Cytoreductive surgery followed by chemotherapy versus chemotherapy alone for recurrent platinum- sensitive epithelial ovarian cancer (SOCceR trial):a multicenter randomised controlled study

BACKGROUND: Improvement in treatment for patients with recurrent ovarian cancer is needed. Standard therapy in patients with platinum-sensitive recurrent ovarian cancer consists of platinum-based chemotherapy. Median overall survival is reported between 18 and 35 months. Currently, the role of surgery in recurrent ovarian cancer is not clear. In selective patients a survival benefit up to 62 months is reported for patients undergoing complete secondary cytoreductive surgery. Whether cytoreductive surgery in recurrent platinum-sensitive ovarian cancer is beneficial remains questionable due to the lack of level I-II evidence. METHODS/DESIGN: Multicentre randomized controlled trial, including all nine gynecologic oncologic centres in the Netherlands and their affiliated hospitals. Eligible patients are women, with first recurrence of FIGO stage Ic-IV platinum-sensitive epithelial ovarian cancer, primary peritoneal cancer or fallopian tube cancer, who meet the inclusion criteria. Participants are randomized between the standard treatment consisting of at least six cycles of intravenous platinum based chemotherapy and the experimental treatment which consists of secondary cytoreductive surgery followed by at least six cycles of intravenous platinum based chemotherapy. Primary outcome measure is progression free survival. In total 230 patients will be randomized. Data will be analysed according to intention to treat. DISCUSSION: Where the role of cytoreductive surgery is widely accepted in the initial treatment of ovarian cancer, its value in recurrent platinum-sensitive epithelial ovarian cancer has not been established so far. A better understanding of the benefits and patients selection criteria for secondary cytoreductive surgery has to be obtained. Therefore the 4(th) ovarian cancer consensus conference in 2010 stated that randomized controlled phase 3 trials evaluating the role of surgery in platinum-sensitive recurrent epithelial ovarian cancer are urgently needed. We present a recently started multicentre randomized controlled trial that will investigate the role of secondary cytoreductive surgery followed by chemotherapy will improve progression free survival in selected patients with first recurrence of platinum-sensitive epithelial ovarian cancer. TRIAL REGISTRATION: Netherlands Trial Register number: NTR3337

Injury Surveillance in Elite New Zealand Track Cyclists

Introduction: Injury surveillance is an essential component of elite sport. Little data is available on injury rates in track cyclists, with the majority of cycling research focussed on road cycling, and suggesting cyclists are at highest risk of overuse knee, back and neck injuries, and acute injuries involving the shoulder/clavicle, lower back and knee. Purpose: This research aims to establish the baseline incidence and prevalence of injury, and its effect on training and competition for elite New Zealand track-cyclists. Methods: All members of Cycling New Zealand’s elite track squad were invited to take part in this prospective, longitudinal study. Participants completed two baseline questionnaires detailing current and past injury status, current training volume, and other baseline characteristics. They then completed an online self-reporting injury survey every week for 52 consecutive weeks in the form of the Programme for Injury and Illness Surveillance (PILLS) tool. Injuries were classified using the OSICS-10 classification system. Key outcome measures were injury incidence and prevalence. Also recorded were self-reported measures of training exposures and intensity, injury classification, treatment received, duration of injury and where (geographical location) the injury occurred. Comparison of participant and therapist injury classification were made, and all outcome measures were calculated for the squad as a whole, as well as with breakdown for gender and squad. Results: Data were collected from 33 members of the elite NZ track cycling squad, comprising 17 males (17-32 years - mean 22.71, SD: 4.45), and 16 females (17-31 years - mean 21.5 years, SD: 4.82). 21 of the 33 participants sustained an injury during the period of inclusion in the study. Four reported injuring multiple body sites at one time, with one participant reporting two multi-site incidents during the period of data collection. 13 participants sustained multiple injuries, and 12 reported no incidence of injury. 11 injuries occurred in sports specific training, 20 in the gym, six in competition and seven other (mean 11, SD 6.38). 82% of injuries were recorded as being acute, 18% recurrent, with no overuse injuries reported. 8962 training exposures were planned (mean 689 exposures per four-weeks, SD 142), with 60 sessions (0.67%) missed and 84 (0.94%) modified due to injury, totalling 144/8962 (1.6%) training exposures affected by injury (mean 11.1, SD 7) per four-week block of surveys. Injury Incidence was 4.9 injuries per 1000 training and competition exposures. For all injuries sustained (53 body parts injured from 44 events), the injury incidence was 5.9 per 1000 exposures. Point prevalence ranged from one injury per four-week block to seven (mean 3.38, SD 1.80). No significant relationships were found between squad, gender, previous injury, years in sport, new injuries or injury frequency, or number of treatments. Conclusion: This research provides the first descriptive injury profile for the elite New Zealand track cycling cohort. 64% of participants sustained an injury over the study period, however injury incidence and prevalence was low with rapid return to training and competition. Greatest number of injuries was seen in the lower back, hip/buttock/pelvis region, and the knee, possibly reflecting the biomechanical requirements of cycling and the nature of the training required for this cohort. Previous studies investigating road cycling describe similar body sites injured, but with a large proportion classified as overuse whereas no overuse injuries were self-reported in this study. Further research is required to determine any reason for this. Total training exposures were recorded however little detail was documented on the intensity, nature and load of each specific training session and warrants more detailed investigation through future research

Single Nucleotide Polymorphism (SNP)-Based Loss of Heterozygosity (LOH) Testing by Real Time PCR in Patients Suspect of Myeloproliferative Disease

During tumor development, loss of heterozygosity (LOH) often occurs. When LOH is preceded by an oncogene activating mutation, the mutant allele may be further potentiated if the wild-type allele is lost or inactivated. In myeloproliferative neoplasms (MPN) somatic acquisition of JAK2V617F may be followed by LOH resulting in loss of the wild type allele. The occurrence of LOH in MPN and other proliferative diseases may lead to a further potentiating the mutant allele and thereby increasing morbidity. A real time PCR based SNP profiling assay was developed and validated for LOH detection of the JAK2 region (JAK2LOH). Blood of a cohort of 12 JAK2V617F-positive patients (n = 6 25–50% and n = 6>50% JAK2V617F) and a cohort of 81 patients suspected of MPN was stored with EDTA and subsequently used for validation. To generate germ-line profiles, non-neoplastic formalin-fixed paraffin-embedded tissue from each patient was analyzed. Results of the SNP assay were compared to those of an established Short Tandem Repeat (STR) assay. Both assays revealed JAK2LOH in 1/6 patients with 25–50% JAK2V617F. In patients with >50% JAK2V617F, JAK2LOH was detected in 6/6 by the SNP assay and 5/6 patients by the STR assay. Of the 81 patients suspected of MPN, 18 patients carried JAK2V617F. Both the SNP and STR assay demonstrated the occurrence of JAK2LOH in 5 of them. In the 63 JAK2V617F-negative patients, no JAK2LOH was observed by SNP and STR analyses. The presented SNP assay reliably detects JAK2LOH and is a fast and easy to perform alternative for STR analyses. We therefore anticipate the SNP approach as a proof of principle for the development of LOH SNP-assays for other clinically relevant LOH loci

Doxapram versus placebo in preterm newborns: a study protocol for an international double blinded multicentre randomized controlled trial (DOXA-trial)

Abstract Background Apnoea of prematurity (AOP) is one of the most common diagnoses among preterm infants. AOP often leads to hypoxemia and bradycardia which are associated with an increased risk of death or disability. In addition to caffeine therapy and non-invasive respiratory support, doxapram might be used to reduce hypoxemic episodes and the need for invasive mechanical ventilation in preterm infants, thereby possibly improving their long-term outcome. However, high-quality trials on doxapram are lacking. The DOXA-trial therefore aims to investigate the safety and efficacy of doxapram compared to placebo in reducing the composite outcome of death or severe disability at 18 to 24 months corrected age. Methods The DOXA-trial is a double blinded, multicentre, randomized, placebo-controlled trial conducted in the Netherlands, Belgium and Canada. A total of 396 preterm infants with a gestational age below 29 weeks, suffering from AOP unresponsive to non-invasive respiratory support and caffeine will be randomized to receive doxapram therapy or placebo. The primary outcome is death or severe disability, defined as cognitive delay, cerebral palsy, severe hearing loss, or bilateral blindness, at 18–24 months corrected age. Secondary outcomes are short-term neonatal morbidity, including duration of mechanical ventilation, bronchopulmonary dysplasia and necrotising enterocolitis, hospital mortality, adverse effects, pharmacokinetics and cost-effectiveness. Analysis will be on an intention-to-treat principle. Discussion Doxapram has the potential to improve neonatal outcomes by improving respiration, but the safety concerns need to be weighed against the potential risks of invasive mechanical ventilation. It is unknown if the use of doxapram improves the long-term outcome. This forms the clinical equipoise of the current trial. This international, multicentre trial will provide the needed high-quality evidence on the efficacy and safety of doxapram in the treatment of AOP in preterm infants. Trial registration ClinicalTrials.gov NCT04430790 and EUDRACT 2019-003666-41. Prospectively registered on respectively June and January 2020

Single-Nucleotide-Polymorphism Genotyping of Coxiella burnetii during a Q Fever Outbreak in The Netherlands▿

Coxiella burnetii is the etiological agent of Q fever. Currently, the Netherlands is facing the largest Q fever epidemic ever, with almost 4,000 notified human cases. Although the presence of a hypervirulent strain is hypothesized, epidemiological evidence, such as the animal reservoir(s) and genotype of the C. burnetii strain(s) involved, is still lacking. We developed a single-nucleotide-polymorphism (SNP) genotyping assay directly applicable to clinical samples. Ten discriminatory SNPs were carefully selected and detected by real-time PCR. SNP genotyping appeared to be highly suitable for discrimination of C. burnetii strains and easy to perform with clinical samples. With this new method, we show that the Dutch outbreak is caused by at least 5 different C. burnetii genotypes. SNP typing of 14 human samples from the outbreak revealed the presence of 3 dissimilar genotypes. Two genotypes were also present in livestock at 9 farms in the outbreak area. SNP analyses of bulk milk from 5 other farms, commercial cow milk, and cow colostrum revealed 2 additional genotypes that were not detected in humans. SNP genotyping data from clinical samples clearly demonstrate that at least 5 different C. burnetii genotypes are involved in the Dutch outbreak

Large-Scale Identification of Disease Genes Involved in Acute Myeloid Leukemia

Acute myeloid leukemia (AML) is a heterogeneous group of diseases in which chromosomal aberrations, small insertions or deletions, or point mutations in certain genes have profound consequences for prognosis. However, the majority of AML patients present without currently known genetic defects. Retroviral insertion mutagenesis in mice has become a powerful tool for identifying new disease genes involved in the pathogenesis of leukemia and lymphoma. Here we have used the Graffi-1.4 strain of murine leukemia virus, which causes predominantly AML, in a screen to identify novel genes involved in the pathogenesis of this disease. We report 79 candidate disease genes in common integration sites (CISs) and 15 genes whose family members previously were found to be affected in other studies. The majority of the identified sequences (60%) were not found in lymphomas and monocytic leukemias in previous screens, suggesting a specific involvement in AML. Although most of the virus integrations occurred in or near the 5′ or 3′ ends of the genes, suggesting deregulation of gene expression as a consequence of virus integration, 18 CISs were located exclusively within the genes, conceivably causing gene disruption

Real-Time PCR with Serum Samples Is Indispensable for Early Diagnosis of Acute Q Fever▿

The world's largest Q fever outbreak is ongoing in The Netherlands with around 3,000 confirmed cases since the first half of 2007. Increased awareness has resulted in early referral of patients for diagnostics. An important drawback to serological diagnosis of acute Q fever is the lag phase in antibody response. Therefore, we evaluated the performance of a real-time PCR for detection of Coxiella burnetii DNA using serum samples from patients with acute Q fever. PCR, targeting IS1111, was retrospectively performed on acute-phase and follow-up convalescent-phase serum samples from 65 patients with acute Q fever as diagnosed by immunofluorescence assay. The results obtained by PCR were related to disease stage as defined by subsequent appearance of phase II IgM, phase II IgG, phase I IgM, and phase I IgG (IgM-II, IgG-II, IgM-I, and IgG-I, respectively) antibodies and time since onset of disease. In addition, we analyzed seronegative acute-phase serum samples from patients with inconclusive Q fever serology, because no convalescent-phase serum samples were available. PCR was scored positive in 49/50 (98%) seronegative sera, 9/10 (90%) sera with isolated IgM-II antibodies, 3/13 (23%) sera with IgM-II/IgG-II antibodies, 2/41 (5%) sera with IgM-II/IgG-II/IgM-I antibodies, 0/15 (0%) sera with IgM-II/IgG-II/IgM-I/IgG-I antibodies, and 0/1 (0%) serum sample with IgM-II/IgG-II/IgG-I antibodies. The latest time point after onset of disease in which C. burnetii DNA could be detected was at day 17. In patients with inconclusive Q fever serology, PCR was positive in 5/50 (10%) cases. We conclude that real-time PCR with serum samples is indispensable for early diagnosis of acute Q fever. C. burnetii DNA becomes undetectable in serum as the serological response develops

Pitfalls of molecular diagnostic testing for Coxiella burnetii DNA on throat swabs.

INTRODUCTION: Coxiella burnetii, the causative pathogen of Q fever, is regularly detected in throat swabs from patients without serological evidence of Q fever infection. C. burnetii is also frequently found in bulk tank milk from dairy cows. We evaluated the false positivity rate of polymerase chain reaction (PCR) for C. burnetii DNA on throat swabs and investigated whether recent consumption of C. burnetii DNA-positive cow milk could contribute to this phenomenon. METHODS: C. burnetii PCR was performed on throat swabs obtained from patients in whom a throat swab was ordered for other diagnostic purposes; patients with community-acquired pneumonia (CAP); and healthy volunteers after consumption of commercial C. burnetii-containing cow milk products. RESULTS: C. burnetii DNA was found in 5.0% of throat swabs ordered for other diagnostic purposes and in 15.3% of throat swabs from CAP patients without serological evidence of Q fever pneumonia. The positive and negative predictive value of C. burnetii PCR on throat swabs for Q fever pneumonia were 66.7% (95% CI, 38.0-88.2) and 48.9% (95% CI, 41.3-54.6), respectively. After consumption of commercial C. burnetii-containing cow milk products, C. burnetii DNA could be detected in throat swabs for as long as 30 min after ingestion. CONCLUSION: C. burnetii PCR on throat swabs is of low diagnostic value for Q fever pneumonia and was false positive in 15.3% of CAP patients without Q fever pneumonia. Recent consumption of C. burnetii-containing products can influence the outcome of C. burnetii PCR on throat swabs. Therefore, diagnosis of C. burnetii infection should be made in combination with serology or PCR performed on blood