Empowering CO2 Eco-Refrigeration With Colossal Breathing-Caloric-Like Effects in MOF-508b

Today, ≈20% of the electric consumption is devoted to refrigeration; while, ≈50% of the final energy is dedicated to heating applications. In this scenario, many cooling devices and heat-pumps are transitioning toward the use of CO2 as an eco-friendly refrigerant, favoring carbon circular economy. Nevertheless, CO2 still has some limitations, such as large operating pressures (70-150 bar) and a critical point at 31 °C, which compromises efficiency and increases technological complexity. Very recently, an innovative breathing-caloric mechanism in the MIL-53(Al) compound is reported, which implies gas adsorption under CO2 pressurization boosted by structural transitions and which overcomes the limitations of stand-alone CO2. Here, the breathing-caloric-like effects of MOF-508b are reported, surpassing by 40% those of MIL-53(Al). Moreover, the first thermometry device operating at room temperature and under the application of only 26 bar of CO2 is presented. Under those conditions, this material presents values of ΔT ≈ 30 K, reaching heating temperatures of 56 °C and cooling temperatures of -10 °C, which are already useful for space heating, air-conditioning, food refrigeration, and freezing applications.

A hybrid artificial intelligence model leverages multi-centric clinical data to improve fetal heart rate pregnancy prediction across time-lapse systems

STUDY QUESTION

Can artificial intelligence (AI) algorithms developed to assist embryologists in evaluating embryo morphokinetics be enriched with multi-centric clinical data to better predict clinical pregnancy outcome?

SUMMARY ANSWER

Training algorithms on multi-centric clinical data significantly increased AUC compared to algorithms that only analyzed the time-lapse system (TLS) videos.

WHAT IS KNOWN ALREADY

Several AI-based algorithms have been developed to predict pregnancy, most of them based only on analysis of the time-lapse recording of embryo development. It remains unclear, however, whether considering numerous clinical features can improve the predictive performances of time-lapse based embryo evaluation.

STUDY DESIGN, SIZE, DURATION

A dataset of 9986 embryos (95.60% known clinical pregnancy outcome, 32.47% frozen transfers) from 5226 patients from 14 European fertility centers (in two countries) recorded with three different TLS was used to train and validate the algorithms. A total of 31 clinical factors were collected. A separate test set (447 videos) was used to compare performances between embryologists and the algorithm.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Clinical pregnancy (defined as a pregnancy leading to a fetal heartbeat) outcome was first predicted using a 3D convolutional neural network that analyzed videos of the embryonic development up to 2 or 3 days of development (33% of the database) or up to 5 or 6 days of development (67% of the database). The output video score was then fed as input alongside clinical features to a gradient boosting algorithm that generated a second score corresponding to the hybrid model. AUC was computed across 7-fold of the validation dataset for both models. These predictions were compared to those of 13 senior embryologists made on the test dataset.

MAIN RESULTS AND THE ROLE OF CHANCE

The average AUC of the hybrid model across all 7-fold was significantly higher than that of the video model (0.727 versus 0.684, respectively, P = 0.015; Wilcoxon test). A SHapley Additive exPlanations (SHAP) analysis of the hybrid model showed that the six first most important features to predict pregnancy were morphokinetics of the embryo (video score), oocyte age, total gonadotrophin dose intake, number of embryos generated, number of oocytes retrieved, and endometrium thickness. The hybrid model was shown to be superior to embryologists with respect to different metrics, including the balanced accuracy (P ≤ 0.003; Wilcoxon test). The likelihood of pregnancy was linearly linked to the hybrid score, with increasing odds ratio (maximum P-value = 0.001), demonstrating the ranking capacity of the model. Training individual hybrid models did not improve predictive performance. A clinic hold-out experiment was conducted and resulted in AUCs ranging between 0.63 and 0.73. Performance of the hybrid model did not vary between TLS or between subgroups of embryos transferred at different days of embryonic development. The hybrid model did fare better for patients older than 35 years (P < 0.001; Mann-Whitney test), and for fresh transfers (P < 0.001; Mann-Whitney test).

LIMITATIONS, REASONS FOR CAUTION

Participant centers were located in two countries, thus limiting the generalization of our conclusion to wider subpopulations of patients. Not all clinical features were available for all embryos, thus limiting the performances of the hybrid model in some instances.

WIDER IMPLICATIONS OF THE FINDINGS

Our study suggests that considering clinical data improves pregnancy predictive performances and that there is no need to retrain algorithms at the clinic level unless they follow strikingly different practices. This study characterizes a versatile AI algorithm with similar performance on different time-lapse microscopes and on embryos transferred at different development stages. It can also help with patients of different ages and protocols used but with varying performances, presumably because the task of predicting fetal heartbeat becomes more or less hard depending on the clinical context. This AI model can be made widely available and can help embryologists in a wide range of clinical scenarios to standardize their practices.

STUDY FUNDING/COMPETING INTEREST(S)

Funding for the study was provided by ImVitro with grant funding received in part from BPIFrance (Bourse French Tech Emergence (DOS0106572/00), Paris Innovation Amorçage (DOS0132841/00), and Aide au Développement DeepTech (DOS0152872/00)). A.B.-C. is a co-owner of, and holds stocks in, ImVitro SAS. A.B.-C. and F.D.M. hold a patent for 'Devices and processes for machine learning prediction of in vitro fertilization' (EP20305914.2). A.D., N.D., M.M.F., and F.D.M. are or have been employees of ImVitro and have been granted stock options. X.P.-V. has been paid as a consultant to ImVitro and has been granted stocks options of ImVitro. L.C.-D. and C.G.-S. have undertaken paid consultancy for ImVitro SAS. The remaining authors have no conflicts to declare.

TRIAL REGISTRATION NUMBER

N/A.

[Birth weight and frozen embryo transfer: State of the art]

The aim of this study was to update our acknowledgment if there is a link between assisted embryo cryopreservation and epigenetics in human? Animal studies have demonstrated epigenetics consequence and especially imprinting disorders due to in vitro culture. In human, it is important to note that after frozen embryo transfer birth weight is significantly increased by 81 to 250g. But these studies cannot identify the reasons of such difference. This review strongly suggests that embryo cryopreservation is responsible for birth weight variations but mechanisms not yet elucidated. Epigenetics is probably one of these but to date, none study is able to prove it. We have to be attentive on a possible link between assisted reproductive technology (ART) and epigenetics reprogrammation.

Clinical factors leading to lamotrigine prescription in bipolar outpatients: subanalysis of the SIN-DEPRES study

BACKGROUND

The use of lamotrigine is a point of discrepancy among the diverse guidelines published on the management of bipolar disorder (BD). Evidence supporting the long-term efficacy is reasonably robust. Nonetheless, the effectiveness of lamotrigine in acute treatment is vigorously debated and it is unclear how this drug is used in routine clinical practice. This subanalysis of the SIN-DEPRES study was designed to understand the clinical profile of bipolar patients receiving lamotrigine.

METHODS

In this prospective national multicenter study, 652 patients with clinically stable bipolar I and II disorder were recruited. Clinical assessments included sociodemographic and clinical data, the Modified Clinical Global Impression scale for BD (CGI-BP-M), the Hamilton Depression Rating Scale (HDRS), and prescriptions of psychotropic medications and their doses.

RESULTS

By means of a logistic regression model, an association between receiving treatment with lamotrigine and the following clinical variables was found: number of past depressive episodes (O.R.=2.875, 95% CI: 1.203-6.869, p=0.018), depressive polarity of the most recent episode (O.R.=1.945, 95% CI: 1.267-2.985, p=0.002), severity in CGI-BD-M depression (O.R.=1.850, 95% CI: 1.215-2.817, p=0.004), bipolar II disorder diagnosis (O.R.=1.635, 95% CI: 1.078-2.482, p=0.021) and number of episodes per year (O.R.=1.310, 95% CI: 1.069-1.605, p=0.009).

LIMITATIONS

Subanalysis of the SIN-DEPRES study with a cross-sectional design.

CONCLUSIONS

The use of lamotrigine in clinical practice is in accordance with most of the guidelines, which support its use in patients with depressive predominant polarity and bipolar II disorder.

[Validated translation to Spanish of the evaluation questionnaire of patients with restless legs syndrome.]

Introduction. Restless legs syndrome (RLS) is a common sensory- motor condition, characterised by the irresistible need to move the legs while sitting or lying down, usually presenting late in the day, from the end of the afternoon into the night. Objective. To describe the translation process to Spanish of three different research RLS tools: the diagnosis criteria, the Practitioner Screening Questionnaire and the Basic Set of Questions for Epidemiological Studies. A procedure is proposed for the translation of these tools into other languages. Methods. The back translation method was employed. Five translators took part: two translated into their mother tongue and two into their foreign tongue, and once the translations were completed, a fifth independent translator introduced the changes using his mother tongue. Two expert analysts determined the equivalence between the original questionnaire and the translation. The clarity of the translated questionnaires was evaluated in a sample of students, who completed these themselves, and in RLS patients, for whom the doctor(s) or another authorised person filled them out. Results. The procedure undertaken varied according as to how each instrument were to be used either by health care professionals (diagnosis criteria) or to obtain information from patients (the questionnaire being directly completed by the patient directly or indirectly by a health care professional). No significant differences between the original and the translation of the practitioner screening questionnaire and the basic set of questions for epidemiological studies were found. The translators aimed to maintain concept equivalence function and validity of the original instrument were preserved in the trans lation. The same terminology was employed in the di fferent translations to make sure they were all consistent should they be used together. The Spanish version of the practitioner screening questionnaire has added terms to the first item by providing examples of sensations to ensure its understanding by patients from different parts of Spain. Conclusions. Spanish translated versions of three different questionnaires have been obtained to be used for RLS assessment in Spain, following appropriate psychometric validation. The instrument translated in the third place showed the closest equivalence with original.

Subsyndromal depressive symptoms in patients with bipolar and unipolar disorder during clinical remission

BACKGROUND

Subsyndromal depressive symptoms seem to be quite prevalent in mood disorders although very few studies have assessed them in patients considered to be in remission by clinical and psychometric criteria. This study sought to evaluate the presence of subsyndromal depressive symptoms in bipolar and unipolar patients in clinical remission.

METHODS

One-hundred seventy-six patients with DSM-IV bipolar (62 bipolar I, 58 bipolar II) or unipolar mayor depression (n=58) in clinical remission and 60 healthy subjects were assessed using several psychometric instruments including the 17 items Hamilton Depression Rating Scale (HDRS). To be considered in clinical remission patients assessed with the Clinical Impression for Bipolar Disorder-Modified (CGI-BP-M) had to be stable for 6 months and scoring 6 or less in the Young Mania Rating Scale (YMRS) and 8 or less in the HDRS.

RESULTS

Both Unipolar Disorder (UD) and Bipolar Disorder (BD) patients in clinical remission presented statistically significant higher HRSD scores, than healthy subjects. The HRSD scores were statistically higher in UD patients under remission than in BD patients. The subsyndromal symptoms more strongly associated with a clinical diagnosis of either UD or BD were Depressed Mood, Somatic Anxiety, Impact on Work and Activities, Psychic Anxiety, Gastrointestinal and Somatic Symptoms, Retardation during the Interview and Genital Symptoms.

CONCLUSION

Subsyndromal depressive symptoms are present in affective disorder patients, both UD and BD, who apparently are in clinical remission. Remitted unipolar patients may have more residual symptoms than bipolar patients, particularly in items related to anxiety and somatic complaints.

Impact of Phyllocnistis citrella (Lepidoptera: Gracillariidae) on leaf area development and yield of mature citrus trees in the Mediterranean area

Seasonal population trends and damage to citrus trees by the leafminer Phyllocnistis citrella Stainton were studied in the Valencia area of eastern Spain from 1996 to 1999. The area-wide seasonal flushing pattern of citrus trees and leafminer population trends were determined in 10 mature citrus orchards. In the 10 orchards, the annual percentage of new shoots that developed in the spring ranged from 51 to 96% for individual orchards (mean of 80%). Phyllocnistis citrella populations damaged new leaves from July to November. During this period, approximately 45% of the new leaf area was lost due to leafminer mining. In addition, at three mature citrus orchards, two 'Navelina' sweet oranges from 1996 to 1999 and one 'Clementine' mandarin (variety 'Clemenules') in 1998 and 1999, the leaf area damage, spring flushing pattern, and crop yield were determined in trees sprayed one to three times a year with abamectin (Epimeck, 0.02%) to control P. citrella and compared with nonsprayed control trees. In these three orchards, damaged leaf area in summer-fall flushes was on average 52% in nonsprayed and 8% in sprayed trees. No significant differences were found between sprayed and nonsprayed trees in the spring flushing and flowering pattern, number of fruits or fruit diameter. In Mediterranean areas, P. citrella damaged only 5-15% of the annual new leaf area of mature trees and yield was usually not affected by the pest.

Dental health for the pediatrician

Pediatricians play an important role in promoting oral health care, and their advice regarding dental procedures or therapies may be solicited. This review is intended to provide answers for the more common questions that parents may have regarding the oral health of their children. The controversies surrounding early orthodontic therapy and mercury-containing amalgam fillings continue to be areas of contention. Why does the orthodontist want to initiate orthodontic treatment in a 7-year-old child? Is there justification for the banning of amalgam fillings, as has occurred in some countries? Also explored are the current therapies for two of the more common oral mucosal disorders: aphthous ulcers and recurrent herpes simplex labialis. These subjects have relevance not only for pediatric patients but also for adults (and for many providers) as well.