Efektywność leczenia zespołu bólowego miednicy mniejszej metodą neurektomii przedkrzyżowej u pacjentek z i bez endometriozy

Abstract Objective: Presacral neurectomy (PSN) is used in treatment of central chronic pelvic pain (CPP); however, the confounding effect of concomitant resection of endometriosis remains uncertain. This study was undertaken to evaluate and compare the effectiveness of presacral neurectomy (PSN) in the presence and absence of endometriosis. Material and Methods: Twenty-three women with midline CPP (age 30.3+/-7.9, range 21-46) unresponsive to medical therapy were recruited to the study. Endometriosis was absent in seven and present in sixteen subjects. Laparoscopic PSN using a harmonic scalpel was performed in all subjects; simultaneous excision of endometriotic lesions was also carried out in subjects with endometriosis. Intensity of dysmenorrhoea and pelvic pain was measured by visual analogue pain scale (VAPS) at 3 and 12 months postoperatively. Results: Dysmenorrhoea decreased at 3 months by 75% (P=0.018) in those without endometriosis and by 78% (P=0.001) in those with endometriosis. At 12-months, dysmenorrhea increased in women with endometriosis (P=0.008), but not in those without endometriosis. Pelvic pain not related to menses decreased by 67% (P=0.0007) and by 87% (P=0.028), respectively, in women with and without endometriosis. Dyspareunia, declined dramatically at 3 and 12 months to a median score of 0 (the majority of subjects had no discomfort; PStreszczenie Cel pracy: Neurektomia przedkrzyżowa jest stosowana w leczeniu zespołu bólowego miednicy mniejszej, jakkolwiek sumaryczny efekt jednoczasowo przeprowadzonej resekcji ognisk endometriozy pozostaje niejasny. Prezentowana praca ma na celu porównanie skuteczności laparoskopowej neurektomii przedkrzyżowej w przypadku obecności endometriozy, oraz u chorych, u których ta choroba nie występuje. Materiał i metody: Badaniem objęto dwadzieścia trzy kobiety z centralnie zlokalizowanym przewlekłym bólem miednicy mniejszej (wiek 30,3+/-7,9; 21-46 lat), nieodpowiadającym na leczenie farmakologiczne. Endometriozę stwierdzono u 16 pacjentek. W badanej grupie wykonano laparoskopową neurektomię przedkrzyżową z zastosowaniem skalpela harmonicznego, uzupełnioną o wycięcie ognisk endometriozy w 16 w/w przypadkach. Nasilenie bólu towarzyszącego krwawieniu miesiączkowemu oraz bólu niezwiązanego z krwawieniem oceniano na podstawie wzrokowej skali bólu (VAPS) przed zabiegiem oraz po 3 i 12 miesiącach po operacji. Bolesność stosunków płciowych oceniono z zastosowaniem czterostopniowej skali. Wyniki: Po 3 miesiącach od operacji intensywność bólu związanego z krwawieniem miesiączkowym zmniejszyła się znacząco w obu grupach pacjentek (u chorych bez endometriozy o 75% (P=0,018), a w grupie z endometriozą o 78% (P=0,001). Po 12 miesiącach zaobserwowano wzrost intensywności odczuwanego bólu u kobiet z endometriozą (P=0,008), natomiast u pacjentek bez endometriozy poprawa była na niezmienionym poziomie. Odczuwalność bólu w miednicy mniejszej niezwiązanego z krwawieniem miesiączkowym zmniejszyła się na skutek operacji o 67% (P=0,0007) i o 87% (P=0,028) odpowiednio w grupie z endometriozą i bez endometriozy. Bolesność stosunków płciowych zmniejszyła się istotnie 3 miesiące po operacji i efekt utrzymywał się nadal po 12 miesiącach (większość pacjentek nie podawała żadnego dyskomfortu,

Kształtowanie wizerunku firmy w oczach klientów na przykładzie firmy Ciarko

Niniejsza praca opisuje sposób oraz znaczenie posiadania pozytywnego wizerunku przedsiębiorstwa w oczach otoczenia. Podkreślono znaczenie posiadania przez firmę pozytywnego wizerunku oraz opisano elementy, które mają wpływ na jego kształtowanie. Uwagę skupiono na podstawowych definicjach wizerunku, tożsamości przedsiębiorstwa i marki. Praca zawiera informacje na temat public relations. Opisuje jego cele i zadania, a także narzędzia i techniki wykorzystywane w procesie kształtowania obrazu przedsiębiorstwa. W przebiegu pracy przeprowadzono badania ankietowe z udziałem 70 osób – 35 pracowników i 35 klientów firmy Ciarko sp. z o.o. w Sanoku. Badania miały zweryfikować postawione hipotezy. W przebieg badań ustalono, że proces kształtowania wizerunku przedsiębiorstwa w analizowanej firmie nie przebiega w sposób prawidłowy. Dyrekcja firmy dba o jej wizerunek i stara się kształtować go za pomocą dostępnych metod, jednak właściwe rezultaty otrzymuje tylko w stosunku do wizerunku wewnętrznego, w oczach swoich pracowników. Brak jest odpowiednich działań na zewnątrz firmy, które pozwoliłyby na uzyskanie pozytywnych wyników procesu w oczach klientów i odbiorców zewnętrznych. W efekcie pisania pracy autorka doszła do wniosku, że w badanym przedsiębiorstwie należy stworzyć komórkę odpowiedzialną za public relations lub skorzystać z wyspecjalizowanych w tym zakresie agencji. Pozwoli to firmie właściwie ulokować środki przeznaczone na cele wizerunkowe i ograniczy negatywne skutki niewłaściwie podejmowanych działań.This master’s thesis presents the significance of positive image of the company among the customers. It describes the meaning of the positive image and the elements that may affect it’s success. Basic definitions of image, company and brand identity are included in the thesis. Furthermore, it contains information about the public relation and it’s aims, tasks and techniques used in the process of positive image creation. The survey was conducted in Sanok among 35 customers and 35 Ciarko employees. The aim of study was hyphothesis verification. Thanks to the survey it was figured out that that creation of positive image in the company doesn’t proceeds properly. Management takes care of the company’s image using all available methods. Nevertheless, positive image is perceived just among the employees who were tested. There are no proper actions which could form positive image outside the company among the customers. It was concluded, that the certain company needs to establish the team to be responsible for positive image, or to ask for help specialised agency. That could enable the company improvement of positive image not only inside the company

Lipophilic statins inhibit growth and reduce invasiveness of human endometrial stromal cells

PURPOSE:To compare effects of lipid-soluble statins (simvastatin, lovastatin, atorvastatin) and water-soluble statin (pravastatin) on growth and invasiveness of human endometrial stromal (HES) cells. METHODS:Endometrial biopsies were collected during the proliferative phase from five volunteers. HES cells were isolated and cultured in the absence or in the presence of simvastatin, lovastatin, atorvastatin, and pravastatin. Effects of statins on DNA synthesis, cell viability, activity of caspases 3/7 and invasiveness were evaluated. RESULTS:The proliferation of HES cells was significantly decreased by simvastatin (by 47-89%), lovastatin (by 46-78%), and atorvastatin (by 21-48%) in a concentration-dependent manner. Activity of executioner caspases 3/7 was significantly increased by simvastatin (by 10-25%), lovastatin (by 19%) and atorvastatin (by 7-10%) in a concentration-dependent manner. The greatest effects were observed in response to simvastatin. Accounting for the effects of statins on cell number, the invasiveness of HES cells was significantly decreased in cells treated with simvastatin (by 49%), lovastatin (by 54%), and atorvastatin (by 53%). Pravastatin had little or no effects on any of the tested endpoints. CONCLUSIONS:Present findings demonstrate that only lipid-soluble among tested statins were effective in inhibition of growth and invasiveness of HES cells. These findings may have clinical relevance in treatment of endometriosis

Comparison of Effects of Different Statins on Growth and Steroidogenesis of Rat Ovarian Theca-Interstitial Cells1

Statins are competitive inhibitors of 3-hydroxy-3-methyl-glutaryl-CoA reductase, the rate-limiting enzyme of the cellular production of cholesterol and other products of the mevalonate pathway. Statins exert hepatic and extrahepatic effects, modulating the function of various tissues and organs, including ovaries. Previously, we have demonstrated that simvastatin inhibited cellular proliferation and reduced androgen production by ovarian theca-interstitial cells. The above actions are of translational relevance to the most common endocrine disorder among women in reproductive age: polycystic ovary syndrome. However, different statins may have distinctly different profiles of effects on cholesterol and androgens. The present study was designed to compare the effects of several statins on growth and steroidogenesis of rat theca-interstitial cells. The cells were incubated in the absence (control) or in the presence of simvastatin, lovastatin, atorvastatin, or pravastatin. Assessment of effects of statins on cell growth was carried out by evaluation of DNA synthesis and by estimation of the number of viable cells. Effects on steroidogenesis were evaluated by quantification of steroid production and expression of mRNA for the key enzyme regulating androgen production: Cyp17a1. Among tested statins, simvastatin exerted the greatest inhibitory effects on all tested parameters. The rank order of the effects of the tested statins is as follows: simvastatin > lovastatin > atorvastatin ≥ pravastatin. While the lipophilicity is likely to play a major role in determining the ability of statins to act on nonhepatic cells, other factors unique to individual cell types are also likely to be relevant

Comparison of Effects of Different Statins on Growth and Steroidogenesis of Rat Ovarian Theca-Interstitial Cells1

Statins are competitive inhibitors of 3-hydroxy-3-methyl-glutaryl-CoA reductase, the rate-limiting enzyme of the cellular production of cholesterol and other products of the mevalonate pathway. Statins exert hepatic and extrahepatic effects, modulating the function of various tissues and organs, including ovaries. Previously, we have demonstrated that simvastatin inhibited cellular proliferation and reduced androgen production by ovarian theca-interstitial cells. The above actions are of translational relevance to the most common endocrine disorder among women in reproductive age: polycystic ovary syndrome. However, different statins may have distinctly different profiles of effects on cholesterol and androgens. The present study was designed to compare the effects of several statins on growth and steroidogenesis of rat theca-interstitial cells. The cells were incubated in the absence (control) or in the presence of simvastatin, lovastatin, atorvastatin, or pravastatin. Assessment of effects of statins on cell growth was carried out by evaluation of DNA synthesis and by estimation of the number of viable cells. Effects on steroidogenesis were evaluated by quantification of steroid production and expression of mRNA for the key enzyme regulating androgen production: Cyp17a1. Among tested statins, simvastatin exerted the greatest inhibitory effects on all tested parameters. The rank order of the effects of the tested statins is as follows: simvastatin > lovastatin > atorvastatin ≥ pravastatin. While the lipophilicity is likely to play a major role in determining the ability of statins to act on nonhepatic cells, other factors unique to individual cell types are also likely to be relevant

Statins Inhibit Growth of Human Theca-Interstitial Cells in PCOS and Non-PCOS Tissues Independently of Cholesterol Availability

Context: Polycystic ovary syndrome (PCOS) is associated with ovarian enlargement, prominent theca-interstitial hyperplasia, and excessive androgen production. Recent clinical trials have demonstrated that statins, 3-hydroxy-3-methyl-glutaryl-CoA reductase inhibitors, decrease androgen levels in women with PCOS

Resveratrol potentiates effects of simvastatin on inhibition of rat ovarian theca-interstitial cells steroidogenesis

BACKGROUND: Polycystic ovary syndrome (PCOS) is characterized by ovarian enlargement, hyperplastic theca compartment and increased androgen production due to, at least in part, excessive expression of several key genes involved in steroidogenesis. Previously, our group has demonstrated that simvastatin, competitive inhibitor of 3-hydroxy-3-methyl-glutaryl-CoA reductase (HMG-CoA reductase), a rate-limiting step of the mevalonate pathway, reduces rat-theca interstitial cell steroidogenesis by inhibiting Cyp17a1 gene expression, the key enzyme of the androgen biosynthesis pathway. Recently, we demonstrated that resveratrol, a bioflavonoid abundant in red grapes, decreases rat theca-interstitial cell steroidogenesis and this suppressive effect is mediated through mechanisms independent of the mevalonate pathway. The present study evaluated the effect of combining simvastatin and resveratrol treatments on rat theca-interstitial cell steroidogenesis. METHODS: Rat theca-interstitial cells isolated from 30 day-old female rats were cultured for up to 48 h with or without simvastatin (1 μM) and/or resveratrol (3-10 μM). Steroidogenic enzymes gene expression was evaluated by quantitative real time PCR and steroid levels were measured by liquid chromatography-mass spectrometry. Comparisons between groups were performed using ANOVA and Tukey test. RESULTS: Resveratrol potentiated inhibitory effects of simvastatin on androstenedione and androsterone production in theca-interstitial cells. This suppressive effect correlated with profound inhibition in Cyp17a1 mRNA expression in the presence of a combination of resveratrol and simvastatin. CONCLUSIONS: The present findings indicate that resveratrol potentiates the simvastatin-induced inhibitory effect on theca-interstitial cell androgen production, raising the possibility of development of novel treatments of PCOS