Acellular Dermal Matrices as an New Alternative for Treatment in Reproductive Organ Static Disorders: A Pilot Study.

Background: The study aimed to evaluate the clinical effects of utilizing acellular dermal matrix (ADM) for treating pelvic organ prolapse. The motivation behind exploring a new treatment method stems from the limited efficacy of current surgical options, which are often associated with side effects. Methods: Ten patients with reproductive organ prolapse underwent surgery at the Chair and Department of Gynecology, Obstetrics, and Gynecological Oncology in Katowice. ADM was used as a support material, with eight patients receiving double TOT and two undergoing a six-point fixation mesh procedure. Pelvic organ prolapse was evaluated pre-operatively and one month post-surgery using the Pelvic Organ Prolapse Quantification (POP-Q) System. General medical history and complaints were assessed using the short form (PFDIQ-SF20). The study included ten patients aged 39 to 71 (mean: 63.6 years), all with a history of at least one vaginal delivery (mean of two). None had undergone a cesarean section. Four patients exhibited POP-Q 3, and five had POP-Q 2. Results: The mean PFDIQ-SF20 score before surgery was 70.6 points. No major complications occurred during or after surgery. One patient experienced a vaginal fungal infection and an allergic reaction to sutures. Post-operation, ailments reduced by an average of 60.76 points, with five patients reporting no complaints. Conclusions: ADM emerges as a material of interest for gynecological surgery, with initial reports highlighting its effectiveness and optimistic safety profile. Further research is warranted to explore its potential as a promising option in pelvic organ prolapse treatment.

Survival and Neurogenesis-Promoting Effects of the Co-Overexpression of BCLXL and BDNF Genes on Wharton's Jelly-Derived Mesenchymal Stem Cells.

The main problem with using MSC (mesenchymal stem cells) to treat the deficient diseases of the central nervous system is the low cell survival rate after the transplant procedure and their low ability to spontaneously differentiate into functional neurons. The aim of this study was to investigate the effects of genetically modifying MSC. A co-overexpression of two genes was performed: BCLXL was supposed to increase the resistance of the cells to the toxic agents and BDNF was supposed to direct cells into the neuronal differentiation pathway. As a result, it was possible to obtain the functional overexpression of the BCLXL and BDNF genes. These cells had an increased resistance to apoptosis-inducing toxicants (staurosporine, doxorubicin and H2O2). At the same time, the genes of the neuronal pathway (CHAT, TPH1) were overexpressed. The genetically modified MSC increased the survival rate under toxic conditions, which increased the chance of surviving a transplant procedure. The obtained cells can be treated as neural cell progenitors, which makes them a universal material that can be used in various disease models. The production of neurotransmitters suggests that cells transplanted into the brain and subjected to the additional influence of the brain's microenvironment, will be able to form synapses and become functional neurons.

Application of Acellular Dermal Matrix in Gynaecology-A Current Review.

The aim of our study is to draw attention to the multitude of applications of acellular dermal matrix (ADM) in the surgical treatment of urogynaecological disorders, such as reduction in the reproductive organs, and in reconstructive gynaecology. Despite the existence of numerous operational methods and materials, the effectiveness of transvaginal operation is still insufficient. Native tissue operations are often not durable enough, while operations with synthetic materials have numerous side effects, such as infections, hematomas, vaginal erosion, or dyspareunia. Hence, the search continues for a different material with a better efficacy and safety profile than those previously mentioned. It seems that ADM can meet these requirements and be a useful material for urogynaecological surgery. Key words related to the usage of ADM in gynaecological reconstructive surgery were used to search relevant databases (NCBI MedLine, Clinical Key, Clinicaltrials.gov). This manuscript is based on 43 literature sources, 28 (65.11%) of which were released after 2016. Older sources are cited for the purpose of presenting basic science, or other important issues related to the manuscript. ADM seems to be an ideal material for urogynaecological and reconstructive surgery. It has high durability, and thus high effectiveness. Moreover, it does not have the side effects typical for synthetic materials. There are no reports of material rejection, erosion or dyspareunia directly related to the presence of the mesh. Due to the difficulties in obtaining ADM and the need to perform additional tests, this material is not common in routine clinical practice. Therefore, the number of cases and the size of the research groups are insufficient to clearly define the potential of mesh from biological tissue. However, the results are so promising that it is worth considering a wider introduction to the use of this material. Our hope is that increasing clinicians' awareness of this topic will lead to more studies comparing methods using native tissues or synthetic materials and those using ADM.

Benefit of Silver and Gold Nanoparticles in Wound Healing Process after Endometrial Cancer Protocol.

It is intractable to manage the vast majority of wounds in a classical surgical manner, however if silver, likewise gold and its representative nanoparticles, can lead to the amelioration of the wound healing process after extensive procedures, they should be employed in the current gynecological practice as promptly as possible. Most likely due to its antimicrobial properties, silver is usually applied as an additional component in the wound healing process. In wound management, we obtained various aspects that can lead to impaired wound healing; the crucial aspect for the wound milieu is to prevent the offending agents from occurring. The greatest barrier to healing is represented by the bacterial biofilm, which can occur naturally or in other ways. Biofilm bacteria can produce extracellular polymers, which can then resist concentrated anti-bacterial treatment. The published literature on the use of silver nanoparticles' utilization in wound healing becomes slightly heterogenous and requires us in difficult moments to set up proper treatment guidelines.

Anaesthesia of pregnant women.

Labor pain is not only an unpleasant mental experience, but one of the most important factors that may negatively affect the course of labor and the well-being of the fetus. Over the years, many techniques for relieving labor pain have been developed, ranging from non-pharmacological (acupuncture, TENS, hypnosis...), through opioids and aeriform anesthetics, to regional analgesia techniques. Numerous studies and meta-analyzes prove that central blockades are the gold standard of labor analgesia and debunk the myths that these blockages are negatively limited to the course of labor. In the light of recent studies, the claim that epidural analgesia increases the risk of termination by caesarean section should be rejected. It has also been proven that central blockades do not lower the child's APGAR score. Feeling, an indication to use a central block during labor, should be a subjective intolerance to pain and the wishes of the mother in labor. The review presents the directions of development and the current state of knowledge of modern medicine regarding various anesthesia techniques, their safety for the mother, fetus and newborn, as well as practical tips to increase the satisfaction of the mother in labor.

Circulating omentin-1 levels and inflammation in polycystic ovary syndrome.

OBJECTIVES: The aim of the study was to analyze interrelation between plasma omentin-1 levels and nutritional status and inflammation in PCOS. MATERIAL AND METHODS: A cross-sectional study involving 86 PCOS (47 obese) and 72 Non-PCOS women (41 obese) determined anthropometric parameters and body composition. Serum glucose, insulin and omentin-1, TNF-α, sTNFRs, IL-6 and sR-IL6 were measured in the fasting state. RESULTS: Plasma omentin-1 levels were significantly lower in the PCOS than in the Non-PCOS group and both corresponding normal weight and obese subgroups. In three analyzed least-angle regression (LARS) models the lower plasma omentin- 1 levels was associated with PCOS occurrence, higher circulating TNF-α and lower IL-6 levels. CONCLUSIONS: Suppressed omentin-1 levels in PCOS are characteristic for this disturbance and proinflammatory cytokines are factors modifying secretion of this adipokine.

The influence of p02, BE, BB parameters of perinatally obtained cord blood on quantity of obtained cells and focus on the perfect donor criteria.

The aim of the study was to analyze the influence of oxygene partial pressure (p02), base excess (BE) and buffer base (BB) parameters of cord blood obtained perinatally on quantity of obtained cells and focus on the perfect donor criteria. The study included 50 pregnant women aged between 18 and 38 years in which spontaneous labors and elective cesarean sections were performed. Umbilical cord blood was collected immediately after the women were delivered of newborns. The cells were analyzed in the Polish Stem Cells Bank in Warsaw. In the study group of patients different stem cells viability levels did not differ significantly in terms of pO2, BB and BE level, however, there was a trend that the higher the viability the lower BE value. The experiment showed also that the cord blood (CB) oxygenation scope is vitally important for the CB cells viability.

Hysterectomy costs depending on operational technique.

OBJECTIVES: The aim of the study was to perform a comparative analysis of hysterectomy costs versus the operative technique based on the data of 656 patients operated at the Department of Obstetrics and Gynecology with Gynecological Oncology Subdivision, Brothers Hospitallers of Saint John of God Hospital, Katowice, between 2016 and 2018 (until May 31, 2018). MATERIAL AND METHODS: This retrospective research involved 656 patients who underwent hysterectomy for non-oncological reasons. The patients were subdivided into three groups, depending on the operative method (transabdominal, laparoscopic or transvaginal). Next, treatment costs were compared, including the costs of hospitalization, operating block, operating block materials, drugs, anesthesia, and medical staff. The duration of the operation and the hospital stay were also analyzed as they significantly affected the final result. RESULTS: Data analysis revealed that transvaginal hysterectomy generated the lowest costs. A positive relationship between low costs and the duration of surgery and hospitalization, which is significantly shortened in case of transvaginal hysterectomy, was confirmed. CONCLUSIONS: 1. The transvaginal approach is the most cost-effective technique of hysterectomy. 2. Apart from the financial advantage, transvaginal hysterectomy is also associated with shorter hospitalization and faster recovery. 3. Emphasis should be placed on training physicians in minimally invasive hysterectomies - especially the transvaginal approach - so that the greatest percentage of patients who are deemed eligible for hysterectomy could be operated using this minimally invasive technique.

[The influence of pH and pCO2 levels of umbilical cord blood obtained perinatally on selected parameters of stem cells]. / Wplyw pH i pCO2 krwi pepowinowej uzyskiwanej okoloporodowo na wybrane parametry komórek macierzystych.

OBJECTIVE: The aim of the study was to demonstrate a correlation between pH and pCO2 levels in umbilical cord blood and the quality of the harvested material. Additionally the effect of pH and pCO2 on the number of cord blood CD34+ cells and their vitality was analyzed. MATERIAL AND METHODS: The study included 50 pregnant women after vaginal delivery at term or elective cesarean section. Umbilical cord blood was collected immediately after birth. The probes were analyzed at the Polish Stem Cell Bank in Warsaw. RESULTS: The number of CD34+ cells ranged from 0.1-0.2 in white blood cells count over 12 thousand/ml and pH of > 7.3. If pH ranged between 7.35-7.40, the number of CD34+ was 0.3-0.4. The highest number of CD34+ cells was noted for pH of 7.30-7.35 and amounted to 0.4-0.5. Analysis of stem cell vitality showed that the highest level, over 98%, was obtained when pH was < 7.3 and > or = 7.4. The study revealed the viability of stem cells to drop to 97-98% at pH level of 7.3-7.4. Low values of CD34+ (0.01-0.09) were related to pCO2 of > 40.0 mmHg. For pCO2 < 38 mmHg, the value of CD34+ cells was 0.2-0.3%, which is relatively high. However when pCO2 was > or = 38 mmHg, the number of CD34+ ranged between 0.1-0.2. CONCLUSIONS: Viability of the umbilical cord stem cells increases along with the decrease of pH and pCO2 levels. The mode of delivery does not influence the viability of the stem cells.