Impact of aneuploidy on reproductive success in young infertile women: prospective analysis

RESEARCH QUESTION

What is the clinical outcome of the first attempt at conception between two embryo selection methods, blastocyst morphology and preimplantation genetic testing for aneuploidies (PGT-A), chosen at the initial physician IVF consultation?

DESIGN

In this prospective analysis, a clinical decision regarding embryo selection, blastocyst morphology (group A) or PGT-A (group B) was made during initial physician IVF consultation. Female infertility patients were matched based on maternal age (mean 32.6 ± 3.6 years; range 25-43 years) and a similar time frame of oocyte retrieval. The primary outcome was live birth rate from the initial consultation to the first conception attempt for all female patients and for a subset analysis of patients aged <35 years.

RESULTS

The inclusion of PGT-A (group B) for embryo selection during the initial physician IVF consultation resulted in 23 additional women out of the total 100 achieving a healthy live birth following the first conception attempt in this maternally age-matched infertile population (group B = 72.0% versus group A = 49.0%; P = 0.0014). This same benefit was observed for age-matched, younger infertility patients (<35 years), with live birth rates from the initial consultation being significantly higher when the upfront clinical decision included PGT-A for embryo selection (group B = 76.7% versus group A = 53.4%; P = 0.0052). Interestingly, 17 women from group B would have received an aneuploid embryo transfer if selection had been determined by blastocyst morphology alone, as their best-grade embryo was aneuploid.

CONCLUSIONS

This prospective analysis from the initial physician IVF consultation revealed that euploid embryo selection significantly improved live birth potential with the first conception attempt, even for younger women with infertility.

Control of mitochondrial integrity influences oocyte quality during reproductive aging

Reduced quality in oocytes from women of advanced maternal age (AMA) is associated with dysfunctional mitochondria. The objective of this study was to investigate the mechanisms controlling mitochondrial quality during maternal aging in mouse and human oocytes. We first evaluated the expression of proteins involved in the mitochondrial unfolded protein response (UPRmt) and mitophagy in in vivo matured metaphase II (MII) oocytes collected from young and aged mice. Expression of UPRmt proteins, HSPD1 and LONP1, and mitophagy proteins, total-PRKN and phosphorylated-PRKN, was significantly decreased in aged compared to young oocytes. Treatment of aged oocytes during in vitro maturation with the mitochondrially targeted antioxidant mitoquinone (MQ) specifically restored total-PRKN and phosphorylated-PRKN expression to levels seen in young oocytes. We next investigated whether maturing young oocytes under a high-oxygen environment would mimic the effects observed in oocytes from aged females. Phosphorylated-PRKN expression in oxidatively stressed young oocytes was reduced compared to that in oocytes matured under normal oxygen levels, and the mitochondrial DNA (mtDNA) copy number was increased. Treating oxidatively challenged young oocytes with MQ restored the phosphorylated-PRKN expression and mtDNA copy numbers. Treatment of oxidatively challenged oocytes with MQ also increased the co-localization of mitochondria and lysosomes, suggesting increased mitophagy. These data correlated with the developmental potential of the oocytes, as blastocyst development and hatching of oxidatively stressed oocytes were reduced, while treatment with MQ resulted in a significant increase in blastocyst development and hatching, and in the percentage of inner cell mass. Consistent with our results in mice, MII oocytes from women of AMA exhibited a significant decrease in phosphorylated-PKRN and total-PRKN compared to those of young women. Our findings suggest that the protein machinery to control the health of the mitochondria via UPRmt and mitophagy may be compromised in oocytes from aged females, which may result in inefficient clearance of dysfunctional mitochondria and reduced oocyte quality.

The Use of Nursing Theory to Support Sexual and Reproductive Health Care Education in Nursing Curricula

BACKGROUND

Inclusive sexual and reproductive health care (SRH) content is limited in nursing curricula, resulting in nurses who lack education to provide complex SRH services to marginalized patients, especially sexual and gender minorities (SGM).

METHOD

The 10 Caritas Processes, the framework of Watson's Theory of Caring, were evaluated for being integral components of SRH. This theory is used to advocate for SGM-inclusive SRH content in nursing curricula.

RESULTS

The interpretation of Caritas Processes 2, 4, and 7 provide theoretical support for SGM-inclusive SRH content. Specific strategies to modify and improve nursing curricula are described.

CONCLUSION

There is a need to incorporate inclusive SRH education into nursing curricula to normalize evidence-based SRH for diverse, marginalized patient populations. By emphasizing the caring intentions necessary for nursing professionals, Watson's Theory of Caring is an appropriate framework to guide the development of SGM-relevant SRH content in nursing education. [J Nurs Educ. 2023;62(2):69-74.].

Rethinking Nursing Education and Curriculum Using a Racial Equity Lens

BACKGROUND

Health educators are called on to dismantle health care inequities as they train future health care clinicians to deliver care that promotes equity, improves access to care, and actively addresses antiracism.

METHOD

Through an Advanced Nursing Workforce grant by the Health Resources and Services Administration, a partnership was established with the Institute for Perinatal Quality Improvement to provide training for health care clinicians and students on ways to SPEAK UP against implicit and explicit bias with an emphasis on maternal health.

RESULTS

Dismantling racism is a continuous process. Activities included self-reflection, small group meetings, antiracism and bias training, and community engagement.

CONCLUSION

Acknowledging that racism and health inequities exist and directly contribute to the rise in maternal and infant mortality is only the beginning. Rethinking nursing education, curriculum, and clinical care to train culturally responsive health care clinicians is required to address systemic and structural racism in health care. [J Nurs Educ. 2022;61(8):493-496.].

Addition of "Septal Window" to Lower Blepharoplasty for the Management of Fat of the Lower Eyelids

BACKGROUND

The most common reason for dissatisfaction and reoperation in lower blepharoplasty patients is persistent bulging of the lateral fat pad. This compartment contributes the most to fat herniation and yet is the most commonly overlooked. The addition of a septal window, a small opening of the septum on the most prominent part of the lateral fat compartment, helps with precise removal of lateral fat and allows for additional fat excision after septal reset without disrupting the arcuate expansion.

METHODS

Our lower blepharoplasty approach includes 1) a subcilliary incision; 2) aggressive lateral fat excision through a septal window; 3) central and medial fat excision, transposition, and septal reset; 4) canthopexy; 5) orbicularis oculi muscle suspension; and 6) no dissection of orbicularis oculi medially and no skin resected medially to avoid lid retraction. We performed a retrospective review of all lower blepharoplasty cases by a single surgeon over 10 years. Demographics and operative outcomes were queried.

RESULTS

There were 224 cases, 90% were women with a mean age of 58.2 years. The most common postoperative occurrences were eyelid edema, malar edema, and chemosis, all of which were self-limiting. Two patients needed additional removal of lateral fat of their lower eyelids.Two patients had lid retraction, one of which had a previous facial nerve palsy and the other did not have a canthopexy and developed transient unilateral lid retraction that resolved with conservative treatment. Resumption of full activities and exercises at 6 weeks was typical.

CONCLUSION

The septal window facilitates aggressive resection of the lateral fat pad and additional fat excision after septal reset to create a smooth lid-cheek junction. In our practice, it is a critical component of a successful lower blepharoplasty.

M Health Fairview: An aligned academic health system

BACKGROUND

The aim of this article is to familiarize the reader with one system's approach to creating an aligned academic health system that facilitates delivery of academic health care in community hospitals.

METHODS

A wide variety of approaches to this challenge include viewing the community facilities as strictly feeders to the academic centers with no shared governance, to viewing them as branding opportunities with aligned governance, to a more integrated model such as ours, and to creating exclusive centers of excellence in the community facilities by consolidating services initially dispersed across competing hospitals into one center.

RESULTS

We leveraged service lines and domains to standardize care across all hospital settings which facilitated delivery of complex tertiary care in community hospitals, thus increasing capacity in the Academic Medical Center for complex quarternary care.

CONCLUSION

Through creating a more completely integrated, patient centric health system that leverages the community partners we minimized the need for people to travel from their community hospitals to the Academic Medical Center while still ensuring they received the expertise of a leading academic institution.

Spontaneous Atraumatic Subdural Hematoma Related to Methamphetamine Use

There are multiple risk factors associated with spontaneous subdural hematoma (SDH), including substance abuse, hypertension, vascular abnormalities, and neoplasms. The illicit drugs typically cited as risk factors for spontaneous SDH are alcohol and cocaine. We report a rare case of spontaneous, significant SDH associated exclusively with methamphetamine. Although it is unclear whether the underlying pathophysiology involves vasculitis, sympathomimetic-induced hypertension, or a combination of both, this case further illustrates the risks of methamphetamine abuse.

Euploid day 7 blastocysts of infertility patients with only slow embryo development have reduced implantation potential

RESEARCH QUESTION

What is the reproductive potential of embryos that achieve blastulation on day 7 followed by preimplantation genetic testing for aneuploidies (PGT-A) for infertility patients with slow embryo development?

DESIGN

This was a retrospective cohort study in a private IVF clinic of consecutive female infertility patients (n = 2966) aged 24-48 (36.3 ± 3.8) years who underwent frozen embryo transfer (FET) of a single euploid blastocyst.

RESULTS

The women underwent single euploid FET of an embryo that achieved blastulation on day 5 (n = 1880), day 6 (n = 986) or day 7 (n = 100). Day 7 embryos resulted in lower implantation and live birth rates compared with both day 5 and day 6 embryos (P < 0.001). The day 5, day 6 and day 7 groups had 68.5%, 55.2% and 36.0% live birth rates, respectively. The day 7 group was older than the day 5 group (P < 0.001); comparing age-matched cohorts, the day 7 group still had lower implantation and live birth rates (P < 0.0001 and P < 0.001, respectively). Embryo grade was unrelated to live birth rates. Day 7 embryos of expansion grade 5 or 6 or trophectoderm grade A were more likely to be euploid compared with expansion grade 3 or trophectoderm grade B.

CONCLUSIONS

Euploid day 7 embryos represented reduced implantation potential, even when controlling for maternal age. Of all day 7 embryos that underwent PGT-A, euploidy was associated with expansion grade 5 or 6 and trophectoderm grade A. These results can help providers manage patient expectations in cases where infertile women have slow embryo development.

Healthcare provider knowledge, attitudes, and preferences in management of genitourinary syndrome of menopause in the Mid-South

OBJECTIVE

This study explored the clinical management practices of healthcare providers who treat menopausal women in an urban Mid-South area. The study specifically examined their knowledge of prescribing and counseling related to the care of women who present with complaints or clinical findings of genitourinary syndrome of menopause.

METHODS

An electronic questionnaire was distributed to healthcare providers involved in the care of women undergoing menopausal transition spanning a variety of medical specialties. The questionnaire was distributed to academic program directors, coordinators, and ListServ administrators to forward to targeted respondents. Items included demographic questions, clinical knowledge, management practices, and preferences. Statistical analysis for associations between demographics was performed using Chi-squared tests and between age groups with Kruskal Wallis tests.

RESULTS

The final sample contained 106 healthcare providers. Respondents were demographically diverse and encompassed multiple levels of professional training including Attendings, Trainees (Residents and Fellows), as well as Advanced Practice Registered Nurses. Significant differences were noted in many areas examined in our questionnaire, comprising knowledge, management, counseling, and prescribing practices surrounding the treatment of genitourinary syndrome of menopause when accounting for training level, specialty, and years in practice. Among all respondents, 10.4% reported rarely or never discussing menopausal symptoms with their patients. Most respondents (76.4%) stated they had prescribed topical therapies for genitourinary syndrome of menopause, with over 90% of practitioners prescribing lubricants/moisturizers and estradiol cream; however, only 55% reported being familiar with the US Food and Drug Administration's boxed warning on low-dose vaginal estrogen. Nearly half of the respondents (49%) reported being uncomfortable counseling about the boxed warning on low-dose vaginal estrogen.

CONCLUSION

This study identifies gaps in Mid-South healthcare providers' awareness of the boxed warning on low-dose vaginal estrogen as well as their comfort level in providing counseling regarding the risks, benefits, and alternatives to vaginal estrogen. Integrated practice between physicians and Advanced Practice Registered Nurses can lead to a significant benefit to patients experiencing menopause as shared experience and knowledge are shared between each group. Our survey does reveal gaps in knowledge and practice for optimal outcomes for patients experiencing genitourinary syndrome of menopause. These results will be useful in providing continuing education to providers and more effective communication, evaluation, and treatment to patients.

Early prenatal presentation of the cartilage-hair hypoplasia / anauxetic dysplasia spectrum of disorders mimicking recurrent thanatophoric dysplasia

Three sibling fetuses identified with limb shortening and thoracic narrowing at twelve weeks' gestation on first trimester ultrasound examination are presented. The parents were non-consanguineous, Caucasian, healthy, of normal stature and had a healthy normal daughter. The radiographic abnormalities were highly suggestive of thanatophoric dysplasia, but molecular analysis failed to identify a pathogenic variant in FGFR3. The three fetuses were found to have identical compound heterozygous mutations in RMRP in trans, one inherited from the mother and one from the father. This represents the early prenatal presentation and fetal findings of metaphyseal dysplasia type McKusick (Cartilage-hair hypoplasia; CHH)/anauxetic dysplasia spectrum of disorders.

Influence of Lab Adapted Natural Diet and Microbiota on Life History and Metabolic Phenotype of Drosophila melanogaster

Symbiotic microbiota can help its host to overcome nutritional challenges, which is consistent with a holobiont theory of evolution. Our project investigated the effects produced by the microbiota community, acquired from the environment and horizontal transfer, on metabolic traits related to obesity. The study applied a novel approach of raising Drosophila melanogaster, from ten wild-derived genetic lines on naturally fermented peaches, preserving genuine microbial conditions. Larvae raised on the natural and standard lab diets were significantly different in every tested phenotype. Frozen peach food provided nutritional conditions similar to the natural ones and preserved key microbial taxa necessary for survival and development. On the peach diet, the presence of parental microbiota increased the weight and development rate. Larvae raised on each tested diet formed microbial communities distinct from each other. The effect that individual microbial taxa produced on the host varied significantly with changing environmental and genetic conditions, occasionally to the degree of opposite correlations.

Successful Endovascular Treatment of Delayed Spontaneous Intracranial Internal Carotid Artery Blowout Following Orbital Exenteration and Radiation

Most head and neck cancers require aggressive surgical resection followed by external beam radiation therapy. The carotid artery can be injured by surgery or radiation resulting in a delayed “blowout.”

A patient who had undergone orbital exenteration for a lacrimal adenoid cystic carcinoma (ACC) followed by external beam radiation presented 16 years later with arterial bleeding from the orbit caused by “blowout” of the cavernous internal carotid artery (ICA). We review the literature on carotid blowout syndrome (CBS) and treatment.

The patient was emergently transferred to a hybrid operating room and underwent a balloon occlusion test (BOT) and endovascular sacrifice of the ICA with no neurological deficits postoperatively.

Emergent endovascular embolization is an effective treatment for an intracranial ICA blowout in this first reported case of a blowout through the orbit. Elevated radiation dose and lack of tissue coverage may put the cavernous ICA at risk for this delayed complication.

NEXMIF encephalopathy: an X-linked disorder with male and female phenotypic patterns

PURPOSE

Pathogenic variants in the X-linked gene NEXMIF (previously KIAA2022) are associated with intellectual disability (ID), autism spectrum disorder, and epilepsy. We aimed to delineate the female and male phenotypic spectrum of NEXMIF encephalopathy.

METHODS

Through an international collaboration, we analyzed the phenotypes and genotypes of 87 patients with NEXMIF encephalopathy.

RESULTS

Sixty-three females and 24 males (46 new patients) with NEXMIF encephalopathy were studied, with 30 novel variants. Phenotypic features included developmental delay/ID in 86/87 (99%), seizures in 71/86 (83%) and multiple comorbidities. Generalized seizures predominated including myoclonic seizures and absence seizures (both 46/70, 66%), absence with eyelid myoclonia (17/70, 24%), and atonic seizures (30/70, 43%). Males had more severe developmental impairment; females had epilepsy more frequently, and varied from unaffected to severely affected. All NEXMIF pathogenic variants led to a premature stop codon or were deleterious structural variants. Most arose de novo, although X-linked segregation occurred for both sexes. Somatic mosaicism occurred in two males and a family with suspected parental mosaicism.

CONCLUSION

NEXMIF encephalopathy is an X-linked, generalized developmental and epileptic encephalopathy characterized by myoclonic-atonic epilepsy overlapping with eyelid myoclonia with absence. Some patients have developmental encephalopathy without epilepsy. Males have more severe developmental impairment. NEXMIF encephalopathy arises due to loss-of-function variants.

Refinement of the clinical and mutational spectrum of UBE2A deficiency syndrome

UBE2A deficiency, that is, intellectual disability (ID) Nascimento type (MIM 300860), is an X-linked syndrome characterized by developmental delay, moderate to severe ID, seizures, dysmorphisms, skin anomalies, and urogenital malformations. Forty affected subjects have been reported thus far, with 31 cases having intragenic UBE2A variants. Here, we report on additional eight affected subjects from seven unrelated families who were found to be hemizygous for previously unreported UBE2A missense variants (p.Glu62Lys, p.Arg95Cys, p.Thr99Ala, and p.Arg135Trp) or small in-frame deletions (p.Val81_Ala83del, and p.Asp101del). A wide phenotypic spectrum was documented in these subjects, ranging from moderate ID associated with mild dysmorphisms to severe features including congenital heart defects (CHD), severe cognitive impairment, and pineal gland tumors. Four variants affected residues (Glu62, Arg95, Thr99 and Asp101) that contribute to stabilizing the structure of the E3 binding domain. The three-residue in-frame deletion, p.Val81_Ala83del, resulted from aberrant processing of the transcript. This variant and p.Arg135Trp mapped to regions of the protein located far from the E3 binding region, and caused variably accelerated protein degradation. By reviewing available clinical information, we revise the clinical and molecular profile of the disorder and document genotype-phenotype correlations. Pineal gland cysts/tumors, CHD and hypogammaglobulinemia emerge as recurrent features.

Innovation in Fischer–Tropsch: Developing Fundamental Understanding to Support Commercial Opportunities

In this contribution we provide details of the BP-Johnson Matthey proprietary Fischer–Tropsch technology and the advanced CANS reactor and catalyst system. The advanced CANS catalyst carrier reactor provides superior heat transfer, reduced pressure drop and higher productivity that lead to major economic savings. Fundamental understanding of catalyst behaviour is also key to obtaining a catalyst that is stable over the lifetime of its use. Synthesis, calcination and reduction steps introduce changes in the catalyst properties prior to syngas introduction. In particular, the presence of water can affect the final catalyst performance. The activity of a good catalyst can be significantly reduced by a sub-optimal activation or start-up. Similarly, stable operation and minimising deactivation are vital for long and stable catalyst life, with years of operation without requiring regeneration. In this report we also share a fundamental study on the catalyst activation across different catalyst supports. This combines advanced in situ techniques with reactor testing to explore the role of the support on catalyst performance. The results illustrate the critical need for a logical and systematic catalyst development programme to explore these effects to optimise the whole FT process. The combination of a joint approach in development plays a key role in a long term success in a process. The fundamental catalyst understanding, optimisation and improvements in combination with the novel CANS reactor design maximise their potential and offer the potential for a world leading technology.

Use of Structured Self-Monitoring in Transplant Education

A self-assessment instrument for use at home by transplant recipients was developed to help foster partnership between patients and their healthcare provider. Self-monitoring at home has not replaced the need for close follow-up but does allow patients to provide concrete data to their healthcare provider in order to promote earlier detection of and response to adverse events. Patients are taught the essentials of self-monitoring while they are in the hospital for their transplant. Patients who perform routine self-assessment would be able to detect and provide information about problems early in the course of events. Thus, early intervention could potentially decrease the severity of the problem and prevent repeated hospitalizations. The concern that patients would not be able to perform a reliable self-assessment was unfounded; patients exceeded expectations and embraced the opportunity to communicate physical signs and symptoms effectively.

Perceptual and Behavioral Manifestations of the Chronic Illness and Recovery Models among Clinical Transplant Coordinators

This descriptive, qualitative study examines manifestations of the Chronic Illness and Recovery models among clinical transplant coordinators. Data collected through focused group interviews revealed that the Chronic Illness model fosters patient dependency, education about the illness itself, a perception that transplantation does not change the chronic nature of illness, a view of patients as socioeconomically disadvantaged and dependent on the transplant center, and the use of reactive approaches to care. In contrast, the Recovery model encourages patient independence, limits coordinators' protective feelings toward patients, provides education for life tasks, perceives patients as socioeconomically advantaged people capable of managing their own lives, and conducts patient care in a proactive manner.

Development of a series of aryl pyrimidine kynurenine monooxygenase inhibitors as potential therapeutic agents for the treatment of Huntington's disease

We report on the development of a series of pyrimidine carboxylic acids that are potent and selective inhibitors of kynurenine monooxygenase and competitive for kynurenine. We describe the SAR for this novel series and report on their inhibition of KMO activity in biochemical and cellular assays and their selectivity against other kynurenine pathway enzymes. We describe the optimization process that led to the identification of a program lead compound with a suitable ADME/PK profile for therapeutic development. We demonstrate that systemic inhibition of KMO in vivo with this lead compound provides pharmacodynamic evidence for modulation of kynurenine pathway metabolites both in the periphery and in the central nervous system.

Abstract P1-09-11: Can patient navigation help overcome barriers to breast cancer treatment in patients with health care disparities?

Background: Patient navigation has been demonstrated to aid in adherence to breast cancer screening initiatives. Fewer studies have documented benefit for patients undergoing treatment, and especially among those with barriers to care. Cancer health disparities affecting low-income and minority patients are well documented. Causes of poor outcomes include treatment delays coupled with social and financial barriers. This report examines the impact of patient navigation on adherence to prescribed cancer treatment, including in patients receiving treatment in adjuvant and metastatic breast cancer settings.

Methods: This Patient Navigation project (supported by an Avon Foundation grant) was initiated at our public safety net hospital to test whether there was sufficient benefit to warrant a larger randomized trial. Health care coverage included 58% Medicaid, 7% uninsured or undocumented. This study was conducted over a 4 month period with new medical oncology practice patients. Those deemed to be at high risk for non-adherence received navigated care. Navigator duties included care coordination, appointment reminders, patient education materials, translation services, and transportation arrangement. Data collected prospectively included patient characteristics, cancer type, time from referral to first RT, and compliance with visits; this was compared with usual care controls during the 4 month period.

Results: Patient Navigation Program patient characteristics: N = 52 patients (42% breast cancer, 12% prostate cancer, 10% lung cancer and 36% with other cancers). Mean age = 55; 48% Black, 38% Hispanic, 8% Asian, 6% White. The table below gives the results of percentage of adherence to visits (and time to first RT) for all patients in the study receiving navigated care, for just the patients with breast cancer receiving navigated care, and for the usual care control (no navigated care).

Table 1. NAVIGATED CARE: ALL PATIENTS (N = 52)NAVIGATED CARE: BREAST CANCER (n = 22)USUAL CARE GROUPPhysician Visits (Medical Oncology)(141 Visits) 90% (95% CI: 84%-95%)(56 Visits) 91% (95% CI: 80%-97%)(2021 Visits) 79% (95% CI: 77%-81%)Chemotherapy Treatment(107 Treatments) 95% (95% CI: 89%-99%)(30 Treatments) 97% (95% CI: 83%-99%)(1656 Treatments) 86% (95% CI: 84%-88%)Time to first RT32 Days (n = 25)35 Days (n = 8)30 Days

Conclusions: This Patient Navigation Program is associated with observed improvements in adherence to chemotherapy and in follow up physician visits. No impact on time to first RT was shown. These results document that a Patient Navigation Program can help overcome barriers to good cancer care.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-09-11.

SAR Development of Lysine-Based Irreversible Inhibitors of Transglutaminase 2 for Huntington's Disease

We report a series of irreversible transglutaminase 2 inhibitors starting from a known lysine dipeptide bearing an acrylamide warhead. We established new SARs resulting in compounds demonstrating improved potency and better physical and calculated properties. Transglutaminase selectivity profiling and in vitro ADME properties of selected compounds are also reported.

Irreversible 4-Aminopiperidine Transglutaminase 2 Inhibitors for Huntington's Disease

A new series of potent TG2 inhibitors are reported that employ a 4-aminopiperidine core bearing an acrylamide warhead. We establish the structure-activity relationship of this new series and report on the transglutaminase selectivity and in vitro ADME properties of selected compounds. We demonstrate that the compounds do not conjugate glutathione in an in vitro setting and have superior plasma stability over our previous series.

Boys do it the right way: sex-dependent amygdala lateralization during face processing in adolescents

Previous studies have observed a sex-dependent lateralization of amygdala activation related to emotional memory. Specifically, it was shown that the activity of the right amygdala correlates significantly stronger with memory for images judged as arousing in men than in women, and that there is a significantly stronger relationship in women than in men between activity of the left amygdala and memory for arousing images. Using a large sample of 235 male adolescents and 235 females matched for age and handedness, we investigated the sex-specific lateralization of amygdala activation during an emotional face perception fMRI task. Performing a formal sex by hemisphere analysis, we observed in males a significantly stronger right amygdala activation as compared to females. Our results indicate that adolescents display a sex-dependent lateralization of amygdala activation that is also present in basic processes of emotional perception. This finding suggests a sex-dependent development of human emotion processing and may further implicate possible etiological pathways for mental disorders most frequent in adolescent males (i.e., conduct disorder).

The IMAGEN study: reinforcement-related behaviour in normal brain function and psychopathology

A fundamental function of the brain is to evaluate the emotional and motivational significance of stimuli and to adapt behaviour accordingly. The IMAGEN study is the first multicentre genetic-neuroimaging study aimed at identifying the genetic and neurobiological basis of individual variability in impulsivity, reinforcer sensitivity and emotional reactivity, and determining their predictive value for the development of frequent psychiatric disorders. Comprehensive behavioural and neuropsychological characterization, functional and structural neuroimaging and genome-wide association analyses of 2000 14-year-old adolescents are combined with functional genetics in animal and human models. Results will be validated in 1000 adolescents from the Canadian Saguenay Youth Study. The sample will be followed up longitudinally at the age of 16 years to investigate the predictive value of genetics and intermediate phenotypes for the development of frequent psychiatric disorders. This review describes the strategies the IMAGEN consortium used to meet the challenges posed by large-scale multicentre imaging-genomics investigations. We provide detailed methods and Standard Operating Procedures that we hope will be helpful for the design of future studies. These include standardization of the clinical, psychometric and neuroimaging-acquisition protocols, development of a central database for efficient analyses of large multimodal data sets and new analytic approaches to large-scale genetic neuroimaging analyses.

Quality Control in Human In Vitro Fertilization

The implementation of suitable quality control (QC) is not only required for the accreditation of a human in vitro fertilization (IVF) laboratory, but is also fundamental to its success. Several assays have been employed to screen culture media and contact supplies. The suitability of one assay in particular, the mouse embryo assay (MEA), has been questioned over the years. Here we discuss how the conditions of such an assay, together with the stage of embryonic development used, have a profound effect on the outcome of the assay. Furthermore, by assessing embryos at multiple time points during the preimplantation period (rather than simply determining blastocyst formation), together with quantitating key parameters such as blastocyst cell number, it is possible to identify suboptimal components of a culture system. As well as identifying those components that result in outright embryonic demise, under the appropriate conditions the MEA can detect components that lead to impaired development. It is proposed that under the appropriate conditions, the MEA is a useful adjunct to quality control in human IVF, but several assays used in concert are better than a single test.

The characterization of a promising new optical source for use with a radiotherapy treatment simulator

We report on an experimental examination of a new powerful optical source with potential application in radiotherapy treatment simulation. The illuminance, effective source position, and source size have been measured for this new source and, for comparison, for conventional sources on a simulator and a linear accelerator. This new source is considerably brighter than those in common use in radiotherapy. Its effective optical source size is larger than that on the linear accelerator tested but comparable with that on a conventional simulator.