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  1. Article ; Online: Functionally Selective Inhibition of the Oxytocin Receptor by Retosiban in Human Myometrial Smooth Muscle.

    Brighton, Paul J / Fossler, Michael J / Quenby, Siobhan / Blanks, Andrew M

    Endocrinology

    2020  Volume 161, Issue 2

    Abstract: Novel small molecule inhibitors of the oxytocin receptor (OTR) may have distinct pharmacology and mode of action when compared with first-generation oxytocin antagonists when used for the prevention of preterm birth. The aim was to determine the ... ...

    Abstract Novel small molecule inhibitors of the oxytocin receptor (OTR) may have distinct pharmacology and mode of action when compared with first-generation oxytocin antagonists when used for the prevention of preterm birth. The aim was to determine the mechanism of action of small molecule OTR antagonists retosiban and epelsiban compared with the currently used peptide-based compound atosiban. Human myometrial samples were obtained at cesarean section and subjected to pharmacological manipulations to establish the effect of antagonist binding to OTR on downstream signaling. Retosiban antagonism of oxytocin action in human myometrium was potent, rapid, and reversible. Inhibition of inositol 1,4,5-trisphosphate (IP3) production followed single-site competitive binding kinetics for epelsiban, retosiban, and atosiban. Retosiban inhibited basal production of IP3 in the absence of oxytocin. Oxytocin and atosiban but not retosiban inhibited forskolin, and calcitonin stimulated 3',5'-cyclic adenosine 5'-mono-phosphate (cAMP) production. Inhibition of cAMP was reversed by pertussis toxin. Oxytocin and atosiban, but not retosiban and epelsiban, stimulated extracellular regulated kinase (ERK)1/2 activity in a time- and concentration-dependent manner. Oxytocin and atosiban stimulated cyclo-oxygenase 2 activity and subsequent production of prostaglandin E2 and F2α. Prostaglandin production was inhibited by rofecoxib, pertussin toxin, and ERK inhibitor U0126. Oxytocin but not retosiban or atosiban stimulated coupling of the OTR to Gα q G-proteins. Oxytocin and atosiban but not retosiban stimulated coupling of the OTR to Gα i G-proteins. Retosiban and epelsiban demonstrate distinct pharmacology when compared with atosiban in human myometrial smooth muscle. Atosiban displays agonist activity at micromolar concentrations leading to stimulation of prostaglandin production.
    MeSH term(s) Diketopiperazines/pharmacology ; Diketopiperazines/therapeutic use ; Drug Evaluation, Preclinical ; Female ; Humans ; Morpholines/pharmacology ; Morpholines/therapeutic use ; Myometrium/drug effects ; Myometrium/metabolism ; Piperazines/pharmacology ; Piperazines/therapeutic use ; Premature Birth/prevention & control ; Primary Cell Culture ; Receptors, Oxytocin/antagonists & inhibitors
    Chemical Substances Diketopiperazines ; GSK221149A ; Morpholines ; Piperazines ; Receptors, Oxytocin ; epelsiban (T2EZ19HX73)
    Language English
    Publishing date 2020-01-06
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 427856-2
    ISSN 1945-7170 ; 0013-7227
    ISSN (online) 1945-7170
    ISSN 0013-7227
    DOI 10.1210/endocr/bqz043
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Direct oral anticoagulants or vitamin K antagonists in emergencies: comparison of management in an observational study.

    Baker, Ross I / Gilmore, Grace / Chen, Vivien / Young, Laura / Merriman, Eileen / Curnow, Jennifer / Joseph, Joanne / Tiao, Jim Y / Chih, Jun / McRae, Simon / Harper, Paul / Tan, Chee W / Brighton, Timothy / Royle, Gordon / Hugman, Amanda / Hankey, Graeme J / Crowther, Helen / Boey, Jirping / Gallus, Alexander /
    Campbell, Philip / Tran, Huyen

    Research and practice in thrombosis and haemostasis

    2023  Volume 7, Issue 5, Page(s) 100196

    Abstract: Background: Restoring hemostasis in patients on oral anticoagulants presenting with major hemorrhage (MH) or before surgical intervention has changed, with the replacement of vitamin K antagonist (VKA) with direct oral anticoagulants (DOACs).: ... ...

    Abstract Background: Restoring hemostasis in patients on oral anticoagulants presenting with major hemorrhage (MH) or before surgical intervention has changed, with the replacement of vitamin K antagonist (VKA) with direct oral anticoagulants (DOACs).
    Objectives: To observe the difference in urgent hemostatic management between patients on VKA and those on DOACs.
    Methods: A multicenter observational study evaluated the variation in laboratory testing, hemostatic management, mortality, and hospital length of stay (LOS) in patients on VKA or DOACs presenting with MH or urgent hemostatic restoration.
    Results: Of the 1194 patients analyzed, 783 had MH (61% VKA) and 411 required urgent hemostatic restoration before surgery (56% VKA). Compared to the international normalized ratio (97.6%), plasma DOAC levels were measured less frequently (<45%), and the time taken from admission for the coagulation sample to reach the laboratory varied widely (median, 52.3 minutes; IQR, 24.8-206.7). No significant plasma DOAC level (<50 ng/mL) was found in up to 19% of patients. There was a poor relationship between plasma DOAC level and the usage of a hemostatic agent. When compared with patients receiving VKA (96.5%) or dabigatran (93.7%), fewer patients prescribed a factor Xa inhibitor (75.5%) received a prohemostatic reversal agent. The overall 30-day mortality for MH (mean: 17.8%) and length of stay (LOS) (median: 8.7 days) was similar between VKA and DOAC patients.
    Conclusion: In DOAC patients, when compared to those receiving VKA, plasma DOAC levels were measured less frequently than the international normalized ratio and had a poor relationship with administering a hemostatic reversal agent. In addition, following MH, mortality and LOS were similar between VKA and DOAC patients.
    Language English
    Publishing date 2023-05-26
    Publishing country United States
    Document type Journal Article
    ISSN 2475-0379
    ISSN (online) 2475-0379
    DOI 10.1016/j.rpth.2023.100196
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Evidence-based Medicine in Pediatric Orthopaedics: Evidence-based Practice Committee Summary of Levels of Evidence, Clinical Practice Guidelines, Appropriate Use Criteria, and Best Practice Guidelines.

    Gandhi, Jigar S / Shea, Kevin G / Sponseller, Paul D / Brighton, Brian K / Ganley, Theodore J

    Journal of pediatric orthopedics

    2018  Volume 38, Issue 6, Page(s) e349–e353

    Abstract: The concept of evidence-based medicine has evolved over the past 2 decades, and has become a cornerstone to clinical decision-making in virtually every aspect of medicine. With a commitment to providing its members with high-quality evidence-based ... ...

    Abstract The concept of evidence-based medicine has evolved over the past 2 decades, and has become a cornerstone to clinical decision-making in virtually every aspect of medicine. With a commitment to providing its members with high-quality evidence-based guidelines, the American Academy of Orthopaedic Surgeons has instituted concerted efforts since 2006 to develop clinical practice guidelines (CPGs) and appropriate use criteria (AUCs) for certain orthopaedic conditions. Many of these CPGs and AUCs detail the management of pediatric orthopaedic conditions. By the same token, members of the Pediatric Orthopaedic Society of North America (POSNA) Evidence Based Practice Committee have been publishing succinct evaluations of randomized controlled trials in pediatric orthopaedic surgery to create an evidence-based repository for quick reference to available high-level evidence as well as resource to identify gaps in the current research and identify opportunities for future investigation. In instances where higher-level evidence needed to develop CPGs is not available to address a critically important clinical question, consensus recommendations from experts in the field have been obtained to develop best practice guidelines (BPGs). The purpose of this review is to provide readers with a deeper understanding of the key principles of evidence-based medicine and methodologies used for the development of CPGs, AUCs, and BPGs.
    MeSH term(s) Child ; Clinical Decision-Making ; Consensus ; Evidence-Based Medicine ; Humans ; North America ; Orthopedic Surgeons ; Orthopedics/standards ; Practice Guidelines as Topic ; Societies, Medical
    Language English
    Publishing date 2018-05-04
    Publishing country United States
    Document type Journal Article
    ZDB-ID 604642-3
    ISSN 1539-2570 ; 0271-6798
    ISSN (online) 1539-2570
    ISSN 0271-6798
    DOI 10.1097/BPO.0000000000001185
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Characterization of highly proliferative decidual precursor cells during the window of implantation in human endometrium.

    Diniz-da-Costa, Maria / Kong, Chow-Seng / Fishwick, Katherine J / Rawlings, Thomas / Brighton, Paul J / Hawkes, Amelia / Odendaal, Joshua / Quenby, Siobhan / Ott, Sascha / Lucas, Emma S / Vrljicak, Pavle / Brosens, Jan J

    Stem cells (Dayton, Ohio)

    2021  Volume 39, Issue 8, Page(s) 1067–1080

    Abstract: Pregnancy depends on the wholesale transformation of the endometrium, a process driven by differentiation of endometrial stromal cells (EnSC) into specialist decidual cells. Upon embryo implantation, decidual cells impart the tissue plasticity needed to ... ...

    Abstract Pregnancy depends on the wholesale transformation of the endometrium, a process driven by differentiation of endometrial stromal cells (EnSC) into specialist decidual cells. Upon embryo implantation, decidual cells impart the tissue plasticity needed to accommodate a rapidly growing conceptus and invading placenta, although the underlying mechanisms are unclear. Here we characterize a discrete population of highly proliferative mesenchymal cells (hPMC) in midluteal human endometrium, coinciding with the window of embryo implantation. Single-cell transcriptomics demonstrated that hPMC express genes involved in chemotaxis and vascular transmigration. Although distinct from resident EnSC, hPMC also express genes encoding pivotal decidual transcription factors and markers, most prominently prolactin. We further show that hPMC are enriched around spiral arterioles, scattered throughout the stroma, and occasionally present in glandular and luminal epithelium. The abundance of hPMC correlated with the in vitro colony-forming unit activity of midluteal endometrium and, conversely, clonogenic cells in culture express a gene signature partially conserved in hPMC. Cross-referencing of single-cell RNA-sequencing data sets indicated that hPMC differentiate into a recently discovered decidual subpopulation in early pregnancy. Finally, we demonstrate that recurrent pregnancy loss is associated with hPMC depletion. Collectively, our findings characterize midluteal hPMC as novel decidual precursors that are likely derived from circulating bone marrow-derived mesenchymal stem/stromal cells and integral to decidual plasticity in pregnancy.
    MeSH term(s) Cell Differentiation ; Decidua ; Embryo Implantation ; Embryo, Mammalian ; Endometrium ; Female ; Humans ; Pregnancy ; Stromal Cells
    Language English
    Publishing date 2021-03-25
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 1143556-2
    ISSN 1549-4918 ; 1066-5099
    ISSN (online) 1549-4918
    ISSN 1066-5099
    DOI 10.1002/stem.3367
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  5. Article ; Online: A pilot study assessing the implementation of 96-well plate-based aggregometry (Optimul) in Australia.

    Hsu, Hannah / Chan, Melissa V / Armstrong, Paul C / Crescente, Marilena / Donikian, Dea / Kondo, Mayuko / Brighton, Timothy / Chen, Vivien / Chen, Qiang / Connor, David / Joseph, Joanne / Morel-Kopp, Marie-Christine / Stevenson, William S / Ward, Christopher / Warner, Timothy D / Rabbolini, David J

    Pathology

    2022  Volume 54, Issue 6, Page(s) 746–754

    Abstract: Identification of disordered platelet function is important to guide peri-operative bleeding management as well as long term treatment and prognostic strategies in individuals with platelet bleeding disorders. Light transmission aggregometry (LTA), the ... ...

    Abstract Identification of disordered platelet function is important to guide peri-operative bleeding management as well as long term treatment and prognostic strategies in individuals with platelet bleeding disorders. Light transmission aggregometry (LTA), the current gold standard diagnostic test of platelet function is a time consuming technique almost exclusively performed in specialised laboratories and almost universally unavailable in regional centres in Australia, where there is an unmet need for access to specialised platelet function diagnostic services. 96-well plate-based aggregometry (Optimul, UK), has been utilised in research laboratories as a novel platform to investigate platelet function. We evaluated the Optimul assay at two centres in Australia, one regional and one tertiary metropolitan, to assess its feasibility as a screening test applicable to remote regional centres. Concentration-response curves were established from 45 healthy volunteers at the participating regional hospital and from 31 healthy volunteers at the tertiary institution. Optimul successfully detected anti-platelet effects in individuals taking aspirin (n=4), NSAID (n=2), clopidogrel (n=2) and dual therapy with aspirin and clopidogrel (n=1). When tested in parallel to LTA in individuals referred for the evaluation of abnormal bleeding symptoms there was overall a very good level of agreement between Optimul and LTA [Cohen's kappa (k
    MeSH term(s) Anti-Inflammatory Agents, Non-Steroidal ; Aspirin/pharmacology ; Blood Platelet Disorders/diagnosis ; Clopidogrel/pharmacology ; Humans ; Pilot Projects ; Platelet Aggregation ; Platelet Function Tests/methods
    Chemical Substances Anti-Inflammatory Agents, Non-Steroidal ; Clopidogrel (A74586SNO7) ; Aspirin (R16CO5Y76E)
    Language English
    Publishing date 2022-06-21
    Publishing country England
    Document type Journal Article
    ZDB-ID 7085-3
    ISSN 1465-3931 ; 0031-3025
    ISSN (online) 1465-3931
    ISSN 0031-3025
    DOI 10.1016/j.pathol.2022.03.012
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  6. Article ; Online: Embryo biosensing by uterine natural killer cells determines endometrial fate decisions at implantation.

    Kong, Chow-Seng / Ordoñez, Alexandra Almansa / Turner, Sarah / Tremaine, Tina / Muter, Joanne / Lucas, Emma S / Salisbury, Emma / Vassena, Rita / Tiscornia, Gustavo / Fouladi-Nashta, Ali A / Hartshorne, Geraldine / Brosens, Jan J / Brighton, Paul J

    FASEB journal : official publication of the Federation of American Societies for Experimental Biology

    2021  Volume 35, Issue 4, Page(s) e21336

    Abstract: Decidualizing endometrial stromal cells (EnSC) critically determine the maternal response to an implanting conceptus, triggering either menstruation-like disposal of low-fitness embryos or creating an environment that promotes further development. ... ...

    Abstract Decidualizing endometrial stromal cells (EnSC) critically determine the maternal response to an implanting conceptus, triggering either menstruation-like disposal of low-fitness embryos or creating an environment that promotes further development. However, the mechanism that couples maternal recognition of low-quality embryos to tissue breakdown remains poorly understood. Recently, we demonstrated that successful transition of the cycling endometrium to a pregnancy state requires selective elimination of pro-inflammatory senescent decidual cells by activated uterine natural killer (uNK) cells. Here we report that uNK cells express CD44, the canonical hyaluronan (HA) receptor, and demonstrate that high molecular weight HA (HMWHA) inhibits uNK cell-mediated killing of senescent decidual cells. In contrast, low molecular weight HA (LMWHA) did not attenuate uNK cell activity in co-culture experiments. Killing of senescent decidual cells by uNK cells was also inhibited upon exposure to medium conditioned by IVF embryos that failed to implant, but not successful embryos. Embryo-mediated inhibition of uNK cell activity was reversed by recombinant hyaluronidase 2 (HYAL2), which hydrolyses HMWHA. We further report a correlation between the levels of HYAL2 secretion by human blastocysts, morphological scores, and implantation potential. Taken together, the data suggest a pivotal role for uNK cells in embryo biosensing and endometrial fate decisions at implantation.
    MeSH term(s) Cell Adhesion Molecules ; Coculture Techniques ; Embryo Implantation/physiology ; Female ; GPI-Linked Proteins ; Gene Expression Regulation, Developmental ; Humans ; Hyaluronan Receptors/genetics ; Hyaluronan Receptors/metabolism ; Hyaluronic Acid/metabolism ; Hyaluronoglucosaminidase ; Killer Cells, Natural/physiology ; Uterus/cytology ; Uterus/physiology
    Chemical Substances CD44 protein, human ; Cell Adhesion Molecules ; GPI-Linked Proteins ; Hyaluronan Receptors ; Hyaluronic Acid (9004-61-9) ; Hyal2 protein, human (EC 3.2.1.25) ; Hyaluronoglucosaminidase (EC 3.2.1.35)
    Language English
    Publishing date 2021-03-22
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 639186-2
    ISSN 1530-6860 ; 0892-6638
    ISSN (online) 1530-6860
    ISSN 0892-6638
    DOI 10.1096/fj.202002217R
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  7. Article ; Online: Reciprocal regulation of β

    Pearce, Alexander / Sanders, Lucy / Brighton, Paul J / Rana, Shashi / Konje, Justin C / Willets, Jonathon M

    Cellular signalling

    2017  Volume 38, Page(s) 182–191

    Abstract: Activation of Gs coupled receptors (e.g. ... ...

    Abstract Activation of Gs coupled receptors (e.g. β
    MeSH term(s) Adult ; Arrestins/metabolism ; Cell Line ; Cyclic AMP Response Element-Binding Protein/metabolism ; Cyclic AMP-Dependent Protein Kinases/metabolism ; Female ; Humans ; Isoproterenol/pharmacology ; Middle Aged ; Myometrium/metabolism ; Phosphorylation/drug effects ; Pregnancy ; Receptors, Adrenergic, beta-2/metabolism ; Signal Transduction/drug effects ; Time Factors ; beta-Arrestin 1/metabolism ; p38 Mitogen-Activated Protein Kinases/metabolism
    Chemical Substances Arrestins ; Cyclic AMP Response Element-Binding Protein ; Receptors, Adrenergic, beta-2 ; arrestin3 ; beta-Arrestin 1 ; Cyclic AMP-Dependent Protein Kinases (EC 2.7.11.11) ; p38 Mitogen-Activated Protein Kinases (EC 2.7.11.24) ; Isoproterenol (L628TT009W)
    Language English
    Publishing date 2017-07-18
    Publishing country England
    Document type Journal Article
    ZDB-ID 1002702-6
    ISSN 1873-3913 ; 0898-6568
    ISSN (online) 1873-3913
    ISSN 0898-6568
    DOI 10.1016/j.cellsig.2017.07.011
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  8. Article ; Online: Recurrent pregnancy loss is associated with a pro-senescent decidual response during the peri-implantation window.

    Lucas, Emma S / Vrljicak, Pavle / Muter, Joanne / Diniz-da-Costa, Maria M / Brighton, Paul J / Kong, Chow-Seng / Lipecki, Julia / Fishwick, Katherine J / Odendaal, Joshua / Ewington, Lauren J / Quenby, Siobhan / Ott, Sascha / Brosens, Jan J

    Communications biology

    2020  Volume 3, Issue 1, Page(s) 37

    Abstract: During the implantation window, the endometrium becomes poised to transition to a pregnant state, a process driven by differentiation of stromal cells into decidual cells (DC). Perturbations in this process, termed decidualization, leads to breakdown of ... ...

    Abstract During the implantation window, the endometrium becomes poised to transition to a pregnant state, a process driven by differentiation of stromal cells into decidual cells (DC). Perturbations in this process, termed decidualization, leads to breakdown of the feto-maternal interface and miscarriage, but the underlying mechanisms are poorly understood. Here, we reconstructed the decidual pathway at single-cell level in vitro and demonstrate that stromal cells first mount an acute stress response before emerging as DC or senescent DC (snDC). In the absence of immune cell-mediated clearance of snDC, secondary senescence transforms DC into progesterone-resistant cells that abundantly express extracellular matrix remodelling factors. Additional single-cell analysis of midluteal endometrium identified DIO2 and SCARA5 as marker genes of a diverging decidual response in vivo. Finally, we report a conspicuous link between a pro-senescent decidual response in peri-implantation endometrium and recurrent pregnancy loss, suggesting that pre-pregnancy screening and intervention may reduce the burden of miscarriage.
    MeSH term(s) Abortion, Habitual/etiology ; Abortion, Habitual/metabolism ; Cell Line ; Cellular Senescence/genetics ; Decidua/metabolism ; Disease Susceptibility ; Embryo Implantation/genetics ; Female ; Gene Expression Profiling ; Gene Expression Regulation, Developmental ; Gene Regulatory Networks ; Humans ; Immunologic Surveillance ; Models, Biological ; Pregnancy ; Signal Transduction ; Single-Cell Analysis ; Transcriptome
    Language English
    Publishing date 2020-01-21
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ISSN 2399-3642
    ISSN (online) 2399-3642
    DOI 10.1038/s42003-020-0763-1
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  9. Article ; Online: Impact of sitagliptin on endometrial mesenchymal stem-like progenitor cells: A randomised, double-blind placebo-controlled feasibility trial.

    Tewary, Shreeya / Lucas, Emma S / Fujihara, Risa / Kimani, Peter K / Polanco, Angela / Brighton, Paul J / Muter, Joanne / Fishwick, Katherine J / Da Costa, Maria José Minhoto Diniz / Ewington, Lauren J / Lacey, Lauren / Takeda, Satoru / Brosens, Jan J / Quenby, Siobhan

    EBioMedicine

    2020  Volume 51, Page(s) 102597

    Abstract: Background: Recurrent pregnancy loss (RPL) is associated with the loss of endometrial mesenchymal stem-like progenitor cells (eMSC). DPP4 inhibitors may increase homing and engraftment of bone marrow-derived cells to sites of tissue injury. Here, we ... ...

    Abstract Background: Recurrent pregnancy loss (RPL) is associated with the loss of endometrial mesenchymal stem-like progenitor cells (eMSC). DPP4 inhibitors may increase homing and engraftment of bone marrow-derived cells to sites of tissue injury. Here, we evaluated the effect of the DPP4 inhibitor sitagliptin on eMSC in women with RPL, determined the impact on endometrial decidualization, and assessed the feasibility of a full-scale clinical trial.
    Methods: A double-blind, randomised, placebo-controlled feasibility trial on women aged 18 to 42 years with a history of 3 or more miscarriages, regular menstrual cycles, and no contraindications to sitagliptin. Thirty-eight subjects were randomised to either 100 mg sitagliptin daily for 3 consecutive cycles or identical placebo capsules. Computer generated, permuted block randomisation was used to allocate treatment packs. Colony forming unit (CFU) assays were used to quantify eMSC in midluteal endometrial biopsies. The primary outcome measure was CFU counts. Secondary outcome measures were endometrial thickness, study acceptability, and first pregnancy outcome within 12 months following the study. Tissue samples were subjected to explorative investigations.
    Findings: CFU counts following sitagliptin were higher compared to placebo only when adjusted for baseline CFU counts and age (RR: 1.52, 95% CI: 1.32-1.75, P<0.01). The change in CFU count was 1.68 in the sitagliptin group and 1.08 in the placebo group. Trial recruitment, acceptability, and drug compliance were high. There were no serious adverse events. Explorative investigations showed that sitagliptin inhibits the expression of DIO2, a marker gene of senescent decidual cells.
    Interpretation: Sitagliptin increases eMSCs and decreases decidual senescence. A large-scale clinical trial evaluating the impact of preconception sitagliptin treatment on pregnancy outcome in RPL is feasible and warranted.
    Funding: Tommy's Baby Charity.
    Clinical trial registration: EU Clinical Trials Register no. 2016-001120-54.
    MeSH term(s) Administration, Oral ; Adult ; Colony-Forming Units Assay ; Dipeptidyl Peptidase 4/metabolism ; Double-Blind Method ; Endometrium/cytology ; Feasibility Studies ; Female ; Humans ; Mesenchymal Stem Cells/cytology ; Patient Selection ; Placebos ; Pregnancy ; Pregnancy Outcome ; Regression Analysis ; Sitagliptin Phosphate/administration & dosage ; Sitagliptin Phosphate/pharmacology
    Chemical Substances Placebos ; DPP4 protein, human (EC 3.4.14.5) ; Dipeptidyl Peptidase 4 (EC 3.4.14.5) ; Sitagliptin Phosphate (TS63EW8X6F)
    Language English
    Publishing date 2020-01-09
    Publishing country Netherlands
    Document type Journal Article ; Randomized Controlled Trial
    ZDB-ID 2851331-9
    ISSN 2352-3964
    ISSN (online) 2352-3964
    DOI 10.1016/j.ebiom.2019.102597
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  10. Article ; Online: Two Weeks of Low Molecular Weight Heparin for Isolated Symptomatic Distal Vein Thrombosis (TWISTER study).

    Merriman, Eileen / Chunilal, Sanjeev / Brighton, Tim / Chen, Vivien / McRae, Simon / Ockelford, Paul / Curnow, Jennifer / Tran, Huy / Chong, Beng / Smith, Mark / Royle, Gordon / Crowther, Helen / Slocombe, Alison / Tran, Huyen

    Thrombosis research

    2021  Volume 207, Page(s) 33–39

    Abstract: Background: Treatment of low-risk patients with isolated symptomatic distal deep vein thrombi (IDDVT) is uncertain.: Objective: assess whether two weeks of therapeutic anticoagulation is efficacious/safe for IDDVT.: Primary outcome: symptomatic ... ...

    Abstract Background: Treatment of low-risk patients with isolated symptomatic distal deep vein thrombi (IDDVT) is uncertain.
    Objective: assess whether two weeks of therapeutic anticoagulation is efficacious/safe for IDDVT.
    Primary outcome: symptomatic three-month venous thromboembolism (VTE) incidence in the two-week anticoagulation group. Secondary outcomes included post-thrombotic syndrome (PTS) and bleeding.
    Methods: Prospective multicentre cohort study. Consecutive low-risk IDDVT patients enrolled within 72 h of diagnosis and treated with therapeutic dose enoxaparin or rivaroxaban. At two weeks, patients had repeat complete whole leg compression ultrasound (CUS)/clinical review. If resolution of leg symptoms AND no radiological evidence of thrombus extension, anticoagulation was stopped. If ongoing symptoms and/or radiographic extension within distal veins, anticoagulation was continued for four more weeks. Patients with extension into the popliteal vein on two-week ultrasound were treated off-study. Patients were reviewed at three and six months.
    Findings/interpretation: 241 eligible patients received ≥2 weeks anticoagulation. 167/241 (69%) were assigned to the 2-week anticoagulation group; 71/241 (30%) to the six-week anticoagulation group; 3/241 patients (1%) had extension into the popliteal vein on two-week CUS. Two patients in the two-week anticoagulation group had symptomatic IDDVT recurrence in ≤3 months; VTE recurrence 2/156; 1.3%(95% CI 0.05-4.85%). 69% of patients had complete resolution of symptoms within two weeks. Six-month PTS rates were 8/184, 4.4%(95% CI 2.1-8.5%). No major bleeding was reported. Our findings suggest it's safe/efficacious to stop therapeutic anticoagulation at two weeks in low-risk IDDVT patients with resolution of symptoms/no extension on ultrasound. This could replace 6-12 weeks of anticoagulation for ambulatory, low-risk IDDVT patients.
    Trial registration: ClinicalTrials.govNCT01252420.
    Language English
    Publishing date 2021-09-11
    Publishing country United States
    Document type Journal Article
    ZDB-ID 121852-9
    ISSN 1879-2472 ; 0049-3848
    ISSN (online) 1879-2472
    ISSN 0049-3848
    DOI 10.1016/j.thromres.2021.09.004
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