Construction of prediction model for fetal growth restriction during first trimester in an Asian population

OBJECTIVE

To construct a prediction model for fetal growth restriction (FGR) during the first trimester of pregnancy and evaluate its screening performance.

METHODS

This was a prospective cohort study of singleton pregnancies that underwent routine ultrasound screening at 11 to 13 + 6 weeks at the Affiliated Suzhou Hospital of Nanjing Medical University between January 2019 and April 2022. Basic clinical information, ultrasound indicators and serum biomarkers of pregnant women were collected. Fetal weight assessment was based on the fetal growth curve for the Southern Chinese population. FGR was diagnosed according to Delphi consensus criteria. Least absolute shrinkage and selection operator (lasso) regression was used to select variables for inclusion in the model. Discrimination, calibration and clinical effectiveness of the model were evaluated in training and validation cohorts.

RESULTS

A total of 1188 pregnant women were included, of whom 108 had FGR. Lasso regression identified seven predictive features, including history of maternal hypertension, maternal smoking or passive smoking, gravidity, uterine artery pulsatility index, ductus venosus pulsatility index and multiples of the median values of placental growth factor and soluble fms-like tyrosine kinase-1. The nomogram prediction model constructed from these seven variables accurately predicted FGR, and the area under the receiver-operating-characteristics curve in the validation cohort was 0.82 (95% CI, 0.74-0.90). The calibration curve and Hosmer-Lemeshow test demonstrated good calibration, and the clinical decision curve and clinical impact curve supported its practical value in a clinical setting.

CONCLUSION

The multi-index prediction model for FGR has good predictive value during the first trimester. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

[The impact of the highest mediastinal lymph node metastasis on postoperative recurrence and survival in non-small cell lung cancer patients]

Objective: To examine whether the highest mediastinal lymph node (HMLN) metastasis had an influence on postoperative recurrence and survival among non-small cell lung cancer (NSCLC) patients with pN2 lymph node metastasis. Methods: A total of 261 patients who underwent radical resection of lung cancer and systematic lymph node dissection in the Department of Thoracic Surgery of Peking University First Hospital from January 2007 to December 2016 were retrospectively analyzed. There were 180 males and 81 females, aged (61.5±9.4) years (range: 31 to 83 years). There were 128 cases of HMLN-positive and 133 cases of HMLN-negative. They were pathologically confirmed N2 stage NSCLC and postoperative recurrence and survival were followed up. The Kaplan-Meier method was used to calculate disease-free survival (DFS) and overall survival (OS) curves according to whether HMLN metastasize or not. The Cox proportional hazards regression model was used for the prognostic analysis. Results: The median DFS and the median OS of the whole group were 28 months and 44 months, respectively. The median DFS in HMLN-positive and HMLN-negative patients was 19 months and 33 months, respectively (P=0.005). The median OS of HMLN-positive and HMLN-negative group was 37 months and 49 months, respectively (P=0.005). Multivariate analysis showed that pneumonectomy and visceral pleural invasion were independent risk factors for both postoperative OS (HR=1.85, 95%CI: 1.25 to 2.72, P=0.002; HR=1.82, 95%CI: 1.30 to 2.56, P=0.007) and DFS (HR=1.61, 95%CI: 1.10 to 2.35, P=0.014; HR=1.77, 95%CI: 1.27 to 2.46,P=0.001). HMLN metastasis and lymphovascular invasion were independent risk factors for only postoperative DFS (HR=1.39, 95%CI: 1.03 to 1.87, P=0.030; HR=1.40, 95%CI: 0.99 to 1.81, P=0.042). Conclusions: For patients of pN2 stage NSCLC, both postoperative recurrence and long-term survival were significantly worse in the HMLN metastatic group. In addition, pneumonectomy and visceral pleural invasion were unfavorable factors that affected both recurrence and overall survival. HMLN metastasis and lymphovascular invasion could shorten the postoperative time for DFS.

[A method for sensitivity analysis of deviation factor for geometric correction of cone-beam CT system]

OBJECTIVE

To propose a sensitivity test method for geometric correction position deviation of cone-beam CT systems.

METHODS

We proposed the definition of center deviation and its derivation. We analyzed the influence of the variation of the three-dimensional spatial center of the steel ball point, the projection center and the size of the steel ball point on the deviation of geometric parameters and the reconstructed image results by calculating the geometric correction parameters based on the Noo analytical method using the FDK reconstruction algorithm for image reconstruction.

RESULTS

The radius of the steel ball point was within 3 mm. The deviation of the center of the calibration parameter was within the order of magnitude and negligible. A 10% Gaussian perturbation of a single pixel in the 3D spatial coordinates of the steel ball point produced a deviation of about 3 pixel sizes, while the same Gaussian perturbation of the 2D projection coordinates of the steel ball point produced a deviation of about 2 pixel sizes.

CONCLUSION

The geometric correction is more sensitive to the deviation generated by the three-dimensional spatial coordinates of the steel ball point with limited sensitivity to the deviation generated by the two-dimensional projection coordinates of the steel ball point. The deviation sensitivity of a small diameter steel ball point can be ignored.

[Prediction of 1p/19q codeletion status in diffuse lower-grade glioma using multimodal MRI radiomics]

OBJECTIVE

To develop a noninvasive method for prediction of 1p/19q codeletion in diffuse lower-grade glioma (DLGG) based on multimodal magnetic resonance imaging (MRI) radiomics.

METHODS

We collected MRI data from 104 patients with pathologically confirmed DLGG between October, 2015 and September, 2022. A total of 535 radiomics features were extracted from T₂WI, T₁WI, FLAIR, CE-T₁WI and DWI, including 70 morphological features, 90 first order features, and 375 texture features. We constructed logistic regression (LR), logistic regression least absolute shrinkage and selection operator (LRlasso), support vector machine (SVM) and Linear Discriminant Analysis (LDA) radiomics models and compared their predictive performance after 10-fold cross validation. The MRI images were reviewed by two radiologists independently for predicting the 1p/19q status. Receiver operating characteristic curves were used to evaluate classification performance of the radiomics models and the radiologists.

RESULTS

The 4 radiomics models (LR, LRlasso, SVM and LDA) achieved similar area under the curve (AUC) in the validation dataset (0.833, 0.819, 0.824 and 0.819, respectively; P>0.1), and their predictive performance was all superior to that of resident physicians of radiology (AUC=0.645, P=0.011, 0.022, 0.016, 0.030, respectively) and similar to that of attending physicians of radiology (AUC=0.838, P>0.05).

CONCLUSION

Multiparametric MRI radiomics models show good performance for noninvasive prediction of 1p/19q codeletion status in patients with in diffuse lower-grade glioma.

Modelling interventions and contact networks to reduce the spread of carbapenem-resistant organisms between individuals in the ICU

BACKGROUND

Contact precautions are widely used to prevent the transmission of carbapenem-resistant organisms (CROs) in hospital wards. However, evidence for their effectiveness in natural hospital environments is limited.

OBJECTIVE

To determine which contact precautions, healthcare worker (HCW)-patient interactions, and patient and ward characteristics are associated with greater risk of CRO infection or colonization.

DESIGN, SETTING AND PARTICIPANTS

CRO clinical and surveillance cultures from two high-acuity wards were assessed through probabilistic modelling to characterize a susceptible patient's risk of CRO infection or colonization during a ward stay. User- and time-stamped electronic health records were used to build HCW-mediated contact networks between patients. Probabilistic models were adjusted for patient (e.g. antibiotic administration) and ward (e.g. hand hygiene compliance, environmental cleaning) characteristics. The effects of risk factors were assessed by adjusted odds ratio (aOR) and 95% Bayesian credible intervals (CrI).

EXPOSURES

The degree of interaction with CRO-positive patients, stratified by whether CRO-positive patients were on contact precautions.

MAIN OUTCOMES AND MEASURES

The prevalence of CROs and number of new carriers (i.e. incident CRO aquisition).

RESULTS

Among 2193 ward visits, 126 (5.8%) patients became colonized or infected with CROs. Susceptible patients had 4.8 daily interactions with CRO-positive individuals on contact precautions (vs 1.9 interactions with those not on contact precautions). The use of contact precautions for CRO-positive patients was associated with a reduced rate (7.4 vs 93.5 per 1000 patient-days at risk) and odds (aOR 0.03, 95% CrI 0.01-0.17) of CRO acquisition among susceptible patients, resulting in an estimated absolute risk reduction of 9.0% (95% CrI 7.6-9.2%). Also, carbapenem administration to susceptible patients was associated with increased odds of CRO acquisition (aOR 2.38, 95% CrI 1.70-3.29).

CONCLUSIONS AND RELEVANCE

In this population-based cohort study, the use of contact precautions for patients colonized or infected with CROs was associated with lower risk of CRO acquisition among susceptible patients, even after adjusting for antibiotic exposure. Further studies that include organism genotyping are needed to confirm these findings.

[A region-level contrastive learning-based deep model for glomerular ultrastructure segmentation on electron microscope images]

OBJECTIVE

We propose a novel region- level self-supervised contrastive learning method USRegCon (ultrastructural region contrast) based on the semantic similarity of ultrastructures to improve the performance of the model for glomerular ultrastructure segmentation on electron microscope images.

METHODS

USRegCon used a large amount of unlabeled data for pre- training of the model in 3 steps: (1) The model encoded and decoded the ultrastructural information in the image and adaptively divided the image into multiple regions based on the semantic similarity of the ultrastructures; (2) Based on the divided regions, the first-order grayscale region representations and deep semantic region representations of each region were extracted by region pooling operation; (3) For the first-order grayscale region representations, a grayscale loss function was proposed to minimize the grayscale difference within regions and maximize the difference between regions. For deep semantic region representations, a semantic loss function was introduced to maximize the similarity of positive region pairs and the difference of negative region pairs in the representation space. These two loss functions were jointly used for pre-training of the model.

RESULTS

In the segmentation task for 3 ultrastructures of the glomerular filtration barrier based on the private dataset GlomEM, USRegCon achieved promising segmentation results for basement membrane, endothelial cells, and podocytes, with Dice coefficients of (85.69 ± 0.13)%, (74.59 ± 0.13)%, and (78.57 ± 0.16)%, respectively, demonstrating a good performance of the model superior to many existing image-level, pixel-level, and region-level self-supervised contrastive learning methods and close to the fully- supervised pre-training method based on the large- scale labeled dataset ImageNet.

CONCLUSION

USRegCon facilitates the model to learn beneficial region representations from large amounts of unlabeled data to overcome the scarcity of labeled data and improves the deep model performance for glomerular ultrastructure recognition and boundary segmentation.

User experience with a parenting chatbot micro intervention

Background

The use of chatbots to address mental health conditions have become increasingly popular in recent years. However, few studies aimed to teach parenting skills through chatbots, and there are no reports on parental user experience. Aim: This study aimed to assess the user experience of a parenting chatbot micro intervention to teach how to praise children in a Spanish-speaking country.

Methods

A sample of 89 parents were assigned to the chatbot micro intervention as part of a randomized controlled trial study. Completion rates, engagement, satisfaction, net promoter score, and acceptability were analyzed.

Results

66.3% of the participants completed the intervention. Participants exchanged an average of 49.8 messages (SD = 1.53), provided an average satisfaction score of 4.19 (SD = .79), and reported that they would recommend the chatbot to other parents (net promoter score = 4.63/5; SD = .66). Acceptability level was high (ease of use = 4.66 [SD = .73]; comfortability = 4.76 [SD = .46]; lack of technical problems = 4.69 [SD = .59]; interactivity = 4.51 [SD = .77]; usefulness for everyday life = 4.75 [SD = .54]).

Conclusions

Overall, users completed the intervention at a high rate, engaged with the chatbot, were satisfied, would recommend it to others, and reported a high level of acceptability. Chatbots have the potential to teach parenting skills however research on the efficacy of parenting chatbot interventions is needed.

Rare Case of Distant Cutaneous Metastasis of Urothelial Carcinoma

Introduction/Objective

Cutaneous metastasis of urothelial carcinoma is extremely rare with poor prognosis. Many cutaneous metastases present in locoregional areas such as abdomen, groin, genitalia or thigh. Only very few cases present with distant cutaneous metastases. We report a rare case of urothelial carcinoma presenting with a cutaneous metastasis to the right neck.

Methods/Case Report

A 71-year-old male with a history of prostate cancer in 2009 presented with hematuria with clots, urinary retention and dysuria. The patient was also noted to have right submandibular ulcerative mass measuring 2.6 cm. Cystoscopy revealed a nodular tumor in the right lateral trigone area and transurethral resections of bladder tumor revealed high-grade papillary urothelial carcinoma, invasive into muscularis propria with lymphovascular invasion. Skin punch biopsy of the right submandibular mass was obtained revealing an infiltrative nodular proliferation of sheets of atypical epithelioid cells with readily identifiable mitoses in at least the dermis without an epidermal connection. Immunostains show the lesional cells are positive for CK5/6, EMA, Ber-EP4 (weak), p40, and GATA3 with variable positivity for p16, consistent with metastatic urothelial carcinoma. The patient received 4 cycles of cisplatin-gemcitabine chemotherapy with good partial response, continued with avelumab for maintenance therapy and is alive up to 6 months.

Results (if a Case Study enter NA)

NA.

Conclusion

Most cutaneous metastases of urothelial carcinoma occur in the local region and have poor prognosis with patients dying within several weeks without treatment. It is important for pathologists to be aware of cutaneous metastatic urothelial carcinoma in more distant sites.

Atrial fibrillation in patients with Graves disease: incidence, risk factors and outcomes

Background

Graves' disease (GD) is associated with atrial fibrillation (AF) with a prevalence ranging between 16% and 60%, but its risk factors are not well-defined. We aimed to describe the incidence, risk factors and outcomes of GD-related AF.

Methods

Patients diagnosed with GD between 2009 and 2019 were included retrospectively. We defined GD-related AF as AF diagnosed within 30 days before or any time after diagnosis of GD. Late onset AF was defined as GD-related AF diagnosed more than 90 days after GD diagnosis. Observed AF events were compared to the expected events in the general population utilizing published data of age and sex-specific rates of AF.

Results

Of 1371 patients with GD, AF occurred in 139 (10.1%) patients. Late onset AF occurred in 32 (23%), of which 50% had attained euthyroidism. The observed incidence of AF was higher in GD than that expected in the general population (p<0.001), Figure 1. When comparing the incidence of only late AF to that in the general population, late AF still happened more frequently in GD although not achieving statistical significance (p=0.06), Figure 1. Independent risk factors were age [HR 1.05 (1.03–1.06) per year], overt hyperthyroidism [HR 2.71 (1.35–5.44)], and male gender [HR 2.42 (1.57–3.71)] for early AF and age [HR 1.06 (1.02–1.09) per year], BMI [1.07 (1.01–1.12) per unit], COPD [3.33 (1.08–10.27)), heart failure [HR 4.19 (1.39–17.42)], and treatment with thionamide [vs. radioiodine ablation HR 2.94 (1.38–6.27)] for late AF. AF was associated with higher rates of mortality [HR 16.32 (4.66–56.58)], acute coronary syndrome/stable angina events [HR 3.89 (1.23–12.31)], and cardiac hospitalizations [HR 15.39 (8.17–29.00)] when adjusted to age, sex, and previous AF.

Conclusion

AF occurred in 10.1% of GD patients. Late onset AF is an important entity comprising a quarter of GD-related AF cases and requires surveillance even after restoring euthyroidism. Risk factors for AF in GD are similar to those in general population, although overt hyperthyroidism conferred the highest risk, especially for early AF. Treatment with thionamide was associated with late AF.

Funding Acknowledgement

Type of funding sources: None.

P-676 Comparison of hCG triggering versus hCG in combination with a GnRH agonist: a prospective randomized controlled trial

Study question

Does co-administration of GnRH agonist and Human chorionic gonadotropin(dual trigger) in PGT cycles improve the number of usable blastocysts per patient compared to hCG alone?

Summary answer

Using the dual trigger has no effect on the number of usable blastocysts undergoing the GnRH-ant protocol for PGT compared to triggering with hCG alone.

What is known already

HCG is used at the end of controlled ovarian hyperstimulation as a surrogate LH surge to induce final oocyte maturation. Recently, based on retrospective studies, the co-administration of GnRH agonist and hCG for final oocyte maturation (dual trigger) has been suggested to improve IVF outcome and pregnancy rates.

Study design, size, duration

A prospective, randomized, open-label controlled clinical trial (ChiCTR-ICR-2000031342), enrolled patients attending our university affiliated Infertility and IVF center (the Reproductive and Genetic Hospital of CITIC-Xiangya, China) between August 2020 and June 2021. This sample size achieves with a power of 80%, at a significance level(α) of 0.05. A sample size of 160 patients, 80 randomized to each group, was chosen to allow for those 10% dropped out.

Participants/materials, setting, methods

The inclusion criteria for participating were: women age 20–35years, AMH≥1.2ng/ml and /or AFC ≥5, Couples with PGT-SR preimplantation genetic testing for chromosomal structural rearrangements (patients with abnormal chromosomal structure only in male or female), undergoing one of their first PGT cycle attempts. Patients fulfilled the criteria on the trigger day were randomly assigned to receive hCG or the dual trigger for final oocyte maturation. The primary outcome was the number of usable blastocysts per patient.

Main results and the role of chance

160 patients were included in the study. The age (29.1 years versus 29.4 years), BMI (22.1 kg/m2 versus 21.9 kg/m2) and the AMH (5.3 ng/ml versus 5.3 ng/ml) were comparable between the two groups. Based on PP analysis, there were no statistical difference in the number of eggs retrieved (17.1 versus 15.9), the MII oocytes (13.3 versus 12.5), the number of usable blastocysts per patient (5.0 versus 4.6) and top-quality blastocysts per patient (3.4 versus 3.2) between the two groups.

Limitations, reasons for caution

None

Wider implications of the findings

The enhanced response observed with the dual trigger might lead to better IVF outcomes were it used more widely.

Trial registration number

ChiCTR-ICR-2000031342

P-524 Bi-allelic CFAP61 variants cause male infertility in humans and mice with severe oligoasthenoteratozoospermia

Study question

Are mutations in cilia and flagella-associated protein 61 (CFAP61) associated with human male infertility?

Summary answer

Bi-allelic variants ([NM_015585.4: c.1654C>T (p.R552C) and c.2911G>A (p.D971N), c.144-2A>G and c.1666G>A (p.G556R)] in CFAP61 were identified as contributory genetics factor in severe oligoasthenoteratozoospermia (OAT).

What is known already

Cfap61 knockout mice were infertile due to multiple morphological abnormalities of the sperm flagella (MMAF). However, so far there is no direct evidence that mutations of CFAP61 cause OAT and male infertility.

Study design, size, duration

Variant screening was performed by whole-exome sequencing (WES) from 325 infertile patients with OAT and 392 fertile individuals. A knockout mouse model was generate to confirm the candidate disease-causing gene, intracytoplasmic sperm injection (ICSI) was used to evaluate the efficiency of clinical treatment.

Participants/materials, setting, methods

A total 325 OAT-affected patients and 392 men with normal fertility were recruited from China. WES was performed, followed by Sanger sequencing validation. In silico bioinformatics predictions and in vitro functional analyses were performed to evaluate the impacts of candidate disease-causing variants. Hematoxylin and eosin (H&E) staining, electron microscopy, and immunofluorescence assays were performed to evaluate the sperm morphology. Two OAT-affected men with CFAP61 variants were treated by ICSI, and pregnancy outcomes were followed.

Main results and the role of chance

We identified bi-allelic CFAP61 variants [NM_015585.4: c.1654C>T (p.R552C) and c.2911G>A (p.D971N), c.144-2A>G and c.1666G>A (p.G556R)] in two (0.62%) of the 325 OAT-affected men. In silico bioinformatics analysis predicted that all four variants were deleterious, and in vitro functional analysis confirmed the deleterious effects of the mutants. Notably, H&E staining and electron microscopy analyses of the spermatozoa revealed multiple morphological abnormalities of sperm flagella, the absence of central pair microtubules, and mitochondrial sheath malformation in sperm flagella from man with CFAP61 variants. Further immunofluorescence assays revealed markedly reduced CFAP61 staining in the sperm flagella. In addition, Cfap61-deficient mice showed the OAT phenotype, suggesting that loss of function of CFAP61 was the cause of OAT. Two individuals accepted ICSI therapy using their own ejaculated sperm, and one of them succeeded in fathering a healthy baby.

Limitations, reasons for caution

Limitations include the lack of in vivo data from the one of patients, and the exact molecular mechanism should be further investigated.

Wider implications of the findings

Our findings indicate that CFAP61 is essential for spermatogenesis and that bi-allelic CFAP61 variants lead to OAT and male infertility in humans and mice. In addition, our results show that ICSI treatment can be recommended for CFAP61-related OAT.

Trial registration number

not applicable

P-060 Bubble-shaped Acrosome: Novel phenotype of Teratozoospermia Caused by Mutation in Actin-like 7A

Study question

What’s the etiology of severe teratozoospermia characteristic as bubble-shaped acrosome (BSA)?

Summary answer

Severe teratozoospermia characterized as BSA caused by mutation (c.1024G>A) in actin-like 7A (ACTL7A).

What is known already

Teratozoospermia is a common cause of male infertility, defined by having a proportion of morphologically normal sperm at less than 4%. It exhibits aberrant sperm phenotypes in the head, neck, midpiece, and endpiece of sperm. Teratozoospermia with ephalic abnormalities are among the most severe and characteristic sperm defects. Some genetic factors are reported to be associated with ephalic abnormalities such as globozoospermia and macrozoospermia. However, other phenotypes and the causative genes of ephalic abnormalities, especially in acrosomal structure, and were largely unknown.

Study design, size, duration

Severe teratozoospermia were recruited from the Reproductive and Genetic Hospital of CITIC-Xiangya from Jan 2019 to Dec 2021.

Participants/materials, setting, methods

Whole-exome sequencing analysis was used to analyze the genetic factor of man. An Actl7a-mutated mouse model was generated by CRISPER-Cas9. Transmission electron microscopy was used to detect the abnormality of ultrastructure during acrosome biogenesis. Immunostaining was used to analyze the localization of ACTL7A and PLCζ. Immunoprecipitation followed by liquid chromatography-mass spectrometry (LC-MS) was used to select the differentially expressed proteins. ICSI with calcium ionophore exposure was performed in couple with ACTL7A mutation.

Main results and the role of chance

We found a man with severe teratozoospermia characterized as BSA carrying a mutation (c.1024G>A) in ACTL7A. Homozygous Actl7a-mutated male mice were sterile, and all of sperm showed acrosomal abnormalities. During acrosomal biogenesis, it detected the acrosome detach from the nuclear in Actl7a-mutated mice. Furthermore, mutant ACTL7A failed to attach to the acroplaxome and was discharged by cytoplasmic droplets, which led to the absence of ACTL7A in mature sperm. The mutant sperm failed to activate the oocyte, and PLCζ discharge accompanied by ACTL7A was observed, leading to total fertilization failure (TFF). Immunoprecipitation followed by LC-MS showed that several differentially expressed proteins participate in acrosome assembly and actin filament organization. Furthermore, assisted oocyte activation by calcium ionophore exposure successfully overcame TFF in a couple with an ACTL7A mutation.

Limitations, reasons for caution

More cases are needed to demonstrate the relationship between mutation and phenotype.

Wider implications of the findings

Our study defined a novel phenotype of the acrosomal abnormality characterized as BSA and revealed the underlying mechanism of mutation in ACTL7A and provided a genetic marker and a therapeutic option for male infertility.

Trial registration number

Not Applicable

Pregnancy outcome after in-vitro fertilization/intracytoplasmic sperm injection in women with congenital uterus didelphys

OBJECTIVE

To investigate the pregnancy and obstetric outcomes of patients with congenital uterus didelphys who achieved clinical pregnancy after in-vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI).

METHODS

This was a retrospective matched-cohort study of 83 infertile patients with uterus didelphys who underwent IVF/ICSI and achieved clinical pregnancy from January 2005 to December 2018 at our center. For each patient in the study group, three control patients with normal uterine morphology who underwent IVF/ICSI in 2018 were selected randomly. Patients in the two groups were matched for number of gestational sacs, maternal age, infertility type, cause of infertility, fertilization method, endometrial thickness 1 day before embryo transfer and number of embryos transferred. The classification of congenital uterine anomalies was based on the American Fertility Society system (1988). The pregnancy and obstetric outcomes of the didelphic and control groups were compared separately for singleton and twin pregnancies, and for all pregnancies combined.

RESULTS

In singleton pregnancies, women with uterus didelphys had increased risk of preterm birth (odds ratio (OR), 4.68; rate difference (RD), 0.14; P < 0.001), Cesarean section (OR, 2.80; RD, 0.17; P = 0.016) and birth weight < 2500 g (OR, 4.06; RD, 0.10; P = 0.017) compared to women with normal uterine morphology. In twin pregnancies, the presence of uterus didelphys was associated with increased risk of preterm delivery (OR, 4.79; RD, 0.37; P = 0.006), perinatal mortality (OR, 3.16; RD, 0.19; P = 0.043) and birth weight < 2500 g (OR, 9.57; RD, 0.35; P = 0.001).

CONCLUSIONS

The presence of uterus didelphys was associated with significantly increased risk of some adverse pregnancy outcomes compared to pregnancies with normal uterine morphology in women who underwent IVF/ICSI. A twin pregnancy in women with uterus didelphys was associated with worse perinatal outcome. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.

Pulmonary artery pulsatility index by echocardiography predicts mortality in patients with pulmonary hypertension

Funding Acknowledgements

Type of funding sources: None.

Background

Pulmonary hypertension (PH) is a progressive pulmonary vascular disorder with an elevated mortality risk due to right ventricular failure. Pulmonary arterial pulsatility index (PAPi) based on invasively acquired parameters has emerged as a potentially valuable hemodynamic risk predictor. Whether non-invasively derived PAPi (PA pulse pressure/ RA pressure) is valuable is unclear.

Purpose

To assess whether PAPi measured non-invasively by transthoracic echocardiography acts as a prognostic hemodynamic biomarker of patient risk.

Methods

Consecutive patients undergoing transthoracic echocardiography for known or suspected PH over a one year period were included. PA systolic and diastolic pressure were estimated in standard fashion from peak tricuspid and end-pulmonary regurgitant Doppler profiles. Right atrial pressure was estimated based on 2D & Doppler assessment of the inferior vena cava  hepatic vein. In those patients with PH (mean PA pressure &gt; 20 mm Hg), PAPi was divided into 3 groups based on prior publications with invasive data as &lt;1.5, 1.5 to 3 and &gt;3. Mortality was assessed over 5 years.

Results

Of 1,045 patients enrolled 64% had PH. Patients with the lowest PAPi (table) had higher NT-proBNP levels, larger right ventricles, worse right heart systolic function (cardiac output, TAPSE, systolic annular velocity, free wall systolic strain) and greater degrees of tricuspid regurgitation (Table). In patients with PH, PAPi was inversely associated with death (figure, p &lt; 0.0001) with each group of PAPi correlating with incrementally worse survival. Patients with a PAPi of &lt;1.5 had worst right heart size and dysfunction on echo (table) and worst survival (figure).

Conclusions

In patients with PH, low PAPi derived non-invasively by transthoracic echocardiography is associated with markers of right heart failure, right ventricular dysfunction and worse survival. PAPi could be incorporated into the conventional echo parameters reported in patients with known or suspected PH and maybe a useful predictor of outcome. Abstract Table  Abstract Figure

RV free wall longitudinal strain as an independent predictor of survival in wtATTR-CA patients

Background

Wild type transthyretin cardiac amyloidosis (wtATTR-CA) is increasingly recognized as a cause of heart failure with preserved ejection fraction (HFpEF) but prognosis is often limited due to late or misdiagnosis.Longitudinal left ventricular strain and biomarkers are established as markers of disease severity, but the role of RV free wall strain, reflecting RV contractility, is less well understood.

Purpose

We sought to determine whether RV free wall strain might add incremental prognostic value in wtATTR-CA.

Methods

Consecutive patients diagnosed with wtATTR-CA with tissue confirmation at Mayo clinic between 2013 and 2015 were included. Patients with TTR gene mutations were excluded. Baseline characteristics and transthoracic echocardiography measurements were obtained from the medical records. Speckle tracking RV free wall longitudinal 2D strain and peak LA longitudinal 2D strain were measured using Tom Tec Imaging System. Survival was determined using Kaplan Meier estimates and using the cox proportional hazard ratio, univariate and multivariable analysis were performed to identify predictors of mortality in patients with wtATTR.

Results

The study group comprised 139 patients (mean age 74.9±8.6, 92.8% male), of which 102 had adequate image quality for RV strain, and 99 for LA strain. Amongst these, 102 (73.3%) had AF and 118 patients (84.8%) had HF. During 3.23±2.0 years of follow up, 66 patients died. Both mean RV and LA strain were impaired at baseline: RV free wall strain was −14.7±4.9, and peak atrial longitudinal strain (PALS) was 13.2±8.8%. Using ROC analysis, RV strain of −16.8% was an independent predictor of all-cause mortality. In univariate modeling, higher levels of NT-proBNP (HR: 1.1 per 1000 pg.ml; 95%, CI 1.05–1.15, p&lt;0.001) and Troponin T (HR: 2.0 per 0.1ng/ml; 95% CI 1.49–2.61, p&lt;0.001) were associated with increased all-cause mortality. In addition, LV GLS (HR: 1.13 per 1%; 95% CI1.04–1.24, p=0.003), RV free wall LS (HR: 2.16 per 5%; 95%, CI 1.57–3.03, p&lt;0.0001), and PALS (HR: 0.91 per1%; 95% CI 0.85–0.96, p&lt;0.0001) were univariate predictors of all-cause mortality. In multivariate analysis using a stepwise regression model, RV free wall longitudinal strain (HR: 1.81; 95% CI 1.29–2.62, p&lt;0.001) and Troponin T (HR: 1.7; 95% CI 1.25–2.26, p=0.001) remained independent predictors. Kaplan-Meier survival analysis demonstrated a higher mortality rate above −16.8 RV strain cut-off (Wilcoxon &lt;0.0001). All stages were divided into two groups by −16.8% RV strain, and survival in individual stages analyzed. Stage 1 and 2 with &lt;−16.8 RV free wall strain value had higher mortality than ≤-16.8% RV strain (Stage 1: Wilcoxon = 0.0041 and Stage 2: Wilcoxon = 0.023). However, there was not a survival difference between two RV strain groups in stage3 (Wilcoxon = 0.34)

Conclusion

RV free wall strain is an independent predictor of survival in wtATTR patients and may add incremental prognostic value to NT-proBNP and Troponin.

Funding Acknowledgement

Type of funding sources: None. Kaplan-Meier curve of all patientsKaplan-Meier curve of stages

P–147 The impact of blastocyst morphological parameters on live birth and singleton birthweight in single blastocyst transfer cycles

Study question

Does blastocyst morphological parameters: blastocyst expansion degree(Expansion), inner cell mass (ICM), and trophectoderm (TE) grades affect live birth and singleton birthweight in single blastocyst transfer cyles?

Summary answer

The effects of blastocyst morphological parameters on live birth and singleton birthweight are different between biopsied blastocysts cycles and non-biopsied blastocysts cycles.

What is known already

It has been known that blastocysts with highest scores for three blastocyst morphological parameters achieve highest pregnancy rates, however, very few studies have comparatively analysed the effect of individual parameters on live birth and singleton birthweight about single blastocyst transfer cycles.

Study design, size, duration

This retrospective study involved all single blastocyst transfers cycles and their live birth outcome and singleton birthweight during the period from January 2014 to August 2019 at a tertiary care center.

Participants/materials, setting, methods

A total of 28515 single blastocyst transfer cycles were available for analysis and were divided into four groups: biopsied blastocysts cycles (BBC), thawed blastocysts cycles(TBC), blastocysts from thawed cleavage embryos cycles(BTCEC) and fresh blastocysts cycles(FBC). The primary outcome were live birth and singleton birthweight. Multiple logistics regression and linear regression analyses were respectively performed to investigate the effect of blastocyst morphological parameters on live birth and birthweight after adjusting potential confounders.

Main results and the role of chance

While analyzing the effect on live birth, we found that live birth of grade B ICM were lower than grade A ICM , live birth of grade C TE were lower than grade A TE and Expansion doesn’t matter. Those result were same in three kinds of non-biopsied cycles. While all three parameters were statistically independently significant in biopsied blastocysts cycles.

While analyzing the effect on singleton birthweight, only Expansion was found to be statistically significant in biopsied blastocysts cycles, and birthweight of Expansion grade 5 was lower than Expansion grade 6(P = 0.005),with a mean difference of 57g(3375.12±527.91 versus 3318.42±510.33). Limitations, reasons for caution: Most blastocysts with poor grade, especially ICM grade C, were not transferred, then the effect of poor grade such as ICM grade C were still unknown.

Wider implications of the findings: The study identified the association between blastocyst morphological parameters and live rate and compared the relative importance of three parameters in different kind of cycles through large size comparative analysis, which would help selecting high-quality embryos for transfer.

Trial registration number

Not applicable

P-525 Analysis of segregation patterns of trivalent structure and the effect on genome stability in Robertsonian translocation carriers

Study question

What are the factors that affect the separation pattern of Robertsonian translocation trivalent, and whether the structure of the trivalent affected the chromosome stability?

Summary answer

The meiotic segregation modes can be affected by the carrier’s sex and special chromosome, and a trivalent structure can affect the stability of the genome.

What is known already

Robertson translocation occurs when two proximal acrocentric chromosomes fuse at the centromere, and forms a trivalent structure during meiosis. This structure will affect the fertility of Robertsonian translocation carriers, and may destroy the stability of the genome by affecting the separation of other chromosomes, which is called Inter-Chromosomal Effect (ICE). Previous research have confirmed that the use of PGT in Robertsonian translocation carriers can effectively reduce abortion and increase live birth. But some studies dispute this conclusion and the existence of ICE. However, there is no large data study to verify these controversies.

Study design, size, duration

PGT results of 928 oocyte retrieval cycles in 763 couples(one of the couples is a Robertsonian translocation carrier) were analysied from December 2012 to June 2020. A total of 1492 couples who received PGT-A were collected as control group, and matched according to age and testing time stage. The study was approved by the ethics committee(LL-SC-SG-2006-008 and LL-SC-SG-2014-016).

Participants/materials, setting, methods

Cytogenetic analysis was performed using GTG standard method (trypsin and GiemsaG banding) to analyze the chromosomes of peripheral blood lymphocytes. Blastocysts obtained by standard IVF procedure were biopsied on the 5th or 6th morning after fertilization, and the trophoblast cells were amplified by PicoPLEX whole genome amplification kit (Rubicon Genology) or Repli-g Single Cell Kit(Qiagen). PGT-SR was performed using SNP array or NGS as previously described.

Main results and the role of chance

In this study, a total of 3423 blastocysts from 763 couples were analysed using SNP-array or NGS. Among them, the rate of alternate segregation of male Robertsonian translocation carriers was significantly higher than that in female carriers (82.26% vs 59.96%, P &lt; 0.001), and meiotic segregation modes could be affected by the special chromosome such as 13 in female(P = 0.042) and 15 in male(P = 0.045) involved. A trivalent structure can affect the stability of the genome during mitosis, which is associated with an increase in the propotion of chromosome mosaic compared with the PGT-A control group(1.18% vs 0.53%, P &lt; 0.01). In addition, we found an interesting phenomenon: in the meiotic segregation of female Robertsonian translocation carriers associated with chromosomes 21 and 22, the chromosome 21 or 22 of the two chromosomes involved in translocation are more likely to be abnormal, and according to our results, the effect of chromosome 21 seems to be greater.

Limitations, reasons for caution

(1) Limitations of retrospective analysis; (2) The results are not fully representative of the general population; (3) PGT-A patients always had repeated implantation failure or recurrent aboration, which may cause deviation to the results.

Wider implications of the findings

This study analyzed the influencing factors of the separation patterns of trivalent, and verified the existence of ICE. This suggest that PGT-SR can have a better outcome in patients with Robertsonian translocation, especially in male carriers. These results will provide carrier couple with more appropriate genetic counseling.

Trial registration number

no

P–568 Homozygous Pathogenic Variants in ACTL9 Cause Fertilization Failure and Male Infertility in Human and Mouse

Study question

What are the other male factors that cause total fertilization failure (TFF) excepting for variants in PLCZ1?

Summary answer

Homozygous variants in ACTL9 (actin like 9) cause abnormal localization of PLCζ in a loosened perinuclear theca (PT) structure and leads to TFF.

What is known already

In previous studies, investigators have reported that the female factors in TFF after intracytoplasmic sperm injection (ICSI) include pathogenic variants in WEE2, TLE6, and TUBB8, whereas for male factors, pathogenic variants in PLCZ1 were reported to be the primary cause of TFF, which account for approximately 30% of couples with male factors in TFF excluding globozoospermia. Most recently, it was reported that pathogenic variants in ACTL7A led to reduced expression and abnormal localization of PLCζ, thereby identifying this genetic variant as a potential cause of TFF.

Study design, size, duration

Fifty-four infertile couples with TFF or poor fertilization (fertilization rate of &lt; 20%) at the Reproductive and Genetic Hospital of CITIC-Xiangya during January 2014 to June 2020 were recruited into this study.

Participants/materials, setting, methods

Male factors were identified in (MOAT). WES analysis was used to analyze the genetic factors of individuals with male factors. Sperm morphological study was conducted by H&E staining and TEM. Immunostaining of PLCζ was used to analyze the status of sperm-borne activation factor. A knock-in mouse model was generated by CRISPER-Cas9 technology. Sperm from homozygous Actl9 variant mice were analyzed by TEM and ICSI. ICSI with AOA was performed in couples with ACTL9 variants.

Main results and the role of chance

A total of 54 couples with TFF or poor fertilization were screened, with 21 couples determined to have a male infertility factor by MOAT. Whole-exome sequencing of these 21 male individuals identified three homozygous pathogenic variants in ACTL9 in three individuals. ACTL9 variations led to abnormal ultrastructure of the PT, with PLCζ absent in the head and present in the neck of the mutant sperm, which contributed to failed normal calcium oscillations in oocytes and subsequent TFF. The key roles of ACTL9 in the PT structure and TFF after ICSI were further confirmed in Actl9-mutated mouse model. Furthermore, assisted oocyte activation by calcium ionophore exposure successfully overcame TFF and achieved live births in a couple with an ACTL9 variant.

Limitations, reasons for caution

The mechanism of how ACTL9 regulate PLCζ remains unknown.

Wider implications of the findings: It provided a genetic marker and a therapeutic option for individuals who have undergone ICSI without successful fertilization.

Trial registration number

not applioable

P–525 Analysis of segregation patterns of trivalent structure and the effect on genome stability in Robertsonian translocation carriers

Study question

What are the factors that affect the separation pattern of Robertsonian translocation trivalent, and whether the structure of the trivalent affected the chromosome stability?

Summary answer

The meiotic segregation modes can be affected by the carrier’s sex and special chromosome, and a trivalent structure can affect the stability of the genome.

What is known already

Robertson translocation occurs when two proximal acrocentric chromosomes fuse at the centromere, and forms a trivalent structure during meiosis. This structure will affect the fertility of Robertsonian translocation carriers, and may destroy the stability of the genome by affecting the separation of other chromosomes, which is called Inter-Chromosomal Effect (ICE). Previous research have confirmed that the use of PGT in Robertsonian translocation carriers can effectively reduce abortion and increase live birth. But some studies dispute this conclusion and the existence of ICE. However, there is no large data study to verify these controversies.

Study design, size, duration

PGT results of 928 oocyte retrieval cycles in 763 couples(one of the couples is a Robertsonian translocation carrier) were analysied from December 2012 to June 2020. A total of 1492 couples who received PGT-A were collected as control group, and matched according to age and testing time stage. The study was approved by the ethics committee(LL-SC-SG–2006–008 and LL-SC-SG–2014–016).

Participants/materials, setting, methods

Cytogenetic analysis was performed using GTG standard method (trypsin and GiemsaG banding) to analyze the chromosomes of peripheral blood lymphocytes. Blastocysts obtained by standard IVF procedure were biopsied on the 5th or 6th morning after fertilization, and the trophoblast cells were amplified by PicoPLEX whole genome amplification kit (Rubicon Genology) or Repli-g Single Cell Kit(Qiagen). PGT-SR was performed using SNP array or NGS as previously described.

Main results and the role of chance

In this study, a total of 3423 blastocysts from 763 couples were analysed using SNP-array or NGS. Among them, the rate of alternate segregation of male Robertsonian translocation carriers was significantly higher than that in female carriers (82.26% vs 59.96%, P &lt; 0.001), and meiotic segregation modes could be affected by the special chromosome such as 13 in female(P = 0.042) and 15 in male(P = 0.045) involved. A trivalent structure can affect the stability of the genome during mitosis, which is associated with an increase in the propotion of chromosome mosaic compared with the PGT-A control group(1.18% vs 0.53%, P &lt; 0.01). In addition, we found an interesting phenomenon: in the meiotic segregation of female Robertsonian translocation carriers associated with chromosomes 21 and 22, the chromosome 21 or 22 of the two chromosomes involved in translocation are more likely to be abnormal, and according to our results, the effect of chromosome 21 seems to be greater.

Limitations, reasons for caution

(1) Limitations of retrospective analysis; (2) The results are not fully representative of the general population; (3) PGT-A patients always had repeated implantation failure or recurrent aboration, which may cause deviation to the results.

Wider implications of the findings: This study analyzed the influencing factors of the separation patterns of trivalent, and verified the existence of ICE. This suggest that PGT-SR can have a better outcome in patients with Robertsonian translocation, especially in male carriers. These results will provide carrier couple with more appropriate genetic counseling.

Trial registration number

no

Assessment of deep brain stimulation candidacy during the COVID-19 pandemic: Lessons learned and future directions for neuropsychologists

OBJECTIVE

Neuropsychological assessment is integral to the pre-surgical deep brain stimulation (DBS) workup for patients with movement disorders. The COVID-19 pandemic quickly affected care access and shifted healthcare delivery, and neuropsychology has adapted successfully to provide tele-neuropsychological (teleNP) DBS evaluations during this time, thus permanently changing the landscape of neuropsychological practice. Method: In this paper, we discuss the lessons learned from the pandemic and we offer care management guidelines for teleNP and in-person evaluations of pre-DBS populations, with exploration of the feasibility of the different approaches for uninterrupted care access. Results: We summarize the strengths and weaknesses of these care models and we provide future directions for the state of clinical neuropsychological practice for DBS programs, with implications for broader patient populations. Conclusions: A better understanding of these dynamics will inform and educate the DBS team and community regarding the complexities of performing DBS neuropsychological evaluations during COVID-19 and beyond.

The global pandemic has permanently changed the state of practice for pre-DBS neuropsychological evaluations

The evaluation and management of patients with movement disorders has evolved considerably due to the COVID-19 pandemic, including the assessment of candidates for deep brain stimulation (DBS) therapy. Members of the Neuropsychology Focus Group from the Parkinson Study Group Functional Neurosurgical Working Group met virtually to discuss current practices and solutions, build consensus, and to inform the DBS team and community regarding the complexities of performing DBS neuropsychological evaluations during COVID-19. It is our viewpoint that the practice of neuropsychology has adapted successfully to provide tele-neuropsychological pre-DBS evaluations during the global pandemic, thus permanently changing the landscape of neuropsychological services.

Quantitative proteomics analysis reveals the response mechanism of peanut (Arachis hypogaea L.) to imbibitional chilling stress

Imbibitional chilling stress inhibits normal seed germination and seedling establishment and leads to large losses in peanut production. This is a major limiting factor when sowing peanut earlier and further north. To reveal the response mechanism of peanut to imbibitional chilling stress, a Tandem Mass Tag (TMT)-based quantitative proteomics analysis was conducted to identify differentially accumulated proteins (DAPs) under imbibitional chilling stress. Hormone profiling and transcriptional analysis were performed to confirm the proteomics data. Further seed priming analysis with exogenous cytokinins was conducted to validate the role of cytokinins in alleviating imbibitional chilling injury. A total of 5029 proteins were identified and quantified in all of the experimental groups. Among these, 104 proteins were DAPs as compared with the control. Enrichment analysis revealed that these DAPs were significant in various molecular functional and biological processes, especially for biosynthesis and metabolism of plant hormones. Hormone profiling and transcription analysis suggested that the reduced abundance of cytokinin oxidase may be caused by down-regulation of gene expression of the corresponding genes and leads to an elevated content of cytokinins under chilling stress. Seed priming analysis suggested that exogenous application of cytokinins may alleviate injury caused by imbibitional chilling. Our study provides a comprehensive proteomics analysis of peanut under imbibitional chilling stress, suggesting the role of plant hormones in the response mechanism. The results provide a better understanding of the imbibitional chilling stress response mechanism in peanut that will aid in peanut production.

[Baseline characteristics of the participants of China National Birth Cohort]

Objective: To explore the effects of environmental, genetic factors as well as the interactions in early life on the short-term and long-term health of offspring and to systematically evaluate the pregnancy outcomes and health of offspring after birth between families with assisted reproductive technology (ART) conception and families with spontaneous conception. Methods: The China National Birth Cohort (CNBC), a multicenter prospective birth cohort study, includes both families with ART conception and families with spontaneous conception. Since 2016, CNBC has recruited families from 24 hospitals located in 12 provinces, municipalities and autonomous regions throughout China. Information and biospecimens were collected before ART treatment, embryo transfer, at early, second, third trimester and delivery, and at 42 days, 6, 12 and 36 months after birth. Results: By June 2020, CNBC had included 27 044 families with ART conception and 29 589 families with spontaneous conception. The majority of the participants are urban residents. Among the families with ART conception, 65.5% of the men and 63.7% of the women had college degrees or higher. The mean age distribution of men and women was (33.83±5.52) and (32.38±4.67) years. 83.2% of women were primiparas, and the prevalence rates of current regular smokers and current alcohol drinkers were 0.8% and 2.1% in women. Among the families with spontaneous conception, 81.5% of the men and 86.5% of the women had college degrees or higher. The mean age distribution of men and women was (32.06±5.09) and (30.40±4.27) years. 67.2% of women were primiparas, and the prevalence rates of current regular smokers and current alcohol drinkers were 0.1% and 2.2% in women. The baseline characteristics were different between the families with ART conception and spontaneous conception in different regions. Conclusion: CNBC provides a powerful and rich resource in studying the impact of genetic, environmental factors and interactions in early life and ART treatment on the health of offspring after birth.

[Profile of China National Birth Cohort]

With the rapid changes in lifestyle, natural and social environment, the reproductive health status of couples in childbearing age continues to decline, and long-term outcomes of the rapidly increasing offspring conceived by assisted reproductive technology (ART) needs to be evaluated urgently. Therefore, the focus of research now needs to be extended from death and severe diseases to full life cycle and full disease spectrum. In order to meet the demand for such research, we launched the China National Birth Cohort (CNBC) study, an ongoing prospective and longitudinal study aiming to recruit 30 000 families underwent ART and 30 000 families with spontaneous pregnancies. Long-term follow-up programs will be conducted for both spouses and their offspring. Data of couples and their offspring, such as environmental exposure, reproductive history, psychological and behavioral status, will be collected during follow-up. Peripheral blood, urine, umbilical blood, follicular fluid, semen were also collected at different follow-up nodes. Based on high-quality data and biological samples, CNBC will play an extremely important supporting role and have a far-reaching impact on maternal and children's health care and reproductive health in China. This paper is exactly a brief introduction to the construction and basic design of CNBC.

Decreased right ventricular strain before LVAD implantation is associated with adverse early outcome

Objectives

Right ventricular (RV) failure occurring after left ventricular assist device (LVAD) implantation is associated with increased mortality.

Purpose

We sought to determine whether RV strain by echocardiography predicts outcomes following LVAD.

Methods

Consecutive patients who underwent continuous flow LVAD placement at our clinic between February 2007 and October 2018 were included. Patients with complex congenital heart disease and arrhythmogenic right ventricular cardiomyopathy were excluded. Baseline characteristics, pre-operative hemodynamic catheterization (1 week) transthoracic echocardiography (1 month) measurements were obtained from the medical record. Speckle tracking RV free wall longitudinal 2D strain was measured using TomTec Imaging System. Univariate and multivariable analysis performed to identify predictors of mortality following LVAD.

Results

The study group was comprised of 323 patients (mean age 60.8±11.5, 79.9% male) of which 256 had adequate image quality for RV strain. RV strain was impaired in most patients (mean −11.7±3.47). RV strain of −8.1% was identified as predictive of poor outcomes. RV strain did not correlate with other measures of RV dysfunction including pulmonary artery pulsatility index (PAPi) and RVFAC. After adjusting for PAPi, RA pressure, and clinical cumulative risk scores (Matthews, Kormos and Lietz-Miller) impaired RV free wall longitudinal strain (OR: 1.14; 95% CI: 1.01–1.29, p=0.025), tricuspid regurgitation (by vena contracta width (TRvc) (OR: 1.19; 95% CI: 1.05–1.36, p=:0.0021) and smaller LVEDD (OR: 0.95; 95% CI: 0.92–0.99, p:0.023) predicted 30-day all-cause mortality and RV failure. Decreased RV free wall strain also predicted peri-operative mortality (22.58% vs. 4.89%, p=0.0003) and prolonged inotropic support (247.0.±277.4 vs. 122.8±139.3, p=0.024).

Conclusions

RV free wall strain is a non-invasive independent predictor of 30-day adverse outcomes (RV failure or all-cause mortality) Routine measurement of RV free strain may identify those patients at highest risk for early and long term mortality following LVAD.

Funding Acknowledgement

Type of funding source: None

Prognostic utility of cardiopulmonary exercise testing indices in arrhythmogenic right ventricular cardiomyopathy

Introduction

Cardiopulmonary exercise testing (CPET) has an established role in the clinical evaluation of exercise intolerance and in the risk stratification of patients with heart failure. There is limited data assessing its prognostic utility in the evaluation of patients with Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC). The predisposition of patients with ARVC for ventricular arrhythmias and sudden cardiac death has led to recommendations for exercise restrictions and limits our understanding of how the impairment in oxygen extraction and cardiac output impact disease progression and outcomes in these patients.

Purpose

We examined the association between CPET indices and event free survival (time to mortality or cardiac transplantation) in patients with Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC).

Methods

Patients with definite ARVC based on 2010 task force criteria and genetically positive were enrolled into our institutional ARVC registry. 43 patients underwent CPET and have been included in our analyses. Indications for testing included: Evaluation of exercise-induced palpitations/arrhythmias or syncope (37%), pharmacotherapy optimization (28%), heart failure evaluation (19%), and ARVC management decisions (16%). CPET data (peak oxygen consumption (pVO2), respiratory exchange ratio (RER), and ventilatory efficiency (VE/VCO2) were assessed in patients at time of initial evaluation. Median follow-up time was 4.9 years (IQR 9 years).

Results

126 patients were studied (age 43.7+ 15 yrs; 41% women; LVEF 57+ 11%; 15% with LVEF &lt;50%) and 43 underwent CPET evaluation. 41 patients (95%) performed at near maximal effort (RER &gt;1) and no fatal events were reported during testing. During the follow up period, the outcome (death or cardiac transplantation) occurred in 31 patients. On Kaplan Meier analysis, pVO2 ≤14 mL/kg/min was associated with worse outcomes (unadjusted p&lt;0.001). Peak oxygen consumption (pVO2) ≤14 mL/kg/min and ventilatory efficiency (VE/VCO2) &gt;34 were associated with shorter event free survival (HR 5.58, p=0.002 and HR 5.56 p=0.005, respectively). After adjusting for age, sex, and right ventricular function, the association between peak oxygen consumption (pVO2) and event free survival remained significant (p=0.02).

Conclusions

In patients with ARVC, peak oxygen consumption (pVO2) was a prognostic indicator of worse outcomes. Our findings suggest a potential role for pVO2 in disease surveillance and early assessment for advanced heart failure therapies.

Figure 1. KM plot pVO2 & event free survival

Funding Acknowledgement

Type of funding source: Other. Main funding source(s): Mayo Clinic

Endosperm enrichment and physicochemical properties of superior and inferior grain starch in super hybrid rice

A significant asynchronous phenomenon exists in super hybrid rice because of the differences in spike and spikelet positions, which affect the accumulation and properties of starch. However, little is known about the endosperm enrichment and physicochemical properties of starch in superior and inferior grains in super hybrid rice. Rice YY2640 was selected as study material to investigate the enrichment and physicochemical properties of starch in superior and inferior grains in super rice using semi-thin sections, X-ray diffraction and related technologies. Superior grain filling was a continuous process, whereas inferior grain only started 8-10 days after anthesis. The order of starch accumulation starts in the central endosperm, then in the endosperm of the proximal vascular bundle and finally in the aleurone layer. Compared with the inferior grains, the superior grains have a higher 1000-grain weight, apparent amylose content, total starch content, average starch granule size, relative crystallinity, solubility and a resonance peak ratio at 1022/995 cm^-1 , whereas the swelling power and ratio of the resonance peak at 1045/1022 cm^-1 were lower. The final degree of hydrolysis of HCl, AAG and PPA of the superior grains were significantly lower than those of the inferior grains. The findings indicate that the different physicochemical properties of starch were mainly related to the development order of superior and inferior grains and the spatial enrichment of starch.

Genomic origin and EGFR-TKI treatments of pulmonary adenosquamous carcinoma

BACKGROUND

Adenosquamous carcinoma (ASC) of the lung is a heterogeneous disease that is composed of both adenocarcinoma components (ACC) and squamous cell carcinoma components (SCCC). Their genomic profile, genetic origin, and clinical management remain controversial.

PATIENTS AND METHODS

Resected ASC and metastatic tumor in regional lymph nodes (LNs) were collected. The ACC and SCCC were separated by microdissection of primary tumor. The 1021 cancer-related genes were evaluated by next-generation sequencing independently in ACC and SCCC and LNs. Shared and private alterations in the two components were investigated. In addition, genomic profiles of independent cohorts of adenocarcinomas and squamous cell carcinomas were examined for comparison. We have also carried out a retrospective study of ASCs with known EGFR mutation status from 11 hospitals in China for their clinical outcomes.

RESULTS

The most frequent alterations in 28 surgically resected ASCs include EGFR (79%), TP53 (68%), MAP3K1 (14%) mutations, EGFR amplifications (32%), and MDM2 amplifications (18%). Twenty-seven patients (96%) had shared variations between ACC and SCCC, and pure SCCC metastases were not found in metastatic LNs among these patients. Only one patient with geographically separated ACC and SCCC had no shared mutations. Inter-component heterogeneity was a common genetic event of ACC and SCCC. The genomic profile of ASC was similar to that of 170 adenocarcinomas, but different from that of 62 squamous cell carcinomas. The incidence of EGFR mutations in the retrospective analysis of 517 ASCs was 51.8%. Among the 129 EGFR-positive patients who received EGFR-TKIs, the objective response rate was 56.6% and the median progression-free survival was 10.1 months (95% confidence interval: 9.0-11.2).

CONCLUSIONS

The ACC and SCCC share a monoclonal origin, a majority with genetically inter-component heterogeneity. ASC may represent a subtype of adenocarcinoma with EGFR mutation being the most common genomic anomaly and sharing similar efficacy to EGFR TKI.

Organic trace minerals improve eggshell quality by improving the eggshell ultrastructure of laying hens during the late laying period

The objective of this study was to investigate the effects of low inclusion levels of organic trace minerals (iron, copper, manganese, and zinc) on performance, eggshell quality, serum hormone levels, and enzyme activities of laying hens during the late laying period. A total of 405 healthy hens (HY-Line White, 50-week-old) were randomly divided into 3 treatments, with 9 replications per treatment and 15 birds per replication. The dietary treatments included a basal diet supplemented with inorganic trace minerals at commercial levels (CON), a basal diet supplemented with inorganic trace minerals at 1/3 commercial levels (ITM), and a basal diet supplemented with proteinated trace minerals at 1/3 commercial levels (TRT). The trial lasted 56 D (8 wk). Compared with the CON group, the ITM group showed decrease in (P < 0.05) egg production, eggshell strength, eggshell palisade layer, palisade layer ratio, serum estrogen, luteinizing hormone, glycosaminoglycan concentration, and carbonic anhydrase activity and increase in (P < 0.05) egg loss and mammillary layer ratio. However, the TRT group almost kept all the indices close to the CON group (P > 0.05). Furthermore, hens fed with low inclusion levels of organic trace minerals had smaller mammillary knobs (P < 0.05) than those in the CON and ITM groups. In conclusion, hens fed with low inclusion levels of proteinated trace minerals had better performance and eggshell strength than those fed with identical levels of inorganic compounds; organic trace minerals improved eggshell quality by improving the eggshell ultrastructure of laying hens during the late laying period.

P5717Risk of QTC interval prolongation among cancer patients treated with tyrosine kinase inhibitors

Objective

QTc interval prolongation can lead to life-threatening complications such as torsade de pointes (TdP), ventricular tachycardia (VT), and sudden cardiac death (SCD). It can occur with various tyrosine kinase inhibitors (TKIs) but comparative analyses on the incidence and complication rates are scarce. We thus conducted a comprehensive analysis of TKI use and QTc prolongation in clinical practice.

Methods

We retrospectively reviewed the electronic medical records of all cancer patients who were treated with TKI between 01/2005 and 12/2018 at our institution. QTc prolongation was defined as a QTc ≥450 ms or 460 ms among male or female patients, respectively. For each type of TKIs, we determined the administration rate and incidence of QTc interval prolongation. We also studied the frequency of QTc prolongation ≥500 ms, the rate of increase of the QTc interval by ≥60 ms, and the development of complications (VT, TdP, and SCD).

Results

In the present study, we analyzed the data of 685 cancer patients (431 male and 254 female), including 299 patients with RCC, 188 with chronic leukemia, 55 with acute leukemia, 65 with thyroid cancer, 48 with lung cancer and 39 with GIST. These patients received 902 TKI administrations and QTc prolongation was reported in 1/3 of these (289 administrations). The highest frequency was seen with imatinib, nilotinib, and dasatinib (30, 40 and 50%). Among cases of QTc prolongation, a QTc interval ≥500 ms was documented in 53 (18.3%) and QTc progression ≥60 ms in 72 (25%). Complications were found in 14 cases (5%) including VT in 9, TdP in 2 and SCD in 3 administrations. Table 1 demonstrates the findings for each TKI.

Findings for TKIs in all patients Total Prolonged QTc QTc ≥500 QTc progression ≥60 VT SCD TdP Imatinib 165 54 13 10 2 Nilotinib 75 33 8 19 Dasatinib 115 58 10 16 2 1 Sunitinib 134 31 1 2 1 1 Pazopanib 165 36 5 6 2 1 Others 248 77 16 18 2 1 1

Conclusion

The current findings suggest that TKI therapy leads to QTc prolongation in 1/3 of patients on average and most commonly with the Bcr-Abl TKIs, imatinib, nilotinib, and dasatinib. While SCD is rare (1%) it can still evolve and in 5% of all QTc prolongations with TKIs are potentially life-threatening. These data support recommendations for serial ECGs in cancer patients undergoing TKI therapy.

Acknowledgement/Funding

None

P2601Trans-catheter or surgical mitral valve procedure versus conservative treatment in heart failure patients with preserved ejection fraction

Background

Secondary mitral regurgitation (SMR) impacts outcomes in heart failure with reduced ejection fraction (HFrEF) but whether it is a specific therapeutic target in heart failure patients with preserved ejection fraction (HFpEF) is less clear.

Purpose

The aims of this study were to investigate whether surgical or trans-catheter intervention reduces SMR and improves outcomes compared to optimal medical therapy in HFpEF patients.

Methods

We retrospectively identified 120 HFpEF patients with moderate-to-severe or greater SMR from January 1, 2007, until December 31, 2017. Moderate-to-severe SMR was defined as an effective regurgitant orifice area of >0.3cm2, and/or a regurgitation volume of >45ml per beat. Those with primary mitral regurgitation, endocarditis, HFrEF, hypertrophic cardiomyopathy, congenital heart disease, and history of valve intervention were excluded. All-cause mortality was analyzed and correlated to clinical and echocardiographic characteristics. Amongst the 120 patients, 36 received surgical or trans-catheter procedure in addition to medical therapy (procedure group) and 84 patients received optimal medical therapy only (conservative treatment group). The median follow-up period was 864 (15–3553) days.

Results

Patients in the procedure group were younger (75±8 vs 81±10, P=0.0002) and with fewer comorbidities (Charlson Comorbidity Index 7.0±2.4 vs 8.0±2.0, P=0.022) compared to the conservative treatment group. In addition, the procedure group had larger left ventricular end-diastolic diameters and higher SMR volume at baseline. During follow-up, SMR decreased by ≥2 grades in 75% of patients (27/36) in the procedure group compared to 20% of patients (12/60) in the conservative treatment group. After adjusting for age and comorbidities, the procedure group showed better overall survival compared to the conservative treatment group (HR 0.37; 95% CI 0.17–0.80; P=0.011). On multivariate analysis for the different groups (procedure group vs. conservative treatment group) (HR 0.40; 95% CI 0.17–0.91; P=0.019), increasing Charlson Comorbidity Index (HR 1.16; 95% CI 1.02–1.32; P=0.028) and average mitral E/e' ratio (HR 1.06; 95% CI 1.01–1.11; P=0.031) were independent predictors of increased all-cause mortality.

Kaplan-Meier Survival Curve

Conclusion

Among heart failure patients with preserved ejection fraction and moderate-to-severe or severe SMR, surgical or trans-catheter mitral-valve repair or replacement resulted in lower all-cause mortality compared to conservative treatment after 9 years of follow-up.