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Wilding M, Fleming J, Moore K, Crook A, Reddy R, Choi S, Schlub TE, Field M, Thiyagarajan L, Thompson J, Berman Y. Clinical and imaging modality factors impacting radiological interpretation of breast screening in young women with neurofibromatosis type 1. Fam Cancer 2023; 22:499-511. [PMID: 37335380 DOI: 10.1007/s10689-023-00340-5] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 05/28/2023] [Indexed: 06/21/2023]
Abstract
Young women with Neurofibromatosis type 1 (NF1) have a high risk of developing breast cancer and poorer survival following breast cancer diagnosis. International guidelines recommend commencing breast screening between 30 and 35 years; however, the optimal screening modality is unestablished, and previous reports suggest that breast imaging may be complicated by the presence of intramammary and cutaneous neurofibromas (cNFs). The aim of this study was to explore potential barriers to implementation of breast screening for young women with NF1.Twenty-seven women (30-47 years) with NF1 completed breast screening with breast MRI, mammogram and breast ultrasound. Nineteen probably benign/suspicious lesions were detected across 14 women. Despite the presence of breast cNFs, initial biopsy rate for participants with NF1 (37%), were comparable to a BRCA pathogenic variant (PV) cohort (25%) (P = 0.311). No cancers or intramammary neurofibromas were identified. Most participants (89%) returned for second round screening.The presence of cNF did not affect clinician confidence in 3D mammogram interpretation, although increasing breast density, frequently seen in young women, impeded confidence for 2D and 3D mammogram. Moderate or marked background parenchymal enhancement on MRI was higher in the NF1 cohort (70.4%) than BRCA PV carriers (47.3%), which is an independent risk factor for breast cancer.Breast MRI was the preferred mode of screening over mammogram, as the majority (85%) with NF1 demonstrated breast density (BI-RADS 3C/4D), which hinders mammogram interpretation. For those with high breast density and high cNF breast coverage, 3D rather than 2D mammogram is preferred, if MRI is unavailable.
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Affiliation(s)
- Mathilda Wilding
- NSLHD Familial Cancer Service, Department of Cancer Services, Royal North Shore Hospital, Sydney, NSW, Australia.
| | - Jane Fleming
- Department of Clinical Genetics, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Katrina Moore
- Department of Endocrine Surgery, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Ashley Crook
- NSLHD Familial Cancer Service, Department of Cancer Services, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Ranjani Reddy
- North Shore Radiology & Nuclear Medicine, Pacific Highway, Sydney, NSW, Australia
| | - Sarah Choi
- North Shore Radiology & Nuclear Medicine, Pacific Highway, Sydney, NSW, Australia
| | - Timothy E Schlub
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Michael Field
- NSLHD Familial Cancer Service, Department of Cancer Services, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Lavvina Thiyagarajan
- Department of Clinical Genetics, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Jeff Thompson
- Northern Clinical School, Faculty of Health and Medicine, University of Sydney, Sydney, NSW, Australia
| | - Yemima Berman
- Department of Clinical Genetics, Royal North Shore Hospital, Sydney, NSW, Australia
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Chambers C, Lichten L, Crook A, Uhlmann WR, Dratch L. Incorporating Genetic Testing Into the Care of Patients With Amyotrophic Lateral Sclerosis/Frontotemporal Degeneration Spectrum Disorders. Neurol Clin Pract 2023; 13:e200201. [PMID: 37736067 PMCID: PMC10511270 DOI: 10.1212/cpj.0000000000200201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 08/14/2023] [Indexed: 09/23/2023]
Abstract
Purpose of Review Amyotrophic lateral sclerosis (ALS) and frontotemporal degeneration (FTD) spectrum disorders have a strong genetic component. Genetic counselors are a limited resource, and therefore, other providers must be prepared to integrate genetic testing into their practice. Recent Findings Recent ALS/FTD studies have demonstrated that lack of family history does not preclude a genetic etiology. The benefits of a genetic diagnosis have expanded to include the potential to treat; thus, genetic testing is increasingly recommended to be offered to all persons with ALS/FTD. Summary Offering genetic testing to persons with ALS/FTD spectrum disorders should be part of routine clinical neurologic care. All genetic testing should include discussion about the medical and psychosocial implications of testing for the patient and family members. Neurologists should be prepared to facilitate this process and recognize when referral to a genetic counselor is indicated.
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Affiliation(s)
- Chelsea Chambers
- Department of Neurology (CC), University of Virginia, Charlottesville; Emory University School of Medicine (LL), Atlanta, GA; Macquarie University (AC); University of Technology Syndey (AC), Australia; University of Michigan (WRU), Ann Arbor; University of Pennsylvania (LD), Philadelphia
| | - Lauren Lichten
- Department of Neurology (CC), University of Virginia, Charlottesville; Emory University School of Medicine (LL), Atlanta, GA; Macquarie University (AC); University of Technology Syndey (AC), Australia; University of Michigan (WRU), Ann Arbor; University of Pennsylvania (LD), Philadelphia
| | - Ashley Crook
- Department of Neurology (CC), University of Virginia, Charlottesville; Emory University School of Medicine (LL), Atlanta, GA; Macquarie University (AC); University of Technology Syndey (AC), Australia; University of Michigan (WRU), Ann Arbor; University of Pennsylvania (LD), Philadelphia
| | - Wendy R Uhlmann
- Department of Neurology (CC), University of Virginia, Charlottesville; Emory University School of Medicine (LL), Atlanta, GA; Macquarie University (AC); University of Technology Syndey (AC), Australia; University of Michigan (WRU), Ann Arbor; University of Pennsylvania (LD), Philadelphia
| | - Laynie Dratch
- Department of Neurology (CC), University of Virginia, Charlottesville; Emory University School of Medicine (LL), Atlanta, GA; Macquarie University (AC); University of Technology Syndey (AC), Australia; University of Michigan (WRU), Ann Arbor; University of Pennsylvania (LD), Philadelphia
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Berlowitz DJ, Mathers S, Hutchinson K, Hogden A, Carey KA, Graco M, Whelan BM, Charania S, Steyn F, Allcroft P, Crook A, Sheers NL. The complexity of multidisciplinary respiratory care in amyotrophic lateral sclerosis. Breathe (Sheff) 2023; 19:220269. [PMID: 37830099 PMCID: PMC10567075 DOI: 10.1183/20734735.0269-2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 06/20/2023] [Indexed: 10/14/2023] Open
Abstract
Motor neurone disease/amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disorder with no known cure, where death is usually secondary to progressive respiratory failure. Assisting people with ALS through their disease journey is complex and supported by clinics that provide comprehensive multidisciplinary care (MDC). This review aims to apply both a respiratory and a complexity lens to the key roles and areas of practice within the MDC model in ALS. Models of noninvasive ventilation care, and considerations in the provision of palliative therapy, respiratory support, and speech and language therapy are discussed. The impact on people living with ALS of both inequitable funding models and the complexity of clinical care decisions are illustrated using case vignettes. Considerations of the impact of emerging antisense and gene modifying therapies on MDC challenges are also highlighted. The review seeks to illustrate how MDC members contribute to collective decision-making in ALS, how the sum of the parts is greater than any individual care component or health professional, and that the MDC per se adds value to the person living with ALS. Through this approach we hope to support clinicians to navigate the space between what are minimum, guideline-driven, standards of care and what excellent, person-centred ALS care that fully embraces complexity could be. Educational aims To highlight the complexities surrounding respiratory care in ALS.To alert clinicians to the risk that complexity of ALS care may modify the effectiveness of any specific, evidence-based therapy for ALS.To describe the importance of person-centred care and shared decision-making in optimising care in ALS.
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Affiliation(s)
- David J. Berlowitz
- The University of Melbourne, Parkville, Australia
- Institute for Breathing and Sleep, Heidelberg, Australia
- Department of Physiotherapy, Austin Health, Heidelberg, Australia
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Australia
| | - Susan Mathers
- Calvary Health Care Bethlehem, Caulfield South, Australia
- School of Clinical Sciences, Monash University, Clayton, Australia
| | - Karen Hutchinson
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
- Central Coast Local Health District, Gosford, Australia
| | - Anne Hogden
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - Kate A. Carey
- The University of Melbourne, Parkville, Australia
- Institute for Breathing and Sleep, Heidelberg, Australia
| | - Marnie Graco
- The University of Melbourne, Parkville, Australia
- Institute for Breathing and Sleep, Heidelberg, Australia
| | - Brooke-Mai Whelan
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Salma Charania
- Motor Neurone Disease Association of Queensland, Oxley, Australia
| | - Frederik Steyn
- School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Peter Allcroft
- Southern Adelaide Palliative Services, Flinders Medical Centre, Bedford Park, Australia
- College of Medicine and Public Health, Flinders University, Bedford Park, Australia
| | - Ashley Crook
- Graduate School of Health, University of Technology Sydney, Chippendale, Australia
- Centre for MND Research and Department of Clinical Medicine, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Nicole L. Sheers
- The University of Melbourne, Parkville, Australia
- Institute for Breathing and Sleep, Heidelberg, Australia
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O’Shea R, Crook A, Jacobs C, Kentwell M, Gleeson M, Tucker KM, Hampel H, Rahm AK, Taylor N, Lewis S, Rankin NM. A mainstreaming oncogenomics model: improving the identification of Lynch syndrome. Front Oncol 2023; 13:1140135. [PMID: 37305562 PMCID: PMC10256118 DOI: 10.3389/fonc.2023.1140135] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 04/24/2023] [Indexed: 06/13/2023] Open
Abstract
Introduction "Mainstreaming" is a proposed strategy to integrate genomic testing into oncology. The aim of this paper is to develop a mainstreaming oncogenomics model by identifying health system interventions and implementation strategies for mainstreaming Lynch syndrome genomic testing. Methods A rigorous theoretical approach inclusive of conducting a systematic review and qualitative and quantitative studies was undertaken using the Consolidated Framework for Implementation Research. Theory-informed implementation data were mapped to the Genomic Medicine Integrative Research framework to generate potential strategies. Results The systematic review identified a lack of theory-guided health system interventions and evaluation for Lynch syndrome and other mainstreaming programs. The qualitative study phase included 22 participants from 12 health organizations. The quantitative Lynch syndrome survey included 198 responses: 26% and 66% from genetic and oncology health professionals, respectively. Studies identified the relative advantage and clinical utility of mainstreaming to improve genetic test access and to streamline care, and adaptation of current processes was recognized for results delivery and follow-up. Barriers identified included funding, infrastructure and resources, and the need for process and role delineation. The interventions to overcome barriers were as follows: embedded mainstream genetic counselors, electronic medical record genetic test ordering, results tracking, and mainstreaming education resources. Implementation evidence was connected through the Genomic Medicine Integrative Research framework resulting in a mainstreaming oncogenomics model. Discussion The proposed mainstreaming oncogenomics model acts as a complex intervention. It features an adaptable suite of implementation strategies to inform Lynch syndrome and other hereditary cancer service delivery. Implementation and evaluation of the model are required in future research.
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Affiliation(s)
- Rosie O’Shea
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Ashley Crook
- Discipline of Genetic Counselling, Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Chris Jacobs
- Discipline of Genetic Counselling, Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Maira Kentwell
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Parkville, VIC, Australia
- Department of Oncology, Royal Women’s Hospital, Parkville, VIC, Australia
| | - Margaret Gleeson
- Hunter Genetics, Hunter Family Cancer Service, Newcastle, NSW, Australia
| | | | - Heather Hampel
- Division of Clinical Cancer Genomics, Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA, United States
| | | | - Natalie Taylor
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Cancer Research Division, Cancer Council NSW, Sydney, NSW, Australia
| | - Sarah Lewis
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Nicole M. Rankin
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Melbourne School of Population and Global Health, Melbourne University, Melbourne, VIC, Australia
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Crook A, Jacobs C, Newton‐John T, McEwen A. Genetic counseling and diagnostic genetic testing for familial amyotrophic lateral sclerosis and/or frontotemporal dementia: A qualitative study of client experiences. J Genet Couns 2022; 31:1206-1218. [PMID: 35635300 PMCID: PMC9796327 DOI: 10.1002/jgc4.1591] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 12/22/2021] [Revised: 05/01/2022] [Accepted: 05/07/2022] [Indexed: 01/01/2023]
Abstract
Genetic counseling and diagnostic genetic testing is part of the multidisciplinary care of people with amyotrophic lateral sclerosis (ALS, commonly called motor neurone disease, MND) and frontotemporal dementia (FTD). We explored client experiences of genetic counseling and diagnostic testing to inform the care of future families. Semi-structured interviews with individuals with ALS/MND/FTD or their relatives were conducted. The study was designed to include a wide variety of participants with varying disease status and abilities. Genetic counseling and diagnostic testing experiences were explored using interpretive description methodology. Bioecological theory was used as the framework for the reflexive thematic analysis. Eighteen individuals with ALS/MND/FTD or their relatives from 13 Australian families participated. Three themes were identified: sharing knowledge, (un)supportive care, and 'circumstance is everything'. Consistent with bioecological theory, one's genetic counseling experience was informed by individual circumstances, time, and proximal factors. These informed the level of information and support required in the genetic counseling process. Although some client circumstances cannot be changed, efforts could be made to enhance genetic counseling experiences by improving interactions between the client and their care team. Some clients may benefit from further discussions regarding the familial implications of genetic testing, and greater support with family communication. Clients' needs were derived from the data and will contribute to genetic counseling consensus guidelines.
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Affiliation(s)
- Ashley Crook
- Graduate School of HealthUniversity of Technology SydneyChippendaleNew South WalesAustralia,Faculty of Medicine, Health and Human Sciences, Centre for MND ResearchMacquarie UniversitySydneyNew South WalesAustralia
| | - Chris Jacobs
- Graduate School of HealthUniversity of Technology SydneyChippendaleNew South WalesAustralia
| | - Toby Newton‐John
- Graduate School of HealthUniversity of Technology SydneyChippendaleNew South WalesAustralia
| | - Alison McEwen
- Graduate School of HealthUniversity of Technology SydneyChippendaleNew South WalesAustralia
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Richardson E, McEwen A, Newton-John T, Crook A, Jacobs C. Outcomes of Importance to Patients in Reproductive Genetic Carrier Screening: A Qualitative Study to Inform a Core Outcome Set. J Pers Med 2022; 12:jpm12081310. [PMID: 36013258 PMCID: PMC9409855 DOI: 10.3390/jpm12081310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 08/02/2022] [Accepted: 08/10/2022] [Indexed: 11/22/2022] Open
Abstract
There is significant heterogeneity in the outcomes assessed across studies of reproductive genetic carrier screening (RGCS). Only a small number of studies have measured patient-reported outcomes or included patients in the selection of outcomes that are meaningful to them. This study was a cross-sectional, qualitative study of 15 patient participants conducted to inform a core outcome set. A core outcome set is an approach to facilitate standardisation in outcome reporting, allowing direct comparison of outcomes across studies to enhance understanding of impacts and potential harms. The aim of this study was to incorporate the patient perspective in the development of a core outcome set by eliciting a detailed understanding of outcomes of importance to patients. Data were collected via online, semi-structured interviews using a novel method informed by co-design and the nominal group technique. Data were analysed using reflexive thematic analysis. Outcomes elicited from patient stakeholder interviews highlighted several under-explored areas for future research. This includes the role of grief and loss in increased risk couples, the role of empowerment in conceptualising the utility of RGCS, the impact of societal context and barriers that contribute to negative experiences, and the role of genetic counselling in ensuring that information needs are met and informed choice facilitated as RGCS becomes increasingly routine. Future research should focus on incorporating outcomes that accurately reflect patient needs and experience.
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Richardson E, McEwen A, Newton-John T, Crook A, Jacobs C. Incorporating patient perspectives in the development of a core outcome set for reproductive genetic carrier screening: a sequential systematic review. Eur J Hum Genet 2022; 30:756-765. [PMID: 35347269 PMCID: PMC9259674 DOI: 10.1038/s41431-022-01090-1] [Citation(s) in RCA: 2] [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: 11/30/2021] [Revised: 03/07/2022] [Accepted: 03/10/2022] [Indexed: 11/09/2022] Open
Abstract
There is currently no consensus on the key outcomes of reproductive genetic carrier screening (RGCS). This has led to a large amount of variability in approaches to research, limiting direct comparison and synthesis of findings. In a recently published systematic review of quantitative studies on RGCS, we found that few studies incorporated patient-reported outcomes. In response to this gap, we conducted a sequential systematic review of qualitative studies to identify outcomes exploring the patient experience of RGCS. In conjunction with the review of quantitative studies, these outcomes will be used to inform the development of a core outcome set. Text excerpts relevant to outcomes, including quotes and themes, were extracted verbatim and deductively coded as outcomes. We conducted a narrative synthesis to group outcomes within domains previously defined in our review of quantitative studies, and identify any new domains that were unique to qualitative studies. Seventy-eight outcomes were derived from qualitative studies and grouped into 19 outcome domains. Three new outcome domains were identified; 'goals of pre- and post-test genetic counselling', 'acceptability of further testing and alternative reproductive options', and 'perceived utility of RGCS'. The identification of outcome domains that were not identified in quantitative studies indicates that outcomes reflecting the patient perspective may be under-represented in the quantitative literature on this topic. Further work should focus on ensuring that outcomes reflect the real world needs and concerns of patients in order to maximise translation of research findings into clinical practice.
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Affiliation(s)
- Ebony Richardson
- grid.117476.20000 0004 1936 7611Graduate School of Health, University of Technology Sydney, Sydney, NSW Australia
| | - Alison McEwen
- grid.117476.20000 0004 1936 7611Graduate School of Health, University of Technology Sydney, Sydney, NSW Australia
| | - Toby Newton-John
- grid.117476.20000 0004 1936 7611Graduate School of Health, University of Technology Sydney, Sydney, NSW Australia
| | - Ashley Crook
- grid.117476.20000 0004 1936 7611Graduate School of Health, University of Technology Sydney, Sydney, NSW Australia
| | - Chris Jacobs
- grid.117476.20000 0004 1936 7611Graduate School of Health, University of Technology Sydney, Sydney, NSW Australia
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McNeill A, Amador MDM, Bekker H, Clarke A, Crook A, Cummings C, McEwen A, McDermott C, Quarrell O, Renieri A, Roggenbuck J, Salmon K, Volk A, Weishaupt J. Predictive genetic testing for Motor neuron disease: time for a guideline? Eur J Hum Genet 2022; 30:635-636. [PMID: 35379930 PMCID: PMC9177585 DOI: 10.1038/s41431-022-01093-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 03/17/2022] [Indexed: 12/05/2022] Open
Affiliation(s)
- Alisdair McNeill
- Department of Neuroscience, the University of Sheffield, 385A Glossop Road, Sheffield, S10 2HQ, UK.
| | - Maria-Del-Mar Amador
- Département de Neurologie, Centre de Référence SLA de Paris, Assistance Publique-Hôpitaux de Paris, Sorbonne Université Hospital Pitié-Salpêtrière, Paris, France
| | - Hilary Bekker
- Leeds Unit of Complex Intervention Development (LUCID), Leeds Institute of Health Science, University of Leeds, Leeds, UK
| | - Angus Clarke
- Medical Genetics, School of Medicine, Cardiff University, Wales, CF10 3AT, UK
| | - Ashley Crook
- Centre for MND Research, Department of Biomedical Science, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Cathy Cummings
- International Aliance of ALS/MND Associations, Northampton, UK
| | - Alison McEwen
- Graduate School of Health, University of Technology Sydney, Chippendale, NSW, Australia
| | - Christopher McDermott
- Department of Neuroscience, the University of Sheffield, 385A Glossop Road, Sheffield, S10 2HQ, UK
| | - Oliver Quarrell
- Department of Neuroscience, the University of Sheffield, 385A Glossop Road, Sheffield, S10 2HQ, UK
| | | | - Jennifer Roggenbuck
- Department of Neurology and Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, 43212, USA
| | - Kristiana Salmon
- Department of Neurology & Neurosurgery, Montreal Neurological Institute-Hospital, McGill University, Montreal, QC, Canada
| | - Alexander Volk
- Institute of Human Genetics, University Medical Center Hamburg Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Germany
| | - Jochen Weishaupt
- Division of Neurodegeneration, Department of Neurology, Mannheim Center for Translational Neurosciences (MCTN), Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
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Davidoff DF, Benn DE, Field M, Crook A, Robinson BG, Tucker K, De Abreu Lourenco R, Burgess JR, Clifton-Bligh RJ. Surveillance Improves Outcomes for Carriers of SDHB Pathogenic Variants: A Multicenter Study. J Clin Endocrinol Metab 2022; 107:e1907-e1916. [PMID: 35037935 PMCID: PMC9016424 DOI: 10.1210/clinem/dgac019] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Indexed: 11/22/2022]
Abstract
CONTEXT Carriers of succinate dehydrogenase type B (SDHB) pathogenic variants (PVs) are at risk of pheochromocytoma and paraganglioma (PPGL) from a young age. It is widely recommended carriers enter a surveillance program to detect tumors, but there are limited studies addressing outcomes of surveillance protocols for SDHB PV carriers. OBJECTIVE The purpose of this study was to describe surveillance-detected (s-d) tumors in SDHB PV carriers enrolled in a surveillance program and to compare their outcomes to probands. METHODS This was a multicenter study of SDHB PV carriers with at least 1 surveillance episode (clinical, biochemical, imaging) in Australian genetics clinics. Data were collected by both retrospective and ongoing prospective follow-up. Median duration of follow-up was 6.0 years. RESULTS 181 SDHB PV carriers (33 probands and 148 nonprobands) were assessed. Tumors were detected in 20% of nonprobands undergoing surveillance (age range 9-76 years). Estimated 10-year metastasis-free survival was 66% for probands and 84% for nonprobands with s-d tumors (P = .027). S-d tumors were smaller than those in probands (median 27 mm vs 45 mm respectively, P = .001). Tumor size ≥40 mm was associated with progression to metastatic disease (OR 16.9, 95% CI 2.3-187.9, P = .001). Patients with s-d tumors had lower mortality compared to probands: 10-year overall survival was 79% for probands and 100% for nonprobands (P = .029). CONCLUSION SDHB carriers with s-d tumors had smaller tumors, reduced risk of metastatic disease, and lower mortality than probands. Our results suggest that SDHB PV carriers should undertake surveillance to improve clinical outcomes.
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Affiliation(s)
- Dahlia F Davidoff
- Cancer Genetics Laboratory, Kolling Institute, Royal North Shore Hospital, St Leonards, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Department of Endocrinology, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Diana E Benn
- Cancer Genetics Laboratory, Kolling Institute, Royal North Shore Hospital, St Leonards, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Michael Field
- NSLHD Familial Cancer Service, Department of Cancer Services, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Ashley Crook
- NSLHD Familial Cancer Service, Department of Cancer Services, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Bruce G Robinson
- Cancer Genetics Laboratory, Kolling Institute, Royal North Shore Hospital, St Leonards, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Department of Endocrinology, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Katherine Tucker
- Hereditary Cancer Centre, Prince of Wales Hospital, Randwick, NSW, Australia
- Prince of Wales Clinical School, UNSW Medicine, Kensington, NSW, Australia
| | - Richard De Abreu Lourenco
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Haymarket, Sydney, Australia
| | - John R Burgess
- Department of Diabetes and Endocrinology, Royal Hobart Hospital, Hobart, TAS, Australia
- School of Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Roderick J Clifton-Bligh
- Cancer Genetics Laboratory, Kolling Institute, Royal North Shore Hospital, St Leonards, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Department of Endocrinology, Royal North Shore Hospital, St Leonards, NSW, Australia
- Correspondence: Roderick J. Clifton-Bligh, BSc (med), MBBS, PhD, FRACP, FFSc (RCPA), Department of Endocrinology, Royal North Shore Hospital, St Leonards, NSW 2065, Australia.
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Crook A, McEwen A. Genetic counselling and testing for neurodegenerative disorders using a proposed standard of practice for ALS/MND: diagnostic testing comes first. Eur J Hum Genet 2022; 30:394-395. [PMID: 34983943 PMCID: PMC8990066 DOI: 10.1038/s41431-021-01036-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 12/20/2021] [Indexed: 11/09/2022] Open
Affiliation(s)
- Ashley Crook
- Graduate School of Health, University of Technology Sydney, Chippendale, NSW, Australia.
- Centre for MND research and Department of Clinical Medicine, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia.
| | - Alison McEwen
- Graduate School of Health, University of Technology Sydney, Chippendale, NSW, Australia
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Crook A, Jacobs C, Newton-John T, McEwen A. Toward genetic counseling practice standards for diagnostic testing in amyotrophic lateral sclerosis and frontotemporal dementia. Amyotroph Lateral Scler Frontotemporal Degener 2022; 23:562-574. [PMID: 35343344 DOI: 10.1080/21678421.2022.2051553] [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: 11/01/2022]
Abstract
Objective: Genetic counseling and diagnostic genetic testing are considered part of the multidisciplinary care of individuals with amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD). We aimed to investigate the ideal components of genetic counseling for ALS/FTD diagnostic testing amongst various stakeholders using an online, modified Delphi survey. Methods: Experts in genetic counseling and testing for ALS/FTD were purposively then snowball recruited and included genetic health professionals, health professionals outside of genetics and consumer experts (patients, relatives, and staff representatives from ALS/FTD support organizations). First-round items were informed by two systematic literature reviews and qualitative interviews with patients and families who had experienced diagnostic testing. Analysis of each round informed the development of the subsequent round and the final results. Results: Forty-six experts participated in the study, 95.65% completed both rounds. After round one, items were updated based on participant responses and were presented again for consensus in round two. After round two, a high level of consensus (≥80% agreement) was achieved on 16 items covering various topics related to genetic counseling service delivery, before and after diagnostic testing is facilitated. Conclusions: Genetic counseling for individuals with ALS/FTD and their families should include the provision of client-centered counseling, education and support throughout. The items developed are adaptable to varied healthcare settings and may inform a standard of genetic counseling practice for health professionals who facilitate testing and counseling discussions. This area of work is timely, given demand for testing is likely to increase as more genotype-driven clinical trials become available.
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Affiliation(s)
- Ashley Crook
- Graduate School of Health, University of Technology Sydney, Chippendale, NSW, Australia.,Centre for MND research, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Chris Jacobs
- Graduate School of Health, University of Technology Sydney, Chippendale, NSW, Australia
| | - Toby Newton-John
- Graduate School of Health, University of Technology Sydney, Chippendale, NSW, Australia
| | - Alison McEwen
- Graduate School of Health, University of Technology Sydney, Chippendale, NSW, Australia
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Crook A, Jacobs C, Newton-John T, Richardson E, McEwen A. Patient and Relative Experiences and Decision-making About Genetic Testing and Counseling for Familial ALS and FTD: A Systematic Scoping Review. Alzheimer Dis Assoc Disord 2021; 35:374-385. [PMID: 34054018 DOI: 10.1097/wad.0000000000000458] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 12/06/2020] [Accepted: 04/13/2021] [Indexed: 11/25/2022]
Abstract
Genetic testing and counseling is an emerging part of care for patients with amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD) and their families. This scoping review aimed to map patients' and relatives' experiences of genetic testing and counseling for familial ALS and FTD and the factors influencing their decision to proceed with testing or counseling. Informed by the Joanna Briggs Institute methodology, 5 databases were systematically searched. Thirty studies from 39 references were included. A descriptive numerical summary analysis and narrative synthesis was conducted. Mostly positive diagnostic testing experiences were reported, but issues arose due to progressive disease and discordant results. Predictive testing impacted at-risk relatives, regardless of the result received, and psychosocial sequelae ranged from relief to guilt, worry or contemplating suicide. Four reproductive testing experiences were reported. Personal, familial and practical factors, and the lived experience of disease, informed decision-making. Greater uncertainty and complexity may be faced in familial ALS/FTD than in other late-onset neurodegenerative diseases due to clinical and genetic heterogeneity, and testing limitations. Genetic counseling models of care should consider this difference to ensure that individuals with, or at risk of, ALS/FTD are effectively managed. Implications for research and practice are discussed.
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Affiliation(s)
- Ashley Crook
- Graduate School of Health, University of Technology Sydney, Chippendale
- Department of Biomedical Science, Centre for MND Research
- Department of Clinical Medicine, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Chris Jacobs
- Graduate School of Health, University of Technology Sydney, Chippendale
| | - Toby Newton-John
- Graduate School of Health, University of Technology Sydney, Chippendale
| | - Ebony Richardson
- Graduate School of Health, University of Technology Sydney, Chippendale
| | - Alison McEwen
- Graduate School of Health, University of Technology Sydney, Chippendale
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13
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O’Shea R, Taylor N, Crook A, Jacobs C, Jung Kang Y, Lewis S, Rankin NM. Health system interventions to integrate genetic testing in routine oncology services: A systematic review. PLoS One 2021; 16:e0250379. [PMID: 34010335 PMCID: PMC8133413 DOI: 10.1371/journal.pone.0250379] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 04/06/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Integration of genetic testing into routine oncology care could improve access to testing. This systematic review investigated interventions and the tailored implementation strategies aimed at increasing access to genetic counselling and testing and identifying hereditary cancer in oncology. METHODS The search strategy results were reported using the PRISMA statement and four electronic databases were searched. Eligible studies included routine genetic testing for breast and ovarian cancer or uptake after universal tumour screening for colorectal or endometrial cancer. The titles and abstracts were reviewed and the full text articles screened for eligibility. Data extraction was preformed using a designed template and study appraisal was assessed using an adapted Newcastle Ottawa Scale. Extracted data were mapped to Proctor's et al outcomes and the Consolidated Framework for Implementation Research and qualitatively synthesised. RESULTS Twenty-seven studies, published up to May 2020, met the inclusion criteria. Twenty-five studies ranged from poor (72%), fair to good (28%) quality. Most interventions identified were complex (multiple components) such as; patient or health professional education, interdisciplinary practice and a documentation or system change. Forty-eight percent of studies with complex interventions demonstrated on average a 35% increase in access to genetic counselling and a 15% increase in testing completion. Mapping of study outcomes showed that 70% and 32% of the studies aligned with either the service and client or the implementation level outcome and 96% to the process or inner setting domains of the Consolidated Framework for Implementation Research. CONCLUSION Existing evidence suggests that complex interventions have a potentially positive effect towards genetic counselling and testing completion rates in oncology services. Studies of sound methodological quality that explore a greater breadth of pre and post implementation outcomes and informed by theory are needed. Such research could inform future service delivery models for the integration of genetics into oncology services.
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Affiliation(s)
- Rosie O’Shea
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Discipline of Genetic Counselling, Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Natalie Taylor
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Cancer Research Division, Cancer Council NSW, Sydney, New South Wales, Australia
| | - Ashley Crook
- Discipline of Genetic Counselling, Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Chris Jacobs
- Discipline of Genetic Counselling, Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Yoon Jung Kang
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Cancer Research Division, Cancer Council NSW, Sydney, New South Wales, Australia
| | - Sarah Lewis
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Nicole M. Rankin
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
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14
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Crook A, Kwa R, Ephraums S, Wilding M, Thiyagarajan L, Fleming J, Moore K, Berman Y. The psychological impact and experience of breast cancer screening in young women with an increased risk of breast cancer due to neurofibromatosis type 1. Fam Cancer 2021; 21:241-253. [PMID: 33963463 PMCID: PMC8105152 DOI: 10.1007/s10689-021-00259-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 04/20/2021] [Indexed: 01/22/2023]
Abstract
Women with neurofibromatosis type 1 (NF1) have an increased risk of developing early breast cancer with a poorer prognosis compared to the general population. Therefore, international management guidelines recommend regular screening in women with NF1 starting from 30 to 35 years. As the psychological impacts of breast cancer screening in other high-risk populations cannot be extended to women with NF1, due to increased incidence of cognitive and mental health issues, the psychological harms of breast screening in women with NF1 are unknown. Consequently, the aim of this study was to assess the psychological impact of breast cancer screening in women with NF1 attending an established risk management clinic. Twenty-eight women with NF1 (30–50 years) completed psychological well-being and patient experience questionnaires, administered across five time points, before and after their initial and second round annual breast screening visits. Preliminary findings demonstrated the screening regimen was well-tolerated, with most participants reporting high satisfaction with the screening process. Overall, no significant increase in psychological distress related to the breast screening process was identified, with mean cancer worry and anxiety scores decreasing over time. However, some women did experience negative aspects of screening and barriers to re-attendance at annual breast screening appointments. As some women with NF1 exhibited clinical levels of psychological distress prior to screening, efforts to identify those at risk and additional support to address concerns and expectations throughout the breast screening process may be beneficial.
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Affiliation(s)
- Ashley Crook
- Department of Clinical Genetics, Royal North Shore Hospital, Sydney, NSW, Australia.
- NSLHD Familial Cancer Service, Department of Cancer Services, Royal North Shore Hospital, Sydney, NSW, Australia.
| | - Rebekah Kwa
- Northern Clinical School, Faculty of Health and Medicine, University of Sydney, Sydney, NSW, Australia
| | - Sarah Ephraums
- Northern Clinical School, Faculty of Health and Medicine, University of Sydney, Sydney, NSW, Australia
| | - Mathilda Wilding
- Department of Clinical Genetics, Royal North Shore Hospital, Sydney, NSW, Australia
- NSLHD Familial Cancer Service, Department of Cancer Services, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Lavvina Thiyagarajan
- Department of Clinical Genetics, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Jane Fleming
- Department of Clinical Genetics, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Katrina Moore
- Department of Breast Surgery, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Yemima Berman
- Department of Clinical Genetics, Royal North Shore Hospital, Sydney, NSW, Australia
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15
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Schlub GM, Crook A, Barlow-Stewart K, Fleming J, Kirk J, Tucker K, Greening S. Helping young children understand inherited cancer predisposition syndromes using bibliotherapy. J Genet Couns 2021; 30:1119-1132. [PMID: 33788335 DOI: 10.1002/jgc4.1396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 09/08/2020] [Revised: 01/21/2021] [Accepted: 01/31/2021] [Indexed: 12/23/2022]
Abstract
Communication with children about hereditary conditions in the family can be difficult for parents. Yet, good communication strategies are leading determinants of adaptation and resilience. With inherited cancer predisposition syndromes that can affect young children such as Li-Fraumeni syndrome (LFS) and hereditary pheochromocytoma and paraganglioma syndrome (HPPS), genetic testing and subsequent surveillance in at-risk children is the optimal intervention. Given testing often commences early, providing children and their parents with appropriate genetic counseling and communication strategies is important for informed decision making. To inform such communication strategies, we used a bibliotherapeutic framework, where stories are delivered prescriptively (i.e., 'bibliotherapy'), to develop a psycho-educational resource for children aged 5-10 years old at risk of either LFS or HPPS. Illustrated storybooks for children were created based on models of developmental comprehension. To ascertain their experience, parents were invited to read a storybook to their child/ren and participate in semi-structured qualitative interviews. Transcripts were analyzed thematically using a general inductive approach. The bibliotherapeutic resource reportedly supported parents with communication about these issues without raising emotional distress in either themselves or their children. The key stages of a bibliotherapeutic interaction were facilitated by the use of this resource, and all parents reported that it would have been useful when their children were first tested and/or diagnosed. This study lays the foundation for the application of bibliotherapy as a psycho-educational intervention in genetic counseling and demonstrates that bibliotherapy may improve the process of communication between parents and children regarding pediatric-inherited cancer syndromes.
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Affiliation(s)
- Georgina M Schlub
- Faculty of Health and Medicine, Northern Clinical School, University of Sydney, Camperdown, NSW, Australia.,NSLHD Familial Cancer Service, Department of Cancer Services, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Ashley Crook
- NSLHD Familial Cancer Service, Department of Cancer Services, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Kristine Barlow-Stewart
- Faculty of Health and Medicine, Northern Clinical School, University of Sydney, Camperdown, NSW, Australia
| | - Jane Fleming
- Faculty of Health and Medicine, Northern Clinical School, University of Sydney, Camperdown, NSW, Australia
| | - Judy Kirk
- Familial Cancer Service, Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, NSW, Australia
| | - Kathy Tucker
- Hereditary Cancer Clinic, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Sian Greening
- Hereditary Cancer Clinic, Illawarra Cancer Care Centre, Wollongong, NSW, Australia
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16
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Moore G, Rickard H, Stevenson D, Aranega-Bou P, Pitman J, Crook A, Davies K, Spencer A, Burton C, Easterbrook L, Love HE, Summers S, Welch SR, Wand N, Thompson KA, Pottage T, Richards KS, Dunning J, Bennett A. Detection of SARS-CoV-2 within the healthcare environment: a multi-centre study conducted during the first wave of the COVID-19 outbreak in England. J Hosp Infect 2021; 108:189-196. [PMID: 33259882 PMCID: PMC7831847 DOI: 10.1016/j.jhin.2020.11.024] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/25/2020] [Accepted: 11/25/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Understanding how severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is spread within the hospital setting is essential in order to protect staff, implement effective infection control measures, and prevent nosocomial transmission. METHODS The presence of SARS-CoV-2 in the air and on environmental surfaces around hospitalized patients, with and without respiratory symptoms, was investigated. Environmental sampling was undertaken within eight hospitals in England during the first wave of the coronavirus disease 2019 outbreak. Samples were analysed using reverse transcription polymerase chain reaction (PCR) and virus isolation assays. FINDINGS SARS-CoV-2 RNA was detected on 30 (8.9%) of 336 environmental surfaces. Cycle threshold values ranged from 28.8 to 39.1, equating to 2.2 x 105 to 59 genomic copies/swab. Concomitant bacterial counts were low, suggesting that the cleaning performed by nursing and domestic staff across all eight hospitals was effective. SARS-CoV-2 RNA was detected in four of 55 air samples taken <1 m from four different patients. In all cases, the concentration of viral RNA was low and ranged from <10 to 460 genomic copies/m3 air. Infectious virus was not recovered from any of the PCR-positive samples analysed. CONCLUSIONS Effective cleaning can reduce the risk of fomite (contact) transmission, but some surface types may facilitate the survival, persistence and/or dispersal of SARS-CoV-2. The presence of low or undetectable concentrations of viral RNA in the air supports current guidance on the use of specific personal protective equipment for aerosol-generating and non-aerosol-generating procedures.
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Affiliation(s)
- G Moore
- National Infection Service, Public Health England, Porton Down, Salisbury, UK.
| | - H Rickard
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - D Stevenson
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - P Aranega-Bou
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - J Pitman
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - A Crook
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - K Davies
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - A Spencer
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - C Burton
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - L Easterbrook
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - H E Love
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - S Summers
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - S R Welch
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - N Wand
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - K-A Thompson
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - T Pottage
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - K S Richards
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - J Dunning
- Emerging Infections and Zoonoses Unit, National Infection Service, Public Health England, Colindale, London, UK; NIHR Health Protection Research Unit in Emerging Infections and Zoonoses, Liverpool, UK
| | - A Bennett
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
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17
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Tudini E, Davidson AL, Dressel U, Andrews L, Antill Y, Crook A, Field M, Gattas M, Harris R, Kirk J, Pachter N, Salmon L, Susman R, Townshend S, Trainer AH, Tucker KM, Mitchell G, James PA, Ward RL, Mar Fan H, Poplawski NK, Spurdle AB. Implementing gene curation for hereditary cancer susceptibility in Australia: achieving consensus on genes with clinical utility. J Med Genet 2020; 58:853-858. [PMID: 33168572 DOI: 10.1136/jmedgenet-2020-107140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 04/23/2020] [Revised: 09/08/2020] [Accepted: 09/12/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND The strength of evidence supporting the validity of gene-disease relationships is variable. Hereditary cancer has the additional complexity of low or moderate penetrance for some confirmed disease-associated alleles. METHODS To promote national consistency in interpretation of hereditary cancer/tumour gene test results, we requested opinions of representatives from Australian Family Cancer Clinics regarding the clinical utility of 157 genes initially collated for a national research project. Viewpoints were sought by initial survey, face-to-face workshop and follow-up survey. Subsequent review was undertaken by the eviQ Cancer Genetics Reference Committee, a national resource providing evidence-based and consensus-driven cancer treatment protocols. RESULTS Genes were categorised by clinical actionability as: relevant for testing on presentation of common cancer/tumour types (n=45); relevant for testing in the context of specific rare phenotypes (n=74); insufficient clinical utility (n=34) or contentious clinical utility (n=3). Opinions for several genes altered during the study time frame, due to new information. CONCLUSION Through an iterative process, consensus was achieved on genes with clinical utility for hereditary cancer/tumour conditions in the Australian setting. This study highlighted need for regular review of gene-disease lists, a role assumed in Australia for hereditary cancer/tumour predisposition genes by the eviQ Cancer Genetics Reference Committee.
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Affiliation(s)
- Emma Tudini
- Department of Genetics and Computational Biology, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.,Australian Genomics Health Alliance, Melbourne, Victoria, Australia
| | - Aimee L Davidson
- Department of Genetics and Computational Biology, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Uwe Dressel
- Australian Genomics Health Alliance, Melbourne, Victoria, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Lesley Andrews
- Hereditary Cancer Clinic, Prince of Wales Hospital, Randwick, New South Wales, Australia.,Prince of Wales Medical School, University of New South Wales, Randwick, New South Wales, Australia
| | - Yoland Antill
- Cabrini Family Cancer Clinic, Cabrini Hospital, Malvern, Victoria, Australia
| | - Ashley Crook
- Familial Cancer Service, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Michael Field
- Familial Cancer Service, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Michael Gattas
- Brisbane Genetics, Nicholson St Specialist Centre, Greenslopes, Queensland, Australia
| | - Rebecca Harris
- Familial Cancer Service, Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, New South Wales, Australia
| | - Judy Kirk
- Familial Cancer Service, Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, New South Wales, Australia.,Sydney Medical School, University of Sydney, Centre for Cancer Research, Westmead Institute for Medical Research, Westmead, New South Wales, Australia
| | - Nicholas Pachter
- Genetic Services of Western Australia, King Edward Memorial Hospital, Perth, Western Australia, Australia.,Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Lucinda Salmon
- Department of Clinical Genetics, Austin Health, Melbourne, Victoria, Australia
| | - Rachel Susman
- Genetic Health Queensland, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Sharron Townshend
- Genetic Services of Western Australia, King Edward Memorial Hospital, Perth, Western Australia, Australia
| | - Alison H Trainer
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Katherine M Tucker
- Hereditary Cancer Clinic, Prince of Wales Hospital, Randwick, New South Wales, Australia.,Prince of Wales Medical School, University of New South Wales, Randwick, New South Wales, Australia
| | - Gillian Mitchell
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Paul A James
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Robyn L Ward
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Helen Mar Fan
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Genetic Health Queensland, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Nicola K Poplawski
- Adult Genetics Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Amanda B Spurdle
- Department of Genetics and Computational Biology, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
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Roy S, Liu W, Nandety RS, Crook A, Mysore KS, Pislariu CI, Frugoli J, Dickstein R, Udvardi MK. Celebrating 20 Years of Genetic Discoveries in Legume Nodulation and Symbiotic Nitrogen Fixation. Plant Cell 2020; 32:15-41. [PMID: 31649123 PMCID: PMC6961631 DOI: 10.1105/tpc.19.00279] [Citation(s) in RCA: 301] [Impact Index Per Article: 75.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 09/17/2019] [Accepted: 10/24/2019] [Indexed: 05/13/2023]
Abstract
Since 1999, various forward- and reverse-genetic approaches have uncovered nearly 200 genes required for symbiotic nitrogen fixation (SNF) in legumes. These discoveries advanced our understanding of the evolution of SNF in plants and its relationship to other beneficial endosymbioses, signaling between plants and microbes, the control of microbial infection of plant cells, the control of plant cell division leading to nodule development, autoregulation of nodulation, intracellular accommodation of bacteria, nodule oxygen homeostasis, the control of bacteroid differentiation, metabolism and transport supporting symbiosis, and the control of nodule senescence. This review catalogs and contextualizes all of the plant genes currently known to be required for SNF in two model legume species, Medicago truncatula and Lotus japonicus, and two crop species, Glycine max (soybean) and Phaseolus vulgaris (common bean). We also briefly consider the future of SNF genetics in the era of pan-genomics and genome editing.
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Affiliation(s)
- Sonali Roy
- Noble Research Institute, Ardmore, Oklahoma 73401
| | - Wei Liu
- Noble Research Institute, Ardmore, Oklahoma 73401
| | | | - Ashley Crook
- College of Science, Clemson University, Clemson, South Carolina 29634
| | | | | | - Julia Frugoli
- College of Science, Clemson University, Clemson, South Carolina 29634
| | - Rebecca Dickstein
- Department of Biological Sciences and BioDiscovery Institute, University of North Texas, Denton Texas 76203
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19
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Crook A, Hogden A, Mumford V, Blair IP, Williams KL, Rowe DB. CMS-01 Genetic testing for familial amyotrophic lateral sclerosis (ALS): insights and challenges. Amyotroph Lateral Scler Frontotemporal Degener 2019; 20:327-347. [PMID: 31702461 DOI: 10.1080/21678421.2019.1647002] [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: 10/25/2022]
Abstract
Background: Pathogenic variants in ALS genes are known to be present in up to 70% of familial and 10% of apparently sporadic ALS cases, and can be associated with risks for ALS only, or risks for other neurodegenerative diseases (eg. frontotemporal dementia). While there are no changes to medical management for patients confirmed as pathogenic variant carriers, genetic testing may be important for future drug trials. Confirmation of a pathogenic variant also provides relatives with the opportunity to consider predictive and/or reproductive genetic testing. Genetic counselling is an important aspect of testing decision-making as it enables individuals to make informed decisions about genetic testing while minimising adverse psychological, ethical and legal outcomes. Few studies have explored how individuals decide whether to pursue testing, nor the needs and experiences of familial ALS families.Objective: To identify factors that influence patient and family member decision-making about genetic testing for ALS genes, assess the impact of familial disease on the patient and their family, and identify information and support needs.Methods: In-depth, semi-structured interviews with individuals from Australian ALS families with known pathogenic gene variants explored experiences of familial ALS, and factors that influenced genetic testing decision-making. Interviews were analysed using an inductive approach.Results: Thirty-four individuals from 24 families were interviewed and included patients (n = 4), spouses (n = 4), and asymptomatic at-risk relatives (n = 26). Life stage, experience of disease, costs, research opportunities, and attitudes to familial ALS and/or reproductive options influenced decision-making. Some patients and relatives experienced difficulty gaining accurate information from their health professionals about the costs and implications of genetic counselling or testing, resulting in a reluctance to proceed.Discussion and conclusion: This study provides new insight into the Australian experience of genetic testing and counselling for familial ALS. It highlights the need to work together with other health professionals to ensure the complexities of genetic testing decision-making, and referral pathways are better understood.
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Affiliation(s)
- Ashley Crook
- Department of Clinical Medicine.,Macquarie University Centre for Motor Neuron Disease Research, Department of Biomedical Science, Faculty of Medicine and Health Sciences; Macquarie University, Sydney, Australia.,Graduate School of Health, University of Technology Sydney, Ultimo, Australia
| | - Anne Hogden
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia.,Australian Institute of Health Service Management, University of Tasmania, Sydney, Australia
| | - Virginia Mumford
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Ian P Blair
- Macquarie University Centre for Motor Neuron Disease Research, Department of Biomedical Science, Faculty of Medicine and Health Sciences; Macquarie University, Sydney, Australia
| | - Kelly L Williams
- Macquarie University Centre for Motor Neuron Disease Research, Department of Biomedical Science, Faculty of Medicine and Health Sciences; Macquarie University, Sydney, Australia
| | - Dominic B Rowe
- Department of Clinical Medicine.,Macquarie University Centre for Motor Neuron Disease Research, Department of Biomedical Science, Faculty of Medicine and Health Sciences; Macquarie University, Sydney, Australia
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20
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Wen L, Chen Y, Schnabel E, Crook A, Frugoli J. Correction to: Comparison of efficiency and time to regeneration of Agrobacterium-mediated transformation methods in Medicago truncatula. Plant Methods 2019; 15:95. [PMID: 31452671 PMCID: PMC6699079 DOI: 10.1186/s13007-019-0480-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
[This corrects the article DOI: 10.1186/s13007-019-0404-1.].
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Affiliation(s)
- Li Wen
- Department of Genetics and Biochemistry, Clemson University, Clemson, USA
- Department of Food and Biological Engineering, Changsha University of Science and Technology, Changsha, People’s Republic of China
| | - Yuanling Chen
- Department of Genetics and Biochemistry, Clemson University, Clemson, USA
- College of Life Sciences, South China Agricultural University, Guangzhou, People’s Republic of China
| | - Elise Schnabel
- Department of Genetics and Biochemistry, Clemson University, Clemson, USA
| | - Ashley Crook
- Department of Genetics and Biochemistry, Clemson University, Clemson, USA
- Department of Biology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
| | - Julia Frugoli
- Department of Genetics and Biochemistry, Clemson University, Clemson, USA
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21
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Oakey J, Smith C, Underwood D, Afsharnasab M, Alday-Sanz V, Dhar A, Sivakumar S, Sahul Hameed AS, Beattie K, Crook A. Global distribution of white spot syndrome virus genotypes determined using a novel genotyping assay. Arch Virol 2019; 164:2061-2082. [PMID: 31131427 PMCID: PMC6591196 DOI: 10.1007/s00705-019-04265-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 03/29/2019] [Indexed: 11/25/2022]
Abstract
White spot disease, caused by infection with white spot syndrome virus (WSSV), is a serious panzootic affecting prawn aquaculture. The disease has spread rapidly around the prawn-culturing regions of the world through a number of previously identified mechanisms. The ability to distinguish and trace strains of WSSV is of great benefit to identify, and then limit, the translocation routes of the disease. Here, we describe a novel genotyping method using 34 short tandem repeat regions of the viral genome concurrently. This technique is highly sensitive to strain differences when compared to previous methods. The efficacy of the described method is demonstrated by testing WSSV isolates from around the globe, showing regional genotypic differences. The differences in the genotypes were used to create a global minimum spanning network, and in most cases the observed relationships were substantiated with verification of transboundary movement. This novel panel of STR markers will provide a valuable epidemiological tool for white spot disease. We have applied this to an outbreak of the disease in Queensland, Australia, that occurred in 2016. While the results indicate that the source of this outbreak currently remains cryptic, the analyses have provided valuable insights with which to further study the origins of the strains involved.
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Affiliation(s)
- J Oakey
- Biosecurity Sciences Laboratory, Biosecurity Queensland, Queensland Department of Agriculture and Fisheries, 39 Kessels Road, Coopers Plains, QLD, 4108, Australia.
| | - C Smith
- Biosecurity Sciences Laboratory, Biosecurity Queensland, Queensland Department of Agriculture and Fisheries, 39 Kessels Road, Coopers Plains, QLD, 4108, Australia
| | - D Underwood
- Biosecurity Sciences Laboratory, Biosecurity Queensland, Queensland Department of Agriculture and Fisheries, 39 Kessels Road, Coopers Plains, QLD, 4108, Australia
| | - M Afsharnasab
- Department of Aquatic Animal Health and Diseases, Iranian Fisheries Research Organization, Tehran, Iran
| | - V Alday-Sanz
- National Aquaculture Group, King Abdul Aziz Rd, Al Murjan, Jeddah, 23715, Kingdom of Saudi Arabia
| | - A Dhar
- School of Animal and Comparative Biomedical Sciences, The University of Arizona, 1041 E Lowell St, Tucson, AZ, 85721, USA
| | - S Sivakumar
- Aquatic Animal Health Laboratory, C. Abdul Hakeem College, Melvisharam, Vellore District, Tamil Nadu, India
| | - A S Sahul Hameed
- Aquatic Animal Health Laboratory, C. Abdul Hakeem College, Melvisharam, Vellore District, Tamil Nadu, India
| | - K Beattie
- Biosecurity Queensland, Queensland Department of Agriculture and Fisheries, 41 George Street, Brisbane, 4000, Australia
| | - A Crook
- Biosecurity Queensland, Queensland Department of Agriculture and Fisheries, 41 George Street, Brisbane, 4000, Australia
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22
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Crook A, McEwen A, Fifita JA, Zhang K, Kwok JB, Halliday G, Blair IP, Rowe DB. The C9orf72 hexanucleotide repeat expansion presents a challenge for testing laboratories and genetic counseling. Amyotroph Lateral Scler Frontotemporal Degener 2019; 20:310-316. [PMID: 30907153 DOI: 10.1080/21678421.2019.1588904] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 12/12/2022]
Abstract
C9orf72 hexanucleotide repeat expansions are the most common known cause of amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD). Genetic testing for C9orf72 expansions in patients with ALS and/or FTD and their relatives has become increasingly available since hexanucleotide repeat expansions were first reported in 2011. The repeat number is highly variable and the threshold at which repeat size leads to neurodegeneration remains unknown. We present the case of an ALS patient who underwent genetic testing through our Motor Neurone Disease Clinic. We highlight current limitations to analysing and interpreting C9orf72 expansion test results and describe how this resulted in discordant reports of pathogenicity between testing laboratories that confounded the genetic counselling process. We conclude that patients with ALS or FTD and their at-risk family members, need to be adequately counselled about the limitations of current knowledge to ensure they are making informed decisions about genetic testing for C9orf72. Greater collaboration between clinicians, testing laboratories and researchers is required to ensure risks to patients and their families are minimised.
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Affiliation(s)
- Ashley Crook
- a Department of Clinical Medicine, Faculty of Medicine and Health Sciences , Macquarie University , Sydney , Australia.,b Centre for MND Research, Department of Biomedical Science, Faculty of Medicine and Health Sciences , Macquarie University , Sydney , Australia.,c Graduate School of Health , University of Technology Sydney , Ultimo , Australia
| | - Alison McEwen
- c Graduate School of Health , University of Technology Sydney , Ultimo , Australia
| | - Jennifer A Fifita
- b Centre for MND Research, Department of Biomedical Science, Faculty of Medicine and Health Sciences , Macquarie University , Sydney , Australia
| | - Katharine Zhang
- b Centre for MND Research, Department of Biomedical Science, Faculty of Medicine and Health Sciences , Macquarie University , Sydney , Australia
| | - John B Kwok
- d Central Clinical School and Brain and Mind Centre , The University of Sydney , Sydney , Australia.,e School of Medical Sciences , University of New South Wales , Sydney , Australia
| | - Glenda Halliday
- d Central Clinical School and Brain and Mind Centre , The University of Sydney , Sydney , Australia
| | - Ian P Blair
- b Centre for MND Research, Department of Biomedical Science, Faculty of Medicine and Health Sciences , Macquarie University , Sydney , Australia
| | - Dominic B Rowe
- a Department of Clinical Medicine, Faculty of Medicine and Health Sciences , Macquarie University , Sydney , Australia.,b Centre for MND Research, Department of Biomedical Science, Faculty of Medicine and Health Sciences , Macquarie University , Sydney , Australia
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23
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Wen L, Chen Y, Schnabel E, Crook A, Frugoli J. Comparison of efficiency and time to regeneration of Agrobacterium-mediated transformation methods in Medicago truncatula. Plant Methods 2019; 15:20. [PMID: 30858871 PMCID: PMC6394069 DOI: 10.1186/s13007-019-0404-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 02/18/2019] [Indexed: 05/13/2023]
Abstract
BACKGROUND Tissue culture transformation of plants has an element of art to it, with protocols passed on between labs but often not directly compared. As Medicago truncatula has become popular as a model system for legumes, rapid transformation is critical, and many protocols exist, with varying results. RESULTS The M. truncatula ecotypes, R108 and A17, were utilized to compare the effect of a modification to a previously used protocol based on shoot explants on the percentage of transformed plants produced from calli. This percentage was then compared to that of two additional transformation protocols based on root explants in the R108 ecotype. Variations in embryonic tissue sources, media components, time for transformation, and vectors were analyzed. CONCLUSIONS While no A17 transgenic plants were obtained, transgenic plantlets from the R108 ecotype were produced in as little as 4 months with a comparison of the two widely studied ecotypes under a single set of conditions. While the protocols tested gave similar results in percentage of transformed plants produced, considerations of labor and time to transgenics that vary between the root explant protocols tested were discovered. These considerations may influence which protocol to choose for introducing a single transgene versus creating lines with multiple mutations utilizing a CRISPR/Cas9 construct.
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Affiliation(s)
- Li Wen
- Department of Genetics and Biochemistry, Clemson University, Clemson, USA
- Department of Food and Biological Engineering, Changsha University of Science and Technology, Changsha, People’s Republic of China
| | - Yuanling Chen
- Department of Genetics and Biochemistry, Clemson University, Clemson, USA
- College of Life Sciences, South China Agricultural University, Guangzhou, People’s Republic of China
| | - Elise Schnabel
- Department of Genetics and Biochemistry, Clemson University, Clemson, USA
| | - Ashley Crook
- Department of Genetics and Biochemistry, Clemson University, Clemson, USA
- Department of Biology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
| | - Julia Frugoli
- Department of Genetics and Biochemistry, Clemson University, Clemson, USA
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24
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Benn DE, Zhu Y, Andrews KA, Wilding M, Duncan EL, Dwight T, Tothill RW, Burgess J, Crook A, Gill AJ, Hicks RJ, Kim E, Luxford C, Marfan H, Richardson AL, Robinson B, Schlosberg A, Susman R, Tacon L, Trainer A, Tucker K, Maher ER, Field M, Clifton-Bligh RJ. Bayesian approach to determining penetrance of pathogenic SDH variants. J Med Genet 2018; 55:729-734. [PMID: 30201732 PMCID: PMC6252366 DOI: 10.1136/jmedgenet-2018-105427] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [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: 04/13/2018] [Revised: 08/15/2018] [Accepted: 08/20/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Until recently, determining penetrance required large observational cohort studies. Data from the Exome Aggregate Consortium (ExAC) allows a Bayesian approach to calculate penetrance, in that population frequencies of pathogenic germline variants should be inversely proportional to their penetrance for disease. We tested this hypothesis using data from two cohorts for succinate dehydrogenase subunits A, B and C (SDHA-C) genetic variants associated with hereditary pheochromocytoma/paraganglioma (PC/PGL). METHODS Two cohorts were 575 unrelated Australian subjects and 1240 unrelated UK subjects, respectively, with PC/PGL in whom genetic testing had been performed. Penetrance of pathogenic SDHA-C variants was calculated by comparing allelic frequencies in cases versus controls from ExAC (removing those variants contributed by The Cancer Genome Atlas). RESULTS Pathogenic SDHA-C variants were identified in 106 subjects (18.4%) in cohort 1 and 317 subjects (25.6%) in cohort 2. Of 94 different pathogenic variants from both cohorts (seven in SDHA, 75 in SDHB and 12 in SDHC), 13 are reported in ExAC (two in SDHA, nine in SDHB and two in SDHC) accounting for 21% of subjects with SDHA-C variants. Combining data from both cohorts, estimated lifetime disease penetrance was 22.0% (95% CI 15.2% to 30.9%) for SDHB variants, 8.3% (95% CI 3.5% to 18.5%) for SDHC variants and 1.7% (95% CI 0.8% to 3.8%) for SDHA variants. CONCLUSION Pathogenic variants in SDHB are more penetrant than those in SDHC and SDHA. Our findings have important implications for counselling and surveillance of subjects carrying these pathogenic variants.
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Affiliation(s)
- Diana E Benn
- Hormones and Cancer, Cancer Genetics Laboratory, Kolling Institute, Royal North Shore Hospital, St Leonards, New South Wales, Australia,Department of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Ying Zhu
- Hormones and Cancer, Cancer Genetics Laboratory, Kolling Institute, Royal North Shore Hospital, St Leonards, New South Wales, Australia,Department of Medicine, University of Sydney, Sydney, New South Wales, Australia,Department of Cancer Services, Northern Sydney Local Health District Familial Cancer Service, Royal North Shore Hospital, Saint Leonards, New South Wales, Australia
| | - Katrina A Andrews
- Department of Medical Genetics, University of Cambridge and NIHR Cambridge Biomedical Research Centre and Cancer Research UK Cambridge Centre and Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, UK
| | - Mathilda Wilding
- Department of Cancer Services, Northern Sydney Local Health District Familial Cancer Service, Royal North Shore Hospital, Saint Leonards, New South Wales, Australia
| | - Emma L Duncan
- School of Biomedical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia,Department of Endocrinology, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
| | - Trisha Dwight
- Hormones and Cancer, Cancer Genetics Laboratory, Kolling Institute, Royal North Shore Hospital, St Leonards, New South Wales, Australia,Department of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Richard W Tothill
- Department of Oncology, The Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
| | - John Burgess
- Faculty of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Ashley Crook
- Department of Cancer Services, Northern Sydney Local Health District Familial Cancer Service, Royal North Shore Hospital, Saint Leonards, New South Wales, Australia
| | - Anthony J Gill
- Department of Medicine, University of Sydney, Sydney, New South Wales, Australia,Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Rodney J Hicks
- Department of Oncology, The Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
| | - Edward Kim
- Hormones and Cancer, Cancer Genetics Laboratory, Kolling Institute, Royal North Shore Hospital, St Leonards, New South Wales, Australia,Department of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Catherine Luxford
- Hormones and Cancer, Cancer Genetics Laboratory, Kolling Institute, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Helen Marfan
- Genetic Health Queensland, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
| | - Anne Louise Richardson
- Hormones and Cancer, Cancer Genetics Laboratory, Kolling Institute, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Bruce Robinson
- Hormones and Cancer, Cancer Genetics Laboratory, Kolling Institute, Royal North Shore Hospital, St Leonards, New South Wales, Australia,Department of Medicine, University of Sydney, Sydney, New South Wales, Australia,Department of Endocrinology, Royal North Shore Hospital, St Leonards, New South Wales, USA
| | - Arran Schlosberg
- Department of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Rachel Susman
- Genetic Health Queensland, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
| | - Lyndal Tacon
- Hormones and Cancer, Cancer Genetics Laboratory, Kolling Institute, Royal North Shore Hospital, St Leonards, New South Wales, Australia,Department of Medicine, University of Sydney, Sydney, New South Wales, Australia,Department of Endocrinology, Royal North Shore Hospital, St Leonards, New South Wales, USA
| | - Alison Trainer
- Department of Oncology, The Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
| | - Katherine Tucker
- Department of Clinical Genetics, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Eamonn R Maher
- Department of Medical Genetics, University of Cambridge and NIHR Cambridge Biomedical Research Centre and Cancer Research UK Cambridge Centre and Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, UK
| | - Michael Field
- Department of Cancer Services, Northern Sydney Local Health District Familial Cancer Service, Royal North Shore Hospital, Saint Leonards, New South Wales, Australia
| | - Roderick J Clifton-Bligh
- Hormones and Cancer, Cancer Genetics Laboratory, Kolling Institute, Royal North Shore Hospital, St Leonards, New South Wales, Australia,Department of Medicine, University of Sydney, Sydney, New South Wales, Australia,Department of Endocrinology, Royal North Shore Hospital, St Leonards, New South Wales, USA
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25
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Affiliation(s)
- A Crook
- Department of Clinical Medicine
| | - A Hogden
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - V Mumford
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - D Rowe
- Department of Clinical Medicine
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26
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Murthy SE, Chatterjee F, Crook A, Dawson R, Mendel C, Murphy ME, Murray SR, Nunn AJ, Phillips PPJ, Singh KP, McHugh TD, Gillespie SH. Pretreatment chest x-ray severity and its relation to bacterial burden in smear positive pulmonary tuberculosis. BMC Med 2018; 16:73. [PMID: 29779492 PMCID: PMC5961483 DOI: 10.1186/s12916-018-1053-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [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: 08/04/2017] [Accepted: 04/09/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Chest radiographs are used for diagnosis and severity assessment in tuberculosis (TB). The extent of disease as determined by smear grade and cavitation as a binary measure can predict 2-month smear results, but little has been done to determine whether radiological severity reflects the bacterial burden at diagnosis. METHODS Pre-treatment chest x-rays from 1837 participants with smear-positive pulmonary TB enrolled into the REMoxTB trial (Gillespie et al., N Engl J Med 371:1577-87, 2014) were retrospectively reviewed. Two clinicians blinded to clinical details using the Ralph scoring system performed separate readings. An independent reader reviewed discrepant results for quality assessment and cavity presence. Cavitation presence was plotted against time to positivity (TTP) of sputum liquid cultures (MGIT 960). The Wilcoxon rank sum test was performed to calculate the difference in average TTP for these groups. The average lung field affected was compared to log 10 TTP by linear regression. Baseline markers of disease severity and patient characteristics were added in univariable regression analysis against radiological severity and a multivariable regression model was created to explore their relationship. RESULTS For 1354 participants, the median TTP was 117 h (4.88 days), being 26 h longer (95% CI 16-30, p < 0.001) in patients without cavitation compared to those with cavitation. The median percentage of lung-field affected was 18.1% (IQR 11.3-28.8%). For every 10-fold increase in TTP, the area of lung field affected decreased by 11.4%. Multivariable models showed that serum albumin decreased significantly as the percentage of lung field area increased in both those with and without cavitation. In addition, BMI and logged TTP had a small but significant effect in those with cavitation and the number of severe TB symptoms in the non-cavitation group also had a small effect, whilst other factors found to be significant on univariable analysis lost this effect in the model. CONCLUSIONS The radiological severity of disease on chest x-ray prior to treatment in smear positive pulmonary TB patients is weakly associated with the bacterial burden. When compared against other variables at diagnosis, this effect is lost in those without cavitation. Radiological severity does reflect the overall disease severity in smear positive pulmonary TB, but we suggest that clinicians should be cautious in over-interpreting the significance of radiological disease extent at diagnosis.
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Affiliation(s)
- S E Murthy
- UCL Centre for Clinical Microbiology, Department of Infection, University College London, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK.
| | - F Chatterjee
- Department of Radiology, Barts Health NHS Trust, The Royal London Hospital, Whitechapel Road, London, E1 1BB, UK
| | - A Crook
- Medical Research Council UK Clinical Trials Unit at University College London, Aviation House, 125 Kingsway, London, WC2B 6NH, UK
| | - R Dawson
- University of Cape Town Lung Institute, George Street, Mowbray, Cape Town, South Africa
| | - C Mendel
- Global Alliance for Tuberculosis Drug Development, New York, NY, 10005, USA
| | - M E Murphy
- UCL Centre for Clinical Microbiology, Department of Infection, University College London, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK
| | - S R Murray
- Global Alliance for Tuberculosis Drug Development, New York, NY, 10005, USA
| | - A J Nunn
- Medical Research Council UK Clinical Trials Unit at University College London, Aviation House, 125 Kingsway, London, WC2B 6NH, UK
| | - P P J Phillips
- Medical Research Council UK Clinical Trials Unit at University College London, Aviation House, 125 Kingsway, London, WC2B 6NH, UK
| | - Kasha P Singh
- UCL Centre for Clinical Microbiology, Department of Infection, University College London, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK
| | - T D McHugh
- UCL Centre for Clinical Microbiology, Department of Infection, University College London, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK
| | - S H Gillespie
- Medical and Biological Sciences, School of Medicine, University of St Andrews, North Haugh, St Andrews, KY16 9TF, UK.
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Abstract
Developments in amyotrophic lateral sclerosis research and care delivery have created new arenas, and new dilemmas, for patients’ decision making. This review explores three aspects of amyotrophic lateral sclerosis patient-centered care and decision making: patient-centered service delivery through the expanding multidisciplinary team; decision making for genetic testing and the implications of undergoing testing; and development of user-designed decision support tools to help patients and families make decisions as their choices become more complex. Until a cure is found, well-timed and effective decision making will rely on patient and family preferences to guide them through an increasingly complicated disease landscape.
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Affiliation(s)
- Anne Hogden
- Australian Institute of Health Innovation, Faculty of Medicine & Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Ashley Crook
- Department of Clinical Medicine, Faculty of Medicine & Health Sciences, Macquarie University, Sydney, New South Wales, Australia
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28
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Najdawi F, Crook A, Maidens J, McEvoy C, Fellowes A, Pickett J, Ho M, Nevell D, McIlroy K, Sheen A, Sioson L, Ahadi M, Turchini J, Clarkson A, Hogg R, Valmadre S, Gard G, Dooley SJ, Scott RJ, Fox SB, Field M, Gill AJ. Lessons learnt from implementation of a Lynch syndrome screening program for patients with gynaecological malignancy. Pathology 2017; 49:457-464. [PMID: 28669579 DOI: 10.1016/j.pathol.2017.05.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [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: 03/22/2017] [Revised: 05/02/2017] [Accepted: 05/04/2017] [Indexed: 10/19/2022]
Abstract
Despite a trend towards universal testing, best practice to screen patients presenting with gynaecological malignancy for Lynch syndrome (LS) is uncertain. We report our institutional experience of a co-ordinated gynaecological LS screening program. All patients with endometrial carcinoma or carcinosarcoma, or gynaecological endometrioid or clear cell carcinomas undergo reflex four panel immunohistochemistry (IHC) for MLH1, PMS2, MSH2 and MSH6 followed by cascade somatic hypermethylation analysis of the MLH1 promoter locus for dual MLH1/PMS2 negative tumours. On the basis of these results, genetic counselling and targeted germline mutation testing is then offered to patients considered at high risk of LS. From 1 August 2013 to 31 December 2015, 124 patients were screened (mean age 64.6 years). Thirty-six (29.0%) demonstrated abnormal MMR IHC: 26 (72.2%) showed dual loss of MLH1/PMS2, five (13.9%) dual loss of MSH2/MSH6, three (8.3%) isolated loss of MSH6, and two (5.6%) isolated loss of PMS2. Twenty-five of 26 (96.1%) patients with dual MLH1/PMS2 loss demonstrated MLH1 promoter methylation. Therefore, 11 (8.9%) patients screened were classified as high risk for LS, of whom nine (81.8%) accepted germline mutation testing. Three (2.4% of total screened) were confirmed to have LS, two with germline PMS2 and one with germline MSH2 mutation. Massive parallel sequencing of tumour tissue demonstrated somatic mutations which were concordant with the IHC results in the remainder. Interestingly, the one MLH1/PMS2 IHC negative but not hypermethylated tumour harboured only somatic MLH1 mutations, indicating that universal cascade methylation testing in MLH1/PMS2 IHC negative tumours is very low yield and could be reconsidered in a resource-poor setting. In conclusion, universal screening for LS in patients presenting with gynaecological malignancy using the algorithm described above identified LS in three of 124 (2.4%) of our population. Only three of nine (33.3%) patients considered at high risk for LS by combined IHC and hypermethylation analysis were proven to have LS. Only one of the LS patients was less than 50 years of age and none of these patients would have been identified had more restrictive Amsterdam or Bethesda criteria been applied.
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Affiliation(s)
- Fedaa Najdawi
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, St Leonards, NSW, Australia; Department of Anatomical Pathology, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Ashley Crook
- NSLHD Familial Cancer Service, Department of Cancer Services, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Jayne Maidens
- Gynaecological Oncology, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Christopher McEvoy
- Department of Pathology, Peter MacCallum Cancer Centre, Parkville, Vic, Australia
| | - Andrew Fellowes
- Department of Pathology, Peter MacCallum Cancer Centre, Parkville, Vic, Australia
| | - Justine Pickett
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, St Leonards, NSW, Australia; Department of Anatomical Pathology, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Musei Ho
- SA Pathology, Molecular Oncology Unit, Adelaide, SA, Australia
| | - David Nevell
- Department of Anatomical Pathology, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Kirsten McIlroy
- Department of Anatomical Pathology, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Amy Sheen
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, St Leonards, NSW, Australia
| | - Loretta Sioson
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, St Leonards, NSW, Australia
| | - Mahsa Ahadi
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, St Leonards, NSW, Australia; Department of Anatomical Pathology, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - John Turchini
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, St Leonards, NSW, Australia; Department of Anatomical Pathology, Royal North Shore Hospital, St Leonards, NSW, Australia; University of Sydney, Sydney, NSW, Australia
| | - Adele Clarkson
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, St Leonards, NSW, Australia; Department of Anatomical Pathology, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Russell Hogg
- Gynaecological Oncology, Royal North Shore Hospital, St Leonards, NSW, Australia; University of Sydney, Sydney, NSW, Australia
| | - Sue Valmadre
- Gynaecological Oncology, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Greg Gard
- Gynaecological Oncology, Royal North Shore Hospital, St Leonards, NSW, Australia; University of Sydney, Sydney, NSW, Australia
| | - Susan J Dooley
- Pathology North, John Hunter Hospital, Newcastle, NSW, Australia; School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, NSW, Australia
| | - Rodney J Scott
- Pathology North, John Hunter Hospital, Newcastle, NSW, Australia; School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, NSW, Australia
| | - Stephen B Fox
- Department of Pathology, Peter MacCallum Cancer Centre, Parkville, Vic, Australia
| | - Michael Field
- NSLHD Familial Cancer Service, Department of Cancer Services, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Anthony J Gill
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, St Leonards, NSW, Australia; Department of Anatomical Pathology, Royal North Shore Hospital, St Leonards, NSW, Australia; University of Sydney, Sydney, NSW, Australia.
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29
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Crook A, Williams K, Adams L, Blair I, Rowe DB. Predictive genetic testing for amyotrophic lateral sclerosis and frontotemporal dementia: genetic counselling considerations. Amyotroph Lateral Scler Frontotemporal Degener 2017; 18:475-485. [PMID: 28585888 DOI: 10.1080/21678421.2017.1332079] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Once a gene mutation that is causal of amyotrophic lateral sclerosis (ALS) and/or frontotemporal dementia (FTD) is identified in a family, relatives may decide to undergo predictive genetic testing to determine whether they are at risk of developing disease. Recent advances in gene discovery have led to a pressing need to better understand the implications of predictive genetic testing. Here we review the uptake of genetic counselling, predictive and reproductive testing, and the factors that impact the decision to undergo testing, for consideration in clinical practice. The literature suggests that the factors impacting the decision to undergo testing are complex due to the nature of these diseases, absence of available preventative medical treatment and variable age of onset in mutation carriers. Gaining further insight into the decision-making process and the impact of testing is critical as we seek to develop best-practice guidelines for predictive testing for familial ALS and FTD.
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Affiliation(s)
- Ashley Crook
- a Department of Clinical Medicine, Faculty of Medicine and Health Sciences , Macquarie University , Sydney , New South Wales , Australia and
| | - Kelly Williams
- b Centre for MND Research , Department of Biomedical Science, Faculty of Medicine and Health Sciences , Macquarie University , Sydney , New South Wales , Australia
| | - Lorel Adams
- a Department of Clinical Medicine, Faculty of Medicine and Health Sciences , Macquarie University , Sydney , New South Wales , Australia and
| | - Ian Blair
- b Centre for MND Research , Department of Biomedical Science, Faculty of Medicine and Health Sciences , Macquarie University , Sydney , New South Wales , Australia
| | - Dominic B Rowe
- a Department of Clinical Medicine, Faculty of Medicine and Health Sciences , Macquarie University , Sydney , New South Wales , Australia and
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Abdel-Rahman ME, Butler J, Sydes MR, Parmar MKB, Gordon E, Harper P, Williams C, Crook A, Sandercock J, Swart AM, Rachet B, Coleman MP. No socioeconomic inequalities in ovarian cancer survival within two randomised clinical trials. Br J Cancer 2014; 111:589-97. [PMID: 24918817 PMCID: PMC4119977 DOI: 10.1038/bjc.2014.303] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [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] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 05/09/2014] [Accepted: 05/11/2014] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Ovarian cancer is the leading cause of death among cancers of the female genital tract, with poor outcomes despite chemotherapy. There was a persistent socioeconomic gradient in 1-year survival in England and Wales for more than 3 decades (1971-2001). Inequalities in 5-year survival persisted for more than 20 years but have been smaller for women diagnosed around 2000. We explored one possible explanation. METHODS We analysed data on 1406 women diagnosed with ovarian cancer during 1991-1998 and recruited to one of two randomised clinical trials. In the second International Collaborative Ovarian Neoplasm (ICON2) trial, women diagnosed between 1991 and 1996 were randomised to receive either the three-drug combination cyclophosphamide, doxorubicin and cisplatin (CAP) or single-agent carboplatin given at optimal dose. In the ICON3 trial, women diagnosed during 1995-1998 were randomised to receive either the same treatments as ICON2, or paclitaxel plus carboplatin.Relative survival at 1, 5 and 10 years was estimated for women in five categories of socioeconomic deprivation. The excess hazard of death over and above background mortality was estimated by fitting multivariable regression models with Poisson error structure and a dedicated link function in a generalised linear model framework, adjusting for the duration of follow-up and the confounding effects of age, Federation of Gynecology and Obstetrics (FIGO) stage and calendar period. RESULTS Unlike women with ovarian cancer in the general population, no statistically significant socioeconomic gradient was seen for women with ovarian cancer treated in the two randomised controlled trials. The deprivation gap in 1-year relative survival in the general population was statistically significant at -6.7% (95% CI (-8.1, -5.3)), compared with -3.6% (95% CI (-10.4, +3.2)) in the trial population. CONCLUSIONS Although ovarian cancer survival is significantly lower among poor women than rich women in England and Wales, there was no evidence of an association between socioeconomic deprivation and survival among women with ovarian cancer who were treated and followed up consistently in two well-conducted randomised controlled trials. We conclude that the persistent socioeconomic gradient in survival among women with ovarian cancer, at least for 1-year survival, may be due to differences in access to treatment and standards of care.
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Affiliation(s)
- M E Abdel-Rahman
- Cancer Research UK Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - J Butler
- Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK
| | - M R Sydes
- MRC Clinical Trials Unit at UCL, Aviation House, 125 Kingsway, London WC2B 6NH, UK
| | - M K B Parmar
- MRC Clinical Trials Unit at UCL, Aviation House, 125 Kingsway, London WC2B 6NH, UK
| | - E Gordon
- National Cancer Intelligence Centre, Office for National Statistics, Cardiff Road, Newport NP10 8XG, UK
| | - P Harper
- London Oncology Clinic, 95 Harley Street, London W1G 6AF, UK
| | - C Williams
- Bristol Haematology and Oncology Centre, University Hospitals Bristol, Horfield Road, Bristol BS2 8ED, UK
| | - A Crook
- MRC Clinical Trials Unit at UCL, Aviation House, 125 Kingsway, London WC2B 6NH, UK
| | | | - A M Swart
- Norwich Medical School, University of East Anglia, Norwich Research Park NR4 7TJ, UK
| | - B Rachet
- Cancer Research UK Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - M P Coleman
- Cancer Research UK Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
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Toon CW, Walsh MJ, Chou A, Capper D, Clarkson A, Sioson L, Clarke S, Mead S, Walters RJ, Clendenning M, Rosty C, Young JP, Win AK, Hopper JL, Crook A, von Deimling A, Jenkins MA, Buchanan DB, Gill AJ. BRAFV600E immunohistochemistry facilitates universal screening of colorectal cancers for Lynch syndrome. Am J Surg Pathol 2013; 37:1592-602. [PMID: 23797718 PMCID: PMC3773060 DOI: 10.1097/pas.0b013e31828f233d] [Citation(s) in RCA: 106] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BRAFV600E mutation in microsatellite-unstable (MSI) colorectal carcinomas (CRCs) virtually excludes Lynch syndrome (LS). In microsatellite-stable (MSS) CRCs it predicts poor prognosis. We propose a universal CRC LS screening algorithm using concurrent reflex immunohistochemistry (IHC) for BRAFV600E and mismatch-repair (MMR) proteins. We compared BRAFV600E IHC with multiplex polymerase chain reaction (PCR) and matrix-assisted laser desorption/ionization-time of flight mass spectrometry in 216 consecutive CRCs from 2011. Discordant cases were resolved with real-time PCR. BRAFV600E IHC was performed on 51 CRCs from the Australasian Colorectal Cancer Family Registry (ACCFR), which were fully characterized for BRAF mutation by allele-specific PCR, MMR status (MMR IHC and MSI), MLH1 promoter methylation, and germline MLH1 mutation. We then assessed MMR and BRAFV600E IHC on 1403 consecutive CRCs. By matrix-assisted laser desorption/ionization-time of flight mass spectrometry 15 cases did not yield a BRAF result, whereas 38/201 (19%) were positive. By IHC 45/216 (20%) were positive. Of the 7 discordant cases, real-time PCR confirmed the IHC result in 6. In the 51 CRCs from the ACCFR, IHC was concordant with allele-specific PCR in 50 cases. BRAFV600E and MSI IHC on 1403 CRCs demonstrated the following phenotypes: BRAF/MSS (1029 cases, 73%), BRAF/MSS (98, 7%), BRAF/MSI (183, 13%), and BRAF/MSI (93, 7%). All 11/1403 cancers associated with proven LS were BRAF/MSI. We conclude that BRAF IHC is highly concordant with 2 commonly used PCR-based BRAFV600E assays; it performed well in identifying MLH1 mutation carriers from the ACCFR and identified all cases of proven LS among the 1403 CRCs. Reflex BRAFV600E and MMR IHC are simple cheap tests that facilitate universal LS screening and identify the poor prognosis of the BRAFV600E-mutant MSS CRC phenotype.
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Affiliation(s)
- Christopher W Toon
- Department of Anatomical Pathology, Royal North Shore Hospital, Sydney, NSW Australia 2065
- Northern Cancer Translational Research Unit, Royal North Shore Hospital, Sydney, NSW Australia 2065
| | - Michael J Walsh
- School of Medicine, University of Queensland, Herston QLD 4006
- Cancer and Population Studies Group, Queensland Institute of Medical Research Brisbane QLD Australia 4029
| | - Angela Chou
- Department of Pathology, SYDPATH, St Vincents Hospital Darlinghurst NSW Australia 2010
- University of NSW Sydney NSW 2052 Australia
| | - David Capper
- Department of Neuropathology, Institute of Pathology, Ruprecht-Karls University; Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Adele Clarkson
- Department of Anatomical Pathology, Royal North Shore Hospital, Sydney, NSW Australia 2065
| | - Loretta Sioson
- Department of Anatomical Pathology, Royal North Shore Hospital, Sydney, NSW Australia 2065
| | - Stephen Clarke
- Northern Cancer Translational Research Unit, Royal North Shore Hospital, Sydney, NSW Australia 2065
- Familial Cancer Clinic, Royal North Shore Hospital Sydney NSW Australia 2065
| | - Scott Mead
- Department of Pathology, SYDPATH, St Vincents Hospital Darlinghurst NSW Australia 2010
- University of NSW Sydney NSW 2052 Australia
| | - Rhiannon J. Walters
- Cancer and Population Studies Group, Queensland Institute of Medical Research Brisbane QLD Australia 4029
| | - Mark Clendenning
- Cancer and Population Studies Group, Queensland Institute of Medical Research Brisbane QLD Australia 4029
| | - Christophe Rosty
- Cancer and Population Studies Group, Queensland Institute of Medical Research Brisbane QLD Australia 4029
- Molecular and Cellular Pathology, University of Queensland, School of Medicine, Herston, QLD 4006, Australia
- Envoi Specialist Pathologists, Herston Q4006
| | - Joanne P. Young
- Cancer and Population Studies Group, Queensland Institute of Medical Research Brisbane QLD Australia 4029
| | - Aung Ko Win
- Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, School of Population Health, University of Melbourne, Carlton VIC 3053, Australia
| | - John L. Hopper
- Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, School of Population Health, University of Melbourne, Carlton VIC 3053, Australia
| | - Ashley Crook
- Familial Cancer Clinic, Royal North Shore Hospital Sydney NSW Australia 2065
| | - Andreas von Deimling
- Department of Neuropathology, Institute of Pathology, Ruprecht-Karls University; Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Mark A. Jenkins
- Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, School of Population Health, University of Melbourne, Carlton VIC 3053, Australia
| | - Daniel B Buchanan
- Cancer and Population Studies Group, Queensland Institute of Medical Research Brisbane QLD Australia 4029
| | - Anthony J Gill
- Department of Anatomical Pathology, Royal North Shore Hospital, Sydney, NSW Australia 2065
- Northern Cancer Translational Research Unit, Royal North Shore Hospital, Sydney, NSW Australia 2065
- University of Sydney, Sydney, NSW Australia 2006
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Young MA, Wake S, Alsop K, Bowtell D, Mitchell G, Plunkett L, Crook A, Gleeson M, Hallowell N. The experiences of research participants offered genetic test results as a result of taking part in a population based ovarian cancer research study? Hered Cancer Clin Pract 2012. [PMCID: PMC3326695 DOI: 10.1186/1897-4287-10-s2-a15] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- MA Young
- The Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - S Wake
- Department of Paediatrics, the University of Melbourne, Royal Children’s Hospital, Flemington Rd, Parkville, VIC, Australia
| | - K Alsop
- The Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - D Bowtell
- The Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - G Mitchell
- The Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - L Plunkett
- Department of Paediatrics, the University of Melbourne, Royal Children’s Hospital, Flemington Rd, Parkville, VIC, Australia
| | - A Crook
- Department of Paediatrics, the University of Melbourne, Royal Children’s Hospital, Flemington Rd, Parkville, VIC, Australia
| | - M Gleeson
- Hunter Genetics, Newcastle, NSW, Australia
| | - N Hallowell
- Newcastle University, Newcastle upon Tyne, UK
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Crook A. Questions associated with proposed changes to the Criminal Code: The CVMA Animal Welfare Committee responds. Can Vet J 2001; 42:534-5. [PMID: 17424633 PMCID: PMC1476637] [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: 05/14/2023]
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Crook A. The CVMA animal abuse position--how we got here. Can Vet J 2000; 41:631-5. [PMID: 10945130 PMCID: PMC1476237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Affiliation(s)
- A Crook
- Atlantic Veterinary College, University of Prince Edward Island, Charlottetown
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Crook A, Hill B. Disorders of genetic origin in dogs. Canine Inherited Disorders Database in progress. Can Vet J 1998; 39:686-7. [PMID: 9818134] [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: 02/09/2023]
Affiliation(s)
- A Crook
- Atlantic Veterinary College, Charlottetown, Prince Edward Island
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Crook A, Duffy A, Girling D, Souhami R, Parmar M. 25 Survey on the treatment of non-small cell lung cancer (NSCLC) in England and Wales. Lung Cancer 1997. [DOI: 10.1016/s0169-5002(97)89304-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
As an adjunct to a meta-analysis of chemotherapy for non-small cell lung cancer (NSCLC), a survey was conducted in England and Wales of clinicians' views on the role of chemotherapy in NSCLC and the benefits it would have to offer to lead them to change their practice. Radiotherapists, medical oncologists, surgeons and physicians specializing in thoracic medicine, and physicians of palliative medicine were asked their views on the treatment of three case histories of 65 yr old men: Case 1, resected tumour involving a hilar lymph node (tumour (T)2, node (N)1, metastasis (M)0); Case 2, tumour that had spread to mediastinal lymph nodes bilaterally (T2, N3, M0); and Case 3, metastatic cancer (M1) accompanied by minor haemoptysis. Six hundred and ninety eight (85%) of the 821 clinicians responded. For Case 1, 74% would not recommend any adjuvant treatment, 24% would recommend radiotherapy, and <1% chemotherapy, and there was little expectation that adjuvant treatment would improve survival. For Case 2, 68% would recommend radiotherapy, 11% chemotherapy, and 1% surgery, 7% recommending a combination. Adjuvant treatment, regardless of modality, was expected to improve survival. For Case 3, only 11% would recommend chemotherapy, but 26% if the patient was aged < or = 50 yrs. There was little expectation of survival beyond 1 yr, or of improving survival with chemotherapy. For all three cases, most of those not recommending chemotherapy would require it to achieve substantially improved survival for them to use it routinely. Surgery alone is currently considered sufficient for resectable non-small cell lung cancer. Chemotherapy is rarely recommended for disease of any stage.
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Affiliation(s)
- A Crook
- Medical Research Council Cancer Trials Office, Cambridge, UK
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Crook A. 162 O Randomized study of cyclophosphamide, doxorubicin & cisplatin (CAP) vs single agent carboplatin in ovarian cancer patients requiring chemotherapy: Interim results of ICON2. Eur J Cancer 1996. [DOI: 10.1016/0959-8049(96)84918-5] [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: 10/18/2022]
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Abstract
The object of this paper is to describe the essential features for the design and conduct of clinical trials. We include aspects of patient eligibility, random allocation to treatment including the principle of uncertainty, assessment of endpoints including those observed at different time points for each patient and trial size. Indications of appropriate methods of analysis are given, and the intention to treat principle is discussed. Some pointers to difficulties associated with data collection and management are included.
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Affiliation(s)
- A Bailey
- Medical Research Council Cancer Trials Office, Cambridge, UK
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Crook A. More on sexism. Can Vet J 1991; 32:389. [PMID: 17423814 PMCID: PMC1481002] [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: 05/14/2023]
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Jackson SH, Crook A, Malone V, Drake TGH. The Retention of Thiamine, Riboflavin and Niacin in Cooking Pork and in Processing Bacon. J Nutr 1945. [DOI: 10.1093/jn/29.6.391] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Crook A. Blood Transfusion in Obstetrics. West J Med 1939. [DOI: 10.1136/bmj.1.4075.298-b] [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: 11/03/2022]
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Crook A. PROGNOSIS IN ECLAMPSIA AND ALBUMINURIA OF PREGNANCY. West J Med 1929. [DOI: 10.1136/bmj.1.3558.523-b] [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: 11/03/2022]
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Crook A. PROGNOSIS IN ECLAMPSIA AND ALBUMINURIA OF PREGNANCY. West J Med 1929. [DOI: 10.1136/bmj.1.3554.320-c] [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: 11/04/2022]
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Crook A. The Abuse of Caesarean Section. West J Med 1927. [DOI: 10.1136/bmj.2.3481.567-b] [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: 11/03/2022]
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Crook A. Communication on Necrosis of the Cortex of the Kidney after Labour. Proc R Soc Med 1927; 20:1249-1260. [PMID: 19985914 PMCID: PMC2100537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Crook A. INFECTED MYOMA COMPLICATING PREGNANCY. West J Med 1925. [DOI: 10.1136/bmj.2.3382.768] [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: 11/03/2022]
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Crook A. Incidence of Glycosuria during Pregnancy. Proc R Soc Med 1925; 18:33-38. [PMID: 19984497 PMCID: PMC2202365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Crook A. THE GENERAL PRACTITIONER AND THE MATERNITY SERVICE. West J Med 1924. [DOI: 10.1136/bmj.2.3334.972-a] [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: 11/03/2022]
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