural widths differ significantly.

Search for the Rare Decays B_{s}^{0}→e^{+}e^{-} and B^{0}→e^{+}e^{-}

A search for the decays B_{s}^{0}→e^{+}e^{-} and B^{0}→e^{+}e^{-} is performed using data collected with the LHCb experiment in proton-proton collisions at center-of-mass energies of 7, 8, and 13 TeV, corresponding to integrated luminosities of 1, 2, and 2  fb^{-1}, respectively. No signal is observed. Assuming no contribution from B^{0}→e^{+}e^{-} decays, an upper limit on the branching fraction B(B_{s}^{0}→e^{+}e^{-})<9.4(11.2)×10^{-9} is obtained at 90(95)% confidence level. If no B_{s}^{0}→e^{+}e^{-} contribution is assumed, a limit of B(B^{0}→e^{+}e^{-})<2.5(3.0)×10^{-9} is determined at 90(95)% confidence level. These upper limits are more than one order of magnitude lower than the previous values.

A Lassa Virus Live-Attenuated Vaccine Candidate Based on Rearrangement of the Intergenic Region

Lassa virus (LASV) poses a significant public health problem within the regions of Lassa fever endemicity in Western Africa. LASV infects several hundred thousand individuals yearly, and a considerable number of Lassa fever cases are associated with high morbidity and lethality. No approved LASV vaccine is available, and current therapy is limited to an off-label usage of ribavirin that is only partially effective and associated with significant side effects. The impact of Lassa fever on human health, together with the limited existing countermeasures, highlights the importance of developing effective vaccines against LASV. Here, we present the development and characterization of a recombinant LASV (rLASV) vaccine candidate [rLASV(IGR/S-S)], which is based on the presence of the noncoding intergenic region (IGR) of the small (S) genome segment (S-IGR) in both large (L) and S LASV segments. In cultured cells, rLASV(IGR/S-S) was modestly less fit than wild-type rLASV (rLASV-WT). rLASV(IGR/S-S) was highly attenuated in guinea pigs, and a single subcutaneous low dose of the virus completely protected against otherwise lethal infection with LASV-WT. Moreover, rLASV(IGR/S-S) was genetically stable during serial passages in cultured cells. These findings indicate that rLASV(IGR/S-S) can be developed into a LASV live-attenuated vaccine (LAV) that has the same antigenic composition as LASV-WT and a well-defined mechanism of attenuation that overcomes concerns about increased virulence that could be caused by genetic changes in the LAV during multiple rounds of multiplication.IMPORTANCE Lassa virus (LASV), the causative agent of Lassa fever, infects several hundred thousand people in Western Africa, resulting in many lethal Lassa fever cases. No U.S. Food and Drug Administration-licensed countermeasures are available to prevent or treat LASV infection. We describe the generation of a novel LASV live-attenuated vaccine candidate rLASV(IGR/S-S), which is based on the replacement of the large genomic segment noncoding intergenic region (IGR) with that of the small genome segment. rLASV(IGR/S-S) is less fit in cell culture than wild-type virus and does not cause clinical signs in inoculated guinea pigs. Importantly, rLASV(IGR/S-S) protects immunized guinea pigs against an otherwise lethal exposure to LASV.