Abstract Aim: It has been suggested that chronic hyperinsulinemia from insulin resistance is involved in the etiology of endometrial cancer (EC). We performed a systematic review and meta-analysis to assess whether insulin resistance is associated with the risk of EC. Methods: We searched PubMed-Medline, Embase, Scopus, and Web of Science for articles published from database inception through 30th September 2014. We included all observational studies evaluating components defining insulin resistance in women with and without EC. Quality of the included studies was assessed by NewcastleeOttawa scale. Randomeffects models and inverse variance method were used to meta-analyze the association between insulin resistance components and EC. Results: Twenty-five studies satisfied our inclusion criteria. Fasting insulin levels (13 studies, n Z 4088) were higher in women with EC (mean difference [MD] 33.94 pmol/L, 95% confi- dence interval [CI] 15.04e52.85, p Z 0.0004). No differences were seen in postmenopausal versus pre- and postmenopausal subgroup analysis. Similarly, non-fasting/fasting C-peptide levels (five studies, n Z 1938) were also higher in women with EC (MD 0.14 nmol/L, 95% CI 0.08e0.21, p < 0.00001). Homeostatic model assessment - insulin resistance (HOMA-IR) values (six studies, n Z 1859) in EC patients were significantly higher than in women without EC (MD 1.13, 95% CI 0.20e2.06, p Z 0.02). There was moderate-to-high heterogeneity among the included studies. Conclusion: Currently available epidemiologic evidence is suggestive of significantly higher risk of EC in women with high fasting insulin, non-fasting/fasting C-peptide and HOMAIR values. / Revisión por pares

OBJECTIVE: To determine overall patient satisfaction with the balloon endometrial ablation procedure in women with menorrhagia. STUDY DESIGN: Thirty-one women in a university hospital underwent thermal balloon endometrial ablation in the year 2000. Of these, 3 were lost to follow-up. Twenty-eight women were called and asked to participate in a survey that quantified overall satisfaction with the procedure as well as change in menstrual flow and menstrual pain. Women were asked if any further medical or surgical therapy was required to control the bleeding. All patients participated in the study and stated that they underwent the procedure secondary to "heavy bleeding." All operative reports were reviewed and contained menorrhagia, menometorrhagia or dysfunctional uterine bleeding in the preoperative diagnosis. RESULTS: A total of 57% of women reported overall satisfaction with the endometrial ablation procedure, 14% were very dissatisfied, and 4% were neutral. Fifty-seven percent of women reported no bleeding or very decreased bleeding following the procedure, while 11% had slightly decreased bleeding. Thirty-two percent experienced no change, 43% reported decreased menstrual pain, and 57% had no change. Thirteen of 28 women underwent subsequent hysterectomy. CONCLUSION: Less than 60% of women reported saatisfaction with balloon endometrial ablation; and 40% underwent hysterectomy within 1 year of it.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第17820号 / 医博第3818号 / 新制||医||999(附属図書館) / 30635 / 京都大学大学院医学研究科医学専攻 / (主査)教授 富樫 かおり, 教授 伊藤 壽一, 教授 楠見 明弘 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第18152号 / 医博第3872号 / 新制||医||1002(附属図書館) / 31010 / 京都大学大学院医学研究科医学専攻 / (主査)教授 小川 誠司, 教授 武藤 学, 教授 戸井 雅和 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Endometrial cancer is the most common female reproductive cancer in the United States. Most known risk factors for endometrial cancer are either genetic or related to exposure to estrogens; less is known about risk due to environmental exposures. While several studies have examined the relationship between perineal powder use and ovarian cancer risk, only one study has addressed the relationship with endometrial cancer risk. The Women's Health Initiative Observational Study, a prospective cohort study of 93,676 United States postmenopausal women from 1993-2005, measured perineal powder use at baseline via self-report. Cases of endometrial cancer were self-reported and confirmed by both local and central physician adjudicators. Cox proportional hazards regression was used to examine the association between perineal powder use and endometrial cancer, adjusting for known risk factors. Of the 48,912 women in our analysis, 25,181 (52%) reported ever use of perineal powders. There were 452 incident cases of endometrial cancer diagnosed during 366,872 person-years of follow-up. Ever use of perineal powder was not significantly associated with increased risk of endometrial cancer (hazard ratio 1.05, 95% confidence interval 0.87-1.27). However, use of any perineal powder for 20 or more years was associated with a 30% increase in risk (hazard ratio 1.30, 95% CI 1.01-1.67) compared to never users. Use of powder on both a diaphragm and the perineal area was associated with a 39% increase in risk (hazard ratio 1.39, 95% CI 1.00-1.93). Cessation of perineal powder use, particularly on a diaphragm, may help reduce risk of endometrial cancer.

京都大学 / 新制・課程博士 / 博士(医学) / 甲第23778号 / 医博第4824号 / 新制||医||1057(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 黒田 知宏, 教授 溝脇 尚志, 教授 波多野 悦朗 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

As condições do trato reprodutivo da fêmea, assim como a qualidade do sêmen são fatores que interferem na fertilidade. Os objetivos deste trabalho foram avaliar a resposta inflamatória uterina e a taxa de prenhez em éguas, considerando hemodinâmica uterina e citologia endometrial após a inseminação artificial (IA) com sêmen congelado de alta e baixa qualidade. Para o presente estudo foram realizados dois experimentos. No Experimento 1 foram utilizadas 15 éguas distribuídas de forma aleatória em quatro grupos: CT - controle: mimetização do procedimento de IA (n=7), DIL: infusão intrauterina de diluidor a base de leite desnatado (n=7), ALTA: IA com sêmen de alta qualidade (n=7), e BAIXA: IA com sêmen de baixa qualidade (n=7). A avaliação uterina foi realizada por ultrassonografia transretal com Doppler nos modos Espectral e Color-flow em sete momentos: prévio à indução da ovulação (TIO), imediatamente antes da IA (TIA), 2 (T2), 6 (T6), 12 (T12), 24 (T24) e 48 horas (T48) após a IA. Foram considerados os valores de índice de resistência (RI) da artéria uterina e de escore de vascularização (EV) uterino. A citologia uterina foi realizada 6 h após a IA. No Experimento 2 foram utilizadas 12 éguas, e seus ciclos foram distribuídos nos tratamentos: CT - controle: mimetização do procedimento de IA (n=8), DIL: infusão intrauterina de diluidor (n=8), ALTA: IA com sêmen de alta qualidade (n=8), e BAIXA: IA com sêmen de baixa qualidade (n=8). O delineamento experimental foi em Quadrado Latino 4X4. A avaliação uterina foi realizada por ultrassonografia transretal com Doppler modos Espectral e Color-flow em três momentos: prévio à indução da ovulação (TIO), imediatamente antes da IA (TIA) e 6 horas (T6) após a IA. A citologia uterina foi realizada 6 h após a IA. Neste experimento foi considerada a taxa de prenhez comparando-se os ciclos utilizados para os grupos ALTA e BAIXA. O diagnóstico de gestação foi realizado 14 dias após a ovulação. Foi utilizado o procedimento misto (PROC MIXED) do SAS (Versão 9.3) para a análise estatística e foi considerada diferença significativa quando p &le;0,05. No Experimento 1, não foi encontrada diferença estatística entre os grupos para os valores de hemodinâmica uterina RI e EV. Houve aumento significativo de células inflamatórias no endométrio de éguas inseminadas com sêmen de baixa qualidade, porém não diferiu do grupo de éguas inseminadas com sêmen de alta qualidade. No Experimento 2, não houve diferença estatística entre os grupos para os valores de RI, mas se observou maior EV uterino nos grupos inseminados com sêmen de alta e de baixa qualidade quando comparados com o grupo controle. Na citologia uterina não foi encontrada diferença estatística. A taxa de prenhez para os grupos ALTA (81,82%) e BAIXA (54,55%) não foi estatisticamente diferente. Conclui-se que a deposição de sêmen no útero, leva a um processo inflamatório do endométrio, e esta pode alterar a hemodinâmica uterina detectável por ultrassonografia Doppler em éguas. Não existe diferença significativa na resposta inflamatória entre as qualidades de sêmen. A inseminação com sêmen congelado de menor qualidade não altera a taxa de prenhez, mas são necessários mais estudos para verificar esta diferença. / The female reproductive tract soundness, as well as semen quality are factors that interfere in fertility. The aims of this study were to evaluate inflammatory uterine response and pregnancy rate in mares, considering uterine hemodynamics and endometrial cytology after artificial insemination (IA) with frozen semen of high and low quality. Two experiments were executed for the present study. For Experiment 1, fifteen mares were randomly distributed between four groups: CT - control: mimic of the procedure of IA (n=7), DIL: intrauterine infusion of skim milk semen extender (n=7), ALTA: IA with high quality semen (n=7), and BAIXA: IA with low quality semen (n=7). Uterine evaluation was done using transrectal Doppler ultrasonography by Spectral and Color-flow modes on seven moments: immediately before ovulation induction (TIO), immediately before AI (TIA), 2 (T2), 6 (T6), 12 (T12), 24 (T24) and 48 (T48) hours after IA. There were considered the numerical values of resistance index (RI) of uterine arteries and vascularity scores (EV) of uterine horns. Endometrial cytology was done at 6 h after IA. On Experiment 2, were used 12 mares which their cycles were distributed between the treatments: CT - control: only mimic of IA procedure (n=8), DIL: intrauterine infusion of semen extender (n=8), ALTA: IA with high quality semen (n=8), and BAIXA: IA with low quality semen (n=8). The experimental design was a Latin Square. Uterine evaluation was done using transrectal Doppler ultrasonography by Spectral and Color-flow modes on three moments: before ovulation induction (TIO), immediately before AI (TIA) and 6 hours (T6) after IA. Endometrial cytology was done at 6 h after IA. In this experiment it was considered the pregnancy rate comparing the cycles for groups ALTA e BAIXA. The pregnancy diagnosis was done 14 days after ovulation. It was used the Mixed Procedure (PROC MIXED) from SAS (Version 9.3) for statistical analysis and significant difference was considered when p&le;0.05. On Experiment 1, no statistical difference was found between the groups for uterine hemodynamic values RI and EV. There was a significant increase of inflammatory cells on the mares inseminated with low quality semen, however it wasnt different from the group if mares inseminated with high quality semen. On Experiment 2, there was no statistical difference between the groups for RI values, but the uterine EV was higher for the groups inseminated with high and low quality when compared with the control group. There was no statistical difference on endometrial cytology. There was no statistical difference on pregnancy rate for the groups ALTA (81,82%) and BAIXA (54,55%). As a conclusion, the deposition of semen in the uterus causes an inflammatory process on the endometrium, and it could alter uterine dynamics detected by Doppler ultrasonography in mares. It does not exist significant difference on the inflammatory response between semen qualities. Low quality frozen-semen insemination does not alter pregnancy rate, but more studies are necessary in order to verify this difference.

Base teórica: o tratamento do carcinoma endometrial é feito através do estadiamento cirúrgico, que envolve histerectomia com salpingo-oforectomia bilateral e linfadenectomia pélvica e para-aórtica. Questiona-se o benefício da linfadenectomia sistemática em todos os pacientes, já que o risco de disseminação linfática em tumores de baixo risco é pequeno e não há evidências de benefício terapêutico em sua realização. Desse modo, tentam-se encontrar modos de determinar, na avaliação pré-operatória, quais são os pacientes que poderão se beneficiar da linfadenectomia e aqueles que podem prescindir do procedimento. Objetivos: avaliar a concordância da avaliação anatomopatológica entre a amostra endometrial pré-operatória e a peça cirúrgica das pacientes submetidas a tratamento cirúrgico primário do carcinoma de endométrio, correlacionando com características das pacientes e das amostras da patologia. Métodos: foram incluídos pacientes submetidos a tratamento cirúrgico para carcinoma de endométrio que tinham diagnóstico pré-operatório através de amostragem endometrial. Os prontuários foram revisados e as amostras disponíveis na instituição foram procuradas para posterior releitura por dois patologistas cegados para as demais informações anatomopatológicas. Resultados: foram incluídos 166 pacientes, com uma idade média de 64,6 anos. Das biópsias, 118 eram tumores endometrioides, 38 não-endometrioides e as demais, hiperplasia. As taxas de concordância foram de 93,2% para tumores endometrioides e 68,9% para não-endometrioides, com um índice kappa (k) de 0,73 para o tipo histológico. O grau tumoral distribui-se na amostra como G1 em 37,1%, G2 em 35,7% e G3 em 27,1%, com uma taxa de concordância de 61,5%, 56% e 78,9%, respectivamente, e k=0,46. Dos tumores G1, somente 1,9% teve upgrade para G3, em comparação com 16% das lesões G2. Não houve diferença estatística na taxa de concordância do tipo histológico e grau tumoral em função do local de execução da biópsia, método de amostragem e intervalo biópsia-cirurgia. Biópsias com pés > 3g tiveram uma concordância do grau tumoral significativamente melhor (p=0,040). Amostras de 105 pacientes estavam disponíveis no HCPA e foram reavaliadas por dois patologistas, com uma taxa de concordância interobservador geral de 73,3% (k=0,58) para o tipo histológico e 57,9% (k=0,54) para o grau tumoral. Conclusão: a acurácia da biópsia pré-operatória em predizer as características da peça cirúrgica não é ideal. Deve-se ter cuidado ao utilizar essa informação para determinar a extensão da cirurgia a ser realizada, sob risco de ser realizado subestadiamento. Estas baixas taxas de concordância correlacionam-se também com as baixas taxas de concordância interobservador. Novos sistemas de graduação e equipes de especialistas são possibilidades para melhorar esta questão. / Background: endometrial carcinoma treatment is based on surgical staging, including hysterectomy with bilateral salpingo-oophorectomy and pelvic and paraortic lymphadenectomy. The benefits of systematic lymphadenectomy in all patients have been questioned, since the risk of dissemination in low risk tumors is small and there is no evidence of benefits in its execution. Thereby, researches are looking for ways to determine, by preoperative evaluation, which patient will benefit from full staging and those who can do without the procedure. Objectives: evaluate the agreement between the preoperative endometrial samples and the surgical specimens in endometrial carcinoma, correlating it with characteristics of the samples and patients included, and evaluate the interobserver agreement of the preoperative biopsy. Methods: patients submitted to surgery as primary treatment for endometrial carcinoma at HCPA with a preoperative endometrial sampling were included. Their medical charts were reviewed. The available samples of the preoperative biopsies were recollected for reanalyzes by two pathologists. Inadequate transcriptions of the biopsy report were excluded. Results: we included 166 patients, with a mean age of 64.6 years. Of the biopsies, 118 were endometrioid, 38 were non-endometrioid and the remaining, hyperplasia. The agreement rates were 93.2% for endometrioid tumors and 68.9% for non-endometrioid, with a kappa index of 0.73 for the tumor cell type. The tumor FIGO grade distributed as G1 in 37.1%, G2 in 35.7% and G3 in 27.1%, with an agreement rate of 61.5%, 56% and 78.9%, respectively. The general kappa index for FIGO grading was 0.46. Of the G1 tumors, only 1.9% upgraded to G3, while 16% of the G2 lesions upgraded. There was no statistical difference in the agreement rates of tumor cell type and FIGO grading in function of place of biopsy execution, method of endometrial sampling and biopsy-surgery interval. Biopsies weighing more than 3g had a significantly better agreement in FIGO grading (p=0.040). Samples of 105 were available at HCPA and were reevaluated by 2 pathologists, with a general interobserver agreement 73.3/% (k=0.58) for tumor cell type and 57.9% (k=0.54) for grading. Conclusion: the accuracy of the preoperative biopsy in predicting the definite surgical characteristics it is not ideal. Caution must be taken when using this information to determine the surgical extension, due to the risk of under staging. These low rates of agreement are correlated with the low interobserver agreement. New grading systems and specialists teams are possible ways of improving this issue.

A elucidação dos eventos fisiológicos, pelos quais os esteroides ovarianos atuam no desenvolvimento endometrial de novilhas pré-púberes, é fundamental para o emprego de ferramentas de manejo reprodutivo que reduzam a idade ao primeiro parto e aumentem a taxa de desfrute do rebanho Nelore. Objetivou-se com este estudo averiguar os efeitos de implante de liberação sustentada de progesterona (DIB) e da manipulação do crescimento folicular, através de aspiração folicular transvaginal (AFTV), sobre mecanismos moleculares de genes modulados pela progesterona (P4) e pelo estradiol (E2) no endométrio de novilhas Nelore pré-púberes. 60 novilhas com 13,9 &#177; 2,9 meses, peso de 273,6 &#177; 5,6 kg, escore de condição corporal 5,9 &#177; 0,7, em uma escala de 0 a 9, sem sinais de ovulação, foram aleatoriamente e equitativamente distribuídas em quatro estratégias hormonais: 1) AFTV1 sem DIB&reg;: submetidas a aspiração folicular transvaginal guiada por ultrassonografia um dia antes do abate (AFTV1), sem o emprego de DIB; 2) AFTV4 sem DIB: também sem DIB e submetidas a aspiração folicular transvaginal guiada por ultrassonografia quatro dias antes do abate (AFTV4); 3) AFTV1 com DIB&reg; submetidas a uso de dispositivo intravaginal de liberação sustentada de progesterona (DIB&reg;, MSD Saúde Animal Brasil), usado previamente por duas vezes em vacas Bos indicus e AFTV1; Grupo 4; com DIB&reg; e AFTV4. Ao final do experimento, 35 animais, que não apresentaram presença de corpo lúteo, foram abatidos e tiveram seus úteros dissecados no lado ipso e contralateral, levando-se em consideração o maior diâmetro de folículo um dia antes do abate. Para a extração do ácido ribonucleico (RNA) total foram selecionados tecidos intercarunculares, obtidos das porções do terço médio do corno uterino direito e esquerdo, de seis animais de cada tratamento, totalizando 48 amostras de RNA total. Após a extração do RNA total e síntese do ácido desoxirribonucleico complementar (cDNA), a abundância dos transcritos foi avaliada empregando PCR em tempo real. Para estudar a regulação endometrial dos receptores de esteroides, foi mensurada a expressão relativa do: receptor de estrógenos alpha (ESR1) e beta (ESR2), receptor de progesterona isoformas A (PGR1), B (PGR2) e C (PGR3), receptor componente de membrana 1 (PGRMC1) e 2 (PGRMC2). Assim como de genes envolvidos em vias de resposta a P4 e ao E2: AQP4 (transporte de água), EGFR, FGF2, FGF2R, VEGFA, WNT5A (proliferação celular), OXTR, LPL, LTF, SERPINA14, SLC2A1 (atividade secretória), MMP2, MMP9 (remodelamento de matriz extracelular) e MUC1 (adesão celular). O GAPDH foi utilizado como gene constitutivo para correção dos resultados de expressão gênica. Os dados foram submetidos a análise de variância, utilizando o PROC MIXED do SAS 9.3. Houve interação entre os efeitos de corno uterino, DIB e AFTV sobre a expressão relativa de ESR1 (P = 0,05); EGFR (P = 0,05); PGR1 (P = 0,02); FGF2 (P = 0,01); FGFR2 (P = 0,10) e LPL (P = 0,04). Também foi verificado interação AFTV x corno uterino sobre a expressão relativa de PGR3 (P = 0,07); PGRMC1 e 2 (P = 0,02; P = 0,01), respectivamente; AQP4 (P = 0,09); MUC1 (P = 0,03); SLC2A1 (P = 0,09). Ocorreu interação DIB x corno uterino sobre a expressão relativa de PGRMC1 e 2 (P = 0,05; P = 0,03), respectivamente; AQP4 (P = 0,09) e OXTR (P = 0,08). E interação AFTV x DIB sobre a expressão de VEGFA (P = 0,09); MMP9 (P = 0,09); WNT5A (P = 0,01); SLC2A1 (P = 0,01). Enquanto que a expressão relativa da SERPINA14 foi influenciada pelo DIB (P = 0,02) e localização do corno uterino (P = 0,05). Estes resultados confirmam a complexa modulação dos receptores de esteroides ovarianos pela presença de DIB&reg; e dia da AFTV, na alteração da ação biológica de genes alvos, no tecido endometrial de novilhas Nelore pré-púberes. Baixos diâmetros foliculares próximo ao abate, aumentaram a expressão relativa de MUC1 no corno contralateral, sugerindo uma menor receptividade neste. Ademais, o aumento do peso uterino em função da inclusão do DIB, possivelmente seja uma consequência da maior abundância de transcritos de SERPINA14 e AQP4, mediados principalmente pelo PGRMC1 e PGRMC2. / The elucidation of the physiological events by which ovarian steroids act on endometrial development of pre-pubertal Nellore heifers, is critical for the for the use of reproductive management tools that reduce the age of first calving and increase the slaughter rate of the Nellore herd. The objective of this study was to investigate the effects of progesterone sustained release implant (DIB) and manipulation of follicular growth, through transvaginal follicular aspiration (TFA), on molecular mechanisms of genes modulated by progesterone (P4) and estradiol (E2) in the molecular mechanisms involved in the endometrial development of pre-pubertal Nellore heifers. Sixty heifers with 13.9 &#177; 2.9 months of age, weight of 273.6 &#177; 5.6 kg, body condition score 5.9 &#177; 0.7, on a scale from 0 to 9, without signs of ovulation, were randomly and evenly distributed into four hormonal strategies: 1) TFA1 without DIB&reg;: submitted to transvaginal follicular aspiration guided by ultrasonography one day before slaughter (TFA1), without the use of DIB; 2) TFA4 without DIB&reg;: also without DIB and submitted to transvaginal follicular aspiration guided by ultrasound four days before slaughter (TFA4); 3) TFA1 with DIB&reg;: Submitted to the use of intravaginal progesterone sustained release device (DIB&reg;, MSD Animal Health Brazil), previously used twice in Bos indicus cows and TFA1; Group 4; with DIB&reg; and TFA4. At the end of the experiment, 35 animals, which did not present a corpus luteum, were slaughtered and had their uterus dissected on the ipso and contralateral sides, taking into account the largest follicle diameter one day before slaughter. For the extraction of total ribonucleic acid (RNA), intercaruncular tissues were obtained from the middle third of the right and left uterine horns of six animals from each treatment, totaling 48 samples of total RNA. After extraction of total RNA and complementary deoxyribonucleic acid (cDNA) synthesis, abundance of the transcripts was assessed using real-time PCR. To study the endometrial regulation of steroid receptors, the relative expression of: alpha (ESR1) and beta (ESR2) estrogen receptor, progesterone receptor isoforms A (PGR1), B (PGR2) and C (PGR3), membrane component receptor 1 (PGRMC1) and 2 (PGRMC2). As well as genes involved in P4 and E2 response pathways: AQP4 (water transport), EGFR, FGF2, FGF2R, VEGFA, WNT5A (cell proliferation), OXTR, LPL, LTF, SERPINA14, SLC2A1 (secretory activity), MMP2, MMP9 (extracellular matrix remodeling) and MUC1 (cell adhesion). GAPDH was used as a constitutive gene for the correction of gene expression results. The data were submitted to analysis of variance, using PROC MIXED of SAS 9.3. There was interaction between the effects of uterine horn, DIB and TFA on the relative expression of ESR1 (P = 0.05); EGFR (P = 0.05); PGR1 (P = 0.02); FGF2 (P = 0.01); FGFR2 (P = 0.10) and LPL (P = 0.04). It was also verified the TFA x uterine interaction on the relative expression of PGR3 (P = 0.07); PGRMC1 and 2 (P = 0.02, P = 0.01, respectively); AQP4 (P = 0.09); MUC1 (P = 0.03); SLC2A1 (P = 0.09). DIB x uterine interaction occurred on the relative expression of PGRMC1 and 2 (P = 0.05; P = 0.03, respectively); AQP4 (P = 0.09) and OXTR (P = 0.08). And TFA x DIB interaction on VEGFA expression (P = 0.09); MMP9 (P = 0.09); WNT5A (P = 0.01); SLC2A1 (P = 0.01). While the relative expression of SERPINA14 was influenced by DIB (P = 0.02) and location of the uterine horn (P = 0.05). These results confirm the complex modulation of ovarian steroid receptors by the presence of DIB&reg; and TFA day in the alteration of the biological action of target genes in the endometrial tissue of prepubertal Nellore heifers. Low follicular diameters close to slaughter, increased the relative expression of MUC1 in the contralateral horn, suggesting a lower receptivity. In addition, increased uterine weight as a function of the DIB&reg; inclusion is possibly a consequence of the greater abundance of SERPINA14 and AQP4 transcripts, mainly mediated by PGRMC1 and PGRMC2.

As enfermidades reprodutivas representam um entrave à produção de bovinos leiteiros, à medida que a enfermidade diminui a fertilidade dos rebanhos e causa muitos prejuízos ligados ao custo de tratamento e perda produtiva. Entre estas as endometrites possuem papel de destaque. Existem diferentes técnicas para o diagnóstico destas enfermidades como a palpação uterina por via transretal, a vaginoscopia, o cultivo microbiológico de fluidos uterinos, a biópsia uterina, a citologia endometrial e a ultrassonografia que variam em grau de praticidade, especificidade e sensibilidade. O presente trabalho teve por finalidade avaliar e comparar a vaginoscopia, ultrassonografia, a histopatologia e suas possíveis associações para o diagnóstico da endometrite através da determinação da sensibilidade, da especificidade e do coeficiente de concordância kappa utilizando a citologia endometrial como padrão ouro. Para este fim foi necessário desenvolver um método adaptado para avaliação do exame histopatológico de útero bovino. Neste estudo, 106 bovinos do sexo feminino da raça Holandesa, foram submetidos ao exame ginecológico. Destes animais, os que não apresentaram secreção vaginal de aspecto catarral foram submetidos ao exame ultrassonográfico, à colheita de material para exames de citologia endometrial e a colheita de biópsia uterina. Os resultados demonstraram que a ultrassonografia constitui um método diagnóstico pratico e rápido, sendo da associação entre a determinação da presença de líquido uterino e a determinação do diâmetro cervical a maior eficiência diagnóstica neste contexto, com sensibilidade, especificidade e coeficiente de concordância kappa de 50%, 88% e 39% respectivamente. A histopatologia por sua vez também constituiu um bom método diagnóstico, no entanto menos prático que a ultrassonografia / Reproductive diseases are a great barrier to the dairy production, as it diminishes fertility and causes economical losses with treatment costs and lowering production. In this context, endometritis plays an important role. There are different diagnostic techniques for endometritis, rectal uterine palpation vaginoscopy, microbiological tests, uterine biopsies, endometrial cytology and ultrasonography, these tests vary in sensitivity and specificity. This work had as an objective evaluating and comparing vaginoscopic, ultrasongraphic and histopathological examinations, as well as their associations, for the endometritis diagnosis by determining their sensitivity, specificity and kappa agreement coefficient using endometrial cytology as gold standard. It was necessary developing an adaptive reading score to perform the uteris histological examination. In this study 106 female Holstein cows were submitted to a gynecological examination. The ones that had no vaginal catarrh were submitted to an ultrasonographic examination, to endometrial cytology examination and uterine biopsy. Results shows that ultrasonography is a practical and good diagnostic method, the association between the determination of intra-uterine fluid and cervical diameter was the most efficient ultrasonographic method, with 50%, 88% and 39% of sensitivity, specificity and agreement coefficient kappa respectively. Histopathological examination was good diagnostic method, even though not as practical as ultrasonography