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<strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> <strong>and</strong> Gynaecology<br />

26 th Annual<br />

RESEARCH<br />

DAY<br />

FRIDAY, MAY 8, 2009<br />

8:00 a.m. – 6:30 p.m.<br />

Emmanuel College, 1st Floor<br />

Victoria <strong>University</strong>, 75 Queen’s Park<br />

<strong>University</strong> <strong>of</strong> <strong>Toronto</strong><br />

HENDERSON LECTURE: 4:15 p.m. – 5:15 p.m.<br />

“Burning the C<strong>and</strong>le at Both Ends – A Telomere Theory <strong>of</strong> Reproductive Aging"<br />

David L Keefe MD<br />

James M. Ingram Pr<strong>of</strong>essor <strong>and</strong> Chairman,<br />

<strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> <strong>and</strong> Gynecology,<br />

<strong>University</strong> <strong>of</strong> South Florida College <strong>of</strong> Medicine.<br />

WINE & CHEESE RECEPTION: 5:20 – 6:30 P.M.


DEPARTMENT OF OBSTETRICS AND GYNAECOLOGY<br />

UNIVERSITY OF TORONTO<br />

26 th ANNUAL RESEARCH DAY<br />

Fri<strong>day</strong> May 8, 2009<br />

TABLE OF CONTENTS<br />

Page<br />

1. Programme-at-a-Glance .…... 2<br />

2. Programme .…... 5<br />

3. – Oral Sessions I & II (a.m.) .…... 5, 12<br />

4. – Poster Session I (a.m.) .…... 6<br />

5. – Oral Session III (p.m.) .……13<br />

6. – Poster Session II (p.m.) .…....14<br />

7. Henderson Lecture .…... 21, 22<br />

8. Awards .…... 23<br />

9. Oral Abstracts .…...25<br />

10. Poster Abstracts .…...40<br />

11. Index <strong>of</strong> Presenters<br />

– by Last Name .…... 99<br />

– by Abstract # & Session .…...102


2<br />

PROGRAMME-AT-A-GLANCE<br />

(A.M.)<br />

7:30 a.m. on Poster Set-up for Poster Session I [EM 1 st floor W Entrance Hall 106V,<br />

100K Foyer & Rm 108]<br />

8:00 a.m. Registration & Continental Breakfast [EM 1st floor Foyer 100V]<br />

8:25 – 8:30 a.m. Welcome: Dr. Alan Bocking, Chair [EM 1 st floor Rm 119]<br />

8:30 – 9:30 a.m. Oral Session I (O1-O4) [EM 1 st floor, Rm 119]<br />

Chair: Dr. Isabella Caniggia; Judges: Drs. Gareth Seaward, Theodore J<br />

Brown & John Kingdom<br />

9:30 – 10:00 a.m. C<strong>of</strong>fee Break & Poster Session I Walkabout [EM 1 st floor W Entrance<br />

Hall 106V, 100K Foyer & Rm 108]<br />

10:00 – 11:00 a.m. Poster Session I Tour [EM 1 st floor W Entrance Hall 106V, 100K Foyer &<br />

Rm 108]<br />

Groups A-F<br />

Group: Chairs/Judges; Judge<br />

A: Drs. Bhagu Bhavnani & Jennifer Blake; Dr. Hani Akoury<br />

B: Drs. Stephane Laframboise & Ian Rogers; Dr. Titus Owolabi<br />

C: Drs. May Alarab & Lisa Allen; Dr. Isabella Caniggia<br />

D: Drs. Wendy Whittle & Christine Derzko; Dr. Michelle Letarte<br />

E: Drs. Theodore J Brown & Marcus Bernardini; Dr. Wusun Paek<br />

F: Drs. Joan Murphy & John Kingdom; Dr. Richard Pittini<br />

Poster Takedown for a.m. session<br />

Until 2:40 p.m.<br />

Poster Set-up for p.m. session [EM 1 st floor W Entrance Hall 106V, 100K<br />

Foyer & Rm 108]<br />

11:00 – 12:00 noon Oral Session II (O5-O8) [EM 1 st floor Rm 119]<br />

Chair: Dr. Joan Murphy; Judges: Drs. Lee Adamson & Harold Drutz<br />

12:05 – 1:05 p.m. Lunch [Dining Room, Burwash Hall]


3<br />

PROGRAMME-AT-A-GLANCE<br />

(P.M.)<br />

1:10 – 2:40 p.m. Oral Session III (O9-O14) [EM 1 st floor Rm 119]<br />

Chair: Dr. Ellen Greenblatt; Judges: Drs. Steve Matthews & Rose<br />

Kung<br />

2:40 – 3:10 p.m. C<strong>of</strong>fee Break & Poster Session II Walkabout [EM 1 st floor W Entrance<br />

Hall 106V, 100K Foyer & Rm 108]<br />

3:10 – 4:10 p.m. Poster Session II Tour [EM 1 st floor W Entrance Hall 106V, 100K Foyer<br />

& Rm 108]<br />

Groups G-L<br />

Group: Chairs/Judges; Judge<br />

G: Drs. Andrea Lausman & Robert Casper; Dr. Knox Ritchie<br />

H: Drs. Ori Nevo & Filomena Meffe; Dr. Heather Shapiro<br />

I: Drs. Jon Barrett & Andrea Jurisicova; Dr. Sony Sierra<br />

J: Drs. Guylaine Lefebvre & Clifford Librach; Dr. Theodore J Brown<br />

K: Drs. Grace Liu & Jason Dodge; Dr. Cynthia Maxwell<br />

L: Drs. Howard Berger & Lee Adamson; Dr. Nan Okun<br />

Poster Takedown<br />

4:15 – 5:15 p.m. Henderson Lecture [EM 1 st floor Rm 119]<br />

Dr. David L Keefe<br />

James M. Ingram Pr<strong>of</strong>essor <strong>and</strong> Chairman,<br />

<strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> <strong>and</strong> Gynecology,<br />

<strong>University</strong> <strong>of</strong> South Florida College <strong>of</strong> Medicine<br />

Topic: “Burning the C<strong>and</strong>le at Both Ends – A Telomere Theory <strong>of</strong><br />

Reproductive Aging"<br />

5:15 – 5:20 p.m. Closing Remarks: Dr. Alan Bocking [EM 1 st floor Rm 119]<br />

5:20 – 6:30 p.m. Wine & Cheese Reception <strong>and</strong> JW Knox Ritchie Research Awards &<br />

Papsin Award Presentations [Dining Room, Burwash Hall]


5<br />

PROGRAMME<br />

26TH ANNUAL RESEARCH DAY<br />

Fri<strong>day</strong> May 8, 2009<br />

Emmanuel College, 1 st Floor, Victoria <strong>University</strong>,<br />

75 Queen’s Park, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong><br />

7:30 a.m. on Poster Set-up for Poster Session I [EM 1 st floor W Entrance Hall 106V,<br />

100K Foyer & Rm 108]<br />

8:00 a.m. Registration & Continental Breakfast [EM 1 st floor Foyer 100V]<br />

8:25 – 8:30 a.m. Welcome: Dr. Alan Bocking, Chair [EM 1 st floor Rm 119]<br />

8:30 – 9:30 a.m. ORAL SESSION I<br />

Oral Session I (O1-O4) (4 presentations @15 minutes – 10 minute presentation + 5 minutes for<br />

questions) [EM 1 st floor, Rm 119]<br />

Chair/Judge: Dr. Isabella Caniggia<br />

Judges: Drs. P. Gareth Seaward, Theodore J Brown & John Kingdom<br />

8:30-8:45 O1 CO-ENZYME Q10 SUPPLEMENTATION IMPROVES OVARIAN<br />

RESPONSE AND MITOCHONDRIAL FUNCTION IN AGED MICE.<br />

Eliezer Burstein[F](1)(2), Alla Perumalsamy (2), Yaakov Bentov (1)(2),Navid<br />

Esf<strong>and</strong>iari (1), Andrea Jurisicova (2) <strong>and</strong> Robert F. Casper (1)(2).<br />

(1)<strong>Toronto</strong> Center for Advanced Reproductive Technologies (TCART), (2) Samuel<br />

Lunenfeld Research Institute (SLRI).<br />

8:45-9:00 O2 WHAT WOMEN WANT: PATIENTS’ PREFERENCES ABOUT<br />

REPORTING OF ULTRASOUND SOFT MARKERS<br />

Rebecca Cash [R] (1), Myuri Manogaran (2), Hana Sroka (3), Nan Okun<br />

(1)<strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> <strong>and</strong> Gynecology, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>, (2) <strong>University</strong><br />

<strong>of</strong> <strong>Toronto</strong>, (3) <strong>Department</strong> <strong>of</strong> Genetics, Mount Sinai Hospital (4) Maternal Fetal<br />

Medicine Division, <strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> <strong>and</strong> Gynecology, Mount Sinai<br />

Hospital<br />

9:00-9:15 O3 VEPH1 IS A NOVEL REGULATOR OF TGF-ß SIGNALING IN<br />

OVARIAN CANCER CELLS.<br />

Premalatha Shathasivam[G](1,2,3), J Wrana(1,4), <strong>and</strong> TJ Brown(1,2,3).<br />

(1)Samuel Lunenfeld Research Institute, Mount Sinai Hospital; <strong>Department</strong>s <strong>of</strong><br />

(2)Physiology, (3)<strong>Obstetrics</strong> <strong>and</strong> Gynaecology, <strong>and</strong> (4)Medical Genetics <strong>and</strong><br />

Microbiology, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>


6<br />

9:15-9:30 O4 DISSECTING THE MOLECULAR PATHWAY OF NALP5 IN<br />

MURINE EMBRYO DEVELOPMENT (Work in Progress)<br />

Alagammal Perumalsamy [PD] (1), Roxanne Fern<strong>and</strong>es (1,3), Andrea Jurisicova<br />

(1,2,3). (1)Samuel Lunenfeld Research Institute, (2) <strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> &<br />

Gynaecology, Mount Sinai Hospital, (3) <strong>Department</strong> <strong>of</strong> Physiology, <strong>University</strong> <strong>of</strong><br />

<strong>Toronto</strong>.<br />

9:30 – 11:00 a.m. POSTER SESSION I<br />

9:30 – 10:00 a.m. C<strong>of</strong>fee Break & Poster Session I Walkabout [EM 1 st floor W Entrance<br />

Hall 106V, 100K Foyer & Rm 108]<br />

10:00 – 11:00 a.m. Poster Session I Tour (3-5 minute presentation + 5 minutes for questions)<br />

[EM 1 st floor W Entrance Hall 106V, 100K Foyer & Rm 108]<br />

Groups A-F<br />

GROUP A:<br />

Chairs/Judges: Drs. Bhagu Bhavnani & Jennifer Blake<br />

Judge: Dr. Hani Akoury<br />

P-A1 TRANSOBTURATOR TAPE FOR THE TREATMENT OF STRESS<br />

URINARY INCONTINENCE: EFFECTIVENESS AND PREDICTORS OF<br />

OUTCOME<br />

Maria Augusta T. Bortolini[F], Victor Mir<strong>and</strong>a, Raed S. Ahmed, Andrea Lischka,<br />

Heng R. Wang, May Alarab, Danny Lovatsis, Harold P. Drutz<br />

Urogynaecology Division, <strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> & Gynaecology, Mount Sinai<br />

Hospital.<br />

P-A2 INCREASED MATERNAL PERIPHERAL WHITE BLOOD CELL<br />

COUNT IS A MARKER OF ACTIVE HUMAN LABOUR.<br />

Oksana Shynlova [O](1), Craig Pennell (4), Wendy Whittle (1,2) <strong>and</strong> Stephen Lye<br />

(1,2,3). (1) Samuel Lunenfeld Research Institute, Mount Sinai Hospital, (2)<br />

<strong>Department</strong>s Ob/Gyn <strong>and</strong> (3) Physiology, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>, (4) School <strong>of</strong><br />

Women’s <strong>and</strong> Infants` Health, <strong>University</strong> <strong>of</strong> Western Australia, Perth, Australia<br />

P-A3 CANADIAN HEALTH POLICY CHANGE ANALYSIS: THE HPV<br />

VACCINE TRUST<br />

Jacob McGee [F] (1,2), Jennifer Keelan (2)<br />

(1) Gynaecologic Oncology, <strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> & Gynaecology, <strong>University</strong><br />

<strong>of</strong> <strong>Toronto</strong>, (2) Dalla Lana School <strong>of</strong> Public Health, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>


7<br />

P-A4 PHENOTYPE OF EARLY ONSET INTRAUTERINE GROWTh<br />

RESTRICTION (IUGR)<br />

Nihal Al Riyami [F](1), Leslie Proctor(1)Yoav Yinon(1), Elizabeth Winsor(2),<br />

John Kingdom(1)<br />

(1)<strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> <strong>and</strong> Gynaecology (Division <strong>of</strong> Maternal Fetal<br />

Medicine); (2)<strong>Department</strong> <strong>of</strong> Laboratory Medicine <strong>and</strong> Pathobiology; Mount Sinai<br />

Hospital; <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>.<br />

P-A5 CHARACTERIZATION OF THE SMAC FVB PHENOTYPE IN<br />

MURINE OOCYTES<br />

(Work-in-Progress)<br />

Roxanne Fern<strong>and</strong>es [G](1,2), Han Li (2), Hitoshi Okada (4), Andrea Jurisicova<br />

(1,2,3) (1) <strong>Department</strong> <strong>of</strong> Physiology, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>, (2) Samuel Lunenfeld<br />

Research Institute, Mount Sinai Hospital, (3) <strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> &<br />

Gynaecology, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>,<br />

(4) Ontario Cancer Institute, <strong>University</strong> Health Network<br />

GROUP B:<br />

Chairs/Judges: Drs. Stephane Laframboise & Ian Rogers<br />

Judge: Dr. Titus Owolabi<br />

P-B1 ANGIOGENIC CD56 bright NATURAL KILLER CELLS<br />

ACCUMULATE IN THE FOLLICULAR FLUID OF PATIENTS<br />

UNDERGOING IN VITRO FERTILIZATION<br />

Ofer Fainaru[F](1), Hagay Amsalem(2) <strong>and</strong> Robert F Casper (1)<br />

(1)<strong>Toronto</strong> Centre for Advanced Reproductive Technology, Division <strong>of</strong><br />

Reproductive Sciences, <strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> <strong>and</strong> Gynaecology, <strong>University</strong> <strong>of</strong><br />

<strong>Toronto</strong>, Samuel Lunenfeld Research Institute, Mount Sinai Hospital, (2)Maternal-<br />

Fetal Medicine Division, <strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> & Gynaecology, Mount Sinai<br />

Hospital.<br />

P-B2 LACTOBACILLUS RHAMNOSUS GR-1 STIMULATES<br />

GRANULOCYTE-COLONY STIMULATING FACTOR (G-CSF) OUTPUT<br />

IN PLACENTAL TROPHOBLAST CELLS IN A FETAL SEX-DEPENDANT<br />

MANNER<br />

Maryam Yeganegi[G](1,3), Chiashan G Leung(1), Andrew Martins(2), Sung O<br />

Kim(2), Gregor Reid(2), John RG Challis (1), Alan D Bocking(1,3).<br />

(1) <strong>Department</strong> <strong>of</strong> Physiology & <strong>Obstetrics</strong> <strong>and</strong> Gynaecology, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong><br />

(2) <strong>Department</strong> <strong>of</strong> Microbiology & Immunology, <strong>University</strong> <strong>of</strong> Western Ontario,<br />

London, Ontario, (3) Samuel Lunenfeld Research Institute, Mount Sinai Hospital.


8<br />

P-B3 UNDERSTANDING THE BURDEN OF CARDIAC DISEASE<br />

AMONG PREGNANT WOMEN AT MOI TEACHING AND REFERRAL<br />

HOSPITAL IN ELDORET, KENYA: A RETROSPECTIVE REVIEW<br />

Heather C Millar[M](1), Rachel F. Spitzer(1,2), Mathew Sermer(1,2), Hillary<br />

Mabeya(3), Elkanah Omenge(3).<br />

(1)<strong>University</strong> <strong>of</strong> <strong>Toronto</strong>; (2)<strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> & Gynaecology, Mount Sinai<br />

Hospital; (3) Moi Teaching <strong>and</strong> Referral Hospital, Eldoret, Kenya<br />

P-B4 ENDOMETRIAL PROTECTION AND SYMPTOM CONTROL OF A<br />

NOVEL REGIMEN OF COMBINATION HORMONE REPLACEMENT<br />

THERAPY USING VAGINAL PROGESTERONE<br />

Jamie Kr<strong>of</strong>t[R], Natalie Klostermann, Evan Taerk, Wendy Wolfman.<br />

<strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> <strong>and</strong> Gynaecology, Mount Sinai Hospital, <strong>University</strong> <strong>of</strong><br />

<strong>Toronto</strong>.<br />

P-B5 LOW VITAMIN D LEVELS IN AN URBAN PRENATAL<br />

POPULATION: DOES SEASONALOR TRIMESTER VARIATION<br />

EXPLAIN IT ALL IMPLICATIONS FOR SUPPLEMENTATION<br />

Diane Ahn [O](1) Christine M. Derzko (2), Amy Strauss (3), Gemma Baik (4)<br />

(1) Dalhousie Medical School, Halifax, Nova Scotia, (2)Reproductive<br />

Endocrinology <strong>and</strong> Infertility <strong>and</strong> Menopause, Division <strong>of</strong> Endocrinology,<br />

<strong>Department</strong> <strong>of</strong> Medicine, St. Michael’s Hospital, (3) Division <strong>of</strong> Endocrinology, St.<br />

Michael’s Hospital, (4) <strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> & Gynecology, St. Michael’s<br />

Hospital<br />

GROUP C:<br />

Chairs/Judges: Drs. May Alarab & Lisa Allen<br />

Judge: Dr. Isabella Caniggia<br />

P-C1 EARLY TRANSVAGINAL ULTRASOUND AT 13-15 WEEKS IS<br />

HIGHLY EFFECTIVE IN DETECTION OF FETAL ANOMALIES.<br />

Erika Frasca [M](1), Ants Toi (2), David Chitayat (3), Dan Farine (4), Karen<br />

Chong (3), Katherine Fong K. (2), Ori Nevo (5). (1) Faculty <strong>of</strong> Medicine,<br />

<strong>University</strong> <strong>of</strong> <strong>Toronto</strong>, (2) <strong>Department</strong> <strong>of</strong> Medical Imaging, Mount Sinai Hospital,<br />

(3) Prenatal Diagnosis <strong>and</strong> Medical Genetics Program, Mount Sinai Hospital (4)<br />

Maternal Fetal Medicine, <strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> <strong>and</strong> Gynaecology, Mount Sinai<br />

Hospital, 5) Maternal-Fetal Medicine, <strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> <strong>and</strong> Gynaecology,<br />

Sunnybrook Health Sciences Centre. <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>.


9<br />

P-C2 ESTROGEN EXTRACTION FROM MICRODROP CLINICAL<br />

SAMPLES BY DIGITAL MICROFLUIDICS<br />

Noha Mousa [G] (1), M.J.Jebrail (2), H. Yang, M. Abdelgawad(2), P. Metalnikov<br />

(3), A.R.Wheeler (2), Robert Casper (4) (1)Institute <strong>of</strong> Medical Science, Mount<br />

Sinai Hospital, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>, (2) <strong>Department</strong> <strong>of</strong> Chemistry, <strong>University</strong> <strong>of</strong><br />

<strong>Toronto</strong>, (3) Ontario Cancer Biomarker Network, <strong>Toronto</strong>, (4)<strong>Department</strong> <strong>of</strong><br />

<strong>Obstetrics</strong> <strong>and</strong> Gynecology, Mount Sinai Hospital <strong>and</strong> the <strong>University</strong> <strong>of</strong> <strong>Toronto</strong><br />

P-C3 A COMPARATIVE COST ANALYSIS OF LAPAROSCOPIC<br />

HYSTERECTOMY VERSUS ABDOMINAL HYSTERECTOMY<br />

Clarissa Bambao[F], Romy Nitsch, Sasha Svystonyuk, Grace Liu, Herb Wong.<br />

<strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> <strong>and</strong> Gynaecology, Sunnybrook Health Sciences Centre,<br />

<strong>University</strong> <strong>of</strong> <strong>Toronto</strong>.<br />

P-C4 PRETERM PERMATURE RUPTURE OF MEMBRANES IN THE<br />

PRESENCE OF CERCLAGE: IS THE RISK FOR INTRA-UTERINE<br />

INFECTION INCREASED<br />

Matthew D Laskin[R](1), Yoav Yinon[F](2), Wendy Whittle(2).<br />

(1) <strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> & Gynaecology, Mount Sinai Hospital, <strong>University</strong> <strong>of</strong><br />

<strong>Toronto</strong>, (2) Maternal-Fetal Medicine Division, <strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> &<br />

Gynaecology, Mount Sinai Hospital, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>.<br />

GROUP D:<br />

Chairs/Judges: Drs. Wendy Whittle & Christine Derzko<br />

Judge: Dr. Michelle Letarte<br />

P-D1 HEREDITARY PERSISTENCE OF FETAL HEMOGLOBIN IN<br />

PREGNANCY<br />

Ally Murji [R], Rajiv Shah, Howard Berger<br />

<strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> <strong>and</strong> Gynaecology, St. Micheal’s Hospital, <strong>University</strong> <strong>of</strong><br />

<strong>Toronto</strong>,<br />

P-D2 CRYOPRESERVATION OF OOCYTES: A RANDOMIZED<br />

CONTROLLED TRIAL COMPARING SLOW-FREEZING TO<br />

VITRIFICATION<br />

Tina Lo (F), Ellen Greenblatt, Toni Di Berardino<br />

Mount Sinai Centre for Fertility <strong>and</strong> Reproductive Health, <strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong><br />

<strong>and</strong> Gynaecology, Mount Sinai Hospital.<br />

P-D3 REPEAT STI SCREENING IN ADOLESCENT OBSTETRIC<br />

PATIENTS<br />

Anjali Aggarwal [F](1,2), Rachel F Spitzer (1,2), Nicolette Caccia (1,2), Lisa<br />

Allen (1,2)<br />

(1)<strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> <strong>and</strong> Gynaecology, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>, (2)Hospital<br />

for Sick Children.


10<br />

P-D4 DIFFERENTIAL EXPRESSION OF VON HIPPEL LINDAU (VHL)<br />

PROTEIN IN PHYSIOLOGICAL AND PATHOLOGICAL HUMAN<br />

PLACENTATION AND ITS ROLE IN FIBRONECTIN EXPRESSION<br />

Livia Deda [G] (1,2,3), Stacey Zamudio (4) <strong>and</strong> Isabella Caniggia, (1,2,3)<br />

(1) Mount Sinai Hospital, Samuel Lunenfeld Research Institute, <strong>Department</strong>s <strong>of</strong> (2)<br />

Physiology <strong>and</strong> (3) <strong>Obstetrics</strong> <strong>and</strong> Gynaecology Faculty <strong>of</strong> Medicine, <strong>University</strong> <strong>of</strong><br />

<strong>Toronto</strong> (4) <strong>Obstetrics</strong> <strong>and</strong> Gynaecology & Women's Health, New Jersey Medical<br />

School, Newark, NJ.<br />

P-D5 THE POTENTIAL ROLE OF HLA-G IN HUMAN FIRST<br />

TRIMESTER UMBILICAL CORD STEM CELLS<br />

Rong Xiao[PD], Wei Gong, Yu Peng, Junhai Zhao <strong>and</strong> Clifford L. Librach<br />

<strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> <strong>and</strong> Gynaecology, Sunnybrook Health Sciences Centre<br />

<strong>and</strong> Women’s College Hospital, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong><br />

GROUP E:<br />

Chairs/Judges: Theodore J Brown & Marcus Bernardini<br />

Judge: Dr. Wusun Paek<br />

P-E1 THE ROLE OF ANDROGEN SIGNALING IN THE ONSET OF<br />

LABOR. (WORK-IN-PROCESS)<br />

Yunqing Li [G] (1,2), Oksana Shynlova (1), Xuesen Dong (4), Stephen J Lye<br />

(1,2,3).<br />

(1)Samuel Lunenfeld <strong>research</strong> Institute, Mount Sinai Hospital, <strong>Department</strong> <strong>of</strong> (2)<br />

Physiology <strong>and</strong> (3)<strong>Obstetrics</strong> & Gynaecology, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>, (4)Prostate<br />

Center at Vancouver General Hospital, <strong>University</strong> <strong>of</strong> British Columbia.<br />

P-E2 OXYTOCIN PREEXPOSURE DOES NOT AFFECT OXYTOCIN<br />

INDUCED MYOMETRIAL CONTRACTIONS IN TERM PREGNANT<br />

WOMEN<br />

Mrinalini Balki (1), Magda Erik-Soussi [O](1), Robert K. Parkes (1), John<br />

Kingdom (2), Jose CA Carvalho (1,2)<br />

(1)<strong>Department</strong> <strong>of</strong> Anaesthesia <strong>and</strong> Pain Management <strong>and</strong> (2) <strong>Department</strong> <strong>of</strong><br />

<strong>Obstetrics</strong> <strong>and</strong> Gynaecology, Mount Sinai Hospital, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong><br />

P-E3 CELL CYCLE INHIBITOR, P27, IS DIFFERENTIALLY<br />

REGULATED IN EARLY SEVERE PREECLAMPTIC PLACENTAE<br />

COMPARED TO CONTROL<br />

Jocelyn Ray[G], J Xu, Andrea Jurisicova, Isabella Caniggia.<br />

<strong>Department</strong>s <strong>of</strong> <strong>Obstetrics</strong> <strong>and</strong> Gynaecology, Samuel Lunenfeld Research Institute,<br />

Mount Sinai Hospital, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>.


11<br />

P-E4 LAPAROSCOPIC PERITONEAL ENTRY PREFERENCES AMONG<br />

CANADIAN GYNAECOLOGISTS<br />

Ambika Aneja [R], Jamie Kr<strong>of</strong>t, Jessica Tyrwhitt, Artin Ternamian.<br />

<strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> <strong>and</strong> Gynaecology, Division <strong>of</strong> Gynaecologic Endoscopy,<br />

St. Joseph’s Health Centre, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>.<br />

GROUP F:<br />

Chairs/Judges: Drs. Joan Murphy & John Kingdom<br />

Judge: Dr. Richard Pittini<br />

P-F1 DEXAMETHASONE STIMULATES PLACENTAL AMINO ACID<br />

TRANSPORT AND SYNCYTIOTROPHOBLAST DIFFERENTIATION.<br />

Melanie C Audette[G](1), Susan L Greenwood(2), Colin P Sibley(2), Carolyn J<br />

Jones(2), Stephen G Matthews(1), John R Challis(1), <strong>and</strong> Rebecca L Jones(2).<br />

(1) <strong>Department</strong> <strong>of</strong> Physiology, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>, Canada <strong>and</strong> (2)Maternal <strong>and</strong><br />

Fetal Heath Research Group, <strong>University</strong> <strong>of</strong> Manchester, United Kingdom.<br />

P-F2 PERIPHERAL LEUKOCYTES AS NOVEL TARGETS FOR THE<br />

PREVENTION OF PRETERM BIRTH<br />

Tamara Nedd-Roderique[G](1,2), Oksana Shynlova (1),Anna Dorogin (1), &<br />

Stephen Lye (1,2,3)<br />

(1) Samuel Lunenfeld Research Institute, Mount Sinai Hospital, (2) <strong>Department</strong> <strong>of</strong><br />

Physiology, <strong>and</strong> (3) <strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> & Gynaecology, <strong>University</strong> <strong>of</strong><br />

<strong>Toronto</strong>.<br />

P-F3 EDUCATING SURGICAL SPECIALTY RESIDENTS FOR<br />

LEADERSHIP AND ADVOCACY IN CANADIAN HEALTHCARE<br />

REFORM<br />

Noor Ladhani [R](1), Nan Okun(1), Heather Shapiro(1), Danielle Martin(2)<br />

(1) <strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong>/Gynaecology <strong>and</strong> (2) <strong>Department</strong> <strong>of</strong> Family Medicine,<br />

<strong>University</strong> <strong>of</strong> <strong>Toronto</strong>.<br />

P-F4 ABSTRACT #P-F4<br />

THE EXPRESSION OF PAR6 DURING HUMAN PLACENTATION<br />

Tharini Sivasubramaniyam [G], Isabella Caniggia<br />

<strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> & Gynaecology, Mount Sinai Hospital, <strong>University</strong> <strong>of</strong><br />

<strong>Toronto</strong>.<br />

P-F5 OUTCOMES IN ROBOTIC-ASSISTED SURGERY FOR<br />

GYNAECOLOGIC ONCOLOGY<br />

Lilian T Gien [F], Barry Rosen, Marcus Bernardini<br />

Division <strong>of</strong> Gynecologic Oncology, Princess Margaret Hospital, <strong>University</strong> <strong>of</strong><br />

<strong>Toronto</strong>.<br />

**POSTER TAKEDOWN IMMEDIATELY AFTER POSTER SESSION**


12<br />

ORAL SESSION II<br />

11:00 – 12:00 noon Oral Session II (4 presentations @15 minutes – 10 minute presentation + 5<br />

minutes for questions) [EM 1 st floor Rm 119]<br />

Chair/Judge: Dr. Joan Murphy<br />

Judges: Drs. Lee Adamson & Harold Drutz<br />

11:00-11:15 O5 TISSUE SPECIFIC TRANSCRIPTION START SITE AND<br />

ALTERNATIVE SPLICING OF THE MAESTRO GENE (MRO): IN<br />

GRANULOSA CELLS FROM PCOS AND NON-PCOS PATIENTS, AND IN<br />

CONTROL NON-OVARIAN TISSUES.<br />

Shlomit Kenigsberg [PD], Rodica M<strong>and</strong>el, Hanna Balakier, Vera Radunovic <strong>and</strong><br />

Clifford L. Librach.<br />

CReATe Fertility Centre <strong>and</strong> the <strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> <strong>and</strong> Gynaecology,<br />

Sunnybrook Health Sciences Centre, Women’s College Hospital <strong>and</strong> the <strong>University</strong><br />

<strong>of</strong> <strong>Toronto</strong>.<br />

11:15-11:30 O6 MECHANISM OF FACTOR INHIBITING HIF-1 (FIH-1)<br />

REGULATION IN PLACENTAE FROM NORMAL AND HELLP<br />

SYNDROME PREGNANCIES<br />

Antonella Racano[G](1, 2), Aless<strong>and</strong>ro Rolfo (1), <strong>and</strong> Isabella Caniggia (1,2,3).<br />

(1) Samuel Lunenfeld Research Institute, Mount Sinai Hospital; <strong>Department</strong>s <strong>of</strong> (2)<br />

Physiology <strong>and</strong> (3) <strong>Obstetrics</strong> <strong>and</strong> Gynecology, Faculty <strong>of</strong> Medicine, <strong>University</strong> <strong>of</strong><br />

<strong>Toronto</strong>.<br />

11:30-11:45 O7 JOB SATISFACTION AMONG PHYSICIANS AND NURSES IN A<br />

TEACHING AND REFERRAL HOSPITAL IN WESTERN KENYA: DO<br />

PARTNERSHIPS WITH HIGH RESOURCE INSTITUTIONS IN NORTH<br />

AMERICA MAKE A DIFFERENCE<br />

Sarah E Sinasac[R](1), Sarah J. Taleski(3), Rachel F. Spitzer(1), Elkanah O.<br />

Omenge(2).<br />

(1)<strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> <strong>and</strong> Gynaecology, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>.<br />

(2)<strong>Department</strong> <strong>of</strong> Reproductive Health, Moi Teaching <strong>and</strong> Referral Hospital.<br />

(3)Dalla Lana School <strong>of</strong> Public Health, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>.<br />

11:45-12:00 O8 PREVENTING THE DISRUPTIVE EFFECTS OF NOCTURNAL<br />

LIGHT EXPOSURE ON MOOD, COGNITION AND SEROTONIN<br />

SECRETION DURING SIMULATED SHIFTWORK CONDITIONS BY<br />

FILTERING SHORT WAVELENGTHS<br />

Shadab A Rahman [G](1,2), Shai Marcu(3), Colin M Shapiro(3,4), Theodore J<br />

Brown (1,2) <strong>and</strong> Robert F Casper(1,2).<br />

(1)<strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> <strong>and</strong> Gynaecology, Samuel Lunenfeld Research<br />

Institute, Mount Sinai Hospital, (2)<strong>Department</strong> <strong>of</strong> Physiology, (3)<strong>Department</strong> <strong>of</strong><br />

Psychiatry, (4)<strong>Department</strong> <strong>of</strong> Ophthalmology <strong>and</strong> Vision Sciences, <strong>University</strong> <strong>of</strong><br />

<strong>Toronto</strong>.


13<br />

12:05 – 1:05 p.m. LUNCH [Dining Room, Burwash Hall]<br />

**Poster Takedown for a.m. session <strong>and</strong> Set-up for p.m. session**<br />

[EM 1 st floor W Entrance Hall 106V, 100K Foyer & Rm 108]<br />

ORAL SESSION III<br />

1:10 – 2:40 p.m. Oral Session III (O9-O14) (6 presentations @15 minutes – 10 minute<br />

presentation + 5 minutes for questions) [EM 1 st floor Rm 119]<br />

Chair: Dr. Ellen Greenblatt<br />

Judges: Drs. Steve Matthews & Rose Kung<br />

1:10-1:25 O9 ABDOMINAL VISCERAL ADIPOSITY IN THE FIRST TRIMESTER<br />

PREDICTS GLUCOSE INTOLERANCE IN LATER PREGNANCY<br />

Aisling Martin [F](1), Howard Berger (1), Andrea Lausman (1), Joel G Ray(1,2,3).<br />

(1)<strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> <strong>and</strong> Gynaecology, St. Michael’s Hospital,<br />

(2)<strong>Department</strong> <strong>of</strong> Medicine, Divisions <strong>of</strong> Endocrinology <strong>and</strong> Metabolism <strong>and</strong><br />

General Internal Medicine, St. Michael’s Hospital, (3)<strong>Department</strong> <strong>of</strong> Health Policy<br />

Management <strong>and</strong> Evaluation, St. Michael’s Hospital, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>.<br />

1:25-1:40 O10 GCM1 REGULATION OF SFLT-1 EXPRESSION IN FIRST<br />

TRIMESTER PLACENTAL VILLI: THE MISSING LINK BETWEEN<br />

DISORDERED TROPHOBLAST DIFFERENTIATION AND THE<br />

DEVELOPMENT OF SEVERE EARLY-ONSET PREECLAMPSIA<br />

Sascha Drewlo [PD](1), Dora Baczyk (1), John Kingdom (1,2,3)<br />

(1) Research Centre for Women’s <strong>and</strong> Infants’ Health (RCWIH) at the Samuel<br />

Lunenfeld Research Institute <strong>of</strong> Mount Sinai Hospital, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>, (2)<br />

<strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> <strong>and</strong> Gynaecology, Mount Sinai Hospital, <strong>University</strong> <strong>of</strong><br />

<strong>Toronto</strong>, (3) <strong>Department</strong> <strong>of</strong> Pathology, Mount Sinai Hospital, <strong>University</strong> <strong>of</strong><br />

<strong>Toronto</strong>.<br />

1:40-1:55 O11 REGULATORY EFFECTS OF MELATONIN ON GONADOTROPIN-<br />

INHIBITORY HORMONE AND KISSPEPTIN GENE EXPRESSION USING<br />

NOVEL REPRESENTATIVE RAT HYPOTHALAMIC CELL LINES<br />

Sarah Gingerich[PD](1), Xiaomei Wang(1), S<strong>and</strong>eep S. Dhillon(1), Jennifer A<br />

Chalmers (1), <strong>and</strong> Denise D Belsham(1,2,3)<br />

<strong>Department</strong> <strong>of</strong> Physiology(1) <strong>and</strong> Medicine(2), <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>, Cellular <strong>and</strong><br />

Molecular Biology(3), <strong>University</strong> Health Network.


14<br />

1:55-2:10 O12 AN ACTIVE ROLE FOR UTERINE NATURAL KILLER CELLS<br />

AND MACROPHAGES IN EARLY DECIDUAL VASCULAR<br />

REMODELING IN VITRO<br />

Aleah D Hazan[G](1,2), Caroline E Dunk (2), Samantha Smith (3), Rebecca L<br />

Jones (3), Stephen Lye (1,2,4)<br />

(1)<strong>Department</strong> <strong>of</strong> Physiology, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>, (2) Samuel Lunenfeld<br />

Research Institute, Mount Sinai Hospital, (3) Maternal <strong>and</strong> Fetal Health, St. Mary’s<br />

Hospital, Manchester, UK, (4) <strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> <strong>and</strong> Gynaecology,<br />

<strong>University</strong> <strong>of</strong> <strong>Toronto</strong>.<br />

2:10-2:25 O13 THE EFFECT OF CHRONIC MATERNAL ADVERSITY (CMA) ON<br />

LEARNING AND ENDOCRINE FUNCTION IN ADULT OFFSPRING:<br />

IMPACT OF PERIPUBERTAL ENVIRONMENTAL ENRICHMENT (EE)<br />

Jeff Emack[G](1), Alice Kostaki(1), <strong>and</strong> Stephen Matthews(1,2,3)<br />

<strong>Department</strong>s <strong>of</strong> (1)Physiology, (2)<strong>Obstetrics</strong> <strong>and</strong> Gynecology, <strong>and</strong> (3)Medicine,<br />

Faculty <strong>of</strong> Medicine, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>.<br />

2:25-2:40 O14 RISK FACTORS FOR FALLOPIAN TUBE PRECURSOR LESIONS<br />

IN BRCA MUTATION CARRIERS<br />

Danielle Vicus[F](1,2), Patricia A. Shaw(3), Amy Finch(2), Barry Rosen(1), Susan<br />

Armel(1), Ping Sun(2), Steven A. Narod(2).<br />

(1)Division <strong>of</strong> Gynaecologic Oncology, <strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> <strong>and</strong> Gynecology,<br />

<strong>University</strong> <strong>of</strong> <strong>Toronto</strong>, (2) Women's College Research Institute, Women’s College<br />

Hospital, (3) <strong>Department</strong> <strong>of</strong> Pathology, <strong>University</strong> Health Network.<br />

2:40– 4:10 p.m. POSTER SESSION II<br />

2:40 – 3:10 p.m. C<strong>of</strong>fee Break & Poster Session II Walkabout [EM 1 st floor W Entrance<br />

Hall 106V, 100K Foyer & Rm 108]<br />

3:10 – 4:10 p.m. Poster Session II Tour (3-5 minute presentation + 5 minutes for questions)<br />

[EM 1 st floor W Entrance Hall 106V, 100K Foyer & Rm 108]<br />

Groups G-L<br />

GROUP G:<br />

Chairs/Judges: Drs. Andrea Lausman & Robert Casper<br />

Judge: Dr. Knox Ritchie<br />

P-G1 INCIDENCE OF GESTATIONAL HYPERTENSIVE DISORDERS IN<br />

PREGNANCIES COMPLICATED BY IUGR: TWINS VERSUS<br />

SINGLETONS<br />

Katy Gouin[F](1), Jon Barrett(1), Yoav Yinon(1), Ori Nevo(1).<br />

(1)Maternal-Fetal Medicine Division, <strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> & Gynaecology,<br />

Sunnybrook Health Science Center, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>.


15<br />

P-G2 P16 ONCOPROTEIN AS A TRIAGE TOOL IN PATIENTS WITH<br />

LOW GRADE SQUAMOUS INTRAEPITHELIAL LESION OF THE<br />

UTERINE CERVIX: A PILOT STUDY.<br />

Clarissa Bambao [F](1), Golnar Rasty(2), Michael Shier(1).(1) <strong>Department</strong> <strong>of</strong><br />

<strong>Obstetrics</strong> <strong>and</strong> Gynaecology, Sunnybrook Health Sciences Centre, (2) <strong>Department</strong><br />

<strong>of</strong> Pathology, Sunnybrook Health Sciences Center, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>.<br />

P-G3 USE OF COMPLEMENTARY MEDICINE (CAM) AMONG WOMEN<br />

RECEIVING CHEMOTHERAPY FOR OVARIAN CANCER: A<br />

COMPARISON OF ATTITUDES BETWEEN TWO PATIENT<br />

POPULATIONS<br />

Limor Helpman Bek [F](1), S. E. Ferguson(1), M. Mackean(2), L. Le(1), A.<br />

Rogerson(2), A. Dewan(1), H. Mackay(1)<br />

(1)Princess Margaret Hospital, <strong>Toronto</strong>, (2)Edinburgh Cancer Centre, Edinburgh<br />

P-G4 ALTERED ADRENOCORTICAL REGULATION IN FEMALE<br />

OFFSPRING OF PRENATAL BETAMETHASONE-EXPOSED GUINEA<br />

PIGS: A TRANSGENERATIONAL STUDY<br />

Majid Iqbal[G](1), A. Kostaki(1), S.G. Matthews(1, 2, 3).<br />

<strong>Department</strong>s <strong>of</strong> (1)Physiology, (2)<strong>Obstetrics</strong> <strong>and</strong> Gynaecology <strong>and</strong> (3)Medicine,<br />

Faculty <strong>of</strong> Medicine, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>.<br />

P-G5 OXYTOCIN BUT NOT ERGONOVINE OR CARBOPROST<br />

INHIBITS CONTRACTIONS IN OXYTOCIN PRE-EXPOSED PREGNANT<br />

RAT MYOMETRIUM<br />

Mrinalini Balki (1); Alex<strong>and</strong>ra L Cristian [M](1); Robert K. Parkes(2), John<br />

Kingdom (3), Jose C.A. Carvalho (1,3)<br />

(1)<strong>Department</strong> <strong>of</strong> AnAesthesia <strong>and</strong> Pain Management, Mount Sinai Hospital,<br />

(2)Samuel Lunenfeld Research Institute, Mount Sinai Hospital, (3)<strong>Department</strong> <strong>of</strong><br />

<strong>Obstetrics</strong> <strong>and</strong> Gynaecology, Mount Sinai Hospital.<br />

GROUP H:<br />

Chairs/Judges: Drs. Ori Nevo & Filomena Meffe<br />

Judge: Dr. Heather Shapiro<br />

P-H1 RETINAL HEMORRHAGES IN TERM NEWBORNS AFTER<br />

INSTRUMENTAL VERSUS SPONTANEOUS VAGINAL DELIVERY – A<br />

SYSTEMATIC REVIEW AND META-ANALYSIS<br />

Taher Al Jishi [F](1), P Gareth Seaward (2)<br />

(1)<strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> <strong>and</strong> Gynaecology, Mount Sinai Hospital, (2)Maternal-<br />

Fetal Medicine Division, <strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> & Gynaecology, Mount Sinai<br />

Hospital


16<br />

P-H2 A NOVEL ED-BASED SEXUAL ASSAULT CENTER IN WESTERN<br />

KENYA: DESCRIPTION OF PATIENTS AND ANALYSIS OF<br />

TREATMENT PATTERNS<br />

Elissa Rennert-May[M](1), Megan L Ranney(2), Rachel Spitzer(3), Hillary<br />

Mabeya(4).<br />

(1) <strong>Department</strong> <strong>of</strong> Undergraduate Medicine, Faculty <strong>of</strong> Medicine, <strong>University</strong> <strong>of</strong><br />

<strong>Toronto</strong>, (2) <strong>Department</strong> <strong>of</strong> Emergency Medicine, Faculty <strong>of</strong> Medicine, Brown<br />

<strong>University</strong>, (3) <strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> <strong>and</strong> Gynecology, Faculty <strong>of</strong> Medicine,<br />

<strong>University</strong> <strong>of</strong> <strong>Toronto</strong>, (4) <strong>Department</strong> <strong>of</strong> Reproductive Health, Faculty <strong>of</strong><br />

Medicine, Moi <strong>University</strong>.<br />

P-H3 A ROLE FOR MCL-1 IN REGULATING CELL CYCLE<br />

PROGRESSION IN PLACENTAL DEVELOPMENT AND<br />

PATHOLOGIES<br />

Manpreet Kalkat (G)(1), Aless<strong>and</strong>ro Rolfo (2), Isabella Caniggia (1,2).<br />

(1) <strong>Department</strong> <strong>of</strong> Physiology, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>; (2) <strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong><br />

<strong>and</strong> Gynaecology, Mount Sinai Hospital, Samuel Lunenfeld Research Institute.<br />

P-H4 RECRUITMENT INITIATIVES TO COMBAT MID-TRIAL<br />

FATIGUE<br />

Christine Tassopoulos[O](1), Dalah Mason(1), Sheila Hewson(1), Elizabeth<br />

Asztalos(1), Jon Barrett(2).<br />

(1)Centre for Mother, Infant, <strong>and</strong> Child Research, Sunnybrook Health Sciences<br />

Centre, (2)<strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> <strong>and</strong> Gynaecology, Sunnybrook Health Sciences<br />

Centre.<br />

P-H5 A NOVEL ROLE FOR UROCORTIN 2 IN CELL CYCLING<br />

REGULATION<br />

Letizia Galleri [PD](1), JRG Challis (1, 2), Isabella Caniggia (1, 3, 4)<br />

(1) <strong>Department</strong> <strong>of</strong> Physiology, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>, (2) Michael Smith<br />

Foundation for Health Research, Vancouver, BC, (3) Samuel Lunenfeld Research<br />

Institute, Mount Sinai Hospital, (4) <strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> <strong>and</strong> Gynecology,<br />

<strong>University</strong> <strong>of</strong> <strong>Toronto</strong>.


17<br />

GROUP I:<br />

Chairs/Judges: Drs. Jon Barrett & Andrea Jurisicova<br />

Judge: Dr. Sony Sierra<br />

P-I1 VASCULAR DYSFUNCTION IN WOMEN WITH A HISTORY OF<br />

PRE-ECLAMPSIA AND INTRAUTERINE GROWTH RESTRICTION:<br />

INSIGHTS INTO FUTURE CARDIOVASCULAR RISK<br />

Yoav Yinon [F](1), David Cherney(2), Ori Nevo(3), John Kingdom(1), Michelle<br />

Hladunewich(2)<br />

(1) Maternal-Fetal Medicine Division, <strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> <strong>and</strong> Gynecology,<br />

Mount Sinai Hospital, (2) Division <strong>of</strong> Nephrology, <strong>University</strong> Health Network,<br />

<strong>Toronto</strong> General Hospital, (3) <strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> <strong>and</strong> Gynecology,<br />

Sunnybrook Health Sciences Centre, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>, <strong>Toronto</strong><br />

P-I2 THE TIMING OF DELIVERY FOR MONOCHORIONIC VS.<br />

DICHORIONIC TWINS<br />

Sharon Maslovitz[F](1), Ori Nevo(1), Andrea Lausman(2) Jon F. R. Barrett(1),<br />

(1)Maternal-Fetal Medicine Division, <strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> & Gynaecology,<br />

Sunnybrook Health Sciences Centre.<br />

(2) Maternal-Fetal Medicine Division, <strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> & Gynaecology, St<br />

Michaels Hopsital<br />

P-I3 SENTINEL LYMPH NODE BIOPSY IMPROVES DETECTION OF<br />

METASTATIC LYMPH NODES IN EARLY CERVICAL CANCER<br />

Limor Gortzak-Uzan[F](1), Sharon N<strong>of</strong>ech-Mozes(2), Nadia Ismiil(2), Mahmoud<br />

Khalifa(2), Valerie Dube(2), Allan Covens(1)<br />

(1) Division <strong>of</strong> Gynecologic Oncology, (2)<strong>Department</strong> <strong>of</strong> Anatomic Pathology,<br />

Sunnybrook Health Sciences Centre, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>.<br />

P-I4 OMEGA-3 FATTY ACID SUPPLEMENTATION REDUCES<br />

OBESITY, IMPROVES GLUCOSE TOLERANCE AND INSULIN<br />

RESISTANCE IN C57BL/6J MALE MICE SUBJECTED TO ANTENATAL<br />

DIET RESTRICTION<br />

Lauren Chun [G](1), Brian Knight (1), Stephen Lye (1)(2).<br />

(1) <strong>Department</strong> <strong>of</strong> Physiology, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>, (2) Samuel Lunenfeld<br />

Research Institute, Mount Sinai Hospital.<br />

P-I5 THREE YEAR RESULTS OF THE TRANSOBTURATOR TENSION<br />

FREE VAGINAL TAPE PROCEDURE FOR STRESS<br />

URINARY INCONTINENCE<br />

Kalpana Sharma [R], Lisa Merovitz, <strong>and</strong> Patricia Lee<br />

Division <strong>of</strong> Urogynaecology, <strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> <strong>and</strong> Gynaecology,<br />

Sunnybrook Health Sciences Centre, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>


18<br />

GROUP J:<br />

Chairs/Judges: Drs. Guylaine Lefebvre & Clifford Librach<br />

Judge: Dr. Theodore J Brown<br />

P-J1 WHAT IS KEEPING ESTROGEN INSIDE THE HUMAN OVARIAN<br />

FOLLICLE<br />

Yaakov Bentov [F](1)(2), Theodore J Brown (2), Navid Esf<strong>and</strong>iari (1), Robert F.<br />

Casper (1)(2).<br />

(1)<strong>Toronto</strong> Center for Advanced Reproductive Technologies (TCART), (2) Samuel<br />

Lunenfeld Research Institute.<br />

P-J2 UPDATE: HEPARIN FOR THE PREVENTION OF<br />

COMPLICATIONS RELATED TO PLACENTAL INSUFFICIENCY - THE<br />

HEPRIN RANDOMIZED CONTROLLED TRIAL<br />

Leslie Proctor[O](1), Jodie Dodd(1), Rory Windrim(1), Anne McLeod(2), Edmund<br />

Kelly(3), Sarah Keating(4), Howard Berger(5), Ori Nevo(6), John Kingdom(1)<br />

(1) Maternal-Fetal Medicine Division, (2)Haematology, (3) Neonatology, (4)<br />

Perinatal Pathology, Mount Sinai Hospital, (5) Maternal-Fetal Medicine, St<br />

Michael’s Hospital, (6). Maternal-Fetal Medicine, Sunnybrook Health Sciences<br />

Centre, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>.<br />

P-J3 HUMAN EMBRYONIC FIBROBLAST LINES PROVIDE<br />

ENHANCED SUPPORT OF HUMAN EMBRYONIC STEM CELLS IN<br />

XENO-FREE CULTURE CONDITIONS<br />

Mark Kibschull [PD] (1), Maria Mileikovsky (1), Andras Nagy (1), Stephen Lye<br />

(1,2,3).<br />

(1)Samuel Lunenfeld Research Institute, Mount Sinai Hospital, <strong>Department</strong>s <strong>of</strong><br />

(2)<strong>Obstetrics</strong> & Gynaecology <strong>and</strong> (3)Physiology, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>.<br />

P-J4 CAN PEDIATRIC & ADOLESCENT GYNAECOLOGICAL CARE BE<br />

DELIVERED VIA TELEHEALTH <br />

Shannon Corbett [R], Anjali Aggarwal, Joley Johnstone, Melanie, Sari Kives, Lisa<br />

Allen, Nicolette Caccia.<br />

<strong>Department</strong> <strong>of</strong> Paediatric & Adolescent Gynaecology, Hospital for Sick Children,<br />

<strong>University</strong> <strong>of</strong> <strong>Toronto</strong>.<br />

P-J5 BARRIERS TO COMPLIANCE WITH COLPOSCOPY/FOLLOW-UP<br />

IN A POPULATION OF PATIENTS WITH PAP SMEAR<br />

ABNORMALITIES: A SURVEY APPROACH.<br />

Andrea N Simpson [M](1), Catriona J Buick(2), K Joan Murphy(2)<br />

(1)<strong>University</strong> <strong>of</strong> <strong>Toronto</strong>, (2)<strong>Department</strong> <strong>of</strong> Gynaecologic Oncology, Princess<br />

Margaret Hospital, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>.


19<br />

GROUP K:<br />

Chairs/Judges: Drs. Grace Liu & Jason Dodge<br />

Judge: Dr. Cindy Maxwell<br />

P-K1 DIFFERENTIATION OF HEPATOCYTES FROM HUMAN FIRST<br />

TRIMESTER UMBILICAL CORD STEM CELLS<br />

Junhai Zhao [PD], Rong Xiao, Shangmian Yie <strong>and</strong> Clifford L. Librach<br />

<strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> <strong>and</strong> Gynaecology, Sunnybrook Health Sciences Centre,<br />

Women’s College Hospital, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>.<br />

P-K2 THE “DUC” TRIAL: A RANDOMIZED CONTROLLED TRIAL OF<br />

IMMEDIATE VS. DELAYED CORD CLAMPING IN PRETERM INFANTS<br />

BORN BETWEEN 24 AND 32 WEEKS’ GESTATION [Work in progress]<br />

Kelly Chu [R] (1), Kellie Murphy (2), Wendy Whittle (2), Rory Windrim (2),<br />

Prakesh Shah (3).<br />

(1)<strong>University</strong> <strong>of</strong> <strong>Toronto</strong>(2) Maternal-Fetal Medicine, Mount Sinai Hospital, (3)<br />

Neonatal Intensive Care Unit, Mount Sinai Hospital.<br />

P-K3 KISSPEPTIN CELL MODELS FROM THE HYPOTHALAMUS<br />

Ginah L. Kim[G](1), Sarah Gingerich(1), Maria-Luisa Centeno(1), Xiaomei<br />

Wang(1), Jennifer A. Chalmers(1), Margaret M. Koletar(1), David R. Thompson(1)<br />

<strong>and</strong> Denise D. Belsham(1,2,3). (1)<strong>Department</strong>s <strong>of</strong> Physiology, (2)Medicine, <strong>and</strong><br />

(3)<strong>Obstetrics</strong> <strong>and</strong> Gynaecology, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>.<br />

P-K4 IS THERE A ROLE FOR SCREENING FOR BACTERIAL<br />

VAGINOSIS AT THE TIME OF IUD INSERTION [Work-in-Progress]<br />

Alice Pham [R] (1), Mark H. Yudin (2), Sari Kives (2), Romy Nitsch (3), Lisa<br />

Merovitz (3)<br />

(1) <strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> & Gynaecology, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>, (2)<br />

<strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> & Gynaecology, St. Michael’s Hospital, (3) <strong>Department</strong><br />

<strong>of</strong> <strong>Obstetrics</strong> & Gynaecology, Sunnybrook Health Sciences Centre.<br />

P-K5 MCL-1 IS A PROSURVIVAL FACTOR THAT REGULATES<br />

OVARIAN FOLLICLE FATE AND REPRODUCTIVE FUNCTION<br />

Shakib Omari[G](1), Andrea Jurisicova(1,2).<br />

(1) <strong>Department</strong> <strong>of</strong> Physiology, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>, (2) <strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong><br />

<strong>and</strong> Gynecology, Samuel Lunenfeld Research Institute, Mount Sinai Hospital


20<br />

GROUP L:<br />

Chairs/Judges: Drs. Howard Berger & Lee Adamson<br />

Judge: Dr. Nan Okun<br />

P-L1 EXPRESSION AND REGULATION OF BREAST CANCER<br />

RESISTANCE PROTEIN (BCRP1) IN THE MOUSE PLACENTA AND<br />

FETAL BLOOD-BRAIN BARRIER<br />

Sophie Petropoulos [G](1), A Kostaki(1), W Gibb(4), SG Matthews(1)(2)(3).<br />

<strong>Department</strong>s <strong>of</strong> (1)Physiology, (2)<strong>Obstetrics</strong> <strong>and</strong> Gynaecology, (3)Medicine,<br />

<strong>University</strong> <strong>of</strong> <strong>Toronto</strong>; <strong>Department</strong>s <strong>of</strong> (4)<strong>Obstetrics</strong> <strong>and</strong> Gynecology, Cellular <strong>and</strong><br />

Molecular Medicine, <strong>University</strong> <strong>of</strong> Ottawa.<br />

P-L2 DOES SIZE MATTER ASSOCIATIONS BETWEEN SUBMUCOSAL<br />

UTERINE FIBROID SIZE AND COMPLICATIONS DURING<br />

HYSTEROSCOPIC MYOMECTOMY<br />

Suma Shastry [F], Mark Yudin, Deborah Robertson, Abheha Satkunaratnam,<br />

Guylaine Lefebvre.<br />

<strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> & Gynaecology, St Michael’s Hospital.<br />

P-L3 IS ZONA PELLUCIDA THICKNESS AN INDICATOR OF EMBRYO<br />

IMPLANTATION POTENTIAL<br />

Siamak Bashar [O], Gelareh Motamedi, Agata Sojecki, Rodica M<strong>and</strong>el, Hanna<br />

Balakier, <strong>and</strong> Clifford Librach<br />

CReATe Fertility Center, <strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> <strong>and</strong> Gynaecology, Sunnybrook<br />

Health Sciences Centre <strong>and</strong> Women’s College Hospital, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>.<br />

P-L4 DAB2 MEDIATES GLUCOCORTICOID RECEPTOR SIGNALING<br />

IN EPITHELIAL OVARIAN CANCER CELLS.<br />

Alicia Tone [G] (1-4), Carl Virtanen (5), Patricia Shaw (2-4) <strong>and</strong> Theodore J.<br />

Brown (1,3). (1)The Samuel Lunenfeld Research Institute, Mount Sinai Hospital,<br />

<strong>Department</strong>s <strong>of</strong> (2)Laboratory Medicine <strong>and</strong> Pathobiology, <strong>and</strong> (3)<strong>Obstetrics</strong> <strong>and</strong><br />

Gynaecology, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>, <strong>and</strong> (4)<strong>Department</strong> <strong>of</strong> Pathology, <strong>and</strong> the<br />

(5)Microarray Center, <strong>University</strong> Health Network.<br />

P-L5 SPECTRUM OF VASCULAR LESIONS ASSOCIATED WITH<br />

FETAL VASCULAR OBSTRUCTION<br />

Aseel Hamoudi [R], Sarah Keating, John Kingdom, Ge<strong>of</strong>frey Machin.<br />

<strong>Department</strong> <strong>of</strong> Perinatal Pathology, Mount Sinai Hospital, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>.<br />

4:10 p.m. on **Poster Takedown for p.m. session **<br />

[EM 1 st floor W Entrance Hall 106V, 100K Foyer & Rm 108]


21<br />

4:15 – 5:15 p.m. Henderson Lecture<br />

[EM 1 st floor Rm 119]<br />

Dr. David L Keefe<br />

James M Ingram Pr<strong>of</strong>essor <strong>and</strong> Chairman,<br />

<strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> <strong>and</strong> Gynecology,<br />

<strong>University</strong> <strong>of</strong> South Florida College <strong>of</strong> Medicine<br />

Topic: “Burning the C<strong>and</strong>le at Both Ends – A Telomere Theory <strong>of</strong><br />

Reproductive Aging"<br />

5:15 – 5:20 p.m. Closing Remarks: Dr. Alan Bocking [EM 1 st floor Rm 119]<br />

5:20 – 6:20 p.m. Wine & Cheese Reception <strong>and</strong> JW Knox Ritchie Research Awards &<br />

Papsin Award Presentations [Dining Room, Burwash Hall]<br />

**************


22<br />

THE HENDERSON LECTURE<br />

The D. Nelson Henderson Lectureship in <strong>Obstetrics</strong> <strong>and</strong> Gynaecology was established in 1965,<br />

through the generosity <strong>of</strong> the Henderson family, in honour <strong>of</strong> Dr. Donald Nelson Henderson, a<br />

highly respected clinician-scientist <strong>and</strong> eminent member <strong>of</strong> the <strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> <strong>and</strong><br />

Gynaecology at the <strong>Toronto</strong> General Hospital.<br />

Dr. David L Keefe<br />

This year we are very pleased to have Dr. David L. Keefe present the<br />

Henderson Lecture on Research Day, speaking on the topic, “Burning the<br />

C<strong>and</strong>le at Both Ends – A Telomere Theory <strong>of</strong> Reproductive Aging". Dr.<br />

Keefe is the James M. Ingram Pr<strong>of</strong>essor <strong>and</strong> Chairman <strong>of</strong> the <strong>Department</strong><br />

<strong>of</strong> <strong>Obstetrics</strong> <strong>and</strong> Gynecology, <strong>University</strong> <strong>of</strong> South Florida College <strong>of</strong><br />

Medicine. His expertise is in reproductive endocrinology <strong>and</strong> infertility. A<br />

graduate, magna cum laude, from Harvard, he received his specialty<br />

training at Northwestern <strong>and</strong> Yale Universities. He has received several<br />

prestigious awards over his career for his scholarship, clinical skills,<br />

<strong>research</strong> <strong>and</strong> teaching. He is a reviewer for numerous leading medical<br />

journals, <strong>and</strong> has authored over 100 original scientific papers, <strong>and</strong> more<br />

than 20 book chapters <strong>and</strong> reviews. Dr. Keefe’s most recent <strong>research</strong><br />

involves reproductive aging <strong>and</strong> stem cell biology.<br />

Recent Henderson lecturers <strong>and</strong> topics:<br />

2008 Dr. Andrew Berchuck, Duke <strong>University</strong> Medical Center, Durham, North Carolina, USA<br />

Individualized ovarian cancer treatment <strong>and</strong> prevention in the genomic era<br />

2007 Dr. David Phillips, <strong>University</strong> <strong>of</strong> Southampton, UK<br />

Small babies, stress <strong>and</strong> the metabolic syndrome<br />

2006 Dr. Robert L Reid, Queen’s <strong>University</strong>, Kingston, Ontario.<br />

Bringing scientific discovery into the public domain: Rigour <strong>and</strong> Responsibility<br />

2005 Dr. Chris Redman, <strong>University</strong> <strong>of</strong> Oxford, UK<br />

A new view <strong>of</strong> pre-eclampsia<br />

2004 Dr. JB Trimbos, Leiden <strong>University</strong>, The Netherl<strong>and</strong>s<br />

Nerve sparing in radical surgery: Technique <strong>and</strong> pro<strong>of</strong> <strong>of</strong> principle<br />

2002 Dr. David A Grimes, Family Health International, North Carolina, USA<br />

Potholes on the road to evidence-based practice<br />

2001 Dr. DT Baird, <strong>University</strong> <strong>of</strong> Edinburgh, UK<br />

Hormonal control <strong>of</strong> folliculo-genesis: The key to successful reproduction<br />

2000 Dr. Les Myatt, <strong>University</strong> <strong>of</strong> Cincinnati, USA<br />

Prediction <strong>of</strong> preeclampsia – Is it possible


23<br />

AWARDS<br />

The Papsin Award<br />

The Dr. Frederick R. Papsin Postgraduate Award was inaugurated in 2003 in memory <strong>of</strong> Dr.<br />

Frederick R Papsin, Chief <strong>of</strong> the <strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> <strong>and</strong> Gynaecology at Mount Sinai<br />

Hospital from 1971 to 1988. The award is presented to a postgraduate resident in the final year <strong>of</strong><br />

training, <strong>and</strong> is based on teaching ability, mentorship activities <strong>and</strong> leadership, as chosen by the<br />

winner’s peers. There have been four recipients, Dr. Andrea Lausman (2005), Dr. Kerry Myckan<br />

(2006), Dr. Matthew Morton (2007), <strong>and</strong> Dr. Shereen Chirayilkalam (2008).<br />

JW Knox Ritchie Research Awards<br />

Dr. JW Knox Ritchie<br />

The JW Knox Ritchie Research Awards were endowed by a grateful.<br />

medical staff at the <strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> <strong>and</strong> Gynaecology, Mount<br />

Sinai Hospital <strong>and</strong> the <strong>University</strong> <strong>of</strong> <strong>Toronto</strong> on the occasion <strong>of</strong> Dr.<br />

Ritchie’s retirement from the position <strong>of</strong> Chief for Mount Sinai <strong>and</strong> Chair<br />

for the <strong>University</strong> <strong>of</strong> <strong>Toronto</strong> <strong>Department</strong>s <strong>of</strong> <strong>Obstetrics</strong> <strong>and</strong> Gynaecology<br />

in 2003.<br />

The JW Knox Ritchie Research Awards are awarded for best<br />

abstract/presentation by trainee category (Graduate Student, Resident,<br />

Clinical Fellow, Post-Doctoral Fellow, Medical Student).<br />

Previous recipients <strong>of</strong> the JW Knox Ritchie Research Awards:<br />

2008 Post-Doctoral Fellow: Christine Wong (Supervisor: Robert Casper )<br />

Clinical Fellow: Marcus Bernardini (Supervisor: Allan Covens)<br />

Resident: Taymaa May (Supervisor: Theodore J Brown)<br />

Graduate Student: Maryam Yeganegi (Supervisor: Alan Bocking)<br />

Medical Student: Sue Jin Kim (Supervisor: Wendy Whittle)<br />

2007 Post-Doctoral Fellow: Sascha Drewlo (Supervisor: J. Kingdom)<br />

Clinical Fellow: Kimberly Liu (Supervisor: E. Greenblatt)<br />

Resident: Taymaa May (Supervisor: T. Brown)<br />

Graduate Student: Ingrid Lai (Supervisor: A. Jurisicova)<br />

Medical Student: K. Ashley Hawrylyshyn (Supervisor: J. Murphy)<br />

2006 Post-Doctoral Fellow: Jing Xu (Supervisor: I. Caniggia)<br />

Clinical Fellow: Valérie Dubé (Supervisor: T. Colgan)<br />

Resident: Am<strong>and</strong>a Selk (Supervisors: E. Greenblatt & H. Shapiro)<br />

Graduate Student: Alicia A Tone (Supervisors: P. Shaw & T. Brown)


ORAL ABSTRACTS<br />

25


26<br />

ABSTRACT #O1*<br />

CO-ENZYME Q10 SUPPLEMENTATION IMPROVES OVARIAN RESPONSE AND<br />

MITOCHONDRIAL FUNCTION IN AGED MICE.<br />

Eliezer Burstein[F](1)(2), Alla Perumalsamy (2), Yaakov Bentov (1)(2),Navid Esf<strong>and</strong>iari (1),<br />

Andrea Jurisicova (2) <strong>and</strong> Robert F. Casper (1)(2). (1) <strong>Toronto</strong> Center for Advanced<br />

Reproductive Technologies (TCART), (2) Samuel Lunenfeld Research Institute (SLRI).<br />

*Abstract available in hardcopy version only.


27<br />

ABSTRACT #O2<br />

WHAT WOMEN WANT: PATIENTS’ PREFERENCES ABOUT REPORTING OF<br />

ULTRASOUND SOFT MARKERS<br />

Rebecca Cash [R](1), Myuri Manogaran (2), Hana Sroka (3), Nan Okun (4)<br />

(1) <strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> <strong>and</strong> Gynaecology, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>, (2) <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>,<br />

(3) <strong>Department</strong> <strong>of</strong> Genetics, Mount Sinai Hospital (4) Maternal Fetal Medicine Division,<br />

<strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> <strong>and</strong> Gynaecology, Mount Sinai Hospital<br />

Objective: The Society <strong>of</strong> Obstetricians <strong>and</strong> Gynecologists <strong>of</strong> Canada (SOGC) recommends<br />

routine use <strong>of</strong> a single ultrasound at 18-20 weeks in all pregnancies. New guidelines from the<br />

SOGC , the American College <strong>of</strong> <strong>Obstetrics</strong> <strong>and</strong> Gynecology (ACOG) <strong>and</strong> the American College<br />

<strong>of</strong> Medical Genetics recommend that all pregnant women, regardless <strong>of</strong> their age, be <strong>of</strong>fered<br />

screening for Down syndrome. S<strong>of</strong>t marker screening at the time <strong>of</strong> anatomical ultrasound has<br />

been incorporated into the multitude <strong>of</strong> genetic screens available to pregnant women. The process<br />

<strong>of</strong> informed consent for ultrasound screening has been shown to be grossly inadequate. To date,<br />

there are no studies that examine women’s views on the examination for, <strong>and</strong> reporting <strong>of</strong><br />

ultrasound s<strong>of</strong>t markers. We conducted a survey <strong>of</strong> women’s prior knowledge <strong>and</strong> opinions on<br />

ultrasound s<strong>of</strong>t markers.<br />

Methods: A prospective survey <strong>of</strong> 263 women undergoing18-20 week anatomy ultrasound at<br />

Mount Sinai Hospital, a level three perinatal referral center for a multiethnic population <strong>of</strong><br />

approximately 2.5 million, after ethics approval.<br />

Results: Prior to reading an information pamphlet provided in the context <strong>of</strong> this survey, 30 %<br />

(79/263) <strong>of</strong> women reported having heard <strong>of</strong> the term s<strong>of</strong>t marker <strong>and</strong> 59% (47/79) <strong>of</strong> these women<br />

had discussed s<strong>of</strong>t markers with their caregiver. 85% <strong>of</strong> women attending a midwife who had heard<br />

<strong>of</strong> the term s<strong>of</strong>t marker reported having discussed this with that caregiver compared to 54% <strong>of</strong><br />

comparable women attending an obstetrician. The latter group more commonly reported their<br />

source <strong>of</strong> information to be from a genetic counselor or from the internet. Of women who were<br />

familiar with the term s<strong>of</strong>t marker 25% attended an obstetrician, 35% attended a family doctor <strong>and</strong><br />

68% attended a midwife for prenatal care. Of all respondents, 53% preferred that s<strong>of</strong>t marker<br />

findings should be reported routinely, 20% said they should be reported if the caregiver thought it<br />

was required <strong>and</strong> 23% preferred they be reported only after discussion prior to the ultrasound<br />

exam. A minority <strong>of</strong> respondents (8%) had not participated in prenatal screening for aneuploidy.<br />

Of these women, all preferred that s<strong>of</strong>t markers should only be reported after prior discussion.<br />

Conclusions: The study demonstrates that a majority <strong>of</strong> women have received little to no<br />

counseling regarding routine examination for s<strong>of</strong>t markers at second trimester ultrasound. Only 8%<br />

<strong>of</strong> our study population had not participated in genetic screening in the first trimester <strong>of</strong> her<br />

pregnancy. Of these women, all stated that they believed s<strong>of</strong>t markers should only be reported after<br />

prior discussion. These findings validate <strong>and</strong> emphasize the importance <strong>of</strong> counseling our patients<br />

appropriately <strong>and</strong> attaining adequate informed consent for genetic screening not only conducted in<br />

the first trimester but also at the time <strong>of</strong> second trimester ultrasound scan.


28<br />

ABSTRACT #O3*<br />

VEPH1 IS A NOVEL REGULATOR OF TGF-ß SIGNALING IN OVARIAN CANCER<br />

CELLS.<br />

Premalatha Shathasivam[G](1,2,3) J Wrana(1,4), <strong>and</strong> TJ Brown(1,2,3).<br />

(1)Samuel Lunenfeld Research Institute, Mount Sinai Hospital; <strong>Department</strong>s <strong>of</strong> (2)Physiology,<br />

(3)<strong>Obstetrics</strong> <strong>and</strong> Gynaecology, <strong>and</strong> (4)Medical Genetics <strong>and</strong> Microbiology, <strong>University</strong> <strong>of</strong><br />

<strong>Toronto</strong>, <strong>Toronto</strong><br />

*Abstract available in hardcopy version only.


29<br />

ABSTRACT #O4<br />

DISSECTING THE MOLECULAR PATHWAY OF NALP5 IN MURINE EMBRYO<br />

DEVELOPMENT (Work in Progress)<br />

Alagammal Perumalsamy [PD] (1), Roxanne Fern<strong>and</strong>es (1,3), Andrea Jurisicova (1,2,3)<br />

(1)Samuel Lunenfeld Research Institute, (2) <strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> & Gynaecology, Mount<br />

Sinai Hospital, (3) <strong>Department</strong> <strong>of</strong> Physiology, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>.<br />

Objective: To determine molecular mode <strong>of</strong> action mediated by NALP5 <strong>and</strong> test whether NALP5<br />

forms a signaling complex involved in NFκB activation in mouse embryos. NALPs mediate<br />

molecular responses to a variety <strong>of</strong> signals such as bacterial peptide signaling, <strong>and</strong> foreign<br />

DNA/RNA responses. Also, due to NALPs interaction with cell death proteins, caspases, they have<br />

been implicated in cell death/survival decisions. However, the specific pathways in response to<br />

NALPs in germ cells have not been determined. To investigate the biological role <strong>of</strong> NALP5 as a<br />

cell survival molecule, we established whether altered NFκB translocation <strong>and</strong> response occurs in<br />

NALP5 deficient (KO) zygotes. NALP5 can be a modulator <strong>of</strong> NFκB activity, <strong>and</strong> thus<br />

contributing to efficient activation <strong>of</strong> embryonic genome.<br />

Methods: To determine pattern <strong>and</strong> level <strong>of</strong> expression <strong>of</strong> various components <strong>of</strong> canonical <strong>and</strong><br />

non-canonical NFκB signaling in wildtype (WT) <strong>and</strong> NALP5 KO murine oocytes <strong>and</strong> zygotes, real<br />

time qRT-PCR <strong>and</strong> immunocytochemistry will be employed. To determine whether NALP5 also<br />

act as other NALPs, immunoprecipitation experiments will be performed using HEK293 cells<br />

preceded by transient transfection <strong>of</strong> epitope tagged ASC <strong>and</strong> NALP5. The effect <strong>of</strong> NALP5&ASC<br />

interaction on NFκB activity will be analyzed by performing NFκB DNA binding reporter assays.<br />

We will also investigate if NALP5 facilitates caspase activation, via recruitment <strong>of</strong> ASC protein,<br />

resulting in efficient NFκB nuclear translocation <strong>and</strong> gene activation.<br />

Results: We determined the expression <strong>of</strong> ASC in NALP5 oocytes <strong>and</strong> two cell embryos. While<br />

transcript levels <strong>of</strong> ASC were not altered, ASC protein formed clear specks in the nuclei <strong>of</strong> WT<br />

embryos, whereas in the KO embryos, specks were mislocalized, as they were seen in both the<br />

cytoplasm <strong>and</strong> nuclei. This altered distribution between WT <strong>and</strong> KO embryos may indicate altered<br />

signaling platform. Additionally, embryos lacking NALP5 also exhibit decreased spontaneous<br />

caspase activity as measured by cell permeable fluorescently labeled caspase substrate. In order to<br />

determine if decreased level <strong>of</strong> caspase activity contribute to abnormal embryo development, we<br />

cultured zygotes in presence <strong>of</strong> pan-caspase inhibitor. These results suggest that proper ASC<br />

protein localization <strong>and</strong> maternal caspases may be required for setting up events leading to proper<br />

initiation <strong>of</strong> embryonic development. NFκB subunit RelA (p65) expression levels are also altered<br />

between WT <strong>and</strong> KO oocytes <strong>and</strong> zygotes, <strong>and</strong> cytoplasmic localization, determined by<br />

immunocytochemistry analysis with NFκB p65 antibodies. While elevated cytoplasmic NFκB<br />

expression was observed in NALP5 KO oocytes, decreased nuclear <strong>of</strong> NFκB was detected in<br />

NALP KO zygotes.<br />

Conclusions: Further elucidation <strong>of</strong> the precise molecular role <strong>of</strong> NALP5 in embryo development<br />

is an important finding <strong>and</strong> the results can have broad applications to underst<strong>and</strong>ing the basic<br />

biology <strong>of</strong> mammalian embryo development but also may have further implications on the<br />

underst<strong>and</strong>ing <strong>of</strong> early embryo loss in humans.


30<br />

ABSTRACT #O5*<br />

TISSUE SPECIFIC TRANSCRIPTION START SITE AND ALTERNATIVE SPLICING<br />

OF THE MAESTRO GENE (MRO): IN GRANULOSA CELLS FROM PCOS AND NON-<br />

PCOS PATIENTS, AND IN CONTROL NON-OVARIAN TISSUES.<br />

Shlomit Kenigsberg [PD], Rodica M<strong>and</strong>el, Hanna Balakier, Vera Radunovic <strong>and</strong> Clifford L.<br />

Librach.<br />

CReATe Fertility Centre <strong>and</strong> the <strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> <strong>and</strong> Gynaecology, Sunnybrook Health<br />

Sciences Centre, Women’s College Hospital <strong>and</strong> the <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>.<br />

*Abstract available in hardcopy version only.


31<br />

ABSTRACT #O6<br />

MECHANISM OF FACTOR INHIBITING HIF-1 (FIH-1) REGULATION IN<br />

PLACENTAE FROM NORMAL AND HELLP SYNDROME PREGNANCIES<br />

Antonella Racano[G](1, 2), Aless<strong>and</strong>ro Rolfo (1), <strong>and</strong> Isabella Caniggia (1,2,3).<br />

(1) Samuel Lunenfeld Research Institute, Mount Sinai Hospital; <strong>Department</strong>s <strong>of</strong> (2) Physiology<br />

<strong>and</strong> (3) <strong>Obstetrics</strong> <strong>and</strong> Gynecology, Faculty <strong>of</strong> Medicine, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>.<br />

Objective: Factor Inhibiting HIF1 (FIH) is an O 2 -dependent asparaginyl hydroxylase that<br />

represses the transcriptional activity <strong>of</strong> Hypoxia Inducible Factor 1 (HIF1), the key factor that<br />

mediates the cellular response to hypoxia. Albeit FIH is a key regulator <strong>of</strong> the hypoxic response,<br />

little is known about its regulation. Recent studies conducted in cells have shown that Seven In<br />

Absentia Homologue 1 (Siah1), an O 2 sensor <strong>and</strong> E3 ubiquitin ligase, facilitates FIH degradation<br />

via the ubiquitin-proteasome pathway. We have previously reported that HIF1 plays an important<br />

role in placental development <strong>and</strong> that HIF1 expression is increased in preeclampsia (PE), resulting<br />

in enhanced HIF1 transcriptional activity. Herein, we investigated the expression <strong>of</strong> FIH in normal<br />

<strong>and</strong> pathological placentae <strong>and</strong> examined the contribution <strong>of</strong> Siah1 in regulating its stability.<br />

Methods: First trimester (n=30), HELLP (n=14), <strong>and</strong> age-matched control (n=20) placentae were<br />

used. FIH <strong>and</strong> Siah1 protein levels were assessed by Western blot (WB). FIH/Siah1 co-localization<br />

was examined by immun<strong>of</strong>luorescence (IF) in JEG3 cells. To test FIH-Siah1 association <strong>and</strong> FIH<br />

degradation, FIH immunoprecipitation (IP) was performed followed by Siah1 <strong>and</strong> Ubiquitin WB,<br />

respectively, in human placental lysates.<br />

Results: During placental development, FIH exhibited a peak <strong>of</strong> expression between 10-12 weeks<br />

<strong>of</strong> gestation, at a time when Siah1 levels were low. Preliminary IP studies indicate that during<br />

placental development FIH associates with Siah1 <strong>and</strong> that this association is increased with<br />

advancing gestation. IF staining in JEG3 cells suggests a positive perinuclear co-localization <strong>of</strong><br />

both FIH <strong>and</strong> Siah1. Of clinical relevance, FIH expression was significantly decreased in HELLP<br />

syndrome relative to preterm <strong>and</strong> term controls. Moreover, IP studies indicated that FIH/Siah1<br />

association <strong>and</strong> FIH ubiquitination are increased in HELLP placentae relative to controls,<br />

suggesting increased FIH degradation in placentae from pregnancies complicated by HELLP<br />

syndrome.<br />

Conclusion: Our data highlights a novel role for Siah1 as a potential regulator <strong>of</strong> FIH stability in<br />

the developing placenta. Therefore, decreased FIH expression in placentae from HELLP<br />

pregnancies may be due to its degradation via Siah1.<br />

Funded by: CIHR/IGH <strong>and</strong> Genesis Research Foundation


32<br />

ABSTRACT #O7<br />

JOB SATISFACTION AMONG PHYSICIANS AND NURSES IN A TEACHING AND<br />

REFERRAL HOSPITAL IN WESTERN KENYA: DO PARTNERSHIPS WITH HIGH<br />

RESOURCE INSTITUTIONS IN NORTH AMERICA MAKE A DIFFERENCE<br />

Sarah E Sinasac[R](1), Sarah J. Taleski(3), Rachel F. Spitzer(1), Elkanah O. Omenge(2).<br />

(1)<strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> <strong>and</strong> Gynaecology, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>. (2)<strong>Department</strong> <strong>of</strong><br />

Reproductive Health, Moi Teaching <strong>and</strong> Referral Hospital. (3)Dalla Lana School <strong>of</strong> Public Health,<br />

<strong>University</strong> <strong>of</strong> <strong>Toronto</strong>.<br />

Objective: Over the past decade the ASANTE Consortium, led by Indiana <strong>University</strong> <strong>and</strong> Moi<br />

<strong>University</strong> School <strong>of</strong> Medicine (MUSOM) in Eldoret, Kenya, has worked to build a sustainable<br />

partnership within their <strong>Department</strong>s <strong>of</strong> Internal Medicine (DIM) <strong>and</strong> Pediatrics (DP). A new<br />

partnership involving the <strong>University</strong> <strong>of</strong> <strong>Toronto</strong> <strong>and</strong> MUSOM’s <strong>Department</strong> <strong>of</strong> Reproductive<br />

Health (DRH) has recently begun. Collaborative efforts to improve the delivery <strong>of</strong> reproductive<br />

health care <strong>and</strong> thereby improve staff satisfaction are being implemented. Job satisfaction among<br />

health care providers has been linked to patient satisfaction, job performance <strong>and</strong> job retention, <strong>and</strong><br />

is therefore an important marker <strong>of</strong> the impact that such collaborations may have. The objective<br />

was to compare levels <strong>of</strong> job satisfaction between departments with existing international<br />

partnerships <strong>and</strong> the DRH.<br />

Methods: A self-administered questionnaire was given to a sample <strong>of</strong> nurses <strong>and</strong> physicians from<br />

all three departments. The previously validated global job satisfaction (GJS) scale ranged from 5-<br />

25, with 5 being high satisfaction.<br />

Results: 40 DRH, 35 DIM <strong>and</strong> 38 DP staff participated, for a total <strong>of</strong> 113. The median GJS score<br />

was 12 (Inter-quartile range: 9-17). Differences in GJS were noted by staff position (consultants<br />

more satisfied than nurses or junior physicians; p=0.006), <strong>and</strong> gender (males more satisfied than<br />

females; p=0.01). GJS did not vary by department.<br />

Conclusion: The presence <strong>of</strong> an international collaboration between low- <strong>and</strong> high-resource<br />

educational institutions does not appear to have a direct effect on levels <strong>of</strong> global job satisfaction<br />

among health care providers. Further exploration <strong>of</strong> the factors which contribute to job satisfaction<br />

will need to be considered to assist in the development <strong>of</strong> a successful partnership.


33<br />

ABSTRACT #O8*<br />

PREVENTING THE DISRUPTIVE EFFECTS OF NOCTURNAL LIGHT EXPOSURE ON<br />

MOOD, COGNITION AND SEROTONIN SECRETION DURING SIMULATED<br />

SHIFTWORK CONDITIONS BY FILTERING SHORT WAVELENGTHS<br />

Shadab A Rahman [G](1,2), Shai Marcu(3), Colin M Shapiro(3,4), Theodore J Brown (1,2) <strong>and</strong><br />

Robert F Casper(1,2).<br />

(1)<strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> <strong>and</strong> Gynaecology, Samuel Lunenfeld Research Institute, Mount Sinai<br />

Hospital, (2)<strong>Department</strong> <strong>of</strong> Physiology, (3)<strong>Department</strong> <strong>of</strong> Psychiatry, (4)<strong>Department</strong> <strong>of</strong><br />

Ophthalmology <strong>and</strong> Vision Sciences, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>.<br />

*Abstract available in hardcopy version only.


34<br />

ABSTRACT #O9<br />

ABDOMINAL VISCERAL ADIPOSITY IN THE FIRST TRIMESTER PREDICTS<br />

GLUCOSE INTOLERANCE IN LATER PREGNANCY<br />

Aisling Martin [F](1), Howard Berger (1), Andrea Lausman (1), Joel G Ray (1,2,3).<br />

(1)<strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> <strong>and</strong> Gynaecology, St. Michael’s Hospital, (2)<strong>Department</strong> <strong>of</strong> Medicine,<br />

Divisions <strong>of</strong> Endocrinology <strong>and</strong> Metabolism <strong>and</strong> General Internal Medicine, St. Michael’s<br />

Hospital, (3)<strong>Department</strong> <strong>of</strong> Health Policy Management <strong>and</strong> Evaluation, St. Michael’s Hospital,<br />

<strong>University</strong> <strong>of</strong> <strong>Toronto</strong>.<br />

Objectives: To assess the reliability <strong>of</strong> ultrasound measurement <strong>of</strong> maternal subcutaneous <strong>and</strong><br />

visceral adiposity at 11-14 weeks gestation <strong>and</strong> to elucidate whether greater visceral adiposity is<br />

associated with a higher risk <strong>of</strong> glucose intolerance later in pregnancy.<br />

Study Design: This is a prospective cohort study at a single outpatient clinic in <strong>Toronto</strong>, Ontario.<br />

Women with a singleton pregnancy <strong>and</strong> no history <strong>of</strong> diabetes were enrolled between 11 <strong>and</strong> 14<br />

weeks gestation. Subcutaneous <strong>and</strong> visceral fat depths were independently measured three times by<br />

two sonographers. Intra- <strong>and</strong> inter-observer reliability were calculated for each. A 50-g glucose<br />

challenge test (GCT) was subsequently performed between 24 <strong>and</strong> 28 weeks' gestation, with a<br />

positive test at a cut <strong>of</strong>f point ≥ 7.8 mmol/L.<br />

Results: There were 62 women enrolled in the study, <strong>of</strong> whom 58 also underwent a GCT. Intraobserver<br />

agreement was ≥ 0.94 for all sonographic measurements. Inter-observer reliability was<br />

0.79 (95% confidence interval [CI] 0.69 to 0.88) for subcutaneous adiposity <strong>and</strong> 0.87 (95% CI 0.82<br />

to 0.93) for visceral adiposity. A visceral adipose tissue depth above the upper quartile was<br />

significantly associated with a positive GCT in later pregnancy (adjusted OR 16.9, 95% CI 1.5 to<br />

194.6). No association was seen for subcutaneous adipose tissue, however (adjusted 1.7, 95% CI<br />

0.18 to 16.5).<br />

Conclusions: Measurement <strong>of</strong> subcutaneous <strong>and</strong> visceral adipose tissue depth in early pregnancy<br />

is both feasible <strong>and</strong> reliable. Visceral adiposity may be associated with glucose intolerance in<br />

pregnancy, but it remains to be determined whether it predicts the overt development <strong>of</strong> gestational<br />

DM, fetal macrosomia or birth-related trauma.


35<br />

ABSTRACT #O10<br />

GCM1 REGULATION OF SFLT-1 EXPRESSION IN FIRST TRIMESTER PLACENTAL<br />

VILLI: THE MISSING LINK BETWEEN DISORDERED TROPHOBLAST<br />

DIFFERENTIATION AND THE DEVELOPMENT OF SEVERE EARLY-ONSET<br />

PREECLAMPSIA<br />

Sascha Drewlo [PD] (1), Dora Baczyk (1), John Kingdom (1,2,3)<br />

(1) Research Centre for Women’s <strong>and</strong> Infants’ Health (RCWIH) at the Samuel Lunenfeld Research<br />

Institute <strong>of</strong> Mount Sinai Hospital, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>, (2) <strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> <strong>and</strong><br />

Gynaecology, Mount Sinai Hospital, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>, (3) <strong>Department</strong> <strong>of</strong> Pathology, Mount<br />

Sinai Hospital, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>.<br />

Introduction/Objective<br />

Women with severe early-onset preeclampsia have a reversible vasculopathy <strong>and</strong> renal injury<br />

mediated by anti-angiogenic proteins released from placental villi; these include the soluble<br />

receptors <strong>of</strong> vascular endothelial growth factor (sflt-1) <strong>and</strong> endoglin (sEng). By contrast women<br />

whose pregnancies have the related but distinct placental pathology causing severe intrauterine<br />

growth restriction (IUGR) remain normotensive, <strong>and</strong> have relatively low circulating levels <strong>of</strong> these<br />

proteins. We previously reported the key physiologic role <strong>of</strong> Glial Cell Missing-1 (GCM1) in<br />

mediating the proper differentiation <strong>of</strong> villous syncytiotrophoblast. In loss-<strong>of</strong>-function studies,<br />

where GCM1 is repressed, placental villi have increased cytotrophoblast proliferation yet shed<br />

necrotic syncytiotrophoblast, analagous to the villous pathology <strong>of</strong> severe pre-eclampsia. We<br />

recently reported the divergent anatomical <strong>and</strong> molecular pathology <strong>of</strong> placental villi <strong>of</strong> severe<br />

early preeclamptic vs. IUGR placentas to IFPA 2008; in severe pre-eclampsia GCM1 is reduced,<br />

whereas in severe IUGR it is increased.<br />

We therefore tested the hypothesis that GCM1 regulates the secretion <strong>of</strong> sflt- 1 into maternal<br />

blood using our first trimester floating villous explants model.<br />

Methods <strong>and</strong> Results:<br />

We silenced (by siRNAor antisense oligo's) or induced (using forskolin) GCM1 expression in a<br />

floating villous explant model in first trimester tissue <strong>and</strong> assessed a.) syncytiotrophoblast<br />

differentiation <strong>and</strong> GCM1 protein expression b.) Cytotrophoblast proliferation (by BrdU<br />

incorporation <strong>and</strong> Ki67 staining) <strong>and</strong> c.) soluble flt-1 secretion by ELISA assessment <strong>of</strong> the culture<br />

supernatants. In conditions that repress GCM1 translation by 95 ±2.8% at 72 hours the secretion <strong>of</strong><br />

sflt-1 was significantly increased up to 7.2-fold (mean 5.2 ±2 fold; mean values 456.38 ±142pg/ml<br />

vs. 92.48 ±35.7pg/ml n=6) compared to control conditions that maintain physiologic turnover <strong>of</strong><br />

syncytiotrophoblast.<br />

Conclusions: Our data indicate that GCM1, the key regulator <strong>of</strong> syncytiotrophoblast<br />

differentiation that is expressed divergently in these serious pathologies, acts in a downstream<br />

manner to explain the development <strong>of</strong> pre-eclampsia via a sflt1-dependent manner.<br />

Funded by: CIHR


36<br />

ABSTRACT #O11<br />

REGULATORY EFFECTS OF MELATONIN ON GONADOTROPIN-INHIBITORY<br />

HORMONE AND KISSPEPTIN GENE EXPRESSION USING NOVEL<br />

REPRESENTATIVE RAT HYPOTHALAMIC CELL LINES<br />

Sarah Gingerich[PD] (1), Xiaomei Wang(1), S<strong>and</strong>eep S. Dhillon(1), Jennifer A Chalmers (1), <strong>and</strong><br />

Denise D Belsham(1,2,3)<br />

<strong>Department</strong> <strong>of</strong> Physiology(1) <strong>and</strong> Medicine(2), <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>, Cellular <strong>and</strong> Molecular<br />

Biology(3), <strong>University</strong> Health Network.<br />

Gonadotropin-inhibitory hormone (GnIH) neurons <strong>and</strong> kisspeptin neurons have recently emerged<br />

as important players in reproductive function via modulation <strong>of</strong> gonadotropin-releasing hormone<br />

(GnRH) neurons. Melatonin has been shown to suppress reproductive function through its direct<br />

inhibitory actions on GnRH neurons <strong>and</strong> recent evidence suggests that GnIH <strong>and</strong> kisspeptin<br />

neurons may be involved in mediating these actions.<br />

Objective: To generate a series <strong>of</strong> clonal, immortalized hypothalamic rat cell lines <strong>and</strong> using the<br />

cell lines rHypoE-7 <strong>and</strong> rHypoE-8 to investigate the presence <strong>of</strong> functional melatonin receptors as<br />

well as the effect <strong>of</strong> melatonin on mRNA expression <strong>of</strong> GnIH <strong>and</strong> kisspeptin.<br />

Methods: Primary hypothalamic neurons from embryonic rats (E18) were immortalized by<br />

infecting with recombinant murine retrovirus harboring simian virus (SV40) large T antigen <strong>and</strong><br />

the neomycin resistance gene from the pZIPNeo SV(X) 1 vector. Neurons were treated with<br />

geneticin (G418) to allow for the selection <strong>of</strong> infected neurons <strong>and</strong> subsequent subcloning<br />

generated a phenotypic array <strong>of</strong> 22 clonal cell lines.<br />

Results: Using RT-PCR, rHypoE-7 <strong>and</strong> rHypoE-8 were found to express the MT1 <strong>and</strong> MT2<br />

subtypes <strong>of</strong> the classic melatonin receptors. Furthermore, cAMP RIA studies demonstrated the<br />

presence <strong>of</strong> functional receptor(s), as melatonin (10 nM) inhibited the forskolin-induced increase in<br />

cAMP accumulation in both rHypoE-7 <strong>and</strong> rHypoE-8. Time course studies showed that melatonin<br />

(10 nM) increased GnIH mRNA expression at 1 hr <strong>and</strong> subsequently decreased expression at 24<br />

hrs in rHypoE-7 neurons, as determined by quantitative RT-PCR. On the contrary, melatonin<br />

decreased KISS mRNA expression at 1 hr <strong>and</strong> increased KISS at 24 hrs in rHypoE-8 neurons.<br />

Conclusions: These results demonstrate that melatonin differentially modulates mRNA expression<br />

<strong>of</strong> the important reproductive genes, GnIH <strong>and</strong> kisspeptin. The generation <strong>of</strong> these novel rat cell<br />

lines provides us with unique models to study the complex interactions <strong>of</strong> neurons governing the<br />

regulation <strong>of</strong> reproduction.<br />

Funded by: CIHR, CRC, <strong>and</strong> CFI


37<br />

ABSTRACT #O12<br />

AN ACTIVE ROLE FOR UTERINE NATURAL KILLER CELLS AND MACROPHAGES<br />

IN EARLY DECIDUAL VASCULAR REMODELING IN VITRO<br />

Aleah D Hazan[G](1,2), Caroline E Dunk (2), Samantha Smith (3), Rebecca L Jones (3), Stephen<br />

Lye (1,2,4)<br />

(1)<strong>Department</strong> <strong>of</strong> Physiology, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>, (2) Samuel Lunenfeld Research Institute,<br />

Mount Sinai Hospital, (3) Maternal <strong>and</strong> Fetal Health, St. Mary’s Hospital, Manchester, UK, (4)<br />

<strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> <strong>and</strong> Gynaecology, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong><br />

Objective: Establishment <strong>of</strong> utero-placental circulation, including transformation <strong>of</strong> the decidual<br />

arteries, is essential for progression <strong>of</strong> healthy pregnancy. Increasing evidence suggests that<br />

maternal uterine Natural Killer (uNK) cells <strong>and</strong> macrophage are involved in spiral artery<br />

angiogenesis <strong>and</strong> transformation. Using an in vitro model <strong>of</strong> decidual vascular transformation,<br />

quantified in this study, we investigate the role <strong>of</strong> leukocytes in the active remodeling <strong>of</strong> vessels.<br />

Methods: Following informed consent, first trimester placental & decidual tissues (n=12) were<br />

collected from patients <strong>of</strong> the Morgentaler clinic undergoing elective termination. Placentaldecidual<br />

co-culture: placenta <strong>and</strong> decidua were dissected <strong>and</strong> cultured together over a time-course<br />

for up to 6 <strong>day</strong>s in vitro to mimic normal spiral artery remodeling. Immunohistochemistry <strong>and</strong><br />

image analysis (Visiopharm) were performed to assess the degree <strong>of</strong> vessel transformation,<br />

involvement <strong>of</strong> leukocytes with remodeling vessels, <strong>and</strong> phagocytosis by leukocytes at <strong>day</strong>s 3 & 6<br />

<strong>of</strong> culture. Measurements <strong>of</strong> transformation include vessel lumen size <strong>and</strong> smooth muscle/ lumen<br />

area ratios.<br />

Results: Decidual spiral arteries undergo active remodeling in vitro. UNK <strong>and</strong> macrophages<br />

cluster around the vessels, penetrate the vessel walls just prior to evidence <strong>of</strong> trophoblast, <strong>and</strong> are<br />

absent in vessels that are fully transformed <strong>and</strong> are relined with trophoblast. We found that a<br />

number <strong>of</strong> the maternal immune cells associated with actively remodeling vessels demonstrate<br />

phagocytic activity. Degree <strong>of</strong> decidual vascular remodeling in the presence <strong>of</strong> placenta increases<br />

over the 6 <strong>day</strong> co-culture. Differences between co-cultures <strong>and</strong> controls are most pronounced in the<br />

tissues proximal to the luminal surface (site <strong>of</strong> placental attachment in co-cultures). In these<br />

proximal vessels, numbers <strong>of</strong> leukocytes within 30μm <strong>of</strong> the vessel lumen are increased as<br />

compared to 1) decidual controls <strong>and</strong> 2) distal vessels from the same co-cultures.<br />

Conclusions: Our results support the hypothesis <strong>of</strong> a critical role for leukocytes in first trimester<br />

spiral artery transformation. We demonstrate that immune cells are involved in the early stages <strong>of</strong><br />

remodeling, preceding trophoblast invasion <strong>of</strong> the vessel lumen <strong>and</strong> complete vascular<br />

transformation. Some <strong>of</strong> the leukocytes associated with actively remodeling vessels exhibit<br />

phagocytic activity suggesting that they may be involved in the destruction <strong>of</strong> vascular smooth<br />

muscle cells <strong>and</strong> loss <strong>of</strong> endothelium.<br />

Funded by: Canadian Institutes <strong>of</strong> Health Research IHD-86232 & CGS, a Bernard Ludwig<br />

OSOTF Award, an Ontario Graduate Scholarship Master’s Award, & the <strong>University</strong> <strong>of</strong> <strong>Toronto</strong><br />

Fellowship in Physiology


38<br />

ABSTRACT #O13<br />

THE EFFECT OF CHRONIC MATERNAL ADVERSITY (CMA) ON LEARNING AND<br />

ENDOCRINE FUNCTION IN ADULT OFFSPRING: IMPACT OF PERIPUBERTAL<br />

ENVIRONMENTAL ENRICHMENT (EE)<br />

Jeff Emack[G](1), Alice Kostaki(1), <strong>and</strong> Stephen Matthews(1,2,3)<br />

<strong>Department</strong>s <strong>of</strong> (1)Physiology, (2)<strong>Obstetrics</strong> <strong>and</strong> Gynecology, <strong>and</strong> (3)Medicine, Faculty <strong>of</strong><br />

Medicine, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>.<br />

Objectives: Maternal adversity during the perinatal period increases risk for impaired behavioural<br />

<strong>and</strong> cognitive development in humans. We have shown that chronic maternal adversity (CMA)<br />

causes elevation <strong>of</strong> basal maternal cortisol levels in late gestation <strong>and</strong> results in altered HPA<br />

function <strong>and</strong> locomotor activity in pre-pubertal <strong>of</strong>fspring. In the present study, we hypothesize that<br />

CMA modifies learning <strong>and</strong> HPA function in adult <strong>of</strong>fspring but that peripubertal environmental<br />

enrichment (EE) can prevent these effects.<br />

Methods: Pregnant guinea pigs were exposed to a r<strong>and</strong>om stressor every other <strong>day</strong> over the second<br />

half <strong>of</strong> gestation <strong>and</strong> from postnatal <strong>day</strong> (pnd) 1 until weaning on pnd25. A group <strong>of</strong> control<br />

animals remained undisturbed throughout. At weaning, half the <strong>of</strong>fspring were placed in an<br />

enriched environment (large social pen (10 animals) with toys). Remaining <strong>of</strong>fspring were pair<br />

housed in st<strong>and</strong>ard conditions. At pnd70, <strong>of</strong>fspring were tested in the Morris Water Maze (MWM)<br />

to assess spatial learning <strong>and</strong> memory; saliva samples were taken prior to <strong>and</strong> following testing to<br />

assess cortisol (HPA activity).<br />

Results: There was no effect <strong>of</strong> CMA or EE on latency to find the hidden platform in male<br />

<strong>of</strong>fspring in the MWM. However, in the reversal learning task CMA male <strong>of</strong>fspring displayed<br />

decreased retention <strong>of</strong> the platform location compared to controls (P


39<br />

ABSTRACT #O14<br />

RISK FACTORS FOR FALLOPIAN TUBE PRECURSOR LESIONS IN BRCA<br />

MUTATION CARRIERS.<br />

Danielle Vicus[F](1,2), Patricia A. Shaw(3), Amy Finch(2), Barry Rosen(1), Susan Armel(1), Ping<br />

Sun(2), Steven A. Narod(2).<br />

(1)Division <strong>of</strong> Gynaecologic Oncology, <strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> <strong>and</strong> Gynecology, <strong>University</strong> <strong>of</strong><br />

<strong>Toronto</strong>, (2) Women's College Research Institute, Women’s College Hospital, (3) <strong>Department</strong> <strong>of</strong><br />

Pathology, <strong>University</strong> Health Network.<br />

Objective: To evaluate specific risk factors for fallopian tube precursor lesions in BRCA mutation<br />

carriers.<br />

Methods: 172 BRCA mutation carriers who had undergone a prophylactic hysterectomy <strong>and</strong><br />

salpingo-oophorectomy at the <strong>University</strong> Health Network, <strong>Toronto</strong> between 2000-2008 were<br />

evaluated for the presence <strong>of</strong> a fallopian tube precursor lesion. Paraffin blocks were retrieved <strong>and</strong><br />

all sections immunostained for p53. Diagnoses were assigned based on combined histology, <strong>and</strong><br />

immunostaining results. All patients found to have p53 overexpression, a Pre-Tubal Intraepithelial<br />

Carcinoma or a Tubal Intraepithelial Carcinoma were considered to have a precursor lesion. We<br />

obtained a risk factor questionnaire from all patients. Risk factors including: age at prophylactic<br />

surgery, BRCA mutation, oral contraceptive use, parity, age at first birth, hormone replacement<br />

therapy use, breast cancer diagnosis, chemotherapy, tubal ligation, smoking, BMI, height <strong>and</strong> use<br />

<strong>of</strong> talcum were evaluated.<br />

Results: Of the 172 patients who underwent prophylactic surgery 96 were BRCA1 mutation<br />

carriers <strong>and</strong> 76 BRCA2 mutation carriers. 42 (24%) <strong>of</strong> the patients were found to have a precursor<br />

lesion: 21/96 (22%) <strong>of</strong> the BRCA1 mutation carriers <strong>and</strong> 21/76 (27%) <strong>of</strong> the BRCA2 mutation<br />

carriers. The prevalence <strong>of</strong> fallopian tube precursor lesions increased with the age <strong>of</strong> the patient,<br />

6% per year (OR = 1.06, 95%CI = 1.01-1.11, p = 0.02). For BRCA2 mutation carriers an 8%<br />

decrease in risk per year <strong>of</strong> oral contraceptive use (OR = 0.92, 95%CI = 0.72-0.98, p = 0.02) <strong>and</strong> a<br />

49% risk reduction when oral contraceptives were taken for ≥ 5 years (OR = 0.51, 95%CI = 0.29-<br />

0.88, p = 0.02) was found. Obesity, at time <strong>of</strong> surgery, was found to double the risk <strong>of</strong> a fallopian<br />

tube precursor lesion (OR = 2.18, 95%CI = 1.06-4.49, p = 0.03). In multivariate analysis, adjusted<br />

for age at surgery <strong>and</strong> oral contraceptive treatment, all variables remained significant.<br />

Other risk factors that were evaluated were not found to be significant.<br />

Conclusions: In correlation with prior reports showing that the use <strong>of</strong> oral contraceptives<br />

decreases the risk <strong>of</strong> ovarian cancer in BRCA mutation carriers we found a similar benefit for<br />

fallopian tube precursor lesions in BRCA2 mutation carriers. Patients overweight at time <strong>of</strong><br />

surgery were found to have a two-fold increase in risk <strong>of</strong> developing a precursor lesion. Each year<br />

patients delay prophylactic surgery presents a 6% increase in the risk <strong>of</strong> developing a fallopian<br />

tube precursor lesion <strong>and</strong> potentially cancer. BRCA mutation carriers should be counseled to have<br />

surgery early, in completion <strong>of</strong> their family planning.


POSTER ABSTRACTS<br />

40


41<br />

ABSTRACT #P-A1<br />

TRANSOBTURATOR TAPE FOR THE TREATMENT OF STRESS URINARY<br />

INCONTINENCE: EFFECTIVENESS AND PREDICTORS OF OUTCOME<br />

Maria Augusta T. Bortolini[F], Victor Mir<strong>and</strong>a, Raed S. Ahmed, Andrea Lischka, Heng R.<br />

Wang, May Alarab, Danny Lovatsis, Harold P. Drutz<br />

Urogynaecology Division, <strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> & Gynaecology, Mount Sinai Hospital.<br />

Objective: The objective <strong>of</strong> the study was to determine the success rate <strong>and</strong> predictors <strong>of</strong> failure <strong>of</strong><br />

transobturator tape (TOT) for the surgical treatment <strong>of</strong> stress urinary incontinence (SUI) in women.<br />

Methods: Retrospective data collection was performed for 250 women who had undergone TOT in<br />

Mount Sinai Hospital, <strong>Toronto</strong>, between February 2005 <strong>and</strong> August 2008. Preoperative <strong>and</strong><br />

postoperative assessment included history, physical examination, ur<strong>of</strong>lowmetry <strong>and</strong> multichannel<br />

urodynamic testing. Postoperative follow-up took place at 6 weeks, 6 months <strong>and</strong> then annually.<br />

Multichannel urodynamic testing was repeated at 1 year follow-up. Subjective success was defined<br />

as lack <strong>of</strong> stress urinary incontinence symptoms <strong>and</strong> objective success was defined as a negative<br />

cough test during physical exam. Statistical analysis was performed using simple descriptive<br />

techniques. Multivariable Cox regression analysis was used to evaluate predictors <strong>of</strong> failure. Local<br />

ethics board approval was obtained.<br />

Results: During the study period, 265 TOT were performed; however, 15 cases were excluded<br />

because <strong>of</strong> inaccessible records. This study therefore included 250 cases <strong>of</strong> whom 237 (94.8%)<br />

primary cases <strong>of</strong> SUI. The mean age was 56.59, BMI was 27, parity was 2.42, 44.5% had estrogen<br />

therapy replacement, 65% had associated overactive bladder symptoms <strong>and</strong> 110 (44%) patients had<br />

concomitant surgeries (11% had hysterectomy, 42% had anterior <strong>and</strong>/or posterior repair, <strong>and</strong> 16%<br />

had sacrospinous vault suspension or laparoscopic colposacropexy). The mean follow-up time was<br />

8.5 months (range 1.5 – 36 months). Objective success rate was 84.6% <strong>and</strong> subjective success rate<br />

was 78% in 6 months, <strong>and</strong> 92.6% <strong>and</strong> 86.6%, respectively, at the end <strong>of</strong> 1 year. Variables as age,<br />

BMI > 30, smoking, vaginal delivery, menopause status, HRT <strong>and</strong> previous gynecology surgery<br />

were not predictors <strong>of</strong> failure. Menopause, previous hysterectomy <strong>and</strong> BMI > 30 increased the<br />

chances <strong>of</strong> failure in 1.7, 3 <strong>and</strong> 2.3 times, respectively, but were not statistically significant.<br />

Conclusions: We concluded that TOT procedure is effective with a success rate <strong>of</strong> 90% at one year<br />

follow up. Age, BMI > 30, smoking, vaginal delivery, menopause status, HRT <strong>and</strong> previous<br />

gynecology surgery were not predictors <strong>of</strong> failure.


42<br />

ABSTRACT #P-A2<br />

INCREASED MATERNAL PERIPHERAL WHITE BLOOD CELL COUNT IS A<br />

MARKER OF ACTIVE HUMAN LABOUR.<br />

Oksana Shynlova [O](1), Craig Pennell (4), Wendy Whittle (1,2) <strong>and</strong> Stephen Lye (1,2,3). (1)<br />

Samuel Lunenfeld Res Institute, Mount Sinai Hospital, (2) <strong>Department</strong>s Ob/Gyn <strong>and</strong> (3)<br />

Physiology, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>, (4) School <strong>of</strong> Women’s <strong>and</strong> Infants` Health, <strong>University</strong> <strong>of</strong><br />

Western Australia, Perth, Australia<br />

Introduction: Early studies <strong>of</strong> leukocyte levels in maternal peripheral blood showed a pronounced<br />

increase in the total white blood cell (WBC) counts following spontaneous delivery as compared to<br />

elective caesarean delivery prior to labour. We hypothesized that peripheral WBC might be good<br />

predictors <strong>of</strong> preterm <strong>and</strong> term human labour.<br />

Objective: To study an association between WBC counts <strong>and</strong> labor as well as to determine the<br />

leukocyte subpopulations that are activated during term <strong>and</strong> preterm labour.<br />

Methods: The association between elevated total WBC counts <strong>and</strong> labor was studied for both<br />

preterm <strong>and</strong> term patients at Mount Sinai Hospital, <strong>Toronto</strong>.<br />

Results: Total WBC numbers (10 9 /L) collected from patients with uncomplicated term labour<br />

were significantly higher (mean 12.0, range 4.43-18.27, n=72) than in uncomplicated term patients<br />

presenting for elective delivery by cesarean section in the absence <strong>of</strong> labor (mean 8.1, range 6.61-<br />

10.11, n=21). Total WBC (area under receiver-operator curve [ROC] 0.87) <strong>and</strong> neutrophil counts<br />

(area under ROC 0.89) were both excellent predictors <strong>of</strong> labour. The optimum threshold for<br />

prediction <strong>of</strong> labour at term was a total WBC <strong>of</strong> 9.14: sensitivity 74%, specificity 91%, positive<br />

likelihood ratio <strong>of</strong> 7.73, negative likelihood ratio 0.29. Moreover, WBC was significantly higher<br />

(p


43<br />

ABSTRACT #P-A3<br />

CANADIAN HEALTH POLICY CHANGE ANALYSIS: THE HPV VACCINE TRUST<br />

Jacob McGee [F](1,2), Jennifer Keelan (2)<br />

(1) Gynaecologic Oncology, <strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> & Gynaecology, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>, (2)<br />

Dalla Lana School <strong>of</strong> Public Health, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong><br />

Objectives: The focus <strong>of</strong> this analysis is the policy decision behind the creation <strong>of</strong> the HPV<br />

Vaccine Trust, from its emergence <strong>of</strong> Gardasil as a preventative option for cervical CA, to the<br />

announcement <strong>of</strong> the Trust in the spring <strong>of</strong> 2007. This analysis explores how well the HPV<br />

vaccine policy decisions at the Canadian federal level correspond to the theory <strong>of</strong> punctuated<br />

equilibrium (a model for underst<strong>and</strong>ing policy change), addressing the implications <strong>of</strong> Gardasil’s<br />

implementation for future vaccine initiatives.<br />

Methods: A systematic literature review was conducted to evaluate the policy climate preceeding<br />

the announcement <strong>of</strong> the HPV Vaccine Trust in the 2007 Canadian Federal Budget. Analysis was<br />

then undertaken to assess whether the HPV Vaccine Trust announcement can be generalized to<br />

punctuated equilibrium theory ideas, which state that the stability <strong>of</strong> policy monopolies are<br />

maintained over time through the process <strong>of</strong> incrementalism, with changes to the policy system<br />

occurring only through exogenous punctuations or shocks.<br />

Results: The HPV Vaccine Trust announcement came after the approval <strong>of</strong> the National Advisory<br />

Committee on Immunization, but prior to the Canadian Immunization Committee’s<br />

recommendations on implementation <strong>of</strong> an HPV immunization program. The announcement<br />

directly contravened the process laid out in the National Immunization Strategy <strong>of</strong> the Public<br />

Health Agency <strong>of</strong> Canada (PHAC). The prematurity <strong>of</strong> the announcement sent shockwaves<br />

through the public health community, <strong>and</strong> fuelled further the debate surrounding this already<br />

controversial vaccine. Analysis reveals that the basis <strong>of</strong> the decision had little to do with the merit<br />

<strong>of</strong> the vaccine, directly contradicting the position <strong>of</strong> the Conservative Party <strong>of</strong> Canada on the HPV<br />

vaccine, <strong>and</strong> hinged instead on the political advantage to be gained. This paper argues that the<br />

process closely mirrored that <strong>of</strong> the Australian government <strong>of</strong> the time, highlighting another<br />

example <strong>of</strong> policy borrowed from a politically successful ally.<br />

Conclusions: The cost <strong>of</strong> the creation <strong>of</strong> the HPV Vaccine Trust was the undermining <strong>of</strong> the<br />

National Immunization Strategy - a process designed to ensure equity in the national provision <strong>of</strong><br />

vaccines. This analysis reveals the powerlessness <strong>of</strong> the PHAC to federal budgetary<br />

announcements. With the HPV Vaccine Trust announcement, the federal government dismantled a<br />

multilateral union - with the PHAC at its core - in favor <strong>of</strong> a federal-provincial intergovernmental<br />

model. The HPV Vaccine Trust announcement is best understood as a punctuation <strong>of</strong> a<br />

punctuation - while the HPV Vaccine would have rolled out eventually across Canada, the Trust<br />

forced provinces to step outside the NIS process <strong>and</strong> implement the vaccine ahead <strong>of</strong> CIC<br />

recommendations. In the province <strong>of</strong> Ontario, this resulted in less than a 50% uptake amongst<br />

eligible females in its first year, a dismal result for a publicly funded program. The implications for<br />

HPV vaccination, <strong>and</strong> for future vaccines, are far reaching. The politicization <strong>of</strong> the HPV Vaccine<br />

Trust announcement reveals how knowledge is transformed by the powers that wield it.


44<br />

ABSTRACT #P-A4<br />

PHENOTYPE OF EARLY ONSET INTRAUTERINE GROWTH RESTRICTION (IUGR)<br />

Nihal Al Riyami [F](1), Leslie Proctor(1)Yoav Yinon(1), Elizabeth Winsor(2), John Kingdom(1)<br />

(1)<strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> <strong>and</strong> Gynaecology (Division <strong>of</strong> Maternal Fetal Medicine);<br />

(2)<strong>Department</strong> <strong>of</strong> Laboratory Medicine <strong>and</strong> Pathobiology; Mount Sinai Hospital; <strong>University</strong> <strong>of</strong><br />

<strong>Toronto</strong>.<br />

Objectives: To demonstrate that all early onset IUGR pregnancies due to placental diseases are<br />

asymmetrical. To determine the incidence <strong>and</strong> pattern <strong>of</strong> chromosomal abnormalities in fetal<br />

growth restriction <strong>and</strong> demonstrate that early onset IUGR due to placental disease more closely<br />

mimics triploidy than trisomy 18.<br />

Methods: A retrospective chart review from 2001 to 2008 using the cytogenetics database for the<br />

prenatal diagnosis <strong>of</strong> trisomy 18 or triploidy by invasive fetal testing <strong>of</strong> amniotic fluid, placental<br />

sample by chorionic villous sample (CVS) or fetal blood sample. A retrospective review <strong>of</strong> all<br />

early onset IUGR due to placental disease, from week 18 to week 32+6 using the placental clinic<br />

database. All feuses with an absent or reversed end diastolic flow (AREDF) <strong>of</strong> the umbilical artery<br />

within a week <strong>of</strong> delivery at Mount Sinai Hospital were included. The head over the abdominal<br />

circumference ratio (HC/AC) was measured. An elevated ratio indicated fetal asymmetry.<br />

Results: 73 women with placental mediated early onset IUGR were identified, <strong>and</strong> 62% <strong>of</strong> the<br />

fetuses had a HC/AC ratio above the 95 th percentile for gestational age, suggesting that the<br />

majority are asymmetrical growth restricted. 8 out <strong>of</strong> 9 patients with triploidy were asymmetrical<br />

IUGR. There were 50 patients with trisomy 18 out <strong>of</strong> witch, 18 were asymmetrical IUGR <strong>and</strong> 32<br />

were symmetrical IUGR; this was significantly different from the early onset IUGR group<br />

(p=0.0306).<br />

Conclusions: Early onset IUGR due to placental disease presented mostly as an asymmetrical<br />

pattern <strong>and</strong> this mimicked triploidy rather than trisomy 18 patients.


45<br />

ABSTRACT #P-A5<br />

CHARACTERIZATION OF THE SMAC FVB PHENOTYPE IN MURINE OOCYTES<br />

(Work-in-Progress)<br />

Roxanne Fern<strong>and</strong>es [G](1,2), Han Li (2), Hitoshi Okada (4), Andrea Jurisicova (1,2,3)<br />

(1) <strong>Department</strong> <strong>of</strong> Physiology, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>, (2) Samuel Lunenfeld Research Institute,<br />

Mount Sinai Hospital, (3) <strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> & Gynaecology, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>,<br />

(4) Ontario Cancer Institute, <strong>University</strong> Health Network<br />

Objective: Smac/DIABLO is a mitochondrial proapoptotic protein that moderates the caspase<br />

inhibition <strong>of</strong> IAPs (inhibitor <strong>of</strong> apoptosis proteins). Smac enters the cytosol when cells receive<br />

apoptotic signals <strong>and</strong> promotes caspase-9 activation by binding to IAPs <strong>and</strong> thus blocking their<br />

function. Previous literature has shown that Smac deficient mice do not exhibit an overt phenotype<br />

in mice on the FVB background. However, FVB mice have defects in their mitochondrial<br />

morphology, leading to leakiness <strong>of</strong> mitochondria proteins, which results in an increased rate <strong>of</strong><br />

oocyte apoptosis.<br />

As genetic modifiers <strong>of</strong> apoptosis exist, our goal was to characterize the Smac FVB ovarian <strong>and</strong><br />

oocyte phenotype. Further, we attempted to characterize the cell death pathway on this genetic<br />

background.<br />

Methods: As part <strong>of</strong> the characterization <strong>of</strong> the Smac gene on the FVB background, we analyzed<br />

follicular endowment as well as reactive oxygen species production, mitochondrial membrane<br />

potential <strong>and</strong> mitochondrial copy number in ovulated oocytes. In order to ascertain the pathway by<br />

which death occurs, we assessed caspase-2 activity in intact oocytes using a caspase fluorescent<br />

substrate <strong>and</strong> cytochrome-c levels via immunocytochemistry coupled with deconvolution<br />

microscopy. Further, the involvement <strong>of</strong> pro-apoptotic Bax (a member <strong>of</strong> the Bcl-2 family) in this<br />

pathway was also analyzed via oocyte cytoplasmic fragmentation assays.<br />

Results: Ovarian morphometric analysis revealed that Smac deficient females contained a higher<br />

number <strong>of</strong> primordial follicles. Moreover, ovulated oocytes exhibit high mitochondrial membrane<br />

potential <strong>and</strong> contain lower levels <strong>of</strong> reactive oxygen species, contributing to diminished apoptosis<br />

in the ovulating oocytes. Further, Smac deficient females also exhibited lower caspase-2 activity<br />

levels <strong>and</strong> lower cytochrome-c levels suggesting an involvement <strong>of</strong> these proteins in the cell death<br />

pathway. Bax, on the other h<strong>and</strong>, did not exhibit a difference in the oocyte fragmentation assay<br />

implying that it is not involved in this pathway.<br />

Conclusions: These data indicate a functional requirement <strong>of</strong> Smac in regulation <strong>of</strong> germ line<br />

survival. Further underst<strong>and</strong>ing <strong>of</strong> this cell death pathway, could help improve oocyte quality <strong>and</strong><br />

pregnancy rates in ART outcome.


46<br />

ABSTRACT #P-B1*<br />

ANGIOGENIC CD56 bright NATURAL KILLER CELLS ACCUMULATE IN THE<br />

FOLLICULAR FLUID OF PATIENTS UNDERGOING IN VITRO FERTILIZATION<br />

Ofer Fainaru[F](1), Hagay Amsalem(2) <strong>and</strong> Robert F Casper (1)<br />

(1)<strong>Toronto</strong> Centre for Advanced Reproductive Technology, Division <strong>of</strong> Reproductive Sciences,<br />

<strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> <strong>and</strong> Gynaecology, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>, Samuel Lunenfeld Research<br />

Institute, Mount Sinai Hospital, (2)Maternal-Fetal Medicine Division, <strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> &<br />

Gynaecology, Mount Sinai Hospital.<br />

*Abstract available in hardcopy version only.


47<br />

ABSTRACT #P-B2<br />

LACTOBACILLUS RHAMNOSUS GR-1 STIMULATES GRANULOCYTE-COLONY<br />

STIMULATING FACTOR (G-CSF) OUTPUT IN PLACENTAL TROPHOBLAST CELLS<br />

IN A FETAL SEX-DEPENDANT MANNER<br />

Maryam Yeganegi[G](1,3), Chiashan G Leung(1), Andrew Martins(2), Sung O Kim(2), Gregor<br />

Reid(2), John RG Challis (1), Alan D Bocking(1,3).<br />

(1) <strong>Department</strong> <strong>of</strong> Physiology & <strong>Obstetrics</strong> <strong>and</strong> Gynaecology, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong> (2)<br />

<strong>Department</strong> <strong>of</strong> Microbiology & Immunology, <strong>University</strong> <strong>of</strong> Western Ontario, London, Ontario, (3)<br />

Samuel Lunenfeld Research Institute, Mount Sinai Hospital.<br />

Objective: Bacterial Vaginosis (BV) is associated with a 1.4-fold increased risk <strong>of</strong> preterm birth.<br />

Studies have shown that there is a higher incidence <strong>of</strong> spontaneous preterm birth <strong>and</strong> poorer<br />

neonatal outcome in pregnancies with a male fetus. We have shown previously that Lactobacillus<br />

rhamnosus GR-1 cell culture supernatant up-regulates IL-10 output in LPS-treated human<br />

placental trophoblast cells. We hypothesize that lactobacilli exerts its anti-inflammatory effect<br />

through up-regulation <strong>of</strong> G-CSF which is dependent on the sex <strong>of</strong> the fetus.<br />

Methods: Term placentae were collected from women undergoing elective Caesarean section.<br />

Placental trophoblasts were isolated using established primary culture protocols. Cells were treated<br />

with lipopolysaccharide (LPS) in the presence or absence <strong>of</strong> pretreatments with GR-1 cell culture<br />

supernatant or chemical inhibitors <strong>of</strong> the intracellular signaling pathways. Phosphorylations <strong>of</strong> p38<br />

<strong>and</strong> STAT3 were measured by Western Blot analysis <strong>and</strong> output <strong>of</strong> G-CSF <strong>and</strong> IL-10 were<br />

determined by ELISA.<br />

Results: G-CSF output was increased relative to control only in the female placental trophoblast<br />

cells treated with LPS (>233.1-fold), GR-1 cell culture supernatant (>588.7-fold) <strong>and</strong> a<br />

combination <strong>of</strong> both treatments (>737.1-fold) (n=6 females, n=5 males, p=0.002). Phosphorylation<br />

<strong>of</strong> STAT-3 was up-regulated with GR-1 supernatant alone (>1.7-fold) <strong>and</strong> when combined with<br />

LPS (>1.8-fold) (n=10, p=0.018). In addition, p38 phosphorylation was increased with LPS (>1.3-<br />

fold), GR-1 supernatant (>2.1-fold) <strong>and</strong> combination <strong>of</strong> both treatments (>2.1-fold) (n=4,<br />

p=0.005). IL-10 output was inhibited by both JAK <strong>and</strong> p38 inhibitors (n=9, P


48<br />

ABSTRACT #P-B3<br />

UNDERSTANDING THE BURDEN OF CARDIAC DISEASE AMONG PREGNANT<br />

WOMEN AT MOI TEACHING AND REFERRAL HOSPITAL IN ELDORET, KENYA: A<br />

RETROSPECTIVE REVIEW<br />

Heather C Millar[M](1), Rachel F. Spitzer(1,2), Mathew Sermer(1,2), Hillary Mabeya(3),<br />

Elkanah Omenge(3).<br />

(1)<strong>University</strong> <strong>of</strong> <strong>Toronto</strong>; (2)<strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> & Gynaecology, Mount Sinai Hospital; (3)<br />

Moi Teaching <strong>and</strong> Referral Hospital, Eldoret, Kenya<br />

Objective: Cardiac disease in pregnancy is associated with an increased risk <strong>of</strong> poor maternal <strong>and</strong><br />

fetal outcomes. In many low income countries, where rheumatic heart disease remains prevalent<br />

<strong>and</strong> resources are strained, health practitioners struggle to care for these women. This study aimed<br />

to characterize the burden <strong>of</strong> cardiac disease among pregnant women at a referral Hospital in<br />

Eldoret, Kenya as a step towards improving their management <strong>and</strong> health outcomes.<br />

Methods: A retrospective chart review was conducted. From 2006-2008, 19 inpatient charts were<br />

identified that fit criteria <strong>of</strong>: pregnant at the time <strong>of</strong> presentation <strong>and</strong> chart coding <strong>of</strong> cardiac<br />

disease. Demographic information, cardiac disease indicators, maternal <strong>and</strong> fetal outcomes were<br />

extracted.<br />

Results: The average age <strong>of</strong> presentation to hospital was 26.6 [20-31]. 87.5% presented in NYHA<br />

Class III or IV. Average length <strong>of</strong> hospital stay was 38.4 <strong>day</strong>s [1-114]. There were 5 fetal losses<br />

(27.8%) Maternal outcomes included 1 death (5.6%), 3 ICU admissions (16.7%), <strong>and</strong> 7 cases <strong>of</strong><br />

arrhythmia (53.8%). 8 women (53.3%) required oxygen.<br />

Conclusions: At MTRH, admitted pregnant women with cardiac disease are young <strong>and</strong> suffer<br />

significant morbidity. A large population <strong>of</strong> at-risk women are likely missed due to poor outpatient<br />

monitoring <strong>and</strong> home deliveries. Despite anecdotal evidence <strong>of</strong> many patients relevant to the<br />

study, extensive data collection challenges were encountered <strong>and</strong> provide important lessons for<br />

retrospective <strong>research</strong> in such settings. There is an urgent need for improved health records <strong>and</strong><br />

outpatient follow-up in order to accurately underst<strong>and</strong> <strong>and</strong> improve women’s health in the region.


49<br />

ABSTRACT #P-B4<br />

ENDOMETRIAL PROTECTION AND SYMPTOM CONTROL OF A NOVEL REGIMEN<br />

OF COMBINATION HORMONE REPLACEMENT THERAPY USING VAGINAL<br />

PROGESTERONE<br />

Jamie Kr<strong>of</strong>t[R], Natalie Klostermann, Evan Taerk, Wendy Wolfman.<br />

<strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> <strong>and</strong> Gynaecology, Mount Sinai Hospital, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>.<br />

Objectives: To conduct a retrospective review <strong>of</strong> safety <strong>and</strong> efficacy for women on a novel<br />

regimen <strong>of</strong> hormone replacement therapy (HRT) using vaginal prometrium.<br />

Study Methods: We conducted a retrospective chart review <strong>of</strong> menopausal patients aged 48-64<br />

identified at the Menopause Clinic at Mount Sinai Hospital who started taking HRT at least one<br />

year ago, consisting <strong>of</strong> an estradiol patch <strong>and</strong> vaginally administered prometrium. We collated<br />

available transvaginal ultrasound measurements <strong>of</strong> endometrial thickness <strong>and</strong> endometrial biopsy<br />

results after at least one year <strong>of</strong> HRT use. We also reviewed symptom relief, bleeding <strong>and</strong> side<br />

effects.<br />

Results: We identified 37 patients who were started on HRT consisting <strong>of</strong> an estrogen patch<br />

ranging from 25-50ug twice weekly <strong>and</strong> vaginal prometrium either continuously 3-5 <strong>day</strong>s weekly<br />

(32 patients), or sequentially 12 <strong>day</strong>s/month (5 patients). Thirteen patients were either lost to<br />

follow-up or discontinued HRT within one year. Only 17.6% <strong>of</strong> patients who had transvaginal<br />

ultrasounds after one year (3/17 patients) had a thickened endometrial lining on ultrasound<br />

(>5mm), all <strong>of</strong> whom had subsequent normal endometrial biopsies. There was vaginal bleeding in<br />

only 33.3% <strong>of</strong> patients within one year. All 24 patients had relief <strong>of</strong> their menopausal symptoms,<br />

<strong>and</strong> only one patient experienced breast tenderness, which improved after changing to sequential<br />

administration <strong>of</strong> vaginal prometrium. Five patients required the addition <strong>of</strong> local estrogen for<br />

relief <strong>of</strong> vaginal dryness.<br />

Conclusions: Vaginal administration <strong>of</strong> progesterone has the potential for decreasing side effects<br />

(such as breast tenderness <strong>and</strong> dizziness) while maintaining endometrial safety. Larger prospective<br />

trials are warranted.


50<br />

ABSTRACT #P-B5<br />

LOW VITAMIN D LEVELS IN AN URBAN PRENATAL POPULATION: DOES<br />

SEASONALOR TRIMESTER VARIATION EXPLAIN IT ALL IMPLICATIONS FOR<br />

SUPPLEMENTATION<br />

Diane Ahn [O](1) Christine M. Derzko (2), Amy Strauss (3), Gemma Baik (4)<br />

(1) Dalhousie Medical School, Halifax, Nova Scotia, (2)Reproductive Endocrinology <strong>and</strong><br />

Infertility <strong>and</strong> Menopause, Division <strong>of</strong> Endocrinology, <strong>Department</strong> <strong>of</strong> Medicine, St. Michael’s<br />

Hospital, (3) Division <strong>of</strong> Endocrinology, St. Michael’s Hospital, (4) <strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> &<br />

Gynecology, St. Michael’s Hospital<br />

Objective: To investigate the seasonal <strong>and</strong> trimester pattern <strong>of</strong> vitamin D levels in a healthy,<br />

urban prenatal population in <strong>Toronto</strong>.<br />

Methods: This was a retrospective chart review with institutional ethics approval. One hundred<br />

<strong>and</strong> four charts <strong>of</strong> consecutive obstetrical patients seen in a downtown obsterics <strong>and</strong> gynecology<br />

practice were reviewed, specifically recording the date <strong>and</strong> trimester during which serum vitamin<br />

D (i.e. 25-OH cholecalciferol) levels were obtained. The outcome measure was to record vitamin<br />

D levels across all seasons <strong>and</strong> all stages <strong>of</strong> pregnancy (including preconception <strong>and</strong> postpartum)<br />

<strong>and</strong> document other potential confounding factors that would affect vitamin D levels. These<br />

include age, BMI, ethnicity (skin colour), parity, diet, education, types <strong>of</strong> prenatal multivitamin<br />

supplementation, <strong>and</strong> chronic medical illnesses<br />

Results: Preliminary results show 33% <strong>of</strong> all vitamin D levels were measured from April –<br />

October; 67% <strong>of</strong> vitamin D levels were measured from November – March. Approximately 45%<br />

were recorded in the 2 nd trimester, 23% in the 1 st trimester, 17% in the 3 rd trimester, <strong>and</strong> the<br />

remainder in the postpartum or preconception period.<br />

Vitamin D sufficient levels <strong>of</strong> 80 nmol/l or higher were observed in 22%. These levels were<br />

distributed across all trimesters. Of this 22% group, 54% were drawn from April-October. Vitamin<br />

D deficient levels <strong>of</strong> 40 nmol/l or less were observed in a second group <strong>of</strong> 22% <strong>of</strong> patients. These<br />

very low levels were observed across all trimesters. Of this second 22% group, 74% were recorded<br />

from November –March. Overall, Vitamin D insufficient levels <strong>of</strong>


51<br />

ABSTRACT #P-C1<br />

EARLY TRANSVAGINAL ULTRASOUND AT 13-15 WEEKS IS HIGHLY EFFECTIVE<br />

IN DETECTION OF FETAL ANOMALIES.<br />

Erika Frasca [M](1), Ants Toi (2), David Chitayat (3), Dan Farine (4), Karen Chong (3), Katherine<br />

Fong K. (2), Ori Nevo (5). (1) Faculty <strong>of</strong> Medicine, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>, (2) <strong>Department</strong> <strong>of</strong> Medical<br />

Imaging, Mount Sinai Hospital, (3) Prenatal Diagnosis <strong>and</strong> Medical Genetics Program, Mount Sinai<br />

Hospital (4) Maternal Fetal Medicine, <strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> <strong>and</strong> Gynaecology, Mount Sinai Hospital, 5)<br />

Maternal-Fetal Medicine, <strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> <strong>and</strong> Gynaecology, Sunnybrook Health Sciences Centre.<br />

<strong>University</strong> <strong>of</strong> <strong>Toronto</strong>.<br />

Objectives: Transabdominal fetal ultrasound at 19-21 weeks is currently the most accepted<br />

practice for fetal anomaly detection, even in women at high risk for having a baby with major<br />

anomalies. However, earlier detection <strong>of</strong> fetal anomalies may enable sufficient time for further<br />

tests <strong>and</strong> safer management. The objective <strong>of</strong> this study was to compare the detection rate <strong>of</strong> fetal<br />

anomalies <strong>and</strong> completeness <strong>of</strong> transvaginal early anatomy ultrasound (TEAU) at 13-15 weeks to<br />

the st<strong>and</strong>ard 19-21 week transabdominal ultrasound (TAS).<br />

Methods: Data from women who had a TEAU at Sunnybrook Health Sciences Centre at 13-15<br />

weeks between April 2007 <strong>and</strong> August 2008 was collected. TEAU included detailed fetal anatomy<br />

examination comparable to the st<strong>and</strong>ard ultrasound at 19-21 weeks. Women with higher risk for<br />

fetal anomalies due to an elevated nuchal translucency, previous fetal anomalies, maternal<br />

conditions or other risk factors, <strong>and</strong> obese women (BMI ≥ 30 kg/m 2 ) were included. St<strong>and</strong>ard TAS<br />

was performed at 19-21 weeks. TEAU was performed by a single highly skilled physician, <strong>and</strong><br />

TAS was performed by qualified technologists in a university facility. Detection rate <strong>of</strong> fetal<br />

anomalies <strong>and</strong> complete ability to assess the various fetal organs during the scan were compared<br />

between the TEAU <strong>and</strong> the st<strong>and</strong>ard TAS, <strong>and</strong> to the outcome at delivery.<br />

Results: 156 women were included with a mean maternal age <strong>of</strong> 33.2±4.5 years. The indications<br />

for a TEAU were an elevated nuchal translucency (25%), fetal anomaly in previous pregnancy<br />

(44%), maternal conditions (18%) <strong>and</strong> other risk factors (12%). 17% <strong>of</strong> the women were obese.<br />

TEAU was performed at a mean gestational age <strong>of</strong> 14.8±0.8 weeks <strong>and</strong> TAS was performed at a<br />

mean gestational age <strong>of</strong> 19.3±0.8 weeks. A total <strong>of</strong> 27 fetal abnormalities were observed, 23 <strong>of</strong><br />

which had ultrasonographically detectable anomalies. There was no significant difference in the<br />

anomaly detection rate between TEAU versus a later TAS. TEAU detected 22/23 (95.6%)<br />

anomalies; one undetected abnormality was a late onset skeletal dysplasia. 16 pregnancies were<br />

terminated before the second scan. All abnormalities (100%) were detected in fetuses <strong>of</strong> women<br />

who completed a TAS. Increased BMI was associated with more complete images using TEAU<br />

(73% vs. 59%). 9/39 (23%) fetuses with elevated nuchal translucency had fetal anomalies that were<br />

detected by TEAU <strong>and</strong> 3 additional fetuses had anomalies that were not ultrasonographically<br />

detectable. At the time <strong>of</strong> the TEAU, s<strong>of</strong>t markers for Down syndrome (elevated nuchal<br />

translucency, echogenic bowel, pleural effusion) were detected in 39 women. In 23 cases, the s<strong>of</strong>t<br />

markers were not seen at the TAS. 20/23 had normal outcomes, while 3 had abnormal outcomes.<br />

Conclusions: Early transvaginal ultrasound performed at 13-15 weeks is highly effective in<br />

detecting fetal anomalies <strong>and</strong> is comparable to the st<strong>and</strong>ard ultrasound at 19-21 weeks.<br />

Additionally, TEAU improves the completeness <strong>of</strong> scans in obese women compared to the<br />

st<strong>and</strong>ard ultrasound. TEAU has an important role in the management <strong>of</strong> women with high risk for<br />

fetal anomalies <strong>and</strong> in obese women <strong>and</strong> should be <strong>of</strong>fered to patients.


52<br />

ABSTRACT #P-C2*<br />

ESTROGEN EXTRACTION FROM MICRODROP CLINICAL SAMPLES BY DIGITAL<br />

MICROFLUIDICS<br />

Noha Mousa [G] (1), M.J.Jebrail (2), H. Yang, M. Abdelgawad(2), P. Metalnikov (3),<br />

A.R.Wheeler (2), Robert Casper (4) (1)Institute <strong>of</strong> Medical Science, Mount Sinai Hospital,<br />

<strong>University</strong> <strong>of</strong> <strong>Toronto</strong>, (2) <strong>Department</strong> <strong>of</strong> Chemistry, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>, (3) Ontario Cancer<br />

Biomarker Network, <strong>Toronto</strong>, (4)<strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> <strong>and</strong> Gynecology, Mount Sinai Hospital<br />

<strong>and</strong> the <strong>University</strong> <strong>of</strong> <strong>Toronto</strong><br />

*Abstract available in hardcopy version only.


53<br />

ABSTRACT #P-C3<br />

A COMPARATIVE COST ANALYSIS OF LAPAROSCOPIC HYSTERECTOMY<br />

VERSUS ABDOMINAL HYSTERECTOMY<br />

Clarissa Bambao[F], Romy Nitsch, Sasha Svystonyuk, Grace Liu, Herb Wong.<br />

<strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> <strong>and</strong> Gynaecology, Sunnybrook Health Sciences Centre, <strong>University</strong> <strong>of</strong><br />

<strong>Toronto</strong>.<br />

Objectives: Hysterectomy is the most frequently performed major surgical procedure in<br />

Gynecology. The majority <strong>of</strong> hysterectomies are performed via an abdominal incision. With the<br />

advancement <strong>of</strong> minimally invasive surgery, the number <strong>of</strong> laparoscopic hysterectomies is now<br />

increasing. A laparoscopic hysterectomy provides many post-operative benefits to patients<br />

compared to the conventional abdominal hysterectomy. The purpose <strong>of</strong> the study is to perform a<br />

comparative cost analysis <strong>of</strong> Laparoscopic hysterectomy versus Abdominal Hysterectomy.<br />

Methods: A retrospective chart review <strong>of</strong> patients who have either undergone a total laparoscopic<br />

hysterectomy (TLH) or a total abdominal hysterectomy (TAH) at Sunnybrook Health Sciences<br />

Centre From January 2005 to December 2007. Patient demographics, surgical <strong>and</strong> medical history<br />

<strong>and</strong> indication for surgery were collected. Operative details involving complications <strong>and</strong> blood loss<br />

were recorded <strong>and</strong> specimen weight <strong>and</strong> pathology results were documented.<br />

Resource utilization was determined by collecting the date under three categories: 1) Operative<br />

room resources (prophylactic antibiotics/anticoagulants, nursing time, instrument processing <strong>and</strong><br />

cost, anesthetic medications, total operative time <strong>and</strong> recovery room time), 2) Hospital stay<br />

resources (total length <strong>of</strong> hospital stay in ICU or ward), 3) Follow-up resources (emergency visit,<br />

readmission <strong>and</strong> homecare use). Average per patient dollar cost was calculated (mean <strong>and</strong> median)<br />

<strong>and</strong> a cost analysis was performed comparing TLH <strong>and</strong> TAH.<br />

Results: From Jan 2005 to December 2007, 205 TAH were performed <strong>and</strong> 108 TLH were<br />

performed. Of the 108 TLH, 8 were converted to TAH. The mean uterine weight for the TAH was<br />

549.46g. The mean uterine weight for the TLH was 179.99g. The mean operating time for the TAH<br />

was 109.3 min compared with 166 min for the TLH. The mean post operative stay for the TAH<br />

was 3.5 <strong>day</strong>s compared with 1.5 <strong>day</strong>s for the TLH. There were a total <strong>of</strong> 6 complications in the<br />

TAH group (2 bowel injuries, 2 hemorrhages requiring transfusions <strong>and</strong> 2 bladder injuries). There<br />

were 2 complications in the TLH group (1 hemorrhage requiring transfusion <strong>and</strong> 1 vascular injury).<br />

Statistical analysis was preformed to calculate the cost for each procedure. We assessed<br />

pr<strong>of</strong>essional fees (physicians <strong>and</strong> nurses), drugs, capital equipment, disposable equipment, <strong>and</strong><br />

length <strong>of</strong> stay. The total cost <strong>of</strong> the TAH performed was $1,199,722.49. The average cost for a<br />

TAH was $6089.96*. The total cost <strong>of</strong> the TLH was $362,518.04. The average cost for a TLH was<br />

$3356.65*. The total cost <strong>of</strong> disposable instruments for the TLH was $1620.00. (* numbers subject to<br />

change with final evaluation)<br />

Conclusions: TLH can be completed safely with costs that are lower than those incurred by<br />

patients having TAH. The authors cannot make any conclusions about the appropriateness <strong>of</strong> the<br />

selection <strong>of</strong> patients for TAH versus TLH.


54<br />

ABSTRACT #P-C4<br />

PRETERM PERMATURE RUPTURE OF MEMBRANES IN THE PRESENCE OF<br />

CERCLAGE: IS THE RISK FOR INTRA-UTERINE INFECTION INCREASED<br />

Matthew D Laskin[R](1), Yoav Yinon[F](2), Wendy Whittle(2).<br />

(1) <strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> & Gynaecology, Mount Sinai Hospital, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>, (2)<br />

Maternal-Fetal Medicine Division, <strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> & Gynaecology, Mount Sinai<br />

Hospital, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>.<br />

Objective: To determine whether preterm premature rupture <strong>of</strong> membranes (PPROM) in the<br />

presence <strong>of</strong> a cervical cerclage is associated with an increased incidence <strong>of</strong> intrauterine infection<br />

<strong>and</strong>/or adverse neonatal outcome compared to PPROM in the absence <strong>of</strong> cerclage.<br />

Methods: By retrospective chart review (from 2000-08), patients diagnosed with PPROM between<br />

24-34 weeks at Mount Sinai Hospital (<strong>Toronto</strong>, Canada) were evaluated. Fifty-four pregnancies<br />

with PPROM <strong>and</strong> no cerclage matched (2:1) for gestational age at the time <strong>of</strong> PPROM, gestational<br />

number <strong>and</strong> chorionicity to 27 pregnancies with PPROM <strong>and</strong> cerclage. The primary outcome<br />

measure was clinical chorioamnionitis necessitating delivery (defined as maternal fever > 37.5°C,<br />

leukocytosis, <strong>and</strong>/or fetal tachycardia). Secondary outcome measures included gestational age at<br />

delivery, latency to delivery, histological chorioamnionitis, neonatal morbidity <strong>and</strong> mortality. All<br />

outcome measures were compared using Mann-Whitney test/t-test for continuous variables <strong>and</strong> Chi<br />

square test for categorical variables.<br />

Results: The incidence <strong>of</strong> clinical chorioamnionitis <strong>and</strong> histological chorioamnionitis was<br />

comparable between groups: 30% <strong>and</strong> 70% respectively in the cerclage group versus 20% <strong>and</strong> 64%<br />

respectively in the no cerclage group (p=0.3). The latency time from PPROM to delivery <strong>and</strong> the<br />

gestational age at delivery was not significantly different between the two groups. There were no<br />

differences in the rates <strong>of</strong> neonatal morbidity <strong>and</strong> mortality (p=0.3) between groups.<br />

Conclusions: The presence <strong>of</strong> cerclage in patients with PPROM does not seem to increase the risk<br />

<strong>of</strong> intra-uterine infection or affect neonatal outcome; it may be justified to leave a cerclage in place<br />

in patients diagnosed with PPROM.


55<br />

ABSTRACT #P-D1<br />

HEREDITARY PERSISTENCE OF FETAL HEMOGLOBIN IN PREGNANCY<br />

Ally Murji [R], Rajiv Shah, Howard Berger<br />

<strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> <strong>and</strong> Gynaecology, St. Micheal’s Hospital, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>,<br />

Objective: Hereditary persistence <strong>of</strong> fetal haemoglobin (HPFH) is characterized by high levels <strong>of</strong><br />

hemoglobin F (HbF) into adulthood. In pregnancy, this presents a unique situation where both<br />

mother <strong>and</strong> fetus have similar hemoglobin compositions. Theoretically, this can impair the<br />

unloading <strong>of</strong> oxygen at the fetal-placental interface, creating the potential for intra-uterine growth<br />

restriction (IUGR).<br />

Methods: We present a case <strong>of</strong> maternal HPFH, resulting in two pregnancies, <strong>and</strong> a review <strong>of</strong> the<br />

literature.<br />

Results: A 28-year-old primigravid woman was referred in her first pregnancy for a haemoglobin<br />

electrophoresis revealing 100% fetal hemoglobin. Genetic studies confirmed the deletional form<br />

<strong>of</strong> HPFH. Her haematological indices were unremarkable, except for mild gestational<br />

thrombocytopenia. Serial prenatal fetal ultrasounds demonstrated growth between 40 th <strong>and</strong> 50 th<br />

centiles <strong>and</strong> normal uterine, umbilical <strong>and</strong> middle cerebral artery doppler studies. She had a term<br />

spontaneous vaginal delivery <strong>of</strong> a vigorous 2650g female neonate. Cord blood gases were within<br />

normal limits. Placental pathology demonstrated extensive punctate microcalcification <strong>of</strong> chorionic<br />

plate with no other abnormalities.<br />

The patient had a second unremarkable pregnancy approximately one <strong>and</strong> half years later,<br />

delivering a small for gestational age 2399g neonate at term. One <strong>and</strong> five minute Apgar scores<br />

were 7 <strong>and</strong> 9 with normal arterial <strong>and</strong> venous blood gases. Placental pathology was within normal<br />

limits.<br />

Conclusions: Women with HPFH are capable <strong>of</strong> delivering healthy babies. Vigilant prenatal<br />

monitoring for signs <strong>of</strong> fetal growth restriction <strong>and</strong> optimisation <strong>of</strong> maternal haemoglobin is<br />

suggested.


56<br />

ABSTRACT #P-D2<br />

CRYOPRESERVATION OF OOCYTES: A RANDOMIZED CONTROLLED TRIAL<br />

COMPARING SLOW-FREEZING TO VITRIFICATION<br />

Tina Lo (F), Ellen Greenblatt, Toni Di Berardino<br />

Mount Sinai Centre for Fertility <strong>and</strong> Reproductive Health, <strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> <strong>and</strong><br />

Gynaecology, Mount Sinai Hospital<br />

Objective: To compare slow-freezing to vitrification in human oocytes<br />

Methods: This is a r<strong>and</strong>omized controlled trial with institutional ethics approval. IVF Patients <<br />

38 years with a BMI < 30 <strong>and</strong> who are identified as likely to produce 14 or more oocytes at ovum<br />

pick up are eligible for the study. Following written informed consent these patients will donate 4<br />

oocytes for this study. Donated oocytes from a single patient will be r<strong>and</strong>omized to one <strong>of</strong> the 2<br />

freezing protocols. One arm represents the slow-freezing protocol as described originally (Porcu et<br />

al 2000). The other arm represents the vitrification protocol as described previously ( Yoon et al<br />

2003).<br />

Study patients who do not conceive from the transfer <strong>of</strong> fresh embryos in the original IVF cycle ,<br />

will undergo embryo transfer using cryopreserved MII oocytes, which will be thawed <strong>and</strong> fertilized<br />

by ICSI. Demographic <strong>and</strong> cycle specific parameters that will be collected are age, units <strong>of</strong><br />

exogenous FSH required for stimulation, peak estradiol level, <strong>day</strong>s <strong>of</strong> stimulation <strong>and</strong> number <strong>of</strong><br />

oocytes obtained.<br />

The primary outcome parameter is post-thaw oocyte survival rate. The secondary outcome<br />

parameters are fertilization rate, cleavage <strong>and</strong> embryo development, implantation rate <strong>and</strong> ongoing<br />

pregnancy.<br />

Results: This is a work in progress. Recruitment <strong>of</strong> patients for this study started August 2008. So<br />

far 45 patients were eligible,11 patients have not decided yet, 21 declined, 13 signed to enter the<br />

study <strong>of</strong> ,which 9 patients cryopreserved oocytes. 1 Patient was excluded because < 14 eggs were<br />

retrieved.<br />

3 Patients conceived with the fresh embryo transfer. Pregnancy test is pending on 2 patients.<br />

4 Patients thawed their oocytes, 3 <strong>of</strong> them did not have any survival. 1 Patient thawed 4 oocytes,<strong>of</strong><br />

which 2 survived <strong>and</strong> fertilized, 1 embryo was transferred but unfortunately no pregnancy<br />

occurred.<br />

3 Patients have not started their IVF cycle yet.<br />

Conclusions: Although it is still too early to make any conclusions , this study is currently the only<br />

prospective r<strong>and</strong>omized controlled trial comparing slow-freezing to vitrification in human oocytes.<br />

It is registered under Clinical Trial.gov: NCT00777382<br />

Funded by: <strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> <strong>and</strong> Gynaecology Research Fund


57<br />

ABSTRACT #P-D3<br />

REPEAT STI SCREENING IN ADOLESCENT OBSTETRIC PATIENTS<br />

Anjali Aggarwal [F](1,2), Rachel F Spitzer (1,2), Nicolette Caccia (1,2), Lisa Allen (1,2)<br />

(1)<strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> <strong>and</strong> Gynaecology, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>, (2)Hospital for Sick<br />

Children<br />

Objective: We have reviewed demographic characteristics <strong>of</strong> our adolescent obstetric patients,<br />

possible risk factors <strong>and</strong> the results <strong>of</strong> repeat STI screening done in their pregnancies <strong>and</strong><br />

postpartum in order to underst<strong>and</strong> if repeat screening is necessary <strong>and</strong> if there any risk factors that<br />

would help to predict those that will contract an STI in their pregnancy.<br />

Methods: Research ethics approval was obtained. A retrospective chart review <strong>of</strong> 100 adolescent<br />

obstetric patients was undertaken. Data was entered into Excel, which was used to perform<br />

statistical analyses including t-tests, chi-square tests <strong>and</strong> odds ratios.<br />

Results: Of the 100 patients reviewed, 89 had screening in both the first <strong>and</strong> third trimester.<br />

Three patients were not screened in the first trimester due to late presentation <strong>and</strong> eight were not<br />

screened in the third trimester; five were lost to follow up, two delivered preterm <strong>and</strong> one was not<br />

rescreened as her pregnancy was due to sexual assault. All patients were screened at least once in<br />

their pregnancy. Seventy-seven patients were screened for STIs postpartum. Twenty-six patients<br />

were diagnosed with an STI either during pregnancy or postpartum; seventeen in the first trimester,<br />

seven in the third trimester, one in the postpartum period <strong>and</strong> one was diagnosed in the first<br />

trimester <strong>and</strong> again due to symptoms later in pregnancy. There were four failed tests-<strong>of</strong>-cure. The<br />

most common STI diagnosed was chlamydia (24), followed by trichomonas (7) <strong>and</strong> then gonorrhea<br />

(3). Seven patients had multiple STI’s.<br />

The mean age <strong>of</strong> our patients was 15.97 (range 13 – 17). There was no statistically significant<br />

difference in age between those who developed an STI in pregnancy <strong>and</strong> those who did not (15.96<br />

vs. 15.97, p = 0.48). Possible risk factors such as previous pregnancy, previous STI, substance<br />

abuse, living situation, relationship with the baby’s father, number <strong>of</strong> previous partners <strong>and</strong><br />

previous use <strong>of</strong> contraception or condoms were assessed. The only risk factor that was<br />

significantly associated with developing an STI in pregnancy was not using contraception (other<br />

than condoms) in the past (p


58<br />

ABSTRACT #P-D4<br />

DIFFERENTIAL EXPRESSION OF VON HIPPEL LINDAU (VHL) PROTEIN IN<br />

PHYSIOLOGICAL AND PATHOLOGICAL HUMAN PLACENTATION AND ITS ROLE<br />

IN FIBRONECTIN EXPRESSION<br />

Livia Deda [G] (1,2,3), Stacey Zamudio (4) <strong>and</strong> Isabella Caniggia, (1,2,3)<br />

(1) Mount Sinai Hospital, Samuel Lunenfeld Research Institute, <strong>Department</strong>s <strong>of</strong> (2) Physiology<br />

<strong>and</strong> (3) <strong>Obstetrics</strong> <strong>and</strong> Gynaecology Faculty <strong>of</strong> Medicine, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong> (4) <strong>Obstetrics</strong> <strong>and</strong><br />

Gynaecology & Women's Health, New Jersey Medical School, Newark, NJ.<br />

Objective: Von Hippel Lindau (VHL) is a tumor suppressor protein known to act as a substrate<br />

recognition component <strong>of</strong> an E3 ubiquitin ligase complex which targets Hypoxia Inducible Factor<br />

for degradation. Independent <strong>of</strong> this function, VHL has been shown to interact with fibronectin<br />

(FN), an extracellular matrix (ECM) glycoprotein. Emerging evidence supports a novel role for<br />

VHL in establishing the structure <strong>of</strong> ECM during murine vascular placental development by<br />

regulating fibronectin assembly. In this study we investigated the interaction <strong>of</strong> VHL <strong>and</strong> FN in the<br />

developing human placenta.<br />

Methods: Placental tissues were collected from normal placentae throughout gestation (5-14 wks<br />

n=13; term n=5), high altitude placentae (HA n=14), preeclamptic placentae (PE n=25), <strong>and</strong> agematched<br />

controls (AMC n=21). VHL mRNA was assessed by qPCR <strong>and</strong> VHL <strong>and</strong> FN protein<br />

expression was assessed by immunoblotting. Localization <strong>of</strong> VHL <strong>and</strong> FN was determined by<br />

immun<strong>of</strong>lourescent staining <strong>of</strong> placental sections throughout gestation, HA, PE, <strong>and</strong> AMC. To<br />

study the role <strong>of</strong> VHL in regulating fibronectin protein levels, we silenced VHL in the JEG3<br />

choriocarcinoma cell line with siRNA, using a liposome based-reagent.<br />

Results: We investigated the association between the temporal <strong>and</strong> spatial pattern <strong>of</strong> VHL <strong>and</strong> FN<br />

protein expression during human placenta development. VHL peaked in early gestation <strong>and</strong><br />

localized primarily to trophoblast cells <strong>and</strong> stromal region. Interestingly, we observed VHL <strong>and</strong> FN<br />

colocalization around blood vessels using dual immun<strong>of</strong>lourescent staining. To further investigate<br />

this association, we studied placentae characterized by an altered vascular phenotype. Placentae<br />

from pregnancies at high altitude are characterized by a hypervascularized phenotype <strong>and</strong> exhibited<br />

increased levels <strong>of</strong> VHL mRNA <strong>and</strong> protein. Interestingly we found this to be associated with an<br />

increase in FN. In contrast, in PE, a pathology characterized by aberrant placental vasculature, we<br />

observed decreased VHL mRNA <strong>and</strong> protein expression compared to AMC <strong>and</strong> this associated<br />

with increased FN levels. Importantly, FN protein expression increased in VHL silenced JEG3<br />

cells, indicating a direct role <strong>of</strong> VHL in regulating FN synthesis <strong>and</strong>/or degradation.<br />

Conclusions: These data provide evidence that VHL plays a direct role on fibronectin expression<br />

in human placental development <strong>and</strong> disease.<br />

Funded by: Supported by CIHR/IGH


59<br />

ABSTRACT #P-D5<br />

THE POTENTIAL ROLE OF HLA-G IN HUMAN FIRST TRIMESTER UMBILICAL<br />

CORD STEM CELLS<br />

Rong Xiao[PD], Wei Gong, Yu Peng, Junhai Zhao <strong>and</strong> Clifford L. Librach<br />

<strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> <strong>and</strong> Gynaecology, Sunnybrook Health Sciences Centre <strong>and</strong> Women’s<br />

College Hospital, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong><br />

Objective: It has been reported that preimplantation human embryos secrete human leukocyte<br />

antigen-G (HLA-G), which plays an important role in immune tolerance, protecting the fetus from<br />

maternal immune attack. This HLA Class I molecule may also contribute to graft tolerance <strong>and</strong><br />

resistance <strong>of</strong> tumors to host immune attack. We have previously isolated <strong>and</strong> exp<strong>and</strong>ed stem cells<br />

from the first trimester human umbilical cord (UCSC) <strong>and</strong> demonstrated that these cells have<br />

embryonic-like stem cell characteristics with the capacity to differentiate into a wide variety <strong>of</strong> cell<br />

types that include derivatives <strong>of</strong> all three embryonic germ layers. Therefore, these cells may be a<br />

novel source <strong>of</strong> stem cells for regenerative medicine <strong>and</strong> tissue engineering in the future. Several<br />

investigators have found a good correlation between HLA-G expression <strong>and</strong> graft acceptance, here<br />

we investigate whether HLA-G is expressed by first trimester UCSC’s at the mRNA <strong>and</strong> protein<br />

levels.<br />

Methods: Twenty-six individual first trimester umbilical cord stem cell samples were obtained.<br />

Cells were isolated <strong>and</strong> cultured according to previously described methodology. Cells from<br />

different samples <strong>and</strong> passages were used for detection <strong>of</strong> HLA-G gene transcription by RT-PCR.<br />

HLA-G protein expression was tested by Western blotting <strong>and</strong> immunocytochemistry. ELISA was<br />

performed to detect soluble HLA-G molecules in culture supernatant.<br />

Results: We found that 18 <strong>of</strong> 26 (69%) <strong>of</strong> first trimester UCSC samples expressed HLA-G as<br />

detected by the HLA-G primers. The HLA-G positive samples continued to express HLA-G<br />

transcripts from passage 3 until the last passage tested, the 21st. The membrane-bound HLA-G1-4<br />

mRNA is<strong>of</strong>orms were examined by nested RT-PCR. Which specific is<strong>of</strong>orms <strong>and</strong> their expression<br />

patterns varied between samples. To analyze the presence <strong>of</strong> HLA-G protein on first trimester<br />

UCSC’s, we used the our specific 4H84 antibody, which confirmed that HLA-G protein was<br />

readily detectable with immunocytochemistry <strong>and</strong> Western blotting. A mean value <strong>of</strong><br />

35.35±7.5ng/ml HLA-G protein was detected in first trimester UCSC culture surpernatants.<br />

However, the soluble HLA-G expression varied under different culture conditions.<br />

Conclusions: This study provides strong evidence that first trimester UCSC’s express HLA-G<br />

mRNA <strong>and</strong> protein. These results are very encouraging for the potential application <strong>of</strong> first<br />

trimester UCSC’s in cellular transplantation <strong>and</strong> tissue regeneration therapies.


60<br />

ABSTRACT #P-E1<br />

THE ROLE OF ANDROGEN SIGNALING IN THE ONSET OF LABOR. (WORK-IN-<br />

PROCESS)<br />

Yunqing Li [G] (1,2), Oksana Shynlova (1), Xuesen Dong (4), Stephen J Lye (1,2,3).<br />

(1)Samuel Lunenfeld <strong>research</strong> Institute, Mount Sinai Hospital, <strong>Department</strong> <strong>of</strong> (2) Physiology <strong>and</strong><br />

(3)<strong>Obstetrics</strong> & Gynaecology, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>, (4)Prostate Center at Vancouver General<br />

Hospital, <strong>University</strong> <strong>of</strong> British Columbia.<br />

It was reported earlier that plasma levels <strong>of</strong> <strong>and</strong>rogen during pregnancy in rats show the similarity<br />

to those <strong>of</strong> progesterone. The decrease <strong>of</strong> <strong>and</strong>rogen levels in the circulation near term (analogous to<br />

the decrease <strong>of</strong> progesterone levels) may facilitate up-regulation <strong>of</strong> contraction associated protein<br />

(CAP) gene expression in the myometrium. The <strong>and</strong>rogen receptor (AR) is a member <strong>of</strong> the<br />

nuclear receptor super-family that functions as a lig<strong>and</strong>-dependent transcription factor that can<br />

regulate the expression <strong>of</strong> target genes. Our preliminary data show that AR was able to suppress<br />

transcriptional activity <strong>of</strong> Cx43 promoter in vitro. Thus, we hypothesize that the AR, similar to<br />

the progesterone receptor (PR), is able to suppress CAP genes (i.e. Cx43) in vivo in the pregnant<br />

rat myometrium.<br />

Objective: (1) To study the protein expression <strong>of</strong> AR in rat myometrium throughout gestation; (2)<br />

To develop a new rat preterm labor model using Casodex, a well-known inhibitor <strong>of</strong> AR as to<br />

investigate whether <strong>and</strong>rogen signaling regulate the expression <strong>of</strong> CAP genes in vivo.<br />

Methods: (1) Myometrial tissues were collected from pregnant rats on gestational <strong>day</strong>s 8, 10, 14,<br />

15, 19, 21, 23 (<strong>day</strong> <strong>of</strong> labor) <strong>and</strong> <strong>day</strong> 1 postpartum (n = 4 at each time point) for Western blot<br />

analysis <strong>of</strong> AR expression.<br />

(2) Pregnant animals (gestational <strong>day</strong> 17) were split into two groups. Group 1 consisted <strong>of</strong> 8<br />

animals treated with subcutaneous injections <strong>of</strong> Casodex (100 mg/kg/<strong>day</strong> or 50 mg/kg/<strong>day</strong>) <strong>and</strong><br />

group 2 consisted <strong>of</strong> 8 animals treated with vehicle (DMSO). For each group, uterine tissues are<br />

collected after 24 hours (4 animals) <strong>and</strong> 48 hours (4 animals) <strong>and</strong> processed for<br />

immunohistochemical <strong>and</strong> biochemical analysis.<br />

Results: Densitometric analysis revealed high levels <strong>of</strong> AR expression throughout early <strong>and</strong> midpregnancy<br />

<strong>and</strong> a significant decrease with the approach <strong>of</strong> term <strong>and</strong> during labor (p < 0.05). This<br />

data confirms that protein gestational pr<strong>of</strong>ile for AR is similar to that <strong>of</strong> PR. We are currently in<br />

process <strong>of</strong> developing the Casodex-induced rat preterm labor model.<br />

Conclusions: Our preliminary data suggest that during pregnancy <strong>and</strong>rogen signaling may play an<br />

important role by repressing labor-related genes during first half <strong>of</strong> gestation. At term, when<br />

progesterone <strong>and</strong> <strong>and</strong>rogen plasma levels decrease <strong>and</strong> both receptors (PR <strong>and</strong> AR) are downregulated<br />

in the myometrium, the suppression <strong>of</strong> CAP genes is abolished.<br />

Funded by: CIHR #42378


61<br />

ABSTRACT #P-E2<br />

OXYTOCIN PREEXPOSURE DOES NOT AFFECT OXYTOCIN INDUCED<br />

MYOMETRIAL CONTRACTIONS IN TERM PREGNANT WOMEN<br />

Mrinalini Balki (1), Magda Erik-Soussi [O](1), Robert K. Parkes (1), John Kingdom (2), Jose CA<br />

Carvalho (1,2)<br />

(1)<strong>Department</strong> <strong>of</strong> Anaesthesia <strong>and</strong> Pain Management <strong>and</strong> (2) <strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> <strong>and</strong><br />

Gynaecology, Mount Sinai Hospital, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong><br />

Objective: To investigate the in-vitro myometrial response in term pregnant women after<br />

preexposure to different concentrations <strong>of</strong> oxytocin for variable durations.<br />

Methods: After REB approval, the study was conducted in 32 nonlaboring term pregnant women<br />

undergoing elective CS under spinal anesthesia. A small sliver <strong>of</strong> myometrium was excised from<br />

the incision on the lower uterine segment immediately before oxytocin administration, <strong>and</strong> then<br />

was dissected into 4 strips (2x2x10mm each). The strips were allowed to equilibrate in 10ml organ<br />

bath chambers containing physiological salt solution (PSS) at 1g tension. Two strips were then<br />

exposed to either 10 -10 M or 10 -8 M oxytocin (experimental groups), <strong>and</strong> the other two were kept in<br />

PSS (control groups) for 2h (n=23). All the muscle strips were then subjected to dose-response<br />

testing with oxytocin (10 -10 to10 -5 M). Similar experiments were done after the preexposure <strong>of</strong><br />

separate myometrial strips to oxytocin/PSS for 4h (n=26), 6h (n=38), <strong>and</strong> 12h (n=26) periods. The<br />

amplitude <strong>and</strong> frequency <strong>of</strong> contractions during the dose-response period were analyzed using<br />

mixed linear modeling <strong>and</strong> compared among the groups.<br />

Results: There was no statistically significant difference in the amplitude <strong>of</strong> contractions during<br />

the dose-response period when the myometrial strips were preexposed to varying concentrations <strong>of</strong><br />

oxytocin (0, 10 -10 M, or 10 -8 M) (p=0.35), or for varying periods <strong>of</strong> time (2h, 4h, 6h, <strong>and</strong> 12h).<br />

There was, however, some evidence that the shape <strong>of</strong> the curves for amplitude <strong>of</strong> contractions<br />

differed during the dose-response period (p=0.020). The dose-response curves (experimental <strong>and</strong><br />

control groups combined) showed decreases in the amplitude <strong>of</strong> contractions with longer<br />

pretreatment periods (mean p


62<br />

ABSTRACT #P-E3<br />

CELL CYCLE INHIBITOR, P27, IS DIFFERENTIALLY REGULATED IN EARLY<br />

SEVERE PREECLAMPTIC PLACENTAE COMPARED TO CONTROL<br />

Jocelyn Ray[G], J Xu, Andrea Jurisicova, Isabella Caniggia.<br />

<strong>Department</strong>s <strong>of</strong> <strong>Obstetrics</strong> <strong>and</strong> Gynaecology, Samuel Lunenfeld Research Institute, Mount Sinai<br />

Hospital, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>.<br />

Objective: Scientific <strong>research</strong> continues to highlight the importance <strong>of</strong> cell cycle regulation in<br />

development <strong>and</strong> disease. Nevertheless, little is known about cell cycle regulation in preeclampsia,<br />

a placental pathology hallmarked by a hyper-proliferative status. Recently we found cyclin E1, a<br />

promoter <strong>of</strong> the G1 to S phase transition, to be increased in preeclampsia. Herein we investigate the<br />

regulation <strong>of</strong> p27, an inhibitor <strong>of</strong> cyclin E1, in normal <strong>and</strong> preeclamptic placentae.<br />

Methods: Human placental samples were collected from normal pregnancies throughout gestation<br />

(n=60), from severe early onset preeclamptic (n=36), age-matched (n=22) <strong>and</strong> term control placentae<br />

(n=25). Expression <strong>of</strong> cyclin E1 <strong>and</strong> p27 mRNA was evaluated by qPCR analysis. Western blot<br />

analysis <strong>and</strong> fluorescence immunohistochemistry was used to determine protein expression <strong>and</strong><br />

spatial localization <strong>of</strong> cyclin E1, total p27, <strong>and</strong> phospho-p27(ser-10). First trimester explants,<br />

cultured at 3, 8 <strong>and</strong> 20% oxygen, were examined following treatment with or without TGFβ3.<br />

Results: During normal placentation expression <strong>of</strong> cyclin E1 decreased with gestational age as<br />

levels <strong>of</strong> p27 increased. Surprisingly, in preeclampsia, the protein levels <strong>of</strong> both p27 <strong>and</strong> cyclin E1<br />

were elevated compared to age matched controls. No change was detected at the transcript level,<br />

suggesting, that in this pathology regulation <strong>of</strong> cyclin E1 <strong>and</strong> p27 occur at the protein level.<br />

Phosphorylation <strong>of</strong> p27 at the ser-10 residue can lead to its transport from the nucleus into the<br />

cytoplasm, preventing its inhibitory function on cyclin E1. Interestingly, expression studies<br />

indicated that, in preeclamptic placentae, the majority <strong>of</strong> p27 was phosphorylated at ser-10 <strong>and</strong><br />

localized to the cytoplasm <strong>of</strong> cyclin E1 positive cytotrophobast cells. We have previously shown<br />

that trophoblast differentiation is driven in part by TGFβ3 as well as by the change in oxygen<br />

status. Moreover, we have reported on both increased TGFβ3 <strong>and</strong> a hypoxic environment in<br />

preeclamptic placentae. Intriguingly, the combined treatment <strong>of</strong> TGFβ3 <strong>and</strong> 3%O 2 lead to an<br />

increase in p27 expression in placental explants.<br />

Conclusion: A low O 2 environment along with TGFβ3 expression may explain the elevated levels<br />

<strong>of</strong> p27 seen in preeclampsia. Although the cell cycle inhibitor p27 is increased, cytotrophoblast<br />

cells in preeclampsia remain hyperproliferative due to altered p27 regulation.<br />

Funded by: CIHR, OWH/IGH)


63<br />

ABSTRACT #P-E4<br />

LAPAROSCOPIC PERITONEAL ENTRY PREFERENCES AMONG CANADIAN<br />

GYNAECOLOGISTS<br />

Ambika Aneja [R], Jamie Kr<strong>of</strong>t, Jessica Tyrwhitt, Artin Ternamian.<br />

<strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> <strong>and</strong> Gynaecology, Division <strong>of</strong> Gynaecologic Endoscopy, St. Joseph’s<br />

Health Centre, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>.<br />

Objectives: To underst<strong>and</strong> current laparoscopic entry practices among Canadian gynecologists <strong>and</strong><br />

to raise Patient Safety awareness in accordance with the recent Society <strong>of</strong> Obstetricians <strong>and</strong><br />

Gynecologists <strong>of</strong> Canada (SOGC) Clinical Practice Guidelines for Laparoscopic Entry publication<br />

May 2007.<br />

Methods: A national survey was designed to determine different laparoscopic entry methods <strong>and</strong><br />

entry locations, mishaps <strong>and</strong> demographics <strong>of</strong> practicing gynecologists. Institutional Research<br />

Ethics Board approval was obtained <strong>and</strong> the survey was translated into French for Francophone<br />

practitioners. In total, the survey was forwarded to 590 SOGC members.<br />

Results: Of 405 responses (68.6% response rate), 202 responses were from<br />

obstetrician/gynecologists who identified themselves as currently practicing laparoscopy. Seventyfive<br />

percent <strong>of</strong> respondents self-reported that they had read the SOGC laparoscopic entry<br />

guidelines. There was no significant difference in practice patterns when comparing geographic<br />

practice location <strong>and</strong> number <strong>of</strong> years in practice. In virginal abdomens, the commonest entry<br />

method is the Veress-insufflation Closed trocar entry (78.9%). When adhesions are suspected, only<br />

25.4% utilize the Left Upper Quadrant. Only 28.7% use an insufflation pressure <strong>of</strong> 20-25 mmHg.<br />

Conclusions: Our survey had a significant response rate <strong>and</strong> was able to delineate current<br />

laparoscopic entry practice patterns <strong>of</strong> gynecologists, which were consistent across Canada.<br />

Despite a 75% self-reported familiarity with the recent SOGC Clinical Practice Guidelines, it<br />

appears that clinical practice does not necessarily coincide with current recommendations. These<br />

variances in gynecological practice emphasize the necessity for further educational initiatives to<br />

ensure application <strong>of</strong> evidence-based <strong>research</strong> into contemporary safe clinical practice nationally.


64<br />

ABSTRACT #P-F1<br />

DEXAMETHASONE STIMULATES PLACENTAL AMINO ACID TRANSPORT AND<br />

SYNCYTIOTROPHOBLAST DIFFERENTIATION.<br />

Melanie C Audette[G](1), Susan L Greenwood(2), Colin P Sibley(2), Carolyn J Jones(2),<br />

Stephen G Matthews(1), John R Challis(1), <strong>and</strong> Rebecca L Jones(2).<br />

(1) <strong>Department</strong> <strong>of</strong> Physiology, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>, Canada <strong>and</strong> (2)Maternal <strong>and</strong> Fetal Heath<br />

Research Group, <strong>University</strong> <strong>of</strong> Manchester, United Kingdom.<br />

Objective: Synthetic glucocorticoids (GCs) are routinely given to women with threatened preterm<br />

delivery, <strong>and</strong> have been linked to fetal growth restriction. In animal models, GC administration<br />

during pregnancy results in reduced birthweight due to decreased placental size <strong>and</strong> endocrine<br />

function. Whether GCs affect the development or function <strong>of</strong> human placenta is unknown. System<br />

A is an amino acid transporter that transfers small neutral amino acids across the placenta <strong>and</strong> is<br />

essential for normal fetal growth. We hypothesized that GCs would adversely affect placental<br />

amino acid transport.<br />

Methods: Human term placental explants (n=7) were cultured for 4 <strong>day</strong>s to allow<br />

syncytiotrophoblast (ST) shedding <strong>and</strong> regrowth. Explants were then treated for 48hr with<br />

dexamethasone (DEX 10 -8 M or 10 -6 M) or vehicle alone. On <strong>day</strong> 6, system A activity <strong>of</strong> placental<br />

explants was assessed by measuring uptake <strong>of</strong> 14 C-meAIB. Further, explants were processed for<br />

electron microscopy (EM) <strong>and</strong> IHC for proliferation marker Ki67. RNA was isolated from explants<br />

to examine expression <strong>of</strong> system A genes, Slc38a1 <strong>and</strong> Slc38a2 using qRT-PCR. hCG secretion<br />

from explants <strong>and</strong> mRNA expression <strong>of</strong> 11βHSD-2 were assessed as ST markers.<br />

Results: DEX at 10 -6 M stimulated system A activity compared to control levels (p


65<br />

ABSTRACT #P-F2<br />

PERIPHERAL LEUKOCYTES AS NOVEL TARGETS FOR THE PREVENTION OF<br />

PRETERM BIRTH<br />

Tamara Nedd-Roderique [G](1,2), Oksana Shynlova (1), Anna Dorogin (1), Stephen Lye(1,2,3)<br />

(1) Samuel Lunenfeld Research Institute, Mount Sinai Hospital, (2) <strong>Department</strong> <strong>of</strong> Physiology, <strong>and</strong><br />

(3) <strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> & Gynaecology, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>.<br />

Objective: Uterine tissues (myometrium <strong>and</strong> decidua) are major sources <strong>of</strong> pro-inflammatory<br />

cytokines <strong>and</strong> prostagl<strong>and</strong>ins that contribute to labour. Previous studies in the Wistar rat have<br />

shown an increased expression <strong>of</strong> uterine chemokines prior to the onset <strong>of</strong> term labour in<br />

association with infiltration <strong>of</strong> peripheral leukocytes (PLs). We hypothesize that PLs infiltrate<br />

uterine tissues where they contribute to the development <strong>of</strong> tissue inflammation contributing to the<br />

initiation <strong>of</strong> term <strong>and</strong> preterm labour (PTL). Targeting these cells might therefore represent a novel<br />

approach to the prevention <strong>of</strong> PTL. The objective <strong>of</strong> this study is to characterize leukocyte<br />

infiltration (1) throughout normal gestation <strong>and</strong> term labour in mice, <strong>and</strong> (2) during<br />

lipopolysaccharide (LPS) induced PTL in mice.<br />

Methods: (1) Pregnant CD-1 mice are euthanized on gestational <strong>day</strong> 6, 12, 18, 20 (Labour) <strong>and</strong> 1-<br />

<strong>day</strong> post partum (PP). (2) On <strong>day</strong> 15 <strong>of</strong> gestation pregnant CD-1 mice (n=6) undergo a laparotomy<br />

in the lower abdomen. LPS (250µg/mouse) is infused into the uterus between the two gestational<br />

sacs most proximal to the cervix. Sham animals (n=6) receive an intrauterine injection <strong>of</strong> sterile<br />

saline. Animals are euthanized during PTL or 24 hours post surgery. One whole uterine horn<br />

(myometrium <strong>and</strong> decidua) is collected, fixed in 4% paraformaldehyde or formalin <strong>and</strong> used for<br />

immunohistochemical analysis to characterize the leukocyte infiltration during normal term labour<br />

<strong>and</strong> inflammation-induced PTL. Specific antibodies will be used to (1) detect the amount <strong>and</strong><br />

location <strong>of</strong> leukocyte sub-populations (neutrophils, macrophages <strong>and</strong> T-cells) within these tissues<br />

<strong>and</strong> (2) to compare the level <strong>of</strong> leukocyte infiltration throughout normal gestation, during term<br />

labour, PP <strong>and</strong> during inflammation-induced PTL.<br />

Results: We have been successful in reproducing the mouse model <strong>of</strong> LPS- induced PTL with CD-<br />

1 mice delivering 8, 11 <strong>and</strong> 15 hours post surgery. Preliminary data suggests that there is a marked<br />

increase in neutrophils <strong>and</strong> macrophages in uterine samples collected from preterm CD-1 mice<br />

when compared to the sham surgery control animals.<br />

Conclusions: Our preliminary results have identified neutrophils <strong>and</strong> macrophages as two<br />

leukocyte subsets that may play a role in the activation <strong>of</strong> the myometrium leading to premature<br />

delivery. This identifies two cell types that could potentially be targeted for the delay or blockage<br />

<strong>of</strong> PTL.<br />

Funded by: CIHR # 37775


66<br />

ABSTRACT #P-F3<br />

EDUCATING SURGICAL SPECIALTY RESIDENTS FOR LEADERSHIP AND<br />

ADVOCACY IN CANADIAN HEALTHCARE REFORM<br />

Noor Ladhani [R](1), Nan Okun(1), Heather Shapiro(1), Danielle Martin(2)<br />

(1) <strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong>/Gynaecology <strong>and</strong> (2) <strong>Department</strong> <strong>of</strong> Family Medicine, <strong>University</strong> <strong>of</strong><br />

<strong>Toronto</strong>.<br />

Objective: To evaluate the impact <strong>of</strong> a single educational session about health care systems issues<br />

<strong>and</strong> challenges on the perception <strong>of</strong> the resident as advocate, manager <strong>and</strong> collaborator within that<br />

system.<br />

Methods: A single 1.5 hour interactive session on health care policy was created as part <strong>of</strong> the<br />

general academic curriculum <strong>of</strong> the senior <strong>Obstetrics</strong> <strong>and</strong> Gynaecology residents at the <strong>University</strong><br />

<strong>of</strong> <strong>Toronto</strong>. Included were topics related to the Canadian health care system: history, current status,<br />

comparison with other systems, issues <strong>and</strong> challenges <strong>and</strong> potential roles for<br />

obstetrical/gynecological residents as advocates, collaborators <strong>and</strong> managers within that system. A<br />

pre <strong>and</strong> post session survey was administered.<br />

Results: The survey revealed that this single session had a positive impact on residents’ knowledge<br />

<strong>of</strong> the Canada Health Act, different means <strong>of</strong> financing <strong>and</strong> delivery <strong>of</strong> health care, <strong>and</strong> differences,<br />

strengths <strong>and</strong> weaknesses <strong>of</strong> the Canadian health care system compared with the American <strong>and</strong><br />

British systems. Both prior to <strong>and</strong> after the session, the most commonly identified health care<br />

system concerns were financial resources within the Canadian Healthcare system, access to health<br />

care in general, access to primary care, wait times <strong>and</strong> the aging population. Advocacy efforts <strong>and</strong><br />

participation in pr<strong>of</strong>essional organizations were the most commonly cited ways residents suggested<br />

that they might engage in healthcare reform, <strong>and</strong> many participants stated that they personally<br />

would contribute by altering practice patterns <strong>and</strong> serving as advocates for their patients.<br />

Residents rated satisfaction with the session highly, <strong>and</strong> endorsed its’ future inclusion in the<br />

general curriculum.<br />

Conclusion: A single, interactive session on health care policy positively impacts<br />

obstetrical/gynecological residents’ knowledge <strong>and</strong> perception <strong>of</strong> their personal role as advocate,<br />

collaborator <strong>and</strong> manager within that system. This session could be relevant to these CanMeds<br />

objectives in other surgical specialty training programs.


67<br />

ABSTRACT #P-F4<br />

THE EXPRESSION OF PAR6 DURING HUMAN PLACENTATION<br />

Tharini Sivasubramaniyam [G], Isabella Caniggia<br />

<strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> & Gynaecology, Mount Sinai Hospital, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>.<br />

Objective: Evidence has shown that stem cells use polarity to generate cell diversity, whereas<br />

differentiated cells use polarity to execute specific functions such as migration. Evidently, this<br />

seems to be recapitulated in the placenta with progenitor cytotrophoblast cells behaving as stemlike<br />

cells <strong>and</strong> extravillous trophoblast cells acquiring a migratory phenotype. Accordingly, this<br />

study examines the contribution <strong>of</strong> cell polarity to trophoblast differentiation by studying Par6<br />

(Partioning defective protein 6), a key regulator <strong>of</strong> cell polarity.<br />

Methods: The temporal expression <strong>of</strong> Par6 was examined throughout placental development by<br />

Western Blot analysis on placental lysates using Par6 (goat polyclonal, Santa Cruz) antibody.<br />

Spatial localization <strong>of</strong> Par6 was determined by immun<strong>of</strong>lourescence staining on placental lysates.<br />

Spatial localization was done in conjunction with tight junction marker, Zona occludin-1 (ZO-1)<br />

using ZO-1 (rabbit monoclonal, Santa Cruz) antibody. To investigate whether oxygen participates<br />

in the regulation <strong>of</strong> Par6 expression in placental trophoblasts, JEG3 choriocarcinoma cells were<br />

cultured in 3% <strong>and</strong> 20% oxygen tension <strong>and</strong> Par6 expression was assessed by Western Blot<br />

analysis. Furthermore, Par6 expression was assessed in preeclampsia, a form <strong>of</strong> placental<br />

pathology.<br />

Results: Par6 expression was increased around 10-14wks <strong>of</strong> gestation. Furthermore, using<br />

immun<strong>of</strong>luorescence staining, within the floating villi, Par6 was found to be localized early on in<br />

gestation predominantly to the nucleus <strong>of</strong> cytotrophoblast cells <strong>and</strong> later on in gestation localized<br />

to the cytosol <strong>of</strong> the syncytiotrophoblast layer. Within the anchoring villi, Par6 expression is also<br />

seen in the nuclei <strong>of</strong> extravillous trophoblast cells located in the distal part <strong>of</strong> the anchoring<br />

column. Par6 is also shown to localize with ZO-1. In addition, Par6 expression is shown to<br />

change with oxygen tension, increasing with higher oxygen levels. Furthermore in preeclampsia,<br />

Par6 expression is decreased relative to age matched control.<br />

Conclusions: Par6 exhibits a unique temporal <strong>and</strong> spatial pattern <strong>of</strong> expression coinciding with<br />

active trophoblast invasion <strong>and</strong> increase oxygen tension during placental development. Our data<br />

demonstrates that Par6 may play a role in the events accompanying trophoblast cell differentiation<br />

in normal <strong>and</strong> pathological pregnancies.<br />

Funded by: CIHR


68<br />

ABSTRACT #P-F5<br />

OUTCOMES IN ROBOTIC-ASSISTED SURGERY FOR GYNAECOLOGIC ONCOLOGY<br />

Lilian T Gien [F], Barry Rosen, Marcus Bernardini<br />

Division <strong>of</strong> Gynecologic Oncology, Princess Margaret Hospital, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong><br />

Objective: The purpose <strong>of</strong> this study was to analyze the perioperative <strong>and</strong> quality <strong>of</strong> life outcomes<br />

in patients with robotic-assisted surgery for gynaecologic oncology.<br />

Methods: In this prospective observational study, patients had robotic-assisted surgery consisting<br />

<strong>of</strong> a hysterectomy <strong>and</strong> bilateral salpingo-oophorectomy (HBSO) +/- omentectomy, pelvic <strong>and</strong> paraaortic<br />

node dissection between December 1, 2008 <strong>and</strong> February 23, 2009. All cases were done by<br />

two gynaecologic oncologists at a single institution. Data collection included operative time,<br />

estimated blood loss, intra- <strong>and</strong> post-operative complications, lymph node counts, <strong>and</strong> length <strong>of</strong><br />

stay. The median operative time for the first half <strong>of</strong> patients was compared to that <strong>of</strong> the second<br />

half. Post-operative questionnaires were completed to evaluate pain control, return to normal<br />

activity, <strong>and</strong> quality <strong>of</strong> life. Statistical analysis included the Mann-Whitney U test.<br />

Results: Twenty gynaecologic oncology patients had robotic-assisted surgery. Median age was<br />

63 years <strong>and</strong> median BMI was 32.7 kg/m 2 (range 20.8-57.9 kg/m 2 ). 85% had a malignancy,<br />

including endometrial, cervical or ovarian carcinoma. 50% <strong>of</strong> cases included pelvic <strong>and</strong> paraaortic<br />

lymphadenectomy; median lymph node count was 20. The median operative time was 203<br />

mins (range 101-355 mins). Among those with HBSO +/- omentectomy, operative time<br />

significantly decreased between the first half <strong>and</strong> second half <strong>of</strong> patients (201 mins vs 124 mins,<br />

p=0.043). Conversion to a vaginal approach occurred in two patients. Five patients had minor<br />

postoperative complications such as UTI or genit<strong>of</strong>emoral nerve injury. Median estimated blood<br />

loss was 80 cc <strong>and</strong> median length <strong>of</strong> stay was 1 <strong>day</strong>. By 3 weeks after surgery, the majority <strong>of</strong><br />

patients reported minimal to no pain, a return to normal activity, <strong>and</strong> a good quality <strong>of</strong> life.<br />

Conclusion: Robotic-assisted surgery is feasible in gynaecologic oncology patients who require<br />

surgical staging, <strong>and</strong> is associated with minimal blood loss, short hospital stay, <strong>and</strong> excellent<br />

patient recovery. As a tool for promoting minimally invasive surgery, increasing experience with<br />

the Da Vinci robotic system with even a small number <strong>of</strong> cases leads to a significant decrease in<br />

operative time.


69<br />

ABSTRACT #P-G1<br />

INCIDENCE OF GESTATIONAL HYPERTENSIVE DISORDERS IN PREGNANCIES<br />

COMPLICATED BY IUGR: TWINS VERSUS SINGLETONS<br />

Katy Gouin[F](1), Jon Barrett(1), Yoav Yinon(1), Ori Nevo(1).<br />

(1)Maternal-Fetal Medicine Division, <strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> & Gynaecology, Sunnybrook<br />

Health Science Center, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>.<br />

Objective: To compare the incidence <strong>of</strong> gestational hypertensive disorders (GHD) in twin<br />

pregnancies complicated by intrauterine growth restriction (IUGR) to singleton IUGR pregnancies.<br />

Methods: A database <strong>and</strong> chart review <strong>of</strong> all pregnancies (twins <strong>and</strong> singletons) delivered at 23-41<br />

weeks at a tertiary referral centre from July 2002 to 2007 was performed. Patients’ characteristics<br />

as well as birth weight, chorionicity <strong>and</strong> umbilical artery Doppler were collected. GHD included<br />

gestational hypertension <strong>and</strong> preeclampsia. IUGR was defined as birth weight ≤ 10 percentile using<br />

twin <strong>and</strong> singleton curves respectively. Chi-square <strong>and</strong> Student t test were used when appropriate.<br />

Results: 815 twin pregnancies <strong>and</strong> 16 666 singletons were delivered during the study period.<br />

16.1% <strong>of</strong> twin pregnancies were complicated by IUGR <strong>of</strong> one twin (25% <strong>of</strong> them were<br />

monochorionic) compared to an incidence <strong>of</strong> 2.8% <strong>of</strong> IUGR in singleton pregnancies (p


70<br />

ABSTRACT #P-G2<br />

P16 ONCOPROTEIN AS A TRIAGE TOOL IN PATIENTS WITH LOW GRADE<br />

SQUAMOUS INTRAEPITHELIAL LESION OF THE UTERINE CERVIX: A PILOT<br />

STUDY.<br />

Clarissa Bambao [F](1), Golnar Rasty(2), Michael Shier(1).(1) <strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> <strong>and</strong><br />

Gynaecology, Sunnybrook Health Sciences Centre, (2) <strong>Department</strong> <strong>of</strong> Pathology, Sunnybrook<br />

Health Sciences Center, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>.<br />

Objectives: Women with low grade squamous intraepithelial lesions (LSIL) <strong>of</strong> the cervix comprise<br />

the majority <strong>of</strong> patients seen on referral or follow-up in colposcopy units in North America. A<br />

small percentage <strong>of</strong> LSIL may progress to high-grade lesions or invasive cancer <strong>of</strong> the cervix. To<br />

date there has been no reliable markers <strong>of</strong> predicting which lesions will progress. P16 oncoprotein,<br />

a tumor suppressor protein <strong>and</strong> cyclin-dependent kinase inhibitor, is specifically over-expressed by<br />

viral oncogenes in cervical lesions at high risk <strong>of</strong> progressing to high-grade dysplasia. This pilot<br />

study investigates the utility <strong>of</strong> p16 oncoprotein as a prognostic marker for the management <strong>and</strong><br />

triage <strong>of</strong> patients with LSIL.<br />

Methods: A prospective r<strong>and</strong>omized pilot study <strong>of</strong> 144 patients referred to colposcopy for LSIL on<br />

cytology. All patients underwent colposcopy <strong>and</strong> biopsy to obtain histological confirmation <strong>of</strong> the<br />

LSIL diagnosis. Patient’s smoking <strong>and</strong> immunological status were also determined. Exclusion<br />

criteria included unsatisfactory colposcopy, previous history <strong>of</strong> abnormal cytology <strong>and</strong> biopsy<br />

confirming lesions other than LSIL. A total <strong>of</strong> 81 patients were enrolled in the pilot study.<br />

Immunohistochemistry using p16 antibody was used to detect the up-regulation <strong>of</strong> p16 oncoprotein<br />

on LSIL (CIN 1) confirmed biopsies. The colposcopist was blinded to the p16 status <strong>of</strong> the<br />

patients. Patients were then r<strong>and</strong>omized to treatment with ultrapulse laser vaporization <strong>of</strong> the<br />

cervix or follow-up. Follow-up for all patients consisted <strong>of</strong> colposcopy every 3 months. Lesion<br />

resolution (no visible lesion) or progression <strong>of</strong> the lesion was determined by satisfactory<br />

colposcopy with type 1 transformation zone.<br />

Results: Forty-nine patients were determined to be p16 oncoprotein positive <strong>and</strong> 32 patients were<br />

p16 oncoprotein negative. In the p16 oncoprotein positive group, 26 patients had follow-up <strong>and</strong> 23<br />

patients received laser vaporization. In the p16 oncoprotein negative group, 17 patients had followup<br />

<strong>and</strong> 15 patients received laser vaporization. The p16 oncoprotein positive follow-up group: 15<br />

patients had persistence <strong>of</strong> LSIL or progression <strong>of</strong> disease (60)%. The lesion cleared in 10 patients<br />

<strong>and</strong> 1 patient was lost to follow-up. The p16 oncoprotein positive laser vaporization group: 21<br />

patients had their lesion cleared <strong>and</strong> 2 were lost to follow-up. The p16 oncoprotein negative<br />

follow-up group: the lesion was cleared in all 17 patients. The p16 oncoprotein negative laser<br />

vaporization group: the lesion was cleared in 14 patients <strong>and</strong> one <strong>of</strong> the patients developed a new<br />

lesion. One patient was lost to follow-up. Median follow-up time was 24 months (maximum 34).<br />

Conclusions: This pilot study demonstrates the utility <strong>of</strong> p16 oncoprotein as a prognostic triage<br />

tool for LSIL. P16 oncoprotein negative LSIL lesions can be followed by yearly cytology <strong>and</strong> p16<br />

oncoprotein positive lesions can be triaged to close follow-up or treatment. Determining the p16<br />

oncoprotein status <strong>of</strong> a lesion can significantly decrease the volume <strong>of</strong> patients seen in colposcopy,<br />

shorten waiting lists, decrease health care costs <strong>and</strong> lower patient anxiety.


71<br />

ABSTRACT #P-G3<br />

USE OF COMPLEMENTARY MEDICINE (CAM) AMONG WOMEN RECEIVING<br />

CHEMOTHERAPY FOR OVARIAN CANCER: A COMPARISON OF ATTITUDES<br />

BETWEEN TWO PATIENT POPULATIONS<br />

Limor Helpman Bek [F](1), S. E. Ferguson(1), M. Mackean(2), L. Le(1), A. Rogerson(2), A.<br />

Dewan(1), H. Mackay(1)<br />

(1)Princess Margaret Hospital, <strong>Toronto</strong>, (2)Edinburgh Cancer Centre, Edinburgh<br />

Objective: To compare patterns <strong>of</strong> CAM use <strong>and</strong> attitudes to CAM among ovarian cancer (EOC)<br />

pts in Canada <strong>and</strong> Scotl<strong>and</strong>.<br />

Methods: Patients receiving chemotherapy for EOC in Princess Margaret Hospital (PMH),<br />

<strong>Toronto</strong> <strong>and</strong> the Edinburgh Cancer Centre (ECC), Scotl<strong>and</strong>, completed a survey on CAM taken<br />

within the previous month as well as a questionnaire assessing patient attitudes <strong>and</strong> perceptions <strong>of</strong><br />

CAM. A comparison between the 2 patient populations <strong>and</strong> between CAM users <strong>and</strong> non-users<br />

was made.<br />

Results: 194 pts (100 ECC: 94 PMH) were enrolled on study. The use <strong>of</strong> CAM in PMH was<br />

significantly higher than in ECC (52% vs. 36%, p=0.02). Whilst both populations thought it<br />

important for their oncologist to be aware <strong>of</strong> CAM usage (86% PMH: 93% ECC), pts from PMH<br />

were less likely to inform their MD compared to pts from ECC (50% vs 81%, p=0.02). Patterns <strong>of</strong><br />

CAM use differed between the 2 populations: Multivitamins were the most common CAM in both<br />

populations (31% PMH:13% ECC). They were not considered CAM for the purpose <strong>of</strong> analysis.<br />

Most commonly used CAM in PMH were Soy products (12%), vitamin C (10%) <strong>and</strong> Green Tea<br />

(9%); in ECC pts used Omega 3 <strong>and</strong> fish oil (9%), Evening Primrose (7%) <strong>and</strong> vitamin C (6%).<br />

Although the majority <strong>of</strong> CAM users in both populations found CAM to be helpful (57% PMH:<br />

61% ECC) only a minority thought they would cure their cancer (18% PMH: 6% ECC), prevent its<br />

spread (31% PMH: 14% ECC) or prevent a recurrence (20% PMH: 11% ECC). Users more <strong>of</strong>ten<br />

felt CAM relieved symptoms (45% PMH: 42% ECC), boosted the immune system (55% PMH:<br />

56% ECC) or improved their quality <strong>of</strong> life (43% PMH: 53% ECC). ECC CAM users were more<br />

likely than PMH users to concede that CAMs have side effects (39% vs 29%) or could impact the<br />

efficacy <strong>of</strong> conventional treatment (17% vs 6%). CAM users were more likely than non-users to<br />

agree with positive statements <strong>and</strong> to disagree with negative statements about CAM.<br />

Conclusions: CAM use is common among pts receiving chemotherapy for EOC. CAM use was<br />

more prevalent among North American pts than Scottish pts. Attitudes <strong>and</strong> patterns <strong>of</strong> CAM usage<br />

differ <strong>and</strong> are culturally sensitive. Oncologists need to be aware <strong>of</strong> this when initiating discussion<br />

about CAM with their patients during cancer treatment.


72<br />

ABSTRACT #P-G4<br />

ALTERED ADRENOCORTICAL REGULATION IN FEMALE OFFSPRING OF<br />

PRENATAL BETAMETHASONE-EXPOSED GUINEA PIGS: A<br />

TRANSGENERATIONAL STUDY<br />

Majid Iqbal[G](1), A. Kostaki(1), S.G. Matthews(1, 2, 3).<br />

<strong>Department</strong>s <strong>of</strong> (1)Physiology, (2)<strong>Obstetrics</strong> <strong>and</strong> Gynaecology <strong>and</strong> (3)Medicine, Faculty <strong>of</strong><br />

Medicine, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>.<br />

Objective: Approximately 10% <strong>of</strong> pregnant women are at risk <strong>of</strong> preterm delivery <strong>and</strong> the<br />

majority <strong>of</strong> these women receive treatment with synthetic glucocorticoid (sGC) treatments to<br />

reduce infant respiratory distress syndrome. Prenatal exposure to synthetic glucocorticoids has<br />

been associated with modification <strong>of</strong> hypothalamic-pituitary-adrenal (HPA) function in the first<br />

(F1) <strong>and</strong> second (F2) generation. In the present study, we hypothesized that the reduction in HPA<br />

responsiveness to a challenge in F2 <strong>of</strong>fspring results from altered pituitary expression <strong>of</strong> genes<br />

involved in the regulation <strong>of</strong> adrenocortical function.<br />

Methods: Pituitaries were collected from the female <strong>of</strong>fspring (F2) <strong>of</strong> mothers (F1) that had<br />

themselves been prenatally exposed to betamethasone (1 mg/kg) (BETA) or saline (VEH).<br />

Anterior pituitary expression <strong>of</strong> proopiomelanocortin (POMC), adrenocorticotrophic hormone<br />

(ACTH), corticotrophin releasing hormone receptor 1 (CRH-R), arginine vasopressin receptor 1b<br />

(AVP-R) <strong>and</strong> glucocorticoid receptor (GR) mRNA <strong>and</strong>/or protein were analyzed using in situ<br />

hybridization <strong>and</strong> western blot analysis.<br />

Results: Gr<strong>and</strong>maternal exposure to sGC resulted in a significant decrease in the expression <strong>of</strong><br />

POMC mRNA (P < 0.01) <strong>and</strong> a corresponding decrease in ACTH protein expression (P < 0.05) in<br />

the anterior pituitaries <strong>of</strong> adult F2 female <strong>of</strong>fspring. The BETA treatment group also displayed a<br />

significant decrease in GR mRNA (P < 0.05) <strong>and</strong> GR protein (P < 0.01) as well as a significant<br />

reduction in CRH-R mRNA (P < 0.05). There were no differences in AVP-R protein expression<br />

between the treatment groups.<br />

Conclusions: There are transgenerational influences <strong>of</strong> prenatal exposure to sGC on HPA<br />

function in adult female <strong>of</strong>fspring, <strong>and</strong> the present data indicate that these effects are mediated, in<br />

part, by altered molecular regulation within the anterior pituitary. The reduction is CRH-R<br />

expression is consistent with the inability <strong>of</strong> these animals to mount a normal HPA response to<br />

stress. We are currently undertaking studies to determine the mechanisms that underlie<br />

transgenerational programming <strong>of</strong> HPA function following antenatal exposure to sGC.<br />

Funded by: Canadian Institutes for Health Research.


73<br />

ABSTRACT #P-G5<br />

OXYTOCIN BUT NOT ERGONOVINE OR CARBOPROST INHIBITS CONTRACTIONS<br />

IN OXYTOCIN PRE-EXPOSED PREGNANT RAT MYOMETRIUM<br />

Mrinalini Balki (1); Alex<strong>and</strong>ra L Cristian [M](1); Robert K. Parkes(2), John Kingdom (3), Jose<br />

C.A. Carvalho (1,3)<br />

(1)<strong>Department</strong> <strong>of</strong> AnAesthesia <strong>and</strong> Pain Management, Mount Sinai Hospital, (2)Samuel Lunenfeld<br />

Research Institute, Mount Sinai Hospital, (3)<strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> <strong>and</strong> Gynaecology, Mount<br />

Sinai Hospital.<br />

Objective: The objective <strong>of</strong> our study was to compare the in-vitro contractile response <strong>of</strong> the<br />

uterine muscle <strong>of</strong> pregnant rats to oxytocin, ergonovine <strong>and</strong> carboprost following pre-exposure to<br />

oxytocin.<br />

Methods: Longitudinal myometrial strips (n=60) were isolated from 16 pregnant Wistar rats at 20<br />

-22 <strong>day</strong>s <strong>of</strong> gestation, <strong>and</strong> pre-exposed to either oxytocin 10 -8 M (experimental groups) or PSS<br />

(control groups) for 1h period. All muscle strips were then subjected to a dose-response study with<br />

oxytocin (n=28), ergonovine (n=16) <strong>and</strong> carboprost (n=16), with cumulative increases in log molar<br />

concentrations <strong>of</strong> the drugs from 10 -10 to 10 -5 M. The amplitude <strong>and</strong> frequency <strong>of</strong> contractions were<br />

recorded <strong>and</strong> compared between the groups.<br />

Results: The amplitude <strong>and</strong> frequency <strong>of</strong> the oxytocin-induced contractions were significantly<br />

suppressed in the groups pre-exposed to oxytocin compared to the control groups (p


74<br />

ABSTRACT #P-H1<br />

RETINAL HEMORRHAGES IN TERM NEWBORNS AFTER INSTRUMENTAL<br />

VERSUS SPONTANEOUS VAGINAL DELIVERY – A SYSTEMATIC REVIEW AND<br />

META-ANALYSIS<br />

Taher Al Jishi (F)(1), P Gareth Seaward (2)<br />

(1)<strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> <strong>and</strong> Gynaecology, Mount Sinai Hospital, (2)Maternal-Fetal Medicine<br />

Division, <strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> & Gynaecology, Mount Sinai Hospital<br />

Introduction: Assisted vaginal delivery is a widely practiced intervention. Retinal hemorrhages<br />

(RH) in the newborn occur, with different frequency, after spontaneous as well as instrumental<br />

vaginal delivery.<br />

Objective: To evaluate the association <strong>of</strong> neonatal RH with vacuum or forceps assisted delivery in<br />

comparison to a contemporaneous, matched, spontaneously delivered control group.<br />

Methods: A comprehensive search <strong>of</strong> entries in electronic databases (MEDLINE, EMBASE,<br />

Cochrane, SciSearch) was supplemented with references cited in original articles, to identify case<br />

control studies that compared the incidence <strong>of</strong> RH in term newborns delivered by vacuum<br />

extraction or forceps with a contemporaneous control group <strong>of</strong> neonates delivered spontaneously.<br />

Case <strong>and</strong> control groups consisted <strong>of</strong> singeton pregnancies, matched for parity, maternal <strong>and</strong><br />

gestational age, as well as for obstetric risk factors. The outcome assessed was RH <strong>of</strong> the newborn.<br />

Quality evaluation was performed according to pre-established validity criteria <strong>and</strong> the Cochrane<br />

h<strong>and</strong>book criteria for observational studies. Data from each trial were abstracted <strong>and</strong> 2x2 tables<br />

were created. The combinability <strong>of</strong> studies was assessed by clinical <strong>and</strong> statistical methods (test <strong>of</strong><br />

homogeneity Breslow-Day). Data on dichotomous outcome represented by newborn RH in the<br />

instrumentally versus spontaneously delivered group, were pooled using common odds ratios (OR)<br />

with 95% confidence intervals (CI), as measures <strong>of</strong> effect size, calculated by a fixed effects model.<br />

Results: 18 studies were identified, 6 <strong>of</strong> which satisfied the inclusion criteria. There were 220<br />

newborns delivered by forceps, 468 delivered by vacuum extraction <strong>and</strong> 2720 delivered<br />

spontaneously. Compared with spontaneously delivered newborns, vacuum extraction was<br />

associated with a statistically significant increase in the number <strong>of</strong> newborns with RH (OR 2.5;<br />

95%CI 2.00-3.14). Newborns delivered by forceps did not differ from those delivered<br />

spontaneously in terms <strong>of</strong> RH (OR 1.12; 95%CI 0.81-1.55).<br />

Conclusion:<br />

Newborn RH is increased after vacuum extraction, but not after forceps delivery, when compared<br />

with the same contemporaneous, matched group <strong>of</strong> spontaneously delivered term neonates.


75<br />

ABSTRACT #P-H2<br />

A NOVEL ED-BASED SEXUAL ASSAULT CENTER IN WESTERN KENYA:<br />

DESCRIPTION OF PATIENTS AND ANALYSIS OF TREATMENT PATTERNS<br />

Elissa Rennert-May[M](1), Megan L Ranney(2), Rachel Spitzer(3), Hillary Mabeya(4).<br />

(1) <strong>Department</strong> <strong>of</strong> Undergraduate Medicine, Faculty <strong>of</strong> Medicine, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>, (2)<br />

<strong>Department</strong> <strong>of</strong> Emergency Medicine, Faculty <strong>of</strong> Medicine, Brown <strong>University</strong>, (3) <strong>Department</strong> <strong>of</strong><br />

<strong>Obstetrics</strong> <strong>and</strong> Gynecology, Faculty <strong>of</strong> Medicine, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>, (4) <strong>Department</strong> <strong>of</strong><br />

Reproductive Health, Faculty <strong>of</strong> Medicine, Moi <strong>University</strong>.<br />

Objectives: In March, 2007, The Center for Assault Recovery–Eldoret (CAR-E) was established at<br />

Moi Teaching <strong>and</strong> Referral Hospital in Western Kenya. Few studies in Africa, none in Kenya, look<br />

at the efficacy <strong>of</strong> such a centre. This study aimed to improve knowledge <strong>of</strong> demographic<br />

characteristics <strong>of</strong> sexual assault survivors, <strong>and</strong> assess the effectiveness <strong>of</strong> the treatment protocol.<br />

Methods: A st<strong>and</strong>ardized retrospective chart review <strong>of</strong> all patients attending CAR-E from 5/07-<br />

5/08 was performed. Statistics, as appropriate, were calculated.<br />

Results: CAR-E treated 321 survivors. Mean age=15.9 (range 8mo–100yrs), with 50% < 14yo;<br />

300 (93%) female; 259 (81%) single; 168 (52%) attended at most primary school. Most (201, 63%)<br />

knew their assailant <strong>and</strong> most (259, 81%) had a single assailant.<br />

124 (39%) had no genital trauma <strong>and</strong> younger age was significantly associated with increased<br />

genital trauma (1-sided t-test, p=0.03).<br />

139 (43%) <strong>of</strong> assaults were reported to the police. STI prophylaxis was given to 261/311 (84%) in<br />

whom it was indicated. Emergency contraception (EC) was given to 128/202 eligible (64%). PEP<br />

for HIV was given to 195/309 eligible (63%). 142 (44%) received counselling. Patients were more<br />

likely to get STI prophylaxis, PEP, <strong>and</strong> EC if they had genital injury.<br />

Conclusions: This study <strong>of</strong>fers valuable information on demographics <strong>of</strong> sexual assault survivors<br />

presenting to a public treatment center in Kenya. A st<strong>and</strong>ardized treatment protocol resulted in<br />

high rates <strong>of</strong> provision <strong>of</strong> STI prophylaxis, PEP, <strong>and</strong> EC. More needs to be done to increase police<br />

reporting, counselling, <strong>and</strong> provision <strong>of</strong> treatments for survivors without genital injuries.<br />

Funding: This <strong>research</strong> was funded by the Medical Alumni Association <strong>of</strong> the <strong>University</strong> <strong>of</strong><br />

<strong>Toronto</strong> as well as the Comprehensive Research Experience for Medical Students Program.


76<br />

ABSTRACT #P-H3<br />

A ROLE FOR MCL-1 IN REGULATING CELL CYCLE PROGRESSION IN<br />

PLACENTAL DEVELOPMENT AND PATHOLOGIES<br />

Manpreet Kalkat (G)(1), Aless<strong>and</strong>ro Rolfo (2), Isabella Caniggia (1,2).<br />

(1) <strong>Department</strong> <strong>of</strong> Physiology, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>; (2) <strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> <strong>and</strong><br />

Gynaecology, Mount Sinai Hospital, Samuel Lunenfeld Research Institute.<br />

Objective: Recently it has been reported that small nuclear myeloid cell leukemia factor1 (snMcl-<br />

1), a proteolytic fragment <strong>of</strong> the pro-survival Bcl-2 family member Mcl-1, interacts with cyclin<br />

dependent kinase 1 (Cdk1), a key regulator <strong>of</strong> cell cycle progression at the expense <strong>of</strong><br />

Cdk1/cyclinB1 binding leading to cell cycle arrest during the G2/M transition. We have previously<br />

demonstrated a pivotal role <strong>of</strong> Mcl-1 in the regulation <strong>of</strong> trophoblast cell fate during human<br />

placental development. However its interaction with Cdk-1 <strong>and</strong> its role in finely tuning cell cycle<br />

progression in the human placenta, where the balance between cell proliferation <strong>and</strong> death is<br />

critical for normal function, remain elusive. The objective <strong>of</strong> this study was to investigate Mcl-1,<br />

Cdk1 <strong>and</strong> cyclinB1 expression, spatial localization <strong>and</strong> interactions during placental development<br />

<strong>and</strong> in the placental pathologies, intra-uterine growth restriction (IUGR) <strong>and</strong> preeclampsia.<br />

Methods: First trimester placental samples were obtained from elective pregnancy terminations.<br />

Mcl-1, Cdk1 <strong>and</strong> cyclinB1 protein expression were assessed by western blot analysis using<br />

commercially available antibodies. Cdk1/Mcl-1 <strong>and</strong> Cdk1/cyclinB1 interactions were investigated<br />

by Cdk1 immunoprecipitation followed by Mcl-1 <strong>and</strong> cyclinB1 immunoblots. Immun<strong>of</strong>luorescence<br />

dual-staining followed by deconvolution microscopy was performed on developmental placenta<br />

sections in order to determine Mcl-1 <strong>and</strong> Cdk1 spatial localization in trophoblast cells.<br />

Results: Cyclin B1 also showed a peak <strong>of</strong> expression at 4-7 weeks <strong>and</strong> declined thereafter,<br />

showing an inverse pattern <strong>of</strong> expression to that <strong>of</strong> Mcl-1 via western blot analysis. Mcl-1 staining<br />

was increased in both the cytoplasm <strong>and</strong> nuclei <strong>of</strong> cytotrophoblast cells at 10-12 weeks, where it<br />

was co-expressed with Cdk1 in the nuclei <strong>of</strong> trophoblast cells. Association via<br />

immunoprecipitation assay <strong>of</strong> Cdk1 with Mcl-1 <strong>and</strong> snMcl-1 was maximal at 10-12 weeks <strong>of</strong><br />

gestation. This observation lends support that Mcl-1/snMcl-1 interacts with Cdk1 via displacement<br />

<strong>of</strong> cyclinB1. Furthermore, high co-expression <strong>of</strong> Mcl-1 <strong>and</strong> Cdk1 was observed in the cytoplasm<br />

<strong>of</strong> cytotrophoblast cells in preeclamptic placentae but was not observed in IUGR placentae.<br />

Conclusions: Our data suggest an active role <strong>of</strong> Mcl-1 in regulating G2/M<br />

phase transition in placental trophoblast cells in addition to its classical role as<br />

a pro-survival molecule.<br />

Funded by: CIHR


77<br />

ABSTRACT #P-H4<br />

RECRUITMENT INITIATIVES TO COMBAT MID-TRIAL FATIGUE<br />

Christine Tassopoulos[O](1), Dalah Mason(1), Sheila Hewson(1), Elizabeth Asztalos(1), Jon<br />

Barrett(2).<br />

(1)Centre for Mother, Infant, <strong>and</strong> Child Research, Sunnybrook Health Sciences Centre,<br />

(2)<strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> <strong>and</strong> Gynaecology, Sunnybrook Health Sciences Centre.<br />

Objective: To highlight recruitment initiatives implemented by the Twin Birth Study team to<br />

combat mid-trial fatigue.<br />

Methods: The Twin Birth Study (TBS) is an international multicentre r<strong>and</strong>omised controlled trial<br />

which seeks to determine in women expecting twins, whether a policy <strong>of</strong> planned caesarean section<br />

decreases the likelihood <strong>of</strong> perinatal or neonatal mortality or serious neonatal morbidity, compared<br />

to a policy <strong>of</strong> planned vaginal birth.<br />

Recruitment for TBS began in December 2003 with a goal <strong>of</strong> recruiting 2800 women pregnant<br />

with twins. After nearly four years <strong>of</strong> recruitment, the study had 80 centres from 20 countries <strong>and</strong><br />

had recruited approximately 1200 women. Although the recruitment rate had increased gradually<br />

over the first three years, at year four it had begun to plateau despite the introduction <strong>of</strong> new sites.<br />

To combat what appeared to be mid-trial fatigue, the DCC is undertaking a variety <strong>of</strong> initiatives to<br />

try to overturn the slowdown in recruitment. These initiatives include contacting sites that do not<br />

recruit during any 3 month period, teleconferences among centres within similar time zones,<br />

newsletter tips on recruitment, distributing new promotional items, <strong>and</strong> weekly emails to<br />

summarize recruitment. Additional site visits are being planned <strong>and</strong> key collaborators will be<br />

invited to join a Steering Committee meeting to discuss recruitment <strong>and</strong> networking opportunities<br />

to try to enlist additional centres. Finally, we have distributed new recruitment packages which<br />

involved a redesigned poster <strong>and</strong> a USB key containing slides to enable site investigators to present<br />

the Twin Birth Study locally to their colleagues.<br />

Results: Through the implementation <strong>of</strong> these strategies we hope to reverse the recruitment<br />

slowdown common to studies <strong>of</strong> long duration. The presentation will explore the success <strong>of</strong> the<br />

recruitment initiatives undertaken by the Data Coordinating Centre.<br />

Conclusions: The initiatives implemented were very successful. TBS currently has 90 active<br />

centres, <strong>and</strong> over 1700 recruits. We are hopeful that recruitment will be completed within a two<br />

year time period.<br />

Funded by: Canadian Institutes <strong>of</strong> Health Research


78<br />

ABSTRACT #P-H5<br />

A NOVEL ROLE FOR UROCORTIN 2 IN CELL CYCLING REGULATION<br />

Letizia Galleri [PD] (1), John .R.G. Challis (1, 2), Isabella Caniggia (1, 3, 4)<br />

(1) <strong>Department</strong> <strong>of</strong> Physiology, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>, (2) Michael Smith Foundation for Health<br />

Research, Vancouver, BC, (3) Samuel Lunenfeld Research Institute, Mount Sinai Hospital, (4)<br />

<strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> <strong>and</strong> Gynecology, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>.<br />

Objective: Pre-eclampsia is a syndrome typical <strong>of</strong> human pregnancy, characterized by decreased<br />

utero-placental perfusion <strong>and</strong> aberrant cell turnover, including increased apoptosis <strong>of</strong> trophoblast<br />

cell. Presently, the mechanisms regulating trophoblast cell turnover in pre-eclampsia are not fully<br />

elucidated. Corticotropin-releasing hormone (CRH) <strong>and</strong> Urocortin 1 (Ucn) are peptides belonging<br />

to the family <strong>of</strong> stress-hormones, involved in stress-induced responses. Two peptides recently<br />

discovered, Urocortin 2 (Ucn2) <strong>and</strong> Urocortin 3 (Ucn3), belong to the same family. All peptides<br />

are expressed in the human placenta <strong>and</strong> membranes, <strong>and</strong> are secreted in the biological fluids. They<br />

are able to bind CRH receptor type I or type II (CRHRI CRHRII). In the event <strong>of</strong> stress, maternal<br />

or fetal physiologic <strong>and</strong> pathologic conditions may influence placental secretion <strong>of</strong> CRH <strong>and</strong> CRHrelated<br />

peptides. While it is well known that placental CRH <strong>and</strong> maternal <strong>and</strong> fetal plasma levels <strong>of</strong><br />

Ucn are increased in pre-eclampsia, little is known about Ucn2 <strong>and</strong> Ucn3 in this syndrome.<br />

Therefore, the aims <strong>of</strong> this study were: 1) to evaluate Ucn2 <strong>and</strong> Ucn3 mRNA expression levels in<br />

pre-eclamptic placentae, <strong>and</strong> 2) to examine the effects <strong>of</strong> Ucns on cell cycle <strong>and</strong> on cell death.<br />

Methods: Human placental samples were collected from pre-eclamptic <strong>and</strong> age-matched control<br />

placentae following informed written consent. Changes in placental mRNA expression <strong>of</strong> Ucn2<br />

<strong>and</strong> Ucn3 were evaluated by quantitative RT-PCR. Primary cytotrophoblast cells were cultured for<br />

24 h alone, with vehicle or with increasing Ucn2 concentrations (10 -9 <strong>and</strong> 10 -7 M). The common<br />

markers <strong>of</strong> cell proliferation as well as apoptosis were measured after stimulation. Intracellular<br />

over-expression <strong>of</strong> Ucn2 vector was assessed by transient transfection <strong>of</strong> JEG cells <strong>and</strong> CHO cells<br />

- human choriocarcinoma <strong>and</strong> Chinese Hamster Ovary cell lines, respectively - at 12 <strong>and</strong> 24 hours,<br />

at 3% <strong>and</strong> 20% <strong>of</strong> oxygen tension. Effects <strong>of</strong> Ucn2 treatment, Ucn2 over-expression <strong>and</strong> its effect<br />

on markers <strong>of</strong> mitogenic activity <strong>and</strong> markers <strong>of</strong> apoptosis, were assessed by western blot.<br />

Results: Pre-eclamptic placentae showed an increase in Ucn2 <strong>and</strong> Ucn3 mRNA expression, as<br />

compared to age-matched control tissues. Treatment <strong>of</strong> primary cytotrophoblast cells with<br />

synthetic peptide Ucn2 increased PCNA (proliferating cell nuclear antigen) levels at both<br />

concentrations. Markers <strong>of</strong> apoptosis did not exhibit any change when compared to negative<br />

controls. Intracellular Ucn2 over-expression did not show any effect on transfected JEG cells <strong>and</strong><br />

CHO cells, irrespective <strong>of</strong> time or oxygen tension.<br />

Conclusions: Our data suggest that Ucn2 can be involved in the mechanisms regulating<br />

trophoblast cell cycle through an extracellular pathway, activating the CRHRII receptor, which is<br />

specific to Ucn2. No intracellular pathways are activated by Ucn2 in either transfected cell line. It<br />

is possible that enhanced Ucn2 expression in pre-eclampsia may contribute to impaired trophoblast<br />

cell turnover typical <strong>of</strong> this disorder. Intracellular mechanisms by which Ucn2 may carry out this<br />

function remain to be elucidated.


79<br />

ABSTRACT #P-I1<br />

VASCULAR DYSFUNCTION IN WOMEN WITH A HISTORY OF PRE-ECLAMPSIA<br />

AND INTRAUTERINE GROWTH RESTRICTION: INSIGHTS INTO FUTURE<br />

CARDIOVASCULAR RISK<br />

Yoav Yinon [F](1), David Cherney(2), Ori Nevo(3), John Kingdom(1), Michelle Hladunewich(2)<br />

(1) Maternal-Fetal Medicine Division, <strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> <strong>and</strong> Gynecology, Mount Sinai<br />

Hospital, (2) Division <strong>of</strong> Nephrology, <strong>University</strong> Health Network, <strong>Toronto</strong> General Hospital, (3)<br />

<strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> <strong>and</strong> Gynecology, Sunnybrook Health Sciences Centre, <strong>University</strong> <strong>of</strong><br />

<strong>Toronto</strong>, <strong>Toronto</strong><br />

Objective: Women with a history <strong>of</strong> preeclampsia or intra-uterine growth restriction (IUGR) are at<br />

increased risk for the future development <strong>of</strong> hypertension <strong>and</strong> cardiovascular disease. The aim <strong>of</strong><br />

this study was to examine whether vascular function is impaired in postpartum women with a<br />

history <strong>of</strong> preeclampsia or IUGR by measuring endothelial function <strong>and</strong> arterial stiffness.<br />

Methods: Healthy women with a history <strong>of</strong> early onset pre-eclampsia (n=10), late onset preeclampsia<br />

(n=5), IUGR without pre-eclampsia (n=5) <strong>and</strong> prior normal pregnancy (n=10) were<br />

studied 6-24 months after delivery. Endothelial-dependent vasodilatation <strong>and</strong> endothelialindependent<br />

vasodilatation were studied using high-resolution ultrasound by examination <strong>of</strong> the<br />

brachial artery responses to post-ischemic reactive hyperemia <strong>and</strong> sublingual glycerylnitrate.<br />

Carotid <strong>and</strong> radial arterial stiffness were assessed by pulse-wave analysis. Laboratory evaluation<br />

included fasting insulin <strong>and</strong> glucose levels, a lipid pr<strong>of</strong>ile <strong>and</strong> a urine albumin to creatinine ratio.<br />

Results: Baseline BMI, mean arterial pressure, <strong>and</strong> fasting glucose, insulin <strong>and</strong> cholesterol levels<br />

did not significantly differ among the groups. Endothelial-dependent vasodilatation was<br />

significantly reduced in women with previous pre-eclampsia or IUGR compared to women with<br />

previous normal pregnancy (4.1 % vs 8%, p=0.02), whereas endothelial-independent vasodilatation<br />

was similar in both groups (18.6% vs 17.13%, p=0.44). Radial arterial stiffness in the previously<br />

pre-eclamptic or IUGR groups was significantly increased with an augmentation index <strong>of</strong> 26.4%<br />

compared to 14.5% in the control group (p=0.001). Sub-group analysis demonstrated impaired<br />

endothelial-dependent vasodilatation in women with previous early-onset pre-eclampsia as well as<br />

women with previous IUGR without pre-eclampsia compared to the control group (3.3 % vs 8%,<br />

p=0.015; 2.6% vs 8%, p= 0.03). In women with a history <strong>of</strong> late-onset pre-eclampsia, endothelialdependent<br />

vasodilatation was not significantly different compared to the control group (6.6% vs<br />

8%, p= 0.55).<br />

Conclusions: Women with a history <strong>of</strong> early onset pre-eclampsia as well as women with previous<br />

IUGR without pre-eclampsia exhibit impaired vascular function. This observation might explain<br />

the higher risk <strong>of</strong> cardiovascular disease in these women. Women with a history <strong>of</strong> late-onset preeclampsia,<br />

however, may not fall into this high cardiovascular risk category.<br />

Funded by: PSI Foundation


80<br />

ABSTRACT #P-I2<br />

THE TIMING OF DELIVERY FOR MONOCHORIONIC VS. DICHORIONIC TWINS<br />

Sharon Maslovitz[F](1), Ori Nevo(1), Andrea Lausman(2) Jon F. R. Barrett(1),<br />

(1)Maternal-Fetal Medicine Division, <strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> & Gynaecology, Sunnybrook<br />

Health Sciences Centre.<br />

(2) Maternal-Fetal Medicine Division, <strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> & Gynaecology, St Michaels<br />

Hopsital<br />

Objective: To compare outcomes <strong>of</strong> uncomplicated DC/DA vs uncomplicated MC/DA twins > 34<br />

weeks gestation.<br />

Methods: Shared care by specialist twin clinic <strong>and</strong> community OB until 34 weeks. DC/DA twins<br />

scanned q4weeks; MC/DA q2 weeks. Both scanned weekly after 34 weeks. Patients discharged<br />

from clinic at 34 weeks if uncomplicated. Delivery method <strong>and</strong> gestation decided by referring OB.<br />

Outcomes: APGAR, admission to NICU, stillbirth, neonatal death rate <strong>and</strong> delivery method.<br />

Results: 273 DC/DA <strong>and</strong> 133 MC/DA twins included. No difference in birth weight, percentage<br />

<strong>of</strong> IUGR, NND, SB or the percentage <strong>of</strong> babies with APGAR < 4. More MC/DA twins were<br />

ventilated (13.6% vs. 3.8 %, < 0.001) , were admitted to NICU (21% vs. 7.9%, p < .001)., were<br />

delivered by elective LSCS (63% vs. 38%, p < .001), <strong>and</strong> were delivered at < 37 weeks. (61% vs.<br />

17%, p < .001). No difference in rate <strong>of</strong> emergency LSCS or rate <strong>of</strong> LSCS <strong>of</strong> Twin B following<br />

vaginal birth <strong>of</strong> Twin A.<br />

Conclusions: Early delivery <strong>of</strong> MC/DA twins results in increased morbidity. A policy <strong>of</strong> early<br />

delivery in MC/DA must be exercised because iatrogenic RDS.


81<br />

ABSTRACT #P-I3<br />

SENTINEL LYMPH NODE BIOPSY IMPROVES DETECTION OF METASTATIC<br />

LYMPH NODES IN EARLY CERVICAL CANCER<br />

Limor Gortzak-Uzan[F](1), Sharon N<strong>of</strong>ech-Mozes(2), Nadia Ismiil(2), Mahmoud Khalifa(2),<br />

Valerie Dube(2), Allan Covens(1)<br />

(1) Division <strong>of</strong> Gynecologic Oncology, (2)<strong>Department</strong> <strong>of</strong> Anatomic Pathology, Sunnybrook Health<br />

Sciences Centre, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>.<br />

Objective: To compare the incidence <strong>of</strong> pelvic lymph node metastases in early stage cervical<br />

cancer patients undergoing sentinel lymph node biopsy (SLN) to a matched cohort undergoing<br />

pelvic lymphadenectomy.<br />

Methods: All patient data were entered prospectively into an ongoing cervical cancer database.<br />

Since April 2004, 87 patients with clinical FIGO stage IA/B1 cervical cancer underwent SLN<br />

detection with identification <strong>of</strong> bilateral SLN. This cohort was compared to a matched group <strong>of</strong><br />

patients who underwent complete pelvic lymphadenectomy. The groups were matched 3:1 for<br />

tumour size (±5mm), histology, depth <strong>of</strong> invasion (±2mm), <strong>and</strong> presence <strong>of</strong> capillary lymphatic<br />

space invasion (CLS). Descriptive statistics were calculated for all variables <strong>of</strong> interest. The<br />

association between cases <strong>and</strong> controls <strong>and</strong> lymph node metastases, was carried out using a<br />

conditional logistic regression analysis which takes into account the matching between cases <strong>and</strong><br />

controls. Results were presented as odds ratios <strong>and</strong> their associated 95% confidence intervals.<br />

Results: 81 cases were matched with 1 control, 72 cases with 2 controls, <strong>and</strong> 65 cases with 3<br />

controls. There were no differences in mean age, tumour size, depth <strong>of</strong> invasion, histology, or<br />

presence <strong>of</strong> CLS. Among cases, 14 (17%) had pelvic lymph nodes metastases vs. 15 (7%) in the<br />

controls (p=0.0059, odds ratio = 2.8, 95% CI = 1.3-5.9). Among the 14 cases <strong>of</strong> SLN metastases,<br />

11 were detected by frozen section <strong>and</strong> 3 were detected on final paraffin sectioning. All were<br />

detected by H&E stains. The size <strong>of</strong> the SLN metastases ranged from less than 1mm to 8 mm. Of<br />

162 hemipelvises, the SLN was located in the obturator nodes (127), external iliac nodes (36),<br />

common iliac nodes (18), internal iliac nodes (7) <strong>and</strong> paraortic node (1).<br />

Conclusions: Sentinel lymph node biopsy in early cervical cancer detects a higher incidence <strong>of</strong><br />

pelvic lymph node metastases as compared to complete lymphadenectomy. Ultrastaging <strong>of</strong> lymph<br />

nodes, aberrant locations <strong>of</strong> sentinel lymph nodes, <strong>and</strong> improved lymph node acquisition are likely<br />

explanations.


82<br />

ABSTRACT #P-I4<br />

OMEGA-3 FATTY ACID SUPPLEMENTATION REDUCES OBESITY, IMPROVES<br />

GLUCOSE TOLERANCE AND INSULIN RESISTANCE IN C57BL/6J MALE MICE<br />

SUBJECTED TO ANTENATAL DIET RESTRICTION<br />

Lauren Chun [G](1), Brian Knight (1), Stephen Lye (1)(2).<br />

(1) <strong>Department</strong> <strong>of</strong> Physiology, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>, (2) Samuel Lunenfeld Research Institute,<br />

Mount Sinai Hospital.<br />

Objective: Maternal diet restriction during pregnancy is associated with fetal growth restriction<br />

<strong>and</strong> the subsequent development <strong>of</strong> symptoms <strong>of</strong> the metabolic syndrome, such as glucose<br />

intolerance <strong>and</strong> insulin resistance when the <strong>of</strong>fspring reach adulthood. The objective <strong>of</strong> this study<br />

is to determine whether a postnatal diet rich in omega-3 fatty acids can hinder or prevent the<br />

development <strong>of</strong> such symptoms in C57BL/6J male mice that have been subjected to antenatal diet<br />

restriction.<br />

Methods: Pregnant C57BL/6J (B6) female mice were either treated as controls (C) <strong>and</strong> fed ad<br />

libitum for the duration <strong>of</strong> pregnancy, or subjected to prenatal nutrient restriction (R). Postweaning,<br />

male B6 pups were either fed as controls or a diet rich in omega-3 (Ω-3) fatty acids.<br />

Glucose tolerance testing was conducted at 12 weeks <strong>and</strong> between 12-13 months <strong>of</strong> age; serum<br />

glucose <strong>and</strong> insulin was measured using commercially available kits. At 12 months <strong>of</strong> age, body<br />

composition was determined by Dual-energy X-ray absorptiometry (DEXA). Mice were<br />

euthanized at 13.5-15.5 months <strong>of</strong> age, <strong>and</strong> dissected livers were subjected for histological<br />

analysis.<br />

Results: At 12 weeks <strong>of</strong> age, the R group fed the postnatal Ω-3 diet had improved glucose<br />

tolerance <strong>and</strong> insulin resistance compared to the R mice on the st<strong>and</strong>ard diet; this difference was<br />

maintained through to 12 months <strong>of</strong> age. Furthermore, B6R mice fed the postnatal Ω-3 diet had a<br />

lower percentage <strong>of</strong> body fat compared to B6R mice on the control diet.<br />

Conclusions: Our data supports our hypothesis that a postnatal diet rich in omega-3 fatty acids<br />

reduces or prevents the development <strong>of</strong> symptoms associated with the metabolic syndrome in<br />

C57BL/6J male mice subjected to antenatal diet restriction.<br />

Funded by: CIHR


83<br />

ABSTRACT #P-I5<br />

THREE YEAR RESULTS OF THE TRANSOBTURATOR TENSION FREE VAGINAL<br />

TAPE PROCEDURE FOR STRESS URINARY INCONTINENCE<br />

Kalpana Sharma [R], Lisa Merovitz, Patricia Lee<br />

Division <strong>of</strong> Urogynaecology, <strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> <strong>and</strong> Gynaecology, Sunnybrook Health<br />

Sciences Centre, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong><br />

Objective: To assess the long-term effectiveness <strong>of</strong> the transobturator tension free vaginal tape<br />

procedure (TVT-O, Gynecare) in the treatment <strong>of</strong> stress urinary incontinence (SUI).<br />

Introduction: The tension-free vaginal tape procedure (TVT) is a midurethral sling developed in<br />

1995 by Ulmsten <strong>and</strong> Petros. This minimally invasive, out-patient procedure is now used<br />

worldwide for treating stress urinary incontinence (SUI). Reports show that the use <strong>of</strong> the TVT<br />

procedure results in the vast majority (83-90%) <strong>of</strong> the women remaining continent even out to 10<br />

years following the surgery. These results are similar to the reported results with an open bladder<br />

neck suspension (Burch) procedure. The transobturator midurethral sling is a more recent<br />

modification <strong>of</strong> the TVT. It also is a minimally invasive approach that passes a strip <strong>of</strong><br />

polypropylene mesh under the mid urethra vaginally <strong>and</strong> then through the obturator<br />

foramen bilaterally. It was introduced as an outside-in technique in 2001 by Delorme (TOT) <strong>and</strong><br />

then later revised as an inside-out technique by de Leval (TVT-O). The TVT-O is a safer<br />

procedure than the TVT with reduced risk <strong>of</strong> bladder injuries. While short term success rates<br />

(continence rates approaching 90% at 1-2 years) are excellent, there is little data on long term<br />

urinary continence rates or success following a TVT-O. The aim <strong>of</strong> our study was to describe the<br />

long term continence rates following a TVT-O at Sunnybrook Health Sciences Centre.<br />

Methods: A retrospective review was carried out for patients undergoing a TVT-O procedure<br />

between January 2005 <strong>and</strong> March 2009 with a minimal follow up <strong>of</strong> 3 years. Charts were<br />

reviewed, <strong>and</strong> where information was incomplete/lost to follow-up, telephone interviews were<br />

conducted. Success rates were compared at 12, 24, 36 <strong>and</strong> 48 months follow up. Success was<br />

defined as no stress urinary incontinence or improved SUI with occasional episodes < 2x/<br />

week as subjectively reported by the patient. The perioperative <strong>and</strong> postoperative complication<br />

rates were also assessed. Ethics approval for this study was obtained through the REB at<br />

Sunnybrook Health Sciences Centre.<br />

Results: Of the 34 patients with TVT-O performed from 36-48 months prior to this study there<br />

were no immediate surgical complications (no bladder perforations, no blood transfusions<br />

required). Of all who returned for follow-up, no vaginal mesh erosions were noted on<br />

examination. 6 <strong>of</strong> 34 patients were lost to follow-up. Of the patients who completed follow-up, 22<br />

were dry, 2 were improved (total <strong>of</strong> 86% dry or improved) <strong>and</strong> 4 (14%) were incontinent <strong>and</strong><br />

dissatisfied.<br />

Conclusions: The transobturator tension free vaginal tape is an effective minimally invasive<br />

procedure for the treatment <strong>of</strong> stress urinary incontinence with success rates which are comparable<br />

to the reported rates for the TVT <strong>and</strong> the open bladder neck suspension (Burch) procedures.


84<br />

ABSTRACT #P-J1*<br />

WHAT IS KEEPING ESTROGEN INSIDE THE HUMAN OVARIAN FOLLICLE<br />

Yaakov Bentov [F](1)(2), Theodore J Brown (2), Navid Esf<strong>and</strong>iari (1), Robert F. Casper (1)(2).<br />

(1)<strong>Toronto</strong> Center for Advanced Reproductive Technologies (TCART), (2) Samuel Lunenfeld<br />

Research Institute.<br />

*Abstract available in hardcopy version only.


85<br />

ABSTRACT #P-J2<br />

UPDATE: HEPARIN FOR THE PREVENTION OF COMPLICATIONS RELATED TO<br />

PLACENTAL INSUFFICIENCY - THE HEPRIN RANDOMIZED CONTROLLED TRIAL<br />

Leslie Proctor[O](1), Jodie Dodd(1), Rory Windrim(1), Anne McLeod(2), Edmund Kelly(3),<br />

Sarah Keating(4), Howard Berger(5), Ori Nevo(6), John Kingdom(1)<br />

(1) Maternal-Fetal Medicine Division, (2)Haematology, (3) Neonatology, (4) Perinatal Pathology,<br />

Mount Sinai Hospital, (5) Maternal-Fetal Medicine, St Michael’s Hospital, (6). Maternal-Fetal<br />

Medicine, Sunnybrook Health Sciences Centre, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>.<br />

Objectives: Placental dysfunction is associated with the occurrence <strong>of</strong> adverse pregnancy<br />

outcomes, including preterm birth, preeclampsia, abruption, <strong>and</strong> perinatal death. These adverse<br />

outcomes are potentially mediated via placental ischaemic-thrombotic lesions. While there is<br />

interest in investigating the role <strong>of</strong> heparin for women who screen positive for a thrombophilic<br />

condition, most women with adverse pregnancy outcome are ultimately shown to be thrombophilia<br />

negative. It is uncertain whether heparin has a therapeutic role to play in improving pregnancy<br />

outcomes for this group <strong>of</strong> women. The aims <strong>of</strong> this trial are to assess whether the use <strong>of</strong><br />

subcutaneous unfractionated heparin (UFH) in women with identified placental dysfunction during<br />

pregnancy will reduce the risk <strong>of</strong> intrauterine fetal death <strong>and</strong> other adverse pregnancy outcomes,<br />

improve maternal <strong>and</strong> infant health, without increasing maternal risks.<br />

Methods: Inclusion criteria: Women with a singleton pregnancy, at 18 +0 -23 +6 weeks gestation,<br />

with evidence <strong>of</strong> placental dysfunction in their current pregnancy as determined by two or more <strong>of</strong><br />

the following: abnormal ultrasonographic placental morphology; abnormal uterine artery Doppler<br />

waveforms; abnormal biochemical markers on first or second trimester maternal serum screening.<br />

Exclusion criteria: Women with known positive thrombophilic screening; known lethal fetal<br />

anomaly; the presence <strong>of</strong> early onset IUGR prior to trial entry; any contraindication to heparin<br />

therapy or continuation <strong>of</strong> the pregnancy; clinical need for heparin therapy during pregnancy.<br />

Eligible women were r<strong>and</strong>omized to either receive Heparin (self-administer 7500IU <strong>of</strong> UFH<br />

subcutaneously twice a <strong>day</strong> from r<strong>and</strong>omisation until 34 weeks gestation) or St<strong>and</strong>ard Care<br />

(ongoing antenatal surveillance).<br />

Twenty-two women have fit these criteria <strong>and</strong> were approached. Fifteen (63%) agreed to<br />

participate, with 7 r<strong>and</strong>omized to heparin <strong>and</strong> 8 r<strong>and</strong>omized to st<strong>and</strong>ard care. Thirteen women<br />

have delivered, with 5 (38%) delivering extremely preterm (


86<br />

ABSTRACT #P-J3<br />

HUMAN EMBRYONIC FIBROBLAST LINES PROVIDE ENHANCED SUPPORT OF<br />

HUMAN EMBRYONIC STEM CELLS IN XENO-FREE CULTURE CONDITIONS<br />

Mark Kibschull [PD] (1), Maria Mileikovsky (1), Andras Nagy (1), Stephen Lye (1,2,3).<br />

(1)Samuel Lunenfeld Research Institute, Mount Sinai Hospital, <strong>Department</strong>s <strong>of</strong> (2)<strong>Obstetrics</strong> &<br />

Gynaecology <strong>and</strong> (3)Physiology, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>.<br />

Introduction: Human embryonic stem cells (hESCs) are a promising tool for future applications in<br />

human therapeutics <strong>and</strong> basic <strong>research</strong>. Their use requires the development <strong>of</strong> xeno-free culture<br />

conditions to prevent the transmission <strong>of</strong> pathogens from non-human origins. A critical factor for<br />

these cultures is the source <strong>of</strong> human fibroblasts serving as feeders.<br />

Objective: To analyze if the use <strong>of</strong> human embryonic fibroblasts leads to an improvement in<br />

human embryonic stem cell cultures using xeno-free conditions.<br />

Methods: Two xeno-free derived human embryonic fibroblast lines were established <strong>and</strong> checked<br />

for the absence <strong>of</strong> pathogens. Their ability to support maintenance <strong>of</strong> the Canadian hESCc lines<br />

CA1 <strong>and</strong> CA2 was compared to two xeno-free derived human foreskin fibroblast lines. CA1 <strong>and</strong><br />

CA2 were cultured in parallel on all four <strong>of</strong> the fibroblast lines using the commercially available<br />

complete medium HEScGRO (Millipore), <strong>and</strong> TrypLE select together with ROCK inhibitor for<br />

enzymatic passaging as components <strong>of</strong> the xeno-free culture system. hESCs were analyzed for<br />

growth, morphology <strong>and</strong> stem cell marker expression.<br />

Results: We show that the two embryonic fibroblasts lines were able to support continuous growth<br />

<strong>of</strong> CA1 <strong>and</strong> CA2 in xeno-free culture conditions. Pluripotency <strong>of</strong> hESCs was maintained indicated<br />

by specific stem cell marker (Oct4 <strong>and</strong> alkaline phosphatase) expression <strong>of</strong> CA1 <strong>and</strong> CA2. In<br />

contrast, cultures <strong>of</strong> hESC on human foreskin fibroblasts in HEScGRO media <strong>and</strong> enzymatic<br />

passaging were poorly maintained <strong>and</strong> subject to differentiation. Proliferation in these cultures was<br />

limited <strong>and</strong> the hESCs differentiated within three passages.<br />

Conclusions: This study demonstrates that the source <strong>of</strong> human fibroblasts has a strong influence<br />

on growth <strong>and</strong> pluripotency <strong>of</strong> hESCs lines using xeno-free culture conditions <strong>and</strong> enzymatic<br />

passaging – with fibroblasts derived from human embryos providing a significant improvement.<br />

The mechanisms responsible for this growth advantage remain to be determined.<br />

Funded by: Stem Cell Network (SCN)


87<br />

ABSTRACT #P-J4<br />

CAN PEDIATRIC & ADOLESCENT GYNAECOLOGICAL CARE BE DELIVERED VIA<br />

TELEHEALTH <br />

Shannon Corbett [R], Anjali Aggarwal, Joley Johnstone, Melanie, Sari Kives, Lisa Allen,<br />

Nicolette Caccia.<br />

<strong>Department</strong> <strong>of</strong> Paediatric & Adolescent Gynaecology, Hospital for Sick Children, <strong>University</strong> <strong>of</strong><br />

<strong>Toronto</strong>.<br />

Objectives: To assess whether consultation <strong>and</strong>/or follow-up via the telemedicine network would<br />

be appropriate in the Paediatric <strong>and</strong> Adolescent Gynecology patient population seen at the Hospital<br />

for Sick Children, <strong>and</strong> to assess patient <strong>and</strong> family interest in such a service.<br />

Methods: This is a prospective observational study. Non-identifying data was collected on all<br />

patients attending the Paediatric & Adolescent Gynecology clinics at the Hospital for Sick<br />

Children over the 9 month period from July 15, 2008 – April 15, 2009 to obtain a sample size <strong>of</strong><br />

over 1000 visits. Data on each visit included patient postal code (to determine distance travelled to<br />

the hospital), diagnosis, availability <strong>of</strong> a local hospital suitable for telehealth <strong>and</strong> appropriateness<br />

for patient assessment via telephone assessment <strong>and</strong> telemedicine. Patients <strong>and</strong> their families were<br />

informed <strong>of</strong> the study <strong>and</strong> asked questions as to their willingness to utilize telemedicine. Reasons<br />

why or why not a visit was telemedicine appropriate were codified as were patient/family reasons<br />

for preferring telemedicine. Visits were stratified by diagnosis type to determine if certain<br />

conditions are more amenable to telemedicine.<br />

Results: Data is still being collected. Preliminary review suggests that telephone consultation, <strong>and</strong><br />

to a lesser extent telemedicine, may be appropriate for up to 5% <strong>of</strong> patients referred to the Hospital<br />

for Sick Children for Pediatric <strong>and</strong> Adolescent Gynecological care, <strong>and</strong> that patient interest in<br />

telemedicine exists.<br />

Conclusions: Offering the possibility <strong>of</strong> telemedicine may help address the geographical<br />

challenges posed in the provision <strong>of</strong> Pediatric & Adolescent Gynecology subspecialty care for a<br />

small proportion <strong>of</strong> patients.


88<br />

ABSTRACT #P-J5<br />

BARRIERS TO COMPLIANCE WITH COLPOSCOPY/FOLLOW-UP IN A<br />

POPULATION OF PATIENTS WITH PAP SMEAR ABNORMALITIES: A SURVEY<br />

APPROACH.<br />

Andrea N. Simpson [M](1), Catriona J. Buick(2), K. Joan Murphy(2)<br />

(1)<strong>University</strong> <strong>of</strong> <strong>Toronto</strong>, (2)<strong>Department</strong> <strong>of</strong> Gynaecologic Oncology, Princess Margaret Hospital,<br />

<strong>University</strong> <strong>of</strong> <strong>Toronto</strong>.<br />

Objective: To determine the underlying health beliefs <strong>and</strong> demographic, lifestyle, psychological,<br />

<strong>and</strong> social factors that predict patterns <strong>of</strong> compliance or non-compliance to follow-up among<br />

women requiring care for Pap smear abnormalities.<br />

Methods: A comparative survey design method will be used to examine thirty women who have<br />

been referred to Princess Margaret Hospital/<strong>University</strong> Health Network (UHN) in <strong>Toronto</strong>,<br />

Ontario, for an abnormal Pap smear. On completion <strong>of</strong> consent <strong>and</strong> the survey, women who have<br />

missed one or more scheduled appointments will be assigned to the study group. Women who have<br />

complied with appointments will be assigned to the contrast group. The survey has been adapted<br />

from a previously validated survey, the Mammography Screening Beliefs Questionnaire, <strong>and</strong> is<br />

based on the Health Belief Model. The survey will also encompass demographic information, a<br />

brief health history, <strong>and</strong> an open-ended qualitative portion where participants may address their<br />

specific concerns. The study was approved by the UHN Research Ethics Board in November 2008.<br />

Results: Data will be analyzed for common themes <strong>and</strong> for differences between the group <strong>of</strong><br />

women who attended their scheduled appointment(s) <strong>and</strong> those who did not.<br />

Conclusions: To our knowledge, barriers to compliance with follow-up for abnormal Pap smears<br />

have never been studied in a diverse population <strong>of</strong> women in a large metropolitan area, specifically<br />

the Greater <strong>Toronto</strong> Area. The information collected in this study is valuable in future program<br />

planning to manage the needs <strong>of</strong> the target population(s) <strong>and</strong> potentially improve adherence to, <strong>and</strong><br />

thus efficacy <strong>of</strong>, recommended screening algorithm.


89<br />

ABSTRACT #P-K1<br />

DIFFERENTIATION OF HEPATOCYTES FROM HUMAN FIRST TRIMESTER<br />

UMBILICAL CORD STEM CELLS<br />

Junhai Zhao [PD], Rong Xiao, Shangmian Yie <strong>and</strong> Clifford L. Librach<br />

<strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> <strong>and</strong> Gynaecology, Sunnybrook Health Sciences Centre, Women’s<br />

College Hospital, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>.<br />

Objective: We have previously isolated <strong>and</strong> exp<strong>and</strong>ed stem cells from the first trimester human<br />

umbilical cord (UCSC) <strong>and</strong> have shown that these cells have embryonic stem cell–like<br />

characteristics. We have demonstrated that these UCSC’s have the ability to form embryoid<br />

bodies (EBs) in vitro, <strong>and</strong> have the capacity to differentiate into a wide variety <strong>of</strong> cell types which<br />

demonstrate characteristics <strong>of</strong> all three embryonic germ layers (such as neuroectoderm,<br />

cardiomyocyte, osteogenic, adipogenic mesoderm <strong>and</strong> pancreatic endoderm). We report here a<br />

robust <strong>and</strong> efficient process for the production <strong>of</strong> hepatocyte-like cells from first trimester UCSC’s<br />

in vitro.<br />

Methods: After formed EBs in suspension culture conditions, UCSC’s were transferred into an<br />

endoderm culture medium. Five <strong>day</strong>s later, definitive endoderm cells (DE) were then induced to<br />

differentiate using factors involved in early hepatic development, on a Collagen I matrix in serumfree<br />

media. Morphologic changes were examined at each step. Expression <strong>of</strong> hepatic markers was<br />

analyzed using RT-PCR <strong>and</strong> Immunocytochemistry (ICC).<br />

Results: During culture <strong>of</strong> UCSC’s in hepatocyte differentiation conditions, the cultures remained<br />

mostly homogeneous aside from some cells appearing to be smaller <strong>and</strong> closer together. As the<br />

cells matured, on <strong>day</strong> 20 th , they developed cytoplasmic vacuoles resembling confluent cultures <strong>of</strong><br />

polygonal vacuolated primary human hepatocytes. The expression pr<strong>of</strong>ile <strong>of</strong> hepatic lineage genes<br />

through the time course <strong>of</strong> differentiation was examined. Alpha Fetoprotein (AFP) <strong>and</strong> Albumin<br />

(ALB) were detectable at <strong>day</strong> 11 <strong>and</strong> beyond. Expression <strong>of</strong> the hepatic maturation <strong>and</strong><br />

transcription genes, Cyp3a4 <strong>and</strong> Cyp7a1, was found on <strong>day</strong> 20 <strong>of</strong> culture.<br />

Conclusions: We have demonstrated that first trimester UCSC’s cells represent an embryonic-like<br />

stem cell population with the capacity to differentiate into cells that demonstrate key<br />

1)morphologic changes, 2)gene expression <strong>and</strong> 3)protein expression found in mature hepatocytes.


90<br />

ABSTRACT #P-K2<br />

THE “DUC” TRIAL: A RANDOMIZED CONTROLLED TRIAL OF IMMEDIATE VS.<br />

DELAYED CORD CLAMPING IN PRETERM INFANTS BORN BETWEEN 24 AND 32<br />

WEEKS’ GESTATION [Work in progress]<br />

Kelly Chu [R] (1), Kellie Murphy (2), Wendy Whittle (2), Rory Windrim (2), Prakesh Shah (3).<br />

(1)<strong>University</strong> <strong>of</strong> <strong>Toronto</strong>(2) Maternal-Fetal Medicine, Mount Sinai Hospital, (3) Neonatal<br />

Intensive Care Unit, Mount Sinai Hospital.<br />

Objective: To examine the effects <strong>of</strong> delayed umbilical cord clamping in preterm infants on<br />

neonatal outcomes using a prospective r<strong>and</strong>omized controlled trial comparing immediate cord<br />

clamping (st<strong>and</strong>ard at present) with delayed cord clamping.<br />

Methods: This is a prospective r<strong>and</strong>omized controlled trial (RCT). Women who present in<br />

preterm birth (PTB) between 24-32 weeks gestation will be approached for the study. Women<br />

will be r<strong>and</strong>omly assigned to one <strong>of</strong> the two groups: immediate cord clamping (ICC) or delayed<br />

cord clamping (DCC) when delivery is anticipated. Groups will be stratified based on gestational<br />

age (24 to 27+6wks, 28 to 32wks) to ensure balanced groups. In the ICC group the cord will be<br />

clamped <strong>and</strong> cut between 0-15s after delivery. In the DCC group, the infant will be held in a warm<br />

blanket 10-15cm below the introitus (vaginal delivery) or incision level (cesarean section),<br />

ensuring no tension on the cord. The umbilical cord will then be clamped <strong>and</strong> cut 30-45secs after<br />

delivery. After cord cutting the infant will be given to the awaiting pediatrician <strong>and</strong> supporting<br />

neonatal resuscitation team for routine care, in both groups. The primary outcome is a composite<br />

<strong>of</strong> perinatal <strong>and</strong> neonatal mortality or morbidity (defined as intraventricular hemorrhage <strong>and</strong> late<br />

onset sepsis). Secondary outcomes include respiratory distress syndrome, necrotizing enterocolitis,<br />

hyperbilirubinemia, anemia, length <strong>of</strong> stay, <strong>and</strong> retinopathy <strong>of</strong> prematurity. To answer this<br />

question, the DUC trial intends to recruit 296 women, which will be the biggest trial to date.<br />

Results: To date 36 participants have been recruited. Below are the demographics <strong>of</strong> those<br />

recruited.<br />

24-27 +6 weeks 28-32 weeks<br />

ICC (n=7) DCC (n=5) ICC (n=11) DCC<br />

(n=12)<br />

Maternal Age 33.0 28.2 30.2 31.3<br />

PPROM 2 1 8 1<br />

Preterm Labour 1 2 4 7<br />

Pre-eclampsia 2 1 2 5<br />

Chorioamnionitis 2 0 1 1<br />

IUGR/NRFHR 0 1 2 3<br />

Mode <strong>of</strong> delivery – SVD/CS 4/3 2/3 6/5 6/6<br />

Timing <strong>of</strong> Cord Clamping (sec) 4.57 21.0 6.27 49.03<br />

Funded by: Mount Sinai <strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> <strong>and</strong> Gynaecology Research Fund (2008)


91<br />

ABSTRACT #P-K3<br />

KISSPEPTIN CELL MODELS FROM THE HYPOTHALAMUS<br />

Ginah L Kim[G](1), Sarah Gingerich(1), Maria-Luisa Centeno(1), Xiaomei Wang(1), Jennifer A.<br />

Chalmers(1), Margaret M. Koletar(1), David R. Thompson(1) <strong>and</strong> Denise D. Belsham(1,2,3).<br />

(1)<strong>Department</strong>s <strong>of</strong> Physiology, (2)Medicine, <strong>and</strong> (3)<strong>Obstetrics</strong> <strong>and</strong> Gynaecology, <strong>University</strong> <strong>of</strong><br />

<strong>Toronto</strong>.<br />

Objective: Kisspeptin, a peptide hormone secreted by neurons in the hypothalamus, has emerged<br />

as a key regulator <strong>of</strong> the hypothalamic-pituitary-gonadal axis through its potent stimulation <strong>of</strong><br />

GnRH release. Although this essential role <strong>of</strong> kisspeptin in reproductive function has been well<br />

established, there has been a paucity <strong>of</strong> studies focusing on the regulation <strong>of</strong> the hypothalamic<br />

Kiss1 gene (which encodes kisspeptin) due to the lack <strong>of</strong> appropriate cell models. In order to<br />

address this problem, we have generated immortalized, clonal, murine cell lines derived from both<br />

embryonic <strong>and</strong> adult hypothalamic primary culture.<br />

Methods: A number <strong>of</strong> immortalized, clonal, neuronal, hypothalamic cell lines were generated<br />

through retroviral gene transfer <strong>of</strong> the oncogene SV40 T-antigen into primary hypothalamic<br />

neuronal cell cultures. RT-PCR <strong>and</strong> immunocytochemistry were used to screen these cell lines for<br />

gene expression <strong>and</strong> synthesis <strong>of</strong> kisspeptin, <strong>and</strong> RT-PCR was used to screen for gene expression<br />

<strong>of</strong> neurokinin B, dynorphin, substance P <strong>and</strong> tyrosine hydroxylase.<br />

Results: Screening embryonic <strong>and</strong> adult male cell lines for Kiss1 expression using RT-PCR <strong>and</strong><br />

immunocytochemistry revealed low levels <strong>of</strong> expression, whereas adult female cell lines showed<br />

strong expression <strong>of</strong> Kiss1. This finding is in accordance with the observation that females exhibit<br />

higher kisspeptin expression than males in certain regions <strong>of</strong> the hypothalamus. In total, we have<br />

established over twenty cell lines that exhibit endogenous kisspeptin synthesis. Importantly, there<br />

are two separate populations <strong>of</strong> Kiss1 neurons found in the hypothalamus: Kiss1 neurons in the<br />

arcuate nucleus (ARC), which are negatively regulated by estrogen, <strong>and</strong> Kiss1 neurons in the<br />

anteroventral periventricular nucleus (AVPV), which are positively regulated by estrogen. Based<br />

on evidence that Kiss1 neurons in the ARC co-express neurokinin B, dynorphin <strong>and</strong> substance P,<br />

<strong>and</strong> Kiss1 neurons in the AVPV co-express tyrosine hydroxylase, we have performed coexpression<br />

studies <strong>of</strong> these neuropeptides in order to differentiate which Kiss1 population each cell<br />

line represents. Our findings indicate that our cell lines contain representatives from both<br />

populations.<br />

Conclusions: These Kiss1-expressing cell models will be key to studying the cellular events<br />

underlying differential estrogen regulation <strong>of</strong> Kiss1 neurons. Furthermore, there is considerable<br />

ambiguity over the location <strong>of</strong> the mouse Kiss1 promoter due to the unavailability <strong>of</strong> hypothalamic<br />

Kiss1-expressing cell lines. Thus, our cell models will also enable a more precise analysis <strong>of</strong> the<br />

hypothalamus-specific 5’-regulatory region. Overall, these cell lines are invaluable for the<br />

mechanistic analysis <strong>of</strong> endogenous Kiss1 gene regulation <strong>and</strong> kisspeptin secretion. These studies<br />

have not been possible in the whole brain <strong>and</strong> will lead to a better underst<strong>and</strong>ing <strong>of</strong> how Kiss1<br />

neurons are controlled directly by hormones <strong>and</strong> neuropeptides.<br />

Funded by: CIHR, CRC, <strong>and</strong> CFI


92<br />

ABSTRACT #P-K4<br />

IS THERE A ROLE FOR SCREENING FOR BACTERIAL VAGINOSIS AT THE TIME<br />

OF IUD INSERTION [Work-in-Progress]<br />

Alice Pham [R] (1), Mark H. Yudin (2), Sari Kives (2), Romy Nitsch (3), Lisa Merovitz (3)<br />

(1) <strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> & Gynaecology, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>, (2) <strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong><br />

& Gynaecology, St. Michael’s Hospital, (3) <strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> & Gynaecology,<br />

Sunnybrook Health Sciences Centre.<br />

Objectives: The primary objectives <strong>of</strong> the study were (1) to estimate the prevalence <strong>of</strong> bacterial<br />

vaginosis (BV) among women attending outpatient gynecology clinics for an intrauterine device<br />

(IUD) insertion; <strong>and</strong> (2) to describe any differences among BV(+) versus BV(-) women with<br />

respect to the following four primary outcomes: expulsion <strong>of</strong> IUD, pain, pelvic infection, <strong>and</strong><br />

abnormal bleeding. The secondary objective was to determine if there is a change in vaginal flora<br />

at 1-month post-IUD insertion.<br />

Methods: This is a prospective observational study with ethics approval at St. Michael’s Hospital<br />

<strong>and</strong> Sunnybrook Health Sciences Centre. Following informed written consent, 70 women are to be<br />

followed over a 1-month period after IUD insertion. Vaginal culture for BV is obtained prior to<br />

<strong>and</strong> at one month after IUD insertion. Women found to be BV+ <strong>and</strong> who are asymptomatic are not<br />

treated as this is not currently the st<strong>and</strong>ard <strong>of</strong> care. At the initial visit, information regarding<br />

demographics <strong>and</strong> clinical history is collected. At the one-month follow-up visit, patients are<br />

asked whether they experienced any problems relating to the four primary outcomes.<br />

Results: As <strong>of</strong> December 2008, 55 women had been recruited (24 Nova-T, 31 Mirena). 3 <strong>of</strong> the 55<br />

(5.5%) were BV+ (two Mirena, 1 Nova-T) <strong>and</strong> <strong>of</strong> these, none had significant problems with the<br />

IUD in terms <strong>of</strong> the primary outcomes. Interestingly, <strong>of</strong> those who were BV(-), one woman<br />

reported persistent thick vaginal discharge which resolved with metronidazole treatment, although<br />

all swabs for BV <strong>and</strong> STIs were negative. Another woman developed a unilateral tubo-ovarian<br />

abscess 3 months post-IUD insertion, requiring IV antibiotics, again with all swabs being negative.<br />

In terms <strong>of</strong> the secondary outcome, 32 women had one-month follow- up cultures performed <strong>and</strong><br />

3/32 (9.4%) had a shift from normal flora to BV(+).<br />

Conclusions: Ethics approval is being renewed in order to continue recruitment for this <strong>research</strong>in-progress.<br />

From this preliminary data, there is certainly a lower prevalence than expected for<br />

bacterial vaginosis in our study population. It is clear that we will need to follow more BV(+)<br />

women in order to be able to comment on any trends in the primary outcomes, <strong>and</strong> ultimately on<br />

whether there might be a role for BV screening prior to IUD insertion.


93<br />

ABSTRACT #P-K5<br />

MCL-1 IS A PROSURVIVAL FACTOR THAT REGULATES OVARIAN FOLLICLE<br />

FATE AND REPRODUCTIVE FUNCTION<br />

Shakib Omari[G](1), Andrea Jurisicova(1,2).<br />

(1) <strong>Department</strong> <strong>of</strong> Physiology, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>, (2) <strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> <strong>and</strong><br />

Gynecology, Samuel Lunenfeld Research Institute, Mount Sinai Hospital<br />

Objective: To uncover the role <strong>of</strong> Mcl-1 in survival <strong>of</strong> germ <strong>and</strong> granulosa cells in murine ovarian<br />

follicles.<br />

Methods: Mcl-1 has been detected in germ cells <strong>and</strong> growing follicle granulosa cells. In rat<br />

ovaries, Mcl-1 was found to be regulated by gonadotropin. We confirmed Mcl-1 expression <strong>and</strong> its<br />

increase upon gonadotropin stimulation in mouse ovaries using immunohistochemistry <strong>and</strong><br />

Western blot analyses. RT-PCR was used to analyze Mcl-1 levels <strong>and</strong> its pro-apoptotic short<br />

is<strong>of</strong>orm (Mcl-1S) in ovulated MII oocytes from young <strong>and</strong> old mice. A floxed Mcl-1 mouse line<br />

was crossed with a transgenic mouse line containing Cre under the control <strong>of</strong> the zona pellucida<br />

(ZP-3) promoter to ensure oocyte specific excision <strong>of</strong> Mcl-1. Females with complete germ cellexcision<br />

<strong>of</strong> Mcl-1 were compared to wild type controls at various ages to assess breeding<br />

performance, ovulation rates, <strong>and</strong> signs <strong>of</strong> premature ovarian failure (POF). Histomorphometric<br />

analyses were performed on ovaries from Mcl-1 cKO mice compared to wild type controls.<br />

Ovulated oocytes from Mcl-1 excised mice were analyzed, relative to wt controls, for<br />

fragmentation rates in vitro <strong>and</strong> mitochondrial parameters were assessed at various ages.<br />

Results: Mcl-1 was confirmed in germ <strong>and</strong> granulosa cells <strong>of</strong> growing follicles <strong>and</strong> was found to<br />

be increased upon gonadotropin stimulation in mice. The Mcl-1 germ cell-specific deletion<br />

resulted in an age-dependant decrease in the number <strong>of</strong> ovulated oocytes until an apparent loss by 6<br />

months <strong>of</strong> age. MII oocytes from Mcl-1 germ cell-specific deleted mice had an increase in<br />

fragmentation rates when cultured in vitro compared to wild type controls.<br />

Conclusions: Our data suggests a role for Mcl-1 as a pro-survival factor in the regulation <strong>of</strong><br />

follicle fate. The deletion <strong>of</strong> Mcl-1 in germ cells results in a decrease in viable germ cells <strong>and</strong> a<br />

putative premature ovarian failure. The increase in fragmentation rates <strong>of</strong> cultured Mcl-1-deficient<br />

oocytes compared to wild type suggests a role for Mcl-1 in survival post-ovulation. The early<br />

oocyte survival <strong>and</strong> resulting ovulation till 6 months <strong>of</strong> age may be due to the timing <strong>of</strong> Cre<br />

excision. As the ZP3 promoter is activated in the primordial to primary oocyte transition, a number<br />

<strong>of</strong> oocytes may escape Mcl-1 excision.


94<br />

ABSTRACT #P-L1<br />

EXPRESSION AND REGULATION OF BREAST CANCER RESISTANCE PROTEIN<br />

(BCRP1) IN THE MOUSE PLACENTA AND FETAL BLOOD-BRAIN BARRIER<br />

Sophie Petropoulos [G](1), A Kostaki(1), W Gibb(4), SG Matthews(1)(2)(3). <strong>Department</strong>s <strong>of</strong><br />

(1)Physiology, (2)<strong>Obstetrics</strong> <strong>and</strong> Gynaecology, (3)Medicine, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>; <strong>Department</strong>s<br />

<strong>of</strong> (4)<strong>Obstetrics</strong> <strong>and</strong> Gynecology, Cellular <strong>and</strong> Molecular Medicine, <strong>University</strong> <strong>of</strong> Ottawa.<br />

Objective: Human Breast Cancer Resistance Protein (BCRP) is an active efflux transporter with a<br />

wide range <strong>of</strong> substrates including xenobiotics (chemotherapeutic agents <strong>and</strong> therapeutic drugs)<br />

<strong>and</strong> endobiotics (folic acid <strong>and</strong> steroids). In both the human <strong>and</strong> mouse, we have recently shown<br />

that Bcrp1 is localized in the placental labyrinth. In the mouse, Bcrp1 mRNA is highly expressed<br />

at mid-gestation, but dramatically declines towards term. Such changes in expression correspond<br />

to increasing levels <strong>of</strong> circulating glucocorticoid concentrations, indicating a possible role in the<br />

regulation <strong>of</strong> Bcrp1 expression. In the mouse, we have also localized Bcrp1 in the fetal blood-brain<br />

barrier (BBB) in late gestation, however, nothing is known regarding its ontogenic expression.<br />

Further, information pertaining to the regulation <strong>of</strong> Bcrp1 in both the placenta <strong>and</strong> fetal BBB is<br />

non-existent. In this study, we hypothesize that; 1) Bcrp1 expression in the fetal BBB will increase<br />

with advancing gestation, providing local protection to the developing brain at this time. 2)<br />

Synthetic glucocorticoid administration will down-regulate placental Bcrp1 <strong>and</strong> up-regulate Bcrp1<br />

expression in the BBB.<br />

Methods: Pregnant FVB mice were treated with either DEX (1mg/kg) or vehicle from either<br />

embryonic <strong>day</strong> (E)9.5-15.5 or E12.5-E18.5. On E15.5 or E18.5, dams were euthanized <strong>and</strong><br />

placentas <strong>and</strong> fetal brains collected. Total RNA <strong>and</strong> protein was extracted using TRIzol.<br />

Expression <strong>of</strong> Bcrp1 mRNA <strong>and</strong> protein were measured by real-time RT PCR <strong>and</strong> Western<br />

analysis respectively.<br />

Results: We have now shown that expression <strong>of</strong> Bcrp1 mRNA in the fetal BBB significantly<br />

(P


95<br />

ABSTRACT #P-L2<br />

DOES SIZE MATTER ASSOCIATIONS BETWEEN SUBMUCOSAL UTERINE<br />

FIBROID SIZE AND COMPLICATIONS DURING HYSTEROSCOPIC MYOMECTOMY<br />

Suma Shastry [F], Mark Yudin, Deborah Robertson, Abheha Satkunaratnam, Guylaine Lefebvre.<br />

<strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> & Gynaecology, St Michael’s Hospital.<br />

Objective: To determine whether there is an association between submucosal fibroid size <strong>and</strong><br />

complications during hysteroscopic myomectomy.<br />

Methods: A retrospective chart review was performed on all patients who underwent<br />

hysteroscopic myomectomy between July 2007 <strong>and</strong> August 2008 at St. Michael’s Hospital in<br />

<strong>Toronto</strong>. Data collected included patient age <strong>and</strong> parity, preoperative submucosal fibroid diameter,<br />

preoperative treatment with luprolide or misoprostol, intraoperative fluid deficits, length <strong>of</strong><br />

procedure <strong>and</strong> intraoperative or postoperative complications. Data was analyzed using SAS version<br />

9.1. Correlations between different parameters were estimated using the Spearman correlation<br />

coefficient. Groups <strong>and</strong> proportions were compared using the Wilcoxon rank-sum test or Fisher’s<br />

exact tests.<br />

Results: During the study period 94 patients underwent a hysteroscopic myomectomy. 61 patients<br />

met the inclusion criteria <strong>and</strong> were enrolled in the study. The mean age was 45 years <strong>and</strong> mean<br />

submucosal uterine fibroid diameter was 2.25 cm. 57% received pre-operative misoprostol <strong>and</strong> 7%<br />

received pre-operative Lupron. Fluid absorption during hysteroscopy was estimated by manual<br />

count in 40% <strong>of</strong> cases <strong>and</strong> by Storz fluid management system in 60% <strong>of</strong> cases. 10% (6/61) <strong>of</strong><br />

patients sustained fluid overload (defined as fluid loss >1500 cc) <strong>and</strong> post-operative hyponatremia.<br />

Increasing fibroid diameter increased the probability <strong>of</strong> post-operative hyponatremia (3.15cm vs.<br />

2.0cm, p=0.05). Patients with post-operative hyponatremia had longer procedure times (55 minutes<br />

vs. 35 minutes, p=0.0278) <strong>and</strong> greater fluid deficits (1850 cc vs. 250 cc, p=0.0025)<br />

Conclusions: Greater submucosal uterine fibroid diameter increases the probability <strong>of</strong> fluid<br />

overload <strong>and</strong> post-operative hyponatremia during hysteroscopic myomectomy. Careful preoperative<br />

optimization <strong>and</strong>/or two-stage procedure may minimize complications <strong>of</strong> fluid overload.


96<br />

ABSTRACT #P-L3<br />

IS ZONA PELLUCIDA THICKNESS AN INDICATOR OF EMBRYO IMPLANTATION<br />

POTENTIAL<br />

Siamak Bashar [O], Gelareh Motamedi, Agata Sojecki, Rodica M<strong>and</strong>el, Hanna Balakier, <strong>and</strong><br />

Clifford Librach<br />

CReATe Fertility Center, <strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> <strong>and</strong> Gynaecology, Sunnybrook Health<br />

Sciences Centre <strong>and</strong> Women’s College Hospital, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>.<br />

Objective: Zona pellucida thickness (ZT) <strong>and</strong> the process <strong>of</strong> gradual zona thinning have been<br />

suggested to be the most predictive indicators for the implantation potential <strong>of</strong> transferred embryos.<br />

However, little is known about the intrinsic <strong>and</strong> external factors that regulate the thinning process<br />

<strong>of</strong> human zona pellucidae. The objective <strong>of</strong> our study was to evaluate whether zona pellucida<br />

thickness on <strong>day</strong> 3 <strong>of</strong> in vitro culture is correlated with maternal (patient) age, embryo quality, Day<br />

3 FSH, peak estradiol (E2) levels, implantation rate <strong>and</strong> pregnancy outcome.<br />

Methods: After obtaining REB approval, data on zona thickness <strong>and</strong> patient clinical parameters<br />

was collected from 360 patients <strong>of</strong> all ages undergoing IVF or ICSI procedures. Zona pellucida<br />

measurements were performed on all Day 3 embryos (n = 2396) derived from normal zygotes<br />

(normally fertilized oocytes). Zona thickness was classified into 6 categories according to an<br />

ascending range <strong>of</strong> mean values from 9.0 µm to >=19.1 µm.<br />

Results: No significant correlation was observed between zona thickness <strong>and</strong> the age <strong>of</strong> the<br />

patients (P=0.654; Table 1). The overall mean zona thickness was 15.97±2.53 µm <strong>and</strong> the<br />

embryos with very thin zona pellucida were rare in all age groups. 59 out <strong>of</strong> 2396 (2.5%) embryos<br />

had a zona thickness in the range <strong>of</strong> 9.0µm to11.0 µm <strong>and</strong> 8% <strong>of</strong> embryos had zona thickness in<br />

the range 11.1 <strong>and</strong> 13.0µ (212/2396). The majority <strong>of</strong> embryos ranged between 15.1-19.0 µm<br />

(54.5%). No significant relationship was observed between zona thickness <strong>and</strong> the maximum E2<br />

value on the <strong>day</strong> <strong>of</strong> HCG administration. The proportion <strong>of</strong> embryos in the six categories <strong>of</strong> mean<br />

zona thickness was similar regardless <strong>of</strong> E2 level (P=0.2561). There was also no association<br />

between zona thickness <strong>and</strong> FSH values on Day 3 <strong>of</strong> the cycle prior (P-0.3824). A very significant<br />

association was found between zona thickness <strong>and</strong> individual embryo quality (P=0.0005).<br />

Embryos with no or minimal number <strong>of</strong> cytoplasmic fragments (0-10%) <strong>and</strong> equal cell size (G1-<br />

G2; n=1967) had significantly thinner zonae (Av. 15.87µ±2.48) compared with the embryos<br />

containing more fragments <strong>and</strong> uneven blastomeres (G3 = 16.36µ±2.57 <strong>and</strong> G4-G5 =<br />

16.59µ±3.06). A total <strong>of</strong> 137 clinical pregnancies resulted from 360 embryo transfer cycles<br />

(38.1%). Comparison <strong>of</strong> zona thickness <strong>of</strong> all transferred embryos between pregnant versus nonpregnant<br />

patients showed no significant differences (15.96 versus 16.97; P =0.5002).<br />

Conclusions: The thickness <strong>of</strong> the human zona pellucida is not influenced by intrinsic <strong>and</strong> external<br />

factors such as patient age, <strong>day</strong> 3 FSH or peak E2 levels. Zona thickness is highly correlated with<br />

embryo quality. It appears that overall zona thickness is not correlated with pregnancy rate,<br />

suggesting that embryo hatching depends more on inherent properties <strong>of</strong> gametes <strong>and</strong> the<br />

developmental potential <strong>of</strong> the resultant fertilized embryos.


97<br />

ABSTRACT #P-L4*<br />

DAB2 MEDIATES GLUCOCORTICOID RECEPTOR SIGNALING IN EPITHELIAL<br />

OVARIAN CANCER CELLS.<br />

Alicia Tone [G] (1-4), Carl Virtanen (5), Patricia Shaw (2-4) <strong>and</strong> Theodore J. Brown (1,3).<br />

(1)The Samuel Lunenfeld Research Institute, Mount Sinai Hospital, <strong>Department</strong>s <strong>of</strong> (2)Laboratory<br />

Medicine <strong>and</strong> Pathobiology, <strong>and</strong> (3)<strong>Obstetrics</strong> <strong>and</strong> Gynaecology, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>, <strong>and</strong><br />

(4)<strong>Department</strong> <strong>of</strong> Pathology, <strong>and</strong> the (5)Microarray Center, <strong>University</strong> Health Network.<br />

*Abstract available in hardcopy version only.


98<br />

ABSTRACT #P-L5<br />

SPECTRUM OF VASCULAR LESIONS ASSOCIATED WITH FETAL VASCULAR<br />

OBSTRUCTION<br />

Aseel Hamoudi [R], Sarah Keating, John Kingdom, Ge<strong>of</strong>frey Machin.<br />

<strong>Department</strong> <strong>of</strong> Perinatal Pathology, Mount Sinai Hospital, <strong>University</strong> <strong>of</strong> <strong>Toronto</strong>.<br />

Objective: Placental changes <strong>of</strong> chronic fetal vascular obstruction (FVO) are relatively common<br />

occurring in approximately 5-10% <strong>of</strong> placental specimens. Histologically, they are characterized<br />

by thrombi in umbilical, chorionic plate <strong>and</strong> stem villous vessels <strong>and</strong> secondary regressive changes<br />

in villi in proximity to the thrombi. The currently favored pathologic term is fetal thrombotic<br />

vasculopathy. It requires vascular thrombosis (FTV) <strong>and</strong> at least one cluster <strong>of</strong> avascular terminal<br />

villi. Placental FVO represents an important, possibly under recognized cause or marker <strong>of</strong> sudden<br />

intrauterine death, intrauterine growth restriction (IUGR), neonatal thrombosis, fetal <strong>and</strong> maternal<br />

coagulopathy, neonatal cerebral infarcts <strong>and</strong> encephalopathy. The purpose <strong>of</strong> our study is to assess<br />

the full spectrum <strong>of</strong> vascular lesions in placentas with evidence <strong>of</strong> FVO <strong>and</strong> to identify which <strong>of</strong><br />

these histologic findings are associated with predictors <strong>of</strong> poor neonatal outcome.<br />

Methods: We retrospectively gathered 101 placentas for the years 2006 <strong>and</strong> 2007 from the<br />

pathology archives at Mount Sinai hospital in which a diagnosis <strong>of</strong> fetal vascular obstructive<br />

lesions was made. Twin placentas <strong>and</strong> placentas showing moderate or severe villitis were excluded<br />

from analysis. Each placenta was assessed for the presence <strong>and</strong> location <strong>of</strong> vessels showing<br />

thrombi, fibrin cushions, endothelial cushions, dilatation, fibromuscular luminal stenosis or<br />

obstruction. In addition, the presence <strong>of</strong> avascular villi, villous stromal vascular karyorrhexis, distal<br />

villous hypoplasia (DVH), accelerated villous maturation (AVM), infarcts <strong>and</strong> other significant<br />

pathology were recorded.<br />

The following clinical data were gathered on chart review: general characteristics, antepartum <strong>and</strong><br />

intrapartum findings, placental function tests <strong>and</strong> neonatal outcome.<br />

Results: Our preliminary results show that mothers whose placentas demonstrate FVO were young<br />

with a median age <strong>of</strong> 32 years, 12 <strong>of</strong> them had a previous history <strong>of</strong> 2 or more miscarriages <strong>and</strong> 7<br />

had a history <strong>of</strong> hypothyroidism. Although biochemical markers for placental function were<br />

normal, in 17 cases there was abnormal placental morphology seen on third trimester ultrasound.<br />

FVO was associated with the following antenatal complications: IUGR, oligohydramnios without<br />

membrane rupture, <strong>and</strong> vaginal bleeding during pregnancy. Median gestational age at delivery was<br />

34.5 weeks, however, 50 patients delivered before 37 weeks <strong>and</strong> 25 <strong>of</strong> them were extremely<br />

premature. During the course <strong>of</strong> labour 29 women had abnormal fetal cardiotocography <strong>and</strong>, <strong>of</strong><br />

those, 25 had variable decelerations.<br />

Addition <strong>of</strong> controls <strong>and</strong> subdivision <strong>of</strong> the severity <strong>of</strong> placental pathology is underway <strong>and</strong> will be<br />

associated with clinical findings.


99<br />

INDEX<br />

Presenters by Last Name<br />

P/O # Name Category* Supervisor(s)<br />

D3 Aggarwal, Anjali F Allen<br />

B5 Ahn, Diane O Derzko<br />

H1 Al Jishi, Taher F Seaward<br />

A4 Al Ryami, Nihal F Kingdom<br />

E4 Aneja, Ambika R Ternamian<br />

F1 Audette , Melanie G Challis/Matthews<br />

G2 Bambao, Clarissa F Shier<br />

C3 Bambao, Clarissa F Nitsch<br />

L3 Bashar, Siamak O Librach<br />

J1 Bentov, Yaakov F Casper<br />

A1 Bortolini, Maria F Drutz<br />

O1 Burstein, Eliezer F Casper<br />

O2 Cash, Rebecca R Okun<br />

K2 Chu, Kelly R Murphy (K)<br />

I4 Chun, Lauren G Lye<br />

J4 Corbett, Shannon R Caccia<br />

G5 Cristian, Alex<strong>and</strong>ra M Balki/Kingdom/Carvalho<br />

D4 Deda, Livia G Caniggia<br />

O10 Drewlo, Sascha PD Kingdom<br />

O13 Emack, Jeff G Matthews<br />

E2 Erik-Soussi , Magda O Balki/Kingdom/Carvalho<br />

B1 Fainaru, Ofer F Casper<br />

A5 Fern<strong>and</strong>es, Roxanne G Jurisicova<br />

C1 Frasca, Erika M Nevo<br />

H5 Galleri, Letizia PD Challis<br />

F5 Gien, Lilian F Bernardini<br />

O11 Gingerich, Sarah PD Belsham<br />

I3 Gortzak-Uzan, Limor F Covens<br />

G1 Gouin, Katy F Nevo<br />

L5 Hamoudi, Aseel R Keating<br />

O12 Hazan, Aleah G Lye<br />

G3 Helpman, Limor F Covens<br />

G4 Iqbal, Majid G Matthews


100<br />

Presenters by Last Name cont’d<br />

P/O # Name Category* Supervisor(s)<br />

H3 Kalkat, Manpreet G Caniggia<br />

O5 Kenigsberg, Shlomit O Librach<br />

J3 Kibschull, Mark PD Lye<br />

K3 Kim, Ginah G Belsham<br />

B4 Kr<strong>of</strong>t, Jamie R Wolfman<br />

F3 Ladhani, Noor R Okun<br />

C4 Laskin, Matthew R Whittle<br />

E1 Li, Yunqing G Lye<br />

D2 Lo, Tina F Greenblatt<br />

O9 Martin, Aisling F Berger<br />

I2 Maslovitz, Sharon F Barrett<br />

A3 McGee , Jacob F Keelan/Rosen<br />

B3 Millar, Heather M Spitzer<br />

C2 Mousa, Noha G Casper<br />

D1 Murji, Ally R Berger<br />

F2 Nedd-Roderique, Tamara G Lye<br />

O4 Perumalsamy, Alagammal PD Jurisicova<br />

L1 Petropoulos, Sophie G Matthews<br />

K4 Pham, Alice R Yudin<br />

J2 Proctor, Leslie O Kingdom<br />

O6 Racano, Antonella G Caniggia<br />

O8 Rahman, Shadab G Casper<br />

E3 Ray, Jocelyn G Caniggia<br />

H2 Rennert-May, Elissa M Spitzer<br />

K5 Shakib, Omari G Jurisicova<br />

I5 Sharma, Kalpana R Lee<br />

L2 Shastry, Suma F Lefebvre<br />

O3 Shathasivam, Premalatha G Brown (T)<br />

A2 Shynlova, Oksana O Lye<br />

J5 Simpson, Andrea M Murphy (J)/Buick<br />

O7 Sinasac, Sarah R Spitzer<br />

F4 Sivasubramaniyam, Tharini G Caniggia<br />

H4 Tassopoulos, Christine O Barrett<br />

L4 Tone, Alicia G Shaw/Brown (T)


101<br />

Presenters by Last Name cont’d<br />

O14 Vicus, Danielle F Shaw<br />

D5 Xiao, Rong PD Librach<br />

B2 Yeganegi, Maryam G Bocking<br />

I1 Yinon, Yoav F Kingdom<br />

K1 Zhao, Junhai PD Librach<br />

*F=Clinical Fellow; G=Graduate Student; M=Medical Student; PD=Post Doctoral Fellow;<br />

R=Resident; O=Other (non-eligible for awards; eg. non-trainee, non U <strong>of</strong> T)


102<br />

Presenters by Abstract # <strong>and</strong> Session<br />

ORALS<br />

Morning<br />

Oral Session I (8:30-9:30 a.m.)<br />

O1<br />

O2<br />

O3<br />

O4<br />

Burstein, Eliezer<br />

Cash, Rebecca<br />

Shathasivam, Premalatha<br />

Perumalsamy, Alagammal<br />

Oral Session II (11:00-12:00 noon)<br />

O5<br />

O6<br />

O7<br />

O8<br />

Kenigsberg, Shlomit<br />

Racano, Antonella<br />

Sinasac, Sarah<br />

Rahman, Shadab<br />

Afternoon<br />

Oral Session III (1:10-2:40 p.m.)<br />

O9<br />

O10<br />

O11<br />

O12<br />

O13<br />

O14<br />

Martin, Aisling<br />

Drewlo, Sascha<br />

Gingerich, Sarah<br />

Hazan, Aleah<br />

Emack, Jeff<br />

Vicus, Danielle


103<br />

Presenters by Abstract # <strong>and</strong><br />

Session cont’d<br />

POSTERS (P)<br />

SESSION I (MORNING)<br />

(Groups A-F) (9:15-10:45 a.m.)<br />

Poster Group A<br />

A1 Bortolini, Maria<br />

A2 Shynlova, Oksana<br />

A3 McGee, Jacob<br />

A4 Al Ryami, Nihal<br />

A5 Fern<strong>and</strong>es, Roxanne<br />

Poster Group B<br />

B1 Fainaru, Ofer<br />

B2 Yeganegi, Maryam<br />

B3 Millar, Heather<br />

B4 Kr<strong>of</strong>t, Jamie<br />

B5 Ahn, Diane<br />

Poster Group E<br />

E1 Li, Yunqing<br />

E2 Erik-Soussi, Magda<br />

E3 Ray, Jocelyn<br />

E4 Aneja, Ambika<br />

Poster Group F<br />

F1 Audette, Melanie<br />

F2 Nedd-Roderique, Tamara<br />

F3 Ladhani, Noor<br />

F4 Sivasubramaniyam, Tharini<br />

F5 Gien, Lilian<br />

Poster Group C<br />

C1 Frasca, Erika<br />

C2 Mousa, Noha<br />

C3 Bambao, Clarissa<br />

C4 Laskin, Matthew<br />

Poster Group D<br />

D1 Murji, Ally<br />

D2 Lo, Tina<br />

D3 Aggarwal, Anjali<br />

D4 Deda, Livia<br />

D5 Xiao, Rong


104<br />

Presenters by Abstract # <strong>and</strong><br />

Session cont’d<br />

POSTERS (P)<br />

SESSION II (AFTERNOON)<br />

(Groups G-L) (3:10-4:10 p.m.)<br />

Poster Group G<br />

G1 Gouin, Katy<br />

G2 Bambao, Clarissa<br />

G3 Helpman, Limor<br />

G4 Iqbal, Majid<br />

G5 Cristian, Alex<strong>and</strong>ra<br />

Poster Group H<br />

H1 Al Jishi, Taher<br />

H2 Rennert-May, Elissa<br />

H3 Kalkat, Manpreet<br />

H4 Tassopoulos, Christine<br />

H5 Galleri, Letizia<br />

Poster Group I<br />

I1 Yinon, Yoav<br />

I2 Maslovitz, Sharon<br />

I3 Gortzak-Uzan, Limor<br />

I4 Chun, Lauren<br />

I5 Sharma, Kalpana<br />

Poster Group K<br />

K1 Zhao, Junhai<br />

K2 Chu, Kelly<br />

K3 Kim, Ginah<br />

K4 Pham, Alice<br />

K5 Shakib, Omari<br />

Poster Group L<br />

L1 Petropoulos, Sophie<br />

L2 Shastry, Suma<br />

L3 Bashar, Siamak<br />

L4 Tone, Alicia<br />

L5 Hamoudi, Aseel<br />

Poster Group J<br />

J1 Bentov, Yaakov<br />

J2 Proctor , Leslie<br />

J3 Kibschull, Mark<br />

J4 Corbett, Shannon<br />

J5 Simpson, Andrea


We<br />

gratefully acknowledge<br />

the sponsorship <strong>of</strong>:<br />

BAYER HEALTHCARE PHARMACEUTICALS<br />

ABBOTT LABORATORIES LTD.<br />

in support<br />

<strong>of</strong> our<br />

26 th Annual Research Day.<br />

<strong>Department</strong> <strong>of</strong> <strong>Obstetrics</strong> <strong>and</strong> Gynaecology<br />

Faculty <strong>of</strong> Medicine<br />

<strong>University</strong> <strong>of</strong> <strong>Toronto</strong><br />

92 College St.<br />

<strong>Toronto</strong>, Ontario M5G 1L4<br />

Telephone: 416 978 2668<br />

Fax: 416 978 8350<br />

Website: http://www.obgyn.utoronto.ca/

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