Noninvasive

非侵入性
  • 文章类型: Journal Article
    共振频率分析(RFA)对于评估植入物状态很有价值。在之前的调查中,使用激光RFA评估髋臼杯固定,并在体外环境中预测下拉力。虽然下拉力足以进行初始固定评估,需要评估基础的骨强度以进行后续固定。骨骼质量下降会导致微动,迁移,和持久的骨整合,因此,提高了假体周围骨折和内在骨小梁骨失效的敏感性。关于使用RFA评估杯子周围的骨矿物质密度(BMD)的研究有限。对于激光RFA的体内应用,我们实现了扫描脉冲激发方法,并设计了一种创新的激光RFA设备,具有低激光能量和小尺寸。我们专注于特定的频率范围(2500-4500Hz),其中峰值频率被认为受基础密度的影响。使用体模进行定量计算机断层扫描来评估假体周围的BMD。使用新型激光RFA设备在实验室和体内评估指定范围内的共振频率与杯子周围的密度之间的相关性。Kruskal-Wallis检验在两个实验中均显示出稳健的相关性(实验室研究:R=0.728,p<0.001;体内研究:R=0.619,p<0.001)。我们的激光RFA系统可以评估杯子周围骨骼的质量。激光RFA有望预测松动的风险,并可能有助于通过螺钉插入进行额外固定的决策过程。
    Resonance frequency analysis (RFA) is valuable for assessing implant status. In a previous investigation, acetabular cup fixation was assessed using laser RFA and the pull-down force was predicted in an in vitro setting. While the pull-down force alone is sufficient for initial fixation evaluation, it is desirable to evaluate the bone strength of the foundation for subsequent fixation. Diminished bone quality causes micromotion, migration, and protracted osseointegration, consequently elevating susceptibility to periprosthetic fractures and failure of ingrained trabecular bone. Limited research exists on the evaluation of bone mineral density (BMD) around the cup using RFA. For in vivo application of laser RFA, we implemented the sweep pulse excitation method and engineered an innovative laser RFA device having low laser energy and small dimensions. We focused on a specific frequency range (2500-4500 Hz), where the peak frequency was presumed to be influenced by foundational density. Quantitative computed tomography with a phantom was employed to assess periprosthetic BMD. Correlation between the resonance frequency within the designated range and the density around the cup was evaluated both in the laboratory and in vivo using the novel laser RFA device. The Kruskal-Wallis test showed robust correlations in both experiments (laboratory study: R = 0.728, p < 0.001; in vivo study: R = 0.619, p < 0.001). Our laser RFA system can assess the quality of bone surrounding the cup. Laser RFA holds promise in predicting the risk of loosening and might aid in the decision-making process for additional fixation through screw insertion.
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  • 文章类型: Journal Article
    微波和毫米波(MMW)成像技术越来越受到食品检测的关注。它允许非侵入性,非接触式,和快速扫描功能,同时具有成本效益和对人类安全。本文介绍了电磁波与食品材料相互作用的基本原理以及当前用于食品的MMW传感和成像系统。然后,我们介绍了MMW成像中用于检测食品质量和安全性的新兴技术,旨在满足现代食品工业的需求。根据最新的技术进步,预计高性能天线,超宽带宽信号的产生,纳米半导体技术,具有电感电容谐振器的射频识别,和机器学习可以显着增强MMW成像系统用于食品检测的能力。
    The microwave and millimeter-wave (MMW) imaging technology is gaining increasing interest for food inspection. It allows for noninvasive, contactless, and fast scanning capabilities, while being cost-efficient and safe to human. This review paper introduces the fundamentals in the interaction of electromagnetic wave with food materials and the current MMW sensing and imaging systems used for foods. Then we present emerging technologies in MMW imaging for inspecting food quality and safety, aiming to meet the modern food industry\'s demand. According to the most recent technological advancements, it is expected that high-performance antenna, ultrawide bandwidth signal generation, nano-scale semiconductor technologies, radio frequency identification with inductance-capacitance resonator, and machine learning could significantly enhance the capabilities of MMW imaging systems for food inspection.
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  • 文章类型: Journal Article
    皮下间质液中葡萄糖的中红外光谱分析已被广泛用作需要通过皮肤穿刺进行血液采样的标准血糖检测的非侵入性替代方法。但是提高这种替代的置信水平仍然是非常可取的。这里,我们证明了在测量和数据管理中具有创新的属性度量,实现了将我们改进的光谱分析的测试结果与标准检测结果相关联的高精度。首先,我们的比较激光散斑对比成像皮下间质液在指尖,鱼际和小鱼际揭示了小鱼际的光谱测量,使用衰减全反射傅里叶变换红外光谱仪,给出比指尖的刻板印象测量更强烈的信号。第二,我们证明了光谱位置和范围的判别选择,为了最小化频谱干扰并最大化信噪比,至关重要。最佳条带固定在1000±3cm-1和1040±3cm-1之间。第三,我们通过对来自四个受试者的光谱数据进行支持向量回归分析,提出了一个个体排他性预测模型。平均预测决定系数,4名受试者的均方根误差和平均绝对误差分别为0.97、0.21mmol/L,0.17mmol/L,分别,在克拉克误差网格的A区的平均概率为100.00%。此外,我们用Bland和Altman图证明,我们提出的模型与便携式血糖仪检测方法具有最高的一致性。
    Mid-infrared spectral analysis of glucose in subcutaneous interstitial fluid has been widely employed as a noninvasive alternative to the standard blood-glucose detection requiring blood-sampling via skin-puncturing, but improving the confidence level of such a replacement remains highly desirable. Here, we show that with an innovative metric of attributes in measurements and data-management, a high accuracy in correlating the test results of our improved spectral analysis to those of the standard detection is accomplished. First, our comparative laser speckle contrast imaging of subcutaneous interstitial fluid in fingertips, thenar and hypothenar reveal that spectral measurements from hypothenar, with an attenuated total reflection Fourier transform infrared spectrometer, give much stronger signals than the stereotype measurements from fingertips. Second, we demonstrate that discriminative selection of the spectral locations and ranges, to minimize spectral interference and maximize signal-to-noise, are critically important. The optimal band is pinned at that between 1000 ± 3 cm-1 and1040 ± 3 cm-1. Third, we propose an individual exclusive prediction model by adopting the support vector regression analysis of the spectral data from four subjects. The average predicted coefficient of determination, root mean square error and mean absolute error of four subjects are 0.97, 0.21 mmol/L, 0.17 mmol/L, respectively, and the average probability of being in Zone A of the Clark error grid is 100.00 %. Additionally, we demonstrate with the Bland and Altman plot that our proposed model has the highest consistency with portable blood glucose meter detection method.
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  • 文章类型: Journal Article
    目的:微RNA(miRNA)以稳定形式存在于人血清中。循环miRNA越来越被认为是早期癌症检测的有前途的生物标志物。这项研究的目的是鉴定血清miRNA作为壶腹周围腺癌(PAC)的生物标志物。
    方法:本研究招募了68名PAC患者和50名健康对照(HCs)受试者。使用SYBR-green定量逆转录聚合酶链反应(qRT-PCR)方法测定血清样品中11种选择的miRNA的表达水平。使用受试者工作特征(ROC)分析来评估血清miRNA的诊断潜力。
    结果:三种miRNA的表达水平(miR-215-5p,miR-192-5p,与来自HC的血清样品相比,来自PAC患者的血清样品中miR-378a-5p)显着上调(p<0.001)。ROC分析表明,所有三个显著改变的miRNA(miR-215-5p,miR-192-5p,和miR-378a-5p)可能会将PAC患者与HC患者区分开来,AUC值为0.771(95%CI:0.684-0.843),分别为0.877(95%CI:0.799-0.927)和0.768(95%CI:0.674-0.853)。进一步比较显示,这三种血清miRNA(miR-215-5p,miR-192-5p,和miR-378a-5p)可以强烈区分早期PAC患者与HC,AUC值为0.802(95%CI:0.719-0.886),分别为0.870(95%CI:0.793-0.974)和0.793(95%CI:0.706-0.880),可能有助于PAC的早期检测。
    结论:综合来看,我们的研究结果表明,这三个血清miRNA(miR-215-5p,miR-192-5p,和miR-378a-5p)可以作为早期检测PAC的非侵入性生物标志物。
    OBJECTIVE: MicroRNAs (miRNAs) are present in human serum in a stable form. Circulating miRNAs are increasingly recognized as promising biomarkers for early cancer detection. The aim of this study was to identify serum miRNAs as biomarkers for periampullary adenocarcinoma (PAC).
    METHODS: 68 patients with PAC and 50 healthy controls (HCs) subjects were recruited in this study. The expression levels of 11 selected miRNAs were determined in serum samples using the SYBR-green quantitative reverse transcription polymerase chain reaction (qRT-PCR) method. Receiver operating characteristic (ROC) analysis was used to evaluate the diagnostic potential of serum miRNAs.
    RESULTS: The expression levels of three miRNAs (miR-215-5p, miR-192-5p, and miR-378a-5p) were significantly upregulated in the serum samples derived from the PAC patients compared with those from the HC (p < 0.001). The ROC analysis showed that all three significantly altered miRNAs (miR-215-5p, miR-192-5p, and miR-378a-5p) could potentially discriminate patients with PAC from HC with AUC value of 0.771 (95% CI: 0.684-0.843), 0.877 (95% CI: 0.799-0.927) and 0.768 (95% CI: 0.674-0.853) respectively. Further comparisons showed that these three serum miRNAs (miR-215-5p, miR-192-5p, and miR-378a-5p) can strongly discriminate early-stage PAC patients from HC with an AUC value of 0.802 (95% CI: 0.719-0.886), 0.870 (95% CI: 0.793-0.974) and 0.793 (95% CI: 0.706-0.880) respectively, may aid in early detection of PAC.
    CONCLUSIONS: Taken together, our findings demonstrated that these three serum miRNAs (miR-215-5p, miR-192-5p, and miR-378a-5p) may serve as noninvasive biomarkers for the early detection of PAC.
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  • 文章类型: Journal Article
    由于分子亚组测试的广泛难以接近和数据匮乏,阻碍了髓母细胞瘤的全球调查。为了弥合这个差距,我们建立了一个国际分子特征数据库,包括来自中国和美国13个中心的934例髓母细胞瘤患者.我们展示了基于图像的机器学习策略如何有潜力为非侵入性创建替代途径,术前,和低成本分子亚群预测在髓母细胞瘤临床治疗中的应用。我们强大的验证策略-包括交叉验证,外部验证,和连续验证-证明模型作为可推广的分子诊断分类器的功效。对MRI特征的详细分析通过细微的射线照相透镜补充了对髓母细胞瘤的理解。此外,东亚和北美子集之间的比较突出了关键的管理意义。我们制作了这个全面的数据集,其中包括MRI特征,临床病理特征,治疗变量,和生存数据,公开可用于推进全球髓母细胞瘤研究。
    Global investigation of medulloblastoma has been hindered by the widespread inaccessibility of molecular subgroup testing and paucity of data. To bridge this gap, we established an international molecularly characterized database encompassing 934 medulloblastoma patients from thirteen centers across China and the United States. We demonstrate how image-based machine learning strategies have the potential to create an alternative pathway for non-invasive, presurgical, and low-cost molecular subgroup prediction in the clinical management of medulloblastoma. Our robust validation strategies-including cross-validation, external validation, and consecutive validation-demonstrate the model\'s efficacy as a generalizable molecular diagnosis classifier. The detailed analysis of MRI characteristics replenishes the understanding of medulloblastoma through a nuanced radiographic lens. Additionally, comparisons between East Asia and North America subsets highlight critical management implications. We made this comprehensive dataset, which includes MRI signatures, clinicopathological features, treatment variables, and survival data, publicly available to advance global medulloblastoma research.
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  • 文章类型: Journal Article
    射血分数降低(HFrEF)的心力衰竭的特征是心室重塑和心肌能量受损。可以使用心血管磁共振(CMR)成像非侵入性地进行左心室压力-容积(PV)环分析,以评估心脏热力学效率。
    这项研究的目的是调查非侵入性PV环参数,源自CMR,可以预测HFrEF患者的主要不良心脏事件(MACE)。
    PV回路参数(冲程功,心室效率,外部电源,收缩性,和每个喷射体积的能量)是从CMR电影图像和肱动脉血压计算得出的。主要终点是MACE(心血管死亡,心力衰竭(HF)住院治疗,心肌梗塞,血运重建,室性心动过速/纤颤,心脏移植,或5年内植入左心室辅助装置)。使用多变量Cox回归评估PV环路参数与MACE之间的关联。
    164名HFrEF患者(左心室射血分数≤40%,年龄63[IQR:55-70]岁,79%的男性)在2004年至2014年期间接受了临床CMR检查。88例患者(54%)在平均2.8年后至少经历了一次MACE。未调整模型显示MACE与所有肺静脉环路参数之间存在显着关联(全部P<0.05),HF病因(P<0.001),左心室射血分数(P=0.003),全局纵向应变(P<0.001),和N末端脑钠肽激素原水平(P=0.001)。在校正年龄的多变量Cox回归分析中,性别,高血压,糖尿病,和HF病因,心室效率与MACE相关(HR:1.04(95%CI:1.01-1.08)百分比下降,P=0.01)。
    心室效率,来自标准CMR扫描的非侵入性PV环路分析,与HFrEF患者的MACE有关。
    UNASSIGNED: Heart failure with reduced ejection fraction (HFrEF) is characterized by ventricular remodeling and impaired myocardial energetics. Left ventricular pressure-volume (PV) loop analysis can be performed noninvasively using cardiovascular magnetic resonance (CMR) imaging to assess cardiac thermodynamic efficiency.
    UNASSIGNED: The aim of the study was to investigate whether noninvasive PV loop parameters, derived from CMR, could predict major adverse cardiac events (MACE) in HFrEF patients.
    UNASSIGNED: PV loop parameters (stroke work, ventricular efficiency, external power, contractility, and energy per ejected volume) were computed from CMR cine images and brachial blood pressure. The primary end point was MACE (cardiovascular death, heart failure (HF) hospitalization, myocardial infarction, revascularization, ventricular tachycardia/fibrillation, heart transplantation, or left ventricular assist device implantation within 5 years). Associations between PV loop parameters and MACE were evaluated using multivariable Cox regression.
    UNASSIGNED: One hundred and sixty-four HFrEF patients (left ventricular ejection fraction ≤40%, age 63 [IQR: 55-70] years, 79% male) who underwent clinical CMR examination between 2004 and 2014 were included. Eighty-eight patients (54%) experienced at least one MACE after an average of 2.8 years. Unadjusted models demonstrated a significant association between MACE and all PV loop parameters (P < 0.05 for all), HF etiology (P < 0.001), left ventricular ejection fraction (P = 0.003), global longitudinal strain (P < 0.001), and N-terminal prohormone of brain natriuretic peptide level (P = 0.001). In the multivariable Cox regression analysis adjusted for age, sex, hypertension, diabetes, and HF etiology, ventricular efficiency was associated with MACE (HR: 1.04 (95% CI: 1.01-1.08) per-% decrease, P = 0.01).
    UNASSIGNED: Ventricular efficiency, derived from noninvasive PV loop analysis from standard CMR scans, is associated with MACE in patients with HFrEF.
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  • 文章类型: Journal Article
    监测术中血压(BP)至关重要。我们的目的是比较全身麻醉(GA)在正常血压期间通过侵入性和非侵入性方法同时记录的BP值,高血压,和低血压。还将通过自动化技术计算的平均动脉压(MAP)值与使用预定义公式获得的值进行比较。
    观测,前瞻性研究是在GA下接受择期手术的250例成年患者中进行的。诱导前,使用自动振荡器在仰卧位的手臂中测量无创血压(NIBP).对臂桡动脉插管。血压正常时同时记录NIBP和动脉血压(ABP),低血压,和高血压。
    在正常血压和高血压期间,NIBP和ABP测量的收缩压(SBP)具有可比性。NIBP患者血压正常时舒张压(DBP)和MAP明显升高(73.65±7.73vs.65.69±8.39和87.79±8.43vs.分别为84.24±8.82)。在高血压期间,DBP和MAP明显高于NIBP(90.44±11.61vs.78.59±11.09和111.67±10.43vs.分别为105.63±11.06)。在低血压期间,ABP患者的SBP明显高于ABP(91.14±6.90vs.86.24±6.06),DBP和MAP具有可比性。通过ABP和NIBP技术测量的MAP与使用预定义公式在常压下计算的MAP的比较显示,自动化技术的值明显更高。
    在正常血压和高血压期间,与ABP相比,NIBP技术的DBP和MAP显示出明显更高的值,具有可比的SBP值。在低血压期间,使用ABP技术,SBP显示出明显更高的值,具有可比性的DBP和MAP。使用预定义公式和自动化方法在常压下获得的MAP明显高于自动化技术。
    UNASSIGNED: Monitoring of intraoperative blood pressure (BP) is essential. We aimed to compare BP values simultaneously recorded by invasive and noninvasive methods under general anesthesia (GA) during normotension, hypertension, and hypotension. Mean arterial pressure (MAP) values calculated by the automated technique were also compared to the values obtained using predefined formula.
    UNASSIGNED: An observational, prospective study was conducted in 250 adult patients undergoing elective surgeries under GA. Before induction, noninvasive blood pressure (NIBP) was measured in the arm in a supine position using an automated oscillometer. Radial artery in the opposite arm was cannulated. NIBP and arterial BP (ABP) were recorded simultaneously during normotension, hypotension, and hypertension.
    UNASSIGNED: During normotension and hypertension, systolic BP (SBP) measured by NIBP and ABP were comparable. Diastolic BP (DBP) and MAP during normotension were significantly higher with NIBP (73.65 ± 7.73 vs. 65.69 ± 8.39 and 87.79 ± 8.43 vs. 84.24 ± 8.82, respectively). During hypertension, DBP and MAP were significantly higher with NIBP (90.44 ± 11.61 vs. 78.59 ± 11.09 and 111.67 ± 10.43 vs. 105.63 ± 11.06, respectively). During hypotension, SBP was significantly higher in ABP (91.14 ± 6.90 vs. 86.24 ± 6.06), and DBP and MAP were comparable. Comparison of MAP measured by ABP and NIBP techniques with the MAP calculated using predefined formula in normotension showed significantly higher values with the automated technique.
    UNASSIGNED: During normotension and hypertension, DBP and MAP showed significantly higher values with the NIBP technique compared to ABP, with comparable SBP values. During hypotension, SBP showed significantly higher values with the ABP technique, with comparable DBP and MAP. MAP obtained using predefined formula and automated method in normotension was significantly higher with the automated technique.
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  • 文章类型: Journal Article
    背景非侵入性成像模式的主要发展,与传统的计算机断层扫描(CT)和胶囊内窥镜检查相比,计算机断层成像(CTE)具有许多优势.通过利用多探测器计算机断层扫描(MDCT)技术,CTE加快了对小肠疾病的评估,特别是在那些无法通过传统内窥镜检查的部分。本研究的主要目标是全面评估CTE对一系列小肠疾病的诊断准确性。方法论在这次调查中,这是一项前瞻性观察研究,40名患者,25男15女,怀疑小肠疾病和年龄范围从10到70接受CTE。为了评估诊断的准确性,临床症状的组合,成像数据,和组织病理学/超声检查结果进行了评估。在整个研究过程中,纳入了伦理问题和统计分析,以保证有效性和遵守伦理规范。结果CTE最常见的表现是肠管增厚和粘膜过度增强,在25例(62.5%)和20例(50%)患者中观察到,分别。大多数患者(65%)在III级中表现出回肠和空肠环充分扩张。在35%的患者中,观察到回肠和空肠环的II级扩张性。结论在准确检测小肠疾病时,CTE优越。它评估肠外,壁画,和具有疗效的腔内疾病,特别是在难以到达的地方。它对于指导临床决策至关重要,因为它有能力在内窥镜检查之前评估疾病活动并查看后果。
    Background A major development in noninvasive imaging modalities, computed tomographic enterography (CTE) has a number of benefits over conventional computed tomography (CT) and capsule endoscopy. Through the utilization of multidetector computed tomography (MDCT) technology, CTE expedites the assessment of small bowel diseases, especially in those segments that are not accessible through traditional endoscopy. This study\'s main goal is to thoroughly evaluate CTE\'s diagnostic accuracy for a range of small intestinal conditions. Methodology In this investigation, which is a prospective observational study, 40 patients, 25 men and 15 women, with suspected small intestinal disorders and ages ranging from 10 to 70 underwent CTE. To evaluate diagnosis accuracy, a combination of clinical symptoms, imaging data, and histopathological/ultrasonography findings were evaluated. Throughout the research procedure, ethical issues and statistical analysis were incorporated to guarantee validity and adherence to ethical norms. Results The most frequent findings on CTE were bowel thickening and mucosal hyperenhancement, which were seen in 25 (62.5%) and 20 (50%) of the patients, respectively. The majority of patients (65%) exhibited both the ileal and jejunal loops to be adequately distended in grade III. In 35% of the patients, grade II distensibility of the ileal and jejunal loops was seen. Conclusion When it comes to accurately detecting small intestinal disorders, CTE is superior. It evaluates extraintestinal, mural, and intraluminal diseases with efficacy, particularly in places that are difficult to reach. It is essential for directing clinical decisions because of its capacity to assess disease activity prior to endoscopy and see consequences.
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  • 文章类型: Journal Article
    非酒精性脂肪性肝病(NAFLD),在全球最常见的慢性肝病中,影响了大约25%的全球人口。由于各种危险因素,其发病率正在增加,包括遗传变异,代谢健康,饮食习惯,和微生物群。肝脏脂肪变性是NAFLD的关键组织学特征。评估肝脏脂肪含量对于识别和跟踪有发展NAFLD风险的患者至关重要。NAFLD包括简单的肝脏脂肪变性和更严重的形式,如炎症,非酒精性脂肪性肝炎,纤维化,和肝硬化。脂肪肝的早期评估对于逆转肝脏疾病进展很重要。代谢(功能障碍)相关的脂肪肝疾病最近取代NAFLD成为全球最常见的肝病。本文回顾了无创成像的现状,尤其是超声波,用于肝脏脂肪定量。
    Nonalcoholic fatty liver disease (NAFLD), among the most common chronic liver diseases worldwide, affects approximately 25% of the global population. Its incidence is increasing owing to various risk factors, including genetic variation, metabolic health, dietary habits, and microbiota. Hepatic steatosis is a critical histological characteristic of NAFLD. Evaluating liver fat content is vital for identifying and following up with patients at risk of developing NAFLD. NAFLD includes simple liver steatosis and more severe forms such as inflammation, nonalcoholic steatohepatitis, fibrosis, and cirrhosis. The early assessment of fatty liver is important for reversing liver disease progression. Metabolic (dysfunction)-associated fatty liver disease recently replaced NAFLD as the most common hepatic disease worldwide. This article reviews the current state of noninvasive imaging, especially ultrasound, for liver fat quantification.
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    当代辅助生殖技术研究的主要目标之一是实现健康的单胎出生并改善总体生育结果。在改进单个胚胎移植的选择方面取得了重大进展,目的是最大限度地提高成功植入的可能性。这种选择的主要标准是胚胎形态。形态学评估系统是基于传统的参数,包括细胞计数和碎片,原核形态,卵裂率,囊胚形成,和各种顺序胚胎评估。为了减少多胎妊娠的发生率,并确定具有最高生长潜力的单个胚胎,植入前遗传筛查等侵入性技术被用于体外受精诊所。然而,新的方法已经被建议用于临床应用,不伤害胚胎,并提供一致的,准确的结果。非侵入性技术,比如延时成像和组学,利用形态动力学参数和胚胎代谢的副产物,分别,为有能力的单胚胎选择确定非侵入性预后标志物。虽然这些技术在研究界引起了相当大的兴趣,它们尚未纳入常规临床实践,仍有很大的改进空间。目前,最有前途的策略包括整合多种方法,预计这些因素加在一起会增加成功怀孕的可能性。
    Among the primary objectives of contemporary assisted reproductive technology research are achieving the births of healthy singletons and improving overall fertility outcomes. Substantial advances have been made in refining the selection of single embryos for transfer, with the aim of maximizing the likelihood of successful implantation. The principal criterion for this selection is embryo morphology. Morphological evaluation systems are based on traditional parameters, including cell count and fragmentation, pronuclear morphology, cleavage rate, blastocyst formation, and various sequential embryonic assessments. To reduce the incidence of multiple pregnancies and to identify the single embryo with the highest potential for growth, invasive techniques such as preimplantation genetic screening are employed in in vitro fertilization clinics. However, new approaches have been suggested for clinical application that do not harm the embryo and that provide consistent, accurate results. Noninvasive technologies, such as time-lapse imaging and omics, leverage morphokinetic parameters and the byproducts of embryo metabolism, respectively, to identify noninvasive prognostic markers for competent single embryo selection. While these technologies have garnered considerable interest in the research community, they are not incorporated into routine clinical practice and still have substantial room for improvement. Currently, the most promising strategies involve integrating multiple methodologies, which together are anticipated to increase the likelihood of successful pregnancy.
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