Cervical Digital Photography: An Alternative Method to Colposcopy.

OBJECTIVE: This study sought to evaluate the performance of cervical digital photography as an alternative to colposcopy. METHODS: Colposcopy and cervical digital photography were performed on 228 women. The cervical digital photographs were evaluated through the Internet by three colposcopy experts. The agreement between methods was calculated with kappa and percentages of agreement. Next, the sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were calculated for colposcopy and cervical digital photography. Histology was used as the gold standard (Canadian Task Force Classification II-2). RESULTS: Cervical digital photography and colposcopy were in agreement in 89.9% of the cases (κ = 0.588). Cervical digital photography had higher sensitivity (52.5%) and positive predictive value (60%) than colposcopy (35% and 48.28%, respectively). There were no other significant differences between cervical digital photography and colposcopy: specificity was 91.86% and 91.28%, negative predictive value was 89.3% and 85.8%, and diagnostic accuracy was 84.4% and 80.7%, respectively. CONCLUSION: Cervical digital photography is a promising alternative method to colposcopy.

Comparative analysis of three human adipocyte size measurement methods and their relevance for cardiometabolic risk.

OBJECTIVE: To determine whether adipocyte diameters from three measurement methods are similarly associated with adiposity measurements and cardiometabolic variables. METHODS: Surgical samples of omental and abdominal subcutaneous adipose tissue were obtained in a sample of 60 women (age 35-59 years; body mass index 20.3-41.1 kg/m2 ). Median adipocyte diameter of the main cell population was determined by collagenase digestion, osmium tetroxide fixation, and histological analysis. Adiposity and cardiometabolic risk factors were assessed. RESULTS: Adipocyte diameter was consistently smaller with formalin fixation than with collagenase digestion, whereas osmium-fixed cells were larger (P < 0.0001, for all). Median adipocyte diameters derived from all methods were intercorrelated (r = 0.46-0.83, P < 0.001 for all). Positive associations were found between adipocyte diameters from all techniques and regional or total adiposity measurements (P < 0.01 for all). Omental adipocyte diameter was positively associated with fasting glucose, insulin, and homeostatic model assessment of insulin resistance (r = 0.30-0.52, P < 0.05 for all), with osmium-fixed cell size as a stronger correlate. Osmium-fixed cell diameter was also a better correlate of plasma adiponectin and leptin. CONCLUSIONS: Although measurement techniques generated systematic differences in adipocyte size, associations with adiposity were only slightly affected by the technique. Osmium fixation generated stronger associations with cardiometabolic risk factors than collagenase digestion and histological analysis.

Impact of uterine closure on residual myometrial thickness after cesarean: a randomized controlled trial.

BACKGROUND: Incomplete healing of uterine scar after cesarean has been associated with adverse gynecological and obstetrical outcomes. Several studies reported that uterine closure at cesarean influences the healing of uterine scar and the risk of uterine rupture at subsequent pregnancies: the commonly used locked single-layer suture including the decidua being associated with a 4-fold increased risk of uterine rupture. However, data from randomized trials are lacking. OBJECTIVE: We sought to evaluate the impact of 3 techniques of uterine closure after cesarean delivery on uterine scar healing. STUDY DESIGN: This was a 3-arm 1:1:1 randomized study in women with singleton pregnancies undergoing elective primary cesarean delivery at ≥38 weeks' gestation. Closure of the uterine scar was carried out by locked single layer including the decidua, double layer with locked first layer including the decidua, or double layer with unlocked first layer excluding the decidua. Primary outcome was residual myometrial thickness (RMT) at the site of the scar, measured by transvaginal ultrasound 6 months after delivery. Secondary outcome was the RMT as a percentage of the myometrial thickness above the scar (healing ratio). Intent-to-treat analyses using Student t test were performed to compare each double-layer technique to the single-layer closure, and P < .025 was considered significant. RESULTS: Complete follow-up was obtained from 73 (90%) of the 81 participants. Compared to single-layer closure, double-layer closure with unlocked first layer was associated with thicker RMT (3.8 ± 1.6 mm vs 6.1 ± 2.2 mm; P < .001) and greater healing ratio (54 ± 20% vs 73 ± 23%; P = .004). In contrast, double-layer closure with locked first layer was not significantly different than single-layer closure in either RMT (4.8 ± 1.3; P = .032) or healing ratio (60 ± 21%; P = .287). CONCLUSION: Double-layer closure with unlocked first layer is associated with better uterine scar healing than locked single layer.

Abdominal subcutaneous and omental adipocyte morphology and its relation to gene expression, lipolysis and adipocytokine levels in women.

OBJECTIVE: We tested the hypothesis that women with adipocyte hypertrophy in either omental (OM) or subcutaneous (SC) adipose tissue are characterized by alterations in adipocyte lipolysis and adipose tissue expression of genes coding for proteins involved in adipocyte metabolism or inflammation, independent of overall adiposity and fat distribution. METHODS: OM and SC fat samples were obtained surgically in 44 women (age: 47.1±5.0years, BMI: 27.7±5.3kg/m(2)). In a given depot, women with larger adipocytes than predicted by the regression of adipocyte size vs. total and regional adiposity measurements were considered as having adipocyte hypertrophy, whereas women with smaller adipocytes than predicted were considered as having adipocyte hyperplasia. RESULTS: Women with OM adipocyte hypertrophy had significantly lower SC GLUT4 mRNA abundance (p≤0.05), higher SC CEBPB mRNA expression (p≤0.05) as well as higher mRNA expression of OM PLIN (p≤0.05), CD68 (p≤0.10), CD14 (p≤0.10), CD31 (p≤0.05) and vWF (p≤0.05) compared to women with OM adipocyte hyperplasia. OM adipocyte isoproterenol- (10(-10) to 10(-5)mol/L), forskolin- (10(-5)mol/L) and dibutyryl cAMP- (10(-3)mol/L) stimulated lipolysis was higher in women with hypertrophic OM adipocytes (p≤0.05, for all). Women with SC adipocyte hypertrophy had lower SC mRNA expression of GLUT4 (p≤0.10), higher SC mRNA expression of CEBPB (p≤0.05), lower plasma adiponectin concentrations (p≤0.05) and higher SC adipocyte isoproterenol- (10(-9) to 10(-5)mol/L) stimulated lipolysis (p≤0.05) compared to women with SC adipocyte hyperplasia. CONCLUSION: Hypertrophic adipocytes in both fat compartments are characterized by alterations in adipocyte lipolysis and adipose tissue expression of genes coding for proteins involved in adipocyte metabolism or inflammation.

Visceral fat accumulation is an indicator of adipose tissue macrophage infiltration in women.

We tested the hypothesis that visceral obesity is the best correlate of abdominal adipose tissue macrophage infiltration in women. Omental and subcutaneous fat samples were surgically obtained from 40 women (age, 47.0 ± 4.0 years; body mass index, 28.4 ± 5.8 kg/m(2)). CD68+ cells were identified using fluorescence immunohistochemistry. Expression of macrophage markers was measured by real-time reverse transcriptase polymerase chain reaction. Body composition and fat distribution were measured by dual-energy x-ray absorptiometry and computed tomography, respectively. Mean CD68+ cell percentage tended to be higher in subcutaneous (18.3%) compared with omental adipose tissue (15.5%, P = .07). Positive correlations were observed between CD68+ cell percentage as well as CD68 messenger RNA expression in a given depot vs the other (P ≤ .01). Visceral adipose tissue area and omental adipocyte diameter were positively related to CD68+ cell percentage in omental fat (r = 0.52 and r = 0.35, P ≤ .05). Total and visceral adipose tissue areas as well as subcutaneous adipocyte diameter were significantly correlated with CD68+ cell percentage in subcutaneous adipose tissue (0.32 ≤ r ≤ 0.40, P ≤ .05). Adipose tissue areas and subcutaneous adipocyte diameter were also significantly associated with expression of commonly used macrophage markers including CD68 in the subcutaneous fat compartment (0.32 ≤ r ≤ 0.57, P ≤ .05). Visceral adipose tissue area was the best correlate of CD68+ cell percentage in both omental and subcutaneous fat tissues, explaining, respectively, 20% and 12% of the variance in models also including subcutaneous adipose tissue area, adipocyte sizes, and total body fat mass. Visceral adipose tissue accumulation is the best correlate of macrophage infiltration in both the subcutaneous and omental fat compartments of lean to obese women.

Pitfall in ultrasound evaluation of uterine scar from prior preterm cesarean section.

We report two cases of women with a previous cesarean performed before active labor at 29 weeks of gestation who underwent sonographic measurement of the lower uterine segment (LUS) at 36 weeks' gestation in their subsequent pregnancy. In both cases, uterine scar defect was detected on the upper part of the LUS, at ∼9 to 11 cm from the cervical os, and was only visualized by the transabdominal approach. We suggest that early gestational age and the absence of labor at previous cesarean can lead to a higher uterine scar location on the LUS and, therefore, increase the risk of uterine rupture in subsequent pregnancy. The heterogeneity of uterine scar location could explain discrepancies observed in studies using the transabdominal versus the transvaginal approach or both regarding the predictive value of LUS measurements for uterine rupture.

Sonography of lower uterine segment thickness and prediction of uterine rupture.

BACKGROUND: Sonographic evaluation of the lower uterine segment was undertaken to study the degree of thinning and, thus, to predict uterine rupture. However, the best measuring technique and recommended cutoff values remain controversial. CASE: Sonographic evaluation of the lower uterine segment at 36 weeks of gestation in a 31-year-old patient with prior low transverse cesarean delivery revealed a full thickness of 3.6 mm and a myometrial layer of 1.1 mm. Nevertheless, the patient experienced a large uterine rupture during a trial of labor at term. CONCLUSION: In this case, there was a discrepancy between the full thickness and the myometrial layer, which could be representative of the lower uterine segment resistance. Such a case emphasizes the need for a consensus on sonographic measuring techniques for the prediction of uterine rupture.