Is telomere length one of the determinants of reproductive life span?

The mechanism of final cessation of the reproductive life span has not been solved yet. It is generally assumed that the most important factor is ovarian follicular reserve. In ovaries at intrauterine period, a major factor that determines the number of the primordial follicle is the mitotic ability as well as the number of primordial germ cells, which migrate to gonadal ridge. The telomere length is one factor that determines the number of mitosis of the cell. The differences between the telomere lengths of same aged healthy women reflect the difference of the telomeres of the primordial germ cells at the intrauterine period. Women with long telomeres supposedly have had their primordial germ cells at the beginning of life with long telomeres. So, these cells should have had more mitotic division and more follicle numbers in the ovaries than the short ones. The aim of this study was to analyse the relation of the reproductive life span and telomere length. The telomere lengths of 37 women volunteers aged 50 years were measured by fiber FISH technique. A positive correlation was found between reproductive life span and the telomere length.     

Supraventricular tachycardia during the first year of life: is subclinical inflammation the trigger?

Background: Neutrophil/lymphocyte ratio (NLR) and red cell distribution width (RDW) may be associated with the onset of arrhythmias in adults, thus underlining a possible inflammatory etiology. Paroxysmal supraventricular tachycardia (SVT) is the most frequent pathological tachycardia in childhood.

Aim: To verify NLR and RDW levels in a group of children (<1 year) affected by SVT with a structurally normal heart and without fever or inflammatory diseases; to compare NLR and RDW before and after SVT resolution, to verify whether the latter was related with the reduction in inflammatory state; to identify – in SVT subtypes caused by a reentry mechanism – an NLR and RDW cutoff point beyond which adenosine was ineffective in preventing SVT recurrence.

Methods: Eighteen SVT patients were recruited (mean age 18.9?±?3.2 days; 50% males) and compared with 18 healthy peers.

Results: NLR was higher in SVT group than in controls (p?p?6000/mm³.

Conclusions: Elevated NLR is associated with an increased risk of SVT during the first year of life, while its decline looks like to lead the SVT resolution. A subclinical inflammatory status, as assessed by lymphocytes count, influences SVT recurrence. These results provide further support for an inflammatory etiology of SVT in babies.     

In search of social support in the NICU: features,benefits and antecedents of parents’ tendency to share with others the premature birth of their baby

Abstract

Objective: To investigate social sharing among 40 parents (20 couples) of hospitalized premature newborns, the social network of addressees with whom they shared their experience, the perceived benefits of this activity and the sources of individual differences.

Method: Emotional reaction and attachment status were assessed within 7 days and between 30 and 45 days from birth, respectively. At 3 months of infant’s corrected age, parents completed a self-report assessing retrospectively their social sharing.

Results: Over 80% of the parents felt the need to share the event and actually did within a week; one’s own partner was the most preferred addressee. The extent of father’s social sharing was mainly related to the newborn’s medical risk, while mother’s to her own emotional reaction. Guilt and anger were found to lengthen the latency of sharing in mothers and fathers, respectively. Secure attachment status, compared to insecure ones, was found to be the most effective in promoting social sharing.

Conclusions: These findings help to understand why parents differ from each other in their use of social support in the NICU; from a practical standpoint, they highlight important factors which require attention when implementing intervention program in the NICU directed to parents of premature newborns.     

‘Super-mothers’: the meaning of mothering after assisted reproductive technology

Objective: The objective was to explore mothers’ experiences after assisted reproductive technology (ART). Background: The experience of mothering in women after assisstive reproductions has not been fully understood. Study design: An interpretive phenomenology approach was used to conduct the study. Participants: A purposive sample of nine mothers who had babies through ART participated in the study. Data were collected using semi-structured in-depth interviews. Findings: ‘Super-mothering’ was the main theme emerging from the data, describing mothers who wanted to be exceptional by performing all of their mothering responsibilities without fatigue or exhaustion and who were ready to do everything in their power to support the child. This theme incorporates four sub-themes: (1) over-care; (2) over-protection; (3) over-emotional investment; and (4) over-expectation of themselves and others. Conclusion: The challenge to be a mother through ART is a stressful phenomenon, particularly so for the majority who are also first-time mothers. Healthcare professionals need to consider the concept of super-mothering in trying to understand and care effectively for this group.     

Tatoos, piercing: body art? Body damage? Debasement of the body or return to a primitive way of life?

Tatoos and piercing, though they might appear as something like a trend, if not a craze, remain for a majority minority and even fringe practices. For the adolescent, questing for his identity (no more a child, not yet an adult), the tegmental sign is a way of engraving in the flesh dramatic events of his existence. The body mark is a search for independence, a symbolic attainment of self-reliance, a way of severing the umbilical cord and of asserting oneself. In face of a life no longer under control, the body is an object at hand, on which self-will is almost unbridled... These body modifications testify to change.     

Congenital absence of the vagina: in search of the perfect solution. When,and by what technique,should a vagina be created?

PURPOSE OF REVIEW: To review the Mayer-von Rokitansky-Küster-Hauser syndrome and to address means of diagnosis, patient education and counselling. The timing of, and vast options for, creation of a functional vaginal are also discussed. RECENT FINDINGS: The diagnosis of Mayer-von Rokitansky-Küster-Hauser usually occurs during an evaluation of primary amenorrhea. Counselling and support are of great importance for affected young women and their families. Educational materials have increased with the availability of Internet web sites and there is a vast number of options for creation of a functional vagina; most international centers promote the utilization of vaginal dilators. SUMMARY: Young girls, adolescents and women with Mayer-von Rokitansky-Küster-Hauser should be offered a comprehensive evaluation, and presented with information regarding all options for management and support. Ongoing psycho-social and educational support is extremely important. International centers that focus on congenital anomalies of the reproductive tract should be developed. These centers of excellence will facilitate long-term follow up studies to improve patient care and evidence based medical options.     

Can clitoris-conserving surgery for early vulvar cancer improve the outcome in terms of quality of life and sexual sensation?

Objectives

Vulvar carcinomas (VC) and vulvar in situ cancers (VCIS) are rare genital malignancies. Total vulvectomy as the standard of care has been replaced by local excision during the early stages of the disease. We studied whether conservation of the clitoris in vulvar surgery has a positive effect on either the quality of life (QoL) or the sexual sensation of the patient.

Study design

In a retrospective study, patients with and without clitoris-sparing surgery were interviewed using the Female Sexual Function Index questionnaire (FSFI) and the Short Form 12^® questionnaire (SF-12). The frequencies of high and low levels and the medians were compared using the Cox-Mantel, Chi² and Fisher's exact tests.

Results

We identified 24 patients who had surgery in our department for VCIS or VC stage I/II, between 2006 and 2008. Ten of these patients required total inguinal lymphadenectomies and another five required sentinel node biopsies. In twelve patients, the clitoris had been spared, whereas in the remaining twelve, the clitoris had needed to be removed. These groups did not differ in terms of tumor size, stage, type of surgery or age of the patients. The evaluation of the SF-12 indicated high satisfaction in the physical scores for 33% of patients with clitoris-sparing surgery vs. 67% after clitoris resection (n.s.). For the mental domain, the rates were 58% and 67% (n.s.), respectively. In the FSFI, both groups showed comparable values <18 (n = 7) and >18 (n = 5) in sexual sensation.

Conclusion

Reducing the surgical resection is oncologically acceptable, but improvement in the patients’ quality of life or sexual sensation is not achieved solely by conserving the clitoris.     

What would MacGyver do? The meaning(s) of resistance and survival

Drawing on interviews conducted with victims of New Zealand serial rapist, Malcolm Rewa, this article highlights the limitations of the terms resistance and survival as they are typically applied to women's responses to rape attacks. Although acknowledging that formulations that stress women's abilities to resist and their capacities to survive have been critically important in challenging popular notions of women as passive victims, the women's accounts presented here suggest a need to question whether such formulations are adequate to reflect the complexity and diversity of women's responses to sexual assaults. A preliminary attempt is also made to explore the implications associated with embracing expanded understandings of what resistance and survival might mean.     

Resource utilization for ovarian cancer patients at the end of life: how much is too much?

OBJECTIVE: End-of-life (EOL) medical care consumes 10-12% of national health care expenditures and 27% of Medicare dollars annually. Studies suggest that hospice services decrease EOL expenditures by 25-40%. The goal of this study was to compare the total cost of hospital-based resources utilized in ovarian cancer patients during their last 60 days of life for those enrolled in hospice versus those not on hospice. METHODS: Study eligibility included patients who expired from ovarian cancer from 1999 to 2003. Medical records were reviewed for demographic data as well as treatment, response and recurrence rates, histologic type, grade and stage. Billing records were analyzed for costs of inpatient and outpatients visits, including radiologic, laboratory and pharmacy charges. Total cost of hospital resources was compared between patients managed on hospice for >10 days (hospice group) versus <10 days (non-hospice group) using the following methods: Mann-Whitney U, Kruskal-Wallis and Student's t tests. Overall survival was compared using Kaplan-Meier statistics. RESULTS: Of the 84 patients analyzed, 67 (79.8%) were in the non-hospice group and 17 (20.2%) were in the hospice group. Demographic, histologic and staging characteristics as well as platinum sensitivity were similar between the two groups before the last 60 days of life. Mean number of chemotherapy cycles before the study period was also similar (20.4 and 21.0, respectively). However, during the study period, the mean total cost per patient in the non-hospice group was dollar 59,319 versus dollar 15,164 in the hospice group (P = 0.0001). A significant difference in cost was noted for mean inpatient days (dollar 6584 vs. dollar 1629, P = 0.0007), radiology (dollar 6063 vs. dollar 2343, P = 0.003), laboratory (dollar 12,281 vs. dollar 2026, P = 0.0004) and pharmacy charges (dollar 13,650 vs. dollar 4465, P = 0.0017) as well as for treating physician per patient (dollar 112,707 vs. dollar 34,677, P = 0.04). Overall survival for the two groups was the same. CONCLUSIONS: Our findings demonstrate that there is a significant cost difference with no appreciable improvement in survival between ovarian cancer patients treated aggressively versus those enrolled in hospice at the EOL. These data suggest that earlier hospice enrollment is beneficial. Furthermore, cost variations between physicians and patients imply that education may be an important variable.