BackgroundDirect aspiration thrombectomy techniques use large bore aspiration catheters for mechanical thrombectomy. Several aspiration catheters are now available. We report a bench top exploration of a novel beveled tip catheter and our experience in treating large vessel occlusions (LVOs) using next-generation aspiration catheters.MethodsA retrospective analysis from a prospectively maintained database comparing the bevel shaped tip aspiration catheter versus non-beveled tip catheters was performed. Patient demographics, periprocedural metrics, and discharge and 90-day modified Rankin Scale (mRS) scores were collected. Patients were divided into two groups based on which aspiration catheter was used.ResultsOur data showed no significant difference in age, gender, IV tissue plasminogen activator administration, admission NIH Stroke Scale score, baseline mRS, or LVO location between the beveled tip and flat tip groups. With the beveled tip, Thrombolysis in Cerebral Infarction (TICI) 2C or better recanalization was more frequent overall (93.2% vs 74.2%, p=0.017), stent retriever usage was lower (9.1% vs 29%, p=0.024), and patients had lower mRS on discharge (median 3 vs 4, p<0.001) and at 90 days (median 2 vs 4, p=0.008).ConclusionPatients who underwent mechanical thrombectomy with the beveled tip catheter had a higher proportion of TICI 2C or better and had a significantly lower mRS score on discharge and at 90 days.

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Purpose: The identification of biomarkers for use during selection of embryos for intrauterine implantation can enhance in vitro fertilization (IVF) success rates. Assessing apoptotic molecular markers found in blastocoel fluid-conditioned media from human embryos with known ploidy status provides the opportunity to study patterns and processes occurring during early embryo development. Apoptosis occurs during preimplantation development and may serve to selectively eliminate aneuploid cells from the developing embryo. Therefore, apoptotic remnants such as cell-free DNA (cfDNA) may reside within the embryo's blastocoel fluid and vary depending upon embryo ploidy status. In this study we compared cfDNA content of blastocoel fluid-conditioned media from euploid and aneuploid embryos.Methods: Blastocoel fluid-conditioned media was collected following trophectoderm (TE) biopsy of day-5 IVF blastocysts. cfDNA in the media from 89 embryos was quantified using fluorospectrometry.Results: cfDNA content in human blastocoel fluid-conditioned media decreased as ploidy status deviated from euploid. Conclusions:The alterations in cfDNA content may represent levels unique to embryos that are euploid. In addition to preimplantation genetic testing for aneuploidy via analysis of trophectoderm cells, uncovering different molecular features in the blastocoel fluid that are unique to euploid embryos suggests that analysis of the fluid may provide an additional measure of embryo quality, that is marginally-invasive.

sites (TFBS) are often accessible in the active genes and not uniformly distributed over the promoter region. Our data showed that ATAC peak distributions of the promoter regions (<1kb) and distal regions versus other regions were significantly different between ICM vs TE samples (P<0.01). We detected that higher percentage of accessible binding loci were located within 1kb of the transcription start site in ICM compared to TE (p<0.01). However, higher percentage of accessible regions were detected in the distal region of TE compared to ICM. In addition, 8 differential peaks with the FDR<0.05 between ICM and TE were detected and these 8 accessible locations were identified in ICM samples.CONCLUSIONS: This is the first study to compare the landscape of the accessible chromatin between ICM and TE of human preimplantation embryos, which unveiled chromatin-level epigenetic regulation of cell lineage specification in early embryo development.

DESIGN: ACOG recommends universal carrier screening for cystic fibrosis (CF) and spinal muscular atrophy (SMA) and ethnicity-based screening when appropriate. ACOG acknowledges that expanded carrier screening (ECS) has many benefits but states ECS panels should only include high impact disorders (well-understood, severe, and common.) 1,2 Our laboratory offers carrier screening for up to 301 genes. These genes are available in pre-curated panels (3, 46, or 288 genes), or they can be ordered as customized panels. Thirteen additional genes (common, variable, and/or adult onset) are available as an add-on to any panel. All combinations are offered at the same out-of-pocket cost.MATERIALS AND METHODS: Testing for up to 301 genes was performed by NGS. Ordering patterns by clinician type and positive rates were assessed.RESULTS: In a ten-month period, 16,459 patient samples from 1,390 clinicians were tested. Almost half of all orders came from REIs and 9% of orders identified the patient/partner as pregnant. The largest pre-curated panel was ordered most frequently (n¼6,699). Concurrent testing was performed for 62% of opposite-sex couple orders. Guideline-based testing accounted for 23% of all orders with ObGyns having the highest adherence to guideline-based ordering (31%) and genetic counselors (GCs) having the lowest (5%). MFMs were the only group that did not order all available genes (Table 1).Of all tests, 31% were positive for 1 disorder, 21% were positive for 2 or more, and 48% were negative. The most common autosomal recessive disorders at-risk couples screened positive for (add-on genes excluded) include CFTR-related disorders, GJB2-related non-syndromic hearing loss, HBBrelated hemoglobinopathies, Smith-Lemli-Optiz syndrome, SMA and phenylalanine hydroxylase deficiency (PKU).CONCLUSIONS: Despite current guidelines, our data shows that 56% of clinicians preferred a large panel (R288 genes), even including frequent/variable disorders and only 12% ordered the 46 gene panel with only high impact disorders. Additional investigation is needed to understand the decision tree within and between practices including the role insurance coverage and cost plays on carrier screening ordering.