Microablative fractional radiofrequency for sexual dysfunction and vaginal Trophism: A randomized clinical trial.

OBJECTIVES: To evaluate Microablative Fractional Radiofrequency (MAFRF) as a possible option in treating vaginal atrophy. METHODS: This was a randomized, controlled clinical trial with postmenopausal women diagnosed with vaginal atrophy. The treatment consisted of three sessions of MAFRF, compared to vaginal estrogen administration and an untreated control group. Assessments occurred at baseline and 90 days. The primary endpoints were sexual function, evaluated by the Female Sexual Function Index (FSFI), and vaginal health, assessed by the Vaginal Health Index (VHI). Secondary outcomes included vaginal microbiota composition (Nugent score) and epithelial cell maturation (Maturation Value ‒ MV). RESULTS: One hundred and twenty women (40 in each group) were included. Concerning the FSFI, both groups, MAFRF (median 4.8 [3.6‒6.0]) and vaginal estrogen (mean 4.7 ± 1.1), experienced improved sexual desire when compared to the control group (median 3.6 [2.4‒4.8]). Regarding the total score of VHI, the authors observed an improvement in the mean of the MAFRF (23.7 ± 2.0) and vaginal estrogen groups (23.5 ± 1.9) when compared to the control (14.8 ± 2.9). The Nugent score was reduced in the MAFRF and estrogen groups (p < 0.01) compared to the control group. Lastly, the MV was modified after treatment with MAFRF (p < 0.01) and vaginal estrogen (p < 0.001). No differences existed between the MAFRF and vaginal estrogen groups in the studied variables. No adverse effects were reported following the MAFRF protocol. CONCLUSIONS: Radiofrequency was comparable in efficacy to estrogen administration for treating vulvovaginal atrophy. It deserves consideration as a viable option in managing this condition.

Evaluation of Exosomal miRNA as Potential Biomarkers in Cervical Cancer.

Different studies show that small non-coding RNAs, such as microRNAs (miRNAs) obtained from exosomes, are considered potential biomarkers in several types of cancer, including cervical cancer (CC). Therefore, the present study seeks to present an overview of the role of circulating exosomal miRNAs with the potential to act as biomarkers for the diagnosis and prognosis of CC and to analyze the presence of these miRNAs according to the stage of CC. For this purpose, a review was developed, with articles consulted from the electronic databases MEDLINE/PubMed, Scopus, and Web of Science published between 2015 and 2021. Seven articles were included after a selection of studies according to the eligibility criteria. In addition to the methods used for sample analysis, detection, and isolation of miRNAs in each article, clinical data were also extracted from the patients studied, such as the stage of cancer. After analyzing the network of the seven miRNAs, they were associated with the immune system, CC progression and staging, and cisplatin resistance. With the belief that studies on miRNAs in cervical cancer would have major clinical implications, in this review, we have attempted to summarize the current situation and potential development prospects.

Histomorphometric analysis in HPV-induced cervical lesions

SUMMARY Introduction: squamous intraepithelial lesions (SIL) of the cervix involve dysplastic change, or abnormal cell maturation and their progression can result in cervical carcinoma. Some studies have reported the importance of the immune system in the process of tumor progression. Therefore, it is important to characterize the inflammatory infiltration as a possible marker of prognosis. Aim: to analyze density of the inflammatory infiltrate in different degrees of SIL and in cervical cancer to under-stand local and systemic changes in the interactions between HPV associated cervical lesions and the immune system. Methods: one hundred and eight (108) cervical biopsy specimens were obtained from patients treated at the tertiary hospital and were stratified into four groups: Low-grade squamous intraepithelial lesion (LSIL), High-grade squamous intraepithelial lesion (HSIL), cervical cancer (CC) and negative for intraepithelial lesion and malignancy (NILM). Histomorphometric analysis was performed from the identification and quantification of inflammatory cells in ten (10) fields per sample in images captured by a digital system and analyzed using the software Leica Qwin Pro V 3.5.1, Leica Microsystems Ltd. Differences between groups were evaluated by Anova followed by Tukey test. Tests yielding p values < 0.05 were considered significant. Results: we found a significant increase in the average number of lymphocytes (cells/mm2 and cells/field) in samples of CC in relation to the other groups. No statistical difference was observed in relation to neutrophils, plasma cells and eosinophils. Conclusion: cervical cancer specimens had significantly more lymphocytes than NILM, or LSIL and HSIL, suggesting that this cell type plays a central role in cellular immunity against cervical carcinoma.

Introducción: las lesiones escamosas intraepiteliales (SIL) del cuello uterino implican cambios displásicos o maduración celular anormal y su progresión puede resultar en carcinoma cervical. Algunos estudios han informado de la importancia del sistema inmunológico en el proceso de progresión tumoral. Por tanto, es importante caracterizar la infiltración inflamatoria como un posible marcador de pronóstico. Objetivo: analizar la densidad del infiltrado inflamatorio en diferentes grados de SIL y en cáncer de cuello uterino para comprender los cambios locales y sistêmicos en las interacciones entre las lesiones cervicales asociadas al VPH y el sistema inmunológico. Métodos: se obtuvieron ciento ocho (108) muestras de biopsia cervical de pacientes tratados en el hospital terciario y se estratificaron en cuatro grupos: Lesión intraepitelial escamosa de bajo grado (LSIL), Lesión intraepitelial escamosa de alto grado (HSIL), cáncer de cuello uterino (CC) y negativo para lesiones intraepiteliales y malignidad (NILM). El análisis histomorfométrico se realizó a partir de la identificación y cuantificación de células inflamatorias en diez (10) campos por muestra en imágenes capturadas por un sistema digital y analizadas utilizando el software Leica Qwin Pro-V 3.5.1, Leica Microsystems Ltd. Anova seguido de la prueba de Tukey. Las pruebas que arrojaron valores de p <0,05 se consideraron significativas. Resultados: encontramos un aumento significativo en el número medio de linfocitos (células/mm2 y células/campo) en muestras de CC en relación con los otros grupos. No se observó diferencia estadística en relación con neutrófilos, células plasmáticas y eosinófilos. Conclusión: las muestras de cáncer de cuello uterino tenían significativamente más linfocitos que NILM o LSIL y HSIL, lo que sugiere que este tipo de células juega un papel central en la inmunidad celular contra el carcinoma de cuello uterino.

Introdução: Lesões intraepiteliais escamosas (SIL) do colo do útero envolvem alteração displásica ou maturação celular anormal e sua progressão pode resultar em carcinoma cervical. Alguns estudos relatam a importância do sistema imunológico no processo de progressão tumoral. Portanto, é importante caracterizar o infiltrado inflamatório como um possível marcador de prognóstico. Objetivo: analisar a densidade do infiltrado inflamatório em diferentes graus de SIL e no câncer cervical para compreender as alterações locais e sistêmicas nas interações entre as lesões cervicais associadas ao HPV e o sistema imunológico. Métodos: Cento e oito (108) espécimes de biópsia cervical foram obtidos de pacientes tratados no hospital terciário e foram estratificados em quatro grupos: Lesão intraepitelial escamosa de baixo grau (LSIL), Lesão intraepitelial escamosa de alto grau (HSIL), câncer cervical (CC) e negativo para lesão intraepitelial e malignidade (NILM). A análise histomorfométrica foi realizada a partir da identificação e quantificação das células inflamatórias em dez (10) campos por amostra em imagens capturadas por um sistema digital e analisadas no software Leica Qwin Pro V 3.5.1, Leica Microsystems Ltd. As diferenças entre os grupos foram avaliadas por Anova seguida do teste de Tukey. Os testes com valores de p <0,05 foram considerados significativos. Resultados: encontramos um aumento significativo no número médio de linfócitos (células/mm2 e células/campo) nas amostras de CC em relação aos demais grupos. Não foi observada diferença estatística em relação aos neutrófilos, plasmócitos e eosinófilos. Conclusão: as amostras de câncer cervical tinham significativamente mais linfócitos do que NILM, ou LSIL e HSIL, sugerindo que este tipo de célula desempenha um papel central na imunidade celular contra o carcinoma cervical.

Does 100% Rapid Review Improve Cervical Cancer Screening?

OBJECTIVE: The aim of this work was to evaluate 100% rapid review (100% RR) as a useful tool to detect false negative (FN) results. STUDY DESIGN: A sample of 8,677 swabs was investigated; the unsatisfactory and negative results were referred to 100% RR, concordant results were taken as the final diagnosis, while the discordant results were debated in a consensus meeting to reach a conclusion. The positive results were examined by 2 cytologists. The data were entered into SAS statistical software, and the agreement of the 100% RR results with the final diagnosis was tested with the weighted kappa statistic. RESULTS: There was a significant increase in unsatisfactory results from 348 to 1,927, and of positive results from 174 to 349. On the other hand, there was a substantial decrease in negative results from 8,155 to 6,401. Assessing the relative risk of FN results in smears that were not referred to quality control (100% RR) revealed the following results: atypical squamous cells of undetermined significance (ASC-US), 2.93; low-grade squamous intraepithelial lesion (LSIL), 2.72; high-grade squamous intraepithelial lesion/atypical squamous cells - cannot exclude HSIL (HSIL/ASC-H), 2.25. Evaluating by age group, a higher risk for LSIL (4.90) and ASC-US (3.85) was observed in patients aged under 25 years, whereas patients between 25 and 64 years and those over 64 years presented a higher risk for HSIL and ASC-H: 2.46 and 2.75, respectively. CONCLUSION: 100% RR is an effective screening tool for FN results in countries where molecular tests for DNA-HPV and prophylactic vaccines are not available in cervical cancer screening programs.

Genetic polymorphisms of Interleukin-18 are not associated with allograft function in kidney transplant recipients.

Interleukin 18 (IL-18) is a proinflammatory cytokine that plays a role in host defense by upregulating both innate and acquired immune responses. Analysis of IL18 polymorphisms may be clinically important since their roles have been recognized in a variety of inflammatory and autoimmune disorders. However, the role of this cytokine polymorphisms in kidney transplant still remains unclear. In this study, we evaluated the associations between IL18 polymorphisms and graft function assessed by creatinine clearance in kidney transplant recipients. A total of 82 kidney transplant recipients and 183 healthy controls were enrolled, and frequencies of alleles, genotypes and haplotypes for IL18 polymorphisms were determined and compared with creatinine clearance. The -607C/A (rs1946518) and -137C/G (rs187238) variant alleles in the IL18 gene were determined by polymerase chain reaction. In our study, no significant association was found between the IL18 variants and creatinine clearance (p > 0.05). Nonetheless, polymorphism analysis revealed an increase in the frequency of the IL18 major haplotype -607C/-137G in kidney transplant patients (odds ratio 2.57, 95% confidence interval 1.45-4.55, p = 0.0014). Finally, we found that IL18 polymorphisms did not influence the renal function and that IL18 haplotype -607C/-137G seems to be associated with kidney transplant recipients.

Upregulation of soluble and membrane-bound human leukocyte antigen G expression is primarily observed in the milder histopathological stages of chronic hepatitis C virus infection.

Chronic hepatitis C virus (HCV) infection is a worldwide health problem that may evolve to cirrhosis and hepatocellular carcinoma. Incompletely understood immune system mechanisms have been associated with impaired viral clearance. The nonclassical class I human leukocyte antigen G (HLA-G) molecule may downregulate immune system cell functions exhibiting well-recognized tolerogenic properties. HCV genotype was analyzed in chronic HCV-infected patients. Because HLA-G expression may be induced by certain viruses, we evaluated the presence of HLA-G in the liver microenvironment obtained from 89 biopsies of patients harboring chronic HCV infection and stratified according to clinical and histopathological features. Overall, data indicated that HCV genotype 1 was predominant, especially subgenotype 1a, with a prevalence of 87%. HLA-G expression was observed in 45 (51%) liver specimens, and it was more frequent in milder stages of chronic hepatitis (67.4%) than in moderate (27.8%; p = 0.009) and severe (36.0%; p = 0.021) stages of the disease. Altogether, these results suggest that the expression of HLA-G in the context of HCV is a complex process modulated by many factors, which may contribute to an immunologic environment favoring viral persistence. However, because the milder forms predominantly expressed HLA-G, a protective role of this molecule may not be excluded.

Human leukocyte antigen-G 3' untranslated region polymorphisms are associated with better kidney allograft acceptance.

Human leukocyte antigen-G (HLA-G) plays a well-recognized role in the modulation of the immune response, and HLA-G expression has been associated with increased graft survival and decreased rejection episodes. To investigate the role of the HLA-G 3' untranslated region (3'UTR) in renal transplantation, we evaluated several polymorphic sites (14-bp Del/Ins +3003T/C, +3010C/G, +3027C/A, +3035C/T, +3142G/C, and +3187A/G) in patients exhibiting or not exhibiting rejection episodes. A total of 104 patients (15 with acute and 48 with chronic rejection, and 41 with no rejection) and 142 healthy individuals were studied. HLA-G 3'UTR was typed by direct sequencing. The +3035C-C genotype was more frequent in patients exhibiting chronic rejection compared with healthy controls, and the +3035C-T genotype was less frequent in chronic rejection compared with patients without rejection (acute plus chronic) or compared with healthy controls. The +3187G-A genotype, in which the A allele is associated with increased mRNA degradation, showed increased frequency in the rejection group (acute plus chronic) when compared with healthy controls. The 14 base pair Deletion/Insertion genotype was marginally increased in patients with acute rejection. This is the first study to show associations among numerous polymorphic sites in the HLA-G 3'UTR in kidney allotransplantation, which may contribute to the understanding of HLA-G post-transcriptional mechanisms.