scholarly journals Follicular Fluid Oocyte/Cumulus-Free DNA Concentrations as a Potential Biomolecular Marker of Embryo Quality and IVF Outcome

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
M. Dimopoulou ◽  
G. Anifandis ◽  
C. I. Messini ◽  
K. Dafopoulos ◽  
S. Kouris ◽  
...  
Keyword(s):  
Follicular Fluid ◽  
Embryo Quality ◽  
Ivf Outcome ◽  
Quantitative Real Time Pcr ◽  
Direct Role ◽  
Free Dna ◽  
Detection Approach ◽  
Sybr Green Detection ◽  
Group 2 ◽  
Group 1

The present prospective study examined the follicular fluid oocyte/cumulus-free DNA concentrations (ff o/c-free DNA) during ovarian stimulation and the possible association between ff o/c-free DNA and embryological results such as embryo quality and pregnancy rate. Eighty-three women undergoing IV/ICSI-ET treatments were prospectively included in this study. ff o/c-free DNA was determined by conventional quantitative real time PCR-Sybr green detection approach. The 83 ff samples were categorized in two groups: group 1n=62with cumulus oocytes complexes (CoCs)≥2 and group 2n=21with CoCs = 1. Group 1 revealed significant higher embryo quality in terms of mean score of embryo transfer (MSET), but lower ff o/c-free DNA concentrations compared to group 2. The two groups showed comparable pregnancy rates (positive hCG and clinical pregnancy). The higher the ff o/c-free DNA concentration, the lower the number of produced oocytes. ff o/c-free DNA did not seem to have any direct role in the IVF outcome. Further research is required to clarify whether ff o/c-free DNA is a biomolecular marker of embryo quality and IVF outcome.

scholarly journals Cell-free DNA in Human Follicular Fluid as Biomarker for Intracytoplasmic Sperm Injection Procedure Outcome

2021 ◽  
Vol 9 (B) ◽  
pp. 1745-1750
Author(s):  
Maanee Azzam ◽  
Adeela Hamood ◽  
Hind Abdulkadim
Keyword(s):  
Pregnancy Outcome ◽  
Follicular Fluid ◽  
Fertilization Rate ◽  
P Value ◽  
Human Follicular Fluid ◽  
Cell Free Dna ◽  
Free Dna ◽  
Detection Approach ◽  
Iraqi Women ◽  
High Level

Background: Follicular fluid considered as an important microenvironment for oocyte development, cell free-DNA (cfDNA) fragments that are found in this fluid and are released from cell apoptosis and/or necrosis, aimed to quantified the level of cf-DNA, in the follicular fluid and to assess any relation between the level of cf-DNA in this fluid with women’s age, duration of infertility, cause of infertility, her ovarian reserve values. Methods: Eighty-nine women were prospectively included in this study FF cf-DNA which was determined by conventional real time PCR-syber green detection approach which quantified by ALU-specific primers. Results: cell-free DNA (cfDNA) level in Follicular fluid samples of Iraqi women level was; cfDNA (Mean±SD, 0.916±0.106 ng/μl). there was no significant relation between cfDNA and pregnancy outcome, but very low level and very high level cf DNA were related to negative pregnancy outcome, cfDNA was second most important predictive factor of pregnancy outcome after fertilization rate, but both not statistically significant p value was (0.622 and 0.241) respectively. Conclusion: current study notice that cfDNA in the follicular fluid may mainly reflect the cellular activity and the balance between programed apoptosis and cell necrosis.

scholarly journals Estradiol and leptin as conditional prognostic IVF markers

Reproduction ◽  
2005 ◽  
Vol 129 (4) ◽  
pp. 531-534 ◽  
Author(s):  
G Anifandis ◽  
E Koutselini ◽  
K Louridas ◽  
V Liakopoulos ◽  
K Leivaditis ◽  
...  
Keyword(s):  
Follicular Fluid ◽  
Embryo Quality ◽  
Oocyte Retrieval ◽  
Dependent Manner ◽  
Ivf Outcome ◽  
Concentration Dependent Manner ◽  
Conditional Interaction ◽  
Estradiol Levels ◽  
Ivf Et

We studied the concentration of serum estradiol and serum and follicular fluid leptin in 200 women undergoing their first in vitro fertilization with embryo transfer (IVF-ET) program at the time of human chorionic gonadotrophin administration and oocyte retrieval, in an attempt to assess their concerted role on embryo quality and the prognosis of IVF outcome. Low serum (46.49 ± 8.4 ng/ml) and follicular fluid (52 ± 9.8 ng/ml) leptin levels were associated with a high number of ‘good-quality’ embryos (73.6%) and high implantation (11.2%) and pregnancy (35.8%) rates and were observed in women with normal peak estradiol levels of between 1000 and 2000 pg/ml. It appears that leptin and estradiol interact coordinately in a concentration-dependent manner to control IVF outcome. Further studies will be required to substantiate and clarify the mechanism of proposed conditional interaction between the two hormonal systems.

109 INTRAFOLLICULAR GLUCOSE CONCENTRATION HAS AN INFLUENCE ON THE SEX OF BOVINE BLASTOCYSTS PRODUCED IN VITRO

2011 ◽  
Vol 23 (1) ◽  
pp. 160
Author(s):  
E. Abele ◽  
H. Stinshoff ◽  
A. Hanstedt ◽  
S. Wilkening ◽  
S. Meinecke-Tillmann ◽  
...  
Keyword(s):  
Sex Ratio ◽  
Follicular Fluid ◽  
Glucose Concentration ◽  
Blastocyst Stage ◽  
Total Cell ◽  
Bovine Embryos ◽  
Developmental Rates ◽  
Group 2 ◽  
Group 1

Several factors have been shown to alter the sex ratio of bovine embryos generated in vitro, i.e. the maturity of the oocyte at the time of insemination, the duration of sperm-oocyte co-incubation and the culture conditions after in vitro fertilization. It has been shown that the presence of glucose during in vitro culture reduced the development of female embryos to the blastocyst stage compared with controls cultured in the absence of glucose. The sex ratio of bovine embryos has also been linked with changes in the composition of the follicular fluid in which the oocyte undergoes growth and maturation, i.e. the intrafollicular testosterone concentration. However, no information is available regarding the effect of intrafollicular glucose concentration on the sex ratio of embryos after in vitro production (IVP). The purpose of this study was to determine whether different glucose concentrations in the follicular fluid at the time of cumulus–oocyte complex (COC) collection have an effect on the sex ratio of the resulting blastocysts after IVP. Ovaries from a local abattoir were transported to the laboratory within 2 h of slaughter. Follicles (3–8 mm) were individually dissected and the glucose concentration of each follicle was measured using a blood glucose monitoring system (Freestyle Freedom Lite, Abbott, Germany). Based on a glucose concentration, COC [low glucose: <1.1 mM (group 1) and high glucose: >1.1 mM (group 2)] were pooled in groups and used for blastocyst production employing standard protocols for IVP. Developmental rates were recorded at Day 3 (cleavage) and Day 7/8 (blastocyst stage). Total cell number of blastocysts was determined after Hoechst staining. Sex of the embryos was analysed via PCR using bovine X- and Y-chromosome specific primers. Developmental rates for COC stemming from follicles with different glucose concentrations did not show significant differences (P > 0.05) compared to each other [Cleavage rate: group 1: 81.8 ± 4.7% (93/117); group 2: 79.3 ± 4.9% (94/123); blastocyst rate: group 1: 35.6 ± 5.2% (38/117); group 2: 31.6 ± 5.2% (38/123)]. Total cell numbers were similar in embryos of both groups [Group 1: 117.7 ± 8.1 (n = 18); group 2: 117.2 ± 6.4 (n = 18)]. The overall sex ratio significantly differed (P < 0.05) from 1:1 in favour of females in both groups [Group 1: 85 v. 15% (n = 20); group 2: 63.6 v. 36.4% (n = 22)]. No significant difference (P > 0.05) in the overall sex ratio was detected in blastocysts produced under standard IVP conditions employed in the laboratory [without measurement of follicular glucose concentration, 55.0 v. 45.0%, (n = 20)]. In conclusion, under the conditions used in the present study, the intrafollicular glucose concentration from which the immature COC was collected affects the sex of the resulting embryo after IVP, favouring females. Further studies are needed to confirm these findings in living cows using the ovum pickup technique.

P–249 Does the re-expansion of thawed embryos affect the clinical outcomes of human blastocyst vitrification?

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
T Huong ◽  
A Ph. Th. Tú ◽  
L H Mai ◽  
N Doã. Thảo ◽  
C A Mạnh
Keyword(s):  
Pregnancy Rate ◽  
Clinical Outcomes ◽  
Embryo Quality ◽  
Cell Mass ◽  
Clinical Pregnancy ◽  
Clinical Pregnancy Rate ◽  
Ongoing Pregnancy ◽  
Ongoing Pregnancy Rate ◽  
Group 2 ◽  
Group 1

Abstract Study question Is that essential for prolonged culture of thawed blastocysts in order to be fully re-expanded before transferring? Summary answer Ongoing pregnancy rates decreased in blastocysts that not fully re-expanded after thawing. What is known already: The thaw survival of blastocysts is examined based on morphology of inner cell mass (ICM) and trophectoderm (TE). However, thawed blastocysts experience multiple changes in morphology and might be collapse after thawing due to the presence of blastocoel cavity. It is then difficult to evaluate blastocyst quality. Therefore, the blastocyst re-expansion is considered as a criteria to assess quickly the competent embryos. It also reflects the status energy metabolism from high quality embryo. After all, there are still some controversial opinions about the influence of re-expansion status after thawing. Study design, size, duration This was a retrospective study based on data collected between October 2019 and December 2020. A total 528 thawed blastocysts which were divided into two groups according to the post-thaw reexpansion status: fully re-expanded blastocysts (n = 416), partial or no re-expanded blastocysts (n = 112). The re-expansion status of blastocyst was assess prior to loading on the catheter by senior embryologists. Participants/materials, setting, methods Primary outcome is ongoing pregnancy. Only frozen single D5 transfer cycles were included. We excluded the frozen sperm/oocytes/embryos donation cycles, missing data, non-intact embryos after thawing. Statistical analyses were performed with T or chi-squared tests. Multivariable regression analysis was performed adjusting for the following confounding factors: age, BMI, embryo quality, re-expansion status, biopsied blastocyst. Main results and the role of chance Female age, BMI, number of previous cycles, endometrial thickness, positive HCG results, clinical pregnancy rate were comparable among patients within two groups. The rate of ongoing pregnancy rate in group 1 was significant higher compared with group 2 (51 vs 40.2, p &lt; 0.05). The number of good quality blastocyst transferred in group 1 was higher than in group 2 (p &lt; 0.001). However, under the same embryo quality, there were no difference between clinical pregnancy rate and ongoing pregnancy rate between two groups. When logistic regression were performed: only embryo quality, but not the re-expansion status, was noted to be an independent predictor of ongoing pregnancy (OR = 3.53;95% CI; 1.734–7.184;p=0.001). Limitations, reasons for caution The main limitation of the study is its retrospective design. Wider implications of the findings: Clinical outcomes are comparable between re-expanded blastocyst and partial or no re-expanded blastocysts, although ongoing pregnancy can be improved when embryos are fully expanded. As expected, blastocysts quality has the most important impact on ongoing pregnancy rate. Trial registration number Not applicable

Effect of bovine follicular fluid treatment and progesterone priming on luteal function in GnRH-treated seasonally anoestrous ewes

1996 ◽  
Vol 62 (3) ◽  
pp. 443-450 ◽  
Author(s):  
G. F. Basiouni ◽  
M. Khalid ◽  
W. Haresign
Keyword(s):  
Follicular Fluid ◽  
Corn Oil ◽  
Pulse Amplitude ◽  
Follicle Development ◽  
Lh Surge ◽  
Luteal Function ◽  
Treatment Groups ◽  
Early Stages ◽  
Group 2 ◽  
Group 1

AbstractThe main objective of the present experiment was to investigate whether progesterone priming eliminates defective luteal function in seasonally anoestrous ewes induced to ovulate with pulsatile GnRH treatment by synchronizing the early stages of follicle development. This was achieved by suppressing and synchronizing the early stages of follicle development with bovine follicular fluid (bFF) and then investigating whether this was sufficient to eliminate defective luteal function following the induction of ovulation with GnRH. Ewes in group 1 (no. = 10) were injected s.c. with 2 ml bFF at 8-h intervals for a period of 3 days before the start of GnRH treatment. Animals in group 2 (no. = 10), ivhich served as positive controls, were given a single i.m. injection of 20 mg progesterone 3 days before the start of GnRH treatment, while those in group 3 (no. = 10), which served as negative controls, were injected with corn oil alone at this time. Ewes in all the three groups were induced to ovulate by administration of 2-hourly injections of GnRH (250 ng per injection) for 54 h. Frequent blood samples for LH, FSH, and oestradiol were collected around the time of both progesterone/bFF injections and GnRH treatment, as well as daily thereafter to monitor luteal function.The bFF injections given to animals in group 1 resulted in a significant (P<0·001) suppression of FSH concentrations, followed by a rebound rise in concentrations after the cessation of treatment. GnRH treatment significantly (P < 0·05) increased both mean LH pulse amplitude and overall mean LH concentrations in all the three groups, while LH pulse frequency was increased only in non-bFF-treated ewes. Plasma oestradiol concentrations 24 h after the start of GnRH treatment were significantly (P < 0·05) higher in groups 2 and 3 compared with group 1. These differences in the patterns of oestradiol concentrations over time were associated with a significant (P <0·05) delay in the onset of the pre-ovulatory LH surge in ewes treated witli bFF (group 1). However, there was no difference in either the duration or the height of pre-ovulatory LH surge between the three treatment groups. Ewes in all three treatment groups ovulated in response to GnRH treatment. However, both laparoscopic examination and plasma progesterone concentrations revealed that the incidence of normal luteal function was significantly (P < 0·05) higher in group 2 (10/10) compared with groups 1 (2/10) and 3 (4/10), with no difference between groups 1 and 3. Overall, these results suggest that progesterone priming does not eliminate defective luteal function through synchronizing early stages offollicle development.

scholarly journals Cell-free DNA in human follicular fluid as a biomarker of embryo quality

2014 ◽  
Vol 29 (12) ◽  
pp. 2661-2669 ◽  
Author(s):  
E. Scalici ◽  
S. Traver ◽  
N. Molinari ◽  
T. Mullet ◽  
M. Monforte ◽  
...  
Keyword(s):  
Follicular Fluid ◽  
Embryo Quality ◽  
Human Follicular Fluid ◽  
Cell Free Dna ◽  
Free Dna

scholarly journals Endocrine, sexual and reproductive functions in patients with Klinefelter Syndrome compared to non-obstructive azoospermic patients.

2021 ◽  
Author(s):  
Fatih Kocamanoğlu ◽  
Bulent Ayas ◽  
Mustafa Bolat ◽  
Ummet Abur ◽  
Recep Bolat ◽  
...  
Keyword(s):  
Live Birth ◽  
General Health ◽  
Embryo Quality ◽  
Psychological Status ◽  
Sperm Retrieval ◽  
Birth Rates ◽  
Live Birth Rates ◽  
Group 2 ◽  
Group 1

Aims: We aimed to investigate fertilization rates, quality of embryo, pregnancy and live birth rates, endocrine, sexual function, psychological status and quality of life of cases diagnosed with Klinefelter syndrome (KS). Methods: Clinical findings, hormone values and semen analyses in patients with nonmosaic KS (Group 1, n=121) and those with non-genetic nonobstructive azoospermia (NOA) (Group 2, n=178) were retrospectively analyzed. Sperm retrieval outcomes with microdissection testicular sperm extraction (micro-TESE), fertilization rates and embryo quality, pregnancy, abortion, and live birth rates were compared. Sexual functions were assessed using IIEF-15, quality of life was evaluated, and psychological status was assessed. Results: There was no difference in terms of age between groups. Sperm retrieval rates was 38% and 55.6% in Group 1 and 2, respectively (p=0.012). Sperm retrieval rates were higher in Group 1 before 31.5 years than in Group 2 (AUC=0.620, 0.578). Compared to Group 2, the fertilization rate was low in Group 1, whereas embryo quality was similar. Live birth rates were 12.5% and 23% in Group 1 and 2, respectively (p=0.392). The education level, libido, erectile functions, and general health satisfaction were lower in Group 1 than in Group 2 (buraya p değeri yaz). Depression and anxiety levels were higher in Group 2 than Group 1 (p değeri yaz). Conclusion: Higher sperm retrieval rate has been achieved in group 1 younger than 31.5 years. Similar embryo quality is provided between groups. Sexual dysfunction and psychiatric problems were higher in Group 1, with lower satisfaction and general health than Group 2. Patients with KS should be monitored not only with their reproductive functions but also with their general health status.

scholarly journals Does a Very Short Length of Abstinence Improve Assisted Reproductive Technique Outcomes in Infertile Patients with Severe Oligo-Asthenozoospermia?

2021 ◽  
Vol 10 (19) ◽  
pp. 4399
Author(s):  
Federica Barbagallo ◽  
Aldo E. Calogero ◽  
Rosita A. Condorelli ◽  
Ashraf Farrag ◽  
Emmanuele A. Jannini ◽  
...  
Keyword(s):  
Pregnancy Rate ◽  
Live Birth ◽  
Embryo Quality ◽  
Clinical Pregnancy ◽  
Clinical Pregnancy Rate ◽  
Sperm Parameters ◽  
Male Partners ◽  
Group 2 ◽  
Infertile Patients ◽  
Group 1

In recent years, a growing number of studies seem to support the beneficial effects of a very short abstinence period on sperm parameters, especially in patients with oligo-asthenozoospermia (OA). On this basis, the aim of this study was to evaluate the effects of a short period of abstinence (1 h) on intracytoplasmic sperm injection (ICSI) outcomes in infertile patients with severe OA. We performed a retrospective study on 313 ICSI cycles in which couples were divided into two different groups based on sperm parameters of the male partners. Group 1 included normozoospermic men or male partners with a mild OA (n = 223). Group 2 included male partners with severe OA (n = 90). They were asked to provide a second consecutive ejaculation after 1 h from the first one. The best ejaculate was used to perform ICSI. We found a significant increase of total (p < 0.001) and progressive motility (p < 0.001) in the second ejaculate of patients of Group 2 compared with those of the first one. Spermatozoa of the second ejaculate were chosen for ICSI for all patients in Group 2. We found statistically significant improvement of clinical pregnancy rate (p = 0.001) and embryo quality (p = 0.003) in couples in Group 2 compared to those of Group 1. No statistically significant difference was found in fertilization, implantation, live birth delivery, and miscarriage rates between the two groups. Therefore, a second semen sample collected after a very short time-interval in patients with severe OA allowed us to obtain significantly higher clinical pregnancy rate with improved embryo quality compared to normozoospermic men or patients with mild OA. Fertilization, implantation, live birth delivery, and miscarriage rates were similar between the two groups. The present study shows that a second consecutive ejaculate could represent a simple strategy to obtain better sperm parameters and assisted reproductive technology (ART) outcomes in infertile patients with mild-severe OA.

365 THE EFFECT OF ADMINISTERING PROGESTERONE AND ESTRADIOL PRIOR TO eFSH ON THE SUPEROVULATORY RESPONSE OF MARES

2006 ◽  
Vol 18 (2) ◽  
pp. 290 ◽  
Author(s):  
N. Logan ◽  
P. McCue ◽  
M. Alonso ◽  
E. Squires
Keyword(s):  
Embryo Quality ◽  
Animal Health ◽  
T Test ◽  
Exact Test ◽  
Embryo Recovery ◽  
Multiple Ovulation ◽  
Fisher’S Exact Test ◽  
Good For ◽  
Group 2 ◽  
Group 1

eFSH has been used to induce multiple ovulation in cycling mares. However, the response to eFSH is variable. Generally, eFSH is initiated 5 to 7 days after ovulation at a time when the follicular population on the ovaries may be variable. The objective of this study was to determine whether administration of progesterone and estradiol for 10 days prior to eFSH (Bioniche Animal Health, Athens, GA) would enhance the response to eFSH administration. Thirty normal cycling mares were assigned to 1 of 2 groups. Group 1: Control eFSH treatment - mares were examined daily with ultrasonography beginning 5 days after ovulation. Once the follicles in these mares reached 20 to 25 mm in size, eFSH treatment (12.5 mg, i.m.) was administered twice a day. Cloprostenol (Schering-Plough, Union, NJ, USA) treatment (250 �g) was administered on the second day of eFSH treatment. eFSH treatment continued until the majority of the cohort of follicles reached e35 mm. Treatment was stopped and after approximately 36 h hCG (2500 IU, i.v.; Chorulon; Intervet, Millsboro, MD, USA) was administered. Group 2: Injectable progesterone + estradiol (150 mg of progesterone and 10 mg of estradiol; P+E) treatment was initiated in diestrus (5 to 7 days post-ovulation) for 8 mares and in early estrus for 7 mares in this group. Injectable progesterone was continued for 10 days and Cloprostenol (250 �g) was administered on Day 10. Mares were then examined daily with ultrasonography and, once they had acquired 20- to 25-mm follicles, eFSH treatment was initiated. Twice-daily injections of eFSH (12.5 mg, i.m.) were continued until a majority of the cohort of follicles was e35 mm. hCG was administered approximately 36 h later. All mares were inseminated with 1 billion progressively motile spermatozoa from one of two stallions on the day of hCG administration and on the following day with cooled semen (1 billion progressively motile spermatozoa) from the same stallion. Data were analyzed by t-test and Fisher's Exact Test. The number of days of eFSH treatment was similar for the P+E (2) vs. the control (1) group (4.2 � 2.0 vs. 4.9 � 1.3 days, respectively). However, the number of ovulations induced in response to eFSH was greater for mares in the eFSH control (1) group (5.6 � 2.0) than for those in the P+E (2) group (3.0 � 1.9). Embryo recovery per flush was also greater for eFSH control (1) mares (2.7) vs. P+E (2) mares (1.1). Embryo quality was excellent or good for all embryos in both groups. Seventy-three percent of the mares (11 of 15) in both groups gave at least one embryo at each recovery attempt. However, more mares in the eFSH control (1) group gave two or more embryos (60%) compared to those in the P+E (2) group (20%). In summary, treatment of mares with P+E prior to eFSH treatment resulted in fewer ovulations, fewer embryos recovered, and fewer mares providing e2 embryos. Thus, there was no advantage in pretreating mares with P+E prior to eFSH treatment.

In-vivo evaluation of the effect of cyanoacrylate on prosthetic vascular graft infection – does cyanoacrylate increase the severity of infection?

VASA ◽  
2020 ◽  
Vol 49 (4) ◽  
pp. 281-284
Author(s):  
Atıf Yolgosteren ◽  
Gencehan Kumtepe ◽  
Melda Payaslioglu ◽  
Cuneyt Ozakin
Keyword(s):  
Vascular Graft ◽  
Graft Infection ◽  
Vascular Graft Infection ◽  
Group 4 ◽  
Significant Difference ◽  
Group 3 ◽  
Group 2 ◽  
Prosthetic Vascular Graft Infection ◽  
Group 1

Summary. Background: Prosthetic vascular graft infection (PVGI) is a complication with high mortality. Cyanoacrylate (CA) is an adhesive which has been used in a number of surgical procedures. In this in-vivo study, we aimed to evaluate the relationship between PVGI and CA. Materials and methods: Thirty-two rats were equally divided into four groups. Pouch was formed on back of rats until deep fascia. In group 1, vascular graft with polyethyleneterephthalate (PET) was placed into pouch. In group 2, MRSA strain with a density of 1 ml 0.5 MacFarland was injected into pouch. In group 3, 1 cm 2 vascular graft with PET piece was placed into pouch and MRSA strain with a density of 1 ml 0.5 MacFarland was injected. In group 4, 1 cm 2 vascular graft with PET piece impregnated with N-butyl cyanoacrylate-based adhesive was placed and MRSA strain with a density of 1 ml 0.5 MacFarland was injected. All rats were scarified in 96th hour, culture samples were taken where intervention was performed and were evaluated microbiologically. Bacteria reproducing in each group were numerically evaluated based on colony-forming unit (CFU/ml) and compared by taking their average. Results: MRSA reproduction of 0 CFU/ml in group 1, of 1410 CFU/ml in group 2, of 180 200 CFU/ml in group 3 and of 625 300 CFU/ml in group 4 was present. A statistically significant difference was present between group 1 and group 4 (p < 0.01), between group 2 and group 4 (p < 0.01), between group 3 and group 4 (p < 0.05). In terms of reproduction, no statistically significant difference was found in group 1, group 2, group 3 in themselves. Conclusions: We observed that the rate of infection increased in the cyanoacyrylate group where cyanoacrylate was used. We think that surgeon should be more careful in using CA in vascular surgery.

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