The relationship between clinicopathological variables, systemic inflammation, and CT-derived body composition with survival in patients with advanced non-small cell lung cancer receiving nivolumab as a second-line treatment

BACKGROUND

Second-line immunotherapy is currently recognized to help only a subset of patients with advanced forms of non-small cell lung cancer (NSCLC). The current study analyzes the connection between prior treatment host/tumor characteristics and survival in advanced NSCLC patients receiving nivolumab as a second-line therapy.

METHODS

A retrospective cohort analysis was carried out on individuals with advanced NSCLC receiving second-line Nivolumab with palliative intent between February 2016 and May 2019 across three health boards in NHS Greater Glasgow and Clyde, Lanarkshire, Ayrshire, and Arran in Scotland to examine the association between systemic inflammation, body composition, and survival were determined using computed tomography (CT).

RESULTS

The current study investigates the connection between prior treatment host/tumor characteristics and survival in advanced NSCLC patients receiving nivolumab as a second-line therapy. The majority were 65 years of age or older (51%), female (53%), had adenocarcinoma (53%), and had good performance status (ECOG 0/1) (86%). Most patients had high SFI (70%) or VFA (54%). The median overall survival after starting Nivolumab was 15 months. ECOG-PS and hypoalbuminemia were significant predictors of 12-month survival in patients with advanced NSCLC following Nivolumab treatment, according to Cox regression (p-value = 0.047 and 0.014, respectively).

CONCLUSION

In patients with advanced NSCLC receiving Nivolumab as a second-line therapy, ECOG-PS and hypoalbuminemia were strongly associated with survival. Systemic inflammation and hypoalbuminemia measurements may enhance the ECOG-PS stratification of expected outcomes.

Factors associated with embryo mosaicism: a systematic review and meta-analysis

PURPOSE

Evaluate which factors are involved in the increased rate of mosaicism in embryos.

METHODS

A systematic review and meta-analysis was performed. After an exhaustive search of the literature, a total of seven papers were included in the analysis. In addition, data collected from IVF cycles performed in our fertility clinic were also analysed. Day of biopsy, embryo quality, maternal and paternal age and seminal quality were the chosen factors to be studied.

RESULTS

The results of the meta-analysis show that neither embryo quality nor seminal quality were related to mosaic embryo rate (OR: 1.09; 95% CI: 0.94-1.28 and OR: 1.10; 95% CI: 0.87-1.37, respectively). A positive association was observed for the variable "biopsy day" with embryos biopsied at day 6 or 7 having the highest rate of mosaicism (OR: 1.06; 95% CI: 1.01-1.11). In opposite to what happens with aneuploidy rate, which increases with maternal age, embryo mosaicism is higher in younger women (<34 years) rather than in older ones (≥34 years) (OR: 0.95; 95% CI: 0.92-0.98). However, for the "paternal age" factor, no association with mosaicism was found (OR: 1.04; 95% CI: 0.90-1.21).

CONCLUSIONS

With the present study, we can conclude that the factors related to the presence of mosaicism in embryos are the embryo biopsy day and maternal age. The rest of the studied factors showed no significant relationship with mosaicism. These results are of great importance as knowing the possible causes leading to mosaicism helps to improve the clinical results of reproductive treatments.

Identification of novel candidate genes associated with meiotic aneuploidy in human embryos by whole-exome sequencing

PURPOSE

To identify novel genetic variants responsible for meiotic embryonic aneuploidy.

METHODS

A prospective observational cohort study that included 29 couples who underwent trophectoderm biopsies from 127 embryos and performed whole-exome sequencing (WES) between November 2019 and March 2022. Patients were divided into two groups according to the expected embryo aneuploidy rate based on maternal age.

RESULTS

After variant filtering in the WES analysis of 58 patients/donors, five heterozygous variants were identified in female partners from the study group that had an impact on embryo aneuploidy. Additionally, a slowdown in embryo development and a decrease in the number of blastocysts available for biopsy were observed in the study group embryos.

CONCLUSION

This study has identified new candidate genes and variants not previously associated with meiotic embryo aneuploidy, but which are involved in important biological processes related to cell division and chromosome segregation. WES may be an efficient tool to identify patients with a higher-than-expected risk of embryo aneuploidy based on maternal age and allow for individualized genetic counselling prior to treatment.

Application of machine learning to predict aneuploidy and mosaicism in embryos from in vitro fertilization (IVF) cycles

BACKGROUND

OBJECTIVE

STUDY DESIGN

RESULTS

CONCLUSION

P-370 The vaginal microbiome in the first trimester of pregnancy is different in spontaneous versus IVF gestation

Study question

Are there differences in the vaginal microbiome of pregnant women who had a spontaneous pregnancy compared to those who required IVF?

Summary answer

The composition of the vaginal microbiome at 12 week's gestation is different in women who achieve the pregnancy spontaneously or by IVF.

What is known already

The vaginal microbiome plays an important role in women's reproductive health, finding associations between different microbiome patterns and the presence of infertility and embryo implantation failure in IVF. Additionally, recent studies show a correlation between obstetrics and perinatal outcomes and the composition of vaginal microbiota in pregnant women, as well as an increased risk of obstetrics complications in pregnant women after IVF.

Study design, size, duration

Observational, prospective and multicentre study. A total of 64 women were enrolled between January 2020 and June 2021. Spontaneous pregnancies n = 30; and IVF pregnancies n = 34.

Participants/materials, setting, methods

Vaginal swabs were obtained by speculum exam at 12 weeks of gestation in two public hospitals and a fertility private clinic in Spain, to evaluate the differences in vaginal microbiome between both cohorts. The microbiome composition was analyzed by sequencing the V3-V4 region of the 16S rRNA on the Illumina MiSeq platform.

Main results and the role of chance

There were no significant differences in socio-demographic characteristics between groups, except for an expected higher maternal age in the IVF cohort.

Lactobacillus was the most prevalent genus in both groups. When we compared the beta diversity of vaginal microbial by cohort a significant difference was obtained (p = 0.001).

Gardenella, Neisseria, Prevotella and Staphyloccocus were significantly enriched in the IVF group (p = 0.01).

A further evaluation of the four most abundant Lactobacillus species showed that Lactobacillus iners was dominant in IVF pregnancies (15.2%) compared to spontaneous (9.8%) (p = 0.002). On the other hand, Lactobacillus  gasseri showed a lower abundance in vaginal microbiome from women belonged to IVF (9.2%) vs spontaneous pregnant group (13.8%) (p = 0.005).

These findings allowed us to create a model to identify a microbial signature. This model is able to discriminate between IVF and spontaneous pregnancies.

Limitations, reasons for caution

The main limitation of our study is the small sample size. Larger studies are needed to corroborate our findings and their relationship with important aspects such as obstetric and perinatal complications.

Wider implications of the findings

The microbiome composition is different between both cohorts. The microbiome found in our IVF cohort has been also associated with obstetric complications as preterm delivery in previous studies. This suggest that the microbiome composition could be a plausible etiology for a higher risk of adverse pregnancy outcomes in IVF patients.

Trial registration number

Not applicable

O-025 Factors affecting biochemical pregnancy: Machine learning-assisted identification

Study question

What variables in a PGT-A cycle can influence biochemical pregnancy loss?

Summary answer

There are paternal, maternal, ovarian stimulation, endometrial and embryo biopsy factors that are associated with the rate of biochemical pregnancy after the euploid embryo transfer.

What is known already

Biochemical miscarriage is an early termination in the development of pregnancy. Embryonic chromosomal alterations have been proposed to cause biochemical pregnancy. However, even though euploid embryos are transferred in PGT-A cycles, biochemical pregnancy rates do not seem to be modified, so there must be other factors associated with this type of miscarriage.

The classical-statistical methods used to establish the factors related to biochemical miscarriage have produced contradictory results and there is no unanimity in the literature. As an alternative to traditional methods, different artificial intelligence algorithms are being used for the analysis of biological data.

Study design, size, duration

The study design is observational and retrospective. A total of 5892 embryos from 1919 PGT-A cycles were considered (January-2017 to October-2021). Only transferred embryos were included in the study (n = 1161). The trophoectoderm biopsies on D5, D6 or D7 blastocysts were analysed by NGS using the Illumina platform (VeriSeq Illumina®, San Diego, CA, USA). The biopsied embryos were vitrified and transferred in a subsequent cycle.

Participants/materials, setting, methods

Indications for PGT-A were advanced maternal age, altered karyotype or sperm FISH, history of chromosomal abnormalities in the offspring, repeated miscarriages and recurrent implantation failures.

Clinical outcomes were recorded in a database including additional potential factors (n = 48) associated with biochemical pregnancy and related to progenitors, embryos and their biopsy, ovarian stimulation and adjuvant treatments.

The association between the different variables and biochemical pregnancy was analysed using SPSS (v20.0) and R (v. 4.0.5) statistical software.

Main results and the role of chance

In order to determine which factors might increase biochemical pregnancy rates in euploid embryos, a multivariate analysis using logistic regression was initially performed. In the best predictive model (AUC=0.659) with a lower AIC (Akaike information criterion) value, only 3 factors showed a statistically significant association: uterine alterations (OR = 4.88, 95% CI [1.65-12.64]), day of embryo biopsy (OR = 2.19, 95% CI [1.46-3.31]) and mosaicism (number of altered chromosomes: OR = 1.59, 95% CI [1.10-2.22]) which significantly increased the risk of biochemical pregnancy.

To identify other variables that might modify biochemical pregnancy rates and could be missed by classic statistical methods, different types of machine learning algorithms were used: unsupervised model (cluster analysis) and supervised predictive models (support vector machines (AUC=0.845), k-nearest neighbors (AUC=0.858), random forest (AUC=0.853), neural networks multilayer (AUC=0.719) and gradient boosting (AUC=0.825).

The variables that had the greatest predictive power in the different machine learning algorithms were the variables associated with the embryo biopsy (day, number of laser pulses and biopsied cells), endometrial thickness and variables related to the male factor (sperm aneuploidy and DNA fragmentation). These algorithms apply different methodologies, but all agree on the fundamental role of these variables.

Limitations, reasons for caution

To confirm that the new identified variables are associated with biochemical pregnancy, it would be necessary to carry out prospective studies.

Wider implications of the findings

Biochemical pregnancy is the least studied clinical outcome in IVF. Knowledge of the variables that could affect biochemical pregnancy may be relevant as it may be a target for new therapies to reduce biochemical pregnancy rates and thus increase success rates.

Trial registration number

Not Applicable

P-575 Follicle-stimulating hormone receptor genotype and its influence on the results of ovarian stimulation using corifollitropin alfa

Study question

Does the follicle-stimulating hormone receptor (FSHR) genotype influence the results of the ovarian stimulation treatment using corifollitropin alfa?

Summary answer

The use of collifolitropin alfa in SS genotype patients appears to be associated with the obtention of a lower number of oocytes and MII.

What is known already

Previous studies suggest that FSH receptor polymorphism in position 680 influences the response to ovarian stimulation: patients with SS genotype perform better with urinary FSH and need a higher dose of FSH to obtain similar results to the SN and NN genotypes.

These differences could be explained by the longer half-life of urinary gonadotropins, which might compensate for the lower affinity of the receptor in SS genotype patients. Our aim was to elucidate whether corifollitropin alfa, a long-acting recombinant FSH, has the same impact with respect to FSH receptor genotypes as recombinant FSH used habitually.

Study design, size, duration

One hundred and fifty-two egg donors were included in a retrospective cohort study between September 2019 and September 2020. In 80 of them, ovarian stimulation treatment was carried out using a single dose of Elonva 150 micrograms (Group 1). In 72 of them, in addition to the 150 microgram dose of Elonva, stimulation was continued with a daily dose of Puregon 225 UI from the eighth day of controlled ovarian stimulation (Group 2).

Participants/materials, setting, methods

To genotype the 680 position of the FSH receptor, a real-time PCR for allelic discrimination was carried out using StepOnePlus™ Real-Time PCR System (Applied Biosystems™). Linear regression analysis was performed to study the differences between the groups doing a correction for the variables anti-müllerian hormone, age and BMI. The statistical analysis was made with Software Statistical Product and Service Solutions, version 20.0 (SPSS, Chicago, IL, EE.UU.).

Main results and the role of chance

Regarding the whole set of patients, the results of ovarian stimulation using corifollitropin alfa are better in egg donors with SN and NN genotypes compared to those with SS genotype. Statistically significant differences were found in the number of retrieved oocytes (15.78 versus 10.83; p = 0.007) and retrieved MII (12.34 versus 9.00; p = 0.026).

There were no statistically significant differences between both groups of genotypes (SN-NN versus SS) in terms of age (24.04 versus 26.44; p = 0.514), BMI (22.22 versus 22.83; p = 0.781), anti-müllerian hormone levels (26.40 versus, 23.58; p = 0.495), antral follicle count (15.57 versus 14.97; p = 0.567) and the number of previous ovarian stimulations (2.71 versus 2.53; p = 0.812).

Studying both treatment groups separately, in Group 2, we find significant differences in the number of retrieved oocytes (17.55 versus 13.06, p = 0.012) and retrieved MII (14.25 versus 11.39; p = 0.031), between SN-NN versus SS, respectively.

On the other hand, in Group 1, we observe a trend towards statistical significance in the number of retrieved oocytes (13.83 versus 7.50, p = 0.089) and retrieved MII (10.24 versus 5.42; p = 0.120) comparing the same groups of genotypes.

Limitations, reasons for caution

The group of egg donors with the SS genotype barely represents 20% of the donors included in the study. This percentage is similar to its prevalence in the general population, so it is necessary to have a large sample size to be able to carry out studies regarding this genotype.

Wider implications of the findings

Despite the fact that corifollitropin alfa has a longer half-life, the results of SS patients do not match the rest of genotypes, so other factors must influence. Therefore, it would be advisable to genotype patients for 680 position of FSHR in order not to treat SS patients with this gonadotropin.

Trial registration number

-

P-519 Relationship between the quality control parameters in PGT-A results by NGS with the chromosomal mosaicism diagnosis in trophoectoderm biopsies

Study question

Are quality control (QC) parameters in NGS results related to mosaicism rate in trophoectoderm samples?

Summary answer

A high number of filtered reads in PGT-A results correlates with a higher mosaicism rate. But the overall noise does not influence the mosaicism rate.

What is known already

The implementation of NGS have led to increased reporting of mosaicism. There is intense research on the biological mechanisms behind mosaicism, but also on the technical factors that might be influencing in its diagnosis. Low quality samples and DNA amplification artefacts lead to an increase in overall noise after sample analysis. The Derivative Log Ratio (DLR) quality control parameter in sequencing results measures the overall noise present in a sample. High DLR values indicate noisy profiles. Additionally, insufficient numbers of sequencing reads will result in noisy profiles and false copy number assignments.

Study design, size, duration

A retrospective analysis of PGT-A results, corresponding to trophoectoderm biopsies from embryos on day 5, 6 or 7 of development, was performed (February 2017- November 2021). After the quality analysis, 5245 samples that reached the optimum QC measures were included (samples with DLR &lt; 0.4 and number of filtered reads &gt; 250.000).

Participants/materials, setting, methods

PGT-A was carried out with the VeriSeq kit (Illumina), after genome amplification with the Picoplex technique. Sequencing data was analyzed with BlueFuse Multi software (Illumina). Data analysis was performed using SPSSv20.0. An embryo was designated as mosaic when the percentage of aneuploidy for at least one chromosome was between 25 and 50%. For this study, we considered euploid-aneuploid and aneuploid-aneuploid mosaic embryos.

Main results and the role of chance

Considering the 5245 samples included in the analysis, the number of embryos carrying chromosomal mosaicism was 960, which corresponds to 18.3%. To analyze whether the percentage of mosaic embryos varied according to the DRL, we used a logistic regression analysis, introducing maternal and paternal age, embryo quality, and biopsy day as confounding variables, and categorized the DLR using as a point cut the median (0.19). There were no significant differences in the percentage of embryos carrying mosaicism between the group of higher DLR (≥0.19) compared to the group of lower DLR (&lt;0.19) (18.7% vs 18.0%; p = 0.278). On the other hand, to study the relationship between mosaicism and the number of filtered reads obtained in the sequencing analysis, we performed the same analysis using the median of filtered reads (556.688) as cut point. The samples with a number of filtered reads higher than the median had a higher rate of mosaicism (19.3% vs 17.4%, p = 0.041). Moreover, we analyse the data according to the type of mosaicism (segmental or whole chromosome) and we did not observe any difference neither for the DLR nor for the reads.

Limitations, reasons for caution

The main limitation of this study compared with other studies is the different criteria in the mosaicism diagnosis between the different laboratories. Moreover, we are not able to identify if worse QC are due to issues with the biopsy procedure, sample quality, DNA amplification or library preparation.

Wider implications of the findings

The overall noise in PGT-A results doesn't seem to influence the mosaicism rate. However, increased mosaicism rate is observed in samples with high number of filtered reads. This finding suggests that too many cells may lead to amplification saturation and underestimation of the relative quantity of DNA.

Trial registration number

Not applicable

P-024 Identification of spermatogenic infertility phenotypes using next generation sequencing

Study question

Can next generation sequencing (NGS) contribute to diagnoses male idiopathic infertility?

Summary answer

A male factor gene panel identifies pathogenic variants associated to spermatogenic failure in oligozoospermia and cryptozoospermia patients.

What is known already

In 50% of cases, infertility is due to a male factor problem. Although the causes of male infertility are heterogeneous, genetic causes account for approximately 30% of cases. Some phenotypes have been associated with specific genetic disorders such as chromosomal abnormalities and chromosome Y microdeletions. However, current genetic studies explain only 4% of cases, whilst most cases of male factor infertility remain without a clear diagnosis. Therefore, new techniques that explain the cause of male infertility are needed. Advances in NGS allowed us to study a large number of genes involved in spermatogenesis process in patients with idiopathic infertility.

Study design, size, duration

A retrospective study was performed from July 2020 until May 2021. A total of 30 patients with abnormal seminal count parameters (oligozoospermic and cryptozoospermic) were included in the male factor gene panel study. Patients carrying Y-chromosome microdeletions or abnormal karyotype were excluded. The control group included 20 normozoospermic healthy donors selected on the basis of normal semen parameters according to the WHO criteria (2010).

Participants/materials, setting, methods

Genomic DNA extraction from blood-EDTA of the patients was performed using the commercial MagMax DNA MultiSample Ultra kit and the King-Fisher automated extractor (ThermoFisher®). Next Generation Sequencing (NGS) was done using a panel with 426 genes involved in the spermatogenesis process. Panel sequencing for identification of genetic variants was performed using Nextera Enrichment technology (Illumina®). FASTAQ data were processed using BWA and GATK algorithms. VCF files were analyzed using Variant Interpreter software.

Main results and the role of chance

After data analysis, we observed that eight of the thirty patients studied were carriers of mutations in least one of the genes included in the panel (8/30, 26.7%). We identified the following pathogenic variants: a missense mutation (Phe1052Val) and a deletion (Phe508del) of CFTR gene (2/30, 6.6%), two frameshifts (Asp128GlufsTer34 and Lys1299Ter) of CEP290 (2/30, 6.6%), a missense mutation (Tyr284Cys) of GNRHR gene (1/30, 3.3%), a missense mutation (Tyr416Cys) of SCN5A gene (1/30, 3.3%), a deletion (Ser83del) of NANOS1 gene (1/30, 3.3%), a stop gained in splice region Arg341Ter of TEX14 gene (1/30, 3.3%), a splicing donor c.362 + 2T&gt;C of ESR2 gene (1/30, 3.3%) and a missense mutation (Ser321Leu) of DNAH5 gene (1/30, 3.3%), which are related to spermatogenesis failure. Additionally, some variants classified as benign have been identified, which are not associated with pathogenicity. All the variants identified are related with male infertility, affecting spermatogenesis process, such as congenital bilateral absence of the vas deferens (CFTR), reproductive system syndrome (CEP190), endocrine disorder (GNRHR, hypogonadotropic hypogonadism), testis expressed (SCN5A), spermatogenic failure (NANOS1, TEX14 and ESR2) and syndromic infertility (DNAH5). Nevertheless, no pathogenic mutations associated to spermatogenic failure were observed in the control group.

Limitations, reasons for caution

The main limitation of this study is the small number of patients included. Further studies including a higher number of males with idiopathic infertility are warranted to confidently link the genetic variants included in our gene panel to spermatogenic failure.

Wider implications of the findings

The gene list included in our panel represents a step-forward in the diagnosis screening of males with altered sperm parameters. Our results may add in the knowledge of male factor infertility in order to provide etiologic factors towards a personalized treatment and adequate genetic counselling.

Trial registration number

Not applicable

P-520 Factors associated with embryonic mosaicism: a systematic review and meta-analysis

Study question

What factors are involved in chromosomal mosaicism in human blastocysts?

Summary answer

Progenitors’ age and embryo biopsy day are associated with mosaicism rate.

What is known already

Chromosomal abnormalities are common in embryos analyzed in preimplantation genetic testing for aneuploidy (PGT-A) cycles. Mosaicism is a usual event in embryos derived from IVF cycles.

With the development of Next-Generation Sequencing (NGS) techniques, the ability to detect mosaicism in embryos has been improved.

Several studies show that mosaic embryos have reduced potential to reach term compared to euploid. Furthermore, the existing scientific evidence regarding the cause of embryonic mosaicism is scarce with conclusions generating considerable controversy.

Study design, size, duration

A systematic review and meta-analysis were conducted following the PRISMA guidelines on Medline and Google Scholar (January 2016 to December 2021).

Studies addressing factors associated with embryo mosaicism were comprehensively analyzed. As inclusion criteria: mosaicism should have been detected from a blastocyst trophectoderm biopsy on day 5,6 o 7 and analyzed by NGS.

Embryo quality, maternal and paternal age, day of biopsy and seminal quality were the outcomes variables included for analysis.

Participants/materials, setting, methods

A comprehensive database search resulted in 195 articles, 18 of which were included for abstract reading. Search, screen, and data extraction were performed by two reviewers independently based on inclusion criteria.

The study by meta-analysis of the effect of the different factors associated with embryonic mosaicism was carried out using the inverse variance method. Depending on the existence of heterogeneity between studies, the fixed effects method or the random effects method were used.

Main results and the role of chance

After critically and thoroughly reading the selected papers, 10 of them were included in the meta-analysis. Data from our reproductive clinic were also enclosed in the analysis (2513 cycles, 7242 embryos).

The results of the meta-analysis show that neither embryo quality nor seminal quality (male factor) were related to mosaic embryo rate (OR: 1.15; 95%CI: 0.98-1.35 and OR: 1.01; 95%CI: 0.80-1.27, respectively).

In contrast, a positive association with embryo mosaicism was observed for the variable “biopsy day” (OR: 1.06; 95% CI: 1.01-1.11): in embryos biopsied on day 6 or 7 of embryonic development, a small increase in the mosaicism rate was observed, in comparison with day 5. A significative positive association was also observed when we studied “paternal age” factor (OR: 1.13; 95% CI: 1.02-1.26): embryo mosaicism increases with paternal age.

On the other hand, maternal age showed a negative association with mosaicism (OR: 0.84; 95% CI: 0.74-0.95). Interestingly, in opposite to what happens with the aneuploidy rate, embryo mosaicism is higher in young women.

Limitations, reasons for caution

The main limitation is the low number of papers analyzed in the meta-analysis. Limitations also include the retrospective design and heterogeneity of studies, limiting comparison and pooling of data. Nonetheless, our conclusions were based on studies with low risk of bias.

Wider implications of the findings

Our result, combined with the body of medical evidence available suggest that embryo mosaicism rate is influenced by trophectoderm biopsy day and maternal and paternal age. This information will add in the knowledge for elucidating the uncertainties surrounding the factors by which mosaicism is generated in embryos.

Trial registration number

Not applicable

Identification of vaginal microbiome associated with IVF pregnancy

The factors that cause a preterm birth (PTB) are not completely understood up to date. Moreover, PTB is more common in pregnancies achieved by in-vitro fertilization (IVF) than in spontaneous pregnancies. Our aim was to compare the composition of vaginal microbiome at 12 weeks of gestation between women who conceived naturally or through IVF in order to study whether IVF PTB-risk could be related to vaginal microbiome composition. We performed an observational, prospective and multicentre study among two public hospitals and a fertility private clinic in Spain. Vaginal swabs from 64 pregnant women at 12 weeks of gestation were collected to analyse the microbiome composition by sequencing the V3-V4 region of the 16S rRNA. Our results showed that the vaginal microbiome signature at 12 weeks of pregnancy was different from women who conceived naturally or through IVF. The beta diversity and the genus composition were different between both cohorts. Gardnerella, Neisseria, Prevotella, and Staphylococcus genus were enriched genus in the vaginal microbiome from the IVF group, allowing us to create a balance model to predict both cohorts. Moreover, at species level the L. iners abundance was higher and L. gasseri was lower in the IVF group. As a conclusion, our findings were consistent with a proposed framework in which IVF pregnancy are related to risk for preterm birth (PTB) suggesting vaginal microbiome could be the reason to the relation between IVF pregnancy and risk for PTB.

O-203 Application of machine learning to predict aneuploidy and mosaicism in embryos from in vitro fertilization (IVF) cycles

Study question

Is it possible to predict the likelihood of an IVF embryo being aneuploid and/or mosaic using a machine learning algorithm?

Summary answer

There are paternal, maternal, embryonic and IVF-cycle factors that are associated with embryonic chromosomal status that can be used as predictors in machine learning models.

What is known already

The factors associated with embryonic aneuploidy have been extensively studied. Mostly maternal age and to a lesser extent male factor and ovarian stimulation have been related to the occurrence of chromosomal alterations in the embryo.

On the other hand, the main factors that may increase the incidence of embryo mosaicism have not yet been established.

The models obtained using classical statistical methods to predict embryonic aneuploidy and mosaicism are not of high reliability. As an alternative to traditional methods, different machine and deep learning algorithms are being used to generate predictive models in different areas of medicine, including human reproduction.

Study design, size, duration

The study design is observational and retrospective. A total of 4654 embryos from 1558 PGT-A cycles were included (January-2017 to December-2020). The trophoectoderm biopsies on D5, D6 or D7 blastocysts were analysed by NGS. Embryos with ≤25% aneuploid cells were considered euploid, between 25-50% were classified as mosaic and aneuploid with &gt;50%.

The variables of the PGT-A were recorded in a database from which predictive models of embryonic aneuploidy and mosaicism were developed.

Participants/materials, setting, methods

The main indications for PGT-A were advanced maternal age, abnormal sperm FISH and recurrent miscarriage or implantation failure. Embryo analysis were performed using Veriseq-NGS (Illumina).

The software used to carry out all the analysis was R (RStudio). The library used to implement the different algorithms was caret. In the machine learning models, 22 predictor variables were introduced, which can be classified into 4 categories: maternal, paternal, embryonic and those specific to the IVF cycle.

Main results and the role of chance

The different couple, embryo and stimulation cycle variables were recorded in a database (22 predictor variables). Two different predictive models were performed, one for aneuploidy and the other for mosaicism. The predictor variable was of multi-class type since it included the segmental and whole chromosome alteration categories.

The dataframe were first preprocessed and the different classes to be predicted were balanced. A 80% of the data were used for training the model and 20% were reserved for further testing. The classification algorithms applied include multinomial regression, neural networks, support vector machines, neighborhood-based methods, classification trees, gradient boosting, ensemble methods, Bayesian and discriminant analysis-based methods. The algorithms were optimized by minimizing the Log_Loss that measures accuracy but penalizing misclassifications.

The best predictive models were achieved with the XG-Boost and random forest algorithms. The AUC of the predictive model

for aneuploidy was 80.8% (Log_Loss

1.028) and for mosaicism 84.1% (Log_Loss: 0.929). The best predictor variables of the models were maternal age, embryo quality, day of biopsy and whether or not the couple had a history of pregnancies with chromosomopathies. The male factor only played a relevant role in the mosaicism model but not in the aneuploidy model.

Limitations, reasons for caution

Although the predictive models obtained can be very useful to know the probabilities of achieving euploid embryos in an IVF cycle, increasing the sample size and including additional variables could improve the models and thus increase their predictive capacity.

Wider implications of the findings

Machine learning can be a very useful tool in reproductive medicine since it can allow the determination of factors associated with embryonic aneuploidies and mosaicism in order to establish a predictive model for both. To identify couples at risk of embryo aneuploidy/mosaicism could benefit them of the use of PGT-A.

Trial registration number

Not Applicable

P–550 Clinical outcomes of mosaic embryos are similar between young and older women

Study question

Are there differences in the clinical outcomes of mosaic embryos depending on the female age?

Summary answer

Clinical outcomes of mosaic embryo transfers are similar regardless female age.

What is known already

Chromosomal abnormalities are common in embryos analyzed in preimplantation genetic testing for aneuploidy (PGT-A) cycles. Mosaicism (the presence of two or more chromosomally distinct cell lines) is a usual event in embryos derived from IVF cycles.

Several studies show that mosaic embryos have reduced potential to reach term, compared to euploid embryos. The factors affecting the implantation potential and development of mosaic embryos are controversial. Recently, Victor et al. (2019) argued that mosaic blastocysts generated at younger ages show better outcomes compared to older ages. The aim of this study was to test this hypothesis in our centre.

Study design, size, duration

A total of 136 mosaic embryos from patients undergoing PGT-A cycles from May 2014 to October 2020 were retrospectively analyzed in this study. The blastocyst trophoectoderm biopsies of day 5 and 6 were analysed by aCGH (n = 47, 30.1%) and NGS (n = 109, 69.9%). An embryo was considered mosaic when the percentage of aneuploid cells were 25–50% in aCGH and 20–50% in NGS. Only single embryo transfer cycles were included in the analysis.

Participants/materials, setting, methods

Embryo analysis were performed using Agilent SurePrint G3 8x60K CGH microarrays or Veriseq NGS (Illumina), with previous whole genome amplification. We evaluated if clinical results of mosaic embryos transfers in IVF cycles were correlated with female age. The main outcome measures were β-hCG, implantation rate and ongoing pregnancy rate. β-hCG was measured in blood 14 days after the embryo transfer and was considered positive when it was &gt;2 mUI/ml.The statistical analysis was performed with SPSSv20.0.

Main results and the role of chance

A total of 136 mosaic embryos were included in this study. Overall, we evaluated factors affecting embryo mosaicism implantation potential. Neither the percentage of mosaicism nor the segmental mosaicism were related to mosaic embryo implantation, pregnancy and ongoing pregnancy rates.

To evaluate the impact of female age in clinical outcomes, we established two different groups depending on whether mosaic blastocysts were generated from oocytes retrieved at young maternal ages (≤35 years; n = 62) or at older ages (&gt;35years; n = 74).

No differences were found between groups. Nonetheless, to reduce bias, embryo quality, percentage of mosaicism, segmental mosaicism and whether the transferred embryo was frozen or fresh were included as confounding factors.

The rate of positive β-hCG was similar between groups: 45.2% in ≤ 35y group vs 54.1% in &gt; 35y (p = 0.476). The implantation rate was also similar: 30.6% vs 39.2%% (p = 0.855), respectively. Furthermore, the ongoing pregnancy rate was higher in the &gt;35y group (35.1%), compared to the ≤35y group (19.4%) without reaching statistically significant differences (p = 0.245).

Limitations, reasons for caution

The sample size is a limitation. aCGH test and a different definition for mosaic embryo in terms of percentage of abnormal cells was employed in this study compared to Victor et. al. (2019) study. Larger prospective studies should evaluate the impact of maternal age in the outcome of mosaic embryos.

Wider implications of the findings: Our results challenge that female age is associated with clinical outcomes after the transfer of mosaic embryos. Comparable results were obtained in young and older women. Therefore, in the absence of euploid embryos, mosaic embryos might be considered for transfer and similar outcomes are expected regardless of the maternal age.

Trial registration number

Not applicable

P–588 Follicle-stimulating hormone receptor genotype and its influence on the results of double ovarian stimulation in IVF cycles

Study question

Does the follicle-stimulating hormone receptor (FSHR) genotype influence the results of the ovarian stimulation treatment in the luteal phase?

Summary answer

All patients undergoing in-vitro fertilization benefit from luteal phase ovarian stimulation, regardless of their follicle-stimulating hormone receptor genotype.

What is known already

Previous studies suggest that FSH receptor polymorphism in position 680 influences the response to ovarian stimulation in the luteal phase. It was observed that patients with SS genotype seems to require a higher dose to obtain an optimal ovarian response. Later, it was reported that, in patients with SS genotype, a better performance seems to be obtained by administering highly purified urinary FSH while, in SN patients, better results were obtained with recombinant FSH. In patients with NN genotype, no differences were found. Our aim was to test whether this concept is applicable to ovarian stimulation in the luteal phase.

Study design, size, duration

One hundred and thirty-four patients were included in a retrospective study between July 2017 and September 2020. In these patients, a double stimulation protocol was carried out and the FSH receptor was genotyped either as part of the pre-treatment fertility tests or for the current study. Patients with a double stimulation treatment who could not be genotyped were excluded from the analysis.

Participants/materials, setting, methods

To genotype the 680 position of the FSH receptor, a real-time PCR for allelic discrimination was carried out using StepOnePlus™ Real-Time PCR System (Applied Biosystems™. Ref: 4376600). Non-parametic tests were used to study the differences between the groups. They were performed with the software R Statistical Software, version 4.0.3.

Main results and the role of chance

The results of ovarian stimulation in the luteal phase were better compared to the conventional follicular phase. Statistically significant differences (p &lt; 0.001) were found in the number of retrieved oocytes (5.06 versus 3.51), retrieved MII (4.13 versus 2.91), fertilized oocytes (3.22 versus 1.81) and blastocysts formed (1.79 versus 0.62). Furthermore, these differences remained regardless of the genotype for the 680 position of the FSH receptor in all groups (p &lt; 0.05).

In addition, better results were obtained in the luteal phase in patients who have been stimulated with the type of gonadotropin that already had better performance in the follicular phase for its genotype, that is, highly purified urinary FSH in SS patients and recombinant FSH in SN patients, compared to other types of gonadotropin (p &lt; 0.05).

We also observed that stimulation in the luteal phase lasts longer and consume more gonadotropins than in the follicular phase. This is especially notable in the case of patients with SS genotype, who required slightly higher consumption of gonadotropins compared to the other genotypes in the luteal phase, as had previously been observed in the follicular phase for this genotype.

Limitations, reasons for caution

The retrospective study design and the sample size could be a limitation. Furthermore, we cannot determine whether the improvement in luteal phase performance is related to differences in the physiological environment between phases of the cycle or is caused by a possible activation of the ovary from the previous stimulation.

Wider implications of the findings: All patients undergoing in-vitro fertilization seems to benefit from luteal phase ovarian stimulation, regardless of their genotype for FSHR. In addition, the pharmacogenetic recommendation when choosing the type of FSH for ovarian stimulation should be the same both in the follicular phase and in the luteal phase.

Trial registration number

Not applicable

P–540 A feasible diagnostic approach for the cryptic subtelomeric traslocations in early recurrent miscarriage patients by preimplantation genetic testing (PGT)

Study question

Could cryptic subtelomeric traslocations in early recurrent miscarriage patients be diagnosed by preimplantation genetic testing?

Summary answer

PGT is a powerful tool to detect subtelomeric cryptic traslocations identifying the cause of early recurrent miscarriage and allowing subsequent genetic counselling. What is known already: Chromosome translocations are frequently associated with birth defects, spontaneous early pregnancy losses and infertility. However, submicroscopic traslocations (so-called cryptic traslocations) are too small to be detected by conventional karyotyping.. Due to balanced status, high resolution molecular techniques as arrayCGH are not able to detect it. Thus, cryptic traslocations detection is challenging. PGT is able to detect CNVs at higher resolution than routine karyotyping. Therefore, the recurrent diagnosis of CNV at embryo level could suggest a subchromosomal parental traslocation. The aim of this study is to investigate the feasibility of using PGT as an indicator of parental balanced cryptic traslocations.

Study design, size, duration

We included three couples who underwent PGT for unexplained repeated pregnancy loss (RPL) in our clinic from February 2020 to November 2020. Common established causes of RPL (uterine anomalies, antiphospholipid syndrome, immunological, hormonal and metabolic disorders) were previously rouled-out. Even couple karyotypes were normal. Twenty-three embryos from those couples were biopsied at blastocyst and analysed for CNVs detection using low coverage whole genome NGS.

Participants/materials, setting, methods

PGT by NGS was performed by Veriseq-NGS (Illumina), with previous whole genome amplification. Fluorescence in situ hybridization (FISH) using parental blood samples were performed to validate the origin of subchromosomal number variation. Commercially available subtelomeric specific probes were selected according to the CNV identified and the procedures were performed according to the manufacturer’s protocols.

Main results and the role of chance

Overall, CNVs of terminal duplication and deletion that imply unbalanced traslocation derivatives were detected in the 43.5% of biopsied embryos. For couple 1, 4 out of 5 embryos (80%) carried deletion of telomeric region on chromosomes 5 and 21. Three out of 6 biopsed embyos (50%) were diagnosed with subchromosomal copy variants at telomeric region on chromosomes 6 and 16 for couple 2. In the case of couple 3, three out of 12 embryos (25%) were carriers of CNV at subtelomeric region on chromosomes 2 and 6. The size of CNVs detected ranges from 8Mb to 20Mb. Accurate diagnosis with the parental study was made by FISH. The combination of probes to detect the structural chromosome alteration were: Tel5qter-LSI21q, Tel6pter-CEP16 and Tel6pter-CEP6 for each couple respectively. The FISH studies reveal that CNVs were inherited from one parent carrying the balanced cryptic traslocation. Ultimately, the abnormal karyotype from the carrier parent were 46,XY,t(5;21)(q33.2;q21.2) for couple 1, 46,XY,t(6;16)(p22.3;q22.1) for couple 2 and 46,XY,t(2;6)(p25.1;p24.2) for couple 3. Finally, each couple performed a cryotransfer of a single normal balanced embryo. Two pregnancies are ongoing.

Limitations, reasons for caution

The main limitation of this approach is the NGS- PGT resolution. CNVs smaller than 5Mb could not be detected.

Wider implications of the findings: This study shows the value of PGT for unexplained RPL, followed by parental FISH to better characterize CNVs and identify couples in whom one partner carries a cryptic translocation. Accurate diagnosis of parental chromosome translocation can achieve with FISH only, but FISH would not be performed unless PGT showed CNVs.

Trial registration number

Not applicable

Real-life behaviour of direct oral anticoagulants in a Spanish cohort with non-valvular atrial fibrillation: Refase Registry

Aim: To analyse the effectiveness and safety of DOAC (direct oral anticoagulants) in non-valvular atrial fibrillation (NVAF) patients attending clinical practice.Methods: Retrospective study of AF patients who started treatment with DOAC from January 1, 2013 to December 31, 2016 in three Spanish hospitals. Mean follow-up was 1.6 years. The primary outcomes were rates of all-cause death, ischaemic stroke, and bleeding. These outcomes were also studied depending on correct dosage adjustment and standard/adjusted dose.Results: The study included 2494 patients (age = 76.0 ± 9.5 years, CHA₂DS₂-VASc = 4.0 ± 1.6). The most prescribed DOAC was rivaroxaban (41.1%). Patients taking dabigatran were the youngest (mean age = 73.1 ± 10.3 years), with better kidney function (mean CrCl = 80.6 ± 35.8 ml/min) and lower CHA₂DS₂-VASc (3.7 ± 1.4) and HAS-BLED (2.1 ± 0.9) scores. Patients taking apixaban were the oldest, and had the highest CHA2DS2-VASc and HAS-BLED scores (4.3 ± 1.6 and 2.6 ± 0.9, respectively). Rates of stroke/major bleeding/intracranial bleeding were 1.8/3.0/0.3 events per 100 patient-years, respectively, with no differences among DOAC. Based on dose adjustment according to technical data, it was observed that 517 patients (23.5%) received DOAC doses inconsistent with labelling (p < .001) and, within this group, under-dosed patients had a higher death rate although it did not reach a significant result after multivariate adjustment.Conclusions: The results of safety and efficacy are very similar to those of other previously published national registries. There were no differences among the different types of DOAC regarding outcomes. However, it was found that people taking the adjusted dose of the drug seemed to have a higher risk of death. A non-negligible proportion of patients received DOAC doses inconsistent with labelling (mostly underdose).

Real-world uptake, safety profile and outcomes of docetaxel in newly diagnosed metastatic prostate cancer

OBJECTIVES

To investigate the uptake, safety and efficacy of docetaxel chemotherapy in hormone-naïve metastatic prostate cancer (mPC) in the first year of use outside of a clinical trial.

PATIENTS AND METHODS

Patients in the West of Scotland Cancer Network with newly diagnosed mPC were identified from the regional multidisciplinary team meetings and their treatment details were collected from electronic patient records. The rate of febrile neutropenia, hospitalisations, time to progression, and overall survival were compared between those patients who received docetaxel and androgen-deprivation therapy (ADT), or ADT alone using survival analysis.

RESULTS

Of the 270 eligible patients, 103 received docetaxel (38.1%). 35 patients (34%) were hospitalised and there were 17 episodes of febrile neutropenia (16.5%). Two patients (1.9%) died within 30 days of chemotherapy. Patients who received ADT alone had an increased risk of progression (hazard ratio [HR] 2.03, 95% confidence interval [CI] 1.27-3.25; log-rank test, P = 0.002) and had an increased risk of death (HR 5.88, 95% CI: 2.52-13.72; log-rank test, P = 0.001) compared to the docetaxel group. The risk of febrile neutropenia was nine-times greater if chemotherapy was started within 3 weeks of ADT initiation (95% CI: 1.22-77.72; P = 0.032).

CONCLUSION

Docetaxel chemotherapy in hormone-naïve mPC has significant toxicities, but has a similar effect on time to progression and overall survival as seen in randomised trials. Chemotherapy should be started at ≥3 weeks after ADT.

Challenges in the treatment of early non-small cell lung cancer: what is the standard, what are the challenges and what is the future for radiotherapy?

In the last 15 years, the use of Stereotactic Ablative Radiation Therapy (SABRT) in the management of small peripheral lung tumours has developed considerably, so that it currently represents a standard of care for inoperable stage I non-small cell lung cancer (NSCLC), offering a survival advantage over traditional radiotherapy, local control rates at 3 years around 90%, with a low risk of toxicity. Indications have extended to larger tumours up to 5 cm and centrally located tumours. In this review we will explore the role of SABRT in early stage NSCLC, the state of the art, the challenges and the future for this technique. There are ongoing studies to optimize such approaches within a multicentric setting. Trials comparing surgery to SABRT in operable or marginally operable have failed because of poor accrual. Several questions remain that need to be addressed in prospective studies.

Association of anthracycline-related cardiac histological lesions with NADPH oxidase functional polymorphisms

OBJECTIVE

Treatment with anthracyclines may cause cardiac dysfunction, but the sequence of anthracycline-induced heart lesions has been incompletely characterized. NADPH oxidase, a key mediator of oxidative cardiac damage and remodeling, modulates anthracycline clinical cardiotoxicity. Our aim was to determine which cardiac histological lesions are specifically induced by anthracycline treatment and to investigate the role of NADPH functional genetic polymorphisms in their development.

PATIENTS AND METHODS

Using a retrospective case-control design, we evaluated cardiac histological lesions and NADPH genotype (polymorphisms rs1883112, rs4673, and rs13058338) in 97 consecutive decedents with a cancer diagnosis (48 treated with anthracyclines).

RESULTS

Myocytolysis (60%), patched myocardial necrosis (19%), and myocardial fibrosis (diffuse and patched; 62% and 23%, respectively) were associated with anthracycline treatment. In patients receiving anthracyclines, NADPH oxidase polymorphism rs4673 protected against focal myocardial necrosis (odds ratio [OR], 0.11; 95% confidence interval [CI], 0.20-0.63) whereas rs1883112 was strongly associated with cardiac fibrosis (OR, 5.11; 95% CI, 1.59-16.43), which was present in all homozygotes.

CONCLUSION

Anthracyclines induce a cardiac remodeling pattern characterized by interstitial or patched fibrosis. The contribution of the functionally relevant NADPH polymorphisms rs1883112 and rs4673 to anthracycline-related heart lesions provides a plausible explanation for their modulation of cardiotoxicity. If confirmed, these findings may lead to better individualized strategies for early detection and prevention of anthracycline cardiotoxicity.

Retrospective analysis of 132 patients with stage I seminoma: Observation versus adjuvant radiation or chemotherapy in a single institution

e15033

Background: Classically, radiotherapy (RT) has been the standard adjuvant treatment for stage I seminoma patients. Improvements in early relapse diagnosis have led high cure rates. Two cycles of adjuvant carboplatin present similar efficacy to radiotherapy with less toxicity have led to re-examination of the standard treatment approach. Methods: Retrospective study of 132 patients diagnosed with stage I seminoma from 1980-2010 who received whether treatment with RT, chemotherapy (Cht) or active surveillance (AS) after orchiectomy at one Universitary Hospital. The objective was to determine the relapse-free survival (RFS), overall survival (OS), and disease -specific survival (DSS). Results: Of the 132 patients, 68 were treated with prophylactic irradiation (paraaortic ± pelvic nodes, the median total dose radiation 26 Gy at 2 Gy per fraction), 33 with adjuvant chemotherapy (31 had carboplatin x 2, 2 had BEP x 2), and 31 underwent surveillance. Among the RT patients (median follow-up 121months), mean age was 40 years (range: 20-70) with mean tumor size of 5.5 cm (range: 1-14). 6% of them had rete testis involvement and 15% vascular invasion. There was 1 relapse with a median disease-free survival (DFS) of 103 months and no deaths from seminoma. RFS was 98% at 10 years. OS and DSS were 100% at 10years. Among the chemotherapy patients mean age was 30 years (range: 18-66) with mean tumor size of 6,18cm (range: 1,5-10). 9% of them had rete testis involvement and 60 % vascular invasion. With a median follow-up of 66 months, there was 1 relapse. Five-year RFS was 97%, OS and DSS were 100%. Among the observation patients (median follow-up 148 months), mean age was 35 years (range: 20-78) with mean tumor size of 3,7cm (range: 1,3-7). 6% of them had rete testis involvement and 6 % vascular invasion. There were 6 relapses with no deaths from seminoma. RFS was 80%, specific OS and DSS was 100% at 10 years. Of the patients who relapsed, all were rendered disease-free with chemotherapy; with non evidence disease at last follow-up. Conclusions: Consistent with published trials both radiotherapy, chemotherapy or active surveillance are safe and effective treatments with similar oncologic results.

Clinical and genetic determinants of anthracycline-induced cardiac iron accumulation

BACKGROUND

The involvement of iron in anthracycline cardiotoxicity is supported by extensive experimental data, and by the preventive efficacy of dexrazoxane, an iron chelator. However, no clinical evidence of anthracycline-induced cardiac iron accumulation is available and the influence of previous iron overload or of genetic factors in human-induced heart disease is largely unknown. Our aim was to test the hypothesis that anthracyclines increase iron heart concentration and that HFE genotype modulates this iron deposit.

METHODS

We retrospectively evaluated cardiac events, cardiac iron and HFE genotype in 97 consecutive necropsies from patients with solid and hematological neoplasms. Heart and liver iron concentration was determined by atomic absorption spectroscopy. HFE gene mutations (C282Y and H63D) linked to hereditary hemochromatosis were analyzed by Fluorescence Resonance Energy Transfer (FRET) genotyping.

RESULTS

Heart iron concentration was increased in cases treated with a cumulative doxorubicin dose greater than 200mg/m(2) (490 vs 240 μg/g; p=0.01), independently of liver iron load or transfusion history. HFE mutated haplotypes 282C/63D (p=0.049) and 282Y/63H (p=0.027) were associated to higher cardiac iron deposits. The haplotype C282Y-Y/H63D-H interacted with anthracyclines for increasing cardiac iron load. In a multivariate linear regression analysis both HFE genotypes and anthracyclines contributed to heart iron concentration (R(2)=0.284).

CONCLUSIONS

Our data support the occurrence of an HFE-modulated heart iron accumulation in individuals treated with anthracyclines, independently of systemic iron load. If prospectively confirmed, iron-related parameters might be useful as predictive factors for anthracycline cardiotoxicity.

Evaluation of four rapid methods for hemoglobin screening of whole blood donors in mobile collection settings

INTRODUCTION

Predonation hemoglobin measurement is a problematic requirement in mobile donation settings, where accurate determination of venous hemoglobin by hematology analyzers is not available.

OBJECTIVE

We have evaluated hemoglobin screening in prospective donors by the semiquantitative copper sulphate test and by capillary blood samples analyzed by three portable photometers, HemoCue, STAT-Site MHgb, and the CompoLab HB system.

METHODS

Capillary blood samples were obtained from 380 donors and tested by the copper sulphate test and by at least one of the named portable photometers. Predonation venous hemoglobin was also determined in all donors using a Coulter Max-M analyzer.

RESULTS

The three photometers provided acceptable reproducibility (CV below 5%), and displayed a significant correlation between the capillary blood samples and the venous hemoglobin (R2 0.5-0.8). HemoCue showed the best agreement with venous hemoglobin determination, followed by STAT-Site MHgb, and the CompoLab HB system. The copper sulphate test provided the highest rate of donors acceptance (83%) despite unacceptable hemoglobin levels, and the lowest rate for donor deferral (1%) despite acceptable hemoglobin levels. The percentage of donors correctly categorized for blood donation by the portable hemoglobinometers was 85%, 82%, and 76% for CompoLab HB system, HemoCue and STAT-Site, respectively.

CONCLUSION

Our data suggest that hemoglobin determination remains a conflictive issue in donor selection in the mobile setting. Without appropriate performance control, capillary hemoglobin screening by either the copper sulphate method or by the novel portable hemoglobinometers could be inaccurate, thus potentially affecting both donor safety and the blood supply.

[Epidemiologic situation of tuberculosis under the influence of HIV in the health area of Ibiza and Formentera (1987-1993)]

OBJECTIVES

To analyse the epidemiology of Tuberculosis and determine the characteristics of patients infected by HIV vs those not infected.

DESIGN

A descriptive-retrospective study.

SETTING

Ibiza and Formentera Health Area.

PATIENTS

268 patients over 16 diagnosed with TB between 7/1/1987 and 12/31/1993.

MEASUREMENTS AND MAIN RESULTS

The highest accumulated annual incidence was detected in 1989 (82.4/100,000 inhabitants), but had decreased considerably by 1993 (42.8/100,000). The proportion of HIV+ cases increased to 37.0% of the total in 1993. 75% of the total were male and 57.5% between 20 and 39 (x = 38.1; SD = 15.4). 63.1% had pulmonary TB, 60.8% producing bacilli, 19.8% were HIV+, of which 47.2% were intravenous drug users and 20.8% homosexuals. There was a 75.4% cure rate, 4.9% who left treatment and 16.1% lost during follow-up.

CONCLUSIONS

During the study period a progressive increase in the proportion of cases with HIV infection was observed. Control and follow-up of Tuberculosis was more difficult in these patients.

Human subcutaneous dirofilariasis caused by Dirofilaria repens in Ibiza, Spain

A case of human subcutaneous dirofilariasis contracted in Ibiza, Spain is reported. An incomplete nematode extracted from the eyelid of a woman patient was identified on the basis of its anatomic and histologic characteristics as a nongravid adult female of the species Dirofilaria repens. The subcutaneous location of the worm, together with the epidemiologic data, support this finding.