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Armstrong A, Kroener L, Miller J, Nguyen A, Kwan L, Quinn M. The nature of embryonic mosaicism across female age spectrum: an analysis of 21,345 preimplantation genetic testing for aneuploidy cycles. F S Rep 2023; 4:256-261. [PMID: 37719098 PMCID: PMC10504531 DOI: 10.1016/j.xfre.2023.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 03/27/2023] [Accepted: 03/29/2023] [Indexed: 09/19/2023] Open
Abstract
Objective To understand how mosaicism varies across patient-specific variables and clinics. Design Cross-sectional cohort. Setting Genetic testing laboratory. Patients A total of 86,208 embryos from 17,366 patients underwent preimplantation genetic testing for aneuploidy using next-generation sequencing. Interventions Mosaic embryos were classified as either low-level (20%-40%) or high-level (40%-80%) and by type of mosaic error: single segmental, complex segmental, single chromosome, or complex abnormal mosaic. The rate of mosaicism was stratified by the Society for Assisted Reproductive Technology age categories: <35 years, 35-37 years, 38-40 years, 41-42 years, and >42 years. Main Outcome Measures Distribution of chromosomal findings and prevalence of mosaicism type by age. Probability of creating mosaic embryos in a subsequent cycle. Results Among all embryos, 44% were euploid, 40.2% were aneuploid, and 15.8% were mosaic. Both low-level and high-level mosaicism were more prevalent among younger patients. Of all mosaic embryos, the youngest age cohort <35 years had the highest proportions of single and complex segmental mosaicism (37.9% and 6.8%, respectively), whereas those aged >42 years had the highest single whole chromosome and complex abnormal mosaicism (37.1% and 34.0%, respectively). Although there was variability in mosaic rates across clinics, the median mosaic rate over 3 years ranged from 14.48% to 17.72%. A diagnosis of a mosaic embryo in a previous cycle did not increase a patient's odds for having a mosaic embryo in a subsequent cycle. Conclusions Mosaicism is overall higher in younger patients, but the complexity of mosaic errors increases with age. A history of mosaicism was not associated with mosaicism in subsequent cycles. Additional research is needed to understand the etiologies of the various subtypes of mosaic embryos and clinical outcomes associated with their transfer.
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Affiliation(s)
- Abigail Armstrong
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of California, Los Angeles, California
| | - Lindsay Kroener
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of California, Los Angeles, California
| | | | - Anissa Nguyen
- Department of Urology, University of California, Los Angeles, California
| | - Lorna Kwan
- Department of Urology, University of California, Los Angeles, California
| | - Molly Quinn
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Keck School of Medicine at University of Southern California, Los Angeles, California
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Armstrong A, Kroener L, Cohen JG, Han CS, Nitti VW, Rible R, Brennan K. Faculty and applicant perceptions of virtual interviews on subspecialty fellowship match in obstetrics and gynecology. Med Educ Online 2022; 27:2068993. [PMID: 35473575 PMCID: PMC9067945 DOI: 10.1080/10872981.2022.2068993] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 03/23/2022] [Accepted: 04/19/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND In response to COVID-19, the AAMC recommended that hospitals conduct interviews in a virtual setting. OBJECTIVE To evaluate whether fellowship video conference interviews (VCIs) are an acceptable alternative to in-person interviews from both the applicant and program perspectives. METHODS Applicants and faculty from a single academic institution with five OBGYN subspecialty fellowship programs were invited to complete surveys regarding their experience using VCIs during the 2020 interview season. Survey responses used a 5-point Likert scale (strongly disagree to strongly agree). Comparative analyses between faculty and applicants responses to survey questions were performed with two-tailed Student's t-tests. RESULTS 45 faculty members and 131 applicants received the survey. Response rate for faculty members and applicants was 95.6% (n = 43) and 46.6% (n = 61), respectively. Faculty and applicants agreed that the VCIs allowed them to accurately represent themselves (83.7% vs. 88.6%, p = 0.48). Most applicants (62.3%, n = 38) reported a fundamental understanding of the fellowship's culture. The majority of applicants (77.1%, n = 47) and faculty (72.1%, n = 31) agreed that they were able to develop connections during the virtual interview (p = 0.77). Faculty and applicants stated that VCIs assisted them in determining whether the candidate or program, respectively, was a good fit (83.7% vs. 67.2%, p = 0.98). CONCLUSIONS The VCI fellowship recruitment process allowed OBGYN fellowship applicants and programs to accurately represent themselves compared to in-person interviews. Most applicants and faculty were able to develop relationships over the virtual platform. Although not explicitly assessed, it is possible that the virtual interviews can achieve a suitable match between applicant and program across all OBGYN subspecialty fellowships. The VCI process may be a long-term resolution to minimize both the financial burden and time commitment presented by traditional in-person interviews. Follow-up studies should assess the performance of the virtually selected fellows compared to those selected in previous years using traditional in-person interviews.
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Affiliation(s)
- Abigail Armstrong
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of California at Los Angeles, Los Angeles, California, USA
| | - Lindsay Kroener
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of California at Los Angeles, Los Angeles, California, USA
| | - Joshua G. Cohen
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California at Los Angeles, Los Angeles, California, USA
| | - Christina S. Han
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California at Los Angeles, Los Angeles, California, USA
| | - Victor W. Nitti
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of California at Los Angeles, Los Angeles, California, USA
| | - Radhika Rible
- Division of Family Planning, Department of Obstetrics and Gynecology, University of California at Los Angeles, Los Angeles, California, USA
| | - Kathleen Brennan
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of California at Los Angeles, Los Angeles, California, USA
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Armstrong A, Miller J, Quinn M, Nguyen AV, Kwan L, Kroener L. To mask or not to mask mosaicism? The impact of reporting embryo mosaicism on reproductive potential. J Assist Reprod Genet 2022; 39:2035-2042. [PMID: 35857256 PMCID: PMC9474961 DOI: 10.1007/s10815-022-02576-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 07/12/2022] [Indexed: 10/17/2022] Open
Abstract
PURPOSE To evaluate euploidy rates and probability of having at least one euploid embryo for transfer per cycle when mosaicism is reported compared to when it is masked. METHODS Women age 18-46 years who underwent PGT-A with next generation sequencing of blastocyst biopsies were analyzed. When reported, mosaic embryos were classified as low-level, 20-40% mosaic, or high-level, 41-80% mosaic. When masked, low-level mosaics were categorized as euploid and high-level mosaics were considered aneuploid. Comparative analyses were performed with χ2 tests and t-tests. RESULTS A total of 22,504 PGT-A biopsy cycles from 18,401 patients were included. These cycles were from 293 different clinics with a mean of 1.22 cycles per patient. The majority of cycles (94.8%) reported mosaicism, and only 5.2% cycles were masked. The euploidy rate was significantly lower when mosaicism was reported versus masked (38.7% v 47.4%, p < 0.0001), which remained significant for age 40 years old and younger. The mosaic reporting cohort was less likely to have at least one euploid embryo for transfer (68.8%) compared to the masked cohort (75.7%) (p < 0.0001); however, this was no longer significant after stratification by age. CONCLUSION Mosaicism reporting shows an overall expected reduction in euploidy rate. In turn, the probability of having a euploid embryo to transfer depends on clinic transfer practices and patient preference. If mosaic embryos are not transferred, we observe a reduction in probability of having an embryo for transfer. Although the magnitude of these differences is small, our data show that mosaic reporting may contribute to embryo attrition rate.
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Affiliation(s)
- A Armstrong
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, UCLA, 200 Medical Plaza Driveway Suite 220, CA, 90095, Los Angeles, USA.
| | - J Miller
- CooperSurgical, 3 Regent St, Livingston, NJ, 07039, USA
| | - M Quinn
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Keck School of Medicine at University of Southern California, 2020 Zonal Avenue, IRD 534, CA, 90033, Los Angeles, USA
| | - A V Nguyen
- Department of Urology, UCLA, 200 Medical Plaza Driveway Suite 140, CA, 90095, Los Angeles, USA
| | - L Kwan
- Department of Urology, UCLA, 200 Medical Plaza Driveway Suite 140, CA, 90095, Los Angeles, USA
| | - L Kroener
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, UCLA, 200 Medical Plaza Driveway Suite 220, CA, 90095, Los Angeles, USA
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Dilday EA, Kroener L, Akopians AL, Ramos NE, Xu N, Jackson NJ, Barritt JA. LASER-ASSISTED HATCHING ON DAY 1 DEMONSTRATES EQUIVALENT EMBRYO YIELD, TIMING OF BLASTOCYST DEVELOPMENT AND EMBRYO EUPLOIDY RATES COMPARED WITH STANDARD DAY 3 ASSISTED HATCHING. Fertil Steril 2021. [DOI: 10.1016/j.fertnstert.2021.07.383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Armstrong A, Miller JO, Quinn MM, Nguyen AV, Kwan L, Kroener L. REPORTING EMBRYO MOSAICISM USING PREIMPLANTATION GENETIC TESTING FOR ANEUPLOIDY (PGT-A): IMPACT ON EUPLOIDY RATE AND LIKELIHOOD OF EMBRYOS AVAILABLE FOR TRANSFER. Fertil Steril 2021. [DOI: 10.1016/j.fertnstert.2021.07.1068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Dilday EA, Kroener L, Akopians AL, Ramos NE, Xu N, Jackson NJ, Barritt JA. LASER-ASSISTED HATCHING ON DAY 1 OF EMBRYO CULTURE DEMONSTRATES EQUIVALENT ONGOING CLINICAL PREGNANCY RATES COMPARED TO EMBRYOS WITH STANDARD DAY 3 ASSISTED HATCHING. Fertil Steril 2021. [DOI: 10.1016/j.fertnstert.2021.07.1185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Armstrong A, Kroener L, Cohen J, Han CS, Nitti V, Rible R, Brennan K. THE INFLUENCE OF VIRTUAL INTERVIEWS ON THE FELLOWSHIP MATCH IN OBSTETRICS AND GYNECOLOGY (OBGYN). Fertil Steril 2021. [DOI: 10.1016/j.fertnstert.2021.07.211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Dilday E, Ramos N, Kroener L, Xu N, Jackson N, Barritt J. LASER-ASSISTED HATCHING ON DAY 1 OF EMBRYO CULTURE DEMONSTRATES SIGNIFICANT IMPLANTATION RATE INCREASE COMPARED TO EMBRYOS WITH STANDARD DAY 3 ASSISTED HATCHING. Fertil Steril 2021. [DOI: 10.1016/j.fertnstert.2021.05.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Shapiro AJ, Kroener L, Quinn MM. Expanded carrier screening for recessively inherited disorders: economic burden and factors in decision-making when one individual in a couple is identified as a carrier. J Assist Reprod Genet 2021; 38:957-963. [PMID: 33501564 DOI: 10.1007/s10815-021-02084-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 01/20/2021] [Indexed: 11/27/2022] Open
Abstract
PURPOSE When undergoing expanded carrier screening (ECS), couples are often screened sequentially to reduce need for a second individual's test. It is unknown how often partners of individuals found to be carriers complete the recommended testing with a sequential approach and what factors contribute to decision-making regarding partner testing. Additionally, the economic burden placed on individuals by ECS testing and its effect on partner testing has not been evaluated. METHODS In part 1, all individuals at a university-affiliated reproductive endocrinology and infertility practice identified to be carriers of a recessively inherited mutation using the Counsyl/Foresight ECS were included. Conditions were categorized by severity according to a previously described classification system. In part 2, all individuals who underwent ECS with a single test provider between September 1, 2013 and February 1, 2020 were contacted via email to complete a confidential and anonymized online survey. RESULTS In part 1, a total of 2061 patients were screened. 36.9% were carriers of one or more recessively inherited disorders. Twenty-seven percent of positively screened individuals did not have their partner screened. Carriers of a moderate condition had a trend towards a reduced odds for having their partner screened compared to a profound condition (OR 0.36, 95% CI 0.12-1.05, p = 0.06). Number of conditions was not predictive of subsequent partner screening (OR 0.95, 95% CI 0.72-1.25, p = 0.72). In part 2, the cost of ECS was not covered by insurance for 54.5% (103/189) and most paid over $300 out-of-pocket for testing (47.6%). The most common reason for not completing partner testing was that the results would not alter their course when seeking conception (33.3%). 73.5% of patients knew that the largest benefit of ECS comes from knowing a partner's results as well as their own. CONCLUSIONS Not all carriers of recessively inherited disorders choose to undergo partner screening. Patients found to be carrier of more debilitating genetic disorders may be more likely to screen their reproductive partners. For many, ECS testing is not covered by insurance, and this test may impose a significant economic burden. For some patients, the results of ECS would not change what they would do when seeking conception. Providers should evaluate whether a patient's ECS result would change their treatment course prior to testing.
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Affiliation(s)
- Alice J Shapiro
- Department of Obstetrics and Gynecology, University of California, Los Angeles, Los Angeles, CA, USA.
| | - Lindsay Kroener
- Department of Obstetrics and Gynecology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Molly M Quinn
- Department of Obstetrics and Gynecology, University of California, Los Angeles, Los Angeles, CA, USA
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Riestenberg C, Kroener L, Quinn M, Ching K, Ambartsumyan G. Routine endometrial receptivity array in first embryo transfer cycles does not improve live birth rate. Fertil Steril 2021; 115:1001-1006. [PMID: 33461752 DOI: 10.1016/j.fertnstert.2020.09.140] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 09/08/2020] [Accepted: 09/15/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To compare the live birth rate between patients who undergo personalized embryo transfer (pET) after endometrial receptivity array (ERA) versus frozen embryo transfer (FET) with standard timing in first single euploid FET cycles. To report the rate of displacement of the window of implantation (WOI) in an infertile population without a history of implantation failure. DESIGN Prospective cohort study of patients who underwent their first single euploid programmed FET. SETTING Private fertility clinic. PATIENT(S) Patients who underwent first autologous single euploid programmed FET between January 2018 and April 2019. INTERVENTION(S) Endometrial biopsy with ERA followed by pET as indicated. MAIN OUTCOME MEASURE(S) Live birth rate and rate of receptive and nonreceptive ERA. RESULT(S) A total of 228 single euploid FET cycles were included in our analysis. Of those, 147 (64.5%) were ERA/pET cycles, and 81 (35.5%) were standard timing FET cycles. Endometrial receptivity array was receptive in 60/147 (40.8%) and nonreceptive in 87/147 (59.2%) patients. Nonreceptive ERAs were prereceptive in 93.1% of cases. The live birth rate did not differ between patients who underwent FET with standard timing and patients who underwent ERA/pET, 45/81 (56.6%) and 83/147 (56.5%), respectively. CONCLUSION(S) Our data do not support the routine use of ERA in an unselected patient population undergoing first autologous single euploid programmed embryo transfer.
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Affiliation(s)
- Carrie Riestenberg
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of California, Los Angeles, Los Angeles, California.
| | - Lindsay Kroener
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of California, Los Angeles, Los Angeles, California
| | - Molly Quinn
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of California, Los Angeles, Los Angeles, California
| | - Kaycee Ching
- Wayne State University School of Medicine, Detroit, Michigan
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Dilday EA, Hoyos LR, Quinn MM, Kroener L. LUTEAL PHASE SUPPORT WITH PROGESTERONE DOES NOT IMPROVE PREGNANCY RATES IN PATIENTS UNDERGOING CONTROLLED OVARIAN STIMULATION WITH LETROZOLE. Fertil Steril 2020. [DOI: 10.1016/j.fertnstert.2020.08.542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Riestenberg C, Kroener L, Ching K, Ambartsumyan G. Routine Endometrial Receptivity Array In First Embryo Transfer Cycles Does Not Improve Live Birth Rate. Fertil Steril 2020. [DOI: 10.1016/j.fertnstert.2020.08.777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Mehr H, Al-Safi Z, Riestenberg C, Lee V, Guo R, Brennan K, Kroener L. USE OF ADJUVANT HUMAN GROWTH HORMONE DOES NOT IMPROVE BLASTOCYST EUPLOIDY RATES IN PATIENTS UNDERGOING IN VITRO FERTILIZATION. Fertil Steril 2020. [DOI: 10.1016/j.fertnstert.2020.08.859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Armstrong AA, Kroener L, Brower M, Al-Safi ZA. Analysis of Reported Adverse Events with Uterine Artery Embolization for Leiomyomas. J Minim Invasive Gynecol 2019; 26:667-670.e1. [DOI: 10.1016/j.jmig.2018.07.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 06/16/2018] [Accepted: 07/06/2018] [Indexed: 11/30/2022]
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Lee B, Koeppel AF, Wang ET, Gonzalez TL, Sun T, Kroener L, Lin Y, Joshi NV, Ghadiali T, Turner SD, Rich SS, Farber CR, Rotter JI, Ida Chen YD, Goodarzi MO, Guller S, Harwood B, Serna TB, Williams J, Pisarska MD. Differential gene expression during placentation in pregnancies conceived with different fertility treatments compared with spontaneous pregnancies. Fertil Steril 2019; 111:535-546. [PMID: 30611556 DOI: 10.1016/j.fertnstert.2018.11.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 11/03/2018] [Accepted: 11/05/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To identify differences in the transcriptomic profiles during placentation from pregnancies conceived spontaneously vs. those with infertility using non-in vitro fertilization (IVF) fertility treatment (NIFT) or IVF. DESIGN Cohort study. SETTING Academic medical center. PATIENT(S) Women undergoing chorionic villus sampling at gestational age 11-13 weeks (n = 141), with pregnancies that were conceived spontaneously (n = 74), with NIFT (n = 33), or with IVF (n = 34), resulting in the delivery of viable offspring. INTERVENTION(S) Collection of chorionic villus samples from women who conceived spontaneously, with NIFT, or with IVF for gene expression analysis using RNA sequencing. MAIN OUTCOME MEASURE(S) Baseline maternal, paternal, and fetal demographics, maternal medical conditions, pregnancy complications, and outcomes. Differential gene expression of first-trimester placenta. RESULT(S) There were few differences in the transcriptome of first-trimester placenta from NIFT, IVF, and spontaneous pregnancies. There was one protein-coding differentially expressed gene (DEG) between the spontaneous and infertility groups, CACNA1I, one protein-coding DEG between the spontaneous and IVF groups, CACNA1I, and five protein-coding DEGs between the NIFT and IVF groups, SLC18A2, CCL21, FXYD2, PAEP, and DNER. CONCLUSION(S) This is the first and largest study looking at transcriptomic profiles of first-trimester placenta demonstrating similar transcriptomic profiles in pregnancies conceived using NIFT or IVF and spontaneous conceptions. Gene expression differences found to be highest in the NIFT group suggest that the underlying infertility, in addition to treatment-related factors, may contribute to the observed gene expression profiles.
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Affiliation(s)
- Bora Lee
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Alex F Koeppel
- Center for Public Health Genomics, University of Virginia, Charlottesville, Virginia
| | - Erica T Wang
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California; Department of Obstetrics and Gynecology, University of California, Los Angeles (UCLA) David Geffen School of Medicine, Los Angeles, California
| | - Tania L Gonzalez
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Tianyanxin Sun
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Lindsay Kroener
- Department of Obstetrics and Gynecology, University of California, Los Angeles (UCLA) David Geffen School of Medicine, Los Angeles, California
| | - Yayu Lin
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Nikhil V Joshi
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California; Department of Obstetrics and Gynecology, University of California, Los Angeles (UCLA) David Geffen School of Medicine, Los Angeles, California
| | - Tejal Ghadiali
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Stephen D Turner
- Center for Public Health Genomics, University of Virginia, Charlottesville, Virginia
| | - Stephen S Rich
- Center for Public Health Genomics, University of Virginia, Charlottesville, Virginia
| | - Charles R Farber
- Center for Public Health Genomics, University of Virginia, Charlottesville, Virginia
| | | | | | - Mark O Goodarzi
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Seth Guller
- Department of Obstetrics/Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Bryna Harwood
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Tania B Serna
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California
| | - John Williams
- Department of Obstetrics and Gynecology, University of California, Los Angeles (UCLA) David Geffen School of Medicine, Los Angeles, California; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Margareta D Pisarska
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California; Department of Obstetrics and Gynecology, University of California, Los Angeles (UCLA) David Geffen School of Medicine, Los Angeles, California.
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Zore T, Kroener L, Wang C, Liu L, Buyalos R, Hubert G, Shamonki M. Transfer of embryos with segmental mosaicism is associated with a significant reduction in live birth rate compared to euploid controls. Fertil Steril 2017. [DOI: 10.1016/j.fertnstert.2017.07.269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Xu N, Barlow GM, Cui J, Wang ET, Lee B, Akhlaghpour M, Kroener L, Williams J, Rotter JI, Chen YDI, Goodarzi MO, Pisarska MD. Comparison of Genome-Wide and Gene-Specific DNA Methylation Profiling in First-Trimester Chorionic Villi From Pregnancies Conceived With Infertility Treatments. Reprod Sci 2016; 24:996-1004. [PMID: 28090815 DOI: 10.1177/1933719116675056] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Assisted reproductive technologies are associated with altered methylation in term placenta. However, it is unclear whether methylation patterns are the result of fertility treatments or intrauterine environment. Thus, we set out to determine whether there are differences in the first-trimester placenta that may be altered by the underlying fertility treatments. Genome-wide DNA methylation analyses from chorionic villus sampling (CVS) from matched singleton pregnancies conceived using in vitro fertilization (IVF), non-IVF fertility treatment (NIFT), or those conceived spontaneously were performed using Illumina Infinium HumanMethylation450 BeadChip from 15 matched CVS samples. Nanofluidic quantitative polymerase chain reaction (qPCR) of differently methylated genes was performed in a confirmatory cohort of 23 IVF conceptions and 24 NIFT conceptions. RESULTS Global methylation was similar among the IVF, NIFT, and spontaneous conceptions. However, differential methylation from IVF and NIFT pregnancies was present at 34 CpG sites, which was significantly different. Of those, 14 corresponded to known genes, with methylation changes detected at multiple loci in 3 genes, anaphase-promoting complex subunit 2 ( ANAPC2), C-X-C motif chemokine ligand 14 ( CXCL14), and regulating synaptic membrane exocytosis 1 ( RIMS1). Nanofluidic qPCR of differentially methylated genes identified pre T-cell antigen receptor alpha ( PTCRA) to be significantly downregulated in IVF versus NIFT conceptions. CONCLUSION Although global methylation patterns are similar, there are differences in methylation of specific genes in IVF compared to NIFT conceptions, leading to altered gene expression. PTCRA was differentially methylated and downregulated in IVF conceptions, warranting further investigation. It remains to be determined whether these changes affect placentation and whether it is due to the more profound underlying infertility requiring IVF, yet these data provide unique insight into the first-trimester placental epigenome.
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Affiliation(s)
- Ning Xu
- 1 Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Gillian M Barlow
- 2 Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jinrui Cui
- 1 Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Erica T Wang
- 2 Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,3 UCLA School of Medicine, Los Angeles, CA, USA
| | - Bora Lee
- 2 Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Marzieh Akhlaghpour
- 2 Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Lindsay Kroener
- 2 Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,3 UCLA School of Medicine, Los Angeles, CA, USA
| | - John Williams
- 3 UCLA School of Medicine, Los Angeles, CA, USA.,4 Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jerome I Rotter
- 5 Institute for Translational Genomics and Population Sciences, LA Biomed/Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Yii-der I Chen
- 5 Institute for Translational Genomics and Population Sciences, LA Biomed/Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Mark O Goodarzi
- 1 Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,3 UCLA School of Medicine, Los Angeles, CA, USA
| | - Margareta D Pisarska
- 2 Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,3 UCLA School of Medicine, Los Angeles, CA, USA
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18
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Kaing A, Kroener L, Tassin R, Li M, Liu L, Buyalos R, Hubert G, Shamonki M. Earlier day of blastocyst trophectoderm biopsy is predictive of embryonic euploidy across all age groups in both autologous and donor cycles: essential data for counseling patients. Fertil Steril 2016. [DOI: 10.1016/j.fertnstert.2016.07.998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
Normal placentation during the first trimester sets the stage for the rest of pregnancy and involves a finely orchestrated cellular and molecular interplay of maternal and fetal tissues. The resulting intrauterine environment plays an important role in fetal programming and the future health of the fetus, and is impacted by multiple genetic and epigenetic factors. Abnormalities in placentation and spiral artery invasion can lead to ischemia, placental disease, and adverse obstetrical outcomes including preeclampsia, intrauterine growth restriction, and placental abruption. Although first trimester placentation is affected by multiple factors, preconception environmental influences such as mode of conception, including assisted reproductive technologies which result in fertilization in vitro and intrauterine influences due to sex differences, are emerging as potential significant factors impacting first trimester placentation.
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Affiliation(s)
- Lindsay Kroener
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Erica T Wang
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Margareta D Pisarska
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California
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20
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Kaing A, Kroener L, Brower M, Hill D, Danzer H, Barritt J. Rebiopsy and preimplanation genetic screening (PGS) reanalysis demonstrate the majority of originally “no diagnosis” embryos are euploid with comparable pregnancy rates. Fertil Steril 2015. [DOI: 10.1016/j.fertnstert.2015.07.869] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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21
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Goldstein E, Kroener L, Hill D, Surrey M, Danzer H, Ghadir S, Barritt J. Embryos Developing after a Failure to Visualize Pronuclei at the Time of Fertilization Check Very Rarely Produce Blastocysts to Transfer or Freeze. Fertil Steril 2015. [DOI: 10.1016/j.fertnstert.2014.12.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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22
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Goldstein E, Kroener L, Hill D, Surrey M, Danzer H, Ghadir S, Barritt J. One Pronucleus Zygotes, Derived Both from ICSI and Insemination, Rarely Develop to Quality Blastocysts and They are Significantly Less Likely to Be Frozen or Transferred. Fertil Steril 2015. [DOI: 10.1016/j.fertnstert.2014.12.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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23
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Kroener L, Ambartsumyan G, Yee B. Impact of lead follicle size in clomiphene citrate-only minimal stimulation in-vitro fertilization (IVF) cycles. Fertil Steril 2014. [DOI: 10.1016/j.fertnstert.2014.07.227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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24
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Kroener L, Ambartsumyan G, Briton-Jones C, Dumesic D, Surrey M, Munné S, Hill D. The effect of timing of embryonic progression on chromosomal abnormality. Fertil Steril 2012; 98:876-80. [DOI: 10.1016/j.fertnstert.2012.06.014] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2012] [Revised: 05/24/2012] [Accepted: 06/07/2012] [Indexed: 11/28/2022]
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25
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Kroener L, Ambartsumyan G, Hill D, Surrey M, Pisarska M, Briton-Jones C. Increased blastomere numbers in cleavage stage embryos are associated with higher aneuploidy rates determined by comparative genomic hybridization. Fertil Steril 2012. [DOI: 10.1016/j.fertnstert.2012.07.054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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26
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Marrinucci D, Bethel K, Bruce RH, Curry DN, Hsieh B, Humphrey M, Krivacic RT, Kroener J, Kroener L, Ladanyi A, Lazarus NH, Nieva J, Kuhn P. Case study of the morphologic variation of circulating tumor cells. Hum Pathol 2006; 38:514-9. [PMID: 17188328 DOI: 10.1016/j.humpath.2006.08.027] [Citation(s) in RCA: 124] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2006] [Revised: 08/24/2006] [Accepted: 08/25/2006] [Indexed: 12/27/2022]
Abstract
We report a detailed cytomorphologic evaluation of the circulating component of widely metastatic breast carcinoma. A previously healthy 38-year-old woman was diagnosed with breast cancer. Wide local excision revealed a 1.7-cm infiltrating ductal adenocarcinoma, BSR score 7/9 with angiolymphatic invasion, and 4/20 lymph nodes positive for carcinoma. Five years later, a bone marrow biopsy revealed involvement of bone marrow by metastatic breast carcinoma, and shortly thereafter, metastases were identified in the liver and lung hilum. She enrolled in a clinical investigation for the detection of circulating tumor cells (CTCs) in breast carcinoma. A total of 659 CTCs were identified in a 10-mL blood sample using an immunofluorescent protocol targeting cytokeratins and detected using fiber-optic array scanning technology. The detected CTCs were subsequently stained with a Wright-Giemsa stain, and representative cells were evaluated in detail by light microscopy for morphologic evaluation. We find that the patient's CTCs exhibit a high degree of pleomorphism including CTCs with high and low nuclear-to-cytoplasmic ratios along with CTCs exhibiting early and late apoptotic changes. In addition, in comparison with her tumor cells in other sites, the full morphologic spectrum of cancer cells present in primary and metastatic tumor is also present in peripheral blood circulation.
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Affiliation(s)
- Dena Marrinucci
- The Scripps-PARC Institute for Advanced Biomedical Science, Department of Cell Biology, The Scripps Research Institute, La Jolla, CA 92037, USA
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Hsieh HB, Marrinucci D, Bethel K, Curry DN, Humphrey M, Krivacic RT, Kroener J, Kroener L, Ladanyi A, Lazarus N, Kuhn P, Bruce RH, Nieva J. High speed detection of circulating tumor cells. Biosens Bioelectron 2006; 21:1893-9. [PMID: 16464570 DOI: 10.1016/j.bios.2005.12.024] [Citation(s) in RCA: 141] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2005] [Revised: 11/23/2005] [Accepted: 12/21/2005] [Indexed: 12/22/2022]
Abstract
Epithelial tumor cells circulate in peripheral blood at ultra-low concentrations in cancer patients. We have developed an instrument capable of rapid and accurate detection of rare cells in circulation utilizing fiber-optic array scanning technology (FAST). The FAST cytometer can locate immunofluorescently labeled rare cells on glass substrates at scan rates 500 times faster than conventional automated digital microscopy. These high scan rates are achieved by collecting fluorescent emissions using a fiber bundle with a large (50 mm) field of view. Very high scan rates make possible the ability to detect rare events without the requirement for an enrichment step. The FAST cytometer was used to detect, image and re-image circulating tumor cells in peripheral blood of breast cancer patients. This technology has the potential to serve as a clinically useful point-of-care diagnostic and a prognostic tool for cancer clinicians. The use of a fixed substrate permits the re-identification and re-staining of cells allowing for additional morphologic and biologic information to be obtained from previously collected and identified cells.
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Affiliation(s)
- H Ben Hsieh
- The Scripps-PARC Institute for Advanced Biomedical Science, Palo Alto Research Center, 3333 Coyote Hill Rd., Palo Alto, CA 94304, United States
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28
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Musshoff F, Lachenmeier DW, Kroener L, Schmidt P, Dettmeyer R, Madea B. Simultaneous gas chromatographic-mass spectrometric determination of dopamine, norsalsolinol and salsolinol enantiomers in brain samples of a large human collective. Cell Mol Biol (Noisy-le-grand) 2003; 49:837-49. [PMID: 14528920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
Using a solid-phase extraction procedure, an enantioselective derivatization and a gas chromatographic-mass spectrometric method, the levels of dopamine (DA) and of the dopamine-derived tetrahydroisoquinoline alkaloids (R)/(S)-salsolinol (SAL) and norsalsolinol (NorSAL) were determined in human brain samples. A complex pre-analytical synthesis of reference substances as well as deuterated internal standards allowed the standardized and reproducible analysis. In this study, to our best knowledge for the first time, the regional distribution of (R)-SAL and (S)-SAL, as well as NorSAL is examined systematically in a large collective of human brain samples obtained by autopsy. The material comprises 91 brains and 8 standardized specimens in each case. Anatomical concentration differences and no ubiquitous occurence were encountered. Significant amounts of (R)-SAL, (S)-SAL and NorSAL were only found in dopamine-rich areas of the basal ganglia, whereas in other regions of the brain no tetrahydroisoquinolines were detected. These findings suggest that the concentration of the substrate dopamine may determine the alkaloid level during in vivo formation. In our opinion, non-enzymatic formation of SAL via the Pictet-Spengler reaction reveals both the SAL enantiomers. An additional enzymatic synthesis of only (R)-SAL could explain the predominant occurrence of this enantiomer. Especially in the nucleus caudatus, the concentrations of DA, SAL and NorSAL decreased significantly with rising age, which may be consistent with apoptotic effects of ageing. Our data can serve as reference for other studies in humans concerning the etiology of alcoholism or other neurodegenerative diseases with the involvement of tetrahydroisoquinolines.
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Affiliation(s)
- F Musshoff
- Institute of Legal Medicine, Rheinische Friedrich-Wilhelms-University, Stiftsplatz 12, 53111 Bonn, Germany.
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