Growth-profile configuration for specific deformations of tubular organs: A study of growth-induced thinning and dilation of the human cervix.

Growth is a significant factor that results in deformations of tubular organs, and particular deformations associated with growth enable tubular organs to perform certain physiological functions. Configuring growth profiles that achieve particular deformation patterns is critical for analyzing potential pathological conditions and for developing corresponding clinical treatments for tubular organ dysfunctions. However, deformation-targeted growth is rarely studied. In this article, the human cervix during pregnancy is studied as an example to show how cervical thinning and dilation are generated by growth. An advanced hyperelasticity theory called morphoelasticity is employed to model the deformations, and a growth tensor is used to represent growth in three principle directions. The computational results demonstrate that both negative radial growth and positive circumferential growth facilitate thinning and dilation. Modeling such mixed growth represents an advancement beyond commonly used uniform growth inside tissues to study tubular deformations. The results reveal that complex growth may occur inside tissues to achieve certain tubular deformations. Integration of further biochemical and cellular activities that initiate and mediate such complex growth remains to be explored.

Plano estrategico Multissectorial de prevenção e controlo de doenças não transmissíveis / Multisectoral strategic plan for the prevention and control of non-communicable diseases

A morte prematura por Doenças Não Transmissíveis (DNTs), continua a ser um dos principais desafios para o desenvolvimento a nível global, ceifando por ano perto de 15 milhões de vidas em idades compreendidas entre 30 e 70 anos. Moçambique não permanece inócuo pois já é notável a transição epidemiológica com o duplo peso das doenças transmissíveis e não transmissíveis. Em África o peso das Doenças Cardiovasculares, Diabetes Mellitus, Doenças Respiratórias Crónicas e o Cancro tem estado a aumentar de forma desproporcional entre os países de baixa e média renda, afetando sobretudo os grupos populacionais mais pobres e vulneráveis, impulsionado por factores como a pobreza, a globalização do mercado, o comércio de produtos prejudiciais à saúde, a crescente urbanização, crescimento e envelhecimento da população. Em Moçambique, à semelhança de muitos países, o desenvolvimento económico está a trazer grandes benefícios, mas também mudanças negativas na dieta e estilos de vida. É estimado que cerca de um terço das mortes no país sejam causadas pelas DNTs, e o risco de mortalidade prematura, ou seja, o risco de morte por DNTs antes dos 70 anos de idade, é de 18%. Este facto é preocupante pois maioria destas mortes prematuras e incapacidade por DNTs, pode ser evitada ou adiada através da redução da exposição aos factores de risco como consumo excessivo de álcool, consumo do tabaco, dieta não saudável e inatividade física.

Collagen, glycosaminoglycans and matrix metalloproteinase-2 and metalloproteinase-9 in the cervix of the ewe during prepubertal development.

The tortuous nature of the ovine cervix restricts the transcervical passage of the cannula, and many studies have aimed to understand the endocrine mechanism of the remodelling of cervical tissue in adult ewe. However, little is known about the remodelling of the cervical tissue during the prepubertal development of the lambs. To obtain histochemical and biochemical evidence about the nature of the prepubertal development of the cervix of the ewe, cervices of Corriedale lambs obtained at 0, 1, 2, 4, 6 and 8 months of age (n = 5 to 6 in each) were processed. Neutral and acidic glycosaminoglycans (by PAS-Alcian stain) were weakly in the cervical stroma and not shown change during the development, whereas the percentage volume of fibrillar collagen (by van Gieson stain) increases throughout the experimental period in the superficial fold stroma and deep wall stroma (p < 0.05). The relative cervical weight (g/kg of body weight) and the collagen concentration (by spectrophotometry, mg/mg wet tissue) showed an early decreasing phase from months 0 to 4 and a later increasing phase from months 4 to 8 (p < 0.05). The latent form of matrix metalloproteinase-2 (MMP-2) detected by gelatin zymography (ng/mg protein) decreased from months 0 to 2 and increased from months 4 to 8, whereas the activated form decreased from months 0 to 2, remained low until month 6 and then recovered on month 8 (p < 0.0001). Data suggest that the relative cervical weight biphasic pattern during the development is related to MMP-2-dependent changes in the collagen content.

Effects of age, nursing, and oral IGF1 supplementation on neonatal porcine cervical development.

Nursing supports neonatal porcine uterine and testicular development, however, lactocrine effects on cervical development are undefined. Studies were conducted to determine the effects of i) age and the imposition of the lactocrine-null state from birth (postnatal day 0 (PND0)) by milk replacer feeding on cervical histology; ii) imposition of the lactocrine-null state for 2 days from birth on cervical cell proliferation, as reflected by proliferating cell nuclear antigen immunostaining; and iii) a single feeding of colostrum or milk replacer, administered at birth, with or without oral IGF1, on cervical cell proliferation and phosphorylated AKT (pAKT) and B-cell lymphoma 2 (BCL2) protein levels at 12 h postnatal. Cervical crypt depth and height of luminal epithelium (LE) increased with age by PND14, when both responses were reduced in replacer-fed gilts. Cell proliferation was reduced in LE at PND2, and in crypt epithelium and stroma by PND14 in replacer-fed gilts. Returning replacer-fed gilts to nursing on PND2 did not rescue the cervical phenotype by PND14. A single feeding of colostrum, but not milk replacer, was sufficient to support cervical cell proliferation at 12 h postnatal. IGF1 supplementation induced cell proliferation in replacer-fed gilts, and increased cervical pAKT and BCL2 levels in colostrum-fed gilts and replacer-fed gilts at 12 h postnatal. Results indicate that age and nursing support porcine cervical development, support is initiated at first ingestion of colostrum, IGF1 may be lactocrine-active, and identification of lactocrine-active factors can be accomplished by 12 h postnatal using this bioassay system.

The developmental origin of cervical and vaginal epithelium and their clinical consequences: a systematic review.

OBJECTIVE: Studies on the development of the embryological and fetal development of the cervix and the vagina are rare and mostly go back to the first decades of the last century. The aims of this review were to present the latest knowledge concerning the developmental origin of cervical and vaginal epithelium and to point out new results in the context of different clinical findings. MATERIALS AND METHODS: Relevant studies published between 1910 and 2013 were identified via PubMed, MEDLINE, OVID, Web of Science, and EMBASE. The reference lists of retrieved articles were reviewed to locate additional articles. Each abstract was reviewed, and the appropriate publications were obtained and reviewed as well. A total of 33 articles and 8 book chapters were selected for citation in this review. RESULTS: New objective findings clearly show that human prenatal epithelialization of the cervix and vagina results in 3 morphogenetically determined units: (i) the Müllerian columnar epithelium of the endocervix, (ii) the Müllerian squamous epithelium of the ectocervix and the upper vagina, and (iii) the vaginal squamous epithelium of the lower vagina. CONCLUSIONS: These results are of high clinical relevance and may provide new insight into the histogenesis of ectopy, vaginal adenosis, and the congenital transformation zone. They should be added to the explanations in gynecological, colposcopical, and gynecopathological textbooks.

Nursing during the first two days of life is essential for the expression of proteins important for growth and remodeling of the neonatal porcine cervix.

The neonatal porcine cervix is sensitive to hormones, including relaxin (RLX), from birth. Whether nursing is required to establish the cervical developmental program or to determine cervical developmental trajectory is unknown. The objective of study 1 was to determine effects of age and nursing on expression of molecular markers and mediators of porcine cervical growth and remodeling from birth to postnatal day (PND) 2 and to document effects of RLX treatment during this period on expression of targeted gene products in nursed vs. replacer-fed gilts. Study 2 was conducted to determine effects of age at first nursing and duration of nursing from birth on expression of targeted transcripts or proteins at PND 14. Nursing supported cervical estrogen receptor-α, vascular endothelial growth factor, matrix metalloproteinase (MMP)9, and antiapoptotic B-cell lymphoma-2 protein expression on PND 2. These proteins were undetectable in replacer-fed gilts. Returning replacer-fed gilts to nursing after PND 2 did not restore cervical expression of these proteins by PND 14. RLX increased (P < 0.05) cervical estrogen receptor-α, vascular endothelial growth factor, and B-cell lymphoma-2 protein in nursed gilts, MMP2 protein in nursed and replacer-fed gilts, and decreased (P < 0.05) pro-MMP9 protein in nursed gilts, and RXFP1 mRNA levels in nursed and replacer-fed gilts at PND 2. Replacer feeding for 2 wk from birth increased (P < 0.05) RXFP1 mRNA levels on PND 14. Results support the lactocrine hypothesis for maternal programming of neonatal tissues. Nursing from birth is required to establish the neonatal cervical developmental program and to maintain cervical developmental trajectory to PND 14.

Efficient synthesis of a novel m-phenylene derivative as a selective EP4 agonist inducing follicular growth and maturation in the ovary.

An efficient and straightforward synthesis of a novel m-phenylene derivative has been developed. The optically pure dibromo compound was selected as a starting material. Through a protocol involving the Prins reaction and two steps of the Horner-Wadsworth-Emmons reaction, the basic skeleton was constructed with appropriate alpha and omega side chains. The compound proved to be a highly selective EP(4) agonist and a possible drug candidate for maturation of the uterine cervix.

Trabalho de parto prematuro predição e prevenção / Preterm labor: prediction and prevention

A prematuridade representa um dos maiores desafios da Obstetrícia moderna, sendo a principal causa de morbimortalidade neonatal. Apesar dos avanços nas últimas décadas, sua incidência permanece inalterada no Brasil. Além disso, o diagnóstico do trabalho de parto prematuro pode, muitas vezes, ser um desafio: nem todas as pacientes com contrações antes de 37 semanas irão evoluir para um parto prematuro. A fim de tornar esse diagnóstico mais preciso e elucidar para os obstetras quais são as pacientes que realmente apresentam um risco maior para prematuridade, muitos autores têm pesquisado marcadores capazes de predizer tal risco. Com o objetivo de diminuir a incidência dos partos prematuros, atualmente buscam-se estratégias capazes de prevenir o parto prematuro. A presente revisão discute os principais preditores de risco e métodos de prevenção

The prematurity represents one of the major challenges in modern Obstetrics, and it is the leading cause of neonatal mortality and morbidity. Despite technological advances in the past decades, the rate of preterm birth remains the same in Brazil. Moreover, the diagnosis of preterm labor can often be a challenge: not all patients with contractions before 37 weeks go on to a premature delivery. To make this a more precise diagnosis for obstetricians and to really elucidate which patients have higher risk for prematurity, many authors have investigated markers that could predict such risk. In order to reduce the incidence of preterm delivery, obstetricians are now looking for strategies to prevent preterm birth. This review discusses the most important predictors of risk and the main methods of prevention

Avaliação do comprimento do colo uterino em gestantes normais entre 20 e 34 semanas de gestação por meio da ultrassonografia endovaginal / Endovaginal sonographic assessment of cervical length in healthy pregnant women between 20 and 34 gestational weeks

OBJETIVO: Avaliar o comprimento do colo uterino pela ultrassonografia transvaginal em uma população de gestantes normais e construir uma curva de normalidade no período de 20 a 34 semanas de gestação. MATERIAIS E MÉTODOS: Estudo de corte transversal, incluindo 145 gestantes normais, com feto único, vivo, sem enfermidades, entre 20 e 34 semanas de gravidez, examinadas nos serviços de ultrassonografia do Hospital Universitário Júlio Müller e de uma clínica privada. As gestantes foram submetidas a ultrassonografia endovaginal, com registro do comprimento cervical. Critérios de exclusão foram: parto prematuro, rotura prematura pré-termo das membranas, placenta prévia, uso de fármacos tocolíticos e/ou progesterona, cerclagem ou qualquer intervenção cirúrgica prévia no colo. A associação entre o comprimento do colo uterino e a idade gestacional foi examinada por regressão linear. RESULTADOS: O comprimento cervical diminuiu progressivamente em 0,8 mm a cada semana, à medida que a idade gestacional progrediu (r = -0,351; p < 0,001). As mulheres que tiveram afunilamento cervical apresentaram colo mais curto que as demais (p = 0,001). A interpolação dos percentis 5, 50 e 95 provê gráfico passível de ser utilizado como referência. CONCLUSÃO: O comprimento médio cervical em gestantes normais diminui 0,8 mm por semana, entre a 20ª e a 34ª semanas de gestação.

OBJECTIVE: To evaluate the cervical length by means of transvaginal ultrasonography in a population of healthy pregnant women, developing a normality curve in the period between the 20th and 34th gestational weeks. MATERIALS AND METHODS: Cross sectional study involving 145 healthy singleton pregnancies with healthy fetuses between 20 and 34 weeks of gestation, evaluated at the units of ultrasonography of Hospital Universitário Júlio Müller and of a private center. Each pregnant woman underwent a single transvaginal ultrasonography study, with measurement and recording of the cervical length. Exclusion criteria were: preterm labor, preterm premature rupture of membranes, placenta previa, use of tocolytics and/or progesterone, cerclage or any surgical intervention prior to pregnancy. The association between cervical length and gestational age was evaluated by linear regression analysis. RESULTS: The cervical length presented a progressive decrease (0.8 mm/week) as the gestational age progressed (r = -0.351; p < 0.001). The women with cervical funneling presented shorter cervix (p = 0.001). Interpolation of the 5th, 50th and 95th percentiles provides a graph to be used as a reference. CONCLUSION: The mean cervical length decreases about 0.8 mm per week in the period between the 20th and 34th gestational weeks.

Factors that influence the rate of epithelial maturation in the cervix in healthy young women.

PURPOSE: To examine the longitudinal changes in the epithelial topography of the cervix in healthy young women; and to determine the sociodemographic, behavioral, and biological factors associated with the rate of cervical epithelial maturation. METHODS: Healthy young women were enrolled from October 2000 to September 2002 as part of a larger study of human papillomavirus (HPV). At interval visits, interviews, infection testing, and colpophotography (3% acetic acid; 10x, 16x magnifications) were performed. Areas of total cervical face and cervical immaturity, defined as columnar and early squamous metaplasia, were quantitatively measured using computerized planimetry. Cervical immaturity was expressed as percentage of total cervical face. This analysis includes the first consecutive 145 women with greater than 10% immaturity at baseline. The rate of cervical maturation was defined as change in percent-immaturity. Predictors included sociodemographics, sexual behaviors, and infections. Data analyses included multivariate generalized linear models with repeated measures. RESULTS: The baseline mean age was 17.8 years. Colpophotographs were available from 815 total visits, representing 2.7 years mean follow-up per woman and 5.9-month mean intervals. Women began the study with a median of 39% immaturity and ended with 8% immaturity. After adjusting for time and baseline percent-immaturity, an increased rate of cervical maturation was associated with oral contraceptive pill use (parameter estimate -.023, p =.04) and smoking (-.039, p =.01). CONCLUSIONS: Cervical maturation was documented during relatively short time periods for the vast majority of these women. Oral contraceptive pills and smoking may accelerate the maturational process, representing increased cell proliferation and thus a possible greater vulnerability to HPV.

Factores asociados con lesiones neoplásicas del tracto genital inferior femenino en adolescentes del departamento de Caldas / Fatores associados com lesões neoplásticas do conduto genital inferior feminino em adolescentes do departamento de Caldas / Factors associated with neoplasm of the lower female genital tract in teens in the department of Caldas

En este artículo se presentan los resultados de un estudio epidemiológico analítico-descriptivo, cuyos objetivos fueron: conocer y determinar cómo se asocian factores biológicos y psicosociales con la presencia de lesiones neoplásicas del tracto genital inferior femenino en una población adolescente del departamento de Caldas, lo cual se relacionó, por un lado, con el análisis de la distribución y frecuencia de la población estudiada en cuanto a sexualidad, reproducción, factores culturales y factores psicosociales, y por otro, con la interacción de factores de riesgo en la aparición de dichas lesiones. Se tomó una muestra de 269 mujeres, seleccionadas después de su participación en jornadas educativas respecto a cáncer de cuello uterino y de mama. A este grupo se le aplicó una encuesta estructurada, diseñada para tal fin, la cual se diligenció directamente por los investigadores, previo consentimiento informado. A cada informante se le realizó citología y colposcopia, con un manejo estrictamente confidencial de la información. Los datos se analizaron retomando su distribución y frecuencia por categorías de variable, con lo cual se buscó determinar la asociación de los factores con la presencia o no de lesiones neoplásicas al contrastarlos con los resultados de citología y colposcopia.

This article presents the results of an epidemiologic analytical-descriptive study whose objectives were to examine and determine how biological and psychosocial factors are associated to the presence of neoplastic lesions of the lower female genital tract in a teenage population in the department of Caldas. The study analyzed the distribution and frequency of the studied population in terms of sexuality, reproduction, cultural and psychosocial factors, and secondly, the interaction of risk factors in the occurrence of such injury. A sample of 269 women, selected after their involvement in educational sessions related to cervical cancer and breast cancer, was interviewed by means of a structured survey, which was filled-out directly by the researchers, with prior consent from the women. A cervical smear and a colposcopy were performed on each patient, confidentially handling the information. The data was analyzed taking into consideration the distribution and frequency of the variable categories, looking to determine the association of factors with the presence or absence of neoplastic lesions, when contrasted with the cervical smear and colposcopy results.

Em este artigo apresentam se os resultados duma pesquisa epidemiológica analítico-descritivo, cujos objetivos foram: conhecer e determinar como associam se fatores biológicos y psicossociais com a presença de lesões neoplásicas do conduto genital inferior feminino numa povoação adolescente do Departamento de Caldas, o qual se relacionou, por um lado, com a análise da distribuição e freqüência da povoação estudada em quanto a sexualidade, reprodução, fatores culturais e fatores psicossociais, e por outro lado, com a interação de fatores de risco na aparição de ditas lesões. Tomou se uma amostra de 269 mulheres, selecionadas depois de sua participação em jornadas educativas respeito ao câncer de colo uterino e mama. A este grupo aplicou se uma enquete estruturada, desenhada tal fim, a qual diligenciou se direitamente por os pesquisadores, prévio consentimento informado. A cada informante realizou se citologia e colposcopia, com um manejo estritamente confidencial da informação. Os dados realizaram se retomando sua distribuição e freqüência por categorias de variável, com o qual se procurou determinar a associação dos fatores com a presença ou não de lesões neoplásicas ao contrastarlos com os resultados de citologias e colposcopias.

Una mirada al programa de prevención del cáncer de cuello uterino en Caldas (Colombia), 2005-2006 / Uma mirada ao programa de prevenção do câncer de colo uterino en Caldas (Colombia), 2005-2006 / A glimpse at the cervical cancer prevention program in Caldas (Colombia), 2005-2006

El cáncer de cuello uterino es un problema de salud específico de la mujer con repercusiones sociales y económicas, en ella, la familia y la comunidad; en este sentido, los programas de detección precoz deben estructurarse y sistematizarse adecuadamente con el fin de garantizar educación, prevención, diagnóstico precoz y tratamiento oportuno. Con el fin de evaluar la estructura, procesos y resultados del Programa de Prevención de Cáncer Cuello Uterino en Caldas durante los años 2005 y 2006, se realizó un estudio en alianza Universidad de Caldas, Dirección Territorial de Salud de Caldas, con un diseño descriptivo, evaluativo y retrospectivo. Se seleccionaron 4 municipios estratégicamente situados en el departamento de Caldas; los responsables del programa de cada hospital, diligenciaron una base de datos que fué la guía para el diagnóstico, diseñado por las investigadoras. Las mujeres asistentes al programa en su mayoría tenían entre 26 y 45 años. Las horas de dedicación del personal de salud encargado fueron muy altas con relación al número de citologías tomadas; se presentaron problemas de registro de colposcopias; faltaron reportes de citologías; aspectos estos que afectan la calidad de la atención a las usuarias y al programa. Los reportes obtenidos sobre cáncer invasivo se realizaron sólo a través de citología; en el informe recibido no se reportaron resultados de biopsias a pesar de ser esta la prueba de oro que confirma el diagnóstico; además, el seguimiento a las usuarias tratadas era incipiente y discontinuo. Se evidenciaron fallas y ambigüedad para especificar las funciones del personal de enfermería; las citologías fueron tomadas en su mayoría por auxiliar de enfermería y la norma técnica para tamizaje recomienda que sea realizado por médico o enfermera capacitados. Del mismo modo, se detectaron debilidades en la educación para la salud a la comunidad para la prevención del cáncer de cuello uterino.

A structured and systematized early detection program for cervical cancer should ensure education, prevention, early diagnosis, and adequate treatment. Cervical cancer is a social and economic problem that impacts the woman, as well as her family and community. This study was conducted during 2005 and 2006 by means of an alliance with the Universidad de Caldas, Department and Territorial Health Office of Caldas. The study had a descriptive, evaluative and retrospective design. Four strategically located municipalities of Caldas were selected for education and follow-up. The staff of each hospital filled out a database that guided the process, which was designed by the researchers. Women between the ages of 26 and 45 were the most common cases. The hours the staff dedicated to the program were high, in comparison to the number of cervical smears performed. There were problems regarding the colposcopy records, lost cervical smear records, all of which affect the program's patients. The reports on invasive cancer were obtained only by means of cervical smears; no biopsies were reported, despite this being the best test for confirming the diagnosis. The patients' follow-ups were not continuous. A lack of specificity in nursing functions was also seen, since cervical smears are usually performed by nursing assistants, when the norm states that a trained physician or chief nurse should perform the procedure. A weakness in education to the community was seen.

O câncer de colo uterino é um problema de saúde especifico da mulher com repercussões sociais e econômicas, na família e a comunidade, neste sentido, os programas de detenção preços devem estruturasse e sistematizasse adequadamente com o fim de garantir educação, prevenção, diagnostico preços e tratamento oportuno. Com o fim de avaliar a estrutura, processos e resultados do Programa de Prevenção de Câncer de Colo Uterino em Caldas durante os anos 2005 e 2006, se realizou uma pesquisa em aliança Universidade Caldas, Direção Territorial de Saúde de Caldas, com um desenho descritivo, evaluativo, e retrospectivo. Se selecionaram 4 municípios estrategicamente situados no Estado de Caldas; os responsáveis do programa de cada hospital, diligenciaram uma base de dados que foi a guia para o diagnostico, desenhado pelas investigadoras. As mulheres assistentes ao programa em sua maioria tinham entre 26 e 45 anos. As horas de dedicação do pessoal de saúde encarregado foram muito altas com relação ao numero de citologias tomadas; se apresentaram problemas de risco de colposcopias; faltaram reportes de citologias, aspectos estes que afetam a qualidade da atenção às usuárias e ao programa. Os reportes obtidos sobre câncer invasivo se realizaram só a través de citologia, no informe recebido não se reportaram resultados de biopsias a pesar de ser esta a prova de ouro que confirma o diagnostico; alias o seguimento às usuárias tratadas era incipiente e descontinuo. Evidenciaram-se falha e antiguidades para especificar as funções do pessoal de enfermaria; as citologias foram tomadas em sua maioria por auxiliares de enfermaria e a norma técnica para tamisasse recomenda que seja realizado por um medico ou enfermeira capacitados. Do mesmo modo, detectaram debilidades na educação para a saúde à comunidade para a prevenção do câncer de colo uterino.

[Study on the estrogenic effects of isoflavone].

OBJECTIVE: The study aimed to investigate the endocrine disruptive toxicity of isoflavone in vivo, through comparing with genistein, to study main active parts of isoflavone in estrogenic active, also. METHODS: Uterotrophic assay was carried out. 0.1, 0.2, 0.5, 1.5 g/kg bw isoflavone, 0.05, 0.10, 0.25, 7.50 g/kg bw genistein, 3.0 microg/kg estradiol as positive control, water and oil as control were respectively administered orally to the animal for 3 consecutive day. In the end of the test, uterine wet and blotted weight, histopathology of ovary, uterus and vaginal were measured. Finally, all the effects caused by isoflavone and geinistein were compared. RESULTS: Both isoflavone and genistein induce uterine weight increase significantly; histopathology of uterus and vagina showed that both isoflavone and genistein induce proliferation; there are dose-response relationship; in the related dose level, isoflavone and genistein caused similar effects. CONCLUSION: In uterotrophic assay, genistein was the main active part of isoflavone; via oral administration to immature prepuberty rat, isoflavone had endocrine disruptive effects which had obviously dose-response relationship.

Ultra-sonografia tridimensional do colo uterino na gestação: perspectivas / Three-dimensional ultrasound of uterine cervix in pregnancy: prospects

A medida do comprimento cervical por ultra-sonografia transvaginal é útil no rastreamento do parto prematuro, sendo o encurtamento do colo fator preditor do trabalho de parto pré-termo. Os métodos tradicionais para avaliar a cérvice na gestação são limitados e insatisfatórios. O exame de toque digital, considerado método padrão, demonstra variação entre diferentes examinadores, entretanto, a ultra-sonografia transvaginal é exame eficiente durante a gravidez. Recentemente, o exame ultra-sonográfico tridimensional tem sido utilizado na prática clínica, incluindo o estudo do colo. Grande volume de informações pode ser obtido e armazenado utilizando-se a tecnologia tridimensional. A informação armazenada permite ser manipulada e analisada por número infinito de planos. O exame ultra-sonográfico transvaginal tridimensional é o único capaz de obter o plano coronal pela visualização da imagem em organização multiplanar. Este método aparenta oferecer potencial diagnóstico no aumento da acurácia da ultra-sonografia cervical.

The measurement of cervical length utilizing transvaginal ultrasound is of help for pregnant women screening for premature labor, the shortening of the cervix being a predictor of higher risk of preterm delivery. Traditional methods for evaluating the uterine cervix during pregnancy are limited and unsatisfactory. Digital examination of cervix, considered as the standard method, demonstrates large variation among different examiners; on the other hand, transvaginal sonography is an effective method of examination during pregnancy. Recently, three-dimensional ultrasound has been used in the clinical practice including the study of uterine cervix. The three-dimensional technology allows acquisition and storage of a large volume of data. Such stored information can be reformatted and analyzed through an unlimited number of planes. The three-dimensional transvaginal ultrasound is the unique imaging method capable of obtaining a true coronal plane by direct correlation of the views in a multiplanar display. This method seems to offer a diagnostic potential because of the cervical ultrasonography increased accuracy.

Comprimento do colo uterino e dilatação do orifício interno avaliados pela ultra-sonografia bidimensional e tridimensional / Cervical length and internal cervical os dilatation evaluated by two-dimensional and three-dimensional ultrasound

OBJETIVO: comparar as medidas do comprimento da cérvice e afunilamento, obtidas por ultra-sonografia transvaginal bidimensional e tridimensional na gestação. MÉTODOS: estudo descritivo, prospectivo, com comparação de grupos realizado no período de abril de 2004 a fevereiro de 2005. Foram incluídas 74 gestantes com idade gestacional entre a 19ª e a 24ª semana, independente da presença ou não de fatores de risco para parto prematuro. O exame ultra-sonográfico da cérvice foi efetuado uma única vez na mesma paciente e por único observador. As medidas aferidas por ultra-sonografia bidimensional foram feitas no momento da realização dos exames, e pela tridimensional, com intervalo de 7 a 15 dias do exame bidimensional. A medição do comprimento da cérvice, diâmetro e comprimento do funil cervical foi realizada por ultra-sonografia bidimensional no plano sagital e tridimensional nos planos sagital e coronal. Para testar a diferença estatística entre os resultados médios das medidas do comprimento cervical obtidas nos exames bi e tridimensional, foi utilizado o teste t pareado. Também foi calculado para essas medidas o coeficiente de correlação de Pearson. RESULTADOS: objetivando-se determinar associação linear entre elas encontramos diferença significante entre as medidas aferidas no plano sagital por meio da ultra-sonografia bidimensional e plano coronal da USG 3D (p=0,009), e na ultra-sonografia tridimensional entre os cortes sagital e coronal (p=0,001), sendo as médias das medidas do comprimento cervical (±desvio padrão) de 3,9±0,92c; 4,1±0,97 e 3,9±0,88 cm, respectivamente. O número de afunilamento em nossa casuística foi de 9/74 exames (12,1 por cento). As ultra-sonogafias bi- e tridimensional visualizaram o mesmo número de afunilamento (8/9). Na ultra-sonografia tridimensional, o corte coronal detectou número maior de funil cervical que o corte sagital (8/9). Não houve diferença significativa entre as médias...

PURPOSE: to compare the uterine cervix measurements and funneling obtained by two- and three-dimensional transvaginal sonography during pregnancy. METHODS: a prospective, descriptive study, with group comparison, was carried out between April 2004 and February 2005 in 74 pregnant women, who were between the 19th and 24th week of pregnancy, regardless of risk factors for premature delivery. The ultrasound examination of the cervix was carried out only once in the same patient and by only one observer. The measurements of the cervix by two-dimensional ultrasound were made at the time of the test and by three-dimensional ultrasound at intervals of 7 to 15 days after the two-dimensional ultrasound. The measurements of cervical length, funnel width and length were taken by two-dimensional ultrasound in the sagittal plane and by three-dimensional in the sagittal plane as well as in coronal plane. RESULTS: there was no significant difference between the averages of the measurements of the cervix obtained by two- and three-dimensional ultrasound in the sagittal plane (p=0.23); however, there was a difference in the averages of the measurements of the cervix obtained by two-dimensional ultrasound in sagittal plane and three-dimensional ultrasound in the coronal plane (p=0.009) and between three-dimensional ultrasound in the sagittal and coronal planes (p=0.001). The kappa test (0.86) showed no superiority of either the two-dimensional and three-dimensional ultrasound in the visualization of the cervical funnel. No statistically significant difference was observed between the methods when the average of the measurements of funneling was compared (p>0.05). CONCLUSION: there were differences between two-dimensional and three-dimensional ultrasound of cervical length, only using the coronal plane of the three-dimensional ultrasound.

Estrogenic effects of genistein on reproductive tissues of ovariectomized gilts.

The soybean phytoestrogen genistein has a range of estrogenic actions demonstrated in various species; however, only limited research has been done to investigate its effects in swine. The objective of this study was to characterize the effects of a graded dose of genistein on estrogen-sensitive uterine and cervical tissues in ovariectomized gilts. Thirty-four postpubertal gilts were ovariectomized and assigned randomly to 1 of 6 treatment groups 15 d postovariectomy. Treatment groups received vehicle, estradiol benzoate (2 mg/d), or genistein (50, 100, 200, or 400 mg/d) via intramuscular injection at 12-h intervals for 10 d. Following the treatment period, gilts were euthanized, and uterine and cervical tissues were collected and processed for chemical or histological analysis. Uterine and cervical tissue mass, as indicated by wet, dry, and protein weights and total DNA content (expressed per 100 kg of BW), increased as the dosage of genistein increased (P < 0.001 for each regression). Uterine and cervical wet weights were increased by a dosage of 200 mg of genistein/d (P < 0.001 and P < 0.01, respectively) but not by 100 mg of genistein/d (P = 0.38 and P = 0.14, respectively) compared with those of control gilts. Height of epithelial cells lining the uterine glands and the lumen of uterus and cervix increased when gilts were treated with estradiol benzoate or 400 mg of genistein/d (P < 0.01). When the gilts were treated with estradiol benzoate or 400 mg of genistein/d, immunohistochemical staining demonstrated an increase in the percentage of cells that stained positive for progesterone receptor in the uterine glands and in the cells lining the vaginal cervix (P < 0.05). In gilts treated with 400 mg of genistein/d, the percentage of cells stained positive for proliferating cell nuclear antigen increased in the epithelium of the uterine glands, uterine lumen, and vaginal cervix (P < 0.05). Tissue growth was stimulated by genistein in a dosage-dependent manner, although no dosage of genistein induced a response as great as that of estradiol benzoate. Estrogen-sensitive tissues of the ovariectomized gilt, such as the cervix and uterus, are affected by injection of large dosages of the phytoestrogen genistein. The sensitivity of the uterus of the gilt to estrogenic substances makes it a potential model to examine the impact of environmental endocrine modulators on reproductive tissues.

Utilización de la longitud cervical para la reducción de la estancia hospitalaria en pacientes ingresadas por amenaza de parto pretérrmino / Impact of ultrasound cervical length assessment on length of hospital stay in the clinical management of preterm labor

Objetivo: Evaluar el impacto que tiene en la estancia hospitalaria la utilización de la longitud cervical ecográfica en pacientes ingresadas por amenaza de parto pretérmino. Material y métodos: Estudio prospectivo longitudinal que incluyó una muestra de pacientes ingresadas por amenaza de parto pretérmino en 2 unidades de hospitalización. En la unidad 1 las pacientes fueron tratadas según el protocolo habitual, basado en el índice de Bishop y la constatación de la presencia de dinámica uterina en la monitorización. En la unidad 2 se modificó el protocolo de actuación en función de la longitud cervical ecográfica, optándose por el alta precoz en las pacientes con una longitud ecográfica >= 25 mm. Se analizaron las características de ambos grupos, la duración media del ingreso y la tasa de parto antes de 7 días, 34 y 37 semanas de gestación en ambas unidades. Resultados: Se incluyó en el estudio a un total de 138 pacientes. La tasa de parto antes de 7 días, 34 y 37 semanas fue similar en las 2 unidades, así como la incidencia de reingresos. Sin embargo, la estancia media hospitalaria se redujo significativamente en la unidad 2 (6,14 frente a 3,86 días; p < 0,001), donde se introdujo la longitud cervical ecográfica como uno de los criterios para decidir el alta. Conclusiones: La introducción de la longitud cervical ecográfica en el manejo clínico de pacientes ingresadas por amenaza de parto pretérmino puede hacer disminuir la estancia media hospitalaria sin aumentar la tasa de partos prematuros ni los reingresos hospitalarios

Objective: To evaluate the impact of ultrasound cervical length measurement on length of hospital stay in patients admitted for preterm labor. Material and methods: We performed a prospective longitudinal study of a sample of patients with preterm labor admitted to two admission wards (units 1 and 2). In unit 1, the patients were managed according to the routine protocol, based on Bishop's index and the presence of uterine activity confirmed by monitoring. In unit 2, the protocol was modified according to cervical length measured by ultrasound and early discharge was planned if cervical length was 25 mm or more. The characteristics of both groups, mean length of hospital stay and delivery rates within 7 days and before 34 and 37 weeks' gestation were analyzed. Results: One hundred thirty-eight patients were included in the study. Delivery rates within 7 days and before 34 and 37 weeks' gestation and the incidence of readmission were similar in both groups. However, length of hospital stay was significantly reduced in unit 2 (6.14 days vs 3.86; p < 0.001), where cervical length was used as a criterion for discharge. Conclusions: Routine use of ultrasound assessment of cervical length in patients admitted for preterm labor may reduce length of hospital stay without increasing preterm delivery rates or the percentage of readmissions

Ultrasonographic evaluation of the pre-pubertal development of the reproductive tract in beef heifers.

To study the development of the reproductive tract in heifers, the ovaries, uterus, cervix and vagina were examined by transrectal ultrasonography every 2 weeks, from 2 to 60 weeks after birth. First ovulation occurred at 63.7 +/- 1.1 weeks of age. Ovarian dimensions increased rapidly from 2 to 14 weeks of age, and increased again after 34 weeks of age (P<0.05). The size of the largest ovarian follicles increased from 8 to 14 weeks of age, from 38 to 42 weeks of age, and finally from 52 to 60 weeks of age (P<0.05). The number of follicles > or =3 mm in diameter tended to increase from 6 to 14 weeks of age (P<0.10) and increased significantly from 6 to 60 weeks of age (P<0.05). Mean numerical pixel values of the ovarian images decreased from 4 to 26 weeks of age, and then rose to 44 weeks of age (P<0.05). Diameter of the uterine body, cervix and vagina increased from 2 to 20-24 weeks of age, and again after 32 weeks of age (P<0.05). Mean numerical pixel values for the uterus and vagina decreased initially (uterus: 4-8 weeks and vagina: 6-22 weeks of age) and then increased (uterus: 14-42 weeks and vagina: 22-32 weeks of age; P<0.05). Pixel heterogeneity showed a consistent peak at 20-22 weeks of age for the uterus, cervix and vagina (P<0.05). In summary, in the heifer calf, the marked growth of the reproductive tract in the first few months of age, and prior to first ovulation, reflects phases of increased ovarian follicle (> or =3 mm in diameter) numbers and size. Ultrasonographic image analysis revealed patterns of numerical pixel values and heterogeneity that may be useful in determining important stages of growth and differentiation of the reproductive system.