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Baquero F, Pérez-Cobas AE, Aracil-Gisbert S, Coque TM, Zamora J. Selection versus transmission: Quantitative and organismic biology in antibiotic resistance. Infect Genet Evol 2024; 121:105606. [PMID: 38768878 DOI: 10.1016/j.meegid.2024.105606] [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] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 05/12/2024] [Accepted: 05/17/2024] [Indexed: 05/22/2024]
Abstract
We aimed to determine the importance of selection (mostly dependent on the anthropogenic use of antimicrobials) and transmission (mostly dependent on hygiene and sanitation) as drivers of the spread of antibiotic-resistant bacterial populations. The first obstacle to estimating the relative weight of both independent variables is the lack of detailed quantitative data concerning the number of bacterial cells, potentially either pathogenic or harmless, and bacterial species exposed to antimicrobial action in the microbiotas of specific environments. The second obstacle is the difficulty of considering the relative importance of the transmission and selection exerting their combined effects on antibiotic resistance across eco-biological levels. As a consequence, advances are urgently required in quantitative biology and organismic biology of antimicrobial resistance. The absolute number of humans exposed to antibiotics and the absolute number of potentially pathogenic and commensal bacteria in their microbiomes should influence both the selection and transmission of resistant bacterial populations. The "whole Earth" microbiome, with astonishingly high numbers of bacterial cells and species, which are also exposed to anthropogenic antimicrobials in various biogeographical spaces, shapes the antibiotic resistance landscape. These biogeographical spaces influence various intensities of selection and transmission of potentially pathogenic bacteria. While waiting for more precise data, biostatistics analysis and mathematical or computational modeling can provide proxies to compare the influence of selection and transmission in resistant bacteria. In European countries with lower sanitation levels, antibiotic consumption plays a major role in increasing antibiotic resistance; however, this is not the case in countries with high sanitation levels. Although both independent variables are linked, their relative influence on the level of antibiotic resistance varies according to the particular location. Therefore, interventions directed to decrease antibiotic resistance should be designed "a la carte" for specific locations with particular ecological conditions, including sanitation facilities.
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Affiliation(s)
- F Baquero
- Department of Microbiology, Ramón y Cajal University Hospital, Ramón y Cajal Institute for Health Research (IRYCIS), Madrid, Spain; Center for Biomedical Research in Epidemiology and Public Health Network (CIBERESP-Group 33), Madrid, Spain.
| | - A E Pérez-Cobas
- Department of Microbiology, Ramón y Cajal University Hospital, Ramón y Cajal Institute for Health Research (IRYCIS), Madrid, Spain; Center for Biomedical Research in Infectious Diseases Network (CIBERINFEC), Madrid, Spain
| | - S Aracil-Gisbert
- Department of Microbiology, Ramón y Cajal University Hospital, Ramón y Cajal Institute for Health Research (IRYCIS), Madrid, Spain; Center for Biomedical Research in Infectious Diseases Network (CIBERINFEC), Madrid, Spain
| | - T M Coque
- Department of Microbiology, Ramón y Cajal University Hospital, Ramón y Cajal Institute for Health Research (IRYCIS), Madrid, Spain; Center for Biomedical Research in Infectious Diseases Network (CIBERINFEC), Madrid, Spain
| | - J Zamora
- Clinical Biostatistics Unit, Ramón y Cajal University Hospital, and Ramón y Cajal Institute for Health Research (IRYCIS) Madrid, Spain; Center for Biomedical Research in Epidemiology and Public Health Network (CIBERESP-Group 42), Madrid, Spain; Institute of Metabolism and Systems Research, Biostatistics in Maternal and Perinatal Health, University of Birmingham, UK
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Ferrández Infante A, Novella Arribas B, Khan KS, Zamora J, Jurado López AR, Fragoso Pasero M, Suárez Fernández C. Obesity and female sexual dysfunctions: A systematic review of prevalence with meta-analysis. Semergen 2023; 49:102022. [PMID: 37331210 DOI: 10.1016/j.semerg.2023.102022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 05/22/2023] [Accepted: 05/24/2023] [Indexed: 06/20/2023]
Abstract
Obesity represents a major global health challenge. Female sexual dysfunctions have a negative impact on quality of life and overall health balance. A higher rate of female sexual dysfunctions in obese women has been suggested. This systematic review summarized the literature on female sexual dysfunction prevalence in obese women. The review was registered (Open Science Framework OSF.IO/7CG95) and a literature search without language restrictions was conducted in PubMed, Embase and Web of Science, from January 1990 to December 2021. Cross-sectional and intervention studies were included, the latter if they provided female sexual dysfunction rate data in obese women prior to the intervention. For inclusion, studies should have used the female sexual function index or its simplified version. Study quality was assessed to evaluate if female sexual function index was properly applied using six items. Rates of female sexual dysfunctions examining for differences between obese vs class III obese and high vs low quality subgroups were summarized. Random effects meta-analysis was performed, calculating 95% confidence intervals (CI) and examining heterogeneity with I2 statistic. Publication bias was evaluated with funnel plot. There were 15 relevant studies (1720 women participants in total with 153 obese and 1567 class III obese women). Of these, 8 (53.3%) studies complied with >4 quality items. Overall prevalence of female sexual dysfunctions was 62% (95% CI 55-68%; I2 85.5%). Among obese women the prevalence was 69% (95% CI 55-80%; I2 73.8%) vs 59% (95% CI 52-66%; I2 87.5%) among those class III obese (subgroup difference p=0.15). Among high quality studies the prevalence was 54% (95% CI 50-60%; I2 46.8%) vs 72% (95% CI 61-81%; I2 88.0%) among low quality studies (subgroup difference p=0.002). There was no funnel asymmetry. We interpreted that the rate of sexual dysfunctions is high in obese and class III obese women. Obesity should be regarded as a risk factor for female sexual dysfunctions.
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Affiliation(s)
- A Ferrández Infante
- Coordinator of the Primary Care Physicians Spanish Society (SEMERGEN) Sexology Working Group, Guadarrama Continuity Care Center, 28440 Madrid, Spain.
| | - B Novella Arribas
- Grupo de Investigación 49, Instituto de Investigación del Hospital Universitario de La Princesa, Foundation for Biomedical Research and Innovation in Primary Care of the Community of Madrid (FIIBAP), 28006 Madrid, Spain
| | - K S Khan
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain; Department of Preventive Medicine and Public Health, University of Granada, 18016 Granada, Spain
| | - J Zamora
- Head of the Clinical Biostatistics Unit, Hospital Ramón y Cajal, IRYCIS, 28034 Madrid, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
| | - A R Jurado López
- Member of the Primary Care Physicians Spanish Society (SEMERGEN) Sexology Working Group, President of the European Institute of Sexology, 29602 Marbella, Spain
| | - M Fragoso Pasero
- Biostatistician, Grupo de Investigación 49, Instituto de Investigación del Hospital Universitario de La Princesa, Foundation for Biomedical Research and Innovation in Primary Care of the Community of Madrid (FIIBAP), 28006 Madrid, Spain
| | - C Suárez Fernández
- Head of the Internal Medicine Service of the Hospital Universitario de La Princesa, 28006 Madrid, Spain
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Lumbreras-Fernández B, Vicente Bártulos A, Fernandez-Felix BM, Corres González J, Zamora J, Muriel A. Improvement in the management of suspected acute aortic syndrome in the emergency room through a clinical algorithm and study of predictive factors. Radiologia (Engl Ed) 2023; 65:423-430. [PMID: 37758333 DOI: 10.1016/j.rxeng.2022.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 03/15/2022] [Indexed: 10/03/2023]
Abstract
BACKGROUND AND OBJECTIVE Acute aortic syndrome (AAS) is uncommon and difficult to diagnose, with great variability in clinical presentation. To develop a computerized algorithm, or clinical decision support system (CDSS), for managing and requesting imaging in the emergency department, specifically computerized tomography of the aorta (CTA), when there is suspicion of AAS, and to determine the effect of implementing this system. To determine the factors associated with a positive radiological diagnosis that improve the predictive capacity of CTA findings. MATERIALS AND METHODS After developing and implementing an evidence-based algorithm, we studied suspected cases of AAS. Chi-squared test was used to analyze the association between the variables included in the algorithm and radiological diagnosis, with 3 categories: no relevant findings, positive for AAS, and alternative diagnoses. RESULTS 130 requests were identified; 19 (14.6%) had AAS and 34 (26.2%) had a different acute pathology. Of the 19 with AAS, 15 had been stratified as high risk and 4 as intermediate risk. The probability of AAS was 3.4 times higher in patients with known aortic aneurysm (P = .021, 95% CI 1.2-9.6) and 5.1 times higher in patients with a new aortic regurgitation murmur (P = .019, 95% CI 1.3-20.1). The probability of having an alternative severe acute pathology was 3.2 times higher in patients with hypotension or shock (P = .02, 95% CI 1.2-8.5). CONCLUSION The use of a CDSS in the emergency department can help optimize AAS diagnosis. The presence of a known aortic aneurysm and new-onset aortic regurgitation were shown to significantly increase the probability of AAS. Further studies are needed to establish a clinical prediction rule.
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Affiliation(s)
| | - A Vicente Bártulos
- Servicio de Radiología de Urgencias, Hospital Universitario Ramón y Cajal, Madrid, Centro de Investigación Biomédica en Red Enfermedades respiratorias (CIBERES), Madrid, Spain
| | - B M Fernandez-Felix
- Unidad de Bioestadística Clínica, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - J Corres González
- Servicio de Urgencias, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - J Zamora
- Unidad de Bioestadística Clínica, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, España, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom
| | - A Muriel
- Unidad de Bioestadística Clínica, Hospital Universitario Ramón y Cajal, IRYCIS, CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Departamento de Enfermería de la Universidad de Alcalá, Madrid, Spain
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González-Campo L, Vicente-Bártulos A, Gaetano-Gil A, Estelles-Lerga P, Pecharromán-de Las Heras I, Zamora J. Coronary computed tomography in emergencies: The importance of the radiologist's experience. Radiologia (Engl Ed) 2023; 65:298-306. [PMID: 37516483 DOI: 10.1016/j.rxeng.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 07/19/2021] [Indexed: 07/31/2023]
Abstract
INTRODUCTION Incorporating coronary computed tomography angiography (CTA) in the hospital workup for suspected acute coronary syndrome requires appropriate skills for interpreting this imaging test. Radiologists' skills can affect the interobserver agreement in evaluating these studies. OBJECTIVE To determine the interobserver agreement according to radiologists' experience in the interpretation of coronary CTA studies done in patients who present at the emergency department with acute chest pain and low-to-intermediate probability of acute coronary syndrome. MATERIALS AND METHODS We studied the interobserver agreement in the urgent evaluation of coronary CTA studies in which CAD-RADS was used to register the findings. We created pairs of observers among a total of 8 assessors (4 attending radiologists and 4 radiology residents). We used the kappa coefficient to estimate the overall concordance and the concordance between subgroups according to their experience. RESULTS The agreement was substantial between experienced radiologists and residents (k=0.627; 95%CI: 0.436-0.826) as well as between all the pairs of observers (k=0.661; 95%CI: 0.506-0.823) for all the CAD-RADS together. The degree of agreement within the group of experienced radiologists was greater than that within the group of residents in all the analyses. The agreement was excellent for the overall CAD-RADS (k=0.950; 95% CI: 0.896-1) and for CAD-RADS ≥ 4 (k=1); the agreement was lower for CAD-RADS ≥ 3 (k=0.754; 95% CI: 0.246-1.255). The agreement for the residents for these categories was k=0.623, k=0.596, and k=0.473, respectively. CONCLUSION The agreement among attending radiologists regarding the assessment of urgent coronary CTA studies is excellent. The agreement is lower when residents are paired with attending radiologists. These findings should be taken into consideration when implementing coronary CTA in emergency departments and in the organisation of radiological staff for interpreting and reporting this imaging test.
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Affiliation(s)
- L González-Campo
- Servicio de Radiodiagnóstico, Hospital Universitario Ramón y Cajal, Madrid, Spain.
| | - A Vicente-Bártulos
- Servicio de Radiodiagnóstico, Hospital Universitario Ramón y Cajal, Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - A Gaetano-Gil
- Unidad de Bioestadística Clínica, Hospital Ramón y Cajal (IRYCIS), Madrid, Spain
| | | | | | - J Zamora
- Unidad de Bioestadística Clínica, Hospital Ramón y Cajal (IRYCIS), Madrid, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain; Institute of Applied Research, University of Birmingham, United Kingdom
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Khan KS, Bueno Cavanillas A, Zamora J. [Systematic reviews in five steps: V. Interpreting the findings]. Semergen 2023; 49:101854. [PMID: 36410229 DOI: 10.1016/j.semerg.2022.101854] [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: 07/05/2022] [Revised: 09/10/2022] [Accepted: 09/17/2022] [Indexed: 11/19/2022]
Abstract
The last step in a systematic review is the interpretation of the findings. The important findings need to be explicitly identified. A level of strength of evidence should be assigned to support each key finding, based on factors such as study design, methodological quality and risk of publication bias. Variations in the magnitude of associations observed also need to be explored. The aim of this analysis is to determine in which clinical groups the intervention is more or less effective, the impact of exposure is greater or lesser, or a diagnostic test is more useful. At this stage, for better interpretation of the findings, the magnitude of the association can be estimated either globally or stratified according to the characteristics of the participants. All this is helpful in formulating recommendations for clinical practice and policy.
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Affiliation(s)
- K S Khan
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Granada, Granada, España; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, España
| | - A Bueno Cavanillas
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Granada, Granada, España; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, España.
| | - J Zamora
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, España; Unidad de Bioestadística Clínica, Hospital Ramón y Cajal, Madrid, España; Institute of Metabolism and Systems Research, Universidad de Birmingham, Birmingham, Reino Unido
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Mondaza Hernandez J, Moura D, Lopez-Alvarez M, Sanchez-Bustos P, Blanco-Alcaina E, Castilla-Ramirez C, Collini P, Merino-Garcia J, Zamora J, Carrillo-Garcia J, Maestro R, Hindi N, Garcia-Foncillas J, Martin-Broto J. ISG15 as a prognostic biomarker in solitary fibrous tumour. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01087-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Khan K, Bueno Cavanillas A, Zamora J. Revisiones sistemáticas en cinco pasos: I. Cómo formular una pregunta para la que se pueda obtener una respuesta válida. Semergen 2022; 48:356-361. [DOI: 10.1016/j.semerg.2021.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 12/21/2021] [Accepted: 12/27/2021] [Indexed: 11/24/2022]
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Chronopoulou E, Shaikh S, Gaetano-Gil A, Raperport C, Tsiveriotis K, Al Wattar B, Zamora J, Bhide P. P-122 Optimising IUI; a systematic review and network meta-analysis. Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.117] [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: 11/13/2022] Open
Abstract
Abstract
Study question
What is the effectiveness of add-on interventions to the standard intra-uterine insemination (IUI) protocol in improving reproductive outcomes?
Summary answer
Amongst the add-ons studied only luteal phase support and endometrial scratch were found beneficial for (LBR)/ongoing pregnancy rate (OPR) in IUI cycles.
What is known already
IUI is a fertility treatment offered to couples and single women for varied indications worldwide. Although cheaper and less invasive than in-vitro fertilization (IVF), it has received less attention and success rates remain low. Various add-ons have been introduced to boost IUI outcomes. However, their use remains largely empirical and is not standardized. Exploring the effectiveness of different protocol add-ons in comparisons with each other and with the standard protocol, could help develop evidence-based recommendations and optimize IUI treatment.
Study design, size, duration
We conducted a systematic review and meta-analysis aiming to assess the value of various IUI add-ons on clinical outcomes (PROSPERO registration number CRD42022300857). A computerized literature search was performed using EMBASE, MEDLINE, CINAHL and the Cochrane Central from database inception to October 2021. Two authors independently assessed the studies for quality and risk of bias. Studied add-ons included use of hydrotubation, endometrial scratch, trigger, double insemination, ultrasound guidance, bed rest, tocolysis and luteal phase support.
Participants/materials, setting, methods
Randomized controlled trials (RCTs) were included, reporting on one or more cycles of IUI with any protocol and indication using partner’s or donor sperm. We summarized the LBR or OPR when LBR was not available. We calculated odds ratios with 95% confidence intervals (CI) using random effects meta-analysis after transforming data using Freeman-Tukey double arcsine transformation. Heterogeneity was reported as I2 and Tau2 estimates.
Main results and the role of chance
Sixty one RCTs were included in the analysis. Amongst the add-ons studied, luteal phase support and endometrial scratch were found to increase chance of LBR/OPR by 1.48 times (CI 1.1243-1.9402, I2= 13.3%, Tau2= 0,0156 p = 0.330) and 1.58 times (CI 1.0992-2.2685, I2= 0.0%,Tau2=0,00 p = 0.510) respectively. No statistically significant difference was found for the use of hydrotubation (pooled OR 1.4192, CI 0.4936 - 4.0804, I2= 67.3%, Tau2=0,57 p = 0.047), trigger (pooled OR 0.6649, CI 0.2422- 1.8257, I2= 74.7%, Tau2=0,3972, p = 0.047), hCG versus agonist trigger (pooled OR 1.1570, CI 0.7501- 1.7847, I2=0.0%, Tau2=0.00, p = 0.502), ultrasound guidance (pooled OR 2.119, CI 0.8289-5.3809, p = 0.437), double IUI (pooled OR 0.9718, CI 0.5721-1.6508, I2=0.0%, Tau2=0.00, p = 0.567), and bed rest (pooled OR 1.1459, CI 0.4789-2.7418, I2=0.0%, Tau2=0.00, p = 0.005). No eligible studies were found on tocolytic agents. Two studies were identified for the use of misoprostol but the authors do not report results on the outcomes of interest.
Limitations, reasons for caution
The risk of bias was considered as “high”/“some concerns” for all included studies and the overall quality of evidence is low. Included studies randomized both per woman and per cycle and significant differences were noticed in ovarian stimulation protocols. More well-designed RCTs are needed in order to reach sound conclusions.
Wider implications of the findings
This meta-analysis provides evidence that luteal phase support and endometrial scratch provide clinical benefit for IUI success rates. However, it is possible that different add-ons could benefit specific patient groups. There is place for more research in the field to explore the value of add-ons in relation to subfertility background.
Trial registration number
n/a
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Affiliation(s)
- E Chronopoulou
- CRGH- The Centre for Reproductive & Genetic Health, Fertility and Assisted Reproduction , London, United Kingdom
| | - S Shaikh
- CREATE Fertility, Fertility and Assisted Reproduction , London, United Kingdom
| | - A Gaetano-Gil
- London North West University Healthcare NHS Trust- Queen Mary University of London, Obstetrics and Gynaecology , London, United Kingdom
| | - C Raperport
- Hospital Universitario Ramón y Cajal IRYCIS- Clinical Biostatistics Unit, Clinical Biostatistics , Madrid, Spain
| | - K Tsiveriotis
- General University Hospital of Patras, Obstetrics and Gynaecology- Fetal Medicine , Patras, Greece
| | - B.H Al Wattar
- Institute for Womens Health- University College London- Women's Health Department- University College London Hospitals, Women's Health , London, United Kingdom
| | - J Zamora
- Clinical Biostatistics Unit- Hospital Universitario Ramón y Cajal IRYCIS- CIBER Epidemiology and Public Health CIBERESP- Women's Health Research Unit- Queen Mary University of London, Clinical Biostatistics , Madrid, Spain
| | - P Bhide
- Homerton University Hospital- Queen Mary University of London, Fertility and Assisted Reproduction , London, United Kingdom
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Khan K, Bueno Cavanillas A, Zamora J. Revisiones sistemáticas en cinco pasos: III. Cómo evaluar la calidad de los estudios. Semergen 2022; 48:101808. [DOI: 10.1016/j.semerg.2022.05.001] [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: 12/31/2021] [Revised: 05/06/2022] [Accepted: 05/14/2022] [Indexed: 10/18/2022]
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Lumbreras-Fernández B, Vicente Bártulos A, Fernandez-Felix B, Corres González J, Zamora J, Muriel A. Mejora en el manejo de la sospecha del síndrome aórtico agudo en urgencias mediante un algoritmo clínico y el estudio de factores predictivos. Radiología 2022. [DOI: 10.1016/j.rx.2022.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Allotey J, Whittle R, Snell KIE, Smuk M, Townsend R, von Dadelszen P, Heazell AEP, Magee L, Smith GCS, Sandall J, Thilaganathan B, Zamora J, Riley RD, Khalil A, Thangaratinam S. External validation of prognostic models to predict stillbirth using International Prediction of Pregnancy Complications (IPPIC) Network database: individual participant data meta-analysis. Ultrasound Obstet Gynecol 2022; 59:209-219. [PMID: 34405928 DOI: 10.1002/uog.23757] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 04/20/2021] [Revised: 06/30/2021] [Accepted: 08/02/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Stillbirth is a potentially preventable complication of pregnancy. Identifying women at high risk of stillbirth can guide decisions on the need for closer surveillance and timing of delivery in order to prevent fetal death. Prognostic models have been developed to predict the risk of stillbirth, but none has yet been validated externally. In this study, we externally validated published prediction models for stillbirth using individual participant data (IPD) meta-analysis to assess their predictive performance. METHODS MEDLINE, EMBASE, DH-DATA and AMED databases were searched from inception to December 2020 to identify studies reporting stillbirth prediction models. Studies that developed or updated prediction models for stillbirth for use at any time during pregnancy were included. IPD from cohorts within the International Prediction of Pregnancy Complications (IPPIC) Network were used to validate externally the identified prediction models whose individual variables were available in the IPD. The risk of bias of the models and cohorts was assessed using the Prediction study Risk Of Bias ASsessment Tool (PROBAST). The discriminative performance of the models was evaluated using the C-statistic, and calibration was assessed using calibration plots, calibration slope and calibration-in-the-large. Performance measures were estimated separately in each cohort, as well as summarized across cohorts using random-effects meta-analysis. Clinical utility was assessed using net benefit. RESULTS Seventeen studies reporting the development of 40 prognostic models for stillbirth were identified. None of the models had been previously validated externally, and the full model equation was reported for only one-fifth (20%, 8/40) of the models. External validation was possible for three of these models, using IPD from 19 cohorts (491 201 pregnant women) within the IPPIC Network database. Based on evaluation of the model development studies, all three models had an overall high risk of bias, according to PROBAST. In the IPD meta-analysis, the models had summary C-statistics ranging from 0.53 to 0.65 and summary calibration slopes ranging from 0.40 to 0.88, with risk predictions that were generally too extreme compared with the observed risks. The models had little to no clinical utility, as assessed by net benefit. However, there remained uncertainty in the performance of some models due to small available sample sizes. CONCLUSIONS The three validated stillbirth prediction models showed generally poor and uncertain predictive performance in new data, with limited evidence to support their clinical application. The findings suggest methodological shortcomings in their development, including overfitting. Further research is needed to further validate these and other models, identify stronger prognostic factors and develop more robust prediction models. © 2021 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- J Allotey
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - R Whittle
- Centre for Prognosis Research, School of Medicine, Keele University, Keele, UK
| | - K I E Snell
- Centre for Prognosis Research, School of Medicine, Keele University, Keele, UK
| | - M Smuk
- Medical Statistics Department, London School of Hygiene and Tropical Medicine, London, UK
| | - R Townsend
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - P von Dadelszen
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - A E P Heazell
- Maternal and Fetal Health Research Centre, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - L Magee
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - G C S Smith
- Department of Obstetrics and Gynaecology, NIHR Biomedical Research Centre, Cambridge University, Cambridge, UK
| | - J Sandall
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
- Health Service and Population Research Department, Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - B Thilaganathan
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - J Zamora
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - R D Riley
- Centre for Prognosis Research, School of Medicine, Keele University, Keele, UK
| | - A Khalil
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - S Thangaratinam
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
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12
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Zamora J, Stafford S, Mifflin R, Gilbertson S, Cunningham K, Anastasio N. Pharmacological profiles of 5‐HT
2A
Receptor (5‐HT
2A
R):5‐HT
2C
R Interactions
In Vitro. FASEB J 2021. [DOI: 10.1096/fasebj.2021.35.s1.03788] [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: 11/11/2022]
Affiliation(s)
- J. Zamora
- Center for Addiction ResearchUniversity of Texas Medical BranchGalvestonTX
- Pharmacology and ToxicologyUniversity of Texas Medical BranchGalvestonTX
| | - S. Stafford
- Center for Addiction ResearchUniversity of Texas Medical BranchGalvestonTX
- Pharmacology and ToxicologyUniversity of Texas Medical BranchGalvestonTX
| | - R. Mifflin
- Center for Addiction ResearchUniversity of Texas Medical BranchGalvestonTX
- Pharmacology and ToxicologyUniversity of Texas Medical BranchGalvestonTX
| | | | - K. Cunningham
- Center for Addiction ResearchUniversity of Texas Medical BranchGalvestonTX
- Pharmacology and ToxicologyUniversity of Texas Medical BranchGalvestonTX
| | - N. Anastasio
- Center for Addiction ResearchUniversity of Texas Medical BranchGalvestonTX
- Pharmacology and ToxicologyUniversity of Texas Medical BranchGalvestonTX
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13
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Gil MM, Molina FS, Rodríguez‐Fernández M, Delgado JL, Carrillo MP, Jani J, Plasencia W, Stratieva V, Maíz N, Carretero P, Lismonde A, Chaveeva P, Burgos J, Santacruz B, Zamora J, De Paco Matallana C. New approach for estimating risk of miscarriage after chorionic villus sampling. Ultrasound Obstet Gynecol 2020; 56:656-663. [PMID: 32281125 PMCID: PMC7984173 DOI: 10.1002/uog.22041] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 03/07/2020] [Accepted: 03/22/2020] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To estimate the risk of miscarriage associated with chorionic villus sampling (CVS). METHODS This was a retrospective cohort study of women attending for routine ultrasound examination at 11 + 0 to 13 + 6 weeks' gestation at one of eight fetal-medicine units in Spain, Belgium and Bulgaria, between July 2007 and June 2018. Two populations were included: (1) all singleton pregnancies undergoing first-trimester assessment at Hospital Clínico Universitario Virgen de la Arrixaca in Murcia, Spain, that did not have CVS (non-CVS group); and (2) all singleton pregnancies that underwent CVS following first-trimester assessment at one of the eight participating centers (CVS group). We excluded pregnancies diagnosed with genetic anomalies or major fetal defects before or after birth, those that resulted in termination and those that underwent amniocentesis later in pregnancy. We used propensity score (PS) matching analysis to estimate the association between CVS and miscarriage. We compared the risk of miscarriage of the CVS and non-CVS groups after PS matching (1:1 ratio). This procedure creates two comparable groups balancing the maternal and pregnancy characteristics that are associated with CVS, in a similar way to that in which randomization operates in a randomized clinical trial. RESULTS The study population consisted of 22 250 pregnancies in the non-CVS group and 3613 in the CVS group. The incidence of miscarriage in the CVS group (2.1%; 77/3613) was significantly higher than that in the non-CVS group (0.9% (207/22 250); P < 0.0001). The PS algorithm matched 2122 CVS with 2122 non-CVS cases, of which 40 (1.9%) and 55 (2.6%) pregnancies in the CVS and non-CVS groups, respectively, resulted in a miscarriage (odds ratio (OR), 0.72 (95% CI, 0.48-1.10); P = 0.146). We found a significant interaction between the risk of miscarriage following CVS and the risk of aneuploidy, suggesting that the effect of CVS on the risk of miscarriage differs depending on background characteristics. Specifically, when the risk of aneuploidy is low, the risk of miscarriage after CVS increases (OR, 2.87 (95% CI, 1.13-7.30)) and when the aneuploidy risk is high, the risk of miscarriage after CVS is paradoxically reduced (OR, 0.47 (95% CI, 0.28-0.76)), presumably owing to prenatal diagnosis and termination of pregnancies with major aneuploidies that would otherwise have resulted in spontaneous miscarriage. For example, in a patient in whom the risk of aneuploidy is 1 in 1000 (0.1%), the risk of miscarriage after CVS will increase to 0.3% (0.2 percentage points higher). CONCLUSIONS The risk of miscarriage in women undergoing CVS is about 1% higher than that in women who do not have CVS, although this excess risk is not solely attributed to the invasive procedure but, to some extent, to the demographic and pregnancy characteristics of the patients. After accounting for these risk factors and confining the analysis to low-risk pregnancies, CVS seems to increase the risk of miscarriage by about three times above the patient's background risk. Although this is a substantial increase in relative terms, in pregnancies without risk factors for miscarriage, the risk of miscarriage after CVS remains low and similar to, or slightly higher than, that in the general population. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- M. M. Gil
- Department of Obstetrics and GynecologyHospital Universitario de Torrejón, Torrejón de ArdozMadridSpain
- School of Health SciencesUniversidad Francisco de Vitoria, Pozuelo de AlarcónMadridSpain
| | - F. S. Molina
- Department of Obstetrics and GynecologyHospital Clínico San Cecilio, Instituto de Investigación Biosanitaria IBSGranadaSpain
| | - M. Rodríguez‐Fernández
- Department of Obstetrics and GynecologyHospital Universitario de Torrejón, Torrejón de ArdozMadridSpain
| | - J. L. Delgado
- Department of Obstetrics and GynecologyHospital Clínico Universitario ‘Virgen de la Arrixaca’, El PalmarMurciaSpain
- Institute for Biomedical Research of Murcia, IMIB‐Arrixaca, El PalmarMurciaSpain
| | - M. P. Carrillo
- Department of Obstetrics and GynecologyHospital Universitario ‘Virgen de las Nieves’GranadaSpain
| | - J. Jani
- Department of Obstetrics and Gynecology, University Hospital BrugmannUniversité Libre de BruxellesBrusselsBelgium
| | | | - V. Stratieva
- Obs/Gyn Dr Shterev HospitalSofiaBulgaria
- OSCAR ClinicSofiaBulgaria
| | - N. Maíz
- Fetal Medicine Unit, Department of Obstetrics and GynecologyBioCruces Health Research Institute, Hospital Universitario Cruces, Universidad del País Vasco (UPV/EHU), BarakaldoPaís VascoSpain
| | - P. Carretero
- Department of Obstetrics and GynecologyHospital Clínico San Cecilio, Instituto de Investigación Biosanitaria IBSGranadaSpain
| | - A. Lismonde
- Department of Obstetrics and Gynecology, University Hospital BrugmannUniversité Libre de BruxellesBrusselsBelgium
| | | | - J. Burgos
- Fetal Medicine Unit, Department of Obstetrics and GynecologyBioCruces Health Research Institute, Hospital Universitario Cruces, Universidad del País Vasco (UPV/EHU), BarakaldoPaís VascoSpain
| | - B. Santacruz
- Department of Obstetrics and GynecologyHospital Universitario de Torrejón, Torrejón de ArdozMadridSpain
- School of Health SciencesUniversidad Francisco de Vitoria, Pozuelo de AlarcónMadridSpain
| | - J. Zamora
- CIBER Epidemiology and Public HealthClinical Biostatistics Unit, Hospital Ramón y CajalMadridSpain
- Barts Research Centre for Women's Health, WHO Collaborating CentreQueen Mary University of LondonLondonUK
| | - C. De Paco Matallana
- Department of Obstetrics and GynecologyHospital Clínico Universitario ‘Virgen de la Arrixaca’, El PalmarMurciaSpain
- Institute for Biomedical Research of Murcia, IMIB‐Arrixaca, El PalmarMurciaSpain
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14
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Caceres A, Shlobin NA, Lam S, Zamora J, Segura JL. Correction to: Stingray spear injury to the pediatric spinal cord: case report and review of the literature. Childs Nerv Syst 2020; 36:1817. [PMID: 32583149 DOI: 10.1007/s00381-020-04739-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The original version of this article unfortunately contained an error in the spelling of the last name of one of the co-authors. The corresponding author did not notice that the last name of one of the co-authors, Nathan Shlobin, was misspelled as "Schlobin". The correct spelling of his last name is "Shlobin". Given in this article is the corrected author name.
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Affiliation(s)
- A Caceres
- Servicio de Neurocirugía, Hospital Nacional de Niños, "Dr. Carlos Sáenz Herrera", San José, Costa Rica.
| | - N A Shlobin
- Division of Pediatric Neurosurgery and Department of Neurosurgery, Ann and Robert H Lurie Children's Hospital and Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - S Lam
- Division of Pediatric Neurosurgery and Department of Neurosurgery, Ann and Robert H Lurie Children's Hospital and Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - J Zamora
- Servicio de Neurocirugía, Hospital Nacional de Niños, "Dr. Carlos Sáenz Herrera", San José, Costa Rica
| | - J L Segura
- Servicio de Neurocirugía, Hospital Nacional de Niños, "Dr. Carlos Sáenz Herrera", San José, Costa Rica
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15
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Caceres A, Shlobin NA, Lam S, Zamora J, Segura JL. Stingray spear injury to the pediatric spinal cord: case report and review of the literature. Childs Nerv Syst 2020; 36:1811-1816. [PMID: 32361931 DOI: 10.1007/s00381-020-04629-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 04/16/2020] [Indexed: 01/22/2023]
Abstract
Stingray injuries are rare, mostly causing injuries to the lower extremities but occasionally fatal if there is direct puncture of the thorax, abdomen, or neck. Direct combined stingray injury to the central nervous system has not been reported in the literature. Herein we present the case of a 12-year-old boy who, while wading at the seashore of the Costa Rica's Pacific Ocean, sustained a combined oblique penetrating injury to the C6 vertebra caused by a Stingray. He initially presented to the hospital with a complete asymmetric right C6/left T1 ASIA A examination, priapism, and loss of anal sphincter tone. Imaging revealed fracture of the posterior elements of C6 with an oblique trajectory into the left radicular foramen. T2W images did not reveal anatomical section but rather edema and minor bleeding in the epidural space. The patient underwent medical management and serial imaging. During the next 3 months, there was recovery of sensation on the right hemi body, bilateral paresthesias and asymmetric progressive improvement in strength on both legs. Acute care management and midterm term follow up are provided, along with a review of the literature for salient management considerations when evaluating and treating combined penetrating and envenomation injuries caused by stingrays. To our knowledge, this is the first report of such injury to the spine.
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Affiliation(s)
- A Caceres
- Servicio de Neurocirugía, Hospital Nacional de Niños, "Dr. Carlos Sáenz Herrera", San José, Costa Rica.
| | - N A Shlobin
- Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Division of Pediatric Neurosurgery, Lurie Children's Hospital, Chicago, IL, USA
| | - S Lam
- Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Division of Pediatric Neurosurgery, Lurie Children's Hospital, Chicago, IL, USA
| | - J Zamora
- Servicio de Neurocirugía, Hospital Nacional de Niños, "Dr. Carlos Sáenz Herrera", San José, Costa Rica
| | - J L Segura
- Servicio de Neurocirugía, Hospital Nacional de Niños, "Dr. Carlos Sáenz Herrera", San José, Costa Rica
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16
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Fernández Lucas M, Ruíz-Roso G, Merino JL, Sánchez R, Bouarich H, Herrero JA, Muriel A, Zamora J, Collado A. Initiating renal replacement therapy through incremental haemodialysis: Protocol for a randomized multicentre clinical trial. Trials 2020; 21:206. [PMID: 32075665 PMCID: PMC7031943 DOI: 10.1186/s13063-020-4058-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 08/22/2019] [Accepted: 01/08/2020] [Indexed: 01/25/2023] Open
Abstract
Background Thrice-weekly haemodialysis is the usual dose when starting renal replacement therapy; however, this schedule is no longer appropriate since it does not consider residual renal function. Several reports have suggested the potential benefit of beginning haemodialysis less frequently and incrementally increasing the dose as the residual renal function decreases. However, all the data published so far are from observational studies. Thus, this clinical trial avoids any potential selection bias and will assess the possible benefits that have been observed in observational studies. Methods/design This report describes the study protocol of a randomized prospective multi-centre open-label clinical trial to evaluate whether starting renal replacement therapy with twice-weekly haemodialysis sessions preserves residual renal function better than the standard thrice-weekly regimen. We also explore other clinical parameters, such as concentrations of uremic toxins, dialysis doses, control of anaemia, removal of medium-weight uremic toxins, nutritional status, quality of life, hospital admissions and mortality. Only incident haemodialysis patients who can maintain a urea clearance rate KrU ≥ 2.5 mL/min/1.73 m2 are eligible. Patient recruitment began on 1 January 2017 and will last for 2 years or until the required sample size has been recruited to ensure the established statistical power has been reached. The minimum follow-up period will be 1 year. Anuric patients with acute renal failure and patients who return to haemodialysis after a kidney transplant failure are excluded. It has been calculated that 44 patients should be recruited into each group to achieve a power of 80% in a two-sided comparison of means with a usual significance level of 0.05. A time-to-event analysis will estimate the probability of kidney function survival in both groups using the Kaplan–Meier method. Survival curves will be compared with log-rank tests. This survival analysis will be complemented with a proportional hazard model to estimate the hazard ratio of kidney function survival adjusted for any confounding factors. Analyses will be carried out in accordance with the intention-to-treat principle. Discussion The incremental initiation of dialysis may preserve residual renal function better than the conventional treatment, with similar or higher survival rates, as reported by observational studies. To our knowledge, this is the first clinical trial to evaluate whether initiating renal replacement therapy with twice-weekly haemodialysis sessions preserves residual renal function better than beginning with the standard thrice-weekly regimen. Trial registration ClinicalTrials.gov, NCT03302546. Registered on 5 October 2017.
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Affiliation(s)
- M Fernández Lucas
- Servicio de Nefrología, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain. .,Departamento de Medicina, Universidad de Alcala, Alcalá de Henares, Madrid, Spain.
| | - G Ruíz-Roso
- Servicio de Nefrología, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - J L Merino
- Hospital Universitario del Henares, Madrid, Spain
| | - R Sánchez
- Hospital Universitario La Paz, Madrid, Spain
| | - H Bouarich
- Hospital Universitario Principe de Asturias, Alcalá de Henares, Madrid, Spain
| | - J A Herrero
- Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - A Muriel
- Unidad de Bioestadística, H. U, Ramón y Cajal, IRYCIS, Madrid, Spain
| | - J Zamora
- Unidad de Bioestadística, H. U, Ramón y Cajal, IRYCIS, Madrid, Spain
| | - A Collado
- Servicio de Nefrología, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
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17
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Perez-Molina JA, Pulido F, Di Giambenedetto S, Ribera E, Moreno S, Zamora J, Coscia C, Alejos B, Pitch J, Gatell JM, De Luca A, Arribas JR. Individual patient data meta-analysis of randomized controlled trials of dual therapy with a boosted PI plus lamivudine for maintenance of virological suppression: GeSIDA study 9717. J Antimicrob Chemother 2019; 73:2927-2935. [PMID: 30085184 DOI: 10.1093/jac/dky299] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 06/26/2018] [Indexed: 12/24/2022] Open
Abstract
Background Dual therapy (DT) with a ritonavir-boosted PI (PI/r) plus lamivudine has proven non-inferior (12% margin) to triple therapy (TT) with PI/r plus two nucleos(t)ide reverse transcriptase inhibitors [N(t)RTIs] in four clinical trials. It remains unclear whether DT is non-inferior based on the US FDA endpoint (virological failure with a margin of 4%) or in specific subgroups. Methods We performed a systematic search (January 1990 to March 2017) of randomized controlled trials that compared switching of maintenance ART from TT to DT. The principal investigators were contacted and agreed to share study databases. The primary endpoint was non-inferiority of DT to TT based on the current FDA endpoint (4% non-inferiority margin for virological failure at week 48). We also analysed whether efficacy was modified by gender, active HCV infection and type of PI. Effect estimates and 95% CIs were calculated using generalized estimating equation-based models. Results We found 881 references that yielded eight articles corresponding to four clinical trials (1051 patients). At week 48, 4% of patients on DT versus 3.04% on TT had experienced virological failure (difference 0.9%; 95% CI -1.2% to 3.1%), and 84.7% of patients on DT versus 83.2% on TT had <50 copies of HIV RNA/mL (FDA snapshot algorithm) (difference 1.4%; 95% CI -2.8% to 5.8%). Gender, active HCV infection and type of PI had no effect on differences in treatment efficacy between DT and TT. Conclusions DT was non-inferior to TT using both current and past FDA endpoints. The efficacy of DT was not influenced by gender, active HCV infection status, or type of PI.
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Affiliation(s)
- J A Perez-Molina
- Infectious Diseases Department, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - F Pulido
- HIV Unit, Hospital Universitario Doce de Octubre, imas12, UCM, Madrid, Spain
| | - S Di Giambenedetto
- Institute of Clinical Infectious Diseases, Catholic University of Sacred Heart, Rome, Italy
| | - E Ribera
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - S Moreno
- Infectious Diseases Department, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - J Zamora
- Clinical Biostatistics Unit and CIBERESP, Hospital Ramón y Cajal, IRYCIS, Madrid, Spain.,Queen Mary University, London, UK
| | - C Coscia
- Clinical Biostatistics Unit and CIBERESP, Hospital Ramón y Cajal, IRYCIS, Madrid, Spain
| | - B Alejos
- Centro Nacional de Epidemiología, Instituto Carlos III, Madrid, Spain
| | - J Pitch
- Hospital Clínic/Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - J M Gatell
- Hospital Clínic/Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - A De Luca
- UOC Malattie Infettive, Azienda Ospedaliera Universitaria Senese, and Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - J R Arribas
- Hospital Universitario La Paz, IDIPAZ, Madrid, Spain
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18
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Husain S, Allotey J, Drymoussi Z, Wilks M, Fernandez-Felix BM, Whiley A, Dodds J, Thangaratinam S, McCourt C, Prosdocimi EM, Wade WG, de Tejada BM, Zamora J, Khan K, Millar M. Effects of oral probiotic supplements on vaginal microbiota during pregnancy: a randomised, double-blind, placebo-controlled trial with microbiome analysis. BJOG 2019; 127:275-284. [PMID: 30932317 PMCID: PMC6973149 DOI: 10.1111/1471-0528.15675] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [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] [Accepted: 02/26/2019] [Indexed: 12/12/2022]
Abstract
Objective To determine the effects on the vaginal microbiota of an oral probiotic preparation administered from early pregnancy. Design Randomised, double blind, placebo‐controlled trial. Setting Four maternity units in the UK. Population Women aged 16 years or older recruited at 9–14 weeks' gestation. Methods Participants were randomly allocated to receive oral capsules of probiotic containing Lactobacillus rhamnosus GR‐1 and Lactobacillus reuteri RC‐14 each at 2.5 × 109 colony‐forming units (CFUs) or placebo once daily from recruitment until the end of pregnancy. Main outcome measure Rates of bacterial vaginosis (BV, defined as Nugent score ≥7) at 18–20 weeks' gestation compared by logistic regression adjusted for possible confounders. Results The primary analysis included 78% (238/304) of participants who initially consented (probiotic group 123, placebo group 115). Of these participants, 95% (227/238) reported an intake of 93% or more of the required number of capsules. The rates of BV did not differ between groups at 18–20 weeks' gestation (15% (19/123) in the probiotic group vs. 9% (10/115) in the placebo group, adjusted odds ratio 1.82, 95% confidence interval 0.64–5.19). There were also no differences between the groups in the proportion of women colonised with the probiotic strains, Escherichia coli, group B streptococci or other vaginal microbiota. There were no differences in the alpha diversity or composition of the bacterial communities between or within the probiotic and placebo groups at 9–14 and 18–20 weeks’ gestation. Conclusions Oral probiotics taken from early pregnancy did not modify the vaginal microbiota. Tweetable abstract The oral probiotic preparation used in this study does not prevent BV in pregnant women. The oral probiotic preparation used in this study does not prevent BV in pregnant women.
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Affiliation(s)
- S Husain
- Barts and the London School of Medicine and Dentistry, Blizard Institute, Queen Mary University of London, London, UK.,Neonatal Unit, Homerton University Hospital NHS Foundation Trust, London, UK
| | - J Allotey
- Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Z Drymoussi
- Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - M Wilks
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,Barts Health NHS Trust, London, UK
| | - B M Fernandez-Felix
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Clinical Biostatistics Unit, Hospital Ramon y Cajal (IRYCIS), Madrid, Spain
| | - A Whiley
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,Barts Health NHS Trust, London, UK
| | - J Dodds
- Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - S Thangaratinam
- Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - C McCourt
- City University of London, University of London, London, UK
| | - E M Prosdocimi
- Centre for Host-Microbiome Interactions, King's College London, London, UK
| | - W G Wade
- Centre for Host-Microbiome Interactions, King's College London, London, UK
| | - B M de Tejada
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - J Zamora
- Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Clinical Biostatistics Unit, Hospital Ramon y Cajal (IRYCIS), Madrid, Spain
| | - K Khan
- Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - M Millar
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,Barts Health NHS Trust, London, UK
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19
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Yelland LN, Schuit E, Zamora J, Middleton PF, Lim AC, Nassar AH, Rode L, Serra V, Thom EA, Vayssière C, Mol B, Gates S. Correlation between neonatal outcomes of twins depends on the outcome: secondary analysis of twelve randomised controlled trials. BJOG 2018; 125:1406-1413. [PMID: 29790271 DOI: 10.1111/1471-0528.15292] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To estimate the magnitude of the correlation between neonatal outcomes of twins and demonstrate how this information can be used in the design of randomised controlled trials (RCTs) in women with twin pregnancies. DESIGN Secondary analysis of data from 12 RCTs. SETTING Obstetric care in multiple countries, 2004-2012. POPULATION OR SAMPLE 4504 twin pairs born to women who participated in RCTs to assess treatments given during pregnancy. METHODS Intraclass correlation coefficients (ICCs) were estimated using log-binomial and linear models. MAIN OUTCOME MEASURES Perinatal death, respiratory distress syndrome, bronchopulmonary dysplasia, intraventricular haemorrhage, necrotising enterocolitis, sepsis, neonatal intensive care unit admission, birthweight, low birthweight and two composite measures of adverse neonatal outcome. RESULTS ICCs for the composite measures of adverse neonatal outcome were all above 0.5, indicating moderate to strong correlation between adverse outcomes of twins. For individual neonatal outcomes, median ICCs across trials ranged from 0.13 to 0.79 depending on the outcome. An example illustrates how ICCs can be used in sample size calculations for RCTs in women with twin pregnancies. CONCLUSIONS The correlation between neonatal outcomes of twins varies considerably between outcomes and may be lower than expected. Our ICC estimates can be used for designing and analysing RCTs that recruit women with twin pregnancies and for performing meta-analyses that include such RCTs. Researchers are encouraged to report ICCs for neonatal outcomes in twins in their own RCTs. TWEETABLE ABSTRACT Correlation between neonatal outcomes of twins depends on the outcome and may be lower than expected.
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Affiliation(s)
- L N Yelland
- South Australian Health and Medical Research Institute, Adelaide, SA, Australia.,School of Public Health, The University of Adelaide, Adelaide, SA, Australia
| | - E Schuit
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - J Zamora
- Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,CIBER Epidemiology and Public Health and IRYCIS, Madrid, Spain
| | - P F Middleton
- South Australian Health and Medical Research Institute, Adelaide, SA, Australia.,Robinson Research Institute, School of Medicine, The University of Adelaide, Adelaide, SA, Australia
| | - A C Lim
- Department of Obstetrics & Gynecology and GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - A H Nassar
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
| | - L Rode
- Department of Obstetrics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - V Serra
- Maternal-Fetal Medicine Unit, Valencia Infertility Institute, University of Valencia, Valencia, Spain
| | - E A Thom
- George Washington University Biostatistics Center, Washington, DC, USA
| | - C Vayssière
- Department of Obstetrics and Gynecology, Paule de Viguier Hospital, CHU Toulouse, Toulouse, France.,UMR 1027 INSERM, University of Paul Sabatier Toulouse III, Toulouse, France
| | - Bwj Mol
- Department of Obstetrics and Gynaecology, Monash Medical Centre, Monash Health and Monash University, Clayton, Vic., Australia
| | - S Gates
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
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20
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Harb HM, Knight M, Bottomley C, Overton C, Tobias A, Gallos ID, Shehmar M, Farquharson R, Horne A, Latthe P, Edi-Osagie E, MacLean M, Marston E, Zamora J, Dawood F, Small R, Ross J, Bourne T, Coomarasamy A, Jurkovic D. Caesarean scar pregnancy in the UK: a national cohort study. BJOG 2018; 125:1663-1670. [PMID: 29697890 DOI: 10.1111/1471-0528.15255] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To estimate the incidence of caesarean scar pregnancy (CSP) and to describe the management outcomes associated with this condition. DESIGN A national cohort study using the UK Early Pregnancy Surveillance Service (UKEPSS). SETTING 86 participating Early Pregnancy Units. POPULATION All women diagnosed in the participating units with CSP between November 2013 and January 2015. METHODS Cohort study of women identified through the UKEPSS monthly mailing system. MAIN OUTCOME MEASURES Incidence, clinical outcomes and complications. RESULTS 102 cases of CSP were reported, with an estimated incidence of 1.5 per 10 000 (95% CI 1.1-1.9) maternities. Full outcome data were available for 92 women. Management was expectant in 21/92 (23%), medical in 15/92 (16%) and surgical in 56/92 (61%). The success rates of expectant, medical and surgical management were 43% (9/21), 46% (7/15) and 96% (54/56), respectively. The complication rates were 15/21 (71%) with expectant, 9/15 (60%) with medical and 20/56 (36%) with surgical management. Discharge from care (median number of days) was 82 (range 37-174) with expectant, 21 (range 10-31) with medical and 11 (range 4-49) with surgical management. CONCLUSIONS Surgical management appears to be associated with a high success rate, low complication rate and short post-treatment follow up. TWEETABLE ABSTRACT Surgery for CSP appears to be successful, with low complication rates and short post-treatment follow up.
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Affiliation(s)
- H M Harb
- Tommy's National Centre for Miscarriage Research, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - M Knight
- National Perinatal Epidemiology Unit, Oxford, UK
| | - C Bottomley
- Chelsea and Westminster Hospital, London, UK
| | | | - A Tobias
- Tommy's National Centre for Miscarriage Research, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - I D Gallos
- Tommy's National Centre for Miscarriage Research, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - M Shehmar
- Birmingham Women's Hospital, Edgbaston, UK
| | | | - A Horne
- The Queen's Medical Research Institute, University of Edinburgh and Royal Infirmary of Edinburgh, Edinburgh, UK
| | - P Latthe
- Tommy's National Centre for Miscarriage Research, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - E Edi-Osagie
- Central Manchester University Hospitals, Saint Mary's Hospital, Manchester, UK
| | - M MacLean
- NHS Ayrshire and Arran, Crosshouse Hospital, Kilmarnock, Ayrshire, UK
| | - E Marston
- College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK
| | - J Zamora
- Hospital Ramon y Cajal, Madrid, Spain
| | - F Dawood
- Liverpool Women's Hospital, Liverpool, UK
| | - R Small
- Heart of England NHS Foundation Trust, Heartlands Hospital, Bordesley Green East, UK
| | - J Ross
- King's College Hospital, London, UK
| | - T Bourne
- Tommy's National Centre for Miscarriage, Research, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
| | - A Coomarasamy
- Tommy's National Centre for Miscarriage Research, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
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Maura F, Petljak M, Lionetti M, Cifola I, Liang W, Pinatel E, Alexandrov LB, Fullam A, Martincorena I, Dawson KJ, Angelopoulos N, Samur MK, Szalat R, Zamora J, Tarpey P, Davies H, Corradini P, Anderson KC, Minvielle S, Neri A, Avet-Loiseau H, Keats J, Campbell PJ, Munshi NC, Bolli N. Biological and prognostic impact of APOBEC-induced mutations in the spectrum of plasma cell dyscrasias and multiple myeloma cell lines. Leukemia 2018; 32:1044-1048. [PMID: 29209044 PMCID: PMC5886048 DOI: 10.1038/leu.2017.345] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- F Maura
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Cancer Genome Project, Wellcome Trust Sanger Institute, Hinxton, UK
| | - M Petljak
- Cancer Genome Project, Wellcome Trust Sanger Institute, Hinxton, UK
| | - M Lionetti
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Hematology, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - I Cifola
- Institute for Biomedical Technologies, National Research Council, Milan, Italy
| | - W Liang
- Integrated Cancer Genomics Division, Translational Genomics Research Institute, Phoenix, AZ, USA
| | - E Pinatel
- Institute for Biomedical Technologies, National Research Council, Milan, Italy
| | - L B Alexandrov
- Department of Cellular and Molecular Medicine, University of California, San Diego, La Jolla, CA, USA
- Department of Bioengineering, University of California, San Diego, La Jolla, CA, USA
- Moores Cancer Center, University of California, San Diego, La Jolla, CA, USA
| | - A Fullam
- Cancer Genome Project, Wellcome Trust Sanger Institute, Hinxton, UK
| | - I Martincorena
- Cancer Genome Project, Wellcome Trust Sanger Institute, Hinxton, UK
| | - K J Dawson
- Cancer Genome Project, Wellcome Trust Sanger Institute, Hinxton, UK
| | - N Angelopoulos
- Cancer Genome Project, Wellcome Trust Sanger Institute, Hinxton, UK
| | - M K Samur
- Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - R Szalat
- Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - J Zamora
- Cancer Genome Project, Wellcome Trust Sanger Institute, Hinxton, UK
| | - P Tarpey
- Cancer Genome Project, Wellcome Trust Sanger Institute, Hinxton, UK
| | - H Davies
- Cancer Genome Project, Wellcome Trust Sanger Institute, Hinxton, UK
| | - P Corradini
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Department of Oncology and Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - K C Anderson
- Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - S Minvielle
- CRCINA, INSERM, CNRS, Université d’Angers, Université de Nantes, Nantes, France and CHU de Nantes, Nantes, France
| | - A Neri
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Hematology, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - H Avet-Loiseau
- Genomics of Myeloma Laboratory, L’Institut Universitaire du Cancer Oncopole, Toulouse, France
| | - J Keats
- Integrated Cancer Genomics Division, Translational Genomics Research Institute, Phoenix, AZ, USA
| | - P J Campbell
- Cancer Genome Project, Wellcome Trust Sanger Institute, Hinxton, UK
| | - N C Munshi
- Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
- Boston Veterans Administration Healthcare System, West Roxbury, MA, USA
| | - N Bolli
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Cancer Genome Project, Wellcome Trust Sanger Institute, Hinxton, UK
- Department of Oncology and Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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22
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Allotey J, Zamora J, Cheong-See F, Kalidindi M, Arroyo-Manzano D, Asztalos E, van der Post JAM, Mol BW, Moore D, Birtles D, Khan KS, Thangaratinam S. Cognitive, motor, behavioural and academic performances of children born preterm: a meta-analysis and systematic review involving 64 061 children. BJOG 2017; 125:16-25. [DOI: 10.1111/1471-0528.14832] [Citation(s) in RCA: 216] [Impact Index Per Article: 30.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2017] [Indexed: 11/28/2022]
Affiliation(s)
- J Allotey
- Women's Health Research Unit; Barts and the London School of Medicine and Dentistry; Queen Mary University of London; London UK
- Multidisciplinary Evidence Synthesis Hub (mEsh); Queen Mary University of London; London UK
| | - J Zamora
- Women's Health Research Unit; Barts and the London School of Medicine and Dentistry; Queen Mary University of London; London UK
- CIBER Epidemiology and Public Health (CIBERESP); Madrid Spain
- Clinical Biostatistics Unit; Hospital Ramon y Cajal (IRYCIS); Madrid Spain
| | - F Cheong-See
- Women's Health Research Unit; Barts and the London School of Medicine and Dentistry; Queen Mary University of London; London UK
| | - M Kalidindi
- Women's Health Research Unit; Barts and the London School of Medicine and Dentistry; Queen Mary University of London; London UK
| | - D Arroyo-Manzano
- CIBER Epidemiology and Public Health (CIBERESP); Madrid Spain
- Clinical Biostatistics Unit; Hospital Ramon y Cajal (IRYCIS); Madrid Spain
| | - E Asztalos
- Department of Paediatrics and Obstetrics/Gynaecology; University of Toronto; Toronto ON Canada
| | - JAM van der Post
- Departments of Obstetrics and Gynaecology; Academic Medical Centre; University of Amsterdam; Amsterdam The Netherlands
| | - BW Mol
- The Robinson Research Institute; School of Paediatrics and Reproductive Health; University of Adelaide; Adelaide SA Australia
- The South Australian Health and Medical Research Institute; Adelaide SA Australia
| | - D Moore
- School of Psychology; University of Surrey; Guildford Surrey UK
| | - D Birtles
- School of Psychology; University of East London; London UK
| | - KS Khan
- Women's Health Research Unit; Barts and the London School of Medicine and Dentistry; Queen Mary University of London; London UK
- Multidisciplinary Evidence Synthesis Hub (mEsh); Queen Mary University of London; London UK
| | - S Thangaratinam
- Women's Health Research Unit; Barts and the London School of Medicine and Dentistry; Queen Mary University of London; London UK
- Multidisciplinary Evidence Synthesis Hub (mEsh); Queen Mary University of London; London UK
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Jimenez D, Martin-Saborido C, Muriel A, Zamora J, Morillo R, Barrios D, Klok E, Huisman M, Tapson V, Yusen R. P1613Efficacy and safety outcomes of recanalization procedures in patients with acute symptomatic pulmonary embolism: systematic review and network meta-analysis. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1613] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Sobhy S, Babiker Z, Zamora J, Khan KS, Kunst H. Maternal and perinatal mortality and morbidity associated with tuberculosis during pregnancy and the postpartum period: a systematic review and meta-analysis. BJOG 2017; 124:727-733. [PMID: 27862893 DOI: 10.1111/1471-0528.14408] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is a dearth of data on the clinical features and outcomes of active tuberculosis (TB) in pregnancy. Studies have shown varied results and the relationship between TB and adverse pregnancy outcomes remains unclear. OBJECTIVES We conducted a systematic review and meta-analysis to evaluate pregnancy outcomes associated with TB. SEARCH STRATEGY Major databases were searched from inception until December 2015 without restrictions using the terms: 'TB', 'pregnancy', 'maternal morbidity', 'mortality' and 'perinatal morbidity', 'mortality'. SELECTION CRITERIA We included studies that compared the outcomes of pregnant women with and without active TB. DATA COLLECTION AND ANALYSIS We computed odds ratios for maternal and perinatal complications, and pooled them using a random effects model. We assessed for heterogeneity using chi-squared tests and evaluated its magnitude using the I2 statistic. We used the Newcastle-Ottawa scale for quality assessment. MAIN RESULTS Thirteen studies, including 3384 pregnancies with active TB and 119 448 without TB were included. Compared with pregnant women without TB, pregnant women with active TB was associated with increased odds of maternal morbidity [odds ratio (OR) 2.8, 95% CI 1.7-4.6; I2 = 60.3%], anaemia (OR 3.9, 95% CI 2.2-6.7; I2 = 29.8%), caesarean delivery (OR 2.1, 95% CI 1.2-3.8; I2 = 61.1%), preterm birth (OR 1.7, 95% CI 1.2-2.4; I2 = 66.5%), low birth weight (OR 1.7, 95% CI 1.2-2.4; I2 = 53.7%), birth asphyxia (OR 4.6, 95% CI 2.4-8.6; I2 = 46.3), and perinatal death (OR 4.2, 95% CI 1.5-11.8; I2 = 57.2%). AUTHOR'S CONCLUSION Active TB in pregnancy is associated with adverse maternal and fetal outcomes. Early diagnosis of TB is important to prevent significant maternal and perinatal complications. TWEETABLE ABSTRACT Active tuberculosis in pregnancy is associated with adverse maternal and perinatal outcomes.
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Affiliation(s)
- S Sobhy
- Women's Health Research Unit, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Zoe Babiker
- Department of Infection, Royal London Hospital, Barts Health NHS Trust, London, UK
- Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE
| | - J Zamora
- Women's Health Research Unit, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Multidisciplinary Evidence Synthesis Hub (mEsh), Centre of Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK
- Clinical Biostatistics Unit, Hospital Ramon y Cajal (IRYCIS) and CIBER Epidemiology and Public Health, Madrid, Spain
| | - K S Khan
- Women's Health Research Unit, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Multidisciplinary Evidence Synthesis Hub (mEsh), Centre of Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK
| | - H Kunst
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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25
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Nijjar SK, D'Amico MI, Wimalaweera NA, Cooper NAM, Zamora J, Khan KS. Participation in clinical trials improves outcomes in women's health: a systematic review and meta-analysis. BJOG 2017; 124:863-871. [DOI: 10.1111/1471-0528.14528] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2016] [Indexed: 11/28/2022]
Affiliation(s)
- SK Nijjar
- Women's Health Research Unit; Centre for Primary Care and Public Health; Blizard Institute; Barts and The London School of Medicine and Dentistry; London UK
| | - MI D'Amico
- Women's Health Research Unit; Centre for Primary Care and Public Health; Blizard Institute; Barts and The London School of Medicine and Dentistry; London UK
| | | | - NAM Cooper
- Women's Health Research Unit; Centre for Primary Care and Public Health; Blizard Institute; Barts and The London School of Medicine and Dentistry; London UK
| | - J Zamora
- Women's Health Research Unit; Centre for Primary Care and Public Health; Blizard Institute; Barts and The London School of Medicine and Dentistry; London UK
- Clinical Biostatistics Unit; Hospital Ramon y Cajal (IRYCIS) and CIBER Epidemiologia y Salud Publica; Madrid Spain
| | - KS Khan
- Multidisciplinary Evidence Synthesis Hub (mEsh); Barts and the London School of Medicine and Dentistry; Queen Mary University; London UK
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26
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Duffy JMN, Chequer S, Braddy A, Mylan S, Royuela A, Zamora J, Ip J, Hayden S, Showell M, Kinnersley P, Chenoy R, Westwood OM, Khan KS, Cushing A. Educational effectiveness of gynaecological teaching associates: a multi-centre randomised controlled trial. BJOG 2016; 123:1005-10. [PMID: 26776314 DOI: 10.1111/1471-0528.13824] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2015] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To evaluate, among medical students learning the female pelvic examination, the added benefits of training by gynaecological teaching associates compared with training involving a manikin only. DESIGN Randomised controlled trial. SETTING Nine university teaching hospitals. POPULATION Ninety-four medical students recruited prior to commencing a 4-week obstetrics and gynaecology rotation. METHODS The control training consisted of lectures, demonstration of the pelvic examination on a manikin, and opportunities to practise on this low-fidelity simulation (n = 40). The experimental group received additional gynaecological teaching associate training, delivered by pairs of experienced associates to groups of four medical students (n = 54). MAIN OUTCOME MEASURES Outcomes measured at the end of the rotation included knowledge of the correct order of examination components (Yes/No), and student comfort [Likert scales anchored between 1 (very uncomfortable) and 4 (very comfortable) on four items] and confidence [Likert scales anchored between 1 (No) and 3 (Yes) on six items]. The primary outcome, measured at the end of the academic year, was the objective structured clinical examination of a female pelvis (score range 0-54). RESULTS At baseline, the groups were similar in age, gender, and ethnicity. At the end of the clinical rotation, when compared with the control intervention, the experimental intervention had a moderate effect on student knowledge [difference 29.9% (95% CI 11.2-48.6%); P = 0.002] and confidence [difference 1 (95% CI 0-2); P < 0.001], and a large effect on student comfort [difference 1.8 (95% CI 0.6-3.0); P = 0.004]. At the end of the academic year, the experimental intervention had no impact on skills compared with the control [difference 2 (95% CI-1 to 4); P = 0.26]. CONCLUSIONS Among medical students taught the female pelvic examination by low-fidelity simulation, additional training by gynaecology teaching associates improved knowledge, comfort, and confidence at the end of the clinical rotation but did not improve examination skills at end of the academic year.
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Affiliation(s)
- J M N Duffy
- Balliol College, University of Oxford, Oxford, UK
| | | | - A Braddy
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - S Mylan
- Department of Primary Care and Population Health, UCL Medical School, London, UK
| | - A Royuela
- Clinical Biostatistics Unit, Hospital Ramón y Cajal, Madrid, Spain
| | - J Zamora
- Clinical Biostatistics Unit, Hospital Ramón y Cajal, Madrid, Spain
| | - J Ip
- Department of Obstetrics and Gynaecology, Homerton University Hospital NHS Foundation Trust, London, UK
| | - S Hayden
- Clinical and Communication Skills Learning Unit, Institute of Health Sciences Education, Barts and the London School of Medicine and Dentistry, London, UK
| | - M Showell
- Cochrane Menstrual Disorders and Subfertility Group, University of Auckland, Auckland, New Zealand
| | - P Kinnersley
- Institute of Medical Education, Cardiff University, Cardiff, UK
| | - R Chenoy
- Women's Health Research Unit, Queen Mary, University of London, London, UK
| | - O M Westwood
- Clinical and Communication Skills Learning Unit, Institute of Health Sciences Education, Barts and the London School of Medicine and Dentistry, London, UK
| | - K S Khan
- Women's Health Research Unit, Queen Mary, University of London, London, UK
| | - A Cushing
- Clinical and Communication Skills Learning Unit, Institute of Health Sciences Education, Barts and the London School of Medicine and Dentistry, London, UK
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Allen RE, Morlando M, Thilaganathan B, Zamora J, Khan KS, Thangaratinam S, Bhide A. Predictive accuracy of second-trimester uterine artery Doppler indices for stillbirth: a systematic review and meta-analysis. Ultrasound Obstet Gynecol 2016; 47:22-27. [PMID: 26031231 DOI: 10.1002/uog.14914] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Revised: 05/06/2015] [Accepted: 05/11/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To assess the predictive accuracy for stillbirth of second-trimester uterine artery Doppler. METHODS We searched MEDLINE, EMBASE and The Cochrane Library databases from inception until March 2015 without language restrictions. The included studies were those that assessed the association of abnormal uterine artery Doppler parameters and stillbirth. Two independent reviewers selected the studies, extracted data and assessed quality. Results for studies that were performed in the second trimester were pooled and summary estimates of sensitivity, specificity, likelihood ratios and their 95% confidence intervals were obtained. An overall summary of test accuracy was provided by the diagnostic odds ratio. Subgroup analysis was performed according to whether the study population was high risk or unselected. RESULTS Literature searches returned 338 relevant citations with 32 considered in full. Thirteen studies met our search criteria (85 845 women, 508 stillbirths) and were included in the review. Bivariate pooled estimate for sensitivity was 65% (95% CI, 38-85%) and for specificity 82% (95% CI, 72-88%). The positive likelihood ratio was 3.5 (95% CI, 2.3-5.5) and negative likelihood ratio 0.43 (95% CI, 0.22-0.85). The diagnostic odds ratio was 8.3 (95% CI, 3.0-22.4). Heterogeneity was high in the studies of high-risk women. CONCLUSIONS Abnormal uterine artery Doppler indices are associated with a three- to four-fold increase in the risk of stillbirth. The heterogeneity was particularly high in the high-risk group rendering it impossible to draw firm conclusions. In view of this, there is a role for individual patient data meta-analysis to define which Doppler parameter and threshold value should be measured.
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Affiliation(s)
- R E Allen
- Fetal Medicine Centre, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - M Morlando
- Fetal Medicine Unit, St George's Healthcare NHS Trust, London, UK
| | - B Thilaganathan
- Fetal Medicine Unit, St George's Healthcare NHS Trust, London, UK
| | - J Zamora
- Clinical Biostatistics Unit, Hospital Ramon y Cajal (IRYCIS), Madrid, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - K S Khan
- Women's Health Research Unit, Multidisciplinary Evidence Synthesis Hub (mEsh), Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK
- London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - S Thangaratinam
- Women's Health Research Unit, Multidisciplinary Evidence Synthesis Hub (mEsh), Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK
- London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - A Bhide
- Fetal Medicine Unit, St George's Healthcare NHS Trust, London, UK
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Kovacs FM, Barriga A, Royuela A, Seco J, Zamora J. Spanish adaptation of the Quality of Life Index-Spinal Cord Injury version. Spinal Cord 2015; 54:895-900. [PMID: 26572603 DOI: 10.1038/sc.2015.200] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 09/29/2015] [Accepted: 10/08/2015] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN A cross-sectional, validation study. OBJECTIVES To (a) develop the Spanish version of the Quality of Life Index-Spinal Cord Injury version (SV-QLI/SCI) and (b) assess its psychometric characteristics among permanent wheelchair users and specifically among those with SCI. SETTING Associations of wheelchair users in Mallorca (Spain). METHODS Two forward and backward translations of the QLI/SCI into Spanish were carried out separately. Seventy-seven subjects were randomly selected among the members of the associations. They completed the SV-QLI/SCI and validated instruments to measure depression and spinal pain upon recruitment and 14 days later. Assessments included comprehensibility, reproducibility, floor and ceiling effects and correlations between quality of life, pain and depression (Spearman's correlation coefficient). Analyses were repeated excluding data from subjects without SCI. RESULTS Three items of the SV-QLI/SCI required rephrasing. Reproducibility was 'almost perfect' for the entire questionnaire and its 'Health and functioning' subscale, 'substantial' for the 'Social and economic' and 'Family' subscales and 'moderate' for the 'Psychological/spiritual' subscale. Floor effect was not observed, and only for the 'Family' subscale >3% of the subjects reached the maximum possible score. The correlation between quality of life and depression was the strongest (r=-0.628). Results were virtually identical in the subsample with SCI. CONCLUSION These results support the use of the SV-QLI/SCI among Spanish-speaking wheelchair users.
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Affiliation(s)
- F M Kovacs
- Research Department, Spanish Back Pain Research Nework, Kovacs Foundation, Palma de Mallorca, Spain.,Spanish Back Pain Research Network, Palma de Mallorca, Spain
| | - A Barriga
- Spanish Back Pain Research Network, Palma de Mallorca, Spain.,Hospital Nacional de Parapléjicos, Toledo, Spain
| | - A Royuela
- Spanish Back Pain Research Network, Palma de Mallorca, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Unidad de Bioestadística Clínica, Hospital Ramón y Cajal, IRYCIS, Madrid, Spain
| | - J Seco
- Spanish Back Pain Research Network, Palma de Mallorca, Spain.,Institute of Biomedicine (IBIOMED), University of León, University of the Basque Country, Campus Universitario, León, Spain
| | - J Zamora
- Spanish Back Pain Research Network, Palma de Mallorca, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Unidad de Bioestadística Clínica, Hospital Ramón y Cajal, IRYCIS, Madrid, Spain.,Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Troncoso M, Mateluna C, Parra P, Lara S, Hidalgo M, Muñoz D, Zamora J, Balut F. Pediatric arterial ischemic stroke: outcome and prognosis features. J Neurol Sci 2015. [DOI: 10.1016/j.jns.2015.09.083] [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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Cheze M, Hoizey G, Eliot E, Zamora J, Borlot AL, Toulourat T, Oudart R, Pepin G, Deveaux M. Nouvelles drogues : bilan à partir des saisies de produits analysés au laboratoire Toxlab sur la période 2012–014. Toxicologie Analytique et Clinique 2015. [DOI: 10.1016/j.toxac.2015.03.098] [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: 11/15/2022]
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Romo S, Castañeda S, Hernandez CA, Mendoza JH, Trejo FJ, Zamora J, Fernandez JE, Ducolomb Y, Kjelland ME. 315 IVF-DERIVED CROSSBRED EMBRYOS PRODUCED WITH SEXED SEMEN AND TRANSFERRED IN PAIRS TO BOS TAURUS × BOS INDICUS COWS AND HEIFERS. Reprod Fertil Dev 2015. [DOI: 10.1071/rdv27n1ab315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Biotechnology has continued to evolve rapidly, allowing the development of techniques to increase reproductive efficiency and contribute to the genetic improvement of cattle. Some of these techniques include the in vitro maturation (IVM) and IVF of oocytes, sperm sexing and embryo transfer (ET) to recipient females to obtain pregnancies and offspring. These modern assisted-reproduction techniques (ART) can help produce twin pregnancies and calving of a pre-determined sex. The aim of this study was to produce a high proportion of female bovine embryos in vitro using X-chromosome-selected sexed semen and to transfer them in pairs to recipient females, in order to evaluate the efficiency of transferring two female embryos in both cows and heifers. Cebu-cross ovaries were obtained from a local slaughterhouse and transported to a nearby laboratory in Chiapas, Mexico, to obtain cumulus-oocyte complexes by follicular aspiration and culture in maturation medium for 24 h. For IVF, frozen X-sorted semen (Milking Gyr and Holstein breeds, 90% purity, Sexing Technologies, Navasota, TX, USA) was used. Gametes were co-incubated for 22 h, then moved to embryo development medium and cultured for 7 days. Recipient Cebu-cross commercial cows (n = 98) and heifers (n = 50) were synchronized, using intravaginal devices impregnated with progesterone, administering eCG and prostaglandin at withdrawal. Seven days after heat, 88 recipients were subjected to non-surgical ET (59 cows and 29 heifers). Embryo transfers were performed in Tamaulipas and Veracruz, Mexico, and were divided into 2 groups: A) cows, and B) heifers. Only grade-1 embryos were selected for ET. Two embryos were loaded in a single 0.25 mL French straw and transferred to the uterine horn ipsilateral to the ovary with a corpus luteum. Pregnancy diagnosis was performed by ultrasound or rectal palpation 60 days after ET. A Fisher's exact test (SPSS v. 16.0, SPSS Inc., Chicago, IL, USA) was used to determine statistical differences (α = 0.05). Of IVF oocytes, 176/180 (98%) and 242/300 (81%) were fertilized, producing 96/180 (53.3%) Milking Gyr (semen)-Cebu (oocytes) and 92/300 (30.7%) Holstein (semen)-Cebu (oocytes) grade-1 embryos, respectively. Of the 88 recipients, 33 were pregnant (37.5%), however, it was not possible (at that time) to determine the number and sex of fetuses developing in utero. Overall, 8 of the 29 heifers were pregnant (27.6%), compared to 25 pregnancies in 59 cows (42.4%). For heifers, the pregnancy results for transferring Milking Gyr-Cebu embryos (4/11) versus Holstein-Cebu embryos (4/18) were not significantly different (P = 0.433, two-tailed Fisher's exact test). A similar comparison could not be made for cows given smaller sample sizes due to the extra variable of having taken place on several different ranches (n = 11). The concept herein is that smaller twin female crossbred calves may reduce issues associated with freemartinism and dystocia while still maintaining the vigor of crossbred offspring. Results from this research can help contribute to the study and development of ART for increasing cattle production efficiency.
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Shiohira S, Yoshida T, Sugiura H, Nishida M, Nitta K, Tsuchiya K, Grampp S, Goppelt-Strube M, Eckardt KU, Schodel J, Kang SW, Kim Y, Seo SK, Kim T, Ong S, Yang WS, Han NJ, Lee JM, Baek CH, Park SK, Kemter E, Aigner B, Wanke R, Troyano Suarez N, Olmos Centenero G, Mora I, Griera M, Cano JL, Martin P, Zamora J, Ruiz-Torres MP, Falke LL, Leask A, Lyons K, Nguyen TQ, Goldschmeding R, Park SK, Kim D, Lee AS, Jung YJ, Yang KH, Lee S, Kim W, Kim W, Kang KP, Garcia-Jerez A, Luengo-Rodriguez A, Ramirez-Chamond R, Carracedo J, Medrano-Andres D, Rodriguez-Puyol D, Calleros L, Kim HW, Park SK, Yang WS, Lee SK, Chang JW, Seo JW, Lee CT, Chou CA, Lee YT, Ng HY, Sanchez-Nino MD, Fernandez-Fernandez B, Perez-Gomez MV, Poveda J, Sanz AB, Cannata-Ortiz P, Egido J, Selgas R, Ortiz A, Ma SK, Kim IJ, Kim CS, Bae EH, Kim SW, Kokeny G, Boo'Si M, Fazekas K, Rosivall L, Mozes MM, Mijuskovic M, Ulrich C, Berger H, Trojanowicz B, Kohler F, Wolf A, Seibert E, Fiedler R, Markau S, Glomb M, Girndt M, Lajdova I, Spustova V, Oksa A, Chorvat D, Marcek Chorvatova A, Choi SO, Kim JS, Han BG, Yang JW, Liu S, Lv J, Chang R, Su F, Liang W, Zawada AM, Rogacev KS, Hundsdorfer J, Sester U, Fliser D, Heine GH, Chen JS, Cheng CW, Chang LC, Wu CZ, Novaes AS, Borges FT, Boim MA, Tramonti G, Romiti N, Chieli E, Hamahata S, Nagasawa Y, Kawabe M, Kida A, Yahiro M, Nanami M, Hasuike Y, Kuragano T, Nakasho K, Ohyama H, Nakanishi T, Tanaka S, Yano S, Sugimoto T, Bae E, Stevens KK, Hillyard DZ, Delles C, Jardine AG, Burke M, Morais C, Soyer P, Sinnya S, Winterford C, Oliver K, Lambie D, Staatz C, Carroll R, Campbell S, Isbel N, Felaco P, Pesce M, Patruno A, Sirolli V, Speranza L, Amoroso L, Franceschelli S, Bonomini M, Thilo F, Zakrzewicz A, Tepel M, Thilo F, Zakrzewicz A, Tepel M, Liu S, Li Y, Liang W, Su F, Wang B. CELL SIGNALLING AND APOPTOSIS. Nephrol Dial Transplant 2014. [DOI: 10.1093/ndt/gfu161] [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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Velauthar L, Plana MN, Kalidindi M, Zamora J, Thilaganathan B, Illanes SE, Khan KS, Aquilina J, Thangaratinam S. First-trimester uterine artery Doppler and adverse pregnancy outcome: a meta-analysis involving 55,974 women. Ultrasound Obstet Gynecol 2014; 43:500-507. [PMID: 24339044 DOI: 10.1002/uog.13275] [Citation(s) in RCA: 155] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/29/2013] [Indexed: 06/03/2023]
Abstract
OBJECTIVES To determine the accuracy with which uterine artery Doppler in the first trimester of pregnancy predicts pre-eclampsia and fetal growth restriction, particularly early-onset disease. METHODS We searched MEDLINE (1951-2012), EMBASE (1980-2012) and the Cochrane Library (2012) for relevant citations without language restrictions. Two reviewers independently selected studies that evaluated the accuracy of first-trimester uterine artery Doppler to predict adverse pregnancy outcome and performed data extraction to construct 2 × 2 tables. We synthesized sensitivity and specificity for various Doppler indices using a bivariate random-effects model. RESULTS From 1866 citations, we identified 18 studies (55,974 women). The sensitivity and specificity of abnormal uterine artery flow velocity waveform (FVW) in the prediction of early-onset pre-eclampsia were 47.8% (95% CI: 39.0-56.8) and 92.1% (95% CI: 88.6-94.6), and in the prediction of early-onset fetal growth restriction were 39.2% (95% CI: 26.3-53.8) and 93.1% (95% CI: 90.6-95.0), respectively. The sensitivities for predicting any pre-eclampsia and fetal growth restriction were 26.4% (95% CI: 22.5-30.8) and 15.4% (95% CI: 12.4-18.9), respectively, and the specificities were 93.4% (95% CI: 90.4-95.5%) and 93.3% (95% CI: 90.9-95.1), respectively. The number needed to treat (NNT) with aspirin to prevent one case of early-onset pre-eclampsia fell from 1000 to 173 and from 2500 to 421 for background risks varying between 1% and 0.4%, respectively. CONCLUSIONS First-trimester uterine artery Doppler is a useful tool for predicting early-onset pre-eclampsia, as well as other adverse pregnancy outcomes. Based on the NNT, abnormal uterine artery Doppler in low-risk women achieves a sufficiently high performance to justify aspirin prophylaxis in those who test positive.
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Affiliation(s)
- L Velauthar
- Women's Health Research Unit, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK; Women's Health Unit, Barts Health NHS Trust, London, UK
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Cerecedo I, Zamora J, Fox M, Voordouw J, Plana N, Rokicka E, Fernandez-Rivas M, Vázquez Cortés S, Reche M, Fiandor A, Kowalski M, Antonides G, Mugford M, Frewer LJ, De la Hoz B. The impact of double-blind placebo- controlled food challenge (DBPCFC) on the socioeconomic cost of food allergy in Europe. J Investig Allergol Clin Immunol 2014; 24:418-424. [PMID: 25668893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND Double-blind placebo controlled food challenge (DBPCFC) is the gold standard diagnostic test in food allergy because it minimizes diagnostic bias. OBJECTIVE To investigate the potential effect of diagnosis on the socioeconomic costs of food allergy. METHODS A prospective longitudinal cost analysis study was conducted in Spain and Poland within the EuroPrevall project. Food-allergic patients were enrolled into the study and in all cases diagnosis was confirmed through a standardized DBPCFC. Data were collected through a self-administered survey on all aspects of health and social care resource use, costs of living, and costs of leisure activities. Costs were measured before and 6 months after the DBPCFC and reported in international dollars with 2007 as the benchmark year. RESULTS Forty-two patients were enrolled. Twenty-one patients had a negative DBPCFC and the suspected food was reintroduced into their diet. Comparing total direct costs before and after the DBPCFC, the reactive group spent a significantly higher amount (median increase of $813.1 over baseline), while the tolerant group's spending decreased by a median of $87.3 (P = .031). The amount of money spent on food 6 months after diagnosis was also significantly higher in the reactive group (P = .040). Finally, a larger, but not statistically significant, decrease in total indirect costs was observed in the tolerant group compared with the reactive group ($538.3 vs $32.3). CONCLUSION DBPCFC has an impact on indirect and direct costs of living. The main contribution to this increase was money spent on food.
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Joshi M, Royuela A, Zamora J. Proper analysis in clinical trials: how to report and adjust for missing outcome data. BJOG 2013; 120:915-9. [DOI: 10.1111/1471-0528.12219] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2013] [Indexed: 11/30/2022]
Affiliation(s)
- M Joshi
- Centre for Primary Care and Public Health; Barts and The London School of Medicine and Dentistry; London; UK
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Yildirim T, Yilmaz R, Altindal M, Turkmen E, Arici M, Altun B, Erdem Y, Guliyev O, Erkmen Uyar M, Tutal E, Bal Z, Sezer S, Erkmen Uyar M, Bal U, Bal Z, Tutal E, Say n B, Guliyev O, Erdemir B, Sezer S, O'Rourke-Potowki A, Gauge N, Penny H, Cronin A, Frame S, Goldsmith DJ, Yagan JA, Chandraker A, Velickovic Radovanovic RM, Catic Djordjevic A, Mitic B, Stefanovic N, Cvetkovic T, Serpieri N, Grosjean F, Sileno G, Torreggiani M, Esposito V, Mangione F, Abelli M, Castoldi F, Catucci D, Esposito C, Dal Canton A, Vatazin AV, Zulkarnaev AB, Borst C, Liu Y, Thoning J, Tepel M, Libetta C, Margiotta E, Borettaz I, Canevari M, Martinelli C, Lainu E, Abelli M, Meloni F, Sepe V, Dal Canton A, Miguel Costa R, Vasquez Martul E, Reboredo J, Rivera C, Simonato F, Tognarelli G, Daidola G, Gallo E, Burdese M, Cantaluppi V, Biancone L, Segoloni GP, Burdese M, Priora M, Messina M, Tamagnone M, Daidola G, Linsalata A, Lavacca A, Biancone L, Segoloni G, Zuidema W, Erdman R, van de Wetering J, Dor F, Roodnat J, Massey E, Timmerman L, IJzermans J, Weimar W, Goldsmith DJ, Sibley-Allen C, Hilton R, Moghul M, Burnapp L, Blake G, Koo TY, Park JS, Park HC, Kim GH, Lee CH, Oh IH, Kang CM, Hwang JK, Park SC, Choi BS, Chun HJ, Kim JI, Yang CW, Moon IS, Van Laecke S, Van Biesen W, Nagler EV, Taes Y, Peeters P, Vanholder R, Pruthi R, Ravanan R, Casula A, Harber M, Roderick P, Fogarty D, Cho A, Shin JH, Jang HR, Lee JE, Huh W, Kim DJK, Oh HY, Kim YG, Sancho Calabuig A, Gavela Martinez E, Kanter Berga J, Beltran Catalan S, Avila Bernabeu AI, Pallardo Mateu LM, Gonzalez E, Polanco N, Molina M, Gutierrez E, Garcia Puente L, Sevillano A, Morales E, Praga M, Andres A, Banasik M, Boratynska M, Koscielska-Kasprzak K, Bartoszek D, Myszka M, Zmonarski S, Nowakowska B, Wawrzyniak E, Halon A, Chudoba P, Klinger M, Rojas-Rivera J, Gonzalez E, Polanco N, Morales E, Andres A, Morales JM, Egido J, Praga M, Kopecky CM, Haidinger M, Kaltenecker C, Antlanger M, Marsche G, Holzer M, Kovarik J, Werzowa J, Hecking M, Saemann MD, Hwang JK, Kim JM, Koh ES, Chung BH, Park SC, Choi BS, Kim JI, Yang CW, Kim YS, Moon IS, Banasik M, Boratynska M, Koscielska-Kasprzak K, Krajewska M, Mazanowska O, Kaminska D, Bartoszek D, Zabinska M, Halon A, Malkiewicz B, Patrzalek D, Klinger M, Sulowicz J, Szostek S, Wojas-Pelc A, Ignacak E, Sulowicz W, Bellizzi V, Calella P, Cupisti A, Capitanini A, D'Alessandro C, Giannese D, Camocardi A, Conte G, Barsotti M, Bilancio G, Luciani R, Locsey L, Seres I, Kovacs D, Asztalos L, Paragh G, Wohlfahrtova M, Balaz P, Rokosny S, Wohlfahrt P, Bartonova A, Viklicky O, Kers J, Geskus RB, Meijer LJ, Bemelman F, ten Berge IJM, Florquin S, Hwang JC, Jiang MY, Lu YH, Weng SF, Testa A, Porto G, Sanguedolce M, Spoto B, Parlongo R, Pisano A, Enia G, Tripepi G, Zoccali C, Zuidema W, Mamode N, Lennerling A, Citterio F, Massey E, Van Assche K, Sterckx S, Frunza M, Jung H, Pascalev A, Johnson R, Loven C, Weimar W, Dor F, Soleymanian T, Keyvani H, Jazayeri SM, Fazeli Z, Ghamari S, Mahabadi M, Chegeni V, Najafi I, Ganji MR, Meys KME, Groothoff JW, Jager K, Schaefer F, Tonshoff B, Mota C, Cransberg K, van Stralen K, Gurluler E, Gures N, Alim A, Gurkan A, Cakir U, Berber I, Van Laecke S, Caluwe R, Nagler E, Van Biesen W, Peeters P, Van Vlem B, Vanholder R, Sulowicz J, Wojas-Pelc A, Ignacak E, Betkowska-Prokop A, Kuzniewski M, Krzanowski M, Sulowicz W, Masson I, Flamant M, Maillard N, Cavalier E, Moranne O, Alamartine E, Mariat C, Delanaye P, Canas Sole LL, Iglesias Alvarez E, Pastor MCMC, Moreno Flores FF, Abujder VV, Graterol FF, Bonet Sol JJ, Lauzurica Valdemoros RR, Yoshikawa M, Kitamura K, Nakai K, Goto S, Fujii H, Ishimura T, Takeda M, Fujisawa M, Nishi S, Prasad N, Gurjer D, Bhadauria D, Gupta A, Sharma R, Kaul A, Cybulla M, West M, Nicholls K, Torras J, Sunder-Plassmann G, Feriozzi S, Lo S, Wong PYH, Ip D, Wong CK, Chow VCC, Mo SKL, Molnar M, Ujszaszi A, Czira ME, Novak M, Mucsi I, Cruzado JM, Coelho S, Porta N, Bestard O, Melilli E, Taco O, Rivas I, Grinyo J, Pouteau LM, N'Guyen JM, Hami A, Hourmant M, Ghahramani N, Karparvar Z, Shadrou S, Ghahramani M, Fauvel JP, Hadj-Aissa A, Buron F, Morelon E, Ducher M, Heine C, Glander P, Neumayer HH, Budde K, Liefeldt L, Montero N, Webster AC, Royuela A, Zamora J, Crespo M, Pascual J, Adema AY, van Dorp WTH, Mallat MJK, de Fijter HW, Kim YS, Hong YA, Chung BH, Park CW, Yang CW, Kim YS, Choi BS, Suleymanlar G, Uzundurukan Z, Kapuagas A, Sencan I, Akdag R, Pascual J, Torio A, Mas V, Perez-Saez MJ, Mir M, Faura A, Montes-Ares O, Checa MD, Crespo M, Sawinski D, Trofe-Clark J, Sparkes T, Patel P, Goral S, Bloom R, Kim HJ, Park SJ, Kim TH, Kim YW, Kim YH, Kang SW, Abdel Halim M, Gheith O, Al-Otaibi T, Mosaad A, Awadeen W, Said T, Nair P, Nampoory MRN. Transplantation: clinical studies - A. Nephrol Dial Transplant 2013. [DOI: 10.1093/ndt/gft123] [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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García-Blázquez V, Vicente-Bártulos A, Olavarria-Delgado A, Plana MN, van der Winden D, Zamora J. Accuracy of CT angiography in the diagnosis of acute gastrointestinal bleeding: systematic review and meta-analysis. Eur Radiol 2012. [PMID: 23192375 DOI: 10.1007/s00330-012-2721-x] [Citation(s) in RCA: 100] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To assess the diagnostic accuracy of computed tomography (CT) angiography in the evaluation of patients with an episode of acute gastrointestinal haemorrhage. METHODS Systematic review and meta-analysis to estimate pooled accuracy indices. A bivariate random effects model was adjusted to obtain a summary receiver-operating characteristic (sROC) curve and the corresponding area under the curve (AUC). RESULTS Twenty-two studies were included and provided data on 672 patients (range of age 5-74) with a mean age of 65 years. The overall sensitivity of CT angiography for detecting active acute GI haemorrhage was 85.2 % (95 % CI 75.5 % to 91.5 %). The overall specificity of CT angiography was 92.1 % (95 % CI 76.7 % to 97.7 %). The likelihood ratios for positive and negative test results were 10.8 (95 % CI 3.4 to 34.4) and 0.16 (95 % CI 0.1 to 0.27) respectively, with an AUC of 0.935 (95 % CI 0.693 to 0.989). The sources of heterogeneity explored had no significant impact on diagnostic performance. CONCLUSIONS CT shows high diagnostic accuracy and is an excellent diagnostic tool for detection and localising of intestinal bleeding sites. It is highly available, provides fast detection and localisation of the bleeding site, and is minimally invasive. KEY POINTS • CT angiography is increasingly used for investigating severe gastrointestinal bleeding. • This systematic review and meta-analysis updates previous ones. • In patients with massive gastrointestinal bleeding, CT angiography/MDCT detects bleeding accurately. • CT angiography is useful in locating the bleeding site and determining appropriate treatment.
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Affiliation(s)
- V García-Blázquez
- Department of Radiology, University Hospital Ramón y Cajal, Madrid, Spain
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Blake M, De La Mata D, Zamora J, Peña O, Macedo O, Flores Estrada D, Turcott J, Arrieta O. Phase II Trial: Concurrent Chemotherapy and Radiation Therapy With Nitroglycerin in Locally Advanced Non-small Cell Lung Cancer Patients. Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.1529] [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: 10/27/2022]
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Cáceres P, Zamora J. EP-1257 PALLIATIVE RADIOTHERAPY IN THE TREATMENT OF GASTRIC AND GASTROESOPHAGIC UNION CANCER. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)71590-6] [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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De La Mata M, Arrieta O, Blake-Cerda M, Villareal-Garza C, Martinez-Barrera L, Zamora J, Gallardo D. Long-term Survival in Patients with Non-small Cell Lung Cancer and Synchronous Brain Metastasis Treated with Whole-brain Radiotherapy and Thoracic Chemo-radiation. Int J Radiat Oncol Biol Phys 2011. [DOI: 10.1016/j.ijrobp.2011.06.1140] [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: 11/16/2022]
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Zamora J, Velásquez A, Troncoso L, Barra P, Guajardo K, Castillo-Duran C. [Zinc in the therapy of the attention-deficit/hyperactivity disorder in children. A preliminar randomized controlled trial]. Arch Latinoam Nutr 2011; 61:242-246. [PMID: 22696891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The attention-deficit/hyperactivity disorder (ADHD) is a neurological/behavioral disorder which begins in childhood. Zinc has a potential role as an adjuvant therapy for ADHD. The objective was to evaluate the effect ofZn supplementation on behavior, as a complementary therapy to metylphenidate, in pediatrics patients with ADHD. In a controlled, double blind design, 40 patients with clinical criteria ofADHD (DSM-IV) and psychometric evaluation (WISC-R), were selected (31 boys and 9 girls, 7-14 years of age). They were randomized to receive methylphenidate 0.3 mg/kg/d + placebo (sucrose) (group placebo, GPL) or methylphenidate 0.3 mg/kg/d + zinc (sulfate) 10 mg/d (group Zn, GZN) for 6 weeks. A blood sample was drawn at time 0 and 6 weeks, for plasma Zn analysis. The teacher and parent ADHD rating scale (Conners' global index, CGI) was applied at both times. Among the results, plasma Zn was normal at time 0, decreasing especially in the GPL after 6 weeks (GPL: 95.9 +/- 21.5 to 77.9 +/- 15.5; GZN: 90.3 +/- 9.1 to 85.0 +/- 12.0 microg/dL; NS). The CGI by teachers showed a non-significant improvement with Zn: GPL: 18 (9-28) to 16 points (2-26); GZN: 19 (6-24) to 11 points (3-23) (p = 0.07); no significant difference in the CGI by parents by groups was found: GPL: 19 (7-25) to 13 (3-22); GZN: 19(7-25) to 11(2-19). We conclude that a decrease in plasma Zn levels in both groups was found, greater in the placebo group. An apparent improvement in ADHD signs in children was observed with the Zn supplementation, according to the Conners global index by teachers.
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Affiliation(s)
- José Zamora
- Departamento de Pediatría, Facultad de Medicina Campus Centro, Universidad de Chile. Servicio de Neuropsiquiatría Infantil, Hospital San Boja-Arriarán, Chile
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Chan YY, Jayaprakasan K, Zamora J, Thornton JG, Raine-Fenning N, Coomarasamy A. The prevalence of congenital uterine anomalies in unselected and high-risk populations: a systematic review. Hum Reprod Update 2011; 17:761-71. [PMID: 21705770 PMCID: PMC3191936 DOI: 10.1093/humupd/dmr028] [Citation(s) in RCA: 349] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The prevalence of congenital uterine anomalies in high-risk women is unclear, as several different diagnostic approaches have been applied to different groups of patients. This review aims to evaluate the prevalence of such anomalies in unselected populations and in women with infertility, including those undergoing IVF treatment, women with a history of miscarriage, women with infertility and recurrent miscarriage combined, and women with a history of preterm delivery. METHODS Searches of MEDLINE, EMBASE, Web of Science and the Cochrane register were performed. Study selection and data extraction were conducted independently by two reviewers. Studies were grouped into those that used ‘optimal’ and ‘suboptimal’ tests for uterine anomalies. Meta-analyses were performed to establish the prevalence of uterine anomalies and their subtypes within the various populations. RESULTS We identified 94 observational studies comprising 89 861 women. The prevalence of uterine anomalies diagnosed by optimal tests was 5.5% [95% confidence interval (CI), 3.5–8.5] in the unselected population, 8.0% (95% CI, 5.3–12) in infertile women, 13.3% (95% CI, 8.9–20.0) in those with a history of miscarriage and 24.5% (95% CI, 18.3–32.8) in those with miscarriage and infertility. Arcuate uterus is most common in the unselected population (3.9%; 95% CI, 2.1–7.1), and its prevalence is not increased in high-risk groups. In contrast, septate uterus is the most common anomaly in high-risk populations. CONCLUSIONS Women with a history of miscarriage or miscarriage and infertility have higher prevalence of congenital uterine anomalies compared with the unselected population.
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Affiliation(s)
- Y Y Chan
- Department of Obstetrics and Gynaecology, Nottingham University Hospitals NHS Trust, Queen's Medical Centre Campus, Derby Road, Nottingham NG7 2UH, UK.
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García‐Castillo M, del Campo R, Baquero F, Morosini M, Turrientes M, Zamora J, Cantón R. Stationary biofilm growth normalizes mutation frequencies and mutant prevention concentrations in Pseudomonas aeruginosa from cystic fibrosis patients. Clin Microbiol Infect 2011; 17:704-11. [DOI: 10.1111/j.1469-0691.2010.03317.x] [Citation(s) in RCA: 9] [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: 11/30/2022]
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Vañó-Galván S, Hidalgo Á, Aguayo-Leiva I, Gil-Mosquera M, Ríos-Buceta L, Plana M, Zamora J, Martorell-Calatayud A, Jaén P. Teledermatología diferida: análisis de validez en una serie de 2.000 observaciones. Actas Dermo-Sifiliográficas 2011; 102:277-83. [DOI: 10.1016/j.ad.2010.11.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2010] [Revised: 11/03/2010] [Accepted: 11/03/2010] [Indexed: 11/27/2022] Open
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Arana E, Kovacs FM, Royuela A, Estremera A, Sarasíbar H, Amengual G, Galarraga I, Martínez C, Muriel A, Abraira V, Zamora J, Campillo C. Influence of nomenclature in the interpretation of lumbar disk contour on MR imaging: a comparison of the agreement using the combined task force and the nordic nomenclatures. AJNR Am J Neuroradiol 2011; 32:1143-8. [PMID: 21493764 DOI: 10.3174/ajnr.a2448] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The CTF nomenclature had not been tested in clinical practice. The purpose of this study was to compare the reliability and diagnostic confidence in the interpretation of disk contours on lumbar 1.5T MR imaging when using the CTF and the Nordic nomenclatures. MATERIALS AND METHODS Five general radiologists from 3 hospitals blindly and independently assessed intravertebral herniations (Schmorl node) and disk contours on the lumbar MR imaging of 53 patients with low back pain, on 4 occasions. Measures were taken to minimize the risk of recall bias. The Nordic nomenclature was used for the first 2 assessments, and the CTF nomenclature, in the remaining 2. Radiologists had not previously used either of the 2 nomenclatures. κ statistics were calculated separately for reports deriving from each nomenclature and were categorized as almost perfect (0.81-1.00), substantial (0.61-0.80), moderate (0.41-0.60), fair (0.21-0.40), slight (0.00-0.20), and poor (<0.00). RESULTS Categorization of intra- and interobserver agreement was the same across nomenclatures. Intraobserver reliability was substantial for intravertebral herniations and disk contour abnormalities. Interobserver reliability was moderate for intravertebral herniations and fair to moderate for disk contour. CONCLUSIONS In conditions close to clinical practice, regardless of the specific nomenclature used, a standardized nomenclature supports only moderate interobserver agreement. The Nordic nomenclature increases self-confidence in an individual observer's report but is less clear regarding the classification of disks as normal versus bulged.
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Affiliation(s)
- E Arana
- Department of Radiology, Fundación Instituto Valenciano de Oncología, Valencia, Spain.
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Morris RK, Malin G, Robson SC, Kleijnen J, Zamora J, Khan KS. Fetal umbilical artery Doppler to predict compromise of fetal/neonatal wellbeing in a high-risk population: systematic review and bivariate meta-analysis. Ultrasound Obstet Gynecol 2011; 37:135-142. [PMID: 20922778 DOI: 10.1002/uog.7767] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/02/2010] [Indexed: 05/29/2023]
Abstract
OBJECTIVE We investigated the accuracy of fetal umbilical artery Doppler to predict the risk of compromise of fetal/neonatal wellbeing in a high-risk population. METHODS Searches in MEDLINE, Embase, The Cochrane Library and Medion (from inception to March 2009) were carried out, together with hand searching of relevant journals, reference list checking of included articles and contact with experts. Criteria for selection were observational studies with umbilical artery Doppler used in a high-risk pregnant population with an outcome measure for compromise of fetal/neonatal wellbeing. Data on study design, quality and results were extracted to construct 2 × 2 tables. Bivariate meta-analysis was performed. Likelihood ratios (LRs) were used as the summary measure of accuracy. RESULTS One-hundred and four studies met the selection criteria (19 191 fetuses). In a high-risk population, umbilical artery Doppler predicted small-for-gestational age with a pooled LR+ of 3.76 (2.96, 4.76) and pooled LR- of 0.52 (0.45, 0.61), and compromise of fetal/neonatal wellbeing with a pooled LR+ of 3.41 (2.68, 4.34) and pooled LR- of 0.55 (0.48, 0.62). In this group it was also possible to predict, with accuracy, intrauterine death (pooled LR+ = 4.37 (0.88, 21.8); pooled LR- = 0.25 (0.07, 0.91)) and acidosis (pooled LR+ = 2.75 (1.48, 5.11); pooled LR- = 0.58 (0.36, 0.94)). CONCLUSIONS In a high-risk population, fetal umbilical artery Doppler is a moderately useful test with which to predict mortality and risk of compromise.
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Affiliation(s)
- R K Morris
- Department of Obstetrics and Gynaecology, University of Birmingham, Birmingham Women's Hospital, Birmingham, UK.
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Vañó-Galván S, Hidalgo Á, Aguayo-Leiva I, Gil-Mosquera M, Ríos-Buceta L, Plana M, Zamora J, Martorell-Calatayud A, Jaén P. Store-and-Forward Teledermatology: Assessment of Validity in a Series of 2000 Observations. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/s1578-2190(11)70803-4] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Ruvolo G, Giovannelli L, Schillaci R, Alimondi P, Pane A, Perino A, Cittadini E, Lambers MJ, Groeneveld E, Stakelbeek MEF, van den Belt-Dusebout AW, Mooij TM, Heymans MW, Schats R, Hompes PGA, Hoek A, Burger CW, van Leeuwen FE, Lambalk CB, Cobo Cabal A, Garrido N, Castello D, de los Santos MJ, Pellicer A, Remohi J, Sunkara SK, Rittenberg V, Raine-Fenning N, Bhattacharya S, Zamora J, Coomarasamy A, Ahuja KK, Andonov M, Wang JJ, Linara E, Nair S. SELECTED ORAL COMMUNICATION SESSION, SESSION 21: FEMALE FERTILITY AND ART, Monday 4 July 2011 15:15 - 16:30. Hum Reprod 2011. [DOI: 10.1093/humrep/26.s1.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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