Randomized comparison of total laparoscopic, laparoscopically assisted vaginal and vaginal hysterectomies for myomatous uteri

To compare the operative data and early postoperative outcomes of total laparoscopic hysterectomy (TLH), laparoscopically assisted vaginal hysterectomy (LAVH) and vaginal hysterectomy (VH). One hundred and eight women requiring hysterectomy for enlarged myomatous uterus were randomly allocated into three treatment arms: TLH (n = 36); LAVH (n = 36); VH (n = 36). Randomization procedure was based on a computer-generated list. The primary outcome was the discharge time comparison. The secondary outcomes were operating time, blood loss, paralytic ileus time, intraoperative complications, postoperative pain, and early postoperative complications. The mean discharge time was shorter after VH than after LAVH and TLH (P = 0.001). Operating time significantly influenced the discharge time, considered as a dependent variable in general linear model analysis (P = 0.006). In contrast, blood loss did not influence the discharge time (P = 0.55).The mean operating time was significantly shorter in VH than in TLH and LAVH groups (P = 0.000).The intraoperative blood loss was greater during LAVH than during TLH and VH (P = 0.000).Paralytic ileus time was shorter after VH than after TLH and LAVH (P = 0.000). No intraoperative complications or conversion to laparotomy occurred. VH was the faster operative technique with smaller blood loss and shorter discharge time compared with the others two techniques. So, VH should be considered the preferred approach in patients with enlarged myomatous uteri. When VH is not feasible or salpingo-oophorectomy is required, LAVH or TLH should be considered as valid alternatives. It is necessary to continue prospective comparative studies between the various surgical options to identify the best approach for hysterectomy in each single woman

Diagnostic factors for recurrent pregnancy loss: an expanded workup

Purpose: There is limited information on the risk factors for recurrent pregnancy loss (RPL). Methods: In this study, a patient-based approach was used to investigate the possible involvement and relative relevance of a large number of diagnostic factors in 843 women with RPL who underwent an extensive diagnostic workup including 44 diagnostic factors divided into 7 major categories. Results: The rates of abnormalities found were: (1) genital infections: 11.74%; (2) uterine anatomic defects: 23.72%; (3) endocrine disorders: 29.42%; (4) thrombophilias: 62%; (5) autoimmune abnormalities: 39.2%; (6) parental karyotype abnormalities 2.25%; (7) clinical factors: 87.78%. Six hundred and fifty-nine out of eight hundred and forty-three women (78.17%) had more than one abnormality. The mean number of pregnancy losses increased by increasing the number of the abnormalities found (r = 0.86949, P < 0.02). The factors associated with the highest mean number of pregnancy losses were cervical isthmic incompetence, anti-beta-2-glycoprotein-1 antibodies, unicornuate uterus, anti-prothrombin A antibodies, protein C deficiency, and lupus anticoagulant. The majority of the considered abnormalities had similar, non-significant prevalence between women with 2 versus ≥ 3 pregnancy losses with the exception of age ≥ 35 years and MTHFR A1298C heterozygote mutation. No difference was found between women with primary and secondary RPL stratified according to the number of abnormalities detected (Chi-square: 8.55, P = 0.07). In these women, the only factors found to be present with statistically different rates were age ≥ 35 years, cigarette smoking, and genital infection by Ureaplasma. Conclusion: A patient-based diagnostic approach in women with RPL could be clinically useful and could represent a basis for future research

Gastric aspiration, epithelial injury and chronic lung allograft rejection

Introduction For patients with a variety of end stage lung diseases, lung transplantation has become an effective therapy. Chronic allograft rejection occurs in over 50% of patients 5 years post transplantation however. Although alloimmune-mediated injury directed against endothelial and epithelial structures were traditionally thought to be the major culprit, non-alloimmunologic inflammation after bile acid aspiration has been implicated in cystic fibrosis (CF) lung injury, after transplantation. Hypothesis Reflux with aspiration of bile acid is present in the lower airways of people with cystic fibrosis associated lung injury before and after transplantation. Bile acid challenge would cause cytoxicity and release of inflammatory mediators from patient derived primary epithelial cells (PBECs), before and after transplantation. Methods PBECs from lung transplantation patients, explanted CF patient cultures and a goblet cell line were used to perform proof of concept experiments. In these experiments the effect of individual primary and secondary bile acids, porcine pepsin, different patient derived gastric juices (whole or filtered and dialysed) samples and an artificial bile acid mixture were evaluated. Cell death, Interleukin 8 (IL-8), Interleukin 6 (IL-6) and Granulocyte Macrophage Colony Stumulating Factor (GMCSF) production were measured by Titer blue and multiplex ELISA. Results Epithelial cells can be cultured successfully from the bronchial brushings of lung transplant recipient, CF patient explanted lungs and a Goblet cell line. In work connected with this study my research group has demonstrated that the lungs of people with advanced CF lung disease removed at the time of transplantation contained significant levels of bile acids higher than expected based on normal serum levels. I therefore tested the effects of bile acids on PBECs from lung transplant and CF patients. Challengesof ≥10mol/l was associated with significant cell death. Potentially physiological challenges with 1, 5 and 10 mol/l bile acids led to a significant release of pro-neutrophilic cytokines from lung transplant PBECs and CF PBECs .The goblet cell line HT-29 MTX was resistant to bile acids. Conclusion Aspiration of bile acids in CF lungs before and after transplantation may cause cell damage and inflammation. This injury may benefit from medical and surgical treatments for reflux, which may benefit the lung allograft generally.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Coexistence and conviviality in multi-faith, multi-ethnic Burgazadasi, the princes' islands of Istanbul

This thesis aims to provide an understanding of the existing cultural plurality and diversity in Burgazadası, within a post-Ottoman and homogenising context in Turkey. Most of the scholars working on conflict resolution and peace projects in the Balkans and the Middle East have attempted to analyse cultural plurality with the concept of “coexistence”. “Coexistence” as a concept presupposes the pre-existing categories of ethnicity, class and religion (i.e. coexistence between Israelis and Palestinians; Greek and Turkish Cypriots; Serbs, Croats and Bosnians). In this thesis, I demonstrate the inadequacy of the concept of “coexistence” and propose a “conviviality” approach to explore cultural pluralism. In the post-Ottoman, Turkish context in Burgaz, “coexistence” can be used when describing the homogenisation process, the construction and perception of categorisations of differences, the crystallisation of ethnic and religious identities and ruptures to cultural pluralism; but it is deficient in describing the continuity of cultural pluralism and what is shared between the members of the community in Burgaz. By contrast, “conviviality” provides an understanding of the continuity of cultural pluralism in Burgaz, the changes in sociality patterns, shared ways of living, the diversity and differentiations within “different groups”, the islanders' sense of belonging in Burgaz, their appreciation of diversity and acts of solidarity at the times of crisis. I argue that the homogenisation process in Turkey brought ruptures in cultural pluralism in Turkey, and changed the demographics in Burgaz; however the homogenisation process did not rupture the conviviality on the island and Burgazian identity which embraces all types of diversities of its inhabitants. At times of crisis, like in September 1955 riots, Burgaz islanders emphasised their shared Burgaz identity which overrode religious, class and ethnic differencesEThOS - Electronic Theses Online ServiceGBUnited Kingdo

Scalable Synthesis of Few-Layered 2D Tungsten Diselenide (2H-WSe2) Nanosheets Directly Grown on Tungsten (W) Foil Using Ambient-Pressure Chemical Vapor Deposition for Reversible Li-Ion Storage

We report a facile two-furnace APCVD synthesis of 2H-WSe2. A systematic study of the process parameters is performed to show the formation of the phase-pure material. Extensive characterization of the bulk and exfoliated material confirm that 2H-WSe2 is layered (i.e., 2D). X-ray diffraction (XRD) confirms the phase, while high-resolution scanning electron microscopy (HRSEM), high-resolution transmission electron microscopy (HRTEM), and atomic force microscopy (AFM) clarify the morphology of the material. Focused ion beam scanning electron microscopy (FIB-SEM) estimates the depth of the 2H-WSe2 formed on W foil to be around 5-8 μm, and Raman/UV-vis measurements prove the quality of the exfoliated 2H-WSe2. Studies on the redox processes of lithium-ion batteries (LiBs) show an increase in capacity up to 500 cycles. On prolonged cycling, the discharge capacity up to the 50th cycle at 250 mA/g of the material shows a stable value of 550 mAh/g. These observations indicate that exfoliated 2H-WSe2 has promising applications as an LiB electrode material

Understanding the complex organisational processes that help and hinder creativity and innovation

This study looks at the topics of creativity and innovation and how they are experienced as ordinary, everyday work. In business publications there is much hype and hope around the words “creativity” and “innovation”, but there is also a limited understanding of how creativity and innovation are enacted in organisations. Consequently, academics have stressed the need for ‘opening the black box’ of the firm and understanding how innovation really works (Birdi et al, 2003). This research uses the Complex Responsive Processes approach to understand the ordinary, everyday experiences of people involved in work which was novel for the organisations concerned. I selected three organisational cases from the health and education sectors. I selected these because, in each case, people were working on complex challenges which had no single, obvious solution and which required the generation and development of new and useful ideas. The research makes a novel contribution to knowledge in three ways. First, it has been unusual in that it has extended the application of complex responsive processes to understand the processes which impact on creativity and innovation in the health and education sectors. While complex responsive processes thinking has been applied to these sectors before, to my knowledge, this is the first time it has been applied to understand processes impacting on creativity and innovation in these sectors. Second, this research finds a pattern of dynamics between trust and a paradoxical concept of diversity, comprising both sufficient difference and sufficient common-ground between organizational members. In this research, trust was a necessary foundation for the exploration of ideas. However, for risks to be taken and ideas to be implemented, in contexts of high uncertainty and risk, trust alone was insufficient. The quality of conversational life flourished where both trust and diversity were present. Finally, this research makes a methodological contribution through using Stacey’s five areas for focusing attention as a conceptual framework. The use of this framework helps provide a depth of compelling detail and insights which would not have been obtained through traditional lenses from the domains of creativity and innovation. This is the first time this framework for focusing attention has been applied in this way to understanding creativity and innovation in empirical settings.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

The genetics of feto-placental development: A study of acid phosphatase locus 1 and adenosine deaminase polymorphisms in a consecutive series of newborn infants

<p>Abstract</p> <p>Background</p> <p>Acid phosphatase locus 1 and adenosine deaminase locus 1 polymorphisms show cooperative effects on glucose metabolism and immunological functions. The recent observation of cooperation between the two systems on susceptibility to repeated spontaneous miscarriage prompted us to search for possible interactional effects between these genes and the correlation between birth weight and placental weight. Deviation from a balanced development of the feto-placental unit has been found to be associated with perinatal morbidity and mortality and with cardiovascular diseases in adulthood.</p> <p>Methods</p> <p>We examined 400 consecutive newborns from the Caucasian population of Rome. Birth weight, placental weight, and gestational length were registered. Acid phosphatase locus 1 and adenosine deaminase locus 1 phenotypes were determined by starch gel electrophoresis and correlation analysis was performed by SPSS programs. Informed verbal consent to participate in the study was obtained from the mothers.</p> <p>Results</p> <p>Highly significant differences in birth weight-placental weight correlations were observed among acid phosphatase locus 1 phenotypes (p = 0.005). The correlation between birth weight and placental weight was markedly elevated in subjects carrying acid phosphatase locus 1 phenotypes with medium-low F isoform concentration (A, CA and CB phenotypes) compared to those carrying acid phosphatase locus 1 phenotypes with medium-high F isoform concentration (BA and B phenotypes) (p = 0.002). Environmental and developmental variables were found to exert a significant effect on birth weight-placental weight correlation in subjects with medium-high F isoform concentrations, but only a marginal effect was observed in those with medium-low F isoform concentrations. The correlation between birth weight and placental weight is higher among carriers of the adenosine deaminase locus 1 allele*2, which is associated with low activity, than in homozygous adenosine deaminase locus 1 phenotype 1 carriers (p = 0.04). The two systems show a cooperative effect on the correlation between birth weight and placental weight: the highest value is observed in newborns carrying adenosine deaminase locus 1 allele*2 and acid phosphatase locus 1 phenotypes with medium-low F isoform concentration (p = 0.005).</p> <p>Conclusion</p> <p>These data suggest that zygotes with low adenosine deaminase locus 1 activity and low F activity may experience the most favourable intrauterine conditions for a balanced development of the feto-placental unit.</p

Vaccine hesitancy and knowledge regarding maternal immunization among reproductive age women in central Italy: a cross sectional study

BackgroundVaccination in pregnancy offers protection to the mother and the newborn. In Italy, influenza, pertussis, and COVID-19 vaccinations are recommended in pregnancy, but vaccination coverage is still far from the National Immunization Plan goals. We aimed to assess knowledge and attitude on maternal immunization in two groups of Italian women, in pregnancy and in reproductive age (non pregnant).MethodsA cross sectional study on Italian childbearing age women gathering information on their knowledge on maternal immunization and attitudes to receiving influenza and pertussis vaccines in pregnancy was carried out at the University of Rome Tor Vergata, between September 2019 and February 2020. Logistic and multinomial regressions were chosen as statistical tests for our analysis.Results1,031 women participated in the survey by answering the questionnaire. Out of these, 553 (53.6%) women were pregnant, and 478 (46.4%) were in the reproductive age. 37% (204/553) of pregnant women and 41% (198/476) of non pregnant women are aware of the existence of an immunization plan for pregnant women in Italy. The group with age between 20 and 30, for both pregnant women and women in the reproductive age, has a better knowledge of vaccination in pregnancy. Working status is a variable associated with more awareness about vaccination during pregnancy only for pregnant women (OR = 2.34, p &lt; 0.00001). Educational status, trimester of pregnancy and knowledge on the topic are associated with vaccine hesitancy in our multivariate analysis for pregnant women. In the reproductive age group women who had a previous pregnancy are more likely to be hesitant towards vaccination in pregnancy, on the other hand the one with a higher knowledge and educational status are more likely to get vaccinated.ConclusionsThe study highlights the persistent vaccine hesitancy among Italian women of reproductive age and pregnant women. Despite healthcare providers being identified as a reliable source of information, their recommendations alone are insufficient to overcome vaccine hesitancy. Factors such as employment status, educational level, pregnancy trimester, and knowledge about vaccinations during pregnancy influence vaccine hesitancy. Tailored educational interventions and communication campaigns targeting these areas can help reduce vaccine hesitancy and promote maternal immunization

Lattice measurements in metallic nanoparticles by means of HRTEM images

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