Magister Artium (Psychology) - MA(Psych) / Over time, the ‘normal’ experience of pregnancy transitioned to the hospital setting, leading to a discourse steeped in the notions of risks and complications. Risks and complications refer to health problems expectant women may experience, causing them to have a high-risk pregnancy. High-risk pregnancy refers to a pregnancy that negatively affects the health of the mother, the baby, or both, and evoking a range of emotional and psychological experiences. Research on high-risk pregnancy is predominantly found in the medical arena. Such research usually concerns the disease, while women’s emotional/psychological experiences are not sufficiently documented. For this reason, the objectives of this study was to explore the emotional and psychological experiences of women in the reviewed articles throughout their high-risk pregnancies, and identify the medical conditions and complications in the same reviewed articles. Ethics clearance was obtained from the senate research committee at UWC. The systematic review examined qualitative studies, including the qualitative components of mixed method studies published between January 2006 and June 2017. The databases that were searched are EbscoHost, JSTOR, Sage Journals Online, ScienceDirect, SpringerLink, Sabinet, Scopus, Emerald eJournals Premier, Pubmed, as well as Taylor and Francis Open Access eJournals. The study evaluated the literature found on these databases for methodological quality by using three stages of review (i.e. abstract reading, title reading, and full-text reading) and applying a meta-synthesis to the current evidence on the research topic. The findings provide empirical evidence based on sound research that medical conditions and complications (i.e. HELLP syndrome, thrombophilia, gestational diabetes, maternal near-miss syndrome, foetal abnormality, preterm birth, hypertension, and uterine rupture) are associated with women’s emotional and psychological experiences (i.e. fear, shock, feeling frightened, sadness, worry, alienation, frustration, grief, guilt, anger, ambivalence, despair, upset, loneliness and isolation, anxiety, depression, and PTSD) throughout their high-risk pregnancies. As a result of this, survivors of severe pregnancy complications have subsequent psychological and emotional challenges. It is therefore recommended that future researchers consider including quantitative studies in a systematic review on the same topic.

Magister Public Health - MPH / Background: Antenatal Care (ANC) is a key strategy in achieving positive maternal health outcomes. ANC is an important entry point into formal health care services. ANC is very low in cost and among the most effective packages to promote and establish good health before childbirth and the early postnatal period; therefore, it is very feasible for the good results it is proven to have on maternal and child health. South Africa has had free ANC services since 1994. Despite these free services a lot of women still attend the ANC clinics late or do not attend follow-up visits, hindering the quality of care during pregnancy. The first ANC visit should be in the first trimester of pregnancy or as early as possible, because with the first visit underlying conditions must be identified and managed to promote maternal and foetal health. ANC initiation after 20 weeks may increase maternal, foetal and perinatal morbidity and mortality. In the Cape Winelands there are still 27.3% of women that attend ANC after 20 weeks gestation. This may hinder the quality of care during pregnancy and may lead to negative health outcomes for mother and or baby. The purpose of the study is to understand why some women still do not attend ANC before 20 weeks gestation even when it is available.

Intrinsecamente, todo procedimento cirúrgico apresenta um certo índice de intercorrências e/ou complicações associadas. Hemorragias, infecções, parestesias ou disestesias e perda primária dos implantes são algumas das intercorrências e complicações mais comuns relacionadas a procedimentos cirúrgicos para implantodontia. Este estudo avaliou retrospectivamente o índice de intercorrências e complicações após cirurgia para a instalação de implantes dentais osteointegráveis. Foram avaliados, retrospectivamente, 660 prontuários clínicos de pacientes submetidos à instalação de implantes osteointegráveis no período 8 anos atendidos na Área de Cirurgia Buco-Maxilo-Facial da Faculdade de Odontologia de Piracicaba - Unicamp. Os resultados demonstraram que houve um maior índice de intercorrências e complicações quando os pacientes eram atendidos por alunos de especialização (p= 0,015) e quando o exame por imagem realizado era somente a radiografia panorâmica convencional (p= 0,011). Os resultados demonstraram também um maior índice de intercorrências e complicações nos pacientes quando estes eram submetidos a procedimentos cirúrgicos de reconstrução óssea alveolar (p< 0,0001). A presença de infecção pós-operatória influenciou significativamente para o aumento no índice de perda primária de implantes (p< 0,0001). / Intrinsically, every surgical procedure presents a certain rate of associated intercurrences and/or complications. Hemorrhages, infections, paresthesias or dysesthesias and primary loss of implants are some of the most common intercurrences and complications related to surgical procedures in implant dentistry. This study conducted a retrospective evaluation of the rate of intercurrences and complications related to patients submitted to osseointegratable dental implant placement. A retrospective evaluation was made of 660 clinical record charts of patients submitted to osseointegratable dental implants in the period of 8 years, attended in the Oral and Maxillofacial Surgery Department of Piracicaba Dental School - Unicamp. The results showed that there was a higher rate of intercurrences and complications when patients were attended by residents (p= 0.015) and when the panoramic radiograph was the only preoperative image exam requested (p= 0.011). The results also showed a higher rate of intercurrences and complications in patients when they were submitted to surgical procedures of alveolar bone reconstruction (p< 0.0001). The presence of post-operative infection had a significant influence on the increase in the primary loss of implants (p< 0.0001).

A hérnia perineal é uma enfermidade que ocorre comumente em cães machos, principalmente não castrados com faixa etária entre cinco e 14 anos. A etiologia é desconhecida, sendo que vários fatores já foram associados tais como alterações hormonais, neurogênicas ou características anatômicas. Sabe-se que a atrofia muscular, principalmente do músculo elevador do ânus, está relacionada diretamente com o desenvolvimento da hérnia perineal e, de acordo com os músculos envolvidos, é classificada em caudal, dorsal, ventral ou ciática. Várias técnicas cirúrgicas foram descritas para sua correção, porém as taxas de complicações e recidivas são elevadas, sem que tenha havido avaliações comparativas das técnicas e determinação de qual é mais adequada para cada caso. Portanto, objetivou-se com o presente estudo a avaliação crítica das técnicas de herniorrafia perineal realizadas em cães machos, por meio da colimação dos resultados coligidos em trabalhos científicos observados na literatura. Para tanto foi realizada uma busca nas bases de dados referenciais eletrônicas Embase, Google Acadêmico, PubMed, SciELO, Science Direct e Web of Science. Os processos de reparação de hérnia perineal tais como a técnica de sutura padrão, transposição do músculo obturador interno; transposição do músculo glúteo superficial; transposição do músculo semitendinoso; reparação com uso de membranas sintéticas ou biológicas; e colopexia associada ou não a cistopexia foram avaliados quanto à presença de complicações e recidivas. Com a busca por meio das bases de dados referenciais eletrônicas obteve-se 5311 resultados em português e inglês. A busca manual resultou na obtenção de outros 41 artigos. Após avaliação do título e resumo, exclusão dos resultados repetidos, e leitura do texto completo, foram selecionados 30 artigos de acordo com os critérios de inclusão e exclusão. Baseando-se na comparação e avaliação dos resultados é possível concluir que existe falta de dados clínicos padronizados bem como informações sobre o tempo de acompanhamento pós-operatório e taxas de recidiva extremamente variáveis, dificultando estabelecer paralelo entre o nível de gravidade da enfermidade com as complicações advindas após realização das diferentes técnicas cirúrgicas preconizadas, dificultando a avaliação da eficácia de tais técnicas / Perineal hernia is a disease that occurs commonly in male dogs, especially uncastrated aged between five and 14 years. The etiology is unknown, and several factors have been associated such as hormonal, neurogenic or anatomical features changes. It is known that muscle atrophy, mainly of the levator ani muscle, is directly related to the development of perineal hernia and, according to the involved muscles, it is classified into caudal, dorsal, ventral or sciatica. Several surgical techniques have been described for its repair, but the complications and recurrences rates are high, without there have been comparative evaluation techniques and determination of which is more appropriate for each case. Therefore, the present study had the objective of critically evaluate the perineal hernia repair techniques performed in male dogs through collimation of the results collected in scientific studies reported in the literature. Therefore it was carried out a search in the electronic reference databases Embase, Google Scholar, PubMed, SciELO, Science Direct and Web of Science. The perineal hernia repair procedures such as standard suture technique, transposition of the internal obturator muscle; transposition of superficial gluteal muscle; transposition of semitendinosus muscle; repair with the use of synthetic or biological membranes; and colopexy with or without cistopexia were evaluated for the presence of complications and recurrences. With the search through the electronic reference databases, it was obtained 5311 results in Portuguese and English. The manual search resulted in obtaining another 41 articles. After evaluation of the title and abstract, excluding the repeated result and reading the full text, it was selected 30 articles according to the inclusion and exclusion criteria. Based on the comparison and evaluation of the results it is possible to conclude that there is a lack of standardized clinical data as well as information about the time of postoperative follow-up and extremely variable recurrences rates, making it difficult to establish a parallel between the level of the disease severity with complications arising after implementation of the various preconized surgical techniques, making it difficult to evaluate the effectiveness of such techniques

O cirurgião dentista comumente em sua prática clínica se vê diante de pacientes sistemicamente comprometidos. Entre esses pacientes encontramos o grupo dos hipertensos que merecem especial atenção pelo profissional, devido às possíveis alterações psicossomáticas que podem vir a acontecer durante um atendimento odontológico. O presente estudo teve como objetivo estabelecer a prevalência e suas implicações em pacientes hipertensos em uma amostra de 424 pacientes sob tratamento na FO-USP. Com os resultados da amostra, quase 1/3 da população analisada era hipertensa, confirmando a alta prevalência da patologia na amostragem estudada. Os fatores de risco que mais influenciaram na presença de hipertensão observados nesta pesquisa foram o diabetes e o sedentarismo, elucidando o quão é necessário correlacionar a história médica e os hábitos do paciente para chegar a um diagnóstico diferencial. Já 10,53% dos pacientes hipertensos não eram cientes sobre sua condição sistêmica e, um grande número daqueles que já eram cientes, todavia apresentavam-se descompensados, confirmando a importância e a necessidade do cirurgião dentista aferir a pressão arterial de seus pacientes em clínica rotineiramente. Enfim, uma completa anamnese, acompanhada de exames complementares, como mensurações da pressão arterial, garante um tratamento odontológico seguro e efetivo. / The dentist commonly takes care of patients with systemic diseases in its routine clinic. Among these patients we find the group of the hypertensives that deserve special attention for the professional, whom had possible psychosomatic alterations that can come to happen during an odontology attendance. The present study had the objective to establish the prevalence and its implications among hypertensives in a sample of 424 patients under treatment in the FOUSP. As a result of the sample, almost 1/3 of the analyzed population was hypertensive, confirming the high prevalence of the pathology in the studied sampling. The risk factors that had increased the appearance of hypertension observed in this research were diabettes and the sedentary life, elucidating how is necessary to correlate medical history and the habits of the patient to establish a distinguishing diagnosis. In addition, 10.53% of the hypertensive patients did not know about their systemic condition and a great number of the patients that had already known, were not medicated, confirming the importance and the necessity of the dentist to survey the arterial pressure of its patients in clinic routinely. Therefore, complete anamnesis, followed by complementary examinations such as measurement of the arterial pressure, guarantees a safe and effective odontology treatment.

INTRODUÇÃO: Existem várias doenças que evoluem com hipertensão pulmonar (HP), entre elas a Hipertensão Arterial Pulmonar Idiopática (HAPI) e a Esquistossomose. Acredita-se que um dos principais fatores desencadeantes da HP esteja relacionado com a disfunção endotelial. OBJETIVOS: 1. Avaliar a disfunção endotelial de pacientes com HAPI e esquistossomóticos com e sem HAP usando os marcadores plasmáticos Endotelina-1, Selectina E, VEGF, PDGFAB e PDGF-BB; 2.Avaliar se pacientes com HAP associada à esquistossomose possuem o mesmo grau de disfunção endotelial que pacientes com esquistossomose sem HAP. METODOLOGIA: Foram formados 4 grupos distintos: Controle (n=13), HAPI (n=11), pacientes com esquistossomose e HP (ESQ+HP) (n=13) e pacientes com esquistossomose sem HP (ESQ)(n=13). Os pacientes foram submetidos a avaliação clínica (caracterizados quanto a gravidade), funcional (realizaram ecocardiograma com medida de pressão sistólica de ventrículo direito, ultrassonografia abdominal quando indicada e exames para excluir outras doenças) e laboratorial (entre eles, contagem de leucócitos, plaquetas e dosagem de BNP). A avaliação hemodinâmica foi realizada nos pacientes com HP. Para a análise da disfunção endotelial, foram coletados 40 mL de sangue de todos os indivíduos para a dosagem de Endotelina-1, Selectina E, VEGF, PDGF-AB e PDGF-BB. RESULTADOS: Observou-se que os grupos não se diferiram quanto a idade, houve um predomínio do sexo feminino e os grupos controle e ESQ apresentaram valores de PSVD menores do que os grupos com HP (controles: 23,4±4,6, ESQ: 29,5±8,5, HAPI: 79,8±26,4 e ESQ+HP: 75,2±15,3 mmHg). As medidas hemodinâmicas foram semelhantes em ambos os grupos com HAP. Quanto aos marcadores da função endotelial, o grupo controle apresentou valores séricos de PDGF-BB mais aumentados (8,9±4,8x 103 pg/mL, p<0,001) que os grupos HAPI, ESQ+HP, ESQ (3,7±2,1; 5,2±3 ; 2,4±1,7 x 103 pg/mL, respectivamente). O grupo HAPI apresentou valores mais elevados de Selectina E (61,5±24,2 x 103 pg/mL) que os grupos controle, ESQ+HP e ESQ (14,5±12,2; 23,9±15,3; 21,4±18 x 103 pg/mL, respectivamente, p=0,005). Os valores séricos de PDGF-AB do grupo controle foram mais elevados que no grupo ESQ (p=0,006). Não foram encontradas diferenças significantes nos valores séricos de Endotelina-1 entre os grupos (p=0,281). Em relação ao VEGF, os pacientes com HAPI apresentaram valores séricos similares ao grupo ESQ+HP e mais elevados que o grupo controle e ESQ (p=0,002). O ponto de corte da dosagem da selectina E (43.806 pg/mL) para diferenciar pacientes com HAPI dos pacientes com ESQ+HP apresentou uma sensibilidade de 91% e a especificidade de 89%. O PDGF-BB apresentou uma boa acurácia para distinguir o grupo controle dos demais, com uma sensibilidade de 77% e uma especificidade de 83%. Além disso, a Selectina E apresentou uma forte correlação com o níveis séricos de BNP (r=0,74, p=0,006). O número de leucócitos e de plaquetas foram diferentes entre os três grupos do estudo. Pacientes com HAPI tinham maior número de leucócitos e plaquetas quando comparados com esquistossomóticos. CONCLUSÕES: 1.Pacientes com HAPI apresentaram valores séricos mais elevados de Selectina E do que pacientes com esquistossomose e controles; 2.Pacientes portadores de esquistossomose com e sem HP apresentaram os mesmos valores séricos dos marcadores de disfunção endotelial / INTRODUCTION: There are several diseases that cause Pulmonary hypertension (PH), such as Idiopathic Pulmonary Arterial Hypertension and Schistosomiasis. The mechanisms that lead to PH are thought to be related to endothelial dysfunction. OBJECTIVES: To evaluate endothelial dysfunction, using plasma markers such as Endothelin-1(ET-1), E-Selectin, VEGF, PDGF-AB and -BB, in patients with idiopathic pulmonary arterial hypertension (IPAH) and schistosomiasis patients with or without PH; and to evaluate if schistosomiasis groups have endothelial dysfunction in the same degree. METHODOLOGY: Patients were divided in 4 different groups: Patients with IPAH (n=11), Patients with PH associated to Schistosomiasis (SchPH)(n=13), Patients with Schistosomiasis without PH (Sch)(n=13) and Controls(n=13). PAH patients were classified according to severity. All groups were submitted to echocardiography and right ventricule systolic pressure(RVSP) was measured. Abdominal ultrassonography was used to rule in or rule out schistosomiasis diagnosis. PH patients went through haemodynamics evaluation and all patients had laboratorial assessment (leucocytes and platelet count and BNP levels) Soluble adhesion molecules such as E-Selectin, VEGF, PDGF-AB, PDGF-BB e ET-1 were determined by ELISA. Leucocytes and platelet counts as well as BNP levels were also evaluated. Results: Subjects did not differ according to age and there was a higher proportion of female patients. Controls and Sch subjects had lower RVSP compared to PH groups (Sch: 23.4±4.6, controls: 29.5±8.5, IPAH: 79.8±26.4 and Sch+HP: 75.2±15.3 mmHg). Haemodynamics data did not differ in PH patients. In IPAH group, E-selectin was elevated (61.5±24,2x103pg/mL) compared to controls, Sch+HP and Sch (14.5±12.2; 23.9±15.3; 21.4±18 x103pg/mL, respectively, p=0,005). PDGF-BB was decreased in IPAH, Sch+HP, Sch (3.7±2.1; 5.2±3; 2.4±1.7x103pg/mL, respectively) compared to controls (8.9±4.8x 103 pg/mL, p<0.001). PDGF-AB was elevated in controls (25.6±8.6x103pg/mL) when compared to Sch (11.4±8.6 x103pg/mL)(p=0.006). There were no differences in ET-1 levels within groups. In relation to VEGF, IPAH group had higher levels compared to controls and Sch (96,6±68,2, 38,4±28, 37,±19,2 pg/mL, respectively) (p=0,002). Based on ROC curve, E-selectin cutoff value of 43.806 pg/mL showed a sensitivity of 91% and a specificity of 89% to distinguish IPAH patients from other groups and PDGF-BB had a good accuracy to differentiate controls with a sensitivity of 77% and a specificity of 83%. Furthermore, E-selectin had a strong correlation with BNP levels (r=0,74, p=0,006). The number of leucocytes and platelets were different within groups. IPAH patients had the highest, and Sch group had the lowest blood cells and platelets count. Conclusions: 1. IPAH patients had higher levels of serum E-selectin and VEGF and controls had higher levels of PDGF-BB and AB; 2. Schistosomiasis patients with or without PH had the same levels of endothelial dysfunction serum markers

Introdução -O aumento da população idosa traz consigo o aumento das doenças crônicas não transmissíveis, entre elas o Diabetes Mellitus (DM). DM é uma doença que tem como principal característica a hiperglicemia e essa pode levar ao desenvolvimento de várias complicações que aumenta a mortalidade e morbidade de seus portadores. Objetivo -Verificar a incidência de complicações crônicas auto-referidas devidas ao DM e seus fatores associados na população idosa do SABE. Métodos - A amostra foi constituída por 259 idosos diabéticos que foram entrevistados em 2006 e tiveram seu segmento em 2010. Análise estatística realizada por teste qui-quadrado com correção de Rao Scott e regressão logística considerando amostra complexa. Resultados - Dentro da amostra 126 (41,7 por cento ) indivíduos afirmaram ter algum tipo de complicação devido à doença. A proporção de mulheres entre os indivíduos que apresentaram complicações foi de 68,8 por cento e a faixa etária de 70 a 79 anos possui a maior proporção destes com 48,7 por cento . A taxa de incidência de complicações foi calculada por 1.000 pessoas-ano sendo maior para as mulheres do que para os homens, 5,1 e 0,9 casos respectivamente. Para a amostra em geral a incidência foi de 507,9 casos/1.000 pessoas-ano. No modelo de regressão logística a variável renda esteve associada à incidência de complicações como um fator de proteção com uma Razão de Risco Relativo de 0,14 (IC= 0,02;0,98). Conclusão - A maior incidência de complicações em mulheres mostra a necessidade de oferecer maior suporte e orientação para essa população. Os resultados também sugerem que há uma demanda de melhoria nas informações e atenção dada aos idosos com menor condição financeira / Introduction - The increase of the elderly population brings with it the increase of chronic non-transmitted diseases, among them Diabetes Mellitus (DM). DM is a disease that has as main characteristic a hyperglycemia and this can lead to the development of several complications that increases the mortality and morbidity of its carriers. Objective - To verify the incidence of self-reported chronic complications due to DM and its associated factors in the elderly population of SABE Survey. Methods - The sample consisted of 259 elderly diabetics who were interviewed in 2006 and had their segment in 2010. Statistical analysis performed by chi-square test with Rao Scott correction and logistic regression considering a complex sample.Results - Within the sample 126 (41.7 per cent ) individuals reported having some type of complication due to the disease. The proportion of women among those presenting with complications was 68.8 per cent and the age group 70-79 had the highest proportion with 48.7 per cent . The incidence rate of complications was calculated per 1,000 person-times being higher for women than for men, 5.1 and 0.9 cases respectively. For the general sample, the incidence was 507,9 cases/1,000 person-times. In the logistic regression model the income variable was associated with the incidence of complications as a protection factor with a Relative Risk Ratio of 0.14 (CI = 0.02, 0.98). Conclusion - The higher incidence of complications in women shows the need to offer more support and guidance to this population. The results also suggest that there is a demand for improvement in the information and attention given to the elderly with lower financial condition

Introdução -O aumento da população idosa traz consigo o aumento das doenças crônicas não transmissíveis, entre elas o Diabetes Mellitus (DM). DM é uma doença que tem como principal característica a hiperglicemia e essa pode levar ao desenvolvimento de várias complicações que aumenta a mortalidade e morbidade de seus portadores. Objetivo -Verificar a incidência de complicações crônicas auto-referidas devidas ao DM e seus fatores associados na população idosa do SABE. Métodos - A amostra foi constituída por 259 idosos diabéticos que foram entrevistados em 2006 e tiveram seu segmento em 2010. Análise estatística realizada por teste qui-quadrado com correção de Rao Scott e regressão logística considerando amostra complexa. Resultados - Dentro da amostra 126 (41,7 por cento ) indivíduos afirmaram ter algum tipo de complicação devido à doença. A proporção de mulheres entre os indivíduos que apresentaram complicações foi de 68,8 por cento e a faixa etária de 70 a 79 anos possui a maior proporção destes com 48,7 por cento . A taxa de incidência de complicações foi calculada por 1.000 pessoas-ano sendo maior para as mulheres do que para os homens, 5,1 e 0,9 casos respectivamente. Para a amostra em geral a incidência foi de 507,9 casos/1.000 pessoas-ano. No modelo de regressão logística a variável renda esteve associada à incidência de complicações como um fator de proteção com uma Razão de Risco Relativo de 0,14 (IC= 0,02;0,98). Conclusão - A maior incidência de complicações em mulheres mostra a necessidade de oferecer maior suporte e orientação para essa população. Os resultados também sugerem que há uma demanda de melhoria nas informações e atenção dada aos idosos com menor condição financeira / Introduction - The increase of the elderly population brings with it the increase of chronic non-transmitted diseases, among them Diabetes Mellitus (DM). DM is a disease that has as main characteristic a hyperglycemia and this can lead to the development of several complications that increases the mortality and morbidity of its carriers. Objective - To verify the incidence of self-reported chronic complications due to DM and its associated factors in the elderly population of SABE Survey. Methods - The sample consisted of 259 elderly diabetics who were interviewed in 2006 and had their segment in 2010. Statistical analysis performed by chi-square test with Rao Scott correction and logistic regression considering a complex sample.Results - Within the sample 126 (41.7 per cent ) individuals reported having some type of complication due to the disease. The proportion of women among those presenting with complications was 68.8 per cent and the age group 70-79 had the highest proportion with 48.7 per cent . The incidence rate of complications was calculated per 1,000 person-times being higher for women than for men, 5.1 and 0.9 cases respectively. For the general sample, the incidence was 507,9 cases/1,000 person-times. In the logistic regression model the income variable was associated with the incidence of complications as a protection factor with a Relative Risk Ratio of 0.14 (CI = 0.02, 0.98). Conclusion - The higher incidence of complications in women shows the need to offer more support and guidance to this population. The results also suggest that there is a demand for improvement in the information and attention given to the elderly with lower financial condition

Hui Sau Lei Raydi. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1999. / Includes bibliographical references (leaves 71-82). / Abstracts in English and Chinese. / ABSTRACT (English and Chinese) --- p.i / ACKNOWLEDGMENT --- p.1 / LIST OF FIGURES --- p.2 / LIST OF TABLES --- p.3 / LIST OF ABBREVIATIONS --- p.4 / Chapter I. --- Introduction and Objectives --- p.5-8 / Chapter II. --- Literature review --- p.9 / Chapter II.A --- Corticotrophin-releasing hormone --- p.9 / Chapter II.A.1. --- Structure of Corticotrophin-releasing hormone --- p.9-10 / Chapter II.A.2. --- Corticotrophin releasing hormone and normal Physiology --- p.11 / Chapter II.A.2.a. --- Pituitary-adrenal axis --- p.11-12 / Chapter II.A.2.b. --- Role of Pituitary-adrenal axis --- p.12 / Chapter II.A.3. --- Placental Corticotrophin releasing hormone --- p.13 / Chapter II.A.3.a. --- Origin --- p.13 / Chapter II.A.3.b. --- Physiology --- p.14 / Chapter II.A.3.C. --- Normal pregnancy --- p.15 / Chapter II.A.3.d. --- Association with human parturition --- p.16 / Chapter II.A.3.e. --- Association with preterm delivery and other abnormal pregnancy outcomes --- p.17-18 / Chapter II.B. --- Alpha-fetoprotein --- p.19 / Chapter II.B.1. --- Physiology --- p.19-20 / Chapter II.B.2. --- Maternal alpha-fetoprotein levels in the second trimester --- p.21-22 / Chapter III : --- Materials & Method --- p.23 / Chapter III.A. --- Study population --- p.23-24 / Chapter III.B. --- Sample collection and Analysis --- p.25 / Chapter III.C. --- Corticotrophin releasing hormone radioimmunoassay --- p.26 / Chapter III.C.l.a. --- Theoretical basis for radioimmunoassay --- p.26-27 / Chapter III.C.l.b. --- Vycor extraction of maternal plasma samples --- p.28-30 / Chapter III.C.l.c. --- Standard curve --- p.31-32 / Chapter III.C.l.d. --- Antisera --- p.33 / Chapter III.C.1.e. --- Tracer --- p.34-35 / Chapter III.C.l.f. --- HPLC Tracer Purification --- p.36-37 / Chapter III.C.l.g. --- Separation of bound from unbound Cortico- trophin-releasing hormone: second antibody --- p.38 / Chapter III.C.1.h. --- Corticotrophin-releasing hormone radio- immunoassay procedure --- p.39 / Chapter III.C.2. --- Corticotrophin-releasing hormone reagents --- p.40-41 / Chapter III.C.3. --- Estimation of Corticotrophin-releasing hormone extraction recovery --- p.42 / Chapter III.C.4. --- Sample dilution --- p.43 / Chapter III.D. --- Alpha-fetoprotein: microparticle enzyme immunoassay --- p.44 / Chapter III.D.1. --- Principles --- p.44 / Chapter III.D.2. --- Reaction Process --- p.45-46 / Chapter III.D.3. --- MEIA Optical Assembly --- p.47 / Chapter III.D.4. --- Operation --- p.47 / Chapter III.D.5. --- Alpha-fetoprotein reagents --- p.48 / Chapter III.D.6. --- Sample Dilution --- p.49 / Chapter III.D.7. --- Inter-assay and Intra-assay Variation --- p.50-52 / Chapter III.E. --- Data handling --- p.53 / Chapter III.F. --- Statistical Analysis --- p.53 / Chapter IV: --- Results --- p.54 / Chapter IV.A. --- Demographic Data --- p.55-57 / Chapter IV.B. --- Corticotrophin-releasing hormone levels --- p.58 / Chapter IV.B.1. --- Corticotrophin-releasing hormone levels increases as gestation advances --- p.58 / Chapter IV.B.2 --- The association between the plasma Corticotrophin releasing hormone levels and the time to delivery --- p.59 / Chapter IV.B.3 --- Elevated Corticotrophin-releasing hormone levels among the preterm group --- p.60 / Chapter IV.B.4. --- Corticotrophin releasing hormone levels and history of threatened abortion --- p.61 / Chapter IV.C. --- Alpha-fetoprotein levels --- p.62 / Chapter IV.C.1. --- Alpha-fetoprotein levels and gestational age --- p.62 / Chapter IV.C.2. --- Alpha-fetoprotein levels and preterm labour --- p.63 / Chapter V: --- Discussion --- p.64-65 / Chapter V.A. --- Importance of dating --- p.64 / Chapter V.B. --- Diagnosis of preterm labour --- p.64-65 / Chapter V.C.1. --- Corticotrophin-releasing hormone and labour --- p.65-66 / Chapter V.C.2. --- Corticotrophin-releasing hormone and infection --- p.66-67 / Chapter V.C.3. --- Diurnal rhythm of Corticotrophin-releasing hormone --- p.67 / Chapter V.C.4. --- Laboratory assays of Corticotrophin-releasing hormone --- p.68 / Chapter V.D. --- Alpha-fetoprotein and labour --- p.69-70 / Chapter VI. --- Reference --- p.71-82

Yeung Sau-Man. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2002. / Includes bibliographical references (leaves 139-172). / Abstracts in English and Chinese. / Title page --- p.i / Acknowledgements --- p.ii / Table of Content --- p.iv / List of Figures --- p.viii / List of Graphs --- p.x / List of Tables --- p.xi / Abbreviations --- p.xiv / Abstract --- p.xv / Chinese Abstract --- p.xvii / Chapter Chapter 1 --- General Introduction --- p.1 / Chapter 1.1 --- Diabetes Mellitus --- p.2 / Chapter 1.1.1 --- Type 1 diabetes mellitus --- p.3 / Chapter 1.1.2 --- Type 2 diabetes mellitus --- p.5 / Chapter 1.1.3 --- Maturity onset diabetes of the young (MODY) --- p.6 / Chapter 1.1.4 --- Gestational diabetes --- p.7 / Chapter 1.2 --- Effect of Diabetes on Pregnancy --- p.9 / Chapter 1.3 --- Suggested Causes of Diabetic Embryopathy --- p.10 / Chapter 1.3.1 --- Glucose --- p.10 / Chapter 1.3.2 --- Ketone bodies --- p.11 / Chapter 1.3.3 --- Somatomedin inhibitors --- p.12 / Chapter 1.3.4 --- TNF-α --- p.12 / Chapter 1.3.5 --- Oxidative stress --- p.13 / Chapter 1.4 --- Animal Model of Diabetes --- p.15 / Chapter 1.4.1 --- Chemically-induced --- p.15 / Chapter 1.4.2 --- Mutants --- p.17 / Chapter 1.5 --- Gene-teratogen Interaction under Diabetic Pregnancy --- p.19 / Chapter 1.6 --- Strategy of the Thesis --- p.21 / Chapter Chapter 2 --- General Materials and Methods --- p.24 / Chapter 2.1 --- Mouse Maintenance and Mating Method --- p.25 / Chapter 2.2 --- Induction of Diabetes --- p.25 / Chapter 2.3 --- Preparation of All-trans Retinoic Acid --- p.26 / Chapter 2.4 --- Dissection of Embryos --- p.26 / Chapter 2.5 --- DNA Extraction from Yolk Sac for Genotyping --- p.27 / Chapter 2.6 --- Genotyping of Embryos --- p.28 / Chapter 2.7 --- Preparation of RNA Probes for In Situ Hybridization --- p.29 / Chapter 2.7.1 --- Mini-scale preparation of plasmid DNA --- p.29 / Chapter 2.7.2 --- Linearization of plasmid DNA --- p.30 / Chapter 2.7.3 --- In vitro transcription --- p.31 / Chapter 2.8 --- Whole Mount In Situ Hybridization --- p.33 / Chapter 2.8.1 --- Fixation and dehydration of embryos --- p.33 / Chapter 2.8.2 --- Hybridization --- p.33 / Chapter 2.8.3 --- Post-hybridization wash --- p.34 / Chapter 2.8.4 --- Antibody wash and color development --- p.35 / Chapter 2.8.5 --- Embryo powder preparation --- p.36 / Chapter 2.8.6 --- Pre-absorption of antibody --- p.35 / Chapter 2.9 --- Whole Mount TUNEL Staining --- p.36 / Chapter Chapter 3 --- "Maternal Diabetes, Sp2H and RA Interaction" --- p.39 / Chapter 3.1 --- Introduction --- p.40 / Chapter 3.1.1 --- Neural tube defects --- p.41 / Chapter 3.1.2 --- Retinoic acid as environmental factor --- p.41 / Chapter 3.1.3 --- Sp2H as genetic factor --- p.44 / Chapter 3.1.4 --- Experimental design of this chapter --- p.46 / Chapter 3.2 --- Material and Methods --- p.47 / Chapter 3.2.1 --- Sp2H mice --- p.47 / Chapter 3.2.2 --- Mating and RA injection protocol --- p.47 / Chapter 3.2.3 --- Dissection of fetuses and analysis of neural tube development --- p.48 / Chapter 3.3 --- Results --- p.49 / Chapter 3.3.1 --- Maternal diabetes alone --- p.50 / Chapter 3.3.2 --- Sp2H mutation alone --- p.51 / Chapter 3.3.3 --- RA alone --- p.52 / Chapter 3.3.4 --- Maternal diabetes and RA interaction --- p.53 / Chapter 3.3.5 --- Sp2H mutation and RA interaction --- p.55 / Chapter 3.3.6 --- Sp2H mutation and maternal diabetes interaction --- p.57 / Chapter 3.3.7 --- "Maternal diabetes, Sp2H mutation and RA interaction" --- p.59 / Chapter 3.4 --- Discussion --- p.62 / Chapter 3.4.1 --- Maternal diabetes alone does not cause neural tube defects --- p.62 / Chapter 3.4.2 --- RA induces neural tube defects --- p.63 / Chapter 3.4.3 --- Interaction of maternal diabetes with RA in increasing the susceptibility to neural tube defects --- p.64 / Chapter 3.4.4 --- Embryos with Sp2H allele show increased susceptibility to neural tube defects when triggered by maternal diabetes and RA --- p.67 / Chapter Chapter 4 --- Molecular and Cellular Bases of Interaction --- p.71 / Chapter 4.1 --- Introduction --- p.72 / Chapter 4.1.1 --- Mechanism of diabetic embryopathy --- p.72 / Chapter 4.1.2 --- Mechanism of Sp2H mutation in development of neural tube defects --- p.74 / Chapter 4.1.3 --- Mechanism of RA teratogenicity --- p.75 / Chapter 4.1.4 --- "Possible common pathways shared by maternal diabetes, RA and Sp2H mutation" --- p.76 / Chapter 4.1.5 --- Experimental design of this chapter --- p.78 / Chapter 4.2 --- Materials and Methods --- p.80 / Chapter 4.2.1 --- Sample collection for studying Pax3 expression in Sp2H/+ And +/+ embryos in response to maternal diabetes or RA by whole mount in situ hybridization --- p.80 / Chapter 4.2.2 --- "Sample collection for studying the level of apoptosis in response to the interaction of maternal diabetes, Sp2H mutation and RA by whole mount TUNEL staining" --- p.82 / Chapter 4.3 --- Results --- p.86 / Chapter 4.3.1 --- Expression levels of Pax3 mRNA detected by whole mount in situ hybridization / Chapter 4.3.1.1 --- Expression of Pax3 in Sp2H/+/- and +/+ embryos --- p.86 / Chapter 4.3.1.2 --- Effect of maternal diabetes on Pax3 expression in Sp2H/+ and +/+ embryos --- p.87 / Chapter 4.3.1.3 --- Effect of RA on Pax3 expression in Sp2H /+ and +/+ embryos --- p.88 / Chapter 4.3.2 --- Level of apoptosis detected by whole mount TUNEL --- p.89 / Chapter 4.3.2.1 --- Effect of Sp2H allele on apoptosis --- p.94 / Chapter 4.3.2.2 --- Effect of maternal diabetes on apoptosis in Sp2H/+ and +/+ embryos --- p.95 / Chapter 4.3.2.3 --- Effect of RA on apoptosis in Sp2H/+ and +/+ embryos --- p.96 / Chapter 4.3.2.4 --- Effect of maternal diabetes and RA on apoptosis in Sp2H/+ and +/+ embryos --- p.97 / Chapter 4.4 --- Discussion --- p.99 / Chapter 4.4.1 --- Underexpression of Pax3 and increases in apoptosis under maternal diabetes --- p.99 / Chapter 4.4.2 --- "RA does not down regulate Pαx3, but increases apoptosis" --- p.102 / Chapter 4.4.3 --- Interaction of maternal diabetes and RA in increasing apoptosis --- p.104 / Chapter Chapter 5 --- "Maternal Diabetes, NOD and RA Interaction" --- p.108 / Chapter 5.1 --- Introduction --- p.109 / Chapter 5.1.1 --- Diabetic embryopathy in NOD mice --- p.109 / Chapter 5.1.2 --- Experimental design of this chapter --- p.110 / Chapter 5.2 --- Materials and Methods --- p.112 / Chapter 5.2.1 --- NOD mice --- p.112 / Chapter 5.2.2 --- Mating and RA Injection Protocol --- p.112 / Chapter 5.2.3 --- Sample Collection for the Study of Pax3 Expression --- p.113 / Chapter 5.3 --- Results --- p.115 / Chapter 5.3.1 --- Maternal diabetic alone --- p.116 / Chapter 5.3.2 --- NOD mutation alone --- p.117 / Chapter 5.3.3 --- RA alone --- p.118 / Chapter 5.3.4 --- Maternal diabetes and RA interaction --- p.119 / Chapter 5.3.5 --- NOD mutation and RA interaction --- p.121 / Chapter 5.3.6 --- NOD mutation and maternal diabetes interaction --- p.123 / Chapter 5.3.7 --- "Maternal diabetes, NOD mutation and RA interaction" --- p.125 / Chapter 5.3.8 --- Expression of Pax3 in embryos with different copies of NOD alleles --- p.128 / Chapter 5.4 --- Discussion --- p.130 / Chapter 5.4.1 --- Maternal diabetes interacts with NOD mutation to increase susceptibility to neural tube defects --- p.130 / Chapter 5.4.2 --- Interaction of maternal diabetes with NOD mutation is greatly exacerbated when exposed to RA --- p.131 / Chapter 5.4.3 --- Pax3 is not involved in the interaction --- p.133 / Chapter Chapter 6 --- Conclusion and Future Perspectives --- p.134 / References --- p.139 / Figures / Graphs