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Dominguez JA, Pacheco LA, Moratalla E, Carugno JA, Carrera M, Perez-Milan F, Caballero M, Alcázar JL. Diagnosis and management of isthmocele (Cesarean scar defect): a SWOT analysis. Ultrasound Obstet Gynecol 2023; 62:336-344. [PMID: 36730180 DOI: 10.1002/uog.26171] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 12/28/2022] [Accepted: 01/17/2023] [Indexed: 06/18/2023]
Abstract
The purpose of this State-of-the-Art Review was to provide a strategic analysis, in terms of strengths, weaknesses, opportunities and threats (SWOT analysis), of the current evidence regarding the management of uterine isthmocele (Cesarean scar defect). Strengths include the fact that isthmocele can be diagnosed on two-dimensional transvaginal ultrasound, and that surgical repair may restore natural fertility potential and prevent secondary infertility, as well as reduce the risk of miscarriage and other obstetric complications. However, there is a lack of high-quality evidence regarding the best diagnostic method and criteria, as well as the potential benefits of surgical repair with respect to fertility. There is a need for experienced surgeons skilled in the various isthmocele repair techniques. Isthmocele repair does not prevent the need for Cesarean delivery in subsequent pregnancies. There is increasing awareness regarding the accuracy of transvaginal ultrasound in diagnosing isthmocele. This may lead to surgical correction and prevention of obstetric and perinatal complications in subsequent pregnancies, including Cesarean scar pregnancy. Regarding threats, the existence of different surgical techniques means that there is a risk of selecting an inadequate approach if the type of isthmocele and the patient's characteristics are not considered. There is a risk of overtreatment when asymptomatic defects are repaired surgically. Finally, there is an absence of cost-effectiveness analyses to justify routine repair. Thus, while there are many data suggesting that isthmocele has an adverse effect on both natural fertility and the outcome of assisted reproduction techniques, high-quality evidence to support surgical isthmocele repair in all asymptomatic patients desiring future fertility are lacking. There is increasing agreement to recommend hysteroscopic repair of isthmocele as a first-line approach as long as the residual myometrial thickness is at least 2.5-3.0 mm. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- J A Dominguez
- IERA (Instituto Extremeño de Reproducción Asistida), Badajoz, Spain
| | | | - E Moratalla
- Department of Obstetrics and Gynecology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - J A Carugno
- Minimally Invasive Gynecology Division, University of Miami, Miami, FL, USA
| | - M Carrera
- Department Obstetrics and Gynecology, Hospital Universitario Doce de Octubre, Madrid, Spain
| | - F Perez-Milan
- Department of Obstetrics and Gynecology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - M Caballero
- Department of Obstetrics and Gynecology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - J L Alcázar
- Department of Obstetrics and Gynecology, Clínica Universidad de Navarra, Pamplona, Spain
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Alcalá Vicente C, Lacruz L, Gascón F, Carratalà S, Quintanilla-Bordás C, Sanz MT, Carcelén-Gadea M, Mallada J, Carreres J, Gabaldón Torres L, Dominguez JA, Cañizares E, Gil-Perotin S, Cubas L, Gasqué Rubio R, Castillo-Villalba J, Pérez-Miralles FC, Casanova B. Oligoclonal M bands and cervical spinal cord lesions predict early secondary progressive multiple sclerosis. Front Neurol 2022; 13:991596. [DOI: 10.3389/fneur.2022.991596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 09/26/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveTo determine baseline cerebrospinal fluid and magnetic resonance imaging (MRI) variables at the onset of a clinically isolated syndrome (CIS) suggestive of multiple sclerosis (MS) that predict evolution to secondary progressive MS (SPMS).Methods276 CIS patients with a minimum follow-up of 10 years were studied. Baseline presence of oligoclonal IgG and IgM bands (OCGB and OCMB respectively); number of brain T2 lesions (B-T2L), brain gadolinium enhancement lesions (brain-GEL), cervical spinal cord T2 lesions (cSC-T2L); and fulfillment of 2017 McDonald criteria among other variables were collected.Results14 patients ended up with a non-MS condition. 138/276 CIS patients fulfilled 2017 McDonald criteria. Mean age was 32.4 years, 185 female. 227 received treatment, 95 as CIS. After a mean follow-up of 12 years, 36 patients developed SPMS. Conversion to SPMS was associated with OCGB (p = 0.02), OCMB (p = 0.0001); ≥ 9 B-T2L (p = 0.03), brain-GEL (p = 0.03), and cSC-T2L (p = 0.03). However, after adjusting for sex, age, BT2L, brain-GEL, SC-T2, and OCMB status, only OCMB (HR 4.4, 1.9–10.6) and cSC-T2L (HR 2.2, 1.0–6.2) suggested an independent association with risk of conversion to SPMS. Patients with both risk factors had a HR of 6.12 (2.8–12.9).DiscussionOCMB and SC-T2 lesions are potential independent predictors of conversion to SPMS.
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3
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Sharmin S, Bovis F, Malpas C, Horakova D, Havrdova EK, Izquierdo G, Eichau S, Trojano M, Prat A, Girard M, Duquette P, Onofrj M, Lugaresi A, Grand'Maison F, Grammond P, Sola P, Ferraro D, Terzi M, Gerlach O, Alroughani R, Boz C, Shaygannejad V, van Pesch V, Cartechini E, Kappos L, Lechner-Scott J, Bergamaschi R, Turkoglu R, Solaro C, Iuliano G, Granella F, Van Wijmeersch B, Spitaleri D, Slee M, McCombe P, Prevost J, Ampapa R, Ozakbas S, Sanchez-Menoyo JL, Soysal A, Vucic S, Petersen T, de Gans K, Butler E, Hodgkinson S, Sidhom Y, Gouider R, Cristiano E, Castillo-Triviño T, Saladino ML, Barnett M, Moore F, Rozsa C, Yamout B, Skibina O, van der Walt A, Buzzard K, Gray O, Hughes S, Perez Sempere A, Singhal B, Fragoso Y, Shaw C, Kermode A, Taylor B, Simo M, Shuey N, Al-Harbi T, Macdonell R, Dominguez JA, Csepany T, Sirbu CA, Sormani MP, Butzkueven H, Kalincik T. Confirmed disability progression as a marker of permanent disability in multiple sclerosis. Eur J Neurol 2022; 29:2321-2334. [PMID: 35582938 PMCID: PMC9539581 DOI: 10.1111/ene.15406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 05/05/2022] [Indexed: 11/30/2022]
Abstract
Background and purpose The prevention of disability over the long term is the main treatment goal in multiple sclerosis (MS); however, randomized clinical trials evaluate only short‐term treatment effects on disability. This study aimed to define criteria for 6‐month confirmed disability progression events of MS with a high probability of resulting in sustained long‐term disability worsening. Methods In total, 14,802 6‐month confirmed disability progression events were identified in 8741 patients from the global MSBase registry. For each 6‐month confirmed progression event (13,321 in the development and 1481 in the validation cohort), a sustained progression score was calculated based on the demographic and clinical characteristics at the time of progression that were predictive of long‐term disability worsening. The score was externally validated in the Cladribine Tablets Treating Multiple Sclerosis Orally (CLARITY) trial. Results The score was based on age, sex, MS phenotype, relapse activity, disability score and its change from baseline, number of affected functional system domains and worsening in six of the domains. In the internal validation cohort, a 61% lower chance of improvement was estimated with each unit increase in the score (hazard ratio 0.39, 95% confidence interval 0.29–0.52; discriminatory index 0.89). The proportions of progression events sustained at 5 years stratified by the score were 1: 72%; 2: 88%; 3: 94%; 4: 100%. The results of the CLARITY trial were confirmed for reduction of disability progression that was >88% likely to be sustained (events with score ˃1.5). Conclusions Clinicodemographic characteristics of 6‐month confirmed disability progression events identify those at high risk of sustained long‐term disability. This knowledge will allow future trials to better assess the effect of therapy on long‐term disability accrual.
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Affiliation(s)
- Sifat Sharmin
- CORe, Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Francesca Bovis
- Department of Health Sciences (DISSAL), University of Genoa, Italy
| | - Charles Malpas
- CORe, Department of Medicine, University of Melbourne, Melbourne, Australia.,Melbourne MS Centre, Department of Neurology, Royal Melbourne Hospital, Melbourne, Australia
| | - Dana Horakova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - Eva Kubala Havrdova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
| | | | - Sara Eichau
- Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Maria Trojano
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, Bari, Italy
| | - Alexandre Prat
- Hopital Notre Dame, Montreal, Canada; CHUM and Universite de Montreal, Montreal, Canada
| | - Marc Girard
- Hopital Notre Dame, Montreal, Canada; CHUM and Universite de Montreal, Montreal, Canada
| | - Pierre Duquette
- Hopital Notre Dame, Montreal, Canada; CHUM and Universite de Montreal, Montreal, Canada
| | - Marco Onofrj
- Department of Neuroscience, Imaging, and Clinical Sciences, University G. d'Annunzio, Chieti, Italy
| | - Alessandra Lugaresi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italia; Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italia
| | | | | | - Patrizia Sola
- Department of Neuroscience, Azienda Ospedaliera Universitaria, Modena, Italy
| | - Diana Ferraro
- Department of Neuroscience, Azienda Ospedaliera Universitaria, Modena, Italy
| | - Murat Terzi
- Medical Faculty, 19 Mayis University, Samsun, Turkey
| | - Oliver Gerlach
- Department of Neurology, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
| | - Raed Alroughani
- Division of Neurology, Department of Medicine, Amiri Hospital, Sharq, Kuwait
| | - Cavit Boz
- KTU Medical Faculty Farabi Hospital, Trabzon, Turkey
| | | | - Vincent van Pesch
- Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | | | - Ludwig Kappos
- Neurologic Clinic and Policlinic, Departments of Medicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland
| | - Jeannette Lechner-Scott
- School of Medicine and Public Health, University Newcastle, Newcastle, Australia; Department of Neurology, John Hunter Hospital, Hunter New England Health, Newcastle, Australia
| | | | - Recai Turkoglu
- Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Claudio Solaro
- Department of Rehabilitaiton, ML Novarese Hospital Moncrivello, Italy
| | | | - Franco Granella
- Department of Medicine and Surgery, University of Parma, Parma, Italy; Department of General Medicine, Parma University Hospital, Parma, Italy
| | - Bart Van Wijmeersch
- Rehabilitation and MS-Centre Overpelt and Hasselt University, Hasselt, Belgium
| | - Daniele Spitaleri
- Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati Avellino, Avellino, Italy
| | - Mark Slee
- Flinders University, Adelaide, Australia
| | - Pamela McCombe
- University of Queensland, Brisbane, Australia; Royal Brisbane and Women's Hospital, Brisbane, Australia
| | | | | | | | | | - Aysun Soysal
- Bakirkoy Education and Research Hospital for Psychiatric and Neurological Diseases, Istanbul, Turkey
| | | | | | | | | | | | - Youssef Sidhom
- Department of Neurology, Razi Hospital, Manouba, Tunisia
| | - Riadh Gouider
- Department of Neurology, Razi Hospital, Manouba, Tunisia
| | | | - Tamara Castillo-Triviño
- Instituto de Investigación Sanitaria Biodonostia, Department of Neurology, Hospital Universitario Donostia, San Sebastián, Spain
| | | | | | | | - Csilla Rozsa
- Jahn Ferenc Teaching Hospital, Budapest, Hungary
| | - Bassem Yamout
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon
| | - Olga Skibina
- Central Clinical School, Monash University, Melbourne, Australia; Department of Neurology, The Alfred Hospital, Melbourne, Australia
| | - Anneke van der Walt
- Central Clinical School, Monash University, Melbourne, Australia; Department of Neurology, The Alfred Hospital, Melbourne, Australia
| | - Katherine Buzzard
- Central Clinical School, Monash University, Melbourne, Australia; Department of Neurology, The Alfred Hospital, Melbourne, Australia
| | - Orla Gray
- South East Trust, Belfast, United Kingdom
| | | | | | - Bhim Singhal
- Bombay Hospital Institute of Medical Sciences, Mumbai, India
| | - Yara Fragoso
- Universidade Metropolitana de Santos, Santos, Brazil
| | | | - Allan Kermode
- Perron Institute, University of Western Australia, Nedlands, Australia; Institute of Immunology and Infectious Diseases, Murdoch University, Sir Charles Gairdner Hospital, Perth, Australia
| | | | | | - Neil Shuey
- St Vincents Hospital, Fitzroy, Melbourne, Australia
| | - Talal Al-Harbi
- Neurology Department, King Fahad Specialist Hospital-, Dammam, Saudi Arabia
| | | | | | - Tunde Csepany
- Department of Neurology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Carmen Adella Sirbu
- Titu Maiorescu University, Central Military Emergency University Hospital, Bucharest, Romania
| | | | - Helmut Butzkueven
- Central Clinical School, Monash University, Melbourne, Australia; Department of Neurology, The Alfred Hospital, Melbourne, Australia
| | - Tomas Kalincik
- CORe, Department of Medicine, University of Melbourne, Melbourne, Australia.,Melbourne MS Centre, Department of Neurology, Royal Melbourne Hospital, Melbourne, Australia
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Mataro D, Cuevas-Saiz I, Castilla JA, Dominguez JA, Prados N, Buch B, González López de Bustamante B, Prados FJ, Ruiz-Jorro M, Gomez JL, De la Fuente L, Devesa M, Muñoz-Cantero M, Pardos C, Martinez L. O-104 Low SARS-CoV-2 positivity rate in women included in ART programs following the recommendations of the Spanish scientific societies on reproduction (SEF/ASEBIR). Hum Reprod 2021. [PMCID: PMC8385905 DOI: 10.1093/humrep/deab126.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Study question
What is the SARS-CoV-2 positivity rate following the Spanish Fertility Society (SEF)/Association for the Study of Reproductive Biology (ASEBIR) screening recommendations?
Summary answer
The SARS-CoV-2 positivity rate in the centers following the SEF/ASEBIR screening recommendations was 0.316% after the first survey and 0.364% after the second one
What is known already
Due to the Sars-Cov-2 pandemic, all the Medical Assisted Reproduction (MAR) centers in Spain had to interrupt their activity most of the time during the first pandemic wave. On April 27th activity was restarted, and SEF and ASEBIR jointly elaborated a guide describing their SARS-CoV-2 screening recommendations for MAR centers. This document aims to achieve a safe environment for patients and staff. It includes the possibility of screening patients through a targeted clinical interview and the use of reverse-transcriptase polymerase chain reaction (RT-PCR). The aim of this study is to quantify the SARS-CoV-2 positivity rate based on these recommendations.
Study design, size, duration
National multicenter cross-sectional study. Information was gathered from centers using an anonymous survey asking for aggregated data about the number of positive cases among screened patients, sent twice. The first survey covered the period April 27th - June 30th. Second survey covered July 1st - August 31st. Response rates among centres were 9% (29/319) and 6% (20/319), respectively. This study includes 2,695 and 4,068 screenings performed in the first and the second survey, respectively.
Participants/materials, setting, methods
The SEF/ASEBIR recommendations describe two screening strategies. Strategy (a) consists in a targeted clinical interview (TCI) evaluating clinical symptoms and exposure risk, first before starting the cycle, and before egg-retrieval, intrauterine insemination (IUI), and/or embryo transfer (ET). Suspicious cases could be confirmed by further RT-PCR testing. Strategy (b) consists in conducting the same first TCI, and a systematic RT-PCR testing before the medical procedure in all patients. All patients in both strategies have a TCI.
Main results and the role of chance
In the 1st survey, 1,177 screenings and 919 RT-PCR (78.07%) were performed before the egg-retrieval. One patient with a negative TCI and positive RT-PCR was detected, and the cycle was cancelled. 1,518 screenings and 1,161 RT-PCRs (76.48%) were performed before the ET/IUI. Two patients with a positive TCI were detected, one did not perform a RT-PCR, while the other resulted in a positive RT-PCR. Both cycles were cancelled. Besides, 5 patients with negative TCI performed a RT-PCR with a positive result; all 5 were cancelled. Overall, the SARS-CoV-2 positivity rate was 8/2533 (0.316%), of which 7/2533 (0.276%) were identified by RT-PCR testing.
The 2nd survey included 1,376 screenings and 1,009 RT-PCR (73.32%) performed before the egg-retrieval. Four patients with negative TCI and further positive RT-PCR were detected, and their cycle was cancelled. 2,692 screenings and 2,134 RT-PCR (79.27%) were performed before ET/IUI. Two patients had a positive TCI, one with a negative, the other with a positive RT-PCR testing; both cycles were cancelled. Besides, 8 patients with negative TCI, but positive RT-PCR testing, were detected and their cycles cancelled. Overall, the SARS-CoV-2 positivity rate was 14/3846 (0.364%), of which 13/3846 (0.338%) after positive RT-PCR testing.
Limitations, reasons for caution
The criteria for performing the RT-PCR testing were not the same in all MAR Centres or even in the same centre at different times. Due to the low response rate of the study, we should not extend these results to all the MAR Centres in Spain.
Wider implications of the findings
The results of the surveys suggest that the SEF/ASEBIR recommendations could be a good screening strategy for SARS-Cov-2 at MAR Centres. Further survey collected at different times of the pandemic are warranted, including new strategies for screening as antigen tests or vaccination status.
Trial registration number
Not applicable
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Affiliation(s)
- D Mataro
- CIRH Center for Infertility and Human Reproduction, Medical Department, Barcelona, Spain
| | - I Cuevas-Saiz
- Hospital General Universitario de Valencia, IVF Laboratory, Valencia, Spain
| | - J A Castilla
- Hospital Universitario Virgen de las Nieves, Unidad de reproducción, Granada, Spain
| | - J A Dominguez
- IERA instituto extremeño de reproducción asistida, Medical Department, Badajoz, Spain
| | - N Prados
- IVIRMA Sevilla, IVF Laboratory, Sevilla, Spain
| | - B Buch
- Centro Gutenberg, IVF Laboratory, Malaga, Spain
| | | | - F J Prados
- IVF Centre Consulting, Consulting, Madrid, Spain
| | - M Ruiz-Jorro
- CREA Medicina de la reproducción, Departamento de Andrología Reproductiva, Valencia, Spain
| | - J L Gomez
- Centro CEFIVBA-Wilson Fertility, Medical Department, Palma de Mallorca, Spain
| | - L De la Fuente
- Hospital 12 de Octubre, Asisted Reproduction Unit. O&G Department, Madrid, Spain
| | - M Devesa
- Dexeus University Hospital, Department of Obstetrics- Gynecology and Reproductive Medicine Dexeus Mujer, Barcelona, Spain
| | | | - C Pardos
- Dexeus University Hospital, Department of Obstetrics- Gynecology and Reproductive Medicine Dexeus Mujer, Barcelona, Spain
| | - L Martinez
- Hospital Universitario Virgen de las Nieves, Unidad de reproducción, Granada, Spain
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Carrera M, Milan FP, Dominguez JA, Gris JM, Segura C, Caballero M. P–682 Serum progesterone level as prognostic factor in frozen-thawed embryo transfer cycles: effect of selected threshold on gestational results. Systematic review, stratified meta-analysis and meta-regression. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Study question
Is there an optimum progesterone threshold level below which gestational results are significantly worse in frozen embryo transfer cycles (FET) with hormone replacement therapy (HRT)?
Summary answer
Low serum progesterone during luteal phase of HRT-FET cycles impairs substantially its gestational outcomes, regardless of threshold level, origin of oocytes and euploidy of embryos.
What is known already
HRT for endometrial preparation in FET or oocyte donation cycles is widely used. Oestrogen doses are usually patient-tailored varying upon endometrial thickness, whereas the optimal level of progesterone exposure has not been defined. Various studies have found a negative association between serum progesterone levels measured during luteal phase and FET results in terms of pregnancy and miscarriage rates. Most likely there is an optimal level below which results are worse but a standard threshold level is yet to be established, as in almost every study a different threshold has been found.
Study design, size, duration
Systematic review and stratified meta-analysis with meta-regression following PRISMA guidelines. An electronic search of MEDLINE, EMBASE, Web of Science, Cochrane Gynaecology and Fertility Specialised Register of Controlled Trials and ClinicalTrials.gov was conducted from inception to January 2021. The aim was to identify prospective or retrospective cohort studies measuring serum progesterone levels around frozen embryo transfer date in HRT cycles. A combination of the following key search terms was used: “progesterone”, “serum”, “frozen embryo”, “transfer”, “frozen-thawed”.
Participants/materials, setting, methods
Studies analyzing association of luteal serum progesterone with FET-HRT outcomes were included. Risk of bias within studies was assessed using the Newcastle-Ottawa Scale (NOS). Clinical/ongoing pregnancy and miscarriage rates (C/OPR,MR) were considered as primary and secondary outcomes respectively. Odds Ratios with 95% Confidence Interval (OR,95%CI) were calculated applying a random effects model meta-analysis. Heterogeneity was assessed using the I2 statistic. A meta-regression was conducted to examine the association of the effect with the threshold level.
Main results and the role of chance
The systematic search retrieved 792 studies, 494 after duplicates removal of which 343 were screened and 51 assessed for eligibility. 12 studies, reporting 14 threshold levels, were included in the meta-analysis involving 5009 HRT-FET cycles. Two of them were prospective cohort studies while the rest were retrospective. 10 of them have been published in peer review journals and two were conference abstracts. Quality of studies assessed with NOS varied between 5 and 9. The progesterone threshold ranged from 5.0 to 21.94 ng/ml. Low progesterone levels were associated with less C/OPR (OR: 0.52; 95% CI: 0.40 to 0.66; 11 studies, 5009 cycles). Low progesterone was also associated with high MR (OR: 2.01; 95% CI: 1.57 to 2.58; 9 studies, 2560 pregnancies). These effects showed remarkable consistency in specific sub-analyses considering separately studies with progesterone thresholds up to or above 10 mg/mL, and studies carried out in cycles using oocyte donation, autologous oocytes and embryo aneuploidies screening. Meta-regression did not identify significant association between size effect and progesterone threshold, regarding neither C/OPR (regression coefficient: 0.02; CI 95%: –0.02 to 0.06; p: 0.28) nor MR (regression coefficient: 0.11; CI 95%: –0.13 to 0.36; p: 0.32).
Limitations, reasons for caution
High degree of clinical and statistical heterogeneity was found due to different routes and doses of progesterone administration, date of progesterone analyses and variety of thresholds as well as high diversity of embryo origin. Despite sensibility analysis by embryo origin any of these sources of heterogeneity can preclude the results.
Wider implications of the findings: Despite low progesterone levels are significantly associated to lower gestational results, and a threshold of 10 ng/ml constitutes the median value of our distribution, high quality prospective studies are needed to validate the prognostic value of progesterone levels and to establish an standardised threshold level for clinical application.
Trial registration number
not required
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Affiliation(s)
- M Carrera
- Reproductive Medicine Unit., Obstetrics and Gynaecology Department. Hospital Universitario Doce de Octubre, Madrid, Spain
| | - F Pere Milan
- Reproductive Medicine Unit., Obstetrics and Gynaecology Department. Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - J A Dominguez
- Fertility Unit, Instituto Extremeño de Reproducción Asistida, Badajoz, Spain
| | - J M Gris
- Fertility Unit, Hospital Universitary Vall D´Hebrón, Barcelona, Spain
| | - C Segura
- UR Moncloa, Obstetrics and Gynaecology, Madrid, Spain
| | - M Caballero
- Reproductive Medicine Unit., Obstetrics and Gynaecology Department. Hospital General Universitario Gregorio Marañon, Madrid, Spain
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6
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Roos I, Leray E, Frascoli F, Casey R, Brown JWL, Horakova D, Havrdova EK, Trojano M, Patti F, Izquierdo G, Eichau S, Onofrj M, Lugaresi A, Prat A, Girard M, Grammond P, Sola P, Ferraro D, Ozakbas S, Bergamaschi R, Sá MJ, Cartechini E, Boz C, Granella F, Hupperts R, Terzi M, Lechner-Scott J, Spitaleri D, Van Pesch V, Soysal A, Olascoaga J, Prevost J, Aguera-Morales E, Slee M, Csepany T, Turkoglu R, Sidhom Y, Gouider R, Van Wijmeersch B, McCombe P, Macdonell R, Coles A, Malpas CB, Butzkueven H, Vukusic S, Kalincik T, Duquette P, Grand'Maison F, Iuliano G, Ramo-Tello C, Solaro C, Cabrera-Gomez JA, Rio ME, Bolaños RF, Shaygannejad V, Oreja-Guevara C, Sanchez-Menoyo JL, Petersen T, Altintas A, Barnett M, Flechter S, Fragoso Y, Amato MP, Moore F, Ampapa R, Verheul F, Hodgkinson S, Cristiano E, Yamout B, Laureys G, Dominguez JA, Zwanikken C, Deri N, Dobos E, Vrech C, Butler E, Rozsa C, Petkovska-Boskova T, Karabudak R, Rajda C, Alkhaboori J, Saladino ML, Shaw C, Shuey N, Vucic S, Sempere AP, Campbell J, Piroska I, Taylor B, van der Walt A, Kappos L, Roullet E, Gray O, Simo M, Sirbu CA, Brochet B, Cotton F, De Sèze J, Dion A, Douek P, Guillemin F, Laplaud D, Lebrun-Frenay C, Moreau T, Olaiz J, Pelletier J, Rigaud-Bully C, Stankoff B, Marignier R, Debouverie M, Edan G, Ciron J, Ruet A, Collongues N, Lubetzki C, Vermersch P, Labauge P, Defer G, Cohen M, Fromont A, Wiertlewsky S, Berger E, Clavelou P, Audoin B, Giannesini C, Gout O, Thouvenot E, Heinzlef O, Al-Khedr A, Bourre B, Casez O, Cabre P, Montcuquet A, Créange A, Camdessanché JP, Faure J, Maurousset A, Patry I, Hankiewicz K, Pottier C, Maubeuge N, Labeyrie C, Nifle C. Delay from treatment start to full effect of immunotherapies for multiple sclerosis. Brain 2020; 143:2742-2756. [DOI: 10.1093/brain/awaa231] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 04/30/2020] [Accepted: 06/01/2020] [Indexed: 01/21/2023] Open
Abstract
Abstract
In multiple sclerosis, treatment start or switch is prompted by evidence of disease activity. Whilst immunomodulatory therapies reduce disease activity, the time required to attain maximal effect is unclear. In this study we aimed to develop a method that allows identification of the time to manifest fully and clinically the effect of multiple sclerosis treatments (‘therapeutic lag’) on clinical disease activity represented by relapses and progression-of-disability events. Data from two multiple sclerosis registries, MSBase (multinational) and OFSEP (French), were used. Patients diagnosed with multiple sclerosis, minimum 1-year exposure to treatment, minimum 3-year pretreatment follow-up and yearly review were included in the analysis. For analysis of disability progression, all events in the subsequent 5-year period were included. Density curves, representing incidence of relapses and 6-month confirmed progression events, were separately constructed for each sufficiently represented therapy. Monte Carlo simulations were performed to identify the first local minimum of the first derivative after treatment start; this point represented the point of stabilization of treatment effect, after the maximum treatment effect was observed. The method was developed in a discovery cohort (MSBase), and externally validated in a separate, non-overlapping cohort (OFSEP). A merged MSBase-OFSEP cohort was used for all subsequent analyses. Annualized relapse rates were compared in the time before treatment start and after the stabilization of treatment effect following commencement of each therapy. We identified 11 180 eligible treatment epochs for analysis of relapses and 4088 treatment epochs for disability progression. External validation was performed in four therapies, with no significant difference in the bootstrapped mean differences in therapeutic lag duration between registries. The duration of therapeutic lag for relapses was calculated for 10 therapies and ranged between 12 and 30 weeks. The duration of therapeutic lag for disability progression was calculated for seven therapies and ranged between 30 and 70 weeks. Significant differences in the pre- versus post-treatment annualized relapse rate were present for all therapies apart from intramuscular interferon beta-1a. In conclusion we have developed, and externally validated, a method to objectively quantify the duration of therapeutic lag on relapses and disability progression in different therapies in patients more than 3 years from multiple sclerosis onset. Objectively defined periods of expected therapeutic lag allows insights into the evaluation of treatment response in randomized clinical trials and may guide clinical decision-making in patients who experience early on-treatment disease activity. This method will subsequently be applied in studies that evaluate the effect of patient and disease characteristics on therapeutic lag.
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Affiliation(s)
- Izanne Roos
- CORe, Department of Medicine, University of Melbourne, Melbourne, 3050, Australia
- Melbourne MS Centre, Department of Neurology, Royal Melbourne Hospital, Melbourne, 3050, Australia
| | - Emmanuelle Leray
- Rennes University, EHESP, REPERES (Pharmaco-epidemiology and Health services research) - EA 7449, Rennes, France
| | - Federico Frascoli
- Faculty of Science, Engineering and Technology, School of Science, Department of Mathematics, Swinburne University of Technology, Melbourne, 3122, Australia
| | - Romain Casey
- University of Lyon, Claude Bernard University Lyon 1, F-69000 Lyon, France
- Hospices Civils de Lyon, Service de Neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation, F-69677 Bron, France
- Observatoire Français de la Sclérose en Plaques, Lyon Neuroscience Research Centre, INSERM 1028 et CNRS UMR 5292, F-69003 Lyon, France
- EUGENE DEVIC EDMUS Foundation against multiple sclerosis, state-approved foundation, F-69677 Bron, France
| | - J William L Brown
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Dana Horakova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, 12808, Czech Republic
| | - Eva K Havrdova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, 12808, Czech Republic
| | - Maria Trojano
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, Bari, 70122, Italy
| | - Francesco Patti
- GF Ingrassia Department, University of Catania, Catania, 95123, Italy
- Policlinico G Rodolico, 95123, Catania, Italy
| | | | - Sara Eichau
- Hospital Universitario Virgen Macarena, Sevilla, 41009, Spain
| | - Marco Onofrj
- Department of Neuroscience, Imaging, and Clinical Sciences, University G. d’Annunzio, 66100 Chieti, Italy
| | - Alessandra Lugaresi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOSI Riabilitazione Sclerosi Multipla, Bologna, 40139, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Alexandre Prat
- CHUM MS Center and Universite de Montreal, Montreal, H2L 4M1, Canada
| | - Marc Girard
- CHUM MS Center and Universite de Montreal, Montreal, H2L 4M1, Canada
| | | | - Patrizia Sola
- Department of Neuroscience, Azienda Ospedaliera Universitaria, Modena, 41100, Italy
| | - Diana Ferraro
- Department of Neuroscience, Azienda Ospedaliera Universitaria, Modena, 41100, Italy
| | | | | | - Maria José Sá
- Centro Hospitalar Universitário de São João and Universidade Fernando Pessoa, 4249-004 Porto, Portugal
| | - Elisabetta Cartechini
- UOC Neurologia, Azienda Sanitaria Unica Regionale Marche - AV3, Macerata, 62100, Italy
| | - Cavit Boz
- KTU Medical Faculty Farabi Hospital, Karadeniz Technical University, Trabzon, 61080, Turkey
| | - Franco Granella
- Department of Medicine and Surgery, University of Parma, Parma, 43126, Italy
- Department of General Medicine, Parma University Hospital, Parma, 43126, Italy
| | - Raymond Hupperts
- Zuyderland Ziekenhuis, Sittard, Sittard, 6131 BK, The Netherlands
| | - Murat Terzi
- Medical Faculty, 19 Mayis University, Kurupelit, Samsun, 55160, Turkey
| | - Jeannette Lechner-Scott
- School of Medicine and Public Health, University Newcastle, 2308, Australia
- Department of Neurology, John Hunter Hospital, Hunter New England Health, Newcastle, 2305, Australia
| | - Daniele Spitaleri
- Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati Avellino, Contrada Amoretta, Avellino, 83100, Italy
| | | | - Aysun Soysal
- Bakirkoy Education and Research Hospital for Psychiatric and Neurological Diseases, Istanbul, 34142, Turkey
| | - Javier Olascoaga
- Instituto de Investigación Sanitaria Biodonostia, Hospital Universitario Donostia, San San Sebastián, Spain, 20014, Spain
| | | | | | - Mark Slee
- Flinders University, Adelaide, 5042, Australia
| | - Tunde Csepany
- Department of Neurology, Faculty of Medicine, University of Debrecen, Debrecen, 4032, Hungary
| | - Recai Turkoglu
- Haydarpasa Numune Training and Research Hospital, Selimiye Mahallesi, Istanbul, 34668, Turkey
| | - Youssef Sidhom
- Department of Neurology, Razi Hospital, 2010, Tunis, Manouba, Tunisia
| | - Riadh Gouider
- Department of Neurology, Razi Hospital, 2010, Tunis, Manouba, Tunisia
| | - Bart Van Wijmeersch
- Rehabilitation and MS-Centre Overpelt and Hasselt University, Hasselt, 3900, Belgium
| | - Pamela McCombe
- University of Queensland, St Lucia, 4072, Australia
- Royal Brisbane and Women's Hospital, Herston, 4029, Australia
| | - Richard Macdonell
- Department of Neurology, Austin Health, Heidlberg, 3084, Australia
- Faculty of Medicine and Dental Health Sciences, University of Melbourne, Melbourne, 3050, Australia
| | - Alasdair Coles
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Charles B Malpas
- CORe, Department of Medicine, University of Melbourne, Melbourne, 3050, Australia
- Melbourne MS Centre, Department of Neurology, Royal Melbourne Hospital, Melbourne, 3050, Australia
| | - Helmut Butzkueven
- Central Clinical School, Monash University, Melbourne, 3004, Australia
- Department of Neurology, The Alfred Hospital, Melbourne, 3004, Australia
- Department of Neurology, Box Hill Hospital, Monash University, Melbourne, 3128, Australia
| | - Sandra Vukusic
- University of Lyon, Claude Bernard University Lyon 1, F-69000 Lyon, France
- Hospices Civils de Lyon, Service de Neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation, F-69677 Bron, France
- Observatoire Français de la Sclérose en Plaques, Lyon Neuroscience Research Centre, INSERM 1028 et CNRS UMR 5292, F-69003 Lyon, France
| | - Tomas Kalincik
- CORe, Department of Medicine, University of Melbourne, Melbourne, 3050, Australia
- Melbourne MS Centre, Department of Neurology, Royal Melbourne Hospital, Melbourne, 3050, Australia
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Gil-Perotin S, Castillo-Villalba J, Cubas-Nuñez L, Gasque R, Hervas D, Gomez-Mateu J, Alcala C, Perez-Miralles F, Gascon F, Dominguez JA, Casanova B. Combined Cerebrospinal Fluid Neurofilament Light Chain Protein and Chitinase-3 Like-1 Levels in Defining Disease Course and Prognosis in Multiple Sclerosis. Front Neurol 2019; 10:1008. [PMID: 31608004 PMCID: PMC6768010 DOI: 10.3389/fneur.2019.01008] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Accepted: 09/04/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Neurofilament light chain protein (NFL) and chitinase3-like1 (CHI3L1) have gained importance recently as prognostic biomarkers in multiple sclerosis (MS). Objectives: We aimed to investigate NFL and CHI3L1 cerebrospinal fluid (CSF) profiles in multiple sclerosis and the informative and prognostic potential of the individual and combined measures. Methods: CSF NFL and CHI3L1 levels were measured in a cross-sectional cohort of 157 MS patients [99 relapsing-remitting (RRMS), 35 secondary progressive (SPMS), and 23 primary progressive (PPMS)]. Clinical relapse and/or gadolinium-enhanced lesions (GEL) in MRI within 90 days from CSF collection by lumbar puncture (LP) were registered and considered as indicators of disease activity. Longitudinal treatment and disability data were evaluated during medical visits with a median follow-up of 50 months. Results: CSF levels of NFL and CHI3L1 were higher in MS patients compared to non-MS controls. In RRMS and SPMS patients, increased NFL levels were associated with clinical relapse, and gadolinium-enhanced lesions in MRI (p < 0.001), while high CHI3L1 levels were characteristic of progressive disease (p = 0.01). In RRMS patients, CSF NFL, and CHI3L1 levels correlated with each other (r = 0.58), and with IgM-oligoclonal bands (p = 0.02 and p = 0.004, respectively). In addition, CSF CHI3L1 concentration was a predictor for 1-point EDSS worsening {HR = 2.99 [95% CI (1.27, 7.07)]} and progression during follow-up {HR = 18 [95% CI (2.31, 141.3)]}. The pattern of combined measure of biomarkers was useful to discriminate MS phenotypes and to anticipate clinical progression: RRMS more frequently presented high NFL combined with low CHI3L1 levels, compared to SPMS (HR 0.41 [0.18-0.82]), and PPMS (HR 0.46 [0.19-0.87]), while elevation of both biomarkers preceded diagnosis of clinical progression in RRMS patients (log rank = 0.02). Conclusions: Individual measures of CSF NFL and CHI3L1 are biomarkers of disease activity and progression, respectively. The pattern of combined measure discriminates MS phenotypes. It also predicts the subset of RRMS patients that will progress clinically allowing early intervention.
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Affiliation(s)
- Sara Gil-Perotin
- Multiple Sclerosis Unit, Hospital Universitari i Politècnic La Fe, Valencia, Spain.,Research Group in Neuroimmunology, Health Research Institute La Fe, Valencia, Spain
| | - Jessica Castillo-Villalba
- Multiple Sclerosis Unit, Hospital Universitari i Politècnic La Fe, Valencia, Spain.,Research Group in Neuroimmunology, Health Research Institute La Fe, Valencia, Spain
| | - Laura Cubas-Nuñez
- Multiple Sclerosis Unit, Hospital Universitari i Politècnic La Fe, Valencia, Spain.,Research Group in Neuroimmunology, Health Research Institute La Fe, Valencia, Spain
| | - Raquel Gasque
- Research Group in Neuroimmunology, Health Research Institute La Fe, Valencia, Spain
| | - David Hervas
- Biostatistics Unit, Health Research Institute La Fe, Valencia, Spain
| | - Josep Gomez-Mateu
- Neurology Department, Hospital Universitari Dr. Peset, Valencia, Spain
| | - Carmen Alcala
- Multiple Sclerosis Unit, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | - Francisco Gascon
- Neuroimmunology Unit, Hospital Clínic de València, Valencia, Spain
| | | | - Bonaventura Casanova
- Multiple Sclerosis Unit, Hospital Universitari i Politècnic La Fe, Valencia, Spain.,Research Group in Neuroimmunology, Health Research Institute La Fe, Valencia, Spain
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Dominguez JA, Martin A, Anriquez A, Albanesi A. The combined effects of Pseudomonas fluorescens and Tuber melanosporum on the quality of Pinus halepensis seedlings. Mycorrhiza 2012; 22:429-436. [PMID: 22068563 DOI: 10.1007/s00572-011-0420-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Accepted: 10/27/2011] [Indexed: 05/31/2023]
Abstract
The ecological, economic and social values of the ectomycorrhizal fungi of the black truffle found in the rural Mediterranean are well known. The inoculation of Pinus halepensis seedlings with mycorrhizal fungi and rhizobacteria can improve the morphology and physiology of the seedlings and benefit the regeneration of arid regions and the reintroduction of inocula of mycorrhizal fungi into these areas. Some rhizobacteria can improve the establishment and functioning of ectomycorrhizal symbiosis. In this study, seedlings of P. halepensis were inoculated with the mycorrhizal fungus Tuber melanosporum and the rhizobacteria Pseudomonas fluorescens CECT 844 under non-limiting greenhouse conditions. Five months after inoculation, we analysed the growth, water parameters (osmotic potential at saturation, osmotic potential at turgor loss and modulus of elasticity), concentrations of mycorrhizal colonies, nutrient concentration and nutrient contents (N, P, K, Ca, Mg and Fe) in roots and aerial parts of the seedlings. Subsequently, tests were performed to estimate the root growth potentials. None of the treatments changed the water parameters or growth potentials of the roots. The inoculations improved the growth and nutrient uptake of the seedlings, although the combination of P. fluorescens CECT 844 and T. melanosporum did not generally lead to a significant improvement over the positive effects of a simple inoculation of T. melanosporum; however, the addition of P. fluorescens CECT 844 did double the rate of the mycorrhization of T. melanosporum. These results may be promising for enhancing the cultivation of truffles.
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Affiliation(s)
- J A Dominguez
- E.T.S.I Mountains and E.U.I.T Forestry, Polytechnic University of Madrid, Av/Ciudad Universitaria s/n., 28040, Madrid, Spain.
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Dvorak B, McWilliam DL, Williams CS, Dominguez JA, Machen NW, McCuskey RS, Philipps AF. Artificial formula induces precocious maturation of the small intestine of artificially reared suckling rats. J Pediatr Gastroenterol Nutr 2000; 31:162-9. [PMID: 10941968 DOI: 10.1097/00005176-200008000-00013] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND The artificially reared rat model was used successfully to study the effect of nutrition during the early postnatal period on growth and development of the neonate. Overgrowth and morphologic changes of the gastrointestinal tract are known consequences of artificial rearing. The major goal of our study was to elucidate whether artificial rearing-enhanced gut development is caused by artificial diet or by gastrostomy and the artificial rearing technique itself. METHODS Suckling rats at day 8 of age underwent intragastric cannulation and were machine fed either a cow's milk-based artificial rat's milk substitute or pooled rat's milk for 4 days. Dam-fed littermates served as a control. RESULTS Body growth did not differ in the three experimental groups. In rats receiving rat's milk substitute, small intestinal wet weight was approximately 60% greater than in rats fed rat's milk or control rats. Additionally, the entire small intestine was approximately 20% longer in the rat's milk substitute group. Morphologically, rat's milk substitute-fed pups demonstrated significantly greater intestinal villus length and crypt depth compared with rat's milk-fed or control rats. Jejunum and midjejunum of the rat's milk and control groups did not differ in these parameters. Intestinal sucrase activity of rat's milk substitute-fed rats was significantly elevated compared with rat's milk-fed rats or control animals. CONCLUSIONS These results indicate that cow's milk-based formula, not gastrostomy or artificial feeding technique, is a principal cause of the small intestine overgrowth and precocious maturation of some intestinal functions observed in artificially reared sucklings.
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Affiliation(s)
- B Dvorak
- Department of Pediatrics and Steele Memorial Children's Research Center, University of Arizona, Tucson 85724-5073, USA
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Dvorak B, Williams CS, McWilliam DL, Shinohara H, Dominguez JA, McCuskey RS, Philipps AF, Koldovsky O. Milk-borne epidermal growth factor modulates intestinal transforming growth factor-alpha levels in neonatal rats. Pediatr Res 2000; 47:194-200. [PMID: 10674346 DOI: 10.1203/00006450-200002000-00008] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Epidermal growth factor (EGF) is present in milk from various mammalian species, but its physiologic function in neonatal development remains unclear. Transforming growth factor-alpha (TGF-alpha) is a peptide structurally related to EGF, and its presence is detected in the developing small intestine of rats. The purpose of the present study was to examine the effect of milk-borne EGF on endogenous production of EGF and TGF-alpha in the small intestine of suckling rats. Neonatal rats were fed via gastrostomy either growth factor-free rat milk substitute (RMS) or RMS supplemented with EGF (100 ng/mL of RMS) from 8 to 12 d of age. Artificially reared rats were then compared with their dam-fed littermates. Animals fed the EGF-deficient diet RMS had markedly increased EGF and TGF-alpha mRNA levels in duodenum and ileum compared with dam-fed controls and significantly elevated total intestinal content of TGF-alpha peptide. Intestinal EGF content and EGF serum levels were significantly decreased in the RMS group compared with controls. The addition of EGF to the RMS diet normalized TGF-alpha mRNA levels in the duodenum and ileum, EGF mRNA levels in the ileum, and total intestinal TGF-alpha content and EGF serum levels to the levels measured in dam-fed littermates. Motility studies showed that enteral administration of EGF did not affect stomach emptying and intestinal transit. These studies indicate that exogenous milk-borne EGF modulates endogenous production of TGF-alpha in developing small intestine. It is likely that neither TGF-alpha nor EGF are solely responsible for small intestinal overgrowth of artificially reared neonatal rats.
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Affiliation(s)
- B Dvorak
- Department of Pediatrics and Steele Memorial Children's Research Center, University of Arizona, Tucson 85724-5073, USA
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Dominguez JA, Corella EL, Auró A. Oral papillomatosis in two laboratory rabbits in Mexico. Lab Anim Sci 1981; 31:71-3. [PMID: 7253554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Oral papillomas were identified in two New Zealand white male rabbits from Mexico City. The growths were observed on the tip and ventral aspect of the tongue in a 3-year-old rabbit weighing 4 kg and on the tip of the tongue in a 15-month-old rabbit weighing 3.6 kg. Microscopic examination of the lesions revealed epithelial papillomas around fibrovascular stalks, and ultrastructural examination disclosed crystalline arrays of viral particles consistent with papova virus. This finding extends the known geographic distribution of the disease. Previous cases have been from the United States, The Netherlands, and Great Britain.
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Smith MG, Eddleston AL, Dominguez JA, Evans DB, Bewick M, Williams R. Changes in leucocyte migration after renal transplantation. Br Med J 1969; 4:275-8. [PMID: 4899455 PMCID: PMC1629681 DOI: 10.1136/bmj.4.5678.275] [Citation(s) in RCA: 43] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The leucocyte migration test, an in-vitro measure of cellular immunity, has been used to follow the changes in cell-mediated hypersensitivity to kidney and histocompatibility antigens in three patients after renal transplantation.Inhibition of leucocyte migration, indicating strong sensitization to the antigens used, occurred in each patient, starting five to seven days after transplantation. Satisfactory renal function had not been established in any of the patients at this time. In one case inhibition of leucocyte migration persisted almost continuously until the 24th day and was associated with poor renal function proved histologically to be due to rejection. Treatment with increased dosage of prednisone was associated with a rapid reversion to normal of the migration index and improvement in renal function. Later, inhibition of migration occurred again, and shortly afterwards the graft ceased to function. In the other two cases the migration index became normal without alteration in immunosuppressive therapy and a satisfactory diuresis followed. It is suggested that this simple test should prove useful in the specific diagnosis of rejection and in control of immunosuppressive therapy.
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