199 results found
Vali S, Jones BP, Saso S, et al., 2021, Uterine transplantation: Legal and regulatory implications in England., BJOG
Uterus transplantation (UTx) is fast evolving from an experimental to a clinical procedure, combining solid organ transplantation with assisted reproductive technology. The commencement of the first human uterus transplant trial in the United Kingdom leads us to examine and reflect upon the legal and regulatory aspects closely intertwined with UTx from the process of donation to potential implications on fertility treatment and the birth of the resultant child. As the world's first ephemeral transplant, the possibility of organ restitution requires consideration and is discussed herein.
Salvo G, Ramirez PT, Leitao MM, et al., 2021, Open Versus Minimally Invasive Radical Trachelectomy in Early-Stage Cervical Cancer: International Radical Trachelectomy Assessment Study., Am J Obstet Gynecol
BACKGROUND: Minimally invasive radical trachelectomy has emerged as an alternative to open radical hysterectomy for patients with early-stage cervical cancer desiring future fertility. Recent data suggest worse oncologic outcomes after minimally invasive radical hysterectomy than after open radical hysterectomy in stage I cervical cancer. OBJECTIVE: To compare 4.5-year disease-free survival after open versus minimally invasive radical trachelectomy. STUDY DESIGN: This was a collaborative, international retrospective study (International Radical Trachelectomy Assessment Study) of patients treated during 2005-2017 at 18 centers in 12 countries. Eligible patients had squamous, adenocarcinoma, or adenosquamous carcinoma; had preoperative tumor size ≤2 cm; and underwent open or minimally invasive (robotic or laparoscopic) radical trachelectomy with nodal assessment (pelvic lymphadenectomy and/or sentinel lymph node biopsy). Exclusion criteria included neoadjuvant chemotherapy or preoperative pelvic radiotherapy, prior lymphadenectomy or pelvic retroperitoneal surgery, pregnancy, stage IA1 disease with lymphovascular space invasion, aborted trachelectomy (conversion to radical hysterectomy), or vaginal approach. Surgical approach, indication, and adjuvant therapy regimen were at the discretion of the treating institution. A total of 715 consecutive patients were entered in the study database. Sixty-nine patients were excluded, leaving 646 in the analysis. Endpoints were the 4.5-year disease-free survival rate (primary), 4.5-year overall survival rate (secondary), and recurrence rate (secondary). Kaplan-Meier methods were used to estimate disease-free survival and overall survival. A post hoc weighted analysis was conducted to compare the recurrence rate between surgical approaches, with open surgery considered standard and minimally invasive surgery considered experimental. RESULTS: Of the 646 patients, 358 underwent open surgery, and 288 underwent minimally invasive s
Hughes T, Bracewell-Milnes T, Saso S, et al., 2021, A review on the motivations, decision-making factors, attitudes and experiences of couples using pre-implantation genetic testing for inherited conditions., Hum Reprod Update, Vol: 27, Pages: 944-966
BACKGROUND: In pre-implantation genetic testing (PGT), fertile couples undergo IVF with genetic testing of embryos to avoid conceptions with a genetic condition. There is an exponentially increasing uptake with over 600 applications listed by the Human Fertilisation and Embryology Authority in the UK. The psychological aspects of the decision-making process and the experience of PGT, however, are relatively underevaluated, with the potential to leave patients unsupported in their journeys. OBJECTIVE AND RATIONALE: In this review, we aim to comprehensively report on every aspect of couples' experiences of PGT. We consider what motivates users, the practical and ethical decisions involved and how couples navigate the decision-making process. Additionally, we report on the social and psychological impact on couples who are actively undergoing or have completed the PGT process. SEARCH METHODS: A systematic search of English peer-reviewed journals of three computerized databases was undertaken following PRISMA guidelines. Studies that examined the motivations, attitudes, decision-making factors and experiences of patients who have been actively engaged in the PGT process were included. No restrictions were placed on study design or date of publication. Studies examining patients using PGT in a hypothetical context or solely using PGT for aneuploidy were excluded. Qualitative data were extracted using thematic analysis. OUTCOMES: The main outcomes were patient motivations, deciding factors and attitudes, as well as the patient experience of coming to a decision and going through PGT.Patients were primarily motivated by the desire to have a healthy child and to avoid termination of pregnancy. Those with a sick child or previous experience of termination were more likely to use PGT. Patients also felt compelled to make use of the technology available, either from a moral responsibility to do so or to avoid feelings of guilt if not. The main factors considered when deciding
Ahmed-Salim Y, Saso S, Meehan H, et al., 2021, A novel application of calcium electroporation to cutaneous manifestations of gynaecological cancer, European Journal of Gynecological Oncology, Vol: 42, Pages: 662-672, ISSN: 0392-2936
Introduction: Calcium electroporation (CaEP) is a new technique whereby intracellular concentrations of calcium are elevated by transient permeabilisation of the cell membrane using high-voltage electrical pulses. Tumour necrosis is induced with little damage to healthy tissue. Within gynaecological cancer, vulval cancer and vulval intraepithelial neoplasia (VIN) pose challenges for treatment, given the high recurrence rate, persistent symptoms and repeated resections required. In certain cases, CaEP may provide a suitable alternative.Methods: We present a case series of six patients with recurrent vulval squamous cell carcinoma(n=2), VIN III (n=2) and metastatic ovarian cancer (n=2), five of whom were treated with CaEP. This is the first known application of CaEP to gynaecological cancers .Results: The median follow-up time was 14 months (range 2-18 months). Within the cohort of patients, CaEP was applied a total of 10 times, achieving a complete response five times and partial response four times. Symptoms improved within six weeks for eight episodes following CaEP application. Beyond six weeks, symptoms eventually recurred in all patients and four patients required more than one CaEP procedure. CaEP was useful for palliation of distressing symptoms in one case of metastatic ovarian cancer. No intra-operative or post-operative complications have been reported to date. Conclusion: CaEP may be a promising short-term treatment in selected patients with recurrent VIN and vulval cancer, where other treatments had failed. If validated, it could provide an acceptable alternative where surgery is unacceptable. Long term follow-up is required to evaluate effects on recurrence.
Jones BP, Kasaven L, Vali S, et al., 2021, Uterine Transplantation: Review of Livebirths and Reproductive Implications, TRANSPLANTATION, Vol: 105, Pages: 1695-1707, ISSN: 0041-1337
Bracewell-Milnes T, Holland JC, Jones BP, et al., 2021, Exploring the knowledge and attitudes of women of reproductive age from the general public towards egg donation and egg sharing: a UK-based study., Human Reproduction, Vol: 36, Pages: 2189-2201, ISSN: 0268-1161
STUDY QUESTION: What are the knowledge and views of UK-based women towards egg donation (ED) and egg sharing (ES)? SUMMARY ANSWER: Lacking knowledge of the practices of ED and ES could be an influential factor in donor egg shortages, rather than negative perceptions or lack of donor anonymity and financial incentives. WHAT IS KNOWN ALREADY: The increasing age of women trying to conceive has led to donor egg shortages, with ED and ES failing to meet demand. Indeed, in recent years in the UK, ES numbers have fallen. This results in long waiting lists, forcing patients abroad for fertility treatment to take up cross border reproductive care. Previous research suggests a lack of knowledge of ED among members of the general public; however, no study has yet assessed knowledge or views of ES in the general public. STUDY DESIGN, SIZE, DURATION: Six hundred and thirty-five UK-based women over 18 years were voluntarily recruited from social media community groups by convenience sampling. The recruitment period was from February to April 2020. PARTICIPANTS/MATERIALS, SETTING, METHODS: Participants completed a previously validated questionnaire regarding female fertility, ED and ES, including knowledge, perceptions and approval of the practices and relevant legislation. This included ranking key benefits and issues regarding egg sharing. The questionnaire was completed using the online Qualtrics survey software. Statistical analysis was conducted using SPSS. MAIN RESULTS AND THE ROLE OF CHANCE: Regarding knowledge of ED and ES, 56.3% and 79.8%, respectively had little or no prior knowledge. Upon explanation, most approved of ED (85.8%) and ES (70.4%). A greater proportion of respondents would donate to a family member/friend (49.75%) than to an anonymous recipient (35.80%). Overall, ES was viewed less favourably than ED, with ethical and practical concerns highlighted. Women aged 18-30 years were significantly more likely to approve of egg donation practice compa
Sorbi F, Capezzuoli T, Saso S, et al., 2021, The relation between endometrioma and ovarian cancer, MINERVA OBSTETRICS AND GYNECOLOGY, Vol: 73, Pages: 347-353, ISSN: 2724-606X
Keefe D, 2021, Fertility Treatment and Cancers-The Eternal Conundrum: A Systematic Review and Meta-analysis, OBSTETRICAL & GYNECOLOGICAL SURVEY, Vol: 76, Pages: 343-344, ISSN: 0029-7828
Elfaki N, Lutaaya N, Hardiman PJ, et al., 2021, Oocyte cryopreservation for social reasons versus fertility preservation; a systematic review, Publisher: WILEY, Pages: 238-238, ISSN: 1470-0328
Ahmed-Salim Y, Galazis N, Bracewell-Milnes T, et al., 2021, The application of metabolomics in ovarian cancer management: a systematic review, INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER, Vol: 31, Pages: 754-774, ISSN: 1048-891X
Jones BP, Saso S, Yazbek J, et al., 2021, Uterine Transplantation Scientific Impact Paper No. 65 April 2021, BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Vol: 128, Pages: E51-E66, ISSN: 1470-0328
Vali S, Jones B, Saso S, et al., 2021, Uterine transplantation: Legal and regulatory implications in the UK, BJOG: an International Journal of Obstetrics and Gynaecology, ISSN: 1470-0328
Uterus transplantation (UTx) is fast evolving from an experimental to a clinical procedure, combining solid organ transplantation with assisted reproductive technology. The commencement of the first human uterus transplant trial in the United Kingdom leads us to examine and reflect upon the legal and regulatory aspects closely intertwined with UTx from the process of donation to potential implications on fertility treatment and the birth of the resultant child. As the world’s first ephemeral transplant, the possibility of organ restitution requires consideration and is discussed herein. Public funding of fertility treatments pertaining to UTx remains variable and warrants review.
Kasaven LS, Jones BP, Keays R, et al., 2021, Anaesthetic considerations for fertility-sparing surgery and uterine transplantation, ANAESTHESIA, Vol: 76, Pages: 46-55, ISSN: 0003-2409
Jones BP, Ranaei-Zamani N, Vali S, et al., 2021, Options for acquiring motherhood in absolute uterine factor infertility; adoption, surrogacy and uterine transplantation, OBSTETRICIAN & GYNAECOLOGIST, Vol: 23, Pages: 138-147, ISSN: 1467-2561
Barcroft JF, Galazis N, Jones BP, et al., 2021, Fertility treatment and cancers-the eternal conundrum: a systematic review and meta-analysis., Human Reproduction, Vol: 36, Pages: 1093-1107, ISSN: 0268-1161
STUDY QUESTION: Does fertility treatment (FT) significantly increase the incidence of breast, ovarian, endometrial or cervical cancer? SUMMARY ANSWER: Overall, FT does not significantly increase the incidence of breast, ovarian or endometrial cancer and may even reduce the incidence of cervical cancer. WHAT IS KNOWN ALREADY: Infertility affects more than 14% of couples. Infertility and nulliparity are established risk factors for endometrial, ovarian and breast cancer, yet the association with FT is more contentious. STUDY DESIGN, SIZE, DURATION: A literature search was carried out using Cochrane Library, EMBASE, Medline and Google Scholar up to December 2019. Peer-reviewed studies stating cancer incidence (breast, ovarian, endometrial or cervical) in FT and no-FT groups were identified. Out of 128 studies identified, 29 retrospective studies fulfilled the criteria and were included (n = 21 070 337). PARTICIPANTS/MATERIALS, SETTING, METHODS: In the final meta-analysis, 29 studies were included: breast (n = 19), ovarian (n = 19), endometrial (n = 15) and cervical (n = 13), 17 studies involved multiple cancer types and so were included in each individual cancer meta-analysis. Primary outcome of interest was cancer incidence (breast, ovarian, endometrial and cervical) in FT and no-FT groups. Secondary outcome was cancer incidence according to specific fertility drug exposure. Odds ratio (OR) and random effects model were used to demonstrate treatment effect and calculate pooled treatment effect, respectively. A meta-regression and eight sub-group analyses were performed to assess the impact of the following variables, maternal age, infertility, study size, outliers and specific FT sub-types, on cancer incidence. MAIN RESULTS AND THE ROLE OF CHANCE: Cervical cancer incidence was significantly lower in the FT group compared with the no-FT group: OR 0.68 (95% CI 0.46-0.99). The incidences
Jones BP, Bracewell-Milnes T, Kasaven L, et al., 2021, Pre-implantation genetic testing for aneuploidy: motivations, concerns, and perceptions in a UK population, 36th Virtual Annual Meeting of the European-Society-of-Human-Reproduction-and-Embryology (ESHRE), Publisher: SPRINGER/PLENUM PUBLISHERS, Pages: I344-I345, ISSN: 1058-0468
Jones BP, Rajamanoharan A, Williams NJ, et al., 2021, Uterine Transplantation Using Living Donation: A Cross-sectional Study Assessing Perceptions, Acceptability, and Suitability, TRANSPLANTATION DIRECT, Vol: 7, ISSN: 2373-8731
Grewal K, Jones B, L'Heveder A, et al., 2021, The use of intra-operative ultrasound in gynecological surgery: a review, Future Science OA, Vol: 7, ISSN: 2056-5623
Ultrasound is a readily available, safe and portable imaging modality that is widely applied in gynecology. However, there is limited guidance for its use intra-operatively especially with complex gynecological procedures. This narrative review examines the existing literature published on the use of intraoperative ultrasound (IOUS) in benign gynecology and in gynecological oncology. We searched for the following terms: ‘intraoperative,’ ‘ultrasonography,’ ‘gynecology’ and ‘oncology’ using Pubmed/Medline. IOUS can minimize complications and facilitate difficult benign gynecological procedures. There is also a role for its use in gynecological oncology surgery and fertility-sparing surgery. The use of IOUS in gynecological surgery is an emerging field which improves visualization in the surgical field and aids completion of minimally invasive techniques.
Jones BP, Rajamanoharan A, Vali S, et al., 2021, Perceptions and Motivations for Uterus Transplant in Transgender Women, JAMA NETWORK OPEN, Vol: 4, ISSN: 2574-3805
Glasbey JC, Omar O, Nepogodiev D, et al., 2021, Preoperative nasopharyngeal swab testing and postoperative pulmonary complications in patients undergoing elective surgery during the SARS-CoV-2 pandemic, BRITISH JOURNAL OF SURGERY, Vol: 108, Pages: 88-96, ISSN: 0007-1323
Sorbi F, Fambrini M, Saso S, et al., 2020, Office hysteroscopy in pre- and post-menopausal women: a predictive model, GYNECOLOGICAL ENDOCRINOLOGY, Vol: 37, Pages: 206-210, ISSN: 0951-3590
Murugesu S, Galazis N, Jones B, et al., 2020, Evaluating the use of Telemedicine in Gynaecological Practice: A Systematic Review, BMJ Open, Vol: 10, ISSN: 2044-6055
Objectives The aim of this systematic review is to examine the use of telemedicine in the delivery and teaching of gynaecological clinical practice. To our knowledge, no other systematic review has assessed this broad topic.Design Systematic review of all studies investigating the use of telemedicine in the provision of gynaecological care and education. The search for eligible studies followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and focused on three online databases: PubMed, Science Direct and SciFinder.Eligibility criteria Only studies within gynaecology were considered for this review. Studies covering only obstetrics and with minimal information on gynaecology, or clinical medicine in general were excluded. All English language, peer-reviewed human studies were included. Relevant studies published up to the date of final submission of this review were considered with no restrictions to the publication year.Data extractions and synthesis Data extracted included author details, year of publication and country of the study, study aim, sample size, methodology, sample characteristics, outcome measures and a summary of findings. Data extraction and qualitative assessment were performed by the first author and crossed checked by the second author. Quality assessment for each study was assessed using the Newcastle-Ottawa scale.Results A literature search carried out in August 2020 yielded 313 records published between 1992 and 2018. Following a rigorous selection process, only 39 studies were included for this review published between 2000 and 2018. Of these, 19 assessed gynaecological clinical practice, eight assessed gynaecological education, one both, and 11 investigated the feasibility of telemedicine within gynaecological practice. 19 studies were classified as good, 12 fair and eight poor using the Newcastle-Ottawa scale. Telecolposcopy and abortion care were two areas where telemedicine was found to be effective in p
Ben-Nagi J, Kasaven LS, Jones BP, et al., 2020, Oocyte yield in social, medical and donor oocyte cryopreservation cycles, HUMAN FERTILITY, ISSN: 1464-7273
Kasaven LS, Saso S, Barcroft J, et al., 2020, Authors' reply Re: Implications for the future of Obstetrics and Gynaecology following the COVID-19 pandemic: a commentary, BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Vol: 128, Pages: 616-617, ISSN: 1470-0328
Platts S, Trigg B, Bracewell-Milnes T, et al., 2020, Exploring women's attitudes, knowledge, and intentions to use oocyte freezing for non-medical reasons: A systematic review, ACTA OBSTETRICIA ET GYNECOLOGICA SCANDINAVICA, Vol: 100, Pages: 383-393, ISSN: 0001-6349
Kasaven LS, Saso S, Barcroft J, et al., 2020, Implications for the future of obstetrics and gynaecology following the COVID-19 pandemic: a commentary., BJOG: an International Journal of Obstetrics and Gynaecology, Vol: 127, Pages: 1318-1323, ISSN: 1470-0328
In March 2020, the World Health Organization (WHO) declared COVID-19 a global pandemic. At the time of writing, more than 261,184 cases of COVID-19 have been confirmed in the UK resulting in over 36,914 directly attributable deaths.1 The National Health Service (NHS) has been confronted with the unprecedented task of dealing with the enormity of the resultant morbidity and mortality. In addition, the workforce has been depleted as a direct consequence of the disease, in most cases temporarily, but in some tragic cases permanently.
Jones B, Rajamanoharan A, Kasaven L, et al., 2020, The novel use of fertility quality of life (FertiQoL) treatment subscale to assess treatment acceptability in social egg freezing, HUMAN FERTILITY, ISSN: 1464-7273
Bracewell-Milnes T, Saso S, Jones B, et al., 2020, A systematic review exploring the patient decision-making factors and attitudes towards pre-implantation genetic testing for aneuploidy and gender selection, ACTA OBSTETRICIA ET GYNECOLOGICA SCANDINAVICA, Vol: 100, Pages: 17-29, ISSN: 0001-6349
Phelps DL, Saso S, Ghaem-Maghami S, 2020, Is ovarian cancer surgery stuck in the dark ages?: a commentary piece reviewing surgical technologies, BRITISH JOURNAL OF CANCER, Vol: 123, Pages: 1471-1473, ISSN: 0007-0920
Phelps DL, Saso S, Ghaem-Maghami S, 2020, Analysis of worldwide surgical outcomes in COVID-19-infected patients: a gynecological oncology perspective, Future Science OA, Vol: 6, Pages: 1-8, ISSN: 2056-5623
Coronavirus Disease 2019 (COVID-19) guidance limits all but the most urgent surgery in the United Kingdom. We review the literature and our experience in gynecology to assess perioperative outcomes. PubMed was searched with (surg*[Title])AND(COVID[Title]), (surg*[Title])AND(2019-nCoV[Title]), and (surg*[Title])AND(SARS-CoV-2[Title]), and 67 COVID-19-positive surgical patients across ten hospitals in four countries are included. Median mortality was 33%. Cardiac and pulmonary co-morbidities associated with higher risk of COVID-19-positive postoperative death. Mortality was high in neurosurgery (80%) and the lowest in gynecological oncology surgery (none). This analysis provides an evidence base on which to consider surgical risk assessment for different specialties. Risk of perioperative death needs to be assessed in the context of patients’ co-morbidities and surgical specialty. An individualized approach toward surgical decision making is imperative.
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