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O'Keeffe R, Mulligan K, McParland P, McAuliffe FM, Mahony R, Corcoran S, O'Connor C, Carroll S, Walsh J. Estimating fetal weight in gastroschisis: A 10 year audit of outcomes at the National Maternity Hospital. Int J Gynaecol Obstet 2024. [PMID: 38572954 DOI: 10.1002/ijgo.15525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 03/14/2024] [Accepted: 03/24/2024] [Indexed: 04/05/2024]
Abstract
OBJECTIVE To identify whether conventional methods of estimating fetal growth (Hadlock's formula), which relies heavily on abdominal circumference measurements, are accurate in fetuses with gastroschisis. METHODS A retrospective cohort study was performed between the period January 1, 2011 and December 31, 2021 in a tertiary referral maternity hospital identifying all pregnancies with a diagnosis of gastroschisis. Projected fetal weight was obtained using the formula (EFW [Hadlock's formula] + 185 g × [X/7]) where X was the number of days to delivery. RESULTS During the study period 41 cases were identified. The median maternal age was 25. The median BMI was 25 and 63% were primiparous women (n = 26). Median gestation at diagnosis was 21 weeks. Median gestation at delivery was 36 weeks. A total of 4.8% of mothers had a history of drug use (n = 2). The rate of maternal tobacco use was 21.9% (n = 9). A total of 4.8% of fetuses had additional congenital anomalies including amniotic band syndrome and myelomeningocele (n = 2). Estimated fetal weight (EFW) and birth weight data were available for 34 cases. A Wilcoxon signed-rank test showed projected EFW using Hadlock's formula did not result in a statistically significant different birth weight (Z = -1.3, P = 0.169). Median projected weight and actual birth weight were 2241.35 and 2415 g respectively. Median difference was 0.64 g (95% CI: -148 to -28.5). CONCLUSION Our data showed accuracy using standard formulae for EFW in fetuses with gastroschisis.
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Affiliation(s)
- Rachel O'Keeffe
- UCD School of Medicine and Medical Science, National Maternity Hospital, Dublin, Ireland
| | - Karen Mulligan
- UCD School of Medicine and Medical Science, National Maternity Hospital, Dublin, Ireland
| | - Peter McParland
- UCD School of Medicine and Medical Science, National Maternity Hospital, Dublin, Ireland
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Fionnuala M McAuliffe
- UCD School of Medicine and Medical Science, National Maternity Hospital, Dublin, Ireland
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Rhona Mahony
- UCD School of Medicine and Medical Science, National Maternity Hospital, Dublin, Ireland
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Siobhan Corcoran
- UCD School of Medicine and Medical Science, National Maternity Hospital, Dublin, Ireland
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Clare O'Connor
- UCD School of Medicine and Medical Science, National Maternity Hospital, Dublin, Ireland
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Stephen Carroll
- UCD School of Medicine and Medical Science, National Maternity Hospital, Dublin, Ireland
| | - Jennifer Walsh
- UCD School of Medicine and Medical Science, National Maternity Hospital, Dublin, Ireland
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
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van Heerden X, Jansen C, Corcoran S, Price A, Kotze N, Rowan FE, Cleary MS. Novel Clinics and their Effect on the Elective Orthopaedic Waiting List. Ir Med J 2024; 117:898. [PMID: 38260711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
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3
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van Heerden X, Jansen C, Corcoran S, Price A, Kotze N, Rowan FE, Cleary MS. Novel Clinics and their Effect on the Elective Orthopaedic Waiting List. Ir Med J 2024; 117:898. [PMID: 38260710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
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4
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Corbett GA, Windrim C, Higgins S, McAuliffe FM, Wilkinson M, O'Brien D, Corcoran S. Laparoscopic prepregnancy transabdominal cerclage: operative and pregnancy outcomes for a novel technique of suture placement using port closure device. Am J Obstet Gynecol 2023:S0002-9378(23)02119-1. [PMID: 38065377 DOI: 10.1016/j.ajog.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 11/15/2023] [Accepted: 12/04/2023] [Indexed: 01/05/2024]
Abstract
Transabdominal cerclage is an effective surgical intervention for preterm birth prevention. Placement of cervical sutures using a port closure device for prepregnancy laparoscopic abdominal cerclage has been used at our unit in recent years. We report the operative and pregnancy outcomes for prepregnancy laparoscopic abdominal cerclage using the port closure device and compare it with the outcomes of the traditional approach. For prepregnancy laparoscopic transabdominal cerclage (n=52), the port closure device approach was associated with less blood loss during surgery (0.95±4.4 mL vs 5.4±15.7 mL; P=.007) and a shorter hospital length of stay (0.0; 0.0-0.0 days vs 1.0; 0.0-1.0 days; P<.001). There were also trends toward shorter operating times (41.4±15.3 minutes vs 50.1±18.0 minutes; P=.167) and lower perioperative complication rates (0.0%; 0/21 vs 16.1%; 5/31; P=.065) when compared with the traditional technique. There was no significant difference between the port closure device technique and the traditional approach in the rate of preterm birth in a subsequent pregnancy (0.0%; 0/9 vs 22.6%; 7/39; P=.248). Use of the port closure device for suture placement during prepregnancy laparoscopic cerclage for preterm birth prevention was reported. This technique was associated with less blood loss and a shorter hospital length of stay, had trends toward shorter operating times and lower perioperative complication rates, and had similar rates of preterm birth.
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Affiliation(s)
- Gillian A Corbett
- University College Dublin Perinatal Research Centre, National Maternity Hospital, Dublin 2, Ireland.
| | | | | | - Fionnuala M McAuliffe
- University College Dublin Perinatal Research Centre, National Maternity Hospital, Dublin 2, Ireland
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Duncan A, McDermott H, Corcoran S, Devine C, Barry C. Pyroglutamic acidosis caused by the combination of two common medicines prescribed in everyday practice. Oxf Med Case Reports 2023; 2023:omad048. [PMID: 37260733 PMCID: PMC10228107 DOI: 10.1093/omcr/omad048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 03/13/2023] [Accepted: 04/10/2023] [Indexed: 06/02/2023] Open
Abstract
We present the case of a 71-year-old female treated for infective endocarditis with flucloxacillin and paracetamol. Her clinical course became complicated by a blood-gas demonstrating a raised anion gap metabolic acidosis. The patient was diagnosed with pyroglutamic metabolic acidosis. This is a rare interaction between high dose flucloxacillin and paracetamol, and is an important complication to recognize.
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Affiliation(s)
- A Duncan
- Correspondence address. General Internal Medicine, Bon Secours, Dublin, Ireland. Tel: +353-0871206988; E-mail:
| | - H McDermott
- Department of Medicine, Bon Secours Hospital, Dublin, Ireland
- Department of Microbiology, Bon Secours, Dublin, Ireland
| | - S Corcoran
- Department of Medicine, Bon Secours Hospital, Dublin, Ireland
- Department of Microbiology, Bon Secours, Dublin, Ireland
| | - C Devine
- Department of Medicine, Bon Secours Hospital, Dublin, Ireland
- Department of Microbiology, Bon Secours, Dublin, Ireland
- Department of Pharmacy, Bon Secours, Dublin, Ireland
| | - C Barry
- Department of Medicine, Bon Secours Hospital, Dublin, Ireland
- Department of Microbiology, Bon Secours, Dublin, Ireland
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6
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O'Keeffe R, Redmond A, Leuthe L, Corcoran S. Review of Outcomes for Vaginal-Approach Cervical Cerclage in Women at Risk of Spontaneous Preterm Birth. Ir Med J 2023; 116:757. [PMID: 37555555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
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7
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Dempsey S, R Alijshi R, Corcoran S, Curley A. A Guide for Clinicians supporting Women and Families navigating Surrogacy. Ir Med J 2023; 116:731. [PMID: 37555787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
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8
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Ryan GA, Start AO, Cathcart B, Hughes H, Denona B, Higgins S, Corcoran S, Walsh J, Carroll S, Mahony R, Crimmins D, Caird J, Robinson I, Colleran G, McParland P, McAuliffe FM. Prenatal findings and associated survival rates in fetal ventriculomegaly: A prospective observational study. Int J Gynaecol Obstet 2022; 159:891-897. [PMID: 35373343 PMCID: PMC9790218 DOI: 10.1002/ijgo.14206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 03/22/2022] [Accepted: 03/28/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Fetal ventriculomegaly is associated with varying degrees of genetic and structural abnormalities. The objective was to present the experience of fetal ventriculomegaly in a large European center in relation to: 1. grade of ventriculomegaly; 2. additional chromosomal/structural abnormalities; and 3. perinatal survival rates. METHODS This was a prospective observational study of patients referred with fetal ventriculomegaly from January 2011 to July 2020. Data were obtained from the hospital database and analyzed to determine the rate of isolated ventriculomegaly, associated structural abnormalities, chromosomal/genetic abnormalities, and survival rates. Data were stratified into three groups; mild (Vp = 10-12 mm), moderate (Vp = 13-15 mm) and severe (Vp > 15 mm) ventriculomegaly. RESULTS There were 213 fetuses included for analysis. Of these 42.7% had mild ventriculomegaly, 44.6% severe and 12.7% had moderate ventriculomegaly. Initial ultrasound assessment reported isolated ventriculomegaly in 45.5% fetuses, with additional structural abnormalities in 54.5%. The rate of chromosomal/genetic abnormalities was high,16.4%. After all investigations, the true rate of isolated VM was 36.1%. The overall survival was 85.6%. Survival was higher for those with isolated VM across all groups (P < 0.05). CONCLUSION Ventriculomegaly is a complex condition and patients should be counselled that even with apparently isolated VM, there remains the possibility of additional genetic and/or structural problems being diagnosed in up to 10% of fetuses.
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Affiliation(s)
- Gillian A. Ryan
- UCD Perinatal Research CentreUniversity College Dublin, The National Maternity HospitalDublinIreland,Fetal Medicine DepartmentThe National Maternity HospitalDublinIreland
| | - Alexander O. Start
- UCD Perinatal Research CentreUniversity College Dublin, The National Maternity HospitalDublinIreland,Fetal Medicine DepartmentThe National Maternity HospitalDublinIreland
| | - Barbara Cathcart
- Fetal Medicine DepartmentThe National Maternity HospitalDublinIreland
| | - Heather Hughes
- Fetal Medicine DepartmentThe National Maternity HospitalDublinIreland
| | | | - Shane Higgins
- UCD Perinatal Research CentreUniversity College Dublin, The National Maternity HospitalDublinIreland,Fetal Medicine DepartmentThe National Maternity HospitalDublinIreland
| | - Siobhan Corcoran
- UCD Perinatal Research CentreUniversity College Dublin, The National Maternity HospitalDublinIreland,Fetal Medicine DepartmentThe National Maternity HospitalDublinIreland
| | - Jennifer Walsh
- UCD Perinatal Research CentreUniversity College Dublin, The National Maternity HospitalDublinIreland,Fetal Medicine DepartmentThe National Maternity HospitalDublinIreland
| | - Stephen Carroll
- Fetal Medicine DepartmentThe National Maternity HospitalDublinIreland
| | - Rhona Mahony
- Fetal Medicine DepartmentThe National Maternity HospitalDublinIreland
| | - Darach Crimmins
- Neurosurgery DepartmentChildren's University HospitalDublinIreland,UCD School of MedicineUniversity College DublinIreland
| | - John Caird
- Neurosurgery DepartmentChildren's University HospitalDublinIreland
| | - Ian Robinson
- Radiology DepartmentThe National Maternity HospitalDublinIreland
| | - Gabrielle Colleran
- UCD School of MedicineUniversity College DublinIreland,Radiology DepartmentThe National Maternity HospitalDublinIreland
| | - Peter McParland
- UCD Perinatal Research CentreUniversity College Dublin, The National Maternity HospitalDublinIreland,Fetal Medicine DepartmentThe National Maternity HospitalDublinIreland
| | - Fionnuala M. McAuliffe
- UCD Perinatal Research CentreUniversity College Dublin, The National Maternity HospitalDublinIreland,Fetal Medicine DepartmentThe National Maternity HospitalDublinIreland
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9
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Armstrong F, Mulligan K, Mac Dermott R, Bartels HC, Carroll S, Robson M, Corcoran S, Mc Parland P, Brien DO, Brophy D, Brennan DJ. Caesarean Scar Niche An evolving concern in clinical practice. Int J Gynaecol Obstet 2022; 161:356-366. [PMID: 36317541 DOI: 10.1002/ijgo.14509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/05/2022] [Accepted: 10/10/2022] [Indexed: 11/05/2022]
Abstract
Increasing cesarean section rates have led to an increased awareness of associated complications such as the formation of cesarean scar niche, defined as an indentation at the site of the cesarean scar with a depth of at least 2 mm, diagnosed by ultrasound or magnetic resonance imaging. The precise prevalence of cesarean scar niche is unclear. The cause of a cesarean scar niche appears to be multifactorial and likely a combination of technical factors (low incision location), anatomical factors (uterine retroflexion), and patient factors, which might impair healing (body mass index, smoking, maternal age). Most patients with cesarean scar niche are asymptomatic; however, women can present with postmenstrual bleeding, pelvic pain, and subfertility. In pregnancy, cesarean scar niches have been associated with placenta accreta spectrum disorder and uterine rupture. Treatment should be reserved for symptomatic women. Hormonal treatment using either the combined oral contraceptive pill or a progesterone-containing intrauterine device may address irregular vaginal bleeding. Surgical management should be reserved for those in whom hormonal manipulation has failed or is contraindicated. The aim of this review was to summarize current literature pertaining to the cause, prevalence, diagnosis, and symptoms of cesarean scar niche and to make recommendations for managing this relatively new condition.
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Affiliation(s)
| | - Karen Mulligan
- UCD School of Medicine National Maternity Hospital, Holles Street Dublin 2
| | - Roisin Mac Dermott
- St Vincent's University Hospital University College Dublin Elm Park Dublin 4
| | - Helena C. Bartels
- UCD School of Medicine National Maternity Hospital, Holles Street Dublin 2
| | - Stephen Carroll
- UCD School of Medicine National Maternity Hospital, Holles Street Dublin 2
| | - Michael Robson
- UCD School of Medicine National Maternity Hospital, Holles Street Dublin 2
| | - Siobhan Corcoran
- UCD School of Medicine National Maternity Hospital, Holles Street Dublin 2
| | - Peter Mc Parland
- UCD School of Medicine National Maternity Hospital, Holles Street Dublin 2
| | - Donal O. Brien
- UCD School of Medicine National Maternity Hospital, Holles Street Dublin 2
- St Vincent's University Hospital University College Dublin Elm Park Dublin 4
| | - David Brophy
- St Vincent's University Hospital University College Dublin Elm Park Dublin 4
| | - Donal J. Brennan
- UCD School of Medicine National Maternity Hospital, Holles Street Dublin 2
- St Vincent's University Hospital University College Dublin Elm Park Dublin 4
- Systems Biology Ireland, UCD School of Medicine, Belfield Dublin 4
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10
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Bamford T, Easter C, Montgomery S, Smith R, Coomarasamy A, Smith RD, Young S, Anna B, Iasonos R, Louise B, Gina A, Wachter A, Corcoran S, Amy B, Alison C. A morphokinetic ploidy prediction model built and validated on over 8000 blastocysts. Reprod Biomed Online 2022. [DOI: 10.1016/j.rbmo.2022.08.039] [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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11
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Best L, Corcoran S, Armstrong E, Page A, Montgomery S, Nice L, Berrisford K, Drezet C, Lodge Y, Campbell A. A retrospective assessment of outcomes according to the concentration of protein in culture medium following vitrified oocyte warming. Reprod Biomed Online 2022. [DOI: 10.1016/j.rbmo.2022.08.017] [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: 10/07/2022]
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12
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Ryan GA, Finnegan C, McAuliffe FM, Malone FD, Müllers SM, Corcoran S, Mulcahy C, Dalrymple J, Donnelly J, Walsh J, Mcparland P, Martin A, Carroll S, Kent E. Fetoscopic Laser Ablation for Twin-to-Twin Transfusion Syndrome: A 15-year Review of Perinatal Survival. Ir Med J 2022; 115:595. [PMID: 35696199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Objective Twin to twin transfusion syndrome (TTTS) complicates 5-15% of monochorionic twin pregnancies and untreated is associated with a 90% mortality rate. The aim was to present the perinatal survival of patients with TTTS treated with laser ablation, by a national fetal medicine team. Methods This was a review of all cases of TTTS treated with fetoscopic laser ablation performed from March 2006 through to December 2020. All patients treated with fetoscopic laser were identified from the hospital database. The perinatal outcomes for the overall cohort and the individual Quintero stages were determined. Results A total of 155 cases of TTTS underwent fetoscopic laser ablation during the study period. The median gestational age at diagnosis was 19+1 weeks, with a mean growth discordance of 23.6%. The Quintero stage at diagnosis was: Stage 1 6.5% (10/155), Stage 2 49% (76/155), Stage 3 38.7% (60/155), Stage 4 5.8% (9/155). There was at least one survivor in 83.2% (129/155) of pregnancies, with dual survival in 52.9% (82/155). An increase in the rate of any survivor was observed from 75% (2006-2014) to 94% (2014-2020) (p<0.05). Dual survival decreased with increasing Quintero Stage (p<0.05). 80.6% (125/155) of pregnancies delivered prior to 34+6 weeks gestation. Conclusion Fetoscopic laser ablation is the recommended first line treatment for severe TTTS. We observed a survival rate of at least one twin in 83.2% pregnancies which is comparable to internationally published data on single-centre outcomes.
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Affiliation(s)
- G A Ryan
- Department of Obstetrics and Gynaecology, The National Maternity Hospital, Dublin, Ireland
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - C Finnegan
- Department of Obstetrics and Gynaecology, Rotunda Hospital, Dublin, Ireland
- Department of Obstetrics and Gynaecology, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
| | - F M McAuliffe
- Department of Obstetrics and Gynaecology, The National Maternity Hospital, Dublin, Ireland
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - F D Malone
- Department of Obstetrics and Gynaecology, Rotunda Hospital, Dublin, Ireland
- Department of Obstetrics and Gynaecology, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
| | - S M Müllers
- Department of Obstetrics and Gynaecology, Rotunda Hospital, Dublin, Ireland
| | - S Corcoran
- Department of Obstetrics and Gynaecology, The National Maternity Hospital, Dublin, Ireland
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - C Mulcahy
- Department of Obstetrics and Gynaecology, The National Maternity Hospital, Dublin, Ireland
| | - J Dalrymple
- Department of Obstetrics and Gynaecology, Rotunda Hospital, Dublin, Ireland
| | - J Donnelly
- Department of Obstetrics and Gynaecology, Rotunda Hospital, Dublin, Ireland
- UCD Obstetrics & Gynaecology, University College Dublin, Ireland
| | - J Walsh
- Department of Obstetrics and Gynaecology, The National Maternity Hospital, Dublin, Ireland
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - P Mcparland
- Department of Obstetrics and Gynaecology, The National Maternity Hospital, Dublin, Ireland
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - A Martin
- UCD Obstetrics & Gynaecology, University College Dublin, Ireland
- Department of Obstetrics and Gynaecology, The Coombe Women And Infants University Hospital, Dublin, Ireland
| | - S Carroll
- Department of Obstetrics and Gynaecology, The National Maternity Hospital, Dublin, Ireland
| | - E Kent
- Department of Obstetrics and Gynaecology, Rotunda Hospital, Dublin, Ireland
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Riordan SL, Ryan GA, Cathcart B, Hughes H, Higgins S, Fitzgerald J, Corcoran S, Walsh J, Mahony R, Carroll S, Mcauliffe FM, Mcparland P. The Rate of Decline in Fetal Hemoglobin following Intrauterine Blood Transfusion in the Management of Red Cell Alloimmunization. Eur J Obstet Gynecol Reprod Biol 2022; 271:93-96. [DOI: 10.1016/j.ejogrb.2022.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 01/31/2022] [Accepted: 02/07/2022] [Indexed: 11/16/2022]
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14
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Start AO, Ryan GA, Cathcart B, Hughes H, Higgins S, Corcoran S, Walsh J, Carroll S, Mahony R, Crimmins D, Caird J, Colleran G, McParland P, McAuliffe FM. Severe fetal ventriculomegaly: Fetal morbidity and mortality, caesarean delivery rates and obstetrical challenges in a large prospective cohort. Prenat Diagn 2021; 42:109-117. [PMID: 34870870 DOI: 10.1002/pd.6072] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 09/12/2021] [Accepted: 10/07/2021] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Severe fetal ventriculomegaly (VM) is defined as an enlargement of the atria of the lateral cerebral ventricles (Vp) of greater than 15 mm. While it is well established that it confers significant risk of morbidity and mortality to the neonate, there is limited information pertaining to the caesarean delivery rates and the obstetric management of these complex cases. The aim of this study was twofold: firstly, to determine survival rates in fetuses with severe VM, and secondly to determine the caesarean delivery rates in continuing pregnancies. We explore the obstetric challenges associated with these difficult cases. METHODS This was a prospective observational study of patients with antenatal severe VM, attending the Department of Fetal Medicine, National Maternity Hospital, Dublin, Ireland, from 1st January 2011 to 31st July 2020. Data were obtained from the hospital database and those with severe VM (Vp > 15 mm) were identified. The rates of chromosomal abnormalities, the survival rates and the caesarean delivery (CD) rates for the overall group were then determined. The data were then further sub-divided into two groups: 1. Vp < 20 mm and 2. Vp > 20 mm, and the results compared. Statistical analysis was performed using the Chi-Square test. RESULTS A total of N = 95 pregnancies with severe VM were included for analysis, of which additional structural abnormalities on ultrasound were apparent in 67/95 (70.5%) and 28/95 (29.5%) had isolated severe VM. Chromosomal abnormalities were diagnosed in 15/95 (15.8%) of cases, with (2/28) 7.1% in the isolated SVM group versus (13/67) 19.4% in the non-isolated SVM group. The overall survival rate (excluding TOP) was 53/74 (71.6%), with 20/23 (86.9%) in the isolated SVM group. The overall CD rate was 47/72 (65.3%), which was significantly higher than the CD for the hospital during the same time period of 25.4% (P < 0.01). The data were subdivided into Vp < 20 and Vp > 20 and those with a Vp > 20 had higher rates of additional intracranial findings on ultrasound (Vp < 20 13/41 (31.7%) versus Vp > 20 32/54 (59.3%) (P < 0.05)) and macrocrania (Vp < 20 14/41 (34.1%) versus Vp > 20 35/54 (64.8%) (P < 0.05)). No significant difference was observed in the overall survival or CD rates between the two groups. CONCLUSION In conclusion this study reports significant fetal morbidity and mortality with severe VM with high CD rates observed in this cohort. Significant challenges exist in relation to the obstetric management and counseling of parents regarding an often uncertain neonatal prognosis. In continuing pregnancies with significant macrocrania delivery plans should be individualized to improve neonatal outcomes where possible and minimize harm to the mother.
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Affiliation(s)
- Alex O Start
- UCD Perinatal Research Centre, University College Dublin, The National Maternity Hospital, Dublin, Ireland.,Fetal Medicine Department, The National Maternity Hospital, Dublin, Ireland
| | - Gillian A Ryan
- UCD Perinatal Research Centre, University College Dublin, The National Maternity Hospital, Dublin, Ireland.,Fetal Medicine Department, The National Maternity Hospital, Dublin, Ireland
| | - Barbara Cathcart
- Fetal Medicine Department, The National Maternity Hospital, Dublin, Ireland
| | - Heather Hughes
- Fetal Medicine Department, The National Maternity Hospital, Dublin, Ireland
| | - Shane Higgins
- UCD Perinatal Research Centre, University College Dublin, The National Maternity Hospital, Dublin, Ireland.,Fetal Medicine Department, The National Maternity Hospital, Dublin, Ireland
| | - Siobhan Corcoran
- UCD Perinatal Research Centre, University College Dublin, The National Maternity Hospital, Dublin, Ireland.,Fetal Medicine Department, The National Maternity Hospital, Dublin, Ireland
| | - Jennifer Walsh
- UCD Perinatal Research Centre, University College Dublin, The National Maternity Hospital, Dublin, Ireland.,Fetal Medicine Department, The National Maternity Hospital, Dublin, Ireland
| | - Stephen Carroll
- Fetal Medicine Department, The National Maternity Hospital, Dublin, Ireland
| | - Rhona Mahony
- Fetal Medicine Department, The National Maternity Hospital, Dublin, Ireland
| | - Darach Crimmins
- Neurosurgery Department, Children's University Hospital, Dublin, Ireland.,UCD School of Medicine, University College Dublin, Dublin, Ireland
| | - John Caird
- Neurosurgery Department, Children's University Hospital, Dublin, Ireland
| | - Gabrielle Colleran
- UCD School of Medicine, University College Dublin, Dublin, Ireland.,Radiology Department, The National Maternity Hospital, Dublin, Ireland
| | - Peter McParland
- UCD Perinatal Research Centre, University College Dublin, The National Maternity Hospital, Dublin, Ireland.,Fetal Medicine Department, The National Maternity Hospital, Dublin, Ireland
| | - Fionnuala M McAuliffe
- UCD Perinatal Research Centre, University College Dublin, The National Maternity Hospital, Dublin, Ireland.,Fetal Medicine Department, The National Maternity Hospital, Dublin, Ireland
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Glennon K, Donnelly J, Knowles S, McAuliffe FM, O’Reilly A, Corcoran S, Walsh J, McMorrow R, Higgins T, Bolger L, Clinton S, O’Riordan S, Start A, Roche D, Bartels H, Malone C, McAuley K, McDermott A, Inzitari R, O’Donnell CPF, Malone F, Higgins S, De Gascun C, Doran P, Brennan DJ. Immunological assessment of SARS-CoV-2 infection in pregnancy from diagnosis to delivery: A multicentre prospective study. PLoS One 2021; 16:e0253090. [PMID: 34543278 PMCID: PMC8451988 DOI: 10.1371/journal.pone.0253090] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 05/27/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Background Population-based data on SARS-CoV-2 infection in pregnancy and assessment of passive immunity to the neonate, is lacking. We profiled the maternal and fetal response using a combination of viral RNA from naso-pharyngeal swabs and serological assessment of antibodies against SARS-CoV-2. METHODS This multicentre prospective observational study was conducted between March 24th and August 31st 2020. Two independent cohorts were established, a symptomatic SARS-CoV-2 cohort and a cohort of asymptomatic pregnant women attending two of the largest maternity hospitals in Europe. Symptomatic women were invited to provide a serum sample to assess antibody responses. Asymptomatic pregnant women provided a nasopharyngeal swab and serum sample. RT-PCR for viral RNA was performed using the Cobas SARS-CoV-2 6800 platform (Roche). Umbilical cord bloods were obtained at delivery. Maternal and fetal serological response was measured using both the Elecsys® Anti-SARS-CoV-2 immunoassay (Roche), Abbott SARS-CoV-2 IgG Assay and the IgM Architect assay. Informed written consent was obtained from all participants. RESULTS Ten of twenty three symptomatic women had SARS-CoV-2 RNA detected on nasopharyngeal swabs. Five (5/23, 21.7%) demonstrated serological evidence of anti-SARS-CoV-2 IgG antibodies and seven (30.4%, 7/23) were positive for IgM antibodies. In the asymptomatic cohort, the prevalence of SARS-CoV-2 infection in RNA was 0.16% (1/608). IgG SARS-CoV-2 antibodies were detected in 1·67% (10/598, 95% CI 0·8%-3·1%) and IgM in 3·51% (21/598, 95% CI 2·3-5·5%). Nine women had repeat testing post the baseline test. Four (4/9, 44%) remained IgM positive and one remained IgG positive. 3 IgG anti-SARS-CoV-2 antibodies were detectable in cord bloods from babies born to five seropositive women who delivered during the study. The mean gestation at serological test was 34 weeks. The mean time between maternal serologic positivity and detection in umbilical cord samples was 28 days. CONCLUSION Using two independent serological assays, we present a comprehensive illustration of the antibody response to SARS-CoV-2 in pregnancy, and show a low prevalence of asymptomatic SARS-CoV2. Transplacental migration of anti-SARS-CoV-2 antibodies was identified in cord blood of women who demonstrated antenatal anti-SARS-CoV-2 antibodies, raising the possibility of passive immunity.
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Affiliation(s)
- Kate Glennon
- UCD School of Medicine, National Maternity Hospital, Dublin, Ireland
| | | | - Susan Knowles
- Department of Microbiology, National Maternity Hospital, Dublin, Ireland
| | - Fionnuala M. McAuliffe
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Alma O’Reilly
- RCSI School of Medicine, Rotunda Hospital, Dublin, Ireland
| | | | | | | | | | - Lucy Bolger
- National Maternity Hospital, Dublin, Ireland
| | | | | | - Alexander Start
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | | | | | | | - Karl McAuley
- Clinical Research Centre, UCD School of Medicine, St Vincent’s University Hospital, Dublin, Ireland
| | - Anthony McDermott
- Clinical Research Centre, UCD School of Medicine, St Vincent’s University Hospital, Dublin, Ireland
| | - Rosanna Inzitari
- Clinical Research Centre, UCD School of Medicine, St Vincent’s University Hospital, Dublin, Ireland
| | - Colm P. F. O’Donnell
- Neonatal Unit, UCD School of Medicine National Maternity Hospital, Dublin, Ireland
| | - Fergal Malone
- RCSI School of Medicine, Rotunda Hospital, Dublin, Ireland
| | - Shane Higgins
- UCD School of Medicine, National Maternity Hospital, Dublin, Ireland
- National Maternity Hospital, Dublin, Ireland
| | - Cillian De Gascun
- National Virus Reference Laboratory, University College Dublin, Dublin, Ireland
| | - Peter Doran
- Clinical Research Centre, UCD School of Medicine, St Vincent’s University Hospital, Dublin, Ireland
| | - Donal J. Brennan
- UCD School of Medicine, National Maternity Hospital, Dublin, Ireland
- Systems Biology Ireland, UCD School of Medicine, Dublin, Ireland
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Corcoran S, Corcoran D, Wachter A, Andrews E, Campbell J, Delphine D, Kuczera B, Campbell A. P–253 Description of a rare spontaneous monozygotic blastocyst splitting into two discrete euploid blastocysts in vitro detected with time-lapse imaging and preimplantation genetic testing (PGT). Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study question
Can spontaneous and complete blastocyst splitting into two, in vitro, be investigated using time-lapse imaging and biopsy of each trophectoderm, for inference of ploidy?
Summary answer
Time-lapse imaging combined with PGT-A gives insights into the incidence, dynamics and timing of rare blastocyst splitting and the ploidy status of each resulting blastocyst.
What is known already
It is well known that multiple births occur more often with Assisted Reproductive Technologies (ART) than spontaneous conception, even after single embryo transfer. The mechanism of Monozygotic Twinning (MZT) during ART is still unclear but cryopreservation, extended culture, PGT, maternal age and assisted hatching are reported risk factors. MZT is a rare phenomenon, with an incidence of 0.4% in natural conception compared with up to 4.9% in ART. The timing of embryo splitting dictates the type of twinning, in terms of chorionicity and amnionicty, and this is officially determined using ultrasound scanning.
Study design, size, duration
This is a case study describing the detection of the complete splitting of an IVF blastocyst at 140 hours post insemination (hpi), using time-lapse imaging.
The 40-year-old patient previously experienced biochemical pregnancy and several miscarriages; an ectopic molar pregnancy and a probable cornual ectopic. The 39-year-old male partner was normozoospermic.
Participants/materials, setting, methods
Facilitative laser breaching was performed, according to standard operating procedure, of the morula at 96hpi of embryo development, prior to PGT. Images were collected every 10 minutes and developmental events and embryos morphology annotated using the EmbryoScope+™ time lapse incubator and software.
Main results and the role of chance
Over 50,000 hatching blastocysts have been time-lapse imaged, scrutinised and annotated within this group of fertility clinics. This is the first time that such a rare blastocyst splitting event has been recorded and studied.
Following observation of two pronuclei following IVF and typical cleavage development to blastocyst, with facilitative zona breaching on, at 106.7hpi, the full blastocyst’s trophectoderm (TE) began to herniate and hatch. By 114.3hpi a second internal blastocoel cavity formed appearing to divide the inner cell mass (ICM) within the zona pellucida (ZP). This resulting blastocyst proceeded to hatch as its discrete ICM migrated out of the ZP, along with its TE. TE cells from the original blastocyst then began to hatch at 117.5hpi at the same breached site in the ZP with its ICM visibly evacuating the ZP.
By 140hpi the blastocyst had split into two discrete blastocysts while hatching from the ZP. Both resulting blastocysts had clear and separate ICMs and TEs present. Biopsy of approximately 5 cells was performed for each TE, and the blastocysts were vitrified individually. Next Generation Sequencing (NGS) reported both blastocysts to be euploid.
Limitations, reasons for caution
This case may have been detectable without time-lapse imaging, as the splitting was completed prior to biopsy. More expert scrutiny of the images may result in earlier signs of twinning in progress being detected.
Wider implications of the findings: The nature of this detectable in vitro blastocyst splitting, indicates these embryos (if they implanted) to be monozygotic, dichoriol-diamniotic ‘identical’ twins. However – as single embryo transfer is the preferred treatment plan; they may be born years apart. These observations could shed light on the debated models of monozygotic twinning.
Trial registration number
Not applicable
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Affiliation(s)
- S Corcoran
- Beacon CARE Fertility Clinic, Laboratory, Dublin, Ireland
| | - D Corcoran
- Beacon CARE Fertility Clinic, Laboratory, Dublin, Ireland
| | - A Wachter
- Beacon CARE Fertility Clinic, Laboratory, Dublin, Ireland
| | - E Andrews
- Beacon CARE Fertility Clinic, Laboratory, Dublin, Ireland
| | - J Campbell
- Beacon CARE Fertility Clinic, Laboratory, Dublin, Ireland
| | - D Delphine
- Beacon CARE Fertility Clinic, Laboratory, Dublin, Ireland
| | - B Kuczera
- Beacon CARE Fertility Clinic, Clinical, Dublin, Ireland
| | - A Campbell
- CARE Fertility Group, Director of Embryology, Manchester, United Kingdom
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17
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O'Reilly P, Dakin A, Keating N, Luethe L, Corcoran S. "Does the use of gestation-specific centiles for cervical length change the management of pregnancies at risk of recurrent spontaneous preterm birth?". Eur J Obstet Gynecol Reprod Biol 2021; 264:349-352. [PMID: 34385081 DOI: 10.1016/j.ejogrb.2021.07.052] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 07/18/2021] [Accepted: 07/28/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Preterm birth is the leading cause of neonatal morbidity and mortality. Spontaneous Preterm Birth (sPTB) has many and varied causes but is known to be strongly associated with a short or shortening cervix in the midtrimester of pregnancy. The strongest risk factor for sPTB is a previous sPTB. In women with a history of sPTB, we can offer surveillance and treatments which have been proven to reduce the risk of sPTB, such as cervical cerclage and vaginal progesterone supplementation. Alongside other indications, we currently use 25 mm or shorter as a "trigger threshold" for offering cervical cerclage treatment in the Preterm Birth Prevention Clinic at The National Maternity Hospital. AIM To determine if using gestation-specific centiles instead of a 25 mm cut-off for cervical length changes the antenatal management of women at high risk of sPTB. METHOD This was a retrospective chart review of all women attending the preterm birth clinic over the 2-year period 2018-2020 in a large tertiary referral unit in Dublin, Ireland. Demographic details, obstetric history, preterm birth risk factors and preventative treatments offered were collected and analysed. Cervical lengths were measured with ultrasound using a standardised protocol and all performed or supervised by 2 experienced sonographers. RESULTS A total of 200 patients with known risk factors for sPTB attended the Preterm Birth Surveillance Clinic at the National Maternity Hospital during the study period. Of these, 36/200 (18%) went on to deliver again prior to 37 weeks despite attending the clinic +/- receiving interventions & this group are the focus of this paper. The indications for surveillance in this group that had a recurrent sPTB included recurrent second-trimester pregnancy losses/preterm delivery < 34 weeks (26/36 (72%)), cervical trauma (including treatment of CIN) (12/36 (33%)), congenital abnormalities (1/36 (2.8%)), uterine anomaly (1/36 (2.8%)) and placental bleeding (1/36 (2.8%)). There was one smoker in this series. Funnelling was observed in 3/36 cases (8.3%). Of the 36 patients, an additional 15 would have received a cerclage had gestation-specific centiles, i.e., <5th centile, been used and an additional 10/36 (28%) would have been offered progesterone therapy. CONCLUSION In those at high risk of preterm birth, the use of gestation-specific centiles for cervical length increases the proportion of patients that would be eligible for cervical cerclage. It is unclear whether this would change clinical outcome.
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Affiliation(s)
- Pauric O'Reilly
- Obstetrics and Gynaecology, National Maternity Hospital, Dublin 2, Ireland.
| | - Alex Dakin
- Obstetrics and Gynaecology, National Maternity Hospital, Dublin 2, Ireland
| | - Niamh Keating
- Obstetrics and Gynaecology, National Maternity Hospital, Dublin 2, Ireland; UCD Perinatal Research Centre, National Maternity Hospital, University College Dublin, Ireland
| | - Larissa Luethe
- Obstetrics and Gynaecology, National Maternity Hospital, Dublin 2, Ireland
| | - Siobhan Corcoran
- Obstetrics and Gynaecology, National Maternity Hospital, Dublin 2, Ireland; UCD Perinatal Research Centre, National Maternity Hospital, University College Dublin, Ireland
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18
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Choi JW, Corcoran S, Wang B, Häupl B, Ceribelli M, Huang DW, Wright GW, Shaffer AL, Phelan JD, Scheich S, Yu X, Yang Y, Thomas C, Oellerich T, Staudt LM. TARGETING PROXIMAL BCR SIGNALING PATHWAY IN DIFFUSE LARGE B‐CELL LYMPHOMA. Hematol Oncol 2021. [DOI: 10.1002/hon.11_2879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- J. W Choi
- National Cancer Institute Lymphoid Malignancy Branch Bethesda USA
| | - S Corcoran
- National Cancer Institute Lymphoid Malignancy Branch Bethesda USA
| | - B Wang
- National Cancer Institute Lymphoid Malignancy Branch Bethesda USA
| | - Björ Häupl
- Goethe University Department of Medicine II, Hematology/Oncology Frankfurt Germany
| | - M Ceribelli
- National Center for Advancing Translational Sciences Division of Preclinical Innovation Gaithersburg USA
| | - D. W Huang
- National Cancer Institute Lymphoid Malignancy Branch Bethesda USA
| | - G. W Wright
- National Cancer Institute Lymphoid Malignancy Branch Bethesda USA
| | - A. L Shaffer
- National Cancer Institute Lymphoid Malignancy Branch Bethesda USA
| | - J. D Phelan
- National Cancer Institute Lymphoid Malignancy Branch Bethesda USA
| | - S Scheich
- National Cancer Institute Lymphoid Malignancy Branch Bethesda USA
| | - X. Yu
- National Cancer Institute Lymphoid Malignancy Branch Bethesda USA
| | - Y Yang
- National Cancer Institute Lymphoid Malignancy Branch Bethesda USA
| | - C Thomas
- National Center for Advancing Translational Sciences Division of Preclinical Innovation Gaithersburg USA
| | - T Oellerich
- Goethe University Department of Medicine II, Hematology/Oncology Frankfurt Germany
| | - L. M Staudt
- National Cancer Institute Lymphoid Malignancy Branch Bethesda USA
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19
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Mulligan KM, Bartels HC, Armstrong F, Immel E, Corcoran S, Walsh JM, McAuliffe F, McParland P, Carroll S, Higgins S, Mahony R, Donnelly J, Geoghegan T, Colleran G, O'Cearbhaill E, Downey P, Brennan DJ. Comparing three-dimensional models of placenta accreta spectrum with surgical findings. Int J Gynaecol Obstet 2021; 157:188-197. [PMID: 33998689 DOI: 10.1002/ijgo.13743] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 02/19/2021] [Revised: 04/30/2021] [Accepted: 05/14/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Placenta accreta spectrum (PAS) is associated with significant maternal morbidity mainly related to blood loss. Pre-operative planning is aided by antenatal ultrasound and magnetic resonance imaging. We sought to assess whether three-dimensional (3D) models from MR images were accurate when compared with surgical and pathological findings. METHODS Digital Imaging and Communications in Medicine files containing MR images with varying severity of PAS (n = 4) were modeled using 3D Slicer. Placenta, bladder, and myometrial defects were modeled. Myometrial defects at three different uterine locations were included-anterior, lateral and inferior. 3D models were used to identify the relationship between the myometrial defect and the internal cervical os. Findings were validated in a larger series of PAS cases (n = 14) where patterns of invasion were compared with estimated blood loss and distance from defect to the internal os. RESULTS The defect illustrated in the four 3D models correlates to both surgical and pathological findings in terms of depth and pattern of invasion, location of defect, bladder involvement. Blood loss and topography of the defect from 3D modeling were examined in 14 further cases. Inferior defects were associated with increased blood loss compared with anterior defects. Increased distance from cervix was associated with reduced blood loss (R2 = 0.352, P = 0.01). CONCLUSION Three-dimensional models of PAS provide an accurate preoperative description of placental invasion and should be investigated as a tool for selecting patients for uterine-conserving surgery. Accurate 3D models of placenta accreta spectrum are achievable and may provide additional information, such as distance of the defect from the internal os.
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Affiliation(s)
- Karen M Mulligan
- UCD School of Medicine, National Maternity Hospital, Dublin, Ireland
| | - Helena C Bartels
- UCD School of Medicine, National Maternity Hospital, Dublin, Ireland
| | | | - Erwin Immel
- School of Mechanical & Materials Engineering, UCD School for Biomedical Engineering, University College Dublin, Ireland
| | - Siobhan Corcoran
- UCD School of Medicine, National Maternity Hospital, Dublin, Ireland
| | - Jennifer M Walsh
- UCD School of Medicine, National Maternity Hospital, Dublin, Ireland
| | | | - Peter McParland
- UCD School of Medicine, National Maternity Hospital, Dublin, Ireland
| | - Stephen Carroll
- UCD School of Medicine, National Maternity Hospital, Dublin, Ireland
| | - Shane Higgins
- UCD School of Medicine, National Maternity Hospital, Dublin, Ireland
| | - Rhona Mahony
- UCD School of Medicine, National Maternity Hospital, Dublin, Ireland
| | | | - Tony Geoghegan
- Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - Eoin O'Cearbhaill
- School of Mechanical & Materials Engineering, UCD School for Biomedical Engineering, University College Dublin, Ireland
| | - Paul Downey
- UCD School of Medicine, National Maternity Hospital, Dublin, Ireland
| | - Donal J Brennan
- UCD School of Medicine, National Maternity Hospital, Dublin, Ireland.,Systems Biology Ireland, UCD School of Medicine, Dublin, Ireland
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20
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Bartels HC, Mulligan KM, Craven S, Rogers AC, Higgins S, O'Brien DJ, McVey R, McParland P, Walsh JM, Carroll S, Corcoran S, Robson M, Mahony R, Downey P, Brophy D, Colleran G, McAuliffe FM, Brennan DJ. Maternal morbidity in placenta accreta spectrum following introduction of a multi-disciplinary service compared to standard care: an Irish perspective. Ir J Med Sci 2021; 190:1451-1457. [PMID: 33449329 DOI: 10.1007/s11845-020-02473-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 09/03/2020] [Accepted: 12/14/2020] [Indexed: 12/01/2022]
Abstract
AIM The purpose of this study is to compare maternal outcomes in patients with placenta accreta spectrum (PAS) when managed as part of a multi-disciplinary team (MDT) compared to standard care. METHODS Patients in the standard care group were retrospectively identified from pathology records, with patients in the MDT group prospectively collected on an electronic database. Data on maternal demographics, delivery, estimated blood loss (EBL), transfusion requirements, and morbidity were recorded. RESULTS Sixty patients were diagnosed with PAS between 2006 and 2019, of whom 32 were part of the standard care group and 28 in the MDT group. Compared to standard care, MDT care was associated with an increase in antenatal diagnosis from 56.3 to 92.9% (p < 0.0001), a significant reduction in EBL (4150 mL (800-19500) vs 1975 (495-8500), p < 0.0001), and transfusion requirements (median 7 (0-30) units of RCC vs 1 (0-13), p < 0.0001). CONCLUSION PAS is associated with significant maternal morbidity and warrants management in an MDT setting with specialist input, which is associated with improved outcomes.
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Affiliation(s)
| | | | - Simon Craven
- National Maternity Hospital, Holles Street, Dublin 2, Ireland
| | - Ailin C Rogers
- Department of Surgery, Mater Misericordiae University Hospital, Dublin, 7, Ireland
| | - Shane Higgins
- National Maternity Hospital, Holles Street, Dublin 2, Ireland
| | - Donal J O'Brien
- National Maternity Hospital, Holles Street, Dublin 2, Ireland
| | - Ruaidhri McVey
- National Maternity Hospital, Holles Street, Dublin 2, Ireland
| | - Peter McParland
- National Maternity Hospital, Holles Street, Dublin 2, Ireland
| | | | - Stephen Carroll
- National Maternity Hospital, Holles Street, Dublin 2, Ireland
| | | | - Mike Robson
- National Maternity Hospital, Holles Street, Dublin 2, Ireland
| | - Rhona Mahony
- National Maternity Hospital, Holles Street, Dublin 2, Ireland
| | - Paul Downey
- National Maternity Hospital, Holles Street, Dublin 2, Ireland
| | - David Brophy
- National Maternity Hospital, Holles Street, Dublin 2, Ireland
| | | | - Fionnuala M McAuliffe
- National Maternity Hospital, Holles Street, Dublin 2, Ireland.,Department of UCD Obstetrics and Gynaecology, School of Medicine, University College Dublin, National Maternity Hospital, Holles Street, Dublin 2, Ireland
| | - Donal J Brennan
- National Maternity Hospital, Holles Street, Dublin 2, Ireland. .,Department of UCD Obstetrics and Gynaecology, School of Medicine, University College Dublin, National Maternity Hospital, Holles Street, Dublin 2, Ireland.
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21
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Egan SA, Corcoran S, McDermott H, Fitzpatrick M, Hoyne A, McCormack O, Cullen A, Brennan GI, O'Connell B, Coleman DC. Hospital outbreak of linezolid-resistant and vancomycin-resistant ST80 Enterococcus faecium harbouring an optrA-encoding conjugative plasmid investigated by whole-genome sequencing. J Hosp Infect 2020; 105:726-735. [PMID: 32439548 DOI: 10.1016/j.jhin.2020.05.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 03/30/2020] [Accepted: 05/11/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Linezolid is an antibiotic used to treat infections caused by multi-drug-resistant Gram-positive bacteria. Linezolid resistance in enterococci has been reported with increasing frequency, with a recent rise in resistance encoded by optrA, poxtA or cfr. AIM To investigate a hospital outbreak of linezolid- and vancomycin-resistant Enterococcus faecium (LVREfm) using whole-genome sequencing (WGS). METHODS Thirty-nine VREfm from patient screening (19 isolates, 17 patients) and environmental sites (20 isolates) recovered in October 2019 were investigated. Isolates were screened using polymerase chain reaction for optrA, poxtA and cfr, and underwent Illumina MiSeq WGS. Isolate relatedness was assessed using E. faecium core genome multi-locus sequence typing (cgMLST). One LVREfm underwent MinION long-read WGS (Oxford Nanopore Technologies) and hybrid assembly with MiSeq short-read sequences to resolve an optrA-encoding plasmid. FINDINGS Twenty isolates (51.3%) were LVREfm and optrA-positive, including the LVREfm from the index patient. A closely related cluster of 28 sequence type (ST) 80 isolates was identified by cgMLST, including all 20 LVREfm and eight linezolid-susceptible VREfm, with an average allelic difference of two (range 0-10), indicating an outbreak. Nineteen (95%) LVREfm harboured a 56,684-bp conjugative plasmid (pEfmO_03). The remaining LVREfm exhibited 44.1% sequence coverage to pEfmO_03. The presence of pEfmO_03 in LVREfm and the close relatedness of the outbreak cluster isolates indicated the spread of a single strain. The outbreak was terminated by enhanced infection prevention and control (IPC) and environmental cleaning measures, ceasing ward admissions and ward-dedicated staff. CONCLUSION WGS was central in investigating an outbreak of ST80 LVREfm. The rapid implementation of enhanced IPC measures terminated the outbreak.
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Affiliation(s)
- S A Egan
- Microbiology Research Unit, Division of Oral Biosciences, Dublin Dental University Hospital, University of Dublin, Trinity College, Dublin, Ireland
| | - S Corcoran
- Department of Clinical Microbiology, Bon Secours Hospital Dublin, Glasnevin, Dublin, Ireland
| | - H McDermott
- Department of Clinical Microbiology, Bon Secours Hospital Dublin, Glasnevin, Dublin, Ireland
| | - M Fitzpatrick
- Infection Prevention and Control Department, Bon Secours Hospital Dublin, Glasnevin, Dublin, Ireland
| | - A Hoyne
- Department of Clinical Microbiology, Bon Secours Hospital Dublin, Glasnevin, Dublin, Ireland
| | - O McCormack
- Department of Clinical Microbiology, Bon Secours Hospital Dublin, Glasnevin, Dublin, Ireland
| | - A Cullen
- Pharmacy Department, Bon Secours Hospital Dublin, Glasnevin, Dublin, Ireland
| | - G I Brennan
- National MRSA Reference Laboratory, St. James's Hospital, Dublin, Ireland
| | - B O'Connell
- National MRSA Reference Laboratory, St. James's Hospital, Dublin, Ireland; Department of Clinical Microbiology, School of Medicine, University of Dublin, Trinity College, St. James's Hospital, Dublin, Ireland
| | - D C Coleman
- Microbiology Research Unit, Division of Oral Biosciences, Dublin Dental University Hospital, University of Dublin, Trinity College, Dublin, Ireland.
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22
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Fennelly O, Blake C, FitzGerald O, Caffrey A, Fletcher L, Smart K, Corcoran S, Shé ÉN, Casserley-Feeney S, Desmeules F, Cunningham C. Advanced musculoskeletal physiotherapy practice: The patient journey and experience. Musculoskelet Sci Pract 2020; 45:102077. [PMID: 31731056 DOI: 10.1016/j.msksp.2019.102077] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 10/16/2019] [Accepted: 10/28/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND As many patients referred to orthopaedic and rheumatology services do not require medical or surgical interventions, advanced practice physiotherapists (APPs) have been introduced into hospital services to triage the care of these patients. Patient perspectives are critical to review the acceptance of this model of care and potential for expansion into primary care. This study aimed to explore the clinical journeys, and the experiences and perceptions of patients attending APP services. METHOD Semi-structured interviews (n = 10) were conducted with patients across two hospital sites, with narrative data subjected to a thematic analysis. MSK journeys were mapped via medical chart and interview data, with surveys collecting demographics. RESULTS Patient journeys involved multiple contact points and some duplication in MSK health services. Overall, experiences of the APP service were positive, with faster access into the hospital system and patients valued the interpersonal and professional skills of the APP. Having already attended a physiotherapist, some patients did have a preconception of what the APP could offer them. However, initial concerns were mitigated following the APP appointment, as the APP had extensive MSK knowledge. Hospitals remained the preferred location for MSK appointments due to availability of diagnostics and 'specialists', and close proximity of the doctor. CONCLUSION Patients were positive about the new MSK APP service and benefits related to shorter wait times and seeing a specialist who listened and involved them in their management. However, a cultural shift regarding patient perceptions of the 'specialists' in hospitals and the role of a physiotherapist is required.
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Affiliation(s)
- Orna Fennelly
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Dublin, Ireland.
| | - Catherine Blake
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Dublin, Ireland.
| | - Oliver FitzGerald
- Department of Rheumatology, St. Vincent's University Hospital, Dublin, Ireland; Conway Institute, University College Dublin, Belfield, Dublin, Ireland.
| | - Aoife Caffrey
- Bone and Joint Clinic, St. Vincent's University Hospital, Dublin, Ireland.
| | - Laura Fletcher
- Physiotherapy Department, University Hospital Waterford, Waterford, Ireland.
| | - Keith Smart
- Bone and Joint Clinic, St. Vincent's University Hospital, Dublin, Ireland.
| | - Siobhan Corcoran
- Physiotherapy Department, University Hospital Waterford, Waterford, Ireland.
| | - Éidín Ní Shé
- School of Nursing and Health Systems, University College Dublin, Belfield, Dublin, Ireland.
| | | | | | - Caitriona Cunningham
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Dublin, Ireland.
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Kissick DJ, Martin-Garcia JM, Hu H, Venugopalan N, Xu S, Corcoran S, Ferguson D, Hilgart MC, Makarov O, Xu Q, Ogata C, Stepanov S, Thifault D, Marlowe T, Alvarado C, Zacks M, Cance W, Fromme P, Fischetti RF. Improvements in serial crystallography capabilities at GM/CA. Acta Crystallogr A Found Adv 2019. [DOI: 10.1107/s010876731909562x] [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] Open
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24
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Corcoran S, Breen A, Niamh M, McHugh A, Tully E, Malone FD, Kent E. 201: Informing the uncertainty around severe early onset intrauterine growth restriction. Am J Obstet Gynecol 2018. [DOI: 10.1016/j.ajog.2017.10.078] [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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25
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Murphy NC, Dunne H, Corcoran S, Finnegan C, Kelliher N, Dalrymple J, O'Beirne J, Flood K. 476: Expectant management of prenatally diagnosed aneuploidy-what have we learnt in the last ten years? Am J Obstet Gynecol 2018. [DOI: 10.1016/j.ajog.2017.11.002] [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: 10/18/2022]
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Winters ZE, Afzal M, Rutherford C, Holzner B, Rumpold G, da Costa Vieira RA, Hartup S, Flitcroft K, Bjelic-Radisic V, Oberguggenberger A, Panouilleres M, Mani M, Catanuto G, Douek M, Kokan J, Sinai P, King MT, Spillane A, Snook K, Boyle F, French J, Elder E, Chalmers B, Kabir M, Campbell I, Wong A, Flay H, Scarlet J, Weis J, Giesler J, Bliem B, Nagele E, del Angelo N, Andrade V, Assump¸ão Garcia D, Bonnetain F, Kjelsberg M, William-Jones S, Fleet A, Hathaway S, Elliott J, Galea M, Dodge J, Chaudhy A, Williams R, Cook L, Sethi S, Turton P, Henson A, Gibb J, Bonomi R, Funnell S, Noren C, Ooi J, Cocks S, Dawson L, Patel H, Bailey L, Chatterjee S, Goulden K, Kirk S, Osborne W, Harter L, Sharif MA, Corcoran S, Smith J, Prasad R, Doran A, Power A, Devereux L, Cannon J, Latham S, Arora P, Ridgway S, Coulding M, Roberts R, Absar M, Hodgkiss T, Connolly K, Johnson J, Doyle K, Lunt N, Cooper M, Fuchs I, Peall L, Taylor L, Nicholson A. International validation of the European Organisation for Research and Treatment of Cancer QLQ-BRECON23 quality-of-life questionnaire for women undergoing breast reconstruction. Br J Surg 2017; 105:209-222. [PMID: 29116657 DOI: 10.1002/bjs.10656] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 03/02/2017] [Accepted: 06/23/2017] [Indexed: 11/12/2022]
Abstract
Abstract
Background
The aim was to carry out phase 4 international field-testing of the European Organisation for Research and Treatment of Cancer (EORTC) breast reconstruction (BRECON) module. The primary objective was finalization of its scale structure. Secondary objectives were evaluation of its reliability, validity, responsiveness, acceptability and interpretability in patients with breast cancer undergoing mastectomy and reconstruction.
Methods
The EORTC module development guidelines were followed. Patients were recruited from 28 centres in seven countries. A prospective cohort completed the QLQ-BRECON15 before mastectomy and the QLQ-BRECON24 at 4–8 months after reconstruction. The cross-sectional cohort completed the QLQ-BRECON24 at 1–5 years after reconstruction, and repeated this 2–8 weeks later (test–retest reliability). All participants completed debriefing questionnaires.
Results
A total of 438 patients were recruited, 234 in the prospective cohort and 204 in the cross-sectional cohort. A total of 414 reconstructions were immediate, with a comparable number of implants (176) and donor-site flaps (166). Control groups comprised patients who underwent two-stage implant procedures (72, 75 per cent) or delayed reconstruction (24, 25 per cent). Psychometric scale validity was supported by moderate to high item-own scale and item-total correlations (over 0·5). Questionnaire validity was confirmed by good scale-to-sample targeting, and computable scale scores exceeding 50 per cent, except nipple cosmesis (over 40 per cent). In known-group comparisons, QLQ-BRECON24 scales and items differentiated between patient groups defined by clinical criteria, such as type and timing of reconstruction, postmastectomy radiotherapy and surgical complications, with moderate effect sizes. Prospectively, sexuality and surgical side-effects scales showed significant responsiveness over time (P < 0·001). Scale reliability was supported by high Cronbach's α coefficients (over 0·7) and test–retest (intraclass correlation more than 0·8). One item (finding a well fitting bra) was excluded based on high floor/ceiling effects, poor test–retest and weak correlations in factor analysis (below 0·3), thus generating the QLQ-BRECON23 questionnaire.
Conclusion
The QLQ-BRECON23 is an internationally validated tool to be used alongside the EORTC QLQ-C30 (cancer) and QLQ-BR23 (breast cancer) questionnaires for evaluating quality of life and satisfaction after breast reconstruction.
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Affiliation(s)
- Z E Winters
- Breast Cancer Surgery Patient-Reported and Clinical Outcomes Research Group, University of Bristol, School of Clinical Sciences, Southmead Hospital, Bristol, UK
- Surgical and Interventional Trials Unit, Division of Surgical Sciences, University College London, London, UK
- Quality of Life Office, School of Psychology, Faculty of Science, University of Sydney, New South Wales, Australia
| | - M Afzal
- Breast Cancer Surgery Patient-Reported and Clinical Outcomes Research Group, University of Bristol, School of Clinical Sciences, Southmead Hospital, Bristol, UK
| | - C Rutherford
- Quality of Life Office, School of Psychology, Faculty of Science, University of Sydney, New South Wales, Australia
| | - B Holzner
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Innsbruck, Austria
| | - G Rumpold
- Department of Medical Psychology, Evaluation Software Development, Rum, Austria
| | | | - S Hartup
- St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - K Flitcroft
- Breast and Surgical Oncology, Poche Centre, University of Sydney, New South Wales, Australia
| | - V Bjelic-Radisic
- Department of Breast Surgery and Gynaecology, Medical University Graz, Graz, Austria
| | - A Oberguggenberger
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Innsbruck, Austria
| | - M Panouilleres
- Department of Plastic Surgery, Besançon University Hospital, Besançon, France
| | - M Mani
- Department of Surgical Sciences, Plastic and Reconstructive Surgery, Uppsala University, Uppsala, Sweden
| | - G Catanuto
- Multidisciplinary Breast Care, Cannizzaro Hospital, Catania, Italy
| | - M Douek
- Department of Surgical Oncology, Guy's Hospital, London, London, UK
| | - J Kokan
- Cancer Resource Centre, Macclesfield Hospital, Macclesfield, UK
| | - P Sinai
- Breast Cancer Surgery Patient-Reported and Clinical Outcomes Research Group, University of Bristol, School of Clinical Sciences, Southmead Hospital, Bristol, UK
| | - M T King
- Quality of Life Office, School of Psychology, Faculty of Science, University of Sydney, New South Wales, Australia
- Sydney Medical School, Faculty of Medicine, University of Sydney, New South Wales, Australia
| | - A Spillane
- Poche Centre, Sydney, New South Wales, Australia
| | - K Snook
- Poche Centre, Sydney, New South Wales, Australia
| | - F Boyle
- Poche Centre, Sydney, New South Wales, Australia
| | - J French
- The Crown Princess Mary Westmead Breast Cancer Centre and Specialist Services, Sydney, New South Wales, Australia
| | - E Elder
- The Crown Princess Mary Westmead Breast Cancer Centre and Specialist Services, Sydney, New South Wales, Australia
| | - B Chalmers
- The Crown Princess Mary Westmead Breast Cancer Centre and Specialist Services, Sydney, New South Wales, Australia
| | - M Kabir
- The Crown Princess Mary Westmead Breast Cancer Centre and Specialist Services, Sydney, New South Wales, Australia
| | | | - A Wong
- Waikato Hospital, Hamilton, New Zealand
| | - H Flay
- Waikato Hospital, Hamilton, New Zealand
| | - J Scarlet
- Waikato Hospital, Hamilton, New Zealand
| | - J Weis
- University of Freiburg, Freiberg, Germany
| | - J Giesler
- University of Freiburg, Freiberg, Germany
| | - B Bliem
- Medical University Graz, Graz, Austria
| | - E Nagele
- Medical University Graz, Graz, Austria
| | | | - V Andrade
- Barretos Cancer Hospital, Sao Paolo, Brazil
| | | | - F Bonnetain
- Besançon University Hospital, Besançon, France
| | | | - S William-Jones
- Clinical Research Network, West Midlands, Queen-s Hospital, Burton upon Trent, UK
| | - A Fleet
- Clinical Research Network, West Midlands, Queen-s Hospital, Burton upon Trent, UK
| | - S Hathaway
- Clinical Research Network, West Midlands, Queen-s Hospital, Burton upon Trent, UK
| | - J Elliott
- Clinical Research Network, West Midlands, Queen-s Hospital, Burton upon Trent, UK
| | - M Galea
- Cancer Research Unit, Great Western Hospital, Swindon, UK
| | - J Dodge
- Cancer Research Unit, Great Western Hospital, Swindon, UK
| | - A Chaudhy
- Cancer Research Unit, Great Western Hospital, Swindon, UK
| | | | - L Cook
- Guy's Hospital, London, UK
| | | | - P Turton
- Leeds Teaching Hospital, Leeds, UK
| | - A Henson
- Leeds Teaching Hospital, Leeds, UK
| | - J Gibb
- Leeds Teaching Hospital, Leeds, UK
| | - R Bonomi
- Worthing Hospital, Western Sussex Hospitals, Worthing, UK
| | - S Funnell
- Worthing Hospital, Western Sussex Hospitals, Worthing, UK
| | - C Noren
- Worthing Hospital, Western Sussex Hospitals, Worthing, UK
| | - J Ooi
- Royal Bolton Hospital, Bolton, UK
| | - S Cocks
- Royal Bolton Hospital, Bolton, UK
| | - L Dawson
- Royal Bolton Hospital, Bolton, UK
| | - H Patel
- Royal Bolton Hospital, Bolton, UK
| | - L Bailey
- Royal Bolton Hospital, Bolton, UK
| | | | | | - S Kirk
- Salford Royal Hospital, UK
| | | | | | | | | | - J Smith
- Stepping Hill Hospital, Stockport, UK
| | - R Prasad
- Royal AlbertEdward Infirmary, Wigan, UK
| | - A Doran
- Royal AlbertEdward Infirmary, Wigan, UK
| | - A Power
- Royal AlbertEdward Infirmary, Wigan, UK
| | | | - J Cannon
- Royal AlbertEdward Infirmary, Wigan, UK
| | - S Latham
- Royal AlbertEdward Infirmary, Wigan, UK
| | - P Arora
- Tameside General Hospital, Ashton-under-Lyne, UK
| | - S Ridgway
- Tameside General Hospital, Ashton-under-Lyne, UK
| | - M Coulding
- Tameside General Hospital, Ashton-under-Lyne, UK
| | - R Roberts
- Tameside General Hospital, Ashton-under-Lyne, UK
| | - M Absar
- North ManchesterGeneral Hospital, Manchester, UK
| | - T Hodgkiss
- North ManchesterGeneral Hospital, Manchester, UK
| | - K Connolly
- North ManchesterGeneral Hospital, Manchester, UK
| | - J Johnson
- North ManchesterGeneral Hospital, Manchester, UK
| | - K Doyle
- North ManchesterGeneral Hospital, Manchester, UK
| | - N Lunt
- Cancer Resource Centre, Macclesfield Hospital, Macclesfield, UK
| | - M Cooper
- Bristol Breast Care Centre, Southmead Hospital, Bristol, UK
| | - I Fuchs
- Bristol Breast Care Centre, Southmead Hospital, Bristol, UK
| | - L Peall
- Bristol Breast Care Centre, Southmead Hospital, Bristol, UK
| | - L Taylor
- Bristol Breast Care Centre, Southmead Hospital, Bristol, UK
| | - A Nicholson
- Bristol Breast Care Centre, Southmead Hospital, Bristol, UK
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Corcoran S, Achamallah N, O'Loughlin J, Stafford P, Meaney S, Kelleher G, Tully E, Dicker P, Malone FD, Breathnach F. 621: Serum adiponectin in early pregnancy as a biomarker for gestational diabetes; defining thresholds to identify a particularly high risk sub-group. Am J Obstet Gynecol 2017. [DOI: 10.1016/j.ajog.2016.11.355] [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: 11/28/2022]
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Corcoran S, Briggs K, O’ Connor H, Mullers S, Monteith C, Donnelly J, Dicker P, Franklin O, Malone FD, Breathnach FM. Prenatal detection of major congenital heart disease – optimising resources to improve outcomes. Eur J Obstet Gynecol Reprod Biol 2016; 203:260-3. [DOI: 10.1016/j.ejogrb.2016.06.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 06/01/2016] [Accepted: 06/11/2016] [Indexed: 10/21/2022]
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Corcoran S, Achamallah N, John OL, Grainne K, Stafford P, Meaney S, Tully E, Dicker P, Breathnach F, Fergal M. 739: Can first trimester high-sensitivity C-reactive protein and Sex Hormone Binding Globulin predict the onset of gestational diabetes? A prospective study of a high risk cohort. Am J Obstet Gynecol 2016. [DOI: 10.1016/j.ajog.2015.10.787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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30
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Corcoran S, Unterscheider J, Daly S, Geary M, Kennelly M, McAuliffe F, O'Donoghue K, Hunter A, Morrison J, Burke G, Dicker P, Tully E, Malone F. 227: Fetal growth restriction co-existing with gestational diabetes – impact on perinatal outcome: results of the multicenter PORTO study. Am J Obstet Gynecol 2015. [DOI: 10.1016/j.ajog.2014.10.273] [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: 10/24/2022]
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31
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Corcoran S, Briggs K, Connor HO, Muellers S, Monteith C, Donnelly J, Dicker P, Franklin O, Malone F, Breathnach F. 226: Prenatal detection of congenital heart disease. Am J Obstet Gynecol 2015. [DOI: 10.1016/j.ajog.2014.10.272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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32
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Corcoran S, Breathnach F, Burke G, McAuliffe F, Geary M, Daly S, Higgins J, Hunter A, Morrison J, Mahony R, Dicker P, Tully E, Malone F. 49: Dichorionic twin ultrasound surveillance – four-weekly significantly underperforms two-weekly ultrasound: results of the prospective multicenter ESPRiT study. Am J Obstet Gynecol 2015. [DOI: 10.1016/j.ajog.2014.10.095] [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: 10/24/2022]
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33
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Corcoran S, Breathnach FM. The early bird catches the worm - predicting the onset of gestational diabetes in the first trimester. J Matern Fetal Neonatal Med 2014; 28:823-4. [PMID: 24920284 DOI: 10.3109/14767058.2014.934221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Siobhan Corcoran
- Department of Obsterics and Gynaecology, Rotunda Hospital , Dublin , Ireland
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34
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Corcoran S, Kearney M, Vaughan D, Tully E, Dicker P, Flood K, Breathnach F. 335: Accuracy of third trimester ultrasound in predicting macrosomia in patients with diabetes in pregnancy. Am J Obstet Gynecol 2014. [DOI: 10.1016/j.ajog.2013.10.368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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35
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Corcoran S, Daly N, Eogan M, Holohan M, Clarke T, Geary M. How safe is preterm operative vaginal delivery and which is the instrument of choice? J Perinat Med 2013; 41:57-60. [PMID: 23095187 DOI: 10.1515/jpm-2012-0092] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Accepted: 07/13/2012] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The objective of this study was to determine neonatal outcomes in preterm operative vaginal delivery given the current paucity of data available to guide clinicians. STUDY DESIGN A retrospective review of 64 cases was conducted, and neonatal outcomes were compared to spontaneous vaginal deliveries in similar gestations. The primary outcomes studied were death and occurrence of intraventricular haemorrhage. Secondary outcomes included admission to NICU, Apgar < 3 at 5 min, ventilation requirement, jaundice requiring treatment, culture-proven sepsis and necrotising enterocolitis. The study was conducted in a stand-alone maternity unit of approximately 9000 deliveries per year. RESULTS AND CONCLUSIONS We concluded that although vacuum delivery is avoided in preterm infants, outcomes were similar to forceps deliveries of similar gestations.
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Affiliation(s)
- Siobhan Corcoran
- Department of Obstetrics and Gynaecology, Rotunda Hospital, Parnell Square, Dublin 1, Ireland.
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Corcoran S, Donnelly JC, Breathnach F. Managing the emerging clinical risk of cutaneous bullae and decubitus ulcers in obstetric patients. Int J Gynaecol Obstet 2012; 120:285-6. [PMID: 23228818 DOI: 10.1016/j.ijgo.2012.10.012] [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: 04/18/2012] [Revised: 10/16/2012] [Accepted: 11/21/2012] [Indexed: 10/27/2022]
Affiliation(s)
- Siobhan Corcoran
- Department of Obstetrics and Gynecology, Rotunda Hospital, Dublin, Ireland.
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Ogata CM, Sanishvili R, Hilgart M, Stepanov S, Becker M, Nagarajan V, Xu S, Makarov O, Pothineni S, Yoder D, Corcoran S, Smith JL, Fischetti RF. Automation and remote control at GM/CA CAT at the APS. Acta Crystallogr A 2011. [DOI: 10.1107/s0108767311093019] [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: 11/10/2022] Open
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38
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Goldfarb SB, Kelvin JF, Thom B, Kaplan J, Margolies A, Corcoran S, McCabe MS, Hudis C, Basch EM, Dickler MN. Fertility preservation: Are we telling patients what they want to know? J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e19657] [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: 11/20/2022] Open
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39
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Aung A, Corcoran S, Nagalingam V, Paul E, Newnham H. Prevalence, Associations and Risk Factors for Orthostatic Hypotension in Medical, Surgical and Trauma Inpatients: An Observational Cohort Study. Heart Lung Circ 2011. [DOI: 10.1016/j.hlc.2011.05.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Delany C, McDonnell R, Robson M, Corcoran S, Fitzpatrick C, De La Harpe D. Folic acid supplement use in the prevention of neural tube defects. Ir Med J 2011; 104:12-15. [PMID: 21387878] [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: 05/30/2023]
Abstract
In 2008, planned folic acid fortification for the prevention of Neural Tube Defects (NTD) was postponed. Concurrently, the economic recession may have affected dietary folic acid intake, placing increased emphasis on supplement use. This study examined folic acid supplement use in 2009. A cross-sectional survey of 300 ante-natal women was undertaken to assess folic acid knowledge and use. Associations between demographic, obstetric variables and folic acid knowledge and use were examined. A majority, 284/297 (96%), had heard of folic acid, and 178/297 (60%) knew that it could prevent NTD. Most, 270/297 (91%) had taken it during their pregnancy, but only 107/297 (36%) had used it periconceptionally. Being older, married, planned pregnancy and better socioeconomic status were associated with periconceptional use. Periconceptional folic acid use in 2009 was very low, little changed from economic status were associated with periconceptional use. Periconceptional folic acid use in 2009 was very low, little changed from earlier years. Continuous promotion efforts are necessary. Close monitoring of folic acid intake and NTD rates is essential, particularly in the absence of fortification.
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Affiliation(s)
- C Delany
- RCSI, 123 St Stephen's Green, Dublin 2
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41
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Goldfarb SB, Kelvin JF, Thom B, Kaplan J, Corcoran S, Margolies A, McCabe MS, Norton L, Hudis C, Basch E, Dickler MN. Abstract P2-14-08: Patient Perspectives on Information Communicated Regarding Effects of Treatment on Fertility. Cancer Res 2010. [DOI: 10.1158/0008-5472.sabcs10-p2-14-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Many breast cancer survivors diagnosed during their reproductive years desire to have children after treatment and are distressed about the possibility of treatment-induced infertility. Informing patients about fertility preservation options before therapy may optimize quality of life after treatment. This study was undertaken to evaluate the information patients received about effects of therapy on fertility, early menopause, and fertility preservation options. Methods:
An IRB approved cross-sectional study was performed to evaluate patient perceptions of the impact of treatment on fertility and early menopause. The survey was developed at Memorial Sloan-Kettering Cancer Center (MSKCC) for patients ages 18-45, with items derived from existing surveys in the literature and input from a multidisciplinary committee. We evaluated two groups of patients, one who had completed treatment and the other who was currently undergoing therapy. Surveys were mailed to 395 women who began treatment (all modalities) for breast cancer at MSKCC between 7/1/07 and 6/30/08. A second cohort of patients (n=35) completed surveys during patient visits to breast cancer medicine ambulatory clinics
between 3/22/2010 and 4/8/2010.
Results:
The survey was completed by 159 pts. (129/395 and 30/35). At the time of diagnosis, 69% (110/159) had children and 45% (70/156) were interested in having children. 79% (123/155) reported that the impact of treatment on fertility was discussed with them before initiating therapy. A healthcare provider initiated the discussion 54% (83/155) of the time. However, only 35% (54/152) and 47% (71/150) of women felt they received an adequate amount of information about the effect of cancer treatment on fertility and menopause, respectively. Based on their ranking, patients preferred to receive fertility information in person either from their physician or a fertility specialist, or through written material. After treatment, 5 patients attempted pregnancy (7 naturally, 1 with assisted technology), yielding 8 live births. Conclusions:
Many breast cancer survivors wish to have children after treatment. To optimize success, patients should be adequately informed about the effects of therapy on fertility, early menopause, and options for fertility preservation. These findings are informing an institution-wide fertility program.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P2-14-08.
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Affiliation(s)
- SB Goldfarb
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - JF Kelvin
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - B Thom
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - J Kaplan
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - S Corcoran
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - A Margolies
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - MS McCabe
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - L Norton
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - C Hudis
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - E Basch
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - MN. Dickler
- Memorial Sloan-Kettering Cancer Center, New York, NY
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Sanishvili R, Xu S, Nagarajan V, Yoder D, Becker M, Stepanov S, Pothineni S, Hilgart M, Makarov O, Corcoran S, Akey D, Smith J, Fischetti R. Small beams can play big roles in macromolecular crystallography. Acta Crystallogr A 2008. [DOI: 10.1107/s0108767308098887] [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: 11/10/2022] Open
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43
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Fischetti R, Sanishvili R, Yoder D, Vogt S, Rosenbaum G, Benn R, Corcoran S, Makarov O, Xu S, Nagarajan V, Becker M, Pothineni S, Smith J. Probing radiation damage with a 1-micron beam. Acta Crystallogr A 2008. [DOI: 10.1107/s0108767308094270] [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: 11/10/2022] Open
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44
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Portlock CS, Hamlin P, Noy A, Chey W, Gaydos CA, Palomba L, Schwartz I, Corcoran S, Rosenzweig L, Walker D, Papanicolaou G, Markowitz A. Infectious disease associations in advanced stage, indolent lymphoma (follicular and nonfollicular): developing a lymphoma prevention strategy. Ann Oncol 2007; 19:254-8. [PMID: 17965114 DOI: 10.1093/annonc/mdm484] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Eradication of Helicobacter pylori in gastric mucosa-associated lymphoid tumor can result in lymphoma remission. We prospectively identified/treated infections in nonbulky, advanced stage indolent lymphoma (follicular; nonfollicular lymphoma) eligible for observation. MATERIALS AND METHODS Stool H. pylori, hepatitis C and Borrelia serologies, Borrelia and Chlamydia fixed tissue PCR, Chlamydia peripheral blood mononuclear cell PCR and hydrogen breath test for small bowel bacterial overgrowth (SBBO) were obtained. RESULTS Fifty-six patients were enrolled. Positive infections: H. pylori (13); hepatitis C (3); SBBO (11). Negative: Borrelia (13); Chlamydophila psittaci (12, except one PCR). Lymphoma responses to antimicrobial therapy: H. pylori [one complete response (CR), 24+ months; one transient near CR]; hepatitis C [two CRs, 18+ and 30+ months; one partial response (PR) but hepatitis C virus persistent]; SBBO (one PR, 30+ months). Patients with associated infections, but without lymphoma CR, have required lymphoma treatment sooner than those without initial infections (treatment-free survival at 23.4 months median follow-up, 40.5% versus 74.7%, P = 0.01), indicating a different biology. CONCLUSION Infections are common in advanced stage indolent lymphoma (37.5% in our series). Anecdotal lymphoma responses have been seen and three have been durable CRs (18 to 30+ months) with infection eradication alone. The identification and treatment of associated infections may be a first step towards developing a lymphoma prevention strategy.
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Affiliation(s)
- C S Portlock
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, NY 10021, USA.
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Jarvie EM, North Laidler VJ, Corcoran S, Bassil A, Sanger GJ. Differences between the abilities of tegaserod and motilin receptor agonists to stimulate gastric motility in vitro. Br J Pharmacol 2007; 150:455-62. [PMID: 17211452 PMCID: PMC2189716 DOI: 10.1038/sj.bjp.0707118] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [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: 01/13/2023] Open
Abstract
BACKGROUND AND PURPOSE Motilin or 5-HT4 receptor agonists stimulate gastrointestinal motility. Differences in activity are suggested but direct comparisons are few. A method was devised to directly compare the gastric prokinetic activities of motilin, the motilin receptor agonist, erythromycin, and the 5-HT4 receptor agonist, tegaserod. EXPERIMENTAL APPROACH Gastric prokinetic-like activity was assessed by measuring the ability to facilitate cholinergically-mediated contractions evoked by electrical field stimulation (EFS) in rabbit isolated stomach. Comparisons were made between potency, maximal activity and duration of responses. KEY RESULTS Rabbit motilin (r.motilin) 0.003-0.3 microM, [Nle13]motilin 0.003-0.3 microM, erythromycin 0.3-10 microM and tegaserod 0.1-10 microM caused concentration - dependent potentiation of EFS-evoked contractions. The potency ranking was r.motilin = [Nle13]motilin > tegaserod > erythromycin. The Emax ranking was r.motilin = [Nle13]motilin = erythromycin > tegaserod. Responses to r.motilin and [Nle13]motilin faded rapidly (t1/2 9 and 11 min, respectively) whereas those to erythromycin and tegaserod were maintained longer (t1/2 24 and 28 min). The difference did not appear to be due to peptide degradation. A second application of [Nle13]motilin was excitatory after 60 min contact and fade of the initial response (responses to 0.03 and 0.1 microM [Nle13]motilin were not different from those caused by the first application). CONCLUSIONS AND IMPLICATIONS Prokinetic-like activities of the 5-HT4 agonist tegaserod and the motilin receptor agonists were compared by measuring changes in cholinergically-mediated contractions. This novel approach highlighted important differences between classes (greater Emax of motilin, compared with tegaserod) and for the first time, within each class (short t1/2 for motilin, compared with erythromycin).
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Affiliation(s)
- E M Jarvie
- Neurology & Gastrointestinal Centre of Excellence for Drug Discovery, GlaxoSmithKline Research & Development Limited New Frontiers Science Park, Harlow, Essex UK
| | - V J North Laidler
- Neurology & Gastrointestinal Centre of Excellence for Drug Discovery, GlaxoSmithKline Research & Development Limited New Frontiers Science Park, Harlow, Essex UK
| | - S Corcoran
- Neurology & Gastrointestinal Centre of Excellence for Drug Discovery, GlaxoSmithKline Research & Development Limited New Frontiers Science Park, Harlow, Essex UK
| | - A Bassil
- Neurology & Gastrointestinal Centre of Excellence for Drug Discovery, GlaxoSmithKline Research & Development Limited New Frontiers Science Park, Harlow, Essex UK
| | - G J Sanger
- Neurology & Gastrointestinal Centre of Excellence for Drug Discovery, GlaxoSmithKline Research & Development Limited New Frontiers Science Park, Harlow, Essex UK
- Author for correspondence:
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Abstract
BACKGROUND Streptococcal throat infections and HLA Cw6 (Cw*06) have been implicated in the pathogenesis of psoriasis, particularly in the guttate form. OBJECTIVES To study 105 Irish patients with psoriasis to investigate the relationship between streptococcal infections and Cw*06. METHODS The patients were divided into two groups: those with guttate psoriasis or guttate flare (guttate group, GG, n=64) and those with chronic plaque psoriasis (chronic plaque group, CPG, n=41). RESULTS The incidence of Cw*06 was 86% in the GG and 73% in the CPG, which was not significantly different (P=0.1725) but the incidence in both groups was significantly higher than in an Irish control group (18%) (P<0.0001 vs. GG and P<0.0001 vs. CPG). Evidence for streptococcal infection was higher in the GG (56%) than in the CPG (32%) (P=0.0231). Of those patients with evidence of streptococcal infection, 30 of 36 GG (83%) and nine of 13 CPG (69%) patients possessed the Cw*06 genotype. CONCLUSIONS Thus, not all patients with streptococcal-related psoriasis carry Cw*06. The role of Cw*06 in psoriasis, if any, has yet to be determined.
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Affiliation(s)
- L Fry
- Faculty of Medicine, Imperial College, London, UK, and The Skin Hospital, Dublin 2, Ireland
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Fischetti RF, Stepanov S, Xu S, Makarov O, Urakhchin A, Sanishvili R, Smith WW, Yoder D, Benn R, Corcoran S, Devarapalli S, Diete W, Schwoerer-Boehing M, Signorato R, Berman LE, Smith JL. GM/CA canted undulator beamlines for protein crystallography. Acta Crystallogr A 2005. [DOI: 10.1107/s0108767305094110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Portlock CS, Noy A, Hamlin P, Qin J, Rosenzweig L, Corcoran S, Chey W, Papanicolaou G, Markowitz A. Infectious disease associations in indolent lymphoma (follicular, FL and non-follicular, nFL): Developing a lymphoma prevention strategy. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.6701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- C. S. Portlock
- Memorial Sloan-Kettering Cancer Center, New York, NY; University of Michigan, Ann Arbor, MI
| | - A. Noy
- Memorial Sloan-Kettering Cancer Center, New York, NY; University of Michigan, Ann Arbor, MI
| | - P. Hamlin
- Memorial Sloan-Kettering Cancer Center, New York, NY; University of Michigan, Ann Arbor, MI
| | - J. Qin
- Memorial Sloan-Kettering Cancer Center, New York, NY; University of Michigan, Ann Arbor, MI
| | - L. Rosenzweig
- Memorial Sloan-Kettering Cancer Center, New York, NY; University of Michigan, Ann Arbor, MI
| | - S. Corcoran
- Memorial Sloan-Kettering Cancer Center, New York, NY; University of Michigan, Ann Arbor, MI
| | - W. Chey
- Memorial Sloan-Kettering Cancer Center, New York, NY; University of Michigan, Ann Arbor, MI
| | - G. Papanicolaou
- Memorial Sloan-Kettering Cancer Center, New York, NY; University of Michigan, Ann Arbor, MI
| | - A. Markowitz
- Memorial Sloan-Kettering Cancer Center, New York, NY; University of Michigan, Ann Arbor, MI
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Dass NB, Munonyara M, Bassil AK, Hervieu GJ, Osbourne S, Corcoran S, Morgan M, Sanger GJ. Growth hormone secretagogue receptors in rat and human gastrointestinal tract and the effects of ghrelin. Neuroscience 2003; 120:443-53. [PMID: 12890514 DOI: 10.1016/s0306-4522(03)00327-0] [Citation(s) in RCA: 139] [Impact Index Per Article: 6.6] [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: 11/21/2022]
Abstract
The peptide hormone ghrelin is known to be present within stomach and, to a lesser extent, elsewhere in gut. Although reports suggest that gastric function may be modulated by ghrelin acting via the vagus nerve, the gastrointestinal distribution and functions of its receptor, the growth hormone secretagogue receptor (GHS-R), are not clear and may show signs of species-dependency. This study sought to determine the cellular localisation and distribution of GHS-R-immunoreactivity (-Ir) using immunofluorescent histochemistry and explore the function of ghrelin in both human and rat isolated gastric and/or colonic circular muscle preparations in which nerve-mediated responses were evoked by electrical field stimulation. The expression of GHS-R-Ir differed to a greater extent between species than between gut regions of the same species. Both the human and rat gastric and colonic preparations (n=3 each) expressed GHS-R-Ir within neuronal cell bodies and fibres, cells associated with gastric glands and putative entero-endocrine and/or mast cells. Smooth muscle cells and epithelia were devoid of GHS-R-Ir and only rat preparations expressed GHS-R-Ir on nerve fibres associated with the muscle layers. GHS-R-Ir was fully competed in all cases in pre-adsorption studies and antiserum specificity was confirmed using a cell line transiently expressing the rat GHS-R. In rat isolated forestomach circular muscle, ghrelin 0.1-10 microM had no effect on smooth muscle tension but concentration-dependently facilitated the amplitude of contractions evoked by excitatory nerve stimulation (n=4-7; P<0.05 for each concentration versus vehicle; n=18). When examined under similar conditions, in both rat distal colon (n=4-6, P>0.05 each) and human ascending (n=3) and sigmoid (n=1) colon, these concentrations of ghrelin were without effect (P>0.05 each). The data suggest that ghrelin has the potential to profoundly affect gastrointestinal functions in both species and at least one of these functions is to exert a gastric prokinetic activity. Moreover, we suggest that this activity of ghrelin is mediated via the enteric nervous system, in addition to known vagus nerve-dependent mechanisms.
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Affiliation(s)
- N B Dass
- Neurology and GI Centre of Excellence for Drug Discovery, GlaxoSmithKline, New Frontiers Science Park, Third Avenue, Harlow, UK
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Baker BS, Ovigne JM, Powles AV, Corcoran S, Fry L. Normal keratinocytes express Toll-like receptors (TLRs) 1, 2 and 5: modulation of TLR expression in chronic plaque psoriasis. Br J Dermatol 2003; 148:670-9. [PMID: 12752123 DOI: 10.1046/j.1365-2133.2003.05287.x] [Citation(s) in RCA: 222] [Impact Index Per Article: 10.6] [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: 11/20/2022]
Abstract
BACKGROUND Toll-like receptors (TLRs) are part of the innate immune system involved in the response to microbial pathogens. TLR2 recognizes various ligands expressed by Gram-positive bacteria, while TLR3, TLR4 and TLR5 are specific for double-stranded RNA, Gram-negative lipopolysaccharides and bacterial flagellin, respectively. OBJECTIVES To determine, firstly, whether epidermal keratinocytes of normal skin express TLRs and, secondly, whether modulation of TLR expression occurs in psoriasis, an inflammatory skin disease associated with certain microorganisms such as streptococci, staphylococci and yeasts. METHODS Eight samples of normal, and 15 samples of lesional and nonlesional psoriatic skin were stained with polyclonal antibodies specific for TLR1-5 using an avidin-biotin-peroxidase technique. RESULTS Epidermal keratinocytes in normal skin constitutively expressed TLR1, TLR2 and TLR5, while TLR3 and TLR4 were, in most cases, barely detectable. Cytoplasmic TLR1 and TLR2 were expressed throughout the epidermis, with higher staining of the latter on basal keratinocytes, while TLR5 expression was concentrated in the basal layer. In contrast, in lesional epidermis from patients with psoriasis, TLR2 was more highly expressed on the keratinocytes of the upper epidermis than on the basal layer, while TLR5 was downregulated in basal keratinocytes compared with corresponding nonlesional psoriatic epidermis. In addition, nuclear TLR1 staining was observed in the upper layers of both nonlesional and lesional psoriatic epidermis, but not in that of normal skin. CONCLUSIONS These findings suggest that TLRs expressed by epidermal keratinocytes constitute part of the innate immune system of the skin. The relevance of altered keratinocyte TLR expression in psoriasis remains to be determined.
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Affiliation(s)
- B S Baker
- Department of Dermatology, Faculty of Medicine, Imperial College of Science, Technology and Medicine, St Mary's Campus, Norfolk Place, Paddington, London W2 1PG, UK.
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