Some studies have observed increased TSH levels 14 days (D14 TSH) after fresh ET; however, few studies have focused on the impact of D14 TSH after frozen-thawed embryo transfer (FET) on clinical outcomes. In this study, we selected infertile women with basal TSH levels within the normal range and investigated the association between altered TSH levels and clinical outcomes after FET.
Though some studies have reported increased D14 TSH after fresh ET, few studies have focused on the impact of D14 TSH after frozen-thawed embryo transfer (FET) on clinical outcomes, the ideal D14 TSH after FET, whether this parameter matters for clinical outcomes. The purpose of this study was to explore the role of D14 TSH in predicting clinical pregnancy or miscarriage after FET.
Multi-segmental acceleration data was obtained from 25 PD patients performing 134 timed up and go tasks, and clinical assessment of FOG was performed by two experienced raters from video. Four metrics were used to compare objective and clinical measures; the intraclass correlation coefficient (ICC) for number of FOG episodes and the percent time frozen per trial; and the sensitivity and specificity of FOG detection.
The seven-sensor configuration was the most robust, scoring highly on all measures of performance (ICC number of FOG 0.75; ICC percent time frozen 0.80; sensitivity 84.3%; specificity 78.4%). A simpler single-shank sensor approach provided similar ICC values and exhibited a high sensitivity to FOG events, but specificity was lower at 66.7%. Recordings from the lumbar sensor offered only moderate agreement with the clinical raters in terms of absolute number and duration of FOG events (likely due to musculoskeletal attenuation of lower-limb 'trembling' during FOG), but demonstrated a high sensitivity (86.2%) and specificity (82.4%) when considered as a binary test for the presence/absence of FOG within a single trial.
Visual representation of the dataset generated by a single TUG trial. Each of the seven sensors generated an acceleration trace; each trace was processed with sampling windows of 2.5, 5, 7.5 and 10 s to generate four iFOG waveforms (the ratio of freeze to locomotor band power); fourteen binary traces from each of the four iFOG waveforms were then formed using an iFOG threshold of 0.5 to 7 in steps of 0.5, resulting in a total of 56 binary FOG traces per sensor, and 392 per TUG trial. Each binary waveform provided a measure of number of FOG events and the percent time frozen.
The reliability of the quantification of the number of FOG episodes and percent time frozen was calculated between the clinical observers and the objective accelerometer-derived (iFOG) measures using the ICC; the 134-element arrays for frequency, and relative duration of FOG, obtained from clinical assessment were compared to each of the 392 arrays representing the full range of window size (n=4), iFOG thresholds (n=14) and sensor locations (n=7). We used the following classification of ICC power: 0.9 very strong. Sensitivity-specificity analysis assessed the performance of each sensor group as a binary classification test, assuming that the subjective clinical ratings were a true 'gold standard'. For each of the 134-element arrays, sensitivity was defined as the ratio of the number of trials having at least one FOG event as determined from objective acceleration data over the number of trials having at least one FOG event as identified by the clinical raters. Similarly, specificity was defined as the ratio of the number of trials having no FOG activity as determined from objective acceleration data over the number of trials having no FOG activity as identified by the clinical raters.
Twenty out of the twenty-five participants exhibited clinically identifiable FOG during the study. A total of 298 FOG events (range 0-50 per subject; mean 11.9 [S.D. 13.4]) were identified from the video recordings by the clinical raters; percent time frozen averaged 24.1% [SD 24.8] (range 0-72.4%). The frequency and relative duration of FOG determined by the sensors was dependent on three parameters; 1) the sensor location(s), 2) the size of the sampling window, and 3) the iFOG threshold. For example, with a sampling window of 5s and an iFOG threshold of 3 (as shown in Figure 2) the results from all seven sensors (majority vote) were a total of 354 FOG events (range 0-59 per subject; mean 13.9 [S.D. 13.3]), and percent time frozen averaged 22.7% [SD 18.4] (range 0 - 66.3%).
Agreement between clinical assessment and accelerometry (as measured by the intraclass correlation coefficient, ICC) for number of FOG events (A-D) and percent time frozen (E-H), as a function of sensor location, sampling window width, and threshold.
The agreement between clinicians and sensors for percent time frozen was essentially independent of the width of the sampling window (Figure 4E-H). The best performing locations were all seven IMUs (majority vote) and the individual left and right shank sensors, with ICCs>0.7 within a threshold range of 2-4.
Objective identification of the number of FOG events tended towards overestimation relative to the clinical observers; for example, using seven sensors with a 5 s second window and an iFOG threshold of 3 identified 354 discrete FOG events from the 134 TUG trials, 19% higher than the 298 episodes observed by the clinicians. This may be due to the ability of accelerometry to detect subclinical variations in trembling intensity not visible to the naked eye, resulting in a higher FOG count. Moreover, our recent work[10, 24] has demonstrated that percent time frozen is a more robust clinical metric of FOG severity than simply counting the number of freeze events, as it minimizes individual differences in scoring multiple sequential, or one longer, FOG event(s). Agreement (ICC) between 10 movement disorder specialists scoring a set of 14 videos of patients performing the TUG task was 16% higher for percent time frozen relative to number of FOG (our two raters demonstrated a similar relative agreement in the same study, with an ICC of 0.82 for number of FOG and 0.99 for percent time frozen). In the current study, mean percent time frozen (all seven sensors; 5s window, iFOG threshold 3) per subject from accelerometry (22.7%) and clinical observation (24.1%) was in close agreement.
Additional file 1: Agreement between clinical assessment and accelerometry (as measured by the intraclass correlation coefficient, ICC) for number of FOG events and percent time frozen for individual (right and left) thigh and feet sensors. (XLSX 14 KB)
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The frozen section procedure is a pathological laboratory procedure to perform rapid microscopic analysis of a specimen. It is used most often in oncological surgery. The technical name for this procedure is cryosection. The microtome device that cold cuts thin blocks of frozen tissue is called a cryotome.
The quality of the slides produced by frozen section is of lower quality than formalin fixed paraffin embedded tissue processing. While diagnosis can be rendered in many cases, fixed tissue processing is preferred in many conditions for more accurate diagnosis.
The intraoperative consultation is the name given to the whole intervention by the pathologist, which includes not only frozen section but also gross evaluation of the specimen, examination of cytology preparations taken on the specimen (e.g. touch imprints), and aliquoting of the specimen for special studies (e.g. molecular pathology techniques, flow cytometry). The report given by the pathologist is often limited to a \"benign\" or \"malignant\" diagnosis, and communicated to the surgeon operating via intercom. When operating on a previously confirmed malignancy, the main purpose of the pathologist is to inform the surgeon if the resection margin is clear of residual cancer, or if residual cancer is present at the resection margin. The method of processing is usually done with the bread loafing technique. But margin controlled surgery (CCPDMA) can be performed using a variety of tissue cutting and mounting methods, including Mohs surgery.
The frozen section procedure as practiced today in medical laboratories is based on the description by Dr Louis B. Wilson in 1905. Wilson developed the technique from earlier reports at the request of Dr William Mayo, surgeon and one of the founders of the Mayo Clinic  Earlier reports by Dr Thomas S. Cullen at Johns Hopkins Hospital in Baltimore also involved frozen section, but only after formalin fixation, and pathologist Dr William Welch, also at Hopkins, experimented with Cullen's procedure but without clinical consequences. Hence, Wilson is generally credited with truly pioneering the procedure (Gal & Cagle, 2005).
The principal use of the frozen section procedure is the examination of tissue while surgery is taking place. This may be for various reasons. In the performance of Mohs surgery, it is a simple method for real-time margin control of a surgical specimen. If a tumor appears to have metastasized, a sample of the suspected metastasis is sent for cryosection to confirm its identity. This will help the surgeon decide whether there is any point in continuing the operation. Usually, aggressive surgery is performed only if there is a chance to cure the patient. If the tumor has metastasized, surgery is usually not curative, and the surgeon will choose a more conservative surgery, or no resection at all. If a tumor has been resected but it is unclear whether the resection margin is free of tumor, an intraoperative consultation is requested to assess the need to make a further resection for clear margins. In a sentinel node procedure, a sentinel node containing tumor tissue prompts a further lymph node dissection, while a benign node will avoid such a procedure. 153554b96e