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Gopinath D.,Stepping Hill Hospital | Jha S.,Jessop Wing
International Urogynecology Journal and Pelvic Floor Dysfunction | Year: 2015

Introduction and hypothesis: The concept of multidisciplinary team (MDT) is well accepted in the current National Health Service (NHS) and is considered good practice for the management of chronic conditions. There has been a recent drive to have MDTs in managing women with incontinence and complex prolapse as a result of recommendations by National Institute for Health and Care Excellence (NICE) guidance, Medicines and Healthcare Products Regulatory Agency (MHRA) etc. Currently, there are no data on the outcome of case discussion at urogynaecology MDTs. The aim of this study was to review the clinical impact of discussion of a select group of cases at an urogynaecology MDT and review the clinical literature to justify the MDT approach. Methods: MDT proformas of cases discussed from October 2012 to December 2013 were reviewed. Outcomes of the MDT were compared with recommendations at the initial consultation. This included change in management plan, type of surgery and surgeon as well as time delay due to MDT discussion. Results: One hundred six proformas were available for analysis. Age range was 23–89 (58) years. Average time from clinic visit to MDT discussion was 8.32 + 5.9 days. The MDT recommended a change in management plan in 31 cases (29.3 %), with 11 cases (10.4 %) resulting in alternative surgery and 1 case (0.9 %) with an alternative surgeon. In 18.5 % of cases, MDT discussion formulated the initial management plan. Conclusions: Case discussions at our MDT provide an effective clinical forum to formulate management plans for complex cases. The decision-making process is made robust, without significant impact on waiting time. Investment in setting up MDTs has financial implications but provides patient benefit. © 2015, The International Urogynecological Association.

Laird S.M.,Sheffield Hallam University | Widdowson R.,Sheffield Hallam University | El-Sheikhi M.,Sheffield Hallam University | Hall A.J.,Sheffield Hallam University | Li T.C.,Jessop Wing
Human Reproduction | Year: 2011

Background: Although several studies have suggested that CXCL12 and its receptor, CXCR4, may play a role in embryo implantation, there are limited reports of expression of CXCR4 and CXCL12 in human endometrium. The aim of this study was to investigate CXCL12 and CXCR4 expression in human endometrium and to see if CXCL12 could affect matrix metalloproteinase (MMP) production by endometrial stromal and epithelial cells.MethodsQuantitative real-time RTPCR (qRTPCR) was used to detect the expression of CXCL12 and CXCR4 mRNA in endometrial biopsy samples obtained from fertile women (n 30). Immunohistochemical analysis was carried out to determine where in the endometrium CXCL12 and CXCR4 were expressed. Primary cell culture followed by qRTPCR and zymography was used to investigate whether CXCL12 affected MMP-2 and -9 production by endometrial stromal and epithelial cells.ResultsBoth CXCL12 and CXCR4 were detected in the endometrium. There was no difference in CXCL12 expression at different times in the cycle, but expression of CXCR4 mRNA was significantly higher in the early proliferative (P < 0.01) compared with late proliferative and secretory phases of the cycle. CXCL12 expression was strongest in the epithelial compartment, and weaker in blood vessel walls. CXCR4 immunostaining was strong in the epithelium and blood vessel walls and weaker in the stroma. CXCL12 (10 and 100 ng/ml) had no effect on mRNA expression or activity of MMP-2 or MMP-9 in either stromal or epithelial cells. Conclusions The Results show that the expression of CXCL12 in human endometrium does not alter during the menstrual cycle, while the endometrial expression of its receptor, CXCR4, is highest in the early proliferative phase. In contrast to its effects in other cells, CXCL12 had no effect on MMP-2 or MMP-9 production by endometrial stromal or epithelial cells. © 2011 The Author.

Jokhi R.P.,Jessop Wing | Whitby E.H.,University of Sheffield
Developmental Medicine and Child Neurology | Year: 2011

Fetal magnetic resonance imaging (MRI) has become established as part of clinical practice in many centres worldwide especially when visualization of the central nervous system pathology is required. In this review we summarize the recent literature and provide an overview of fetal development and the commonly encountered fetal pathologies visualized with MRI and illustrated with numerous MR images. We aim to convey the role of fetal MRI in clinical practice and its value as an additional investigation alongside ultrasound yet emphasize the need for caution when interpreting fetal MR images especially where experience is limited. © The Authors. Journal compilation © Mac Keith Press 2010.

Hou H.Y.,College of Logistics | Wang D.,Chinese Peoples Armed Police forces Academy | Zou X.P.,College of Logistics | Yang Z.H.,College of Logistics | And 2 more authors.
Archives of Gynecology and Obstetrics | Year: 2014

Objective: To examine the associations between the ambient air pollution and early fetal loss. Study design: A retrospective case-control study was conducted. 959 fetal losses and 959 normal intrauterine pregnancies within 14 weeks of pregnancy in 15 general or obstetrics and gynecology hospitals were selected into case and control groups, respectively. Data based on hospital records and national pollution monitor station records were collected. Logistic regression model was conducted to examine the associations between 4 ambient air pollutants (SO2, PM10, NO2 and TSP) exposures and fetal loss. Results: The ratio of fetal loss to termination of pregnancy for heating months (2.28 %) was significantly (P < 0.001) higher than that for the non-heating months (1.77 %). Logistic regression suggested that fetal loss within 14 weeks was associated with higher exposure to SO2 (OR = 19.76, 95 % CI 2.34-166.71) and TSP (OR = 2.04, 95 % CI 1.01-4.13) in the first month of pregnancy. Conclusion: Exposure to high levels of SO2 and TSP during the first month of pregnancy was associated with an increased risk of fetal loss in early pregnancy. © 2013 Springer-Verlag Berlin Heidelberg.

Mariee N.,University of Sheffield | Li T.C.,Jessop Wing | Laird S.M.,Sheffield Hallam University
Human Reproduction | Year: 2012

Background Several studies have suggested that endometrial interleukin 15 (IL-15) and the leukaemia inhibitory factor (LIF) may be important in embryo implantation. IL-15 is postulated to play a role in the control of uterine natural killer (uNK) cell proliferation and function, and uNK cells are also known to play a role in implantation. The aims of this study was to (1) compare endometrial levels of IL-15 and the LIF in women with recurrent implantation failure (RIF) after IVF with those in fertile women (controls) and (2) examine the relation of IL-15 and LIF levels to the uNK cell number. Methods We investigated IL-15 and LIF in precisely timed endometrial biopsies (days LH 7-LH 9, where the day of the LH surge is LH 0) obtained from control women (n 15) and women with RIF (n 45) by immunohistochemistry. A semi-quantitative analysis was performed by the H-score analysis of staining intensity in the stroma, glandular epithelium and luminal epithelium, separately. We also correlated expression of LIF and IL15 with uNK cell numbers (obtained in an earlier study of the same samples). Results The quantity of the LIF protein in endometrial glandular epithelium in women with RIF [median and range; 179 (70365)] was lower (P 0.01) than in control women [median and range; 247 (120287)]. In contrast, the level of the IL-15 protein in the stroma in women with RIF [median and range; 90 (0175)] was higher (P 0.009) than in control women [median and range; 60 (15150)]. There was a significant correlation between the uNK cell number and stromal expression of IL-15 (r 0.427, P 0.001). No correlation between the LIF expression in any compartment and the uNK cell number was seen. Conclusions The results show an altered expression of LIF and IL-15 in the endometrium of women with RIF. Despite the limitation of not identifying uNK cells by phenotypic markers, the correlation between the uNK cell number and the stromal cell IL-15 suggests that IL-15 may play a role in the control of endometrial uNK cell function or proliferation. © The Author 2012. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved.

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