P–263 Life Whisperer™, an AI-based algorithm to select non invasively best quality blastocysts for transfer: A multicenter analysis

Study question Is the AI-based Life Whisperer™ (LW) tool, suitable to evaluate blastocysts quality and predict clinical pregnancy (CP) in couples undergoing ICSI cycles? Summary answer LW blastocyst score is comparable to the scores of other classification methods. This AI model showed high sensitivity and a comparable specificity for CP. What is known already The morphology grading is the most widely used method for the selection and classification of the embryos in clinical practice.However,this evaluation entails intervariability and intravariability decision among the embryologists.Recently, research has been focused on new embryo selection systems based on computer-assisted evaluation such as time-lapse with complex algorithms that allow the recognition of objective parameters of the embryo morphology.The implementation of these technologies requires substantial investments that are not available for all clinics.LW is a new embryo selection method based on AI,where specific hardware is not needed,as it is based on single blastocyst images taken with a routine microscope. Study design, size, duration Between 2017–2020, a total of 513 Day–5 blastocysts, after ICSI, comming from egg donation treatment were included in this retrospective-multicentre study.Day–5 embryos were evaluated with 3 classification methods:Gardner’s blastocyst grade (GB), the computer derived-output Eeva (EV) and LW AI-supported system. The good quality blastocysts were first evaluated using the GB and EV scores and subsequently compared with the LW scores.The sensitivity and specificity of LW was assessed to validate this system as a clinical pregnancy predictor. Participants/materials, setting, methods A total of 513 Day–5 blastocysts, from 134 oocyte donation cycles, were evaluated first by GB score: expansion (1–6), inner cell mass and throphoectoderm (A-C).EV analyses the cell division timing P2 (2cells stage duration) and P3 (3cells stage duration) differentiating three categories:High,Medium and Low(VerMilyea et al.,2014).LW scores ranked 1–10 from a single Day–5 blastocyst HR Image performed on inverted microscope,with a threshold >5 for defining a viable blastocyst.T-test and ROC-curves were used for statistical analysis. Main results and the role of chance The average of LW score obtained from GB higher blastocyst expansion score (≥4) was 7.48±0.09, while the average of LW score obtained from GB lower blastocyst expansion score (<4) was 4.69±0.3 (P < 0.001). The average of LW score yielded from GB good morphology of Inner Cell Mass and trophoectoderm (AA,AB,BA) was 7.98±0.1 while the average of LW score obtained from GB lower quality blastocyst score (BB,BC,CB,CA,AC) was 6.36±0.156 (P < 0.001).The average of LW score resulted from EV High blastocysts was 7.42±0.17, while the average of this obtained from EV low score was 6.43±0.3 (P = 0.009).A correlation between EV and LW score could be assesed, except for the blastocyst that are considered Medium score from EV. Therefore, a strong correlation between GB and LW system, as well GB+EV and LW, was found and an equivalent usability of the LW tool could be confirmed. The analyse of LW score for transferred embryos (N = 156), using ROC curve, showed a high sensitivity (0,928) but a low specificity (0,154) with a threshold of 5. Regarding our data, ROC curve shows that a threshold of 8,46 could enhance the prediction of CPR because in this point the specifity value is higher than 0.5. Limitations, reasons for caution The LW score validation compared to GB and EV methodology was carried out on a small number of embryos.Additionally,not all embryos had been transferred at the time of the analysis.Thus to enhance the accuracy of these data and the specificity of the clinical prediction, a higher sample size is needed. Wider implications of the findings: Blastocyst selection looks equivalent between all systems,but the LW tool is more objective and faster, saving time and costs significantly, without needing substantial hardware investments. Additionally,the LW-system shows almost the highest sensibility and may also improve the specificity by self-learning feeding the AI-system, thus tailoring predictions to each laboratory unique environment. Trial registration number NA

LYMPHOVENOUS ANASTOMOSIS FOR THE TREATMENT OF LYMPHEDEMA: A SYSTEMATIC REVIEW OF THE LITERATURE AND META-ANALYSIS

Lymphovenous anastomosis (LVA) has been described as an effective treatment for early stages of lymphedema (LE). The aim of this study was to deepen the evaluation of the effectiveness of LVA by performing a meta-analysis to provide information about its utility in specific anatomical sites, clinical stages, duration of lymphedema, and surgical technique. A systematic literature search using PubMed/Medline, Google Scholar, and Cochrane Database was performed in November 2019. Only original studies in which exclusively LVA was performed for primary and/or secondary lymphedema in humans were eligible for data extraction. A meta-analysis was performed on articles with a well-defined endpoint and a subgroup analysis was conducted in relation to surgical technique, duration of lymphedema, stage of pathology. Forty-eight studies, including 6 clinical trials and 42 low-risk bias observational studies were included in our meta-analysis. 1,281 subjects were included and the majority of articles reported a pre-post analysis. Lymphaticovenular anastomosis appears to result effectively in treatment of lymphedema with an odds ratio of 0.07 (CI: 0.04, 0.13, p<0.001). All subgroup meta-analyses were statistically significant for LVAs specifically with regard to anatomical site, clinical stage, duration of LE, or type of microsurgical procedure (p<0.05). Our meta-analysis confirmed the efficacy of LVAs for the treatment of lymphedema, even when subgroup analysis was performed for clinical stage, duration of pathology, anatomical site of lymphedema, or type of microsurgical procedure. Further prospective trials with a common clearly defined outcome measure are warranted for an unbiased evaluation.

Retained placenta and postpartum hemorrhage: time is not everything

Purpose Postpartum hemorrhage is the major cause of maternal mortality worldwide. Retained placenta accounts for nearly 20% of severe cases. We investigated the influence of the time factor and retained placenta etiology on postpartum hemorrhage dynamics. Methods Our retrospective study analyzed a single-center cohort of 296 women with retained placenta. Blood loss was measured using a validated and accurate technique based on calibrated blood collection bags, backed by the post- vs pre-partum decrease in hemoglobin. We evaluated the relationship between these two blood loss parameters and the duration of the third stage of labor using Spearman rank correlation, followed by subgroup analysis stratified by third stage duration and retained placenta etiology. Results Correlation analysis revealed no association between third stage duration and measured blood loss or decrease in hemoglobin. A shorter third stage (< 60 min) was associated with significantly increased uterine atony (p = 0.001) and need for blood transfusion (p = 0.006). Uterine atony was significantly associated with greater decrease in hemoglobin (p < 0.001), higher measured blood loss (p < 0.001), postpartum hemorrhage (p = 0.048), and need for blood transfusion (p < 0.001). Conclusion Postpartum blood loss does not correlate with third stage duration in women with retained placenta. Our results suggest that there is neither a safe time window preceding postpartum hemorrhage, nor justification for an early cut-off for manual removal of the placenta. The prompt detection of uterine atony and immediate prerequisites for manual removal of the placenta are key factors in the management of postpartum hemorrhage.

THE ANALYSIS OF THERMAL FIELDS AT THE PRIMARY STAGE OF THE STEAM-ASSISTED GRAVITY DRAINAGE PROCESS

This article analyzes the temperature distribution in a producer well at the primary stage of the steam-assisted gravity drainage process. The increase in share of hard-to-recover reserves requires using steam-assisted gravity drainage (SAGD). Its successful application, in turn, depends on warming up the inter-well zone, which demands steam circulation in both wells at the primary stage of the process. The duration of this stage affects the transition to oil production and the profitability of the process, which emphasizes the importance of analyzing thermal fields at this stage to assess its duration. The existing research does not allow estimating the temperature in the producer, using the correct formulation of the problem. This paper presents the temperature distribution in a producer for SAGD for classical and chess well patterns for the first time. The aim of the work is to choose a development system for the minimum duration of primary stage of SAGD. For this purpose, the fundamental solution of the non-stationary heat equation for a continuous stationary point source in an unbounded medium is used. The estimation of temperature, at which oil becomes mobile, allows determining the primary stage duration. The authors compare the classical and chess well patterns. In addition, they have obtained the temperature distribution in producer. The results show that classical well pattern provides faster heating of inter-well zone. It is determined that the closest injection well has the greatest influence on the temperature in the producing well.

White Matter Changes, Duration of Hypertension, and Age Are Associated With Cerebral Microbleeds in Hypertensive Patients of Different Stages

Purpose We aimed to investigate risk factors for the presence and number of cerebral microbleeds (CMBs) in patients with different hypertension stages, with an emphasis on the relationship between white matter changes (WMCs) and CMBs.Materials and methods Since 2016, participants aged 40 years or more have been evaluated for the presence of CMBs using enhanced 3D multi-echo GE T2*-weighted angiography (ESWAN) sequences. The Mann-Whitney U test and Pearson χ2 test were used to compare the clinical characteristics between the CMB and no-CMB groups of patients. Furthermore, we used Spearman’s rank correlation analyses to examine the association between the degree of CMB severity and other important factors.Results CMBs were detected in 110 (36.7%) of 300 participants. Among patients with stage 2 hypertension, the majority also had CMBs. CMBs were positively correlated with age, hypertension stage, duration of hypertension, WMCs, and silent cerebral infarction. Patients with grade 3 WMCs were significantly more likely to have CMBs than those without WMCs; this association was true for patients with both stage 1 and stage 2 hypertension. In patients with stage 1 or stage 2 hypertension lasting longer than 20 years, the majority had CMBs.Conclusions CMBs detected in hypertensive patients are more likely to occur in deep structures, and the grade of WMCs and duration of hypertension are more closely associated with the CMB degree than with age.Synopsis: The grade of WMCs and duration of hypertension are more closely associated with the CMB degree than with age.