Applying Different Chemical Methods to Develop an Efficient Acellular Rat Uterine Tissue Matrix

Purpose: Decellularized uterine scaffold, as a new achievement in tissue engineering, permits recellularization and regeneration of uterine tissues and supports pregnancy in a fashion comparable to the intact uterus. The main purpose of this study was using of different chemical methods to introduce an optimized protocol for decellularization of rat uterus.Method: We decellularized rat uteruses by four different protocols using sodium dodecyl sulfate (SDS) and triton-X100 with different doses and time incubations.We characterized the scaffolds through histopathological staining, DNA quantification, MTT assay, Blood compatibility assay, Field Emission Scanning Electron Microscopy (FESEM), and biomechanical studies.Results: Histology assessment showed that only in protocol 4, cell residues were completely removed. Masson’s trichrome staining demonstrates that in protocol P3 collagen bundles were decreased; however, no damage in the collagen bundles was observed by other protocols. Cell viabilities indirect MTT assays of all protocols were significantly higher than the native samples. The RBC hemolysis percent in the presence of prepared scaffolds from all 4 protocols was less than 2%. The mechanical properties of none of the protocols were significantly different from the native sample. Conclusion: Protocol 4 which used freeze-thawing before using detergent, was introduced as the optimized protocol due to complete removal of cell residue, preservation of the three-dimensional structure, complete removal of detergents, and preservation of the mechanical property of the scaffolds.

Successful laparoscopic resection of ovarian abscess caused by Staphylococcus aureus in a 13-year-old girl: a case report and review of literature

Background Ovarian abscesses, which occur mostly in sexually active women via recurrent salpingitis, occur rarely in virginal adolescent girls. Here, we present a case of an ovarian abscess in a virginal adolescent girl who was diagnosed and treated by laparoscopy. Case presentation A 13-year-old healthy girl presented with fever lasting for a month without abdominal pain. Computed tomography scan and magnetic resonance imaging indicated a right ovarian abscess. Laparoscopic surgery revealed a right ovarian abscess with intact uterus and fallopian tubes. The abscess was caused by Staphylococcus aureus. The patient recovered completely after excision of the abscess, followed by antibiotic treatment. Conclusions Ovarian abscess may occur in virginal adolescent girls; Staphylococcus aureus, an uncommon species causing ovarian abscess, may cause the infection.

Bioidentical Oral 17β-Estradiol and Progesterone for the Treatment of Moderate to Severe Vasomotor Symptoms of Menopause

Objective To review the efficacy, safety, and available literature regarding the novel combination bioidentical product Bijuva, or 17β-estradiol/progesterone (17β-E/P), for the treatment of moderate to severe menopausal symptoms in cisgender females with an intact uterus. Data Sources Literature searches of both PubMed (1966 to October 2020) and Google Scholar were conducted using search terms including bioidentical, estradiol, progesterone, menopause, E2/P4, TX-001HR, and Bijuva. Study Selection and Data Extraction All articles with studies conducted in cisgender human females and in the English language were considered for review; 18 publications were included. Data Synthesis In 1 phase 3 clinical study, 17β-E/P was proven to be effective at reducing the frequency and severity of vasomotor symptoms (VMS) at 12 weeks compared with placebo, and no cases of endometrial hyperplasia were observed over the 52-week safety study period. Menopausal women with an intact uterus were included in the study population. Relevance to Patient Care and Practice Concerns over content and safety of compounded bioidentical hormones have been raised by several professional societies. As women experience VMS of menopause, a desire for a Food and Drug Administration–regulated bioidentical combination product for the treatment of moderate to severe menopausal symptoms may be desirable. Given as a once-daily oral capsule at the dose of 1 mg estradiol/100 mg progesterone, 17β-E/P is approved for the treatment of VMS associated with menopause. Conclusions 17β-E/P is a novel bioidentical product that is the first of its kind in the treatment of moderate to severe menopausal symptoms.

Analysis of Primary Caesarean Section in a District Hospital

Background: Caesarean delivery is defined as an operative procedure to deliver the fetus or foetuses after the period of viaility through an incision on the adominal wall and uterine wall in an intact uterus. The World Health Organization (WHO) has identified an ideal caesarean section (CS) rate for a nation of around 10-15%1. The objective of the present study was to find the rate of primary caesarean deliveries in and its contribution to total caesarean rate and to analyze the indications of the caesarean sections. Methods: It is a retrospective observational study conducted in the Department of Obstetrics and Gynaecology at Regional hospital,Bilaspur. A total of 90 primary caesarean deliveries were studied. Results: The total deliveries during the study period were 809 and the total caesarean section rate observed was 14.96%. The caesarean section rate among primigravidae was 74.38%. Out of the total number of primicaesarean deliveries, 92.22% were performed in emergency and 7.78% were performed electively. Among the emergency caesarean sections performed, 60.24% of patients had induced labor and 39.76% had spontaneous labor. The most common indication of caesarean section was fetal distress (43.33%) followed by failed induction(18.89%) and malpresentations (16.67%). Conclusions: Caesarean audit should be performed routinely and every case should be scrutinised. Reducing the primary caesarean rate not only decreases total caesarean rate but also many long-term complications associated with previous caesarean sections like adherent placenta ,rupture uterus

Uterine rupture: a preventable obstetric catastrophe

Background: Maternal health has long been acknowledged to be the cornerstone in public health. The objective of this study was to determine the incidence, etiology, risk factors, complications, treatment strategies, maternal and fetal outcome associated with uterine rupture and to determine how to decrease the maternal morbidity and mortality pertaining to it, as it is indeed a preventable obstetric catastrophe!Methods: This is a retrospective study which was carried out in our institute. Analysis of 45 cases of uterine rupture including scar dehiscence, registered/emergency, rupture occurring in the antepartum or intrapartum period, irrespective of previous vaginal or cesarean delivery was done between July 2017 to June 2019 out of 16,330 deliveries. None of the cases were excluded. Statistical analysis was done comparing the mortality in general population and study population and it was determined that it contributes to the maternal mortality significantly hence making it essential to promptly diagnose and treat the cases.Results: The incidence of rupture of uterus is average 0.27% (1 in 362). Out of 45 cases 9 (20%) were registered, and 36 (80%) were referred patients. The 20-30 years age group is the most vulnerable. Scarred uterus undergoing rupture were 34 (75.55%) as compared to rupture in intact uterus which were 11 (24.44%). The commonest modality of treatment used is suturing of tear which was done in 34 (75.55%) followed by total hysterectomy. There were 2 maternal deaths giving maternal mortality rate of 4.44% and perinatal mortality occurred in 18 (40%) cases.Conclusions: Uterine rupture is a dire emergency with a high incidence of maternal and fetal morbidity and mortality. Skilled attendance with accessible obstetric care, focused antenatal care, strict intrapartum monitoring and good surgical approach are key elements for the prevention and management of uterine rupture.

Current Evidence of the Oncological Benefit-Risk Profile of Hormone Replacement Therapy

Hormone replacement therapy (HRT) remains the most effective treatment for menopausal symptoms and has been shown to prevent bone loss and fracture. The progestogen is added to provide endometrial protection in women with an intact uterus. After the publication of the initial WHI (Women’s Health Initiative) results in 2002 reporting an overall increased risk of breast cancer, many women discontinued HRT. Despite the re-analysis of the results by subgroups of patients and updates with extended follow-up, much controversy remains, which we will analyze later in the text. Different types of estrogen or progestogen, as well as different formulations, doses, and durations, may play a role in HRT’s effects on breast tissue. Evidence states that conjugated equine estrogen (CEE), compared to estro-progestin therapy, shows a better profile risk (HR 0.79, CI 0.65–0.97) and that, among different type of progestins, those structurally related to testosterone show a higher risk (RR 3.35, CI 1.07–10.4). Chronic unopposed endometrial exposure to estrogen increases the risk of endometrial hyperplasia and cancer, whereas the association with progestins, especially in continuous combined regimen, seems to reduce the risk (RR 0.71, CI 0.56–0.90). HRT was also associated with a protective effect on colon cancer risk (HR 0.61, CI 0.42–0.87). Data about ovarian and cervical cancer are still controversial.

Choice of progestogen for endometrial protection in combination with transdermal estradiol in menopausal women

Transdermal estradiol (TE) application (using gels, patches or a novel spray) is now a preferred route of hormone therapy (HT) in menopausal women, because various risks such as venous thromboembolism, stroke and unwanted hepatic effects can be reduced compared with oral HT. However, in the presence of an intact uterus, concurrent administration of progestogen is needed for endometrial protection. Due to the variety of progestogens available and differences in their clinical effects, the selection of the most appropriate substance and dosing for individual combination therapy can be difficult. This is especially true for TE gels and the novel spray because no fixed combination products are commercially available, meaning all progestogens must be added separately, and even for patches only two transdermal synthetic progestogens are available. The aim of this review was to summarize data on the endometrial effects of the different progestogens and to provide practical recommendations for the choice of progestogen (type and dosing), with a focus on endometrial protection when using TE, especially when using the novel estradiol (E2) spray.

A Retrospective Study of Cytology, High-Risk HPV, and Colposcopy Results of Vaginal Intraepithelial Neoplasia Patients

There is currently no large sample data of cytology, high-risk human papillomavirus (hrHPV), and colposcopy results of vaginal intraepithelial neoplasia (VaIN) in women who underwent hysterectomy and those who did not. We aim to explore the values of cytology, hrHPV, and colposcopy reports in detecting VaIN. A retrospective study of women diagnosed with VaIN by colposcopy-directed biopsy was performed at the Obstetrics and Gynecology Hospital of Fudan University, China, between January 1, 2014, and December 31, 2014. A total of 529 cases of VaIN were diagnosed, including 16.1% VaIN2/3 and 83.9% VaIN1. The ratio of VaIN2/3 in VaIN among patients after hysterectomy and with an intact uterus was 35.1% and 12.0%, respectively. The sensitivity of cytology for VaIN2/3 in only, concomitant, and posthysterectomy VaIN was 42.1%, 80.0%, and 80.8%, respectively. The sensitivity of hrHPV and cytology/hrHPV cotesting for VaIN2/3 in patients with an intact uterus versus those after hysterectomy was 93.5% versus 92.3% and 92.0% versus 100.0%, respectively. Notably, 13.3% of the patients with VaIN and 9.7% of the patients with VaIN2/3 underwent hysterectomy for noncervical diseases. The sensitivity of cytology and hrHPV for VaIN is noninferior to that of CIN2+, and thus these methods can help in the early detection of VaIN effectively.