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POI is different from premature menopause. With premature menopause, your periods stop before age 40. You can no longer get pregnant. The cause can be natural or it can be a disease, surgery, chemotherapy, or radiation. With POI, some women still have occasional periods. They may even get pregnant. In most cases of POI, the cause is unknown.
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Research shows that POI is related to problems with the follicles. Follicles are small sacs in your ovaries. Your eggs grow and mature inside them. One type of follicle problem is that you run out of working follicles earlier than normal. Another is that the follicles are not working properly. In most cases, the cause of the follicle problem is unknown. But sometimes the cause may be:
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Primary ovarian insufficiency occurs when the ovaries stop functioning as they should before age 40. When this happens, your ovaries don't produce typical amounts of the hormone estrogen or release eggs regularly. This condition is also called premature ovarian failure and often leads to infertility.
Primary ovarian insufficiency is sometimes confused with premature menopause, but these conditions aren't the same. Women with primary ovarian insufficiency can have irregular or occasional periods for years and might even get pregnant. But women with premature menopause stop having periods and can't become pregnant.
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The scaffolding proteins of double-stranded DNA viruses are required for the polymerization of capsid subunits into properly sized closed shells but are absent from the mature virions. Phage P22 scaffolding subunits are elongated 33-kDa molecules that copolymerize with coat subunits into icosahedral precursor shells and subsequently exit from the precursor shell through channels in the procapsid lattice to participate in further rounds of polymerization and dissociation. Purified scaffolding subunits could be refolded in vitro after denaturation by high temperature or guanidine hydrochloride solutions. The lack of coincidence of fluorescence and circular dichroism signals indicated the presence of at least one partially folded intermediate, suggesting that the protein consisted of multiple domains. Proteolytic fragments containing the C terminus were competent for copolymerization with capsid subunits into procapsid shells in vitro, whereas the N terminus was not needed for this function. Proteolysis of partially denatured scaffolding subunits indicated that it was the capsid-binding C-terminal domain that unfolded at low temperatures and guanidinium concentrations. The minimal stability of the coat-binding domain may reflect its role in the conformational switching needed for icosahedral shell assembly.
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The recommendation for surgical fusion on a nearly skeletally mature individual with a 40 to 45-degree curve is in fact quite common in North America. Many recent articles in the peer review literature recommend this approach. The non-surgical approach to a 45-degree curve is probably a minority position in this country although there is a growing body of evidence that non-surgical treatment of the curves in question in our case scenario is a very viable option. A fair examination of the long-term medical consequences of AIS, whether the curve is progressive or not, reveals that definitive serious cardiopulmonary consequence and disabling pain are not generally expected. Surgeons ought not frighten patients into choosing surgery under the guise of preventing cardiopulmonary issues or disabling pain. The literature does tell us that there is a chance that a 45-degree curve may progress into adulthood and progression may be a real cosmetic or psychological concern to the patient. The patient may well choose to undergo surgery to address these cosmetic concerns. Our responsibility as surgeons is to give patients accurate information on the natural history of AIS and to point out the risks and benefits that can be expected if surgery is elected. The decision to undergo elective AIS surgery should be entirely up to the patient and family. We surgeons should never attempt to sway a patient with a 40 to 45-degree curve into having surgery but rather should discuss honestly all of the factors that may help the patient make his or her own decision. If this type of honest, balanced, open discussion takes place many patients will elect to forego surgery but many others will opt to have surgery. There is no right or wrong patient decision but there is a right or wrong way to supply information to patients.
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