P–761 Can modified luteal support in fresh cycle after agonist trigger “rescue” the cumulative live birth rate (CLBR) in high responders

Study question

Can modified luteal support in fresh cycle “rescue” the cumulative live birth rate (CLBR) in high responders who receive agonist trigger?

Summary answer

Live birth rate in high responders who had agonist trigger in fresh cycle was significantly reduced despite modified luteal support.

What is known already

Previous studies, including small randomised controlled trials, claimed that good live birth rate could be achieved at fresh transfer in “high responders” who had GnRHa trigger with modified luteal phase support. However, majority of these studies exclude the true high responders (patients with 20 and above oocytes) and average number of collected eggs reported in many of these studies in the range of 9 to 12. The data on outcome of fresh transfer in true high responders is very limited.

Study design, size, duration

A prospective observational study was conducted in 407 patients, aged 23–42 years who were expected to be at risk of high response (AFC>18, AMH>20 pmol/l) undergoing controlled ovarian stimulation between 2014–2019 triggered either with HCG or GnRH agonist. Live birth rate (LBR) in a fresh and subsequent 3 frozen transfers were compared in groups with different triggers and freeze all.

Participants/materials, setting, methods

Patients were stimulated in short antagonist protocol. The trigger was chosen based on the background characteristics, peak oestradiol and clinician discretion. Triggering was achieved either with 0.5 mg buserelin (GnRHa) 0.5mgin 230 patients (A) or with 250 mcg of hCG(H) in 177 patients. Modified luteal support included vaginal progesterone, oral oestrogen and 1500 iu of hCG on the day of egg retrieval. The later was omitted with more than 20 oocytes.

Main results and the role of chance

The mean age, AFC, number of previous cycles, number of embryos transferred were 33.3, 22.4, 0.26 and 1.2 respectively and did not have significant difference between different triggers. Whereas AMH (53 pmol/l (A) vs 43.1 pmol/l (H), P = 0.003), peak oestradiol (15140.74 (A) vs 9738.59 (H), P = 5.59X10–14), and number of oocytes collected (21 vs.17, P = 5.63X10–7) were significantly higher in GnRHa group. Seventeen patients in buserelin group had elective freeze all. Ovarian Hyperstimulation Syndrome (OHSS) rate was 3.9% in buserelin group (more then half of these cases had a bolus of hCG at egg collection; most were mild/moderate). On the other hand, hCG group had 2.5% of OHSS (all severe). Live birth rate in fresh cycle was 31% in hCG and 21% in GnRHa groups. If freeze all was undertaken in fresh cycle after GnRHa trigger, then LBR in the first frozen cycle of this group was 53% (P = 0.003, fresh vs frozen GnRHa group). CLBR was not different between GnRHa and hCG groups (51%). However, this was significantly lower than CLBR in GnRHa trigger freeze all group 76% (P = 0.03)

Limitations, reasons for caution

The limitation of this study is its non-randomised nature. However, since it is one of the biggest studies for high responders it has a power to minimise bias by adjusting for multiple variables.

Wider implications of the findings: Proceeding with fresh transfer in high responders after GnRHa trigger with modified luteal support not only maintains the risk of OHSS (equivalent to hCG group) but also significantly impairs the LBR not compensated even after 3 subsequent frozen embryo transfers. Therefore, freeze-all approach should be preferred in this group.

Trial registration number

NA

Green Synthesis of Gold Nano-bioconjugates from Onion Peel Extract and Evaluation of Their Antioxidant, Anti-inflammatory, and Cytotoxic Studies

Plant secondary metabolites such as flavonoids demonstrate high degrees of antioxidant, anti-inflammatory, and anticancer activities. Among flavonoids, quercetin plays an important role in inflammation by downregulating the level of various cytokines. Thereby, in this work, onion (Allium cepa) peel was successfully utilized for the synthesis of gold nano-bioconjugates acting as a natural therapeutic drug. In this process, crude onion peel extract was first divided into different fractionates, namely, ethyl acetate, butanol, methanol, and water, and they were subjected to various preliminary studies of antioxidant activities. The ethyl acetate fractionate shows high antioxidant activities in all the assays. The bioactive components were identified and found to contain a high amount of quercetin as confirmed by liquid chromatography with tandem mass spectrometry and high-performance liquid chromatogrpahy. Three gold nano-bioconjugates were prepared with different concentrations of the ethyl acetate fractionate. Various biochemical anti-inflammatory assays were carried out and compared with the active ethyl acetate fraction of the onion peel drug (OPD). The cytotoxicity of the nano-bioconjugate system and the OPD was checked in the myoblast L6 cell line from skeletal muscle tissues to evaluate the toxicity. All the three nano-bioconjugates A, B, and E demonstrated high percentages of cell viability, viz., 73.07, 72.3, and 69.15%, respectively, at their highest concentration of 200 μg/mL. The OPD also showed 88.56% cell viability with no toxic effects in the myoblast L6 cell line from skeletal muscle tissues. The reactive oxygen species reduction of nano-bioconjugate B showed a marked reduction of 76.77% at a maximum concentration of 200 μg/mL, whereas the OPD showed 68.17%. Hence, through this work, a cheap source of nano-bioconjugates is developed, which can act as a potent antioxidant and anti-inflammatory agent and are more active in comparison to the OPD alone.

Silver Trauma- a true challenging entity

Historically trauma has been identified as the leading cause of death in the younger under 40’s population (1). However, with an aging population there is a higher incidence of trauma sustained in the elderly population. Silver trauma is defined as elderly patient of retirement age or over the age of 65 years. This has been taken into consideration when trauma guidelines have been incorporated. To name a few examples, the CCSR (Canadian C-spine rule) includes the at-risk population as those >/= 65 years of age in the context of potential cervical spine injury. In various major trauma trial tools, the >65 years of age group are considered to be a high risk of deteoriation group. Through clinical practice clinicians have noted that in this group of patients’ injuries can be missed which would be detrimental to the overall outcome of these patients. Through this article I aim to highlight the main issues that make the initial management of the elderly trauma patient at times challenging. Furthermore, suggestion for potential management strategies will also be highlighted.

Phytochemical-Based Nanomedicine for Advanced Cancer Theranostics: Perspectives on Clinical Trials to Clinical Use

In the current chapter, a new strategic compilation of phytochemicals with potent antitumor properties has been addressed, most importantly focusing on cell cycle arrest and apoptotic signaling mechanism. A promising approach in tumor prevention is to eliminate cancer cells preferably via cell cycle arrest and programmed cell death with lesser harm to neighboring normal cells. Cancer cells have a survival advantage to escape apoptosis and relentlessly divide to proliferate, gearing up the cell cycle process. Recently, the use of phytochemical-derived conjugated chemotherapeutic agents has increased dramatically owing to its biocompatibility, low cytotoxicity, low resistance, and dynamic physiochemical properties discriminating normal cells in the treatment of various cancer types. For decades, biomedical investigations have targeted cell cycle and apoptotic cell death mechanism as an effective cancer-killing tool for systemically assessing the potential biological interactions of functional phytocompounds compared to its synthetic counterparts during their complete life cycles from entry, biodistribution, cellular/molecular interactions to excretion. Newly emerging nanotechnology application in anticancer drug formulations has revolutionized cancer therapy. Tissue-specific phyto-nanomedicine plays a vital role in advanced cancer diagnostics using liposome, micelle, and nanoparticles as a precise and effective delivery vehicle. This chapter specifically focuses on the therapeutic phytomolecules approved by the Food and Drug Administration (FDA, USA) along with phyto-chemopreventives currently on clinical trials (Phase-I/II/III/IV). Besides, detailed coverage is given to the FDA-approved nanotechnology-based formulations only in the areas of cancer theranostics via cell cycle arrest and apoptotic pathways including present challenges and future perspectives.

Tunable electrical properties of carbon dot doped photo-responsive azobenzene-clay nanocomposites

The development of photo-responsive nanocomposite materials is important in the fabrication of optoelectronic devices. In this work, we fabricated a carbon dot doped azobenzene–clay nanocomposite which possesses different ac conductivity with and without UV treatment. At first, azobenzene nanoclusters were synthesised and then successfully used to make an azobenzene–clay nanocomposite. It was observed that there is a small change in the ac conductivity of the azobenzene–clay nanocomposite with and without UV treatment. However, this change in ac photoconductivity can be enhanced in the azobenzene–clay nanocomposite by doping with electron-rich cysteine and methionine carbon dots. Hence, ac conductivity properties of the carbon-doped azobenzene–clay nanocomposite can be tuned using UV light. Impedance measurements were determined using Electrochemical Impedance Spectroscopy. Mechanistic insight into the phenomenon is also discussed in the paper. Thus fabrication of tunable carbon dot doped photo-responsive azobenzene–clay nanocomposites will lead to the use of carbon dot doped azobenzene–clay nanocomposites in photo-switchable optoelectronic devices.

We demonstrate successful fabrication of an azobenzene–clay nanocomposite doped with electron-rich cysteine and methionine carbon dots with photo-switchable ac conductivity.

High-performance water-borne fluorescent acrylic-based adhesive: synthesis and application

Water-borne adhesives have immense importance in cellulose-based materials, where their durability, handling, and strength remain to be a major concern. The present work demonstrates the development of three water-borne adhesives, namely, poly(1-vinyl-2-pyrrolidone-co-acrylic acid), poly(acrylonitrile-co-acrylic acid), and poly(1-vinyl-2-pyrrolidone-co-acrylonitrile-co-acrylic acid) applicable for cellulose-based materials. These acrylic-acid based adhesives were characterized by Fourier-transform infra-red spectroscopy, thermogravimetric analysis, X-ray diffraction, gel permeation chromatography, and universal testing machine. The synthesized polymer adhesives can be stored in the powder form for a longer period, thus utilizing less space. In order to use as adhesives, suitable formulations can be prepared in water. The adhesives show thermal stability up to 300 °C. Our studies show that poly(1-vinyl-2-pyrrolidone-co-acrylonitrile-co-acrylic acid) showed higher lap shear strength (ASTM D-906) than commercially available adhesives. In addition, these adhesives, being fluorescent in nature, can be detected under UV light and thus are applicable for the detection of fractured joints of any specimen. This property also helps in anti-counterfeiting applications, thus adding further to their utility.

Synthesis and application of a water-borne fluorescent acrylic adhesive, which can be stored as a powder for long-term use.

The most important attribute: stakeholder perspectives on what matters most in a physician

Background

Most people can think of important attributes that they believe physicians should have. The canmeds framework defines domains of attributes in medical training (Leader, Medical Expert, Scholar, Communicator, Advocate, Collaborator, and Professional). Whether some are more valued by various stakeholders is unknown. Previous research has shown that patients can receive suboptimal care if physician and patient expectations of a health care encounter differ. In the present study, we sought to identify what various stakeholders identified as the single most important attribute for a physician to possess.

Methods

A simple survey asked the question "What is the single most important attribute a physician should have?" at a single academic teaching hospital and affiliated medical school. The survey was administered to medical students, doctors, nurses, patients, and caregivers. Age and sex were also collected. Responses were assigned to domains and analyzed to identify trends. The primary outcome is a descriptive analysis of the findings.

Results

From 362 individuals who responded, 109 different responses were obtained. The single most common answer was "compassion" (n = 86). Responses were categorized into these 5 domains: Caring, n = 209; Professional or Collaborator, n = 58; Medical Expert, n = 54; Communicator, n = 32; and Other, n = 9. Compared with men, women chose attributes in the Caring domain more frequently (64% vs. 49%), although that domain was the most popular for both sexes. Medical students were less likely to highly value Communicator attributes.

Conclusions

All stakeholder group identified attributes in the Caring domain as being most important. Although all canmeds roles are important, our research highlights the priorities of stakeholders.

DNA Carbon-Nanodots based Electrochemical Biosensor for Detection of Mutagenic Nitrosamines

Mutagenic and Carcinogenic substances are a threat to any living organism, and its detection is of paramount importance. In this work, we fabricate for the first time a DNA-carbon dots based electrochemical biosensor for sensitive and selective detection of mutagenic nitrosamines like N-nitrosodimethylamine (NDMA) and N-nitrosodiethanolamine (NDEA). At first, on the glassy carbon electrode (GCE), chitosan carbon dot was deposited, then, DNA was electro-statically immobilizing on the surface of carbon dots to fabricate the sensing electrode (DNA/chiCD/GCE modified electrode). In the presence of NDMA and NDEA, in differential pulse voltammetry technique, the absolute peak current increases, and thus it can detect NDMA and NDEA. The system DNA/chiCD/GCE modified electrode is highly selective and sensitive toward NDMA and NDEA. The detection limit was determined to be 9.9 × 10^-9 M and 9.6 × 10^-9 M, respectively. The possible reason for DNA/chiCD/GCE modified electrode showing such electrochemical selectivity toward nitrosamines is investigated and discussed.

P1727 Large coronary artery to pulmonary artery fistula as primary source of pulmonary blood supply in tetralogy of fallot with pulmonary atresia

Funding Acknowledgements

Not Applicable

OnBehalf

Not Applicable

Introduction

Pulmonary blood supply in patients of Tetralogy of Fallot with pulmonary atresia is usually from patent arterial duct or major aortopulmonary collaterals (MAPCAs) arising from descending thoracic aorta. We describe a case in which large coronary to pulmonary artery fistula was the primary source of pulmonary blood supply.

Case Report

A 17 years old female was referred to our hospital for diagnostic workup of suspected congenital heart disease. She was previously undiagnosed and now complains of progressive shortness of breath for last few months.

On physical examination she was non-dysmorphic with oxygen saturation of ∼ 77 % in room air, blood pressure of ∼ 117/72 mmHg, pulse rate of ∼ 89 beats per minute and respiratory rate of ∼ 24 breaths per minute. She was clinically cyanosed with grade 3 clubbing and polycythemic. Cardiovascular examination revealed quiet precordium with normally placed apex beat, grade 2 parasternal heave with single second heart sound and grade 3/6 continuous murmur along left mid sternal border.

Twelve lead electrocardiogram (ECG) showed normal sinus rhythm, right axis deviation and right ventricular hypertrophy. There was no evidence of ischemia. Chest X-ray revealed "boat shaped heart" with oligaemic lung fields. Transthoracic echocardiography showed large conoventricular ventricular septal defect with bidirectional flow. There was aortic over-ride with dilated left main coronary artery. No forward flow was seen across right ventricular outflow tract. Considering hugely dilated left main coronary artery, suspicion of coronary to pulmonary artery fistula was made and cardiac computed tomography followed by conventional angiography was done, both confirmed the diagnosis of Tetralogy of Fallot with pulmonary atresia and large coronary artery to main pulmonary artery fistula as a primary pulmonary blood supply. Two small collaterals (MAPCAs) were also identified supplying small part of right and left lungs.

Conclusion

This case highlights unusual source of pulmonary blood supply in Tetralogy of Fallot with pulmonary atresia. Correct pre-operative diagnosis is essential for appropriate surgical planning and better outcome.

Abstract P1727 Figure. TOF-PA with CA to PA Fistula

Nano-Bioconjugate Film from Aloe vera To Detect Hazardous Chemicals Used in Cosmetics

It is of utmost importance to detect hazardous chemicals that affect human health. In this work, a simple method has been developed using a traditional medicinal herb Aloe vera as a carbon source to fabricate a nano-bioconjugate film. The nano-bioconjugate system comprises of A. vera gel itself and sodium alginate to form a fluorescent nano-bioconjugate film. The film was successfully used as an optical "turn-off" sensor in detecting analytes viz. para-Aminobenzoic acid (PABA), benzophenone, hydroquinone, and propylparaben, which are used in cosmetics and are listed as "red-listed" chemicals. The applicability of the fluorescent film in detecting these hazardous chemicals was even assessed with some locally purchased cosmetic samples. Mechanistic insight into the fluorescent quenching shown by nano-bioconjugate film is also discussed. Developments of such a detection system from sustainable sources make it an interesting option for fabricating sensors for hazardous chemicals.

Spatio-temporal distribution analysis of circulating genotypes of dengue virus type 1 in western and southern states of India by a one-step real-time RT-PCR assay

Dengue virus type 1 (DENV-1) Asian and American/African (AM/AF) genotypes were reported to be co-circulating in southern and western states of India based on envelope (E) gene sequencing of few representative samples. The objective of the present study was to develop a one-step real-time RT-PCR to discriminate between Asian and AM/AF genotypes of DENV-1 and investigate the spatio-temporal distribution of the DENV-1 genotypes in southern and western states of India. A one-step real-time RT-PCR to discriminate the Asian and AM/AF genotypes of DENV-1 was developed and validated using 40 samples (17 Asian and 23 AM/AF), for which the envelope (E) gene sequence data was available. DENV-2, DENV-3 and DENV-4 isolates, one each and DENV negative samples (n = 17) were also tested by the assay. Additional 296 samples positive for DENV-1 from selected Southern and Western states of India were genotyped using the real-time RT-PCR assay. Among the samples used for validation, the genotyping results were concordant with sequencing results for 39 samples. In the one discordant sample which was positive for AM/AF by sequencing, the genotyping assay tested positive for both Asian and AM/AF genotype. DENV-2, DENV-3 and DENV-4 isolates were not reactive in the assay. None of the DENV negative samples were positive (sensitivity 100% and specificity 98.2%). A total of 336 samples (40 samples with sequence data and 296 samples without sequence data) were used for spatio-temporal distribution analysis. The results revealed that the Asian genotype was the predominant genotype in Tamil Nadu and Kerala, the southern states. The AM/AF genotype was the predominant genotype in Maharashtra, a western state of India. In Nashik district of Maharashtra, Asian genotype was observed in 32.6% of DENV-1 samples during 2017 while the same decreased to 7.3% during 2018. In Pune district, Asian genotype was observed in 40.0% of DENV-1 samples during 2018 only. To conclude, a one step real-time RT-PCR has been developed for discriminating Asian and AM/AF genotypes of DENV-1. This assay can act as a complement to sequencing but not a substitute and can be utilized in resource limited settings for molecular surveillance of DENV-1. DENV-1 Asian genotype was the dominant genotype in South India while, AM/AF genotype was dominant in Western India.

Dual emission carbon dots from carotenoids: Converting a single emission to dual emission

Dual emission carbon dots have a high potential for use as fluorescence-based sensors with higher selectivity and sensitivity. This study demonstrated the possibility of conversion of a biological molecular system with a single emission peak to a double emission carbon dots system. This report is the first to describe the synthesis of dual emission carbon dots by tuning the electronic environment of a conjugated system. Here we prepared carbon dots from a natural extract, from which carotenoids were used as a new source for carbon dots. Formation of the carbon dots was confirmed by images obtained under a transmission electron microscope as well as from a dynamic light scattering study. The prepared carbon dots system was characterized and its optical property was monitored. The study showed that, after irradiation with microwaves, the fluorescence intensity of the whole system changed, without any change in the original peak position of the carotenoid but with the appearance of an additional peak. A Fourier transform infrared study confirmed breaking of the conjugated system. When using ethylene glycol as a surface passivating agent added to these carotenoid carbon dots, the dual emission spectra became more distinct.

Carbon dots derived from water hyacinth and their application as a sensor for pretilachlor

Recently,carbon-based nanomaterials have been attracted much interest among the scientific community due to its extraordinary properties and applications. Mostly the fluorescent carbon nanomaterials are prepared from commercially available precursors. In this work, develop a new strategy for producing carbon nanoparticles (carbon dots) using phosphoric acid as an activating agent from water hyacinth present in Assam, India. These carbon nanoparticles show green fluorescence under UV light, and the sizes are found below 10 nm. These carbon dots are applied as a fluorescence sensor for detecting the herbicide (pretilachlor). The developed PL sensor is exclusively selective and sensitive for detection of this herbicide, and the limit of detection is found to be 2.9 μM.This sensor is also tested for real samples like soil contaminated with pretilachlor.

Primary Non-Hodgkin Lymphoma of Sphenoid Sinus Involving Cavernus Sinus and Clivus with Isolated 3rd Nerve Palsy

Lymphomas are group of malignant neoplasm having origins from lymphoreticular cells. B cell Non Hodgkin Lymphoma (BNHL) of sphenoid sinus as primary site for lymphomas are very rare and whenever involves comes usually with ocular manifestations. The proximity of the lesion to optic nerve and cavernous sinus present a high risk of developing unilateral ophthalmoplegia or even blindness. The vast majority of cases of localized sphenoid sinus lymphomas are usually curable to surgery, chemotherapy alone or combination of both, sometimes radiotherapy. Here we report a case of 58 years old male attended at Bangabandhu Sheikh Mujib Medical University (BSMMU) on 9th February 2017 at 9:00 AM having headache and gradually developing ptosis in left eye over 15 days. MRI of brain revealed homogeneously enhancing lesion occupying sphenoid sinus, clivus extending towards left cavernous sinus. Gross total resection of tumor was achieved by endoscopic endonasal approach. Histopathology revealed non-Hodgkin lymphoma and immunohistochemically it was positive for CD 20, CD 45, CD 79 and BCL 2, strongly compatible with diffuse large B cell lymphoma. Treatment with R-CHOP regimen following surgery resulted in initiation of improvement of the condition of the patient. Primary B cell Non-Hodgkin Lymphoma (PBNHL) of the sphenoid sinus is a rare entity which can be perplexing and misleading for a surgeon until the histopathological proof is in hand. Early diagnosis with strong suspicion of sphenoid lymphoma in mind during workouts and timely management, close monitoring and follow ups have high potential for cure and longer disease-free survival of the BNHL patients.

Vulnerabilities and risks of HIV infection among migrants in the Thane district, India

OBJECTIVES

To explore the vulnerabilities and risks of HIV infection among female migrants compared with male migrants in the Thane district of Maharashtra, India.

STUDY DESIGN

This is a cross-sectional epidemiological study.

METHODS

Data from 35,841 migrants (men 96.2% and women 3.8%) were collected using the web-based 'Migrant Service Delivery System.' The data were then analysed in SPSS, version 23.0. Statistical analysis, including Chi-squared test and multivariate logistic regression, was used to identify factors influencing HIV infection for both male and female migrants.

RESULTS

It was observed that 2.96% of female migrants had HIV infection compared with 0.77% of male migrants. We found that 12.1% of women consumed alcohol compared with 41.9% of men, and access to bars was 1.5% among women and 3.5% in men. We observed an even larger difference between men and women in their previous history of using brothels for sex; only 5.9% of female migrants reported previously having used brothels for sex, compared with 62.9% of male migrants. Approximately 12.3% of married women and 93.6% of married men had sex with someone other than their spouse. We found that 67.0% of married women and 73.9% of married men reported using a condom during their last sexual act compared with 60.9% of unmarried women and 68.1% of unmarried men.

CONCLUSIONS

In Thane, female migrants faced higher vulnerabilities and risks of HIV infection than male migrants. Consequently, innovative strategies are required to address these particular needs of female migrants.

Tuning the wettability and photoluminescence of graphene quantum dots via covalent modification

In this paper, we have tuned the dual properties, i.e., wettability and photoluminescence of GQDs by simply covalent modification with long chain alkyl (–C₁₂H₂₇) groups.

A multicentre study investigating vital sign changes occurring in complicated and uncomplicated transfusions

BACKGROUND AND OBJECTIVES

Many hospitals require transfusions to be discontinued when vital signs stray from predetermined ranges, regardless of clinical symptoms. Variations in vital signs may be unrelated to transfusion, however, and needlessly stopping a transfusion may delay medical care while increasing donor exposures and healthcare costs. We hypothesized that a detailed study of vital sign changes associated with transfusion of blood product by component, including those associated with potential reactions (complicated) and those deemed to be uncomplicated, would establish a useful framework of reference for treating clinicians and transfusion services alike.

MATERIALS AND METHODS

A retrospective electronic record review of transfusion service and transfusion recipient data was completed on 3852 inpatient transfusion episodes over a 6-month period at four academic tertiary care hospitals across the United States. Vital signs pre- and post-transfusion were recorded by trained clinical research nurses. Serious reactions were adjudicated by a panel of transfusion medicine experts.

RESULTS

In both uncomplicated transfusions (n = 3765) and those including an adverse reaction (n = 87), vital sign fluctuations were generally modest. Compared to uncomplicated transfusions, transfusions complicated by febrile reactions were associated with higher pretransfusion temperature and higher pretransfusion pulse rates. Episodes of transfusion circulatory overload were associated with higher pretransfusion respiration rates compared to uncomplicated transfusions.

CONCLUSION

Most transfusions are associated with only modest changes in vital signs. Pretransfusion vital signs may be an important yet previously understudied predictor of vital sign changes during transfusion. The optimal role of vital sign assessment during blood transfusion deserves further study.