BD SurePath Direct to Slide (DTS) cervical cytology: Migrating the benefits of liquid-based cytology to low-resource settings

OBJECTIVES

The benefits of liquid-based cytology (LBC) in routine cervical cancer screening are often associated with the availability of instrumented platforms and economic considerations. A low-cost alternative to LBC in low-volume settings remains an unmet need.

METHODS

A multisite evaluation of the BD SurePath (SurePath) LBC Direct to Slide (DTS) method was conducted. The DTS preparations were evaluated across 3 sites. Cytology features for DTS preparation included predetermined thresholds for total cellularity, cell distribution, cellular preservation, and stain quality. Rare event detection was evaluated using SiHa cells spiked into pools from negative cytology specimens. Concordance between Bethesda classification results was evaluated for SurePath LBC and DTS methods using routinely collected SurePath specimens in a split-sample study design.

RESULTS

The DTS specimens met criteria for total cellularity, cell distribution, cellular preservation, and stain quality in more than 98% of all cases. Rare event detection was observed with an average detection of 5 SiHa cells per 2 mL of specimen. Concordant cervical cytology classifications were observed between SurePath LBC and DTS methods.

CONCLUSIONS

The results demonstrate that the DTS process is suitable for routine cervical cytology evaluation. The procedure is reproducible and detected abnormal cervical cells in concordance with standard SurePath LBC preparation.

National audit of non-melanoma skin cancer excisions performed by plastic surgery in the UK

A national, multi-centre audit of non-melanoma skin cancer excisions by plastic surgery.

P-670 Phytoestrogen concentration in women’s urine and follicular fluid are associated with better IVF outcomes in euploid single embryo transfer cycles

Study question

What is phytoestrogen exposure impact on the reproductive outcomes of women undergoing IVF treatment?

Summary answer

Increased urinary and follicular fluid phytoestrogen concentration were associated with better IVF outcomes.

What is known already

The impact and safety of phytoestrogens, plant-derived isoflavones with estrogenic activity predominantly present in soy, on female reproductive health and on IVF outcomes continues to be hotly debated. Numerous studies suggest healthy benefits of phytoestrogen consumption: protection against reprotoxic substances, reductions in breast and other cancers, fibroids, menopausal symptoms, cardiovascular disease, inflammation, and metabolic syndrome and obesity. However, many studies suggest a harmful effect due to the endocrine-disruptor properties of phytoestrogens in both male and female reproductive tissues. Its impact on IVF treatments success is still understudied.

Study design, size, duration

60 women attending IVI-RMA New Jersey undergoing IVF with single-embryo transfer (SET) of euploid good-quality blastocyst after PGT analysis were recruited. Patients underwent PGT-SET cycles following standard protocols. Concentrations of two phytoestrogens (daidzein and genistein) were measured in follicular fluid (FF) and urine collected at oocyte pick-up (UOP) and urine collected at transfer day (UT). These measurements were correlated with IVF clinical outcomes.

Participants/materials, setting, methods

Participants were aged 18-42 years old 18.5-29.9 kg/m2 BMI. Measure of both phytoestrogens’ concentration in follicular fluid and urine samples collected at two different time-points was performed by UPLC-MSMS, with internal standards. Urine phytoestrogen concentrations were normalized by creatinine, measured by Jaffe reaction. Generalized linear models were employed to explore IVF outcomes association, estimated as percentile 20th to 80th increase (95% confidence intervals), among log-transformed phytoestrogen concentration. Both unadjusted and age-BMI-adjusted models were applied.

Main results and the role of chance

In fully adjusted models, higher sum of phytoestrogen concentration in follicular fluid (FF) were significantly associated with higher estradiol at hCG [1.31 (1.04, 1.65), p = 0.023]; whereas the sum of creatinine-corrected phytoestrogens measured in oocyte pick-up urine (UOP) were significantly associated with higher MII oocytes number [1.29 (1.07, 1.56), p = 0.008] and higher fertilized oocytes number [1.34 (1.10, 1.64), p = 0. 004]. Regarding clinical IVF outcomes, in fully adjusted models a higher follicular fluid and oocyte pick-up urine phytoestrogens concentration was significantly associated with higher implantation ratio [8.60 (1.09, 68.03), p = 0. 023] for FF, and [5.01 (0.96, 26.21), p = 0. 05] for UOP; higher clinical pregnancies ratio [5.58 (1.31, 23.73), p = 0.017] for FF, and [3.25 (0.99, 10.63), p = 0.045] for UOP; higher live newborns ratio [5.58 (1.31, 23.73), p = 0.017] for FF, and [3.25 (0.99, 10.63), p = 0.045] for UOP; and higher number of women with live newborns among those who started treatment [4.29 (1.28, 14.38), p = 0.016] for FF, and [2.83 (0.99, 8.07), p = 0.047] for UOP.

Limitations, reasons for caution

Further studies are needed to confirm this association in other populations, including the measurement of other estrogenic isoflavones and its metabolites.

Wider implications of the findings

This is the first work evaluating the association between phytoestrogens concentrations in different biofluids and IVF reproductive outcomes. Our results, using an euploid SET, suggest a beneficial effect of phytoestrogen consumption in women undergoing IVF treatment, further studies are needed to assess the benefit of phytoestrogen supplementation on IVF outcomes.

Trial registration number

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Men's health promotion in waiting rooms: an observational study

Thesis Statement

Men experience poorer health outcomes than females and gender specific targeted health promotion needs to adequately address this gender bias.

Methodology

This prospective observational study audited all printed health promotional materials in all health facility waiting rooms within a defined geographic region. A total of 24 sites were surveyed which included general practice centres, community health centres and hospitals. The surveyed health literature included posters, brochures, and booklets.

Results

There were 1143 health materials audited across the sites. Of these, 3.15% (n = 36) were male-specific literature, 15.31% (n = 175) were female specific health literature and 81.54% (n = 932) were gender neutral. Literature which had a gendered focus was overwhelmingly female to male with a ratio of approximately 5:1.

Conclusions and Implications

This research highlighted that despite the known outcomes of lower male life expectancy and higher burden of disease, male specific literature is significantly under-represented within health facility waiting spaces. There remains potential for health clinicians to provide targeted male health education and thereby improve male health literacy.

Key messages

Men's health both within Australia and globally remains under-represented despite lower health expectancy and higher burden of disease. Health facilities ought to actively control the health promotion messaging to vulnerable population groups.

Posterior urethral valves: Metabolic consequences in a cohort of patients

BACKGROUND

Despite the improvements in diagnosis and management of posterior urethral valves (PUVs), about one third of patients develop chronic kidney disease (CKD). Children with PUVs might have abnormal calcium, phosphorus, vitamin D and parathyroid hormone levels, which could affect their bone growth and overall health.

OBJECTIVE

The aim was to determine the relationship between kidney function, vitamin D deficiency and secondary hyperparathyroidism in children with PUVs.

PATIENTS AND METHODS

Sixty-four children with PUVs were followed for a period of 3.64 ± 2.50 years after their initial presentation and management. Their laboratory parameters were compared with 20 age-, gender- and race-matched children in a control group, including: serum calcium, phosphorus, intact parathyroid hormone (iPTH), 25-hydroxyvitamin D levels, and kidney function.

RESULTS

Children with PUVs had significantly lower estimated kidney function (P = 0.006) and vitamin D levels (P < 0.001) and higher iPTH levels (P = 0.042). There were no significant between-group differences in serum calcium, phosphorus, alkaline phosphatase, sodium, potassium, and bicarbonate levels. There was a strong correlation between the degree of vitamin D deficiency and hyperparathyroidism and the degree of kidney dysfunction (r = 0.52 and -0.52, respectively) in the PUV group. On a multivariate analysis, the kidney dysfunction was the only independent predictor of vitamin D deficiency (ρ = 0.271, P < 0.001), while kidney dysfunction, serum calcium and alkaline phosphatase were independent predictors for hyperparathyroidism (ρ = 0.925, P<0.001, ρ = 0.933, P<0.001 and ρ = 0.913, P < 0.001, respectively).

DISCUSSION

The prevalence of CKD in children with PUVs ranges from 30 to 60%. Patients with CKD are more likely to have vitamin D deficiency and display more-prominent hyperparathyroidism. Compared with a control group with normal kidney function, the present cohort had lower 25-hydroxyvitamin D and higher iPTH serum levels. Abnormal kidney function was a major predictor for both serum levels. In this cohort, there were no significant differences in serum calcium and phosphorus between children with PUVs and the control group, and also between those with and without CKD. On the contrary, vitamin D level decreased early in the disease and progressively declined thereafter, while iPTH was the opposite. These findings were comparable to previous studies. This study had some limitations because it was a single center cross-sectional non-randomized study. However, the findings in this study can be extrapolated to children with PUVs and CKD from other origins because the unit is considered as a referral center in the Middle East region.

CONCLUSION

Abnormal kidney function, vitamin D deficiency, and secondary hyperparathyroidism are prevalent in children with PUVs. Kidney function is the main determinant of vitamin D and parathyroid hormone levels. Efforts should be directed toward managing CKD, and controlling vitamin D deficiency and hyperparathyroidism in children after ablation of PUV.

Stroke physician versus stroke neurologist: can anyone thrombolyse?

BACKGROUND/AIM

The aim of this study is to compare the outcomes of thrombolysis under standard clinical settings between subjects treated by a stroke neurologist versus those treated by a non-neurologist stroke physician.

METHODS

Single-centre, observational cohort study of subjects thrombolysed in a calendar year, stratified according to the physician type authorising thrombolysis. Endpoints measured include proportion of subjects with symptomatic intracranial haemorrhage, door-to-needle time, change in National Institute of Health Stroke Scale and discharge destination.

RESULTS

Forty-nine subjects with a mean age 76 ± 16 years underwent thrombolysis, 21 were under the care of a stroke neurologist and 28 by a non-neurologist stroke physician. No symptomatic intracranial haemorrhages were observed. There was no difference in terms of door-to-needle time, proportion of individuals with haemorrhagic transformation, mortality or discharge destination between the two groups.

CONCLUSION

Due to the single-centre, observational nature of this study, the equivalent outcomes between those thrombolysed by a stroke neurologist versus those thrombolysed by a stroke physician must be interpreted with caution pending further studies. Nevertheless, in the current setting, no signal for harm has been detected. This study is unique as it is the first to our knowledge comparing outcomes between a neurologist and non-neurologist following thrombolysis.

153. COMBINATION METHOTREXATE AND EPIDERMAL GROWTH FACTOR RECEPTOR INHIBITION AS A NOVEL MEDICATION-BASED CURE OF ECTOPIC PREGNANCIES

Ectopic pregnancies are serious gynaecological emergencies that can cause fatal haemorrhage. Most are treated surgically. Given the placenta is heavily reliant on Epidermal Growth Factor Receptor (EGFR) signaling, we set out to develop a medication-based treatment of ectopics using combination gefitinib (EGFR inhibitor) and methotrexate (folate antagonist). Both drugs are well tolerated and available in tablet form. We used in vitro and in vivo approaches to test the ability of gefitinib and methotrexate to regress placental tissue, and to explore molecular mechanisms. In vitro assays included immunohistochemistry (EGFR staining) western blot (EGFR phosphorylation), cell viability assays (Cell-Titre Blue, LDH cytotoxicity assay, xCELLigence system), apoptosis assays (PCR, FACS of M30 antibody) and The Bioplex Platform (phosphorylation of the EGFR pathway). JEG-3 xenografts were used to assess regression of placental tissue in vivo, where serum hCG was also measured (ELISA). EGFR was highly expressed in placentae from ectopic pregnancies. Combination treatment was supra-additive in inducing cell death of placental tissue in vitro, with >70% cell death by 48 hours (Syncytialised BeWos, JEG-3 and 1st trimester trophoblast). This supra-additive effect was demonstrated in both end point assays (cell viability) and regular monitoring using The xCELLigence system. Gefitinib potently blocks EGFR phosphorylation in placental tissues in vitro (Western blot). Both drugs may be converging to inhibit Akt phosphorylation (Bioplex analysis). Combination treatment increases apoptosis (FACS of M30 antibody). In vivo, Gefitinib or MTX as single agents induced significant decrease in xenograft tumour volume in a dose dependent manner (n ≤ 5 mice per treatment). However, combining these drugs was supra-additive in decreasing xenograph tumour volume and weight. Serum hCG in mice was lowest with combination treatment. Combination gefitinib and methotrexate potently regresses placental tissue. It may be a novel therapeutic approach to cure ectopic pregnancies, potentially replacing surgery with tablets.