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Gould S, Wrzesinski C, Stebbings R, Segal L. Report from an ICT 2022 workshop on toxicology for Covid19 vaccines: Industry, regulatory and CRO perspectives. Vaccine 2023; 41:5919-5924. [PMID: 37633751 DOI: 10.1016/j.vaccine.2023.08.040] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/14/2023] [Accepted: 08/15/2023] [Indexed: 08/28/2023]
Abstract
The Covid pandemic took the world by surprise in late 2019 and the need for rapid development of vaccines became paramount. The challenge was how to accelerate standard vaccine development times as much as possible. With knowledge of the genetic code of SARsCOV2, vaccine manufacturers throughout the world have risen to the challenge and several new vaccines were rapidly developed for emergency use. In March 2020, global Regulatory Authorities met to consider how to start early clinical trials and accept rolling submissions. Before use in clinical trials or any mass vaccination campaigns, the safety of the candidate vaccine needs to be evaluated. Non-clinical toxicology studies are required as an important part of vaccine safety evaluation. The extent of the toxicology evaluation prior to the start of clinical trials depended on several factors, including: the type of the candidate vaccine as well as already available supportive information with the candidate vaccine or similar vaccine types. For vaccine candidates with pre-existing data, this would save valuable time whilst a full toxicology evaluation was completed in parallel. For vaccines with more limited data, toxicology data was required before clinical development could start. This workshop examined the nonclinical toxicology studies for new Covid vaccines from the perspectives of: Vaccine manufacturers with different vaccine technologies, managing global regulatory submissions/responses; CROs, managing the urgency of conducting and reporting studies and supporting new players in the vaccine world; and Regulatory Authorities, in supporting the review process, juggling the need for safety and quality with mounting pressure to approve vaccines.
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Segal L. ES18.03 The Lung Microbiome and Lung Cancer Progression. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Segal L, Etzion S, Elyagon S, Numa M, Livitas A, Muhammad E, Kapiloff M, Parvari R, Etzion Y. DOCK10 is vital for normal cardiac function under neurohormonal activation. J Mol Cell Cardiol 2018. [DOI: 10.1016/j.yjmcc.2018.05.061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Segal L, Penman MG, Piriou Y. Evaluation of the systemic toxicity and mutagenicity of OLIGOPIN®, procyanidolic oligomers (OPC) extracted from French Maritime Pine Bark extract. Toxicol Rep 2018; 5:531-541. [PMID: 29725583 PMCID: PMC5930179 DOI: 10.1016/j.toxrep.2018.03.013] [Citation(s) in RCA: 11] [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: 12/12/2017] [Revised: 03/21/2018] [Accepted: 03/31/2018] [Indexed: 11/29/2022] Open
Abstract
The potential systemic toxicity of Oligopin®, a French Maritime Pine Bark extract (FMPBE) rich in procyanidolic oligomers, was evaluated in an acute oral limit test and a 90-day repeated dose oral toxicity study with Sprague Dawley rats. The potential mutagenicity was assessed in a bacterial reverse mutation assay and in vitro mammalian chromosome aberration assay with human lymphocytes. The results indicate that Oligopin® was nongenotoxic in both bacterial and human cell assays, was not acutely toxic via oral administration at up to 2000 mg/kg and was well tolerated following 90 days of oral administration to SD rats, with a no observed adverse effect level of 1000 mg/kg/day. The lack of significant adverse systemic effects in the 90 day study is concordant with findings from several human clinical trials. The acute toxicity and mutagenicity data are consistent with data reported by AFSSA in a summary of FMPBE safety, in which a NOAEL of 100 mg/kg/day was established. In contrast, the NOAEL derived from the 90-day study with Oligopin® was 1000 mg/kg/day, suggesting that it is less systemically toxic than other FMPBE previously evaluated in subchronic studies, and comparable to proanthocyanidins extracted from grape seeds, which are widely used as nutritional supplement ingredients.
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Affiliation(s)
- L Segal
- Penman Consulting BVBA, 1210 Brussels, Belgium
| | - M G Penman
- Penman Consulting BVBA, 1210 Brussels, Belgium
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Hughes JDM, Olynyc T, Chapdelaine H, Segal L, Miedzybrodzki B, Ben-Shoshan M. Effective management of severe cutaneous mastocytosis in young children with omalizumab (Xolair ® ). Clin Exp Dermatol 2018; 43:573-576. [PMID: 29451318 DOI: 10.1111/ced.13408] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2017] [Indexed: 11/29/2022]
Abstract
Omalizumab (Xolair® ) is an anti-IgE monoclonal antibody, which may benefit adults with systemic mastocytosis. We report effective treatment with omalizumab in two toddlers with severe diffuse cutaneous mastocytosis. Our cases offer preliminary evidence to support the safe use of omalizumab in paediatric patients with cutaneous mastocytosis.
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Affiliation(s)
- J D M Hughes
- University of Ottawa - Department of Medicine, Ottawa, Ontario, Canada
| | - T Olynyc
- Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - H Chapdelaine
- Department of Medicine, Centre Hospitalier Universitaire de Montreal, Montreal, Quebec, Canada
| | - L Segal
- Department of Medicine, Community Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - B Miedzybrodzki
- Department of Pediatrics, Division of Allergy and Clinical Immunology and Dermatology, Department of Pediatrics, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - M Ben-Shoshan
- Department of Pediatrics, Division of Allergy and Clinical Immunology and Dermatology, Department of Pediatrics, Montreal Children's Hospital, Montreal, Quebec, Canada.,Department of Medicine, Division of Experimental Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
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Scher J, Joshua V, Ubeda C, Artacho A, Grunewald J, Segal L, Catrina A. AB0109 The Lung Microbiome in Rheumatoid Arthritis and Associated Local/systemic Autoimmunity. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.4731] [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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Joshua V, Scher JU, Ubeda C, Artacho A, Segal L, Grunewald J, Catrina AI. A3.05 The lung microbiome in rheumatoid arthritis and associated local/systemic autoimmunity. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-209124.82] [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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Garçon N, Silvano J, Kuper CF, Baudson N, Gérard C, Forster R, Segal L. Non-clinical safety evaluation of repeated intramuscular administration of the AS15 immunostimulant combined with various antigens in rabbits and cynomolgus monkeys. J Appl Toxicol 2015; 36:238-56. [PMID: 26032931 PMCID: PMC5033012 DOI: 10.1002/jat.3167] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 03/11/2015] [Accepted: 04/03/2015] [Indexed: 12/31/2022]
Abstract
Combination of tumor antigens with immunostimulants is a promising approach in cancer immunotherapy. We assessed animal model toxicity of AS15 combined with various tumor antigens: WT1 (rabbits), or p501, dHER2 and recPRAME (cynomolgus monkeys), administered in seven or 20 dose regimens versus a saline control. Clinical and ophthalmological examinations, followed by extensive post‐mortem pathological examinations, were performed on all animals. Blood hematology and biochemistry parameters were also assessed. Antigen‐specific antibody titers were determined by enzyme‐linked immunosorbent assay. Additional assessments in monkeys included electrocardiography and immunohistochemical evaluations of the p501 expression pattern. Transient increases in body temperature were observed 4 h or 24 h after injections of recPRAME + AS15 and dHER2 + AS15. Edema and erythema were observed up to 1 week after most injections of recPRAME + AS15 and all injections of dHER2 + AS15. No treatment‐related effects were observed for electrocardiography parameters. Mean fibrinogen levels were significantly higher in all treated groups compared to controls, but no differences could be observed at the end of the treatment‐free period. Transient but significant differences in biochemistry parameters were observed post‐injection: lower albumin/globulin ratios (p501 + AS15), and higher bilirubin, urea and creatinine (dHER2 + AS15). Pathology examinations revealed significant increases in axillary lymph node mean weights (recPRAME + AS15) compared to controls. A 100% seroconversion rate was observed in all treated groups, but not in controls. p501 protein expression was observed in prostates of all monkeys from studies assessing p501 + AS15. These results suggest a favorable safety profile of the AS15‐containing candidate vaccines, supporting the use of AS15 for clinical development of potential anticancer vaccines. Copyright © 2015 The Authors. Journal of Applied Toxicology Published by John Wiley & Sons Ltd. The aim of the current paper was to assess the safety profile of vaccine candidates containing the AS15 immunostimulant combined with different antigens in two animal models. Several antigens were tested for this purpose: WT1 (rabbits), p501, dHER2 and recPRAME (cynomolgus monkeys). Only transient differences in hematology and biochemical parameters could be observed, while pathology testing revealed no safety concerns. Our findings support the use of AS15 for clinical development of potential immunotherapeutic cancer vaccines.
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Affiliation(s)
- N Garçon
- GSK Vaccines, 1300, Wavre, Belgium.,Bioaster, 321 Avenue Jean Jaurès, 69007, Lyon, France
| | - J Silvano
- CiToxLAB France, 27005, Evreux, France
| | - C F Kuper
- TNO Quality of Life, 3700, AJ Zeist, the Netherlands
| | - N Baudson
- GSK Vaccines, 1330 Rixensart, 1300, Wavre, Belgium
| | - C Gérard
- GSK Vaccines, 1330 Rixensart, 1300, Wavre, Belgium
| | - R Forster
- CiToxLAB France, 27005, Evreux, France
| | - L Segal
- GSK Vaccines, 1330 Rixensart, 1300, Wavre, Belgium
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Scher J, Ubeda C, Segal L, Vijay J, Artacho A, Catrina A. THU0054 The Lung Microbiome in Rheumatoid Arthritis and Local/Systemic Autoimmunity. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.5911] [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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Destexhe E, Stannard D, Wilby OK, Grosdidier E, Baudson N, Forster R, Gérard CM, Garçon N, Segal L. Nonclinical reproductive and developmental safety evaluation of the MAGE-A3 Cancer Immunotherapeutic, a therapeutic vaccine for cancer treatment. Reprod Toxicol 2014; 51:90-105. [PMID: 25530039 DOI: 10.1016/j.reprotox.2014.12.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 12/01/2014] [Accepted: 12/11/2014] [Indexed: 11/25/2022]
Abstract
We assessed potential toxic effects of the MAGE-A3 Cancer Immunotherapeutic on female fertility and embryo-fetal, pre- and post-natal development in rats and on male fertility in rats and monkeys. Three groups of 48 female (Study 1) or 22 male (Study 2) CD rats received 5 or 3 injections of 100μL of saline, AS15 immunostimulant, or MAGE-A3 Cancer Immunotherapeutic (MAGE-A3 recombinant protein combined with AS15) at various timepoints pre- or post-mating. Male Cynomolgus monkeys (Study 3) received 8 injections of 500μL of saline (n=2) or the MAGE-A3 Cancer Immunotherapeutic (n=6) every 2 weeks. Rats were sacrificed on gestation day 20 or lactation day 25 (Study 1) or 9 weeks after first injection (Study 2) and monkeys, 3 days or 8 weeks after last injection. Injections were well tolerated. Female rat mating performance or fertility, pre- and post-natal survival, offspring development up to 25 days of age, and male mating performance (rats) or fertility parameters (rats and monkeys) were unaffected.
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Affiliation(s)
- E Destexhe
- GSK Vaccines, Rue de l'Institut 89, 1330 Rixensart, Belgium
| | - D Stannard
- Huntingdon Life Sciences, Eye Research Centre, Eye, Suffolk IP23 7PX, UK
| | - O K Wilby
- Huntingdon Life Sciences, Eye Research Centre, Eye, Suffolk IP23 7PX, UK
| | | | - N Baudson
- GSK Vaccines, Rue de l'Institut 89, 1330 Rixensart, Belgium
| | - R Forster
- CiToxLAB France, BP 563, 27005 Evreux, France
| | - C M Gérard
- GSK Vaccines, Rue de l'Institut 89, 1330 Rixensart, Belgium
| | - N Garçon
- Bioaster, 321 Avenue Jean Jaurès, 69007 Lyon, France
| | - L Segal
- GSK Vaccines, Parc de la Noire Epine, Rue Fleming 20, 1300 Wavre, Belgium.
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Keystone E, Weber D, Mitroi E, Cottrell J, Segal L, Reuter H, Weber M, Mitroi P. AB1130 Real World Data on Patient Understanding and Preference in Their Biologic Treatment for Inflammatory Autoimmune Disease - A Qualitative Anonymous Patient Survey. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.4371] [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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Lenoir-Wijnkoop I, Jones PJ, Uauy R, Segal L, Milner J. Nutrition economics - food as an ally of public health. Br J Nutr 2013; 109:777-84. [PMID: 23339933 PMCID: PMC3583164 DOI: 10.1017/s0007114512005107] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Revised: 10/18/2012] [Accepted: 10/18/2012] [Indexed: 11/23/2022]
Abstract
Non-communicable diseases (NCD) are a major and increasing contributor to morbidity and mortality in developed and developing countries. Much of the chronic disease burden is preventable through modification of lifestyle behaviours, and increased attention is being focused on identifying and implementing effective preventative health strategies. Nutrition has been identified as a major modifiable determinant of NCD. The recent merging of health economics and nutritional sciences to form the nascent discipline of nutrition economics aims to assess the impact of diet on health and disease prevention, and to evaluate options for changing dietary choices, while incorporating an understanding of the immediate impacts and downstream consequences. In short, nutrition economics allows for generation of policy-relevant evidence, and as such the discipline is a crucial partner in achieving better population nutritional status and improvements in public health and wellness. The objective of the present paper is to summarise presentations made at a satellite symposium held during the 11th European Nutrition Conference, 28 October 2011, where the role of nutrition and its potential to reduce the public health burden through alleviating undernutrition and nutrition deficiencies, promoting better-quality diets and incorporating a role for functional foods were discussed.
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Affiliation(s)
- I Lenoir-Wijnkoop
- Danone Research, RD 128, 91767, Scientific Affairs, Palaiseau, France.
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Robinson PJ, Bell RJ, Lanzafame A, Segal L, Kirby C, Piterman L, Davis SR. Comparison of plain vertebral X-ray and dual-energy X-ray absorptiometry for the identification of older women for fracture prevention in primary care. Intern Med J 2013; 43:38-45. [DOI: 10.1111/j.1445-5994.2012.02930.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Accepted: 07/26/2012] [Indexed: 11/30/2022]
Affiliation(s)
- P. J. Robinson
- Women's Health Research Program; School of Public Health and Preventive Medicine; Monash University; Melbourne
| | - R. J. Bell
- Women's Health Research Program; School of Public Health and Preventive Medicine; Monash University; Melbourne
| | | | - L. Segal
- Health Economics and Social Policy Group; Division of Health Sciences; University of South Australia; Adelaide South Australia Australia
| | - C. Kirby
- Research Fellow, Office of the Pro Vice-Chancellor; Monash University; Victoria
| | - L. Piterman
- Pro Vice-Chancellor (Berwick and Peninsula campuses); Monash University; Victoria
| | - S. R. Davis
- Women's Health Research Program; School of Public Health and Preventive Medicine; Monash University; Melbourne
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Lenoir-Wijnkoop I, Nuijten MJC, Gutiérrez-Ibarluzea I, Hutton J, Poley MJ, Segal L, Bresson JL, van Ganse E, Jones P, Moreno L, Salminen S, Dubois D. Workshop Report: concepts and methods in the economics of nutrition--gateways to better economic evaluation of nutrition interventions. Br J Nutr 2012; 108:1714-20. [PMID: 22947201 PMCID: PMC3513712 DOI: 10.1017/s0007114512003704] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2012] [Revised: 07/11/2012] [Accepted: 07/12/2012] [Indexed: 01/07/2023]
Abstract
Improving health through better nutrition of the population may contribute to enhanced efficiency and sustainability of healthcare systems. A recent expert meeting investigated in detail a number of methodological aspects related to the discipline of nutrition economics. The role of nutrition in health maintenance and in the prevention of non-communicable diseases is now generally recognised. However, the main scope of those seeking to contain healthcare expenditures tends to focus on the management of existing chronic diseases. Identifying additional relevant dimensions to measure and the context of use will become increasingly important in selecting and developing outcome measurements for nutrition interventions. The translation of nutrition-related research data into public health guidance raises the challenging issue of carrying out more pragmatic trials in many areas where these would generate the most useful evidence for health policy decision-making. Nutrition exemplifies all the types of interventions and policy which need evaluating across the health field. There is a need to start actively engaging key stakeholders in order to collect data and to widen health technology assessment approaches for achieving a policy shift from evidence-based medicine to evidence-based decision-making in the field of nutrition.
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Segal L, Damsten M. Strategy for the safety assessment of residuals and contaminants in vaccines. Toxicol Lett 2011. [DOI: 10.1016/j.toxlet.2011.05.833] [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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Day L, Finch CF, Harrison JE, Hoareau E, Segal L, Ullah S. Modelling the population-level impact of tai-chi on falls and fall-related injury among community-dwelling older people. Inj Prev 2010; 16:321-6. [DOI: 10.1136/ip.2009.025452] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
AIMS Chronic disease management is increasingly informed by clinical practice guidelines (CPGs). However, their implementation requires not only knowledge of guideline content by clinicians and practice processes that support implementation, but also a health workforce with the capacity to deliver care consistent with CPGs. This has a health services planning as well as a health workforce dimension. However, it is not known whether CPGs are described in a way that can inform health services and health workforce planning and potentially drive better quality care. This study aimed to ascertain whether CPGs are useful for health service and health workforce planning. METHODS This question was explored taking diabetes mellitus as a case study. A systematic search of Medline, EMBASE, CINAHL and Scopus was carried out to identify all CPGs relating to the management of diabetes mellitus in the primary healthcare setting. The search was limited to guidelines published in the English language between 2003 and 2009. The quality of guidelines was assessed against a subset of criteria set by the Appraisal of Guidelines for Research and Evaluation (AGREE) collaboration. RESULTS Seventy-five diabetes-related CPGs were identified, of which 27 met the inclusion criteria. In terms of quality, many guidelines adopted evidence-based recommendations for diabetes care (59%) and most were endorsed by national authorities (70%). With regards to coverage of 17 identified subpopulations, guidelines were generally selective in the populations they covered. Whilst many provided adequate coverage of common complications and comorbidities, approaches to management for those with reduced capacity for effective diabetes self-care were largely absent, except for indigenous populations. CONCLUSIONS Clinical practice guidelines are potentially useful for health services and health workforce planning, but would be more valuable for this purpose if they contained more detail about care protocols and specific skills and competencies, especially for subpopulations who would be expected to have reduced capacity for effective self-care. If service planning ignores these subgroups that tend to require more resource-intensive management, underprovision of services is likely.
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Affiliation(s)
- M J Leach
- Health Economics and Social Policy Group, School of Nursing & Midwifery, University of South Australia, Adelaide, SA, Australia.
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Peretz H, Blinder P, Segal L, Baranes D, Vago R. Erratum: Aragonite crystalline matrix as an instructive microenvironment for neural development. Journal of Tissue Engineering and Regenerative Medicine2008; 2: 463-471. J Tissue Eng Regen Med 2009. [DOI: 10.1002/term.155] [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: 11/11/2022]
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Sivak JG, Stuart DD, Herbert KL, Van Oostrom JA, Segal L. Optical Properties of the Cultured Bovine Ocular Lens as an in Vitro Alternative to the Draize Eye Toxicity Test: Preliminary Validation for Alcohols. ACTA ACUST UNITED AC 2008. [DOI: 10.3109/15376519209050864] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Dalziel K, Segal L. Time to give nutrition interventions a higher profile: cost-effectiveness of 10 nutrition interventions. Health Promot Int 2007; 22:271-83. [DOI: 10.1093/heapro/dam027] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [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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D'Hooghe TM, Mihalyi AM, Simsa P, Kyama CK, Peeraer K, De Loecker P, Meeuwis L, Segal L, Meuleman C. Why we need a noninvasive diagnostic test for minimal to mild endometriosis with a high sensitivity. Gynecol Obstet Invest 2006; 62:136-8. [PMID: 16679771 DOI: 10.1159/000093120] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- T M D'Hooghe
- Leuven University Fertility Center, Department of Obstetrics and Gynecology, Leuven University Hospitals, Leuven, Belgium.
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Khan SA, Wolfman JA, Segal L, Benjamin S, Nayar R, Wiley EL, Bryk M, Morrow M. Ductal lavage (DL) findings in women with mammographic microcalcifications undergoing biopsy. Ann Surg Oncol 2004. [DOI: 10.1007/bf02523993] [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: 11/29/2022]
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26
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Erol B, Segal L, Huff D, States L, Dormans JP. Low back pain in a 13-year-old girl. Clin Orthop Relat Res 2003:323-31. [PMID: 12897625 DOI: 10.1097/01.blo.0000081205.51121.a2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- B Erol
- Department of Orthopaedic Surgery, The Children's Hospital of Philadelphia, 34th & Civic Center Boulevard, Philadelphia, PA 19104-4399, USA
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Abstract
Health service funding mechanisms are pivotal in the pursuit of health system objectives, as they provide strong financial incentives for actors in the system to achieve policy goals. Underpinning funding mechanisms is a set of key economic principles, or objectives, that should guide their design and use: efficiency, equity, and accountability. The Australian health system has historically performed relatively poorly in relation to these objectives, with evidence of inefficiencies, inequities, and poor accountability in many areas of health services. The primary cause of these shortcomings may lie in the complex set of funding and delivery arrangements at the State and Federal levels of government. Potentially significant improvements in the performance of the health system would be available from the integration of the funding and delivery of services within a single tier of government, coupled with the development of a national weighted capitation approach to funding. To develop a national capitation funding model a number of unique factors require consideration, including the current fragmentation of services, the role of the private sector, the needs of indigenous populations, and the effects of rurality. The data available to develop a capitation model is of a level of detail and quality not readily found elsewhere. If policy statements promoting efficiency, accountability, and particularly equity are to be actively pursued, a national capitation model based on robust methods should become a cornerstone of Australian health system reform.
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Affiliation(s)
- S Peacock
- Health Economics Unit, Monash University, West Heidelberg, Victoria, Australia.
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Ghosh S, Watanabe RM, Hauser ER, Valle T, Magnuson VL, Erdos MR, Langefeld CD, Balow J, Ally DS, Kohtamaki K, Chines P, Birznieks G, Kaleta HS, Musick A, Te C, Tannenbaum J, Eldridge W, Shapiro S, Martin C, Witt A, So A, Chang J, Shurtleff B, Porter R, Kudelko K, Unni A, Segal L, Sharaf R, Blaschak-Harvan J, Eriksson J, Tenkula T, Vidgren G, Ehnholm C, Tuomilehto-Wolf E, Hagopian W, Buchanan TA, Tuomilehto J, Bergman RN, Collins FS, Boehnke M. Type 2 diabetes: evidence for linkage on chromosome 20 in 716 Finnish affected sib pairs. Proc Natl Acad Sci U S A 1999; 96:2198-203. [PMID: 10051618 PMCID: PMC26760 DOI: 10.1073/pnas.96.5.2198] [Citation(s) in RCA: 170] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/1998] [Indexed: 12/22/2022] Open
Abstract
We are conducting a genome scan at an average resolution of 10 centimorgans (cM) for type 2 diabetes susceptibility genes in 716 affected sib pairs from 477 Finnish families. To date, our best evidence for linkage is on chromosome 20 with potentially separable peaks located on both the long and short arms. The unweighted multipoint maximum logarithm of odds score (MLS) was 3.08 on 20p (location, chi = 19.5 cM) under an additive model, whereas the weighted MLS was 2.06 on 20q (chi = 57 cM, recurrence risk,lambda(s) = 1. 25, P = 0.009). Weighted logarithm of odds scores of 2.00 (chi = 69.5 cM, P = 0.010) and 1.92 (chi = 18.5 cM, P = 0.013) were also observed. Ordered subset analyses based on sibships with extreme mean values of diabetes-related quantitative traits yielded sets of families who contributed disproportionately to the peaks. Two-hour glucose levels in offspring of diabetic individuals gave a MLS of 2. 12 (P = 0.0018) at 9.5 cM. Evidence from this and other studies suggests at least two diabetes-susceptibility genes on chromosome 20. We have also screened the gene for maturity-onset diabetes of the young 1, hepatic nuclear factor 4-a (HNF-4alpha) in 64 affected sibships with evidence for high chromosomal sharing at its location on chromosome 20q. We found no evidence that sequence changes in this gene accounted for the linkage results we observed.
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Affiliation(s)
- S Ghosh
- Genetics and Molecular Biology Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA.
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Cohen J, Piterman L, McCall LM, Segal L. Near-patient testing for serum cholesterol: attitudes of general practitioners and patients, appropriateness, and costs. Med J Aust 1998; 168:605-9. [PMID: 9673622 DOI: 10.5694/j.1326-5377.1998.tb141446.x] [Citation(s) in RCA: 9] [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: 11/17/2022]
Abstract
OBJECTIVE To determine the attitudes of general practitioners (GPs) and patients to near-patient testing (NPT) for serum cholesterol level, the appropriateness of NPT, and cost compared with testing in a specialist pathology laboratory. DESIGN A descriptive survey of registered Category 5 general practices in Victoria, 1994. Matched questionnaires were completed by GPs providing NPT and patients being tested. PARTICIPANTS 13 GPs performing NPT and 206 patients having NPT. RESULTS Thirteen of the 17 Victorian Category 5-accredited practices participated in this study (77%), and 203 of the 260 GP questionnaires and 206 of the 260 patient questionnaires were returned. NPT of serum cholesterol level was found to be appropriately used by GPs, and recommended management guidelines for lowering cholesterol level were followed. Both GPs and patients strongly supported the role of NPT in general practice on the basis of convenience, issues of patient care, quality, efficiency and cost, but GPs felt the registration and quality assurance fees were unreasonably high. We identified potential cost savings for patients and the Health Insurance Commission with NPT of cholesterol level by GPs compared with testing at specialist pathology laboratories. CONCLUSIONS NPT appears to be of benefit to both GPs and patients and to provide cost savings. However, the registration charges and quality assurance fees for NPT laboratories may be limiting GPs' use of NPT.
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Affiliation(s)
- J Cohen
- Department of Community Medicine and General Practice, Monash University, Melbourne, VIC
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Abstract
With restricted public sector budgets, there is increasing pressure to obtain value for money in the allocation of health sector resources. Distortions and inefficiencies created by features of Australia's health funding arrangements prevent health resources moving from lower valued to higher valued activities. These distortions tend to restrict resources being allocated to disease prevention and health promotional approaches, favouring medical treatment. These propositions are illustrated, largely with reference to diabetes.
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Affiliation(s)
- L Segal
- Health Economics Unit, Monash University, Melbourne, Victoria
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Abstract
Health system reform is on the agenda in Australia, across Europe and North America and elsewhere. Reform is being driven by attempts to meet ever increasing health service demands in the face of cost containment pressures. There is little agreement concerning the preferred features of health funding models. A micro-economic framework is used to define universal performance characteristics for optimal health funding arrangements. Two principle requirements emerge. These are (1) demand side reform to empower consumers and (2) supply side reform, to promote opportunities and incentives for a responsive service system and competition amongst providers. A focus on supply side issues only, without recognition of the fundamental importance of consumer empowerment will fail to promote an efficient solution to the distribution of health resources. Mechanisms to promote active consumer involvement in health care decisions are identified as a central requirement in health system reform.
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Affiliation(s)
- L Segal
- Monash University, Centre for Health Program Evaluation, West Heidelberg, Victoria, Australia.
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Easton JL, Segal L. Opportunistic screening for diabetes. Med J Aust 1998; 168:45. [PMID: 9451399 DOI: 10.5694/j.1326-5377.1998.tb123352.x] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Segal L, Dalton AC, Richardson J. Cost-Effectiveness of the Primary Prevention of Non-Insulin Dependent Diabetes Mellitus. Health Promot Int 1998. [DOI: 10.1093/heapro/13.3.197] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Schoysman R, Lejeune B, van Roosendaal E, Segal L, Vanderzwalmen P, Nijs M, Vandamme B, Bertin G. [Medically assisted reproduction with immature spermatozoa. Clinical examination and surgical technics]. Acta Urol Belg 1997; 65:21-6. [PMID: 9324905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The authors report their experience with the use of spermatids in TESE programs where mature spermatozoa could not be isolated from testicular biopsies. The details of the indications for spermatid insemination, the technicity of the procedure and the results are exposed.
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Affiliation(s)
- R Schoysman
- Hôpital van Helmont, Schoysman Infertility Management Foundation (S.I.M.A.F.)
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36
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Lejeune B, Vanderzwalmen P, Vandamme B, Nijs M, Berlin G, Segal L, Vanroosendaal E, Schoysman R. O-008. Reduced implantation rate after the transfer of frozen-thawed embryos obtained by ICSI. Hum Reprod 1997. [DOI: 10.1093/humrep/12.suppl_2.3-b] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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37
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Vanderzwalmen P, Zech H, Birkenfeld A, Yemini M, Bertin G, Lejeune B, Nijs M, Segal L, Stecher A, Vandamme B, van Roosendaal E, Schoysman R. Intracytoplasmic injection of spermatids retrieved from testicular tissue: influence of testicular pathology, type of selected spermatids and oocyte activation. Hum Reprod 1997; 12:1203-13. [PMID: 9222002 DOI: 10.1093/humrep/12.6.1203] [Citation(s) in RCA: 112] [Impact Index Per Article: 4.1] [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: 02/04/2023] Open
Abstract
Spermatid microinjection into oocytes has proven to be a successful assisted reproduction procedure in the animal model and in the human species, since in the latter a few full-term pregnancies were actually obtained. Patients entering our spermatid injection study included those with a total absence of spermatozoa in the testicular tissue notwithstanding previous positive biopsies (n = 29): an obstructive problem (n = 3), secretory azoospermia (n = 26), and those with total arrest at the spermatogenesis level in previous explorative biopsies (n = 15). In the latter group, absence of spermatids was recorded in four cases. Mature, elongated, elongating and round spermatids (ROS) were injected in respectively 3, 2, 3, and 32 attempts. A total of 260 metaphase II oocytes were injected with ROS, 36 oocytes with spermatids at other stages of maturity. The rates of oocytes showing two pronuclei (2PN) and two polar bodies reached 22% and 64% respectively after injection of round or elongated-mature spermatids. The fertilization rate after ROS injection was influenced by the percentage of spermatozoa observed in a previous biopsy. Patients with a positive preliminary biopsy had significantly more 2PN (33%) when compared to those with a severe spermatogenic dysfunction and in whom no spermatozoa were found (only 11%) (P < 0.05). Incubation of oocytes in calcium ionophore after ROS injection had a positive effect on the rate of 2PN formation (36 versus 16%). Ninety per cent of all the normally fertilized oocytes cleaved. The percentage of grade A and B embryos depended on the type of injected cells: 12% after ROS and 30% with the other types of haploid cells. A total of 39 transfers resulted in five pregnancies: three full term with healthy babies delivered (one after ROS injection, and two after injection of an elongating and a mature spermatid), one 4 months ongoing (after elongating spermatid injection) and one miscarriage at 4 weeks (after elongated cell injection). Compared to our conventional intracytoplasmic sperm injection-testicular sperm extraction (ICSI-TESE) programme, the implantation rate after ROS injection was very low (5.5 versus 10.5%).
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Affiliation(s)
- P Vanderzwalmen
- Schoysman Infertility Management Foundation, Vaartsraat, Vilvoorde, Belgium
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Schoysman R, Lejeune B, Van Roosendaal E, Segal L. [Andrologic/gynecologic microsurgery and fertilization in vitro: complementary approaches?]. Contracept Fertil Sex 1997; 25:306-312. [PMID: 9229521] [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: 05/22/2023]
Abstract
The authors give their detailed results of andrological and gynecological microsurgical procedures and compare these to the cumulative results of their IVF work. They do defend the idea that to abandon microsurgery in favour of IVF and its last developments such as MESA & TESE is unreasonable and believe that every case demands a precise evaluation in which the gynecological situation and the age of the partner is mandatory.
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40
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Nijs M, Vanderzwalmen P, Vandamme B, Segal-Bertin G, Lejeune B, Segal L, van Roosendaal E, Schoysman R. Fertilizing ability of immotile spermatozoa after intracytoplasmic sperm injection. Hum Reprod 1996; 11:2180-5. [PMID: 8943526 DOI: 10.1093/oxfordjournals.humrep.a019073] [Citation(s) in RCA: 89] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Sometimes spermatozoa from ejaculate, epididymis or testis show a total absence of motility. For some patients, however, very few spermatozoa with very poor motility can be found after several hours of incubation (initially immotile spermatozoa). Other samples show no motility at all even after extended culture (totally immotile spermatozoa). Intracytoplasmic sperm injection (ICSI) is the only method available to select and retrieve a single immotile or initially immotile spermatozoon and inject it into the oocyte. A total of 103 patients with asthenozoospermia underwent ICSI in this study. It was shown that initially immotile and totally immotile spermatozoa, whatever their origin, have the capacity to fertilize an oocyte after ICSI. No significant difference could be observed between the fertilizing capacity of testicular or epididymal spermatozoa. Totally immotile ejaculated spermatozoa, however, fertilized significantly fewer oocytes after ICSI when compared with initially immotile ejaculated spermatozoa. Embryos of lower quality tended to be produced when totally immotile spermatozoa of any origin were used, compared with embryos resulting from initially immotile spermatozoa. Ongoing pregnancies were conceived after ICSI with initially immotile spermatozoa from any origin and totally immotile spermatozoa retrieved from testis only. One biochemical pregnancy was the result of embryo transfer after ICSI with totally immotile ejaculated spermatozoa. No supernumerary embryos could be cryopreserved for patients with totally immotile spermatozoa from ejaculate or epididymis. For a Kartagener patient, subzonal insemination (SUZI) seemed to be a better approach for obtaining fertilization and pregnancy than ICSI because no fertilization occurred after ICSI on sibling oocytes. Hence a healthy pregnancy was obtained after SUZI.
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Affiliation(s)
- M Nijs
- Schoysman Infertility Management Foundation, Van Helmont Hospital, Vilvoorde, Belgium
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41
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Schoysman R, Lejeune B, Segal L, van Roosendaal E, Vanderzwalmen P, Nijs M, Bertin SG, Vandamme B. New therapeutic possibilities handling residual azoospermia. Acta Eur Fertil 1995; 26:131-6. [PMID: 9098474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Obviously, medical therapy of secretory azoospermia or microsurgical therapy of excretory azoospermia are not always successful. The unsolvable cases therefore can be grouped as residual azoospermias. Both the medical and microsurgical approaches are reviewed and their success rates analyzed. Some problems are unsolvable after work-up of the diagnosis. Till the early nineties, such patients were discouraged to undergo further medical therapeutic approaches and were advised to consider either adoption or donor insemination. At the present time, new possibilities have risen since the use of epididymal spermatozoa for performing assisted fertilization has considerably altered the picture. Furthermore, the last breakthrough of using testicular spermatozoa combined with the ICSI procedures have offered solutions that were unthinkable only a few years ago. The impact of these new approaches is discussed and the future development of microsurgery versus assisted reproduction techniques is also considered.
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42
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Lipnick RL, Cotruvo JA, Hill RN, Bruce RD, Stitzel KA, Walker AP, Chu I, Goddard M, Segal L, Springer JA. Comparison of the up-and-down, conventional LD50, and fixed-dose acute toxicity procedures. Food Chem Toxicol 1995; 33:223-31. [PMID: 7896233 DOI: 10.1016/0278-6915(94)00136-c] [Citation(s) in RCA: 141] [Impact Index Per Article: 4.9] [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: 01/27/2023]
Abstract
The up-and-down procedure (UDP), fixed-dose procedure (FDP) and conventional LD50 tests were compared to determine their consistency in chemical hazard classification for acute oral toxicity according to the European Economic Community (EEC) system. There was consistent classification for 23 out of 25 cases between the UDP and the conventional LD50 results, in 16 out of 20 cases between the FDP and the conventional LD50, and in seven out of 10 cases between the UDP and the FDP. The UDP needed only between six and 10 animals of one sex (fewer than either the LD50 or the FDP). Available literature indicates that the sexes are usually similar in their acute toxicity responses and that of females are often more sensitive than males when acute toxicity differences do exist, thus obviating the need for both sexes to be tested in most cases. Unlike the FDP, the UDP also estimates an LD50, thus providing data directly applicable to all current hazard classification systems based on acute oral toxicity.
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Affiliation(s)
- R L Lipnick
- US Environmental Protection Agency, Office of Prevention, Pesticides and Toxic Substances, Washington, DC 20460
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43
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Pastore S, Shivji GM, Kondo S, Kono T, McKenzie RC, Segal L, Somers D, Sauder DN. Effects of contact sensitizers neomycin sulfate, benzocaine and 2,4-dinitrobenzene 1-sulfonate, sodium salt on viability, membrane integrity and IL-1 alpha mRNA expression of cultured normal human keratinocytes. Food Chem Toxicol 1995; 33:57-68. [PMID: 7821878 DOI: 10.1016/0278-6915(95)80249-5] [Citation(s) in RCA: 10] [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: 01/27/2023]
Abstract
The toxic effect of three potential contact sensitization chemicals [the aminoglycosidic antibiotic neomycin sulfate, the local anaesthetic benzocaine and the primary sensitizer 2,4-dinitrobenzene 1-sulfonate, sodium salt (DNBS)], on cultured human keratinocytes was examined. The three chemicals were compared with respect to their cytotoxic potential (determined by crystal violet staining assay), their membrane disruptive potential ([3H]arachidonic acid release assay), and their effects on interleukin 1 alpha (IL-1 alpha) mRNA expression [reverse transcription-polymerase chain reaction (RT-PCR)]. At the concentrations used, neomycin sulfate (0.004-0.32%) and benzocaine (0.0165-0.165%) did not show relevant cytotoxicity or membrane perturbation. On the other hand, DNBS (0.001-1%) caused a significant dose-dependent cytotoxic response at concentrations higher than 0.1%, while the [3H]arachidonic acid release assay indicated absence of membrane perturbation activity in all the range of DNBS concentrations examined. The effects of the three sensitizers on IL-1 alpha mRNA expression were varied; neomycin sulfate caused a dose-dependent induction of IL-1 alpha mRNA, benzocaine did not significantly affect its signal, and DNBS suppressed IL-1 alpha gene expression.
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Affiliation(s)
- S Pastore
- Division of Dermatology, Sunnybrook Health Science Centre, University of Toronto, Ontario, Canada
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44
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Schoysman R, Vanderzwalmen P, Nijs M, Segal L, Segal-Bertin G, Geerts L, van Roosendaal E, Schoysman-Deboeck A. Pregnancy obtained with human testicular spermatozoa in an in vitro fertilization program. J Androl 1994; 15 Suppl:10S-13S. [PMID: 7721668] [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: 01/26/2023]
Abstract
The fertilizing capacity of human testicular spermatozoa and the positive outcome of an in vitro fertilization program open a wide range of opportunities for men suffering from obstructive and inoperable azoospermia. In six cases, subzonal sperm injection or intracytoplasmic sperm injection techniques were applied to inject testicular spermatozoa into human oocytes. The fertilization rate after testicular sperm injection reached 45%. Normal cleavage was observed and replacement of 10 embryos in 6 patients resulted in one chemical and one ongoing pregnancy.
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Affiliation(s)
- R Schoysman
- Schoysman Infertility Management Foundation, I.V.F. Laboratory, Vilvoorde, Belgium
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45
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Schoysman R, Lejeune B, Segal L, van Roosendaal E, Vanderzwalmen P, Nijs M, Segal-Bertin G, Vandamme B. Indications for use of deferential sperm in IVF programs. Acta Eur Fertil 1994; 25:347-9. [PMID: 8838876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- R Schoysman
- S.I.M.A.F., van Helmont Hospital, Vilvoorde, Belgium
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Abstract
Obesity is a known risk factor for a number of diseases with serious mortality and morbidity implications. Thus, obesity is an economic burden to communities, since it reduces quality of life and leads to premature mortality; in addition, healthcare resources are used to manage obesity-related disease. It was estimated that in 1989, management of disease due to obesity (defined as body mass index greater than 30) cost A$395 million. This estimate covers the healthcare costs for the management of obesity, non-insulin-dependent diabetes mellitus (NIDDM), gallstones, hypertension, coronary heart disease (CHD), breast cancer (among postmenopausal women), and colon cancer. As this estimate excludes the costs of some disease attributable to obesity, it is an underestimate of the true costs. Nonetheless, the estimated cost of the management of obesity-related conditions represents 86% of the healthcare costs used for the management of alcohol-related diseases in Australia. Healthcare costs attributable to obesity have not yet been estimated for countries elsewhere in Asia and the Pacific. However, it is acknowledged that obesity is a major problem in the Pacific, with exceptionally high prevalence rates and concomitant high rates of diseases for which obesity is a major risk factor, particularly NIDDM and CHD. It would, therefore, be useful to explore the cost of disease attributable to obesity in healthcare systems in these communities, and the potential for preventive programmes to reduce these costs.
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Affiliation(s)
- L Segal
- National Centre for Health Program Evaluation, Melbourne, Australia
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47
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Schoysman R, Vanderzwalmen P, Nijs M, Segal L, Segal-Bertin G, Geerts L, van Roosendaal E, Schoysman D. Pregnancy after fertilisation with human testicular spermatozoa. Lancet 1993; 342:1237. [PMID: 7901551 DOI: 10.1016/0140-6736(93)92217-h] [Citation(s) in RCA: 209] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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48
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Schoysman R, Segal L, Van der Zwalmen P, Nijs M, Bertin G, Cittadini E, Cimino C, Ruvolo G, Cefalù E, Palermo R. Fertilization of oocytes by testicular spermatozoa and pregnancy in the human. Acta Eur Fertil 1993; 24:103-105. [PMID: 7985451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Affiliation(s)
- R Schoysman
- Van Helmont Hospital, Unit for Infertility, Vilvoorde, Belgium
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49
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Schoysman R, Segal L, Van Der Zwalmen P, Nijs M, Bertin G, Cittadini E, Cimino C, Ruvolo G, Cefalù E, Palermo R. Assisted fertilization with epididymal spermatozoa. Acta Eur Fertil 1993; 24:7-12. [PMID: 8303974] [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: 01/29/2023]
Abstract
In vitro fertilization is used for several years as a technique for resolving infertility problems due to moderate or severe oligospermia. More recently, techniques of micro-insemination of oocytes have also become available for cases of extremely severe oligospermia which cannot be resolved by classical I.V.F. Nevertheless, although these particular techniques have already led to results which have gone far beyond initial hopes, they are not able to resolve all cases of male sterility. There are indeed many situations of excretory azoospermia associated with normal spermatogenesis; the spermatozoa remain trapped in a more or less extensive part of the epididymis because its passage is blocked, either because of post-infectious sclerosis, or of agenesis of a variably extensive area of the Wolffian duct. Post-inflammatory occlusions can be treated by micro-surgery, whereas in cases of agenesis, attempts to collect spermatozoa by means of an artificial spermatocele have led to far too many failures, and this technique has now been abandoned, in spite of some successful pregnancies. The extraordinary development of in vitro fertilization techniques has led to the logical idea that it might be possible to collect epididymal spermatozoa for oocyte fertilization.
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Nijs M, Vanderzwalmen P, Segal-Bertin G, Geerts L, Van Roosendaal E, Segal L, Schoysman-Deboeck A, Schoysman R. A monozygotic twin pregnancy after application of zona rubbing on a frozen-thawed blastocyst. Hum Reprod 1993; 8:127-9. [PMID: 8458915 DOI: 10.1093/oxfordjournals.humrep.a137861] [Citation(s) in RCA: 8] [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: 01/30/2023] Open
Abstract
Assisted hatching techniques enhance the success rate of implantation of in-vitro fertilized human embryos. We report here the successful transfer of a frozen-thawed human blastocyst on which we applied a non-invasive zona rubbing technique (reduction of the thickness of the zona pellucida by gentle rubbing with a microneedle). The implantation in the uterus led to the delivery of healthy monozygotic twins.
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Affiliation(s)
- M Nijs
- IVF Centre, Van Helmont Ziekenhuis, Vilvoorde, Belgium
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