Impact of aneuploidy on reproductive success in young infertile women: prospective analysis.

RESEARCH QUESTION: What is the clinical outcome of the first attempt at conception between two embryo selection methods, blastocyst morphology and preimplantation genetic testing for aneuploidies (PGT-A), chosen at the initial physician IVF consultation? DESIGN: In this prospective analysis, a clinical decision regarding embryo selection, blastocyst morphology (group A) or PGT-A (group B) was made during initial physician IVF consultation. Female infertility patients were matched based on maternal age (mean 32.6 ± 3.6 years; range 25-43 years) and a similar time frame of oocyte retrieval. The primary outcome was live birth rate from the initial consultation to the first conception attempt for all female patients and for a subset analysis of patients aged <35 years. RESULTS: The inclusion of PGT-A (group B) for embryo selection during the initial physician IVF consultation resulted in 23 additional women out of the total 100 achieving a healthy live birth following the first conception attempt in this maternally age-matched infertile population (group B = 72.0% versus group A = 49.0%; P = 0.0014). This same benefit was observed for age-matched, younger infertility patients (<35 years), with live birth rates from the initial consultation being significantly higher when the upfront clinical decision included PGT-A for embryo selection (group B = 76.7% versus group A = 53.4%; P = 0.0052). Interestingly, 17 women from group B would have received an aneuploid embryo transfer if selection had been determined by blastocyst morphology alone, as their best-grade embryo was aneuploid. CONCLUSIONS: This prospective analysis from the initial physician IVF consultation revealed that euploid embryo selection significantly improved live birth potential with the first conception attempt, even for younger women with infertility.

Neurosurgery at Baylor Scott & White Health: Recent History and a Decade of Neurosurgery Residency Training.

Neurosurgery at Baylor Scott & White Memorial Hospital in Temple, Texas began as a division in the Department of Surgery many decades ago. The hospital has long served as the flagship tertiary referral center for the Baylor Scott & White healthcare system, which merged in 2013 with Baylor University Medical Center, a hospital system based in Dallas. It is now the largest non-profit hospital system as well as the most awarded hospital system by the US News and World Report within the state of Texas. The Department of Neurosurgery was established at Baylor Scott & White Memorial Hospital in the 2006-2007 academic year. Between then and 2014, four neurosurgeons served as department chair or interim chair: Dr. Robert Buchanan, Dr. Gerhard Friehs, Dr. Ibrahim El Nihum, and Dr. David Garrett Jr. In 2014, Dr. Jason Huang was appointed chairman after a national search and established the neurosurgery residency program in 2015. The department has undergone tremendous growth under the leadership of Dr. Huang, and the residency program is a priority of the department. Surgical excellence is honed at primarily three campuses: Baylor Scott & White Memorial Hospital, Baylor Scott & White McLane Children's Medical Center, and Baylor Scott & White Medical Center - Hillcrest. In this editorial, we provide a brief history of the institution, a recent history of the neurosurgical presence at Baylor Scott & White Memorial Hospital in Temple, Texas, and briefly describe the program's future directions under the continued leadership of Dr. Jason Huang.

Investigating the phylogenetic history of toxin tolerance in mushroom-feeding Drosophila.

Understanding how and when key novel adaptations evolved is a central goal of evolutionary biology. Within the immigrans-tripunctata radiation of Drosophila, many mushroom-feeding species are tolerant of host toxins, such as cyclopeptides, that are lethal to nearly all other eukaryotes. In this study, we used phylogenetic and functional approaches to investigate the evolution of cyclopeptide tolerance in the immigrans-tripunctata radiation of Drosophila. First, we inferred the evolutionary relationships among 48 species in this radiation using 978 single copy orthologs. Our results resolved previous incongruities within species groups across the phylogeny. Second, we expanded on previous studies of toxin tolerance by assaying 16 of these species for tolerance to α-amanitin and found that six of them could develop on diet with toxin. Finally, we asked how α-amanitin tolerance might have evolved across the immigrans-tripunctata radiation, and inferred that toxin tolerance was ancestral in mushroom-feeding Drosophila and subsequently lost multiple times. Our findings expand our understanding of toxin tolerance across the immigrans-tripunctata radiation and emphasize the uniqueness of toxin tolerance in this adaptive radiation and the complexity of biochemical adaptations.

The Genomics Education Partnership: First findings on genomics research in community colleges.

The Genomics Education Partnership (GEP), a consortium of diverse colleges/universities, provides support for integrating genomics research into undergraduate curricula. To increase research opportunities for underrepresented students, GEP is expanding to more community colleges (CC). Genomics research, requiring only a computer with internet access, may be particularly accessible for 2-year institutions with limited research capacity and significant budget constraints. To understand how GEP supports student research at CCs, we analyzed student knowledge and self-reported outcomes. We found that CC student gains are comparable to non-CC student gains, with improvements in attitudes toward science and thriving in science. Our early findings suggest that the GEP model of centralized support with flexible CURE implementation benefits CC students and may help mitigate barriers to implementing research at CCs.

Control of mitochondrial integrity influences oocyte quality during reproductive aging.

Reduced quality in oocytes from women of advanced maternal age (AMA) is associated with dysfunctional mitochondria. The objective of this study was to investigate the mechanisms controlling mitochondrial quality during maternal aging in mouse and human oocytes. We first evaluated the expression of proteins involved in the mitochondrial unfolded protein response (UPRmt) and mitophagy in in vivo matured metaphase II (MII) oocytes collected from young and aged mice. Expression of UPRmt proteins, HSPD1 and LONP1, and mitophagy proteins, total-PRKN and phosphorylated-PRKN, was significantly decreased in aged compared to young oocytes. Treatment of aged oocytes during in vitro maturation with the mitochondrially targeted antioxidant mitoquinone (MQ) specifically restored total-PRKN and phosphorylated-PRKN expression to levels seen in young oocytes. We next investigated whether maturing young oocytes under a high-oxygen environment would mimic the effects observed in oocytes from aged females. Phosphorylated-PRKN expression in oxidatively stressed young oocytes was reduced compared to that in oocytes matured under normal oxygen levels, and the mitochondrial DNA (mtDNA) copy number was increased. Treating oxidatively challenged young oocytes with MQ restored the phosphorylated-PRKN expression and mtDNA copy numbers. Treatment of oxidatively challenged oocytes with MQ also increased the co-localization of mitochondria and lysosomes, suggesting increased mitophagy. These data correlated with the developmental potential of the oocytes, as blastocyst development and hatching of oxidatively stressed oocytes were reduced, while treatment with MQ resulted in a significant increase in blastocyst development and hatching, and in the percentage of inner cell mass. Consistent with our results in mice, MII oocytes from women of AMA exhibited a significant decrease in phosphorylated-PKRN and total-PRKN compared to those of young women. Our findings suggest that the protein machinery to control the health of the mitochondria via UPRmt and mitophagy may be compromised in oocytes from aged females, which may result in inefficient clearance of dysfunctional mitochondria and reduced oocyte quality.

Long-read genome assemblies for the study of chromosome expansion: Drosophila kikkawai, Drosophila takahashii, Drosophila bipectinata, and Drosophila ananassae.

Flow cytometry estimates of genome sizes among species of Drosophila show a 3-fold variation, ranging from ∼127 Mb in Drosophila mercatorum to ∼400 Mb in Drosophila cyrtoloma. However, the assembled portion of the Muller F element (orthologous to the fourth chromosome in Drosophila melanogaster) shows a nearly 14-fold variation in size, ranging from ∼1.3 Mb to >18 Mb. Here, we present chromosome-level long-read genome assemblies for 4 Drosophila species with expanded F elements ranging in size from 2.3 to 20.5 Mb. Each Muller element is present as a single scaffold in each assembly. These assemblies will enable new insights into the evolutionary causes and consequences of chromosome size expansion.

Investigating the phylogenetic history of toxin tolerance in mushroom-feeding Drosophila.

Understanding how and when key novel adaptations evolved is a central goal of evolutionary biology. Within the immigrans-tripunctata radiation of Drosophila , many mushroom-feeding species are tolerant of host toxins, such as cyclopeptides, that are lethal to nearly all other eukaryotes. In this study, we used phylogenetic and functional approaches to investigate the evolution of cyclopeptide tolerance in the immigrans-tripunctata radiation of Drosophila . We first inferred the evolutionary relationships among 48 species in this radiation using 978 single copy orthologs. Our results resolved previous incongruities within species groups across the phylogeny. Second, we expanded on previous studies of toxin tolerance by assaying 16 of these species for tolerance to α-amanitin and found that six of these species could develop on diet with toxin. Third, we examined fly development on a diet containing a natural mix of toxins extracted from the Death Cap Amanita phalloides mushroom. Both tolerant and susceptible species developed on diet with this mix, though tolerant species survived at significantly higher concentrations. Finally, we asked how cyclopeptide tolerance might have evolved across the immigrans-tripunctata radiation and inferred that toxin tolerance was ancestral and subsequently lost multiple times. Our results suggest the evolutionary history of cyclopeptide tolerance is complex, and simply describing this trait as present or absent does not fully capture the occurrence or impact on this adaptive radiation. More broadly, the evolution of novelty can be more complex than previously thought, and that accurate descriptions of such novelties are critical in studies examining their evolution.

Quamdiu? Time to proficiency in endoscope-assisted minimally invasive clot evacuation.

INTRODUCTION: Spontaneous intraparenchymal brain hemorrhages are a devastating disease associated with significant disability or death. Minimally invasive clot evacuation (MICE) techniques can reduce mortality. We reviewed our experience with learning endoscope-assisted MICE to determine whether adequate results could be obtained in less than 10 cases. METHODS: We performed a retrospective chart review of patients undergoing endoscope-assisted MICE at a single institution by a single surgeon from January 1, 2018 to January 1, 2023 using a neuro-endoscope, a commercial clot evacuation device, and frameless stereotaxis. Demographic data was collected along with surgical results and complications. Image analysis using software determined the degree of clot removal. Hospital length of stay and functional outcomes were assessed using the Glasgow Coma Scale score (GCS) and Glasgow Outcome Score (extended) (GOS-E). RESULTS: Eleven patients were identified: average age 60.82 years old, 64 % male, all had hypertension. There was a clear improvement in IPH evacuation over the series. By case #7, greater than 80 % of clot volume was evacuated consistently. All patients remained neurologically stable or improved following surgery. In long-term follow-up, four patients (36.4 %) had good outcomes (GOS-E ≥ 6) and 2 patients had fair outcomes (GOS-E = 4) (18 %). There were no surgical mortalities, re-hemorrhages, or infections. CONCLUSIONS: With an experience of less than 10 cases, it is possible to obtain results comparable to most published series of endoscope-assisted MICE. Benchmarks such as greater than 80 % volume removal, less than 15 mL residual, and 40 % good functional outcomes can be obtained.

Long-read genome assemblies for the study of chromosome expansion: Drosophila kikkawai , Drosophila takahashii , Drosophila bipectinata , and Drosophila ananassae.

Flow cytometry estimates of genome sizes among species of Drosophila show a 3-fold variation, ranging from ∼127 Mb in Drosophila mercatorum to ∼400 Mb in Drosophila cyrtoloma . However, the assembled portion of the Muller F Element (orthologous to the fourth chromosome in Drosophila melanogaster ) shows a nearly 14-fold variation in size, ranging from ∼1.3 Mb to > 18 Mb. Here, we present chromosome-level long read genome assemblies for four Drosophila species with expanded F Elements ranging in size from 2.3 Mb to 20.5 Mb. Each Muller Element is present as a single scaffold in each assembly. These assemblies will enable new insights into the evolutionary causes and consequences of chromosome size expansion.

Early Surgery for Moyamoya Is Not Associated with Worse Outcomes: Analysis of a North American Adult Cohort.

BACKGROUND: Patients with symptomatic moyamoya disease (MMD) or moyamoya syndrome (MMS) are at high risk of recurrent stroke. Surgical revascularization with either direct or indirect superficial temporal artery to middle cerebral artery bypass is a well-accepted treatment. However, the optimal timing and surgical technique for adult patients with MMD or MMS remain unknown. METHODS: We performed a retrospective medical record review of patients who had undergone superficial temporal artery to middle cerebral artery bypass for MMD or MMS from January 1, 2017, to January 1, 2022. The data collected included demographics, comorbidities, complications, as well as angiographic, and clinical outcomes. Early surgery was defined as surgery performed ≤2 weeks of the last stroke and delayed surgery as surgery performed >2 weeks after the last stroke. In the statistical analysis, we compared early versus delayed surgery and direct versus indirect bypass. RESULTS: Nineteen patients had undergone bypass surgery on 24 hemispheres. Of the 24 cases, 10 were early and 14 were delayed. In addition, 17 were direct, and 7 were indirect. No statistically significant difference was found in total complications between the early (3 of 10; 30%) and delayed (3 of 14; 21%; P = 0.67) groups. Five complications occurred in the direct group (5 of 17; 29%) and one in the indirect group (1 of 7; 14%; P = 0.63). No mortalities related to surgery occurred. Angiographic follow-up showed more extensive revascularization after early direct bypass than after delayed indirect bypass. CONCLUSIONS: In our population of North American adults who had undergone surgical revascularization for MMD or MMS, early surgery within 2 weeks of the last stroke did not differ from delayed surgery in terms of complications or clinical outcomes. Early direct bypass showed more revascularization on angiography than did delayed indirect surgery.

The Use of Nursing Theory to Support Sexual and Reproductive Health Care Education in Nursing Curricula.

BACKGROUND: Inclusive sexual and reproductive health care (SRH) content is limited in nursing curricula, resulting in nurses who lack education to provide complex SRH services to marginalized patients, especially sexual and gender minorities (SGM). METHOD: The 10 Caritas Processes, the framework of Watson's Theory of Caring, were evaluated for being integral components of SRH. This theory is used to advocate for SGM-inclusive SRH content in nursing curricula. RESULTS: The interpretation of Caritas Processes 2, 4, and 7 provide theoretical support for SGM-inclusive SRH content. Specific strategies to modify and improve nursing curricula are described. CONCLUSION: There is a need to incorporate inclusive SRH education into nursing curricula to normalize evidence-based SRH for diverse, marginalized patient populations. By emphasizing the caring intentions necessary for nursing professionals, Watson's Theory of Caring is an appropriate framework to guide the development of SGM-relevant SRH content in nursing education. [J Nurs Educ. 2023;62(2):69-74.].

A Systematic Review of the Reported Complications Related to Facial and Upper Extremity Vascularized Composite Allotransplantation.

INTRODUCTION: Twenty three years after the first successful upper extremity transplantation, the role of vascularized composite allotransplantation (VCA) in the world of transplantation remains controversial. Face and upper extremity reconstruction via transplantation have become successful options for highly selected patients with severe tissue and functional deficit when conventional reconstructive options are no longer available. Despite clear benefit in these situations, VCA has a significant potential for complications that are more frequent when compared to visceral organ transplantation. This study intended to perform an updated systematic review on such complications. MATERIALS AND METHODS: MEDLINE database via PubMed, Embase and Cochrane Library were searched. Face and upper extremity VCA performed between 1998 and 2021 were included in the study. Relevant media and press conferences reports were also included. Complications related to face and upper extremity VCA were recorded and reviewed including their clinical characteristics and complications. RESULTS: One hundred fifteen patients underwent facial (43%) or upper extremity (57%) transplantation. Overall, the surgical complication rate was 23%. Acute and chronic rejection was identified in 89% and 11% of patients, respectively. Fifty eight percent of patients experienced opportunistic infection. Impaired glucose metabolism was the most common immunosuppression-related complication other than infection. Nineteen percent of patients ultimately experienced partial or complete allograft loss. CONCLUSIONS: Complications related to VCA are a significant source of morbidity and potential mortality. Incidence of such complications is higher than previously reported and should be strongly emphasized in patient consent process. Strict patient selection criteria, complex preoperative evaluation, consideration of alternatives, and thorough disclosure to patients should be routinely performed prior to VCA indication.

Supporting the democratization of science during a pandemic: genomics Course-based Undergraduate Research Experiences (CUREs) as an effective remote learning strategy.

The initial phase of the COVID-19 pandemic changed the nature of course delivery from largely in-person to exclusively remote, thus disrupting the well-established pedagogy of the Genomics Education Partnership (GEP; https://www.thegep.org). However, our web-based research adapted well to the remote learning environment. As usual, students who engaged in the GEP's Course-based Undergraduate Research Experience (CURE) received digital projects based on genetic information within assembled Drosophila genomes. Adaptations for remote implementation included moving new member faculty training and peer Teaching Assistant office hours from in-person to online. Surprisingly, our faculty membership significantly increased and, hence, the number of supported students. Furthermore, despite the mostly virtual instruction of the 2020-2021 academic year, there was no significant decline in student learning nor attitudes. Based on successfully expanding the GEP CURE within a virtual learning environment, we provide four strategic lessons we infer toward democratizing science education. First, it appears that increasing access to scientific research and professional development opportunities by supporting virtual, cost-free attendance at national conferences attracts more faculty members to educational initiatives. Second, we observed that transitioning new member training to an online platform removed geographical barriers, reducing time and travel demands, and increased access for diverse faculty to join. Third, developing a Virtual Teaching Assistant program increased the availability of peer support, thereby improving the opportunities for student success. Finally, increasing access to web-based technology is critical for providing equitable opportunities for marginalized students to fully participate in research courses. Online CUREs have great potential for democratizing science education.

Evaluating the Impact of Protocol-Driven Treatment for COVID-19 in an Emergency Department Observation Unit.

Background Hospital overcrowding and operating above capacity have occurred frequently throughout the COVID-19 pandemic. Both phenomena can lead to worsened patient outcomes; thus, it is imperative to find solutions that tackle both. Our goal was to create a treatment protocol for a subset of patients with mild to moderate COVID-19 infection that would combat inpatient overcrowding by diverting these patients to an emergency department (ED) observation unit (EDOU). This protocol was based on dynamic treatment guidelines and required regular updates to allow our team to provide the most up-to-date care throughout the pandemic. Methods This study is a retrospective chart review of all adult patients seen at two large suburban EDs for symptoms related to COVID-19 from April 2020 to January 2022. We subsequently identified adult patients who met the criteria for treatment with our COVID-19 protocol and were placed in our observation unit. These patients were identified using a flag for the protocol order set within our electronic medical record. Primary outcomes include the need for hospital admission, bounce back rate, and death rate. Results A total of 2,417 patients were treated in our ED observation units using our COVID-19 protocol. Our study population was evenly divided by gender, while a majority self-identified as white (76%). Five hundred two patients (20.8%) required admission to the hospital, and of these, 55 (11%) patients required intensive care unit (ICU) level of care. A total of 27 (1.1%) patients died. No deaths occurred for patients that remained within our ED observation units. Bounce back rates at the 48-hour, 72-hour, and seven-day marks were 3.6%, 4.6%, and 7.9%, respectively. Finally, we calculated a total of 284 inpatient days saved with the implementation of our protocol. Conclusion This study shows that our newly created protocol is effective in that it reduces the need for inpatient hospital admissions and results in low bounce back rates. Protocol-driven care in ED observation units can be a powerful tool against hospital overcrowding. Creating such protocols offers opportunities for hospital systems to provide efficient care at a significant cost savings without sacrificing quality of care. Our COVID-19 treatment protocol can be replicated by other hospital systems within their own ED observation units should any future similar outbreaks occur.

Twenty Years of Abdominal Wall Allotransplantation: A Systematic Review of the Short- and Long-Term Outcomes.

BACKGROUND: Abdominal wall allotransplantation following intestinal and multivisceral transplant procedures has proven to be successful in achieving adequate closure in patients in whom other techniques have proven inadequate. Thus far, the focus of these abdominal wall allotransplants has been on graft and overall patient survival following surgery and the implementation of immunosuppression. The purpose of this study was to review the outcomes of abdominal wall allotransplantation reported in the literature. METHODS: The PubMed database was queried, and 2595 articles were found. Search criteria used were "abdominal wall transplant" and "abdominal wall allotransplant." Of these, eight met inclusion/exclusion criteria. RESULTS: In the present study, eight publications were identified reporting abdominal wall allotransplants, for a total of 38 full-thickness abdominal wall allotransplantations performed worldwide. All studies reported abdominal wall allotransplantation in combination with visceral organ allotransplantation. Abdominal wall allotransplantations reported thus far have been nonneurotized. Abdominal wall allotransplantations have proven to be beneficial both in terms of abdominal wall closure and acting as a sentinel marker for rejection for underlying visceral organ allotransplantation. The success of abdominal wall allotransplants and their long-term survival has introduced the question of functionality and long-term durability. Cadaveric studies have shown that it is possible to neurotize abdominal wall allotransplants, and future direction toward neurotized abdominal wall allotransplantation requires tools to assess functional outcomes of these transplants. CONCLUSIONS: Abdominal wall allotransplantation is an important reconstructive option when abdominal wall closure is challenging and should be considered in combination with visceral organ allotransplantations. There may be potential benefit in neurotizing the abdominal wall allotransplant for functional use, and future studies should aim to include functional outcomes.

Rethinking Nursing Education and Curriculum Using a Racial Equity Lens.

BACKGROUND: Health educators are called on to dismantle health care inequities as they train future health care clinicians to deliver care that promotes equity, improves access to care, and actively addresses antiracism. METHOD: Through an Advanced Nursing Workforce grant by the Health Resources and Services Administration, a partnership was established with the Institute for Perinatal Quality Improvement to provide training for health care clinicians and students on ways to SPEAK UP against implicit and explicit bias with an emphasis on maternal health. RESULTS: Dismantling racism is a continuous process. Activities included self-reflection, small group meetings, antiracism and bias training, and community engagement. CONCLUSION: Acknowledging that racism and health inequities exist and directly contribute to the rise in maternal and infant mortality is only the beginning. Rethinking nursing education, curriculum, and clinical care to train culturally responsive health care clinicians is required to address systemic and structural racism in health care. [J Nurs Educ. 2022;61(8):493-496.].

Drosophila eugracilis - Akt.

Gene Model for Akt in the D. eugracilis (DeugGB2) assembly (GCA_000236325.2).