INTRODUCTION: Pre-eclampsia affects ~5%-7% of pregnancies. Although improved obstetric care has significantly diminished its associated maternal mortality, it remains a leading cause of maternal morbidity and mortality in the world. Term pre-eclampsia accounts for 70% of all cases and a large proportion of maternal-fetal morbidity related to this condition. Unlike in preterm pre-eclampsia, the prediction and prevention of term pre-eclampsia remain unsolved. Previously proposed approaches are based on combined third-trimester screening and/or prophylactic drugs, but these policies are unlikely to be widely implementable in many world settings. Recent evidence shows that the soluble fms-like tyrosine kinase-1 (s-Flt-1) to placental growth factor (PlGF) ratio measured at 35-37 weeks' gestation predicts term pre-eclampsia with an 80% detection rate. Likewise, recent studies demonstrate that induction of labour beyond 37 weeks is safe and well accepted by women. We hypothesise that a single-step universal screening for term pre-eclampsia based on sFlt1/PlGF ratio at 35-37 weeks followed by planned delivery beyond 37 weeks reduces the prevalence of term pre-eclampsia without increasing the caesarean section rates or worsening the neonatal outcomes. METHODS AND ANALYSIS: We propose an open-label randomised clinical trial to evaluate the impact of a screening of term pre-eclampsia with the sFlt-1/PlGF ratio followed by planned delivery in asymptomatic nulliparous women at 35-37 weeks. Women will be assigned 1:1 to revealed (sFlt-1/PlGF known to clinicians) versus concealed (unknown) arms. A cut-off of >90th centile is used to define the high risk of subsequent pre-eclampsia and offer planned delivery from 37 weeks. The efficacy variables will be analysed and compared between groups primarily following an intention-to-treat approach, by ORs and their 95% CI. This value will be computed using a Generalised Linear Mixed Model for binary response (study group as fixed effect and the centre as intercept random effect). ETHICS AND DISSEMINATION: The study is conducted under the principles of Good Clinical Practice. This study was accepted by the Clinical Research Ethics Committee of Hospital Clinic Barcelona on 20 November 2020. Subsequent approval by individual ethical committees and competent authorities was granted. The study results will be published in peer-reviewed journals and disseminated at international conferences. TRIAL REGISTRATION NUMBER: NCT04766866.
- MeSH
- biologické markery MeSH
- císařský řez MeSH
- lidé MeSH
- multicentrické studie jako téma MeSH
- novorozenec MeSH
- placentární růstový faktor MeSH
- prediktivní hodnota testů MeSH
- preeklampsie * diagnóza prevence a kontrola epidemiologie MeSH
- randomizované kontrolované studie jako téma MeSH
- receptor 1 pro vaskulární endoteliální růstový faktor MeSH
- těhotenství MeSH
- Check Tag
- lidé MeSH
- novorozenec MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- protokol klinické studie MeSH
Vaginal birth causes pelvic floor injury which may lead to urinary incontinence. Cell therapy has been proposed to assist in functional recovery. We aim to assess if intra-arterial injection of rat mesoangioblasts (MABs) and stable Vascular Endothelial Growth Factor (VEGF)-expressing MABs, improve recovery of urethral and vaginal function following simulated vaginal delivery (SVD). Female rats (n = 86) were assigned to either injection of saline (control), allogeneic-MABs (MABsallo), autologous-MABs (MABsauto) or allogeneic-MABs transduced to stably expressed VEGF (MABsallo-VEGF). One hour after SVD, 0.5 × 106 MABs or saline were injected into the aorta. Primary outcome was urethral (7d and 14d) and vaginal (14d) function; others were bioluminescent imaging for cell tracking (1, 3 and 7d), morphometry (7, 14 and 60d) and mRNAseq (3 and 7d). All MABs injected rats had external urethral sphincter and vaginal function recovery within 14d, as compared to only half of saline controls. Functional recovery was paralleled by improved muscle regeneration and microvascularization. Recovery rate was not different between MABsallo and MABsauto. MABsallo-VEGF accelerated functional recovery and increased GAP-43 expression at 7d. At 3d we detected major transcriptional changes in the urethra of both MABsallo and MABsallo-VEGF-injected animals, with upregulation of Rho/GTPase activity, epigenetic factors and dendrite development. MABSallo also upregulated transcripts that encode proteins involved in myogenesis and downregulated pro-inflammatory processes. MABsallo-VEGF also upregulated transcripts that encode proteins involved in neuron development and downregulated genes involved in hypoxia and oxidative stress. At 7d, urethras of MABsallo-VEGF-injected rats showed downregulation of oxidative and inflammatory response compared to MABSallo. Intra-arterial injection of MABsallo-VEGF enhances neuromuscular regeneration induced by untransduced MABs and accelerates the functional urethral and vaginal recovery after SVD.
- MeSH
- krysa rodu rattus MeSH
- modely nemocí na zvířatech MeSH
- porod MeSH
- potkani Sprague-Dawley MeSH
- stresová inkontinence moči * MeSH
- těhotenství MeSH
- uretra * MeSH
- vaskulární endoteliální růstový faktor A genetika metabolismus MeSH
- zvířata MeSH
- Check Tag
- krysa rodu rattus MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
OBJECTIVE: To evaluate the effect of iatrogenic menopause on the physiology of the vagina of the ewe and to evaluate if vaginal changes in ewes can be translated to women with genitourinary syndrome of menopause (GSM). METHODS: Preclinical research with Dohne Merino ewes. Iatrogenic menopause was induced by bilateral ovariectomy (OVX). Animals were randomized for surgery, blinded for allocation and outcome assessment. Differences between groups were determined by linear regression analyses at 5 months after OVX. Outcome measures were vaginal epithelial thickness, pH, vaginal maturation value, vaginal maturation index, epithelial glycogen accumulation, content of elastin fibers, collagen, and vascularity. RESULTS: OVX ewes (n = 20) showed epithelial thinning of the vaginal wall from 146 μm to 47 μm (mean, P < 0.001). Furthermore, epithelial glycogen accumulation and vascularity of the vaginal wall significantly decreased (43% and 23%, respectively) as compared with the control group (no intervention; n = 5). No significant differences were found for other outcome measures. CONCLUSION: This study established the ewe as a suitable large animal model for GSM. Furthermore, the similar relevant outcomes in humans and ewes hold great value for future translational research for the evaluation and optimization of different treatment modalities for GSM.
- MeSH
- glykogen MeSH
- iatrogenní nemoci MeSH
- lidé MeSH
- menopauza * MeSH
- modely u zvířat MeSH
- ovarektomie škodlivé účinky MeSH
- ovce MeSH
- vagina * chirurgie MeSH
- zvířata MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
OBJECTIVE: Focal cortical dysplasia (FCD) is the most common malformation causing refractory focal epilepsy. Surgical removal of the entire dysplastic cortex is crucial for achieving a seizure-free outcome. Precise presurgical distinctions between FCD types by neuroimaging are difficult, mainly in patients with normal magnetic resonance imaging findings. However, the FCD type is important for planning the extent of surgical approach and counselling. METHODS: This study included patients with focal drug-resistant epilepsy and definite histopathological FCD type I or II diagnoses who underwent intracranial electroencephalography (iEEG). We detected interictal epileptiform discharges (IEDs) and their recruitment into repetitive discharges (RDs) to compare electrophysiological patterns characterizing FCD types. RESULTS: Patients with FCD type II had a significantly higher IED rate (p < 0.005), a shorter inter-discharge interval within RD episodes (p < 0.003), sleep influence on decreased RD periodicity (p < 0.036), and longer RD episode duration (p < 0.003) than patients with type I. A Bayesian classifier stratified FCD types with 82% accuracy. CONCLUSION: Temporal characteristics of IEDs and RDs reflect the histological findings of FCD subtypes and can differentiate FCD types I and II. SIGNIFICANCE: Presurgical prediction of FCD type can help to plan a more tailored surgical approach in patients with normal magnetic resonance findings.
- MeSH
- Bayesova věta MeSH
- elektroencefalografie škodlivé účinky MeSH
- elektrokortikografie škodlivé účinky MeSH
- epilepsie * chirurgie MeSH
- fokální kortikální dysplazie * MeSH
- lidé MeSH
- magnetická rezonanční tomografie MeSH
- malformace mozkové kůry * diagnostické zobrazování chirurgie komplikace MeSH
- refrakterní epilepsie * diagnostické zobrazování chirurgie etiologie MeSH
- retrospektivní studie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
V našem přehledovém článku jsme se zaměřili na raritní téma endometriózy v postmenopauze. Endometrióza je především onemocněním žen v reprodukčním věku. V postmenopauze většinou dochází k atrofizaci ložisek endometriózy. Ovšem byla popsána i rekurence nebo dokonce de novo výskyt endometriózy v postmenopauze. Prevalence v postmenopauze se uvádí okolo 2–5 %. Faktory, které mohou stát za rekurencí endometriózy, jsou exogenně podávané estrogeny, vlastní produkce estrogenů v periferní tukové tkáni nebo aktivace aromatázy v ložisku endometriózy. Při nutnosti hormonální terapie dosahuje nejlepších výsledků podávání Tibolonu. Rizikovými faktory rekurence a následných obtíží jsou rozsah endometriózy, ponechaná děloha a adnexa. Nejčastějším symptomem byla bolest ve 43,5 % a ve 28 % palpační nález. Endometriotické buňky jsou schopné proliferace, schopné přežití v ektopické lokalizaci a metastazování do vzdálených lokalizací. Riziko maligní transformace se pohybuje okolo 1 % a nejčastěji se jedná o ovariální nádory. S endometriózou asociované ovariální nádory jsou typicky low grade onemocněním, histologicky se jedná o endometrioidní nebo clear cell karcinomy. Diagnostika je založena na ultrazvuku a magnetické rezonanci. Základem terapie u nově vzniklé endometriózy nebo při objevení se symptomů spojených s rizikem endometriózy je operační řešení, především k vyloučení nádorového procesu.
In our review article, we focused on the rare topic of endometriosis in postmenopause. Endometriosis is primarily a disease of women of reproductive age. In postmenopause, atrophy of endometriosis foci usually occurs. However, recurrence or even de novo occurrence of endometriosis in postmenopause has also been described. The prevalence in postmenopause has been reported to be around 2–5%. Factors that may account for the recurrence of endometriosis are exogenously administered estrogens, self-production of estrogens in peripheral adipose tissue, or activation of aromatase in the focus of endometriosis. When hormonal therapy is required, the best results are achieved by administration of Tibolone. Risk factors for recurrence and subsequent difficulties are the extent of endometriosis, the retained uterus and adnexa. Pain was the most common symptom in 43.5% and palpable finding in 28%. Endometriotic cells are capable of proliferation, survival in an ectopic localization and metastasis to distant locations. The risk of malignant transformation is around 1% and the most common are ovarian tumors. Endometriosis-associated ovarian tumors are typically low-grade disease, histologically endometrioid or clear cell carcinomas. Diagnosis is based on ultrasound and magnetic resonance imaging. The basis of therapy for newly developed endometriosis or when symptoms associated with the risk of endometriosis appear is a surgical solution, primarily to exclude the cancerous process.
- MeSH
- bolest MeSH
- endometrióza * komplikace patologie MeSH
- estrogeny MeSH
- hormonální substituční terapie MeSH
- lidé MeSH
- nádory vaječníků etiologie patologie MeSH
- postmenopauza MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- přehledy MeSH
Úvod: S rostoucím počtem císařských řezů roste i počet gravidit v jizvě po císařském řezu (CSP – cesarean scar pregnancy). Jedná se o relativně novou jednotku mimoděložní gravidity, která je riziková především pro možnou souvislost s placenta accreta spektrem. Předpokládá se, že CSP reprezentuje asi 6 % z celkového počtu ektopických gravidit u všech žen, které mají alespoň jeden císařský řez v anamnéze. Incidence CSP se odhaduje okolo 1/1 688 všech těhotenství a přibližně 1/2 000 všech císařských řezů. Materiál a metodika: Retrospektivní analýza jednotlivých případů gravidit v jizvě po císařském řezu, které jsme řešili v našem zdravotnickém zařízení v letech 2012-2021. Výsledky: Celkově jsme řešili 16 případů gravidity v jizvě po císařském řezu u 15 žen. U jedné ženy jsme CSP zaznamenali 2krát. Věkový průměr žen byl 36,6 let (27-41). Průměr císařských řezů v anamnéze byl 1,6 (1-3) a týden gestace 7 (4-10). Doba od císařského řezu byla v průměru 3,6 let (2-11). Řešením bylo jednou podání metotrexátu, jednou hysteroskopická resekce, 11krát primárně pouze vakuumaspirace, kdy ve dvou případech jsme museli pro pooperační krvácení připojit laparoskopickou ligaturu uterinních arterií. Dvakrát jsme prováděli primárně ligaturu uterinních arterií před provedením vakuumaspirace. U gravidit nad 10. týden těhotenství jsme zaznamenali více krvácivých komplikací s nutností operačního řešení. Krvácivé komplikace také souvisely s přítomností akce srdeční u plodů. Závěr: V řešení CSP je nezbytná časná správná diagnostika. Gravidity do 10. týdne gestace řešíme pomocí prosté vakuumaspirace pod ultrazvukovou kontrolou. Pokud se jedná o graviditu nad 10. týden gestace a obzvláště s akcí srdeční, doplňujeme před vakuumaspirací laparoskopickou ligaturu uterinních arterií. Všem pacientkám následně doporučuje laparoskopickou resuturu dolního děložního segmentu.
Introduction: With the increasing number of caesarean sections, the number of cesarean scar pregnancies (CSP) is also increasing. This is a relatively new entity of an ectopic pregnancy, which is risky mainly because of its possible association with placenta accreta spectrum. CSP is thought to represent about 6% of the total number of ectopic pregnancies in all women who have a history of at least one caesarean section. The estimated incidence of CSP is about 1/1,688 of all pregnancies and about 1/2,000 of all caesarean sections. Material and methods: Retrospective analysis of individual cases of cesarean scar pregnancies managed in our health care facility in the years 2012–2021. Results: In total, we managed 16 cases of pregnancy in the caesarean scar in 15 women. In one woman, we recorded CSP twice. The mean age of the women was 36.6 years (27–41). The mean number of caesarean sections was 1.6 (1–3) and gestational week was 7 (4–10). The average time since the caesarean section was 3.6 years (2–11). The management was methotrexate administration once, hysteroscopic resection once and 11times primarily vacuum aspiration only, when in two cases we had to attach laparoscopic uterine artery ligation due to postoperative bleeding. We performed primary ligature of uterine arteries twice before performing vacuum aspiration. In pregnancies above 10 weeks of gestation, we observed more bleeding complications requiring surgical management. Bleeding complications were also related to the presence of fetal cardiac action. Conclusion: Early correct diagnosis is essential in the management of CSP. Pregnancies up to the 10th week of gestation are managed by simple vacuum aspirations under ultrasound guidance. If the pregnancy is over the 10th week of gestation and especially with cardiac activity, we add laparoscopic uterine artery ligation before vacuum aspiration. All patients are subsequently advised to undergo laparoscopic resuturing of the lower uterine segment.
- Klíčová slova
- gravidita v jizvě po císařském řezu,
- MeSH
- arteria uterina chirurgie MeSH
- císařský řez škodlivé účinky MeSH
- jizva komplikace MeSH
- komplikace těhotenství * MeSH
- lidé MeSH
- ligace metody MeSH
- methotrexát terapeutické užití MeSH
- mimoděložní těhotenství * chirurgie etiologie MeSH
- retrospektivní studie MeSH
- těhotenství MeSH
- ultrasonografie MeSH
- vakuová extrakce porodnická MeSH
- vakuová kyretáž MeSH
- Check Tag
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Klíčová slova
- Foleyův katétr,
- MeSH
- alprostadil analogy a deriváty terapeutické užití MeSH
- analýza dat MeSH
- dinoproston analogy a deriváty terapeutické užití MeSH
- dospělí MeSH
- indukovaný porod * metody přístrojové vybavení MeSH
- katétry klasifikace MeSH
- lidé MeSH
- porod účinky léků MeSH
- prostaglandiny aplikace a dávkování farmakologie klasifikace terapeutické užití MeSH
- těhotné ženy MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- randomizované kontrolované studie MeSH
INTRODUCTION AND HYPOTHESIS: We aimed to summarize the knowledge on the pathogenesis of pelvic organ prolapse (POP) generated in animal models. METHODS: We searched MEDLINE, Embase, Cochrane and the Web of Science to establish what animal models are used in the study of suggested risk factors for the development of POP, including pregnancy, labor, delivery, parity, aging and menopause. Lack of methodologic uniformity precluded meta-analysis; hence, results are presented as a narrative review. RESULTS: A total of 7426 studies were identified, of which 51 were included in the analysis. Pregnancy has a measurable and consistent effect across species. In rats, simulated vaginal delivery induces structural changes in the pelvic floor, without complete recovery of the vaginal muscular layer and its microvasculature, though it does not induce POP. In sheep, first vaginal delivery has a measurable effect on vaginal compliance; measured effects of additional deliveries are inconsistent. Squirrel monkeys can develop POP. Denervation of their levator ani muscle facilitates this process in animals that delivered vaginally. The models used do not develop spontaneous menopause, so it is induced by ovariectomy. Effects of menopause depend on the age at ovariectomy and the interval to measurement. In several species menopause is associated with an increase in collagen content in the longer term. In rodents there were no measurable effects of age apart of elastin changes. We found no usable data for other species. CONCLUSION: In several species there are measurable effects of pregnancy, delivery and iatrogenic menopause. Squirrel monkeys can develop spontaneous prolapse.
- MeSH
- krysa rodu rattus MeSH
- modely u zvířat MeSH
- ovce MeSH
- pánevní dno MeSH
- parita MeSH
- prolaps pánevních orgánů * MeSH
- těhotenství MeSH
- vedení porodu MeSH
- zvířata MeSH
- Check Tag
- krysa rodu rattus MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- systematický přehled MeSH
