Determinants associated with uncontrolled asthma in Portugal: A national population-based study

INTRODUCTION AND OBJECTIVES

Asthma is a chronic and heterogeneous disease that affects people of all ages and has a high estimated increase in prevalence worldwide. Asthma control represents a main goal in the disease management. International studies revealed low levels of disease control resulting in a significant burden for healthcare systems, not only in terms of quality of life, but also in terms of health costs. Modifiable and non-modifiable factors have been identified as relating to poor asthma control level. In this study we evaluated the distribution of asthma control levels in Portuguese adult population and examine the determinants associated with uncontrolled asthma.

MATERIALS AND METHODS

Using a similar methodology to the one employed in the Asthma Insights and Reality in Europe (AIRE) survey, 327 active asthmatic patients were identified by random phone number and completed a questionnaire during 2011 to 2012. Asthma control was assessed by the evaluation of GINA based symptom control, by Asthma Control Test.äó (ACT) and by self-perception of control. To examine the relationship between uncontrolled asthma and its determinants, univariate logistic regression analysis, sequential multivariable regression and population attributable risk percentage were determinate.

RESULTS

35.2% active asthmatic patients had uncontrolled asthma, 64.8% partially controlled and none of the individuals had total control of asthma assessed by ACT test. Factors significantly associated with poor asthma control scores were: age (OR 1.02 per year of age; 95% CI: 1.01.Çô1.03), female sex (OR 1.87; 95% CI: 1.15.Çô3.04), educational level (OR 0.5; 95% CI: 0.28.Çô0.89 at high school level or over), occupation (OR 4.92; 95% CI: 2.12.Çô11.42 if looking for a first job or unemployed) (OR 2.51; 95% CI: 1.35.Çô4.65 if being retired), income (OR 0.23; 95% CI: 0.07.Çô0.72 if >619 euros), BMI (OR 1.09 per BMI unit; 95% CI: 1.03.Çô1.14), having rhinitis symptoms (OR 4.40; 95% CI: 2.56.Çô7.58) and using inhaled corticosteroids (OR 0.44; 95%CI: 0.24.Çô0.82 if used in the past or never used). Looking for a first job or being unemployed, BMI and having rhinitis symptoms remained significant after multivariate adjustments.

CONCLUSIONS

Uncontrolled asthma was associated with several determinants. Their identification can contribute to improve asthma care both from clinical and from public health perspectives.

P-722 Ending the anonymity of egg donors in shared donation programs could reduce the number of participants

Study question

Loss of egg donor anonymity could affect shared donation programs in Brazil?

Summary answer

Yes. Approximately 20% of the women who participated in this study would drop out of the program, especially those with higher incomes.

What is known already

The Brazilian Federal Council of Medicine seems to be increasingly flexible with regard to maintaining mandatory secrecy on the identity of donors. The resolution regarding assisted reproduction techniques, approved in 2021, concerns the possibility of donation between family members, up to fourth degree relatives. The possibility to know and have access to this identity or even the search for half-brothers can be a reality in many countries for children born through access to reproductive technology but the opinion or behaviour of this population about the presence or absence of anonymity is limited to a few studies.

Study design, size, duration

Women (n = 800) who applied for enrolment in the shared egg donation program at a private IVF clinic were invited to participate in an electronic survey developed using the online Survio® tool. The invitation to participate was sent by email from June to November 2021. 279 women (34.8%, 20-35 years) responded to the survey.

Participants/materials, setting, methods

The information was obtained through questioning and gaining information about: socioeconomic profile of the donors, their motives, ambivalence in relation to the sharing of eggs and feelings about a possible end of anonymity. Thereafter, answers given to 10 specific questions were recorded. Furthermore, a correlation analysis was performed to assess the relationship between acceptance of the end of donor anonymity and various study parameters.

Main results and the role of chance

Approximately 61% of patients would want to become egg donors for two reasons: to reduce IVF costs and to help another woman. However, significantly younger women want to be part of the egg donation program just to reduce their treatment costs (P < 0.05). Approximately 71% of women do not want any contact with the child born from their eggs; 69% of them would not like to meet the recipients and 75% would not like to meet the child, even if only the recipient had become pregnant. If donors lost a child, they would not even want to meet the child who was born with their donated eggs (76%).

Most participants also responded that they would be in the program even if the anonymity was not maintained (80%). However, women with higher income would drop out of the program if donor anonymity was not maintained (56.3%) compared to women with lower income (13.5%;P < 0.001).

Limitations, reasons for caution

Confounding variables related to the male partner's opinion cannot be excluded. Studies with larger samples are needed to confirm these findings.

Wider implications of the findings

A possible end to the anonymity of egg donors in Brazil would pose numerous challenges to the current practice of gamete donation. These concerns give rise to a broad discussion in society about how best to safeguard and promote the interests of donor-conceived children and protect the rights of donors.

Trial registration number

Not applicable.

P-534 Noninvasive preimplantation genetic testing for aneuploidies (NIPGT-A) x Preimplantation genetic testing for aneuploidies (PGT-A): NIPGT-A is more reliable than PGT-A

Study question

Does NIPGT-A have lower false-positive rates (FPR) than PGT-A?

Summary answer

When DNA from whole embryo cells was used as the gold-standard, the FPR of NIPGT-A was 3.57-times smaller than that obtained with PGT-A.

What is known already

After many years of using PGT-A, there are still many concerns, such as risks of invasive action and difficulties in the correct interpretation of mosaicism, which could lead to errors in the interpretation of false-positive and false-negative results. Recently, a new technology (NIPGT-A) has arisen using cell-free DNA present in the spent culture media of human blastocysts. Unlike PGT-A that uses only trophoblastic cells, NIPGT-A reflects the ploidy status of trophoblastic cells and inner cell mass, suggesting that this new technology could be less prone to errors and thus more reliable than invasive tests.

Study design, size, duration

This multicentric cohort study included a total of 56 blastocysts vitrified on day/5 that were previously biopsied for PGT-A(all these embryos presented a diagnosis of aneuploidy). The embryos were donated under informed consent by patients following the Human Medical Authority regulations. Blastocysts were thawed and cultured in 15μl drops of culture medium under oil. After their expansion(4-8hours), the blastocysts and their corresponding spent media were transferred to PCR tubes and stored at -20ºC until analysis.

Participants/materials, setting, methods

The DNA of all samples (spent culture medium and whole embryo) was amplified by the MALBAC® technology(Yikon Genomics). The DNA concentration of the amplified product was measured using Qubit 3.0 Fluorometer(Thermo Fisher Scientific). The samples were subjected to next-generation sequencing(NGS) using Illumina MiSeq® System. The ploidy status results obtained from ChromGo™ software(Yikon Genomics) for spent culture medium and whole embryo were compared to determine the accuracy of NIPGT-A for screening chromosomal abnormalities in each embryo.

Main results and the role of chance

DNA from all 56 spent media samples and whole embryos were successfully amplified. Comparing the results of NIPGT-A and whole embryos sequencing, the positive predictive value (PPV) was 93.5% and the FPR was 6.5% (Table 1). On the other hand, comparing the whole embryo and PGT-A results, the PPV was 76.8%, and the FPR was 23.2% (Table 2). NIPGT-A had a negative predictive value (NPV) of 100% and a false negative rate (FNR) of 0%.

Limitations, reasons for caution

Despite the sample size could be considered small, comparative analyses between the results of invasive/noninvasive PGT-A with whole embryo are rare. All donated embryos were classified as aneuploidy. Additionally, the cut-off for aneuploidy in cases of PGT-A could be variable(multicentre-study). Euploid embryos have not been donated for research to date.

Wider implications of the findings

NIPGT-A has a lower FPR than PGT-A and does not require micromanipulation skills, avoiding trophectoderm biopsy trauma and seems to provide more accurate results corresponding to the ploidy status of the whole embryo. Thereby NIPGT-A should be considered as the test of choice for genetic evaluation of the embryo.

Trial registration number

Not Applicable

P-535 Preimplantation Genetic Testing for Aneuploidy (PGT-A) for patients aged ≤ 37 years: Today, evidence-based medicine does not support its use. A meta-analysis

Study question

Do patients aged ≤37 years truly benefit from using PGT-A as an add-on to increase ongoing pregnancy rate (OPR)/live birth rate (LBR) in their first IVF/ICSI cycle?

Summary answer

The use of PGT-A is not superior to classic morphological embryonic selection to increase OPR/LBR in patients aged ≤37 years in their first IVF/ICSI cycle.

What is known already

The embryonic aneuploidies increase exponentially with advancing-maternal-age, ranging from 30-50% up to 37 years to 80% in women ≥42 years. Consequently, the use of PGT-A seems to be a useful add-on for patients with advanced-maternal-age, but not necessarily for young women undergoing their first IVF/ICSI cycle. Recent studies investigated the benefit of PGT-A, concluding that it was accompanied with lower OPR/LBR, when compared to conventional-cycles in women aged ≤37 years. However, the use of this add-on in IVF/ICSI cycles is increasing alarmingly. Furthermore, adding PGT-A in reproductive treatments is related with increased costs and limitations inherent to the test itself.

Study design, size, duration

A systematic review based on electronics searches of databases (PubMed/MEDLINE, EMBASE, Web of Science, Scopus, and Cochrane database. Keywords: PGT-A; Morphological embryonic selection; ongoing pregnancy; live birth) up to December 2021 was conducted to identify randomised controlled trials (RCTs) comparing clinical outcomes of IVF/ICSI cycles with PGT-A versus Morphological embryonic selection. The primary outcomes were ongoing pregnancy and live birth rates.

Participants/materials, setting, methods

Seven RCTs were included as targets for data extraction and meta-analysis. Three studies reported on OPR and five reported LBR of patients who underwent their first IVF/ICSI cycle. Data were combined for meta-analysis using StatsDirect statistical software. Dichotomous data were expressed as Relative Risk(RR) with a 95% confidence interval(CI). The amount of heterogeneity was evaluated using Cochran’sQ and I2. Study data were combined using a Random-effects model. P-values <0.05 were considered to be statistically significant.

Main results and the role of chance

-Ongoing pregnancy rates (three trials): PGT-A group: 67.4% (485/720) versus morphological embryo selection group: 63.2% (460/728) with no statistically significant differences (RR = 1.11; 95% CI = 0.89–1.39; P=0.35)

-Live birth rate (five trials): PGT-A group: 58.9% (578/981) versus Morphological embryo selection group: 57.9% (585/1010) with no statistically significant differences (RR = 1.01; 95% CI = 0.81–1.26; P=0.91).

Table 1 shows the data.

Limitations, reasons for caution

The main limitation of this meta-analysis is the low number and heterogeneity of studies included. However, all of the included studies are randomised controlled trials, and the data were meta-analysed using Random-effects.

Wider implications of the findings

This meta-analysis brings to light a fundamental discussion currently, in which physicians and embryologists employ add-ons to improve clinical outcomes even without adequate scientific support.Medical practices are based on scientific evidence and Reproductive Medicine is not different. Therefore, at the moment, PGT-A should not be indicated for patients aged ≤37years.

Trial registration number

Not applicable

O-190 Endometrial compaction in artificial frozen-thawed embryo transfer cycles is associated with improvement in pregnancy outcomes: a meta-analysis

Study question

Does the decrease in endometrial thickness between the end of oestrogen phase and embryo transfer day (endometrial compaction) impact the pregnancy outcomes in frozen-thawed embryo transfer (FET) cycles?

Summary answer

The combined data indicated that cycles with endometrial compaction resulted in significantly higher ongoing pregnancy/live birth rate than cycles with no decrease in endometrial thickness.

What is known already

In FET cycles the monitoring of endometrial thickness was mostly concentrated at the end of the endometrium proliferation phase, while research on endometrial thickness in the luteal phase around the embryo transfer day was relatively rare. In addition, few studies have investigated the change in endometrial thickness after progesterone administration, and the conclusions are contradictory. Some studies included women who used hormone replacement therapy for endometrial preparation and showed that endometrial compaction (decreased thickness between the end of oestrogen phase and embryo transfer day) was associated with higher pregnancy rates. However, others reached different conclusions.

Study design, size, duration

A systematic review and meta-analyses was carried out to analyse the effect of endometrial compaction on FET cycle outcomes. The search strategy included online searching of databases (MEDLINE, EMBASE, The Science Citation Index, Google scholar, Cochrane Controlled Trials Register and OVID) up to December 2021. There was no language restriction and included grey literature. The following Medical Subject Headings and text words were used: frozen-thawed embryo transfer, hormonal preparation, endometrial thickness, endometrial compaction.

Participants/materials, setting, methods

Only cycles with artificial endometrial lining preparation (oestrogen-progesterone) and that compared outcomes of endometrial compaction cycles versus no endometrial compaction (no change/increased in endometrial thickness) cycles were considered. The primary outcomes were clinical pregnancy(CPR), miscarriage(MR) and ongoing pregnancy/livebirth (OPR/LBR) rates. The Breslow–Day-statistic, Q-statistic and I² (inconsistency) were used to determine the combinability of the trials. The random effects model was used for odds ratio(OR). The StatsDirect statistical software (Cheshire, UK) was used for data analysis.

Main results and the role of chance

Although endometrial compaction does not significantly affect CPR (OR:1.31[0.91-1.89],P=0.14) and MR (OR:1.18[0.87-1.59];P=0.27, it seems to be associated with a higher OPR/LBR (OR:1.54[1.12-2.13];P=0.007). Table 1 shows the data.

Limitations, reasons for caution

Some trials did not report clinical pregnancy or miscarriage rate. It could be associated with differences in the results. The retrospective nature and lack of standardisation of procedures across studies should be highlighted. Some analyses show high heterogeneity. Although statistically significant, the results in both arms are very close. 

Wider implications of the findings

The combined results support the change in endometrial thickness as an easy, low-cost, potential noninvasive marker of endometrial receptivity. However, additional trials are still needed.

Trial registration number

Not applicable

O-180 Body mass index (BMI) is not associated with ovarian response to gonadotropin during IVF/ICSI treatment: An evaluation of 4499 IVF/ICSI cycles

Study question

Is there an association between body mass index (BMI) and ovarian response in IVF/ICSI treatment?

Summary answer

BMI does not seem to be associated with the ovarian response to gonadotropin.

What is known already

Obesity is becoming an increasingly widespread health problem. Elevated BMI in patients who undergo assisted reproduction technology has been associated with higher doses of gonadotropins, higher risks of ovarian hyperstimulation syndrome, increased cancellation rates, and lower oocyte recovery compared to women with normal BMI. In addition, overweight and obese women submitted to IVF may present reduced rates of clinical pregnancy and live births and an increased miscarriage rate. However, population differences should be considered.

Study design, size, duration

This prospective cohort study included 4499 women who underwent IVF/ICSI cycles. Only one cycle per couple was considered. Inclusion criteria included normal karyotype, presence of two ovaries as observed by ultrasound examination, and no history of ovarian surgery, endometriosis, hydrosalpinx, infection, or endocrine disorders. Patients were stratified into four groups by BMI: <18.5 kg/m2 (underweight); 18.5-24.9 kg/m2 (normal weight); 25-29.9 kg/m2 (overweight); and ≥30 kg/m2 (obesity).

Participants/materials, setting, methods

The BMI values were associated with age, anti-Müllerian hormone (AMH) levels, antral follicle counts (AFC), total dose of FSH and LH, number of follicles and number of retrieved oocytes (total and metaphase II) of IVF/ICSI cycles. The statistical analyses for group comparisons were performed using t test, Mann–Whitney test and the Kruskal–Wallis test.

Main results and the role of chance

No statistically significant differences were observed between BMI groups regarding age, AMH levels, AFC, dose of gonadotropin used (FSH and LH), days of stimulation, number of follicles and number of retrieved eggs (total and metaphase II). Table 1 summarizes the results.

Limitations, reasons for caution

A possible limitation is the cross-sectional nature of the data. Differences in sample size between BMI groups may have influenced the results.

Wider implications of the findings

Against common sense in the literature, the results did not reveal a relationship between BMI and the ovarian response to gonadotropins. BMI as an additional tool in the individualization of ovarian stimulation protocols should be reviewed.

Trial registration number

Not applicable.

O-157 Female body mass index (BMI) influences pregnancy outcomes: An evaluation of 4349 IVF/ICSI cycles

Study question

Does female body mass index (BMI) impair pregnancy outcomes after IVF/ICSI cycles?

Summary answer

High BMI (overweight and obesity) and low BMI (underweight) are associated with decreased clinical pregnancy and live birth rates and an increased miscarriage rate.

What is known already

Obese women undergoing treatment for infertility may face problems, such as the need for higher doses of drugs to stimulate ovulation, oocyte morphological changes, reduction in fertilization and implantation rates, and embryo quality. Compared to women of normal BMI, obese women submitted to IVF may present reduced rates of clinical pregnancy and live births and an increased miscarriage rate. Regarding the effects of low BMI, unfavourable pregnancy outcomes and infertility problems have been described, but evidence is still scarce and conflicting.

Study design, size, duration

A prospective analysis was performed of 4349 couples who underwent IVF/ICSI treatment and fresh embryo transfer. Only one cycle per couple was considered. Exclusion criteria included abnormal karyotype, uterine defects, evidence of hydrosalpinx, infections, endocrine problems, coagulation defects or thrombophilia and autoimmune defects. Couples were stratified into four groups by female BMI: <18.5kg/m2 (underweight); 18.5-24.9kg/m2 (normal weight); 25-29.9kg/m2 (overweight); and ≥30kg/m2 (obesity). Clinical pregnancy, miscarriage and live birth rates were the outcomes analysed.

Participants/materials, setting, methods

Variables such as age, duration/type of infertility, previous embryo transfers, aetiologies, endometrial thickness, type of ovarian stimulation, and number/quality/development stage of embryo transferred were included as potential confounding factors. For group comparisons, the t test or chi-square test was used. Multivariate logistic regression analyses were performed to evaluate the associations between BMI and the probabilities of clinical pregnancy (CP), miscarriage and live birth (LB). Normal-weight patients were considered as the reference group.

Main results and the role of chance

Regarding confounding factors, no significant differences between BMI groups were observed.

-BMI-group comparisons showed that CP, miscarriage and LB rates significantly worsened with the increase in BMI (overweight and obesity groups). Miscarriage and LB rates also worsened with the decrease in BMI (underweight group) (Table 1).

-Compared with the normal-weight group, the overweight and obesity groups had significantly reduced rates of CP (19%/29%, respectively) and LB (27%/40%, respectively) and an increased rate of miscarriage (1.7x and 2.3x, respectively). Underweight was associated with a 49%-reduced rate of LB and a 3.0x increase in the rate of miscarriage (Table 2).

Limitations, reasons for caution

Differences in sample size between BMI groups may have influenced the results. In clinical outcomes, only fresh transfers were considered (not cumulative data). Population characteristics should be considered when interpreting the results.

Wider implications of the findings

The study suggests that higher BMI (overweight and obesity) and lower BMI (underweight) in women have a detrimental effect on ART outcomes, especially regarding the evolution of pregnancies. Problems associated with abnormal BMI should be discussed when advising couples interested in fertility treatment.

Trial registration number

Not applicable.

P-177 Non-invasive aneuploidy testing versus conventional morphological embryo selection in good prognosis patients

Study question

Can non-invasive preimplantation genetic testing of aneuploidies (niPGT-A) improve the clinical outcome in good prognosis patients compared to morphological embryo selection without aneuploidy testing?

Summary answer

Embryonic cell-free DNA (cfDNA) in the blastocyst culture medium offers more objective information for blastocyst selection, resulting in higher ongoing pregnancy rate in good-prognosis patients.

What is known already

One of the biggest challenges in IVF is accurately selecting viable embryos that are most likely to produce a healthy child at home after embryo transfer. Trophectoderm biopsy and PGT-A have improved implantation and clinical pregnancy rates per transfer; however, two recent studies have shown that PGTA does not improve clinical pregnancy rates below 35 years. A non-invasive alternative is to analyze (the cfDNA) in blastocyst culture medium. Several studies have shown that cfDNA testing on blastocyst culture medium at day 6 of development allows detection of aneuploidies with high concordance rates compared to TE biopsy and inner cell mass

Study design, size, duration

This observational study reports data from September 2020 to December 2021. During this period, niPGT-A was performed on 25 patients under 35 years of age whit average age of 32, where cfDNA analysis was applied to the culture medium of 92 blastocysts. A total of 20 single embryo transfers (SETs) have been performed so far, comparing the results with 31 transfers performed in the same period based only on morphological criteria.

Participants/materials, setting, methods

In the niPGT-A group, embryos were cultured in a Geri incubator up to day-4, and then individually cultured in 10 µl drops of CCSS (Fujifilm) until day 6 in an ESCO –system whit low oxygen concentration. At day-6, blastocysts were vitrified, and media collected in sterile PCR tubes after at least 40 hours in culture. After collection, media were immediately frozen and analyzed by Next Generation Sequencing analysis. Deferred transfer was performed according to media results.

Main results and the role of chance

In the niPGT-A group euploidy rate was 57% whit 8% non- informative results. Pregnancy rate was 80% with 75% ongoing pregnancy and 5% miscarriage rates, having 8 live births up to now. For the morphology group, pregnancy rate was 58% with 55% ongoing pregnancy and 3% miscarriage rates.

We did a secondary analysis identifiying which blastocyst we would be transfered, if only morphology would be considered. We observed that in 65% of the cases we would choose the same embryo as with niPGT-A, however in 35% of the cases we would have transferred a blastocyst with an aneuploid medium. Regarding blastocyst quality for throphoectoderm classified as A,B or C the euploidy rate were 62%,58% and 33% respectively, and pregnancy rates were 100%, 78% and 33%. For inne cell mass, similar euploidy rates werw observed for blastocyst classified as A,B or C (59%,52% and 57% respectively) and pregnancy rates were 100%, 73% and 100%. Evaluating the expansion grade in blastocoel no differences were observed in euploidy rates for cathegories 4, 5 and 6 (52%, 54% and 50% respectively) and pregnancy rates were 82%, 100% and 100%. We observed the lower pregnancy rate for blastocysts whit throphoectoderm C previously suggested by other authors.

Limitations, reasons for caution

Our results are encouraging since this group of good prognosis could improve their ongoing pregnancy rate even having a good reproductive prognosis whit morphology selection. Larger randomized controlled trials are needed to verify and extend our findings in this age range

Wider implications of the findings

These results support the clinical application of niPGT-A in the laboratory routine as a proritization tool, without the need of embryo manipulation, reducing subjectivity for blastocyst selection compared to morphology and increasing the ongoing pregnancy rate in good prognosis patients

Trial registration number

Sa-16552/19-EC:428

Impact of the COVID-19 Pandemic on a Cancer Fast-Track Programme

Introduction

The COVID-19 pandemic has disrupted many aspects of clinical practice in oncology, particularly regarding early cancer diagnosis, sparking public health concerns that possible delays could increase the proportion of patients diagnosed at advanced stages. In 2009, a cancer fast-track program (CFP) was implemented at the Clinico-Malvarrosa Health Department in Valencia, Spain with the aim of shortening waiting times between suspected cancer symptoms, diagnosis and therapy initiation.

Objectives

The study aimed to explore the effects of the COVID-19 pandemic on our cancer diagnosis fast-track program.

Methods

The program workflow (patients included and time periods) was analysed from the beginning of the state of alarm on March 16th, 2020 until March 15th, 2021. Data was compared with data from the same period of time from the year before (2019).

Results

During the pandemic year, 975 suspected cancer cases were submitted to the CFP. The number of submissions only decreased during times of highest COVID-19 incidence and stricter lockdown, and overall, referrals were slightly higher than in the previous 2 years. Cancer diagnosis was confirmed in 197 (24.1%) cases, among which 33% were urological, 23% breast, 16% gastrointestinal and 9% lung cancer. The median time from referral to specialist appointment was 13 days and diagnosis was reached at a median of 18 days. In confirmed cancer cases, treatment was started at around 30 days from time of diagnosis. In total, 61% of cancer disease was detected at early stage, 20% at locally advanced stage, and 19% at advanced stage, displaying time frames and case proportions similar to pre-pandemic years.

Conclusions

Our program has been able to maintain normal flow and efficacy despite the challenges of the current pandemic, and has proven a reliable tool to help primary care physicians referring suspected cancer patients.

Angiotensin-converting enzyme inhibitors in preclinical myxomatous mitral valve disease in dogs: systematic review and meta-analysis

To determine the efficacy and adverse events of the administration of angiotensin-converting enzyme inhibitors for the management of preclinical myxomatous mitral valve disease in dogs. A comprehensive search using Pubmed/MEDLINE, LILACS and CAB abstracts databases was performed. Randomised clinical trials that assessed efficacy and adverse events of angiotensin-converting enzyme inhibitors for the management of preclinical myxomatous mitral valve disease in dogs were included. Certainty of evidence was rated using GRADE methods. Four randomised clinical trials were included. While safe, angiotensin-converting enzyme inhibitors administration to dogs with myxomatous mitral valve disease and cardiomegaly results in little to no difference in the risk of development congestive heart failure (high certainty of evidence; relative risk: 1.03; 95% confidence interval: 0.87 to 1.23) and may result in little to no difference in cardiovascular-related (low certainty of evidence; relative risk: 1.01; 95% confidence interval: 0.54 to 1.89) and all-cause mortality (low certainty of evidence; relative risk: 0.93; 95% confidence interval: 0.63 to 1.36). Administration of angiotensin-converting enzyme inhibitors to dogs with myxomatous mitral valve disease without cardiomegaly may result in a reduced risk of congestive heart failure development. However, the range in which the actual effect for this outcome may be, the "margin of error," indicates it might also increase the risk of congestive heart failure development (low certainty of evidence; relative risk: 0.86; 95% confidence interval: 0.54 to 1.35). Administration of angiotensin-converting enzyme inhibitors to dogs with preclinical myxomatous mitral valve disease and cardiomegaly results in little to no difference in the risk of the development of congestive heart failure and may result in little to no difference in cardiovascular-related and all-cause mortality. The certainty of evidence of the efficacy of angiotensin-converting enzyme inhibitors administration to dogs without cardiomegaly was low.

P–560 Comparative analysis of non-invasive preimplantation genetic testing of aneuploidies (niPGT-A), PGT-A and IVF cycles without aneuploidy testing: preliminary results

Study question

Can non-invasive preimplantation genetic testing of aneuploidies (niPGT-A) improve the clinical outcome in IVF patients after proper validation?

Summary answer

We demonstrate the usefulness of the embryonic cell-free DNA (cfDNA) in the blastocyst culture medium to select more objectively the blastocysts with higher implantation potential.

What is known already

One of the greatest challenges in IVF is accurately selecting viable embryos that are more likely to achieve healthy livebirths following embryo transfer. Trophectoderm (TE) biopsy and PGT-A provide a direct assessment of chromosome status and improve implantation and clinical pregnancy rates per transfer. A non-invasive alternative is to analyse embryonic cfDNA in the blastocyst culture medium. Previous studies have shown that cfDNA testing in culture medium of blastocysts on day 6 of development allows aneuploidy detection with high concordance rates compared to TE biopsy and inner cell mass (Rubio et al., 2020).

Study design, size, duration

Observational study of the clinical application of niPGT-A (July 2020-December 2020). The clinical application consisted in a first validation phase, comparing TE biopsies with cfDNA in the media of 28 blastocysts. And, in a second phase, niPGT-A was applied and the outcome of 13 single embryo transfers (SETs) compared to 13 PGT-A SETs and 130 IVF/ICSI SETs performed in a period of six months. In the three groups, women and donors age was ≤38 years.

Participants/materials, setting, methods

Embryos were cultured in a Geri incubator (Merck) up to day 4, and then individually cultured in 10µl drops of CCSS (Fujifilm) until day 6 in a bench-top K-system. At day 6, blastocysts were vitrified, and media collected in sterile PCR tubes after at least 40 hours in culture. After collection, media were immediately frozen and analyzed by NGS analysis in our reference laboratory (Igenomix, Spain). Deferred transfer was performed according to media results.

Main results and the role of chance

Before the first clinical cases, a validation of the protocol comparing the results of cfDNA with the TE biopsies of the same day–6 blastocyst was performed, and ploidy concordance rates were 87.5%.

Similar results were found for niPGT-A and PGT-A in terms of aneuploidy results and in clinical outcomes. The percentages of informative results were 95% and 97% and the aneuploidy rates were 44% and 46%, for niPGT-A and PGT-A, respectively. Clinical pregnancy rates were in both groups of aneuploidy testing, 69.2%, with 8 ongoing pregnancies (61.5%) and 4 tested by prenatal screaning NACE. For untested embryos clinical pregnancy (57.7%) and ongoing pregnancy rates (48.5%) were lower than in the two groups of tested embryos (niPGT-A and PGT-A).

In the niPGT-A cycles embryo transfer was performed according to media results and morphology. We did a secondary analysis of which blastocyst we would transfer, if only morphology is considered. We observed that if we only select the embryos by morphology, in 61.5% of the cases we would choose the same embryo than with niPGT-A, and in 30.4% of the cases we would transfer a blastocyst with an aneuploid medium.

Limitations, reasons for caution

Our results are encouraging but should be interpreted with caution due to the small sample size. Larger and randomized controlled trials are needed to verify and extend our findings in each group.

Wider implications of the findings: We observed consistent results for niPGT-A compared to TE biopsies in our internal validation. These results endorse the clinical application of niPGT-A in the routine of the laboratory and can avoid the embryo manipulation also reducing the subjectivity when embryos are selected only by morphology.

Trial registration number

Sa–16552/19-EC:428

Ten-year assessment of a cancer fast-track programme to connect primary care with oncology: reducing time from initial symptoms to diagnosis and treatment initiation

Background

Cancer is the second leading cause of mortality worldwide. Integrating different levels of care by implementing screening programmes, extending diagnostic tools and applying therapeutic advances may increase survival. We implemented a cancer fast-track programme (CFP) to shorten the time between suspected cancer symptoms, diagnosis and therapy initiation.

Patients and methods

Descriptive data were collected from the 10 years since the CFP was implemented (2009-2019) at the Clinico-Malvarrosa Health Department in Valencia, Spain. General practitioners (GPs), an oncology coordinator and 11 specialists designed guidelines for GP patient referral to the CFP, including criteria for breast, digestive, gynaecological, lung, urological, dermatological, head and neck, and soft tissue cancers. Patients with enlarged lymph nodes and constitutional symptoms were also considered. On identifying patients with suspected cancer, GPs sent a case proposal to the oncology coordinator. If criteria were met, an appointment was quickly made with the patient. We analysed the timeline of each stage of the process.

Results

A total of 4493 suspected cancer cases were submitted to the CFP, of whom 4019 were seen by the corresponding specialist. Cancer was confirmed in 1098 (27.3%) patients: breast cancer in 33%, urological cancers in 22%, gastrointestinal cancer in 19% and lung cancer in 15%. The median time from submission to cancer testing was 11 days, and diagnosis was reached in a median of 19 days. Treatment was started at a median of 34 days from diagnosis.

Conclusions

The findings of this study show that the interval from GP patient referral to specialist testing, cancer diagnosis and start of therapy can be reduced. Implementation of the CFP enabled most patients to begin curative intended treatment, and required only minimal resources in our setting.

•

Our CFP easily connects GPs and hospital specialists.

•

Our CFP shortens assessment time in patients with suspected cancer, adding to quality care.

•

Our CFP decreases emotional stress in patients without cancer.

Glucagon-like peptide-1 receptor agonists in patients treated with antipsychotics

Introduction

Glucagon-like peptide-1 (GLP-1) is an endogenous peptide that stimulates insulin secretion and decreases glucagon secretion. The use of GLP-1 receptor agonists (GLP-1RA) showed efficacy reducing the weight and glucose levels in patients with and without type 2 diabetes. This effect was also associated with a decreased risk of major cardiovascular events.

Objectives

Our aim is to review the role of GLP-1RA in psychiatric patients at cardio-metabolic risk due to antipsychotics treatment.

Methods

We reviewed articles published in PubMed using the keywords: “GLP-1” “glucagon like peptide” “antipsychotics” and “psychiatry”.

Results

The number need to treat (NNT) to achieve clinical meaningful weight loss was 3.8. GLP-1RA treatment was also associated with greater reductions in body mass index, fasting glucose, HbA1c and visceral fat. This effect is true for antipsychotic treatment in general and for those on clozapine and olanzapine in particular. Overall, the GLP-1RA are well tolerated with nausea being the most common related adverse effect. Other variables such as age, sex, psychosis severity, nausea or any adverse drug reaction did not affect the weight loss.

Conclusions

Studies showed a promising role in the management of antipsychotics induced weight gain, particularly in clozapine and olanzapine treated patients. Although these promising results, the route of administration, with a daily or weekly subcutaneous injection, and the GLP-1RA associated financial costs, can be viewed as important factors which can limit the wide use of this type of treatment in psychiatric patients.

Disclosure

No significant relationships.

Multi-annual survey of health status disturbance in the Bilbao estuary (Bay of Biscay) based on sediment chemistry and juvenile sole (Solea spp.) histopathology

The Bilbao estuary (SE Bay of Biscay) is a recovering ecosystem whose sediments are still contaminated. They represent a potential risk for the biota including benthic and demersal species living in direct contact with the sediment. In this context, the present study aims to survey trends of the health status of the Bilbao estuary based on sediment chemistry and sole (Solea spp.) histopathology. Monitoring campaigns were carried out every autumn from 2011 to 2017 along the estuary. Contaminant levels were measured in sediments; liver, gills and gonads of juvenile fish were collected for histopathology. Overall, contaminant levels fluctuated throughout the years, with highest values recorded in the earlier years of the study period. Sole histopathology showed alterations of mild severity. Results permitted to assess the environmental health status of the Bilbao estuary during 7 years, although no clear temporal trend was detected. Longer-term monitoring programmes are necessary to confirm the ecosystem recovery.

3D ultrasound estimation of the effective volume for popliteal block at the level of division

Local anaesthetic injection between the tibial and commmon peroneal nerves within connective tissue sheath results in a predictable diffusion and allows for a reduction in the volume needed to achieve a consistent sciatic popliteal block. Using 3D ultrasound volumetric acquisition, we quantified the visible volume in contact with the nerve along a 5cm segment.

METHODS

We included 20 consecutive patients scheduled for bunion surgery. Ultrasound guided popliteal block was performed using a posterior, out of plane approach at the level of división of the sciatic nerve. Thirty ml of mepivacaine 1.5% and levobupivacaine 0.5% were slowly injected while assessing the injection pressure and the diffusion of the local anaesthetic. Volumetric acquisition was performed before and after the block to quantify the the volume of the sciatic nerve and the volume of the surrounding hypoechoic halo contained inside the connective tissue in a 5cm segment.

RESULTS

All blocks were successful within 20min after the injection. The total estimated volume contained inside the common connective tissue sheath was 6.8±2.6cm³. Of this, the volume of the halo sorrounding the nerve was 4.4±1.7cm³ and the volume inside the sciatic nerve was 2.4±1.7cm³.

CONCLUSIONS

The volume of local anaesthetic in close contact with the sciatic nerve can be estimated by volumetric acquisition. Our results suggest that the effective volume of local anaesthetic needed for a successful sciatic popliteal block could be reduced to less than 7ml.

Biological characterization of a new silicon based coating developed for dental implants

Taking into account the influence of Si in osteoblast cell proliferation, a series of sol-gel derived silicon based coating was prepared by controlling the process parameters and varying the different Si-alkoxide precursors molar rate in order to obtain materials able to release Si compounds. For this purpose, methyltrimethoxysilane (MTMOS) and tetraethyl orthosilicate (TEOS) were hydrolysed together and the sol obtained was used to dip-coat the different substrates. The silicon release ability of the coatings was tested finding that it was dependent on the TEOS precursor content, reaching a Si amount value around ninefolds higher for coatings with TEOS than for the pure MTMOS material. To test the effect of this released Si, the in vitro performance of developed coatings was tested with human adipose mesenchymal stem cells finding a significantly higher proliferation and mineralization on the coating with the higher TEOS content. For in vivo evaluation of the biocompatibility, coated implants were placed in the tibia of the rabbit and a histological analysis was performed. The evaluation of parameters such as the bone marrow state, the presence of giant cells and the fibrous capsule proved the biocompatibility of the developed coatings. Furthermore, coated implants seemed to produce a qualitatively higher osteoblastic activity and a higher number of bone spicules than the control (uncoated commercial SLA titanium dental implant).

Trunk strength is associated with sit-to-stand performance in both stroke and healthy subjects

BACKGROUND

Since impairments of the trunk muscles are observed in stroke subjects, who also demonstrate limitations in performing the sit-to-stand (STS) task, it is possible that these limitations are related to decreased strength of the trunk muscles.

AIM

To compare the STS performances and isokinetic measures of trunk strength between stroke and matched healthy subjects and to investigate if there were associations between STS performances and strength of the trunk muscles.

DESIGN

Exploratory study.

SETTING

University Laboratory.

POPULATION

Eighteen stroke and 18 match-ed healthy subjects.

METHODS

Subjects performed the five-repetition sit-to-stand test and were also asked to stand up and sit down at both self-selected and fast speeds (motion analysis system). The scores of the five-repetition sit-to-stand test and the total duration of the STS, as well as the duration of phases I and II were used as measures of STS performances. Isokinetic strength of the trunk muscles was assessed at a speed of 60º/s: concentric peak torque and total normalized work.

RESULTS

Stroke subjects showed poorer STS performances (P≤0.02), except for the duration of phase I at self-selected speed, as well as decreased strength of the trunk muscles (P≤0.001). Significant and negative correlations were found between STS performance and trunk strength variables, which were classified as low (-0.38≤r≤-0.49) or moderate (-0.50≤r≤-0.63).

CONCLUSION

In general, poorer STS performances observed in stroke subjects was related to weakness of the trunk muscles.

CLINICAL REHABILITATION IMPACT

Evaluation and interventions involving trunk strength should be included in rehabilitation of stroke subjects, who show limitations in STS performances.

Histopathological baseline levels and confounding factors in common sole (Solea solea) for marine environmental risk assessment

Liver and gonad histopathology, biometric parameters and hepatic metal bioaccumulation were assessed monthly over a one-year period in common soles from the Basque continental shelf, in order to determine baseline levels and confounding factors within biomonitoring studies. Biometric parameters and hepatic metal bioaccumulation varied according to season and gender. Accordingly, hepatic histopathological traits presented seasonal variations related to the reproductive cycle. However, the hepatic histopathological index showed that seasonality and gender were not significant confounding factors. Conversely, the gonad histopathological index was modulated by season and gender. As for organ comparison, the liver endured more severe histopathological damage than the gonad. In brief, the sampling period and gender may not affect the estimation of hepatic histopathological indices for biomonitoring purposes. Nonetheless, due to different sensitivities to environmental 'noise' variables, the sampling period and gender differentiation should be thoroughly considered for the assessment of gonad histopathology, biometrics and metal bioaccumulation.

Evaluation of frozen thawed cauda epididymal sperms and in vitro fertilizing potential of bovine sperm collected from the cauda epididymal

In the present study, the fertilizing potential of semen recovered from slaughtered bulls epididymis was evaluated after cryopreservation, by conventional techniques and flow cytometry methods. The cauda epididymal was dissected and sperm were recovered and evaluated for volume, sperm concentration, and membrane and acrosome integrity using a flow cytometer. Sperm fertility potential was tested by in vitro fertilization (IVF). For each bull, three trials of IVF were performed. Before freezing, on average, the sperm concentration was 216 ± 27.5 × 10(6) sperm/ml. Sperm viability averaged 86.5 ± 4%. The mean percentage of sperm with intact plasma membrane and acrosome before and after cryopreservation was 90.7 ± 2.9% and 90.8 ± 1.9% (P≥0.05), respectively. The fertilization rate using frozen/thawed epididymal semen averaged 64.1 ± 3.9% fertilization with no significant differences between bulls (P>0.05). For the bull considered as control, the fertilization rate was 72.2 ± 4.5%, differing significantly (P>0.05) from the frozen/thawed epididymal semen's fertilization rate. In conclusion, it is possible to use in vitro techniques with cryopreserved spermatozoa obtained from bull's epididymis using a controlled rate freezing method with a predetermined freezing curve, and with assessment of sperm's viability by conventional techniques and flow cytometry methods, together with the fertilizing ability of cryopreserved epididymal spermatozoa.

Reproductive versatility in legumes: the case of amphicarpy in Trifolium polymorphum

Amphicarpy is a fascinating reproductive strategy, defined as fruit produced both below the soil surface and as aerial fruit on the same plant. Trifolium polymorphum is a grassland species subject to herbivory that combines amphicarpy with vegetative reproduction through stolons. Underground flowers have been described as obligate autogamous and aerial ones as self-compatible allogamous, with aerial floral traits favouring cross-pollination. In the present work we performed different pollination treatments on aerial flowers to analyse rates of pollen tube development and offspring fitness, measured as fruit set, seed production and germination percentage. This last variable was compared to that of seeds produced underground. No significant differences were found between fruit set in self- and cross-pollinations. Seed production was higher in self-pollinations, which is consistent with the higher rate of pollen tube development observed in self-crosses. Spontaneous self-pollination is limited in aerial flowers; thus pollen transfer by means of a vector is required even within the same flower. Germination tests showed that aerial seeds produced after self- and cross-pollination did not differ in fitness, but underground seeds had higher germination percentage than aerial ones. Thus, we conclude that T. polymorphum has a mixed mating system. In grasslands with heavy grazing pressure, clonal propagation and underground seed production ensure persistence in the field. An intermediate level of selfing in aerial flowers ensures offspring, but morphological (herkogamy) and functional (dicogamy) floral traits maintain a window to incorporate genetic variability, allowing the species to tolerate temporal and spatial pressures.

Out of America: tracing the genetic footprints of the global diffusion of maize

Maize was first domesticated in a restricted valley in south-central Mexico. It was diffused throughout the Americas over thousands of years, and following the discovery of the New World by Columbus, was introduced into Europe. Trade and colonization introduced it further into all parts of the world to which it could adapt. Repeated introductions, local selection and adaptation, a highly diverse gene pool and outcrossing nature, and global trade in maize led to difficulty understanding exactly where the diversity of many of the local maize landraces originated. This is particularly true in Africa and Asia, where historical accounts are scarce or contradictory. Knowledge of post-domestication movements of maize around the world would assist in germplasm conservation and plant breeding efforts. To this end, we used SSR markers to genotype multiple individuals from hundreds of representative landraces from around the world. Applying a multidisciplinary approach combining genetic, linguistic, and historical data, we reconstructed possible patterns of maize diffusion throughout the world from American "contribution" centers, which we propose reflect the origins of maize worldwide. These results shed new light on introductions of maize into Africa and Asia. By providing a first globally comprehensive genetic characterization of landraces using markers appropriate to this evolutionary time frame, we explore the post-domestication evolutionary history of maize and highlight original diversity sources that may be tapped for plant improvement in different regions of the world.