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Academic literature on the topic 'R Medicine (General) : RG Gynecology and obstetrics'
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Journal articles on the topic "R Medicine (General) : RG Gynecology and obstetrics"
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Huynh, Anhtuan, Jennifer Savitski, Melissa Kirven, Jennifer Godwin, and Karen M. Gil. "Effect of Medical Students' Experiences With Residents as Teachers on Clerkship Assessment." Journal of Graduate Medical Education 3, no. 3 (September 1, 2011): 345–49. http://dx.doi.org/10.4300/jgme-03-03-35.
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Abstract Background We assessed the impact of resident teaching in medical students' overall assessment of an obstetrics and gynecology clerkship. Methods Between September 2007 and March 2010, third-year medical students completed a questionnaire at the end of their clerkship. Questions covered the number of topics they recalled learning about from residents, perceptions of the quality of education received from residents, perceptions of the experience with the residents as teachers, and overall rating of the obstetrics and gynecology clerkship. Results Questionnaires were completed by all medical students (N = 74), with 63 students returning complete surveys. There was a small correlation between the number of topics students recalled learning about from residents and ratings of quality of education (r = 0.249, P = .03), a small correlation between the number of topics students recalled learning about from residents and level of satisfaction with the clerkship (r = 0.262, P = .04), and a larger correlation between assessment of the overall experience with residents as teachers and ratings of quality of education received from residents (r = 0.687, P < .001). Overall experience with residents as teachers and perceived quality of education from residents were both associated with satisfaction with the clerkship (r = 0.756, P < .001 and r = 0.603, P < .001, respectively). A regression model with these variables accounted for 58% of the variability in students' ratings of the clerkship (F = 27.103, P < .001, R = .761, R2 = .579). The only significant independent variable was assessment of the overall experience with residents as teachers (t = 5.350, P < .001). Conclusion Quality of interactions between residents and medical students is a key factor in medical students' assessment of their clerkship.
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Tao, Xiao-Ling, Wei-Chang Yu, De-Jun Chen, Li-Ming Wang, Lu Liu, and Qi Xing. "Hepatocyte Nuclear Factor -1α stimulates cervical cancer cells to migrate and invade through regulating pyruvate kinase L/R." Investigación Clínica 62, no. 3 (September 2, 2021): 236–46. http://dx.doi.org/10.22209/ic.v62n3a05.
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This study was aimed to analyze the role of hepatocyte nuclear factor -1α (HNF-1α) in regulating migrative and invasive potentials in cervical cancer via the involvement of pyruvate kinase L/R (PKLR). The expression of HNF-1α and PKLR in cervical cancer tissues classified by tumor size and FIGO (Federation International of Gynecology and Obstetrics) stage were detected by qRT-PCR. The expression correlation between HNF-1α and PKLR in cervical cancer tissues was analyzed by Pearson correlation test. After intervening HNF-1α and PKLR levels in SiHa and Hela cells, their migratory and invasive abilities were examined by the Transwell assay. HNF-1α was upregulated in cervical cancer tissues, particularly those with large tumor size or advanced FIGO stage. PKLR was highly expressed in cervical cancer tissues as well, presenting a positive correlation with the HNF-1α level. Knockdown of HNF-1α attenuated migratory and invasive abilities in SiHa cells, whereas overexpression of HNF-1α enhanced migratory and invasive abilities in SiHa cells. PKLR was able to abolish the regulatory effects of HNF-1α on cervical cancer metastasis. HNF-1α and PKLR synergistically promote cervical cancer to migrate and invade.
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Sandeva, Milena, and Petar Uchikov. "Analysis of Pathology in Premature Infants in Obstetrics and Gynecology Clinic at St George University Hospital, Plovdiv between 2013 and 2015." Folia Medica 63, no. 1 (February 28, 2021): 88–96. http://dx.doi.org/10.3897/folmed.63.e52203.
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Introduction: Premature birth is now one of the most profound prenatal problems worldwide because of the high morbidity and mor-tality it is associated with at the beginning of life. Advances in prenatal medicine over the past decades have led to a significant improve-ment of neonatal survival in risk groups of newborns. Infants of gestational age of 22-25 weeks represent the greatest medical, social, and ethical dilemma in neonatology. Most of these newborns need intensive care to survive, and most infants born between 28 and 32 weeks of gestation require special care. Those born 34 to 36 weeks’ gestation also have higher rates of short-term morbid premature birth-related conditions such as respiratory distress syndrome (RDS) and intraventricular hemorrhage (IVH) than their peers born at term. Aim: To carry out an analysis of morbidity during the neonatal period in premature babies. Materials and methods: A retrospective triennial study was conducted on 598 premature newborns. Results: The results of the study show that morbidity rate in premature born infants is high. The most frequent reasons for admission to the neonatal intensive care unit are the other forms of respiratory distress syndrome (45%). Respiratory distress syndrome (RDS) was observed in 23.41% of the prematurity, 10.7% of them were suspected of having other pathology, and 20.9% of premature neonates manifested no complications in the neonatal period. There was a significant difference in the diagnosis of newborns after birth (p=0.0001, r=0.58), with the newborns with RDS demonstrating the most complications in the neonatal period. Conclusions: The conclusions to be drawn from the analysis of the data are as follows: there is wide comorbidity in the prematurity of RDS. Lower gestational age strongly correlates with the development of RDS. If no corticosteroid therapy is administered the risk of developing hyaline membrane disease increases. There is extremely high probability of neonatal mortality in children with hyaline membrane disease. There is significant difference between the primary diagnosis and the condition of the child at discharge from the medical establishment. Adequate and specialized prenatal care is essential when trying to reduce the incidence of preterm birth.
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Yoneda, Naoto, Minoru Irahara, Seiichiro Saito, Hirokazu Uemura, and Toshihiro Aono. "Usefulness of recombinant human prolactin for treatment of poor puerperal lactation in a rat model." European Journal of Endocrinology 133, no. 5 (November 1995): 613–17. http://dx.doi.org/10.1530/eje.0.1330613.
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Yoneda N, Irahara M, Saito S, Uemura H, Aono T. Usefulness of recombinant human prolactin for treatment of poor puerperal lactation in a rat model. Eur J Endocrinol 1995;133:613–7. ISSN 0804–4643 Recombinant human prolactin (r-hPRL) was produced by a line of murine C127 cells transfected with human PRL gene. To assess the biological efficacy of r-hPRL in vivo, we studied its influence on milk secretion using a rat model in which lactation was reduced by bromocriptine treatment. Puerperal rats were injected daily for 9 days after delivery with bromocriptine or bromocriptine plus r-hPRL, and lactational performance was assessed by weighing the pups. The concentrations of rat and human PRL in rat serum were measured by specific radioimmunoassays and the mammary glands were examined on postpartum day 10. Daily injection of bromocriptine (0.1 mg/rat) significantly reduced the endogenous level of rat PRL and impaired the weight gain of the pups. Administration of r-hPRL increased the serum level of human PRL. Daily injections of r-hPRL (50 μg/rat, twice a day) restored lactational performance and significantly increased the weight of the pups. The detrimental effect of bromocriptine on the mammary glands, assessed by both weight and histological appearance, was reversed by administration of r-hPRL. These results demonstrate that r-hPRL is biologically active in vivo and replacement therapy of r-hPRL is effective in improving the lactational performance in bromocriptine-treated rats, and also that r-hPRL may be useful for the treatment of women with poor lactation. Naoto Yoneda, Department of Obstetrics and Gynecology, School of Medicine, The University of Tokushima, 3-18-15 Kuramoto, Tokushima 770, Japan
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Celik, Esra, Seyithan Taysi, Seyhun Sucu, Hasan Ulusal, Emin Sevincler, and Ahmet Celik. "Urotensin 2 and Oxidative Stress Levels in Maternal Serum in Pregnancies Complicated by Intrauterine Growth Restriction." Medicina 55, no. 7 (July 2, 2019): 328. http://dx.doi.org/10.3390/medicina55070328.
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Background and objectives: In this study, the aim was to investigate Urotensin 2 (U-II) levels and oxidant/antioxidant system parameters in pregnancies with intrauterine growth restriction (IUGR). Materials and Methods: A total of 36 healthy, pregnant women who had not been diagnosed with IUGR and 36 pregnant women who had been diagnosed with IUGR at the Obstetrics and Gynecology Outpatient Clinic at Gaziantep University Hospital were enrolled in this study. The serum total antioxidant status (TAS), total oxidant status (TOS), thiol-disulfide levels, U-II measurements, and oxidative stress index (OSI) calculations were carried out at the biochemistry laboratory at Gaziantep University. Results: According to this study, there was no statistically significant difference between the group with IUGR and the control group of healthy, pregnant women in terms of total antioxidant status (TAS), total oxidant status (TOS), oxidative stress index (OSI), native thiol, total thiol, disulfide, disulfide/native thiol, disulfide/total thiol, native thiol/total thiol, and U-II values. There was, however, a positive linear correlation between TOS and total thiol levels in the group with IUGR (p = 0.021, r = 0.384), and a positive linear correlation between OSI and total thiol values in the control group (p = 0.049, r = 0.330). In addition, there was a negative correlation between disulfide levels and gestational weeks at birth in the group with IUGR (p = 0.027, r = 0.369). Conclusions: Consequently, there was no significant difference between the control group and the group with pregnancies complicated by idiopathic IUGR in terms of serum oxidant/antioxidant system parameters and U-II levels. It is necessary to conduct more extensive studies evaluating placental, maternal, and fetal oxidative stress in conjunction in order to investigate the role of oxidative stress in IUGR.
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Weitzner, John S. "Book Review Danforth's Obstetrics and Gynecology Sixth edition. Edited by James R. Scott, Philip J. DiSaia, Charles B. Hammond, and William N. Spellacy. 1245 pp., illustrated. Philadelphia, J.B. Lippincott, 1990. $89.50." New England Journal of Medicine 323, no. 7 (August 16, 1990): 493–94. http://dx.doi.org/10.1056/nejm199008163230723.
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Knobel, Roxana, Lia Volpato, Liliam Gervasi, Raquel Viergutz, and Alberto Trapani. "A Simple, Reproducible and Low-cost Simulator for Teaching Surgical Techniques to Repair Obstetric Anal Sphincter Injuries." Revista Brasileira de Ginecologia e Obstetrícia / RBGO Gynecology and Obstetrics 40, no. 08 (August 2018): 465–70. http://dx.doi.org/10.1055/s-0038-1668527.
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Objective To describe and evaluate the use of a simple, low-cost, and reproducible simulator for teaching the repair of obstetric anal sphincter injuries (OASIS). Methods Twenty resident doctors in obstetrics and gynecology and four obstetricians participated in the simulation. A fourth-degree tear model was created using low-cost materials (condom simulating the rectal mucosa, cotton tissue simulating the internal anal sphincter, and bovine meat simulating the external anal sphincter). The simulator was initially assembled with the aid of anatomical photos to study the anatomy and meaning of each component of the model. The laceration was created and repaired, using end-to-end or overlapping application techniques. Results The model cost less than R$ 10.00 and was assembled without difficulty, which improved the knowledge of the participants of anatomy and physiology. The sutures of the layers (rectal mucosa, internal sphincter, and external sphincter) were performed in keeping with the surgical technique. All participants were satisfied with the simulation and felt it improved their knowledge and skills. Between 3 and 6 months after the training, 7 participants witnessed severe lacerations in their practice and reported that the simulation was useful for surgical correction. Conclusion The use of a simulator for repair training in OASIS is affordable (low-cost and easy to perform). The simulation seems to improve the knowledge and surgical skills necessary to repair severe lacerations. Further systematized studies should be performed for evaluation.
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Gaiser, Robert. "Subtest Scores From the In-Training Examination: An Evaluation Tool for an Obstetric-Anesthesia Rotation." Journal of Graduate Medical Education 2, no. 2 (June 1, 2010): 246–49. http://dx.doi.org/10.4300/jgme-d-09-00066.1.
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Abstract Objective To evaluate resident performance in the obstetric-anesthesia rotation using resident portfolios and their In-Training Examination scores, which are provided by the American Board of Anesthesiology/American Society of Anesthesiologists. Methods We reviewed academic portfolios for second- and third-year anesthesiology residents at a single institution from 2006–2008 to examine United States Medical Licensing Exam Step 1 and 2 scores, grade for obstetrics-gynecology in medical school, and performance on the In-Training Examination. Faculty evaluation of medical knowledge and correlations for the various scores were obtained. Results We examined scores for 43 residents. The subtest score for obstetric anesthesia increased after completing a rotation in obstetric anesthesia, 26.1 ± 10.3 versus 36.3 ± 10.6 (P = .02). The subtest score correlated with United States Medical Licensing Exam Step 2, r = 0.46 (P = .027) but not with United States Medical Licensing Exam Step 1 or with the grade obtained in medical school. There was no correlation between faculty evaluations of medical knowledge and resident subtest scores in obstetric anesthesia. Conclusions Subtest scores in obstetric anesthesia are valid and provide a tool for the assessment of the educational program of a rotation. Knowledge as assessed by a faculty member is different from the knowledge assessed on a written examination. Both methods can help provide a more complete assessment of the resident and the rotation.
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Silberstein, Tali, Batel Hamou, Shelly Cervil, Tamar Barak, Ariela Burg, and Oshra Saphier. "Colostrum of Preeclamptic Women Has a High Level of Polyphenols and Better Resistance to Oxidative Stress in Comparison to That of Healthy Women." Oxidative Medicine and Cellular Longevity 2019 (February 21, 2019): 1–5. http://dx.doi.org/10.1155/2019/1380605.
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Preeclampsia is a common pregnancy complication. Abnormal development of the placenta is the prevailing cause theory of this complication. Women with preeclampsia suffer from acute oxidative stress and high lipid oxidation in plasma. The aim of this study was to compare levels of polyphenols and lipid peroxidation in colostrum of nursing mothers with and without preeclampsia. The study was conducted at the Department of Obstetrics and Gynecology at Soroka University Medical Center. The study group consisting of 18 women, who were diagnosed with preeclampsia, was compared to the control group: 22 healthy women. The total phenolic content in the colostrum was determined by using the Folin–Ciocalteu method. Lipid peroxidation was determined by measuring MDA, using the TBARS assay. Polyphenol concentrations were significantly higher (about 33%) in the colostrum of the study group compared with the control group (p=0.00042). Lipid peroxidation levels (MDA) were significantly lower (about 20%) in the colostrum of the study group compared with the control group (p=0.03). Negative correlation was found between MDA concentration and the polyphenol level (R=−0.41, p=0.02). In conclusion, we showed in this study a potential compensation mechanism that protects the newborn of a mother with preeclampsia from the stress process experienced by its mother.
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Wang, Ningning, Yufeng Zhang, and Bin Liu. "Demographic and Clinical Features of Endometrial Polyps in Patients with Endometriosis." BioMed Research International 2016 (2016): 1–5. http://dx.doi.org/10.1155/2016/1460793.
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Aims. To compare the clinical features of endometrial polyps (EPs) between patients with endometriosis (EM) (EM group) and without EM (non-EM group).Methods and Results. Seventy-six cases in the EM group and 133 cases in the non-EM group underwent laparotomy or hysteroscopy and laparoscopy; later, it was confirmed that the results by pathology from July 2002 to April 2008 in the Department of Gynecology and Obstetrics at the First Affiliated Hospital of Sun Yat-sen University. The recurrence of EPs was followed up after the surgery until 2013. The following parameters were assessed: age, gravidity, parity, infertility, and menstrual cycle changes, as well as polyps diameters, locations, number, association with the revised American Fertility Society (r-AFS) classification, and their recurrence. On review, 76 EPs cases of EM group histologically resembled EPs but the majority of EPs with EM occurred in primary infertility cases and in fewer pregnancy rate women who had stable and smaller EPs without association with the AFS stage. The recurrence rate of EPs in EM group was higher than that in non-EM group.Conclusion. It is important to identify whether infertile patients with EM are also having EPs. Removing any coexisting EPs via hysteroscopy would be clinically helpful in treating endometriosis-related infertility in these patients.
Dissertations / Theses on the topic "R Medicine (General) : RG Gynecology and obstetrics"
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Barrie, Amy. "Time-lapse systems : incubation and annotation." Thesis, Edge Hill University, 2017. http://repository.edgehill.ac.uk/9940/.
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Time-lapse system(s) (TLS) have, potentially, two benefits over standard incubation systems; an undisturbed culture environment and an enormous volume of images of the embryos within them. The current research aimed to determine if a TLS could provide a comparably stable culture environment compared to a standard incubator measured as pH, osmolality and treatment success rates. Second, the hypothesis that patient, treatment and environment specific embryo selection algorithms (ESAs) are required to improve the efficacy of a TLS as an embryo assessment tool was tested. A TLS was shown to provide a comparably stable environment when compared to a standard incubator in terms of pH and osmolality. In addition, using a strict matched-pair design, embryos cultured in a TLS resulted in a significantly higher implantation, clinical pregnancy and live birth rates. It was also concluded that, of six published ESAs, none performed with clinically relevant predictive capabilities when applied to the same cohort of known implantation embryos. Owing to this, the identification of five abnormal division events as significantly reducing an embryos implantation potential was performed providing an easily adopted, clinically relevant means to deselect embryos cultured in a TLS. A regression analysis found a number of treatment and patient parameters having a significant effect on crucial morphokinetic parameters, although no systemic effect was observed. Finally, an interim analysis of a sibling oocyte study of three, commercially available culture media revealed significant differences in the time of embryo compaction as well as embryo quality and utilisation. Together, these results highlight that a TLS provides a stable culture environment and leads to increased implantation, clinical pregnancy and live birth rates. It is also likely that the patient, treatment type and environment can significantly alter an embryos morphokinetic profile and specific ESAs are required to unlock the true potential of time-lapse technology.
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Nicholson, Deborah. "Secrets of success : the development of obstetric ultrasound in Scotland, 1963-1990." Thesis, University of Glasgow, 2003. http://theses.gla.ac.uk/3400/.
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This thesis examines the diffusion of obstetric ultrasound technology in Scotland, from the early 1960s through to the end of the 1980s. Although the origins of obstetric ultrasound can be traced to 1955, and the pioneering work undertaken by Professor Ian Donald and his colleagues in Glasgow on the gynaecological applications of ultrasound, it was not until the early 1960s that the pathologies associated with pregnancy were directly investigated. Over the next thirty years, the technology underwent a number of significant transformations - in technical design, application and use, and organisation. The main focus of this thesis is on the uptake and implementation of obstetric ultrasound in new locations across Scotland, and on the dynamics of change associated with its use in clinical practice. U sing a case-study approach which centres on four individual Scottish hospitals, this thesis traces the complexity and heterogeneity evident in the diffusion of this technology. The definition of 'technology' employed in this thesis is three-dimensional - comprising of technical, cognitive and interactive/performative dimensions. Here it is argued that all three of these dimensions compose a technology, and that all three are open to adaptation and change, thus essentially changing the nature of the technology itself. This is highlighted through a comparative account, focussing on site-specific differences in the development, organisation and use of the technology. The evidence presented here has been drawn from a variety of historical sources. The recollections of a number of actors involved in the introduction, use and development of obstetric ultrasound in Scotland, as well as of women who experienced ultrasound during their pregnancies, have been collected using semi-structured interviews. To this oral history has been added information from a variety of archival sources held at the British Medical Ultrasound Society's Historical Collection (housed at The Queen Mother's Hospital, Glasgow). These include specialist professional journals, correspondence relating to ultrasound, manufacturers' literature, draft versions of key published papers, transcripts of interviews with prominent actors in the field and material donated by ultrasound workers across Scotland. Furthermore, the Collection also boasts a wide array of visual information (including pictures of various types of ultrasound equipment and images generated from them) and artifacts (ultrasound machines dating from the 1950s through to the 1980s). These, less conventional, historical sources are also employed in this thesisIn this comparative study of the diffusion of ultrasound, three related arguments are presented. Firstly, it is argued that innovation and diffusion are not mutually exclusive terms or periodising concepts, but are interwoven processes and forms of activity. The diffusion of obstetric ultrasound did not signal the 'end' of innovation, but merely the point at which new actors in new locations undertook it. Innovation is a crucial component in adapting a technology to new circumstances, users or contexts and thus it is argued that innovation and diffusion are inter-related, mutually dependent forms of interested human action. Secondly, obstetric ultrasound is characterised in this thesis as an emergent phenomenon, shaped by both technical and social factors. When the development of this technology is examined in a variety of historical and spatial contexts, it is evident that the form it takes is determined by the interplay of social factors (professional relationships and interests, actors interpretations of technology, etc.) and more technical or material factors (the way a machine responds to new demands or itself requires certain types of human or social response). Thus a complete account of the diffusion of obstetric ultrasound necessitates an approach that considers both social and material influences on technological change. Finally, this thesis explores the significance of site-specific local arrangements for the shaping of obstetric ultrasound. Interactions with technology take place within specific historical and locational settings. The specific character of each setting can affect the nature of inter-professional relationships, the organisation and administration of the technology, the characteristics of the patient population, and so on. Thus, the diffusion of obstetric ultrasound and the form that it takes in each new location are partly shaped by the way in which the technology interacts with new environments
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Velayutham, Thangaratinam Shakila Selvambigai. "Health technology assessment in maternal and perinatal medicine : delphi survey of practice, systematic reviews of evidence and meta analyses." Thesis, University of Birmingham, 2011. http://etheses.bham.ac.uk//id/eprint/1614/.
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Objective To undertake Health Technology Assessment (HTA) in maternal and perinatal medicine for tests and treatment in the areas of pre eclampsia, preterm labour, epilepsy and congenital heart disease (CHD) in newborn. Methods The work undertaken in the thesis is divided into 4 sections: Delphi survey of practice; Systematic review of reviews; Systematic reviews of therapeutic effectiveness; Systematic reviews of test accuracy Results The Delphi survey identified blood pressure to be the best predictor of complications. A significant benefit of progestational agents was observed in reducing preterm delivery before 37 weeks (OR 0.42, 95% CI 0.31 to 0.57). The combined rate of seizure deterioration was 0.40 (95% CI 0.26 to 0.55) in pregnant women with epilepsy on lamotrigine dosage based on serum levels compared to 0.73 (95% CI 0.56 to 0.86) in those managed by clinical features only. The abstracts of 19,500 citations were reviewed to identify the studies of accuracy of tests in pre eclampsia including proteinuria, uric acid, liver function tests, symptoms and blood pressure. The sensitivity and specificity were 0.63 (95% CI 0.39, 83) and 0.998% (95% CI, 0.99, 100) respectively for detecting CHD in the newborn by pulse oximetry. Conclusion Through the HTA of tests and treatment in priority areas of maternal and perinatal medicine, the thesis has led to the generation of clinical recommendation where there was clear evidence of benefit and for further research where there were gaps in evidence.
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Hillman, Sarah Christine. "The use of prenatal chromosomal microarrays when performed for a fetus with structural abnormalities on ultrasound scan." Thesis, University of Birmingham, 2014. http://etheses.bham.ac.uk//id/eprint/4762/.
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Fetal chromosomes are examined conventionally by G-band karyotyping. More recently Prenatal Chromosomal Microarray (CMA) has been used to look for fetal chromosomal abnormalities. Advantages of CMA include its higher detection rate. Disadvantages include its detection of Variants of Unknown Significance (VOUS). I recruited a prospective cohort of 243 women with structural abnormalities on fetal ultrasound scan. A 1Mb targeted BAC array was performed in addition to G-band karyotyping. In 62 cases from this cohort an additional higher resolution 60K oligonucleotide array was used. A health economic analysis, by use of a decision tree, was performed. Finally qualitative work determined women’s feelings about testing. The 1Mb BAC cohort found a 4.1% increase in fetal chromosomal abnormalities over karyotyping, with a low detection rate of VOUS (0.4%). The 60K sub-cohort noted an extra 4.8% pathogenic chromosomal anomalies but, in addition, a 13% increase in VOUS. The health economic analysis indicated that when CMA is £360 (per test) and the Willingness To Pay (WTP) for a “positive diagnosis” is £9768; then CMA is cost effective over karyotyping. Qualitative analysis showed that couples were keen for as much information as possible. They struggled to recall and retain information conveyed at the time of the testing.
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Lebbe, Marie. "Androgen synthesis, metabolism and action in the developing ovarian follicle." Thesis, University of Birmingham, 2016. http://etheses.bham.ac.uk//id/eprint/6991/.
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The ovarian follicle is the major site of sex steroid production in females, hormones that are crucially required for normal ovarian function and female reproduction. The biosynthesis and metabolism of androgens by individual follicles throughout development has been difficult to study because androgens and androgen precursors are structurally similar molecules present in low concentrations. Androgens have dual dose-dependent effects on folliculogenesis, with reduced or exaggerated levels of androgens being deleterious for follicle development. Few studies have shown the whole spectrum of androgen action using a single experimental model. Here we employed tandem mass spectrometry to measure sex steroid production by murine follicles, cultured in an alginate encapsulated, 3-dimensional model. We showed developmental stage-dependant FSH-stimulated androgen and oestrogen secretion. When follicles were cultured in the presence of non-aromatisable 5-dihydrotestosterone, endogenous androgen production decreased. Following exposure to the universal sex steroid precursor dehydroepiandrosterone, high androgen generation was achieved by immature follicles. We described androgen receptor-mediated growth-promoting effects of androgen supplementation in developing follicles. However, when androgen exposure was gradually increased, we first observed suppression of oocyte development, followed by stagnation of follicle growth. These data provide the rationale for androgen treatment in women with low ovarian reserve, but call for caution as over-replacement might cause harm to oocyte quality. Furthermore, this study describes mechanisms which might contribute to the follicular developmental arrest that is observed in androgen excess conditions such as polycystic ovary syndrome.
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Varma, Rajesh. "An investigation of basic science and clinical research methodologies to benefit clinical practice." Thesis, University of Birmingham, 2009. http://etheses.bham.ac.uk//id/eprint/306/.
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The aim of this PhD thesis was to produce research that could inform and benefit clinical practice by exploring the application of basic science and clinical research methodologies to disorders in obstetrics and gynaecology. Chapter 1’s investigation of endometriosis is the first to 1) report detailed genetic mapping of endometriosis-associated ovarian cancer, 2) report the existence of micro-LOH (loss of heterozygosity) in ovarian endometriosis through a SNP 100K DNA array. Chapter 2 explores the efficacy of interventions to treat menstrual abnormalities using clinical cohort studies. Furthermore, Chapter 2 highlights how negligence in female sterilization failure may be mathematically (Bayesian) modelled. Chapter 3 explores the value of systematic reviews for preventing preterm delivery and use of LNG-IUS (Mirena coil). The clinical guidelines published in Chapter 4 include: vaginal birth after previous caesarean, ectopic pregnancy, safe laparoscopic entry and minimising risk of sterilisation failure. The thesis concludes (Chapter 5) by suggesting strategies to augment the research methodological approaches evaluated in this thesis in order fulfill the aim of benefitting clinical practice. Work included in this PhD thesis has been orally presented at international conferences, published in peer-reviewed journals, and published as a national clinical guideline by the Royal College of Obstetricians and Gynaecologists, UK (RCOG).
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Morris, Rachel Katherine. "Prediction and prevention of fetal growth restriction and compromise of fetal wellbeing : systematic reviews and meta-analyses with model based economic evaluation." Thesis, University of Birmingham, 2011. http://etheses.bham.ac.uk//id/eprint/1319/.
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Restriction of fetal growth and compromise of its wellbeing remain significant causes of perinatal death and childhood disability. There is a lack of scientific consensus about the best strategies for predicting these conditions before birth and thus there is uncertainty about the best management of pregnant women who might have a growth-restricted baby. This health technology assessment thesis used state of the art methods to review 337 studies including 472,544 women. It determined : 1. The accuracy of available tests for predicting small for gestational age infants (SGA) and 2. Compromise of fetal wellbeing and 3. Summarised the effectiveness of available treatments for these conditions. To allow translation of these results into patient care, the diagnostic and therapeutic information was integrated in a model based economic evaluation. This thesis has demonstrated that the tests reviewed have a limited use in screening/diagnosis for SGA/compromise of fetal and neonatal wellbeing when used in isolation. The quality of primary research was variable with recommendations being made particularly for the use of standardised and relevant outcome measures. The decision model and economic analysis identified that an effective, affordable and safe intervention applied to all mothers without prior testing is likely to be the most cost-effective strategy in the prevention of these conditions.
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Collins, Stuart Ian. "An investigation of the natural history of early cervical human papillomavirus infection and its relationship to the acquisition of epithelial abnormalities of the cervix." Thesis, University of Birmingham, 2010. http://etheses.bham.ac.uk//id/eprint/532/.
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Cervical human papillomavirus (HPV) infection is a very common sexually transmitted disease which is now considered to be a necessary, but not sufficient, cause of cervical cancer. It has been suggested that the association between HPV infection and cervical neoplasia can be exploited to improve the efficiency and effectiveness of primary- and secondary-prevention programmes for cervical cancer. However, whether this aspiration can be realized in practice requires a greater understanding of the natural history of early cervical HPV infection and its role in the acquisition of epithelial abnormalities of the cervix. In this thesis, a longitudinal study of young women who had recently embarked on sexual activity has provided sequential observations on the natural history of cervical HPV infection. This thesis addresses four aspects of this natural history: the association between HPV infection and the proximity of first sexual intercourse to menarche; the association between smoking, cervical HPV infection and high-grade cervical disease; the validation of a neutralising antibody assay and its use in defining the kinetics of the humoral immune response to cervical HPV16 and HPV18 infections; and the analysis of measurements of the viral load of HPV16 and HPV18, and their association with epithelial abnormalities of the cervix
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Farquharson, Malcolm John. "Improving the understanding of platinum sensitivity and the tumour microenvironment in high grade serous ovarian cancer." Thesis, University of Glasgow, 2018. http://theses.gla.ac.uk/31006/.
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Ovarian cancer is one of the most lethal malignancies and often presents at an advanced stage, resulting in a poor prognostic outlook. Platinum chemotherapy leads to an initial clinical response, however most patients will ultimately relapse and there remains a sub-group who are intrinsically resistant to platinum. I focussed on high grade serous ovarian cancer (HGSOC), the most common subtype of ovarian cancer. The ID8 CRISPR-generated models represented a novel and simple tool to investigate the biology of HGSOC. By using this in vivo model, I aimed to further the understanding of platinum sensitivity in HGSOC by investigating the homologous recombination pathway and the tumour microenvironment. In vitro work showed that sensitivity to PARP inhibitors was clearly correlated with defective homologous recombination but the relationship with platinum sensitivity was more complicated. Using the ID8 derivatives, in vivo cisplatin experiments identified Pten and Nf1 loss to be associated with the worst prognosis with the knockout of Brca1 or Brca2 prolonging survival. A Brca1 mutation in the PALB2 domain compared to the BRCT2 domain was found to be associated with a greater sensitivity to cisplatin. The tumour microenvironment was shown to differ between genotypes and altered with the addition of platinum chemotherapy. Specifically, the loss of Pten was associated with an immunosuppressive microenvironment with increased levels of myeloid-derived suppressor cells (MDSCs) and tumour-associated macrophages (TAMs). The chemokines, Ccl2 and Ccl7 were shown to be significantly increased in the Trp53-/-;Pten-/- genotype. I targeted both the cytokine/chemokine response directly by using a transgenic mouse model (CCR1, 2, 3, 5 receptors knockout) and the PI3K/AKT pathway by using a PI3K inhibitor (p110β) (AZD8186) to attempt to reverse the effect of Pten loss. The transgenic mouse model (GGTACKO) showed encouraging early results with a reduction in MDSCs and TAMs in the knockout mice injected with the Trp53-/-;Pten-/- genotype but a repeat experiment is required before valid conclusions can be made. The AZD8186 in vivo experiment showed a significant reduction in MDSC levels in the ascites following AZD8186 treatment in mice injected with the Trp53-/; Pten-/- genotype and a non-significant decrease in the tumour samples. There was also a reversal in the anaemia previously shown with the loss of Pten and a decrease in Ccl2 and Ccl7 expression. I have used a transplantable in vivo model for HGSOC to investigate potential mechanisms of platinum sensitivity and identified poor prognostic genotypes (Pten, Nf1). I have found Pten loss to be associated with an immunosuppressive microenvironment and highlighted potential therapeutic targets. By targeting the PI3K/AKT pathway I have shown that the effect of Pten loss can be reversed. The next step will be to determine whether this reversal results in a prolonged survival.
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Healy, Maria Isobel. "Rethinking postnatal care : a Heideggerian hermeneutic phenomenological study of postnatal care in Ireland." Thesis, University of Central Lancashire, 2012. http://clok.uclan.ac.uk/6654/.
Full textAbstract:
The postnatal period is an important and extremely vulnerable time for new mothers and their infants. Research has outlined the considerable extent of maternal physiological and psychological morbidity following childbirth. The underreporting and undiagnosed aspect of this morbidity has also been highlighted. Newborn infants are totally dependent on their needs being met and are also at risk of newborn conditions particularly if they are undiagnosed, for example neonatal jaundice. There is however, mounting evidence regarding the lack of postnatal support from health professionals, with women continuing to report their dissatisfaction with postnatal care. Research into postnatal care is pre-dominantly quantitative and clinically focused. Few empirical studies have examined the meaning women give to their postnatal care experiences. This research aims to generate a deeper understanding of the meanings, and lived experiences of postnatal care. In addition, it aims to reveal future possibilities to enhance women’s postnatal care experiences. Initially, an in-depth examination of relevant literature is undertaken followed by a presentation of the process and findings from a qualitative meta-synthesis. An in-depth exploration of Martin Heidegger’s biography and explication of his philosophy is then outlined. This research is a Heideggerian hermeneutical phenomenological study of Irish women’s aspirations for, and experiences of, postnatal care. Purposive sampling is utilised in this research, which was undertaken in two phases. Phase one involved group interviews over three different time periods (between 28-38 weeks gestation, 2-8 weeks and 3-4 months postnatally), with a cohort of primigravid women and a cohort of multigravid women. The second phase involved recruiting two further cohorts of primigravid and multigravid women who participated in individual in-depth interviews over the same longitudinal period. In total nineteen women completed the study. Thirty-three interviews were held in total. The data analysis is guided by Crist and Tanner’s (2003) interpretative hermeneutic framework. The women’s aspirations/expectations for their postnatal care are represented through three interpretive themes: ‘Presencing’, ‘Breastfeeding help and support’ and ‘Dispirited perception of postnatal care’. In addition, five main themes emerged from the data and capture the meanings the women gave to their lived experiences of postnatal care: ‘Becoming Family’, ‘Seen or not seen’, ‘Saying what matters’, ‘Checked in but not always checked out’ and ‘The struggle of postnatal fatigue’. The original insights from this research clearly illuminate the vulnerability women face in the days following birth. A further in-depth interpretation and synthesis of the findings was undertaken. This philosophical-based discussion drew from the work of Heidegger (1962) and Arendt (1998). Engaging with these theoretical perspectives contributed to a new understanding about why some women within a similar context, have positive experiences of postnatal care while others do not. As such, the very nature that midwives and other postnatal carers are human beings has an influence on a woman’s experience of her care. These carers, in their exposition of ‘being’ have the ability to demonstrate ‘inauthentic’ or ‘authentic’ caring practices. It is those who choose to be ‘the sparkling gems’ that are the postnatal carers who make a difference and stand out from the others. For the women in this study, their postnatal care experiences mattered. While some new mothers reported positive and meaningful experiences others revealed experiences which impacted unnecessarily. The relevance of these findings, recommendations and suggestions for future research are offered.