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Barrett D, Laird S, Iskander J, Lee LM. In Memoriam: Remembering Dr Leonard Ortmann: Public Health Ethics Teacher and Mentor. Public Health Rep 2024; 139:252-254. [PMID: 38044626 PMCID: PMC10851895 DOI: 10.1177/00333549231205887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023] Open
Affiliation(s)
| | | | - John Iskander
- US Public Health Service Commissioned Corps, Rockville, MD, USA
| | - Lisa M. Lee
- Division of Scholarly Integrity and Research Compliance, Department of Population Health Sciences, Virginia Tech, Blacksburg, VA, USA
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Zhao Y, Man GCW, Zhang R, Wong CK, Chen X, Chung JPW, Wang CC, Laird S, Zhang T, Li TC. A prospective study comparing the inflammation-related cytokine and chemokine profile from the day of blastocyst transfer to 7 weeks of gestation between pregnancies that did or did not result in a miscarriage. J Reprod Immunol 2022; 154:103755. [PMID: 36272272 DOI: 10.1016/j.jri.2022.103755] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/24/2022] [Accepted: 10/09/2022] [Indexed: 11/27/2022]
Abstract
The dynamics of maternal immunomodulation is essential in early pregnancy. In our previous study, successful implantation is characterized by a transient increase of pro-inflammatory cytokines followed by a switch to an anti-inflammatory state in peripheral blood around 3-6 days after embryo transfer (ET). In this study, we aimed to extend the time points to compare the cytokine and chemokine profiles between women who did or did not subsequently miscarry. We utilized precisely timed serum samples on the day of ET and 3, 6, 9, 16, 23 and 30 days after ET in women undergoing single blastocyst transfer. Our analysis revealed a significant alteration in cytokine profile after day ET+ 9 between the two groups. Regarding pro-inflammatory cytokine profile, there was a significant increase in IL-17 on days ET+ 16, + 23, and + 30 (50.60 ± 9.97 vs 37.09 ± 3.25, 53.20 ± 8.13 vs 36.51 ± 3.34, 57.06 ± 8.83 vs 33.04 ± 3.11 pg/mL), TNF-α on days ET+ 23 and + 30 (73.90 ± 12.42 vs 50.73 ± 3.55, 74.16 ± 12.46 vs 46.59 ± 3.21 pg/mL), IFN-γ on day ET+ 30 (69.52 ± 13.19 vs 42.28 ± 7.76 pg/mL) in women who miscarried compared to women who had a live birth. In contrast, the concentrations of anti-inflammatory cytokines IL-10 on days ET+ 23 and + 30 (26.23 ± 2.11 vs 38.30 ± 4.64, 23.77 ± 2.06 vs 39.16 ± 4.99 pg/mL) and TGF-β1 on day ET+ 30 (20.30 ± 1.25 vs 23.81 ± 0.88 ng/mL) were significantly decreased in women who miscarried compared to women who had a live birth. While for the chemokine profile, there was no significant alteration observed between the two groups across all the time points. These findings suggest that a sustained anti-inflammatory milieu is concomitant with the maintenance of early pregnancy, while the remarkable pro-inflammatory shift as early as day ET+ 16 in women who subsequently miscarried was observed before the diagnosis of miscarriage.
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Affiliation(s)
- Yiwei Zhao
- Department of Obstetrics and Gynecology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, China; Assisted Reproductive Technology Unit, Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, the Hong Kong Special Administrative Region of China
| | - Gene Chi Wai Man
- Assisted Reproductive Technology Unit, Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, the Hong Kong Special Administrative Region of China
| | - Ruizhe Zhang
- Assisted Reproductive Technology Unit, Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, the Hong Kong Special Administrative Region of China
| | - Chun-Kwok Wong
- Department of Chemical Pathology, The Chinese University of Hong Kong, the Hong Kong Special Administrative Region of China
| | - Xiaoyan Chen
- Assisted Reproductive Technology Unit, Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, the Hong Kong Special Administrative Region of China; Department of Obstetrics and Gynaecology, Shenzhen Baoan Women's and Children's Hospital, Shenzhen University, Shenzhen, China
| | - Jacqueline Pui-Wah Chung
- Assisted Reproductive Technology Unit, Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, the Hong Kong Special Administrative Region of China
| | - Chi-Chiu Wang
- Assisted Reproductive Technology Unit, Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, the Hong Kong Special Administrative Region of China; Reproduction and Development Laboratory, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, the Hong Kong Special Administrative Region of China; School of Biomedical Sciences, The Chinese University of Hong Kong, the Hong Kong Special Administrative Region of China; Chinese University of Hong Kong -Sichuan University Joint Laboratory in Reproductive Medicine, The Chinese University of Hong Kong, the Hong Kong Special Administrative Region of China
| | - Susan Laird
- Department of Biosciences and Chemistry, Sheffield Hallam University, UK
| | - Tao Zhang
- Assisted Reproductive Technology Unit, Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, the Hong Kong Special Administrative Region of China.
| | - Tin-Chiu Li
- Assisted Reproductive Technology Unit, Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, the Hong Kong Special Administrative Region of China; Chinese University of Hong Kong -Sichuan University Joint Laboratory in Reproductive Medicine, The Chinese University of Hong Kong, the Hong Kong Special Administrative Region of China.
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Zhang T, Zhao Y, Cheung WC, Gan YH, Huang L, Li M, Leung KT, Chung PW, Wang CC, Laird S, Chen X, Li TC. Serial changes in two immune checkpoint receptors and ligands, Tim-3/Gal-9 and PD-1/PD-L1 in peripheral blood prior to miscarriage: Comparison with pregnancies resulting in a live birth. Am J Reprod Immunol 2022; 87:e13524. [PMID: 35130363 DOI: 10.1111/aji.13524] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/25/2022] [Accepted: 02/03/2022] [Indexed: 12/31/2022] Open
Abstract
PROBLEM Immune checkpoints Tim-3/Gal-9 and PD-1/PL-1 are involved in the maintenance of maternal-fetal immune tolerance systematically and locally. This study aimed to compare the serial changes of Tim-3/Gal-9, and PD-1/PL-1 in peripheral blood over a 4-week period after blastocyst transfer, between women who had a live birth and those who miscarried. METHODS OF STUDY Serial blood samples were obtained on the day of ET, and 9, 16, 23, and 30 days after ET for the measurement of Tim-3 and PD-1 expressions on various lymphocytes by flow cytometry. Concentrations of serum Gal-9 and PD-L1 were measured by ELISA. RESULTS In pregnancies that resulted in a live birth, a significant and sustained increase in the proportion of Tim-3+ pNK cells was observed from the 9th to 30th days after ET, whilst the concentration of serum PD-L1 was significantly increased on the 23rd and 30th days after ET when compared to the day of ET. In pregnancies that later miscarried, none of the parameters were significantly changed across all the time points examined. When comparing the results between the two groups, the proportion of Tim-3+ CD56dim NK cells in the women who had a live birth was significantly higher than that in women who miscarried from the 9th to 30th day after ET. CONCLUSION A significant and sustained increase in the proportion of Tim-3+ pNK cells was observed in pregnancies resulting in a live birth but not in pregnancies resulting in a miscarriage, suggesting the changes may be associated with successful pregnancy outcomes.
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Affiliation(s)
- Tao Zhang
- Assisted Reproductive Technology Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Yiwei Zhao
- Assisted Reproductive Technology Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Wing Ching Cheung
- Assisted Reproductive Technology Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Yong Huang Gan
- Assisted Reproductive Technology Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Lin Huang
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Jiangxi, China
| | - Mingqing Li
- Laboratory for Reproductive Immunology, NHC Key Laboratory of Reproduction Regulation (Shanghai Institute of Planned Parenthood Research), Hospital of Obstetrics and Gynecology, Shanghai Medical School, Fudan University, Shanghai, China
| | - Kam Tong Leung
- Department of Pediatrics, The Chinese University of Hong Kong, Hong Kong, China
| | - Piu Wah Chung
- Assisted Reproductive Technology Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Chi Chiu Wang
- Assisted Reproductive Technology Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.,Reproduction and Development Laboratory, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, China.,School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong, China.,Chinese University of Hong Kong -Sichuan University Joint Laboratory in Reproductive Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Susan Laird
- Biomolecular Sciences Research Center, Sheffield Hallam University, Sheffield, UK
| | - Xiaoyan Chen
- Assisted Reproductive Technology Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.,Department of Obstetrics and Gynecology, Shenzhen Baoan Women's and Children's Hospital, Shenzhen University, Shenzhen, China
| | - Tin Chiu Li
- Assisted Reproductive Technology Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.,Chinese University of Hong Kong -Sichuan University Joint Laboratory in Reproductive Medicine, The Chinese University of Hong Kong, Hong Kong, China
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Metwally M, Chatters R, Pye C, Dimairo M, White D, Walters S, Cohen J, Young T, Cheong Y, Laird S, Mohiyiddeen L, Chater T, Pemberton K, Turtle C, Hall J, Taylor L, Brian K, Sizer A, Hunter H. Endometrial scratch to increase live birth rates in women undergoing first-time in vitro fertilisation: RCT and systematic review. Health Technol Assess 2022; 26:1-212. [PMID: 35129113 PMCID: PMC8859770 DOI: 10.3310/jnzt9406] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND In vitro fertilisation is a widely used reproductive technique that can be undertaken with or without intracytoplasmic sperm injection. The endometrial scratch procedure is an in vitro fertilisation 'add-on' that is sometimes provided prior to the first in vitro fertilisation cycle, but there is a lack of evidence to support its use. OBJECTIVES (1) To assess the clinical effectiveness, safety and cost-effectiveness of endometrial scratch compared with treatment as usual in women undergoing their first in vitro fertilisation cycle (the 'Endometrial Scratch Trial') and (2) to undertake a systematic review to combine the results of the Endometrial Scratch Trial with those of previous trials in which endometrial scratch was provided prior to the first in vitro fertilisation cycle. DESIGN A pragmatic, multicentre, superiority, open-label, parallel-group, individually randomised controlled trial. Participants were randomised (1 : 1) via a web-based system to receive endometrial scratch or treatment as usual using stratified block randomisation. The systematic review involved searching electronic databases (undertaken in January 2020) and clinicaltrials.gov (undertaken in September 2020) for relevant trials. SETTING Sixteen UK fertility units. PARTICIPANTS Women aged 18-37 years, inclusive, undergoing their first in vitro fertilisation cycle. The exclusion criteria included severe endometriosis, body mass index ≥ 35 kg/m2 and previous trauma to the endometrium. INTERVENTIONS Endometrial scratch was undertaken in the mid-luteal phase of the menstrual cycle prior to in vitro fertilisation, and involved inserting a pipelle into the cavity of the uterus and rotating and withdrawing it three or four times. The endometrial scratch group then received usual in vitro fertilisation treatment. The treatment-as-usual group received usual in vitro fertilisation only. MAIN OUTCOME MEASURES The primary outcome was live birth after completion of 24 weeks' gestation within 10.5 months of egg collection. Secondary outcomes included implantation, pregnancy, ectopic pregnancy, miscarriage, pain and tolerability of the procedure, adverse events and treatment costs. RESULTS One thousand and forty-eight (30.3%) women were randomised to treatment as usual (n = 525) or endometrial scratch (n = 523) and were followed up between July 2016 and October 2019 and included in the intention-to-treat analysis. In the endometrial scratch group, 453 (86.6%) women received the endometrial scratch procedure. A total of 494 (94.1%) women in the treatment-as-usual group and 497 (95.0%) women in the endometrial scratch group underwent in vitro fertilisation. The live birth rate was 37.1% (195/525) in the treatment-as-usual group and 38.6% (202/523) in the endometrial scratch group: an unadjusted absolute difference of 1.5% (95% confidence interval -4.4% to 7.4%; p = 0.621). There were no statistically significant differences in secondary outcomes. Safety events were comparable across groups. No neonatal deaths were recorded. The cost per successful live birth was £11.90 per woman (95% confidence interval -£134 to £127). The pooled results of this trial and of eight similar trials found no evidence of a significant effect of endometrial scratch in increasing live birth rate (odds ratio 1.03, 95% confidence interval 0.87 to 1.22). LIMITATIONS A sham endometrial scratch procedure was not undertaken, but it is unlikely that doing so would have influenced the results, as objective fertility outcomes were used. A total of 9.2% of women randomised to receive endometrial scratch did not undergo the procedure, which may have slightly diluted the treatment effect. CONCLUSIONS We found no evidence to support the theory that performing endometrial scratch in the mid-luteal phase in women undergoing their first in vitro fertilisation cycle significantly improves live birth rate, although the procedure was well tolerated and safe. We recommend that endometrial scratch is not undertaken in this population. TRIAL REGISTRATION This trial is registered as ISRCTN23800982. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 10. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Mostafa Metwally
- Assisted Conception Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Robin Chatters
- Sheffield Clinical Trials Research Unit (CTRU), School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Clare Pye
- Assisted Conception Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Munya Dimairo
- Sheffield Clinical Trials Research Unit (CTRU), School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - David White
- Sheffield Clinical Trials Research Unit (CTRU), School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Stephen Walters
- Design, Trials and Statistics, School of Health and Related Research (ScHARR), Sheffield, UK
| | - Judith Cohen
- Hull Health Trials Unit, University of Hull, Hull, UK
| | - Tracey Young
- Health Economic and Decision Science, School of Health and Related Research (ScHARR), Sheffield, UK
| | - Ying Cheong
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Susan Laird
- Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
| | - Lamiya Mohiyiddeen
- Saint Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Tim Chater
- Sheffield Clinical Trials Research Unit (CTRU), School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Kirsty Pemberton
- Sheffield Clinical Trials Research Unit (CTRU), School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Chris Turtle
- Sheffield Clinical Trials Research Unit (CTRU), School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Jamie Hall
- Sheffield Clinical Trials Research Unit (CTRU), School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Liz Taylor
- Assisted Conception Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | | | - Helen Hunter
- Department of Reproductive Medicine, Old St Mary's Hospital, Manchester, UK
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5
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Akbar A, Arnott I, Kennedy NA, Nolan J, Peake S, Whiteoak SR, Probert C, Fraser A, Cheshire A, Lewis A, Sugrue K, Laird S, Scott G. Recommendations for the optimal use of mesalazine in the management of patients with mild to moderate ulcerative colitis. Br J Hosp Med (Lond) 2021; 82:1-11. [PMID: 34726945 DOI: 10.12968/hmed.2021.0399] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The 2021 National report from IBD UK included responses from over 10 000 patients with inflammatory bowel disease, over 70% of whom reported having at least one flare in the last 12 months. As the first-line treatment for patients with mild and moderate ulcerative colitis, the action and delivery mechanisms of mesalazine are crucial for successful management of the disease. The choice of the most appropriate formulation of mesalazine and securing patient concordance and adherence to treatment remains a challenge for healthcare professionals. This article details the outcome of a roundtable discussion involving a group of gastroenterology consultants and specialist nurses which considered the importance of ensuring that patients have individualised mesalazine therapy before escalation to other treatments and gives recommendations for the management of patients with mild or moderate ulcerative colitis.
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Affiliation(s)
- Ayesha Akbar
- Consultant Gastroenterologist, St Marks Hospital, Harrow, Middlesex, UK
| | - Ian Arnott
- Consultant Gastroenterologist, Western General Hospital, Edinburgh, UK
| | - Nicholas A Kennedy
- Consultant Gastroenterologist, Royal Devon & Exeter Hospital NHS Foundation Trust, Exeter, UK
| | - Jonathan Nolan
- Consultant Gastroenterologist, Kingston Hospital, Kingston Upon Thames, UK
| | - Simon Peake
- Consultant Gastroenterologist, Imperial College Healthcare NHS Trust, London, UK
| | - Simon R Whiteoak
- Consultant Gastroenterologist, University Hospitals Dorset, Bournemouth, UK
| | - Chris Probert
- Professor of Gastroenterology, University of Liverpool, Liverpool, UK
| | - Aileen Fraser
- IBD Advanced Clinical Practitioner, University Hospitals Bristol & Weston, UK
| | - Alex Cheshire
- Day Case Unit/Endoscopy Nurse Team Lead, Queen Mary's Hospital, St George's University Hospital Trust, London, UK
| | - Allyson Lewis
- IBD Specialist Nurse, Royal Gwent Hospital, Newport, UK
| | - Kathleen Sugrue
- Advanced Nurse Practitioner, Mercy University Hospital, Cork, Ireland
| | - Susan Laird
- IBD Clinical Nurse Specialist Team Lead, Queen Elizabeth University Hospital, Glasgow, UK
| | - Glyn Scott
- Consultant Nurse Gastroenterology/Endoscopy/IBD, East Kent Hospital, Canterbury, UK
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Metwally M, Chatters R, Dimairo M, Walters S, Pye C, White D, Bhide P, Chater T, Cheong Y, Choudhary M, Child T, Drakeley A, Evbuomwan I, Gelbaya T, Grace J, Harris P, Laird S, da Silva SM, Mohiyiddeen L, Pemberton K, Raine-Fenning N, Rajkhowa M, Young T, Cohen J. A randomised controlled trial to assess the clinical effectiveness and safety of the endometrial scratch procedure prior to first-time IVF, with or without ICSI. Hum Reprod 2021; 36:1841-1853. [PMID: 34050362 PMCID: PMC8213451 DOI: 10.1093/humrep/deab041] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 11/18/2020] [Revised: 01/19/2021] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION What is the clinical-effectiveness and safety of the endometrial scratch (ES) procedure compared to no ES, prior to usual first time in vitro fertilisation (IVF) treatment? SUMMARY ANSWER ES was safe but did not improve pregnancy outcomes when performed in the mid-luteal phase prior to the first IVF cycle, with or without intracytoplasmic sperm injection (ICSI). WHAT IS KNOWN ALREADY ES is an ‘add-on’ treatment that is available to women undergoing a first cycle of IVF, with or without ICSI, despite a lack of evidence to support its use. STUDY DESIGN, SIZE, DURATION This pragmatic, superiority, open-label, multi-centre, parallel-group randomised controlled trial involving 1048 women assessed the clinical effectiveness and safety of the ES procedure prior to first time IVF, with or without ICSI, between July 2016 and October 2019. PARTICIPANTS/MATERIALS, SETTING, METHODS Participants aged 18–37 years undergoing their first cycle of IVF, with or without ICSI, were recruited from 16 UK fertility clinics and randomised (1:1) by a web-based system with restricted access rights that concealed allocation. Stratified block randomisation was used to allocate participants to TAU or ES in the mid-luteal phase followed by usual IVF with or without ICSI treatment. The primary outcome was live birth after completing 24 weeks gestation within 10.5 months of egg collection. MAIN RESULTS AND THE ROLE OF CHANCE In total, 1048 women randomised to TAU (n = 525) and ES (n = 523) were available for intention to treat analysis. In the ES group, 453 (86.6%) received the ES procedure. IVF, with or without ICSI, was received in 494 (94.1%) and 497 (95.0%) of ES and TAU participants respectively. Live birth rate was 37.1% (195/525) in the TAU and 38.6% (202/523) in the ES: an unadjusted absolute difference of 1.5% (95% CI −4.4% to 7.4%, P = 0.621). There were no statistical differences in secondary outcomes. Adverse events were comparable across groups. LIMITATIONS, REASONS FOR CAUTION A sham ES procedure was not undertaken in the control group, however, we do not believe this would have influenced the results as objective fertility outcomes were used. WIDER IMPLICATIONS OF THE FINDINGS This is the largest trial that is adequately powered to assess the impact of ES on women undergoing their first cycle of IVF. ES was safe, but did not significantly improve pregnancy outcomes when performed in the mid-luteal phase prior to the first IVF or ICSI cycle. We recommend that ES is not undertaken in this population. STUDY FUNDING/COMPETING INTEREST(S) Funded by the National Institute of Health Research. Stephen Walters is an National Institute for Health Research (NIHR) Senior Investigator (2018 to present) and was a member of the following during the project: National Institute for Health Research (NIHR) Health Technology Assessment (HTA) Clinical Trials and Evaluation Committee (2011–2017), NIHR HTA Commissioning Strategy Group (2012 to 2017); NIHR Programme Grants for Applied Research Committee (2020 to present); NIHR Pre doctoral Fellowship Committee (2019 to present). Dr. Martins da Silva reports grants from AstraZeneca, during the conduct of the study; and is Associate editor of Human Reproduction and Editorial Board member of Reproduction and Fertility. Dr. Bhide reports grants from Bart's Charity and grants and non-financial support from Pharmasure Pharmaceuticals outside the submitted work. TRIAL REGISTRATION NUMBER ISRCTN number: ISRCTN23800982. TRIAL REGISTRATION DATE 31 May 2016 DATE OF FIRST PATIENT’S ENROLMENT 04 July 2016
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Affiliation(s)
- Mostafa Metwally
- Obstetrics, Gynaecology & Neonatology, Sheffield Teaching Hospitals NHS Foundation Trust and The University of Sheffield, Sheffield, S10 2JF, UK
| | - Robin Chatters
- Sheffield Clinical Trials Research Unit, The University of Sheffield, Sheffield, S1 4DA, UK
| | - Munya Dimairo
- Sheffield Clinical Trials Research Unit, The University of Sheffield, Sheffield, S1 4DA, UK
| | - Stephen Walters
- School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, S1 4DA, UK
| | - Clare Pye
- Obstetrics, Gynaecology & Neonatology, Sheffield Teaching Hospitals NHS Foundation Trust and The University of Sheffield, Sheffield, S10 2JF, UK
| | - David White
- Sheffield Clinical Trials Research Unit, The University of Sheffield, Sheffield, S1 4DA, UK
| | - Priya Bhide
- Fertility Centre, Homerton University Hospital NHS Foundation Trust, Clapton, E9 6SR, UK
| | - Tim Chater
- Sheffield Clinical Trials Research Unit, The University of Sheffield, Sheffield, S1 4DA, UK
| | - Ying Cheong
- Faculty of Medicine, University of Southampton, Southampton, SO17 1BJ, UK
| | - Meenakshi Choudhary
- Oxford Fertility, The Fertility Partnership, Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, OX4 2HW, UK
| | - Tim Child
- Newcastle Fertility Centre at Life, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, NE1 4EP, UK
| | - Andrew Drakeley
- The Hewitt Fertility Centre, Liverpool Women's NHS Foundation Trust, Liverpool, L8 7SS, UK
| | - Isaac Evbuomwan
- Gateshead Fertility Unit, Gateshead Health NHS Foundation Trust, Gateshead, NE9 6SX, UK
| | - Tarek Gelbaya
- Leicester Fertility Centre, University Hospitals of Leicester NHS Trust, Leicester, LE1 5WW, UK
| | - Jan Grace
- Assisted Conception Unit, Guy's and St Thomas' NHS Foundation Trust, London, SE1 9RT, UK
| | - Philip Harris
- Fertility Fusion, Wrightington, Wigan & Leigh Teaching Hospitals NHS Foundation Trust, Appley Bridge, WB6 9EP, UK
| | - Susan Laird
- Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, S1 1WB, UK
| | | | - Lamiya Mohiyiddeen
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, M13 9PL, UK
| | - Kirsty Pemberton
- Sheffield Clinical Trials Research Unit, The University of Sheffield, Sheffield, S1 4DA, UK
| | | | | | - Tracey Young
- School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, S1 4DA, UK
| | - Judith Cohen
- Hull Health Trials Unit, The University of Hull, Hull, HU6 7RX, UK
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Robbins T, Berry L, Wells F, Randeva H, Laird S. Healthcare staff perceptions towards influenza and potential COVID-19 vaccination in the 2020 pandemic context. J Hosp Infect 2021; 112:45-48. [PMID: 33746009 PMCID: PMC7973053 DOI: 10.1016/j.jhin.2021.02.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 12/10/2020] [Revised: 02/22/2021] [Accepted: 02/22/2021] [Indexed: 12/04/2022]
Abstract
The COVID-19 pandemic generated renewed focus on infectious disease transmission in healthcare settings. This study aimed to evaluate staff perceptions towards influenza vaccination in the COVID-19 context. All healthcare workers within a major UK tertiary referral hospital were invited to answer a survey conducted from September 2nd to 13th, 2020. In all, 593 responses were received across a spectrum of roles; 44% reported they were more likely to get an influenza vaccine this year due to COVID-19; however, 10% felt that an influenza vaccine was less important due to social distancing. Additional questions evaluated intention to receive COVID-19 vaccination. There were substantial differences of opinion between staff groups.
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Affiliation(s)
- T Robbins
- University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK; Institute of Digital Healthcare, WMG, University of Warwick, Coventry, UK
| | - L Berry
- University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - F Wells
- University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - H Randeva
- University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK; Warwick Medical School, University of Warwick, Coventry, UK
| | - S Laird
- University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK; Warwick Medical School, University of Warwick, Coventry, UK.
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8
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Robbins T, Kyrou I, Laird S, Morgan N, Anderson N, Imray C, Patel K, Sankar S, Randeva H, Jones C. Healthcare staff perceptions and misconceptions regarding antibody testing in the United Kingdom: implications for the next steps for antibody screening. J Hosp Infect 2020; 111:102-106. [PMID: 33309938 PMCID: PMC7834281 DOI: 10.1016/j.jhin.2020.11.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 09/16/2020] [Revised: 11/22/2020] [Accepted: 11/23/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Healthcare workers have been at increased risk of exposure, infection and serious complications from COVID-19. Antibody testing has been used to identify staff members who have been previously infected by SARS-CoV-2, and has been rolled out rapidly in the United Kingdom. A number of comment and editorial articles have been published that raise concerns about antibody testing in this context. We present perceptions of National Health Service (NHS) healthcare workers in relation to SARS-CoV-2 antibody testing. METHODS An electronic survey regarding perceptions towards SARS-CoV-2 antibody testing was distributed to all healthcare workers at a major NHS tertiary hospital following implementation of antibody testing. RESULTS In total, 560 healthcare workers completed the survey (80% female; 25% of Black and Minority Ethnic background; 58% from frontline clinical staff). Exploring whether they previously had COVID-19 was the primary reported reason for choosing to undergo antibody testing (85.2%). In case of a positive antibody test, 72% reported that they would feel relieved, whilst 48% felt that they would be happier to work in a patient-facing area. Moreover, 12% responded that a positive test would mean "social distancing is less important", with 34% of the responders indicating that in this case they would be both less likely to catch COVID-19 and happier to visit friends/relatives. CONCLUSIONS NHS staff members primarily seek out SARS-CoV-2 antibody testing for an appropriate reason. Based on our findings and given the lack of definite data regarding the extent of immunity protection from a positive SARS-CoV-2 antibody test, significant concerns may be raised regarding the reported interpretation by healthcare workers of positive antibody test results. This needs to be further explored and addressed to protect NHS staff and patients.
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Affiliation(s)
- T Robbins
- University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK; Institute of Digital Healthcare, WMG, University of Warwick, Coventry, UK.
| | - I Kyrou
- University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK; Aston Medical Research Institute, Aston Medical School, Aston University, Birmingham, UK; Warwick Medical School, University of Warwick, Coventry, UK
| | - S Laird
- University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK; Warwick Medical School, University of Warwick, Coventry, UK
| | - N Morgan
- University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - N Anderson
- University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - C Imray
- University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK; Warwick Medical School, University of Warwick, Coventry, UK
| | - K Patel
- University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK; Warwick Medical School, University of Warwick, Coventry, UK
| | - S Sankar
- University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK; Warwick Medical School, University of Warwick, Coventry, UK
| | - H Randeva
- University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK; Warwick Medical School, University of Warwick, Coventry, UK
| | - C Jones
- University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
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Zhao Y, Zhang T, Guo X, Wong CK, Chen X, Chan YL, Wang CC, Laird S, Li TC. Successful implantation is associated with a transient increase in serum pro-inflammatory cytokine profile followed by a switch to anti-inflammatory cytokine profile prior to confirmation of pregnancy. Fertil Steril 2020; 115:1044-1053. [PMID: 33272613 DOI: 10.1016/j.fertnstert.2020.10.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 10/05/2020] [Accepted: 10/06/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To compare the changing peripheral levels of inflammation-related cytokine profile during a 9-day period after blastocyst transfer between women who did and did not conceive. DESIGN Prospective, observational, and longitudinal study. SETTING University-affiliated hospital. PATIENT(S) Forty-seven women with infertility who were undergoing single day-5 blastocyst transfer were recruited. INTERVENTION(S) This prospective observational and longitudinal study on 47 women with infertility was performed in an in vitro fertilization unit from December 2018 to August 2019. The amounts of a range of cytokines was measured on serial blood samples obtained during a 9-day period after blastocyst transfer. MAIN OUTCOME MEASURE(S) Serial blood samples were obtained on the day of embryo transfer, and 3, 6, and 9 days afterward for measurement of serum interferon gamma (IFN-γ), tumor necrosis factor alpha, interleukin (IL)-2, IL-4, IL-10, IL-12, IL-13, IL-17, IL-18, and IL-22 using cytometric bead arrays; transforming growth factor beta 1 (TGF-β1) was measured using commercial enzyme-linked immunosorbent assay kits. RESULT(S) The cytokine profile was similar between the women who conceived and those who did not on the day of blastocyst transfer. In women who conceived, IFN-γ and IL-17 (pro-inflammatory cytokines) exhibited a transient and significant increase on day 3 after blastocyst transfer, which decreased to the baseline levels by day 6. Meanwhile, IL-10 (anti-inflammatory cytokine) was increased significantly on days 6 and 9, and TGF-β1 (anti-inflammatory cytokine) was increased significantly on day 9 after blastocyst transfer. In women who did not conceive, there was a more pronounced increase in IFN-γ and IL-17 (pro-inflammatory cytokines) on day 3, which was sustained on days 6 and 9 without a switch to an anti-inflammatory cytokine profile. CONCLUSION(S) Among women who conceived after blastocyst embryo transfer, there was a transient and modest increase in serum pro-inflammatory cytokine profile (IFN-γ and IL-17) 3 days after blastocyst transfer, which was followed by a switch to anti-inflammatory cytokine profile (increase IL-10 and TGF-β1) by 6 days after blastocyst transfer and the latter increase was sustained 9 days after blastocyst transfer, when pregnancy was confirmed.
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Affiliation(s)
- Yiwei Zhao
- Assisted Reproductive Technology Unit, Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Tao Zhang
- Assisted Reproductive Technology Unit, Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, People's Republic of China.
| | - Xi Guo
- Assisted Reproductive Technology Unit, Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Chun Kwok Wong
- Department of Chemical Pathology, the Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Xiaoyan Chen
- Assisted Reproductive Technology Unit, Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, People's Republic of China; Department of Obstetrics and Gynaecology, Shenzhen Baoan Women's and Children's Hospital, Shenzhen University, Shenzhen, People's Republic of China
| | - Yiu Leung Chan
- Assisted Reproductive Technology Unit, Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Chi Chiu Wang
- Assisted Reproductive Technology Unit, Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, People's Republic of China; Reproduction and Development Laboratory, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, People's Republic of China; School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong, People's Republic of China; Chinese University of Hong Kong -Sichuan University Joint Laboratory in Reproductive Medicine, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Susan Laird
- Department of Biosciences and Chemistry, Sheffield Hallam University, Sheffield, United Kingdom
| | - Tin Chiu Li
- Assisted Reproductive Technology Unit, Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, People's Republic of China; Chinese University of Hong Kong -Sichuan University Joint Laboratory in Reproductive Medicine, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
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10
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Chen X, Zhang T, Liu Y, Cheung WC, Zhao Y, Wang CC, Laird S, Li TC. Uterine CD56 + cell density and euploid miscarriage in women with a history of recurrent miscarriage: A clinical descriptive study. Eur J Immunol 2020; 51:487-489. [PMID: 32976648 DOI: 10.1002/eji.202048868] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/13/2020] [Accepted: 09/23/2020] [Indexed: 11/12/2022]
Abstract
In women with a history of recurrent miscarriage, the uterine CD56+ cell density in subjects with subsequent euploid miscarriage was significantly higher than those with subsequent aneuploid miscarriage. Both endometrial and embryonic factors should be investigated when interpreting uterine CD56+ cell density results relating to recurrent miscarriage.
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Affiliation(s)
- Xiaoyan Chen
- Department of Obstetrics and Gynaecology, Shenzhen Baoan Women's and Children's Hospital, Shenzhen University, Shenzhen, China.,Assisted Reproductive Technology Unit, Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Shatin, China
| | - Tao Zhang
- Assisted Reproductive Technology Unit, Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Shatin, China
| | - Yingyu Liu
- Assisted Reproductive Technology Unit, Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Shatin, China
| | - Wing Ching Cheung
- Assisted Reproductive Technology Unit, Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Shatin, China
| | - Yiwei Zhao
- Assisted Reproductive Technology Unit, Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Shatin, China
| | - Chi Chiu Wang
- Assisted Reproductive Technology Unit, Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Shatin, China
| | - Susan Laird
- Biomolecular Sciences Research Centre, Sheffield Hallam University, Sheffield, UK
| | - Tin Chiu Li
- Assisted Reproductive Technology Unit, Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Shatin, China
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11
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Zhang T, Zhu W, Zhao Y, Cheung WC, Liu Y, Chen X, Du Y, Leung KT, Chan YL, Wang CC, Laird S, Li TC. Early transient suppression of immune checkpoint proteins T-cell immunoglobulin mucin-3 and programmed cell death-1 in peripheral blood lymphocytes after blastocyst transfer is associated with successful implantation. Fertil Steril 2020; 114:426-435. [DOI: 10.1016/j.fertnstert.2019.12.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 12/11/2019] [Accepted: 12/11/2019] [Indexed: 12/15/2022]
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12
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Mason A, Gerasimidis K, Iljuhhina J, Laird S, Munro J, Gaya DR, Russell RK, Ahmed SF. Long-Term Skeletal Disproportion in Childhood-Onset Crohn's Disease. Horm Res Paediatr 2018; 89:132-135. [PMID: 29212077 DOI: 10.1159/000485185] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 11/07/2017] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND It is unclear whether Crohn's disease (CD) is associated with skeletal disproportion in adulthood. METHODS Height (Ht), sitting height (SHt) and leg length were studied in 44 children (male: 22), 23 adults (male: 10) with childhood-onset (CO) CD and 26 adults (male: 9) with adult-onset (AO) CD with a median (range) age of 13.7 (10, 17.3), 21.5 (18, 32) and 31.0 (22, 40) years, respectively. RESULTS Adults with CO-CD had a median Ht standard deviation score (SDS) of -0.9 (-2.3, 0.0) compared to 0.6 (-0.8, 1.0) in those with AO-CD (p < 0.05). Compared to a normal population, men, but not women, with CO-CD also had lower median SHt SDS at -1.1 (2.5, -0.5) (p < 0.05). The expected positive association that is normally found between leg length and SHt SDS was not evident in the adults with CO-CD. CONCLUSION Short stature in adults with CO-CD is more pronounced in men and may be associated with poor spinal growth.
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Affiliation(s)
- Avril Mason
- Developmental Endocrinology Research Group, School of Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Royal Hospital for Children, Glasgow, United Kingdom
| | - Konstantinos Gerasimidis
- Human Nutrition, School of Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow Royal Infirmary, Glasgow, United Kingdom
| | - Jelena Iljuhhina
- Human Nutrition, School of Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow Royal Infirmary, Glasgow, United Kingdom
| | - Susan Laird
- Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow, United Kingdom
| | - Joanne Munro
- Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow, United Kingdom
| | - Daniel R Gaya
- Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow, United Kingdom
| | - Richard K Russell
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, Royal Hospital for Children, Glasgow, United Kingdom
| | - S Faisal Ahmed
- Developmental Endocrinology Research Group, School of Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Royal Hospital for Children, Glasgow, United Kingdom
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13
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14
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Pye C, Chatters R, Cohen J, Brian K, Cheong YC, Laird S, Mohiyiddeen L, Skull J, Walters S, Young T, Metwally M. Induced endometrial trauma (endometrial scratch) in the mid-luteal menstrual cycle phase preceding first cycle IVF/ICSI versus usual IVF/ICSI therapy: study protocol for a randomised controlled trial. BMJ Open 2018; 8:e020755. [PMID: 29780028 PMCID: PMC5961587 DOI: 10.1136/bmjopen-2017-020755] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Endometrial trauma commonly known as endometrial scratch (ES) has been shown to improve pregnancy rates in women with a history of repeated implantation failure undergoing in vitro fertilisation (IVF), with or without intracytoplasmic sperm injection (ICSI). However, the procedure has not yet been fully explored in women having IVF/ICSI for the first time. This study aims to examine the effect of performing an ES in the mid-luteal phase prior to a first-time IVF/ICSI cycle on the chances of achieving a clinical pregnancy and live birth. If ES can influence this success rate, there would be a significant cost saving to the National Health Service through decreasing the number of IVF/ICSI cycles necessary to achieve a pregnancy, increase the practice of single embryo transfer and consequently have a large impact on risks and costs associated with multiple pregnancies. METHODS AND ANALYSIS This 30-month, UK, multicentre, parallel group, randomised controlled trial includes a 9-month internal pilot and health economic analysis recruiting 1044 women from 16 fertility units. It will follow up participants to identify if IVF/ICSI has been successful and live birth has occurred up to 6 weeks post partum. Primary analysis will be on an intention-to-treat basis. A substudy of endometrial samples obtained during the ES will assess the role of immune factors in embryo implantation. Main trial recruitment commenced on January 2017 and is ongoing.Participants randomised to the intervention group will receive the ES procedure in the mid-luteal phase of the preceding cycle prior to first-time IVF/ICSI treatment versus usual IVF/ICSI treatment in the control group, with 1:1 randomisation. The primary outcome is live birth rate after completed 24 weeks gestation. ETHICS AND DISSEMINATION South Central-Berkshire Research Ethics Committee approved the protocol. Findings will be submitted to peer-reviewed journals and abstracts to relevant national and international conferences. TRIAL REGISTRATION NUMBER ISRCTN23800982; Pre-results.
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Affiliation(s)
- Clare Pye
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Robin Chatters
- Clinical Trials Research Unit, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Judith Cohen
- Hull Health Trials Unit, University of Hull, Hull
| | - Kate Brian
- Patient and Public Involvement (PPI), Fertility Network UK, London, UK
| | - Ying C Cheong
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Susan Laird
- Biomolecular Sciences Research Centre, Sheffield Hallam University, Sheffield, UK
| | - Lamiya Mohiyiddeen
- Saint Mary's Hospital - Central Manchester University Hospitals, Manchester, UK
| | - Jonathan Skull
- Fertility Unit - Jessop Wing, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Stephen Walters
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Tracey Young
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Mostafa Metwally
- Fertility Unit - Jessop Wing, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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15
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Liu Y, Chen X, Huang J, Wang CC, Yu MY, Laird S, Li TC. Comparison of the prevalence of chronic endometritis as determined by means of different diagnostic methods in women with and without reproductive failure. Fertil Steril 2018; 109:832-839. [DOI: 10.1016/j.fertnstert.2018.01.022] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 01/17/2018] [Accepted: 01/18/2018] [Indexed: 11/24/2022]
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16
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Mehta P, Horton DK, Kasarskis EJ, Tessaro E, Eisenberg MS, Laird S, Iskander J. CDC Grand Rounds: National Amyotrophic Lateral Sclerosis (ALS) Registry Impact, Challenges, and Future Directions. MMWR Morb Mortal Wkly Rep 2017; 66:1379-1382. [PMID: 29267263 PMCID: PMC5751576 DOI: 10.15585/mmwr.mm6650a3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Amyotrophic lateral sclerosis (ALS), commonly known as Lou Gehrig's disease, is a rapidly progressive fatal neurologic disease. Currently, there is no cure for ALS and the available treatments only extend life by an average of a few months. The majority of ALS patients die within 2-5 years of diagnosis, though survival time varies depending on disease progression (1,2). For approximately 10% of patients, ALS is familial, meaning it and has a genetic component; the remaining 90% have sporadic ALS, where etiology is unknown, but might be linked to environmental factors such as chemical exposures (e.g., heavy metals, pesticides) and occupational history (3).
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17
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Chen X, Mariee N, Jiang L, Liu Y, Wang CC, Li TC, Laird S. Measurement of uterine natural killer cell percentage in the periimplantation endometrium from fertile women and women with recurrent reproductive failure: establishment of a reference range. Am J Obstet Gynecol 2017; 217:680.e1-680.e6. [PMID: 28935491 DOI: 10.1016/j.ajog.2017.09.010] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 09/07/2017] [Accepted: 09/11/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Uterine natural killer cells are the major leukocytes present in the periimplantation endometrium. Previous studies have found controversial differences in uterine natural killer cell percentage in women with recurrent reproductive failure compared with fertile controls. OBJECTIVE We sought to compare the uterine natural killer cell percentage in women with recurrent reproductive failure and fertile controls. STUDY DESIGN This was a retrospective study carried out in university hospitals. A total of 215 women from 3 university centers participated in the study, including 97 women with recurrent miscarriage, 34 women with recurrent implantation failure, and 84 fertile controls. Endometrial biopsy samples were obtained precisely 7 days after luteinization hormone surge in a natural cycle. Endometrial sections were immunostained for CD56 and cell counting was performed by a standardized protocol. Results were expressed as percentage of positive uterine natural killer cell/total stromal cells. RESULTS The median uterine natural killer cell percentage in Chinese ovulatory fertile controls in natural cycles was 2.5% (range 0.9-5.3%). Using 5th and 95th percentile to define the lower and upper limits of uterine natural killer cell percentage, the reference range was 1.2-4.5%. Overall, the groups with recurrent reproductive failure had significantly higher uterine natural killer cell percentage than the controls (recurrent miscarriage: median 3.2%, range 0.6-8.8%; recurrent implantation failure: median 3.1%, range 0.8-8.3%). However, there was a subset of both groups (recurrent miscarriage: 16/97; recurrent implantation failure: 6/34) that had lower uterine natural killer cell percentage compared to fertile controls. CONCLUSION A reference range for uterine natural killer cell percentage in fertile women was established. Women with recurrent reproductive failure had uterine natural killer cell percentages both above and below the reference range.
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Affiliation(s)
- Xiaoyan Chen
- Department of Obstetrics and Gynecology, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Najat Mariee
- Biomolecular Sciences Research Center, Sheffield Hallam University, Sheffield, United Kingdom
| | - Lingming Jiang
- Department of Obstetrics and Gynecology, Shenzhen People's Hospital, Second Affiliated Hospital of Jinan University, Shenzhen, China
| | - Yingyu Liu
- Department of Obstetrics and Gynecology, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Chi Chiu Wang
- Department of Obstetrics and Gynecology, Chinese University of Hong Kong, Shatin, Hong Kong; Li Ka Shing Institute of Health Science, Chinese University of Hong Kong, Shatin, Hong Kong; School of Biomedical Science, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Tin Chiu Li
- Department of Obstetrics and Gynecology, Chinese University of Hong Kong, Shatin, Hong Kong.
| | - Susan Laird
- Biomolecular Sciences Research Center, Sheffield Hallam University, Sheffield, United Kingdom
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18
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Huang J, Qin H, Yang Y, Chen X, Zhang J, Laird S, Wang CC, Chan TF, Li TC. A comparison of transcriptomic profiles in endometrium during window of implantation between women with unexplained recurrent implantation failure and recurrent miscarriage. Reproduction 2017; 153:749-758. [PMID: 28283674 DOI: 10.1530/rep-16-0574] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 03/02/2017] [Accepted: 03/09/2017] [Indexed: 01/09/2023]
Abstract
The endometrium becomes receptive to the embryo only in the mid-luteal phase, but not in the other stages of the menstrual cycle. Endometrial factors play an important role in implantation. Women with recurrent miscarriage and recurrent implantation failure have both been reported to have altered expression of receptivity markers during the window of implantation. We aimed to compare the gene expression profiles of the endometrium in the window of implantation among women with unexplained recurrent implantation failures (RIF) and unexplained recurrent miscarriages (RM) by RNA sequencing (RNA-Seq). In total 20 patients (9 RIF and 11 RM) were recruited. In addition 4 fertile subjects were included as reference. Endometrium samples were precisely timed on the 7th day after luteal hormone surge (LH + 7). All the 24 endometrium samples were extracted for total RNA. The transcriptome was determined by RNA-Seq in the first 14 RNA samples (5 RIF, 6 RM and 3 fertile). Differentially expressed genes between RM and RIF were validated by quantitative real-time PCR (qPCR) in all 24 RNA samples (9 RIF, 11 RM and 4 fertile). Transcriptomic profiles of RM and RIF, but not control samples, were separated from each other by principle component analysis (PCA) and support vector machine (SVM). Complementary and coagulation cascades pathway was significantly up-regulated in RIF while down-regulated in RM. Differentially expressed genes C3, C4, C4BP, DAF, DF and SERPING1 in complement and coagulation cascade pathway between RM and RIF were further validated by qPCR. This study compared endometrial transcriptome among patients with RIF and RM in the window of implantation; it identified differential molecular pathways in endometrium between RIF and RM, which potentially affect the implantation process.
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Affiliation(s)
- Jin Huang
- Department of Obstetrics and Gynaecology
| | - Hao Qin
- School of Life SciencesThe Chinese University of Hong KongHong Kong SAR, China
| | - Yihua Yang
- Department of Obstetrics and Gynaecology
- Reproductive Medicine Centre of the Affiliated HospitalGuilin Medical University, Guilin, Guangxi, China
| | | | - Jiamiao Zhang
- Department of Obstetrics and Gynaecology
- Reproductive Medicine Centre of the Affiliated HospitalGuilin Medical University, Guilin, Guangxi, China
| | - Susan Laird
- Biomolecular Sciences Research CentreSheffield Hallam University, Sheffield, UK
| | - Chi Chiu Wang
- Department of Obstetrics and Gynaecology
- Li Ka Shing Institute of Health Sciences
- School of Biomedical SciencesThe Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ting Fung Chan
- School of Life SciencesThe Chinese University of Hong KongHong Kong SAR, China
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Dopson SA, Griffey S, Ghiya N, Laird S, Cyphert A, Iskander J. Structured Mentoring for Workforce Engagement and Professional Development in Public Health Settings. Health Promot Pract 2017; 18:327-331. [PMID: 28125904 DOI: 10.1177/1524839916686927] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Mentoring is commonly used to facilitate professional growth and workforce development in a variety of settings. Organizations can use mentoring to help achieve broader personnel goals including leadership development and succession planning. While mentorship can be incorporated into training programs in public health, there are other examples of structured mentoring, with time commitments ranging from minutes to months or longer. Based on a review of the literature in public health and aggregated personal subject matter expertise of existing programs at the Centers for Disease Control and Prevention, we summarize selected mentoring models that vary primarily by time commitments and meeting frequency and identify specific work situations to which they may be applicable, primarily from the federal job experience point of view. We also suggest specific tasks that mentor-mentee pairs can undertake, including review of writing samples, practice interviews, and development of the mentee's social media presence. The mentor-mentee relationship should be viewed as a reciprocally beneficial one that can be a source of learning and personal growth for individuals at all levels of professional achievement and across the span of their careers.
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Affiliation(s)
| | | | - Neelam Ghiya
- 1 Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Susan Laird
- 1 Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - John Iskander
- 1 Centers for Disease Control and Prevention, Atlanta, GA, USA
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20
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Svolos V, Gerasimidis K, Buchanan E, Curtis L, Garrick V, Hay J, Laird S, Munro J, Gaya DR, Russell RK, Hansen R. Dietary treatment of Crohn's disease: perceptions of families with children treated by exclusive enteral nutrition, a questionnaire survey. BMC Gastroenterol 2017; 17:14. [PMID: 28103809 PMCID: PMC5247812 DOI: 10.1186/s12876-016-0564-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 12/22/2016] [Indexed: 01/13/2023] Open
Abstract
Background Diet is strongly associated with the aetiology of Crohn’s Disease (CD) and exclusive enteral nutrition (EEN) is the primary induction treatment in paediatric CD. This study explored opinions around the use of EEN and alternative novel, solid food-based diets (SFDs) expressed by paediatric patients with CD, previously treated with EEN and their parents. Methods This anonymous questionnaire surveyed families of CD patients treated with EEN over 1 year. Two questionnaire forms were completed; one asking the patients’ opinions and another referring to their main carer. This questionnaire explored participants’ demographic characteristics; acceptability of a repeat EEN course to treat a future flare (EEN repeat); their opinion on how difficult EEN would be compared to an example SFD; and their intention to participate in a future clinical trial assessing the therapeutic efficacy of an SFD in CD. Results Forty-one families of CD patients were approached with 29 sending replies (71%). Most of our participants were positive on completing another EEN course, however the majority would choose an SFD alternative (Patients:66, Parents:72%). Both patients and their parents rated EEN to be more difficult to adhere to compared to an example SFD (p < 0.05), and their ratings were strongly correlated (EEN:r = 0.83, SFD:r = 0.75, p < 0.001). The majority of our respondents would agree to participate in a clinical trial assessing an SFD’s effectiveness (Patients:79, Parents:72%) for the management of active CD. Conclusions While patients with CD and their families would accept an EEN repeat, the majority would prefer an SFD alternative. CD families surveyed are supportive of the development of solid food-based dietary treatments. Electronic supplementary material The online version of this article (doi:10.1186/s12876-016-0564-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Vaios Svolos
- Human Nutrition, School of Medicine, Dentistry & Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK
| | - Konstantinos Gerasimidis
- Human Nutrition, School of Medicine, Dentistry & Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK
| | - Elaine Buchanan
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, Royal Hospital for Children, Glasgow, UK
| | - Lee Curtis
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, Royal Hospital for Children, Glasgow, UK
| | - Vikki Garrick
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, Royal Hospital for Children, Glasgow, UK
| | - Jacqueline Hay
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, Royal Hospital for Children, Glasgow, UK
| | - Susan Laird
- Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow, UK
| | - Joanna Munro
- Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow, UK
| | - Daniel R Gaya
- Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow, UK
| | - Richard K Russell
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, Royal Hospital for Children, Glasgow, UK
| | - Richard Hansen
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, Royal Hospital for Children, Glasgow, UK.
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Unger ER, Lin JMS, Brimmer DJ, Lapp CW, Komaroff AL, Nath A, Laird S, Iskander J. CDC Grand Rounds: Chronic Fatigue Syndrome - Advancing Research and Clinical Education. MMWR Morb Mortal Wkly Rep 2016; 65:1434-1438. [PMID: 28033311 DOI: 10.15585/mmwr.mm655051a4] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Chronic fatigue syndrome (CFS) is a complex and serious illness that is often misunderstood. Experts have noted that the terminology "chronic fatigue syndrome" can trivialize this illness and stigmatize persons who experience its symptoms (1). The name was coined by a group of clinicians convened by CDC in the late 1980s to develop a research case definition for the illness, which, at the time, was called chronic Epstein-Barr virus syndrome. The name CFS was suggested because of the characteristic persistent fatigue experienced by all those affected and the evidence that acute or reactivated Epstein-Barr virus infection was not associated with many cases (2). However, the fatigue in this illness is striking and quite distinct from the common fatigue everyone experiences. A variety of other names have been used, including myalgic encephalomyelitis (ME), ME/CFS, chronic fatigue immune dysfunction, and most recently, systemic exertion intolerance disease (3). The lack of agreement about nomenclature need not be an impediment for advancing critically needed research and education. The term ME/CFS will be used in this article.
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Laird S, Kühn I, Wilcock P, Miller HM. The effects of phytase on grower pig growth performance and ileal inositol phosphate degradation. J Anim Sci 2016. [DOI: 10.2527/jas.2015-9762] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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23
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Watson M, Thomas CC, Massetti GM, McKenna S, Gershenwald JE, Laird S, Iskander J, Lushniak B. CDC Grand Rounds: Prevention and Control of Skin Cancer. Am J Transplant 2016. [DOI: 10.1111/ajt.13720] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- M. Watson
- Division of Cancer Prevention; National Center for Chronic Disease Prevention and Health Promotion; CDC
| | - C. C. Thomas
- Division of Cancer Prevention; National Center for Chronic Disease Prevention and Health Promotion; CDC
| | - G. M. Massetti
- Division of Cancer Prevention; National Center for Chronic Disease Prevention and Health Promotion; CDC
| | - S. McKenna
- Arizona SunWise Skin Cancer Prevention Program; Arizona Department of Health Services
| | | | - S. Laird
- Office of the Associate Director for Science; CDC
| | - J. Iskander
- Office of the Associate Director for Science; CDC
| | - B. Lushniak
- Office of the Surgeon General; U.S. Department of Health and Human Services
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Watson M, Thomas CC, Massetti GM, McKenna S, Gershenwald JE, Laird S, Iskander J, Lushniak B. CDC Grand Rounds: Prevention and Control of Skin Cancer. MMWR Morb Mortal Wkly Rep 2015; 64:1312-4. [PMID: 26633233 DOI: 10.15585/mmwr.mm6447a2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Skin cancer is the most common cancer in the United States, and most cases are preventable. Persons with certain genetic risk factors, including having a lighter natural skin color; blue or green eyes; red or blonde hair; dysplastic nevi or a large number of common moles; and skin that burns, freckles, or reddens easily or becomes painful after time in the sun, have increased risk for skin cancer. Persons with a family or personal history of skin cancer, especially melanoma, are also at increased risk. Although these genetic factors contribute to individual risk, most skin cancers are also strongly associated with ultraviolet (UV) radiation exposure. Most UV exposure comes from the sun, although some persons use UV-emitting indoor tanning devices (e.g., beds, booths, and lamps).
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Liu L, Sailan S, Li T, Mariee N, Laird S, Jiang Z, Zhang S. The effect of a high progesterone concentration before oocyte retrieval on the peri-implantation endometrium. Reprod Biomed Online 2015; 31:739-46. [PMID: 26515148 DOI: 10.1016/j.rbmo.2015.09.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Revised: 08/30/2015] [Accepted: 09/02/2015] [Indexed: 10/23/2022]
Abstract
In this single-centre, prospective cohort study, the effect of high progesterone level before oocyte retrieval on endometrial morphology and uterine natural killer cell (uKN) count in the peri-implantation period was investigated. A total of 106 women undergoing IVF treatment who did not proceed to fresh embryo transfer were included. Endometrial samples were obtained 7 days after HCG administration. Multiple regression analysis was used to identify factors affecting the results of histological staging and uNK cell count. Progesterone level on the day after HCG administration was the only significant variable associated with the results of histological staging (P = 0.004). Endometrial development in women with high progesterone level was significantly (P < 0.001) more advanced than that of women with normal progesterone; progesterone level on the day of HCG administration was the only significant variable associated with uNK cell count. The median (range) of uNK cell count of 9.6% (2.3-21.6%) in women with high progesterone was significantly (P < 0.001) higher than the median (range) of uNK cell count of 5.7% (1.4-18.7%) in women with normal progesterone. High progesterone level before oocyte retrieval was correlated with advancement in endometrial development as well as increased uNK cell count.
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Affiliation(s)
- Liu Liu
- Center of Reproductive Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, China; Department of Obstetric and Gynecology, Chinese University of Hong Kong, China
| | - Sumaia Sailan
- Biomedical Research Center, Sheffield Hallam University, Sheffield, UK
| | - Tinchiu Li
- Department of Obstetric and Gynecology, Chinese University of Hong Kong, China
| | - Najat Mariee
- Biomedical Research Center, Sheffield Hallam University, Sheffield, UK
| | - Susan Laird
- Biomedical Research Center, Sheffield Hallam University, Sheffield, UK
| | - Zhinong Jiang
- Center of Reproductive Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, China
| | - Songying Zhang
- Center of Reproductive Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, China.
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Liu B, Mariee N, Laird S, Smith J, Li J, Li T. The prognostic value of uNK cell count and histological dating in the mid-luteal phase of women with reproductive failure. Eur J Obstet Gynecol Reprod Biol 2014; 181:171-5. [DOI: 10.1016/j.ejogrb.2014.07.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 06/16/2014] [Accepted: 07/20/2014] [Indexed: 12/13/2022]
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Naismith GD, Smith LA, Barry SJE, Munro JI, Laird S, Rankin K, Morris AJ, Winter JW, Gaya DR. A prospective evaluation of the predictive value of faecal calprotectin in quiescent Crohn's disease. J Crohns Colitis 2014; 8:1022-9. [PMID: 24566170 DOI: 10.1016/j.crohns.2014.01.029] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2013] [Revised: 01/30/2014] [Accepted: 01/31/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND Faecal calprotectin (FC) is a non-invasive marker of gastrointestinal inflammation. AIM To determine whether higher FC levels in individuals with quiescent Crohn's disease are associated with clinical relapse over the ensuing 12 months. METHODS A single centre prospective study was undertaken in Crohn's disease patients in clinical remission. The receiver operating characteristic (ROC) curve for the primary endpoint of clinical relapse by 12 months, based on FC at baseline, was calculated. Kaplan-Meier curves of time to relapse were based on the resulting optimal FC cutoff for predicting relapse. RESULTS Of 97 patients recruited, 92 were either followed up for 12 months without relapsing, or reached the primary endpoint within that period. Of these, 10 (11%) relapsed by 12 months. Median FC was lower for non-relapsers, 96 μg/g (IQR 39-237), than for relapsers, 414 μg/g (IQR 259-590), (p=0.005). The area under the ROC curve to predict relapse using FC was 77.4%. An optimal cutoff FC value of 240 μg/g to predict relapse had sensitivity of 80.0% and specificity of 74.4%. Negative predictive value was 96.8% and positive predictive value was 27.6%, FC ≥240 μg/g was associated with likelihood of relapse by 12-months 12.18 (95% CI 2.55-58.2) times higher than lower values (p=0.002). CONCLUSIONS In this prospective dataset, FC is a useful tool to help identify quiescent Crohn's disease patients at a low risk of relapse over the ensuing 12 months. FC of 240 μg/g was the optimal cutoff in this cohort.
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Affiliation(s)
- Graham D Naismith
- Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow, United Kingdom.
| | - Lyn A Smith
- Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow, United Kingdom.
| | - Sarah J E Barry
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom.
| | - Joanna I Munro
- Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow, United Kingdom.
| | - Susan Laird
- Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow, United Kingdom.
| | - Karen Rankin
- Department of Clinical Biochemistry, Glasgow Royal Infirmary, Glasgow, United Kingdom.
| | - Allan J Morris
- Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow, United Kingdom.
| | - Jack W Winter
- Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow, United Kingdom.
| | - Daniel R Gaya
- Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow, United Kingdom.
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28
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Naismith GD, Smith LA, Barry SJE, Munro JI, Laird S, Rankin K, Morris AJ, Winter JW, Gaya DR. A prospective single-centre evaluation of the intra-individual variability of faecal calprotectin in quiescent Crohn's disease. Aliment Pharmacol Ther 2013; 37:613-21. [PMID: 23347334 DOI: 10.1111/apt.12221] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2012] [Revised: 11/16/2012] [Accepted: 01/03/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND As a non-invasive marker of gastrointestinal inflammation, faecal calprotectin (FC) is being increasingly used to guide the management of Crohn's disease. It is therefore a concern that studies have shown variability in day to day levels. AIM To determine the degree of this intrapersonal variability in the context of quiescent Crohn's disease. METHODS A single-centre prospective study was undertaken in 143 Crohn's disease patients in clinical remission. Three faecal calprotectin levels were analysed from stool samples on consecutive days. Consistency of faecal calprotectin levels was determined by measuring the intraclass correlation (ICC). Due to higher variability at higher faecal calprotectin levels, the ICC was calculated for the log-transformed values. The reliability of detecting a 'case' of active inflammation as defined for specific concentrations of faecal calprotectin was measured by the kappa statistic. RESULTS Ninety-eight complete sets of results were obtained. The ICC was 0.84 (95% CI: 0.79-0.89), which represents low variability across samples. The kappa statistic for the reliability of detecting a case as defined by an FC level of >50 μg/g was substantial at 0.648 (0.511-0.769). CONCLUSIONS Day to day variability of faecal calprotectin is low in our cohort of quiescent Crohn's disease patients and the reliability of defining a 'case' is moderately good. These data provide reassurance to clinicians using a single calprotectin sample to inform therapeutic strategies in this cohort.
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Affiliation(s)
- G D Naismith
- Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow, UK
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29
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Mariee NG, Tuckerman E, Laird S, Li TC. The correlation of autoantibodies and uNK cells in women with reproductive failure. J Reprod Immunol 2012; 95:59-66. [PMID: 22884101 DOI: 10.1016/j.jri.2012.04.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Revised: 04/16/2012] [Accepted: 04/23/2012] [Indexed: 12/19/2022]
Abstract
There is conflicting evidence on the role of autoimmune disorders in reproductive failure, including recurrent miscarriage (RM) and recurrent implantation failure (RIF), after in vitro fertilisation (IVF). Several commonly studied autoimmune markers in women with reproductive failure include antiphospholipid antibodies (APAs), thyroid peroxidase antibodies (TPA) and uterine natural killer (uNK) cells. However, there have not been any studies that have examined the correlation of these markers in women with reproductive failure. To determine if women who tested positive for autoantibodies (APA and thyroid peroxidase antibodies) have significantly higher uNK cell numbers than women who tested negative for these antibodies, the percentage of stromal cells that stained positive for CD56 was identified by immunocytochemistry in endometrial biopsies from 42 women with unexplained RM (29 women tested negative for autoantibodies and 13 women tested positive for autoantibodies) and 40 women with unexplained RIF (30 women tested negative for autoantibodies and 10 women tested positive for autoantibodies). Biopsies were obtained on days LH+7 to LH+9. There was no significant difference in uNK cell numbers between women with unexplained RM who tested negative and those who tested positive for autoantibodies. Similarly, there was no significant difference in uNK cell numbers between women with unexplained RIF who tested negative and those who tested positive for autoantibodies. In women with reproductive failure the presence of autoantibodies does not appear to affect the numbers of uNK cells in the endometrium around the time of implantation.
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Affiliation(s)
- N G Mariee
- Academic Unit of Reproductive and Developmental Medicine, The University of Sheffield, Sheffield S10 2SF, UK.
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30
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Dakka M, Laird S, Nangalia R, Kishore M. Rate of micrometastases in sentinel lymph nodes for operable breast cancer. Eur J Surg Oncol 2011. [DOI: 10.1016/j.ejso.2011.08.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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31
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Udayashankar R, Baker D, Tuckerman E, Laird S, Li TC, Moore HD. Characterization of invasive trophoblasts generated from human embryonic stem cells. Hum Reprod 2010; 26:398-406. [PMID: 21163855 DOI: 10.1093/humrep/deq350] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Abnormal human embryo implantation leads to poor foetal development and miscarriage, or pre-eclampsia. Ethical and practical considerations concerning implantation limit its investigation, and it is often difficult to extrapolate findings in laboratory animals when implantation processes show diverse species differences. Therefore, it is important to develop new in vitro models to study the earliest events of human implantation. The aim of this study was to derive trophoblast cell lines from human embryonic stem cells (hESCs) by a robust protocol and co-culture of these cells with an established endometrial cell culture system to validate a model of trophoblast invasion at implantation. METHODS Derivation of trophoblast cell lines from hESC lines was established by spontaneous and induced differentiation of embryoid bodies and by initial measurement of hCGβ secretion by enzyme-linked immunosorbent assay and their phenotype investigated using gene- and protein-expression markers. Vesicles formed from an aggregating trophoblast were co-cultured with decidualized human endometrial stromal cells in hypoxic (2% oxygen) and normoxic (20% oxygen) environments. RESULTS Derived villous cytotrophoblast cell (CTB) lines further differentiated to invasive, extra-villous CTBs. Eventually, cells lost their proliferative capacity, with some lines acquiring karyotypic changes, such as a gain in the X chromosome. Cell-invasion assays confirmed that the extra-villous CTBs were invasive and erosion of the endometrial stromal layer occurred, particularly under hypoxic conditions in vitro. CONCLUSIONS Trophoblast cell lines derived from hESCs differentiate and adapt in vitro and can be used as a model to study the mechanisms of early trophoblast invasion.
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Affiliation(s)
- R Udayashankar
- Centre for Stem Cell Biology, University of Sheffield, Sheffield S10 2TN, UK.
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Tuckerman E, Mariee N, Prakash A, Li TC, Laird S. Uterine natural killer cells in peri-implantation endometrium from women with repeated implantation failure after IVF. J Reprod Immunol 2010; 87:60-6. [PMID: 20800899 DOI: 10.1016/j.jri.2010.07.001] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2010] [Revised: 07/08/2010] [Accepted: 07/22/2010] [Indexed: 11/17/2022]
Abstract
Several studies have suggested that endometrial uNK (CD56+) cells may play a role in implantation. The aim of this study was to investigate the number of CD56+, CD16+ and CD69+ cells in the unstimulated endometrium of women with recurrent implantation failure after IVF. The percentage of stromal cells positive for CD56, CD16 and CD69 was identified by immunocytochemistry in endometrial biopsies from 15 normal control women and 40 women with recurrent implantation failure. All biopsies were obtained on days LH+7 to LH+9. The density of CD56+ cells in endometrium from women with repeated implantation failure after IVF [median (range) CD56+ cell density=14.5% (1.5-71.4%)] was significantly higher (P=0.005) than in endometrium from control women [5% (2.1-19.2%)]. There was no significant difference in the densities of CD16+ and CD69+ cells in the endometrium from women in the two groups. The increased density of CD56+ cells in the endometrium of women with recurrent implantation failure suggests that these cells are directly involved in the implantation process; alternatively this may indicate a general endometrial defect in these women, which leads to the inability of the embryo to implant.
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MESH Headings
- Antigens, CD/analysis
- Antigens, CD/immunology
- Antigens, Differentiation, T-Lymphocyte/analysis
- Antigens, Differentiation, T-Lymphocyte/immunology
- CD56 Antigen/analysis
- CD56 Antigen/immunology
- Embryo Implantation
- Embryo Loss/immunology
- Endometrium/immunology
- Endometrium/pathology
- Female
- Fertilization in Vitro
- Fluorescent Antibody Technique
- Humans
- Killer Cells, Natural/immunology
- Lectins, C-Type/analysis
- Lectins, C-Type/immunology
- Pregnancy/immunology
- Receptors, IgG/analysis
- Receptors, IgG/immunology
- Stromal Cells/immunology
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Affiliation(s)
- Elizabeth Tuckerman
- Biomedical Research Unit, Jessop Wing, Tree Root Walk, Sheffield S10 2SF, UK
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Udayashankar R, Kershaw-Young C, Tuckerman E, Baker D, Laird S, Li TC, Moore HD. A Model for Human Embryo Implantation Using Trophoblast Generated from Embryonic Stem Cells. Biol Reprod 2008. [DOI: 10.1093/biolreprod/78.s1.57c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Prakash A, Tuckerman E, Laird S, Ola B, Li TC, Ledger WL. A preliminary study comparing the endometrial expression of inhibin, activin and follistatin in women with a history of implantation failure after IVF treatment and a control group. BJOG 2008; 115:532-6; discussion 536-7. [PMID: 18271891 DOI: 10.1111/j.1471-0528.2007.01624.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The aim of this study was to evaluate the expression of activin: beta A and beta B subunit and follistatin in endometrium of women with implantation failure (n = 10) and compare it with a fertile control group (n = 7). Immunohistochemical staining intensity for follistatin in the endometrial glandular epithelium from women with implantation failure were significantly lower than that in control women (P = 0.03). The decreased expression of follistatin in epithelial cells in the endometrium of women with implantation failure after in vitro fertilisation (IVF) may suggest that follistatin may play a role in the implantation process.
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Affiliation(s)
- A Prakash
- Academic Unit of Reproductive and Developmental Medicine, University of Sheffield, Sheffield, UK.
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Prakash A, Li TC, Tuckerman E, Laird S, Wells M, Ledger WL. A study of luteal phase expression of inhibin, activin, and follistatin subunits in the endometrium of women with recurrent miscarriage. Fertil Steril 2006; 86:1723-30. [DOI: 10.1016/j.fertnstert.2006.05.040] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2006] [Revised: 05/07/2006] [Accepted: 05/07/2006] [Indexed: 11/16/2022]
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Amer SA, Laird S, Ledger WL, Li TC. Effect of laparoscopic ovarian diathermy on circulating inhibin B in women with anovulatory polycystic ovary syndrome. Hum Reprod 2006; 22:389-94. [PMID: 17023489 DOI: 10.1093/humrep/del373] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Laparoscopic ovarian diathermy (LOD) frequently induces ovulation in patients with polycystic ovary syndrome (PCOS). The mechanism by which this effect occurs remains largely unexplained. The aim of this study was to measure changes in inhibin B production in response to LOD to see whether this could explain the mechanism of action of LOD. METHODS This prospective study included 50 anovulatory women with PCOS. All women underwent LOD. Blood samples were collected before and after LOD to measure plasma concentrations of inhibin B, gonadotrophins and androgens. RESULTS The pre-operative median plasma concentration of inhibin B was 110.0 pg/ml (range 19.0-567.0 pg/ml). There was a statistically significant inverse correlation (r= -0.286; P < 0.05) between body mass index (BMI) and inhibin B. Non-obese women with PCOS (BMI <or= 30 kg/m2; n=37) displayed significantly (P < 0.05) higher plasma inhibin B concentrations [122.0 pg/ml (range 19.0-567.0 pg/ml)] compared with those [51.0 pg/ml (range 27.0-201.0 pg/ml)] of obese PCOS women (BMI > 30 kg/m2; n=13). Following LOD, 39 women ovulated. No statistically significant change of inhibin B after LOD was observed in the overall group of women with PCOS or in the subgroup of non-obese PCOS women with higher pre-operative inhibin B. CONCLUSIONS The lack of any change of inhibin B after LOD makes it unlikely that this hormone has any role to play in the mechanism of action of LOD.
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Affiliation(s)
- S A Amer
- Reproductive Medicine and Surgery Unit, University of Sheffield, Sheffield Teaching Hospitals, Sheffield, UK.
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Prakash A, Li TC, Laird S, Nargund G, Ledger WL. Absence of follicular phase defect in women with recurrent miscarriage. Fertil Steril 2006; 85:1784-90. [PMID: 16643909 DOI: 10.1016/j.fertnstert.2005.11.045] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2005] [Revised: 11/08/2005] [Accepted: 11/08/2005] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The study was designed to compare the follicular phase of women with recurrent pregnancy loss and a healthy control group. It is possible that a defective or aberrant follicular phase may be associated with poor oocyte quality leading to a production of an embryo with compromised quality and hence early pregnancy loss. DESIGN Prospective case-control study. SETTING A tertiary care hospital of Sheffield, UK. PATIENT(S) Thirty-four women with recurrent miscarriage and 10 women with no previous history of miscarriage and regular menstrual cycles (control group) were recruited. INTERVENTION(S) The characteristics studied included Doppler assessment of blood flow to the follicle and the endometrium. Simultaneously, serum concentrations of biochemical markers such as anti-Müllerian hormone, inhibin B, FSH, LH, and P were compared in the two groups. MAIN OUTCOME MEASURE(S) Differences in the two groups. RESULT(S) We were unable to detect significant differences in various biochemical and ultrasound measurements in the follicular phase between women with recurrent miscarriage and a control group; however, the expected correlation between ovarian and pituitary hormones, which was observed in the control group, was absent in women with recurrent miscarriage. CONCLUSION(S) There may be subtle derangements of the feedback mechanism responsible for regulation of follicle development in this group of women. However, there were no obvious differences in the follicular phase of women with recurrent miscarriage and a healthy control group.
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Affiliation(s)
- Alka Prakash
- Academic Unit of Reproductive and Developmental Medicine, University of Sheffield, United Kingdom.
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Prakash A, Laird S, Li TC, Ledger WL. Preliminary prospective study of the endocrinology of conception cycles and early pregnancy in women with antiphospholipid syndrome treated with low molecular weight heparin. Fertil Steril 2006; 85:165-70. [PMID: 16412749 DOI: 10.1016/j.fertnstert.2005.07.1288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2004] [Revised: 07/07/2005] [Accepted: 07/07/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To examine whether there were any differences in the endocrinological profiles during conception cycle and early pregnancy between a control group and women with a history of recurrent miscarriage that was caused by antiphospholipid syndrome and that was treated with aspirin and low molecular weight heparin. DESIGN Prospective observational study. SETTING Recurrent Miscarriage Clinic, Department of Obstetrics and Gynaecology in a tertiary care centre. PATIENT(S) Five women with recurrent pregnancy loss were recruited as cases, whereas another five women having natural cycle donor insemination were used as control. INTERVENTION(S) Serial measurement of serum beta-hCG, activin A, and inhibin A was performed from postovulatory day 12 until 11 weeks of gestation. MAIN OUTCOME MEASURE(S) Comparison of levels of beta-hCG, activin A, and inhibin A at the time of conception onwards till 11 weeks in the two groups. RESULT(S) There were no significant differences between the two groups. CONCLUSION(S) There does not appear to be any obvious endocrinological alteration in the conception cycle of women with antiphospholipid syndrome compared with a control group. Furthermore, the initiation of heparin does not produce a significant change in activin A and inhibin A levels.
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Affiliation(s)
- Alka Prakash
- Academic Unit of Reproductive and Developmental Medicine, Sheffield Hallam University, City Campus, Sheffield, United Kingdom.
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Linjawi S, Li TC, Laird S, Blakemore A. Interleukin-1 receptor antagonist and interleukin-1 beta polymorphisms in women with recurrent miscarriage. Fertil Steril 2005; 83:1549-52. [PMID: 15866604 DOI: 10.1016/j.fertnstert.2004.10.052] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2004] [Revised: 10/28/2004] [Accepted: 10/28/2004] [Indexed: 11/28/2022]
Abstract
Genotypes and allele distributions for the interleukin (IL)-1beta -511 C/T and the IL-1 receptor antagonist gene intron 2 tandem repeat polymorphisms were compared in 206 women with recurrent miscarriage and a control population. No significant differences were observed between the distributions of IL-1beta or IL-1 receptor antagonist gene alleles in either the recurrent miscarriage group as a whole or when divided according to the cause of recurrent miscarriage compared with controls, which suggests that variation in the IL-1 receptor antagonist gene and IL-1beta genes individually does not play a role in susceptibility to recurrent miscarriage.
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Affiliation(s)
- Sabah Linjawi
- Biomedical Research Centre, Sheffield Hallam University, City Campus, UK
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Prakash A, Laird S, Tuckerman E, Li TC, Ledger WL. Inhibin A and activin A may be used to predict pregnancy outcome in women with recurrent miscarriage. Fertil Steril 2005; 83:1758-63. [PMID: 15950648 DOI: 10.1016/j.fertnstert.2004.11.072] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2004] [Revised: 11/30/2004] [Accepted: 11/30/2004] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To look at the role of inhibin and activin in predicting pregnancy outcome in patients with history of recurrent miscarriage. DESIGN Observational clinical study. SETTING Recurrent miscarriage clinic of a tertiary care teaching hospital. PATIENT(S) Patients with history of recurrent miscarriage. INTERVENTION(S) Serial serum inhibin A and activin A concentrations were measured in weeks 5 though 8 of pregnancy. MAIN OUTCOME MEASURE(S) Serum concentrations of inhibin A and activin A levels. RESULT(S) Mean inhibin A concentration at 5 to 6 weeks for women who miscarried and those who had live births was 33 and 51 pg/mL, respectively; activin A at same gestation for the two groups was 534 and 643 pg/mL, respectively. After 2 weeks, mean inhibin A concentration for women who miscarried and those who had live births was 66 and 145 pg/mL, respectively, and activin A was 747 and 1,123 pg/mL, respectively. CONCLUSION(S) It is possible that inhibin A and activin A may be used as markers to predict pregnancies that are likely to miscarry.
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Affiliation(s)
- Alka Prakash
- Academic Unit of Reproductive and Developmental Medicine, University of Sheffield, Jessop Wing, Sheffield, United Kingdom.
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Levar J, Jordan W, Laird S, Mandell L, Friess G, Ross M, Page R. Gender differences in the onset of symptoms of cancer-related anemia. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.8100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- J. Levar
- University of North Texas, Health Science Center, Fort Worth, TX; Texas Cancer Care, Fort Worth, TX
| | - W. Jordan
- University of North Texas, Health Science Center, Fort Worth, TX; Texas Cancer Care, Fort Worth, TX
| | - S. Laird
- University of North Texas, Health Science Center, Fort Worth, TX; Texas Cancer Care, Fort Worth, TX
| | - L. Mandell
- University of North Texas, Health Science Center, Fort Worth, TX; Texas Cancer Care, Fort Worth, TX
| | - G. Friess
- University of North Texas, Health Science Center, Fort Worth, TX; Texas Cancer Care, Fort Worth, TX
| | - M. Ross
- University of North Texas, Health Science Center, Fort Worth, TX; Texas Cancer Care, Fort Worth, TX
| | - R. Page
- University of North Texas, Health Science Center, Fort Worth, TX; Texas Cancer Care, Fort Worth, TX
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Abstract
OBJECTIVE To describe the pattern of pregnancy loss in women with a history of recurrent miscarriage (RM). DESIGN Retrospective, observational study. SETTING A tertiary referral center for RM. PATIENT(S) Five hundred thirty-eight subjects with RM. INTERVENTION(S) Women with antiphospholipid syndrome were treated with clexane and aspirin; some patients with uterine anomalies underwent corrective surgery, and some cases of retarded endometrium were treated with hMG. MAIN OUTCOME MEASURE(S) Pregnancy outcome, including the stage of pregnancy at which pregnancy loss occurred. RESULT(S) In women with a prothrombotic state, the miscarriage rate before the detection of fetal heart activity (early loss) in the untreated group (50%) was significantly higher than in the treatment group (17.5%). In women with a uterine anomaly, the early loss rate and the later loss rate (after detection of fetal heart activity) were both increased. Women with retarded endometrium, women with >/=6 losses, and older women (>/=41 years) are more likely to have a further early loss but not a later loss. CONCLUSION(S) An understanding of the patterns of pregnancy loss provides further insight into the mechanism of the reproductive failure, which has implications for treatment.
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Affiliation(s)
- Tin Chiu Li
- The Jessop Wing, Sheffield Teaching Hospitals NHS Trust, Sheffield, United Kingdom.
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Abstract
Recurrent miscarriage (RM) is a heterogeneous condition. A large number of studies has recently been published, yet many of them have conflicting conclusions. The various aetiological factors, management, prognostic features and outcomes of a subsequent pregnancy in women with RM are reviewed.
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Affiliation(s)
- T C Li
- Biomedical Research Unit, Tree Root Walk, Sheffield, UK.
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Li TC, Ding SH, Anstie B, Tuckerman E, Wood K, Laird S. Use of human menopausal gonadotropins in the treatment of endometrial defects associated with recurrent miscarriage: preliminary report. Fertil Steril 2001; 75:434-7. [PMID: 11172853 DOI: 10.1016/s0015-0282(00)01708-8] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To test the hypothesis that controlled ovarian stimulation by gonadotropins, which enhances estrogen priming, is of beneficial value in the treatment of endometrial defects associated with recurrent miscarriage. DESIGN A retrospective, observational, nonrandomized study. SETTING A regional recurrent miscarriage clinic in a teaching hospital. PATIENT(S) Twenty-one subjects with otherwise unexplained recurrent miscarriage who had retarded endometrial development in the mid-luteal phase. Endometrial biopsies were timed by the luteinizing hormone surge. INTERVENTION(S) Controlled ovarian stimulation using human menopausal gonadotropins and repeat endometrial biopsy in the treatment cycle in 13 subjects. MAIN OUTCOME MEASURE(S) Histological dating of endometrial biopsy in treatment cycles and miscarriage rate in treatment and nontreatment cycles. RESULT(S) Eleven (85%) of the 13 biopsies in the treatment cycle were found to be normal. The miscarriage rate in the treatment group, 2 of 13, was significantly lower than that in the nontreatment group (7/12) (chi2 5.0, P<.05). CONCLUSION(S) In this small series, preliminary experience suggests that controlled ovarian stimulation by human menopausal gonadotropins in the follicular phase is an effective treatment for luteal phase defect associated with recurrent pregnancy loss. There is now a case for a prospective, controlled study to confirm the value of such a treatment.
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Affiliation(s)
- T C Li
- Jessop Hospital for Women, Leavygreave Road, Sheffield S3 7RE, United Kingdom
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Abstract
OBJECTIVE To investigate the endocrinological and endometrial factors in women with unexplained recurrent miscarriage DESIGN Prospective, case study SETTING Recurrent miscarriage clinic, Jessop Hospital for Women, Sheffield PARTICIPANTS One hundred and forty-four women with unexplained recurrent (> or =3) miscarriages METHODS A blood sample was obtained in early follicular phase (day 3-5) to measure follicle stimulating hormone, luteinising hormone, prolactin, androgens and thyroid function; daily blood/urine samples were obtained from mid-follicular phase to measure luteinising hormone until the luteinising hormone surge was identified; endometrial biopsy and a further blood sample for progesterone measurement were obtained in the mid-luteal phase. A transvaginal ultrasonography was performed to evaluate ovarian morphology. RESULTS Hypersecretion of luteinising hormone or ultrasonographic features of polycystic ovarian disease was present in 8% and 7.8% of women, respectively. The free androgen index was elevated in 14.6% of subjects. In the mid-luteal phase, low progesterone level was found in 17.4% and delayed endometrial development was noted in 27.1% of women. Although women with recurrent miscarriage women and delayed endometrium had significantly lower progesterone levels than those with normal endometrial development, only 8/24 had mid-luteal progesterone levels below 30 nmol/L. Recurrent miscarriage was not associated with hyperprolactinaemia or abnormal thyroid function test. CONCLUSIONS Endocrinological and endometrial abnormalities are present in about a quarter of women with unexplained recurrent miscarriage.
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Affiliation(s)
- T C Li
- Jessop Hospital for Woman, Sheffield, UK
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Okon MA, Lee S, Laird S, Li TC. P229 The morphological and biochemical response of the endometrium to two “period-free” hormone replacement therapy. Maturitas 1996. [DOI: 10.1016/s0378-5122(97)81419-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Laber-Laird K, Laird S, Swindle MM. Determination of animal facility staffing levels. Contemp Top Lab Anim Sci 1993; 33:13-8. [PMID: 16471481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
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Tarter RE, Laird S, Bukstein O. Multivariate comparison of adolescent offspring of substance abuse parents: community and treatment samples. J Subst Abuse 1991; 3:301-6. [PMID: 1821286 DOI: 10.1016/s0899-3289(10)80013-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Adolescent offspring of substance abuse parents (SA+) were compared on the scales of the Drug Use Screening Inventory to offspring of control parents (SA-). Neither clinical nor community samples of SA+ subjects were different from controls. These findings indicate that parental substance abuse does not necessarily impart maladjustment to their offspring.
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Affiliation(s)
- R E Tarter
- University of Pittsburgh, Western Psychiatric Institute and Clinic, PA 15213
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Grant P, Laird S, Coppage D. Disposable versus reusable pillows: a case study. Hosp Mater Manage Q 1990; 11:32-5. [PMID: 10103647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- P Grant
- Baptist Medical Center Montclair, Birmingham, AL
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