São freqüentes as queixas entre as mulheres, particularmente entre as cantoras, de que ocorrem alterações na voz após a menopausa. Há relatos na literatura de que a freqüência fundamental da voz da mulher se altera nesta fase da vida. Como a prega vocal possui receptores para os esteróides sexuais, é possível que essas alterações sejam decorrentes da deficiência estrogênica observada no climatério. O presente trabalho teve como objetivo comparar a freqüência fundamental da voz (F0) de mulheres na pós-menopausa usuárias e não usuárias de terapia de reposição hormonal (TRH) com mulheres no menacme. Foram estudadas 45 pacientes: grupo-controle (15 mulheres de 20 a 40 anos, não usuárias de anticoncepcional hormonal, não fumantes, com ciclos menstruais regulares), grupo com TRH (15 mulheres de 45 a 60 anos, menopausadas há mais de 2 anos, usuárias de valerato de estradiol 1mg/norgestimato 90 mcg há no mínimo 6 meses) e grupo sem TRH (15 mulheres com idade de 45 a 60 anos, menopausadas há mais de 2 anos sem TRH há no mínimo 6 meses). Todas as pacientes foram submetidas à avaliação otorrinolaringológica e videolaringoscopia para confirmar a integridade da laringe. Posteriormente, avaliou-se a F0 com a emissão das vogais “e" e “i" na altura de fala habitual da paciente. A F0 foi analisada através do programa Dr.Speech 3.0®. Foi utilizado o teste ANOVA para comparação das médias de F0 entre os grupos. A média da idade dos grupos controle, com TRH e sem TRH foi respectivamente 30,3 anos, 54,5 anos e 56,5 anos. A média da F0 dos grupos foram respectivamente: vogal “e": 215,97 Hz; 206,21 Hz e 200,71 Hz, e vogal “i": 229,89 Hz; 221,79 Hz e 212,79 Hz. Os resultados mostraram uma tendência de agravamento da F0 em menopausadas, sendo a média do grupo com TRH mais próxima do grupo-controle que do grupo sem TRH. Entretanto não houve diferença estatisticamente significativa na F0 da voz para as vogais “e" (p=0,2127) e “i" (p=0,193), comparando os três grupos entre si. De acordo com esses resultados, parece não haver diferença clinicamente relevante na F0 da voz falada entre mulheres no menacme, menopausadas usuárias e não usuárias de TRH. A tendência à diminuição de F0 nas pacientes hipoestrogênicas sugere a possibilidade de que pequenas diferenças, decorrentes da influência hormonal sobre a laringe, que não tenham sido detectadas neste estudo, possam atingir maiores níveis de significância, quando os grupos forem analisados para a voz cantada. / The complaints between the women are frequent, particularly between the singers, of whom alterations in the voice occur after the menopause. It has been reported, in literature, that woman’ fundamental frequency is altered in this phase of the life. As the vocal fold possess receivers for the sexual steroids are possible that these alterations are decurrent of the observed hypoestrogenism in the climacteric. To compare the voice fundamental frequency (F0) of postmenopausal women, users and non-users of HRT with women in menache. Forty-five patients have been trialed, divided into the following groups: control group (15 women of 20 to 40 years of age, non-users of hormonal contraceptives, non smokers, with regular menstrual cycles), group with HRT (15 women of 45 to 60 years of age, menopaused for over 2 years, users of estradiol valerate 1mg/norgestimato 90mcg for a minimum period of 6 months) and the group without HRT (15 women of 45 to 60 years of age, menopaused for over 2 years, without HRT for a minimum period of 6 months). All patients had been submitted to the otolaryngological evaluation and videolaryngoscopy in order to confirm the integrity of the larynx. Afterwards F0 has been evaluated by emitting the vowels [e] and [i] in the patient’s habitual voice pitch. The F0 was analyzed using the Dr.Speech Pro. 3 software. The ANOVA test was used in order to compare the averages of F0 between the groups. The average ages of the groups control, with HRT and without HRT were respectively 30,3 years, 54,5 years and 56,5 years. The average F0 of the groups control, with HRT and without HRT were respectively: vowel [e]: 215,97Hz; 206,21Hz and 200,71Hz and vowel [i]: 229,89Hz; 221,79Hz and 212,79Hz. The results showed a trend of aggravation of the F0 in postmenopausal women, once the F0 average of the group with HRT was closer to the group control than the group without HRT. However, in a comparison between those three groups, there were no significant statistical difference in the voice F0 for the vowels [e] (p=0,2127) and [i] (p=0,193). There were no differences in F0, in the speaking voice, between women in menache and postmenopausal users and non-users of HRT. However it’s been recorded a trend in the aggravation of F0 in the postmenopausal women, mainly amongst the without HRT users. In accordance with these results seem not to have significant clinical difference in the F0 of the voice said between women in menacme, postmenopausal users and non-users of HRT. The trend the reduction of F0 in the hypoestrogenism patients suggests the possibility of that small decurrent differences of the hormonal influence on the larynx, that they have not been detected in this study, can reach greaters levels of significance when the groups will be analyzed for the sung voice.

Animal research has elucidated the neurobiological substrates and environmental determinants of pain modulation. Despite these advances, relatively little is known about how psychological processes activate pain modulatory systems. One psychological process that is thought to play an important role in regulating pain sensitivity is emotion. In addition, previous research into the human menstrual cycle and the animal estrous cycle have determined that either the presence of certain gonadal hormones or the fluctuations of these hormones may lead to changes in how females perceive pain, regulate emotion, and modulate pain. The present study examines both the role of emotion and the human menstrual cycle in pain modulation. Participants were 39 female undergraduate students with a mean age of 18.7 years (SD=1.46). Results are consistent with prior studies indicating that progesterone has antiinflammatory effects. Specifically, significant effects were observed primarily in the luteal phase. Subjects in the luteal phase demonstrated less sympathetic arousal during the experiment but greater autonomic arousal during the noise stressor. Participants in the luteal phase also demonstrated an analgesic/anti-inflammatory response evidenced by an observed decrease in secondary hyperalgesia for those that did not receive the noise stressor. No such changes in pain perception were discovered in the ovulation and follicular phases. Finally, in response to the noise stressor, an inhibition of the analgesic/anti-inflammatory effects was observed in the luteal phase. No such evidence of stress-induced pain modulation was discovered in the ovulation and follicular phases. Although the specific mechanisms of this action still remain unclear, prior evidence points to the role of centrally-mediated pain modulation. It is likely that the stressor worked to inhibit the anti-inflammatory effects commonly observed in the luteal phase to persistent inflammatory pain through centrally-mediated pain modulatory mechanisms. It is hypothesized that hormone-mediated effects at the level of the amygdala influenced the impact of affective pain modulation.

This study investigated the effect of the mouse estrous cycle on myocyte contractile function. Female mice displayed irregular estrous cycles unless induced to cycle though exposure to bedding collected from cages housing male mice. Fractional shortening and Ca2+ transient amplitudes were significantly larger in myocytes isolated from mice in estrus. The effect of the estrous cycle was preserved even when cells were paced at a more physiological frequency and in the presence of ?-adrenergic stimulation. Myofilament Ca2+ sensitivity was also modified by the estrous cycle, as myofilaments isolated from the hearts of mice in estrus were least sensitive to Ca2+. However, acute application of either 17?-estradiol or the G protein-coupled estrogen receptor (GPER) agonist, G-1, had no effect on contractions or Ca2+ transients, regardless of the estrous stage. Thus, physiological fluctuations in sex hormone levels modify myocyte contractions, Ca2+ release, and myofilament Ca2+ sensitivity.

Diss. (sammanfattning) Stockholm : Karol. inst., 2003. / Härtill 4 uppsatser.

São freqüentes as queixas entre as mulheres, particularmente entre as cantoras, de que ocorrem alterações na voz após a menopausa. Há relatos na literatura de que a freqüência fundamental da voz da mulher se altera nesta fase da vida. Como a prega vocal possui receptores para os esteróides sexuais, é possível que essas alterações sejam decorrentes da deficiência estrogênica observada no climatério. O presente trabalho teve como objetivo comparar a freqüência fundamental da voz (F0) de mulheres na pós-menopausa usuárias e não usuárias de terapia de reposição hormonal (TRH) com mulheres no menacme. Foram estudadas 45 pacientes: grupo-controle (15 mulheres de 20 a 40 anos, não usuárias de anticoncepcional hormonal, não fumantes, com ciclos menstruais regulares), grupo com TRH (15 mulheres de 45 a 60 anos, menopausadas há mais de 2 anos, usuárias de valerato de estradiol 1mg/norgestimato 90 mcg há no mínimo 6 meses) e grupo sem TRH (15 mulheres com idade de 45 a 60 anos, menopausadas há mais de 2 anos sem TRH há no mínimo 6 meses). Todas as pacientes foram submetidas à avaliação otorrinolaringológica e videolaringoscopia para confirmar a integridade da laringe. Posteriormente, avaliou-se a F0 com a emissão das vogais “e” e “i” na altura de fala habitual da paciente. A F0 foi analisada através do programa Dr.Speech 3.0®. Foi utilizado o teste ANOVA para comparação das médias de F0 entre os grupos. A média da idade dos grupos controle, com TRH e sem TRH foi respectivamente 30,3 anos, 54,5 anos e 56,5 anos. A média da F0 dos grupos foram respectivamente: vogal “e”: 215,97 Hz; 206,21 Hz e 200,71 Hz, e vogal “i”: 229,89 Hz; 221,79 Hz e 212,79 Hz. Os resultados mostraram uma tendência de agravamento da F0 em menopausadas, sendo a média do grupo com TRH mais próxima do grupo-controle que do grupo sem TRH. Entretanto não houve diferença estatisticamente significativa na F0 da voz para as vogais “e” (p=0,2127) e “i” (p=0,193), comparando os três grupos entre si. De acordo com esses resultados, parece não haver diferença clinicamente relevante na F0 da voz falada entre mulheres no menacme, menopausadas usuárias e não usuárias de TRH. A tendência à diminuição de F0 nas pacientes hipoestrogênicas sugere a possibilidade de que pequenas diferenças, decorrentes da influência hormonal sobre a laringe, que não tenham sido detectadas neste estudo, possam atingir maiores níveis de significância, quando os grupos forem analisados para a voz cantada. / The complaints between the women are frequent, particularly between the singers, of whom alterations in the voice occur after the menopause. It has been reported, in literature, that woman’ fundamental frequency is altered in this phase of the life. As the vocal fold possess receivers for the sexual steroids are possible that these alterations are decurrent of the observed hypoestrogenism in the climacteric. To compare the voice fundamental frequency (F0) of postmenopausal women, users and non-users of HRT with women in menache. Forty-five patients have been trialed, divided into the following groups: control group (15 women of 20 to 40 years of age, non-users of hormonal contraceptives, non smokers, with regular menstrual cycles), group with HRT (15 women of 45 to 60 years of age, menopaused for over 2 years, users of estradiol valerate 1mg/norgestimato 90mcg for a minimum period of 6 months) and the group without HRT (15 women of 45 to 60 years of age, menopaused for over 2 years, without HRT for a minimum period of 6 months). All patients had been submitted to the otolaryngological evaluation and videolaryngoscopy in order to confirm the integrity of the larynx. Afterwards F0 has been evaluated by emitting the vowels [e] and [i] in the patient’s habitual voice pitch. The F0 was analyzed using the Dr.Speech Pro. 3 software. The ANOVA test was used in order to compare the averages of F0 between the groups. The average ages of the groups control, with HRT and without HRT were respectively 30,3 years, 54,5 years and 56,5 years. The average F0 of the groups control, with HRT and without HRT were respectively: vowel [e]: 215,97Hz; 206,21Hz and 200,71Hz and vowel [i]: 229,89Hz; 221,79Hz and 212,79Hz. The results showed a trend of aggravation of the F0 in postmenopausal women, once the F0 average of the group with HRT was closer to the group control than the group without HRT. However, in a comparison between those three groups, there were no significant statistical difference in the voice F0 for the vowels [e] (p=0,2127) and [i] (p=0,193). There were no differences in F0, in the speaking voice, between women in menache and postmenopausal users and non-users of HRT. However it’s been recorded a trend in the aggravation of F0 in the postmenopausal women, mainly amongst the without HRT users. In accordance with these results seem not to have significant clinical difference in the F0 of the voice said between women in menacme, postmenopausal users and non-users of HRT. The trend the reduction of F0 in the hypoestrogenism patients suggests the possibility of that small decurrent differences of the hormonal influence on the larynx, that they have not been detected in this study, can reach greaters levels of significance when the groups will be analyzed for the sung voice.

Objectives: To study recovery after hysterectomy under Enhanced Recovery After Surgery (ERAS) care, and in relation to different operation techniques. Materials and Methods: An observational study was conducted comparing 85 patients undergoing hysterectomy with ERAS care to 120 patients immediately before establishing ERAS. In a prospective cohort study of 121 consecutive patients undergoing hysterectomy, the outcome was compared for patients with malignant versus benign indications. The main outcome measure was length of stay (LOS). A randomised controlled trial (RCT) of 20 women scheduled for hysterectomy compared robot-assisted laparoscopic with abdominal hysterectomy in terms of the development of insulin resistance, inflammatory reactions, and clinical recovery, and examined the relation to hormonal status. All studies were conducted in 2011--2015, at the Department of Obstetrics and Gynaecology, Örebro University Hospital, Sweden. Results: Implementation of a structured ERAS protocol significantly reduced LOS compared to non-ERAS care. The effect was similar between patients with malignant and benign indications for surgery. No difference in complications was found. There was no difference in development of insulin resistance between robotic and abdominal technique, but clinical outcomes and inflammatory responses significantly favoured robot-assisted hysterectomy. Female sex hormone status was associated with the development of insulin resistance. Conclusions: Recovery after hysterectomy can be influenced. ERAS care seems to be effective and safe. Clinical outcome can also be influenced by operational technique. Hysterectomy triggers a stress reaction in both the metabolic and the inflammatory system. It remains unclear why the reduced inflammatory reaction and favourable clinical outcome in robotic surgery were not mirrored by less insulin resistance. This could not be explained by female sex hormone status.

Background/objective: Environmental and dietary exposures alter the levels of homocysteine in the human body; little is known about the effect of smoking status on homocysteine levels. This study aimed to examine the effect of smoking status on homocysteine levels and to determine if the association is modified by estradiol and cholesterol. Methods: National representative data (n=4,580) were obtained for adults aged ≥20 years. The outcome was homocysteine and exposure was smoking status, categorized as current, former or never smoker. Current smoker defined as a person who smoked ≥100 cigarettes in their lifetime and at least once in the last month; former smoker- one who had smoked ≥100 cigarettes and had quit smoking at the time of the interview; never smoker- adult who never smoked cigarettes in their lifetime. General linear models (GLM) were used to examine the associations between smoking status and homocysteine levels; while assessing the impact of estradiol and cholesterol. Estradiol was stratified as low (/ml), normal (10-40 pg/mL), and high (>40 pg/ml). Cholesterol- stratified as normal (<200mg/dl) or high (≥200mg/dl). Results: Adjusting for age, gender, ethnicity, education, and income level, smoking status was associated with the levels of serum homocysteine using unadjusted GLM (p0.05). Adjusting for multiple comparisons using Tukey’s method, there were statistically significant differences between former smokers and never smokers (p Conclusion: Homocysteine levels were found to vary among smoking strata. Statistically significant differences exist between former smokers and never smokers. Former smokers may be more prone to having risk factors of elevated homocysteine levels compared to never and current smokers, putting them at risk of cerebrovascular accidents and acute coronary syndromes. These findings suggest that it is vital for people not to initiate smoking. Keywords: Smoking, Homocysteine, Sex hormones, Estradiol, Cholesterol.

No description available.

No description available.

Although women constitute more than half of the estimated 34-40 million people living with HIV/AIDS worldwide, little is known about the early events of HIV-1 infection in the female genital tract (FGT). Genital epithelial cells (GECs) line the FGT and act as intrinsic barriers providing mechanical protection against foreign microbes. GECs are also sentient and are capable of sensing and immunologically responding to various types of pathogens including sexually transmitted infections (STIs). These responses play a central role in preventing disease and also help mobilize both innate and adaptive immune cells against invading threats. While it is well understood that GECs exert important physical and immunological protective roles in the FGT, little is known regarding the role of GECs and GEC inflammatory responses in HIV infection. It is estimated that 40% of all new HIV infections are established each year in the FGT. Our understanding of the early events following HIV transmission in the FGT remains particularly elusive in the context of endogenous or exogenous factors found in the genital microenvironment that may influence susceptibility to HIV-1. Inflammation is known to play a critical role in increasing HIV susceptibility, replication as well as initiating and maintaining chronic immune activation, a hallmark of disease progression. Among the key factors in the FGT that are known to or that could influence inflammation are sexually transmitted co-infections and female sex hormones. The work summarized in this thesis examines how GEC innate immune responses to co-infecting microbes or female sex hormones impact HIV infection and replication in the FGT. Our results show that GEC innate immune response against herpes simplex virus type 2 (HSV-2), a common HIV co-infecting agent, consists of elevated proinflammatory cytokines and chemokines in addition to biologically active interferon-β. Furthermore, our results show that these responses require potent viral HSV-2 replication and that proinflammatory cytokine and chemokine responses are enhanced in the absence of the HSV-2 virus host shutoff protein. Based on this work, we decided to investigate whether GEC inflammatory responses to common STIs played a role in regulating HIV replication in T-cells. We found that HIV co-infecting microbes, specifically HSV-1, HSV-2 and Neisseria gonorrhoeae, directly induced HIV replication in T-cells, and caused primary GECs to upregulate inflammatory responses that indirectly increased HIV replication in T-cells. Next we examined a translational aspect of the aforementioned studies by examining whether blocking inflammatory pathways, using the broad anti-inflammatory compound curcumin, could provide prophylactic or therapeutic protection against HIV. We found that curcumin pre-treatment a) protected the genital epithelial barrier against HIV-1-mediated disruption and inflammation, b) prevented the gp120-mediated upregulation of chemokines by GECs that recruit HIV target cells to the FGT, c) blocked GEC innate inflammatory responses to co-infecting microbes and indirect activation of the HIV promoter in T-cells, d) decreased HIV amplification in chronically infected T-cells and e) blocked HSV-2 viral replication in GECs by a mechanism that likely involves NFκB. Lastly, it has long been speculated that female sex hormones can regulate inflammatory responses, and numerous lines of evidence suggest that they may also regulate susceptibility to HIV-1. Thus, we investigated how female sex hormones and the hormonal contraceptive medroxyprogesterone acetate (MPA), used by more than 100 million women worldwide, regulated HIV infection and replication in GECs and whether inflammation played an important role in this regulation. Our results showed that progesterone and in particular MPA increased uptake of HIV-1 and transcytosis, but not replication, across GECs – in the absence of a proinflammatory milieu - and that this enhanced transcytosis resulted in increased infection of HIV target cells. These results demonstrate that sex hormones and co-infection both play an important role in regulating HIV-1 infection and replication in the FGT. Furthermore, our results suggest that anti-inflammatory compounds such as curcumin may offer paradigm shifting prophylactic or therapeutic strategies against HIV-1 infection and future research should investigate its potential benefit in vivo. / Thesis / Doctor of Philosophy (Medical Science)