Embryo quality predictive models based on cumulus cells gene expression

Abstract Since the introduction of in vitro fertilization (IVF) in clinical practice of infertility treatment, the indicators for high quality embryos were investigated. Cumulus cells (CC) have a specific gene expression profile according to the developmental potential of the oocyte they are surrounding, and therefore, specific gene expression could be used as a biomarker. The aim of our study was to combine more than one biomarker to observe improvement in prediction value of embryo development. In this study, 58 CC samples from 17 IVF patients were analyzed. This study was approved by the Republic of Slovenia National Medical Ethics Committee. Gene expression analysis [quantitative real time polymerase chain reaction (qPCR)] for five genes, analyzed according to embryo quality level, was performed. Two prediction models were tested for embryo quality prediction: a binary logistic and a decision tree model. As the main outcome, gene expression levels for five genes were taken and the area under the curve (AUC) for two prediction models were calculated. Among tested genes, AMHR2 and LIF showed significant expression difference between high quality and low quality embryos. These two genes were used for the construction of two prediction models: the binary logistic model yielded an AUC of 0.72 ± 0.08 and the decision tree model yielded an AUC of 0.73 ± 0.03. Two different prediction models yielded similar predictive power to differentiate high and low quality embryos. In terms of eventual clinical decision making, the decision tree model resulted in easy-to-interpret rules that are highly applicable in clinical practice.</jats:p

Utility of venous blood gases for the assessment of traumatic shock: a prospective observational study

BackgroundABG samples are often obtained in trauma patients to assess shock severity. Venous blood gas (VBG) sampling, which is less invasive, has been widely used to assess other forms of shock. The study aim was to determine the agreement between VBG and ABG measurements in trauma.MethodsPatients were enrolled at an Australian trauma centre between October 2016 and October 2018. Bland-Altman limits of agreement (LOA) between paired blood gas samples taken &lt;30 min apart were used to quantify the extent of agreement. The impact of using only VBG measurements was considered using an a priori plan. Cases where venous sampling failed to detect ‘concerning levels’ were flagged using evidence-based cut-offs: pH ≤7.2, base deficit (BD) ≤−6, bicarbonate &lt;21 and lactate ≥4. Case summaries of these patients were assessed by independent trauma clinicians as to whether an ABG would change expected management.ResultsDuring the study period 176 major trauma patients had valid paired blood gas samples available for analysis. The median time difference between paired measurements was 11 min (IQR 6–17). There was a predominance of men (81.8%) and blunt trauma (92.0%). Median Injury Severity Score was 13 (range 1–75) and inpatient mortality was 6.3%. Mean difference (ABG−VBG) and LOA between paired arterial and venous measurements were 0.036 (LOA −0.048 to 0.120) for pH, −1.27 mmol/L (LOA −4.35 to 1.81) for BD, −0.64 mmol/L (LOA −1.86 to 0.57) for lactate and −1.97 mmol/L (LOA −5.49 to 1.55) for bicarbonate. Independent assessment of the VBG ‘false negative’ cases (n=20) suggested an ABG would change circulatory management in two cases.ConclusionsIn trauma patients VBG and ABG parameters displayed suboptimal agreement. However, in cases flagged as VBG ‘false negative’ independent review indicated that the availability of an ABG was unlikely to change management.</jats:sec