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1.
Proc Natl Acad Sci U S A ; 115(31): 7919-7924, 2018 07 31.
Artículo en Inglés | MEDLINE | ID: mdl-30012609

RESUMEN

Foaming in liquids is ubiquitous in nature. Whereas the mechanism of foaming in aqueous systems has been thoroughly studied, nonaqueous systems have not enjoyed the same level of examination. Here we study the mechanism of foaming in a widely used class of nonaqueous liquids: lubricant base oils. Using a newly developed experimental technique, we show that the stability of lubricant foams can be evaluated at the level of single bubbles. The results obtained with this single-bubble technique indicate that solutocapillary flows are central to lubricant foam stabilization. These solutocapillary flows are shown to originate from the differential evaporation of multicomponent lubricants-an unexpected result given the low volatility of nonaqueous liquids. Further, we show that mixing of some combinations of different lubricant base oils, a common practice in the industry, exacerbates solutocapillary flows and hence leads to increased foaming.

2.
BJOG ; 127(9): 1102-1107, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-32146729

RESUMEN

OBJECTIVE: To investigate the demographics, natural history and treatment outcomes of non-molar gestational choriocarcinoma. DESIGN: A retrospective national population-based study. SETTING: UK 1995-2015. POPULATION: A total of 234 women with a diagnosis of gestational choriocarcinoma, in the absence of a prior molar pregnancy, managed at the UKs two gestational trophoblast centres in London and Sheffield. METHODS: Retrospective review of the patient's demographic and clinical data. Comparison with contemporary UK birth and pregnancy statistics. MAIN OUTCOMES: Incidence statistics for non-molar choriocarcinoma across the maternal age groups. Cure rates for patients by FIGO prognostic score group. RESULTS: Over the 21-year study period, there were 234 cases of non-molar gestational choriocarcinoma, giving an incidence of 1:66 775 relative to live births and 1:84 226 to viable pregnancies. For women aged under 20, the incidence relative to viable pregnancies was 1:223 494, for ages 30-34, 1:80 227, and for ages 40-45, 1:41 718. Treatment outcomes indicated an overall 94.4% cure rate. Divided by FIGO prognostic groups, the cure rates were low-risk group 100%, high-risk group 96% and ultra-high-risk group 80.5%. CONCLUSIONS: Non-molar gestational choriocarcinoma is a very rare diagnosis with little prior detailed information on the demographics and natural history. The data in this study give age-related incidence data based on a large national population study. The results also demonstrated the widely varying natural history of this rare malignancy and the marked correlation of disease incidence with rising maternal age. TWEETABLE ABSTRACT: National gestational choriocarcinoma database indicates a close association between increasing maternal age and incidence.


Asunto(s)
Coriocarcinoma/epidemiología , Neoplasias Uterinas/epidemiología , Adolescente , Adulto , Distribución por Edad , Coriocarcinoma/complicaciones , Coriocarcinoma/secundario , Coriocarcinoma/terapia , Femenino , Número de Embarazos , Humanos , Incidencia , Nacimiento Vivo/epidemiología , Edad Materna , Persona de Mediana Edad , Embarazo , Complicaciones Neoplásicas del Embarazo/epidemiología , Complicaciones Neoplásicas del Embarazo/patología , Complicaciones Neoplásicas del Embarazo/terapia , Pronóstico , Factores de Riesgo , Resultado del Tratamiento , Reino Unido/epidemiología , Hemorragia Uterina/etiología , Neoplasias Uterinas/complicaciones , Neoplasias Uterinas/patología , Neoplasias Uterinas/terapia , Adulto Joven
3.
J Appl Microbiol ; 127(1): 109-120, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31067345

RESUMEN

AIMS: To determine how the microbicide ceragenin-13 (CSA-13) kills Bacillus subtilis spores prepared on growth or sporulation media, and these spores' properties. METHODS AND RESULTS: Spores made on Luria broth (LB) growth or double-strength Schaeffer's-glucose (2xSG) sporulation plates found that spores made on LB plates have coat defects as evidenced by their lower hypochlorite resistance, faster germination with dodecylamine and slower germination with Ca2+ -dipicolinic acid (CaDPA) than 2xSG plate spores. CSA-13 triggered CaDPA release from spores, an early step in germination, but only well at 70°C and better with spores made on LB than on 2xSG plates. Approximately 90% of spores with elevated levels of SpoVA proteins that form a CaDPA release channel, released CaDPA with CSA-13 at 70°C, and faster with spores made on LB than 2xSG plates. Levels of CSA-13 killing of spores made on LB and 2xSG plates were similar to levels of CaDPA release triggered by this agent. CONCLUSIONS: CSA-13 kills bacterial spores, but only at high concentrations and temperatures, and is preceded by CaDPA release. SIGNIFICANCE AND IMPACT OF THE STUDY: CSA-13 is not a direct sporicide as reported previously, but most likely germinates spores via activation of spores' CaDPA channel, albeit inefficiently, and then killing the germinated spores.


Asunto(s)
Antiinfecciosos/farmacología , Bacillus subtilis/efectos de los fármacos , Medios de Cultivo/química , Medios de Cultivo/farmacología , Esporas Bacterianas/efectos de los fármacos , Esporas Bacterianas/crecimiento & desarrollo , Esteroides/farmacología , Aminas , Ácidos Picolínicos/metabolismo , Esporas Bacterianas/metabolismo
4.
J Fish Dis ; 40(6): 757-771, 2017 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-27716959

RESUMEN

A microsporidian species with 98.3-98.4% nucleotide identity to Tetramicra brevifilum (Journal of Fish Diseases, 3, 1980, 495) was diagnosed in lumpfish (Cyclopterus lumpus, L.) broodstock held at a breeding and rearing facility in western Ireland. The fish were wild-caught from the west coast of Ireland, and the first case was diagnosed one year after capture. Clinical signs included severe bloating, lethargy, exophthalmos, anorexia, white patches on the cornea and externally visible parasitic cysts on skin and fins. Necropsy revealed severe ascites, white nodules and vacuoles in all the internal organs and partial liquefaction of the skeletal muscle. On histological examination, microsporidian xenomas were observed in all internal organs, the skin, skeletal muscle, gills and the eyes. The microsporidian species was identified by molecular analysis and transmission electron microscopy. This is the first record of T. brevifilum infecting lumpfish, and the disease is considered to be of potential significance to the rising aquaculture industry of this species.


Asunto(s)
Enfermedades de los Peces/microbiología , Microsporidios/aislamiento & purificación , Microsporidiosis/veterinaria , Perciformes , Animales , Acuicultura , ADN de Hongos/genética , Enfermedades de los Peces/patología , Irlanda , Microscopía Electrónica de Transmisión , Microsporidios/genética , Microsporidios/ultraestructura , Microsporidiosis/mortalidad , Microsporidiosis/patología , Análisis de Secuencia de ADN
5.
BJOG ; 123(8): 1330-5, 2016 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-26444183

RESUMEN

OBJECTIVE: To re-evaluate the safety of hormonal contraceptives (HC) after uterine evacuation of complete hydatidiform mole (CHM). DESIGN: Historical database review. SETTING: Charing Cross Hospital Gestational Trophoblastic Disease Centre, London, United Kingdom. POPULATION: Two thousand four hundred and twenty-three women with CHM of whom 154 commenced HC while their human chorionic gonadotropin (hCG) was still elevated, followed between 2003 and 2012. METHODS: We compared time to hCG remission between HC users and nonusers. The relationship between HC use and gestational trophoblastic neoplasia (GTN) development was assessed. The relationship between HC use and a high International Federation of Gynecology and Obstetrics (FIGO) risk score was determined. MAIN OUTCOME MEASURES: Time to hCG remission, risk of developing postmolar GTN and proportion of women with high FIGO risk score. RESULTS: No relationship was observed between HC use with mean time to hCG remission (HC users versus non-users: 12 weeks in both, P = 0.19), GTN development (HC users versus non-users: 20.1 and 16.7%, P = 0.26) or high-risk FIGO score (HC users versus nonusers: 0% and 8%, P = 0.15). Moreover, no association between HC and GTN development was found, even when an age-adjusted model was used (OR = 1.37, 95% CI 0.91-2.08, P = 0.13). CONCLUSIONS: The use of current HC is not associated with development of postmolar GTN or delayed time to hCG remission. Therefore, HC can be safely used to prevent a new conception following CHM regardless of hCG level. TWEETABLE ABSTRACT: Non-concurrent cohort study to re-evaluate the safety of low dose HCs after uterine evacuation of CHM.


Asunto(s)
Anticonceptivos Hormonales Orales/uso terapéutico , Enfermedad Trofoblástica Gestacional/epidemiología , Mola Hidatiforme/cirugía , Neoplasias Uterinas/cirugía , Adolescente , Adulto , Gonadotropina Coriónica/sangre , Bases de Datos Factuales , Femenino , Humanos , Mola Hidatiforme/sangre , Persona de Mediana Edad , Oportunidad Relativa , Embarazo , Estudios Retrospectivos , Factores de Riesgo , Reino Unido/epidemiología , Neoplasias Uterinas/sangre , Adulto Joven
6.
BJOG ; 123(7): 1175-81, 2016 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-26774079

RESUMEN

OBJECTIVE: To determine the outcome of women with persistently raised but falling human chorionic gonadotrophin (hCG) levels 6 months after surgical evacuation of a molar pregnancy. DESIGN: An 11-year retrospective review. SETTING: The United Kingdom supra-regional trophoblastic disease treatment centres at Weston Park Hospital (Sheffield) and Charing Cross Hospital (London). POPULATION: Women with raised but falling serum human chorionic gonadotrophin (hCG) levels 6 months after evacuation of a molar pregnancy. METHODS: Retrospective case note review of eligible women identified by the electronic databases held at each supra-regional centre. MAIN OUTCOME MEASURES: The proportion of women that attain normal hCG levels spontaneously without chemotherapy. In addition, rates of gestational trophoblastic neoplasia (GTN), drug resistance, disease relapse and overall survival are reported. RESULTS: Thirty-five women with molar pregnancy and raised but falling serum hCG levels continued surveillance 6 months after evacuation. Levels of hCG in 30 of the patients (86%) fell to normal levels spontaneously. One woman defaulted follow up prior to hCG normalisation (3%) and the remaining four women (11%) were treated with chemotherapy due to a plateau or rise in serum hCG levels indicating GTN. All treated women were successfully salvaged by either first (n = 1) or second line (n = 2) chemotherapy or found to have persistently raised low level hCG of uncertain clinical relevance (n = 1). No women developed relapsed disease and overall survival was 100%. CONCLUSIONS: Women with a molar pregnancy and a raised but falling hCG level beyond 6 months from uterine evacuation can be safely observed with regular hCG monitoring and can usually avoid potentially toxic chemotherapy. TWEETABLE ABSTRACT: Women with treated molar pregnancy may avoid chemotherapy if 6-month hCG levels are raised but falling.


Asunto(s)
Mola Hidatiforme/cirugía , Neoplasias Uterinas/cirugía , Adulto , Antineoplásicos/uso terapéutico , Gonadotropina Coriónica/metabolismo , Femenino , Humanos , Mola Hidatiforme/tratamiento farmacológico , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Regresión Neoplásica Espontánea , Embarazo , Terapia Recuperativa/métodos , Neoplasias Uterinas/tratamiento farmacológico , Adulto Joven
7.
Curr Oncol ; 23(6): e626-e629, 2016 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-28050153

RESUMEN

INTRODUCTION: The years since 2005 have seen major changes in cancer treatment and significant increases in the number of anticancer drugs available. However, there are relatively few published data to reflect how those changes are affecting the activity and workload of oncology services. To explore the effects of those changes, we reviewed the population-based cancer treatment activity on Vancouver Island for the period 2010-2015. METHODS: Information about new patient referrals, radiation courses, new chemotherapy cycles commenced, total intravenous (IV) chemotherapy treatment visits, and pharmacy activity for oral anticancer drug prescriptions was obtained from BC Cancer Agency databases. RESULTS: During the 5-year study period, the Vancouver Island population increased by 2.8% and the number of new referrals to the BC Cancer Agency increased by 17.7%. The overall number of radiation courses increased by 6.1%. In contrast, IV chemotherapy activity increased by 52.1% for new courses commenced and by 62% for total IV chemotherapy attendances. Oral anticancer drug prescriptions rose by 22.9% during the 5-year period. CONCLUSIONS: Our study documents substantial recent increases in cancer therapy activity in terms of patient referrals and particularly IV chemotherapy and oral anticancer therapy. The data reported here could be of value in planning for future care provision.

8.
Br J Cancer ; 112(6): 1037-41, 2015 Mar 17.
Artículo en Inglés | MEDLINE | ID: mdl-25668005

RESUMEN

BACKGROUND: Over the past 20 years, the mechanisms of action, duration of benefits and economic costs of newly licenced cancer drugs have changed significantly; however, summary data on these characteristics are limited. METHODS: In this study, using historical copies of the British National Formulary and relevant contemporary publications, we have documented for each new cancer drug the year of introduction, therapeutic classification, initial indication, median duration of treatment and the cost of treatment at introduction relative to the then current UK GDP per capita. RESULTS: Before 2000, there were 69 cancer treatment drugs available, of which 50 (72.5%) were classical cytotoxic drugs. In the subsequent 15 years, there have been 63 more new cancer treatment drugs added, including 20 kinase inhibitors and 11 monoclonal antibodies. The average median duration of treatment with a new drug has risen from 181 days in 1995-1999 to 263 days in 2010-2014. The average cost of treatment has also risen from £3036.91 (20.6% of UK per capita GDP) in 1995-1999 to £20 233 (89.0%) in 2005-2009 and now to £35 383 (141.7%) in 2010-2014. CONCLUSIONS: The last 5 years has seen 33 new cancer drugs. These drugs deliver significant benefits in patient outcomes and are taken for increasing lengths of time. Alongside these clinical benefits, the direct costs of new treatments have increased significantly over the past decade.


Asunto(s)
Antineoplásicos/economía , Antineoplásicos/uso terapéutico , Neoplasias/tratamiento farmacológico , Neoplasias/economía , Análisis Costo-Beneficio , Costos de los Medicamentos/tendencias , Humanos , Reino Unido
9.
Hum Reprod ; 30(9): 2055-63, 2015 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-26202916

RESUMEN

STUDY QUESTION: What is the risk of further molar pregnancies for women with one or more hydatidiform moles (HM) in relation to molar subtype. SUMMARY ANSWER: Women with a complete hydatidiform mole (CM) have a 1 in 100 and 1 in 4 risk of further CM after one or two consecutive CM, respectively, while women with a partial hydatidiform mole (PM) have only a small increase in risk for further molar pregnancies. WHAT IS KNOWN ALREADY: Women with a molar pregnancy have an increased risk of further HM. A small subgroup of women with recurrent HM has an autosomal recessive condition, familial recurrent hydatidiform moles (FRHM), that predisposes them to molar pregnancies. STUDY DESIGN, SIZE, DURATION: A retrospective study of subsequent pregnancies in 16 000 women registered at a centralized referral centre, with a CM or PM, between 1990 and 2009. PARTICIPANTS/MATERIALS, SETTING, METHODS: One hundred and sixty-six women with two or more molar pregnancies were identified from electronic records and patient notes. Histopathological features of all molar tissue were reviewed in these cases and genotyping performed where diagnosis was not possible on the basis of histopathological features alone. In addition, genotyping of molar tissue was performed in all cases of women with three or more CM to establish whether the tissue was diploid and biparental or androgenetic. MAIN RESULTS AND THE ROLE OF CHANCE: This study confirms an increased recurrence risk of ∼1% for a second molar pregnancy and in addition that this risk is associated with CM rather than PM. The data further indicate that the risk of a third HM is associated almost exclusively with CM and enabled an estimate that 1 in 640 women registered with a CM has the rare condition FRHM. The study also found that there was no significant difference between the risk of developing gestational trophoblastic neoplasia (GTN) for typical sporadic CM and the diploid biparental CM associated with FRHM (GTN; proportion difference 0.05, Z = 0.87, P = 0.29). LIMITATIONS, REASONS FOR CAUTION: While pathology was reviewed for all women with two or more molar pregnancies, not all cases registered underwent central review particularly those women registered in the early 1990s. It is therefore possible that the total number of CM and PM may differ slightly from that stated. While women were followed for a minimum of 5 years, it is possible that some women may subsequently have further molar pregnancies that will not have been included in the present study. WIDER IMPLICATIONS OF THE FINDINGS: This is the largest study to date on recurrence for molar pregnancies, and as such provides the most detailed information so far regarding the risk of further molar pregnancies for women with a PM or CM. Furthermore, the data provide new insights into the incidence of the rare autosomal recessive condition, FRHM, important information for counselling women with molar pregnancies. STUDY FUNDING/COMPETING INTERESTS: No competing interests declared. No funding was obtained for this study.


Asunto(s)
Mola Hidatiforme/epidemiología , Recurrencia Local de Neoplasia/epidemiología , Neoplasias Uterinas/epidemiología , Adolescente , Adulto , Femenino , Humanos , Mola Hidatiforme/genética , Londres/epidemiología , Persona de Mediana Edad , Recurrencia Local de Neoplasia/genética , Embarazo , Estudios Retrospectivos , Riesgo , Neoplasias Uterinas/genética , Adulto Joven
10.
Gynecol Oncol ; 136(2): 258-63, 2015 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-25542400

RESUMEN

OBJECTIVE: To determine whether single agent chemotherapy with intramuscular methotrexate 50mg administered on days 1, 3, 5, and 7 and oral folinic acid 15mg administered on days 2, 4, 6, and 8 in 2 weekly cycles (IM MTX/FA) is an effective treatment regimen for patients with low risk gestational choriocarcinoma. METHOD: Electronic databases were searched to identify patients with gestational choriocarcinoma at the Sheffield and Charing Cross supra-regional trophoblastic disease centres from January 2000 to December 2011. Clinical notes of low risk patients with FIGO score 0-6 were retrospectively reviewed to assess treatment outcomes and subsequent relapse. RESULTS: 65 patients were identified with low risk choriocarcinoma. Serum hCG levels normalised in 24 patients without the requirement of chemotherapy (19 with histological confirmation, 4 highly suspicious histology and 1 clinical diagnosis). Of 23 patients with histologically confirmed choriocarcinoma, 8 (35%) had a sustained complete response to IM MTX/FA and did not relapse. Both patients with FIGO score 6, and 1 patient with FIGO stage III metastatic disease developed resistance to IM MTX/FA and required further treatment. Despite the development of drug resistance or relapse all patients were successfully salvaged by subsequent treatments. CONCLUSIONS: Not all patients with low risk choriocarcinoma that have had primary intervention prior to staging, such as surgical resection or uterine evacuation will require chemotherapy, providing hCG levels continue to decline to normal. Low risk (FIGO 0-5) patients should initially receive IM MTX/FA due to its low toxicity, outpatient administration and reasonable efficacy. Patients with FIGO score 6 or FIGO stage III disease should make an informed choice between IM MTX/FA and combination chemotherapy.


Asunto(s)
Antimetabolitos Antineoplásicos/uso terapéutico , Coriocarcinoma/tratamiento farmacológico , Enfermedad Trofoblástica Gestacional/tratamiento farmacológico , Metotrexato/uso terapéutico , Adulto , Coriocarcinoma/sangre , Gonadotropina Coriónica/sangre , Femenino , Enfermedad Trofoblástica Gestacional/sangre , Humanos , Embarazo , Estudios Retrospectivos , Factores de Riesgo , Reino Unido
11.
Curr Oncol ; 22(1): e27-37, 2015 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-25684994

RESUMEN

BACKGROUND: This evidence-based practice guideline was developed to update and address new issues in the handling of cytotoxics, including the use of oral cytotoxics; the selection and use of personal protective equipment; and treatment in diverse settings, including the home setting. METHODS: The guideline was developed primarily from an adaptation and endorsement of an existing guideline and from three systematic reviews. Before publication, the guideline underwent a series of peer and external reviews to gather feedback. All comments were addressed, and the guideline was amended when required. The guideline applies to health care workers who could come into contact with cytotoxic drugs at any point in the medication circuit. The intended users are hospital administrators, educators, and managers; occupational health and safety services; and pharmacy and health care workers. RESULTS: The recommendations represent a reasonable and practical set of procedures that the intended users of this guideline should implement to minimize opportunities for accidental exposure. They are not limited to just the point of care; they cover the entire chain of cytotoxics handling from the time such agents enter the institution until they leave in the patient or as waste. CONCLUSIONS: Reducing the likelihood of accidental exposure to cytotoxic agents within the medication circuit is the main objective of this evidenced-based guideline. The recommendations differ slightly from earlier guidelines because of the availability of new evidence.

12.
Br J Cancer ; 108(9): 1810-6, 2013 May 14.
Artículo en Inglés | MEDLINE | ID: mdl-23591194

RESUMEN

BACKGROUND: In low-risk gestational trophoblastic neoplasia (GTN) patients, a predictive marker for early identification of methotrexate (MTX) resistance would be useful. We previously demonstrated that kinetic modelling of human chorionic gonadotrophin (hCG) measurements could provide such a marker. Here we validate this approach in a large independent patient cohort. METHODS: Serum hCG measurements of 800 low-risk GTN patients treated with MTX were analysed. The cohort was divided into Model and Test data sets. hCG kinetics were described from initial treatment day to day 50 using: '(hCG(time))=hCG0*exp(-k*time)+hCGres', where hCGres is the modelled residual production, hCG0 is the baseline hCG level, and k is the rate constant. HCGres-predictive value was investigated against previously reported predictors of MTX resistance. RESULTS: Declining hCG measurements were well fitted by the model. The best discriminator of MTX resistance in the Model data set was hCGres, categorised by an optimal cut-off value of >20.44 IU l(-1): receiver-operating characteristic (ROC) area under the curve (AUC)=0.87; Se=0.91; Sp=0.83. The predictive value of hCGres was reproducible using the Test data set: ROC AUC=0.87; Se=0.88; Sp=0.86. Multivariate analyses revealed hCGres as a better predictor of MTX resistance (HR=1.01, P<0.0001) and MTX failure-free survival (HR=13.25, P<0.0001) than other reported predictive factors. CONCLUSION: hCGres, a modelled kinetic parameter calculated after fully dosed three MTX cycles, has a reproducible value for identifying patients with MTX resistance.


Asunto(s)
Antimetabolitos Antineoplásicos/uso terapéutico , Gonadotropina Coriónica/sangre , Resistencia a Antineoplásicos , Enfermedad Trofoblástica Gestacional/tratamiento farmacológico , Metotrexato/uso terapéutico , Adulto , Biomarcadores de Tumor , Femenino , Humanos , Análisis Multivariante , Embarazo , Curva ROC , Insuficiencia del Tratamiento
13.
BJOG ; 120(8): 1012-5, 2013 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-23759086

RESUMEN

OBJECTIVE: The Uterine Artery Pulsatility Index (UAPI) is an ultrasound measure of tumour vascularity. In this study, we hypothesised that a UAPI ≤ 1 (high vascularity) would identify women with gestational trophoblastic neoplasia (GTN) at increased risk of resistance to first-line single-agent methotrexate (MTX-R). DESIGN: Single-centre cohort study. SETTING: Charing Cross Hospital, a UK national centre for the treatment of trophoblastic disease. POPULATION: All women with a GTN FIGO score 5-6 treated with methotrexate (n = 92), between 1999 and 2011, at Charing Cross Hospital. METHODS: UAPI was measured before the start of chemotherapy, and women were monitored for the development of MTX-R. MAIN OUTCOME MEASURES: Frequency of MTX-R in women with UAPI ≤ 1 compared with UAPI >1. RESULTS: UAPI was measured before chemotherapy in 73 of 92 women with GTN FIGO score 5-6. UAPI ≤ 1 predicted MTX-R independent of the FIGO score (hazard ratio 2.9, P = 0.04), with an absolute risk of MTX-R in women with a UAPI ≤ 1 of 67% (95% CI 53-79%) compared with 42% (95% CI 24-61%) with a UAPI >1 (P = 0.036). CONCLUSION: Our results suggest UAPI is an independent predictor of MTX-R in women with FIGO 5-6 GTN.


Asunto(s)
Resistencia a Antineoplásicos/fisiología , Enfermedad Trofoblástica Gestacional/tratamiento farmacológico , Metotrexato/uso terapéutico , Arteria Uterina/fisiopatología , Neoplasias Uterinas/tratamiento farmacológico , Estudios de Cohortes , Femenino , Enfermedad Trofoblástica Gestacional/fisiopatología , Humanos , Metotrexato/efectos adversos , Embarazo , Medición de Riesgo , Reino Unido , Neoplasias Uterinas/fisiopatología
14.
J Obstet Gynaecol ; 33(4): 406-11, 2013 May.
Artículo en Inglés | MEDLINE | ID: mdl-23654327

RESUMEN

The national registration and treatment service for molar pregnancies in the UK allows for the collection of accurate data on this relatively rare diagnosis. In England and Wales, between 2000 and 2009, 5,793 patients with complete moles and 7,790 with partial moles were registered, compared with a total of 8,242,511 conceptions. The overall molar pregnancy incidence was 1 for every 607 conceptions (complete mole 1:1,423; partial mole 1:1,058), but with major variations with age. For complete moles, the risk varied from < 1:1,000 for ages 18-40, to 1:156 for women aged 45 and 1:8 for those aged 50 and above. The overall risk of requiring chemotherapy after a complete mole was 13.6% and 1.1% for partial mole, while the risk of a further molar pregnancy in the next conception was 1:68 but each of these figures have considerable variations with age. These modern statistics on molar pregnancy risks and outcomes should be of value to clinicians and their patients, while discussing this rare diagnosis.


Asunto(s)
Mola Hidatiforme/epidemiología , Edad Materna , Sistema de Registros , Neoplasias Uterinas/epidemiología , Femenino , Humanos , Mola Hidatiforme/tratamiento farmacológico , Incidencia , Embarazo , Resultado del Embarazo , Medición de Riesgo , Reino Unido/epidemiología , Neoplasias Uterinas/tratamiento farmacológico
15.
Br J Cancer ; 107(11): 1810-4, 2012 Nov 20.
Artículo en Inglés | MEDLINE | ID: mdl-23059744

RESUMEN

BACKGROUND: Post-molar pregnancy gestational trophoblastic tumours (GTT) have been curable with chemotherapy treatment for over 50 years. Because of the rarity of the diagnosis, detailed structured information on prognosis, treatment escalations and outcome is limited. METHODS: We have reviewed the demographics, prognostic variables, treatment course and clinical outcomes for the post-mole GTT patients treated at Charing Cross Hospital between 2000 and 2009. RESULTS: Of the 618 women studied, 547 had a diagnosis of complete mole, 13 complete mole with a twin conception and 58 partial moles. At the commencement of treatment, 94% of patients were in the FIGO low-risk group (score 0-6). For patients treated with single-agent methotrexate, the primary cure rate ranged from 75% for a FIGO score of 0-1 through to 31% for those with a FIGO score of 6. CONCLUSION: In the setting of a formal follow-up programme, the expected cure rate for GTT after a molar pregnancy should be 100%. Prompt treatment and diagnosis should limit the exposure of most patients to combination chemotherapy. Because of the post-treatment relapse rate of 3% post-chemotherapy, hCG monitoring should be performed routinely.


Asunto(s)
Enfermedad Trofoblástica Gestacional/tratamiento farmacológico , Mola Hidatiforme/complicaciones , Adulto , Gonadotropina Coriónica/sangre , Femenino , Humanos , Leucovorina/uso terapéutico , Metotrexato/uso terapéutico , Embarazo , Pronóstico , Estudios Retrospectivos , Resultado del Tratamiento
16.
Br J Cancer ; 106(6): 1089-94, 2012 Mar 13.
Artículo en Inglés | MEDLINE | ID: mdl-22374461

RESUMEN

BACKGROUND: Neo-angiogenesis is a hallmark of cancer. The aim of this study was to test the hypothesis, in a prospective patient cohort, that in low-risk gestational trophoblastic neoplasia (LR-GTN) the uterine artery pulsatility index (UAPI), a measure of tumour vascularity, can predict resistance to methotrexate chemotherapy (MTX-R). METHODS: 286 LR-GTN patients (Charing Cross Hospital (CXH) score 0-8, or FIGO score 0-6) were treated with methotrexate between January 2008 and June 2011 at CXH. During staging investigations, patients underwent a Doppler ultrasound to assess the UAPI. RESULTS: 239 patients were assessable for both UAPI and MTX-R. The median UAPI was lower (higher vascularity) in MTX-R compared with MTX-sensitive patients (0.8 vs 1.4, P<0.0001). In multivariate logistic regression, UAPI≤1 predicted MTX-R, independent of both CXH and FIGO scores. The risk of MTX-R in patients with a FIGO score of 6 and UAPI≤1 was 100% vs 20% in patients with UAPI>1 (χ(2) P<0.0001). CONCLUSION: UAPI represents an independently validated clinically useful predictor of MTX-R in LR-GTN. Further, consideration of whether to incorporate UAPI into the FIGO scoring system is now warranted so that patients with a score of 6 and a UAPI ≤1 might be upstaged and offered combination chemotherapy rather than MTX.


Asunto(s)
Antimetabolitos Antineoplásicos/farmacología , Resistencia a Antineoplásicos , Enfermedad Trofoblástica Gestacional/irrigación sanguínea , Metotrexato/farmacología , Flujo Pulsátil , Arteria Uterina/fisiopatología , Adulto , Antimetabolitos Antineoplásicos/uso terapéutico , Velocidad del Flujo Sanguíneo , Femenino , Enfermedad Trofoblástica Gestacional/tratamiento farmacológico , Humanos , Modelos Logísticos , Metotrexato/uso terapéutico , Análisis Multivariante , Embarazo , Factores de Riesgo , Estadísticas no Paramétricas
17.
Gynecol Oncol ; 125(3): 576-9, 2012 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-22410329

RESUMEN

OBJECTIVE: Methotrexate (MTX) alternating with folinic acid is a commonly used treatment regimen for low-risk gestational trophoblastic neoplasia (GTN). In The Netherlands, two courses of MTX are administered after normalization of serum human chorionic gonadotrophin (hCG) levels (consolidation courses), whereas in the United Kingdom, three consolidation courses are given. In a retrospective setting we compared relapse rates of women completing MTX therapy for low-risk GTN in The Netherlands and the UK. METHODS: From 1980 to 2008, 351 patients were collected from the Dutch Central Registry for Hydatidiform Moles and records from the Dutch Working Party on Trophoblastic Disease. From the Charing Cross Hospital Trophoblast Disease Centre (London), 600 low-risk GTN patients were identified from 1992 to 2008. RESULTS: In 4.0% of patients relapse occurred after MTX treatment with three consolidation courses, whereas 8.3% of patients relapsed after MTX treatment with two consolidation courses (p=0.006). Although patients from The Netherlands had a higher level of hCG (p<0.001) and more patients had metastases before the start of treatment (p=0.012), the number of courses of MTX to achieve a normal hCG did not differ significantly between patients from The Netherlands and the UK (p=0.375). CONCLUSIONS: Relapse rates were higher in patients treated with two consolidation courses of MTX. Although other factors might have influenced the observed difference in relapse rates, three courses of consolidation chemotherapy may be preferable to two in the treatment of low-risk GTN in order to decrease the risk of disease relapse. A prospective randomized study would be required to confirm these findings.


Asunto(s)
Antimetabolitos Antineoplásicos/uso terapéutico , Enfermedad Trofoblástica Gestacional/tratamiento farmacológico , Metotrexato/uso terapéutico , Adolescente , Adulto , Gonadotropina Coriónica/sangre , Femenino , Enfermedad Trofoblástica Gestacional/sangre , Humanos , Mola Hidatiforme/sangre , Mola Hidatiforme/tratamiento farmacológico , Persona de Mediana Edad , Embarazo , Recurrencia , Estudios Retrospectivos , Factores de Riesgo , Resultado del Tratamiento , Adulto Joven
18.
J Appl Microbiol ; 112(6): 1173-83, 2012 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-22469097

RESUMEN

AIMS: CSA-13 is an antimicrobial cationic steroid with some toxicity against eukaryotic cells. The purpose of this work was to test whether pluronic acid F-127 could interfere with the toxicity of CSA-13 on human umbilical vein endothelial (HUVEC) without modifying its bactericidal activity against Pseudomonas aeruginosa. METHODS AND RESULTS: The addition of pluronic acid F-127 slightly decreased the number of dead cells after exposure to CSA-13. Pluronic acid F-127 blocked the permeabilizing effect of CSA-13 on the plasma membrane of HUVEC (uptake of ethidium bromide, release of lactate dehydrogenase) without modifying its toxic effect on their mitochondrial function (MTT test, uptake of tetramethyl rhodamine ethyl ester). CONCLUSION: Pluronic acid F-127 decreased the toxicity of CSA-13 against eukaryotic cells without completely protecting them from mitochondrial damage at high concentrations of the drug. SIGNIFICANCE AND IMPACT OF THE STUDY: This work establishes that studies on the toxic effects of synthetic antimicrobials on eukaryotic cells should not only focus on the permeability of the plasma membrane but also on the integrity of the mitochondria.


Asunto(s)
Antibacterianos/farmacología , Células Eucariotas/efectos de los fármacos , Poloxámero/farmacología , Pseudomonas aeruginosa/efectos de los fármacos , Esteroides/farmacología , Antibacterianos/efectos adversos , Etidio/metabolismo , Células Endoteliales de la Vena Umbilical Humana , Humanos , L-Lactato Deshidrogenasa/metabolismo , Viabilidad Microbiana/efectos de los fármacos , Mitocondrias/efectos de los fármacos , Poloxámero/efectos adversos , Esteroides/efectos adversos
19.
J Fish Dis ; 35(8): 579-90, 2012 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-22724390

RESUMEN

The development and the application of a quantitative real-time PCR for the detection of Tenacibaculum maritimum are described. A set of primers and probe was designed to amplify a 155-bp fragment specific to the T. maritimum 16S rRNA gene. The test was shown to be very sensitive, able to detect as little as 4.8 DNA copies number µL(-1) . In addition, the assay was found to have a high degree of repeatability and reproducibility, with a linear dynamic range (R(2) = 0.999) extending over 6 log(10) dilutions and a high efficiency (100%). The assay was applied to DNA samples extracted from 48 formalin-fixed paraffin-embedded (FFPE) Atlantic salmon, Salmo salar, gill tissues showing varying degrees of gill pathology (scored 0-3) and from 26 jellyfish samples belonging to the species Phialella quadrata and Muggiaea atlantica. For each sample, the bacterial load was normalised against the level of the salmonid elongation factor alpha 1 (ELF) detected by a second real-time PCR using previously published primers and probe. Tenacibaculum maritimum DNA was detected in 89% of the blocks with no signs of gill disease as well as in 95% of the blocks with mild-to-severe gill pathology. Association between bacterial load and gill pathology severity was investigated. T. maritimum DNA was detected at low level in four of the 26 jellyfish tested.


Asunto(s)
Enfermedades de los Peces/diagnóstico , Infecciones por Flavobacteriaceae/veterinaria , Escifozoos/microbiología , Tenacibaculum/genética , Animales , Carga Bacteriana , Monitoreo del Ambiente , Enfermedades de los Peces/microbiología , Enfermedades de los Peces/patología , Infecciones por Flavobacteriaceae/diagnóstico , Infecciones por Flavobacteriaceae/microbiología , Infecciones por Flavobacteriaceae/patología , Branquias/microbiología , Branquias/patología , ARN Ribosómico 16S/genética , Reacción en Cadena en Tiempo Real de la Polimerasa , Reproducibilidad de los Resultados , Salmo salar
20.
Clin Exp Immunol ; 166(1): 121-33, 2011 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-21910729

RESUMEN

Because invariant natural killer T (iNK T) cells link innate and adaptive immunity, the structure-dependent design of iNK T cell agonists may have therapeutic value as vaccines for many indications, including autoimmune disease. Previously, we showed that treatment of non-obese diabetic (NOD) mice with the iNK T cell activating prototypic glycolipid α-galactosylceramide (α-GalCer) protects them from type 1 diabetes (T1D). However, α-GalCer is a strong agonist that can hyperactivate iNK T cells, elicit several side effects and has shown only limited success in clinical trials. Here, we used a structure-guided design approach to identify an iNK T cell agonist that optimally protects from T1D with minimal side effects. Analyses of the kinetics and function of a panel of synthetic α-GalCer fatty acyl chain derivatives (C8:0-C16:0) were performed in NOD mice. C16:0 elicited the highest protection from insulitis and T1D, which was associated with a higher frequency and survival of iNK T cells and enhanced activity of tolerogenic dendritic cells (DCs) in draining pancreatic lymph nodes (PLN), inability to transactivate NK cells and a more rapid kinetics of induction and recovery of iNK T cells from anergy. We conclude that the length and structure of the acyl chain of α-GalCer regulates the level of protection against T1D in mice, and propose that the extent of this protection depends on the relative capacity of the acyl chain to accommodate an endogenous spacer lipid of appropriate length and structure. Thus, our findings with the α-GalCer C16:0 derivative suggest strongly that it be considered as a lead glycolipid candidate in clinical trials of T1D.


Asunto(s)
Diabetes Mellitus Tipo 1/prevención & control , Diseño de Fármacos , Galactosilceramidas , Activación de Linfocitos/efectos de los fármacos , Terapia Molecular Dirigida/métodos , Células T Asesinas Naturales/efectos de los fármacos , Páncreas/efectos de los fármacos , Animales , Citocinas/análisis , Citocinas/biosíntesis , Células Dendríticas/efectos de los fármacos , Células Dendríticas/inmunología , Células Dendríticas/metabolismo , Diabetes Mellitus Tipo 1/inmunología , Diabetes Mellitus Tipo 1/metabolismo , Femenino , Citometría de Flujo , Galactosilceramidas/química , Galactosilceramidas/inmunología , Galactosilceramidas/farmacología , Inmunización , Inyecciones Intraperitoneales , Ganglios Linfáticos/efectos de los fármacos , Ganglios Linfáticos/inmunología , Activación de Linfocitos/inmunología , Ratones , Ratones Endogámicos BALB C , Ratones Endogámicos C57BL , Ratones Endogámicos NOD , Células T Asesinas Naturales/inmunología , Células T Asesinas Naturales/metabolismo , Páncreas/inmunología , Relación Estructura-Actividad Cuantitativa
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