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Background: Late gadolinium-enhanced (LGE) MRI has become a widely used technique to non-invasively image the left atrium prior to catheter ablation. However, LGE-MRI images are prone to variable image quality, with quality metrics that do not necessarily correlate to the image's diagnostic quality. In this study, we aimed to define consistent clinically relevant metrics for image and diagnostic quality in 3D LGE-MRI images of the left atrium, have multiple observers assess LGE-MRI image quality to identify key features that measure quality and intra/inter-observer variabilities, and train and test a CNN to assess image quality automatically., Methods: We identified four image quality categories that impact fibrosis assessment in LGE-MRI images and trained individuals to score 50 consecutive pre-ablation atrial fibrillation LGE-MRI scans from the University of Utah hospital image database. The trained individuals then scored 146 additional scans, which were used to train a convolutional neural network (CNN) to assess diagnostic quality., Results: There was excellent agreement among trained observers when scoring LGE-MRI scans, with inter-rater reliability scores ranging from 0.65 to 0.76 for each category. When the quality scores were converted to a binary diagnostic/non-diagnostic, the CNN achieved a sensitivity of 0.80 ± 0.06 and a specificity of 0.56 ± 0.10 ., Conclusion: The use of a training document with reference examples helped raters achieve excellent agreement in their quality scores. The CNN gave a reasonably accurate classification of diagnostic or non-diagnostic 3D LGE-MRI images of the left atrium, despite the use of a relatively small training set., Competing Interests: Declarations. Ethics approval: This retrospective study was approved by the University of Utah Internal Review Board (IRB). Consent to participate: This study was retrospective and was thus conducted on already available MRI data in the University of Utah Hospital database, so no patient consent was necessary. All MRI scans were de-identified. Competing interests: Ravi Ranjan has research grants and/or consults for Biosense Webster (Johnson and Johnson), Abbott (St Jude), Medtronic, and Boston Scientific. Alan Morris has equity interest in Marrek, Inc., which has licensed technologies from the University of Utah for performing 3D LGE-MRI of left atrium and quantification of fibrosis/scar from such scans. Alan Morris also serves as a consultant for Marrek, Inc. Eugene Kholmovski has equity interest in Marrek, Inc., which has licensed technologies from the University of Utah for performing 3D LGE-MRI of left atrium and quantification of fibrosis/scar from such scans. Eugene Kholmovski also serves as a consultant for Marrek, Inc. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Dengue has become an alarming global problem and is endemic in many countries, particularly in tropical and subtropical countries. The aim of this study was to investigate dengue fever outbreak in Banadir Region, Somalia, to understand the risk factors (time, place, personal characteristics)., Methods: A descriptive cross-sectional study was undertaken to determine the levels of circulating anti-dengue virus antibodies and DENV NS1 antigen among Banadir Region residents, while a questionnaire survey was conducted to understand the clinical and demographic characteristics of the patients., Results: A total of 735 febrile patients were studied, with 55.6% men and 44.3% women. The majority of the participants were children aged 14 years and younger. Among them, 10.8% tested positive for IgM antibodies against dengue virus (DENV), while the prevalence of DENV NS1 antigen was 11.8%. Fever and myalgia were the most common symptoms observed in the DENV-positive patients., Conclusions: A dengue fever outbreak has been confirmed in Banadir region, Somalia. This study provides information on the most affected districts and identifies risk factors contributing to DF outbreaks. The study recommends improving outbreak readiness and response, particularly in surveillance and laboratory diagnostics, by fostering intersectoral collaboration and establishing regulatory frameworks for financial and operational participation., (© 2024. The Author(s).)

In several mammals studied, ovulation appears to stimulate coordinated translocation of a few potential fertilizing spermatozoa to the ampulla from the caudal isthmus of the Fallopian tube. The present experiments demonstrate that, in the rat, this movement is regulated to a considerable degree within each duct by the ipsilateral ovary. Unilateral ovariectomy had no effect on ipsilateral sperm transport into the uterus, but this brought a unilateral quenching of sperm transport to the ampulla of the oviduct, from which spermatozoa were often totally or almost absent. This suppression was always complete on the ipsilateral side in unilaterally ovariectomized females anaesthetized with sodium pentobarbital soon after ovulation, and was evident bilaterally also at a highly significant level among intact females that were anaesthetized in this way. Unilateral ovariectomy and sodium barbital anaesthesia could provide experimental situations through which to decipher the mechanisms of normal sperm transport in the Fallopian tube.

A large proportion of patients undergoing in-vitro fertilization (IVF) are aged > or = 35 years. It has been estimated that in this age group, 50% of embryos are chromosomally abnormal, with aneuploidy being the major contributing factor. Since the origin of most aneuploidies is maternal meiosis I non-disjunction, unfertilized oocytes could be safely screened for aneuploidy by analysing their first polar bodies. To determine the feasibility of first polar body aneuploidy analysis, polar bodies were analyzed by fluorescence in-situ hybridization (FISH) using probes simultaneously for chromosomes X, Y, 18, 13/21 or X, Y, 18 and 16. Within 6 h of retrieval, 88% showed a normal segregation involving a single chromosome of each kind, with double-dotted hybridization signals, corresponding to dyads (chromosomes in metaphase I composed of two chromatids). The rest showed non-disjunction of full dyads (6%), or an unbalanced pre-division of dyads (6%), which gives a segregation of one chromatid or one dyad and a chromatid with the first polar body. But only 34% of polar bodies analysed 24 h after retrieval or later showed a normal segregation, with most of the other polar bodies showing balanced pre-division, with two separated hybridization signals for all the chromosomes analysed. The rates of non-disjunction and unbalanced pre-division after > or = 24 h in culture were similar to the rates in fresh oocytes. When both types of aneuploidy were considered together, an increase of aneuploidy with maternal age was detected, which although slight, was significant (P = 0.025).(ABSTRACT TRUNCATED AT 250 WORDS)

Objective: Our purpose was to determine the feasibility of ascertaining aneuploidy for chromosomes X, Y, 18, and 16 by use of multiple-probe fluorescence in situ hybridization in blastomeres from preimplantation human embryos., Study Design: A short fluorescence in situ hybridization procedure involving the simultaneous use of four deoxyribonucleic acid probes detected with red, green, blue, or a mixture of red and green fluorochromes was developed to determine numeric abnormalities of chromosomes X, Y, 18, and 16. Embryos underwent biopsy, and all or most cells were analyzed to distinguish true aneuploidy from mosaicism and to assess technique variations within the same embryo (n = 64)., Results: The analysis of all the blastomeres of an embryo was achieved in 91% of the embryos. Successful analyses including biopsy, fixation, and fluorescence in situ hybridization were achieved in 87.8% of the blastomeres. Of the four chromosomes tested, numeric aberrations were found in 23% and 42% of normally and abnormally developing embryos, respectively, including aneuploidy, polyploidy, haploidy, and mosaicism. When diploid embryos containing one or several tetraploid cells are counted as chromosomally abnormal, then 49% and 61% of normally and abnormally developing embryos, respectively, were chromosomally abnormal. Aneuploid embryos consisted of two monosomies for chromosome 16, one for chromosome 18, and a trisomy for chromosome 16. There was a tendency for aneuploidy to increase with maternal age., Conclusions: Fluorescence in situ hybridization is a more efficient method than cytogenetic analysis to study specific aneuploidies at preimplantation stages of development in human embryos. In addition, the preimplantation genetic diagnosis of two blastomeres per eight-cell embryo may be sufficient to ensure successful analysis of polyploidy, haploidy, and specific aneuploidies without endangering the survival of the embryo. The technique can be easily modified to consider other chromosomes, including 13 and 21. Because most chromosomally abnormal embryos do not develop to term, the use of this technique may increase the delivery rate per embryo by allowing only transfer of embryos normal for the tested chromosomes. This technique would be most useful for older women undergoing in vitro fertilization, because aneuploidy appears to increase with advancing maternal age.

Uni-pronuclear embryos (n = 42) were analysed by fluorescence in-situ hybridization (FISH) with two to four chromosome pair-specific probes. Half of these embryos resulted from conventional insemination and half from intracytoplasmic sperm injection (ICSI). The majority of uni-pronuclear embryos from conventional insemination were normally diploid (61.9%) whereas only 9.5% of uni-pronuclear ICSI embryos (P < 0.001) were diploid. In addition, a significantly higher number of uni-pronuclear embryos from conventional insemination had a Y chromosome (10/21, 47.6%) when compared with ICSI embryos (2/21, 9.5%) (P = 0.015). It is concluded that the majority of uni-pronuclear embryos following regular in-vitro fertilization are fertilized, whereas those from ICSI are parthenogenetically activated. The latter embryos should not be considered for embryo replacement.

Objective: Chlamydia trachomatis infections of the female genital tract, although a major cause of infertility, are often asymptomatic and undetected. Since many infertile women now seek in vitro fertilization, a procedure whereby fertilization and embryo implantation are precisely timed, we sought to determine the relation between an unsuspected C. trachomatis infection and the ability of embryos to implant and develop after their transfer to the uterus., Study Design: At the time of oocyte aspiration, endocervical samples were obtained from 216 women and assayed by enzyme-linked immunoassay for immunoglobulin A antibodies to C. trachomatis structural membrane components and to recombinant C. trachomatis heat shock protein. The presence of C. trachomatis in the cervices was assessed by the polymerase chain reaction. The outcome of each in vitro fertilization cycle was then ascertained., Results: Oocytes from 198 (91.7%) of the women were fertilized in vitro and subsequently transferred to the uterus. Term deliveries of healthy infants occurred after 68 (34.3%) of these transfers. Cervical immunoglobulin A antibodies to chlamydial heat shock protein were detected in 5 (7.3%) of the women with term births, and 1 (1.5%) also had immunoglobulin A antibody to chlamydial structural components; 3 (4.4%) were positive by the polymerase chain reaction for C. trachomatis. In contrast, among the 130 women whose embryo transfers did not result in an ongoing pregnancy, 36 (27.7%) had cervical antiheat shock protein immunoglobulin A (p = 0.0007) and 24 (18.5%) had antichlamydial structural component immunoglobulin A (p = 0.0002); 15 (11.5%) of these women had positive results of polymerase chain reaction for C. trachomatis. The majority of women with cervical antibodies to chlamydial structural antigens were also positive for antibody to heat shock protein. However, only 35% of the women with antibodies to heat shock protein were also positive for the other chlamydial antibodies. C. trachomatis was detected by polymerase chain reaction in 29.2% of women with anti-C. trachomatis antibodies and 7.8% of women with anti-heat shock protein antibodies. Women positive for antichlamydial immunoglobulin A were more likely to be undergoing a repeat in vitro fertilization cycle than were women who were antibody negative (p = 0.007)., Conclusion: Unsuspected C. trachomatis infection or reactivation of an immune response to the C. trachomatis heat shock protein may induce an inflammatory reaction in the uterus that impairs embryo implantation and/or facilitates immune rejection after uterine transfer of in vitro fertilized embryos.

Objective: Our objective was to analyze the risk factors, stimulation characteristics, and future fecundity of patients with ectopic pregnancies after in vitro fertilization (IVF)., Methods: We retrospectively evaluated all cases of ectopic pregnancy occurring between January 1989 and March 1993 (Cornell series 1 to 17). A case-control group of intrauterine pregnancies was used for comparison of the stimulation and transfer characteristics., Results: Twenty-seven of 1123 pregnancies (2.4%) were ectopic, following 2812 fresh IVF embryo transfers, while 8 of 105 pregnancies (7.6%) were ectopic, following 405 frozen-thawed embryo transfers. Tubal factor was the cause of infertility in the majority (85.7%) of ectopic pregnancies. No difference was found between the ectopics and the matched controls in stimulation and transfer characteristics. Thirty ectopic pregnancies were ampullary, two were interstitial, two were cervical, and one was heterotopic. Twenty of the patients subsequently underwent 29 IVF attempts, with a pregnancy rate of 41.4% per transfer., Conclusions: Ectopic pregnancy after IVF appears to be related to preexisting tubal pathology; embryo transfer of cryopreserved thawed embryos in a natural cycle may result in a higher ectopic rate in these patients; in subsequent IVF cycles the intrauterine pregnancy rate of these patients is not decreased.

This is a report of a 34-year-old patient with a 3-year history of unexplained infertility, who conceived after IVF-ET. Her serum P levels were < 2.0 ng/mL (conversion factor to SI unit, 3.180) between 5 and 6 weeks of gestation. She subsequently delivered a viable infant at term.

In this series 40 patients presenting for HSG had cervical stenosis impeding cervical cannulation with an acorn tip catheter. Successful cervical cannulation was obtained in all instances, using a modified tom cat catheter as described. Successful visualization of the uterine cavity was achieved in all 40 patients.