The influence of oxygen concentration during embryo culture on obstetric and neonatal outcomes: a secondary analysis of a randomized controlled trial.

STUDY DESIGN, SIZE, DURATION: A secondary analysis of a previous randomized controlled trial assessing clinical pregnancy outcomes was carried out. This analysis included 1125 consecutive oocyte donation cycles utilizing ICSI or IVF and Day 3 embryo transfers between November 2009 and April 2012. The whole cohort of donated oocytes from patients who agreed to participate in the study were randomly allocated (1:1 ratio) to a reduced O2 tension group (6% O2) or an air-exposed group (20% O2) based on a computergenerated randomization list. Fresh and vitrified oocytes were used for oocyte donation. Only those pregnancies with a live birth at or beyond 24 weeks of gestation were included. PARTICIPANTS/MATERIALS, SETTING, METHODS: Day 3 embryos were cultured in an atmosphere of 5.5% CO2, 6% O2, 88.5% N2 versus a dual gas system in air. MAIN RESULTS AND THE ROLE OF CHANCE: From the eligible 1125 cycles, 564 were allocated to the 6% O2 group and 561 cycles to the 20% O2 group. However, 50 and 62 cycles did not reach embryo transfer in the 6% and 20% O2 groups, respectively. No differences were found between 6% O2 and atmospheric O2 tension in the number of livebirths per embryo transfer (mean § SD, 0.5 § 0.7 versus 0.5 § 0.7), pregnancy complications or neonatal outcomes. Both groups (6% and atmospheric O2) had similar single and twin delivery rates (40.8% versus 38.1% and 10.7% versus 12.3%, respectively). Preterm delivery rates and very preterm delivery rates (10.80% versus 13.24% and 1.25% versus 2.94%, respectively), birthweight (3229 § 561 g versus 3154 § 731 g), low birthweight (2.92% versus 2.45%), birth height (50.18 § 2.41 cm versus 49.7 § 3.59 cm), head circumference (34.16 § 1.87 cm versus 33.09 § 1.85 cm) and 1 min Apgar scores (8.96 § 0.87 versus 8.89 § 0.96) were also similar between 6% and atmospheric O2 groups, respectively. LIMITATIONS, REASONS FOR CAUTION: The number of liveborns finally analyzed is still small and not all obstetric and neonatal variables could be evaluated. Furthermore, a small proportion of the obstetric and neonatal data was obtained through a questionnaire VC The Author(s) 2020. Published by Oxford University Press on behalf of European Society of Human Reproduction and Embryology. All rights reserved. For permissions, please email: [email protected] Human Reproduction, Vol.0, No.0, pp. 1-14, 2020 doi:10.1093/humrep/deaa152 One reason for the lack of effect of oxygen concentration on pregnancy outcome could be the absence of trophectoderm cells at cleavage stage, which may make Day 3 embryos less susceptible to hypoxic conditions. WIDER IMPLICATIONS OF THE FINDINGS: Nowadays many IVF laboratories use a more physiological oxygen concentration for embryo culture. However, the benefits of using low oxygen concentration on both laboratory and clinical outcomes during embryo culture are still under debate. Furthermore, long-term studies investigating the effect of using atmospheric O2 are also needed. Gathering these type of clinical data is indeed, quite relevant from the safety perspective. The present data show that, at least in egg donation cycles undergoing Day 3 embryo transfers, culturing embryos under atmospheric oxygen concentration seems not to affect perinatal outcome

Transformaciones y retos de la educación en las artes y los diseños (tomo 1)

El presente libro contiene doce reflexiones que nos sugieren un balance para repensar la educación superior tras las experiencias pandémicas en tres dimensiones: pedagogía, didáctica general y didácticas especiales, Estas tres dimensiones ofrecen un panorama integral para repensar los problemas educativos actuales. A diferencia de otros balances que hemos visto o leído en los últimos años, el presente se compone de tres ejes que atraviesan todas las reflexiones: reorganización de ideas, consolidación de la inter y transdisciplina, y mejora efectiva de las prácticas de enseñanza-aprendizaje desde planes y programas de estudios hasta actividades entre docentes y alumnos.Coordinadoras: Alma Elisa Delgado Coellar, Juana Cecilia Angeles Cañedo & Daniela Velázquez Ruí

¿Cómo funciona un robot?

Este documento incluye un texto que responde la pregunta planteada en el título, un mapa de contenidos y una guía metodológica para la realización de un taller. El texto inicia definiendo un robot como un dispositivo mecatrónico diseñado para ejecutar una o varias tareas, en general se utilizan para reducir costos, mejorar y facilitar procesos. Un robot tiene tres partes esenciales: la mecánica, su estructura física; los actuadores, aquellos que hacen posible efectuar los movimientos; y los sensores, destinados a que el robot perciba asuntos específicos en su interior o en su exterior. Ahora bien, la inteligencia del robot puede limitarse a unas instrucciones programadas pero también puede partir de los aprendizajes del robot, a esta capacidad de aprender se le conoce como inteligencia artificial. Finalmente, en aras de responder la pregunta, se recalca que para que un robot funcione es necesario programarlo para que su inteligencia pueda saber qué hacer y darle órdenes a sus actuadores y a los elementos terminales encargados de interactuar con el entorno del robot

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)