Vaginal Er:YAG laser application in the menopausal ewe model: a randomised estrogen and sham-controlled trial.

OBJECTIVE: To describe effects of non-ablative erbium-doped:yttrium-aluminium-garnet (Er:YAG) laser on vaginal atrophy induced by iatrogenic menopause in the ewe. DESIGN: Animal experimental, randomised, sham and estrogen-treatment controlled study with blinding for primary outcome. SETTING: KU Leuven, Belgium. SAMPLE: Twenty-four ewes. METHODS: Menopause was surgically induced, after which the ewes were randomised to three groups receiving vaginal Er:YAG laser application three times, with a 1-month interval; three sham manipulations with a 1-month interval; or estrogen replacement and sham manipulations. At given intervals, ewes were clinically examined and vaginal wall biopsies were taken. Vaginal compliance was determined by passive biomechanical testing from explants taken at autopsy. MAIN OUTCOME MEASURES: Vaginal epithelial thickness (primary), composition of the lamina propria (collagen, elastin, glycogen and vessel content), vaginal compliance, clinical signs. RESULTS: Animals exposed to Er:YAG laser application and sham manipulation, but not to estrogens, displayed a significant and comparable increase in vaginal epithelial thickness between baseline and 7 days after the third application (69% and 67%, respectively, both P < 0.0008). In laser-treated ewes, temporary vaginal discharge and limited thermal injury were observed. Estrogen-substituted ewes displayed a more prominent increase in epithelial thickness (202%; P < 0.0001) and higher vaginal compliance (P < 0.05). None of the interventions induced changes in the lamina propria. CONCLUSIONS: Vaginal Er:YAG laser has comparable effect to sham manipulation in menopausal ewes. TWEETABLE ABSTRACT: Vaginal Er:YAG laser has comparable effect to sham manipulation in menopausal ewes #LASER #GSM #RCT.

Functional evaluation of prevascularization in one-stage versus two-stage tissue engineering approach of human bio-artificial muscle.

A common shortcoming of current tissue engineered constructs is the lack of a functional vasculature, limiting their size and functionality. Prevascularization is a possible strategy to introduce vascular networks in these constructs. It includes among others co-culturing target cells with endothelial (precursor) cells that are able to form endothelial networks through vasculogenesis. In this paper, we compared two different prevascularization approaches of bio-artificial skeletal muscle tissue (BAM) in vitro and in vivo. In a one-stage approach, human muscle cells were directly co-cultured with endothelial cells in 3D. In a two-stage approach, a one week old BAM containing differentiated myotubes was coated with a fibrin hydrogel containing endothelial cells. The obtained endothelial networks were longer and better interconnected with the two-stage approach. We evaluated whether prevascularization had a beneficial effect on in vivo perfusion of the BAM and improved myotube survival by implantation on the fascia of the latissimus dorsi muscle of NOD/SCID mice for 5 or 14 d. Also in vivo, the two-stage approach displayed the highest vascular density. At day 14, anastomosis of implanted endothelial networks with the host vasculature was apparent. BAMs without endothelial networks contained longer and thicker myotubes in vitro, but their morphology degraded in vivo. In contrast, maintenance of myotube morphology was well supported in the two-stage prevascularized BAMs. To conclude, a two-stage prevascularization approach for muscle engineering improved the vascular density in the construct and supported myotube maintenance in vivo.

Laser therapy for urinary incontinence and pelvic organ prolapse: a systematic review.

BACKGROUND: Laser therapy is now being proposed for the treatment of pelvic organ prolapse (POP) and urinary incontinence (UI). OBJECTIVES: To systematically review the available literature on laser therapy for POP and UI. SEARCH STRATEGY: PubMed, Web Of Science and Embase were searched for relevant articles, using a three-concept (POP, UI, laser therapy) search engine composed as (concept 1 OR concept 2) AND concept 3. SELECTION CRITERIA: Only full-text clinical studies in English. DATA COLLECTION AND ANALYSIS: Data on patient characteristics, laser setting, treatment outcome and adverse events were independently collected by two researchers. There was a lack of methodological uniformity so meta-analysis was not possible and the results are presented narratively. MAIN RESULTS: Thirty-one studies recruiting 1530 adult women met the inclusion criteria. All studies showed significant improvement either on UI, POP or both; however the heterogeneity of laser settings, application and outcome measures was huge. Only one study was a randomised controlled trial, two studies were controlled cohort studies. All three were on UI and used standardised validated tools. The risk of bias in the randomised controlled trial was low on all seven domains; the controlled studies had a serious risk of bias. No major adverse events were reported, mild pain and burning sensation were the most commonly described adverse events. CONCLUSIONS: All studies on vaginal and/or urethral laser application for POP and UI report improvement, but the quality of studies needs to be improved. TWEETABLE ABSTRACT: There is weak evidence that laser therapy is effective for urinary incontinence and pelvic organ prolapse #LASER#UI#POP.

[Selective feticide in monochorionic twin pregnancies with discordant fetal anomalies: management and outcome]. / Selektivní fetoredukce u monochoriálních gravidit komplikovaných vrozenou vývojovou vadou jednoho z plodu: management a výsledky péce.

OBJECTIVE: To analyze results and outcome after selective feticide for discordant anomalies in monochorionic twins. DESIGN: Prospective cohort study. SETTING: Fetal medicine center, Institute for the Care of Mother and Child, Praha. METHODS: Analysis of outcome of monochorionic pregnancies after intrauterine surgery for structural abnormalities between January 2013 and June 2016. RESULTS: We performed 13 intrauterine operations in monochorionic twins with structural anomalies during the period. There were 12 monochorionic diamniotic and one monochorionic monoamniotic twins. We encountered four cases of Twin Reversed Arterial Perfusion sequence (TRAP), six central nervous system lesions, two abdominal wall defects and one heterokaryotypic pregnancy with trisomy 13. In seven cases we performed bipolar cord occlusion, in four cases of TRAP sequence we performed radiofrequency ablation (RFA). We also performed laser photocoagulation of placental anastomoses in a case of gastroschisis complicated with twin-to-twin transfusion syndrome. One operation was unsuccessful for technical reasons - failing to perform amnioinfusion in a fetus with eventeration and anhydramnios. All procedures were performed in local anesthesia. Fetuses were born between 26 a 41 weeks of gestation (mean 35 weeks; 77% of fetuses were delivered after 32 weeks). Mean neonatal weight 2260 g. We encountered no intrauterine demise of a healthy fetus. CONCLUSION: Patients with discordant fetal anomalies in monochorionic twins can be offered a selective feticide via bipolar umbilical cord occlusion or radiofrequency ablation that are proven to be safe and effective.

[Retrospective analysis of monochorionic twin pregnancies born in the Institute for the Care of Mother and Child between 2012-2015]. / Analýza prípadu monochoriálních dvojcat porozených v Ústavu pro péci o matku a díte ve ctyrletém období (2012-2015).

OBJECTIVE: The purpose of this study was to describe monochorionic twin pregnancies and their complications, born between 24th and 37th week of gestation in the Institute for the Care of Mother and Child in years 2012-2015. DESIGN: Retrospective cohort. SETTING: The Institute for the Care of Mother and Child, Praha. METHODS: From 2012 to 2015 we observed 177 monochorionic twin pregnancies from which two or one viable fetuses were born, or both fetuses died in utero. RESULTS: From a total of 177 women, 12 (6.8%) gave birth before 26th week of gestation, between 26+0 - 27+6 four women (2.3%) gave birth, 37 women (20.9%) between 28+0 - 31+6, 84 women (47.8%) between 32+0 - 35+6 and after 36th week of gestation 40 women (22.6%) gave birth. Mean week of delivery was 33.8. Indications for termination of pregnancies were premature rupture of membranes (PPROM) in 11.9%, onset of spontaneus uterine contractions in 12.4% and in 53.3% other iatrogenic indication. 23.3% of pregnancies in our cohort were uncomplicated and terminated after 36th week of gestation. We performed caesarean section in 94.3%, in 5.7% patients gave birth vaginally. In vitro fertilization had 19.9% women, 80.1% conceived spontaneously. The age range of pregnant women in our cohort was 20-43, with median 32.3. Mean weight of bigger fetus was 2047.6 g (min. 520 g, max. 3530 g), mean weight of smaller fetus was 1799.5 g (min. 350 g, max. 2790 g). In 30 cases (16. 9%) we performed intrauterine intervetion. In 21/30 cases (11.9%) for TTTS diagnose, in 5/30 cases (2.8%) for congenital abnormalities or TRAP sequence and in 4/30 cases (2.2%) for sIUGR type III. The most frequent complication in our cohort was sIUGR (36 patients - 20.3%), TTTS (21 patients - 11.9%) and on the third place congenital abnormality or TRAP sequence (five patients - 2.8%) Nineteen patients gave birth to one viable fetus, in two cases both fetuses died in utero. In one case, in twin pair, one new-born died shortly after the birth - it had several congenital abnormalities and due to anhydramnion it was impossible to perform amnioinfusion and umbilical cord occlusion. After the birth it was given palliative care. CONCLUSION: The study brought data about specific risks in monochorionic twin pregnancies and suggests careful observation of women in fixed intervals and necessity of immediate referral to perinatal centre in case of any suspicious or pathological finding.