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International audience; OBJECTIVE: Long term effects of perineal tears pose a major worldwide health issue for women during delivery. Since bacterial vaginosis is related to major obstacles in obstetrics the aim of this study was to determine the relationship between bacterial vaginosis and the occurrence of perineal tears during vaginal delivery.METHODS: Between June 2013 and December 2013 pregnant women delivering after 37 weeks were recruited at one University hospital / tertiary care referral center in the course of this single-center, prospective cohort study. Bacterial vaginosis was assessed according to Nugent score method. Logistic-regression model was used to estimate odds ratios, adjusted for other risk factors to test the relationship between bacterial vaginosis and the occurrence of 1st to 4th degree perineal tears in women undergoing vaginal delivery.RESULTS: A total of 728 woman were included, 662 analyzed with a complete Nugent Score of the vaginal swab. The prevalence of 1st to 4th degree perineal tears was 35.8% (95% Confidence Interval (95%CI) = [32.2; 39.6]). The presence of BV was not significantly associated to the incidence of perineal tears neither in the univariate analysis (crude Odds Ratio = 1.43; 95%CI = [0.79; 2.60]; p = 0.235) nor in the multivariate analysis (adjusted Odds Ratio = 1.65; 95%CI = [0.81; 3.36]; p = 0.167). Instrumental delivery was the most important risk factor for perineal lacerations.CONCLUSIONS: There is no evidence that vaginosis is a risk factor for vaginal tears.TRIAL REGISTRATION: ClinicalTrials.gov N° NCT01822782.

The basis of the preventive medical management during pregnancy in Austria is the mother-child pass which documents all examinations serving to monitor the normal course of pregnancy. Progress during the last few years has shown that regular medical preventive check-ups during pregnancy demonstrably lead to a reduction of maternal and fetal morbidity and mortality. The aim of these preventive pregnancy check-ups is--in addition to the registration of high-risk pregnancies which need an intensified supervision--the earliest identification possible of pregnancy-induced diseases in order to be able to monitor and treat them adequately. In Austria, these medical check-ups during pregnancy are required for the mother to receive the full child care benefit also from the 21st month of life onwards. For this, 5 prenatal preventive check-ups are absolutely necessary. In addition, ultrasound examinations between the 18th and 22nd and between the 30th and 34th weeks of pregnancy are recommended. Any further tests, like ultrasonography during the 1st trimester, nuchal translucency screening, combined test, invasive diagnostics (amniocentesis, chorionic villus sampling) or the oral glucose tolerance test, are not part of the current concept of prevention according to the mother-child pass; however, they are an option in the case of certain indications or at the request of the expectant mother.

Background: Acute compartment syndrome (ACS) is a life-threatening process induced by abnormally high pressure between muscles and enveloping fasciae. There are few reports in connection with gynecologic surgery. Case: A 38-year-old patient underwent extended surgery for a malignant yolk sac tumor of the ovary. The operating time was almost 6 hours, and anesthesia time and time in lithotomy position was almost 7 hours. On the first postoperative day, the patient reported pain and swelling in the lower left leg and ACS was diagnosed. An immediate fasciotomy with necrectomy of the soleus muscle was performed. The patient subsequently required repeated debridement on the 4th and 6th postoperative days. Five (5) months postoperatively, after physical therapy, the patient was well and mobile but her foot drop persisted. Conclusions: ACS is a clinical diagnosis confirmed by laboratory findings. It is well-known to trauma and plastic surgeons, but the well-leg variant is rare and may not be familiar to ...

Background: Pelvic organ prolapse (POP) is defined as the descent of one or more of the pelvic structures into the vagina and includes uterine, vaginal vault, and anterior or posterior vaginal wall prolapse. The treatment of POP may include implantation of a synthetic mesh. However, the long-term benefit of mesh surgery is controversial due to complications such as mesh exposure or pain. The aim of this study was to use a tissue engineering (TE) approach to assess the in vivo biological and biomechanical behavior of a new gelatin/polyamide mesh, seeded with a novel source of mesenchymal stem cells in a subcutaneous rat model of wound repair. Methods: W5C5-enriched human endometrial mesenchymal stem cells (eMSC) were seeded onto meshes (gelatin-coated polyamide knit) at 100,000 cells/cm2. Meshes, with or without cells were subcutaneously implanted dorsally in immunocompromised rats for 7, 30, 60, and 90 days. Flow cytometry was used to detect DiO labeled cells after explantation. Immunohistochemical assessment of foreign body reaction and tissue integration were conducted. Total collagen and the levels of collagens type III and type I were determined. Uniaxial tensiometry was performed on explanted meshes, originally seeded with and without cells, at days 7 and 90. Results: Implanted meshes were well tolerated, with labeled cells detected on the mesh up to 14 days postimplantation. Meshes with cells promoted significantly more neovascularization at 7 days (p

Mesenchymal stromal cells (MSC) are a promising treatment for autoimmune disorders and tissue regeneration. Our laboratory has focused on an autologous approach using adipose tissue (AT) derived MSC (adMSC). In an effort to move these therapeutic cells into the clinic, we have performed studies to optimize and characterize the processes and the cells as the foundation of the manufacturing protocols for our clinical trials. Early on, we developed a media supplement derived from human platelets that is the basis of our culture protocol (PLTMax, Mill Creek Lifesciences, Rochester, MN). We have used this protocol to grow adMSC from otherwise healthy patients undergoing bariatric surgeries and from >30 patients with a variety of diseases including ALS, Crohn’s disease, type 1 diabetes, and ovarian cancer. We saw no differences in growth kinetics or phenotype associated with underlying disease. We have successfully cultured adMSC to more than 25 population doublings without loss of growth rate or change in phenotype. This protocol typically yielded 1 10 MSC in 3 weeks from a starting product of 1-2 gms of AT. When thawed, cells frozen for more than a year retained their pre-freeze proliferation rate. adMSC inhibited dendritic cell maturation as well as inhibited dendritic cell mediated stimulation of CD4 T cells. Safety studies in rabbits, pigs and mice have shown that cells have expected bio-distribution. No malignant transformation was seen during the injection of more than one billion adMSC into immune deficient mice. These and other preliminary data have led to the opening of phase I clinical trials using these cells to treat ALS, multiple system atrophy, and renal stenosis. Two other applications are under review.

Introduction Fascial defects are a common problem in the abdominal wall and in the vagina leading to hernia or pelvic organ prolapse that requires mesh enhancement to reduce operation failure. However, the long-term outcome of synthetic mesh surgery may be unsatisfactory due to post-surgical complications. We hypothesized that mesh fabricated from alternative synthetic polymers may evoke a different tissue response, and provide more appropriate mechanical properties for hernia repair. Our aim was to compare the in vivo biocompatibility of new synthetic meshes with a commercial mesh. Methods We have fabricated 3 new warp-knitted synthetic meshes from different polymers with different tensile properties polyetheretherketone (PEEK), polyamide (PA) and a composite, gelatin coated PA (PA+G). The rat abdominal hernia model was used to implant the meshes (25×35 mm, n = 24/ group). After 7, 30, 60, 90 days tissues were explanted for immunohistochemical assessment of foreign body reaction and tissue integration, using CD31, CD45, CD68, alpha-SMA antibodies. The images were analysed using an image analysis software program. Biomechanical properties were uniaxially evaluated using an Instron Tensile® Tester. Results This study showed that the new meshes induced complex differences in the type of foreign body reaction over the time course of implantation. The PA, and particularly the composite PA+G meshes, evoked a milder early inflammatory response, and macrophages were apparent throughout the time course. Our meshes led to better tissue integration and new collagen deposition, particularly with the PA+G meshes, as well as greater and sustained neovascularisation compared with the PP meshes. Conclusion PA, PA+G and PEEK appear to be well tolerated and are biocompatible, evoking an overlapping and different host tissue response with time that might convey mechanical variations in the healing tissue. These new meshes comprising different polymers may provide an alternative option for future treatment of fascial defects.

We describe the distribution of indoleamine 2,3-dioxygenase 1 (IDO1) in vascular endothelium of human first-trimester and term placenta. Expression of IDO1 protein on the fetal side of the interface extended from almost exclusively sub-trophoblastic capillaries in first-trimester placenta to a nearly general presence on villous vascular endothelia at term, including also most bigger vessels such as villous arteries and veins of stem villi and vessels of the chorionic plate. Umbilical cord vessels were generally negative for IDO1 protein. In the fetal part of the placenta positivity for IDO1 was restricted to vascular endothelium, which did not co-express HLA-DR. This finding paralleled detectability of IDO1 mRNA in first trimester and term tissue and a high increase in the kynurenine to tryptophan ratio in chorionic villous tissue from first trimester to term placenta. Endothelial cells isolated from the chorionic plate of term placenta expressed IDO1 mRNA in contrast to endothelial cells originating from human umbilical vein, iliac vein or aorta. In first trimester decidua we found endothelium of arteries rather than veins expressing IDO1, which was complementory to expression of HLA-DR. An estimation of IDO activity on the basis of the ratio of kynurenine and tryptophan in blood taken from vessels of the chorionic plate of term placenta indicated far higher values than those found in the peripheral blood of adults. Thus, a gradient of vascular endothelial IDO1 expression is present at both sides of the feto-maternal interface.