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Reproductive Challenges in Young Female Cancer Patients

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Journal of Reproduction and Contraception 2014年第4期25卷 241-257页

作者： Ibrahim I BOLAJI Arabinda Saha ka yan shirley sze Department of Obstetrics and Gynaecology DianaPrincess of Wales HospitalNLG Foundation NHS TrustHull York Medical School

The last three decades have seen a significant improvement and advancement in both the diagnostic and therapeutic modalities with improved surgical technique, chemoradio and supportive therapy in cancer treatment. This has produced a correspondingly increase in the 5-year relative survival rate for many cancers and for all races. However, the chemo-radiotherapy which is often gonadotoxic, has a substantial impact on quality of life issues especially that of reproduction in young female patients on account of increasing survival rates and delayed childbearing in the western hemisphere. This case based discussion paper using two real life case scenarios from our department focuses on the negative impact of cancer treatments on fertility and various options available for fertility preservation and / or fertility preservation measures. It is concluded that a lot of variables have to be considered when deciding upon fertility preservation treatments including patient＇s age, cancer stage, proposed treatment regime and time before it is initiated, availability of partner sperm and issues of individual patients. The latter include surgical complications, ovarian hyperstimu-lation syndrome, delay in cancer treatment and reintroduction of cancer cells, cost, low success rates and experimental nature of these treatments and the disposition of gametes in the event that the patient does not survive her cancer. It is very important for physician to advise patients of all these factors so that they can make an informed decision regarding the fertility preservation options and each case is unique and requires a different strategy of fertility preservation.

关键词： fertility preservation chemotherapy radiotherapy in vitro fertilization (IVF) cryopreservation cancer treatment in young females

Evaluation of Current Termination of Pregnancy and Related Services at Grimsby(UK) and Recommendations for Service Improvement

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Journal of Reproduction and Contraception 2013年第3期24卷 181-193页

作者： ka yan shirley sze Ibrahim BOLAJI Department of Obstetrics and Gynaecology Hull York Medical School(HYMS)DianaPrincess of Wales HospitalScartho RoadNLAG NHS Foundation TrustGrimsby DN33 2BAEngland

Objective To develop local termination of pregnancy （TOP） dataset and to identify ＂hotspots＂ for highest activity and gaps in our fertility control services. Methods This was a retrospective analysis of 305 women who received TOP under section C of the Abortion Act 1967 over a period of 9 consecutive months from 1st March through to 31st October 2012. Results There were 275 （90.2%） British White （BW） and 30 non-BW women. Among 30 non-BW women, 10 （3.3%） were British Asian, 8 （2.6%） were Polish, 6 （2.0%） were British Black or Black, 5 （1.6%） were Chinese and i （0.3%） was White Latvian. The TOP rate was 8.9% in the under 18 years old and 27.9% in the over 30 years old. Totally 240 TOPs （78. 7%） occurred in 〈10 weeks and 276 TOPs （90.5%） occurred under 13 weeks of gestation. Eight-five women who received TOP-service have had one or more previous termination（s） in the last 3 years. The contraception use was low pre-TOP and none of the women were on long-acting reversible contraception （LARCs） pre- TOP, including those who had repeat terminations. Conclusion There are inequalities and gaps in the TOP and related services in Grimsby which must be addressed to reduce the rate of TOP. This is a major challenge involving multiple agencies. Provision of contraception across all age and ethnic groups, improving sex education, engaging with parents and women to improve their negotiation skills for safer sex, supporting vulnerable women, reducing risk factors e.g. alcohol and substance misuse and raising aspirations across the region will contribute to a reduction in termination rate.

关键词： termination of pregnancy (TOP) contraception long acting reversible contraception (LARC)

Intravenous fluid selection rationales in acute clinical management

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World Journal of Emergency Medicine 2018年第1期9卷 13-19页

作者： Wing yan shirley Cheung Wai Kwan Cheung Chun Ho Lam Yeuk Wai Chan Hau Ching Chow ka Lok Cheng Yau Hang Wong Chak Wah kam Accident and Emergency Department Tuen Mun Hospital

BACKGROUND: Intravenous fluid(IVF) is commonly used in acute clinical management. This study aimed to review the choice and primary considerations in IVF prescriptions and to evaluate the adequacy of guidelines and trainings on it in the New Territories West Cluster(NTWC) of Hong ***: This is a descriptive study based on data collected from an online survey. Data were processed by SPSS for statistical analysis. This study focused on a general description and doctor-nurse between group comparison. Participants were asked the choice of IVF for nine acute clinical scenarios and provide reason. A 1–10 scale was used to assess the sufficiency of guideline, training and information, and time for revision on IVF ***: 0.9% sodium chloride was the most familiar IVF(36%), followed by 5% Dextrose solution(26%). In the nine scenarios, the most chosen IVF was 0.9% sodium chloride(37%–61%). There was significant difference in the choice of IVF between doctors and nurses in 7 cases. The second most chosen IVF for doctors was Plasma-Lyte A while that for nurses was Gelofusine. Departmental practice was the most chosen reason to account for the prescription. The adequacy of guideline, information and training, and time for revision was rated 5. Doctors had significantly more time at work than nurses to update knowledge in IVF prescription(5.41 versus 4.57).CONCLUSION: 0.9% sodium chloride was mostly chosen. The choice of IVF was mainly based on departmental practice. Adequacy of guideline, information and training, and time for revision on IVF prescription were average, indicating significant training deficit.

关键词： Intravenous fluid Acute care Resuscitation

LRRK2, GBA and their interaction in the regulation of autophagy: implications on therapeutics in Parkinson’s disease

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Translational Neurodegeneration 2022年第1期11卷 869-882页

作者： shirley Yin-Yu Pang Rachel Cheuk Nam Lo Philip Wing-Lok Ho Hui-Fang Liu Eunice Eun Seo Chang Chi-Ting Leung Yasine Malki Zoe Yuen-Kiu Choi Wing yan Wong Michelle Hiu-Wai Kung David Boyer Ramsden Shu-Leong Ho Division of Neurology Department of MedicineQueen Mary HospitalUniversity of Hong KongHong KongChina School of Biomedical Sciences Li Ka Shing Faculty of MedicineUniversity of Hong KongHong KongChina Institute of Metabolism and Systems Research University of BirminghamBirminghamUK.

Mutations in leucine-rich repeat kinase 2 (LRRK2) and glucocerebrosidase (GBA) represent two most common genetic causes of Parkinson’s disease (PD). Both genes are important in the autophagic-lysosomal pathway (ALP), defects of which are associated with α-synuclein (α-syn) accumulation. LRRK2 regulates macroautophagy via activation of the mitogen activated protein kinase/extracellular signal regulated protein kinase (MAPK/ERK) kinase (MEK) and the calcium-dependent adenosine monophosphate (AMP)-activated protein kinase (AMPK) pathways. Phosphorylation of Rab GTPases by LRRK2 regulates lysosomal homeostasis and endosomal trafficking. Mutant LRRK2 impairs chaperone-mediated autophagy, resulting in α-syn binding and oligomerization on lysosomal membranes. Mutations in GBA reduce glucocerebrosidase (GCase) activity, leading to glucosylceramide accumulation, α-syn aggregation and broad autophagic abnormalities. LRRK2 and GBA influence each other: GCase activity is reduced in LRRK2 mutant cells, and LRRK2 kinase inhibition can alter GCase activity in GBA mutant cells. Clinically, LRRK2 G2019S mutation seems to modify the effects of GBA mutation, resulting in milder symptoms than those resulting from GBA mutation alone. However, dual mutation carriers have an increased risk of PD and earlier age of onset compared with single mutation carriers, suggesting an additive deleterious effect on the initiation of PD pathogenic processes. Crosstalk between LRRK2 and GBA in PD exists, but its exact mechanism is unclear. Drugs that inhibit LRRK2 kinase or activate GCase are showing efficacy in pre-clinical models. Since LRRK2 kinase and GCase activities are also altered in idiopathic PD (iPD), it remains to be seen if these drugs will be useful in disease modification of iPD.

关键词： Parkinson’s disease Interaction LRRK2 GBA GCase Mutation Autophagy α-Synuclein