Publications by authors named "Marcin Jozwik"

48 Publications

Personalized Healthcare: The Importance of Patients' Rights in Clinical Practice from the Perspective of Nursing Students in Poland, Spain and Slovakia-A Cross-Sectional Study.

J Pers Med 2021 Mar 11;11(3). Epub 2021 Mar 11.

Department of Gynecology and Obstetrics, Faculty of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, 44 Niepodleglosci Street, 10-045 Olsztyn, Poland.

Background: This study aimed to define the role and importance of patients' rights in personalized healthcare from the perspective of nursing students in Poland, Spain and Slovakia.

Methods: The research was carried out by means of a diagnostic survey, using the survey technique, with the participation of 1002 nursing students attending a full-time undergraduate study program at three European countries. The "Patients' rights" questionnaire was used as a research tool. The average age of students was 21.6 years (±3.4). The empirical material collected was subjected to a statistical analysis.

Results: The study demonstrated that 72.1% of nursing students from Spain, 51.2% from Poland and 38.5% from Slovakia believe that patients' rights are respected at a good level in their country. Significant intergroup differences (F = 67.43; < 0.0001) were observed in the self-assessment of students' knowledge of patients' rights. The highest average values were obtained by students from Spain (3.54 ± 0.92), while 35.9% of students from Slovakia and 25.5% from Poland were quite critical and pointed to their low level of knowledge of patients' rights in their self-assessment. When ranking patients' rights related to respecting dignity, students from Spain obtained much higher average values (4.37 ± 0.92) than students from the other two countries.

Conclusions: The level of students' knowledge of patients' rights and the respect for patients' rights by medical personnel is, in the opinion of the respondents, quite diverse and requires in-depth educational activities among nursing students at the university level in respective countries.
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http://dx.doi.org/10.3390/jpm11030191DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7999689PMC
March 2021

Myometrial Responses to Beta-Adrenoceptor Antagonists in Gynecological Malignancies.

Gynecol Obstet Invest 2021 26;86(1-2):162-169. Epub 2021 Feb 26.

Department of Gynecology and Gynecologic Oncology, Medical University of Białystok, Białystok, Poland,

Objective: The aim of the study was to determine the influence of beta-adrenoceptor (ADRB) antagonists on contractile activity of the nonpregnant human uterus in patients affected by gynecological malignancies.

Design: This was a controlled and prospective ex vivo study.

Setting: The work was conducted as a collaboration between 4 academic departments.

Materials And Methods: Myometrial specimens were obtained from women undergoing hysterectomy for benign gynecological disorders (reference group; N = 15), and ovarian (N = 15), endometrial (N = 15), synchronous ovarian-endometrial (N = 3), and cervical cancer (N = 10). Contractions of myometrial strips in an organ bath before and after applications of ADRB antagonists (propranolol, bupranolol, SR 59230A, and butoxamine) were studied under isometric conditions.

Results: Propranolol and bupranolol attenuated contractions in the endometrial and cervical cancer groups similar to that in the reference group (all p < 0.05), whereas opposite effects were observed in the ovarian and synchronous ovarian-endometrial cancer groups. SR 59230A and butoxamine significantly increased contractions in the ovarian cancer group (both p < 0.001).

Limitations: These results require now to be placed into a firm clinical context.

Conclusions: Our study indicates that ovarian cancer considerably alters contractile activity of the nonpregnant human uterus in response to ADRB antagonists. This suggests a pathogenetic role of beta-adrenergic pathways in this malignancy. Furthermore, propranolol and bupranolol substantially influence spontaneous uterine contractility.
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http://dx.doi.org/10.1159/000513718DOI Listing
June 2021

Relationship Between Frequency and Intensity of Menopausal Symptoms and Quality of Life Among Polish Nurses.

Risk Manag Healthc Policy 2021 11;14:97-107. Epub 2021 Jan 11.

Department of Gynecology and Obstetrics, Collegium Medicum, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland.

Purpose: The study aims to compare the quality of life of nurses in the somatic, mental, social and environmental dimensions in the full reproductive and perimenopausal period and to determine the relationship between the frequency and intensity of menopausal symptoms and the quality of life of nurses aged 45-55.

Patients And Methods: The study involved 334 nurses, of which: 158 (47.31%) were aged 25-35 and 176 (52.69%) aged 45-55, included in the perimenopausal group. A diagnostic survey was used as the research method and the WHOQoL-Bref Questionnaire and the Menopause Symptom List were used to collect data.

Results: Nurses aged 25-35 achieved a significantly ( < 0.02) higher level of satisfaction with overall health quality (M = 3.9; SD = ±0.7) than nurses in the 45-55 age group (M = 3.7; SD = ±0.7). A variation in the frequency (F = 62.64; 0.0001) and intensity (F = 130.18; 0.0001) of menopausal symptoms was identified. It was found that the frequency and intensity of psychological symptoms were significantly higher than vasomotor ( 0.0001) and somatic ( 0.0001) symptoms. Additionally, negative relations between the frequency and intensity of menopausal symptoms and the quality of life of nurses in the 45-55 age group in the somatic, mental, social and environmental domains were demonstrated, with their value ranging from r = -0.19 to r = -0.48.

Conclusion: The quality of life of the examined nurses varies. In the perimenopausal period, the frequency and intensity of psychological, vasomotor and somatic symptoms have a significant negative impact on the quality of life of nurses.
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http://dx.doi.org/10.2147/RMHP.S287767DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7810674PMC
January 2021

Elastography of Endometrium in Women Taking Tamoxifen: A New Approach to an Old Diagnostic Problem.

J Clin Med 2020 Nov 28;9(12). Epub 2020 Nov 28.

Clinic of Gynecology, Oncological Gynecology and Obstetrics, Municipal Polyclinical Hospital in Olsztyn, Niepodległości Str. 44, 10-045 Olsztyn, Poland.

Tamoxifen is a commonly used selective estrogen receptor modulator applied in the treatment for breast cancer. However, in the endometrium, Tamoxifen stimulates tissue growth, cellular transformation, the migration of the cells, and metastatic potential in endometrial cancer. Considering that uterine cancer is the most common neoplasm of the reproductive tract and the third most common neoplastic disease in women, the aim of this study was to investigate if applying elastography in examining the endometrium was beneficial for uterine cancer screening protocols in women on selective estrogen receptor modulator therapy. This study was based on the execution of a classic assessment of the endometrium that included the evaluation of the following: echogenicity, central endometrial stripe, presence of fluid in the uterine lumen, myometrium-endometrium interface, intensity of vascularization and vascular pattern. An ultrasound presentation was then processed and analyzed with elastography. The values of the elastography parameters demonstrated good consistency for the measurement of the softest endometrial layer thickness in elastography. A strong positive correlation (R = 0.56) was demonstrated between the endometrial thickness, as determined by ultrasound examination, and the softest endometrial layer in elastography ( < 0.001). The research showed that the elastography measurements of the width of the softest endometrium layer, based on a population of women taking Tamoxifen, appeared to be a promising option for endometrial cancer screening.
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http://dx.doi.org/10.3390/jcm9123870DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7760647PMC
November 2020

Cancer Prevention by Natural Products Introduced into the Diet-Selected Cyclitols.

Int J Mol Sci 2020 Nov 26;21(23). Epub 2020 Nov 26.

Department Pathophysiology, School of Medicine, University of Warmia and Mazury, 10-082 Olsztyn, Poland.

Cancer is now the second leading cause of death worldwide. It is estimated that every year, approximately 9.6 million people die of oncologic diseases. The most common origins of malignancy are the lungs, breasts, and colorectum. Even though in recent years, many new drugs and therapeutic options have been introduced, there are still no safe, effective chemopreventive agents. Cyclitols seem poised to improve this situation. There is a body of evidence that suggests that their supplementation can decrease the incidence of colorectal cancer, lower the risk of metastasis occurrence, lower the proliferation index, induce apoptosis in malignant cells, enhance natural killer (NK) cell activity, protect cells from free radical damage, and induce positive molecular changes, as well as reduce the side effects of anticancer treatments such as chemotherapy or surgery. Cyclitol supplementation appears to be both safe and well-tolerated. This review focuses on presenting, in a comprehensive way, the currently available knowledge regarding the use of cyclitols in the treatment of different malignancies, particularly in lung, breast, colorectal, and prostate cancers.
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http://dx.doi.org/10.3390/ijms21238988DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7729485PMC
November 2020

Anti-Müllerian Hormone Type II Receptor Expression in Endometrial Cancer Tissue.

Cells 2020 10 17;9(10). Epub 2020 Oct 17.

Department of Gynecology and Obstetrics, School of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, 10-082 Olsztyn, Poland.

Anti-Müllerian hormone (AMH) is responsible for the Müllerian ducts' regression in male fetuses. In cells of cancers with AMH receptors (AMHRII), AMH induces cell cycle arrest or apoptosis. As AMH occurs naturally and does not exhibit significant side effects while reducing neoplastic cell colonies, it can be considered as a potential therapeutic agent for cancer treatment. The purpose of this study was to assess the AMHRII expression in endometrial cancer (EC) in correlation to various demographic data and clinical conditions. Immunohistochemical analysis was used to assess AMHRII expression in EC tissue samples retrieved from 230 women with pre-cancerous state of endometrium (PCS) and EC. AMHRII was detected in 100% of samples. No statistical difference was observed for AMHRII expression depending on the histopathological type of EC, cancer staging, body mass index, and age, as well as the number of years of menstruation, births and miscarriages, and average and total breastfeeding time. Diabetes mellitus type 2 is the only factor that has an impact on AMHRII expression in EC tissue. Thus, this study supports the idea of theoretical use of AMH in EC treatment because all histopathological types of EC at all stages of advancement present receptors for AMH.
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http://dx.doi.org/10.3390/cells9102312DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7603004PMC
October 2020

Role of Global Self-Esteem in Predicting Life Satisfaction of Nursing Students in Poland, Spain and Slovakia.

Int J Environ Res Public Health 2020 07 27;17(15). Epub 2020 Jul 27.

Department of Gynecology and Obstetrics, Faculty of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, 10-045 Olsztyn, Poland.

This study analyzed the role of global self-esteem and selected sociodemographic variables in predicting life satisfaction of nursing students in Poland, Spain and Slovakia. : The study subjects were full-time nursing students from three European countries. A diagnostic survey was used as a research method, while the Rosenberg self-esteem scale (SES) and the satisfaction with life scale (SWLS) were used to collect data. The research was performed on a group of 1002 students. The mean age of those surveyed was 21.6 (±3.4). The results showed significant differences both in the level of the global self-esteem index (F = 40.74; < 0.0001) and in the level of general satisfaction with life (F = 12.71; < 0.0001). A comparison of the structure of results demonstrated that there were significantly fewer students with high self-esteem in Spain (11.06%) than in Poland (48.27%) and in Slovakia (42.05%), while more students with a high sense of life satisfaction were recorded in Spain (64.90%) than in Poland (37.87%) or in Slovakia (47.44%). A positive, statistically significant correlation was found between global self-esteem and satisfaction with life in the group of Slovak students (r = 0.37; < 0.0001), Polish students (r = 0.31; < 0.0001) and Spanish students (r = 0.26; < 0.0001). Furthermore, a regression analysis proved that three variables explaining a total of 12% output variation were the predictors of life satisfaction in Polish students. The regression factor was positive (ßeta = 0.31; R = 0.12), which indicates a positive correlation and the largest share was attributed to global self-esteem (9%). In the group of Spanish students, global self-esteem explained 7% (ßeta = 0.27; R = 0.07) of the output variation and 14% in the group of Slovak students (ßeta = 0.38; R = 0.14). The global self-esteem demonstrates the predictive power of life satisfaction of nursing students, most clearly marked in the group of Slovak students. The measurement of the variables under consideration may facilitate the planning and implementation of programs aimed at increasing self-esteem among young people and promoting the well-being of nursing students.
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http://dx.doi.org/10.3390/ijerph17155392DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7432823PMC
July 2020

Role of Global Self-Esteem, Professional Burnout and Selected Socio-Demographic Variables in the Prediction of Polish Nurses' Quality of Life - A Cross-Sectional Study.

Risk Manag Healthc Policy 2020 26;13:671-684. Epub 2020 Jun 26.

Department of Gynecology and Obstetrics, Collegium Medicum, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland.

Purpose: The aim of the study was to analyze the role of global self-esteem and professional burnout in predicting Polish nurses' quality of life.

Materials And Methods: The research involved 1806 nurses who were employed in 23 hospitals in north-eastern Poland. Forty-seven percent of nurses, aged ≤44 years, were qualified to Group 1, while 53% of nurses, aged ≥45 years, were included in Group 2. A diagnostic survey was applied as a research method. For the collection of data, the WHOQoL-Bref questionnaire, the Rosenberg Self-Esteem Scale and the Copenhagen Professional Burnout Inventory were used. For the statistical analysis, the significance level of < 0.05 was adopted.

Results: Global self-esteem had a positive orientation towards the prediction of the quality of life among the younger nurse group in the psychological and social domains by explaining 20% (ßeta = 0.33; R = 0.20) and 15% (ßeta = 0.28; R = 0.15) of the result variation, respectively. In the older nurse group, personal burnout, which took a negative orientation in the somatic (ßeta = -0.33 R = 0.19), social (ßeta = -0.37; R = 0.17) and environmental domains (ßeta = -0.28; R = 0.32), had the greatest share in predicting the quality of life.

Conclusion: There is a need for the implementation of professional burnout prevention programs, as professional burnout adversely affects the quality of life in the somatic, social and environmental domain, particularly in the older nurse group.
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http://dx.doi.org/10.2147/RMHP.S252270DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7326165PMC
June 2020

Analysis of the Relationship between Stress Intensity and Coping Strategy and the Quality of Life of Nursing Students in Poland, Spain and Slovakia.

Int J Environ Res Public Health 2020 06 24;17(12). Epub 2020 Jun 24.

Department of Gynecology and Obstetrics, Faculty of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, 44 Niepodleglosci Street, 10-045 Olsztyn, Poland.

This study aimed to determine the relationship between stress intensity and coping strategies and the quality of life and health among nursing students in Poland, Spain and Slovakia. The study was performed on a group of 1002 nursing students from three European countries. A diagnostic survey was used as a research method and the data collection was based on the Perceived Stress Scale PSS-10, Mini-COPE Coping Inventory-and the WHOQoL-Bref questionnaire. The average age of all the respondents was 21.6 years (±3.4). Most of the surveyed students rated their stress intensity over the last month as moderate or high. Comparison of the results of the stress levels in relation to the country of residence did not reveal statistically significant differences. In the group of Polish students, the most positive relationship between active coping strategies and the quality of life in the psychological (r = 0.43; < 0.001) and physical health domain (r = 0.42; < 0.001) were most strongly marked. Among Slovak students, significant correlations of low intensity were found between active coping strategies and the quality of life in the physical health (r = 0.15; < 0.01), psychological (r = 0.21; < 0.001), social relationships (r = 0.12; < 0.05) and environment (r = 0.19; < 0.001) domain. In overcoming stressful situations, Spanish students used the Sense of Humour strategy, which is considered less effective, although very useful in some cases. In this group, the strongest positive correlation was found for the psychological domain (r = 0.40; < 0.001). There is a need to implement prevention and stress coping programmes at every stage of studies to ensure effective protection against the negative effects of stress and to improve the quality of life of nursing students.
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http://dx.doi.org/10.3390/ijerph17124536DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7344765PMC
June 2020

Association of burnout syndrome and global self-esteem among Polish nurses.

Arch Med Sci 2020 14;16(1):135-145. Epub 2019 Oct 14.

Department of Gynecology and Obstetrics, School of Medicine, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland.

Introduction: The development of burnout syndrome is conditioned by demographic variables, personality-related variables, ways of coping with difficulties and organizational/professional factors. Burnout is a psychological syndrome of emotional exhaustion and fatigue that may occur in people working with other people in certain ways. Understanding the role of global self-esteem and sociodemographic and work environment-related variables in the development of burnout syndrome in Polish nurses was the aim of this study.

Material And Methods: The study included 1,806 nurses working in 23 hospitals in north-eastern Poland. The average age was 44.7 ±7.96 years. The questionnaire was of a proprietary design. The Copenhagen Burnout Inventory Scale and the Rosenberg SES scale were used.

Results: With regard to contact with patients, symptoms of burnout were present in 28.2% of respondents. Furthermore, 27% of respondents showed work-related burnout and personal burnout was indicated in 21% of them. Almost half of the respondents (46.6%) evaluated their self-esteem at an average level. The obtained results of the regression analysis indicated that global self-esteem was a predictor of professional burnout in nurses. Global self-esteem has important consequences in many aspects of the mental condition. It was found that global self-esteem is a key factor influencing personal burnout symptoms, and its modification may be used as a preventive measure.

Conclusions: Developing personal resources and deriving benefits from them may be important in the prevention of burnout syndrome. This study indicated the need to carry out preventive measures in the workplace to protect nurses from burnout.
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http://dx.doi.org/10.5114/aoms.2019.88626DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6963150PMC
October 2019

Laparoscopic approach to pelvic organ prolapse - the way to go or a blind alley?

Wideochir Inne Tech Maloinwazyjne 2019 Dec 15;14(4):469-475. Epub 2019 Oct 15.

Department of Gynecology and Obstetrics, University of Warmia and Mazury, Olsztyn, Poland.

Pelvic organ prolapse represents a relatively frequent diagnosis that requires attention due to its detrimental effect on quality of life. Not surprisingly, it is one of the commonest indications for surgery in premenopausal and postmenopausal women, often requiring a complex multidisciplinary approach. Traditional vaginal procedures are being gradually replaced by laparoscopic techniques, offering anticipated benefits in reduced recurrence and complication rates, while respecting the trend towards uterus sparing if desirable. Recently, questions about the safety of alloplastic materials used in pelvic organ prolapse surgery were raised, leading to official restrictions in their use, particularly for transvaginal application. As a result, laparoscopic procedures might appear slightly favored but caution must be taken to assure proper technique of mesh placement while maintaining high awareness of possible long-term mesh-related complications that require close surveillance. Therefore, adequate education and training becomes even more important to achieve optimal results and to avoid possible serious medico-legal charges.
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http://dx.doi.org/10.5114/wiitm.2019.88749DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6939204PMC
December 2019

Inositols' Importance in the Improvement of the Endocrine-Metabolic Profile in PCOS.

Int J Mol Sci 2019 Nov 18;20(22). Epub 2019 Nov 18.

Department of Pathophysiology, School of Medicine, Collegium Medicum, University of Warmia and Mazury, 10-082 Olsztyn, Poland.

Polycystic ovary syndrome (PCOS) is one of the most common causes of infertility and metabolic problems among women of reproductive age. The mechanism of PCOS is associated with concurrent alterations at the hormonal level. The diagnosis assumes the occurrence of three interrelated symptoms of varying severity, namely ovulation disorders, androgen excess, or polycystic ovarian morphology (PCOM), which all require a proper therapeutic approach. The main symptom seems to be an increased androgen concentration, which in turn may contribute to different metabolic disorders. A number of papers have demonstrated the significant role of inositol therapy in PCOS. However, there is a lack of detailed discussion about the importance of myo-inositol (MI) and d-chiro-inositol (DCI) in reference to particular symptoms. Thus, the aim of this review is to present the effectiveness of MI and DCI treatment for PCOS symptoms. Moreover, the review is focused on analyzing the use of inositols, taking into account their physiological properties, together with the mechanism of individual PCOS symptom formation.
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http://dx.doi.org/10.3390/ijms20225787DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6888190PMC
November 2019

Positive Orientation and Strategies for Coping with Stress as Predictors of Professional Burnout among Polish Nurses.

Int J Environ Res Public Health 2019 11 2;16(21). Epub 2019 Nov 2.

Department of Gynecology and Obstetrics, Faculty of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, 44 Niepodleglosci Street, 10-045 Olsztyn, Poland.

A psychological resource, positive orientation, may moderate stress and protect nurses from burnout. The purpose of this study was to determine the role of positive orientation and stress-coping strategies in predicting professional burnout among Polish nurses. A total of 1806 nurses employed in 23 hospitals in northeastern Poland participated in the study. The study used a standardized Positive Orientation Scale, Mini-COPE, and the Copenhagen Burnout Inventory. On the stenographic scale, 21.8% of nurses had high levels of positive orientation, 46.8% were average, and 31.9% had low positive orientation. A total of 21.1% of respondents reported personal burnout. Most nurses reported work-related burnout (27%) and burnout in contacts with patients (28.4%) With increasing levels of positive orientation, nurses more often used adaptive strategies that focus on a problem and emotions. Personal burnout accounted for 16% of the variance of the dependent variable (β = -0.32; = 0.16), which was slightly lower than work-related burnout (10% (β = -0.23; = 0.10)), and burnout in contacts with patients (9% (β = -0.22; = 0.09)). The reduced level of positive orientation proved to be the main determinant of the professional burnout of Polish nurses. Burnout-prophylactic programs should be geared towards developing individual psychological resources, including positive orientation and the acquisition of effective stress-coping skills.
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http://dx.doi.org/10.3390/ijerph16214264DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6862310PMC
November 2019

The effects of extended nitric oxide release on responses of the human non-pregnant myometrium to endothelin-1 or vasopressin.

Pharmacol Rep 2019 Oct 11;71(5):892-898. Epub 2019 May 11.

Department of Biophysics, Medical University of Białystok, Białystok, Poland.

Background: Uterotonic mediators: endothelin-1 (ET-1), arginine vasopressin (AVP), and nitric oxide (NO) play important roles in the regulation of uterine contractility. We hypothesize that NO affects both ET-1 or AVP. Therefore, this study investigated the involvement of extended exogenous NO release in the regulation of responses of the human non-pregnant myometrium to ET-1 and AVP.

Methods: Specimens were obtained from 10 premenopausal women, undergoing hysterectomy for benign gynecological disorders. Responses of the myometrial strips to ET-1 or AVP in the absence and presence of an exogenous NO donor (diethylenetriamine; DETA/NO; 10 mol/L) were recorded under isometric conditions. To inhibit endogenous NO, a competitive inhibitor of NO synthase, L-N-nitroarginine (L-NNA) was added to the organ bath.

Results: ET-1 enhanced the spontaneous contractile activity of the myometrium more powerfully (p < 0.01) than AVP. Preincubation with exogenous NO weakened ET-1- or AVP-induced increases in this contractile activity (p < 0.05). However, unexpected results were obtained after preincubation with L-NNA and with DETA/NO then added. Both ET-1 and AVP induced augmented contractile effects in almost all concentrations compared with the responses to these peptides alone or after NOS synthase inhibition (both p < 0.01).

Conclusions: This study demonstrated for the first time that extended incubation with a NO donor influences the uterine muscle response evoked by ET-1 and AVP. Both endogenous and exogenous NO is involved in the control of the uterine responses to ET-1 or AVP of non-pregnant myometrium. Furthermore, both peptides stimulate increased uterine contractility when the local imbalance between the constrictive and relaxing mediators takes place.
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http://dx.doi.org/10.1016/j.pharep.2019.05.003DOI Listing
October 2019

Recent progress in human placental transcriptomics.

Dev Period Med 2019 ;23(2):104-108

Department of Gynecology and Obstetrics, School of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland.

The placenta serves as a metabolic, respiratory, excretory, and endocrine organ that provides appropriate conditions required for adequate fetal development during pregnancy. The development of particular structures and proper functioning of the placenta are under the influence of sophisticated pathways controlled by the expression of substantial genes that are additionally regulated by long non-coding ribonucleic acids (RNAs). Disruptions to adaptive changes in the placental transcriptome as a response to alterations in the feto-maternal environment may be associated with pregnancy complications and compromised fetal outcomes. The aim of the current paper was to present recent findings in transcriptomics of the human placenta. Different approaches in bioinformatic analyses of the RNA-sequencing results were presented. Novel knowledge about the genes and mechanisms that are crucial for the proper development of the placenta is essential for the understanding what stands behind both the normal and complicated pregnancy.
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January 2020

Placenta Transcriptome Profiling in Intrauterine Growth Restriction (IUGR).

Int J Mol Sci 2019 Mar 26;20(6). Epub 2019 Mar 26.

Department of Human Physiology, School of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, Warszawska Str 30, 10-082 Olsztyn, Poland.

Intrauterine growth restriction (IUGR) is a serious pathological complication associated with compromised fetal development during pregnancy. The aim of the study was to broaden knowledge about the transcriptomic complexity of the human placenta by identifying genes potentially involved in IUGR pathophysiology. RNA-Seq data were used to profile protein-coding genes, detect alternative splicing events (AS), single nucleotide variant (SNV) calling, and RNA editing sites prediction in IUGR-affected placental transcriptome. The applied methodology enabled detection of 37,501 transcriptionally active regions and the selection of 28 differentially-expressed genes (DEGs), among them 10 were upregulated and 18 downregulated in IUGR-affected placentas. Functional enrichment annotation indicated that most of the DEGs were implicated in the processes of inflammation and immune disorders related to IUGR and preeclampsia. Additionally, we revealed that some genes (, , , and ) involved in the alternation of splicing events were mainly implicated in angiogenic-related processes. Significant SNVs were overlapped with 6533 transcripts and assigned to 2386 coding sequence (CDS), 1528 introns, 345 5' untranslated region (UTR), 1260 3'UTR, 918 non-coding RNA (ncRNA), and 10 intergenic regions. Within CDS regions, 543 missense substitutions with functional effects were recognized. Two known mutations (rs4575, synonymous; rs3817, on the downstream region) were detected within the range of AS and DEG candidates: and , respectively. Novel genes that are dysregulated in IUGR were detected in the current research. Investigating genes underlying the IUGR is crucial for identification of mechanisms regulating placental development during a complicated pregnancy.
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http://dx.doi.org/10.3390/ijms20061510DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6471577PMC
March 2019

Anti-Müllerian Hormone Expression in Endometrial Cancer Tissue.

Int J Mol Sci 2019 Mar 15;20(6). Epub 2019 Mar 15.

Department of Human Physiology, School of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, 10-082 Olsztyn, Poland.

Anti-Müllerian hormone (AMH) is a commonly known factor secreted by Sertoli cells, responsible for regression of the Müllerian ducts in male fetuses. AMH has also other functions in humans. In vivo and in vitro studies have shown that AMH inhibits cell cycle and induces apoptosis in cancers with AMH receptors. The aim of the study was to assess whether the tissue of pre-cancerous states of endometrium (PCS) and various histopathologic types of endometrial cancer (EC) exhibit the presence of AMH. We aimed to investigate whether the potential presence of the protein concerns menopausal women or those regularly menstruating, and whether is related to cancers with a good or a bad prognosis, as well as what other factors may influence AMH expression. The undertaken analysis was carried out on tissues retrieved from 232 women who underwent surgical treatment for PCS and EC. Tissues were prepared for immunohistochemical assessment with the use of a tissue microarrays method. AMH expression was confirmed in 23 patients with well differentiated endometrioid adenocarcinoma (G1), moderately differentiated endometrioid adenocarcinoma (G2), clear cell carcinoma (CCA) and nonatypical hyperplasia. AMH was not found in EC tissues in regularly menstruating women. An appropriately long mean period of breastfeeding in line with a prolonged period of hormonal activity had a positive effect on AMH expression. Our results may suggest that AMH is a factor which protects the organism against cancer, and should be further investigated as a potential prognosis marker and a therapeutic agent.
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http://dx.doi.org/10.3390/ijms20061325DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6471522PMC
March 2019

The impact of birth anesthesia on the parameters of oxygenation and acid-base balance in umbilical cord blood.

J Matern Fetal Neonatal Med 2020 Oct 10;33(20):3445-3452. Epub 2019 Feb 10.

Department of Gynecology and Obstetrics, Uniwersytet Warminsko-Mazurski Wydzial Nauk Medycznych, Olsztyn, Poland.

There is a great number of studies dealing with the impact of birth anesthesia on the course of labor and condition of the newborn. The aim of this study was to investigate the impact of birth anesthesia on the parameters of oxygenation and acid-base balance in umbilical cord blood. Subjects were divided into four groups: vaginal delivery without anesthesia, vaginal delivery with epidural anesthesia, delivery by cesarean section under a subarachnoid block, and delivery by cesarean section under general anesthesia. The study included mothers aged 18-45 and their newborns born from a singleton normal pregnancy lasting 37-42 weeks, calculating the date of birth according to Naegele's Rule, which was confirmed by ultrasound assessment. The inclusion criteria were a birth weight between 2800 and 4100 g Hematocrit, total hemoglobin, blood oxygen capacity and carboxyhemoglobin content (umbilical artery and vein mean values respectively in all study groups: 41.9 and 42.6%, 14.3 and 14.5 g/dl, 19.3 and 19.6 ml/dl) were similar in all groups and did not correlate with pH in either group. The mean pH value of umbilical cord arterial blood in the "vaginal delivery with epidural anesthesia" group was 7.27 and was significantly the lowest ( < .05) of all the examined groups, in the remaining groups, the mean values ranged between 7.29 and 7.30. Hemoglobin oxygen saturation, oxygenated hemoglobin content, and total oxygen content in umbilical cord blood were statistically significant ( < .001), almost twice as high in cesarean sections under general anesthesia than in cases of regional anesthesia regardless of the method of delivery. Vaginal deliveries had intermediate values of oxygenation parameters. Blood oxygenation of the fetus is a very good parameter to evaluate the clinical state of the baby. Due to most common hypotension of the mother by the regional anesthesia (subarachnoid or epidural), which is compensated by the application of the vasoconstrictors or only by the fluids, it comes to decrease in the oxygen supply of the fetus. We consider in this study that the general anesthesia can be, in some cases, more indicated than the regional anesthesia. The decision of which kind of anesthesia should be used needs to be made by the anesthetists and also by the obstetrician because it can affect the neonatal state after the delivery. It also needs to be mentioned that the time between the start of the anesthesia and the extraction of the fetus by the cesarean section should be as short as possible.
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http://dx.doi.org/10.1080/14767058.2019.1574740DOI Listing
October 2020

Studies on selected molecular factors in endometrial cancers.

Adv Clin Exp Med 2018 Oct;27(10):1417-1424

1st Department and Clinic of Gynaecology and Obstetrics, Wroclaw Medical University, Poland

Background: Endometrial carcinomas (EC) differ in etiology, clinical course and prognosis.

Objectives: This multi-center study aimed at a closer recognition of molecular factors linked to heterogeneity of EC by evaluating estrogen and progesterone receptors, proteins dependent on MMR genes, proteins linked to poor prognosis and metastases, and mutations in BRCA1.

Material And Methods: Using sections of paraffin-embedded preparations, in 115 patients with EC type I and 31 with EC type II, expression of ERα, ERβ1, PR, MLH1, and MSH2 proteins, as well as ARID1A, c-MET and BRCA1, was estimated by immunohistochemistry using specific antibodies.

Results: Expression of ERβ1 was augmented in EC type II, in poorly differentiated cancers and with growing clinical advancement. An augmented expression of ERα was noted in well-differentiated EC and at lower clinical stage. An increased expression of PR and decreased of MLH1 were detected in type I EC. The expression of ARID1A and c-MET proteins showed no differences between the types of EC, stages of clinical advancement or grading. In 51.6% patients with type II EC, a loss of BRCA1 expression was disclosed; in this group of cancers a decreased expression of ERα was noted.

Conclusions: An augmented expression of ERβ1 was linked to type II EC. A higher expression of ERα in EC cancers was associated with a lower histopathological grade. A decreased expression of MLH1 protein was estimated in EC type I. Type II EC may be connected to BRCA1 mutation.
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http://dx.doi.org/10.17219/acem/70861DOI Listing
October 2018

Congenital vesicouterine fistulas-A PRISMA-compliant systematic review.

Neurourol Urodyn 2018 11 14;37(8):2361-2367. Epub 2018 Aug 14.

Chair of Clinical Sciences, Faculty of Health Sciences, State Higher School of Computer Science and Business Administration, Łomża, Poland.

Aims: Vesicouterine fistulas (VUFs) are infrequent abnormal connections between the bladder and the uterine cavity or cervical canal, being mainly sequelae of repeat Cesarean sections. Exceedingly rare are congenital VUFs. This is a systematic review of available world data aimed to characterize congenital VUFs and better understand the mechanism(s) of their formation.

Methods: The PubMed database via MEDLINE search engine was explored from its inception to March 2018. Relevant studies were identified using selected Medical Subject Heading-based terms. This was further supplemented by cross-referencing and handsearching. Retrieved literature was evaluated in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, or PRISMA, guidelines.

Results: A total of 6561 articles were identified of which 10 were analyzed. Three VUFs accompanied broader syndromes of congenital defects. A lack of patency at the level of the vagina was present in all assessed cases. Unilateral renal agenesis was confirmed in four of eight (50%) verified patients. Hence, unilateral kidney agenesis was related to a lesser degree (P = 0.0186) than vaginal atresia to VUF. The principal features of these fistulas were as follows: partial or complete vaginal atresia resulting in primary amenorrhea, menouria present since menarche, and urinary continence.

Conclusions: This review provides the first systematic evidence that congenital VUFs are chiefly associated with concomitant vaginal atresia. The symptomatology of such VUFs is consistent with that of type I acquired fistulas.
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http://dx.doi.org/10.1002/nau.23795DOI Listing
November 2018

Preliminary RNA-Seq Analysis of Long Non-Coding RNAs Expressed in Human Term Placenta.

Int J Mol Sci 2018 Jun 27;19(7). Epub 2018 Jun 27.

Department of Human Physiology, School of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, 10-082 Olsztyn, Poland.

Development of particular structures and proper functioning of the placenta are under the influence of sophisticated pathways, controlled by the expression of substantial genes that are additionally regulated by long non-coding RNAs (lncRNAs). To date, the expression profile of lncRNA in human term placenta has not been fully established. This study was conducted to characterize the lncRNA expression profile in human term placenta and to verify whether there are differences in the transcriptomic profile between the sex of the fetus and pregnancy multiplicity. RNA-Seq data were used to profile, quantify, and classify lncRNAs in human term placenta. The applied methodology enabled detection of the expression of 4463 isoforms from 2899 annotated lncRNA loci, plus 990 putative lncRNA transcripts from 607 intergenic regions. Those placentally expressed lncRNAs displayed features such as shorter transcript length, longer exon length, fewer exons, and lower expression levels compared to messenger RNAs (mRNAs). Among all placental transcripts, 175,268 were classified as mRNAs and 15,819 as lncRNAs, and 56,727 variants were discovered within unannotated regions. Five differentially expressed lncRNAs (HAND2-AS1, XIST, RP1-97J1.2, AC010084.1, TTTY15) were identified by a sex-bias comparison. Splicing events were detected within 37 genes and 4 lncRNA loci. Functional analysis of cis-related potential targets for lncRNAs identified 2021 enriched genes. It is presumed that the obtained data will expand the current knowledge of lncRNAs in placenta and human non-coding catalogs, making them more contemporary and specific.
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http://dx.doi.org/10.3390/ijms19071894DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6073670PMC
June 2018

Breast cancer in an 18-year-old female: A fatal case report and literature review.

Cancer Biol Ther 2018 07;19(7):543-548

e Medical Genetics Laboratory, DNA Research Center , Poznań , Poland.

Breast cancer (BC) is the most frequent malignancy in both pre- and postmenopausal women. However, it is exceedingly rare in very young patients, and especially in adolescents. Herein, we report a case of an 18-year-old female diagnosed with invasive BC. The proband had been found to be negative for BC in close family members. A common BC genetic screening test for the Polish population did not detect any known founder mutations in the BRCA1 gene. Further evaluation identified a p.Ile157Thr (I157T) mutation in the CHEK2 gene, a p.Ala1991Val (A1991V) variant of unknown significance in the BRCA2 gene, p.Lys751Gln (K751Q) variant in the XPD (ERCC2) gene, and a homozygous p.Glu1008Ter (E1008*) mutation in the NOD2 gene. No other mutation had been found by next generation sequencing in major BC high-risk susceptibility genes BRCA1, BRCA2, as well as 92 other genes. To date, all these found alterations have been considered as low to moderate risk factors in the general population and moderate risk factors in younger women (<35 years of age). There are no previous articles relating low and moderate risk gene mutations to very young onset (below 20 years) BC with a fatal outcome. In our patient, a possible cumulative or synergistic risk effect for these 4 alterations, and a mutation in the NOD2 gene in particular, of which both presumably healthy parents were found to be carriers, is suggested.
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http://dx.doi.org/10.1080/15384047.2017.1416931DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5989804PMC
July 2018

Structural arrangement of vesicouterine fistula revisited: An immunohistochemical study documenting the presence of the endometrium.

J Obstet Gynaecol Res 2018 Feb 9;44(2):341-346. Epub 2017 Nov 9.

Department of Reproductive Health, National Research Institute of Mother and Child, Warsaw, Poland.

Previous research has described a woman of reproductive age who presented with a vesicouterine fistula (VUF) of 20 months' duration. The VUF was lined with a metaplastic glandular epithelium containing both estrogen receptors (ER) and progesterone receptors (PR) in abundance. The aim of the present investigation was to evaluate the histology of the VUF canal when exposure to urine of the cellular elements within the fistula was of much shorter duration. A 41-year-old woman who developed a VUF during her third cesarean section was treated with transvesical fistula excision, electrocoagulation, and subsequent attempted hormonal treatment. Later, the patient underwent open surgery fistula repair. Postoperative specimens were subjected to anatomopathological examination together with immunohistochemical staining for ER and PR using monoclonal anti-human antibodies. Herein, we present for the first time detailed microscopic evidence that, at two separate timepoints, the fistulous tract was lined with the endometrium, which covered approximately 80% of the length of the VUF canal. In its intermediate segment, the urothelium formed an additional layer on the surface of the endometrium. At both timepoints, in the columnar epithelial and stromal endometrial cells lining the fistula, both ER and PR were present in abundance. In conclusion, VUF in subjects of reproductive age fulfill criteria for endometriosis. This study provides a rationale for the conservative treatment of VUF consistent with the hormonal treatment of endometriosis.
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http://dx.doi.org/10.1111/jog.13525DOI Listing
February 2018

Multimodal ultrasound computer-assisted tomography: An approach to the recognition of breast lesions.

Comput Med Imaging Graph 2018 04 3;65:102-114. Epub 2017 Jul 3.

DRAMIŃSKI S.A. Ultrasound Scanners, Olsztyn, Poland. Electronic address:

The research here presented aims at developing a new, promising method for the imaging diagnostics of breast lesions - ultrasound tomography (UST). A currently implemented device enables the reconstruction three complementary images for each coronal breast section. Based on in vivo breast examination, the authors developed an approach to breast diagnostics which employs ultrasound transmission and reflection tomography imaging. The obtained transmission images of ultrasound speed distribution show good correlation of glandular tissue areas with their visualization on MRI images. The results also allow a prediction that the implemented UST device offering fusion of reconstructed images may contribute to achieving a new standard for breast cancer diagnostics through non-invasive, fast and cheap screening tests.
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http://dx.doi.org/10.1016/j.compmedimag.2017.06.009DOI Listing
April 2018

Competitive inhibition of amino acid transport in human preovulatory ovarian follicles.

Syst Biol Reprod Med 2017 Oct 11;63(5):311-317. Epub 2017 Jul 11.

e Department of Reproductive Health , National Research Institute of Mother and Child , Warsaw , Poland.

To date we have yet to examine whether amino acid (AA) transport in human ovarian follicles is affected by competitive inhibition. In contrast, transplacental transfer of AAs in late-gestation sheep is characterized by reciprocal competition. This phenomenon has been described by algebraic equations of umbilical uptake of AAs based on maternal arterial concentrations. In the present translational study at a university teaching hospital, we verified whether these equations apply to the transport of AAs from blood to follicular fluid (FF) in human preovulatory follicles. For this purpose we used our data on AA concentrations in blood and FF measured earlier by high-performance liquid chromatography in specimens from 14 patients undergoing oocyte retrieval for in vitro fertilization after controlled ovarian stimulation. The main outcome measure was statistical significance of Spearman correlation coefficients for measured versus calculated concentrations of 8 AAs: isoleucine, leucine, valine, phenylalanine, methionine, threonine, lysine, and arginine. Equations for umbilical uptake provided a highly accurate description of blood-to-FF transport for 7 AAs with the exception of lysine: R ≥ 0.899 (p < 0.0001) for the branched-chain AAs, R = 0.829 (p = 0.0003) for threonine, R = 0.754 (p = 0.0019) for arginine, and R = 0.631 (p = 0.0156) for phenylalanine and methionine. We conclude that these equations indicate competitive inhibition between the AAs studied. Our study strongly suggests that many AA transport systems operating in the placenta should also be active in the cells of the preovulatory follicle. Future studies on AA fluxes in human ovarian follicles must consider possible competitive inhibition.

Abbreviations: AA: amino acid; FF: follicular fluid; HPLC: high-performance liquid chromatography.
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http://dx.doi.org/10.1080/19396368.2017.1341962DOI Listing
October 2017

Identification of Novel Placentally Expressed Aspartic Proteinase in Humans.

Int J Mol Sci 2017 Jun 8;18(6). Epub 2017 Jun 8.

Department of Animal Physiology, Faculty of Biology and Biotechnology, University of Warmia and Mazury in Olsztyn, Oczapowskiego Str 1A, 10-719 Olsztyn, Poland.

This study presents pioneering data concerning the human pregnancy-associated glycoprotein-Like family, identified in the genome, of the term placental transcriptome and proteome. RNA-seq allowed the identification of 1364 bp cDNA with at least 56.5% homology with other aspartic proteinases (APs). In silico analyses revealed 388 amino acids (aa) of full-length hPAG-L polypeptide precursor, with 15 aa-signal peptide, 47 aa-blocking peptide and 326 aa-mature protein, and two Asp residues (D), specific for a catalytic cleft of the APs (VVFDTGSSNLWV91-102 and AIVDTGTSLLTG274-285). Capillary sequencing identified 9330 bp of the gene (Gen Bank Acc. No. KX533473), composed of nine exons and eight introns. Heterologous Western blotting revealed the presence of one dominant 60 kDa isoform of the hPAG-L amongst cellular placental proteins. Detection with anti-pPAG-P and anti-Rec pPAG2 polyclonals allowed identification of the hPAG-L proteins located within regions of chorionic villi, especially within the syncytiotrophoblast of term singleton placentas. Our novel data extend the present knowledge about the human genome, as well as placental transcriptome and proteome during term pregnancy. Presumably, this may contribute to establishing a new diagnostic tool for examination of some disturbances during human pregnancy, as well as growing interest from both scientific and clinical perspectives.
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http://dx.doi.org/10.3390/ijms18061227DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5486050PMC
June 2017

Transcriptome profile of the human placenta.

Funct Integr Genomics 2017 Sep 1;17(5):551-563. Epub 2017 Mar 1.

Department of Human Physiology, Faculty of Medical Sciences, University of Warmia and Mazury in Olsztyn, Warszawska Str 30, 10-082, Olsztyn, Poland.

The human placenta is a particular organ that inseparably binds the mother and the fetus. The proper development and survival of the conceptus relies on the essential interplay between maternal and fetal factors involved in cooperation within the placenta. In our study, high-throughput sequencing (RNA-seq) was applied to analyze the global transcriptome of the human placenta during uncomplicated pregnancies. The RNA-seq was utilized to identify the global pattern of the gene expression in placentas (N = 4) from women in single and twin pregnancies. During analyses, we obtained 228,044 transcripts. More than 91% of them were multi-exon, and among them 134 were potentially unknown protein coding genes. Expression levels (FPKM) were estimated for 38,948 transcriptional active regions, and more than 3000 of genes were expressed with FPKM >20 in each sample. Additionally, all unannotated transcripts with estimated FPKM values were localized on the human genome. Highly covered splice junctions unannotated in the human genome (6497) were identified, and among them 30 were novel. To gain a better understanding of the biological implications, the assembled transcripts were annotated with gene ontology (GO) terms. Single nucleotide variants were predicted for the transcripts assigned to each analyzed GO category. Our results may be useful for establishing a general pattern of the gene expression in the human placenta. Characterizing placental transcriptome, which is crucial for a pregnancy's outcome, can serve as a basis for identifying the mechanisms underlying physiological pregnancy, as well as may be useful for an early detection of the genomic defects.
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http://dx.doi.org/10.1007/s10142-017-0555-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5561170PMC
September 2017

Urinary tract infections during pregnancy - an updated overview.

Dev Period Med 2016;20(4):263-272

Women's Health Center GYNEKA, Kraków, Poland, Department of Gynecology and Obstetrics, Faculty of Medical Sciences, University of Warmia and Mazury, Olsztyn, Poland.

Urinary tract infections (UTIs) are the most common type of infection during pregnancy, affecting up to 10% of pregnant women. They are also recognized as the second most common ailment of pregnancy, after anemia. Three clinical types of pregnancy-related UTI are distinguished: asymptomatic bacteriuria (ASB), cystitis, and pyelonephritis. A particular form of ASB is the presence of Group B streptococci in the urinary tract of the pregnant woman. All clinical types of UTI may lead to serious maternal and fetal complications. Therefore, unlike in the nonpregnant female patient, all UTIs during pregnancy, including the asymptomatic infection, require treatment. In some patients, antibiotic prophylaxis should also be introduced. In the present work, we collectively summarize current practical recommendations from a number of international bodies and organizations.
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September 2017

Altered uterine contractility in response to β-adrenoceptor agonists in ovarian cancer.

J Physiol Sci 2017 Nov 12;67(6):711-722. Epub 2016 Nov 12.

Department of Biophysics, Medical University of Białystok, Mickiewicza 2A, 15-089, Białystok, Poland.

We aimed to prospectively examine β-adrenoceptor-mediated uterine contractility in women suffering from gynecological malignancies. Myometrial specimens were obtained from non-pregnant women undergoing hysterectomy for benign gynecological disorders, and ovarian, endometrial, synchronous ovarian-endometrial, and cervical cancer. Contractions of myometrial strips in an organ bath before and after cumulative dosages of β- and β-adrenoceptor agonists with preincubation of propranolol, SR 59230A, and butoxamine were studied. All agonists induced a dose-dependent attenuation for uterine contractility in endometrial or cervical cancer, similar to that observed in the reference group. Contradictory effects were observed for ovarian cancer alone or in combination with endometrial cancer. CL 316243 or ritodrine abolished the relaxation, whereas BRL 37344 increased the uterine contractility in ovarian cancer. Moreover, β-adrenoceptor antagonists caused varied effects for β- or β-adrenoceptor agonists. Our experiments demonstrate that ovarian cancer, alone or as synchronous ovarian-endometrial cancer, substantially alters uterine contractility in response to β-adrenoceptor agonists.
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http://dx.doi.org/10.1007/s12576-016-0500-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5639028PMC
November 2017

[Levonorgestrel-releasing intrauterine system Mirena® (Bayer) for the prevention and treatment of endometrial adenocarcinoma and the incidence of other malignancies in women].

Ginekol Pol 2015 Apr;86(4):305-10

The use of hormone-releasing intrauterine devices has been on the increase for the last three decades. To date, evidence of their long-term efficiency is available. The aim of the present paper was to briefly review beneficial prophylactic effects of the levonorgestrel-releasing intrauterine system on the incidence of a variety of malignancies in women. Such an influence is of a particular importance in the light of the currently observed increased prevalence of endometrial and cervical adenocarcinomas. Low-dose releasing intrauterine systems are also available, but the hard evidence-based medical data have been derived primarily for Mirena® (Bayer) device, which topically releases from 20 to 14 pg of levonorgestrel daily. Consequently the risk of developing endometrial carcinoma in Mirena® users is lowered by as much as 50% compared with the general population risk To a lesser extent, the intrauterine system decreases the risk for cervical adenocarcinoma and squamous cell carcinoma, as well as ovarian, pancreas, and lung carcinomas. In one population-based study Mirena® increased the risk for breast carcinoma by approximately 20%, whereas a number of other studies failed to demonstrate such a hazard. In the recent decades of the increased predominance of insulin resistance and obesity and an occurrence of hormone-dependent carcinomas at earlier age, a broad application of levonorgestrel-releasing intrauterine systems may become a particularly important component of primary prevention of malignancies in women. Both obese and overweight patients seem perfect candidates for such a hormonal intervention.
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http://dx.doi.org/10.17772/gp/2078DOI Listing
April 2015
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