Use of quantitative molecular diagnostic methods to investigate the effect of enteropathogen infections on linear growth in children in low-resource settings : longitudinal analysis of results from the MAL-ED cohort study

Funding Information: The Etiology, Risk Factors and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development Project (MAL-ED) was carried out as a collaborative project supported by the Bill & Melinda Gates Foundation (OPP1131125), the Foundation for the National Institutes of Health (AI130326), and the Fogarty International Center. The authors thank the staff and participants of the MAL-ED Network Project for their important contributions. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the US National Institutes of Health or Department of Health and Human Services. Publisher Copyright: © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licensePeer reviewedPublisher PD

Intraoperative ventilator settings and their association with postoperative pulmonary complications in neurosurgical patients : post-hoc analysis of LAS VEGAS study

Funding Information: LAS VEGAS was partly sponsored by the European Society of Anaesthesiology and the Amsterdam University Medical Centers, location ‘AMC’. It was also funded by a grant from the AAGBI via the NIAA in the UK. MFVM was supported by grant NIH-NHLBI UG3-HL140177. Funders provided support for logistic and study development. Funding Information: LAS VEGAS [8] was an international multicentre observational prospective study (registered at www. clini-caltrials.gov (study identifier NCT01601223)), endorsed and supported by the European Society of Anaesthesiology and the Amsterdam University Medical Centres, location AMC, Amsterdam, The Netherlands. Details about the LAS VEGAS study collaborators, participating centres and hospital characteristics of participating centres are reported in ESM Tables S2a, b and S3.Peer reviewedPublisher PD

The Association of Intraoperative driving pressure with postoperative pulmonary complications in open versus closed abdominal surgery patients : a posthoc propensity score–weighted cohort analysis of the LAS VEGAS study

Funding Information: G. Mazzinari: No interest declared; A. Serpa Neto: No interest declared; S.N.T. Hemmes: No interest declared; G. Hedenstierna: No interest declared; S. Jaber: No interest declared; M. Hiesmayr: No interest declared; M.W. Hollmann: Executive Section Editor Pharmacology with Anesthesia & Analgesia, Section Editor Anesthesiology with Journal of Clinical Medicine, and CSL Behring, no conflict of interest with the current work; G.H. Mills: No interest declared; M.F. Vidal Melo: is funded by NIH/NHLBI grant UH3-HL140177; R.M. Pearse: No interest declared; C. Putensen: No interest declared; W. Schmid: No interest declared; P. Severgnini: No interest declared; H.Wrigge: No interest declared; O. Diaz–Cambronero: had received a Merck Sharp & Dohme investigator–initiated grant (protocol code #53607). Sponsors and funders have no roles in study design, analysis of data or reporting. Also received speakers fees for lecture and medical advice from Merck Sharp & Dohme, no conflict of interest with the current work; L.Ball: No interest declared; M. Gama de Abreu: Ambu, GE Healthcare, ZOLL consulting fees, no conflict of interest with the current work; P.Pelosi: No interest declared; M.J.Schultz: No interest declared. Funding Information: The ethical committee of the Academic Medical Center, Amsterdam, the Netherlands, approved the LAS VEGAS study protocol (W12_190#12.17.0227). Each participating centre obtained approval from their institutional review board if needed, and patients were included after obtaining written informed consent when dictated by national or regional legislation. The LAS VEGAS study was partially funded and endorsed by the European Society of Anaesthesiology and registered at clinicaltrials.gov (study identifier NCT01601223, first posted date: 17/05/2012).Peer reviewedPublisher PD

Exploring the structural relationship between interviewer and self-rated affective symptoms in Huntington’s disease

This study explores the structural relationship between self-report and interview measures of affect in Huntington’s disease. The findings suggest continued use of both to recognize the multidimensionality within a single common consideration of distress

Perinatal insults and neurodevelopmental disorders may impact Huntington's disease age of diagnosis

Introduction: The age of diagnosis of Huntington's disease (HD) varies among individuals with the same HTT CAG-repeat expansion size. We investigated whether early-life events, like perinatal insults or neurodevelopmental disorders, influence the diagnosis age. Methods: We used data from 13,856 participants from REGISTRY and Enroll-HD, two large international multicenter observational studies. Disease-free survival analyses of mutation carriers with an HTT CAG repeat expansion size above and including 36 were computed through Kaplan-Meier estimates of median time until an HD diagnosis. Comparisons between groups were computed using a Cox proportional hazard survival model adjusted for CAG-repeat expansion length. We also assessed whether the group effect depended on gender and the affected parent. Results: Insults in the perinatal period were associated with an earlier median age of diagnosis of 45.00 years (95%CI: 42.07–47.92) compared to 51.00 years (95%CI: 50.68–51.31) in the reference group, with a CAG-adjusted hazard ratio of 1.61 (95%CI: 1.26–2.06). Neurodevelopmental disorders were also associated with an earlier median age of diagnosis than the reference group of 47.00 years (95% CI: 43.38–50.62) with a CAG-adjusted hazard ratio of 1.42 (95%CI: 1.16–1.75). These associations did not change significantly with gender or affected parent. Conclusions: These results, derived from large observational datasets, show that perinatal insults and neurodevelopmental disorders are associated with earlier ages of diagnosis of magnitudes similar to the effects of known genetic modifiers of HD. Given their clear temporal separation, these early events may be causative of earlier HD onset, but further research is needed to prove causation

A Randomized, Double-blind, Placebo-Controlled Study of Latrepirdine in Patients With Mild to Moderate Huntington Disease.

BACKGROUND Latrepirdine is an orally administered experimental small molecule that was initially developed as an antihistamine and subsequently was shown to stabilize mitochondrial membranes and function, which might be impaired in Huntington disease. OBJECTIVE To determine the effect of latrepirdine on cognition and global function in patients with mild to moderate Huntington disease. DESIGN Randomized, double-blind, placebo-controlled study. SETTING Sixty-four research centers in Australia, Europe, and North America. PATIENTS Four hundred three patients with mild to moderate Huntington disease and baseline cognitive impairment (Mini-Mental State Examination score, 10-26). INTERVENTION Latrepirdine (20 mg) vs matching placebo administered orally 3 times daily for 26 weeks. MAIN OUTCOME MEASURES The co-primary outcome measures were cognition as measured by the change in Mini-Mental State Examination score from baseline to week 26 and global function at week 26 as measured by the Clinician Interview-Based Impression of Change, plus carer interview, which ranges from 1 (marked improvement) to 7 (marked worsening). Secondary efficacy outcome measures included behavior, daily function, motor function, and safety. RESULTS The mean change in Mini-Mental State Examination score among participants randomized to latrepirdine (1.5-point improvement) did not differ significantly from that among participants randomized to placebo (1.3-point improvement) (P = .39). Similarly, the distribution of the Clinician Interview-Based Impression of Change, plus carer interview did not differ significantly among those randomized to latrepirdine compared with placebo (P = .84). No significant treatment effects were detected on the secondary efficacy outcome measures. The incidence of adverse events was similar between those randomized to latrepirdine (68.5%) and placebo (68.0%). CONCLUSION In patients with mild to moderate Huntington disease and cognitive impairment, treatment with latrepirdine for 6 months was safe and well tolerated but did not improve cognition or global function relative to placebo. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00920946

Progression of motor subtypes in Huntington’s disease. a 6-year follow-up study

The objective of this study is to investigate the progression of predominantly choreatic and hypokinetic-rigid signs in Huntington's disease (HD) and their relationship with cognitive and general functioning over time. The motor signs in HD can be divided into predominantly choreatic and hypokinetic-rigid subtypes. It has been reported in cross-sectional studies that predominantly choreatic HD patients perform better on functional and cognitive assessments compared to predominantly hypokinetic-rigid HD patients. The course of these motor subtypes and their clinical profiles has not been investigated longitudinally. A total of 4135 subjects who participated in the European HD Network REGISTRY study were included and classified at baseline as either predominantly choreatic (n = 891), hypokinetic-rigid (n = 916), or mixed-motor (n = 2328), based on a previously used method. The maximum follow-up period was 6 years. The mixed-motor group was not included in the analyses. Linear mixed models were constructed to investigate changes in motor subtypes over time and their relationship with cognitive and functional decline. Over the 6-year follow-up period, the predominantly choreatic group showed a significant decrease in chorea, while hypokinetic-rigid symptoms slightly increased in the hypokinetic-rigid group. On the Total Functional Capacity, Stroop test, and Verbal fluency task the rate of change over time was significantly faster in the predominantly choreatic group, while on all other clinical assessments the decline was comparable for both groups. Our results suggest that choreatic symptoms decrease over time, whereas hypokinetic-rigid symptoms slightly increase in a large cohort of HD patients. Moreover, different motor subtypes can be related to different clinical profiles

Clinical picture and risk prediction of short-term mortality in cardiogenic shock

AIMS: The aim of this study was to investigate the clinical picture and outcome of cardiogenic shock and to develop a risk prediction score for short-term mortality. METHODS AND RESULTS: The CardShock study was a multicentre, prospective, observational study conducted between 2010 and 2012. Patients with either acute coronary syndrome (ACS) or non-ACS aetiologies were enrolled within 6 h from detection of cardiogenic shock defined as severe hypotension with clinical signs of hypoperfusion and/or serum lactate >2 mmol/L despite fluid resuscitation (n = 219, mean age 67, 74% men). Data on clinical presentation, management, and biochemical variables were compared between different aetiologies of shock. Systolic blood pressure was on average 78 mmHg (standard deviation 14 mmHg) and mean arterial pressure 57 (11) mmHg. The most common cause (81%) was ACS (68% ST-elevation myocardial infarction and 8% mechanical complications); 94% underwent coronary angiography, of which 89% PCI. Main non-ACS aetiologies were severe chronic heart failure and valvular causes. In-hospital mortality was 37% (n = 80). ACS aetiology, age, previous myocardial infarction, prior coronary artery bypass, confusion, low LVEF, and blood lactate levels were independently associated with increased mortality. The CardShock risk Score including these variables and estimated glomerular filtration rate predicted in-hospital mortality well (area under the curve 0.85). CONCLUSION: Although most commonly due to ACS, other causes account for one-fifth of cases with shock. ACS is independently associated with in-hospital mortality. The CardShock risk Score, consisting of seven common variables, easily stratifies risk of short-term mortality. It might facilitate early decision-making in intensive care or guide patient selection in clinical trials

Challenges and priorities for pediatric critical care clinician-researchers in low- and middle-income countries

IntroductionThere is need for more data on critical care outcomes and interventions from low- and middle-income countries (LMIC). Global research collaborations could help improve health-care delivery for critically ill children in LMIC where child mortality rates remain high.Materials and methodsTo inform the role of collaborative research in health-care delivery for critically ill children in LMIC, an anonymous online survey of pediatric critical care (PCC) physicians from LMIC was conducted to assess priorities, major challenges, and potential solutions to PCC research. A convenience sample of 56 clinician-researchers taking care of critically ill children in LMIC was targeted. In addition, the survey was made available on a Latin American PCC website. Descriptive statistics were used for data analysis.ResultsThe majority of the 47 survey respondents worked at urban, public teaching hospitals in LMIC. Respondents stated their primary PCC research motivations were to improve clinical care and establish guidelines to standardize care. Top challenges to conducting research were lack of funding, high clinical workload, and limited research support staff. Respondent-proposed solutions to these challenges included increasing research funding options for LMIC, better access to mentors from high-income countries, research training and networks, and higher quality medical record documentation.ConclusionLMIC clinician-researchers must be better empowered and resourced to lead and influence the local and global health research agenda for critically ill children. Increased funding options, access to training and mentorship in research methodology, and improved data collection systems for LMIC PCC researchers were recognized as key needs for success

Ovarian cancer pathology characteristics as predictors of variant pathogenicity in BRCA1 and BRCA2

Funding Information: The authors gratefully thank all patients and their families for submitting their data and all the collaborators, researchers, clinicians, technicians and coordinating teams who have enabled this work to be carried out. We acknowledge the Cyprus Institute of Neurology and Genetics (CING), the CING institution and the Telethon organisation Cyprus for supporting this work. We acknowledge the contribution of the CIMBA (https://cimba.ccge.medschl.cam.ac.uk/) and ENIGMA (https://enigmaconsortium.org/) consortium, members and collaborators. We also acknowledge the contributions of the OTTA consortium (https://ottaconsortium.org/) and the AOCS Group (http://www.aocstudy.org). AOCS gratefully acknowledges additional support from Ovarian Cancer Australia and the Peter MacCallum Cancer Foundation. CIMBA acknowledges: All the families and clinicians who contributed to the studies; Catherine M. Phelan for her contribution to CIMBA until she passed away on 22 September 2017; Sue Healey, in particular taking on the task of mutation classification with the late Olga Sinilnikova; clinicians, patients, researchers, technicians and nurses of A.C. Camargo Cancer Center for their contribution to this study; Oncogenetic Department, Clinical and Functional Genomics Group, Center of Genomic Diagnostics, Biobank and other International Research Center-CIPE’ facilities at AC. Camargo Cancer Center, especially Karina Miranda Santiago, Giovana Tardin Torrezan, José Claudio Casali, Nirvana Formiga and Fabiana Baroni Makdissi; Maggie Angelakos, Judi Maskiell, Gillian Dite, Helen Tsimiklis; members and participants in the New York site of the Breast Cancer Family Registry; members and participants in the Ontario Familial Breast Cancer Registry; Vilius Rudaitis and Laimonas Griškevičius; Drs Janis Eglitis, Anna Krilova and Aivars Stengrevics; Yuan Chun Ding and Linda Steele for their work in participant enrollment and biospecimen and data management; Bent Ejlertsen for the recruitment and genetic counselling of participants; Alicia Barroso, Rosario Alonso and Guillermo Pita; all the individuals and the researchers who took part in CONSIT TEAM (Consorzio Italiano Tumori Ereditari Alla Mammella), in particular: Dario Zimbalatti, Daniela Zaffaroni, Laura Ottini, Giuseppe Giannini, Laura Papi, Gabriele Lorenzo Capone, Maria Grazia Tibiletti, Daniela Furlan, Antonella Savarese, Aline Martayan, Stefania Tommasi, Brunella Pilato and the personnel of the Cogentech Cancer Genetic Test Laboratory, Milan, Italy. The FCCC cohort (Godwin) acknowledges Ms. JoEllen Weaver and Dr. Betsy Bove, and the KUMC cohort (Sharma and Godwin) acknowledge the support of Michele Park, Lauren DiMartino, Alex Webster and the current and past members of the Biospecimen Repository Core Facility (BRCF) at KUMC; all participants, clinicians, family doctors, researchers, and technicians for their contributions and commitment to the DKFZ study and the collaborating groups in Lahore, Pakistan (Muhammad U. Rashid, Noor Muhammad, Sidra Gull, Seerat Bajwa, Faiz Ali Khan, Humaira Naeemi, Saima Faisal, Asif Loya, Mohammed Aasim Yusuf) and Bogota, Colombia (Diana Torres, Ignacio Briceno, Fabian Gil). FPGMX: members of the Cancer Genetics group (IDIS): Marta Santamariña, Miguel E. Aguado-Barrera, Olivia Fuentes Ríos and Ana Crujeiras-González; the GIIS025 research nurses and staff for their contributions to this resource, and the many families who contribute to GIIS025; IFE - Leipzig Research Centre for Civilisation Diseases (Markus Loeffler, Joachim Thiery, Matthias Nüchter, Ronny Baber); Genetic Modifiers of Cancer Risk in BRCA1/2 Mutation Carriers (GEMO) study is a study from the National Cancer Genetics Network UNICANCER Genetic Group, France. We wish to pay tribute to Olga M. Sinilnikova, who with Dominique Stoppa-Lyonnet initiated and coordinated GEMO until she sadly passed away on the June 30, 2014. The team in Lyon (Olga Sinilnikova, Mélanie Léoné, Laure Barjhoux, Carole Verny-Pierre, Sylvie Mazoyer, Francesca Damiola, Valérie Sornin) managed the GEMO samples until the biological resource centre was transferred to Paris in December 2015 (Noura Mebirouk, Fabienne Lesueur, Dominique Stoppa-Lyonnet). We want to thank all the GEMO collaborating groups for their contribution to this study: Coordinating Centre, Service de Génétique, Institut Curie, Paris, France: Muriel Belotti, Ophélie Bertrand, Anne-Marie Birot, Bruno Buecher, Sandrine Caputo, Chrystelle Colas, Emmanuelle Fourme, Marion Gauthier-Villars, Lisa Golmard, Marine Le Mentec, Virginie Moncoutier, Antoine de Pauw, Claire Saule, Dominique Stoppa-Lyonnet, and Inserm U900, Institut Curie, Paris, France: Fabienne Lesueur, Noura Mebirouk, Yue Jiao. Contributing Centres: Unité Mixte de Génétique Constitutionnelle des Cancers Fréquents, Hospices Civils de Lyon - Centre Léon Bérard, Lyon, France: Nadia Boutry-Kryza, Alain Calender, Sophie Giraud, Mélanie Léone. Institut Gustave Roussy, Villejuif, France: Brigitte Bressac-de-Paillerets, Odile Cabaret, Olivier Caron, Marine Guillaud-Bataille, Etienne Rouleau. Centre Jean Perrin, Clermont–Ferrand, France: Yves-Jean Bignon, Nancy Uhrhammer. Centre Léon Bérard, Lyon, France: Valérie Bonadona, Sophie Dussart, Christine Lasset, Pauline Rochefort. Centre François Baclesse, Caen, France: Pascaline Berthet, Laurent Castera, Dominique Vaur. Institut Paoli Calmettes, Marseille, France: Violaine Bourdon, Catherine Noguès, Tetsuro Noguchi, Cornel Popovici Audrey Remenieras, Hagay Sobol. CHU Arnaud-de-Villeneuve, Montpellier, France: Isabelle Coupier, Pascal Pujol. Centre Oscar Lambret, Lille, France: Claude Adenis, Aurélie Dumont, Françoise Révillion. Centre Paul Strauss, Strasbourg, France: Danièle Muller. Institut Bergonié, Bordeaux, France: Emmanuelle Barouk-Simonet, Françoise Bonnet, Virginie Bubien, Anaïs Dupré, Anne Floquet, Michel Longy, Marie Louty, Cécile Maninna, Nicolas Sevenet, Institut Claudius Regaud, Toulouse, France: Laurence Gladieff, Rosine Guimbaud, Viviane Feillel, Christine Toulas. CHU Grenoble, France: Hélène Dreyfus, Dominique Leroux, Clémentine Legrand, Christine Rebischung. CHU Dijon, France: Amandine Baurand, Geoffrey Bertolone, Fanny Coron, Laurence Faivre, Caroline Jacquot, Sarab Lizard, Sophie Nambot. CHU St-Etienne, France: Caroline Kientz, Marine Lebrun, Fabienne Prieur. Hôtel Dieu Centre Hospitalier, Chambéry, France: Sandra Fert Ferrer. Centre Antoine Lacassagne, Nice, France: Véronique Mari. CHU Limoges, France: Laurence Vénat-Bouvet. CHU Nantes, France: Stéphane Bézieau, Capucine Delnatte. CHU Bretonneau, Tours and Centre Hospitalier de Bourges France: Isabelle Mortemousque. Groupe Hospitalier Pitié-Salpétrière, Paris, France: Florence Coulet, Mathilde Warcoin. CHU Vandoeuvre-les-Nancy, France: Myriam Bronner, Johanna Sokolowska. CHU Besançon, France: Marie-Agnès Collonge-Rame. CHU Poitiers, Centre Hospitalier d’Angoulême and Centre Hospitalier de Niort, France: Stéphanie Chieze-Valero, Paul Gesta, Brigitte Gilbert-Dussardier. Centre Hospitalier de La Rochelle: Hakima Lallaoui. CHU Nîmes Carémeau, France: Jean Chiesa. CHI Poissy, France: Denise Molina-Gomes. CHU Angers, France: Olivier Ingster; CHU de Martinique, France: Odile Bera; Mickaelle Rose; Drs. Taru A. Muranen and Carl Blomqvist, RN Outi Malkavaara; The Hereditary Breast and Ovarian Cancer Research Group Netherlands (HEBON) consists of the following Collaborating Centres: Netherlands Cancer Institute (coordinating center), Amsterdam, NL: M.K. Schmidt, F.B.L. Hogervorst, F.E. van Leeuwen, M.A. Adank, D.J. Stommel-Jenner, R. de Groot; Erasmus Medical Center, Rotterdam, NL: J.M. Collée, M.J. Hooning, I.A. Boere; I.R. Geurts-Giele; Leiden University Medical Center, NL: C.J. van Asperen, P. Devilee, R.B. van der Luijt, T.C.T.E.F. van Cronenburg; Radboud University Nijmegen Medical Center, NL: M.R. Wevers, A.R. Mensenkamp; University Medical Center Utrecht, NL: M.G.E.M. Ausems, M.J. Koudijs; Amsterdam UMC, NL: K. van Engelen, J.J.P. Gille; Maastricht University Medical Center, NL: E.B. Gómez García, M.J. Blok, M. de Boer; University Medical Center Groningen, University of Groningen, NL: L.P.V. Berger, A.H. van der Hout, M.J.E. Mourits, G.H. de Bock; The Netherlands Comprehensive Cancer Organisation (IKNL): S. Siesling, J. Verloop; The nationwide network and registry of histo- and cytopathology in The Netherlands (PALGA): Q.J.M Voorham; the study participants and the registration teams of IKNL and PALGA for part of the HEBON data collection; Hong Kong Sanatorium and Hospital; the Hungarian Breast and Ovarian Cancer Study Group members (Attila Patócs, János Papp, Anikó Bozsik, Timea Pócza, Henriett Butz, Zoltán Mátrai, Lajos Géczi, National Institute of Oncology, Budapest, Hungary) and the clinicians and patients for their contributions to this study; Fatemeh Yadegari, Shiva Zarinfam and Rezvan Esmaeili for their role in participant enrollment and biospecimen and data management; the study participants and registration teams of the Hereditary Cancer Genetics Group of the Valld’Hebron Institute of Oncolgy (VHIO) and the Clinical and Molecular Genetics Department of the University Hospital Vall d’Hebron (HVH), the Cellex Foundation for providing research facilities, and CERCA Programme/Generalitat de Catalunya for institutional support; members and participants of the Inherited Cancer Registry (ICARE); the ICO Hereditary Cancer Program team led by Dr. Gabriel Capella; the ICO Hereditary Cancer Program team led by Dr. Gabriel Capella; Dr Martine Dumont for sample management and skilful assistance; Catarina Santos and Pedro Pinto; members of the Center of Molecular Diagnosis, Oncogenetics Department and Molecular Oncology Research Center of Barretos Cancer Hospital; Heather Thorne, Eveline Niedermayr, all the kConFab research nurses and staff, the heads and staff of the Family Cancer Clinics, and the Clinical Follow Up Study (which has received funding from the NHMRC, the National Breast Cancer Foundation, Cancer Australia, and the National Institute of Health (USA)) for their contributions to this resource, and the many families who contribute to kConFab; the KOBRA Study Group; all participants and the collaborators from RCGEB “Georgi D. Efremov”, MASA (Ivana Maleva Kostovska, Simona Jakovcevska, Sanja Kiprijanovska), University Clinic of Radiotherapy and Oncology (Snezhana Smichkoska, Emilija Lazarova, Marina Iljovska), Adzibadem-Sistina Hospital (Katerina Kubelka-Sabit, Dzengis Jasar, Mitko Karadjozov), and Re-Medika Hospital (Andrej Arsovski and Liljana Stojanovska) for their contributions and commitment to the MACBRCA study; Csilla Szabo (National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA); Lenka Foretova and Eva Machackova (Department of Cancer Epidemiology and Genetics, Masaryk Memorial Cancer Institute and MF MU, Brno, Czech Republic); Petra Kleiblova, Marketa Janatova, Jana Soukupova (Institute of Medical Biochemistry and Laboratory Diagnostics, 1st Faculty of Medicine, Charles University and General University Hospital in Prague (VFN), Czechia), Petra Zemankova, Petr Nehasil (Institute of Pathological Physiology, 1st Faculty of Medicine, Charles University, Czechia), Michal Vocka (Department of Oncology, General University Hospital in Prague (VFN), Czechia), Anne Lincoln, Lauren Jacobs; the participants in Hereditary Breast/Ovarian Cancer Study and Breast Imaging Study for their selfless contributions to our research; the NICCC National Familial Cancer Consultation Service team led by Sara Dishon, the lab team led by Dr. Flavio Lejbkowicz, and the research field operations team led by Dr. Mila Pinchev; the staff of Genetic Health Service NZ and the families who have contributed; members and participants in the Ontario Cancer Genetics Network; Hayley Cassingham. Leigha Senter, Kevin Sweet, Julia Cooper, and Amber Aielts; research nurses and staff of Breast Unit, Pauls Stradins Clinical University Hopsital, RSUIO and the many families who contribute to the CIMBA registry of RSUIO; Yip Cheng Har, Nur Aishah Mohd Taib, Phuah Sze Yee, Norhashimah Hassan and all the research nurses, research assistants and doctors involved in the MyBrCa Study for assistance in patient recruitment, data collection and sample preparation, Philip Iau, Sng Jen-Hwei and Sharifah Nor Akmal for contributing samples from the Singapore Breast Cancer Study and the HUKM-HKL Study respectively; the National Cancer Centre Singapore Cancer Genetics Service (NCCS) for patient recruitement; the Meirav Comprehensive breast cancer center team at the Sheba Medical Center; Christina Selkirk; Håkan Olsson, Helena Jernström, Karin Henriksson, Katja Harbst, Maria Soller, Ulf Kristoffersson; from Gothenburg Sahlgrenska University Hospital: Anna Öfverholm, Margareta Nordling, Per Karlsson, Zakaria Einbeigi; from Stockholm and Karolinska University Hospital: Anna von Wachenfeldt, Annelie Liljegren, Annika Lindblom, Brita Arver, Gisela Barbany Bustinza, Johanna Rantala; from Umeå University Hospital: Beatrice Melin, Christina Edwinsdotter Ardnor, Monica Emanuelsson; from Uppsala University: Hans Ehrencrona, Maritta Hellström Pigg, Richard Rosenquist; from Linköping University Hospital: Marie Stenmark-Askmalm, Sigrun Liedgren; Cecilia Zvocec, Qun Niu; Joyce Seldon and Lorna Kwan; Dr. Robert Nussbaum, Beth Crawford, Kate Loranger, Julie Mak, Nicola Stewart, Robin Lee, Amie Blanco and Peggy Conrad and Salina Chan; Simon Gayther and Patricia Harrington; Geoffrey Lindeman, Marion Harris, Joanne McKinley, Simone McInerny, and Ella Thompson for performing all DNA amplification. HEBCS thanks Drs. Kristiina Aittomäki, Carl Blomqvist and Taru A. Muranen and research nurses Irja Erkkilä and Outi Malkavaara. HJO acknowledges the oncologists Tjoung-Won Park-Simon and Peter Hillemanns at Hannover Medical School, Clemens Liebrich at the Gynecology Clinics Wolfsburg, Ingo Runnebaum at the Gynaecology Clinics at the University of Jena, and Peter Dall at the Gynecology Clinics at the University of Lüneburg for providing clinical data and medical records to this analysis, Peter Schürmann for technical assistance, and Dhanya Ramachandran for contributing to BRCA1 and BRCA2 VUS analyses. The contents of the published material are solely the responsibility of the authors and do not reflect the views of NHMRC. Publisher Copyright: © 2023, The Author(s).Background: The distribution of ovarian tumour characteristics differs between germline BRCA1 and BRCA2 pathogenic variant carriers and non-carriers. In this study, we assessed the utility of ovarian tumour characteristics as predictors of BRCA1 and BRCA2 variant pathogenicity, for application using the American College of Medical Genetics and the Association for Molecular Pathology (ACMG/AMP) variant classification system. Methods: Data for 10,373 ovarian cancer cases, including carriers and non-carriers of BRCA1 or BRCA2 pathogenic variants, were collected from unpublished international cohorts and consortia and published studies. Likelihood ratios (LR) were calculated for the association of ovarian cancer histology and other characteristics, with BRCA1 and BRCA2 variant pathogenicity. Estimates were aligned to ACMG/AMP code strengths (supporting, moderate, strong). Results: No histological subtype provided informative ACMG/AMP evidence in favour of BRCA1 and BRCA2 variant pathogenicity. Evidence against variant pathogenicity was estimated for the mucinous and clear cell histologies (supporting) and borderline cases (moderate). Refined associations are provided according to tumour grade, invasion and age at diagnosis. Conclusions: We provide detailed estimates for predicting BRCA1 and BRCA2 variant pathogenicity based on ovarian tumour characteristics. This evidence can be combined with other variant information under the ACMG/AMP classification system, to improve classification and carrier clinical management.Peer reviewe