Synthesis and Properties of Pyridine-Fused Triazolylidene-Palladium: Catalyst for Cross-Coupling Using Chloroarenes and Nitroarenes

The synthesis and catalytic activity of pyridine-fused triazolylidene as a novel abnormal N-heterocyclic carbene (aNHC) ligand is described. The evaluation of physical properties using X-ray crystallographic analysis and infrared spectroscopy revealed that these triazolylidenes have a high electron-donating ability toward the metal center. The application of this triazolylidene to the palladium-catalyzed cross-coupling of chloroarenes and nitroarenes with arylboronic acids showcased its ability to activate C-Cl and C-NO₂ bonds.

Tislelizumab versus chemotherapy as second-line treatment of advanced or metastatic esophageal squamous cell carcinoma (RATIONALE 302): impact on health-related quality of life

Background

RATIONALE 302 (NCT03430843) an open-label, phase III study of second-line treatment of advanced/metastatic esophageal squamous cell carcinoma (ESCC), reported that tislelizumab, relative to investigator-chosen chemotherapy (ICC), was associated with improvements in overall survival and a favorable safety profile. This study assessed the health-related quality of life (HRQoL) and ESCC-related symptoms of patients in RATIONALE 302.

Methods

Adults with advanced/metastatic ESCC whose disease progressed following prior systemic therapy were randomized 1 : 1 to receive either tislelizumab or ICC (paclitaxel, docetaxel, or irinotecan). HRQoL was measured using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 items (EORTC QLQ-C30), the EORTC Quality of Life Questionnaire Oesophageal Cancer Module 18 items (QLQ-OES18), and the EuroQoL Five-Dimensions Five-Levels (EQ-5D-5L) visual analogue scale. Mixed effect modeling for repeated measurements examined changes from baseline to weeks 12 and 18. The Kaplan–Meier method was used to examine time to deterioration.

Results

Overall, 512 patients were randomized to tislelizumab (n = 256) or ICC (n = 256). The tislelizumab arm maintained QLQ-C30 global health status/quality whereas the ICC arm worsened at week 12 {difference in least square (LS) mean change: 5.8 [95% confidence interval (CI): 2.0-9.5], P = 0.0028} and week 18 [difference in LS mean change: 8.1 (95% CI: 3.4-12.8), P = 0.0008]. Physical functioning (week 18) and fatigue (weeks 12 and 18) worsened less in the tislelizumab compared with the ICC arm. The tislelizumab arm improved in reflux symptoms, whereas the ICC worsened at week 12 [difference in LS mean change: −4.1 (95% CI: −7.6 to −0.6), P = 0.0229]. The visual analogue scale remained consistent in the tislelizumab arm whereas it worsened in the ICC arm. The hazard of time to deterioration was lower in tislelizumab patients compared with ICC for physical functioning and reflux.

Conclusions

HRQoL, including fatigue symptoms and physical functioning, was maintained in patients with advanced or metastatic ESCC receiving tislelizumab compared with ICC-treated patients. These results provide additional support for the benefits of tislelizumab in this patient population.

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Global health status and HRQoL remained consistent in the tislelizumab arm whereas the ICC arm experienced worsening.

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Fatigue and physical functioning worsened in both arms; however, the worsening was greater in the ICC arm.

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The tislelizumab arm was at lower risk of reaching the threshold for worsening in physical functioning and reflux.

Imaging-based feedback cooling of a levitated nanoparticle

Imaging-based detection of the motion of levitated nanoparticles complements a widely used interferometric detection method, providing a precise and robust way to estimate the position of the particle. Here, we demonstrate a camera-based feedback cooling scheme for a charged nanoparticle levitated in a linear Paul trap. The nanoparticle levitated in vacuum was imaged using a complementary metal-oxide semiconductor (CMOS) camera system. The images were processed in real-time with a microcontroller integrated with a CMOS image sensor. The phase-delayed position signal was fed back to one of the trap electrodes, resulting in cooling by velocity damping. Our study provides a simple and versatile approach applicable for the control of low-frequency mechanical oscillators.

O-272 Letrozole-induced endometrial preparation improved pregnancy outcomes after frozen blastocyst transfer compared to the natural cycle

Study question

Does letrozole-induced endometrial preparation affect pregnancy outcomes, perinatal outcomes, and congenital anomalies after single vitrified-warmed blastocyst transfers (SVBTs) when compared with the natural cycle?

Summary answer

Letrozole-induced endometrial preparation improved live birth rate without any adverse effects on perinatal outcomes and congenital anomalies after SVBTs.

What is known already

Letrozole treatment is considered an effective option in endometrial preparation for frozen embryo transfers in patients with ovulation disorders or irregular menstruation; however, the effectiveness of letrozole-induced endometrial preparation is still unclear in ovulatory patients. Furthermore, there is no comparative study reporting on pregnancy complications and congenital anomalies after frozen embryo transfers comparing natural and letrozole-assisted cycles.

Study design, size, duration

This retrospective study, at a major academic fertility centre, analysed a total of 14,611 clinical records of women who underwent SVBTs comprising both natural and letrozole-assisted cycles between July 2015 and June 2020. The cycle characteristics, pregnancy outcomes (clinical pregnancy, ongoing pregnancy, and live birth), and the incidence of pregnancy complications and congenital anomalies were statistically compared between the natural and letrozole groups.

Participants/materials, setting, methods

The study reviewed ovulatory patients who underwent their first SVBT during the study period. Some patients took letrozole during the early proliferative phase to promote follicular development and maturation (letrozole group). Ovulation was triggered by GnRH agonist and SVBTs were performed on day five after ovulation. Propensity score matching was performed to reduce any bias from patient characteristics. Multivariate logistic analysis was performed to evaluate the effects of letrozole administration on pregnancy and perinatal outcomes.

Main results and the role of chance

After propensity score matching, the characteristics of patients and transferred blastocysts were comparable between groups. The serum progesterone level was also significantly increased in the letrozole group (P < 0.0001). Although no difference was observed regarding implantation rate between groups, the rates of clinical pregnancy, ongoing pregnancy, and delivery in the letrozole group were all significantly higher than that in the natural group (P = 0.0273, P = 0.0162, P = 0.0479, respectively). The incidence of early pregnancy loss, miscarriage, and stillbirth were comparable between groups. Multivariate logistic regression analysis also demonstrated that the administration of letrozole during an SVBT cycle significantly improved the live birth rate (AOR, 1.160; P = 0.0355). The incidence of pregnancy complications was comparable between groups. The caesarean section rate was significantly lower in the letrozole group than that in the natural group (P = 0.0464). Gestational age, birth length, birth weight, and infant sex, as well as the incidence of pregnancy complications and birth defects, were statistically comparable between groups. Furthermore, multivariate logistic regression analysis showed that perinatal outcomes were not affected by letrozole-induced endometrial preparation, although the incidence of caesarean section was decreased in the letrozole group (AOR, 0.788; P = 0.0355).

Limitations, reasons for caution

Our findings are not compared with reported incidences of pregnancy complications and congenital anomalies in natural pregnancy. Furthermore, the study was retrospective in nature, and further multicentre studies are required to ascertain the generalisability of these findings for other clinics with different protocols and/or patient demographics.

Wider implications of the findings

Letrozole administration both extended the proliferative phase and increased luteal function, resulting in an improvement of live birth rates without any adverse effects. Therefore, letrozole-induced endometrial preparation might be a safe and more effective strategy for patients with shortened proliferative phase or insufficient luteal function.

Trial registration number

not applicable

O-064 Recovery culture of human cryopreserved blastocysts with prolactin after warming improves trophoblast outgrowth

Study question

Does prolactin (PRL) treatment during recovery culture affect human blastocyst outgrowth?

Summary answer

PRL treatment for 120 min promoted trophoblast outgrowth in cryopreserved human blastocysts by upregulating the expressions of epithelial-to-mesenchymal transition (EMT) and focal adhesion-related genes.

What is known already

Human embryos express the PRL receptor at the morula and the blastocyst stages. This expression correlates with the blastocyst diameter and the time required for the embryos to reach the blastocyst stage. Treatment with PRL from cleavage to the blastocyst stage improves blastocyst outgrowth to fibronectin. However, whether PRL treatment after warming cryopreserved blastocysts cultured to the blastocyst stage without PRL influences outgrowth competence remains unknown. Furthermore, the optimal time for post-warming PRL treatment remains to be ascertained.

Study design, size, duration

A total of 374 discarded human vitrified blastocysts donated for research by consenting couples were used. The study was approved by the Institutional Review Board. The blastocysts were randomly allocated to two groups, to be cultured in medium either with PRL (n = 208) or without PRL (control; n = 166). The gene expression level, blastocyst adhesion, outgrowth area, and distance of trophoblast migration were compared between the groups.

Participants/materials, setting, methods

Vitrified human blastocysts were cultured for 120 min after warming. Some blastocysts were treated with PRL for 15–120 min during the recovery period. The blastocysts were plated on fibronectin-coated dishes and cultured to assess blastocyst adhesion and outgrowth. The expressions of PRL-interacting genes were assessed by quantitative RT-PCR 12 h after outgrowth culture. The migration distance at the outer edge of the trophoblast cells was examined using time-lapse systems.

Main results and the role of chance

The mRNA expressions of ezrin, radixin, and moesin, which regulate cell adhesion and invasion by controlling actin reorganisation during EMT, was stimulated by PRL treatment for 120 min. The expressions of EMT-related genes, transforming growth factor β1, snail1, and twist1 were also promoted by treatment with PRL for 120 min. The blastocysts treated with PRL also exhibited augmented expression of cadherin2 and transcriptional repression of cadherin1. Higher mRNA expressions of integrin-based focal adhesion-related genes, ITGA5 and ITGB1, were observed after treatment with PRL for 120 min compared to that in the other groups. PRL treatment for 120 min did not alter the rate of blastocyst adhesion to fibronectin-coated dishes 96 h after the outgrowth culture assay. However, multiple linear regression analysis revealed that the outgrowth area was significantly increased in blastocysts treated with PRL. The migration distance of trophoblast cells was significantly increased after PRL treatment. Furthermore, a more beneficial effect of prolactin treatment on blastocyst outgrowth was observed when the blastocysts were vitrified on day 5 compared to that when the blastocysts were vitrified on day 6. Moreover, the outgrowth area was increased by PRL treatment when the blastocyst diameter was larger than 180 µm.

Limitations, reasons for caution

The results may vary between in vivo and in vitro conditions. Further clinical studies are required to explore the clinical efficacy of PRL treatment.

Wider implications of the findings

This study showed that PRL treatment for 120 min improved trophoblast migration in cryopreserved human blastocysts. Therefore, recovery culture with PRL treatment post-warming followed by blastocyst transfer could improve pregnancy outcomes.

Trial registration number

not applicable

O-006 Annotation-free embryo score calculated by iDAScore® correlated with live birth and has no correlation with neonatal outcomes after single vitrified-warmed blastocyst transfer

Study question

Does the embryo score calculated by annotation-free embryo scoring system based on deep learning and time-lapse sequence images correlate with live birth (LB) and neonatal outcomes?

Summary answer

Annotation-free embryo score calculated by iDAScore correlates with decreased miscarriage and increased LB and has no correlation with neonatal outcomes.

What is known already

Embryo ranking models have recently been developed based on artificial intelligence (AI) and deep learning to rank embryos according to their potential for pregnancy. The practicability and usability of such models have been reported. And the previous report suggested iDAScore which is one of the deep learning models for embryo scoring was superior to traditional morphological assessment methods and morphokinetic embryo assessment models. However, few studies have used independent datasets to analyze the correlation between the score calculated by AI models, LB, and neonatal outcomes.

Study design, size, duration

A total of 3,010 single vitrified-warmed blastocyst transfer (SVBT) cycles were analyzed retrospectively. The quality and scoring of embryos were assessed using iDAScore v1.0 (iDAScore, Vitrolife, Sweden). The cohort was divided into four groups based on the iDAScore according to the percentile (9.9-9.3, 9.2-8.7, 8.6-7.3 and, 7.2-1.0).

Participants/materials, setting, methods

Scores were calculated using the iDAScore software module in the Vitrolife Technology Hub (Vitrolife, Gothenburg, Sweden). The correlation between iDAScore, LB rates and total miscarriage (TM), including 1st and 2nd trimester miscarriage, were analysed using a trend-test and multivariable logistic regression analysis. Furthermore, similarly, correlation between the iDAScore and neonatal outcomes were analysed.

Main results and the role of chance

LB rates decreased as the iDAScore decreased (P < 0.05), and a similar inverse trend was observed for the TM rates (P < 0.05). Additionally, multivariate logistic regression analysis showed that iDAScore significantly correlated with increased LB (adjusted odds ratio: 1.742, 95% CI: 1.601–1.904, P < 0.05) and decreased TM (adjusted odds ratio: 0.799, 95% CI: 0.706–0.905, P < 0.05). There was no significant correlation between iDAScore and neonatal outcomes, including congenital malformations, sex, gestational age, and birth weight. Multivariate logistic regression analysis, which included maternal and paternal age, maternal body mass index, parity, smoking, and the presence or absence of caesarean section as confounding factors, revealed no significant difference in any neonatal characteristics (low birth weight, small for gestation, large for gestation, preterm birth, male sex rates, and major congenital malformation).

Limitations, reasons for caution

SVBT was performed following minimal stimulation and natural cycle in vitro fertilisation. Therefore, only a few cycles of elective blastocyst transfer were available. However, there was no bias in selecting embryos for SVBT.

Wider implications of the findings

Objective embryo assessment using a completely automatic and annotation-free model, like iDAScore, showed a good correlation with increased LB and decreased TM. Furthermore, it did not correlate with neonatal outcomes. Therefore, iDAScore may be an optimal LB prediction model after SVBT without affecting neonatal outcomes.

Trial registration number

not applicable

P-754 Perinatal outcomes and congenital anomalies after clomiphene citrate based minimal ovarian stimulation in vitro fertilisation stratified by embryo transfer method: a 10-year cohort study

Study question

Is the embryo transfer method associated with perinatal outcomes and congenital anomalies after minimal ovarian stimulation in vitro fertilisation (IVF) with clomiphene citrate (CC)?

Summary answer

Single vitrified-warmed blastocyst transfers in natural cycles had a lower incidence of pregnancy complications compared to single fresh cleaved embryo transfers after CC-based ovarian stimulation.

What is known already

Pregnancies resulting from IVF are associated with a higher risk of adverse perinatal outcomes compared to spontaneous conception; therefore, the next focus in reproductive medicine is to assess whether the increased risks are attributable to the IVF. Perinatal outcomes and congenital anomalies should be considered in addition to pregnancy outcomes in selecting the embryo transfer method. However, studies describing the influence of transfer methods on perinatal and maternal outcomes are limited.

Study design, size, duration

This study retrospectively analysed a single centre 10-year cohort. A total of 82,491 clinical records of women who underwent oocyte retrieval during a CC-based minimal stimulation cycle followed by single fresh cleaved embryo transfer (SFCT), single vitrified-warmed cleaved embryo transfer (SVCT), or single vitrified-warmed blastocyst transfer (SVBT) at the Kato Ladies Clinic between January 2008 and December 2017 were retrospectively analysed.

Participants/materials, setting, methods

The oocyte retrievals were performed in CC-based minimal ovarian stimulation. The embryos were transferred 2–3 days after retrieval, or vitrified at the cleavage or blastocyst stages. The vitrified embryos were warmed and transferred within the natural cycles. Perinatal outcomes and congenital anomalies were stratified by the transfer method. Multivariate logistic regression analysis was performed to evaluate the effect of transfer methods on pregnancy complications and congenital anomalies.

Main results and the role of chance

The perinatal outcomes and congenital anomalies in 19,069 singleton pregnancies were analysed. Multivariate logistic regression analysis revealed that the incidence of hypertensive disorders of pregnancy was significantly lower in the SVBT group compared with the SFCT group (adjusted odds ratio [AOR], 0.628; P < 0.0001). The incidence of low-lying placenta (AOR 0.359 P = 0.0483; AOR 0.452 P < 0.0001, respectively) and placenta previa (AOR 0.300 P = 0.0021; AOR 0.542 P < 0.0001, respectively) were lower in the SVCT and SVBT groups than in the SFCT group. The rate of preterm delivery was lower in SVBT compared with SFCT (AOR 0.732 P < 0.0001). The rate of low birth weight was significantly lower after SVCT and SVBT, compared with the SFCT group (AOR 0.751; P = 0.0261: AOR, 0.560; P < 0.0001: respectively). A lower incidence of small for gestational age (AOR 0.720 P = 0.0436; AOR 0.494 P < 0.0001, respectively) and higher incidence of large for gestational age (AOR 1.287 P = 0.0332; AOR 1.706 P < 0.0001, respectively) were observed in the SVCT and SVBT groups compared to the SFCT group. The incidence of each congenital anomaly was similar among the groups.

Limitations, reasons for caution

The data was collected through self-reported parental questionnaires on neonatal outcomes and congenital malformations. Furthermore, this study was retrospective in nature; further studies are necessary to ascertain the generalisability of these findings to other clinics with different protocols and/or patient demographics.

Wider implications of the findings

This study demonstrated reassuring outcomes for SVBT, in terms of a lower incidence of pregnancy complications compared with SFCT. Our findings provide valuable knowledge to improve perinatal outcomes in CC-based stimulation and to inform couples of the possible benefits and harms of each type of embryo transfer method.

Trial registration number

not applicable

P-152 The first morphokinetic map of human abnormal fertilisation

Study question

What are the similarities and differences between the morphokinetics of abnormal, one- (1PN) and three-pronuclear (3PN) and normal bi-pronuclear (2PN) fertilisation?

Summary answer

The morphokinetic analysis of 1PN/3PN fertilisation reveals novel aspects of abnormal early development.

What is known already

Assisted reproduction technology has allowed the observation of early human development. Initially assessed statically at a single time point, fertilization has revealed its complexity once observed by Time-Lapse Microscopy (TLM). Detailed morphokinetic analysis of fertilisation has been reported in the last few years, unveiling previously unknown cytoplasmic phenomena (e.g. the cytoplasmic wave and halo) and the importance of cell symmetry for embryo development. At present, abnormal fertilization remains neglected, despite potential for understanding the physiology and pathology of early human development.

Study design, size, duration

This retrospective study involved TLM observation of normally (2PN, n = 2,685) and abnormally (1PN, n = 41; 3PN, n = 127) fertilised oocytes generated in ICSI cycles. Oocyte retrievals were carried out after the clomiphene citrate-based minimal ovarian stimulation, between October 2019 and December 2020. Oocytes of patients with different diagnoses of infertility were included in the analysis, while cases involving cryopreserved gametes or surgically retrieved sperm were excluded.

Participants/materials, setting, methods

Microinjected oocytes were assessed by a combined TLM-culture system (Embryoscope). Oocytes not suitable for TLM assessment, due to excess of residual corona cells or inadequate orientation for correct observation, were not analysed. Phenomena, relevant to meiotic resumption, pronuclear dynamics, cytoplasmic/cortical modifications, cleavage pattern, and embryo quality, were annotated and compared between groups.

Main results and the role of chance

Second polar body (PBII) extrusion was observed in all 1PN- and in a majority of 3PN-zygotes (92.1%). A 0.3-hour delay in PBII extrusion was confirmed in 3PN-zygotes (P = 0.0439). In a significant proportion of 3PN-zygotes, a third (female) PN formed from reabsorption of the PBII. The cytoplasmic wave was observed not only in 2PN- and 3PN-, but also in 1PN-zygotes. The presence and position of cytoplasmic halo were comparable among the three classes of zygotes. However, the duration of the cytoplasmic halo was prolonged in 1PN-zygotes (P < 0.0001). PN juxtaposition immediately before PN breakdown was less frequent in 3PN- compared with 2PN-zygotes (P = 0.0159). Furthermore, asynchronous PN breakdown was increased in 3PN- compared with 2PN-zygotes (P = 0.0026). The PN area of 1PN- was larger than that of 2PN-zygotes; however, the PN area of 3PN-zygotes was smaller than that of 2PN-zygotes. In 1PN-zygotes, a developmental delay was observed starting from the disappearance of the cytoplasmic halo, reaching 9 hours at the time of cleavage (P < 0.0001). A higher incidence of abnormal cleavage (P = 0.0019) and blastomere fragmentation (P < 0.0001) was observed in 1PN-zygotes. Cleavage progression was increasingly affected especially in 1PN-zygotes, resulting in blastocyst formation rates of 70.2%, 12.2% and 53.5% in 2PN-, 1PN- and 3PN-zygotes, respectively (P < 0.0001).

Limitations, reasons for caution

The study data derive from treatments carried out in a single centre. The study findings therefore require independent verification from other research groups.

Wider implications of the findings

These observations suggest that 1PN and 3PN fertilisation follow the general pattern of normal fertilization. Crucially, they also shed light on diverse and previously undescribed phenomena - e.g. reabsorption of the PBII in 3PN zygotes - underpinning the origins of abnormal fertilization and potentially clinically relevant.

Trial registration number

not applicable

Alterations of default mode and cingulo-opercular salience network and frontostriatal circuit: A candidate endophenotype of obsessive-compulsive disorder

Background It is gradually becoming clear that obsessive-compulsive disorder (OCD) patients have aberrant resting-state large-scale intrinsic networks of cingulo-opercular salience (SN), default mode (DMN), and front-parietal network (FPN). However, it remains unknown whether unaffected first-degree relatives of OCD patients have these alterations as a vulnerability marker to the disorder. Methods We performed resting-state functional magnetic resonance imaging (rsfMRI) scans of 47 medication-free OCD patients, 21 unaffected healthy first-degree relatives of OCD patients, and 62 healthy control (HC) participants. We explored differences between the three groups in the functional connectivity from SN (seeds: anterior-insula (AI) and dorsal anterior cingulate cortex (dACC)), DMN (seeds: medial prefrontal cortex (MPFC) and posterior parietal cortex (PCC)), and FPN (seeds: dorsolateral prefrontal cortex (DLPFC)). Results Compared to HC, both OCD patients and first-degree relatives showed significantly greater functional connectivity between AI and PCC and between DLPFC and the thalamus. Compared to first-degree relatives and HC, OCD patients showed reduced functional connectivity between PCC and DLPFC, and this altered functional connectivity was negatively correlated with anxiety and depressive symptom within OCD group. Conclusions OCD patients and unaffected first-degree relatives of OCD patients showed overlapping alterations in resting state functional connectivity between the regions of SN and DMN and between DLPFC and the thalamus. Our results suggested that alterations between large-scale intrinsic networks and within the dorsal cognitive cortico-striato-thalamo-cortical (CSTC) circuit could represent endophenotype markers of OCD.

POS0081 LONG-TERM EFFICACY AND SAFETY OF UPADACITINIB IN PATIENTS WITH PSORIATIC ARTHRITIS: 2-YEAR RESULTS FROM THE PHASE 3 SELECT-PsA 1 STUDY

Background

In SELECT-PsA 1, patients (pts) with psoriatic arthritis (PsA) and an inadequate response or intolerance to ≥1 non-biologic disease-modifying antirheumatic drug showed improvement in the signs and symptoms of PsA with upadacitinib 15 mg (UPA15) or 30 mg (UPA30), an oral Janus kinase (JAK) inhibitor, through week (wk) 56.1

Objectives

To evaluate the efficacy and safety of UPA and UPA vs adalimumab (ADA) at wk 104 from the ongoing long-term extension of SELECT-PsA 1.

Methods

Pts received UPA15, UPA30, ADA 40 mg, or placebo (PBO) for 24 wks, at which point, PBO pts switched to UPA15 or UPA30. Efficacy endpoints were analyzed using non-responder imputation (NRI) and as observed (AO) (binary endpoints) or mixed-effect model repeated measures and AO (continuous endpoints), with nominal P-values shown, for continuous UPA and ADA treatment groups. Treatment-emergent adverse events were summarized for pts who received ≥1 dose of study drug using a visit-based cut-off at wk 104.

Results

1704 pts received ≥1 dose of study drug. At wk 104, 25.4% of patients had discontinued study drug. The proportions of pts who achieved ACR20/50/70, MDA, PASI75/90/100, and resolution of enthesitis or dactylitis showed consistent responses, or further improvements, from wk 561 to wk 104 (Table 1). ACR20/50/70 and MDA responses, as well as mean change from baseline (BL) in HAQ-DI, patient’s assessment of pain, BASDAI, and ASDAS, were greater with UPA vs ADA. Mean change from BL in modified total Sharp/van der Heijde Score (mTSS) was generally similar across groups and comparable to wk 56.1 The safety profile of UPA was generally comparable to ADA (Figure 1) and consistent with wk 561 data. Rates of serious infection, herpes zoster, lymphopenia, and elevated CPK remained numerically higher with UPA30 vs UPA15; rates in both UPA groups were higher vs ADA. Rates of malignancies, MACE, or VTE were similar across groups, and consistent with wk 561 data. Two deaths were reported with UPA15, 1 with UPA30, and 1 with ADA.

Table 1.

Efficacy Endpoints at Week 104

EndpointUPA15(n=429)UPA30(n=423)ADA(n=429)Proportion of Pts (%)aNRIAONRIAONRIAOACR2069.087.969.587.963.485.1ACR5053.667.459.3*74.147.162.3ACR7038.0*47.443.5*54.429.439.1Minimal Disease Activity (MDA)42.054.845.9*56.837.850.3PASI75b57.973.462.478.658.876.5PASI90b46.759.053.366.548.863.3PASI100b34.143.442.451.434.144.0Resolution of enthesitis by LEIc53.375.552.272.049.173.9Resolution of dactylitis by LDId69.994.571.796.272.495.2Change from BLeMMRMAOMMRMAOMMRMAOHealth Assessment Questionnaire - Disability Index (HAQ-DI)-0.55*-0.57-0.55*-0.59-0.45-0.47Patient’s assessment of pain (numeric rating scale)-3.3-3.5-3.4*-3.6-3.0-3.2Bath Ankylosing Spondylitis Disease Activity Index (BASDAI)f-3.0-3.2-3.3-3.6-2.7-2.6Ankylosing Spondylitis Disease Activity Score (ASDAS)f-1.6-1.8-1.9*-2.1-1.5-1.6Modified total Sharp/van der Heijde Score (mTSS)0.030.010.010.000.110.11

ACR20/50/70, ≥20%/50%/70% improvement in American College of Rheumatology criteria; ADA, adalimumab; AO, as observed; BL, baseline; LDI, Leeds Dactylitis Index; LEI, Leeds Enthesitis Index; MMRM, mixed effect model repeated measurement; NRI, non-responder imputation; PASI75/90/100, ≥75%/90%/100% improvement in Psoriasis Area and Severity Index; pts, patients; UPA, upadacitinib.

aData shown as NRI and AO for binary endpoints.

bFor pts with psoriasis affecting ≥3% of body surface area at BL.

cFor pts with LEI >0 at BL; resolution LEI=0.

dFor pts with LDI >0 at BL; resolution LDI=0.

eData shown as MMRM (LS mean) and AO (mean) for continuous endpoints.

fFor pts with psoriatic spondylitis at BL.

Nominal *P<0.05, UPA15 or UPA30 vs ADA for NRI and MMRM; AO descriptive only.

Conclusion

In PsA pts, efficacy responses were similar or greater with UPA15 or UPA30 vs ADA at wk 104, and inhibition of radiographic progression was maintained. No new safety signals were identified with long-term exposure to UPA up to 2 years.

References

[1]McInnes I, et al. RMD Open, 2021; 7(3):e001838.

Acknowledgements

AbbVie and the authors thank the patients, study sites, and investigators who participated in this clinical trial (NCT03104400). AbbVie funded this study and participated in the study design, research, analysis, data collection, interpretation of data, reviewing, and approval of the publication. All authors had access to relevant data and participated in the drafting, review, and approval of this publication. No honoraria or payments were made for authorship. Medical writing support was provided by Monica R.P. Elmore, PhD of AbbVie.

Disclosure of Interests

Iain McInnes Consultant of: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Gilead, Janssen, Novartis, Pfizer, Sanofi Regeneron, and UCB Pharma, Grant/research support from: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Gilead, Janssen, Novartis, Pfizer, Sanofi Regeneron, and UCB Pharma, Koji Kato Shareholder of: Employee of AbbVie and may hold stock or options, Employee of: Employee of AbbVie, Marina Magrey Consultant of: UCB, Novartis, Eli Lilly, Pfizer, and Janssen, Grant/research support from: Amgen, AbbVie, and UCB Pharma, Joseph F. Merola Consultant of: Merck, Bristol-Myers Squibb, AbbVie, Dermavant, Eli Lilly, Novartis, Janssen, UCB, Celgene, Sanofi, Regeneron, Arena, Sun Pharma, Biogen, Pfizer, EMD Sorono, Avotres, and Leo Pharma, Mitsumasa Kishimoto Consultant of: AbbVie, Amgen-Astellas BioPharma, Asahi-Kasei Pharma, Astellas, Ayumi Pharma, BMS, Celgene, Chugai, Daiichi-Sankyo, Eisai, Eli Lilly, Gilead, Janssen, Kyowa Kirin, Novartis, Ono Pharma, Pfizer, Tanabe-Mitsubishi, Teijin Pharma, and UCB Pharma, Derek Haaland Speakers bureau: AbbVie, Amgen, AstraZeneca, Bristol-Myers Squibb, GlaxoSmithKline, Janssen, Novartis, Pfizer, Roche, Sanofi Genzyme, Takeda, Consultant of: AbbVie, Amgen, AstraZeneca, Bristol-Myers Squibb, Eli-Lilly, GlaxoSmithKline, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi Genzyme, Takeda, UCB, Grant/research support from: AbbVie, Adiga Life-Sciences, Amgen, Bristol-Myers Squibb, Can-Fite Biopharma, Celgene, Eli-Lilly, Gilead, GlaxoSmithKline, Janssen, Novartis, Pfizer, Regeneron, Sanofi-Genzyme, UCB, Liang Chen Shareholder of: Employee of AbbVie and may hold stock or options, Employee of: Employee of AbbVie, Yuanyuan Duan Shareholder of: Employee of AbbVie and may hold stock or options, Employee of: Employee of AbbVie, Jianzhong Liu Shareholder of: Employee of AbbVie and may hold stock or options, Employee of: Employee of AbbVie, Ralph Lippe Shareholder of: Employee of AbbVie and may hold stock or options, Employee of: Employee of AbbVie, Peter Wung Shareholder of: Employee of AbbVie and may hold stock or options, Employee of: Employee of AbbVie

OP0024 DIFFERENTIATION BETWEEN IL-6 AND IL-17 PATHWAY INHIBITION IN RELATIONSHIP WITH CLINICAL OUTCOMES IN NON-BIOLOGICAL DMARD-IR AND BIOLOGICAL DMARD-IR PSORIATIC ARTHRITIS PATIENTS TREATED WITH UPADACITINIB IN SELECT-PsA 1 AND SELECT-PsA 2 STUDIES

Background

The differential contribution of IL-6 and IL-17 pathways to the pathogenesis of psoriatic arthritis (PsA) is not fully understood. Upadacitinib (UPA), an oral JAK inhibitor, was more effective than placebo (PBO) in improving key clinical manifestations of PsA in two global phase 3 trials, SELECT-PsA 1 (non-biological DMARD-IR, nbDMARD-IR) and SELECT-PsA 2 (biological DMARD-IR, bDMARD-IR).1,2 Targeted proteomic analysis suggested that UPA modulates multiple biological pathways in innate and adaptive immune systems via direct and indirect inhibition of key regulators, including IL-6 and IL-17 pathways, with a possible shift from Th1 predominance in nbDMARD-IR PsA to a more Th17 bias in bDMARD-IR PsA.3

Objectives

We assessed the relationship between IL-6 and IL-17 pathway modulation and different clinical outcomes after UPA treatment in nbDMARD-IR and bDMARD-IR PsA patients.

Methods

A subset of patients was randomly selected from SELECT-PsA 1 (n=74 of UPA 15 mg QD, n=74 of PBO) and PsA 2 studies (n=90 of UPA 15 mg QD, n=81 of PBO). Serum levels of IL-6, IL-17A, IL-17F, and beta-defensin 2 (BD2) proteins were measured at baseline, week 2, and week 12 by validated immunoassays. The quantitative cytokine measurements were transformed as log10, and PASI score was transformed as log10 (x+1) prior to analysis. A Repeated Measure Mixed Linear Model was used to compare UPA versus PBO treatment effects in overall selected patients and between responders and non-responders defined by PASDAS score ≤ 3.6 (Minimal Disease Activity, MDA)4 and PASI75 at week 12, respectively. The relationships between cytokines and clinical outcomes (PASI and DAS28-CRP) were assessed by Pearson’s correlation at baseline and after treatment.

Results

In nbDMARD-IR PsA patients, baseline IL-17A, IL-17F, and BD2 levels correlated with each other and with PASI, while IL-6 appeared independent from the IL-17 pathway and correlated with DAS28-CRP. At week 12, UPA treatment significantly decreased IL-6 and BD2. The decrease of IL-6 was more pronounced in PASDAS MDA responders and correlated with DAS28-CRP improvement, but the decrease of BD2 was significant in PASI75 responders and correlated with PASI improvement. In contrast, IL-17A and IL-17F were not significantly changed after UPA treatment, neither correlated with clinical outcomes at week 12.

In bDMARD-IR PsA patients, baseline IL-17A level was significantly elevated compared to nbDMARD-IR patients but weakly correlated with other cytokines and show no correlation with PASI. At week 12, the reduction of IL-6 after UPA treatment was not different between responders and non-responders (PASDAS MDA or PASI75) and did not correlate with DAS28-CRP improvement, while the reduction of BD2 remained significant in PASI75 responders and correlated with PASI improvement. Further, UPA treatment significantly reduced IL-17A in PASDAS MDA responders and IL-17F in PASI75 responders compared to non-responders, respectively. The reduction of IL-17F correlated with PASI improvement at week 12.

Conclusion

IL-6 and IL-17 pathway inhibition after UPA treatment showed different profiles in relationship with clinical outcomes in nbDMARD-IR versus bDMARD-IR PsA patients. IL-6 decrease was more pronounced in nbDMARD-IR PsA patients and associated with joint manifestation improvement, while IL-17A and IL-17F decreases were only observed in bDMARD-IR PsA patients and associated with psoriasis improvement. BD2, a biomarker of Th17-associated skin pathology, significantly decreased after UPA treatment in both nbDMARD-IR and bDMARD-IR PsA studies, which likely contributed to UPA effects on psoriasis improvement in a broad range of PsA patients.

References

[1]McInnes IB, et al. N Engl J Med 2021;384:1227-39.

[2]Mease PJ, et al. Ann Rheum Dis 2020;80:312-20.

[3]Sornasse T, et al. Ann Rheum Dis 2021;80:433.

[4]Salaffi F, et al. Biomed Res Int 2014;2014:528105.

Acknowledgements

AbbVie, Inc., in collaboration with the authors, contributed to the study design, data collection and analysis, interpretation of the results, and preparation, review and approval of the final version. No honoraria or payments were made for authorship.

Disclosure of Interests

Fang Cai Shareholder of: AbbVie, Employee of: AbbVie, Thierry Sornasse Shareholder of: AbbVie, Employee of: AbbVie, Melanie Ruzek Shareholder of: AbbVie, Employee of: AbbVie, Yuni Fang Shareholder of: AbbVie, Employee of: AbbVie, Koji Kato Shareholder of: AbbVie, Employee of: AbbVie, Peter Wung Shareholder of: AbbVie, Employee of: AbbVie, Iain McInnes Consultant of: AbbVie, AstraZeneca, BMS, Lilly, Amgen, Causeway, Oxford Biodynamics, Novartis, Janssen, Pfizer, Boehringer, and UCB, Grant/research support from: AbbVie, AstraZeneca, BMS, Lilly, Amgen, Causeway, Oxford Biodynamics, Novartis, Janssen, Pfizer, Boehringer, and UCB.

Ring-opening fluorination of bicyclic azaarenes

We have discovered a ring-opening fluorination of bicyclic azaarenes. Upon treatment of bicyclic azaarenes such as pyrazolo[1,5-a]pyridines with electrophilic fluorinating agents, fluorination of the aromatic ring is followed by a ring-opening reaction. Although this overall transformation can be classified as an electrophilic fluorination of an aromatic ring, it is a novel type of fluorination that results in construction of tertiary carbon-fluorine bonds. The present protocol can be applied to a range of bicyclic azaarenes, tolerating azines and a variety of functional groups. Additionally, mechanistic studies and enantioselective fluorination have been examined.

Inverse Association Between Resting-State Putamen Activity and Iowa Gambling Task Performance in Patients With Obsessive-Compulsive Disorder and Control Subjects

BACKGROUND

Symptoms of obsessive-compulsive disorder (OCD) have been conceptualized as manifestations of decision-making deficits. Patients with OCD exhibit impairment during the decision-making process, as assessed by the Iowa Gambling Task (IGT). This impairment is independent of clinical severity and disease progression. However, the association between the decision-making deficit and resting-state brain activity of patients with OCD has not been examined.

METHODS

Fifty unmedicated patients with OCD and 55 matched control subjects completed IGT. Resting-state brain activity was examined using the fractional amplitude of low-frequency fluctuations (fALFFs). fALFF analysis focused on the slow-4 and 5 bands. Group comparisons were performed to determine the association between IGT performance and fALFFs.

RESULTS

There was a significant group difference in the association between the IGT total net score and slow-4 fALFFs in the left putamen (voxel height threshold of p < 0.001; cluster size threshold of p < 0.05; family wise error-corrected). Higher putamen slow-4 fALFFs were correlated with lower IGT scores for OCD patients (r = -0.485; p < 0.0005) and higher IGT scores for control subjects (r = 0.402; p < 0.005). There was no group difference in the association between the IGT total net score and slow-5 fALFFs.

CONCLUSIONS

These findings in unmedicated patients demonstrate the importance of resting-state putamen activity for decision-making deficit associated with OCD, as measured by IGT. The inverse correlation may be explained by the hypersensitive response of the putamen in patients with OCD.

Increased functional connectivity between presupplementary motor area and inferior frontal gyrus associated with the ability of motor response inhibition in obsessive-compulsive disorder

Recent evidence suggests that presupplementary motor area (pre‐SMA) and inferior frontal gyrus (IFG) play an important role in response inhibition. However, no study has investigated the relationship between these brain networks at resting‐state and response inhibition in obsessive–compulsive disorder (OCD). We performed resting‐state functional magnetic resonance imaging scans and then measured the response inhibition of 41 medication‐free OCD patients and 49 healthy control (HC) participants by using the stop‐signal task outside the scanner. We explored the differences between OCD and HC groups in the functional connectivity of pre‐SMA and IFG associated with the ability of motor response inhibition. OCD patients showed a longer stop‐signal reaction time (SSRT). Compared to HC, OCD patients exhibit different associations between the ability of motor response inhibition and the functional connectivity between pre‐SMA and IFG, inferior parietal lobule, dorsal anterior cingulate cortex, insula, and anterior prefrontal cortex. Additional analysis to investigate the functional connectivity difference from the seed ROIs to the whole brain voxels revealed that, compared to HC, OCD exhibited greater functional connectivity between pre‐SMA and IFG. Also, this functional connectivity was positively correlated with the SSRT score. These results provide additional insight into the characteristics of the resting‐state functional connectivity of the regions belonging to the cortico‐striato‐thalamo‐cortical circuit and the cingulo‐opercular salience network, underlying the impaired motor response inhibition of OCD. In particular, we emphasize the importance of altered functional connectivity between pre‐SMA and IFG for the pathophysiology of motor response inhibition in OCD.

Stepwise Generation of Mono-, Di-, and Triply-Reduced Warped Nanographenes: Charge-Dependent Aromaticity, Surface Nonequivalence, Swing Distortion, and Metal Binding Sites

The stepwise chemical reduction of a molecular warped nanographene (WNG) having a negatively curved π-surface and defined C₈₀ H₃₀ composition with Cs metal used as the reducing and complexing agent allowed the isolation of three different reduced states with one, two, and three electrons added to its π-conjugated system. This provided a unique series of nanosized carbanions with increasing negative charge for in-depth structural analysis of consequences of controlled electron charging of non-planar nanographenes, using X-ray crystallographic and computational tools. The 3D molecular electrostatic potential (MEP) maps identified the negative charge localization at the central part of the WNG surface where selective coordination of Cs⁺ ions is confirmed crystallographically. In-depth theoretical investigation revealed a complex response of the WNG to the stepwise electron acquisition. The extended and contorted π-surface of the WNG undergoes subtle swinging distortions that are accompanied by notable changes in the electronic structure and site-dependent aromaticity of the resulting carbanions.

Early onset of heart failure in Japanese ARVC patients with pathogenic desmosomal gene variants

Background

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited cardiomyopathy mainly caused by desmosomal gene variants. Although there are a lot of reports regarding to European ARVC patients, the ones in Asian are a few, and the characteristics of Asian ARVC have been still unclear. We have reported that the genetic backgrounds in Japanese ARVC patients were different from those in European ones. In this study, we aimed to examine the phenotype and outcome of Japanese ARVC patients with specific genetic backgrounds.

Methods and results

This study included 104 Japanese ARVC patients who were diagnosed as definite in the 2010 Task Force Criteria for ARVC and received genetic analysis (79 males [76%]; median age at diagnosis, 40 years [IQR 22–53 years].) Fifty-seven patients carried variants in desmosomal genes classified as pathogenic based on ACMG guideline: 30 in DSG2 (29%), 22 in PKP2 (21%), 2 in DSC2 (2%) and 3 in DSP (3%). The median age of diagnosis was significantly younger in the patients with the pathogenic variants than in those without (37 years [IQR 21–49 years] vs. 46 years [IQR 34–58 years], P=0.01). During a median follow-up of 9.3 years (IQR 3.5–20.9 years), 10 patients died and 2 were received heart transplantation. Sixty-two suffered lethal arrhythmic events including cardiopulmonary arrest, ventricular fibrillation, sustained ventricular tachycardia and appropriate shocks by implantable cardioverter defibrillator. Twenty-two were hospitalized for heart failure. There was no difference in these events rate between the two groups. However, survival analysis revealed that patients with pathogenic variants hospitalized for heart failure significantly earlier in their life than those without (P=0.04, log-rank test, Figure 1).

Conclusions

The Japanese ARVC patients with pathogenic variants in desmosomal genes are diagnosed and hospitalize for heart failure at younger age than those without. These findings have not been reported in other ethnics. Our study warns that we should be cautious for not only the prevention of lethal arrhythmic events but also the progress of the heart failure in Japanese ARVC patients with pathogenic variants.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): Japan Agency for Medical Research and Development Figure 1

Kissing off the Defeat: Cross-Dressing as the Japanese Postwar Condition in Oitsu Owaretsu

This paper focuses on cross-dressing performances in Yūzō Kawashima's Oitsu Owaretsu (1946), and the postwar socio-political conditions in which the text was released. The film is known for offering the very first kiss scene in a history of Japanese cinema. Produced under the strict censorship by the Occupation force, however, a kiss is not just a kiss, but represents Americanism, masculinity, and heterosexuality. This is significant as a vital postwar concern for Japanese men was how they could regain masculine pride after the emasculation. The male in disguise, therefore, is an abject representation of postwar Japan. In spite of the "feminization" of male characters, a masculine order is restored at the end, with a democratic kiss that makes the protagonist a Westernized hero. Cross-dressing performances function as an initiation rite for the defeated nation, after which Japan can attain a Westernized future and reclaim its masculine national identity.

O-223 Fatty acid supplementation into warming solutions improve the developmental competence of mouse, bovine, and human oocytes and embryos after vitrification

Study question

Does fatty acid (FA) supplementation into vitrification and warming solutions influence the developmental competence of oocyte and embryo after vitrification and warming?

Summary answer

FA supplementation during the warming process improves the developmental competence of vitrified-warmed mouse oocytes and embryonic-morphologies after vitrification at the cleavage-stage in bovines and humans.

What is known already

Vitrified metaphase II stage oocytes exhibit a diminished ability to develop into blastocysts and live births. Previous studies have shown reduction in intracellular lipid content as one of the factors associated with reduced developmental competence of oocytes after vitrification as the intracellular lipid content of oocytes is affected by vitrification. FAs derived from break down of lipids are primarily transferred to the mitochondria, where it plays a crucial role in cellular metabolism. However, the effects of FA supplementation in warming solutions on the cytoplasmic lipid content and subsequent embryo development are unknown.

Study design, size, duration

A chemically defined FA mixture was added to the vitrification and/or warming solutions. Oocytes collected from C57BL6/N (n = 80) were randomly divided into three groups (fresh, n = 634; non-FA (control), n = 961; FA, n = 1,686), and were vitrified-warmed with/without FA. Lipid composition, developmental competence, and gene expression levels were compared among the groups. Bovine embryos (fresh, n = 420; control, n = 524; FA, n = 492) and discarded human day-2 embryos (control, n = 87; FA, n = 92) were used to examine the developmental competence of embryos.

Participants/materials, setting, methods

Lipids in the ooplasm were stained with Nile red and the fluorescence intensity was analysed. The developmental competence of mouse oocytes was examined by performing intracytoplasmic sperm injection. Expressions of FA metabolism-related genes were measured. The bovine embryos were vitrified at the four-cell stage and cultured to the blastocyst stage after warming. Cryopreserved discarded human embryos were warmed and cultured. The obtained blastocysts were then placed on fibronectin-coated dishes to examine the outgrowth formation.

Main results and the role of chance

Lipid content of mouse oocytes was significantly lower in the control group compared to that in the fresh group (P &lt; 0.05). On the contrary, lipid contents of FA and fresh groups were comparable (P = 0.24). Blastocyst formation rate was significantly higher in the FA group than that in the control group (55.7% and 44.8%, respectively; P &lt; 0.05). To examine the optimal timing for FA supplementation, FA was added to the vitrification solution (FAvit), warming solution (FAthaw), and/or both solutions (FAvit-thaw). Blastocyst formation rate was significantly higher in the FAthaw group than that in the control group (59.8% and 50.0%, respectively; P &lt; 0.05). The mRNA expressions of Acaa2 and Hadha in mouse embryos were significantly higher in the FAthaw group compared to that in the control group (P &lt; 0.05). Moreover, FA supplemented warming solutions significantly improved the blastocyst formation rate in bovines (control, 53.5%; FAthaw, 64.5%; P &lt; 0.05). Developmental rate to the expanded blastocyst stage was slightly improved in human embryos (control, 53.7%; FAthaw, 63%; P = 0.38) and the proportion of Grade A in inner cell mass and trophectoderm was significantly higher in the FAthaw group than that in the control group (P &lt; 0.05). There were no differences in the outgrowth abilities between the control and FAthaw groups.

Limitations, reasons for caution

Since the experiments of the current study on human embryos were performed in vitro using discarded embryos, in vivo developmental ability was not evaluated. Therefore, to validate the application of our findings in human assisted reproductive technologies, further clinical trials (ART) are warranted.

Wider implications of the findings

FA supplementation into the warming solutions improved the developmental competence of vitrified–warmed oocytes and cleaved embryos by activating the β-oxidation pathway. These results indicate that FA supplementation into warming solutions is a potential strategy to improve clinical outcomes in human ART.

Trial registration number

not applicable

O-220 An annotation-free embryo scoring system (iDAScore®) based on deep learning shows high performance for pregnancy prediction after single-vitrified blastocyst transfer

Study question

How is the performance of an automated embryo scoring system for pregnancy prediction after single-vitrified blastocyst transfer (SVBT) compared to other, annotation-dependent blastocyst grading systems?

Summary answer

Automatic embryo ranking by iDAScore shows a higher or equal performance, with regards to pregnancy prediction after SVBT, compared to manual, annotation-dependent grading systems.

What is known already

Blastocyst viability can be assessed by blastocyst morphology grades and/or morphokinetic parameters. However, morphological and morphokinetic embryo assessment is prone to both inter- and intra-observer variation. Recently, embryo ranking models have been developed based on artificial intelligence (AI) and deep learning. Such models rank embryos according to their potential for pregnancy only based on images and do not require any user-dependent annotation. So far, no study has independently assessed the performance of AI models compared to other embryo scoring models, including traditional morphological grading.

Study design, size, duration

A total of 3,014 SVBT cycles were retrospectively analysed. Embryos were stratified according to SART age groups. The quality and scoring of embryos were assessed by iDAScore v1.0 (iDAS, Vitrolife, Sweden), KIDScoreTM D5 v3 (KS; Vitrolife), and Gardner criteria. The performance of the pregnancy prediction for each embryo scoring model was compared using the area under curve (AUC) of the receiver operating characteristic curve for each maternal age group.

Participants/materials, setting, methods

Embryos were cultured in the EmbryoScope+ and EmbryoScopeFlex (Vitrolife). iDAS was automatically calculated using the iDAScore model running on the EmbryoViewer (Vitrolife). KS was calculated in EmbryoViewer after annotation of the required parameters. ICM and TE were annotated according to the Gardner criteria. The degree of expansion in all blastocysts was Grade 4 due to our freezing policy. Furthermore, Gardner’s scores were stratified into four grades (Excellent: AA, Good: AB BA, Fair: BB, Poor: others).

Main results and the role of chance

The AUCs of the &lt; 35 years age group (n = 389) for pregnancy prediction were 0.72 for iDAS, 0.66 for KS and 0.64 for Gardner criteria. The AUC of iDAS was significantly higher (P &lt; 0.05) compared to the other two models. For the 35–37 years age group (n = 514) the AUCs were 0.68, 0.68, and 0.65 for iDAS, KS and Gardner, respectively, and were not significantly different. The AUCs of the 38–40 years age group (n = 796) were 0.67 for iDAS, 0.65 for KS and 0.64 for Gardner criteria and where was not significantly different. The AUCs of the 41–42 years age group (n = 636) were 0.66, 0.66, and 0.63 for iDAS, KS and Gardner, respectively, and there was no significant difference among the pregnancy prediction models. For the &gt; 42 years age group (n = 389) AUCs were 0.76 for iDAS, 0.75 for KS and 0.75 for Gardner criteria and not significantly different. Thus, for all age groups, iDAS was either highest or equal to the highest AUC, although a significant difference was only observed for the youngest age group.

Limitations, reasons for caution

In this study, SVBT was performed after minimal stimulation and natural cycle in vitro fertilisation (IVF). Therefore, we had only few cycles with elective blastocyst transfer. However, there was also no bias in selecting the embryos for SVBT.

Wider implications of the findings

Our results showed that objective embryo assessment by a completely automatic and annotation-free model, iDAScore, does perform as good or even better than more traditional embryo assessment or an annotation-dependent ranking tool. iDAS could be an optimal pregnancy prediction model after SVBT, especially in young and advanced age patients.

Trial registration number

not applicable

(9-Isocyanoanthracene)gold(I) Complexes Exhibiting Two Modes of Crystal Jumps by Different Structure Change Mechanisms

The first examples of single crystals exhibiting salient effects by different structure change mechanisms are reported. The crystals of newly prepared aryl(9-isocyanoanthracene)gold(I) complexes jump in response to two different external stimuli: ultraviolet (UV) irradiation and cooling. The photosalient effect is triggered by photodimerization reaction of the anthracene moieties under photoirradiation. By contrast, the thermosalient effect is caused by anisotropic thermal contraction upon cooling without a chemical structure change. By taking advantage of the multiple-jump feature, we also show sequential jumps of crystals by cooling and then UV irradiation for demonstration of the programmed motion of molecular crystals.