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The effects of calcium hydroxide and diclofenac sodium as root canal medicaments on post-endodontic pain: a double-blinded, parallel group, randomized controlled clinical trial

Odontology. 2025 Nov 9. doi: 10.1007/s10266-025-01252-9. Online ahead of print.

ABSTRACT

The aim of this study was to evaluate the effects of calcium hydroxide (CH), diclofenac sodium (DCS), and their combination (CH + DCS) as intracanal medicaments on post-endodontic pain in teeth diagnosed with symptomatic irreversible pulpitis. This study included 90 participants with one first or second mandibular molar with symptomatic irreversible pulpitis. They were randomly divided into three groups according to intracanal medicament (CH, DCS, CH + DCS) (n = 30). The participants were asked to rate their pain intensity on a VAS as none, mild, moderate, severe, or very severe after the 7 days following the first visit. Patients were also asked to record the number of prescribed analgesic medication tablets taken. Statistical analysis was performed using the Kruskal-Wallis test, the Friedman test, the Wilcoxon signed-rank test, and the Chi-square test. The significance level was established at 0.05. Ninety patients were analyzed at the 1-week follow-up. The pain scores gradually decreased after the first visit in all medication groups compared to the preoperative period (p < 0.05). DCS was more effective at reducing post-treatment pain when used alone than were DCH + CH and CH (p < 0.05). The number of patients who used postoperative analgesics was similar across the groups (p > 0.05). Compared with CH, the use of DCS alone as an intracanal medicament is more effective in reducing postoperative pain. The significant effect of DCS alone in reducing postoperative pain scores supports its consideration as an alternative to CH in endodontic treatment. ClinicalTrials.gov ID NCT06632015, Registration Date 10 July 2024 (retrospectively registered).

PMID:41206809 | DOI:10.1007/s10266-025-01252-9

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Effect of Instrument-Assisted Soft Tissue Mobilization Combined With Lidocaine Phonophoresis on Tension-Type Headache: A Randomized Clinical Trial

J Manipulative Physiol Ther. 2025 Nov 8:S0161-4754(25)00022-3. doi: 10.1016/j.jmpt.2025.09.010. Online ahead of print.

ABSTRACT

OBJECTIVE: The purpose of this study was to investigate the effects of instrument-assisted soft tissue mobilization (IASTM) and lidocaine phonophoresis combined or separated on trigger points in patients with tension-type headache (TTH).

METHODS: A double-blind randomized trial. A total of 60 participants with TTH were randomized into 4 equal groups. All groups received conventional treatment at the National Institute of Neuromotor System. Group A received conventional treatment only; group B received IASTM; group C received lidocaine phonophoresis; and group D received IASTM and phonophoresis. Visual analog scale (VAS), Arabic neck disability index (ANDI), headache frequency, and pressure pain threshold (PPT) were among the outcome measurements. All variables were measured before treatment and 4 weeks post-treatment.

RESULTS: Within the group’s analysis, multiple pairwise comparison tests revealed improvements at all measurement variables (P < .01) in all groups. Post-treatment, results showed a significant difference in groups D versus group A, groups B, and C with mean difference (MD) and 95% CI in VAS [3.18 (2.379-3.981), 1.133 (0.332-1.935), and 1.907 (1.105-2.708) respectively], ANDI [10.267 (8.382-12.151), 4.2 (2.316-6.084) 7 (5.116-8.884) respectively], headache frequency [1.9 (1.246-2.554), 0.8 (0.146-1.454), and 1.4 (0.764-2.054) respectively], and PPT. Additionally, there was a significant difference in all variables between group A and group B with MD in VAS, ANID, and headache frequency (2.047, 6.067, and 1.1 respectively) in favor of group B. Moreover, there was a statistically significant difference between group A and group C in VAS, ANDI, and PPT of left the suboccipital muscles on the side of group C. In group B versus group C, there was a statistically significant difference in ANDI and PPT of the left upper fibers of the trapezius muscles as P < .05 in favor of group B.

CONCLUSION: Both conventional treatments, IASTM, lidocaine phonophoresis, and the combination of IASTM and phonophoresis had statistically significant effects in relieving pain, increasing neck functional ability, decreasing headache frequency, and improving PPT in participants with TTP. Adding IASTM and lidocaine phonophoresis to conventional treatment was more effective than the other treatments.

PMID:41206797 | DOI:10.1016/j.jmpt.2025.09.010

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Predictive Value of Ambulatory ECG Monitoring for Malignant arrhythmic Events in Genetic Dilated Cardiomyopathy

Europace. 2025 Nov 8:euaf279. doi: 10.1093/europace/euaf279. Online ahead of print.

ABSTRACT

BACKGROUND: The prognostic significance of arrhythmias and conduction disorders on ambulatory ECG in recently diagnosed genetic versus non-genetic dilated cardiomyopathy (DCM) remains unknown.

OBJECTIVE: To compare the prevalence of abnormalities on ambulatory ECG monitoring between genetic and non-genetic DCM patients and evaluate the predictive value for malignant ventricular adverse events (MVAE).

METHODS: Clinical and ambulatory ECG data were collected from 354 genotyped DCM probands, with a median follow-up of 8 years (IQR:5-9years). MVAE was defined as ventricular fibrillation, sustained ventricular tachycardia, anti-tachy pacing, appropriate device therapy, or sudden cardiac death. C-statistics assessed the predictive performance of the regression models.

RESULTS: 123 (35%) patients carried a (likely) pathogenic variant. Abnormalities on ambulatory ECG were more frequent in genetic DCM patients (80%) compared to non-genetic DCM (67%; p=0.013). Permanent atrial fibrillation (perAF), paroxysmal supraventricular tachycardia (parox-SVT) and non-sustained ventricular tachycardia (NSVT) were more frequent in genetic DCM patients (p=0.041, <0.001 and <0.001). Structural cardiac parameters showed minimal group differences. Using Cox-proportional hazard analyses to predict MVAE, ambulatory ECG variables (perAF, AV-block, NSVT, >500 premature ventricular complexes (PVC)/24 hours) had an AUC of 0.768 in genetic and 0.628 in non-genetic DCM patients (p=0.044). PVC burden was only predictive for MVAE in genetic DCM. Adding clinical variables provided little incremental predictive value for genetic versus non-genetic DCM (AUC Δ+0.004 versus Δ+0.150, respectively).

CONCLUSION: Ambulatory ECG monitoring abnormalities are prevalent in genetic DCM patients. In contrast to non-genetic DCM patients, ambulatory ECG parameters have an important predictive value to determine the risk of MVAE in genetic DCM patients.

PMID:41206691 | DOI:10.1093/europace/euaf279

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Secrets and lies and donor conceptions: what donor-conceived individuals feel about their disclosure/discovery experience

Hum Reprod. 2025 Nov 7:deaf215. doi: 10.1093/humrep/deaf215. Online ahead of print.

ABSTRACT

STUDY QUESTION: What are the satisfaction levels, as defined by emotional comfort or contentment, of adult individuals conceived via donor-assisted reproduction concerning the method, timing, and circumstances surrounding the disclosure/discovery of their conception?

SUMMARY ANSWER: Inadvertent discovery and older age at the time of disclosure of donor-conceived status are associated with lower rates of satisfaction among donor-conceived individuals.

WHAT IS KNOWN ALREADY: The proliferation of commercial DNA testing has resulted in many donor-conceived people learning inadvertently of their donor origins. As a result, donor-conceived people, healthcare professionals, and parents seek information and research about best disclosure practices and outcomes.

STUDY DESIGN, SIZE, DURATION: A survey-based cross-sectional cohort study from 2022 to 2023 was conducted involving 530 participants, of whom 422 completed the survey.

PARTICIPANTS/MATERIALS, SETTING, METHODS: A total of 546 people ages 18 years and over opened the survey, with 530 people qualifying to complete the survey as donor-conceived persons (DCPs). Four hundred and twenty-two DCPs (79.6%) completed the survey. Descriptive statistics were applied, and data distributions were analyzed for a selection of appropriate statistical tests; parametric tests such as Student’s t-test or ANOVA, and non-parametric tests such as Mann U Whitney or Kruskal-Wallis Rank Sum test were utilized as applicable, for comparing continuous data between groups. Multivariable logistic regression analyses were used to examine satisfaction levels, adjusting for potential confounders.

MAIN RESULTS AND THE ROLE OF CHANCE: After accounting for age at discovery, sex, the origin of disclosure, and education, individuals with early intentional disclosure were more than three times as likely to experience disclosure satisfaction as those with late unintentional disclosure/inadvertent discovery (P-value = 0.005).

LIMITATIONS, REASONS FOR CAUTION: Lack of ethnic diversity among survey respondents, and limited control over reposting of the survey to other sites, potentially contributing to sampling bias.

WIDER IMPLICATIONS OF THE FINDINGS: Preliminary but substantial evidence that early, intentional disclosure to DCPs results in greater satisfaction and acceptance. This data will ultimately assist all stakeholders, including reproductive health professionals and parents in family-building counseling and decision-making.

STUDY FUNDING/COMPETING INTEREST(S): None.

TRIAL REGISTRATION NUMBER: N/A.

PMID:41206682 | DOI:10.1093/humrep/deaf215

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The Association Between Insomnia and Migraine Disability and Quality of Life: A Secondary Analysis of a Randomized Controlled Trial

Pain Med. 2025 Nov 7:pnaf149. doi: 10.1093/pm/pnaf149. Online ahead of print.

ABSTRACT

OBJECTIVE: People with migraine have a higher prevalence and severity of insomnia. We examined the relationship between insomnia severity and migraine-related disability (MIDAS) and migraine-specific quality of life (MSQv2.1).

METHODS: We conducted a post-hoc analysis of a pilot randomized controlled study assessing the RELAXaHEAD application in those with insomnia and comorbid migraine. Descriptive statistics were used to summarize demographic and clinical characteristics. Linear mixed model analysis was conducted to evaluate Insomnia Severity Index (ISI) as a predictor of each MSQv2.1 domain and MIDAS.

RESULTS: Forty-two participants completed baseline and at least one follow-up survey. Mean age was 43.8 years (SD 12.6) and the majority (85.7%) were female. Most participants (81.0%) had severe migraine-related disability (median baseline MIDAS, 32 (IQR 52)). Over half (54.8%) of participants had moderate clinical insomnia (mean baseline ISI, 18.5 (SD 4.6)). Baseline median MSQv2.1 scores were 44.3 (IQR 31.4) for Role Function-Restrictive (RFR), 65.0 (IQR 45.0) for Role Function-Preventive (RFP), and 46.7 (IQR 46.7) for Emotional Function (EF). The effect of ISI on MIDAS was statistically significant (rate ratio (RR)=1.10, p < 0.05, 95%CI [1.028, 1.171], meaning each one-point increase in ISI was associated with a 10% higher MIDAS score). Additionally, a 1-point increase in ISI was associated with a decrease of 1.2 points in MSQ-RFR (B=-1.205, p = 0.001),1.0 point in MSQ-RFP (B=-0.981, p = 0.020), and 1.4 points in MSQ-EF (B=-1.66, p = 0.001).

CONCLUSIONS: Our study revealed significant associations between insomnia severity and migraine-related disability and quality of life, highlighting the importance of prevention and sleep intervention for patients with migraine.

PMID:41206664 | DOI:10.1093/pm/pnaf149

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Lifetime occupational and para-occupational exposure to organic solvents and testicular germ cell tumor risk: a French case-control study-TESTIS

Int J Epidemiol. 2025 Oct 14;54(6):dyaf175. doi: 10.1093/ije/dyaf175.

ABSTRACT

BACKGROUND: Despite an incidence increase in recent decades, the etiology of testicular germ cell tumors (TGCT) remains poorly understood. The hypothesis of a two-stage development, combining initial alteration in utero followed by malignant transformation later in life, has been suggested. This study examined the association between cumulative lifetime occupational and para-occupational solvent exposure and TGCT risk.

METHODS: The French multicenter case-control study TESTIS included 454 cases and 670 controls. Participants provided information on their occupational history; participants’ mothers (N = 547) provided information on their own and the father’s occupational history. Solvent exposure was assessed by using the Matgéné job-exposure matrices. The influence of the parental and subject’s occupational exposures over the lifetime and at different periods (i.e. fetal life/infancy; childhood; adolescence; subject’s exposure) on TGCT was examined. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated by using conditional logistic regression models.

RESULTS: An OR for TGCT of 1.03 (95% CI 0.59-1.79) was found for the lifetime solvent exposure. When each period was examined individually, the results showed an increased TGCT risk in adult males who were occupationally exposed to trichloroethylene (OR = 3.09; 95% CI 1.25-7.65); fuels and petroleum-based solvents (OR = 1.91; 95% CI 1.21-3.02); diesel, kerosene, and fuel oil (OR = 2.26; 95% CI 1.16-4.41); and ketones and esters (OR = 1.66; 95% CI 1.02-2.71), and suggested a positive association with solvent exposure during adolescence (OR = 1.77; 95% CI 0.95-3.31).

CONCLUSION: Overall, this study did not suggest a substantial role of cumulative lifetime solvent exposure and TGCT risk. The results showed an increased TGCT risk associated with solvent exposure during adulthood. Indirect exposure to certain solvents during adolescence might also promote TGCT development.

PMID:41206641 | DOI:10.1093/ije/dyaf175

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Efficacy of Bacillus Calmette-Guérin revaccination in preventing tuberculosis disease: a systematic review and meta-analysis

Int J Epidemiol. 2025 Oct 14;54(6):dyaf186. doi: 10.1093/ije/dyaf186.

ABSTRACT

BACKGROUND: There is no consensus on the efficacy of Bacillus Calmette-Guérin (BCG) revaccination. Because of this, we aimed to compare the effect of BCG revaccination with no revaccination in preventing tuberculosis (TB) disease.

METHODS: We searched PubMed, Embase, and the Cochrane Library databases from inception to December of 2023 for studies that compared BCG revaccination with no revaccination or placebo for this systematic review and meta-analysis. Outcomes of interest were incidence of TB disease, pulmonary TB and extrapulmonary TB. We pooled odds ratios (ORs) with 95% confidence interval (CI) using a random-effects model in R statistical software version 4.3.1. Heterogeneity was assessed with I2 statistics.

RESULTS: Five studies, involving 1 012 007 patients, of whom 501 597 (49.56%) were revaccinated with BCG, were included in the meta-analysis. There was a benefit in tuberculosis disease incidence in patients who received revaccination compared to patients who did not (OR 0.89; 95% CI: 0.81-0.98; P = .019; I2 = 53%) in the randomized controlled trials. When including observational studies, we found the same trend (OR 0.90; 95% CI: 0.77-1.05; P = .124; I2 = 26%) as well as in preventing against both extrapulmonary (OR 0.82; 95% CI: 0.38-1.76; P = .375; I2 = 24%) and pulmonary (OR 0.93; 95% CI: 0.86-1.01; P = .062; I2 = 0%) cases.

CONCLUSIONS: BCG revaccination was associated with a slight decrease in the incidence of tuberculosis, pulmonary tuberculosis, and extrapulmonary tuberculosis.

PMID:41206639 | DOI:10.1093/ije/dyaf186

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Inpatient Psychiatric Treatment of Adolescents in a Military Setting: A 5 Year Retrospective Study

Mil Med. 2025 Nov 7:usaf551. doi: 10.1093/milmed/usaf551. Online ahead of print.

ABSTRACT

INTRODUCTION: This study compared 5 years of admission data at the only active Adolescent Psychiatric Inpatient Unit in all the U.S. government’s military hospitals to national databases to investigate the similarities and disparities between the two populations.

MATERIALS AND METHODS: Data for this study were collected from the Adolescent Inpatient Behavioral Health Service (AIBHS) at the Alexander T. Augusta Military Medical Center and were compared with national databases. Descriptive statistics were performed to analyze the relationships between the primary outcome variable (length of stay, LOS), secondary outcome variable (Risk-Standardized Readmission Rate, RSRR) and each independent predictor variable (age, LOS, sex, fiscal year, diagnosis type, and risk of mortality).

RESULTS: Comparing the AIBHS data to national database data showed a similar protective effect in LOS for age (i.e., for each additional year of age, the LOS decreased) and an increased LOS based on increasing risk for self-harm and having an admission diagnosis of a psychotic disorder. There was also agreement between datasets that an increased LOS was predictive of increased RSRR. On average, the AIBHS LOS was longer (11 vs 6 days) but the RSRR was lower (3% vs 8%) when compared to national databases.

CONCLUSIONS: While the similarities of predictors of LOS and RSRR indicate a common driving force between the two different populations, the marked differences in LOS and RSRR warrant further research to help determine if they are related or if there is some other factor that explains the difference.

PMID:41206629 | DOI:10.1093/milmed/usaf551

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Vertical Heterophoria and Vestibular Symptoms in Military Personnel with Chronic mTBI

Mil Med. 2025 Nov 7:usaf534. doi: 10.1093/milmed/usaf534. Online ahead of print.

ABSTRACT

PURPOSE: Among the most common sequelae of mild traumatic brain injury (mTBI) are visual and vestibular complaints, particularly in military populations exposed to blast injuries and repetitive concussive events. This study aimed to investigate the prevalence of vestibular symptoms (dizziness, imbalance, visual motion hypersensitivity, and motion sickness) and their association with subjective vertical heterophoria (SVH) and vertical vergence imbalance (VVI) in military service members with chronic mTBI.

MATERIALS AND METHODS: This study was a retrospective analysis of patients with chronic mTBI treated at the National Intrepid Center of Excellence, Walter Reed National Military Medical Center (WRNMMC), from July 2024 to January 2025. The study was approved by the WRNMMC Institutional Review Board before data collection. Written informed consent was obtained from all participants. Patients who had been diagnosed with strabismus or other ocular pathologies that could confound the results were excluded. Clinical data were collected from standard assessment during the Neuro-Optometry appointment. Data analysis included the following variables: (1) Vestibular symptoms, assessed via a binary self-report (yes/no) indicating the presence or absence of dizziness, imbalance, visual motion hypersensitivity, and motion sickness; (2) Total vestibular symptom score, representing the total number of symptoms reported; (3) SVH, a patient-reported measure of vertical misalignment of the visual axes obtained through the alternating cover test; and (4) VVI, defined as the absolute difference (in prism diopters, Δ) between the right and left eyes in the breakpoint of vertical fusional vergence ranges. Descriptive statistics, logistic regression, Mann-Whitney U tests, and Spearman’s rank correlation were used for the analysis.

RESULTS: A total of 84 subjects were included in the analysis with mean age of 40.3 ± 5.1 years, and 100% of the participants were male. The prevalence of vestibular symptoms was as follows: dizziness (40.5%), imbalance (23.8%), visual motion hypersensitivity (13.1%), and motion sickness (17.9%). Overall, 71.4% of subjects (60/84) had at least one vestibular symptom. SVH was reported in 54.8% of participants; 54.8% had VVI ≥ 0.5Δ, and 23.8% had VVI ≥ 1.0Δ. No significant correlations were found between SVH/VVI and individual vestibular symptoms (all P > .05); however, there was a significant positive correlation between the vestibular symptom score and VVI (ρ = .27, P = .01).

CONCLUSIONS: In this population of military personnel with a history of chronic mTBI, both persistent vestibular complaints and vertical heterophoria were prevalent. The study showed that elevated vertical vergence imbalance between the two eyes was significantly correlated with more vestibular symptoms in patients with chronic mTBI. Vertical heterophoria may be a useful clinical technique; however, effectiveness of vertical heterophoria correction for the management of symptomatic mTBI requires further investigation.

PMID:41206627 | DOI:10.1093/milmed/usaf534

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Mitochondrial metabolism influences meiotic maturation in human oocytes of young and advanced maternal age women

Hum Reprod. 2025 Nov 6:deaf207. doi: 10.1093/humrep/deaf207. Online ahead of print.

ABSTRACT

STUDY QUESTION: Is there a relationship between the mitochondrial activity and the meiotic progression of oocytes from germinal vesicle (GV) to metaphase II (MII) stages in young and advanced maternal age (AMA) women?

SUMMARY ANSWER: Poor mitochondrial metabolism impairs the meiotic progression of human GV oocytes, contributing to a lower oocyte maturation capacity of AMA oocytes.

WHAT IS KNOWN ALREADY: AMA oocytes are characterized by diminished quality, mostly due to the higher rates of chromosomal segregation errors occurring during meiosis I. Another hallmark of AMA oocytes is impaired mitochondrial metabolism. Studies in mice have suggested a link between metabolic dysfunction and meiotic failure, but this relationship has not been fully elucidated in humans. Metabolic dynamics can be visualized by indirect measurements through mitochondrial staining and quantified more directly using fluorescence lifetime imaging microscopy (FLIM). This live-imaging approach can generate metabolic timelapse profiles of oocytes throughout meiosis. In the present study, we explored mitochondrial distribution and functionality in human oocytes at the GV and MII stages, obtained from young and AMA women, to establish the role of mitochondrial metabolism in meiosis progression.

STUDY DESIGN, SIZE, DURATION: A total of 340 GV oocytes from young (≤34 years) and AMA (>37 years) women were included in the study. Denuded GVs were matured in vitro in G2-plus medium for 30 h. Maturation was determined by the presence of the extruded first polar body (PB1). The collected oocytes were processed for mitochondrial protein imaging (n = 80), or for live imaging (n = 171). Moreover, 89 oocytes were used for loss-of-function analysis by treating young GVs with 1 μM trifluoromethoxy-carbonylcyanide-phenylhydrazone (FCCP) for 30 min before in vitro maturation.

PARTICIPANTS/MATERIALS, SETTING, METHODS: The proteins dihydrolipoamide-S-acetyltransferase (D-LAT) and translocase-of-outer mitochondrial-membrane (TOMM20) were analyzed in young and AMA oocytes by immunofluorescence to assess mitochondrial activity and localization, respectively. Fluorescence mean intensities (arbitrary-unit, AU) were quantified with ImageJ and compared by t-test; maturation rates were compared by chi-squared test. FLIM comprehensive metabolism (NAD(P)H; FAD+) was taken at GV stage. Different FLIM parameters (fluorescence intensity, fraction bound, short/long lifetime) and the Redox ratio (NAD(P)H intensity/FAD+ intensity) were evaluated.

MAIN RESULTS AND THE ROLE OF CHANCE: The findings revealed that active mitochondria are specifically localized in the subcortical area, while mitochondria in general are distributed across the whole oocyte. This pattern was substantially maintained in AMA oocytes, which were in turn characterized by a lower mitochondrial activity (D-LAT intensity of 78 614 ± 58 534 AU in young, 12 517 ± 10 187 AU in AMA, P = 0.003), while a lower number of mitochondria was observed In AMA patients but the difference did not reach statistical significance (TOMM20 intensity of 61 674 ± 24 322 AU in young, 32 186 ± 33 414 AU in AMA, P = 0.195). Using non-invasive FLIM, we assessed the metabolic dynamics of maturing oocytes (Redox ratio in young 2e + 00 ± 0.15, in AMA 1e + 00 ± 0.16, P = 2.969e-05), confirming a similar pattern observed by immunofluorescence. Specifically, FLIM microscopy revealed that GV oocytes from young women slightly increased their metabolism, by 4% on average, after the GV breakdown, and the increase was very consistent across different oocytes. On the contrary, in AMA maturing oocytes, little to no increase in metabolism was observed; they were characterized instead by higher variability, and more AMA oocytes failed to successfully reach the MII stage [AMA oocytes (62.3%; 38/61) compared with young oocytes (86.3%; 63/73; P = 0.002). These differential trends observed in AMA oocytes compared to the young oocytes suggest that impaired metabolic activity significantly compromises maturation capacity, revealing a functional link between adequate metabolic levels and successful meiosis progression.

LIMITATIONS, REASONS FOR CAUTION: Maturation rates were assessed by the presence of an extruded PB1 and variations in spindle assembly timings may have been overlooked. The quantification of mitochondrial activity in loss-of-function studies was assessed only by immunofluorescence staining. Additionally, the oocytes included in the present study were collected from women who underwent ovarian stimulation and may not faithfully recapitulate physiological maturation.

WIDER IMPLICATIONS OF THE FINDINGS: Our findings demonstrate the presence of a functional link between oocyte mitochondrial metabolism and meiosis progression, which may contribute to the decline of oocyte quality with aging. Overall, we provided evidence to understand the biological mechanisms in mitochondrial metabolism that might contribute to driving the decay in oocyte quality in AMA women.

STUDY FUNDING/COMPETING INTEREST(S): This project received intramural funding from the Eugin Group and funding from the European Union’s Horizon 2020 research and innovation program under the Marie Skłodowska-Curie grant agreement No 860960. T.S. is a former owner and former stock owner of Optiva Fertility Inc (company closed) and filed two patents for Optiva Fertility Inc (both abandoned). D.S.: Presenter EMD Senoro and Dep. Editor of Human Reproduction. All of the other authors (S.P., M.M., M.B., E.I., M.P., R.V., and F.Z.) have no conflicts of interest to declare. All of the authors contributed substantially to the manuscript and approve its submission.

TRIAL REGISTRATION NUMBER: N/A.

PMID:41206610 | DOI:10.1093/humrep/deaf207