RESUMO
BACKGROUND: Pelvic floor muscles (PFM) and rectus abdominis muscles (RAM) of pregnant diabetic rats exhibit atrophy, co-localization of fast and slow fibers and an increased collagen type I/III ratio. However, the role of similar PFM or RAM hyperglycemic-related myopathy in women with gestational diabetes mellitus (GDM) remains poorly investigated. This study aims to assess the frequency of pelvic floor muscle disorders and pregnancy-specific urinary incontinence (PS-UI) 12 months after the Cesarean (C) section in women with GDM. Specifically, differences in PFM/RAM hyperglycemic myopathy will be evaluated. METHODS: The Diamater is an ongoing cohort study of four groups of 59 pregnant women each from the Perinatal Diabetes Research Centre (PDRC), Botucatu Medical School (FMB)-UNESP (São Paulo State University), Brazil. Diagnosis of GDM and PS-UI will be made at 24-26 weeks, with a follow-up at 34-38 weeks of gestation. Inclusion in the study will occur at the time of C-section, and patients will be followed at 24-48 h, 6 weeks and 6 and 12 months postpartum. Study groups will be classified as (1) GDM plus PS-UI; (2) GDM without PS-UI; (3) Non-GDM plus PS-UI; and (4) Non-GDM without PS-UI. We will analyze relationships between GDM, PS-UI and hyperglycemic myopathy at 12 months after C-section. The mediator variables to be evaluated include digital palpation, vaginal squeeze pressure, 3D pelvic floor ultrasound, and 3D RAM ultrasound. RAM samples obtained during C-section will be analyzed for ex-vivo contractility, morphological, molecular and OMICS profiles to further characterize the hyperglycemic myopathy. Additional variables to be evaluated include maternal age, socioeconomic status, educational level, ethnicity, body mass index, weight gain during pregnancy, quality of glycemic control and insulin therapy. DISCUSSION: To our knowledge, this will be the first study to provide data on the prevalence of PS-UI and RAM and PFM physical and biomolecular muscle profiles after C-section in mothers with GDM. The longitudinal design allows for the assessment of cause-effect relationships between GDM, PS-UI, and PFMs and RAMs myopathy. The findings may reveal previously undetermined consequences of GDM.
Assuntos
Diabetes Gestacional/fisiopatologia , Doenças Musculares/fisiopatologia , Incontinência Urinária/fisiopatologia , Adulto , Brasil , Cesárea , Estudos de Coortes , Feminino , Idade Gestacional , Ganho de Peso na Gestação , Humanos , Idade Materna , Contração Muscular/fisiologia , Força Muscular/fisiologia , Palpação , Diafragma da Pelve/fisiopatologia , Período Pós-Parto , Gravidez , Reto do Abdome/fisiopatologia , VaginaRESUMO
Objective: The objective of this study was to evaluate the action of soy isoflavones (ISO) and 17ß-estradiol on collagen I (CollI) and sulfated glycosaminoglycans (GAGs) in the bone matrix of diabetic rats.Methods: Sixty adult female rats (Rattus norvegicus albinus) underwent ovariectomy, and then were randomized into six groups of 10 animals each: GI, sham control ovariectomized animals; GII, sham control diabetic (DM) ovariectomized animals; GIII, control ovariectomized animals receiving propylene glycol vehicle; GIV, control ovariectomized DM animals receiving propylene glycol vehicle; GV, ovariectomized DM animals treated with ISO (150 mg/kg by gavage); and GVI, ovariectomized DM animals treated with estrogen (17ß-estradiol, 10 mg/kg, subcutaneously). 17ß-Estradiol was used as a positive control when compared with ISO. To obtain significant depletion of the estrogen levels and subsequent bone loss, a postsurgical period of 90 days was observed. Treatments occurred during 30 consecutive days. After euthanasia, shafts of the animals' femurs were immersed in liquid nitrogen for molecular biology analysis, and the distal femurs were removed and processed for paraffin embedding.Results: ISO (GV) and 17ß-estradiol (GVI) improved bone formation, increasing GAGs and CollI formation when compared to the control group (GIV) (p < 0.05).Conclusions: ISO and 17ß-estradiol contribute to the decrease of bone loss in diabetic rats.
Assuntos
Osso e Ossos/metabolismo , Estradiol/farmacologia , Estrogênios/farmacologia , Isoflavonas/química , Animais , Colágeno Tipo I/análise , Diabetes Mellitus Experimental , Diabetes Mellitus Tipo 1/metabolismo , Estradiol/metabolismo , Estrogênios/metabolismo , Feminino , Glicosaminoglicanos/análise , Humanos , Isoflavonas/metabolismo , Ovariectomia , Pós-Menopausa , Distribuição Aleatória , RatosRESUMO
BACKGROUND: Sleep disturbances and pain are assumed to be reciprocally linked. Insomnia and pain are central symptoms of the postmenopausal period and are closely related. Insomnia affects quality of life, increases pain sensitivity, the risk of pain-related disability, and other health problems. OBJECTIVE: To investigate whether insomnia influences aspects of pain (pain intensity and the effect of pain on daily function) in postmenopausal women, and to evaluate the objective sleep pattern of insomniacs with pain. METHODS: Fifty-seven women completed questionnaires about insomnia, climacteric symptoms, and pain. Polysomnography data were collected as well as their medical history. Patients were allocated into three groups: control, subthreshold insomnia, and insomnia. Pain intensity, climacteric symptoms and objective sleep pattern were compared between groups. RESULTS: Postmenopausal women with insomnia had statistically significant higher pain interference in their activities (e.g. relationships with other people, enjoyment of life and sleep) than controls, and had more severe climacteric symptoms. There were no statistically significant differences in pain intensity and objective sleep pattern between groups. CONCLUSIONS: Insomnia status affected climacteric symptoms and pain interference, but not pain intensity in postmenopausal women. Women with insomnia had higher rates of climacteric symptoms than those without insomnia or those with subthreshold insomnia. No changes in objective sleep pattern were found.
Assuntos
Dor Crônica/psicologia , Pós-Menopausa/psicologia , Distúrbios do Início e da Manutenção do Sono/psicologia , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Medição da Dor , Inquéritos e QuestionáriosRESUMO
BACKGROUND: The performance of a bacterial 16S ribosomal DNA real-time polymerase chain reaction (PCR) assay was evaluated and validated with an automated culture system to determine its use for screening of platelet concentrates (PCs). STUDY DESIGN AND METHODS: PCs were spiked with suspensions of Escherichia coli, Serratia marcescens, Staphylococcus epidermidis and St. aureus at 1, 10, and 100 colony-forming units (CFUs) mL and stored for 5 days. DNA amplification was performed using real-time PCR. The BacT/ALERT was used as a reference method and samples were inoculated into an aerobic culture bottle; for the PCR assay, aliquots were drawn from all (spiked) PCs on days 0 to 5 of storage. RESULTS: Real-time PCR detected only the gram-positive bacteria in PCs spiked with low bacterial titres (1 CFU mL) after 48 h; however, it was able to detect all positive samples in PCs spiked with 10 CFU mL of either gram-positive or gram-negative bacteria after 48 h. In addition, real-time PCR detected all positive samples in PCs spiked with high gram-positive bacterial titres (100 CFU mL) after 24 h. On the other hand, the BacT/ALERT system showed positive results in all samples within 24 h. CONCLUSION: The BacT/ALERT method is more sensitive and should continue to be the gold standard for identifying bacterial contaminations in blood samples. The real-time PCR approach can be used for the screening of PCs for microbial detection before they are released from blood centres or shortly before they are used in blood transfusion, and thus allow an extended shelf life of the platelets.
Assuntos
Bactérias/isolamento & purificação , Plaquetas/microbiologia , Reação em Cadeia da Polimerase/métodos , Bactérias/genética , Bactérias Gram-Negativas , Bactérias Gram-Positivas , Humanos , RNA Ribossômico 16S , Células-Tronco , Fatores de TempoRESUMO
OBJECTIVE: To describe the outcomes after uterine artery embolization treatment of leiomyoma. DESIGN: Case report. SETTING: Department of Gynecology - Federal University of São Paulo. PATIENT: a 34-year-old woman with a diagnosis of leiomyoma for two years. INTERVENTION: embolization of uterine arteries with 500 to 700-microm diameter polyvinyl alcohol particles. MAIN OUTCOME MEASURE: pregnancy and delivery. RESULTS: After embolization, the follow-up revealed a good clinical response with significant reduction in uterus and leiomyoma volume. Also, the patient became spontaneously pregnant, but the delivery was cesarean section due to placenta accreta.. CONCLUSION: Regardless of arterial embolization results for controlling uterine bleeding, this procedure might have some consequences on pregnancy outcome.
Assuntos
Leiomioma/terapia , Complicações Neoplásicas na Gravidez/terapia , Embolização da Artéria Uterina/métodos , Neoplasias Uterinas/terapia , Útero/patologia , Adulto , Feminino , Humanos , Leiomioma/irrigação sanguínea , Gravidez , Resultado do Tratamento , Neoplasias Uterinas/irrigação sanguínea , Útero/irrigação sanguíneaRESUMO
The decline in sex hormone levels that accompanies the menopause has substantial effects on the tissues of the urogenital system, leading to atrophic changes. These changes can have negative effects on sexual and urinary function. The authors evaluate the repercussion of hypoestrogenism and sexual steroids on some elements of the pelvic floor and lower urinary tract. They summarize their research work and review significant published papers. They emphasize the changes in urinary mucosae, periurethral vessels, muscular layer, connective tissue, gene expression, autonomic nervous system receptors, as well as the main clinical aspects involved.
Assuntos
Estrogênios/deficiência , Sistema Urinário/metabolismo , Urotélio/fisiologia , Envelhecimento/fisiologia , Animais , Atrofia , Colágeno/análise , Colágeno/efeitos dos fármacos , Ciclo-Oxigenase 1/genética , Terapia de Reposição de Estrogênios , Estrogênios/fisiologia , Estrogênios/uso terapêutico , Matriz Extracelular/metabolismo , Feminino , Expressão Gênica , Glicosaminoglicanos/metabolismo , Humanos , Ácido Hialurônico/metabolismo , Microcirculação/efeitos dos fármacos , Músculo Liso/efeitos dos fármacos , Neovascularização Fisiológica/efeitos dos fármacos , Diafragma da Pelve/irrigação sanguínea , RNA Mensageiro/metabolismo , Receptores Muscarínicos/efeitos dos fármacos , Receptores Muscarínicos/fisiologia , Moduladores Seletivos de Receptor Estrogênico/uso terapêutico , Incontinência Urinária/tratamento farmacológico , Incontinência Urinária/fisiopatologia , Sistema Urinário/irrigação sanguínea , Urotélio/efeitos dos fármacos , Prolapso Uterino/fisiopatologia , Vagina/metabolismo , Vagina/patologia , Fator A de Crescimento do Endotélio Vascular/efeitos dos fármacos , Fator A de Crescimento do Endotélio Vascular/genética , Fator A de Crescimento do Endotélio Vascular/metabolismo , Microglobulina beta-2/genéticaRESUMO
OBJECTIVE: To evaluate glycosaminoglycans (GAGs) in the parametrium, paraurethral tissue and vaginal apex in postmenopausal women with uterine prolapse and to evaluate the effect of 30-day estrogen therapy in these patients. MATERIAL AND METHODS: Double-blind trial of estrogen and placebo in 40 women with a control group of 20 premenopausal women without uterine prolapse. Twenty postmenopausal women with prolapse formed a second group and were treated with placebo for 30 days before vaginal hysterectomy. The third group included 20 postmenopausal women with prolapse who received 0.625 mg oral conjugated estrogens for 30 days before vaginal hysterectomy. Samples of the parametrium, vaginal apex and paraurethral tissue were obtained during surgery. RESULTS: Hyaluronic acid was the predominant GAG detected, followed by dermatan sulfate, chondroitin sulfate and heparan sulfate. In postmenopausal women with prolapse, we did not observe significant differences in total GAGs compared to the control group. However, hyaluronic acid was increased in the parametrium of women receiving estrogen compared to those treated with the placebo (2033.39â±â3037.90 mg/g vs. 587.87â±â697.89 mg/g, respectively; pâ=â0.041). CONCLUSIONS: There are differences in GAGs in the parametrium, paraurethral tissue and vaginal apex between women in premenopause and those in the postmenopause period. Therefore, 30-day estrogen therapy produces significant differences in levels of hyaluronic acid, dermatan sulfate and chondroitin sulfate.
Assuntos
Tecido Conjuntivo/metabolismo , Terapia de Reposição de Estrogênios , Glicosaminoglicanos/metabolismo , Uretra/metabolismo , Prolapso Uterino/terapia , Vagina/metabolismo , Método Duplo-Cego , Estrogênios/administração & dosagem , Estrogênios Conjugados (USP)/administração & dosagem , Feminino , Humanos , Histerectomia Vaginal , Pessoa de Meia-Idade , Pós-MenopausaRESUMO
OBJECTIVE: Apoptosis is an important fail-safe control in human papillomavirus (HPV)-associated carcinogenesis. We tested the hypothesis that the A/G polymorphism at -670 of Fas promoter is associated with an increased risk for cervical cancer, using a matched case-control setting. METHODS: The material in this case-control study consisted of 91 patients with cervical carcinoma and 176 population-based control subjects, recruited between 2002 and 2004; all the ethnic Brazilian women had histologically confirmed cervical carcinoma. Control subjects were age-matched; healthy women who were selected following a negative cervical cytology and normal colposcopy. Fas genotyping was performed using a PCR-RFLP technique. RESULTS: No significant difference existed in the distribution of the Fas polymorphisms (wild, heterozygous, mutant) between the cases and controls. The heterozygous (OR: 4.85, 95% CI: 1.1-22.6) genotypes among the younger (< 48 yrs) cancer patients were almost 5-fold increased, as compared with the wild type. No such increase was observed among the patients older than 48 years. CONCLUSIONS: Our data suggest that 670A/G polymorphism in the promoter region of the death receptor Fas is associated with an increased risk of cervical cancer among Brazilian women under 48 years. The mechanisms would be the inhibition of apoptosis by Fas -670G allele-mediated down-regulation of Fas transcription.
Assuntos
Polimorfismo Genético , Regiões Promotoras Genéticas/genética , Neoplasias do Colo do Útero/genética , Receptor fas/genética , Adulto , Apoptose , Feminino , Frequência do Gene , Predisposição Genética para Doença , Humanos , Pessoa de Meia-Idade , Receptores de Morte Celular/genéticaRESUMO
UNLABELLED: Lack of estrogen affects the urinary tract mainly by diminishing vascular, muscular and epithelial trophism, resulting in negative effects on continence in postmenopausal women. Therefore, the use of estrogens in these patients may revert these alterations and lead to an expressive improvement of the urinary symptoms. OBJECTIVE: Study the effect of topical estrogen therapy (conjugated equine estrogens, estriol or promestriene) in periurethral vessels detected by Dopplervelocimetric analysis using, as parameters: the number of vessels, resistance and pulsatility indexes, as well as the minimum diastolic value. METHODS: Forty-one postmenopausal women with stress urinary incontinence were randomized into three groups according to different types of topical estrogen received during 3 months. Group 1 received conjugated equine estrogens, group 2 received estriol and group 3 received promestriene. Periurethral Dopplervelocimetry analysis was done before estrogen administration and during treatment in all groups. RESULTS: We observed an increase in the number of the periurethral vessels in group 1 and group 2, being higher in group 1 than in group 2. The pulsatility index remained unchanged in all three groups. The resistance index at the periurethral vessels reduced only at the conjugated estrogen group (group 1). In this same group we noticed an increase in the mean minimal diastolic value, meaning a better periurethral vascularization. CONCLUSION: Topical conjugated equine estrogens and estriol were effective in increasing the number of periurethral vessels in postmenopausal women with urinary stress incontinence, with the conjugated equine estrogens being the most effective intervention studied.
Assuntos
Estradiol/análogos & derivados , Estriol/administração & dosagem , Estrogênios Conjugados (USP)/administração & dosagem , Uretra/irrigação sanguínea , Incontinência Urinária por Estresse/tratamento farmacológico , Administração Intravaginal , Idoso , Estradiol/administração & dosagem , Terapia de Reposição de Estrogênios/métodos , Feminino , Humanos , Fluxometria por Laser-Doppler/métodos , Pessoa de Meia-Idade , Pós-Menopausa , Estatísticas não Paramétricas , Ultrassonografia , Uretra/diagnóstico por imagem , Uretra/efeitos dos fármacos , Incontinência Urinária por Estresse/diagnóstico por imagemRESUMO
The aim of this study was the comparison of the stiffness of different meshes under two types of mechanical tests. Five different mesh types were mechanically tested. The methods used consisted on uniaxial tension test (tensile stiffness) and tape ring tests, experimental continuous compression of the mesh loops (flexural stiffness). The most significant difference of tensile stiffness behaviour appears between Aris and TVTO. From the analysis of the experimental data, we divided the flexural stiffness, in two main groups. The first group includes Auto Suture and Aris meshes. The two meshes seem to have a similar flexural behaviour. The second group includes TVTO, Uretex and Avaulta. The difference between these two groups is clearly evident comparing TVTO and Aris. This study shows that there are significant differences on the mechanical properties between urogynecology meshes.