The use of modern minimally invasive technologies and imaging (CT) methods in the diagnosis and surgical treatment of endometrial hyperplastic processes and combined gynecological pathology

On the basis of retrospective and prospective analysis of case reports of 540 patients with recurrent endometrial hyperplasia and combined intrauterine pathology (recurrent endometrial hyperplasia + hysteromyoma and/or adenomyosis) some aspects of surgical treatment of the pathology are considered, the effectiveness of different kinds of endoscopic operations is analyzed. Potentialities of spiral computerized tomography (SCT) for diagnosis of uterine disease are examined.

Assessment of Sensitivity and Profitability of an Intravaginal Sensor for Remote Calving Prediction in Dairy Cattle

One critical point of dairy farm management is calving and neonatal first care. Timely calving assistance is associated with the reduction of calf mortality and postpartum uterine disease, and with improved fertility in dairy cattle. This study aimed to evaluate the performance and profitability of an intravaginal sensor for the prediction of stage II of labor in dairy farms, thus allowing proper calving assistance. Seventy-three late-gestating Italian Holstein cows were submitted to the insertion of an intravaginal device, equipped with light and temperature sensors, connected with a Central Unit for the commutation of a radio-signal into a cell phone alert. The remote calving alarm correctly identified the beginning of the expulsive phase of labor in 86.3% of the monitored cows. The mean interval from alarm to complete expulsion of the fetus was 71.56 ± 52.98 min, with a greater range in cows with dystocia (p = 0.012). The sensor worked correctly in both cold and warm weather conditions, and during day- or night-time. The intravaginal probe was well tolerated, as any cow showed lesions to the vaginal mucosa after calving. Using sex-sorted semen in heifers and beef bull semen in cows at their last lactation, the economic estimation performed through PrecisionTree™ software led to an income improvement of 119 € and 123 €/monitored delivery in primiparous and pluriparous cows, respectively. Remote calving alarm devices are key components of “precision farming” management and proven to improve animal welfare, to reduce calf losses and to increase farm incomes.

262 Reproductive Microbiomes as Predicators of Fertility in Beef Cattle

Over the past decade, a multitude of research has sought to understand the complexity and role of the reproductive microbiome as it pertains to fertility. Previously, the reproductive microbiome was evaluated using culture-dependent methods; however, recent advancements in culture-independent, 16S rRNA gene amplicon community sequencing have vastly expanded our understanding of the reproductive tract microbiome. Early sequencing studies sought to compare the vaginal microbiome of cattle to the vaginal microbiome of healthy women, which predominantly consists of bacteria in the genus Lactobacillus and believed to be an indicator of fertility. In the vagina of beef cattle, however, there are incredibly low abundances of Lactobacillus and a greater diversity of bacterial species present. Beta-diversity, which examine differences in bacterial communities between samples, does not appear to differ in the vagina between unbred, open, or pregnant cattle. In postpartum beef cattle just prior to breeding, there are greater levels of diversity and increased bacterial species richness in the vagina compared to the uterus. Research on bacterial species within the uterus have primarily focused on pathogenic bacteria in postpartum cattle diagnosed with uterine disease. Fewer studies have investigated uterine bacterial species in presumed healthy postpartum beef cattle and the subsequent effects on fertility outcomes (e.g., pregnant vs. open at day 30). When evaluating the uterine microbiome during an industry standard estrus synchronization protocol, bacterial community abundance and diversity reduce over time regardless of resulting fertility outcomes. The greatest difference in uterine bacterial abundance between resulting pregnant and non-pregnant cattle appears to occur just prior to breeding. Numerous mechanisms could be contributing to the fluctuations in the uterine microbiome in beef cattle including circulating hormone concentrations or local immunoregulation. This presentation will focus on recent research investigating potential mechanisms that may alter the reproductive microbiome and ultimately impact fertility.

Conservative treatment of microinvasive squamous cell carcinoma of the cervix stage IA1: Defining conization height to an optimal oncological outcome

Objective This paper searches an ideal cone height for stage definition and safe treatment of cervical microinvasive squamous carcinoma stage IA1 (MIC IA1), avoiding excessive cervix resection, favoring a future pregnancy. Methods A retrospective study was performed involving 562 women with MIC IA1, from 1985 to 2013, evaluating cone margin involvement, depth of stromal invasion, lymph vascular invasion, conization height, and residual uterine disease (RD). High-grade squamous lesions or worse detection was considered recurrence. Univariate and multivariate regression analyses were performed, including age, conization technique (CKC, cold-knife, or ETZ, excision of transformation zone), and pathological results. Conization height to provide negative margins and the risk of residual disease were analyzed. Results Conization was indicated by biopsy CIN2/3 in 293 cases. Definitive treatments were hysterectomy (69.8%), CKC (20.5%), and ETZ (9.7%). Recurrence rate was 5.5%, more frequent in older women (p = 0.030), and less frequent in the hysterectomy group (p = 0.023). Age ≥40 years, ETZ and conization height are independent risk factors for margin involvement. For ages <40 years, 10 mm cone height was associated with 68.6% Negative Predictive Value (NPV) for positive margins, while for 15 mm and 25 mm, the NPV was 75.8% and 96.2%, respectively. With negative margins, the NPV for RD varied from 85.7–92.3% for up to 24 mm cone height and 100% from 25 mm. Conclusion Conization 10 mm height for women <40 years provided adequate staging for almost 70%, with 10% of RD and few recurrences. A personalized cone height and staging associated with conservative treatment are recommended.

Frequency and Spectrum of Non-Malignant Lesions in Abdominal Hysterectomy Specimens

Objective: To determine the histological spectrum of non-malignant lesions in abdominal hysterectomy specimens from women of reproductive age group. Study Design and Setting: This was a descriptive cross-sectional study carried out at a private hospital in Karachi from December 2018 to December 2019. Methodology: The uterine specimens of patients (n=262) between the ages of 24 to 55 years were collected. Hysterectomies done due to any benign uterine disease were included in the study. Hysterectomies due to malignant causes were excluded. Pathological diagnosis was done on light microscopy using routine hematoxylin and eosin staining technique. Data collected during the study period included patient's age, clinical history/diagnosis and histological diagnosis. On receiving the hysterectomy specimens as per protocol, specimens were immediately put in 10% formalin, appropriately labeled for patient’s name, gender, age and procedure. In histopathology lab, grossing of the specimens was done using standard protocols. Frequency and variables were analyzed by using descriptive statistics of SPSS-version 22. Results: Total n=262 hysterectomies were received. Mean age of all the patients was 34.7 years ±7.8. Non-malignant uterine pathologies on histopathology included 124(47.7%) leiomyomas, 52(20%) adenomyosis, 32(12.3%) endometrial polyps, 16(6.2%) endometrial hyperplasia, 6(2.3%) endometritis, 3(1.2%) disordered proliferative endometrium and 1(0.4%) endometrial stromal nodule. Rest of the cases showed normal phases of endometrial cycle. Only two cases (0.76%) out of 262 received as clinically benign uterine disease, were diagnosed as malignant on histopathology. Conclusion: Leiomyoma is the most common uterine pathology diagnosed in clinical setting as well as encountered at histopathological examination followed by Adenomyosis and endometrial polyps in women of reproductive age group in Pakistan.

Gynecological Disease Diagnosis Expert System Using the Web-Based Dempster Shafer Method

Uterine disease is a disease that generally attacks female reproduction. Most women know a disease that is in their womb when the disease is declared severe or so-called advanced stage. With this expert system, it is hoped that human uterine diseases can be detected early and can minimize the occurrence of more dangerous diseases. The method used in this expert system is the Dempster Shafer calculation method. This expert system works by entering the symptoms experienced by the patient after which the system will work according to the calculations determined by the expert who entered the knowledge base. The result of this research is to build an expert system for diagnosis of gynecology using a website-based dempster shafer. This website can be used as the use of technology so that it can be used to diagnose uterine diseases precisely and accurately, so that people with gynecological diseases are handled more quickly from an early age.

Effect of pegbovigrastim on clinical mastitis and uterine disease during a full lactation in grazing dairy cows

In this randomized controlled trial on four commercial grazing dairy farms, we investigated whether pegbovigrastim (PEG) treatment affects clinical mastitis (CM) and uterine disease (i.e. retained placenta (RP), metritis and endometritis) occurrence during a full lactation. The association of prepartum body condition score and prepartum non-esterified fatty acid (NEFA) concentration with disease occurrence was also evaluated. Holstein cows were randomly assigned to one of two treatments: first PEG dose approximately 7 d before the expected calving date and a second dose within 24 h after calving (PEG) compared to untreated controls (Control). In total, 2,153 animals were included in the study: 733 primiparous cows (Control = 391, PEG = 342) and 1420 multiparous cows (Control = 723, PEG = 697). Treatment effects were evaluated with generalized linear mixed models and Cox’s proportional hazard models. Treatment with PEG reduced the occurrence of a first case of CM during the first 30 days in milk (DIM) by 24.6% and reduced the hazard of a first case and the rate of total cases of CM during the full lactation. All PEG treatment effects were independent of parity. Prepartum body condition score interacted with PEG treatment: in over-conditioned cows, PEG reduced the occurrence of a first case of CM during the first 30 DIM by 49.5%. The hazard analysis of a first case of CM during the full lactation suggested that the preventive effect of PEG disappeared with increasing DIM. Treatment with PEG did not affect the occurrence of RP or metritis. Pegbovigrastim treated cows with metritis subsequently showed a reduced occurrence of endometritis compared to control cows with metritis. Pegbovigrastim reduces the occurrence of CM particularly in cows at risk of elevated lipid mobilization, and PEG ameliorates the uterine healing process in cows that experienced metritis.

Ceftiofur reduced Fusobacterium leading to uterine microbiota alteration in dairy cows with metritis

Background Metritis is an inflammatory uterine disease found in ~ 20% of dairy cows after parturition and associated with uterine microbiota with high abundance of Fusobacterium, Bacteroides, and Porphyromonas. Ceftiofur is a common treatment, but the effect on uterine microbiota is poorly understood. Herein, we investigated the short-term impact of ceftiofur on uterine microbiota structure and function in cows with metritis. Eight cows received ceftiofur (CEF) and 10 remained untreated (CON). Uterine swabs were collected for PCR and metagenomic analysis at diagnosis before treatment (5 ± 1 DPP) and 2 days after diagnosis/treatment (7 ± 1 DPP) from the same individuals. Seven CEF and 9 CON passed quality control and were used for 16S rRNA gene sequencing. Results Ceftiofur treatment resulted in uterine microbiota alteration, which was attributed to a decrease in relative abundance of Fusobacterium and in gene contents involved in lipopolysaccharide biosynthesis, whereas uterine microbiota diversity and genes involved in pantothenate and coenzyme A biosynthesis increased. Ceftiofur treatment also reduced rectal temperature and tended to reduce total bacteria in the uterus. However, other uterine pathogens such as Bacteroides and Porphyromonas remained unchanged in CEF. The blaCTX-M gene was detected in 37.5% of metritic cows tested but was not affected by CEF. We found that β-hydroxybutyric acid, pyruvic acid, and L-glutamine were preferentially utilized by Fusobacterium necrophorum according to metabolic activity with 95 carbon sources. Conclusions Ceftiofur treatment leads to alterations in the uterine microbiota that were mainly characterized by reductions in Fusobacterium and genes involved in LPS biosynthesis, which may be associated with a decrease in rectal temperature. The increase in pantothenate and coenzyme A biosynthesis indicates microbial response to metabolic stress caused by ceftiofur. Preference of Fusobacterium for β-hydroxybutyric acid may help to explain why this strain becomes dominant in the uterine microbiota of cows with metritis, and it also may provide a means for development of new therapies for the control of metritis in dairy cows.