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Feferkorn I, Albar M, Suarthana E, Ao A, Zhang XY, Zhang L, Dr EP, Hizkiyahu R, Liu KE, Buckett WM, Raina J. THE BLASTULATION RATE AND THE RATIO OF 1PN/2PN EMBRYOS ARE ASSOCIATED WITH THE COHORT OF EMBRYOS PLOIDY RATIO. Fertil Steril 2022. [DOI: 10.1016/j.fertnstert.2022.08.705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Mahutte N, Meng L, Lanes A, Liu KE. Reply of the Authors: Quality or quantity? Pitfalls of assessing the effect of endometrial thickness on live birth rates. Fertil Steril 2022; 118:429. [PMID: 35725673 DOI: 10.1016/j.fertnstert.2022.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 05/10/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Neal Mahutte
- The Montreal Fertility Centre, Montreal, Québec, Canada
| | | | | | - Kimberly E Liu
- Division of Reproductive Endocrinology & Infertility, Department of Obstetrics & Gynecology, University of Toronto, Toronto, Ontario, Canada
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Mahutte N, Hartman M, Meng L, Lanes A, Luo ZC, Liu KE. Optimal endometrial thickness in fresh and frozen-thaw in vitro fertilization cycles: an analysis of live birth rates from 96,000 autologous embryo transfers. Fertil Steril 2022; 117:792-800. [PMID: 35109980 DOI: 10.1016/j.fertnstert.2021.12.025] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 12/19/2021] [Accepted: 12/22/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To study the effect of increasing endometrial thickness on live birth rates in fresh and frozen-thaw embryo transfer (FET) cycles. DESIGN Retrospective cohort study. SETTING National data from Autologous in vitro fertilization (IVF) embryo transfer and FET cycles in Canada from the Canadian Assisted Reproductive Technology Registry Plus (CARTR Plus) database for records between January 2013 and December 2019. PATIENTS Thirty-three Canadians clinics participated in voluntary reporting of IVF and pregnancy outcomes to the Canadian Assisted Reproductive Technology Registry Plus database, and a total of 43,383 fresh and 53,377 frozen transfers were included. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Clinical pregnancy, pregnancy loss, and live birth rates. RESULTS In fresh IVF-embryo transfer cycles, increasing endometrial thickness is associated with significant increases in the mean number of oocytes retrieved, peak estradiol levels, number of usable embryos, clinical pregnancy rates, live birth rates, and mean term singleton birth weights, and a decrease in pregnancy loss rates. However, live birth rates plateau after 10-12 mm. In contrast, in FET cycles live birth rates plateau after the endometrium measures 7-10 mm. The improvement in live birth rates with increasing endometrial thickness was independent of patient age, timing of embryo transfer (e.g., cleavage stage vs. blastocyst stage), or the number of oocytes at retrieval. CONCLUSIONS In cycles with a fresh embryo transfer, live birth rates increase significantly until an endometrial thickness of 10-12 mm, while in FET cycles live birth rates plateau after 7-10 mm. However, an endometrial thickness <6 mm was associated clearly with a dramatic reduction in live birth rates in fresh and frozen embryo transfer cycles.
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Affiliation(s)
- Neal Mahutte
- The Montreal Fertility Centre, Montreal, Québec.
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Jones CA, Mehta C, Zwingerman R, Liu KE. Fertility patients' use and perceptions of online fertility educational material. Fertil Res Pract 2020; 6:11. [PMID: 32695432 PMCID: PMC7368747 DOI: 10.1186/s40738-020-00083-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 07/15/2020] [Indexed: 12/03/2022]
Abstract
Background Online educational information is highly sought out by patients with infertility. This study aims to assess patient-reported usage and helpfulness of fertility educational material on a clinic website and social media accounts. Methods Educational material was created on common fertility topics in text and video format and posted on the clinic website and social media accounts. At the first consultation for infertility, patients were provided with a postcard directing them to material online. At the first follow-up appointment, patients were invited to fill out a survey assessing whether patients viewed the online educational material and if they found the information helpful. Results 98.4% (251/255) of patients completed the survey, of which 42.6% (106/249) looked at the online material. Of those who viewed the online information, 99.1% (115/116) found the information helpful or somewhat helpful and 67.6% (73/108) found reading the material online better prepared them for making fertility decisions at their doctor’s appointment Conclusion Patients found online fertility information on the clinic website and social media accounts useful for making fertility treatment decisions. Providing online educational material has the potential to improve patient care by empowering patients with the knowledge to make more informed treatment decisions, and improving the quality of the time spent with the physician.
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Affiliation(s)
- Claire Ann Jones
- Mount Sinai Fertility, Sinai Health System, 250 Dundas St. West, Suite 700, Toronto, Ontario M5T 2Z5 Canada.,Department of Obstetrics and Gynaecology, University of Toronto, 123 Edward St., Suite 1200, Toronto, Ontario M5G 1E2 Canada
| | - Chaula Mehta
- Department of Obstetrics and Gynaecology, University of Toronto, 123 Edward St., Suite 1200, Toronto, Ontario M5G 1E2 Canada
| | - Rhonda Zwingerman
- Mount Sinai Fertility, Sinai Health System, 250 Dundas St. West, Suite 700, Toronto, Ontario M5T 2Z5 Canada.,Department of Obstetrics and Gynaecology, University of Toronto, 123 Edward St., Suite 1200, Toronto, Ontario M5G 1E2 Canada
| | - Kimberly E Liu
- Mount Sinai Fertility, Sinai Health System, 250 Dundas St. West, Suite 700, Toronto, Ontario M5T 2Z5 Canada.,Department of Obstetrics and Gynaecology, University of Toronto, 123 Edward St., Suite 1200, Toronto, Ontario M5G 1E2 Canada
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Zwingerman R, Melenchuk K, McMahon E, Liu KE, Siren A, Laferriere N, Greenblatt EM. Expanding Urgent Oncofertility Services for Reproductive Age Women Remote from a Tertiary Level Fertility Centre by Use of Telemedicine and an On-site Nurse Navigator. J Cancer Educ 2020; 35:515-521. [PMID: 30820926 DOI: 10.1007/s13187-019-01490-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The objective of this study was to examine a 1-year pilot program aimed at increasing access to fertility preservation (FP) information and services for reproductive-age women newly diagnosed with cancer at a centre geographically remote from a tertiary fertility clinic. An oncofertility nurse navigator (ONN) position was created within the regional cancer centre with the goals of (1) improving local physician knowledge of FP and FP services and (2) improving patient access to FP counselling and services. The ONN identified all women diagnosed with cancer requiring treatment that could impact their fertility and discussed FP options with them and their physicians. As part of a comprehensive program aimed at facilitating access to FP services, the ONN arranged consultations with fertility specialists via telemedicine and coordinated satellite cycle monitoring with a local gynaecologist in order to minimize travel. Patients were surveyed about their reproductive plans, decision-making around FP and experiences with the program. Physicians were surveyed about their engagement with FP services, barriers to FP access and satisfaction with the program. Twenty-two women were eligible for FP during the year-long pilot program. All participated in the study. The most common diagnoses were breast and cervical cancer. At the time of diagnosis, 36.4% of women had no biological children and 68.2% did not desire (more) children. Four women had an FP consultation, and two proceeded with oocyte or embryo cryopreservation. At the end of the pilot program, more physician respondents often or always discussed FP with their patients, stated they frequently refer for FP consultations and stated their patients could obtain FP services in a timely fashion. An ONN within a cancer centre remote from tertiary fertility care can enable access to FP services with minimal need for travel by using local gynaecologic expertise and telemedicine.
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Affiliation(s)
- Rhonda Zwingerman
- Mount Sinai Fertility, Mount Sinai Hospital, Sinai Health System, Toronto, ON, Canada.
- Department of Obstetrics & Gynaecology, University of Toronto, Toronto, ON, Canada.
| | - Karen Melenchuk
- Regional Cancer Care Northwest, Thunder Bay, ON, Canada
- Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada
| | - Eileen McMahon
- Mount Sinai Fertility, Mount Sinai Hospital, Sinai Health System, Toronto, ON, Canada
| | - Kimberly E Liu
- Mount Sinai Fertility, Mount Sinai Hospital, Sinai Health System, Toronto, ON, Canada
- Department of Obstetrics & Gynaecology, University of Toronto, Toronto, ON, Canada
| | - Andrew Siren
- Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada
| | - Nicole Laferriere
- Regional Cancer Care Northwest, Thunder Bay, ON, Canada
- Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada
| | - Ellen M Greenblatt
- Mount Sinai Fertility, Mount Sinai Hospital, Sinai Health System, Toronto, ON, Canada
- Department of Obstetrics & Gynaecology, University of Toronto, Toronto, ON, Canada
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Liu KE, Hartman M, Hartman A, Luo ZC, Mahutte N. The impact of a thin endometrial lining on fresh and frozen-thaw IVF outcomes: an analysis of over 40 000 embryo transfers. Hum Reprod 2019; 33:1883-1888. [PMID: 30239738 PMCID: PMC6145412 DOI: 10.1093/humrep/dey281] [Citation(s) in RCA: 166] [Impact Index Per Article: 33.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 08/24/2018] [Indexed: 12/20/2022] Open
Abstract
STUDY QUESTION Does each millimeter decrease in endometrial thickness lead to lower pregnancy and live birth rates in fresh and frozen IVF cycles? SUMMARY ANSWER Clinical pregnancy and live birth rates decline as the endometrial thickness decreases below 8 mm in fresh IVF-ET and below 7 mm in frozen–thaw embryo transfer (ET) cycles. WHAT IS KNOWN ALREADY Previous studies have been heterogenous and have shown conflicting results on the impact of endometrial thickness on IVF outcomes. Most studies do not include many patients with an endometrial thickness below 6 mm, and there are few studies of frozen–thaw ET cycles. STUDY DESIGN, SIZE, DURATION This study is a retrospective cohort analysis of all Canadian IVF fresh and frozen–thaw ET cycles from the CARTR-BORN database for autologous and donor fresh and frozen–thaw IVF-ET cycles from 1 January 2013 to 31 December 2015. A total of 24 363 fresh and 20 114 frozen–thaw IVF-ET cycles were reported during this timeframe. PARTICIPANTS/MATERIALS, SETTING, METHODS 33 Canadians clinics participated in voluntary reporting of IVF and pregnancy outcomes to the CARTR-BORN database. The impact of endometrial thickness on pregnancy, live birth and pregnancy loss rates were analyzed for fresh IVF-ET and frozen–thaw cycles. MAIN RESULTS AND THE ROLE OF CHANCE In fresh IVF-ET cycles, clinical pregnancy and live birth rates decreased (P < 0.0001) and pregnancy loss rates increased (P = 0.01) with each millimeter decline in endometrial thickness below 8 mm. Live birth rates were 33.7, 25.5, 24.6 and 18.1% for endometrial thickness ≥8, 7–7.9, 6–6.9 and 5–5.9 mm, respectively. In frozen–thaw ET cycles, clinical pregnancy (P = 0.007) and live birth rates decreased (P = 0.002) with each millimeter decline in endometrial thickness below 7 mm, with no significant difference in pregnancy loss rates. Live birth rates were 28.4, 27.4, 23.7, 15 and 21.2% for endometrial thickness ≥8, 7–7.9, 6–6.9, 5–5.9 and 4–4.9 mm, respectively. The likelihood of achieving an endometrial thickness ≥8 mm decreased with age (89.7, 87.8 and 83.9% in women <35, 35–39 and ≥40, respectively) (P < 0.0001). LIMITATIONS, REASONS FOR CAUTION This study only included cycles which proceeded to ET, which may overestimate pregnancy outcomes. Approximately 8% of cycles could not be included in the analysis due to data irregularity related to data entry. Demographic data aside from age were unavailable but may be important as lower endometrial thickness may be associated with poor ovarian response. WIDER IMPLICATIONS OF THE FINDINGS Although pregnancy and live birth rates decrease with endometrial thickness, reasonable outcomes were obtained even with lower endometrial thickness measurements. These data provide valuable guidance for both physicians and patients when confronted with decisions related to a persistently thin endometrium. STUDY FUNDING/COMPETING INTEREST(S) This study was not funded. The authors do not have any conflicts of interests to declare. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- K E Liu
- Mount Sinai Fertility, 250 Dundas St. W, Suite 700, Toronto, Ontario, Canada.,Department of Obstetrics and Gynecology, Mount Sinai Hospital, 600 University Ave., University of Toronto, Toronto, Ontario, Canada
| | - M Hartman
- Trio Fertility, 655 Bay St., Suite 1101, Toronto, Ontario, Canada
| | - A Hartman
- True North Imaging, 7330 Yonge St., Thornhill, Ontario, Canada
| | - Z-C Luo
- Department of Obstetrics and Gynecology, Mount Sinai Hospital, 600 University Ave., University of Toronto, Toronto, Ontario, Canada.,Lunenfeld-Tanenbaum Research Institute, Prosserman Population Health Center, Mount Sinai Hospital, 600 University Ave., Toronto, Ontario, Canada
| | - N Mahutte
- The Montreal Fertility Centre, 5252 Boulevard de Maisonneuve O, #220, Montreal, Québec, Canada
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Liu KE, Hartman M, Hartman A. Management of thin endometrium in assisted reproduction: a clinical practice guideline from the Canadian Fertility and Andrology Society. Reprod Biomed Online 2019; 39:49-62. [PMID: 31029557 DOI: 10.1016/j.rbmo.2019.02.013] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 02/12/2019] [Indexed: 02/03/2023]
Abstract
The impact and management of thin endometrium is a common challenge for patients undergoing assisted reproduction. The objective of this Canadian Fertility and Andrology Society (CFAS) guideline is to provide evidence-based recommendations using the GRADE (Grading of Recommendations, Assessment, Development and Evaluations) framework on the assessment, impact and management of thin endometrium in assisted reproduction. The effect of endometrial thickness on pregnancy and live birth outcomes in ovarian stimulation and IVF (fresh and frozen cycles) is addressed. In addition, recommendations on the use of adjuvants to improve endometrial thickness and pregnancy outcomes are provided.
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Affiliation(s)
- Kimberly E Liu
- Mount Sinai Fertility, 250 Dundas St. W, Suite 700, Dept of Obstetrics and Gynecology, Mount Sinai Hospital, 600 University Ave., University of Toronto, Toronto ON, M5T 2Z5, Canada.
| | - Michael Hartman
- Trio Fertility, 655 Bay St., Suite 1101, Toronto ON, M5G 2K4, Canada
| | - Alex Hartman
- True North Imaging, 7330 Yonge St., Suite 120, Thornhill ON, L4J 7Y7, Canada
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Liu KE, Shapiro J, Robertson D, Chamberlain S. No 246-Examens pelviens menés par des étudiants en médecine. Journal of Obstetrics and Gynaecology Canada 2017; 39:e325-e328. [DOI: 10.1016/j.jogc.2017.06.002] [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: 12/01/2022]
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Abstract
OBJECTIVE To improve awareness of the natural age-related decline in female and male fertility with respect to natural fertility and assisted reproductive technologies (ART), provide recommendations for their management, and to review investigations in the assessment of ovarian aging. OPTIONS This guideline reviews options for the assessment of ovarian reserve and fertility treatments using ART with women of advanced reproductive age presenting with infertility. OUTCOMES The outcomes measured are the predictive value of ovarian reserve testing and pregnancy rates with natural and assisted fertility. EVIDENCE Published literature was retrieved through searches of PubMed or Medline, CINAHL, and The Cochrane Library in June 2010, using appropriate key words ("ovarian aging," "ovarian reserve," "advanced maternal age," "advanced paternal age," and "assisted reproductive technology"). Results were restricted to systematic reviews, randomized controlled trials/controlled clinical trials, and observational studies. There were no date or language restrictions. Searches were updated on a regular basis and incorporated into the guideline to December 2010. VALUES The quality of evidence was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care. Recommendations for practice were ranked according to the method described in that report. BENEFITS, HARMS, AND COSTS Primary and specialist health care providers and women will be better informed about ovarian aging and the age-related decline in natural fertility and about options for ART. RECOMMENDATIONS
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Liu KE, Case A. N o 346-Âge génésique avancé et fertilité. J Obstet Gynaecol Can 2017; 39:696-708. [PMID: 28549562 DOI: 10.1016/j.jogc.2017.03.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIFS Sensibiliser la population à la baisse naturelle de la fertilité avec l'âge, chez les femmes et les hommes, et à l'égard de la reproduction naturelle et des technologies de procréation assistée (TPA); formuler des recommandations de prise en charge; et analyser les méthodes d'évaluation du vieillissement ovarien. OPTIONS La présente directive clinique passe en revue les options offertes pour l'évaluation de la réserve ovarienne et pour le traitement de l'infertilité faisant appel aux TPA chez les femmes d'âge génésique avancé infertiles. ISSUES Les issues mesurées sont les valeurs prédictives de l'évaluation de la réserve ovarienne et les taux de grossesse découlant de la fertilité naturelle et de la fertilité assistée. DONNéES: Nous avons examiné des études publiées récupérées au moyen de recherches dans PubMed, Medline, CINAHL et la Bibliothèque Cochrane en juin 2010 à l'aide de mots-clés appropriés (ovarian aging, ovarian reserve, advanced maternal age, advanced paternal age, et assisted reproductive technology). Nous n'avons tenu compte que des résultats provenant de revues systématiques, d'essais cliniques, randomisés ou non, et d'études observationnelles. Aucune restriction de date ou de langue n'a été employée. Les recherches ont été refaites régulièrement, et les résultats ont été incorporés à la directive clinique jusqu'en décembre 2010. VALEURS La qualité des données a été évaluée au moyen des critères énoncés dans le rapport du Groupe d'étude canadien sur les soins de santé préventifs. Les recommandations quant à la pratique ont été classées conformément à la méthode décrite dans ce rapport. AVANTAGES, DéSAVANTAGES ET COûTS: Les patientes et les fournisseurs de soins primaires et spécialisés seront mieux renseignés sur le vieillissement ovarien, la baisse de la fertilité naturelle liée à l'âge et les TPA. RECOMMENDATIONS
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Liu KE, Barankin B, Howard J, Guenther LC. One-Year Followup on the Impact of a Sun Awareness Curriculum on Medical Students' Knowledge, Attitudes, and Behavior. J Cutan Med Surg 2016. [DOI: 10.1177/120347540100500301] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: A one-week sun awareness curriculum was developed at the University of Western Ontario to educate first-year medical students on skin cancer risks and prevention. Objective: To assess the retention of knowledge, attitudes, and behavioral practices one year after receiving education in sun awareness. Method: Three surveys were administered: before, immediately after the sun awareness teaching, and one year later. Actual practiced behavior in the past year was compared with the intended behavior. Results: Half as many sunburns were reported in the year following the sun awareness curriculum compared with the previous year. Medical students demonstrated a good retention of the knowledge learned a year earlier. However, many students still believed that a tanned appearance looks healthy. While there was intent to adopt more healthy behavior after the curriculum, the actual behavior practiced varied. Conclusions: An undergraduate medical curriculum on sun awareness can be effective in improving the knowledge, attitudes, and behaviors of future physicians.
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Affiliation(s)
| | | | - John Howard
- The University of Western Ontario, London, Ontario, Canada
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Zou XL, Wang C, Liu KE, Nie W, Ding ZY. Prognostic significance of osteopontin expression in non-small-cell lung cancer: A meta-analysis. Mol Clin Oncol 2015; 3:633-638. [PMID: 26137280 DOI: 10.3892/mco.2015.517] [Citation(s) in RCA: 9] [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] [Received: 01/08/2014] [Accepted: 02/09/2015] [Indexed: 02/05/2023] Open
Abstract
Osteopontin (OPN) plays an important role in the progression and metastasis of cancer. However, the role of OPN as a prognostic factor in non-small-cell lung cancer (NSCLC) remains controversial. The aim of this study was to investigate the association between OPN expression and prognosis in patients with NSCLC using a meta-analysis. Based on PubMed, Ovid Medline, Embase, ISI, ScienceDirect and SpringerLink databases, related articles published prior to January, 2013 were collected. A meta-analysis was conducted to investigate the association of OPN expression with overall survival (OS) and progression-free survival (PFS) in patients with NSCLC. Hazard ratio (HR) with 95% confidence interval (CI) was used to assess the strength of this association. A total of 6 studies, including 776 patients, were found to be eligible for the meta-analysis. No heterogeneity was observed in OS or PFS, whereas low OPN expression was found to be correlated with better OS (HR=0.57, 95% CI: 0.46-0.70) and PFS (HR=0.62, 95% CI: 0.49-0.77). This meta-analysis demonstrated an association of OPN with poor prognosis in NSCLC patients. However, prospective studies are required to confirm these findings.
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Affiliation(s)
- Xue-Lin Zou
- Division of Thoracic Cancer, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Chun Wang
- Department of Endocrinology, State Key Laboratory of Biotherapy, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - K E Liu
- Department of Occupational Health and Radiological Health, Zigong Center for Disease Control and Prevention, Zigong, Sichuan 643000, P.R. China
| | - Wen Nie
- School of Clinical Medicine, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Zhen-Yu Ding
- Division of Thoracic Cancer, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan 610041, P.R. China
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Liu KE, Lo CL, Hu YH. Improvement of adequate use of warfarin for the elderly using decision tree-based approaches. Methods Inf Med 2013; 53:47-53. [PMID: 24136011 DOI: 10.3414/me13-01-0027] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 09/16/2013] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Due to the narrow therapeutic range and high drug-to-drug interactions (DDIs), improving the adequate use of warfarin for the elderly is crucial in clinical practice. This study examines whether the effectiveness of using warfarin among elderly inpatients can be improved when machine learning techniques and data from the laboratory information system are incorporated. METHODS Having employed 288 validated clinical cases in the DDI group and 89 cases in the non-DDI group, we evaluate the prediction performance of seven classification techniques, with and without an Adaptive Boosting (AdaBoost) algorithm. Measures including accuracy, sensitivity, specificity and area under the curve are used to evaluate model performance. RESULTS Decision tree-based classifiers outperform other investigated classifiers in all evaluation measures. The classifiers supplemented with AdaBoost can generally improve the performance. In addition, weight, congestive heart failure, and gender are among the top three critical variables affecting prediction accuracy for the non-DDI group, while age, ALT, and warfarin doses are the most influential factors for the DDI group. CONCLUSION Medical decision support systems incorporating decision tree-based approaches improve predicting performance and thus may serve as a supplementary tool in clinical practice. Information from laboratory tests and inpatients' history should not be ignored because related variables are shown to be decisive in our prediction models, especially when the DDIs exist.
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Affiliation(s)
| | | | - Y-H Hu
- Ya-Han Hu, Department of Information Management and Graduate Institute of Healthcare Information Management, National Chung Cheng University, 168 University Road, Min-Hsiung Chia-Yi 62102, Taiwan, E-mail:
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Abstract
BACKGROUND Recent studies suggest that vitamin D may play a role in human reproduction. Our goal was to investigate whether vitamin D levels are predictive of implantation and clinical pregnancy rates in infertile women following in vitro fertilization (IVF). METHODS We prospectively evaluated vitamin D status, as determined by serum 25-hydroxy-vitamin D (25[OH]D) levels, in a cohort of 173 women undergoing IVF at Mount Sinai Hospital, Toronto, Ontario. Serum 25(OH)D samples were collected within 1 week before oocyte retrieval. We classified patients as having sufficient (≥ 75 nmol/L) or insufficient (or deficient; hereafter referred to as "insufficient"; < 75 nmol/L) serum levels of 25(OH)D. We compared patient demographics and IVF cycle parameters between groups. The primary outcome measure was clinical pregnancy (intrauterine sac visible on ultrasound performed 4-5 weeks after embryo transfer). RESULTS Of the included women, 54.9% had insufficient 25(OH)D levels and 45.1% had sufficient levels. Women with sufficient levels had significantly higher rates of clinical pregnancy per IVF cycle started (52.5%) compared with women with insufficient levels (34.7%; p < 0.001). Implantation rates were also higher in the sufficient 25(OH)D group, but the results were not statistically significant. Multivariable logistic regression analysis (adjusted for age, body mass index and day 5 [v. day 3] embryo transfer) showed that serum 25(OH)D level may be a predictor of clinical pregnancy (adjusted odds ratio 1.01, 95% confidence interval 1.00-1.03). INTERPRETATION Our findings suggest that women with sufficient levels of vitamin D are significantly more likely to achieve clinical pregnancy following IVF. Vitamin D supplementation could provide an easy and cost-effective way of improving pregnancy rates; this merits further investigation. TRIAL REGISTRATION ClinicalTrials.gov, no. NCT01348594.
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Affiliation(s)
- Kimberley Garbedian
- Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | | | - Joel Moody
- Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, Ont
| | - Kimberly E. Liu
- Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ont
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Yee S, Abrol K, McDonald M, Tonelli M, Liu KE. Addressing oncofertility needs: views of female cancer patients in fertility preservation. J Psychosoc Oncol 2012; 30:331-46. [PMID: 22571247 DOI: 10.1080/07347332.2012.664257] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
A total of 41 questionnaires were returned from 64 respondents who consented to receive a questionnaire through the mail. Almost all valued the opportunity to receive consultation to address their fertility concerns and discuss fertility preservation options. Psychological stress, time pressure, and costs were identified as main factors affecting respondents' decision to proceed with in-vitro fertilization to cryopreserve oocytes or embryos. About one third indicated that the discussion of fertility matters was initiated by themselves, their friends, and families rather than their health care providers. The findings have identified several major barriers encountered by female cancer patients when seeking fertility preservation services.
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Affiliation(s)
- Samantha Yee
- Centre for Fertility and Reproductive Health, Mount Sinai Hospital, Toronto, ON, Canada.
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Liu KE, Shapiro J, Robertson D, Chamberlain S, Shapiro J, Akhtar SS, Camire B, Christilaw J, Corey J, Nelson E, Pierce M, Robertson D, Simmonds AH. Examens pelviens menés par des étudiants en médecine. Journal of Obstetrics and Gynaecology Canada 2010. [DOI: 10.1016/s1701-2163(16)34661-8] [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: 10/22/2022]
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Liu KE, Dunn JS, Robertson D, Chamberlain S, Shapiro J, Akhtar SS, Camire B, Christilaw J, Corey J, Nelson E, Pierce M, Robertson D, Simmonds AH. Pelvic Examinations by Medical Students. Journal of Obstetrics and Gynaecology Canada 2010; 32:872-874. [DOI: 10.1016/s1701-2163(16)34660-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Liu KE, Tataryn IV, Sagle M. Use of Metformin for Ovulation Induction in Women Who Have Polycystic Ovary Syndrome With or Without Evidence of Insulin Resistance. Journal of Obstetrics and Gynaecology Canada 2006; 28:595-599. [PMID: 16916482 DOI: 10.1016/s1701-2163(16)32202-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To determine whether women with polycystic ovary syndrome (PCOS) and abnormal insulin levels treated with metformin had different rates of ovulation and pregnancy from women with PCOS and normal insulin levels. METHODS The outcomes of treatment with metformin in 146 infertile women with PCOS were analyzed using a retrospective cohort study design. Baseline characteristics and initial blood work results were recorded. The follow-up period was three months, and the primary outcome was ovulation. RESULTS Of the 146 women with PCOS, one third had elevated fasting insulin levels. After treatment with metformin, cumulative rates of ovulation were similar in women with elevated fasting serum insulin levels (48.8%) and those with normal levels (44.7%). Rates of ovulation were also similar in women with normal and abnormal glucose to insulin ratios. There was no difference in cumulative pregnancy rates based on fasting insulin levels. A fasting insulin level above 20 mU/L correlated with an abnormal glucose to insulin ratio (98%). CONCLUSION In anovulatory women with PCOS, fasting insulin levels and glucose to insulin ratios do not predict the ovulatory response to metformin.
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Affiliation(s)
- Kimberly E Liu
- Department of Obstetrics and Gynaecology, University of Alberta, Edmonton, AB
| | | | - Margaret Sagle
- Department of Obstetrics and Gynaecology, University of Alberta, Edmonton, AB
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Liu KE, Robertson D, Posner G, Singh SS, Oppenheimer L. Archivée: Examens pelviens effectués par des stagiaires en médecine. Journal of Obstetrics and Gynaecology Canada 2006. [DOI: 10.1016/s1701-2163(16)32130-2] [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: 10/22/2022]
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Abstract
OBJECTIVE To evaluate the effects of an interdisciplinary session on medical ethics and legal issues related to obstetrics and gynaecology on medical students' knowledge, attitudes, and behaviours. METHODS Second-year medical students at the University of Alberta were asked to complete surveys before and after an interdisciplinary panel session on ethics and legal issues in reproductive health. Survey questions were related to knowledge of ethics and law, attitudes toward controversial topics in reproductive health, and predicted behaviours in specific clinical scenarios. In the postsession survey, students were asked to evaluate the session's usefulness and impact. RESULTS Fifty-seven students completed both the pre- and postsession surveys. Most students listed family, religion, culture, peer groups, scientific thought and theory, and school and education as influences on their own personal ethics and morality. Fifty-five students (97%) stated that the panel session was useful. Most students (79%) reported that the session increased their knowledge of ethical and legal issues in reproductive health. Many students felt that the panel session would change the way they practise in similar clinical situations (63%). The panel session appeared to affect knowledge and predicted behaviour. CONCLUSION A large-group interdisciplinary panel session can influence medical students' knowledge and future behaviours related to ethics and law in obstetrics and gynaecology. Medical students gave this session a high rating.
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Affiliation(s)
- Kimberly E Liu
- Department of Obstetrics and Gynecology, University of Alberta, Edmonton, Alberta, Canada
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Abstract
Birth control techniques were widely available in 19th-century Canada, despite the fact that they were illegal. Most physicians remained silent about contraception, with a small minority vocally opposed to the practice of birth control. Canadian physicians were influenced by the social, economic, legal, and political values of their time, and their support of birth control initially lagged far behind public interest and need. At later points in Canadian medical history, physicians actively supported increased access to contraceptive services, and played a significant role in the legalization of contraception in this country. The Canadian birth control movement made tremendous strides in the 1930s with the dissemination of contraceptive information to the public and the opening of the first public birth control clinic. The Canadian Medical Association supported contraceptive practice as part of preventive medicine in the 1930s, and the legalization of contraception in the early and mid 1960s. Contraception was formally legalized in Canada in 1969 and has become a significant aspect of medical practice. In Canada, current medical controversies in contraception include issues of public education, advertising, contraceptive research, and the integration of contraception with other aspects of reproductive and sexual health in medical practice.
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Affiliation(s)
- Kimberly E Liu
- Department of Obstetrics and Gynaecology, University of Alberta, Edmonton, AB
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Liu KE, Barankin B, Howard J, Guenther LC. One-year followup on the impact of a sun awareness curriculum on medical students' knowledge, attitudes, and behavior. J Cutan Med Surg 2001; 5:193-200. [PMID: 11685664 DOI: 10.1007/s102270000025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND A one-week sun awareness curriculum was developed at the University of Western Ontario to educate first-year medical students on skin cancer risks and prevention. OBJECTIVE To assess the retention of knowledge, attitudes, and behavioral practices one year after receiving education in sun awareness. METHOD Three surveys were administered: before, immediately after the sun awareness teaching, and one year later. Actual practiced behavior in the past year was compared with the intended behavior. RESULTS Half as many sunburns were reported in the year following the sun awareness curriculum compared with the previous year. Medical students demonstrated a good retention of the knowledge learned a year earlier. However, many students still believed that a tanned appearance looks healthy. While there was intent to adopt more healthy behavior after the curriculum, the actual behavior practiced varied. CONCLUSIONS An undergraduate medical curriculum on sun awareness can be effective in improving the knowledge, attitudes, and behaviors of future physicians.
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Affiliation(s)
- K E Liu
- The University of Western Ontario, London, Ontario, Canada
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Liu KE, Barankin B, Guenther LC. Promoting sun awareness and skin cancer prevention. Acad Med 2000; 75:1046-1047. [PMID: 11078658 DOI: 10.1097/00001888-200011000-00004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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Liu KE, Lippard SJ. Redox properties of the hydroxylase component of methane monooxygenase from Methylococcus capsulatus (Bath). Effects of protein B, reductase, and substrate. J Biol Chem 1991; 266:12836-9. [PMID: 1649166] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The reduction potentials of the hydroxylase component of the soluble methane monooxygenase from Methylococcus capsulatus (Bath) have been investigated through potentiometric titrations. The potentials were determined by EPR spectroscopic quantitation of the mixed valent hydroxylase as a function of added sodium dithionite in the presence of appropriate mediators. The reduction of the oxidized Fe(III).Fe(III) form to the mixed valent Fe(II).Fe(III) form occurs at 48 mV versus NHE while the potential for the formation of the fully reduced Fe(II).Fe(II) species from the mixed valent form was determined to be -135 mV. Addition of the substrate propylene to the hydroxylase did not have a major effect on the reduction potentials. Introduction of the protein B and the reductase components, however, completely inhibited reduction of the hydroxylase at potentials as far negative as -200 mV. Addition of propylene to all three methane monooxygenase components greatly facilitated hydroxylase reduction. Under these conditions, the fully reduced form of the protein was obtained at potentials of greater than 150 mV. This high redox potential indicates that the oxidized form of the protein is highly reactive, as required for methane oxidation. The present results reveal aspects of how both protein B and substrate can regulate electron transfer into and out of the hydroxylase component of methane monooxygenase.
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Affiliation(s)
- K E Liu
- Department of Chemistry, Massachusetts Institute of Technology, Cambridge 02139
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