Guidance on good practice in authorship of journal publications [guest editorial]

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Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome

Study Question: What is the recommended assessment and management of women with polycystic ovary syndrome (PCOS), based on the best available evidence, clinical expertise, and consumer preference? Summary Answer: International evidence-based guidelines including 166 recommendations and practice points, addressed prioritized questions to promote consistent, evidence-based care and improve the experience and health outcomes of women with PCOS. What Is Known Already: Previous guidelines either lacked rigorous evidence-based processes, did not engage consumer and international multidisciplinary perspectives, or were outdated. Diagnosis of PCOS remains controversial and assessment and management are inconsistent. The needs of women with PCOS are not being adequately met and evidence practice gaps persist. Study Design, Size, Duration: International evidence-based guideline development engaged professional societies and consumer organizations with multidisciplinary experts and women with PCOS directly involved at all stages. Appraisal of Guidelines for Research and Evaluation (AGREE) II-compliant processes were followed, with extensive evidence synthesis. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework was applied across evidence quality, feasibility, acceptability, cost, implementation and ultimately recommendation strength. Participants/Materials, Setting, Methods: Governance included a six continent international advisory and a project board, fi ve guide- line development groups, and consumer and translation committees. Extensive health professional and consumer engagement informed guideline scope and priorities. Engaged international society-nominated panels included pediatrics, endocrinology, gynecology, primary care, reproductive endocrinology, obstetrics, psychiatry, psychology, dietetics, exercise physiology, public health and other experts, alongside consumers, project management, evidence synthesis, and translation experts. Thirty-seven societies and organizations covering 71 countries engaged in the process. Twenty face-to-face meetings over 15 months addressed 60 prioritized clinical questions involving 40 systematic and 20 narrative reviews. Evidence-based recommendations were developed and approved via consensus voting within the fi ve guideline panels, modi fi ed based on international feedback and peer review, with fi nal recommendations approved across all panels. Main Results and the Role of Chance: The evidence in the assessment and management of PCOS is generally of low to moderate quality. The guideline provides 31 evidence based recommendations, 59 clinical consensus recommendations and 76 clinical practice points all related to assessment and management of PCOS. Key changes in this guideline include: i) considerable re fi nement of individual diagnostic criteria with a focus on improving accuracy of diagnosis; ii) reducing unnecessary testing; iii) increasing focus on education, lifestyle modi fi cation, emotional wellbeing and quality of life; and iv) emphasizing evidence based medical therapy and cheaper and safer fertility management. Limitations, Reasons for Caution: Overall evidence is generally low to moderate quality, requiring signi fi cantly greater research in this neglected, yet common condition, especially around re fi ning speci fi c diagnostic features in PCOS. Regional health system variation is acknowledged and a process for guideline and translation resource adaptation is provided. Wider Implications of the Findings: The international guideline for the assessment and management of PCOS provides clinicians with clear advice on best practice based on the best available evidence, expert multidisciplinary input and consumer preferences. Research recommendations have been generated and a comprehensive multifaceted dissemination and translation program supports the guideline with an integrated evaluation program. Study Funding/Competing Interest(S): The guideline was primarily funded by the Australian National Health and Medical Research Council of Australia (NHMRC) supported by a partnership with ESHRE and the American Society for Reproductive Medicine. Guideline development group members did not receive payment. Travel expenses were covered by the sponsoring organizations. Disclosures of con- fl icts of interest were declared at the outset and updated throughout the guideline process, aligned with NHMRC guideline processes. Full details of con fl icts declared across the guideline development groups are available at https://www.monash.edu/medicine/sphpm/mchri/ pcos/guideline intheRegister ofdisclosures ofinterest. Ofnamed authors,Dr Costello has declared sharesinVirtus Healthand pastsponsor- ship from Merck Serono for conference presentations. Prof. Laven declared grants from Ferring, Euroscreen and personal fees from Ferring, Euroscreen, Danone and Titus Healthcare. Prof. Norman has declared a minor shareholder interest in an IVF unit. The remaining authors have no con fl icts of interest to declare. The guideline was peer reviewed by special interest groups across our partner and collaborating so- cieties and consumer organizations, was independently assessed against AGREEII criteria and underwent methodological review. This guideline was approved by all members of the guideline development groups and was submitted for fi nal approval by the NHMRC.Helena J. Teede, Marie L. Misso … Bernardus W (Ben) Mol … Lisa J Moran … Robert J Norman … Raymond J Rodgers … et al. (on behalf of the International PCOS Network

Spectrum of pheochromocytoma in the 131 I-MIBG era

131 I-metaiodobenzylguanidine ( 131 I-MIBG) scintigraphy allows for both functional diagnosis and anatomical localization of pheochromocytoma. The spectrum of pheochromocytoma since the routine use of preoperative 131 I-MIBG scan was studied. From 1980 to 1986, a total of 34 patients were primarily diagnosed and treated at the University of Michigan Medical Center, Ann Arbor, Michigan, U.S.A. There were 16 males and 18 females. The mean age was 38 years and 4 patients (11.8%) were under 18 years of age. Six patients (17.6%) had family history of pheochromocytoma or multiple endocrine neoplasia (MEN) II syndrome. The presenting symptoms were hypertension in 29 patients (85.3%); attacks of headache, palpitation, sweating, and flushing in 4 (11.8%), and 1 patient presented with a neck mass. Plasma catecholamines were elevated in 97% of patients while urinary catecholamines and metabolites were elevated in 93.5%. 131 I-MIBG was accurate in 82.3%, partly positive in 11.8%, and false-negative in 5.9% of patients. CT scan was accurate in 80%, partly positive in 10%, but failed to show the tumor in another 10% of patients. At operation, extraadrenal lesions were found in 38.2% of the patients and among these, one-third were extraabdominal. Multiple tumors occurred in 5 (14.7%), and bilateral adrenal lesions occurred in 4 patients (11.8%). Malignancy was diagnosed in 3 patients (8.8%) after an average follow-up period of 2 years. We conclude that the use of routine preoperative 131 I-MIBG scanning improves localization of pheochromocytoma and earlier diagnosis is possible in patients with MEN II syndrome. Multiple tumors, extraadrenal and extraabdominal lesions occur more often than commonly believed. The low rate of confirmed malignancy is probably related to the short period of follow-up. La scintigraphie à l' 131 I-MIBG permet de diagnostiquer et de localiser les phéochromocytomes. Toute la gamme de types de phéochromocytomes reconnu depuis l'utilisation préopératoire systématique de la scintigraphie à l' 131 I-MIBG est présentée. Entre 1980 et 1986, 34 patients ont été explorés et traités au Centre Médical de l'Université de Michigan, Ann Arbor, Michigan. Il y avait 16 hommes et 18 femmes. L'âge moyen était de 38 ans, et 4 patients (11.8%) avaient moins de 18 ans. Six patients (17.6%) avaient des antécédents familiaux de phéochromocytome ou de néoplasmes endocrines multiples (MEN) du type II. Les symptômes amenant à consulter étaient l'hypertension chez 29 patients (85.3%), des crises de céphalées, des palpitations et un flush chez 4 patients (11.8%); un patient présentait une masse cervicale. Les catécholamines plasmatiques étaient élevées chez 97% des patients alors que les catécholamines et leurs métabolites étaient en quantité élevée chez 93.5% des patients. La scintigraphie à l' 131 I-MIBG était positive chez 82.3%, partiellement positive chez 11.8%, et faussement négative chez 5.9% des patients. La tomodensitométrie était positive chez 80%, partiellement positive chez 10%, et faussement négative chez 10% des patients. A l'intervention, des lésions extra-surrénales étaient présentes dans 38.2% des cas, et parmi celles-ci, un tiers étaient extra-abdominales. Les tumeurs étaient multiples dans 5 cas (14.7%), et bilatérales surrénales dans 4 cas (11.8%). Une tumeur maligne était diagnostiquée chez 3 patients (8.8%), après une période de suivi de 2 ans en moyenne. Nous concluons que l'utilisation systématique de la scintigraphie à l' 131 I-MIBG améliore la localisation des phéochromocytomes, permettant un diagnostic plus précoce chez les patients présentant un syndrome MEN II. La multiplicité tumorale et les localisations extra-médullosurrénales ou extra-abdominales se voient beaucoup plus fréquemment qu'on le pensait auparavant. Le taux de malignité peu élevé était probablement en rapport avec la courte période de suivi. La escintigrafía con 131 I-MIBG permite tanto la localización anatómica como el diagnóstico funcional del feocromocitoma. Las características o espectro del feocromocitoma a partir del uso rutinario de 131 I-MIBG han sido estudiadas.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/41282/1/268_2005_Article_BF01655447.pd

Malignant islet-cell tumors of the pancreas

Although malignant islet-cell tumors are uncommon, they are an important group of pancreatic neoplasms because appropriate treatment can often result in effective palliation even though cure is infrequent. In general, these tumors are relatively slow growing so that a combination of surgical and chemotherapeutic measures may prove very beneficial. In some patients with tumors hypersecreting insulin, gastrin, glucagon, or vasoactive intestinal polypeptide (VIP), the hormonal effects of the neoplasm can be life-threatening. Surgical treatment must, therefore, consider both the functional and malignant characteristics of the individual tumor. In many patients with functional tumors, surgical debulking of the primary tumor may be indicated even when a curative resection cannot be accomplished. Some malignancies may be cured by an appropriate pancreatic resection even when peripancreatic lymph nodes are already involved. Although a Whipple procedure is not indicated when hepatic metastases are present, this procedure may cure tumors localized to the pancreatic head and/or peripancreatic lymph nodes. Because hepatic metastases are usually multiple and involve both lobes, liver resections, other than wedge excisions of peripherally located functional metastases, are not indicated. Malignant nonfunctioning islet-cell tumors are probably best treated with systemic or regional chemotherapy when metastatic. Surgical resections or bypass procedures may be infrequently useful in those cases in which the primary tumor causes either duodenal or bile duct obstruction. The most effective methods used to control hepatic metastases are systemic and hepatic arterial chemotherapy. An alternative is selective hepatic artery embolization. Recently, an implantable hepatic arterial infusion pump has been used with encouraging results in this group of patients. The chemotherapeutic agents that have been most effective in the treatment of hepatic metastases include streptozotocin, DTIC, and fluorouracil . Les tumeurs insulaires malignes sont rares mais elles présentent un grand intérêt car si le traitement entraîne exceptionnellement leur guérison il assure une survie des malades qui en sont porteurs. Ce sont en effet des tumeurs malignes à développement lent, sensibles à l'action de l'association de la chimiothérapie et de la chirurgie. Chez certains sujets les tumeurs secrétant de l'insuline, de la gastrine, du glucagon, du V.I.P. peuvent mettre en jeu la vie du malade sous l'effet de l'hypersecrétion hormonale. Le traitement chirurgical dépend de ce fait, des caractères fonctionnels et du degré de malignité de chaque type de tumeur. En présence de lésions hypersecrétantes l'exérèse de la tumeur primitive doit être envisagée alors même que la possibilité d'obtenir une guérison définitive ne peut être escomptée. Il est aussi à noter que certaines lésions malignes ont été traitées avec succès alors que les ganglions lymphatiques correspondants étaient déjà envahis. Si l'opération est contre-indiquée en présence de métastases hépatiques la duodénopancréatectomie céphalique s'applique aux tumeurs insulaires céphaliques qu'elles s'accompagnent ou non d'un envahissement des ganglions juxta-pancréatiques. Du fait que les métastases hépatiques sont souvent multiples et qu'elles intéressent les deux lobes l'action sur le foie se limite à l'éxérèse des métastases accessibles à la résection hépatique segmentaire. Les tumeurs insulaires malignes qui ne sont pas hypersecrétantes relèvent de la chimiothérapie par voie générale ou de la chimiothérapie régionale dès lors qu'elles s'accompagnent de métastases. C'est seulement lorsque ces lésions entraînent une obstruction de la voie biliaire principale ou du duodénum que la résection ou les anastomoses de dérivation sont indiquées. La chimiothérapie par voie générale ou par la voie de l'artère hépatique ou encore l'embolisation de cette dernière représentent les meilleures méthodes de traitement des métastases hépatiques. L'emploi récent de pompes à infusion de l'artère hépatique a donné des résultats intéressants chez ces malades. Les agents chimiques les plus efficaces sont la streptozotocine, le DTIC et le Fluorouracil. Aunque los tumores malignos de células insulares del páncreas son raros, éstos constituyen un grupo importante entre las neoplasias pancreáticas por cuanto el tratamiento apropiado con frecuencia resulta en una paliación efectiva a pesar de que la curación sea poco frecuente. En general estos tumores son de crecimiento lento y la combinación de la cirugía con quimioterapia puede llegar a ser beneficiosa. En algunos pacientes con tumores que hipersecretan insulina, gastrina, glucagón o VIP (polipéptido vasoactivo intestinal), los efectos hormonales del neoplasma pueden poner en peligro la vida. Por ello el tratamiento quirúrgico debe considerar tanto las caracteristicas funcionales como las de malignidad de cada tumor en particular. En muchos pacientes con neoplasmas funcionantes, el debultamiento quirúrgico del tumor primario puede estar indicado cuando la resección curativa no es realizable. Algunas neoplasias malignas pueden ser curadas mediante una resección pancreática adecuada a pesar de que los ganglios linfáticos peripancreáticos ya se hallen afectados. Aún cuando el procedimiento de Whipple no esta indicado en presencia de metástasis hepáticas, esta operación puede curar tumores localizados en la cabeza del páncreas y/o en los ganglios linfáticos peripancreáticos. Debido a que las metástasis hepáticas generalmente son múlitples y afectan a ambos lóbulos, las resecciones hepáticas, diferentes de las resecciones en cuña para lesiones funcionantes localizadas en la periferie del higado no están indicadas. Los tumores malignos no funcionantes de células insulares probablemente deben ser tratadas con quimioterapia sistémica o regional cuando se encuentren en fase metastásica. Las resecciones quirúrgicas o los procedimientos derivativos infrecuentemente son de utilidad en aquellos casos en los cuales el tumor primario causa obstrucción duodenal o del conducto biliar. Los métodos de mayor efectividad en el control de las metéstasis hepáticas son los de quimioterapia sistémica y arterial hepática. Una alternativa es la embolización selectiva de la arteria hepática. Recientemente ha venido a ser utilizada una bomba implantable de infusión arterial heptica con resultados halagadores en este grupo de pacientes. Los agentes quimioterapéuticos que han probado ser de mayor efectividad en el tratamiento de las metástasis hepáticas incluyen la estreptozotocina, la dimetiltrizenoimidazol carboxamida (DTIC) y el Fluorouracilo.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/41316/1/268_2005_Article_BF01656036.pd

Fine-Scale Mapping of the 5q11.2 Breast Cancer Locus Reveals at Least Three Independent Risk Variants Regulating MAP3K1

Peer reviewe

Use of SMS texts for facilitating access to online alcohol interventions: a feasibility study

A41 Use of SMS texts for facilitating access to online alcohol interventions: a feasibility study In: Addiction Science & Clinical Practice 2017, 12(Suppl 1): A4

Reduction of visual acuity decreases capacity to evaluate radiographic image quality

Aim: To determine the impact of reduced visual acuity on the evaluation of a test object and appendicular radiographs. Methods: Visual acuity was reduced by two different magnitudes using simulation glasses and compared to normal vision (no glasses). During phase one phantom images were produced for the purpose of counting objects by 13 observers and on phase 2 image appraisal of anatomical structures was performed on anonymized radiographic images by 7 observers. The monitors were calibrated (SMPTE RP133 test pattern) and the room lighting was maintained at 7 ±1 lux. Image display and data on grading were managed using ViewDEX (v.2.0) and the area under the visual grading characteristic (AUCVGC) was calculated using VGC Analyzer (v1.0.2). Inferential statistics were calculated using SPSS. Results: For the evaluation of appendicular radiographs the total interpretation time was longer when visual acuity was reduced with 2 pairs of simulation glasses (15.4 versus 8.9 min). Visual grading analysis showed that observers can lose the ability to detect anatomical and contrast differences when they have a simulated visual acuity reduction, being more challenging to differentiate low contrast details. No simulation glasses, compared to 1 pair gives an AUCVGC of 0.302 (0.280, 0.333), that decreases to 0.197 (0.175, 0.223) when using 2 pairs of glasses. Conclusions: Reduced visual acuity has a significant negative impact on the evaluation of test objects and clinical images. Further work is required to test the impact of reduced visual acuity on visual search, technical evaluation of a wider range of images as well as pathology detection/characterization performance