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11 ["Ovarian Cancer in Elderly Patients: Patterns of Care and Treatment Outcomes According to Age and Modified Frailty Index"] 10.1097/igc.0000000000001097 2017-08-01T21:01:48Z [] 28 10 ["1048-891X", "1525-1438"] International Journal of Gynecologic Cancer <jats:sec><jats:title>Objective</jats:title><jats:p>The present study assessed the predictive value of age and Modified Frailty Index (mFI) on the management of primary epithelial ovarian cancer (EOC) patients aged 70 years or older (elderly).</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>A retrospective multicenter study selected elderly EOC patients treated between 2006 and 2014. Treatments were analyzed according to the following age group categories: (1) 70 to 75 years versus (2) older than 75 years, and mFI of less than 4 (low frailty) versus greater than or equal to 4 (high frailty).</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Seventy-eight patients were identified (40 in age group 1 and 38 in age group 2). The mFI was greater than or equal to 4 in 23 women. Median age of low frailty and high frailty was not significantly different (75.6 vs 75.3). Comorbidities were equally distributed according to age, whereas diabetes, hypertension, obesity, and chronic renal failure were more frequent in the high-frailty group. Performance status was different only according to mFI. Twenty percent of age group 1 versus 55.3% of age group 2 underwent none or only explorative surgical approach (<jats:italic>P</jats:italic> = 0.003), whereas surgical approaches were similar in the 2 frailty groups. The rate of postoperative complications was higher in high-frailty patients compared with low-frailty patients (23.5% vs 4.3%; <jats:italic>P</jats:italic> = 0.03). Chemotherapy was administered to all the patients, a monotherapy regimen to 50% of them. No differences in toxicity were registered, except more hospital recovery in the high-frailty cohort. Median survival time was in favor of younger patients (98 versus 30 months) and less-frailty patients (56 vs 27 months).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Elderly EOC patients can receive an adequate treatment, but patients who are older than 75 years can be undertreated, if not adequately selected. The pretreatment assessment of frailty through mFI could be suggested in the surgical and medical management.</jats:p></jats:sec> 8 [] ["Annamaria Ferrero", "Luca Fuso", "Elisa Tripodi", "Roberta Tana", "Alberto Daniele", "Valentina Zanfagnin", "Stefania Perotto", "Angiolo Gadducci"] [""] [""] [""]
12 ["Exploring the potential chemopreventative effect of aspirin and rofecoxib on hereditary nonpolyposis colorectal cancer\u2013like endometrial cancer cells in vitro through mechanisms involving apoptosis, the cell cycle, and mismatch repair gene expression"] 10.1111/j.1525-1438.2007.00867.x 2007-02-21T17:45:30Z [] 34 10 ["1048-891X", "1525-1438"] International Journal of Gynecologic Cancer <jats:p>Women in hereditary nonpolyposis colorectal cancer (HNPCC) families have up to a 71% lifetime risk for developing endometrial cancer (EC). This compares to the female lifetime risk for colorectal cancer (CRC) in HNPCC of 60%. The basis of HNPCC is an inherited mutation in a mismatch repair gene (MMR). Aspirin and COX2 inhibitors seem to have a chemoprotective effect on CRC in the general population and are the subject of prospective clinical studies in patients at high risk for CRC including HNPCC. There is no evidence that these agents have any protective effect against EC in the general population. This study investigated the effect of aspirin and a COX2 inhibitor (rofecoxib) on an HNPCC EC cell line model (Ishikawa) by assessing the effect on proliferation, apoptosis, the cell cycle, and MMR gene expression. Aspirin inhibits EC cell proliferation by inducing apoptosis and changes in the cell cycle. This effect is not mediated by changes in MMR gene (hMSH2) expression as assessed by quantitative reverse transcription–polymerase chain reaction. Rofecoxib inhibits EC cell proliferation; this did not appear to be mediated by induction of apoptosis, by alterations of the cell cycle, or by changes in MMR gene expression</jats:p> 5 [] ["N. J. Wood", "N. A. Quinton", "S. Burdall", "E. Sheridan", "S. R. Duffy"] [""] [""] [""]
13 ["Assessing clinical reasoning using a script concordance test with electrocardiogram in an emergency medicine clerkship rotation"] 10.1136/emermed-2012-201737 2013-03-29T00:49:44Z ["Critical Care and Intensive Care Medicine", "Emergency Medicine", "General Medicine"] 19 10 ["1472-0205", "1472-0213"] Emergency Medicine Journal <jats:sec><jats:title>Objectives</jats:title><jats:p>Script concordance tests (SCTs) can be used to assess clinical reasoning, especially in situations of uncertainty, by comparing the responses of examinees with those of emergency physicians. The examinee's answers are scored based on the level of agreement with responses provided by a panel of experts. Emergency physicians are frequently uncertain in the interpretation of ECGs. Thus, the aim of this study was to validate an SCT combined with an ECG.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>An SCT-ECG was developed. The test was administered to medical students, residents and emergency physicians. Scoring was based on data from a panel of 12 emergency physicians. The statistical analyses assessed the internal reliability of the SCT (Cronbach's α) and its ability to discriminate between the different groups (ANOVA followed by Tukey's post hoc test).</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>The SCT-ECG was administered to 21 medical students, 19 residents and 12 emergency physicians. The internal reliability was satisfactory (Cronbach's α=0.80). Statistically significant differences were found between the groups (F<jats:sub>0.271</jats:sub>=21.07; p&lt;0.0001). Moreover, significant differences (post hoc test) were detected between students and residents (p&lt;0.001), students and experts (p&lt;0.001), and residents and experts (p=0.017).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>This SCT-ECG is a valid tool to assess clinical reasoning in a context of uncertainty due to its high internal reliability and its ability to discriminate between different levels of expertise.</jats:p></jats:sec> 5 [] ["Caroline Boulouffe", "Bruno Doucet", "Xavier Muschart", "Bernard Charlin", "Dominique Vanpee"] [""] [""] [""]
14 ["Study protocol for a randomised controlled trial evaluating the effect of prenatal omega-3 LCPUFA supplementation to reduce the incidence of preterm birth: the ORIP trial"] 10.1136/bmjopen-2017-018360 2017-09-26T00:10:18Z [] 0 10 ["2044-6055", "2044-6055"] BMJ Open <jats:sec><jats:title>Introduction</jats:title><jats:p>Preterm birth accounts for more than 85% of all perinatal complications and deaths. Seventy-five per cent of early preterm births (EPTBs) occur spontaneously and without identifiable risk factors. The need for a broadly applicable, effective strategy for primary prevention is paramount. Secondary outcomes from the docosahexaenoic acid (DHA) to Optimise Mother Infant Outcome trial showed that maternal supplementation until delivery with omega-3 (ω-3) long chain polyunsaturated fatty acid (LCPUFA), predominantly as DHA, resulted in a 50% reduction in the incidence of EPTB and an increase in the incidence of post-term induction or post-term prelabour caesarean section due to extended gestation. We aim to determine the effectiveness of supplementing the maternal diet with ω-3 LCPUFA until 34 weeks’ gestation on the incidence of EPTB.</jats:p></jats:sec><jats:sec><jats:title>Methods and analysis</jats:title><jats:p>This is a multicentre, parallel group, randomised, blinded and controlled trial. Women less than 20 weeks’ gestation with a singleton or multiple pregnancy and able to give informed consent are eligible to participate. Women will be randomised to receive high DHA fish oil capsules or control capsules without DHA. Capsules will be taken from enrolment until 34 weeks’ gestation. The primary outcome is the incidence of EPTB, defined as delivery before 34 completed weeks’ gestation. Key secondary outcomes include length of gestation, incidence of post-term induction or prelabour caesarean section and spontaneous EPTB. The target sample size is 5540 women (2770 per group), which will provide 85% power to detect an absolute reduction in the incidence of preterm birth of 1.16% (from 2.45% to 1.29%) between the DHA and control group (two sided α=0.05). The primary analysis will be based on the intention-to-treat principle.</jats:p></jats:sec><jats:sec><jats:title>Trial registration number</jats:title><jats:p>Australia and New Zealand Clinical Trial Registry Number: 2613001142729; Pre-results.</jats:p></jats:sec> 7 [] ["Shao J Zhou", "Karen Best", "Robert Gibson", "Andrew McPhee", "Lisa Yelland", "Julie Quinlivan", "Maria Makrides"] [] ["National Health and Medical Research Council"] ["10.13039/501100000925"]