Keynote Speaker
Liane Deligdisch
Icahn School of Medicine at Mount Sinai, USA
Title: Hormone pathology of the uterus
Time: 10:00 - 10:50
Biography
Liane Deligdisch has graduated from Medical
School in Bucharest , Romania and was trained in Obstetrics-Gynecology and
Pathology in Romania, Israel and in the USA : Resident at the Boston Free
hospital for Women, Harvard Medical
School, Boston Mass. and
Fellowship at The Mount Sinai Medical Center, N.Y. She is a tenured Professor
of Pathology and Obstetrics-Gynecology since 1986, Founder of, and Director of
the Division of Gynecologic Pathology and of the Course of Gynecologic
Pathology at the Mount Sinai Icahn School of Medicine (Professor Emeritus since
2017). Author of 148 peer reviewed articles, most on Gynecologic Pathology,
Editor of 7 textbooks. The 8th book on Hormonal Pathology of the Uterus will be
published by Springer Verlag this year. She is a member of the French National
Academy of Medicine since 2007
Abstract
The
uterus and especially its internal layer, the endometrium are sensitive targets
for steroid sex hormones, capable to modify structure and functions with
promptness and versatility. Hormone therapy is used to counteract abnormal and
deleterious functions or effects of “natural” hormones and is now widely
prescribed being used by millions of women all over the world. It seems that
most women would use at least some hormone therapy at some point of their life:
adolescents and young women use hormonal contraceptives; reproductive
technology for infertility includes hormonal ovulation stimulation;
post-menopausal symptoms are frequently treated with hormone replacement
therapy despite controversial data on their safety and efficiency; endometrial
and myometrial benign and neoplastic proliferations are treated with hormone
therapy, including reversal of premalignant lesions. Adjuvant breast cancer
therapy with Tamoxifen is sometime associated with uterine abnormal
proliferation and neoplasia.
The diagnosis of uterine tissue, mostly
endometrial biopsies, from patients undergoing hormone therapy is often
confusing and difficult to interpret due to the complexity of histologic
changes. Permanently changing hormonal pharmaceutic products, regimens, dosages
as well as new concepts of therapy are challenges for both users and medical
prescribers.
Keynote Speaker
Michail Shafir
Icahn School of Medicine at Mount Sinai, USA
Title: Neuroendocrine /carcinoid ovarian tumors: clinical-pathologic review
Time: 12:10 - 13:00
Biography
Michail Shafir MD MPH FACS, Clinical Professor
of Surgery and Oncologic Sciences at Icahn School of Medicine at Mount Sinai in
New York, has a long standing interest in Carcinoid and Neuroendocrine Tumors.
He has written extensively on surgical treatment of neuroendocrine tumors involving
multiple abdominal sites, including the gastro intestinal tract, pancreas and liver
metastases, including cryoablation and radiofrequency ablation for non
curatively resectable liver metastases. His work has been presented nationally
and internationally
Abstract
Ovarian carcinoids are extremely
rare (0.1 % of all ovarian neoplasms). We report on 67 patients from a single
institution from 1994 to 2015. Most benign
tumors were diagnosed at surgery for pelvic mass. 29 cases were primary and 38
were metastatic. 93% of the primary tumors were unilateral, mostly with teratomas
,struma ovarii ,trabecular, mucinous and insular . Metastatic tumors were
bilateral in 72% of which half were from small bowel, (mainly mucinous
adenocarcinomas with neuroendocrine differentiation). All cases had
neurosecretory granules ( chromogranin, synaptophysin and 67% expressed CDX2,
signaling intestinal origin. Mean age
was 48 for the benign cases and 53 for the malignant ones. Carcinoid syndrome
was present in 45% of the malignant cases. Surgery was performed in 95% of the
cases and adjuvant treatment in 74%. Overall survival was 86% for benign tumors
and 50% for malignant ones at 5 years.
In conclusion: ovarian carcinoids
have generally a more indolent course than the more common ovarian cancers and
have a better survival. Carcinoid syndrome is present mainly in metastatic
tumors as well as well as proliferation index (Ki67), and cytologic atypia.
Keynote Speaker
Nicholas Vivian John Pairaudeau
University of Toronto, Canada
Title: What is the best way to perform a hysterectomy?
Time: 13:50 - 14:40
Biography
Nicholas Pairaudeau has been an Obstetrician and
Gynecologist in practice since 1976. He trained in Obstetrics and Gynecology in
the United Kingdom, Kings College Hospital, London University and transferred
to The University of Toronto in 1973. In 1976 He took up his specialist
practice at North York General Hospital, an affiliate of the University of
Toronto. He still has a very busy practice of both Gynecology and Obstetrics,
teaching, mentoring, as well as striving to be innovative in practice. He
travels extensively, particularly in China, where he has visited from the North
to the South, and he has been involved in teaching, mentoring, and
assisting. He is also a member of the
Royal Society of Medicine, Royal of Surgeons Canada, SOGC, ESGE, AAGL, as well
as an active member of the SLS, which is an organization based out of Florida
in the USA.
Abstract
Hysterectomy
is one of the most widely performed operations on Woman, yet the jury is still
out as to the best way to remove the uterus. Though through advances with
technology, the uterus can be removed through small incisions, the cost for
these operations can be increasingly high, and third world countries have
neither the resources or the training for these operations. The other issue is
that with longer operations the effects on the body increase, and the time
taken to operate increases the waiting list.
Historically,
the earliest known hysterectomy recorded in the English literature was apparently
by a Charles Clay in Manchester UK in 1843.(1) There were subsequently other
gynecologists who performed hysterectomy and these were recorded in the medical
literature of the Day.(2) In 1929 Dr Richardson published a complete full
hysterectomy, including cervix as well ovaries(3). Since then various
approaches have been described, including the original subtotal by laparotomy,
to the more complete operations, with various techniques.(4)
With
the pioneering work of Palmer in Paris, (5) with laparoscopy, in the late 1930s
this became the modern and increasingly popular route for pelvic and abdominal
surgery in the 1960s, after competing against culdoscopy in the USA. This set
up Dr Semm(6) in Germany , and Dr Harry Reich in The USA to show that MIS, (minimally
invasive surgery), laparoscopy hysterectomy was not only possible, but had many
advantages over the more traditional way that was carried out over the world. They
taught many gynecologists throughout the world, who later made various changes
to the way that they taught.
BY
2000, the Robot began to be incorporated into nonmilitary, non-battlefield
surgery, with mostly prostate surgery. By 2005, FDA approval, (7) was given for
the Da Vinci Robot to be used in gynecological surgery. As time went on, the operations that could be
performed with the robot mushroomed.
However,
with all MIS, minimally invasive surgery, there were significant startup costs,
and then there was the maintenance of the equipment.(8) Disposables contributed
greatly to the cost of each operation, but there was no alternative to this
system until recently. With the Senhance system. (9) Interesting variations in
the technology needed for successful safe robotic surgery were and are still
being developed.
However
with all medical treatments there is a cost.
NO wealth no health is well known to persons in the third world. Gradually,
modern gynecology surgery began to deviate with the original core approach to
hysterectomy, laparotomy, to being replaced by more modern techniques, but
leaving the third world with the challenge of no money and lack of the skills
to complete the more advanced procedures. Most conferences tend to focus on the latest, innovative,
but also more expensive technology to remove the uterus. There is little
enthusiasm for looking backwards, when gleaming new equipment that with
experienced operators and assistants, can make these operations very
impressive, with results that suggest that recovery is quicker and easier.
There
is NO doubt that that in busy centres with highly skilled surgeons there are
lower complications. And centres that embark upon regular reviews of
performance are all too few. Only when we get some sort of level playing field,
with studies that are not biased, superficial and lacking very basic data, are
we able to really answer the question, what is the best way for a hysterectomy.
Keynote Speaker
John Studd
London PMS and Menopause Clinic, UK
Title: Effect of hormones on depression in women
Time: 14:40 - 15:30
Biography
Professor John Studd, DSc,MD,FRCOG was Consultant Gynaecologist at the
Chelsea & Westminster Hospital, London and also Professor of Gynaecology at
Imperial College. He qualified in 1962 and has worked and trained in
Birmingham. Zimbabwe and London. He was Consultant Gynaecologist in Salisbury,
Rhodesia and Consultant and Senior Lecturer at the University of Nottingham.
His early research was on chronic renal disease and high blood pressure in
pregnancy (MD thesis) but later started the first menopause clinic in Europe in
Birmingham in 1969. This hormone treatment for the menopause was so
controversial at that time that the clinic was closed down for three months
following protests from the BMA. However, the optimism placed in HRT has been
confirmed and John Studd has continued to work on specific treatments for
menopausal symptoms. He pioneered the sequential oestrogen/progestogen
treatment and also the continuous combined oestrogen/progestogen non-bleeding
treatment. He has championed the use of hormone implants for women with
osteoporosis or with severe depressive or sexual problems after the menopause
and as an almost routine route of HRT after hysterectomy. He first described
the use of oestrogen patches and oestrogen implants for the treatment of severe
PMS. He is also shows the efficacy of moderately high dose transdermal
oestrogens for the treatment of hormone responsive depression in women,
particularly post-natal depression, pre-menstrual depression, menopausal
depression and post-hysterectomy depression. He has a D.Sc. for 25 years of
published work on oestrogen therapy in women. He has written more than 500
scientific articles and written or edited more than 25 post-graduate books on
gynaecology. He needs to write one for the public, but that is much more
challenging. He is Founder and Vice-President of the Royal Osteoporosis Society
and has been a Council Member of the Royal College of Obstetricians and
Gynaecologists for 20 years and a Past-President of the Section of Obstetrics
and Gynaecology at the Royal Society of Medicine. In 2005-2007 Professor Studd
was Chairman of the British Menopause Society. He is now in fulltime private
practice and runs the London PMS & Menopause Clinic at 46 Wimpole Street
London W1G8SD. At the same address he has The Osteoporosis Screening Centre for
the assessment and treatment of osteoporosis. In 2008 he was awarded the Blair
Bell Gold Medal of the Royal Society of Medicine which is given every five
years for the obstetrician/gynaecologist who has made the greatest lifetime
contribution to the specialty
Abstract
The effect of hormones on depression in
women is recognised by most gynaecologists but it is neglected by
psychiatrists. This leads to a greater use of antidepressants or
antipsychotic therapy often of doubtful benefit.
The concept of ‘Reproductive
Depression’ is associated with depression occurring with changes in
ovarian hormones. This is most obvious in menopausal depression, PMT and
PMDD and becomes more troublesome with age. Another example is post-natal
depression which has been shown to improve considerably with oestrogens
compared with a placebo.Later in life this is followed by menopausal depression
which is more severe for the two or three years preceding the cessation of
periods within the years called the ‘menopausal transition’. We thus have
three peaks of depression in women, PMS, postnatal depression and menopausal
depression which often occurs in the same woman throughout her reproductive
life. There are other important aspects of history to consider such as
these women are often well with no depression during pregnancy but develop
postnatal depression. hey are usually well with prolonged breast feeding, and
the postnatal depression now often cyclical only occurs when the breast feeding
stops and when ovulation and the cycles reoccurs. The first challenge is
to recognise the hormonal component of depression by the history and not be
blood tests which are irrelevant .
Treatment consists of transdermal
oestrogens by patch or by gel often with the addition of testosterone.
The ideal dosage would be Oestrogel, three to four measures daily and
testosterone gel in the form of Testogel making one sachet/tube last for a
week. In women with a uterus they should have cyclical progesterone such
as a natural progesterone, Utrogestan 100mgs for the first seven to twelve days
of every calendar month. It should be stressed that these patients
particularly those with PMS are often progesterone intolerant and a short
course of seven day is usually prescribed rather than the more orthodox twelve
days. Ultimately these women may choose to have a hysterectomy and
bilateral oophorectomy with replacement oestradiol and testosterone which
invariably cures premenstrual depression and other aspects of Reproductive
Depression.
Keynote Speaker
Bruno Mozzanega
University of Padua, Italy
Title: Emergency contraceptives work prevalently through a post-fertilization, anti-implantation, mechanism
Time: 15:30 - 16:20
Biography
Bruno Mozzanega, md, is
author/co-author of over 180 scientific papers, included presentations in
Congresses and abstracts. He wrote a textbook (Da Vita a Vita-IIIrd Ed. SEU, Rome,2013). He
participated in researches about menopause since 1980, in particular concerning
the oncogen and cardio-vascular risk, osteoporosis and coagulation disorders,
the circulating levels of Insulin Like Growth Factors and their Binding
Proteins during different schedules of HRT, the endometrial features in breast
cancer patients treated by tamoxifen. He participated in the pioneer studies
(1980) on the assay of sex steroids hormonal receptors in hormone dependent
benign and neoplastic diseases. He collaborated in Molecular Biology researches
concerning the endometrium in PCOS. Currently, he is highly interested in the
mechanism of action of emergency contraceptives and actively works in forming
high-school teachers and students in Reproduction knowledge and Fertility
Control. He is the President of the Italian Society of Responsible Procreation
(SIPRe, www.sipre.eu).
Abstract
Statement of the Problem - Emergency Contraceptive Pills (ECPs) are described as drugs that work by either inhibiting or delaying ovulation without affecting implantation. In our opinion, however, EMA documents and the experimental papers indicate that they prevalently inhibit embryo-implantation.
Literature concerning LNG-ECPs - The EMA-EPAR on ellaOne® (Table 1, p.9) reports that LNG never prevents ovulation when is taken in the most fertile days. On the contrary, it prevents the formation of an adequate corpus luteum.
Literature concerning UPA-ECPs - The EMA-CHMP Assessment-Report on ellaOne® (EMA/73099/2015, Table 2, p.7), evidences that 91.7% of women taking ellaOne® weekly for eight consecutive weeks have normal ovulation, with a permeable cervical mucus.
Besides, literature shows that ellaOne® prevents ovulation only when is taken in the first fertile day. Thereafter its anti-ovulatory effect drops sharply and becomes insignificant (8%) 36 hours before ovulation, in the most fertile days; its decreasing trend cannot explain a consistently high effectiveness in preventing pregnancies (?80%) that does not decrease depending on which of the five days it is taken after unprotected intercourse.
Lastly, Lira-Albarràn administered ellaOne® to women in the most fertile pre-ovulatory days: they had normal ovulation, but their endometrium, evaluated through samples obtained in the implantation window, became inhospitable: the expression of 1183 genes was exactly the opposite of that observed in the receptive pro-gestational endometrium. This agrees with information by EMA-CHMP Assessment-Report for ellaOne® (EMEA-261787-2009,p.8): after UPA administration “the proteins necessary to begin and maintain pregnancy are not synthesized.”
In EMA/73099/2015(p.9), EMA removed the warning against repeated administration of ellaOne ellaOne® within the same menstrual cycle, basing on HRA2914-554 study, where women were exposed to UPA-amounts equal to or higher than theose, potentially hepatotoxic, taken through Esmya®.
Conclusion - Emergency Contraceptives work prevalently by preventing embryo-implantation. People shall receive correct information.
Keynote Speaker
Nicholas Vivian John Pairaudeau
University of Toronto, Canada
Title: Global aspects of post partum hemorrhage management
Time: 16:50 - 18:10 (Special Session)
Biography
Nicholas
Pairaudeau has been an Obstetrician and Gynecologist in practice since 1976. He
trained in Obstetrics and Gynecology in the United Kingdom, Kings College
Hospital, London University and transferred to The University of Toronto in
1973. In 1976 He took up his specialist practice at North York General Hospital,
an affiliate of the University of Toronto. He still has a very busy practice of
both Gynecology and Obstetrics, teaching, mentoring, as well as striving to be
innovative in practice. He travels extensively, particularly in China, where he
has visited from the North to the South, and he has been involved in teaching,
mentoring, and assisting. He is also a
member of the Royal Society of Medicine, Royal of Surgeons Canada, SOGC, ESGE,
AAGL, as well as an active member of the SLS, which is an organization based
out of Florida in the USA.
Abstract
Introduction:
Post-Partum Haemorrhage as defined by a
blood loss of more than 500 ccs at vaginal delivery, and 1000 cc at C section
is a worldwide Issue and is the leading cause of maternal mortality. It occurs
between 5 to 15 % of deliveries, though rates vary in different parts of the
world.
It
appears from the world literature that this rate is increasing and is
attributed to many causes including the association of increased labour
induction, augmentation of labour, previous C section, placenta previa, and
abnormal placentation.
After
many years of watching how we conduct labour and delivery, despite this
association of PPH and maternal morbidity and mortality, the use of new drugs
and procedures the figures seem to rise. I see some marked deficiencies in the
way we conduct a normal labor and delivery, and management of the third stage.
With the advent of delayed cord clamping, and cord blood banking, the chances
of post-partum haemorrhage can increase.
The
proper management of potential post-partum hemorrhage starts in the prenatal clinic,
a risk tool for PPH in Labour and delivery, the appropriate management of
labour, and care in avoiding bleeding from perineal laceration or episiotomy
and making every effort to get the uterus to contract. Medications to assist in
the uterus to contract are recommended.
A normal placentation and with strong uterine contraction, the placenta
will usually be delivered by 15 minutes. Care must be taken to check the
placenta and that it is complete. Careful observation of the post-partum patient
in the hour or two after delivery is paramount as up to 25 % of PPH occurs
after leaving the delivery area.
With
a full understanding of the antecedent factors leading up to a PPH, a very
significant drop can be expected if standard precautions are taken. Even in the
best hands however PPH can occur, and the sequence of practices that can deal
with this mostly treatable complication of pregnancy will be outlined.
This
session will go over the full picture from clinic to discharge from hospital
and later 4 to 6-week post-partum check. Cases will be presented, and it is
hoped that delegates enrolled in this session will bring their own cases too.
Conclusion:
PPH contributes to significant morbidity and mortality in the world today,
despite new drugs, devices and interventions. The session will allow us the
explore the prevention, careful management of the three stages of labour, and reduction
in PPH rates without incurring huge costs.
Keynote Speaker
Michael J Sinosich
DHM Pathology, Australia
Title: Non – Invasive prenatal screening
Time: 10:00-11:00 (Special Session)
Biography
Michael
J Sinosich has completed his PhD on Trophoblast Physiology and PAPP-A. His
research interests include non-invasive assessment of fetomaternal wellbeing.
He is the Director of Prenatal Testing (DHM Pathology) and serves as Consultant
at Pictor Ltd, a developer and manufacturer of multiplexed microELISA assay
platform. He has published/presented numerous papers in reputed journals and
holds several patents.
Abstract
Over
the past several decades, Non-Invasive Prenatal Screening (NIPS) has undergone
a complete metamorphosis. Early population screening programs were very
simplistic, eg., application of maternal age as a single discriminator for
identifying population of women of advance maternal age and, hence, requiring
invasive testing (amniocentesis). Ultrasonography ushered in era of direct
fetal visualisation and biometrics, whilst maternal serum AFP quantitation
remained the biochemical marker for prenatal detection of open neural tube
defects (oNTDs). However, the obstetric population demanded more. So, by 1990s,
ultrasonography (NT thickness) was combined with first trimester biochemistry
to raise clinical efficacy of screening for Trisomy 21.
Global uptake of cfDNA based NIPS surpassed all expectations. Again, obstetric population demanded greater clinical coverage. Interpretive algorithms were refined to report sub-chromosomal disorders and, more recently, complete fetal chromosome enumeration. As these technical boundaries are continually pushed back, it should not be forgotten that the source of feto-placental cfDNA, in maternal circulation, often touted as “fetal”, is actually derived from placental trophoblast cell. Hence, regulatory recommendations for confirmation of abnormal cfDNA findings, prior to initiation of interventional management.
Conclusions:
Designing the optimal prenatal healthcare assessment program, should include
ultrasonography, first trimester biochemistry and cfDNA. Such a program offers
enhanced detection of major autosomal aneuploidies, whilst simultaneously
screening for fetal structure and polyploidy and pre- eclampsia.
Keynote Speaker
Michael J Sinosich
DHM Pathology, Australia
Title: CfDNA based non-invasive prenatal screening (NIPS) for healthcare providers
Time: 10:00-11:00 (Special Session)
Biography
Michael
J Sinosich has completed his PhD on Trophoblast Physiology and PAPP-A. His
research interests include non-invasive assessment of fetomaternal wellbeing.
He is the Director of Prenatal Testing (DHM Pathology) and serves as Consultant
at Pictor Ltd, a developer and manufacturer of multiplexed microELISA assay
platform. He has published/presented numerous papers in reputed journals and
holds several patents.
Abstract
Since the initial of Dennis Lo and colleagues (1997)1,
describing the presence of “Presence of fetal DNA in maternal plasma and
serum”, commercial investment and interest knew no bounds. Until the reality
check of Sequenom, line between good science and commercial conflicts of
interests had been breached.
Since the broad acceptance of cfDNA based aneuploidy
screening, the past decade has provided many cautionary lessons:
1.
Source of cfDNA in maternal circulation:
Figure 1: Fetal gender assignment + RhD typing, at
10 weeks gestation (S Cheong MSc Thesis 2009).
In a multiplex RT-PCR assay, detection of male (SRY) foetuses was readily achieved. However, in one SRY positive case, the woman gave birth to a male baby, 10 years before submitting to test. At time of testing, the woman was neither pregnant nor sexually active.
2. Fetal fraction (FF): One of the most critical parameters of cfDNA based NIPS is fetal fraction, ie., the abundance of extracellular feto-placental derived DNA relative to maternal derived extracellular (cf) DNA. In general, fetal fraction increases with gestation but is inversely related to maternal weight (or BMI). Unlike placental derived biochemistry, it is not possible to adjust FF with weight correction factor. For most NIPS technologies, FF limits range between 1 – 4%. Other factors which impact on FF, include, specimen integrity, maternal health. In cases where cfDNA testing failed, these women should be considered at increased risk for aneuploidy.
3. Technical Vs Ethical: Major cfDNA NIPS service providers have technical capability to expand clinical coverage to include sub-chromosomal abnormalities and, even, full chromosome enumeration. Despite regulatory recommendations against population-based screening for genome-wide chromosome abnormalities and microdeletion syndromes, NIPS service providers continue to offer expanded cfDNA screening, for a slightly more expanded price.
Conclusions: The benefits (clinical efficacy) of
targetted cfDNA NIPS for major autosomal aneuploidies has seen significant
commercial force driving for the implementation of cfDNA NIPS as THE front line
screening test. This concern regarding our understanding of cfDNA NIPS
technology, its benefits and limitations, and associated commercial drivers,
has led some concerned voices to openly question the quality of information and
support provided by NIPS service providers.
Keynote Speaker
Michael J Sinosich
DHM Pathology, Australia
Title: Case studies of prenatal screening
Time: 11:30 - 12:30 (Special Session)
Biography
Michael J Sinosich has completed his PhD on
Trophoblast Physiology and PAPP-A. His research interests include non-invasive
assessment of fetomaternal wellbeing. He is the Director of Prenatal Testing
(DHM Pathology) and serves as Consultant at Pictor Ltd, a developer and
manufacturer of multiplexed microELISA assay platform. He has
published/presented numerous papers in reputed journals and holds several
patents.
Abstract
Prenatal screening is the process by which we identify a population of pregnancies considered at increased risk for a disorder, such as, trisomy 21. Whilst some screens may be clinically more efficient at detecting targeted abnormalities, it should not be forgotten that, prior to initiation of clinical management, ALL abnormal screens should be followed with diagnostic investigations. In this presentation are detailed four case studies which highlight the need for vigilance and caution.
1. Case 1: False Positive cfDNA 2. Case
2: False Negative cfDNA
CFTS
Risk: Tri 21 = 1/69366 CFTS Risk: Tri 21 = 1/5
cfDNA
= Tri 13 (High Risk) cfDNA
= Low risk
Invasive Testing: 46XX Invasive Testing: 47XX + 21
3. Case
3: Fetal Development 4. Case 4: False Negative cfDNA
CFTS
Risk: Tri 21 = 1 / 28 CFTS
Risk: Tri 21 = 14170
cfDNA
= Low risk cfDNA = Low risk
Invasive: 46XX
Invasive: 69XXX
Diagnosis: Skeletal dysplasia + FGR
The above 4 cases highlight the nature of screening,
ie., identifying an at risk population requiring definitive investigation. The
above cases also demonstrate that to maximise screening efficacy, we need to
incorporate complementary screening modalities. Hence, early pregnancy
screening programs should include feto-placental biochemistry, extracellular
DNA and ultrasonography.
Keynote Speaker
Michael J Sinosich
DHM Pathology, Australia
Title: Cell based non-invasive prenatal screening
Time: 11:30 - 12:30 (Special Session)
Biography
Michael J Sinosich has completed his PhD on
Trophoblast Physiology and PAPP-A. His research interests include non-invasive
assessment of fetomaternal wellbeing. He is the Director of Prenatal Testing
(DHM Pathology) and serves as Consultant at Pictor Ltd, a developer and
manufacturer of multiplexed microELISA assay platform. He has
published/presented numerous papers in reputed journals and holds several
patents.
Abstract
Over the past decade, we have witnessed the
convergence of molecular technology and physiology in the development of molecular
diagnostics based on low abundance of template. Application of extracellular
(or cell free, cf) DNA has impacted on every facet of healthcare, such as,
prenatal screening, transplantation, oncology, regenerative and testing for
infections. Furthermore, application of low template detection has been applied
to food industry, environment, forensics and defence.
Figure 1: Investigative options for prenatal
assessment of feto-maternal wellbeing
Presence of fetal cells in maternal circulation was first described over a century ago. By many, the holy grail of non-invasive prenatal screening is considered to be based on genomic (g) DNA derived from feto-placental cells. Target cells include fetal nucleated (fn) red blood cells (RBC), fetal leukocytes (fWBC) and trophoblast cells. For many decades, there have been numerous at developing a sustainable screening program based on gDNA.
Whilst it is generally accepted that concentration of fetal cells in maternal circulation is positively correlated to gestation, current isolation / enrichment protocols generally yield < 1 cell / mL of maternal blood. Fetal cell isolation / enrichment is based on various combinations of physico-chemical (charge, size) + positive/negative immunological confirmation. Single cells are excised by laser dissection. Whilst these processes provide single cells for genotyping, in general, the rate limiting step of immunological confirmation and laser dissection, renders these procedures non-viable for population screening. Clearly, here is situation in need for combination of microfluidics + AI.
Of the numerous efforts to develop robust fetal cell isolation workflow, most have failed to materialise and the remaining focus is now on trophoblast cells. Trophoblast cells are markedly different from blood cell components. Differences include, physical size, membrane physiology and immunological reactivities. Given that trophoblast cells are source of biochemistry markers (PAPP-A, F?hCG) and cfDNA for NIPS testing, then the same caution must be applied, ie., any positive findings based on trophoblast derived gDNA must be confirmed with definitive testing.
Conclusions: Progress towards the holy grail of
non-invasive prenatal fetal genotyping has progressed immensely over the past
decade. Proof of concept studies have demonstrated that preferred cellular
target is trophoblast cell. Technology for single cell genomics is readily
available from many commercial sources. So, the remaining challenge is to
develop microfluidics applicable to population screening.
Speaker
Pawel Szymanowski
Andrzej Frycz Modrzewski Krakow University, Poland
Title: Is hysterectomy still justifiable in pelvic floor surgery?
Time: 13:20 - 13:50
Biography
Pawel Szymanowski graduated medicine from the
Medical School of Hannover and then did a specialization in gynecology and
obstetrics in Germany where he worked for 15 years. He has been the head of
department since 2006. His main focus over the years and still to today is
urogynecology. In 2013 he moved to Poland where he has continued his work in
urogynecology and operative gynecology. He is currently the head of the
Department of Gynecology and Urogynecology at Andrzej Frycz Modrzewski Krakow
University. In May 2017 he became the President of the Polish Urogynecological
Association
Abstract
More than 30% of women in the western world
suffer from different urogynecological diseases like urinary incontinence and
pelvic organ prolapse (POP). In cases of POP the most commonly used operative
procedure is still a hysterectomy with anterior and posterior colporrhaphy even
though the uterus is not the cause of the prolapse. Instead POP is a result of
different defects of fascia and ligaments in the pelvic floor. These defects
should be accurately detected and taken into account when planning operative
treatment. There are plenty of minimally invasive and uterus preserving
laparoscopic methods dedicated to these defects such as: laparoscopic hystero-,
colpo-, cervicosacropexy, pectopexy, laparoscopic lateral repair and
laparoscopic colporrhaphy. The use of minimally invasive, uterus preserving
methods in pelvic floor repair is less of a burden for the patients and reduces
the hospitalization time and recurrence rates immensely. Finally preserving the
uterus is also important for the sense of body integrity and helps to avoid
mental health problems
Biography
Wioletta
K. Szepieniec graduated medicine from the Jagiellonian University in Krakow and
did her specialization in gynecology and obstetrics in Germany where she worked
for 10 years. Her main focus over the years and still to today is urogynecology
but also breast surgery and aesthetic gynecology. In 2014 she moved to Poland
where she has continued her work in urogynecology and operative gynecology. She
is currently senior doctor of the Department of Gynecology and Urogynecology at
Andrzej Frycz Modrzewski Krakow University
Abstract
Introduction and
methods: The aim
of this study
is to show
a novel approach
of the repair
of the lateral
paravaginal defect causing
the cystocele. The
extraperitoneal
(preperitoneal) approach has
its advantages and
can be used
in patients with
comorbidities and in
obese patients. The
main advantage of
this procedure is
omitting of the
pneumoperitoneum and of the Trendelenburg
position during the
operation. The avoiding
of peritoneal adhesions
is also important.
Results: This
study presents the
first results of
this novel approach
on 27 patients.
All of the
patients have a
cystocele POP Q
2 and 59%
of them concomitant
stress urinary incontinence
due to lateral
defect of the
vesico-vaginal fascia. Mean operation time was 80 minutes. After
the operation by all of
the patients was
achieved the reduction
of the cystocele
to POP Q
I or 0.
Follow-up after 6
months revealed only
1 recurrence of
the cystocele. Quality
of life was
controlled with PIFQ
Questionnaire and revealed
a statistical improvement
from average 6,8
point before operation
to average 0,7
points after (p<0,05).
Conclusion: Preperitoneal
laparoscopic lateral defect
repair is a
relatively fast operation.
It is feasible
also for obese
women and for
patients with cardiac
risk, because of
the omitted Trendelenburg
position and pneumoperitoneum. Postoperative
can be achieved
a very satisfied
effect with the
reduction of patient’s
complaints and reduction
of the cystocele.
Biography
On 24 February 2016, Marjeta Logar ?u?ek, MSc is defending her doctoral thesis at the Medical Faculty in Ljubljana. She spent the period between December 2013 and August 2015 researching the influence of health and educational intervention on raising the awareness and consequently improving the responsiveness of the Roma women with regard to their own care for reproductive health. Ms Logar ?u?ek was able to establish and confirm positive influences of education and training on the Roma women’s decisions regarding the choosing of possibilities for the use of health services in the area of reproductive health. A clear connection can also be seen between the use of educational materials and the women being more aware of the consequences of their own decisions. She was the first to start research into the awareness of reproductive health of the Roma women in Slovenia.
Abstract
A prospective interventional research was carried out (between December 2013 and August 2015) with the view to improving Roma women’s care for reproductive health. Within the framework of the entire research, it was carried out in three stages. At the beginning, interviews were conducted with Roma women in their settlement. Their answers provided an insight into their viewpoints regarding reproductive health, the behaviour of health care professionals and the decisions of the women to use the services of the women’s clinic. On the basis of the results of the qualitative analysis of the interviews, an educational leaflet was prepared. The leaflet, which was explained to each particular women that decided to participate in the research, helped raise the Roma women’s awareness regarding reproductive health. They become more familiar with different ways of making appointments, time frame and the need for preventive check-up appointments.
The effectiveness of the leaflet has been checked in two ways, namely using a questionnaire given to all Roma women in the settlement, and two focus groups with health care professionals in the Trebnje health centre.
The results of the first part of the research have shown that the Roma women are still tightly connected to their cultural tradition which greatly influences their care for reproductive health. But significant changes can be observed in terms of their views becoming more and more similar to the majority population, which is particularly apparent in younger generation.
The usefulness of the leaflet is mostly seen in the provision of urgent data regarding the women’s clinic (69%) and in the training for finding a suitable time to see a doctor and make an appointment (73.5%). The answers of women in childbearing age and those before or past it are statistically significantly different. However, it needs to be remembered that educational materials distributed among Roma women have a desired effect only if certain conditions are fulfilled, such as literacy of the target group (at least partial) and the ability of the women to identify with the materials (in this case women in childbearing age.)
Health care
professionals report that raising the health literacy marked the beginning of
positive changes in the reproductive care of Roma women. It can be concluded
that Roma women need and accept educational materials adapted to their values
and tradition, which is changing under the influence of the majority
population.
Speaker
Marya El Alami
University of Valencia, Spain
Title: Relevance of oxygen concentration in stem cells culturing in vitro
Time: 14:50 - 15:20
Biography
El Alami M. has
completed her PhD at the age of 30 years from University of Valencia, Spain.
She has 9 publications. She is a doctor of pharmacy and has a master degree on
pharmacology. She speaks 5 languages.
Abstract
Statement of the problem: The key hallmark of stem cells is their ability to self-renew while keeping a differentiation potential. Intrinsic and extrinsic cell factors may contribute to a decline in these stem cell properties, and this is of the most importance when culturing them. Very much importance was given to the balance of nutrients, growth factors and pH buffers used to grow stem cells in vitro, little importance was given to the oxygen concentration in the culture media, as it was assumed that the ambiental 21% O2 was adequate for cell growth. Oxygen concentration has been closely linked to the maintenance of stemness and the widely used environmental 21% O2 concentration represents a hyperoxic non-physiological condition, that can impair stem cell behaviour by many mechanisms.
The aim of this study: Minimizing the time obtention
of a large amount of viable dental pulp stem cells (DPSC) as critically
important for stem cell banking for clinical use and to study the effect of the
usual, high oxygen concentration (21% O2), compared to the physiological (3%
O2), on the parameters of proliferation, oxidative stress and cell cycle
regulation.
Speaker
Shaikh Zinnat Ara Nasreen
Z H Shikder Women’s Medical College Hospital, Bangladesh
Title: Progesterone-to support pregnancy; Analysis of meta- analysis
Time: 15:20 - 15:50
Biography
Professor
Shaikh Zinnat ara Nasreen is working relentlessly for the improvement of
women’s health. She has graduated from Dhaka medical college in 1984 with
honours marks in Medicine and in anatomy. She obtained Gold Medal for
extraordinary academic activities. Later she obtained her FCPS degree from BCPS
and Mph from North South University. She also got MRCOG and FRCOG from Royal
college of Obs/Gyne, UK. She is at present working as professor and Head of
obs/gyne dept of ZHSikder women’s medical college and hospital, Dhaka. She has
national and international publication and she had attended several international
conferences. At present she is the secretary general of BMS and organizing
secretary of OGSB, and Member secretary of BCPS.
Abstract
Pregnancy
loss brings tremendous psychological effect. Empirical treatments are aspirin,
heparin and progesterone. Progesterone from corpus luteum, placenta is the key
hormone for implantation and maintenance of pregnancy. Much work is going on
since 1940, removal of corpus luteum is associated with pregnancy loss but
replacement with progesterone can help to maintain the pregnancy. Progesterone
antagonists readily induces abortion. Deficiency of progesterone may lead to
Pre term birth (PTB). The safety of progesterone was reported and showed no
anomalies.
Meta-analysis of 60 RCT (1989) showed that
pregnancies reached at least 20 weeks RR =3.09 (95% CI 1.28-7.42) with
progesterone and meta-analysis (2002) suggested luteal support with
progesterone is superior to HCG. Level evidence 1 support, progesterone
prevents PTB. On the contrary study by Mohammed reported, progesterone in any
route proved to have limitation and side effects. Meta-analysis of 25 articles
stated luteal support of progesterone is unnecessary for it, slow benefits,
costs and side effects. Meta-analysis of
53 publications by Leyan showed progesterone resulted increase in pregnancy
rate odds (OR= I.12; p<0.01), but the study of Stephanie Castillo (PROMISE)
reflected, benefit of progesterone is not proven for miscarriage. Amanda (2017) showed that 2/3 of women who used
progesterone, successfully delivered despite they had previous two
miscarriages. Meta-analysis of 10 RCT by Saccon G showed progesterone in 1st
trimester lowered risk for pregnancy loss (RR 0.72; 95% CI, 0.53-0.97).
Suk-Joo
Choi stated, progesterone is effective in preventing PTB. Meta-analysis
analysed 39 RCT showed lowered risk of PTB with progesteron. In contrast
OPTIMUM and PROGRESS trials found no significant benefits but OPTIMUM study
showed progesterone reduces PTB where Cervix is shortened. Progesterone is not
effective for preventing PTB following PROM.
Meta-analysis
of 168 articles (Salim Daya) suggested use of progesterone but efficacy has not
been demonstrated. Mesen supported exogenous progesterone for Luteal phase
support in ART. Meta-analysis by
Katherene 2017 concluded, progesterone as luteal support is beneficial, live
birth rate (RR 1.77, 95% CI 1.30-2.42).
Conclusion
Analysis of
Meta-analysis suggested, progesterone supports pregnancy. But the optimum dose,
type, route, nature, duration and starting time are not been evaluated.
