"obs-and-gynae" via Stockport Education Centre Library

by Jennifer Walker, Sepehr N. Tabrizi, Christopher K. Fairley, Marcus Y. Chen, Catriona S. Bradshaw, Jimmy Twin, Nicole Taylor, Basil Donovan, John M. Kaldor, Kathleen McNamee, Eve Urban, Sandra Walker, Marian Currie, Hudson Birden, Francis Bowden, Jane Gunn, Marie Pirotta, Lyle Gurrin, Veerakathy Harindra, Suzanne M. Garland, Jane S. Hocking

Background

This study aimed to estimate rates of chlamydia incidence and re-infection and to investigate the dynamics of chlamydia organism load in prevalent, incident and re-infections among young Australian women.

Methods

1,116 women aged 16 to 25 years were recruited from primary care clinics in Australia. Vaginal swabs were collected at 3 to 6 month intervals for chlamydia testing. Chlamydia organism load was measured by quantitative PCR.

Results

There were 47 incident cases of chlamydia diagnosed and 1,056.34 person years of follow up with a rate of 4.4 per 100 person years (95% CI: 3.3, 5.9). Incident infection was associated with being aged 16 to 20 years [RR = 3.7 (95%CI: 1.9, 7.1)], being employed [RR = 2.4 (95%CI: 1.1, 4.9)] and having two or more new sex partners [RR = 5.5 (95%CI: 2.6, 11.7)]. Recent antibiotic use was associated with a reduced incidence [RR:0.1 (95%CI: 0.0, 0.5)]. There were 14 re-infections with a rate of 22.3 per 100 person years (95%CI: 13.2, 37.6). The median time to re-infection was 4.6 months. Organism load was higher for prevalent than incident infections (p<0.01) and for prevalent than re-infections (p<0.01).

Conclusions

Chlamydia is common among young women and a high proportion of women are re-infected within a short period of time, highlighting the need for effective partner treatment and repeat testing. The difference in organism load between prevalent and incident infections suggests prevalent infection may be more important for ongoing transmission of chlamydia.

by Emily Northrup, Nils-Holger Zschemisch, Regina Eisenblätter, Silke Glage, Dirk Wedekind, Edwin Cuppen, Martina Dorsch, Hans-Jürgen Hedrich

A spontaneous mutation leading to the formation of congenital ovarian and testicular tumors was detected in the WKY/Ztm rat strain. The histological evaluation revealed derivatives from all three germ layers, thereby identifying these tumors as teratomas. Teratocarcinogenesis was accompanied by infertility and the underlying mutation was termed ter. Linkage analysis of 58 (WKY-ter×SPRD-Cu3) F2 rats associated the ter mutation with RNO18 (LOD = 3.25). Sequencing of candidate genes detected a point mutation in exon 4 of the dead-end homolog 1 gene (Dnd1), which introduces a premature stop codon assumed to cause a truncation of the Dnd1 protein. Genotyping of the recessive ter mutation revealed a complete penetrance of teratocarcinogenesis and infertility in homozygous ter rats of both genders. Morphologically non-tumorous testes of homozygous ter males were reduced in both size and weight. This testicular malformation was linked to a lack of spermatogenesis using immunohistochemical and histological staining. Our WKY-Dnd1ter/Ztm rat is a novel animal model to investigate gonadal teratocarcinogenesis and the molecular mechanisms involved in germ cell development of both genders.

Background: The growing trend of women infected with HIV through sexual transmission is alarming. Factors influencing condom use have not yet been fully identified, especially in countries with conservative cultures and backgrounds. The present study aimed to explore the barriers of condom use in Iranian women at risk of HIV. Methods: Using the grounded theory methodology, participants' experiences and their perceptions regarding condom were collected during semi structured in depth interviews. Participants were 22 women, aged 21-49 years, considered to be at risk for HIV, due to their own or their partner's sexual behaviors. Qualitative analysis of the data was conducted manually and was guided by constant comparative analysis. Results: Two main barriers, personal and socio-environmental emerged from data analysis. Lack of perceived threat, absence of protective motivation, inadequate knowledge, perceived lack of control, negative attitudes towards condom and misperception were the major personal barriers, while unsupportive environments and cultural norms were the common socioenvironmental barriers to condom use among these at risk women. Conclusions: These critical barriers have to be addressed for implementing effective prevention programs against HIV among populations at risk for HIV.

by Chun S. Wu, Ellen A. Nohr, Bodil H. Bech, Mogens Vestergaard, Jørn Olsen

Background

To examine whether prenatal exposure to parental type 1 diabetes, type 2 diabetes, or gestational diabetes is associated with an increased risk of malignant neoplasm or diseases of the circulatory system in the offspring.

Methods/Principal Findings

We conducted a population-based cohort study of 1,781,576 singletons born in Denmark from 1977 to 2008. Children were followed for up to 30 years from the day of birth until the onset of the outcomes under study, death, emigration, or December 31, 2009, whichever came first. We used Cox proportional hazards model to estimate hazard ratios (HR) with 95% confidence intervals (95% CI) for the outcomes under study while adjusting for potential confounders. An increased risk of malignant neoplasm was found in children prenatally exposed to maternal type 2 diabetes (HR = 2.2, 95%CI: 1.5–3.2). An increased risk of diseases of the circulatory system was found in children exposed to maternal type 1 diabetes (HR = 2.2, 95%CI: 1.6–3.0), type 2 diabetes (HR = 1.4, 95%CI: 1.1–1.7), and gestational diabetes (HR = 1.3, 95%CI: 1.1–1.6), but results were attenuated after excluding children with congenital malformations. An increased risk of diseases of the circulatory system was also found in children exposed to paternal type 2 diabetes (HR = 1.5, 95%CI: 1.1–2.2) and the elevated risk remained after excluding children with congenital malformations.

Conclusions

This study suggests that susceptibility to malignant neoplasm is modified partly by fetal programming. Diseases of the circulatory system may be modified by genetic factors, other time-stable family factors, or fetal programming.

by Keith C. Summa, Martha Hotz Vitaterna, Fred W. Turek

Background

The circadian clock has been linked to reproduction at many levels in mammals. Epidemiological studies of female shift workers have reported increased rates of reproductive abnormalities and adverse pregnancy outcomes, although whether the cause is circadian disruption or another factor associated with shift work is unknown. Here we test whether environmental disruption of circadian rhythms, using repeated shifts of the light:dark (LD) cycle, adversely affects reproductive success in mice.

Methodology/Principal Findings

Young adult female C57BL/6J (B6) mice were paired with B6 males until copulation was verified by visual identification of vaginal plug formation. Females were then randomly assigned to one of three groups: control, phase-delay or phase-advance. Controls remained on a constant 12-hr light:12-hr dark cycle, whereas phase-delayed and phase-advanced mice were subjected to 6-hr delays or advances in the LD cycle every 5–6 days, respectively. The number of copulations resulting in term pregnancies was determined. Control females had a full-term pregnancy success rate of 90% (11/12), which fell to 50% (9/18; p<0.1) in the phase-delay group and 22% (4/18; p<0.01) in the phase-advance group.

Conclusions/Significance

Repeated shifting of the LD cycle, which disrupts endogenous circadian timekeeping, dramatically reduces pregnancy success in mice. Advances of the LD cycle have a greater negative impact on pregnancy outcomes and, in non-pregnant female mice, require longer for circadian re-entrainment, suggesting that the magnitude or duration of circadian misalignment may be related to the severity of the adverse impact on pregnancy. These results explicitly link disruptions of circadian entrainment to adverse pregnancy outcomes in mammals, which may have important implications for the reproductive health of female shift workers, women with circadian rhythm sleep disorders and/or women with disturbed circadian rhythms for other reasons.

by Jun Woo Jo, Byung Chul Jee, Chang Suk Suh, Seok Hyun Kim

Antifreeze proteins (AFPs) are a class of polypeptides that permit organismal survival in sub-freezing environments. The purpose of this study was to investigate the effect of AFP supplementation on immature mouse oocyte vitrification. Germinal vesicle-stage oocytes were vitrified using a two-step exposure to equilibrium and vitrification solution in the presence or absence of 500 ng/mL of AFP III. After warming, oocyte survival, in vitro maturation, fertilization, and embryonic development up to the blastocyst stage were assessed. Spindle and chromosome morphology, membrane integrity, and the expression levels of several genes were assessed in in vitro matured oocytes. The rate of blastocyst formation was significantly higher and the number of caspase-positive blastomeres was significantly lower in the AFP-treated group compared with the untreated group. The proportion of oocytes with intact spindles/chromosomes and stable membranes was also significantly higher in the AFP group. The AFP group showed increased Mad2, Hook-1, Zar1, Zp1, and Bcl2 expression and lower Eg5, Zp2, Caspase6, and Rbm3 expression compared with the untreated group. Supplementation of the vitrification medium with AFP has a protective effect on immature mouse oocytes, promoting their resistance to chilling injury. AFPs may preserve spindle forming ability and membrane integrity at GV stage. The fertilization and subsequent developmental competence of oocytes may be associated with the modulation of Zar1, Zp1/Zp2, Bcl2, Caspase6, and Rbm3.

The initial sample size calculation in our protocol (Hegeman et al, BMC Pregnancy Childbirth, 2009, 9:44) was based on the expected proportion of 'bad neonatal outcome' in the intervention group (3.9%) and control group (7.2%) and accounts for the fact that the outcomes in children form multiple pregnancies are non-independent using an intra class correlation of 0.6. As the intervention is performed on the mother, analysis should be done on the maternal level. This adjustment was made during recruitment and approved by the medical ethics committee of the Academic Medical Centre in Amsterdam (ref. No. MEC 09/107). The sample size is calculated based on the primary outcome 'bad neonatal outcome'.

Background: Neonatal anxiety and depression and breastfeeding cessation are significant public healthproblems. There is an association between maternal symptoms of anxiety and depression andearly breastfeeding cessation. In earlier studies, the causality of this association wasinterpreted both ways; symptoms of anxiety and depression prepartum significantly impactsbreastfeeding, and breastfeeding cessation significantly impacts symptoms of anxiety anddepression.First, we aimed to investigate whether breastfeeding cessation is related to an increase insymptoms of anxiety and depression from pregnancy to six months postpartum. Second, wealso investigated whether the proposed symptom increase after breastfeeding cessation wasdisproportionately high for those women already suffering from high levels of anxiety anddepression during pregnancy. Methods: To answer these objectives, we examined data from 42 225 women in the Norwegian Motherand Child Cohort Study (MoBa). Subjects were recruited in relation to a routine ultra-soundexamination, and all pregnant women in Norway were eligible. We used data from theMedical Birth Registry of Norway and questionnaires both pre and post partum. Symptoms ofanxiety and depression at six months postpartum were predicted in a linear regressionanalysis by WHO-categories of breastfeeding, symptoms of anxiety and depressionprepartum (standardized score), and interaction terms between breastfeeding categories andprepartum symptoms of anxiety and depression. The results were adjusted for cesareansections, primiparity, plural births, preterm births, and maternal smoking. Results: First, prepartum levels of anxiety and depression were related to breastfeeding cessation (beta0.24; 95%CI 0.21-0.28), and breastfeeding cessation was predictive of an increase inpostpartum anxiety and depression (beta 0.11; 95%CI 0.09-0.14). Second, prepartum anxietyand depression interacted with the relation between breastfeeding cessation and postpartumanxiety and depression (beta 0.04; 95%CI 0.01-0.06). The associations could not be accountedfor by the adjusting variables. Conclusions: Breastfeeding cessation is a risk factor for increased anxiety and depression. Women withhigh levels of anxiety and depression during pregnancy who stop breastfeeding early are at anadditional multiplicative risk for postpartum anxiety and depression.

by Yamil Gerena, Richard L. Skolasky, Joyce M. Velez, Dianedis Toro-Nieves, Raul Mayo, Avindra Nath, Valerie Wojna

Background

Blood sugar metabolism abnormalities have been identified in HIV-infected individuals and associated with HIV-associated neurocognitive disorders (HAND). These abnormalities may occur as a result of chronic HIV infection, long-term use of combined antiretroviral treatment (CART), aging, genetic predisposition, or a combination of these factors, and may increase morbidity and mortality in this population.

Objective

To determine if changes in soluble and cell-associated insulin receptor (IR) levels, IR substrate-1 (IRS-1) levels, and IRS-1 tyrosine phosphorylation are associated with the presence and severity of HAND in a cohort of HIV-seropositive women.

Methods and Results

This is a retrospective cross-sectional study using patient database information and stored samples from 34 HIV-seropositive women and 10 controls without history of diabetes from the Hispanic-Latino Longitudinal Cohort of Women. Soluble IR subunits [sIR, ectodomain (α) and full-length or intact (αβ)] were assayed in plasma and CSF samples by ELISA. Membrane IR levels, IRS-1 levels, and IRS-1 tyrosine phosphorylation were analyzed in CSF white cell pellets (WCP) using flow cytometry.HIV-seropositive women had significantly increased levels of intact or full-length sIR in plasma (p<0.001) and CSF (p<0.005) relative to controls. Stratified by HAND, increased levels of full-length sIR in plasma were associated with the presence (p<0.001) and severity (p<0.005) of HAND. A significant decrease in IRS-1 tyrosine-phosphorylation in the WCP was also associated with the presence (p<0.02) and severity (p<0.02) of HAND.

Conclusions

This study provides evidence that IR secretion is increased in HIV-seropositive women, and increased IR secretion is associated with cognitive impairment in these women. Thus, IR dysfunction may have a role in the progression of HAND and could represent a biomarker for the presence and severity of HAND.