Sexualdifferenzierungsstörungen

Sexual development and differentiation is a complex system which is influenced by a number of different factors. An intricate series of steps must occur in gonadal differentiation. A number of genes are critical to appropriate male or female genital development. In these steps genetic, gonadal and somatic sex are developed. If there are failures in the system, sex reversal with intersexual development could occur so that the phenotype differs from the genotype or the phenotype can not be accurately classified. In this case, the androgen insensitivity syndrome or the adrenogenital syndrome, as well as gonadal dysgenesis (e.g. Swyer syndrome) could arise. Psychological aspects of the diagnosis and therapy of these syndromes are also discussed.     

精子细胞发育过程中高尔基体的超微结构变化

本实验用电镜观察大鼠睾丸不同发育阶段精子细胞高尔基体的超微结构。结果表明,在精子细胞发育过程中,高尔基体经历一系列的超微结构变化。GERL 只存在于高尔基期和顶帽期精子细胞的高尔基体中,其主要功能是参与形成顶体系统和多泡体;顶体期精子细胞高尔基体的GERL 退化,但高尔基体可能仍具有一定功能;成熟期精子细胞中,高尔基体逐层退化,最后消失。     

Lessons Learned from Implementation of a Perinatal Documentation System

Implementation of an electronic medical record (EMR) system is a complex process with broad implications. In a Midwestern hospital perinatal setting, EMR implementation involved several critical steps: strategic planning and project goal setting; project structure and governance; system requirements analysis; vendor selection and contract negotiation; and EMR training. No difference in patient care activities and communications among clinicians was found between pre‐ and post‐EMR implementation; however, nurses’ perceptions of EMR were more negative afterward. Lessons learned and implications are provided.     

IDENTIFICATION AND MANAGEMENT OF SHOULDER DYSTOCIA

Shoulder dystocia is most often an unpredictable occurrence. Inappropriate management may lead to long term sequelae for both mother and infant. Correct management includes specific steps to follow when attempting to deliver the infant with shoulder dystocia. It is imperative that we as nurse-midwives be thoroughly familiar with the difficulties encountered with shoulder dystocia and commit the management steps to memory. This paper presents an overview of the problem as well as the steps included in clinical management.     

A WORKSHOP FOR TRAINERS OF TRADITIONAL BIRTH ATTENDANTS IN ZAIRE

Combining traditional healing and contemporary medicine requires several steps. The western health professional cannot easily interact with the traditional healers. Intermediate steps are essential: the persons steeped in western medicine and culture must transmit their knowledge to educated health personnel from the indigenous society, who then interpret knowledge and skills and convey them to the indigenous healers. The paper describes the first of a series of training-of-trainers' workshops held for 20 experienced midwives and auxiliary midwives working in the organized health system in rural areas of Zaire. After returning to their posts, these persons train the rural traditional birth attendants (TBAs). The workshop instructed the midwives to identify customs and practices of TBAs; how to teach them about maternity care and family planning; and how to evaluate and supervise them in their communities.     

Total mesometrial resection: nerve-sparing extended radical abdominal hysterectomy]

The total mesometrial resection (TMMR) is the first radical hysterectomy procedure based on defined anatomical landmarks with all surgical steps. The new abdominal operation combines maximum resection of the oncologically relevant mesometrium with minimal tissue traumatization and sparing of the pelvic autonomic nervous system. The extended pelvic and low periaortic lymph node dissection which is part of the procedure includes the removal of the lymphatic tissue localized laterally and dorsally of the main vessels. A prospective multidimensional trial is currently under way to evaluate the potential of the total mesometrial resection to improve the therapeutic index in the surgical treatment of carcinoma of the uterine cervix, especially for high risk tumors.     

Elucidating nuclear reprogramming mechanisms: taking a synergistic approach

Nuclear reprogramming is the process by which a differentiated somatic nucleus has developmental potential restored to it. It involves heritable changes in gene expression as well as structural and functional changes to chromatin structure. This process is naturally induced immediately after fertilization, but can also be artificially induced by nuclear transfer, cell fusion and also now by viral transduction with four stem cell genes. However, the frequency of successful reprogramming is low in each system. The highest success rates, those using nuclear transfer, are only of the order of 2-5%. This article briefly reviews these three methods and proposes a synergistic approach where conditions that facilitate reprogramming in one system are transposed to the others. This might increase the incidence of successful reprogramming and identify common steps necessary for the reacquisition of developmental potential.     

Patient and tissue identification in the assisted reproductive technology laboratory

Several high-profile cases involving in vitro fertilization have recently received considerable media attention and highlight the importance of assuring patient and tissue identification. Within the assisted reproductive technology (ART) laboratory, there are many steps where wrong patient or tissue identity could have drastic results. Erroneous identity can result in tragic consequences for the patient, the laboratory, and for those working in the program as a whole. Such errors can result in enormous psychological and financial costs, as well as a loss in confidence. There are several critical steps that should be taken every single time and for each specific procedure performed in the ART laboratory to ensure the correct identification of patients and their tissue. These steps should be detailed in protocols that include the method of identification, the two unique identifiers that will be used, the sources of these identifiers, and often a system in which more than one person is involved in the identification. Each protocol should ideally include a checklist that is actively used for the implementation of each procedure. The protocol should also indicate what to do if the identification does not match up, including rapid handling and notification of the patient involved in the error. All ART laboratories should instill in their employees an atmosphere of full and open disclosure for cases where mistakes are made.     

Time for action: audit, accountability and confidential enquiries into maternal deaths in Nigeria

Improving the quality of care is essential for achieving reductions in maternal mortality. Audit is one of the methods which can be used to simultaneously assess as well as improve quality. This commentary discusses one type of audit--confidential enquiries into maternal death. We believe that the enthusiasm for establishing a confidential enquiry system in Nigeria is growing. The challenges faced in setting up an audit system are discussed and 6 steps are proposed to locate the conduct of a confidential enquiry as part of a set of activities which will take cognizance of existing know-how, create shared ownership and provide a coherent picture of needs and information gaps in the provision of quality maternity services. Having such a system in place can be a route towards achieving a progressive vision of accountability for the reduction of maternal mortality in Nigeria.     

Endometriosis. Is it a problem of the immunological signs?

Endometriosis syndrome affects 5% to 35% of women in reproductive age. Many theories have been suggested, but the true importance is the survival mechanism of endometriotic tissue, which seems to be related to a defect of the immunological vigilance from macrophages, which are responsible for secretion of a variety of biochemical substances such as cytokines, prostaglandins and growth factors, which through different ways stimulates the growth of the endometrial cells. This has been observed for the clear interrelation between the homeostasis of the body and the evident association of the hormonal factors with the processes of the immunological system, in whose field many steps are unknown.     

Immuntherapie in der gynäkologischen Onkologie

Given the limits of conventional therapeutic regimens, there is an urgent need to investigate alternative treatment approaches for the improvement of quality of life in patients with gynecological tumors. An attractive option is to engage the patient’s own immune system to eradicate tumor cells and to induce immunological memory mechanisms, which efficiently prevent the development of new tumors. The considerable progress made in molecular immunology has led to an ongoing search for new strategies in tumor vaccination. The results of clinical studies generally show the immune activity and safety of various tumor vaccines, although until now potent clinical success is missing. However, the identification of crucial weak points in current concepts opens new pathways for combinatory therapy modalities simultaneously affecting different steps of host-tumor interactions.     

Evolution of mammalian pregnancy in the presence of the maternal immune system

Eutherian mammals have inherited a typical vertebrate immune system, which protects the body against infectious organisms by detecting and destroying foreign biological material. However, with the evolution of longer gestation periods, this protective mechanism became a potential threat to the 'semi-foreign' fetus and so eutherians have developed systems to prevent immune rejection of their developing fetuses. In many species, this is achieved by reducing placental expression of major histocompatibility complex (MHC) genes, the products of which are responsible for most transplantation rejection reactions. Unexpectedly, however, major histocompatibility complex expression is often re-established in the most invasive trophoblast cells. It is not known why transplantation antigen expression in the fetal cells most exposed to the maternal immune system is advantageous. It is possible that such expression aids the process of invasion or exerts an immunoprotective effect on the fetus. It may prove possible to identify the essential steps that all eutherian fetuses take to ensure their survival in the face of potential maternal immune attack by studying the common features of the placental immunology of different species.     

Vascular morphogenesis in the ovary.

Vascular morphogenesis through mechanisms of vasculogenesis, angiogenesis and intussusception is associated primarily with embryonic and fetal development and is down-regulated in the healthy adult. Physiological angiogenesis in the adult is restricted to the female reproductive system where it occurs cyclically in the ovary and the uterus as well as pregnancy-associated in the placenta and in the mammary gland. Of all the different organs, the cyclic corpus luteum of the ovary is the organ site with the strongest physiological angiogenesis. The hormonally regulated cyclic processes in the corpus luteum are characterized by discrete phases of blood vessel growth, vessel maturation and vessel regression. This chapter discusses the morphological changes of the vasculature in the cyclic corpus luteum in relation to the regulating molecular mechanisms. These data establish the dynamic processes in the ovarian corpus luteum as a unique system for studying all steps of the angiogenic cascade, including vessel maturation and vessel regression. Inhibition of angiogenesis impairs the normal ovarian cycle, reflecting that angiogenesis is rate-limiting for ovulation and growth of the corpus luteum and may, thus, be a potential target for therapeutic intervention in the reproductive function.     

Cervix dysplasias: study of Rb and p53 gene expression and correlation with mitotic activity

OBJECTIVE: Certain HPV types have transforming properties. These oncogenic activities are related to the abilities of the viral proteins E6 and E7 to inhibit the products of two cellular tumor suppressor genes (p53 and Rb respectively). But the early steps of cervical carcinogenesis are not well known. The goal of our study was to evaluate cervical intraepithelial neoplasia (CIN) for the tumor suppressor genes p53 and pRb, the HPV status and the mitotic activity, in order to better understand the mechanism of carcinogenesis. MATERIAL AND METHODS: Twenty formalin-fixed paraffin-embedded cone biopsies were selected because they contained adjacent to normal epithelium different grades of CIN. Immunohistochemistry was performed for evaluation of PCNA, pRb and p53. Expression of these different biomarkers was assessed with the help of an image analysis system, in the different epithelial layers of the different normal and pathological cervical areas. The results were compared to normal controls. RESULTS: There is an increase of PCNA expression in normal epithelium adjacent to CIN, compared to normal controls. As tissues progress from adjacent normal epithelium to condylomatous lesion and to the different grades of CIN, PCNA expression increases (mainly in the superficial epithelial layers). For p53 and pRb, the expression is increased in the basal and parabasal layers of adjacent normal epithelium and condylomatous lesions. The observance of histologic signs of CIN is associated with a disappearance of p53 and pRB expression. CONCLUSIONS: These results indicate that the early steps of cervical carcinogenesis involve proliferative dysregulation in relation to the p53 and pRb modulatory mechanism. So expression of viral proteins of HPV is probably the earlier step of carcinogenesis in cervical carcinoma.     

Cyclic AMP and cyclic GMP in the implantation site of the rat

Endometrial differentiation of the implantation site (IS) is regulated by hormonal and local influences (egg). To better understand the possible participation of cyclic nucleotides in this process, we measured cAMP and cGMP by RIA in IS of the rat on day 6 of pregnancy. IS showed an increase of both nucleotides (3.54 and 0.57 pmoles/mg DNA) when compared with the remaining endometrium (NIS) (2.70 and 0.30). The cAMP/cGMP ratio did not change significantly. We also found an increase in the proteins/mg DNA ratio (12.04 in IS vs 10.63 in NIS) and in the hydration of IS. Our hypothesis is that together these two nucleotides function as a monodirectional system in which they act cooperatively as positive effectors of different sequential steps in the overall process of implantation.     

Development and current applications of assisted fertilization

Since the very early establishment of in vitro insemination, it became clear that one of the limiting steps is the achievement of fertilization. Among the different assisted fertilization methods, intracytoplasmic sperm injection emerged as the ultimate technique to allow fertilization with ejaculated, epididymal, and testicular spermatozoa. This work describes the early steps that brought forth the development of intracytoplasmic sperm injection and its role in assisted reproductive techniques. The current methods to select the preferential male gamete will be elucidated and the concerns related to the offspring of severe male factor couples will be discussed.     

Exemple d’une mise en place de réseau en maternités privées: le Pôle périnatal de prévention en santé mentale (P3SM)

This article reviews the steps taken to establish a network of early care facilities in private maternity services in Montpellier. Four years from the start and after the management of 1,400 pregnant women who were psychologically vulnerable, some aspects of care are examined. We look at rapid access to the hub which ensures a personalised response, and at the provision of expert postpartum staff to forestall failures in the system by guaranteeing continuing care. In addition, we describe coordination of the service and, in particular, the role of a coordinating midwife and the need for supervision of psychologists and paediatric psychiatrists working with pregnant women.     

Teenage pregnancy: strategies for prevention

Teenage pregnancy is a cause and consequence of inequality, limiting the life chances of young parents and their children. It is an issue of global concern, with many countries developing programmes of prevention. This review focuses on the experience of the England strategy, launched in 1999 to address the historically high rates. It is one of the few examples of a successful long term, multi-agency programme, led by national government and locally delivered which, between 1998 and 2015, reduced the under-18 conception rate by 55%. It sets out the case for helping young people delay early pregnancy, the international evidence for prevention, and how evidence is translated into a ‘whole system’ approach. Questions are included to encourage both investigation into local programmes on teenage pregnancy prevention, and reflection on individual practice. The review concludes with summarising the next steps for England and the lessons that can be shared more widely.     

Teenage pregnancy: strategies for prevention

Teenage pregnancy is a cause and consequence of inequality, limiting the life chances of young parents and their children. It is an issue of global concern, with many countries developing programmes of prevention. This review focuses on the experience of the England strategy, launched in 1999 to address the historically high rates. It is one of the few examples of a successful long term, multi-agency programme, led by national government and locally delivered which, between 1998 and 2018, reduced the under-18 conception rate by 64%. It sets out the case for helping young people delay early pregnancy, the international evidence for prevention, how evidence is translated into a ‘whole system’ approach and the priorities for further reducing inequalities. Questions are included to encourage both investigation into local programmes on teenage pregnancy prevention, and reflection on individual practice. The review concludes with summarizing the next steps for England and the lessons that can be shared more widely.