Supporting practitioners to talk about sexual wellness and pleasure during radiotherapy for gynaecological cancer.

INTRODUCTION: Radiotherapy treatment for gynaecological cancer has significant negative effects on sexual wellness and pleasure (1-3). Patients undergoing radiotherapy for gynaecological cancers have more sexual dysfunction and experience more sexual and depressive symptoms than those who undergo surgery alone (4). The World Health Organization defines sexual health as a crucial part of health and wellbeing and recognizes the importance of positive and respectful approaches to sexuality, alongside safe and pleasurable sexual experiences free from violence and coercion (5). METHODS: Taking a sex critical approach to sexual wellness and pleasure, this project aimed to support practitioners to have improved and impactful conversations with people receiving radiotherapy treatment for gynaecological cancers. A series of three professional development workshops were held to explore language, unpack assumptions and develop key competencies for practitioners. A fourth workshop involved co-development of resources for use by other practitioners. RESULTS: The group united, sharing insights, learning, and developing practices through reflection developing critical awareness about damaging silences around sexual wellness and pleasure. Co-created resources included conversation cards and a poster. CONCLUSION: The project aimed to build and extend research findings to develop practitioner skills in supporting sexual wellness and pleasure for people receiving gynae-radiotherapy. The study shows the benefits of discussing norms and harms associated with biomedically focused conversations in gynae-radiotherapy to acknowledge diversity and validate concerns about sexual wellbeing and pleasure. IMPLICATIONS FOR PRACTICE: A sex critical approach to sexual wellness and pleasure should be considered a core principle of care for patients during their treatment for gynaecological cancers. Conversations are a key (free) resource within the practitioner-patient relationship that can address and improve patients' psychosocial wellbeing.

Choice and birth method: mixed-method study of caesarean delivery for maternal request.

OBJECTIVE: To explore whether women view decision-making surrounding vaginal or caesarean birth as their choice. DESIGN: Longitudinal cohort study utilising quantitative (questionnaire, routinely collected data) and qualitative (in-depth interviews) methods simultaneously. SETTING: A large hospital providing National Health Service maternity care in the UK. SAMPLE: Four-hundred and fifty-four primigravid women. METHODS: Women completed up to three questionnaires between their antenatal booking appointment and delivery. Amongst these women, 153 were interviewed at least once during pregnancy (between 24 and 36 weeks) and/or after 12 moths after birth. Data were also obtained from women's hospital delivery records. Descriptive statistical analysis was performed (survey and delivery data). Interview data were analysed using a seven-stage sequential form of qualitative analysis. RESULTS: Whilst many women supported the principle of choice, they identified how, in practice their autonomy was limited by individual circumstance and available care provision. All women felt that concerns about their baby's or their own health should take precedence over personal preference. Moreover, expressing a preference for either vaginal or caesarean birth was inherently problematic as choice until the time of delivery was neither static nor final. Women did not have autonomous choice over their actual birth method, but neither did they necessarily want it. CONCLUSIONS: The results of this large exploratory study suggest that choice may not be the best concept through which to approach the current arrangements for birth in the UK. Moreover, they challenge the notion of choice that currently prevails in international debates about caesarean delivery for maternal request.

Cloning and expression of a mouse member of the PLUNC protein family exclusively expressed in tongue epithelium.

Palate, lung, and nasal epithelium clone (Plunc, now renamed Splunc1) is a small secreted protein expressed in the oropharynx and upper airways of humans, mice, rats, and cows. This protein is structurally homologous to known mediators of host defense against gram-negative bacteria. We have characterized the genomic sequence and expression of a novel but closely related gene from rodents, which we call splunc5. Mouse Splunc5 sequence is 60% identical to mouse Splunc1. The genes also share highly conserved genomic elements including intron-exon structure and intronic sequence. Strikingly, splunc5 is expressed exclusively in the interpapillary epithelium of the tongue's dorsal surface. By comparing the expression profiles of splunc5, splunc1, and a third related sequence, lplunc1, in mice, we show that these genes are expressed in unique domains along a continuous corridor of oral, lingual, pharyngeal, and respiratory epithelia. This expression pattern is consistent with the hypothesis that these proteins protect epithelial surfaces colonized by potentially pathogenic microorganisms.

Genomic organization of the mouse plunc gene and expression in the developing airways and thymus.

Few genes have been isolated which display specific expression in the proximal airways. A recently identified mouse cDNA, plunc, appears to be confined to the upper airways and nasopharyngeal epithelium, and may prove a useful marker for these regions. We now report the genomic cloning and characterization of the mouse plunc gene as well as its developmental expression in the nasal and airway epithelium. We also report the novel finding that plunc is also expressed in the medullary compartment of the murine thymus. The mouse gene contains nine exons and the intron-exon boundaries are conserved with those in the human homologue. At e14.5 plunc is expressed in the nasal epithelium and several days later is seen in the thymic lobes, but not in the lining of the tracheobronchial tree. Expression in the trachea and main-stem bronchi first appears at 1--2 days after birth. Tracheobronchial expression persists at high levels throughout adulthood, as do regional areas of nasal and thymic expression. Finally, we show that the human homologue is expressed in bronchial epithelium, suggesting a transcript that is evolutionarily conserved in the mammalian airway.

Exon skipping in Mcl-1 results in a bcl-2 homology domain 3 only gene product that promotes cell death.

Mcl-1 is a member of the Bcl-2 family that is regulated transcriptionally and post-transcriptionally, with expression of the full-length Mcl-1-encoded gene product resulting in enhanced cell survival. As reported here, the human Mcl-1 gene can also undergo differential splicing, which yields an internally deleted, death-inducing gene product, Mcl-1(s/Delta)(TM). Whereas full-length Mcl-1 derives from three coding exons (instead of the two present in Bcl-2 and other anti-apoptotic members of this family), the Mcl-1(s/Delta)(TM) splice variant results from the joining of the first and third exons with skipping of the central exon. Because of the skipped exon and a shift in the reading frame downstream, the Bcl-2 homology domain (BH3) remains intact, whereas the BH1-, BH2-, and transmembrane-encoding domains do not. Mcl-1(s/Delta)(TM) thus has features similar to BH3 only, pro-apoptotic Bcl-2 family members and, accordingly, was found to promote cell death. In addition to a variety of other types of regulation, the Mcl-1 gene appears ideally designed for the generation of either a Bcl-2-like viability promoting or, as reported here, a BH3 only death-inducing gene product.

Characterization and growth-depressing activity for chickens of several natural phenolic materials.

Several natural phenolic materials were analyzed for gallic acid and were further characterized for dialyzability and flavonoid content. These materials were added to a diet and fed to broiler strain chicks for 4 weeks. The depression in growth caused by these phenolic materials was compared with that of tannic acid on a gallic acid equivalency basis. The activities relative to tannic acid (congruent to 100) were as follows: methyl gallate, 195; valonia, 117; wattle, 114; allepo tannic acid, 107; eucalyptus, 105, myrobalan, 98; tara crystals, 76; mangrove, 72; quebracho, 39; gallic acid, and ellagic acid, O. It was impossible to clearly relate the growth depressing activity of the materials to hydrolyzability or relative content of smaller phenols.