BACKGROUND:Recent advances suggest fallopian tube as the main cellular source for women's pelvic serous carcinoma (PSC). In addition to TP53 mutations, many other genetic changes are involved in pelvic serous carcinogenesis. IMP3 is an oncofetal protein which has recently been observed to be overexpressed in benign-looking tubal epithelia. Such findings prompted us to examine the relationship between IMP3 over-expression, patient age and the likelihood of development of PSC.METHODS:Fallopian tubes from three groups (low-risk, high-risk, and PSC) of patients with matched ages were studied. Age was recorded in 10years intervals ranging from age 20 to older than 80. The number of IMP3 signatures (defined by 10 or more tubal secretory cells stained positively and continuously in benign appearing tubal mucosa) from both tubal fimbria and ampulla segments was measured. The data was analyzed by standard contingency table and Poisson distribution methods after age adjustment. IMP3 overexpression was also examined in serous tubal intraepithelial carcinoma and PSC.RESULTS:The positive IMP3-stained cells are mainly tubal secretory cells. The absolute number of tubal IMP3 signatures increased significantly within each age group. Age remained a significant risk factor for serous neoplasia after age adjustment. IMP3 signatures were more frequent in the patients of both high-risk and PSC groups. The presence of IMP3 signatures in tubal mucosa was significantly associated with tubal or pelvic serous carcinogenesis (p<0.001).CONCLUSIONS:The findings suggest that tubal secretory cells with IMP3 signatures showing growth advantage could potentially serve as a latent precancer biomarker for tubal or pelvic serous carcinomas in women.

Glucocorticoids are well known for altering bone structure and elevating fracture risk. Nevertheless, there are very few reports on pelvic ring fractures, compared to other bones, especially with a predominantly ligamentous insufficiency, resulting in a rotationally unstable pelvic girdle.We report a 39-year-old premenopausal woman suffering from an atraumatic symphysiolysis and disruption of the left sacroiliac joint. She presented with external rotational pelvic instability and immobilization. Prior to the injury, she received high-dose glucocorticoids for a tentative diagnosis of rheumatoid arthritis over two months. This diagnosis was not confirmed. Other causes leading to the unstable pelvic girdle were excluded by several laboratory and radiological examinations. Elevated basal cortisol and adrenocorticotropic hormone levels were measured and subsequent corticotropin-releasing hormone stimulation, dexamethasone suppression test, and petrosal sinus sampling verified the diagnosis of adrenocorticotropic hormonedependent Cushing’s disease. The combination of adrenocorticotropic hormone-dependent Cushing’s disease and the additional application of exogenous glucocorticoids is the most probable cause of a rare atraumatic rotational pelvic instability in a premenopausal patient. To the authors’ knowledge, this case presents the first description of a rotationally unstable pelvic ring fracture involving a predominantly ligamentous insufficiency in the context of combined exogenous and endogenous glucocorticoid elevation.

Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) is a prevalent, refractory pelvic pain condition characterized by pain in the pelvic area and urinary frequency, largely unresponsive to medical interventions. This study used multiple mediations to test the associations of validated pain appraisal and behavioural coping strategies between pain and quality of life. Patients (N = 175) were recruited from tertiary care urology clinics and completed questionnaires. Exploratory factor analyses were conducted on four individual measures (Chronic Pain Coping Inventory, Survey of Pain Attitudes – Control subscale, Center for Epidemiologic Studies Depression Scale, and Pain Catastrophizing Scale), then on the empirically derived factors that produced four factors to be used in regression and multiple mediation models: illness-focused behavioural coping, catastrophizing, wellness-focused behavioural coping, and depression. In regressions, CP/CPPS patient symptoms (p < .01), illness-focused behavioural coping (p < .01) and wellness-focused behavioural coping (p < .05) predicted physical quality of life, while catastrophizing (p < .01) and illness-focused behavioural coping (p < .05) predicted mental quality of life. Mediation analyses showed that illness-focused behavioural coping strategies partially mediated the relationship between pain and physical quality of life, whereas catastrophizing and illness-focused behavioural coping strategies both fully mediated the relationship between pain and mental quality of life. These results identify catastrophizing and illness-focused coping as key psychosocial targets for interventions for patient quality of life in CP/CPPS. / Thesis (Master, Psychology) -- Queen's University, 2013-08-27 17:07:11.853

Medical education is changing. Physicians have less time for teaching clinical skills and for direct observation of medical students, due to sicker patients in the hospital, shorter hospital stays, competing demands of research and patient care, and implementation of the eighty hour work week for residents. The consumer movement increased awareness of medical errors, patient safety and quality of healthcare. Teaching the pelvic examination is ethically complex. Questions have arisen about medical students learning to conduct the pelvic examination on actual patients. This study utilizes the pelvic examination simulator and genital teaching associates (GTAs) to teach pelvic exam skills to optimize limited resources, as well as address safety and ethical concerns. The purpose of the study was to provide medical students with more practice in pelvic examination skills, to test a pelvic examination simulator, and to explore a new model for teaching pelvic examination skills to second year medical students. After IRB approval, one hundred sixty eight second year medical students at Virginia Commonwealth University School of Medicine participated in the study. A two-armed trial design provided all medical students with pelvic exam training on the pelvic exam simulator and genital teaching associate. Data were gathered via an experience and demographic questionnaire, blood pressure readings, the Fear of Pelvic Examination Scale scores and performance scores after the training. Data analysis consisted of descriptive statistics, paired and independent sample t-tests and the linear mixed model. Statistical tests determined the relationship between fear, blood pressure and performance. The findings revealed that the GTA training group had significantly more fear than the pelvic exam simulator group and significantly higher performance scores than the simulator group. The gender analysis indicated that males had significantly more fear than females. Prior experience with pelvic exam simulators did not appear to reduce anxiety among medical students when first conducting pelvic exams with humans. Completion of pelvic exam training with a GTA may reduce fear substantially and make later training with the pelvic exam simulator the optimal first experience. Use of simulation in medical education reduces ethical concerns, optimizes limited resources and reduces patient safety issues.

Title: An examination of pelvic floor activity following the application of special exercises Objectives: The aim of this thesis is to validate the usefulness of carrying out local pelvic floor muscle examinations as an indication and education for therapy. A second objective is for the women involved in the research to subjectively evaluate the examination methods and therapy. Furthermore, the thesis aims to establish an example of a comprehensive and detailed local examination of the pelvic floor muscles. Methods: We measured the pelvic floor activity per vaginam using an EMG biofeedback device on clients with a pelvic floor dysfunction and grade I stress incontinence symptoms. Based on the results of the examination, therapy using the vaginal device was recommended and in six weeks a follow-up examination was carried out. The changes in pelvic floor activity were evaluated by comparing the initial and follow-up examinations. Thus the usefulness of carrying out an examination of the local pelvic floor muscles before indicating a therapy was validated. At the end of the examination an interview with participating clients was conducted in order to subjectively evaluate the method. Results: All of the women participating in the research had previously undergone a different method of pelvic floor...

The thesis deals with primary dysmenorrhea (PD) in relation to the locomotor system. The aim of the the sis was to compare the frequency of selected joint blocks and the incidence of constitutional hypermobility in PD patients in comparison with the control group. The patient group included 9 women with PD symptoms and the control group consisted of 10 women without these symptoms. The incidence of atlanto - occipital joint block within the patient group was significantly higher than within the control group (p < 0,05). The total number of stuck ribs was also considerably higher in PD patients (p < 0,01). Pain on palpation on the top of the coccygeum apex was significantly higher within the patient group (p < 0,001). Patients with PD did not show significantly different results in Beighton score test for constitutional hypermobility assessment when compared with the control group. Another aim of the thesis was to judge the effect of physical therapy on PD symptoms. For three months, the group of 9 patients had been encouraged to do regular exercises with the impact on postural stability and diagnosed functional disorders of the locomotor system by means of physical therapy. As was shown after the therapy, the reduction of the total number of stuck ribs was statistically significant (p < 0,001). Furthermore,...

Le complexe lombo-pelvi-fémoral est une zone charnière du corps humain. Son rôle d’équilibration a étédémontré à de nombreuses reprises alors que sa fonction motrice, lors de mouvements explosifs requérant uneextension totale de la chaine articulaire, a été peu étudiée. Ainsi, l’objectif de ce travail a été d’évaluer le rôle moteurdu complexe lombo-pelvi-fémoral lors d’un mouvement de squat jump. A cet effet, une approche expérimentale(cinématique, dynamique et électromyographique) couplée à un modèle de simulation du système musculo-squelettiqueont été appliqués à l’analyse du squat jump dans le plan sagittal. Les résultats montrent, dans un premier temps, que lesétudes ne prenant pas en compte le complexe lombo-pelvi-fémoral conduisent à des erreurs de surestimation du travailmécanique attribué à l’articulation de la hanche lors de squat jumps avec ou sans balancé de bras. Dans un secondtemps, il apparaît que l’extension du rachis lombaire permise par l’erector spinae participe à l’atteinte d’une hauteurmaximale de saut. Ceci confirme l’hypothèse du rôle moteur du complexe lombo-pelvi-fémoral, soulignant égalementla contribution effectrice du muscle erector spinae, qui est accrue avec l’augmentation de sa force maximale et lorsd’une flexion initiale du tronc importante. En conclusion, il semble pertinent d’intégrer le complexe lombo-pelvifémoraldans l’analyse du squat jump en vue d’ouvrir de nouvelles perspectives d’entrainement visant à l’améliorationde la détente verticale. / The lumbo-pelvic-hip complex is an important structure of the human body. Its function of balancing the bodyhas been pointed out in many studies. While its motor function has rarely been investigated, especially duringexplosive movements involving a global extension of the whole body. Thus, the purpose of this work was to evaluatethe role of the lumbo-pelvic-hip complex during squat jumping. To this end, an experimental approach (kinematics,kinetics and electromyographic) as well as a simulation model of the musculoskeletal system have been used to analyzethe squat jump in the sagittal plan. The results show, firstly that studies which do not take into consideration the lumbopelvic-hip complex, lead to an overestimation of the mechanical work attributed to the hip joint during maximal squatjumps performed arms akimbo or with an arm swing. Secondly, the extension of the lumbar spine enabled by theerector spinae activation contributes to achieve a maximal vertical jump height. This result confirms the assumptionsabout the motor function of the lumbo-pelvic-hip complex and the erector spinae. Moreover, the contribution of thismuscle is increased when its maximal strength is enhanced and when the trunk is initially flexed. In conclusion, itseems relevant to take into consideration the lumbo-pelvic-hip complex when maximal squat jumping is studied. Thiswould also contribute to new training perspectives in order to improve maximal vertical jump height.

Title: Dysmenorrhea and its possible treatment by physiotherapy Objectives: The aim of this thesis has been to assess the effect of simple feet exercises along with the practice of pelvic floor activation and relaxation on women struggling with dysmenorrhea. Subsequently, it also deals with the issue of whether the pelvic floor treat- ment per rectum together with the exercises is more effective than just plain exercising. Methods: This research has been based on an experiment. This thesis includes both a the- oretical part and a practical part. The methods used for the practical part are as follows: questionnaire (specifically Menstrual Symptom Questionnaire), simple feet exercises, ex- ercises used for the activation and relaxation of the pelvic floor as well as the pelvic floor treatment per rectum and final processing of the gathered data into statistics. Results: The menstrual cycle of every woman is completely individual and every woman perceives it quite differently. The result of the research was that simple feet exercises along with the practice of pelvic floor activation, relaxation and the pelvic floor treatment per rectum help women struggling with dysmenorrhea. We didn't discover any data that confirms whether the pelvic floor treatment per rectum, together with the exercises, is more...

Thesis advisor: Katherine Hutchinson / Lower urinary tract (LUTS) storage symptoms, including overactive bladder (OAB) and urinary incontinence (UI), are common conditions among women with significant health and economic consequences. Much of the existing literature on LUTS focuses on older, often postmenopausal women, and there is limited research available about prevalence, incidence and severity of LUTS in young women. For many young women in the United States, the period from the late teens through early twenties coincides with the period of emerging adulthood and college enrollment. The unique factors influencing women at this stage of development may be influential in understanding prevalence and correlates of OAB and UI later in the life-course. The purpose of this cross-sectional descriptive survey-based study was to explore and describe the experience of urinary storage symptoms, specifically OAB and UI, among female undergraduate college students, and to identify associated factors. Qualtrics online platform was used to create and distribute the survey to a sample of 1,800 female college undergraduate students at a private Catholic university in the northeast. Two instruments previously used to assess LUTS, the ICIQ-FLUTS and LUTS Tool, were combined into the Urinary Symptoms Scale with a one-week recall. Twelve items assessed LUTS storage symptoms of OAB and UI. The final sample consisted of 456 female undergraduate college students with a mean age of 20.3-years-old. The sample was predominantly White non-Hispanic. Most commonly reported symptoms included urgency (47.6%), frequency (52.6%), urinary incontinence (21.3%), stress urinary incontinence (28.8%), and urge urinary incontinence (16.4%). Total severity scores were low and highly skewed towards the lower range (M = 3.31; SD = 3.91). Participants with symptoms, most commonly reported experiencing symptoms rarely or sometimes during the past week. Perceived bother from urinary symptoms mean scores were low (M = 1.77) but extended the full range on a 0 to 10 scale. In this study, perceived bother from urinary symptoms as well as perceived impact of urinary symptoms on activities of daily life (ADLs) were significantly associated with care-seeking and use of self-management strategies. Interestingly, LUTS storage symptom severity was not significantly associated with care-seeking, but it was related to use of self-management strategies in this population. Perception of overall health, history of constipation/IBS, sexual activity, delayed toileting behaviors, and premature toileting behaviors were significant in multivariate analyses when controlling for other factors. Further research on the relationship of these factors and LUTS storage symptoms is needed. This study represented a first step in understanding college women’s experiences with LUTS storage symptoms and identifying the unique personal, behavioral and environmental factors associated with LUTS. The study found that OAB and UI symptoms are common among female college undergraduates. In addition, a number of personal and behavioral factors were found to be associated with LUTS storage symptoms. Given that many health-related behaviors established during college years may persist later in adulthood, identifying experiences and influences of young women’s LUTS storage symptoms is important in informing future research and practice recommendations. / Thesis (PhD) — Boston College, 2018. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

A capacidade de contração dos músculos do assoalho pélvico (MAP) está diretamente relacionada a viabilidade de realizar o seu treinamento. A literatura até hoje não traz informações a respeito da capacidade das mulheres estimarem sua própria contração dos músculos do assoalho pélvico. Os objetivos deste estudo foram avaliar a auto-percepção de mulheres da contração dos MAP e de sua intensidade, os relatos de sintomas de disfunções dos MAP, e avaliar a correlação entre os relatos de sintomas de disfunção dos MAP e a auto-percepção da contração muscular. Trata-se de um estudo observacional transversal conduzido no Centro de Saúde Escola Dr. Joel Domingos Machado de agosto de 2016 a abril de 2018. Foram recrutadas mulheres residentes em Ribeirão Preto com idades acima de 18 anos. A escala de Oxford modificada (EOM) foi utilizada como medida de desfecho para avaliar a percepção da contração dos MAP pelas mulheres. Uma avaliadora cega em relação a percepção da contração pelas participantes realizou o exame da função dos MAP utilizando o mesmo instrumento. Os sintomas de disfunção dos MAP foram avaliados por meio dos questionários validados International Consultation on Incontinence Questionnaire on Urinary- Short Form (ICIQ-SF), Pelvic Organ Prolaps/ Urinary Incontinence Sexual Questionnaire (PISQ-12), Pelvic Organ Prolaps Impact Questionnaire (PFIQ-7) e Pelvic Organ Prolaps Distress Inventory (PFDI- 20). Os seguintes testes foram utilizados na análise estatística: coeficiente de correlação de concordância de kappa ponderado, o coeficiente de correlação de Pearson e o teste exato de Fisher. As análises estatísticas foram realizadas utilizando o software estatístico SPSS 22. Os valores de p<=0,05 foram considerados estatisticamente significativos. Foram recrutadas 163 mulheres da cidade de Ribeirão Preto, destas 81 não comparecem para avaliação e 82 foram incluídas na pesquisa. A média de idade das mulheres foi de 46,83 (±17,94), 34 (41,5%) eram casadas, 59 (71,9%) brancas, 38 (46,4%) com 8 á 11 anos de escolaridade, multíparas com uma média de 2,17 gestações, 45 (54,9%) não apresentavam sintomas de IU e 77 (93,9%) nunca realizaram o treinamento dos MAP. As mulheres apresentaram uma baixa auto-percepção de contração dos MAP, somente 33% acertou corretamente a intensidade da sua contração. A avaliação da contração dos MAP por meio da palpação vaginal não apresentou uma concordância mínima com a auto percepção(p=0,087/?=0,139). A auto-percepção não apresentou correlação com os sintomas de disfunções através dos questionários PFDI-20, PFIQ-7, ICIQ-SF e PISQ-12. A avaliação da contração muscular apresentou uma correlação fraca negativa com o questionário PFDI-20 nos domínios IU (rs=-0,315/p=0,004), POP (rs=-0,330/p=0,002) e escore total (rs=0,387/p=0,000), uma correlação fraca negativa com o questionário PFIQ-7 nos domínios IU (rs=-0,320/p=0,003), POP (rs=-0,244/p=0,027) e escore total (rs=- 0,329/p=0,003). Uma correlação fraca positiva com o questionário de função sexual PISQ-12 (rs=0,360/p=0,008) e uma correlação negativa moderada com o questionário ICIQ-SF de sintomas de incontinência urinária (rs=-0,406/p=0,000). Concluiu-se que as mulheres dessa amostra apresentaram uma baixa auto-percepção da contração dos MAP, somente 33% estimou corretamente a sua contração muscular. / The ability to perform a pelvic floor muscles (PFM) contraction is directly related to the feasibility of performing their training. To date the literature does not provide information regarding to women\'s ability to estimate their own PFM contraction. This study aims to assess women\'s self-perception of PFM contraction and its intensity, the prevalence of PFM dysfunction symptoms, and to analyse the relation between these symptoms and self-perception of muscle contraction. This is a cross-sectional observational study conducted at Dr. Joel Domingos Machado School Health Center from August, 2016 to April, 2018. Women living in Ribeirão Preto aged above 18 years were recruited. The modified Oxford scale was used as an outcome measure to assess women\'s perception of PFM contraction. A blind evaluator regarding to women\'s self-perception of PFM contraction assessed PFM function using vaginal palpation to classify it with same instrument. PFM dysfunction symptoms were assessed using the following validated questionnaires International Consultation on Incontinence Questionnaire on Urinary- Short Form (ICIQ-SF), Pelvic Organ Prolaps/ Urinary Incontinence Sexual Questionnaire (PISQ-12), Pelvic Organ Prolaps Impact Questionnaire (PFIQ-7) e Pelvic Organ Prolaps Distress Inventory (PFDI-20). Weighted kappa concordance correlation coefficient, Pearson\'s correlation coefficient and Fisher\'s exact test were used in the statistical analysis. SPSS 22 statistical software was used and values of p<=0.05 were considered statistically significant. A total of 163 women were recruited, 81 did not attend for evaluation and 82 were included in the study. The mean age of the participants was 46.83 (± 17.94), 34 (41.5%) were married, 59 (71.9%) were white, 38 (46.4%) have from 8 to 11 years of formal education. Most of them were multiparous with an average of 2.17 pregnancies, 45 (54.9%) had no symptoms of urinary incontinence, and 77 (93.9%) had never performed PFM training. The participants had a low self-perception of PFM contraction, only 33% hit correctly the intensity of their contraction. PFM contraction assessed by vaginal palpation did not show a minimum agreement with self-perception (p = 0.087/ ?= 0,139). Self-perception did not correlate with dysfunctions symptoms evaluated by the questionnaires PFDI-20, PFIQ-7, ICIQ-SF and PISQ-12. The PFMfunction presented a weak negative correlation with the PFDI-20 questionnaire in the domains of UI symptoms (rs = -0.315 / p = 0.004), POP (rs = -0.330 / p = 0.002) and total score (rs = 0.387 / p = 0.0002), with PFIQ-7 questionnaire in the IU domains (rs = -0.320 / p = 0.003), POP (rs = -0.224 / p = 0.027) and total score 0.003). A weak positive correlation was found between self-perception and PISQ-12 questionnaire (rs = 0.360 / p = 0.008) and a moderate negative correlation with the ICIQ-SF (rs = -0.406 / p = 0.000). In conclusion women of this sample had a low self-perception of PFM contraction, only 33% correctly estimated their muscle contraction.