Heritability of attention problems in children II: longitudinal results from a study of twins age 3 to 12.

this paper we present data of large samples of twin families, with an equal number of girls and boys. The well-known gender difference with boys displaying more OA and AP was observed at each age. Even at the age of 3, boys display more OA problems than girls. Clinical studies have indicated that severe problem behavior can be identified in very young children (see for review, Campbell, 1995; Keenan & Wakschlag, 2000; Shaw, Owens, Giovannelli, & Winslow, 2001) and that the onset of ADHD is during the pre-school period (Barkley, Fisher, Edelbrock, & Smallish, 1990; Table 6 Top part includes percentages of total variances (diagonal) and covariances (off-diagonal) explained by additive genetic, genetic dominance, and unique environmental components based on best fitting models. Percentages for boys and girls are reported below and above diagonal, respectively. Lower part includes correlations calculated for additive genetic, genetic dominance, and unique environmental sources of variance between different ages. Correlations for boys and girls are reported below and above diagonal, respectively Relative proportions of variance and covariance BoysnGirls A% D% E% OA 3 AP 7 AP 10 AP 12 OA 3 AP 7 AP 10 AP 12 OA 3 AP 7 AP 10 AP 12 OA 3 50n41 73 79 75 22n33 17 13 14 28n26 10 8 11 AP 7 59 33n57 50 53 31 39n16 31 28 10 28n27 19 19 AP 10 86 31 41n48 47 6 51 31n25 32 8 18 28n27 21 AP 12 71 24 31 40n54 16 55 45 30n18 13 21 24 30n28 Correlations between different ages BoysnGirls ADE OA 3 AP 7 AP 10 AP 12 OA 3 AP 7 AP 10 AP 12 OA 3 AP 7 AP 10 AP 12 OA 3 1.00 .60 .66 .57 1.00 .30 .16 .20 1.00 .15 .12 .14 AP 7 .57 1.00 .62 .57 .41 1.00 .99 1.00 .15 1.00 .46 .41 AP 10 .68 .56 1.00 .61 .08 .94 1.00 1.00 .11 .42 1.00 .50 AP 12 .49 .42 .53 1.00 .20 .98 .99 1.00 .14 .45 .58 1.00 ..

The significance of hysteroscopy screening prior to assisted reproduction

In the Netherlands, yearly 7000 couples rely on IVF or intracytoplasmic sperm injection (ICSI) treatment as a tool to enhance their chances for a live birth. Despite the numerous advances in the field of IVF/ICSI, there still exists a maximum implantation rate per embryo transferred of about 30%. Implantation failure could be due to the embryo, the uterine environment or a combination of both. Since hysteroscopy has become easy to perform in an outpatient setting, it is increasingly recommended to implement routine hysteroscopy screening prior to a first IVF/ICSI. However, high quality evidence for this recommendation is absent. The aim of this thesis was to assess the true value of routine hysteroscopy in IVF/ICSI indicated patients, who are not suspected of intrauterine pathology. Focus was on the prevalence of intrauterine pathology, the observer agreement in evaluation of the uterine cavity, the endometrial biopsy and the cost-effectiveness of screening hysteroscopy. At the University Medical Center Utrecht (UMCU) and the Academic Hospital at the Dutch-speaking Brussels Free University (AZVUB) a group of 678 consecutive, unselected patients, indicated for IVF/ICSI and allocated for a randomized trial, underwent office hysteroscopy. Only asymptomatic patients, aged ≤42 years, with normal TVS findings and no previous hysteroscopy were included. The observed prevalence of intrauterine abnormalities at hysteroscopy in our patient population was 11%, which is lower than reported in similar previous reported articles (20-45%). Next to differences in the investigated patient populations, one of the explanations for this discrepancy could be the unsatisfying interobserver agreement on evaluation of the uterine cavity. Perfect agreement occurred in 77.6% of the cases. The interobserver agreement on the appearance of any of the predefined intrauterine abnormalities was moderate (kappa = 0.491). Also, the value of the hysteroscopy guided endometrial biopsy to diagnose chronic endometritis was assessed. The histopathology examination of the endometrial biopsy for diagnosing chronic endometritis was found to be reproducible between two pathologists. The prevalence of chronic endometritis was low, 2.8%. Moreover, the live birth rate did not significantly differ between patients with or without chronic endometritis, 76% versus 54% (P-value: 0.11). Also, the cumulative live birth rate per embryo transfer was not significantly different (Hazard Ratio 1.456, 95% CI: 0.770 - 2.750, P-value: 0.2). Therefore, the hysteroscopy guided endometrial biopsy did not seem to be useful as a routine procedure. Finally, the cost-effectiveness of two distinct strategies (hysteroscopy after 2 failed IVF cycles and routine hysteroscopy prior to IVF) was compared to the reference strategy (no hysteroscopy). In general, based on data obtained from the current literature, screening hysteroscopy seemed to be a cost effective procedure. Thus, during a screening hysteroscopy prior to IVF/ICSI only a small amount of intrauterine abnormalities are detected, nevertheless, it might be a cost-effective procedure. Future research to the true prevalence of intrauterine abnormalities at hysteroscopy, the precise increase in pregnancy rate after hysteroscopy and the aetiology behind the positive effect of a hysteroscopy must be performed before routine hysteroscopy should be implemented in the daily clinical infertility practic

Incorporating molecular profiling into endometrial cancer management requires prospective studies

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Patients' and gynecologists' views on sentinel lymph node mapping in low- and intermediate-risk endometrial cancer: a Dutch vignette study

Item does not contain fulltextOBJECTIVE: Sentinel lymph node (SLN) mapping in endometrial cancer is gaining ground. However, patient views on this new technique are unknown. The aim of this study was to determine factors important to patients and gynecologists when considering SLN mapping in low- and intermediate-risk endometrial cancer. METHODS: We performed a vignette study. Patients who underwent a total hysterectomy for low- or intermediate-risk endometrial cancer between 2012 and 2015 were invited. Dutch gynecologists specializing in gynecologic oncology were also invited. We based the selection for attributes in the vignettes on literature and interviews: risk of complications of SLN mapping; chance of finding a metastasis; survival gain; risk of complications after radiotherapy; operation time; and hospital of surgery (travel time). We developed a questionnaire with 18 hypothetical scenarios. Each attribute level varied and for each scenario, participants were asked how strongly they would prefer SLN on a scale from 1 to 7. The strength of preference for each scenario was analyzed using linear mixed effects models. RESULTS: A total of 38% of patients (41/108) and 33% of gynecologists (42/126) participated in the study. Overall, they had a preference for SLN. The mean preference for patients was 4.29 (95% CI 3.72 to 4.85) and 4.39 (95% CI 3.99 to 4.78) for gynecologists. Patients' preferences increased from 3.4 in the case of no survival gain to 4.9 in the case of 3-year survival gain (P60 min (-0.4, P=0.024), or with an increased risk of complications after adjuvant radiotherapy (-0.6, P=0.002). For gynecologists all attributes except travel time were important. CONCLUSIONS: Overall, patients and gynecologists were in favor of SLN mapping in low- and intermediate-risk endometrial cancer. Most important to patients were survival gain, travel time, and complication risk after adjuvant radiotherapy. These preferences should be taken into account when counseling about SLN mapping

Risk Stratification of Endometrial Cancer Patients: FIGO Stage, Biomarkers and Molecular Classification

Simple Summary: Endometrial cancer (EC) is the most common gynaecologic malignancy in developed countries. Most patients are sufficiently treated with removal of uterus, tubes and ovaries. It depends on the estimated risk of metastases at diagnosis if more extensive surgery (removal of lymph nodes, peritoneum and/or omentum), to detect small metastases, is indicated. Metastases are associated with a higher risk of recurrence and justify adjuvant treatment (i.e., radiotherapy and/or chemotherapy). Recently it is advised to also subdivide EC into four molecular subgroups. Each subgroup is highly associated to a certain risk of recurrence and helps to decide for adjuvant treatment. What surgery should be performed in each of the subgroups is currently unknown. Moreover, it is uncertain if integration of other factors into the molecular classification could help to improve the risk classification. This review summarizes different aspects of surgery. Moreover, the relation between metastases and other factors including molecular classification are evaluated.Endometrial cancer (EC) is the most common gynaecologic malignancy in developed countries. The main challenge in EC management is to correctly estimate the risk of metastases at diagnosis and the risk to develop recurrences in the future. Risk stratification determines the need for surgical staging and adjuvant treatment. Detection of occult, microscopic metastases upstages patients, provides important prognostic information and guides adjuvant treatment. The molecular classification subdivides EC into four prognostic subgroups: POLE ultramutated; mismatch repair deficient (MMRd); nonspecific molecular profile (NSMP); and TP53 mutated (p53abn). How surgical staging should be adjusted based on preoperative molecular profiling is currently unknown. Moreover, little is known whether and how other known prognostic biomarkers affect prognosis prediction independent of or in addition to these molecular subgroups. This review summarizes the factors incorporated in surgical staging (i.e., peritoneal washing, lymph node dissection, omentectomy and peritoneal biopsies), and its impact on prognosis and adjuvant treatment decisions in an era of molecular classification of EC. Moreover, the relation between FIGO stage and molecular classification is evaluated including the current gaps in knowledge and future perspectives

Prognostic value of molecular classification in stage IV endometrial cancer

Objectives Multiple studies have proven the prognostic value of molecular classification for stage I–III endometrial cancer patients. However, studies on the relevance of molecular classification for stage IV endometrial cancer patients are lacking. Hypothetically, poor prognostic molecular subtypes are more common in higher stages of endometrial cancer. Considering the poor prognosis of stage IV endometrial cancer patients, it is questionable whether molecular classification has additional prognostic value. Therefore, we determined which molecular subclasses are found in stage IV endometrial cancer and if there is a correlation with progression-free and overall survival.Methods A retrospective multicenter cohort study was conducted using data from five Dutch hospitals. Patients with stage IV endometrial cancer at diagnosis who were treated with primary cytoreductive surgery or cytoreductive surgery after induction chemotherapy between January 2000 and December 2018 were included. Exclusion criteria were age POLE and estrogen receptor status). The Kaplan–Meier method was used to calculate progression free and overall survival in the molecular subclasses, for the different histological subtypes and for estrogen receptor positive versus estrogen receptor negative tumors. Groups were compared using the log-rank test.Results 164 stage IV endometrial cancer patients were molecularly classified. Median age of the patients was 67 years (range 33–86). Most patients presented with a non-endometrioid histological subtype (58%). Intra-abdominal complete cytoreductive surgery was achieved in 60.4% of the patients. 101 tumors (61.6%) were classified as p53 abnormal, 35 (21.3%) as no specific molecular profile, 21 (12.8%) as mismatch repair deficient, and 6 (3%) as POLE mutated. Molecular classification had no significant impact on progression free (p=0.056) or overall survival (p=0.12) after cytoreductive surgery. Overall survival was affected by histologic subtype (pConclusion The distribution of the molecular subclasses in stage IV endometrial cancer patients differed substantially from the distribution in stage I–III endometrial cancer patients, with the unfavorable subclasses being more frequently present. Although the molecular classification was not prognostic in stage IV endometrial cancer, it could guide adjuvant treatment decisions.</p

Endometrial scratching in women with implantation failure after a first IVF/ICSI cycle; does it lead to a higher live birth rate? The SCRaTCH study: a randomized controlled trial (NTR 5342)

Contains fulltext : 177721.pdf (publisher's version ) (Open Access)BACKGROUND: Success rates of assisted reproductive techniques (ART) are approximately 30%, with the most important limiting factor being embryo implantation. Mechanical endometrial injury, also called 'scratching', has been proposed to positively affect the chance of implantation after embryo transfer, but the currently available evidence is not yet conclusive. The primary aim of this study is to determine the effect of endometrial scratching prior to a second fresh in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycle on live birth rates in women with a failed first IVF/ICSI cycle. METHOD: Multicenter randomized controlled trial in Dutch academic and non-academic hospitals. A total of 900 women will be included of whom half will undergo an endometrial scratch in the luteal phase of the cycle prior to controlled ovarian hyperstimulation using an endometrial biopsy catheter. The primary endpoint is the live birth rate after the 2nd fresh IVF/ICSI cycle. Secondary endpoints are costs, cumulative live birth rate (after the full 2nd IVF/ICSI cycle and over 12 months of follow-up); clinical and ongoing pregnancy rate; multiple pregnancy rate; miscarriage rate and endometrial tissue parameters associated with implantation failure. DISCUSSION: Multiple studies have been performed to investigate the effect of endometrial scratching on live birth rates in women undergoing IVF/ICSI cycles. Due to heterogeneity in both the method and population being scratched, it remains unclear which group of women will benefit from the procedure. The SCRaTCH trial proposed here aims to investigate the effect of endometrial scratching prior to controlled ovarian hyperstimulation in a large group of women undergoing a second IVF/ICSI cycle. TRIAL REGISTRATION: NTR 5342 , registered July 31st, 2015. PROTOCOL VERSION: Version 4.10, January 4th, 2017

Hysteroscopy before in-vitro fertilisation (inSIGHT): a multicentre, randomised controlled trial

GynecologyCervix cance