Prospects for primary and secondary prevention of cervical adenocarcinoma

This thesis comprises a portfolio of reports examining various aspects of the aetiology, diagnosis, treatment and pathogenesis of Cervical Intraepithelial Glandular Neoplasia. (CIGN), a putative precursor of cervical adenocarcinoma. The first is a multicentre case control study of risk factors for CIGN. This employed a standard questionnaire concerning lifestyle, reproductive, sexual and contraceptive factors and a serum assay for the presence of neutralising antibodies to herpes virus. The risk factor profile obtained for CIGN indicates that it has characteristics of a sexually transmitted disease, manifestation of the disorder possibly being dependent on an altered reproductive/endocrine milieu, as indicated by associations with late onset of menarche and low parity. There was no evidence in support of an association between CIGN and oral contraceptives. With respect to identification of a possible infective agent, the study fails to provide clear evidence of an association between either HSV-1 or HSV-2 and CIGN. The second study is a multicentre prospective assessment of the effectiveness of cone biopsy as primary therapy for CIGN. Regular cytological examination was employed as a means of follow-up. Preliminary results indicate that following cone biopsy, further surgery is unnecessary when the margins of the specimen are free of atypical epithelium. To date there are no cases of residual CIGN or invasive disease in subjects so managed. The final study employs the AgNOR technique to assess the possible presence of zones of poorly recognised epithelial atypia adjacent to adenocarcinoma-in-situ/high grade CIGN. The results give no support to the presence of such areas, and thus provide further experimental support for the validity of conisation as adequate primary treatment of CIGN

To the Point: Medical Education Reviews-Ongoing Call for Faculty Development

This article in the To the Point series will focus on best practices regarding faculty development in medical education in the field of obstetrics and gynecology. Faculty development is an essential component in achieving teacher and learner satisfaction as well as improving learner outcomes. The Liaison Committee on Medical Education requires medical school faculty to have the capability and longitudinal commitment to be effective teachers. Although many programs have been created to address faculty development, there remains a paucity of literature documenting the impact of these programs on learner outcomes. We reviewed the qualities of an excellent medical educator, expectations regarding medical school teaching faculty, elements of comprehensive faculty development programs, and outcome measures for evaluating the effectiveness of these programs

\u3ci\u3eDrosophila\u3c/i\u3e Muller F Elements Maintain a Distinct Set of Genomic Properties Over 40 Million Years of Evolution

The Muller F element (4.2 Mb, ~80 protein-coding genes) is an unusual autosome of Drosophila melanogaster; it is mostly heterochromatic with a low recombination rate. To investigate how these properties impact the evolution of repeats and genes, we manually improved the sequence and annotated the genes on the D. erecta, D. mojavensis, and D. grimshawi F elements and euchromatic domains from the Muller D element. We find that F elements have greater transposon density (25–50%) than euchromatic reference regions (3–11%). Among the F elements, D. grimshawi has the lowest transposon density (particularly DINE-1: 2% vs. 11–27%). F element genes have larger coding spans, more coding exons, larger introns, and lower codon bias. Comparison of the Effective Number of Codons with the Codon Adaptation Index shows that, in contrast to the other species, codon bias in D. grimshawi F element genes can be attributed primarily to selection instead of mutational biases, suggesting that density and types of transposons affect the degree of local heterochromatin formation. F element genes have lower estimated DNA melting temperatures than D element genes, potentially facilitating transcription through heterochromatin. Most F element genes (~90%) have remained on that element, but the F element has smaller syntenic blocks than genome averages (3.4–3.6 vs. 8.4–8.8 genes per block), indicating greater rates of inversion despite lower rates of recombination. Overall, the F element has maintained characteristics that are distinct from other autosomes in the Drosophila lineage, illuminating the constraints imposed by a heterochromatic milieu