Sonographic prediction of successful embryonic implantation in in-vitro fertilization and embryo transfer cycle procedures, using a multi-parameter approach.

INTRODUCTION: The success of in vitro fertilization and embryo transfer (IVF-ET) cycles depend on maternal age, embryo quality and uterine receptivity. Prediction of embryonic implantation prior to IVF has become crucial in counseling patients due to the cost of failed procedure, in terms of huge financial expenditure, time taken for the procedure, associated health risks and psychological effects following unfulfilled expectation. The objective of this study was therefore to develop a scoring protocol and consequently, a predictive model for a successful embryonic implantation in IVF-ET cycles using maternal demographic, endometrial, ovarian, and hormonal parameters as tools for clinical decision and patient counseling. MATERIAL AND METHODS: The body mass index (BMI), age, endometrial pattern and thickness, antral follicle count, (AFC) and anti-Mullerian hormone (AMH) concentration of 295 women between the ages of 18-45 years were evaluated prior to IVF- ET at a fertility clinic in Lagos, Nigeria. The AFC, endometrial pattern and thickness were determined sonographically and the AMH assayed, using ELISA test kits. Multiple regression analysis was used to determine the contribution of each parameter to the likelihood of a successful implantation, and a 4 point rating scale was developed based on the relative contribution of each parameter. Scores were then assigned based on the strength of each predictor variable to implantation rates. RESULTS: Eighteen women that conceived had a full score of 20, while five that failed to conceive scored below 9. Chi square test indicated that endometrial pattern, thickness, age, AFC and AMH are highly significant in predicting embryonic implantation at IVF, while BMI was insignificant (r = -1.831, p = 0.094). CONCLUSION: The prediction model demonstrated a positive correlation between the cumulative score and implantation rate. The use of the scoring system could provide a guide to clinicians to predict the success rate of each IVF-ET procedure prior to commencement of treatment. IMPLICATIONS FOR PRACTICE: The availability of this prediction model provides a counselling tool for physicians to IVF clients which ensures improved confidences level and reduced disappointments from failures in successful implantation and embryonic transfer including its associated financial costs and health risks.

Statistical quantification of hip radiograph assessment using Shenton line femur neck length ratio.

INTRODUCTION: Identification of a poorly positioned hip radiograph often requires a subjective assessment by the radiographer, which, due to the observer dependency of this method, may have conflicting opinions between radiographers. A quantitative approach may be a better personnel independent approach for assessing an optimally positioned hip radiograph. A Shenton line length femur neck length ratio (SLFLR) could be used to achieve this, which is the aim of this study. METHODS: Seventy-three (48 digital and 25 analog) optimally positioned non-pathological hip radiographs of asymptomatic patients aged between 20 and 59 years and reported by the consultant radiologist as normal were conveniently selected. Three different radiographers, each blinded to the results of the other two, measured the Shenton line length and the femur neck length with the aid of flexible and straight meter rules for the analog images and inbuilt electronic calipers for the digital images. Bland-Altman method of agreement was used to assess for reproducibility and reliability of the measurements while the 5th, 25th, 75th, and 95th percentiles of the SLFLR were computed. RESULTS: The mean ± SD SLFLR for both genders were 1.07 ± 0.08 cm (females: 1.06 ± 0.09 and males: 1.08 ± 1.07 cm). The measurements demonstrated high reproducibility and reliability between (interclass correlation coefficient: 0.993) and within (intraclass correlation coefficient: 0.998) radiographers. The 5th, 25th, 75th, and 95th percentile values of the SLFLR are 0.90, 1.03, 1.12, and 1.18. CONCLUSION: For a hip radiograph to be reported as optimal for patients aged 20-59 years, the SLFLR should be between 0.90 and 1.18. This method is highly reproducible and repeatable and could be adopted for quantitative assessment of radiographs. IMPLICATIONS FOR PRACTICE: The SLFLR could be used as an additional tool by the radiographer to quantitatively assess for a well-positioned hip radiograph.

Measuring wall shear stress distribution in the carotid artery in an African population: Computational fluid dynamics versus ultrasound doppler velocimetry.

INTRODUCTION: Computational fluid dynamics (CFD) and ultrasound Doppler velocimetry are diagnostic tools useful for determining carotid artery segments susceptible to atheromatous plaque development. This study computes and compares the difference in Wall Shear Stress (WSS) measurements between these two methods. METHODS: The carotid artery of 204 volunteers selected using simple random sampling were scanned using standard carotid doppler protocols. Four segments of the carotid artery - the common, internal, external carotid, and the carotid bulb were sonographically assessed. The intima-media thickness, diameter, peak systolic velocity, and end-diastolic velocity were measured at a point 2 cm away from the carotid bifurcation for the three segments, while the carotid bulb was measured at the bifurcation. A 2D incompressible Navier-Stokes Equation for modelling Newtonian, pulsatile, and laminar flow in a viscoelastic pipe was applied to model velocity flow across the carotid artery using COMSOL software. WSS values were computed for experimental and CFD measurements and the results were compared. RESULTS: The WSS values generated by the model had respectively peak and average values of 19.81 N/cm2 and 15.76 ± 1.81 N/cm2 for the common carotid, 10.77 N/cm2 and 7.57 ± 1.66 N/cm2 for the internal carotid, 11.51 N/cm2 and 8.05 ± 1.65 N/cm2 for the external carotid, 37.55 N/cm2 and 26.55 ± 6.62 N/cm2 for the carotid bifurcation, 1.39 N/cm2 and 3.13 ± 1.34 N/cm2 for the carotid bulb. The model measurements matched doppler velocimetry measurements with <15% variation. CONCLUSION: Model based WSS values were higher but comparable with doppler velocimetry measurements. The carotid bulb had low WSS and is therefore the segment highly disposed to atheromatous plaque formation. IMPLICATIONS FOR PRACTICE: Subject-specific mathematical models could be incorporated during cardiovascular scan work up for accurate WSS distribution and early prediction of possible atherosclerotic sites.