Single live birth derived from conjoined oocytes using laser-cutting technique: a case report

Summary The finding of conjoined oocytes is a rare occurrence that accounts for only 0.3% of all human retrieved oocytes. This phenomenon is quite different from that of a traditional single oocyte emanating from one follicle, and may result in dizygotic twins and mosaicism. Given the insufficient evidence on how to approach conjoined oocytes, their fate is variable among different in vitro fertilization (IVF) centres. In this observational report, we propose a new protocol for the use of these conjoined oocytes using intracytoplasmic sperm injection (ICSI), laser-cutting technique and next-generation sequencing (NGS). The first case report demonstrates that conjoined oocytes can penetrate their shared zona pellucida (ZP) at Day 6. The second case is that of a 25-year-old female patient who underwent a successful embryo transfer cycle after removal of one oocyte in which a pair of conjoined human oocytes underwent ICSI, laser-cutting separation and NGS testing. The patient achieved pregnancy and gave birth to single healthy female originally derived from conjoined oocytes. This case provided a means through which normal pregnancy may be achieved from conjoined oocytes using laser-cutting separation techniques. The protocol described may be especially beneficial to patients with a limited number of oocytes.

Safety profile of enhanced thromboprophylaxis strategies for critically ill COVID-19 patients during the first wave of the pandemic: observational report from 28 European intensive care units

Introduction Critical illness from SARS-CoV-2 infection (COVID-19) is associated with a high burden of pulmonary embolism (PE) and thromboembolic events despite standard thromboprophylaxis. Available guidance is discordant, ranging from standard care to the use of therapeutic anticoagulation for enhanced thromboprophylaxis (ET). Local ET protocols have been empirically determined and are generally intermediate between standard prophylaxis and full anticoagulation. Concerns have been raised in regard to the potential risk of haemorrhage associated with therapeutic anticoagulation. This report describes the prevalence and safety of ET strategies in European Intensive Care Unit (ICUs) and their association with outcomes during the first wave of the COVID pandemic, with particular focus on haemorrhagic complications and ICU mortality. Methods Retrospective, observational, multi-centre study including adult critically ill COVID-19 patients. Anonymised data included demographics, clinical characteristics, thromboprophylaxis and/or anticoagulation treatment. Critical haemorrhage was defined as intracranial haemorrhage or bleeding requiring red blood cells transfusion. Survival was collected at ICU discharge. A multivariable mixed effects generalised linear model analysis matched for the propensity for receiving ET was constructed for both ICU mortality and critical haemorrhage. Results A total of 852 (79% male, age 66 [37–85] years) patients were included from 28 ICUs. Median body mass index and ICU length of stay were 27.7 (25.1–30.7) Kg/m2 and 13 (7–22) days, respectively. Thromboembolic events were reported in 146 patients (17.1%), of those 78 (9.2%) were PE. ICU mortality occurred in 335/852 (39.3%) patients. ET was used in 274 (32.1%) patients, and it was independently associated with significant reduction in ICU mortality (log odds = 0.64 [95% CIs 0.18–1.1; p = 0.0069]) but not an increased risk of critical haemorrhage (log odds = 0.187 [95%CI − 0.591 to − 0.964; p = 0.64]). Conclusions In a cohort of critically ill patients with a high prevalence of thromboembolic events, ET was associated with reduced ICU mortality without an increased burden of haemorrhagic complications. This study suggests ET strategies are safe and associated with favourable outcomes. Whilst full anticoagulation has been questioned for prophylaxis in these patients, our results suggest that there may nevertheless be a role for enhanced / intermediate levels of prophylaxis. Clinical trials investigating causal relationship between intermediate thromboprophylaxis and clinical outcomes are urgently needed.

Interplay Between Class II HLA Genotypes and the Microbiome and Immune Phenotypes in Individuals With PTEN Hamartoma Tumor Syndrome

PURPOSE We evaluate potential contributors to the development of autoimmunity and other phenotypes consistent with immune dysregulation in individuals with germline mutations in the tumor suppressor gene PTEN in this observational report. MATERIALS AND METHODS Illumina sequencing of bacterial and fungal microbes was carried out on patient-donated fecal samples in a cohort of 67 patients with pathogenic germline PTEN mutations, including 41 individuals with autoimmunity and/or phenotypes consistent with immune dysregulation (cases) and 26 individuals without (controls). From these data, we measured differences in alpha and beta diversity between cases and controls and identified differentially abundant bacterial and fungal taxa using phyloseq and MicrobiomeSeq packages in R. We analyzed correlations between these taxa and specific HLA genotypes, along with correlations between HLA diversity and microbial diversity, by conducting high-resolution HLA genotyping at four class II loci (DRB1, DRB345, DQA1, and DQB1). RESULTS We found that alpha diversity distributions for both bacterial and fungal genera were statistically different between cases and controls. We identified differentially abundant bacterial and fungal taxa between cases and controls. Network analysis of differentially abundant bacterial taxa revealed some co-varying bacterial genera. We additionally found significant correlations between certain HLA genotypes and certain taxa and significant correlations between HLA diversity and alpha diversity. CONCLUSION PTEN-associated immune phenotypes might be influenced by the gut microbiome, and class II HLA molecules, in part, crosstalk with the gut microbiome. These preliminary observations should lay the groundwork for future studies to ultimately derive clinical measures, which could use gut microbiome and HLA molecule biomarkers to predict, and perhaps prevent, immunity and inflammation in patients predisposed to cancer because of germline PTEN mutations.

Kemampuan Siswa dalam Menyusun Gagasan Utama dan Gagasan Penjelas pada Teks Laporan Hasil Observasi dengan Media Kartu Observasi (Students' Ability to Arrange Main Ideas and Explanatory Ideas in the Text of Observational Report with Card Observation Media)

Penelitian ini bertujuan mendeskripsikan kemampuan siswa dalam menyusun gagasan utama, gagasan penjelas, serta kepaduan antara gagasan utama dengan gagasan penjelas pada teks laporan hasil observasi dengan media kartu observasi. Penelitian ini merupakan penelitian deskriptif yang dilakukan di kelas X MIPA 2 SMAN 7 Malang. Data penelitian ini adalah gagasan utama dan gagasan penjelas yang dituliskan siswa pada kartu observasi. Data dikumpulkan dengan teknik dokumentasi. Analisis data dilakukan terhadap karakteristik bahasa dan hubungan antara gagasan utama dan gagasan penjelas yang disusun siswa. Hasil penelitian menunjukkan bahwa para siswa mampu menyusun gagasan utama dan gagasan penjelas yang saling berhubungan. Gagasan utama telah mencakup informasi inti yang ingin disampaikan, sedangkan gagasan penjelas berisi informasi terperinci yang menjelaskan gagasan utama. Hal itu terbukti dengan persentase siswa yang melebihi KKM, yaitu 87.10% siswa pada kemampuan mengembangkan gagasan utama, 93.55% siswa pada kemampuan mengembangkan gagasan penjelas, dan 87.10% siswa pada kemampuan membentuk kepaduan antara gagasan utama dengan gagasan penjelas. Di sisi lain, terdapat empat siswa (12,90 %) yang skornya sama dengan KKM pada kemampuan mengembangkan gagasan utama. Terdapat dua siswa (6,45 %) yang skornya sama dengan KKM pada kemampuan mengembangkan gagasan penjelas. Pada kemampuan membentuk kepaduan antara gagasan utama dan gagasan penjelas, terdapat 12,90 % siswa yang sama dengan KKM.Kata Kunci: gagasan utama, gagasan penjelas, laporan hasil observasiABSTRACTThis study aims to describe the ability of students to compile main ideas, explanatory ideas, and coherence between the main ideas and explanatory ideas in the text of the observation report with the observation card media. This research is a descriptive study conducted in class X MIPA 2 SMAN 7 Malang. The data of this study are the main ideas and explanatory ideas written by students on the observation card. Data is collected by documentation techniques. Data analysis was carried out on the characteristics of the language and the relationship between the main ideas and explanatory ideas that students composed. The results of the study show that students are able to compile key ideas and explanatory ideas that are interconnected. The main idea includes the core information that you want to convey, while the explanatory idea contains detailed information that explains the main ideas. This is evidenced by the presence of 87.10% of students who score the same as minimum criteria on the ability to develop main ideas, 93.55% of students in the ability to develop explanatory ideas, and 87.10% of students in the ability to form coherence between the main ideas and explanatory ideas. On the other hand, there are four students (12.90%) whose score the same as minimum criteria on the ability to develop the main ideas. There are two students (6.45%) whose score the same as mimimum criteria on the ability to develop explanatory ideas. In the ability to form coherence between main ideas and explanatory ideas, there are 12.90% of students who are the same as mimimum criteria.

Acute Disseminated Encephalomyelitis in COVID-19: presentation of two cases and review of the literature

ABSTRACT Background: Neurological manifestations of COVID-19 are still incompletely understood. Neurological manifestations may be due to direct viral effect on neurons and glial cells, to an immune-mediated response to the virus, or to a hypercoagulable state and associated endothelial damage, as well as to severe systemic disease with prolonged intensive care unit stay. Objective: To describe two patients with severe SARS-CoV-2 infection and delayed recovery of consciousness after sedation withdrawal, in whom MRI disclosed multifocal white matter brain lesions, compatible with the diagnosis of acute disseminated encephalomyelitis. Methods: Observational report of two cases of severe COVID-19 infection in patients from two tertiary hospitals in São Paulo, Brazil. Results: These patients underwent neurologic and systemic evaluation for delayed awakening after sedation withdrawal. MRI displayed multifocal centrum semiovale lesions, suggestive of demyelinating inflammation. Cerebrospinal fluid (CSF) polymerase chain reaction (PCR) for SARS-CoV-2 was negative in both cases. Conclusion: A recurrent pattern of multifocal white matter lesions can occur in COVID-19 patients, possibly associated with delayed awakening. Additional studies are necessary to elucidate the role of the viral infection and of inflammatory and immune-mediated associated changes in neurological manifestations of COVID-19.

DUA POLA PIKIR MATEMATIKA SEBAGAI TEKNIK MENULIS TEKS LAPORAN HASIL OBSERVASI SISWA KELAS IV SDN DUKUH MENANGGAL 1 SURABAYA

Two mathematical mindsets are two of four mathematical midsets what integrated in the technique of writing observational report text. The four mathematical mindset is the one of latest writing technique that was invented by Ayu Utami. This research aims to determine whether or not the influence of two mathematical mindset assisted skill of writing text on observational reports at 4th grade of SDN Dukuh Menanggal 1 Surabaya. Research use quantitative approach with experimental research is quasi experimental posttest-only design. Sampel in this research is student at 4thA grade as control team and 4thB grade as experiment team.T-test shows that the value of t-test count obtained is 9,860, while the t-table value at 5% significance level with degrees of freedom 37 obtained for 2,0262. This indicates that t-test count (10,794) > t-table (2,0262), so that the hypothesis accepted. The conclusion of research is two mathematical mindsets’ technique is influence assisted by skill of writing text on observational reports at 4th grade of SDN Dukuh Menanggal 1 Surabaya.