O-065 The effect of double vitrification on embryo reproductive potential and clinical outcome

Study question

Do double-vitrified embryos have impaired implantation potential compared to embryos vitrified once?

Summary answer

Double-vitrified embryos demonstrated significantly lower percentages of positive β-HCG, clinical pregnancy (CPR) and live birth (LBR) compared to embryos vitrified once.

What is known already

Since vitrification became a core player in ART, many clinics adopted a freeze-all strategy, including vitrification of more than one embryo per vitrification device. Nowadays, the guidelines’ suggestion for single embryo transfers often results in a surplus of good quality embryos post warming which are re-vitrified to avoid embryo wastage. Thus, transfers of double-vitrified embryos have been performed worldwide, leading to successful pregnancies. It remains yet to be answered whether embryos after double vitrification exhibit the same reproductive performance as embryos vitrified once. By now, limited studies including various cryopreservation methods show relatively conflicting results.

Study design, size, duration

This retrospective cohort study was conducted in Embryolab Fertility Clinic, Greece. Assisted reproductive cycles included in the study were performed from January 2015 to December 2020. Both PGT cycles and cryopreserved oocyte cycles were excluded. The mean women age was 32.8 years old (±5.9) in the study group and 33 (±5.9) in the control group. There was no variation in the cryopreservation methods used, since all embryos were cryopreserved by the same vitrification protocol.

Participants/materials, setting, methods

For the present study, 233 embryo transfers of 334 double-vitrified embryos (309 blastocysts/25 cleavage embryos) and 172 transfers of 260 embryos vitrified once (246 blastocysts/14 cleavage) were analyzed to explore the impact of double vitrification on positive β-HCG, CPR, LBR and miscarriage rate. Moreover, the performance of embryos that were cultured for at least 24 hours before re-vitrification was compared to embryos warmed and re-vitrified on the same day, for the same parameters mentioned above.

Main results and the role of chance

All embryos survived vitrification (100% survival rate) in both study and control group. An alpha level of .05 was used for all statistical tests. Results showed that positive β-HCG percentage was significantly lower in the double vitrification group (45.1% for double -vitrified embryos -study group-, 57.0% for embryos vitrified once -control group-, p=.02), as well as CPR (28.3% in study group - 42.4% in control group, p=.003) and LBR (26.6% in study group - 40.4% in control group, p=.004). The miscarriage rate did not significantly differ between two groups (35% in study group - 25% in control group, p=.121). Moreover, positive β-HCG percentage was significantly higher in transfers with embryos that were cultured at least 24 hours before re-vitrification (group A: 48.9%), compared to embryos that were warmed and re-vitrified on the same day (group B: 30.6%, p=.02). Interestingly, although CPR (31% in group A, 18.4% in group B, p=.08), LBR (29.4% in group A, 16.3% in group B, p=.06) and miscarriage rate (35.6% in group A, 33% in group B, p=.87) were not significantly different between these groups, there was a tendency for rates to be higher in group A compared to group B.

Limitations, reasons for caution

This is a retrospective study, including transfers of embryos of different stage (day 2 – day 5). However, the control group was matched to the study group, in terms of embryo stage. The number of previous treatments per couple was not included in the study.

Wider implications of the findings

Although double-vitrified embryos can lead to successful pregnancies, our results showed an adverse effect of double vitrification on embryo reproductive potential. To avoid lower pregnancy rates, culture of embryos until day 5 and cryopreservation of one embryo per vitrification device should be considered.

Trial registration number

not applicabe

Effectiveness and safety of apremilast in biologic-naïve patients with moderate psoriasis treated in routine clinical practice in Greece: the APRAISAL study

BACKGROUND

Apremilast is an oral phosphodiesterase-4 inhibitor indicated for patients with moderate-to-severe chronic plaque psoriasis and active psoriatic arthritis.

OBJECTIVES

To examine the effectiveness of apremilast on Dermatology Life Quality Index (DLQI), Psoriasis Area and Severity Index (PASI) and nail, scalp and palmoplantar involvement, when administered prior to biologics.

METHODS

This 52-week real-world study included biologic-naive adults with moderate psoriasis (psoriasis-involved body surface area 10% to <20%, or PASI 10 to <20 and DLQI 10 to <20). Apremilast was initiated ≤7 days before enrolment. Data from the first 100 eligible patients who completed 24 weeks (W24) of observation (or were prematurely withdrawn) are presented in this interim analysis using the last-observation-carried-forward imputation method.

RESULTS

Eligible patients (mean age: 49.9 years; 71.0% males; median disease duration: 8.0 years) were consecutively enrolled between April and October 2017, by 18 dermatology specialists practising in hospital outpatient settings in Greece. Baseline DLQI (median: 12.0) and PASI (median: 11.7) scores improved (P < 0.001) at all postbaseline timepoints (Weeks 6, 16 and 24; W24 median decreases: 9.0 and 9.4 points respectively). At W24, DLQI ≤5, DLQI 0 or 1, and PASI-75 response rates were 63.0%, 25.0% and 48.0% respectively. The Nail Psoriasis Severity Index score in patients with baseline nail involvement (n = 57) decreased at all postbaseline timepoints (P < 0.001; W24 median decrease: 20.0 points). At W24, 50.0% and 51.7% of patients with baseline scalp (n = 76) and palmoplantar (n = 29) involvement respectively achieved postbaseline Physician's Global Assessment (PGA) score of 0 or 1 if baseline score was ≥3, or 0 if baseline score was 1 or 2. The adverse drug reaction rate was 21.0% (serious: 2.0%).

CONCLUSIONS

These interim results indicate that through 24 weeks, apremilast improved quality of life and reduced disease severity in biologic-naive patients with moderate plaque psoriasis, while demonstrating safety consistent with the known safety profile.

The clinical significance of an incidentally detected open internal inguinal ring

INTRODUCTION AND OBJECTIVE

An open internal inguinal ring (IIR) may be discovered incidentally either in the context of correcting pathology involving the contralateral side or at the time of surgical exploration for reasons unrelated to a patent processus vaginalis (PPV). The aim of this study is to determine the evolution of an incidentally encountered open IIR in patients undergoing laparoscopy for reasons not associated with unilateral inguinal hernia or cryptorchidism.

MATERIALS AND METHODS

The authors conducted a prospective study of all patients who underwent laparoscopic surgery in the department of pediatric surgery at Agios Loukas hospital between 2004 and 2013 for various indications. Patients operated for inguinal hernia and cryptorchidism were excluded. During this period, 572 patients underwent laparoscopy for reasons not related to PPV. The median age at time of initial laparoscopy was 9,4 years (range 2 days-16 years). The IIRs were always inspected. No attempt was made to repair the open IIRs, as they were asymptomatic. Parents were informed after the operation, and instructions were given to inform us, in case that inguinal hernia symptoms manifested. The duration of the follow-up was 4 years.

RESULTS

Among these 572 patients, 39 patients with 44 open IIRs were found (6,82%). From the 39 patients, 35 were male and four were female; 22 had a right open IIR, 12 had a left one, and five of them a bilateral open IIR. The median age was 7,82 years (3-14 years). Four patients were lost during follow-up. Of the remaining 35 patients with 40 open IIRs, four developed an inguinal hernia (11,43%) and were operated on with laparoscopically assisted (subcutaneous endoscopically assisted ligation [SEAL]) technique at the time of diagnosis. The study results are demonstrated on Fig. 1.

DISCUSSION

The percentage of an incidentally discovered open IIR in this study is lower in comparison with studies including patients with PPV pathologies. There is a possibility, in those patients, of underlying pathology which can affect both sides. It is also lower in comparison with previous studies including younger patients. However, gender and side predominance is in accordance with most published studies. In this study group, the possibility of developing a symptomatic hernia from an asymptomatic open IIR is rather small.

CONCLUSIONS

An incidentally discovered open IIR in patients without symptoms, excluding those with contralateral inguinal hernias or cryptorchidism, has relatively low chance of developing an inguinal hernia. Thus, the authors support the strategy of close follow-up in these patients.

Perspectives for integrated municipal solid waste management in Thessaloniki, Greece

Local authorities need updated and reliable data on the quantity and the quality of the waste generated in their area, in order to establish an integrated solid waste management system capable of fulfilling regional and national waste management targets. This paper presents information about the quantity and the characteristics of the municipal solid waste generated in Thessaloniki, which is the second largest city in Greece. It is based on the results of three research programs investigating the evolution of municipal solid waste. The investigations were carried out over the last 20 years at the landfill of Thessaloniki by the same research group using statistically acceptable practices for sampling and hand sorting. The results show a great increase in the incoming quantities during the last years and a significant increase of the per capita generation. There is also a significant change in the composition, demonstrated mainly by a decrease in the organic fraction followed by an increase of packaging materials (paper and plastic).

Cutaneous alternariosis revealing acute myeloid leukaemia in an adult patient. Fallbericht. Hautalternariose als Indikator einer akuten myeloischen Leukamie bei einem Erwachsenen

We report a case of cutaneous alternariosis in a 69-year-old male patient. During hospitalization for treatment of the skin disorder, acute myeloid leukaemia was diagnosed. He received multiple chemotherapeutic agents but the leukaemia remained refractory to therapy and the patient died. The clinical picture, diagnosis and treatment of cutaneous alternariosis will be discussed and a review of the literature regarding patients with haematological diseases will be given.

Langerhans’ cell histiocytosis and haemophagocytic lymphohistiocytosis in an elderly patient

We present a case of a 78-year-old man suffering from a chronic psoriasiform eruption, with rapid deterioration over the previous 8 weeks. Langerhans' cell histiocytosis with skin and bone involvement was diagnosed, and there was evidence of liver and lung dysfunction. The patient was treated with prednisolone and etoposide, and initially experienced a partial improvement. Three weeks later, haemophagocytic lymphohistiocytosis and subsequently a large pulmonary abscess with sepsis attributed to opportunistic gram-negative enterobacteriaceae Serratia marcescens developed, and the patient died. The present case of Langerhans' cell histiocytosis is of particular interest because of the previously unreported development of haemophagocytic lymphohistiocytosis in the elderly population.

Ultrasonography of the pancreas, as a function index, in children with beta-thalassemia

Increased echogenicity of the pancreas, due to hemosiderosis, is a frequent laboratory finding in children and adolescents with beta-thalassemia. The aim of this study was to investigate whether increased echogenicity of the pancreas is associated with dysfunction. The ultrasonic image of the pancreas was examined in 34 children aged 12+/-3.8 years old and was compared to the endocrine and exocrine functioning of the gland. Oral glucose tolerance test (OGTT) was performed with simultaneous measurement of insulin and serum trypsin. Twenty-six of the 34 patients (76.5%) presented increased echogenicity, while 8 (23.5%) had a normal ultrasonic pancreatic image. 77% of the patients with increased echogenicity had abnormal OGTT, 46%, with subnormal or increased insulin values, and 32.5% manifested low levels of trypsin. Among the patients with normal ultrasound, 25% had abnormal OGTT and 37.5% abnormal insulin values. Statistical analysis with Student's t-test revealed that patients with increased echogenicity had significantly higher glucose values on OGTT at 60: 7.6 +/- 1.8 mmol/l (137.3 +/- 33.7 mg/dl) as compared to the patients with normal ultrasound: 6.1 +/- 1.2 mmol/l (110.75 +/- 21.72 mg/dl) (p<0.05). Insulin values were significantly affected at 30, 60, and 90 min: 570+/-301, 332+/-156, 294+/-158 pmol/l (79.54 +/- 42, 46.4 +/- 21.8, 41.04 +/- 22 mU/l) respectively in patients with increased echogenicity in comparison to those with normal ultrasonographic image of the gland: 301 +/- 170, 192 +/- 52, 135 +/- 63 pmol/l (42 +/- 23.7, 26.85 +/- 7.36, 18.9 +/- 8.8 mU/l) (p<0.05). No statistical significance was observed between the two groups regarding trypsin levels, even though abnormal values were observed in more children with increased echogenicity than in patients with a normal ultrasound. The above findings confirm that increased echogenicity of the pancreas is associated with disturbance of its function. This simple imaging method could be used as a rough early index of detection of an increased risk for developing diabetes mellitus in patients with beta-thalassemia.

[Anatomic anomalies of P. Robin syndrome and therapeutic management]

The authors present their experience in the treatment of the Pierre Robin Syndrome in 32 cases. The purpose of this anatomical and clinical study is to guide and codify the surgical treatment of this malformation.

Mycosis fungoides: expression of C-myc p62 p53, bcl-2 and PCNA proteins and absence of association with Epstein-Barr virus

The expression of C-myc p62, bcl-2, p53, PCNA and EBV-encoded LMP-1 proteins was studied by immunohistochemistry on paraffin-embedded skin specimens from 14 patients with early stage (premycotic erythema and second stage plaques) mycosis fungoides (MF), 21 patients with advanced stage MF (third stage plaques and tumors), 3 patients with Sezary's syndrome (SS) and 3 patients with pleomorphic medium and large cell cutaneous T-cell lymphomas (PML-CTCL). All 41 cases were also screened for the presence of EBV by using RNA in situ hybridization with EBER 1/2 oligonucleotides. Increased expression of C-myc p62, p53 and PCNA proteins was found in PML-CTCL and advanced stages of MF as compared to early stages of MF. These results suggest a relationship between levels of C-myc p62, p53 and PCNA proteins and aggressiveness of the cutaneous T-cell lymphomas. Furthermore, C-myc p62 and bcl-2 proteins were found to be frequently coexpressed in the present series. In view of the background information from in vitro findings and animal models that cooperation of C-myc and bcl-2 is important for lymphomagenesis, our results suggest that coexpression of these oncogenes may be implicated in the pathogenesis and/or the progression of cutaneous T-cell lymphomas. Neither LMP-1 expression nor EBV EBER l/2 transcripts were detected in our series suggesting that EBV is not involved in the pathogenesis of cutaneous T-cell lymphomas.