Search Results (486)

Introduction: In patients with conductive and mixed hearing loss, implantable hearing devices such as active middle ear implants (AMEIs) and bone conduction implants (BCIs) are established alternatives when conventional hearing aids fail. Although bone conduction (BC) thresholds are routinely used as eligibility criteria, their role as frequency-specific predictors of postoperative functional outcomes remains poorly defined. This study aimed to evaluate the influence of preoperative BC thresholds across the audiometric spectrum on postoperative speech recognition outcomes after implantation with AMEIs and BCIs. Methods: A retrospective observational study was conducted at a tertiary referral center including patients implanted with BCIs or AMEIs. Pre- and postoperative audiological data were analyzed, including air and bone conduction thresholds, frequency-segmented BC measures (low, mid, and high frequencies), cochlear frequency gradient (ΔBC Slope), and speech recognition scores (SRSs) at 65 dB HL one year after implantation. Results: 102 patients were included (50 BCI, 52 AMEI). Both implant types achieved significant postoperative improvements in tonal thresholds and SRS compared with pre-implantation values (all p < 0.001). High-frequency BC thresholds (BC-High, 4–6 kHz) showed a significant inverse correlation with postoperative SRS in both BCI (r = −0.382, p = 0.001) and AMEI users (r = −0.398, p < 0.001), and emerged as the only independent predictor in multivariable models (BCI: β = −0.533, p = 0.022; AMEI: β = −0.491, p = 0.020). Low- and mid-frequency BC measures were not associated with postoperative speech outcomes (all p > 0.05). ROC analyses demonstrated excellent discriminative performance of BC-High for identifying suboptimal outcomes, with area under the curve values of 0.92 for BCI (p = 0.001) and 0.94 for AMEI (p = 0.002), and implant-specific cutoff values of >47 dB HL and >61 dB HL, respectively. Conclusions: High-frequency BC thresholds showed the strongest association with postoperative speech recognition after implantable hearing rehabilitation. BC-High could function as a prognostic marker of functional outcome rather than an eligibility criterion, providing clinically meaningful information to refine preoperative counseling and individualized decision-making within current indication frameworks. Full article

Background and aim: Hemoglobinopathies have become an important public health problem due to global migration. The aim of this project was to address the problem of hemoglobinopathy among immigrants living in Türkiye, Spain, and Italy, in addition to training health managers and Syrian family physicians at immigrant health centers in the southeastern provinces of Türkiye. Material and methods: A three-year international project, named EQUALITY PLUS, was supported by the European Union Erasmus Project. We planned transnational meetings (TPM), vocational education meetings (VET), and Practical Implementation Meetings (PIEM) for the education program. Results: Four TPMs were held in Türkiye, Spain, and Italy, involving a total of 49 professionals. Two VETs were held in Spain and Italy. A total of 23 professionals attended both VETs. Six PIEMs were held in the southern and southeastern Turkish provinces, such as Adana Mersin, Hatay, Gaziantep, Kilis, and Sanliurfa. A total of 442 people, including 373 Syrian family physicians and 69 provincial health managers, were educated in six provinces in Türkiye. Discussion: While the immigrants to Italy and Spain come mainly from Central and North West African maritime routes, immigrants to Türkiye predominantly come from Syria. Among a total of 4 million Syrian immigrants to Türkiye, 200.000 were found to be carriers of thalassemia. In the refugee camps where Syrian immigrants live, the fertility rate is high and the number of sick newborns is increasing, and birth control, genetic counseling, and prenatal diagnosis methods are not sufficient. This project was intended to serve as a guide to prevent hemoglobinopathy in Syrian immigrants. Further projects are needed to address the fertility rate and increased number of sick newborns in these refugee camps. Family physicians at migrant health centers received training on the prevention of hemoglobinopathies. This training included providing detailed genetic counseling to families and providing prenatal diagnosis and preimplantation genetic diagnosis opportunities. Because of the major earthquake that occurred in this region after the project, the work could not continue and preliminary data could not be obtained. Public health services will follow the results of project and the registered number of sick newborns with hemoglobinopathies. Full article

Background/Objectives: Dynamic remodeling of the zona pellucida (ZP) is a fundamental biochemical and structural process during human preimplantation development; however, its quantitative characterization and clinical relevance remain incompletely defined. The objective of this study was to evaluate dynamic ZP thinning as a functional marker of embryo developmental competence and to examine its relationship with follicular fluid (FF) biomarkers and clinical pregnancy. Methods: This prospective observational study included 47 IVF cycles performed at a single center, yielding 64 transferred blastocysts with complete time-lapse data. ZP thickness was measured from fertilization to 120 h post-fertilization using time-lapse imaging. Two quantitative parameters were derived: the relative thinning ratio (Δrel) and the linear thinning rate (slope). FF concentrations of growth differentiation factor 9 (GDF-9), hyaluronic acid (HA), and syndecan-4 (Syn4) were quantified by ELISA. Embryo-level associations with spontaneous blastocyst hatching were assessed using logistic regression and multivariate analyses, while patient-level models evaluated predictors of clinical pregnancy. Results: Embryos that underwent spontaneous hatching exhibited significantly greater Δrel than non-hatching embryos (p < 0.001). Δrel remained the strongest predictor of hatching in multivariable models (AUC = 0.91). Among FF biomarkers, only GDF-9 showed a positive association with spontaneous hatching. At the patient level, higher Δrel values of transferred embryos were associated with clinical pregnancy (OR 3.65, p = 0.009), whereas FF biomarkers and assisted hatching showed no significant association. Conclusions: Dynamic ZP thinning quantified by Δrel represents a promising indicator of embryo developmental competence. The concordance between embryo-level hatching behavior and patient-level clinical pregnancy suggests potential clinical relevance of ZP dynamics as an integrative embryological marker, warranting validation in larger cohorts. Full article

Short Interspersed Elements (SINEs) are eukaryotic non-autonomous retrotransposons that rely on RNA polymerase III (pol III) for transcription. A subset of mammalian SINEs—designated T⁺ SINEs—harbors a canonical polyadenylation signal (AATAAA), a pol III terminator, and an A-rich tail at their 3′ end, thereby acquiring the unusual ability to undergo AAUAAA-dependent polyadenylation. Here, we delineate the genomic architecture, evolutionary history, and polyadenylation behavior of the C SINE family in Lagomorpha. Comprehensive bioinformatics searches identified 1.2–1.6 million C copies distributed across Leporidae (hares and rabbits) and Ochotonidae (pikas) genomes. Phylogenetic reconstruction resolved two diverged leporid subfamilies, C1 and C2, with C1 predating C2 and comprising five-fold more copies. Only C1 qualifies as a T⁺ SINE, retaining functional or rudimentary AATAAA motifs and pol III terminators. In contrast, C2 is absent from pika genomes, yet remains retrotranspositionally competent in hares and rabbits. Lineage-specific analyses further reveal episodic activity of certain C1 variants throughout the last 10 million years of pika evolution. Functional assays in transfected HeLa cells demonstrate that AATAAA and an upstream polypyrimidine tract constitute the minimal cis-determinant for efficient C1 transcript polyadenylation. Finally, transcriptome profiling of pre-implantation rabbit embryos indicates that pol III-driven SINE C transcription is activated at the 16-cell stage. Full article

The formation and expansion capacity of blastocysts plays a very important role in successful implantation. During mammalian embryo development derived from in vitro production (IVP), early embryos are highly susceptible to various cellular stresses, including endoplasmic reticulum (ER) stress, which has been identified in IVP embryos, suggesting that ER stress modulation is crucial for IVP embryo development. In this study, we aimed to evaluate the influences of ER stress on preimplantation embryos during blastocyst formation and expansion potential in pigs. Tunicamycin (TM), an ER stress inducer, was employed in porcine embryos, significantly increasing the mRNA levels of ER stress-related markers ATF6, CHOP, and GRP78. When one-cell embryos were cultured in the presence of TM, the blastocyst formation and diameter (reflecting the blastocyst expansion capacity) were significantly inhibited in a dose-dependent manner. When morula-stage porcine embryos were cultured in TM, the blastocyst formation rate, blastocyst diameter, total cells and EdU-positive cell numbers were significantly lower than the TM-free control group. TM reduced the potential of blastocoel recovery (ex-expansion) in blastocysts collapsed by cytochalasin D and impeded blastocyst expansion. In addition, TM reduced the mRNA levels of CDH1 and TJP1 and affected the normal expression pattern of E-cadherin, Oct4, Sox2 and Cdx2 in porcine blastocysts. Taken together, these findings suggest that TM treatment during embryo development in vitro interferes with the formation and expansion capacity of the blastocoel in pigs. Full article

Background: Occipital nerve stimulation (ONS) is an effective therapy for patients with refractory chronic cluster headache (rCCH); however, it is not without complications, and to date, there are no conclusive findings regarding factors that would allow the prediction of treatment response. The primary objective of this study is to identify such factors to improve patient selection. Methods: This single-center prospective observational study will be conducted at the Department of Neurology, Hospital Universitario La Paz (Madrid, Spain). Given the low prevalence of rCCH, a convenience sampling approach will be adopted, with an expected enrollment of a minimum of 15 patients over 24 months of the study. The study is structured into three periods: Pre-ONS (pre-implantation), ONS (implantation), and Post-ONS (follow-up at 12 months). During the pre-implantation phase, patients will undergo a multidimensional assessment encompassing structural 3T brain magnetic resonance imaging (MRI), blood analysis (calcitonin gene-related peptide (CGRP), pituitary adenylate cyclase-activating peptide 38 (PACAP38), and vasoactive intestinal peptide (VIP)), neuropsychological evaluation, auditory evoked potentials, algometry (pressure pain threshold, temporal summation, conditioned pain modulation), and transcutaneous electrical nerve stimulation (TENS). Follow-up visits will be conducted at 3, 6, and 12 months post-implantation. Results: This study aims to identify biomarkers or their combinations capable of reliably predicting patients who would benefit from ONS. Conclusions: Through this multidimensional assessment, this study seeks to identify predictive factors of response to ONS, thereby improving patient selection, optimizing healthcare resources, and advancing the understanding of treatment response mechanisms. Full article

Human preimplantation embryo arrest (PREMBA) represents a significant clinical hurdle in assisted reproductive technology (ART), in which approximately 10% of in vitro fertilized (IVF) embryos arrest at the cleavage stages. Whole-exome sequencing (WES) studies have discovered numerous genetic mutations associated with preimplantation embryo arrest. These mutations often disrupt critical biological milestones such as maternal mRNA clearance (BTG4, ZFP36L2, ZAR1), subcortical maternal complex (TLE6, PADI6, OOEP, NLRP2, NLRP5, NLRP7, KHDC3L), DNA double-strand break formation and homologous recombination (REC114, TOP6BL, MEI1, MEI4, TRIP13), spindle assembly (TUBB8 and TUBA4A) and cell cycle and checkpoints (FBXO43, MOS, CHEK1, TRIP13, CDC20), as well as nuclear transport and translational regulation (KPNA7, DDOST). However, the cause of most clinical cases remains genetically unexplained. Studies investigating these unexplained arrests have uncovered widespread multi-omics abnormalities, including transcriptional arrest, DNA hypermethylation, higher chromatin accessibility, aberrant histone modification, chromosomal aneuploidy and senescent-like states. This review provides a comprehensive overview of the molecular mechanisms underlying PREMBA, categorized into those that are attributable to known genetic mutations and those with unexplained reasons. Full article

Oxygen (O₂) tension is a critical factor influencing in vitro development of pre-implantation embryos. The in vivo environment has lower O₂ tension (2–10%) than atmospheric air (~20%), along the female reproductive tract, from the oviducts (8–10%) to the uterus (2–5%), supporting development of early-stage embryos. As the female reproductive tract is inherently hypoxic, replicating low-O₂ conditions in vitro may enhance embryo development. In contrast, culturing embryos under non-physiological O₂ tension may impair stress adaptation and reduce developmental competence. Optimal O₂ tension likely varies with species and embryo stage, suggesting a single uniform O₂ tension throughout in vitro culture may not be ideal; conditions beneficial at one stage may be detrimental at another. Although atmospheric O₂ harms embryo development and redox balance, specific advantages of low (5%) or ultra-low (≤2%) O₂ remain uncertain, despite many studies documenting improved development under hypoxia. This review examines the current literature on effects of atmospheric, low, and ultra-low O₂ tension during in vitro embryo culture, emphasizing impacts on in vitro fertilization (IVF) outcomes, and the regulation of transcription and epigenomics during pre-implantation embryo development. Full article

Background: Advanced paternal age is increasingly encountered in assisted reproduction as parenthood is deferred. The clinical question is whether paternal age from about 40 to 45 years and older affects embryo development or outcomes, and to what extent any effect relates to the sperm epigenome. Methods: This narrative review synthesized PubMed-indexed evidence on sperm aging biology, including DNA methylation, chromatin packaging and nucleosome retention, small non-coding RNAs, telomere dynamics, DNA fragmentation, and oxidative and mitochondrial stress, and their potential clinical impact on assisted reproduction outcomes. Results: Maternal age remains the principal determinant of embryo aneuploidy. After multivariable adjustment, independent paternal-age effects on fertilization, blastocyst formation, and preimplantation genetic testing for aneuploidy are small or not detected. At very advanced paternal ages near or above 50 years, some studies report higher miscarriage and lower live birth, without a consistent change in early embryo morphology. Aging in men is linked to higher DNA fragmentation and oxidative and mitochondrial signatures, together with reproducible sperm-epigenome changes, including age-linked DNA methylation, altered histone retention, and small-RNA shifts. These molecular findings support modest intergenerational influences on early development, while stable transgenerational inheritance in humans is not supported. Conclusions: Advanced paternal age should be regarded as a risk modifier rather than a primary driver of preimplantation failure. Counseling should emphasize realistic effect sizes and the predominance of maternal age. Laboratory workflows should minimize oxidative stress. Selective DNA-fragmentation testing may be appropriate in recurrent ART failure or recurrent loss. Sperm-epigenome assays remain investigational and should undergo prospective, standardized validation before use in routine care. Full article

Spinocerebellar ataxia type 2 (SCA2) is an autosomal dominant neurodegenerative disorder caused by a pathogenic CAG trinucleotide repeat expansion in the ATXN2 gene. At-risk couples can embark on unaffected pregnancies through preimplantation genetic testing of monogenic disorders (PGT-M) of SCA2, which should involve accurate repeat expansion detection together with risk haplotype tracking using informative linked markers. Two couples underwent SCA2 PGT-M involving analysis of whole genome amplified embryonic trophectoderm cells by ATXN2 (CAG)n triplet-primed PCR (TP-PCR) and linkage-based risk allele genotyping using customized markers. To simplify and expedite the identification of informative markers for future PGT-M cases, putative microsatellite markers closely linked to ATXN2 were initially screened for polymorphism using a small set of anonymous DNA samples obtained from Coriell Cell Repository. Shortlisted markers with high polymorphism likelihood were then multiplexed in a single-tube reaction and genotyped on 190 anonymous DNA samples to determine their polymorphic information content. Across both SCA2 PGT-M clinical cases, the linked marker genotypes corroborated the TP-PCR results, allowing clear differentiation between unaffected and affected embryos. In both cases, transfer of an unaffected embryo led to a successful pregnancy and live birth of a healthy baby. In silico mining, filtering, and curation identified 287 microsatellites located within 1.65 Mb of either side of the ATXN2 CAG repeat. Of these, eight upstream and nine downstream polymorphic markers were successfully co-amplified in a single-tube assay and demonstrated high overall heterozygosity in both Chinese and Caucasian populations. Conclusion: To ensure high diagnostic accuracy for PGT-M of SCA2, we developed a heptadecaplex microsatellite marker panel for haplotype-based linkage analysis to complement TP-PCR-based direct detection of the ATXN2 CAG repeat. The panel can rapidly identify informative markers from virtually any couple, and it works equally well on MDA-amplified DNAs for embryonic haplotype analysis. Full article

Over the past decade, given safety, reduced heart failure-related hospitalizations, and, above all, 5-year mortality rates nearly identical to those of heart transplants, left ventricular assist devices (LVADs) have increasingly become a treatment option for patients with advanced heart failure. However, improvements in functional capacity after LVAD implantation are minimal or modest, depending on pre-implantation right ventricular function, the patient’s hemodynamic status, the optimization of guideline-directed medical therapy, and noncardiac factors (physical deconditioning, skeletal muscle alterations, anemia, and alterations in alveolar gas exchange). Therefore, cardiac rehabilitation (CR) is a fundamental element from the early stages after LVAD implantation, as it is not only safe but also highly effective, leading to improved functional capacity and fewer episodes of worsening heart failure, and may be associated with reduced mortality. To perform safe and effective CR in patients with LVADs, it is crucial to account for the unique issues in this group. This includes the difficulty of detecting an arterial pulse with standard tools during CPR and the importance of closely monitoring the transmission line and LVAD controller to prevent unintended damage. Overall, the clinical trial indicates that exercise-based CR has the potential to improve functional capacity. Furthermore, some data suggest that CR is associated with fewer HF-related hospitalizations and may be linked to lower mortality; however, there is no consensus on this matter, partly because most studies supporting this assertion are observational. Full article

Background: Fragile X Syndrome (FXS) is an X-linked neurodevelopmental disorder characterised by intellectual disability, developmental delays, anxiety, and social and behavioural challenges. Currently, no effective treatments exist to address the root cause of FXS. Mouse models are the most widely used for studying molecular pathogenesis and conducting preclinical treatment testing. However, therapeutic interventions that show promise in rodent models have yet to succeed in clinical trials. After evaluating the current models, we have developed an ovine model to address this clinical translation gap. We expect this model to more accurately reflect the human condition in brain size, structure, and neurodevelopmental trajectory. We aim to establish this model as a valuable preclinical platform for testing therapies for FXS. Methods: To generate the sheep model, we used CRISPR-Cas9 dual-guide editing to knock out the Fragile X Messenger Ribonucleoprotein 1 (FMR1) gene in ovine embryos. Results: Two founder animals were created, one ram (male) and one ewe (female), both of which carried FMR1 gene knockouts. The ewe carries inactivating mutations on both alleles, with the edits in both animals resulting in no detectable Fragile X Messenger Ribonucleoprotein (FMRP) as expected. Both founders have undergone molecular characterisation and basic health checks, with the female founder showing increased joint flexibility, a characteristic of FXS. The ram has been used for breeding, with the successful transmission of the edited allele to his offspring. Importantly, specific lamb cohorts for postnatal treatment testing can be produced efficiently utilising accelerated breeding methods and preimplantation selection. Full article

Background and Objectives: Aneuploidy is the leading cause of implantation failure and miscarriage, with prevalence increasing with maternal age. Embryos classified as chaotic, characterized by the presence of five or more chromosomal abnormalities, and those with complex aneuploidies, defined by two to four abnormalities, represent a controversial category in preimplantation genetic testing for aneuploidy (PGT-A), as the potential for misclassification remains a significant concern. Materials and Methods: We performed a retrospective study at the Calla IVF Center, Oradea, analyzing 230 blastocysts grouped by maternal age (25–30, 31–35, 36–40, and 41–50 years). A trophoblast biopsy was performed on days 5–7, and the samples were analyzed by next-generation sequencing (NGS). Embryos were classified as euploid, aneuploid, mosaic, or chaotic. The 19 embryos initially diagnosed as chaotic were thawed and subjected to re-biopsy. Statistical analysis included descriptive statistics (chi-square tests and ANOVA) and multivariable regression models, with p < 0.05 as the criterion for statistical significance. Results: Aneuploidy increased with maternal age, from 29.6% in women aged 25–30 years to 68.7% in those aged 41–50 (p = 0.002). Poor-quality blastocysts exhibited higher aneuploidy rates (72.4%) than good-quality embryos (34.6%; p = 0.004). Chaotic embryos comprised 8.3% of the cohort. Upon re-biopsy, none were confirmed as euploid; all remained abnormal and were reassigned to aneuploid, mosaic, or persistently chaotic categories. This finding suggests that apparent euploid results reported elsewhere may reflect technical variability and sampling limitations in PGT-A rather than accurate chromosomal normalization. Conclusions: The prevalence of aneuploid embryos showed a progressive increase with advancing maternal age. Chaotic embryos are heterogeneous, and re-biopsy may help refine the interpretation of complex PGT-A profiles, supporting its role as a diagnostic and quality control tool rather than a strategy to identify euploid embryos. Our study offers novel insights through age-stratified analysis, the integration of morphology with genetics in a Romanian IVF cohort, and a detailed evaluation of chaotic embryos, providing clinical recommendations for patient counseling and embryo selection. Full article

Small-diameter synthetic grafts often fail from thrombosis, intimal hyperplasia, and compliance mismatch, highlighting the need for alternatives that better support endothelialization and remodeling. Here, we evaluated multilayer plant-based vascular grafts fabricated from decellularized leatherleaf viburnum reinforced with cross-linked gelatin, seeded with vascular smooth muscle cells and endothelial cells, and conditioned in a perfusion bioreactor to mimic physiological shear stress. Pre-implant assays confirmed effective decellularization, low residual detergent, and mechanical integrity suitable for surgical handling. In a rat abdominal aorta interposition model, plant-based grafts remained patent at 1, 4, and 24 weeks and showed higher survival than silicone controls. Ultrasound imaging demonstrated flow patterns and resistance indices similar to native vessels, and plant-based grafts maintained significantly higher endothelial cell coverage than silicone controls, reaching native-like density by 24 weeks. Histology and biochemical assays showed early collagen and elastin coverage comparable to native aorta and increased collagen by 24 weeks. Scanning electron microscopy showed smooth luminal surfaces with minimal thrombus formation, contrasting with the rougher, thrombus-prone surfaces of silicone grafts. These findings indicate that plant-based grafts support endothelialization, maintain long-term patency, and undergo favorable remodeling in vivo, supporting their potential as a biomimetic alternative for small-diameter arterial repair. Full article

Anthocyanin is a flavonoid known for its strong antioxidant and anti-inflammatory activities in both in vitro and in vivo systems. This study investigated whether anthocyanin supplementation could improve the developmental competence, hatching rate, and the expression of development- and proliferation-related markers in ICR mouse blastocysts cultured in vitro. Mouse embryos were cultured in KSOM medium supplemented with 2, 4, or 8 μM anthocyanin. Among these, 4 μM was selected as the working concentration within the tested range. Morphological assessment was used to evaluate blastocyst development and hatching, while quantitative real-time polymerase chain reaction (qPCR) was performed to measure the expression of GLUT4 and PI3K. Anthocyanin supplementation significantly enhanced blastocyst quality, as reflected by higher developmental competence and increased hatching rates compared with the control group. In addition, anthocyanin-treated blastocysts displayed elevated mRNA expression of GLUT4 and PI3K, indicating a potential association with enhanced metabolic readiness and cellular proliferation. Overall, these findings indicate that anthocyanin supports embryo quality during preimplantation development in vitro, with potential relevance to implantation-related processes. Further research is needed to clarify the underlying mechanisms and explore the potential applications of anthocyanin in reproductive medicine. Full article