| Literature DB >> 35453722 |
Warittha U-Krit1,2, Surasak Wadsungnoen3, Punnawut Yama1, Jakree Jitjumnong4, Molarat Sangkate1, Nalinthip Promsao1, Napatsorn Montha1, Paiwan Sudwan5, Raktham Mektrirat6, Julakorn Panatuk7, Wilasinee Inyawilert8, Payungsuk Intawicha9, Pin-Chi Tang4,10, Tossapol Moonmanee1,11.
Abstract
The antral follicle count (AFC) is a test in which the number of oocyte-containing follicles that are developing in both ovaries are visually counted. The count of these follicles strongly relates to the population of the growing follicle reserve on the ovaries. However, the importance of the main number of antral follicle populations (mAFC) in mono-ovulatory animal species has yet to be completely elucidated. Moreover, the investigation of the ovarian interrelationship with unilateral mAFC (main number of antral follicle populations appearing on only one side of the ovary) and bilateral mAFC (main number of antral follicle populations appearing in equivalent numbers on both sides of the ovary) and how understanding this interrelationship can offer possible indicators of ovarian response to hormonal induction have not yet been investigated in mono-ovulatory Bos indicus beef cows. The aim of this study is to investigate the different ovarian interrelationships of mAFC (unilateral and bilateral mAFC) at the time of exogenous hormonal stimulation on the total number of AFC (left and right ovaries) at the beginning of the hormonal protocol for ovarian stimulation and ovarian response at the completion of exogenous hormonal stimulation as well as their usefulness as possible biomarkers of successful hormonal stimulation in Bos indicus beef cattle. Beef cows (n = 104) with low total numbers of AFC (4.7 ± 2.4 follicles) were stimulated with a gonadotropin-releasing hormone-progesterone-prostaglandin F2α-based protocol. At the beginning of the hormonal protocol, ovarian ultrasound scans were performed to evaluate AFC from both ovaries of cows. Beef cows were divided into two groups, unilateral (n = 74) and bilateral mAFC (n = 30), according to the ovarian interrelationship. At the completion of the hormonal stimulation, ovarian ultrasound scans were performed to evaluate the dominant follicle (DF) and cows with DF > 8.5 mm in diameter emerging on their ovaries were defined as having experienced a response to hormonal stimuli. There was a difference of 19.1% between Bos indicus cows bearing unilateral mAFC that produced an increase in ovarian response (odds ratio = 2.717, p < 0.05) compared to the responsive rate of cows displaying bilateral mAFC (82.4% vs. 63.3%). In unilateral mAFC, cows bearing mAFC ipsilateral to the ovary of dominant follicle (DF) had a higher responsive rate than cows bearing mAFC contralateral to the DF ovary (50.0% vs. 32.4%, p < 0.05). In mAFC ipsilateral to the DF ovary, pregnancy rates were greatest in cows bearing mAFC and DF on the right ovary compared with cows bearing mAFC and DF on the left ovary (25.0% vs. 9.1%, p < 0.05). In primiparous and multiparous cows, unilateral mAFC occurs with a greater (p < 0.05) frequency than bilateral mAFC (69.0% and 72.0% vs. 31.0% and 28.0%, respectively). In unilateral mAFC, primiparous cows bearing mAFC ipsilateral to the DF ovary had a greater responsive rate than primiparous cows bearing mAFC contralateral to the DF ovary (55.0% vs. 20.0%, p < 0.05). In mAFC ipsilateral to the DF ovary, responsive and pregnancy rates were greatest (p < 0.05) in multiparous cows bearing mAFC and DF on the right ovary compared with multiparous cows bearing mAFC and DF on the left ovary (58.1% and 22.6% vs. 25.8% and 3.2%, respectively). Furthermore, there was a positive correlation between the mean diameter of AFC at the time of the exogenous hormonal trigger and the mean diameter of DF at the completion of hormonal synchronisation (p < 0.05). Our findings emphasise that the ovarian interrelationship with unilateral mAFC at the time of the hormonal trigger might be a promising biomarker for predicting success in ovarian response to hormonal stimulation of mono-ovulatory Bos indicus beef cows with low AFCs.Entities:
Keywords: antral follicle growth; dominant follicle; mono-ovulatory animal species; ovarian biology; transrectal ultrasonography
Year: 2022 PMID: 35453722 PMCID: PMC9029639 DOI: 10.3390/biology11040523
Source DB: PubMed Journal: Biology (Basel) ISSN: 2079-7737
Figure 1Illustration of the ovarian interrelationships between mAFC on the day of initiation of hormonal stimulation (day 0) and DF at the completion of hormonal stimulation (day 9) in Bos indicus cows (n = 104). Unilateral mAFC means that the number of antral follicle populations appears on only one side of the ovary. Bilateral mAFC means that the main number of antral follicle populations appears in equivalent numbers on both sides of the ovary. Black circles represent antral follicles (≥3.0 mm in diameter). AFC, antral follicle count; mAFC, main number of antral follicle populations; DF, dominant follicle.
Figure 2Schematic representation of hormonal protocol for ovarian stimulation. CIDR, controlled internal drug release; FTAI, fixed-time artificial insemination; GnRH, gonadotropin-releasing hormone; P4, progesterone; PGF2α, prostaglandin F2α.
The OR for the risk factors contributing to ovarian response of in vivo Bos indicus cow model subjected to the hormonal stimulation (n = 104).
| Variable | Responsive Cows | Nonresponsive Cows | Responsive Rate | OR | 95% CI | |
|---|---|---|---|---|---|---|
| Ovarian interrelationship (Ref = Bilateral mAFC) | ||||||
| Bilateral mAFC 1 | 19 | 11 | 63.3 (19/30) | |||
| Unilateral mAFC 2 | 61 | 13 | 82.4 (61/74) | 2.717 | 1.061–6.953 | 0.037 |
| Parity (Ref = Primiparous) | ||||||
| Primiparous | 20 | 9 | 69.0 (20/29) | |||
| Multiparous | 60 | 15 | 80.0 (60/75) | 1.800 | 0.685–4.732 | 0.233 |
| BCS (Ref = <2.5) | ||||||
| <2.5 | 10 | 5 | 66.7 (10/15) | |||
| 2.5–3.0 | 62 | 18 | 77.5 (62/80) | 1.722 | 0.523–5.671 | 0.371 |
| >3.0 | 8 | 1 | 94.7 (8/9) | 4.000 | 0.409–39.120 | 0.233 |
| Age (Ref = <72 months) | ||||||
| <72 months | 41 | 16 | 71.9 (41/57) | |||
| 72–96 months | 35 | 7 | 83.3 (35/42) | 1.951 | 0.724–5.260 | 0.186 |
| >96 months | 4 | 1 | 80.0 (4/5) | 1.561 | 0.161–15.089 | 0.700 |
1 Bilateral mAFC means that the main number of antral follicle populations appears in equivalent numbers on both sides of the ovary. 2 Unilateral mAFC means that the main number of antral follicle populations appears on only one side of the ovary. mAFC, main number of antral follicle populations; BCS, body condition score; OR, odds ratio; CI, confidence interval.
Frequency of ovarian interrelationships and the impacts of ovarian interrelationships (unilateral and bilateral mAFC) on mean number and diameter of AFC (mean ± SEM), ovarian response, and pregnancy outcomes in in vivo Bos indicus cow model submitted to hormonal stimulation.
| Items | Ovarian Interrelationships ( | ||
|---|---|---|---|
| Unilateral mAFC 1 | Bilateral mAFC 2 | ||
| Total beef cows ( | 74 | 30 | - |
| On day 0 3 | |||
| Frequency relationship (%, | 71.2 (74/104) | 28.8 (30/104) | 0.001 |
| Mean number of AFC from left to right ovaries ( | 4.6 ± 0.27 | 4.7 ± 0.47 | 0.974 |
| Mean diameter of AFC from left to right ovaries (mm) | 4.5 ± 0.16 | 4.2 ± 0.21 | 0.303 |
| On day 9 4 | |||
| Beef cows DF > 8.5 mm in diameter (%, | 82.4 (61/74) | 63.3 (19/30) | 0.037 |
| Mean diameter of DF (mm) | 11.0 ± 0.40 | 10.4 ± 0.63 | 0.412 |
| On day 32 5 | |||
| Pregnancy rate (%, | 35.1 (26/74) | 30.0 (9/30) | 0.617 |
1 Unilateral mAFC means that the main number of antral follicle populations appears on only one side of the ovary. 2 Bilateral mAFC means that the main number of antral follicle populations appears in equivalent numbers on both sides of the ovary. 3 The day of initiation of hormonal stimulation. 4 The day of the FTAI (at the completion of hormonal stimulation). 5 The day of the post-FTAI. AFC, antral follicle count; mAFC, main number of antral follicle populations; FTAI, fixed-time artificial insemination.
Frequency of unilateral mAFC relationships (mAFC ipsilateral and contralateral to the DF ovary) and impact on mean number and diameter of AFC (mean ± SEM), ovarian response, and pregnancy outcomes in in vivo Bos indicus cow model submitted to the hormonal stimulation.
| Items | Unilateral mAFC ( | |||||
|---|---|---|---|---|---|---|
| mAFC Ipsilateral to the DF Ovary | mAFC Contralateral to the DF Ovary | |||||
| mAFC on | mAFC on | Total | mAFC on | mAFC on | Total | |
| Total beef cows ( | 13 | 31 | 44 | 14 | 16 | 30 |
| On day 0 2 | ||||||
| Frequency relationship (%, | 29.5 (13/44) b | 70.5 (31/44) a | 59.5 (44/74) A | 46.7 (14/30) | 53.3 (16/30) | 40.5 (30/74) B |
| Mean number of AFC from left to right ovaries ( | 4.6 ± 0.60 | 4.7 ± 0.42 | 4.7 ± 0.35 | 4.6 ± 0.45 | 4.9 ± 0.70 | 4.6 ± 0.43 |
| Mean diameter of AFC from left to right ovaries (mm) | 4.3 ± 0.29 | 4.3 ± 0.26 | 4.3 ± 0.20 | 4.4 ± 0.21 | 5.0 ± 0.42 | 4.7 ± 0.25 |
| On day 9 3 | ||||||
| Beef cows DF > 8.5 mm in diameter (%, | 27.3 (12/44) b | 56.8 (25/44) a | 50.0 (37/74) A | 36.7 (11/30) | 43.3 (13/30) | 32.4 (24/74) B |
| Mean diameter of DF (mm) | 11.1 ± 0.62 | 11.0 ± 0.63 | 11.0 ± 0.48 | 11.2 ± 1.03 | 10.8 ± 0.89 | 10.9 ± 0.68 |
| On day 32 4 | ||||||
| Pregnancy rate (%, | 9.1 (4/44) b | 25.0 (11/44) a | 20.3 (15/74) | 13.3 (4/30) | 23.3 (7/30) | 14.9 (11/74) |
1 Unilateral mAFC means that the main number of antral follicle populations appears on only one side of the ovary. 2 The day of initiation of hormonal stimulation. 3 The day of the FTAI (at the completion of hormonal stimulation). 4 The day of the post-FTAI. A,B Values with different superscript letters indicate significant differences between mAFC ipsilateral and contralateral to the DF ovary at p-value < 0.05. a,b Values with different superscript letters indicate significant differences between mAFC on the left ovary and the right ovary in mAFC ipsilateral to the DF ovary at p-value < 0.05. AFC, antral follicle count; mAFC, main number of antral follicle populations; DF, dominant follicle; FTAI, fixed-time artificial insemination.
Frequency of mAFC and DF on the left ovary and the right ovary and impact on mean number and diameter of AFC (mean ± SEM), ovarian response, and pregnancy outcomes in in vivo Bos indicus cow model with bilateral mAFC submitted to hormonal stimulation.
| Items | Bilateral mAFC ( | ||
|---|---|---|---|
| mAFC and DF | mAFC and DF | ||
| Total beef cows ( | 15 | 15 | - |
| On day 0 2 | |||
| Frequency relationship (%, | 50.0 (15/30) | 50.0 (15/30) | 1.000 |
| Mean number of AFC from left to right ovaries ( | 4.1 ± 0.44 | 5.2 ± 0.80 | 0.267 |
| Mean diameter of AFC from left to right ovaries (mm) | 4.0 ± 0.27 | 4.4 ± 0.32 | 0.326 |
| On day 9 3 | |||
| Beef cows DF > 8.5 mm in diameter (%, | 53.3 (8/15) | 73.3 (11/15) | 0.264 |
| Mean diameter of DF (mm) | 9.4 ± 1.02 | 11.4 ± 0.63 | 0.116 |
| On day 32 4 | |||
| Pregnancy rate (%, | 26.7 (4/15) | 33.3 (5/15) | 0.695 |
1 Bilateral mAFC means that the main number of antral follicle populations appears in equivalent numbers on both sides of the ovary. 2 The day of initiation of hormonal stimulation. 3 The day of the FTAI (at the completion of hormonal stimulation). 4 The day of the post-FTAI. AFC, antral follicle count; mAFC, main number of antral follicle populations; FTAI, fixed-time artificial insemination.
Frequency of ovarian interrelationships and the impacts of ovarian interrelationships (unilateral and bilateral mAFC) on mean number and diameter of AFC (mean ± SEM), ovarian response, and pregnancy outcomes in primiparous cows submitted to hormonal stimulation.
| Items | Ovarian Interrelationships ( | ||
|---|---|---|---|
| Unilateral mAFC 1 | Bilateral mAFC 2 | ||
| Primiparous beef cows ( | 20 | 9 | - |
| On day 0 3 | |||
| Frequency relationship (%, | 69.0 (20/29) | 31.0 (9/29) | 0.004 |
| Mean number of AFC from left to right ovaries ( | 5.8 ± 0.55 | 4.2 ± 0.49 | 0.059 |
| Mean diameter of AFC from left to right ovaries (mm) | 4.2 ± 0.20 | 4.3 ± 0.41 | 0.867 |
| On day 9 4 | |||
| Primiparous cows DF > 8.5 mm in diameter (%, | 75.0 (15/20) | 55.6 (5/9) | 0.304 |
| Mean diameter of DF (mm) | 10.8 ± 0.89 | 9.2 ± 1.14 | 0.305 |
| On day 32 5 | |||
| Pregnancy rate (%, | 50.0 (10/20) | 33.3 (3/9) | 0.412 |
1 Unilateral mAFC means that the main number of antral follicle populations appears on only one side of the ovary. 2 Bilateral mAFC means that the main number of antral follicle populations appears in equivalent numbers on both sides of the ovary. 3 The day of initiation of hormonal stimulation. 4 The day of the FTAI (at the completion of hormonal stimulation). 5 The day of the post-FTAI. AFC, antral follicle count; mAFC, main number of antral follicle populations; FTAI, fixed-time artificial insemination.
Frequency of unilateral mAFC relationships (mAFC ipsilateral and contralateral to the DF ovary) and impact on mean number and diameter of AFC (mean ± SEM), ovarian response, and pregnancy outcomes in primiparous cows submitted to the hormonal stimulation.
| Items | Unilateral mAFC ( | |||||
|---|---|---|---|---|---|---|
| mAFC Ipsilateral to the DF Ovary | mAFC Contralateral to the DF Ovary | |||||
| mAFC on | mAFC on | Total | mAFC on | mAFC on | Total | |
| Primiparous beef cows ( | 4 | 9 | 13 | 5 | 2 | 7 |
| On day 0 2 | ||||||
| Frequency relationship (%, | 30.8 (4/13) | 69.2 (9/13) | 65.0 (13/20) | 71.4 (5/7) | 28.6 (2/7) | 35.0 (7/20) |
| Mean number of AFC from left to right ovaries ( | 6.8 ± 0.89 | 6.0 ± 0.93 | 6.2 ± 0.71 | 5.0 ± 0.80 | 4.5 ± 1.77 | 4.9 ± 0.77 |
| Mean diameter of AFC from left to right ovaries (mm) | 4.1 ± 0.38 | 4.4 ± 0.30 | 4.3 ± 0.23 | 4.2 ± 0.36 | 4.0 ± 0.82 | 4.1 ± 0.36 |
| On day 9 3 | ||||||
| Primiparous cows DF > 8.5 mm in diameter (%, | 30.8 (4/13) | 53.8 (7/13) | 55.0 (11/20) A | 42.9 (3/7) | 14.3 (1/7) | 20.0 (4/20) B |
| Mean diameter of DF (mm) | 12.6 ± 1.31 | 10.5 ± 1.19 | 10.5 ± 1.17 | 10.2 ± 2.31 | 10.0 ± 2.63 | 11.3 ± 1.33 |
| On day 32 4 | ||||||
| Pregnancy rate (%, | 23.1 (3/13) | 30.8 (4/13) | 35.0 (7/20) | 28.6 (2/7) | 14.3 (1/7) | 15.0 (3/20) |
1 Unilateral mAFC means that the main number of antral follicle populations appears on only one side of the ovary. 2 The day of initiation of hormonal stimulation. 3 The day of the FTAI (at the completion of hormonal stimulation). 4 The day of the post-FTAI. A,B Values with different superscript letters indicate significant differences between mAFC ipsilateral and contralateral to the DF ovary at p-value < 0.05. AFC, antral follicle count; mAFC, main number of antral follicle populations; DF, dominant follicle; FTAI, fixed-time artificial insemination.
Frequency of mAFC and DF on the left ovary and the right ovary and impact on mean number and diameter of AFC (mean ± SEM), ovarian response, and pregnancy outcomes in primiparous cows with bilateral mAFC submitted to hormonal stimulation.
| Items | Bilateral mAFC ( | ||
|---|---|---|---|
| mAFC and DF | mAFC and DF | ||
| Primiparous beef cows ( | 7 | 2 | - |
| On day 0 2 | |||
| Frequency relationship (%, | 77.8 (7/9) | 22.2 (2/9) | 0.022 |
| Mean number of AFC from left to right ovaries ( | 3.7 ± 0.48 | 6.0 ± 0.00 | 0.005 |
| Mean diameter of AFC from left to right ovaries (mm) | 4.4 ± 0.50 | 4.0 ± 0.55 | 0.708 |
| On day 9 3 | |||
| Primiparous cows DF > 8.5 mm in diameter (%, | 57.1 (4/7) | 50.0 (1/2) | 0.866 |
| Mean diameter of DF (mm) | 9.0 ± 1.39 | 9.9 ± 1.51 | 0.747 |
| On day 32 4 | |||
| Pregnancy rate (%, | 28.6 (2/7) | 50.0 (1/2) | 0.593 |
1 Bilateral mAFC means that the main number of antral follicle populations appears in equivalent numbers on both sides of the ovary. 2 The day of initiation of hormonal stimulation. 3 The day of the FTAI (at the completion of hormonal stimulation). 4 The day of the post-FTAI. AFC, antral follicle count; mAFC, main number of antral follicle populations; FTAI, fixed-time artificial insemination.
Frequency of ovarian interrelationships and the impacts of ovarian interrelationships (unilateral and bilateral mAFC) on mean number and diameter of AFC (mean ± SEM), ovarian response, and pregnancy outcomes in multiparous cows submitted to hormonal stimulation.
| Items | Ovarian Interrelationships ( | ||
|---|---|---|---|
| Unilateral mAFC 1 | Bilateral mAFC 2 | ||
| Multiparous beef cows ( | 54 | 21 | - |
| On day 0 3 | |||
| Frequency relationship (%, | 72.0 (54/75) | 28.0 (21/75) | 0.001 |
| Mean number of AFC from left to right ovaries ( | 4.2 ± 0.29 | 4.9 ± 0.63 | 0.389 |
| Mean diameter of AFC from left to right ovaries (mm) | 4.6 ± 0.20 | 3.8 ± 0.18 | 0.190 |
| On day 9 4 | |||
| Multiparous cows DF > 8.5 mm in diameter (%, | 85.2 (46/54) | 66.7 (14/21) | 0.074 |
| Mean diameter of DF (mm) | 11.1 ± 0.43 | 9.7 ± 0.90 | 0.825 |
| On day 32 5 | |||
| Pregnancy rate (%, | 29.6 (16/54) | 28.6 (6/21) | 0.928 |
1 Unilateral mAFC means that the main number of antral follicle populations appears on only one side of the ovary. 2 Bilateral mAFC means that the main number of antral follicle populations appears in equivalent numbers on both sides of the ovary. 3 The day of initiation of hormonal stimulation. 4 The day of the FTAI (at the completion of hormonal stimulation). 5 The day of the post-FTAI. AFC, antral follicle count; mAFC, main number of antral follicle populations; FTAI, fixed-time artificial insemination.
Frequency of unilateral mAFC relationships (mAFC ipsilateral and contralateral to the DF ovary) and impact on mean number and diameter of AFC (mean ± SEM), ovarian response, and pregnancy outcomes in multiparous cows submitted to the hormonal stimulation.
| Items | Unilateral mAFC ( | |||||
|---|---|---|---|---|---|---|
| mAFC Ipsilateral to the DF Ovary | mAFC Contralateral to the DF Ovary | |||||
| mAFC on | mAFC on | Total | mAFC on | mAFC on | Total | |
| Multiparous beef cows ( | 9 | 22 | 31 | 9 | 14 | 23 |
| On day 0 2 | ||||||
| Frequency relationship (%, | 29.0 (9/31) b | 71.0 (22/31) a | 57.4 (31/54) | 39.1 (9/23) | 60.9 (14/23) | 42.6 (23/54) |
| Mean number of AFC from left to right ovaries ( | 3.7 ± 0.52 | 4.1 ± 0.41 | 4.0 ± 0.33 | 4.3 ± 0.52 | 4.8 ± 0.81 | 4.7 ± 0.76 |
| Mean diameter of AFC from left to right ovaries (mm) | 4.4 ± 0.39 | 4.3 ± 0.34 | 4.3 ± 0.27 | 4.5 ± 0.26 | 5.2 ± 0.45 | 4.9 ± 0.30 |
| On day 9 3 | ||||||
| Multiparous cows DF > 8.5 mm in diameter (%, | 25.8 (8/31) b | 58.1 (18/31) a | 48.1 (26/54) | 34.8 (8/23) | 52.2 (12/23) | 37.0 (20/54) |
| Mean diameter of DF (mm) | 10.5 ± 0.56 | 11.2 ± 0.74 | 10.9 ± 0.58 | 11.7 ± 0.92 | 10.9 ± 0.94 | 11.4 ± 0.64 |
| On day 32 4 | ||||||
| Pregnancy rate (%, | 3.2 (1/31) b | 22.6 (7/31) a | 14.8 (8/54) | 8.7 (2/23) | 26.1 (6/23) | 14.8 (8/54) |
1 Unilateral mAFC means that the main number of antral follicle populations appears on only one side of the ovary. 2 The day of initiation of hormonal stimulation. 3 The day of the FTAI (at the completion of hormonal stimulation). 4 The day of the post-FTAI. a,b Values with different superscript letters indicate significant differences between mAFC on the left ovary and the right ovary in mAFC ipsilateral to the DF ovary at p-value < 0.05. AFC, antral follicle count; mAFC, main number of antral follicle populations; DF, dominant follicle; FTAI, fixed-time artificial insemination.
Frequency of mAFC and DF on the left ovary and the right ovary and impact on mean number and diameter of AFC (mean ± SEM), ovarian response, and pregnancy outcomes in multiparous cows with bilateral mAFC submitted to hormonal stimulation.
| Items | Bilateral mAFC ( | ||
|---|---|---|---|
| mAFC and DF | mAFC and DF | ||
| Multiparous beef cows ( | 8 | 13 | - |
| On day 0 2 | |||
| Frequency relationship (%, | 38.1 (8/21) | 61.9 (13/21) | 0.127 |
| Mean number of AFC from left to right ovaries ( | 4.5 ± 0.68 | 5.1 ± 0.91 | 0.636 |
| Mean diameter of AFC from left to right ovaries (mm) | 3.6 ± 0.16 | 4.5 ± 0.35 | 0.046 |
| On day 9 3 | |||
| Multiparous cows DF > 8.5 mm in diameter (%, | 50.0 (4/8) | 76.9 (10/13) | 0.215 |
| Mean diameter of DF (mm) | 9.7 ± 1.46 | 11.6 ± 0.67 | 0.176 |
| On day 32 4 | |||
| Pregnancy rate (%, | 25.0 (2/8) | 30.8 (4/13) | 0.782 |
1 Bilateral mAFC means that the main number of antral follicle populations appears in equivalent numbers on both sides of the ovary. 2 The day of initiation of hormonal stimulation. 3 The day of the FTAI (at the completion of hormonal stimulation). 4 The day of the post-FTAI. AFC, antral follicle count; mAFC, main number of antral follicle populations; FTAI, fixed-time artificial insemination.
Figure 3Associations between mean number and diameter of AFC on the day of initiation of hormonal stimulation (day 0) and mean diameter of DF at the completion of hormonal stimulation (day 9) in all Bos indicus cows ((A,B), n = 104) and in Bos indicus cows with unilateral ((C,D), n = 74) and bilateral mAFC ((E,F), n = 30) relationships.