The association between endometrial polyps, chronic endometritis, and IVF outcomes

OBJECTIVE

Endometrial polyps (EPs) are one of the most common pathologies detected during the examination of the uterine cavity of infertile women. We aimed to demonstrate the relationship between EPs, chronic endometritis (CE) and in vitro fertilization (IVF) outcomes.

PATIENTS AND METHODS

This retrospective study was performed on 394 hysteroscopically examined infertility cases. We performed polyp resections (PR) and extensive biopsies of the endometrium to demonstrate the association with clinical pregnancy (CP) by IVF. We performed statistical analysis to compare these associations.

RESULTS

The incidence of CE was twice as high in the presence of EPs as in the absence of EPs. The associations between EPs and PR were found to be significant for positive CP outcomes. A significant difference in IVF outcome was found between the group with EPs and the group without EPs. All these associations were statistically significant (p < 0.05).

CONCLUSIONS

We found a frequent association between EPs and CE. The pregnancy rate obtained after IVF was negatively affected by the presence of EPs. Treatment of these pathologies improved IVF outcomes.

Vaccine hesitancy educational tools for healthcare providers and trainees: A scoping review

In the era of vaccine hesitancy, highlighted by the current SARS-CoV2 pandemic, there is an acute need to develop an approach to reduce and address apprehension towards vaccinations. We sought to map and present an overview of existing educational interventions for healthcare providers (HCPs) on strategies to engage in effective vaccine discussion. We applied the Joanna Briggs Institute methodology framework in this scoping review. We searched five relevant databases (MEDLINE, CINAHL, EMBASE, PsycInfo, and SCOPUS) and grey literature through the Google search engine using keywords and subject headings that were systematically identified. We identified 3384 citations in peer-reviewed literature and 41 citations in grey literature. After screening for our inclusion criteria, we included 28 citations from peer reviewed literature and 16 citations from grey literature for analysis. We identified a total of 41 unique education interventions. Interventions were available from multiple disciplines, training levels, clinical settings, and diseases/vaccines. Interventions predominantly centered around two foci: knowledge sharing and communication training. Most interventions identified from peer-reviewed literature were facilitated and were applied with multiple modes of delivery. Interventions from grey literature were more topical and generally self-directed. We identified several gaps in knowledge. Firstly, accessibility and generalizability of interventions was limited. Secondly, distribution of interventions did not adequately address nursing and pharmacy disciplines, and did not cover the breadth of medical specialties for whom vaccine discussions apply. Thirdly, no interventions addressed self monitoring and the clinicians' recognition and management of emotions during difficult conversations. There is a need to address this gap and provide available, credible and comprehensive educational interventions that will support our healthcare providers in effective communication with vaccine hesitant patients.

Evaluation of human factor engineering influence in nuclear safety using probabilistic safety assessment techniques

This paper provides the empirical basis to support predictions of the Human Factor Engineering (HFE) influences in Human Reliability Analysis (HRA). A few methods were analyzed to identify HFE concepts in approaches of Performance Shaping Factors (PSFs): Technique for Human Error Rate Prediction (THERP), Human Cognitive Reliability (HCR) and Cognitive Reliability and Error Analysis Method (CREAM), Success Likelihood Index Method (SLIM) Plant Analysis Risk – Human Reliability Analysis (SPAR-H), A Technique for Human Error Rate Prediction (ATHEANA) and Man-Machine-Organization System Analysis (MMOSA). Also, in order to identify other necessary PSFs in HFE, an additional investigation process of human performance (HPIP) in event occurrences was used. Thus, the human error probability could be reduced and its evaluating can give out the information for error detection and recovery. The HFE analysis model developed using BHEP values (maximum and pessimistic) is based on the simplifying assumption that all specific circumstances of HFE characteristics are equal in importance and have the same value of influence on human performance. This model is incorporated into the PSA through the HRA methodology. Finally, a clarification of the relationships between task analysis and the HFE is performed, ie between potential human errors and design requirements.

A38 SUBOPTIMAL VACCINATION ADHERENCE IN MOTHERS WITH INFLAMMATORY BOWEL DISEASE AND THEIR BIOLOGIC-EXPOSED INFANTS

Background

Data suggests that postpartum IBD patients have low self-reported vaccine rates despite being exposed to multiple care providers. To date, there is limited data on vaccine safety in infants exposed to biologic therapies in utero for the treatment of maternal IBD, with only questionnaire style studies and one case report of a fatal outcome post BCG vaccine. This has led to guidelines recommending against live vaccines under 6 months, such as the rotavirus vaccine, in biologic exposed infants.

Aims

To assess vaccine compliance in mothers with IBD and their infants and evaluate rotavirus safety to help optimize preventative medicine and guide future vaccine recommendations.

Methods

We obtained data from the University of Calgary’s Pregnancy in IBD Registry from 2012 to 2018 and from provincial vaccination and personal health records. Vaccine rates for Hep-A, Hep-B, Pneu-C-13, Pneu-C-23 and DTap were obtained for 117 mothers who received biologic therapy during pregnancy. Rotavirus (n=74 as it was introduced in ‘14) and DTap-IPV-Hib, Men-C, Pneu-C-13 and MMR (n=117) rates were obtained for infants exposed to biologics in utero. Rotavirus (n=92) and non-rotavirus (n=142) rates for non-biologic exposed infants were also collected. Rotavirus complications, characterized by related emergency room visits, were obtained. Descriptive statistics were performed with chi-square tests.

Results

We found the following rates of vaccine uptake in the biologic treated mothers: Hep-A (47%), Pneu-C-13 (32%), Pneu-C-23 (36%), Hep-B (75%) and DTap (79%). When comparing biologic and non-biologic exposed infants there were high rates of compliance for recommended vaccines with no differences in DTap-IPV-Hib (91% vs. 89%, p=0.11), Men-C (96% vs. 92%, p=0.80), Pneu-C-13 (95% vs. 93%, p=0.14) and MMR (96% vs. 92%, p=0.80). There was a significant difference in rotavirus rates (20% vs. 87%, n &lt; 0.0001) given the recommendation against vaccination in biologic exposed infants. There was a significant difference in vaccination guideline adherence within the biologic group when comparing inappropriately administered rotavirus vaccines with inappropriately missed recommended vaccines (20% vs. 6%, p=0.02). No infants who received the rotavirus vaccine suffered from intussusception or death nor was there a significant difference in adverse events between the two groups (20% vs 9%; p=0.71).

Conclusions

The study highlights the need for improved vaccination education and implementation given suboptimal vaccine adherence in biologic treated mothers and the inadvertent administration of the live rotavirus vaccine in their biologic exposed infants. The lack of rotavirus vaccine adverse events shows potential vaccine safety in biologic exposed infants and requires further study.

Funding Agencies

None

Evaluation of Dosimetry, Quantitative Methods, and Test-Retest Variability of 18F-PI-2620 PET for the Assessment of Tau Deposits in the Human Brain

¹⁸F-PI-2620 is a next-generation tau PET tracer that has demonstrated ability to image the spatial distribution of suspected tau pathology. The objective of this study was to assess the tracer biodistribution, dosimetry, and quantitative methods of ¹⁸F-PI-2620 in the human brain. Full kinetic modeling to quantify tau load was investigated. Noninvasive kinetic modeling and semiquantitative methods were evaluated against the full tracer kinetics. Finally, the reproducibility of PET measurements from test and retest scans was assessed. Methods: Three healthy controls (HCs) and 4 Alzheimer disease (AD) subjects underwent 2 dynamic PET scans, including arterial sampling. Distribution volume ratio (DVR) was estimated using full tracer kinetics (reversible 2-tissue-compartment [2TC] model and Logan graphical analysis [LGA]) and noninvasive kinetic models (noninvasive LGA [NI-LGA] and the multilinear reference tissue model [MRTM2]). SUV ratio (SUVR) was determined at different imaging windows after injection. The correlation between DVR and SUVR, effect size (Cohen's d), and test-retest variability (TRV) were evaluated. Additionally, 6 HCs received 1 tracer administration and underwent whole-body PET for dosimetry calculation. Organ doses and the whole-body effective dose were calculated using OLINDA 2.0. Results: A strong correlation was found across different kinetic models (R ² > 0.97) and between DVR(2TC) and SUVR between 30 and 90 min, with an R ² of more than 0.95. Secular equilibrium was reached at around 40 min after injection in most regions and subjects. TRV and effect size for SUVR across different regions were similar at 30-60 min (TRV, 3.8%; Cohen's d, 3.80), 45-75 min (TRV, 4.3%; Cohen's d, 3.77) and 60-90 min (TRV, 4.9%; Cohen's d, 3.73) and increased at later time points. Elimination was via the hepatobiliary and urinary systems. The whole-body effective dose was 33.3 ± 2.1 μSv/MBq for an adult female and 33.1 ± 1.4 μSv/MBq for an adult male, with a 1.5-h urinary bladder voiding interval. Conclusion: ¹⁸F-PI-2620 exhibits fast kinetics, suitable dosimetry, and low TRV. DVR measured using the 2TC model with arterial sampling correlated strongly with DVR measured by NI-LGA, MRTM2, and SUVR. SUVR can be used for ¹⁸F-PI-2620 PET quantification of tau deposits, avoiding arterial blood sampling. Static ¹⁸F-PI-2620 PET scans between 45 and 75 min after injection provide excellent quantification accuracy, a large effect size, and low TRV.

Preclinical Evaluation and Nonhuman Primate Receptor Occupancy Study of 18F-JNJ-64413739, a PET Radioligand for P2X7 Receptors

The P2X7 receptor is an adenosine triphosphate-gated ion channel, which is abundantly expressed in glial cells within the central nervous system and in the periphery. P2X7 receptor activation leads to the release of the proinflammatory cytokine IL-1β in the brain, and antagonism of the P2X7 receptor is a novel therapeutic strategy to dampen adenosine triphosphate-dependent IL-1β signaling. PET ligands for the P2X7 receptor will not only be valuable to assess central target engagement of drug candidates but also hold promise as surrogate markers of central neuroinflammation. Herein we describe the in vitro and in vivo evaluation of ¹⁸F-JNJ-64413739, an ¹⁸F-labeled PET ligand for imaging the P2X7 receptor in the brain. Methods: P2X7 receptor affinity and specificity, pharmacokinetics, metabolic stability, blood-brain barrier permeability, and off-target binding of JNJ-64413739 were evaluated in a series of in vitro, ex vivo, and in vivo assays. ¹⁸F-JNJ-64413739 was radiolabeled via a one-step nucleophilic aromatic substitution. The tracer was also studied in rhesus macaques, and PET images were analyzed with an arterial plasma input function-based Logan graphical analysis. Results: The potency (half-maximal inhibitory concentration) of the P2X7 receptor antagonist JNJ-64413739 is 1.0 ± 0.2 nM and 2.0 ± 0.6 nM at the recombinant human and rat P2X7 receptor, respectively, and the binding affinity is 2.7 nM (rat cortex binding assay) and 15.9 nM (human P2X7 receptor). In nonhuman primate PET imaging studies, dose-dependent receptor occupancy of JNJ-54175446 was observed in 2 rhesus monkeys. At a 0.1 mg/kg dose (intravenous) of JNJ-54175446, the receptor occupancy was calculated to be 17% by Logan graphical analysis, whereas a dose of 2.5 mg/kg yielded a receptor occupancy of 60%. Conclusion: The preclinical evaluation of ¹⁸F-JNJ-64413739 demonstrates that the tracer engages the P2X7 receptor. Reproducible and dose-dependent receptor occupancy studies with the P2X7 receptor antagonist JNJ-54175446 were obtained in rhesus monkeys. This novel PET tracer exhibits in vitro and in vivo characteristics suitable for imaging the P2X7 receptor in the brain and warrants further studies in humans.

Data collection assessment for the human performance analysis in nuclear installations

The purpose of this paper is to provide a good knowledge and understanding on the main factors influencing human performance in complex systems operation. Identification and establishment of the necessary data for human factor performance analysis in a socio-technical context based on the analysis of HRA methods are performed. An evaluation of the techniques used for collecting and characterization of necessary data for HRA (observation, questionnaire, interview, task analysis, change analysis, simulator, expert judgement) is achieved also. The necessary data to perform HRA for the TRIGA reactor operation, for activities of the post-irradiation examination laboratory and activities of the radioactive waste plant treatment from RATEN ICN Pitesti were obtained. Recommendations on how to obtain data and knowledge related to development of methodical framework of HRA data collection, characterization and evaluation are also presented in this paper.

Synthesis and in vivo Evaluation of Fluorine-18 and Iodine-123 Pyrazolo[4,3-e]-1,2,4-triazolo[1,5-c]pyrimidine Derivatives as PET and SPECT Radiotracers for Mapping A2A Receptors

Imaging agents that target adenosine type 2A (A2A ) receptors play an important role in evaluating new pharmaceuticals targeting these receptors, such as those currently being developed for the treatment of movement disorders like Parkinson's disease. They are also useful for monitoring progression and treatment efficacy by providing a noninvasive tool to map changes in A2A receptor density and function in neurodegenerative diseases. We previously described the successful evaluation of two A2A -specific radiotracers in both nonhuman primates and in subsequent human clinical trials: [(123) I]MNI-420 and [(18) F]MNI-444. Herein we describe the development of both of these radiotracers by selection from a series of A2A ligands, based on the pyrazolo[4,3-e]-1,2,4-triazolo[1,5-c]pyrimidine core of preladenant. Each of this series of 16 ligands was found to bind to recombinant human A2A receptor in the low nanomolar range, and of these 16, six were radiolabeled with either fluorine-18 or iodine-123 and evaluated in nonhuman primates. These initial in vivo results resulted in the identification of 7-(2-(4-(4-(2-[(18) F]fluoroethoxy)phenyl)piperazin-1-yl)ethyl)-2-(furan-2-yl)-7H-pyrazolo[4,3-e][1,2,4]triazolo[1,5-c]pyrimidin-5-amine ([(18) F]MNI-444) and 7-(2-(4-(2-fluoro-4-[(123) I]iodophenyl)piperazin-1-yl)ethyl)-2-(furan-2-yl)-7H-imidazo[1,2-c]pyrazolo[4,3-e]pyrimidin-5-amine ([(123) I]MNI-420) as PET and SPECT radiopharmaceuticals for mapping A2A receptors in brain.

Identification and in vivo evaluation of a fluorine-18 rolipram analogue, [(18) F]MNI-617, as a radioligand for PDE4 imaging in mammalian brain

Phosphodiesterase (PDE) 4 is the most prevalent PDE in the central nervous system (CNS) and catalyzes hydrolysis of intracellular cAMP, a secondary messenger. By therapeutic inhibition of PDE4, intracellular cAMP levels can be stabilized, and the symptoms of psychiatric and neurodegenerative disorders including depression, memory loss and Parkinson's disease can be ameliorated. Radiotracers targeting PDE4 can be used to study PDE4 density and function, and evaluate new PDE4 therapeutics, in vivo in a non-invasive way, as has been shown using the carbon-11 labeled PDE4 inhibitor R-(-)-rolipram. Herein we describe a small series of rolipram analogs that contain fluoro- or iodo-substituents that could be used as fluorine-18 PET or iodine-123 SPECT PDE4 radiotracers. This series was evaluated with an in vitro binding assay and a 4-(fluoromethyl) derivative of rolipram, MNI-617, was identified, with a five-fold increase in affinity for PDE4 (Kd  = 0.26 nM) over R-(-)-rolipram (Kd  = 1.6 nM). A deutero-analogue d2 -[(18) F]MNI-617 was radiolabeled and produced in 23% yield with high (>5 Ci/µmol) specific activity and evaluated in non-human primate, where it rapidly entered the brain, with SUVs between 4 and 5, and with a distribution pattern consistent with that of PDE4.

PARTIAL INDEPENDENCE OF FINGOLIMOD EFFECT ON DIFFUSE VS. FOCAL DAMAGE

Objective

To investigate if the effects of fingolimod 0.5mg on brain volume loss are mediated through effects on focal disease activity (FD) or independent-reduction of diffuse damage (DD).

Methods

FREEDOMS and FREEDOMS-II data was pooled and analyzed post-hoc. Assessment of the percent brain volume change (PBVC) at M12 and 24, in patients with no evidence of FD, (absence of new Gd+ T1-lesions and/or new/enlarging T2-lesions) and clinical relapses. Regression analysis of the intent-to-treat (ITT) population to quantified whether the extent of the treatment effect was maintained for patients with new/active lesions and relapses

Results

Of the 1383 patients included, 808 patients (placebo=142; fingolimod=666) showed no FD at M12 and 573 patients (placebo=79; fingolimod=494) at M24 showed no FD. Fingolimod significantly reduced PBVC by 52% and 42% vs. placebo, over 12M and 24M respectively. In the pooled ITT population, fingolimod reduced 49% of PBVC (p<0.001)vs placebo over 24M. This effect was still evident when adjusting for new-active lesions and relapse activity (28% reduction vs placebo, p<0.001). The regression model suggests 57% of fingolimod effect on PBVC is FD-independent. Fingolimod effect on DD is partly independent of its treatment effect on FD, suggesting fingolimod impacts both inflammatory and neurodegenerative components.

Ultra-high ordered, centimeter scale preparation of microsphere Langmuir films

Controlling the preparation of nano/microsphere monolayers on large areas remains a difficult task but is crucial for several fabrication methods of highly-ordered periodic nanostructures. We demonstrate the preparation of ordered monolayers of few square centimeters with an extremely high coverage ratio (>98%) by implementing a modified protocol (MP) Langmuir Blodgett (LB) technique. We use octadecyl type hydrocarbon (C18) functionalized spherical particles (polystyrene and silica) with diameters in the range 1-5 μm, and a selected mixture of solvents for accurate control of the surface tension and particles' mobility at the water surface. This leads to a delicate growth of crystal-like monolayers which are subsequently transferred to glass or silicon substrates. While operating the Langmuir-Blodgett trough, a key enabling the quality enhancement resides not only on surface tension measurements but also on simple visual inspections of the water surface supporting the monolayer. The protocol yields a strong reduction of sensitivity to thermodynamical and mechanical disturbances leading to a robust method that could be automated by adding a feedback on the operated system based real-time image processing. A simple analytical approach is used to explain why this MP-LB technique is more appropriate in growing micrometric-sized objects in comparison to standard protocols optimized for the preparation of molecular films.