Uterine defences against bacterial challenge are more efficient during oestrus than during dioestrus. The exact reasons and mechanisms responsible for this difference are, however, still incompletely understood. The leukocyte reaction is one of the defence mechanisms that has been cited as being able to respond better to a bacterial challenge during oestrus than during dioestrus. The aim of the present study was to test the hypothesis that the magnitude of endometrial leukocyte migration following the instillation of semen into the uterine lumen is greater during oestrus than during dioestrus. Eight Nooitgedacht mares of normal fertility, aged between 8 and 16 years (11.5 ± 2.7; mean ± SD), were used in the study. Each mare received a different treatment during each of four oestrous cycles, with a rest cycle after each treatment. Two treatments were performed during dioestrus and two during oestrus. One treatment for each stage of the cycle was a control treatment without challenge to the endometrium. At time zero of challenged cycles a single aliquot of 13 ml raw semen, frozen-thawed without addition of any cryoprotectant or extender, was instilled into the uterus. An endometrial biopsy was taken 6 and 48 h after time zero and a swab for cytology and culture (if cytology was positive) was collected 48 and 120 h after time zero. An image analyzer was used to record the total number of cells, round cells, neutrophils and eosinophils per unit surface area of epithelium, stratum compactum (SC) and stratum spongiosum (SS). The relative number of round cells, neutrophils and eosinophils were expressed as proportions of the number of each cell type to the total number of cells. The use of an image analyser made the collection of quantitative data from histologic sections possible. However, the operator still had to make some critical decisions, namely to choose the field of the section for analysis and to assign individual cells to a chosen category. The total numbers of cells in the epithelium and the SS were greater during dioestrus than during oestrus, while no such difference could be demonstrated for the SC. The stage of the oestrous cycle had no meaningful influence on any other (measured or calculated) variable. During challenged cycles, absolute and relative numbers of neutrophils were significantly greater in the epithelium, SC and SS than during control cycles. There was an interaction (not always reaching significance) between treatment and time with regard to the absolute and relative numbers of neutrophils in epithelium and SS and round cells in the epithelium. Numbers of neutrophils and round cells were significantly higher 6 h after treatment than 48 h after treatment in challenged cycles, but did not differ during control cycles. During challenged cycles, the stage of the oestrous cycle when treatment occurred had no effect on the duration of the induced endometritis, the occurrence of positive cytology or culture results, or the type of bacteria that were cultured. Regardless of the stage of their cycles when they were challenged, all mares rid themselves of the opportunistic pathogens placed into the uterine lumen within one oestrous cycle. The hypothesis was rejected and it is therefore concluded that the stage of the oestrous cycle did not influence the magnitude of the endometrial leukocyte response to a standardized challenge with semen in these reproductively sound mares. A similar study will be required to test whether this conclusion also holds true for mares that are susceptible to endometritis. / Dissertation (MMedVet (Gyn))--University of Pretoria, 2006. / Production Animal Studies / unrestricted

Indiana University-Purdue University Indianapolis (IUPUI) / Endometrial cancer is the most common gynecologic cancer in the United States, and patients with early-stage endometrioid adenocarcinoma have a favorable prognosis. Over the past decade, the gynecologic oncology community has debated whether potential harms of systematic lymph node dissection (LND) outweigh potential benefits for these patients. To minimize number of nodes removed, sentinel lymph node dissection (SLND) is under investigation as an alternative. However, ongoing uncertainty of LND/SLND best practices may result in variations in disease management and discrepant outcomes. Methods Three retrospective cohort studies examined LND/SLND use in patients with endometrioid adenocarcinoma. Two examined temporal and geographic variations, respectively, utilizing the Surveillance, Epidemiology, and End Results (SEER) 18 dataset for the years 2004 through 2015. The third used the SEER-Medicare dataset from 2003 through 2016 to quantify and compare the risk of developing 6-month post-surgical lymphedema, lymphocele, hemorrhage, ileus, infection, thrombosis, and all-cause death by number of lymph nodes removed (0, 1-4, 5-9, or 10+). Results Time trend analyses found LND increased from 2004 through 2008, followed by a significant decline through 2015. SLND was rare and did not increase significantly. Significant geographic variation existed for LND use but not SLND. Per 1,000 patients, analyses of 6-month post-surgical complications found 6.5 experienced lymphedema, 3.9 experienced lymphocele, 15.7 experienced hemorrhage, 28.7 experienced ileus, 37.1 experienced infection, 18.6 experienced thrombosis, and 19.8 died. Controlling for size of primary tumor, tumor grade, comorbidities, race/ethnicity, age at diagnosis, adjuvant chemotherapy, and radiotherapy, adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) showed greater risk for ileus (HR: 1.53; 95% CI: 1.24-1.90), infection (HR: 1.52; 95% CI: 1.25-1.83), and thrombosis (HR: 1.41; 95% CI: 1.09-1.82) when comparing removal of 10+ nodes versus 0 nodes. Conclusion Overall, these studies found significant temporal and geographic variation in LND, as well as increasing risk of post-surgical complications associated with increasing numbers of lymph nodes removed. Should continued research into SLND find strong evidence that it effectively detects cancer spread, patients may benefit through decreased risk of post-surgical ileus, infection, and thrombosis.

The final, definitive version of this paper has been published in Acta radiologica by SAGE Publications Ltd, All rights reserved.Final publication is available at http://acr.sagepub.com/ / 京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第19582号 / 医博第4089号 / 新制||医||1014(附属図書館) / 32618 / 京都大学大学院医学研究科医学専攻 / (主査)教授 山田 泰広, 教授 戸井 雅和, 教授 羽賀 博典 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Black women have higher incidence rates of aggressive subtypes of endometrial cancer and worse survival rates compared with white women. The overall incidence rate has been increasing in black women and, accounting for their higher prevalence of hysterectomy, may be higher than in white women. Exposures related to obesity and metabolic disorders, reproductive factors, and use of exogenous hormones have been associated with endometrial cancer risk in prior studies. However, because these studies have primarily included white women, little is known about these associations in black women. We therefore examined associations of endometrial cancer with previously identified risk factors in 47,555 participants in the Black Women’s Health Study, a prospective cohort of U.S. black women. Study 1 focused on anthropometric and metabolic factors. After adjustment for age at menarche, parity, menopausal status, smoking, and use of oral contraceptives, estrogen-only female menopausal hormones (FMH), and estrogen plus progestin FMH, self-reported body mass index (BMI), BMI at age 18, greater weight gain since age 18, and diagnosis of diabetes were positively associated with endometrial cancer risk. Self-reported diagnosis of hypercholesterolemia and hypertension were not independently associated. In study 2, we examined associations with reproductive factors. Endometrial cancer incidence was higher among women with early age at menarche, a history of infertility, a greater number of lifetime menstrual cycles, and diagnosis of polycystic ovary syndrome. Parity and early age at first birth were associated with lower risk, while a greater number of births and breastfeeding were not associated with risk. Positive associations with late age at menarche among premenopausal women and longer duration of breastfeeding among obese women require confirmation in other studies. In study 3, we examined the associations of endometrial cancer with exogenous hormone use. The inverse association with oral contraceptive use was primarily among women who used oral contraceptives for ≥5 years. Incidence was higher among current users of estrogen-only and estrogen plus progestin FMH, and ever users of progestin only FMH. Lower risk was observed among former users of estrogen plus progestin FMH. / 2019-04-30

No description available.

Do ponto de vista da produtividade, a fertilidade é um dos parâmetros de maior importância em um rebanho bovino comercial e esta é influenciada por vários fatores, entre eles estão as condições do trato reprodutivo das fêmeas e a qualidade do sêmen utilizado. O influxo de células inflamatórias no local da deposição do sêmen logo após a inseminação artificial (IA) pode ser intensificada na presença de maior número de espermatozoides lesados durante a IA, caracterizando uma endometrite. Este estudo foi conduzido em três experimentos. Com o objetivo de comparar os métodos de colheita de material endometrial por escova ginecológica (EU) e lavado uterino (LU), bem como a interferência destes procedimentos na hemodinâmica uterina, foi proposto o Experimento 01, onde pode-se constatar que ambas as técnicas permitem o recolhimento de amostras em quantidade e qualidade suficiente para contagem, e que a porcentagem de células polimorfonucleares obtidas pela técnica LU foi superior a EU. Maior fluxo sanguíneo das artérias uterinas foi encontrado no momento de 4 horas após a realização de LU, sugerindo que este influencia na resposta vascular inflamatória. Para avaliar o efeito da LU após a IA em Tempo Fixo (IATF) na fertilidade dos animais, executou-se o Experimento 02 e constatou-se que não há diferença no índice de prenhez entre os animais submetidos ou não à LU, demonstrando que a técnica não interfere na taxa de fertilidade. Com o intuito de investigar a interferência da qualidade do sêmen na fertilidade, resposta inflamatória e hemodinâmica uterina, foi proposto o Experimento 03, onde foi possível observar influência da qualidade do sêmen sobre a taxa de prenhez, verificou-se maior porcentagem de vacas prenhes quando inseminadas com sêmen com maiores percentuais de espermatozoides apresentando integridade das membranas plasmática e acrossomal e função mitocondrial (PIAIC). Notou-se ainda a ocorrência de endometrite em 65,3 % dos animais, os quais apresentaram taxa de prenhez inferior aos que não apresentaram inflamação. Pode-se concluir que a qualidade do sêmen e a endometrite interferem na taxa de fertilidade bovina. / When productivity is taking into account, fertility is one of the most important parameters in a commercial herd. It is influenced by several factors, especially by the conditions of the female reproductive tract and the quality of the semen used. The influx of inflammatory cells at the site of semen deposition after artificial insemination (AI) can be intensified by the deposition of a greater number of dead spermatozoa during AI, which characterized endometritis. This study was conducted in three different experiments. In order to compare the methods of collection of endometrial sampling by swab using a gynecological brush (GB) or uterine flushing (UF), as well as the interference of these procedures in uterine hemodynamics, we designed experiment 01. Our results reveal that both techniques allow collecting samples with good quality and sufficient quantity to be counted; moreover, the average percentage of polymorphonuclear cells obtained by UF was greater compared to those obtained by GB. It may be noted that the increased blood flow was observed in samples collected four hours after the UF procedure, suggesting that it may have an influence on the vascular inflammatory response. To evaluate the effect of uterine flushing after AIFT on animal fertility we designed the experiment 02. Our results revealed that there is no statistical difference in pregnancy rates between flushed and non flushed animals, showing that the UF does not interfere with fertility rate. Experiment 03 was designed in order to assess the inflammatory response induced by different qualities of semen and their interference on uterine hemodynamic and fertility. There was an influence of semen quality on pregnancy rates: higher percentage of pregnancy was found in the group of cows inseminated with semen with plasma and acrossome membrane integrity and mitochondrial function (PIAIC). Endometritis was noticed in 65.3% of the cows and these animals presented lower pregnancy rate compared to those that did not show an inflammatory response. We concluded that semen quality and endometritis interferes with fertility rate in bovine species.

Orientador: Rogério Dias / Coorientador: Daniel Spadoto Dias / Banca: Nilton José Leite / Banca: Reginaldo Guedes Coelho Lopes / Resumo: Objetivo do estudo. Comparar os resultados entre duas técnicas de ablação endometrial de primeira geração. Tipo de estudo. Estudo prospectivo, longitudinal e analítico (Canadian Task Force II-2). Local do estudo. Hospital público terciário, centro universitário de ensino. Pacientes e métodos. Durante o período de outubro de 2011 a setembro de 2013, 73 pacientes com história de sangramento uterino anormal (SUA) e resposta insatisfatória ao tratamento clínico por um período mínimo de 12 meses, foram randomizadas e submetidas à ablação endometrial por ressecção com eletrodo monopolar em alça "U" seguida de eletrocoagulação com rollerball no grupo A (36 pacientes) e eletrocoagulação apenas com rollerball no grupo B (37 pacientes). As mulheres foram acompanhadas por período médio de 359 dias (280;751) e 370 dias (305;766), respectivamente. Intervenções. As pacientes foram submetidas à ablação endometrial conforme a técnica de cada grupo. Avaliações nos tempos 30, 90, 180 e 360 dias foram realizadas através de protocolo de pesquisa, que procurou avaliar o padrão de sangramento, sintomas associados, índice de falha e taxa de satisfação. Resultados. Os grupos foram clínico-epidemiologicamente homogêneos (P ≥ 0,05). O tempo cirúrgico e o volume utilizado do meio distensor foram menores nas pacientes do grupo B [média de 48,5 (±12,0) vs. 31,9 (±5,6) minutos; P < 0,001 e 5.700 mL vs. 3.500 mL; P < 0,01]. Observou-se uma considerável melhora no quadro clínico após ablação endometrial, em ambos os grupos, com redução do número de dias de sangramento (P < 0,01), assim como do número de absorventes utilizados no dia de maior fluxo (P < 0,01) e durante todo o período menstrual (P < 0,01). Houve também menor incidência de infecção do sítio cirúrgico no grupo B (30,5% vs. 8,1%; P < 0,05). A taxa de histerectomia observada no estudo foi de 9,6%, decorrente de ... / Abstract: Purpose of the study. Compare the results of two techniques of endometrial ablation first generation. Type of study. Prospective, longitudinal and analytical study (Canadian Task Force II-2). The study site. Tertiary public hospital, university teaching center. Patients and methods. During the period October 2011 to September 2013, 73 patients with a history of abnormal uterine bleeding (AUB) and poor response to medical treatment for a minimum period of 12 months, were randomized and underwent endometrial ablation with monopolar resection electrode handle "U" followed by rollerball electrocoagulation with the group a (36 patients) with rollerball electrocoagulation only in group B (37 patients). The women were followed for an average period of 359 days (280;751) and 370 days (305;766), respectively. Interventions. The patients were submitted to endometrial ablation technique according to each group. Ratings at 30, 90, 180 and 360 days were accomplished through research protocol, which sought to assess the pattern of bleeding, associated symptoms, failure rate and satisfaction rate. Results. The groups were homogeneous clinical and epidemiologically (P ≥ 0.05). Surgical time and the volume of distension medium used were lower in group B patients [mean of 48.5 (±12.0) vs. 31.9 (±5.6) minutes; P < 0.001 and 5.700 mL vs. 3.500 mL; P < 0.01]. There was a significant improvement in clinical symptoms after endometrial ablation in both groups, reducing the number of bleeding days (P < 0.01), as well as the number of pads used on the day of the flow rate (P < 0.01) and throughout the menstrual cycle (P < 0.01). There was also a lower incidence of surgical site infection in group B (30.5% vs. 8.1%; P < 0.05). The hysterectomy rate observed in the study was 9.6%, due to technical difficulties and intraoperative hemorrhage, persistence of SUA, development of incapacitating dysmenorrhea and / or pelvic pain ... / Mestre

Introdução: o carcinoma de endométrio é uma das neoplasias ginecológicas mais comuns nos países industrializados. O tratamento desta doença é primariamente cirúrgico. Segundo a normatização da Federação Internacional de Ginecologia e Obstetrícia (FIGO), a cirurgia ideal consiste na realização de histerectomia total, anexectomia bilateral, linfadenectomia retroperitonial e coleta de citologia peritoneal. No entanto, a realização sistemática da linfadenectomia tem sido contestada. Alguns centros de referência acreditam que deva ser realizada apenas em um grupo de pacientes com alto risco para disseminação linfática da doença. O desafio é encontrar marcadores pré-operatórios que possam ser preditivos da presença de doença linfonodal e, assim , virem a ser utilizados para a definição da necessidade da linfadenectomia. Objetivos: verificar se a expressão imuno-histoquímica (IMH) positiva da p53 na amostra endometrial diagnóstica e, se o valor sérico do CA 125 obtido no tempo pré-operatório, podem ser efetivos para prever a presença de doença linfonodal. Métodos: um estudo transversal restrospectivo foi realizado. Foram incluídas 111 pacientes com carcinoma de endométrio submetidas a histerectomia com anexectomia bilateral e linfadenectomia com ou sem citologia peritoneal. Noventa pacientes apresentavam CA 125 pré-operatório e 73, a avaliação da p53. Cinquenta e quatro pacientes apresentavam as duas variáveis em combinação. Foram estabelecidas as associações entre o valor de CA 125 e da expressão IMH da p53 com o envolvimento linfonodal. Uma curva ROC foi construída para identificar o valor de CA 125 com melhor Sensibilidade (S) e Especificidade (E) para doença linfonodal. / Introduction: endometrial carcinoma is one of the most common gynecological malignancies in industrialized countries. The treatment of this disease is primarily surgical. According to the International Federation of Gynecology and Obstetrics surgery ideal consists in performing total hysterectomy, bilateral adnexectomy, retroperitoneal lymphadenectomy and peritoneal cytology. However, the systematic lymphadenectomy has been disputed, and should only be performed in a group of patients at high risk of lymphatic spread of the disease. The challenge is to find preoperative markers that may be predictive of the presence of lymph node disease and thus come to be used to determine the necessity of lymphadenectomy. Objectives: to determine whether the positive immunohistochemical expression (IMH) of p53 in diagnostic endometrial sample and, if the value of serum CA 125, obtained during pre-operative, can be effective to predict the presence of lymph node disease. Methods: a cross-sectional study was conducted. The final sample consisted of 111 patients with endometrial carcinoma undergoing hysterectomy with bilateral adnexectomy and lymphadenectomy with or without peritoneal cytology. Ninety two patients had preoperative CA 125 and 73, evaluation of p53. Fifty four patients had both variables in combination. Associations have been established between the value of CA 125 and IMH expression of p53 with lymph node involvement. A ROC curve was constructed to identify the value of CA 125 with better sensitivity (S) and specificity (E) for lymph node disease.

A proliferação celular mediada pela progesterona (P4) é essencial para a funcão uterina. Dessa forma, alterações nesse processo podem comprometer a reprodução. O diabetes do tipo 1 (DM1) está associado a diversos distúrbios reprodutivos. No entanto, o impacto do DM1 sobre a ação da P4 no ambiente uterino ainda não é conhecido. Para isso, utilizamos fêmeas de camundongo DM1 induzidas por aloxana, submetidas à ovarectomia (OVX) e reposição por P4. Verificamos por meio de histomorfometria e imunohistoquímica (PCNA) uma diminuição da área de estroma uterino e do índice de proliferação. As quantificações proteícas por Western blot monstraram um aumento do PR-A nas fêmeas diabéticas OVX e nas tratadas pela P4. Ressalta-se que as fêmeas DM1 tratados pela P4 não apresentaram a mesma expressão do RNAm para o fator de crescimento Hoxa-10. Houve também um aumento do RNAm da p27 nas fêmeas DM1 não tratadas, visto por qPCR. Nossos resultados demonstraram que o DM1 interfere negativamente na resposta proliferativa promovida pela P4. Contribuindo para compreensão dos mecanismos biológicos pelos quais o diabetes compromete as funções reprodutivas. / Progesterone (P4)-mediated cell proliferation is essential for uterine function. Therefore, alteration in this process could compromise reproduction. The type 1 diabetes (DM1) relates to several reproductive disturbs. However, the impact of DM1 on the P4 function is still not elucidated. Thus, we used alloxan-induced diabetic mice females subjected to ovariectomy and hormonal replacement therapy with P4. Histomorphometrical and immunohistochemistry to PCNA approaches showed a decrease of the uterine stromal area and the cell proliferation index. Protein quantification by Western blot showed increased levels of PR-A in both ovariectomized and P4-treated diabetic females. Importantly, P4 did not recovered the mRNA expression to the Hoxa-10 transcription factor in diabetic females. Additionally, qPCR analysis revealed increased level of p27 mRNA in diabetic females non-treated with P4. Together these results show that DM1 has a negative action on the P4-mediated cell proliferative response. These are new and important results to a better understand of the biological mechanisms by which diabetes affects the reproductive functions.

<p>ABSTRACT</p><p>A defect implantation process is the major reason for unexplained infertility. Estrogen andprogesterone are steroid hormones preparing the endometrium for implantation. They mediatetheir effect through their receptors: estrogen receptor alpha and beta and progesteronereceptor A and B, respectively. Leukemia inhibitory factor (LIF), which is also important forimplantation, mediates its effect through LIF receptor and the coreceptor, gp130, and is downregulated by suppressors of cytokine signaling 1. The aim of the study was to compare thelevels of the steroid hormone receptors and LIF related factors in the endometrium of twogroups of women with the diagnosis unexplained infertility: one that became pregnant afterassisted reproduction and one that did not become pregnant. Before treatment of thesewomen, endometrial mRNA was collected during the window of implantation in themenstrual cycle. The levels of specific mRNAs were measured with real-time PCR. Womenwho had become pregnant had a significantly higher level of steroid hormone receptors. Thus,these proteins seem to be important for a pregnancy and may be suitable as receptivitymarkers.</p>