Should there be an "AI" in TEAM? Embryologists selection of high implantation potential embryos improves with the aid of an artificial intelligence algorithm.

PURPOSE: A deep learning artificial intelligence (AI) algorithm has been demonstrated to outperform embryologists in identifying euploid embryos destined to implant with an accuracy of 75.3% (1). Our aim was to evaluate the performance of highly trained embryologists in selecting top quality day 5 euploid blastocysts with and without the aid of a deep learning algorithm. MATERIALS AND METHODS: A non-overlapping series of 200 sets of day 5 euploid embryo images with known implantation outcomes was distributed to 17 highly trained embryologists. One embryo in each set was known to have implanted and one failed implantation. They were asked to select which embryo to transfer from each set. The same 200 sets of embryos, with indication of which embryo in each set had been identified by the algorithm as more likely to implant was then distributed. Chi-squared, t-test, and receiver operating curves were performed to compare the embryologist performeance with and without AI. RESULTS: Fourteen embryologists completed both assessments. Embryologists provided with AI results selected successfully implanted embryos in 73.6% of cases compared to 65.5% for those selected using visual assessments alone (p < 0.001). All embryologists improved in their ability to select embryos with the aid of the AI algorithm with a mean percent improvement of 11.1% (range 1.4% to 15.5%). There were no differences in degree of improvement by embryologist level of experience (junior, intermediate, senior). CONCLUSIONS: The incorporation of an AI framework for blastocyst selection enhanced the performance of trained embryologists in identifying PGT-A euploid embryos destined to implant.

The impact of male factor infertility on early and late morphokinetic parameters: a retrospective analysis of 4126 time-lapse monitored embryos.

STUDY QUESTION: Is there an effect of male factor infertility (MFI) on either early or late morphokinetic parameters obtained during embryonic culture to blastocyst stage in a time-lapse imaging (TLI) incubator? SUMMARY ANSWER: Neither mild nor severe MFI had an impact on overall time to blastocyst or duration of individual cleavage stages in the total embryo population. WHAT IS KNOWN ALREADY: Prior studies have suggested that paternal DNA and sperm quality affect embryo morphokinetic parameters, but the impact of MFI is not fully understood. STUDY DESIGN, SIZE, DURATION: This retrospective cohort study, at a major academic fertility centre, included 536 couples (women, ≤44 years of age) undergoing IVF between September 2013 and September 2016. PARTICIPANTS/MATERIALS, SETTING, METHODS: Data from 4126 embryos cultured to the blastocyst stage in a TLI-monitored incubator were retrospectively reviewed. Embryos derived from the sperm of men with MFI were compared with those derived from patients with other infertility diagnoses. Generalized fixed and random effects models, t-test and χ2 were used as appropriate. MAIN RESULTS AND THE ROLE OF CHANCE: Couples with MFI had a higher rate of ICSI utilization and fewer usable embryos on average, and the men were older compared with couples with other diagnoses. Additionally, the women in MFI couples were younger and had higher antral follicle counts (AFCs) and higher anti-Müllerian hormone (AMH) levels compared with the other women undergoing IVF. When controlling for maternal and paternal ages, AMH and fertilization method (conventional IVF versus ICSI), neither mild nor severe MFI affected duration of individual cleavage stages or overall time to the blastocyst stage, when all or only usable embryos were examined (coefficient 0.44 hours in all embryos, P = 0.57; coefficient 0.39 hours in usable embryos, P = 0.60). Whether the sperm was surgically extracted similarly had no significant effect on embryo morphokinetic parameters. When the fertilization method was assessed independently, ICSI lengthened the overall time to blastocyst stage by 1.66 hours (P = 0.03) on average, primarily due to an increase in duration of the time from 5-cell embryo stage to early blastulation (P5SB). LIMITATIONS, REASONS FOR CAUTION: This large cohort study avoided embryo selection bias due to random assignment of embryos to the TLI incubators. However, our findings may not be generalizable to groups under-represented in our clinic population. Future studies should also evaluate the impact of male hormonal status and detailed sperm morphology, such as head versus flagellum defects, on embryo morphokinetic development. WIDER IMPLICATIONS OF THE FINDINGS: Our findings suggest that the fertilization method rather than MFI per se impacts time to early blastulation. The clinical implications of this effect on embryo development warrant further investigation. STUDY FUNDING/COMPETING INTEREST(S): There were no sources of funding for this study. There are no competing interests. TRIAL REGISTRATION NUMBER: N/A.

Correction to: Abstracts : 31st European Congress of Pathology.

The name of the co-author of E-PS-07-008 (page S294) was presented as 'S. Despina' instead of 'D. Sgouridi' in the authorship group The name has been corrected in the authorship group shown above.

Bilesional serpiginous cutaneous ectoparasitosis in a Greek grazier.

A Balkan case of paucilesional truncal autochthonous hookworm-related cutaneous larva migrans contracted during winter in a cowman, successfully treated by 10% albendazole topical preparation.

The effect of day 2 versus day 3 embryo transfer on early pregnancy outcomes in women with a low yield of fertilized oocytes.

PURPOSE: To evaluate the differences in implantation and pregnancy rates when embryo transfer occurs on D2 versus D3 in women with a low yield of fertilized oocytes. METHODS: A total of 156 IVF/ICSI cycles from 141 women at an academic fertility center were analyzed in a retrospective fashion. Women with a low number of fertilized oocytes (≤ 2 two pronuclei (2PN) stage zygotes) who had their fresh embryo transfer on D2 or D3 were included in the study. Positive pregnancy test per IVF cycle (PPT), clinical pregnancy rate (CPR), spontaneous abortion rate (SABR), and implantation rate (IMPR) were the main outcome measures assessed. Mann-Whitney U test and χ2 test were used as appropriate. A generalized linear mixed effect model adjusted for relevant covariates was conducted. P < 0.05 was considered significant. RESULTS: Patients having their embryo transfer on D2, when compared to those who had a D3 embryo transfer, experienced similar PPT [30.8 vs. 28.2%, respectively; adjusted OR (95%CI): 0.49 (0.16, 1.52)], CPR [26.9 vs. 25.6%, respectively; adjusted OR (95%CI): 0.44 (0.12, 1.67)], and IMPR [17.3 vs. 16.7%, respectively; adjusted ß (95%CI) - 5.6% (- 15.0, 3.9)]. CONCLUSION: Our findings suggest that transferring embryos on D2 versus D3 in women with a limited number of 2PN stage zygotes does not affect early pregnancy outcomes. These results indicate that there can be some flexibility in scheduling the day of transfer at the convenience of both the patient and the center.

Device-associated infections in the intensive care units of Cyprus: results of the first national incidence study.

BACKGROUND: Surveillance of healthcare-associated infections (HCAIs) has become an integral part of infection control programs in several countries, especially in the intensive care unit (ICU) setting. In contrast, surveillance data on the epidemiology of ICU-acquired infections in Cyprus are limited. The aim of this study was to assess the risk of ICU-acquired infections and to identify areas for improvement in Cypriot hospitals by comparing observed incidence rates with international benchmarks and by specifying the microbiological and antibiotic resistance profiles of infecting organisms. MATERIALS AND METHODS: An active surveillance protocol was introduced in the ICUs of the four major public hospitals in Cyprus, based on the methodology of the US National Nosocomial Infections Surveillance system. RESULTS: During February to December 2007, 2,692 patients who were hospitalized in ICUs for a mean length of stay of 5 days acquired 214 infections for an overall incidence rate of 15.8 infections per 1,000 patient-days [95% confidence interval (CI): 13.8-18.1]. Bloodstream infections, pneumonias and urinary tract infections accounted for 80.4% of all infections; of these, 87.8% were device-related. Central line-associated bloodstream infection (CL-BSI) posed the greatest risk (18.6 cases per 1,000 central line-days; 95% CI 14.9-22.9), followed by ventilator-associated pneumonia (VAP) (6.4 cases per 1,000 ventilator-days; 95% CI 4.5-8.8) and catheter-associated urinary tract infection (2.8 cases per 1,000 urinary catheter-days; 95% CI 1.9-4.1). Most frequently isolated pathogens included Pseudomonas aeruginosa (21.6% of all isolates), coagulase-negative Staphylococcus (11.7%), Enterococcus spp. (11.3%) and Staphylococcus aureus (9.2%). Overall, 29.8% of P. aeruginosa isolates were imipenem-resistant and 68.2% of S. aureus were methicillin-resistant. The crude excess mortality rate associated with ICU-acquired infections was 33.2% (95% CI 24.9-41.9%) and the mean post-infection stay in the ICUs was 21.6 days (95% CI 17.0-26.2). CONCLUSION: In comparison to international benchmarks, the markedly high rate of CL-BSI, the high rate of VAP and the resistance patterns of major infecting pathogens identified in this study emphasize the need to improve current practices for appropriate use and management of invasive devices in Cypriot ICUs.

Factors affecting chromatin stability of bovine spermatozoa.

The structural stability of transcriptionally inert paternal chromatin is of vital importance for the fertilization process and early embryonic development. Accordingly, a series of eight experiments were conducted during a 7-month period to investigate: (1) effects of bull breed, individuality, successive ejaculations, semen quality characteristics (SQC), semen dilution rates and hypothermic storage of semen in a Tris-egg yolk extender on incidence of sperm nuclear chromatin instability (NCI), and (2) effects of the interaction between variation of NCI within a frozen ejaculate and variation of oocytes quality due to maturation time and/or season on the efficiency of in vitro embryo production (IVEP). Semen samples were collected once a week from six bulls using an AV and only ejaculates (n=220) of >0.30x10(9) sperm/ml and >or=60% motility were used. NCI was measured by: (1) detection of lysine-rich histones in sperm chromatin using aniline blue staining, (2) sperm susceptibility to acid-induced nuclear DNA denaturation in situ using acridine orange test, and (3) sperm susceptibility to nuclear chromatin decondensation (NCD). Bovine oocytes (n=695) were matured in vitro for 18 or 24 h, fertilized after sperm selection through a swim-up procedure and cultured for 72 h. The results showed that the 2nd ejaculates were superior to the 1st ones with respect to chromatin stability. Dilution of semen to 49.67+/-8.56x10(6) sperm/ml (1:19) decreased resistance of sperm to NCD. Cooling of semen had no significant effect on chromatin stability. Cryopreservation of semen augmented sperm vulnerability to DNA denaturation. Improvement of SQC (semen volume, sperm motility, velocity, viability and morphological normalcy) was generally concomitant with increase of sperm resistance to NCI. While Blonde d'Aquitaine bulls had a resistance to NCD higher than Limousine bulls in fresh semen, the former showed a greater susceptibility to DNA denaturation than the latter in cooled semen. Individuality significantly influenced NCI. The variability of NCI within a frozen ejaculate affected efficiency of IVEP. Significant negative correlations were observed between incidence of NCI and both fertilization rate and developmental capacity of embryos after maturation of oocytes for 18 h. The significant variation in IVEP traits due to season was independent of the effect of sperm chromatin instability.

[Determination of effectiveness of FMD vaccine type Asia 1 in neutralization tests in cattle]. / Wirksamkeitsbestimmung von MKS-Vakzine Typ Asia 1 im Neutralisationstest bei Rindern.

On June 20th 1984 FMD type ASIA 1 appeared in two herds of cattle for the first time in Europe (Greece). All affected and suspected cattle (1200) were killed on July 4th to 13th 1984. Blood samples of 125 of these animals were collected and examined by neutralisation test. All susceptible animals in this area as well as of buffer zone were vaccinated against ASIA 1 (from FAO, produced by IFFA Merieux). In three weeks after this first vaccination blood samples from 148 animals were collected, examined and the results of the neutralisation test were correlated with the effectiveness of the vaccine. 17.2% from these animals have been found to have neutralisation titers less than 1.2.

[Epizootiology of foot and mouth disease during a quarter century (1962-1988) in Greece]. / Epizootiologie der Maul- und Klauenseuche während eines Vierteljahrhunderts (1962-1988) in Griechenland.

Greece has been considered as free from FMD since 1984. During the years 1962-1988 29 primary and 240 secondary (totally 269) outbreaks had appeared in Greece. From these 187 were of Type O, 60 of Type A, 14 of Type C, 6 of Type SAT 1 and 2 of Type ASIA 1. From the 269 cases 81 appeared in Attiki, 57 in Evros (near the Turkey) and 131 in the other provinces. With reference to animal species 197 were in cattle, 60 in pigs and 12 in sheep and goats. Most of the 29 primary outbreaks appeared in January and none in December. According to the epizootiological results FMD seems to be introduced in Greece either by imported meat and meat products (especially in Attiki) or from the neighbour Turkey (especially in Evros), where the disease is enzootic. Because of the geographical position of Greece it seems very important for all EEC countries that the FMD-Institute in Athens as well as the State Veterinary Service in Evros should be better organised so that any zoonoses from Asia could be controlled without delay.

[Detection of neutralizing antibodies in calves after single vaccination against foot-and-mouth disease virus type ASIA 1 in the field]. / Nachweis von neutralisierenden Antikörpern bei Kälbern nach einmaliger Vakzination gegen MKS-Typ ASIA 1 in der Praxis.

On June 20th 1984 appeared the first FMD-Type ASIA 1 outbreak in Greece. Around the outbreak all susceptible animals were vaccinated with ASIA 1 vaccine produced by IFFA Mereiux. Three weeks after this first vaccination blood samples have been collected and examined for neutralizing antibodies. From 101 examined calves 37 were younger than 6 months, 63 between 6-11 months and one was 12 months old. The titer of the first group was less than 1.2 in 14 and greater than 1.8 in 8 calves. By the second group (63 animals) the titer was less than 1.2 in 28 and greater than 1.8 in 11 calves. The 12 months old calf had a titer of 2.1. Generally the titer only of 59 out of the 101 examined calves was greater than or equal to 1.2 (59%). That means that the vaccine used had a weak immunogenicity.

[Laboratory diagnosis of foot-and-mouth disease and swine vesicular disease in the years 1962-1988 in Greece]. / Labordiagnose der Maul- und Klauenseuche und Swine Vesicular Disease in den Jahren 1962-1988 in Griechenland.

During 26 years (1962-1988) 499 samples from FMD-suspicious cases were examined in Greece. These materials came from 348 (70%) cattle, 95 (19%) pigs and 56 (11%) sheep and goats. The cattle with 197 (72.4%) positive cases seems to play the most important roll in FMD. The different isolated virus types belonged in 60 cases to type A, in 187 to type O, in 14 to type C, in 6 to type SAT 1 and in 2 cases to type ASIA 1, respectively. SVD was isolated in 3 cases from the same area and at the same time. Most samples have been examined by means of CF, cell culture, unweaned mice or by a combined way of these assays. From 363 samples have examined: A) 148 by CF, B) 32 by CF and cell culture, C) 64 by CF and baby mice D) 80 by CF, cell culture baby mice E) 8 by cell culture, F) 18 in cell culture and baby mice and G) 13 by baby mice. Form these samples were found positive in the case A) 74 (50%), E) 3 (38%) and none in case G. On the other hand, the correlation of the positive samples in combined assays were in case B) 9:21, C) 9:1, D) 8:22:16 and the case F) 3:2 respectively. The D case shows that CF detected less positive cases than the cell culture did. For a reliable labor diagnosis of FMD every sample must be examined by more than one method.