Universitair Ziekenhuis Brussel

It has been established that male cigarette smoking has a negative effect on the semen quality and that it can induce DNA damage leading to worsening of reproductive outcomes. The aim of our large retrospective study is to determine the influence of male cigarette smoking on assisted reproduction, more specifically in IVF and ICSI outcomes.

Our study included all consecutive infertile couples (with a nonsmoking female partner) having their first IVF/ICSI cycle. All patients had smoking assessment. Smokers were further classified into mild (1-10 cigarettes/day), moderate (11-20 cigarettes/day) or heavy smokers (>20 cigarettes/day). The primary outcome was live birth rates (LBR).

The overall number of patients analyzed was 4004 and among them 433 (10.8%) were smokers. Baseline characteristics, such as female age and BMI differed significantly between nonsmokers and smokers. The crude analysis showed higher positive hCG and LBR in smokers (positive hCG 28.34% in nonsmokers vs 33.95% in smokers, p = 0.015; LBR 23.55% in nonsmokers vs 28.64% in smokers, p = 0.019) However after adjustment for relevant confounders (female age, BMI, cause of infertility, number of oocytes retrieved, insemination procedure, number of embryos transferred and day of embryo transfer) the smoking status was not significantly associated with fresh LBR (OR = 1.16, CI = 0.92-1.48; p = 0.2). The results were replicated after classification of smoking into mild/moderate/heavy [OR for nonsmokers (reference category) vs. mild vs. moderate vs. heavy= 1, 1.17, 1, 2.99; p = 0.18)].

Male smoking does not seem to impair live birth rates in patients undergoing IVF/ICSI treatment.

Coronary computed tomography angiography (CCTA)-derived fractional flow reserve (FFR_CT) strategy significantly decreases unnecessary invasive coronary angiography and refines the appropriateness of revascularization decision. The present study aimed to evaluate how FFR_CT guided - strategy impacts outcomes postrevascularization.

We included patients with suspected obstructive coronary artery disease (OCAD in a registry from 2013 to 2021. FFR_CT entered Heart-Team decision from 2017. Propensity score adjusted Cox - and logistic - regression analyzed FFR_CT's impact on post- revascularization major adverse cardiovascular events (MACE) and myocardial injury (PMI).

Among 7541 patients, 1601 had suspected OCAD. 559 patients underwent revascularization: 69.0 % PCI, 29.7 % CABG and 1.2 % both. 252(45.1 %) patients underwent FFR_CT. Over 4.4 ± 2.2 years, 137(24.5 %) patients experienced MACE. FFR_CT was associated with a trend toward reduced MACE (HR 0.736, 95 % CI 0.513-1.055, p = 0.095) and significantly reduced all-cause mortality (HR 0.476, 95 % CI 0.230-0.985, p = 0.046). In the post-2017 cohort (413 patients, follow-up 3.7 ± 1.5 years), FFR_CT significantly reduced MACE (HR 0.610, 95 % CI 0.390-0.954, P = 0.030) and all-cause mortality (HR 0.285, 95 % CI 0.104-0.779, P = 0.014). In CABG patients, FFR_CT was associated with lower PMI incidence (5.3 % vs. 15.6 %, p = 0.044). Multivariable analysis revealed no significant association between FFR_CT use and PMI.

Revascularization decision-making with FFR_CT translates into better post-revascularization outcomes, primarily by reducing MACE through lower mortality. There was no clear impact on PMI. These findings suggests that FFR_CT's value lies indeed in improving patient selection for revascularization, but warrants further confirmation in randomized clinical trials.

High protein nutrition may improve outcomes after critical illness. We recently published the primary frequentist analysis of the PRECISe trial, showing that high (2.0 g/kg/day) compared with standard (1.3 g/kg/day) protein provision led to statistically significant worse health-related quality of life. The study, however, was not powered to draw definitive conclusions about clinical and other functional outcomes under a frequentist framework. We present a pre-planned and pre-specified Bayesian analysis to facilitate the clinical interpretation of these paramount endpoints.

The trial enrolled 935 patients and used the EQ-5D-5L health utility score as the primary endpoint. We performed Bayesian analyses of the primary and selected secondary endpoints, and relevant subgroups, under weakly informative priors. Sensitivity analyses were performed using skeptical and enthusiastic priors, and informed priors (when available) based on existing literature. Thresholds for clinically relevant differences were predefined.

The posterior probability of benefit from high (2.0 g/kg/day) protein targets with respect to the EQ-5D-5L health utility score was 0 %. Concerning 60-day mortality, the posterior probability of any benefit from high protein provision was 8 %, with a posterior probability of clinically important harm (>5 % absolute risk difference) of 47 %, which varied between 1 and 21 % across various sensitivity analyses under reference or literature-based priors.

This pre-planned Bayesian re-analysis of the PRECISe trial shows that high (2.0 g/kg/day) compared to standard (1.3 g/kg/day) protein provision in critically ill patients has a low probability to yield any benefit and results in a high probability of an increase of 60-day mortality.

NCT04633421.