Thirdly, a modality-agnostic vision transformer (MIViT) module is proposed as the shared bottleneck layer for all input modalities. This module naturally combines convolutional-like local processing with the global processing of transformers to learn universally applicable modality-independent features. Third, a multi-modal cross pseudo supervision (MCPS) approach for semi-supervised learning is designed, enforcing consistency between pseudo-segmentation maps produced by two altered networks to extract substantial annotation data from unlabeled, unpaired multi-modal scans.
Experiments, performed extensively, utilize two unpaired CT and MR segmentation datasets, including a cardiac substructure dataset from the MMWHS-2017 dataset and an abdominal multi-organ dataset consisting of the BTCV and CHAOS datasets. Experimental results indicate that our proposed method markedly exceeds the performance of other existing state-of-the-art methods across various labeling ratios, demonstrating segmentation performance that rivals single-modal methods using fully labeled data, and requiring only a small subset of labeled instances. Under a 25% labeling ratio, our method achieved remarkable mean DSC scores of 78.56% for cardiac and 76.18% for abdominal segmentation, significantly improving the average DSC over single-modal U-Net models by 1284%.
Our novel method minimizes the annotation demands for unpaired multi-modal medical images, a crucial factor in clinical settings.
Our proposed method effectively reduces the annotation workload for unpaired multi-modal medical images in clinical settings.
Is the quantity of oocytes retrieved from a single cycle of dual ovarian stimulation (duostim) superior to that obtained from two sequential antagonist cycles in the context of poor responder patients?
In women exhibiting poor ovarian response, the retrieval of total and mature oocytes does not show a positive outcome when comparing duostim to two consecutive antagonist cycles.
Research in recent times has confirmed that comparable quality oocytes can be obtained from both the follicular and luteal phases, coupled with a higher quantity per cycle when applying the duostim method. Follicle sensitization and recruitment of smaller follicles during follicular stimulation might amplify the subsequent selection of follicles in the luteal phase, as supported by non-randomized controlled trials (RCTs). For women experiencing POR, this consideration is particularly important.
Four IVF centers served as sites for a multicenter, open-label, randomized controlled trial (RCT), which took place between September 2018 and March 2021. Oocytes retrieved over the two cycles were the primary metric for assessing treatment effectiveness. The study's central objective was to demonstrate that, in women affected by POR, administering two ovarian stimulations within the same cycle (first in the follicular phase, then in the luteal) produced 15 (2) more oocytes than the combined total from two conventional, consecutive stimulations using an antagonist protocol. A superiority hypothesis, requiring a power of 0.08, an alpha-risk of 0.005, and a 35% cancellation rate, resulted in a sample size requirement of 44 patients per group. Randomization of patients was executed by a computer algorithm.
A controlled trial randomized 44 women to the duostim group and 44 to the control group; these women all displayed polyovulatory response (POR) as per adjusted Bologna criteria, defined as an antral follicle count of 5 or more and/or an anti-Mullerian hormone level of 12 ng/mL. Utilizing a flexible antagonist protocol and HMG at 300 IU daily, ovarian stimulation was performed, excluding luteal phase stimulation in the Duostim group. By employing a freeze-all protocol, pooled oocytes from the duostim group were inseminated following the second retrieval. NT157 chemical structure Fresh embryo transfers were implemented in the control group; concurrently, both the control and duostim groups underwent frozen embryo transfers, during natural cycles. The data's analysis included intention-to-treat and per-protocol approaches.
No variations were detected amongst the groups when considering demographics, ovarian reserve markers, and stimulation parameters. Regarding the cumulative number of oocytes retrieved following two ovarian stimulations (mean [standard deviation]), there was no statistically significant difference between the control and duostim groups (46 [34] and 50 [34], respectively). The mean difference (95% confidence interval) was +4 [-11; 19], with a p-value of 0.056. Comparative analysis revealed no statistically significant variation in the mean cumulative values of mature oocytes and total embryos obtained for each group. The control group demonstrated a markedly higher total number of embryo transfers compared to the duostim group, with 15 transferred (11 successful implantations) versus 9 transferred (11 successful implantations). This difference proved statistically significant (P=0.003). After two successive cycles, 78% of participants in the control group and a substantial 538% of those in the duostim group successfully underwent at least one embryo transfer, showcasing a statistically significant disparity (P=0.002). No statistically significant difference was observed in the average number of total and mature oocytes retrieved per cycle when Cycle 1 was compared to Cycle 2, for both the control and duostim groups. Controls exhibited a noticeably extended period, 28 (13) months, until the second oocyte retrieval, contrasting with the 3 (5) month duration in the Duostim group, a statistically significant difference (P<0.0001). A similar implantation rate was observed in both cohorts. Comparative analysis of live birth rates between control and duostim groups demonstrated no statistically significant difference; 341% and 179%, respectively (P=0.008). The time taken to achieve a continuing pregnancy subsequent to transfer did not diverge between the control group (17 [15] months) and the Duostim cohort (30 [16] months) (P=0.008). No reports of significant adverse events were received.
The pandemic caused by the coronavirus disease 2019, along with the 10-week standstill of IVF treatments, impacted the RCT. This period's delays were recalculated, yet one woman in the duostim group was unable to undergo luteal stimulation. OTC medication Subsequent to the initial oocyte retrieval, both groups surprisingly experienced favorable ovarian responses and pregnancies; the control group demonstrated a more pronounced rate of these occurrences. Our hypothesis, notwithstanding, rested on the presumption of 15 more oocytes in the luteal phase as opposed to the follicular phase, particularly within the duostim group, and the required number of patients (N=28) was achieved in this group. The statistical power of this study was exclusively limited by the total count of oocytes retrieved.
Representing an initial randomized controlled trial (RCT), this study analyzes the comparative outcomes of two consecutive therapy cycles, whether delivered during the same menstrual period or spanning two subsequent menstrual cycles. The current randomized controlled trial did not demonstrate a routine clinical benefit for duostim in patients with POR regarding fresh embryo transfer. This was because the study detected no improvement in the number of oocytes retrieved in the luteal phase following follicular phase stimulation, differing from earlier non-randomized studies. Moreover, the implemented freeze-all strategy eliminated the possibility of a fresh embryo transfer pregnancy in the first cycle. Nevertheless, duostim seems to be a safe option for women. Oocyte/embryo loss is a potential consequence of the required freezing/thawing steps that are part of the duostim process. The only advantage of duostim, when collecting oocytes/embryos is desired, is a two-week reduction in the time it takes to achieve a subsequent retrieval.
This investigator-initiated study is supported by a research grant from IBSA Pharma. N.M.'s institution is the beneficiary of grants from MSD (Organon France), consulting fees from MSD (Organon France), Ferring, and Merck KGaA, honoraria from Merck KGaA, General Electrics, Genevrier (IBSA Pharma), and Theramex; travel and meeting stipends from Theramex, Merck KGaG, and Gedeon Richter; and equipment from Goodlife Pharma. I.A. receives honoraria from GISKIT, along with travel and meeting support, also from GISKIT. G.P.-B.: This item needs to be returned. Compensation was received for consulting services from Ferring and Merck KGaA. Theramex, Gedeon Richter, and Ferring provided honoraria payments. Expert testimony from Ferring, Merck KGaA, and Gedeon Richter was also compensated. Finally, travel and meeting support was provided by Ferring, Theramex, and Gedeon Richter. A list of sentences is returned by this JSON schema. IBSA pharma, Merck KGaA, Ferring, and Gedeon Richter have declared grants, with additional support for travel and meetings coming from IBSA pharma, Merck KGaG, MSD (Organon France), Gedeon Richter, and Theramex. Participation on the advisory board is also provided by Merck KGaA. Regarding travel and conferences, E.D. supports initiatives from IBSA pharma, Merck KGaG, MSD (Organon France), Ferring, Gedeon Richter, Theramex, and General Electrics. The JSON schema, which includes a list of sentences, is provided by C.P.-V. Maternal immune activation The support for travel and meetings, as declared, comes from IBSA Pharma, Merck KGaA, Ferring, Gedeon Richter, and Theramex. Pi, a mathematical constant, is fundamentally important in many fields of study. In a declaration, Ferring, Gedeon Richter, and Merck KGaA express their support for travel and meetings. Regarding Pa. M. Honoraria from Merck KGaA, Theramex, and Gedeon Richter are disclosed by the individual, coupled with support for travel and meetings, provided by Merck KGaA, IBSA Pharma, Theramex, Ferring, Gedeon Richter, and MSD (Organon France). H.B.-G. mandates this JSON schema for a list of sentences. The speaker's participation is supported by honoraria from Merck KGaA and Gedeon Richter, and meeting and travel support from Ferring, Merck KGaA, IBSA Pharma, MSD (Organon France), Theramex, and Gedeon Richter. S.G. and M.B. have no items subject to mandatory declaration.