Search Results (142)

The equine respiratory and reproductive tract microbiomes are complex and subject to constant fluctuations. Among the microbial inhabitants, Streptococcus equi subsp. zooepidemicus (SEZ) is recognized as the dominant bacterium. It is an opportunistic pathogen that may occasionally lead to various types of infections. A key virulence factor of SEZ is the streptolysin S (SLS) toxin, which is responsible for the characteristic β-hemolysis on blood agar and tissue damage. Viruses and bacteria may interact and aggravate lesions and disease. This study aimed to evaluate the impact of an SLS-containing supernatant from SEZ on the nasal and vaginal mucosa and the subsequent replication of equine herpesviruses. The SLS-containing supernatant was prepared, and three 10-fold dilutions (optical density “OD” 10⁻², 10⁻³, 10⁻⁴) were applied to equine nasal and vaginal explants. Untreated and EGTA-treated explants served as controls. Epithelial integrity was assessed by measuring the thickness and intercellular spaces. Nasal explants were inoculated with EHV-1 and EHV-4, while vaginal explants received EHV-1 and EHV-3. Viral replication was estimated via immunofluorescence staining and confocal microscopy. SLS-containing supernatants 10⁻² and 10⁻³ compromised epithelial integrity. Viral replication increased in explants treated with SLS 10⁻³, demonstrating SLS’s damaging effects on the epithelium, facilitating equine herpesvirus replication. Full article

Background/Objectives: Pelvic exenteration (PE) might be a curative option for patients with advanced pelvic malignancies. Due to its significant morbidity and mortality rates, PE necessitates meticulous patient selection, and a comprehensive understanding of disease spread. This study outlines the experience at a single tertiary referral center and investigates prognostic factors influencing survival post-PE, thereby guiding clinical decision-making processes. Methods: Patients undergoing PE for advanced pelvic gynecological malignancies between 01/2016 and 12/2023 were retrospectively analyzed using a prospectively managed database. Eligibility for PE was determined through individualized tumor board evaluations based on CT/MRI imaging, excluding patients with distant metastases. Baseline demographic and clinical characteristics, operative details, complication rates, and histopathological findings were assessed using univariate and multivariate regression analyses. Disease-free (DFS) and overall survival (OS) were assessed by Kaplan-Meier analysis. Poor outcome prognostic factors were identified, outlining an optimal candidate profile for PE. Results: A total of 70 patients were included. The median age was 54.5 years. Forty-three patients (61.4%) presented with recurrent disease and the majority were diagnosed with cervical cancer (n = 48, 68.6%). Total PE was performed in 40 patients (57.1%), with complete tumor resection achieved in 68.6% of patients (n = 48). Sixteen patients (22.8%) experienced grade IV/V complications. Median DFS and OS were 8.2 and 16.4 months, respectively. Multivariate analysis identified R1 resection status and para-aortic lymph node involvement as independent negative prognostic factors. Conclusions: PE is a viable option for selected patients with advanced primary and recurrent pelvic gynecological malignancies. When complete tumor resection is feasible, patients may derive benefit from PE, although the risk of severe perioperative complications must be carefully evaluated. Full article

Background: Total laparoscopic hysterectomy (TLH) is widely accepted as the preferred minimally invasive technique for the treatment of benign gynecologic conditions. However, significant heterogeneity persists in the literature regarding the operative sequence, particularly for steps such as uterine artery ligation, ureteral identification, and vaginal cuff closure. This lack of standardization may affect complication rates, reproducibility in surgical training, and procedural efficiency. The objective of this study was to develop and evaluate a standardized, anatomically justified surgical protocol for TLH primarily designed for training purposes but applicable to most clinical cases. Methods: This retrospective observational study analyzed 109 patients who underwent TLH between January 2016 and July 2020 at a single tertiary care center. A fixed sequence of surgical steps was applied in all cases, emphasizing early uterine artery ligation at its origin, broad ligament fenestration above the ureter, and laparoscopic figure-of-eight vaginal cuff closure. Patient demographics, operative data, and perioperative outcomes were extracted and analyzed. Results: The mean operative time was 67.2 ± 18.4 min, and the mean uterine weight was 211.9 ± 95.3 g. Intraoperative complications were observed in 3.7% of cases and included bladder injury in 1.8% and small bowel injury in 1.8%, all of which were managed laparoscopically without conversion. Vaginal cuff dehiscence occurred in 1.8%, and postoperative vaginal bleeding in 3.7% of patients. One patient (0.9%) required reoperation due to a vaginal cuff hematoma/abscess. No postoperative infections requiring intervention were reported. The mean hemoglobin drop on the first postoperative day was 1.2 ± 0.9 g/dL. Conclusions: Our findings support the feasibility, reproducibility, and safety of a structured TLH protocol based on anatomical landmarks and early vascular control. Widespread adoption of similar protocols may improve consistency and training, with broad applicability in routine surgical practice and potential adaptation in severely complex cases; however, further validation in multicenter studies is warranted. Full article

Histopathological images represent a valuable data source for pathologists, who can provide clinicians with essential landmarks for complex pathologies. The development of sophisticated computational models for histopathological images has received significant attention in recent years, but most of them rely on free datasets. Materials and Methods: Motivated by this drawback, the authors created an original histopathological image dataset that resulted from an animal experimental model, acquiring images from normal female rats/rats with experimentally induced diabetes mellitus (DM)/rats who received an antidiabetic therapy with a synthetic compound (AD_SC). Images were acquired from vaginal, uterine, and ovarian samples from both MD and AD_DC specimens. The experiment received the approval of the Medical Ethics Committee of the “Gr. T. Popa” University of Medicine and Pharmacy, Iași, Romania (Approval No. 169/22.03.2022). The novelty of the study consists of the following aspects. The first is the use of a diabetes-induced animal model to evaluate the impact of an antidiabetic therapy with a synthetic compound in female rats, focusing on three distinct organs of the reproductive system (vagina, ovary, and uterus), to provide a more comprehensive understanding of how diabetes affects female reproductive health as a whole. The second comprises image classification with a custom-built convolutional neural network (CB-CNN), the extraction of textural features (contrast, entropy, energy, and homogeneity), and their classification with PyCaret Auto Machine Learning (AutoML). Results: Experimental findings indicate that uterine tissue, both for MD and AD_DC, can be diagnosed with an accuracy of 94.5% and 85.8%, respectively. The Linear Discriminant Analysis (LDA) classifier features indicate a high accuracy of 86.3% when supplied with features extracted from vaginal tissue. Conclusions: Our research underscores the efficacy of classifying with two AI algorithms, CNN and machine learning. Full article

The use of post-operative drainage has been a topic of debate for several years. While the trend has increasingly shifted toward avoiding routine drainage, opinions on its necessity remain divided. The main objective of this comprehensive review is to effectively summarize and present the current knowledge and up-to-date evidence on the role of prophylactic drainage in women undergoing obstetric, oncological, or other types of gynecological surgical procedures in terms of the indications, post-operative surgical infections, morbidity recovery, post-operative complications and outcomes. Prophylactic drainage does not seem to decrease morbidity in cases of lymphadenectomy and radical hysterectomy. Debulking surgery does not necessitate prophylactic drainage in the majority of cases; however, its usage should be individualized based on the surgical complexity. Conflicting evidence exists regarding drains’ effectiveness in preventing anastomotic leakage, with high rates of re-operation and abscess formation noted. Despite the fact that vaginal drains may help with hematoma and infectious morbidity, the overall benefit of vaginal and peritoneal drains in preventing post-operative morbidity is questionable. Finally, negative pressure wound therapy may reduce surgical site infection rates in patients undergoing cytoreductive surgery for ovarian cancer. Although there is still a great need for further investigation, the topic has been covered adequately by many prospective trials and the international guidelines have provided clear suggestions to guide physicians in clinical practice. However, need for individualization and personalized strategies is well emphasized by the published evidence in an effort to balance the benefits and risks of drainage usage determined by the type of surgery and patient status. Full article

Background/Objective: Recently, we published three studies describing the development and optimization of a new, safe, and efficacious vaccine to protect sheep from ovine enzootic abortion, which is caused by the zoonotic pathogen Chlamydia abortus. The vaccine, which can be delivered through a single inoculation, is based on a detergent-extracted outer membrane protein (chlamydial outer membrane complex or COMC) preparation of the pathogen. This study aimed to optimize the vaccine further by comparing the effects of different adjuvants on protective efficacy. Methods: We evaluated the effectiveness of three different vaccines (2.5 µg COMC) formulated with one of three adjuvants (Montanide ISA 70VG, Montanide ISA 61VG, and QuilA) to reduce the rate of abortion, placental load and pathology, and post-partum vaginal shedding of organisms in comparison to our benchmark 20 µg COMC/Montanide ISA 70 VG vaccine and a challenge control group of animals. The humoral and cellular immunological responses to vaccination and to challenge were also assessed. Results: The two low-dose Montanide formulated vaccines resulted in low abortion rates of 3.2 and 8.1% for ISA 70 VG and ISA 61 VG, respectively, which were comparable to the benchmark vaccine group (2.7%) and considerably lower than the QuilA (23.7%) and challenge control (36.8%) groups. Similarly, the Montanide-adjuvanted groups had much lower bacterial loads (range: 136–431 genome copies) on vaginal swabs post-parturition than the QuilA (8.9 × 10⁴ copies) and challenge control (2.4 × 10⁵ copies) groups. Conclusions: The results showed that both Montanide adjuvants are more effective for maximizing COMC vaccine efficacy than the QuilA adjuvant and result in much lower bacterial shedding of the pathogen post-parturition, which is important for minimizing potential transmission to naïve animals. Full article

The pathogenesis of obesity is complex and incompletely understood, with an underlying interplay between our genetic architecture and obesogenic environment. The public understanding of the development of obesity is shrouded in myths with widespread societal misconceptions. Body Mass Index (BMI) is a highly heritable trait. However, despite reports from recent genome-wide association studies, only a small proportion of the overall heritability of BMI is known to be lurking within the human genome. Other non-genetic heritable traits may contribute to BMI. The gut microbiome is an excellent candidate, implicating complex interlinks with hypothalamic control of appetite and metabolism via entero-endocrine, autonomic, and neuro-humeral pathways. The neonatal gut microbiome derived from the mother via transgenerational transmission (vaginal delivery and breastfeeding) tends to have a permanence within the gut. Conversely, non-maternally derived gut microbiota manifest mutability that responds to changes in lifestyle and diet. We should all strive to optimize our lifestyles and ensure a diet that is replete with varied and unprocessed plant-based foods to establish and nurture a healthy gut microbiome. Women of reproductive age should optimize their gut microbiome, particularly pre-conception, ante- and postnatally to enable the establishment of a healthy neonatal gut microbiome in their offspring. Finally, we should redouble our efforts to educate the populace on the pathogenesis of obesity, and the role of heritable (but modifiable) factors such as the gut microbiome. Such renewed understanding and insights would help to promote the widespread adoption of healthy lifestyles and diets, and facilitate a transition from our current dispassionate and stigmatized societal approach towards people living with obesity towards one that is epitomized by understanding, support, and compassion. Full article

Cesarean sections (CSs) are essential in certain medical contexts but, when overused, can carry risks for both the mother and child. In the unique multilingual landscape of Luxembourg, this study explores whether non-medical factors—such as the language spoken—affect CS rates. Through a survey conducted with women in Luxembourg, we first applied statistical methods to investigate the influence of various social and linguistic parameters on CS. Additionally, we explored how these factors relate to the feelings of happiness and respect women experience during childbirth. Subsequently, we employed four machine learning models to predict CS based on the survey data. Our findings reveal that women who speak Spanish have a statistically higher likelihood of undergoing a CS than women that do not report speaking that language. Furthermore, those who had CS report feeling less happy and respected compared to those with vaginal births. With both limited and augmented data, our models achieve an average accuracy of approximately 81% in predicting CS. While this study serves as an initial exploration into the social aspects of childbirth, it underscores the need for larger-scale studies to deepen our understanding and to inform policy-makers and health practitioners that support women during their pregnancies and births. This preliminary research advocates for further investigation to address this complex social issue comprehensively. Full article

Little is known about the complex events driving host–pathogen and pathogen–pathogen interplay in polymicrobial infections. Using an in vitro model of a reconstituted vaginal epithelium (RVE) employing the A-431 cell line supplemented with synthetic vaginal fluid (SVF), we studied the consequences of single versus dual infections with Candida albicans and/or Herpes Simplex Virus-2 (HSV-2). Our data show (a) a relevant, SVF-enhanced expression of the differentiation marker cytokeratin 5/6 in the RVE; (b) the ability of Candida albicans to enhance HSV-2 in the dual infection model, with the virus titer almost doubling in the presence of SVF; (c) RVE damage (>20%), mostly attributable to Candida albicans and related to oxidative stress whether SVF is present; (d) the dysregulation of mucin-1, the production of which is enhanced (from 13 to 21 ng/mL) or impaired (from 21 to 10 ng/mL) in response to either SVF or infection, respectively; and (e) a partial-to-negligible cytokine response from the RVE, depending upon SVF presence. In conclusion, using an in vitro RVE model upgraded through the addition of synthetic vaginal fluid, we provide details on epithelial cell–pathogen–pathogen interaction, contributing to a better comprehension of the pathogenesis of polymicrobial infections at a mucosal level. Full article

Objectives: To explore the feasibility and surgical outcomes of robot-assisted vaginal natural orifice transluminal endoscopic surgery (RA-vNOTES) for women suffering from gynecologic disease. Methods: We performed an observational study reporting and analyzing the perioperative outcomes of 298 patients with gynecologic disease who underwent RA-vNOTES in a single institution from June 2019 to August 2024. Results: A total of 298 patients with a median age of 41 years and median body mass index of 29 kg/m² underwent RA-vNOTES. The primary indications for surgery were endometriosis (43.62%), chronic pelvic pain (11.07%), abnormal uterine bleeding (20.81%), and uterine leiomyomata (14.77%). A total of 286 of 298 (95.97%) patients had a hysterectomy. The median total operating time was 138 min, with a port placement time of 5 min, dock time of 3 min, and robot console time of 63 min. The median estimated blood loss was 50 milliliters. Endometriosis resection of all stages was performed in 192 of 298 (64.43%) patients. Three cases (1.01%) were converted to laparoscopic surgery. One case was converted to robot-assisted single incision plus one port laparoscopic surgery (SILS plus one) and two cases were converted to robot-assisted multi-port surgery. The total complication rate was 17.45% (52 cases), of which 2.1% (6 cases) were intraoperative complications and 15.44% (46 cases) were postoperative complications. Conclusions: Our findings indicate that RA-vNOTES is a feasible and less invasive option for various gynecologic procedures, including complex endometriosis excision and sacrocolpopexy. Full article

Complex biological features such as the human microbiome and gene expressions play a crucial role in human health by mediating various biomedical processes that influence disease progression, such as immune responses and metabolic processes. Understanding these mediation roles is essential for gaining insights into disease pathogenesis and improving treatment outcomes. However, analyzing such high-dimensional mediation features presents challenges due to their inherent structural and correlations, such as the hierarchical taxonomic structures in microbial operational taxonomic units (OTUs), gene–pathway relationships, and the high dimensionality of the datasets, which complicates mediation analysis. We propose the Med-CNN model, an iterative approach using Convolutional Neural Networks (CNNs) to incorporate the complex biological network of the mediation features. The output values from network-specific CNN models are condensed into an integrative mediation metric (IMM), which captures essential biological information for estimating mediation effects. Our approach is designed to handle high-dimensional data and accommodate their unique structures and non-linear interactive mediation effects. Through comprehensive simulation studies, we evaluated the performance of our algorithm across different scenarios, including various mediation effects, effect sizes, and sample sizes, and we compared it to conventional methods. Our simulations demonstrated consistently lower biases in mediation effect estimates, with values ranging from 0.17 to 0.56, which were lower than other established methods ranging from 0.24 to 13.27. In a real data application, our method identified a mediation effect of 0.06 between ethnicity and vaginal pH levels. Full article

Many antifungal agents, including isoconazole nitrate (ISN), suffer from low aqueous solubility and inconsistent dissolution kinetics, which limit their therapeutic potential. To address these challenges, this study aimed to enhance the solubility and stability of ISN through the development of inclusion complexes with hydroxypropyl-β-cyclodextrin (HP-β-CD). HP-β-CD inclusion complexes were prepared using a spray-drying technique and characterized through phase-solubility studies, scanning electron microscopy (SEM), Fourier transform infrared spectroscopy (FT-IR), proton nuclear magnetic resonance (¹H-NMR), and differential scanning calorimetry (DSC). The inclusion complex significantly improved ISN solubility, increasing from 0.5088 mg/mL to 3.6550 mg/mL. These complexes were incorporated into a thermosensitive, mucoadhesive in situ gel system using Pluronic^® F127 and hydroxypropyl methylcellulose (HPMC) to optimize vaginal drug delivery. The formulations were evaluated for gelation temperature, viscosity, swelling behavior, and pH, confirming their suitability for vaginal application. Antimicrobial studies demonstrated that the ISN/HP-β-CD gels exhibited superior activity against Candida albicans, C. glabrata, and C. krusei compared to ISN alone. In vitro release studies further revealed sustained drug release following Peppas-Sahlin kinetics, supporting enhanced bioavailability and prolonged therapeutic action. This study demonstrates that the ISN/HP-β-CD-loaded in situ gel system offers a promising and effective approach for improving the solubility, stability, and antifungal efficacy of ISN for the treatment of vaginal infections. Full article

Pelvic organ prolapse (POP) is a prevalent condition characterized by the descent of one or more pelvic organs, such as the bladder, uterus, or rectum, into the vaginal canal due to weakened pelvic floor support. This comprehensive review elucidates the multifactorial etiology of POP, which includes genetic predisposition, hormonal changes, obstetric factors, lifestyle influences, and age-related pelvic floor decline. Epidemiological data underscore its rising prevalence, particularly among older women, highlighting disparities across populations and risk factors such as parity and socioeconomic status. POP frequently coexists with significant comorbidities like urinary incontinence, sexual dysfunction, and pelvic pain, which exacerbate its impact on quality of life. Accurate evaluation through patient history, physical examinations, and imaging modalities like ultrasound and MRI is critical for diagnosis and management. The review emphasizes advancements in POP evaluation methods, including the POP-Q system, and explores the interplay of anatomical, functional, and psychosocial factors affecting patient outcomes. Key findings reveal that a tailored and holistic approach to treatment, addressing both anatomical correction and associated symptoms, significantly improves patient outcomes. Surgical interventions can alleviate related comorbidities, including urinary and bowel dysfunctions, as well as enhance body image and sexual function. However, the long-term success of such treatments necessitates continued research into preventive strategies and innovative therapeutic approaches. In conclusion, understanding the complexities of POP’s etiology, epidemiology, and management is vital for mitigating its burden and improving the health and well-being of affected individuals. This review highlights the need for integrated care strategies and further studies to advance diagnostic and therapeutic paradigms. Full article

Body image, a complex interplay of perceptions, thoughts, and feelings about one’s physical appearance, has been a subject of extensive research. It is a dynamic construct that evolves throughout a woman’s lifespan, influenced by a multitude of biological, psychological, and sociocultural factors. From adolescence, marked by the onset of puberty and societal pressures to conform to specific beauty standards, to adulthood and the physical changes associated with aging, women’s body image undergoes significant transformations. Aging is a universal process that affects all organs, including the female genitalia. The vaginal tract undergoes significant atrophy due to declining estrogen levels, particularly during and after menopause. Aesthetic gynecology offers a range of procedures to address both functional and aesthetic concerns related to aging genitalia. Aesthetic gynecology, a burgeoning field within women’s health, provides various procedures aimed at enhancing genital appearance and function. It also helps balance the hormonal and anatomical changes that every woman experiences over time. The goal is to strengthen each patient’s intimate well-being and self-esteem, enabling them to experience intimacy peacefully. While often driven by concerns about physical attractiveness and sexual satisfaction, the psychological implications of these procedures are complex and multifaceted. It is crucial to recognize the interplay between psychological factors and the decision to undergo these procedures. Collaboration between surgeons and mental health professionals can ensure that candidates are psychologically prepared and have realistic expectations. By adopting a patient-centered approach and conducting rigorous research, healthcare providers can ensure that aesthetic gynecology is used as a tool for empowerment rather than exploitation. This article explores the intricate relationship between psychological well-being and aesthetic gynecology, examining how these procedures can impact body image, self-esteem, and overall quality of life. Full article

Background: O₃-O₂ therapy is an alternative medical treatment that introduces a mixture of O₃-O₂ into the body for therapeutic purposes. The objective of this study is to evaluate its margins of applicability in the eradication of HPV infection from the lower gynecological tract by means of vaginal insufflation. Methods: An in-depth review of the international literature on this topic is carried out; in addition, O₃-O₂ therapy is compared with other treatments currently available in terms of its advantages, disadvantages, and exploited technologies. Results: The possible benefits and limitations of O₃-O₂ vaginal insufflation are explained in detail; overall, it appears to be an interesting tool as part of complex management to prevent HPV-related cancers of the lower gynecological tract in infected patients. Conclusions: The rationale and guidelines of this innovative procedure have been successfully illustrated, providing the technical specifications for further developments. Full article