ABSTRACT
Female reproductive mucosa must allow allogenic sperm survival whereas at the same time, avoid pathogen infection. To preserve sperm from neutrophil attack, neutrophils disappear from the vagina during the ovulatory phase (high estradiol); although the mechanisms that regulate neutrophil influx to the vagina during insemination remain controversial. We investigated the sex hormone regulation of the neutrophil migration through the cervix during insemination and revealed that ovulatory estradiol dose fades the CXCL1 epithelial expression in the ectocervix and fornix; hence, retarding neutrophil migration and retaining them in the epithelium. These mechanisms spare sperm from neutrophil attack to preserve reproduction, but might compromise immunity. However, luteal progesterone dose promotes the CXCL1 gradient expression to restore neutrophil migration, to eliminate sperm and prevent sperm associated pathogen dissemination. Surprisingly, these mechanisms are hormone dependent and independent of the insemination. Thus, sex hormones orchestrate tolerance and immunity in the vaginal lumen by regulating neutrophil transepithelial migration in the fornix and ectocervix.
Subject(s)
Cervix Uteri/immunology , Chemokine CXCL1/metabolism , Estradiol/metabolism , Insemination/immunology , Neutrophils/immunology , Animals , Cervix Uteri/cytology , Cervix Uteri/metabolism , Estrogen Receptor alpha/genetics , Estrogen Receptor alpha/metabolism , Female , Immune Tolerance , Male , Mice , Mice, Knockout , Mucous Membrane/immunology , Mucous Membrane/metabolism , Neutrophils/metabolism , Spermatozoa/immunology , Spermatozoa/metabolism , Transendothelial and Transepithelial Migration/immunologyABSTRACT
Objetivo: Identificar los factores clínicos de riesgo del desarrollo de vitreorretinopatía proliferativa (PVR) severa tras la cirugía escleral del desprendimiento de retina (DR).Métodos: Se realizó un estudio retrospectivo de 124 pacientes con DR tratados inicialmente con procedimientos esclerales convencionales sin PVR o con PVR de grado menor al C.1 en el examen inicial. Después de la cirugía la PVR severa se definió como grado C.2 o peor. Se evaluaron los datos relativos a las 34 series estadísticas (96 variables) mediante un análisis univariable y una regresión logística múltiple. Resultados: Se comprobó el desarrollo de una PVR severa tras la cirugía en 13 pacientes (10,48 por ciento). Se identificaron siete variables predictivas significativas: grado A de PVR preoperatoria (p=0,005), desprendimiento que afecta a más de 2 cuadrantes (p=0,019), tracción vítrea preoperatoria (p=0,012), inyecciones perforantes (p=0,046), perforaciones esclerales (p=0,001), desgarros no sellados (p=0,001), y tracción vítrea postoperatoria (p=0,002).Conclusiones: Los resultados indican que además de la extensión del desprendimiento, y presencia de inflamación preoperatoria o bajo grado de PVR, los problemas y atrogénicos son también factores importantes en la patogénesis de PVR severa tras la cirugía del DR (AU)
Subject(s)
Middle Aged , Adult , Adolescent , Aged, 80 and over , Aged , Male , Female , Humans , Risk Factors , Vitreoretinopathy, Proliferative , Postoperative Complications , Retrospective Studies , Retinal DetachmentABSTRACT
PURPOSE: To identify the clinical risk factors for the development of severe proliferative vitreoretinopathy (PVR) after scleral buckling procedures for retinal detachment (RD). METHODS: A retrospective study of 124 patients with rhegmatogeneus RD treated initially with buckling procedures, with either no PVR or with no PVR of grade C-l or less at initial examination was conducted. After surgery, severe PVR was defined as grade C-2 or worse. Univariate analysis and stepwise logistic regression evaluated the data relating to 34 statistical series (96 variables). RESULTS: Severe PVR develop after surgery in 13 patients (10.48%). Seven significant predictive variables were identified: grade A preoperative PVR (p=0.005), detachment involving more than 2 quadrants (p=0.019), preoperative vitreous traction (p=0.002), intravitreal injection (p=0.046), scleral perforation (p=0.001), unsealed break (p=0.001), and postoperative vitreous traction (p=0.012). CONCLUSIONS: The results indicate that in addition to the extent of detachment, and presence of preoperative inflammation or low grade PVR, iatrogenic problems also are important factors in the pathogenesis of severe PVR after surgery for RD.
