Purpose Bacterial vaginosis (BV) is a dysbiosis of the vaginal microbiome and a condition found in 20-30% of all women. Literature describing the possible link between BV and subfertility is... Show morePurpose Bacterial vaginosis (BV) is a dysbiosis of the vaginal microbiome and a condition found in 20-30% of all women. Literature describing the possible link between BV and subfertility is increasing. Newer techniques such as quantitative polymerase chain reactions (qPCR) detect BV more accurately than traditional methods but come with high costs. The association between pH and BV as diagnosed using traditional methods is well-established in a symptomatic population. This study is the first to investigate the association between pH and BV diagnosed by qPCR in an asymptomatic subfertile population and to examine the usefulness of pH as a means of cost reduction.Methods Data of 170 pH-qPCR combinations were used from a prospective cohort study examining bacterial vaginosis in a subfertile population. 102 women received a vaginal swab and pH measurement at baseline and subsequent advanced reproductive technology (ART) treatments. The swabs are analysed using the -AmpliSens (R) Florocenosis/Bacterial vaginosisFRT qPCR kit.Results pH is strongly associated with BV as diagnosed by qPCR (OR 3.06, p = 0.000, CI 1.65-5.68). The cut-off point for pH >= 4.7 maximised diagnostic performance [AUC 0.74 (CI 0.66-0.83), sensitivity 76%] and reduced costs by 60%.Conclusion This study shows that the vaginal pH for a multi-ethnic, asymptomatic population of women attending fertility clinics is strongly associated with BV qPCR outcome. Using the cut-off of pH of 4.7 has a high sensitivity for diagnosis of BV by qPCR and can be achieved at a cost reduction of 60%. Show less
Longitudinal growth is the key characteristic that distinguishes children from adults. Growth is regulated in the growth plates, which are layers of cartilage located at the ends of the long bones.... Show moreLongitudinal growth is the key characteristic that distinguishes children from adults. Growth is regulated in the growth plates, which are layers of cartilage located at the ends of the long bones. The cartilage cells are called chondrocytes and go through a coordinated program of proliferation, maturation, hypertrophic differentiation, apoptosis and replacement by bone. This process is called endochondral bone formation. A complex network of hormones (endocrine regulators) is involved in this process. The mechanism of actions of these hormones is not completely understood. A possible mechanism of action is the interaction of systemic hormones with locally produced growth factors (paracrine regulators), like the Parathyroid Hormone (PTH) related Peptide (PTHrP) and its receptor, the type 1 PTH/PTHrP receptor (PTHR1). PTHrP and PTHR1 are among the key regulators in the process of endochondral bone formation. The working mechanism of PTHrP signalling, alone or in combination with other growth factors or systemic hormones, in endochondral bone formation is not completely understood. In this thesis, we have further addressed the actions of PTHrP in the complex network of endocrine and paracrine regulation of endochondral bone formation. Show less
