Transition metal oxides exhibit potential in various application fields due to the special d-electrons. Solid state chemistry focuses on discovering the structure-property relationships. The work in this thesis mainly discusses compounds with hexagonal or brownmillerite-type structure and their practical properties. Hexagonal YIn[subscript 1-x]Fe[subscript x]O��� (x = 0-0.3, 0.7-1.0) phases have been prepared and characterized. All phases appear to have the ferroelectric structure known for YInO���. The color of the phases changes from yellow to orange to dark red with increasing Fe content. Magnetic measurements confirm high-spin Fe����� for all phases. Similarly, solid solution YAl[subscript 1-x]Fe[subscript x]O��� (x = 0-0.4, 0.7-1.0) phases were successfully synthesized through the sol-gel method. The Al-rich compounds present paraelectric YAlO��� structure while the Fe-rich side samples exhibit YFeO��� structure. The color of the compounds appear to be yellow with small Fe content and change to brown which has higher Fe content. Brownmillerite-type oxides Ba���In[subscript 2-x]Mn[subscript x]O[subscript 5+x] (x = 0.1-0.7) have been prepared and characterized. Magnetic measurements confirm that Mn in as prepared samples is substituting as Mn������ for all values of x with observed paramagnetic spin-only moments close to values expected for two unpaired electrons. Neutron diffraction structure refinements show Mn������ occupies tetrahedral sites for orthorhombic (x = 0.1) and tetragonal (x = 0.2) phases. For Mn ��� 0.3 samples, neutron refinements show the phases are cubic with disordered cations and oxygen vacancies. The colors of the phases change from light yellow (x = 0) to intense turquoise (x =0.1), to green (x = 0.2, 0.3) or dark green (x ��� 0.4). Solid solution Ba���In[subscript 2-x]Fe[subscript x]O[subscript 5+y] (x = 0.1-1.5) also exhibit brownmillerite-type structure. The color of the compounds appear to be green with small Fe content and change to black with higher Fe content (x ��� 0.3). Magnetic measurements and M��ssbauer spectroscopy conclude the mixed valence of Fe�����/Fe������ for all the phases. Nonstoichiometry compound YCu���.���Ti���.���O[subscript 3-��] has been prepared and characterized. Structure study indicates that oxygen vacancy is favored under the synthesis condition. This change in oxygen content was further studied in the Mn-doped system. And the effect of stoichiometric difference in the Mn-doped samples was not as obvious as the initial compound. The disorder in the cation site enhanced the tolerance of the structure in the aspect of oxygen content. The hexagonal phases LnCu���.���Ti���.���O��� (Ln = Y, Tb-Lu) phases were prepared by the traditional solid state reactions. The prepared compounds were reduced at high temperature in the reduction atmosphere created by the H���/N��� gas mixture. Study on the structure and properties changes by reduction was conducted by X-ray diffraction, optical measurement, magnetic measurement and thermalgravimetric analysis. And we observed some evidence of the presence of Cu��� in the reduced phase by these characterization methods. Solid solution YMn[subscript x]Ti[subscript y]O[subscript 3-��] (y = 0.1-0.4) was successfully prepared through conventional solid state approach. All the samples showed hexagonal structure. But the structure transition from ferroelectric P6���cm to paraelectric P6���/mmc occurred when Ti amount is higher than 0.2. Based on the neutron diffraction refinement, the lattice expanded in the ab plane but contracted along the c axis direction. / Graduation date: 2013

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 5 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst. / Härtill 7 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2005. / Härtill 4 uppsatser.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2006. / Härtill 5 uppsatser.

Dissertation (Ph.D.)--University of South Florida, 2009. / Includes vita. Includes bibliographical references.

Introdução: A reserva ovariana (RO) refere-se à quantidade e, para alguns autores, à qualidade de folículos presentes nos ovários em um dado momento. É a medida pela qual se avalia a produção de oócitos e consequente potencial reprodutivo. Ela pode ser inferida mediante dosagem dos níveis séricos do hormônio folículo estimulante (FSH), estradiol, inibina B e hormônio antimülleriano (HAM), e ainda, ultrassonograficamente, através da contagem de folículos antrais (CFA). Na década de 50 observou-se que mulheres submetidas à quimioterapia (QT) apresentavam falência ovariana mais precocemente, efeito atribuído à gonadotoxicidade quimioterápica. Objetivos: Estudar o HAM como marcador da RO em mulheres com câncer de mama expostas à QT gonadotóxica comparando-o com outros marcadores da RO e determinar preditores de risco da ocorrência de anovulação (amenorreia ou ciclos irregulares) nessas mulheres. Métodos: Foi realizado estudo de coorte com 52 mulheres com diagnóstico de câncer de mama e necessidade de QT com ciclofosfamida, com idade até 40 anos, ciclos menstruais regulares e sem histórico de tratamento quimioterápico prévio. As pacientes realizaram coleta de sangue e ultrassonografia pélvica transvaginal (USTV) antes da QT (T1) e 2 (T2) e 6 (T3) meses após seu término. Resultados: A idade média das pacientes estudadas foi 35,3 ± 3,8 anos e o tempo médio de seguimento foi de 14 ± 3 meses. A prevalência de anovulação foi de 40% durante a QT, 85% 2 meses após o término da QT (4 a 6 ciclos de ciclofosfamida) e de 60% 6 meses após a QT. A média de idade das pacientes que se tornaram anovulatórias foi de 36,5 ± 3,8 anos, enquanto que nas que permaneceram ovulatórias foi de 32,9 ± 3,5 anos com p = 0,02. O FSH acompanhou o status menstrual, apresentando aumento e queda significativos em T2 e T3. O HAM diminuiu significativamente de T1 (2,53 (1 - 5,31) ng/mL) para T2 (valores abaixo do detectável) com p < 0,0001 e não se modificou de T2 para T3, mesmo com uma parcela de pacientes retomando a ciclicidade menstrual. CFA em T1 foi 11 (8 - 13,5) folículos, sendo estatisticamente maior que nos tempos T2 e T3 (p < 0,0001). Entre T2 e T3 não houve diferença. As pacientes que mantiveram ciclos ovulatórios após o término da QT apresentaram no final do estudo níveis significativamente mais baixos de HAM do que previamente à QT (1,46 (< 0,08 - 4,31) ng/ml versus 6,17 (3,19 - 10,07) ng/mL) e CFA (7 (5,5 - 10) folículos versus 13 (11 - 15,5) folículos). HAM e CFA apresentaram correlação negativa e significativa com a idade. Trinta e dois anos foi a idade que apresentou sensibilidade de 96% e especificidade de 39% para predição de anovulação, mesmo que sem amenorreia, com área sob a curva (ASC) ROC de 0,77. Os marcadores de RO e os respectivos pontos de corte com poder de predizer ocorrência de anovulação em pacientes expostas à QT foram HAM < 3,32 ng/ml (sensibilidade de 85%, especificidade de 75% e ASC de 0,86) e CFA < 13 folículos antrais (sensibilidade de 81%, especificidade de 62% e ASC de 0,81). Para a predição de amenorreia exclusivamente, o HAM teve como ponto de corte o valor de 1,87 ng/ml (sensibilidade de 82%, especificidade de 83% e ASC de 0,84) e a CFA valor de 9 folículos (sensibilidade de 71%, especificidade de 78% e ASC de 0,73 ). As avaliações dos marcadores de RO não foram influenciadas pelo número de ciclos de QT (4 ou 6 ciclos), nem pela dose de quimioterápico utilizado por área corporal. Conclusão: O HAM e a CFA são igualmente capazes de determinar a queda da RO em pacientes submetidas à QT gonadotóxica. Pacientes com diagnóstico de câncer de mama que necessitam de QT com ciclofosfamida devem ser alertadas para o risco de amenorreia especialmente quando a idade for de 32 anos ou mais, dosagens séricas de HAM abaixo de 3,32 ng/ml, CFA < 13, devendo receber informações a respeito da preservação da fertilidade. Dentre esses marcadores, o HAM foi o de maior poder em predizer a ocorrência de amenorreia. / Introduction: Ovarian reserve (OR) refers to quantity and, to some authors, quality of follicles present in ovaries at a given time. It is the measure used to assess the capacity of the ovary to produce oocytes. Its evaluation is trough serum analysis of FSH, estradiol, inhibin and anti-Müllerian hormone (AMH) and trough ultrassonography to count de antrals follicles (AFC). In the 50s, it was observed that women exposed to chemotherapy experienced premature ovarian failure, effect attributed to chemotherapy. Objectives: To ascertain OR by means of AMH in young women with breast cancer exposed to chemotherapy comparing them with another ovarian reserve tests. To define risk predictors of anovulation (oligomenorrhea or amenorrhea) in those women. Methods: A cohort study with 52 eumenorrheic patients (age < 40years) with breast cancer who received chemotherapy with cyclophosphamide. Assessment was carried out with serum samples and pelvic ultrasonography before chemotherapy (T1), and 2 (T2) and 6 (T3) months after chemotherapy. Results: Mean age was 35.3 ± 3.8 years. Mean duration of follow-up was 14 ± 3 months. Anovulation was present in 40% of women during the chemotherapy, 85% 2 months after and 60% 6 months after chemotherapy. Mean age of anovulatory women in T3 was 36.5 ± 3.8 years. Women with regular cycles was 32.9 ± 3.5 years (p = 0.02). FSH levels rises and decreased significantly in T2 and T3. AMH levels declined significantly, down to undetectable levels at T2 from a median of 2.53 (1 –5.31 ng/mL) at T1 (p < 0.0001) and remained unchanged from T@ and T3, even though some patients resumed normal menses. Median AFC was 11 ( 8.0 – 13.5) follicles at T1 and significantly lower at T2 and T3 (p < 0.0001). No difference was found between T2 and T3 in patients who resumed ovulation cycles after completion of chemotherapy, AMH and AFC levels were significantly lower as compared with baseline: 1.46 (< 0.08 – 4.31) ng/mL vs. 6.17 (3.19 – 10.07) ng/mL and 7 (5.5 - 10) follicles vs. 13 (11 – 15.5) follicles. In patients who remained ovulatory during chemotherapy or resumed normal menses, FSH and estradiol levels remained unchanged relative to baseline. AMH and AFC presented significantly negative correlation with age. The age of thirty-two years presented 96% of sensitivity and 39% of specificity to predict anovulation with ROC area under the curve (AUC) of 0.77. The ovarian reserve (OVR) tests with power to predict anovulation in women exposed to CT were AMH < 3.32 ng/mL (sensitivity of 85%, specificity of 75% and AUC of 0.87) and AFC < 13 follicles (sensitivity of 81%, specificity of 62% and AUC of 0.81). The AMH cut off to predict amenorrhea was 1,87 ng/mL (sensitivity of 82%, specificity of 83% and AUC of 0,84) and the AFC cut off was 9 follicles (sensitivity of 71%, specificity of 78% and AUC of 0.73 ). The analysis was not influenced by the number of cycles or dose of CT. Conclusions: AMH and AFC are equally able to determine the OVR decline in chemotherapy exposed women. FSH is not adequate for this purpose, except in women who become amenorrheic. Thirty-two year old or older women, AMH levels < 3.32 ng/mL and AFC < 13 follicles determined significantly higher risk of anovulation after CT with cyclophosphamide. These women should be encouraged to preserve their fertility. Among the OVR tests, AMH was the powerful to predict the anovulation.

Introdução: A reserva ovariana (RO) refere-se à quantidade e, para alguns autores, à qualidade de folículos presentes nos ovários em um dado momento. É a medida pela qual se avalia a produção de oócitos e consequente potencial reprodutivo. Ela pode ser inferida mediante dosagem dos níveis séricos do hormônio folículo estimulante (FSH), estradiol, inibina B e hormônio antimülleriano (HAM), e ainda, ultrassonograficamente, através da contagem de folículos antrais (CFA). Na década de 50 observou-se que mulheres submetidas à quimioterapia (QT) apresentavam falência ovariana mais precocemente, efeito atribuído à gonadotoxicidade quimioterápica. Objetivos: Estudar o HAM como marcador da RO em mulheres com câncer de mama expostas à QT gonadotóxica comparando-o com outros marcadores da RO e determinar preditores de risco da ocorrência de anovulação (amenorreia ou ciclos irregulares) nessas mulheres. Métodos: Foi realizado estudo de coorte com 52 mulheres com diagnóstico de câncer de mama e necessidade de QT com ciclofosfamida, com idade até 40 anos, ciclos menstruais regulares e sem histórico de tratamento quimioterápico prévio. As pacientes realizaram coleta de sangue e ultrassonografia pélvica transvaginal (USTV) antes da QT (T1) e 2 (T2) e 6 (T3) meses após seu término. Resultados: A idade média das pacientes estudadas foi 35,3 ± 3,8 anos e o tempo médio de seguimento foi de 14 ± 3 meses. A prevalência de anovulação foi de 40% durante a QT, 85% 2 meses após o término da QT (4 a 6 ciclos de ciclofosfamida) e de 60% 6 meses após a QT. A média de idade das pacientes que se tornaram anovulatórias foi de 36,5 ± 3,8 anos, enquanto que nas que permaneceram ovulatórias foi de 32,9 ± 3,5 anos com p = 0,02. O FSH acompanhou o status menstrual, apresentando aumento e queda significativos em T2 e T3. O HAM diminuiu significativamente de T1 (2,53 (1 - 5,31) ng/mL) para T2 (valores abaixo do detectável) com p < 0,0001 e não se modificou de T2 para T3, mesmo com uma parcela de pacientes retomando a ciclicidade menstrual. CFA em T1 foi 11 (8 - 13,5) folículos, sendo estatisticamente maior que nos tempos T2 e T3 (p < 0,0001). Entre T2 e T3 não houve diferença. As pacientes que mantiveram ciclos ovulatórios após o término da QT apresentaram no final do estudo níveis significativamente mais baixos de HAM do que previamente à QT (1,46 (< 0,08 - 4,31) ng/ml versus 6,17 (3,19 - 10,07) ng/mL) e CFA (7 (5,5 - 10) folículos versus 13 (11 - 15,5) folículos). HAM e CFA apresentaram correlação negativa e significativa com a idade. Trinta e dois anos foi a idade que apresentou sensibilidade de 96% e especificidade de 39% para predição de anovulação, mesmo que sem amenorreia, com área sob a curva (ASC) ROC de 0,77. Os marcadores de RO e os respectivos pontos de corte com poder de predizer ocorrência de anovulação em pacientes expostas à QT foram HAM < 3,32 ng/ml (sensibilidade de 85%, especificidade de 75% e ASC de 0,86) e CFA < 13 folículos antrais (sensibilidade de 81%, especificidade de 62% e ASC de 0,81). Para a predição de amenorreia exclusivamente, o HAM teve como ponto de corte o valor de 1,87 ng/ml (sensibilidade de 82%, especificidade de 83% e ASC de 0,84) e a CFA valor de 9 folículos (sensibilidade de 71%, especificidade de 78% e ASC de 0,73 ). As avaliações dos marcadores de RO não foram influenciadas pelo número de ciclos de QT (4 ou 6 ciclos), nem pela dose de quimioterápico utilizado por área corporal. Conclusão: O HAM e a CFA são igualmente capazes de determinar a queda da RO em pacientes submetidas à QT gonadotóxica. Pacientes com diagnóstico de câncer de mama que necessitam de QT com ciclofosfamida devem ser alertadas para o risco de amenorreia especialmente quando a idade for de 32 anos ou mais, dosagens séricas de HAM abaixo de 3,32 ng/ml, CFA < 13, devendo receber informações a respeito da preservação da fertilidade. Dentre esses marcadores, o HAM foi o de maior poder em predizer a ocorrência de amenorreia. / Introduction: Ovarian reserve (OR) refers to quantity and, to some authors, quality of follicles present in ovaries at a given time. It is the measure used to assess the capacity of the ovary to produce oocytes. Its evaluation is trough serum analysis of FSH, estradiol, inhibin and anti-Müllerian hormone (AMH) and trough ultrassonography to count de antrals follicles (AFC). In the 50s, it was observed that women exposed to chemotherapy experienced premature ovarian failure, effect attributed to chemotherapy. Objectives: To ascertain OR by means of AMH in young women with breast cancer exposed to chemotherapy comparing them with another ovarian reserve tests. To define risk predictors of anovulation (oligomenorrhea or amenorrhea) in those women. Methods: A cohort study with 52 eumenorrheic patients (age < 40years) with breast cancer who received chemotherapy with cyclophosphamide. Assessment was carried out with serum samples and pelvic ultrasonography before chemotherapy (T1), and 2 (T2) and 6 (T3) months after chemotherapy. Results: Mean age was 35.3 ± 3.8 years. Mean duration of follow-up was 14 ± 3 months. Anovulation was present in 40% of women during the chemotherapy, 85% 2 months after and 60% 6 months after chemotherapy. Mean age of anovulatory women in T3 was 36.5 ± 3.8 years. Women with regular cycles was 32.9 ± 3.5 years (p = 0.02). FSH levels rises and decreased significantly in T2 and T3. AMH levels declined significantly, down to undetectable levels at T2 from a median of 2.53 (1 –5.31 ng/mL) at T1 (p < 0.0001) and remained unchanged from T@ and T3, even though some patients resumed normal menses. Median AFC was 11 ( 8.0 – 13.5) follicles at T1 and significantly lower at T2 and T3 (p < 0.0001). No difference was found between T2 and T3 in patients who resumed ovulation cycles after completion of chemotherapy, AMH and AFC levels were significantly lower as compared with baseline: 1.46 (< 0.08 – 4.31) ng/mL vs. 6.17 (3.19 – 10.07) ng/mL and 7 (5.5 - 10) follicles vs. 13 (11 – 15.5) follicles. In patients who remained ovulatory during chemotherapy or resumed normal menses, FSH and estradiol levels remained unchanged relative to baseline. AMH and AFC presented significantly negative correlation with age. The age of thirty-two years presented 96% of sensitivity and 39% of specificity to predict anovulation with ROC area under the curve (AUC) of 0.77. The ovarian reserve (OVR) tests with power to predict anovulation in women exposed to CT were AMH < 3.32 ng/mL (sensitivity of 85%, specificity of 75% and AUC of 0.87) and AFC < 13 follicles (sensitivity of 81%, specificity of 62% and AUC of 0.81). The AMH cut off to predict amenorrhea was 1,87 ng/mL (sensitivity of 82%, specificity of 83% and AUC of 0,84) and the AFC cut off was 9 follicles (sensitivity of 71%, specificity of 78% and AUC of 0.73 ). The analysis was not influenced by the number of cycles or dose of CT. Conclusions: AMH and AFC are equally able to determine the OVR decline in chemotherapy exposed women. FSH is not adequate for this purpose, except in women who become amenorrheic. Thirty-two year old or older women, AMH levels < 3.32 ng/mL and AFC < 13 follicles determined significantly higher risk of anovulation after CT with cyclophosphamide. These women should be encouraged to preserve their fertility. Among the OVR tests, AMH was the powerful to predict the anovulation.

Introdução: A reserva ovariana (RO) refere-se à quantidade e, para alguns autores, à qualidade de folículos presentes nos ovários em um dado momento. É a medida pela qual se avalia a produção de oócitos e consequente potencial reprodutivo. Ela pode ser inferida mediante dosagem dos níveis séricos do hormônio folículo estimulante (FSH), estradiol, inibina B e hormônio antimülleriano (HAM), e ainda, ultrassonograficamente, através da contagem de folículos antrais (CFA). Na década de 50 observou-se que mulheres submetidas à quimioterapia (QT) apresentavam falência ovariana mais precocemente, efeito atribuído à gonadotoxicidade quimioterápica. Objetivos: Estudar o HAM como marcador da RO em mulheres com câncer de mama expostas à QT gonadotóxica comparando-o com outros marcadores da RO e determinar preditores de risco da ocorrência de anovulação (amenorreia ou ciclos irregulares) nessas mulheres. Métodos: Foi realizado estudo de coorte com 52 mulheres com diagnóstico de câncer de mama e necessidade de QT com ciclofosfamida, com idade até 40 anos, ciclos menstruais regulares e sem histórico de tratamento quimioterápico prévio. As pacientes realizaram coleta de sangue e ultrassonografia pélvica transvaginal (USTV) antes da QT (T1) e 2 (T2) e 6 (T3) meses após seu término. Resultados: A idade média das pacientes estudadas foi 35,3 ± 3,8 anos e o tempo médio de seguimento foi de 14 ± 3 meses. A prevalência de anovulação foi de 40% durante a QT, 85% 2 meses após o término da QT (4 a 6 ciclos de ciclofosfamida) e de 60% 6 meses após a QT. A média de idade das pacientes que se tornaram anovulatórias foi de 36,5 ± 3,8 anos, enquanto que nas que permaneceram ovulatórias foi de 32,9 ± 3,5 anos com p = 0,02. O FSH acompanhou o status menstrual, apresentando aumento e queda significativos em T2 e T3. O HAM diminuiu significativamente de T1 (2,53 (1 - 5,31) ng/mL) para T2 (valores abaixo do detectável) com p < 0,0001 e não se modificou de T2 para T3, mesmo com uma parcela de pacientes retomando a ciclicidade menstrual. CFA em T1 foi 11 (8 - 13,5) folículos, sendo estatisticamente maior que nos tempos T2 e T3 (p < 0,0001). Entre T2 e T3 não houve diferença. As pacientes que mantiveram ciclos ovulatórios após o término da QT apresentaram no final do estudo níveis significativamente mais baixos de HAM do que previamente à QT (1,46 (< 0,08 - 4,31) ng/ml versus 6,17 (3,19 - 10,07) ng/mL) e CFA (7 (5,5 - 10) folículos versus 13 (11 - 15,5) folículos). HAM e CFA apresentaram correlação negativa e significativa com a idade. Trinta e dois anos foi a idade que apresentou sensibilidade de 96% e especificidade de 39% para predição de anovulação, mesmo que sem amenorreia, com área sob a curva (ASC) ROC de 0,77. Os marcadores de RO e os respectivos pontos de corte com poder de predizer ocorrência de anovulação em pacientes expostas à QT foram HAM < 3,32 ng/ml (sensibilidade de 85%, especificidade de 75% e ASC de 0,86) e CFA < 13 folículos antrais (sensibilidade de 81%, especificidade de 62% e ASC de 0,81). Para a predição de amenorreia exclusivamente, o HAM teve como ponto de corte o valor de 1,87 ng/ml (sensibilidade de 82%, especificidade de 83% e ASC de 0,84) e a CFA valor de 9 folículos (sensibilidade de 71%, especificidade de 78% e ASC de 0,73 ). As avaliações dos marcadores de RO não foram influenciadas pelo número de ciclos de QT (4 ou 6 ciclos), nem pela dose de quimioterápico utilizado por área corporal. Conclusão: O HAM e a CFA são igualmente capazes de determinar a queda da RO em pacientes submetidas à QT gonadotóxica. Pacientes com diagnóstico de câncer de mama que necessitam de QT com ciclofosfamida devem ser alertadas para o risco de amenorreia especialmente quando a idade for de 32 anos ou mais, dosagens séricas de HAM abaixo de 3,32 ng/ml, CFA < 13, devendo receber informações a respeito da preservação da fertilidade. Dentre esses marcadores, o HAM foi o de maior poder em predizer a ocorrência de amenorreia. / Introduction: Ovarian reserve (OR) refers to quantity and, to some authors, quality of follicles present in ovaries at a given time. It is the measure used to assess the capacity of the ovary to produce oocytes. Its evaluation is trough serum analysis of FSH, estradiol, inhibin and anti-Müllerian hormone (AMH) and trough ultrassonography to count de antrals follicles (AFC). In the 50s, it was observed that women exposed to chemotherapy experienced premature ovarian failure, effect attributed to chemotherapy. Objectives: To ascertain OR by means of AMH in young women with breast cancer exposed to chemotherapy comparing them with another ovarian reserve tests. To define risk predictors of anovulation (oligomenorrhea or amenorrhea) in those women. Methods: A cohort study with 52 eumenorrheic patients (age < 40years) with breast cancer who received chemotherapy with cyclophosphamide. Assessment was carried out with serum samples and pelvic ultrasonography before chemotherapy (T1), and 2 (T2) and 6 (T3) months after chemotherapy. Results: Mean age was 35.3 ± 3.8 years. Mean duration of follow-up was 14 ± 3 months. Anovulation was present in 40% of women during the chemotherapy, 85% 2 months after and 60% 6 months after chemotherapy. Mean age of anovulatory women in T3 was 36.5 ± 3.8 years. Women with regular cycles was 32.9 ± 3.5 years (p = 0.02). FSH levels rises and decreased significantly in T2 and T3. AMH levels declined significantly, down to undetectable levels at T2 from a median of 2.53 (1 –5.31 ng/mL) at T1 (p < 0.0001) and remained unchanged from T@ and T3, even though some patients resumed normal menses. Median AFC was 11 ( 8.0 – 13.5) follicles at T1 and significantly lower at T2 and T3 (p < 0.0001). No difference was found between T2 and T3 in patients who resumed ovulation cycles after completion of chemotherapy, AMH and AFC levels were significantly lower as compared with baseline: 1.46 (< 0.08 – 4.31) ng/mL vs. 6.17 (3.19 – 10.07) ng/mL and 7 (5.5 - 10) follicles vs. 13 (11 – 15.5) follicles. In patients who remained ovulatory during chemotherapy or resumed normal menses, FSH and estradiol levels remained unchanged relative to baseline. AMH and AFC presented significantly negative correlation with age. The age of thirty-two years presented 96% of sensitivity and 39% of specificity to predict anovulation with ROC area under the curve (AUC) of 0.77. The ovarian reserve (OVR) tests with power to predict anovulation in women exposed to CT were AMH < 3.32 ng/mL (sensitivity of 85%, specificity of 75% and AUC of 0.87) and AFC < 13 follicles (sensitivity of 81%, specificity of 62% and AUC of 0.81). The AMH cut off to predict amenorrhea was 1,87 ng/mL (sensitivity of 82%, specificity of 83% and AUC of 0,84) and the AFC cut off was 9 follicles (sensitivity of 71%, specificity of 78% and AUC of 0.73 ). The analysis was not influenced by the number of cycles or dose of CT. Conclusions: AMH and AFC are equally able to determine the OVR decline in chemotherapy exposed women. FSH is not adequate for this purpose, except in women who become amenorrheic. Thirty-two year old or older women, AMH levels < 3.32 ng/mL and AFC < 13 follicles determined significantly higher risk of anovulation after CT with cyclophosphamide. These women should be encouraged to preserve their fertility. Among the OVR tests, AMH was the powerful to predict the anovulation.

THE DISSERTATION IS IN AFRIKAANS: The multi-linguistic and multi-cultural population of South Africa poses some unique challenges for valid and reliable service delivery by South African audiologists and acousticians, specifically when conducting valid and reliable speech audiometry evaluations. This is examined in the South African context, and set the base for the main aim of this study, namely the comparison of the ideal criteria for speech audiometry with the South African clinical practice of speech audiometry. Many variables can be identified in the course of the test stimuli and subsequent response when conducting speech audiometry. These variables can be divided into two categories, namely stimulus related variables (test content and test procedure) and test subject related variables. The variables are examined in light of the multi-linguistic and multi-cultural South African context, because of the challenges posed by this context to the South African audiologist. The study is conducted in three different phases, according to three sub aims. A thorough review of the subject literature was done to identify ideal criteria for speech audiometry. A questionnaire was sent to South African audiologists and acousticians, to examine the present clinical practice of speech audiometry in South Africa, and compare it to the criteria suggested in the literature in order to investigate the attainability of criteria and to identify problem areas. The results show low comparison regarding test content between the ideal criteria and South African clinical practice, especially because South African audiologists do not use a test battery consisting of different types of test material. Low comparison can be seen regarding the selection of test items, length of lists and degree of difficulty. Low comparison can also be seen with test procedure, mainly because audiologists rarely use pre-recorded test materials. High levels of comparison are found regarding presentation levels and test environment. With test subject variables, a discrepancy is also found between the ideal criteria and South African clinical practice, mainly because tests are not always conducted in the test subjects’ first language. By using the identified deficiencies in the clinical practice of speech audiometry in South Africa as a starting point, one can use further research to reach the ideal, namely the ideal criteria of conducting speech audiometry. The conclusions of this study can be used as suggestions for solutions for the unique problems that the practicing audiologist in South Africa has to deal with. The complexity of these problems will need further attention from researchers in this and other fields of study. / Dissertation (MCommunication Pathology)--University of Pretoria, 2007. / Speech-Language Pathology and Audiology / Unrestricted