Fertility-Preserving Treatments and Patient- and Parental Satisfaction on Fertility Counseling in a Cohort of Newly Diagnosed Boys and Girls with Childhood Hodgkin Lymphoma

Purpose: The purpose of this study is to evaluate the use of fertility-preserving (FP) treatments and fertility counseling that was offered in a cohort of newly diagnosed children with classical Hodgkin lymphoma (cHL). Methods: In this observational study, boys and girls with cHL aged ≤ 18 years with scheduled treatment according to the EuroNet-PHL-C2 protocol were recruited from 18 sites (5 countries), between January 2017 and September 2021. In 2023, a subset of Dutch participants (aged ≥ 12 years at time of diagnosis) and parents/guardians were surveyed regarding fertility counseling. Results: A total of 101 boys and 104 girls were included. Most post-pubertal boys opted for semen cryopreservation pre-treatment (85% of expected). Invasive FP treatments were occasionally chosen for patients at a relatively low risk of fertility based on scheduled alkylating agent exposure (4/5 testicular biopsy, 4/4 oocyte, and 11/11 ovarian tissue cryopreservation). A total of 17 post-menarchal girls (20%) received GnRH-analogue co-treatment. Furthermore, 33/84 parents and 26/63 patients responded to the questionnaire. Most reported receiving fertility counseling (97%/89%). Statements regarding the timing and content of counseling were generally positive. Parents and patients considered fertility counseling important (94%/87% (strongly agreed) and most expressed concerns about (their child’s) fertility (at diagnosis 69%/46%, at present: 59%/42%). Conclusion: Systematic fertility counseling is crucial for all pediatric cHL patients and their families. FP treatment should be considered depending on the anticipated risk and patient factors. We encourage the development of a decision aid for FP in pediatric oncology.</p

The influence of TAP1 and TAP2 gene polymorphisms on TAP function and its inhibition by viral immune evasion proteins

Herpesviruses encode numerous immune evasion molecules that interfere with the immune system, particularly with certain stages in the MHC class I antigen presentation pathway. In this pathway, the transporter associated with antigen processing (TAP) is a frequent target of viral immune evasion strategies. This ER-resident transporter is composed of the proteins TAP1 and TAP2, and plays a crucial role in the loading of viral peptides onto MHC class I molecules. Several variants of TAP1 and TAP2 occur in the human population, some of which are linked to autoimmune disorders and susceptibility to infections. Here, we assessed the influence of naturally occurring TAP variants on peptide transport and MHC class I expression. In addition, we tested the inhibitory capacity of three viral immune evasion proteins, the TAP inhibitors US6 from human cytomegalovirus, ICP47 from herpes simplex virus type 1 and BNLF2a from Epstein-Barr virus, for a series of TAP1 and TAP2 variants. Our results suggest that these TAP polymorphisms have no or limited effect on peptide transport or MHC class I expression. Furthermore, our study indicates that the herpesvirus-encoded TAP inhibitors target a broad spectrum of TAP variants; inhibition of TAP is not affected by the naturally occurring polymorphisms of TAP tested in this study. Our findings suggest that the long-term coevolution of herpesviruses and their host did not result in selection of inhibitor-resistant TAP variants in the human population

Oncofertility care for newly diagnosed girls with cancer in a national pediatric oncology setting, the first full year experience from the Princess Máxima Center, the PEARL study.

BackgroundChildhood cancer patients often remain uninformed regarding their potential risk of gonadal damage. In our hospital we introduced a five step standard oncofertility care plan for all newly diagnosed female patients aiming to identify, inform and triage 100% of patients and counsel 100% of patients at high risk (HR) of gonadal damage. This observational retrospective study (PEARL study) evaluated the use of this standard oncofertility care plan in the first full year in a national cohort.MethodsThe steps consist of 1)timely (preferably before start of gonadotoxic treatment) identification of all new patients, 2)triage of gonadal damage risk using a standardized gonadal damage risk stratification tool, 3)informing all patients and families, 4)counseling of a selected subset of girls, and 5) fertility preservation including ovarian tissue cryopreservation (OTC) in HR patients using amended Edinburgh criteria. A survey of the medical records of all girls newly diagnosed with cancer the first year (1-1-2019 until 31-12-2019) was conducted.ResultsOf 261 girls, 228 (87.4%) were timely identified and triaged. Triage resulted in 151 (66%) low(LR), 32 (14%) intermediate(IR) and 45 (20%) high risk(HR) patients. Ninety-nine families were documented to be timely informed regarding gonadal damage risk. In total, 35 girls (5 LR, 5 IR, 25 HR) were counseled by an oncofertility expert. 16/25 HR patients underwent fertility preservation (1 ovariopexy + OTC, oocyte cryopreservation (1 with and 1 without OTC) and 13 OTC). Fertility preservation did not lead to complications or delay of cancer treatment in any patient.ConclusionWe timely identified and triaged most girls (88%) with cancer with a high risk of gonadal damage to be counseled for fertility preservation. We aim to optimize the oncofertility care plan and the standardized gonadal damage risk stratification tool based on this experience and these may be of value to other pediatric oncology centers

Integrated sustainable waste management in developing countries

This paper uses the lens of 'integrated sustainable waste management' to examine how cities in developing countries have been tackling their solid waste problems. The history of related concepts and terms is reviewed, and ISWM is clearly differentiated from integrated waste management, used mostly in the context of technological integration in developed countries. Instead, integrated sustainable waste management examines both the physical components (collection, disposal and recycling) and the governance aspects (inclusivity of users and service providers; financial sustainability; coherent, sound institutions underpinned by proactive policies). The data show that performance has improved significantly over the last 10 years. Levels of collection coverage and controlled disposal of 95% in middleincome and 50% in low-income cities are already commonplace. Recycling rates of 20-30% are achieved by the informal sector in many lower income countries, at no direct cost to the city - presenting a major opportunity for all key stakeholders if the persistent challenges can be resolved. The evidence suggests that efficient, effective and affordable systems are tailored to local needs and conditions, developed with direct involvement of service beneficiaries. Despite the remaining challenges, evidence of recent improvements suggests that sustainable solid waste and resources management is feasible for developing countries

The Evolution of Educational Technology in Veterinary Anatomy Education.

"All learning is in the learner, not the teacher." Plato was right. The adage has passed the test of time and is still true in an era where technology accompanies us in not only professional but also recreational life every day, everywhere. On the other hand, the learner has evolved and so have the sources being used to satisfy curiosity and learning. It therefore appears intuitive to embrace these technological advances to bring knowledge to our pupils with the aim to facilitate learning and improve performance. It must be clear that these technologies are not intended to replace but rather consolidate knowledge partly acquired during more conventional teaching of anatomy. Veterinary medicine is no outlier. Educating students to the complexity of anatomy in multiple species requires that three-dimensional concepts be taught and understood accurately if appropriate treatment is to be set in place thereafter. Veterinary anatomy education has up to recently walked diligently in the footsteps of John Hunter's medical teaching using specimens, textbooks, and drawings. The discipline has yet to embrace fully the benefits of advancement being made in technology for the benefit of its learners. Three-dimensional representation of anatomy is undeniably a logical and correct way to teach whether it is through the demonstration of cadaveric specimen or alternate reality using smartphones, tablets, headsets or other digital media. Here we review some key aspects of the evolution of educational technology in veterinary anatomy