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Siegel HG, Soriano MA, Clark CJ, Johnson NP, Wulsin HG, Deziel NC, Plata DL, Darrah TH, Saiers JE. Natural and Anthropogenic Processes Affecting Domestic Groundwater Quality within the Northwestern Appalachian Basin. Environ Sci Technol 2022; 56:13761-13773. [PMID: 36129683 PMCID: PMC9536308 DOI: 10.1021/acs.est.2c04011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 08/29/2022] [Accepted: 09/08/2022] [Indexed: 06/15/2023]
Abstract
Domestic wells serve as the primary drinking-water source for rural residents in the northern Appalachian Basin (NAB), despite a limited understanding of contaminant distributions in groundwater sources. We employ a newly collected dataset of 216 water samples from domestic wells in Ohio and West Virginia and an integrated contaminant-source attribution method to describe water quality in the western NAB and characterize key agents influencing contaminant distributions. Our results reveal arsenic and nitrate concentrations above federal maximum contaminant levels (MCLs) in 6.8 and 1.3% of samples and manganese concentrations above health advisory in 7.3% of samples. Recently recharged groundwaters beneath upland regions appear vulnerable to surface-related impacts, including nitrate pollution from agricultural activities and salinization from road salting and domestic sewage sources. Valley regions serve as terminal discharge points for long-residence-time groundwaters, where mixing with basin brines is possible. Arsenic impairments occurred in alkaline groundwaters with major-ion compositions altered by ion exchange and in low-oxygen metal-rich groundwaters. Mixing with as much as 4-10% of mine discharge-like waters was observed near coal mining operations. Our study provides new insights into key agents of groundwater impairment in an understudied region of the NAB and presents an integrated approach for contaminant-source attribution applicable to other regions of intensive resource extraction.
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Affiliation(s)
- H. G. Siegel
- School
of the Environment, Yale University, New Haven, Connecticut 06411, United States
| | - M. A. Soriano
- School
of the Environment, Yale University, New Haven, Connecticut 06411, United States
| | - C. J. Clark
- School
of Public Health, Yale University, New Haven, Connecticut 06511, United States
| | - N. P. Johnson
- School
of Public Health, Yale University, New Haven, Connecticut 06511, United States
| | - H. G. Wulsin
- School
of Earth Sciences, Ohio State University, Columbus, Ohio 43210, United States
| | - N. C. Deziel
- School
of Public Health, Yale University, New Haven, Connecticut 06511, United States
| | - D. L. Plata
- Department
of Civil and Environmental Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States
| | - T. H. Darrah
- School
of Earth Sciences, Ohio State University, Columbus, Ohio 43210, United States
- Ohio
State University Global Water Institute, Ohio State University, Columbus, Ohio 43210, United States
| | - J. E. Saiers
- School
of the Environment, Yale University, New Haven, Connecticut 06411, United States
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Tomassetti C, Johnson NP, Petrozza J, Abrao MS, Einarsson JI, Horne AW, Lee TTM, Missmer S, Vermeulen N, Zondervan KT, Grimbizis G, De Wilde RL. An International Terminology for Endometriosis, 2021. Facts Views Vis Obgyn 2021; 13:295-304. [PMID: 34672510 PMCID: PMC9148705 DOI: 10.52054/fvvo.13.4.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background Different classification systems have been developed for endometriosis, using different definitions for the disease, the different subtypes, symptoms and treatments. In addition, an International Glossary on Infertility and Fertility Care was published in 2017 by the International Committee for Monitoring Assisted Reproductive Technologies (ICMART) in collaboration with other organisations. An international working group convened over the development of a classification or descriptive system for endometriosis. As a basis for such system, a terminology for endometriosis was considered a condition sine qua non. Objectives The aim of the current paper is to develop a set of terms and definitions on endometriosis that would be the basis for standardisation in disease description, classification and research. Materials and Methods The working group listed a number of terms relevant to be included in the terminology, documented currently used and published definitions, and discussed and adapted them until consensus was reached within the working group. Following stakeholder review, further terms were added, and definitions further clarified. Although definitions were collected through published literature, the final set of terms and definitions is to be considered consensus-based. After finalisation of the first draft, the members of the international societies and other stakeholders were consulted for feedback and comments, which led to further adaptations. Results A list of 49 terms and definitions in the field of endometriosis is presented, including a definition for endometriosis and its subtypes, different locations, interventions, symptoms and outcomes. Endometriosis is defined as a disease characterised by the presence of endometrium-like epithelium and/or stroma outside the endometrium and myometrium, usually with an associated inflammatory process. Conclusions The current paper outlines a list of 49 terms and definitions in the field of endometriosis. The application of the defined terms aims to facilitate harmonisation in endometriosis research and clinical practice. Future research may require further refinement of the presented definitions. What is new? A consensus based international terminology for endometriosis for clinical and research use.
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Vermeulen N, Abrao MS, Einarsson JI, Horne AW, Johnson NP, Lee TTM, Missmer S, Petrozza J, Tomassetti C, Zondervan KT, Grimbizis G, De Wilde RL. Endometriosis classification, staging and reporting systems: a review on the road to a universally accepted endometriosis classification. Facts Views Vis Obgyn 2021; 13:305-330. [PMID: 34672508 PMCID: PMC9148706 DOI: 10.52054/fvvo.13.3.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background In the field of endometriosis, several classification, staging and reporting systems have been developed. However, endometriosis classification, staging and reporting systems that have been published and validated for use in clinical practice have not been systematically reviewed up to now. Objectives The aim of the current review is to provide a historical overview of these different systems based on an assessment of published studies. Materials and Methods A systematic Pubmed literature search was performed. Data were extracted and summarised. Results Twenty-two endometriosis classification, staging and reporting systems have been published between 1973 and 2021, each developed for specific and different purposes. There is still no international agreement on how to describe the disease. Studies evaluating different systems are summarised showing a discrepancy between the intended and the evaluated purpose, and a general lack of validation data confirming a correlation with pain symptoms or quality of life for any of the current systems. A few studies confirm the value of the Enzian system for surgical description of deep endometriosis. With regards to infertility, the endometriosis fertility index has been confirmed valid for its intended purpose. Conclusions Of the 22 endometriosis classification, staging and reporting systems identified in this historical overview, only a few have been evaluated, in 46 studies, for the purpose for which they were developed. It can be concluded that there is no international agreement on how to describe endometriosis or how to classify it, and that most classification/staging systems show no or very little correlation with patient outcomes. What is new? This overview of existing systems is a first step in working towards a universally accepted endometriosis classification.
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4
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Johnson NP, Baidya S, Jessup SO, Muthukaruppan A, Hadden WE, Hull ML, Mehta S, Shelling AN, Print CG, Chamley LW. The Lipiodol Uterine Bathing Effect to Improve Fertility May Include Uterine Natural Killer Cell Up-regulation in the Endometrium. FandR 2021. [DOI: 10.1142/s2661318221500018] [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: 11/18/2022] Open
Abstract
BACKGROUND: Lipiodol has a dramatic short term fertility enhancing effect for women with endometriosis. Microarray studies have shown transcriptomic regulation of molecular markers of endometrial inflammation, most notably a consistent down-regulation of endometrial osteopontin. We further explored the endometrial bathing effect of lipiodol on leukocyte expression in endometrium. METHODS: A cohort of four women, nested within a randomised trial of twelve women assessing the lipiodol uterine bathing effect, was studied as an ‘own control’ group, with their mid-luteal endometrium assessed before and after endometrial lipiodol exposure. Pipelle endometrial sampling allowed endometrial assessment by immunochemistry. Endometrial tissue samples were assessed by immunochemistry for total CD45+ leukocytes, CD68+ macrophages, CD3+ T-cells and CD56+ uterine natural killer cells. RESULTS: There was a statistically significant increase in the mean density of uterine natural killer cells in the endometrium of women post-lipiodol. No other significant differences were found in the mean densities of all leukocytes, macrophages or T cells in the endometrium of women post-lipiodol. CONCLUSIONS: These preliminary data further support the concept of a uterine bathing effect of lipiodol. Whether the increase in the mean density of uterine natural killer cells in the endometrium might contribute to an improvement in endometrial receptivity to embryo implantation merits further investigation.
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Affiliation(s)
- N. P. Johnson
- Department of Obstetrics and Gynaecology, The University of Auckland, New Zealand
- Robinson Research Institute, University of Adelaide, Australia
- Repromed Auckland; Auckland Gynaecology Group, 105 Remuera Road, Auckland, New Zealand
| | - S. Baidya
- Department of Obstetrics and Gynaecology, The University of Auckland, New Zealand
| | - S. O. Jessup
- Demeter Fertility Clinic, Sydney, New South Wales, Australia
| | - A. Muthukaruppan
- Department of Obstetrics and Gynaecology, The University of Auckland, New Zealand
| | - W. E. Hadden
- Auckland Radiology Group, 101 Remuera Road, Auckland, New Zealand
| | - M. L. Hull
- Robinson Research Institute, University of Adelaide, Australia
| | - S. Mehta
- Department of Molecular Medicine and Pathology; Maurice Wilkins, Centre; The Bioinformatics Institute, The University of Auckland, New Zealand
| | - A. N. Shelling
- Department of Obstetrics and Gynaecology, The University of Auckland, New Zealand
| | - C. G. Print
- Department of Molecular Medicine and Pathology; Maurice Wilkins, Centre; The Bioinformatics Institute, The University of Auckland, New Zealand
| | - L. W. Chamley
- Department of Obstetrics and Gynaecology, The University of Auckland, New Zealand
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5
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Duffy JMN, Adamson GD, Benson E, Bhattacharya S, Bhattacharya S, Bofill M, Brian K, Collura B, Curtis C, Evers JLH, Farquharson RG, Fincham A, Franik S, Giudice LC, Glanville E, Hickey M, Horne AW, Hull ML, Johnson NP, Jordan V, Khalaf Y, Knijnenburg JML, Legro RS, Lensen S, MacKenzie J, Mavrelos D, Mol BW, Morbeck DE, Nagels H, Ng EHY, Niederberger C, Otter AS, Puscasiu L, Rautakallio-Hokkanen S, Sadler L, Sarris I, Showell M, Stewart J, Strandell A, Strawbridge C, Vail A, van Wely M, Vercoe M, Vuong NL, Wang AY, Wang R, Wilkinson J, Wong K, Wong TY, Farquhar CM. Top 10 priorities for future infertility research: an international consensus development study. Fertil Steril 2021; 115:180-190. [PMID: 33272617 DOI: 10.1016/j.fertnstert.2020.11.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [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: 05/11/2020] [Revised: 07/05/2020] [Accepted: 07/22/2020] [Indexed: 12/21/2022]
Abstract
STUDY QUESTION Can the priorities for future research in infertility be identified? SUMMARY ANSWER The top 10 research priorities for the four areas of male infertility, female and unexplained infertility, medically assisted reproduction, and ethics, access, and organization of care for people with fertility problems were identified. WHAT IS KNOWN ALREADY Many fundamental questions regarding the prevention, management, and consequences of infertility remain unanswered. This is a barrier to improving the care received by those people with fertility problems. STUDY DESIGN, SIZE, DURATION Potential research questions were collated from an initial international survey, a systematic review of clinical practice guidelines, and Cochrane systematic reviews. A rationalized list of confirmed research uncertainties was prioritized in an interim international survey. Prioritized research uncertainties were discussed during a consensus development meeting. Using a formal consensus development method, the modified nominal group technique, diverse stakeholders identified the top 10 research priorities for each of the categories male infertility, female and unexplained infertility, medically assisted reproduction, and ethics, access, and organization of care. PARTICIPANTS/MATERIALS, SETTING, METHODS Healthcare professionals, people with fertility problems, and others (healthcare funders, healthcare providers, healthcare regulators, research funding bodies and researchers) were brought together in an open and transparent process using formal consensus methods advocated by the James Lind Alliance. MAIN RESULTS AND THE ROLE OF CHANCE The initial survey was completed by 388 participants from 40 countries, and 423 potential research questions were submitted. Fourteen clinical practice guidelines and 162 Cochrane systematic reviews identified a further 236 potential research questions. A rationalized list of 231 confirmed research uncertainties were entered into an interim prioritization survey completed by 317 respondents from 43 countries. The top 10 research priorities for each of the four categories male infertility, female and unexplained infertility (including age-related infertility, ovarian cysts, uterine cavity abnormalities, and tubal factor infertility), medically assisted reproduction (including ovarian stimulation, IUI, and IVF), and ethics, access, and organization of care, were identified during a consensus development meeting involving 41 participants from 11 countries. These research priorities were diverse and seek answers to questions regarding prevention, treatment, and the longer-term impact of infertility. They highlight the importance of pursuing research which has often been overlooked, including addressing the emotional and psychological impact of infertility, improving access to fertility treatment, particularly in lower resource settings, and securing appropriate regulation. Addressing these priorities will require diverse research methodologies, including laboratory-based science, qualitative and quantitative research, and population science. LIMITATIONS, REASONS FOR CAUTION We used consensus development methods, which have inherent limitations, including the representativeness of the participant sample, methodological decisions informed by professional judgement, and arbitrary consensus definitions. WIDER IMPLICATIONS OF THE FINDINGS We anticipate that identified research priorities, developed to specifically highlight the most pressing clinical needs as perceived by healthcare professionals, people with fertility problems, and others, will help research funding organizations and researchers to develop their future research agenda. STUDY FUNDING/ COMPETING INTEREST(S) The study was funded by the Auckland Medical Research Foundation, Catalyst Fund, Royal Society of New Zealand, and Maurice and Phyllis Paykel Trust. Geoffrey Adamson reports research sponsorship from Abbott, personal fees from Abbott and LabCorp, a financial interest in Advanced Reproductive Care, committee membership of the FIGO Committee on Reproductive Medicine, International Committee for Monitoring Assisted Reproductive Technologies, International Federation of Fertility Societies, and World Endometriosis Research Foundation, and research sponsorship of the International Committee for Monitoring Assisted Reproductive Technologies from Abbott and Ferring. Siladitya Bhattacharya reports being the Editor-in-Chief of Human Reproduction Open and editor for the Cochrane Gynaecology and Fertility Group. Hans Evers reports being the Editor Emeritus of Human Reproduction. Andrew Horne reports research sponsorship from the Chief Scientist's Office, Ferring, Medical Research Council, National Institute for Health Research, and Wellbeing of Women and consultancy fees from Abbvie, Ferring, Nordic Pharma, and Roche Diagnostics. M. Louise Hull reports grants from Merck, grants from Myovant, grants from Bayer, outside the submitted work and ownership in Embrace Fertility, a private fertility company. Neil Johnson reports research sponsorship from Abb-Vie and Myovant Sciences and consultancy fees from Guerbet, Myovant Sciences, Roche Diagnostics, and Vifor Pharma. José Knijnenburg reports research sponsorship from Ferring and Theramex. Richard Legro reports consultancy fees from Abbvie, Bayer, Ferring, Fractyl, Insud Pharma and Kindex and research sponsorship from Guerbet and Hass Avocado Board. Ben Mol reports consultancy fees from Guerbet, iGenomix, Merck, Merck KGaA and ObsEva. Ernest Ng reports research sponsorship from Merck. Craig Niederberger reports being the Co Editor-in-Chief of Fertility and Sterility and Section Editor of the Journal of Urology, research sponsorship from Ferring, and retains a financial interest in NexHand. Jane Stewart reports being employed by a National Health Service fertility clinic, consultancy fees from Merck for educational events, sponsorship to attend a fertility conference from Ferring, and being a clinical subeditor of Human Fertility. Annika Strandell reports consultancy fees from Guerbet. Jack Wilkinson reports being a statistical editor for the Cochrane Gynaecology and Fertility Group. Andy Vail reports that he is a Statistical Editor of the Cochrane Gynaecology & Fertility Review Group and of the journal Reproduction. His employing institution has received payment from HFEA for his advice on review of research evidence to inform their 'traffic light' system for infertility treatment 'add-ons'. Lan Vuong reports consultancy and conference fees from Ferring, Merck and Merck Sharp and Dohme. The remaining authors declare no competing interests in relation to the present work. All authors have completed the disclosure form. TRIAL REGISTRATION NUMBER Not applicable.
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Affiliation(s)
- J M N Duffy
- King's Fertility, Fetal Medicine Research Institute, London, UK; Institute for Women's Health, University College London, London, UK.
| | - G D Adamson
- ARC Fertility, Cupertino, California, United States
| | - E Benson
- Patient and Public Participation Group, Priority Setting Partnership for Infertility, University of Auckland, Auckland, New Zealand
| | - S Bhattacharya
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - S Bhattacharya
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - M Bofill
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - K Brian
- Women's Network, Royal College of Obstetricians and Gynecologists, London, UK
| | - B Collura
- Resolve: The National Infertility Association, Virginia, United States
| | - C Curtis
- School of Psychology, University of Waikato, Hamilton, New Zealand
| | - J L H Evers
- Centre for Reproductive Medicine and Biology, University Medical Centre Maastricht, Maastricht, The Netherlands
| | - R G Farquharson
- Department of Obstetrics and Gynaecology, Liverpool Women's NHS Foundation Trust, Liverpool, UK
| | | | - S Franik
- Department of Obstetrics and Gynaecology, Münster University Hospital, Münster, Germany
| | - L C Giudice
- Center for Research, Innovation and Training in Reproduction and Infertility, Center for Reproductive Sciences, University of California, San Francisco, California, United States; International Federation of Fertility Societies, Mount Royal, New Jersey, United States
| | - E Glanville
- Auckland District Health Board, Auckland, New Zealand
| | - M Hickey
- Department of Obstetrics and Gynaecology, University of Melbourne, Victoria, Australia
| | - A W Horne
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - M L Hull
- Robinson Research Institute and Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - N P Johnson
- Robinson Research Institute and Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - V Jordan
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Y Khalaf
- Department of Women and Children's Health, Kings College London, London, UK
| | | | - R S Legro
- Department of Obstetrics and Gynaecology, Penn State College of Medicine, Pennsylvania
| | - S Lensen
- Department of Obstetrics and Gynaecology, University of Melbourne, Victoria, Australia
| | | | - D Mavrelos
- Reproductive Medicine Unit, University College Hospital, London, UK
| | - B W Mol
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
| | - D E Morbeck
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand; Fertility Associates, Auckland, New Zealand
| | - H Nagels
- Cochrane Gynaecology and Fertility, University of Auckland, Auckland, New Zealand
| | - E H Y Ng
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Hong Kong; Shenzhen Key Laboratory of Fertility Regulation, The University of Hong Kong-Shenzhen Hospital, China
| | - C Niederberger
- Department of Urology, University of Illinois at Chicago College of Medicine, Chicago, Illinois
| | | | - L Puscasiu
- Pharmacy, Science, and Technology, University of Medicine, Targu Mures, Romania; Center for Reproductive Medicine, Amsterdam Reproduction and Development Institute, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | | | - L Sadler
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand; Auckland District Health Board, Auckland, New Zealand
| | - I Sarris
- King's Fertility, Fetal Medicine Research Institute, London, UK
| | - M Showell
- Cochrane Gynaecology and Fertility, University of Auckland, Auckland, New Zealand
| | - J Stewart
- British Fertility Society, Middlesex, UK
| | - A Strandell
- Sahlgrenska Academy, Dept of Obstetrics and Gynecology, University of Gothenburg, Sahlgrenska University Hospital, Göteborg, Sweden
| | | | - A Vail
- Centre for Biostatistics, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - M van Wely
- Center for Reproductive Medicine, Amsterdam Reproduction and Development Institute, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - M Vercoe
- Cochrane Gynaecology and Fertility, University of Auckland, Auckland, New Zealand
| | - N L Vuong
- Department of Obstetrics and Gynaecology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - A Y Wang
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Australia
| | - R Wang
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
| | - J Wilkinson
- Centre for Biostatistics, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - K Wong
- School of Psychology, University of Waikato, Hamilton, New Zealand
| | - T Y Wong
- Auckland District Health Board, Auckland, New Zealand
| | - C M Farquhar
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand; Cochrane Gynaecology and Fertility, University of Auckland, Auckland, New Zealand
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6
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Duffy JMN, Adamson GD, Benson E, Bhattacharya S, Bhattacharya S, Bofill M, Brian K, Collura B, Curtis C, Evers JLH, Farquharson RG, Fincham A, Franik S, Giudice LC, Glanville E, Hickey M, Horne AW, Hull ML, Johnson NP, Jordan V, Khalaf Y, Knijnenburg JML, Legro RS, Lensen S, MacKenzie J, Mavrelos D, Mol BW, Morbeck DE, Nagels H, Ng EHY, Niederberger C, Otter AS, Puscasiu L, Rautakallio-Hokkanen S, Sadler L, Sarris I, Showell M, Stewart J, Strandell A, Strawbridge C, Vail A, van Wely M, Vercoe M, Vuong NL, Wang AY, Wang R, Wilkinson J, Wong K, Wong TY, Farquhar CM. Top 10 priorities for future infertility research: an international consensus development study† ‡. Hum Reprod 2020; 35:2715-2724. [PMID: 33252677 PMCID: PMC7744161 DOI: 10.1093/humrep/deaa242] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/05/2020] [Indexed: 12/13/2022] Open
Abstract
STUDY QUESTION Can the priorities for future research in infertility be identified? SUMMARY ANSWER The top 10 research priorities for the four areas of male infertility, female and unexplained infertility, medically assisted reproduction and ethics, access and organization of care for people with fertility problems were identified. WHAT IS KNOWN ALREADY Many fundamental questions regarding the prevention, management and consequences of infertility remain unanswered. This is a barrier to improving the care received by those people with fertility problems. STUDY DESIGN, SIZE, DURATION Potential research questions were collated from an initial international survey, a systematic review of clinical practice guidelines and Cochrane systematic reviews. A rationalized list of confirmed research uncertainties was prioritized in an interim international survey. Prioritized research uncertainties were discussed during a consensus development meeting. Using a formal consensus development method, the modified nominal group technique, diverse stakeholders identified the top 10 research priorities for each of the categories male infertility, female and unexplained infertility, medically assisted reproduction and ethics, access and organization of care. PARTICIPANTS/MATERIALS, SETTING, METHODS Healthcare professionals, people with fertility problems and others (healthcare funders, healthcare providers, healthcare regulators, research funding bodies and researchers) were brought together in an open and transparent process using formal consensus methods advocated by the James Lind Alliance. MAIN RESULTS AND THE ROLE OF CHANCE The initial survey was completed by 388 participants from 40 countries, and 423 potential research questions were submitted. Fourteen clinical practice guidelines and 162 Cochrane systematic reviews identified a further 236 potential research questions. A rationalized list of 231 confirmed research uncertainties was entered into an interim prioritization survey completed by 317 respondents from 43 countries. The top 10 research priorities for each of the four categories male infertility, female and unexplained infertility (including age-related infertility, ovarian cysts, uterine cavity abnormalities and tubal factor infertility), medically assisted reproduction (including ovarian stimulation, IUI and IVF) and ethics, access and organization of care were identified during a consensus development meeting involving 41 participants from 11 countries. These research priorities were diverse and seek answers to questions regarding prevention, treatment and the longer-term impact of infertility. They highlight the importance of pursuing research which has often been overlooked, including addressing the emotional and psychological impact of infertility, improving access to fertility treatment, particularly in lower resource settings and securing appropriate regulation. Addressing these priorities will require diverse research methodologies, including laboratory-based science, qualitative and quantitative research and population science. LIMITATIONS, REASONS FOR CAUTION We used consensus development methods, which have inherent limitations, including the representativeness of the participant sample, methodological decisions informed by professional judgment and arbitrary consensus definitions. WIDER IMPLICATIONS OF THE FINDINGS We anticipate that identified research priorities, developed to specifically highlight the most pressing clinical needs as perceived by healthcare professionals, people with fertility problems and others, will help research funding organizations and researchers to develop their future research agenda. STUDY FUNDING/COMPETING INTEREST(S) The study was funded by the Auckland Medical Research Foundation, Catalyst Fund, Royal Society of New Zealand and Maurice and Phyllis Paykel Trust. G.D.A. reports research sponsorship from Abbott, personal fees from Abbott and LabCorp, a financial interest in Advanced Reproductive Care, committee membership of the FIGO Committee on Reproductive Medicine, International Committee for Monitoring Assisted Reproductive Technologies, International Federation of Fertility Societies and World Endometriosis Research Foundation, and research sponsorship of the International Committee for Monitoring Assisted Reproductive Technologies from Abbott and Ferring. Siladitya Bhattacharya reports being the Editor-in-Chief of Human Reproduction Open and editor for the Cochrane Gynaecology and Fertility Group. J.L.H.E. reports being the Editor Emeritus of Human Reproduction. A.W.H. reports research sponsorship from the Chief Scientist's Office, Ferring, Medical Research Council, National Institute for Health Research and Wellbeing of Women and consultancy fees from AbbVie, Ferring, Nordic Pharma and Roche Diagnostics. M.L.H. reports grants from Merck, grants from Myovant, grants from Bayer, outside the submitted work and ownership in Embrace Fertility, a private fertility company. N.P.J. reports research sponsorship from AbbVie and Myovant Sciences and consultancy fees from Guerbet, Myovant Sciences, Roche Diagnostics and Vifor Pharma. J.M.L.K. reports research sponsorship from Ferring and Theramex. R.S.L. reports consultancy fees from AbbVie, Bayer, Ferring, Fractyl, Insud Pharma and Kindex and research sponsorship from Guerbet and Hass Avocado Board. B.W.M. reports consultancy fees from Guerbet, iGenomix, Merck, Merck KGaA and ObsEva. E.H.Y.N. reports research sponsorship from Merck. C.N. reports being the Co Editor-in-Chief of Fertility and Sterility and Section Editor of the Journal of Urology, research sponsorship from Ferring and retains a financial interest in NexHand. J.S. reports being employed by a National Health Service fertility clinic, consultancy fees from Merck for educational events, sponsorship to attend a fertility conference from Ferring and being a clinical subeditor of Human Fertility. A.S. reports consultancy fees from Guerbet. J.W. reports being a statistical editor for the Cochrane Gynaecology and Fertility Group. A.V. reports that he is a Statistical Editor of the Cochrane Gynaecology & Fertility Review Group and the journal Reproduction. His employing institution has received payment from Human Fertilisation and Embryology Authority for his advice on review of research evidence to inform their 'traffic light' system for infertility treatment 'add-ons'. N.L.V. reports consultancy and conference fees from Ferring, Merck and Merck Sharp and Dohme. The remaining authors declare no competing interests in relation to the present work. All authors have completed the disclosure form. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- J M N Duffy
- King’s Fertility, Fetal Medicine Research Institute, London, UK
- Institute for Women’s Health, University College London, London, UK
| | | | - E Benson
- Patient and Public Participation Group, Priority Setting Partnership for Infertility, University of Auckland, Auckland, New Zealand
| | - S Bhattacharya
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - S Bhattacharya
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - M Bofill
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - K Brian
- Women’s Network, Royal College of Obstetricians and Gynecologists, London, UK
| | - B Collura
- Resolve: The National Infertility Association, VA, USA
| | - C Curtis
- School of Psychology, University of Waikato, Hamilton, New Zealand
| | - J L H Evers
- Centre for Reproductive Medicine and Biology, University Medical Centre Maastricht, Maastricht, The Netherlands
| | - R G Farquharson
- Department of Obstetrics and Gynaecology, Liverpool Women's NHS Foundation Trust, Liverpool, UK
| | | | - S Franik
- Department of Obstetrics and Gynaecology, Münster University Hospital, Münster, Germany
| | - L C Giudice
- Center for Research, Innovation and Training in Reproduction and Infertility, Center for Reproductive Sciences, University of California, San Francisco, CA, USA
- International Federation of Fertility Societies, Mount Royal, NJ, USA
| | - E Glanville
- Auckland District Health Board, Auckland, New Zealand
| | - M Hickey
- Department of Obstetrics and Gynaecology, University of Melbourne, Victoria, Australia
| | - A W Horne
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - M L Hull
- Robinson Research Institute and Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - N P Johnson
- Robinson Research Institute and Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - V Jordan
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Y Khalaf
- Department of Women and Children’s Health, Kings College London, London, UK
| | | | - R S Legro
- Department of Obstetrics and Gynaecology, Penn State College of Medicine, PA, USA
| | - S Lensen
- Department of Obstetrics and Gynaecology, University of Melbourne, Victoria, Australia
| | | | - D Mavrelos
- Reproductive Medicine Unit, University College Hospital, London, UK
| | - B W Mol
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
| | - D E Morbeck
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
- Fertility Associates, Auckland, New Zealand
| | - H Nagels
- Cochrane Gynaecology and Fertility, University of Auckland, Auckland, New Zealand
| | - E H Y Ng
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Hong Kong
- Shenzhen Key Laboratory of Fertility Regulation, The University of Hong Kong-Shenzhen Hospital, China
| | - C Niederberger
- Department of Urology, University of Illinois at Chicago College of Medicine, Chicago, IL, USA
| | | | - L Puscasiu
- ARC Fertility, Cupertino, CA, USA
- Institute for Women’s Health, University College London, London, UK
- Center for Reproductive Medicine, Amsterdam Reproduction and Development Institute, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | | | - L Sadler
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
- Auckland District Health Board, Auckland, New Zealand
| | - I Sarris
- King’s Fertility, Fetal Medicine Research Institute, London, UK
| | - M Showell
- Cochrane Gynaecology and Fertility, University of Auckland, Auckland, New Zealand
| | - J Stewart
- British Fertility Society, Middlesex, UK
| | - A Strandell
- Sahlgrenska Academy, Department of Obstetrics and Gynecology, University of Gothenburg, Sahlgrenska University Hospital, Göteborg, Sweden
| | | | - A Vail
- Centre for Biostatistics, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - M van Wely
- Center for Reproductive Medicine, Amsterdam Reproduction and Development Institute, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - M Vercoe
- Cochrane Gynaecology and Fertility, University of Auckland, Auckland, New Zealand
| | - N L Vuong
- Department of Obstetrics and Gynaecology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - A Y Wang
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology, Sydney, Australia
| | - R Wang
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
| | - J Wilkinson
- Centre for Biostatistics, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - K Wong
- School of Psychology, University of Waikato, Hamilton, New Zealand
| | - T Y Wong
- Auckland District Health Board, Auckland, New Zealand
| | - C M Farquhar
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
- Cochrane Gynaecology and Fertility, University of Auckland, Auckland, New Zealand
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7
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Lier MCI, Özcan H, Schreurs AMF, van de Ven PM, Dreyer K, van der Houwen LEE, Johnson NP, Vandekerckhove F, Verhoeve HR, Kuchenbecker W, Mol BW, Lambalk CB, Mijatovic V. Uterine bathing with sonography gel prior to IVF/ICSI-treatment in patients with endometriosis, a multicentre randomised controlled trial. Hum Reprod Open 2020; 2020:hoaa054. [PMID: 33225080 PMCID: PMC7668398 DOI: 10.1093/hropen/hoaa054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 09/09/2020] [Indexed: 01/27/2023] Open
Abstract
STUDY QUESTION What is the effect of uterine bathing with sonography gel prior to IVF/ICSI-treatment on live birth rates after fresh embryo transfer in patients with endometriosis? SUMMARY ANSWER After formal interim analysis and premature ending of the trial, no significant difference between uterine bathing using a pharmacologically neutral sonography gel compared to a sham procedure on live birth rate after fresh embryo transfer in endometriosis patients (26.7% vs. 15.4%, relative risk (RR) 1.73, 95% confidence interval (CI) 0.81-3.72; P-value 0.147) could be found, although the trial was underpowered to draw definite conclusions. WHAT IS KNOWN ALREADY Impaired implantation receptivity contributes to reduced clinical pregnancy rates after IVF/ICSI-treatment in endometriosis patients. Previous studies have suggested a favourable effect of tubal flushing with Lipiodol® on natural conceptions. This benefit might also be explained by enhancing implantation through endometrial immunomodulation. Although recent studies showed no beneficial effect of endometrial scratching, the effect of mechanical stress by intrauterine infusion on the endometrium in endometriosis patients undergoing IVF/ICSI-treatment has not been investigated yet. STUDY DESIGN SIZE DURATION We performed a multicentre, patient-blinded, randomised controlled trial in which women were randomly allocated to either a Gel Infusion Sonography (GIS, intervention group) or a sham procedure (control group) prior to IVF/ICSI-treatment. Since recruitment was slow and completion of the study was considered unfeasible, the study was halted after inclusion of 112 of the planned 184 women. PARTICIPANTS/MATERIALS SETTING METHODS We included infertile women with surgically confirmed endometriosis ASRM stage I-IV undergoing IVF/ICSI-treatment. After informed consent, women were randomised to GIS with intrauterine instillation of ExEm-gel® or sonography with gel into the vagina (sham). This was performed in the cycle preceding the embryo transfer, on the day GnRH analogue treatment was started. The primary endpoint was live birth rate after fresh embryo transfer. Analysis was performed by both intention-to-treat and per-protocol. MAIN RESULTS AND THE ROLE OF CHANCE Between July 2014 to September 2018, we randomly allocated 112 women to GIS (n = 60) or sham procedure (n = 52). The live birth rate after fresh embryo transfer was 16/60 (26.7%) after GIS versus 8/52 (15.4%) after the sham (RR 1.73, 95% CI 0.81-3.72; P-value 0.147). Ongoing pregnancy rate was 16/60 (26.7%) after GIS versus 9/52 (17.3%) in the controls (RR 1.54, 95% CI 0.74-3.18). Miscarriage occurred in 1/60 (1.7%) after GIS versus 5/52 (9.6%) in the controls (RR 0.17, 95% CI 0.02-1.44) women. Uterine bathing resulted in a higher pain score compared with a sham procedure (visual analogue scale score 2.7 [1.3-3.5] vs. 1.0 [0.0-2.0], P < 0.001). There were two adverse events after GIS compared with none after sham procedures. LIMITATIONS REASONS FOR CAUTION The study was terminated prematurely due to slow recruitment and trial fatigue. Therefore, the trial is underpowered to draw definite conclusions regarding the effect of uterine bathing with sonography gel on live birth rate after fresh embryo transfer in endometriosis patients undergoing IVF/ICSI-treatment. WIDER IMPLICATIONS OF THE FINDINGS We could not demonstrate a favourable effect of uterine bathing procedures with sonography gel prior to IVF/ICSI-treatment in patients with endometriosis. STUDY FUNDING/COMPETING INTERESTS Investigator initiated study. IQ Medical Ventures provided the ExEm FOAM® kits free of charge, they were not involved in the study design, data management, statistical analyses and/or manuscript preparation, etc. C.B.L. reports receiving grants from Ferring, Merck and Guerbet, outside the submitted work. C.B.L. is Editor-in-Chief of Human Reproduction. V.M. reports grants and other from Guerbet, outside the submitted work. B.W.M. reports grants from NHMRC (GNT1176437), personal fees from ObsEva, Merck and Merck KGaA, Guerbet and iGenomix, outside the submitted work. N.P.J. reports research funding from Abb-Vie and Myovant Sciences and consultancy for Vifor Pharma, Guerbet, Myovant Sciences and Roche Diagnostics, outside the submitted work. K.D. reports personal fees from Guerbet, outside the submitted work. The other authors do not report any conflicts of interest. No financial support was provided. TRIAL REGISTRATION NUMBER NL4025 (NTR4198). TRIAL REGISTRATION DATE 7 October 2013. DATE OF FIRST PATIENT’S ENROLMENT 22 July 2014.
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Affiliation(s)
- M C I Lier
- Department of Reproductive Medicine, Academic Endometriosis Center, Amsterdam University Medical Center – Location VUmc, Amsterdam, the Netherlands
- Correspondence address. Department of Reproductive Medicine, Academic Endometriosis Center, Amsterdam University Medical Center – Location VUmc, De Boelelaan 1118, 1081 HZ, Amsterdam, the Netherlands. Tel: +31204445278; E-mail: https://orcid.org/0000-0002-9603-7718
| | - H Özcan
- Department of Reproductive Medicine, Academic Endometriosis Center, Amsterdam University Medical Center – Location VUmc, Amsterdam, the Netherlands
| | - A M F Schreurs
- Department of Reproductive Medicine, Academic Endometriosis Center, Amsterdam University Medical Center – Location VUmc, Amsterdam, the Netherlands
| | - P M van de Ven
- Department of Epidemiology & Biostatistics, Amsterdam University Medical Center – Location VUmc, Amsterdam, the Netherlands
| | - K Dreyer
- Department of Reproductive Medicine, Academic Endometriosis Center, Amsterdam University Medical Center – Location VUmc, Amsterdam, the Netherlands
| | - L E E van der Houwen
- Department of Reproductive Medicine, Academic Endometriosis Center, Amsterdam University Medical Center – Location VUmc, Amsterdam, the Netherlands
| | - N P Johnson
- Robinson Research Institute, University of Adelaide, North Adelaide, Australia
- Repromed Auckland and Auckland Gynaecology Group, Auckland, New Zealand
- The University of Auckland, Auckland, New Zealand
| | - F Vandekerckhove
- Department of Reproductive Medicine, Ghent University Hospital, Gent, Belgium
| | - H R Verhoeve
- Department of Reproductive Medicine, OLVG, Amsterdam, the Netherlands
| | - W Kuchenbecker
- Department of Reproductive Medicine, Isala, Zwolle, the Netherlands
| | - B W Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia
| | - C B Lambalk
- Department of Reproductive Medicine, Academic Endometriosis Center, Amsterdam University Medical Center – Location VUmc, Amsterdam, the Netherlands
| | - V Mijatovic
- Department of Reproductive Medicine, Academic Endometriosis Center, Amsterdam University Medical Center – Location VUmc, Amsterdam, the Netherlands
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8
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Duffy J, Hirsch M, Vercoe M, Abbott J, Barker C, Collura B, Drake R, Evers J, Hickey M, Horne AW, Hull ML, Kolekar S, Lensen S, Johnson NP, Mahajan V, Mol BW, Otter AS, Puscasiu L, Rodriguez MB, Rombauts L, Vail A, Wang R, Farquhar CM. A core outcome set for future endometriosis research: an international consensus development study. BJOG 2020; 127:967-974. [PMID: 32227676 DOI: 10.1111/1471-0528.16157] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To develop a core outcome set for endometriosis. DESIGN Consensus development study. SETTING International. POPULATION One hundred and sixteen healthcare professionals, 31 researchers and 206 patient representatives. METHODS Modified Delphi method and modified nominal group technique. RESULTS The final core outcome set includes three core outcomes for trials evaluating potential treatments for pain and other symptoms associated with endometriosis: overall pain; improvement in the most troublesome symptom; and quality of life. In addition, eight core outcomes for trials evaluating potential treatments for infertility associated with endometriosis were identified: viable intrauterine pregnancy confirmed by ultrasound; pregnancy loss, including ectopic pregnancy, miscarriage, stillbirth and termination of pregnancy; live birth; time to pregnancy leading to live birth; gestational age at delivery; birthweight; neonatal mortality; and major congenital abnormalities. Two core outcomes applicable to all trials were also identified: adverse events and patient satisfaction with treatment. CONCLUSIONS Using robust consensus science methods, healthcare professionals, researchers and women with endometriosis have developed a core outcome set to standardise outcome selection, collection and reporting across future randomised controlled trials and systematic reviews evaluating potential treatments for endometriosis. TWEETABLE ABSTRACT: @coreoutcomes for future #endometriosis research have been developed @jamesmnduffy.
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Affiliation(s)
- Jmn Duffy
- Institute for Women's Health, University College London, London, UK.,King's Fertility, The Fetal Medicine Research Institute, London, UK
| | - M Hirsch
- Institute for Women's Health, University College London, London, UK.,University College London Hospitals NHS Foundation Trust, London, UK
| | - M Vercoe
- Cochrane Gynaecology and Fertility Group, University of Auckland, Auckland, New Zealand
| | - J Abbott
- School of Women's and Children's Health, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - C Barker
- Radcliffe Women's Health Patient Participation Group, University of Oxford, Oxford, UK
| | - B Collura
- Resolve: The National Infertility Association, McLean, Virginia, USA
| | - R Drake
- endo:outcomes Patient and Public Participation Group, University of Auckland, Auckland, New Zealand
| | - Jlh Evers
- Centre for Reproductive Medicine and Biology, University Medical Centre Maastricht, Maastricht, the Netherlands
| | - M Hickey
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
| | - A W Horne
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - M L Hull
- Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
| | - S Kolekar
- endo:outcomes Patient and Public Participation Group, University of Auckland, Auckland, New Zealand
| | - S Lensen
- Cochrane Gynaecology and Fertility Group, University of Auckland, Auckland, New Zealand
| | - N P Johnson
- Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia.,World Endometriosis Society, Vancouver, British Columbia, Canada
| | - V Mahajan
- endo:outcomes Patient and Public Participation Group, University of Auckland, Auckland, New Zealand
| | - B W Mol
- Department of Obstetrics and Gynaecology, School of Medicine, Monash University, Melbourne, Victoria, Australia
| | - A-S Otter
- Osakidetza, OSI Bilbao, Basurto, Spain
| | - L Puscasiu
- University of Medicine, Pharmacy, Science, and Technology, Targu Mures, Romania
| | - M B Rodriguez
- Cochrane Gynaecology and Fertility Group, University of Auckland, Auckland, New Zealand
| | - L Rombauts
- Department of Obstetrics and Gynaecology, School of Medicine, Monash University, Melbourne, Victoria, Australia
| | - A Vail
- Centre for Biostatistics, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - R Wang
- Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
| | - C M Farquhar
- Cochrane Gynaecology and Fertility Group, University of Auckland, Auckland, New Zealand
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9
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Haeck JD, Zimmermann FM, Van 'T Veer M, Neumann FJ, Triantafyllis AS, Abdel-Wahab M, Omerovic E, Boxma-De Klerk BM, Pijls NH, Richardt G, Tonino PA, Johnson NP, Smits PC. P1251Percutaneous coronary intervention versus medical therapy for coronary lesions with positive fractional flow reserve (FFR) but preserved coronary flow reserve (CFR). A substudy of the COMPARE-ACUTE. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
International guidelines recommend performing percutaneous coronary intervention (PCI) on stable coronary lesions with a positive fractional flow reserve (FFR) to improve clinical outcomes. It remains unclear if FFR positive lesions with preserved coronary flow reserved (CFR) might be better treated medically.
Purpose
This study compared clinical outcomes between PCI and medical therapy for stable FFR-positive lesions with preserved CFR.
Methods
We performed a substudy of the randomized, multicenter COMPARE-ACUTE trial in which treated ST-elevation myocardial infarction patients with stable non-culprit lesions were randomized to either FFR-guided PCI or medical therapy. Based on baseline and hyperaemic pressure gradients, we computed the so-called pressure bounded-CFR (pb-CFR) and classified lesions as low (<2) or preserved (≥2). Our primary end point was a composite of death from any cause, non-fatal myocardial infarction, revascularization, or cerebrovascular events (MACCE) at 12 months.
Results
A total of 980 lesions from 885 subjects were included in this sub-study due to availability of baseline and hyperaemic pressure gradients. For the 462 lesions with FFR≤0.80, 249 had a pb-CFR<2 while 29 had a preserved CFR (pb-CFR≥2). The rate of MACCE at 1 year did not differ significantly between subjects with FFR≤0.80 and pb-CFR<2 versus FFR≤0.80 and pb-CFR≥2 (24% vs. 30%, p=0.44). Because of randomization, baseline characteristics were well balanced between subjects with FFR≤0.80 and pb-CFR≥2 who were treated by PCI or medical therapy. Importantly for subjects with FFR≤0.80 and pb-CFR≥2, MACCE occurred more frequently when treated medically compared with PCI (50% vs. 0% respectively, p=0.01).
Conclusions
In this post-hoc substudy from a large randomized controlled trial of 885 subjects with 980 lesions, a preserved pb-CFR≥2 did not associate with an improved clinical outcome when FFR≤0.80. Subjects with FFR-positive coronary lesions but a preserved pb-CFR experienced significantly worse clinical outcomes when treated medically instead of with PCI. These data suggest that a stenosis with a FFR≤0.80, even when pb-CFR remains preserved, benefits from treatment with PCI.
Acknowledgement/Funding
Maasstad Cardiovascular Research, Abbott Vascular and St. Jude Medical
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Affiliation(s)
- J D Haeck
- Medical Center Leeuwarden, Cardiology, Leeuwarden, Netherlands (The)
| | - F M Zimmermann
- Catharina Hospital, Cardiology, Eindhoven, Netherlands (The)
| | - M Van 'T Veer
- Catharina Hospital, Cardiology, Eindhoven, Netherlands (The)
| | - F J Neumann
- University Heart Center Freiburg-Bad Krozingen, Cardiology, Bad Krozingen, Germany
| | | | | | - E Omerovic
- University of Gothenburg, Cardiology, Gothenburg, Sweden
| | | | - N H Pijls
- Catharina Hospital, Cardiology, Eindhoven, Netherlands (The)
| | - G Richardt
- Heart Center Bad Segeberg, Bad Segeberg, Germany
| | - P A Tonino
- Catharina Hospital, Cardiology, Eindhoven, Netherlands (The)
| | - N P Johnson
- McGovern Medical School at UTHealth, Medicine, Houston, United States of America
| | - P C Smits
- Maasstad Hospital, Cardiology, Rotterdam, Netherlands (The)
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10
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Murai T, Van De Hoef TP, Stegehuis VE, Wijntjens GWM, Yonetsu T, Hoshino M, Kanaji Y, Lee T, Kirkeeide RL, Johnson NP, Kakuta T, Piek JJ. P5618Coronary flow capacity to identify stenosis associated with coronary flow improvement after coronary revascularization. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Coronary flow capacity (CFC) has recently been introduced as a comprehensive assessment of the coronary circulation by combining coronary flow reserve (CFR) and maximal coronary flow velocity to overcome the limitations of using CFR alone, and was reported to provide enhanced risk stratification compared with CFR. However, its potential to identify stenosis that would be associated with clinically relevant flow coronary flow improvement after revascularization has not been investigated.
Aims
The aim of this study is to quantify coronary flow changes after revascularization in relation to CFC and CFR.
Methods and results
Using a combined dataset of DEFINE FLOW and the Amsterdam UMC prospective ComboWire database, a total of 133 patients (135 vessels) with intermediate coronary artery lesions who underwent intracoronary physiologic assessment including intracoronary Doppler flow measurement before and after PCI were analyzed. The median values of fractional flow reserve (FFR) and CFR before PCI were 0.70 (Q1–3: 0.56–0.80) and 1.64 (Q1–3: 1.30–2.06). The number of lesions classified by CFC before PCI were 14 for normal CFC, 40 for mildly reduced CFC, 33 for moderately reduced CFC and 48 for severely reduced CFC. The lesions with larger impairment of CFC showed greater increase in coronary flow, and vice versa (median percent increase in coronary flow by revascularization: 4.2% for normal CFC; 25.9% for mildly reduced; 50.1% for moderately reduced; 145.5% for severely reduced, P<0.0001). Using the same CFR distribution based on CFC criteria showed that only lesions with severely reduced CFR showed a significantly higher coronary flow increase after PCI (−2.6% for CFR in the normal zone; 26.6% for CFR in the mildly reduced zone; 33.3% for CFR in the moderately reduced zone; 81.7% for CFR in the severely reduced zone, P=0.0007). Compared with the established CFR cut-off value of 2.0, moderate to severely reduced CFC showed higher specificity and positive predictive value (PPV) to predict at least 20% increase in coronary flow after PCI (specificity and PPV: 86.4% and 72.5% for ischemic CFC vs. 75.8% and 40% for CFR cut-off value 2.0). Multivariate logistic regression analysis revealed that the lesions with moderately or severely reduced CFC (odd ratio [OR] = 7.606 95%interconfidence interval [CI]: 2.834–20.412, P<0.001) and pre-PCI FFR (OR=0.0002, 95% CI: 0.0002–0.0204, P<0.001) were the independent predictors of coronary flow increase after PCI.
Conclusion
CFC showed a higher diagnostic efficiency for identification of lesions which benefit from revascularization compared to CFR with respect to coronary flow improvement. This study provides the physiological rational of revascularization for the lesions with moderately to severely reduced CFC from the perspective of coronary flow increase.
Acknowledgement/Funding
Philips Volcano
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Affiliation(s)
- T Murai
- Academic Medical Center of Amsterdam, Amsterdam, Netherlands (The)
| | - T P Van De Hoef
- Academic Medical Center of Amsterdam, Amsterdam, Netherlands (The)
| | - V E Stegehuis
- Academic Medical Center of Amsterdam, Amsterdam, Netherlands (The)
| | - G W M Wijntjens
- Academic Medical Center of Amsterdam, Amsterdam, Netherlands (The)
| | - T Yonetsu
- Tokyo Medical and Dental University, Department of Cardiology, Tokyo, Japan
| | - M Hoshino
- Tsuchiura Kyodo Hospital, Tsuchiura, Japan
| | - Y Kanaji
- Tsuchiura Kyodo Hospital, Tsuchiura, Japan
| | - T Lee
- Tokyo Medical and Dental University, Department of Cardiology, Tokyo, Japan
| | - R L Kirkeeide
- University of Texas Health Science Center at Houston, Department of Internal Medicine, Houston, United States of America
| | - N P Johnson
- University of Texas Health Science Center at Houston, Department of Internal Medicine, Houston, United States of America
| | - T Kakuta
- Tsuchiura Kyodo Hospital, Tsuchiura, Japan
| | - J J Piek
- Academic Medical Center of Amsterdam, Amsterdam, Netherlands (The)
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11
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Wang R, van Welie N, van Rijswijk J, Johnson NP, Norman RJ, Dreyer K, Mijatovic V, Mol BW. Effectiveness on fertility outcome of tubal flushing with different contrast media: systematic review and network meta-analysis. Ultrasound Obstet Gynecol 2019; 54:172-181. [PMID: 30740799 DOI: 10.1002/uog.20238] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 02/01/2019] [Accepted: 02/06/2019] [Indexed: 05/23/2023]
Abstract
OBJECTIVES To compare, in women with infertility, the effectiveness and safety of tubal flushing using oil-based contrast medium, water-based contrast medium or their combination, and no tubal flushing, and to evaluate the effectiveness of tubal flushing on fertility outcome over time. METHODS We performed a systematic review and network meta-analysis, searching the electronic databases MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials, and trial registries, up to 25 September 2018. We included randomized controlled trials (RCTs) comparing the following interventions with each other or with no intervention in women with infertility: tubal flushing using water-based contrast medium, tubal flushing using oil-based contrast medium or additional tubal flushing with oil-based medium following diagnostic tubal flushing with water-based medium. The outcomes included clinical pregnancy, live birth, ongoing pregnancy, miscarriage, ectopic pregnancy and adverse events. RESULTS Of the 283 studies identified through the search, 14 RCTs reporting on 3852 women with infertility were included. Network meta-analysis showed that tubal flushing using oil-based contrast medium was associated with higher odds of clinical pregnancy within 6 months after randomization and more subsequent live births compared with tubal flushing using water-based medium (odds ratio (OR), 1.67 (95% CI, 1.38-2.03), moderate certainty of evidence; and OR, 2.18 (95% CI, 1.30-3.65), low certainty of evidence, respectively) and compared with no intervention (OR, 2.28 (95% CI, 1.50-3.47), moderate certainty of evidence; and OR, 2.85 (95% CI, 1.41-5.74), low certainty of evidence, respectively). These results agreed with those of the pairwise meta-analysis. For clinical pregnancy within 6 months, there was insufficient evidence of a difference between tubal flushing with water-based contrast medium and no intervention (OR, 1.36 (95% CI, 0.91-2.04), low certainty of evidence). For fertility outcomes after 6 months, there was insufficient evidence of a difference in any comparison (low to very low certainty of evidence). Compared with tubal flushing using water-based contrast medium, the use of oil-based contrast medium was associated with higher odds of asymptomatic intravasation (OR, 5.06 (95% CI, 2.29-11.18), moderate certainty of evidence). CONCLUSIONS In women with infertility undergoing fertility workup, tubal flushing using oil-based contrast medium probably increases clinical pregnancy rates within 6 months after randomization and may increase subsequent live-birth rates, compared with tubal flushing using water-based contrast medium and compared with no intervention. Evidence on fertility outcomes beyond 6 months is inadequate to draw firm conclusions. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- R Wang
- Robinson Research Institute and Adelaide Medical School, The University of Adelaide, North Adelaide, Australia
| | - N van Welie
- Department of Reproductive Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - J van Rijswijk
- Department of Reproductive Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - N P Johnson
- Robinson Research Institute and Adelaide Medical School, The University of Adelaide, North Adelaide, Australia
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - R J Norman
- Robinson Research Institute and Adelaide Medical School, The University of Adelaide, North Adelaide, Australia
- Fertility SA, Adelaide, Australia
| | - K Dreyer
- Department of Reproductive Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - V Mijatovic
- Department of Reproductive Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - B W Mol
- Robinson Research Institute and Adelaide Medical School, The University of Adelaide, North Adelaide, Australia
- Department of Obstetrics and Gynaecology, Monash Medical Centre, Monash University and Monash Health, Clayton, Australia
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12
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Mbomson IG, Tabor S, Lahiri B, Sharp G, McMeekin SG, De La Rue RM, Johnson NP. Asymmetric split H-shape nanoantennas for molecular sensing. Biomed Opt Express 2017; 8:395-406. [PMID: 28101426 PMCID: PMC5231308 DOI: 10.1364/boe.8.000395] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 12/14/2016] [Accepted: 12/14/2016] [Indexed: 05/20/2023]
Abstract
In this paper we report on a very sensitive biosensor based on gold asymmetric nanoantennas that are capable of enhancing the molecular resonances of C-H bonds. The nanoantennas are arranged as arrays of asymmetric-split H-shape (ASH) structures, tuned to produce plasmonic resonances with reflectance double peaks within the mid-infrared vibrational resonances of C-H bonds for the assay of deposited films of the molecule 17β-estradiol (E2), used as an analyte. Measurements and numerical simulations of the reflectance spectra have enabled an estimated enhancement factor on the order of 105 to be obtained for a thin film of E2 on the ASH array. A high sensitivity value of 2335 nm/RIU was achieved, together with a figure of merit of approximately 8. Our experimental results were corroborated using numerical simulations for the C-H stretch vibrational resonances from the analyte, superimposed on the plasmonic resonances of the ASH nanoantennas.
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Affiliation(s)
- I. G. Mbomson
- School of Engineering, University of Glasgow, Glasgow, G12 8LT, UK
| | - S. Tabor
- School of Engineering, University of Glasgow, Glasgow, G12 8LT, UK
| | - B. Lahiri
- School of Engineering, University of Glasgow, Glasgow, G12 8LT, UK
| | - G. Sharp
- School of Engineering, University of Glasgow, Glasgow, G12 8LT, UK
| | - S. G. McMeekin
- School of Computing and Engineering, Glasgow Caledonian University, Glasgow, G4 0BA, UK
| | - R. M. De La Rue
- School of Engineering, University of Glasgow, Glasgow, G12 8LT, UK
| | - N. P. Johnson
- School of Engineering, University of Glasgow, Glasgow, G12 8LT, UK
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Johnson NP, Hummelshoj L. Reply: When is a consensus not a consensus? Hum Reprod 2013; 28:3161-2. [DOI: 10.1093/humrep/det282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Farquhar CM, Brown J, Arroll N, Gupta D, Boothroyd CV, Al Bassam M, Moir J, Johnson NP. A randomized controlled trial of fallopian tube sperm perfusion compared with standard intrauterine insemination for women with non-tubal infertility. Hum Reprod 2013; 28:2134-9. [DOI: 10.1093/humrep/det108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Daniels JP, Middleton L, Xiong T, Champaneria R, Johnson NP, Lichten EM, Sutton C, Vercellini P, Gray R, Hills RK, Jones KD, Aimi G, Khan KS. Individual patient data meta-analysis of randomized evidence to assess the effectiveness of laparoscopic uterosacral nerve ablation in chronic pelvic pain. Hum Reprod Update 2010; 16:568-76. [PMID: 20634210 DOI: 10.1093/humupd/dmq031] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND There have been conflicting results in randomized trials of the effects of laparoscopic uterosacral nerve ablation (LUNA) in chronic pelvic pain. Our objective was to perform a meta-analysis using individual patient data (IPD) to provide the most comprehensive and reliable assessment of the effectiveness of LUNA. METHODS Electronic searches were conducted in the Medline, Embase, PsycInfo and Cochrane Library databases from database inception to August 2009. The reference lists of known relevant papers were searched for any further articles. Randomized trials comparing LUNA with no additional intervention were selected and authors contacted for IPD. Raw data were available from 862 women randomized into five trials. Pain scores were calibrated to a 10-point scale and were analysed using a multilevel model allowing for repeated measures. RESULTS There was no significant difference between LUNA and No LUNA for the worst pain recorded over a 12 month time period (mean difference 0.25 points in favour of No LUNA on a 0-10 point scale, 95% confidence interval: -0.08 to 0.58; P = 0.1). CONCLUSIONS LUNA does not result in improved chronic pelvic pain.
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Affiliation(s)
- J P Daniels
- University of Birmingham, Birmingham Women's Hospital, Edgbaston, Birmingham B15 2TG, UK.
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Jiang Y, Zhao J, Hua M, Zhen X, Yan G, Hu Y, Sun H, Selvaggi L, Zannoni GF, Tagliaferri V, De Cicco S, Vellone VG, Romualdi D, Lanzone A, Guido M, Fassbender A, Vodolazkaia AV, Bossuyt XB, Kyama MK, Meuleman CM, Peeraer KP, Tomassetti CT, D'Hooghe TM, Lumini A, Nanni L, Manna C, Pappalardo S, Melin A, Lundholm C, Malki N, Swahn ML, Sparen P, Bergqvist A, Manna C, Crescenzi F, Farrag A, Sallam HN, Zou L, Ding G, Zhang R, Sheng J, Huang H, von Kleinsorgen C, Wilson T, Thiel-Moder U, Ebert AD, Reinfandt M, Papadopolous T, Melo AS, Rodrigues JK, Dib LA, Andrade AZ, Donabela FC, Ferriani RA, Navarro PA, Tocci A, Royo P, Lucchini C, Ramos P, Alcazar JL, Habara T, Terada S, Yoshioka N, Hayashi N, Haouzi D, Assou S, Monzo C, Anahory T, Dechaud H, De Vos J, Hamamah S, Gonzalez-Ramos R, Rojas C, Rocco J, Poch A, Sovino H, Kohen P, Munoz A, Devoto L, Aygen MA, Atakul T, Oner G, Ozgun MT, Sahin Y, Ozturk F, Li R, Qiao J, Zhylkova I, Feskov A, Feskova I, Somova O, Chumakova N, Bontekoe S, Blake D, Heineman MJ, Williams EC, Johnson NP, Motta A, Colaci D, Horton M, Faut M, Bisioli C, Kopcow L, de Zuniga I, Wiener-Megnazi Z, Khaytov M, Lahav - Baratz S, Shiloh H, Koifman M, Oslander R, Dirnfeld M, Sundqvist J, Andersson KL, Scarselli G, Gemzell-Danielsson K, Lalitkumar PGL, Tokushige N, Markham R, Crossett B, Ahn S, Nelaturi V, Khan A, Fraser IS, Van Vaerenbergh I, Fatemi HM, Blockeel C, Van Lommel L, In't Veld P, Schuit F, Kolibianakis EM, Devroey P, Bourgain C, Sugino N, Tamura I, Lee R, Maekawa R, Gelbaya T, Gordts S, D'Hooghe TN, Gergolet M, Nardo LG, Yu H, Wang H, Huang H, Lee C, Soong Y, Kremenska Y, Masliy Y, Goncharova Y, Kremenskoy M, Veselovskyy V, Zukin V, Sudoma I, Delgado-Rosas F, Gomez R, Tamarit S, Abad A, Simon C, Pellicer A, Racicot M, Dean NL, Antaki R, Menard S, Kadoch IJ, Garcia-Guzman R, Cabrera Romero L, Hernandez J, Palumbo A, Marshall E, Lowry J, Maybin JA, Collins F, Critchley HOD, Saunders PTK, Chaudhury K, Jana SK, Banerjee P, Mukherjee S, Chakravarty BN, Allegra A, Marino A, Lama A, Santoro A, Agueli C, Mazzola S, Volpes A, Delvoux B, de Graaff AA, D'Hooghe TM, Kyama CM, Dunselman GAJ, Romano A, Caccavo D, Pellegrino NM, Totaro I, Panzarino M, Nardelli C, Depalo R, Flores R, Montanana V, Monzo A, Polo P, Garcia-Gimeno T, Cabo A, Rubio JM, Pellicer A, de Graaff AA, Dunselman GAJ, Beets GL, van Lankveld JJ, Kim HY, Lee BS, Cho SH, Choi YS, Seo SK, Lee KE, Yang HI, Abubakirov A, Vacheyshvili T, Krechetova L, Ziganshina M, Demura T, Nazarenko T, Fulop I, Rucz A, Herczegh SZ, Ujvari A, Takacs SZ, Szakonyi T, Lopez - Muniz A, Zamora L, Serra O, Guix C, Lopez-Teijon M, Benadiva C, Alvarez JG, Goudakou M, Karkanaki A, Kalogeraki A, Mataliotakis I, Kalogiannidis I, Prapas I, Hosie M, Thomson KJ, Penny CB, Thomson KJ, Penny C, Hosie MJ, McKinnon B, Klaeser B, Bersinger N, Mueller MD, Horcajadas JA, Martinez-Conejero JA, Montesinos M, Morgan M, Fortuno S, Simon C, Pellicer A, Yi KW, Shin JH, Park HT, Kim T, Kim SH, Hur JY, Chan RWS, Chan YY, Ng EHY, Yeung WSB, Santulli P, Borghese B, Chopin N, Marcellin L, de Ziegler D, Chapron C, Elnashar A, Badawy A, Mosbah A, Tzioras S, Polyzos NP, Messini CI, Papanikolaou EG, Valachis A, Patavoukas E, Mauri D, Badawy A, Messinis IE, Acar N, Hirota Y, Tranguch S, Daikoku T, Burnum KE, Xie H, Kodama A, Osuga Y, Ustunel I, Friedman DB, Caprioli RM, Dey SK, Mitra A, Sahu R, Pal M, Bhattachrayya AK, Bhattachrya J, Ferrero S, Remorgida V, Rollandi GA, Biscaldi E, Cho S, Choi YS, Kim HY, Seo SK, Yang HI, Lee KE, Shin JH, Lee BS, Arena E, Morando A, Remorgida V, Ferrero S, Tomazevic T, Ban-Frangez H, Virant-Klun I, Verdenik I, Pozlep B, Vrtacnik-Bokal E, Valenzano Menada M, Biscaldi E, Remorgida V, Morotti M, Venturini PL, Rollandi GA, Ferrero S, Dimitriadis E, Salamonsen LA, Hannan N, O'Connor O, Rombauts L, Stoikos C, Mahmoudi M, Shaikh A, Mousavifar N, Rastin M, Baharara J, Tabasi N, Takemura Y, Fujimoto A, Osuga Y, Tsutsumi R, Ooi N, Yano T, Taketani Y, Karkanaki A, Goudakou M, Kalogiannidis I, Panagiotidis I, Prapas Y, Zhang D, Lv PP, Ding GL, Zhang RJ, Zou LB, Xu GF, Gao HJ, Zhu YM, Sheng JZ, Huang HF, Martinez-Conejero JA, Labarta E, Alama P, Pellicer A, Horcajadas JA, Bosch E. Posters * Endometriosis, Endometrium and Implantation. Hum Reprod 2010. [DOI: 10.1093/humrep/de.25.s1.242] [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: 11/14/2022] Open
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Johnson NP, Stewart AW, Falkiner J, Farquhar CM, Milsom S, Singh VP, Okonkwo QL, Buckingham KL. PCOSMIC: a multi-centre randomized trial in women with PolyCystic Ovary Syndrome evaluating Metformin for Infertility with Clomiphene. Hum Reprod 2010; 25:1675-83. [PMID: 20435692 DOI: 10.1093/humrep/deq100] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Ovulation induction treatment with metformin, either alone or in combination with clomiphene citrate (CC), remains controversial even though previous randomized trials have examined this. METHODS A double blinded multi-centre randomized trial was undertaken including 171 women with anovulatory or oligo-ovulatory polycystic ovary syndrome. Women with high body mass index (BMI) > 32 kg/m(2) received placebo ('standard care') or metformin; women with BMI < or = 32 kg/m(2) received CC ('standard care'), metformin or both. Treatment continued for 6 months or until pregnancy was confirmed. Primary outcomes were clinical pregnancy and live birth. RESULTS For women with BMI > 32 kg/m(2), clinical pregnancy and live birth rates were 22% (7/32) and 16% (5/32) with metformin, 15% (5/33) and 6% (2/33) with placebo. For women with BMI < or = 32 kg/m(2), clinical pregnancy and live birth rates were 40% (14/35) and 29% (10/35) with metformin, 39% (14/36) and 36% (13/36) with CC, 54% (19/35) and 43% (15/35) with combination metformin plus CC. CONCLUSIONS There is no evidence that adding metformin to 'standard care' is beneficial. Pregnancy and live birth rates are low in women with BMI > 32 kg/m(2) whatever treatment is used, with no evidence of benefit of metformin over placebo. For women with BMI < or = 32 kg/m(2) there is no evidence of significant differences in outcomes whether treated with metformin, CC or both. ClinicalTrials.gov number NCT00795808; trial protocol accepted for publication November 2005: Johnson, Aust N Z Journal Obstet Gynaecol 2006;46:141-145.
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Affiliation(s)
- N P Johnson
- Department of Obstetrics & Gynaecology, University of Auckland, Level 12, Auckland Hospital, Auckland, New Zealand.
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Abstract
The effectiveness of laparoscopic ovarian drilling for treatment of anovulation in polycystic ovarian syndrome (PCOS) has been proved. The role of ovarian surgery in the treatment of symptoms related to hyperandrogenaemia, such as hirsutism and acne, has been less clear. This review sought to evaluate the effectiveness of ovarian surgery in the treatment of non-infertility symptoms related to PCOS. A systematic literature review was undertaken, by searching the Medline database for the years 1966-2002 inclusive. The search yielded 19 studies recording the outcomes of hirsutism, acne or androgen levels from surgical treatment for women with PCOS: three assessed unilateral oophorectomy; two ovarian wedge resection; and 14 ovarian drilling. There was no consensus of a clear improvement in hirsutism or acne in women undergoing surgery. There was a trend towards a decrease in serum androgen levels in most studies. We conclude that, while there is evidence that ovarian surgery may decrease androgen levels in some women with PCOS, the evidence that this translates into a clear improvement in hirsutism and acne is less clear. Further high quality clinical research, including data from randomisation, would be required to answer this question.
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Affiliation(s)
- N P Johnson
- University Division of Obstetrics and Gynaecology, National Women's Hospital, Auckland, New Zealand.
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Johnson NP, Bishop E, Buist R. Hydrostatic replacement of acute inversion of the uterus can cause acute pulmonary oedema by intrauterine fluid intravasation. J OBSTET GYNAECOL 2009; 19:544-5. [PMID: 15512391 DOI: 10.1080/01443619964463] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- N P Johnson
- Department of Obstetrics and Gynaecology, National Women's Hospital, Auckland, New Zealand
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Van Peperstraten A, Proctor ML, Johnson NP, Philipson G. Techniques for surgical retrieval of sperm prior to intra-cytoplasmic sperm injection (ICSI) for azoospermia. Cochrane Database Syst Rev 2008; 2008:CD002807. [PMID: 18425884 PMCID: PMC7133779 DOI: 10.1002/14651858.cd002807.pub3] [Citation(s) in RCA: 33] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Azoospermia, the absence of sperm in ejaculated semen, is the most severe form of male-factor infertility and is present in approximately 5% of all investigated infertile couples. The advent of intra-cytoplasmic sperm injection (ICSI) has transformed treatment of this type of severe male-factor infertility. Sperm can be retrieved for ICSI from either the epididymis or the testis, depending on the type of azoospermia. OBJECTIVES To evaluate the efficacy of the various surgical retrieval techniques for men with obstructive or non-obstructive azoospermia prior to ICSI. SEARCH STRATEGY We searched the Cochrane Menstrual Disorders and Subfertility Group Trials Register (November 2007), Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2007, Issue 4), MEDLINE (1966 to November 2007), EMBASE (1980 to November 2007), Biological Abstracts (1980 to November 2007), and reference lists of identified articles. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing the effectiveness of different sperm-retrieval techniques in men with azoospermia prior to ICSI. Due to the lack of RCTs, non-randomised trials that used the participants as their own control were also considered in the review but their results were not included in the meta-analysis. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial quality and extracted data. Study authors were contacted for additional information. MAIN RESULTS The search was revised and re-run in November 2007. No new trials were located therefore the results of the updated review remain unchanged from those published in 2006. Two trials involving 98 men were included. The first small RCT had 59 participants and compared two epididymal techniques. The trial gave limited evidence that microsurgical epididymal sperm aspiration (MESA) achieved a significantly lower pregnancy rate (one pregnancy in 29 procedures compared with seven pregnancies in 30 procedures; OR 0.19, 95% CI 0.04 to 0.83) and fertilisation rate (OR 0.16, 95% CI 0.05 to 0.48) than the micropuncture with perivascular nerve stimulation technique. The other RCT comparing two testicular aspiration techniques (TSA) in 39 participants gave no statistically significant evidence for the superiority of the ultrasound-guided technique compared to the aspiration technique without ultrasound. TSA with ultrasound resulted in pregnancy in three out of 16 participants compared with four out of 23 participants (OR 1.10, 95% CI 0.21 to 5.74). AUTHORS' CONCLUSIONS There is insufficient evidence to recommend any specific sperm retrieval technique for azoospermic men undergoing ICSI. In the absence of evidence to support more invasive or more technically difficult methods, the review authors recommend the least invasive and simplest technique available. Further randomised trials are warranted, preferably multi-centred trials. The classification of azoospermia as obstructive and non-obstructive appears to be relevant to a successful clinical outcome and a distinction according to the cause of azoospermia is important for future clinical trials.
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Affiliation(s)
- A Van Peperstraten
- Department of Obstetrics & Gynecology, nr 791, Geert Grooteplein 10, PO Box 9101, Nijmegen, Netherlands, 6500HB.
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Abstract
BACKGROUND The randomized controlled trial (RCT) is the least biased measure of the effectiveness of interventions, including surgical interventions. The aim was to review the available evidence base in gynaecologic surgery, to assess what progress has been made and to determine gaps in the evidence for clinical decision-making. METHODS Systematic reviews involving gynaecological surgery interventions were extracted from the Cochrane Database of Systematic Reviews (Issue 2, 2007) and data were extracted for key primary outcomes from each of the randomized trials in the reviews. The reviews were categorized as to whether they had provided evidence of effectiveness for pre-defined outcomes of most relevance to patients. RESULTS Of 371 reviews or protocols published on the Cochrane Database of Systematic Reviews (Issue 2, 2007), only 30 were completed reviews assessing surgical interventions. Seven reviews concluded there was evidence of a significant effect (whether beneficial or harmful) of the interventions studied for pre-defined primary outcomes; 11 reviews concluded there was some evidence of significant effects for primary outcomes along with some gaps for primary outcomes; 12 reviews concluded insufficient evidence of effectiveness. Common themes of unique methodological challenges and pitfalls with trials of surgical interventions were apparent. CONCLUSIONS Cochrane reviews have gone a long way to establishing a sound evidence base in gynaecologic surgery: some gaps in the evidence have been eliminated and others highlighted. In general, gynaecology has been a specialty where surgical interventions have been well exposed to the scrutiny of RCTs compared with other surgical specialties.
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Affiliation(s)
- N P Johnson
- Department of Obstetrics and Gynaecology, University of Auckland, National Women's Health, Level 12, Auckland Hospital, Auckland, New Zealand.
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Johnson NP, Kwok R, Stewart AW, Saththianathan M, Hadden WE, Chamley LW. Lipiodol fertility enhancement: two-year follow-up of a randomized trial suggests a transient benefit in endometriosis, but a sustained benefit in unexplained infertility. Hum Reprod 2007; 22:2857-62. [PMID: 17890725 DOI: 10.1093/humrep/dem275] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [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: 11/13/2022] Open
Abstract
BACKGROUND A New Zealand randomized trial has shown that lipiodol treatment enhances fertility with high short-term effectiveness for women with endometriosis. METHODS An open randomized trial in a single-centre secondary- and tertiary-level infertility service assessing lipiodol flushing versus no intervention. A total of 158 women with unexplained infertility (62 women with mild endometriosis and 96 women with pure unexplained infertility) were evaluated at 24 months after trial entry. The main outcome measure was clinical pregnancy, assessed using a Cox proportional hazards regression model. RESULTS There was a significant benefit in overall pregnancy rate following lipiodol [hazard ratio 2.0, 95% confidence interval (CI) 1.3-3.2]. Among women with endometriosis, the benefit in pregnancy rate seen in the first 6 months following lipiodol (hazard ratio 5.4, 95% CI 2.1-14.2) was not present at 6-24 months (hazard ratio 0.6, 95% CI 0.2-2.1). There was a more consistent effect of lipiodol on fertility throughout the 24-month follow-up among women with unexplained infertility (hazard ratio 2.0, 95% CI 1.1-3.5). CONCLUSIONS Lipiodol flushing is effective at enhancing fertility not only for women with endometriosis, but also for those with pure unexplained infertility.
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Affiliation(s)
- N P Johnson
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand.
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Johnson NP, Bagrie EM, Coomarasamy A, Bhattacharya S, Shelling AN, Jessop S, Farquhar C, Khan KS. Ovarian reserve tests for predicting fertility outcomes for assisted reproductive technology: the International Systematic Collaboration of Ovarian Reserve Evaluation protocol for a systematic review of ovarian reserve test accuracy. BJOG 2007; 113:1472-80. [PMID: 17176280 DOI: 10.1111/j.1471-0528.2006.01068.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The presence of a wide range of tests of ovarian reserve suggests that no single test provides a sufficiently accurate result. Many tests are used without reference to an evidence base. So far, individual studies conducted on these tests are too small to give precise estimates of prognostic accuracy. OBJECTIVES To systematically assess the accuracy of the available tests of ovarian reserve in terms of prediction of fertility outcomes. SEARCH STRATEGY The search will be conducted using the name of the respective index test being studied (as listed on the MESH database), if more than 2000 citations are listed, 'ovary' and or 'ovarian', 'fertility' and or 'reserve' will be combined with the original search term as required. Studies of the accuracy of tests of ovarian reserve will be obtained without language restrictions from 1980 to 2005 using the following electronic databases and Ovid software: MEDLINE, EMBASE, PUBmed, Biological extracts, Pascal, Cochrane Library (CDSR, DARE, CCTR, HTA), Best Evidence databases, SCISEARCH, Conference Proceedings (ISI Proceedings, Healthstar, Current Contents, Science Citation Index, Cancerlit and Econlit and NHS Economic Evaluation database. The National Research Register, the Medical Research Council's Clinical Trials Register, MEDION, DARE, and the US Clinical Trials register. SELECTION CRITERIA Studies will be selected if accuracy of tests are compared with a reference standard and include data that can be abstracted into a two-by-two table to calculate sensitivity and specificity. The studies to be included in this review will examine one of the following index 'tests' within a study population of women undergoing assisted reproductive technology: * Clinical variables--age, history of cancelled cycles. * Basal blood tests--follicle-stimulating hormone (FSH), lutenising hormone (LH), FSH:LH ratios, estradiol (E(2)), inhibin A and B, progesterone (P(4)), P(4):E(2) ratios, antimullerian hormone, testosterone, vascular endothelial growth factor, insulin-like growth factor-1:insulin-like growth factor binding protein-1 ratios. * Dynamic tests--clomiphene citrate challenge test, gonadotropin analogue stimulating test, exogenous FSH ovarian reserve test. * Ultrasound tests-antral follicle count, ovarian volume, ovarian stromal peak systolic velocity, including waveform and pulsatility index, ovarian follicular vascularity. * Histology--ovarian biopsy. Data collection and analysis Two independent reviewers will perform quality assessment and data extraction. Prognostic accuracy will be determined by calculating positive and negative likelihood ratios for the following outcomes or reference standards: live birth, ongoing pregnancy, clinical pregnancy, biochemical pregnancy, embryos available for transfer, eggs obtained at oocyte retrieval, cycles cancelled prior to oocyte retrieval. Main results and conclusions N/A.
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Affiliation(s)
- N P Johnson
- National Women's Department and FertilityPlus, Auckland Hospital, Auckland, New Zealand
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Brown PM, Farquhar CM, Lethaby A, Sadler LC, Johnson NP. Cost-effectiveness analysis of levonorgestrel intrauterine system and thermal balloon ablation for heavy menstrual bleeding. BJOG 2006; 113:797-803. [PMID: 16827763 DOI: 10.1111/j.1471-0528.2006.00944.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To compare the cost-effectiveness of levonorgestrel intrauterine system (LNG-IUS) (Mirena; Schering Co., Turku, Finland) and thermal balloon ablation (Thermachoicetrade mark; Gynecare Inc., Menlo Park, CA, USA) for the treatment of heavy menstrual bleeding. DESIGN An open, pragmatic, prospective randomised trial. SETTING A menstrual disorders clinic at National Women's Hospital, Auckland, New Zealand. POPULATION Seventy-nine women with self-defined heavy menstrual bleeding randomised to the LNG-IUS (40 women) or the thermal balloon ablation (39 women). METHODS Decision tree modelling using primary source data was used to identify the incremental cost-effectiveness of the two treatments. MAIN OUTCOME MEASURES Direct and indirect costs of medical treatment, including treatment costs, subsequent medical procedures, lost income and medical treatment for failed procedures. The change in quality of life as assessed by the Short Form-36 (SF-36) measured between time of treatment and 24 months was the primary outcome measure. Economic modelling examined the expected cost and outcome for a woman entering each treatment. Sensitivity analysis explored the robustness of the results. RESULTS The expected cost of treatment was $NZ1241 ($US869) for the LNG-IUS and $NZ2418 ($US1693) for the thermal balloon ablation. The LNG-IUS was associated with an increase of 15 points on the SF-36 scale, compared with 12 points for the thermal balloon ablation. Sensitivity analysis indicates that the results are robust to a 25% decrease in the price of the primary cost drivers and to variations in the rates of failed treatment between the conditions. CONCLUSION The LNG-IUS would appear to be cost-effective when compared with the thermal balloon ablation for treatment of heavy menstrual bleeding.
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Affiliation(s)
- P M Brown
- School of Population Health, University of Auckland, Auckland, New Zealand.
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Abstract
BACKGROUND Azoospermia, the absence of sperm in ejaculated semen, is the most severe form of male factor infertility and is present in approximately 5% of all investigated infertile couples. The advent of intra-cytoplasmic sperm injection (ICSI), however, has transformed treatment of this type of severe male factor infertility. Sperm can be retrieved for ICSI from either the epididymis or the testis depending on the type of azoospermia. OBJECTIVES To evaluate the efficacy of the various surgical retrieval techniques for men with obstructive or non obstructive azoospermia prior to ICSI. SEARCH STRATEGY We searched the Cochrane Menstrual Disorders and Subfertility Group Trials Register (searched 12 Jan 2005), Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 4, 2004), MEDLINE (1966 to Nov 2004), EMBASE (1980 to Dec 2004), and Biological Abstracts (1980 to Nov 2004) and reference lists of articles. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing the effectiveness of sperm retrieval techniques in men with azoospermia prior to ICSI. Due to the lack of RCTs, non-randomised trials that used the participants as their own control, were also considered in the review but not included in the meta-analysis. DATA COLLECTION AND ANALYSIS Two reviewers independently assessed trial quality and extracted data. Study authors were contacted for additional information. MAIN RESULTS Two trials involving 98 men were included. The first small RCT had 59 participants and compared two epididymal techniques. The trial gave limited evidence that microsurgical epididymal sperm aspiration (MESA) achieved significantly lower pregnancy (One pregnancy in 29 procedures compared with seven pregnancies in 30 procedures, OR 0.19, 95% CI 0.04 to 0.83) and fertilisation rates (OR 0.16, 95% CI 0.05 to 0.48) than the micropuncture with perivascular nerve stimulation technique. The other RCT comparing two testicular techniques in 39 participants gave no statistically significant evidence about the superiority of the ultrasound guided aspiration technique compared to the aspiration technique without ultrasound guidance. TSA with ultrasound resulted in pregnancy in 3 out of 16 participants and TSA without ultrasound in four pregnancies with 23 participants (OR 1.10, 95% CI 0.21 to 5.74) AUTHORS' CONCLUSIONS There is insufficient evidence to recommend any specific sperm retrieval technique for azoospermic men undergoing ICSI. In the absence of evidence to support more invasive or more technically difficult methods the reviewers recommend the least invasive and simplest technique available. Further randomised trials are warranted, preferably multi-centred trials. The classification of azoospermia as obstructive and non-obstructive appears to be relevant to a successful clinical outcome so a distinction according to the cause azoospermia is important for future clinical trials.
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Affiliation(s)
- A Van Peperstraten
- Department of Obstetrics & Gynecology, nr 791, Geert Grooteplein 10, POBox 9101, Nijmegen, Netherlands 6500HB.
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Abstract
BACKGROUND Hysterectomy using an abdominal approach removes either the uterus alone (subtotal hysterectomy) or both the uterus and the cervix (total hysterectomy). The latter is more common but outcomes have not been systematically compared. OBJECTIVES To assess and compare outcomes with subtotal hysterectomy versus total abdominal hysterectomy for benign gynaecological conditions. SEARCH STRATEGY We searched the Cochrane Menstrual Disorders and Subfertility Group's specialised register of controlled trials (December 2005), Central (December 2005), Medline (1966 to December 2005), EmBase (1980 to December 2005), Biological Abstracts (1980 to December 2005), the National Research Register and relevant citation lists. SELECTION CRITERIA Only randomised controlled trials of women undergoing either total or subtotal hysterectomy for benign gynaecological conditions were included. DATA COLLECTION AND ANALYSIS Three trials that included 733 participants were included. Independent selection of trials and data extraction were undertaken by 2 reviewers and results compared. MAIN RESULTS There was no evidence of a difference in the rates of incontinence, constipation or measures of sexual function. In one unblinded trial, a significantly greater proportion of women indicated that they had frequent episodes of urinary incontinence after subtotal hysterectomy when compared with total hysterectomy (OR=2.1, 1.02 to 4.3), but these results were not confirmed by the other two trials that measured both stress and urge incontinence and urinary frequency. . Length of surgery and amount of blood lost during surgery were significantly reduced during subtotal hysterectomy when compared with total hysterectomy, but there was no evidence of a difference in the odds of transfusion. Febrile morbidity was less likely (OR=0.43, 0.25 to 0.75) and ongoing cyclical vaginal bleeding one year after surgery was more likely (OR=11.3, 4.1 to 31.2) after subtotal when compared with total hysterectomy. There was no evidence of a difference in the rates of other complications, recovery from surgery or readmission rates. AUTHORS' CONCLUSIONS This review has not confirmed the perception that subtotal hysterectomy offers improved outcomes for sexual, urinary or bowel function when compared with total abdominal hysterectomy. Surgery is shorter and intraoperative blood loss and fever are reduced but women are more likely to experience ongoing cyclical bleeding up to a year after surgery with subtotal hysterectomy compared to total hysterectomy.
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Affiliation(s)
- A Lethaby
- School of Population Health, Section of Epidemiology and Biostatistics (Level four), Tamaki Campus, University of Auckland, Private Bag 92019, Auckland, New Zealand.
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Abstract
BACKGROUND Dysmenorrhoea is the occurrence of painful menstrual cramps of uterine origin and is a very common gynaecological complaint with negative effect on a sufferer's quality of life. Medical therapy for dysmenorrhoea includes oral contraceptive pills (OCP) and nonsteroidal anti-inflammatory drugs (NSAIDs) which both act by suppressing prostaglandin levels. While these treatments are very successful there is still a 20 to 25% failure rate and surgery has been an option for such cases. Uterine nerve ablation (UNA) and presacral neurectomy (PSN) are two surgical treatments that have become increasingly utilised in recent years due to advances in laparoscopic procedures. These procedures both interrupt the majority of the cervical sensory pain nerve fibres. Observational studies have supported the use of these procedures for primary dysmenorrhoea. However, both operations only partially interrupt the cervical sensory nerve fibres in the pelvic area and, therefore, this type of surgery may not always benefit women with dysmenorrhoea. OBJECTIVES To assess the effectiveness of surgical interruption of pelvic nerve pathways as treatment for primary and secondary dysmenorrhoea, and to determine the most effective surgical treatment. SEARCH STRATEGY We searched the Cochrane Menstrual Disorders and Subfertility Group Trials Register (searched 9 June 2004), CENTRAL (The Cochrane Library Issue 2, 2004), MEDLINE (1966 to Nov 2003), EMBASE (1980 to Nov 2003), and CINAHL (1982 to Oct 2003). Attempts were also made to identify trials from the metaRegister of Controlled Trials and the citation lists of review articles and included trials. In most cases the first or corresponding author of each included trial was contacted for additional information. SELECTION CRITERIA The inclusion criteria were randomised comparisons of surgical techniques of interruption of the pelvic nerve pathways (using both open and laparoscopic procedures) for the treatment of primary and secondary dysmenorrhoea. The main outcome measures were pain relief and adverse effects. DATA COLLECTION AND ANALYSIS Eleven randomised controlled trials (RCTs) were identified that initially appeared to fulfil the inclusion criteria for this review. Two trials were subsequently excluded (Garcia Leon 2003; Sutton 1991). Of the remaining nine trials, eight were included in the meta-analysis. The results of one trial were included in the text of the review for discussion because the data were not available in a form that allowed them to be combined in the meta-analysis. Five trials investigated laparoscopic uterine nerve ablation (LUNA), two trials laparoscopic presacral neurectomy (LPSN) and two open presacral neurectomy (PSN). MAIN RESULTS For the treatment of primary dysmenorrhoea there was some evidence of the effectiveness of laparoscopic uterine nerve ablation (LUNA) when compared to a control or no treatment. The comparison between LUNA and laparoscopic presacral neurectomy (LPSN) for primary dysmenorrhoea showed no significant difference in pain relief in the short term; however, long-term LPSN was shown to be significantly more effective than LUNA. For the treatment of secondary dysmenorrhoea six identified RCTs addressed endometriosis and one included women with uterine myomas. The treatment of LUNA combined with surgical treatment of endometrial implants versus surgical treatment of endometriosis alone showed that the addition of LUNA did not aid pain relief. For PSN combined with endometriosis treatment versus endometriosis treatment alone there was an overall difference in pain relief although the data suggests this may be specific to laparoscopy and for midline abdominal pain only. Adverse events were significantly more common for presacral neurectomy; however, the majority were complications such as constipation, which may spontaneously improve. AUTHORS' CONCLUSIONS There is insufficient evidence to recommend the use of nerve interruption in the management of dysmenorrhoea, regardless of cause. Future methodologically sound and sufficiently powered RCTs should be undertaken.
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Affiliation(s)
- M L Proctor
- Department of Corrections, Psychological Service, PO Box 302 457, North Harbour, Auckland, New Zealand 1310.
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McLachlan MA, Johnson NP, De La Rue RM, McComb DW. Domain size and thickness control of thin film photonic crystals. ACTA ACUST UNITED AC 2005. [DOI: 10.1039/b414874f] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
UNLABELLED This paper is based on a Cochrane review published in The Cochrane Library, issue 2, 2002 (see www.CochraneLibrary.net for information) with permission from The Cochrane Collaboration and John Wiley and Sons. Cochrane reviews are regularly updated as new evidence emerges and in response to comments and criticisms, and The Cochrane Library should be consulted for the most recent version of the review. BACKGROUND The aim of this study was to determine the relative merits of blastocyst versus cleavage stage embryo transfer, concerning the chance of pregnancy, live birth, multiple pregnancy and the factors contributing to these primary outcomes, from the best available evidence. METHODS A systematic review employing the principles of the Cochrane Menstrual Disorders and Subfertility Group was undertaken. Fourteen randomized controlled trials, all comparing day 2/3 with day 5/6 embryo transfer, were included in a meta-analysis. RESULTS For day 2/3 versus day 5/6 transfer, there was no significant difference in the odds of pregnancy [odds ratio (OR) = 0.91, 95% confidence interval (CI) 0.71-1.17] nor of live birth (OR = 0.83, 95% CI 0.48-1.42) per treated couple. These results were similar whether all trials, only trials with transfer of equal numbers of day 2/3 versus day 5/6, or only trials with transfer of fewer day 5/6 than day 2/3 embryos, were pooled. There was no significant difference in the odds of multiple pregnancy for day 2/3 versus day 5/6 transfer overall (OR 0.77, 95% CI 0.52-1.13) nor when fewer day 5/6 than day 2/3 embryos were transferred (day 2/3 versus day 5/6 OR 0.69, 95% CI 0.42-1.12). CONCLUSION The current evidence fails to support a widespread change of practice from cleavage stage to blastocyst stage embryo transfer in couples undergoing IVF.
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Affiliation(s)
- D A Blake
- Cochrane Menstrual Disorders & Subfertility Group Editorial Base, Obstetrics & Gynaecology Department, National Women's Hospital, Auckland, New Zealand.
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Farquhar CM, Johnson NP. EDITORIAL: The evidence base for current infertility treatment. BJOG 2004; 111:1163-4. [PMID: 15521859 DOI: 10.1111/j.1471-0528.2004.00410.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Johnson NP, Farquhar CM, Crossley S, Yu Y, Van Peperstraten AM, Sprecher M, Suckling J. A double-blind randomised controlled trial of laparoscopic uterine nerve ablation for women with chronic pelvic pain. BJOG 2004; 111:950-9. [PMID: 15327610 DOI: 10.1111/j.1471-0528.2004.00233.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine the effectiveness of laparoscopic uterine nerve ablation (LUNA) for chronic pelvic pain in women with endometriosis and women with no laparoscopic evidence of endometriosis. DESIGN A prospective double-blind randomised controlled trial (RCT). SETTING Single-centre, secondary-level gynaecology outpatient service and tertiary-level pelvic pain and endometriosis outpatient service in Auckland, New Zealand. POPULATION One hundred and twenty-three women undergoing laparoscopy for investigation and management of chronic pelvic pain, 56 with no laparoscopic evidence of endometriosis and 67 with endometriosis. METHODS Women were randomised from the two populations, firstly those with no evidence of endometriosis and secondly those undergoing laparoscopic surgical treatment for endometriosis, to receive LUNA or no LUNA. Participant and assessor blinding was employed. Follow up for pain outcomes was undertaken at 24 hours, 3 months and 12 months. MAIN OUTCOME MEASURES Changes in non-menstrual pelvic pain, dysmenorrhoea, deep dyspareunia and dyschezia were assessed primarily by whether there was a decrease in visual analogue score for these types of pain of 50% or more from baseline and additionally whether there was a significantly different change in median visual analogue score. The numbers requiring further surgery or starting a new medical treatment for pelvic pain and complications were also measured. RESULTS There was a significant reduction in dysmenorrhoea at 12 month follow up in women with chronic pelvic pain in the absence of endometriosis who underwent LUNA (median change in visual analogue scale (VAS) from baseline -4.8 versus-0.8 (P= 0.039), 42.1%versus 14.3% experiencing a successful treatment defined as a 50% or greater reduction in visual analogue pain scale for dysmenorrhoea (P= 0.045). There was no significant difference in non-menstrual pelvic pain, deep dyspareunia or dyschezia in women with no endometriosis undergoing LUNA versus no LUNA. The addition of LUNA to laparoscopic surgical treatment of endometriosis was not associated with a significant difference in any pain outcomes. CONCLUSIONS LUNA is effective for dysmenorrhoea in the absence of endometriosis, although there is no evidence of effectiveness of LUNA for non-dysmenorrhoeic chronic pelvic pain or for any type of chronic pelvic pain related to endometriosis.
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Affiliation(s)
- N P Johnson
- Department of Obstetrics and Gynaecology, National Women's Hospital, University of Auckland, Auckland, New Zealand
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Johnson NP, Farquhar CM, Hadden WE, Suckling J, Yu Y, Sadler L. The FLUSH trial--flushing with lipiodol for unexplained (and endometriosis-related) subfertility by hysterosalpingography: a randomized trial. Hum Reprod 2004; 19:2043-51. [PMID: 15271870 DOI: 10.1093/humrep/deh418] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.5] [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: 11/13/2022] Open
Abstract
BACKGROUND To assess the effectiveness of flushing with the oil-soluble contrast medium lipiodol in women with unexplained infertility. METHODS An open randomized controlled trial design in a single centre secondary and tertiary level infertility service setting. A total of 158 women with unexplained infertility were stratified into two populations: 96 women without confirmed endometriosis and 62 women with endometriosis who had normal Fallopian tubes and ovaries. Randomization was computer-generated, with allocation concealment by opaque sequentially numbered envelopes. Lipiodol flushing was tested versus no intervention. The main outcome measures were clinical pregnancy (assessed at 6 months following randomization) and live birth. RESULTS Lipiodol flushing resulted in a significant increase in pregnancy [48.0 versus 10.8%, relative risk (RR) 4.44, 95% confidence interval (CI) 1.61-12.21] and live birth (40.0 versus 10.8%, RR 3.70, 95% CI 1.30-10.50) rates versus no intervention for women with endometriosis, although there was no significant difference in pregnancy (33.3 versus 20.8%, RR 1.60, 95% CI 0.81-3.16) or live birth (27.1 versus 14.6%, RR 1.86, 95% CI 0.81-4.25) rates for women with unexplained infertility without confirmed endometriosis. CONCLUSIONS Lipiodol flushing is an effective treatment for couples with unexplained infertility (based on meta-analysis data), but is particularly effective for women with endometriosis who have normal Fallopian tubes and ovaries.
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Affiliation(s)
- N P Johnson
- University of Auckland Department of Obstetrics and Gynaecology, National Women's Hospital, Auckland, New Zealand.
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Abidov A, Hachamovitch R, Friedman JD, Hayes SW, Kang X, Cohen I, Germano G, Berman DS, Kjaer A, Cortsen A, Federspiel M, Hesse B, Holm S, O’Connor M, Dhalla AK, Wong MY, Wang WQ, Belardinelli L, Therapeutics CV, Epps A, Dave S, Brewer K, Chiaramida S, Gordon L, Hendrix GH, Feng B, Pretorius PH, Bruyant PP, Boening G, Beach RD, Gifford HC, King MA, Fessler JA, Hsu BL, Case JA, Gegen LL, Hertenstein GK, Cullom SJ, Bateman TM, Akincioglu C, Abidov A, Nishina H, Kavanagh P, Kang X, Aboul-Enein F, Yang L, Hayes S, Friedman J, Berman D, Germano G, Santana CA, Rivero A, Folks RD, Grossman GB, Cooke CD, Hunsche A, Faber TL, Halkar R, Garcia EV, Hansen CL, Silver S, Kaplan A, Rasalingam R, Awar M, Shirato S, Reist K, Htay T, Mehta D, Cho JH, Heo J, Dubovsky E, Calnon DA, Grewal KS, George PB, Richards DR, Hsi DH, Singh N, Meszaros Z, Thomas JL, Reyes E, Loong CY, Latus K, Anagnostopoulos C, Underwood SR, Kostacos EJ, Araujo LI, Kostacos EJ, Araujo LI, Lewin HC, Hyun MC, DePuey EG, Tanaka H, Chikamori T, Igarashi Y, Harafuji K, Usui Y, Yanagisawa H, Hida S, Yamashina A, Nasr HA, Mahmoud SA, Dalipaj MM, Golanowski LN, Kemp RAD, Chow BJ, Beanlands RS, Ruddy TD, Michelena HI, Mikolich BM, McNelis P, Decker WAV, Stathopoulos I, Duncan SA, Isasi C, Travin MI, Kritzman JN, Ficaro EP, Corbett JR, Allison JS, Weinsaft JW, Wong FJ, Szulc M, Okin PM, Kligfield P, Harafuji K, Chikamori T, Igarashi Y, Tanaka H, Usui Y, Yanagisawa H, Hida S, Ishimaru S, Yamashima A, Giedd KN, Bergmann SR, Shah S, Emmett L, Allman KC, Magee M, Van Gaal W, Kritharides L, Freedman B, Abidov A, Gerlach J, Akincioglu C, Friedman J, Kavanagh P, Miranda R, Germano G, Berman DS, Hayes SW, Damera N, Lone B, Singh R, Shah A, Yeturi S, Prasad Y, Blum S, Heller EN, Bhalodkar NC, Koutelou M, Kollaros N, Theodorakos A, Manginas A, Leontiadis E, Kouzoumi A, Cokkinos D, Mazzanti M, Marini M, Cianci G, Perna GP, Pai M, Greenberg MD, Liu F, Frankenberger O, Kokkinos P, Hanumara D, Goheen E, Wu C, Panagiotakos D, Fletcher R, Greenberg MD, Liu F, Frankenberger O, Kokkinos P, Hanumara D, Goheen E, Rodriguez OJ, Iyer VN, Lue M, Hickey KT, Blood DK, Bergmann SR, Bokhari S, Chareonthaitawee P, Christensen SD, Allen JL, Kemp BJ, Hodge DO, Ritman EL, Gibbons RJ, Smanio P, Riva G, Rodriquez F, Tricoti A, Nakhlawi A, Thom A, Pretorius PH, King MA, Dahlberg S, Leppo J, Slomka PJ, Nishina H, Berman DS, Akincioglu C, Abidov A, Friedman JD, Hayes SW, Germano G, Petrovici R, Husain M, Lee DS, Nanthakumar K, Iwanochko RM, Brunken RC, DiFilippo F, Neumann DR, Bybel B, Herrington B, Bruckbauer T, Howe C, Lohmann K, Hayden C, Chatterjee C, Lathrop B, Brunken RC, Chen MS, Lohmann KA, Howe WC, Bruckbauer T, Kaczur T, Bybel B, DiFilippo FP, Druz RS, Akinboboye OA, Grimson R, Nichols KJ, Reichek N, Ngai K, Dim R, Ho KT, Pary S, Ahmed SU, Ahlberg A, Cyr G, Vitols PJ, Mann A, Alexander L, Rosenblatt J, Mieres J, Heller GV, Ahmed SU, Ahlberg AW, Cyr G, Navare S, O’Sullivan D, Heller GV, Chiadika S, Lue M, Blood DK, Bergmann SR, Bokhari S, Heston TF, Heller GV, Cerqueira MD, Jones PG, Bryngelson JR, Moutray KL, Gegen LL, Hertenstein GK, Moser K, Case JA, Zellweger MJ, Burger PC, Pfisterer ME, Mueller-Brand J, Kang WJ, Lee BI, Lee DS, Paeng JC, Lee JS, Chung JK, Lee MC, To BN, O’Connell WJ, Botvinick EH, Duvall WL, Croft LB, Einstein AJ, Fisher JE, Haynes PS, Rose RK, Henzlova MJ, Prasad Y, Vashist A, Blum S, Sagar P, Heller EN, Kuwabara Y, Nakayama K, Tsuru Y, Nakaya J, Shindo S, Hasegawa M, Komuro I, Liu YH, Wackers F, Natale D, DePuey G, Taillefer R, Araujo L, Kostacos E, Allen S, Delbeke D, Anstett F, Kansal P, Calvin JE, Hendel RC, Gulati M, Pratap P, Takalkar A, Kostacos E, Alavi A, Araujo L, Melduni RM, Duncan SA, Travin MI, Isasi CR, Rivero A, Santana C, Esiashvili S, Grossman G, Halkar R, Folks RD, Garcia EV, Su H, Dobrucki LW, Chow C, Hu X, Bourke BN, Cavaliere P, Hua J, Sinusas AJ, Spinale FG, Sweterlitsch S, Azure M, Edwards DS, Sudhakar S, Chyun DA, Young LH, Inzucchi SE, Davey JA, Wackers FJ, Noble GL, Navare SM, Calvert J, Hussain SA, Ahlberg AM, Katten DM, Boden WE, Heller GV, Shaw LJ, Yang Y, Antunes A, Botelho MF, Gomes C, de Lima JJP, Silva ML, Moreira JN, Simões S, GonÇalves L, Providência LA, Elhendy A, Bax JJ, Schinkel AF, Valkema R, van Domburg RT, Poldermans D, Arrighi J, Lampert R, Burg M, Soufer R, Veress AI, Weiss JA, Huesman RH, Gullberg GT, Moser K, Case JA, Loong CY, Prvulovich EM, Reyes E, Aswegen AV, Anagnostopoulos C, Underwood SR, Htay T, Mehta D, Sun L, Lacy J, Heo J, Brunken RC, Kaczur T, Jaber W, Ramakrishna G, Miller TD, O’connor MK, Gibbons RJ, Bural GG, Mavi A, Kumar R, El-Haddad G, Srinivas SM, A Alavi, El-Haddad G, Alavi A, Araujo L, Thomas GS, Johnson CM, Miyamoto MI, Thomas JJ, Majmundar H, Ryals LA, Ip ZTK, Shaw LJ, Bishop HA, Carmody JP, Greathouse WG, Yanagisawa H, Chikamori T, Tanaka H, Usui Y, Igarashi U, Hida S, Morishima T, Tanaka N, Takazawa K, Yamashina A, Diedrichs H, Weber M, Koulousakis A, Voth E, Schwinger RHG, Mohan HK, Livieratos L, Gallagher S, Bailey DL, Chambers J, Fogelman I, Sobol I, Barst RJ, Nichols K, Widlitz A, Horn E, Bergmann SR, Chen J, Galt JR, Durbin MK, Ye J, Shao L, Garcia EV, Mahenthiran J, Elliott JC, Jacob S, Stricker S, Kalaria VG, Sawada S, Scott JA, Aziz K, Yasuda T, Gewirtz H, Hsu BL, Moutray K, Udelson JE, Barrett RJ, Johnson JR, Menenghetti C, Taillefer R, Ruddy T, Hachamovitch R, Jenkins SA, Massaro J, Haught H, Lim CS, Underwood R, Rosman J, Hanon S, Shapiro M, Schweitzer P, VanTosh A, Jones S, Harafuji K, Giedd KN, Johnson NP, Berliner JI, Sciacca RR, Chou RL, Hickey KT, Bokhari SS, Rodriguez O, Bokhari S, Moser KW, Moutray KL, Koutelou M, Theodorakos A, Kollaros N, Manginas A, Leontiadis E, Cokkinos D, Mazzanti M, Marini M, Cianci G, Perna GP, Nanasato M, Fujita H, Toba M, Nishimura T, Nikpour M, Urowitz M, Gladman D, Ibanez D, Harvey P, Floras J, Rouleau J, Iwanochko R, Pai M, Guglin ME, Ginsberg FL, Reinig M, Parrillo JE, Cha R, Merhige ME, Watson GM, Oliverio JG, Shelton V, Frank SN, Perna AF, Ferreira MJ, Ferrer-Antunes AI, Rodrigues V, Santos F, Lima J, Cerqueira MD, Magram MY, Lodge MA, Babich JW, Dilsizian V, Line BR, Bhalodkar NC, Lone B, Singh R, Prasad Y, Yeturi S, Blum S, Heller EN, Rodriguez OJ, Skerrett D, Charles C, Shuster MD, Itescu S, Wang TS, Bruyant PP, Pretorius PH, Dahlberg S, King MA, Petrovici R, Iwanochko RM, Lee DS, Emmett L, Husain M, Hosokawa R, Ohba M, Kambara N, Tadamura E, Kubo S, Nohara R, Kita T, Thompson RC, McGhie AI, O’Keefe JH, Christenson SD, Chareonthaitawee P, Kemp BJ, Jerome S, Russell TJ, Lowry DR, Coombs VJ, Moses A, Gottlieb SO, Heiba SI, Yee G, Coppola J, Elmquist T, Braff R, Youssef I, Ambrose JA, Abdel-Dayem HM, Canto J, Dubovsky E, Scott J, Terndrup TE, Faber TL, Folks RD, Dim UR, Mclaughlin J, Pollepalle D, Schapiro W, Wang Y, Akinboboye O, Ngai K, Druz RS, Polepalle D, Phippen-Nater B, Leonardis J, Druz R. Abstracts of original contributions ASNC 2004 9th annual scientific session September 3-–October 3, 2004 New York, New York. J Nucl Cardiol 2004. [DOI: 10.1007/bf02974964] [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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Abstract
BACKGROUND Tubal disease, and particularly hydrosalpinx, has a detrimental effect on the outcome of in-vitro fertilisation (IVF). It has been less clear whether surgical intervention for tubal disease prior to IVF is effective in improving the likelihood of successful outcome. Most data are retrospective or poorly controlled. To date no single prospective randomised trial has shown a significant benefit from such surgical treatment prior to IVF. OBJECTIVES To assess the value of surgical treatment for tubal disease prior to IVF. SEARCH STRATEGY We searched the Cochrane Menstrual Disorders and Subfertility Group trials register (10 March 2004), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 1, 2004), MEDLINE (January 1966 to February 2004), EMBASE (January 1985 to February 2004), reference lists of articles and contacted researchers in the field. SELECTION CRITERIA All trials comparing a surgical treatment for tubal disease with a control group generated by randomisation were considered for inclusion in the review. DATA COLLECTION AND ANALYSIS Two reviewers independently assessed trial quality and extracted data. Study authors were contacted for additional information. The studied outcomes were live birth (and ongoing pregnancy), pregnancy, ectopic pregnancy, miscarriage, multiple pregnancy and complications. MAIN RESULTS Three randomised controlled trials involving 295 (or couples) were included in this review. The odds of ongoing pregnancy and live birth (Peto odds ratio (OR) 2.13, 95% confidence interval (CI) 1.24 to 3.65) were increased with laparoscopic salpingectomy for hydrosalpinges prior to IVF. The odds of pregnancy were also increased (Peto odds ratio (OR )1.75, 95%CI 1.07 to 2.86). There was no significant difference in the odds of ectopic pregnancy (Peto OR 0.42, 95%CI 0.08 to 2.14), miscarriage (Peto OR 0.49, 95%CI 0.16 to 1.52) or treatment complications (Peto OR 5.80, 95%CI 0.35 to 96.79). No data were available concerning the odds of multiple pregnancy. REVIEWERS' CONCLUSIONS Laparoscopic salpingectomy should be considered for all women with hydrosalpinges prior to IVF treatment. Currently unilateral salpingectomy for a unilateral hydrosalpinx (bilateral salpingectomy for bilateral hydrosalpinges) should be recommended, although this requires further evaluation. Further randomised trials are required to assess other surgical treatments for hydrosalpinx, such as salpingostomy, tubal occlusion or needle drainage of a hydrosalpinx at oocyte retrieval. The role of surgery for tubal disease in the absence of a hydrosalpinx is unclear and merits further evaluation.
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Affiliation(s)
- N P Johnson
- Obstetrics & Gynaecology Department, National Women's Hospital, Claude Road, Epsom, Auckland, New Zealand, 1003
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Johnson NP, Proctor M, Farquhar CM. Gaps in the evidence for fertility treatment-an analysis of the Cochrane Menstrual Disorders and Subfertility Group database. Hum Reprod 2003; 18:947-54. [PMID: 12721167] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND The randomized controlled trial is considered the best approach to assess the effectiveness of treatments. The aim was to summarize the available evidence and determine gaps in the evidence for clinical decision making in subfertility. METHODS A search of the Cochrane Library for Menstrual Disorders and Subfertility Group reviews was undertaken and, where the reviews were related to subfertility, the authors' conclusions were appraised and correlated with the results and meta-analysis sections of the reviews. Each review was then categorized as to what extent it had answered the clinical question posed by the reviewers. RESULTS Of 38 subfertility reviews currently or previously published on the Cochrane Library from the Menstrual Disorders and Subfertility Group, 12 reviews concluded that there was evidence of effectiveness of the interventions studied. There was insufficient evidence of effectiveness in 26 reviews, from which the authors of 23 reviews called for further research. A tabulated summary of the review conclusions is presented. CONCLUSION Cochrane subfertility reviews have eliminated some gaps in the evidence and highlighted others. Future clinical trial design should focus on adequate power and reporting the major outcome of live-births per couple as well as adverse events.
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Affiliation(s)
- N P Johnson
- Cochrane Menstrual Disorders & Subfertility Group Editorial Base, University of Auckland, and Fertility Plus, Obstetrics & Gynaecology Department, National Women's Hospital, Auckland, New Zealand.
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Johnson NP, Butour JL. Kinetics of the reaction of cis-diammineplatinum dichloride Pt(NH3)2Cl2 with DNAs of different G-C content. J Am Chem Soc 2002. [DOI: 10.1021/ja00414a060] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [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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Abstract
BACKGROUND The aim of this study was to determine whether surgical intervention is effective for women with tubal disease who are due to undergo treatment with IVF. METHODS A systematic review employing the principles of the Cochrane Menstrual Disorders and Subfertility Group was undertaken. Three randomized controlled trials were included, the population of women in all three studies having hydrosalpinges. RESULTS The odds of pregnancy [odds ratio (OR) = 1.75, 95% confidence interval (CI) 1.07-2.86] and of ongoing pregnancy and live birth (OR = 2.13, 95% CI 1.24-3.65) were increased with laparoscopic salpingectomy for hydrosalpinges prior to IVF. There were no significant differences in the odds of embryo implantation (OR = 1.34, 95% CI 0.87-2.05), ectopic pregnancy (OR = 0.42, 95% CI 0.08-2.14), miscarriage (OR = 0.49, 95% CI 0.16-1.52) or treatment complications (OR = 5.80, 95% CI 0.35-96.79). No data were available concerning the odds of multiple pregnancy or the proportion of IVF cycles resulting in embryo transfer. CONCLUSION Laparoscopic salpingectomy should be considered for all women with hydrosalpinges due to undergo IVF; further research is required to assess other pre-IVF surgical interventions (such as needle aspiration of hydrosalpinx fluid, laparoscopic proximal tubal occlusion and laparoscopic salpingostomy) for women with hydrosalpinges.
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Affiliation(s)
- N P Johnson
- Division of Obstetrics and Gynaecology, University of Auckland, National Women's Hospital, Claude Road, Epsom, Auckland, New Zealand.
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Gourves AS, Defais M, Johnson NP. Equilibrium binding of single-stranded DNA to the secondary DNA binding site of the bacterial recombinase RecA. J Biol Chem 2001; 276:9613-9. [PMID: 11121401 DOI: 10.1074/jbc.m004855200] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [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: 11/06/2022] Open
Abstract
The bacterial recombinase RecA forms a nucleoprotein filament in vitro with single-stranded DNA (ssDNA) at its primary DNA binding site, site I. This filament has a second site, site II, which binds ssDNA and double-stranded DNA. We have investigated the binding of ssDNA to the RecA protein in the presence of adenosine 5'-O-(thiotriphosphate) cofactor using fluorescence anisotropy. The RecA protein carried out DNA strand exchange with a 5'-fluorescein-labeled 32-mer oligonucleotide. The anisotropy signal was shown to measure oligonucleotide binding to RecA, and the relationship between signal and binding density was determined. Binding of ssDNA to site I of RecA was stable at high NaCl concentrations. Binding to site II could be described by a simple two-state equilibrium, K = 4.5 +/- 1.5 x 10(5) m(-1) (37 degrees C, 150 mm NaCl, pH 7.4). The reaction was enthalpy-driven and entropy-opposed. It depended on salt concentration and was sensitive to the type of monovalent anion, suggesting that anion-dependent protein conformations contribute to ssDNA binding at site II.
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Affiliation(s)
- A S Gourves
- Institut de Pharmacologie et de Biologie Structurale, UMR 5089, CNRS, 205 Route de Narbonne, 31077 Toulouse Cedex, France
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Michels PJ, Johnson NP, Codd RT, Mallin R. Childhood problems of alcoholic women. J Health Soc Policy 2001; 11:33-44. [PMID: 10557891 DOI: 10.1300/j045v11n03_03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A sample of three hundred and nine alcoholic and non-alcoholic women in South Carolina were asked three family-of-origin questions that were thought to relate to the development of alcoholism. Specifically the women were asked: "While you were growing up did anyone in your family: (1) drink a lot? (2) use drugs? or (3) serve a jail sentence?" Results of multivariate odds ratio analyses indicate that alcoholic women were 7.31 times more likely to indicate a family member who drank a lot, 3.57 times more likely to report a family member who used drugs, and 5.6 times more likely to report a family member who served a jail sentence in their families of origin. The prediction of alcoholism by any of these family of origin variables did not differ as a function of age or race. These data suggest that policy makers may contribute to improved outcome measures by providing attention to children passing through these difficulties.
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Affiliation(s)
- P J Michels
- Department of Family & Preventive Medicine, University of South Carolina School of Medicine, Columbia 29208, USA
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Abstract
A sample of three hundred and nine alcoholic and non-alcoholic women in South Carolina were asked three family of origin questions that were thought to relate to the development of alcoholism. Specifically the women were asked: "While you were growing up did anyone in your family (1) drink a lot, (2) use drugs, and (3) serve a jail sentence." Results of multivariate odds ratio analyses indicate that alcoholic women were 7.31 times more likely to report a family member who drank a lot, 3.57 times more likely to report a family member who used drugs, and 5.6 times more likely to report a family member who served a jail sentence in their families of origin. The prediction of alcoholism by any of these family of origin variables did not differ as a function of age or race.
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Affiliation(s)
- P Michels
- University of South Carolina School of Medicine, Columbia 29208, USA
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Abstract
Few data are available concerning the risk factors for depression among adolescents living in group homes. Two hundred fifty-nine adolescents ranging in age from 10 years to 20 years (median age of 15 years) residing in South Carolina group homes were interviewed for symptoms of depression and characteristics including demographics, personal history, family dynamics, academic performance, and social network. Of the study population, 47 percent are female. Population ethnicity is 64.9 percent Anglo-American and 29.1 percent African-American. Among these adolescents, 74.5 percent had clinical depression defined as a total Center for Epidemiologic Studies Depression Scale (CES-D) score of 16 or more which is much greater than population-based estimates of 0.4 to 8.3 percent. Using a total CES-D score of 23 or more, 42.9 percent of the adolescents had severe depression. Among adolescents who were clinically depressed, gender had an adjusted odds ratio (AOR) of 4.24 with a 95 percent confidence interval (CI) of 1.44 and 12.51. History of suicide attempts had an OR of 4.97 with a 95 percent CI of 1.04 and 23.75. However, among severely depressed adolescents, only gender was a significant risk factor (AOR = 6.92, 95 percent CI = 2.91, 16.42). Careful screening of all depressed adolescents in group homes for suicide attempts is indicated, especially among females, and when identified, the adolescent should receive suicide prevention counseling.
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Affiliation(s)
- C Li
- Department of Family and Preventive Medicine, State University of New York at Buffalo, 270 Farber Hall, 3435 Main Street, Buffalo, NY 14214, USA
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Abstract
Three hundred children age 10-20 living in group homes for children were assessed for behaviors related to alcohol and other drug consumption, suicide attempts, frequency of punishment, attention from parents, conflicts with parents, and other family dynamics. Children who used substances were significantly more likely to have attempted suicide more frequently. Children who had attempted suicide were more likely to perceive that they had not received enough parental attention, to have had more conflicts with parents, and to have run away from home. This seminal article indicates inter-related prevalences of family factors, suicide and substance abuse issues and suggests the need for strong institutional and agency policy development for this understudied "at risk" population.
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Affiliation(s)
- N P Johnson
- Department of Neuropsychiatry and Behavioral Science, University of South Carolina, USA
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Abstract
BACKGROUND Azoospermia, the absence of sperm in ejaculated semen, is the most severe form of male factor infertility and is present in approximately 5% of all investigated infertile couples. The condition is currently classified as "obstructive" or "non-obstructive", although it is important to also consider the specific aetiology of each individual case. Some cases of obstructive azoospermia are treatable using microsurgical reconstruction of the seminal tract (for example, vasectomy reversal). Unreconstructable obstructive azoospermia and non-obstructive azoospermia have historically been relatively untreatable conditions that required the use of donor spermatozoa for fertilisation. The advent of intra-cytoplasmic sperm injection (ICSI), however, has transformed treatment of this type of severe male factor infertility. Sperm can be retrieved for ICSI from either the epididymis or the testis depending on the type of azoospermia. OBJECTIVES To evaluate the efficacy of the various surgical retrieval techniques for men with obstructive or non obstructive azoospermia prior to ICSI. SEARCH STRATEGY Electronic searches of the Cochrane Menstrual Disorders and Subfertility Group specialised register of controlled trials, CCTR, MEDLINE, EMBASE, and Bio extracts were performed to identify relevant randomised controlled trials (RCTs). Attempts were also made to identify trials from the National Research Register, the Clinical Trial Register and the citation lists of review articles and included trials. The first or corresponding author of each included trial was also contacted for additional information. SELECTION CRITERIA Trials were included if they were randomised and compared the effectiveness of sperm retrieval techniques in men with azoospermia prior to ICSI. Due to the lack of RCTs non-randomised trials, who used the participants as their own control, were also considered in the review but not included in the meta-analysis. Trials of surgically extracted sperm versus ejaculated sperm or of diagnostic biopsies with no sperm parameter information were excluded. DATA COLLECTION AND ANALYSIS One RCT was included in this systematic review which compared micropuncture with nerve stimulation versus microsurgical epididymal sperm extraction. Pregnancy rate, sperm retrieval adequate for ICSI and fertilisation rate were primary outcomes. Another RCT comparing microsurgical epididymal sperm extraction versus testicular sperm extraction, was excluded from the meta-analysis due to poor randomisation. Seven non-randomised comparative trials were also identified and included. Main outcomes were pregnancy rate, sperm retrieval adequate for ICSI, fertilisation rate and implantation rate. Quality assessment and data extraction were performed independently by two reviewers. Meta-analysis was performed using odds ratios for dichotomous outcomes and weighted mean differences for continuous outcomes. Data unsuitable for meta-analysis was reported as descriptive data and was also included for discussion. MAIN RESULTS One small RCT comparing two epididymal techniques gave limited evidence that microsurgical epididymal sperm aspiration (MESA) achieved significantly lower pregnancy (OR 0.19, 95% CI 0.04-0.83) and fertilisation rates (OR 0.16, 95% CI 0.05-0.48) than the micropuncture with perivascular nerve stimulation technique. However the small number of participants included and the questionable methodology of this RCT make it impossible to make a definitive statement about the relative merits of either treatment. REVIEWER'S CONCLUSIONS There is insufficient evidence to recommend any specific sperm retrieval technique for azoospermic men undergoing ICSI. Further randomised trials are warranted, preferably multi-centred trials.
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Affiliation(s)
- A M Van Perperstraten
- Menstrual Disorders & Subfertility Group, School of Medicine, University of Auckland, National Women's Hospital, Claude Rd, Epsom, Auckland, New Zealand, 1003.
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Abstract
BACKGROUND Tubal disease, and particularly hydrosalpinx, has a detrimental effect on the outcome of in-vitro fertilisation (IVF). It has been less clear whether surgical intervention for tubal disease prior to IVF is effective in improving the likelihood of successful outcome. Most data are retrospective or poorly controlled. To date no single prospective randomised trial has shown a significant benefit from such surgical treatment prior to IVF. OBJECTIVES To assess the value of surgical treatment for tubal disease prior to IVF. SEARCH STRATEGY The search strategy of the Menstrual Disorders and Subfertility Group was used for the identification of relevant randomised controlled trials. SELECTION CRITERIA All trials where a surgical treatment for tubal disease was compared with a control group generated by randomisation were considered for inclusion in the review. DATA COLLECTION AND ANALYSIS Three randomised controlled trials were identified and included in this review, after an attempt to obtain further information from the authors of all three trials. All trials were assessed for quality criteria. The studied outcomes were live birth (and ongoing pregnancy), pregnancy, ectopic pregnancy, miscarriage, multiple pregnancy, complications, implantation rate and the proportion of IVF cycles resulting in embryo transfer. MAIN RESULTS The odds of pregnancy (OR 1.75, 95%CI 1.07, 2.86) and of ongoing pregnancy and live birth (OR 2.13, 95%CI 1.24, 3.65) were increased with laparoscopic salpingectomy for hydrosalpinges prior to IVF. There was no significant difference in the odds of ectopic pregnancy (OR 0.42, 95%CI 0.08, 2.14), miscarriage (OR 0.49, 95%CI 0.16, 1.52), treatment complications (OR 5.80, 95%CI 0.35, 96.79) or implantation rate (OR 1.34, 95%CI 0.87, 2.05). No data were available concerning the odds of multiple pregnancy or the proportion of IVF cycles resulting in embryo transfer. REVIEWER'S CONCLUSIONS Laparoscopic salpingectomy should be considered for all women with hydrosalpinges prior to IVF treatment. Currently unilateral salpingectomy for a unilateral hydrosalpinx (bilateral salpingectomy for bilateral hydrosalpinges) should be recommended, although this requires further evaluation. Further randomised trials are required to assess other surgical treatments for hydrosalpinx, such as salpingostomy, tubal occlusion or needle drainage of a hydrosalpinx at oocyte retrieval. The role of surgery for tubal disease in the absence of a hydrosalpinx is unclear and merits further evaluation.
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Affiliation(s)
- N P Johnson
- Obstetrics & Gynaecology Department, National Women's Hospital, Claude Road, Epsom, Auckland, New Zealand, 1003.
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Barry MD, Johnson NP, Gorry PA. A fast (30μs) pulsed supersonic nozzle beam source: application to the photodissociation of CS2at 193 nm. ACTA ACUST UNITED AC 2000. [DOI: 10.1088/0022-3735/19/10/011] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Abstract
The objectives of the study was to determine the effectiveness of post-operative procedures following female pelvic reproductive surgery. A systematic review employing the principles of the Cochrane Menstrual Disorders and Subfertility Group was used. Five randomized controlled trials were included. Participants were women undergoing pelvic reproductive surgery; interventions were any post-operative procedure designed to improve fertility; outcomes were pregnancy, live birth, ectopic pregnancy and miscarriage rates and the rates of tubal patency and procedure-related complications. Summary statistics were expressed as odds ratios. The results showed that the odds of pregnancy, live birth, ectopic pregnancy and miscarriage were not significantly altered by post-operative hydrotubation nor second-look laparoscopy with adhesiolysis. Whether hydrotubation was early or late and whether hydrotubation fluid contained steroid or not had no significant impact on the odds of pregnancy, live birth, ectopic pregnancy or miscarriage. The odds of pregnancy and live birth were significantly increased and infective complications significantly decreased by hydrotubation with fluid containing antibiotic compared with hydrotubation with fluid containing no antibiotic, in late hydrotubation following tubal stent removal 6 weeks after tubal surgery. The odds of at least one patent Fallopian tube were significantly increased with late hydrotubation following tubal stent removal compared with early hydrotubation in women who had no tubal stenting, but this intervention had no significant impact on the odds of pregnancy, live birth, ectopic pregnancy or miscarriage. In conclusion, there is insufficient evidence to support the routine practice of hydrotubation or second-look laparoscopy following female pelvic reproductive surgery. The studies on which this conclusion is based were either poor quality or underpowered. Post-operative hydrotubation with fluid containing antibiotic following tubal surgery may offer benefit over hydrotubation fluid without antibiotic. A randomized controlled trial of post-operative hydrotubation with antibiotic-containing fluid versus no hydrotubation for improving fertility following tubal surgery is justified.
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Affiliation(s)
- N P Johnson
- University Department of Obstetrics & Gynaecology, National Women's Hospital, Auckland, New Zealand.
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Gourves AS, Tanguy Le Gac N, Villani G, Boehmer PE, Johnson NP. Equilibrium binding of single-stranded DNA with herpes simplex virus type I-coded single-stranded DNA-binding protein, ICP8. J Biol Chem 2000; 275:10864-9. [PMID: 10753882 DOI: 10.1074/jbc.275.15.10864] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
We have carried out solution equilibrium binding studies of ICP8, the major single-stranded DNA (ssDNA)-binding protein of herpes simplex virus type I, in order to determine the thermodynamic parameters for its interaction with ssDNA. Fluorescence anisotropy measurements of a 5'-fluorescein-labeled 32-mer oligonucleotide revealed that ICP8 formed a nucleoprotein filament on ssDNA with a binding site size of 10 nucleotides/ICP8 monomer, an association constant at 25 degrees C, K = 0.55 +/- 0.05 x 10(6) M(-1), and a cooperativity parameter, omega = 15 +/- 3. The equilibrium constant was largely independent of salt, deltalog(Komega)/deltalog([NaCl]) = -2.4 +/- 0.4. Comparison of these parameters with other ssDNA-binding proteins showed that ICP8 reacted with an unusual mechanism characterized by low cooperativity and weak binding. In addition, the reaction product was more stable at high salt concentrations, and fluorescence enhancement of etheno-ssDNA by ICP8 was higher than for other ssDNA-binding proteins. These last two characteristics are also found for protein-DNA complexes formed by recombinases in their active conformation. Given the proposed role of ICP8 in promoting strand transfer reactions, they suggest that ICP8 and recombinase proteins may catalyze homologous recombination by a similar mechanism.
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Affiliation(s)
- A S Gourves
- Institut de Pharmacologie et de Biologie Structurale, CNRS, 205 Route de Narbonne, 31077 Toulouse Cédex, France
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