Australian Federation of Graduate Women New South Wales

STUDY QUESTIONCan patient-derived organoid models be reliably established from diverse surgical phenotypes of endometriosis, and how do clinical factors such as hormonal treatment affect their growth success and morphology?SUMMARY ANSWEREndometriosis organoids can be established across all major surgical phenotypes with variable efficiency, and hormonal treatment at the time of biospecimen collection significantly reduces organoid establishment success.WHAT IS KNOWN ALREADYOrganoid cultures have been developed from eutopic endometrium and select endometriosis tissue biospecimens previously, but their feasibility as pre-clinical models of endometriosis across diverse tissue types and clinical presentations remains unclear.STUDY DESIGN, SIZE, DURATIONTwenty-eight endometriosis tissue biospecimens were obtained from 23 patients undergoing surgery, with organoid cultures assessed through successive stages of establishment, passage, and cryopreservation.PARTICIPANTS/MATERIALS, SETTING, METHODSEndometriosis biospecimens, including deep infiltrating endometriosis (DIE), ovarian endometrioma (OMA), and superficial peritoneal (SUP) biospecimens, were processed into organoid cultures using a validated low-Wnt culture system. Organoid viability, morphology, hormone receptor expression, and cellular composition were evaluated by microscopy, immunohistochemistry, and quantitative morphometric analysis.MAIN RESULTS AND THE ROLE OF CHANCEOverall, 22/28 (78.6%) biospecimens established 3-dimensional structures, with 15/28 (53.6%) remaining viable after cryopreservation. Establishment success differed by phenotype (OMA 71.4%, DIE 63.6%, SUP 30%). Progesterone receptor expression was retained in SUP and DIE-derived organoids (7/7, 100%), while OMA-derived organoids showed substantial reductions (4/5 cases). Biospecimens from patients receiving hormonal treatment were smaller (P = 0.038) and had reduced organoid establishment success (3/13, 23.1% vs 12/15, 80.0%, P = 0.003). Organoids exhibited distinct morphological patterns correlating with disease phenotype.LIMITATIONS, REASONS FOR CAUTIONUniform culture conditions may limit growth of certain subtypes, and the in vitro organoid models may not fully represent in vivo tissue complexity. Sample sizes were modest, and pooling tissues from the same patient could mask intra-patient heterogeneity.WIDER IMPLICATIONS OF THE FINDINGSThese organoid models offer a promising platform for studying subtype-specific endometriosis biology, including hormone resistance mechanisms, and could inform personalized therapeutic development. The impact of hormonal treatment on organoid viability underscores the need to consider clinical context in pre-clinical models of endometriosis.STUDY FUNDING/COMPETING INTEREST(S)This work was supported by the National Endometriosis Clinical and Scientific Trials (NECST) Network, funded by the Australian Government Department of Health and Aged Care (Grant 4-I66SNMA), and by a research grant from Endometriosis Australia to C.E.F., D.L., and J.A.A. K.G. is supported by an Australian Government Research Training Program Scholarship and a NECST Network Top-Up Scholarship, which did not influence the conduct or outcomes of this study. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. J.A.A. has received consulting fees from Hologic, Gedeon Richter, and BD, personal payments from Hologic, Bayer, Organon, and Gedeon Richter, travel support from Gedeon Richter, and participated on data safety monitoring advisory boards for Hologic and Gideon Richter. He was the former chair of the Australian Endometriosis Guideline Committee and is the Co-Editor-in-Chief of the Journal of Minimally Invasive Gynaecology. All other authors declare no competing interests.TRIAL REGISTRATION NUMBERN/A.

This paper describes the analysis and comparison of the electron current collection of a cylindrical tether for different variables like plasma density and temperature, plasma ion species, tether material, and applied bias. The plasma is generated by ionizing hydrogen, oxygen, and ambient air in a 50 cm × 40 cm plasma chamber. Multiple plasma densities were generated in the range 1 0 14 - 1 0 15 particles per m 3 with corresponding plasma temperatures 2.5 - 4.3 eV. EDT materials — aluminum, tungsten, and aracon were used in the experiment to examine the material performance in the generated plasma environment and evaluate the impact on the current collected. Several observations have been made from the data collected. The I-V curves vary due to each ionized plasma, indicating the impact of ion species on the electron current. The OML model overestimates the current for each experiment run analyzed. Aracon sample exhibited superior performance when placed in oxygen and air plasma, whereas aluminium demonstrated higher I-V curves in hydrogen plasma. Plasma bubbles and secondary plasma were observed during the experiment for both positively and negatively biased tether samples. In the positively biased regime, anomalous electron current occurred for certain plasma densities. In the negatively biased regime, the ion current for hydrogen plasma was recorded to be higher than the oxygen and air plasma. It was concluded that the OML does not accurately estimate the collected current, as more complex interactions are involved. • Electron current collection varies with plasma ion species and tether material. • OML theory overestimates EDT current collected. • Neutral particle density strongly influences EDT current collection efficiency. • OML deviations arise from secondary plasma effects. • Aracon material shows superior performance in oxygen and air plasma conditions.

Congenital heart defects (CHDs) are among the most prevalent congenital anomalies and are frequently detected in pregnancies classified as low-risk, rather than in high-risk groups. Advancements in ultrasound technology have heightened the emphasis on first-trimester fetal cardiac screening. However, due to the small size of the fetal heart at this stage, significant challenges persist, underscoring the need for simplified and reproducible protocols that can be effectively applied on a population-wide scale. This paper describes a screening approach centred on the four-chamber view (4CV) and three-vessel tracheal view (3VTV) with colour Doppler imaging. This includes optimisation of ultrasound machine settings and the use of transabdominal and transvaginal approaches to enhance visualisation. Evidence demonstrates a CHD detection rate of 76% in low-risk populations, with a 95% success rate in obtaining the necessary views. Operator expertise and familiarity with cardiac anomalies are critical for accurate detection. The early identification of CHDs enables informed decision-making regarding pregnancy management. A simplified protocol for first-trimester cardiac screening offers a promising tool for the early identification of CHDs, enabling timely referral and intervention. To optimise detection rates and clinical outcomes, continuous professional education and systematic auditing processes are indispensable for practitioners performing early fetal cardiac screening.

Abstract Artificial intelligence (AI) tools that enhance image acquisition, measurement, and interpretation are a valuable part of contemporary sonographic imaging systems, and emerging AI technology is forecast to feature more extensively in future systems. In this commentary, we draw upon contemporary literature and our experience in curriculum design to indicate how educators should approach integrating AI into the pre‐qualification sonography curriculum. This integration will promote understanding of and engagement with the technology to ensure that graduates are prepared for work with AI‐assisted systems. Knowledge of the technical and interpretive applications, the legal and ethical concerns, plus industry and accreditation body collaboration are proffered as important parts of an AI‐integrated training program.

To perform a nationwide study of quadrichorionic quadriamniotic (QCQA) quadruplet pregnancies and to compare the pregnancy outcome in those undergoing fetal reduction with non-reduced quadruplets and dichorionic diamniotic (DCDA) twin pregnancies from the same time period. This was a retrospective Danish national register-based study performed using data from the national Danish Fetal Medicine Database, which included all QCQA quadruplets and all non-reduced DCDA twin pregnancies with an estimated due date between 2008 and 2018. The primary outcome measure was a composite of adverse pregnancy outcomes, including pregnancy loss or intrauterine death of one or more fetuses. Secondary outcomes included gestational age at delivery, the number of liveborn children, preterm delivery before 28, 32 and 37 gestational weeks and birth weight. Data on pregnancy complications and baseline characteristics were also recorded. Outcomes were compared between reduced and non-reduced quadruplet pregnancies, and between DCDA pregnancies and quadruplet pregnancies reduced to twins. A systematic literature search was performed to describe and compare previous results with our findings. Included in the study were 33 QCQA quadruplet pregnancies, including three (9.1%) non-reduced pregnancies, 28 (84.8%) that were reduced to twin pregnancy and fewer than three (6.1%) that were reduced to singleton pregnancy, as well as 9563 DCDA twin pregnancies. Overall, the rate of adverse pregnancy outcome was highest in non-reduced quadruplets (66.7%); it was 50% in quadruplets reduced to singletons and 10.7% in quadruplets reduced to twins. The proportion of liveborn infants overall was 91.1% of the total number expected to be liveborn in quadruplet pregnancies reduced to twins. This was statistically significantly different from 97.6% in non-reduced dichorionic twins (P = 0.004), and considerably higher than 58.3% in non-reduced quadruplets. The rates of preterm delivery < 28, < 32 and < 37 weeks were decreased in quadruplets reduced to twins compared with those in non-reduced quadruplet pregnancies. Quadruplets reduced to twins did not achieve equivalent pregnancy outcomes to those of DCDA twins. This national study of QCQA quadruplets has shown that multifetal pregnancy reduction improves pregnancy outcome, including a decreased rate of preterm delivery and higher proportion of liveborn children. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Acta PaediatricaAccepted Articles BRIEF REPORT National surveillance of severe microcephaly in Australia Carlos Nunez, Corresponding Author Carlos Nunez [email protected] orcid.org/0000-0002-5417-9582 The University of Sydney. Faculty of Medicine and Health, Discipline of Child and Adolescent Health, Sydney, NSW, Australia The Australian Paediatric Surveillance Unit (APSU). Sydney, NSW, Australia Correspondence Dr Carlos Nunez, the Australian Paediatric Surveillance (APSU), Level 2, Kids Research, The Children's Hospital at Westmead, Locked Bag 4001, Westmead NSW 2145, Australia. Email: [email protected]Search for more papers by this authorAnne Morris, Anne Morris The University of Sydney. Faculty of Medicine and Health, Discipline of Child and Adolescent Health, Sydney, NSW, Australia The Australian Paediatric Surveillance Unit (APSU). Sydney, NSW, Australia Kids Research, The Sydney Children's Hospitals Network (Westmead), Sydney, NSW, AustraliaSearch for more papers by this authorElizabeth J. Elliott, Elizabeth J. Elliott The University of Sydney. Faculty of Medicine and Health, Discipline of Child and Adolescent Health, Sydney, NSW, Australia The Australian Paediatric Surveillance Unit (APSU). Sydney, NSW, Australia Kids Research, The Sydney Children's Hospitals Network (Westmead), Sydney, NSW, AustraliaSearch for more papers by this author Carlos Nunez, Corresponding Author Carlos Nunez [email protected] orcid.org/0000-0002-5417-9582 The University of Sydney. Faculty of Medicine and Health, Discipline of Child and Adolescent Health, Sydney, NSW, Australia The Australian Paediatric Surveillance Unit (APSU). Sydney, NSW, Australia Correspondence Dr Carlos Nunez, the Australian Paediatric Surveillance (APSU), Level 2, Kids Research, The Children's Hospital at Westmead, Locked Bag 4001, Westmead NSW 2145, Australia. Email: [email protected]Search for more papers by this authorAnne Morris, Anne Morris The University of Sydney. Faculty of Medicine and Health, Discipline of Child and Adolescent Health, Sydney, NSW, Australia The Australian Paediatric Surveillance Unit (APSU). Sydney, NSW, Australia Kids Research, The Sydney Children's Hospitals Network (Westmead), Sydney, NSW, AustraliaSearch for more papers by this authorElizabeth J. Elliott, Elizabeth J. Elliott The University of Sydney. Faculty of Medicine and Health, Discipline of Child and Adolescent Health, Sydney, NSW, Australia The Australian Paediatric Surveillance Unit (APSU). Sydney, NSW, Australia Kids Research, The Sydney Children's Hospitals Network (Westmead), Sydney, NSW, AustraliaSearch for more papers by this author First published: 14 May 2023 https://doi.org/10.1111/apa.16846 This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi:10.1111/apa.16846. AboutPDF ToolsExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Accepted ArticlesAccepted, unedited articles published online and citable. The final edited and typeset version of record will appear in the future. RelatedInformation

ObjectivesTo examine early pregnancy risk factors for preterm prelabour rupture of membranes (PPROM) and develop a predictive model. Study designRetrospective analysis of a cohort of mixed-risk singleton pregnancies screened in the first and second trimesters in three Danish tertiary fetal medicine centres, including a cervical length measurement at 11–14 weeks, at 19–21 weeks and at 23–24 weeks of gestation. Univariable and multivariable logistic regression analyses were employed to identify predictive maternal characteristics, biochemical and sonographic factors. Receiver operating characteristic (ROC) curve analysis was used to determine predictors for the most accurate model. ResultsOf 3477 screened women, 77 (2.2%) had PPROM. Maternal factors predictive of PPROM in univariable analysis were nulliparity (OR 2.0 (95% CI 1.2–3.3)), PAPP-A < 0.5 MoM (OR 2.6 (1.1–6.2)), previous preterm birth (OR 4.2 (1.9–8.9)), previous cervical conization (OR 3.6 (2.0–6.4)) and cervical length ≤ 25 mm on transvaginal imaging (first-trimester OR 15.9 (4.3–59.3)). These factors all remained statistically significant in a multivariable adjusted model with an AUC of 0.72 in the most discriminatory first-trimester model. The detection rate using this model would be approximately 30% at a false-positive rate of 10%. Potential predictors such as bleeding in early pregnancy and pre-existing diabetes mellitus affected very few cases and could not be formally assessed. ConclusionsSeveral maternal characteristics, placental biochemical and sonographic features are predictive of PPROM with moderate discrimination. Larger numbers are required to validate this algorithm and additional biomarkers, not currently used for first-trimester screening, may improve model performance.