keyword
https://read.qxmd.com/read/38447864/similar-alterations-of-the-stratum-corneum-ceramide-profile-in-atopic-dermatitis-psoriasis-and-ichthyosis-results-from-a-systematic-review-and-meta-analysis
#1
JOURNAL ARTICLE
Jannik Rousel, Catherine Mergen, Jan W Schoones, Tessa Niemeyer-van der Kolk, Martijn B A van Doorn, Joke A Bouwstra, Jeroen van Smeden, Robert Rissmann
No abstract text is available yet for this article.
March 4, 2024: Journal of Investigative Dermatology
https://read.qxmd.com/read/38198456/effects-of-mdma-assisted-therapy-for-ptsd-on-self-experience
#2
RANDOMIZED CONTROLLED TRIAL
Bessel A van der Kolk, Julie B Wang, Rachel Yehuda, Leah Bedrosian, Allison R Coker, Charlotte Harrison, Michael Mithoefer, Berra Yazar-Klosinki, Amy Emerson, Rick Doblin
INTRODUCTION: There is a resurgence of interest in the therapeutic potential of psychedelic substances such as 3,4-methylenedioxymethamphetamine (MDMA). Primary findings from our randomized, double-blind, placebo-controlled, multi-site Phase 3 clinical trial of participants with severe PTSD (NCT03537014) showed that MDMA-assisted therapy induced significant attenuation in the Clinician-Administered PTSD Scale for DSM-5 compared to Therapy with placebo. Deficits in emotional coping skills and altered self-capacities constitute major obstacles to successful completion of available treatments...
2024: PloS One
https://read.qxmd.com/read/38092944/optimized-whole-genome-sequencing-workflow-for-tumor-diagnostics-in-routine-pathology-practice
#3
REVIEW
Kris G Samsom, Linda J W Bosch, Luuk J Schipper, Daoin Schout, Paul Roepman, Mirjam C Boelens, Ferry Lalezari, Elisabeth G Klompenhouwer, Adrianus J de Langen, Tineke E Buffart, Berit M H van Linder, Kelly van Deventer, Kay van den Burg, Unga Unmehopa, Efraim H Rosenberg, Roelof Koster, Frans B L Hogervorst, José G van den Berg, Immy Riethorst, Lieke Schoenmaker, Daphne van Beek, Ewart de Bruijn, Jacobus J M van der Hoeven, Hans van Snellenberg, Lizet E van der Kolk, Edwin Cuppen, Emile E Voest, Gerrit A Meijer, Kim Monkhorst
Two decades after the genomics revolution, oncology is rapidly transforming into a genome-driven discipline, yet routine cancer diagnostics is still mainly microscopy based, except for tumor type-specific predictive molecular tests. Pathology laboratories struggle to quickly validate and adopt biomarkers identified by genomics studies of new targeted therapies. Consequently, clinical implementation of newly approved biomarkers suffers substantial delays, leading to unequal patient access to these therapies...
December 13, 2023: Nature Protocols
https://read.qxmd.com/read/38006283/impact-of-genetic-counselling-strategy-on-diagnostic-yield-and-workload-for-genome-sequencing-based-tumour-diagnostics
#4
JOURNAL ARTICLE
Roelof Koster, Luuk J Schipper, Noor A A Giesbertz, Daphne van Beek, Matías Mendeville, Kris G Samsom, Efraim H Rosenberg, Frans B L Hogervorst, Paul Roepman, Mirjam C Boelens, Linda J W Bosch, Jose G van den Berg, Gerrit A Meijer, Emile E Voest, Edwin Cuppen, Marielle W G Ruijs, Tom van Wezel, Lizet van der Kolk, Kim Monkhorst
PurposeGenome sequencing (GS) enables comprehensive molecular analysis of tumours and identification of hereditary cancer predisposition. According to guidelines, directly determining pathogenic germline variants (PGVs) requires pre-test genetic counselling, which is cost-ineffective. Referral for genetic counselling based on tumour variants alone could miss relevant PGVs and/or result in unnecessary referrals. MethodsWe validated GS for detection of germline variants and simulated three strategies using paired tumour-normal genome sequencing data of 937 metastatic patients...
November 22, 2023: Genetics in Medicine: Official Journal of the American College of Medical Genetics
https://read.qxmd.com/read/37974545/lesional-skin-of-seborrheic-dermatitis-patients-is-characterized-by-skin-barrier-dysfunction-and-correlating-alterations-in-the-stratum-corneum-ceramide-composition
#5
JOURNAL ARTICLE
Jannik Rousel, Andreea Nădăban, Mahdi Saghari, Lisa Pagan, Ahnjili Zhuparris, Bart Theelen, Tom Gambrah, Hein E C van der Wall, Rob J Vreeken, Gary L Feiss, Tessa Niemeyer-van der Kolk, Jacobus Burggraaf, Martijn B A van Doorn, Joke A Bouwstra, Robert Rissmann
Seborrheic dermatitis (SD) is a chronic inflammatory skin disease characterized by erythematous papulosquamous lesions in sebum rich areas such as the face and scalp. Its pathogenesis appears multifactorial with a disbalanced immune system, Malassezia driven microbial involvement and skin barrier perturbations. Microbial involvement has been well described in SD, but skin barrier involvement remains to be properly elucidated. To determine whether barrier impairment is a critical factor of inflammation in SD alongside microbial dysbiosis, a cross-sectional study was performed in 37 patients with mild-to-moderate facial SD...
November 16, 2023: Experimental Dermatology
https://read.qxmd.com/read/37804933/guselkumab-induction-therapy-demonstrates-long-lasting-efficacy-in-patients-with-mild-psoriasis-results-from-a-randomized-placebo-controlled-exploratory-clinical-trial
#6
JOURNAL ARTICLE
Jannik Rousel, Menthe E Bergmans, Laura W J van der Meulen, Lisa Pagan, Digna T de Bruin, Marieke L de Kam, Naomi B Klarenbeek, Joke A Bouwstra, Marieke M B Seyger, Juul M P A van den Reek, Tessa Niemeyer-van der Kolk, Robert Rissmann, Martijn B A van Doorn
No abstract text is available yet for this article.
October 5, 2023: Journal of the American Academy of Dermatology
https://read.qxmd.com/read/37762625/treatment-with-the-topical-antimicrobial-peptide-omiganan-in-mild-to-moderate-facial-seborrheic-dermatitis-versus-ketoconazole-and-placebo-results-of-a-randomized-controlled-proof-of-concept-trial
#7
RANDOMIZED CONTROLLED TRIAL
Jannik Rousel, Mahdi Saghari, Lisa Pagan, Andreea Nădăban, Tom Gambrah, Bart Theelen, Marieke L de Kam, Jorine Haakman, Hein E C van der Wall, Gary L Feiss, Tessa Niemeyer-van der Kolk, Jacobus Burggraaf, Joke A Bouwstra, Robert Rissmann, Martijn B A van Doorn
Facial seborrheic dermatitis (SD) is an inflammatory skin disease characterized by erythematous and scaly lesions on the skin with high sebaceous gland activity. The yeast Malassezia is regarded as a key pathogenic driver in this disease, but increased Staphylococcus abundances and barrier dysfunction are implicated as well. Here, we evaluated the antimicrobial peptide omiganan as a treatment for SD since it has shown both antifungal and antibacterial activity. A randomized, patient- and evaluator-blinded trial was performed comparing the four-week, twice daily topical administration of omiganan 1...
September 20, 2023: International Journal of Molecular Sciences
https://read.qxmd.com/read/37752376/author-correction-exome-sequencing-identifies-breast-cancer-susceptibility-genes-and-defines-the-contribution-of-coding-variants-to-breast-cancer-risk
#8
Naomi Wilcox, Martine Dumont, Anna González-Neira, Sara Carvalho, Charles Joly Beauparlant, Marco Crotti, Craig Luccarini, Penny Soucy, Stéphane Dubois, Rocio Nuñez-Torres, Guillermo Pita, Eugene J Gardner, Joe Dennis, M Rosario Alonso, Nuria Álvarez, Caroline Baynes, Annie Claude Collin-Deschesnes, Sylvie Desjardins, Heiko Becher, Sabine Behrens, Manjeet K Bolla, Jose E Castelao, Jenny Chang-Claude, Sten Cornelissen, Thilo Dörk, Christoph Engel, Manuela Gago-Dominguez, Pascal Guénel, Andreas Hadjisavvas, Eric Hahnen, Mikael Hartman, Belén Herráez, Audrey Jung, Renske Keeman, Marion Kiechle, Jingmei Li, Maria A Loizidou, Michael Lush, Kyriaki Michailidou, Mihalis I Panayiotidis, Xueling Sim, Soo Hwang Teo, Jonathan P Tyrer, Lizet E van der Kolk, Cecilia Wahlström, Qin Wang, John R B Perry, Javier Benitez, Marjanka K Schmidt, Rita K Schmutzler, Paul D P Pharoah, Arnaud Droit, Alison M Dunning, Anders Kvist, Peter Devilee, Douglas F Easton, Jacques Simard
No abstract text is available yet for this article.
September 26, 2023: Nature Genetics
https://read.qxmd.com/read/37712675/optimising-patient-selection-for-primary-prevention-icd-implantation-utilising-multimodal-machine-learning-to-assess-risk-of-icd-non-benefit
#9
JOURNAL ARTICLE
M Z H Kolk, S Ruipérez-Campillo, B Deb, E Bekkers, C P Allaart, A J Rogers, A C J Van Der Lingen, L Alvarez Florez, I Isgum, B De Vos, P Clopton, A A M Wilde, R E Knops, S M Narayan, F V Y Tjong
BACKGROUND: Left ventricular ejection fraction (LVEF) is suboptimal as a sole marker for predicting sudden cardiac death (SCD). Machine learning (ML) provides new opportunities for personalised predictions using complex, multimodal data. This study aimed to determine if risk stratification for implantable cardioverter defibrillator (ICD) implantation can be improved by ML models that combine clinical variables with 12-lead electrocardiograms (ECG) time-series features. METHODS: A multicentre study of 1010 patients (64...
September 15, 2023: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
https://read.qxmd.com/read/37605508/does-a-proactive-procedure-lead-to-a-higher-uptake-of-predictive-testing-in-families-with-a-pathogenic-brca1-brca2-variant-a-family-cancer-clinic-evaluation
#10
JOURNAL ARTICLE
Fred H Menko, Sophie L van der Velden, Diana N Griffioen, Daoud Ait Moha, Kiki N Jeanson, Frans B L Hogervorst, Noor A A Giesbertz, Eveline M A Bleiker, Lizet E van der Kolk
The uptake of genetic counseling and predictive genetic testing by family members at risk for hereditary tumor syndromes is generally below 50%. To address this issue, a new guideline was introduced in the Netherlands in 2019 that aims to improve the sharing of information within families. In addition to cascade screening supported by follow-up telephone calls with the proband, municipal records were accessed to allow the geneticist to contact at-risk family members directly. We evaluated this procedure in 32 families with a (likely) pathogenic germline BRCA1/BRCA2 variant diagnosed at our hospital between May 1, 2020, and July 31, 2021, comparing current uptake with outcomes achieved for 33 families diagnosed in 2014...
August 21, 2023: Journal of Genetic Counseling
https://read.qxmd.com/read/37592023/exome-sequencing-identifies-breast-cancer-susceptibility-genes-and-defines-the-contribution-of-coding-variants-to-breast-cancer-risk
#11
JOURNAL ARTICLE
Naomi Wilcox, Martine Dumont, Anna González-Neira, Sara Carvalho, Charles Joly Beauparlant, Marco Crotti, Craig Luccarini, Penny Soucy, Stéphane Dubois, Rocio Nuñez-Torres, Guillermo Pita, Eugene J Gardner, Joe Dennis, M Rosario Alonso, Nuria Álvarez, Caroline Baynes, Annie Claude Collin-Deschesnes, Sylvie Desjardins, Heiko Becher, Sabine Behrens, Manjeet K Bolla, Jose E Castelao, Jenny Chang-Claude, Sten Cornelissen, Thilo Dörk, Christoph Engel, Manuela Gago-Dominguez, Pascal Guénel, Andreas Hadjisavvas, Eric Hahnen, Mikael Hartman, Belén Herráez, Audrey Jung, Renske Keeman, Marion Kiechle, Jingmei Li, Maria A Loizidou, Michael Lush, Kyriaki Michailidou, Mihalis I Panayiotidis, Xueling Sim, Soo Hwang Teo, Jonathan P Tyrer, Lizet E van der Kolk, Cecilia Wahlström, Qin Wang, John R B Perry, Javier Benitez, Marjanka K Schmidt, Rita K Schmutzler, Paul D P Pharoah, Arnaud Droit, Alison M Dunning, Anders Kvist, Peter Devilee, Douglas F Easton, Jacques Simard
Linkage and candidate gene studies have identified several breast cancer susceptibility genes, but the overall contribution of coding variation to breast cancer is unclear. To evaluate the role of rare coding variants more comprehensively, we performed a meta-analysis across three large whole-exome sequencing datasets, containing 26,368 female cases and 217,673 female controls. Burden tests were performed for protein-truncating and rare missense variants in 15,616 and 18,601 genes, respectively. Associations between protein-truncating variants and breast cancer were identified for the following six genes at exome-wide significance (P < 2...
September 2023: Nature Genetics
https://read.qxmd.com/read/37550634/perioperative-or-adjuvant-mfolfirinox-for-resectable-pancreatic-cancer-preopanc-3-study-protocol-for-a-multicenter-randomized-controlled-trial
#12
JOURNAL ARTICLE
J L van Dam, E M M Verkolf, E N Dekker, B A Bonsing, S O Bratlie, L A A Brosens, O R Busch, L M J W van Driel, C H J van Eijck, S Feshtali, P Ghorbani, D J A de Groot, J W B de Groot, B C M Haberkorn, I H de Hingh, B van der Holt, T M Karsten, M B van der Kolk, K J Labori, M S L Liem, O J L Loosveld, I Q Molenaar, M B Polée, H C van Santvoort, J de Vos-Geelen, M L Wumkes, G van Tienhoven, M Y V Homs, M G Besselink, J W Wilmink, B Groot Koerkamp
BACKGROUND: Surgical resection followed by adjuvant mFOLFIRINOX (5-fluorouracil with leucovorin, irinotecan, and oxaliplatin) is currently the standard of care for patients with resectable pancreatic cancer. The main concern regarding adjuvant chemotherapy is that only half of patients actually receive adjuvant treatment. Neoadjuvant chemotherapy, on the other hand, guarantees early systemic treatment and may increase chemotherapy use and thereby improve overall survival. Furthermore, it may prevent futile surgery in patients with rapidly progressive disease...
August 7, 2023: BMC Cancer
https://read.qxmd.com/read/37545524/oral-prednisolone-suppresses-skin-inflammation-in-a-healthy-volunteer-imiquimod-challenge-model
#13
RANDOMIZED CONTROLLED TRIAL
Salma Assil, Thomas P Buters, Pieter W Hameeteman, Charlie Hallard, Nicoline Treijtel, Tessa Niemeyer-Van der Kolk, Marieke L de Kam, Edwin F I I I Florencia, Errol P Prens, Martijn B A van Doorn, Robert Rissmann, Naomi B Klarenbeek, Manon A A Jansen, Matthijs Moerland
Imiquimod (IMQ) is a topical agent that induces local inflammation via the Toll-like receptor 7 pathway. Recently, an IMQ-driven skin inflammation model was developed in healthy volunteers for proof-of-pharmacology trials. The aim of this study was to profile the cellular, biochemical, and clinical effects of the marketed anti-inflammatory compound prednisolone in an IMQ model. This randomized, double-blind, placebo-controlled study was conducted in 24 healthy volunteers. Oral prednisolone (0.25 mg/kg/dose) or placebo (1:1) was administered twice daily for 6 consecutive days...
2023: Frontiers in Immunology
https://read.qxmd.com/read/37404971/mdma-assisted-therapy-for-severe-ptsd-a-randomized-double-blind-placebo-controlled-phase-3-study
#14
JOURNAL ARTICLE
Jennifer M Mitchell, Michael Bogenschutz, Alia Lilienstein, Charlotte Harrison, Sarah Kleiman, Kelly Parker-Guilbert, Marcela Ot'alora G, Wael Garas, Casey Paleos, Ingmar Gorman, Christopher Nicholas, Michael Mithoefer, Shannon Carlin, Bruce Poulter, Ann Mithoefer, Sylvestre Quevedo, Gregory Wells, Sukhpreet S Klaire, Bessel van der Kolk, Keren Tzarfaty, Revital Amiaz, Ray Worthy, Scott Shannon, Joshua D Woolley, Cole Marta, Yevgeniy Gelfand, Emma Hapke, Simon Amar, Yair Wallach, Randall Brown, Scott Hamilton, Julie B Wang, Allison Coker, Rebecca Matthews, Alberdina de Boer, Berra Yazar-Klosinski, Amy Emerson, Rick Doblin
Post-traumatic stress disorder (PTSD) presents a major public health problem for which currently available treatments are modestly effective. We report the findings of a randomized, double-blind, placebo-controlled, multi-site phase 3 clinical trial (NCT03537014) to test the efficacy and safety of 3,4-methylenedioxymethamphetamine (MDMA)-assisted therapy for the treatment of patients with severe PTSD, including those with common comorbidities such as dissociation, depression, a history of alcohol and substance use disorders, and childhood trauma...
July 2023: Focus: Journal of Life Long Learning in Psychiatry
https://read.qxmd.com/read/37394722/urinary-incontinence-more-than-15%C3%A2-years-after-premenopausal-risk-reducing-salpingo-oophorectomy-a-multicentre-cross-sectional-study
#15
MULTICENTER STUDY
Lara Terra, Bernadette A M Heemskerk-Gerritsen, Maarten J Beekman, Ellen Engelhardt, Marian J E Mourits, Helena C van Doorn, Joanna A de Hullu, Constantijne H Mom, Brigitte F M Slangen, Katja N Gaarenstroom, Marc van Beurden, Jeanine E Roeters Van Lennep, Eleonora B L van Dorst, Lizet E van der Kolk, J Margriet Collée, Marijke R Wevers, Margreet G E M Ausems, Klaartje van Engelen, Irma van de Beek, Lieke P V Berger, Christi J van Asperen, Encarna B Gomez Garcia, Angela H E M Maas, Maartje J Hooning, Anneke B Steensma, Flora E van Leeuwen
OBJECTIVE: To study the impact of premenopausal risk-reducing salpingo-oophorectomy (RRSO), compared with postmenopausal RRSO, on urinary incontinence (UI) ≥10 years later. DESIGN: Cross-sectional study, nested in a nationwide cohort. SETTING: Multicentre in the Netherlands. POPULATION: 750 women (68% BRCA1/2 pathogenic variant carriers) who underwent either premenopausal RRSO (≤45 years, n = 496) or postmenopausal RRSO (≥54 years, n = 254)...
January 2024: BJOG: An International Journal of Obstetrics and Gynaecology
https://read.qxmd.com/read/37371462/biliverdin-reductase-b-is-a-plasma-biomarker-for-intraplaque-hemorrhage-and-a-predictor-of-ischemic-stroke-in-patients-with-symptomatic-carotid-atherosclerosis
#16
JOURNAL ARTICLE
Melody Chemaly, David Marlevi, Maria-Jesus Iglesias, Mariette Lengquist, Malin Kronqvist, Daniel Bos, Dianne H K van Dam-Nolen, Anja van der Kolk, Jeroen Hendrikse, Mohamed Kassem, Ljubica Matic, Jacob Odeberg, Margreet R de Vries, M Eline Kooi, Ulf Hedin
BACKGROUND: Intraplaque hemorrhage (IPH) is a hallmark of atherosclerotic plaque instability. Biliverdin reductase B (BLVRB) is enriched in plasma and plaques from patients with symptomatic carotid atherosclerosis and functionally associated with IPH. OBJECTIVE: We explored the biomarker potential of plasma BLVRB through (1) its correlation with IPH in carotid plaques assessed by magnetic resonance imaging (MRI), and with recurrent ischemic stroke, and (2) its use for monitoring pharmacotherapy targeting IPH in a preclinical setting...
May 24, 2023: Biomolecules
https://read.qxmd.com/read/37051698/a-multimodal-comprehensive-characterization-of-a-cutaneous-wound-model-in-healthy-volunteers
#17
JOURNAL ARTICLE
Wouter Ten Voorde, Mahdi Saghari, Jiry Boltjes, Marieke L de Kam, Ahnjili Zhuparris, Gary Feiss, Thomas P Buters, Errol P Prens, Jeffrey Damman, Tessa Niemeyer-van der Kolk, Matthijs Moerland, Jacobus Burggraaf, Martijn B A van Doorn, Robert Rissmann
Development of pharmacological interventions for wound treatment is challenging due to both poorly understood wound healing mechanisms and heterogeneous patient populations. A standardized and well-characterized wound healing model in healthy volunteers is needed to aid in-depth pharmacodynamic and efficacy assessments of novel compounds. The current study aims to objectively and comprehensively characterize skin punch biopsy-induced wounds in healthy volunteers with an integrated, multimodal test battery. Eighteen (18) healthy male and female volunteers received three biopsies on the lower back, which were left to heal without intervention...
July 2023: Experimental Dermatology
https://read.qxmd.com/read/37022586/correction-development-of-a-standard-set-of-pros-and-generic-proms-for-dutch-medical-specialist-care
#18
Martijn Oude Voshaar, Caroline B Terwee, Lotte Haverman, Bas van der Kolk, Marleen Harkes, Christiaan S van Woerden, Fenna van Breda, Stephanie Breukink, Irma de Hoop, Hester Vermeulen, Evelien de Graaf, Jan Hazelzet, Barbara van Leiden, Jozette Stienen, Marian Hoekstra, Hans Bart, Hester van Bommel, Domino Determann, Mariët Verburg, Philip van der Wees, Anna J Beurskens
No abstract text is available yet for this article.
April 6, 2023: Quality of Life Research
https://read.qxmd.com/read/36757571/development-of-a-standard-set-of-pros-and-generic-proms-for-dutch-medical-specialist-care-recommendations-from-the-outcome-based-healthcare-program-working-group-generic-proms
#19
JOURNAL ARTICLE
Martijn Oude Voshaar, Caroline B Terwee, Lotte Haverman, Bas van der Kolk, Marleen Harkes, Christiaan S van Woerden, Fenna van Breda, Stephanie Breukink, Irma de Hoop, Hester Vermeulen, Evelien de Graaf, Jan Hazelet, Barbara van Leiden, Jozette Stienen, Marian Hoekstra, Hans Bart, Hester van Bommel, Domino Determann, Mariët Verburg, Philip van der Wees, Anna J Beurskens
PURPOSE: The added value of measuring patient-reported outcomes (PROs) for delivering patient-centered care and assessment of healthcare quality is increasingly evident. However, healthcare system wide data collection initiatives are hampered by the proliferation of patient-reported outcome measures (PROMs) and conflicting data collection standards. As part of a national initiative of the Dutch Ministry of Health, Welfare and Sport we developed a consensus-based standard set of generic PROs and PROMs to be implemented across Dutch medical specialist care...
February 9, 2023: Quality of Life Research
https://read.qxmd.com/read/36715559/long-term-effects-of-premenopausal-risk-reducing-salpingo-oophorectomy-on-cognition-in-women-with-high-familial-risk-of-ovarian-cancer-a-cross-sectional-study
#20
JOURNAL ARTICLE
Lara Terra, Philippe R Lee Meeuw Kjoe, Joost A Agelink van Rentergem, Maarten J Beekman, Bernadette A M Heemskerk-Gerritsen, Marc van Beurden, Jeanine E Roeters van Lennep, Helena C van Doorn, Joanna A de Hullu, Marian J E Mourits, Eleonora B L van Dorst, Constantijne H Mom, Brigitte F M Slangen, Katja N Gaarenstroom, Lizet E van der Kolk, J Margriet Collée, Marijke R Wevers, Margreet G E M Ausems, Klaartje van Engelen, Irma van de Beek, Lieke P V Berger, Christi J van Asperen, Encarna B Gomez Garcia, Angela H E M Maas, Maartje J Hooning, Elsken van der Wall, Flora E van Leeuwen, Sanne B Schagen
OBJECTIVE: To examine the effect of a premenopausal risk-reducing salpingo-oophorectomy (RRSO) in women at increased risk of ovarian cancer on objective and subjective cognition at least 10 years after RRSO. DESIGN: A cross-sectional study with prospective follow-up, nested in a nationwide cohort. SETTING: Multicentre in the Netherlands. POPULATION OR SAMPLE: 641 women (66% BRCA1/2 pathogenic variant carriers) who underwent either a premenopausal RRSO ≤ age 45 (n = 436) or a postmenopausal RRSO ≥ age 54 (n = 205)...
January 30, 2023: BJOG: An International Journal of Obstetrics and Gynaecology
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