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White J, Jackson A, Druce I, Gale J. Oocyte cryopreservation and reciprocal in vitro fertilization in a transgender man on long term testosterone gender-affirming hormone therapy: a case report. F S Rep 2024; 5:111-113. [PMID: 38524208 PMCID: PMC10958692 DOI: 10.1016/j.xfre.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 10/21/2023] [Accepted: 11/06/2023] [Indexed: 03/26/2024] Open
Abstract
Objective To report a successful case of oocyte cryopreservation and subsequent in vitro fertilization (IVF) in a transgender male receiving continued testosterone gender-affirming hormone therapy, followed by reciprocal embryo transfer (ET). Design A case report of a rare case of fertility preservation in a transgender man with concomitant use of testosterone therapy for 4 years before and during ovarian stimulation. Setting Private fertility clinic with university affiliation. Patients A 26-year-old transgender man undergoing oocyte cryopreservation before gender-affirming surgery. Interventions Fertility preservation using oocyte cryopreservation and IVF with reciprocal fresh ET into a cisfemale partner. Main Outcome Measures Successful oocyte cryopreservation, oocyte thawing, and reciprocal IVF cycle. Results Oocyte cryopreservation of 29 mature oocytes. Sixteen mature oocytes survived the thaw, and 12 were fertilized with intracytoplasmic sperm injection. A fresh ET of an advanced blastocyst resulted in a clinical pregnancy and live birth. Conclusions Fertility preservation with oocyte cryopreservation or IVF with embryo cryopreservation is feasible for patients on continued long-term testosterone gender-affirming therapy. Future studies on egg quality and reproductive outcomes are required. Our case report demonstrates a promising outcome in this patient population.
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Affiliation(s)
- Justin White
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Fertilty Centre, Ottawa, Ontario, Canada
| | - Aaron Jackson
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Fertilty Centre, Ottawa, Ontario, Canada
| | - Irena Druce
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Jenna Gale
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Fertilty Centre, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Gilbert DC, Nankivell M, Rush H, Clarke NW, Mangar S, Al-Hasso A, Rosen S, Kockelbergh R, Sundaram SK, Dixit S, Laniado M, McPhail N, Shaheen A, Brown S, Gale J, Deighan J, Marshall J, Duong T, Macnair A, Griffiths A, Amos CL, Sydes MR, James ND, Parmar MKB, Langley RE. A Repurposing Programme Evaluating Transdermal Oestradiol Patches for the Treatment of Prostate Cancer Within the PATCH and STAMPEDE Trials: Current Results and Adapting Trial Design. Clin Oncol (R Coll Radiol) 2024; 36:e11-e19. [PMID: 37973477 DOI: 10.1016/j.clon.2023.10.054] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 10/31/2023] [Indexed: 11/19/2023]
Abstract
AIMS Androgen deprivation therapy (ADT), usually achieved with luteinising hormone releasing hormone analogues (LHRHa), is central to prostate cancer management. LHRHa reduce both testosterone and oestrogen and are associated with significant long-term toxicity. Previous use of oral oestrogens as ADT was curtailed because of cardiovascular toxicity. Transdermal oestrogen (tE2) patches are a potential alternative ADT, supressing testosterone without the associated oestrogen-depletion toxicities (osteoporosis, hot flushes, metabolic abnormalities) and avoiding cardiovascular toxicity, and we here describe their evaluation in men with prostate cancer. MATERIALS AND METHODS The PATCH (NCT00303784) adaptive trials programme (incorporating recruitment through the STAMPEDE [NCT00268476] platform) is evaluating the safety and efficacy of tE2 patches as ADT for men with prostate cancer. An initial randomised (LHRHa versus tE2) phase II study (n = 251) with cardiovascular toxicity as the primary outcome measure has expanded into a phase III evaluation. Those with locally advanced (M0) or metastatic (M1) prostate cancer are eligible. To reflect changes in both management and prognosis, the PATCH programme is now evaluating these cohorts separately. RESULTS Recruitment is complete, with 1362 and 1128 in the M0 and M1 cohorts, respectively. Rates of androgen suppression with tE2 were equivalent to LHRHa, with improved metabolic parameters, quality of life and bone health indices (mean absolute change in lumbar spine bone mineral density of -3.0% for LHRHa and +7.9% for tE2 with an estimated difference between arms of 9.3% (95% confidence interval 5.3-13.4). Importantly, rates of cardiovascular events were not significantly different between the two arms and the time to first cardiovascular event did not differ between treatment groups (hazard ratio 1.11, 95% confidence interval 0.80-1.53; P = 0.54). Oncological outcomes are awaited. FUTURE Efficacy results for the M0 cohort (primary outcome measure metastases-free survival) are expected in the final quarter of 2023. For M1 patients (primary outcome measure - overall survival), analysis using restricted mean survival time is being explored. Allied translational work on longitudinal samples is underway.
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Affiliation(s)
- D C Gilbert
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK; University Hospitals Sussex NHS Foundation Trust, Royal Sussex County Hospital, Brighton, UK.
| | - M Nankivell
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | - H Rush
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | - N W Clarke
- The Christie and Salford Royal Hospitals, Manchester, UK
| | - S Mangar
- Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - A Al-Hasso
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - S Rosen
- National Heart and Lung Institute, Imperial College, London, UK
| | - R Kockelbergh
- Department of Urology, University Hospitals of Leicester, Leicester, UK
| | - S K Sundaram
- Mid-Yorkshire Teaching NHS Trust, Pinderfields Hospital, Wakefield, UK
| | - S Dixit
- Scunthorpe General Hospital, Scunthorpe, UK
| | | | | | | | - S Brown
- Airedale General Hospital, Keighley, UK
| | - J Gale
- Queen Alexandra Hospital, Portsmouth, UK
| | - J Deighan
- Patient Representative, MRC Clinical Trials Unit at UCL, London, UK
| | - J Marshall
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | - T Duong
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | - A Macnair
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK; Guys and St Thomas' NHS Foundation Trust, London, UK
| | - A Griffiths
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | - C L Amos
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | - M R Sydes
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | - N D James
- Institute of Cancer Research, Sutton, UK
| | - M K B Parmar
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | - R E Langley
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
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3
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Nguyen V, Jackson A, Gale J. Live birth rates after resolution of endometrial cavity fluid in frozen embryo transfer cycles. Reprod Biol Endocrinol 2023; 21:100. [PMID: 37891659 PMCID: PMC10605945 DOI: 10.1186/s12958-023-01149-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023] Open
Abstract
RESEARCH QUESTION Are live birth rates affected in frozen embryo transfer cycles that develop transient endometrial cavity fluid that resolves by day of embryo transfer? DESIGN The first frozen blastocyst transfer cycle between January 1st, 2016 and December 31st, 2019 were included in this retrospective cohort study at an academic fertility center. The presence or absence of endometrial cavity fluid (ECF) detected on initial ultrasound and at time of transfer was recorded. Patients who had persistent ECF at time of transfer were excluded from the study. The primary outcome was live birth rate in the group with resolved ECF relative to the group without ECF. RESULTS A total of 1034 frozen blastocyst transfer cycles were included, 54 with resolved ECF and 980 without ECF. Adjusted analyses were performed using a log-binomial regression model. Live birth rates were 35.2% and 34.2%, adjusted risk ratio 1.00 [95% CI 0.70-1.50] in the two groups, respectively. CONCLUSION Live birth rates in frozen embryo transfer cycles are equivalent between patients with resolved endometrial cavity fluid compared to those who never had endometrial cavity fluid. Our findings suggest that the presence of endometrial cavity fluid is likely not detrimental to live birth rates if the fluid spontaneously resolves by the time of embryo transfer.
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Affiliation(s)
- Vincent Nguyen
- Dept of Obstetrics and Gynecology, University of Ottawa, 501 Smyth Road, Ottawa, ON, K1H 8M5, Canada.
| | - Aaron Jackson
- Dept of Obstetrics and Gynecology, University of Ottawa, 501 Smyth Road, Ottawa, ON, K1H 8M5, Canada
- Ottawa Fertility Centre, Green Valley Crescent, Ottawa, ON, 100-955, K2C 3V4, Canada
| | - Jenna Gale
- Dept of Obstetrics and Gynecology, University of Ottawa, 501 Smyth Road, Ottawa, ON, K1H 8M5, Canada
- Ottawa Fertility Centre, Green Valley Crescent, Ottawa, ON, 100-955, K2C 3V4, Canada
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Gale J, Shmorgun D, Bacal V, Leveille MC. Evaluation of Early Frozen Blastocyst Transfer in A True Natural Cycle Protocol in Comparison to A Hormone Replacement Protocol: A Single-Center Cohort Study. Int J Fertil Steril 2023; 17:195-200. [PMID: 37183846 DOI: 10.22074/ijfs.2022.544635.1238] [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] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Indexed: 05/16/2023]
Abstract
OBJECTIVE Timing of frozen embryo transfer (FET) within a purported window of implantation is of increasing interest, and there is a paucity of evidence surrounding the transfer of frozen embryos early within these frozen embryo transfer protocols. This study aimed to evaluate whether live birth rates were equivalent after FET of blastocysts 4 days after luteinizing hormone (LH) surge in a true natural cycle protocol, compared to a hormone replacement (HR) protocol. MATERIALS AND METHODS Single-centre, retrospective cohort study involving patients undergoing autologous frozen blastocyst transfer from January 1st, 2013, to December 31st, 2016. Cycles were grouped according to their protocol: true natural cycle (hormonal detection of LH surge with FET scheduled four days later) versus HR cycle (luteal phase gonadotropin-releasing hormone agonist suppression, oral or vaginal estradiol and intramuscular progesterone starting five days before FET). A total of 850 cycles were included, 501 true natural cycles and 349 HR cycles. The primary outcome was the live birth rate, secondary outcomes included clinical pregnancy rate and miscarriage. Logbinomial regression models were performed adjusting for a priori selected variables. RESULTS Adjusted resulted in live birth rates of 38.7 and 40.4%, [adjusted risk ratio (aRR): 0.96, 95% confidence interval (CI): 0.76-1.22, P=0.729] in the natural cycle and HR groups, respectively. The secondary outcome analyses did not demonstrate any statistically significant difference in the rate of positive human chorionic gonadotropin (hCG), clinical intrauterine pregnancy rate, or miscarriage rate. CONCLUSION The timing of the FET four days after LH surge in a true natural cycle protocol results in equivalent live birth rates compared to a HR protocol. Results of this study suggest that the window of implantation within the natural cycle may be less finite than currently believed and further prospective studies evaluating the timing of frozen embryo transfer are warranted.
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Affiliation(s)
- Jenna Gale
- University of Ottawa, Department of Obstetrics and Gynecology, Ottawa, ON, Canada.
- Ottawa Fertility Centre, 100-955 Green Valley Crescent, Ottawa, ON, Canada
| | - Doron Shmorgun
- University of Ottawa, Department of Obstetrics and Gynecology, Ottawa, ON, Canada
- Ottawa Fertility Centre, 100-955 Green Valley Crescent, Ottawa, ON, Canada
| | - Vanessa Bacal
- University of Ottawa, Department of Obstetrics and Gynecology, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Marie-Claude Leveille
- University of Ottawa, Department of Obstetrics and Gynecology, Ottawa, ON, Canada
- Ottawa Fertility Centre, 100-955 Green Valley Crescent, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
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5
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Wu CQ, Campbell M, Shmorgun D, Torrance S, Gale J, Léveillé MC. Comparative Embryo Development Outcomes following Extending Embryo Culture to Day 6: A Retrospective Cohort Study. Int J Fertil Steril 2023; 17:40-46. [PMID: 36617201 PMCID: PMC9807896 DOI: 10.22074/ijfs.2022.535422.1195] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND Past studies have shown that culturing slow-growing embryos from day 5 to day 6 may increase vitrification yield. This study aims to evaluate if the proportion of embryos eligible for vitrification increases by growing embryos not vitrified by day 5 to day 6. MATERIALS AND METHODS In this retrospective cohort study, a Canadian tertiary-care clinic-based cohort was identified between August 2019 and December 2020. In vitro fertilization (IVF) cycles involving autologous oocytes with at least one viable day 5 embryo were selected for inclusion. We compared embryo developmental outcomes of IVF cycles performed before and after an embryo cryopreservation policy change. Prior to March 2020, good-quality day 5 blastocysts of any stage were eligible for vitrification, and after that date, good-quality expanded blastocysts on either day 5 or day 6 were eligible. The primary outcome is the comparative proportion of embryos eligible for vitrification. The secondary outcome is to identify embryo, maternal and cycle factors that are predictive of day 6 vitrification. RESULTS A total of 3,438 viable embryos across 679 consecutive IVF cycles were included in this study. After the policy change, we found similar mean proportions of blastocysts eligible for cryopreservation (46.9% per IVF cycle in group 2 vs. 44.4% in group 1, mean difference 0.025, 95% confidence interval -0.021 to 0.071, P=0.28). The mean number of cryopreserved embryos were significantly higher in group 2 (mean 2.2 vs. 1.7 embryos, P=0.007). Factors that predicated an embryo's progression to day 6 included: younger age of egg provider, presence of an early blastocyst on day 5, and cycles involving surgically-retrieved sperm. CONCLUSION A cryopreservation policy change to include good-quality full and expanded day 6 blastocysts while avoiding to vitrify early blastocysts on day 5 yielded comparable proportions of embryos eligible for vitrification per IVF cycle.
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Affiliation(s)
- Clara Q. Wu
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Canada,Ottawa Fertility Centre, Ottawa, Canada,Ottawa Hospital Research Institute, Ottawa, Canada,
*Corresponding Address:
Department of Obstetrics and GynecologyUniversity of
OttawaOttawaCanada
| | - Molly Campbell
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Doron Shmorgun
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Canada,Ottawa Fertility Centre, Ottawa, Canada
| | | | - Jenna Gale
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Canada,Ottawa Fertility Centre, Ottawa, Canada,Ottawa Hospital Research Institute, Ottawa, Canada
| | - Marie-Claude Léveillé
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Canada,Ottawa Fertility Centre, Ottawa, Canada,Ottawa Hospital Research Institute, Ottawa, Canada
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Crabb S, Dempsey L, Soulis E, Hinsley S, Song Y, Barber J, Frew J, Gale J, Faust G, Brock S, McGovern U, Parikh O, Enting D, Sundar S, Ratnayake G, Lees K, Hussain S, Powles T, Jones R, Tapper W. 1772P Characterisation of a DNA repair deficiency (DRD) biomarker phenotype in metastatic urothelial carcinoma (mUC) within the ATLANTIS clinical trial platform. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1850] [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: 11/26/2022] Open
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7
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Wu C, Nguyen V, Leveille M, Gale J. P-187 Post-thaw embryo quality is not predictive of live birth rates in frozen embryo transfer cycles: a retrospective cohort study. Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study question
To determine whether post-thaw change in embryo quality is associated with live birth outcomes.
Summary answer
Post-thaw embryo morphology is not predictive of live birth rates in single frozen embryo transfer cycles.
What is known already
Embryo quality is typically evaluated via morphological assessment of embryos based on the Gardner criteria. For medical or elective reasons, embryos are commonly frozen for future use through the vitrification process. Research has shown that embryo quality pre-vitrification correlates highly with freeze-thaw survival, implantation, pregnancy, and subsequent live birth rates. Good-quality embryos are therefore more likely to be selected for vitrification. However, it is not unusual to find a decline in the quality of these vitrified embryos upon thawing them for embryo transfer.
Study design, size, duration
We retrospectively identified a patient cohort based out of the Ottawa Fertility Centre in Ottawa, Ontario, Canada, between 2016 and 2020.
Participants/materials, setting, methods
Frozen single embryo transfer (FET) cycles involving good-quality expanded blastocysts deriving from autologous oocytes were selected for inclusion. We compared FET cycles involving good post-thaw embryo quality to those with worsened/poor post-thaw embryo quality. The primary outcome was live birth after FET. Secondary outcomes included rates of positive serum human chorionic gonadotropin, clinical intrauterine pregnancy, miscarriage, and ectopic pregnancy. We fit a multivariate logistic regression model, adjusting for patient and cycle characteristics.
Main results and the role of chance
A total of 962 single FET cycles were analyzed. There were 826 embryos that preserved their pre-vitrification quality post-thaw and 136 embryos that exhibited poorer quality on post-thaw assessment. Baseline characteristics were mostly comparable between the two groups under study. In the multivariate regression model, the adjusted odds of live birth was not significantly different in the group with good post-thaw embryo quality compared to that in the group with worse/poor post-thaw embryo quality (odds ratio [OR] 1.30, 95% confidence interval [CI] 0.86-1.96, p = 0.21). Similarly, no significant associations were found between post-thaw embryo quality and the secondary outcomes of positive BhCG (OR 1.19, 95% CI 0.81-1.75), clinical intrauterine pregnancy (OR 1.29, 95% CI 0.87-1.87), miscarriage (OR 0.97, 95% CI 0.53-1.77), and ectopic pregnancy rates (OR 0.41, 95% CI 0.14-1.24).
Limitations, reasons for caution
Although a multivariate regression model was used to adjust for clinically relevant confounders, there remains the possibility for residual confounding given the observational nature of our study.
Wider implications of the findings
The results of our study suggest that, after adjusting for patient and cycle characteristics, post-thaw embryo quality does not impact live birth outcomes.
Trial registration number
Not applicable
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Affiliation(s)
- C Wu
- University of Ottawa, Department of Obstetrics and Gynecology. Division of Reproductive Endocrinology and Infertility , Ottawa, Canada
- Ottawa Fertility Centre, Reproductive Endocrinology and Infertility , Ottawa, Canada
| | - V Nguyen
- University of Ottawa, Department of Obstetrics and Gynecology , Ottawa, Canada
| | - M.C Leveille
- University of Ottawa, Department of Obstetrics and Gynecology. Division of Reproductive Endocrinology and Infertility , Ottawa, Canada
- Ottawa Fertility Centre, Reproductive Endocrinology and Infertility , Ottawa, Canada
| | - J Gale
- University of Ottawa, Department of Obstetrics and Gynecology. Division of Reproductive Endocrinology and Infertility , Ottawa, Canada
- Ottawa Fertility Centre, Reproductive Endocrinology and Infertility , Ottawa, Canada
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Dhatt A, Rozon C, Gale J, Wu C. P-428 Fertility outcomes following treatment of chronic endometritis: a systematic review and meta-analysis. Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study question
To determine if treatment of chronic endometritis (CE) impacts fertility outcomes
Summary answer
Treatment of CE in women with infertility, recurrent pregnancy loss, or recurrent implantation failure, improves live birth outcomes
What is known already
Chronic endometritis is an inflammatory condition that involves plasma cells invading the endometrial stroma. Prevalence of CE is high among patients with recurrent pregnancy loss (RPL), recurrent implantation failure (RIF), and infertility. Proposed treatment strategies include oral antibiotics, intrauterine antibiotic infusion, platelet-rich plasma, and hysteroscopic surgery, among others. Although treatment-associated CE cure rates have been high, few studies have reported on fertility outcomes following treatment of CE. Previously published systematic reviews have also yielded widely conflicting outcomes regarding the impact of CE treatment on fertility outcomes.
Study design, size, duration
We conducted a systematic search of the literature until late December 2021 across the Cochrane, EMBASE, and Medline databases. We used a DerSimonian and Laird random-effects meta-analysis model for the quantitative analysis.
Participants/materials, setting, methods
Clinical trials, prospective and retrospective observational studies that examined the treatment outcomes of CE were included. Study eligibility assessment, data extraction, and risk of bias assessment were independently performed by two reviewers. Comparisons were made between the groups of treated versus untreated CE, treated versus persistent CE, and between specific treatment strategies. Pooled risk ratios (RR) for the impact of CE treatment on outcomes such as live birth, clinical pregnancy, and miscarriage rates were assessed
Main results and the role of chance
Twelve studies totalling 1,539 women were included in our systematic review (3 randomized controlled trials and 9 observational studies), and 5 studies were included in the quantitative meta-analysis. Patients all had confirmed CE and a history of infertility, RPL, or RIF. Cure rates ranged between 37.2-91.8%. Live birth rate in the treated CE group ranged from 27.1-84.6%, from 16.4-44.4% in the non-treated CE group, and from 6.7-30.8% in the persistent CE group. Clinical pregnancy rate in the treated CE group ranged from 29.3-76.3%, from 11.1-30% in the non-treated CE group, and from 20-42.3% in the persistent CE group. Miscarriage rate in the treated CE group ranged from 6.7-23.8%, from 35.7-55.6% in the non-treated CE group, and from 27.3-66.7% in the persistent CE group. Risk ratio for the pooled effect of successful CE treatment compared to persistent CE on live birth was 2.98 (95% confidence ratio [CI] 1.51-5.91, I2=36.8%), on clinical pregnancy rate was 2.25 (95% CI 1.59-3.18, I2=40.1%), and on miscarriage rate was 0.55 (95% CI 0.28-1.10, I2=0.0%). Insufficient studies compared specific treatment subtypes to allow for any substantive qualitative or quantitative analysis.
Limitations, reasons for caution
Our results are limited by significant between-study heterogeneity in the study design, patient population, and comparisons used. Subgroup analysis by categories of comparisons mitigates some of this heterogeneity
Wider implications of the findings
Adequate treatment of CE significantly improves live birth rates in patients with RPL, RIF, and infertility. Assessment for CE should become part of routine fertility investigations, and resolution of CE must be confirmed prior to initiating fertility treatments.
Trial registration number
not applicable
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Affiliation(s)
- A Dhatt
- University of Ottawa, Faculty of Medicine , Richmond, Canada
| | - C Rozon
- University of Ottawa, Department of Obstetrics and Gynecology , Ottawa, Canada
| | - J Gale
- University of Ottawa, Department of Obstetrics and Gynecology- Division of Reproductive Endocrinology and Infertility , Ottawa, Canada
| | - C Wu
- University of Ottawa, Department of Obstetrics and Gynecology- Division of Reproductive Endocrinology and Infertility , Ottawa, Canada
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Gale J, Lanes A, Corran B, Bacal V, Nguyen V, Shmorgun D, Singh S, Walker M. P-748 Cesarean scar defect does not predict embryo transfer outcomes: A retrospective cohort study. Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study question
Is the presence of a cesarean scar defect associated with live birth outcomes at the time of embryo transfer?
Summary answer
The presence of a cesarean scar defect is not predictive of live birth rates at the time of embryo transfer.
What is known already
Cesarean delivery is associated with subsequent impaired fertility, with lower pregnancy and live birth rates and longer inter-pregnancy intervals, compared to patients who delivered vaginally. Studies exploring pregnancy rates after IVF and embryo transfer also suggest lower pregnancy rates among patients with prior cesarean delivery. A postulated mechanism by which a prior cesarean delivery may impact fertility is the cesarean scar defect, and prior studies have shown a possible association between a scar defect and suboptimal outcomes.
Study design, size, duration
We retrospectively identified a patient cohort based out of the Ottawa Fertility Centre in Ottawa, Ontario, Canada, between 2013 and 2019.
Participants/materials, setting, methods
This retrospective cohort study included 317 patients with a prior cesarean delivery. Embryo transfer outcomes compared between the two groups based on the finding of a cesarean scar defect. The primary outcome was live birth rate, secondary outcomes of positive hCG, clinical intrauterine pregnancy, miscarriage rate. We fit a multivariate log binomial regression model with a priori variables for the primary and secondary outcomes, adjusting for patient and cycle characteristics.
Main results and the role of chance
There was no statistically significant difference in live birth rate among patients with a cesarean scar defect compared to those without, 28.0% vs 29.5% respectively (adjusted RR 0.95, 95% CI 0.68-1.35). There was no statistically significant difference in any of the secondary outcomes. Area of the defect and subgroup analysis of fresh vs frozen embryo transfer did not demonstrate any difference. Secondary analysis of patients with retroverted uterus had significantly lower live birth rates compared to those with an anteverted uterus, 17.7% vs 32.4%, respectively (adjusted RR 0.56, 95% CI 0.34-0.91).
Limitations, reasons for caution
Although a multivariate log binomial model was used to adjust for clinically relevant confounders, there remains the possibility for residual confounding given the observational nature of our study.
Wider implications of the findings
The results of our study suggest that, after adjusting for patient and cycle characteristics, the presence of a cesarean scar defect may not impact live birth outcomes and secondary analysis of the impact of uterine retroversion requires more study.
Trial registration number
Not applicable
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Affiliation(s)
- J Gale
- University of Ottawa, Gynecologic Reproductive Endocrinology and Infertility , Ottawa, Canada
- Ottawa Hospital Research Institute, Medicine , Ottawa, Canada
- Ottawa Fertility Centre, Infertility , Ottawa, Canada
| | - A Lanes
- Bringham and Women’s Hospital, Department of Obstetrics- Gyneology and Reproductive Biology , Boston- MA, U.S.A
| | - B Corran
- University of Ottawa, Department of Obstetrics and Gynecology , Ottawa- Ontario, Canada
| | - V Bacal
- University of Toronto, Mount Sinai Fertility , Toronto- Ontario, Canada
- University of Toronto, Department of Obstetrics and Gynecology , Toronto- Ontario, Canada
| | - V Nguyen
- University of Ottawa, Department of Obstetrics and Gynecology , Ottawa- Ontario, Canada
| | - D Shmorgun
- University of Ottawa, Department of Obstetrics and Gynecology , Ottawa- Ontario, Canada
| | - S.S Singh
- University of Ottawa, Department of Obstetrics and Gynecology , Ottawa- Ontario, Canada
- Ottawa Hospital Research Institute, Epidemiology , Ottawa- Ontario, Canada
| | - M Walker
- University of Ottawa, Department of Obstetrics and Gynecology , Ottawa- Ontario, Canada
- Ottawa Hospital Research Institute, Epidemiology , Ottawa- Ontario, Canada
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10
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Gale J, Singh SS. A Practical Approach to Fertility Considerations in Endometriosis Surgery. Obstet Gynecol Clin North Am 2022; 49:241-256. [DOI: 10.1016/j.ogc.2022.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Tartia AP, Wu CQ, Gale J, Shmorgun D, Léveillé MC. Time-lapse KIDScore Day 5 can be used as a primary marker to predict embryo pregnancy potential in fresh and frozen single embryo transfers. Reprod Biomed Online 2022; 45:46-53. [DOI: 10.1016/j.rbmo.2022.03.019] [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] [Received: 12/16/2021] [Revised: 03/01/2022] [Accepted: 03/22/2022] [Indexed: 10/18/2022]
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Gale J, Magee B, Forsyth-Greig A, Visram H, Jackson A. Oocyte cryopreservation in a transgender man on long-term testosterone therapy: a case report. F S Rep 2021; 2:249-251. [PMID: 34278362 PMCID: PMC8267393 DOI: 10.1016/j.xfre.2021.02.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/25/2021] [Accepted: 02/13/2021] [Indexed: 11/29/2022] Open
Abstract
Objective To report a case of ovarian stimulation for the purposes of oocyte cryopreservation in a transgender man without cessation of long-term testosterone therapy. Design Report of a unique case of fertility preservation through ovarian stimulation and oocyte cryopreservation in a transgender man who had been on testosterone therapy for 18 months before treatment. The patient elected to continue testosterone therapy throughout ovarian stimulation and oocyte retrieval. To our knowledge, there have not been any published reports of patients undergoing oocyte cryopreservation while continuing long-term testosterone therapy. Setting Private fertility clinic with university affiliation. Patients A 20-year-old transgender man undergoing oocyte cryopreservation before gonadectomy. Interventions Fertility preservation through oocyte cryopreservation. Main Outcome Measures This patient had a robust response to ovarian gonadotropin stimulation. Leuprolide acetate was used for final oocyte maturation to minimize ovarian hyperstimulation syndrome risk. Results Cryopreservation of 22 mature oocytes. Conclusions Cryopreservation of mature oocytes is possible for patients on continued long-term testosterone therapy. The impact of long-term testosterone therapy on markers of ovarian reserve, reproductive potential, and long-term reproductive outcomes have yet to be elucidated and further studies are needed in this area.
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Affiliation(s)
- Jenna Gale
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Ontario, Canada.,Ottawa Fertility Centre, Ottawa, Ontario, Canada
| | - Bryden Magee
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Ontario, Canada.,Ottawa Fertility Centre, Ottawa, Ontario, Canada.,Centre for Excellence in Transgender Medicine, West Ottawa Specialty Care, Ottawa, Ontario, Canada
| | - Amanda Forsyth-Greig
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Ontario, Canada
| | - Hasina Visram
- Department of Obstetrics and Gynecology, Queens University, Kingston, Ontario, Canada
| | - Aaron Jackson
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Ontario, Canada.,Ottawa Fertility Centre, Ottawa, Ontario, Canada
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Gandee Z, Joshi S, Wu F, Gale J, Precopio L, Israelyan A, Liu J, Pajka S, Yusvirazi L, Hou P. 226 Emergency Department Hyperoxia Exposure and Mortality. Ann Emerg Med 2020. [DOI: 10.1016/j.annemergmed.2020.09.239] [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: 11/30/2022]
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Joshi S, Gandee Z, Wu F, Gale J, Precopio L, Israelyan A, Liu J, Pajka S, Yusvirazi L, Hou P. 116 Associations of Emergency Department Sedation and Analgesia and Hospital Outcomes in Mechanically Ventilated Patients. Ann Emerg Med 2020. [DOI: 10.1016/j.annemergmed.2020.09.127] [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: 10/23/2022]
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15
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Woolnough B, Jackson A, Leveille MC, Gale J. Grossesse quadrichoriale quadriamniotique après un transfert d'embryon unique planifié. J Obstet Gynaecol Can 2020; 43:1227-1228. [PMID: 32475702 DOI: 10.1016/j.jogc.2020.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Bonnie Woolnough
- Département d'obstétrique et de gynécologie, Université d'Ottawa, Ottawa, Ont
| | - Aaron Jackson
- Département d'obstétrique et de gynécologie, Université d'Ottawa, Ottawa, Ont
| | | | - Jenna Gale
- Département d'obstétrique et de gynécologie, Université d'Ottawa, Ottawa, Ont
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16
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Woolnough B, Jackson A, Leveille MC, Gale J. Quadrachorionic quadramnionic gestation following elective single embryo transfer. J Obstet Gynaecol Can 2020; 43:1225-1226. [PMID: 32473984 DOI: 10.1016/j.jogc.2020.02.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 02/22/2020] [Accepted: 02/24/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Bonnie Woolnough
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, ON
| | - Aaron Jackson
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, ON
| | | | - Jenna Gale
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, ON
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Woolnough B, Shmorgun D, Leveille MC, Sabri E, Gale J. Does omitting teratospermia as a selection criterion for ICSI change pregnancy rates? J Assist Reprod Genet 2020; 37:1895-1901. [PMID: 32449098 DOI: 10.1007/s10815-020-01827-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 05/13/2020] [Indexed: 05/30/2023] Open
Abstract
PURPOSE There is controversy whether teratospermia is associated with poorer IVF outcomes and if ICSI may overcome this deficit. The debate likely lies in study heterogeneity, poor adjustment for confounders, and inter-observer variation in sperm morphology assessment. Given the current literature, a shift in practice was implemented at our center in February 2017, whereby teratospermia was no longer a criterion for ICSI. We hypothesized that, despite decreasing ICSI rates, we would see no change in ART outcomes. METHODS A retrospective study was performed including 1821 couples undergoing IVF/ICSI at a single center from January 2016 to December 2018, divided into cohorts before and after the practice change. The primary outcome of clinical pregnancy and secondary outcomes of fertilization, fertilization failure, good quality blastocyst formation, embryo utilization, positive hCG, and miscarriage rates was compared, adjusting for potential confounders. Subgroup analysis was performed evaluating teratospermia as the only reason for a male factor infertility diagnosis. RESULTS Despite a decrease in ICSI rate of 30.3%, we found no significant difference in clinical intrauterine pregnancy rate, with an adjusted relative risk of 0.93 (0.81, 1.07, P = 0.3008). There were no significant differences in other secondary outcomes after multivariate adjustment. Subgroup analysis for those with male factor infertility due to teratospermia showed no difference in outcomes. CONCLUSION This study concurs with the recent data suggesting that employing ICSI solely for teratospermia is unnecessary. This may allow clinics to decrease ICSI rates without sacrificing success rates, leading to lower cost and risk associated with treatment.
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Affiliation(s)
- Bonnie Woolnough
- Department of Obstetrics and Gynecology, University of Ottawa, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada. .,Ottawa Fertility Centre, 100-955 Green Valley Crescent, Ottawa, ON, K2C 3V4, Canada.
| | - Doron Shmorgun
- Department of Obstetrics and Gynecology, University of Ottawa, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada.,Ottawa Fertility Centre, 100-955 Green Valley Crescent, Ottawa, ON, K2C 3V4, Canada
| | - Marie-Claude Leveille
- Department of Obstetrics and Gynecology, University of Ottawa, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada.,Ottawa Fertility Centre, 100-955 Green Valley Crescent, Ottawa, ON, K2C 3V4, Canada.,Ottawa Hospital Research Institute, 1053 Carling Ave, Ottawa, Ontario, K1Y 4E9, Canada
| | - Elham Sabri
- Ottawa Hospital Research Institute, 1053 Carling Ave, Ottawa, Ontario, K1Y 4E9, Canada
| | - Jenna Gale
- Department of Obstetrics and Gynecology, University of Ottawa, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada.,Ottawa Fertility Centre, 100-955 Green Valley Crescent, Ottawa, ON, K2C 3V4, Canada.,Ottawa Hospital Research Institute, 1053 Carling Ave, Ottawa, Ontario, K1Y 4E9, Canada
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Affiliation(s)
- Jenna Gale
- Division of Reproductive Medicine (Gale, Claman) and Department of Obstetrics and Gynecology (Clancy), University of Ottawa, The Ottawa Hospital, Ottawa, Ont.
| | - Aisling A Clancy
- Division of Reproductive Medicine (Gale, Claman) and Department of Obstetrics and Gynecology (Clancy), University of Ottawa, The Ottawa Hospital, Ottawa, Ont
| | - Paul Claman
- Division of Reproductive Medicine (Gale, Claman) and Department of Obstetrics and Gynecology (Clancy), University of Ottawa, The Ottawa Hospital, Ottawa, Ont
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Clarke NW, Ali A, Ingleby FC, Hoyle A, Amos CL, Attard G, Brawley CD, Calvert J, Chowdhury S, Cook A, Cross W, Dearnaley DP, Douis H, Gilbert D, Gillessen S, Jones RJ, Langley RE, MacNair A, Malik Z, Mason MD, Matheson D, Millman R, Parker CC, Ritchie AWS, Rush H, Russell JM, Brown J, Beesley S, Birtle A, Capaldi L, Gale J, Gibbs S, Lydon A, Nikapota A, Omlin A, O'Sullivan JM, Parikh O, Protheroe A, Rudman S, Srihari NN, Simms M, Tanguay JS, Tolan S, Wagstaff J, Wallace J, Wylie J, Zarkar A, Sydes MR, Parmar MKB, James ND. Corrigendum to Addition of docetaxel to hormonal therapy in low- and high-burden metastatic hormone sensitive prostate cancer: long-term survival results from the STAMPEDE trial: Ann Oncol 2019; 30: 1992-2003. Ann Oncol 2020; 31:442. [PMID: 32067690 PMCID: PMC8929236 DOI: 10.1016/j.annonc.2020.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- N W Clarke
- Department of Urology, The Christie and Salford Royal NHS Foundation Trusts, Manchester.
| | - A Ali
- Genito-Urinary Cancer Research Group, Division of Cancer Sciences, The University of Manchester, Manchester
| | - F C Ingleby
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London; London School of Hygiene and Tropical Medicine, London
| | - A Hoyle
- Department of Urology, The Christie and Salford Royal NHS Foundation Trusts, Manchester
| | - C L Amos
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | | | - C D Brawley
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - J Calvert
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - S Chowdhury
- Guy's and Saint Thomas' NHS Foundation Trust, London
| | - A Cook
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - W Cross
- St James University Hospital, Leeds
| | | | - H Douis
- Department of Radiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham
| | - D Gilbert
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - S Gillessen
- Division of Cancer Sciences, The University of Manchester, Manchester
| | - R J Jones
- Beatson West of Scotland Cancer Centre, University of Glasgow, Glasgow
| | - R E Langley
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - A MacNair
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - Z Malik
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | | | - D Matheson
- Faculty of Education Health and Wellbeing, University of Wolverhampton, Wolverhampton
| | - R Millman
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - C C Parker
- Institute of Cancer Research, Sutton-London; RoyalMarsden NHS Foundation Trust, London
| | - A W S Ritchie
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - H Rush
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - J M Russell
- Institute of Cancer Sciences, Beatson West of Scotland Cancer Centre, Glasgow
| | - J Brown
- University of Sheffield, Sheffield
| | | | - A Birtle
- Lancashire Teaching Hospitals NHS Foundation Trust, Preston
| | - L Capaldi
- Worcestershire Acute Hospitals NHS Trust, Worcester
| | - J Gale
- Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth
| | | | - A Lydon
- Torbay and South Devon NHS Foundation Trust, Torbay
| | | | - A Omlin
- Department of Oncology and Haematology, Kantonsspital, St Gallen, Switzerland
| | - J M O'Sullivan
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast, UK
| | - O Parikh
- East Lancashire Hospitals NHS Trust, Blackburn, UK
| | - A Protheroe
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - S Rudman
- Guy's and Saint Thomas' NHS Foundation Trust, London
| | - N N Srihari
- Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, UK
| | - M Simms
- Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
| | | | - S Tolan
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | - J Wagstaff
- Swansea University College of Medicine, Swansea, UK
| | - J Wallace
- Beatson West of Scotland Cancer Centre, University of Glasgow, Glasgow
| | - J Wylie
- The Christie NHS Foundation Trust, Manchester, UK
| | - A Zarkar
- Heartlands Hospital, Birmingham, UK
| | - M R Sydes
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - M K B Parmar
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - N D James
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
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20
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Clarke NW, Ali A, Ingleby FC, Hoyle A, Amos CL, Attard G, Brawley CD, Calvert J, Chowdhury S, Cook A, Cross W, Dearnaley DP, Douis H, Gilbert D, Gillessen S, Jones RJ, Langley RE, MacNair A, Malik Z, Mason MD, Matheson D, Millman R, Parker CC, Ritchie AWS, Rush H, Russell JM, Brown J, Beesley S, Birtle A, Capaldi L, Gale J, Gibbs S, Lydon A, Nikapota A, Omlin A, O'Sullivan JM, Parikh O, Protheroe A, Rudman S, Srihari NN, Simms M, Tanguay JS, Tolan S, Wagstaff J, Wallace J, Wylie J, Zarkar A, Sydes MR, Parmar MKB, James ND. Addition of docetaxel to hormonal therapy in low- and high-burden metastatic hormone sensitive prostate cancer: long-term survival results from the STAMPEDE trial. Ann Oncol 2019; 30:1992-2003. [PMID: 31560068 PMCID: PMC6938598 DOI: 10.1093/annonc/mdz396] [Citation(s) in RCA: 222] [Impact Index Per Article: 44.4] [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] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND STAMPEDE has previously reported that the use of upfront docetaxel improved overall survival (OS) for metastatic hormone naïve prostate cancer patients starting long-term androgen deprivation therapy. We report on long-term outcomes stratified by metastatic burden for M1 patients. METHODS We randomly allocated patients in 2 : 1 ratio to standard-of-care (SOC; control group) or SOC + docetaxel. Metastatic disease burden was categorised using retrospectively-collected baseline staging scans where available. Analysis used Cox regression models, adjusted for stratification factors, with emphasis on restricted mean survival time where hazards were non-proportional. RESULTS Between 05 October 2005 and 31 March 2013, 1086 M1 patients were randomised to receive SOC (n = 724) or SOC + docetaxel (n = 362). Metastatic burden was assessable for 830/1086 (76%) patients; 362 (44%) had low and 468 (56%) high metastatic burden. Median follow-up was 78.2 months. There were 494 deaths on SOC (41% more than the previous report). There was good evidence of benefit of docetaxel over SOC on OS (HR = 0.81, 95% CI 0.69-0.95, P = 0.009) with no evidence of heterogeneity of docetaxel effect between metastatic burden sub-groups (interaction P = 0.827). Analysis of other outcomes found evidence of benefit for docetaxel over SOC in failure-free survival (HR = 0.66, 95% CI 0.57-0.76, P < 0.001) and progression-free survival (HR = 0.69, 95% CI 0.59-0.81, P < 0.001) with no evidence of heterogeneity of docetaxel effect between metastatic burden sub-groups (interaction P > 0.5 in each case). There was no evidence that docetaxel resulted in late toxicity compared with SOC: after 1 year, G3-5 toxicity was reported for 28% SOC and 27% docetaxel (in patients still on follow-up at 1 year without prior progression). CONCLUSIONS The clinically significant benefit in survival for upfront docetaxel persists at longer follow-up, with no evidence that benefit differed by metastatic burden. We advocate that upfront docetaxel is considered for metastatic hormone naïve prostate cancer patients regardless of metastatic burden.
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Affiliation(s)
- N W Clarke
- Department of Urology, The Christie and Salford Royal NHS Foundation Trusts, Manchester.
| | - A Ali
- Genito-Urinary Cancer Research Group, Division of Cancer Sciences, The University of Manchester, Manchester
| | - F C Ingleby
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London; London School of Hygiene and Tropical Medicine, London
| | - A Hoyle
- Department of Urology, The Christie and Salford Royal NHS Foundation Trusts, Manchester
| | - C L Amos
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | | | - C D Brawley
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - J Calvert
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - S Chowdhury
- Guy's and Saint Thomas' NHS Foundation Trust, London
| | - A Cook
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - W Cross
- St James University Hospital, Leeds
| | | | - H Douis
- Department of Radiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham
| | - D Gilbert
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - S Gillessen
- Division of Cancer Sciences, The University of Manchester, Manchester
| | - R J Jones
- Beatson West of Scotland Cancer Centre, University of Glasgow, Glasgow
| | - R E Langley
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - A MacNair
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - Z Malik
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | | | - D Matheson
- Faculty of Education Health and Wellbeing, University of Wolverhampton, Wolverhampton
| | - R Millman
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - C C Parker
- Institute of Cancer Research, Sutton-London; Royal Marsden NHS Foundation Trust, London
| | - A W S Ritchie
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - H Rush
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - J M Russell
- Institute of Cancer Sciences, Beatson West of Scotland Cancer Centre, Glasgow
| | - J Brown
- University of Sheffield, Sheffield
| | | | - A Birtle
- Lancashire Teaching Hospitals NHS Foundation Trust, Preston
| | - L Capaldi
- Worcestershire Acute Hospitals NHS Trust, Worcester
| | - J Gale
- Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth
| | | | - A Lydon
- Torbay and South Devon NHS Foundation Trust, Torbay
| | | | - A Omlin
- Department of Oncology and Haematology, Kantonsspital, St Gallen, Switzerland
| | - J M O'Sullivan
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast
| | - O Parikh
- East Lancashire Hospitals NHS Trust, Blackburn
| | - A Protheroe
- Oxford University Hospitals NHS Foundation Trust, Oxford
| | - S Rudman
- Guy's and Saint Thomas' NHS Foundation Trust, London
| | - N N Srihari
- Shrewsbury and Telford Hospital NHS Trust, Shrewsbury
| | - M Simms
- Hull and East Yorkshire Hospitals NHS Trust, Hull
| | | | - S Tolan
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | - J Wagstaff
- Swansea University College of Medicine, Swansea
| | - J Wallace
- Beatson West of Scotland Cancer Centre, University of Glasgow, Glasgow
| | - J Wylie
- The Christie NHS Foundation Trust, Manchester
| | | | - M R Sydes
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - M K B Parmar
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - N D James
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham
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De Meijer L, Merlo D, Skibina O, Grobbee EJ, Gale J, Haartsen J, Maruff P, Darby D, Butzkueven H, Van der Walt A. Monitoring cognitive change in multiple sclerosis using a computerized cognitive battery. Mult Scler J Exp Transl Clin 2018; 4:2055217318815513. [PMID: 30559973 PMCID: PMC6293367 DOI: 10.1177/2055217318815513] [Citation(s) in RCA: 6] [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: 07/29/2018] [Revised: 10/11/2018] [Accepted: 11/01/2018] [Indexed: 11/15/2022] Open
Abstract
Background Cognitive monitoring that can detect short-term change in multiple sclerosis is challenging. Computerized cognitive batteries such as the CogState Brief Battery can rapidly assess commonly affected cognitive domains. Objectives The purpose of this study was to establish the acceptability and sensitivity of the CogState Brief Battery in multiple sclerosis patients compared to controls. We compared the sensitivity of the CogState Brief Battery to that of the Paced Auditory Serial Addition Test over 12 months. Methods Demographics, Expanded Disability Status Scale scores, depression and anxiety scores were compared with CogState Brief Battery and Paced Auditory Serial Addition Test performances of 51 patients with relapsing-remitting multiple sclerosis, 19 with secondary progressive multiple sclerosis and 40 healthy controls. Longitudinal data in 37 relapsing-remitting multiple sclerosis patients were evaluated using linear mixed models. Results Both the CogState Brief Battery and the Paced Auditory Serial Addition Test discriminated between multiple sclerosis and healthy controls at baseline (p<0.001). CogState Brief Battery tasks were more acceptable and caused less anxiety than the Paced Auditory Serial Addition Test (p<0.001). In relapsing-remitting multiple sclerosis patients, reaction time slowed over 12 months (p<0.001) for the CogState Brief Battery Detection (mean change -34.23 ms) and Identification (-25.31 ms) tasks. Paced Auditory Serial Addition Test scores did not change over this time. Conclusions The CogState Brief Battery is highly acceptable and better able to detect cognitive change than the Paced Auditory Serial Addition Test. The CogState Brief Battery could potentially be used as a practical cognitive monitoring tool in the multiple sclerosis clinic setting.
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Affiliation(s)
- L De Meijer
- Rijksuniversiteit, The Netherlands.,Erasmus MC Medical Center, The Netherlands
| | - D Merlo
- Eastern Health Clinical Research Unit, Monash University, Australia.,Department of Neuroscience, Monash University, Australia
| | - O Skibina
- Eastern Health Clinical Research Unit, Monash University, Australia.,Department of Neurology, Eastern Health, Australia.,Department of Neurology, Alfred Health, Australia
| | | | | | - J Haartsen
- Eastern Health Clinical Research Unit, Monash University, Australia.,Department of Neurology, Eastern Health, Australia
| | - P Maruff
- Department of Neuroscience, Monash University, Australia
| | - D Darby
- Department of Neurology, Eastern Health, Australia.,Florey Institute for Neuroscience and Mental Health, University of Melbourne, Australia
| | - H Butzkueven
- Eastern Health Clinical Research Unit, Monash University, Australia.,Department of Neuroscience, Monash University, Australia.,Department of Neurology, Eastern Health, Australia.,Department of Neurology, Alfred Health, Australia
| | - A Van der Walt
- Eastern Health Clinical Research Unit, Monash University, Australia.,Department of Neuroscience, Monash University, Australia.,Department of Neurology, Eastern Health, Australia.,Department of Neurology, Alfred Health, Australia.,These authors contributed equally
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Parker C, James N, Brawley C, Clarke N, Attard G, Chowdhury S, Cross W, Dearnaley D, Gilson C, Jones R, Mason M, Millman R, Gillessen S, Eswar C, Gale J, Lester J, Sheehan D, Tran A, Parmar M, Sydes M. Radiotherapy (RT) to the primary tumour for men with newly-diagnosed metastatic prostate cancer (PCa): Survival results from STAMPEDE. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy424.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Gale J, Thompson C, Lortie KJ, Bougie O, Singh SS. Early Discharge after Laparoscopic Hysterectomy: a Prospective Study. Journal of Obstetrics and Gynaecology Canada 2018; 40:1154-1161. [DOI: 10.1016/j.jogc.2017.11.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 11/21/2017] [Accepted: 11/24/2017] [Indexed: 11/26/2022]
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Sydes MR, Spears MR, Mason MD, Clarke NW, Dearnaley DP, de Bono JS, Attard G, Chowdhury S, Cross W, Gillessen S, Malik ZI, Jones R, Parker CC, Ritchie AWS, Russell JM, Millman R, Matheson D, Amos C, Gilson C, Birtle A, Brock S, Capaldi L, Chakraborti P, Choudhury A, Evans L, Ford D, Gale J, Gibbs S, Gilbert DC, Hughes R, McLaren D, Lester JF, Nikapota A, O'Sullivan J, Parikh O, Peedell C, Protheroe A, Rudman SM, Shaffer R, Sheehan D, Simms M, Srihari N, Strebel R, Sundar S, Tolan S, Tsang D, Varughese M, Wagstaff J, Parmar MKB, James ND. Adding abiraterone or docetaxel to long-term hormone therapy for prostate cancer: directly randomised data from the STAMPEDE multi-arm, multi-stage platform protocol. Ann Oncol 2018; 29:1235-1248. [PMID: 29529169 PMCID: PMC5961425 DOI: 10.1093/annonc/mdy072] [Citation(s) in RCA: 175] [Impact Index Per Article: 29.2] [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] [Indexed: 12/20/2022] Open
Abstract
Background Adding abiraterone acetate with prednisolone (AAP) or docetaxel with prednisolone (DocP) to standard-of-care (SOC) each improved survival in systemic therapy for advanced or metastatic prostate cancer: evaluation of drug efficacy: a multi-arm multi-stage platform randomised controlled protocol recruiting patients with high-risk locally advanced or metastatic PCa starting long-term androgen deprivation therapy (ADT). The protocol provides the only direct, randomised comparative data of SOC + AAP versus SOC + DocP. Method Recruitment to SOC + DocP and SOC + AAP overlapped November 2011 to March 2013. SOC was long-term ADT or, for most non-metastatic cases, ADT for ≥2 years and RT to the primary tumour. Stratified randomisation allocated pts 2 : 1 : 2 to SOC; SOC + docetaxel 75 mg/m2 3-weekly×6 + prednisolone 10 mg daily; or SOC + abiraterone acetate 1000 mg + prednisolone 5 mg daily. AAP duration depended on stage and intent to give radical RT. The primary outcome measure was death from any cause. Analyses used Cox proportional hazards and flexible parametric models, adjusted for stratification factors. This was not a formally powered comparison. A hazard ratio (HR) <1 favours SOC + AAP, and HR > 1 favours SOC + DocP. Results A total of 566 consenting patients were contemporaneously randomised: 189 SOC + DocP and 377 SOC + AAP. The patients, balanced by allocated treatment were: 342 (60%) M1; 429 (76%) Gleason 8-10; 449 (79%) WHO performance status 0; median age 66 years and median PSA 56 ng/ml. With median follow-up 4 years, 149 deaths were reported. For overall survival, HR = 1.16 (95% CI 0.82-1.65); failure-free survival HR = 0.51 (95% CI 0.39-0.67); progression-free survival HR = 0.65 (95% CI 0.48-0.88); metastasis-free survival HR = 0.77 (95% CI 0.57-1.03); prostate cancer-specific survival HR = 1.02 (0.70-1.49); and symptomatic skeletal events HR = 0.83 (95% CI 0.55-1.25). In the safety population, the proportion reporting ≥1 grade 3, 4 or 5 adverse events ever was 36%, 13% and 1% SOC + DocP, and 40%, 7% and 1% SOC + AAP; prevalence 11% at 1 and 2 years on both arms. Relapse treatment patterns varied by arm. Conclusions This direct, randomised comparative analysis of two new treatment standards for hormone-naïve prostate cancer showed no evidence of a difference in overall or prostate cancer-specific survival, nor in other important outcomes such as symptomatic skeletal events. Worst toxicity grade over entire time on trial was similar but comprised different toxicities in line with the known properties of the drugs. Trial registration Clinicaltrials.gov: NCT00268476.
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Affiliation(s)
- M R Sydes
- MRC Clinical Trials Unit at UCL, London.
| | | | | | - N W Clarke
- Christie and Royal Salford Hospital, Manchester
| | | | | | - G Attard
- UCL Cancer Institute, University College London, London
| | - S Chowdhury
- Guy's & St Thomas NHS, Foundation Trust, London
| | - W Cross
- St James University Hospital, Leeds, UK
| | - S Gillessen
- Division of Oncology and Hematology, Kantonsspital St. Gallen, St. Gallen; University of Bern, Bern; Swiss Group for Cancer Clinical Research (SAKK), Bern, Switzerland
| | - Z I Malik
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | - R Jones
- Institute of Cancer Sciences, University of Glasgow, Glasgow; Beatson West of Scotland Cancer Centre, University of Glasgow, Glasgow
| | - C C Parker
- Institute of Cancer Research, Sutton; Royal Marsden Hospital, Sutton
| | | | - J M Russell
- Institute of Cancer Sciences, University of Glasgow, Glasgow; Beatson West of Scotland Cancer Centre, University of Glasgow, Glasgow
| | - R Millman
- MRC Clinical Trials Unit at UCL, London
| | - D Matheson
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton
| | - C Amos
- MRC Clinical Trials Unit at UCL, London
| | - C Gilson
- MRC Clinical Trials Unit at UCL, London
| | - A Birtle
- Rosemere Cancer Centre, Royal Preston Hospital, Preston
| | - S Brock
- Dorset Cancer Centre, Poole Hospital, Poole
| | - L Capaldi
- Worcestershire Acute Hospitals NHS Trust, Worcester
| | | | - A Choudhury
- Division of Cancer Sciences, University of Manchester, Manchester; Manchester Academic Health Science Centre, Manchester; Christie Hospital NHS Foundation Trust, Manchester
| | - L Evans
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield
| | - D Ford
- City Hospital, Cancer Centre at Queen Elizabeth Hospital, Birmingham
| | - J Gale
- Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth
| | | | - D C Gilbert
- Sussex Cancer Centre, Royal Sussex County Hospital, Brighton
| | - R Hughes
- Mount Vernon Group, Mount Vernon Hospital, Middlesex
| | | | | | | | - J O'Sullivan
- Centre for Cancer Research and Cell Biology, Queens University Belfast, Belfast; Belfast City Hospital, Belfast
| | - O Parikh
- Lancashire Teaching Hospitals NHS Trust, Preston
| | - C Peedell
- Department of Oncology & Radiotherapy, South Tees NHS Trust, Middlesbrough
| | - A Protheroe
- Oxford University Hospitals NHS Foundation Trust
| | - S M Rudman
- Guy's & St Thomas NHS, Foundation Trust, London
| | - R Shaffer
- Department of Oncology, Royal Surrey County Hospital, Guildford
| | - D Sheehan
- Royal Devon and Exeter Hospital, Exeter
| | - M Simms
- Hull & East Yorkshire Hospitals NHS Trust, Hull
| | - N Srihari
- Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury, UK
| | - R Strebel
- Kantonsspital Graubünden, Chur; Swiss Group for Cancer Clinical Research (SAKK), Bern, Switzerland
| | - S Sundar
- Department of Oncology, Nottingham, University Hospitals NHS Trust, Nottingham
| | - S Tolan
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | - D Tsang
- Southend Hospital, Southend-on-Sea
| | - M Varughese
- Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust
| | - J Wagstaff
- Swansea University College of Medicine, Swansea
| | | | - N D James
- Institute of Cancer and Genomic Sciences, University of Birmingham, Edgbaston, Birmingham, UK
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James N, de Bono J, Spears M, Clarke N, Mason M, Dearnaley D, Ritchie A, Russell M, Gilson C, Jones R, Gillessen S, Matheson D, Aung S, Birtle A, Chowdhury S, Gale J, Malik Z, O'Sullivan J, Parmar M, Sydes M. Adding abiraterone for patients (pts) with high-risk prostate cancer (PCa) starting long-term androgen deprivation therapy (ADT): Outcomes in non-metastatic (M0) patients from STAMPEDE (NCT00268476). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx440.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Sydes M, Mason M, Spears M, Clarke N, Dearnaley D, Ritchie A, Russell M, Gilson C, Jones R, de Bono J, Gillessen S, Millman R, Tolan S, Wagstaff J, Chowdhury S, Lester J, Sheehan D, Gale J, Parmar M, James N. Adding abiraterone acetate plus prednisolone (AAP) or docetaxel for patients (pts) with high-risk prostate cancer (PCa) starting long-term androgen deprivation therapy (ADT): Directly randomised data from STAMPEDE (NCT00268476). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx440.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Hardy LL, Mihrshahi S, Gale J, Drayton BA, Bauman A, Mitchell J. 30-year trends in overweight, obesity and waist-to-height ratio by socioeconomic status in Australian children, 1985 to 2015. Int J Obes (Lond) 2017; 41:76-82. [PMID: 27847388 PMCID: PMC5220161 DOI: 10.1038/ijo.2016.204] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 09/15/2016] [Accepted: 10/23/2016] [Indexed: 01/25/2023]
Abstract
BACKGROUND/OBJECTIVE To report 30-year (1985-2015) prevalence trends in overweight, obesity and abdominal obesity among children by school level and socioeconomic status (SES). SUBJECTS/METHODS Five cross-sectional, population child surveys (age 4-18 years; n=27 808) conducted in 1985-1997-2004-2010-2015 in New South Wales, Australia. Outcomes were prevalence of measured overweight, obesity and waist-to-height ratio (WHtR⩾0.5) by sex, school level (children (primary) and adolescents (high)) and SES tertile. RESULTS In 2015, the prevalences of overweight, obesity and WHtR⩾0.5 in children were 16.4%, 7.0% and 14.6%, respectively, and in adolescents 21.9%, 17.2% and 4.6%, respectively. Obesity prevalence has not significantly changed in children or adolescents since 1997, nor since 2010 (children, P=0.681; adolescents, P=0.21). Overweight has not significantly changed in children since 1997, but has in adolescents since 1985, with a relative increase of 16 percentage points (P<0.001) between 2010 and 2015. WHtR⩾0.5 prevalence has significantly changed since 1985, except in adolescent girls between 2010 and 2015. Between 2010 and 2015 the relative increase in WHtR⩾0.5 was 17 and 40 percentage points in children and adolescent boys, respectively. Significant disparities in prevalence rates between children and adolescents from low and high SES backgrounds began in 2010 for overweight, since 1997 for obesity and since 2004 for WHtR⩾0.5. Differences between SES groups have become larger over the past 18 years. CONCLUSIONS Since 1997, obesity has remained stable, and overweight has stabilized in children, not in adolescents. WHtR⩾0.5 significantly increased between 1985 and 2015, with prevalence rates at each survey around twice the obesity prevalence. Compared with high SES children and adolescents, the risk of overweight, obesity and WHtR⩾0.5 was significantly higher for low SES children and adolescents. The findings are highly relevant to policy makers involved in child obesity prevention interventions and highlight the need for better targeted interventions among children and adolescents from low SES backgrounds, and adolescents in particular.
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Affiliation(s)
- L L Hardy
- Prevention Research Collaboration, Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - S Mihrshahi
- Prevention Research Collaboration, Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - J Gale
- Prevention Research Collaboration, Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - B A Drayton
- NSW Ministry of Health, North Sydney, NSW, Australia
| | - A Bauman
- Prevention Research Collaboration, Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - J Mitchell
- NSW Ministry of Health, North Sydney, NSW, Australia
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Richards J, Gale J, Ding M. Active body, active brain: Quantifying the role of physical activity in preventing dementia. J Sci Med Sport 2017. [DOI: 10.1016/j.jsams.2017.01.213] [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: 11/27/2022]
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Gale J, Thompson C, Lortie K, Bougie O, Singh SS. Planned Early Discharge After Laparoscopic (PEDAL) Hysterectomy Study: A Pilot Prospective Observational Study. J Minim Invasive Gynecol 2016. [DOI: 10.1016/j.jmig.2016.08.140] [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: 10/20/2022]
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Gervasi NM, Scott SS, Aschrafi A, Gale J, Vohra SN, MacGibeny MA, Kar AN, Gioio AE, Kaplan BB. The local expression and trafficking of tyrosine hydroxylase mRNA in the axons of sympathetic neurons. RNA 2016; 22:883-95. [PMID: 27095027 PMCID: PMC4878614 DOI: 10.1261/rna.053272.115] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 03/01/2016] [Indexed: 05/06/2023]
Abstract
Synthesis and regulation of catecholamine neurotransmitters in the central nervous system are implicated in the pathogenesis of a number of neuropsychiatric disorders. To identify factors that regulate the presynaptic synthesis of catecholamines, we tested the hypothesis that the rate-limiting enzyme of the catecholamine biosynthetic pathway, tyrosine hydroxylase (TH), is locally synthesized in axons and presynaptic nerve terminals of noradrenergic neurons. To isolate pure axonal mRNA and protein, rat superior cervical ganglion sympathetic neurons were cultured in compartmentalized Campenot chambers. qRT-PCR and RNA in situ hybridization analyses showed that TH mRNA is present in distal axons. Colocalization experiments with nerve terminal marker proteins suggested that both TH mRNA and protein localize in regions of the axon that resemble nerve terminals (i.e., synaptic boutons). Analysis of polysome-bound RNA showed that TH mRNA is present in polysomes isolated from distal axons. Metabolic labeling of axonally synthesized proteins labeled with the methionine analog, L-azidohomoalanine, showed that TH is locally synthesized in axons. Moreover, the local transfection and translation of exogenous TH mRNA into distal axons facilitated axonal dopamine synthesis. Finally, using chimeric td-Tomato-tagged constructs, we identified a sequence element within the TH 3'UTR that is required for the axonal localization of the reporter mRNA. Taken together, our results provide the first direct evidence that TH mRNA is trafficked to the axon and that the mRNA is locally translated. These findings raise the interesting possibility that the biosynthesis of the catecholamine neurotransmitters is locally regulated in the axon and/or presynaptic nerve terminal.
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Affiliation(s)
- Noreen M Gervasi
- Laboratory of Molecular Biology, Division of Intramural Research Programs, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland 20892, USA
| | - Shane S Scott
- Laboratory of Molecular Biology, Division of Intramural Research Programs, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland 20892, USA
| | - Armaz Aschrafi
- Laboratory of Molecular Biology, Division of Intramural Research Programs, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland 20892, USA
| | - Jenna Gale
- Laboratory of Molecular Biology, Division of Intramural Research Programs, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland 20892, USA
| | - Sanah N Vohra
- Laboratory of Molecular Biology, Division of Intramural Research Programs, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland 20892, USA
| | - Margaret A MacGibeny
- Laboratory of Molecular Biology, Division of Intramural Research Programs, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland 20892, USA
| | - Amar N Kar
- Laboratory of Molecular Biology, Division of Intramural Research Programs, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland 20892, USA
| | - Anthony E Gioio
- Laboratory of Molecular Biology, Division of Intramural Research Programs, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland 20892, USA
| | - Barry B Kaplan
- Laboratory of Molecular Biology, Division of Intramural Research Programs, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland 20892, USA
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Mackey M, Leaver A, Radas A, Shirley D, Chau J, Engelen L, Gale J, Bouvier AL, Bauman A. Do ergonomic and education interventions reduce prolonged occupational sitting? A randomised controlled trial. Physiotherapy 2015. [DOI: 10.1016/j.physio.2015.03.1663] [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: 11/26/2022]
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Schroeder FA, Wang C, Van de Bittner GC, Neelamegam R, Takakura WR, Karunakaran A, Wey HY, Reis SA, Gale J, Zhang YL, Holson EB, Haggarty SJ, Hooker JM. PET imaging demonstrates histone deacetylase target engagement and clarifies brain penetrance of known and novel small molecule inhibitors in rat. ACS Chem Neurosci 2014; 5:1055-62. [PMID: 25188794 PMCID: PMC4198064 DOI: 10.1021/cn500162j] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [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] [Indexed: 02/08/2023] Open
Abstract
![]()
Histone deacetylase (HDAC) enzymes
have been demonstrated as critical
components in maintaining chromatin homeostasis, CNS development,
and normal brain function. Evidence in mouse models links HDAC expression
to learning, memory, and mood-related behaviors; small molecule HDAC
inhibitor tool compounds have been used to demonstrate the importance
of specific HDAC subtypes in modulating CNS-disease-related behaviors
in rodents. So far, no direct evidence exists to understand the quantitative
changes in HDAC target engagement that are necessary to alter biochemistry
and behavior in a living animal. Understanding the relationship between
target engagement and in vivo effect is essential
in refining new ways to alleviate disease. We describe here, using
positron emission tomography (PET) imaging of rat brain, the in vivo target engagement of a subset of class I/IIb HDAC
enzymes implicated in CNS-disease (HDAC subtypes 1, 2, 3, and 6).
We found marked differences in the brain penetrance of tool compounds
from the hydroxamate and benzamide HDAC inhibitor classes and resolved
a novel, highly brain penetrant benzamide, CN147, chronic treatment
with which resulted in an antidepressant-like effect in a rat behavioral
test. Our work highlights a new translational path for understanding
the molecular and behavioral consequences of HDAC target engagement.
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Affiliation(s)
- F. A. Schroeder
- Athinoula
A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts 02129, United States
- Chemical
Neurobiology Laboratory, Departments of Neurology and Psychiatry,
Center for Human Genetic Research, Massachusetts General Hospital, 185
Cambridge Street, Boston, Massachusetts 02114, United States
| | - C. Wang
- Athinoula
A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts 02129, United States
| | - G. C. Van de Bittner
- Athinoula
A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts 02129, United States
| | - R. Neelamegam
- Athinoula
A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts 02129, United States
| | - W. R. Takakura
- Athinoula
A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts 02129, United States
| | - A. Karunakaran
- Athinoula
A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts 02129, United States
| | - H. Y. Wey
- Athinoula
A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts 02129, United States
| | - S. A. Reis
- Chemical
Neurobiology Laboratory, Departments of Neurology and Psychiatry,
Center for Human Genetic Research, Massachusetts General Hospital, 185
Cambridge Street, Boston, Massachusetts 02114, United States
| | - J. Gale
- Stanley
Center for Psychiatric Research, Broad Institute of Harvard and MIT, 7
Cambridge Center, Cambridge, Massachusetts 02142, United States
| | - Y. L. Zhang
- Stanley
Center for Psychiatric Research, Broad Institute of Harvard and MIT, 7
Cambridge Center, Cambridge, Massachusetts 02142, United States
| | - E. B. Holson
- Stanley
Center for Psychiatric Research, Broad Institute of Harvard and MIT, 7
Cambridge Center, Cambridge, Massachusetts 02142, United States
| | - S. J. Haggarty
- Chemical
Neurobiology Laboratory, Departments of Neurology and Psychiatry,
Center for Human Genetic Research, Massachusetts General Hospital, 185
Cambridge Street, Boston, Massachusetts 02114, United States
| | - J. M. Hooker
- Athinoula
A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts 02129, United States
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Abstract
OBJECTIVES To characterise the phenotype of Border terriers suspected to be affected by canine epileptoid cramping syndrome and to identify possible contributing factors. METHODS Owners of Border terriers with suspected canine epileptoid cramping syndrome were invited to complete an online questionnaire. The results of these responses were collated and analysed. RESULTS Twenty-nine Border terriers were included. Most affected dogs had their first episode before 3 years of age (range: 0·2 to 7·0 years). The majority of episodes lasted between 2 and 30 minutes (range: 0·5 to 150 minutes). The most frequent observations during the episodes were difficulty in walking (27 of 29), mild tremor (21 of 29) and dystonia (22 of 29). Episodes most frequently affected all four limbs (25 of 29) and the head and neck (21 of 29). Borborygmi were reported during episodes in 11 of 29 dogs. Episodes of vomiting and diarrhoea occurred in 14 of 29, with 50% of these being immediately before or after episodes of canine epileptoid cramping syndrome (7 of 14). Most owners (26 of 29) had changed their dog's diet, with approximately 50% (14 of 26) reporting a subsequent reduction in the frequency of episodes. CLINICAL SIGNIFICANCE This study demonstrates similarities in the phenotype of canine epileptoid cramping syndrome to paroxysmal dystonic choreoathetosis, a paroxysmal dyskinesia reported in humans. This disorder appears to be associated with gastrointestinal signs in some dogs and appears at least partially responsive to dietary adjustments.
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Affiliation(s)
- V Black
- Davies Veterinary Specialists, Higham Gobion
| | - L Garosi
- Davies Veterinary Specialists, Higham Gobion
| | - M Lowrie
- Davies Veterinary Specialists, Higham Gobion
| | - R J Harvey
- Department of Pharmacology, UCL School of Pharmacy, London
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Muthuramalingam S, Gale J, Bradbury J. Dexrazoxane efficacy for anthracycline extravasation: use in UK clinical practice. Int J Clin Pract 2013; 67:244-9. [PMID: 23409691 DOI: 10.1111/ijcp.12103] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Accepted: 12/04/2012] [Indexed: 11/30/2022] Open
Abstract
Extravasation is recognised as a major complication of administering intravenous chemotherapy treatment. Of the agents involved in extravasation, anthracyclines are associated with the greatest risk to patients because they are vesicant agents, having the potential to cause blistering and ulceration. If not identified and left untreated, anthracycline extravasation can lead to more serious complications such as tissue necrosis and functional impairment. Dexrazoxane (Savene(®) ) is the only licensed antidote for the treatment of anthracycline extravasation and clinical evidence has shown Savene(®) to be highly effective for preventing the need for surgery following anthracycline extravasation, allowing full recovery in the majority of patients. To date, there have been eight published studies reporting a total of 102 cases of Savene(®) use. Here, we review the published data on the efficacy of Savene(®) and present an analysis of 12 UK case studies. All UK oncology centres where Savene(®) has been used to manage anthracycline extravasation were contacted by SpePharm UK, who requested case studies for this publication. All of the cases received, including two from our own experience of using Savene(®) have been included in the analysis.
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Abstract
Recovery-oriented practice, an approach aligned towards the service user perspective, has dominated the mental health care arena. Numerous studies have explored service users' accounts of the purpose, meaning and importance of 'recovery'; however, far less is known about healthcare staff confidence in its application to care delivery. A self-efficacy questionnaire and content analysis of nursing course documents were used to investigate a cohort of community mental health nurses' recovery-oriented practice and to determine the extent to which the current continuing professional development curriculum met their educational needs in this regard. Twenty-three community mental health nurses completed a self-efficacy questionnaire and 28 course documents were analysed. The findings revealed high levels of nurses' confidence in their understanding and ability to apply the recovery model and low levels of confidence were found in areas of social inclusion. The content analysis found only one course document that used the whole term 'recovery model'. The findings suggest a gap in the nurses' perceived ability and confidence in recovery-oriented practice with what is taught academically. Hence, nursing education needs to be more explicitly focused on the recovery model and its application to care delivery.
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Affiliation(s)
- J Gale
- Faculty of Health & Social Care Sciences, Kingston University & St George's University of London, Cranmer Terrace, London, UK
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Gale J. ‘PREMM 1,2,6 MODEL’ as a new gene specific prediction model for Lynch Syndrome: retrospective review of mutation positive cases. Hered Cancer Clin Pract 2012. [PMCID: PMC3327294 DOI: 10.1186/1897-4287-10-s2-a67] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Ordejón P, Artacho E, Cachau R, Gale J, García A, Junquera J, Kohanoff J, Machado M, Sanchez-Portal D, Soler JM, Weht R. Linear Scaling DFT Calculations with Numerical Atomic Orbitals. ACTA ACUST UNITED AC 2011. [DOI: 10.1557/proc-677-aa9.6] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
ABSTRACTWe have recently developed a method to perform Density Functional Theory calculations in systems with a very large number of atoms, which is based on the use of numerical atomic orbitals as basis sets. The method incorporates Order-N techniques both in the calculation of the Kohn-Sham hamiltonian matrix elements and in the solution of the wave functions, which make the CPU time and memory to scale linearly with the number of atoms, allowing calculations in very large system. In this work, we present results on several test systems to show that the approach and the basis sets used with our method are able to provide an accuracy similar to that of other standard DFT techniques.
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Gale J. Potential Energy Surfaces. EPJ Web of Conferences 2011. [DOI: 10.1051/epjconf/20111402002] [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: 11/14/2022] Open
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Gale J. Simulation of the Thermodynamics of surfaces and interfaces. EPJ Web of Conferences 2011. [DOI: 10.1051/epjconf/20111404001] [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: 11/14/2022] Open
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Martin AJ, White S, Onen A, Gale J, Dunlop J, Baker L, Thompson AM, Pharoah PDP, Berg JN. Abstract P3-12-11: Combining Genotype at Low Penetrance Breast Cancer Loci with Family History Risk Leads to Significant Risk Reclassification. Cancer Res 2010. [DOI: 10.1158/0008-5472.sabcs10-p3-12-11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: A significant proportion of women are at increased genetic risk of breast cancer. Mutations in high penetrance genes such as BRCA1 and BRCA2 are only responsible in the minority of cases, with low penetrance polymorphisms in other genes expected to account for the majority of the remaining genetic risk. An increasing number of such low penetrance polymorphisms are being identified, but each polymorphism only contributes a small amount to overall risk. Currently, in clinical practice, women who are at increased risk of breast cancer are identified by their family history, and the role of genetic testing for multifactorial risk remains uncertain. We have taken the population frequency and genotype relative risk information for the 18 most established low penetrance breast cancer risk loci and explored the effect of combining information from these loci, with risk derived from family history. Results: Genotyping at these 18 loci could provide significant risk information for an individual. The top 1% of women in the genotype risk distribution would have a risk of breast cancer of 2.11 times the general population. At this level of risk, they would qualify for breast cancer screening from age 40 according to evidence based guidelines issued by the UK National Institute of Clinical Excellence (NICE). In addition, the top 5% of the population are at 1.67 times risk of breast cancer and would have the same risk at age 40 as a 50 year old at population risk who would qualify for breast screening according to UK and US National Screening Guidelines. To investigate whether low penetrance genotype has greater potential if combined with other risk factors, we used a simple multiplicative model to combine family history risk of cancer derived using BOADICEA with genotype information. Our data suggest that genotype would result in a significant reclassification of individual risk. For example, 10% of women who only had a sister affected with breast cancer at 55 would qualify for additional screening under NICE criteria if genotype were taken into account. Extending this approach with 160 complex family histories from the Tayside family history breast clinic, we have shown that genotyping could result in reclassification and change of management for 19.1% of women being assessed in this clinic, with 12.4% of women moving into a higher risk category, and 6.7% of women moving into a lower category. Discussion: These data suggest that genotyping for low penetrance breast cancer risk loci is clinically relevant, and that it will be more powerful if it can be combined with other established risk factors.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P3-12-11.
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Affiliation(s)
- AJ Martin
- University of Dundee, United Kingdom; Ninewells Hospital and Medical School, Dundee, United Kingdom; University of Cambridge, United Kingdom
| | - S White
- University of Dundee, United Kingdom; Ninewells Hospital and Medical School, Dundee, United Kingdom; University of Cambridge, United Kingdom
| | - A Onen
- University of Dundee, United Kingdom; Ninewells Hospital and Medical School, Dundee, United Kingdom; University of Cambridge, United Kingdom
| | - J Gale
- University of Dundee, United Kingdom; Ninewells Hospital and Medical School, Dundee, United Kingdom; University of Cambridge, United Kingdom
| | - J Dunlop
- University of Dundee, United Kingdom; Ninewells Hospital and Medical School, Dundee, United Kingdom; University of Cambridge, United Kingdom
| | - L Baker
- University of Dundee, United Kingdom; Ninewells Hospital and Medical School, Dundee, United Kingdom; University of Cambridge, United Kingdom
| | - AM Thompson
- University of Dundee, United Kingdom; Ninewells Hospital and Medical School, Dundee, United Kingdom; University of Cambridge, United Kingdom
| | - PDP Pharoah
- University of Dundee, United Kingdom; Ninewells Hospital and Medical School, Dundee, United Kingdom; University of Cambridge, United Kingdom
| | - JN. Berg
- University of Dundee, United Kingdom; Ninewells Hospital and Medical School, Dundee, United Kingdom; University of Cambridge, United Kingdom
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Abstract
Women who gain excessive weight during pregnancy have an increased risk of post-partum obesity, and retention of gestational weight gain (GWG) post birth is a strong predictor of maternal overweight/obesity a decade or more after the birth. The aim of the current review was to identify, and evaluate the effect of key variables designed to modify risk factors for excessive weight gain in pregnant women that have been targeted in interventions over the last decade. The 10 interventions focused primarily on behavioural changes in relation to physical activity and/or to eating. While six studies reported significantly less weight gain in the intervention women, only three showed that women in the intervention were significantly more likely to gain within recommended guidelines. GWG was reduced in only normal-weight, low-income, obese, or overweight women, or not at all. Only one study reported a reduction in GWG in women with body mass indexes spanning the normal, overweight and obese categories. The findings were inconsistent in relation to what factors need to be targeted in intervention programmes to reduce GWG. Consideration of psychological factors relevant to pregnancy, in addition to behavioural changes in relation to eating and physical activity, is suggested for future intervention studies.
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Affiliation(s)
- H Skouteris
- Deakin University, Melbourne, Vic., Australia.
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Daniels C, Sorrhaindo V, Gale J, Schofield S, Tonkopi E. Sci-Fri AM(1): Imaging-05: Setting Local Diagnostic Reference Levels. Med Phys 2009. [DOI: 10.1118/1.3244188] [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: 11/07/2022] Open
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Brock C, Andresen T, Frokjaer JB, Gale J, Arendt‐Nielsen L, Drewes AM. 172 CENTRAL SENSITIZATION — INDUCTION OF RECTAL HYPER‐SENSITIVITY AND ACTIVATION OF DESCENDING INHIBITION FOLLOWING OESOPHAGEAL ACID AND CAPSAICIN INFUSION. Eur J Pain 2009. [DOI: 10.1016/s1090-3801(09)60175-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- C. Brock
- Mech‐Sense, Aalborg Hospital, Aalborg, Denmark
| | - T. Andresen
- Mech‐Sense, Aalborg Hospital, Aalborg, Denmark
| | | | - J. Gale
- Pfizer, Sandwich, Kent, United Kingdom
| | - L. Arendt‐Nielsen
- Center for Sensory‐Motor Interaction, Aalborg University, Aalborg, Denmark
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Brock C, Nissen TD, Gravesen FH, Frøkjaer JB, Omar H, Gale J, Gregersen H, Svendsen O, Drewes AM. Multimodal sensory testing of the rectum and rectosigmoid: development and reproducibility of a new method. Neurogastroenterol Motil 2008; 20:908-18. [PMID: 18482255 DOI: 10.1111/j.1365-2982.2008.01126.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Evaluation of rectal and rectosigmoid sensation is important in basic, clinical and pharmacological studies. New methods to evoke and assess multimodal (electrical, thermal and mechanical) experimental pain of the upper gut activate distinct pathways and mimics clinical pain. The aims of the current study were to characterize the sensory response and reproducibility to multimodal stimulation of rectum and the rectosigmoid. A multimodal rectal probe was developed. Mucosal electrostimulation was delivered at the recto-sigmoid junction. In Rectum, impedance planimetry was used for measurement of cross-sectional area (CSA) during distension. Circulation of water within the bag at either 4 or 60 degrees C was applied for thermal stimulation. The method was tested in 12 healthy volunteers (six men mean age 32 years) on two subsequent days. Mechanical and sensory responses and referred pain areas were assessed. Stimulation with electrical, thermal and mechanical modalities resulted in different sensory perceptions. The relationship between stimulus intensity and sensory response was linear for all modalities. Sensory response to different modalities did not differ between investigation days (all P-values > 0.1). Approximately 75% of subjects felt referred pain in distinct skin locations. Between-days reproducibility was good for all modalities [intra-class correlation (ICC) > or = 0.6]. At sensory threshold, CSA showed best reproducibility (ICC > or = 0.9). At pain detection threshold stretch ratio, CSA and electrostimulation showed best reproducibility (ICC = 1.0; 0.9; 0.9). The present model was easily implemented, robust and showed good reproducibility. It can be used to study pathophysiology or pharmacological interventions in healthy controls and in patients with diseases involving the distal hindgut.
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Affiliation(s)
- C Brock
- Center for Visceral Biomechanics and Pain, Department of Gastroenterology, Aalborg Hospital, Aalborg, Denmark
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Karanjia R, Eng KT, Gale J, Sharma S, Hove MWT. Electrophysiological effects of intravitreal Avastin (bevacizumab) in the treatment of exudative age-related macular degeneration. Br J Ophthalmol 2008; 92:1248-52. [DOI: 10.1136/bjo.2008.138800] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [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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Tutuian R, Mainie I, Allan R, Hargreaves K, Agrawal A, Freeman J, Gale J, Castell DO. Effects of a 5-HT(4) receptor agonist on oesophageal function and gastro-oesophageal reflux: studies using combined impedance-manometry and combined impedance-pH. Aliment Pharmacol Ther 2006; 24:155-62. [PMID: 16803614 DOI: 10.1111/j.1365-2036.2006.02968.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND 5-HT(4) receptor agonists are used as promotility agents of the stomach, small and large intestine. There is limited information on the influence of 5-HT(4) receptor agonists on oesophageal function and gastro-oesophageal reflux. AIM To evaluate the effects of tegaserod, a 5-HT(4) agonist on oesophageal function using impedance-manometry and postprandial reflux using impedance-pH monitoring. METHODS Twenty healthy volunteers were enrolled in a double-blind randomized three-period crossover placebo-controlled study. Impedance-manometry and impedance-pH monitoring after a refluxogenic meal were performed at baseline and after 2 days of dosing with tegaserod 6 mg b.d. or placebo. Multichannel intraluminal impedance-EM recorded pressure and bolus transit data during standardized swallows. Multichannel intraluminal impedance-pH monitoring recorded the number of 2-h postprandial acid and non-acid reflux episodes. RESULTS We found no significant difference in distal oesophageal amplitude when subjects received placebo (median 94.5; range: 53-243 mmHg) or tegaserod (93.6; 43-216 mmHg). Bolus transit time was similar during dosing with placebo (7.1; 5.3-9.4 s) and tegaserod (7.2; 5.9-11.1 s). We observed similar numbers of acid and non-acid reflux episodes during dosing with placebo (5; 0-15 and 3; 0-18, respectively) and tegaserod (2; 0-11 and 4; 0-19, respectively). CONCLUSION Tegaserod, a 5-HT(4) receptor agonist does not change oesophageal motility and gastro-oesophageal reflux parameters in healthy volunteers.
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Affiliation(s)
- R Tutuian
- Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, SC 29425, USA.
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50
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Abstract
The gating-spring theory of hair cell mechanotransduction channel activation was first postulated over twenty years ago. The basic tenets of this hypothesis have been reaffirmed in hair cells from both auditory and vestibular systems and across species. In fact, the basic findings have been reproduced in every hair cell type tested. A great deal of information regarding the structural, mechanical, molecular and biophysical properties of the sensory hair bundle and the mechanotransducer channel has accumulated over the past twenty years. The goal of this review is to investigate new data, using the gating spring hypothesis as the framework for discussion. Mechanisms of channel gating are presented in reference to the need for a molecular gating spring or for tethering to the intra- or extracellular compartments. Dynamics of the sensory hair bundle and the presence of motor proteins are discussed in reference to passive contributions of the hair bundle to gating compliance. And finally, the molecular identity of the channel is discussed in reference to known intrinsic properties of the native transducer channel.
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Affiliation(s)
- A J Ricci
- Neuroscience Center, Louisiana State University, New Orleans, LA 70112, USA.
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