Attitudes, concerns, and perceptions of patients undergoing fertility treatments in an abortion restrictive state in the aftermath of the Roe v. Wade reversal.

PURPOSE: To investigate the abortion views and reproductive concerns of current in vitro fertilization patients after the US Supreme Court Dobbs v. Jackson decision, which overturned the Roe v. Wade decision guaranteeing abortion access. METHODS: This is a cross-sectional survey of English-speaking patients undergoing in vitro fertilization from January to November 2022 at a large academic institution in a state with restricted abortion care. Participants completed a 43-question electronic survey which measured feelings about abortion, future fertility treatments, and embryo disposition both quantitatively and qualitatively. RESULTS: Of 543 eligible patients, 267 (49%) consented to participate when called and were sent the survey. Of those, 180 (67%) completed it, resulting in a total completion rate of 33%. The majority believe abortion should be legal in the case of birth defects (90.8%) or rape or incest (90.3%). A significant proportion (91.4%) expressed concerns about abortion being illegal in the state that they receive infertility care. They reported some concern about making embryos (89.6%), controlling what happens to them (95.4%), and discarding them (94.4%). Patients wrote about their concerns with pursuing fertility treatments, fear of not having access to needed medical care, and the desire to remain close to states with less restrictive abortion laws. CONCLUSIONS: The evolving political landscape surrounding access to reproductive care has created significant concerns regarding legal regulation of these treatments and the disposition of embryos. By understanding patients' concerns, health care providers can more effectively advocate for the protection of fertility treatments and patients' autonomy in embryo disposition.

A Versatile Nonviral Delivery System for Multiplex Gene-Editing in the Liver.

Recent advances in CRISPR present attractive genome-editing toolsets for therapeutic strategies at the genetic level. Here, a liposome-coated mesoporous silica nanoparticle (lipoMSN) is reported as an effective CRISPR delivery system for multiplex gene-editing in the liver. The MSN provides efficient loading of Cas9 plasmid as well as Cas9 protein/guide RNA ribonucleoprotein complex (RNP), while liposome-coating offers improved serum stability and enhanced cell uptake. Hypothesizing that loss-of-function mutation in the lipid-metabolism-related genes pcsk9, apoc3, and angptl3 would improve cardiovascular health by lowering blood cholesterol and triglycerides, the lipoMSN is used to deliver a combination of RNPs targeting these genes. When targeting a single gene, the lipoMSN achieved a 54% gene-editing efficiency, besting the state-of-art Lipofectamine CRISPRMax. For multiplexing, lipoMSN maintained significant gene-editing at each gene target despite reduced dosage of target-specific RNP. By delivering combinations of targeting RNPs in the same nanoparticle, synergistic effects on lipid metabolism are observed in vitro and vivo. These effects, such as a 50% decrease in serum cholesterol after 4 weeks of post-treatment with lipoMSN carrying both pcsk9 and angptl3-targeted RNPs, could not be reached with a single gene-editing approach. Taken together, this lipoMSN represents a versatile platform for the development of efficient, combinatorial gene-editing therapeutics.

Path to Prevention of Spinal Trauma in a Low- to Middle-income Country: A Single-center Study in Phnom Penh, Cambodia.

This study sought to characterize the epidemiology and outcomes of spinal trauma, with or without a neurologic deficit, at a major government hospital in Phnom Penh, Cambodia. Patient demographics, American Spinal Injury Association (ASIA) score on presentation, location of injury, and cause of injury from 316 patients from September 2013 through December 2016 were compiled. Outcome measures included length of hospitalization and surgical intervention. Falls were the leading cause of spinal injury (50.6%), followed by motor vehicle accidents (29.3%) and other accidents (20.1%). Patients who fell from height had higher surgery rates (P = 0.014), and men had worse ASIA scores (P = 0.0013). Patients with ASIA A-C had a mean age of 38.17 years, whereas the D-E group was on average 42.88 years. Motor vehicle accidents caused the most cervical spine injuries, whereas falls caused more thoracic and lumbar trauma (P = 0.0005). Younger, working men are experiencing more severe spinal injuries, undergoing more surgery, and staying hospitalized longer than other demographics in Phnom Penh. This study characterizes spinal trauma from falls as a public health issue in Cambodia, highlighting the importance of fall injury prevention. Protecting this cohort is an important investment for Cambodia and necessitates workplace reform and safety standard implementation.