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Radcliffe, United Kingdom

Burden C.,Womens Center | Oestergaard J.,Copenhagen University | Larsen C.R.,Copenhagen University
BJOG: An International Journal of Obstetrics and Gynaecology | Year: 2011

Surgery carries the risk of serious harm, as well as benefit, to patients. For healthcare organisations, theatre time is an expensive commodity and litigation costs for surgical specialities are very high. Advanced laparoscopic surgery, now widely used in gynaecology for improved outcomes and reduced length of stay, involves longer operation times and a higher rate of complications for surgeons in training. Virtual-reality (VR) simulation is a relatively new training method that has the potential to promote surgical skill development before advancing to surgery on patients themselves. VR simulators have now been on the market for more than 10 years and, yet, few countries in the world have fully integrated VR simulation training into their gynaecology surgical training programmes. In this review, we aim to summarise the VR simulators currently available together with evidence of their effectiveness in gynaecology, to understand their limitations and to discuss their incorporation into national training curricula. © 2011 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2011 RCOG.


Mackillop L.,Womens Center | Williamson C.,Imperial College London
Postgraduate Medical Journal | Year: 2010

Pregnancy is a time of great maternal physiological and metabolic changes. This affects the biochemical and haematological parameters used in the assessment of liver disease, and it is important to appreciate the different reference ranges in pregnancy to facilitate recognition of liver disorders in pregnancy. Due to the increased physiological and metabolic stress of pregnancy, liver disorders that have previously been subclinical may become symptomatic - for example, primary biliary cirrhosis. Gallstone disease is a common problem in women of childbearing age, and pregnancy promotes their formation. The viral hepatidides constitute a huge disease burden worldwide and the pregnant state confers particular concerns for the mother and her baby. In particular, hepatitis E has a predilection for the pregnant population and confers a particularly poor prognosis. In addition certain pregnancy specific disorders - for example, haemolysis, elevated liver enzymes, low platelets syndrome, acute fatty liver of pregnancy, and obstetric cholestasis - affect primarily the liver. It is important to know how to diagnose and manage these conditions and distinguish them from nonpregnancy specific conditions as this will change the timing and management of affected women and their babies, some of whom can be seriously ill. We propose an approach to the investigation and management of the pregnant patient with abnormal liver function tests.


Hastings R.,Womens Center
Methods in molecular biology (Clifton, N.J.) | Year: 2010

Quality control in the laboratory setting requires the establishment of a quality management system (QMS) that covers training, standard operating procedures, internal quality control, validation of tests, and external quality assessment (EQA). Laboratory accreditation through inspection by an external body is also desirable as this provides an effective procedure for assuring quality and also reassures the patient that the laboratory is working to acceptable international standards. The implementation of fluorescence in situ hybridisation (FISH) in the routine diagnostic laboratory requires rigorous quality control with attention to when it is appropriate to apply the technology, a systematic approach to the validation of probes, policies and procedures documenting the analytical validity of all FISH tests performed, technical procedures involved, and a comprehensive means of reporting results. Knowledge of the limitations of any FISH test is required in relation to the probe and/or tissue being examined, since errors of analysis and interpretation can result in incorrect patient management. A structured QMS with internal quality control and regular audits will minimise the error rate.


Chauhan S.P.,Center for Urban Population Health | Scardo J.A.,Spartanburg Regional Medical Center | Hayes E.,Womens Center | Abuhamad A.Z.,Eastern Virginia Medical School | Berghella V.,Thomas Jefferson Medical School
American Journal of Obstetrics and Gynecology | Year: 2010

The rate of twin pregnancies in the United States has stabilized at 32 per 1000 births in 2006. Aside from determining chorionicity, first-trimester screening and second-trimester ultrasound scanning should ascertain whether there are structural or chromosomal abnormalities. Compared with singleton births, genetic amniocentesisrelated loss at <24 weeks of gestation for twin births is higher (0.9% vs 2.9%, respectively). Selective termination for an anomalous fetus is an option, although the pregnancy loss rate is 7% at experienced centers. For singleton and twin births for African American and white women, approximately 50% of preterm births are indicated; approximately one-third of these births are spontaneous, and 10% of the births occur after preterm premature rupture of membranes. From 1989-2000, the rate of preterm twin births increased, for African American and white women alike, although the perinatal mortality rate has actually decreased. As with singleton births, tocolytics should be used judiciously and only for a limited time (<48 hours) in twin births. Administration of antenatal corticosteroids is an evidence-based recommendation. © 2010 Mosby, Inc. All rights reserved.


Morten K.J.,Womens Center | Badder L.,Womens Center | Knowles H.J.,University of Oxford
Journal of Pathology | Year: 2013

Inappropriate osteoclast activity instigates pathological bone loss in rheumatoid arthritis. We have investigated how osteoclasts generate sufficient ATP for the energy-intensive process of bone resorption in the hypoxic microenvironment associated with this rheumatic condition. We show that in human osteoclasts differentiated from CD14+ monocytes, hypoxia (24 h, 2% O2): (a) increases ATP production and mitochondrial electron transport chain activity (Alamar blue, O2 consumption); (b) increases glycolytic flux (glucose consumption, lactate production); and (c) increases glutamine consumption. We demonstrate that glucose, rather than glutamine, is necessary for the hypoxic increase in ATP production and also for cell survival in hypoxia. Using siRNA targeting specific isoforms of the hypoxia-inducible transcription factor HIF (HIF-1α, HIF-2α), we show that employment of selected components of the HIF-1α-mediated metabolic switch to anaerobic respiration enables osteoclasts to rapidly increase ATP production in hypoxia, while at the same time compromising long-term survival. We propose this atypical HIF-driven metabolic pathway to be an adaptive mechanism to permit rapid bone resorption in the short term while ensuring curtailment of the process in the absence of re-oxygenation. Copyright © 2013 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd. Copyright © 2013 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.

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