Biodegradable Microspheres for Transarterial Chemoembolization in Malignant Liver Disease

Transarterial chemoembolization (TACE) has revolutionized the treatment landscape for malignant liver disease, offering localized therapy with reduced systemic toxicity. This manuscript delves into the use of degradable microspheres (DMS) in TACE, exploring its potential advantages and clinical applications. DMS-TACE emerges as a promising strategy, offering temporary vessel occlusion and optimized drug delivery. The manuscript reviews the existing literature on DMS-TACE, emphasizing its tolerability, toxicity, and efficacy. Notably, DMS-TACE demonstrates versatility in patient selection, being suitable for both intermediate and advanced stages. The unique properties of DMS provide advantages over traditional embolic agents. The manuscript discusses the DMS-TACE procedure, adverse events, and tumor response rates in HCC, ICC, and metastases.

Percutaneous cholecystostomy: techniques and applications

Acute cholecystitis (AC) is a critical condition requiring immediate medical attention and treatment and is one of the most frequently encountered acute abdomen emergencies in surgical practice, requiring hospitalization. Laparoscopic cholecystectomy is considered the favored treatment for patients with AC who are fit for surgery. However, in high-risk patients considered poor surgical candidates, percutaneous cholecystostomy (PC) has been suggested and employed as a safe and reliable alternative option. PC is a minimally invasive, nonsurgical, image-guided intervention that drains and decompresses the gallbladder, thereby preventing its perforation and sepsis. It can act as a bridge to surgery, but it may also serve as a definitive treatment for some patients. The goal of this review is to familiarize physicians with PC and, more importantly, its applications and techniques, pre- and post-procedural considerations, and adverse events.

US-guided trocar versus Seldinger technique for percutaneous cholecystostomy (TROSELC II trial)

OBJECTIVES

The purpose of this study is to investigate the safety and effectiveness of the US-guided bedside trocar vs. the Seldinger technique for percutaneous cholecystostomy (PC) procedures.

METHODS

This is a prospective single-center, randomized, controlled trial (RCT) comparing the trocar (group T; 50 patients [27 men]; mean [± SD] age, 74.16 ± 15.59 years) with the Seldinger technique for PC (group S; 50 patients [23 men]; mean [± SD] age, 80.78 ± 14.09 years) in consecutive patients undergoing the procedure in a bedside setting with the sole employment of US as a guidance modality. Primary outcomes consisted of technical success and complications associated with the procedure. Secondary outcome measures involved procedure duration, intra-/post-procedure pain evaluation, and clinical success.

RESULTS

PC was technically successful for all 100 patients. Clinical success rates were similar between group T and S (94% vs. 92%, respectively; p = 0.34). Equal total procedure-related complications were noted in both groups (4% vs. 4%; p = 0.5). A minor bleeding event (bile mixed with blood) occurred in one patient (2%) in group T and one patient (2%) in group S; accidental catheter dislodgement in one patient (2%) from group T, and a small biloma in one patient (2%) from group S. No procedure-related deaths or major bleeding events were noted. PC was significantly faster in group T (1.41 ± 1.13 vs. 4.41 ± 2.68 min; p < 0.001). Mean pain score during PC was significantly lower in group T compared with group S at 12 h of follow-up (1.43 ± 1.45 vs. 3.36 ± 2.05; p < 0.01).

CONCLUSION

US-guided bedside trocar technique for PC was equally effective and safe as the Seldinger technique, but it was faster and simpler to perform and led to reduced pain following the procedure.

Feasibility and Clinical Value of Intraprocedural Doppler Ultrasonography Blood Flow Parameters During Peripheral Endovascular Procedures for Limb Salvage: A Pilot Study

PURPOSE

To investigate whether Doppler ultrasound (DUS) blood flow parameters could serve as quantifiable functional endpoints of peripheral endovascular arterial procedures for chronic limb-threatening ischemia (CLTI), influencing wound healing.

METHODS

This is a prospective single-center study investigating intraprocedural DUS parameters (pulsatility index [PI] and pedal acceleration time [PAT]) in quantifying immediate hemodynamic alterations in consecutive CLTI patients with wound, ischemia, and foot infection wound class ≥1 undergoing endovascular interventions. Primary endpoints were feasibility of preendovascular and postendovascular treatment measurements of PI/PAT, quantification of immediate PI/PAT modifications of the posterior and anterior foot circulation following revascularization, the correlation between PI and PAT, and 6-month complete wound healing. Secondary endpoints included the 6-month limb salvage (no major amputation) and complete and partial wound healing rates.

RESULTS

A total of 28 patients (75.0% male) were enrolled, and 68 vessels were treated. The overall mean PAT values significantly decreased from 154.15±70.35 ms preprocedural to 107.21±49.6 ms postprocedural (p<0.01), and the mean PI values significantly increased from 0.93±0.99 to 1.92±1.96 (p<0.01). Postprocedural PAT at the anterior tibial (r²=0.804; p=0.346) and the posterior tibial arteries (r²=0.784; p=0.322) had a strong correlation and postprocedural PI at the anterior tibial (r²=0.704; p=0.301) and the posterior tibial arteries (r²=0.707; p=0.369) had a good correlation with 6-month complete wound healing. The 6-month complete and partial wound healing rates were 38.1% and 47.6%, respectively. Limb salvage was 96.4% and 92.4% at 6 and 12 months of follow-up, respectively.

CONCLUSIONS

Pedal acceleration time and PI accurately detected immediate hemodynamic changes of foot perfusion following revascularization and could serve as prognostic factors of wound healing in patients with CLTI.

CLINICAL IMPACT

Intraprocedural measurement of simple Doppler ultrasound blood flow parameters, Pulsatility Index (PI) and Pedal Acceleration Time (PAT), accurately detected immediate hemodynamic changes of foot perfusion following endovascular revascularization and could therefore serve as intraprocedural prognostic factors of wound healing in patients with chronic limb-threatening ischemia. This is the first time that PI has been proposed as a hemodynamic index of successful angioplasty outcome. The optimization of intraprocedural PAT and PI could be used to guide angioplasty and predict clinical success.

Navigation Guidance for Percutaneous Splanchnic Nerve Radiofrequency Neurolysis: Preliminary Results

Background and Objectives: To describe preliminary results upon the application of the “Cube Navigation System” (CNS) for computed tomography (CT)-guided splanchnic nerve radiofrequency neurolysis. Materials and Methods: CT-guided splanchnic nerve neurolysis was performed in five patients; in all cases, neurolysis was performed under CT guidance using the CNS. The mean patient age was 71.6 years (range 54–81 years; male/female: 5/0). Technical success, parameters of the neurolysis session and complications were evaluated. Technical success was defined as a needle position on the defined target. Session parameters included procedure time and number of scans. The CIRSE reporting system was used for complications’ classification and grading. Results: Technical success was obtained in all cases; in 1/5 patients, a slight correction in needle orientation was necessary. Mean procedure time was 12.4 min (range 8–19 min); an average of four CT scans was recorded in the five neurolysis sessions. There were no complications or material failures reported in the present study. Conclusions: Preliminary results of the present study show that computed tomography (CT)-guided splanchnic nerve radiofrequency neurolysis using the CNS is an accurate and time-efficient percutaneous procedure. More prospective and comparative studies with larger patient samples are necessary for verification of this system as well as for drawing broader conclusions.

P-184 The effect of oocyte vitrification accounting for both open and closed systems on embryo developmental arrest rate. A systematic review and network meta-analysis

Study question

To investigate the effect of oocyte vitrification on embryo developmental arrest rate accounting for both open and closed systems.

Summary answer

Open and closed vitrification systems are equally associated with a statistically significant higher embryo developmental arrest rate per MII oocyte vitrified compared to fresh oocytes.

What is known already

Oocyte cryopreservation has increased in popularity as it enhances women’s reproductive autonomy. Numerous studies have been published evaluating its effectiveness. However, the majority of published evidence commonly include comparisons with the now considered as “outdated” method of slow freezing. Additionally, data principally report on fertilization rates and clinical outcomes. It may be timely and essential to focus strictly on the effect of oocyte vitrification on the developmental potential of the embryo. Further to this, data are lacking on whether employing an open or closed vitrification system may affect the outcome of vitrification.

Study design, size, duration

A systematic search of the literature was performed in the databases Pubmed/Medline, Embase, and Cochrane Central Library limited to articles published in English up to October 2021. Only studies employing vitrification were included in this meta-analysis. A total of 17 published prospective studies were eligible. The population consists of oocytes that were either vitrified or fresh and subjected to ICSI. A network meta-analysis was performed comparing the type of vitrification system employed and fresh oocytes.

Participants/materials, setting, methods

The primary outcome measure was developmental arrest rate per MII oocyte vitrified prior to reaching cleavage or blastocyst stage. The secondary outcome measures were fertilization rate per MII oocyte vitrified and developmental arrest rate per 2PN zygote. Further to this, a subgroup analysis was performed according to the stage of developmental arrest. To rank the efficiency between the fresh oocytes and the oocytes vitrified employing the open and closed system, the P-Score was employed.

Main results and the role of chance

The seventeen studies reporting on the effect of oocyte vitrification on embryo developmental arrest per MII oocyte vitrified, presented with high heterogeneity I2=81%. Vitrified oocytes employing either the open or closed vitrification system presented with a statistically higher embryo developmental arrest rate when compared to fresh oocytes (open-systems:RR:1.16; 95%CI:1.07-1.26; closed-systems:RR:1.19 95%CI:1.06-1.34). No statistically significant difference was observed between the two vitrification systems (open vs closed:RR:0.99;95%CI:0.89-1.10). Subgroup analysis was performed according to the developmental stage of embryo arrest. Similarly to the pooled results, when subgrouping for embryos arresting prior to the cleavage stage, a statistically significant difference on developmental arrest was identified when vitrifying (open-systems:RR:1.44; 95%CI:1.18-1.77; closed-systems:RR:1.51 95%CI:1.12-2.04; 8 studies). However, when subgrouping for embryos arresting prior to the blastocyst stage, no statistically significant difference on developmental arrest was observed when vitrifying (open-systems:RR:1.06; 95%CI:0.98-1.15; closed systems:RR:1.10 95%CI:0.98-1.24; 9 studies). Fertilization rate was significantly lower for vitrified oocytes compared to fresh (open-systems:RR:0.86; 95%CI:0.79-0.93; closed-systems:RR:0.81 95%CI:0.72-0.92), while no statistically significant difference was observed between the two vitrification systems (open vs closed:RR:1.04; 95%CI:0.93-1.16). When comparing developmental arrest rate per 2PN zygote no statistically significant difference was detected between vitrification versus fresh (open-systems:RR:1.01; 95%CI:0.87-1.17; closed-systems:RR:0.98 95%CI:0.78-1.22), or between the two vitrification systems (open vs closed:RR:1.03;95%CI:0.82-1.30).

Limitations, reasons for caution

The limited number of studies included along with the heterogeneity identified present as limitations of this study. Further studies and especially Randomized Controlled Trials should be conducted in order to evaluate possible effects of oocyte vitrification on embryo development.

Wider implications of the findings

Oocyte vitrification results to higher developmental arrest rates per oocyte vitrified but not per 2PN zygote. Both vitrification systems perform equally in affecting developmental arrest. The differential expression of miRNAs and cytokinesis-related genes are identified by this systematic review as potential pathways influencing developmental potential following oocyte vitrification.

Trial registration number

Not applicable

P-570 Prokineticin-1 follicular fluid levels are strongly associated with diminished ovarian reserve and poor ovarian response: A prospective observational study

Study question

Are Prokineticin-1 (PROK1) follicular fluid (FF) levels associated with poor ovarian response (POR) as well as with other well-known biomarkers associated with ovarian reserve status?

Summary answer

Poor responders present with increased PROK1 FF levels. Also, PROK1 FF levels are negatively correlated with anti-müllerian hormone (AMH) levels and number of oocytes retrieved.

What is known already

Prokineticin-1 is an angiogenic factor with pleiotropic properties. Considering its role in reproduction, PROK1 mediates significant angiogenic functions in the fetal-maternal interface. Thus, alterations in PROK1 expression and/or function lead to placenta-derived pregnancy complications. Recently published studies also indicate that PROK1 is associated with ovarian function and oocyte competence. However, limited data associating PROK1 with POR are published. This study uniquely investigates possible associations between PROK1 FF levels in POR cases, with stimulation outcome, as well as with FF levels of other factors related to ovarian functionality, namely VEGF, bone morphogenetic protein 15 (BMP-15) and Pigment Epithelium Derived Factor (PEDF).

Study design, size, duration

This prospective-observational study was collaboratively conducted between November 2020 and July 2021 at Genesis Athens Clinic and at the University of Athens Medical School. A total of 64 patients undergoing IVF treatment were enrolled. The study group comprised of 32 POR patients defined according to the Bologna criteria. The control group consisted of 32 normal responder women undergoing IVF due to tubal factor and/or mild male factor infertility. Patients with other infertility aetiologies were excluded.

Participants/materials, setting, methods

Participants in both groups received the standard short GnRH-antagonist protocol. Prior to ovarian stimulation, participants were subjected to basic infertility investigation, including antral follicle count and AMH levels evaluation. The FF samples were collected as part of the oocyte retrieval process, then centrifuged and stored at -80 °C till analysis. Follicular fluid levels of PROK1, VEGF, BMP-15 and PEDF were evaluated via ELISA employing commercially available kits. Statistical analysis was performed employing R Programming Language.

Main results and the role of chance

Significantly higher PROK1 (3229.63 ± 2372.66 vs 1945.95 ± 1408.01 pg/ml; P-value&lt;0.0001), VEGF (2309.63 ± 412.49 vs 2013.22 ± 330.16 pg/ml; P-value=0.006) and lower BMP-15 (434.13 ± 106.38 vs 532.5 ± 108.26 pg/ml; P-value=0.001) levels were recorded in the POR group. No difference was observed regarding PEDF levels (7.43 ± 1.95 vs 8.23 ± 2.54 ng/ml; P-value=0.2). However, the POR group presented with lower PEDF/VEGF ratio (3.33 ± 1.08 vs 4.18 ± 1.41; P-value=0.02), indicating a reduced antioxidant capacity. PROK1 levels were negatively correlated with AMH (P-value=0.04), number of oocytes retrieved (P-value=0.001) and number of MII oocytes (P-value=0.005). BMP-15 was positively correlated with number of oocytes retrieved (P-value&lt;0.001), number of MII oocytes (P-value=0.002), number of normally fertilized zygotes (P-value=0.007), number of cleavage stage embryos (P-value=0.03) and number of blastocysts (P-value=0.04). VEGF was negatively correlated with AMH (P-value=0.004) and number of oocytes retrieved (P-value=0.03). These correlations remained significant when adjusting for ovarian response status. PROK1 levels, with a cut-off value of 2854.25 pg/ml, were able to predict ovarian response status with an area under the curve at 0.64. Sensitivity was 0.55, specificity was 0.88, and accuracy was 0.71. The positive and negative predictive values were 81.82% and 66.67%, respectively.

Limitations, reasons for caution

Limitations of our study refer to the limited size of the studied population, as well as to the lack of data considering pregnancy outcomes. Moreover, molecular data with regards to the possible role of PROK1 on POR pathogenesis are required. Future studies are needed to verify the results presented herein.

Wider implications of the findings

Data presented herein indicate that PROK1 FF levels are strongly associated with diminished ovarian reserve and POR. Considering that FF-PROK1 presents with a similar profile with FF-VEGF, we can form the hypothesis that the compromised angiogenesis observed in POR patients leads to PROK1 and VEGF increase via a negative-feedback-loop.

Trial registration number

Not applicable

P-183 Effect of oxygen levels, temperature, and interruptive evaluation practices during embryo culture on embryo developmental arrest. A systematic review and network meta-analysis

Study question

Do different culture conditions and practices, regarding oxygen levels, temperature, and culture interruption for evaluation purposes, effect embryo developmental arrest?

Summary answer

Ultra-low oxygen levels at 2-3.5%, a temperature below 37oC, and more than one interruption during culture are associated with a higher developmental arrest rate.

What is known already

Literature indicates that embryo culture microenvironment differs among laboratories. According to data, oxygen levels range between 2%-20%, while the optimal temperature during embryo culture, ranging from 36oC-37oC, has not yet been validated. What is more, interrupting embryo culture to evaluate morphology disrupts the stable conditions of the incubator’s microenvironment, while various models of interruptive evaluation practices have been reported on time-points and assessment frequency. Data are lacking on the extent that oxygen levels, temperature and morphology evaluation practices affect the embryos’ developmental potential. Interestingly, reporting on optimal culture conditions and embryo evaluation practices still appears to be timely and essential.

Study design, size, duration

A systematic search of the literature was performed in Pubmed/Medline, Embase, and Cochrane Central Library up to October 2021. Seventeen published prospective studies were included in the three arms of this network meta-analysis. The outcome measure was developmental arrest rate prior to the blastocyst stage. To rank oxygen levels and interruption times, the P-Score was employed. Molecular pathways implicated in developmental arrest associated with each examined parameter were investigated as part of the systematic review.

Participants/materials, setting, methods

A network meta-analysis was performed regarding oxygen levels, temperature, and culture interruption practices for evaluation purposes. The population consisted of preimplantation embryos. Atmospheric conditions (20% O2), low-oxygen levels (5% O2) and ultra-low oxygen levels (2-3.5% O2), along with temperature below or at 37oC were compared. Finally, no interruptions (time-lapse microscopy), one interruption (fertilization evaluation), 2 and 3 interruptions for morphological evaluation were compared. The estimated network effect comprises of direct and indirect effects.

Main results and the role of chance

Eight studies reporting on the effect of different oxygen levels, presented with high heterogeneity I2=88%. No statistically significant difference was observed between atmospheric and low-oxygen level regarding arrest rate (RR:1.07; 95%CI:0.88-1.30). A significantly higher developmental arrest rate was observed in ultra-low oxygen levels versus low (RR:1.29; 95%CI:1.02-1.64). No statistically significant difference was observed between ultra-low oxygen levels and atmospheric conditions (RR:1.21; 95%CI:0.89-1.63). The optimal oxygen levels are low (P-Score=0.87), followed by atmospheric conditions (P-Score=0.57) and ultra-low (P-Score=0.06). Three studies reporting on the effect of different temperatures presented with low heterogeneity I2=30%. Temperature below 37oC presented with a statistically significant higher developmental arrest rate (RR:1.10; 95%CI:1.03-1.17). Six studies reporting on the effect of interruptive evaluation practices showed high heterogeneity I2=84%. Uninterrupted culture presented with no statistically significant difference with the other groups (1-interruption vs Uninterrupted: RR:0.93; 95%CI:0.78-1.12; 2-interruptions vs Uninterrupted: RR:1.08; 95%CI:0.91-1.28; 3-interruptions vs Uninterrupted: RR:1.11; 95%CI:0.92-1.34). A single-interruption presented with marginally no statistically significant difference when compared to two-interruptions (RR:0.87; 95%CI:0.74-1.02), however presented with a lower developmental arrest rate when compared to three-interruptions (RR:0.84; 95%CI:0.71-0.99). Two versus three-interruptions indicated no difference (RR:0.97; 95%CI:0.82-1.14). The optimal interruptive evaluation practice is one (P-Score=0.90) followed by uninterrupted (P-Score=0.63), two-interruptions (P-Score=0.30) and three-interruptions (P-Score=0.16).

Limitations, reasons for caution

The limited number of studies included and the heterogeneity are limitations of this study. The different number of studies and embryos included in each comparison group, along with the fact that randomization was not performed in all studies, present as reasons for caution when interpreting the results of this study.

Wider implications of the findings

Oxygen levels at 5%, 37oC temperature, and single or no-interruption embryo evaluation practices reduce developmental arrest rate. This systematic review indicates potential pathways implicated in developmental arrest as follows: oxygen tension influencing histone modifications, temperature influencing regulatory proteins’ activity, and stress-related cytokines’ differential expression when culture is interrupted multiple times.

Trial registration number

Not applicable

O-122 Reporting on the value of Artificial Intelligence in predicting the optimal embryo for transfer: A systematic review and meta-analysis

Study question

Are Artificial Intelligence (AI) based models effective in robustly predicting in vitro fertilization (IVF) outcome by assessing embryo quality?

Summary answer

The majority of the AI-based models could provide an accurate prediction regarding live birth, clinical pregnancy, clinical pregnancy with fetal heartbeat and embryo ploidy status.

What is known already

Precision and consistency in embryo quality evaluation are of paramount importance regarding the outcome of an IVF cycle. Numerous embryo grading and evaluation systems, employing morphological and morphokinetical assessment, have been proposed but without reaching a consensus yet. The main limitation of the aforementioned assessment systems is that they depend on human evaluation, which may be subject to subjectivity and interobserver variation. Thus, automated prediction models may be essential to optimize objectivity and reliability of embryo grading. Artificial neural network models may process microscopy images or time-lapse videos as input to predict the embryos’ potential competency.

Study design, size, duration

A systematic review and meta-analysis including 18 published studies. The population consists of preimplantation embryos suitable for embryo transfer in IVF/ICSI cycles following employment of an AI-based prediction model. The outcome measures are prediction of live birth, clinical pregnancy, clinical pregnancy with heartbeat and ploidy status.

Participants/materials, setting, methods

A systematic search of the literature was performed in the databases of Pubmed/Medline, Embase, and Cochrane Central Library limited to articles published in English up to August 2021. The initial search yielded a total of 694 studies with 97 of them being duplicates and other 579 being excluded on the grounds of not fulfilling inclusion criteria. Following full-text screening and citation mining a total of 18 studies were identified to be eligible for inclusion.

Main results and the role of chance

Four studies reported on prediction of live birth. The sensitivity was 70.6% (95%C.I.: 38.1-90.4%) and specificity was 90.6% (95%C.I.:79.3-96.1%).  The Area Under the Curve (AUC) of the Summary Receiver Operating Characteristics (SROC) curve was 0.905, while the partial AUC (pAUC) was 0.755. Employing the Bayesian approach, the total Observed:Expected ratio (O:E) was 1.12 (95%CI: 0.26–2.37; 95%PI:0.02-6.54). Ten studies reported on prediction of clinical pregnancy. The sensitivity and the specificity were 71% (95%C.I.: 58.1-81.2%) and 62.5% (95%C.I.: 47.4-75.5%) respectively. The AUC was 0.716, while pAUC was 0.693. Moreover, the total O:E ratio was 0.92 (95%CI: 0.61–1.28; 95%PI:0.13-2.43). Eight studies reported on prediction of clinical pregnancy with fetal heartbeat the sensitivity was 75.2% (95%C.I.: 66.8-82%) and the specificity was 55.3% (95%C.I.: 41.2-68.7%). The AUC was 0.722, while the pAUC was 0.774. The O:E ratio was 0.77 (95%CI: 0.54 – 1.05; 95%PI: 0.21-1.62). Four studies reported on the ploidy status of the embryo. The sensitivity and specificity were 59.4% (95%C.I.: 45.0-73.1%) and 79.2% (95%C.I.: 70.1-86.1%) respectively. The AUC was 0.751 and the pAUC was 0.585. The total O:E ratio was 0.86 (95%CI: 0.42 – 1.27; 95%PI: 0.03-1.83).

Limitations, reasons for caution

The limited number of studies fulfilling inclusion criteria, along with the different designs applied when developing AI models which may lead to increased heterogeneity, stand as limitations. Inclusion of women regardless of their age presents as another limitation, as advanced maternal age has been associated with diminished IVF outcomes.

Wider implications of the findings

Albeit, our findings support that AI is a highly promising tool in the era of personalized medicine providing precise predictions it does not appear to considerably surpass human prediction capabilities. More studies and more collaborations between the developers are of paramount importance prior to AI becoming the gold standard.

Trial registration number

Not applicable

P-012 Investigating the potential role of microRNAs as biomarkers in idiopathic non-obstructive azoospermia: A systematic review and in-silico analysis of the affected pathways

Study question

Is there an association between microRNA profiles in seminal plasma and microRNAs profiles in testicular tissue samples obtained from idiopathic non-obstructive azoospermia (NOA) patients?

Summary answer

This study identified common alterations in microRNA profiles and gene expression patterns between seminal plasma and testicular tissue samples obtained from NOA patients.

What is known already

Despite the significant advances in the field of reproductive medicine the exact infertility aetiology remains unidentified regarding 30-40% of infertile men. This fact highlights the need for more accurate and sensitive diagnostic tools and biomarkers, especially regarding the most severe cases of male infertility, such as idiopathic NOA patients. It has been voiced that microRNA profiling of seminal plasma and testicular tissue samples obtained from idiopathic NOA patients could be a powerful tool towards better understanding the underlined pathogenesis and towards developing novel diagnostic and individualized biomarkers. However, a collective analysis of these data has not been performed hitherto.

Study design, size, duration

A systematic review was performed in PubMed/Medline and Embase up to November 2020. Search strategy included a combination of keywords, namely non-coding RNA OR small non-coding RNA OR microRNA AND non-obstructive azoospermia. Following study selection, original data on altered microRNAs were analyzed aiming to underline differences between microRNA expression profiles in seminal plasma and testicular tissue samples of idiopathic NOA cases. Following this, in-silico analysis was performed to detect commonly affected gene expression pathways.

Participants/materials, setting, methods

Only full-length original retrospective or prospective human studies were included. Strict inclusion-exclusion criteria were applied. The studied population consisted of idiopathic NOA patients, while the control groups consisted of men with normal semen analysis. In-silico analysis was performed employing a combination of bioinformatic tools, namely the DIANA-TarBase, microT-CDS, the GTEx repository and the KEGG database. Statistical analysis was performed using the R-package-limma. The statistically significant threshold indicating altered gene pathways was set at 0.01 P-value.

Main results and the role of chance

Five studies were considered eligible, including 382 NOA cases and 412 controls (Finocchi et al., 2020; Song et al., 2017; Wu et al., 2013; Wu et al., 2012; Wang et al., 2011). Two studies co-evaluated the profile of microRNAs in both seminal plasma and testicular tissue samples (Wu et al., 2013; Wu et al., 2012), one study evaluated only testicular tissue (Song et al., 2017) and the other two only seminal plasma (Finocchi et al., 2020 and Wang et al., 2011). Data extraction revealed a total of 14 differentially expressed microRNAs between NOA patients and controls. The following microRNAs were found to be up-regulated in both seminal plasma and testicular tissue samples of NOA cases: hsa-miR-141-3p, hsa-miR-429, hsa-miR-7-1-3p, hsa-miR-19b-3p and hsa-let-7a-5p. The hsa-miR-188-3p was found to be down-regulated in testicular tissue samples. Finally, the following microRNAs were also downregulated only in seminal plasma: hsa-miR-34c-5p, hsa-miR-122-5p, hsa-miR-181a-5p, hsa-miR-146b-5p, hsa-miR-374b-5p, hsa-miR-509-5p, hsa-miR-513a-5p and hsa-miR-34b-3p. Despite the limited number of common microRNAs between seminal plasma and testicular tissue samples, in-silico analysis revealed 34 statistically significant dysregulated gene pathways, regarding both seminal plasma and testicular tissue samples, indicating that idiopathic NOA patients are sharing several common altered molecular mechanisms involved in NOA pathogenesis.

Limitations, reasons for caution

The limited number of the included studies as well as the small size population characterizing the great majority of them, constitute the main limitations of this systematic review. Moreover, great heterogeneity was observed among the studies regarding the molecular methods employed for microRNA profiling.

Wider implications of the findings

These collective findings indicate that microRNA profiling in seminal plasma could indeed be raised as a powerful non-invasive tool towards better understanding and diagnosing idiopathic NOA. Larger well-controlled studies employing state-of-the-art microRNAome techniques are needed to validate these conclusions. Moreover, the molecular network of targeted gene pathways also merits investigation.

Trial registration number

Not Applicable

P-571 The newly developed highly sensitive reagent GL13 indicates extensively increased cellular senescence in the follicular fluid of poor responder patients: A prospective observational study

Study question

Do women of diminished ovarian reserve and poor ovarian response (POR) present with increased lipofuscin follicular fluid (FF) levels, indicating increased ovarian cellular senescence?

Summary answer

Poor responders present with a six-fold increased lipofuscin FF levels indicating extensive senescence in POR ovaries. Lipofuscin may be a new sensitive biomarker for POR.

What is known already

Lipofuscin is a nondegradable substrate of metabolism accumulating in cells due to impaired mitochondrial/lysosome/proteasome function, upon stress or damage. It is well-documented that lipofuscin constitutes a highly sensitive biomarker of cellular aging and senescence. Recently, a novel reagent (GL13) coupled by a hybrid histochemical–immunohistochemical method were developed for detecting and measuring soluble lipofuscin levels in biological fluids, ascertaining high sensitivity and specificity. Data indicate that lipofuscin levels are associated with oocyte competence and age-related infertility. However, hitherto no data has been published indicating the value of lipofuscin FF levels as a biomarker towards accurately predicting ovarian reserve and response.

Study design, size, duration

This prospective observational study was collaboratively conducted between November 2020 and September 2021 at the Athens University Medical School and at Genesis Athens Clinic. A total of 32 patients undergoing IVF treatment were enrolled. The study group comprised of 16 POR patients defined according to the Bologna criteria. The control group consisted of 16 normal responder women undergoing IVF due to tubal factor or/and mild male factor infertility. Patients with other infertility aetiologies were excluded.

Participants/materials, setting, methods

Participants in both groups received the standard short GnRH-antagonist protocol. The FF samples were collected as part of the oocyte retrieval process. Lipid and protein parts of lipofuscin were isolated from FF samples and stained with GL13. The complex of lipofuscin-GL13 was labeled with an anti-biotin HRP conjugated antibody and detected employing a chemiluminescence reaction. Luminescence was measured and signal intensity was corresponding to lipofuscin concentration. Statistical analysis was performed employing R Programming Language.

Main results and the role of chance

Poor responders presented with a statistically significant six-fold higher lipofuscin FF levels in comparison to the normal responder group (869.21 ± 501.87 vs 146.6 ± 107.64 RLU; P-value &lt;0.0001). Lipofuscin levels were negatively correlated with AFC (Spearman’s Rho: -0.68; P-value &lt;0.0001), AMH levels (Rho: -0.61; P-value =0.0002), estradiol levels on triggering day (Rho: -0.68; P-value &lt;0.0001), number of oocytes retrieved (Rho: -0.54; P-value =0.001), number of mature metaphase II (MII) oocytes obtained (Rho: -0.58; P-value =0.0008), number of normally fertilized (2PN) zygotes (Rho: -0.51; P-value =0.003), number of cleavage stage embryos (Rho: -0.48; P-value =0.005) and number of blastocyst stage embryos (Rho: -0.41; P-value =0.02). These correlations remained statistically significant when adjusting for ovarian stimulation response status. No association was established between Lipofuscin levels and embryo quality neither on Day 3 nor on Day 5. Lipofuscin levels, with a cut-off value at 294, were able to predict ovarian stimulation response status with an area under the curve (AUC) at 0.96. The sensitivity was 0.875, the specificity was 0.938 and the accuracy was 0.906. The positive predictive value was 88.24% and the negative predictive value was 93.33%.

Limitations, reasons for caution

Limitations of our study refer to the limited size of the studied population, as well as to the lack of data referring to pregnancy outcomes. Moreover, molecular data with regards to the possible mechanisms leading to the observed increased senescence are required. Future studies are needed to verify these findings.

Wider implications of the findings

Data presented herein indicates, for the first time in literature, that lipofuscin FF levels measured via the GL13 method may be a promising and sensitive tool for predicting POR and stimulation outcome. Lipofuscin could further serve as a valuable novel biomarker indicating ovarian senescence, ovarian reserve status and oocyte competence.

Trial registration number

Not Applicable

P–676 Mild stimulation followed by embryo accumulation via vitrification appears to be beneficial for managing poor ovarian response: A retrospective cohort study including 610 patients

Study question

Could embryo accumulation employing mild stimulation cycles prove beneficial for managing patients presenting with poor ovarian response (POR)?

Summary answer

Embryo accumulation may be an efficient POR management strategy, enabling a higher number and quality cohort of embryos, ultimately improving success results.

What is known already

It is widely accepted that POR constitutes a challenging condition. The limited oocyte yield associated with POR detrimentally impacts in vitro fertilization (IVF) success rates. Moreover, the documented heterogeneity among POR patients compromises our efforts to successfully address POR, despite the advances noted regarding stimulation protocols employed today. Considering the aforementioned, embryo accumulation following consecutive stimulation cycles has emerged as an alternative management strategy towards increasing the number of available embryos prior to embryo transfer (ET), mimicking normoresponding conditions. However, only few studies have been so far conducted and the need for further data is underlined.

Study design, size, duration

A single-center retrospective study was conducted in the Centre of Human Reproduction, Genesis-Athens Clinic from January 2015-December 2019. Only patients presenting with POR according to Bologna criteria were included. In total, 610 POR patients were considered eligible and were divided in three groups namely, mild stimulation-fresh ET (150 IUs of gonadotropins) (MILDF), mild stimulation employing embryo accumulation (MILDA), and natural cycle employing embryo accumulation (NATA). Respective comparisons on embryology and pregnancy data are provided.

Participants/materials, setting, methods

Resulting embryos from the MILDF, MILDA, and NATA groups were cultured up to the cleavage stage and categorized into three groups according to quality, namely top (grade 1), good (grade 2–3) and poor (grade 4–5) (Veeck, 1999). Top and good quality embryos were considered eligible for ET/vitrification. The banking scenario entailed accumulation of at least three embryos, including at least one top quality embryo. Embryo transfers included up to two cleavage stage embryos.

Main results and the role of chance

Comparing MILDF and MILDA groups, a higher number of available oocytes and embryos was observed in MILDA (2.36±1.15 vs 6.58±1.11; 1.72±1.02 vs 3.51±0.61, P-value&lt;0.001). However, a mean number of 3.90±1.56 oocyte retrievals were required to conclude MILDA compared to MILDF which was concluded following a single oocyte retrieval (P-value&lt;0.001). Cancellation-rate was significantly lower in the MILDA compared to MILDF group (0% vs 18.93%, P-value &lt;0.001). A higher proportion of top quality embryos were transferred in the MILDA group (66.58% vs 43.67%, P-value&lt;0.001). The MILDA group presented with higher positive-HCG (27.89% vs 23.30%, P-value=0.302), clinical-pregnancy (22.11% vs 17.96%, P-value=0.316) and live-birth rates (16.84% vs 14.08%, P-value=0.487). However, these differences were not significant. Comparing MILDA and NATA groups, the MILDA presented with a lower number of required oocyte retrievals and a higher number of oocytes per oocyte retrieval compared with NATA (3.90±1.56 vs 7.15±1.80; 1.95±0.74 vs 0.89±0.20, P-value&lt;0.001). Moreover, the MILDA presented with a higher mean number of resulting embryos (5.20±0.78 vs 4.82±0.88, P-value&lt;0.001). No difference was observed regarding the proportion of the resulting top quality embryos. The MILDA group presented with slightly higher clinical-pregnancy (22.11% vs 20.09%, P-value=0.628) and live-birth (16.84% vs 14.02%, P-value=0.490) rates, however these differences were not significant.

Limitations, reasons for caution

The retrospective nature of the study constitutes a major limitation. Considering that numerous confounders are inevitable when retrospective data is analyzed, authors employed strict eligibility criteria in an effort to reduce bias. Statistical analysis revealed a well-controlled population, considering that general patients’ characteristics did not differ between the three groups.

Wider implications of the findings: Embryo accumulation may constitute an efficient management strategy for POR, as more embryos of better quality are available for ET compared to fresh-IVF-ET. Mild stimulation should be preferred for embryo accumulation instead of natural cycles, as less oocyte retrievals are required. Future studies should be conducted to verify these conclusions.

Trial registration number

Not applicable

P–674 Development of a predictive model indicating the population of poor responders benefiting from luteal phase oocyte retrieval

Study question

Can successful implementation of luteal phase oocyte retrieval (LuPOR) following conventional follicular phase oocyte retrieval (FoPOR) be predicted for poor ovarian response (POR) patients?

Summary answer

Antral follicle count (AFC), number of small follicles recorded in FoPOR, and estradiol (E2) levels on FoPOR and LuPOR trigger days, predict successful LuPOR application.

What is known already

A second follicular wave in the same menstrual cycle was first observed in domestic animals such as horses and cattle and thenceforth in women. The second follicular wave has been introduced as an encouraging means towards optimizing the context of in vitro fertilization (IVF) success rates for infertile women and especially for POR patients. Double ovarian stimulation coupled with two oocyte retrievals in the same menstrual cycle has been proposed, and encouraging results have been reported. However, the high heterogeneity characterizing POR patients dictates that studies should focus on factors indicating efficient LuPOR application.

Study design, size, duration

This retrospective observational study included 1688 women diagnosed with POR, undergoing natural IVF cycles between 2012–2020 including two oocyte retrievals in the same menstrual cycle. Patients’ age, body mass index (BMI), number of previous POR incidences, basal hormonal levels, AFC, E2 evaluated on both trigger days and number of small follicles (8–13 mm) were evaluated on their predictive power regarding retrieval of at least one MII oocyte following LuPOR, being regarded as successful LuPOR implementation.

Participants/materials, setting, methods

A diagnosis of POR according to Bologna criteria served as the inclusion criterion for this single center study. All other infertility etiologies were excluded. Patient dataset was stratified according to age in quantiles. A random 20% of each quantile was employed to validate the model. The remaining 80% was employed to develop this model. The predictive value was determined employing the Area Under the Curve (AUC) of the Receiver Operating Characteristics, employing Youden’s index.

Main results and the role of chance

Patients’ age, BMI, number of previous failed IVF attempts, basal levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin and progesterone failed to be predictive of a successful LuPOR as the AUC was below 0.6. AFC with a threshold value of 4.47, was found to be predictive of an effective LuPOR with an AUC of 0.86, sensitivity 0.8, specificity 0.75, and accuracy 0.79. E2 levels evaluated on the FoPOR trigger day, with a threshold value of 232.66 pg/ml, were similarly predictive of an effective LuPOR presenting with an AUC 0.86, specificity 0.75, sensitivity 0.86 and accuracy 0.82. Similarly, E2 evaluated on the LuPOR trigger day, with a threshold value of 200.89 pg/ml, presented with an AUC 0.89, specificity 0.85, sensitivity 0.95 and accuracy 0.92. The number of small follicles during FoPOR also appeared to be predictive of the presence of at least one MII oocyte during LuPOR, with a threshold value of 2.94. The AUC was 0.82, specificity 0.75, sensitivity 0.76 and accuracy 0.75. When combining the above characteristics into a single predictive model the AUC was 0.88, specificity 0.73, sensitivity 0.94 and accuracy 0.89. The positive and negative predictive value of the model were 93.5% and 46.8%, respectively.

Limitations, reasons for caution

Employment of natural cycles may present as a limitation when examining the value of this study, as the cut-off values reported herein may be altered when stimulation is employed. Since internal validation may be confounded by the fact that this was a single center study, external validation is required.

Wider implications of the findings: The clinical end-point of this study reporting back to the practitioner, is the development of a predictive model identifying the optimal POR population for whom LuPOR practice is valuable. The high positive predictive value of this model may assist clinicians in identifying poor responders who will benefit from this approach.

Trial registration number

Not applicable

Computed Tomography-Guided Percutaneous Radiofrequency Ablation of the Splanchnic Nerves as a Single Treatment for Pain Reduction in Patients with Pancreatic Cancer

The aim of this paper is to prospectively evaluate the efficacy and safety of percutaneous computed tomography (CT)-guided radiofrequency (RF) neurolysis of splanchnic nerves as a single treatment for pain reduction in patients with pancreatic cancer. Patients with pancreatic ductal adenocarcinoma suffering from abdominal pain refractory to conservative medication who underwent CT-guided neurolysis of splanchnic nerves by means of continuous radiofrequency were prospectively evaluated for pain and analgesics reduction as well as for survival. In all patients, percutaneous neurolysis was performed with a bilateral retrocrural paravertebral approach at T12 level using a 20 Gauge RF blunt curved cannula with a 1cm active tip electrode. Self-reported pain scores were assessed before and at the last follow-up using a pain inventory with numeric visual scale (NVS) units. The mean patient age was 65.4 ± 10.8 years (male-female: 19-11). The mean pain score prior to RF neurolysis of splanchnic nerves was 9.0 NVS units; this score was reduced to 2.9, 3.1, 3.6, 3.8, and 3.9 NVS units at 1 week, 1, 3, 6, and 12 months respectively (p < 0.001). Significantly reduced analgesic usage was reported in 28/30 patients. Two grade I complications were reported according to the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) classification system. According to the results of the present study, solely performed computed tomography-guided radiofrequency neurolysis of splanchnic nerves can be considered a safe and efficacious single-session technique for pain palliation in patients with pancreatic ductal adenocarcinoma suffering from abdominal pain refractory to conservative medication. Although effective in pain reduction the technique seems to have no effect upon survival improvement.

A systematic review of the association between postpartum depression and neuraxial labor analgesia

BACKGROUND

Postpartum depression (PPD) is the most common complication after childbirth, affecting 10-15% of women. It is associated with serious long-term consequences for the mother and family. Whether or not neuraxial labor analgesia mitigates the risk is uncertain and controversial. The purpose of this review was to summarize studies investigating the association between neuraxial labor analgesia and the incidence of PPD.

METHODS

A systematic literature search for randomized controlled trials and cohort studies reporting the incidence of PPD among parturients who received neuraxial analgesia compared with non-neuraxial or no analgesia. The primary outcome was the incidence of PPD between 5 and 12 weeks' postpartum. Depression was diagnosed using a cutoff score of ≥10 on the Edinburgh Postnatal Depression scale, a validated screening tool. The risk of bias of each study was evaluated, and odds ratios and 95% confidence intervals calculated from raw data or reported as adjusted odds ratios.

RESULTS

Eleven observational studies involving 5717 patients were included. Three studies had a critical risk, three a serious risk, and five a moderate risk of bias. Two studies reported significantly lower odds for PPD associated with neuraxial analgesia compared with non-neuraxial or no analgesia, whereas the odds ratios in the remaining nine studies were not significantly different.

CONCLUSIONS

Our systematic review did not find compelling evidence for an association between PPD and labor analgesia. Studies were heterogenous in nature and had a high risk of bias. Further research controlling for confounding factors is recommended to determine if a relationship exists.

Platelet microvesicles are associated with the severity of coronary artery disease: comparison between peripheral and coronary circulation

Microvesicles (MVs) have recently emerged as markers of thrombosis. Furthermore, there is an unexplained residual thrombotic risk is observed in patients with acute coronary syndrome (ACS) and/or stable coronary artery disease (CAD), despite treatment. We measured platelet (PMVs) and erythrocyte (ErMVs) in patients with ACS and stable CAD, both in the peripheral and coronary circulation. We studied consecutive eligible patients during a coronary angiography. Blood samples were collected from the stem of the left coronary artery and femoral artery. PMVs were significantly increased in CAD patients compared to controls. ACS patients had also increased PMVs in coronary and peripheral circulation, compared to controls. Furthermore, ACS patients exhibited increased PMVs in coronary compared to peripheral circulation. Lastly, coronary PMVs were associated with the severity of CAD based on the SYNTAX score. No significant differences were observed in the levels of ErMVs among groups. Therefore, PMVs emerge as novel markers of thrombosis in CAD, further augmenting the vicious cycle of inflammation and thrombosis during ACS. Importantly, coronary PMVs may reflect the severity of CAD in this population.

Discarding IVF embryos: reporting on global practices

PURPOSE

To provide a global scale report on a representative sample of the clinical embryology community depicting the practice of discarding supernumerary IVF embryos.

METHODS

A web-based questionnaire titled "Anonymous questionnaire on embryo disposal practices" was designed in order to ensure anonymous participation of practicing clinical embryologists around the world.

RESULTS

During a data collection period of 8 months, 703 filled-in questionnaires from 65 countries were acquired. According to the data acquired, the majority of practitioners, dispose of embryos by placing them directly in a trash can strictly dedicated for embryo disposal for both fresh and frozen cycles (39% and 36.7% respectively). Moreover, 66.4% of practitioners discard the embryos separately-case by case-at different time points during the day. Over half of embryologists (54%) wait until day 6 to discard the surplus embryos, while 65.5% do not implement a specially allocated incubator space as a designated waiting area prior to disposal. The majority of 63.1% reported that this is a witnessed procedure. The vast majority of embryologists (93%) do not employ different protocols for different groups of patients. Nonetheless, 17.8% reported the request to perform a ceremony for these embryos. Assessing the embryologists' perspective, 59.5% of participants stated that the embryology practice would benefit from a universally accepted and practiced protocol.

CONCLUSION(S)

This study uniquely provides insight into global embryo disposal practices and trends. Results highlight the divergence between reported practices, while indicating the significance on standardization of practice, with embryologists acknowledging the need for a universally accepted protocol implementation.

The ESC ACCA EAPCI EORP acute coronary syndrome ST-elevation myocardial infarction registry

Aims 

The Acute Cardiac Care Association (ACCA)–European Association of Percutaneous Coronary Intervention (EAPCI) Registry on ST-elevation myocardial infarction (STEMI) of the EurObservational programme (EORP) of the European Society of Cardiology (ESC) registry aimed to determine the current state of the use of reperfusion therapy in ESC member and ESC affiliated countries and the adherence to ESC STEMI guidelines in patients with STEMI.

Methods and results 

Between 1 January 2015 and 31 March 2018, a total of 11 462 patients admitted with an initial diagnosis of STEMI according to the 2012 ESC STEMI guidelines were enrolled. Individual patient data were collected across 196 centres and 29 countries. Among the centres, there were 136 percutaneous coronary intervention centres and 91 with cardiac surgery on-site. The majority of centres (129/196) were part of a STEMI network. The main objective of this study was to describe the demographic, clinical, and angiographic characteristics of patients with STEMI. Other objectives include to assess management patterns and in particular the current use of reperfusion therapies and to evaluate how recommendations of most recent STEMI European guidelines regarding reperfusion therapies and adjunctive pharmacological and non-pharmacological treatments are adopted in clinical practice and how their application can impact on patients’ outcomes. Patients will be followed for 1 year after admission.

Conclusion 

The ESC ACCA-EAPCI EORP ACS STEMI registry is an international registry of care and outcomes of patients hospitalized with STEMI. It will provide insights into the contemporary patient profile, management patterns, and 1-year outcome of patients with STEMI.

Factors associated with postpartum psychiatric admission in a population-based cohort of women with schizophrenia

OBJECTIVE

We aimed to identify factors associated with postpartum psychiatric admission in schizophrenia.

METHOD

In a population-based cohort study of 1433 mothers with schizophrenia in Ontario, Canada (2003-2011), we compared women with and without psychiatric admission in the 1st year postpartum on demographic, maternal medical/obstetrical, infant and psychiatric factors and identified factors independently associated with admission.

RESULTS

Admitted women (n = 275, 19%) were less likely to be adolescents, more likely to be low income and less likely to have received prenatal ultrasound before 20 weeks gestation compared to non-admitted women. They also had higher rates of predelivery psychiatric comorbidity and mental health service use. Factors independently associated with postpartum admission were age (<20 vs. ≥35 years: adjusted risk ratio, aRR, 0.48, 95% CI 0.24-0.96), income (lowest vs. highest income: aRR 1.67, 1.13-2.47) and the following mental health service use factors in pregnancy: admission (≥35 days/year vs. no days, aRR 4.54, 3.65-5.65), outpatient mental health care (no visits vs. ≥2 visits aRR 0.35, 0.27-0.47) and presence of a consistent mental health care provider during pregnancy (aRR 0.69, 0.54-0.89).

CONCLUSION

Certain subgroups of women with schizophrenia may benefit from targeted intervention to mitigate risk for postpartum admission.

Atrial fibrillation causing ST elevation myocardial infarction due to coronary embolism: case report and review of the literature

BACKGROUND

Atrial fibrillation is a rare but important nonatherosclerotic cause of ST elevation myocardial infarction.

CASE DESCRIPTION

We report the case of a 69 years old woman who presented to our hospital with ST elevation myocardial infarction and permanent atrial fibrillation and eventually treated with thrombus aspiration from the left descending coronary artery.

CONCLUSION

We have to notice the importance of the appropriate antithrombotic treatment in atrial fibrillation to prevent systemic embolism. In selected cases with ST elevation myocardial infarction due to coronary embolism, aspiration thrombectomy with or without balloon dilatation or stenting can be safely performed. Hippokratia 2016, 20(2):160-162.

Maternal and newborn outcomes among women with schizophrenia: a retrospective population-based cohort study

OBJECTIVE

More women with schizophrenia are becoming pregnant, such that contemporary data are needed about maternal and newborn outcomes in this potentially vulnerable group. We aimed to quantify maternal and newborn health outcomes among women with schizophrenia.

DESIGN

Retrospective cohort study.

SETTING

Population based in Ontario, Canada, from 2002 to 2011.

POPULATION

Ontario women aged 15-49 years who gave birth to a liveborn or stillborn singleton infant.

METHODS

Women with schizophrenia (n = 1391) were identified based on either an inpatient diagnosis or two or more outpatient physician service claims for schizophrenia within 5 years prior to conception. The reference group comprised 432 358 women without diagnosed mental illness within the 5 years preceding conception in the index pregnancy.

MAIN OUTCOME MEASURES

The primary maternal outcomes were gestational diabetes mellitus, gestational hypertension, pre-eclampsia/eclampsia, and venous thromboembolism. The primary neonatal outcomes were preterm birth, and small and large birthweight for gestational age (SGA and LGA). Secondary outcomes included additional key perinatal health indicators.

RESULTS

Schizophrenia was associated with a higher risk of pre-eclampsia (adjusted odds ratio, aOR 1.84; 95% confidence interval, 95% CI 1.28-2.66), venous thromboembolism (aOR 1.72, 95% CI 1.04-2.85), preterm birth (aOR 1.75, 95% CI 1.46-2.08), SGA (aOR 1.49, 95% CI 1.19-1.86), and LGA (aOR 1.53, 95% CI 1.17-1.99). Women with schizophrenia also required more intensive hospital resources, including operative delivery and admission to a maternal intensive care unit, paralleled by higher neonatal morbidity.

CONCLUSIONS

Women with schizophrenia are at higher risk of multiple adverse pregnancy outcomes, paralleled by higher neonatal morbidity. Attention should focus on interventions to reduce the identified health disparities.

Quality assessment of observational studies in psychiatry: an example from perinatal psychiatric research

In perinatal psychiatry, randomized controlled trials are often not feasible on ethical grounds. Many studies are observational in nature, while others employ large databases not designed primarily for research purposes. Quality assessment of the resulting research is complicated by a lack of standardized tools specifically for this purpose. The aim of this paper is to describe the Systematic Assessment of Quality in Observational Research (SAQOR), a quality assessment tool our team devised for a series of systematic reviews and meta-analyses of evidence-based literature regarding risks and benefits of antidepressant medication during pregnancy.

Psychosocial and psychological interventions for treating antenatal depression

BACKGROUND

Although pregnancy was once thought of as a time of emotional wellbeing for many women, conferring 'protection' against psychiatric disorders, a recent meta-analysis of 21 studies suggests the mean prevalence rate for depression across the antenatal period is 10.7%, ranging from 7.4% in the first trimester to a high of 12.8% in the second trimester. Due to maternal treatment preferences and potential concerns about fetal and infant health outcomes, non-pharmacological treatment options are needed.

OBJECTIVES

The primary objective of this review is to assess the effects, on mothers and their families, of psychosocial and psychological interventions compared with usual antepartum care in the treatment of antenatal depression.

SEARCH STRATEGY

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (September 2006), the Cochrane Collaboration Depression Anxiety and Neurosis Group's Trials Registers (CCDANCTR-Studies and CCDANCTR-References) (July 2006), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2006, Issue 3), MEDLINE (1966 to July 2006), EMBASE (1980 to July 2006) and CINAHL (1982 to July 2006). We also scanned secondary references and contacted experts in the field to identify other published or unpublished trials.

SELECTION CRITERIA

All published, unpublished and ongoing randomised controlled trials of preventive psychosocial or psychological interventions in which the primary or secondary aim is to treat antenatal depression. We excluded quasi-randomised trials (for example, those randomised by delivery date, or odd versus even medical record numbers) from the analysis.

DATA COLLECTION AND ANALYSIS

All review authors participated in the evaluation of methodological quality and data extraction. Results are presented using relative risk for categorical data and weighted mean difference for continuous data.

MAIN RESULTS

One US trial was included in this review, incorporating 38 outpatient antenatal women who met Diagnostic and Statistical Manual for Mental Disorders-IV criteria for major depression. Interpersonal psychotherapy, compared to a parenting education program, was associated with a reduction in the risk of depressive symptomatology immediately post-treatment using the Clinical Global Impression Scale (one trial, n = 38; relative risk (RR) 0.46, 95% confidence interval (CI) 0.26 to 0.83) and the Hamilton Rating Scale for Depression (one trial, n = 38; RR 0.82, 95% CI 0.65 to 1.03).

AUTHORS' CONCLUSIONS

The evidence is inconclusive to allow us to make any recommendations for interpersonal psychotherapy for the treatment of antenatal depression. The one trial included was too small, with a non-generalisable sample, to make any recommendations.

What treatments patients seek after inpatient care: a follow-up of 24 patients with anorexia nervosa

BACKGROUND

To determine the kind of treatment patients with anorexia nervosa (AN) seek for their eating disorder following hospitalization.

METHOD

Twenty-four women previously treated in the Toronto General Hospital were interviewed to determine the nature and amount of treatment received following discharge.

RESULTS

Mean age: 31 years (SD=9.18). Mean body mass index (BMI) at assessment: 19.97 (SD=4.00). All had seen at least one or more professionals, mainly family doctors and psychiatrists, within the first 6 months. Mean hours of treatment: 85. Eighty-eight per cent had taken psychotropic medication (most commonly antidepressants). Symptomatic and asymptomatic patients did not differ in amount of treatment received.

CONCLUSIONS

Regardless of their symptom state, AN patients continue to use the health system heavily following weight restoration. Their aftercare is thus essential for ongoing maintenance treatment and to prevent relapse, and training primary-care physicians to provide it may be one way to contain health care costs.

Psychometric properties of the Holden psychological screening inventory for a psychiatric offender sample

With a sample of 84 adult patients newly admitted to the forensic unit of a metropolitan psychiatric hospital, we evaluated the psychometric properties of the Holden Psychological Screening Inventory (HPSI). Results indicated that HPSI scales were reliable, and item factor analysis confirmed the HPSI's scoring key and latent structure. Correlations and joint factor analysis with scales from the MMPI-2 and Jackson's Basic Personality Inventory demonstrated the convergent validity of HPSI scales and their sampling adequately from the major components of psychopathology. Overall, findings build toward the clinical construct validity of the HPSI.