Macrophage polarization in cesarean scar diverticulum

Abstract Aims: To determine immunohistochemical features and correlations between M1/M2 polarization status with disease severity of post-cesarean scar diverticulum（CSD）. Methods: Histological and immunohistological staining were performed and inflammatory (CD16, CD163, and TNF-α), fibrosis (α-SMA), and angiogenic (CD31) markers were examined in uterine tissues collected from patients with uterine scar diverticula (CSD) (n=37) and cesarean section (CS) (n=3). Results: CSD tissues have higher expression of α-SMA, TNF-α, CD16, and CD31 and lower expression of CD163 than CS tissue (P <0.05). Compared with adjacent tissues, thick-walled blood vessels, glands, and fibrotic sites have higher expression of α-SMA, TNF-α, and CD16. Statistical correlation was observed between the expression of CD16 and TNF-α (R = 0.693, P <0.001), α-SMA (R = 0.404, P <0.05), and CD31 (R = 0.253, P <0.05) in CSD tissues, especially with the ratio of CD16/CD163 (R = 0.590, P <0.01). A more significant difference was observed between the expression of CD16/CD163 and α-SMA (R = 0.556, P <0.001), TNF-α (R = 0.633, P <0.0001) and CD31 (R = 0.336, P <0.05) Statistical correlation. Conclusion: In this study, TNF-α, α-SMA, CD16, and CD31 proteins were overexpressed in all CSD cases, and CD16/CD163 was positively correlated with tissue inflammation, fibrosis, and neovascularization. Abnormal mononuclear macrophage infiltration may be involved in the origin and progression of CSD.

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Macrophage polarisation in caesarean scar diverticulum

Journal of Clinical Pathology ◽

10.1136/jclinpath-2021-207926 ◽

2022 ◽

pp. jclinpath-2021-207926

Author(s):

Jinfa Huang ◽

Xiaochun Liu ◽

Yi Hou ◽

Yixuan Liu ◽

Kedan Liao ◽

...

Keyword(s):

Smooth Muscle Actin ◽

Statistical Correlation ◽

Macrophage Polarisation ◽

Caesarean Scar ◽

Tnf Α ◽

Significant Difference ◽

Uterine Scar ◽

Factor Α ◽

Necrosis Factor ◽

Lower Expression

AimsTo determine immunohistochemical features and correlations between M1/M2 polarisation status with disease severity of post-caesarean scar diverticulum (CSD).MethodsHistological and immunohistological stainings were performed and inflammatory (CD16, CD163 and tumour necrosis factor-α (TNF-α)), fibrosis (α-smooth muscle actin (α-SMA)) and angiogenic (CD31) markers were examined in uterine tissues collected from patients with uterine scar diverticula (CSD) (n=37) and caesarean section (CS) (n=3).ResultsCSD tissues have higher expression of α-SMA, TNF-α, CD16 and CD31 and lower expression of CD163 than CS tissue (p<0.05). Compared with adjacent tissues, thick-walled blood vessels, glands and fibrotic sites have higher expression of α-SMA, TNF-α and CD16. Statistical correlation was observed between the expression of CD16 and TNF-α (R=0.693, p<0.001), α-SMA (R=0.404, p<0.05) and CD31 (R=0.253, p<0.05) in CSD tissues, especially with the ratio of CD16/CD163 (R=0.590, p<0.01). A more significant difference was observed between the expression of CD16/CD163 and α-SMA (R=0.556, p<0.001), TNF-α (R=0.633, p<0.0001) and CD31 (R=0.336, p<0.05).ConclusionsIn this study, TNF-α, α-SMA, CD16 and CD31 proteins were overexpressed in all CSD cases, and CD16/CD163 was positively correlated with tissue inflammation, fibrosis and neovascularisation. Abnormal mononuclear macrophage infiltration may be involved in the origin and progression of CSD.

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Comparison of Inflammatory Reactions Following Two Different Cesarean Section Techniques: The Modified Misgav-Ladach Versus the Pfannenstiel-Kerr; A Prospective Randomized Trial

Gynecology Obstetrics and Reproductive Medicine ◽

10.21613/gorm.2018.811 ◽

2018 ◽

pp. 1

Author(s):

Baris Buke ◽

Hatice Akkaya ◽

Cigdem Karakukcu

Keyword(s):

Cesarean Section ◽

Inflammatory Reaction ◽

Operation Time ◽

Blood Samples ◽

Inflammatory Reactions ◽

Tnf Α ◽

Significant Difference ◽

The Difference ◽

Group 2 ◽

Group 1

Objectives: There is not yet a consensus on the optimal surgical technique for cesarean section. This is the first study comparing two different (Cesarean Section) with respect to the following inflammatory reaction in means of changes in inflammatory marker levels. To evaluate the differences in inflammatory reactions following two different (Cesarean Section) techniques, the modified Misgav-Ladach versus the Pfannenstiel-Kerr technique.Study Desıgn: The study population included 88 pregnant women who met the inclusion criteria. These women were randomized into two groups according to Consolidated Standards of Reporting Trials guidelines: Group 1 (Misgav-Ladach group) and Group 2 (Pfannenstiel Kerr group). To compare the inflammatory reactions following surgery, Interleukin-6 (IL-6) and Tumor Necrosis Factor-α (TNF-α) levels were measured in venous blood samples drawn from the patients just before (0 hour) and 24 hours (24th hour) after the surgery. In 5 women from Group 1 and 2 women from Group 2, the 24th hour blood samples could not be obtained or were lost. Thus, a total of 81 women, 39 women from Group 1 and 42 women from Group 2, comprised the population of study. The differences in inflammatory reactions between the 0 and 24th hours were analyzed by calculating the percent change in IL-6 and TNF-α levels, and these percentages were then compared between the groups.Results: There was a statistically significant difference between Group 1 and Group 2 regarding the serum IL-6 level change between 0 and 24th hour (530±653% and 196±168%, respectively, p=0.022. The difference in TNF-α was also higher in Group 2, but the difference was not statistically significant (229±306% vs. 571±824%, p=0.12). The mean operation time was significantly shorter in Group 1 (9.44 min. vs. 16.86 min, p=0.0001).Conclusions: The results of this study indicate that the modified Misgav-Ladach technique has a weaker inflammatory reaction, which indicates fewer short- and long-term surgical complications.

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Macrophage polarization in periodontal ligament stem cells enhanced periodontal regeneration

Stem Cell Research & Therapy ◽

10.1186/s13287-019-1409-4 ◽

2019 ◽

Vol 10 (1) ◽

Cited By ~ 9

Author(s):

Jiaying Liu ◽

Bin Chen ◽

Jun Bao ◽

Yangheng Zhang ◽

Lang Lei ◽

...

Keyword(s):

Stem Cell ◽

Stem Cell Transplantation ◽

Periodontal Ligament ◽

Early Stage ◽

Macrophage Polarization ◽

Periodontal Regeneration ◽

Treated Group ◽

M2 Macrophages ◽

M2 Polarization ◽

Tnf Α

Abstract Background The inflammation and regeneration process may be accompanied by the shift in the M1/M2 polarization of macrophages to adapt to extracellular signals. How the macrophages responded to the altered immunological environment in the periodontal niche after stem cell transplantation has never been explored. The purpose of present study is to investigate whether M1/M2 polarization of macrophages participated in the tissue homeostasis and wound healing during periodontal ligament stem cell (PDLSC)-based periodontal regeneration. Methods A rat periodontal defect model was utilized to observe the regeneration process in the PDLSC transplantation-enhanced periodontal repair. Dynamic changes in the markers of M1/M2 macrophages were observed on days 3, 7, and 21 post surgery. In addition, the outcome of regeneration was analyzed on day 21 after surgery. To further investigate the effect of PDLSCs on macrophage polarization, the conditioned medium of PDLSCs was utilized to treat M0, M1, and M2 macrophages for 24 h; markers of M1/M2 polarization were evaluated in macrophages. Results Elevated bone volume and average thickness of bone trabecular was observed in the PDLSC-treated group by micro-computed tomography on day 21. In addition, enhanced periodontal regeneration was observed in the PDLSC-treated group with cementum-like structure regeneration and collagen fiber formation, which inserted into the newly formed cementum. On day 3, PDLSC transplantation increased IL-10 level in the periodontal tissue, while decreased TNF-α in the early stage of periodontal regeneration. On day 7, enhanced CD163+ cell infiltration and heightened expression of markers of M2 macrophages were observed. Furthermore, conditioned medium from PDLSC culture induced macrophage polarization towards the anti-inflammatory phenotype by downregulating TNF-α and upregulating IL-10, Arg-1, and CD163 in vitro. Conclusions PDLSCs could induce macrophage polarization towards the M2 phenotype, and the shift in the polarization towards M2 macrophages in the early stage of tissue repair contributed to the enhanced periodontal regeneration after stem cell transplantation. Therefore, signals from the transplanted PDLSCs might alter the immune microenvironment to enhance periodontal regeneration.

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Various Types of Niche Imaging by Sonohysterography: A Pictorial Review

Donald School Journal of Ultrasound in Obstetrics & Gynecology ◽

10.5005/jp-journals-10009-1369 ◽

2014 ◽

Vol 8 (3) ◽

pp. 311-315 ◽

Cited By ~ 3

Author(s):

Firoozeh Ahmadi ◽

Farnaz Akhbari ◽

Fatemeh Niknejad

Keyword(s):

Cesarean Section ◽

Transvaginal Ultrasound ◽

Subsequent Pregnancy ◽

Previous Cesarean Section ◽

Cesarean Section Delivery ◽

Cesarean Scar ◽

Pictorial Review ◽

Scar Region ◽

Uterine Scar ◽

Previous Cesarean

ABSTRACT Cesarean scar defects (CSD) or niche are the myometrial discontinuity at the previous cesarean section scar region. Recently cesarean section delivery has been raised around the world markedly; therefore women with cesarean scar defects are increased and present in up to 19% of women post cesarean section. The increase of repeat cesarean section has been associated with an increase in complications in subsequent pregnancies such as scar pregnancy with life threatening bleeding, uterus rupture, placenta accreta and its subtypes and prolonged postmenstrual Spotting. The deeper the niche (or the thinner the overlying myometrium), the higher the risk for complications in a subsequent pregnancy. Although the ability of transvaginal ultrasound (TVUS) to detect cesarean scars remains unknown, its higher frequency and proximity to the pelvic organs have been used as a powerful tool for detecting the uterine scar of a previous cesarean section. Recently with the increasing use of sonohysterography (SHG) (transvaginal ultrasound with saline infusion) detection of scar defect has been enhanced frequently. How to cite this article Ahmadi F, Akhbari F, Niknejad F. Various Types of Niche Imaging by Sonohysterography: A Pictorial Review. Donald School J Ultrasound Obstet Gynecol 2014;8(3):311-315.

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Effects of General Anesthesia Versus Spinal Anesthesia on Serum Cytokine Release after Cesarean Section: A Randomized Clinical Trial

Anesthesiology and Pain Medicine ◽

10.5812/aapm.111272 ◽

2021 ◽

Vol In Press (In Press) ◽

Author(s):

Maryam Vosoughian ◽

Mastaneh Dahi ◽

Shideh Dabir ◽

Mohammadreza Moshari ◽

Soodeh Tabashi ◽

...

Keyword(s):

Cesarean Section ◽

General Anesthesia ◽

Spinal Anesthesia ◽

Serum Levels ◽

Major Surgery ◽

Necrosis Factor Alpha ◽

General Anesthesia Group ◽

Anesthesia Group ◽

Tnf Α ◽

Significant Difference

Background: Tissue damage caused by major surgery, such as cesarean section, may lead to a poor host immune response and excessive release of cytokines. These responses may increase the risk of infection, cause postoperative pain, and exert damaging effects on various body organs. Objectives: Anesthesia methods may affect cytokine production after surgery. This study aimed to compare the serum levels of cytokines in general and spinal anesthesia among women undergoing cesarean section. Methods: Thirty parturients (ASA class I and II) undergoing cesarean section were randomly assigned into two equal groups of spinal anesthesia and general anesthesia. Blood samples were taken for measuring the levels of interleukin-6 (IL-6), interleukin-10 (IL-10), and tumor necrosis factor-alpha (TNF-α) before induction of anesthesia and 30 minutes after entering the recovery room. Results: In the general anesthesia group, the postoperative serum levels of IL-6 and TNF-α were significantly higher than the corresponding preoperative levels. Significant differences were found between the two groups in the preoperative and postoperative levels of TNF-α. Changes in the IL-6 and TNF-α concentrations were significantly higher in the general anesthesia group as compared to the spinal anesthesia group. However, there was no significant difference in the IL-6:IL-10 and TNF-α: IL-10 ratios between the two groups. Conclusions: General anesthesia, as compared to spinal anesthesia, significantly increased the IL-6 and TNF-α levels after cesarean section. Therefore, the spinal anesthesia technique may be a better option for patients undergoing cesarean section.

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Evaluation of uterine scar healing by transvaginal ultrasound in 607 nonpregnant women with a history of cesarean section

10.21203/rs.3.rs-131817/v1 ◽

2020 ◽

Author(s):

Xingchen Zhou ◽

Tao Zhang ◽

Huayuan Qiao ◽

Yi Zhang ◽

Xipeng Wang

Keyword(s):

Cesarean Section ◽

Clinical Symptoms ◽

Transvaginal Ultrasound ◽

Cesarean Scar ◽

Female Reproductive Health ◽

Position Detection ◽

The Difference ◽

Uterine Scar ◽

Group B ◽

Scar Healing

Abstract Background: Caesarean scar defect (CSD) seriously affects female reproductive health. In this study, we aim to evaluate uterine scar healing by transvaginal ultrasound（TVS）in nonpregnant women with cesarean section（CS）history and to build a predictive model for cesarean section defects is very necessary. Methods: A total of 607 nonpregnant women with previous CS who have transvaginal ultrasound measurements of the thickness of the lower uterine segment . The related clinical data were recorded and analyzed. Results: All patients were divided into two groups according to their clinical symptoms: Group A (N=405) who had no cesarean scar symptoms, and Group B (N=141) who had cesarean scar symptoms. The difference in frequency of CS, uterine position, detection rate of CSD and the the residual muscular layer (TRM) of the CSD were statistically significant between groups; the TRM measurements of the two groups were (mm) 5.39±3.34 vs 3.22±2.33, P<0.05.All patients were divided into two groups according to whether they had CSDs: Group C (N=337) who had no CSDs , Group D (N=209) who had CSDs on ultrasound examination. The differences in frequency of CS, uterine position, TRM between groups were statistically significant (P<0.05). In the model predicting CSDs by TRM with TVS, the area under the ROC curve was 0.771, the cut-off value was 4.15 mm. The sensitivity and specificity were 87.8% and 71.3%,respectively.Conclusions: Patients with no clinical symptoms had a mean TRM on transvaginal ultrasonography of 5.39 ± 3.34 mm, which could be used as a good reference to predict the recovery of patients with CSDs after repair surgery.

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MSC-derived miR-181b Overexpressing Exosomes Enhanced Osteointegration by Enhancing M2 Polarization of Macrophages via Targeting the PRKCD/AKT Pathway

10.21203/rs.3.rs-52931/v1 ◽

2020 ◽

Author(s):

Wei Liu ◽

Muyu Yu ◽

Feng Chen ◽

Dong Xie ◽

Longqing Wang ◽

...

Keyword(s):

Inflammatory Response ◽

Macrophage Polarization ◽

Underlying Mechanism ◽

Fluorescent Labeling ◽

M2 Macrophage ◽

Implant Loosening ◽

M2 Polarization ◽

Tnf Α

Abstract Background: Many patients suffer from implant loosening after the implantation of titanium alloy caused by immune response to the foreign bodies and this could inhibit osteogenesis, which could possibly give rise to poor osteointegration and there is currently no appropriate solution in clinical practice. Exosomes overexpressing miRNA has been proven to be a suitable candidate for solving this problem. In this study, we explored whether miR-181b could exert beneficial effect on promoting M2 macrophage polarization, thus inhibiting inflammation as well as promoting osteogenesis and elaborated the underlying mechanism in vitro. Furthermore, we aimed to find whether exosomes overexpressing miR-181b (Exo-181b) could enhance osteointegration in vivo.Methods: In vitro and in vivo studies were carried out for assessing the anti-inflammatory and pro-osteogenesis effect of miR-181b. In vitro, ELISA was applied for the detection of the inflammation factors levels including IL-6, TNF-α, as well as IL-10 and the percentage of M1 or M2 polarization was determined by flow cytometry. Also, qRT-PCR was used for the detection of the relative gene expression of the CCR7, CD206, Arg-1, iNOS, VEGF and BMP-2 genes. Western blotting was applied for detecting the protein expression of PRKCD, AKT and p-AKT. In vivo, we established air pouch model for evaluating the effect of Exo-181b on macrophage polarization and distal femoral bone defect model was established for determining the osteointegration effect of Exo-181b by MicroCT, sequential fluorescent labeling and histological analysis. Results: In vitro, we firstly verified that miR-181b significantly enhanced M2 polarization and inhibited inflammation by suppressing PRKCD and activating p-AKT. Then, in vivo, we verified that Exo-181b enhanced M2 polarization, reduced the inflammatory response and enhanced osteointegration. Conclusions: MiR-181b could suppress inflammatory response by regulating the PRKCD/AKT signaling pathway and promoting M2 polarization, which further promoting osteogenesis of hBMSC in vitro and Exo-181b could promote osteointegration in vivo.

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Evaluation of uterine scar healing by transvaginal ultrasound in 607 nonpregnant women with a history of cesarean section

BMC Women s Health ◽

10.1186/s12905-021-01337-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Xingchen Zhou ◽

Tao Zhang ◽

Huayuan Qiao ◽

Yi Zhang ◽

Xipeng Wang

Keyword(s):

Cesarean Section ◽

Clinical Symptoms ◽

Transvaginal Ultrasound ◽

Cesarean Scar ◽

Female Reproductive Health ◽

Position Detection ◽

The Difference ◽

Uterine Scar ◽

Group B ◽

Scar Healing

Abstract Background Caesarean scar defect (CSD) seriously affects female reproductive health. In this study, we aim to evaluate uterine scar healing by transvaginal ultrasound (TVS) in nonpregnant women with cesarean section (CS) history and to build a predictive model for cesarean scar defects is very necessary. Methods A total of 607 nonpregnant women with previous CS who have transvaginal ultrasound measurements of the thickness of the lower uterine segment. The related clinical data were recorded and analyzed. Results All patients were divided into two groups according to their clinical symptoms: Group A (N = 405) who had no cesarean scar symptoms, and Group B (N = 141) who had cesarean scar symptoms. The difference in frequency of CS, uterine position, detection rate of CSD and the residual muscular layer (TRM) of the CSD were statistically significant between groups; the TRM measurements of the two groups were (mm) 5.39 ± 3.34 versus 3.22 ± 2.33, P < 0.05. All patients were divided into two groups according to whether they had CSDs: Group C (N = 337) who had no CSDs, Group D (N = 209) who had CSDs on ultrasound examination. The differences in frequency of CS, uterine position, TRM between groups were statistically significant (P < 0.05). In the model predicting CSDs by TRM with TVS, the area under the ROC curve was 0.771, the cut-off value was 4.15 mm. The sensitivity and specificity were 87.8% and 71.3%, respectively. Conclusions Patients with no clinical symptoms had a mean TRM on transvaginal ultrasonography of 5.39 ± 3.34 mm, which could be used as a good reference to predict the recovery of patients with CSDs after repair surgery.

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Effect of Chewing Gum on Bowel Motility in Women Undergoing Post-Operative Cesarean Section

International Journal of Innovative Research in Medical Science ◽

10.23958/ijirms/vol03-i06/04 ◽

2018 ◽

Vol 3 (06) ◽

Author(s):

Dr.Randa Mohammed AboBaker

Keyword(s):

Cesarean Section ◽

Hospital Stay ◽

Demographic Data ◽

Length Of Hospital Stay ◽

Chewing Gum ◽

Control Group ◽

Controlled Clinical Trial ◽

Bowel Motility ◽

Gum Chewing ◽

Significant Difference

Postoperative Ileus (POI) is one of the most common problems after obstetrics, gynecologic and abdominal surgeries. Sham feeding, such as gum chewing, accelerates the return of bowel function and the length of hospital stay. The present study aims to evaluate the effect of chewing gum on bowel motility in women undergoing post-operative cesarean section. Intervention study was used at the Postpartum Department of Maternity and Children Hospital, KSA. A randomized controlled clinical trial research design. Through a convenience technique, 80 post Caesarian Section (CS) women were included in the study. Data were collected through three tools: Tool (I): Socio-demographic data and reproductive history interview schedule. Tool (II): Postoperative Assessment Sheet. Tool (III): Outcomes of gum chewing and the length of hospital stay. Method: subjects were assigned randomly into two groups of (40) the experimental and (40) the control. Subjects in the study group were asked to chew two pieces of sugarless gum for 30 min/three times daily in the morning, noon, and evening immediately after recovery from anesthesia and in Postpartum Department; while subjects in the control group followed the hospital routine care. Each woman in both groups was tested abdominally using a stethoscope to auscultate the bowel sounds and asked to report immediately the time of either passing flatus or stool. Results: illustrated that a highly statistically significant difference was observed between the two groups concerning their gum chewing outcomes. Where, P = 0.000. The study concluded that gum chewing is safe, well tolerated and appears to be effective in reducing the incidence and consequences of POI following CS.

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Cesarean scar defect: terminological aspects

GYNECOLOGY ◽

10.26442/20795696.2020.5.200415 ◽

2020 ◽

Vol 22 (5) ◽

pp. 70-75

Author(s):

Sergey A. Martynov ◽

Leyla V. Adamyan

Keyword(s):

Caesarean Section ◽

Postpartum Period ◽

Russian Literature ◽

Cesarean Scar ◽

The Status ◽

Uterine Scar

The review aim was to summarize information and to provide terminological analysis of the foreign and Russian literature on assessing the status of the uterine scar after a caesarean section, as well as to identify terms that are most appropriate to use out and during pregnancy, in childbirth and in the postpartum period.

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