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Advances in Wound Care Apr 2021To design and validate a novel murine model of full-thickness (FT) vaginal wound healing that mirrors postinjury tissue repair and underscores the impact of estrogen...
To design and validate a novel murine model of full-thickness (FT) vaginal wound healing that mirrors postinjury tissue repair and underscores the impact of estrogen signaling-driven healing kinetics, inflammation, and neovascularization. Five-week-old female CD1 mice were subjected to two 1-mm FT wounds. To assess wound healing kinetics, vaginas were harvested at 6, 12, 18, 24, 48, and 72 h and 7 days postinjury. Wounds from all time points were analyzed by hematoxylin and eosin and trichrome to, respectively, assess the rate of wound closure and tissue deposition. Inflammatory leukocyte (CD45), neutrophil (Ly6G), and macrophage (F480 and CD206) infiltration was examined by immunohistochemistry (IHC) and the resulting anti-inflammatory M2 (CD206)/total (F480) macrophage ratio quantified. Neovascularization (CD31) and estrogen receptor-α (ERα) expression levels were similarly determined by IHC. We observed rapid healing with resolution of mucosal integrity by 48 h ( < 0.05), and overall neutrophils and polarized type 2 macrophages (M2) apexed at 12 h and reduced to near control levels by day 7 postinjury. Tissue repair was virtually indistinguishable from the surrounding vagina. CD31 vessels increased between 12 h and day 7 and ERα trended to decrease at 12 h postinjury and rebound at day 7 to uninjured levels. A proof-of-concept murine model to study vaginal wound healing kinetics and postinjury regenerative repair in the vagina was developed and verified. We surmise that murine vaginal mucosal repair is accelerated and potentially regulated by estrogen signaling through the ERα, thus providing a cellular and molecular foundation to understand vaginal healing responses to injury.
Topics: Animals; Estrogen Receptor alpha; Estrogens; Female; Inflammation; Kinetics; Macrophages; Mice; Models, Animal; Platelet Endothelial Cell Adhesion Molecule-1; Regeneration; Vagina; Wound Healing
PubMed: 32602816
DOI: 10.1089/wound.2020.1198 -
The British Journal of Radiology Dec 2017The role of ultrasound in the assessment of the female pelvis whether using transabdominal/transluminal approach is well established. Little was reported about the use... (Review)
Review
The role of ultrasound in the assessment of the female pelvis whether using transabdominal/transluminal approach is well established. Little was reported about the use of the superficial transperineal approach that could provide a full assessment of the lower cervix and vagina, which may be overlooked in the standard examinations. The proximity of the probe to the vagina helps not only the detection of organ abnormalities but also proper characterization and differentiation of vaginal masses. . We discuss the diagnostic role of this superficial ultrasound approach in improving the perception and interpretation of the anatomy and different diseases of the vagina.
Topics: Female; Humans; Perineum; Ultrasonography; Vagina; Vaginal Diseases
PubMed: 28937267
DOI: 10.1259/bjr.20170326 -
Journal of Reproductive Immunology Jun 2023There have been few studies concerning an association between unexplained recurrent pregnancy loss (RPL) and the microbiome. A recent study including 67 patients...
There have been few studies concerning an association between unexplained recurrent pregnancy loss (RPL) and the microbiome. A recent study including 67 patients demonstrated that an increase in Ureaplasma species in the endometrium raised the risk of miscarriage with an euploid karyotype. While endometrial sampling is invasive, cervicovaginal sampling is not. We compared vaginal and cervical microbiomes with a 16 S ribosomal RNA sequence between 88 patients with unexplained RPL and 17 healthy women with no history of miscarriage. We prospectively assessed risk factors for maternal colonization at a subsequent miscarriage without an aneuploid karyotype in patients. Cervicovaginal bacteria were dominated by Lactobacillus iners, Gardnerella vaginalis, Atopobium vaginae and Bifidobacterium breve in Japanese population. The proportions of Delftia and unknown bacteria in the cervix were significantly higher in patients with RPL than in controls. Streptococcus, Microbacterium, Delftia, Anaerobacillus and Chloroplast in the cervix were significantly higher in patients with a history of chorioamnionitis compared to the controls. The abundance of Cutibacterium and Anaerobacillus in the cervix was significantly higher in patients who had subsequently miscarried compared to those who gave birth. The miscarriage rate in patients with higher proportions of both Cutibacterium and Anaerobacillus (66.7%, 2/3) was significantly greater than that of patients who lacked these bacteria (9.2%, 6/65, adjusted odds ratio 16.90, 95% confidence interval 1.27-225.47, p = 0.032). The presence of certain bacteria could be a predictor of subsequent miscarriage without an aneuploid karyotype. The cervicovaginal microbiome might be useful for investigating a possible cause of RPL.
Topics: Pregnancy; Humans; Female; Vagina; Cervix Uteri; Abortion, Habitual; Aneuploidy; Microbiota
PubMed: 37060795
DOI: 10.1016/j.jri.2023.103944 -
Revista Da Associacao Medica Brasileira... 2010The aim of this review is to update knowledge about the vaginal ecosystem, non-cultivation methods for bacterial identification (gene amplification), the Lactobacillus... (Review)
Review
The aim of this review is to update knowledge about the vaginal ecosystem, non-cultivation methods for bacterial identification (gene amplification), the Lactobacillus species that comprise normal vaginal flora and influence of host genetics on bacterial interactions with local innate and acquired immune defenses. A Medline (Pubmed) search from 1997-2009 for relevant articles was performed and the most informative articles were selected. Non-culture techniques (gene amplification) allow a comprehensive analysis of the vaginal ecosystem's composition. In the majority of women in the reproductive age there is a predominance of one or more species of Lactobacillus: L. crispatus, L. inners and L gasseri. However, in other apparently healthy women there is a deficiency or complete absence of Lactobacilli. Instead, there is a substitution by other lactic acid-producing bacteria: Atobium, Megasphaera and/or Leptotrichia species. The infectivity and/or proliferation of pathogenic bacteria in the vagina is suppressed by lactic acid production, by products of endogenous bacteria and by activation of local innate and acquired immunity. Vaginal epithelial cells produce several compounds with anti-microbial activity. These cells have Toll-like receptors on their membrane that recognize molecular patterns associated with pathogens. Recognition leads to production of pro-inflammatory cytokines and stimulation of antigen-specific immunity. The production of IgG and IgA antibodies is also triggered in the endocervix and vagina in response to infection. Vaginal flora composition and the immune mechanisms constitute important defenses. Criteria of normal and abnormal flora have to be reviewed and genetic polymorphism can explain variations in flora composition. This new knowledge should be included in the clinical practice of gynecologists and obstetricians to improve patients care.
Topics: Female; Humans; Lactobacillus; Vagina
PubMed: 20676549
DOI: 10.1590/s0104-42302010000300026 -
Revista Colombiana de Obstetricia Y... Dec 2020To present the case of a patient diagnosed with aggressive angiomyxoma of the vagina and to conduct a review of the diagnosis, treatment and prognosis of this disease... (Review)
Review
OBJECTIVE
To present the case of a patient diagnosed with aggressive angiomyxoma of the vagina and to conduct a review of the diagnosis, treatment and prognosis of this disease condition.
METHODS
A 46-year old female patient complaining of dysuria and vaginal mass sensation. Physical exploration and imaging studies revealed a tumor extending into the pelvic cavity. The mass was resected through a vaginal approach and pathology of the surgical specimen showed an aggressive angiomyxoma of the vagina. New retrorectar surgery was performed three months after the initial resection because of recurrence. A search was conducted in the Medline via PubMed, Lilacs, Scielo and Google Scholar databases using the terms "Angiomyxoma," "Aggressive" and "Vagina." The search included review articles, case reports and case series published in English and Spanish since 1995. The information extracted included diagnosis, symptoms, signs, immunohistochemistry and imaging studies used, type of treatment surgical or other - and prognosis. Findings are described in narrative form.
RESULTS
Overall, 23 titles were identified, of which 14 case reports, 2 clinical case series and 1 review article met the inclusion criteria. Sixty-five per cent of the patients were between 30 and 50 years of age. Diagnosis was made by immunohistochemistry in 8 cases, and diagnostic imaging was used in 12 cases. Computed tomography showed sharper contours of the lesions. Surgical treatment was applied in all reports, supplemented by hormonal therapy in 4 cases. There was follow-up in 14 of the 17 cases reported.
CONCLUSIONS
Aggressive angiomyxoma of the vagina is rare. Assessment of the role of various immunohistochemical tests is needed in cases identified as aggressive angiomyxoma on histopathology. Evaluation of hormonal treatment as an adjunct to surgery is required. Prognosis is good.
Topics: Female; Humans; Immunohistochemistry; Middle Aged; Myxoma; Neoplasm Recurrence, Local; Prognosis; Vagina
PubMed: 33515445
DOI: 10.18597/rcog.3527 -
Frontiers in Immunology 2022Vaginal microbiome and the local innate immune defense, including the complement system, contribute to anti- and proinflammatory homeostasis during pregnancy and...
BACKGROUND
Vaginal microbiome and the local innate immune defense, including the complement system, contribute to anti- and proinflammatory homeostasis during pregnancy and parturition. The relationship between commensal vaginal bacteria and complement activation during pregnancy and delivery is not known.
OBJECTIVE
To study the association of the cervicovaginal microbiota composition to activation and regulation of the complement system during pregnancy and labor.
STUDY DESIGN
We recruited women during late pregnancy (weeks 41 + 5 to 42 + 0, n=48) and women in active labor (weeks 38 + 4 to 42 + 2, n=25). Mucosal swabs were taken from the external cervix and lateral fornix of the vagina. From the same sampling site, microbiota was analyzed with 16S RNA gene amplicon sequencing. A Western blot technique was used to detect complement C3, C4 and factor B activation and presence of complement inhibitors. For semiquantitative analysis, the bands of the electrophoresed proteins in gels were digitized on a flatbed photo scanner and staining intensities were analyzed using ImageJ/Fiji win-64 software. Patient data was collected from medical records and questionnaires.
RESULTS
The vaginal microbiota was -dominant in most of the samples (n=60), and being the dominant species. and were found to be more abundant during pregnancy than active labor. abundance correlated with C4 activation during pregnancy but not in labor. was associated with C4 activation both during pregnancy and labor. The amount of correlated with factor B activation during pregnancy but not during labor. was more abundant during pregnancy than labor and correlated with C4 activation during labor and with factor B activation during pregnancy. Activation of the alternative pathway factor B was significantly stronger during pregnancy compared to labor. During labor complement activation may be inhibited by the abundant presence of factor H and FHL1.
CONCLUSIONS
These results indicate that bacterial composition of the vaginal microbiota could have a role in the local activation and regulation of complement-mediated inflammation during pregnancy. At the time of parturition complement activation appears to be more strictly regulated than during pregnancy.
Topics: Bacteria; Complement Activation; Complement Factor B; Female; Gardnerella vaginalis; Humans; Intracellular Signaling Peptides and Proteins; LIM Domain Proteins; Microbiota; Muscle Proteins; Parturition; Pregnancy; Vagina
PubMed: 35958597
DOI: 10.3389/fimmu.2022.925630 -
Reproductive Sciences (Thousand Oaks,... Jun 2021While developments in gynecologic health research continue advancing, relatively few groups specifically focus on vaginal tissue research for areas like wound healing,... (Comparative Study)
Comparative Study Review
While developments in gynecologic health research continue advancing, relatively few groups specifically focus on vaginal tissue research for areas like wound healing, device development, and/or drug toxicity. Currently, there is no standardized animal or tissue model that mimics the full complexity of the human vagina. Certain practical factors such as appropriate size and anatomy, costs, and tissue environment vary across species and moreover fail to emulate all aspects of the human vagina. Thus, investigators are tasked with compromising specific properties of the vaginal environment as it relates to human physiology to suit their particular scientific question. Our review aims to facilitate the appropriate selection of a model aptly addressing a particular study by discussing pertinent vaginal characteristics of conventional animal and tissue models. In this review, we first cover common laboratory animals studied in vaginal research-mouse, rat, rabbit, minipig, and sheep-as well as human, with respect to the estrus cycle and related hormones, basic reproductive anatomy, the composition of vaginal layers, developmental epithelial origin, and microflora. In light of these relevant comparative metrics, we discuss potential selection criteria for choosing an appropriate animal vaginal model. Finally, we allude to the exciting prospects of increasing biomimicry for in vitro applications to provide a framework for investigators to model, interpret, and predict human vaginal health.
Topics: Animals; Biomedical Research; Computer Simulation; Disease Models, Animal; Female; Humans; Mice; Microbiota; Models, Animal; Rabbits; Rats; Sheep; Species Specificity; Swine; Swine, Miniature; Vagina; Vaginal Diseases
PubMed: 33825165
DOI: 10.1007/s43032-021-00529-y -
Fertility and Sterility Jan 2011To describe a rare anomaly of the female reproductive tract and review the embryology associated with the defect. (Review)
Review
OBJECTIVE
To describe a rare anomaly of the female reproductive tract and review the embryology associated with the defect.
DESIGN
Case report and review of the literature.
SETTING
Major academic medical center.
PATIENT(S)
A 14-year-old girl with two hemiuteri lacking any communication with a single normal midline cervix and vagina.
INTERVENTION(S)
Diagnostic laparoscopy with chromopertubation to identify the anomaly and subsequent bilateral supracervical hemihysterectomies.
MAIN OUTCOME MEASURE(S)
Incidence, pathogenesis, fertility implications, and treatment options for patients with congenital defects in the upper vagina, cervix, and uterus.
RESULT(S)
Based on classic embryology, the lower vagina forms from the urogenital sinus while the upper vagina, cervix, and uterus form from the müllerian ducts. If a cervix is present, then the upper vagina and uterus are also usually present and should communicate.
CONCLUSION(S)
This anomaly cannot be fully explained by traditional embryologic developmental theory. It is likely that an insult occurred between 9 weeks, when the uterovaginal canal is formed, and 12 weeks, when the müllerian ducts fuse.
Topics: Adolescent; Cervix Uteri; Female; Humans; Infertility, Female; Laparoscopy; Mullerian Ducts; Vagina
PubMed: 20643405
DOI: 10.1016/j.fertnstert.2010.05.051 -
Fertility and Sterility Jul 2004To review the anatomy and physiology of the vagina, the merits of vaginal drug administration, and the currently available vaginal drug-administration systems. (Review)
Review
OBJECTIVE
To review the anatomy and physiology of the vagina, the merits of vaginal drug administration, and the currently available vaginal drug-administration systems.
DESIGN
Review of basic and clinical research.
RESULT(S)
Although clinicians commonly use topically administered drugs in the vagina, this route for systemic drug administration is somewhat novel. Experience with a variety of products demonstrates that the vagina is a highly effective site for drug delivery, particularly in women's health. The vagina is often an ideal route for drug administration because it allows for the administration of lower doses, steady drug levels, and less frequent administration than the oral route. With vaginal drug administration, absorption is unaffected by gastrointestinal disturbances, there is no first-pass effect, and use is discreet. Knowledge of anatomy, physiology, histology, and immunology of the vagina should allow clinicians to reassure their patients concerning this mode of delivery. Greater understanding and experience by clinicians should lead to increased use and acceptance of the vagina as a route for drug administration.
CONCLUSION(S)
The safety and efficacy of vaginal administration have been well established. The vaginal route of drug delivery is acceptable and may even be a preferable route of administration for many drugs, particularly hormones, whether for contraception or postmenopausal estrogen therapy.
Topics: Administration, Intravaginal; Contraceptive Devices, Female; Drug Delivery Systems; Equipment Design; Estrogen Replacement Therapy; Female; History, 20th Century; Humans; Hydrogen-Ion Concentration; Immune System; Patient Acceptance of Health Care; Vagina
PubMed: 15236978
DOI: 10.1016/j.fertnstert.2004.01.025 -
Current Opinion in HIV and AIDS Mar 2016Women who have genital inflammation are at increased risk of sexual HIV infection. The purpose of this review is to evaluate the mechanisms for this relationship, causes... (Review)
Review
PURPOSE OF REVIEW
Women who have genital inflammation are at increased risk of sexual HIV infection. The purpose of this review is to evaluate the mechanisms for this relationship, causes of genital inflammation, and strategies to manage this condition.
RECENT FINDINGS
We have recently shown in a cohort of South African women that HIV seroconversion was associated with persistently raised genital inflammatory cytokines (including MIP-1α, MIP-1β, and IP-10). Elevated inflammatory cytokine concentrations may facilitate HIV infection by recruiting and activating HIV target cells and disrupting the mucosal epithelial barrier. Bacterial vaginosis and sexually transmitted infections (STIs), which are predominantly asymptomatic in women, cause lower genital tract inflammation and increased HIV acquisition risk. In Africa, where syndromic management of STIs and bacterial vaginosis is standard-of-care, the substantial burden of asymptomatic infections has likely contributed to high-HIV incidence rates.
SUMMARY
A genital inflammatory profile contributes to the high risk of HIV acquisition in African women. STIs and bacterial vaginosis are poorly managed in Africa and other developing nations and as such remain major drivers of persistent genital inflammation and HIV acquisition among these women.
Topics: Africa South of the Sahara; Cytokines; Female; HIV Infections; HIV-1; Humans; Inflammation; Lymphocyte Activation; T-Lymphocytes; Vagina
PubMed: 26628324
DOI: 10.1097/COH.0000000000000232